Community-dwelling Controls Research Articles

Are altered pharmacokinetics of non-steroidal anti-inflammatory drugs (NSAIDs) a risk factor for gastrointestinal bleeding?

We hypothesised that pharmacokinetic factors might go some way to explaining the risk of major gastrointestinal haemorrhage with non-steroidal anti-inflammatory drugs (NSAIDs), with bleeders exhibiting a reduced clearance of NSAIDs compared with non-bleeders and set out to investigate this. Fifty patients presenting to hospital with acute gastrointestinal bleeding while taking piroxicam, indomethacin, diclofenac or naproxen and age, sex, musculoskeletal disease and drug matched community dwelling controls, up to two for each index case, who had not bled were recruited. Clinical details including duration of therapy were recorded. Bleeders discontinued the implicated NSAID at presentation, controls at least five half-lives before the study. Bleeders were contacted by letter 1 month after discharge and invited to take part and were studied after a median delay of 5 months. Subjects received an oral dose of their respective NSAID and venous blood was sampled, over a period determined by the half-life of the NSAID. Plasma concentrations were determined by high performance liquid chromatography. The median length of treatment for the index patients was 1 year (range 2 weeks--28 years) and for the control patients 2 years (1 month--25 years), P<0.0005. There were no significant differences in peak plasma concentration, time to peak plasma concentration or area under the plasma concentration-time curve between bleeders or controls for any of the NSAIDs studied, apart from piroxicam Cmax being lower in bleeders at 2.07 mg l(-1) than in controls at 3.21 mg l(-1), mean difference (95% CI) -1.14 (-1.83 - -0.48), P<0.005. The data failed to support the hypothesis that reduced clearance of NSAIDs, which results in higher plasma concentrations, is a risk factor for acute gastrointestinal haemorrhage.

A comparison of the Barthel index and Nottingham extended activities of daily living scale in the assessment of disability in chronic airflow limitation in old age

there is no disease-specific instrument for measuring activities of daily living (ADLs) in elderly patients with chronic airflow limitation (CAL). We assessed sensitivity, specificity and positive and negative predictive values of two ADL scales: the Barthel index and the Nottingham extended ADL scale in elderly people with and without CAL. the Breathing Problems Questionnaire was used as a measure of quality of life (a low score indicates good quality of life) in 96 outpatients (56 men) with CAL aged 70–93 (mean 78) years and 55 community-dwelling controls (23 men) aged 71–90 (mean 78) years with normal lung function drawn from a recent community survey. CAL subjects had been clinically stable for >6 weeks. All subjects were cognitively intact. mean best 1 s forced expiratory volume/forced vital capacity was 45.5% (SE 1.4) in CAL subjects and 71.4% (SE 1.3) in controls. All CAL subjects considered themselves disabled and had higher breathing questionnaire scores [geometric mean scores: 395 (range 13–112) vs 4.8 (range 0.6–40) for controls; t= 13.4, P<0.0001]. However, the Nottingham extended ADL index (threshold >18) discriminated better than the Barthel index (threshold >17) in terms of sensitivity (76% vs 19%; x2=60.9, P< 0.0001) and negative predictive value (75% vs 40%; x2=20.2, P<0.0001). Altering the Barthel threshold did not improve its performance. Multiple regression analysis showed that variability in physiological and psychological variables related to CAL predicted variability in Nottingham extended ADL score (R2=0.71) but not in Barthel score. the Barthel index underestimates disability in CAL in old age. The Nottingham extended ADL discriminates better between normal old people and those with CAL.

Gender and Comorbid Psychopathology in Adolescents With Alcohol Dependence

Although several mental disorders have been shown to be common in adolescents with substance use disorders, prior studies have not specifically focused on alcohol dependence and have not had sufficient sample sizes to examine gender effects. This study contrasts mental disorder diagnoses and symptoms between a sample of adolescents with alcohol dependence and a community control sample of adolescents and incorporates gender analyses. Adolescents (aged 14 years 0 months to 18 years 0 months) with alcohol dependence (females: n = 55; males: n = 78) and community-dwelling control adolescents without substance use disorders (females: n = 44; males: n = 42) were assessed by means of a semistructured interview for DSM-III-R. While cannabis and hallucinogen use disorders were common in the alcohol dependence group, females and males had similar rates. Conduct disorder (CD), oppositional defiant disorder, attention-deficit hyperactivity disorder, major depression (MD), and posttraumatic stress disorder (PTSD) had significantly higher rates in the alcohol dependence than in the community control group. Depression and PTSD symptoms were more strongly associated with alcohol dependence in females than in males. A configural frequency analysis showed that CD and MD tended to occur together in both female and male adolescents with alcohol dependence. While alcohol-dependent females and males similarly exhibited more comorbid disorders than control adolescents, gender affects the relationship of alcohol dependence to MD and PTSD. Rather than reflecting distinct types, the comorbid disorders of CD and MD jointly characterize many adolescents with alcohol dependence.

Nutritional Status of Patients with Alzheimer's Disease: A 1-Year Study

Objective To describe the effects of activity level and energy intake over time on the body weight of patients with Alzheimer's disease compared with cognitively normal subjects. Design Repeated measures, case-control design with measurements taken at quarterly intervals for 12 months. Subjects were grouped by gender and activity level (sedentary or active) within cognitive status. Setting The Alzheimer's disease Special Care Unit, The Clinical Research Center at University of California, San Diego, and the Fred Kasch Exercise Physiology Laboratories at San Diego State University. Patients Seventeen institutionalized subjects with Alzheimer's disease and 23 community-dwelling control subjects successfully completed the 1-year study. Measurements Before admission to the nursing home, the patients with Alzheimer's disease had a formal assessment for dementia, which showed that they met the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association work group for probable or possible Alzheimer's disease. Control subjects were screened using the Information-Memory-Concentration Mental Status Test and were found to have no cognitive disabilities. Baseline and quarterly measurements included height, weight, bioimpedance for body composition, and activity by accelerometer counts. Dietary intake of energy and protein was determined at baseline and at 6 and 12 months. Results Patients with Alzheimer's disease had a significantly higher energy intake than patients in the control group. Both women and men with Alzheimer's disease maintained their weight. Women with Alzheimer's disease had higher percentage of fat-free mass than the control group, but there were no differences in body composition between the groups of men. Conclusion Subjects with Alzheimer's disease can maintain their weight if they are given a diet with adequate energy (35 kcal/kg of body weight). J Am Diet Assoc. 1996; 96:1013-1018.

Femoral osteoporosis in community-Dwelling elderly females and controls living in retirement or nursing homes

Femoral osteoporosis in community-Dwelling elderly females and controls living in retirement or nursing homes

Mortality and hallucinations in nursing home patients with advanced Parkinson's disease.

We monitored 11 patients with advanced Parkinson's disease (PD) who entered nursing homes over a 5-year period and assessed chronicity of nursing home care, mortality, and hallucinatory status. Two years after the original study's close, none of these patients had ever been discharged from the nursing homes and all were dead. The mortality rate among the nursing home patients was significantly greater than that in 22 community-dwelling subjects with PD who were matched for age, gender, and disease duration. Hallucinatory status was generally stable; 82% of patients had the same hallucinatory status (presence or absence) at the two assessments. Four subjects from the original community-dwelling control group entered nursing homes during the follow-up period. Whereas motor and intellectual impairment scores were similar between these patients and the remaining 18 in the community, the presence of hallucinations was significantly greater among patients transferred to nursing homes. The study demonstrates the permanency of nursing home placement in advanced PD and the high mortality associated with such placement. It also documents the chronicity of hallucinatory behavior in these patients with advanced PD and reinforces our previously reported observations on the relationship between hallucinations and placement in chronic-care facilities.

Fatigue and Mood in Chronic Fatigue Syndrome Patients: Results of a Momentary Assessment Protocol Examining Fatigue and Mood Levels and Diurnal Patterns

Abstract Examined the overall levels and the diurnal patterns of fatigue, mood, and activities in chronic fatigue syndrome (CFS) patients using computer-prompted assessments at random points throughout many days. We hypothesized that levels of fatigue and mood would be different in the groups and that diurnal patterns would also differ by group. Momentary assessment methods avoid many potential biases inherent in retrospective recall techniques. Eight CFS patients and 21 community-dwelling control subjects were randomly prompted between five and six times per day and responded to questions about fatigue, positive affect, negative affect, and the activities they were engaged in at the moment of the prompt. CFS patients participated for 26 days and control subjects participated for 15 days. Compared to the control group, levels of fatigue were higher in the CFS group, yet there were no differences in overall level of positive or negative affect. Strong diurnal patterns of affect were observed for fatigue measures indicating that it was higher in the morning and evening. Diurnal patterns were also observed for mood: Positive affect increased over the day and negative affect decreased. There was very modest support for differential diurnal patterns by group; the effect was only evident for one of the positive affect adjectives. Finally, these results were not diminished when the activities subjects were engaged in at the time of the assessments were controlled.

A Case Control Study of the Risks for Institutionalization of Elderly People in Nova Scotia

ABSTRACTFew studies of the risks of institutionalization of the elderly have had fully specified models using multivariate analysis, and several studies have examined highly selected populations, making their generalizability uncertain. We set out to examine the risks of institutionalization in elderly people in Nova Scotia. A case-control study, executed as part of the Canadian Study of Health and Aging examined 108 incident institutional cases and 533 community-dwelling elderly controls, using a standardized assessment interview conducted by trained interviewers. Multiple logistic regression analysis showed that advancing age, presence of dementia, functional impairment, poor self-rated health, recent hospital admission, and absence of a caregiver were important risks for entry into long term care. Institutions providing long-term care for the elderly need to be able to look after populations with a high prevalence of dementia and functional impairment.

Are systemic levels of non steroidal anti inflammatory drugs relevant to acute upper gastrointestinal haemorrhage?

It is uncertain as to the extent which gastrointestinal (GI) haemorrhage related to NSAIDs is due to a local, topical effect or to an action related to systemic absorption. We hypothesised that, should systemic drug concentrations be of importance, plasma levels of NSAIDs might be higher in patients who had developed GI haemorrhage, from controls who had not. Ten patients with GI haemorrhage, who had ingested piroxicam (and no other NSAID), within the preceding 64 h, at the same dosage and on no new medication for the past 14 days, had blood taken at presentation for measurement of piroxicam concentrations. Plasma piroxicam concentrations were measured in 19 community dwelling controls, matched for age +/- 8 years, gender, daily piroxicam dosage, and time from last dose as their respective index case. All had been taking piroxicam for at least 3 months, and none had experienced GI adverse effects. Median plasma piroxicam concentrations in patients at 8.27 micrograms/l, was higher than in controls at 5.06 micrograms/l. These results suggest that a systemic component, at least with piroxicam, may play a significant (though not necessarily exclusive) role in causing major gastrointestinal haemorrhage.

Blood glucose and insulin response in patients with senile dementia of the Alzheimer's type

We compared community-dwelling SDAT and controls using a standart oral glucose tolerance test(OGTT) under controlled dietary conditions. We measured glucose and insulin levels with fasting and in reponse to a glucose challenge

Psychological deficits in depressed medical patients.

A frequent clinical problem observed in the medical setting is depression secondary to the impact of physical illness and hospitalization. Typically, approaches developed on physically healthy samples are applied to these patients without many specific data on this particular subtype of depression. Both cognitive abilities and behavioral functions were assessed in a sample of medically ill depressed patients, who were compared to medically ill nondepressed patients and community-dwelling healthy controls. Illness and attendant hospitalization were associated with deficits in psychomotor speed, recognition memory, and abstract abilities, but depression was not associated with further disruptions. On behavioral indices, depression, but not hospitalization and illness, was associated with deficits in the interpersonal realm of functioning. These findings suggest that deficits on performance of psychological tasks in depressed ill patients can be explained by illness and hospitalization. The behavioral data further characterize the depressive as having difficulty in social relations, which suggests that interventions like social skills training and mobilization of social networks may be an effective addition in the treatment of the depressed medical patient.