Therapeutic lung lavages in children and adults

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by excessive intra-alveolar accumulation of surfactant lipids and proteins. Therapeutic whole lung lavages are currently the principle therapeutic option in adults. Not much is known on the kinetics of the wash out process, especially in children. METHODS: In 4 pediatric and 6 adult PAP patients 45 therapeutic half lung lavages were investigated retrospectively. Total protein, protein concentration and, in one child with a surfactant protein C mutation, aberrant pro-SP-C protein, were determined during wash out. RESULTS: The removal of protein from the lungs followed an exponential decline and averaged for adult patients 2 – 20 g and <0.5 to 6 g for pediatric patients. The average protein concentration of consecutive portions was the same in all patient groups, however was elevated in pediatric patients when expressed per body weight. The amount of an aberrant pro-SP-C protein, which was present in one patient with a SP-C mutation, constantly decreased with ongoing lavage. Measuring the optical density of the lavage fluid obtained allowed to monitor the wash out process during the lavages at the bedside and to determine the termination of the lavage procedure at normal protein concentration. CONCLUSION: Following therapeutic half lung lavages by biochemical variables may help to estimate the degree of alveolar filling with proteinaceous material and to improve the efficiency of the wash out, especially in children

Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan

<p>Abstract</p> <p>Background</p> <p>Relatively little empirical attention has focused on the association between social participation and depressive symptoms amongst older adults in Asian nations, where persons over the age of 65 represent a rapidly growing segment of the population. This study explores the dynamic relationship between participation in social activities and trajectories of depressive symptomatology among older Taiwanese adults surveyed over 18 years.</p> <p>Methods</p> <p>Data are from a nationally representative sample of 1,388 adults aged 60-64 first surveyed in 1989 and followed over an 18-year time period for a total of six waves. Individual involvement in social activities was categorized into continuous participation, ceased participation before age 70, initiating participation in older adulthood, never participated, and dropped out before age 70. Two domains of depressive symptoms--negative affect and lack of positive affect--were measured using a 10-item version of the Center for Epidemiologic Studies-Depression Scale.</p> <p>Results</p> <p>Analyses using growth curve modeling showed that continuously participating or initiating participation in social activities later life is significantly associated with fewer depressive symptoms among older Taiwanese adults, even after controlling for the confounding effects of aging, individual demographic differences, and health status.</p> <p>Conclusions</p> <p>These findings suggest that maintaining or initiating social participation in later life benefits the mental health of older adults. Facilitating social activities among older adults is a promising direction for programs intended to promote mental health and successful aging among older adults in Taiwan.</p

An integrative approach to quality of life measurement, research, and policy

While Quality of Life (QOL) has long been an explicit or implicit policy goal, adequate definition and measurement have been elusive. Diverse objective and subjective indicators across a range of disciplines and scales, and recent work on subjective well-being (SWB) surveys and the psychology of happiness have spurred renewed interest. Drawing from multiple disciplines, we present an integrative definition of QOL that combines measures of human needs with subjective well-being or happiness. QOL is proposed as a multiscale, multi-dimensional concept that contains interacting objective and subjective elements. We relate QOL to the opportunities that are provided to meet human needs in the forms of built, human, social and natural capital (in addition to time) and the policy options that are available to enhance these opportunities. Issues related to de?ning, measuring, and scaling these concepts are discussed, and a research agenda is elaborated. Policy implications include strategies for investing in opportunities to maximize QOL enhancement at the individual, community, and national scales

Perceived Income Adequacy Among Older Adults in 12 Countries: Findings From the Survey of Health, Ageing, and Retirement in Europe

Purpose: To validate a survey research measure of subjective income, as measured by perceived income adequacy, in an international context. Design and Methods: The study population comprised persons aged 50 years and older in 12 countries from the Survey of Health, Ageing and Retirement in Europe (n = 28,939). Perceived difficulty in making ends meet was regressed on sociodemographic variables, economic indicators, health status measures, and expectations regarding one's financial future. Country differences were also controlled. Results: The findings confirm a multidimensional explanation of perceived income adequacy but also point to the primacy of objective economic indicators in predicting household financial distress. Respondents aged 80 years and older report less financial difficulty. Poor health status and pessimistic financial expectations also predict greater household financial distress but to a lesser degree. Implications: Self-rated economic status is a robust indicator of financial capacity in older age and can be used by practitioners to gain meaningful information. However, practitioners should keep in mind that the oldest-old may underestimate financial difficulties