Search

Background: The literature reports that the eccentric muscular action produces greater force and lower myoelectric activity than the concentric muscular action, while the heart rate (HR) responses are bigger during concentric contraction. Objectives: To investigate the maximum average torque (MAT), surface electromyographic (SEMG) and the heart rate (HR) responses during different types of muscular contraction and angular velocities in older men. Methods: Twelve healthy men (61.7±1.6 years) performed concentric (C) and eccentric (E) isokinetic knee extension-flexion at 60°/s and 120°/s. SEMG activity was recorded from vastus lateralis muscle and normalized by Root Mean Square - RMS (µV) of maximal isometric knee extension at 60°. HR (beats/min) and was recorded at rest and throughout each contraction. The data were analyzed by the Friedman test for repeated measures with post hoc Dunnfs test (p<0.05). Results: The median values of MAT (N.m/kg) was smaller and the RMS (µV) was larger during concentric contraction (C60°/s=2.80 and 0.99; C120°/s=2.46 and 1.0) than eccentric (E60°/s=3.94 and 0.85; E120°/s=4.08 and 0.89), respectively. The HR variation was similar in the four conditions studied. Conclusion: The magnitude of MAT and RMS responses in older men were dependent of the nature of the muscular action and independent of the angular velocity, whereas HR response was not influenced by these factors. [ABSTRACT FROM AUTHOR]

Purpose. In this paper we aim to develop the understanding of what constitutes a 'good' or 'poor' experience in relation to the transition from hospital to home following a stroke. Method. Semi-structured interviews were carried out with 20 people and 13 carers within one month of being discharged from hospital following a stroke. Interviews covered views of mobility recovery and support from therapy and services. Interviews were transcribed verbatim, coded and analysed in depth in order to explore the discharge process. Results. Participants described models of recovery, which involved a sense of momentum and getting on with their life. Discharge was successful if: (i) This sense of momentum was maintained, (ii) they felt supported, and (iii) they felt informed about what was happening. Discharge was seen as difficult when: (a) Momentum was perceived to be lost, (b) people did not feel supported, or (c) they felt in the dark about the plans or their recovery. Conclusions. The discharge experience could be improved by healthcare professionals understanding and exploring patients' individual models of recovery. This would allow professionals to: (a) Access patients concerns, (b) develop programmes addressing these, (c) correct misinterpretations, (d) keep people fully informed, and (e) share and validate the experience, to reduce their sense of isolation. [ABSTRACT FROM AUTHOR]

Purpose. 'Exercise on prescription' (EoP) schemes run by fitness instructors in leisure centres in the UK have potential to promote continued rehabilitation and activity engagement post-discharge from stroke physiotherapy. This study explores the views of physiotherapists, stroke patients and fitness instructors about the appropriateness and acceptability of EoP schemes for stroke patients post-discharge from physiotherapy. Method. This qualitative study collected data from stroke patients referred to EoP, fitness instructors and referring physiotherapists (n = 30). Data were transcribed and analysed thematically. Exploration of key themes within and between groups was made. Results. Referral to EoP appears to alleviate some of the distress that patients and physiotherapists experience at physiotherapy discharge and provide an opportunity for physiotherapists to wean patients from physiotherapy. However, concerns about risks to patients because of fitness instructors' low levels of knowledge about stroke and the limited monitoring of exercisers were identified. Physiotherapists are likely to refer only the most able patients post-stroke to EoP. Conclusions. The study indicates that, in the light of limited health resources, EoP schemes have potential benefit for people post-discharge from physiotherapy. However, safety needs and the concerns of stroke survivors must be considered in EoP scheme development and management if they are to successfully help more people post-stroke maintain healthy levels of activity and fitness. [ABSTRACT FROM AUTHOR]

As our awareness of the impact of globalising trends has increased, so too has social work's interest in international issues grown. At the same time, concerns have been raised about what constitutes international social work, and how this 'international dimension' might be introduced to social work students as part of their preparation for practice. This paper reports on a recently completed study which explored the different ways in which international issues are being addressed in social work programmes leading to the newly established three-year degree in social work across the UK. Based on an email survey of accredited programmes in England, plus a small number of follow-up interviews, findings are presented on the different approaches and innovations adopted in the development of curriculum with an international perspective. Discussion focuses on possible factors promoting and/or inhibiting the development of an international dimension within the qualifying curriculum. The paper concludes with some observations on how the different understandings of 'international social work' can contribute to a greater appreciation of global problems and alternative ways of responding to social needs at local, national and international levels. [ABSTRACT FROM AUTHOR]

The underlying goal of traditional approaches to weight and health is for individuals to be smaller (i.e., lose weight). Little evidence exists supporting the efficacy of such approaches and concern is mounting that they may be causing harm. An effective, compassionate approach to issues of weight and health--Health At Every Size (HAES)--acknowledges the naturally existing diversity in body shapes and sizes, the ineffectiveness and dangers of dieting for weight loss, the importance of relaxed eating in response to internal body clues, and the critical contribution of social, emotional, spiritual, and physical factors to health and happiness. Occupational health nurses can use the HAES approach at the worksite to assist employees with effectively addressing their weight-related concerns. [ABSTRACT FROM AUTHOR]

It would be difficult to overstate the urgency that U.S. government and health officials have placed on the dangers posed by obesity. Given the increasing numbers of individuals being diagnosed as overweight and obese and the emphasis on the contribution of weight to health and disease, it is critical that all health professionals examine the validity of the claims being made. A thorough examination of the research literature does not support the claims that overweight and obesity are major causes of premature mortality, excess fat is pathological and a direct cause of disease, and weight loss is practical and beneficial to health for most individuals. The literature also does not provide any significant evidence-based support for current approaches to weight management. In fact, it suggests that these approaches may likely be doing more harm than good. [ABSTRACT FROM AUTHOR]

Background: Older Puerto Ricans belong to two rapidly growing demographic groups known to have high rates of depression: the aging and Hispanic populations. Studies of depression in Puerto Ricans have primarily focused on the impact of demographic factors and health. This study expands previous research, examining the relationships between depression and social stressors, social support, and religiosity, for Puerto Rican primary care patients aged 50 and older.Patients: Participants included 303 Puerto Ricans from six primary care clinics in a northeastern city.Methods: Patients completed in-person interview in Spanish. The Composite International Diagnostic Interview indicated depressive disorders meeting DSM-IV criteria. Bivariate and multivariate relationships between depression and demographics, health, social stress and support, and religiosity were explored.Results: One fifth of participants met DSM-IV criteria for major depression or dysthymia. Participants with the lowest income, more recent migration, and poor subjective health were significantly more likely to be depressed. In addition, rates of depression increased steeply for patients caring for grandchildren and those with personal or family legal problems. Seeing few relatives each month and needing more instrumental, emotional, or financial support were also related to higher rates of depression. Unexpectedly, low objective illness severity correlated with increased depression, whereas religiosity and religious participation had no relationship to depression.Conclusions: The findings presented here indicate the potential for social stressors and inadequate supports to substantially increase the risk of depression in older Puerto Ricans in primary care settings. Further studies should explore incorporating these social risk factors into improved prevention, clinical detection, and culturally sensitive treatment of older depressed Puerto Ricans. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysm (AAA) is a relatively common disease among the elderly population and may be present in up to 5.9% of the population aged 80 years. Abdominal aortic aneurysm more than 5 cm in diameter are more prone to rupture, with a significant mortality rate. Conventional surgical treatment is quite effective in the lower surgical risk population; however, in the population with a higher risk level the mortality and morbidity significantly increase. The development of less invasive techniques to treat AAA derived from the necessity to reduce the morbidity and mortality. The development of the endovascular endoprostheses was a significant landmark in the management of those patients with AAA, particularly the ones with increased risk. Although the stent-graft technology is still in its infancy, a large amount of information is available and an attempt to summarize this experience is presented herein. An extensive review of the stent-graft technology is presented, including variations in design and classification of the several systems available. Technical aspects of the use of endovascular prostheses are presented, as well as the most recent outcome information available. The problems of endoleaks is discussed and the techniques for treatment and outcomes presented. Finally, a summary of specific information on most of the devices available is presented. [ABSTRACT FROM AUTHOR]

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England. It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices. Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork: team identity; leadership; access to general practitioners; philosophies of care; understanding of team members' roles and responsibilities; and, disagreement regarding roles and responsibilities. Differences in the various views and experiences of teamwork were identified. Midwives and health visitors emerged as the least integrated members of the primary health care team. Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups. The potential for teamwork in the future is discussed. [ABSTRACT FROM AUTHOR]

The angiographic evaluation of 38 patients younger than 40 years of age with lower-extremity arterial disease is reviewed. Although atherosclerosis was the most common diagnosis, other etiologies included thromboembolism, popliteal artery entrapment, Buerger's disease, collagen vascular disease, and arteritis. The two features of the angiographic workup that proved most helpful in establishing an accurate diagnosis were biplane aortography and runoff exams designed to demonstrate possible popliteal artery entrapment. [ABSTRACT FROM AUTHOR]

Objective: To identify the factors that predict recovery in activities of daily living (ADLs) among disabled older persons living in the community.Design: Prospective cohort study with 2-year follow-up.Setting: General community.Participants: 213 men and women 72 years or older, who reported dependence in one or more ADLs.Measurements and Main Results: All participants underwent a comprehensive home assessment and were followed for recovery of ADL function, defined as requiring no personal assistance in any of the ADLs within 2 years. Fifty-nine participants (28%) recovered independent ADL function. Compared with those older than 85 years, participants aged 85 years or younger were more than 8 times as likely to recover their ADL function (relative risk [RR] 8.4; 95% confidence interval [CI] 2.7, 26). Several factors besides age were associated with ADL recovery in bivariate analysis, including disability in only one ADL, self-efficacy score greater than 75, Folstein Mini-Mental State Examination (MMSE) score of 28 or better, high mobility, score in the best third of timed physical performance, fewer than five medications, and good nutritional status. In multivariable analysis, four factors were independently associated with ADL recovery-age 85 years or younger (adjusted RR 4.1; 95% CI 1.3, 13), MMSE score of 28 or better (RR 1.7; 95% CI 1.2, 2.3), high mobility (RR 1.7; 95% CI 1.0, 2.9), and good nutritional status (RR 1.6; 95% CI 1.0, 2.5).Conclusions: Once disabled, few persons older than 85 years recover independent ADL function. Intact cognitive function, high mobility, and good nutritional status each improve the likelihood of ADL recovery and may serve as markers of resiliency in this population. [ABSTRACT FROM AUTHOR]