Impact of socioeconomic status on the prevalence of dementia in an inner city memory disorders clinic.

BACKGROUND: Socioeconomic status (SES) has been identified as a possible risk factor for the development of dementia, with low SES shown to be associated with a higher prevalence of dementia, increased psychiatric comorbidity and worse baseline cognitive functioning. Few studies have actually looked at the impact of SES within a clinical population using multiple measures of SES and cognition. METHODS: Data on 217 patients seen in an Inner City Memory Disorders Clinic were analyzed with respect to demographic status, clinical status and SES. Correlations were then examined looking at the relationship of SES to clinical variables and neurocognitive status. Regression analysis was undertaken to examine the relative contribution of individual sociodemographic factors to a diagnosis of dementia. RESULTS: In general, there was wide variation in the sample examined with respect to most measures of SES. Approximately one third (36%) of the sample had a diagnosis of dementia, the mean age was 66.1 years and the mean Mini-mental State Examination score was relatively high (25.4). There was a strong association between age, individual annual income range, education, medical comorbidity and a diagnosis of dementia, with increased age and medical comorbidity being the strongest predictors. CONCLUSION: Increased age, low education, high medical comorbidity and low annual income are all associated with a diagnosis of dementia in an inner city setting. Age and medical comorbidity appear to be more strongly associated with a diagnosis of dementia than SES in an inner city setting.

Therapeutic drug monitoring of antiretrovirals in human immunodeficiency virus infection.

The era of antiviral therapy directed against HIV-1 has now entered its second decade. In the twelve years since the FDA approved the first antiretroviral drug zidovudine there have been a number of seminal developments that have revolutionized the approach to therapy. These advances converged to change the treatment paradigm from one of therapeutic nihilism to that of cautious optimism. First, several trials demonstrated that combination therapy of nucleoside reverse transcriptase inhibitors (NRTIs) is superior to monotherapy in extending survival and delaying disease progression. Second, the concept of virologic latency in asymptomatic HIV-infected patients was revised. Mathematic modelling demonstrated that there is an ongoing high level of virus production driving a rapid turnover of CD4 cells at all stages of infection. Hence it was concluded that the aim of antiretroviral therapy (ART) should be to "hit early and hit hard." Third, significant advances in molecular virology facilitated the development of quantitative methods to measure the circulating HIV plasma RNA. HIV viral load has been shown to be a sensitive predictor of disease progression and a valuable marker of response to therapy. However, none of these developments would have translated into improved patient care without the advent of two new classes of drugs-the protease inhibitors (PIs) and the nonnucleoside reverse transcriptase inhibitors (NNRTIs).

A strategy for supply cost savings.

A collaborative team effort and a new software program helped this hospital lab to come in $47,500 under budget on supply expenses.

Patterns of alcohol use among rural and small-town adolescents.

Much research has indicated that age, gender, grade in school, religiosity, socioeconomic status, and involvement in extracurricular activities are all related to adolescent alcohol use. However, most of such research focuses on urban youth. The present study examines patterns of rural adolescent alcohol use and factors associated with such use. The Student Alcohol Inventory was administered to 650 students in grades 7-12 in a small, middle-Atlantic town and surrounding county. The survey contained sections addressing demographic data, attitudes regarding students' alcohol use, and their parents' use. Along with standard SES measures, items were included on unemployment and receipt of government assistance. The dependent variables included age at first drink, frequency of drinking, amount of drinking, and a composite heavy-drinking index. Eighty-three percent of the respondents indicated that they had drunk alcohol and 57% had had their first drink by age 12. Gender and grade in school were significant predictors of alcohol use for all four dependent variables. Time spent in social activities was significant in predicting all but age at first drink. Religiosity was a significant predictor for only one dependent variable--age at first drink. The SES measures were also weak predictors of drinking behavior. Policy implications and directions for future research are discussed.

Assessment of the optimal anticoagulant solution for storage of whole blood samples prior to measurement of platelet-associated IgG.

The complexity of assays used to measure platelet-associated IgG (PAIgG) often requires blood samples to be sent to a central laboratory, In order to determine the optimal storage conditions, we measured PAIgG, platelet recovery, and platelet size serially over several days in whole blood samples obtained from healthy individuals. Blood was collected into EDTA, acid-citrate-dextrose (ACD) and citrate-phosphate-dextrose-adenine (CPD-A) with and without the fixative paraformaldehyde (P). The level of PAIgG remained with normal limits in all samples stored for up to six days in the ACD, the CPD-A and the CPD-A-P samples. The least drop in platelet count and change in platelet size occurred in the ACD and CPD-A samples. Blood collected into EDTA plus paraformaldehyde was less satisfactory, with PAIgG rising by day three in some samples, and a decline in the platelet count occurring by day two. Specimens collected into EDTA alone were least satisfactory, with a rise in PAIgG by 24 hours after collection. Collection of whole blood into either ACD or CPD-A and storage at 22 degrees C allows a good recovery of platelets whose level of PAIgG is unchanged for up to six days.