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Age Increases (age + increase)
Selected AbstractsReporting of diabetes on death certificates using data from the UK Prospective Diabetes StudyDIABETIC MEDICINE, Issue 8 2005M. J. Thomason Abstract Aims To study the effect of age at death, sex, ethnic group, date of death, underlying cause of death and social class on the frequency of reporting diabetes on death certificates in known cases of diabetes. Methods Data were extracted from certificates recording 981 deaths which occurred between 1985 and 1999 in people aged 45 years or more who participated in the UK Prospective Diabetes Study, to which 23 English, Scottish and Northern Ireland centres contributed. Diabetes (9th revision of the International Classification of Diseases; ICD-9 250) entered on parts 1A,1C or 2A,2C of the death certificate was considered as reporting diabetes. Logistic regression analyses were used to determine independent factors associated with the reporting of diabetes. Results Diabetes was reported on 42% (419/981) of all death certificates and on 46% (249/546) of those with underlying cardiovascular disease causes. Reporting of diabetes was independently associated on all death certificates with per year of age increase (OR 1.02; 95% CI 1.001,1.04, P = 0.037), underlying cause of death (non-cardiovascular causes OR 0.76; 95% CI 0.59,0.98, P = 0.035) and social class (classes I,II OR 1.00; class III OR 1.35; 95% CI 0.96,1.89, P = 0.084, classes IV,V OR 1.48; 95% CI 1.05,2.10, P = 0.027). Stratification by age, sex, and underlying cause of death also revealed significant differences in the frequency of reporting diabetes over time. Conclusions The rate of reporting of diabetes on cardiovascular disease death certificates remains poor. This may indicate a lack of awareness of the importance of diabetes as a risk factor for cardiovascular disease. [source] Longitudinal patterns of new Benzodiazepine use in the elderly,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2004Gillian Bartlett PhD Abstract Purpose To characterize longitudinal patterns of Benzodiazepine use in the elderly. Methods Prospective cohort of 78,367 community-dwelling Quebec residents aged 66 years or more who were new Benzodiazepine users, was followed for 5 years, 1989,1994. Data acquired from four population-based, provincial administrative databases were used to create time-dependent measures of change in dosage, switching or adding Benzodiazepines for 11 drugs listed in the provincial formulary. Subject-specific Spearman's rank correlation coefficients between dose and time were used to measure the tendency of increasing dose with consecutive periods of use. Multiple logistic regression and generalized estimating equations (GEE) models evaluated subject characteristics associated with increasing dose. Results The mean duration of uninterrupted Benzodiazepine use was 75.5 days. The mean daily dose was about half the recommended adult daily dose but 8.6% of subjects exceeded the recommended adult dose. Some of them (28.8%) switched medications at least once and 8.2% filled two or more prescriptions concurrently. For women, older age at date of first prescription was associated with increasing dose over time (odds ratio (OR) for 10 year age increase,=,1.23, p,<,0.001). Conclusion Long periods of Benzodiazepine use are frequent among Quebec elderly. The evidence of increasing dose, particularly for older women, and long-duration of use has important implications for clinicians. Copyright © 2003 John Wiley & Sons, Ltd. [source] Evaluation of Three Algorithms to Identify Incident Breast Cancer in Medicare Claims DataHEALTH SERVICES RESEARCH, Issue 5 2007Heather T. Gold Objective. To test the validity of three published algorithms designed to identify incident breast cancer cases using recent inpatient, outpatient, and physician insurance claims data. Data. The Surveillance, Epidemiology, and End Results (SEER) registry data linked with Medicare physician, hospital, and outpatient claims data for breast cancer cases diagnosed from 1995 to 1998 and a 5 percent control sample of Medicare beneficiaries in SEER areas. Study Design. We evaluate the sensitivity and specificity of three algorithms applied to new data compared with original reported results. Algorithms use health insurance diagnosis and procedure claims codes to classify breast cancer cases, with SEER as the reference standard. We compare algorithms by age, stage, race, and SEER region, and explore via logistic regression whether adding demographic variables improves algorithm performance. Principal Findings. The sensitivity of two of three algorithms is significantly lower when applied to newer data, compared with sensitivity calculated during algorithm development (59 and 77.4 percent versus 90 and 80.2 percent, p<.00001). Sensitivity decreases as age increases, and false negative rates are higher for cases with in situ, metastatic, and unknown stage disease compared with localized or regional breast cancer. Substantial variation also exists by SEER registry. There was potential for improvement in algorithm performance when adding age, region, and race to an indicator variable for whether the algorithm determined a subject to be a breast cancer case (p<.00001). Conclusions. Differential sensitivity of the algorithms by SEER region and age likely reflects variation in practice patterns, because the algorithms rely on administrative procedure codes. Depending on the algorithm, 3,5 percent of subjects overall are misclassified in 1998. Misclassification disproportionately affects older women and those diagnosed with in situ, metastatic, or unknown-stage disease. Algorithms should be applied cautiously to insurance claims databases to assess health care utilization outside SEER-Medicare populations because of uneven misclassification of subgroups that may be understudied already. [source] A new source of aging?JOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2009Helen Knaggs MD Summary There has been a considerable increase in understanding how skin ages, along with significant progress toward the correction and prevention of the visible signs of aging. However, there are still many unknown factors regarding why we age , and why we all seem to age differently. An area of high interest is the biological or intrinsic processes that affect our appearance over time. This article describes a recent discovery of a membrane bound enzyme proven to be present in skin and increases its activity as biological age increases. The enzyme is located on the external surface of both fibroblast and keratinocytes, and generates free radicals. Therefore, as we age there appears to be a biological mechanism that further increases the production of free radicals. Additionally, there appears to be a relationship between activity of the enzyme and appearance. Data showed that subjects who look younger than their biological age had lower enzyme activity and conversely, subjects who looked older than their biological age had higher enzyme activity. Free radicals are believed to be a major contributing factor in the production of fine lines and wrinkles by destroying the collagen and elastin network keeping skin supple and firm. [source] A population-based cohort study of ambulatory care service utilization among older adultsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2010Jason X. Nie BSc (Hons) Abstract Rationale, aims and objectives, Age-related effects on ambulatory care service utilization are not well understood. We aim to measure the utilization patterns of ambulatory health care services (i.e. family physician visits, specialist physician visits and emergency room visits) in the late life course (65 years and older). Methods, A population-based retrospective cohort study was conducted for the period 1 April 2005 to 31 March 2006. All Ontario, Canada, residents aged 65+ and eligible for government health insurance were included in the analysis. Results, This population-based cohort study demonstrates considerable increase in utilization rates and variability of ambulatory services as age increases. Variations in utilization were observed by gender as overall women were more likely to consult a family physician, and men more likely to visit specialists and the emergency room. A small group of high users, constituting 5.5% of the total population, accounted for 18.7% of total ambulatory visits. Finally, we report socio-economic status (SES) based disparity for specialist services in which high users were more likely to have higher SES. Conclusions, There is increasing utilization and variability in ambulatory service utilization with increase in age. Further research is required to explain the gender and SES differences reported in this study. [source] Morphology of the mammalian vestibulo-ocular reflex: The spatial arrangement of the human fetal semicircular canals and extraocular musclesJOURNAL OF MORPHOLOGY, Issue 10 2007Philip G. Cox Abstract The vestibulo-ocular reflex is the system of compensatory ocular movements in response to stimulation of the kinetic labyrinth seen in all vertebrates. It allows maintenance of a stable gaze even when the head is moving. Perhaps the simplest influence on the VOR is the spatial orientation of the planes of the semicircular canals relative to the extraocular muscles. It is hypothesized that the extraocular muscles are in parallel alignment with their corresponding semicircular canals in order to reduce the amount of neural processing needed and hence keep reflex times to a minimum. However, despite its obvious importance, little is known of this spatial arrangement. Moreover, nothing is known about any ontogenetic changes in the relative orientations of the extraocular muscles and semicircular canals. The morphologies of fetal and adult specimens of Homo sapiens were examined using magnetic resonance (MR) images. Three-dimensional co-ordinate data were taken from the images and used to calculate vector equations of the extraocular muscles and planes of best fit for the semicircular canals. The relative orientations of the muscles and canals were then calculated from the vectors and planes. It was shown that there are significant correlations between both the anterior and lateral semicircular canals and their corresponding extraocular muscles during ontogeny. In the case of the lateral canal with the medial rectus, the lateral canal with the lateral rectus, and the anterior canal with the inferior oblique, the trend is towards, though never reaching, alignment, whereas the anterior canal and the superior rectus muscle move out of alignment as age increases. Furthermore, it was noted that none of the six muscle-canal pairs is in perfect alignment, either during ontogeny or in adulthood. It was also shown that the three semicircular canals are not precisely orthogonal, but that the anterior and posterior canals form an angle of about 85°, while the anterior and lateral canals diverge by ,100°. Overall, it was shown that there is significant reorientation of the extraocular muscles and semicircular canals during ontogeny, but that, in most cases, there is little realignment beyond the fetal period. J. Morphol., 2007. © 2007 Wiley-Liss, Inc. [source] Third molar position following Bionator treatmentORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 3 2000Calogero Dolce Third molar eruption is an unpredictable event. The position of the third molar continuously changes during development. The purpose of this study was to evaluate the influence of Bionator treatment on third molar position against an untreated control group. A Bionator is a loose-fitting intra-oral appliance that postures the mandible forward, thereby producing skeletal and dentoalveolar changes. Data were obtained from direct measurements of existing longitudinal panoramic radiographs taken during the course of a randomized study investigating Class II malocclusion treatment options. The following variables were analyzed: mandibular third molar depth in relation to the cemento-enamel junction of the second molar; anterior,posterior (A,P) position in relation to the anterior border of the ramus; and angulation registered at the functional occlusal plane. Analysis of variance and ordinal logistic regression were used to investigate relationships between the variables. Angulation of the third molars changed substantially with varying depths (p<0.0008) and A,P positions (p<0.0001), but did not appear to relate appreciably to dental age (p>0.5) or treatment condition (p>0.4). The A,P position was significantly correlated to dental age (p>0.004) and Bionator treatment (p<0.0001), whereas depth was marginally associated with dental age (p<0.07) and not influenced by Bionator treatment (p>0.5). Third molars adopt a position further anterior in relation to the ramus with Bionator treatment than they do in controls. As dental age increases, Bionator use appears to positively influence third molar position. [source] Spread of local anaesthetic solution in epidural space visualisation with ultrasound in single shot caudalsPEDIATRIC ANESTHESIA, Issue 6 2007K. Raghavan Background:, Ultrasonography is becoming an important adjunct in paediatric neuraxial blockade. Ultrasound guidance helps in visualisation of relevant neuraxial structures, predicting depth of epidural space from skin, reduction in bony contact and faster epidural placement. The visibility of neuraxial structures declines in patients as age increases. To date, there are no studies looking at the extent of spread of local anaesthetic solution in the epidural space and its correlation to the volume used, under ultrasound guidance. We report the results of our audit on spread of local anaesthetic solution in the epidural space in single shot caudal blocks. This abstract is based on the first 17 patients, the presentation will be based on all 50 patients. Methods:, This audit was approved by the local audit committee. We aimed to follow the extent of the spread of local anaesthetic within the epidural space with real time ultrasonography. Patients were selected when the planned anaesthetic included a single shot caudal block. The anaesthetists performing the anaesthetic and the caudal block consented to our ultrasound visualisation. All patients were below 5 years of age. No attempt was made to standardise the technique, the dose, or the speed of injection. After the placement of the caudal cannula by the primary anaesthetist involved in patient care, a separate anaesthetist, experienced in using ultrasound, visualised the neuraxial structures and subsequent spread of the local anaesthetic solution with real time ultrasound. The spread was followed during the injection and for 10 s after the completion of the injection. A 5 cm 7.5,12 MHz linear array was used longitudinally with either midline or paramedian approach. Results:, We are reporting the preliminary results from 17 patients. Patients were aged between 1 day and 1 year 10 months. They weighed between 3.3 kg and 14.6 kg. Either 22 gauge Jelco or Abbocath were used to perform the procedure; 0.25% or 0.20% L-bupivacaine was used on all occasions. The volume administered per kg ranged between 0.33 and 1.27 ml. The visibility of neuraxial structures was good on all occasions. On calculating the Spearmans correlation coefficient, the extent of spread of local anaesthetic in the epidural space was positively correlated with the volume used by a correlation coefficient of 0.64, with a P value of 0.008. The postoperative pain score in recovery was 0 in 16 out of the 17 cases. The one failure occurred when the observed spread would not have been expected to provide analgesia for the performed operation. Conclusions:, Among children below 5 years of age, there seems to be a positive correlation between the volume of local anaesthetic injected into the epidural space and the extent of its spread. This needs to be further investigated by a prospective randomised control trial. The utility of real time ultrasound to allow a reliable achievement of a desired level of sensory block, should be investigated i.e, whether the volume used in achieving a desired level of local anaesthetic spread, as guided by ultrasound, provides superior analgesia and fewer adverse effects compared with the volume calculated using the Armitage regimen. References, 1,Rapp HJ, Folger A, Grau T. Ultrasound guided epidural catheter insertion in children. Anesth Analg 2005; 101: 333,339. 2,Willschke H, Marhofer P, Bosenberg A, et al. Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss of resistance technique. Br J Anaesth 2006; 97: 200,207. 3,Marhofer P, Bosenberg A, Sitzwohl C et al. Pilot study of neuraxial imaging by ultrasound in infants and children. Pediatr Anesth 2005; 15: 671,676. [source] The Relationship between Personal Income and Net Worth in AustraliaTHE AUSTRALIAN ECONOMIC REVIEW, Issue 2 2007John Creedy This article uses data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey to examine the changing distribution of net worth with age. Even after controlling for age, the relationship between income and net worth is positive, except for the older age groups. Inequality falls as age increases. The income poor save in different forms compared with high income individuals of the same age cohort. Holdings of financial assets, especially equity investments and superannuation, are heavily concentrated in the hands of high income earners, while fixed income investments are favoured by the elderly for all income groups. [source] | ||||||||||