Heidi Splete

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

"We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released," she said. "The answer is a resounding 'yes.'"

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also said their institutions were not doing as much as they could or should to prevent and control MRSA.

"The reason for that is not going to be news to anyone," said Kathy Warye, CEO of APIC. "We are still seeing some infection control professionals struggling to get the support they need." But the overall trend is encouraging, she said. "We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

Meanwhile, the death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

"We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job," Ms. Frain said.

"I have a CEO who gets it," said Marcia Patrick, R.N., the infection control director for the MultiCare Health System in Tacoma, Wash. "In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially." Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For information about preventing infections, visit www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

"We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released," she said. "The answer is a resounding 'yes.'"

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also said their institutions were not doing as much as they could or should to prevent and control MRSA.

"The reason for that is not going to be news to anyone," said Kathy Warye, CEO of APIC. "We are still seeing some infection control professionals struggling to get the support they need." But the overall trend is encouraging, she said. "We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

Meanwhile, the death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

"We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job," Ms. Frain said.

"I have a CEO who gets it," said Marcia Patrick, R.N., the infection control director for the MultiCare Health System in Tacoma, Wash. "In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially." Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For information about preventing infections, visit www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

"We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released," she said. "The answer is a resounding 'yes.'"

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also said their institutions were not doing as much as they could or should to prevent and control MRSA.

"The reason for that is not going to be news to anyone," said Kathy Warye, CEO of APIC. "We are still seeing some infection control professionals struggling to get the support they need." But the overall trend is encouraging, she said. "We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

Meanwhile, the death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

"We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job," Ms. Frain said.

"I have a CEO who gets it," said Marcia Patrick, R.N., the infection control director for the MultiCare Health System in Tacoma, Wash. "In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially." Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For information about preventing infections, visit www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a randomized, controlled trial.

Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “Motor-learning” exercises involve goal-oriented stepping and walking.

Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns with tighter turns. The group also walked on a treadmill to practice increasing speed.

The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits.

After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than did the 24 adults in the standard intervention group.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions, compared with what they felt at the study's beginning.

Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a randomized, controlled trial.

Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “Motor-learning” exercises involve goal-oriented stepping and walking.

Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns with tighter turns. The group also walked on a treadmill to practice increasing speed.

The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits.

After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than did the 24 adults in the standard intervention group.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions, compared with what they felt at the study's beginning.

Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a randomized, controlled trial.

Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “Motor-learning” exercises involve goal-oriented stepping and walking.

Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns with tighter turns. The group also walked on a treadmill to practice increasing speed.

The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits.

After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than did the 24 adults in the standard intervention group.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions, compared with what they felt at the study's beginning.

Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

SAN DIEGO — A Latino population had a significantly lower sustained virologic response to the standard treatment for hepatitis C virus, compared with a non-Latino population, suggesting that targeted treatments based on race and genetics may be keys to better management of chronic hepatitis C, according to data from a prospective study presented at the annual Digestive Disease Week.

Hepatitis C virus (HCV) is common in the Latino population, and data from previous studies have shown that Latinos have a more rapid progression to chronic HCV and cirrhosis, Dr. Maribel Rodriguez-Torres said in an interview.

Latinos are the largest minority population in the United States, so this represents a potentially huge number of patients with severe liver disease, she noted.

Dr. Rodriguez-Torres of the Fundacion de Investigacion de Diego in San Juan, P.R., and her colleagues compared pooled data in a multicenter, open-label study of 269 Latino adults with HCV and 300 non-Latino adults with HCV. Patients in both groups received the standard HCV treatment of 180 mcg of peginterferon α−2a (Pegasys) weekly and 1000–1200 mg of ribavirin daily based on body weight. Hoffmann-La Roche Inc., manufacturer of Pegasys and the Copegus formulation of ribavirin, sponsored the study.

After 6 months, 49.3% of the non-Latino patients had achieved a sustained virologic response (SVR), compared with 33.5% of the Latinos, a statistically significant difference. The almost 16% lower SVR suggests that more studies are needed to determine how best to treat HCV in the Latino population, the investigators noted.

“The standard treatment is capable of curing 40%–51% of people with HCV, but we want to have the highest possible cure rates for all populations,” said Dr. John Vierling of Baylor College of Medicine, Houston, who moderated a discussion of the findings.

“We need to optimize the treatment we have,” Dr. Rodriguez-Torres commented. Data from ongoing studies suggest that using higher doses or perhaps a longer duration of the standard therapy in treatment-resistant patients with higher viral loads and higher body mass indexes may improve outcomes, she explained.

“The most important next step is to make Latinos a priority in clinical research for HCV,” she added.

Dr. Rodriguez-Torres disclosed that he had received funding from Hoffmann-La Roche.

SAN DIEGO — A Latino population had a significantly lower sustained virologic response to the standard treatment for hepatitis C virus, compared with a non-Latino population, suggesting that targeted treatments based on race and genetics may be keys to better management of chronic hepatitis C, according to data from a prospective study presented at the annual Digestive Disease Week.

Hepatitis C virus (HCV) is common in the Latino population, and data from previous studies have shown that Latinos have a more rapid progression to chronic HCV and cirrhosis, Dr. Maribel Rodriguez-Torres said in an interview.

Latinos are the largest minority population in the United States, so this represents a potentially huge number of patients with severe liver disease, she noted.

Dr. Rodriguez-Torres of the Fundacion de Investigacion de Diego in San Juan, P.R., and her colleagues compared pooled data in a multicenter, open-label study of 269 Latino adults with HCV and 300 non-Latino adults with HCV. Patients in both groups received the standard HCV treatment of 180 mcg of peginterferon α−2a (Pegasys) weekly and 1000–1200 mg of ribavirin daily based on body weight. Hoffmann-La Roche Inc., manufacturer of Pegasys and the Copegus formulation of ribavirin, sponsored the study.

After 6 months, 49.3% of the non-Latino patients had achieved a sustained virologic response (SVR), compared with 33.5% of the Latinos, a statistically significant difference. The almost 16% lower SVR suggests that more studies are needed to determine how best to treat HCV in the Latino population, the investigators noted.

“The standard treatment is capable of curing 40%–51% of people with HCV, but we want to have the highest possible cure rates for all populations,” said Dr. John Vierling of Baylor College of Medicine, Houston, who moderated a discussion of the findings.

“We need to optimize the treatment we have,” Dr. Rodriguez-Torres commented. Data from ongoing studies suggest that using higher doses or perhaps a longer duration of the standard therapy in treatment-resistant patients with higher viral loads and higher body mass indexes may improve outcomes, she explained.

“The most important next step is to make Latinos a priority in clinical research for HCV,” she added.

Dr. Rodriguez-Torres disclosed that he had received funding from Hoffmann-La Roche.

SAN DIEGO — A Latino population had a significantly lower sustained virologic response to the standard treatment for hepatitis C virus, compared with a non-Latino population, suggesting that targeted treatments based on race and genetics may be keys to better management of chronic hepatitis C, according to data from a prospective study presented at the annual Digestive Disease Week.

Hepatitis C virus (HCV) is common in the Latino population, and data from previous studies have shown that Latinos have a more rapid progression to chronic HCV and cirrhosis, Dr. Maribel Rodriguez-Torres said in an interview.

Latinos are the largest minority population in the United States, so this represents a potentially huge number of patients with severe liver disease, she noted.

Dr. Rodriguez-Torres of the Fundacion de Investigacion de Diego in San Juan, P.R., and her colleagues compared pooled data in a multicenter, open-label study of 269 Latino adults with HCV and 300 non-Latino adults with HCV. Patients in both groups received the standard HCV treatment of 180 mcg of peginterferon α−2a (Pegasys) weekly and 1000–1200 mg of ribavirin daily based on body weight. Hoffmann-La Roche Inc., manufacturer of Pegasys and the Copegus formulation of ribavirin, sponsored the study.

After 6 months, 49.3% of the non-Latino patients had achieved a sustained virologic response (SVR), compared with 33.5% of the Latinos, a statistically significant difference. The almost 16% lower SVR suggests that more studies are needed to determine how best to treat HCV in the Latino population, the investigators noted.

“The standard treatment is capable of curing 40%–51% of people with HCV, but we want to have the highest possible cure rates for all populations,” said Dr. John Vierling of Baylor College of Medicine, Houston, who moderated a discussion of the findings.

“We need to optimize the treatment we have,” Dr. Rodriguez-Torres commented. Data from ongoing studies suggest that using higher doses or perhaps a longer duration of the standard therapy in treatment-resistant patients with higher viral loads and higher body mass indexes may improve outcomes, she explained.

“The most important next step is to make Latinos a priority in clinical research for HCV,” she added.

Dr. Rodriguez-Torres disclosed that he had received funding from Hoffmann-La Roche.

BALTIMORE — Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8–12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention—healthy, overweight, or obese. Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

In a logistic regression analysis, both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively, Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, the researchers found that obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life. Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote.

Ms. Davis reported that she had no financial conflicts to disclose.

BALTIMORE — Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8–12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention—healthy, overweight, or obese. Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

In a logistic regression analysis, both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively, Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, the researchers found that obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life. Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote.

Ms. Davis reported that she had no financial conflicts to disclose.

BALTIMORE — Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8–12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention—healthy, overweight, or obese. Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

In a logistic regression analysis, both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively, Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, the researchers found that obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life. Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote.

Ms. Davis reported that she had no financial conflicts to disclose.

BALTIMORE — Two measures of lung function—a higher forced expiratory volume in 1 second/forced vital capacity ratio and lower total lung capacity—may predict the presence of obstructive sleep apnea in chronic pulmonary disease patients, according to a poster presented at the annual meeting of the Associated Professional Sleep Societies

Dr. Ramez Sunna and colleagues at the University of Missouri, Columbia, reviewed all adult patients who underwent both pulmonary function testing and polysomnography between 2000 and 2007 at a tertiary care medical center.

Overall, 279 patients (61%) met the criteria for obstructive sleep apnea (OSA), 167 patients (37%) met the criteria for chronic obstructive pulmonary disease (COPD), and 11 patients (2%) did not have either condition.

A total of 101 patients (60%) had both COPD and OSA, but there was no significant correlation between the severity of the COPD and the severity of the OSA.

But the researchers analyzed the COPD patients independently and found that those with both COPD and OSA had a significantly higher forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, compared with COPD patients without OSA (61.03% vs. 54.61%), although both of these values fell below healthy levels. The association remained significant after controlling for variables.

BALTIMORE — Two measures of lung function—a higher forced expiratory volume in 1 second/forced vital capacity ratio and lower total lung capacity—may predict the presence of obstructive sleep apnea in chronic pulmonary disease patients, according to a poster presented at the annual meeting of the Associated Professional Sleep Societies

Dr. Ramez Sunna and colleagues at the University of Missouri, Columbia, reviewed all adult patients who underwent both pulmonary function testing and polysomnography between 2000 and 2007 at a tertiary care medical center.

Overall, 279 patients (61%) met the criteria for obstructive sleep apnea (OSA), 167 patients (37%) met the criteria for chronic obstructive pulmonary disease (COPD), and 11 patients (2%) did not have either condition.

A total of 101 patients (60%) had both COPD and OSA, but there was no significant correlation between the severity of the COPD and the severity of the OSA.

But the researchers analyzed the COPD patients independently and found that those with both COPD and OSA had a significantly higher forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, compared with COPD patients without OSA (61.03% vs. 54.61%), although both of these values fell below healthy levels. The association remained significant after controlling for variables.

BALTIMORE — Two measures of lung function—a higher forced expiratory volume in 1 second/forced vital capacity ratio and lower total lung capacity—may predict the presence of obstructive sleep apnea in chronic pulmonary disease patients, according to a poster presented at the annual meeting of the Associated Professional Sleep Societies

Dr. Ramez Sunna and colleagues at the University of Missouri, Columbia, reviewed all adult patients who underwent both pulmonary function testing and polysomnography between 2000 and 2007 at a tertiary care medical center.

Overall, 279 patients (61%) met the criteria for obstructive sleep apnea (OSA), 167 patients (37%) met the criteria for chronic obstructive pulmonary disease (COPD), and 11 patients (2%) did not have either condition.

A total of 101 patients (60%) had both COPD and OSA, but there was no significant correlation between the severity of the COPD and the severity of the OSA.

But the researchers analyzed the COPD patients independently and found that those with both COPD and OSA had a significantly higher forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, compared with COPD patients without OSA (61.03% vs. 54.61%), although both of these values fell below healthy levels. The association remained significant after controlling for variables.

WASHINGTON —A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and greater need for medical services.

“In fact, a disproportionate number of successful suicides [occurs] in people who are over the age of 65,” Dr. Saliba said.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population.

Several screening tools for mood disorders are in use, but they haven't been compared with one another or with any validated psychiatric-assessment tool, Dr. Saliba said.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, bad feelings about oneself, and trouble with concentration. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression. The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both these tests are validated, “gold standard” tools, Dr. Saliba said.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

A majority of the residents, including the large number with cognitive impairment, could complete the PHQ-9, Dr. Saliba said.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON —A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and greater need for medical services.

“In fact, a disproportionate number of successful suicides [occurs] in people who are over the age of 65,” Dr. Saliba said.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population.

Several screening tools for mood disorders are in use, but they haven't been compared with one another or with any validated psychiatric-assessment tool, Dr. Saliba said.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, bad feelings about oneself, and trouble with concentration. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression. The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both these tests are validated, “gold standard” tools, Dr. Saliba said.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

A majority of the residents, including the large number with cognitive impairment, could complete the PHQ-9, Dr. Saliba said.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON —A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and greater need for medical services.

“In fact, a disproportionate number of successful suicides [occurs] in people who are over the age of 65,” Dr. Saliba said.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population.

Several screening tools for mood disorders are in use, but they haven't been compared with one another or with any validated psychiatric-assessment tool, Dr. Saliba said.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, bad feelings about oneself, and trouble with concentration. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression. The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both these tests are validated, “gold standard” tools, Dr. Saliba said.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

A majority of the residents, including the large number with cognitive impairment, could complete the PHQ-9, Dr. Saliba said.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology. The results were presented in a June 17 teleconference.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals–eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

“We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released,” she said. “The answer is a resounding 'yes.'”

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%).

Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“The reason for that is not going to be news to anyone,” said Kathy Warye, chief executive officer of APIC. “We are still seeing some infection control professionals struggling to get the support they need.” But the overall trend of the poll is encouraging, she said. “We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

“Infection prevention and control is in the spotlight today for a variety of reasons,” she said. “The resources need to catch up.”

The death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the Association for Professionals in Infection Control Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology. The results were presented in a June 17 teleconference.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals–eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

“We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released,” she said. “The answer is a resounding 'yes.'”

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%).

Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“The reason for that is not going to be news to anyone,” said Kathy Warye, chief executive officer of APIC. “We are still seeing some infection control professionals struggling to get the support they need.” But the overall trend of the poll is encouraging, she said. “We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

“Infection prevention and control is in the spotlight today for a variety of reasons,” she said. “The resources need to catch up.”

The death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the Association for Professionals in Infection Control Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology. The results were presented in a June 17 teleconference.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals–eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

“We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released,” she said. “The answer is a resounding 'yes.'”

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%).

Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“The reason for that is not going to be news to anyone,” said Kathy Warye, chief executive officer of APIC. “We are still seeing some infection control professionals struggling to get the support they need.” But the overall trend of the poll is encouraging, she said. “We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

“Infection prevention and control is in the spotlight today for a variety of reasons,” she said. “The resources need to catch up.”

The death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the Association for Professionals in Infection Control Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, results of a randomized, controlled trial of the two approaches show.

Standard physical therapy aimed at building strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.”

“Motor-learning” exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Dr. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions. Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON – An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, results of a randomized, controlled trial of the two approaches show.

Standard physical therapy aimed at building strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.”

“Motor-learning” exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Dr. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions. Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON – An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, results of a randomized, controlled trial of the two approaches show.

Standard physical therapy aimed at building strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.”

“Motor-learning” exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Dr. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions. Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women, findings from a population-based study of 6,892 adults aged 65 years and older show.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier, France, and colleagues reported

Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years. The average age of the participants was 74 years, and approximately half were women. The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained a diagnosis of MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, compared with 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4-year follow-up period (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from mild cognitive impairment to dementia was more than three times as likely if they had the apoE4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL).

In women, progression from mild cognitive impairment to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the apoE4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Significant predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the apoE4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least one activity of daily living. “MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote.

The investigators said they had no financial conflicts to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women, findings from a population-based study of 6,892 adults aged 65 years and older show.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier, France, and colleagues reported

Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years. The average age of the participants was 74 years, and approximately half were women. The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained a diagnosis of MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, compared with 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4-year follow-up period (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from mild cognitive impairment to dementia was more than three times as likely if they had the apoE4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL).

In women, progression from mild cognitive impairment to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the apoE4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Significant predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the apoE4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least one activity of daily living. “MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote.

The investigators said they had no financial conflicts to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women, findings from a population-based study of 6,892 adults aged 65 years and older show.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier, France, and colleagues reported

Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years. The average age of the participants was 74 years, and approximately half were women. The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained a diagnosis of MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, compared with 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4-year follow-up period (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from mild cognitive impairment to dementia was more than three times as likely if they had the apoE4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL).

In women, progression from mild cognitive impairment to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the apoE4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Significant predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the apoE4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least one activity of daily living. “MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote.

The investigators said they had no financial conflicts to disclose.

BALTIMORE – Identifying shared endophenotypes might help clinicians characterize neurobehavioral syndromes and plan treatment, said a specialist in neurobehavioral development.

An endophenotype is a subset of features of a syndrome that are more highly correlated with a genetic mechanism than the whole syndrome, and grouping syndromes that share common features can help target and simplify treatment strategies, said Travis Thompson, Ph.D., also a professor in the department of pediatrics at the University of Minnesota, Minneapolis.

Some genetic evidence suggests that there might be shared inherited traits between autism and Prader-Willi syndrome (PW), and Dr. Thompson presented important behavioral similarities and differences between these two conditions at a meeting on developmental disabilities sponsored by Johns Hopkins University.

“Identifying clinically relevant endophenotypes can be more helpful than trying to figure out exactly which genes cause autism,” he said.

Phenotypic features that differ might be just as informative as those that are the same in understanding genetic and associated brain differences in clinical syndromes, Dr. Thompson said. “The fact that they are alike in some ways but different in a specific way tells you that there is probably a different genetic mechanism,” he said.

Candidates for a common genetic lesion include the γ-aminobutyric acid (GABA) receptor 3 (GABRB3), which might be absent or reduced in children with either autism or PW. And research has shown that both conditions might be associated with genes in the 15q11-q13 region of chromosome 15.

Features that are common to both autism and PW include compulsive behavior, social processing deficits (including facial processing deficits), and self-injury, Dr. Thompson said.

Compulsive behavior in children with either condition might be associated with overactive dopamine due in part to the missing or suppressed GABA-3 receptor. But some differences emerge within these categories. For example, compulsive behavior in children with PW often involves excessive overeating, which might be due to an overproduction of GABA. And skin picking is a common compulsive behavior in children with either condition, although in PW skin picking can start as early as 2 years of age, he said.

Studies have shown that face perception is limited in children with either autism or PW. This problem might be linked to a common genetic defect that might cause hypoactivation of the amygdala and fusiform face area–parts of the brain that recognize facial features.

More research is needed on common behavior phenotypes in neurobehavioral syndromes to determine which individuals show the maximum improvement to different treatments, and what characteristics of those individuals make them responsive to a specific intervention, he added. “That has to be the future of research in this area.”

BALTIMORE – Identifying shared endophenotypes might help clinicians characterize neurobehavioral syndromes and plan treatment, said a specialist in neurobehavioral development.

An endophenotype is a subset of features of a syndrome that are more highly correlated with a genetic mechanism than the whole syndrome, and grouping syndromes that share common features can help target and simplify treatment strategies, said Travis Thompson, Ph.D., also a professor in the department of pediatrics at the University of Minnesota, Minneapolis.

Some genetic evidence suggests that there might be shared inherited traits between autism and Prader-Willi syndrome (PW), and Dr. Thompson presented important behavioral similarities and differences between these two conditions at a meeting on developmental disabilities sponsored by Johns Hopkins University.

“Identifying clinically relevant endophenotypes can be more helpful than trying to figure out exactly which genes cause autism,” he said.

Phenotypic features that differ might be just as informative as those that are the same in understanding genetic and associated brain differences in clinical syndromes, Dr. Thompson said. “The fact that they are alike in some ways but different in a specific way tells you that there is probably a different genetic mechanism,” he said.

Candidates for a common genetic lesion include the γ-aminobutyric acid (GABA) receptor 3 (GABRB3), which might be absent or reduced in children with either autism or PW. And research has shown that both conditions might be associated with genes in the 15q11-q13 region of chromosome 15.

Features that are common to both autism and PW include compulsive behavior, social processing deficits (including facial processing deficits), and self-injury, Dr. Thompson said.

Compulsive behavior in children with either condition might be associated with overactive dopamine due in part to the missing or suppressed GABA-3 receptor. But some differences emerge within these categories. For example, compulsive behavior in children with PW often involves excessive overeating, which might be due to an overproduction of GABA. And skin picking is a common compulsive behavior in children with either condition, although in PW skin picking can start as early as 2 years of age, he said.

Studies have shown that face perception is limited in children with either autism or PW. This problem might be linked to a common genetic defect that might cause hypoactivation of the amygdala and fusiform face area–parts of the brain that recognize facial features.

More research is needed on common behavior phenotypes in neurobehavioral syndromes to determine which individuals show the maximum improvement to different treatments, and what characteristics of those individuals make them responsive to a specific intervention, he added. “That has to be the future of research in this area.”

BALTIMORE – Identifying shared endophenotypes might help clinicians characterize neurobehavioral syndromes and plan treatment, said a specialist in neurobehavioral development.

An endophenotype is a subset of features of a syndrome that are more highly correlated with a genetic mechanism than the whole syndrome, and grouping syndromes that share common features can help target and simplify treatment strategies, said Travis Thompson, Ph.D., also a professor in the department of pediatrics at the University of Minnesota, Minneapolis.

Some genetic evidence suggests that there might be shared inherited traits between autism and Prader-Willi syndrome (PW), and Dr. Thompson presented important behavioral similarities and differences between these two conditions at a meeting on developmental disabilities sponsored by Johns Hopkins University.

“Identifying clinically relevant endophenotypes can be more helpful than trying to figure out exactly which genes cause autism,” he said.

Phenotypic features that differ might be just as informative as those that are the same in understanding genetic and associated brain differences in clinical syndromes, Dr. Thompson said. “The fact that they are alike in some ways but different in a specific way tells you that there is probably a different genetic mechanism,” he said.

Candidates for a common genetic lesion include the γ-aminobutyric acid (GABA) receptor 3 (GABRB3), which might be absent or reduced in children with either autism or PW. And research has shown that both conditions might be associated with genes in the 15q11-q13 region of chromosome 15.

Features that are common to both autism and PW include compulsive behavior, social processing deficits (including facial processing deficits), and self-injury, Dr. Thompson said.

Compulsive behavior in children with either condition might be associated with overactive dopamine due in part to the missing or suppressed GABA-3 receptor. But some differences emerge within these categories. For example, compulsive behavior in children with PW often involves excessive overeating, which might be due to an overproduction of GABA. And skin picking is a common compulsive behavior in children with either condition, although in PW skin picking can start as early as 2 years of age, he said.

Studies have shown that face perception is limited in children with either autism or PW. This problem might be linked to a common genetic defect that might cause hypoactivation of the amygdala and fusiform face area–parts of the brain that recognize facial features.

More research is needed on common behavior phenotypes in neurobehavioral syndromes to determine which individuals show the maximum improvement to different treatments, and what characteristics of those individuals make them responsive to a specific intervention, he added. “That has to be the future of research in this area.”