Dual task performance in Parkinson's disease: a sensitive predictor of impairment and disability.

BACKGROUND: Dual task (DT) performance assesses the ability to perform two tasks simultaneously. Difficulty with DT performance may be a sensitive indicator of early Parkinson's disease (PD) impairment. The objective of this study was to assess what elements of a DT performance (cognition or gait) are most associated with impairment and disability in PD. METHODS: Performance in single and DT conditions was examined in 154 PD patients. The single task assessments included the time required to walk 50 feet (gait speed) and the number of words generated in a verbal fluency task (word generation). The DT comprised simultaneous performance of the single tasks. Impairment and disability were measured with the Unified Parkinson's Disease Rating Scale, Hoehn &Yahr, Berg Balance Scale, and Older Americans Resource and Services Scale. Age, education, and gender were control variables. Standardized residuals from regressions of DT upon single task performance were computed separately for word and gait, indicating the extent that the individual performed proportionally better/worse than predicted in DT considering their single task performance. RESULTS: Multiple regressions revealed that individuals who performed worse than expected in DT-word had greater impairment and disability. Dual task-gait was not significant in any model. Verbal fluency during DT performance is more closely associated with PD-related impairment and disability than gait speed during DT. CONCLUSION: This suggests that subjects prioritize gait performance at the expense of cognitive performance, and that DT word generation may be a sensitive indicator of early PD impairment and disability.

Predictive value from pediatrician plusoptix screening: impact of refraction and binocular alignment.

BACKGROUND: The positive predictive value (PPV) of conventional preschool acuity screening is about 50% whereas previous Polaroid photoscreening with experienced interpretation can achieve PPV greater than 85%. The Plusoptix photoscreener has immediate computer interpretation and a CPT code available to pediatricians. METHODS: Two Plusoptix SO9 were used in two pediatric group practices with previously validated refractive criteria and new manufacturer's binocular alignment criteria. CPT billing was monitored. Referred patients had prior gold-standard AAPOS examinations. RESULTS: 12% of 675 photoscreened preschoolers were referred. Of the 39 with AAPOS gold-standard exams, the PPV from strabismus referrals was 17%, while 26 of 27 refractive referrals had true amblyopia risk factors (PPV 96%). Screening CPT code 99174 reimbursement rose from zero to half of insurers in 15 months. CONCLUSION: Plusoptix photoscreening is valid after adjusting the binocular alignment criteria. Such photoscreening should be employed by pediatric practices to detect and ultimately to reduce amblyopia vision impairment in children.

Killing versus witnessing in combat trauma and reports of PTSD symptoms and domestic violence.

Active participation in combat trauma increased reports of posttraumatic stress disorder (PTSD) symptoms over passive witnessing of trauma. Using archival data from 376 U.S. soldiers who took part in the family interview component of the 1988 National Vietnam Veteran Readjustment Study (NVVRS), findings are that even after statistically accounting for witnessing combat trauma, U.S. soldiers who likely killed enemy soldiers in combat reported elevated levels of PTSD symptoms. Both inference and direct self-reports were used to measure killing in combat, and both measures accounted equally well for variance in PTSD symptoms. The likelihood of a soldier killing enemy combatants was also weakly related to his spouse's report of physical domestic violence in the past year. Diagnosing the mental health symptoms of combat soldiers should specifically assess whether they actively participated in wounding or killing the enemy.

Should routine peripheral blood glucose testing be done for all newborns at birth?

PURPOSE: To determine the (1) incidence of peripheral blood glucose (PBG < 40 mg/dL) in infants within 2 hours of birth and (2) validity of using maternal and infant risk factors and/or infant signs/symptoms of hypoglycemia as a screen for PBG < 40 mg/dL. STUDY DESIGN: Descriptive study with a convenience sample of 220 mother-infant dyads admitted to a mother-baby unit. Maternal and infant risk factors and infant signs/symptoms of hypoglycemia were assessed, and a PBG value was obtained within 2 hours of birth from the infant. Data were analyzed with descriptive statistics, multiple regression analysis, and sensitivity and specificity testing. RESULTS: The incidence of PBG < 40 mg/dL was 5.1% (N = 10 of 198). Fifteen maternal/infant risk factors were found; 2 of the 23 risk factors predicted PBG values within 2 hours of birth at a statistically significant level (jitteriness [p = .011] and tachypnea [p = .033]). Sensitivity was 71.9% and specificity 44.7% for using the presence of at least one maternal/infant risk factor and/or infant signs/symptoms of hypoglycemia to correctly identify PBG < 40 mg/dL within 2 hours of birth. CLINICAL IMPLICATIONS: Nurses working with mothers and infants can use the data from our study along with the recommendations from professional organizations such as American Academy of Pediatrics to begin a conversation at their institutions about revising protocols for routine PBG testing. Screening infants for maternal/infant risk factors and infant signs/symptoms of hypoglycemia could be used instead to safely decrease by 45% the number of infants who would need to have a PBG sample obtained within 2 hours of birth.