RESUMO
BACKGROUND: Existing evidence suggests that proinflammatory cytokines play an intermediary role in postchemotherapy cognitive impairment. This is one of the largest multicentered, cohort studies conducted in Singapore to evaluate the prevalence and proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. PATIENTS AND METHODS: Chemotherapy-receiving breast cancer patients (stages I-III) were recruited. Proinflammatory plasma cytokines concentrations [interleukin (IL)-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, interferon-γ and tumor necrosis factor-α] were evaluated at 3 time points (before chemotherapy, 6 and 12 weeks after chemotherapy initiation). The FACT-Cog (version 3) was utilized to evaluate patients' self-perceived cognitive disturbances and a computerized neuropsychological assessment (Headminder) was administered to evaluate patients' memory, attention, response speed and processing speed. Changes of cognition throughout chemotherapy treatment were compared against the baseline. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations on self-perceived cognitive disturbances and each objective cognitive domain. RESULTS: Ninety-nine patients were included (age 50.5 ± 8.4 years; 81.8% Chinese; mean duration of education = 10.8 ± 3.3 years). Higher plasma IL-1ß was associated with poorer response speed performance (estimate: -0.78; 95% confidence interval (CI) -1.34 to -0.03; P = 0.023), and a higher concentration of IL-4 was associated with better response speed performance (P = 0.022). Higher concentrations of IL-1ß and IL-6 were associated with more severe self-perceived cognitive disturbances (P = 0.018 and 0.001, respectively). Patients with higher concentrations of IL-4 also reported less severe cognitive disturbances (P = 0.022). CONCLUSIONS: While elevated concentrations of IL-6 and IL-1ß were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment. This study is important because cytokines would potentially be mechanistic mediators of chemotherapy-associated cognitive changes.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Biomarcadores Tumorais/sangue , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Transtornos Cognitivos/diagnóstico , Citocinas/sangue , Mediadores da Inflamação/sangue , Neoplasias da Mama/sangue , Neoplasias da Mama/psicologia , Transtornos Cognitivos/sangue , Transtornos Cognitivos/induzido quimicamente , Feminino , Seguimentos , Humanos , Imunoensaio , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos ProspectivosRESUMO
Objectives: To evaluate a newly developed, self-expandable anti-reflux Trumpet (ART) stent customized for cardio oesophageal junctional (COJ) cancer on the feasibility of deployment, stent migration, quality of life, and symptom relief. Design: Prospective case series, Proof of concept pilot study. Setting: Tertiary Health Care Center, Hospital Tuanku Jaafar, Seremban, Malaysia. Department of Surgery. Participants: A total of 17 patients diagnosed with advanced COJ tumour and who had never undergone any surgical, endoscopic, or chemoradiotherapy and indicated for stenting were recruited. Interventions: The study period was over nine months, and follow-up was one-month post-stenting. Main outcome measures: Endpoint measures were feasibility of deployment of the new design, symptoms relief, early stent migration, early complication, GERD Q score, and (QOL)assessment. Results: The ART stent was inserted successfully in all cases (17/17, 100%). There were two stent migrations due to the flexibility of the stent at the neck. There were no early or post-stenting one-month complications associated with the procedure. A good flow of contrast was seen in all the stents deployed. GERD Q score was low in all patients pre and post-stenting. Post-stenting there was a relief of dysphagia, weight gain, and a 60% improvement in QOL score. Conclusions: ART stent is feasible and technically successful in COJ tumours. It provides good symptom relief, improves the QOL, and has minimal early complications. Funding: None declared.
Assuntos
Carcinoma , Neoplasias Esofágicas , Refluxo Gastroesofágico , Humanos , Qualidade de Vida , Projetos Piloto , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/complicações , Cuidados Paliativos/métodos , Refluxo Gastroesofágico/terapia , Refluxo Gastroesofágico/complicações , Stents , Resultado do TratamentoRESUMO
BACKGROUND: Malignant melanoma, generally described as incurable, is notoriously refractory to chemotherapy. The mechanisms contributing to this have not yet been defined and the contributions of drug efflux pumps, implicated in chemo-resistance of many other cancer types, have not been extensively investigated in melanoma. METHODS: In this study, expression of multi-drug resistant (MDR1/P-gp and MRP-1) proteins was examined, by immunohistochemistry, in archival specimens from 134 melanoma patients. This included 92 primary tumours and 42 metastases. RESULTS: On assessing all specimens, MRP-1 and MDR1/P-gp expression was found to be common, with the majority (81%) of melanomas expressing at least one of these efflux pumps. Although there is significant association between expression of these pumps (P=0.007), MRP-1 was found to be the predominant (67% of cases) form detected. chi(2) analysis showed significant associations between expression of MRP-1 and/or MDR1/P-gp and the aggressive nature of this disease specifically increased Breslow's depth, Clark's level and spread to lymph nodes. This association with aggressiveness and spread is further supported by the observation that a significantly higher percentage of metastases, than primary tumours, express MRP-1 (91% vs 57%; P<0.0001) and MDR1/P-gp (74% vs 50%; P=0.010). CONCLUSION: The predominant expression of these pumps and, in particular, MRP-1 suggests that they may be important contributors to the inherent aggressive and resistant nature of malignant melanoma.
Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Melanoma/patologia , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Imuno-Histoquímica , Masculino , Melanoma/metabolismo , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Estudos RetrospectivosRESUMO
AIMS: The treatment of bone metastases in breast cancer is traditionally based upon the receptor status of the primary tumour. However, retrospective studies have shown significant discordance in receptor expression between primary and metastatic tumours. Therefore, the aim of this study was to prospectively assess the incidence of discordant receptor status in primary and metastatic disease and evaluate the role of bone marrow biopsies for the reassessment of receptor status. MATERIALS AND METHODS: Nine patients with known bone metastases were assessed with both a radiologically guided bone biopsy and a bone marrow aspirate and trephine. The oestrogen receptor and progesterone receptor status of these samples was assessed and compared with the primary breast cancer. Bone and bone marrow samples were also evaluated for HER2/neu status and compared with the status of the primary tumour if available. RESULTS: Tumour cells were found in six of the nine bone metastasis specimens and five of the nine bone marrow samples. A discordance rate for the oestrogen receptor was seen in five of nine patients (56%) and for the progesterone receptor in four patients (44%). There seemed to be a correlation between bone and bone marrow biopsies. CONCLUSION: The receptor discordance rate in this study was similar to previous retrospective studies. It seems that bone marrow biopsy may be a simple, safe and well-tolerated way to obtain tissue to reassess the receptor status of metastatic breast cancer.
Assuntos
Medula Óssea/patologia , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/secundário , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Receptor ErbB-2/biossíntese , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Idoso , Biópsia por Agulha , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Neoplasias da Mama/tratamento farmacológico , Difosfonatos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Microbial fuel cell (MFC) is an emerging and promising technology, particularly in the field of wastewater treatment. The MFC capability of achieving organic removal and generating in situ electricity could make it an attractive alternative wastewater treatment technology over conventional treatment technologies. However, MFC is still far from being economically viable, especially because of the cost of the platinum (Pt) catalyst that makes possible the reaction at the cathode. In this study, we tested alternative cathode catalysts, namely sputter-deposited Cobalt (Co) and denitrifying bacteria (biocathode). The performance of these innovative cathodes was compared with that of classic Pt-cathodes. Co competed well with Pt, but further research is still required for biocathodes. However, biocathodes MFC have showed promise.
Assuntos
Fontes de Energia Bioelétrica/microbiologia , Conservação de Recursos Energéticos/métodos , Eliminação de Resíduos Líquidos/métodos , Eletricidade , EletrodosRESUMO
Bronchogenic cysts are often asymptomatic mediastinal masses that are usually diagnosed as incidental findings. Surgical resection can be performed with robotic surgery, and if repair of the airway is needed, this can be achieved by direct closure or by applying a pericardial patch. We present a case of a 45-year-old woman diagnosed with a mass in the visceral mediastinum. She had undergone resection adopting a 4-armed, completely portal robotic technique. However, the removal of the cyst had led to a large tear in the bronchus intermedius. The bronchus was then repaired with a 2.4-cm-long pericardial patch sutured with the V-lock sutures. The entire procedure was performed in a total span of 189 min, and the patient was discharged on postoperative Day 2. The robotic platform, with articulated instruments, allowed complex suturing while conversion was not required. To our knowledge, the robotic surgery has not been applied in bronchial repairs by pericardial patches, and this case is the first of its kind.
Assuntos
Brônquios/cirurgia , Cisto Broncogênico/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Brônquios/diagnóstico por imagem , Cisto Broncogênico/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Pancreatic cancer is one of the most challenging solid organ malignancies. This is due to its aggressiveness, frequent late presentation as advanced disease and chemoresistance. A better understanding of the molecular basis of its drug resistance is needed. MATERIALS AND METHODS: In this study, the first of its kind, the expression of both MDR1 P-gp and MRP-1 protein in pancreatic tumour specimens was examined by immunohistochemistry. Expression of these drug efflux pumps was examined using semi-quantitative immunohistochemistry according to the percentage of cells within the tumour, demonstrating another staining intencity. RESULTS: Overall, 93.3% of pancreatic carcinomas expressed MDR1 P-gp, approximately 31% co-expressed MRP-1 with MDR1 P-gp, while 6.7% expressed neither of these proteins. CONCLUSION: Our results show that drug efflux pumps, in particular that of MDR1 P-gp, are frequently expressed in pancreatic cancer. While a causative role for these efflux pumps in pancreatic cancer chemoresistance cannot necessarily be concluded, the information presented here should be considered when selecting chemotherapy/drug efflux pump inhibitors for future therapies.
Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Neoplasias Pancreáticas/metabolismo , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/biossíntese , Adenocarcinoma/metabolismo , Adulto , Idoso , Carcinoma Neuroendócrino/metabolismo , Colangiocarcinoma/metabolismo , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Proteínas Associadas à Resistência a Múltiplos Medicamentos/biossínteseRESUMO
For the determination of whether lung cancer clusters in families, an analysis was conducted on demographic and morbidity-mortality data, occupational and industrial experiences, and tobacco use practices for family members of 336 deceased lung cancer probands and 307 controls (probands' spouses). First-degree relatives of probands, compared with first-degree relatives of controls, showed a strong excess risk for lung cancer. Overall, male relatives of probands had a greater risk for lung cancer than did their female counterparts, and the risk was fourfold for parents of probands as compared with parents of spouses. Female relatives of probands over 40 years old were at nine times higher risk than similarly aged female controls, even among those who were non-smokers and who had not reported excessive exposure to hazardous occupations; the risk was fourfold to sixfold for heavy smokers. After control for the confounding effects of age, sex, cigarette smoking, and occupational and industrial exposures, relationship to proband remained a significant determinant of lung cancer, with a 2.4-fold greater risk among relatives of probands.
Assuntos
Neoplasias Pulmonares/genética , Adulto , Idoso , Coleta de Dados , Suscetibilidade a Doenças , Métodos Epidemiológicos , Feminino , Humanos , Louisiana , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Ocupações , Linhagem , Risco , População Rural , FumarRESUMO
Segregation analyses that allowed for variable age of onset of lung cancer and smoking history were performed on 337 families, each ascertained through a lung cancer proband. Results indicated compatibility of the data with mendelian codominant inheritance of a rare major autosomal gene that produces earlier age of onset of the cancer. Segregation at this putative locus could account for 69% and 47% of the cumulative incidence of lung cancer in individuals up to ages 50 and 60, respectively. The gene was involved in only 22% of all lung cancers in persons up to age 70, a reflection of an increasing proportion of noncarriers succumbing to the effects of long-term exposure to tobacco.
Assuntos
Neoplasias Pulmonares/genética , Adulto , Idoso , Análise de Variância , Cromossomos/fisiologia , Meio Ambiente , Saúde da Família , Feminino , Genes Dominantes/genética , Genes Recessivos/genética , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Modelos Genéticos , Linhagem , FumarRESUMO
Age has been reported as a strong risk factor for dementia. Supporting data have been derived mainly from prevalence studies, which had varied criteria and sample compositions that precluded direct comparisons, especially among those aged 85 years and older. Data regarding rates of dementia are presented based on 85 incident cases in the Bronx (NY) Aging Study, a prospective study of 488 initially nondemented, old old persons (mean age on entry, 79 years). Overall, the incidence rate over 8 years of follow-up for all-cause dementia was 3.4 per 100 per year (43% Alzheimer's disease, 30% mixed Alzheimer's and vascular, and 27% other). Incidence rose significantly, irrespective of gender, as subjects were followed up through three age intervals--ages 75 to 79 years (1.3/100 per year), 80 to 84 years (3.5), and 85 years and older (6.0). The comparable age-associated prevalence rates of dementia were 3.7%, 12.2%, and 23.9%, respectively, with an overall period prevalence of 22.8%. Additionally, there was a threefold greater mortality associated with dementia. In conclusion, despite the shortened life expectancy of demented persons, dementia is a highly prevalent condition among those aged 85 years and older. Public policy attention is warranted, since this group is the fastest growing population subgroup.
Assuntos
Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Demência/mortalidade , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
The prognostic value of pretreatment pulse pressure as a predictor of myocardial infarction and the relation of pulse pressure and in-treatment diastolic blood pressure reduction to myocardial infarction were investigated in a union-sponsored systematic hypertension control program. In a prospective study, 2207 hypertensive patients with a pretreatment systolic blood pressure greater than or equal to 160 mm Hg and/or diastolic pressure greater than or equal to 95 mm Hg grouped according to tertile of pulse pressure (PP1, < or = 46; PP2, 47 to 62; PP3, > or = 63 mm Hg) were further stratified by the degree of diastolic fall: large (L), > or = 18; moderate (M), 7 to 17; small (S), < or = 6 mm Hg. During an average follow-up of 5 years, 132 cardiovascular events (50 myocardial infarctions, 23 strokes) were observed. Myocardial infarction rates per 1000 person-years were positively related to pulse pressure (PP1, 3.5; PP2, 2.9; PP3, 7.5; PP3 versus PP1, P = .02). Wide pulse pressure was identified as a predictor of myocardial infarction (PP3 versus [PP1 + PP2]: relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.2-4.1), controlling for other known risk factors by Cox regression. A curvilinear relation (resembling a J shape) between diastolic fall and myocardial infarction was observed in patients with the widest pulse pressure, PP3 (L, 9.5; M, 3.9; S, 11.2; L versus M: RR = 2.5, 95% CI = 1.0-6.2; S versus M: RR = 2.9, 95% CI = 1.1-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Pressão Sanguínea , Hipertensão/complicações , Infarto do Miocárdio/epidemiologia , Pulso Arterial , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Análise de RegressãoRESUMO
To determine the effect of race on cardiovascular disease occurrence among treated hypertensive patients, the experience of 1,807 black and 2,962 white hypertensive patients who entered a union/management--sponsored, worksite-based treatment program (1973-1985), was evaluated. Participants had similar socioeconomic profiles, equal access to health benefits, and received standard treatment. Median duration of observation was 42 months. Blacks had 48, and whites 129, of the 177 morbid (strokes and heart attacks) or mortal cardiovascular disease outcomes. At baseline, blacks had more electrocardiographic abnormalities (32% vs. 19%, p less than 0.0001), lower mean cholesterol (218 vs. 230 mg%, p less than 0.001), smoked more (35% vs. 30%, p less than 0.001), and were less likely to be treated for hypertension before entering the program (53% vs. 58%, p less than 0.01) than whites. They were also more likely than whites to belong to unions employing less skilled workers (p less than 0.0001). Overall, all-cause mortality rates between the races were similar. However, total cardiovascular disease morbidity and mortality rates were 10.5 (whites) and 6.4 (blacks) per 1,000 person years (p less than 0.005); the difference was largely explained by higher myocardial infarction rates among older (55 years or older) white men (15.6 vs. 7.5, p less than 0.05). That advantage was not present amongst younger black persons. In fact, blacks lost more years of life before age 65 (102 vs. 64 years/1,000 persons, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
População Negra , Doenças Cardiovasculares/complicações , Hipertensão/etnologia , População Branca , Análise Atuarial , Doenças Cardiovasculares/mortalidade , Transtornos Cerebrovasculares/complicações , Estudos de Coortes , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Estatística como AssuntoRESUMO
Hypertension patients (1781), drawn from seven large employee groups in and around New York City, were studied to determine the prevalence of resistant hypertension among them. The blood pressure criteria for resistance (potential resistance) were failure to reach and maintain a blood pressure less than 160/95 mm Hg on two separate occasions during at least 1 year of treatment. Confirmed resistance required that during the same period of follow-up, in which at least two antihypertensive agents had been prescribed simultaneously, blood pressure control had not been achieved. Potential resistance during 1 year of treatment was found in 75 patients (4.2%), and confirmed resistance for the same period was found in 52 patients (2.9%). Diastolic resistance was far more common than systolic; the systolic/diastolic resistance was the rarest of all. Of the 52 patients with confirmed resistance for the first year, 33 achieved control in subsequent years. In sum, true resistance as defined by rigorous criteria pertaining to the hypotensive effects of pharmacological intervention in the general population is exceedingly rare.
Assuntos
Hipertensão/epidemiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Resistência a Medicamentos , Feminino , Seguimentos , Humanos , Hipertensão/classificação , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Cooperação do Paciente , Fatores de TempoRESUMO
Dementia is a major public health problem among the very old. Available information on incidence and prevalence is sparse and variable; however, there appears to be a higher prevalence among very old women. We present data from a prospective study of initially nondemented community-residing elderly. There were 75 incident dementia cases (up to 7 years of follow-up) of which at least 47% were probable Alzheimer's disease. Based on a proportional hazards analysis, women were over 3 times more likely to develop dementia than men despite controlling for baseline demographic, psychosocial, and medical history variables. Poor word fluency and a high normal Blessed test score at baseline were also strong predictors of dementia. We did not find age, head trauma, thyroid disease, or family history of dementia to be risk factors. A new finding is that history of myocardial infarction (MI) is associated with dementia, such that women with a history of MI were 5 times more prone to dementia than those without a history. This observation was not true for men.
Assuntos
Demência/etiologia , Infarto do Miocárdio/complicações , Idoso , Idoso de 80 Anos ou mais , Viés , Demência/epidemiologia , Feminino , Humanos , Testes de Inteligência , Masculino , Morbidade , Infarto do Miocárdio/epidemiologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores de Risco , Fatores SexuaisRESUMO
PURPOSE: Orthostatic hypotension is common among the elderly, but its relation to falls is not certain. We determined whether orthostatic hypotension, including its timing and frequency, was associated with falls in elderly nursing home residents. SUBJECTS AND METHODS: We conducted a prospective study of 844 elderly (60 years of age and older), long-stay residents at 40 facilities that were part of a multistate nursing home chain. All subjects were able to maintain weight-bearing for at least 1 minute. Orthostatic hypotension was defined as a 20 mm Hg or greater decrease in systolic blood pressure from supine to standing, as measured after 1 or 3 minutes of standing on four occasions (before or after breakfast, or before or after lunch). The outcome was any subsequent fall during a mean of 1.2 years of follow-up. RESULTS: Orthostatic hypotension was present (at least on one measurement) in 50% of the subjects but was not associated with subsequent falls. However, among subjects with a history of previous falls in the past 6 months, those with orthostatic hypotension had an increased risk of recurrent falls [adjusted relative risk (RR) = 2.1; 95% confidence interval (CI), 1.4 to 3.1 ]. The risk of subsequent falls was greatest in previous fallers who had orthostatic hypotension at two or more measurements (RR = 2.6; 95% CI, 1.7 to 4.6). The association between orthostatic hypotension and recurrent falls was independent of measured demographic or clinical risk factors for falls. The timing of orthostatic hypotension (before or after meals) did not affect the risk of falls. CONCLUSIONS: Orthostatic hypotension is an independent risk factor for recurrent falls among elderly nursing home residents. Although the benefit of treating orthostatic hypotension will require further study, it may be prudent to identify high-risk residents and institute precautionary measures.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Instituição de Longa Permanência para Idosos , Hipotensão Ortostática/complicações , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Hipotensão Ortostática/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Modelos de Riscos Proporcionais , Fatores de Tempo , Estados UnidosRESUMO
The prevalence, incidence and prognosis of recognized and unrecognized Q-wave myocardial infarction (MI) was assessed in an 8-year prospective study of 390 community-based subjects (age 75 to 85 years at entry, mean 79 years). Subjects were studied at baseline and with annual follow-up electrocardiographic (ECG) exams. At baseline, 7.9% had a history of MI without ECG evidence, 6.4% had ECG evidence of Q-wave MI without clinical history, 4.1% had both clinical history and ECG evidence and 81.5% had neither history nor ECG evidence (control subjects). After an average follow-up period of 76.2 months, the total mortality rate was 5.9/100 person-years for subjects with some evidence of MI at baseline versus 3.9 in the control group (p = 0.059). The incidence of cardiovascular disease in subjects with evidence of MI was 8.8/100 person-years versus 4.7 among control subjects (p = 0.002). During the follow-up period, 115 new Q-wave MIs occurred (50 unrecognized, rate 2.4/100; 65 recognized, rate 3.2/100). There was no difference in mortality and morbidity outcome between subjects with recognized and unrecognized MIs. Those with only a history of MI at baseline had a threefold greater risk of a new MI (recognized and unrecognized) than the control group (p = 0.003). Unrecognized Q-wave MI is a common occurrence in the "old old" with subsequent morbidity and mortality prognosis comparable to that of recognized MI. History of MI alone in this age group is also associated with an increased risk of MI, suggesting the need for better diagnostic markers of myocardial ischemia in the old.
Assuntos
Infarto do Miocárdio/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Infarto do Miocárdio/mortalidade , Cidade de Nova Iorque/epidemiologia , Prevalência , Prognóstico , Estudos ProspectivosRESUMO
The Bronx Aging Study is a longitudinal investigation of nondemented, nonterminally ill, community-residing, old old volunteer subjects, designed to assess risk factors for the development of dementia and coronary and cerebrovascular diseases. During the first five annual evaluations, total cholesterol, high-density (HDL) and low-density lipoprotein (LDL), and triglyceride levels were measured. Mean cholesterol values (+/- standard error of the mean) for subjects at baseline were significantly higher for women than for men. Respectively, the values for total cholesterol were 6.1 +/- .1 mm/L (234 +/- 3 mg/dL) and 5.3 +/- .1 mm/L (207 +/- 3 mg/dL); for LDL cholesterol, 4.1 +/- .1 mm/L (158 +/- 2 mg/dL) and 3.7 +/- .1 mm/L (141 +/- 3 mg/dl); and for HDL cholesterol, 1.2 +/- .1 mm/L (47 +/- 1 mg/dL) and 1.0 +/- .1 mm/L (38 +/- 1 mg/dL). Mean triglyceride levels were 1.5 +/- .1 mm/L (135 +/- 5 mg/dL) for women and 1.6 +/- .1 mm/L (138 +/- 5 mg/dL) for men. Further, mean values remained stable over time. However, there was considerable intraindividual change observed in a substantial proportion of subjects between initial and final determinations. Changes of at least 10% from baseline were observed in 41%, 63%, 52%, and 78% of the cohort for cholesterol, HDL, LDL, and triglycerides, respectively. Thus, single measurements appear inadequate for establishing a diagnosis of hyperlipidemia in the elderly.
Assuntos
Envelhecimento/sangue , Lipídeos/sangue , Lipoproteínas/sangue , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores de Risco , Triglicerídeos/sangueRESUMO
Orthostatic hypotension (OH) is a potential risk factor for adverse cardiovascular events, but OH is highly variable and may not be detected on a single occasion. To assess the relation between intra-individual variability of systolic orthostatic blood pressure change (DeltaSBP) and cardiovascular outcomes, an algorithm was developed to identify DeltaSBP instability using repeated supine and standing BP measurements. A cohort of 673 nursing home residents underwent baseline postural BP measurements (supine to 1 minute of standing, four times in a single day) and were followed for up to 2 years. Two groups (stable vs. unstable) were identified based on an analysis of DeltaSBP variance components. Differences in outcomes were compared via Cox survival analysis. At baseline 12.6% were unstable, defined as a one standard deviation difference of at least 20.2 mmHg between DeltaSBP readings. Unstable subjects were more likely to have OH on at least one measurement (systolic BP drop of 20 mmHg or more; 85% vs. 36%, respectively) and to be on psychotropic medication at baseline (47% vs 35%) (P-values <0.001). Other characteristics (including previous stroke) did not differ. During a mean follow-up of 10.3 months, stroke incidence was higher in unstable subjects (13.1% vs. 4.9%; P = 0.012), but ischemic heart disease and mortality rates were not significantly different (respectively, 13.5% vs. 7.4%, P = 0.115; 14.8% vs. 10.7%, P = 0.178). Survival analyses (adjusted for age, sex, psychotropic medications, body mass index, ischemic heart disease, and supine systolic pressure) confirmed a higher risk of stroke in unstable subjects (relative risk = 3.7, 95% CI: 1.6-8.4). Highly variable orthostatic BP measures may reflect impaired BP regulatory mechanisms in elders with occult cerebrovascular disease, or may directly affect cerebral blood flow. Orthostatic BP variability may be a better indicator of future stroke than a single supine or orthostatic change measure.
Assuntos
Hipotensão Ortostática/epidemiologia , Acidente Vascular Cerebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Casas de Saúde , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Decúbito Dorsal , Análise de SobrevidaRESUMO
High blood pressure (BP) defines a prognostically heterogeneous group. Because BP varies according to time, setting and means of observation, it has been postulated that BP reactivity might better predict cardiovascular disease (CVD) than does unidimensional measurements. To assess BP reactivity, the difference between pretreatment nurse (RN) and physician (MD) diastolic BP (DBP)--systematically recorded in that order--or MD-RN DBP, was obtained in 1737 previously untreated patients with sustained, RN BP greater than or equal to 160 and/or 95 mmHg. Patients stratified by tertiles of MD-RN DBP [(I) less than or equal to - 3, (II) -2 to 3 and (III) greater than or equal to 4 mmHg] were similar by sex, race, age, body mass index, cholesterol, electrocardiography, prior CVD, smoking and pretreatment or attained in-treatment BPs. During 14 years of followup, myocardial infarction (MI) incidence per 1000/year were, tertile I (3.2), II (3.7), III (7.6) (relative risk = 2.4, III vs I + II, p less than 0.05), whereas stroke incidence and non-CVD mortality were evenly distributed. By Cox survival analysis, controlling for other entry characteristics only age, sex and DBP reactivity remained predictive (p less than or equal to 0.03) of MI or total CVD. Thus, BP reactivity, probably a centrally-mediated phenomenon, identifies a subgroup of hypertensives with an increased propensity for MI despite successful BP control.
Assuntos
Pressão Sanguínea , Hipertensão/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Adulto , Determinação da Pressão Arterial/métodos , Transtornos Cerebrovasculares/epidemiologia , Diástole , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Enfermeiras e Enfermeiros , Médicos , Valor Preditivo dos TestesRESUMO
This paper describes the development, testing, and validation of summary scales measuring nursing processes commonly used in caring for elderly nursing home residents with cognitive, mood, and behavior problems, or other markers of mental disorder. Data were obtained from a cross-sectional study of 1017 residents from a proportionate random sample in Delaware nursing facilities, to determine the prevalence of mental disorders and to describe distinguishing characteristics and treatments. An exploratory factor analysis was performed on 11 frequently encountered nursing management strategies as applied to 808 subjects with some indicator of mental disorder. Two factors emerged, which were subsequently conceptualized as separate scales (composed of six and five elements, respectively) that measure the basic approaches termed Encouragement and Control. Alpha reliability levels determined internal consistency for each scale. Cognitive, behavioral, and mood correlates were identified for each scale using multiple regression. Replication and validation were achieved when similar findings were obtained using a random sample of 290 residents at Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston. LISREL analyses confirmed the presence of at least two dimensions in behavior management strategies. The identification of these approaches is significant in providing non-pharmacologic and non-restraint alternatives to managing elderly residents with symptom distress.