Medication quality and quality of life in the elderly, a cohort study

<p>Abstract</p> <p>Background</p> <p>Modern drugs have made large contributions to better health and quality of life. Increasing proportions of negative side effects due to extensive pharmacological treatment are however observed especially among elderly patients who have multiple health problems. The aim of our study was to see if there is an association between medication quality and quality of life.</p> <p>Methods</p> <p>150 patients discharged from hospital. Inclusion criteria were: living in ordinary homes, ≥ 75 years and ≥ 5 drugs. Home visits were performed to all, including prescription reviews and calculation of medication appropriateness index. The patients were divided into three groups depending on index score and followed for 12 months. The validated and recognized EQ-5D and EQ VAS instruments were used to assess quality of life.</p> <p>Results</p> <p>A lower medication quality was associated with a lower quality of life. EQ-5D index was statistically significantly different (declining for each group) among the groups (p = 0.001 at study start, p = 0.001 at 6 months and p = 0.013 at 12 months) as was EQ VAS (p = 0.026 at study start, p = 0.003 at 6 months and p = 0.007 at 12 months).</p> <p>Conclusions</p> <p>This study has shown the validity of the basic principle in prescribing: the more appropriate medication the better quality of life. Since drug quality is related to the patients' quality of life, there is immense reason to continuously evaluate every prescription and treatment. The evaluation and if possible deprescribing should be done as a process where both the patient and physician are involved.</p

Superconducting gravimeter and seismometer shedding light on FG5’s offsets, trends and noise: what observations at Onsala Space Observatory can tell us

Ten-year worth of absolute gravity (AG) campaigns at Onsala Space Observatory (OSO), Sweden, are simultaneously reducedusing synchronous data from a superconducting gravimeter (SG). In this multi-campaign adjustment, the a priori modelscommonly applied for each setup in AG-alone experiments are sidestepped in favour of SG records and a model to estimateits drift. We obtain a residual (hourly samples) at the 5 nm/s2 RMS level, reducing the SG data with a range of ancillary datafor the site’s exposure to ocean and atmospheric loading, and hydrology effects. The target quantity in AG projects in theBaltic Shield area is the secular change of gravity dominated by glacial isostatic adjustment with land uplift as its major part.Investigating into the details of the associated processes using AG requires a long-term stable reference, which is the aim ofinternational comparison campaigns of FG5 instruments. Two of these have been campaigning at OSO since 2009 when theSG had been installed. In the simultaneous inversion of all sixteen campaigns, we identify weaknesses of AG observations,like varying systematic offsets over time, excess microseismic sensitivity, trends in the AG data and side effects on the SG’sscale factor when campaigns are evaluated one by one. The simultaneous adjustment afforded us an SG scale factor verynear the result from a campaign with a prototype quantum gravimeter.Whence, we propose that single-campaign results maybe biased and conjectures into their variation, let alone its causes misleading. The OSO site appears to present manageableproblems as far as environmental influences are concerned. Our findings advocate the use of AG instruments and proceduresthat are more long-term stable (reference realization), more short-term stable too (setup drifts), less service craving and moreresilient to microseismic noise

Validation of Self-testing as a Method to Estimate the Prevalence of Nickel Allergy

The aim of this study was to investigate the validity of self-patch testing for nickel allergy, in order to determine a cost-effective method for surveillance of the prevalence of nickel allergy. Population-based study including patch testing is the most reliable method to study the prevalence of allergy, but it is expensive and has logistical problems. A total of 191 dermatology patients referred to patch testing were provided with a self-test package with written instructions. The self-test was applied on the arm by the patient, on the same day that the regular patch test was applied on the back. The patient evaluated the self-test before patch test reading at the clinic. Patch test at the dermatology clinic detected 46/191 (24%) nickel-positive individuals. The sensitivity of the self-test was 72% (95% confidence interval (Cl) 57-84), the specificity 91% (95% Cl 85-95), and the proportion of agreement 86% (95% CI 81-91). Thus, in the population studied, the validity of self-testing for nickel allergy was adequate

Interventions for lifestyle changes to promote weight reduction, a randomized controlled trial in primary health care

BACKGROUND: Overweight and obesity are growing public health problems in high income countries and is now growing at a dramatic pace in low and middle income countries, particularly in urban settings. The aim of this trial was to examine the effects of a weight reduction program in adults and to determine whether or not a more extensive intervention was superior to ordinary care. METHODS: Patients seeking advice for overweight/obesity or illness related to overweight/obesity at eight primary health care centers in Sweden were randomized either to intervention or control care groups with both groups given dietary advice and individualized information on increased regular physical activity. In the intervention group advice was more extensive and follow-up more frequent than in the control group during the study period of two years. Main outcome measure was reduction in body weight of five percent or more from study start. RESULTS: From October 2004 to April 2006, 133 patients, 67 in the intervention group and 66 in the control group, were randomized over a period of 18 months. Target weight was achieved at 12 months by 26.7% of the patients in the intervention group compared with 18.4% in the control group (p = 0.335). There was an average absolute weight loss of 2.5 kg in the intervention group and 0.8 kg in the control group at 12 months as compared with the weight at study entry. There were no significant differences between the groups in quality of life, blood glucose and lipids. At 24 months target weight was achieved in 21.9% versus 15.6%, with an average weight reduction of 1.9 kg and 1.2 kg in the two groups, respectively. CONCLUSIONS: Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome. TRIAL REGISTRATION: ClinicalTrial.gov: NCT0160691

Validation of a questionnaire algorithm based on repeated open application testing with the constituents of fragrance mix I

Background In a European study on contact allergy in the general population, it was hypothesized that the combination of contact allergy to a fragrance together with a history indicating dermatitis at exposure, and thereafter subsequent avoidance of scented products, implied a diagnosis of allergic contact dermatitis. Objectives The primary aim of this study was to validate this hypothesis and algorithm. The secondary aim was to investigate whether there was any association between the outcome of the repeated open application test (ROAT) and the patch test reactivity. Methods In total, 109 patients with and without contact allergy to fragrance mix (FM) I were recruited. Volunteers from six European dermatology clinics participated in the study including a patch test and a ROAT. Results Positive ROAT reactions were noted in 26 of the 44 volunteers with contact allergy to FM I. None of the volunteers reacted to the vehicle (P <0 center dot 001). More individuals with a positive algorithm had positive ROATs than those with a negative algorithm. However, the difference was not statistically significant. The lower the patch test concentration eliciting a positive test reaction, the more likely a positive ROAT and the more likely that the positive ROAT appeared early during the investigative period. Conclusions The algorithm used in this study was not substantiated in this ROAT set-up. The stronger the patch test reactivity the more likely was a positive ROAT and the more likely it was that the positive ROAT appeared early during the application period. What's already known about this topic? To the best of our knowledge, a scientifically designed and conducted repeated open application test (ROAT) has never been performed before to validate a diagnosis of allergic contact dermatitis partly based on a questionnaire. What does this study add? This is the largest controlled, randomized and blinded ROAT performed to date. Higher patch test reactivity to fragrance mix I indicated a greater likelihood of a positive ROAT

Validation of questionnaire algorithm based on repeated open application testing with the constituents of fragrance mix II:the EDEN Fragrance Study

Background: In a European study on contact allergy in the general population, it has been hypothesized that the combination of contact allergy to a fragrance together with a history indicating dermatitis at exposure and thereafter subsequent avoidance of scented products implied a diagnosis of allergic contact dermatitis. Objectives: The primary aim of this study was to validate this hypothesis/algorithm. The secondary aim was to investigate whether there was any association between the outcome of the recent repeated open application test (ROAT) and the patch test reactivity. Methods: One hundred nine subjects with and without contact allergy to fragrance mix II (FM II) were recruited. Volunteers from six European dermatology clinics participated in the study including a patch test and a ROAT. Results: Twenty-four positive ROAT reactions were noted in total including 20 of those 32 with contact allergy to FM II. None of the volunteers reacted to the vehicle (P < 0.001). More individuals with a positive algorithm had positive ROATs when compared with those with a negative algorithm. However, the difference was not statistically significant (P = 0.12). The lower the patch test concentration eliciting a positive test reaction, the more likely was a positive ROAT and the more likely that the positive ROAT appeared early during the investigative period. Conclusions: The algorithm used in this study was not validated but it was indicated in this ROAT setup. The stronger the patch test reactivity the more likely was a positive ROAT and the more likely it was that the positive ROAT appeared early during the application period

In VivoEvaluation of the Protective Capacity of Different Gloves Against Hair Dyes

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Femoral Adipose Tissue May Accumulate the Fat That Has Been Recycled as VLDL and Nonesterified Fatty Acids

OBJECTIVE: Gluteo-femoral, in contrast to abdominal, fat accumulation appears protective against diabetes and cardiovascular disease. Our objective was to test the hypothesis that this reflects differences in the ability of the two depots to sequester fatty acids, with gluteo-femoral fat acting as a longer-term "sink." RESEARCH DESIGN AND METHODS: A total of 12 healthy volunteers were studied after an overnight fast and after ingestion of a mixed meal. Blood samples were taken from veins draining subcutaneous femoral and abdominal fat and compared with arterialized blood samples. Stable isotope-labeled fatty acids were used to trace specific lipid fractions. In 36 subjects, adipose tissue blood flow in the two depots was monitored with (133)Xe. RESULTS: Blood flow increased in response to the meal in both depots, and these responses were correlated (r(s) = 0.44, P &lt; 0.01). Nonesterified fatty acid (NEFA) release was suppressed after the meal in both depots; it was lower in femoral fat than in abdominal fat (P &lt; 0.01). Plasma triacylglycerol (TG) extraction by femoral fat was also lower than that by abdominal fat (P = 0.05). Isotopic tracers showed that the difference was in chylomicron-TG extraction. VLDL-TG extraction and direct NEFA uptake were similar in the two depots. CONCLUSIONS: Femoral fat shows lower metabolic fluxes than subcutaneous abdominal fat, but differs in its relative preference for extracting fatty acids directly from the plasma NEFA and VLDL-TG pools compared with chylomicron-TG