The work of rehabilitation.

PURPOSE: To describe three years of activity of a rehabilitation unit and to make comparisons between clients who receive different levels of active rehabilitation. METHOD: A retrospective study set in an inpatient rehabilitation facility located in Dunedin, New Zealand, examining 874 inpatient admissions over three financial years (2000--2002). Outcome measures include Functional Independence Scores (FIM) at admission and discharge, length of stay, weekly gains in FIM scores, and changes in FIM sub-scores. RESULTS: Assessment and rehabilitation patients made significant FIM gains in comparison to assessment only and social relief (respite care) patients. Assessment and rehabilitation patients showed greater gains in the Physical dimensions of the FIM in comparison to the Cognitive although this is probably a function of different scaling. Floor and ceiling effects were not present in the FIM. CONCLUSIONS: The interdisciplinary rehabilitation program brings about real functional and cognitive gains in a range of patients as measured with the FIM. This adds to the considerable body of research which documents FIM gains and further provides evidence that physical and cognitive gains differ.

The West Coast Study. I: Self-reported dental health and the use of dental services.

This study examined self-reported dental health and the use of dental services in a sample of the population of the West Coast of the South Island of New Zealand. The study differs from previous national surveys in that it provides a regional focus in a relatively remote area of the country; it provides an estimate of the prevalence and severity of dental anxiety among New Zealanders, using an instrument with a long history of use and validation; and it estimates the social impact of oral conditions. A questionnaire was mailed to 450 adult members of the population chosen at random from the electoral roll. The overall response rate was 76.6 percent. A dental check-up was the most commonly reported reason for the last visit to the dentist, although presentation for a specific problem accounted for 63 percent of all dental visits. Some 78.8 percent of the respondents described themselves as dentate, and episodic dental visiting was reported by 53 percent of that group. Higher proportions of episodic use of dental services were observed among beneficiaries, those on low incomes, and those who were classified as dentally anxious. Six percent of respondents had their last dentally treatment funded by public monies, and a further 3.6 percent did not have to pay. Beneficiaries and Community Services Cardholders were more likely to make up these groups. While public funding ensures access to care for a substantial number of individuals. West Coast dentists are supplementing this care by providing treatment without charge for a small number of people. Various adverse impacts of oral conditions were reported by up to 8.6 percent of respondents; more Community Cardholders reported feeling self-conscious or embarrassed than non-Community Cardholders. Geographic isolation and lack of choice of dental practitioner did not appear to be factors in determining utilisation. The two characteristics associated with poorer self-reported dental health and infrequent use of dental services were lower socio-economic status and self-reported dental anxiety. The findings of this study provide regional-level confirmation of the general findings of the 1976 and 1988 national studies.

The West Coast Study. II: Dental anxiety and satisfaction with dental services.

Dental anxiety is common, and is a notable factor in the avoidance of dental care. The dental satisfaction of users is an important indicator of the quality of dental care. A postal survey (response rate 76.6 percent) was used to investigate dental anxiety and dental satisfaction among a representative sample of 249 dentate adults living on the West Coast of the South Island of New Zealand. Dental anxiety was reported by 20.8 percent of respondents, and was more prevalent among beneficiaries (individuals in receipt of a Social Welfare benefit) and younger people. Dental satisfaction was lower among younger people and those who were dentally anxious, and was higher among people with a tertiary education. Differences in consumers' expectations were considered responsible for the latter findings. Where appropriate, dentists should be prepared to adapt their manner of communicating with patients.

Hospital morbidity due to head injuries in New Zealand in 1980-1988.

We studied the morbidity in New Zealand using hospital discharge data from 1980 to 1988, and found a reduced head injury (HI) rate over this time overall, but no change in the rate among Maori males and an increased rate among Maori females. In 1988 the rate was 228/100,000 with peaks among males and females aged under 10, males aged 15-25, and both sexes over 84 years old. The rate among young Maori males was higher than in other groups until the age of 55. Motor vehicle crashes caused most head injuries, followed by falls, non-intentional incidents (such as sporting injuries), assaults and pedal cycle accidents. Maori females had a high rate of assault. Hospital stay was longest among pedestrians, and increased with increasing age due to co-morbidity. Prevention strategies were based on the causes of HI.

Epidemiology of spinal cord injury in New Zealand.

Spinal cord injury (SCI) is a catastrophic and costly result of both intentional and unintentional injury. We present data from the Health Statistics Services files of New Zealand for the year 1988 on the epidemiology of SCI resulting in morbidity. New Zealand has one of the highest rates of SCI in the western world and since 1979 this has been increasing. It occurs most often to young, caucasian men and is typically the result of motor transport crashes. The ethnicity adjusted rates show high rates for Maori males. Children in New Zealand have greater than 4 times the risk of an SCI than American children. The rehabilitation and hospital costs for SCI are among the highest for all injuries. There were a higher number of high cervical injuries than reported in previous series and 92% of SCI were incomplete indicating the high rehabilitation potential of the sample. Some measures are suggested to reduce the incidence of SCI.

Is the prevalence of Parkinson's disease in New Zealand really changing?

The prevalence of idiopathic Parkinson's Disease (IPD) in Dunedin, New Zealand on 31st July 1990 was 110.4/100,000. When corrected to a standard population based on the 1960 U.S. census, the prevalence fell to 76.0/100,000 due to changes in the age structure of the population. The corrected prevalence in Wellington (another New Zealand city), in 1962 was 99.6 (before the introduction of levodopa), and in Aberdeen, Scotland in 1984 was 102.7. The principal difference was fewer people under 65 years of age in our study. Case finding methods and diagnostic criteria were similar in all three studies, and case ascertainment was adequate. Under representation of younger people could be due to either a lower incidence rate or poorer survival due to treatment with high doses of levodopa compounds. Prospective research is required to explain our findings.

Medications and their monitoring in Parkinson's disease in Dunedin.

AIMS: to establish the patterns of drug administration and monitoring in people with Parkinson's disease. METHOD: a total community sample was obtained. One hundred and one of the 116 people with Parkinson's disease in Dunedin, who were alive on 31 July 1990, had a full medical assessment. RESULTS: the general practitioner made the diagnosis in 51%, a neurologist in 22%, a geriatrician in 18%, and other in 9%. The general practitioner provided prescriptions for 51 of the 68 people living in the community, a neurologist for 11, and a geriatrician in six cases. The general practitioner provided prescriptions for 23 of the 33 living in an institution, and a geriatrician in ten cases. Medical review took place more frequently than three monthly in 49 cases. There were 81 general practitioners in practice on the prevalence day in the study area. Thirty-six had no patients with Parkinson's disease, 30 had one or two, and the other 15 had varying numbers. Fifty-eight of the 90 patients taking levodopa were taking it as the only therapy. Eight patients were taking phenothiazines. There was a high incidence of side effects and 70 patients had long term complications including loss of effectiveness over time, the end of dose and the on-off phenomena, and dyskinesias. CONCLUSIONS: monitoring of treatment appeared satisfactory but major concerns about drug management included the high use of levodopa monotherapy and the concurrent use by general practitioners of phenothiazines in eight cases. Because most general practitioners have very few patients with Parkinson's disease they will not develop the experience to manage complicated drug regimens in people whose management tends to become more difficult with time. With selegiline and controlled release levodopa only being available on specialist prescription, we suggest that all people with Parkinson's disease should have the benefit of a specialist review at least every two years.

Stress in caregivers of elderly patients: the effect of an admission to a rehabilitation unit.

OBJECT: to study stress in caregivers of elderly dependent persons after admission to a geriatric assessment and rehabilitation unit. METHOD: in 1986-7 we studied patients admitted to a geriatric assessment and rehabilitation unit in Dunedin to establish the relationship between caregiver stress, their psychological health and social functioning, and patient variables such as physical dependency. RESULTS: of the 64 patients who were admitted from the community and who had a caregiver, 42 were discharged back to the community, and 30 remained there until six weeks. On admission caregiver stress was increased by problems perceived in social function (lack of companionship, excessive responsibilities and financial problems) and decreased when the caregiver had a high sense of psychological wellbeing. It was not associated with high patient dependency or the level of social support. Caregiver stress one week after discharge was lower among those with high emotional support and those with an internal locus of control. If caregiver stress one week after discharge was high there was an increased rate of readmission. CONCLUSION: rehabilitation should include interventions directed towards the psychological health and social function of the caregiver as well as the physical independence of the patient. Improved financial support and the provision of companionship through community support groups may result in reduced caregiver stress, which should help dependent elderly people to continue to live in the community.

User pays in the mental health service--256 discharges from Ashburn Hall.

A retrospective descriptive analysis was undertaken on all patients discharged from Ashburn Hall over a 14 month period. The sample of 256 patients was found to have a female to male ratio of 6:4 and contained 4.3% of individuals without school certificate (cf 48.3% national statistics) and 23% with a university degree or diploma (cf 13.2% in the general population). Seventy-four point six percent of the sample had some significant previous psychiatric history although for 68% of the sample this was their first admission to Ashburn Hall. A quarter of the sample came from the surrounding geographic area and patients were more likely to be referred by specialists rather than general practitioners as geographic distance increased from the hospital. Comparisons with the public system showed a predominance of patients with major affective disorder and less patients with a diagnosis of substance abuse and mental retardation.

Benefit from admission to a geriatric assessment and rehabilitation unit. Discrepancy between health professional and client perception of improvement.

To determine differences in perception of benefit from a patient's admission to a geriatric Assessment and Rehabilitation Unit, we asked both medical and nursing staff (health team) and the patient and carer (clients) for their evaluation after discharge. The areas studied were functional ability, relief of the principal symptom, education about the principal problem, and development of coping skills. Of 94 patients studied, 58 patients were discharged to the community (52 to carers, 6 to live alone) and 36 to institutions. In the former group, the health team had a consistently higher perception of benefit than the clients (P less than .001). Factors positively predicting health team perception of benefit were a higher carer happiness, improvement in patient independence, and internalization of the patient's locus of control. A negative predictor was an increase in patients' responsibilities. Client perception of benefit was positively predicted by fewer problems with companionship and communication with others. The health team's perception rated the adequacy of patient education and development of coping skills more highly than did the clients. In the patients discharged to the community, their perception of benefit at 1 week was a good predictor of survival in the community to 6 weeks. The possible reasons for these differences in perception of benefit and their implications are discussed.

AC calorimetry of dimyristoylphosphatidylcholine multilayers: hysteresis and annealing near the gel to liquid-crystal transition.

The gel to liquid-crystal phase transition in dimyristoylphosphatidylcholine liposomes was studied with 0.4-Hz ac calorimetry. The ac heat capacity on heating scans exhibited a peak in the vicinity of 23.9 degrees C with a full width at half-maximum of 0.15-0.20 degrees C. The enthalpy change was 4.8 kcal/mol, in good agreement with conventional differential scanning calorimetry. On cooling scans, the peak shifted to lower temperature by 0.1-0.5 degrees C, the width increased to 0.25-0.40 degrees C, and the apparent enthalpy change was only 40% of that observed on heating. Both the heating and cooling heat capacities were stable for at least 20 min in quasi-isothermal conditions. Following a 1 h anneal at 10 degrees C, the heating scans were quite reproducible. The results have been interpreted in terms of the nucleation and subsequent annealing of small ordered domains in the bilayer on freezing the acyl chains. No peak associated with the pretransition was observed, as expected since the relaxation time for the degrees of freedom the produce the pretransition is much longer than the period of the 0.4-Hz temperature wave.