Image_1_Effects of age and sex on outcomes of the Q-Motor speeded finger tapping and grasping and lifting tests-findings from the population-based BiDirect Study.pdf

BackgroundQ-Motor is a suite of motor tests originally designed to assess motor symptoms in Huntington's disease. Among others, Q-Motor encompasses a finger tapping task and a grasping and lifting task. To date, there are no systematic investigations regarding effects of variables which may affect the performance in specific Q-Motor tests per se, and normative Q-Motor data based on a large population-based sample are not yet available.ObjectiveWe investigated effects of age and sex on five selected Q-Motor outcomes representing the two core Q-Motor tasks speeded finger tapping and grasping and lifting in a community sample of middle-aged to elderly adults. Furthermore, we explored effects of the potentially mediating variables educational attainment, alcohol consumption, smoking status, and depressive symptoms. Moreover, we explored inter-examiner variability. Finally, we compared the findings to findings for the Purdue Pegboard test.MethodsBased on a sample of 726 community-dwelling adults and using multiple (Gaussian) regression analysis, we modeled the motor outcomes using age, sex, years in full-time education, depressive symptoms in the past seven days, alcohol consumption in the past seven days, and smoking status as explanatory variables.ResultsWith regard to the Q-Motor tests, we found that more advanced age was associated with reduced tapping speed, male sex was associated with increased tapping speed and less irregularity, female sex was associated with less involuntary movement, more years of education were associated with increased tapping speed and less involuntary movement, never smoking was associated with less involuntary movement compared to current smoking, and more alcohol consumed was associated with more involuntary movement.ConclusionThe present results show specific effects of age and sex on Q-Motor finger tapping and grasping and lifting performance. In addition, besides effects of education, there also were specific effects of smoking status and alcohol consumption. Importantly, the present study provides normative Q-Motor data based on a large population-based sample. Overall, the results are in favor of the feasibility and validity of Q-Motor finger tapping and grasping and lifting for large observational studies. Due to their low task-complexity and lack of placebo effects, Q-Motor tests may generate additional value in particular with regard to clinical conditions such as Huntington's or Parkinson's disease.</p

Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke

<div><p>Background</p><p>Mortality from ischemic stroke has declined over time. However, little is known about the reasons for the decreased mortality. We therefore aimed to evaluate trends in in-hospital mortality and to identify factors associated with these trends.</p><p>Methods</p><p>This study was based on a prospective database of 26 hospitals of the Stroke Register of Northwestern Germany, which included 73,614 patients admitted between 2000 and 2011. Time trends in observed (crude) and risk-adjusted in-hospital mortality were assessed. Independent factors associated with death after stroke were evaluated using multivariable logistic regression analysis.</p><p>Results</p><p>The observed in-hospital mortality decreased from 6.6% in 2000 to 4.6% in 2008 (P < 0.001 for trend) and then remained fairly stable. The risk-adjusted mortality decreased from 2.85% in 2000 to 1.86% in 2008 (P < 0.01 for trend) and then increased to 2.32% in 2011. Use of in-hospital treatments including antiplatelets within 48 hours, antihypertensive therapy, statins, antidiabetics, physiotherapy and anticoagulants increased over time and was significantly associated with a decrease in mortality. The association of the year of admission with mortality became insignificant after adjustment for antiplatelet therapy within 48 hours (from OR 0.96; 95% CI, 0.94-0.98, to OR 0.99; 95% CI, 0.97-1.01) and physiotherapy (from OR 0.96; 95% CI, 0.94-0.97, to OR 0.99; 95% CI, 0.97-1.00).</p><p>Conclusions</p><p>In-hospital mortality decreased by approximately one third between 2000 and 2008. This decline was paralleled by improvements in different in-hospital managements, and we demonstrated that it was partly mediated by early antiplatelet therapy and physiotherapy use.</p></div

Baseline characteristics of patients with ischemic stroke from 2000 to 2011.

<p>Baseline characteristics of patients with ischemic stroke from 2000 to 2011.</p

Logistic regression analyses^* showing effects of in-hospital managements on the annual decrease in in-hospital mortality.

<p>* All models were adjusted for age, sex, stroke severity on admission indicated by Rankin Scale, sum of comorbidities, year of admission, and separately for different in-hospital managements.</p><p>^‡ Includes intravenous and intra-arterial thrombolysis. Models including thrombolysis considered the time period 2000–2008, models including antiplatelets considered the time period 2000–2002 and 2007–2008, models including antihypertensive therapy, antidiabetic, and statins considered the time period 2003–2008, models including anticoagulants and physiotherapy considered the time period 2000–2008, modes including admission to Stroke Unit considered the time period 2000–2006.</p><p>Abbreviations: aOR, adjusted odds ratio; CI, confidence interval</p><p>Logistic regression analyses^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131473#t003fn001" target="_blank">*</a>} showing effects of in-hospital managements on the annual decrease in in-hospital mortality.</p

In-hospital management of patients with stroke from 2000 to 2011.

<p>^‡ Includes intravenous and intra-arterial thrombolysis.</p><p>Percentages are related to available informations and therefore sum to 100%. Blank cells indicate data not available. Data missing rate: for admission ward 7.9%.</p><p>In-hospital management of patients with stroke from 2000 to 2011.</p

In-hospital mortality among patients with ischemic stroke between 2000 and 2011.

<p>A, Observed (crude) mortality. B, Risk-adjusted mortality was determined with the use of logistic regression models to adjust for age, sex, initial stroke severity, and the number of comorbidities.</p

Mean values in RLS severity (IRLS), quality of life (SF-36), depression (CES-D) and sleep (PSQI) scales at baseline 12-months, 24-months and 36-months follow-up.

a<p>p-value for difference between assessments according to one-way repeated measures ANOVA.</p

Mean IRLS^a score according to six age groups at baseline, 6-, 12- 24- and 36-months follow-up.

<p>Mean IRLS^a score according to six age groups at baseline, 6-, 12- 24- and 36-months follow-up.</p

Clinical characteristics and differences in health status according to changes in RLS severity (IRLS^c) over 36 months.

<p>*p for differences between the 3 groups derived from one-way analysis of variance (ANOVA) unless otherwise noted.</p>a<p>Chi-square test for the difference between gender.</p>b<p>Change in the International Restless Legs Study Group (IRLSSG) Rating Scale for severity of RLS between baseline and 36 months follow-up: worsening = increase in score by >5 points, unchanged = change in score not more than ±5 points, improving =  decrease in score >5 points.</p>c<p>International Restless Legs Study Group Rating Scale for severity of RLS (IRLS).</p

Characteristics of the COR-Study participants at baseline.

a<p>based on self-reported weight and height.</p>b<p>self-reported physician diagnosis.</p