Determination of a Cut-Off Point of a Scale for Achievement Motive in Geriatrics That Predicts the Frequency of Undertaking Instrumental Activities of Daily Living in Community-Dwelling Elderly People

Background: Among elderly people, rehabilitation is important for reducing the risk of falls and hospitalization and to maintain an independent life for longer. Motivation is a factor for elderly people to lead an active daily life and leave home more frequently. Purpose: The purposes of this study were to determine the optimal cut-off point in the Scale for Achievement Motive in Geriatrics (SAMG) that could identify individuals as inactive or active, based on the Frenchay Activities Index (FAI), and to compare characteristics between active and inactive groups classified by the cut-off point. Methods: A cross-sectional study of 285 community-dwelling elderly people measured SAMG and FAI and physical function. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) that was the optimal cut-off point for the SAMG total score, with the associated sensitivity and 1-specificity when compared with the FAI results. Demographic parameters and physical function were compared between two groups defined by cut-off point. Results: The AUC was 0.78, the optimal cut-off for SAMG total score for indicating inactivity was ≤48, the sensitivity was 77.98% and the 1-specificity was 75.00%. The group with SAMG score >48 was characterized by a significantly higher proportion of women, fewer people sharing a house, and participation in more hobbies. Discussion: A cut-off point of 48 in the SAMG could be a predictive index of motivation toward goals for individuals with inactive daily activities. The group with score higher than the cut-off was characterized by more women, fewer people living together, and more hobbies than the group with lower scores.

D-MELD risk capping improves post-transplant and overall mortality under markov microsimulation

AIM: To hypothesize that the product of calculated Model for End-Stage Liver Disease score excluding exception points and donor age(D-MELD) risk capping ± Rule 14 could improve post liver transplant and overall survival after listing.METHODS: Probabilities derived from the United Network for Organ Sharing database between 2002 and 2004 were used to simulate potential outcomes for all patients listed for transplantation. The Markov simula-tion was then modified by screening matches using a 1200 or 1600 D-MELD risk cap ± allowing transplants for Model for End-Stage Liver Disease(MELD) ≤ 14(Rule 14). The differential impact of the rule changes was assessed.RESULTS: The Markov simulation accurately reproduced overall and post transplant survival. A 1200 D-MELD risk cap improved post-transplant survival. Both the 1200 and 1600 risk caps improved overall survival for waitlisted patients. The addition of Rule 14 further improved post transplant and overall survival by redistribution of donor livers to recipients in higher MELD subgroups. The mechanism for improved overall and post-transplant survival after listing was due to shifting a larger percentage of transplants to the moderate MELD score subgroup(MELD 15-29) while also ensuring that high MELD recipients have livers of high quality to achieve excellent post transplant survival.CONCLUSION: A 1200 D-MELD risk cap + Rule 14 provided the greatest overall benefit primarily by focusing liver transplantation towards the moderate MELD recipient.

Functional performance levels of strength and power needed for independence in 80-year-old individuals

Background: The ability to climb stairs (ascending and descending stair without using a handrail) and rise from a chair (rising from chairs without using an elbow rest) are among the most important measures of physical function for ADL evaluation for the independent living, and assessed by the questioners on many epidemiological studies in elderly. But little is known about the relationship between the self-reported performance level of the tasks and lower leg strength and power in very elderly people. The purpose of this study was to ascertain the relationship between the self-reported performance level of two tasks and the lower leg function in community-dwelling 80-year-old population. Methods: Out of 994 persons who were 80 years old living in Morioka City, Iwate Prefecture, Japan, 607 individuals (236 men and 371 women) underwent a physical fitness test that included measurements of leg extensor power and knee extensor strength. The ability to climb up stair and to rise from a chair was assessed by self- reported questionnaire which was ranked in three levels. The area under the receiver-operating characteristic (ROC) curve (AUC) was used to evaluate the measurements. Results: The cut-off points for the leg extensor power of subjects who could completely perform the stair-climbing and chair-rising functions were determined to be approximately 8.6 watt/kg body mass for men and 5.6 watt/kg body mass for women. In addition, the cut-off points for the knee extensor strength of subjects who could completely perform the stair-climbing and chair-rising functions were determined to be approximately 0.97 kg/kg body mass for men and 0.84 kg/kg body mass for women. Conclusions: From a practical viewpoint, the present study suggested that the cut-off points of leg extensor power and knee extensor strength can be used as targets in simple self-reported questionnaires to help in screening for mobility in 80-year-old

Existence and uniqueness of solutions for a hierarchical system of two age-structured populations

We propose a class of new hierarchical model for the evolution of two interacting age-structured populations,which is a system of integro-partial differential equations with global feedback boundary conditions and may describe the interactions such as competition,cooperation and predator-prey relation.Based upon a group of natural conditions,the existence and uniqueness of solutions on infinite time interval are proved by means of fixed point and extension principle,and the continuous dependence of the solution on the initial age distribution is established.These results lay a sound basis for the investigation of stability,controllability and variable optimal control problems.

Effect of electric acupoint stimulation on gastrointestinal hormones and motility among geriatric postoperative patients with gastrointestinal tumors

OBJECTIVE:To evaluate the effects of electric acupoint stimulation on gastrointestinal hormones and motility among geriatric postoperative patients with gastrointestinal tumors,and to explore an efficient and noninvasive method for postoperative recovery of bowel functions.METHODS:Forty patients were randomly and evenly assigned into a regular nursing care group(RNC) and an acupoint electric stimulation group(AES).Patients in the RNC group received regular nursing care and patients in the AES group received regular nursing care plus electric stimulation of acupoints.The serum levels of gastrin(GAS),motilin(MOT),and cholecystokinin(CCK),and an electrogastrogram(EGG) of all the patients were evaluated on the first,third,and fifth day after surgery.The time to first flatus after surgery and the number of patients with side effects such as abdominal pain,abdominal distention,and diarrhea were recorded.RESULTS:There were significant differences between the two groups in GAS,MOT,EGG,time to first flatus,abdominal pain,abdominal distention,and diarrhea(P < 0.05).CONCLUSION:Electric stimulation on acupoints could increase levels of GAS and MOT,promote the recovery of gastrointestinal functions,and decrease complications among postoperative senile patients with gastrointestinal tumors.

略论西南地区早期平底双耳罐的源流及其族属问题

The rock-cut tomb and cist burial culture prevailed once in ancient southwest China.There have long been many discrepancies of views on its origin, evolution, periodization and ethnic attribution in academic circles. Based on an analysis of the pottery flat-bottomed amphoras that constitute its major characteristic feature, the present paper points out that these typical vessels were roughly distributed in the upper Minjiang River valley, western Sichuan, eastern Tibet, northwestern Yunnan, southwestern Sichuan, and the areas to the west of the Dianchi Lake and to the east of the Erhai Lake. Most of the amphoras recorded so far are unearthed from rock-cut and cist tombs while a small number from earthen-pit,brick-and-stone and brick-chambered burials. Those found in Yunnan are from earthen-pit and cist tombs. Through a systematic study of their typological classification, periodization and origin, the author comes to the conclusion that the emergence of these vessels resulted from the constant southward migration of nomads belonging to the Di-Qiang ethnic group in northwest China. The starting point of these vessels can be traced to the turn from the Xia to the Shang period. Latter, with the amalgamation of ethnic groups and the formation of a plural national unity in the Han Dynasty, these immigrants gradually changed their way of life from husbandry to settled farming, and in southwest China early-style flat-bottomed amphoras became extinct little by little. Therefore their lower limit was the Eastern Han period. Thus they were out of prevalence in the Eastern Han period. The above-described amphoras fall roughly into five types and further into several subtypes and styles, which represent respective temporal and spatial links of their evolutionary sequence. Their proto-type and similar forms must have originated from the Keshengzhuang Ⅱ, Qijia, Siba, and Kayao cultures in the northwest China. The cultural source and ethnic attribution of early-style flat-bottomed amphoras in the southwest China reflect clearly that from the Bronze Age to the early Iron Age, owing to the collision of civilizations and the acceleration of their development, a migration ware was again brought about in the ethnic history of west China. The southward migration of the Di-Qiang ethnic group from northwest China was an important origin of nationalities and their cultures in ancient southwest China.

中国青少年中体质指数与丙氨酸氨基转移酶的关系:一项基于学校的横断面研究

背景:许多研究一致认为,体质指数(BMI)较高的成年人丙氨酸氨基转移酶(ALT)水平相对较高,但在青少年人群中是否也存在此种相关性尚不明了,尤其是在中国青少年中。本研究旨在调查中国青少年中BMI与ALT的相关性。方法:2017年2月至2018年6月间,在深圳9所中学进行本项横断面研究。采用年龄和性别调整的广义线性回归模型及二元相关分析来明确BMI与ALT的相关性。结果:7271名9-17岁的青少年纳入研究。男生身高、体重、BMI和ALT均高于女生(均P<0.001)。血清ALT平均为14.16614.77 U/L。男生中BMI与ALT的相关性强于女生(r=0.396,P<0.001 vs r=0.203,P<0.001);14-17岁青少年中BMI与ALT的相关性强于9-13岁青少年(r=0.356,P<0.001 vs r=0.221,P<0.001)。当BMI≥20.5 kg/m^(2),血清ALT水平随BMI的增加显著升高,呈线性关系;BMI每增加1 kg/m^(2),ALT平均升高2.71 U/L(P<0.001)。结论:本研究发现BMI与ALT显著相关。20.5 kg/m^(2)或可作为BMI评估血清ALT的关键阈值。对于深圳青少年,可以将男生BMI≥27.1 kg/m^(2)和女生BMI≥24.9 kg/m^(2)作为筛查ALT升高的高危人群。