Service-based Study Research Articles

Peningkatan Sikap dan Praktik tentang Pertolongan Pertama pada Kecelakaan Lalu Lintas pada First Person on Scene

First person on Scene or lay people around the scene can help provide first aid to accident victims. However, the general public around the accident did not provide assistance to accident victims. From these problems, a solution is needed by providing appropriate information regarding first aid in first person on scene accidents, so that the severity of injury can be prevented and further reduce the mortality rate caused by traffic accident. We designed community service-based study to increase first person on scene in Malang through increasing the knowledge of the first person on scene about managing the first aid in road traffic accident. The method applied in this activity is training with pre-test and the first post-test about first aid. The data were analyzed by descriptive analysis, and a paired t-test was performed to test the pre-test and post-test data. The total participants who participated in this activity were 40 people. The results showed that there was an increase in attitude and practice about first aid in traffic accident. The training, discussion, and distribution of pocketbooks can increase the attitude and practice about first aid in traffic accident of the first person on scene in Polowijen Village.

Prevalence and incidence of oromandibular dystonia: an oral and maxillofacial surgery service-based study.

Oromandibular dystonia is a focal dystonia characterized by sustained or intermittent contractions of the masticatory and/or tongue muscles. This epidemiological study aimed to estimate the prevalence and incidence of oromandibular dystonia in Kyoto (population: 1,465,701). The population sample was citizens of Kyoto who visited our department between 2015 and 2019 and were differentially diagnosed by an oromandibular dystonia specialist having idiopathic (primary) and acquired (secondary) oromandibular dystonia. A total of 144 patients (100 women and 44 men; mean age, 57.5 years) were analyzed for clinical features, and the prevalence (prevalence date, January 1, 2020) and annual incidence were estimated. The male-to-female ratio was 1:2.3 (p<0.001). Age at onset was significantly (p<0.01) earlier in men (47.5 years) than that in women (56.9 years). The crude prevalence of oromandibular dystonia was estimated at 9.8 per 100,000 persons (95% confidence interval: 8.3-11.6) (idiopathic dystonia, 5.7 [4.6-7.1]; tardive dystonia, 3.4 [2.5-4.5]) and incidence at 2.0 (1.3-2.8) per 100,000 person-years (idiopathic dystonia, 1.2 [0.68-1.9], tardive dystonia, 0.68 [0.32-1.3]). The prevalence was 13.0 (10.5-15.8) in women and 6.3 (4.6-8.5) in men. All age groups showed female predominance. The highest prevalence was 23.6 (14.4-36.5) in women aged 60-69 years. As this is an oral and maxillofacial surgery service-based study, the actual prevalence of oromandibular dystonia may be even higher. It was suggested that oromandibular dystonia might be more common than cervical dystonia or blepharospasm.

Profiling planning skills and cognitive flexibility of adults with autism spectrum disorders: Preliminary results from an exploratory service-based study

Background: Executive functions (EF) impairments have long been observed in children and youths with autism spectrum disorders (ASD). Until very recently, little attention has been paid to examine EF profiles of adults with ASD. Given the importance of EF to cope with the demands of daily life and participate in society (e.g. maintaining an employment), this study reports on a preliminary investigation aimed at exploring planning skills and cognitive flexibility in a sample of adults with ASD and without intellectual disability. A secondary aim was to explore the contribution of both intellectual functioning and socio-demographic variables on efficiency of EF. Method: Twenty-nine autistic adults (age range 18-50) were assessed using the Tower of London (ToL) test and the Wisconsin Card Sorting Test (WCST). Intellectual functioning was assessed with the Wechsler Adult Intelligence Scale - IV. Results: From the evaluations emerged poor performances in sub-processes related to planning skills as assessed by ToL (number of Moves, Correct Reponses, and Execution time). In contrast, WCST performance did not result impaired in any of the indicators considered. Exploratory analyses revealed a strong relationship between the time needed to complete the planning tasks and visuo-spatial reasoning. Further, strong inverse associations were found between global intellectual functioning and chronological age in the WCST. Conclusions: The results of this study highlight mixed EF profiles in a sample of adults with ASD. Future investigations may build on the results of the present study to understand whether evaluating planning abilities of adults with ASD by means of measures that do not require a time-limit would yield different results compared to time-constrained assessment procedures.

Association and Familial Coaggregation of Idiopathic Dystonia With Psychiatric Outcomes.

Psychiatric comorbidities are common and major determinants of quality of life in idiopathic dystonia. Their prevalence estimates from service-based studies are heterogeneous. We explored the association between idiopathic dystonia and depressive disorders, anxiety disorders, suicide attempts, and death by suicide using Swedish population-based registers. Diagnoses of idiopathic dystonia and psychiatric outcomes from inpatient and outpatient specialist services (1997-2013) were collected from the National Patient Register and the Cause of Death Register. Familial associations were explored using the Multi-Generation Register. Adjusted logistic regression analyses measured associations with psychiatric disorders in individuals with dystonia compared with general population individuals and their unaffected siblings, as well as in full siblings of individuals with dystonia compared with full siblings of unaffected individuals. Individuals with dystonia were more likely than those without to have a diagnosis of depressive disorder (adjusted odds ratio = 2.00, 95% confidence interval: 1.77-2.26), anxiety disorder (adjusted odds ratio = 2.13, 95% confidence interval: 1.90-2.39), and suicide attempts/death by suicide combined (adjusted odds ratio = 1.80, 95% confidence interval: 1.50-2.17), with odds higher in most idiopathic dystonia forms. In the full sibling comparison, estimates followed the same pattern, with overall attenuated magnitude. Full siblings of individuals with dystonia had higher likelihood of depressive or anxiety disorders and suicide attempts/death by suicide combined compared with siblings of individuals without dystonia. Different forms of idiopathic dystonia confirm its association with increased risk for depressive and anxiety disorders and suicide attempts. Familial coaggregation of dystonia and these psychiatric comorbidities supports shared genetic and extragenetic factors. © 2020 International Parkinson and Movement Disorder Society.

Increasing knowledge about nutrition and health in the elderly and cadres in Banguntapan Village, Bantul

Increase the number of elderly is one of the social problems that require the attention of all involved parties. Health care efforts are now aimed at keeping the elderly healthy, active, independent, and productive socially and economically for themselves, their families and the community. Elderly is an age group where a person has experienced various decreases in body functions that can affect appetite, which ultimately leads to malnutrition. We designed community service-based study to increase the elderly health in the Banguntapan Village through increasing the awareness of the elderly about managing their health, the knowledge and skill to take care elderly of the families who have elderly on their care in Banguntapan Village. The method applied in this activity is counseling with pre-test and the first post-test and distribution pocket of about nutrition and elderly health. To be able to measure the retained knowledge after the activities, we also carried out the second post-test four weeks after the first meeting. The data were analyzed by descriptive analysis, and a paired t-test was performed to test the pre-test and post-test data. The total participants who participated in this activity were 144 people consisting of all cadres in Banguntapan Village, plus the elderly and families who have elderly in Karangbendo Hamlet. This research showed that there was an increase in knowledge about health and nutrition between the 1st pretest-posttest; between the 1st post-test and 2nd post-test; and between the second pretest and posttest (11.14; 14.86; 28.03)%. The counseling, discussion, and distribution of pocketbooks can increase the knowledge of the elderly, family and volunteer in Banguntapan and Karang Bendo Village.

Long-term treatment of blepharospasm with botulinum toxin A: a service-based study over a 16-year follow-up in southern China.

To elucidate the effect of long-term treatment with botulinum toxin A (BTX-A) for blepharospasm. Prevalence data and clinical features in southern China and influencing factors for selecting BTX-A treatment were explored. We collected data retrospectively from 338 consecutive patients diagnosed with blepharospasm over 16 years to assess prevalence data and clinical features. Thereafter, all patients were classified into BTX-A (n = 135) or non-BTX-A (n = 203) treatment groups according to the patients' requests in order to explore the factors influencing whether BTX-A treatment was chosen. Furthermore, dynamic follow-up data were analyzed to evaluate the long-term efficacy in the BTX-A group. The prevalence was 23.3 per million, with an onset age of 50.3 ± 12.3 years and a female:male ratio of 2.4:1; the most common symptom was excessive blinking (91.2%). The symptom severity and psychological assessment scores were significantly decreased by treatment with BTX-A (p < 0.01), and there was no significant difference in response duration with the prolongation of BTX-A injections. Adverse events occurred 52 times (5.0%) among 1038 injections. The symptom severity and psychological assessment scores and the occurrence of eye-opening difficulty were higher, and medical expenses and the symptom tolerability rate were lower in the BTX-A group than in the non-BTX-A group (p < 0.05). The onset age was earlier than that in Western countries. However, starting BTX-A treatment early is justified, even though a higher dosage was needed to maintain reliable long-term efficacy. Additionally, symptom severity and medical expenses are the primary factors affecting whether patients select BTX-A treatment.

LIMPRINT Study: The Turkish Experience.

Background: Lymphedema and chronic edema is a major health care problem in both developed and nondeveloped countries The Lymphoedema Impact and Prevelance - International (LIMPRINT) study is an international health service-based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF).Methods and Results: A total of 1051 patients from eight centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools that assess the demographic and clinical properties as well as disability and quality of life (QoL). Most of the Turkish patients were recruited from specialist lymphedema services and were found to be women, housewives, and having secondary lymphedema because of cancer treatment. The duration of lymphedema was commonly <5 years and most of them had International Society of Lymphology (ISL) grade 2 lymphedema. Cellulitis, infection, and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to lymphedema centers, nevertheless access seemed difficult because of distance and cost.Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment, as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis, and treatment in Turkey that utilize this informative data.

Predictors of Successful Learning in Multilingual Older Adults Acquiring a Majority Language

Understanding language learning in later life can elucidate how linguistic experiences and age-specific cognitive skills can be leveraged for language acquisition, providing insight into how lifelong experiences configure our learning capacity. In this study, we examined to what extent acquisition and maintenance of a non-native language (English) is scaffolded by cognitive skills and previous linguistic experiences in older adults; and to what extent these cognitive/linguistic factors predict older learners’ success in acquiring novel functional language. We recruited 53 participants who were native speakers of Mandarin, Spanish, Tagalog and Somali, had continued to learn English as adults, and were currently exposed to majority-English contexts. To identify contributors to participants’ English skills, we administered a language history and self-reported proficiency interview, brief cognitive testing, and verbal fluency tasks in L1 and English. We found that digit span and orientation measures were cognitive predictors of English proficiency, while similarity of known languages to English, L1 skills, and English language exposure were linguistic predictors of English skills. To examine participants’ ability to maintain language knowledge and to learn new functional English, we also conducted a preliminary longitudinal service-based study in a subset of 19 participants using our Specific-Purpose English Communication System for Seniors (SPECSS) curriculum. In this subset of SPECSS learners, we identified digit span and orientation, but not age, as cognitive predictors of short-term language maintenance and new language learning success. Further, better novel English learning as a result of our curriculum was observed in learners whose other known languages were less similar to English. Findings inform best practices in developing language curricula for older adults, and help generate new hypotheses on preparedness for language learning across the adult lifespan with a possible interaction between cognitive skills and transfer of knowledge from previous languages in multilingual older learners.

Prevalence of progressive supranuclear palsy in Yonago: change throughout a decade.

BackgroundProgressive supranuclear palsy (PSP) is a neurodegenerative disorder that is sometimes confused with Parkinson's disease, multiple system atrophy, and other disorders. The typical clinical features are categorized as Richardson's syndrome (RS), but other clinical subtypes include PSP‐parkinsonism (PSP‐P) and PSP‐pure akinesia with gait freezing (PSP‐PAGF). In this study, we determined the prevalence of PSP in a Japanese rural area compared to our previous 1999 report.MethodsWe collected data in Yonago City from 2009 to 2014 using a service‐based study of PSP. We collected case history data from PSP patients in the area from our hospital. The crude prevalence and 95% confidence interval (CI) were calculated using the population demographics on the prevalence day of 1 October 2010. Age‐ and sex‐adjusted prevalence was calculated by direct standardization to the population demographics in Yonago City on the prevalence day of 1 April 1999.Material and ResultsWe identified 25 patients: 16 with probable RS, 4 with possible RS, 3 with clinical PSP‐P, and 2 with clinical PSP‐PAGF. The prevalence per 100,000 was 17.90 (male = 18.05; female = 17.76). The prevalence of PSP in Yonago in 2010 increased compared to the measurements from 1999.ConclusionThe prevalence of PSP in Japan increased from 1999 to 2010.

Symptomatic Atherosclerotic Disease and Decreased Risk of Cancer-Specific Mortality

The few studies that have assessed the association between symptomatic atherosclerotic disease and risk of cancer have had conflicting results. In addition, these studies ascertained participants either from treatment settings (ie, service-based studies) or by using a records linkage system (ie, medical records of patients evaluated at clinics or hospitals) and, therefore, were prone to selection bias. Our purpose was to estimate the risk of cancer mortality in a large population-based sample of elderly people, comparing participants with symptomatic atherosclerotic disease (atherosclerotic stroke and coronary disease) to their counterparts without symptomatic atherosclerotic disease (ie, controls) in the same population.In this population-based, prospective study (Neurological Disorders of Central Spain, NEDICES), 5262 elderly community-dwelling participants with and without symptomatic atherosclerotic disease were identified and followed for a median of 12.1 years, after which the death certificates of those who died were reviewed.A total of 2701 (53.3%) of 5262 participants died, including 314 (68.6%) of 458 participants with symptomatic atherosclerotic disease and 2387 (49.7%) of 4804 controls. Cancer mortality was reported significantly less often in those with symptomatic atherosclerotic disease (15.6%) than in controls (25.6%) (P < 0.001). In an unadjusted Cox model, risk of cancer-specific mortality was decreased in participants with symptomatic atherosclerotic disease (HR = 0.74, 95% confidence interval [CI], 0.55−0.98, P = 0.04) vs. those without symptomatic atherosclerotic disease (reference group). In an adjusted Cox model, HR = 0.58; 95% CI, 0.38−0.89; P = 0.01.This population-based, prospective study suggests that there is an inverse association between symptomatic atherosclerotic disease and risk of cancer mortality.

A Service-Based Evaluation of a Therapist-Supported Online Cognitive Behavioral Therapy Program for Depression

BackgroundEvidence suggests that Internet-delivered cognitive behavioral therapy (CBT) may be as effective as face-to-face delivery for depression, but attrition and engagement rates remain a challenge.ObjectiveThis service-based study aimed to evaluate an online, therapist-supported, CBT-based program for depression. The program was specifically designed to address engagement issues, most notably by integrating online therapist support and communication within the platform.MethodsParticipants were 80 adults who were registered university students. Participants used the modular online program over 8 weeks, supported by a therapist. Engagement information was gathered automatically by the online system, and analyzed for all participants. Severity of participants’ self-reported symptoms of depression were assessed preintervention and postintervention using the Beck Depression Inventory-II (BDI-II). Postintervention measures were completed by 53 participants.ResultsA high level of engagement was observed compared to a previous study within the same service, along with extensive use of a range of program features. A statistically significant (P<.001) decrease in self-reported depressive symptomatology from preintervention (mean BDI-II 25.47) to postintervention (mean BDI-II 15.53) with a large effect size (d=1.17) was also observed.ConclusionsThe results indicate the potential of unintrusive and easily provided online support to enhance engagement with online interventions. The system described in the paper also illustrates how such online support can be tightly integrated with interactive online programs by using a range of design strategies intended to improve the user experience.

The prevalence of primary dystonia: A systematic review and meta‐analysis

Dystonia is a hyperkinetic movement disorder characterized by sustained muscle contractions that produce repetitive movements and abnormal postures. Specific information on the prevalence of dystonia has been difficult to establish because the existing epidemiological studies of the condition have adopted different methodologies for case ascertainment, resulting in widely differing reported prevalence. Medline and Embase databases were searched using terms specific to dystonia for studies of incidence, prevalence, and epidemiology. All population-based studies reporting an incidence and/or prevalence of primary dystonia were included. Sixteen original studies were included in our systematic review. Fifteen studies reported the prevalence of dystonia, including 12 service-based and three population-based studies. We performed a meta-analysis on the results of the service-based studies, and were able to combine data on the prevalence of several dystonia subtypes. From these studies, we calculated an overall prevalence of primary dystonia of 16.43 per 100,000 (95% confidence interval [CI]: 12.09-22.32). The prevalence of dystonia reported in the three population-based studies appears higher than that reported in the service-based studies. Only 1 of the 16 studies reported an incidence of cervical dystonia. This corresponded to a corrected incidence estimate of 1.07 per 100,000 person-years (95% CI: 0.86-1.32). Despite numerous studies on the epidemiology of dystonia, attempting to determine an accurate prevalence of the condition for health services planning remains a significant challenge. Given the methodological limitations of the existing studies, our own prevalence estimate of primary dystonia likely underestimates the true prevalence of the condition.

Dementia and the impact on carers

‘You’re as sick as they are but you’re not getting the support they are.’Exploring the views of relatives and carers in relation to the design of a carer support group offered by an older-adult inpatient ward.This mixed-methods service-based study aimed to explore the views of relatives and carers in relation to the design of a support group offered by an organic mental health older adult inpatient ward.

Prevalence and diagnostic challenge of dystonia in Thailand: A service-based study in a tertiary university referral centre

Although the subspeciality of movement disorders was established in neurology more than 20 years ago, it is relatively new in Thailand, and while most physicians are generally aware of Parkinson’s disease, they often are not familiar with dystonia. As one of the common movement disorders seen in general practice, a number of family and population studies have suggested that as many as two-thirds of patients with dystonia may be underdiagnosed and it is likely that misdiagnosis occurs frequently. Moreover, there is little information on the prevalence of dystonia in Thailand. The purpose of this study was to determine the prevalence and clinical profile of dystonia among Thai patients who came from the southern part of Bangkok, which is in the catchment area of Chulalongkorn University Hospital. In addition, the diagnostic accuracy of dystonia among referred patients was assessed. The medical records of 207 patients were reviewed and it was determined that a large proportion of them (71.9%) had focal dystonia with cervical dystonia being the most common form. Primary dystonia (68.1%) accounted for the majority of the cases. The prevalence of all forms of dystonia, primary dystonia and focal dystonia was 19.9, 13.6 and 14.3 per 100 000 persons, respectively. The diagnostic accuracy of dystonia among referred patients was 85.5%. The most common misdiagnosis was cervical spondylosis, followed by myofascial pain syndrome. Most patients had an average disease duration of 4 years before dystonia was finally diagnosed. Most patients with focal dystonia responded well to botulinum toxin therapy, with 13.3% suffering only mild transient adverse events. In spite of the limitations of this study, this data will initiate a process of increasing both patient and professional awareness of dystonia in Thailand.

Prevalence of Primary Focal or Segmental Dystonia in Adults in the District of Foggia, Southern Italy: A Service-Based Study

Background: Primary focal or segmental dystonia is a rare clinical condition including early-onset dystonia, which has the tendency to generalize, and late-onset dystonia, which may be focal or segmental. The prevalence of late-onset dystonia ranges from 30 to 7,320 cases per million, but no data are available in Italy. Methods: A service-based study was conducted in the period 1 January 2001 through 31 December 2002 in the administrative district of Foggia, southern Italy (population 541,653). Cases were traced through hospital discharge diagnosis, botulinum toxin services, day hospital access, ear, nose and throat, ophthalmology and orthopedic surgery specialists, and territorial outpatient services. Inclusion criteria were age 17 years or older, residency in the study area and a diagnosis of primary focal/segmental dystonia. Results: A total of 69 patients were included, giving a crude prevalence of 127.4 per 1,000,000 (women: 146.4; men: 107.0; age 18–34 years: 39.2; 35–54 years: 98.7; 55–74 years: 273.6; 75+ years: 163.3). The standardized rate was 137.5 (95% confidence interval 107.0–174.6). Blepharospasm was the commonest clinical condition (prevalence 68.2), followed by cervical dystonia (prevalence 44.8). Conclusion: The prevalence of primary focal or segmental dystonia in Italy is in keeping with several other reports, but is lower than in studies performed in northern Europe, Minnesota, USA, and Japan. The difference in our results may be mostly explained by misdiagnosis, underascertainment of cases and a fairly limited observation period.

Changes in Prevalence and Incidence of Parkinson’s Disease in Japan during a Quarter of a Century

Background/Aim: To determine the prevalence and incidence of Parkinson’s disease (PD) and compare them with results from our previous studies. Methods: We examined epidemiological characteristics of PD patients using a service-based study in Yonago City, and a door-to-door study in Daisen Town. The prevalence days were April 1, 2004 in Yonago, and April 1, 2003 in Daisen. Results: In Yonago, we identified 254 PD patients. The crude prevalence was 180.3 (95% CI, 158.1–202.4) per 100,000 population. The adjusted prevalence was 145.8 (95% CI, 145.2–146.5) in 1980, 147.0 (95% CI, 146.3–147.6) in 1992, and 166.8 (95% CI, 166.1–167.5) in 2004, when calculated using the Japanese population in 2004. The crude incidence was 18.4 (95% CI, 11.3–25.5) per 100,000 population per year. The crude incidence in 1980 was 10.2 (95% CI, 4.6–15.8), and the adjusted incidence was 9.8 (95% CI, 4.3–15.3) in 1992, and 10.3 (95% CI, 4.7–15.9) in 2004, when calculated using the population in Yonago in 1980. In Daisen, there were 21 PD patients. The crude prevalence was 306.6 (95% CI, 175.7–437.6) and the adjusted prevalence was 192.6 (95% CI, 191.9–193.8). Conclusions: The prevalence of PD had increased, primarily because the population had aged. Differences in prevalence between these adjacent areas may have resulted from differences in the methods of investigation.

Can a home-based pelvic examination be used in assessing reproductive morbidity in population-based studies? A Jordanian experience.

Most estimates of reproductive morbidity in a community are derived from health service-based studies. However, these numbers do not reflect the actual magnitude of the problem because of barriers to health care and differences in health-seeking behaviour. As a result, this study uses an alternative method to measure reproductive morbidities amongst women in a Jordanian community. To assess the validity of a home-based pelvic examination in detecting signs of reproductive morbidity when compared with a clinic-based examination. Descriptive study in which women were randomly selected from the study area to participate in the study. Three hundred and seventy nine women, 18 years and above were randomly selected, and general and pelvic examinations were conducted in each woman's home. Thirty-two of these women were again randomly selected and consented to a second pelvic examination in a clinical setting. Two trained female obstetricians conducted the pelvic examination which included examination of the vulva, examination of the vagina and a bimanual examination. Outcome measures. Strength of association between the presence or absence of physical signs of reproductive morbidity detected by the home-based pelvic examination and the same signs identified by the clinic-based examination, deemed in this study as the 'truth'. The overall sensitivity, specificity, positive and negative predictive values of the home-based pelvic examination were 66, 86, 69 and 84%, respectively. The sample size was small, so further studies are recommended to replicate the findings here. Results suggest home-based pelvic examinations can be used in population-based studies for a comprehensive assessment of women's reproductive morbidities.

How familial is familial tremor? The genetic epidemiology of essential tremor.

Essential tremor (ET) is commonly assumed to be partly genetic. This is due to a seemingly excess aggregation within certain families. There are many families containing more than one member with ET, and some large kindreds with multiple affected individuals. Despite this, the proportion of ET cases with affected family members is not known. Estimates vary from 17 to 100%. Additionally, none of the published studies employed control subjects. Therefore, it is unknown to what extent ET aggregates within families beyond that expected by chance, and the importance of genetic susceptibility in the etiology of ET at the population level has not been established. Additionally, whether or not some clinical subtypes of ET are more likely than others to be influenced by genetic susceptibility is unclear. Some studies suggest that early-onset ET may be familial, although increased awareness and earlier recognition of symptoms is an issue. Although many data support the view that ET susceptibility is inherited in an autosomal dominant manner, most studies are kindreds or service-based studies that might favor selection of families with apparent autosomal dominant modes of inheritance. One community-based study suggested an autosomal dominant mode of inheritance, but this has not been confirmed in studies of more heterogeneous populations. Further understanding of the extent of familial aggregation, extent of genetic heterogeneity, and mode of inheritance is essential for clinical counseling and for further research aimed at localizing and identifying susceptibility genes.