Heterogeneous Adult Population Research Articles

Uncovering latent profiles of ICT self-concept among adults in Germany and their relation with gender

ABSTRACT Self-concept related to the use of information and communication technology (ICT-SC) is reflected in how people feel and behave when confronted with digital technologies. Although evidence from variable-centered analyses suggests a hierarchical and multidimensional structure of ICT-SC in heterogeneous populations, it is not yet known whether different profiles of general ICT-SC and specific ICT-SC domains (communicate, process and store, generate content, safe application, solve problems) exist. This study aims to extend previous research using person-centered analyses and to examine whether different profiles of ICT-SC can be identified in a heterogeneous adult population (18–69 years) from Germany and how these profiles relate to gender. Results of a latent profile analysis (German quota sample, N = 369) indicate a reliable three-profile solution. Profile I (n = 48) is characterised by rather low ICT-SC with relative profile strengths in the verbal-interactive domains (communicate, process and store). Profile II (n = 149) is characterised by low to average ICT-SC across ICT-SC domains. Profile III (n = 172) is characterised by high ICT-SC with profile strengths in the technical-analytical domains (safe application, solve problems). Gender did not correlate significantly with profile membership. We discuss the practical implications of the results for ICT-SC interventions and suggest directions for future research.

Permanent Supportive Housing Tenure Among a Heterogeneous Population of Adults with Disabilities.

People with disabilities can face substantial barriers to living stably in community settings. Evidence shows that permanent supportive housing (PSH), which combines subsidized housing with individualized support services, can improve housing stability among subpopulations of people with disabilities, including those with behavioral health conditions. PSH has also been shown to improve some health outcomes among people with severe mental illness or substance use disorder, but effects varied by participants' program tenure. This study assessed retention in a PSH program serving a broad population of adults with disabilities and identified factors associated with program tenure. Administrative data from 2093 individuals who began participating in a North Carolina PSH program between 2015 and 2018 were analyzed. Participants' unadjusted probability of remaining in a PSH placement at specific time points was estimated, with censoring due to death or the end of the study period (July 2020). Using Cox regression, program tenure was modeled as a function of participant and PSH placement location characteristics. Participants had a 71% probability of remaining in PSH after 2 years. Older age, female gender, and non-Hispanic Black race/ethnicity were associated with lower hazard of PSH departure. Having a severe mental illness diagnosis was associated with greater departure hazard. Level of socioeconomic deprivation and rurality of the PSH placement ZIP code were not associated with departure hazard. PSH programs may be able to successfully retain a heterogeneous population of adults with disabilities, although tenure may vary by participant demographic and clinical characteristics.

P.082 The Toronto Concussion Study: The Feasibility and Effects of Early Prescribed Aerobic Exercise on Recovery and Post-Concussive Symptoms in Adults – A Pilot Study

Background: Evidence suggests that aerobic exercise (AE) soon after concussion may facilitate earlier recovery in athletes. The purpose of this pilot study was to investigate the feasibility and effects of early sub-symptom threshold AE on symptom trajectory and recovery time in a heterogeneous adult population. Methods: Adults presenting within 7 days of concussion were randomized to either the experimental group: prescribed AE (90% of symptom-limited heartrate achieved on Buffalo Concussion Treadmill Test [BCTT]), 30 minutes/day, 5 days/week, or the control group: standard of care exercise recommendations. Participants were assigned a heartrate monitor bracelet to track activity. They underwent serial treadmill testing to monitor exercise tolerance, update prescriptions and determine recovery. Results: 20 participants (10 per arm) completed the BCTT protocol within 7 days of injury, with 8/20 demonstrating exercise tolerance at week 1. 66% (4/6) of those in the experimental group were recovered by week 4, compared to only 43% (3/7) in the control group. Average heart rate monitor compliance was 32% of the prescribed time among all participants, and self-reported exercise prescription compliance was 43% in the experimental group. Conclusions: Early post-concussion aerobic exercise in the general adult population is a promising intervention; this study will inform the design of a larger trial.

Intrapatient comparisons of efficacy in a single-arm trial of entrectinib in tumour-agnostic indications

BackgroundEntrectinib is a tropomyosin receptor kinase inhibitor approved for the treatment of neurotrophic tyrosine receptor kinase (NTRK) fusion-positive solid tumours based on single-arm trials. Traditional randomised clinical trials in rare cancers are not feasible; we conducted an intrapatient analysis to evaluate the clinical benefit of entrectinib versus prior standard-of-care systemic therapies.MethodsPatients with locally advanced/metastatic NTRK fusion-positive tumours enrolled in the global phase II, single-arm STARTRK-2 trial were grouped according to prior systemic therapy and response. The key analysis used growth modulation index [GMI; ratio of progression-free survival (PFS) on entrectinib to time to discontinuation (TTD) on the most recent prior therapy]; ratio ≥1.3 indicated clinically meaningful efficacy. Additional analyses investigated TTD and objective response rate (ORR) for entrectinib and prior therapies.ResultsSeventy-one patients were included; 51 received prior systemic therapy. In 38 patients who progressed on prior therapy, ORR was 60.5% (23/38) with entrectinib and 15.8% (6/38) with the most recent prior therapy. Median PFS [11.2 months; 95% confidence interval (CI) 6.7–not estimable] for entrectinib exceeded median TTD (2.9 months; 95% CI 2.0-4.9) for most recent prior therapy. From the intrapatient analysis of GMI, 65.8% had a ratio ≥1.3 and median GMI was 2.53. Consistent results were observed at more stringent GMI thresholds; 60.5% of patients had GMI ≥1.5 or ≥1.8 and 57.9% had GMI ≥2.0.ConclusionsORR was high and PFS was longer on entrectinib versus TTD on prior therapy. Furthermore, 65.8% of patients experienced clinically meaningful benefit based on GMI. This intrapatient analysis demonstrates comparative effectiveness of entrectinib in a rare, heterogeneous adult population.

Identification of Latent Classes of Motor Performance in a Heterogenous Population of Adults

ObjectiveTo determine classes of motor performance based on community deployable motor impairment and functional tests in a heterogeneous adult population. DesignSixteen tests of limb-specific and whole-body measures of motor impairment and function were obtained. Linear regression analysis was used to dichotomize performance on each test as falling within or outside the age- and sex-predicted values. Latent class analysis was used to determine 3 classes of motor performance. The chi-square test of association and the Fisher exact test were used for categorical variables, and analysis of variance and the Kruskal-Wallis test were used for continuous variables to evaluate the relationship between demographic characteristics and latent classes. SettingGeneral community. ParticipantsIndividuals (N=118; 50 men) participated in the study. Quota sampling was used to recruit individuals who self-identified as healthy (n=44) or currently living with a preexisting chronic health condition, including arthritis (n=19), multiple sclerosis (n=18), Parkinson disease (n=17), stroke (n=18), or low functioning (n=2). InterventionNot applicable. Main Outcome MeasureLatent classes of motor performance. ResultsAcross the entire sample, 3 latent classes of motor performance were determined that clustered individuals with motor performance falling: (1) within predicted values on most of the tests (expected class), (2) outside predicted values on some of the tests (moderate class), and (3) outside predicted values on most of the tests (severe class).The ability to distinguish between the respective classes based on the percent chance of falling outside predicted values was achieved using the following community deployable motor performance tests: 10-meter walk test (22%, 80%, and 100%), 6-minute walk test (14.5%, 37.5%, and 100%), grooved pegboard test (23%, 38%, and 100%), and modified physical performance test (3%, 54%, and 96%). ConclusionsIn this heterogeneous group of adults, we found 3 distinct classes of motor performance, with the sample clustering into an expected test score group, a moderate test score deficiency group, and a severed test score deficiency group. Based on the motor performance tests, we established that community deployable, easily administered testing could accurately predict the established clusters of motor performance.

Dimensional connectomics of anxious misery, a human connectome study related to human disease: Overview of protocol and data quality

Disparate diagnostic categories from the Diagnostic and Statistical Manual of Mental Disorders (DSM), including generalized anxiety disorder, major depressive disorder and post-traumatic stress disorder, share common behavioral and phenomenological dysfunctions. While high levels of comorbidity and common features across these disorders suggest shared mechanisms, past research in psychopathology has largely proceeded based on the syndromal taxonomy established by the DSM rather than on a biologically-informed framework of neural, cognitive and behavioral dysfunctions. In line with the National Institute of Mental Health’s Research Domain Criteria (RDoC) framework, we present a Human Connectome Study Related to Human Disease that is intentionally designed to generate and test novel, biologically-motivated dimensions of psychopathology. The Dimensional Connectomics of Anxious Misery study is collecting neuroimaging, cognitive and behavioral data from a heterogeneous population of adults with varying degrees of depression, anxiety and trauma, as well as a set of healthy comparators (to date, n = 97 and n = 24, respectively). This sample constitutes a dataset uniquely situated to elucidate relationships between brain circuitry and dysfunctions of the Negative Valence construct of the RDoC framework. We present a comprehensive overview of the eligibility criteria, clinical procedures and neuroimaging methods of our project. After describing our protocol, we present group-level activation maps from task fMRI data and independent components maps from resting state data. Finally, using quantitative measures of neuroimaging data quality, we demonstrate excellent data quality relative to a subset of the Human Connectome Project of Young Adults (n = 97), as well as comparable profiles of cortical thickness from T1-weighted imaging and generalized fractional anisotropy from diffusion weighted imaging. This manuscript presents results from the first 121 participants of our full target 250 participant dataset, timed with the release of this data to the National Institute of Mental Health Data Archive in fall 2020, with the remaining half of the dataset to be released in 2021.

Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population.

The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.

Identifying common factors of functioning, participation and environment amongst adults requiring specialist oral health care using the International Classification of Functioning, disability and health.

IntroductionPersons unable to access oral health care in the conventional primary health care setting suffer from inequalities in oral health, particularly in terms of unmet dental need. The International Classification of Functioning, disability and health (ICF) is designed to look beyond medical diagnosis and to describe individuals or populations in terms of their ability to function and participate in a social environment. The objective of the study was to describe an adult population requiring specialist oral health care using the ICF and to identify common factors of functioning, participation and environmental context.MethodThe ICF Checklist for Oral Health was completed for 246 participants from five specialist dental services in five countries (mean age 36 ±16.44 years; 16–92). ‘Developmental disability’ and ‘Medically compromised’ groups were identified (72% and 28%).ResultsParticipants presented with oral disease (92%) and dysfunction (66% impaired chewing). 33 ICF items were affected in over 50% of participants in both groups. Impaired body functions included ‘ingestion functions’, ‘energy and drive functions’ and ‘emotional functions’. Participation was restricted for “Acquiring, keeping and terminating a job”, “Intimate relationships”, “Handling stress and psychological demands”, “Economic self-sufficiency”, “Carrying out a daily routine”, “Recreation and leisure”, “Community life” and “Looking after one’s health”. In the environment domain, “Support and relationships” and “Attitudes” were rated as facilitators. Environmental barriers reported for over 25% of the whole group were related to “Services, systems and policies” including, health, social security, general support, transportation, and labour and employment.Discussion and perspectivesCommon aspects of functioning, participation and environment were found amongst a heterogeneous population of adults attending specialist dental services, alongside poor oral health and function. The ICF may be used to describe populations that suffer inequality in oral health in order to develop services that effectively target those in need of additional means.

Comparative durability and costs analysis of ventricular shunts.

Ventricular shunt (VS) durability has been well studied in the pediatric population and in patients with normal pressure hydrocephalus; however, further evaluation in a more heterogeneous adult population is needed. This study aims to evaluate the effect of diagnosis and valve type-fixed versus programmable-on shunt durability and cost for placement of shunts in adult patients. The authors retrospectively reviewed the medical records of all patients who underwent implantation of a VS for hydrocephalus at their institution over a 3-year period between August 2013 and October 2016 with a minimum postoperative follow-up of 6 months. The primary outcome was shunt revision, which was defined as reoperation for any indication after the initial procedure. Supply costs, shunt durability, and hydrocephalus etiologies were compared between fixed and programmable valves. A total of 417 patients underwent shunt placement during the index time frame, consisting of 62 fixed shunts (15%) and 355 programmable shunts (85%). The mean follow-up was 30 ± 12 (SD) months. The shunt revision rate was 22% for programmable pressure valves and 21% for fixed pressure valves (HR 1.1 [95% CI 0.6-1.8]). Shunt complications, such as valve failure, infection, and overdrainage, occurred with similar frequency across valve types. Kaplan-Meier survival curve analysis showed no difference in durability between fixed (mean 39 months) and programmable (mean 40 months) shunts (p = 0.980, log-rank test). The median shunt supply cost per index case and accounting for subsequent revisions was $3438 (interquartile range $2938-$3876) and $1504 (interquartile range $753-$1584) for programmable and fixed shunts, respectively (p < 0.001, Wilcoxon rank-sum test). Of all hydrocephalus etiologies, pseudotumor cerebri (HR 1.9 [95% CI 1.2-3.1]) and previous shunt malfunction (HR 1.8 [95% CI 1.2-2.7]) were found to significantly increase the risk of shunt revision. Within each diagnosis, there were no significant differences in revision rates between shunts with a fixed valve and shunts with a programmable valve. Long-term shunt revision rates are similar for fixed and programmable shunt pressure valves in adult patients. Hydrocephalus etiology may play a significant role in predicting shunt revision, although programmable valves incur higher supply costs regardless of initial diagnosis. Utilization of fixed pressure valves versus programmable pressure valves may reduce supply costs while maintaining similar revision rates. Given the importance of developing cost-effective management protocols, this study highlights the critical need for large-scale prospective observational studies and randomized clinical trials of ventricular shunt valve revisions and additional patient-centered outcomes.

Clinical validation of automated audiometry with continuous noise-monitoring in a clinically heterogeneous population outside a sound-treated environment

Objective: Examine the accuracy of automated audiometry in a clinically heterogeneous population of adults using the KUDUwave automated audiometer. Design: Prospective accuracy study. Manual audiometry was performed in a sound-treated room and automated audiometry was not conducted in a sound-treated environment. Study sample: 42 consecutively recruited participants from a tertiary otolaryngology department in Western Australia. Results: Absolute mean differences ranged between 5.12–9.68 dB (air-conduction) and 8.26–15 dB (bone-conduction). A total of 86.5% of manual and automated 4FAs were within 10 dB (i.e. ±5 dB); 94.8% were within 15 dB. However, there were significant (p < 0.05) differences between automated and manual audiometry at 250, 500, 1000, and 2000 Hz (air-conduction) and 500 and 1000 Hz (bone-conduction). The effect of age (≥55 years) on accuracy (p = 0.014) was not significant on linear regression (p > 0.05; R2 = 0.11). The presence of a hearing loss (better ear ≥26 dB) did not significantly affect accuracy (p = 0.604; air-conduction), (p = 0.218; bone-conduction). Conclusions: This study provides clinical validation of automated audiometry using the KUDUwave in a clinically heterogeneous population, without the use of a sound-treated environment. Whilst threshold variations were statistically significant, future research is needed to ascertain the clinical significance of such variation.

Clinical utility of urine neutrophil gelatinase-associated lipocalin measured at admission to predict outcomes in heterogeneous population of critically ill patients.

Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a reliable early biomarker of acute kidney injury (AKI) in a homogeneous patient population. However, its utility in a heterogeneous population of critically ill, in whom the time of onset of renal insult is often unclear, is not clearly established. We evaluated the ability of a single measurement of uNGAL in a heterogeneous adult population, on admission to intensive care unit (ICU), to predict the occurrence of AKI and hospital mortality. One hundred and two consecutive adult patients had uNGAL measured within 8 h of admission to ICU. The demographic and laboratory data were collected at admission. The diagnosis of AKI was based on AKI Network (AKIN) criteria. The primary outcome was the development of AKI, and the secondary outcome was hospital mortality. The mean age was 54 ± 16.4 years and 65% were males. Urine NGAL (ng/ml) was 69 ± 42 in patients with AKI (n = 42) and 30.4 ± 41.7 in those without AKI (P < 0.001). The area under the receiver operating characteristic (ROC) curve for prediction of AKI was 0.79 and for serum creatinine (SCr) was 0.88. The sensitivity and specificity for a cut-off value of uNGAL of 75 ng/ml to predict AKI were 0.5 and 0.85 respectively. uNGAL > 75 ng/ml was a strong (odd ratio = 5.17, 95% confidence interval: 1.39–19.3) and independent predictor of hospital mortality. A single measurement of uNGAL at admission to ICU exhibited good predictive ability for AKI though the sensitivity was low. The predictive ability of uNGAL was inferior to simultaneously measured SCr at admission, hence limited its clinical utility to predict AKI. However, admission uNGAL was a strong, independent predictor of hospital mortality.

Podocyte-associated gene mutation screening in a heterogeneous cohort of patients with sporadic focal segmental glomerulosclerosis

The utility of genetic testing in sporadic focal segmental glomerulosclerosis (FSGS) is unclear. We sought to determine the frequency of podocyte-related gene mutations in a heterogeneous population of adults and children with biopsy-proven FSGS. The prevalence of pathogenic mutations in five genes (NPHS2, TRPC6, ACTN4, INF2 and PLCE1) and of APOL1 risk alleles (G1 and G2) was ascertained in children and adults diagnosed between 1984 and 2011 with FSGS by renal biopsy. Clinical data were extracted from medical records. A total of 65 patients (28 children, 37 adults) with sporadic FSGS were identified (34 females, 31 males), with a mean age of 25 ± 16 years (range from 3 to 62 years). The majority of patients were African American (39 African American, 21 White and 2 Hispanic). We identified biallelic pathogenic NPHS2 mutations in 2 of 28 (7.1%) children, both of whom were of non-Hispanic Caucasian background. A homozygous NPHS2 p.R138Q/p.R138Q mutation was detected in a 5-year-old Caucasian female. Two compound heterozygous NPHS2 mutations p.R138Q/p.R229Q were identified in a 7-year-old Caucasian male patient. One novel, potentially pathogenic non-synonymous variant in INF2 was identified in an African American patient. The proportion of African Americans with two APOL1 risk alleles was 69.2%. This study delineates a role for genetic testing for NPHS2 in children with biopsy-proven sporadic FSGS. Further studies which specify clinical and pathological details of patients will help further define whether there are specific populations that warrant systematic testing of other podocyte-related genes in sporadic FSGS.

Effect of neck movement on endotracheal tube position

To the Editor, I read with interest the article written by Kim et al. comparing the effects of head movement on endotracheal tube (ETT) position in adults and children. The results should be interpreted with caution, as the study was undertaken in a heterogeneous population of adults and children. Due to shorter tracheal length in the pediatric population, the margin of safety for tracheal tube-tip displacement is decreased in children. In their study, the extent of neck rotation was not described in sufficient detail to allow the procedure to be replicated with precision. Furthermore, due to the differential impact of a fixed (rather than a proportional to body size) movement criterion, the fixed arbitrary movement of 1 cm may have introduced a study design bias in comparing pediatric patients with adult patients. Finally, while it was interesting that the authors observed significant movement of the ETT more frequently in adults than in children (71% vs 50%, respectively) during flexion, the authors did not report whether there were any adverse events relating to tube malposition, such as endobronchial intubation, accidental extubation, or vocal cord injury. Due to the study limitations and potential design bias, it would appear that further studies targeted to the pediatric age group are warranted. It would be ideal if such a study could conclude that neck movement in relation to tube movement is safe up to a certain degree.

Exhaled nitric oxide measurements: Correction equation to compare hand-held device to stationary analyzer

Exhaled nitric oxide (FE(NO)) is a reliable non-invasive marker of airway inflammation. In 2003 FE(NO) chemiluminescence analyzer (NIOX; Aerocrine AB, Solna, Sweden) was approved by U.S. Food and Drug Administration for monitoring asthma therapy. Recently, the same company developed a portable device using electrochemical sensors (NIOX-MINO; Aerocrine AB). The aim of our study was to compare NIOX-MINO FE(NO) values to those obtained by NIOX and to calculate a correction equation. Two adequate measurements obtained by NIOX and NIOX-MINO were recorded in 32 subjects (16 females, mean age 41 years). FE(NO) values measured by NIOX-MINO were systematically higher than those obtained by NIOX (47.1ppb, IC 95% 35.2-59.1 and 36.9ppb, IC 95% 25.0-49.0, respectively). There was a significant correlation (r=0.998, p<0.001) between FE(NO) measured by the two analyzers and the following conversion equation was calculated as: FE(NO(NIOX))=-1.656(SE=0.61)+0.808(SE=0.009)x FE(NO(NIOX-MINO)) DISCUSSION: FE(NO) values measured by the portable nitric oxide analyzer are reliable and strongly correlated with values obtained by the standard stationary device, with a systematic difference observed between the two instruments' values that can be described by the conversion equation we provided. This equation will help clinicians and researchers to compare data obtainable by the two analyzers.

Association Between Neutrophilic Airway Inflammation and Airflow Limitation in Adults With Asthma

There is debate about the mechanisms of persistent airflow limitation in patients with asthma. Chronic inflammation is assumed to be important, although there is limited and contradictory information about the relationship between airway inflammation and postbronchodilator FEV1. We have assessed the cross-sectional relationship between prebronchodilator and postbronchodilator FEV1 and measures of airway inflammation after allowing for the effects of potential confounding factors. Multivariate analysis was performed on data collected from 1,197 consecutive patients with asthma seen at the respiratory outpatient clinic at Glenfield Hospital between 1997 and 2004. Relationships between induced sputum total neutrophil and differential eosinophil cell counts, and prebronchodilator and postbronchodilator lung function were examined. Sputum total neutrophil but not differential eosinophil count was associated with lower postbronchodilator FEV1. Both differential eosinophil and total neutrophil count were associated with lower prebronchodilator FEV1. These effects were independent after adjustment for age, smoking, ethnicity, asthma duration, and inhaled corticosteroid use. A 10-fold increase in neutrophil count was associated with a 92 mL reduction (95% confidence interval, 29 to 158; p = 0.007) in postbronchodilator FEV1. In this large heterogeneous population of adults with asthma, we have shown that prebronchodilator FEV1 is associated with neutrophilic and eosinophilic airway inflammation, whereas sputum total neutrophil counts alone are associated with postbronchodilator FEV1. This supports the hypothesis that neutrophilic airway inflammation has a role in the progression of persistent airflow limitation in asthma and raises the possibility that this progression and the development of COPD share a common mechanism.

Patterns of physical activity in free-living adults in the Southern United States.

To examine the relationship between the amount and patterns of physical activity (PA), body fatness, and age in a heterogeneous adult population in the free living. Cross-sectional study of the amount of PA over a 1-week period. The amount of body movements during PA (PA counts*10(3)) and time spent on various PA intensity categories were calculated from a triaxial accelerometer and compared with subject characteristics, including body fat from hydrodensitometry. Adult healthy men (n=48) and women (n=72) were recruited from the Nashville, Tennessee area and their PA was monitored in their free-living environment. The average weekday PA counts (176.5+/-60.3, P=0.002, r(2)=0.294), PA counts day-to-day variability (47.3+/-32.7, P=0.002, r(2)=0.286), daily maximum PA counts (241.9+/-89.2, P=0.001, r(2)=0.327), minute-to-minute variability on weekdays (0.281+/-0.091, P=0.001, r(2)=0.362), and the difference between maximum and minimum daily PA counts (130.6+/-78.3, P=0.008, r(2)=0.243) were significantly and negatively correlated with body fatness. During awake time, both men and women spent 10-12 h on low intensity (1.0-2.9 metabolic equivalents (METs)) PA, approximately 1 h on moderate (3.0-5.9 MET), and less than 10 min on vigorous (>6.0 MET) PA each day. On weekends, men and women spent more time at rest (1 MET), less time on low-intensity PA, and men spent more time on moderate PA than on weekdays. In adults living in the Southern US the amount of free-living PA was negatively correlated with body fatness. Both men and women spent the majority of active time on low and moderate PA. PA patterns on weekends were different than on weekdays and were related to sex and age, but not to body fatness. National Institutes of Health, US.

Prognostic Scoring Systems for Infectious Diseases: Their Applicability to the Care of Older Adults

Physicians often make clinical predictions about individual patients. For many infectious diseases, published prognostic scoring systems (PSSs) can help predict relevant outcomes. Validated PSSs exist for the general adult population for diseases such as pneumonia, endocarditis, meningitis, and bloodstream infection. Although these PSSs have been rigorously derived and validated, they have limited value in the care of older adults, because most studies have involved a heterogeneous adult population with mortality as the primary end point. In the United States, the number of patients who are > or =65 years old is growing, and their health care costs are increasing. Assessment of clinical outcomes other than merely survival (i.e., physical functional ability, cognitive ability, need for nursing home care, and overall quality of life) is required for this population. Some pioneering work has been done to develop PSSs that specifically address the health care needs of older adults. This review will describe existing PSSs and explore areas of further investigation.

Osteoporosis and osteopenia in adults and adolescents with cystic fibrosis: prevalence and associated factors

BACKGROUNDPatients with cystic fibrosis (CF) have many risk factors for reduced bone mineral density (BMD). The aim of this study was to determine the prevalence of osteoporosis and osteopenia in...

A prognostic rule for elderly patients admitted with community-acquired pneumonia

PURPOSE: We sought to identify admission characteristics predicting mortality in elderly patients hospitalized with community-acquired pneumonia and to develop a prognostic staging system and discriminant rule. PATIENTS AND METHODS: We retrospectively analyzed data from 2,356 patients aged ≥65 years admitted with community-acquired pneumonia. Multivariable analyses of a derivation cohort (n = 1,000) identified characteristics associated with hospital mortality. A staging system and discriminant rule based on these characteristics were tested in a validation cohort (n = 1,356). Our discriminant rule was compared with a rule formulated from a heterogeneous adult population with community-acquired pneumonia. RESULTS: Hospital mortality rates were 9% (derivation cohort) and 12% (validation cohort). We identified five independent predictors of mortality: age ≥85 years [odds ratio 1.8 (95% confidence interval 1.1–3.1)], comorbid disease [odds ratio 4.1 (2.1–8.1)], impaired motor response [odds ratio 2.3 (1.4–3.7)], vital sign abnormality [odds ratio 3.4 (2.1–5.4)], and creatinine level ≥1.5 mg/dL [odds ratio 2.5 (1.5–4.2)]. These variables stratified patients into four distinct stages with increasing mortality in the derivation cohort (Stage 1, 2%; Stage 2, 7%; Stage 3, 22%; Stage 4, 45%; P = 0.001) as well as in the validation cohort (Stage 1, 4%; Stage 2, 11%; Stage 3, 23%; Stage 4, 41%; P = 0.001). The discriminant rule developed from the derivation cohort had greater overall accuracy (77.1%) in the validation cohort than a rule formulated from a heterogeneous adult population (68.0%, P = 0.001). CONCLUSION: Elderly patients with community-acquired pneumonia have characteristics at admission that can predict mortality. Our staging system and discriminant rule improve prognostic stratification of these patients.

Health Status and Social Factors in Nonprescribed Drug Use

This article examines the relationship between a set of demographic, socioeconomic, sociopsychologic, and health status characteristics of a heterogeneous adult population and their use of nonprescribed drugs. The objective is to determine whether nonprescribed drug use is best accounted for by demographic and socioeconomic factors, by health and medical beliefs, by health status, or by some combination of these. The data are derived from a personal interview survey of 2603 adult members of the Kaiser-Permanente Medical Care Program, Oregon Region. The results indicated that a combination of characteristics from among these three sets were the best predictors. Sex, income, education, mental health status, tendency toward self-treatment, and level of concern with health matters were the most important variables, although they account for only a small amount of the variation in nonprescribed drug use. A portrait of the most frequent users of nonprescribed drugs raised the question as to whether these are the classic neurotics, the "worried-well," or persons whose medical care needs have not been adequately recognized or met.