Age and gender differences in seven tests of functional mobility

BACKGROUND: The objective of this study was to examine age and gender differences in seven tests of functional mobility. METHODS: The study included 50 young participants aged 20 to 39 years, and 684 older participants aged 75 to 98 years. Functional mobility measures included the coordinated stability test, the near tandem balance test, the six metre walk test, the sit to stand test with five repetitions, the alternate step test and the stair ascent and descent tests. RESULTS: Older participants performed significantly worse than the younger participants in all of the functional mobility tests (p < 0.001), with the older women performing worse than the older men in all of the tests (p < 0.05). Significant correlations were found within the older group among all the functional mobility tests scores (r = 0.24–0.87, p < 0.001), and between functional mobility performance and age (r = 0.14–0.35, p < 0.001). People with arthritis and stroke performed worse than people without these conditions in these tests. CONCLUSION: This study provides a normative database for performance of young and older community-dwelling people in a battery of validated and reliable functional mobility tests. The results confirm age-related differences in functional mobility between young and older adults

Variation in Individual Responses to Time-Restricted Feeding and Resistance Training

Time-restricted feeding (TRF) is a form of intermittent fasting which limits all caloric intake to a certain period of time each day in an attempt to reduce daily energy intake, promote weight loss, and improve health. Resistance training (RT) has been reported to increase muscular strength and improve body composition. Very limited information is available on the combination of TRF and RT. The purpose of this study was to examine the variation in individual body composition, dietary intake, and muscular performance responses to an 8-wk TRF and RT program. Healthy males (n = 20; age = 22 ± 3 y; BMI = 27 ± 6 kg/m2; % fat = 22 ± 6 % wt) were randomized to TRF + RT or RT alone for 8 wks. RT was performed 3 dys/wk and consisted of alternate workouts of upper and lower body using a resistance progression scheme. TRF limited energy intake to a 4-hr period on the 4 dys/wk when RT was not performed. Energy intake was not restricted in either group, and eating times were not specified in the RT alone group. Body composition, muscular performance, and dietary records were assessed at 0, 4, and 8 wks. Inter- and intra-individual variations in outcome measures were estimated by hierarchical linear growth modeling. The amount of variability attributable to characteristics between or within participants was evaluated from variance estimates. For TRF + RT, percent changes ranged from -5.5 to +2.6% for body weight, -22.1 to +9.4% for fat mass, -7.7 to +4.6% for lean body mass, +3.4 to +30.4% for bench press 1-RM, and +10.1 to +67.6% for leg press 1-RM. For RT alone, percent changes ranged from -6.6 to +2.1% for body weight, -14.4 to +12.6% for fat mass, -4.1 to +3.9% for lean body mass, +4.9 to +12.9% for bench press 1-RM, and +14.3 to +37.7% for leg press 1-RM. Percentages of total variability attributed to inter-individual factors ranged from 3.3 to 49.2% for dietary measures, 59.0 to 93.9% for muscular performance, and 97.0 to 99.6% for body composition. Remaining variability was attributed to intra-individual factors. Individual responses to the study interventions varied widely. Differences between individuals were an important source of variability, indicating participant samples should be homogenous and/or quite large to examine changes in body composition or muscular performance using nutrition and exercise interventions

Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician.</p> <p>Methods/design</p> <p>The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline) including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700). The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1) physicians and patients' decisional conflict; 2) the agreement between the parties' decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration.</p> <p>Discussion</p> <p>DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="NCT01116076">NCT01116076</a></p

Feasibility of a randomised trial of a continuing medical education program in shared decision-making on the use of antibiotics for acute respiratory infections in primary care: the DECISION+ pilot trial

Abstract Background The misuse and limited effectiveness of antibiotics for acute respiratory infections (ARIs) are well documented, and current approaches targeting physicians or patients to improve appropriate use have had limited effect. Shared decision-making could be a promising strategy to improve appropriate antibiotic use for ARIs, but very little is known about its implementation processes and outcomes in clinical settings. In this matter, pilot studies have played a key role in health science research over the past years in providing information for the planning, justification, and/or refinement of larger studies. The objective of our study was to assess the feasibility and acceptability of the study design, procedures, and intervention of the DECISION+ program, a continuing medical education program in shared decision-making among family physicians and their patients on the optimal use of antibiotics for treating ARIs in primary care. Methods A pilot clustered randomised trial was conducted. Family medicine groups (FMGs) were randomly assigned, to either the DECISION+ program, which included three 3-hour workshops over a four- to six-month period, or a control group that had a delayed exposure to the program. Results Among 21 FMGs contacted, 5 (24%) agreed to participate in the pilot study. A total of 39 family physicians (18 in the two experimental and 21 in the three control FMGs) and their 544 patients consulting for an ARI were recruited. The proportion of recruited family physicians who participated in all three workshops was 46% (50% for the experimental group and 43% for the control group), and the overall mean level of satisfaction regarding the workshops was 94%. Conclusions This trial, while aiming to demonstrate the feasibility and acceptability of conducting a larger study, has identified important opportunities for improving the design of a definitive trial. This pilot trial is informative for researchers and clinicians interested in designing and/or conducting studies with FMGs regarding training of physicians in shared decision-making. Trial Registration Clinicaltrials.Gov NCT0035431

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Information system access cadastral register - history, present, possibililty

Crossing a road safely is a complex task requiring good sensorimotor function and integration of information about traffic speed, distances and one's own speed. Poor judgement through age-related sensorimotor or cognitive impairment or a predisposition to take risks could lead to errors with serious consequences. On a simulated road, 85 participants (age ≥70 years) were asked to cross in front of an approaching car with a clearance as small as considered safe in two conditions; (1) with nothing else to attend to (free crossing) and (2) with an additional ball-gathering task while waiting to cross (task crossing). Participants were categorised according to their crossing outcome (failed to cross, 'hit', exact, safe, cautious). Participants also performed two sub-studies; (1) the perception of the time-to-arrival of moving objects and (2) the perception of own gait speed. Physical and cognitive function and everyday risk-taking behaviour were also assessed. In free crossing, clearances varied but no participants were "hit" by the car. In task crossing, participants allowed smaller clearances and 10% of participants would have been hit while 13% missed the opportunity to cross altogether. Across a wide range of physical and cognitive measures, including perceived and actual gait speed, a consistent pattern was observed in the task crossing condition. The exact group performed best, the 'hit', safe and cautious groups performed less well while those who missed the opportunity (fail) performed worst. The exact group reported taking the greatest risks in everyday life whereas the remaining groups reported being cautious. In conclusion, we found older people with poorer perceptual, physical and cognitive function made inappropriate and risky decisions in a divided attention road-crossing task despite self-reports of cautious behaviour in everyday life

Reach distance but not judgment error is associated with falls in older people

Background. Reaching is a vital action requiring precise motor coordination and attempting to reach for objects that are too far away can destabilize balance and result in falls and injury. This could be particularly important for many elderly people with age-related loss of sensorimotor function and a reduced ability to recover balance. Here, we investigate the interaction between reaching ability, errors in judging reach, and the incidence of falling (retrospectively and prospectively) in a large cohort of older people. Methods. Participants (n = 415, 70–90 years) had to estimate the furthest distance they could reach to retrieve a broomstick hanging in front of them. In an iterative dialog with the experimenter, the stick was moved until it was at the furthest distance they estimated to be reached successfully. At this point, participants were asked to attempt to retrieve the stick. Actual maximal reach was then measured. The difference between attempted reach and actual maximal reach provided a measure of judgment error. One-year retrospective fall rates were obtained at initial assessment and prospective falls were monitored by monthly calendar. Results. Participants with poor maximal reach attempted shorter reaches than those who had good reaching ability. Those with the best reaching ability most accurately judged their maximal reach, whereas poor performers were dichotomous and either underestimated or overestimated their reach with few judging exactly. Fall rates were significantly associated with reach distance but not with reach judgment error. Conclusions. Maximal reach but not error in perceived reach is associated with falls in older people

Proprioceptive measurements of perceived hand position using pointing and verbal localisation tasks.

Previous studies revealed that healthy individuals consistently misjudge the size and shape of their hidden hand during a localisation task. Specifically, they overestimate the width of their hand and underestimate the length of their fingers. This would also imply that the same individuals misjudge the actual location of at least some parts of their hand during the task. Therefore, the primary aim of the current study was to determine whether healthy individuals could accurately locate the actual position of their hand when hidden from view, and whether accuracy depends on the type of localisation task used, the orientation of the hidden hand, and whether the left or right hand is tested. Sixteen healthy right-handed participants performed a hand localisation task that involved both pointing to and verbally indicating the perceived position of landmarks on their hidden hand. Hand position was consistently misjudged as closer to the wrist (proximal bias) and, to a lesser extent, away from the thumb (ulnar bias). The magnitude of these biases depended on the localisation task (pointing vs. verbal), the orientation of the hand (straight vs. rotated), and the hand tested (left vs. right). Furthermore, the proximal location bias increased in size as the duration of the experiment increased, while the magnitude of ulnar bias remained stable through the experiment. Finally, the resultant maps of perceived hand location appear to replicate the previously reported overestimation of hand width and underestimation of finger length. Once again, the magnitude of these distortions is dependent on the task, orientation, and hand tested. These findings underscore the need to control and standardise each component of the hand localisation task in future studies

How Weight Affects the Perceived Spacing between the Thumb and Fingers during Grasping.

We know much about mechanisms determining the perceived size and weight of lifted objects, but little about how these properties of size and weight affect the body representation (e.g. grasp aperture of the hand). Without vision, subjects (n = 16) estimated spacing between fingers and thumb (perceived grasp aperture) while lifting canisters of the same width (6.6cm) but varied weights (300, 600, 900, and 1200 g). Lifts were performed by movement of either the wrist, elbow or shoulder to examine whether lifting with different muscle groups affects the judgement of grasp aperture. Results for perceived grasp aperture were compared with changes in perceived weight of objects of different sizes (5.2, 6.6, and 10 cm) but the same weight (600 g). When canisters of the same width but different weights were lifted, perceived grasp aperture decreased 4.8% [2.2 ‒ 7.4] (mean [95% CI]; P < 0.001) from the lightest to the heaviest canister, no matter how they were lifted. For objects of the same weight but different widths, perceived weight decreased 42.3% [38.2 ‒ 46.4] from narrowest to widest (P < 0.001), as expected from the size-weight illusion. Thus, despite a highly distorted perception of the weight of objects based on their size, we conclude that proprioceptive afferents maintain a reasonably stable perception of the aperture of the grasping hand over a wide range of object weights. Given the small magnitude of this 'weight-grasp aperture' illusion, we propose the brain has access to a relatively stable 'perceptual ruler' to aid the manipulation of different objects