Leo Harvill

Long-term effects of strokes on bone mass

The purpose of the study was to determine the long-term effects of muscle weakness secondary to strokes on the bone mineral content of the hemiparetic limb. Patients who had experienced single recent strokes were studied. The bone mineral content of each limb was measured by Dual Energy X-ray Absorptiometry using the region of interest analysis program. Muscle strength of each muscle group was ranked using the Oxford scale, and the mean was calculated for each limb. Bone and muscle parameters were measured within seven days after the stroke and repeated thereafter at monthly intervals for up to 6 mo. A repeated measures analysis of variance, Newman-Keuls pair-wise comparisons, and orthogonal contrasts were done for each parameter. Significance levels were set at P < 0.05. Sixteen patients were included in this study. Demineralization was more pronounced in the upper than lower limbs. Demineralization of bones on the paralyzed side started during the first month after the stroke and gradually progressed. By the fourth month, the bone mineral content decreased by a mean of 9.3% (P = 0.01) and 3.7% (P = 0.01) in the upper and lower limbs, respectively, for the 11 patients followed for 4 mo. In the patients we followed for more than 4 mo, there was no further significant mineral loss. No change in bone mineral content was observed in the healthy nonparetic limbs. In conclusion, after a stroke, bone demineralization occurs in the paralyzed side and reaches its maximum within 3 to 4 mo. Arms are affected more than legs.

Regional differences in bone density of young men involved in different exercises.

In this cross-sectional, retrospective study, the bone mineral content (BMC) and density (BMD) of the whole skeleton, upper limbs, lower limbs, femoral neck, and lumbar vertebrae were measured using dual photon absorptiometry and the results compared in healthy young males involved in: weight-lifting, running, cross-training, or recreational exercises. When adjusted for body weight, the upper limb BMD was highest in those engaged solely in weight-lifting (mean 1.021, SE 0.019, and 95% CI 0.981-1.061) and lowest in runners (mean 0.908, SE 0.019 and 95% CI 0.869-0.946). These differences were significant (P = 0.0004). There were no significant differences in upper limb BMD between weight-lifters and cross-trained athletes and between runners and those engaged in recreational exercises. Significant differences in BMD were observed between weight-lifters and recreational athletes (P = 0.001) and between cross-trained athletes and runners (P = 0.03). No other significant differences were observed. These data suggest that healthy, young, adult males reporting a history of intensive weight-lifting had significantly greater bone mass of the upper limb bones than those reporting a history of non-weight-lifting exercises. These results imply a specific versus generalized effect of mechanical load on bones of the skeleton.

Changes In Bone Mineral Content And Density After Stroke

The purpose of this study was to determine whether there are differences in bone mineral content and density between paralyzed and nonparalyzed sides of patients who had sustained strokes associated with unilateral muscle weakness, to determine the relationship between duration of stroke and degree of demineralization and to compare the degree of demineralization in upper and lower limbs. The bone mineral content and density were measured by dual photon absorptiometry (high resolution scanning mode, Lunar DP4) in ambulant patients with a history of single completed strokes associated with unilateral weakness. The bone mineral content and density of each limb was determined by the region of interest analysis program. In the 30 patients included in this study, the bone mineral content and density were significantly less on the paralyzed than on the nonparalyzed side. The degree of demineralization was more pronounced in the upper than in the lower limbs. The mean percentage differences in bone mineral content and density between paralyzed and nonparalyzed arms were 13.8% (P<0.00001) and 7.95% (P=0.0003), respectively, and between paralyzed and nonparalyzed legs the differences were 4.5% (P=0.0012) and 3.42% (P=0.0028), respectively. A better correlation was noted between the time elapsed since the stroke and the degree of demineralization in the upper limbs (r=0.75, P<0.0001), than in the lower limbs (r=0.60, P=0.0004). In conclusion, patients who have strokes associated with muscle weakness are at an increased risk of developing osteoporosis on the paralyzed side and particularly in the upper limbs.

Use of the Mississippi scale for combat-related PTSD in detecting war-related, non-combat stress symptomatology.

This study investigated the effectiveness of the Mississippi Scale for Desert Storm War Zone Personnel (M-PTSD-DS), developed from the Mississippi Scale for Combat Related PTSD (M-PTSD; Keane, Caddell, & Taylor, 1988), in the measurement of varying degrees of war-related post-traumatic stress (PTS) symptomatology of non-combat Persian Gulf War veterans. Thirty Marines were administered the M-PTSD-DS after 3 months of active duty in Operation Desert Storm. The M-PTSD-DS scores of the Marines were related significantly to the number of PTS symptoms reported by the Marines. This scale appears to be quite effective in detecting varying degrees of war-related stress in non-combatants.

Investigation of the Influence of Acetylsalicylic Acid on the Steady State of Long‐Term Therapy With Theophylline in Elderly Male Patients With Normal Renal Function

The risk inherent in the clinical control of patients with theophylline is widely recognized. Elderly patients may present an additional risk because of altered pharmacokinetics and the use of concomitant medication. Acetylsalicylic acid has been proposed for primary and secondary prevention of myocardial infarction and possible strokes. This investigation was undertaken to determine if concomitant administration of acetylsalicylic acid in elderly patients would alter steady‐state levels of theophylline. A population of smoking male patients older than 60 years of age under long‐term control of chronic obstructive pulmonary disease (COPD) with theophylline were evaluated for a baseline period of 3 days. Serum levels were measured at 6:00 am and 6:00 pm. An enteric‐coated acetylsalicylic acid preparation, 650 mg by mouth, was added to the daily slow‐release theophylline, 6:00 am hour dose regimen for 4 weeks. The serum levels of theophylline and salicylates were measured at 6:00 pm after dosing and at 6:00 am the following day, at weekly intervals for 4 weeks. Urine specimens collected before administration of medication at 6:00 am were analyzed for salicylates to further confirm dosage compliance. All volunteers continued to be clinically controlled throughout the treatment period, and no symptoms of either overdose or underdose of either medication occurred. Plateau or trough theophylline serum levels did not change significantly during the salicylate treatment period. Salicylate serum levels did show during treatment self‐induced metabolism. It is concluded that in elderly male patients, a daily concomitant therapeutic salicylate regimen does not alter steady‐state serum theophylline levels and therefore does not per se necessitate the assay of theophylline blood levels in elderly patients.

Assessing the Test-Wiseness of Health Science Students Development and Validation of an Instrument

Two alternate test forms were developed to assess several test-wiseness (TW)principles for use with students in the health sciences. Each of the 24-item tests has six subtests consisting of four multiple-choice items that assess the examinees skill in using the TWprinciples of similar options, umbrella term, item give-away, convergence principle, length of correct option, and stemoption cue. Analysis of responses from 39 entering medical students showed reasonable internal consistency (KR-20 = .79 for the combinedforms) and alternate form (r = .68) reliabilities. The means (64.1% and 65.7%, standard deviations (13.9% and 14.1%, and KR-20 reliabilities (.65 and .65) were similar for the two forms of the test. Some degree of validity for measuring TW is indicated by the significant gain made on the test by nursing and medical students specifically instructed in test-taking skills and by the correlations with course grades. The test is appropriatefor use with health science students because of the medical nature of the content of the test items and the level of performance on the test by both nursing and medical students, although some question remains concerning the appropriateness of retaining the current items that measure the use of the convergence principle.