Health Sciences & Medicine papers

Sarcopenia in older adults

Timothy Henwood et al. — Mon, 30 Apr 2012 23:33:57 PDT

Extract:
Sarcopenia is a little acknowledged geriatric syndrome associated with significant health care and personal burden (Janssen et al 2004). Defined by an age associated loss in muscle mass and function (either muscle strength or physical performance), sarcopenia is a known precursor to later life disability (Cruz-Jentoft et al 2010). Across the lifespan, an adult can expect a 35% loss in muscle size and 50% loss in muscle strength that will significantly reduce their capacity to undertake activities of daily living, and increase their risk of falls due to reduced balance capacity and core strength (Bean et al 2002).

Assessing the motives of living, non-related donors

Katrina A. Bramstedt et al. — Thu, 08 Mar 2012 18:54:13 PST

Research review: Don't forget to slip, slop, slap ... and salute?

Mike Climstein et al. — Wed, 07 Mar 2012 21:06:40 PST

Haemorheology of the eastern grey kangaroo and the Tasmanian devil

Michael J. Simmonds et al. — Wed, 22 Feb 2012 21:11:32 PST

The blood of two Australian marsupials, the eastern grey kangaroo (Macropus giganteus) and the Tasmanian devil (Sarcophilus harrisii), has been reported to have greater oxygen-carrying capacity (i.e. haemoglobin content) when compared with that of placental mammals. We investigated whether alterations of blood rheological properties are associated with the increased oxygen-carrying capacity of these marsupials. Eastern grey kangaroos (n = 6) and Tasmanian devils (n = 4) were anaesthetised for blood sampling; human blood (n = 6) was also sampled for comparison. Laboratory measurements included blood and plasma viscosity, red blood cell (RBC) deformability, RBC aggregation and the intrinsic tendency of RBC to aggregate, RBC surface charge and haematological parameters. Scanning electron micrographs of RBC from each species provided morphological information. High-shear blood viscosity at native haematocrit was highest for the Tasmanian devil. When haematocrit was adjusted to 0.4 L L–1, lower-shear blood viscosity was highest for the eastern grey kangaroo. RBC deformability was greatly reduced for the Tasmanian devil. Eastern grey kangaroo blood had the highest RBC aggregation, whereas Tasmanian devil RBC did not aggregate. The surface charge of RBC for marsupials was ~15% lower than that of humans. The dependence of oxygen-delivery effectiveness on haemoglobin concentration (i.e. oxygen content) and blood viscosity was quantitated by calculating the haematocrit to blood viscosity ratio and was 15–25% lower for marsupials compared with humans. Our results suggest that environmental pressures since the marsupial–monotreme divergence have influenced the development of vastly different strategies to maintain a match between oxygen demand and delivery.

A comparison of capillary and venous blood sampling methods for the use in haemorheology studies

Michael J. Simmonds et al. — Wed, 22 Feb 2012 20:42:27 PST

There is accumulating evidence that exercise may improve disturbed haemorheological parameters that are typically observed in various chronic diseases, thus there is a growing interest in exploring the influence of various exercise models for the improvement of haemorheology. Blood sampling using venipuncture, however, can be limiting during exercise and/or in field settings. The purpose of the present study was to investigate whether venous and capillary blood samples yield comparable red blood cell (RBC) deformability and aggregation indices. Twelve healthy volunteers (6 males and 6 females; age 30±9 yrs; body mass index 24.9±2.8 kgm−2) provided blood samples that were collected simultaneously from: i) a prominent forearm vein by venipuncture; ii) the earlobe using a lancet; iii) the middle finger using a lancet. Haematocrit, RBC deformability (Rheoscan-D, Sewon Meditech Inc., Korea) and RBC aggregation (Myrenne GmbH, Roetgen, Germany) were measured for each sample. Haematocrit and RBC deformability were not different between the three sampling sites, and the group averages of RBC aggregation parameters were not different between the three sampling methods. The time course of RBC aggregation was slower when using blood sampled from the earlobe, and there was stronger agreement between RBC aggregation parameters measured using venous and capillary finger samples compared with venous and earlobe. It is suggested that capillary blood sampling from the finger may provide a reliable alternative to venous blood sampling in clinical and field settings.

Body mass index of masters basketball players

Joe Walsh et al. — Sun, 15 Jan 2012 21:24:35 PST

Aim and Scope: Thousands of masters athletes participate quadrennially in the World Masters Games (WMG). However, this unique cohort remains under investigated. With a need for multifaceted solutions to the global obesity epidemic, investigating special populations such as those competing in sport at mature-older ages may further the understanding of the nexus between aging, physical activity and obesity. The aim of this cross-sectional comparative study was to investigate body mass index (BMI) within the WMG competitors in context with national populations and health guidelines. We hypothesized that the prevalence of obesity in the WMG cohort would be less than comparative national populations and males would demonstrate a higher level of obesity than females.

Methods: A total of 408 (44.1% male, 55.9% female) WMG basketball players aged 29-77yrs (mean 52.2, SD ± 8.0) were investigated via an online survey and compared to national populations, primarily a representative sample (n=12,366, 47.5% male, 52.5% female) of the Australian population (aged 30-79yrs).

Results: Analysis demonstrated a significantly (p<0.001) reduced classification of obesity in masters basketball players, compared to Australian and other national populations. As expected, male basketball players had , on average, higher BMI than females (p<0.001).

Conclusions: This study indicated that one key index of health, namely obesity, was on average far lower in WMG basketball players compared to a representative sample of population controls. This finding may indicate a lower risk for many diseases such as type 2 diabetes or heart diseases in masters basketball players and the selection of a sport that induces positive health related fitness for both male and female masters athletes.

Can evidence-based medicine and clinical quality improvement learn from each other?

Paul Glasziou et al. — Tue, 20 Dec 2011 21:21:26 PST

The considerable gap between what we know from research and what is done in clinical practice is well known. Proposed responses include the Evidence-Based Medicine (EBM) and Clinical Quality Improvement. EBM has focused more on ‘doing the right things’dbased on external research evidenced whereas Quality Improvement (QI) has focused more on ‘doing things right’ based on local processes. However, these are complementary and in combination direct us how to ‘do the right things right’. This article examines the differences and similarities in the two approaches and proposes that by integrating the bedside application, the methodological development and the training of these complementary
disciplines both would gain.

Letter to the editor: Antibiotics and acute otitis media in children

Paul Glasziou et al. — Tue, 20 Dec 2011 17:31:29 PST

Extract:
In Reply: Because of space constraints, some analyses we conducted had to be left out of our article. Our Evidence Report1 assessed the data concerning the effect of age and laterality on the effectiveness of antibiotic therapy, and it included a detailed discussion of the individual patient data meta-analysis by Rovers et al,2 along with other evidence not included in that analysis and new meta-analyses we conducted ourselves.

Problems and promises of innovation: Why healthcare needs to rethink its love/hate relationship with the new

Mary Dixon-Woods et al. — Tue, 20 Dec 2011 15:46:19 PST

Innovation is often regarded as uniformly positive. This paper shows that the role of innovation in quality improvement is more complicated. The authors identify three known paradoxes of innovation in healthcare. First, some innovations diffuse rapidly, yet are of unproven value or limited value, or pose risks, while other innovations that could potentially deliver benefits to patients remain slow to achieve uptake. Second, participatory, cooperative approaches may be the best way of achieving sustainable, positive innovation, yet relying solely on such approaches may disrupt positive innovation. Third, improvement clearly depends upon change, but change always generates new challenges. Quality improvement systems may struggle to keep up with the pace of innovation, yet evaluation of innovation is often too narrowly focused for the system-wide effects of new practices or technologies to be understood. A new recognition of the problems of innovation is proposed and it is argued that new approaches to addressing them are needed.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation: How strong is the association?

Steven McPhail et al. — Thu, 15 Dec 2011 16:48:37 PST

Extract:

To the Editor: When an elderly patient has a first-time presentation of psychiatric symptoms, a physical cause should be suspected. In geriatric practice, these symptoms are often due to delirium, cognitive decline, or a mood disorder. The present case history illustrates the importance of further investigation when geriatric assessment alone cannot explain the symptoms sufficiently.