Aerobic training in the 'oldest old': the effect of 24 weeks of training

OBJECTIVE: to determine the effects of aerobic training on the maximal aerobic power of healthy, very elderly people. DESIGN: a 12-week control period followed by 24 weeks of progressive, weight bearing, aerobic training. SUBJECTS: 26 men and women aged 79 to 91 years conforming to pre-determined health criteria. METHODS: we took measurements before and after a 12 week control period and following 24 weeks of training. These were maximal aerobic power (VO(2)max), heart rate at an oxygen consumption of 10 ml x kg(-1) x min(-1) (HR at VO(2)10), resting heart rate, isometric knee extensor strength, isometric elbow flexor strength and lower limb extensor power. MAIN RESULTS: pre-control values of VO(2)max for the women and men were 14.1 (SD 2.79) and 22.0 (5.12) ml.kg(-1).min(-1) respectively. There was no significant change in the VO(2)max of either group over the control period. After training, there was a 15% increase in the VO(2)max of the women (P<0.01) but no change was observed in the men. In the women, there was no significant change in HR at VO(2)10 over the control period but a 14% decrease (P<0.01) after training. In the men there was a 7% (P<0.05) increase in HR at VO(2)10 over the control period and a 5% (P<0.05) decrease after training. No effect of training was seen on isometric knee extensor strength, isometric elbow flexor strength or lower limb extensor power of either group. CONCLUSION: progressive aerobic training can increase the maximal aerobic power of very elderly women. A 15% increase in VO(2)max may prevent many elderly women from crossing functionally important thresholds, thereby helping to maintain independence.     

Prevalence of senile dementia in a rural community in Japan: the Tajiri project

Knowledge of the prevalence of dementia in different age groups is needed for the planning of a health policy. This study shows the prevalence of dementia and magnetic resonance imaging (MRI) findings in elderly people aged 65 years and over, living in the town of Tajiri in the northern part of Japan. They were shown by two cognitive screening tests, the Mini-Mental State examination (MMS) and the Dementia Screening Test (DST) and medical diagnosis. Two subject groups were assessed, those who completed both tests (Subjects I, n=2066) and those from among the 200 'MRI-administered subjects' who were interviewed and diagnosed (Subjects II, n=170). For Subjects I, there were 6.3 and 10.2% 'dementia range' according to the severe and mild criteria, respectively. As for Subjects II, 9.4% were clinically diagnosed as having dementia. They met the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria of probable Alzheimer's disease (AD) or possible AD with cerebrovascular disease. The estimated prevalence rate of dementia was 8.0%. Visual ratings of brain atrophy using MRI disclosed two distribution patterns. The 'continuous' pattern of the frontal and temporal lobes atrophy suggest that both are affected by the aging process, while a 'discontinuous' pattern of the hippocampal atrophy could indicate a pathologic background such as early changes of AD.     

Prevalence of leucocyte antibodies in the Dutch donor population

Introduction Donor leucocyte antibodies have been associated with transfusion‐related acute lung injury (TRALI) and can be present in allo‐exposed donors. Donor deferral policies aiming at excluding allo‐exposed donors are increasingly implemented worldwide. We aimed at assessing the prevalence of leucocyte antibodies in different subgroups of allo‐exposed donors in the Dutch donor population. Methods Consecutive donors were enrolled during routine whole blood donation. Donors filled out a questionnaire on allo‐exposure history. Blood samples were tested for human leucocyte antigens (HLA) (LifeScreen Deluxe and the Lifecodes LSA I/II assays) and granulocyte‐reactive (GIFT, GAT, and MAIGA) antibodies. Results Six thousand and thirty‐four consecutive donors (60% men) were included. A total of 2·5% reported a history of blood transfusions, and 51% (of female donors) reported a history of pregnancy. In never allo‐exposed donors, the prevalence of granulocyte‐reactive antibodies was 2·0% (95% CI: 1·6–2·4), and for HLA antibodies, it was 7·0% (95% CI: 6·3–7·8). In previously pregnant donors, the prevalence of granulocyte‐reactive antibodies was increased to 3·0% (95% CI: 2·0–4·0), and for HLA antibodies, it was increased to 33% (95% CI: 30–36). Prevalence of leucocyte antibodies of all types depended on transfusion history, number of pregnancies, time since last pregnancy, and pregnancy outcome. Conclusions Fourteen percent of Dutch blood donors are allo‐immunized against HLA or granulocyte antigens. Deferral of all self‐reported allo‐exposed donors will decrease this prevalence to 9%. Deferral of all female donors and transfused male donors will result in a similar prevalence among remaining donors but approximately twice as many deferrals.     

Prevalence of undernutrition in Dutch hospital outpatients

BackgroundThe prevalence of undernutrition in hospital inpatients is high. Earlier detection and treatment in the hospital outpatient clinic may help to reduce these numbers. The purpose of this study was to assess the prevalence of undernutrition in hospital outpatients in the Netherlands, to determine high risk departments, and to determine the percentage of patients receiving dietetic treatment.MethodsThis cross-sectional multicenter study was conducted in nine hospitals. Patients who visited the outpatient clinic on one of the screening days in the period March–May 2008 received a short questionnaire and were weighed. Patients were classified as severely undernourished, moderately undernourished or not undernourished.Results2288 patients were included in the study, of which 5% were severely undernourished and 2% were moderately undernourished. The prevalence of severe undernutrition was highest in the outpatient departments of oral maxillofacial surgery (17%), oncology (10%), rehabilitation (8%), gastroenterology (7%) and pulmonology (7%). Only 17% of all severely undernourished and 4% of all moderately undernourished patients reported to receive dietetic treatment.ConclusionThe prevalence of undernutrition in hospital outpatients is generally low but largely undertreated. Future screening should focus on high risk departments.     

Prevalence of dementia in institutional care

Information about dementia prevalence in residential and nursing care homes helps these institutions to meet residents' needs. We combined residential characteristics ascertained at a screening interview in 1991-93 with dementia diagnoses from assessment interviews in the UK Medical Research Council Cognitive Function and Ageing Study, a population-based study of 13004 elderly people. Almost 5% of people aged 65 years or older lived in institutions--34% (95% CI 30-39) of individuals with dementia. Within institutions, dementia prevalence was 62% (52-71), and was slightly higher in women than in men, with no increase by age. That most residents have dementia has implications for the type of care that institutions provide.     

Identification of dementia cases in the community: a Brazilian experience

Objectives: To describe the application in Brazil of a simple, low‐cost procedure, developed in India by the 10/66 Dementia Research Group, for the identification of dementia cases in the community. Design: Community‐based dementia case‐finding method. Setting: Piraju, São Paulo, Brazil. Participants: Twenty‐five community health workers were trained to identify dementia cases in 2,222 people aged 65 and older in Piraju, a Brazilian town with 27,871 inhabitants. Measurements: After the training, the health workers prepared a list of possible cases that afterward an experienced psychiatrist clinically evaluated, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV), criteria and the Clinical Dementia Rating. Results: Of the 72 cases that were clinically assessed, 45 met the DSM‐IV diagnostic criteria for dementia. Therefore, the positive predictive value of this case finding method was 62.5%; the estimated frequency of dementia was 2%. Most of the confirmed cases met clinical criteria for Alzheimer's disease and vascular dementia. Conclusion: This simple method was appropriate to identify cases of dementia in the general population and can possibly be extended to other developing countries with limited resources to be applied in health programs.     

The progression of mild idiopathic dementia in a community population

Thirty-one subjects aged 75 years and over who were identified as suffering from mild, idiopathic dementia in a large community survey were reviewed at annual intervals for 2 years. Diagnoses and severity ratings were based on defined criteria following a mental state examination, a medical and psychiatric history, detailed cognitive testing, and an interview with relatives or other key informants. Fourteen subjects became more severely demented within 2 years. The initial cognitive test battery failed to reveal any differences between respondents whose dementia advanced and those whose condition remained unchanged, but, in the former group, subjects' symptoms had been present for longer, and a greater proportion had been recognised as demented, or possibly demented, by their general practitioners. We suggest that subjects whose dementia progressed had actually been more severely disabled at the time of identification.     

Survival to late dementia in Dutch nursing home patients

OBJECTIVES: To investigate the determinants of survival to late dementia in Dutch nursing home patients. DESIGN: Observational analysis of a cohort of patients with a prospective follow-up. SETTING: Psychogeriatric nursing home "Joachim en Anna" in Nijmegen, the Netherlands. PARTICIPANTS: Dementia patients from a psychogeriatric nursing home admitted between 1980 and 1989. MEASUREMENTS: All patients were followed until death. Age, sex, severity of dementia on admission, and type of dementia were analyzed as determinants of survival to late dementia. Late dementia was operationally defined as total impairment on 20 items of the functional status questionnaire. RESULTS:The mean disease duration of the study population was 7.0 years, with a wide range. Some died soon after dementia was diagnosed, whereas others lived for more than 25 years after onset of the disease. One hundred twenty-six patients (14.2%) reached the phase of late dementia, most of whom were women (90%) with Alzheimer's disease (60%). For most of the patients, this phase lasted 1 year or less. Age, sex, type of dementia, and severity of dementia on admission all contributed significantly to predicting survival to late dementia. CONCLUSION: One of seven nursing home patients with dementia survived to late dementia. Nursing home physicians can use these findings to inform relatives about the prognosis.     

Prevalence of duodenal ulcer in a rural community in Israel

The prevalence of duodenal ulcer was studied in a rural area in Israel during a period of 5 yr. The mean, prevalence rate was 4.0%. Prevalence rates were related to age, sex, nativity groups, education, occupation, smoking habits, marital state, socio-economic state and presence of other diseases. A stepwise multiple regression analysis of all variables showed a very low positive association between the prevalence of duodenal ulcer and number of children, anxiety neurosis and smoking and a negative association with hypertension and Cochin and North-African origin. Single persons, males engaged in agricultural work and immigrants from Yemen and Kurdistan, had an increased prevalence rate of ulcer. However, none of these factors was significant when examined by a multiple regression equation. Eight out of 28 variables which were included in the multiple regression equation accounted for only 2.6% of total variance in the etiology of duodenal ulcer.     

Prevalence of domestic violence during pregnancy in a Turkish community

This study was carried out to determine the prevalence and risk factors for domestic violence victimization of women during pregnancy by intimate partner throughout marriage in a Turkish community. Pregnant women living in the servicing area of selected health centers in Elazig were considered for the study and data were obtained through a questionnaire. A total of 249 pregnant women, mean age 26.8 +/- 5.2 years and the mean gravidity 2.6 +/- 1.7, were involved. Of the 249 women, 28.9% were exposed to at least one case of physical violence throughout matrimony, 12.4% being abused during the previous year and 4.8% during the current pregnancy, 30.5% were exposed to verbal insult and 4.4% exposed to sexual abuse during the current pregnancy. In addition, 25.7% were exposed to one or more types of domestic violence during previous pregnancies. There was a significant correlation between the rate of violent victimization and number of children, and the partner's alcohol habits and socioeconomical status of the families (p < 0.05). Results from the self-report of the receiving end of violent behaviors indicate that the rates of any type of intimate partner violence were very high among pregnant women in this studied Turkish population. Efforts to reduce the incidence of this women's rights and public health problem should be given high priority.     

Prevalence of community acquired MRSA in a tertiary care facility

Traditionally, methicillin resistant Staphylococcus aureus (MRSA) is considered as a nosocomial pathogen, but an increasing prevalence of community acquired MRSA is being reported worldwide including India, which implies a strategic change in the antibiotic of choice for treatment of community acquired Staphylococcal infections, which till now is cloxacillin. This study is aimed at identifying the prevalence and susceptibility characteristics of community acquired MRSA in our hospital. The study group consisted of 208 consecutive MRSA identified on the basis of their resistance to cefoxitin disk (30 microg) by the disc diffusion method and mecA gene detection by polymerase chain reaction (PCR). Isolates were categorized as community acquired MRSA based on criteria for inclusion and their antibiotic susceptibility was compared with that of the hospital acquired MRSA isolates. Among the 208 MRSA analyzed, 18% (n = 37) were community acquired and were from infections such as cellulitis and superficial injuries. The isolates were significantly more sensitive to ciprofloxacin than the hospital acquired MRSA isolates. The prevalence of community acquired MRSA in this study (18%) is comparable to its prevalence in other studies across India. Susceptibility to antibiotics other than glycopeptides was an important characteristic of community acquired MRSA. In the absence of other reliable phenotypic test for its identification, susceptibility to ciprofloxacin is suggested as an alternative. A prudent clinician should be aware that, cloxacillin, the drug of choice for skin infections such as carbuncle and cellulitis, will not be effective in these cases and that community acquired MRSA has a range of antibiotics to choose from, other than the glycopeptides, when compared with that of hospital acquired MRSA.     

Prevalence of the use of unconventional remedies for arthritis in a metropolitan community

Of 1,811 individuals sampled in a metropolitan community, 382 reported having a musculoskeletal complaint. Eighty-four percent of them had used an unconventional remedy within the previous 6 months. Most individuals used inexpensive, unharmful remedies such as exercise, prayer, and relaxation. This study indicates that people with musculoskeletal disorders often use unconventional remedies, but raises questions regarding the seriousness of this problem.     

Prevalence and pathogenic role of Cyclospora cayetanensis in a Venezuelan community

The prevalence and pathogenic role of Cyclospora cayetanensis among 212 subjects (age range = two months to 70 years) in an impoverished community in Venezuela were assessed retrospectively. For identification of the coccidium, modified Ziehl-Neelsen carbolfuchsin staining of formalin-ether concentrates was used. For other pathogenic parasites, iron-hematoxylin-stained smears and formalin-ether concentrates were examined. Cyclospora infections were identified in 13 (6.1%) subjects with a high percentage of asymptomatic carriers (11 of 13, 84.6%). Only two (15.4%) infants had diarrhea and the coccidium as the single detectable pathogenic parasite. The findings suggest that Cyclospora infections are relatively common and often asymptomatic in this region.     

Prevalence of chronic disease and health practices in a retirement community

The prevalence of chronic disease based on a mailed questionnaire was estimated as part of a continuing epidemiological study of a retirement community. The prevalence of eight chronic diseases (high blood pressure, angina, myocardial infarction, stroke, diabetes, rheumatoid arthritis, glaucoma, and cancer) was determined across all age and sex groups. The relationships between these diseases and several health related life-style practices were assessed. A health index summarizing five practices (smoking, alcohol consumption, exercise, sleep and obesity) was clearly related to the prevalence of disease.     

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community

BACKGROUND: In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community. METHODS: Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years). RESULTS: Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected. CONCLUSIONS: Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.