Greater Number Of Years Research Articles

Abstract 281: Work history and cancer mortality risks in 90,268 United States radiologic technologists

Abstract Objectives: There have been few studies on medical radiation work history factors and cancer mortality. In this nationwide prospective cohort study of United States radiologic technologists, we expanded our previous evaluation of work history and cancer mortality risks, by extending follow-up by 11 years and examining a broader range of cancers. Methods: Using Cox proportional hazards models, we estimated cancer mortality risks through 2008 according to work history and other data derived from questionnaire responses provided during 1983-89 by 90,268 U.S. radiologic technologists. We controlled for potential confounding by age, birth year, pack-years of cigarettes smoked, body mass index, race, and gender. Results: There were 9,564 deaths and 3,329 deaths from cancer. After controlling for potential confounding factors, we found that technologists who began working before 1950 had marginally increased risk of dying from all cancers (p-trend=0.08), as well as increased risk of dying from female breast cancer (p-trend=0.01) and stomach cancer (p-trend=0.01) compared to those who began working in 1970 or later. Other work history factors, including starting work at a younger age, working greater number of years, or holding patients for x-rays more often, were not consistently associated with increased cancer mortality risks. Conclusions: We found that radiologic technologists who worked before 1950 had increased risk of dying from certain cancers, which may reflect higher occupational radiation exposures before the late 1950s. Note: This abstract was not presented at the meeting. Citation Format: Jason J. Liu, Michele M. Doody, Mark P. Little, D Michal Freedman, Bruce H. Alexander, Cari M. Kitahara, Alice J. Sigurdson, Terrence Lee, Preetha Rajaraman, Jeremy S. Miller, Diane M. Kampa, Steven L. Simon, Dale L. Preston, Martha S. Linet. Work history and cancer mortality risks in 90,268 United States radiologic technologists. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 281. doi:10.1158/1538-7445.AM2014-281

Variation in the orographic extreme rain events over the Meghalaya Hills in northeast India in the two halves of the twentieth century

The daily rainfall data for the twentieth century, from three stations across the region, constitute the basis for statistical analysis. However, the low signal-to-noise ratio makes it difficult to find any significant departure from the simplest null hypothesis of the stability of the rain record at individual stations in northeast India. Only the coarsest possible view, i.e. comparing the two halves of the century, provided strongly significant results in the numbers of days with extreme rain. Using a more general approach, the number of Fourier transform extreme amplitudes also differed significantly. Increasingly heavy events during the summer monsoon season, and partly in the pre- and post-monsoon seasons, are offset by a weakening in the winter monsoon season, so that the annual mean rainfall does not show a significant trend over the Meghalaya Hills. Apart from a greater number of years with noticeable extreme rainfall events in the second half of the twentieth century, we can also observe a more pronounced quasi-periodicity of 10–20 and 30–60 days during the same period. The detection of the latter periodicity indicates that the Madden–Julian oscillation plays an important role in the formation of extreme rainfall events over the Meghalaya Hills during extreme monsoon years.

Gender-differences in disease distribution and outcome in hospitalized elderly: Data from the REPOSI study

Background and purposeWomen live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people. MethodsRetrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied. ResultsA total of 1380 hospitalized elderly subjects, 50.5% women and 49.5% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men. ConclusionsOur study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare.

Clinical and pathogenetic implications of occipital bending in depression.

The lifetime prevalence of major depressive disorder is ∼16.5% and, each year, ∼800 000 individuals worldwide die as a result of suicide, a high proportion of whom suffered from severe depression. Even with treatment, 20% of patients experience chronic symptoms, meaning that major depressive disorder accounts for a greater number of years lived with disability than any other illness. A combination of genetic susceptibility, chronic stress and developmental factors predispose to depression by triggering alterations in neuroplasticity, biochemistry, and brain structure. As illustrated by a recent meta-analysis, structural brain changes predominantly affect the lateral ventricles, basal ganglia, thalamus, hippocampus and frontal lobes (Kempton et al. , 2011). In this issue of Brain , Maller et al. (2014) reveal that structural changes also extend to the occipital lobes, with ‘occipital bending’—in which one occipital lobe wraps around the other—three times more prevalent in patients with treatment-resistant major depressive disorder than in healthy controls. Bending or asymmetry of the occipital cortex has not been examined in major depressive disorder before. However, it is worth noting that although the occipital cortex is not among the core regions that exhibit structural changes in major depression, alterations in biochemistry, white matter structure, resting state connectivity and grey matter volume have previously been reported in the occipital lobes in this disorder (Bhagwagar et al. , 2007 …

Antibody but not memory B-cell responses are tuned-down in vertically HIV-1 infected children and young individuals being vaccinated yearly against influenza

Yearly immunization against seasonal influenza is highly recommended for HIV-1 infected individuals but evaluating the success of vaccination by serological markers may not be fully informative in this population. Recently, it has been hypothesized that the generation of long-lasting immune responses may depend on whether similar antigens challenge the immune system frequently and intermittently. In the present study, in order to search for additional correlates of vaccine-induced protective immunity and to further dissect this theory, both humoral and memory B-cell responses to the trivalent 2012–2013 seasonal influenza vaccination has been evaluated by strain-specific (separately for H1N1, H3N2 and B strain) standard hemagglutination inhibition (HI) assay and B-cell enzyme-linked immunosorbent spot (ELISpot) in a cohort of vertically HIV-1 infected children and young individuals as compared to age-matched healthy controls. A high number of HIV-1 infected individuals had protective antibody levels prior to vaccination and showed low seroconversion rates after vaccination as compared to healthy controls. On the contrary, similar frequencies of influenza-specific memory B-cells were detected by B-cell ELISpot in both groups suggesting that an adequate B-cell response has been elicited. Data from the H1N1 strain, which is recurrent in seasonal influenza vaccines since 2009, pointed out decreasing antibody but not memory B-cell responses for HIV-1 infected patients being vaccinated for a greater number of years. Further investigations are required to standardize the influenza-specific B-cell ELISpot and to understand whether it could be used routinely as an additional tool to evaluate response to influenza vaccination in immune-compromised individuals being vaccinated yearly.

Maintaining wellbeing for South Africans receiving ART: the burden of pain and symptoms is greater with longer ART exposure.

Physical and psychological symptom burden among people with HIV infection is associated with poor quality of life, poorer treatment adherence, viral rebound and risk behaviour. Symptomatology has not been investigated among outpatients in sub-Saharan Africa. To measure the seven-day period prevalence, burden and correlates of pain and other physical and psychological symptoms among HIV patients receiving antiretroviral therapy (ART). This was a cross-sectional self-report study. A total of 378 patients were interviewed using validated tools in three South African public sector clinics. The most prevalent symptoms were feeling sad (64%), feeling irritable (61.6%), worry (60.8%), numbness and tingling in hands/ feet (59.8%), and sexual problems (51%). In multivariate analysis, later disease stage was associated with worse psychological symptom burden (beta = 0.359; 95% confidence interval (CI) 0.202 - 0.516; p < or = 0.001), global symptom burden (beta = 0.365; 95% CI 0.204 - 0.526; p < 0.001) and number of symptoms (beta = 0.308; 95% CI 0.150 - 0.465; p < 0.001). Those receiving treatment for a greater number of years also reported higher burden for physical (beta = 0.083; 95% CI 0.037 - 0.129; p < or = 0.001), psychological (beta = 0.068; 95% CI 0.019 - 0.117; p = 0.007) and global symptoms (beta = 0.065; 95% CI 0.016 - 0.115; p = 0.010), and a greater number of symptoms (beta = 0.081; 95% CI 0.032 - 0.130; p = 0.001). The data reveal a high symptom burden despite treatment. Detailed symptom assessment and control continues to be required in the era of treatment.

The Impact of Ethnicity on Awareness and Knowledge of and Attitudes Towards the Human Papillomavirus and Vaccine Among Adult Women

ObjectiveTo determine whether ethnicity affects awareness, knowledge, and attitudes regarding the human papillomavirus (HPV) and the HPV vaccine. MethodsEnglish speaking women (n = 172) aged 18 and older were recruited from an outpatient gynaecology clinic to complete a self-administered cross-sectional questionnaire that gathered information about (1) virus awareness and knowledge, (2) vaccine awareness and knowledge, (3) attitudes towards the vaccine and (4) participant demographics. Subjects received a virus knowledge score (0 to 6), a vaccine knowledge score (0 to 10) and an attitudes score (8 to 40), with a higher score indicating more positive attitudes towards the vaccine. ResultsVirus and vaccine awareness was significantly higher in Caucasian respondents than in non-Caucasian respondents: 93% versus 69% (P < 0.001) and 94% versus 64%, (P < 0.001), respectively. In a multivariate logistic regression model, the Caucasian ethnic group, higher education status, and greater number of years in Canada each emerged as independent predictors of vaccine awareness. Both virus and vaccine knowledge scores were significantly higher in Caucasian than non-Caucasian women: 4.6 versus 3.89 (P = 0.001) and 7.2 versus 6.4, (P = 0.042), respectively. Caucasian women had significantly higher (more positive) attitudes towards the vaccine than non-Caucasians (31.4 vs. 29.2, P = 0.021). Higher HPV vaccine knowledge was positively associated with an interest in vaccination (r2 = 0.26, P < 0.01) and a more positive vaccine attitudes score (r2 = 0.40, P < 0.001). ConclusionVirus and vaccine awareness were both higher in Caucasian women than in non-Caucasian women. Improving HPV vaccination knowledge has the potential to improve attitudes and vaccine uptake.

Assessment of the value of groundwater age time-series for characterizing complex steady-state flow systems using a Bayesian approach

In this work, the effectiveness of transient environmental tracer data in reducing the uncertainty associated with the inference of groundwater residence time distribution was evaluated. A Bayesian Markov Chain Monte Carlo method was used to infer the parameters of presumed residence time distribution forms—exponential and gamma—using concentrations of five tracers, including CFC-11, CFC-12, CFC-113, SF6, and 85Kr. The transient tracer concentrations were synthetically generated using the residence time distributions obtained from a model of the Plœmeur aquifer in southern Brittany, France. Several measures of model adequacy, including Deviance Information Criteria, Bayes factors, and measures based on the deviation of inferred and true cumulative residence time distribution, were used to evaluate the value of groundwater age time-series. Neither of the presumed forms of residence time distributions, exponential and gamma, perfectly represent the simulated true distribution; therefore, the method was not able to show a definitive preference to one over the other in all cases. The results show that using multiple years of tracer data not only reduces the bias of inference (as defined by the difference between the expected value of a metric of inferred residence time distribution and the true value of the same metric), but also helps quantify the uncertainty more realistically. It was found that when one year of data is used, both models could almost perfectly reproduce the observed tracer data, even when the inferred residence time distributions differed substantially from the true one. When the number of years of tracer data is increased to four years, the uncertainty associated with the distribution parameters and the model structural uncertainly increased, as the presumed forms were not able to reproduce all the data accurately. This resulted in a more realistic assessment of model uncertainty due to structural error. It was also found that regardless of the prescribed age distribution form, the Bayesian method does a better job of capturing the cumulative ages at older ages; however, it is not able to reproduce the early ages well. The ability of the model to capture older ages improves as a greater number of years of tracer data is used, in cases of both presumed exponential and gamma distributions.

CONSTRUCT VALIDATION OF A MEASURE TO ASSESS SUSTAINABILITY OF SCHOOL-WIDE BEHAVIOR INTERVENTIONS

This study assessed aspects of construct validity of the School-wide Universal Behavior Sustainability Index–School Teams (SUBSIST), a measure evaluating critical features of the school context related to sustainability of school-wide interventions. Participants at 217 schools implementing School-wide Positive Behavior Support (SWPBS) were administered the measure. A two-step cluster analysis was performed to classify schools based on responses to the 39 SUBSIST items. A two-cluster solution was obtained, with schools in one cluster (n = 139) obtaining significantly higher scores on SUBSIST items than schools in the other cluster (n = 78). The most critical item that contributed to cluster formation was the use of data for decision making. Results also showed that higher sustainability scores were associated with increased frequency of school team meetings, presentation of data to school staff, access to an external coach/consultant, and greater number of years implementing SWPBS. These results are discussed with regard to implications for sustaining school-wide interventions.

Epidemiology of Nontuberculous Mycobacterial Infections and Associated Chronic Macrolide Use among Persons with Cystic Fibrosis

Persons with cystic fibrosis (CF) are at high risk of nontuberculous mycobacterial (NTM) infection, with treatment requiring prolonged multidrug regimens that include macrolides. Although macrolides, specifically azithromycin, are used in the management of patients with CF with chronic Pseudomonas, macrolide-resistant NTM infections are of growing concern. To evaluate the relationship between chronic macrolide use and NTM infection among patients with CF included in the 2011 CF Patient Registry (CFPR). We performed a nested case-control study: incident NTM cases were persons aged more than 5 years with at least one positive culture for NTM in 2011. Controls were persons with negative cultures in 2010 and 2011. The 2011 CFPR included 27,112 patients; 5,403 (20%) were cultured for mycobacteria in 2010-2011 and met all inclusion criteria. Of these, 191 (4%) were NTM-positive in 2011 only (cases); 5,212 (96%) were NTM-negative in 2010 and 2011 (control subjects). Among the cases, 122 (64%) were culture-positive for Mycobacterium avium complex (MAC) and 69 (36%) for M. abscessus. Azithromycin use in 2010 was less frequently reported among MAC cases (57%; odds ratio = 0.7, P < 0.05) and M. abscessus cases (51%; odds ratio = 0.5, P < 0.01) than in control subjects (66%). Among adolescents and adults, patients with the greatest number of years on chronic macrolides were the least likely to develop incident NTM in 2011 (P < 0.01). Patients with incident NTM infections from either MAC or M. abscessus were less likely to have had chronic azithromycin treatment in the past year. However, because macrolide monotherapy may lead to macrolide resistance, routine screening for NTM should be considered for persons with CF.

Use of imaging and biomarker tests for posttreatment care of early‐stage breast cancer survivors

The American Society of Clinical Oncology (ASCO) recently released a "Top Five" list of opportunities to improve the quality of cancer care. Item 4 on the list advises against using advanced imaging and biomarkers for surveillance in patients with breast cancer who are treated with curative intent. This study examined concordance with ASCO follow-up care guidelines for breast cancer survivors treated at an academic medical center. Claims data and medical records were reviewed and abstracted for early stage breast cancer survivors starting 1 year post diagnosis. A trained abstractor classified imaging tests as diagnostic or surveillance. Proportions and frequencies were generated for receipt of services. Multilevel logistic regression was used to estimate factors associated with receiving recommended and nonrecommended services and biomarker tests. Records were available for 258 patients. Mean age at diagnosis was 58 years (standard deviation of 13 years), mean time since diagnosis was 6 years (standard deviation of 2 years), and 71% were stage 0/1. Only 47% of the sample received a mammogram within 1 year of diagnosis, and 55% of the sample received at least 1 nonrecommended imaging service for surveillance purposes. Seventy-seven percent of the sample received at least 1 nonrecommended biomarker test. Regression results indicate that main treating physician, advanced disease stage, younger age at diagnosis, and greater number of years since diagnosis were associated with receiving nonrecommended services for surveillance. Use of nonrecommended services for surveillance occurs frequently among early-stage breast cancer survivors. There are opportunities to increase use of guideline concordant posttreatment care for breast cancer survivors.

Quality of Life Determinants in Patients of a Psychosocial Care Center for Alcohol and other Drug Users

Quality of life assessments in patients receiving treatment for substance dependence can serve as one predictor of response to treatment. This study aimed to identify determinants of quality of life in patients of a Psychosocial Care Center for alcohol and other drug users (CAPSad). The sample consisted of 77 patients with a diagnosis of substance dependence being treated at CAPSad for more than six months. Severity of substance dependence was assessed using the Addiction Severity Index (ASI-6), quality of life was assessed using the World Health Organization Quality of Life assessment instrument-short version (WHOQOL-BREF), and depressive symptoms were assessed by the Beck Depression Inventory (BDI). Data on CAPSad activities, psychiatric diagnoses, and medications used were collected from the medical records. Quality of life was significantly impaired in more severe cases of substance dependence and in those with more severe depressive symptoms. As for other variables, poorer quality of life was significantly associated with a greater number of years of education, unemployment, use of medications, and greater use of individual sessions with the reference professional. Linear regression analysis revealed depressive symptom severity to be an independent determinant of quality of life impairment, accounting for over 50% of the variation in physical and psychological domains. These results demonstrate the need to consider other factors, such as depressive symptoms and quality of life, in the treatment of substance dependence.

Depressive symptoms in Taiwanese women during the peri- and post-menopause years: Associations with demographic, health, and psychosocial characteristics

ObjectiveThe purpose of this study was to evaluate the prevalence of depressive symptoms in peri- and post-menopausal Taiwanese women, and to investigate the relation between depressive symptoms and demographic variables, chronic disease status, health habits, stress management, menopausal symptoms, and attitudes toward menopause and aging. Study designCross-sectional study, using a purposive sample of 566 women between 45 and 60 years of age from a medical center and residential community in Southern Taiwan. Main outcome measuresDemographic and health habits questionnaire, Women's Health Initiative Symptom Scale, Attitudes Toward Menopause and Aging Scale, and Center for Epidemiological Studies-Depression Scale (CES-D). ResultsThe prevalence of depressive symptoms (CES-D score≧16) was 38.7% in peri- and post-menopausal Taiwanese women. Bivariate correlations and analyses of variance indicated that higher CES-D scores were related to lower family income, younger age, smoking for a greater number of years, consuming more alcohol, having multiple chronic diseases, not exercising regularly, consulting with a specialist for stress management, having more severe menopausal symptoms, and more negative attitudes toward menopause and aging. A stepwise multiple regression analysis indicated that the key predictors, accounting for 33.7% of the variance, were menopausal symptoms, attitudes toward menopause and aging, family income, and chronic disease status. ConclusionsResults highlight the importance of considering psychosocial factors, life style, and chronic disease management in providing health guidance for peri- and post-menopausal women to enhance their quality of life and reduce the risk of depressive symptoms.

Consideration of patient age and life expectancy in implantable cardioverter-defibrillator referral

Primary prevention implantable cardioverter-defibrillator (ICD) guidelines recommend device consideration for at-risk patients with a life expectancy of greater than 1 year regardless of age. We sought to assess the influence of patient age and prognosis on ICD referral. A survey was mailed to a random, national sample of 3,000 physicians in the specialties of cardiology, family medicine, and internal medicine. Participants were asked focused questions regarding patient age, life expectancy, and ICD referral. The overall response rate was 64%. More than one quarter of physicians (n = 386 [27%], 95% CI 25%-30%) withhold primary prevention ICD referral solely because of patient age. Life expectancy is not considered by 23% (n = 324, 95% CI 20%-25%) of physicians before referral, whereas 13% (n = 144, 95% CI 11%-15%) refer patients with a prognosis of less than 1 year. Providers who refer patients for ICD implantation with a life expectancy of less than 1 year are less likely to be cardiologists (odds ratio [OR] 0.50, 95% CI 0.32-0.79, P = .003), are less often affiliated with a teaching hospital (OR 0.62, 95% CI 0.41-0.94, P = .025), and have a greater number of years in practice (OR 1.25 for each 10 years in practice, 95% CI 1.03-1.51, P = .026). Only a minority (n = 315 [22%], 95% CI 20%-24%) of physicians use a life expectancy threshold of 1 year to guide ICD referral. Physicians frequently withhold ICD referral because of patient age. The referral of patients with a prognosis of less than 1 year or without consideration of life expectancy is common.

TAUPO BICYCLE STUDY: FOLLOW UP RESPONSE, PERSONAL CHARACTERISTICS AND INJURY OUTCOME

BackgroundWeb-based surveys are increasingly used as a resource-efficient approach to collecting research data. However, potential biases which may underlie response rates have received little attention in this context.AimsThis paper aimed...

The Role of Family Caregivers and Inappropriate Medication Use in the Community-Dwelling Older Adults with Dementia

Evaluation of: Thorpe JM, Thorpe CT, Kennelty KA, Gellad WF, Schulz R. The impact of family caregivers on potentially inappropriate medication use in noninstitutionalized older adults with dementia. Am. J. Geriatr. Pharmacother. 10(4), 230–241 (2012). The risk of potentially inappropriate medication (PIM), both prescription and over-the-counter use, in dementia patients is high. Informal caregivers often facilitate patients’ use of medications, but the effect of caregiver factors on PIM use has not been a focus of previous research. The aim of this study was to examine PIM use in dementia patients and caregivers, and identify caregiver risk factors for PIM use in dementia patients. The authors conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer’s Caregiver’s Health study. The sample comprised 566 persons with dementia aged 65 years and older and their co-residing family caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their caregivers. Caregiver and patient risk factors included a range of sociodemographic and health variables. In dementia patients, 33% were taking at least one PIM and 39% of their caregivers were also taking a PIM. In fully adjusted models, the following caregiver factors were associated with an increased risk of dementia patient PIM use: caregiver’s own PIM use, spouse caregivers, Hispanic caregivers and greater number of years that the caregiver has lived in the USA. Increased caregiver age was associated with a decreased risk of PIM use in patients. PIM use may be higher in dementia patients and their informal caregivers compared with the general older adult population. Furthermore, patterns of medication use in one member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.

Relation of Serum Lactate Dehydrogenase to Coronary Artery Disease

Serum lactate dehydrogenase (LDH) is known pathologic marker for a diversity of diseases, including myocardial ischemia. Strenuous and enduring physical activity can transiently induce a greater total LDH level, still within its normal range. To date, however, it has not been determined whether normal-range LDH might be inversely associated with coronary artery disease (CAD) in the low-cardiovascular-risk, physically active, adult population. We conducted a retrospective cohort analysis. A total of 5,519 healthy adults aged 34 to 86 years were followed up for a mean period of 4.2 years. The cohort incidence of CAD was 6.1% (338 cases) from 2001 to 2009. In the present cohort, greater mean LDH levels were significantly associated with a greater number of years, days/week, and minutes/week of leisure time activity (p = 0.02, p = 0.04, and p = 0.01, respectively). These associations were externally validated successfully by analysis of all 5,064 healthy participants aged ≥40 years with normal-range LDH from the 2007 to 2010 National Health and Nutrition Examination Surveys combined. For instance, the mean LDH level was significantly greater in those engaged in 6 to 7 versus 1 to 5 days/wk of vigorous-intensity work activity (138.0 ± 20.7 IU/L vs 133.3 ± 21.7 IU/L, respectively, p = 0.007). In our cohort, the hazard ratio for CAD according to the normal total serum LDH tertiles, adjusted for multiple risk and protective CAD factors in a Cox proportional hazards model, was 0.70 (95% confidence interval 0.54 to 0.92) in the greater versus lower tertile (p for trend = 0.01). In conclusion, we suggest that increased normal-range total serum LDH is associated with reduced short-term risk of CAD outcome in this low-risk, physically active population.

The Impact of Family Caregivers on Potentially Inappropriate Medication Use in Noninstitutionalized Older Adults With Dementia

BackgroundThe risk of potentially inappropriate medication (PIM), both prescription and over-the-counter, use in dementia patients is high. Informal caregivers often facilitate patients' use of medications, but the effect of caregiver factors on PIM use has not been a focus of previous research. ObjectiveThe aim of this study was to examine PIM use in dementia patients and caregivers and identify caregiver risk factors for PIM use in dementia patients. MethodsWe conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study. The sample comprised 566 persons with dementia aged 65 and older and their coresiding family caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their caregivers. Caregiver and patient risk factors included a range of sociodemographic and health variables. ResultsIn dementia patients, 33% were taking at least 1 PIM, and 39% of their caregivers were also taking a PIM. In fully adjusted models, the following caregiver factors were associated with an increased risk of dementia patient PIM use: caregiver's own PIM use, spouse caregivers, Hispanic caregivers, and greater number of years that the caregiver has lived in the United States. Increased caregiver age was associated with a decreased risk of PIM use in patients. ConclusionsPIM use may be higher in dementia patients and their informal caregivers compared with the general older adult population. Further, patterns of medication use in 1 member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.

Health care in dementia: Satisfaction and needs of the caregiver

IntroductionPrimary care (PC) and general neurology clinics (NC) assume the leading role in the health care of patients with dementia. There are hardly any studies on the satisfaction of the caregiver at these settings of health care. MethodsA questionnaire was designed and distributed to 75 caregivers of patients with dementia who were reviewed in an NC and who had been referred from PC. The questionnaire included questions associated with the care, the use of services, and satisfaction. Sociodemographic and clinical variables were also collected. The results of the questionnaire are described and a simple correlation analysis (Spearman r) was performed to determine the factors associated with satisfaction. ResultsThe majority of carers were sons or daughters (60%) or spouses (31%), of which 73% were women. The service most used was home help (36%), but 41% of patients had no services available. Satisfaction was high (84% quite or very satisfied with PC, 97% quite or very satisfied with the NC, P<.01). A greater number of years giving care was associated with a lower satisfaction with PC ((r=−0.37, P<.005), while institutionalisation was associated with a lower satisfaction with the NC (r=−0.30, P<.01). ConclusionsIn a context of a scarcity of resources, the satisfaction of the caregivers of patients with dementia, as regards health care, was high, possibly due to the motivation of the health professionals and the positive attitude of the caregivers themselves.

Associations of Cigarette Smoking and Polymorphisms in Brain-Derived Neurotrophic Factor and Catechol-O-Methyltransferase with Neurocognition in Alcohol Dependent Individuals during Early Abstinence

Chronic cigarette smoking and polymorphisms in brain-derived neurotrophic factor (BDNF) and catechol-O-methyltransferase (COMT) are associated with neurocognition in normal controls and those with various neuropsychiatric conditions. The influence of BDNF and COMT on neurocognition in alcohol dependence is unclear. The primary goal of this report was to investigate the associations of single nucleotide polymorphisms (SNPs) in BDNF Val66Met (rs6265) and COMT Val158Met (rs4680) with neurocognition in a treatment-seeking alcohol dependent cohort and determine if neurocognitive differences between non-smokers and smokers previously observed in this cohort persist when controlled for these functional SNPs. Genotyping was conducted on 70 primarily male treatment-seeking alcohol dependent participants (ALC) who completed a comprehensive neuropsychological battery after 33 ± 9 days of monitored abstinence. After controlling for COMT and BDNF genotypes, smoking ALC performed significantly worse than non-smoking ALC on the domains of auditory-verbal and visuospatial learning and memory, cognitive efficiency, general intelligence, processing speed, and global neurocognition. In smoking ALC, greater number of years of smoking over lifetime was related to poorer performance on multiple domains after controlling for genotypes and alcohol consumption. In addition, COMT Met homozygotes were superior to Val homozygotes on measures of executive skills and showed trends for higher general intelligence and visuospatial skills, while COMT Val/Met heterozygotes showed significantly better general intelligence than Val homozygotes. COMT Val homozygotes performed better than heterozygotes on auditory-verbal memory. BDNF genotype was not related to any neurocognitive domain. The findings are consistent with studies in normal controls and neuropsychiatric cohorts that reported COMT Met carriers demonstrated better performance on measures of executive skills and general intelligence. Results also indicated that the poorer performance of smoking compared to non-smoking ALC across multiple neurocognitive domains was not mediated by COMT or BDNF genotype. Overall, the findings lend support to the expanding clinical movement to make smoking cessation programs available to smokers at the inception of treatment for alcohol/substance use disorders.