OBJECTIVES: To determine the prevalence of adverse drug reaction (ADR)‐related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most ...frequently responsible for ADR‐related hospital admissions, and to identify independent factors predictive of these ADRs.
DESIGN: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.
SETTING: Eighty‐one academic hospitals throughout Italy.
PARTICIPANTS: Twenty‐eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.
MEASUREMENTS: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.
RESULTS: Mean age ± standard deviation of the patients was 70 ± 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10–1.54), alcohol use (OR = 1.39, 95% CI = 1.20–1.60), and number of drugs (OR = 1.24, 95% CI = 1.20–1.27 for each drug increase) were independent predictors of ADR‐related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01–2.23 for age 65–79 and OR = 1.53, 95% CI = 1.00–2.33 for age ≥80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05–1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11–1.25 for each drug increase) were the only predisposing factors.
CONCLUSIONS: The most important determinant of risk for ADR‐related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.
This paper summarizes in a simple and intuitive way why the neutrons, the muons and the solar neutrinos cannot give any significant contribution to the DAMA annual modulation results. A number of ...these elements have already been presented in individual papers; they are recalled here together with few simple considerations which demonstrate the incorrectness of the claim reported in Davis (PRL 113:081302,
2014
).
The so-called "silver tsunami" is a metaphor that the individuals 65 and older represent the most rapidly growing segment of the Western world population. Aging is an ongoing process that leads to ...the loss of functional reserve of multiple organ systems, increased susceptibility to stress, it is associated with increased prevalence of chronic disease, and functional dependence. Determined by a combination of genetic and environmental factors, this process is highly individualized and poorly reflected in chronologic age. The heterogeneity and the complexity of the older old population represent the main challenge to the treatment of cancer in those patients. We should discern "fit" elderly in whom standard cancer treatment appears to be comparable to a younger population and "unfit" or "frail" elderly, in which the risks of the treatment may overwhelm potential benefits. There are many aspects that have to be assessed before treating an elderly patient, or before to choose the treatment itself. In our review we will try to explain and describe the meaning and the most important aspects related to the oldest old complex patients, and how to manage those patients.
In the anisotropic scintillators the light output and the pulse shape for heavy particles (
p
,
α
, nuclear recoils) depend on the direction with respect to the crystal axes; the response to
γ
/
β
...radiation is isotropic instead. This feature offers the possibility to study the directionality approach, which is applicable in the particular case of those Dark Matter candidate particles inducing just nuclear recoils. Among the anisotropic scintillators, the ZnWO
4
has unique features, which make it an excellent candidate for this type of research, and there is still plenty of room for the improvement of its performances. In this paper the possibility of a low background pioneer experiment (named ADAMO—Anisotropic detectors for DArk Matter Observation) to exploit deep underground the directionality approach by using anisotropic ZnWO
4
scintillators is discussed.
From 7 naturally occurring Nd isotopes, 5 are unstable in relation to
α
decay. If an excited level of the daughter nucleus is populated, or the daughter nucleus is unstable,
γ
quanta can be emitted. ...We used an ultra-low background spectrometry system with 4 high purity germanium (HPGe) detectors (about 225 cm
3
volume each) to search for such decays using a highly purified Nd-containing sample with mass of 2.381 kg. Measurements were performed at the INFN Gran Sasso underground laboratory (with an overburden of about 3600 m w.e.) during 51,237 h. Half-life limits for
α
decays of
143
Nd and
145
Nd were determined to be
T
1/2
(
143
Nd) > 1.1 × 10
20
year and
T
1/2
(
145
Nd) > 2.7 × 10
19
year at 90% C.L. This is an increase of three and two orders of magnitude, respectively, compared with the most restrictive values currently given in literature. A limit for
α
decay of
144
Nd to the excited level of
140
Ce with
E
exc
= 1596.2 keV was determined for the first time as
T
1/2
(
144
Nd →
140
Ce
*
) > 9.3 × 10
20
year. Restriction for the
α
decay of
146
Nd to the excited level of
142
Ce with
E
exc
= 641.3 keV was increased by 3 orders of magnitude to
T
1/2
(
146
Nd →
142
Ce
*
) > 1.4 × 10
21
year. For
α
and 2
α
decays of
148
Nd, first
T
1/2
limits were set as 4.2 × 10
18
year and 2.1 × 10
20
year, respectively.
The results obtained in the search for possible diurnal effect in the
single-hit
low energy data collected by DAMA/LIBRA-phase1 (total exposure 1.04 ton
×
year) deep underground at the Gran Sasso ...National Laboratory (LNGS) of the INFN are presented. At the present level of sensitivity the presence of any significant diurnal variation and of diurnal time structures in the data can be excluded for both the cases of solar and sidereal time. In particular, the diurnal modulation amplitude expected, because of the Earth diurnal motion, on the basis of the DAMA dark matter annual modulation results is below the present sensitivity.
Pain is one of the most frequent reasons for consultations in general practice, presenting either alone or associated with some comorbidity. In all care settings for older and oldest old patients, a ...gap exists between best-practice recommendations and current clinical practice. Clinical manifestations of persistent pain are often complex and multifactorial in the frail population, so the approach to pain management in older persons differs from that for younger people. The purpose of this review is to describe the best approach to assess and manage persistent cancer and no-cancer pain in the elderly, to explain the principles of pain treatment in this so often frail and complex population and compare the different drugs that should be used or avoided in older and oldest old patients considering the agerelated physiologic changes. Considerable emphasis is placed on conditions more common in the elderly such as neuropathic pain or typical subsets of the aging population such as the assessment of pain in people with dementia.
Objectives
Behavioral factors, including protein intake, influence the quantity and quality of skeletal muscle. The aim of this study was to explore the relationship between animal-derived protein ...intake and muscle mass and function in a large sample of unselected community-dwellers.
Material and Methods
The VIP (Very Important Protein) study, conducted during Expo 2015 in Milan, was a population survey aimed at assessing major health metrics in a population outside of the research setting, with a special focus on the relation between animal-derived protein intake and muscle mass and function. A brief questionnaire exploring lifestyle habits, dietary preferences and the consumption of selected foods was administered. Muscle mass was estimated by calf circumference (CC) and mid-arm muscle circumference (MAMC) of the dominant side. Muscle strength of upper and lower extremities was assessed through handgrip strength testing and repeated chair stand test, respectively.
Results
The mean age of the 1,853 participants was 50.3 years (standard deviation: 15.7; range: 18-98 years), of whom 959 (51.7%) were women. Participants in the highest tertile of protein consumption showed better performance at both the handgrip strength (p <0.001) and chair stand tests than those in the lowest tertile (p <0.01). The same results were found for CC (p <0.001) and MAMC (p <0.001). Participants with high protein intake and engaged in regular physical activity showed the higher scores in all the assessed domains.
Conclusions
The results of the VIP survey suggest an association between animal-derived protein intake and muscle mass and strength across ages. Our findings also indicate a synergistic effect of animal-derived protein intake and physical activity on muscle-related parameters.
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