Number Of Medical Conditions Research Articles

Impact of changes in medical condition burden index and stress on absenteeism among employees of a US utility company

Purpose – The purpose of this paper is to investigate the impact of changes of medical condition burden index (MCBI) and stress on absenteeism and discuss implications for policy/program design. Design/methodology/approach – Sample: US utility employees that participated in Health Risk Appraisals (HRA) during 2009 and 2010 (n=3,711). Methods: the MCBI was created by summing number of medical conditions. Absenteeism was measured from administrative records. Change in MCBI and stress and impact on absenteeism was assessed according to incremental change, by low/high categorizations, and by using multivariate regression. Findings – Incrementally, greater changes in MCBI or stress generally resulted in corresponding absenteeism change. For both MCBI and stress, high categories were associated with greater absenteeism compared to those in low categories. Those remaining in the low MCBI category decreased absenteeism (−0.10 days/year; p=0.01). Changes from low to high MCBI resulted in increased absenteeism (+0.12 days/year; p=0.04. Changes in stress from low to high or from high to low categories resulted in concurrent changes in absenteeism (+0.21 days/year; p=0.04 and −0.31 days/year; p=0.01, respectively). Regression analyses indicated the interaction between stress and MCBI as a significant contributor to absenteeism change. Research limitations/implications – Conclusions: MCBI, stress and their interaction appear to be direct determinants of absenteeism. Companies should consider both physical and emotional health simultaneously in program interventions in order to reduce absenteeism. Originality/value – Unlike most studies illustrating cross-sectional relationships, this study shows how changes in stress and medical conditions relate to changes in absenteeism. The interaction between MCBI and stress in this context is also a novel addition.

Household and neighborhood conditions partially account for associations between education and physical capacity in the National Health and Aging Trends Study

Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults.The National Health and Aging Trends Study measured education (<high school, high school, some college, and ≥Bachelor's), household and neighborhood conditions, using a 16-item environmental checklist and a 3-item social cohesion scale, and physical capacity with the Short Physical Performance Battery (SPPB), grip strength and peak expiratory flow. Structural equation models were used to decompose total educational effects into direct effects and indirect effects via household and neighborhood conditions, using sample weights and adjusting for age, sex, race/ethnicity, marital status, household size, BMI, self-reported health, and number of medical conditions in 6874 community-dwelling participants.Education was directly associated with SPPB scores (β = 0.055, p < 0.05) and peak flow (β = 0.095, p < 0.05), but not grip strength. Also, indirect effects were found for household disorder with SPPB scores (β = 0.013, p < 0.05), grip strength (β = 0.007, p < 0.05), and peak flow (β = 0.010, p < 0.05). Indirect effects were also found for street disorder with SPPB scores (β = 0.012, p < 0.05). Indirect effects of household and neighborhood conditions accounted for approximately 35%, 27% and 14% of the total association between education and SPPB scores, grip strength level, and peak expiratory flow level, respectively.Household disorder and street disorder partially accounted for educational disparities in physical capacity. However, educational disparities in SPPB scores and peak expiratory flow persisted after accounting for household and neighborhood conditions and chronic conditions, suggesting additional pathways. Interventions and policies aiming to support aging in place should consider addressing household-level and street-level disorder.

Posttraumatic stress symptoms in older adults hospitalized for fall injury

ObjectiveAlthough unintentional falls may pose a threat of death or injury, few studies have investigated their psychological impact on older adults. This study sought to gather data on early posttraumatic stress symptoms in older adults in the hospital setting after a fall. MethodParticipants in this study were 100 adults age 65 years or older admitted to a large urban hospital in New York City because of a fall. Men and women were represented approximately equally in the sample; most were interviewed within days of the fall event. The study's bedside interview included the Posttraumatic Stress Symptom Scale, which inquires about the presence and severity of 17 trauma-related symptoms. ResultsTwenty-seven participants reported substantial posttraumatic stress symptoms (moderate or higher severity). Exploratory bivariate analyses suggested an association between posttraumatic stress symptom severity and female gender, lower level of education, unemployment, number of medical conditions, and back/chest injury. ConclusionsA significant percentage of older patients hospitalized after a fall suffer substantial posttraumatic stress. Future investigations are needed to assess the association between the psychiatric impact of a fall and short-term inpatient outcomes as well as longer-term functional outcomes.

Height and heart disease.

Height has a relationship with a number of medical conditions, including heart disease. Atrial fibrillation has been observed to be more common in taller individuals. Marfan syndrome, with its high prevalence of mitral valve disease and abnormalities of the aorta, is associated with increased height. Mitral valve prolapse in patients without Marfan syndrome may be more common in taller people. Conversely, congestive heart failure, coronary artery disease, and possibly aortic valve calcification are less prevalent with increasing height. The relationship between height and health will be of increasing importance as the population grows taller.

Pulmonary effects of intravenous atropine induce ventilation perfusion mismatch.

Atropine is used for a number of medical conditions, predominantly for its cardiovascular effects. Cholinergic nerves that innervate pulmonary smooth muscle, glands, and vasculature may be affected by anticholinergic medications. We hypothesized that atropine causes alterations in pulmonary gas exchange. We conducted a prospective interventional study with detailed physiologic recordings in anesthetized, spontaneously breathing rats (n = 8). Animals breathing a normoxic gas mixture titrated to a partial arterial pressure of oxygen of 110-120 were exposed to an escalating dose of intravenous atropine (0.001, 0.01, 0.1, 5.0, and 20.0 mg/kg body mass). Arterial blood gas measurements were recorded every 2 min (×5) at baseline, and following each of the 5 doses of atropine. In addition, the animals regional pulmonary blood flow was measured using neutron-activated microspheres. Oxygenation decreased immediately following intravenous administration of atropine, despite a small increase in the volume of inspired air with no change in respiratory rate. Arterial blood gas analysis showed an increase in pulmonary dysfunction, characterized by a widening of the alveolar-arteriole gradient (p < 0.003 all groups except for the lowest dose of atropine). The microsphere data demonstrates an abrupt and marked heterogeneity of pulmonary blood flow following atropine treatment. In conclusion, atropine was found to decrease pulmonary gas exchange in a dose-dependent fashion in this rat model.

Adherence to Long-Term Therapies and Beliefs about Medications

Objectives. To assess adherence to long-term medications among patients in family medicine clinics and to evaluate relationship between adherence, beliefs about medications, medication information adequacy, and other factors. Methods. Interviewer assisted survey was conducted to assess adherence using the 8-item Morisky Medication Adherence Scale (MMAS-8), beliefs about medications using beliefs about medicine questionnaire (BMQ), and the patients' perception of medication information adequacy. Results. Of the 408 participants, 56.9% reported low adherence. Pearson's bivariate correlation showed positive association between MMAS-8 score and BMQ-specific necessity (r = 0.526 P < 0.001) and the perceived information adequacy (r = 0.568 P < 0.001), and there was negative association between adherence score and BMQ specific concerns, general overuse, and harm (r = −0.647, −0.466, and −0.663, resp.) (P < 0.001). Multivariable analysis revealed that age, number of medications, number of medical conditions, specific necessity and concerns beliefs, general harm beliefs, and perceived adequacy of medication information were independent predictor of adherence. Furthermore, specific beliefs explain 27.7% of the variance in adherence, while medication information adequacy explains 32.3% of the variance in adherence. Conclusion. The prevalence of low adherence among patients on long-term medications is high and it is related to negative beliefs about medications and to inadequate information given to patients about their medications.

Objective indicators of physical activity and sedentary time and associations with subjective well-being in adults aged 70 and over.

This study explored the associations of the volume and intensity of physical activity and the volume of sedentary time with subjective well-being in a diverse group of 228 older adults in the UK (111 female, mean age 78.2 years (SD 5.8)). Physical activity (PA) and sedentary behaviour were assessed by accelerometry deriving mean steps per day, mean moderate/vigorous PA minutes per hour (MVPA min·h−1) and minutes of sedentary time per hour (ST min·h−1). Lower limb function was assessed by the Short Physical Performance Battery. Subjective well-being was assessed using the SF-12 health status scale, the Ageing Well Profile and the Satisfaction with Life Scale. Linear regressions were used to investigate associations between the independent variables which included physical activity (steps and MVPA), sedentary time, participant characteristics (gender, age, BMI, education, number of medical conditions), and lower limb function and dependent variables which included mental and physical well-being. Steps, MVPA and lower limb function were independently and moderately positively associated with perceived physical well-being but relationships with mental well-being variables were weak. No significant associations between sedentary behaviours and well-being were observed. The association between objectively evaluated physical activity and function and subjective evaluations of physical well-being suggest that improving perceptions of physical health and function may provide an important target for physical activity programmes. This in turn may drive further activity participation.

Trends in antiparkinsonian medication use in new zealand: 1995-2011.

Prescribing trends for medications are influenced by development of new drugs, changes in knowledge about efficacy and side effects, and priorities set by funding agencies. Changes in the utilization of antiparkinsonian agents in the outpatient community in New Zealand were investigated by using the national prescription database for the period 1995–2011. The dispensed volumes of antiparkinsonian agents were converted into number of defined daily doses per 1000 inhabitants per day for analysis. Increases in the dispensed volumes of levodopa (77%), amantadine (350%), and catechol-o-methyl transferase inhibitors (326%) occurred during the study period. Conversely, decreases in the dispensed volumes of anticholinergics (48%), selegiline (82%), and dopamine agonists (6.2%) were observed. New Zealand has seen a substantial increase of the amount of levodopa dispensed in the past 17 years. This increase appears to be related to an increase in the number of people taking the medication. We are unable to extrapolate this change to an increase in the prevalence of PD, given levodopa is used in the treatment of a number of medical conditions. The changes in other antiparkinsonian medications largely reflect changes in availability (increases in entacapone and ropinirole) and best practice treatment (declines in anticholinergics, selegiline, and tolcapone).

It’s Not Easy Being Blue-Green

A 53-year-old-man with prostate cancer underwent prostate brachytherapy one month ago. Since then, he has experienced increased urinary frequency, dysuria, perineal discomfort, re-duced urinary stream velocity, and nocturia. The patient was prescribed the following medications to relieve his urinary fre-quency and dysuria: sulfamethoxazole/trimethoprim, ciprofloxa-cin, tamsulosin, methylprednisolone, ibuprofen, and Phosphasal. He denied any special diet. Urinalysis and culture results were normal except for the blue-green color of the urine. Urinary mi-croscopic examination revealed 3 red blood cells per high-power field. His serum PSA was 7.4 µg/L. The questions were raised as: A) What caused this urine color change? B) What other conditions could cause this urine discol-oration? C) Can this discoloration be pathological or cause any test interference? The normal color of urine ranges from light yellow to dark am-ber, depending on the concentration of solutes in the urine. Pa-tients may be quite frightened at any unusual urine color, espe-cially with accompanying symptoms such as frequent urination and burning pain with urination. Food dyes and additives are the most common causes of blue or green urine. A few foods, especially asparagus, can cause a greenish discoloration. Cer-tain medications can cause blue or green urine, including ami-triptyline, doxorubicin, indomethacin, cimetidine, phenergan, triamterene, rinsapin, propofol, Prosed DS, sildenafil, and B vi-tamins [1, 2]. A number of medical conditions, such as familial hypercalcemia, indicanuria, and pseudomonas infection, may cause urine to become blue or green. Blue or green urine may be caused by a blue dye such as methylene blue, which has weak antiseptic properties and is a component in several medications (Trac Tabs, Urised, Uroblue) used to reduce symptoms of bladder inflammation or irritation [1, 2]. The Phosphasal this patient was given for his dysuria con-tains methylene blue, which contributed to the blue-green urine color [2]. Methylene blue is increasingly used in cancer chemo-therapy regimens. Methylene blue is well absorbed by the gas-trointestinal tract and rapidly reduced to leukomethylene blue, which is stabilized in some combination form in the urine and excreted mostly in unchanged form. It peaks approximately 2-6 hr after oral administration and remains detectable in 24 hr [3]. The blue-green urine is a normal side effect of this medication and is harmless. Urine discoloration due to diet or medication is unlikely to be harmful. If it is due to a medication, the patient should be ad-vised of potential side effects other than urine color change. Methylene blue may cause falsely increased blood methemoglo-bin levels by co-oximetry and other colorimetric assays such as glucose and protein [1, 4]. If the patient has not ingested a food or medication known to change urine color, further investigation is warranted to rule out medical conditions or infection.

The Charlson Comorbidity Index Can Be Used to Identify Patients Who Are No Longer Appropriate for Surveillance Colonoscopy

Purpose: The Charlson Comorbidity Index (CCI) is primarily used to predict survival among dialysis patients by assigning numerical weights to certain major medical problems and the patient's age. We sought to determine if the CCI can also be used to identify patients who, by virtue of significant comorbidity or advanced age, should no longer undergo surveillance colonoscopy. Methods: We performed a retrospective chart review of 1,554 patients who underwent a surveillance colonoscopy at the Manhattan Veterans Affairs Hospital from 2004-2011. Patients were included if they had a colonoscopy for a “history of colonic polyps,” “follow-up of colonic polyps,” or “established colonic polyps.” Patients were excluded if they had evidence of gastrointestinal bleeding, history of colorectal cancer, familial polyposis syndrome, or inflammatory bowel disease. We utilized the CCI to compare patients who died within five years of their surveillance colonoscopy with patients who lived longer than five years after their surveillance colonoscopy. The age at last colonoscopy, gender, race, number of medical conditions, albumin, and CCI level were recorded for each patient. An algorithm that factors in CCI and albumin levels was used to calculate one and two year survival probabilities for each patient. Only medical conditions that fell under CCI criteria were counted. The two groups were compared using a Student's two-tailed t-test. Results: Sixty patients died within five years of their last surveillance colonoscopy and were compared with our control group. The average time to death after colonoscopy was 31.8 months. None of the deaths were due to colorectal cancer. All patients were male. When comparing patients who died within five years to patients who were alive beyond that point, there were significant differences in CCI (5.53 and 4.25, respectively; p=0.005), one year survival probability (0.82 and 0.90, respectively; p=0.003), two year survival probability (0.67 and 0.79, respectively; p=0.001), and number of medical conditions (1.70 and 1.08, respectively; p=0.025). There was no significant difference in age among the two groups (75.12 for dead and 72.28 for alive; p=0.13). Conclusion: Patients who died within five years of colonoscopy had a significantly higher CCI and lower one- and two-year survival probabilities compared to those who are alive at least five years after their colonoscopy. Though there are clear recommendations for ages at which to discontinue screening colonoscopy, similar guidelines for stopping surveillance colonoscopy are currently lacking. CCI could be used to help determine which patients would no longer benefit from continued surveillance colonoscopy by evaluating their mortality risk.

People's Attitudes, Beliefs, and Experiences Regarding Polypharmacy and Willingness to Deprescribe

To capture people's attitudes, beliefs, and experiences regarding the number of medications they are taking and their feelings about stopping medications. Administration of a validated questionnaire. Multidisciplinary ambulatory consulting service at the Royal Adelaide Hospital. Participants were individuals aged 18 and older (median 71.5) taking at least one regular prescription medication; 100 participants completed all items of the questionnaire, 65 of whom were aged 65 and older. Participants were administered the 15-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. Participants were taking an average of 10 different prescription and nonprescription (including complementary), regular and as-needed medications. More than 60% felt that they were taking a "large number" of medications, and 92% stated that they would be willing to stop one or more of their current medications if possible. Number of regular medications, age, and number of medical conditions were not found to be correlated with willingness to stop a medication. The findings were similar in older and younger participants. This study has shown that a cohort of mostly older adults were largely accepting of a trial of cessation of medication(s) that their prescriber deemed to be no longer required. Because few factors were associated with willingness to cease medications, all patients should be individually evaluated for deprescribing.

Long-Term Outcomes of a Randomized Trial of Integrated Skills Training and Preventive Healthcare for Older Adults with Serious Mental Illness

This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness. A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up. HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up. Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.

Effect of Obesity on Patients Undergoing Vaginal Hysterectomy

Obesity is an excess of fat, specifically triglycerides, stored in adipose tissue, in relation to lean body mass. Body mass index (BMI) is a measure of weight in relation to height (Table 1). Morbid obesity affects nearly 60 million Americans and is becoming increasingly prevalent [1]. In the United States, 26% of adults are now estimated to be overweight, up from just 15% a decade ago. These rates from the Centers for Disease Control and Prevention may be an underestimation of the actual numbers because they rely on self-reported height, and women often report themselves taller than they actually are [2]. Gynecologic complications related to obesity include hirsutism, menorrhagia, endometrial cancer, breast cancer, urinary incontinence, and pelvic organ prolapse [3]. In addition, a number of medical conditions associated with obesity have a profound effect on a patient’s quality of life. These conditions include type 2 diabetes, orthopedic joint problems, and cardiovascular diseases, which in turn lead to a shorter lifespan and lost productivity [4]. There are serious social consequences as well. Isolation and depression develop as a result of obesity [5]. Hence, the gynecologic, medical, and social complications together make obesity a morbid disease state. Concurrent with the rise in obesity rates, the number of women nationwide who underwent hysterectomy in past years is at 600 000 such procedures annually [6,7]. Second only to cesarean section, hysterectomy is the most commonly performed surgical procedure in women in the United States. In the United States, 66% of hysterectomies are performed via the abdominal route, and 22% are performed vaginally [8], which is reflective of our institutions as well. Important factors in the choice of hysterectomy route include the extent of gynecologic disease and the need to perform concomitant procedures, as well as relative risks and benefits of each type of hysterectomy; patient preference; surgeon competence and preference; and available support facilities. Specifically, in the obese patient in whom hysterectomy is being considered, thorough examination and evaluation are important, including medical comorbidities, to appropriately assess perioperative risk. In obese patients at high risk, the vaginal route is associated with the lowest risk when in the hands of a competent surgeon.

Reply to Balta et al.

We appreciate the observations made by Balta et al. [1] with regard to red cell distribution width (RDW) and lung cancer. With regard to time from blood sampling to analysis for RDW, a Beckman LH750 was used for all analyses. Correspondence with Beckman, with regard to their coulter counter, advises that, as all samples were analysed within 12 h of collection, no significant errors in RDW measurement will have occurred. Each analyser has different stability parameters and RDW is stable for up to 24 h post-collection when analysed with the LH750. With regard to disease state and RDW, we adjusted for cancer stage. However, tumour half-life was not available. We also adjusted for a number of medical conditions as listed by Balta et al.; however, we did not have liver function data available. Previous analysis has demonstrated that alcohol is a significant factor for in-hospital death, which we adjusted for [2]. Balta et al. quite rightly point out the confounding effect of haemoglobin on RDW values. We adjusted for this, as has been previously described via the use of multivariate regression [3]. With regard to the inflammatory status at the time of measurement, all patients were elective resections; however, we cannot rule out a low-grade systemic inflammatory response. Balta et al. are correct in pointing out the effect of inflammatory markers affecting the accuracy of prediction of clinical outcomes; however, the nature of our paper was identifying the effect of RDW on outcomes in thoracic surgery. We did not develop a model for risk prediction, and any such model would need to include inflammatory markers. Inflammatory markers that are cheap, clinically available and clinically significant remain to be defined and may vary from condition to condition. As Balta et al. point out, RDW seems to be a predictive factor in a number of disease states. We thus speculate that RDW is a marker of bone marrow function, in the same manner as creatinine, ejection fraction and forced expiratory volume in 1 s are for the kidneys, heart and lungs, respectively [2, 4]. We thank Balta et al. for their insightful comments.

PRIMARY CARE RESEARCH FROM THE WOMEN'S HEALTH INITIATIVE

Primary care research can encompass not only a broad range of topics, but also a variety of methodologies, one being secondary data analysis. Secondary data analysis involves the analysis of existing data to evaluate questions not addressed by the original study, and can be used by primary care researchers to conduct clinical, epidemiological, and health services research. The use of secondary data analysis can have several advantages, as it can provide access to large sample sizes in a quick and inexpensive manner. However, the data available is often limited by the measures included in the original study. A variety of sources for secondary data are available, such as the Women’s Health Initiative. The Women’s Health Initiative is an ongoing study of a multiethnic cohort of postmenopausal women from 40 centers in the United States. This study is in its second extension and has over 15 years of cumulative data. Its present focus is on healthy aging, natural history of multiple chronic diseases, symptoms, and functional status. It is thus an ideal cohort for primary care researchers interested in these outcomes. One of the distinguished papers presented at the 40th NAPCRG Annual Meeting in the fall of 2012, reported successfully performed secondary data analysis of the Women’s Health Initiative. The distinguished paper, entitled Social Support and Physical Activity as Moderators of Life Stress in Predicting Baseline Depression and Change in Depression Over Time in the Women’s Health Initiative, was presented by primary care researcher Lisa Uebelacker, PhD, from Brown University. Uebelacker’s research expands on previous research that has shown negative life events, acute stressors and chronic stressors increase risk for onset, persistence, or worsening of depression. Different types of stressors may increase risk for depression. These include interpersonal stressors, such as verbal abuse, physical abuse, social strain, care giving, or negative interpersonal life events; financial stressors such as low income or self-report of financial stress; and medical stressors such as chronic medical conditions or pain. In contrast, social support and physical activity may decrease the risk of depression. The purpose of this analysis was to determine whether social support and/or physical activity actually buffer the association between stressors and increased risk of depression symptoms at a single time point and after a 3-year follow-up period. Uebelacker and colleagues conducted a secondary analysis of data from the Women’s Health Initiative Observational Study. This prospective cohort includes 92,063 community-dwelling post-menopausal women who participated in the study. Depression symptoms were measured at baseline and 3 years later; social support, physical activity, and stressors were measured at baseline. For baseline analyses, the investigators used the entire sample; in order to look at new-onset depression at 3-year follow-up, they used data only from the 68,368 women who were not depressed at baseline and provided follow-up data. They conducted adjusted logistic regressions, with depression status as the dependent variable. Stressors at baseline, including verbal abuse, physical abuse, care giving, social strain, negative life events, financial stress, low income, acute pain, and a greater number of chronic conditions, were all associated with higher levels of depression symptoms at baseline and new onset elevated symptoms at 3-year follow-up. Social support and physical activity were associated with lower levels of depressive symptoms at baseline and at 3-year follow-up. Social support at baseline attenuated the association between concurrent depression and physical abuse, number of medical conditions, financial stress, social strain, and low income. Social support also attenuated the association between financial stress and low income on new-onset depression 3 years later. Physical activity was not a significant effect moderator. These results highlight the important role that social support can play in reducing risk of depression in older women, particularly in times of stress. Although physical activity did not buffer the effects of stress on depression, investigators did find a main effect for physical activity, such that those women with increased physical activity were less likely to develop high levels of depression symptoms 3 years later. Data from the Women’s Health Initiative (WHI) is available for review at the WHI website: http://www.whi.org. Ancillary study proposals, joining working groups, writing groups, and new paper proposals are actively supported by principal investigators at most of the 40 sites. Dr. Charles B. Eaton, senior author on the above paper, is the Principal Investigator at the Brown University, Pawtucket WHI site, and is glad to support any NAPCRG affiliated investigator interested in the WHI datasets. E-mail: gro.irhm@notae_selrahc.

Can we use influencing factors to predict aspiration pneumonia in the United Kingdom?

BackgroundThe current study builds upon the work of others in looking at influencing factors of aspiration pneumonia in people with a swallowing problem. This study differs from previous researches on this topic, focusing on the United Kingdom (UK) population and involving more recently defined influencing factors of aspiration pneumonia. The study aims to explore the multifactorial nature of aspiration pneumonia in a UKdysphagic client group, as well as different disease specific variables.MethodsSpeech and Language Therapists collected data on 33 influencing factors over a period of 6 months during routine bedside swallowing assessment of 687 patients. All subjects were adults referred with suspected dysphagia and included acute inpatients, head and neck cancer patients and adults with learning disabilities. The study population included 400 males and 287 females and ages ranged from 17 to 102 giving a mean age of 72.9 years. The influence of the different variables included in the study was evaluated using multivariate logistic regression analysis.ResultsThe results show that 13 statistically significant influencing factors were implicated in the development of aspiration pneumonia for this group. Out of these, nine correlate with the previous work undertaken in the United States. These were poor mobility, nil by mouth status, age, dependency for feeding, number of medications, Chronic Obstructive Pulmonary Disease (COPD), number of medical conditions, stroke and alcohol abuse. Four further influencing factors were shown to be significant in the UK population, these were dysphagia, only oral intake, bedfast, and male gender.ConclusionsThis study confirms that in the UK there are influencing factors in the development of an aspiration pneumonia. It would be prudent to remember that a direct link is yet to be established when applying this knowledge to inform clinical management.

Can we use influencing factors to predict aspiration pneumonia in the United Kingdom?

Background: The current study builds upon the work of others in looking at influencing factors of aspiration pneumonia in people with a swallowing problem. This study differs from previous researches on this topic, focusing on the United Kingdom (UK) population and involving more recently defined influencing factors of aspiration pneumonia. The study aims to explore the multifactorial nature of aspiration pneumonia in a UKdysphagic client group, as well as different disease specific variables. Methods: Speech and Language Therapists collected data on 33 influencing factors over a period of 6 months during routine bedside swallowing assessment of 687 patients. All subjects were adults referred with suspected dysphagia and included acute inpatients, head and neck cancer patients and adults with learning disabilities. The study population included 400 males and 287 females and ages ranged from 17 to 102 giving a mean age of 72.9 years. The influence of the different variables included in the study was evaluated using multivariate logistic regression analysis. Results: The results show that 13 statistically significant influencing factors were implicated in the development of aspiration pneumonia for this group. Out of these, nine correlate with the previous work undertaken in the United States. These were poor mobility, nil by mouth status, age, dependency for feeding, number of medications, Chronic Obstructive Pulmonary Disease (COPD), number of medical conditions, stroke and alcohol abuse. Four further influencing factors were shown to be significant in the UK population, these were dysphagia, only oral intake, bedfast, and male gender. Conclusions: This study confirms that in the UK there are influencing factors in the development of an aspiration pneumonia. It would be prudent to remember that a direct link is yet to be established when applying this knowledge to inform clinical management.

Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&amp;PP cohort

BackgroundFalls are one of the major health problems in old people. Different risk factors were identified but only few epidemiological studies analysed the influence of conventionally measured blood pressure on falls. The objective of our study was to investigate the relationship between systolic and diastolic blood pressure and falls.MethodsIn 3,544 community-dwelling Austrian women and men aged 60 years and older, data on falls within the previous three months were collected by questionnaire. Blood pressure was measured by general practitioners within the Vorarlberg Health Monitoring and Prevention Programme (VHM&PP) 90 to 1095 days before the fall assessment. A multiple logistic regression analysis was conducted. The models were stratified by gender and adjusted by age, number of medical conditions and subjective feeling of illness.ResultsIn total, 257 falls in 3,544 persons were reported. In women, high systolic and diastolic blood pressure was associated with a decreased risk of falls. An increase of systolic blood pressure by 10 mmHg and of diastolic blood pressure by 5 mmHg reduced the risk of falling by 9% (OR 0.91, 95% Cl 0.84-0.98) and 8% (OR 0.92, 95% Cl 0.85-0.99), respectively. In men, an increased risk of falls was observed in participants with low systolic or low diastolic blood pressure.ConclusionsBlood pressure was associated with the risk of falls. Hypertensive values decreased the risk in women and low blood pressure increased the risk in men.

Metalloproteinase and tissue inhibitor of metalloproteinase in tuberculosis and malignant pleural effusion

Pleural effusions are associated with a number of medical conditions causing fluid accumulation via differing synergistic mechanisms including increased pleural membrane permeability, increased pulmonary capillary pressure, decreased oncotic pleural pressure, and lymphatic obstruction. Pleural fluid analysis yields important diagnostic information in most cases of pleural effusions, biological parameters including pleural matrix metalloproteinase (MMP) levels are markers elevated in the pleural fluid from effusions compared with malignant and other benign settings. The aim of this study was to explore the clinical validity of matrix metalloproteinase 2 (MMP-2), MMP-9 and tissue inhibitor of metalloproteinase 1 (TIMP-1) in discriminating between the tuberculosis pleural effusion and malignant pleural effusion, and also to investigate the serum levels of these enzymes in both diseases. ResultsShowed increase levels of MMP2.9 and TIMP1 in serum of patients with active, old TB and Malignant cases than control (P<0.001) also levels of MMP2.9 and TIMP1 in the pleural fluid were increased in both cases of TB and malignant, but it was significantly higher in tuberculous patients. ConclusionIt was demonstrated that high and unopposed matrix metalloproteinase activity 2.9 in pleural tuberculous patients is more than that of malignant cases.

Influence of weight status on muscle quality in older adults

The aim of this study was to investigate the impact of weight status on muscle quality in older adults. Community‐dwelling older adults (n=139) were assessed for body composition via dual‐energy X‐ray absorptiometry scanning and muscle power using the Nottingham Power Rig. MQ (watts/kg) was defined as leg muscle power (watts) normalized for mineral‐free lean mass of the lower body (kg). The sample was divided into four groups: normal weight males (n=12, 74.1±5.3 y, 23.6±1.3 kg/m2), normal weight females (n=36, 74.5±6.4 y, 22.7±1.5 kg/m2), overweight/obese males (n=29, 77.9±7.3 y, 28.8±3.3 kg/m2), and overweight/obese females (n=62, 73.7±5.3 y, 29.4±3.5 kg/m2). Analysis of covariance adjusted for age and number of medical conditions was conducted to examine the effect of weight status on MQ. Normal weight males (12.8 watts/kg) had significantly greater MQ relative to normal weight females (9.6 watts/kg) and overweight/obese females (8.4 watts/kg) (both p&lt;.01). In addition, MQ was significantly greater in overweight/obese males compared to overweight/obese females (10.5 vs. 8.4 watts/kg, respectively, p&lt;.01). These findings suggest that both weight status and sex influence MQ in older adults. Additional research is necessary to elucidate how weight‐related differences in MQ contribute to varying levels of functional performance in older men and women.