Recommandations des interventions en physiothérapie pour une clientèle âgée souffrant de démence

Travail d'intégration présenté à la Faculté de médecine en vue de l’obtention du grade de maîtrise professionnelle en physiothérapieIntroduction : La prévalence de la démence augmente avec le vieillissement de la population. Considérant qu’elle représente la cause la plus importante d’invalidité chez les aînés, le physiothérapeute doit intervenir efficacement auprès de cette clientèle. Objectifs : Répertorier les outils d’évaluation et d’intervention les plus efficaces en physiothérapie auprès des aînés atteints de démence et émettre des recommandations aux professionnels. Stratégie méthodologique : Une recherche a été effectuée sur PubMed/MEDLINE, EMBASE et PEDro, avec les mots-clés suivants : exercise, dementia, music therapy, patient compliance, Alzheimer, cognition, falls, incontinence, interdisciplinarity, hip protectors, measurement assessment, balance, strength, gait, elderly, geriatric comprehensive assessment. Résultats : L’exercice prévient les démences (évidence grade B), mais son efficacité pour améliorer les fonctions cognitives chez les personnes atteintes est controversée. L’évaluation gériatrique multidimensionnelle est à privilégier. Pour évaluer la force musculaire, le dynamomètre manuel et le Five times sit-to-stand sont fiables, alors que le TUG et le POMA le sont pour la marche et l’équilibre. Les exercices et le traitement de l’incontinence sont efficaces pour prévenir les chutes (évidence grade A et B). En cas de chute, le port de protecteurs de hanche diminue le risque de fracture

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Organizing Electronic Information to Serve the Needs of Health Practitioners and Consumers

From its beginnings as the Library of the Army Surgeon General to today???s Internet-driven information environment, the U.S. National Library of Medicine (NLM) has served a variety of audiences. As NLM strives to provide the best possible service to health scientists and consumers, the form of that service has changed depending on resources available and the state of technology. Throughout its history, NLM has adopted innovative programs and technology at the earliest sensible moment that would serve its patron needs. Today, NLM is a leader in providing electronic biomedical information to health professionals, researchers, the public, and anyone else with access to the Internet. These services have evolved in response to available technology and the demands of the various audiences, from clinicians to consumers. To serve the needs of this variety of patrons, NLM connects health information resources in ways that enable each audience to fi nd the information appropriate to its need. NLM continues to improve this organization as the demand and technology and resources allow.published or submitted for publicatio

Interlibrary loan in US and Canadian health sciences libraries 2005: update on journal article use

Purpose: The authors analyzed 2.48 million interlibrary loan (ILL) requests entered in the National Library of Medicine's (NLM's) DOCLINE system from 3,234 US and Canadian medical libraries during fiscal year (FY) 2005 to study their distribution and nature and the journals in which requested articles were published. Methods: Data from DOCLINE and NLM's indexing system and online catalog were used to analyze all DOCLINE ILL transactions acted on from October 2004 to September 2005. The authors compared results from this analysis to previous data collected in FY 1992. Results: Overall ILL volume in the United States and Canada is at about the same level as FY 1992 despite marked growth in online searching, knowledge discovery tools, and journals available online. Over 21,000 unique journal titles and 1.4 million unique articles were used to fill 2.2 million ILL requests in FY 2005. Over 1 million of the articles were requested only once by any network library. Fifty-two percent (11,022) of journals had 5 or fewer requests for articles from all the years of a journal by all libraries in the network. Fifty-two percent of the articles requested were published within the most recent 5 years. Conclusion: The overall ILL profile in the libraries studied has changed little since FY 1992, notable given other changes in publishing. Small changes, however, may reveal developing trends. Total ILL traffic has been declining in recent years following a peak in 2002, and fewer of the articles requested were published in the most recent five years compared to requests from 1992

Serving Librarians and Physicians Before the

From its beginnings as the Library of the Army Surgeon General to today’s Internet-driven information environment, the U.S. National Library of Medicine (NLM) has served a variety of audiences. As NLM strives to provide the best possible service to health scientists and consumers, the form of that service has changed depending on resources available and the state of technology. Throughout its history, NLM has adopted innovative programs and technology at the earliest sensible moment that would serve its patron needs. Today, NLM is a leader in providing electronic biomedical information to health professionals, researchers, the public, and anyone else with access to the Internet. These services have evolved in response to available technology and the demands of the various audiences, from clinicians to consumers. To serve the needs of this variety of patrons, NLM connects health information resources in ways that enable each audience to find the information appropriate to its need. NLM continues to improve this organization as the demand and technology and resources allow

Endothelial and neuronal nitric oxide synthases are present in the suprachiasmatic nuclei of Syrian hamsters and rats

International audienc