Inter-rater agreement of a modified and extended Swedish version of the Frenchay Activities Index (FAI).

The point of departure for this study was the need for an instrument capturing social activities updated to the living circumstances of the 21st century. Starting out from the Frenchay Activities Index (FAI), the objective was to investigate the inter-rater agreement of the scoring of a modified and extended Swedish version, capturing activity performance and participation. Thirty-one older people, living in the community post stroke, were interviewed in their homes by two raters using the Swedish FAI version, extended with items on use of mode of transport and use of telephone, and modified with additional scales. Besides the original frequency scale, the new scales captured changes in frequency, reasons for change, and performance satisfaction; inter-rater agreement was analyzed with kappa statistics. Overall, the inter-rater agreement was high or very high, with weighted ̄ Κ = 0.924 for the frequency scale and ̄ Κ = 0.784-0.940 for the new scales. As a conclusion, while further validity and reliability testing is necessary, when out-of-home activities are of interest the scoring of the modified and extended Swedish FAI version can be administered with high inter-rater agreement

A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented?

<p>Abstract</p> <p>Background</p> <p>Lower extremity amputations are costly and debilitating complications in patients with diabetes mellitus (DM). Our aim was to investigate changes in the amputation rate in patients with DM at the Karolinska University Hospital in Solna (KS) following the introduction of consensus guidelines for treatment and prevention of diabetic foot complications, and to identify risk groups of lower extremity amputations that should be targeted for preventive treatment.</p> <p>Methods</p> <p>150 diabetic and 191 nondiabetic patients were amputated at KS between 2000 and 2006; of these 102 diabetic and 99 nondiabetic patients belonged to the catchment area of KS. 21 diabetic patients who belonged to KS catchment area were amputated at Danderyd University Hospital. All patients' case reports were searched for diagnoses of diabetes, vascular disorders, kidney disorders, and ulcer infections of the foot.</p> <p>Results</p> <p>There was a 60% reduction in the rate of amputations performed above the ankle in patients with DM during the study period. Patients with DM who underwent amputations were more commonly affected by foot infections and kidney disorders compared to the nondiabetic control group. Women with DM were 10 years older than the men when amputated, whereas men with DM underwent more multiple amputations and had more foot infections compared to the women. 88% of all diabetes-related amputations were preceded by foot ulcers. Only 30% of the patients had been referred to the multidisciplinary foot team prior to the decision of amputation.</p> <p>Conclusions</p> <p>These findings indicate a reduced rate of major amputations in diabetic patients, which suggests an implementation of the consensus guidelines of foot care. We also propose further reduced amputation rates if patients with an increased risk of future amputation (i.e. male sex, kidney disease) are identified and offered preventive treatment early.</p

Age-dependent favorable visual recovery despite significant retinal atrophy in pediatric MOGAD: how much retina do you really need to see well?

BACKGROUND To investigate age-related severity, patterns of retinal structural damage, and functional visual recovery in pediatric and adult cohorts of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) optic neuritis (ON). METHODS All MOGAD patients from the 5 participating centers were included. Patients with initial manifestation 0.5) visual impairment. Independent of retinal atrophy, age at ON onset significantly correlated with visual outcome. CONCLUSION Pediatric MOGAD ON showed better visual recovery than adult MOGAD ON despite profound and almost identical neuroaxonal retinal atrophy. Age-related cortical neuroplasticity may account for the substantial discrepancy between structural changes and functional outcomes

Environmental considerations and current status of grouping and regulation of engineered nanomaterials

This article reviews the current status of nanotechnology with emphasis on application and related environmental considerations as well as legislation. Application and analysis of nanomaterials in infrastructure (construction, building coatings, and water treatment) is discussed, and in particular nanomaterial release during the lifecycle of these applications. Moreover, possible grouping approaches with regard to ecotoxicological and toxicological properties, and the fate of nanomaterials in the environment are evaluated. In terms of potential exposure, the opportunities that arise from leveraging advances in several key areas, such as water treatment and construction are addressed. Additionally, this review describes challenges with regard to the European Commission’s definition of ‘nanomaterial’. The revised REACH information requirements, intended to enable a comprehensive risk assessment of nanomaterials, are outlined

Analytical and toxicological aspects of nanomaterials in different product groups: Challenges and opportunities

The widespread integration of engineered nanomaterials into consumer and industrial products creates new challenges and requires innovative approaches in terms of design, testing, reliability, and safety of nanotechnology. The aim of this review article is to give an overview of different product groups in which nanomaterials are present and outline their safety aspects for consumers. Here, release of nanomaterials and related analytical challenges and solutions as well as toxicological considerations, such as dose-metrics, are discussed. Additionally, the utilization of engineered nanomaterials as pharmaceuticals or nutraceuticals to deliver and release cargo molecules is covered. Furthermore, critical pathways for human exposure to nanomaterials, namely inhalation and ingestion, are discussed in the context of risk assessment. Analysis of NMs in food, innovative medicine or food contact materials is discussed. Specific focus is on the presence and release of nanomaterials, including whether nanomaterials can migrate from polymer nanocomposites used in food contact materials. With regard to the toxicology and toxicokinetics of nanomaterials, aspects of dose metrics of inhalation toxicity as well as ingestion toxicology and comparison between in vitro and in vivo conclusions are considered. The definition of dose descriptors to be applied in toxicological testing is emphasized. In relation to potential exposure from different products, opportunities arising from the use of advanced analytical techniques in more unique scenarios such as release of nanomaterials from medical devices such as orthopedic implants are addressed. Alongside higher product performance and complexity, further challenges regarding material characterization and safety, as well as acceptance by the general public are expected

Early supported discharge after stroke and continued rehabilitation at home coordinated and delivered by a stroke unit in an urban area.

OBJECTIVE: To explore the characteristics and outcome of patients after stroke admitted to early supported discharge (ESD) services, and to investigate changes over time. STUDY POPULATIONS: Patients admitted between June 1997 and September 1998 and participating in a follow-up study (n = 87) and all patients admitted in 2005-06 (n = 226). Background populations: All stroke cases in Malmö alive 3 months after stroke in June 1997 to September 1998 (n = 514) and 2005-06 (n = 1353). RESULTS: There were no differences in age, gender, proportion living alone or Katz Index distribution between the 2 study populations. The Katz Index improved between start and end of ESD (p < 0.001). Patients admitted to ESD services did not differ from the background populations with regard to gender or age, but were less often living alone in 2005-06 (p = 0.002). The mean duration of the ESD input was shorter in 2005-06 (p < 0.001). In 1997-98 the participants were satisfied with most of the dimensions of care; the proportion of patients having activity limitations decreased during the first 6 months after stroke. CONCLUSION: The use of ESD was feasible in the routine setting of an urban stroke unit. The input of the ESD services per patient decreased over time, perhaps indicating an improvement in use of healthcare resources