We also retrieved comparison subjects from the LHID2000. We likewise excluded all enrollees aged ,44 years and those subjects who had ever received a diagnosis of dementia since initiation of the Taiwan NHI in 1995. We also excluded those who died in 2010 and 2011 and those with a diagnosed history of major psychosis, a substance-related disorder, stroke, or traumatic brain injury prior to the index date. Thereafter, we further selected 5,666 comparison subjects (1 comparison subjects per subject withdementia) from the remaining enrollees matched withstudy subjects by gender and age using the SAS proc surveyselect program (SAS, Cary NC, USA). Specifically, in each gender- and age-matched strata, a random sampling process was applied for the selection of comparison subjects. For comparison subjects, we defined the date of their first visit to a physician occurring during 2010 as the index date. Although comparison subjects might have to experience certain health problem for physician visits, by definition, in order to be present in the dataset, representativeness might not be a serious concern. Due to the very low out-of-pocket copayments, comprehensive benefits, unrestricted access to any medical institution of the patient’s choice, and a wide variety of providers including primary care physicians in Taiwan’s NHI program, people in Taiwan did visit the physicians and outpatient departments frequently. In the analyses of NHI program in 2002, only 7.7% persons did not have any visit . The percentage might even be lower among elder population considered in our study.
Background: The existence of multiple chronic conditions in the same patient is a public health problem increas- ingly recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which imply a heavy burden in healthcare use. It is estimated that between 70% and 80% of the total health expenditure is used with chronic conditions. Patientswith multimorbidity are responsible for up to 75% of primary care appointments. These patients are also high hospital users, with up to 14.6 times more risk of hospitalization. Methods: This study analyses the association between healthcare use and multimorbidity in the Portuguese population aged 25–74 years old. The association between socioeconomic variables and healthcare use was studied, based on data from the first Portuguese Health Examination Survey using a logistic regression model, stratified by sex and adjusted for socioeconomic confounding variables. Results: In patientswith multimorbidity, there was a greater use of primary healthcare consultations, medical or surgical specialist consultations and hos- pitalizations. An association was established between female, older age groups and lower educational levels, and increasedhealthcare use. When adjusted to socioeconomic variables, the likelihood of using healthcare services can be as high as 3.5 times, when compared to patients without chronic conditions. Conclusion: Our results show a greater healthcare use in multimorbidity patients, both in primary and hospital care. The availability of scientific evidence regarding the use of healthcare services by multimorbidity patients may support health policy changes, which could allow a more efficient management of these patients.
Our results raise a significant concern regarding the use of psychotropic agents among peo- ple withdementia. In particular, we observed an approximately three-fold increase in antipsy- chotic use one year after the diagnosis of dementia, which was independent of whether the patient suffered an acute admission event (with admission: 13.57% at baseline vs. 35.13% 1 year after diagnosis; without admission: 9.51% at baseline vs. 24.79% 1 year after diagnosis). People withdementia who experienced acute admissions after the diagnosis of dementia were more likely to be exposed to hypnotics (both benzodiazepine and z-hypnotics) compared to those without acute admissions after the diagnosis of dementia. The increased use of psycho- tropic agents during and after acute hospital admissions may also have resulted from the dete- rioration of the behavioral and psychotic symptoms of dementia, particularly when patients were unable to cope with unfriendly acute care environments. This finding is supported by Banerjee, who indicated that physicians too often prescribe antipsychotics as a first-line re- sponse to managing the challenging behaviors of people withdementia. These prescrip- tions may further result in admissions related to fractures or other associated adverse outcomes. This finding also echoes the experience of caregivers who reported that the physical and mental conditions of demented people significantly deteriorated after acute hospi- tal admissions. Although non-pharmacological intervention should be prioritized in the management of behavioral and psychotic symptoms for dementia, these treatments are usually only available in specific units in acute hospitals.
This was a nationwide Swedish prospective and population-based cohort study; the cohort has been described in more detail elsewhere.[13,14] In brief, the entire cohort consisted of 616 pa- tients (90% of all those eligible) who underwent oesophageal resection for cancer of the oe- sophagus or oesophago-gastric junction with curative intent during the period April 2001 to December 2005 in Sweden. The follow-up period was set at a maximum of 5 years to assess healthcare utilisation related to the oesophageal cancer or its treatment, rather than healthcare use for other reasons (although all healthcare utilisation during the study period was evaluat- ed). This study was organised through collaboration in Sweden between 174 hospital depart- ments involved in the diagnosis or treatment of these patients. Exclusions were made for unknown histology (n = 9) and death within 1 year of surgery (n = 217), since our main interest was long-term healthcare utilisation and healthcare utilisation is expected to be disproportion- ally increased in patients who die shortly after surgery. Data were collected on patient, tumour and treatment characteristics from the review of medical records from all Swedish hospitals that performed oesophagectomies during the study period. This included age, sex, comorbidity, histological tumour type and tumour stage, as well as the exposure data on pre-defined compli- cations (presented below). Outcome data on hospitalisation dates, days of in-
The distribution of age (20–34, 35–49, 50–64, and 65 years), sex, and comorbidity were com- pared between the two cohorts by using the chi-squared test for the categorical variables and the Student’s ttest for the continuous variables. Cumulative incidence curves for dementia were plotted using the Kaplan—Meier method, and the differences in cumulative incidence between the two cohorts were tested using a log rank test. Dementia incidence densities were estimated by dividing the number of dementiacases by the number of person-years in each risk factor, and then stratified by age, sex, and comorbidity. Univariateand multivariate Cox proportion hazard regression models were employed to examine the effect of IBS on the risk of dementia, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). The multivariate Cox models were adjusted for age, sex, and comorbidities of diabetes, hypertension, stroke, CAD, head injury, depression, and epilepsy. When the patients were stratified according to age, sex, and comorbidity, the relative risk of dementia in the IBS cohort compared with the non-IBS cohort was also analyzed using Cox models. All analyses were performed using SAS Version 9.4 (SAS Institute, Cary, NC, USA). The significance level was set at less than 0.05 for the two- tailed P value.
Temporal discounting has long been recognized as an important determinant of health and financial behaviors, both of which are essential to maintaining independence and well-being across the lifespan[1–9,16]. Although it stands to reason that temporal discounting would predict adverse health consequences, we are not aware of any longitudinal study that has directly examined this question. This reflects an important gap in knowledge. Further, temporal discounting may be critically important in aging, the time when many consequential decisions are made just as cognitive function and other abilities deteriorate and the burden of disease increases. Relatively little is known about discounting among older persons; some cross sectional studies have sought to clarify whether discounting is greater or lower among older persons compared to younger persons, but findings are mixed[17–21]. Whether or not discounting changes with age, the behaviors associated with discounting may be most damaging in old age; for example, poor health behaviors such as smoking and drinking may be particularly harmful in the later years, as physical function deteriorates. Notably, in this study, we examined the potential role of smoking (among other vascular risk factors) as well as vascular diseases, and the association of discounting with mortality persisted even after adjustment for those risk factors and conditions. This suggests that temporal discounting may reflect a broad construct that works via mechanisms other than physical health status to influence mortality.
Hybrid cardiac rehabilitation has also been used for post-acute myocardial infarction (AMI) patients. In a studywith 87 post-AMI patients, the authors have evidenced that HCR facilitated patients’ adherence to the training program, but the return-to-work indices were higher in men than in women, although the physical capacity improvement was similar for both sexes. 17
AD patients performed more complementary behav- iors than ECs. he overuse of IM, hesitation, and RBs in the former may be associated with the presence of goal- subgoal conlict resolution diiculties. his lack of plan- ning is based on the fact that an early incorrect move can make the problem virtually unsolvable, thereby requiring a step back and a new plan on how to achieve the correct solution. hese high scores suggest diicul- ties in mentally storing and manipulating information
The objective of this qualitative study was to assess the knowledge of community health workers (CHW) with respect to aging and dementia, with the purpose of assisting the implantation of caregiving services focused on dementia, in a city in the State of São Paulo. All ethical guidelines were followed. In all, 51 CHW were evaluated. Semi-structured interviews were con- ducted. The data analysis was based on content analysis. In response to the question, What does elderly mean, for you?, the majority of the workers associated old age with chronologically advanced age and with negative aspects of aging, such as physical and social dependence. With respect to the concept of dementia, the majority of those interviewed defined dementia as a biological problem that affects the brain, compromising memory functions and resulting in dependency. The results demonstrate the need for an educational program for CHW, in the area of gerontology.
POLSCI: A Portuguese population-based longitudinal study (cf. reference 13); 10/66 DRG: Dementia Research Group; AD: Alzheimer’s disease; AGECAT: The Automated Geriatric Examination for Computer Assisted Taxonomy; CDR: Clinical Dementia Rating; CERAD: Consortium to Establish a Registry for Alzheimer’s Disease; CI: Confidence intervals; CSI’D’ COGSCORE: Community Screening Instrument for Dementia, cognitive score; CSI’D’ RELSCORE: Community Screening Instrument for Dementia, informant score; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, fourth edition; EURODEM: European Community Concerted Action on Epidemiology and Prevention of Dementia; GMS: Geriatric Mental State examination; HAS-DDS: History and Aetiology Schedule – Dementia Diagnosis and Subtype; NINDCS-ADRA: National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer Disease and Related Disorders Association Criteria for Alzheimer Disease; NINDS-AIREN vascular dementia: National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et l’Enseignement en Neurosciences; NPI-Q: Neuropsychiatric Inventory – Questionnaire, brief version; WHODAS 2.0: World Health Organization Disability Assessment Schedule version 2.0
One previous double blind, randomized, head-to-head clinical trial had already showed that once-daily 23 mg of donepezil was significantly associated with better outcomes on activities of daily living and cognitive measures, as op- posed to the group on a 10 mg daily regimen. Adverse events were more frequent in the highest dose group, but discontinuation was similar on both groups.
From January 1999 to December 2011, a total of 655 consecutive patientswith operable or locally advanced breast cancer who received NCT at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing, China) were enrolled in the pres- ent study. Medical records were reviewed and relevant information was retrospectively col- lected including demographic characteristics, tumor presentation, histopathologic assessment and therapy details. Diagnosis with invasive carcinoma was confirmed by core needle biopsy (CNB) and the lymph node status was evaluated by fine needle aspiration (FNA) of palpable lymph nodes if applicable. Before the initiation of NCT, bilateral breast MRI or ultrasound, chest X-ray, abdominal ultrasound or CT scan and bone scintigraphy were performed to deter- mine clinical staging. Stage IV disease, bilateral breast cancer, male breast cancer, inflammatory breast cancer or patients complicated with other malignancies were excluded from the current analysis. The study was approved by the institutional review board (IRB) of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Informed consent requirements were waived by the IRB since an honest broker provided a de-identified dataset for the analysis.
Several possible pathophysiological processes may explain the unexpectedly high risk of ischemic stroke observed after treatment for HHS. First, we hypothesize that a worse metabolic profile among the HHS group (compared to the non-HHS group) may partially explain the increased incidence of stroke observed during the one year follow-up in our study. In a study of HHS patients in Taiwan, poor compliance with medication (21.0%) and undiag- nosed DM (10.9%) were the second and third most common precipitating factors in HHS . A second theory links attacks of HHS in DM patientswith marked fluctuations in glucose levels. Intermittent hyperglycemia may induce endothelial cell dysfunc- tion and is associated with high oxidative stress . Other studies have shown that fluctuations in glucose levels can enhance cell proliferation, induce the release of cytokines, and impair endothelial function, all of which contribute to the mechanisms underlying cerebrovascular events [21,22]. Finally, among the HHS precipitating factors (such as infections, alcohol abuse, gastrointestinal bleeding, acute pancreatitis, silent myocardial infarction, mesenteric ischemia, use of certain medications, and Table 4. Hazard ratios for the ischemic stroke in HHS patients.
ABSTRACT: Introduction: The Brazilian National Health System may reduce inequalities in access to health services through strategies that can reach those most in need with no access to care services. Objective: To identify factors associated with the use of health service by children aged 5 to 9 years in the city of Sobral, Ceará, northeastern Brazil. Results: Only 558 (17.0%) children used health care services in the 30 days preceding this survey. Children with any health condition (OR = 3.90) who were frequent attenders of primary care strategy of organization (the Family Health Strategy, FHS) (OR = 1.81) and living in the city’s urban area (OR = 1.51) were more likely to use health services. Almost 80% of children used FHS as their referral care service. Children from poorer families and with easier access to services were more likely to be FHS users. Conclusion: The study showed that access to health services has been relatively equitable through the FHS, a point of entry to the local health system.
performed to evaluate memory, executive function, visual spatial ability, and language function. The severity of dementia was then determined by the CDR [7,8]. Participants who were compatible with the NIA-AA criteria for all-cause dementiawith a CDR score of 0.5 were defined as VMD [7,8]. People with VMD had mild impairment in 2 or more cognitive domains as well as a mild decline in daily functions, whereby the cognitive deficits were sufficient to interfere with independence of daily living function as a result of abnormality in community affairs or at-home hobbies or as a result of personal care as assessed by the CDR. MCI was diagnosed, based on the criteria recommended by the NIA-AA, as a change in cognition with impairment in 1 or more cognitive domains but no evidence of impairment in social or occupational functioning as assessed by the CDR, ADL, and IADL . For the diagnosis of non-dementia, individual should have none of the conditions listed in the NIA-AA core clinical criteria for all-cause dementia and have a CDR score of 0 as well as an education- adjusted TMSE within normal limits. Individual who did not fully meet the aforementioned criteria and whose diagnosis remained unclear after a discussion by the consultant panel were categorized in the unclassified group. For example, certain older people with major depression or another mental disorder or other serious physical illness might have impaired daily living function or impaired cognitive performance; consequently, their CDR score was . 0. This situation did not fully meet the NIA-AA criteria and was also not compatible with our definition of non-dementia.
Congenital anomaly and cancer may have some shared genetic and/or environmental fac- tors that may influence the risk of occurrence. A malformation may also cause physiologic or lifestyle changes that may impact on cancer risk [13,14]. Dysregulation of human development probably plays a vital role in the etiology of cancer among patientswith birth defects [15–17]. Previous studies have shown that patientswith congenital anomalies have increased risk of de- veloping cancer, such as leukemia, lymphoma, brain tumor, neuroblastoma, germ cell tumor, retinoblastoma, and soft tissue sarcoma [14–16,18–25]. Most of these studies have focused on the association of all categories of congenital anomalies with cancer. Congenital cardiovascular anomaly, a major subgroup of congenital anomalies, is the most frequent type of birth defects that also have a cancer diagnosis . A few studies discuss the individual association of CHD with cancer occurrence, but not all categories of congenital anomalies are included and the re- sults have been conflicting [14,20,26–29]. Furthermore, previous studies do not explore the as- sociation between age at CHD diagnosis, gender, duration of follow-up, co-morbidities, and medical radiation examination among CHD patients, and cancer risk.
survey, carried out in a probabilistic sample of indepen- dent-living older adults, 60 years and older, residents of all Chilean Regions. A stratiied, multi-stage sampling design, with selection proportional to population size, was the method applied, ensuring the participation of people from both urban and rural areas. From within each municipality, sectors (and subsequently house- holds) were selected randomly. he population of 80 years and older was oversampled to allow for a more precise estimation of dependency in this growing sector of the Chilean population. he study was approved by the Institute of Nutrition and Food Technology, Univer- sity of Chile Ethics Committee. Dementia was deined using the test validated in the WHO Age associated de- mentias study in Concepción, consisting of a score<22 on the Mini-Mental State Examination (MMSE) 19 and
A dementia and cognitive impairment populationstudy in a community of mixed origin with a high com- ponent of Caucasian features but with particular eating habits will, through the prevalence, incidence and risk factor data gathered, yield two signiicant results. One is to determine the actual local situation with respect to cognitive impairment and dementiawith all preventive, diagnostic, therapeutic and economic implications for the design and planning of a national social and health action. Another is, through comparative analysis of risk factors, to contribute to the international knowledge on the efect of environmental factors linked to lifestyle on the development, natural history and evolution of cog- nitive impairment and dementia.
Early detection and response to abnormal laboratory values is crucial in critical care.  However, there are two main barriers that hinder early detection of abnormalities in critically ill patients. Large quantities of available data can lead to information overload, which potentially limits the quality of decisions in critical care settings.  Furthermore, it has been shown that some commonly presented data points have no meaningful clinical impact on the care of the critically ill patients.  On the other hand normal ranges listed by clinical laboratories and traditional electronic medical (EMR) systems are often defined based on blood analyses of healthy men and non-pregnant women aged between 20–50 years.  However, these values may be normal or at least acceptable in specific populations like elderly patients or an ICU setting. [6,7] For example, a hemoglobin of 9.5 mg/dl may raise concerns at the family physician’s visit in a healthy person but be fully acceptable in non-bleeding patients in the ICU. Thus, when applied across the various hospital populations, such a traditional, ‘‘one size fits all’’ approach is therefore prone to increase false positive alerts, which can dangerously desensitize health care providers and thus prevent recognition of true abnormalities [8–10].
The demographic and clinical data are shown in Table 1. No difference was observed between the two groups regarding education. However, differences were found in age: patients in the control group were statistically younger than those in the AD group. Given this difference, it was performed a multivariate analysis (multivariate intra-group ANOVA) among the controls and among the patients to evaluate how age influenced the values of the variables of interest. This analysis evaluated each of the variables of interest together and in relation to the variable of age within each group. Only in the control group and only for two variables (the Complex Figure Test Delayed Recall (p,0.001) and Cancellation task (p = 0.019)) did age influence the test scores. Therefore, age was not a major cause of differences between the groups.