Acetanilide Oxidation in Phenylbutazone-associated Hypoplastic Anaemia

Acetanilide like phenylbutazone is paraoxidized by the liver endoplasmic reticulum as a primary biotransformation step. Both compounds were given at different times to each of 10 healthy volunteer subjects and the plasma disappearances measured. Correlation was shown between plasma clearance values of the two compounds (r = + 0·7067; P < 0·05).Eight patients with hypoplastic anaemia after phenylbutazone therapy were investigated. Plasma clearance values and half lives of acetanilide were measured in this group of patients and compared with those of a group of 30 healthy volunteer controls. There was a significant decrease in clearance (P < 0·01) and lengthening of half lives (P < 0·001 in the patients with phenylbutazone-associated hypoplasia. Five patients with idiopathic aplastic anaemia—that is, without history of antecedent phenylbutazone ingestion—were similarly investigated with acetanilide and there was no significant difference between the results in these patients and those in the control group.It is suggested that relatively poor paraoxidation of phenylbutazone producing high blood concentrations on a given dose may be a factor responsible for the drug-associated hypoplasia even though it does not explain the similar pattern of adverse reactions reported in association with oral administration of the metabolite oxyphenbutazone.     

The prosthetic need WHO index: a comparison between self‐perception and professional assessment in an elderly population

The purpose of this study was to consider the criteria for establishing the need for prosthesis, by comparing the need perceived subjectively by a patient (self‐perception) with that assessed by an examiner according to the WHO diagnosis criteria. The proposed domiciliary sample comprised 270 elderly (aged 60 years or older) residents in a municipality in southern Brazil. The interviews and oral examinations were conducted by two dentists following a period of training and calibration. The criteria used conformed to the WHO and FDI standards. Statistical treatment of data included bivariate and multivariate analysis using SPSS 10.0. Only five patients identified the need for a prosthesis when not identified by the examiner. In the case of 172 elderly subjects, there was agreement in the self‐perceived and observed treatment needs. The need for prosthesis was found in 93 elderly subjects who did not perceive any need for prosthetic treatment. The multivariate analysis showed that the variables age, gender, residential area and form of service most sought after during their lives were significantly associated with a better self‐perception of oral health. The professional criteria based on WHO guidelines differed from the self‐perceived need. Elderly male subjects who lived in a rural area and were 70 years of age or more, who did not participate in third age groups, and who had not sought dental services for most of their lives were the least likely to perceive the need for prosthetic treatment, thereby underestimating their oral health needs.     

Multiple N-acetyltransferases and drug metabolism. Tissue distribution, characterization and significance of mammalian N-acetyltransferase

Investigations in the rabbit have indicated the existence of more than one N-acetyltransferase (EC 2.3.1.5). At least two enzymes, possibly isoenzymes, were partially characterized. The enzymes differed in their tissue distribution, substrate specificity, stability and pH characteristics. One of the enzymes was primarily associated with liver and gut and catalysed the acetylation of a wide range of drugs and foreign compounds, e.g. isoniazid, p-aminobenzoic acid, sulphamethazine and sulphadiazine. The activity of this enzyme corresponded to the well-characterized polymorphic trait of isoniazid acetylation, and determined whether individuals were classified as either ;rapid' or ;slow' acetylators. Another enzyme activity found in extrahepatic tissues readily catalysed the acetylation of p-aminobenzoic acid but was much less active towards isoniazid and sulphamethazine. The activity of this enzyme remained relatively constant from individual to individual. Studies in vitro and in vivo with both ;rapid' and ;slow' acetylator rabbits revealed that, for certain substrates, extrahepatic N-acetyltransferase contributes significantly to the total acetylating capacity of the individual. The possible significance and applicability of these findings to drug metabolism and acetylation polymorphism in man is discussed.     

A comparison of the dental health of Brazilian and Canadian independently living elderly

doi: 10.1111/j.1741‐2358.2009.00340.x
A comparison of the dental health of Brazilian and Canadian independently living elderly Objective: To compare the dental status of Brazilian and Canadian elderly populations with respect to socioeconomic and quality of life factors. Materials and methods: A total of 496 adults aged 60–75 years, having four or more teeth, and physically and cognitively suitable for a clinical oral examination were included. Subjects answered questions concerning their lifestyle and completed the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. Results: In all populations, the majority were females, aged between 60 and 65 years and married. Although the Canadian New Immigrant population had lower mean income, they had more remaining teeth (23.04 ± 6.1), more functional teeth (sound and restored teeth) (14.92 ± 5.7), more sound teeth (15.40 ± 7.6), but more carious teeth (2.97 ± 3.0). The Brazilian population had higher numbers of restored teeth (12.26 ± 6.8) and fewer remaining teeth (17.80 ± 7.6). In all populations, females, married and younger (60–65 years old) adults were more likely to retain 20 or more teeth. The mean GOHAI scores were similar for Canadians (40.55 ± 5.7) and Canadian New Immigrants (39.28 ± 6.5), but were higher than that among Brazilians (31.97 ± 8.9). Conclusions: The numbers of remaining teeth were related to greater education and higher income status for Brazilian and Canadian populations. However, Canadian New Immigrants with lower income and education retained more teeth than the other populations.     

Flexibility of the shoulder joint measured as range of abduction in a large representative sample of men and women over 65 years of age

In a representative survey of 1000 elderly men and women aged over 65 years living in their own homes, assessments have been made of flexibility measured as range of shoulder abduction in addition to health status, psychological well-being and reported customary activity. The results for shoulder abduction were approximately normally distributed and the mean values (+/- 1 standard deviation) were as follows: - in men aged 65-74 years, 129 (+/- 14) degrees and aged over 74 years, 121 (+/- 19) degrees; in women aged 65-74 years, 124 (+/- 19) degrees and aged over 74 years, 114 (+/- 22) degrees. These mean values are about 30 degrees less than those accepted for younger subjects. Nearly half the distribution falls below the accepted threshold level of 120 degrees for adequate function. There were significant effects of sex and age (P less than 0.001); women had poorer flexibility and the reduction with age amounted to 10 degrees per decade. Multiple regression analysis showed that the effect of age was accounted for in part by health, strength and customary use. The effects of use were most marked in those with some disability. This suggests that maintained or increased use could offset some of the age-related loss of the range of shoulder movement.     

Primary human muscle precursor cells obtained from young and old donors produce similar proliferative,differentiation and senescent profiles in culture

The myogenic behaviour of primary human muscle precursor cells (MPCs) obtained from young (aged 20–25 years) and elderly people (aged 67–82 years) was studied in culture. Cells were compared in terms of proliferation, DNA damage, time course and extent of myogenic marker expression during differentiation, fusion, size of the formed myotubes, secretion of the myogenic regulatory cytokine TGF‐β1 and sensitivity to TGF‐β1 treatment. No differences were observed between cells obtained from the young and elderly people. The cell populations were expanded in culture until replicative senescence. Cultures that maintained their initial proportion of myogenic cells (desmin positive) with passaging (n = 5) were studied and compared with cells from the same individuals in the non‐senescent state. The senescent cells exhibited a greater number of cells with DNA damage (γ‐H2AX positive), showed impaired expression of markers of differentiation, fused less well, formed smaller myotubes and secreted more TGF‐β. The data strongly suggest that MPCs from young and elderly people have similar myogenic behaviour.     

Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.     

Aids and adaptations for the elderly at home: underprovided,underused, and undermaintained

A random sample of 140 elderly people aged over 75 was selected from the age-sex register of an urban general practice to assess the provision and use of aids and adaptations in their homes. Many of the aids that the elderly had were faulty, including half of the walking aids and 15% of hearing aids, reading spectacles, and dentures, and up to half of the aids were not used. Yet despite this underuse there were many disabled elderly people who required aids for the bath and toilet.When screening of elderly people is carried out in general practice assessment of aids and adaptations should be included to see that they are provided where needed, are used, and are adequately maintained.     

Diagnostic Value of Symptom Screening for Pulmonary Tuberculosis in China

ObjectiveTo evaluate the diagnostic value of symptom screening for tuberculosis (TB) case finding defined in National Tuberculosis Control Program in China (China NTP) among elderly people(≥65 years) and younger people(<65 years).MethodsWe made a secondary analysis in a population-based TB prevalence survey in China in 2010. Questionnaire including information for cough and haemoptysis was completed by face to face interview, and then chest radiography was conducted in all eligible participants. Sputum smear and culture were followed for all TB suspects. We calculated the odds ratios (OR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the area under the receiver operating characteristic curve (AUC) of using different symptoms for screening to detect bacteriologically positive TB in subpopulations stratified by age 65, to evaluate the performance of symptom screening for TB.FindingsOf 315 newly diagnosed bacteriologically positive TB, 131 patients (41.59%) were elderly, and 48.57% of TB patients were asymptomatic. Nearly 50% patients did not present cough of any duration, and less than half present cough more than 2 weeks, a defined suspected symptom in China NTP. Cough of any duration was reported more in patients aged under 65 than those in elderly, especially for the acute cough (9.78% vs 6.87%). Those symptoms defined by China NTP were reported by less than half participants in two subpopulations. Acute cough (<2 weeks) was an independent predictor of TB in people aged under 65 (adjusted OR: 3.3, 95% CI: 2.0-5.5), but not in those aged 65 and above (adjusted OR: 1.4, 95% CI: 0.7-2.9). The specificity for each symptom was significantly higher in participants aged under 65 (P<0.01), and sensitivities of most symptoms were significantly higher among elderly (P<0.05 or P<0.01). When compared with cough for 2 weeks and more, using cough of any duration for symptom screening increased the sensitivity from 42.9% to 51. % for all participants, and the AUC increased from 0.70 to 0.74 for participants aged under 65 without significant difference.ConclusionsThere is a high percent of asymptomatic TB patients, and those symptoms adopted in China NTP for screening is poorly predictive for TB. The presence of TB symptoms, the sensitivities and specificities of symptoms for TB were distinct between two subpopulations cut by age 65, implying different case finding strategies should be established for them. The current case finding strategy should be improved, and further studies should be done to evaluate the performance and cost-effectiveness of different symptom screening strategy.     

Mild dehydration and atrial natriuretic peptide in young and elderly subjects.

The influence of mild dehydration on plasma levels of atrial natriuretic peptide (ANP) was studied in both young (aged 18 to 25 years) and elderly (aged 72 to 86 years) subjects. We expected that dehydration would lower ANP concentrations due to the ensuing volume contraction. A different response of the ANP hormonal system in the elderly might help to explain the observation that elderly subjects are more predisposed to dehydration as compared to young subjects. Dehydration was induced by restriction of fluid intake to 25% of normal for one day. During the study, urinary osmolality increased while osmolar clearance and body weight decreased. Basal ANP concentrations were higher in the elderly subjects. However, these levels did not change during the dehydration study neither in the young nor in the elderly subjects. This may be explained by the activation of counter-regulatory systems preventing a decrease in central blood volume and hence a decrease in ANP concentration.     

Artificial environments and an aging population: designing for age-related functional losses

Over the past century there has been a large and continuing increase in the frequency of persons aged over 65 years; particularly those aged over 100 years. During the 21st century the number of persons over 100 years will continue to increase. This will occur at such a rapid rate that the 21st century may one day be called the century of centenarians. Frailty and disability secondary to senescence, disease, and trauma have accompanied old age (often defined as age 65 and over) as far back as recorded history. However, during the 20th century, age, frailty, disability, and chronic degenerative diseases have been decoupled to some extant in the most long-lived human populations. Until recently, there was little need to design artificial environments for the unique needs of the elderly due to their low representation in most national populations. Today that need is increasing in concert with the number of persons aged 65 and older.The purpose of this review is to suggest areas wherein physiological anthropologists may have an opportunity to contribute to design trends for this rapidly increasing aging population. Major considerations for design of environments for the elderly are based upon altering the environment to accommodate their declining visual, auditory, and kinesthetic senses, thereby enhancing their declining faculties and improving their autonomy, independence, and self perceptions of well-being. To date most design considerations have been directed toward improving environments for those suffering from Alzheimer's disease or residing within assisted living facilities. Many such design improvements also may be effective in improving life satisfaction and functional abilities of the non-institutionalized elderly.     

Isoniazid phenotyping of black as well as white patients.

The isoniazid phenotyping in black patients from Birmingham (Alabama) as well as from South Africa yielded a higher frequency of fast inactivation than that in the Canadian and U.S. white participants. Following an oral test dose of 10 mg isoniazid per kilogram, the incidence of fast acetylation was 58.7 and 60.3% in South African and Birmingham blacks, respectively. In the Canadian and Birmingham Caucasians the rate was 41.9 and 41.0%, respectively.     

Ecological Aging: The Settings Approach in Aged Living and Care Accommodation

As the proportion of older people increases within populations, financial demands related to the cost of health service delivery threaten global stability. This population trend challenges the traditional approach to health service delivery to older populations. This article presents the Australian context as a case study to argue that the application of a health promoting settings approach to aged care may lead to improved well-being for older people to the extent that the periods of chronic morbidity often associated with aging can be compressed into an ever shorter period of time. Promoting an ecological perspective to aged care suggests that there is no need to manage older people in isolation, as is common practice, but as integral to the way society lives, works, and plays. The article maps parallels between characteristics of health promoting settings such as Health Promoting Schools and the aged living and care industry, arguing that the setting encompassing services for the elderly is a prime location for the establishment of a new health promotion setting. Supporting life opportunities for our aged is central to such an approach. More broadly, an ecological approach orients us toward the connection between environment and health, and encourages increased attention and action within the aged living and care sector on reducing environmental impacts of this growing population. As such, the application of this approach to the aged living and care sector has the potential to reduce the threat that a dependant older population has on global sustainability.     

Normal erythrocyte sedimentation rate in the elderly.

Two hundred subjects aged 60-89 were selected for a study aimed at defining a reference range for the erythrocyte sedimentation rate in the elderly. The study extended a previous survey in subjects aged 20-65. The results confirmed that the sedimentation rate increases with age and that women have higher values than men but suggested that over half of elderly patients with disease would have rates within the previously defined "normal" range. It is therefore suggested that an erythrocyte sedimentation rate exceeding 19 mm in the first hour in elderly men and 22 mm in the first hour in elderly women warrants investigation.     

Scope of surgery for intracranial aneurysm in the elderly: a preliminary report.

Thirty-two elderly patients were reviewed six months to six years after intracranial surgery for subarachnoid haemorrhage. Out of 24 patients whose surgical outcome had been satisfactory, one had died from an unrelated illness and the remainder were well and leading normal lives. Eight patients had a poor outcome, which in some cases was due to factors other than age. In only three could a poor outcome be attributed to early surgery and advanced age. The results confirm that in at least three-quarters of patients aged 60-65 the risk of further haemorrhage can be removed by surgery without causing a major neurological deficit.     

Sulphadimidine Acetylation Test for Classification of Patients as Slow or Rapid Inactivators of Isoniazid

Sulphadimidine acetylation studies were undertaken in 103 patients, 52 of whom had been classified as slow and 51 as rapid inactivators of isoniazid by a standard microbiological assay method. Each patient received sulphadimidine by mouth in a dose of 44 mg./kg. body weight, and free and total sulphadimidine were estimated in blood and urine collected at six hours. The findings suggest that patients may be classified as slow inactivators of isoniazid if the proportion of acetylated sulphadimidine (total minus free) is (a) less than 25% in blood or (b) less than 70% in urine. The sulphadimidine test is easy to perform and the result is available the same day; urine specimens for the test can be stored at room temperature for over a week without any loss of drug.     

A lighting evaluation of a facility for the elderly

A residential facility for the aged was evaluated for their illumination needs. Only the shared facility and grounds immediately surrounding it were considered. The facility evaluated is one of the most modern and the lighting design is considered its best feature. The age of residents occupying the facility ranges from 60 to 85 years. The lighting evaluation included administering a lighting adequacy/inadequacy questionnaire and measurement of actual light levels in the various parts of the facility during the day and after dark hours. The results indicated that lighting in approximately half the areas surveyed was substandard. An attempt to develop recommendations for the lighting needs of the elderly was unsuccessful. It was concluded that realistic illumination level recommendations need to be developed for the elderly.     

An increasing trend of gastric cancer deaths and inadequate preventive measures in elderly adults

Background

Japan became the world's first country to cover Helicobacter pylori eradication for chronic gastritis under its National Health Insurance (NHI) system in February 2013. Thereafter, H. pylori eradication dramatically increased and gastric cancer deaths began to decrease in Japan. However, the details of gastric cancer deaths and its prevention in the very elderly have not been fully elucidated.

Methods

We analyzed the temporal trend of gastric cancer deaths referencing data from Ministry of Health, Labour and Welfare reports and “Cancer Statistics in Japan–2021” and assessed the numbers of H. pylori test and gastric cancer screening using a national database and a report of cancer screening in Shimane Prefecture, respectively.

Results

Although gastric cancer deaths in total population have clearly decreased since 2013, those in people aged 80 years and older are still increasing. People aged 80 years and older represent 9% of the total population and accounted for half of all gastric cancer deaths in 2020. The numbers of H. pylori eradication and gastric cancer screening in people aged 80 years and older were 25% and 25% of those in other generations, respectively.

Conclusion

In spite of a dramatic increase in H. pylori eradication and a clear decrease in gastric cancer deaths in Japan, gastric cancer deaths in people aged 80 years and older are increasing. This might be due to fewer H. pylori eradication in the elderly than in other generations, indicating the difficulty of gastric cancer prevention in the very elderly.     

Income-related inequalities in denture-wearing by Europeans aged 50 and above

doi: 10.1111/j.1741‐2358.2011.00590.x
Income‐related inequalities in denture‐wearing by Europeans aged 50 and above Background: Despite its importance for the planning of future treatment needs and an optimised allocation of health care resources, only little is known about socio‐economic inequalities in denture‐wearing by late middle‐aged and elderly generations. Objectives: To describe income‐related inequalities in denture‐wearing by elderly populations residing in different European countries. Material and methods: Data from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 2) were used to assess income‐related inequalities in denture‐wearing by means of Concentration Indices (CI) for populations aged 50+ from 14 different European countries. Results: We could identify a significant disproportionate concentration of denture‐wearing amongst the poor elderly populations in Denmark (CI = ?0.3534, corresponding to the highest level of inequality), Sweden (CI = ?0.3479), Switzerland (CI = ?0.2013), Greece (CI = ?0.1953), the Netherlands (CI = ?0.1413), France (CI = ?0.1339), Austria (CI = ?0.0974), Czech Republic (CI = ?0.0959), Belgium (CI = ?0.0947), Germany (CI = ?0.0762), Ireland (CI = ?0.0575) and Spain (CI = ?0.0482, corresponding to the lowest level of pro‐poor inequality). Poland became evident as the only country in which individuals from the upper end of the income scale wear more dentures than their peers from the lower end of the income scale (CI = 0.0379). No significant income‐related inequalities were observable in Italy. Conclusions: There is considerable income‐related inequality in denture‐wearing by several elderly populations in Europe. Future resource planning for prosthetic care should, thus, specifically distinguish between the treatment needs of different socio‐economic groups within elderly populations.