Profiling Dizziness in Older Primary Care Patients: An Empirical Study

The diagnostic approach to dizzy, older patients is not straightforward as many organ systems can be involved and evidence for diagnostic strategies is lacking. A first differentiation in diagnostic subtypes or profiles may guide the diagnostic process of dizziness and can serve as a classification system in future research. In the literature this has been done, but based on pathophysiological reasoning only

Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics

Background: Although dizziness in elderly patients is very common in family practice, most prevalence studies on dizziness are community-based and include a study population that is not representative of family practice. The aim of this study was to investigate the prevalence and incidence of dizziness reported by elderly patients in family practice, to describe their final diagnoses as recorded by the family physician, and to compare the clinical characteristics of dizzy patients with those of non-dizzy patients. Methods: Data were obtained from the Second Dutch National Survey of General Practice, a prospective registration study which took place over a 12-month period in 2001. We developed a search strategy consisting of 15 truncated search terms (based on Dutch synonyms for dizziness), and identified all patients aged 65 or older who visited their family physician because of dizziness (N=3,990). We used the mid-time population as denominator to calculate the prevalence and incidence, and for group comparisons we used the Student's t and Chi-square test, and logistic regression analysis. Results: The one-year prevalence of dizziness in family practice in patients aged 65 or older was 8.3%, it was higher in women than in men, and it increased with age. In patients aged 85 or older the prevalence was similar for men and women. The incidence of dizziness was 47.1 per 1000 person-years. For 39% of the dizzy patients the family physicians did not specify a diagnosis, and recorded a symptom diagnosis as the final diagnosis. Living alone, lower level of education, pre-existing cerebrovascular disease, and pre-existing hypertension were independently associated with dizziness. Conclusions: Dizziness in family practice patients increases with age. It is more common in women than in men, but this gender difference disappears in the very old. Because a large proportion of dizzy elderly patients in family practice remains undiagnosed, it would be worthwhile to carry out more diagnostic research on dizziness in a family practice setting

Hizbullah's Identity Construction (1978-2010)

As the dominant political force in Lebanon and one of the most powerful post-Islamist organizations in the world, Hizbullah is a source of great controversy and uncertainty in the West. Despite the significant attention paid to this group by the media, the details of Hizbullah’s evolution have frequently confounded politicians—and even scholars. In this important study, Joseph Alagha, a scholar with unprecedented access to the organization, exhaustively and objectively analyzes Hizbullah’s historical evolution and offers a revolutionary new perspective on the political phenomenon of the organization. Hizbullah’s Identity Construction is a timely examination of one of the world’s most turbulent regions; a major contribution to the study of contemporary Islamic political movements in the Middle East; and a refreshing departure from the bland hagiographies and ad hominem attacks that are all too common in studies of Hizbullah’s murky history. Superbly documented and argued, and rooted in broad knowledge of contemporary Islamist political thought, this study brings much-needed clarity to a hot-button subject. “Joseph Alagha remains one of the most thorough and careful analysts of Hizbullah’s political ideology and practice. Scholars, analysts, and policy makers will find in this work a veritable treasure trove of research and insights into this complex organization.”—Michaelle Browers, Wake Forest Universit

Jan Six I en het Hollands classicisme

De zeventiende eeuw in de Nederlanden is een Fundgrube van liefde voor de oudheid. De welopgeleide klasse, die in de steden van Holland, Zeeland en de provinciën aanzienlijk was, deed zich volop tegoed aan klassieke kunst en literatuur. De beeldende kunsten door deze te verzamelen, de literatuur door te lezen en in bibliotheken te vereeuwigen en beide door veelvuldig te imiteren. In de archi- tectuur werden uit de oudheid gedestilleerde voorschriften nagevolgd in nieuwe bouwkunst. Deze beweging kan als het classicisme worden aangeduid, in navolging van de hoge status die de klassieke kunst in de Italiaanse renaissance genoot. In deze bijdrage ga ik in op een zeventiende-eeuwse Amsterdammer die exemplarisch was voor deze verzamel- en imitatiedrift: Jan Six (1617-1700). Behalve door zijn vooraanstaande positie als koopman, bestuurder en burgermeester van Amsterdam in 1691, werd hij ook beroemd door het patronaat van een door anderen in zijn tijd vaak miskende kunstenaar: Rembrandt van Rijn (1606-1669)

Polymorphism in pentacene

Pentacene, C22H14, crystallizes in different morphologies characterized by their d(001)-spacings of 14.1, 14.5, 15.0 and 15.4 Å. We have studied the crystal structure of the 14.1 and 14.5 Å d-spacing morphologies grown by vapour transport and from solution. We find a close correspondence between the 14.1 Å structure and the 14.5 Å structure. Single crystals commonly adopt the 14.1 Å d-spacing morphology with an inversion centre on both molecules in the unit cell. Thin films grown on SiO2 substrates above 350 K preferentially adopt the 14.5 Å d-spacing morphology, with a slightly smaller unit-cell volume.

Diagnostic indicators of anxiety and depression in older dizzy patients in primary care

Dizzy patients with both psychological and physical symptoms tend to have high levels of disability and are at risk of remaining symptomatic and disabled. The objective of this study was to develop a prediction model for the presence of anxiety and/or depression in older dizzy patients in primary care. We performed a cross-sectional study among 415 older patients consulting their primary care physician for persistent dizziness. Participants underwent a standardized, comprehensive evaluation and completed self-administered questionnaires regarding anxiety and depression (PRIME-MD Patient Health Questionnaire [PHQ]) and dizziness-related disability (Dizziness Handicap Inventory). To determine the diagnostic indicators of anxiety and/or depression, we used multiple logistic regression analysis with ''presence of Panic Disorder, Other Anxiety Disorder, or Major Depressive Disorder'' as dependent variable. Potential diagnostic indicators included dizziness-related disability, patient characteristics (age, sex, history of anxiety, and history of depression), and dizziness characteristics (description of dizziness, provoking circumstances, associated symptoms, onset, frequency, duration, and avoidance of activities because of dizziness). According to the PHQ, an anxiety and/or depressive disorder was present in 90 patients (22%), of whom 35 reported no medical history of anxiety or depression, nor current pharmacological treatment for these disorders. In the final model, dizziness-related disability, a history of depression, and accompanying fear were associated with an increased odd of anxiety and/or depression, whereas tinnitus and rotational dizziness were associated with a decreased odd of anxiety and/or depression. The model showed good calibration (Hosmer-Lemeshow P value of .46) and discrimination (adjusted area under the receiver operating characteristic curve [AUC] after bootstrapping of .82). Primary care physicians should consider the existence of anxiety and depression in older patients presenting with dizziness. After external validation, our model may contribute to better recognition and hence better management of anxiety and depression in older patients with dizziness in primary car