Nutritional status and clinical outcomes of older patients in rehabilitation

BACKGROUND

Malnutrition is associated with poor outcomes in older adults and those admitted to rehabilitation may be particularly at risk. Objective To assess the nutritional status and outcomes of older adults in rehabilitation.

SUBJECTS AND METHODS

We recruited 133 adults > or = 65 years from consecutive rehabilitation admissions. Nutritional status was assessed using the mini nutritional assessment, body mass index (BMI) and corrected arm muscle area (CAMA). Outcomes measured included length of stay, admission to higher level care, function and quality of life (QOL).

RESULTS

Sixty-two (47%) subjects were well nourished, 63 (47%) at risk of malnutrition and eight (6%) malnourished. Twenty-two (17%) and 27 (20%) were below the desirable reference values for BMI and CAMA respectively. Subjects at risk of malnutrition/malnourished had longer length of stay (P = 0.023) and were more likely to be admitted to higher level care (P < 0.05). These subjects also had poorer function on admission (P < 0.001) and 90 days (P = 0.002) and QOL on admission (P < 0.008) and 90 days (P = 0.001). Those with low CAMA were twice as likely to be admitted to higher level care (P < 0.05) and had poorer function at 90 days (P = 0.017).

CONCLUSIONS

Over half our sample was identified as at risk of malnutrition or malnourished and this was associated with poorer clinical outcomes.

Similar patterns of cardiovascular response during emotional activation as a function of affective valence and arousal and gender

OBJECTIVE

Laboratory studies of emotion-induced cardiovascular responses have been conducted predominantly with a specific affects approach rather than a dimensional approach. The purpose of this study was to apply the principles of the Circumplex Model of Affect (i.e., valence and arousal) to investigate cardiovascular reactivity during emotional activation in men and women.

METHODS

Forty-two healthy university students (mean age = 19.45, 52% women, 58% Caucasian) engaged in personally relevant recall tasks that varied as a function of valence and arousal. Self-reported valence and arousal, systolic and diastolic blood pressure (SBP and DBP, respectively), heart rate (HR), preejection period (PEP), stroke index (SI), cardiac index (CI), and total peripheral resistance (TPR) were measured during baseline and task periods.

RESULTS

Cardiovascular responses were found to be largely comparable across the recall tasks and were characterized by significant increases in blood pressure, HR, and TPR, and decreases in SI (Ps < .001). In addition, SBP during negative valence tasks was significantly higher than during positive valence tasks (P < .03), and PEP lengthened more during low as compared to high arousal tasks (P < .03).

CONCLUSIONS

These results highlight the similarity of hemodynamic adjustments during the verbal expression of emotion across gender and the dimensions of valence and arousal. The overall response pattern suggests alpha-adrenergically mediated sympathetic activation and vagal withdrawal.

Teaching psychosomatic (biopsychosocial) medicine in United States medical schools: survey findings

OBJECTIVE

A survey of US medical schools regarding the incorporation of psychosomatic (biopsychosocial) medicine topics into medical school curriculum was conducted. The perceived importance and success of this curriculum, barriers to teaching psychosomatic medicine, and curricular needs were also assessed.

METHODS

From August 1997 to August 1999, representatives of US medical schools were contacted to complete a survey instrument either by telephone interview or by written questionnaire.

RESULTS

Survey responses were received from 54 of the 118 US medical schools contacted (46%). Responses were obtained from representatives of both public (57%) and private (43%) institutions. Only 20% of respondents indicated that their schools used the term "psychosomatic medicine"; the terms "behavioral medicine" (63%) and "biopsychosocial medicine" (41%) were used more frequently. Coverage of various health habits (eg, substance use and exercise) ranged from 52% to 96%. The conceptualization and/or measurement of psychosocial factors (eg, stress and social support) was taught by 80% to 93% of schools. Teaching about the role of psychosocial factors in specific disease states or syndromes ranged from 33% (renal disease) to 83% (cardiovascular disease). Coverage of treatment-related issues ranged from 44% (relaxation/biofeedback) to 98% (doctor-patient communication). Topics in psychosomatic medicine were estimated to comprise approximately 10% (median response) of the medical school curriculum. On a scale of 1 (lowest) to 10 (highest), ratings of the relative importance of this curriculum averaged 7 (SD = 2.5; range = 2-10). Student response to the curriculum varied from positive to mixed to negative. Perceived barriers to teaching psychosomatic medicine included limited resources (eg, time, money, and faculty), student and faculty resistance, and a lack of continuity among courses. Sixty-three percent of respondents expressed an interest in receiving information about further incorporation of topics in psychosomatic medicine into their school's curriculum.

CONCLUSIONS

Results of this survey reveal variable coverage of specific psychosomatic medicine topics in the medical school curriculum and differential use of nomenclature to refer to this field. There is a need for further curricular development in psychosomatic medicine in US medical schools.

Role-played interpersonal interaction: ecological validity and cardiovascular reactivity

Conflictual role-play scenarios have been used to model brief interpersonal interaction and to elicit cardiovascular reactivity in the laboratory. Here we discuss data suggesting that role-played interactions constitute an ecologically valid laboratory task that may improve laboratory-to-field generalization of cardiovascular response. Specifically, our research indicates that young adults perceive the stress associated with role-play scenarios as similar to that encountered in everyday life. Furthermore, these stress appraisals moderate cardiovascular response to role-play in men. We also find that a social stressor (i.e. speech task) is perceived as significantly more similar to a real-life stressor as compared to other standard laboratory tasks. We propose that particular constellations of cognitive, affective, and behavioral responses to laboratory-based social stressors, such as role-played interaction, may elicit different patterns of hemodynamic response. Further understanding of interrelations among cognitive, affective, behavioral, and physiological response patterns may assist in the study of cardiovascular reactivity as a potential mechanism linking personality factors and the development of cardiovascular disease.

Postural effects on hemodynamic response to interpersonal interaction

Laboratory studies of stress-induced cardiovascular reactivity have been conducted predominantly with participants in a seated posture. This procedure may contribute to limited laboratory-field generalization of cardiovascular response. The present study examined hemodynamic adjustments underlying pressor responses, in addition to heart rate and systolic time intervals, during seated and standing role-played, interpersonal interaction in 60 young adults. Irrespective of gender or race, blood pressure responses to the seated and standing interactions were comparable. However, seated interactions yielded a significantly greater increase in heart rate, shortened preejection period and decreased stroke index as compared to standing. Alternatively, interacting while standing yielded a significantly increased left ventricular ejection time and total peripheral resistance in comparison to sitting. These results suggest that hemodynamic adjustments during stressful interpersonal interaction vary as a function of posture, with somewhat greater cardiac influences apparent while seated and a more pronounced vascular response while standing.