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QianqianXie1994

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Pubmedsum_fiveshot_dynamic_llama2-13b-chat

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{ "id": "PubmedSumm_five_shot_dy0", "query": "***TASK***\nthe task is to summarize an input biomedical literature in six sentences\n\n***INPUT***\nthe input is a biomedical literature\n\n***OUTPUT***\nthe output is the summary of an input biomedical literature in six sentences\n\n***DOCUMENTATION***\n\n***EXAMPLES***\nINPUT: through the studies done so far , strong association is found between dermatological condition and psychological problems . the incidence of psychiatric disorders among dermatological patients is approximately between 30% and 40% . \n the presence of a concomitant psychiatric illness is predominantly observed in patients with various dermatological disorders like dermatitis , acne , pruritus , urticaria , alopecia , psoriasis or vitiligo , of which atopic dermatitis ( ad ) is the most common skin disease observed in general practice . \n ad is a chronic inflammatory skin disease , characterized by pruritic and eczematous skin lesions with series of exacerbations and remissions . \n common age of presentation is children and adolescence , but in one - third of cases it extends to adulthood . \n most frequent symptoms reported as a basis for distress are disfigurement and itching causing significant insomnia , and sleep deprivation leads to fatigue , mood lability , impaired functioning and suicide in few cases . furthermore , frequent bullying and embarrassment due to disfigurement leads to social stigma and social isolation . on the other hand \n , it has been also been appraised that stressful life events often exacerbates or precedes dermatitis . \n any stress causes stimulation of hypothalamic - pituitary - adrenal ( hpa ) axis and autonomic nervous system resulting in inducing helper t cells causing release of neuropeptides and hormones . \n these neuropeptides causes adrenergic and other neurotransmitters release causing vascular instability in dermatitis patients , indicating a link between neuroendocrine and immune system . on the other hand , \n disfigurement caused due to dermatitis can lower patients self esteem , in turn increasing the propensity to anxiety and depression . \n it has also been put forward that intense itching in dermatitis leads to sleep disturbances causing irritable behavior , decreased concentration , and decreased threshold of tolerance which on persisting for a protracted period can cause various psychiatric illness like depression , anxiety , attention - deficit hyperactivity disorder ( adhd ) and autism . \n there is tendency of presentation of somatic symptoms in patients with dermatological conditions in comparison to normal population . \n on exploring the personality of patients suffering from dermatitis , some traits commonly found are of feelings of insecurity , inferiority and inadequacy , tension , anxiety , depression , aggressiveness , dependence , sensitivity , emotional liability , hyperactivity , difficulty in expressing feelings , sexual conflicts , masochism , high intelligence level , shyness and being doubtful \n . therefore timely evaluation of patient 's personality and sub - syndromal psychiatric symptoms ( lack of self esteem / confidence , shame , stigma embarrassment , decrements in body image ) can detect various psychological risk factors in the patient , which would help in early co - morbid psychiatric diagnosis and its proper management . through the current study \n , we aim to assess the relationship of ad and psychiatric illness ( depression and anxiety ) , further strengthening the existing data particularly focusing upon gender differences among the patients . \n this cross - sectional study with consecutive sampling was done in an outpatient clinic of dermatology at a tertiary care center spread over a period of 8 month . \n subjects giving informed consent were evaluated on a brief semi - structured performa for collecting demographic and clinical information . \n primary care evaluation of mental disorders ( prime - md ) was used to assess the presence of psychiatric symptoms in these patients . \n all consecutive subjects not suffering from chronic illness other than skin disease , with no past history of psychiatric illness and no apparent life stress other than the skin disease were included . \n prime - md was an instrument developed and validated in the early 1990s to efficiently diagnose five of the most common types of mental disorders presenting in medical populations : depressive , anxiety , somatoform , alcohol , and eating disorders . \n patients first completed a one - page 27-item screener and , for those disorders for which they screened positive , were asked additional questions by the clinician using a structured interview guide . \n however , this second - stage process took an average of 5 - 6 minutes of clinician time in patients without a mental disorder diagnosis and 11 - 12 minutes in patients with a diagnosis . \n this proved to be a barrier to use given the competing demands in busy clinical practice settings . to overcome this barrier , \n individual screening tools for each psychiatric illness were assessed for their validation . through various studies , patient health questionnaire ( phq-9 ) and generalized anxiety disorder questionnaire ( gad-7 ) have been validated to effectively assessing depression and anxiety disorders when applied alone instead of the whole prime - md . in our study , we have used these two components of prime - md , as these two psychiatric illnesses were commonly found concurrently with skin disorders . \n this is calculated by assigning scores of 0 , 1 , 2 , and 3 , to the response categories of -not at all , -several days , -more than half the days , and -nearly every day , respectively . \n scores of 5 , 10 , 15 , and 20 represent cut points for mild , moderate , moderately severe and severe depression , respectively . \n gad-7 is calculated by assigning scores of 0 , 1 , 2 , and 3 , to the response categories of -not at all , -several days , -more than half the days , and -nearly every day , respectively . \n scores of 5 , 10 , and 15 represent cut - points for mild , moderate , and severe anxiety , respectively . \n independent sample t - test ( for continuous variables ) and chi - square test ( for categorical variables ) were used to find difference between the patients and the care givers on different variables . \n additionally cramer 's v test and phi test were used for 2 4 contingency tables . \n the conditions of confidentiality as specified in the institutional ethical guidelines were strictly adhered to . \n a total of 81 patients were included in the final analysis ( males = 36 , females = 45 ) . \n the mean age of the subjects was 34.94 15.89 years ( 10 - 74 ) . \n there was no significant difference in mean age between male and female subjects ( 36.14 17.62 and 33.98 14.49 years , respectively ; p = 0.54 ) . \n all the subjects belonged to the urban area and it was seen that more females were unemployed than males ( p = 0.001 ) . \n socio - demographic and clinical parameters in the study population about 57% of the patients were diagnosed as having clinically significant depression [ figure 1 ] . \n it included mild ( 31% ) , moderate ( 8% ) , moderately severe ( 5% ) and severe ( 2% ) . \n it included mild ( 27% ) , moderate ( 4% ) and severe ( 8% ) . \n 22.2% reported of a suicidal ideation while only 8.3% male subjects reported of any suicidal ideation . \n bar chart representing the severity of depression amongst the genders in the study population phq-9 = patient health questionnaire bar chart representing the severity of anxiety amongst the genders in the study population gad-7 = generalized anxiety disorder scale females had significantly more anxiety and depression scores than males ( p = 0.04 and p = 0.03 respectively ) , but had no difference in terms of suicidal ideation [ table 2 ] . \n but on comparison of individual severity scores of scales among the genders [ table 3 ] , no difference was observed for anxiety among the groups ( cramer 's v = 0.267 ; p = 0.12 ) . \n gender comparison for depression , anxiety and suicidal ideation among individuals with dermatitis ( m=36 , f=45 ) gender comparison for severity of depression and anxiety phq-9 and gad-7 scores significantly correlated to each other ( ) . \n suicidal ideation was positively correlated to total phq-9 and gad-7 scores ( r = 0.42 , p < 0.001 ; r = 0.37 , p = 0.001 respectively ) . \n age , education , occupation and duration of illness were not found to be correlated to depression , anxiety or suicidal ideation in the overall sample population . among female subjects , \n age was found to be positively correlated to total gad-7 scores ( r = 0.45 , p = 0.002 ) but not to total phq-9 ( r = 0.28 , p = 0.06 ) or suicidal ideation ( r = 0.18 , p = 0.22 ) . \n education , occupation and duration of illness were not found to be correlated to depression , anxiety or suicidal ideation in female subjects . among male subjects , \n being employed was found to be positively correlated to total gad-7 scores ( r = 0.39 , p = 0.01 ) and suicidal ideation ( r = 0.33 , p = 0.04 ) but not to total phq-9 scores ( r = 0.17 , p = 0.31 ) . \n age , education and duration of illness were not found to be correlated to depression , anxiety or suicidal ideation in male subjects . \n the current study confirmed the previous findings of significant association of ad with anxiety , depression and suicidal ideations . \n when including moderate to severe grade of depression or anxiety , the current study found prevalence rates of 15% and 12% , respectively . \n hordaland health study reported that 12.9% had current anxiety only , 4.2% current depression only , and 7.5% had comorbid anxiety / depression . \n the lower prevalence of depression in this study could have been due to utilization of self - reported hads while our study used clinician - administered prime - md , which might have given a more accurate data . \n another study in patients with occupational hand eczema reported that 20% had a positive anxiety score and 14% had a positive depression score . \n the slight difference from our findings could be because we incorporated all cases of ad involving all body locations . \n adolescents with ad are also reported to have high rates of lifetime rates of anxiety ( 9 - 32% ) and depressive ( 12 - 24% ) disorders . \n studies report that both trait anxiety ( ta ) and state anxiety ( sa ) are significantly higher in patients with ad with ta being significantly higher than sa . in our study \n , women were found to be having significantly higher depressive and anxiety symptoms than males . \n young female patients with ad have been reported to be more distressed than older male patients . probably , these findings are due to the reason that women are more concerned regarding their physical appearance than men perceiving the skin disorder as a threat in turn leading to emotional disturbance . \n researchers have also suggested other hypothesis to explain gender - specific association between atopy and depression implicating role of genetic abnormalities in serotonin metabolism , hpa - axis dysfunction , and histamine theory . \n ( 2010 ) found depression to be more in men than women with ad , the opposite of timonens hypothesis . \n more than half of the study group had secondary and higher secondary education indicating that higher the education there is more awareness and concern regarding physical appearance leading to medical consultation contrary to finding by khan et al . \n ( 2011 ) found a substantial reduction in quality of life ( qol ) in patients suffering from dermatitis . \n factors liable for the same could be intense itching leading to disturbed sleep , fatigability , decreased concentration at work , social rejection thinking dermatitis as contagious and emotional disturbances . \n it was also noted that half of the patients were suffering from chronic illness ( > 6 months ) . though there are no studies on association of chronic dermatitis with psychiatric morbidity , but one study mentions that persistent skin disease had higher psychiatric co - morbidity in comparison to intermittent and incident skin disease . \n it could be due to the reason that chronic illness may act as a constant stressor generating higher mental morbidity . \n suicidal ideation was reported by significant proportion of subjects ( 16% ) in our study similar to other studies . \n the prevalence of suicidal ideation in patients with mild , moderate , and severe ad between the age of 15 and 49 years is reported to be 0.21% , 6% , and 19.6% , respectively . \n studies comparing various dermatological disorders report that depression is highest in ad as are suicidal ideation . \n a previous study reported rates of suicidal ideation to be 2.1% among ad patients but did not report on the severity of ad . \n studies support a strong correlation between severity of dermatitis symptoms and psychological burden which may increase the risk of suicidal ideas in ad patients . \n our study also showed more of suicidal ideation in women in comparison to men though not significantly , which could be due to more propensities of women to be affected by stressor and psychological distress leading to pessimistic view regarding the future ending up in suicidal ideation / suicide . \n other studies have also reported suicidal thoughts among female with skin problems to be more than male ad patients . \n while our study did not find any significant correlation between the duration of illness and presence of depression in subjects , other studies have reported the same . \n the current study was limited in generalization due to its limited sample size , cross - sectional assessment , findings from a single tertiary care center and an absence of a control group . \n associated risk factors which might have exacerbated the psychiatric condition were not evaluated like personality traits or any concomitant stressful life event . \n we did nt assess the severity of dermatitis so , we were unable to compare association of severity of dermatitis with anxiety and depression . \n the strength of our study was the through assessment of psychiatric and dermatological illness by specialists of the relevant field increasing the reliability of findings . \n the present study confirmed the previous findings linking an association between dermatological condition and psychiatric illness . \n it can also be concluded that there is a need for thorough assessment of psychiatric illness in patients with dermatological conditions and also there is need to actively assess regarding any suicidal plans / ideations for improving the patient management and overall quality of life . \n female patients suffered from more anxiety and depression than males , which in light of the a female preponderance for ad , making it utmost important to focus upon this population subgroup in the society . \n female patients suffering from atopic dermatitis endure more anxiety and depressive symptoms than malesthere is high prevalence of suicidal ideation ( 16% ) among patients of atopic dermatitis . \n female patients suffering from atopic dermatitis endure more anxiety and depressive symptoms than males there is high prevalence of suicidal ideation ( 16% ) among patients of atopic dermatitis .\nOUTPUT: background : dermatological patients invariably suffer one or the other psychological problems which may escalate to the extent of a mental disorder . \n one of the most common dermatological disorders is atopic dermatitis ( ad ) , but the literature has limited data on gender differences for psychiatric morbidity in such patients.aims:to evaluate and compare gender differences in the prevalence of depression and anxiety in ad.materials and methods : this cross - sectional study with consecutive sampling was done in an outpatient clinic of dermatology at a tertiary care center . \n ad subjects giving informed consent were evaluated on a brief semi - structured performa for collecting demographic and clinical information . \n primary care evaluation of mental disorders ( prime - md ) was used to assess the presence of psychiatric symptoms in these patients . \n descriptive analysis was done for the socio - demographic profile and independent sample t - test , chi - square and cramer 's v test was carried out to find in - between group differences for males and females.results:a total of 81 patients were included in the final analysis ( males = 36 , females = 45 ) with no significant difference in mean age between male and female subjects ( 36.14 17.62 and 33.98 14.49 years , respectively ; p = 0.54 ) . \n when including moderate to severe grade of depression or anxiety , the current study found prevalence rates of 15% and 12% respectively . \n females had significantly more anxiety and depression scores than males ( p = 0.04 and p = 0.03 respectively).conclusions : there is a female preponderance of depression and anxiety disorder in ad patients .\nINPUT: high blood pressure is usually associated with certain cardiovascular disease ( cvd ) risk factors conjointly resulting in increased cvd morbidity.1 these other cvd risk factors vary in proportion from one environment to another,2 and depend on the level of sophistication of the community . \n population - wide strategies to control cvd usually target for efficiency these risk factors which produce relevant intermediate diseases or the cvds themselves.3 though some of the risk factors are non - modifiable , others are . when identified and worked upon , reduction in their rates especially hypertension which is chief , gives rise to significant benefits.4 most works on these risk factors in our environment are hospital - based . \n a more lucid picture of the situation usually emerges if population surveys are done ; as they would include those affected to degrees not warranting presentation to hospitals . \n such studies are few in sub - saharan africa , especially in our locality . despite sharing similar physical and cultural environments , group - level cultural variability and distinct genetic ancestry \n are known to result in different patterns of cvds.5 this reason prompted our desire to see how blood pressure relates to some common cvd risk factors in a rural population in north central nigeria . \n findings would guide primary and secondary preventive efforts to reduce morbidity and mortality burdens of cvds on the long run . \n in 2008 , our team re - surveyed two rural communities that had been studied 17 years previously as part of a national non - communicable diseases survey sponsored by the federal ministry of health and social services in nigeria . after getting ethical clearance from the research ethics committee of jos university teaching hospital , we met with and got clearance from leaders of the area at various levels . finally , we mobilized and got to the study sites where all subjects 15 years and above having been mobilized by their leaders at various levels came out for the survey . \n subjects were made to sit in the order of their arrival to the study site as we had no control over that to remove any bias . \n informed consent was then requested after explanation in english or subjects ' mother tongue of what the study entailed . \n they were then registered and in the same order handed a copy of the study protocol and sample containers ( given in the same order to one in every three subjects ) . \n they then moved to the next station where the history section was filled by research assistants . \n three blood pressure measurements were obtained in stations 3 , 5 and 7 by different trained assistants ( medical registrars ) after subjects had been sitting for about 5 minutes . \n the activities in intervening stations 4 ( height and weight measurement ) and 6 ( waist and hip circumference measurements ) ensured that there was at least 3 minutes in between blood pressure readings . \n mercury ( accosson brand ) sphygmomanometers with appropriate - sized cuffs were used to measure blood pressure in the standard fashion . \n the mean of the last two measurements was calculated in each case and used for analysis . \n weight was measured using a weighing scale on a firm flat surface to the nearest kilogram with subjects in light clothing only ; while height was measured using stadiometer in metres to the nearest centimetre . \n body mass index ( bmi ) was derived from weight ( kilograms ) and height ( metres ) using the formular w / h2 . \n waist circumference was taken using flexible tape at the level of the midpoint between the ribs and the iliac crest from the front in exhalation ; and hip circumference measured at the point where the buttocks extended the most when viewed from the side , at the level of the greater trichinae of the femur . \n urinalysis for protein and sugar were determined using appropriate dipstix method on site for those randomized for laboratory investigations . \n venous blood was taken from the ante - cubital fossae of such subjects and put in appropriate specimen bottles and taken at the end of each day to the base laboratory for analysis by one of the investigators ( ioi ) . \n serum creatinine was measured by the jaffe 's reaction and uric acid ( ua ) by caraway method ; while packed cell volume ( pcv ) was determined using the microhaematocrit centrifuge . at the end \n , data were collated and analysed in the university of jos , computer centre using statistical package of social sciences ( spss ) 17.0 . \n analysis of variance , student t test and pearson 's correlation coefficients were used as appropriate to determine degree of difference or association between blood pressure and some cvd risk factors . \n at the end , data were collated and analysed in the university of jos , computer centre using statistical package of social sciences ( spss ) 17.0 . \n analysis of variance , student t test and pearson 's correlation coefficients were used as appropriate to determine degree of difference or association between blood pressure and some cvd risk factors . \n a total of 840 subjects were studied , 25.1% of whom were males and 74.9% females . \n they were aged between 16 and 104 years with a mean of 45.5 18.2 . \n majority , 78.5% lived most of their last 5 years in the area while 19.3% although resident in the rural area in question at the time of the study lived most of their last 5 years in the urban areas . \n there were few smokers ( 1.8% ) and not many ( 4.1% ) admitted to using alcohol . \n systolic blood pressure ( sbp ) was found to be correlated significantly with bmi , total cholesterol ( tc ) , age and serum uric acid ( p = 0.01 ) ; but not with pulse rate , high density lipoprotein cholesterol ( hdl - c ) , blood sugar , pcv , serum creatinine and atherogenic index ( ai ) defined as quotient of tc and hdl - c . for diastolic blood pressure ( dbp ) , there was significant correlation with bmi , tc , serum uric acid , age and ai ; but not serum creatinine , pcv , blood sugar and hdl - c [ table 1 ] . degree of correlation by blood pressure and various cvd risk factors there was a trend in association between alcohol use and sbp . \n those who drank actually had lower mean sbp than those who did not ( 127.32 vs. 130.51 ) , although the difference did not attain statistical significance ( p = 0.499 ) . \n the small numbers did not permit any worthwhile scrutiny . only 15 subjects ( 1.8% ) smoked a number considered rather small ; hence no further analysis was done . \n exercise was assessed by questions on physical activity in regular occupation and rated as mild , moderate or high . \n it was judged high if the activity left subject feeling out of breath and sweaty , moderate if it left the subject slightly out of breath and warm but not sweaty and mild if it did not result in running out of breath.6 in mild and moderate degrees of physical activity , both sbp and dbp were inversely related to a statistically significant level . \n ( f = 20.3 , p = 0.000 and f = 5.73 , p = 0.03 ) , respectively . when subjected to multiple comparison ( mild , moderate and severe ) , whereas subjects admitting moderate and severe degrees of physical activity in their regular occupation had increasingly significant differences in mean sbp compared with mild degree ; that between moderate and severe was not significant . \n the same trend was observed for physical activity and dbp [ table 2 ] . with regard to leisure time physical activity \n , there was also an inverse significant relationship ; sbp f = 12.93 , p = 0.000 and dbp f = 3.42 , p = 0.03 . \n high - level leisure activity paradoxically but curiously gave higher mean blood pressure values than mild and moderate levels . \n multiple comparison of blood pressure and occupational exercise degrees multiple comparison of blood pressure and leisure exercise degrees for diet , those who ate food preserved with salt , added extra salt after cooking and those who liked their food well - salted had significantly higher sbp ( t = 2.704 , p = 0.007 ; t = 4.795 , p = 0.000 ; t = 2.83 , p = 0.005 , respectively ) . regarding dbp , those who ate food preserved with salt , added extra salt after cooking and liked food well - salted had significantly higher values as well ( t = 2.698 , p = 0.007 ; t = 3.953 , p = 0.000 ; t = 2.459 , p = 0.014 , respectively ) . \n kanwa rock salt as food seasoning did not affect sbp ( t = 0.018 , p = 0.986 ) or dbp ( t = 0.292 , p = 0.77 ) . \n mai - shanu or animal fat believed to be high in saturated fat and also used as food seasoning did not affect sbp ( t = 1.311 , p = 0.19 ) or dbp ( t = 0.098 , p = 0.922 ) . for tc , hdl - c and ai , use of mai - shanu as food seasoning caused a rise , reduction and rise , respectively . the difference in mean values between those who used the seasoning and those who did not failed to attain statistical significance ( t = 0.843 , p = 0.4 ; t = 0.765 , p = 0.445 ; t = 0.726 , p = 0.469 , respectively ) . \n blood pressure both sbp and dbp correlated positively to a statistically significant extent with bmi . \n [ on behalf of the systematic coronary risk evaluation ( score ) investigators ] posited that a single unit rise in bmi was associated with a 1.14 mmhg rise in sbp.7 doll et al . also found that both sbp and dbp rose with bmi8 across all populations . \n individuals who are obese tend to have hyper insulinaemia which in various ways is related to elevated blood pressure . \n there was also a positive significant correlation with total cholesterol , an experience shared by akuyan et al . \n working in zaria , nigeria.9 as shown in the score investigation referred to above,8 a 0.055 mmol / l increase in total cholesterol resulted in a 1.14 mmhg rise in sbp . \n this is a common finding and is attributed to arterial stiffness consequent upon structural alterations in the arterial wall.10 with ageing , the arteries lose elasticity because of medial degeneration and sclerosis.11 excess salt intake either as preference for food preserved with salt or adding extra salt on table after cooking resulted in a significant increase in both sbp and dbp . \n there has been a general consensus on this relationship ; leading to steps in many countries to reduce dietary salt as a population control strategy.12 earlier studies in nigeria also support the observation13 just as the international study of salt and blood pressure.14 excess sodium expands blood volume , thus increasing pre load and cardiac output . \n other mechanisms include increasing vascular reactivity15 and contractility.16 another cvd risk factor that correlated positively with sbp and dbp here was serum uric acid . findings in this area have been inconsistent . whereas some studies see ua as a disease marker17 being high because of renal changes induced by hypertension and drugs used in treating it ; others surmise that it is an independent risk factor for development of hypertension.18 our findings here agree with that of kansui et al.19 in japan that showed ua correlating significantly with blood pressure whether or not such individuals were on anti hypertensives or uricosuric drugs . regarding exercise ( whether occupational or leisure ) , there was a significant association with blood pressure both sbp and dbp . when graded into mild , moderate or severe , \n however , severe occupational physical activity did not produce any significant reduction in bp over that for moderate degree . \n this is also the experience of eicher et al.20 who found that antihypertensive effect of exercise occurred in a dose - dependent fashion . \n regular physical exercise acting as a basic component of life style modification reduces major cardiovascular risk factors chief of which is hypertension . \n it reduces sympathetic activity , reduces angiotensin ii levels , improves lipid profile and produces weight loss , all lowering blood pressure.21 it can also delay progression to hypertension , a response said to be related to decrease in plasma levels of proinflamatory cytokines and norepinephrine , reduction in oxidative stress and diminished activation of the nuclear factor kappa - light - chain - enhancer of activated b cells ( nuclear factor kb ) system.22 whereas severe occupational physical activity did not produce a significant reduction in blood pressure over moderate degree ; severe leisure physical activity recorded blood pressure values higher than moderate degree . why this would be the case is interesting but difficult to fathom ; and \n however , schultz et al.23 had shown though in rats that excessive exercise especially in untreated hypertensives can have deleterious effects on cardiac function . \n we found in this study a reduction in sbp which did not reach statistical significance between those who drank and those who did not . \n most of those who admitted to drinking ( 71% ) were mild drinkers and may be at the nadir of the j - shaped relationship between alcohol and blood pressure.24 osibogun13 had also found in his study that those who drank had lower blood pressures . \n this does not imply encouragement of heavy alcohol intake or advising non drinkers to start ; as beyond a certain level , blood pressures rise with increasing amounts of alcohol . in conclusion , for this sub - saharan rural community bmi , tc , age , serum uric acid and high salt intake are related to blood pressure and would be favourable points to manipulate for population control . \n age is a non - modifiable cardiovascular disease risk factor but the older individuals get , the more careful they should be with their diet to forestall rises in bmi , tc and serum uric acid .\nOUTPUT: background : hypertension is associated with certain cardiovascular disease ( cvd ) risk factors which vary from one place to the other depending on community sophistication . we decided to obtain the situation as it affects this rural nigerian community to be in an evidence - based position to initiate individual and group prevention strategies.design:cross-sectional population survey.materials and methods : we surveyed for cvd risk factors among subjects 15 years and above in this rural community using a questionnaire requesting personal , medical and anthropometric information . \n one in three of them were randomly assigned to laboratory investigations.results:of the 840 subjects studied , 25% were males . \n the population mean age was 45.5 ( 18.2 ) standard deviation ( sd ) , with 1.8% smokers and 4.1% using alcohol . \n systolic blood pressure ( sbp ) correlated with age , body mass index ( bmi ) , total cholesterol ( tc ) and uric acid ( ua ) ; while diastolic blood pressure ( dbp ) correlated with age , bmi , tc , ua and atherogenic index ( ai ) . \n sbp and dbp improved with exercise but not salt intake . \n the local seasonings used in cooking had no impact on blood pressure.conclusion:to reduce cardiovascular morbidity in this and probably other rural sub - saharan african communities , bmi , tc , ua and salt intake in diet should be targeted for reduction . \n physical activity should be encouraged . \n interestingly , these fall into the sphere of healthy lifestyle which should be encouraged and re - inforced .\nINPUT: our study included patients who received bilateral lasek for the correction of myopia at the department of ophthalmology of the chonnam national university hospital from january 2012 to april 2012 and were followed up for at least 6 months after surgery . \n exclusion criteria included ocular diseases , previous ocular surgery , punctal plug insertion , abnormality of the nasolacrimal drainage apparatus , eyelid malposition and abnormality of eyelid margin . \n informed consent was obtained from all subjects , in accordance with the declaration of helsinki , and the protocol was approved by the institutional review board of chonnam national university hospital . \n thirty - one patients were divided into 2 groups based on the presence of dry eye . \n sixteen patients ( 32 eyes ) had dry eye , and 15 patients ( 30 eyes ) did n't have dry eye . \n inclusion criteria for the dry eye group were presence of ocular symptoms , tear film abnormalities ( schirmer i test results < 7 mm/5 minutes , tear film break - up time [ tbut ] < 7 seconds ) and ocular surface damage ( corneal and conjunctival staining ) . \n all patients were treated with preservative - free sodium hyaluronate 0.1% ( hyalu mini ; hanmi pharm , seoul , korea ) . \n additionally , topical cyclosporine a 0.05% ( restasis ; allergan , irvine , ca , usa ) was applied twice a day in the patients with dry eye . \n all patients underwent ophthalmic examinations including uncorrected distance visual acuity ( udva ) by snellen chart , spherical equivalent ( se ) refraction , ocular surface staining with 1% fluorescein dye , tbut , schirmer i test and tear clearance rate ( tcr ) . \n ocular surface staining was graded using the oxford grading scheme ( 0 to 5 ) : absent ( 0 ) , minimal ( 1 ) , mild ( 2 ) , moderate ( 3 ) , marked ( 4 ) , and severe ( 5 ) . \n in addition , the ocular surface disease index ( osdi ) questionnaire was done to assess the ocular symptoms and the quality of vision ( osdi score : 0 to 100 ) . \n in addition , we evaluated the preoperative se refraction and ablation depth in all patients . at 6 months after lasek \n , corneal wavefront aberration was measured using the pentacam ( oculus ; optikgerate gmbh , wetzlar , germany ) . \n the ' wavefront aberration cornea ' data of the pentacam 's zernike analysis was used . \n the selected refractive indices were 1.376 and 1.336 for the cornea and the aqueous , respectively . \n the hoa data were analyzed quantitatively in the central 4-mm pupil diameter up to the sixth order by expanding the set of zernike polynomials . \n the assessed hoa values were total hoa root mean square ( rms ) , third - order coma , third - order trefoil and fourth - order spherical aberration ( sa ) of the anterior corneal surface . \n all measurements were taken between 10 am and 4 pm to minimize diurnal changes and performed on 3 separate days ( within one week ) to yield 3 sets . \n the preoperative hoas were measured immediately after blinking , while the postoperative hoas were measured immediately after blinking and at 10 seconds after blinking to evaluate the influence of tear film instability on hoas of the corneal surface . \n the patients were instructed to remain stationary and to blink completely just before each measurement . \n the chi square test and mann - whitney u - test were used to compare the results between the groups . \n the wilcoxon signed - rank test was used to compare the intragroup differences . in the dry eye group , spearman correlation coefficients \n at 6 months after lasek , corneal wavefront aberration was measured using the pentacam ( oculus ; optikgerate gmbh , wetzlar , germany ) . \n the ' wavefront aberration cornea ' data of the pentacam 's zernike analysis was used . \n the selected refractive indices were 1.376 and 1.336 for the cornea and the aqueous , respectively . \n the hoa data were analyzed quantitatively in the central 4-mm pupil diameter up to the sixth order by expanding the set of zernike polynomials . \n the assessed hoa values were total hoa root mean square ( rms ) , third - order coma , third - order trefoil and fourth - order spherical aberration ( sa ) of the anterior corneal surface . \n all measurements were taken between 10 am and 4 pm to minimize diurnal changes and performed on 3 separate days ( within one week ) to yield 3 sets . \n the preoperative hoas were measured immediately after blinking , while the postoperative hoas were measured immediately after blinking and at 10 seconds after blinking to evaluate the influence of tear film instability on hoas of the corneal surface . \n the patients were instructed to remain stationary and to blink completely just before each measurement . \n spss ver . 12.0 ( spss inc . , chicago , il , usa ) was used for statistical analyses . \n the chi square test and mann - whitney u - test were used to compare the results between the groups . \n the wilcoxon signed - rank test was used to compare the intragroup differences . in the dry eye group , \n the demographics and characteristics of both group patients are presented in table 1 . in the dry eye group , the mean age of the 6 men and 10 women was 25.21 2.62 years . in the non - dry eye group , the mean age of the 4 men and 11 women was 26.25 3.23 years . \n there were no statistically significant differences in age , sex , udva , se refraction ( preoperative and postoperative ) and ablation depth between groups . however , there were statistically significant differences in tbut , schirmer i test , tcr , ocular surface staining and osdi scores between groups ( p < 0.01 ) . \n the dry eye group had lower tbut , schirmer i test , and tcr scores , and higher ocular surface staining and osdi scores compared with the non - dry eye group . \n the preoperative and postoperative hoas of the corneal surface in both groups are presented in tables 2 and 3 . in the dry eye group , \n the total hoa rms value was 0.082 0.031 m preoperatively and 0.196 0.049 m postoperatively ( p < 0.01 ) . \n coma , trefoil and sa values were 0.071 0.036 , 0.054 0.038 , and 0.018 0.015 m preoperatively and 0.128 0.040 , 0.118 0.036 , and 0.090 0.030 m postoperatively , respectively ( p < 0.01 for all ) . in the non - dry eye group , the respective total hoa rms , coma , trefoil and sa values were 0.084 0.041 , 0.068 0.047 , 0.058 0.034 , and 0.010 0.009 m preoperatively and 0.189 0.053 , 0.126 0.030 , 0.124 0.034 , and 0.086 0.028 m postoperatively ( p < 0.01 for all ) . \n when comparing the dry eye and non - dry eye groups , there were no statistically significant differences in all values measured immediately after blinking before and after lasek ( tables 2 and 3 ) . \n however , at 10 seconds after blinking , the dry eye group had significantly higher total hoa rms ( p = 0.01 ) , coma ( p = 0.03 ) , and trefoil ( p = 0.04 ) than the non - dry eye group . in the dry eye group , \n total hoa rms , coma , and trefoil significantly increased at 10 seconds after blinking compared with those measured immediately after blinking ( p < 0.01 , p = 0.03 , and p = 0.04 , respectively ) , whereas there was no significant difference in sa value ( p = 0.62 ) . in the non - dry eye group , there were no statistically significant differences in all hoa parameters ( table 3 and fig . \n 1 ) . the mean pupil sizes measured immediately after blinking and at 10 seconds after blinking did n't show significant differences in either group . \n the correlations between the changes in hoas and dry eye parameters ( tbut , schirmer i test , tcr , ocular surface staining score , and osdi score ) in the dry eye group are demonstrated in table 4 . \n the changes of total hoa rms , coma and trefoil were correlated negatively with tbut ( r = -0.420 , p = 0.03 ; r = -0.473 , p = 0.01 ; r = -0.439 , p = 0.02 ; respectively ) but were correlated positively with osdi score ( r = 0.433 , p = 0.02 ; r = 0.499 , p = 0.02 ; r = 0.532 , p = 0.01 ; respectively ) . \n schirmer i test , tcr , and ocular surface staining scores did not show significant correlations with the hoas . \n although the hoas comprise a relatively a lower proportion of optical aberrations than lower order aberrations , they can have an important effect on retinal image quality in subjects . \n after corneal refractive surgery , the surgically - induced corneal hoas can contribute to glare , halo , decreased night vision and decreased contrast sensitivity . \n as expected , the measured hoas ( total hoa rms , coma , trefoil , and sa ) after lasek were significantly higher than pre - surgery measurements . \n although the severity is milder than laser in situ keratomileusis , lasek can also lead to the ocular symptoms associated with dry eye as well as decreased tear secretion . \n after the blinking , a tear meniscus spreads over the entire ocular surface to form a uniform tear film . \n tear film instability can lead to disproportionate thickness of the tear film , such as the superoinferior asymmetric contribution or thinning of the central cornea . as a result \n these abnormal distributions of the tear film on the corneal surface are intensified in patients who received lasek or patients with dry eye disease . \n some studies demonstrated that tear film instability can cause significantly increased hoas in patients with dry eye . \n montes - mico et al . reported that dry eye patients showed greater optical aberrations compared with normal controls and that an increase of hoas resulted from increased tear film irregularity . \n koh et al . reported that from 5 to 9 seconds after blinking , the total hoas were significantly higher than those measured immediately after blinking in subjects with a short tbut . \n denoyer et al . also reported that the rms of ocular and corneal hoas , especially third - order aberrations , significantly increased from 6 to 10 seconds after blinking in dry eye patients . \n this is the first study , to our knowledge , reporting tear film instability and hoas after corneal surface ablation . \n it is a noninvasive system using rotating scheimpflug camera and a monochromatic slit - light source ( blue led at 475 nm ) for measuring anterior segment topography . \n our study showed that total hoa rms , coma and trefoil significantly increased at 10 seconds after blinking compared with those measured immediately after blinking in dry eye patients after lasek . \n this result can be explained by compound effects of corneal shape changes after lasek and irregular distribution of the tear film by superficial punctuate keratitis , the lid pressure and the gravity effect . on the other hand \n some studies explained that the thinning at the center of the cornea rather than the periphery might contribute to an increase of sa value . also , the relative contribution of sa to the overall wave aberration of the eye increases when pupil dilates . \n we believe that several factors may have an influence on the absence of significant changes in sa values in our study . \n one factor is that there was no definitive pupil size change between the measurement taken immediately after blinking and that at 10 seconds after blinking . \n another factor is that the hoas of the anterior corneal surface might have been affected by the irregular distribution of the tear film rather than thinning of the tear film in the central cornea . \n denoyer et al . reported the progression index for corneal hoas was correlated with the subjective index ( osdi score ) of patient - reported visual outcomes and with objective clinical findings ( tbut ) . \n although there are some differences , such as measurement of hoas using the pentacam in dry eye patients after lasek , our results also showed that the amount of increase in total hoa rms , coma and trefoil at 10 seconds after blinking compared with those measured immediately after blinking was negatively correlated with tbut , but positively correlated with osdi score . \n we assume that additional hoas by tear film instability as well as surgically - induced corneal hoas can lead to a decreased optical quality in dry eye patients after lasek . \n first , because we used the pentacam to measure the hoas , we could only assess hoas of the corneal surface , not whole ocular hoas . \n although optical quality of the actual retinal image is associated with the whole ocular hoas including the posterior cornea , crystalline lens , and other components of the eye , the tear film instability mostly influences aberrations of the anterior corneal surface . \n second , although we have performed repeated measurements for a well - aligned and focused image , there is a possibility of subtle measurement errors . \n further studies with a larger sample size and serial measurements of corneal and ocular hoas are needed . in conclusion , \n the hoas after lasek significantly increased compared with those before surgery . in the dry eye patients after lasek , the values of total hoa rms , coma and trefoil at 10 seconds after blinking showed a significant increase compared with those measured immediately after blinking . \n in addition , the amount of an increase in total hoa rms , coma and trefoil after blinking was significantly correlated with tbut and osdi score . \n therefore , the additional hoas caused by tear film instability in patients after lasek may lead to a reduction in optical quality .\nOUTPUT: purposeto evaluate the changes of higher order aberrations ( hoas ) before and after laser subepithelial keratomileusis ( lasek ) and to analyze the influence of tear film instability on hoas of the corneal surface after lasek.methodsin this cross - sectional study , 31 patients who underwent lasek were divided into dry eye ( 16 patients , 32 eyes ) and non - dry eye groups ( 15 patients , 30 eyes ) . uncorrected distance visual acuity , spherical equivalent refraction , ablation depth , tear film parameters and ocular surface disease index ( osdi ) questionnaire scores were evaluated in both groups . \n total hoa root mean square ( rms ) , third - order coma , third - order trefoil and fourth - order spherical aberration ( sa ) of the corneal surface immediately and at 10 seconds after blinking were measured before and after surgery.resultsthe total hoa rms , coma , trefoil and sa significantly increased after lasek compared with preoperative values in both groups . in the dry eye group , total hoa rms , coma and trefoil significantly increased except for sa at 10 seconds after blinking compared with those measured immediately after blinking . \n in addition , the changes of total hoa rms , coma and trefoil were negatively correlated with tear film break - up time ( r = -0.420 , -0.473 and -0.439 , respectively ) , but positively correlated with osdi score ( r = 0.433 , 0.499 and 0.532 , respectively ) . in the non - dry eye group , there were no significant differences between hoas measured at 10 seconds after blinking and those measured immediately after blinking.conclusionsthe hoas including coma , trefoil and sa significantly increased after lasek . \n the tear film instability in the dry eye can be associated with more deterioration of the optical quality after lasek , due to more significant increase of total hoa rms , coma and trefoil .\nINPUT: she had history of trauma to the neck 10 years earlier with haematoma evacuation , ligation of the left internal jugular vein and removal of the sternal head of the clavicle . during pre - operative \n work - up , she was found to have a left - sided , soft , pulsating swelling extending from the angle of the mandible to the clavicle ( 15 10 cm ) which increased in size significantly on lying flat . \n duplex ultrasound examination of the neck showed a hugely dilated venous channel with sluggish whirling flow . \n contrast - enhanced ct scan confirmed the presence of an aneurysmally dilated venous channel related to the left subclavian vein . in theatre , the patient was cooled to 20c and bypass was discontinued . \n the left brachiocephalic vein was exposed and followed distally past the origin of the subclavian vein . \n cabg was performed with lima to lad and svg to om1 . in the initial post - operative period , \n the swelling increased in size . on the second day , it shrunk to its pre - operative size and disappeared completely by the third day leaving lax overlying skin . \n post - operative duplex ultrasound examination showed complete thrombosis of the venous aneurysm with preserved flow in the left subclavian vein which was confirmed by ct scan ( see figs . 1 and 2 ) . \n venous aneurysms of the head and neck are usually asymptomatic and are only discovered accidentally during imaging studies . occasionally , patients may present with a soft - tissue mass with or without localized pain . \n they rarely present with complications including thromboembolism , rupture , venous obstruction and compression of adjacent structures . \n surgical excision of the aneurysm has been previously reported with variable results a high incidence of complications such as uncontrollable haemorrhage and massive pulmonary embolism . \n other options including polyethylene cellophane wrapping , endovascular stenting and watchful waiting have also been tried . \n [ 35 ] in this report , we describe yet a different approach where sternotomy and cardiopulmonary bypass were used to allow for intraluminal repair of the aneurysm . securing unobstructed venous drainage of the upper limb particularly in the absence of an ipsilateral internal jugular vein was considered mandatory . \n endoaneurysmorraphy facilitated preserving an endothelialized venous channel to drain the upper limb post - operatively . \n cooling and circulatory arrest made an endovascular approach possible without the need for massive dissection and potential injury to adjacent structures . by obstructing the outflow of the venous channel we were able to induce thrombosis of the aneurysm while maintaining physiological venous drainage . \n our report illustrates several points related to this rare condition including pathogenesis , diagnosis and management . \n we believe that our approach to tackle such aneurysms has the advantage of avoiding some of the aforementioned procedural complications . \n regardless of the surgical technique , endovascular stenting and even conservative management remain valid strategies especially in patients with asymptomatic uncomplicated mediastinal venous aneurysms .\nOUTPUT: abstractvenous aneurysms are relatively rare anomalies which can affect different parts of the vascular system \n . diagnosis and management of this condition could pose important problems . \n we here report a giant false aneurysm of the subclavian vein with emphasis on the thought process that determined the management strategy .\nINPUT: basic and instrumental activities of daily living are tasks required to function on a daily basis , and are often impacted by disease processes that reduce cognitive ability such as alzheimer 's disease ( ad ) . \n basic activities of daily living ( adls ) include core tasks of everyday life such as eating , dressing , grooming , and bathing while instrumental activities of daily living ( iadls ) include more complicated , higher - level , tasks such as preparing meals , managing finances , shopping , doing housework , and using the telephone . driving and medication management are other iadls that are significantly disturbed in patients with ad . \n while both adls and iadls are impacted by ad , iadls are the first to decline and the level of functional impairment is the core clinical distinction between ad and milder conditions such as mild cognitive impairment ( mci ) . classification of mci subtypes , suggest that mci - amnestic type and mci patients with multiple - domain impairments are more predictive of later conversion to dementia and are more impaired functionally compared to mci of nonamnestic and single domain subtype . \n patients with ad experience a gradual loss in the abilities to live independently due to impairments in cognitive and memory functioning [ 1 , 3 ] and , as the disease progresses , the ability to carry out these essential activities eventually disappears . \n although there is not a large body of research on the relationship between neuropsychological measures and functional activities , several studies suggest that neuropsychological test performance is predictive of complex adls and iadls in elderly neuropsychiatric patients and those with ad [ 1 , 3 , 6 , 7 ] . \n evans found that performance on neuropsychological evaluations predicted functional capacity beyond negative symptoms in elderly with schizophrenia . \n however , these authors were unable to identify specific cognitive domains that impacted functional impairment . to date \n , most studies have not utilized comprehensive and conceptually sound measures to identify specific cognitive domains to predict particular areas of daily functioning . \n the limited existing literature suggests a correlation between objective neuropsychological assessment and informant reported level of functioning . \n this relative dearth of literature may be attributable to the difficulty in accurately measuring everyday functioning . \n trained observer ratings of functional level may be the gold standard but are very time consuming and impractical in outpatient settings . \n loewenstein et al . found that family members ' report of functional impairment is extremely accurate when compared with objective functional performance and is a useful mechanism to assess functioning . \n the present study evaluated the link between specific neurocognitive measures and informant report of adls and iadls in patients diagnosed with mild ad . \n as recommended by beck et al . , we address challenges in the current literature by utilizing a comprehensive neuropsychological battery to predict daily functioning in this clinical population . to our knowledge no research has addressed the possibility of gender - related differences in the cognitive mechanisms required for select areas of daily functioning . \n for instance , women inherently expend more effort than men in the area of dressing and grooming , which implies increased cognitive effort . \n the majority of studies have dealt with possible gender differences by covarying for gender , which tends to obscure any meaningful relationships that may be gender specific . \n our study directly evaluates gender differences in the ability of specific neuropsychological tests and cognitive domains to predict functioning . \n the total sample consisted of 202 ( 91 male , 111 female ) participants who met criteria for ad enrolled in the longitudinal research cohort of the texas alzheimer 's research consortium ( tarc ) . to reduce the effect of stage of decline on these measures \n , only individuals with a clinical dementia rating scale global score of 1.0 were included in the sample . \n collateral information on adls and iadls ratings was obtained from immediate caregivers who predominately were family members ( spouse and or children ) using the lawton - brody rating scales . \n briefly , the tarc project is a longitudinal multisite study of a cohort of ad patients and normal controls where each participant undergoes an annual evaluation that includes a medical examination , interview , neuropsychological testing , and blood draw . \n ad patients met consensus - based diagnosis for probable ad based on nincds - adrda criteria . \n male participants were 56 to 92 years of age ( m = 74.36 , sd = 8.21 ) , and females participants were 54 to 92 ( m = 76.95 , sd = 7.74 ) . \n the majority of participants were caucasian ( 98% ) , black or african american ( 1.5% ) was the next largest group . \n the tarc project received institutional review board approval , and all participants and/or caregivers provided written informed consent . \n the tarc neuropsychological core battery consists of the following instruments : wechsler digit span , logical memory , and visual reproduction , trail making test a & b , clock drawing test ( cdt ) , boston naming test , the geriatric depression scale ( gds-30 ) , and the clinical rating scale ( cdr ) . \n verbal memory was assessed with the wechsler logical memory i ( lm i ) and wechsler logical memory ii ( lm ii ) , visual memory was assessed with the wechsler visual reproduction i ( vri ) and ii ( vrii ) , attention was evaluated by performance on trails a and total digit span , linguistic capacity was assessed with boston naming test ( bnt ) and verbal fluency ( fas , category naming ( cowat ) ) , measures of executive functioning in this battery included the cdt and trails b. cognitive evaluation was administered in a controlled setting according to standardized instructions . in order to equate scores from digit span and story memory scales , all raw scores were converted to scale scores based on previously published normative data . for the boston naming test , the current group recently conducted an independent study that demonstrated the psychometric properties of an estimated 60-item bnt score that can be calculated from 30-item versions . \n descriptive statistics and one - way anova comparison of male and female samples ( presented in table 1 ) were conducted using spps version 17.0 . \n stepwise regression modeling was used to evaluate the link between each test of cognitive function and adls and iadls . \n independent variables were caregiver ratings on the physical self - maintenance scale for adls and the personal self - maintenance scale for iadls . \n each item has five descriptors from total independence to total dependence or total loss of functional control . \n the adls assessed were toileting , feeding , dressing , grooming , ambulation , and bathing . \n the iadls assessed were telephone use , shopping , food preparation , housekeeping , transportation , laundry management of medications and finances . \n logical memory i ( lmi ) and performance on cdt were significant predictors of iadls ( see table 2 ) . both lmi ( t = 2.34 , p = .022 ) and cdt ( t = 3.78 , p < \n .0001 ) significantly predicted total iadl score ( lmi / cdt combined ; t = 14.38 , p < .0001 ; effect size ( r = 0.26 ) . \n evaluation of specific iadls suggested that executive functioning ( i.e. , cdt ) predicted independence with medication management ( t = 12.23 , p < .0001 ; r = .32 ) , transportation ( t = 9.03 , p < .0001 ; r = .22 ) , laundry ( t = 7.67 , p < .0001 ; r = .22 ) , and housekeeping \n memory and learning capacity ( lmi ) significantly predicted ability to independently manage finances ( t = 11.11 , p < .0001 ; r = .24 ) , shop ( t = 12.70 , p < .0001 ; r = .30 ) , and telephone use ( t = 12.63 , p < .0001 ; r = .32 ) . \n measures of lmi and cdt ( t = 11.36 , p < .0001 ; r = .45 ) individually predicted food preparation ability . \n apoe4 status was excluded from stepwise regression modeling and did not impact the level of iadl functioning in women and men with mild ad . \n total adl scores were predicted by score on the cdt ( t = 14.38 , p < .0001 ; r = .26 ) . \n likewise , cdt score predicted the ability to bath ( t = 10.34 , p < .0001 ; r = .24 ) , groom ( t = 10.34 , p < .0001 ; r = .20 ) , and feed / eat ( t = 18.63 , p < .0001 ; r = .28 ) . \n trails a predicted the patient 's ability for self - dress ( t = 11.18 , p < .0001 ; r = .20 ) as demonstrated by table 3 . \n apoe4 status was excluded from stepwise regression modeling and did not impact the level of adl functioning in women and men with mild ad and as a result was not included in gender analyses . \n significant predictors of the ability of female ad patients to perform iadls included lmi , lmii , cdt , and the bnt . \n total iadl score was predicted by performance on both lmi ( t = 3.73 , p < .0001 ) and cdt ( t = 2.15 , p = .035 ) with combined value of ( t = 12.48 , p < .0001 ; r = .49 ) . \n the cdt alone significantly predicted independent functioning in the area of medication management ( t = 10.76 , p < .0001 ; r = .38 ) and housekeeping ( t = 8.35 , p < .0001 ; r = .36 ) . \n performance on lmi significantly predicted financial management ( t = 10.10 , p < .0001 ; r = .41 ) and the ability to shop independently ( t = 11.50 , p \n lmi and lmii significantly predicted telephone use ( t = 11.25 , p < .0001 ; r = .52 ) and performance on the bnt alone predicted transportation or driving capacity ( t = 9.04 , p < .0001 ; r = .25 ) in women with ad ( see table 4 ) \n . levels of adl functioning in women was predicted by performance on the cdt and trails a. performance on cdt predicted total adl score ( t = 11.55 , p < .0001 ; r = .27 ) and bathing capacity ( t = 8.37 , p < .0001 ; r = .26 ) . \n ability to eat / feed ( t = 14.72 , p < .0001 ; r = .32 ) independently was predicted by performance on trails a. performance on measures of vri ( t = 2.74 , p = .010 ) , vrii ( t = 2.29 , p = .029 ) , trails b ( t = 2.74 , p = .010 ) , and cowat ( t = 2.56 , p = .015 ) predicted medication management capacity in men ( t = 4.67 , p < .0001 ; r = .27 ) . \n food preparation was predicted by performance on the bnt ( t = 5.18 , p < \n vri , trails a , bnt , trails b , and cdt were all significant predictors of level of adl functioning in men with ad ( see table 5 ) . \n = .35 ) was significantly predicted by vri and trails a. performance on vri predicted bathing ability ( t = 6.26 , p < \n .0001 ; r = .41 ) and when combined with trails b also predicted grooming capacity ( t = 5.66 , p < .0001 ; r = .51 ) . the ability to eat / feed independently was predicted by bnt and cdt ( t = 16.65 , p < .0001 ; r = .56 ) . \n previous research has shown that cognitive functioning , as assessed by neuropsychological tests , is the strongest predictor of functional impairment [ 6 , 7 ] . \n specific cognitive domains of executive functioning , praxis / visuospatial skills , and memory have been found to be useful for predicting adl and iadl in assisted - living elders . \n our findings are consistent with previous research and demonstrate a significant relationship between performance of daily living activities and neurocognitive performance . unlike other studies , we found that attention is an important predictor of adls in ad patients . \n prior studies have been conducted in assisted care facilities where caregiver assistance may be sufficient to overcome inattention . \n however , individuals with mild dementia seen as outpatients in our study were likely responsible for basic adls , and , thereby , attention was necessary to facilitate functioning . \n memory and learning ( lmi , lmii , vr i , vrii ) , executive functioning ( cdt , trails b ) , and language ( bnt , cowat ) were significant predictors of adls and iadls . among the measures administered , cdt , lmi , and \n trails a were predictive of both adl and iadl functioning in analysis of the total sample . whereas prior reports suggested that cognitive abilities are most predictive of complex tasks of everyday functioning [ 15 , 16 ] , our results suggest that cognitive test performance also predicts basic adls ( e.g. , bathing , grooming , dressing , and feeding ) . \n this suggests that even in patients with mild ad , basic adls likely also require complex cognitive processes . \n another intriguing finding is that the presence of apoe4 genotype was not predictive of level of iadl and adl functioning in the current sample . \n presence of particular apoe genotype has been associated with greater disability in prior research with patients with mci . \n the current data suggests that the presence of apoe was not significantly associated with level of functioning in patients who have converted to ad status . \n we anticipated gender differences because there are ( a ) differences in task performance and ( b ) differences in strategies used to perform adls and iadls . \n for instance , it has been documented that women tend to use landmarks when driving and given directions where men are more likely to use street names [ 9 , 18 ] . in our research \n we administered several measures within each cognitive domain to facilitate understanding of not only which domain is different for male and female but also which specific measure best predicts functioning . \n figure 1 demonstrates gender differences in adls and iadls with regard to specific cognitive domains assessed . \n language also predicted iadl functions in men ( food preparation ) and women ( driving ) . \n gender differences remained in the domain of learning and memory , suggesting that men rely on this process for both adl and iadl whereas it is only predictive of iadl functions in women . \n a notable gender difference is that cognitive functioning is generally a better predictor of adl and iadl functioning for women compared to men . \n while the administered assessment battery predicted practically all daily tasks for women , it only predicted a few specific ones for men . \n this may be due in part to the likelihood that men especially of the generation in our sample are less likely to be involved in cooking , shopping , housekeeping and laundry and hence have little variability . for men , \n the iadl of medicine management was the only area predicted by performance on several different cognitive measures . among adls , \n only bathing , grooming , and feeding capacity was significantly predicted by vri , trails a and trails b , bnt , and the cdt . \n however , in women , the cdt , verbal learning and memory ( lmi and lmii ) and language were good predictors of capacity to perform almost all adls and iadls . \n these findings suggest that men tended to depend on visual learning and visual memory and women on verbal learning and verbal memory . \n lmi and lmii were predictive of functioning for women , whereas vri and vrii were predictive for men . \n one could speculate that women tend to problem - solve verbally using self - talk whereas men tend to conceptualize visually . \n the cdt appears to be a good measure in predicting functioning for women , but not for men . \n the cdt is typically seen as a measure of executive functioning and of frontal lobe processes . \n the clinical utility of the clock drawing test has been documented for diagnosing patients with dementia , but its relationship to specific functional activities has not been reported . \n the generalizability of our findings suffers from the relatively small sample size and the nature of subject recruitment . \n the current study is one of the first to examine gender differences , and efforts to replicate these findings is warranted due to several sample limitations that include lack of racial diversity and differences in educational levels and age among men and women in this sample . \n though it is unlikely these factors negate current results , it would be best to stratify according to education and age in future studies . \n additional studies with larger more representative samples are needed to further assess the impact of gender on predicting functioning . \n although late - life depression could impact cognitive functioning , gender differences were not significant ( table 1 ) in our sample , and , therefore , depression score was not accounted for in the analyses . \n however , effects of depression are significant and warrant future efforts . although the current research has its limitations this study has several advantages over earlier studies in terms of understanding patients with ad . \n first , the sample was limited to individuals with mild ad which helps control for the affect of disease severity on functional activities . \n third , in addition to evaluating predictive value of specific domains it also evaluated specific measures within those domains in both gender - specific and mixed - gender analyses . \n the findings of this study underscore the importance of gender and the gender - specific relations of neurocognitive measures to everyday activities . \n acknowledging gender differences is important as it may facilitate more accurate interpretation of neurocognitive tasks and its relationship to particular daily living activities . \n these findings also have clinical values for making informed decisions and recommendations of capacity in patients with ad . \n there is generally consensus that executive functioning is an important predictor of capacity to perform complex tasks ( iadls ; 15 ) . \n while this may be accurate for women , current findings suggest that it may be an irrelevant predictor for men . understanding how to most accurately predict level of function will also enable patients to maintain daily functions longer , reducing caregiver fatigue , and also social and economic burden .\nOUTPUT: objectives . to investigate the link between neurocognitive measures and various aspects of daily living ( adl and iadl ) in women and men with mild alzheimer 's disease ( ad ) . methods . \n participants were 202 ad patients ( 91 male , 111 female ) with cdr global scores of 1 . \n adls and iadls ratings were obtained from caregivers . \n cognitive domains were assessed with neuropsychological testing . \n results . memory and executive functioning \n were related to iadl scores . \n executive functioning was linked to total adl . \n comparisons stratified on gender found attention predicted total adl score in both men and women . \n attention predicted bathing and eating ability in women only . \n language predicted iadl functions in men ( food preparation ) and women ( driving ) . \n conclusions . \n associations between adls / iadls and memory , learning , executive functioning , and language suggest that even in patients with mild ad , basic adls require complex cognitive processes . \n gender differences in the domains of learning and memory area were found .\n\n\nINPUT: anxiety affects quality of life in those living with parkinson 's disease ( pd ) more so than overall cognitive status , motor deficits , apathy , and depression [ 13 ] . \n although anxiety and depression are often related and coexist in pd patients , recent research suggests that anxiety rather than depression is the most prominent and prevalent mood disorder in pd [ 5 , 6 ] . yet , \n our current understanding of anxiety and its impact on cognition in pd , as well as its neural basis and best treatment practices , remains meager and lags far behind that of depression . \n overall , neuropsychiatric symptoms in pd have been shown to be negatively associated with cognitive performance . \n for example , higher depression scores have been correlated with lower scores on the mini - mental state exam ( mmse ) [ 8 , 9 ] as well as tests of memory and executive functions ( e.g. , attention ) [ 1014 ] . \n likewise , apathy and anhedonia in pd patients have been associated with executive dysfunction [ 10 , 1523 ] . \n however , few studies have specifically investigated the relationship between anxiety and cognition in pd . \n one study showed a strong negative relationship between anxiety ( both state and trait ) and overall cognitive performance ( measured by the total of the repeatable battery for the assessment of neuropsychological status index ) within a sample of 27 pd patients . \n furthermore , trait anxiety was negatively associated with each of the cognitive domains assessed by the rbans ( i.e. , immediate memory , visuospatial construction , language , attention , and delayed memory ) . \n two further studies have examined whether anxiety differentially affects cognition in patients with left - sided dominant pd ( lpd ) versus right - sided dominant pd ( rpd ) ; however , their findings were inconsistent . \n the first study found that working memory performance was worse in lpd patients with anxiety compared to rpd patients with anxiety , whereas the second study reported that , in lpd , apathy but not anxiety was associated with performance on nonverbally mediated executive functions and visuospatial tasks ( e.g. , tmt - b , wms - iii spatial span ) , while in rpd , anxiety but not apathy significantly correlated with performance on verbally mediated tasks ( e.g. , clock reading test and boston naming test ) . \n furthermore , anxiety was significantly correlated with neuropsychological measures of attention and executive and visuospatial functions . taken together , \n it is evident that there are limited and inconsistent findings describing the relationship between anxiety and cognition in pd and more specifically how anxiety might influence particular domains of cognition such as attention and memory and executive functioning . \n it is also striking that , to date , no study has examined the influence of anxiety on cognition in pd by directly comparing groups of pd patients with and without anxiety while excluding depression . \n given that research on healthy young adults suggests that anxiety reduces processing capacity and impairs processing efficiency , especially in the central executive and attentional systems of working memory [ 26 , 27 ] , we hypothesized that pd patients with anxiety would show impairments in attentional set - shifting and working memory compared to pd patients without anxiety . \n furthermore , since previous work , albeit limited , has focused on the influence of symptom laterality on anxiety and cognition , we also explored this relationship . \n seventeen pd patients with anxiety and thirty - three pd patients without anxiety were included in this study ( see table 1 ) . \n the cross - sectional data from these participants was taken from a patient database that has been compiled over the past 8 years ( since 2008 ) at the parkinson 's disease research clinic at the brain and mind centre , university of sydney . \n inclusion criteria involved a diagnosis of idiopathic pd according to the united kingdom parkinson 's disease society brain bank criteria and were confirmed by a neurologist ( sjgl ) . \n patients also had to have an adequate proficiency in english and have completed a full neuropsychological assessment . \n ten patients in this study ( 5 pd with anxiety ; 5 pd without anxiety ) were taking psychotropic drugs ( i.e. , benzodiazepine or selective serotonin reuptake inhibitor ) . \n patients were also excluded if they had other neurological disorders , psychiatric disorders other than affective disorders ( such as anxiety ) , or if they reported a score greater than six on the depression subscale of the hospital anxiety and depression scale ( hads ) . \n thus , all participants who scored within a depressed ( hads - d > 6 ) range were excluded from this study , in attempt to examine a refined sample of pd patients with and without anxiety in order to determine the independent effect of anxiety on cognition . \n this research was approved by the human research ethics committee of the university of sydney , and written informed consent was obtained from all participants . \n self - reported hads was used to assess anxiety in pd and has been previously shown to be a useful measure of clinical anxiety in pd . \n a cut - off score of > 8 on the anxiety subscale of the hads ( hads - a ) was used to identify pd cases with anxiety ( pda+ ) , while a cut - off score of < 6 on the hads - a was used to identify pd cases without anxiety ( pda ) . \n this criterion was more stringent than usual ( > 7 cut - off score ) , in effort to create distinct patient groups . \n the neurological evaluation rated participants according to hoehn and yahr ( h&y ) stages and assessed their motor symptoms using part iii of the revised mds task force unified parkinson 's disease rating scale ( updrs ) . in a similar way \n this was determined by calculating a total left and right score from rigidity items 3035 , voluntary movement items 3643 , and tremor items 5057 from the mds - updrs part iii ( see table 1 ) . \n processing speed was assessed using the trail making test , part a ( tmt - a , z - score ) . \n attentional set - shifting was measured using the trail making test , part b ( tmt - b , z - score ) . \n working memory was assessed using the digit span forward and backward subtest of the wechsler memory scale - iii ( raw scores ) . \n language was assessed with semantic and phonemic verbal fluency via the controlled oral word associated test ( cowat animals and letters , z - score ) . \n the ability to retain learned verbal memory was assessed using the logical memory subtest from the wechsler memory scale - iii ( lm - i z - score , lm - ii z - score , % lm retention z - score ) . the mini - mental state examination ( mmse ) \n demographic , clinical , and neuropsychological variables were compared between the two groups with the independent t - test or mann whitney u test , depending on whether the variable met parametric assumptions . \n chi - square tests were used to examine gender and symptom laterality differences between groups . \n all analyses employed an alpha level of p < 0.05 and were two - tailed . \n spearman correlations were performed separately in each group to examine associations between anxiety and/or depression ratings and cognitive functions . \n as expected , the pda+ group reported significant greater levels of anxiety on the hads - a ( u = 0 , p < 0.001 ) and higher total score on the hads ( u = 1 , p < 0.001 ) compared to the pda group ( table 1 ) . \n groups were matched in age ( t(48 ) = 1.31 , p = 0.20 ) , disease duration ( u = 259 , p = 0.66 ) , updrs - iii score ( u = 250.5 , p = 0.65 ) , h&y ( u = 245 , p = 0.43 ) , ledd ( u = 159.5 , p = 0.80 ) , and depression ( hads - d ) ( u = 190.5 , p = 0.06 ) . \n additionally , all groups were matched in the distribution of gender ( = 0.098 , p = 0.75 ) and side - affected ( = 0.765 , p = 0.38 ) . \n there were no group differences for tmt - a performance ( u = 256 , p = 0.62 ) ( table 2 ) ; however , the pda+ group had worse performance on the trail making test part b ( t(46 ) = 2.03 , p = 0.048 ) compared to the pda group ( figure 1 ) . \n the pda+ group also demonstrated significantly worse performance on the digit span forward subtest ( t(48 ) = 2.22 , p = 0.031 ) and backward subtest ( u = 190.5 , p = 0.016 ) compared to the pda group ( figures 2(a ) and 2(b ) ) . \n neither semantic verbal fluency ( t(47 ) = 0.70 , p = 0.49 ) nor phonemic verbal fluency ( t(47 ) = 0.39 , p = 0.70 ) differed between groups . \n logical memory i immediate recall test ( u = 176 , p = 0.059 ) showed a trend that the pda+ group had worse new verbal learning and immediate recall abilities than the pda group . however , logical memory ii test performance ( u = 219 , p = 0.204 ) and logical memory % retention ( u = 242.5 , p = 0.434 ) did not differ between groups . \n there were also no differences between groups in global cognition ( mmse ) ( u = 222.5 , p = 0.23 ) . \n participants were split into lpd and rpd , and then further group differences were examined between pda+ and pda. importantly , the groups remained matched in age , disease duration , updrs - iii , dde , h&y stage , and depression but remained significantly different on self - reported anxiety . \n lpda+ demonstrated worse performance on the digit span forward test ( t(19 ) = 2.29 , p = 0.033 ) compared to lpda , whereas rpda+ demonstrated worse performance on the digit span backward test ( u = 36.5 , p = 0.006 ) , lm - i immediate recall ( u = 37.5 , p = 0.008 ) , and lm - ii ( u = 45.0 , p = 0.021 ) but not lm % retention ( u = 75.5 , p = 0.39 ) compared to rpda. \n this study is the first to directly compare cognition between pd patients with and without anxiety . \n the findings confirmed our hypothesis that anxiety negatively influences attentional set - shifting and working memory in pd . \n more specifically , we found that pd patients with anxiety were more impaired on the trail making test part b which assessed attentional set - shifting , on both digit span tests which assessed working memory and attention , and to a lesser extent on the logical memory test which assessed memory and new verbal learning compared to pd patients without anxiety . taken together , \n these findings suggest that anxiety in pd may reduce processing capacity and impair processing efficiency , especially in the central executive and attentional systems of working memory in a similar way as seen in young healthy adults [ 26 , 27 ] . \n although the neurobiology of anxiety in pd remains unknown , many researchers have postulated that anxiety disorders are related to neurochemical changes that occur during the early , premotor stages of pd - related degeneration [ 37 , 38 ] such as nigrostriatal dopamine depletion , as well as cell loss within serotonergic and noradrenergic brainstem nuclei ( i.e. , raphe nuclei and locus coeruleus , resp . , which provide massive inputs to corticolimbic regions ) . over time \n , chronic dysregulation of adrenocortical and catecholamine functions can lead to hippocampal damage as well as dysfunctional prefrontal neural circuitries [ 39 , 40 ] , which play a key role in memory and attention . \n recent functional neuroimaging work has suggested that enhanced hippocampal activation during executive functioning and working memory tasks may represent compensatory processes for impaired frontostriatal functions in pd patients compared to controls . therefore , chronic stress from anxiety , \n for example , may disrupt compensatory processes in pd patients and explain the cognitive impairments specifically in working memory and attention seen in pd patients with anxiety . \n it has also been suggested that hyperactivation within the putamen may reflect a compensatory striatal mechanism to maintain normal working memory performance in pd patients ; however , losing this compensatory activation has been shown to contribute to poor working memory performance . \n anxiety in mild pd has been linked to reduced putamen dopamine uptake which becomes more extensive as the disease progresses . \n this further supports the notion that anxiety may disrupt compensatory striatal mechanisms as well , providing another possible explanation for the cognitive impairments observed in pd patients with anxiety in this study . \n noradrenergic and serotonergic systems should also be considered when trying to explain the mechanisms by which anxiety may influence cognition in pd . although these neurotransmitter systems are relatively understudied in pd cognition , treating the noradrenergic and serotonergic systems has shown beneficial\nOUTPUT:\n", "answer": "research on the implications of anxiety in parkinson 's disease ( pd ) has been neglected despite its prevalence in nearly 50% of patients and its negative impact on quality of life . \n previous reports have noted that neuropsychiatric symptoms impair cognitive performance in pd patients ; however , to date , no study has directly compared pd patients with and without anxiety to examine the impact of anxiety on cognitive impairments in pd . \n this study compared cognitive performance across 50 pd participants with and without anxiety ( 17 pda+ ; 33 pda ) , who underwent neurological and neuropsychological assessment . \n group performance was compared across the following cognitive domains : simple attention / visuomotor processing speed , executive function ( e.g. , set - shifting ) , working memory , language , and memory / new verbal learning . \n results showed that pda+ performed significantly worse on the digit span forward and backward test and part b of the trail making task ( tmt - b ) compared to the pda group . \n there were no group differences in verbal fluency , logical memory , or tmt - a performance . in conclusion , \n anxiety in pd has a measurable impact on working memory and attentional set - shifting ." }

{ "gen_args_0": { "arg_0": "***TASK***\nthe task is to summarize an input biomedical literature in six sentences\n\n***INPUT***\nthe input is a biomedical literature\n\n***OUTPUT***\nthe output is the summary of an input biomedical literature in six sentences\n\n***DOCUMENTATION***\n\n***EXAMPLES***\nINPUT: through the studies done so far , strong association is found between dermatological condition and psychological problems . the incidence of psychiatric disorders among dermatological patients is approximately between 30% and 40% . \n the presence of a concomitant psychiatric illness is predominantly observed in patients with various dermatological disorders like dermatitis , acne , pruritus , urticaria , alopecia , psoriasis or vitiligo , of which atopic dermatitis ( ad ) is the most common skin disease observed in general practice . \n ad is a chronic inflammatory skin disease , characterized by pruritic and eczematous skin lesions with series of exacerbations and remissions . \n common age of presentation is children and adolescence , but in one - third of cases it extends to adulthood . \n most frequent symptoms reported as a basis for distress are disfigurement and itching causing significant insomnia , and sleep deprivation leads to fatigue , mood lability , impaired functioning and suicide in few cases . furthermore , frequent bullying and embarrassment due to disfigurement leads to social stigma and social isolation . on the other hand \n , it has been also been appraised that stressful life events often exacerbates or precedes dermatitis . \n any stress causes stimulation of hypothalamic - pituitary - adrenal ( hpa ) axis and autonomic nervous system resulting in inducing helper t cells causing release of neuropeptides and hormones . \n these neuropeptides causes adrenergic and other neurotransmitters release causing vascular instability in dermatitis patients , indicating a link between neuroendocrine and immune system . on the other hand , \n disfigurement caused due to dermatitis can lower patients self esteem , in turn increasing the propensity to anxiety and depression . \n it has also been put forward that intense itching in dermatitis leads to sleep disturbances causing irritable behavior , decreased concentration , and decreased threshold of tolerance which on persisting for a protracted period can cause various psychiatric illness like depression , anxiety , attention - deficit hyperactivity disorder ( adhd ) and autism . \n there is tendency of presentation of somatic symptoms in patients with dermatological conditions in comparison to normal population . \n on exploring the personality of patients suffering from dermatitis , some traits commonly found are of feelings of insecurity , inferiority and inadequacy , tension , anxiety , depression , aggressiveness , dependence , sensitivity , emotional liability , hyperactivity , difficulty in expressing feelings , sexual conflicts , masochism , high intelligence level , shyness and being doubtful \n . therefore timely evaluation of patient 's personality and sub - syndromal psychiatric symptoms ( lack of self esteem / confidence , shame , stigma embarrassment , decrements in body image ) can detect various psychological risk factors in the patient , which would help in early co - morbid psychiatric diagnosis and its proper management . through the current study \n , we aim to assess the relationship of ad and psychiatric illness ( depression and anxiety ) , further strengthening the existing data particularly focusing upon gender differences among the patients . \n this cross - sectional study with consecutive sampling was done in an outpatient clinic of dermatology at a tertiary care center spread over a period of 8 month . \n subjects giving informed consent were evaluated on a brief semi - structured performa for collecting demographic and clinical information . \n primary care evaluation of mental disorders ( prime - md ) was used to assess the presence of psychiatric symptoms in these patients . \n all consecutive subjects not suffering from chronic illness other than skin disease , with no past history of psychiatric illness and no apparent life stress other than the skin disease were included . \n prime - md was an instrument developed and validated in the early 1990s to efficiently diagnose five of the most common types of mental disorders presenting in medical populations : depressive , anxiety , somatoform , alcohol , and eating disorders . \n patients first completed a one - page 27-item screener and , for those disorders for which they screened positive , were asked additional questions by the clinician using a structured interview guide . \n however , this second - stage process took an average of 5 - 6 minutes of clinician time in patients without a mental disorder diagnosis and 11 - 12 minutes in patients with a diagnosis . \n this proved to be a barrier to use given the competing demands in busy clinical practice settings . to overcome this barrier , \n individual screening tools for each psychiatric illness were assessed for their validation . through various studies , patient health questionnaire ( phq-9 ) and generalized anxiety disorder questionnaire ( gad-7 ) have been validated to effectively assessing depression and anxiety disorders when applied alone instead of the whole prime - md . in our study , we have used these two components of prime - md , as these two psychiatric illnesses were commonly found concurrently with skin disorders . \n this is calculated by assigning scores of 0 , 1 , 2 , and 3 , to the response categories of -not at all , -several days , -more than half the days , and -nearly every day , respectively . \n scores of 5 , 10 , 15 , and 20 represent cut points for mild , moderate , moderately severe and severe depression , respectively . \n gad-7 is calculated by assigning scores of 0 , 1 , 2 , and 3 , to the response categories of -not at all , -several days , -more than half the days , and -nearly every day , respectively . \n scores of 5 , 10 , and 15 represent cut - points for mild , moderate , and severe anxiety , respectively . \n independent sample t - test ( for continuous variables ) and chi - square test ( for categorical variables ) were used to find difference between the patients and the care givers on different variables . \n additionally cramer 's v test and phi test were used for 2 4 contingency tables . \n the conditions of confidentiality as specified in the institutional ethical guidelines were strictly adhered to . \n a total of 81 patients were included in the final analysis ( males = 36 , females = 45 ) . \n the mean age of the subjects was 34.94 15.89 years ( 10 - 74 ) . \n there was no significant difference in mean age between male and female subjects ( 36.14 17.62 and 33.98 14.49 years , respectively ; p = 0.54 ) . \n all the subjects belonged to the urban area and it was seen that more females were unemployed than males ( p = 0.001 ) . \n socio - demographic and clinical parameters in the study population about 57% of the patients were diagnosed as having clinically significant depression [ figure 1 ] . \n it included mild ( 31% ) , moderate ( 8% ) , moderately severe ( 5% ) and severe ( 2% ) . \n it included mild ( 27% ) , moderate ( 4% ) and severe ( 8% ) . \n 22.2% reported of a suicidal ideation while only 8.3% male subjects reported of any suicidal ideation . \n bar chart representing the severity of depression amongst the genders in the study population phq-9 = patient health questionnaire bar chart representing the severity of anxiety amongst the genders in the study population gad-7 = generalized anxiety disorder scale females had significantly more anxiety and depression scores than males ( p = 0.04 and p = 0.03 respectively ) , but had no difference in terms of suicidal ideation [ table 2 ] . \n but on comparison of individual severity scores of scales among the genders [ table 3 ] , no difference was observed for anxiety among the groups ( cramer 's v = 0.267 ; p = 0.12 ) . \n gender comparison for depression , anxiety and suicidal ideation among individuals with dermatitis ( m=36 , f=45 ) gender comparison for severity of depression and anxiety phq-9 and gad-7 scores significantly correlated to each other ( ) . \n suicidal ideation was positively correlated to total phq-9 and gad-7 scores ( r = 0.42 , p < 0.001 ; r = 0.37 , p = 0.001 respectively ) . \n age , education , occupation and duration of illness were not found to be correlated to depression , anxiety or suicidal ideation in the overall sample population . among female subjects , \n age was found to be positively correlated to total gad-7 scores ( r = 0.45 , p = 0.002 ) but not to total phq-9 ( r = 0.28 , p = 0.06 ) or suicidal ideation ( r = 0.18 , p = 0.22 ) . \n education , occupation and duration of illness were not found to be correlated to depression , anxiety or suicidal ideation in female subjects . among male subjects , \n being employed was found to be positively correlated to total gad-7 scores ( r = 0.39 , p = 0.01 ) and suicidal ideation ( r = 0.33 , p = 0.04 ) but not to total phq-9 scores ( r = 0.17 , p = 0.31 ) . \n age , education and duration of illness were not found to be correlated to depression , anxiety or suicidal ideation in male subjects . \n the current study confirmed the previous findings of significant association of ad with anxiety , depression and suicidal ideations . \n when including moderate to severe grade of depression or anxiety , the current study found prevalence rates of 15% and 12% , respectively . \n hordaland health study reported that 12.9% had current anxiety only , 4.2% current depression only , and 7.5% had comorbid anxiety / depression . \n the lower prevalence of depression in this study could have been due to utilization of self - reported hads while our study used clinician - administered prime - md , which might have given a more accurate data . \n another study in patients with occupational hand eczema reported that 20% had a positive anxiety score and 14% had a positive depression score . \n the slight difference from our findings could be because we incorporated all cases of ad involving all body locations . \n adolescents with ad are also reported to have high rates of lifetime rates of anxiety ( 9 - 32% ) and depressive ( 12 - 24% ) disorders . \n studies report that both trait anxiety ( ta ) and state anxiety ( sa ) are significantly higher in patients with ad with ta being significantly higher than sa . in our study \n , women were found to be having significantly higher depressive and anxiety symptoms than males . \n young female patients with ad have been reported to be more distressed than older male patients . probably , these findings are due to the reason that women are more concerned regarding their physical appearance than men perceiving the skin disorder as a threat in turn leading to emotional disturbance . \n researchers have also suggested other hypothesis to explain gender - specific association between atopy and depression implicating role of genetic abnormalities in serotonin metabolism , hpa - axis dysfunction , and histamine theory . \n ( 2010 ) found depression to be more in men than women with ad , the opposite of timonens hypothesis . \n more than half of the study group had secondary and higher secondary education indicating that higher the education there is more awareness and concern regarding physical appearance leading to medical consultation contrary to finding by khan et al . \n ( 2011 ) found a substantial reduction in quality of life ( qol ) in patients suffering from dermatitis . \n factors liable for the same could be intense itching leading to disturbed sleep , fatigability , decreased concentration at work , social rejection thinking dermatitis as contagious and emotional disturbances . \n it was also noted that half of the patients were suffering from chronic illness ( > 6 months ) . though there are no studies on association of chronic dermatitis with psychiatric morbidity , but one study mentions that persistent skin disease had higher psychiatric co - morbidity in comparison to intermittent and incident skin disease . \n it could be due to the reason that chronic illness may act as a constant stressor generating higher mental morbidity . \n suicidal ideation was reported by significant proportion of subjects ( 16% ) in our study similar to other studies . \n the prevalence of suicidal ideation in patients with mild , moderate , and severe ad between the age of 15 and 49 years is reported to be 0.21% , 6% , and 19.6% , respectively . \n studies comparing various dermatological disorders report that depression is highest in ad as are suicidal ideation . \n a previous study reported rates of suicidal ideation to be 2.1% among ad patients but did not report on the severity of ad . \n studies support a strong correlation between severity of dermatitis symptoms and psychological burden which may increase the risk of suicidal ideas in ad patients . \n our study also showed more of suicidal ideation in women in comparison to men though not significantly , which could be due to more propensities of women to be affected by stressor and psychological distress leading to pessimistic view regarding the future ending up in suicidal ideation / suicide . \n other studies have also reported suicidal thoughts among female with skin problems to be more than male ad patients . \n while our study did not find any significant correlation between the duration of illness and presence of depression in subjects , other studies have reported the same . \n the current study was limited in generalization due to its limited sample size , cross - sectional assessment , findings from a single tertiary care center and an absence of a control group . \n associated risk factors which might have exacerbated the psychiatric condition were not evaluated like personality traits or any concomitant stressful life event . \n we did nt assess the severity of dermatitis so , we were unable to compare association of severity of dermatitis with anxiety and depression . \n the strength of our study was the through assessment of psychiatric and dermatological illness by specialists of the relevant field increasing the reliability of findings . \n the present study confirmed the previous findings linking an association between dermatological condition and psychiatric illness . \n it can also be concluded that there is a need for thorough assessment of psychiatric illness in patients with dermatological conditions and also there is need to actively assess regarding any suicidal plans / ideations for improving the patient management and overall quality of life . \n female patients suffered from more anxiety and depression than males , which in light of the a female preponderance for ad , making it utmost important to focus upon this population subgroup in the society . \n female patients suffering from atopic dermatitis endure more anxiety and depressive symptoms than malesthere is high prevalence of suicidal ideation ( 16% ) among patients of atopic dermatitis . \n female patients suffering from atopic dermatitis endure more anxiety and depressive symptoms than males there is high prevalence of suicidal ideation ( 16% ) among patients of atopic dermatitis .\nOUTPUT: background : dermatological patients invariably suffer one or the other psychological problems which may escalate to the extent of a mental disorder . \n one of the most common dermatological disorders is atopic dermatitis ( ad ) , but the literature has limited data on gender differences for psychiatric morbidity in such patients.aims:to evaluate and compare gender differences in the prevalence of depression and anxiety in ad.materials and methods : this cross - sectional study with consecutive sampling was done in an outpatient clinic of dermatology at a tertiary care center . \n ad subjects giving informed consent were evaluated on a brief semi - structured performa for collecting demographic and clinical information . \n primary care evaluation of mental disorders ( prime - md ) was used to assess the presence of psychiatric symptoms in these patients . \n descriptive analysis was done for the socio - demographic profile and independent sample t - test , chi - square and cramer 's v test was carried out to find in - between group differences for males and females.results:a total of 81 patients were included in the final analysis ( males = 36 , females = 45 ) with no significant difference in mean age between male and female subjects ( 36.14 17.62 and 33.98 14.49 years , respectively ; p = 0.54 ) . \n when including moderate to severe grade of depression or anxiety , the current study found prevalence rates of 15% and 12% respectively . \n females had significantly more anxiety and depression scores than males ( p = 0.04 and p = 0.03 respectively).conclusions : there is a female preponderance of depression and anxiety disorder in ad patients .\nINPUT: high blood pressure is usually associated with certain cardiovascular disease ( cvd ) risk factors conjointly resulting in increased cvd morbidity.1 these other cvd risk factors vary in proportion from one environment to another,2 and depend on the level of sophistication of the community . \n population - wide strategies to control cvd usually target for efficiency these risk factors which produce relevant intermediate diseases or the cvds themselves.3 though some of the risk factors are non - modifiable , others are . when identified and worked upon , reduction in their rates especially hypertension which is chief , gives rise to significant benefits.4 most works on these risk factors in our environment are hospital - based . \n a more lucid picture of the situation usually emerges if population surveys are done ; as they would include those affected to degrees not warranting presentation to hospitals . \n such studies are few in sub - saharan africa , especially in our locality . despite sharing similar physical and cultural environments , group - level cultural variability and distinct genetic ancestry \n are known to result in different patterns of cvds.5 this reason prompted our desire to see how blood pressure relates to some common cvd risk factors in a rural population in north central nigeria . \n findings would guide primary and secondary preventive efforts to reduce morbidity and mortality burdens of cvds on the long run . \n in 2008 , our team re - surveyed two rural communities that had been studied 17 years previously as part of a national non - communicable diseases survey sponsored by the federal ministry of health and social services in nigeria . after getting ethical clearance from the research ethics committee of jos university teaching hospital , we met with and got clearance from leaders of the area at various levels . finally , we mobilized and got to the study sites where all subjects 15 years and above having been mobilized by their leaders at various levels came out for the survey . \n subjects were made to sit in the order of their arrival to the study site as we had no control over that to remove any bias . \n informed consent was then requested after explanation in english or subjects ' mother tongue of what the study entailed . \n they were then registered and in the same order handed a copy of the study protocol and sample containers ( given in the same order to one in every three subjects ) . \n they then moved to the next station where the history section was filled by research assistants . \n three blood pressure measurements were obtained in stations 3 , 5 and 7 by different trained assistants ( medical registrars ) after subjects had been sitting for about 5 minutes . \n the activities in intervening stations 4 ( height and weight measurement ) and 6 ( waist and hip circumference measurements ) ensured that there was at least 3 minutes in between blood pressure readings . \n mercury ( accosson brand ) sphygmomanometers with appropriate - sized cuffs were used to measure blood pressure in the standard fashion . \n the mean of the last two measurements was calculated in each case and used for analysis . \n weight was measured using a weighing scale on a firm flat surface to the nearest kilogram with subjects in light clothing only ; while height was measured using stadiometer in metres to the nearest centimetre . \n body mass index ( bmi ) was derived from weight ( kilograms ) and height ( metres ) using the formular w / h2 . \n waist circumference was taken using flexible tape at the level of the midpoint between the ribs and the iliac crest from the front in exhalation ; and hip circumference measured at the point where the buttocks extended the most when viewed from the side , at the level of the greater trichinae of the femur . \n urinalysis for protein and sugar were determined using appropriate dipstix method on site for those randomized for laboratory investigations . \n venous blood was taken from the ante - cubital fossae of such subjects and put in appropriate specimen bottles and taken at the end of each day to the base laboratory for analysis by one of the investigators ( ioi ) . \n serum creatinine was measured by the jaffe 's reaction and uric acid ( ua ) by caraway method ; while packed cell volume ( pcv ) was determined using the microhaematocrit centrifuge . at the end \n , data were collated and analysed in the university of jos , computer centre using statistical package of social sciences ( spss ) 17.0 . \n analysis of variance , student t test and pearson 's correlation coefficients were used as appropriate to determine degree of difference or association between blood pressure and some cvd risk factors . \n at the end , data were collated and analysed in the university of jos , computer centre using statistical package of social sciences ( spss ) 17.0 . \n analysis of variance , student t test and pearson 's correlation coefficients were used as appropriate to determine degree of difference or association between blood pressure and some cvd risk factors . \n a total of 840 subjects were studied , 25.1% of whom were males and 74.9% females . \n they were aged between 16 and 104 years with a mean of 45.5 18.2 . \n majority , 78.5% lived most of their last 5 years in the area while 19.3% although resident in the rural area in question at the time of the study lived most of their last 5 years in the urban areas . \n there were few smokers ( 1.8% ) and not many ( 4.1% ) admitted to using alcohol . \n systolic blood pressure ( sbp ) was found to be correlated significantly with bmi , total cholesterol ( tc ) , age and serum uric acid ( p = 0.01 ) ; but not with pulse rate , high density lipoprotein cholesterol ( hdl - c ) , blood sugar , pcv , serum creatinine and atherogenic index ( ai ) defined as quotient of tc and hdl - c . for diastolic blood pressure ( dbp ) , there was significant correlation with bmi , tc , serum uric acid , age and ai ; but not serum creatinine , pcv , blood sugar and hdl - c [ table 1 ] . degree of correlation by blood pressure and various cvd risk factors there was a trend in association between alcohol use and sbp . \n those who drank actually had lower mean sbp than those who did not ( 127.32 vs. 130.51 ) , although the difference did not attain statistical significance ( p = 0.499 ) . \n the small numbers did not permit any worthwhile scrutiny . only 15 subjects ( 1.8% ) smoked a number considered rather small ; hence no further analysis was done . \n exercise was assessed by questions on physical activity in regular occupation and rated as mild , moderate or high . \n it was judged high if the activity left subject feeling out of breath and sweaty , moderate if it left the subject slightly out of breath and warm but not sweaty and mild if it did not result in running out of breath.6 in mild and moderate degrees of physical activity , both sbp and dbp were inversely related to a statistically significant level . \n ( f = 20.3 , p = 0.000 and f = 5.73 , p = 0.03 ) , respectively . when subjected to multiple comparison ( mild , moderate and severe ) , whereas subjects admitting moderate and severe degrees of physical activity in their regular occupation had increasingly significant differences in mean sbp compared with mild degree ; that between moderate and severe was not significant . \n the same trend was observed for physical activity and dbp [ table 2 ] . with regard to leisure time physical activity \n , there was also an inverse significant relationship ; sbp f = 12.93 , p = 0.000 and dbp f = 3.42 , p = 0.03 . \n high - level leisure activity paradoxically but curiously gave higher mean blood pressure values than mild and moderate levels . \n multiple comparison of blood pressure and occupational exercise degrees multiple comparison of blood pressure and leisure exercise degrees for diet , those who ate food preserved with salt , added extra salt after cooking and those who liked their food well - salted had significantly higher sbp ( t = 2.704 , p = 0.007 ; t = 4.795 , p = 0.000 ; t = 2.83 , p = 0.005 , respectively ) . regarding dbp , those who ate food preserved with salt , added extra salt after cooking and liked food well - salted had significantly higher values as well ( t = 2.698 , p = 0.007 ; t = 3.953 , p = 0.000 ; t = 2.459 , p = 0.014 , respectively ) . \n kanwa rock salt as food seasoning did not affect sbp ( t = 0.018 , p = 0.986 ) or dbp ( t = 0.292 , p = 0.77 ) . \n mai - shanu or animal fat believed to be high in saturated fat and also used as food seasoning did not affect sbp ( t = 1.311 , p = 0.19 ) or dbp ( t = 0.098 , p = 0.922 ) . for tc , hdl - c and ai , use of mai - shanu as food seasoning caused a rise , reduction and rise , respectively . the difference in mean values between those who used the seasoning and those who did not failed to attain statistical significance ( t = 0.843 , p = 0.4 ; t = 0.765 , p = 0.445 ; t = 0.726 , p = 0.469 , respectively ) . \n blood pressure both sbp and dbp correlated positively to a statistically significant extent with bmi . \n [ on behalf of the systematic coronary risk evaluation ( score ) investigators ] posited that a single unit rise in bmi was associated with a 1.14 mmhg rise in sbp.7 doll et al . also found that both sbp and dbp rose with bmi8 across all populations . \n individuals who are obese tend to have hyper insulinaemia which in various ways is related to elevated blood pressure . \n there was also a positive significant correlation with total cholesterol , an experience shared by akuyan et al . \n working in zaria , nigeria.9 as shown in the score investigation referred to above,8 a 0.055 mmol / l increase in total cholesterol resulted in a 1.14 mmhg rise in sbp . \n this is a common finding and is attributed to arterial stiffness consequent upon structural alterations in the arterial wall.10 with ageing , the arteries lose elasticity because of medial degeneration and sclerosis.11 excess salt intake either as preference for food preserved with salt or adding extra salt on table after cooking resulted in a significant increase in both sbp and dbp . \n there has been a general consensus on this relationship ; leading to steps in many countries to reduce dietary salt as a population control strategy.12 earlier studies in nigeria also support the observation13 just as the international study of salt and blood pressure.14 excess sodium expands blood volume , thus increasing pre load and cardiac output . \n other mechanisms include increasing vascular reactivity15 and contractility.16 another cvd risk factor that correlated positively with sbp and dbp here was serum uric acid . findings in this area have been inconsistent . whereas some studies see ua as a disease marker17 being high because of renal changes induced by hypertension and drugs used in treating it ; others surmise that it is an independent risk factor for development of hypertension.18 our findings here agree with that of kansui et al.19 in japan that showed ua correlating significantly with blood pressure whether or not such individuals were on anti hypertensives or uricosuric drugs . regarding exercise ( whether occupational or leisure ) , there was a significant association with blood pressure both sbp and dbp . when graded into mild , moderate or severe , \n however , severe occupational physical activity did not produce any significant reduction in bp over that for moderate degree . \n this is also the experience of eicher et al.20 who found that antihypertensive effect of exercise occurred in a dose - dependent fashion . \n regular physical exercise acting as a basic component of life style modification reduces major cardiovascular risk factors chief of which is hypertension . \n it reduces sympathetic activity , reduces angiotensin ii levels , improves lipid profile and produces weight loss , all lowering blood pressure.21 it can also delay progression to hypertension , a response said to be related to decrease in plasma levels of proinflamatory cytokines and norepinephrine , reduction in oxidative stress and diminished activation of the nuclear factor kappa - light - chain - enhancer of activated b cells ( nuclear factor kb ) system.22 whereas severe occupational physical activity did not produce a significant reduction in blood pressure over moderate degree ; severe leisure physical activity recorded blood pressure values higher than moderate degree . why this would be the case is interesting but difficult to fathom ; and \n however , schultz et al.23 had shown though in rats that excessive exercise especially in untreated hypertensives can have deleterious effects on cardiac function . \n we found in this study a reduction in sbp which did not reach statistical significance between those who drank and those who did not . \n most of those who admitted to drinking ( 71% ) were mild drinkers and may be at the nadir of the j - shaped relationship between alcohol and blood pressure.24 osibogun13 had also found in his study that those who drank had lower blood pressures . \n this does not imply encouragement of heavy alcohol intake or advising non drinkers to start ; as beyond a certain level , blood pressures rise with increasing amounts of alcohol . in conclusion , for this sub - saharan rural community bmi , tc , age , serum uric acid and high salt intake are related to blood pressure and would be favourable points to manipulate for population control . \n age is a non - modifiable cardiovascular disease risk factor but the older individuals get , the more careful they should be with their diet to forestall rises in bmi , tc and serum uric acid .\nOUTPUT: background : hypertension is associated with certain cardiovascular disease ( cvd ) risk factors which vary from one place to the other depending on community sophistication . we decided to obtain the situation as it affects this rural nigerian community to be in an evidence - based position to initiate individual and group prevention strategies.design:cross-sectional population survey.materials and methods : we surveyed for cvd risk factors among subjects 15 years and above in this rural community using a questionnaire requesting personal , medical and anthropometric information . \n one in three of them were randomly assigned to laboratory investigations.results:of the 840 subjects studied , 25% were males . \n the population mean age was 45.5 ( 18.2 ) standard deviation ( sd ) , with 1.8% smokers and 4.1% using alcohol . \n systolic blood pressure ( sbp ) correlated with age , body mass index ( bmi ) , total cholesterol ( tc ) and uric acid ( ua ) ; while diastolic blood pressure ( dbp ) correlated with age , bmi , tc , ua and atherogenic index ( ai ) . \n sbp and dbp improved with exercise but not salt intake . \n the local seasonings used in cooking had no impact on blood pressure.conclusion:to reduce cardiovascular morbidity in this and probably other rural sub - saharan african communities , bmi , tc , ua and salt intake in diet should be targeted for reduction . \n physical activity should be encouraged . \n interestingly , these fall into the sphere of healthy lifestyle which should be encouraged and re - inforced .\nINPUT: our study included patients who received bilateral lasek for the correction of myopia at the department of ophthalmology of the chonnam national university hospital from january 2012 to april 2012 and were followed up for at least 6 months after surgery . \n exclusion criteria included ocular diseases , previous ocular surgery , punctal plug insertion , abnormality of the nasolacrimal drainage apparatus , eyelid malposition and abnormality of eyelid margin . \n informed consent was obtained from all subjects , in accordance with the declaration of helsinki , and the protocol was approved by the institutional review board of chonnam national university hospital . \n thirty - one patients were divided into 2 groups based on the presence of dry eye . \n sixteen patients ( 32 eyes ) had dry eye , and 15 patients ( 30 eyes ) did n't have dry eye . \n inclusion criteria for the dry eye group were presence of ocular symptoms , tear film abnormalities ( schirmer i test results < 7 mm/5 minutes , tear film break - up time [ tbut ] < 7 seconds ) and ocular surface damage ( corneal and conjunctival staining ) . \n all patients were treated with preservative - free sodium hyaluronate 0.1% ( hyalu mini ; hanmi pharm , seoul , korea ) . \n additionally , topical cyclosporine a 0.05% ( restasis ; allergan , irvine , ca , usa ) was applied twice a day in the patients with dry eye . \n all patients underwent ophthalmic examinations including uncorrected distance visual acuity ( udva ) by snellen chart , spherical equivalent ( se ) refraction , ocular surface staining with 1% fluorescein dye , tbut , schirmer i test and tear clearance rate ( tcr ) . \n ocular surface staining was graded using the oxford grading scheme ( 0 to 5 ) : absent ( 0 ) , minimal ( 1 ) , mild ( 2 ) , moderate ( 3 ) , marked ( 4 ) , and severe ( 5 ) . \n in addition , the ocular surface disease index ( osdi ) questionnaire was done to assess the ocular symptoms and the quality of vision ( osdi score : 0 to 100 ) . \n in addition , we evaluated the preoperative se refraction and ablation depth in all patients . at 6 months after lasek \n , corneal wavefront aberration was measured using the pentacam ( oculus ; optikgerate gmbh , wetzlar , germany ) . \n the ' wavefront aberration cornea ' data of the pentacam 's zernike analysis was used . \n the selected refractive indices were 1.376 and 1.336 for the cornea and the aqueous , respectively . \n the hoa data were analyzed quantitatively in the central 4-mm pupil diameter up to the sixth order by expanding the set of zernike polynomials . \n the assessed hoa values were total hoa root mean square ( rms ) , third - order coma , third - order trefoil and fourth - order spherical aberration ( sa ) of the anterior corneal surface . \n all measurements were taken between 10 am and 4 pm to minimize diurnal changes and performed on 3 separate days ( within one week ) to yield 3 sets . \n the preoperative hoas were measured immediately after blinking , while the postoperative hoas were measured immediately after blinking and at 10 seconds after blinking to evaluate the influence of tear film instability on hoas of the corneal surface . \n the patients were instructed to remain stationary and to blink completely just before each measurement . \n the chi square test and mann - whitney u - test were used to compare the results between the groups . \n the wilcoxon signed - rank test was used to compare the intragroup differences . in the dry eye group , spearman correlation coefficients \n at 6 months after lasek , corneal wavefront aberration was measured using the pentacam ( oculus ; optikgerate gmbh , wetzlar , germany ) . \n the ' wavefront aberration cornea ' data of the pentacam 's zernike analysis was used . \n the selected refractive indices were 1.376 and 1.336 for the cornea and the aqueous , respectively . \n the hoa data were analyzed quantitatively in the central 4-mm pupil diameter up to the sixth order by expanding the set of zernike polynomials . \n the assessed hoa values were total hoa root mean square ( rms ) , third - order coma , third - order trefoil and fourth - order spherical aberration ( sa ) of the anterior corneal surface . \n all measurements were taken between 10 am and 4 pm to minimize diurnal changes and performed on 3 separate days ( within one week ) to yield 3 sets . \n the preoperative hoas were measured immediately after blinking , while the postoperative hoas were measured immediately after blinking and at 10 seconds after blinking to evaluate the influence of tear film instability on hoas of the corneal surface . \n the patients were instructed to remain stationary and to blink completely just before each measurement . \n spss ver . 12.0 ( spss inc . , chicago , il , usa ) was used for statistical analyses . \n the chi square test and mann - whitney u - test were used to compare the results between the groups . \n the wilcoxon signed - rank test was used to compare the intragroup differences . in the dry eye group , \n the demographics and characteristics of both group patients are presented in table 1 . in the dry eye group , the mean age of the 6 men and 10 women was 25.21 2.62 years . in the non - dry eye group , the mean age of the 4 men and 11 women was 26.25 3.23 years . \n there were no statistically significant differences in age , sex , udva , se refraction ( preoperative and postoperative ) and ablation depth between groups . however , there were statistically significant differences in tbut , schirmer i test , tcr , ocular surface staining and osdi scores between groups ( p < 0.01 ) . \n the dry eye group had lower tbut , schirmer i test , and tcr scores , and higher ocular surface staining and osdi scores compared with the non - dry eye group . \n the preoperative and postoperative hoas of the corneal surface in both groups are presented in tables 2 and 3 . in the dry eye group , \n the total hoa rms value was 0.082 0.031 m preoperatively and 0.196 0.049 m postoperatively ( p < 0.01 ) . \n coma , trefoil and sa values were 0.071 0.036 , 0.054 0.038 , and 0.018 0.015 m preoperatively and 0.128 0.040 , 0.118 0.036 , and 0.090 0.030 m postoperatively , respectively ( p < 0.01 for all ) . in the non - dry eye group , the respective total hoa rms , coma , trefoil and sa values were 0.084 0.041 , 0.068 0.047 , 0.058 0.034 , and 0.010 0.009 m preoperatively and 0.189 0.053 , 0.126 0.030 , 0.124 0.034 , and 0.086 0.028 m postoperatively ( p < 0.01 for all ) . \n when comparing the dry eye and non - dry eye groups , there were no statistically significant differences in all values measured immediately after blinking before and after lasek ( tables 2 and 3 ) . \n however , at 10 seconds after blinking , the dry eye group had significantly higher total hoa rms ( p = 0.01 ) , coma ( p = 0.03 ) , and trefoil ( p = 0.04 ) than the non - dry eye group . in the dry eye group , \n total hoa rms , coma , and trefoil significantly increased at 10 seconds after blinking compared with those measured immediately after blinking ( p < 0.01 , p = 0.03 , and p = 0.04 , respectively ) , whereas there was no significant difference in sa value ( p = 0.62 ) . in the non - dry eye group , there were no statistically significant differences in all hoa parameters ( table 3 and fig . \n 1 ) . the mean pupil sizes measured immediately after blinking and at 10 seconds after blinking did n't show significant differences in either group . \n the correlations between the changes in hoas and dry eye parameters ( tbut , schirmer i test , tcr , ocular surface staining score , and osdi score ) in the dry eye group are demonstrated in table 4 . \n the changes of total hoa rms , coma and trefoil were correlated negatively with tbut ( r = -0.420 , p = 0.03 ; r = -0.473 , p = 0.01 ; r = -0.439 , p = 0.02 ; respectively ) but were correlated positively with osdi score ( r = 0.433 , p = 0.02 ; r = 0.499 , p = 0.02 ; r = 0.532 , p = 0.01 ; respectively ) . \n schirmer i test , tcr , and ocular surface staining scores did not show significant correlations with the hoas . \n although the hoas comprise a relatively a lower proportion of optical aberrations than lower order aberrations , they can have an important effect on retinal image quality in subjects . \n after corneal refractive surgery , the surgically - induced corneal hoas can contribute to glare , halo , decreased night vision and decreased contrast sensitivity . \n as expected , the measured hoas ( total hoa rms , coma , trefoil , and sa ) after lasek were significantly higher than pre - surgery measurements . \n although the severity is milder than laser in situ keratomileusis , lasek can also lead to the ocular symptoms associated with dry eye as well as decreased tear secretion . \n after the blinking , a tear meniscus spreads over the entire ocular surface to form a uniform tear film . \n tear film instability can lead to disproportionate thickness of the tear film , such as the superoinferior asymmetric contribution or thinning of the central cornea . as a result \n these abnormal distributions of the tear film on the corneal surface are intensified in patients who received lasek or patients with dry eye disease . \n some studies demonstrated that tear film instability can cause significantly increased hoas in patients with dry eye . \n montes - mico et al . reported that dry eye patients showed greater optical aberrations compared with normal controls and that an increase of hoas resulted from increased tear film irregularity . \n koh et al . reported that from 5 to 9 seconds after blinking , the total hoas were significantly higher than those measured immediately after blinking in subjects with a short tbut . \n denoyer et al . also reported that the rms of ocular and corneal hoas , especially third - order aberrations , significantly increased from 6 to 10 seconds after blinking in dry eye patients . \n this is the first study , to our knowledge , reporting tear film instability and hoas after corneal surface ablation . \n it is a noninvasive system using rotating scheimpflug camera and a monochromatic slit - light source ( blue led at 475 nm ) for measuring anterior segment topography . \n our study showed that total hoa rms , coma and trefoil significantly increased at 10 seconds after blinking compared with those measured immediately after blinking in dry eye patients after lasek . \n this result can be explained by compound effects of corneal shape changes after lasek and irregular distribution of the tear film by superficial punctuate keratitis , the lid pressure and the gravity effect . on the other hand \n some studies explained that the thinning at the center of the cornea rather than the periphery might contribute to an increase of sa value . also , the relative contribution of sa to the overall wave aberration of the eye increases when pupil dilates . \n we believe that several factors may have an influence on the absence of significant changes in sa values in our study . \n one factor is that there was no definitive pupil size change between the measurement taken immediately after blinking and that at 10 seconds after blinking . \n another factor is that the hoas of the anterior corneal surface might have been affected by the irregular distribution of the tear film rather than thinning of the tear film in the central cornea . \n denoyer et al . reported the progression index for corneal hoas was correlated with the subjective index ( osdi score ) of patient - reported visual outcomes and with objective clinical findings ( tbut ) . \n although there are some differences , such as measurement of hoas using the pentacam in dry eye patients after lasek , our results also showed that the amount of increase in total hoa rms , coma and trefoil at 10 seconds after blinking compared with those measured immediately after blinking was negatively correlated with tbut , but positively correlated with osdi score . \n we assume that additional hoas by tear film instability as well as surgically - induced corneal hoas can lead to a decreased optical quality in dry eye patients after lasek . \n first , because we used the pentacam to measure the hoas , we could only assess hoas of the corneal surface , not whole ocular hoas . \n although optical quality of the actual retinal image is associated with the whole ocular hoas including the posterior cornea , crystalline lens , and other components of the eye , the tear film instability mostly influences aberrations of the anterior corneal surface . \n second , although we have performed repeated measurements for a well - aligned and focused image , there is a possibility of subtle measurement errors . \n further studies with a larger sample size and serial measurements of corneal and ocular hoas are needed . in conclusion , \n the hoas after lasek significantly increased compared with those before surgery . in the dry eye patients after lasek , the values of total hoa rms , coma and trefoil at 10 seconds after blinking showed a significant increase compared with those measured immediately after blinking . \n in addition , the amount of an increase in total hoa rms , coma and trefoil after blinking was significantly correlated with tbut and osdi score . \n therefore , the additional hoas caused by tear film instability in patients after lasek may lead to a reduction in optical quality .\nOUTPUT: purposeto evaluate the changes of higher order aberrations ( hoas ) before and after laser subepithelial keratomileusis ( lasek ) and to analyze the influence of tear film instability on hoas of the corneal surface after lasek.methodsin this cross - sectional study , 31 patients who underwent lasek were divided into dry eye ( 16 patients , 32 eyes ) and non - dry eye groups ( 15 patients , 30 eyes ) . uncorrected distance visual acuity , spherical equivalent refraction , ablation depth , tear film parameters and ocular surface disease index ( osdi ) questionnaire scores were evaluated in both groups . \n total hoa root mean square ( rms ) , third - order coma , third - order trefoil and fourth - order spherical aberration ( sa ) of the corneal surface immediately and at 10 seconds after blinking were measured before and after surgery.resultsthe total hoa rms , coma , trefoil and sa significantly increased after lasek compared with preoperative values in both groups . in the dry eye group , total hoa rms , coma and trefoil significantly increased except for sa at 10 seconds after blinking compared with those measured immediately after blinking . \n in addition , the changes of total hoa rms , coma and trefoil were negatively correlated with tear film break - up time ( r = -0.420 , -0.473 and -0.439 , respectively ) , but positively correlated with osdi score ( r = 0.433 , 0.499 and 0.532 , respectively ) . in the non - dry eye group , there were no significant differences between hoas measured at 10 seconds after blinking and those measured immediately after blinking.conclusionsthe hoas including coma , trefoil and sa significantly increased after lasek . \n the tear film instability in the dry eye can be associated with more deterioration of the optical quality after lasek , due to more significant increase of total hoa rms , coma and trefoil .\nINPUT: she had history of trauma to the neck 10 years earlier with haematoma evacuation , ligation of the left internal jugular vein and removal of the sternal head of the clavicle . during pre - operative \n work - up , she was found to have a left - sided , soft , pulsating swelling extending from the angle of the mandible to the clavicle ( 15 10 cm ) which increased in size significantly on lying flat . \n duplex ultrasound examination of the neck showed a hugely dilated venous channel with sluggish whirling flow . \n contrast - enhanced ct scan confirmed the presence of an aneurysmally dilated venous channel related to the left subclavian vein . in theatre , the patient was cooled to 20c and bypass was discontinued . \n the left brachiocephalic vein was exposed and followed distally past the origin of the subclavian vein . \n cabg was performed with lima to lad and svg to om1 . in the initial post - operative period , \n the swelling increased in size . on the second day , it shrunk to its pre - operative size and disappeared completely by the third day leaving lax overlying skin . \n post - operative duplex ultrasound examination showed complete thrombosis of the venous aneurysm with preserved flow in the left subclavian vein which was confirmed by ct scan ( see figs . 1 and 2 ) . \n venous aneurysms of the head and neck are usually asymptomatic and are only discovered accidentally during imaging studies . occasionally , patients may present with a soft - tissue mass with or without localized pain . \n they rarely present with complications including thromboembolism , rupture , venous obstruction and compression of adjacent structures . \n surgical excision of the aneurysm has been previously reported with variable results a high incidence of complications such as uncontrollable haemorrhage and massive pulmonary embolism . \n other options including polyethylene cellophane wrapping , endovascular stenting and watchful waiting have also been tried . \n [ 35 ] in this report , we describe yet a different approach where sternotomy and cardiopulmonary bypass were used to allow for intraluminal repair of the aneurysm . securing unobstructed venous drainage of the upper limb particularly in the absence of an ipsilateral internal jugular vein was considered mandatory . \n endoaneurysmorraphy facilitated preserving an endothelialized venous channel to drain the upper limb post - operatively . \n cooling and circulatory arrest made an endovascular approach possible without the need for massive dissection and potential injury to adjacent structures . by obstructing the outflow of the venous channel we were able to induce thrombosis of the aneurysm while maintaining physiological venous drainage . \n our report illustrates several points related to this rare condition including pathogenesis , diagnosis and management . \n we believe that our approach to tackle such aneurysms has the advantage of avoiding some of the aforementioned procedural complications . \n regardless of the surgical technique , endovascular stenting and even conservative management remain valid strategies especially in patients with asymptomatic uncomplicated mediastinal venous aneurysms .\nOUTPUT: abstractvenous aneurysms are relatively rare anomalies which can affect different parts of the vascular system \n . diagnosis and management of this condition could pose important problems . \n we here report a giant false aneurysm of the subclavian vein with emphasis on the thought process that determined the management strategy .\nINPUT: basic and instrumental activities of daily living are tasks required to function on a daily basis , and are often impacted by disease processes that reduce cognitive ability such as alzheimer 's disease ( ad ) . \n basic activities of daily living ( adls ) include core tasks of everyday life such as eating , dressing , grooming , and bathing while instrumental activities of daily living ( iadls ) include more complicated , higher - level , tasks such as preparing meals , managing finances , shopping , doing housework , and using the telephone . driving and medication management are other iadls that are significantly disturbed in patients with ad . \n while both adls and iadls are impacted by ad , iadls are the first to decline and the level of functional impairment is the core clinical distinction between ad and milder conditions such as mild cognitive impairment ( mci ) . classification of mci subtypes , suggest that mci - amnestic type and mci patients with multiple - domain impairments are more predictive of later conversion to dementia and are more impaired functionally compared to mci of nonamnestic and single domain subtype . \n patients with ad experience a gradual loss in the abilities to live independently due to impairments in cognitive and memory functioning [ 1 , 3 ] and , as the disease progresses , the ability to carry out these essential activities eventually disappears . \n although there is not a large body of research on the relationship between neuropsychological measures and functional activities , several studies suggest that neuropsychological test performance is predictive of complex adls and iadls in elderly neuropsychiatric patients and those with ad [ 1 , 3 , 6 , 7 ] . \n evans found that performance on neuropsychological evaluations predicted functional capacity beyond negative symptoms in elderly with schizophrenia . \n however , these authors were unable to identify specific cognitive domains that impacted functional impairment . to date \n , most studies have not utilized comprehensive and conceptually sound measures to identify specific cognitive domains to predict particular areas of daily functioning . \n the limited existing literature suggests a correlation between objective neuropsychological assessment and informant reported level of functioning . \n this relative dearth of literature may be attributable to the difficulty in accurately measuring everyday functioning . \n trained observer ratings of functional level may be the gold standard but are very time consuming and impractical in outpatient settings . \n loewenstein et al . found that family members ' report of functional impairment is extremely accurate when compared with objective functional performance and is a useful mechanism to assess functioning . \n the present study evaluated the link between specific neurocognitive measures and informant report of adls and iadls in patients diagnosed with mild ad . \n as recommended by beck et al . , we address challenges in the current literature by utilizing a comprehensive neuropsychological battery to predict daily functioning in this clinical population . to our knowledge no research has addressed the possibility of gender - related differences in the cognitive mechanisms required for select areas of daily functioning . \n for instance , women inherently expend more effort than men in the area of dressing and grooming , which implies increased cognitive effort . \n the majority of studies have dealt with possible gender differences by covarying for gender , which tends to obscure any meaningful relationships that may be gender specific . \n our study directly evaluates gender differences in the ability of specific neuropsychological tests and cognitive domains to predict functioning . \n the total sample consisted of 202 ( 91 male , 111 female ) participants who met criteria for ad enrolled in the longitudinal research cohort of the texas alzheimer 's research consortium ( tarc ) . to reduce the effect of stage of decline on these measures \n , only individuals with a clinical dementia rating scale global score of 1.0 were included in the sample . \n collateral information on adls and iadls ratings was obtained from immediate caregivers who predominately were family members ( spouse and or children ) using the lawton - brody rating scales . \n briefly , the tarc project is a longitudinal multisite study of a cohort of ad patients and normal controls where each participant undergoes an annual evaluation that includes a medical examination , interview , neuropsychological testing , and blood draw . \n ad patients met consensus - based diagnosis for probable ad based on nincds - adrda criteria . \n male participants were 56 to 92 years of age ( m = 74.36 , sd = 8.21 ) , and females participants were 54 to 92 ( m = 76.95 , sd = 7.74 ) . \n the majority of participants were caucasian ( 98% ) , black or african american ( 1.5% ) was the next largest group . \n the tarc project received institutional review board approval , and all participants and/or caregivers provided written informed consent . \n the tarc neuropsychological core battery consists of the following instruments : wechsler digit span , logical memory , and visual reproduction , trail making test a & b , clock drawing test ( cdt ) , boston naming test , the geriatric depression scale ( gds-30 ) , and the clinical rating scale ( cdr ) . \n verbal memory was assessed with the wechsler logical memory i ( lm i ) and wechsler logical memory ii ( lm ii ) , visual memory was assessed with the wechsler visual reproduction i ( vri ) and ii ( vrii ) , attention was evaluated by performance on trails a and total digit span , linguistic capacity was assessed with boston naming test ( bnt ) and verbal fluency ( fas , category naming ( cowat ) ) , measures of executive functioning in this battery included the cdt and trails b. cognitive evaluation was administered in a controlled setting according to standardized instructions . in order to equate scores from digit span and story memory scales , all raw scores were converted to scale scores based on previously published normative data . for the boston naming test , the current group recently conducted an independent study that demonstrated the psychometric properties of an estimated 60-item bnt score that can be calculated from 30-item versions . \n descriptive statistics and one - way anova comparison of male and female samples ( presented in table 1 ) were conducted using spps version 17.0 . \n stepwise regression modeling was used to evaluate the link between each test of cognitive function and adls and iadls . \n independent variables were caregiver ratings on the physical self - maintenance scale for adls and the personal self - maintenance scale for iadls . \n each item has five descriptors from total independence to total dependence or total loss of functional control . \n the adls assessed were toileting , feeding , dressing , grooming , ambulation , and bathing . \n the iadls assessed were telephone use , shopping , food preparation , housekeeping , transportation , laundry management of medications and finances . \n logical memory i ( lmi ) and performance on cdt were significant predictors of iadls ( see table 2 ) . both lmi ( t = 2.34 , p = .022 ) and cdt ( t = 3.78 , p < \n .0001 ) significantly predicted total iadl score ( lmi / cdt combined ; t = 14.38 , p < .0001 ; effect size ( r = 0.26 ) . \n evaluation of specific iadls suggested that executive functioning ( i.e. , cdt ) predicted independence with medication management ( t = 12.23 , p < .0001 ; r = .32 ) , transportation ( t = 9.03 , p < .0001 ; r = .22 ) , laundry ( t = 7.67 , p < .0001 ; r = .22 ) , and housekeeping \n memory and learning capacity ( lmi ) significantly predicted ability to independently manage finances ( t = 11.11 , p < .0001 ; r = .24 ) , shop ( t = 12.70 , p < .0001 ; r = .30 ) , and telephone use ( t = 12.63 , p < .0001 ; r = .32 ) . \n measures of lmi and cdt ( t = 11.36 , p < .0001 ; r = .45 ) individually predicted food preparation ability . \n apoe4 status was excluded from stepwise regression modeling and did not impact the level of iadl functioning in women and men with mild ad . \n total adl scores were predicted by score on the cdt ( t = 14.38 , p < .0001 ; r = .26 ) . \n likewise , cdt score predicted the ability to bath ( t = 10.34 , p < .0001 ; r = .24 ) , groom ( t = 10.34 , p < .0001 ; r = .20 ) , and feed / eat ( t = 18.63 , p < .0001 ; r = .28 ) . \n trails a predicted the patient 's ability for self - dress ( t = 11.18 , p < .0001 ; r = .20 ) as demonstrated by table 3 . \n apoe4 status was excluded from stepwise regression modeling and did not impact the level of adl functioning in women and men with mild ad and as a result was not included in gender analyses . \n significant predictors of the ability of female ad patients to perform iadls included lmi , lmii , cdt , and the bnt . \n total iadl score was predicted by performance on both lmi ( t = 3.73 , p < .0001 ) and cdt ( t = 2.15 , p = .035 ) with combined value of ( t = 12.48 , p < .0001 ; r = .49 ) . \n the cdt alone significantly predicted independent functioning in the area of medication management ( t = 10.76 , p < .0001 ; r = .38 ) and housekeeping ( t = 8.35 , p < .0001 ; r = .36 ) . \n performance on lmi significantly predicted financial management ( t = 10.10 , p < .0001 ; r = .41 ) and the ability to shop independently ( t = 11.50 , p \n lmi and lmii significantly predicted telephone use ( t = 11.25 , p < .0001 ; r = .52 ) and performance on the bnt alone predicted transportation or driving capacity ( t = 9.04 , p < .0001 ; r = .25 ) in women with ad ( see table 4 ) \n . levels of adl functioning in women was predicted by performance on the cdt and trails a. performance on cdt predicted total adl score ( t = 11.55 , p < .0001 ; r = .27 ) and bathing capacity ( t = 8.37 , p < .0001 ; r = .26 ) . \n ability to eat / feed ( t = 14.72 , p < .0001 ; r = .32 ) independently was predicted by performance on trails a. performance on measures of vri ( t = 2.74 , p = .010 ) , vrii ( t = 2.29 , p = .029 ) , trails b ( t = 2.74 , p = .010 ) , and cowat ( t = 2.56 , p = .015 ) predicted medication management capacity in men ( t = 4.67 , p < .0001 ; r = .27 ) . \n food preparation was predicted by performance on the bnt ( t = 5.18 , p < \n vri , trails a , bnt , trails b , and cdt were all significant predictors of level of adl functioning in men with ad ( see table 5 ) . \n = .35 ) was significantly predicted by vri and trails a. performance on vri predicted bathing ability ( t = 6.26 , p < \n .0001 ; r = .41 ) and when combined with trails b also predicted grooming capacity ( t = 5.66 , p < .0001 ; r = .51 ) . the ability to eat / feed independently was predicted by bnt and cdt ( t = 16.65 , p < .0001 ; r = .56 ) . \n previous research has shown that cognitive functioning , as assessed by neuropsychological tests , is the strongest predictor of functional impairment [ 6 , 7 ] . \n specific cognitive domains of executive functioning , praxis / visuospatial skills , and memory have been found to be useful for predicting adl and iadl in assisted - living elders . \n our findings are consistent with previous research and demonstrate a significant relationship between performance of daily living activities and neurocognitive performance . unlike other studies , we found that attention is an important predictor of adls in ad patients . \n prior studies have been conducted in assisted care facilities where caregiver assistance may be sufficient to overcome inattention . \n however , individuals with mild dementia seen as outpatients in our study were likely responsible for basic adls , and , thereby , attention was necessary to facilitate functioning . \n memory and learning ( lmi , lmii , vr i , vrii ) , executive functioning ( cdt , trails b ) , and language ( bnt , cowat ) were significant predictors of adls and iadls . among the measures administered , cdt , lmi , and \n trails a were predictive of both adl and iadl functioning in analysis of the total sample . whereas prior reports suggested that cognitive abilities are most predictive of complex tasks of everyday functioning [ 15 , 16 ] , our results suggest that cognitive test performance also predicts basic adls ( e.g. , bathing , grooming , dressing , and feeding ) . \n this suggests that even in patients with mild ad , basic adls likely also require complex cognitive processes . \n another intriguing finding is that the presence of apoe4 genotype was not predictive of level of iadl and adl functioning in the current sample . \n presence of particular apoe genotype has been associated with greater disability in prior research with patients with mci . \n the current data suggests that the presence of apoe was not significantly associated with level of functioning in patients who have converted to ad status . \n we anticipated gender differences because there are ( a ) differences in task performance and ( b ) differences in strategies used to perform adls and iadls . \n for instance , it has been documented that women tend to use landmarks when driving and given directions where men are more likely to use street names [ 9 , 18 ] . in our research \n we administered several measures within each cognitive domain to facilitate understanding of not only which domain is different for male and female but also which specific measure best predicts functioning . \n figure 1 demonstrates gender differences in adls and iadls with regard to specific cognitive domains assessed . \n language also predicted iadl functions in men ( food preparation ) and women ( driving ) . \n gender differences remained in the domain of learning and memory , suggesting that men rely on this process for both adl and iadl whereas it is only predictive of iadl functions in women . \n a notable gender difference is that cognitive functioning is generally a better predictor of adl and iadl functioning for women compared to men . \n while the administered assessment battery predicted practically all daily tasks for women , it only predicted a few specific ones for men . \n this may be due in part to the likelihood that men especially of the generation in our sample are less likely to be involved in cooking , shopping , housekeeping and laundry and hence have little variability . for men , \n the iadl of medicine management was the only area predicted by performance on several different cognitive measures . among adls , \n only bathing , grooming , and feeding capacity was significantly predicted by vri , trails a and trails b , bnt , and the cdt . \n however , in women , the cdt , verbal learning and memory ( lmi and lmii ) and language were good predictors of capacity to perform almost all adls and iadls . \n these findings suggest that men tended to depend on visual learning and visual memory and women on verbal learning and verbal memory . \n lmi and lmii were predictive of functioning for women , whereas vri and vrii were predictive for men . \n one could speculate that women tend to problem - solve verbally using self - talk whereas men tend to conceptualize visually . \n the cdt appears to be a good measure in predicting functioning for women , but not for men . \n the cdt is typically seen as a measure of executive functioning and of frontal lobe processes . \n the clinical utility of the clock drawing test has been documented for diagnosing patients with dementia , but its relationship to specific functional activities has not been reported . \n the generalizability of our findings suffers from the relatively small sample size and the nature of subject recruitment . \n the current study is one of the first to examine gender differences , and efforts to replicate these findings is warranted due to several sample limitations that include lack of racial diversity and differences in educational levels and age among men and women in this sample . \n though it is unlikely these factors negate current results , it would be best to stratify according to education and age in future studies . \n additional studies with larger more representative samples are needed to further assess the impact of gender on predicting functioning . \n although late - life depression could impact cognitive functioning , gender differences were not significant ( table 1 ) in our sample , and , therefore , depression score was not accounted for in the analyses . \n however , effects of depression are significant and warrant future efforts . although the current research has its limitations this study has several advantages over earlier studies in terms of understanding patients with ad . \n first , the sample was limited to individuals with mild ad which helps control for the affect of disease severity on functional activities . \n third , in addition to evaluating predictive value of specific domains it also evaluated specific measures within those domains in both gender - specific and mixed - gender analyses . \n the findings of this study underscore the importance of gender and the gender - specific relations of neurocognitive measures to everyday activities . \n acknowledging gender differences is important as it may facilitate more accurate interpretation of neurocognitive tasks and its relationship to particular daily living activities . \n these findings also have clinical values for making informed decisions and recommendations of capacity in patients with ad . \n there is generally consensus that executive functioning is an important predictor of capacity to perform complex tasks ( iadls ; 15 ) . \n while this may be accurate for women , current findings suggest that it may be an irrelevant predictor for men . understanding how to most accurately predict level of function will also enable patients to maintain daily functions longer , reducing caregiver fatigue , and also social and economic burden .\nOUTPUT: objectives . to investigate the link between neurocognitive measures and various aspects of daily living ( adl and iadl ) in women and men with mild alzheimer 's disease ( ad ) . methods . \n participants were 202 ad patients ( 91 male , 111 female ) with cdr global scores of 1 . \n adls and iadls ratings were obtained from caregivers . \n cognitive domains were assessed with neuropsychological testing . \n results . memory and executive functioning \n were related to iadl scores . \n executive functioning was linked to total adl . \n comparisons stratified on gender found attention predicted total adl score in both men and women . \n attention predicted bathing and eating ability in women only . \n language predicted iadl functions in men ( food preparation ) and women ( driving ) . \n conclusions . \n associations between adls / iadls and memory , learning , executive functioning , and language suggest that even in patients with mild ad , basic adls require complex cognitive processes . \n gender differences in the domains of learning and memory area were found .\n\n\nINPUT: anxiety affects quality of life in those living with parkinson 's disease ( pd ) more so than overall cognitive status , motor deficits , apathy , and depression [ 13 ] . \n although anxiety and depression are often related and coexist in pd patients , recent research suggests that anxiety rather than depression is the most prominent and prevalent mood disorder in pd [ 5 , 6 ] . yet , \n our current understanding of anxiety and its impact on cognition in pd , as well as its neural basis and best treatment practices , remains meager and lags far behind that of depression . \n overall , neuropsychiatric symptoms in pd have been shown to be negatively associated with cognitive performance . \n for example , higher depression scores have been correlated with lower scores on the mini - mental state exam ( mmse ) [ 8 , 9 ] as well as tests of memory and executive functions ( e.g. , attention ) [ 1014 ] . \n likewise , apathy and anhedonia in pd patients have been associated with executive dysfunction [ 10 , 1523 ] . \n however , few studies have specifically investigated the relationship between anxiety and cognition in pd . \n one study showed a strong negative relationship between anxiety ( both state and trait ) and overall cognitive performance ( measured by the total of the repeatable battery for the assessment of neuropsychological status index ) within a sample of 27 pd patients . \n furthermore , trait anxiety was negatively associated with each of the cognitive domains assessed by the rbans ( i.e. , immediate memory , visuospatial construction , language , attention , and delayed memory ) . \n two further studies have examined whether anxiety differentially affects cognition in patients with left - sided dominant pd ( lpd ) versus right - sided dominant pd ( rpd ) ; however , their findings were inconsistent . \n the first study found that working memory performance was worse in lpd patients with anxiety compared to rpd patients with anxiety , whereas the second study reported that , in lpd , apathy but not anxiety was associated with performance on nonverbally mediated executive functions and visuospatial tasks ( e.g. , tmt - b , wms - iii spatial span ) , while in rpd , anxiety but not apathy significantly correlated with performance on verbally mediated tasks ( e.g. , clock reading test and boston naming test ) . \n furthermore , anxiety was significantly correlated with neuropsychological measures of attention and executive and visuospatial functions . taken together , \n it is evident that there are limited and inconsistent findings describing the relationship between anxiety and cognition in pd and more specifically how anxiety might influence particular domains of cognition such as attention and memory and executive functioning . \n it is also striking that , to date , no study has examined the influence of anxiety on cognition in pd by directly comparing groups of pd patients with and without anxiety while excluding depression . \n given that research on healthy young adults suggests that anxiety reduces processing capacity and impairs processing efficiency , especially in the central executive and attentional systems of working memory [ 26 , 27 ] , we hypothesized that pd patients with anxiety would show impairments in attentional set - shifting and working memory compared to pd patients without anxiety . \n furthermore , since previous work , albeit limited , has focused on the influence of symptom laterality on anxiety and cognition , we also explored this relationship . \n seventeen pd patients with anxiety and thirty - three pd patients without anxiety were included in this study ( see table 1 ) . \n the cross - sectional data from these participants was taken from a patient database that has been compiled over the past 8 years ( since 2008 ) at the parkinson 's disease research clinic at the brain and mind centre , university of sydney . \n inclusion criteria involved a diagnosis of idiopathic pd according to the united kingdom parkinson 's disease society brain bank criteria and were confirmed by a neurologist ( sjgl ) . \n patients also had to have an adequate proficiency in english and have completed a full neuropsychological assessment . \n ten patients in this study ( 5 pd with anxiety ; 5 pd without anxiety ) were taking psychotropic drugs ( i.e. , benzodiazepine or selective serotonin reuptake inhibitor ) . \n patients were also excluded if they had other neurological disorders , psychiatric disorders other than affective disorders ( such as anxiety ) , or if they reported a score greater than six on the depression subscale of the hospital anxiety and depression scale ( hads ) . \n thus , all participants who scored within a depressed ( hads - d > 6 ) range were excluded from this study , in attempt to examine a refined sample of pd patients with and without anxiety in order to determine the independent effect of anxiety on cognition . \n this research was approved by the human research ethics committee of the university of sydney , and written informed consent was obtained from all participants . \n self - reported hads was used to assess anxiety in pd and has been previously shown to be a useful measure of clinical anxiety in pd . \n a cut - off score of > 8 on the anxiety subscale of the hads ( hads - a ) was used to identify pd cases with anxiety ( pda+ ) , while a cut - off score of < 6 on the hads - a was used to identify pd cases without anxiety ( pda ) . \n this criterion was more stringent than usual ( > 7 cut - off score ) , in effort to create distinct patient groups . \n the neurological evaluation rated participants according to hoehn and yahr ( h&y ) stages and assessed their motor symptoms using part iii of the revised mds task force unified parkinson 's disease rating scale ( updrs ) . in a similar way \n this was determined by calculating a total left and right score from rigidity items 3035 , voluntary movement items 3643 , and tremor items 5057 from the mds - updrs part iii ( see table 1 ) . \n processing speed was assessed using the trail making test , part a ( tmt - a , z - score ) . \n attentional set - shifting was measured using the trail making test , part b ( tmt - b , z - score ) . \n working memory was assessed using the digit span forward and backward subtest of the wechsler memory scale - iii ( raw scores ) . \n language was assessed with semantic and phonemic verbal fluency via the controlled oral word associated test ( cowat animals and letters , z - score ) . \n the ability to retain learned verbal memory was assessed using the logical memory subtest from the wechsler memory scale - iii ( lm - i z - score , lm - ii z - score , % lm retention z - score ) . the mini - mental state examination ( mmse ) \n demographic , clinical , and neuropsychological variables were compared between the two groups with the independent t - test or mann whitney u test , depending on whether the variable met parametric assumptions . \n chi - square tests were used to examine gender and symptom laterality differences between groups . \n all analyses employed an alpha level of p < 0.05 and were two - tailed . \n spearman correlations were performed separately in each group to examine associations between anxiety and/or depression ratings and cognitive functions . \n as expected , the pda+ group reported significant greater levels of anxiety on the hads - a ( u = 0 , p < 0.001 ) and higher total score on the hads ( u = 1 , p < 0.001 ) compared to the pda group ( table 1 ) . \n groups were matched in age ( t(48 ) = 1.31 , p = 0.20 ) , disease duration ( u = 259 , p = 0.66 ) , updrs - iii score ( u = 250.5 , p = 0.65 ) , h&y ( u = 245 , p = 0.43 ) , ledd ( u = 159.5 , p = 0.80 ) , and depression ( hads - d ) ( u = 190.5 , p = 0.06 ) . \n additionally , all groups were matched in the distribution of gender ( = 0.098 , p = 0.75 ) and side - affected ( = 0.765 , p = 0.38 ) . \n there were no group differences for tmt - a performance ( u = 256 , p = 0.62 ) ( table 2 ) ; however , the pda+ group had worse performance on the trail making test part b ( t(46 ) = 2.03 , p = 0.048 ) compared to the pda group ( figure 1 ) . \n the pda+ group also demonstrated significantly worse performance on the digit span forward subtest ( t(48 ) = 2.22 , p = 0.031 ) and backward subtest ( u = 190.5 , p = 0.016 ) compared to the pda group ( figures 2(a ) and 2(b ) ) . \n neither semantic verbal fluency ( t(47 ) = 0.70 , p = 0.49 ) nor phonemic verbal fluency ( t(47 ) = 0.39 , p = 0.70 ) differed between groups . \n logical memory i immediate recall test ( u = 176 , p = 0.059 ) showed a trend that the pda+ group had worse new verbal learning and immediate recall abilities than the pda group . however , logical memory ii test performance ( u = 219 , p = 0.204 ) and logical memory % retention ( u = 242.5 , p = 0.434 ) did not differ between groups . \n there were also no differences between groups in global cognition ( mmse ) ( u = 222.5 , p = 0.23 ) . \n participants were split into lpd and rpd , and then further group differences were examined between pda+ and pda. importantly , the groups remained matched in age , disease duration , updrs - iii , dde , h&y stage , and depression but remained significantly different on self - reported anxiety . \n lpda+ demonstrated worse performance on the digit span forward test ( t(19 ) = 2.29 , p = 0.033 ) compared to lpda , whereas rpda+ demonstrated worse performance on the digit span backward test ( u = 36.5 , p = 0.006 ) , lm - i immediate recall ( u = 37.5 , p = 0.008 ) , and lm - ii ( u = 45.0 , p = 0.021 ) but not lm % retention ( u = 75.5 , p = 0.39 ) compared to rpda. \n this study is the first to directly compare cognition between pd patients with and without anxiety . \n the findings confirmed our hypothesis that anxiety negatively influences attentional set - shifting and working memory in pd . \n more specifically , we found that pd patients with anxiety were more impaired on the trail making test part b which assessed attentional set - shifting , on both digit span tests which assessed working memory and attention , and to a lesser extent on the logical memory test which assessed memory and new verbal learning compared to pd patients without anxiety . taken together , \n these findings suggest that anxiety in pd may reduce processing capacity and impair processing efficiency , especially in the central executive and attentional systems of working memory in a similar way as seen in young healthy adults [ 26 , 27 ] . \n although the neurobiology of anxiety in pd remains unknown , many researchers have postulated that anxiety disorders are related to neurochemical changes that occur during the early , premotor stages of pd - related degeneration [ 37 , 38 ] such as nigrostriatal dopamine depletion , as well as cell loss within serotonergic and noradrenergic brainstem nuclei ( i.e. , raphe nuclei and locus coeruleus , resp . , which provide massive inputs to corticolimbic regions ) . over time \n , chronic dysregulation of adrenocortical and catecholamine functions can lead to hippocampal damage as well as dysfunctional prefrontal neural circuitries [ 39 , 40 ] , which play a key role in memory and attention . \n recent functional neuroimaging work has suggested that enhanced hippocampal activation during executive functioning and working memory tasks may represent compensatory processes for impaired frontostriatal functions in pd patients compared to controls . therefore , chronic stress from anxiety , \n for example , may disrupt compensatory processes in pd patients and explain the cognitive impairments specifically in working memory and attention seen in pd patients with anxiety . \n it has also been suggested that hyperactivation within the putamen may reflect a compensatory striatal mechanism to maintain normal working memory performance in pd patients ; however , losing this compensatory activation has been shown to contribute to poor working memory performance . \n anxiety in mild pd has been linked to reduced putamen dopamine uptake which becomes more extensive as the disease progresses . \n this further supports the notion that anxiety may disrupt compensatory striatal mechanisms as well , providing another possible explanation for the cognitive impairments observed in pd patients with anxiety in this study . \n noradrenergic and serotonergic systems should also be considered when trying to explain the mechanisms by which anxiety may influence cognition in pd . although these neurotransmitter systems are relatively understudied in pd cognition , treating the noradrenergic and serotonergic systems has shown beneficial\nOUTPUT:\n", "arg_1": { "do_sample": false, "min_tokens": 12, "temperature": 0, "until": [ "Question", "</s>", "<|im_end|>" ] } } }

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