bluuebunny/crossref_metadata_2025 huggingface dataset:
Powers of a product of commutators as products of squares
Authors: Abdollahi Alireza
Published: February 2004

We prove that for any odd integer N and any integer n > 0, the Nth power of a product of n commutators in a nonabelian free group of countable infinite rank can be expressed as a product of squares of 2n + 1 elements and, for all such odd N and integers n, there are commutators for which the number 2n + 1 of squares is the minimum number such that the Nth power of its product can be written as a product of squares. This generalizes a recent result of Akhavan‐Malayeri.
Ergodic sequences of probability measures on commutative hypergroups
Authors: Pavel Liliana
Published: February 2004

We study conditions on a sequence of probability measures on a commutative hypergroup K, which ensure that, for any representation π of K on a Hilbert space ℋπ and for any ξ ∈ ℋπ, converges to a π‐invariant member of ℋπ.
Shape‐preserving multivariate polynomial approximation in C[−1,1]m
Authors: Gal Ciprian S. , Gal Sorin G.
Published: February 2004

We construct multivariate polynomials attached to a function f of m variables, m ≥ 2
, which approximate f with Jackson‐type rate involving a multivariate Ditzian‐Totik ‐modulus and preserve some natural kinds of multivariate monotonicity and convexity of function. The result extends the bivariate case in Gal (2002), but does not follow straight from it and requires a careful calculation.
New Insights into Molecular Mechanisms of Atrial Fibrillation: Are We Approaching Possible Novel Pharmacological Principles for Treating This Disorder?
Authors: Goette Andreas , Lendeckel Uwe
Published: February 2004

Atrial fibrillation (AF) is associated with significant electrophysiological, structural and molecular alterations of atrial tissue. Some of these changes (e.g. interstitial fibrosis, atrial dilation) provide a proarrhythmogenic substrate which favors the occurrence of AF, although not all of these changes are primarily induced by the arrhythmia itself. Activation of several tissue proteases seems to be of particular importance for the development of structural atrial changes. An increased activation of the atrial angiotensin II system contributes to the development of interstitial atrial fibrosis, which induces proarrhythmic alterations in atrial conduction. Thus, inhibition of the angiotensin-converting enzyme or blockage of angiotensin II receptors may offer a novel antiarrhythmic approach to prevent AF, in particular in patients with concomitant cardiovascular diseases. This review will describe the role and regulation of the atrial angiotensin II system and other molecular signal transduction systems which may have the potential to provide new pharmacological targets for the therapy of AF.
Emotional and Linguistic Perception of Prosody
Authors: Raithel Vivian , Hielscher-Fastabend Martina
Published: February 2004

The objective of the study was to find out whether there is a connection between the perception of linguistic intonation contours and emotional intonation. Twenty-four subjects were asked to identify and discriminate emotional prosody listening to subtests 8A and 8B of the Tübinger Affect Battery as well as to 36 utterances that differed in linguistic intonation contour and were first presented normally and then low-pass-filtered. The subjects were divided into an older and a younger group in order to detect a possible age effect. The results showed that the ability to recognize and identify emotional prosody did not decline with age. These results are in contrast to the linguistic intonation contours, for which performance typically declined with age. Also, the low-pass-filtered utterances are more difficult to identify if the intonation contour is not salient, as in imperatives. Finally, the results do not show a gender difference. In sum the results indicate that emotional prosody and the reception of linguistic intonation contours seem to be processed by the same or similar brain structures.
Comprehension of Emotional Information in Patients with Aphasia
Authors: Hielscher Martina
Published: February 2004

Comprehension of emotional information has traditionally been attributed to right hemispheric processing. Especially nonverbal emotional communication seems to be much better than verbal competence in aphasics. Yet evidence stressing the importance of the left hemisphere for an adequate interpretation of emotional information has been reported. This article reports data on two experiments primarily aimed at emotional inferences in text comprehension. Patients with cortical lesions in their left vs. right hemisphere showed similar deficits in perceiving both verbal and nonverbal emotion tasks. The question arises, which underlying deficits may result in these similar comprehension patterns. Best predictors in regression analyses differed for patients with left hemisphere and right hemisphere lesions.
The Influence of Hearing Impairment on Preverbal Emotional Vocalizations of Infants
Authors: Scheiner Elisabeth , Hammerschmidt Kurt , Jürgens Uwe , Zwirner Petra
Published: February 2004

The aim of the study was to compare the vocalizations of normally hearing and profoundly hearing-impaired infants in the first year of life. After the first recording all hearing-impaired infants were provided with hearing aids. We focused on three issues: (1) Are there different types of preverbal vocalizations in the vocal repertoire of normally hearing and hearing-impaired infants? (2) Do the vocal types emerge at similar age? (3) Does hearing impairment influence the acoustic structure of the preverbal vocalization types common to normally hearing and hearing-impaired infants? The study shows that both normally hearing and hearing-impaired infants have the same vocal repertoire. Except for babbling, there were no differences in the time of emergence of preverbal utterances. Structural differences could only be found in ‘cries’. In general, it seems that normal auditory input is not essential for the production of single preverbal utterances.
Differences in the Speech of 10- to 13-Year-Old Boys from Divorced and Nondivorced Families against the Background of Emotional Attachment
Authors: Böhm Birgit
Published: February 2004

In Germany, an increasing number of children live with one parent alone and have to cope with the separation or divorce of their parents. Emotional drawbacks have frequently been hypothesized for these children. Thus, we studied if such experiences are reflected in speech behavior. Twenty-eight 10- to 13-year-old boys from separated parents (physical separation of the parents was 2 years before the investigation) were compared with 26 boys from parents living together in an interview focusing on attachment-related themes and everyday situations. The interviews were analyzed with regard to coherence of speech, coping with emotional problems, reflectivity, child representation of both parents, and verbal and nonverbal expression of feelings. Boys from separated parents had incoherent speech, difficulties in coping with emotional problems, a poorer reflectivity (thinking about their own mental states and those of others), they represented neither parent supportively and did not show their feelings openly. These results can be traced back to an insecure attachment representation of the boys with separated parents.
Emotional Satisfaction of Parents and Speech-Language Therapists with Outcome of Training Intervention in Children with Speech and Language Disorders
Authors: Keilmann Annerose , Braun Ludwig , Napiontek Ulrike
Published: February 2004

The compliance of children and their parents is very important for the outcome of speech-language therapy in children. We analyzed 169 questionnaires of parents whose children had received speech-language therapy and 140 questionnaires of speech-language therapists (logopedists) concerning their satisfaction with the outcome of the intervention. Treatment was usually once weekly. We found that the majority of the parents was very satisfied with the outcome of the speech-language therapy, the professional knowledge of the speech-language therapists and the type of therapy. The speech-language therapists were in most cases pleased with the compliance of the parents. Speech-language therapists who have been working for many years tend to spend less time with parents, to consider insufficient progress as a challenge and to treat less frequently.
Voice Handicap of Laryngectomees with Tracheoesophageal Speech
Authors: Schuster Maria , Lohscheller Jörg , Hoppe Ulrich , Kummer Peter , Eysholdt Ulrich , Rosanowski Frank
Published: February 2004

The evaluation of diagnostics and therapies includes more and more subjective, i.e. emotional and social aspects. Focussing on the handicap experienced by dysphonic patients, the Voice Handicap Index (VHI) has previously been found to be of significant clinical and scientific value for different voices. In this study the VHI questionnaire was applied to demonstrate the voice handicap of 20 male laryngectomees using tracheoesophageal voice (Provox®), aged 65.5 ± 8.7 years. Their VHI was 45.5 ± 24.1, which was significantly higher than the score of patients with functional voice disorders, but differed only slightly from patients with organic laryngeal dysphonia. Focussing on individual data, VHI scores ranged from values similar to persons without voice disorder to maximum handicap of 101. Comparing the VHI scores with the laryngectomees’ gradual self-perception of voice disorder severity, no consistent relationship was found. Considering the large interindividual differences, the VHI may serve as a valuable instrument for the assessment of individual interventional needs rather than for the identification of a general laryngectomees’ handicap.
A Multifaceted View of the Concept of Amae : Reconsidering the Indigenous Japanese Concept of Relatedness
Authors: Behrens Kazuko Y.
Published: February 2004

The indigenous Japanese concept of amae has provoked interest from scholars across disciplines. Many have provided their own version of defining amae without much attempt to synthesize it into a demonstrative definition. Non-Japanese scholars have attempted to understand the concept through their own interpretations, which has often led to confusions and erroneous conclusions. The present paper analyzes the concept of amae, focusing on its everyday use with illustrative evidence to provide contextual meanings of varied amae phenomena. A multifaceted view to approach amae is introduced. The new approach proposes to consider amae in different contexts and in three developmental phases, with evidence to support that amae is, in fact, different in each category. Future amae research is discussed.
’[A]s if She Defied the World in her Joyousness’: Rereading Darwin on Emotion and Emotional Development
Authors: Conrad Rachel
Published: February 2004

Darwin’s ideas about emotion are known from his published scientific writings [e.g., Darwin, 1872/1998, 1877], which focus primarily on the evolutionary origins of emotional expressions. The present paper offers an analysis of a personal document – Darwin’s memorial of his daughter Annie, who died at age 10 [Darwin, 1989] – which reveals additional elements of Darwin’s view of emotion. Analysis of the text of the memorial indicates that Darwin did not employ rhetorical strategies conveying objectivity as outlined by Gergen [1994]. Darwin’s rhetorical decision to locate himself in the memorial as a writer and observer in relation to his daughter Annie allowed him to emphasize social functions of emotion and to delineate an implicitly relational perspective on emotion. The memorial demonstrates the value of considering the child in social encounters as the unit of analysis, showing that emotion is accorded meaning in relational contexts, integrating multiple expressive channels in emotional action, and accounting for ways that emotion helps convey the individuality of a child in her social world. Darwin’s style in the text of the memorial enabled a perspective of embodied participation that permits finely detailed observation, yet locates the observer’s point of view, and represents the relational complexity of observations even when the observer himself is involved.
New Trends in Alexithymia Research
Authors: Taylor Graeme J. , Bagby R. Michael
Published: February 2004

Research investigating the alexithymia construct is advancing rapidly and has broadened considerably in recent years as a result of interdisciplinary efforts, new methodologies, and experimental techniques. New developments in the field include a shift from measurement-based validational studies to experimental investigations, which explore the relation between alexithymia and various aspects of emotional processing; the use of functional brain imaging techniques to explore neural activity associated with alexithymia; and experimental studies that measure multiple indices of physiological response to standardized emotion-inducing stimuli. Developmental research and attachment studies are providing ways for investigating potential etiological sources of the construct; and experimental approaches are being used to explore relations between alexithymia and other health-related personality constructs. In addition, longitudinal and treatment studies are clarifying the relation between alexithymia and psychopathology and the extent to which alexithymia predicts treatment outcome. Investigators need to embrace the new methods and techniques for the field of research to further increase understanding of the alexithymia construct and its association with physical and mental illness.
Persistent Psychological Distress in Patients Treated for Endocrine Disease
Authors: Sonino Nicoletta , Navarrini Cecilia , Ruini Chiara , Ottolini Fedra , Paoletta Agostino , Fallo Francesco , Boscaro Marco , Fava Giovanni A.
Published: February 2004

Background: The purpose of the study was to assess the frequency and characteristics of psychological distress, even after adequate treatment, in the heterogeneous population of an endocrine outpatient clinic. Methods: 146 endocrine patients (31 males/115 females; age 39.4 ± 12.5 years), who were cured or in remission, were studied in a university endocrine outpatient clinic. Semistructured clinical interviews to assess psychiatric (Structured Clinical Interview for DSM-IV) and psychological (Diagnostic Criteria for Psychosomatic Research, DCPR) diagnoses were employed and were supplemented by self-rated instruments (the Psychosocial Index and the Medical Outcome Study short form General Health Survey) which could provide the patients’ perception of their own quality of life. Results: There were 118 patients (81%) who presented with at least 1 psychiatric (DSM-IV) or psychological (DCPR) diagnosis. The most frequent diagnostic findings were generalized anxiety disorder (29%), major depression (26%), irritable mood (46%), demoralization (34%) and persistent somatization (21%). By self-rated instruments, patients with at least 1 DSM-IV or DCPR diagnosis reported significantly more stressful life circumstances, psychological distress and an impaired quality of life compared to those who had none. Conclusions: A high prevalence of psychological distress may be encountered in the long-term follow-up of endocrine patients. A biopsychosocial consideration of the person and his/her quality of life appears to be mandatory for improving therapeutic effectiveness in endocrine disorders.
Alexithymia and Psychopathology in Patients with Psychiatric and Functional Gastrointestinal Disorders
Authors: Porcelli Piero , Affatati Valeria , Bellomo Antonello , De Carne Massimo , Todarello Orlando , Taylor Graeme J.
Published: February 2004

Background: Alexithymia and psychopathology may influence the way individuals experience psychological distress and somatic symptoms. This study evaluated patients referred to psychiatric and gastroenterologic outpatient settings in order to investigate the levels of alexithymia and psychopathology, and the possible role of alexithymia in symptom perception and health care utilization. The association between psychiatric disorders and functional gastrointestinal disorders (FGIDs) was also assessed. Methods: Psychopathology (by the Revised 90-item Symptom Checklist), alexithymia (by the 20-item Toronto Alexithymia Scale), and gastrointestinal symptoms (by the Gastrointestinal Symptom Rating Scale) were evaluated in 52 psychiatric outpatients and 58 medical outpatients with FGIDs. Two comorbid subgroups of 25 psychiatric patients with FGIDs and 38 FGID patients with psychiatric disorders were formed and compared. Results: Forty-eight percent of the psychiatric patients had associated FGIDs, and 65.5% of the FGID patients had associated psychiatric disorders. The FGID patients had significantly less psychopathology, but significantly higher alexithymia and more severe gastrointestinal symptoms, than the psychiatric patients. In the comparison of the two subgroups with comorbidity, FGID patients with psychiatric disorders were still more alexithymic and had less psychopathology than psychiatric patients with FGIDs, but gastrointestinal symptoms were not significantly different. Conclusion: Patients with ‘functional’ gastrointestinal symptoms attending a medical care service are likely to be highly alexithymic, whereas those attending a psychiatric care service are likely to show severe psychopathology. Alexithymia seems to influence the presentation of ‘functional’ somatic symptoms and the type of health care utilization.
Communicating with Alexithymic and Non-Alexithymic Patients: An Experimental Study of the Effect of Psychosocial Communication and Empathy on Patient Satisfaction
Authors: Graugaard Peter Kjær , Holgersen Kjersti , Finset Arnstein
Published: February 2004

Background: Previous studies have shown that alexithymia is associated with a wide range of somatic and psychiatric conditions. The aim of this study was to investigate experimentally how psychosocial communication and empathic response from the physician affects satisfaction in alexithymic and non-alexithymic patients. Method: Seven physicians and 65 female patients from a fibromyalgia patient association participated in the study. The Toronto Alexithymia Scale (TAS-20) was used to categorise patients as alexithymic or non-alexithymic. Patients also completed questionnaires regarding trait anxiety and satisfaction with their consultation. Physicians were instructed to differentiate their communication in terms of both psychosocial matters and empathic response. The content of the consultation was analysed using the Roter Interactional Analysis System. Results: Regression analyses revealed that alexithymic patients were significantly more satisfied when they received a greater empathic response from the physician. Non-alexithymic patients, however, were more satisfied when the consultation was of longer duration. Psychosocial communication did not have any statistically significant effect on satisfaction in either of the two subgroups. Conclusions: Verbalised empathic response from the physician may be crucial for the alexithymic patient’s post-consultation satisfaction and may thereby become the basis for a solid treatment alliance. The validity of this hypothesis should be tested in different clinical settings and with different patient populations. Future research on alexithymic patients’ response to psychosocial communication may benefit from determining to what extent this communication is concerned with general distress or more complex emotional phenomena.
A Prospective Study of Alexithymia in Obsessive-Compulsive Patients Treated with Multimodal Cognitive-Behavioral Therapy
Authors: Rufer Michael , Hand Iver , Braatz Anne , Alsleben Heike , Fricke Susanne , Peter Helmut
Published: February 2004

Background: Alexithymia as a predictor of treatment outcome in psychotherapy has often been discussed but rarely evaluated in prospective studies. The present study evaluated the absolute and relative stability of alexithymia in patients with obsessive-compulsive disorder (OCD), and the predictive value of alexithymia for the outcome of treatment. Methods: We conducted a prospective study with 42 inpatients receiving intensive, multimodal cognitive-behavioral therapy (CBT). Patients were assessed for alexithymia at pre- and post-treatment with the 20-item Toronto Alexithymia Scale (TAS-20), for obsessive-compulsive symptoms and depression with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the 21-item Hamilton Depression Rating Scale (HDRS). Results: OCD and comorbid depression showed a highly significant symptom-reduction from pre- to post-treatment while no absolute changes in the TAS-20 total scores and its factors 1 and 3 occurred. Only factor 2 scores decreased significantly, but with a smaller effect size than the effect sizes for the changes in Y-BOCS and HDRS. Alexithymia scores at pre-treatment correlated significantly with alexithymia scores at the end of treatment, indicating its relative stability. In the linear regression analyses, no variables were identified that predicted significantly the outcome of treatment. Conclusions: Our findings support the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon in obsessive-compulsive patients. Alexithymia scores do not predict response to multimodal CBT in OCD. It might be an effect of CBT that patients could at least partly regain or newly learn the capability to describe their feelings.
Childhood Adversities as Risk Factors for Alexithymia and Other Aspects of Affect Dysregulation in Adulthood
Authors: Kooiman Cornelis G. , van Rees Vellinga Sonja , Spinhoven Philip , Draijer Nel , Trijsburg Rutger W. , Rooijmans Harry G.M.
Published: February 2004

Background: Affect regulation is assumed to be a biologically based function that can become disrupted by inadequate parenting and by traumatic experiences. We studied the relation between the perceived parental parenting style, and sexual and physical abuse, with alexithymia, dissociation, anxiety and depression. Methods: In a cross-sectional study psychiatric outpatients were administered a structured interview on childhood physical and sexual abuse and they completed a number of questionnaires about the parenting styles of their parents, and about alexithymia, dissociation and mood pathology. Results: Maternal and paternal parenting styles were moderately correlated with alexithymia and depression. The paternal parenting style was also correlated with dissociation. Optimal parenting of one of the parents had a buffering effect on the degree of alexithymia, but not on the severity of other forms of affect dysregulation. The effect of sexual or physical abuse did not add to that of parental parenting style in terms of predicting affect dysregulation. However, a positively perceived maternal parenting style was found to have a buffering effect in terms of the degree of alexithymia, if sexual abuse had also taken place. Conclusions: Perceived parenting does appear to be of some significance in the development of alexithymia. Optimal parenting of one of the parents may protect against the development of alexithymia when the parenting of the other parent is perceived as non-optimal. However, it is likely that other factors besides parental care and sexual or physical abuse play an important role in the development of an adequate affect regulation.
Interhemispheric Transfer in Alexithymia: A Transcallosal Inhibition Study
Authors: Grabe Hans Joergen , Möller Bertram , Willert Carsten , Spitzer Carsten , Rizos Tim , Freyberger Harald Juergen
Published: February 2004

Objective: This study investigates the hypothesis that alexithymia is associated with an interhemispheric transfer deficit via the corpus callosum (CC). Method: The transcallosal inhibition paradigm was used to assess interhemispheric transfer. Transcranial magnetic stimulation (TMS) and peripheral electromyographic recordings were performed in 10 right-handed male and 10 female students with Toronto Alexithymia Scale (TAS-20) scores of ≧61 and controls (TAS-20 scores of <61). The transcallosal conduction time (TCT) reflects the TMS-induced inhibitory cortical activity that is mediated via the CC. Results: There was a significant interaction between gender and alexithymia (Wilks λ = 0.89; F = 3.4; d.f. = 2, 57; p = 0.04) indicating that alexithymic males had shorter bidirectional TCTs than controls and a significantly shorter left to right TCT than controls (p = 0.002). However, the left to right TCT was not significantly different from the right to left TCT in alexithymic males (p = 0.39). Alexithymic females were not different from controls. Conclusion: Our results clearly stand in contrast to the hypothesis of a transfer deficit due to a dysfunction of the CC in alexithymia. Facilitated, bidirectional transcallosal inhibition of the contralateral motor activity is associated with alexithymia in males. Facilitated cortical inhibition may be a neurobiological correlate of alexithymia.
Strategies for the Laboratory Diagnosis of Some Common Causes of Anaemia in Elderly Patients
Authors: Joosten Etienne
Published: February 2004

Anaemia is a common medical problem in elderly patients and is associated with an increased mortality and morbidity risk and a reduced quality of life. It is not known at which exact haemoglobin level investigations should be initiated in order to optimize the diagnostic efficacy. Serum ferritin determination remains the most accurate laboratory test for the diagnosis of iron deficiency anaemia and its differential diagnosis with the anaemia of chronic disease. The introduction of the metabolites methylmalonic acid and homocysteine has made it possible to diagnose vitamin B12 and folate deficiencies at an early subclinical stage, even without neurological and haematological symptoms, but the clinical importance of this ‘biochemical’ diagnosis is unclear. Other causes of anaemia, such as myelodysplastic syndromes and chronic renal insufficiency, will become more and more common in the elderly because of the ageing of the population. Although erythropoietin analysis has no clear diagnostic value at the moment, it has become more and more obvious that its therapeutic importance in elderly patients with chronic anaemia is increasing. A substantial number of patients have an unexplained anaemia. Whether this is disease related, or may be attributed to an age-related anaemia, is still a matter of debate, but it is advisable to perform an extensive laboratory, cytogenetic, and morphological investigation before one should assess the anaemia as unexplained.
Accumulation of 8-Oxo-2’-Deoxyguanosine (as a Biomarker of Oxidative DNA Damage) in the Tissues of Aged Hamsters and Change in Antioxidant Enzyme Activities after Single Administration of N-Nitrosobis(2-Oxopropyl) Amine
Authors: Takabayashi Fumiyo , Tahara Shoichi , Kaneko Takao , Miyoshi Yoshihiko , Harada Noboru
Published: February 2004

Background: It has been reported that DNA oxidative damage accumulates with age. Two reasons for this phenomenon are the decline in the antioxidant system and the decline in the repair system. It is not clear which of these is the main reason. Objective: To study whether the decline in antioxidant enzyme activities causes the accumulation of DNA oxidative damage, an experimental study was performed with hamsters. Methods: Seventy-four female Syrian golden hamsters were divided into 2 groups: a young group (28 hamsters), and an aged group (46 hamsters). The hamsters in the aged group were kept in our laboratory until they were 18 months old. The levels of 8-oxo-2′-deoxyguanosine (8-oxodG) and the activities of antioxidant enzymes, i.e. catalase, superoxide dismutase (SOD), and glutathione peroxidase (GPx), were measured in both groups. Furthermore, the same parameters were measured in the pancreas and liver following administration of N-nitrosobis(2-oxopropyl)amine (BOP), an inducer of oxidative stress in the hamster pancreas. Results: In the mid brain, cerebellum, lung, heart, spleen and kidney, the 8-oxodG contents in aged hamsters were significantly higher than those in young hamsters. GPx activity decreased with age in the lung, liver and kidney, whereas SOD activity increased in the lung and liver but decreased in the kidney of aged animals. Catalase activity increased in the cerebrum, heart, pancreas and kidney but decreased in the lung and spleen of aged hamsters. When the pancreatic levels of 8-oxodG and antioxidant enzymes were measured after BOP administration, there was no clear-cut relation between the changes in those levels. Conclusions: From these results the increase in 8-oxodG contents in aged hamsters does not seem to be related to the antioxidant system but rather to a possible decline in the repair system against oxidative damage.
Biological Age and 12-Year Cognitive Change in Older Adults: Findings from the Victoria Longitudinal Study
Authors: MacDonald Stuart W.S. , Dixon Roger A. , Cohen Anna-Lisa , Hazlitt Janine E.
Published: February 2004

Background: Although recent cross-sectional findings indicate that markers of biological age (BA) mediate chronological age (CA) differences in cognitive performance, little is known about their influence on actual cognitive changes. Objective: The purpose of this investigation is to examine CA and BA as predictors of 12-year cognitive change in a longitudinal sample of older adults. Methods: Data from the Victoria Longitudinal Study (VLS) were examined for 125 adults between 67 and 95 years of age. Biomarkers, including visual and auditory acuity, grip strength, peak expiratory flow, blood pressure, and body mass index, were submitted to a factor analysis and a composite BA variable was computed based on factor loadings. Intraindividual change across 5 waves of measurement (3-year intervals) was examined as a function of CA and BA for 5 cognitive domains: verbal processing speed, working memory, reasoning, episodic memory, and semantic memory. Results: The latent structure of biomarkers was consistent with previous investigations of functional age and a common factor view of biological aging. Results of hierarchical linear modeling showed that BA predicted actual cognitive change (decline) independent of CA. Conclusions: As a predictor of cognitive performance in late life, CA is a proxy for biological and environmental influences. We have shown that biological influences are independent predictors of actual cognitive change in older adults. This supports the view that cognitive decline is not due to aging per se, but rather is likely due to causal factors that operate along the age continuum.
Health-Related Quality of Life in Patients over Sixty Years Old with Benign Paroxysmal Positional Vertigo
Authors: Gámiz Maria J. , Lopez-Escamez Jose A.
Published: February 2004

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness within the geriatric population causing disability. The diagnosis is established by the position-induced rotatory nystagmus, related to the involved ear, demonstrated by the Dix-Hallpike test (DHT). Although the Epley’s modified manoeuvre, or particle respositioning manoeuvre (PRM), is an effective treatment for this disorder, its impact on health outcome in patients over 60 years old is unknown. Objective: To assess BPPV health-related quality of life in elderly individuals using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S). Methods: A prospective study including new cases of BPPV in patients older than 60 years was carried out. The diagnosis was based on the history of recurrent sudden crises of vertigo and a typical positional-induced nystagmus during the DHT. All patients were treated by a single PRM and relapses were investigated a the 30th post-treatment day. Results: DHT was found negative in 82% (23/28) individuals at 30 days. The eight scales of the SF-36 have a good internal consistency reliability in patients with BPPV (Cronbach’s α > 0.7). The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for role physical, body pain, social function, role emotional and mental health. After PRM, patients restored scores to norms, showing a significant increase in role physical (p < 0.05), body pain (p < 0.04), vitality (p < 0.02), social function (p < 0.003) and mental health scores (p < 0.005). DHI-S total score significantly decreased from 17.19 ± 9.06 (mean ± SD) at the first day to 9.70 ± 10.13 at 30 days (p < 0.001). Conclusions: BPPV has a significant impact on health-related quality of life in elderly patients on their emotional and physical states compared to those unaffected. The PRM can restore health-related quality of life in elderly patients with BPPV.
Changes in Postural Balance in Frail Elderly Women during a 4-Week Visual Feedback Training: A Randomized Controlled Trial
Authors: Sihvonen Sanna E. , Sipilä Sarianna , Era Pertti A.
Published: February 2004

Background: Balance training programs have not shown consistent results among older adults, and it remains unclear how different training methods can be adapted to frail elderly people. Objective: The purpose of this study was to investigate the effects of a 4-week visual feedback-based balance training on the postural control of frail elderly women living in residential care homes. Methods: Elderly women of two residential care facilities were randomized to an exercise group (EG, n = 20) and to a control group (CG, n = 7). The EG participated in training sessions three times/week for 4 weeks. The exercises were carried out with a computerized force platform with visual feedback screen. The dimensions of balance function studied were standing body sway, dynamic weight shifting, and Berg Balance Scale performance. Results: The EG showed significant improvement in balance functions. The performance time in dynamic balance tests improved on average by 35.9% compared with a 0.6% increase in the CG (p = 0.025–0.193). The performance distance in these tests decreased on average by 28.2% in the EG as compared with a 9.8% decrease seen in the CG. The Berg Balance Scale performance improved by 6.9% compared with a 0.7% increase in the CG (p = 0.003). The standing balance tests in the more demanding standing positions showed improvements in the EG, whereas similar changes in the CG were not found. Conclusions: Our findings suggest that balance training based on visual feedback improves the balance control in frail elderly women living in residential care, also enhancing the performance of functional balancing tasks relevant to daily living. The subjects were motivated to participate in the training, as indicated by the high compliance (97.5%) with the program.
Prevalence of Remediable Disability due to Low Vision among Institutionalised Elderly People
Authors: de Winter Leandra J.M. , Hoyng Carel B. , Froeling Paul G.A.M. , Meulendijks Carina F.M. , van der Wilt Gert J.
Published: February 2004

Background: Prevalence of remediable visual disability among institutionalised elderly people, resulting from inappropriate use or non-use of low-vision aids, is reported to be high, but largely rests on anecdotal evidence. Objective: To estimate the prevalence of binocular low vision and underlying eye diseases among institutionalised elderly people in a Dutch urban population and the size of remediable visual disability as the result of inappropriately corrected low vision. Methods: The design was a cross-sectional survey of 284 subjects with low vision (corrected binocular vision <0.4) in nursing homes and homes for the elderly in the Netherlands. Results: 284 of 610 eligible residents were examined. The prevalence of binocular low vision was 31.3%. Among elderly residents with low vision, prevalence of cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy was 77.9, 37.7, 5.2 and 5.2%, respectively. In 32 residents (41.6%), (non)-use of low-vision aids was considered inappropriate. In 50 residents (64.9%), visual disability was considered at least partially remediable, either through better use of low-vision aids, or through cataract extraction. Residents who were not optimally corrected for low vision were significantly more functionally impaired compared with their peers who were optimally corrected. Conclusion: Low vision is likely to be highly prevalent among institutionalised elderly. A significant amount of the associated visual disability may be remediable.
Predictors of Early Neurological Deterioration after Ischaemic Stroke: A Case-Control Study
Authors: Barber Mark , Wright Fiona , Stott David J. , Langhorne Peter
Published: February 2004

Background: Early neurological deterioration after ischaemic stroke (stroke in progression) is reported to be common and associated with poor outcome or death. The causes of progressing stroke are, however, uncertain. Objective: To determine whether prior drug treatment (with anticoagulant or antiplatelet agents) or early adverse physiological features (pyrexia, hypoxia, dehydration or hyperglycaemia) are associated with progressing ischaemic stroke. Methods: The study used a case-control design. From a database of 873 consecutive acute stroke admissions, 196 cases of progressing ischaemic stroke (defined by point deterioration in components of the Scandinavian Stroke Scale or death over the first 72 h after hospital admission) were matched to 196 controls on the basis of age and stroke type. Univariate and conditional logistic regression techniques were used to explore predictors of progressing stroke. Results: Cases and controls were well matched for baseline stroke severity. Warfarin use prior to admission was associated with a reduced risk of progressing stroke [odds ratio (OR) 0.10, p = 0.005]. Prior antiplatelet use was not related. A previous history of diabetes (OR 2.11, p = 0.039) and elevated systolic blood pressure on admission (OR 1.01 for each 1 mm Hg rise, p = 0.017) predicted progressing stroke. Although there were no differences in time to presentation or to brain imaging, a visible causative lesion on CT scanning was more common in the progressing stroke group (OR 2.30, p = 0.022). We found no evidence that adverse physiological features were associated with progressing stroke. Outcomes were worse in the progressing stroke group with 70% being dead or dependent by 30 days compared to 55% in the control group (p = 0.002). Conclusion: Prior warfarin use may be protective against progressing ischaemic stroke. A previous history of diabetes along with elevated admission systolic blood pressure predict deterioration. We found no evidence for an association between adverse physiological features and progressing stroke.
Effects of Dementia on Mortality in the Radiation Effects Research Foundation Adult Health Study
Authors: Yamada Michiko , Kasagi Fumiyoshi , Sasaki Hideo , Mimori Yasuyo , Suzuki Gen
Published: February 2004

Background: Although dementia is rarely listed on death certificates, it does contribute to mortality. The predominant immediate causes of death coincident with dementia are pneumonia and cardiovascular diseases. Objective: To estimate the impact of dementia on specific mortality risks. Methods: We applied DSM-III/R criteria for Alzheimer’s disease (AD) and vascular dementia (VaD) to 2,172 subjects of the Adult Health Study of the Radiation Effects Research Foundation who were 60 or more years old when examined from 1992 to 1996. The underlying causes of death were compiled from death certificates. We performed a Poisson regression analysis to evaluate specific causes of mortality for which AD or VaD was a significant risk factor. Results: The relative risk of mortality was 2.2 for AD and 2.4 for VaD. Mortality from pneumonia and stroke was elevated for both types of dementia, independent of other medical conditions. AD was also associated with death from trauma. Conclusion: Dementia was a predictor of death due to pneumonia, stroke, and trauma among the Japanese elderly. The prevention and early detection of those conditions are important in the medical care and treatment of dementia cases.
Nursing Homes for the Old (‘Gerocomeia’) in Byzantium (324–1453 AD)
Authors: Lascaratos J. , Kalantzis G. , Poulakou-Rebelakou E.
Published: February 2004

Background: Research into the welfare institutions for the elderly, which were established in the Byzantine Empire. Objective: The purpose of the study is the research into the texts of the Byzantine chroniclers and the contemporary historical sources so as to determine the social policy of the Byzantine State regarding the homes for the aged. Methods: The histories and chronicles of the Byzantine writers, written in the original Greek language, were studied and analysed, so as to locate the extracts in the texts concerning the interest shown by the Byzantine State to establish institutions for old and ailing people. Results: The care for the elderly in Byzantium was undertaken in special infirmaries, called ‘gerocomeia’, which operated all over the empire mostly in or near the monasteries. All these nursing homes were highly esteemed and the governor of the institution seems to have been a person of high importance. The most important nursing home was located in Constantinople and was established by Emperor John II Comnenus in the 12th century in the famous monastery and hospital of the Pantocrator. Conclusion: The study and analysis of the historical texts of the Byzantine period (324–1453 AD) prove that human-oriented behaviour, which derived from the intervention of religion, contributed to the foundation of many welfare institutions for the elderly by the Byzantine emperors, the church and some individuals who showed great interest in them.
Diagnostic Imaging of Diffuse Infiltrative Disease of the Lung
Authors: Zompatori Maurizio , Bnà Claudio , Poletti Venerino , Spaggiari Enrica , Ormitti Francesca , Calabrò Elisa , Tognini Giuseppe , Sverzellati Nicola
Published: February 2004

Plain chest radiography remains the first diagnostic approach to diffuse infiltrative lung disease but has limited diagnostic sensitivity and specificity. Many diseases remain occult or are not correctly assessed using chest X-ray, appearing as a nonspecific ‘reticulonodular pattern’. High-resolution CT (HRCT) is actually the recommended imaging technique in the diagnosis, assessment, and follow-up of these diseases, allowing also the evaluation of the effectiveness of the medical therapy and the selection of the type and the location of the biopsy when required. Appropriate techniques must be used to acquire high-quality HRCT scans, with the thin collimation and high spatial reconstruction algorithm being the most important factors. A nodular pattern, linear and reticular opacities, cystic lesions, ground-glass opacities and consolidations are the most common HRCT patterns of diffuse infiltrative lung disease. This article reviews the role of chest radiography and HRCT in the diagnosis and assessment of these diseases, the technical aspects of HRCT, its clinical indications and the radiological pattern of the most common types of chronic diffuse infiltrative lung disease.
Interleukin-6 and Tumor Necrosis Factor-α in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome
Authors: Imagawa S. , Yamaguchi Y. , Ogawa K. , Obara N. , Suzuki N. , Yamamoto M. , Nagasawa T.
Published: February 2004

Background: In previous studies, significantly elevated levels of vascular endothelial growth factor (VEGF) have been reported in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS). On the other hand, plasma tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) have been significantly higher in mild sleep apneics than in normal controls. However, this study included a small number of patients and milder cases of OSAHS. Objectives andMethods: To assess the involvement of IL-6 and TNF-α in VEGF increases in patients with severe OSAHS, serum levels of IL-6 and TNF-α were determined in patients with severe OSAHS (n = 110) and compared to those of controls (n = 45) using an enzyme-linked immunosorbent assay. Results: No significant increase in IL-6 or TNF-α was detected in the present study cohort. However, the body mass index was significantly correlated with the severity of the apnea-hypopnea index. Conclusions: These data suggest that the elevation in VEGF is not directly related to IL-6 or TNF-α levels. However, the question of whether VEGF is the cause or the result of OSAHS remains to be determined. Further studies are needed to clarify the role of IL-6 and TNF-α in the pathogenesis of OSAHS, in which obesity should be entered as an independent factor.
Clinical Validity of Negative Helical Computed Tomography for Clinical Suspicion of Pulmonary Embolism
Authors: Friera Alfonsa , Olivera María José , Suárez Carmen , Ruiz-Giménez Nuria , Caballero Paloma
Published: February 2004

Background: Helical computed tomography has been introduced for the diagnosis of pulmonary embolism. Objective: To determine the clinical safety of withholding anticoagulant treatment in patients with suspicion of pulmonary embolism and negative helical computed tomography study. Methods: During a 9-month period, we performed a prospective study including 209 consecutive patients who underwent helical computed tomography for clinical suspicion of pulmonary embolism. In 53 patients (25.5%), helical computed tomography was diagnostic for pulmonary embolism, and in 24 patients (11.5%) it was indeterminate. In 132 patients (63%), the examination was negative for pulmonary embolism and no anticoagulation treatment was given. A clinical 3-month follow-up was carried out. During this period, 29 patients (22%) were excluded because anticoagulation therapy was initiated for other reasons, or because other diagnostic techniques were performed for pulmonary embolism. Four patients were lost in the 3-month period. In the end, 99 patients (75%) were included in the clinical follow-up. Results: Out of the 99 patients, 9 (9%) died during the 9-month follow-up, the cause of death in each case was not due to thromboembolic venous disease. No venous thromboembolic events were detected in the other 90 patients. Negative predictive value of helical computed tomography for pulmonary embolism was 99.09% (95% CI, 95.03–99.97%). Conclusions: In patients with clinical suspicion of pulmonary embolism and initial negative helical computed tomography from whom anticoagulants are withheld, no thromboembolic disease was detected in a 3-month follow-up. We consider helical computed tomography an effective method for ruling out pulmonary embolism as well as a front-line tool for diagnosis.
Montelukast Treatment Does Not Affect Peripheral Blood Neutrophil Functions in Asthma Patients
Authors: Levy R. , Avnun L. , Shimonovitz F. , Konforty A. , Heimer D.
Published: February 2004

Background: Leukotriene receptor antagonists have become an integral part of asthma treatment as an add-on therapy for patients with moderate disease activity. Objective: To determine whether in vivo treatment with montelukast, a leukotriene receptor antagonist, at the recommended therapeutic dose affects neutrophil functions which are essential for host defense. Methods: Twenty nonsmoking patients between the ages of 18 and 70 with moderate asthma were recruited to the study. All of them were receiving inhaled corticosteroids for at least 6 months and β2-agonist as needed. After the 2-week run-in period, in addition to the regular medication, each patient was treated with 10 mg of montelukast for a 6-week period. Pulmonary function test was performed and blood was tested for neutrophil activity twice during the run-in period and twice during the treatment period. Each assay was performed in parallel to a matched control. Results: The 6-week treatment period with montelukast did not significantly affect neutrophil chemotaxis or phagocytosis nor the elevated superoxide production. However, at 2 weeks of treatment some of the patients showed a reduction in neutrophil function. Conclusions: The study demonstrated that the recommended dose of montelukast has no significant effect on peripheral blood neutrophil activities, indicating that montelukast treatment does not induce an inflammatory process and does not interfere with the first line of host defense.