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PubMed1993

Epidemiology of hepatitis B virus in non-institutionalized children and adolescents affected by handicap.

The aim of the study is to evaluate the prevalence of hepatitis B virus (HBV) markers in a population of non-institutionalized handicapped 1-19-year-old patients. Thirty-six out of 70 patients lived in southern Italy and 19 were affected by Down's syndrome. Only three (4.2%) were positive for anti-HBc (one of these also for anti-HBs) and none for HBsAg. Low prevalence seems to indicate that no particular anti-HBV vaccination strategy is to be considered on this subset of population and on their contacts. Serum prevalence of HBV among nurses and other members of personnel was 11.3%.

Adolescent↗

PubMed1978

Genetic epidemiology of an institutionalized cohort of mental retardates.

By criterion scaling and principal component analysis of performance, social class, symptoms, institutionalization, and medical history, a cohort of mental defectives has been divided into medical, biological, and sociofamilial categories. This division, corresponding to differences in etiology and severity, reveals changing patterns of admission and provides evidence that male excess is not primarily due to sex linkage. The incidence of mental retardation increases about 5% with first-cousin marriage, in agreement with other studies. The decline of IQ with inbreeding appears to be due entirely to rare recessive genes, not to dominance deviations of polygenes.

Consanguinity↗

PubMed1986

A genetic-diagnostic survey in an institutionalized population of 173 severely mentally retarded patients.

In this report we summarize the findings in a genetic-diagnostic survey of an institutionalized population of 173 severely mentally retarded patients. The etiological study was based on a clinical genetic approach with special attention for dysmorphology and neurological findings. A constitutional disorder, as the direct cause of the severe mental handicap, was found in 75 patients (43.35%). A detailed survey of the different data and findings are given, and compared with the results of previous studies.

Adolescent↗

PubMed1991

A clinical, cytogenetic and familial study of 307 mentally retarded, institutionalized, adult male patients with special interest for fra(X) negative X-linked mental retardation.

In this study we report the results of a systematic etiological, clinical genetic study in 307 institutionalized mentally retarded adult males. Special attention is paid to the nosology of X-linked mental retardation. During the survey 63 males with one or more 'Martin Bell'-like features were identified in whom repetitive fragile Xq27-3 screenings were negative. In 13 of them, belonging to 9 different families, pedigree data were compatible with X-linked inheritance. This finding confirms the existence of one (or more) forms of fra(x) negative mental retardation with 'Martin Bell'-like features.

Adult↗

PubMed2005

Prevalence of restless legs syndrome in non-institutionalized Japanese elderly.

The purpose of the present paper was to evaluate the prevalence of restless legs syndrome (RLS) in a non-institutionalized Japanese elderly population. The subjects consisted of 8900 elderly people >65 years of age belonging to the Seniors Association in Izumo City in November 2000. The present study was conducted in two parts. The phase 1 investigation was a screening by mailed questionnaire and the phase 2 investigation was diagnosis by face-to-face interview. Subjects with possible cases of RLS in phase 1 proceeded to phase 2 and definite cases of RLS were then detected. In phase 1, a total of 3287 subjects completely answering all questionnaire items, were defined as the subjects of the present study. A total of 150 were classified as having 'probable RLS', resulting in a prevalence of 4.6%. These subjects with probable RLS in phase 1 were detected as the subjects of phase 2. By face-to-face interview and various clinical examinations, a total of 35 subjects (nine male, 26 female) were diagnosed as having definite RLS, resulting in a prevalence of 1.06%. Furthermore, seven subjects (two male, five female) with symptomatic RLS were detected and finally 28 subjects (seven male, 21 female) were diagnosed as having idiopathic RLS. It was significantly higher in women for both the total and idiopathic RLS groups (0.60% male vs 1.46% female; 0.46% male vs. 1.18% female, respectively). The prevalence of RLS may be lower in the Japanese elderly than that in Caucasian subjects. These results could enhance understanding of the differences in predisposition between the races.

Activities of Daily Living↗

PubMed1975

Serum pyridoxal, folate, and vitamin B12 levels in institutionalized epileptics.

Serum pyridoxal, folate, and vitamin B12 concentrations were measured in 68 institutionalized patients with severe epilepsy. Twenty-five patients had a reduced level of pyridoxal and thirty-three a reduced level of folate. There was no instance of a low serum vitamin B12 although in three patients the levels were found to be abnormally high. Fifteen patients had both a low serum pyridoxal and a low serum folate but there was no significant correlation. All patients had a normal hemoglobin concentration and a normal mean corpuscular volume. There was no close relationship between reduced serum vitamin levels and single or groups of anticonvulsant agents, although the size of the groups was too small to permit a detailed study.

Adolescent↗

PubMed1979

Causes of death in institutionalized epileptics.

To assess the causes of death in institutionalized epileptics, the patient records, death certificates, and other data from the only hospital for epileptics in Finland (Vaajasalo Hospital) were reexamined. During the years 1900--1976, 179 inpatients in Vaajasalo Hospital died; this was 12% of all inpatients. The most common causes of death were as follows: pneumonia in 40 cases, seizures in 34 cases (single seizure in 18 and status epileptics in 16), drowning in 29 cases, stroke in 10 cases, and heart infarct in 9 cases. Chronic intoxication caused by phenytoin and/or phenobarbitol was a common supplementary factor leading to death in patients who died of pneumonia or seizures. Thirteen deaths were recorded as suicides or suspected suicides (11 by drowning and 2 by strangulation). The results reflect the severe epilepsy and the poor conditions of the patients, as well as the poor condition of the local facilities in the past. The information obtained should be useful in the effort to improve medical care for these patients.

Adolescent↗

PubMed1991

Dementia in institutionalized elderly: relation to sleep apnea.

Sleep apnea is characterized by transient hypoxemias which are thought to affect mental functioning. Accordingly, speculation and research have focussed on relationships between sleep apnea and dementia. We studied 235 nursing home (ie institutionalized) patients (152 women with a median age of 83.5; 83 men with a median age of 79.7) with portable sleep recording equipment. The Mattis Dementia Rating Scale and the Geriatric Depression Scale were given to each. Seventy percent of the patients had five or more respiratory disturbances per hour of sleep and 96 percent showed some dementia. Sleep apnea was significantly correlated with all subscales on the dementia rating scale. There were trivial differences in dementia ratings between those with mild-moderate apnea and those with no apnea. There were significant differences, however, between the latter two groups and those with severe apnea. In particular, items reflecting attention, initiation and perseveration, conceptualization, and memory tasks on the DRS distinguished between those with and without severe sleep apnea. Among those patients with no depression, all patients with severe sleep apnea were also severely demented. Our data suggest that there is a strong relationship between dementia and sleep apnea when the sleep apnea and dementia are severe. Although causality cannot be inferred from associations, our hypothesis for study is that sleep apnea causes deficits in brain function, possibly due to global effects rather than any particular cortical or subcortical structure.

Aged↗

PubMed1991

The epidemiology of skin tears in the institutionalized elderly.

While skin tears are a common occurrence in the institutionalized elderly population, nothing has been written about this problem. We retrospectively studied all incident reports during a 1-year period at a large, urban, long-term-care facility to identify residents with skin tears. The overall incidence of skin tears was 0.92 per patient per year. The incidence rate for females, but not for males, increased significantly with age (P = 0.012). The mean length of the skin tear was 1.9 cm +/- 1.4 (mean +/- SD). Eighty percent occurred in the upper extremities, with the most frequent location being the forearm. Almost half of the skin tears reported had an unknown cause. Wheelchairs and accidentally bumping into an object each accounted for a quarter of the skin tears where the cause was known. Transfers and falls contributed to a lesser extent. Impaired mental status was no more likely to be present in residents experiencing a skin tear than in all nursing home residents. Twenty-four of the 147 residents with skin tears had four or more tears, accounting for 40% of all skin tears reported. Ninety-seven percent of the episodes resulted in no attending physicians' orders other than the standing orders. Future studies should be designed to determine if there are adverse consequences of skin tears and to suggest programs to reduce their occurrence.

Aged↗

PubMed1993

Aggressive behaviors among the institutionalized elderly.

OBJECTIVE: To describe the incidence and characteristics of aggressive behaviors in a group of institutionalized elderly. DESIGN: Retrospective survey. SETTING: 350-bed, urban skilled nursing facility. PATIENTS: All nursing home residents who had an incident report completed after an aggressive behavior. MEASUREMENTS: Examination of all incident reports of aggressive behavior for 1 year. RESULTS: There were 94 reports of aggressive behaviors. Twenty-nine residents exhibited one aggressive behavior, 12 residents two, and six residents exhibited three or more aggressive behaviors. These six residents accounted for 44% of all events. The incidence of aggressive behavior was 0.27 per resident per year for the entire facility; on the Alzheimer's unit the incidence was 0.75 per resident per year. Sixty-two percent of the victims of aggressive behavior were other nursing home residents, 37% were employees, and 1% were visitors. The charts of the six residents with three or more aggressive behaviors were reviewed. These residents received trials of multiple scheduled psychotropic medications, often exhibited several additional agitated behaviors around the time of the attack, were at risk for psychiatric hospitalizations during the study period, and often were noted to have underlying acute medical illnesses near the time of the attack. CONCLUSION: Approximately two aggressive behaviors per week occurred in a large nursing home. Residents and staff of Alzheimer's units have a higher risk of being victims of aggressive behavior. A small number of patients account for nearly half of the behaviors, even on the Alzheimer's unit. Aggressive behaviors may be clinical indicators of underlying acute medical illnesses.

Age Factors↗

PubMed1993

Effects of terodiline on urinary incontinence among older non-institutionalized women. Terodiline in the Elderly American Multicenter Study Group.

OBJECTIVE: To determine the effectiveness of terodiline, a drug with calcium antagonist and anticholinergic properties, on the frequency of incontinence in older non-institutionalized women. DESIGN: Randomized, placebo-controlled, parallel-group, double-blind trial. SETTING: Twelve outpatient clinics across the United States affiliated with programs in either geriatrics, gynecology, or urology. PARTICIPANTS: Ninety-eight women, age 60 or older, with symptoms of urge incontinence and self-reported frequency of incontinence four or more times per week and involuntary bladder contractions on dual-channel water cystometry. MAIN OUTCOME MEASURES: Self-reported urinary frequency, urgency, number of incontinence episodes, and number of heavily soaked pads. RESULTS: Eighty-one women, average age 71, completed the trial, 40 in the active drug group, 41 in the placebo group. Incontinence frequency and the number of heavily soaked pads were reduced in the active drug group by 64% and 55%, respectively, and by 21% (P = 0.002) and 9% (P = 0.04) in the placebo group. No patients dropped out due to adverse effects. An intention-to-treat analysis of all 98 patients yielded the same conclusion. CONCLUSION: Terodiline is highly effective in reducing incontinence in older, noninstitutionalized women with urge incontinence. Because of its potential association with polymorphic ventricular tachycardia (torsades de pointes), terodiline must undergo further testing to define its safety before it can be recommended for clinical use in the incontinent geriatric population.

Aged↗

PubMed2004

Stroke prophylaxis in institutionalized elderly patients with atrial fibrillation.

OBJECTIVES: To identify patterns and predictors of antithrombotic use and to evaluate the appropriateness of antithrombotic therapy for stroke prophylaxis in institutionalized elderly patients with atrial fibrillation. DESIGN: Retrospective study. SETTING: Seventeen long-term care institutions in Edmonton, Alberta. SUBJECTS: Two hundred sixty-five long-term care residents, aged 65 and older, with atrial fibrillation. MEASUREMENTS: The proportion of patients who were prescribed warfarin, acetylsalicylic acid (ASA), both, or neither was determined. Odds ratios were calculated to identify risk factors for stroke and bleeding that are predictive of the receipt of anticoagulant therapy. Appropriateness of therapy was evaluated based on whether patients were prescribed antithrombotic therapy in accordance with their risk factors for stroke and bleeding. RESULTS: Warfarin was prescribed for 49% of patients, ASA for 22%, both for 8%, and neither for 20%. Nearly all patients (97%) were considered to be at high risk for stroke, with age being the predominant risk factor (88%>75), whereas about half were considered to be at low risk for bleeding. Multivariate analyses did not find any associations between individual risk factors for bleeding and anticoagulant treatment, with the exception of recent surgery (odds ratio=0.59, 95% confidence interval=0.37-0.94). Overall, 54.8% of patients received appropriate antithrombotic therapy. Of patients who were optimal candidates for anticoagulation, 60% received appropriate therapy (warfarin with or without ASA). CONCLUSION: Although warfarin was the most appropriate treatment in nearly all of this population at high risk for stroke, it was prescribed in fewer than two-thirds of patients. Antithrombotic therapy was not always prescribed in accordance with patients' risk factors for stroke and bleeding. There is a need for systematic identification of appropriate candidates for anticoagulation in the long-term care setting.

Aged↗

PubMed2004

Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status.

OBJECTIVES: To examine whether providing a midmorning nutrition supplement increases habitual energy intake in seniors with probable Alzheimer's disease (AD) and to investigate the effects of body weight status and cognitive and behavioral function on the response to the intervention. DESIGN: Randomized, crossover, nonblinded clinical trial. SETTING: A fully accredited geriatric teaching facility affiliated with the University of Toronto's Medical School with a home for the aged. PARTICIPANTS: Thirty-four institutionalized seniors with probable AD who ate independently. INTERVENTION: Nutrition supplements were provided between breakfast and lunch for 21 consecutive days and compared with 21 consecutive days of habitual intake. MEASUREMENTS: Investigator-weighed food intake, body weight, cognitive function (Severe Impairment Battery and Global Deterioration Scale), behavioral disturbances (Neuropsychiatric Inventory-Nursing Home Version), and behavioral function (London Psychogeriatric Rating Scale). RESULTS: Relative to habitual intake, group mean analyses showed increased 24-hour energy, protein, and carbohydrate intake during the supplement phase, but five of 31 subjects who finished all study phases completely compensated for the energy provided by the supplement by reducing lunch intake, and 24-hour energy intake was enhanced in only 21 of 31 subjects. Compensation at lunch was more likely in subjects with lower body mass indices, increased aberrant motor behavior, poorer attention, and increased mental disorganization/confusion. CONCLUSION: Nutrition supplements were least likely to enhance habitual energy intake in subjects who would normally be targeted for nutrition intervention-those with low body weight status. Those likely to benefit include those with higher body mass indices, less aberrant motor problems, less mental disorganization, and increased attention.

Aged↗

PubMed1981

Osteomalacia in institutionalized epileptic patients on long-term anticonvulsant therapy.

The occurrence of anticonvulsant osteomalacia was studied in 31 epileptic inpatients, 16 women and 15 men. Disturbances in biochemical parameters indicating osteomalacia were frequent. Thirty two per cent of the patients were hypocalcemic, 55% had an increase in S-ALP and 26% in U-HOP, and dU-Ca was decrease in 55%. The S-25OHD3 concentrations were significantly lower in the patients compared with healthy controls. BMD was decreased in females but not in males compared wih the controls. Histomorphometric analysis revealed an increase in the amount of osteoid, but the amount of trabecular bone was no lower than in the controls. The amount of resorption surfaces was increased in the females, but not in the males. The patients who took less physical activity had a pronounced decrease in BMD. The conclusion drawn was that osteomalacia is a frequent complication of long-term anticonvulsant medication, especially among institutionalized patients.

Adult↗

PubMed1981

Prevalence of dementia disorders in institutionalized Swedish old people. The work load imposed by caring for these patients.

The prevalence of dementia disorders were determined among 3,523 institutionalized patients aged 65 years or more in the county of Västerbotten. Approximately one-third of the clientele were considered demented. The prevalence was calculated to be 3.7% of the population in the county. The frequency of dementia disorders among the patients in the somatic long-stay wards, the nursing homes, and the mental hospital was rather similar (55-65%). A surprisingly high percentage of demented (17.1%) was found in the homes for the aged. The work load was highest in the somatic long-stay wards and in the nursing homes. Patients in the mental hospital, however, differed markedly from those in other institutions with higher scores for aggressive and disturbing behaviour, which accounted for the large number of patients in the mental hospital with maximal work load. The findings are discussed with regard to future institutional care of demented patients and point out the need for better education in psychiatric care for the staff.

Activities of Daily Living↗

PubMed1975

Dental status and treatment needs among institutionalized mentally subnormal persons in Norway.

Dental status and treatment needs were studied in a random sample comprising 353 mentally subnormal persons. The sample was drawn to represent institutionalized mentally subnormal persons in Norway aged 5-45. The overall dental health was poor, primarily due to inadequate and fragmentary treatment facilities. Whereas the dental condition of children below 15 years of age was acceptable, as measured by the DMFT index, tooth loss increased rapidly with advancing age. Nearly every second dentulous person needed some conservation, and every tenth needed extraction of one or more teeth. One-third of the patients needed treatment requiring general anesthesia. It was concluded that a new system for the investigation of treatment requirements should be developed. This system must be based on diagnostic and social criteria, and should serve as a guideline for the plannning and delivery of dental services to the various subgroups of mentally subnormal persons.

Adolescent↗

PubMed1986

Oral health in non-institutionalized epileptic children with special reference to phenytoin medication.

The periodontal condition and caries experience was studied in non-institutionalized epileptic children (n = 55) who had not been subjected to any additional preventive measures. The children were distributed in a phenytoin (PHT) group with a mean age of 13.2 yr and a control group (mean age 11.8 yr) consisting of children treated with other anticonvulsants. The PHT group had a DF-s mean value of 5.4 in comparison to 7.2 in the control group. Determinations of gingival overgrowth based on the presence of gingival units with increased probing depth (greater than 4 mm) as well as the thickness of the marginal gingiva in buccolingual dimension measured on stone casts were performed. Although the plaque level and degree of gingival inflammation were similar in the two groups, 43% of the children in the PHT group showed one or more gingival units with increased probing depth (greater than 4 mm), but none in the control group. The thickness of the marginal gingiva was significantly (P less than 0.001) higher in the phenytoin-treated children compared to children who had never had phenytoin medication. In the PHT-group gingival overgrowth based on gingival units with increased probing depth was statistically significantly and positively associated with the variables gingivitis (P less than 0.05), visible plaque index (P less than 0.01), age (P less than 0.01) and years on PHT therapy (P less than 0.05).

Adolescent↗

PubMed2006

Oral health knowledge and practices among Dar es Salaam institutionalized former street children aged 7-16 years.

OBJECTIVES: To find out level of knowledge on causes and prevention of dental caries and bleeding gums, oral hygiene and eating practices among institutionalized former street children. METHODS: A structured standardized questionnaire was used to collect data for this study. Chi-square test was used to test for significant differences. RESULTS AND CONCLUSIONS: Eighty-eight per cent and 83% of the children knew the cause of tooth decay and bleeding gums respectively and 17-68% were aware of preventive measures. At the institutions visited, 92% of the children said they brush their teeth but 74% brushed when living on the streets, this difference was significant (chi2=4.40, P=0.05). About half did not use toothpaste during street life, whilst 8% do not use toothpaste at institutions, the difference was significant (chi2=5.081, P=0.025). Almost 22% use sweets and biscuits at institutions, about 44% used the snacks when living on the streets, the differences were significant (chi2=3.798, P=0.04, and chi2=3.893, P=0.04). Only 6% use sodas and sweetened juices at institutions, while 32-36% used the drinks during street life, the differences were significant (chi2=4.38 P=0.05 and chi(2)-12.87, P=0.01). The findings of this study show that most former street children are aware of the causes of dental caries and bleeding gums but have poor knowledge on prevention of the two diseases. Furthermore, children living on the streets are more likely to eat cariogenic foods and have poor oral hygiene practices.

Adolescent↗