Religious and spiritual beliefs in outpatients suffering from Parkinson Disease.

OBJECTIVE: Personality changes are known to occur in idiopathic Parkinson's Disease (PD). The aim of the study was to evaluate whether religious and spiritual beliefs in PD patients are different from age-matched controls. DESIGN: Eighty-three PD participants, 79 hypertensive individuals not affected by PD and 88 healthy subjects participated to a cross-sectional study. The Royal Free Interview (RFI) was used to evaluate participants' beliefs. The Hospital Anxiety and Depression Scale (HADS) was applied to monitor emotional distress. RESULTS: There was no statistical evidence of a difference between PD participants and the two control groups, the only exception being observed between the left PD onset group and the controls, where the total RFI score was about 5 points higher (t-test: p = 0.0273). RFI total score was uncorrelated with age, severity of illness and depression, but was strongly dependent on the type of beliefs. The percentage of PD participants suffering from anxiety and depression was high (right onset: 54.8%; left onset: 68.6%), while only 15.2% of the hypertensive participants, and none of the healthy controls, had a HADS score above 10 points. Total RFI score was higher in women. CONCLUSION: PD participants maintain their Faith in spite of the disease severity. Differences are found between right and left onset of PD. The possible beneficial effect of religious coping is discussed.

Stability of word comprehension with age. An electrophysiological study.

Behavioural studies have suggested that lexical access is relatively unaffected by normal aging unlike other aspects of semantic processing. This psychophysiological study was designed to gather further evidence on the issue. Using an oddball procedure, an auditory N400 was recorded in both young (mean age 27.7 years) and elderly (mean age 65.1 years) volunteers in normal health. The target was either a high frequency word or a non-word, in two different sessions. The amplitude, onset latency and duration of the N400 did not differ in the two groups of subjects although the peak latency was delayed in the elderly group. The earlier N100-P200 complex had also a longer duration in the elderly group. The results indicate that aging processes affect the various stages of perceptual processing and language comprehension in different ways. Whereas P200, the main index of perceptual processing, was slowed, some measures of lexical access were found to be stable with age.

Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: an observation on non-absorbable antibiotics.

AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS: A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis. RESULTS: When the patients underwent a "breath test", 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1,200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative "breath test" one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, "breath test" remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative "breath test" in one patient only. CONCLUSION: (1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a "breath test" with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.

Return to work in stroke patients.

PURPOSE: To present the current state of knowledge regarding return to work (RTW) following stroke. METHOD: A comprehensive review of the current stroke rehabilitation literature pertaining to prognostic and treatment factors for RTW following stroke. RESULTS: Stroke is a major healthcare problem and one of the most expensive diseases in modern society. Stroke results not only in impairment and limitation in basic daily activities; it also impacts on participation in community activities, such as returning to work. Return to work in post-stroke patients has been reported to range between 19% and 73%. Various studies report on return to work in diverse populations, using different follow-up periods, while utilizing variable definitions of stroke and successful work outcomes. The factors positively related to RTW in stroke patients, as found in the literature, are age less then 65 years, high education level and white-collar employment. The significant negative predictor is the severity of stroke. This is indicated by neurological parameters including functional measures of the presence and extent of motor and cognitive impairment. Significantly, the side of the brain damaged and stroke location were not found to be correlated with RTW. Social and financial factors also significantly influence RTW. CONCLUSIONS: RTW in stroke patients should be considered one of the indicators of a successful rehabilitation as it influences self-image, well-being and life satisfaction. There is still a considerable lack of knowledge regarding effective assessments and interventions in vocational rehabilitation in stroke patients.

Early detection of dementia in clinical practice.

Early identification of dementia and possible risk factors is a critical issue. The Basic Italian Cognitive Questionnaire (BICQ) is designed as a routine instrument for screening patients with initial cognitive impairment in daily practice. It is devoted to the general physician who needs a tool for deciding whether a subject deserves further diagnostic investigation in specialised centres. The administration of BICQ is easy, fast and does not require any training, since it is composed of 12 simple and ecologic questions referring to daily life. The discriminant analysis, a predictive model that generates a function based on linear combinations of the predictor variables, provided the best discrimination between controls with respect to the group of deteriorated patients. According to the classification function coefficients, the questionnaire score predicted correctly 100% of normal subjects and 85% of patients with cognitive impairment. Moreover, the receiving operating characteristics (ROC) analysis showed that the highest sensitivity and specificity were obtained at the cut-off value of 10. Thus, a

Effects of music-based therapy on distress following knee arthroplasty.

Anxiety and depression are frequent after total knee arthroplasty (TKA). Musical intervention can benefit many, including severe patients (agitated older people with dementia and terminal-ill patients) and surgical cases. This pilot study was aimed at verifying whether music therapy is beneficial after TKA. Reducing anxiety and depression is has a positive effect for the wellbeing of patients and is likely to have positive effects on outcome. In their pilot study, the authors found that a positive and specific effect of singing on depression was seen and that music therapy may be recommended after TKA instead of a pharmacological intervention.

Determinants of the subjective functional outcome of total joint arthroplasty.

The aim of the study is three-fold: (i) to analyze association between early subjective functional outcome of total joint arthroplasty (TJA) and patient-related risk factors; (ii) to evaluate the six-month subjective functional outcome of TJA as compared with subjective functional status of non-operated outpatients; (iii) to evaluate TJA self-perceived amelioration rates compared to the status of an age-matched sample from a general medical practice. A prospective consecutive study was performed upon 100 elderly inpatients with recent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis. Interviews on preoperative status and short-term outcome were performed at admission and six months after surgical intervention with Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC). One hundred aged-matched consecutive outpatients were screened for osteoarthritis and interviewed with the same questionnaire in a single session. Differences between baseline and follow-up scores were evident and statistically significant for both TJA groups, although THA patients showed more improvement. The comparison between TJA patients at baseline and age-matched osteoarthritis outpatients highlighted less impairment among outpatients. The situation reversed six months after the intervention. Objective functional outcome of post-operative rehabilitation has not revealed predictive value for the six-month outcome of TJA in terms of self-perceived functional status. Logistic regression analysis indicated that preoperative status was the only significant predictor of higher WOMAC scores six months after TJA. The survey confirms the early benefit of THA or TKA for osteoarthritis, but a less favorable subjective functional outcome is expected at six months when preoperative subjective functional status is severely compromised.

Self-perceived distress and self-perceived functional recovery after recent total hip and knee arthroplasty.

The research was aimed at verifying whether psychological distress and depression are associated to reduced functional improvement following arthroplasty. Thirty-six patients with total knee arthroplasty (TKA) and 36 patients total hip arthroplasty (THA) were enrolled at the beginning of their rehabilitation. The mean age in TKA patients was 71.3+/-7.8 years (S.D.). The mean age in THA patients was 67.9+/-8.4 years. The Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC) and the Hospital Anxiety and Depression (HAD) were applied. Forty-four percent of THA and 58% of TKA showed over-threshold HAD scores at admission. The proportion was even higher considering HAD-Depression sub-scale, where 55% of THA and 61% of TKA patients had over-threshold scores. Lack of depression prompted better functional outcome in TKA. The effect of depression on TKA functional improvement was still significant after adjusting for age and sex. No association was found for THA patients. In order to maximize rehabilitation benefit it is then suggested that patients with recent TKA intervention are screened for distress and depression at admission and that psychological symptoms are treated if over-threshold.

Do nurses exercise power in rehabilitation wards?

AIM: Nowadays, there is a change in nursing policy. The nurse-centred model is shifting to the patient-centred model. Decision-making is therefore transferred to the customer (Power to the Patient). Data from literature mainly deals with acute care and long-term care facilities. The aim of the study was to evaluate whether: i) a nurse-centred model is still effective in rehabilitation wards; ii) patients' dignity is nevertheless considered; iii) nurses experience role satisfaction in a rehabilitation setting. METHODS: A cross-sectional design was applied. Forty-eight nurses of our rehabilitation centre were invited to compile -in an anonymous way- a questionnaire developed by Finnish researchers from both acute care and geriatric units. More questions dealt with personal data. RESULTS: The sum of variables describing the nurses' exercise of power showed that power was most commonly exercised in obligatory daily activities. Power was less in activities necessitated by obligatory daily activities and in voluntary activities. Nurses' power was due to the necessity of organising the individual rehabilitation programs, which are tailored for each patient and require the observance of time-schedules. Nevertheless, patients had a say in many choices and their dignity was maintained. The nurses also answered that work in rehabilitation wards was more stressful than in both medical or surgical acute care. A third of them felt themselves not involved in the rehabilitation of the patients. CONCLUSIONS: The exercise of power is not a negative phenomenon in situations requiring safety, control, quick decisions, coping with time-contingencies, as it daily happens in rehabilitation wards. However, subject's dignity is compatible with that exercise of power. Rehabilitation staff should be aware of the nurse role, which can be only partially perceived. Better communication between nurses and other components of the rehabilitative staff would improve self-esteem and hasten motivation. Apparently, when the association between the ''experience'' variable and the sum variable was considered, it was found that the group of low clinical experience believed that power was exercised more often.

Depression after stroke: an investigation through catamnesis.

BACKGROUND: In the early stage of stroke, depression appears to be linked to certain brain areas. The study evaluated the importance of the side of the lesion in depressed patients 3 years after their first stroke. METHOD: Patients who had suffered a stroke and been discharged after rehabilitation were identified by hospital records. We interviewed 180 patients at home. Demographic as well as socioeconomic data were collected. The North-western University Disability Scale, the Beck Depression Inventory (BDI), the Relatives' Stress Scale, and the Social Dysfunction Rating Scale were applied. The diagnosis was confirmed for each patient by a clinical assessment according to the ICD-10 criteria. Patients with previous psychiatric treatment, comprehension problems, or severe hemi-inattention were excluded. RESULTS: By using a score of 14 on the BDI as a cutoff, 62 patients (34%) proved to be affected by depressive disorders. Clinical records showed that the location of the lesion was in the right hemisphere for 37 patients and in the left hemisphere for 25 patients. Statistical analysis of the mean scores obtained in this subgroup of depressed patients showed (1) no significant relation between depression and the hemispheric location of the lesion or between depression and level of education; (2) relation between BDI score and social activities; and (3) stress on the relatives that was mainly dependent on both the disability of the patients and their loss of social activities, whereas depression played a minor role. CONCLUSION: A high percentage of patients have depressive disorders 3 years or more after the stroke, independent of the side. Such mood disorders worsen the relationship between the disabled patients and their relatives and worsen leisure independent of the affected hemisphere.

EEG changes induced by oxiracetam on diazepam-medicated volunteers.

The present study was carried out in order to verify whether, in benzodiazepine-medicated healthy volunteers, oxiracetam retained the properties already observed after administration in normal volunteers. In a cross-over study, 12 volunteers, medicated the night before with 5 mg diazepam, were i.v. treated with 1 g oxiracetam or saline. An electroencephalogram (EEG) was performed before, and 15 and 120 min after, nootropic or saline injection. Computerized examination of the EEG traces showed an increase of the alpha- and a decrease of the delta-relative activities, particularly in the fronto-temporal regions. These preliminary results suggest that oxiracetam might be useful in benzodiazepine-treated patients by improving their cognitive activities without nullifying the sedation of anxiety and neurotic behavior.

Can we exploit event-related potentials for retraining language after stroke?

PURPOSE: To ascertain the utility of event-related potentials in studying language processing in patients suffering from aphasia. METHODS: Recent methods to evaluate event related potentials in response to spoken words were applied in two young patients suffering from a recent aphasia in whom expressive deficits were particularly marked. Recordings were made on three occasions for each patient at the same time of the day. The second recording session took place after six months and the final one after one year. Eighteen right-handed subjects in normal health (10 women, 8 men) were enrolled as controls. RESULTS: Three kinds of potential were obtained over time, P300, P340 and N400. P300 was useful to monitor attention and discrimination. It improved over time. Both of our patients lacked a defined P340 potential, but longitudinal recordings could show a very slow reappearance over time although with a frequently inverted polarity. Apparently, the expressive aphasia did not improve over a one year interval. In contrast to P340, N400 was relatively preserved. This potential is linked to semantic judgement. The patients with relatively preserved comprehension were able to exhibit a N400 soon after stroke. The bilateral representation indicated that the right hemisphere was involved in some kind of language processing. CONCLUSION: The results indicate that digitized spoken words appear to be an appropriate tool because they permit the study of EEG changes on a millisecond-to-millisecond basis. Apparently, ERPs enable us to study receptive processes in patients with expressive aphasia. Moreover, they appear to be particularly suitable for monitoring the recovery of neural mechanisms responsible for language.

The effects of atrial fibrillation on functional recovery in post-stroke patients.

PURPOSE: This study evaluates the negative effects of atrial fibrillation (AF) on after stroke recovery and its relationship with age and other concomitant diseases. METHOD: One hundred and ninety-nine consecutive inpatients, after their first stroke, were enrolled and entered a rehabilitation program lasting 60 days. The mean interval since the stroke was 19 days. The disability, both at admission and at discharge, was assessed by Functional Independence Measure (FIM). Atrial fibrillation was diagnosed at admission on the basis of electrocardiographic recordings. Gender, age, blood pressure and blood sugar level were also taken into account. RESULTS: Stroke patients suffering from AF, when compared to those lacking AF, have higher disability at admission as well as at discharge and had a lesser gain in functional recovery. No statistical difference of the AF occurrence was found between male and female patients. The negative correlation between age and functional gain was found only in AF patients. There was also a significant association between AF and hypertension, but not between AF and diabetes. At the beginning and at the end of the study, the median FIM scores of all the patients with AF were quite similar irrespective of manifesting hypertension, diabetes or neither of these two. CONCLUSIONS: The presence of AF has a negative prognostic value on post stroke outcome, particularly in the elderly patients. The pattern of recovery of stroke subjects having AF is not influenced by concomitant diseases like hypertension or diabetes.

Importance and evaluation of comorbidity in rehabilitation.

PURPOSE: The aim of this study is to evaluate the relationship between comorbidity and the disability in patients referred to a rehabilitation centre. Patients often suffer from associated diseases which may negatively influence the outcome. METHOD: After evaluation of several scales, the Cumulative Illness Rating Scale (CIRS) was selected. For the study 413 consecutive patients were enrolled. RESULTS: In this series, neurological patients presented with higher severity and higher comorbidity than orthopaedic patients. Orthopaedic cases were older but neurological cases had higher severity and higher comorbidity. Indeed, a significant negative correlation between severity and dependence scores was found. Comorbidity, also, showed a significant negative correlation with FIM both in the orthopaedic and in the neurological patients. These data show that severe comorbid conditions influence functional autonomy. Severity and Comorbidity were correlated both in orthopaedic cases and in neurological cases as well. CONCLUSIONS: A review of geriatric literature demonstrates lower values in the patients in rehabilitation. The difference is due to our accurate selection of patients at admission, where general health conditions are considered. In conclusion the CIRS scale should be used as a method for selecting patients at admission or as a prognostic index for improvement at discharge. CIRS, however, has some inconveniences and amelioration is necessary, such as the inclusion of a double testing (admission-discharge), psychiatric disturbances and a new item for skin alone. CIRS should not be applied if a patient referred for rehabilitation has the worst score in even a single item.

[A catamnestic study of recovered alcoholics]. / Indagine catamnestica su alcoolisti svezzati.

Fifty-one alcoholics, previously admitted to the hospital for medical care and treated with disulfiram, were re-examinated after 1-3 years. In thirty of them (58%) total abstinence was found; eighteen patients (35%) behaved so in spite of disulfiram withhold during the first year of self-administration. No side-effects were reported. General behaviour, mood, work, interest and familiar relationships improved. The treatment generally failed in the cases of secondary alcoholism as in marked neurosis or psychosis. The research proved the main role of family and environment in the successful cases. The treatment with disulfiram is useful but incomplete.

On the stability with age of anagram forming.

Twelve young and 12 old subscribers to an Italian magazine of riddles were invited by mail to form an anagram from a string of meaningful words consisting of 30 letters. Each of the participants was classified as either "overskilled" or "normal". All of the overskilled subjects, regardless of age, employed the 30 letters, whereas only the 50% of the remaining subjects did so. Even stronger differences were seen with regard to the number of complete anagrams. The overskilled elderly outscored the young adults, but the latter paid more attention to the quality of the anagrams. The article confirms previous results on the stability with age of anagram ability.

[Medico-social problems in the recovery from stroke]. / Problemi medico-sociali nel recupero dallo stroke.

Until a few years ago physicians were not rehabilitation-oriented, but recent discoveries regarding the plasticity of the nervous system have made the patient with an acute cerebrovascular lesion a clinical model of great interest. Furthermore, the severity of the frequent residual invalidities and the high social costs are the reasons why this field of medicine is becoming increasingly important. The clinical study of stroke has not changed much during the past century. Perhaps our semeiological abilities are not the same but we have improved our knowledge of the neurosciences and we know that in the acute phase we have to look towards the patient's future and not only at his current condition. A certain degree of recovery occurs immediately after stroke thanks to the resolution of secondary events such as edema and ischemia. Other factors that may have important effects on recovery include the localization, nature, extension and degree of brain damage, the patient's sex and age, the duration of coma, the patient's original cognitive capacity, his personality and motivation as well as the duration and intensity of rehabilitation and the time before starting rehabilitation. Many of these variables are difficult to check in trials performed in humans. Statistical problems make it difficult to prove any beneficial effect of rehabilitation. Some recent trials have shown statistically significant improvements attributable to rehabilitation. For instance, exercise under visual stimulation around a scotoma has been shown to reduce the area of blindness. The improvements occurred only after exercise and never spontaneously. What happens when rehabilitation favours recovery?(ABSTRACT TRUNCATED AT 250 WORDS)

[Subtotal colectomy in splenic flexure carcinoma in a patient with transverse colostomy who had undergone gastric resection (Billroth II)]. / Colectomia subtotale per ca. dell'angolo splenico in gastroresecato (Billroth II) portatore di colostomia sul trasverso.

The Authors report a case of subtotal colectomy for splenic flexure adenocarcinoma in a gastro-resected patient bearing a transverse colostomy. They underline the considerable technical difficulties encountered during dissection because of multiple adhesions related to the previous operations (gastrojejunostomy and transverse colostomy). In fact, a gastric resection according to Billroth II and an emergency colostomy for bowel obstruction had been performed 20 years and 30 days respectively prior to the present operation. Nevertheless, reconstructive steps resulted easier and faster with the use of staplers.

Hydrotherapy after total knee arthroplasty. A follow-up study.

The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population.

Hydrotherapy after total hip arthroplasty: a follow-up study.

The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge. A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program. After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG). Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis. Both groups improved. Pain, stiffness and function were all positively affected. Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population.