Mitral regurgitation, mitral stenosis, and mitral annular calcification in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Because the expected life span after surgery is shorter for the elderly patient at the time of surgery, there is an advantage of bioprosthetic valves over mechanical valves in older patients since anticoagulation is not necessary in the absence of AF. The frequency of AF in elderly patients with moderate to severe chronic MR lessens the advantage because these patients require anticoagulants to prevent systemic emboli (41). There is evidence that valve degeneration occurs much more slowly in elderly than in younger patients. In one study, the rate of primary structural deterioration in patients over the age of 65 years was 0.95% per patient-year (79). For this reason, in patients over 65 years of age, the prevailing opinion is that the preferred valve is a bioprosthetic one.
Housing and Urban Health
Igor Vojnovic, Amber L. Pearson, Gershim Asiki, Geoffrey DeVerteuil, Adriana Allen in Handbook of Global Urban Health, 2019
Structural deterioration and poor housing conditions can cause or contribute to many health problems for adults and children (Miles and Jacobs 2008; Shafiei 2011). In addition to injuries from falling debris or unsafe features like damaged stairs, poor structural conditions may allow water leaks, which can further degrade the structure and promote rot, holes in walls, and other problems (see Figures 39.3 and 39.4). Water leaks from old pipes, structural holes, dampness, and poor ventilation can contribute to the severity, duration, and spread of infections (Barton et al. 2007; Lowe and Haas 2007; Sun et al. 2017). Structural problems also are an attractive environment for pests. In a qualitative study of low-income households in a Boston neighborhood, Hernández (2016) documents the problem of holes in the interior walls of apartments: “insect and rodent infestations were extremely common problems for families living in older and poorly maintained dwellings” (p. 934). Mice and rats can spread a wide range of diseases, either directly through biting and their bodily waste or indirectly by carrying other pests such as fleas or ticks (Childs et al. 1998; Easterbrook et al. 2005; Himsworth et al. 2013). The Centers for Disease Control and Prevention (CDC) maintain a list of diseases associated with such pests, which includes hantavirus pulmonary syndrome, salmonellosis, and Lyme disease (CDC 2012).
Magnetic Resonance Imaging Physics
Debbie Peet, Emma Chung in Practical Medical Physics, 2021
MRI QC is important for minimising the risk of significant deterioration of the MRI system while in clinical use. This could potentially compromise clinical diagnostic quality and ultimately safety. Clinical Scientists perform a number of performance tests to advise whether a detected deterioration requires (i) immediate corrective maintenance, (ii) corrective maintenance during a future planned service and (iii) clinical awareness and monitoring. It is not always feasible or cost effective to carry out corrective maintenance whenever deterioration is detected by QC testing, so experienced judgement and a risk assessment may be required. Sometimes it can take extensive systematic testing by both Clinical Scientists and Engineers to determine exactly what component in the system has caused a deterioration in image quality.
Rates and Predictors of Deterioration in a Trial of Internet-Delivered Cognitive Behavioral Therapy for Reducing Suicidal Thoughts
Published in Archives of Suicide Research, 2022
Philip J. Batterham, Helen Christensen, Alison L. Calear, Aliza Werner-Seidler, Dominique Kazan
In examining the wider field of online mental health interventions, there exists a paucity of research that has explored the potential negative effects of internet interventions (Rozental, Boettcher, Andersson, Schmidt, & Carlbring, 2015). The concept of “negative effects” has been difficult to define in the literature, as they can be measured on the basis of symptom deterioration, adverse events, non-response or drop-out (Cuijpers, Reijnders, Karyotaki, de Wit, & Ebert, 2018). Deterioration is the type of negative effect that has been most widely studied as an indicator of negative effects, and can be defined as “the worsening of target symptoms monitored by a validated outcome measure or behavioral measure” (Rozental et al., 2014, p. 15), with a relatively consistent definition across trials based on reliable change (Ebert et al., 2016).
Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients
Published in International Journal of Neuroscience, 2018
Ophélie Pila, Christophe Duret, Jean-Michel Gracies, Gerard E. Francisco, Nicolas Bayle, Émilie Hutin
Some studies have questioned the efficacy of conventional community therapy in chronic stroke [32–34], and others have demonstrated its lack of meaningful functional efficacy, for example, with clinically minimal improvements of walking speed [35–37]. In the present study, the more severe patients (baseline FM < 17) followed a trend toward greater impairment four years into their stroke, despite the robot-based therapy that benefited them in the subacute phase and despite the community-based therapy (three sessions a week on average) they followed for four years. Such slow, long-term deterioration is reminiscent of the findings by Leonard et al. [10]. The less severely impaired patients in the subacute phase (baseline FM ≥ 17) may have been protected against this deterioration since they even show clinically modest although statistically significant FM score improvement in the present study. The design of the study, however, makes it impossible to ascertain whether this slight improvement might have been partially due to the intensive combined therapy (robot + occupational therapy) performed early after stroke, to the conventional community-based therapy received thereafter, to both or to yet another factor. At least these data tend to suggest that today's community-based therapy is inadequate for severe patients, if the goal is to give them a chance for further improvement in the chronic phase.
Changes in Walking Performance between Childhood and Adulthood in Cerebral Palsy: A Systematic Review
Published in Developmental Neurorehabilitation, 2020
Hsiu-Ching Chiu, Louise Ada, Chiehfeng Chen
Some limitations of the present study should be considered. First, it is difficult to determine the amount of deterioration. We only know about the gross level of walking performance, not more specific walking ability (e.g. walking speed or distance). For example, children with cerebral palsy may still stay at the same GMFCS level but still have changes in walking speed.11 Identifying the association between change in walking speed between childhood and adulthood and the change in motor impairments could provide clinicians with guidance for targeted intervention before the significant change in functional status. Second, we cannot confirm the findings of several previous studies5,9,12,13 that walking performance declines with age in cerebral palsy. This may be because some of these studies were not cohort5,12 or their participants were much older than ours.9,13 The reduced efficiency of walking ability in late adulthood9,13 may perhaps be regarded as part of natural history. This underlines the need for the further longitudinal study in people with cerebral palsy to provide the guidance for therapeutic intervention to maintain walking performance.