[Development of Indicators to Promote Measures for the Prevention and Rehabilitation of Functional Decline in Older People.]

[Development of indicators to promote measures for the prevention and rehabilitation of functional decline in older people.]

Filed under: Rehab Centers

Rev Epidemiol Sante Publique. 2012 Nov 16;
Hébert R, Raîche M, Dubois MF, Gueye NR, Tousignant M

BACKGROUND: In Europe and Asia, long-term care funding is disability-based. This introduces a perverse effect by inappropriately adding value to functional decline among beneficiaries. To support the efforts in prevention and rehabilitation made by personnel in long-term care services, indicators have to be developed to promote functional improvement of beneficiaries. As people receiving those services are already experiencing a functional decline process, it is essential to know the natural magnitude of functional decline in order to assess deviation from this expected decline. The objective of the study was to estimate the natural decrease of autonomy in beneficiaries of home care services and nursing homes. METHODS: Two databases were used: for home-dwelling people, 1235 subjects over 75years old who participated in the PRISMA study; for institutions, 1330 residents over 65years old of a nursing home in Sherbrooke (QC, Canada). These subjects were assessed several times over many years with the Functional Autonomy Measurement System (SMAF). Growth analyses were used to estimate the annual decrease in the SMAF score according to age, gender and the initial autonomy status. RESULTS: At home, only age was significantly associated with the slope of functional decline. The average annual decrease of subjects 75-84years old was 2.4 points on the SMAF score (out of 87); for those aged over 85, the annual loss was 3.8 points. In institutions, gender and the initial autonomy profile were associated with the annual decrease. For men, the annual decrease varied between 0.7 for the most disabled subjects to 5.2 for the most autonomous. For women, those values varied from 0.2 to 6.6, respectively. CONCLUSION: A decrease in the SMAF score less than these expected values should be associated with a bonus to support personnel training, prevention activities, rehabilitation and activities aimed at supporting the autonomy of the beneficiaries. Such a strategy requires the implementation of a precise and reliable assessment instrument like the SMAF and also the availability of a longitudinal database where data for each beneficiary could be linked over time.
HubMed – rehab


Disappearance of 6-acetylmorphine, morphine and codeine from human scalp hair after discontinuation of opiate abuse.

Filed under: Rehab Centers

Forensic Sci Int. 2012 Nov 16;
Shen M, Xiang P, Sun Y, Shen B

Opiates continue to be used at high rates in East and Southeast Asia. Hair analysis for drugs of abuse has been developed into a powerful and widely used tool in forensic and clinical toxicology. Specifically, testing the proximal segment of scalp hair to confirm morphine (MOR) positive urine samples could solve the poppy seed problem. Human scalp hair grows approximately 1cm per month and can therefore reflect a retrospective timeline of drug exposure. This study is the first to investigate the disappearance of 6-acetylmorphine (6-AM), MOR and codeine (COD) from human scalp hair after the discontinuation of drug use. Thirty-two healthy women (ages 21-51 years) with a known history of heroin abuse, who went to a rehabilitation centre and ceased consuming heroin (for 4-5 months), were recruited into the study. A pharmacokinetic analysis in seven individual hair segments was performed using a first-order kinetic. Assuming a rate of hair growth of 1cm/month, the mean hair elimination half-lives of 6-AM, MOR and COD were 0.88 months (95% CI, 0.74-1.03), 0.73 months (95% CI, 0.64-0.81), and 0.61 months (95% CI, 0.54-0.69), respectively. Our results suggest that to evaluate the discontinuation of opiate abuse after a 6-month period of abstinence, the results from a 3-cm proximal hair segment should be free of 6-AM at the proposed 0.2ng/mg cutoff level. This finding should become the basis for the interpretation of results from segmental hair analyses in the evaluation of drug abstinence.
HubMed – rehab


Refractory Chronic Cough: New Perspectives in Diagnosis and Treatment.

Filed under: Rehab Centers

Arch Bronconeumol. 2012 Nov 16;
Pacheco A, Cobeta I, Wagner C

In patients with chronic cough, nearly 40% of the population does not experience definitive improvement of their cough despite correctly applying the anatomic diagnosis. In many of these patients with refractory cough, laryngeal symptoms are frequent. The region of the larynx/pharynx is configured as a bridge between the esophagus and the upper and lower respiratory tract. The association of reflux in patients with chronic cough and symptoms such as globus pharyngis, itchiness or the need to clear one’s throat have recently been given attention due to the possibility of joint therapeutic intervention of the gastroesophageal reflux and larynx, both with new medications as well as with laryngeal rehabilitation therapies, with observed benefits in the disappearance of chronic cough in cases that had been previously labeled as refractory.
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Physiological interference in effective connectivity of action network.

Filed under: Rehab Centers

Neuroreport. 2012 Nov 15;
Huang JM, Cheng CM, Chou CC, Chen YC, Hsu PY, Yeh TC

The effect of temporal interference of physiological signals on time-lag effective connectivity, derived from a functional network connectivity tool box (FNC), was examined by a blood-oxygen-level-dependent functional MRI study of action. The known effect of physiological signals on time-lag FNC was verified by (a) comparison of time-lag FNC analyses without and with retrospective image-based correction (RETROICOR) and (b) the other time-lag FNC analysis including the ventricular component related to the cerebrospinal fluid with dominant physiological effects. Twenty-five right-handed normal individuals performed motor task with motor response by the right middle/index fingers. Behavioral data of the reaction time (RT) and physiological signals (electrocardiogram, respiration, and pulsation) were recorded during neuroimaging studies of a 2-s repetition time at 3T. After standard image preprocessing, RETROICOR of the physiological effects and group independent component analysis (ICA), five action-related components were selected from 59 ICA components according to spatial extension involving known functional correlates of visuomotor tasks. Time-lag FNC was constructed by calculating the maximal correlation coefficients among five selected components. Attenuation of the physiological effect at 0.02-0.25 Hz was an average of 0.63 dB after RETROICOR (P<0.0005). Results of FNC analyses without and with RETROICOR were compatible with the action networks using the right hand. On the basis of the time-lag FNC after RETROICOR, the connectivity among the ventricular component and other components of action network attenuated. The FNC map with RETROICOR was more explicable with known action networks, for example interhemispheric inhibition. The effects of physiological signals significantly misled the interpretation of time-lag FNC in terms of direction and connectivity strength. HubMed – rehab


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