Water-loss (intracellular) dehydration assessed using urinary tests, how well do they work? Diagnostic accuracy in older people

Background: Water-loss dehydration (hypertonic, hyperosmotic or intra-cellular dehydration) is due to insufficient fluid intake and distinct from hypovolemia due to excess fluid losses. It is associated with poor health outcomes such as disability and mortality in older people. Urine specific gravity (USG), color and urine osmolality have been widely advocated for screening for dehydration in older adults. Objective: To assess the diagnostic accuracy of urinary measures to screen for water-loss dehydration in older people.Design: This was a diagnostic accuracy study of people aged ≥65years taking part in the Dehydration Recognition In our Elders (DRIE, living in long-term care) or Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community) studies. The reference standard was serum osmolality, index tests included USG, urine color, osmolality, cloudiness, additional dipstick measures, ability to provide a urine sample, and volume of a random urine sample. Minimum useful diagnostic accuracy was set at sensitivity and specificity ≥70% or receiver operating characteristics plot area under the curve ≥0.70. Results: DRIE participants (67% women, mean age 86 years, n=162) had more limited cognitive and functional abilities than NU-AGE participants (64% women, mean age 70 years, n=151). 19% of DRIE and 22% of NU-AGE participants were dehydrated (serum osmolality >300mOsm/kg). Neither USG nor any other potential urinary tests were usefully diagnostic for water-loss dehydration. Conclusions: Although USG, urine color and urinary osmolality have been widely advocated for screening for dehydration in older adults, we show in the largest study to date that their diagnostic accuracy is too low to be useful and these measures should not be used to indicate hydration status in older people (either alone or as part of a wider tranche of tests). There is a need to develop simple, inexpensive and non-invasive tools for the assessment of dehydration in older people

216 Characteristics of patients with prevalent giant cell arteritis in UK primary care

Background: Giant cell arteritis (GCA) is a rare, but serious condition affecting older people. Prompt diagnosis remains challenging due to non-specific presentations. Furthermore, there are marked variations in GP referral and management approaches. Our aim was to characterise a prevalent GCA population, with specific objectives to examine general health, symptoms experienced pre- and post-diagnosis, treatments and their adverse-effects and comorbidities.Methods: This was a secondary analysis of a cross-sectional survey. 564 patients with prevalent GCA (defined as a GCA Read code in the three years’ pre-survey) aged over 50 from 300 English general practices were sent a baseline questionnaire. This examined demographic information, general physical and mental health (SF-12, physical component summary (PCS) and mental component summary (MCS) scores respectively), symptomatology, treatments, prednisolone adverse-effects and comorbidities. Descriptive statistics characterised the sample and comparisons were made between responders and non-responders and genders.Results: 318 patients with GCA responded to the survey (adjusted response rate=60%). Responders and non-responders were similar in age and gender. Mean age of responders was 73.7 (SD8.2) and approximately two-thirds were female with mean disease duration 2.7 (SD8.3) years. The prevalence of “classic” GCA symptoms were higher pre-diagnosis than at the point of the baseline survey, for example headache (86% vs 30%), scalp tenderness (57% vs 17%) and jaw claudication (45% vs 9%). 96% of patients had used prednisolone and 70% reported still taking it. Use of symptom-targeted medication, such as paracetamol was higher pre-diagnosis than at baseline (56% vs 31%), but use of preventative medications, such as bone protection was higher at baseline than pre-diagnosis (30% vs 13%). There was a high degree of steroid-related adverse-effects, with over half of responders reporting change in face shape, disturbed sleep, increased ease of bruising or weight gain. 35% stated they had, or would like to use alternative therapies (e.g. acupuncture). The most commonly reported comorbidities were cardiovascular, 52% reported hypercholesterolemia and 40% hypertension. Though PCS (41.5 vs 38.1) and MCS scores (46.7 vs 45.9) similar in men and women, these were all lower than population norms.Conclusion: Patients with a prevalent diagnosis of GCA continue to report symptoms despite treatment, and reported physical and mental health is worse than in general populations. This suggests that either current treatment is not entirely effective or there may be alternative underlying causes for symptoms which may pose challenges to assessment of relapse. Glucocorticoid-related adverse effects are frequently reported and their prevention increases the polypharmacy associated with this condition. Patients’ pursuit of alternative treatment methods, several years after diagnosis, suggests dissatisfaction with current treatment. These findings highlight the need for holistic care to support the general health of this patient group and reinforces the necessity for continued research into new treatments

Impacts of AKST on development and sustainability goals

The International Assessment of Agricultural Knowledge, Science, and Technology for Development (IAASTD) looks realistically at how we could effectively use agriculture/AKST to help us meet development and sustainability goals. An unprecedented three-year collaborative effort, the IAASTD involved more than 400 authors in 110 countries and cost more than $11 million. It reports on the advances and setbacks of the past fifty years and offers options for the next fifty years. The results of the project are contained in seven reports: a Global Report, five regional Sub-Global Assessments, and a Synthesis Report. The Global Report gives the key findings of the Assessment, and the five Sub-Global Assessments address regional challenges. The volumes present options for action. All of the reports have been extensively peer-reviewed by governments and experts and all have been approved by a panel of participating governments. The Sub-Global Assessments all utilize a similar and consistent framework: examining and reporting on the impacts of AKST on hunger, poverty, nutrition, human health, and environmental/social sustainability. The IAASTD was initiated by the World Bank and the United Nations Food and Agricultural Organization, with support from the World Bank, the World Health Organization, and other sponsors. Its goal is to analyze the potential of agricultural knowledge, science, and technology (AKST) for reducing hunger and poverty, improving rural livelihoods, and working toward environmentally, socially, and economically sustainable development

Impacts of AKST on development and sustainability goals

The International Assessment of Agricultural Knowledge, Science, and Technology for Development (IAASTD) looks realistically at how we could effectively use agriculture/AKST to help us meet development and sustainability goals. An unprecedented three-year collaborative effort, the IAASTD involved more than 400 authors in 110 countries and cost more than $11 million. It reports on the advances and setbacks of the past fifty years and offers options for the next fifty years. The results of the project are contained in seven reports: a Global Report, five regional Sub-Global Assessments, and a Synthesis Report. The Global Report gives the key findings of the Assessment, and the five Sub-Global Assessments address regional challenges. The volumes present options for action. All of the reports have been extensively peer-reviewed by governments and experts and all have been approved by a panel of participating governments. The Sub-Global Assessments all utilize a similar and consistent framework: examining and reporting on the impacts of AKST on hunger, poverty, nutrition, human health, and environmental/social sustainability. The IAASTD was initiated by the World Bank and the United Nations Food and Agricultural Organization, with support from the World Bank, the World Health Organization, and other sponsors. Its goal is to analyze the potential of agricultural knowledge, science, and technology (AKST) for reducing hunger and poverty, improving rural livelihoods, and working toward environmentally, socially, and economically sustainable development