SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The Shipley-Hartford scales were given to 1,980 institutionalized addicts. Overall, results showed that addict IQs are about normal. Of all demographic variables analyzed, only education explained an appreciable proportion of the variance in scores (12%). There were indications that a relatively high number of addicts may have some intellectual impairment (41%). The latter results await further verification.
Investigated a newly developed MMPI scale--the Institutionalized Chronic Alcohol Scale (ICAS)--designed to separate alcoholics from neurotics. With a sample of 75 alcoholic and 50 neurotic male Veterans Administration Hospital inpatients, the ICAS was found to separate the two groups, correctly identifying 78%, but was slightly less effective than two other previously used alcoholism scales by MacAndrew (Amac) and Holmes (Am). Data from 30 male Veterans Administration Hospital heroin addicts lend some support to the statement, which appears in the original article, that the ICAS should not be used to distinguish between alcoholics and people other than neurotics.
We compared the reliability of the Faschingbauer Abbreviated MMPI (the FAM) to the standard MMPI with a sample of non-institutionalized, independently living elderly individuals. FAM items were extracted from the standard MMPIs of 83 middle-class men and women with a mean age of 74 years. Results indicate that the FAM is correlated highly with the MMPI. Although statistically significant differences were found between the FAM and MMPI forms on some scales, 77% of the profile pairs were judged to satisfy interpretive reliability criteria, and for the profiles that were rejected the FAM was not found to overestimate or underestimate any MMPI scale systematically. The potential value of the FAM as a screening device for elderly individuals who are living in the community is addressed.
OBJECTIVES: To analyze the factor structure, the criterion validity, the internal consistency, inter-rater reliability and test-retest reliability of the Korean version of Cohen-Mansfield Agitation Inventory, to provide data on the frequency and distribution of agitated behaviours, and to compare patterns of agitated behaviours among the institutionalized elderly with Alzheimer's disease (AD) or Vascular dementia (VaD). METHODS: The Korean version of the Cohen-Mansfield Agitation Inventory (CMAI-K) was administered to a total of 257 elderly with AD or VaD in a nursing home in Seoul, Korea. Three kinds of reliability and criterion validity were tested. Factor analysis using principal component analysis with the varimax rotation was performed. To identify different patterns of agitated behaviours, multiple logistic regression analysis was used. RESULTS: This study demonstrated satisfactory reliability and validity for the CMAI-K as an instrument measuring agitation in Korean dementia sufferers in nursing homes. Eighty-three percent of the subjects manifested one or more agitated behaviours at least once a week. Factor analysis yielded four subtypes of agitation: physically aggressive behaviours, physically nonaggressive behaviours, verbally agitated behaviours, and hiding/hoarding behaviours. CONCLUSION: These results indicate that the CMAI-K is a reliable and valid instrument to measure agitated behaviours in Korean elderly with AD or VaD. These results validate and expand previous research on the agitation in dementia, and guide in the development of interventions.
To investigate the seroprevalence of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) in a psychiatric institution in Taiwan, where hepatitis B virus (HBV) is hyperendemic, a total of 780 patients with psychiatric disorders were studied. Enzyme-linked immunosorbent assays (ELISA) were used for testing HBsAg and anti-HCV. The prevalence of HBsAg was higher than that of anti-HCV among these patients (18.1% vs. 6.8%, P < 0.0001). The HBsAg carrier rate in these patients was consistent with that of the general population, with a trend for HBsAg carrier rate to be lower in the aged and in females. In contrast, the prevalence of anti-HCV was higher in these patients than in general population. Anti-HCV positivity was found more frequently in patients who had received blood transfusion previously (24% vs. 6.4%, P < 0.05). The majority (92%) of patients with positive anti-HCV did not have a history of apparent parenteral exposure. The prevalence of anti-HCV increased significantly with duration of the psychiatric disorder. The prevalence of anti-HCV also tended to increase with duration of hospitalization but without reaching statistical significance. These findings suggest that these institutionalized psychiatric patients contract hepatitis B, as does the general population in Taiwan, and they should be considered as a specific risk group for hepatitis C infection.
Conventional HBV serological markers, as well as serum alanine amino transferase and hepatitis B virus DNA (HBV DNA) were studied in a population of 667 institutionalized mentally handicapped males and females and in 676 staff members. The role of Down's syndrome (DS), sex and age-related factors with respect to the prevalence of these markers was analyzed. A young age at admission was found as one of the important factors in the development of the chronic HBsAg carrier state in females. The well-known higher prevalence of HBsAg carriership in DS patients appeared to be restricted to males. Markers indicative of viral replication, HBeAg and HBV DNA, were also more prevalent in male than in female DS residents, or OMR residents. These findings indicate that the phase of active viral replication is prolonged in male HBsAg carriers with DS. However, only 66.7 per cent of HBV DNA-positive and 26.2 per cent of HBsAg-positive residents had abnormal serum alanine aminotransferase (ALT) values. In addition, more than 50 per cent of residents with elevated serum alanine amino transferase values were negative for HBV serological markers. We conclude that male DS residents are the main source of HBV infection in institutions for the mentally handicapped and that determination of ALT values is not very useful in identifying those HBsAg carriers capable of transmission the infection.
A geriatric study was conducted on 213 institutionalized geriatric glaucoma patients (mean age 83.9 years) and 100 control patients (mean age 81.3 years). A 12-lead electrocardiogram (ECG) analyzed according to the Minnesota code was recorded for 212 glaucoma patients and 95 control patients. The most frequent finding (in 56% of the glaucoma patients and in 38% of the control patients, P less than 0.05) was a negative or isoelectric T-wave, suggestive of ischemic heart disease. ECG findings suggestive of coronary heart disease (Q/QS patterns, ST-segment depression, negative or isoelectric T-wave, third or second degree AV block, left bundle branch block or right bundle branch block, intraventricular block or atrial fibrillation or flutter) was seen significantly more often in glaucoma patients (164/212; 77%) than in the control patients (59/95; 62%). Seventeen percent of the glaucoma patients had atrial fibrillation (AF), which was significantly more than for the control group (8/95; 8%). There was no difference in the number of ECG changes between patients with bilateral open-angle glaucoma and bilateral angle-closure glaucoma. The mean intraocular pressure of patients having AF (15.9 +/- 8 mmHg) was significantly lower than that of the other patients (18.4 +/- 11 mmHg) (P less than 0.05). Fifty-five glaucoma patients were considered blind (visual acuity less than 0.05 in the better eye). The visual acuity of patients having AF was lower than that of the other patients, and severe visual field defects (arcuate scotoma or a residual field in the temporal periphery) occurred, slightly more frequently in patients with AF (in 70% vs 51% of the other patients). Arrhythmias, especially AF, are connected with impairment of visual acuity and visual field defects in glaucoma patients. The result of this retrospective study indicate that ECG changes occur frequently, suggesting coronary heart disease in elderly glaucoma patients.
The fragile X [fra(X)] syndrome was screened on 190 Japanese institutionalized females with moderate to severe mental retardation. Two inmates with severe mental retardation (IQ 20) had the fra(X) chromosome in 26% and 15% of the cells examined, indicating that the prevalence of the fra(X) syndrome was about 1% in all female inmates and was about 3.27% in severely mentally retarded females without known causes. However, no female with fra(X) syndrome was found in 35 moderately retarded females. Both had brothers with the fra(X) syndrome and the prevalence was 10% in females with a family history of mental retardation. In addition, the replication study of the fra(X) chromosome in the patients supported the proposal that an excess of the early replicated fra(X) chromosome is related to the mental capacity in heterozygous females. Therefore, the fra(X) syndrome should not be ignored even in severely mentally retarded females with a family history, though the heterozygotes are commonly normal to subnormal in their mental development. In addition, the replication study of the fra(X) chromosome may help to estimate mental development in the carrier children.
Most critics of behavior modification programs for low functioning institutionalized persons fault factors external to the client population for the lack of success of such programs. However, the fundamental cause of failure lies in inherent client variables of severe neurological impairment and its behavioral sequelae. The reality of such organic deficits must be admitted to be a limiting factor in any treatment approach and their specific nature recognized in planning for individual clients.
Quality of life of both the aged person and his relatives depends, to a large extent, on the capacity of the old person to think and to remember. In an attempt to assess the intellectual capabilities (InC) of the elderly and to identify risk factors associated with intellectual impairment (InI), a community study was carried-out. The study population was ethnically heterogeneous and comprised of a high percentage of immigrants and of people who had never attended school. Some methodological issues related to studying InC of a population with these characteristics are discussed. A stratified random sample of non-institutionalized individuals aged 65+ years was home interviewed using a short, portable questionnaire which can be used by non-professional interviewers. The research tool is comprised of 10 questions which check time and place orientation as well as short and long term memory. Although the validity of the questionnaire needs further study, some conclusions can be drawn. Approximately 16% of the subjects failed to answer correctly at least 5 of the 10 questions. People over 75 years old, single persons, those with low education and low environmental stimulation were identified as high risk groups for InI, as defined in our study. Functional limitation, such as immobility, dependence in daily functions and hearing deprivation seem to affect the InC of the aged, especially of the less educated people. Such findings may suggest the need to plan community-oriented prevention programs for the sake of the growing population of the aged in western countries.
The assessment of bone quality by quantitative ultrasound (QUS), a transportable and relatively cheap method, shows some correlations with bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) and with fracture risk. To examine its correlation with bone metabolism in a population of institutionalized elderly people known to be at high risk for vitamin D deficiency and secondary hyperparathyroidism, QUS of the calcaneus and biochemical parameters were measured in 264 women aged 85 +/- 7 (SD) years and in 103 men aged 81 +/- 8 years living in 19 nursing homes. Vitamin D deficiency was frequent in this population: 41.9% of the women and 31.4% of the men had a serum 25-hydroxyvitamin (25OHD) level below the 2.5th percentile level of 3276 normal Swiss adults (6.2 micrograms/l or 15.5 mmol/l). Hyperparathyroidism was less frequent: serum parathyroid hormone (PTH) levels were above the 97.5th percentile level of normal adults (70 pg/l) in 18.9% of women and 9.8% of men. In women, QUS data correlated significantly with age (r = -0.297), body mass index (BMI) (r = 0.403), calcium (r = 0.220), PTH (r = -0.296), 25OHD (r = 0.298) and alkaline phosphatase (AP) (r = -0.170) for broadband ultrasound attenuation (BUA), and with age (r = -0.195), BMI (r = 0.208), PTH (r = -0.174), 25OHD (r = 0.140) and AP (r = -0.130) for speed of sound (SOS). In men, ultrasound data correlated with BMI (r = 0.326), calcium (r = 0.199), 25OHD (r = 0.258) and AP (r = -0.311) for BUA, and with AP (r = -0.196) for SOS. In women, but not in men because of their smaller number, a multivariate analysis was performed to examine relationships between age, BMI, biochemical markers and QUS. Age, BMI, PTH and phosphate explained 30% of the variance of BUA and 10% for SOS. In conclusion, QUS of bone evaluates characteristics of bone that are influenced, at least partially, by age, BMI and the secondary hyperparathyroidism due to vitamin D deficiency.
The sleep of Alzheimer's disease (AD) patients is often disturbed by medications, depression, circadian rhythm changes and sleep disorders. Institutionalization is often precipitated by the effect of the patient's sleep and wakefulness on the caregiver. We examined reports of sleep disturbance in mild AD patients. The study cohort consisted of 246 AD patients and 94 controls. Self-reports of sleep disturbance in mild AD patients were examined as was the relationship of sleep and medication use. Results were compared to those of normal controls, and the patients' responses to the reports of their caregivers. Dementia was assessed with the Mini Mental Status Exam, the Blessed Dementia Scale, the Mattis Dementia Rating Scale, and the Pfeiffer Outpatient Disability Test. The more demented the patients, the more time they spent in bed, the more fragmented their sleep, and the more naps they took. Caregivers reports of increased wandering at night and more aggressive behavior during the day were associated with increased use of sedative-hypnotics and with going to bed early. Lengthy sleep was associated with disruptive behavior. We conclude that increased sleep may be associated with dementia and with more disruptive behavior.
Influenza is a leading cause of morbidity and mortality in elderly people. This prospective, observed-blind, randomized, multicenter trial compares the immunogenicity and safety of three influenza vaccines in a sample of 635 elderly residents of four nursing homes in Milano (Italy). All vaccines were well tolerated: no serious adverse events were recorded, and a small number (9 subjects) of local and systemic reactions were observed. Twenty-nine oropharyngeal swabs were taken during the season from ILI (influenza-like illness) patients, none of whom was positive for influenza and other respiratory viruses. Immunogenicity was evaluated in a subgroup of 111 subjects with blood samples obtained just before vaccination and after 4 and 12 weeks. The adjuvanted vaccines, subunit vaccine with MF59 (a-SUV) and virosome subunit vaccine (v-SUV), induced a higher antibody response than whole virus vaccine (WVV). There was no significant difference between groups that received a-SUV and v-SUV, but the a-SUV group had higher values of geometric mean titres than the v-SUV group for H1N1 and B influenza strains. These findings suggest that influenza vaccination is effective, and they underscore the importance of vaccination programs for institutionalized elderly. Further studies are needed to compare other adjuvanted vaccines in order to define their different properties.
The aim of this study was to determine the prevalence of urogenital symptoms in non-institutionalized Dutch women aged 50-75 years, and the degree of discomfort suffered as a result. A questionnaire was sent to 2157 women, a sample representative of the female population aged 50-75 years with respect to age, marital status, level of education and menopausal age. The usable response was 81.6% (n = 1761). The overall prevalence of vaginal dryness, soreness and dyspareunia was 27%. The prevalence of micturition symptoms, urinary incontinence and recurrent urinary tract infection was 36%. The prevalence estimates for vaginal dryness and urinary incontinence showed a linear decrease with increasing age. Almost half of the symptomatic women reported moderate to severe discomfort. One-third of those affected received medical care. Previous hysterectomy had no effect on the reported prevalence estimates. Hysterectomized women reported moderate to severe complaints more often than non-hysterectomized ones. There were no significant differences in prevalence estimates between former and current smokers and non-smokers.
OBJECTIVES: This paper extends further the systematic nature of social and behavioral risk factor surveillance by showing how it becomes a learning system. The authors argue that such a systematic approach will lead to a better informed public health practice and a better understanding of key public health concerns such as obesity. METHODS: This paper is based on methods developed over some 25 years of experience in designing and operating behavioral risk factor surveillance systems. Measurement issues still remain a key concern and special attention is paid to the role of time as a critical variable in developing a surveillance system. RESULTS: The paper lays out five critical areas for attention if a system is to be considered a learning system. Examples are given from ongoing surveillance systems that have developed a base for a learning system and notes how these are institutionalized. CONCLUSIONS: In the ideal case a learning system based on sociobehavioral surveillance is dependent on data being collected continuously with careful attention paid to the analytical challenges of such complex data. This is an ideal systematic approach that has not been realized in most surveillance systems now available.
INTRODUCTION: There are very few published studies on osteoporosis among the institutionalized elderly in Asian countries, where the incidence of osteoporosis is increasing rapidly. Our objectives were to determine both the prevalence and risk factors of osteoporosis, as assessed by calcaneal bone mineral density (BMD) measurements, in a Thai nursing home. METHODS: Activities of daily living, the Mini-Mental State Examination, blood chemistry, body composition analysis, calcaneal quantitative ultrasound (QUS) and serum C-terminal telopeptides of type I collagen (serum beta-CTx) were assessed in 108 older people living in the largest nursing home for the elderly in Bangkok. Calcaneal BMD was measured by dual-energy X-ray absorptiometry (DXA). RESULTS: The prevalence of osteoporosis, as defined by a calcaneal BMD T-score <1.6, was 79.6%. The prevalence of low bone mass, as defined by a T-score of broadband ultrasound attenuation <1.0, was 80.6%. The prevalence of osteoporosis detected by these two methods was not significantly different (p=1.00). The prevalence of increased bone turnover [with the cutoff point being the mean + 2 standard deviation (SD) of the serum beta-CTx level of a sex- and age-matched control group] was 13.9%. In multiple linear regression analysis, five risk factors -- serum beta-CTx, mental health, mobility index, height and lean body mass -- were able to predict calcaneal BMD at a coefficient of determination R(2)) of 0.54. CONCLUSIONS: These results indicate the importance of mental health and self-care ability as factors associated with osteoporosis. Increased bone turnover was also a significant risk factor of low bone mass. Calcaneal QUS was a useful screening tool for diagnosing osteoporosis in this population and was comparable to calcaneal DXA.
Basic changes in our society and social system lead to a repression of old, frail and impaired people. They are increasingly institutionalized, and the issue of death and dying is delegated to experts. The present investigation describes the burden of routine care of dying people. "Mixed methodology" was used to obtain comprehensive and relevant data. General questions were deduced for the research subject based on qualitative interviews with 17 members of the nursing staff. These questions complete the questionnaire used to conduct the survey in 49 nursing homes. All kinds of occupational groups took part in the study. The quantitative data (n=894) were analyzed descriptively and proved for group differences with nonparametric methods. The results show that talking about the end of life with residents is difficult for almost a quarter of the participating persons. Nearly one third of the staff members tend to avoid the topic of death and dying when talking with relatives. High importance was attached to further interdisciplinary training in terminal care. Working together with different occupational groups like hospice volunteers, chaplains, psychologists and caregivers is seen as a fruitful way and a possibility of increasing the quality of dying in nursing homes.
The treatment of complex tumorous, inflammatory, traumatic, vascular processes, or developmental disorders of the skull base increasingly needs the interdisciplinary cooperation of specialties involved in diagnostics or treatment. Due to this inevitable cooperation of different hospital specialties, institutionalization of skull base surgery, organized as a center or working group, seems recommendable. Moreover, such a center may have additional effects on the external representation of skull base surgery, which is also important. On the initiative of 11 departments and institutes of the university hospital of Leipzing, the Interdisciplinary Center of Skull Base Surgery (IZSL) was founded in March 1997. The following aims were proclaimed: improvement of the interdisciplinary clinical treatment of patients with skull base diseases, evaluation of the patient's data, advancement of clinical and experimental research on the field of skull base surgery, as well as the organization of meetings for training and teaching and scientific meetings. Structure, concept, and first experiences of the interdisciplinary center of skull base surgery are discussed.