bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia
Authors: Pimentel Érica Maria Lima
Published: July 2016

Abstract The prevalence of dementia increases significantly from the age of 65 years, doubling every five years thereafter. Alzheimer's disease (AD) and vascular dementia (VaD) constitute the two main dementia types. Differentiating them encompasses anamnesis, neurological examination, laboratory and neuroimaging exams and neuropsychological assessment. Neuropsychological assessment produces different findings for each dementia type, and reveals those areas most impaired as well as those most preserved. The aim of the present article was to describe the role of neuropsychology in diagnosing dementia and achieving a differential diagnosis between AD and VaD. A general overview follows of the most widely known instruments used to assess cognitive function in dementia, and the cognitive changes seen in AD and VaD. The conclusion drawn was that there is significant overlap in cognitive changes between both these dementia types, while each type has its own specific characteristics which are identifiable and quantifiable on neuropsychological assessments and provide the basis for reaching a differential diagnosis.
The ex-illiterate brain: The critical period, cognitive reserve and HAROLD model
Authors: Nunes Maria Vania Silva , Castro-Caldas Alexandre , Del Rio Dolores , Maestú Fernado , Ortiz Tomás
Published: July 2016

Abstract The lifelong acquisition of cognitive skills shapes the biology of the brain. However, there are critical periods for the best use of the brain to process the acquired information. Objectives: To discuss the critical period of cognitive acquisition, the concept of cognitive reserve and the HAROLD (Hemispheric Asymmetry Reduction in Older adults) model. Methods: Seven women who learned how to read and to write after the age of 50 (ex-illiterates) and five women with 10 years of regular schooling (controls) were submitted to a language recognition test while brain activity was being recorded using magnetoencephalography. Spoken words were delivered binaurally via two plastic tubs terminating in ear inserts, and recordings were made with a whole head magnetometer consisting of 148 magnetometer coils. Results: Both groups performed similarly on the task of identifying target words. Analysis of the number of sources of activity in the left and right hemispheres revealed significant differences between the two groups, showing that ex-illiterate subjects exhibited less brain functional asymmetry during the language task. Conclusions: These results should be interpreted with caution because the groups were small. However, these findings reinforce the concept that poorly educated subjects tend to use the brain for information processing in a different way to subjects with a high educational level or who were schooled at the regular time. Finally, the recruiting of both hemispheres to tackle the language recognition test occurred to a greater degree in the ex-illiterate group where this can be interpreted as a sign of difficulty performing the task.
The brain subcortical white matter and aging: A quantitative fractional anisotropy analysis
Authors: Engelhardt Eliasz , Moreira Denise Madeira , Laks Jerson
Published: July 2016

Abstract To study the integrity of hemispheric subcortical white matter by comparing normal young and elderly subjects using quantitative fractional anisotropy (DTI-FA). Methods: Subjects of two different age groups (young=12, elderly=12) were included. MR - GE Signa Horizon - 1.5T scans were performed. Cases with Fazekas scores £3 were assessed on FLAIR sequence. Standard parameters for DTI-FA were used. ROIs were placed at various sites of the subcortical white matter, and the genu and splenium of the midline corpus callosum. Analysis was performed using Functool. Statistics for anterior and posterior white matter, as well as the genu and splenium were compared between the groups. The study was approved by the Ethics Committee of IPUB-UFRJ and informed consent obtained. Results: DTI-FA showed lower anisotropy values in the anterior region (subcortical white matter and genu), but not in the posterior region (subcortical white matter and splenium), in elderly normal subjects compared to young subjects. Conclusion: The results may represent loss of integrity of anterior (frontal) white matter fibers in the elderly subjects. These fibers constitute important intra- and inter-hemispheric tracts, components of neural networks that provide cognitive, behavioral, motor and sensory integration. The loss of integrity of the anterior segments of the studied fiber systems with ageing, represents a disconnection process that may underlie clinical manifestations found in elderly subjects such as executive dysfunction.
Quality of life and Alzheimer's disease: Influence of participation at a rehabilitation center
Authors: Machado Fernanda , Nunes Paula V. , Viola Luciane F. , Santos Franklin S. , Forlenza Orestes V. , Yassuda Mônica S.
Published: July 2016

Abstract Quality of life is seldom explored in evaluations of therapeutic interventions in Alzheimer's disease. Objective: To verify whether participation in a cognitive and functional rehabilitation program improves quality of life (QOL) among Alzheimer's disease (AD) patients. Methods: 19 AD patients participated in this study, 12 of whom attended 24 multi-professional intervention sessions - the experimental group - whereas the remaining 7 comprised the control group. The following tools were used to assess changes: a) Mini-Mental State Examination (MMSE); b) Geriatric Depression Scale (GDS); c) Quality of Life in AD evaluation scale (QOL-AD); d) Open question on QOL. Results: Participation had no positive impact on quantitative clinical variables (MMSE, GDS, QOL-AD). The answers to the open question, examined using the Collective Subject Discourse (CSD) method, suggested that QOL improved after the intervention. Conclusion: Combining pharmacological treatment with psychosocial intervention may prove to be an effective strategy to enhance the QOL of AD patients.
The "eye sign" due to hemispatial neglect: A case report
Authors: Porto Fábio Henrique de Gobbi , Machado Gislaine Cristina Lopes , Silva Mari-Nilva Maia da , Freitas Gabriel Rodriguez de
Published: July 2016

Abstract Conjugate eye deviation is characterized by a sustained shift in horizontal gaze, usually toward the affected brain hemisphere. When detected on neuroimaging, it is called the "eye sign". It is classically associated with lesions involving the frontal eye fields, ipsilateral to the side of the deviation. Neglect may be conceptualized as a spatially addressed bias of the sensory events in explicit behaviors and in the absence of perceptual and motor deficits. Hemispatial neglect is a common disabling condition that occurs following acute unilateral brain damage, usually to the right side. We report a case of a patient presenting with the "eye sign" on tomography, following an acute subinsular stroke, in the absence of conjugated eyes deviation. Our hypothesis was that the sign may have been due to hemispatial neglect in this patient. The aim of this article was to discuss the mechanisms involved in the attention network and its neuroanatomic correlates.
Cognitive impairment and driving: A review of the literature
Authors: Apolinario Daniel , Magaldi Regina Miksian , Busse Alexandre Leopold , Lopes Leonardo da Costa , Kasai Juliana Yumi Tison , Satomi Erika
Published: July 2016

Abstract Although some drivers with mild dementia may continue to drive after the condition has been diagnosed, the ability to drive a motor vehicle safely is eventually lost as the disease progresses. Clinicians involved in dementia care are often asked to make an assessment on whether a patient is fit to drive, even though they often lack basic knowledge and formal training in this area. The purpose of this review was to identify the factors that may differentiate safe from unsafe drivers with cognitive impairment and to discuss management strategies. Isolated information about staging measures or particular cognitive tests was found to be insufficient for decision making. Driving fitness counseling for patients with cognitive impairment requires a solid knowledge base, comprehensive assessment and thoughtful communication.
Collage technique may provide new perspectives for Alzheimer patients by exploring messages from their inner world
Authors: Meguro Mitsue , Ishizaki Junichi , Meguro Kenichi
Published: July 2016

Abstract Although the collage art technique has been introduced as a psychotherapeutic method, it has not been fully applied in dementia. Objectives: To analyze characteristics of the collage articles produced by patients with Alzheimer's disease (AD). Methods: Twenty AD patients were asked to select and place several clippings as they wished. The MMSE was used for cognitive assessments. Results: Simplification and poor organization in their articles were found. The themes of one patient were found to change according to behavior. We discussed the images of the articles, especially spiritual images in the early stage and family images in the later stage. Conclusions: We concluded that the collage technique could provide new perspectives for dementia patients by exploring messages from their inner world.
Time of delirium onset and prognosis amongst Southern Brazilian hospitalized elderly patients
Authors: Moschetta André Luiz , Silveira Carine Volkweis , Dalacorte Roberta Rigo , Schneider Rodolfo Herberto , Silva Filho Irênio Gomes da
Published: July 2016

Abstract The prognostic significance of delirium in hospitalized elderly has not yet been fully clarified. Objectives: The present study was designed to evaluate the relationship between prevalent delirium (PrD), incident delirium (InD) and final outcome. Methods: A historical cohort of 261 patients was selected. delirium was diagnosed using the Confusion Assessment Method. Results: The total frequency of delirium detected was 42.5%-31.4% PrD and 16.2% InD. Among patients with InD, the average length of hospital stay was 9.1 days longer than for patients without delirium (p=0.002), and the hospital mortality associated with InD was 48% versus 2.7% for those without delirium (p<0.001). However, no difference was observed between patients with PrD and those without delirium. Conclusions: These results suggest that, when investigating delirium and prognosis amongst hospitalized elderly, it is fundamental to differentiate in terms of time of onset. Furthermore, the absence of delirium seems to be an important protective factor.
Association between cardiovascular disease and dementia
Authors: Suemoto Claudia Kimie , Ferretti Renata Eloah , Grinberg Lea Tenenholz , Oliveira Kátia Cristina de , Farfel José Marcelo , Leite Renata Elaine Paraizo , Nitrini Ricardo , Jacob Filho Wilson , Pasqualucci Carlos Augusto
Published: July 2016

Abstract Longitudinal studies have shown association between cardiovascular risk factors and dementia. However, these studies are not capable of detecting asymptomatic cardiovascular alterations and thus may provide erroneous estimates of association. Autopsy studies could be more useful in elucidating these questions. The present clinicopathological study sought to examine the relationship between dementia, cardiovascular risk factors and disease. Methods: 603 subjects, who underwent autopsy, were classified regarding the presence of dementia, according to post mortem cognitive classification. Demographics, cardiovascular risk factors, and anatomically-proven cardiovascular disease (myocardial hypertrophy, cerebral and carotid atherosclerosis) were compared among cognitively normal persons and individuals with dementia. Results: Cognitive deficit was associated with advanced age, stroke, physical inactivity and low body mass index (p<0.05). Circle of Willis atherosclerosis was greater in patients with dementia than in controls on univariate analysis (p=0.01). However, this association lost significance when adjusted by age and gender (p=0.61). Heart failure and anatomopathological cardiac parameters were more severe in the control group than in demented individuals (p<0.05). Carotid artery atherosclerosis and intima-media thickness were similar in both groups. Conclusion: Advanced age, stroke, physical inactivity and low body mass index were linked to dementia. Circle of Willis atherosclerosis was associated with dementia only when age was not considered. Our results suggest that cerebral artery atherosclerosis was not directly associated with clinical expression of dementia.
Semantic Verbal Fluency test in dementia: Preliminary retrospective analysis
Authors: Lopes Marcos , Brucki Sonia Maria Dozzi , Giampaoli Viviana , Mansur Letícia Lessa
Published: July 2016

Abstract The Semantic Verbal Fluency (SVF) test entails the generation of words from a given category within a pre-set time of 60 seconds. Objectives: To verify whether socio-demographic and clinical data of individuals with dementia correlate with the performance on the SVF test and to ascertain whether differences among the criteria of number of answers, clusters and data spread over the intervals, predict clinical results. Methods: This was a retrospective study of 49 charts of demented patients classified according to the Clinical Dementia Rating (CDR) scale. We correlated education, age and gender, as well as CDR and Mini-Mental State Exam (MMSE) scores with the number of answers, clustering and switching distributed over four 15-second intervals on the SVF test. Results: The correlation between number of answers and quartiles was weak (r=0.407, p=0.004; r=0.484, p<0.001) but correlation between the number of clusters and responses was strong (r=0.883, p<0.001). The number of items on the SVF was statistically significant with MMSE score (p=0.01) and there was a tendency for significance on the CDR (p=0.06). The results indicated little activity regarding what we propose to call cluster recalling in the two groups. Discussion: The SVF test, using number of items generated, was found to be more effective than classic screening tests in terms of speed and ease of application in patients with CDR 2 and 3.
The abbreviated form of the Brief Cognitive Battery in the diagnosis of dementia in Alzheimer's disease
Authors: Castro Stephanie , Damin Antonio Eduardo , Porto Cláudia Sellitto , Caramelli Paulo , Nitrini Ricardo
Published: July 2016

Abstract The Brief Cognitive Battery (BCB) developed by our group for cognitive assessment of low educated individuals has also shown to be highly accurate in diagnosing dementia of individuals with medium or high levels of education, making it a useful tool for populations with heterogeneous educational background. The application of BCB takes around eight minutes, a rather long period for a screening test. Objectives: Our aim was to evaluate whether the exclusion of items of the BCB could reduce its application time without losing accuracy. Methods: Patients with Alzheimer's disease with mild or moderate dementia (N=20), and 30 control subjects were submitted to an abbreviated version of the BCB in which the clock drawing test was not included as an interference test for the delayed recall test. Data from another 22 control individuals who were submitted to the original BCB in another study were also included for comparison. A mathematical formula was employed to compare the two versions of the BCB. Descriptive statistics and ROC (receiver operator characteristic) curves were used (alpha=0.05). Results: Using the abbreviated version, the delayed recall test also had high accuracy in diagnosing dementia and the mathematical formula results did not differ to those obtained using the original version, while mean time was reduced by 2 minutes and 37 seconds. Conclusions: This abbreviated form of the BCB is a potentially valuable tool for screening dementia in population studies as well as in busy clinical practices in countries with heterogeneous educational backgrounds.
Accuracy of neuropsychological tests and the Neuropsychiatric Inventory in differential diagnosis between Frontotemporal dementia and Alzheimer's disease
Authors: Bahia Valéria Santoro , Viana Rene
Published: July 2016

Abstract The differential diagnosis between frontotemporal dementia (FTD) and Alzheimer's disease (AD) is sometimes difficult. Objectives: To verify the accuracy of neuropsychological tests and a behavioral disorders scale in the differential diagnosis between FTLD and AD. Methods: Retrospective data on 12 FTD patients and 12 probable AD patients were analyzed. The scores on neuropsychological tests (MMSE score, reverse digit span, delayed recall for drawings, semantic fluency of animals) and the Neuropsychiatric Inventory (NPI) in both groups were compared. Results: Both groups had similar performance on neuropsychological tests. All FTD patients and 50% of AD patients had neuropsychiatric abnormalities. The NPI score was 58.0±19.3 for the FTD patients, and 3.6±4.7 for the AD patients (p<0.01). Using a NPI cut-off score of 13, the sensitivity and specificity were 100% in this sample. The four most common neuropsychiatric disturbances in FTD patients were: apathy, aberrant motor behavior, disinhibition and eating abnormalities. Apathy and dysphoria/depression were the most common behavioral symptoms among the AD patients. Conclusions: In this study, NPI was found to be a useful tool for the differential diagnosis between FTD and AD. The neuropsychological tests commonly used in the medical office were unable to distinguish between the two groups.
Heterogeneity of cognitive aging in Brazilian normal elderls
Authors: Foss Maria Paula , Formigheri Paulo , Speciali José Geraldo
Published: July 2016

Abstract With aging, several cognitive skills inevitably decline. However, cognitive losses do not occur homogenously in all elderly people, differing in number and severity of affected cognitive functions. These differences could be exacerbated by socioeconomic differences in a developing country like Brazil. Objectives: to characterize the cognitive functioning of healthy elderly subjects whose socioeconomic conditions differ to those of other studies. Methods: 60 elderly subjects with a mean age of 68 years, 43 women and 17 men, and mean schooling of 7.1 years, were studied. The cognitive function of this group was assessed using the following neuropsychological tests: Mattis Dementia Rating Scale (MDRS), Stroop Test, Verbal Fluency, Wisconsin Card Sorting Test (WCST), Rey Complex Figure, Vocabulary - Wais - III, Logical Memory (WMS-R), Visual Reproduction (WMS-R), and Rey Auditory-Verbal Learning Test (RAVLT). The neuropsychological data were submitted to Multivariate cluster analysis using SAS - Proc Cluster software and the complete binding hierarchical method. Results: Variability was found allowing classification of the studied group into 4 clusters of individuals who had above-average (C1), average (C3 and C4) and below average (C2) performance. Schooling determined the results obtained, with less educated subjects showing poorer performance than higher-educated subjects. Conclusions: Significant differences in the process of cognitive aging were detected on neuropsychological tests in this group of healthy elderly from the developing country of Brazil, where socioeconomic differences may exacerbate cognitive differences among older adults.
Non-inflammatory cerebral amyloid angiopathy as a cause of rapidly progressive dementia: A case study
Authors: Takada Leonel Tadao , Camiz Paulo , Grinberg Lea T. , Leite Claudia da Costa
Published: July 2016

Abstract A 77 year-old men developed a subacute-onset, rapidly progressive cognitive decline. After 6 months of evolution, he scored 6 on the Mini-Mental State Examination and had left hemiparesis and hemineglect. The patient died 11 months after the onset of cognitive symptoms. Brain MRI showed microhemorrhages on gradient-echo sequence and confluent areas of white matter hyperintensities on T2-weighted images. Brain biopsy revealed amyloid-b peptide deposition in vessel walls, some of them surrounded by micro-bleeds. In this case report, we discuss the role of cerebral amyloid angiopathy (CAA) in cognitive decline, due to structural lesions associated with hemorrhages and infarcts, white matter lesions and co-morbidity of Alzheimer's disease, as well as the most recently described amyloid angiopathy-related inflammation.
Hyperglycemia Associated With Targeted Oncologic Treatment: Mechanisms and Management
Authors: Goldman Jonathan W. , Mendenhall Melody A. , Rettinger Sarah R.
Published: July 2016

Molecularly targeted cancer therapy has rapidly changed the landscape of oncologic care, often improving patients’ prognosis without causing as substantial a quality-of-life decrement as cytotoxic chemotherapy does. Nevertheless, targeted agents can cause side effects that may be less familiar to medical oncologists and that require the attention and expertise of subspecialists. In this review, we focus on hyperglycemia, which can occur with use of new anticancer agents that interact with cell proliferation pathways. Key mediators of these pathways include the tyrosine kinase receptors insulin growth factor receptor 1 (IGF-1R) and epidermal growth factor receptor (EGFR), as well as intracellular signaling molecules phosphatidylinositol 3-kinase (PI3K), AKT, and mammalian target of rapamycin (mTOR). We summarize available information on hyperglycemia associated with agents that inhibit these molecules within the larger context of adverse event profiles. The highest incidence of hyperglycemia is observed with inhibition of IGF-1R or mTOR, and although the incidence is lower with PI3K, AKT, and EGFR inhibitors, hyperglycemia is still a common adverse event. Given the interrelationships between the IGF-1R and cell proliferation pathways, it is important for oncologists to understand the etiology of hyperglycemia caused by anticancer agents that target those pathways. We also discuss monitoring and management approaches for treatment-related hyperglycemia for some of these agents, with a focus on our experience during the clinical development of the EGFR inhibitor rociletinib.
Decline in Cognitive Function in Older Adults With Early-Stage Breast Cancer After Adjuvant Treatment
Authors: Lange Marie , Heutte Natacha , Rigal Olivier , Noal Sabine , Kurtz Jean-Emmanuel , Lévy Christelle , Allouache Djelila , Rieux Chantal , Lefel Johan , Clarisse Bénédicte , Veyret Corinne , Barthélémy Philippe , Longato Nadine , Castel Hélène , Eustache Francis , Giffard Bénédicte , Joly Florence
Published: July 2016

Background.

The impact of chemotherapy on cognition among elderly patients has received little attention, although such patients are more prone to presenting with age-related cognitive deficits and/or cognitive decline during chemotherapy. The present study assessed the cognitive function in older adults treated for early-stage breast cancer (EBC).

Patients and Methods.

The participants were newly diagnosed EBC patients aged ≥65 years without previous systemic treatment or neurological or psychiatric disease and matched healthy controls. They underwent two assessments: before starting adjuvant therapy and after the end of chemotherapy (including doxorubicin ± docetaxel [CT+ group], n = 58) or radiotherapy for patients who did not receive chemotherapy (CT− group, n = 61), and at the same interval for the healthy controls (n = 62). Neuropsychological and geriatric assessments were performed. Neuropsychological data were analyzed using the Reliable Change Index.

Results.

Forty-nine percent of the patients (mean age, 70 ± 4 years) had objective cognitive decline after adjuvant treatment that mainly concerned working memory. Among these patients, 64% developed a cognitive impairment after adjuvant treatment. Comorbidity was not associated with cognitive decline. No significant difference in objective cognitive decline was found between the two groups of patients; however, the CT+ group had more subjective cognitive complaints after treatment (p = .008). The oldest patients (aged 70–81 years) tended to have more objective decline with docetaxel (p = .05).

Conclusion.

This is the largest published study assessing cognitive function in older adults with EBC that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel.
Dramatic Response to Carboplatin, Paclitaxel, and Radiation in a Patient With Malignant Myoepithelioma of the Breast
Authors: Tran Phu N. , Zhuang Lefan , Nangia Chaital i , Mehta Rita S.
Published: July 2016

Malignant myoepithelioma of the breast (MMB) is extremely rare and often presents as a diagnostic challenge. This article reports on a rare case of aggressive MMB in a 52-year-old woman who experienced a dramatic response to carboplatin, paclitaxel, and radiation.
First-Line Chemotherapy for Ovarian Cancer: Inferences From Recent Studies
Authors: Rose Peter G.
Published: July 2016

This review discusses the evolution of platinum and taxane first-line chemotherapy for ovarian cancer and the most recent trials and their impact on the current standard of care.
Policing the private: Social barriers to the effective policing of domestic violence
Authors: Mogstad Heidi , Dryding Dominique , Fiorotto Olivia
Published: July 2016

Problems in policing are commonly framed as institutional failures. This is frequently the case in the policing of domestic violence, where the limited ability of police to assist abuse victims is often reported to be a consequence of a lack of resources or inadequate training for police. This paper examines the challenges and limitations of policing domestic violence from a different angle. Reflecting on key findings from a qualitative study of local perceptions of and attitudes towards domestic violence in the South African township of Khayelitsha, we highlight the strong disciplinary influence of cultural norms and beliefs in shaping victims’ reluctance to involve police in cases of abuse. While our findings clearly underscore the limits of focusing on improved policing absent cultural change, we nuance and qualify this argument by identifying important exceptions from the norm and mapping gendered and intra-gender differences in participants’ concerns.
Memories of the ‘inside’: Prison conditions in South African female correctional facilities
Authors: Abgoola Caroline
Published: July 2016

The inadequate conditions of imprisonment in South African correctional facilities are well known. Health care, sanitation, food provision, access to education and reading materials, and in particular, the overcrowding, of female prisons are considerable challenges faced by the Department of Correctional Services (DCS) regarding the incarceration of female prisoners[i]. A retrospective view of the conditions under which female inmates in South African correctional facilities are incarcerated is examined in this paper. Findings indicate that prison conditions in some South African female correctional facilities are poor: health care and sanitation facilities are largely inadequate, the quality of food is poor, little or no reading materials are made available, and recreational facilities are largely absent. These conditions impact negatively on the female prisoners during, and sometimes, after their incarceration.
Risky localities: Exploring a methodology for measuring socio-economic characteristics of high murder areas
Authors: Lancaster Lizette , Kamman Ellen
Published: July 2016

Every day on average, more than 49 people are murdered in South Africa. A better understanding of the demographics of locations with high murder and other crime rates could assist in the development of effective initiatives to effectively reduce our murder rate. It provides the foundations on which to build research into the impact of social cohesion on violence reduction. This article explores the hypothesis that the risk for murder is associated with certain demographic characteristics of particular locations. This paper proposes a method to analyse the demographic characteristics of police precincts in relation to the murder rate for that police precinct. It provides an explanation of the method used and a summary of initial results. The paper concludes with a discussion on the benefits of this research approach and considerations for future research as well as the need for more indepth analysis on social cohesion.
Do Volunteering and Charity Pay Off? Well-being Benefits of Participating in Voluntary Work and Charity for Older and Younger Adults in Finland
Authors: Tanskanen Antti Olavi , Danielsbacka Mirkka
Published: July 2016

Happiness and health are commonly used well-being indicators, and studies have shown that engaging in voluntary work and charity is associated with increased well-being. However, few studies have analysed the association between volunteering or charity and well-being using nationally representative data from two adult generations. Utilising the Generational Transmissions in Finland surveys collected in 2012, we examined whether volunteering and charity were associated with self-perceived happiness and health in older (born 1945–1950) and younger (born 1962–1993) generations. We found that older adults who engaged in voluntary work were happier than those who did not. Further, younger adults who had made donations to charity were found to be happier than those who had not. With both older and younger generations, we found no correlations between volunteering or charity and self-perceived health. Results are discussed in the light of different life course phases older and younger generations are going through.
Influence of Contextual and Organisational Factors on Combining Informal and Formal Care for Older People. Slovenian Case
Authors: Hlebec Valentina , Filipovic Hrast Masa
Published: July 2016

The need and availability of informal carers are the most important determinants of care arrangements for older people requiring care. In the present study, we focus on the role of predisposing, enabling factors as well as need in predicting the distribution of care arrangements of social home care users in Slovenia. We not only included individual factors but also community factors and, even more importantly, we addressed the organisational factors which have an effect on formal care usage. In a case study in Slovenia we showed that, apart from need for and availability of an informal care network, which were the strongest predictors of care arrangements (no care, informal care only, formal care only, mixed care) across the activities of daily living, organisational factors such as the temporal availability of social home care and the number of users were the second most important predictors of care arrangements of social home care users. The implications for the conceptual framework for studying care arrangements within national studies as well as in cross-national studies are discussed.
“We Are Not a Small Island, We Are the Ocean”. Becoming a Student in Mature Age. An Exploratory Analysis on Italy and Spain
Authors: Iñiguez Berrozpe Tatiana , Marcaletti Francesco
Published: July 2016

The complexity underlying motivations and obstacles encountered by Mature Adults (MA; people over 45 years old) in their participation in educational activities, requires a thorough analysis to determine which factors are most salient for this social group. Under the project funded by the European Commission "IMAL: Innovations in Mature Adult Learning", a study through a questionnaire (n = 1.066) was conducted. From that sample, data for two of the participating countries, Spain (ns= 106) and Italy (ni= 460), have been drawn. The aim of the paper is to make an exploratory analysis of both samples in order to determine the most important motivational factors for MA in their educational participation, through descriptive and bivariate analysis (independent sample test), and to test how the sociodemographic variables influence these factors by an analysis through logistic regression. The results show great similarities between both samples. Lower levels of education and not being in working condition were found as risk factors for not undertaking learning activities. In both samples, the weight of “internal” motivations is very relevant. This evidence leads to interpret MA learning as a process addressed towards personal enrichment, thus claiming for a more holistic and learner centered vision in adult education.
Media construction of Missing White Woman Syndrome: A cultural complex of innocence
Authors: Chattopadhyay Saurabh , Stein Sarah L. , Carlan Philip E. , Nored Lisa S.
Published: July 2016

This study assessed whether the media are influenced by the ‘cultural complex of innocence’ first proposed by psychoanalyst Carl Gustav Jung using content analysis. The cultural complex proposed is that Western society may be culturally conditioned to view blonde-haired (and possibly blue-eyed) Caucasian women as the archetypal image of innocence. In this study it was reviewed 53 missing persons’ cases of women across the United States between the years 2000 and 2009. The characteristics of the missing persons analyzed included age, race, hair color, eye color, socioeconomic status, prostitution history, drug history, history of mental illness, etc. Media related to each of the 533 cases was collected from Google News, CNN online, and MSNBC online. The articles were reviewed to determine frequency of keywords relating to the portrayal of the victim used by the three media outlets.
Age estimation in children using Demirjian’s technique: A retrospective study
Authors: Kende Prajwalit P , Khadilkar Ankeeta S , Gaikwad Rajesh P , Landage Jayant S
Published: July 2016

Age estimation is a sub discipline of forensic odontology which plays an important part in every identification process, especially when information related to the deceased is unavailable. The aim of this study was to evaluate the accuracy of Demirjian’s Dental Age Estimation technique, with the help of Ortho-Pantomo-Graphs (OPG) in 50 children. 50 OPGs of children in the age group of 6-16 years were randomly selected and a cross-sectional retrospective study was conducted. Age estimation was done by the method given by Demirjian and two tailed test of the data was carried out. A significantly high difference was observed in the estimated and chronologic ages in the age group of 13-16 years than in 6-12 years. Demirjian’s original method, using seven mandibular teeth is an accurate method of age estimation in children especially of the younger age group (6-12 years of age).
Determination of proportional relationships between maxillary intercanine distance and various facial dimensions: A cross sectional study
Authors: M. Kalambe Chitralekha
Published: July 2016

The study was conducted on 231 subjects (101 males and 130 females) ranged from 15 years to 69 years in age, with all natural upper anterior teeth present in mouth having no caries, severe attrition, erosion, fracture or restorations were selected. Intercanthal distance (ICthD), intermedialcanthal distance (IMCthD), interpupillary distance (IPD), interalar width (IAW ), inter lip commissural distance (ICmD) and maxillary Intercanine distance from tip to tip (ICD) were measured with a venire caliper with an accuracy of 0.01 mm. Obtained data was entered into Microsoft excel program and various statistical calculations and tests were applied to find out correlation between above mentioned various facial measurements and maxillary intercanine distance in male and female subjects. The statistical results of this study showed that there was positive correlation between intercanthal distance and maxillary intercanine distance in both male and female subjects. Other facial measurements showed no statistically significant correlation with maxillary intercanine distance. Suggesting that the intercanthal distance can be used as a preliminary method to determine the width of the maxillary anterior teeth while constructing complete denture in edentulous patients.
The effect of cyanide exposure to larvae weight for post mortem interval estimation
Authors: Wiraagni Idha Arfianti , Nurhantari Yudha , Umniyati Siti Rahmah
Published: July 2016

Flies are one type of insect, which decompose the organic component in animals, and human cadavers. Therefore, the insects can be used to help the investigators related to human law. One of the methods to determine Post Mortem Interval [PMI] was by identifying the insects that come in the decay process. Some chemicals can affect the development of the insect and its life cycle. Cyanide is widely used to commit murder in Indonesia. The effect of cyanide on the development and life cycle of insects is a very interesting field to study. The purpose of this study was to determine the effect of cyanide exposure to larvae weight for PMI estimation. This research was an experimental research that used larvae of Wistar rat carcass. The control group was killed by neck dislocation, while experimental group were killed by oral lethal doses of cyanide. Data were obtained from the measurement and examination of larvae, started from the 1st day until 4th day after death. Chrysomya, Sarcophaga, and Lucilia larvae were identified from this study. Sarcophaga larvae first appeared and next day followed by Chrysomya and Lucilia. There were significant differences in Chrysomya larvae weight. There were Chrysomya third instar larvae on the 4th day on cyanide group, with 56.4 ± 16.8 mg of weight. There were Chrysomya third instar larvae on the 4th day on control group, with 30.4 ± 5.5 mg of weight. The differences of larvae’s weight, among Sarcophaga and Lucilia larvae, could not be determined because there were not enough samples. Chrysomya third instar larvae of cyanide group significantly heavier than control group on 4th day. The differences of larvae weight, among Sarcophaga and Lucilia larvae, could not be determined because there were not enough samples.
Recent legal aspects of medical negligence
Authors: Bala Ripan , Chanana Ashok
Published: July 2016

In spite of following one of the best management strategies, by the competent doctors with best available infrastructures in patient care, undesired results harming the patient cannot be avoided. Does it mean all these undesired results causing damage to the patient are as a result of medical negligence? Nowadays, patients are more aware of their rights on account of increased literacy level, role of print, electronic and social media and above all enactment of new law i.e. Consumer Protection Act 1986.Though the question of medical negligence is decided by Courts, but Courts on their own are not trained in medical science. Their decision is based on expert’s opinion. Judges apply the basic principle of law in conjunction with the law of land to make a decision. Reasonableness and prudence are the guiding factors. This paper deals with the legal aspects of medical negligence i.e. what is negligence and its type and various judgements especially the Jacob Mathew vs. State of Punjab 2005 and Anr, Martin F.D’Souza vs. Mohd. Ishfaq 2009, V. Kishan Rao vs. Nikhil Super Specialty Hospital 2010 delivered by the Apex Court to make the law of negligence more rational and directions given to subordinate Courts, various Consumer Fora, State and investigating agencies regarding procedures to be followed before filing a complaint or registering a case of criminal negligence against the doctor.
Bio-medical waste- threat to environment: Management, disposal, ethical aspects and legal implications
Authors: Panzoo Qaiser Rasool , Sandhu Ravneet , Sandhu S S , Singh Pardeep
Published: July 2016

The world health organization [WHO] in 1983 discussed bio-medical waste issue. The seriousness of improper biomedical waste management was brought to the limelight during the “beach wash-ups” during summer 1998; which was investigated by the Environment Protection Agency (EPA) of the USA; and it resulted in the passing of Medical waste tracking Act (MWTA) in November 1998. This made USA the pioneer as far as waste management is concerned (1). Most important regarding the bio-medical waste is health hazards to patient and relatives, microbiological and chemical contamination of soil and ground water (2). Every human being should live in a clean environment is one of the Fundamental Rights, and is the innovative judicial interpretations of article 21 of Constitution of India. Article 48-A and 51 of the Constitution provide to protect and improve the natural environment including forests lakes, rivers and wild life. There are number of statutes like The Water Act, The Air Act, The Environment Protection Act, Hazardous Waste (management and Handling) Rules 1980. Forests Act, the Wild Life Acts and Provision of Indian Penal court, Criminal Procedure Code and Factories Act are meant for providing pollution free environment to mankind. There are many categories of institutions which pollute the environment but recently the ignored field which produce the pollution by way of Bio-Medical waste have attracted the attention of the environmentalists are the Hospitals, Dispensaries, Medical Shops, Medical clinics of doctors and other paramedical staff (3).
Letters to Editor
Authors: Sinha Dr Parul Khare
Published: July 2016

The abstract is specific, representative of the article, and in the correct form but fails to stir the inquisitiveness in readers
A retrospective study of ilizarov fixation in infected non-union tibia: 36 cases
Authors: Govindasamy Rajesh , Gnanasundaram Ramkumar , Kasirajan Saravanan , Sengani Pajani , Meleppuram Jimmy J
Published: July 2016

Background: Infected non-union of tibia is most frequently met due to high energy trauma and it poses significant challenge to the treating orthopaedic surgeon. The aim of the study is to evaluate the clinical and functional results in treating infected non-union of tibia by Ilizarov method.

Methods: 36 patients with infected non-union of tibia with bone loss; shortening and deformity treated were retrospectively analyzed in the institution during the period of May 2010 to May 2015 were included in the study. The results were evaluated according to association for the study and application of the methods of Ilizarov (ASAMI) criteria. The Pin tract infections were assessed by Moore and Dahl Grading.

Results: The bony results were excellent in 65% patients, good in 20%, fair in 15%, and poor in nil. The functional results were excellent in 50% patients, good in 25%, fair in 15%, and poor in 10%. The most common recorded complication was pin tract infection.

Conclusions: Ilizarov ring fixator still remains an excellent treatment modality for tibial non-union as it addresses to the problems associated with it.
A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures
Authors: Soylemez Mehmet Salih , Ozturan Burak , Turkmen Ismail , Erturk Selim , Akpinar Fuat , Kilic Bulent , Demiroglu Murat , Ozkan Korhan
Published: July 2016

Background: Implant choice for fixation of intertrochanteric fractures remains controversial despite being one of the most commonly performed operations. Although use of sliding hip screws is still considered a gold standard in treatment of these fractures, there is a wide tendency in using cephalomedullary nails because of their biomechanical superiority over sliding hip screws. This trial was initiated in order to compare the biomechanical properties of two different cephalomedullary nails, aPFN and the PROFIN under axial loading, based on the questions that can a single lag screw with an antirotator blade render better rotational stability? Is there a difference between one lag screw or two lag screws with respect to superior migration or cut-out of the screws? And do different nail designs cause different types of failure and what are the pros and cons of classical and new designs from the view point of biomechanical aspects?

Methods: Ten pairs of third generation synthetic bone models simulating unstable intertrochanteric fracture were used for biomechanical testing.

Results: No posterior displacement of screws was recorded in both groups suggesting rotational unstability.  There was not a significant difference between forces values loaded at the time of failure.

Conclusions: Although there was no statistically significant difference between compressive strengths at the time of failure, aPFN may provide equal rigid fixation with less possible cut-out which may have an important consequences in real clinical applications.
Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures
Authors: Mayi Shivanand C , Shah Sachin , Jidgekar Sadashiv R , Kulkarni Arunkumar
Published: July 2016

Background: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.

Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.

Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.
Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS
Cross pinning versus lateral pinning in type III supracondylar fracture: a retrospective analysis
Authors: Govindasamy Rajesh , Gnanasundaram Ramkumar , Kasirajan Saravanan , Thonikadavath Fawas , Tiwari Rajeev K.
Published: July 2016

Background: The commonly accepted treatment of type III supracondylar fractures of humerus in children is closed reduction percutaneous pinning (CRPP). There is a long debate over stability and complications associated with cross and lateral pinning. The present study compares the functional outcome and complications of both pinning techniques.

Methods: A retrospective analysis of results with regard to ulnar nerve injury, carrying angle and range of movements was made in 27 children with lateral pinning and 28 children with crossed pinning was done in our institution. Functional outcome was graded according to Flynn’s criteria and loss of reduction by Skagg’s criteria.

Results: There was no statistically significant difference with regard to functional outcome and loss of reduction between the two groups. Iatrogenic ulnar nerve injury (IUNI) occurred in three cases (11%) after crossed pinning in which two had significant palsy, which recovered by three months and the other had only  transient paraesthesia.

Conclusions: Lateral pinning technique is reliably safe method in terms of stability as it avoids IUNI, we recommend it.