Increased Pulse Pressure Linked to Dementia: Further Results From the Hypertension in the Very Elderly Trial – HYVET.
Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial – HYVET.
J Hypertens. 2013 Jun 5;
Peters R, Beckett N, Fagard R, Thijs L, Wang JG, Forette F, Pereira L, Fletcher A, Bulpitt C
OBJECTIVES:: High blood pressure (BP) has been associated with increased risk of dementia. Concerns have been raised about lowering BP too far in the very elderly and thereby increasing risk. There is some evidence to suggest a potential ‘J’-shaped relationship between DBP and risk of cognitive impairment. This was investigated using data from the HYpertension in the Very Elderly Trial (HYVET). METHODS:: HYVET was a double-blind, placebo-controlled trial of antihypertensives in patients aged at least 80 years with an untreated SBP of 160-199?mmHg. Active medication was indapamide sustained release 1.5?mg+/- perindopril 2-4?mg to reach goal pressure of less than 150/80?mmHg. Incident dementia was a secondary endpoint and was not significantly different between the two treatment groups. The relationship between pressure and incident dementia was assessed using Cox proportional hazards regression with BP entered as either a discrete (quartile analysis) or continuous predictor variable. Achieved BP was calculated as the mean of all pressures from the 9 month visit onwards. RESULTS:: During a mean follow-up of 2.2 years 263 incident cases of dementia were diagnosed. After adjustment for various covariates, baseline DBP was inversely related to incident dementia (P?=?0.0064). Achieved DBP did not predict later dementia in the placebo group (P?=?0.43), but showed a U-shaped relationship in the active treatment group (P?=?0.0195). The relationship between incident dementia and DBP did however not differ significantly between the placebo and active treatment groups (P?=?0.38). SBP was not associated with incident dementia, at baseline (P?=?0.62) or during follow-up (placebo group P?=?0.13, active group P?=?0.36). Wider achieved pulse pressure (PP) was associated with increased risk of dementia in both treatment groups (placebo P?=?0.032, active P?=?0.0046). The same tendency was observed for baseline PP (P?=?0.095). CONCLUSION:: Wider PP may possibly indicate an increased risk for dementia. Active treatment may act to change the shape of the relationship between DBP and dementia. Future studies need to focus on exploring the ideal goal pressure for this age group. HubMed – rehab
Vestibular rehabilitation with virtual reality in Ménière’s disease.
Braz J Otorhinolaryngol. 2013 Jun; 79(3): 366-374
Garcia AP, Ganança MM, Cusin FS, Tomaz A, Ganança FF, Caovilla HH
Virtual reality technology can provide a wide range of sensory stimuli to generate conflicts of varying degrees of complexity in a safe environment. OBJECTIVE: To verify the effect of a virtual realitybased balance rehabilitation program for patients with Menière’s disease. METHOD: This observational clinical study included 44 patients aged between 18 and 60 years diagnosed with Menière’s disease submitted to a controlled randomized therapeutic intervention. The case and control groups took betahistine and followed a diet. Case group subjects underwent 12 rehabilitation sessions with virtual reality stimuli in a Balance Rehabilitation Unit (BRU TM). Patients were assessed based on DHI scores, the dizziness visual analogue scale, and underwent posturography with virtual reality before and after the intervention. RESULTS: After the intervention, the case group showed significantly lower scores in DHI (p < 0,001) and in the dizziness visual analog scale (p = 0.012), and had significantly greater limit of stability areas (p = 0.016) than controls. CONCLUSION: Virtual reality-based balance rehabilitation effectively improved dizziness, quality of life, and limit of stability of patients with Menière's disease. HubMed – rehab
Digisonic SP® Binaural cochlear implant: the coronal tunneled approach.
Braz J Otorhinolaryngol. 2013 Jun; 79(3): 298-305
Carvalho GM, Guimarães AC, Macedo IS, Onuki LC, Danieli F, Pauna HF, Fernandes FL, Paschoal JR, Bianchini WA, Castilho AM
Cochlear implants represent a significant breakthrough in the treatment of hearing loss. Evidence indicates bilateral hearing brings significant benefits to patients, particularly when binaural hearing is offered. OBJECTIVE: To describe the first case of implantation of a Digisonic SP® Binaural Neurelec device in Brazil (the third implant placed in the Americas, after Mexico and Colombia) and the chosen surgical approach. METHOD: Description of a surgical approach. RESULTS: The procedure was successfully completed. DISCUSSION: The squelch effect, binaural summation, location of the sound source, and the shadow effect of the head are listed among the reasons to explain the superiority of binaural rehabilitation. Cost of treatment must be considered in the development of public health policies. CONCLUSION: The cost of cochlear implants has been one of the main impediments to bilateral rehabilitation. The Digisonic SP® Binaural Neurelec device addresses this issue and exposes patients to less risk through a minimally invasive implantation procedure. HubMed – rehab
Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada.
Osteoporos Int. 2013 Jun 7;
Auais M, Morin S, Nadeau L, Finch L, Mayo N
This study provides evidence that a number of frailty-related characteristics (older age, de novo admission to long-term care (LTC), comorbidities [Charlson Index, osteoporosis, osteoporosis risk factors, sarcopenia risk factors, and dementia]) have increased in the hip fracture population from 2001-2008. This will have significant impact on community resources, as the number of people discharged to the community is also increasing. INTRODUCTION: The aim of this study is to estimate secular changes in the prevalence of selected frailty-related characteristics among the hip fracture population in the Canadian province of Quebec (2001-2008) and the potential impact of these changes on healthcare services. METHODS: The Quebec hospitalization database was used to identify nontraumatic hip fractures for the purposes of calculating age- and sex-specific rates. Also estimated were time trends for selected frailty-related characteristics and discharge destinations. RESULTS: A significant decline in fracture rates was evident for all age groups except for those <65; sex differences were also observed. Almost all frailty-related characteristics increased over time, ranging from 2 to 14 % per year, which translates to an estimated increase from 16 to 112 %, over the study period. For those whose prior living arrangement was LTC, rates of hip fractures declined significantly (women OR?=?0.93, 0.91-0.95; men OR?=?0.97, 0.94-0.99). In-hospital mortality and discharge to inpatient rehabilitation decreased, while discharges back to community and to LTC increased. CONCLUSIONS: Although hip fracture rates decreased for older hip fracture patients, the absolute number and prevalence of specific frailty-related characteristics increased. Policy makers should review care models to ensure that adequate resources are provided to the community to offset the expected increase in demand arising from ongoing changes in patients' characteristics. HubMed – rehab