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La simulation du domicile des personnes hand- icapées dans le service de rééducation buy xenical 120mg without a prescription. Guide des outils de mesure et d’évaluation en médecine physique et de réadaptation discount 60mg xenical free shipping. The impact of assistive technology and environmental in- terventions on function and living situation status with people who are ageing with de- velopmental disabilities order xenical 120 mg with mastercard. Stability and reproductibility of the Que- bec user evaluation of satisfaction with assistive technology order xenical 120mg. Key dimensions of client satisfaction with assistive technology: a cross-validation of a Canadian measure in The Netherlands. Development of a scale to measure the psychosocial im- pact of assistive devices: lessons learned and the road ahead. Toward the development of consumer-based criteria for the evaluation of assistive devices. Assessing consumer profiles of ‘ideal’ assistive technologies in ten categories: an integration of quantitative and qualitative methods. Measuring subjective quality of life following spinal cord in- jury: a validation study of the assistive technology device predisposition assessment. A framework for the conceptual model- ling of assistive technology device outcomes. This shift has great consequences in the adoption of tech- niques and methodologies for the assessment of mobility, since it calls for the objective quantification of mobility outside a laboratory and for long periods, preferably days. Given the complex set of behaviors and heterogeneous nature of physical activity, many different types of instruments have been devised to measure mobility: they can be broadly summarized into two categories: one based on the individual recording the amount of activity, the other on instrumental monitoring. Tech- niques for the collection of this information include self-administered di- aries, logs, recall surveys, retrospective quantitative histories or interview- administered questionnaires. The most common formats used for these kinds of measurement (alone or in combination) are: a) observation/ examination – when health professionals (or others) make a judgment and rate some parameters on the basis of subjective evidence and with minimal input from the patient; b) patient’s report – in the form of a structured interview or, more often, of a self-compiled questionnaire in which the subject is asked to report, with minimal influence from other persons, experienced phenomena. Each of these methods has been formulated and validated according to the respondents’ age and educational levels. Recall surveys generally require less effort by the respondent, al- though some participants can have trouble remembering details of past physical activities. Retrospective quantitative histories generally require specific detail for time frames up to 1 year (10), again, there is an heavy demand on the re- spondent’s memory and the complexity of the survey limits its application. Ambulatory monitoring Ambulatory monitoring techniques require the subject to wear some form of movement recorder. These techniques may offer many advantages for an “ecological” assessment of individual performance and can be used in a nat- ural setting, so allowing the analysis of impact on health of the manipulation of a series of factors, including intervention programs and contextual items. Pedometers or step counters, actigraphs and movement recorders are devices that fall in this category. With each step, the pendulum moves and one electrical event is recorded so that these vertical movements are expressed as the number of counts or steps taken during walking or running. Pedometers can be worn in a variety of places, usually on the waist, clipped on to a waistband or belt, over the center of the leg. Since some sites have been demonstrated to be more reliable than others, for stan- dardization purposes, it has been suggested placing the pedometer over the dominant foot (11). Distance covered and energy expenditure are readily, if not accurate- ly (12, 13), computed from the steps counted by the pedometer, once a subject’s stride length and weight are known. Usually worn on the wrist of the dominant arm or on the waist, these devices collect ‘activity’ data for long periods and sum it over predeter- mined time spans (‘epochs’) for practical reasons, mainly storage space saving. Accelerometer-based devices are by far the most widely used acti- graphs in long-term motion recording (14). Modern accelerometers are typically micro-machined silicon sensors that are based on the detection of the displacement experienced by a small mass linked to a frame by beams when the sensor is subjected to an ac- celeration: the applied force, hence the acceleration, can be derived from the measure of the deflection. Piezo-resistive and variable capacitance accelerometers, very fre- quently used in human movement applications, respond to accelerations due to movement as well as to gravitational acceleration. The static response of these accelerometers reflects the orientation of the accelerometer with respect to gravity and can be used to compute the angle relative to the vertical of the sensor and, consequently, of the body segment on which it is located (15, 16). Since acceleration is a vector quantity, the sensitive part of the trans- ducer is constructed such as to maximize the sensitivity of the sensor along one particular direction, while minimizing crosstalk due to the oth- er acceleration components; one, two or three axis sensors are available in very compact arrangements. Numerous commercial and experimental systems use these sensors (17), embedded in small sized portable microprocessor-based devices, to detect movement and to digitally record parameters derived by the accel- eration signal produced by the changes in body position. This information is convert- ed to a reference scale of data counts (0 to 250, 1 count=12 milliG). The signals produced by movement and posture are transduced and acquired by the recording unit, preprocessed and stored in high capacity memory cards. After that the results are fed into the movement classification algo- rithms, static periods determining posture and rest positions while dy- namic periods are used for activity detection. The classification algorithms presented so far have been based on thresholds (22, 29), artificial neural networks (24, 30, 31), on statistical methods (16, 21), fuzzy logic (32) or combinations of these. The number and position of the sensors affect the detail of the infor- mation obtainable: one tri or bi-axial waist-mounted accelerometer can reliably detect rest and activity periods and can be used for classification of standing, sitting, lying and walking (33-36), while sensors placed also on legs and ankles have been used to produce estimates of spatio-tempo- ral gait parameters (20, 37). The typical report presents an activity diary and accumulated time spent in every specific activity or posture detected with the relative per- centage of the total recording time. As an example, we show a result obtained by our research group with a system based on the Vitaport recorder, 4 uniaxial accelerometers (2 on the trunk, one on each thigh) and a modified version of the protocol de- scribed by Bussmann (21) with discriminant analysis as the classification engine, which was part of the validation of the instrument in our clinical setting. Normal subjects were required to perform 2 repetitions of a sequence of activities/postures in this order: 1. Resting (sitting) The two sequences were separated by a period of exercise on a cyclette. The figure, which presents the results of the classification procedure for one subject, is the activity log of the test, which lasted about 40 minutes: the total time spent in each activity/posture is given on the left, the upper scale is the time of the day and the lower scale is the relative test time. The activity/posture detected is associated with the colored area into which the gray bar ends. One research group has recently also developed algorithms for the classification of upper limb movements (49-51), using a set of accelerom- eters located on the arms. Two commercial systems are available, Dynaport by McRoberts and Bodytrac by Imsystems, specifically designed for activity recording and classification, while two other data recorders (Vitaport by Temec and Physilog developed by the Ecole Politechnique Federale de Lausanne) have specific configuration and software developed for the same goal. All these subjective instruments are easy to use and low-cost, but are retrospective, some disrupt (and/or interfere with) the analyzed perfor- mance, and most require high compliance by the subjects. Besides method-specific issues, attempts at detailed interpretation, in terms of exercise dose and the extent of resulting health benefits, still seem premature, as shown in a recent review (57). In general, commercially available pedometers are affected by limit- ed sensitivity in detecting low-speed movements (for instance, while mov- ing around the house), are prone to artifacts caused by travel in cars or public transportation systems and, of course, cannot discern activities which do not involve ambulatory locomotion, such as weight lifting, thus limiting their usefulness in measuring energy expenditure. Accelerometer-based step counters are more accurate in detecting movements also in difficult conditions, such as in shuffling or in over- weight subjects (60-62). Other studies have used actigraphy for monitoring waking activity in studies of bipolar disorder and depression (69-72), childhood hyperactiv- ity (73-75) and oncology (76-78). Actigraphs, which are easy to use and affordable, with a cost up to 1500 $, are actually the only objective method for practical recording of activity over long periods. The major disadvantages of these systems, other than their high cost, are that they are tethered and, therefore, will lead to discomfort to the subject, especially when a large number of sensors are used, and the fact that they usually cannot be dismounted and set up again by the subject, for instance for showering, therefore preventing recordings lasting more than 1-2 days, even if batteries and storage card capacities could be in- creased to accommodate this. Moreover, validation is usually performed in controlled situations that are different from the real ‘home’ situation in which these systems are designed to operate. For the future, active research is ongoing to help overcome the main limitations, namely the complex wiring setups and the limited length of recording for detailed movement classification: for instance, advances in wireless technology have produced a new and exciting class of sensors not requiring cables to transmit the signal to the recorder, overcoming the possible discomfort due to the wiring (121, 122) while wearable technol- ogy now includes armbands or vests with embedded sensors (123-125). Coupled with telemedicine techniques, signals can be continuously monitored and sent directly via mobile telephone or the Internet to the analysis station, extending the recording period indefinitely (126, 127). Seven-day activity and self-report compared to a direct measure of physical activity. Test-retest relia- bility of the Minnesota Leisure Time Physical Activity Questionnaire. Measurement of physical activity to as- sess health effects in free-living populations. Reliability of long-term recall of participation in physical activity by middle-aged men and women. The assess- ment of historical physical activity and its relation to adult bone parameters.
Vitamin: An essential compound necessary to act as a catalyst in normal processes of the body cheap 60 mg xenical with amex. What distinguishes an optimist from a pessimist is the way in which they explain both good and bad events purchase xenical 60 mg line. Martin Seligman has developed a simple test to determine your level of optimism (see Learned Optimism purchase xenical 60 mg on line, Knopf buy xenical 120mg line, 1981). Your boss gives you too little time in which to finish a project, but you get it finished anyway. In other words, the results will tell you about the way in which you explain things to yourself. There are three crucial dimensions to your explanatory style: permanence, pervasiveness, and personalization. When pessimists are faced with challenges or bad events, they view the events as being permanent. In contrast, people who are optimists tend to view the challenges or bad events as temporary. Each one with a “0” after it is optimistic; each one followed by a “1” is pessimistic. Total the numbers at the right-hand margin of the questions coded PmB, and write the total on the PmB line on the scoring key. If you totaled 0 or 1, you are very optimistic on this dimension; 2 or 3 is a moderately optimistic score; 4 is average; 5 or 6 is quite pessimistic; and 7 or 8 is extremely pessimistic. Now let’s take a look at the difference in explanatory style between pessimists and optimists when there is a positive event in their lives. Pessimists view positive events as temporary, while optimists view them as permanent. If you totaled 7 or 8, you are very optimistic on this dimension; 6 is a moderately optimistic score; 4 or 5 is average; 3 is pessimistic; and 0, 1, or 2 is extremely pessimistic. If you are scoring as a pessimist, you may want to learn how to be more optimistic. Your anxiety may be due to your belief that bad things are always going to happen, while good things are only a fluke. Pervasiveness refers to the tendency to describe things in universals (everyone, always, never, etc. Pessimists tend to describe things in universals, while optimists describe things in specifics. If you totaled 0 or 1, you are very optimistic on this dimension; 2 or 3 is a moderately optimistic score; 4 is average; 5 or 6 is quite pessimistic; and 7 or 8 is extremely pessimistic. Optimists tend to view good events as universal, while pessimists view them as speciﬁc. Total your score for the questions coded PvG (for Pervasive Good): 6, 7, 28, 31, 34, 35, 37, and 43. If you totaled 7 or 8, you are very optimistic on this dimension; 6 is a moderately optimistic score; 4 or 5 is average; 3 is pessimistic; and 0, 1, or 2 is extremely pessimistic. Our level of hope or hopelessness is determined by our combined level of permanence and pervasiveness. If it is 0, 1, or 2, you are extraordinarily hopeful; 3, 4, 5, or 6 is a moderately hopeful score; 7 or 8 is average; 9, 10, or 11 is moderately hopeless; and 12, 13, 14, 15, or 16 is severely hopeless. People who make permanent and universal explanations for their troubles tend to suffer from stress, anxiety, and depression; they tend to collapse when things go wrong. When bad things happen, either we can blame ourselves (internalize) and lower our self-esteem as a consequence, or we can blame things beyond our control (externalize). Although it may not be right to deny personal responsibility, people who tend to externalize blame in relation to bad events have higher self- esteem and are more optimistic. Total your score for the questions coded PsB (for Personalization Bad): 3, 9, 16, 19, 25, 30, 39, 41, and 47. A score of 0 or 1 indicates very high self-esteem and optimism; 2 or 3 indicates moderate self- esteem; 4 is average; 5 or 6 indicates moderately low self-esteem; and 7 or 8 indicates very low self- esteem. When good things happen, the person with high self-esteem internalizes while the person with low self-esteem externalizes. Total your score for those questions coded PsG (for Personalization Good): 1, 4, 11, 12, 23, 27, 36, and 45. If you totaled 7 or 8, you are very optimistic on this dimension; 6 is a moderately optimistic score; 4 or 5 is average; 3 is pessimistic; and 0, 1, or 2 is extremely pessimistic. If your B score is from 3 to 6, you are marvelously optimistic when bad events occur; 10 or 11 is average; 12 to 14 is pessimistic; anything above 14 is extremely pessimistic. If your G score is 19 or above, you think about good events extremely optimistically; 14 to 16 is average; 11 to 13 indicates pessimism; and a score of 10 or less indicates great pessimism. If your overall score (G minus B) is above 8, you are very optimistic across the board; if it’s from 6 to 8, you are moderately optimistic; 3 to 5 is average; 1 or 2 is pessimistic; and a score of 0 or below is very pessimistic. For example, you won’t see nuts, seeds, ﬁsh, poultry, and meats listed, because these foods have little impact on blood sugar levels as they are low in carbohydrates. The acid-alkaline theory of disease is an oversimpliﬁcation, but it essentially states that many diseases are caused by excess acid accumulation in the body. There is accumulating evidence that certain disease states such as osteoporosis, rheumatoid arthritis, gout, and many others may be inﬂuenced by the dietary acid-alkaline balance. For example, osteoporosis may be the result of a chronic intake of acid-forming foods that consistently outweighs the intake of alkaline foods, with the result that the bones are constantly forced to give up their alkaline minerals (calcium and magnesium) in order to buffer the excess acid. The dietary goal for good health is simple: make sure that you consume more alkaline-producing foods than acid-producing foods. Keep in mind that there is a difference between acidic foods and acid-forming foods. For example, although foods like lemons and citrus fruits are acidic, they actually have an alkalizing effect on the body. What determines the pH nature of a food in the body is the metabolic end product when it is digested. For example, the citric acid in citrus fruit is metabolized in the body to its alkaline form (citrate) and may even be converted to bicarbonate, another alkaline compound. The following table was prepared by Professor Jürgen Vormann of the Institute for Prevention and Diet in Ismaning, Germany (used with permission; see http://jn. Foods with a negative value exert a base (B) or alkaline effect, foods with a positive value an acid (A) effect. The calculation is based upon the potential acid load to the kidneys in milliequivalents per 100-g (31/2-oz) serving. In fact, we have chosen to focus on key studies and comprehensive review articles that readers, especially medical professionals, may find helpful. The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at websites of participating publishers. If the publisher has a website that offers full text of its journals, PubMed provides links to that site, as well as sites with other biological data, sequence centers, and so on. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. Coverage is worldwide, but most records are from English-language sources or have English abstracts (summaries). Conducting a search is quite easy, and the site has a link to a tutorial that fully explains the search process. Effects of nonsteroidal anti-inﬂammatory drugs on chondrocyte metabolism in vitro and in vivo. Anti-inﬂammatory drugs and their effects on cartilage synthesis and renal function. Correlation between radiographic severity of knee osteoarthritis and future disease progression. Results from a 3-year prospective, placebo-controlled study evaluating the effect of glucosamine sulfate. Osteoarthritic patients with high cartilage turnover show increased responsiveness to the cartilage protecting effects of glucosamine sulphate. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. A large, randomized, placebo controlled, double-blind study of glucosamine sulfate vs piroxicam and vs their association, on the kinetics of the symptomatic effect in knee osteoarthritis.
Obstruction results from collapse of the tube (due to weak tissues holding the tube in place buy generic xenical 120 mg on-line, an abnormal opening mechanism 60mg xenical free shipping, or both) purchase xenical 60mg fast delivery, blockage by mucus in response to allergy or irritation xenical 60mg with mastercard, swelling of the mucous membrane, or infection. Diagnostic Considerations Bottle-feeding Recurrent ear infection is strongly associated with early bottle-feeding, while breast-feeding for a minimum of three months has a protective effect. In addition, bottle-feeding while a child is lying on his or her back (bottle-propping) leads to regurgitation of the bottle’s contents into the middle ear and should be avoided. Whatever the causative organism in otitis media—viral (respiratory syncytial virus, rhinovirus, or inﬂuenza A) or bacterial (S. Another way in which prolonged breast-feeding prevents otitis media may be by the avoidance of food allergies, particularly if the mother avoids sensitizing foods (i. In addition to breastfeeding, also of value is the exclusion or limited consumption of the foods to which children are most commonly allergic—wheat, egg, peanuts, corn, citrus, chocolate, and dairy products—particularly during the first nine months. Because a child’s digestive tract is quite permeable to food antigens, especially during the ﬁrst three months, careful control of eating patterns (no frequent repetitions of any food, avoiding the common allergenic foods, and introduction of foods in a controlled manner, one food at a time, while carefully watching for a reaction) will reduce or prevent the development of food allergies. The allergic reaction causes blockage of the eustachian tube by two mechanisms: inﬂammatory swelling of the mucous membranes lining the tube and inﬂammatory swelling of the nose, causing the Toynbee phenomenon (swallowing when both mouth and nose are closed, forcing air and secretions into the middle ear). The middle and inner ear are immunologically responsive, and this responsiveness includes food hypersensitivities. The 12-month success rate for 119 of the children, when they were treated with serial dilution titration therapy for inhalant sensitivities and an elimination diet for food allergens, showed that 92% improved. This result is signiﬁcantly higher than that seen in the surgically treated control group (ear tubes and, as indicated, removal of the tonsils and adenoids), which showed only a 52% response. An allergy elimination diet led to a signiﬁcant improvement of chronic otitis media in 70 of 81 patients (86%) as assessed by detailed clinical evaluation. The challenge diet with the suspected offending food provoked a recurrence of serous otitis media in 66 of 70 patients (94%). Therapeutic Considerations The primary treatment goals are to ensure that the eustachian tubes are unobstructed and to promote drainage by identifying and addressing causative factors. The recommendations that follow should be used along with the recommendations given in the chapter “Immune System Support. In a double-blind outpatient trial, one group from Israel studied 171 children ages 5 to 18 who were randomly assigned to receive treatment with naturopathic herbal extract ear drops or anesthetic ear drops (amethocaine and phenazone), with or without amoxicillin (a daily dose of 80 mg/kg per day). All groups had a statistically signiﬁcant improvement in ear pain over the course of the three days, with a 95. Xylitol Xylitol is a commonly used natural sweetener derived mainly from birch and other hardwood trees. Two double-blind clinical trials illustrated xylitol’s ability to reduce acute otitis media incidence by 40%. In one study of 306 children in day care with recurrent acute otitis media, 157 children were given xylitol (8. In a second randomized and controlled blinded trial,27 857 healthy children were randomly assigned to one of ﬁve treatment groups to receive control syrup, xylitol syrup, control chewing gum, xylitol gum, or xylitol lozenges for a period of three months. Although at least one event of otitis media was experienced by 41% of the 165 children who received control syrup, only 29% of the 159 children receiving xylitol syrup were affected. Likewise, the occurrence of otitis decreased by 40% compared with control subjects in the children who received xylitol chewing gum and by 20% in the lozenge group. Thus the occurrence of acute otitis media during the follow-up period was signiﬁcantly lower in those who received xylitol syrup or gum, and these children required antibiotics less often than did controls. Humidifiers Humidiﬁers are popular treatments for otitis media and upper respiratory tract infections in children. This may be justiﬁed, according to a 1994 study that evaluated the role of low humidity in this disorder. Twenty-three rats were housed for ﬁve days in a low-humidity environment (10 to 12% relative humidity), and 23 control rats were housed at 50 to 55% relative humidity. Microscopic ear examinations were graded for otitis media before testing and on test days three and ﬁve. Signiﬁcantly more effusions (ﬂuid in the eustachian tubes) were observed in the low-humidity group on both day three and day ﬁve, but biopsy results were similar in both groups. This study indicated that low humidity may be a contributing factor in otitis media. Possible explanations are that low humidity may induce nasal swelling and reduce ventilation of the eustachian tube, or that it may dry the eustachian tube lining, possibly leading to an inability to clear ﬂuid, as well as to increased secretions. The mast cells that reside in the lining of the eustachian tube may also come into play by releasing histamine and producing swelling. Although preliminary, this research indicates that increasing humidity with the use of a humidiﬁer may be helpful in the treatment of otitis media with effusion. Because it is usually not possible to determine the exact allergen during acute otitis media, the most common allergic foods should be eliminated from the diet: • Milk and other dairy products • Eggs • Wheat • Corn • Oranges • Peanuts • Chocolate The diet should also eliminate concentrated simple carbohydrates (e. These simple dietary recommendations bring relief to most children in a matter of days. Nutritional Supplements • A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures” • Vitamin C: adults, 500 to 1,000 mg three times per day; children, 50 mg for each year of age every two hours • Zinc: adults, 15 to 30 mg per day; children, 2. It can be applied as a hot pack, with warm oil (especially mullein oil) dripped into the ear, or by blowing hot air into the ear with the aid of a straw and a hair dryer. These treatments help to reduce pressure in the middle ear and promote fluid drainage. Endometriosis • Painful menstruation, painful intercourse, and infertility • Physical examination by a physician reveals one or more of the following: tenderness of the pelvic area, enlarged or tender ovaries, a uterus that tips backward and lacks mobility, and adhesions (abnormal scarring) • Pelvic ultrasound detects endometrial tissue outside the uterus • Deﬁnitive diagnosis: laparoscopy or laparotomy visualizing endometrial implants within the pelvic cavity Endometriosis is a women’s health condition in which cells from the lining of the uterus (endometrium) appear and ﬂourish outside the uterine cavity, most commonly on the ovaries. Since the endometrial cells are under the inﬂuence of female hormones even when they reside outside the uterine lining, they can produce symptoms that often worsen at speciﬁc points during the menstrual cycle. Endometriosis lesions react to hormonal stimulation and may “bleed” at the time of menstruation. The blood accumulates locally, causes swelling, and triggers inﬂammatory responses, including the activation of pain-producing molecules known as cytokines. Pain can also occur from adhesions (internal scar tissue) binding internal organs to each other, causing organ dislocation. Fallopian tubes, ovaries, the uterus, the bowels, and the bladder can be bound together in ways that are painful on a daily basis, not just during certain times of the menstrual cycle. Endometriosis affects 10 to 15% of menstruating women between the ages of 24 and 40 years old. Causes The predominant theory of the cause of endometriosis is that during menses, blood ﬂows backward and implants endometrial cells in the pelvic cavity. The problem found with this theory is that more than 90% of menstruating women without endometriosis have this backward ﬂow. Typically their immune system is able to prevent implantation and growth of the endometrial cells outside the uterus, so defects in immune function may be responsible for the development of endometriosis. However, in some patients, endometrial tissue transplanted by retrograde menstruation may be able to implant and establish itself as endometriosis. Women with endometriosis typically show alterations in immune function, particularly in those factors that are responsible for proper surveillance in the pelvic area. Particularly incriminating are phthalates, used as plasticizers (substances added to plastics such as polyvinyl chloride to increase their ﬂexibility, transparency, durability, and longevity). Phthalates are being phased out of many products in the United States, Canada, and the European Union because of health concerns. Risk factors for endometriosis include family history, lack of exercise from an early age, a high-fat diet, use of intrauterine devices, and increased or unbalanced estrogen levels. In younger women who may desire to get pregnant in the future, surgical treatment attempts to remove the stray endometrial tissue and preserve the ovaries. The dominant nonsurgical treatment is the use of hormonal medication that suppresses the natural menstrual cycle, plus pain medication to manage the discomfort. On occasions, naturopathic physicians will use natural progesterone therapy (a form of bioidentical hormone therapy) to help relieve the symptoms of endometriosis. Although progesterone creams may be available over the counter, we recommend being treated and monitored by a physician. The natural approach to endometriosis is designed to achieve the following goals: • Reduce inflammation • Enhance detoxification mechanisms • Reduce bothersome symptoms The strategies discussed in the chapter “Silent Inﬂammation” are extremely important in endometriosis. The consumption of trans-fatty acids appears to increase the risk of endometriosis, while long-chain omega-3 fatty acids from ﬁsh oils appear to be protective. Those women who consumed the most trans-fatty acids were 48% more likely to be diagnosed with endometriosis.