Lower Levels Of Impairment Research Articles

Temporal patterns in the stability, persistence and condition of stream macroinvertebrate communities: relationships with catchment land‐use and regional climate

Summary1. A spatially‐extensive data set of stream macroinvertebrate communities from 49 northern New Zealand sites sampled over a 10‐year period was analysed to assess relationships between the environment (catchment land‐cover, landscape position and regional‐scale weather patterns), and (i) community persistence and stability based on the constancy of species occurrence (presence–absence) and abundance (per cent composition), respectively and (ii) the temporal variability of various community condition metrics.2. No significant relationship was evident between community stability or persistence within sites and a gradient of increasing land‐use stress (LUS) based on types of upstream land‐cover, with interannual mean similarities at all sites falling within the standard deviations recorded at long‐term reference sites. In contrast, condition metrics were inversely related to LUS. Land‐use appeared to be a key factor influencing community composition among sites whereas climate influenced stability and persistence within sites.3. Three response trajectories of community variability to increasing LUS were distinguished based on the coefficient of variation of mean interannual similarities, such that (i) persistence and stability appeared to be more variable at developed sites with low LUS and at sites with high stress relative to the variability experienced naturally, but similar to the natural range at intermediate levels of stress (‘sinusoidal response’); (ii) variability in Ephemeroptera, Plecoptera and Trichoptera metrics increased at low‐to‐moderate stress and then accelerated rapidly at highly developed sites (‘stepped‐exponential response’) and (iii) variability in a pollution tolerance metric increased rapidly and then maintained a similar level of variability along the remaining stress gradient (‘plateau response’).4. The results of this study have implications for biomonitoring approaches that assume high temporal persistence and stability of communities to define site impairment. Misclassifications caused by interannual variability could lead to misinterpretation of site condition, if conclusions are based on single annual surveys. Temporal variability in stability and persistence may help distinguish low levels of impairment where a predominantly healthy fauna experiences increased environmental fluctuations.

Somatization in the population: from mild bodily misperceptions to disabling symptoms

This study investigates the prevalence of current somatization in the population by taking different levels of symptom severity into account. Somatization is described along a continuum from mild and negligible bodily misperceptions to severe and disabling somatoform symptoms. A representative sample of 2.552 persons in Germany was examined with a screening instrument for medically unexplained physical complaints that had occurred during the past 7 days. All 53 symptoms from the ICD-10/DSM-IV sections of somatoform disorders were included. 81.6% reported at least one symptom causing at least mild impairment and 22.1% at least one symptom causing severe impairment. The entire sample had an average of 6.6 symptoms associated with at least mild distress. Somatization of any degree was associated with female gender, age above 45, lower educational level, lower household income and rural area. The most common symptoms with prevalence rates > 20% were various types of pain (back, head, joints, extremities), food intolerance, sexual indifference, painful menstruations and erectile/ejaculatory dysfunction. This population survey demonstrates that medically unclear complaints are an everyday phenomenon. About three out of four cases are below clinical relevance with only low level of impairment. Epidemiological correlates are similar between clinical and non-clinical forms of somatization.

Factors Predicting the Efficacy of Botulinum Toxin-A Treatment of the Lower Limb in Children With Cerebral Palsy

Botulinum toxin A is widely used for spasticity management in children with cerebral palsy, although outcomes are unpredictable. The aim of this study was to identify criteria for selecting patients most likely to benefit from botulinum toxin A treatment. Fifty-five subjects, aged 2.5 to 18 years, were recruited. The assessment covered measures of spasticity (Modified Ashworth Scale), function (using the Gross Motor Function Measure and the Physician's Rating Scale), selective motor control, static range of motion at the ankle with knee extended and flexed, range of motion of the knee flexors, central and peripheral vision, and cognitive ability. Outcomes at 3 months were compared with baseline values. All of the scales showed significant differences between pre- and postinjection values. Significantly increased Gross Motor Function Measure scores were found in children aged 48 months or under and in those able to walk with support. Greater improvements in selective motor control and Physician's Rating Scale were seen in those with a less severe pattern of paralysis, lower levels of impairment, the ability to walk (with or without support), normal visual acuity, and normal or borderline cognition. We identified factors that mark out patients as most likely to achieve functional gains: young age, hemiplegia or diplegia, slight to moderate disability, walking with support, normal or borderline cognition, and normal or borderline visual acuity.

Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment.

This study examined the relationships of measures of cognitive functioning and psychiatric symptoms with work outcomes and use of vocational services for clients with schizophrenia in a supported employment program. Thirty clients who were newly enrolled in a supported employment program were evaluated with cognitive and symptom measures at program entry and two years later. The clients' amounts of competitive work, wages earned, on-job support, and contact with employment specialists during the two-year follow-up period were documented. Predictors of clients' work outcomes included previous work history, amount of government entitlement income received, severity of negative symptoms, involvement in sheltered work activity at baseline, and level of cognitive functioning, including scores on measures of executive functioning and verbal learning and memory. The amounts of on-job support and contact with employment specialists were predicted by the cognitive domains of executive functioning, verbal learning, attention, and psychomotor speed as well as by the severity of psychotic symptoms. Clients with schizophrenia who have higher levels of cognitive impairment may require greater amounts of vocational support than those with lower levels of impairment. A variety of rehabilitation strategies may be required to improve vocational outcomes and reduce the amount of supported employment services needed by clients with schizophrenia.

Fusidic and helvolic acid inhibition of elongation factor 2 from the archaeon Sulfolobus solfataricus.

Fusidic acid (FA) and helvolic acid (HA) belong to a small family of naturally occurring steroidal antibiotics known as fusidanes. FA was studied for its ability to alter the biochemical properties supported by elongation factor 2 isolated from the archaeon Sulfolobus solfataricus (SsEF-2). Both poly(Phe) synthesis and ribosome-dependent GTPase (GTPase(r)) were progressively impaired by increasing concentrations of FA up to 1 mM, whereas no effect was measured in the intrinsic GTPase of SsEF-2 triggered by ethylene glycol in the presence of barium chloride (GTPase(g)). The highest antibiotic concentration caused inhibition of either poly(Phe) synthesis or GTPase(r) only slightly above 50%. A greater response of SsEF-2 was observed when HA was used instead of FA. HA caused even a weak impairment of GTPase(g). A mutated form of SsEF-2 carrying the L452R substitution exhibited an increased sensitivity to fusidane inhibition in either poly(Phe) synthesis or GTPase(r). Furthermore, both FA and HA were able to cause impairment of GTPase(g). The antibiotic concentrations leading to 50% inhibition (IC(50)) indicate that increased fusidane responsiveness due to the use of HA or the L452R amino acid replacement is mutually independent. However, their combined effect decreased the IC(50) up to 0.1 mM. Despite the difficulties in reaching complete inhibition of the translocation process in S. solfataricus, these findings suggest that fusidane sensibility is partially maintained in the archaeon S. solfataricus. Therefore, it is likely that SsEF-2 harbors the structural requirements for forming complexes with fusidane antibiotics. This hypothesis is further evidenced by the observed low level of impairment of GTPase(g), a finding suggesting a weak direct interaction between the archaeal factor and fusidanes even in the absence of the ribosome. However, the ribosome remains essential for the sensitivity of SsEF-2 toward fusidane antibiotics.

Demographic, Clinical, and Functional Characteristics of Youth Enrolled in Six California Systems of Care

We describe the demographic, functional, and clinical status of children served across six California counties implementing a longstanding integrated system of care approach called the California System of Care Model. The children enrolled in the care systems are an ethnically diverse group of predominantly pre-adolescent and adolescent males. The level of functional impairment and degree of symptomatology is high. Seventy to 80% of the youth were in the clinical or borderline clinical ranges as measured by the Child Behavior Checklist. Scores on the Child and Adolescent Functional Assessment Scale, provided by the treating clinician, indicated that up to 94% of the youth were in the moderate to severe levels of impairment. Children and adolescents rated themselves on the Youth Self Report as having lower levels of impairment than did parents. Caregivers and youth ratings emphasized externalizing rather than internalizing problems. Clinician ratings as captured by the CAFAS and the clinical diagnoses, presented a mix between internalizing and externalizing diagnoses and functional impairment areas. The six counties are serving children who have levels of impairment, similar to, or higher than, youth enrolled in other systems of care nationwide.

Carers of people aged over 50 with physical impairment, memory loss and dementia: a comparative study

While studies investigating factors associated with carer burden suggest that intellectual impairment and behavioural disturbance in the care recipient are more demanding for the carer than physical impairment, comparative research findings are equivocal. Family carers of people with a long-term illness or disability were identified through a survey of 26,000 households in Victoria, Australia. Focusing on carers of those aged over 50 years, three subsamples were selected: 186 carers of relatives with physical impairment only, 182 carers of those with diagnosed memory loss and 117 carers of those with intellectual impairment diagnosed as dementia. Carers of physically impaired relatives reported better health, greater life satisfaction, and less overload, negative affect, family conflict, anger and resentment than carers of those with intellectual impairment, whether labelled as dementia or not. Despite lower impairment levels in the care recipient, carers of those with undiagnosed memory loss reported more resentment about their caring role than carers of those with a diagnosed dementia. The effects on the carer of significantly greater impairment in the dementia care recipient group may be ameliorated by having a diagnosis, bringing with it the potential for increased understanding and tolerance. Fortunately, negative feelings predictive of a sense of burden are subject to a range of interventions: providing information to promote understanding; counselling to tackle negative feelings and family conflict; guidelines to deal with behaviour problems and physical aspects of caring; and community services to reduce overload.

Time Delayed and Low-impairment Fluid-loss Control using a Succinoglycan Biopolymer with an Internal Acid Breaker

Abstract The formation damage that results from the incomplete back-production of viscous, fluid-loss control pills can be minimised if a slow acting internal breaker is employed. In particular, core-flow tests have indicated that combining a succinoglycan-based pill with a hydrochloric acid internal breaker enables a fluid-loss system with sustained control followed by delayed breakback and creates only low levels of impairment To describe the delayed breaking of the succinoglycan/hydrochloric acid system, a model, based on bond breaking rate, has been used. With this model, it is possible to predict the change of the rheological properties of the polymer as a function of time for various formation temperatures, transition temperatures of the succinoglycan and acid concentrations. Hence, the model can be used to identify optimum formulations of succinoglycan and acid breaker on the basis of field requirements, such as the time interval over which fluid-loss control is needed, the overbalance a pill should be able to withstand and the brine density required.

An empirical evaluation of multidimensional clinical outcome in chronic low back pain patients

Individuals with persisting pain often present a constellation of symptoms that includes pain, health-related impairment and dysphoric mood. It is now widely accepted that comprehensive assessment must address each of these dimensions. Despite recognition of the value of multidimensional assessment, no empirical efforts have validated the construct of a multidimensional clinical outcome presentation based on the dimensions of pain, impairment and dysphoric mood. We employed cluster analytic procedures on standard measures of pain, impairment and depression in chronic low back pain (CLBP) patients (n = 96) attending a general orthopedic clinic in order to empirically characterize multidimensional clinical outcomes. Results indicated that 3 groups could be identified reliably: 1. (1) ‘Chronic Pain Syndrome’ (n = 25; high levels of pain, impairment and depression), 2. (2) ‘Positive Adaptation to Pain’ (n = 24; high levels of pain with low levels of impairment and depression) 3. (3) ‘Good Pain Control’ (n = 47; low levels of pain, impairment and depression). The reliability of this cluster solution was supported by several tests of internal consistency. Discriminability of the clusters was examined across both the outcome measures themselves and several additional independent variables. The cluster solution was then crossvalidated in an independent sample of pain clinic CLBP patients (n = 180) to test its generalizability. Finally the stability of the cluster dimensions over time was tested by re-assessing 36 CLBP patients 6 months after they initially were characterized into 1 of the 3 outcome groups on the same measures. MANOVA results indicated that the outcome groups were differentiated statistically across assessments. The multiple outcome measures did not change significantly across time, nor did the outcome groups change differentially across time on these measures. We conclude that the outcome dimensions of pain, impairment and depression are relatively stable phenomena that differentially describe CLBP patients.

Death Certificate Reporting of Confirmed Airways Obstructive Disease

Death certificate reporting of chronic airways disease was examined during 13 years of follow-up in the Tucson Epidemiologic Study of Airways Obstructive Disease. The Tucson study population is a geographically clustered stratified random sample of white, non-Mexican-American households in Tucson, Arizona. The initial survey was performed in 1972-1973. Using clinical and physiologic criteria from nine surveys to define airways obstructive disease in the population, the authors compared death certificate reporting with these criteria as the underlying cause and as reported anywhere on the death certificate. Reporting was related to the degree of antemortem airways obstruction. Sex differences in reporting were also noted. Females showed greater rates of reporting at low levels of impairment while males showed greater reporting at high levels of impairment. When airways obstructive disease was not the underlying cause of death, the type of underlying cause was found to affect reporting of airways obstructive disease on the death certificate.

Psychological side effects of breast cancer screening.

Evaluated the impact of receiving abnormal mammogram results on women's anxiety and breast cancer worries and on their breast self-examination (BSE) frequency and intentions to obtain subsequent mammograms. A telephone survey was conducted with 308 women 50 years old and older approximately 3 months following a screening mammogram. Subjects included women with suspicious abnormal mammograms, nonsuspicious abnormal mammograms, and normal mammograms. Women with suspicious abnormal mammograms exhibited significantly elevated levels of mammography-related anxiety and breast cancer worries that interfered with their moods and functioning, despite the fact that diagnostic work-ups had ruled out breast cancer. Women with moderate levels of impairment in mood or functioning were more likely to practice monthly BSE than women with either high or low levels of impairment. Breast cancer worries, perceived susceptibility to breast cancer, and physician encouragement to get mammograms all exhibited independent positive relationships to mammogram intentions.

Psychological side effects of breast cancer screening.

Evaluated the impact of receiving abnormal mammogram results on women's anxiety and breast cancer worries and on their breast self-examination (BSE) frequency and intentions to obtain subsequent mammograms. A telephone survey was conducted with 308 women 50 years old and older approximately 3 months following a screening mammogram. Subjects included women with suspicious abnormal mammograms, nonsuspicious abnormal mammograms, and normal mammograms. Women with suspicious abnormal mammograms exhibited significantly elevated levels of mammography-related anxiety and breast cancer worries that interfered with their moods and functioning, despite the fact that diagnostic work-ups had ruled out breast cancer. Women with moderate levels of impairment in mood or functioning were more likely to practice monthly BSE than women with either high or low levels of impairment. Breast cancer worries, perceived susceptibility to breast cancer, and physician encouragement to get mammograms all exhibited independent positive relationships to mammogram intentions.

ALCOHOLIC MMPI SUBTYPES

The present study was designed, first, to attempt to replicate the previously derived Goldstein and Linden Minnesota Multiphasic Personality Inventory alcoholic personality subtypes, and second, to relate these personality patterns to a multidimensional measure of alcohol usage. Two of the previously obtained profile types were replicated through two independent cluster analytic procedures. These subtypes were defined as psychopathic and neurotic-depressive, respectively. Higher levels of drinking-related impairment were associated with anxiety and depression, while lower levels of impairment were related to psychopathic features among patients hospitalized primarily for alcoholism. However, relatively heterogeneous, distinctive configurations of reported drinking benefits, styles, and consequences were found across the Goldstein-Linden subtypes. Methodological factors potentially contributing to the failure to replicate two of the previously derived subtypes were discussed. The potential therapeutic utility of a multivariate classification of personality functioning and the use of a multidimensional assessment of alcohol usage within alcoholic populations was also discussed.