Polypharmacy and the risk of potentially inappropriate medications among the elderly in Trinidad and Tobago

Objective: The primary objective of this study was to assess the frequency, extent and complications of polypharmacy in elderly patients using Beer's criteria. Design and Methodology; A cross-sectional study was conducted at the outpatient pharmacy of the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago. Interviewer ­ administered questionnaires were used to collect data from 120 participants aged 65 years and above. The questionnaire was specifically designed to gather information regarding the participants' demographics, medical information and the various medications the participants were using at the time of the study. The data collected was entered in SPSS for analyses. Result: The results of the study have shown that the occurrence of polypharmacy was 54.2%, while the use of potentially inappropriate medications was (24.2%) among the study population. It was also shown that age, ethnicity and the number of doctors visited by participants had a significant effect on the occurrence of polypharmacy (with p values of 0.003, 0.003 & <0.001 respectively). Also, it was observed that polypharmacy was a main factor associated with potentially inappropriate medications (p value 0.012). Conclusion: The results of this study indicated a high prevalence of polypharmacy and potentially inappropriate medication use among the study population.

Trends of lack of health insurance among US adults aged 18-64 years: findings from the Behavioral Risk Factor Surveillance System, 1993-2014.

OBJECTIVE: To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18-64 years) in 50 states and the District of Columbia (DC). STUDY DESIGN: Cross-sectional surveys. METHODS: We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18-64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993-2010 and 2011-2014 due to methodologic changes in the BRFSS. RESULTS: From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0-24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2-10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state. CONCLUSIONS: The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18-64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population.

Nutritional status at presentation, comparison of assessment tools, and importance of arm anthropometry in children with cancer in India.

BACKGROUND: In India, approximately 40,000 new cases of cancer in children are diagnosed each year. However, there are no good studies analyzing their nutritional status. Also, since accurate and sensitive nutritional assessment is critical for optimal clinical outcomes through timely remediation of malnutrition, it is important to assess the relative sensitivity and feasibility of commonly used nutritional screening tools. METHODS: This observational study analyzed height/length (cm), weight (kg), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) as well as their Z-scores or percentiles, albumin levels and history of weight loss at diagnosis in children aged 2-15 years being treated for cancer between November 2008 to December 2013. Body mass index (BMI) and arm muscle circumference (AMC) were calculated respectively from height and weight, and MUAC and TSFT. RESULTS: A total of 1693 new patients were enrolled; 1187 had all anthropometric measurements performed. The prevalence of malnutrition was 38%, 57%, 76%, 69% and 81% on the basis of BMI, TSFT, MUAC, AMC, and arm TSFT + MUAC respectively with the highest prevalence in solid abdominal tumours. Addition of BMI and serum albumin to arm anthropometry increased the proportion classified as severely nutritionally depleted by a mere 2% & 1.5% respectively. Positive history of significant weight loss additionally identified 16.5% at nutritional risk over arm anthropometry. CONCLUSIONS: The prevalence of malnutrition in Indian children with cancer at presentation is very high ranging from 40% and 80% depending on the method used for assessment, being higher with MUAC and lowest with BMI. Either MUAC alone or TSFT + MUAC (wherever feasible) should be used for screening for malnutrition in children with cancer at diagnosis to plan timely nutritional interventions, reduce the treatment-related morbidity and optimise their chance of long-term cure.

Study on relationship between the nutritional status and dental caries in 8-12 year old children of Udaipur City, India.

BACKGROUND: The future health of individuals depends on the well being of the children of today. Proper nutrition for children is very important. The most commonly used index of obesity and over weight is Body Mass Index. The growth of children should be monitored using the Body Mass Index (BMI) and risk factors assessed through a dietary and physical activity history. The increase in obesity is attributed to increased carbohydrate consumption among children. Obesity and caries are both diet-based conditions that share a cause that is, excessive ingestion of fermentable carbohydrates. OBJECTIVE: This study was undertaken to determine the association of nutritional status with dental caries in 8 to 12 year old children of Udaipur city. METHOD: The present study was conducted on a random sample of 1000 boys and girls, aged 8-12 years. The children were selected from schools located in the Udaipur City, Rajasthan. The schools examined were of government and private sector schools in Udaipur city. The children from schools of Udaipur city was taken in the study with male, female and age group ratio as per distribution in population. A proforma was used to record children's age, gender, school, year, height, weight, parental income and dental caries status. Statistical analysis was done using Statistical Package of Social Science (SPSS Version 15; Chicago Inc., USA). RESULT: It was found that caries free individuals were more from normal nutritional status group with 134 (13.4 %) subjects where as only 11 (1.1 %) of subjects obese children were found caries free. CONCLUSION: Study shows that the children with normal BMI for age had more caries in their primary teeth, as well as in their permanent teeth, than the overweight children.

Fluoride concentration in community water and bottled drinking water: a dilemma today.

BACKGROUND: Because of the potential for contamination of municipal water supplies, people appear to be turning to alternative sources for their pure drinking water. OBJECTIVES: The present study analyzed the fluoride concentration in community water and bottled drinking water sold in Faridabad city. METHODS: A comparative evaluation of fluoride content in community water supply and bottled drinking water was done using ion-selective electrode method. The community water samples were collected from six different areas (i.e. north zone, south zone, east zone, west zone and central zone) in the city from public health water supply taps while bottled drinking water samples were randomly picked from grocery shops or supermarkets. RESULTS: The fluoride concentration in the community water supply in this study ranges from 0.11 to 0.26 mg/L with mean fluoride concentration of 0.17 mg/L. The mean concentration of fluoride in bottled drinking water was 0.06 mg/L. The differences observed between mean of two water samples was statistically significant. CONCLUSION: The results obtained from the present study clearly state that the fluoride concentration was insufficient in community water supply from all the areas and also was deficient in bottled drinking water sold in Faridabad city. So, Alternative sources of fluorides should be supplemented for optimal dental benefits from the use of fluoride.

Preventing dental caries in children: Indian scenario.

The prevalence of dental caries in developing countries like India is increasing to an alarming level in contrast to developed countries where it has decreased because of variety of preventive measures at the community and individual level. There is no State or Centre funded programs for prevention of dental diseases in India. The present review enlists the targeted prevention of dental caries in permanent teeth of 6 to 16 years old children presenting for dental care.

Obstetric trainees' experience in VBD and ECV in the UK.

A survey of 100 obstetric trainees was performed to determine the level of experience in vaginal breech delivery (VBD) and external cephalic version (ECV) in the UK. The response rate was 80%. Sixty-four of the respondents were in their 4th or 5th year of old-style 'Calman' specialist registrar training, with the majority having had > or =5 years of experience in obstetrics including overseas experience. A total of 15 had performed less than five, 12 between five and ten, and 53 more than ten VBDs. In spite of limited training, 80% of the trainees felt confident in performing vaginal breech deliveries and were happy to offer VBD as an option in the future. All the respondents offered ECV to their patients and 63% had undergone practical training. Training in VBD should be continued in all settings and it should be a part of routine skills and drills teaching.

Imaging of paediatric liver tumours with pathological correlation.

Paediatric hepatic tumours are relatively rare with malignant lesions being twice as frequent as benign neoplasms and are mostly metastases. Imaging has a significant role in the evaluation of most paediatric liver tumours. Differentiating benign from malignant tumours is important as it significantly affects treatment decisions. We present the characteristic radiological and pathological features of the most common paediatric liver tumours.

Depression and anxiety among US adults: associations with body mass index.

BACKGROUND: Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors. METHODS: We analyzed the data collected from 177,047 participants (aged>or=18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software. RESULTS: The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m(2)), in women who were overweight (BMI: 25-<30 kg/m(2)) or obese (BMI>or=30 kg/m(2)), and in men who had class III obesity (BMI>or=40 kg/m(2)) than in those with a normal BMI (18.5-<25 kg/m(2)). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI>or=40 kg/m(2) were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m(2) were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders. CONCLUSIONS: Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

Objective and subjective outcomes in comparing three different aspheric intraocular lens implants with their spherical counterparts.

PURPOSE: To look for objective and subjective differences between three types of aspheric intraocular lens implants and their spherical counterparts. METHODS: Thirty patients were randomised to receive one of six lens implants including three aspheric lenses and their spherical counterparts. Pre and postoperative testing was carried out including visual acuity, contrast sensitivity and wavefront analysis. All patients were asked to fill in a visual function questionnaire (modification of cataract TyPE) to assess subjective differences in visual quality. RESULTS: There was no significant difference between groups for best-corrected visual acuity. Contrast sensitivity testing showed the Tecnis lens to perform better than the Cee-on Edge in all lighting conditions with significant differences at 3 and/or 6 cycles/degree in three out of four lighting conditions. No significant differences in contrast sensitivity were seen between the other lens pairs. All aspheric lenses showed less spherical aberration than their spherical pairs with statistical significance reached in two out of three pairs (the Ceeon Edge vs Tecnis, and Acrysof Natural vs IQ). The questionnaire revealed no evidence of improved subjective vision with the aspheric lenses compared to the spherical lenses. CONCLUSIONS: This pilot study concurs with previously published trials in showing decreased spherical aberration and improved contrast sensitivity with aspheric lenses compared to spherical lenses. There was no evidence that the patients implanted with aspheric lenses rate their quality of vision higher than those implanted with spherical lenses. Study numbers were small and larger numbers may be required to demonstrate statistical differences in subjective data.

Activation of apoptotic processes during transition from hypertrophy to heart failure in guinea pigs.

Changes in oxidative stress and apoptotic process were studied during the progression of a compensated hypertrophy to a decompensated heart failure in guinea pigs. Banding of the ascending aorta resulted in heart hypertrophy. At 10 wk, ventricle-to-body weight ratio and thickness of the interventricular septum as well as the left ventricular wall were increased significantly. Although fractional shortening and ejection fraction were decreased, there were no signs of heart failure. Furthermore, there was no increase in wet-to-dry weight ratios for the lungs and liver at this stage. However, at 20 wk, heart failure was characterized by a significant depression in heart function as indicated by a decrease in fractional shortening, and ejection fraction and a lesser increase in wall thickness from diastole to systole. Animals also showed clinical signs of heart failure, and the wet-to-dry weight ratios of the lungs and liver were significantly higher. Cardiomyocyte oxidative stress was significantly higher in the 20-wk aortic-banded group. The ratio of Bax to Bcl-xl showed an increase at 10 wk, and there was a further increase at 20 wk. Mitochondrial membrane potential in the aortic-banded animals was significantly decreased at 10 and 20 wk. Cytochrome c levels were higher in the cytosol compared with the mitochondria, leading to a considerable increase in the expression of p17 subunit of caspase-3. At 20 wk, both early and late stages of apoptosis were observed in isolated cardiomyocytes. It is suggested that an increase in oxidative stress initiates mitochondrial death pathway during the hypertrophic stage, leading to apoptosis and heart failure at a later stage.

Controlled FiO2 Therapy to Neonates by Oxygenhood in the Absence of Oxygen Analyzer.

BACKGROUND: A study was conducted to evaluate a system of standardizing the oxygen concentration inside the oxygen hood and to develop guidelines for controlled FiO2 administration by changing size of the hood, lid position on the hood and the oxygen flow rate, without an oxygen analyzer. The effect of low flow rates on carbon dioxide (CO2) retention was also studied. METHOD: A dummy patient and thirty neonates, requiring oxygen to be delivered through head box, constituted the material for the study group. Oxygen content in the head box was measured using a standard oxygen analyzer while the size of head box, flow rate and lid position were changed independently and in combination. The head boxes were tested on a dummy patient. These results were analyzed, and applied to thirty neonates requiring oxygen therapy using a head box. RESULT: Volume of headbox had an inverse relation with the oxygen concentration inside the headbox and smaller sized headbox achieved more predictable oxygen concentration at all flow rates. Maximum difference in oxygen concentration by varying the lid position was seen in the large headbox. Keeping the variables constant, oxygen concentration was significantly lower in babies as compared to dummy. No significant CO2 retention was found at a flow rate of four litres per minute (lpm) in small and three lpm in a medium and large head box respectively, while lower flow rates were associated with CO2 retention. CONCLUSION: It is possible to predict the oxygen concentration inside the head box without the use of oxygen analyzer. Larger head box and higher lid position, results in lower oxygen concentration, at a given oxygen flow rate. Oxygen concentration achieved in babies is lesser than the concentration achieved in a dummy. Flow rates of less than four lpm in small and three lpm in medium and large sized head boxes are associated with CO2 retention. These results are not applicable to infants weighing less than 2 kg.

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography.

AIM: To compare the performance of oral fundus fluorescein angiography with a confocal scanning laser ophthalmoscope (SLO) with intravenous fundus fluorescein angiography (IVFFA) with a fundus camera in the assessment of sight-threatening diabetic retinopathy. PATIENTS AND METHODS: A total of 25 patients undergoing IVFFA to investigate their diabetic retinopathy were recruited. Participants returned 1 week later and an oral angiogram with the SLO was performed. Six facets of the oral and intravenous angiograms were scored and compared: visualization of the foveal avascular zone (FAZ); branch retinal identification; macular leakage; identification of microaneurysms in areas of macular leakage; peripheral nonperfusion, and leakage from neovascular complexes. RESULTS: Compared to IVFFA, the FAZ was unreliably visualized with oral angiography (Kappa 0.1, 95% CI 0-0.3). In contrast, macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), identification of microaneurysms in areas of macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), and neovascular complexes (Kappa 1.0) were reliably seen. Analysis of the visualization of peripheral nonperfusion was complicated by the finding that profuse dye leakage from neovascular complexes obscured the view of the peripheral retina. If the five angiograms in which this occurred were excluded, oral angiography identified 23 of the 24 eyes in which significant nonperfusion was found on IVFFA. CONCLUSION: Oral angiography with the SLO can provide high-quality angiograms that allow judgments to be made about the presence of treatable diabetic maculopathy, proliferative diabetic retinopathy, and peripheral nonperfusion. In the presence of coexisting macular oedema, it proved to be an unreliable technique with which to investigate foveal ischaemia.

Thermal and spectroscopic studies on sorption of nickel(II) ion on protonated baker's yeast.

Protonated form (Hy) of yeast was subjected to thermal analysis (TGA and DTG) in the temperature range 60-800 degrees C. Chemically bound water volatilizes around 200 degrees C and the matrix undergoes extensive oxidative decomposition at 450 degrees C, the weight loss reaching 75% at 800 degrees C. The sorption capacity of the matrix for nickel(II) ion increases on heat treatment from 60 to 200 degrees C (from 16.9 to 25.0 mg/g), but was reduced on heating to higher temperatures at an initial nickel(II) ion concentration of 1200 mg/g. The FTIR spectra of Hy and nickel(II) ion saturated yeast, indicated that biosorption occurs on the sugar and nucleic acid regions, possibly involving --COOH and --NH groups.

Photostabilizers for azadirachtin-A (a neem-based pesticide).

Photostability of azadirachtin-A (a neem based pesticide) has been studied without and with adding stabilizers such as ter. butyl-p-cresol, 8-hydroxy quinoline and ter. butyl hydroquinone as thin film on glass surface and on leaf surface under sunlight and UV light. Half-life of azadirachtin has been found to be 48 min and 3.98 days as thin film under UV light and sunlight and 2.47 days on leaf surface, respectively. 8-Hydroxy quinoline and ter. butyl hydroquinone have been found effective in controlling degradation of azadirachtin under both sunlight and UV light with half-life of 44.42 and 35.90 days under sunlight, and 55.80 and 48.50 h under UV light, respectively. Whereas ter. butyl-p-cresol has been found effective A only under sunlight. Significant decreases in antifeedant and insect growth regulatory activity against third instar larvae of Spodopterra litura has been observed with azadirachtin when exposed to sunlight and UV light. However, by the addition of above stabilizers, the biological activity of azadirachtin-A has been retained even after 24 h of irradiation under UV light and up to 30 days of exposure to sunlight.