Factors influencing length of hospital stay in an acute psychogeriatric unit.

BACKGROUND: Dementia patients represent a significant volume of hospital admissions and impose a high cost on the health system. There is a significantly higher length of hospital stay (LOHS) for elderly demented patients. METHODS: This study was carried out in an acute psychogeriatric unit specialising in behavioural and psychological symptoms in dementia. Socio-demographic, cognitive and nutritional variables were taken into account. We first compared the patients returning home (group 1) after hospital discharge with those transferred to the rehabilitation psychogeriatric unit (group 2). We secondarily explored the correlation of LOHS with the variables described above for the two groups. RESULTS: We retained 92 patients (of 375 admitted) for our study, mean age 83.9 ± 6.6, Mini-Mental State Examination 12.8 ± 9.6, initial weight 61.7 ± 13.2 kg and body mass index 24.8 ± 4.7. We noticed significant differences in cognitive status but not in nutritional variables or in socio-demographic characteristics between the two groups. Only weight in nutritional variables was significantly associated with LOHS in the acute psychogeriatric unit. CONCLUSIONS: Our main finding underlined the key role of cognitive factors in patient discharge home. And only initial weigh seems have an influence in LOHS instead of cognitive status or socio-demographic characteristics.

[Tardive dyskinesia following discontinuation of neuroleptic therapy in 87-year-old patient]. / Dyskinésies tardives et neuroleptiques chez une patiente de 87 ans.

In the absence of a therapeutic alternative, the use of neuroleptics in geriatrics should be limited to the bare minimum, given their potentially serious deleterious effects in frail elderly patients. Dyskinesia is one of their most common side effects. Case of an elderly patient in whom the dyskinesia was revealed following abrupt cessation of a neuroleptic taken in the long term with discussions of the etiological hypotheses of this rare situation, which nevertheless deserve to be known.

Assessment of Ammonia Concentrations and Climatic Conditions in Calf Housing Using Stationary and Mobile Sensors.

In calf fattening, housing climate conditions are essential for optimal performance and welfare. Validated methods to measure the long-term housing climate are lacking. The present study investigated climate parameters for 14 weeks in Swiss calf fattening housing with two different ammonia (NH3) sensors: six stationary sensors (Dräger Polytron 8100) were installed at animal level and four mobile sensors (Dräger x-AM 5100) were attached to the calves' heads. Temperature, relative humidity, and carbon dioxide (CO2) concentrations were recorded by two stationary data loggers (testo 160 IAQ). Data were analyzed descriptively, and 4 h mean values of maximum NH3 concentrations of mobile and stationary sensors were compared using the Wilcoxon test for paired data. The 4 h mean values of temperature, relative humidity, and CO2 concentrations and the 4 h mean values of maximum NH3 concentrations of stationary and mobile sensors were analyzed by ANOVA in two linear models. The overall 4 h mean of maximum NH3 concentrations ranged between 5.9-9.4 ppm for measurements of stationary sensors and between 11.3-14.7 ppm for measurements of mobile sensors. The NH3 concentrations measured by mobile sensors showed significantly higher peak values and more fluctuations. Additionally, an interaction effect was observed between the NH3 concentrations measured by either sensor and CO2 concentrations (p < 0.01 (mobile sensors); p < 0.0001 (stationary sensors), temperature values (p < 0.0001 (both sensors)), and relative humidity (p < 0.0001 (both sensors)). The measurements of the implemented method showed that corresponding housing climate parameters fluctuated strongly, and NH3 reached high peak values. Validated measurement methods might allow for a detailed assessment of the housing climate in practice, and for further research on suitable management methods for housing climate optimization in the future.

Questionnaire-based study to assess the association between management practices and mastitis within tie-stall and free-stall dairy housing systems in Switzerland.

BACKGROUND: Prophylactic measures are key components of dairy herd mastitis control programs, but some are only relevant in specific housing systems. To assess the association between management practices and mastitis incidence, data collected in 2011 by a survey among 979 randomly selected Swiss dairy farms, and information from the regular test day recordings from 680 of these farms was analyzed. RESULTS: The median incidence of farmer-reported clinical mastitis (ICM) was 11.6 (mean 14.7) cases per 100 cows per year. The median annual proportion of milk samples with a composite somatic cell count (PSCC) above 200,000 cells/ml was 16.1 (mean 17.3) %. A multivariable negative binomial regression model was fitted for each of the mastitis indicators for farms with tie-stall and free-stall housing systems separately to study the effect of other (than housing system) management practices on the ICM and PSCC events (above 200,000 cells/ml). The results differed substantially by housing system and outcome. In tie-stall systems, clinical mastitis incidence was mainly affected by region (mountainous production zone; incidence rate ratio (IRR) = 0.73), the dairy herd replacement system (1.27) and farmers age (0.81). The proportion of high SCC was mainly associated with dry cow udder controls (IRR = 0.67), clean bedding material at calving (IRR = 1.72), using total merit values to select bulls (IRR = 1.57) and body condition scoring (IRR = 0.74). In free-stall systems, the IRR for clinical mastitis was mainly associated with stall climate/temperature (IRR = 1.65), comfort mats as resting surface (IRR = 0.75) and when no feed analysis was carried out (IRR = 1.18). The proportion of high SSC was only associated with hand and arm cleaning after calving (IRR = 0.81) and beef producing value to select bulls (IRR = 0.66). CONCLUSIONS: There were substantial differences in identified risk factors in the four models. Some of the factors were in agreement with the reported literature while others were not. This highlights the multifactorial nature of the disease and the differences in the risks for both mastitis manifestations. Attempting to understand these multifactorial associations for mastitis within larger management groups continues to play an important role in mastitis control programs.

[Cognitive aging of bipolar patients]. / Le vieillissement cognitif des patients bipolaires.

Bipolar disorder is a severe, recurrent mood disorder, associated with a higher rate of morbidity and mortality. A new population of aging bipolar patients is emerging for which specific studies are scarce. There seem to be an association between bipolar disorder and major cognitive disorder, significantly affecting patients' psychosocial outcomes. Though the neuropathological mecanisms underlying such an evolution have yet to be found, there are three paradigms that can help us understand the clinical heterogeneity within the aging bipolar group. First, there seem to be different cognitive endophenotypes within the bipolar spectrum, related to different neurodevelopmental abnormalities. Each of these endophenotypes will interact with the normal cognitive aging process which is associated with a decline in certain cognitive domains while others remain stable. Nevertheless this cognitive decline will be variable from one patient to another. This can be explained by cognitive reserve which reflects the brain's capacity to endure neuropathology, and minimize clinical manifestations. The second hypothesis is the neuroprogression paradigm that offers an explanation on how a cyclic disorder such as bipolar disorder could evolve progressively into a major cognitive disorder. According to this paradigm, each manic and depressive episode is associated to an allostatic load, a systemic response associated with the secretion of neuroinflammatory factors which will secondarily alter the brain's connectivity. The third paradigm suggests that bipolar patients may develop either vascular dementia which is coherent with their increased vascular risk factor or another neurodegenerative disease. All three paradigms are not exclusive, and many other factors are to be taken into account such as medication, sensory impairment, health related changes and residual mood symptoms, which can alter cognitive functions.