Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

BACKGROUND: The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. METHODS: We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC) facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. RESULTS: The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1%) of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%). There were 300 (18.0%) patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511), medication cost of per day (OR = 1.173), number of medications (OR = 1.140), and age (OR = 0.981) as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. CONCLUSION: The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries

Stable Carbon and Nitrogen Isotopes in a Peat Profile Are Influenced by Early Stage Diagenesis and Changes in Atmospheric CO2 and N Deposition

In this study, we test whether the δ13C and δ15N in a peat profile are, respectively, linked to the recent dilution of atmospheric δ13CO2 caused by increased fossil fuel combustion and changes in atmospheric δ15N deposition. We analysed bulk peat and Sphagnum fuscum branch C and N concentrations and bulk peat, S. fuscum branch and Andromeda polifolia leaf δ13C and δ15N from a 30-cm hummock-like peat profile from an Aapa mire in northern Finland. Statistically significant correlations were found between the dilution of atmospheric δ13CO2 and bulk peat δ13C, as well as between historically increasing wet N deposition and bulk peat δ15N. However, these correlations may be affected by early stage kinetic fractionation during decomposition and possibly other processes. We conclude that bulk peat stable carbon and nitrogen isotope ratios may reflect the dilution of atmospheric δ13CO2 and the changes in δ15N deposition, but probably also reflect the effects of early stage kinetic fractionation during diagenesis. This needs to be taken into account when interpreting palaeodata. There is a need for further studies of δ15N profiles in sufficiently old dated cores from sites with different rates of decomposition: These would facilitate more reliable separation of depositional δ15N from patterns caused by other processes

Formation of carbonate concretions in surface sediments of two mud mounds offshore Costa Rica: A stable isotope study

The surface sediments of two mud mounds (‘‘Mound 11’’ and ‘‘Mound 12’’) offshore southwest Costa Rica contain abundant authigenic carbonate concretions dominated by high-Mg calcite (14–20 mol-% MgCO3). Pore fluid geochemical profiles (sulfate, sulfide, methane, alkalinity, Ca and Mg) indicate recent carbonate precipitation within the zone of anaerobic oxidation of methane (AOM) at variable depths. The current location of the authigenic carbonate concretions is, however, not related to the present location of the AOM zone, suggesting mineral precipitation under past geochemical conditions as well as changes in the flow rates of upward migrating fluids. Stable oxygen and carbon isotope analysis of authigenic carbonate concretions yielded d18Ocarbonate values ranging between 34.0 and 37.7 % Vienna standard mean ocean water (VSMOW) and d13Ccarbonate values from -52.2 to -14.2 % Vienna Pee Dee belemnite (VPDB). Assuming that no temperature changes occurred during mineral formation, the authigenic carbonate concretions have been formed at in situ temperature of 4–5 °C. The d18Ocarbonate values suggest mineral formation from seawater-derived pore fluid (d18Oporefluid = 0 % VSMOW) for Mound 12 carbonate concretions but also the presence of an emanating diagenetic fluid (d18Oporefluid &5 %) in Mound 11. A positive correlation between d13Ccarbonate and d18Ocarbonate is observed, indicating the admixing of two different sources of dissolved carbon and oxygen in the sediments of the two mounds. The carbon of these sources are (1) marine bicarbonate (d13Cporefluid &0 %) and (2) bicarbonate which formed during the AOM (d13Cporefluid &-70 %). Furthermore, the d18Oporefluid composition, with values up to ?4.7 % Vienna standard mean ocean water (VSMOW), is interpreted to be affected by the presence of emanating, freshened and boronenriched fluids. Earlier, it has been shown that the origin of 18O-enriched fluids are deep diagenetic processes as it was indicated by the presence of methane with thermogenic signature (d13CCH4 = -38 %). A combination of present geochemical data with geophysical observations indicates that Mounds 11 and 12 represent a single fluid system interconnected by deep-seated fault(s)