Insights into the clinical management of the syndrome of supine hypertension--orthostatic hypotension (SH-OH): the Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: Our previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension-orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts. METHODS: The study included all TILDA wave 1 participants who had a Finometer® active stand. Automatic data signal checks were carried out to ensure that active stand data were of sufficient quality. Characterisation variables included demographics, cardiovascular and neurological medications (WHO-ATC), and self-reported information on comorbidities and disability. Multivariable statistics consisted of logistic regression models. RESULTS: Of the 4,467 cases, 1,456 (33%) were assigned to MOH-1 (small drop, overshoot), 2,230 (50%) to MOH-2 (medium drop, slower but full recovery), and 781 (18%) to MOH-3 (large drop, non-recovery). In the logistic regression model to predict MOH-3, statistically significant factors included being on antidepressants (OR = 1.99, 95% CI: 1.50 - 2.64, P < 0.001) and beta blockers (OR = 1.60, 95% CI: 1.26 - 2.04, P < 0.001). MOH-3 was an independent predictor of OI after full adjustment (OR = 1.47, 95% CI: 1.25 - 1.73, P < 0.001), together with being on hypnotics or sedatives (OR = 1.83, 95% CI: 1.31 - 2.54, P < 0.001). In addition, OI was an independent predictor of history of falls/blackouts after full adjustment (OR = 1.27, 95% CI: 1.09 - 1.48, P = 0.003). CONCLUSIONS: Antidepressants and beta blockers were independently associated with MOH-3, and should be used judiciously in older patients with SH-OH. Hypnotics and sedatives may add to the OI effect of MOH-3. Several trials have demonstrated the benefits of treating older hypertensive patients with cardiovascular medications that were not associated with adverse outcomes in our study. Therefore, the evidence of benefit does not necessarily have to conflict with the evidence of potential harm

Prevalence of intestinal parasitic infections among school children in capital areas of the Democratic Republic of São Tomé and Príncipe, West Africa

Background: Although the Democratic Republic of Sao Tome and Principe (DRSTP) has undertaken school children-based deworming programs against intestinal parasitic infections (IPIs) using a single dose of mebendazole annually since 2005, it remains unclear as to the outcome to date. The present study intends to  investigate the recent IPIs status among school children living in capital areas of the DRSTP.Methods: A total of 252 school children (121 boys and 131 girls) of grades 4 and 5 from 4 primary schools located in the capital areas participated in the present study and their fresh fecal specimens were examined for the presence of any parasites using the merthiolate- iodine-formaldehyde concentration method as conducted.Results: The overall prevalence of IPIs was 64.7% (163/ 252). No significant gender difference in prevalence between boys (67.8%) and girls (61.8%) was found (p = 0.3). The majority of school children were infected with a single species of parasite (55.8%). Altogether, 12 different intestinal parasite species were identified in DRSTP school children, of which 9 species were pathogenic and the remaining 3 were non-pathogenic.Conclusion: Improving the detection method, sanitation facilities and personal hygiene as well as utilizing combined drugs are all important measures to greatly reduce IPIs in DRSTP school children.Keywords: Democratic Republic of Sao Tome and Principe, school children, intestinal parasitic infection

Falls and falls efficacy: the role of sustained attention in older adults

<p>Abstract</p> <p>Background</p> <p>Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. The aim of this study was to investigate whether performance and variability in sustained attention is associated with falls and falls efficacy in older adults.</p> <p>Methods</p> <p>458 community-dwelling adults aged ≥ 60 years underwent a comprehensive geriatric assessment. Mean and variability of reaction time (RT), commission errors and omission errors were recorded during a fixed version of the Sustained Attention to Response Task (SART). RT variability was decomposed using the Fast Fourier Transform (FFT) procedure, to help characterise variability associated with the arousal and vigilance aspects of sustained attention.</p> <p>The number of self-reported falls in the previous twelve months, and falls efficacy (Modified Falls Efficacy Scale) were also recorded.</p> <p>Results</p> <p>Significant increases in the mean and variability of reaction time on the SART were significantly associated with both falls (p < 0.01) and reduced falls efficacy (p < 0.05) in older adults. An increase in omission errors was also associated with falls (p < 0.01) and reduced falls efficacy (p < 0.05). Upon controlling for age and gender affects, logistic regression modelling revealed that increasing variability associated with the vigilance (top-down) aspect of sustained attention was a retrospective predictor of falling (p < 0.01, OR = 1.14, 95% CI: 1.03 - 1.26) in the previous year and was weakly correlated with reduced falls efficacy in non-fallers (p = 0.07).</p> <p>Conclusions</p> <p>Greater variability in sustained attention is strongly correlated with retrospective falls and to a lesser degree with reduced falls efficacy. This cognitive measure may provide a novel and valuable biomarker for falls in older adults, potentially allowing for early detection and the implementation of preventative intervention strategies.</p

Orthostatic hypotension, orthostatic intolerance and frailty:The Irish Longitudinal Study on Aging-TILDA

Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). This study was based on a cross-sectional analysis of 5692 community dwelling adults aged 50 years and older included in wave 1 of the Irish Longitudinal Study on Aging. Frailty was assessed using both the phenotypic (FP) and frailty index (FI) models. OH was defined as a drop of ≥20 mmHg in systolic blood pressure or a drop of ≥10 mmHg diastolic pressure on standing from a seated position. OI was defined as reporting feeling dizzy, light headed or unsteady during this test. 346 (6.1%) participants had OH and 381 (6.7%) participants had OI. The prevalence OH in frail participants was 8.9%, compared to 5% in robust. Similarly the prevalence of OI was 14.3% in frail and 5.7% in robust participants. After adjustment for age and gender, OH was not significantly related to the FP (OR=1.10 95% CI=0.67, 1.81). Conversely OI was (OR=1.80 95% CI=1.13, 2.87), even after adjustment for age, gender, cardiovascular factors and mental health. In fully adjusted models OI remained related to slowness and low muscle strength and to higher FI scores. These data suggest OI symptoms in older adults may reflect various important underlying health deficits, indicative of increasing levels of frailty. Further assessment of frailty in patients experiencing OI is a potential opportunity for early intervention to delay functional decline

Objective real-time assessment of walking and turning in elderly adults

Recent research suggests that falls are the most common cause of injury and disability in older persons. Invasive systems or body worn sensors can be employed in controlled clinical and laboratory settings to determine clinical measures of gait and stability. This study by contrast aims to explore how video technology, can be employed to unobtrusively determine the same measures. Data from 63 elderly subjects, recruited through a research clinic was analyzed. The derived parameters include: the walk time, the number of steps of the TUG test and stability out of the turn. The results show that video analysis can be used to automate current clinical measures of gait and stability as well as to inform future automated interventions.</p

“ENDEA”: a case study of multidisciplinary practice in the development of assisted technologies for older adults in Ireland

This paper seeks to discuss the authors' experiences of multidisciplinary practice in relation to developing home-based assisted living technologies. The paper draws on almost three years' experience of working within an ongoing, large, multi-sited and multidisciplinary Irish national research programme: the Technology for Independent Living Centre. This involved industry and academic partners. Teams of clinicians, physical and social scientists, technologists, engineers, designers and ethnographers worked with older adults to design, test and deliver, home-based technologies that focus on mitigating falls, keeping socially connected and maintaining or improving cognitive function. The authors' experiences and challenges are organised and presented through their retrospective team building model: ENDEA and through comparison with team building literature

Falls classification using tri-axial accelerometers during the five-times-sit-to-stand test.

We assess the relative performance of a suite of selected models to interpret three-phase oil relative permeability data and provide a procedure to determine identifiability of the model parameters. We ground our analysis on observations of Steady-State two-and three-phase relative permeabilities we collect on a water-wet Sand-Pack sample through series of core-flooding experiments. Three-phase experiments are characterized by simultaneous injection of water and gas into the core sample initiated at irreducible water saturation, a scenario which is relevant for modern enhanced oil recovery techniques. The selected oil relative permeability models include classical and recent formulations and we consider their performance when (i) solely two-phase data are employed and/or (ii) two-and three-phase data are jointly used to render predictions of three-phase oil relative permeability, kro. We assess identifiability of model parameters through the Profile Likelihood (PL) technique. We rely on formal model discrimination criteria for a quantitative evaluation of the interpretive skill of each of the candidate models tested. We also evaluate the relative degree of likelihood associated with the competing models through a posterior probability weight and use Maximum Likelihood Bayesian model averaging to provide modelaveraged estimate of kro and the associated uncertainty bounds. Results show that assessing identifiability of uncertain model parameters on the basis of the available dataset can provide valuable information about the quality of the parameter estimates and can reduce computational costs by selecting solely identifiable models among available candidates.Eni SpA (Project "Microscale modeling of multiphase flow in porous media Micro - Flow") [OdL. 4310160993]24 month embargo; published online: 27 September 2017This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Age-related normative changes in phasic orthostatic blood pressure in a large population study:findings from The Irish Longitudinal Study on Ageing (TILDA)

In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample