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Schanke A.-K.,Sunnaas Rehabilitation Hospital | Schanke A.-K.,University of Oslo | Thorsen K.,Ageing and Health | Thorsen K.,Norwegian Social Research NOVA
Disability and Rehabilitation | Year: 2014

Purpose: The aim of the study is to explore how personal and contextual experiences throughout the life course are recollected as having influenced the development of stigma-handling strategies among people associated with disability and stigma. The article describes the development of stigma handling among ageing persons of restricted growth in order to avert negative effects, develop resilience, strengthen the self and support a positive identity. Method: Qualitative retrospective interviews were conducted with ten persons-seven women and three men aged between 45 and 65 years-of short stature. Their narratives are analysed from a life-course perspective and the results presented under two main themes: the development of strategies during different stages of life, and the use of general non-stage-bound strategies. Results: The study shows how stigma-handling has evolved from childhood to become, by adult years, refined, contextualised strategies demonstrating human resilience. The analysis documents the impact of human agency on personal lives and the subjects' efforts and strengths in handling adversity. Conclusion: The results demonstrate how the "insider perspective" reveals the individual's resources, resilience and strategies and provides an important perspective for the rehabilitation setting. Implications for Rehabilitation • The study document human agency, resilience and strength in a life course perspective among people of restricted growth faced with stigmatization. • The efforts and stigma handling strategies developed during the life course, such as withdrawal, humour, ignoring and positive thinking, are important tools to be recognized with relevance for other patient groups. • The "insider perspective" revealing the potentialities and strength of human agency and resilience, should be further explored within the field of rehabilitation. © 2014 Informa UK Ltd. All rights reserved.

Beveridge L.A.,Ageing and Health | Davey P.G.,University of Dundee | Phillips G.,NHS Tayside | McMurdo M.E.T.,Ageing and Health
Clinical Interventions in Aging | Year: 2011

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials. © 2011 Beveridge et al, publisher and licensee Dove Medical Press Ltd.

Gill R.,Ageing and Health | Birns J.,Ageing and Health
Age and Ageing | Year: 2014

We describe the case of an 80-year-old man who presented with lower limb upper motor neurone weakness and spinothalamic tract sensory deficit secondary to previously undiagnosed syringomyelia. The case highlights the need for methodical history, examination and investigation in elderly patients to achieve diagnostic accuracy. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

Witham M.D.,Ageing and Health | Dove F.J.,Ageing and Health | Dryburgh M.,Ageing and Health | Sugden J.A.,Ageing and Health | And 2 more authors.
Diabetologia | Year: 2010

Aims/hypothesis Low 25-hydroxyvitamin D levels predict future cardiovascular events and are common in patients with type 2 diabetes. We compared the effect of 100,000 and 200,000 IU doses of vitamin D3 on endothelial function, blood pressure and markers of glycaemic control in patients with type 2 diabetes. Methods This was a randomised, parallel group, placebocontrolled trial. Patients with type 2 diabetes and baseline 25-hydroxyvitamin D levels <100 nmol/l were enrolled from community and hospital-based diabetes clinics. Participants were assessed in a university department of clinical pharmacology and received a single oral dose of placebo or vitamin D3 (100,000 IU or 200,000 IU) at baseline, randomly allocated via numbered bottles prepared offsite; participants and investigators were both blinded to treatment allocation. Endothelial function, office blood pressure, B-type natriuretic peptide, insulin resistance and glycosylated haemoglobin were measured at baseline, and at 8 and 16 weeks. Results We randomised 61 participants to the three groups (placebo 22, 100,000 IU vitamin D3 19, 200,000 IU vitamin D3 20). There was no significant difference in the primary outcome of endothelial function at 8 weeks (placebo 5.2%, n=22; 100,000 IU 4.3%, n =19; 200,000 IU 4.9%, n =17) or at 16 weeks. Insulin resistance and glycosylated haemoglobin did not improve with either dose of vitamin D3.On covariate analysis, systolic blood pressure was significantly lower in both treatment arms than in the placebo group at 8 weeks (placebo 146.4 mmHg, 100,000 IU 141.4 mmHg [p=0.04 vs placebo], 200,000 IU 136.8 mmHg [p=0.03 vs placebo]). B-type natriuretic peptide levels were significantly lower in the 200,000 IU group by 16 weeks (placebo 34 pg/ml, 200,000 IU21pg/ml, p=0.02). No significant excess of adverse effects was noted in the treatment arms. Conclusions/interpretation High-dose vitamin D3 improved systolic blood pressure and B-type natriuretic peptide levels, but not endothelial function, insulin resistance or glycosylated haemoglobin in patients with type 2 diabetes. © Springer-Verlag 2010.

Witham M.D.,Ageing and Health | Sugden J.A.,Ageing and Health | Sumukadas D.,Ageing and Health | Dryburgh M.,Ageing and Health | McMurdo M.E.T.,Ageing and Health
Aging Clinical and Experimental Research | Year: 2012

Background and aims: The six minute walk test is widely used to measure aerobic exercise capacity in older people, but lack responsiveness to change. We aimed to compare the reliability, responsiveness and completion rates of the six minute walk with a new test of aerobic exercise capacity - the endurance shuttle walk test. Methods: Two groups were studied: 18 patients from a Medicine for the Elderly Day Hospital (study 1) receiving physiotherapy, and 15 community dwelling older people (study 2) receiving caffeine or placebo in a crossover study, followed by a weekly exercise programme. Six minute walk test and endurance shuttle walk test were performed at baseline and after interventions. Intraclass correlation coefficients were calculated for reliability, and Cohen's effect sizes were calculated to characterize responsiveness. Results: 6/18 of patients in study 1 completed the baseline shuttle walk successfully. For those completing baseline and week one shuttle walk, similar intraclass correlation coefficients were seen (shuttle walk 0.97; six minute walk 0.90). In study 2, all attendees completed baseline and follow-up shuttle walk. 7/15 managed the maximum shuttle walk time at baseline. Effect sizes for caffeine intervention (0.29 for six minute walk, 0.01 for shuttle walk) and for exercise intervention (0.15 for six minute walk, 0.24 for shuttle walk) were similarly low for both tests. Conclusion: The endurance shuttle walk is no more responsive to change than the six minute walk in older people, is limited by ceiling effects, and cannot be performed successfully by very frail older people. ©2012, Editrice Kurtis.

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