Optimal management of urinary tract infections in older people

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials

Artificial Gravity as a Countermeasure to the Cardiovascular Deconditioning of Spaceflight: Gender Perspectives

Space flight-induced physiological deconditioning resulting from decreased gravitational input, decreased plasma volume, and disruption of regulatory mechanisms is a significant problem in returning astronauts as well as in normal aging. Here we review effects of a promising countermeasure on cardiovascular systems of healthy men and women undergoing Earth-based models of space-flight. This countermeasure is produced by a centrifuge and called artificial gravity (AG). Numerous studies have determined that AG improves orthostatic tolerance (as assessed by various protocols) of healthy ambulatory men, of men deconditioned by bed rest or by immersion (both wet and dry) and, in one case, following spaceflight. Although a few studies of healthy, ambulatory women and one study of women deconditioned by furosemide, have reported improvement of orthostatic tolerance following exposure to AG, studies of bed-rested women exposed to AG have not been conducted. However, in ambulatory, normovolemic subjects, AG training was more effective in men than women and more effective in subjects who exercised during AG than in those who passively rode the centrifuge. Acute exposure to an AG protocol, individualized to provide a common stimulus to each person, also improved orthostatic tolerance of normovolemic men and women and of furosemide-deconditioned men and women. Again, men’s tolerance was more improved than women’s. In both men and women, exposure to AG increased stroke volume, so greater improvement in men vs. women was due in part to their different vascular responses to AG. Following AG exposure, resting blood pressure (via decreased vascular resistance) decreased in men but not women, indicating an increase in men’s vascular reserve. Finally, in addition to counteracting space flight deconditioning, improved orthostatic tolerance through AG-induced improvement of stroke volume could benefit aging men and women on Earth

System Design And Motion Artifact Removal Algorithm Implementation For Ambulatory Women Ecg Measurement System:e-Bra System

Cardio Vascular Disease (CVD) leads to sudden cardiac death due to irregular phenomenon of the cardiac signal by the abnormal case of blood vessel and cardiac structure. For last three decades, there is an enhanced interest in research for cardiac diseases.. As a result, the death rate by cardiac disease in men has been falling gradually compared with relatively increasing the death rate for women due to CVD. The main reason for this phenomenon is due to the lack of seriousness to female CVD and different symptoms of female CVD compared with the symptoms of male CVD. Usually, because the CVDs for women accompany with ordinary symptoms not attributable to the heart abnormality signal such as unusual fatigue, sleep disturbances, shortness of breath, anxiety, chest discomfort, and indigestion dyspepsia, most women CVD patients do not realize that these symptoms are actually related to the CVD symptoms. Therefore, periodic ECG signal observation is required not only for women who have been diagnosed with heart disease but also for persons who want to examine their heart activity. Electrocardiogram (ECG) is used to diagnose abnormality of heart. Among the medical checkup methods for CVDs, it is very an effective method for the diagnosis of cardiac disease and the early detection of heart abnormality to monitor ECG periodically. This dissertation proposes an effective ECG monitoring system for woman by attaching the system on woman\u27s brassiere by using augmented chest lead attachment method. The suggested system called E-Bra system in this dissertation consists of an ECG transmission system and a computer installed program called E-Bra pro in order to display and analyze the ECG transmitted from the transmission module. The ECG transmission module consists of three parts such as ECG physical signal detection part with 3 stage amplifier and two electrodes, data acquisition with AD converter, and data transmission part with GPRS (General Packet Radio Service) communication, and it has very compact size that is attachable at the bottom layer of a brassiere for women. However, the ECG signal measured from the transmission module includes not only pure ECG components information; P waves QRS complex, and T wave, but also a motion artifact component (MA) due to subject movements. The MA component is one of the reasons for misdiagnosis. Therefore, the main purpose of the E-Bra system is to provide a reliable ECG data set identical to the quality of an ECG data set collected in hospital. Unfortunately, removing MA is a big challenge because the frequency range of the MA is duplicated on the frequency range of the pure ECG components, P-QRS-T. In this dissertation, two motion artifact removal algorithms (MARAs) with adaptive filter structure and independent component analysis concept are suggested, and the performance of the two MARAs will be evaluated by correlation values and signal noise ratio (SNR) values

Surgical menopause and frailty risk in older community dwelling women: the study of osteoporotic fractures

BACKGROUND: Low testosterone levels in older women have been shown to be associated with frailty. Whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause resulting in lower testosterone levels (surgical menopause) have higher risk for frailty is not known. This prospective study investigated whether women who had surgically-induced menopause had a greater risk of frailty than naturally menopausal women. Furthermore, we also determined whether lower serum testosterone levels would be associated with frailty in our study population of older postmenopausal women. METHODS: The sample included 7699 community-dwelling white women aged ≥ 65 years from the Study of Osteoporotic Fractures (SOF). Participants were determined to have undergone surgical versus natural menopause based on whether or not they reported retrospectively having undergone a bilateral oophorectomy before or after menopause. Frailty status was classified as not frail, somewhat frail (hereafter referred to as Intermediate stage), frail or death at four interviews, conducted 6-18 years post-baseline. Baseline serum total testosterone concentrations were available on a subset of 541 participants. RESULTS: Approximately 12.6% of the participants reported surgical menopause. A total of 39.7% were classified as somewhat frail (intermediate stage) and 10.1% as frail. Twenty-two (22.0%) of the participants died during the interview period when frailty was assessed. Mean age at baseline was 71.2 years. Total serum testosterone levels were significantly lower among surgically menopausal women compared to naturally menopausal women (p<0.01). Surgical menopause was not significantly associated with an increased risk of frailty (Odds Ratio=0.94; 95% CI=0.72-1.22), intermediate stage frailty (Odds Ratio=0.96; 95% CI=0.80-1.10) or death (Odds Ratio=1.17 ; 95% CI=0.97-1.42) after adjusting for age, BMI and number of IADL impairments. Stratified analyses showed that oral estrogen use did not modify these associations. CONCLUSION: Among postmenopausal women, surgical menopause was not associated with a higher risk for frailty compared to naturally menopausal women, even in the absence of estrogen therapy. Future prospective studies are needed to investigate hormonal mechanisms involved in the development of frailty in older postmenopausal women.2017-11-05T00:00:00

High Prevalence of Sarcopenia in Women with Osteoporotic Fractures

The aim of the present study was to assess the prevalence of sarcopenia in women with osteopenia/osteoporosiswith or without fragility fractures.Patients and methods: 112 ambulatory women with osteopenia/osteporosis were included. Body composition wasdetermined by DXA. Weight, height, body mass index (BMI), bone mineral density (BMD) of the total skeleton, totallean mass (LM), appendicular lean mass (ALM) and the index: appendicular lean mass/height² (ALM/h²) weredetermined. Grip strength and self-selected gait speed were assessed. Results: Average (X ± SD) results were: age70.9 ± 8.2 years, BMI: 23.1 ± 3.3 kg/h², total skeleton BMD T-Score:-1.7 ± 0.8, total LM 33.3 ± 3.8 kg, ALM 14.4 ±2.1kg and ALM/h²: 5.86 ± 0.68 kg/h². Walking speed 0.96±0.21m/s and handgrip: 18.8 ± 4.8 kg. The prevalence ofsarcopenia was: 24.7% (International Working Group criteria). Values for BMI, LM, ALM, ALM/h², gait speed andhand grip were significantly lower in sarcopenic vs. non-sarcopenic patients. 29 patients, average age: 70.5 ± 8.0years had osteoporotic fragility fractures (Fx). The prevalence of sarcopenia in the group of patients with Fx was41.4% vs. 19.3% in the non-Fx patients (n=83) (p<0.018).Conclusion: The prevalence of sarcopenia in women with osteopenia/osteoporosis was higher compared to thatusually reported in non-selected patients of similar age. Those with bone fractures had a significantly higherprevalence of sarcopenia compared to the non-fracture patients. The assessment of muscle mass and function inpatients with osteopenia/osteoporosis is recommended.Fil: Fernández, Candela. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: Oliveri, María Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Bagur, Alicia Cristina. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: Gomez Glorioso, Dolores. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: González, Diana. Centro de Osteopatías Médicas Dr Mautalen; ArgentinaFil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Mautalen, Carlos Alfredo. Centro de Osteopatías Médicas Dr Mautalen; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Bone Health Nutrition Issues in Aging

Bone health is an important issue in aging. Calcium and vitamin D currently have the most focus in published research on nutrition and bone health in aging, although evidence from published research is not conclusive. A systematic review was conducted to determine the impact of dietary and supplemental interventions focused on calcium and vitamin D over the past 10 years. Using key words to search, and search limits (aging population, English), 62 papers were found related to diet, nutrition, and bone; and 157 were found related to calcium and bone. Our review found a positive effect on bone health for supplements; food-based interventions; and educational strategies. Although there may be a publishing bias related to non-significant findings not being published, our results suggest the effectiveness of food based and educational interventions with less economic impact to the individual, as well as less risk of physiological side effects occurring