Avoidance behaviour of aquatic macroinvertebrates for real-time detection of micropollutant surge in wastewater effluents.

Micropollutants are regularly detected at the outlets of wastewater treatment plants (WWTPs). Across urban and industrial WWTPs, monitoring directives only require assessment for a handful of chemicals via sampling methods that fail to capture the temporal variability in micropollutant discharge. In this study, we develop a biotest for real-time on-line monitoring of micropollutant discharge dynamics in WWTPs effluents. The selected biomonitoring device ToxMate uses videotracking of invertebrate movement, which was used to deduce avoidance behaviour of the amphipod Gammarus fossarum. Organism conditioning was set up to induce a state of minimal locomotor activity in basal conditions to maximise avoidance signal sensitivity to micropollutant spikes. We showed that with a standardised protocol, it was possible to minimise both overall movement and sensitivity to physio-chemical variations typical to WWTP effluents, as well as capture the spikes of two micropollutants upon exposure (copper and methomyl). Spikes in avoidance behaviour were consistently seen for the two chemicals, as well as a strong correlation between avoidance intensity and spiked concentration. A two-year effluent monitoring case study also illustrates how this biomonitoring method is suitable for real-time on-site monitoring, and shows a promising non-targeted approach for characterising complex micropollutant discharge variability at WWTP effluents, which today remains poorly understood.

Hypertension in the elderly.

The incidence of definite hypertension increases with advancement of age, and one third of the elderly population is affected. Isolated systolic hypertension is frequent in this population (10 to 12 percent in subjects between 65 and 74 years of age). The role of hypertension as a cardiovascular risk factor has been confirmed in the elderly population by the increase in cerebrovascular accidents, and by the incidence of myocardial infarction with the rise in blood pressure. The relationship between elevated diastolic and systolic blood pressure and mortality rates in the elderly is also well documented (Framingham). Effective treatment of hypertension significantly reduces the risk of associated complications: cardiovascular death, congestive heart failure, and stroke. However, the goal of antihypertensive therapy in the elderly should be not only to reduce morbidity and mortality rates, but also to do so without adverse effects on the functional well-being of patients.

Prevalence of diabetes and effect on quality of life in older French living in the community: the PAQUID Epidemiological Survey.

OBJECTIVES: To evaluate the prevalence of diabetes mellitus in older French subjects and to examine the different aspects of quality of life in an older diabetic population. DESIGN: From a random sample of 2792 people older than age 65 living in the community, a diabetic sample was selected using three items from a questionnaire: Are you diabetic? Are you on a diabetic diet? What kind of medications do you take daily? Validation of the questionnaire was carried out previously to correct the observed prevalence. MEASUREMENTS: The questionnaire assessed social and demographic aspects, physical, mental, and subjective health, and functional disabilities. Because quality of life assessment was mainly subjective, demented subjects were excluded. RESULTS: The diabetic group consisted of 237 subjects from the older sample of 2792 (8.5%). No age difference was demonstrated between the two groups (mean, distribution), but the male/female ratio was significantly higher in those with diabetes (49.4% vs 39.3%, P = .003). Corrected prevalence of diabetes was 10.3%. After exclusion of demented subjects, 230/2726 people were investigated. Diabetic subjects were heavier (P < .001), had higher systolic blood pressure (P < .001), and had more frequent symptoms of ischemic heart disease (P < .001) and painful peripheral arterial disease (P < .001) and dyspnea (P < .001), but antecedents of stroke were similar in both groups. Diabetics were more often lacking in autonomy according to the IADL Lawton scale (P < .001), Rosow and Breslow scale (P < .001), and Mobility scale (P = .043), but not according to the Katz ADL scale. They more often exhibited symptoms of depression on the CES-D self-rating scale (21.3% vs 12.7%, P < .001), but evaluation of cognitive function was similar in both groups. Thirteen percent of diabetics, compared with 7.6% of non-diabetics, were unsatisfied with their own situation (P = .002). Health was rated as fair, bad, or very bad by 67.8% of diabetics compared with 49% of non-diabetics (P < .001). Diabetics rated themselves as feeling worse than others (15.3% vs 9.2%, P < < .001) and worried more about their health status (78% vs 63%, P < < .001). CONCLUSION: The observed prevalence of diabetes in older French people living in the community was 8.5%. Quality of life in older diabetics was poorer than that of other people of the same age.

A comparison of the effects of vitamin B12 and aspirin in three experimental pain models in rats and mice.

The effects of vitamin B12 are compared to those of aspirin and 0.9% saline in three different experimental pain models in rats and mice; an electric shock test, the hot-plate test, and the phenylbenzoquinone writhing test. Neither cyanocobalamin nor hydroxocobalamin showed any antinociceptive activity in any of the three tests at any of the doses used, whether the drug was administered as a single injection or as a series of daily injections lasting 7 days. These results run counter to those of clinical trials in man, though close scrutiny of the experimental procedures used in these trials often reveals a lack of rigor which casts doubts on their validity. This consideration, together with the negative findings reported here, suggests that the clinical use of vitamin B12 as an analgesic may be inappropriate.

31P magnetic resonance spectroscopy of human liver in elderly patients: changes according to nutritional status and inflammatory state.

Magnetic resonance spectroscopy (MRS) was used to determine the phosphorylated metabolite content in the liver of elderly patients in various nutritional states: normal, with protein deprivation, and with acute inflammatory syndrome. 31P-MRS investigations were performed at 1.5 T, and localized liver spectra were recorded using a two-dimensional chemical shift imaging sequence. Comparison to control spectra recorded on 10 healthy volunteers (age, 30.5 +/- 2.1 years) showed that the aging process does not significantly modify 31P-MRS liver spectra. Patients with protein deprivation exhibited a higher value than controls for the phosphomonoesters/nucleoside triphosphates (PME/NTP) ratio (P < .05). This increase was not due to the decrease of NTP, since the ratio of inorganic phosphate to NTP (Pi/NTP) remained constant. A decrease in the phosphodiesters to NTP (PDE/NTP) ratio (P < .04) contributed to the observed increase in the PME/PDE ratio (P < .01). In contrast, no significant difference in 31P-MRS spectra was found between elderly patients with hypoalbuminemia associated with inflammatory syndrome and the control group. We conclude that elderly patients with protein deprivation displayed changes in the level of phosphorylated metabolites in the liver that were not observed in the case of inflammatory syndrome despite lower serum albumin (Alb) concentrations.

Prospective audit of diabetes care and outcomes in a group of geriatric French care homes.

BACKGROUND: In geriatric institutions, diabetes prevalence varies from 10 to 20%. However, little is known about patterns of care and their outcomes. To assess both, an 18-month prospective audit was conducted in 240-bed nursing and 80-bed residential care homes. METHODS: In diabetic subjects, items of care were compared to the corresponding French guideline end-points. Dependency in activities for daily living (ADL) was evaluated at inclusion and at the end of the survey for survivors. Diabetic residents were compared to others for age, sex, mortality and one-year change of iso-resource group ranging (IRG), a need-of-care scale. RESULTS: The 73 diabetic patients among 494 residents (14.8%) were not different from the others for age and sex (respectively age: 76.0 y +/- 7.9 compared to 78.2 y +/- 9.4; M/F sex ratio: 0.59 compared to 0.31). Oral hypoglycemic agents were prescribed in 29 (39.7%) and insulin in 26 (35.6%). Control of diabetes with HbA(1C) was in keeping with guidelines in 23.3%, HbA(1C) was never performed in 26%, and > 8% in 20.5%. Rates of items of guidelines that were never addressed ranged from 2 to 80%. During the stay, ADL dependency worsened in diabetic patients, but their one-year change in GIR range was not different from that in the others. Mortality was 30.1% compared to 37.1% in the others (NS). This mortality rate and the evolution of functional dependency were not influenced by the quality of diabetes control. CONCLUSION: In these disabled elderly patients, diabetes management needs to be improved. However, mortality and the evolution of functional dependency were similar in diabetic people than in others. Interventional studies for controlling with reference to geriatric evaluation, i.e. function, nutrition and mental health, are needed in order to establish specific guidelines based on benefit-burden analysis.

Morphological study of the aging human peripheral nerve.

The superficial peroneal nerve from 46 elderly patients was studied by light and electron microscopy. Like most elderly people, these patients displayed evidence of varying degrees of peripheral nervous system dysfunction, but they were not suffering from any disease known to alter the peripheral nerve. A quantitative study showed that myelinated fiber loss predominated in the large diameter group. In the majority of cases, clusters of regenerating myelinated fibers were numerous. On the other hand, Wallerian-like degeneration aspects, segmental demyelination figures and axonal organelle accumulation were relatively rare. Unmyelinated fibers were also notably damaged in most cases. There was moderate reduplication of endoneurial vascular basement membrane.

[Vitamin B12, an analgesic vitamin? Critical examination of the literature]. / La vitamine B12, une vitamine antalgique? Etude critique de la littérature.

Since 1950 it would seem that in some countries vitamin B12 has been regarded as a painkilling vitamin. Only one of the 94 published clinical trials fails to point to this conclusion, but none of these trials meets current methodological requirements for investigation of an analgesic. The hypothesis that vitamin B12 possesses painkilling properties must therefore be questioned, especially as no anti-nociceptive effect is reported in animal experiments.

[Prevalence of dementia in Gironde (France)]. / Prévalence de la démence en Gironde (France).

The objective of the study is to estimate the prevalence of dementia using the data of the Paquid cohort. A sample of 3,149 subjects aged 65 years and older living at home or in institution was randomly chosen in Gironde (France). A questionnaire and psychometric tests were used to evaluate cognitive functioning and the presence of dementia was assessed through DSM III Diagnostic and Statistical Manual of mental disorders (ed. III) criteria. Hachinski scale and work group NINCDS-ADRDA criteria were applied to confirm the presence of dementia and identify Alzheimer's disease. Overall prevalence was estimated to 4.3%. No difference was found between men and women. The prevalence increased with age with nearly a doubling every 5 years of age. In institution, dementia frequency remained stable. The relative risk of a demented subject to be institutionalized with regard to a non demented subject decreased with age.

Red cell filterability and chronic renal failure.

Filterability has been studied during chronic renal failure (with creatinin level above 350 mumol/l); red cells were washed thrice with 9 g/l NaCl or 40 g/l human serum albumin), adjusted to give a PCV of 0.3 and filtered on polycarbonate sieves with pore sizes of 5 micrometer. In the uremic patients groups, the results are heterogeneous and show a significant reduction of the red cell filterability. The filtration time is not well correlated with the degree of uraemia but with the haemoglobin level.

[Plasma, red cell, and cerebrospinal fluid folate in Alzheimer's disease]. / Variations des folates plasmatiques, intraérythrocytaires et intrarachidiens, dans la démence sénile de type Alzheimer.

This study compares plasma, red cell, and cerebrospinal fluid (CSF) folate levels in subjects with mild or moderate Alzheimer's disease (AD) of senile onset and in non-demented control subjects. Twelve subjects with mild or moderate (Folstein's Mini-Mental-State-MMS--between 10 and 23) AD (DSM3 R criteria) and 12 control subjects without dementia and with MMS above 23 were included. To avoid any change in plasma folate levels due to dehydration, all dehydrated subjects were excluded. Were also excluded all subjects obviously suffering from malnutrition or alcoholism, or taking drugs likely to interfere with folate metabolism. Changes in folate levels due to posture or prolonged venous occlusion were carefully avoided. Patients with AD were 5 males and 7 females aged (Mean +/- SD) 80.2 +/- 5.7 years, MMS 14.8 +/- 2.6; controls were 7 males and 5 females aged 78.9 +/- 7.2 y, MMS 28.3 +/- 1.5. The two groups were not statistically different for these variables, except for the MMS. Plasma folate levels were lower (p < 0.006) in patients with AD (4.5 +/- 1.5 micrograms/l) compared with controls (7 +/- 2.2 micrograms/l). Red cell folate levels were lower (p < 0.007) in patients with AD (183.7 +/- 91.1 micrograms/l) compared with controls (300.4 +/- 96.1 micrograms/l). CSF folate levels were lower in AD (18.9 +/- 9.7 micrograms/l) than in controls (21.9 +/- 8.2 micrograms/l) but the difference was not statistically significant (p > 0.05). Our results indicate poorer nutrition in patients with AD.

[Indications and limitations of anticoagulant treatment in elderly patients]. / Indications et limites des traitements anticoagulants chez les personnes âgées.

Anticoagulants constitute the rational treatment of thromboembolic accidents occurring in elderly people, but they are often not prescribed because of the risk of haemorrhage. The chronological age by itself is not a contra-indication, the limitations being the diseases associated with ageing. Anticoagulants may be used as curative treatment in atrial fibrillation with dilated left atrium (greater than 45 mm at echocardiography), in myocardial infarction, embolic strokes and complicated arteritis. They may also be used as preventive and curative treatment in phlebitis and pulmonary embolism. The complications of anticoagulant therapy will be better prevented by using the international normalized ratio and by prescribing doses that are adequate for each indication.

Audit of percutaneous endoscopic gastrostomy in long-term enteral feeding in a nursing home.

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is now easily used in the event of long-term enteral nutrition. Tolerance of long-term enteral feeding has been documented in different populations but the documentation is incomplete in the case of older and frail people. Our aim was to describe early and late tolerance in this population, and to propose ways in which it could be improved. DESIGN: Retrospective study in two parts: tolerance and quality of care; case-control study for tolerance. SETTING: A nursing home with 240 beds in south-west France. who had undergone PEG insertion between January 1990 and June 1994. Fifty-eight patients were involved, 12 under 65 years (48 +/- 10.6), and 46 over 65 (80.7 +/- 9.3). The gastrostomy insertion was performed because of a vegetative state in 6 patients, swallowing difficulties in 31 and anorexia in 21. A control group was gathered in December 1996, which included all patients for whom the question of nutritional support was mentioned books but where no artificial nutrition had been implemented due to the patients' or families' refusal or to a staff decision. This group included 50 patients, 5 younger than 65 years (54 +/- 8.3), and 45 older (84.7 +/- 7.6). In 22 cases the nutritional problem was swallowing difficulties and in 28 cases anorexia. Pressure ulcers were present before insertion in 34 patients in the PEG group and in 7 of the control group (p < 0.001). MAIN OUTCOME MEASURES: Prognosis, early and late cutaneous digestive (ileus, vomiting, gastroesophageal reflux) and pulmonary (bronchorrhea, dyspnea and aspiration pneumonia) complications for PEG and control groups, and patients with signs of poor behavioural tolerance of PEG were recorded in the chart. Audit of quality of care was performed in the PEG group using eight criteria: two concerned the pre-insertion period, two the early follow-up and four the long-term follow-up. RESULTS: Early mortality (4 weeks) was 13.8% in PEG (vs 10%, NS), mid-term mortality (between 4 and 8 weeks) was 12.1% (vs 14%, NS) and late mortality was 19.0% (vs 42.0%, length of follow-up 63.4 +/- 42.1 weeks compared to 53.1 +/- 63.8 weeks, NS). The duration of follow-up of the living patients was 71.6 +/- 61.8 weeks in PEG compared to 48.0 +/- 70.5 in the control group. Only 20% in PEG were free of any cutaneous complication around the insertion site, and 8 abscesses occurred during the first week. Pulmonary complications occurred in 39% of the PEG group (vs 30.0, NS). Aspiration pneumonia was significantly associated with swallowing difficulties in both groups (p < 0.05). Vomiting occurred for 15.5% of the PEG group (vs 12%, NS), ileus in 13.8% (vs 6%, NS). Gastroesophageal reflux was found in 2 PEG patients, compared to 1 case among the control patients. Pressures sores were healing in 20 out of 34 patients in the PEG group (vs 2 out of 7) and new ulcers appeared in 6 out of 24 (vs 8 out of 43). Fifteen (25.8%) of the PEG patients attempted to withdraw the tube.