Current Medical-Conditions News Results

Peripheral sensory neuropathy observed in children with cerebral palsy: is chronic afferent excitation from muscle spindles a possible cause?

Childs Nerv Syst. 2010 Mar 9;
Fukuhara T, Namba Y, Yamadori I

INTRODUCTION: Peripheral sensory neuropathy is known to be associated with several medical conditions; however, it has not been reported in patients with cerebral palsy. Authors have observed pathological changes in the sensory nerve rootlets taken during selective dorsal rhizotomy. This paper reports a possible novel cause of peripheral sensory neuropathy: the chronic afferent excitations from muscle spindles. CASE REPORT: Sensory nerve rootlets on L5 were taken for histological evaluation from two children with cerebral palsy during selective dorsal rhizotomy, performed for their leg spasticities. Rootlets with clonus reaction against intraoperative electrical stimulation show dysmyelination, and in one child, axonal degeneration can also be observed. Rootlets with normal reaction have only minimum changes on their myelin sheath. CONCLUSION: As cerebral palsy is a typical upper motor neuron disorder, peripheral sensory neuropathy is unexplained. Since observed neuropathy is mainly on the myelin sheath, the etiology is considered to be the chronic overload of afferent impulses from muscle spindles in the spastic muscle.

Continuing Impact of Infectious Diseases on Childhood Deaths in England and Wales, 2003-2005.

Pediatr Infect Dis J. 2010 Mar 6;
Ladhani S, Pebody RG, Ramsay ME, Lamagni TL, Johnson AP, Sharland M

BACKGROUND:: Data on the contribution of specific infections to childhood deaths in developed countries are limited. METHODS:: Infection-related deaths in children aged 28 days to 14 years who died in England and Wales between 2003 and 2005 were identified from routine anonymized death certificate dataset provided by the Office for National Statistics to the Health Protection Agency, using predefined International Classification of Diseases codes for infection. RESULTS:: There were 1368 infection-related deaths documented, constituting 20% of all childhood deaths. An underlying medical condition was recorded in 50% (676 cases), the most common being prematurity in infants (322/660, 52%), cerebral palsy in 1 to 4 year olds (46/190, 24%), and malignancy (46/163, 28%) in 5 to 14 year olds. Of the 837 deaths where a pathogen was coded, 494 (59%) specified bacterial infection, 256 (31%) viral infection, and 69 (8%) fungal infection. Among deaths with recorded bacterial infections, a lower proportion of meningococcal and pneumococcal infections (14% [22/155] vs. 60% [205/339], P < 0.0001) and a higher proportion of Gram-negative enteric bacilli (78/155 cases [50%] vs. 17/339 cases [5%], P < 0.0001) were reported in children with and without documented underlying medical conditions, respectively. CONCLUSIONS:: Infections continue to make a major contribution to deaths in children, particularly among those with underlying conditions. Identification of the pathogens associated with childhood deaths should help prioritize the development of intervention strategies for reducing pediatric mortality. Linkage of death registrations to national infectious disease surveillance systems should be undertaken to strengthen monitoring of infectious deaths and evaluate the effect of interventions.

Cognitive Deficits in Chronic Heart Failure.

Nurs Res. 2010 March/April; 59(2): 127-139
Pressler SJ, Subramanian U, Kareken D, Perkins SM, Gradus-Pizlo I, Sauvé MJ, Ding Y, Kim J, Sloan R, Jaynes H, Shaw RM

BACKGROUND:: Patients with heart failure (HF) have been found to have cognitive deficits, but it remains unclear whether these deficits are associated with HF or with aging or comorbid conditions common in HF. OBJECTIVES:: The purpose of this study was (a) to determine the types, the frequency, and the severity of cognitive deficits among patients with chronic HF compared with age- and education-matched healthy participants and participants with major medical conditions other than HF, and (b) to evaluate the relationships between HF severity, age, and comorbidities and cognitive deficits. METHODS:: A sample of 414 participants completed the study (249 HF patients, 63 healthy and 102 medical participants). The HF patients completed measures of HF severity, comorbidity (multiple comorbidity, depressive symptoms), and neuropsychological functioning. Blood pressure and oxygen saturation were assessed at interview; clinical variables were abstracted from records. Participants in the comparison groups completed the same measures as the HF patients except those specific to HF. RESULTS:: Compared with the healthy and medical participants, HF patients had poorer memory, psychomotor speed, and executive function. Significantly more HF patients (24%) had deficits in three or more domains. Higher (worse) HF severity was associated with more cognitive deficits; HF severity interacted with age to explain deficits in executive function. Surprisingly, men with HF had poorer memory, psychomotor speed, and visuospatial recall ability than women. Multiple comorbidity, hypertension, depressive symptoms, and medications were not associated with cognitive deficits in this sample. DISCUSSION:: HF results in losses in memory, psychomotor speed, and executive function in almost one fourth of patients. Patients with more severe HF are at risk for cognitive deficits. Older patients with more severe HF may have more problems in executive function, and men with HF may be at increased risk for cognitive deficits. Studies are urgently needed to identify the mechanisms for the cognitive deficits in HF and to test innovative interventions to prevent cognitive loss and decline.

Next Generation Sequencing of Serum Circulating Nucleic Acids from Patients with Invasive Ductal Breast Cancer Reveals Differences to Healthy and Nonmalignant Controls.

Mol Cancer Res. 2010 Mar 9;
Beck J, Urnovitz HB, Mitchell WM, Schütz E

Circulating nucleic acids (CNA) isolated from serum or plasma are increasingly recognized as biomarkers for cancers. Recently developed next generation sequencing provides high numbers of DNA sequences to detect the trace amounts of unique serum biomarkers associated with breast carcinoma. Serum CNA of 38 women with ductal carcinoma was extracted and sequenced on a 454/Roche high-throughput GS-FLX platform and compared with healthy controls and patients with other medical conditions. Repetitive elements present in CNA were detected and classified, and each repetitive element was normalized based on total sequence count or repeat count. Multivariate regression models were calculated using an information-theoretical approach and multimodel inference. A total of 423,150 and 953,545 sequences for the cancer patients and controls, respectively, were obtained. Data from 26 patients with stages II to IV tumors and from 67 apparently healthy female controls were used as the training data set. Using a bootstrap method to avoid sampling bias, a five-parameter model was developed. When this model was applied to a validation data set consisting of patients with tumor stage I (n = 10) compared with healthy and nonmalignant disease controls (n = 87; 1,261,561 sequences) a sensitivity of 70% at a specificity of 100% was obtained. At a diagnostic specificity level of 95%, a sensitivity of 90% was calculated. Identification of specific breast cancer-related CNA sequences provides the basis for the development of a serum-based routine laboratory test for breast cancer screening and monitoring. Mol Cancer Res; 8(3); 335-42.

Pain management in multiple myeloma.

Expert Rev Anticancer Ther. 2010 Mar; 10(3): 415-25
Niscola P, Scaramucci L, Romani C, Giovannini M, Tendas A, Brunetti G, Cartoni C, Palumbo R, Vischini G, Siniscalchi A, Fabritiis P, Caravita T

Pain is a prominent feature of multiple myeloma (MM) and may be caused by different underlying causes and mechanisms. Indeed, pain may be due to disease-related complications, iatrogenic causes or may be associated with other unrelated medical conditions. This symptom may be particularly devastating and can negatively affect the quality of life of the afflicted patients and their functional status. For most MM patients suffering from continuous nociceptive pain, the WHO's three-step analgesic ladder can provide adequate relief with oral options, although the high prevalence in MM patients of difficult-to-treat pains, such as pains due to skeletal mechanical instability or sustained by neuropathic mechanisms, makes the treatment approach a challenging concern. The management of pain in this setting requires a multidisciplinary approach integrating analgesics and causal interventions. This review focuses on the most common syndromes afflicting MM patients, attempting to provide an understanding of the underlying pain mechanisms and a discussion of the most commonly used treatment strategies.

Heart failure and mouse models.

Dis Model Mech. 2010 Mar-Apr; 3(3-4): 138-43
Breckenridge R

Heart failure is a common, complex condition with a poor prognosis and increasing incidence. The syndrome of heart failure comprises changes in electrophysiology, contraction and energy metabolism. This complexity, and the interaction of the clinical syndrome with very frequently concurrent medical conditions such as diabetes, means that animal modelling of heart failure is difficult. The current animal models of heart failure in common use do not address several important clinical problems. There have been major recent advances in the understanding of cardiac biology in the healthy and failing myocardium, but these are, as yet, unmatched by advances in therapeutics. Arguably, the development of new animal models of heart failure, or at least adaptation of existing models, will be necessary to fully translate scientific advances in this area into new drugs. This review outlines the mouse models of heart failure in common usage today, and discusses how adaptations in these models may allow easier translation of animal experimentation into the clinical arena.

Biopsychosocial Characteristics of Community-Dwelling Older Adults with Limited Ability to Walk One-Quarter of a Mile.

J Am Geriatr Soc. 2010 Feb 22;
Hardy SE, McGurl DJ, Studenski SA, Degenholtz HB

OBJECTIVES: To establish nationally representative estimates of the prevalence of self-reported difficulty and inability of older adults to walk one-quarter of a mile and to identify the characteristics independently associated with difficulty or inability to walk one-quarter of a mile. DESIGN: Cross-sectional analysis of data from the 2003 Cost and Use Medicare Current Beneficiary Survey. SETTING: Community. PARTICIPANTS: Nine thousand five hundred sixty-three community-dwelling Medicare beneficiaries aged 65 and older, representing an estimated total population of 34.2 million older adults. MEASUREMENTS: Self-reported ability to walk one-quarter of a mile, sociodemographics, chronic conditions, body mass index, smoking, functional status. RESULTS: In 2003, an estimated 9.5 million older Medicare beneficiaries had difficulty walking one-quarter of a mile, and 5.9 million were unable to do so. Of the 20.2 million older adults with no difficulty in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), an estimated 4.3 million (21%) had limited ability to walk one-quarter of a mile. Having difficulty or being unable to walk one-quarter of a mile was independently associated with older age, female sex, non-Hispanic ethnicity, lower educational level, Medicaid entitlement, most chronic medical conditions, current smoking, and being overweight or obese. CONCLUSION: Almost half of older adults and 20% of those reporting no ADL or IADL limitations report limited ability to walk one-quarter of a mile. For functionally independent older adults, reported ability to walk one-quarter of a mile can identify vulnerable older adults with greater medical problems and fewer resources and may be a valuable clinical marker in planning their care. Future work is needed to determine the association between ability to walk one-quarter of a mile walk and subsequent functional decline and healthcare use.

Medication error analysis: a systematic approach.

Curr Drug Saf. 2010 Jan 1; 5(1): 2-5
Patel GP, Kane-Gill SL

Medication errors are a common unfortunate occurrence in hospitals. One population that is particularly vulnerable are patients admitted to the Intensive Care Unit (ICU). ICU patients have a combination of rapidly changing medical conditions, laboratory values, and medications, which present a particular challenge for clinicians in practice in every aspect of patient care. Medication errors can occur in different phases (prescribing, distribution, administration, and monitoring) of the medication process and have a significant impact on morbidity and mortality. Medication error analysis requires a structured approach including: detection, reporting, and analysis, in order to provide the most efficient and practical information to the ICU team. In addition, a particular focus is made on the implementation of medication error prevention strategies such as evidenced-based protocols, team education, and technology. In an effort to reduce medication error rates in the ICU requires a collaborative, multi-disciplinary approach in order to be effective and consistent through time. Further research efforts are currently taking place in this challenging aspect of patient care to further provide more strategies for medication error detection, analysis, and prevention.

Probiotics.

Am J Health Syst Pharm. 2010 Mar 15; 67(6): 449-58
Williams NT

Purpose The pharmacology, uses, dosages, safety, drug interactions, and contraindications of probiotics are reviewed. Summary Probiotics are live nonpathogenic microorganisms administered to improve microbial balance, particularly in the gastrointestinal tract. They consist of Saccharomyces boulardii yeast or lactic acid bacteria, such as Lactobacillus and Bifidobacterium species, and are regulated as dietary supplements and foods. Probiotics exert their beneficial effects through various mechanisms, including lowering intestinal pH, decreasing colonization and invasion by pathogenic organisms, and modifying the host immune response. Probiotic benefits associated with one species or strain do not necessarily hold true for others. The strongest evidence for the clinical effectiveness of probiotics has been in the treatment of acute diarrhea, most commonly due to rotavirus, and pouchitis. More research is needed to clarify the role of probiotics for preventing antibiotic-associated diarrhea, Clostridium difficile infection, travelers' diarrhea, irritable bowel syndrome, ulcerative colitis, Crohn's disease, and vulvovaginal candidiasis. There is no consensus about the minimum number of microorganisms that must be ingested to obtain a beneficial effect; however, a probiotic should typically contain several billion microorganisms to increase the chance that adequate gut colonization will occur. Probiotics are generally considered safe and well tolerated, with bloating and flatulence occurring most frequently. They should be used cautiously in patients who are critically ill or severely immunocompromised or those with central venous catheters since systemic infections may rarely occur. Bacteria-derived probiotics should be separated from antibiotics by at least two hours. Conclusion Probiotics have demonstrated efficacy in preventing and treating various medical conditions, particularly those involving the gastrointestinal tract. Data supporting their role in other conditions are often conflicting.

Physicians' Perceptions of Barriers to Cardiovascular Disease Risk Factor Control among Patients with Diabetes: Results from the Translating Research into Action for Diabetes (TRIAD) Study.

J Am Board Fam Med. 2010 Mar-Apr; 23(2): 171-8
Crosson JC, Heisler M, Subramanian U, Swain B, Davis GJ, Lasser N, Ross S, Schmittdiel JA, Onyemere K, Tseng CW

Introduction: Many patients with diabetes have poorly controlled blood glucose, lipid, or blood pressure levels, increasing their risk for cardiovascular disease (CVD) and other complications. Relatively little is known about what physicians perceive to be barriers to good CVD risk factor control or their own role in helping patients achieve good control. METHODS: We interviewed 34 primary care physicians in 4 states to assess their perceptions of patients' barriers to CVD risk factor control. Interviews were coded and analyzed for emergent themes. RESULTS: Physicians attributed barriers primarily to patients (socioeconomic issues, competing medical conditions, and lack of motivation) or to health system barriers (cost of care or lack of a multidisciplinary team). Physicians also expressed high levels of frustration with their efforts to address barriers. CONCLUSIONS: Physicians felt that barriers to CVD risk factor control often were beyond their abilities to address. Training physicians or other members of the primary health care team to address patients' personal barriers and health system barriers to good control could help alleviate high frustration levels, improve relationships with patients, and improve the treatment of diabetes. Supporting such efforts with adequate reimbursement should be a focus of health care reform.

Medical Applications of Implantable Drug Delivery Microdevices Based on MEMS (Micro-Electro-Mechanical-Systems).

Curr Pharm Biotechnol. 2010 Mar 4;
Elman NM, Upadhyay UM

Drug delivery microdevices based on MEMS (Micro-Electro-Mechanical-Systems) represent the next generation of active implantable drug delivery systems. MEMS technology has enabled the scaling down of current delivery modalities to the micrometer and millimeter size. The complementary use of biocompatible materials makes this technology potentially viable for a wide variety of clinical applications. Conditions such as brain tumors, chronic pain syndromes, and infectious abscess represent specialized clinical diseases that will likely benefit most from such drug delivery microdevices. Designing MEMS microdevices poses considerable technical and clinical challenges as devices need to be constructed from biocompatible materials that are harmless to human tissue. Devices must also be miniaturized and capable of delivering adequate pharmacologic payload. Balancing these competing needs will likely lead to the successful application of MEMS drug delivery devices to various medical conditions. This work reviews the various factors that must be considered in optimizing MEMS microdevices for their appropriate and successful application to medical disease.

Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D.

J Bone Miner Res. 2010 Feb 8;
Mulligan GB, Licata A

CONTEXT: Many patients treated for vitamin D deficiency fail to achieve an adequate serum level of 25-hydroxyvitamin D (25OHD) despite high doses of ergo- or cholecalciferol OBJECTIVE: To determine whether administration of vitamin D supplement with the largest meal of the day will improve absorption and increase serum levels of 25OHD DESIGN: Prospective cohort SETTING: Ambulatory tertiary-care referral center PATIENTS: Patients seen at the Cleveland Clinic Foundation Bone clinic for treatment of vitamin D deficiency not responding to treatment INTERVENTION: Take the same vitamin D supplement with the largest meal of the day MAIN OUTCOME MEASURE: Serum 25OHD level after 2-3 months RESULTS: Seventeen patients were analyzed. The mean age (+/-SD) and sex (F/M) ratio were 64.5 +/- 11.0 years and 13/4, respectively. The dose of 25OHD ranged from 1000 to 50,000 international units (IU) daily. The mean baseline serum 25OHD level (+/-SD) was 30.5 +/- 4.7 (range 21.6 - 38.8) ng/mL. The mean serum 25OHD after diet modification (+/-SD) was 47.2 +/- 10.9 (range 34.7 - 74.0) ng/mL (p < 0.01). Overall, the average serum 25OHD level increased by 56.7 +/- 36.7%. A subgroup analysis based on the weekly dose of vitamin D was performed and a similar trend was observed. CONCLUSION: Taking vitamin D with the largest meal improves absorption and results in about a 50% increase in serum levels of 25OHD. Similar increases were observed in a wide range of vitamin D doses taken for a variety of medical conditions. (c) 2010 American Society for Bone and Mineral Research.

Two doses of sclerostin antibody in cynomolgus monkeys increases bone formation, bone mineral density, and bone strength.

J Bone Miner Res. 2010 Jan 8;
Ominsky MS, Vlasseros F, Jolette J, Smith SY, Stouch B, Doellgast G, Gong J, Gao Y, Cao J, Graham K, Tipton B, Cai J, Deshpande R, Zhou L, Hale MD, Lightwood DJ, Henry AJ, Popplewell AG, Moore AR, Robinson MK, Lacey DL, Simonet WS, Paszty C

The development of bone-rebuilding anabolic agents for treating bone-related conditions has been a long-standing goal. Genetic studies in humans and mice have shown that the secreted protein sclerostin is a key negative regulator of bone formation. More recently, administration of sclerostin-neutralizing monoclonal antibodies in rodent studies has shown that pharmacological inhibition of sclerostin results in increased bone formation, bone mass and bone strength. To explore the effects of sclerostin inhibition in primates we administered a humanized sclerostin-neutralizing monoclonal antibody (Scl-AbIV) to gonad-intact female cynomolgus monkeys. Two once-monthly subcutaneous injections of Scl-AbIV were administered at three dose levels (3, 10 and 30 mg/kg), with study termination at 2 months. Scl-AbIV treatment had clear anabolic effects with marked dose-dependent increases in bone formation on trabecular, periosteal, endocortical and intracortical surfaces. Bone densitometry showed that the increases in bone formation with Scl-AbIV treatment resulted in significant increases in BMC and/or BMD at several skeletal sites (femoral neck, radial metaphysis, tibial metaphysis). These increases, expressed as percent changes from baseline, were 11-29 percentage points higher than those found in the vehicle-treated group. Additionally, significant increases in trabecular thickness and bone strength were found at the lumbar vertebrae in the highest dose group. Taken together, the marked bone-building effects achieved in this short-term monkey study suggest that sclerostin inhibition represents a promising new therapeutic approach for medical conditions where increases in bone formation might be desirable, such as in fracture healing and osteoporosis. (c) 2010 American Society for Bone and Mineral Research.

Quantitative Top-Down Proteomics of SILAC Labeled Human Embryonic Stem Cells.

J Am Soc Mass Spectrom. 2010 Feb 6;
Collier TS, Sarkar P, Rao B, Muddiman DC

Human embryonic stem cells (hESCs) are self-renewing pluripotent cells with relevance to treatment of numerous medical conditions. However, a global understanding of the role of the hESC proteome in maintaining pluripotency or triggering differentiation is still largely lacking. The emergence of top-down proteomics has facilitated the identification and characterization of intact protein forms that are not readily apparent in bottom-up studies. Combined with metabolic labeling techniques such as stable isotope labeling by amino acids in cell culture (SILAC), quantitative comparison of intact protein expression under differing experimental conditions is possible. Herein, quantitative top-down proteomics of hESCs is demonstrated using the SILAC method and nano-flow reverse phase chromatography directly coupled to a linear-ion-trap Fourier transform ion cyclotron resonance mass spectrometer (nLC-LTQ-FT-ICR-MS). In this study, which to the best of our knowledge represents the first top-down analysis of hESCs, we have confidently identified 11 proteins by accurate intact mass, MS/MS, and amino acid counting facilitated by SILAC labeling. Although quantification is challenging due to the incorporation of multiple labeled amino acids (i.e., lysine and arginine) and arginine to proline conversion, we are able to quantitatively account for these phenomena using a mathematical model.

Analysis of emergency medical services activations in shenandoah national park from 2003 to 2007.

Prehosp Emerg Care. 2010 Apr 6; 14(2): 182-6
Baker J, Pat McKay M

Abstract Background. Wilderness activities continue to be popular in the United States, but may lead to both direct injuries and exacerbations or complications from chronic diseases. Appropriate response planning requires information on the type and location of emergency medical services (EMS) activations in large outdoor areas with many visitors. Objectives. To describe EMS calls in Shenandoah National Park in Virginia and explore the resultant implications for EMS resources and staging, medical provider training, and potential public health interventions in similar wilderness recreation areas. Methods. A retrospective, descriptive review was conducted of all park EMS activations in Shenandoah National Park from 2003 to 2007. Results. There were 335 EMS activations within the park over the study period. Both call volume and call rate increased during the study period. There were 197 calls (58.8%) for injuries and 138 (41.2%) for illnesses. Weakness/dizziness was the most frequent illness complaint, and lower extremity injury was the most frequent injury. Those with illnesses were more likely to be seen by EMS at a lodge, tended to be female, and were more likely to require emergency transportation to a hospital. Chronic medical problems were reported for twice as many of the illness patients as for those who were injured. Conclusions. EMS runs in Shenandoah are increasing and the majority of calls from 2003 to 2007 were for injuries. A notable number of patients with both injuries and illnesses reported chronic medical conditions. These data may be used to help with EMS support availability planning, provider education, and safety planning within the park, and provide baseline data for future public-safety interventions.

Rhinitis and sinusitis.

J Allergy Clin Immunol. 2010 Feb; 125(2 Suppl 2): S103-15
Dykewicz MS, Hamilos DL

Rhinitis and sinusitis are among the most common medical conditions and are frequently associated. In Western societies an estimated 10% to 25% of the population have allergic rhinitis, with 30 to 60 million persons being affected annually in the United States. It is estimated that sinusitis affects 31 million patients annually in the United States. Both rhinitis and sinusitis can significantly decrease quality of life, aggravate comorbid conditions, and require significant direct medical expenditures. Both conditions also create even greater indirect costs to society by causing lost work and school days and reduced workplace productivity and school learning. Management of allergic rhinitis involves avoidance, many pharmacologic options, and, in appropriately selected patients, allergen immunotherapy. Various types of nonallergic rhinitis are treated with avoidance measures and a more limited repertoire of medications. For purposes of this review, sinusitis and rhinosinusitis are synonymous terms. An acute upper respiratory illness of less than approximately 7 days' duration is most commonly caused by viral illness (viral rhinosinusitis), whereas acute bacterial sinusitis becomes more likely beyond 7 to 10 days. Although the mainstay of management of acute bacterial sinusitis is antibiotics, treatment of chronic sinusitis is less straightforward because only some chronic sinusitis cases have an infectious basis. Chronic rhinosinusitis (CRS) has been subdivided into 3 types, namely CRS without nasal polyps, CRS with nasal polyps, and allergic fungal rhinosinusitis. Depending on the type of CRS present, a variety of medical and surgical approaches might be required.

Effect of a purpose in life on risk of incident Alzheimer disease and mild cognitive impairment in community-dwelling older persons.

Arch Gen Psychiatry. 2010 Mar; 67(3): 304-10
Boyle PA, Buchman AS, Barnes LL, Bennett DA

CONTEXT: Emerging data suggest that psychological and experiential factors are associated with risk of Alzheimer disease (AD), but the association of purpose in life with incident AD is unknown. OBJECTIVE: To test the hypothesis that greater purpose in life is associated with a reduced risk of AD. DESIGN: Prospective, longitudinal epidemiologic study of aging. SETTING: Senior housing facilities and residences across the greater Chicago metropolitan area. PARTICIPANTS: More than 900 community-dwelling older persons without dementia from the Rush Memory and Aging Project. MAIN OUTCOME MEASURES: Participants underwent baseline evaluations of purpose in life and up to 7 years of detailed annual follow-up clinical evaluations to document incident AD. In subsequent analyses, we examined the association of purpose in life with the precursor to AD, mild cognitive impairment (MCI), and the rate of change in cognitive function. RESULTS: During up to 7 years of follow-up (mean, 4.0 years), 155 of 951 persons (16.3%) developed AD. In a proportional hazards model adjusted for age, sex, and education, greater purpose in life was associated with a substantially reduced risk of AD (hazard ratio, 0.48; 95% confidence interval, 0.33-0.69; P < .001). Thus, a person with a high score on the purpose in life measure (score = 4.2, 90th percentile) was approximately 2.4 times more likely to remain free of AD than was a person with a low score (score = 3.0, 10th percentile). This association did not vary along demographic lines and persisted after the addition of terms for depressive symptoms, neuroticism, social network size, and number of chronic medical conditions. In subsequent models, purpose in life also was associated with a reduced risk of MCI (hazard ratio, 0.71; 95% confidence interval, 0.53-0.95; P = .02) and a slower rate of cognitive decline (mean [SE] global cognition estimate, 0.03 [0.01], P < .01). CONCLUSION: Greater purpose in life is associated with a reduced risk of AD and MCI in community-dwelling older persons.

Insurance Coverage Is Associated with Mortality after Gunshot Trauma.

J Am Coll Surg. 2010 Mar; 210(3): 280-285
Dozier KC, Miranda MA, Kwan RO, Cureton EL, Sadjadi J, Victorino GP

BACKGROUND: Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma. STUDY DESIGN: The trauma records for gunshot victims and their insurance status were reviewed at our center from January 1998 to December 2007. Patient demographics (age, gender, race, and insurance coverage), injury severity, hospital care (operations and radiographic studies), and in-hospital mortality were analyzed. RESULTS: There were 2,164 gunshot trauma activations reviewed during the study period. One-quarter (n = 544) of these patients had insurance and three-quarters (n = 1,620) were uninsured. The in-hospital mortality rate was significantly higher for uninsured patients than for insured patients (9% vs 6%, p = 0.02). After controlling for age, gender, race, and injury severity by logistic regression analysis, the odds ratio for death of uninsured patients was 2.2 (95% CI 1.1 to 4.5). Insured patients did not differ from uninsured patients with respect to mean Injury Severity Score ([ISS] 12.2 +/- 10.7 vs 12.6 +/- 12.4, p = 0.56); similar percentages of patients were severely injured (ISS 16 to 24, 17% vs 15%, p = 0.19) and most severely injured (ISS > 24, 15% vs 16%, p = 0.68). Insured patients did not differ from uninsured patients with respect to use of radiographic imaging (53% vs 50%, p = 0.15) or operative intervention (37% vs 35%, p = 0.35). CONCLUSIONS: Despite similar injury severity, uninsured trauma patients were more likely to die after gunshot injury than insured patients. This difference could not be attributed to demographics or hospital resource use. Insurance coverage may reflect the many social determinants of health. Improving the social determinants of health in patients affected by violent trauma may be a step toward improving outcomes after trauma.

Recent advances in the genetics of language impairment.

Genome Med. 2010 Jan 26; 2(1): 6
Newbury DF, Fisher SE, Monaco AP

ABSTRACT : Specific language impairment (SLI) is defined as an unexpected and persistent impairment in language ability despite adequate opportunity and intelligence and in the absence of any explanatory medical conditions. This condition is highly heritable and affects between 5% and 8% of pre-school children. Over the past few years, investigations have begun to uncover genetic factors that may contribute to susceptibility to language impairment. So far, variants in four specific genes have been associated with spoken language disorders - forkhead box P2 (FOXP2) and contactin-associated protein-like 2 (CNTNAP2) on chromosome7 and calcium-transporting ATPase 2C2 (ATP2C2) and c-MAF inducing protein (CMIP) on chromosome 16. Here, we describe the different ways in which these genes were identified as candidates for language impairment. We discuss how characterization of these genes, and the pathways in which they are involved, may enhance our understanding of language disorders and improve our understanding of the biological foundations of language acquisition.

Comorbidities amongst patients with multiple sclerosis: a population-based controlled study.

Eur J Neurol. 2010 Feb 23;
Kang JH, Chen YH, Lin HC

Background: Data regarding the wide spectrum of comorbidity amongst patients with multiple sclerosis (MS) are still scanty, especially in Asian populations. Our goal was to analyze comorbidity prevalences and risks amongst Chinese patients with MS, compared to matched controls. Methods: In total, 898 patients with MS and 4490 randomly matched individuals without MS were extracted from the National Health Insurance Research Dataset in Taiwan. We selected 30 comorbid medical conditions for analysis. Conditional logistic regression analyses were used to examine the risks of comorbidity between the two groups. Results: The regression analyses showed that patients with MS were more likely to have systemic lupus erythematosus (OR = 26.9, 95% CI = 10.3-70.3), depression (OR = 6.9, 95% CI = 5.3-8.9), peripheral vascular disorders (OR = 6.6, 95% CI = 4.0-11.0), deficiency anemias (OR = 4.9, 95% CI = 2.8-8.7), rheumatoid arthritis (OR = 4.8, 95% CI = 2.9-8.1) and fluid and electrolyte disorders (OR = 4.8, 95% CI = 2.8-8.3) than the matched controls. Conclusions: Patients with MS had higher risk of multiple medical comorbidities compared to a matched control group in an ethnic Chinese population.