Modeling physical dependence in arthritis: the relative contribution of specific disabilities and environmental factors.

OBJECTIVES: To explore the relationship between disability and physical dependence handicap, and the mediating effect of personal (demographic) and environmental factors as modeled by the International Classification of Impairments, Disability, and Handicaps. METHODS: Data on people with arthritis-associated disabilities were abstracted from a national population survey (n = 16,017). A hierarchical physical dependence variable was formulated. Nominal logistical regression was used to determine predictors of physical dependence related to specific disability, personal characteristics, and environmental adaptation variables. RESULTS: The risk of physical dependence only increased substantially at age > or = 75 years. Specific types of physical disability differentially predicted different levels of physical dependence. The major predictor of physical dependence was disability alone and in conjunction with environmental factors. CONCLUSIONS: There appears to be a specific and ordered relationship between the level of physical dependence and various types of physical disabilities. The findings could have implications for therapeutic intervention and health status measures.

Determining suitability for home versus community-based ambulatory therapy services for adults with arthritis.

OBJECTIVE: A survey of clients seen by a community-based arthritis therapy service was conducted to investigate how characteristics of clients might provide information to assist in the development of guidelines for services delivered in the home versus in a community-based ambulatory setting. METHODS: Clients completed a self-administered questionnaire, which included the Health Assessment Questionnaire, and a mobility handicap measure. Two indicator variables selected as criteria for suitability for ambulatory therapy were the therapists' rating of client suitability and the clients' report of going out more than once weekly. RESULTS: Based on these indicator variables, 60-76% of clients currently receiving home therapy by this service could potentially receive services in a community-based ambulatory setting. CONCLUSION: The results demonstrate the usefulness of considering client characteristics when deciding whether clients need to be seen at home. This study emphasizes the need to determine the most efficient and effective methods of providing services to people in the community with chronic conditions.

School contact tracing following a cluster of tuberculosis cases in two Scarborough schools.

Ten refugee children from an extended family were diagnosed with active tuberculosis. The family had recently arrived in Scarborough from Somalia. Mantoux skin testing was organized by the local health department for students in the two schools the children attended. An eleventh active case was found on screening. The reactivity rate for children tested once was 1.2% for Canadian-born students, and 14.6% for foreign-born students. Reactivity rates of students tested once were not significantly higher than those in comparison schools. Repeat skin testing of non-reactors revealed a conversion rate of 4.4%. This rate may be an overestimate as a result of the booster phenomenon. Increased risk of testing positive was associated with a history of BCG and being foreign-born in all schools. As rates of tuberculin reactivity have greatly increased in Scarborough schools since the early 1980s, it is recommended that health departments screen foreign-born students for tuberculosis upon entrance to school.

Computed tomography and angiography in the diagnosis of suprasellar mass lesions.

We studied four cases in which the differentiation between a noncalcified suprasellar aneurysm and tuberculum meningioma, and a calcified suprasellar aneurysm and craniopharyngioma, could not be established by computed tomography scan alone. Cerebral angiography clearly showed both aneurysms.

Jugular venography for evaluation of abnormalities of the skull base.

Jugular venography done to evaluate abnormalities at the base of the skull demonstrated three distinctly different patterns depending on whether there is occlusion, invasion, or growth with in the internal jugular vein. Improper technique results in a lack of intracranial dural sinus filling which may masquerade as venous occlusion. This problem is avoided by adequate neck compression along with proper volume and rate of delivery of contrast. Radiographically, an abnormal jugular vein at the base of the skull will show a concave defect in true occlusion, constriction or invasion of the vein by tumor, or tumor growth within the vein.

Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms.

Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.

Intracranial ectopic pituitary adenoma. Case report.

The authors report a unique case of ectopic intracranial pituitary adenoma, associated clinically with generalized seizures and aggressive behavior. The lesion presumably arose from cells in the pars tuberalis and did not involve the sella turcica.