Issues in aging in individuals with life long disabilities

INTRODUCTION: The major research data and findings related to aging among persons with developmental disabilities are discussed. Topics addressed include prevalence and mortality rates, as well as the effects of aging on the sensory systems, the neuromusculoskeletal system and the cardiopulmonary system. The discussion also focuses on the clinical implications of these changes among aging individuals with developmental disabilities. CONCLUSION: Although the individual needs of persons with developmental disabilities vary greatly, knowledge of the effects of aging on this group of individuals can facilitate more effective healthcare by physical therapists for all adults with developmental disabilities.

INTRODUÇÃO: Os dados de pesquisa mais importantes e seus resultados relacionados ao envelhecimento de pessoas com incapacidades prévias são aqui discutidos. Os tópicos abordados incluem a prevalência e os índices de mortalidade, bem como os efeitos do envelhecimento sobre os sistemas sensitivos, músculo-esquelético e cardiopulmonar. A discussão também aborda as implicações clínicas destas mudanças no indivíduo que envelhece sendo portador de uma incapacidade prévia. CONCLUSÃO: Embora as necessidades individuais de pessoas com incapacidades variem muito, o conhecimento dos efeitos do envelhecimento neste grupo de indivíduos pode promover o uso de cuidados de saúde mais eficientes pelos fisioterapeutas que cuidam de adultos com incapacidades prévias.

Ultrasonographic and clinical predictors of intussusception.

OBJECTIVE: The objective of this study was to determine the positive and negative clinical predictors of intussusception and the correlation of ultrasonography and air enema in establishing this diagnosis. STUDY DESIGN: This was a prospective descriptive cohort study. SETTING: This study was performed in a tertiary care pediatric emergency department. PARTICIPANTS: Eighty-eight of 245 candidates were assessed for clinical predictors of intussusception. All 245 cases were examined for correlation between ultrasonography and air enema. INTERVENTIONS: A questionnaire, ultrasonography, and air enema were used. RESULTS: Thirty-five of the 88 patients assessed for clinical predictors were positive for intussusception. Significant positive predictors were right upper quadrant abdominal mass (positive predictive value [PPV] 94%), gross blood in stool (PPV 80%), blood on rectal examination (PPV 78%), the triad of intermittent abdominal pain, vomiting, and right upper quadrant abdominal mass (PPV 93%, p = 0.0001), and the triad with occult or gross blood per rectum (PPV 100%, p = not significant). Significant negative predictors were a combination of > or = 3 of 10 clinically significant negative features (negative predictive value 77%, p = 0.035). Of the total 245 cases, intussusception (as confirmed by doughnut, target, or pseudokidney sign) was ruled out by ultrasonography in 97.4%. Alternate ultrasound findings comprised 27% of negative cases. CONCLUSIONS: Excellent positive predictors of intussusception were identified prospectively. Although no reliable negative predictors were found, patients at low risk may be screened by ultrasonography.

Mammalian hexokinases: a system for the study of co-operativity in monomeric enzymes.

Kinetic and structural studies have been carried out of two isoenzymes of hexokinase from the rat, hexokinase II and glucokinase. Although both enzymes are monomeric, hexokinase II has a molecular weight double that of glucokinase and resembles a dimer of glucokinase. The co-operativity of glucokinase, which is not observed for hexokinase II, appears to be kinetic in origin rather than the consequence of ineractions between distinct glucose-binding sites.