A Self-Management Program for Adolescents and Children with Renal Transplantation

This paper describes the development and implementation of a self-management program designed to address noncompliance in adolescents with renal transplants. Transplantation provides the best treatment alternative for End-Stage Renal Disease (ESRD), but is a procedure that subsequently demands recipients follow a life-long medication regimen. Nonadherance to medical therapy is a serious problem for adolescents; it is one of the most common causes of chronic graft rejection in this population. To improve compliance rates for this population, a self-management program was designed: (1) to provide social support; (2) to review information about medications and transplant management; and (3) to both teach and provide transplantation patients the opportunity to practice self-management skills. Details about the program, including recruitment issues and session content, are provided. Evaluations by participants indicated that the program was effective in creating a supportive environment for both patients and their parents, and in addressing health-related concerns.     

Presurgical Coping, Depression, and Quality of Life in Persons with Parkinson's Disease

This study describes utilization of coping strategies and evaluates the interaction between coping strategies, depression, and quality of life (QOL) in patients with Parkinson's disease (PD) who are being considered for neurosurgical intervention. Eighty patients (mean age 61.7 years) with PD being evaluated for possible deep brain stimulation completed self-report instruments of coping strategies (Coping Responses Inventory), depression (Beck Depression Inventory), and disease-specific QOL (Parkinson's Disease Questionnaire-39). Analyses showed that patients with PD cope with the acute stressor of approaching neurosurgery through a variety of strategies, but particularly avoidant and behavioral strategies. When the correlated but apparently opposing effects of cognitive and behavioral strategies were teased apart, greater use of cognitive strategies was associated with more severe depressive symptomatology (and poorer QOL), while greater use of behavioral strategies appeared to be associated with less depression. Depressive symptomatology, in turn, was associated with poorer QOL. However, coping had minimal direct association with QOL. From this it was concluded that patients with advanced PD generate a variety of coping responses to an acute stressor such as surgery, and the use of behavioral strategies, in particular seeking of alternative enjoyable activities, may be associated with better mood if salutary effects are not overwhelmed by less helpful cognitive coping techniques. The minimization of depressive symptomatology, in turn, is associated with better QOL.     

Some Hindu Insights on a Global Ethic in the Context of Diseases and Epidemics

As we develop a global ethic in the context of diseases, we need to reconsider the wisdom of the religious traditions, for there is more to ailments than their material causes. In the Hindu framework, aside from the Ayurvedic system, which is based on herbal medicines and a philosophical framework, there is the insight that much of what we experience is a direct consequence of our karma (consequential actions). Therefore, here one emphasizes self–restraint and self–discipline in contexts that are conducive to self–hurting behavior.     

The value of stress-management interventions in life-threatening medical conditions

Emotional stress has been associated with the development and progression of several chronic medical conditions. Recently, researchers have assessed the impact of stress-management interventions on patients' psychological functioning, quality of life, and various disease outcomes, including survival. This review summarizes the value of stress-management techniques in the treatment of two important, life-threatening conditions: coronary heart disease and cancer. Results from randomized clinical trials indicate that psychological interventions can improve patients' psychological functioning and quality of life. However, there is limited evidence to suggest that these interventions significantly reduce morbidity and mortality.     

异体造血干细胞移植问题、发展与思考

异体造血干细胞移植(Allo-HSCT)已成为治疗恶性血液病及其他各种疾病的有效方法之一。在Allo-HSCT中由于供体和受体免疫屏障的存在。从而一开始就是一个供受体矛盾的对立统一的过程。对其中矛盾的研究和解决充满了辩证唯物的哲学思想。也促使Allo-HSCT技术不断发展。新的方法和理念不断出现。使Allo-HSCT治疗白血病的疗效不断提高。     

The link between knowledge and remembering in Alzheimer’s disease

Current research on the influence of cognitive support (e.g., activation of task-relevant prior knowledge, item organizability, retrieval cues) on episodic remembering in normal aging and Alzheimer’s disease (AD) is reviewed. Examining the effects of cognitive support on memory may shed light on the relationship between knowledge and remembering, and also provides relevant information pertaining to the development of cognitive intervention procedures. A series of studies from our own and other laboratories reveal a number of interesting empirical regularities. First, AD results in problems in utilizing cognitive support for improving memory. Conceivably, this reduction in cognitive reserve capacity is due to both the overall severity of the episodic memory impairment in AD, as well as to dementia-related deficits in the semantic network that guides encoding and retrieval of information. Nevertheless, AD patients are able to utilize cognitive support in episodic memory tasks, although they typically need more support than their healthy aged counterparts to show memory facilitation. Specifically, it is critical to provide support at both encoding and retrieval in order to demonstrate performance gains in AD. Moreover, successful utilization of retrieval support in this disease is most likely to occur when the encoding requirements force the individual to engage in elaborative cognitive activity (e.g., generation of task-relevant knowledge, categorical organization). Finally, a reduction in cognitive reserve capacity occurs later in the pathogenesis of AD than a generalized episodic memory impairment. This observation reflects the insidious nature of AD, and suggests that the transition from normal aging to AD may be continuous rather than discrete.     

Walking impairs cognitive performance among people with multiple sclerosis but not controls

People with multiple sclerosis (MS) complain of problems completing two tasks simultaneously; sometimes called ‘dual-tasking’ (DT). Previous research in DT among people with MS has focused on how adding a cognitive task interferes with gait and few have measured how adding a motor task could interfere with cognition. We aimed to determine the extent to which walking affects a concurrent working memory task in people with MS compared to healthy controls. We recruited MS participants (n = 13) and controls (n = 10) matched by age (±3 years), education (±3 years) and gender. Participants first completed the cognitive task (subtracting 7’s from the previous number) and then again while walking on an instrumented walkway. Although there were no baseline differences in cognition or walking between MS participants and controls, MS participants demonstrated a 52% decrease in number of correct answers during DT (p < 0.001). Mental Tracking Rate (% correct answers/min) correlated strongly with MS-related disability measured using the Expanded Disability Status Scale (EDSS; r(11) = −0.68, p < 0.01). We propose that compromised mental tracking during walking could be related to limited neural resource capacity and could be a potentially useful outcome measure to detect ecologically valid dual tasking impairments.     

Effort to reduce postural sway affects both cognitive and motor performances in individuals with Parkinson’s disease

ObjectivesTo assess the effects of voluntarily reducing postural sway on postural control and to determine the attention level needed to do so in healthy adults (n = 16, 65.9 ± 9.7) and persons with PD (n = 25, 65.8 ± 9.5 years). Tasks: quiet and still standing conditions with and without a category task. Cognitive performance, center of pressure (CoP) displacement variability (RMSCoP) and velocity (VCoP) were assessed in the anterior-posterior (AP) and medial-lateral (ML) directions.Controls showed larger RMSCoP (AP) and VCoP (AP and ML) during still versus quiet standing (p < 0.01), while the PD group demonstrated no changes. In the PD group, RMSCoP and VCoP (ML) increased in still standing when performed with the cognitive task (p < 0.05). In both groups, cognitive responses decreased in still standing (p < 0.05).In PD, attempting to reduce postural sway did not affect postural control under single task conditions, however ML CoP variability and velocity did increase as a dual task. In older adults, increased displacement and velocity in both AP and ML directions was observed during single, but not dual task conditions. Therefore standing still might not be an adequate postural strategy as it increases the attentional demand and affects motor performance, putting persons with PD at greater risk for falls.     

Investigation of factors impacting mobility and gait in Parkinson disease

Mobility and gait limitations are major issues for people with Parkinson disease (PD). Identification of factors that contribute to these impairments may inform treatment and intervention strategies. In this study we investigated factors that predict mobility and gait impairment in PD. Participants with mild to moderate PD and without dementia (n = 114) were tested in one session ‘off’ medication. Mobility measures included the 6-Minute Walk test and Timed-Up-and-Go. Gait velocity was collected in four conditions: forward preferred speed, forward dual task, forward fast as possible and backward walking. The predictors analyzed were age, gender, disease severity, balance, balance confidence, fall history, self-reported physical activity, and executive function. Multiple regression models were used to assess the relationships between predictors and outcomes. The predictors, in different combinations for each outcome measure, explained 55.7% to 66.9% of variability for mobility and 39.5% to 52.8% for gait velocity. Balance was the most relevant factor (explaining up to 54.1% of variance in mobility and up to 45.6% in gait velocity). Balance confidence contributed to a lesser extent (2.0% to 8.2% of variance) in all models. Age explained a small percentage of variance in mobility and gait velocity (up to 2.9%). Executive function explained 3.0% of variance during forward walking only. The strong predictive relationships between balance deficits and mobility and gait impairment suggest targeting balance deficits may be particularly important for improving mobility and gait in people with PD, regardless of an individual’s age, disease severity, fall history, or other demographic features.     

Everyday‐like memory for objects in ageing and Alzheimer's disease assessed in a visually complex environment: The role of executive functioning and episodic memory

To investigate everyday memory, more and more studies rely on virtual‐reality applications to bridge the gap between in situ approaches and laboratory settings. In this vein, the present study was designed to assess everyday‐like memory from the virtual reality‐based Human Object Memory for Everyday Scenes (HOMES) test (Sauzéon et al., 2012 , Exp. Psychol., 59, 99) in ageing and in Alzheimer's disease (AD). Two aims motivated this study: the first was to assess multiple processes of episodic memory (EM) functioning embedded within contexts closely related to real life in ageing and AD using the multi‐trial free‐recall paradigm, and the second aim was to evaluate the mediating effects of executive functioning (EF), EM, and subjective memory complaints (SMCs) on age differences in the HOMES measures and in AD. To this end, the HOMES test and neurocognitive tests of EF and EM were administered to 23 younger adults, 23 older adults, and 16 patients with AD. The results were: firstly, compared to young adults, elderly adults presented only free‐recall decline that almost disappeared in recognition condition whereas AD patients exhibited a poor clustering, learning, and recognition performance, and also a high amount of false recognition; secondly, age differences as well as AD related deficits on the HOMES test were mediated by both memory and EF measure while those observed on false memory indices were only mediated by EM measure; thirdly, the HOMES indices are related to SMCs even when episodic or EF measures are controlled. Overall, the results supported the fact that the VR‐based memory test is an appropriate device to capture age‐related differences as well as the AD effect with respect to both in situ and laboratory settings.