The Silver Surfer: Trends of Internet Usage in the Over 65 and the Potential Health Benefits

The Internet provides medical information and interventions with promising benefits. This cross-sectional study explores trends in Internet use among the elderly in Ireland from 2002 to 2010 and considers possible implications for health benefit. Data were analysed on 1606 Irish individuals. Internet use in Ireland is increasing at similar rates to the rest of Europe; the percentage of over-65s using the Internet in Ireland nearly trebled from 2002 to 2010, from 26(8.3%) to 92 (24. 1%) (p < 0.001). Subgroups of this population displayed significantly higher rates of Internet usage; namely those with a better education, living with a partner, males and urban dwellers. Of those with good subjective general health, 230 (21%) had internet access, versus 36 (7.1%) with poor health. Web-based interventions targeting the elderly should become more available. These could be particularly useful in populations with limited access to transport and mobility.

Cooperative adsorption behavior of phosphopeptides on TiO2 leads to biased enrichment, detection and quantification

Novel data show that anomalous adsorption behavior and common washing procedures can lead to biased results in TiO₂-based phosphoproteomics.

Impact of a switch to fingolimod versus staying on glatiramer acetate or beta interferons on patient- and physician-reported outcomes in relapsing multiple sclerosis: post hoc analyses of the EPOC trial

Background

The Evaluate Patient OutComes (EPOC) study assessed physician- and patient-reported outcomes in individuals with relapsing multiple sclerosis who switched directly from injectable disease-modifying therapy (iDMT; glatiramer acetate, intramuscular or subcutaneous interferon beta-1a, or interferon beta-1b) to once-daily, oral fingolimod. Post hoc analyses evaluated the impact of a switch to fingolimod versus staying on each of the four individual iDMTs.

Methods

Overall, 1053 patients were randomized 3:1 to switch to fingolimod or remain on iDMT. The primary endpoint was the change in Treatment Satisfaction Questionnaire for Medication (TSQM) Global Satisfaction score. Secondary endpoints included changes in scores for TSQM Effectiveness, Side Effects and Convenience subscales, Beck Depression Inventory-II (BDI-II), Fatigue Severity Scale (FSS), Patient-Reported Outcome Indices for Multiple Sclerosis (PRIMUS) Activities, 36-item Short-Form Health Survey (SF-36) Mental Component Summary (MCS) and Physical Component Summary (PCS) and mean investigator-reported Clinical Global Impressions of Improvement (CGI-I). All outcomes were evaluated after 6 months of treatment.

Results

Changes in TSQM Global Satisfaction scores were superior after a switch to fingolimod when compared with scores in patients remaining on any of the iDMTs (all p <0.001). Likewise, all TSQM subscale scores improved following a switch to fingolimod (all p <0.001), except when compared with glatiramer acetate for the TSQM Side Effects subscale (p = 0.111). FSS scores were found to be superior for fingolimod versus remaining on subcutaneous interferon beta-1a and interferon beta-1b, BDI-II scores were significantly improved for fingolimod except for the comparison with intramuscular interferon beta-1a, and SF-36 scores were superior with fingolimod compared with remaining on interferon beta-1b (MCS and PCS; p = 0.030 and p = 0.022, respectively) and subcutaneous interferon beta-1a (PCS only; p = 0.024). Mean CGI-I scores were superior with fingolimod when compared with continuing treatment with any of the iDMTs (all p <0.001).

Conclusions

After 6 months, a switch to fingolimod showed superiority compared with remaining on each iDMT for a range of patient- and physician-reported outcomes, including global satisfaction with treatment.

Trial registration

ClinicalTrials.gov NCT01216072.

Standardizing corneal nerve fibre length for nerve tortuosity increases its association with measures of diabetic neuropathy

AIMS

Recent studies on corneal markers have advocated corneal nerve fibre length as the most important measure of diabetic peripheral neuropathy. The aim of this study was to determine if standardizing corneal nerve fibre length for tortuosity increases its association with other measures of diabetic peripheral neuropathy.

METHODS

Two hundred and thirty-one individuals with diabetes with either predominantly mild or absent neuropathic changes and 61 control subjects underwent evaluation of diabetic neuropathy symptom score, neuropathy disability score, testing with 10-g monofilament, quantitative sensory testing (warm, cold, vibration detection) and nerve conduction studies. Corneal nerve fibre length and corneal nerve fibre tortuosity were measured using corneal confocal microscopy. A tortuosity-standardised corneal nerve fibre length variable was generated by dividing corneal nerve fibre length by corneal nerve fibre tortuosity. Differences in corneal nerve morphology between individuals with and without diabetic peripheral neuropathy and control subjects were determined and associations were estimated between corneal morphology and established tests of, and risk factors for, diabetic peripheral neuropathy.

RESULTS

The tortuosity-standardised corneal nerve fibre length variable was better than corneal nerve fibre length in demonstrating differences between individuals with diabetes, with and without neuropathy (tortuosity-standardised corneal nerve fibre length variable: 70.5 ± 27.3 vs. 84.9 ± 28.7, P < 0.001, receiver operating characteristic area under the curve = 0.67; corneal nerve fibre length: 15.9 ± 6.9 vs. 18.4 ± 6.2 mm/mm², P = 0.004, receiver operating characteristic area under the curve = 0.64). Furthermore, the tortuosity-standardised corneal nerve fibre length variable demonstrated a significant difference between the control subjects and individuals with diabetes, without neuropathy, while corneal nerve fibre length did not (tortuosity-standardised corneal nerve fibre length variable: 94.3 ± 27.1 vs. 84.9 ± 28.7, P = 0.028; corneal nerve fibre length: 20.1 ± 6.3 vs. 18.4 ± 6.2 mm/mm², P = 0.084). Correlations between corneal nerve fibre length and established measures of neuropathy and risk factors for neuropathy were higher when a correction was made for the nerve tortuosity.

CONCLUSIONS

Standardizing corneal nerve fibre length for tortuosity enhances the ability to differentiate individuals with diabetes, with and without neuropathy.

Increasing Recognition of Fetal Heart Anatomy Using Online Tutorials and Mastery Learning Compared With Classroom Instructional Methods

Assessment of the fetal heart is a challenging part of any routine obstetrical sonogram. The practice of teaching and learning this skill demands expertise in the visualization and interpretation of normal sonographic appearances of the fetal heart. Recognition of the pathological features associated with commonly seen congenital heart diseases is also very important. In the study reported here, students in an obstetrical sonography course were randomly assigned to two groups. The students in the control group (classroom instruction) on average assessed correctly all five anatomic cardiac features but determined the normal or abnormal status of only 19% of cases, 4.7of 25 ± 4.4 SD. The experimental group (online tutorials) correctly identified 39% of cases, 9.9 of 25 ± 2.7 SD, P < .01. The average score in the experimental group was greater than 84% of the students in the control group, a one sigma effect. These data support the conclusion that students learning to assess the fetal heart for the presence of congenital heart disease using a series of online tutorials and practice exercises compared with students receiving conventional classroom instruction demonstrated an improved ability to correctly identify normal and abnormal fetal heart structures.

Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010

BACKGROUND

Although acute rheumatic fever (ARF) and its sequel, rheumatic heart disease (RHD), continue to cause a large burden of morbidity and mortality in disadvantaged populations, most studies investigating the effectiveness of control programs date from the 1950s. A control program, including a disease register, in the Northern Territory of Australia where the Indigenous population has high rates of ARF and RHD allowed us to examine current disease incidence and progression.

METHODS AND RESULTS

ARF and RHD incidence rates, ARF recurrence rates, progression rates from ARF to RHD to heart failure, and RHD survival and mortality rates were calculated for Northern Territory residents from 1997 to 2010. For Indigenous people, ARF incidence was highest in the 5- to 14-year age group (males, 162 per 100,000; females, 228 per 100,000). There was little evidence that the incidence of ARF or RHD had declined. The ARF recurrence rate declined by 9% per year after diagnosis. After a first ARF diagnosis, 61% developed RHD within 10 years. After RHD diagnosis, 27% developed heart failure within 5 years. For Indigenous RHD patients, the relative survival rate was 88.4% at 10 years after diagnosis and the standardized mortality ratio was 1.56 (95% confidence interval, 1.23-1.96).

CONCLUSIONS

For Indigenous Australians in the Northern Territory, ARF and RHD incidence and associated mortality remain very high. The reduction in ARF recurrence indicates that the RHD control program has improved secondary prophylaxis; a decline in RHD incidence is expected to follow.

Effects of the frame acquisition rate on the sensitivity of gastro-oesophageal reflux scintigraphy

OBJECTIVE

To compare the sensitivity of gastro-oesophageal reflux (GOR) scintigraphy at 5-s and 60-s frame acquisition rates.

METHODS

GOR scintigraphy of 50 subjects (1 month-20 years old, mean 42 months) were analysed concurrently using 5-s and 60-s acquisition frames. Reflux episodes were graded as low if activity was detected in the distal half of the oesophagus and high if activity was detected in its upper half or in the oral cavity. For comparison purposes, detected GOR in any number of 5-s frames corresponding to one 60-s frame was counted as one episode.

RESULTS

A total of 679 episodes of GOR to the upper oesophagus were counted using a 5-s acquisition technique. Only 183 of such episodes were detected on 60-s acquisition images. To the lower oesophagus, a total of 1749 GOR episodes were detected using a 5-s acquisition technique and only 1045 episodes using 60-s acquisition frames (these also included the high-level GOR on 5-s frames counted as low level on 60-s acquisition frames). 10 patients had high-level GOR episodes that were detected only using a 5-s acquisition technique, leading to a different diagnosis in these patients. No correlation between the number of reflux episodes and the gastric emptying rates was noted.

CONCLUSION

The 5-s frame acquisition technique is more sensitive than the 60-s frame acquisition technique for detecting both high- and low-level GOR.

ADVANCES IN KNOWLEDGE

Brief GOR episodes with a relatively low number of radioactive counts are frequently indistinguishable from intense background activity on 60-s acquisition frames.

Ultrashort-pulse lasers treating the crystalline lens: will they cause vision-threatening cataract? (An American Ophthalmological Society thesis)

PURPOSE

To demonstrate that ultrashort-pulse laser treatment in the crystalline lens does not form a focal, progressive, or vision-threatening cataract.

METHODS

An Nd:vanadate picosecond laser (10 ps) with prototype delivery system was used. Primates: 11 rhesus monkey eyes were prospectively treated at the University of Wisconsin (energy 25-45 μJ/pulse and 2.0-11.3M pulses per lens). Analysis of lens clarity and fundus imaging was assessed postoperatively for up to 4½ years (5 eyes). Humans: 80 presbyopic patients were prospectively treated in one eye at the Asian Eye Institute in the Philippines (energy 10 μJ/pulse and 0.45-1.45M pulses per lens). Analysis of lens clarity, best-corrected visual acuity, and subjective symptoms was performed at 1 month, prior to elective lens extraction.

RESULTS

Bubbles were immediately seen, with resolution within the first 24 to 48 hours. Afterwards, the laser pattern could be seen with faint, noncoalescing, pinpoint micro-opacities in both primate and human eyes. In primates, long-term follow-up at 4½ years showed no focal or progressive cataract, except in 2 eyes with preexisting cataract. In humans, <25% of patients with central sparing (0.75 and 1.0 mm radius) lost 2 or more lines of best spectacle-corrected visual acuity at 1 month, and >70% reported acceptable or better distance vision and no or mild symptoms. Meanwhile, >70% without sparing (0 and 0.5 mm radius) lost 2 or more lines, and most reported poor or severe vision and symptoms.

CONCLUSIONS

Focal, progressive, and vision-threatening cataracts can be avoided by lowering the laser energy, avoiding prior cataract, and sparing the center of the lens.

Long-term effects of rivastigmine treatment on the need for psychotropic medications in nursing home patients with Alzheimer's disease : results of a 52-week open-label study

BACKGROUND AND OBJECTIVE

Neuropsychiatric symptoms and behavioural disturbances occur in most patients with Alzheimer's disease (AD), are a source of stress for caregivers, and are the primary cause of patient institutionalisation. These symptoms often are treated with psychotropic medications. However, adverse drug interactions, adverse effects and nursing home regulations make reducing the use of psychotropic medications in elderly AD patients an important goal of therapy. Fifty-two-week data including data from a 26-week prospective open-label, multicentre study and its 26-week open-label extension were analysed.

PATIENTS AND METHODS

173 patients with moderate to severe AD residing in nursing homes were treated with rivastigmine 1.5-6mg twice daily. In the study, psychotropic drug use and behavioural symptoms were measured at baseline and at 52 weeks.

RESULTS

Results showed that 40% of patients who were receiving psychotropic medications at baseline had discontinued use or reduced their dose of psychotropic medications at week 52. Furthermore, significant improvements were observed from baseline in 10 of the 12 behavioural domains of the Nursing Home version of the Neuropsychiatric Inventory, including delusions (mean change from baseline -2.0; p = 0.002), hallucinations (mean change -3.1; p < 0.001), anxiety (mean change -1.1; p = 0.014), and euphoria (mean change -3.2; p = 0.006).

CONCLUSION

These data suggest favourable tolerability, behavioural and pharmacoeconomic outcomes in nursing home residents with AD who are treated with rivastigmine.

Cobalamin status in sickle cell disease

INTRODUCTION

Some studies comparing serum cobalamin in individuals with and without sickle cell disease (SCD) have suggested a higher prevalence of cobalamin deficiency in SCD but others have not. Our aim was to prospectively compare cobalamin status in African-Americans with and without SCD.

METHODS

We analyzed blood samples from 86 subjects in two groups: SCD (n = 29) and non-SCD (n = 57). Serum cobalamin, folate, homocysteine, methylmalonic acid (MMA), anti-intrinsic factor antibody, Helicobacter pylori antibody, and gastrin were measured and compared.

RESULTS

The median cobalamin was 235 pM in the SCD group vs. 292 pM in the non-SCD group (P-value = 0.014). No significant differences in MMA or homocysteine were seen. Using the criteria of a low cobalamin and an elevated MMA or an elevated MMA alone, cobalamin deficiency was suggested in 4 (13.8%) in the SCD group and 6 (10.5%) in the non-SCD group. Two of these SCD patients and four of these control subjects had chronic renal disease, which may lead to elevated MMA in the absence of cobalamin deficiency. The remaining four met criteria for cobalamin deficiency, 2 (6.9%) in the SCD group and 2 (3.5%) in the non-SCD group (P = 0.6).

CONCLUSION

A lower cobalamin was observed in SCD patients without a higher prevalence of cobalamin deficiency. The inclusion of haptocorrin and holotranscobalamin measurement in future studies may provide a better assessment of cobalamin status in this patient group.

Retinal nerve fibre layer thinning associated with diabetic peripheral neuropathy

AIMS

To investigate the relationship between retinal nerve fibre layer thickness and peripheral neuropathy in patients with Type 2 diabetes, particularly in those who are at higher risk of foot ulceration.

METHODS

Global and sectoral retinal nerve fibre layer thicknesses were measured at 3.45 mm diameter around the optic nerve head using optical coherence tomography (OCT). The level of neuropathy was assessed in 106 participants (82 with Type 2 diabetes and 24 healthy controls) using the 0-10 neuropathy disability score. Participants were stratified into four neuropathy groups: none (0-2), mild (3-5), moderate (6-8), and severe (9-10). A neuropathy disability score ≥ 6 was used to define those at higher risk of foot ulceration. Multivariable regression analysis was performed to assess the effect of neuropathy disability scores, age, disease duration and retinopathy on RNFL thickness.

RESULTS

Inferior (but not global or other sectoral) retinal nerve fibre layer thinning was associated with higher neuropathy disability scores (P = 0.03). The retinal nerve fibre layer was significantly thinner for the group with neuropathy disability scores ≥ 6 in the inferior quadrant (P < 0.005). Age, duration of disease and retinopathy levels did not significantly influence retinal nerve fibre layer thickness. Control participants did not show any significant differences in thickness measurements from the group with diabetes and no neuropathy (P > 0.24 for global and all sectors).

CONCLUSIONS

Inferior quadrant retinal nerve fibre layer thinning is associated with peripheral neuropathy in patients with Type 2 diabetes, and is more pronounced in those at higher risk of foot ulceration.

Visual sensitivity loss in the central 30° of visual field is associated with diabetic peripheral neuropathy

AIMS/HYPOTHESIS

Impaired central vision has been shown to predict diabetic peripheral neuropathy (DPN). Several studies have demonstrated diffuse retinal neurodegenerative changes in diabetic patients prior to retinopathy development, raising the prospect that non-central vision may also be compromised by primary neural damage. We hypothesise that type 2 diabetic patients with DPN exhibit visual sensitivity loss in a distinctive pattern across the visual field, compared with a control group of type 2 diabetic patients without DPN.

METHODS

Increment light sensitivity was measured by standard perimetry in the central 30° of visual field for two age-matched groups of type 2 diabetic patients, with and without neuropathy (n = 40/30). Neuropathy status was assigned using the neuropathy disability score. Mean visual sensitivity values were calculated globally, for each quadrant and for three eccentricities (0-10°, 11-20° and 21-30°). Data were analysed using a generalised additive mixed model (GAMM).

RESULTS

Global and quadrant between-group visual sensitivity mean differences were marginally but consistently lower (by about 1 dB) in the neuropathy cohort compared with controls. Between-group mean differences increased from 0.36 to 1.81 dB with increasing eccentricity. GAMM analysis, after adjustment for age, showed these differences to be significant beyond 15° eccentricity and monotonically increasing. Retinopathy levels and disease duration were not significant factors within the model (p = 0.90).

CONCLUSIONS/INTERPRETATION

Visual sensitivity reduces disproportionately with increasing eccentricity in type 2 diabetic patients with peripheral neuropathy. This sensitivity reduction within the central 30° of visual field may be indicative of more consequential loss in the far periphery.

Assessing the value of electronic records

BACKGROUND

With the introduction of electronic records, some nurses have expressed concern about the length of time they spend inputting data on computers.

AIM

To explore mental health nurses' views about computer use when engaging with patients in care planning, and to investigate how electronic records contribute to improving service user involvement and care planning in mental health services.

METHOD

A literature review and a descriptive survey based on a questionnaire distributed to 10 wards.

RESULTS

Respondents raised several concerns about electronic records and patient contact. They called for more training specifically on electronic care plans. Concerns were voiced about duplication of work, with nurses continuing to use paper then rewriting on a computer, leaving less time for patient care. A shortage of computers and a lack of space where nurses and patients could meet and develop the electronic care plan together were also issues. A stated benefit was that patient information was easier to read.

CONCLUSION

Ongoing training, availability of interview rooms, staff attitudes and evaluation of electronic care plans in terms of patient care, interaction between nurses and patients, and partnership working need to be addressed.

In vitro evaluation and biodistribution of HER2-targeted liposomes loaded with an (125)I-labelled DNA-intercalator

BACKGROUND

Increasing attention is currently focussed on the issue of finding strategies for the delivery of Auger-electron-emitting radionuclides into tumor cell nuclei.

PURPOSE

In this study, we investigated tumor-cell uptake and cell-killing ability in vitro as well as in vivo biodistribution of an (125)I-labelled anthracycline derivative administered by means of HER2-targeted liposomes.

METHODS

Anthracycline derivative Comp1 was radiolabelled with Auger-emitting (125)I and encapsulated in liposomes (DSPC:Chol:DSPE-PEG) using pH-gradient loading. Single-chain fragment F5 was anchored to the liposomes as targeting device for HER2. Uptake and specificity of (125)I-Comp1 delivered via targeting and non-targeting liposomes were analysed in cultured HER2-overexpressing cells. Cell-killing efficacy was evaluated in SKOV3 cells and biodistribution for up to 48 h was studied after intraperitoneal injection in tumor-bearing female BALB/c nu/nu mice.

RESULTS

(125)I-Comp1 was specifically taken up by the cultured cells when administered by means of HER2-targeted liposomes and a clear dose-effect correlation in survival of cells was seen with increasing specific activity. The biodistribution studies revealed that (125)I-Comp1 accumulated in tumors when distributed using HER2-targeted liposomes and that this effect was absent when using non-targeting liposomes.

CONCLUSION

The HER2-targeted liposomes possess the properties needed to bring about tumor-specific delivery and therapeutic effect of (125)I-Comp1.

A new renormalization group approach for systems with strong electron correlation

The anomalous low energy behaviour observed in metals with strong electron correlation, such as in the heavy fermion materials, is believed to arise from the scattering of the itinerant electrons with low energy spin fluctuations. In systems with magnetic impurities this scattering leads to the Kondo effect and a low energy renormalized energy scale, the Kondo temperature T(K). It has been generally assumed that these low energy scales can only be accessed by a non-perturbative approach due to the strength of the local inter-electron interactions. Here we show that it is possible to circumvent this difficulty by first suppressing the spin fluctuations with a large magnetic field. As a first step field-dependent renormalized parameters are calculated using standard perturbation theory. A renormalized perturbation theory is then used to calculate the renormalized parameters for a reduced magnetic field strength. The process can be repeated and the flow of the renormalized parameters continued to zero magnetic field. We illustrate the viability of this approach for the single impurity Anderson model. The results for the renormalized parameters, which flow as a function of magnetic field, can be checked with those from numerical renormalization group and Bethe ansatz calculations.