Factors contributing to nursing home admission because of disruptive behaviour

The key relative of 417 nursing home residents was interviewed to determine reasons for admission and patient behaviour before admission using the Psychogeriatric Dependency Rating Scale (PGDRS). Families stated that 25% of new nursing home admissions were due to disruptive behaviour but there were nearly always other reasons for admission as well. A receiver operating characteristic curve and cluster analysis showed that a greater amount of generalized behaviour problems predicted admission in the 74% of new residents. Admission because of disruptive behaviour was associated with greater cognitive impairment, possible Alzheimer’s disease, delusions or hallucinations, a psychiatric diagnosis, admission from home, requiring help from others before admission and a permanent move to a nursing home. Both psychiatric and social factors are important determinants of nursing home admission for disruptive behaviour.     

Pharmacologic management of urinary incontinence in women

This article summarizes current thought regarding the efficacy of various types of drug therapy for incontinence in women, borrowing liberally from similar previous presentations. Space limitations for this chapter necessitate some simplification and condensation of these subjects. References have generally been chosen because of their informational or review content and not because of originality or initial publication on a particular subject.     

Incidence and prevalence of overactive bladder

Recent changes in terminology, diagnosis, and therapy have refocused attention on overactive bladder (OAB). This symptom syndrome is highly prevalent worldwide and significantly impairs the quality of life of those who suffer from it. Accurate epidemiologic incidence and prevalence studies of OAB have been hampered in the past by, among other issues, a generalized lack of agreement regarding definition of the disorder, and consequently, accurate case finding. This obstacle resulted in considerably wide estimates in the reported incidence and prevalence of OAB in the literature. A new symptom-based definition of OAB, formally adopted by the Standardization Committee at a recent International Continence Society meeting, should provide a framework for future epidemiologic studies. Current estimates of incidence, prevalence, effects on quality of life, and societal costs may need to be reassessed based on these new data.     

Body composition of children aged 1 to 12 years with biliary atresia or Alagille syndrome

BACKGROUND: Growth and body composition have not been well described in older children with biliary atresia or Alagille syndrome living with their native liver. To optimize nutritional management of these conditions it is essential to understand the normal growth characteristics. OBJECTIVES: The purpose of this study was to evaluate and compare the growth and body composition of children, particularly school-age children, with biliary atresia and Alagille syndrome. METHODS: A single observer measured height, weight, arm anthropometry and skin fold thickness in subjects aged 1 to 12 years with biliary atresia or Alagille syndrome who had not undergone liver transplantation. RESULTS: Forty-six subjects (10 biliary atresia/36 Alagille syndrome) were assessed. Biliary atresia subjects were below average in height for age with normal weight and elevated body mass index. Mean fat stores were mildly depressed. The z-scores for body mass index and weight for age were inversely correlated with age. Alagille subjects were stunted and had low body weight and reduced fat and muscle stores. Body mass index z-score was inversely correlated with age despite improved cholestasis. CONCLUSIONS: Children with Alagille syndrome had significant growth deficits as measured by weight, height and upper arm anthropometry at all ages studied. In contrast, subjects with biliary atresia had normal weights and heights. However, body mass index and weight for age z-scores were lower in the older biliary atresia subjects. Few studies of anthropometry in biliary atresia or Alagille syndrome have included the school-aged child. This study addresses this gap in knowledge and provides baseline data for nutritional interventions in these patients.     

Spontaneous multivessel coronary artery dissection in a young asymptomatic patient

A unique case of spontaneous multivessel coronary artery dissection in a young woman without identifiable risk factors, who remained asymptomatic despite extensive coronary dissection is presented. The management of this condition and a review of the current literature on this subject are presented.