Risks for Peripheral Arterial Disease in the Elderly with Type 2 Diabetes Mellitus : Their Correlation with High Sensitivity C-reactive Protein and Ankle-brachial Index

The Indonesian elderly population has been projected to increase up to about four-fold inthree decades (1990-2020). As a consequence of this population trend, the increased prevalence ofdegenerative diseases would be inevitable; this would include the prevalence of peripheral arterialdisease.This study aims to identify the correlation of diverse risk factors, either traditional or nontraditional,with the ankle-brachial index scores, and the correlation of novel non-traditional riskfactor, e.i. high sensitive C-reactive protein with the prevalence of perioheral arterial disease in theelderly, age 60-80 years old, with type 2 diabetes mellitus.Among the 146 elderly patients with type 2 diabetes mellitus, and based on measurement ofthe ABI score, approximately 30.9% of them had PAD. Some traditional and non-traditional riskfactors having a significant correlation with the ankle-brachial index score, were age (r = -0.396, p <0.001 for right ABI; r = -0.509, p < 0.001 for left ABI), supine systolic blood pressure (r= -0.268, p =0.012 for right ABI; r = -0.267, p = 0.013 for left ABI), 2-hour post-prandial blood glucose (r= -0.252, p = 0.018 for right ABI), and hsCRP (r = -0.280, p = 0.011 for right ABI; r = -0.402, p <0.001 for left ABI); whereas other risk factors like obesity based on waist circumference and BMI,non-supine systolic blood pressure, fasting blood glucose, HbA1C, duration of diabetes, plasma lipidsdid not show statistically significant different odd ratios. After linear regression test for risk factorshaving significant correlations with ABI, age and hsCRP were found to influence the ABI scores.Based on a case-control study, risk factors which, to some extent, had statistically significant valuesas risk factors, include older age (? 70 years old; OR = 7.737 [CI = 2.515-23.805]; p < 0.001),relatively high supine diastolic blood pressure (? 90 mmHg; OR = 6.882 [CI = 0.789-60.060]; p =0.048), and high concentration of hsCRP (> 3 mg/L; OR = 4.420 [CI = 1.287-15.181]; p = 0.013).Among these statistically significant risk factors, after logistic regression test analysis, only the age ofthe patient appeared to have significant influence on the prevalence of PAD.In conclusion, this study demonstrates a negative correlation between hsCRP and ABI score;and high levels of hsCRP appeared to be a risk factor for PAD. The age of the patient, however,appeared to be the strongest risk factor for PAD

Lower Ankle-Brachial Index Is Related to Worse Cognitive Performance in Old Age

Objective: We aimed to study the associations between peripheral artery disease (PAD) and ankle-brachial index (ABI) and performance in a range of cognitive domains in nondemented elderly persons. Methods: Data were collected within the Lothian Birth Cohort 1921 and 1936 studies. These are two narrow-age cohorts at age 87 (n = 170) and 73 (n = 748) years. ABI was analyzed as a dichotomous (PAD vs. no PAD) and a continuous measure. PAD was defined as having an ABI less than 0.90. Measures of nonverbal reasoning, verbal declarative memory, verbal fluency, working memory, and processing speed were administered. Both samples were screened for dementia. Results: We observed no significant differences in cognitive performance between persons with or without PAD. However, higher ABI was associated with better general cognition (β = .23, p = .02, R(2) change = .05) and processing speed (β = .29, p < .01, R(2) change = .08) in the older cohort and better processing speed (β = .12, p < .01, R(2) change = .01) in the younger cohort. This was after controlling for age, sex, and childhood mental ability and excluding persons with abnormally high ABI (>1.40) and a history of cardiovascular or cerebrovascular disease. Conclusion: Lower ABI is associated with worse cognitive performance in old age, especially in the oldest old (>85 years), possibly because of long-term exposure to atherosclerotic disease. Interventions targeting PAD in persons free of manifest cardiovascular and cerebrovascular disease may reduce the incidence of cognitive impairment and dementia

ForgetMeNot: Active Reminder Entry Support for Adults with Acquired Brain Injury

Smartphone reminding apps can compensate for memory impairment after acquired brain injury (ABI). In the absence of a caregiver, users must enter reminders themselves if the apps are going to help them. Poor memory and apathy associated with ABI can result in failure to initiate such configuration behaviour and the benefits of reminder apps are lost. ForgetMeNot takes a novel approach to address this problem by periodically encouraging the user to enter reminders with unsolicited prompts (UPs). An in situ case study investigated the experience of using a reminding app for people with ABI and tested UPs as a potential solution to initiating reminder entry. Three people with severe ABI living in a post-acute rehabilitation hospital used the app in their everyday lives for four weeks to collect real usage data. Field observations illustrated how difficulties with motivation, insight into memory difficulties and anxiety impact reminder app use in a rehabilitation setting. Results showed that when 6 UPs were presented throughout the day, reminder-setting increased, showing UPs are an important addition to reminder applications for people with ABI. This study demonstrates that barriers to technology use can be resolved in practice when software is developed with an understanding of the issues experienced by the user group

Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry

Background: Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. There is growing evidence on ABI’s use within various health care settings, although how they work and which components enhance success is largely unknown. This paper reports on the qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction following an ABI. It focuses on alcohol’s place within participants’ lives and their personal perspectives on reducing consumption. There are a number of randomised controlled trials in this field though few ABI studies have addressed the experiences of hazardous/harmful drinkers. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. Methods: This qualitative study was underpinned by a realist evaluation approach and involved semistructured interviews with ten harmful or hazardous alcohol drinkers. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). All had received ABI, a 20 min motivational counselling interview, six months previously, and had reduced their alcohol consumption. Interviews were recorded, transcribed verbatim and thematically analysed. Results: Participants described their views on alcohol, its’ place in their lives, their personal perspectives on reducing their consumption and future aspirations. Conclusions: The findings provide an insight into participants’ views on alcohol, ABI, and the barriers and enablers to change. Participants described a cost benefit analysis, with some conscious consideration of the advantages and disadvantages of reducing intake or abstaining from alcohol. Findings suggest that, whilst hospital admission can act as a catalyst, encouraging individuals to reflect on their alcohol consumption through ABI may consolidate this, turning this reflective moment into action. Sustainability may be enhanced by the presence of a ‘significant other’ who encourages and experiences benefit. In addition having a purpose or structure with activities linked to employment and/or social and leisure pursuits offers the potential to enhance and sustain reduced alcohol consumption. Trial registration: Trial registration number TRN NCT00982306 September 22nd 200

Femoral Artery Atherosclerosis Is Associated With Physical Function Across the Spectrum of the Ankle-Brachial Index: The San Diego Population Study.

BackgroundThe ankle-brachial index (ABI) is inadequate to detect early-stage atherosclerotic disease, when interventions to prevent functional decline may be the most effective. We determined associations of femoral artery atherosclerosis with physical functioning, across the spectrum of the ABI, and within the normal ABI range.Methods and resultsIn 2007-2011, 1103 multiethnic men and women participated in the San Diego Population Study, and completed all components of the summary performance score. Using Doppler ultrasound, superficial and common femoral intima media thickness and plaques were ascertained. Logistic regression was used to assess associations of femoral atherosclerosis with the summary performance score and its individual components. Models were adjusted for demographics, lifestyle factors, comorbidities, lipids, and kidney function. In adjusted models, among participants with a normal-range ABI (1.00-1.30), the highest tertile of superficial intima media thickness was associated with lower odds of a perfect summary performance score of 12 (odds ratio=0.56 [0.36, 0.87], P=0.009), and lower odds of a 4-m walk score of 4 (0.34 [0.16, 0.73], P=0.006) and chair rise score of 4 (0.56 [0.34, 0.94], P=0.03). Plaque presence (0.53 [0.29, 0.99], P=0.04) and greater total plaque burden (0.61 [0.43, 0.87], P=0.006) were associated with worse 4-m walk performance in the normal-range ABI group. Higher superficial intima media thickness was associated with lower summary performance score in all individuals (P=0.02).ConclusionsFindings suggest that use of femoral artery atherosclerosis measures may be effective in individuals with a normal-range ABI, especially, for example, those with diabetes mellitus or a family history of peripheral artery disease, when detection can lead to earlier intervention to prevent functional declines and improve quality of life

Serum Level Changes of Neurotrophin-3 After Performing Diabetic Foot Exercise in Diabetic Neuropathy

The research aimed to determine the pattern of changes in serum levels of NT-3 in the improvement of diabetic neuropathy, after doing diabetic foot exercise. A true experimental study with randomaized pre – post test control trial. A total of 36 subjects meeting the inclusion and exclusion criteria were included in the exercise group or the control one with age matched systematic random sampling method. Exercise group had a significant improvement on the score of ABI (p.0.002), systolic blood pressure (p.0.014), diastolic blood pressure (p.0.055), DNS (p.0.01), DNE (p.0.001) and increased of serum level of NT-3 (p.0.049). Control group had result respectively on ABI (p.0.131), systolic blood pressure (p.0.668), diastolic blood pressure (p.0.216), DNS (p.1.00), DNE (p.0.543), and increase of NT-3 (p.0.264). The comparation results of the two groups had a significant different on the score of ABI (p.0.01), systolic blood pressure (p.0.01), diastolic blood pressure (p.0.01), DNS (p.0.01), DNE (p.0.01), and increased of NT-3 (p.0.01). Diabetic foot exercise had a peripheral affect on a clinically significant improvement based on ABI scores, systolic and diastolic blood pressure, DNS and DNE, and increase of serum level of NT-3

Post-traumatic growth in adult survivors of brain injury: a qualitative study of participants completing a pilot trial of brief positive psychotherapy

Purpose: Post-traumatic growth (PTG) can occur following acquired brain injury (ABI). It has been proposed that people experiencing psychological distress following ABI may benefit from a positive psychotherapy intervention (PPT) aimed at increasing well-being; PPT may also influence PTG. We aimed to investigate PTG experiences in participants of a positive psychotherapy pilot trial. Methods: ABI survivors who had received PPT or treatment as usual (TAU) were interviewed individually after the end of the trial. Thematic analysis was conducted, to code transcripts for known themes from PTG literature as well as newly emerging themes. Results: Four participants (age = 46–62; n = 3 male; months since injury = 11–20) from the PPT group and three (age = 58–74; n = 2 male; months since injury = 9–22) from the TAU group were interviewed. Six themes were shared across both groups: personal strength, appreciation of life, relating to others, optimism/positive attitude, feeling fortunate compared to others, and positive emotional/behavioral changes. Two themes were expressed by PPT participants only: lifestyle improvements and new possibilities. One TAU participant reported spiritual change. Conclusions: A greater understanding of the development of PTG following ABI may help rehabilitation clinicians to promote better adjustment by focusing on clients’ potential for positive change and enhancing their capacity for growth

Educational Implications Following Idiopathic Encephalopathy and Prolonged Coma: A Longitudinal Case Study

This paper explores standard considerations of accommodations for paediatric acquired brain injury (ABI) survivors as illustrated through an intensive case study. Specifically, we explore methods by which school systems can enhance a middle school student’s learning environment after losing 30 points in his intellectual functioning (IQ) following a rare coma recovery. For the purpose of this paper, coma is defined as a period following neurological injury or illness during which an individual does not open his/her eyes and does not have sleep–wake cycles. This case emphasises the use of current behavioural evidence-based treatments in young ABI patients. Multiple comparisons are especially beneficial in delineating the strength of intervention modalities and specific challenges unique to this population. Current data are of particular interest because measures of both pre- and post-morbid functioning are available, because of earlier school testing for a pre-existing learning disability. Finally, implications for prognosis and treatment of young ABI patients are discussed