Molecular pathology of acquired immunodeficiency syndrome-related non-Hodgkin''s lymphoma

The assumption that Amish cultural value of cooperation leads to greater longevity, prosperity and well-being among elders was examined using historical demographic and ethnographic analysis in a conservative Old Order Amish community. Migration, fertility, mortality and morbidity data since 1948 were used to identify population structure. The population pyramid in the Amish community (3% of the population over age 60, compared to 18% of the neighboring non-Amish rural area) is largely determined by natural fertility with low infant mortality. Household ethnography explored health beliefs, access to health care, caregiving patterns, and economic strategies. The perception that community cooperation and altruistic behavior were of benefit to Amish health is supported by mortality rates. Amish age standardized death rates were 19% below the US death rate in 1960. Migrating to form new communities and selectively utilizing acute (but not preventive or public) health care services, emerged as strong cultural patterns that facilitate reproductive success among the Amish.     

Cultural implications for nursing care of the Amish

The Amish are a conservative Protestant religious sect with a unique set of culture and traditions. In order to provide culturally appropriate and sensitive health care, it is imperative for nurses and other health care providers to have a basic understanding of variations of Amish lifestyle from other cultural groups. Application of Giger and Davidhizar's Transcultural Assessment Model provides information and nursing implications to assist nurses and other health care personnel when caring for Amish clients.     

A potential mechanism for mitral valve prolapse syndrome

The authors examined the prevalence of Alzheimer's disease and apolipoprotein E allele frequencies in the Old Order Amish. A lower frequency of dementia in the Amish does not appear to be due to a reduced E4 frequency.     

Respiratory viral infections in the elderly in a nursing home

The purpose of this study was to investigate what viruses infiltrate into our nursing home, assess the related clinical symptoms in elderly subjects, and compare the incidence of infections with those in the general community. Between July 1994 and June 1995, 40 elderly persons dwelling in the nursing home were evaluated by clinical observation, serologic analysis, and viral culture of samples to determine the presence of viruses. Enteroviruses and herpes simplex I virus could be isolated from asymptomatic elderly subjects. Individuals with influenza B virus and RSV infections diagnosed by serology did have clinical symptoms. The prevalence of both influenza B virus and enteroviruses was related to that of such viruses in the general community. Our data suggest that respiratory viruses are readily transmitted from the community to nursing home residents.     

Gene structure and mutations of glutaryl-coenzyme A dehydrogenase: impaired association of enzyme subunits that is due to an A421V substitution causes glutaric acidemia type I in the Amish

The structure of the human glutaryl coenzyme A dehydrogenase (GCD) gene was determined to contain 11 exons and to span approximately 7 kb. Fibroblast DNA from 64 unrelated glutaric acidemia type I (GA1) patients was screened for mutations by PCR amplification and analysis of SSCP. Fragments with altered electrophoretic mobility were subcloned and sequenced to detect mutations that caused GA1. This report describes the structure of the GCD gene, as well as point mutations and polymorphisms found in 7 of its 11 exons. Several mutations were found in more than one patient, but no one prevalent mutation was detected in the general population. As expected from pedigree analysis, a single mutant allele causes GA1 in the Old Order Amish of Lancaster County, Pennsylvania. Several mutations have been expressed in Escherichia coli, and all produce diminished enzyme activity. Reduced activity in GCD encoded by the A421V mutation in the Amish may be due to impaired association of enzyme subunits.     

Psychological assessment of the Old Order Amish: Unraveling the enigma.

Old Order Amish define their existence as "in" but not "of" the world, expressing their spirituality in a culture currently unique among Christian sects. The mental health professional--"of" the world, by definition--faces the task of providing services to a sequestered people. This article examines the needed modifications in role, to accommodate expectations of equality, and respect for the boundaries that must always exist. Little professional literature--and almost none in recent years--addresses psychological interventions with the Amish. The challenge of providing services to this population illuminates the challenge of a sequestered people, the demands of cross-cultural service, and a humbling recognition of the limitations to existing psychological techniques and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Services for the aged in community mental health centers

The author studied the services provided for the elderly at eight community mental health centers. He describes discrimination against the elderly, the reasons why relatively few elderly persons seek care, and innovations in treatment. He discovered that high-quality care depends more on staff awareness of the unique problems of the elderly than on specialized services. The author recommends a more public-health-oriented approach that would set priorities on the basis of community needs.     

Depression among elderly Chinese immigrants: an exploratory study

Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.     

Mutations in human TBX3 alter limb, apocrine and genital development in ulnar-mammary syndrome

The aim of this study was to determine the effect cognitive impairment has on direct and indirect costs to elderly people, their carers and the community over one year, by following prospectively a cohort of elderly people referred to an aged care assessment team. The 78 subjects were drawn from a random sample of people referred to the NorthWest Hospital team, and validated tools were used to assess their cognitive state. Outcome measures included total costs of community services, residential care, hospital bed use, carer burden and psychological morbidity. A comparison of outcome measures was made between those with cognitive impairment and those without. Use of community services and hospital beds was high overall. Those with cognitive impairment were substantially greater users of residential care, accounting for the higher expenditure in this group. Psychological morbidity and burden remain high in carers of those with cognitive impairment despite a high rate of institutionalisation in this group. The total costs for those referred to aged care assessment teams with cognitive impairment are double those seen for those with normal cognition.     

Les caractéristiques psychosociales associées à la solitude chez les personnes agées, selon le type d'habitat.

The initial phase of the present research verifies whether there is any difference in the degree of loneliness between elderly persons living in the community (house, apartment for the general population) compared to those living in reserved housing (institution, boarding-house, apartment for the elderly). However, the fundamental objective is to determine the social psychological characteristics associated with loneliness for the elderly living in the community or in reserved housing. Two hundred (200) elderly persons of the metropolitan Quebec region (104: community; 96: reserved housing) responded to two questionnaires concerning their loneliness and their social psychological characteristics. There is no significant difference between the degrees of loneliness either according to the type of housing (community and reserved) or according to the sub-type of housing. Several correlations were found to be significant between loneliness and social psychological characteristics for one or the other of the two types of housing. The results are discussed in the light of previous empirical studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Amish way of death: A study of family support systems.

Discusses the fact that coping with death is becoming increasingly difficult in society today. Science and technology have replaced belief and ritual, most deaths take place in institutional settings rather than in the home, and the high rate of mobility of the nuclear family lessens the opportunities for experiencing life and death within an extended-network support system. The author considers that the centrality of the family in Amish society and the unchanged function of the family unit present a rare opportunity to study relational support systems that have been successful in coping with death for the past 400 yrs. 24 Amish families were interviewed in 5 areas: family structure, group structure, funeral customs and rituals of mourning, personal experience with death, and personal feelings about death. Implications are presented for psychosocial issues in contemporary society in terms of improving the quality of life and death for the dying, their families, and the professionals involved in their care. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic and physical mapping of the McKusick-Kaufman syndrome

McKusick-Kaufman syndrome is a human developmental anomaly syndrome comprising mesoaxial or postaxial polydactyly, congenital heart disease and hydrometrocolpos. This syndrome is diagnosed most frequently in the Old Order Amish population and is inherited in an autosomal recessive pattern with reduced penetrance and variable expressivity. Homozygosity mapping and linkage analyses were conducted using two pedigrees derived from a larger pedigree published in 1978. The PedHunter software query system was used on the Amish Genealogy Database to correct the previous pedigree, derive a minimal pedigree connecting those affected sibships that are in the database and determine the most recent common ancestors of the affected persons. Whole genome short tandem repeat polymorphism (STRP) screening showed homozygosity in 20p12, between D20S162 and D20S894 , an area that includes the Alagille syndrome critical region. The peak two-point LOD score was 3.33, and the peak three-point LOD score was 5.21. The physical map of this region has been defined, and additional polymorphic markers have been isolated. The region includes several genes and expressed sequence tags (ESTs), including the jagged1 gene that recently has been shown to be haploinsufficient in the Alagille syndrome. Sequencing of jagged1 in two unrelated individuals affected with McKusick-Kaufman syndrome has not revealed any disease-causing mutations.     

Evaluating the culture of fetal erythroblasts from maternal blood for non-invasive prenatal diagnosis

The aim of this study was to identify the prevalence of homebound elderly (defined as people whose daily activities were limited to their home) and factors related to it among 300 community elderly residents aged 60 and over in Yamagata city. In 1995, the baseline survey was performed and the follow-up survey was conducted one year later. Subjects were divided into two groups according to the extent of their daily activities: the non-homebound group (defined as people whose daily activities extended into their community) and the homebound group. The main results were as follows; 1. The prevalence of homebound elderly was 7.7% in 1995. 2. Chi-square test or t test was performed to examine the relationship between homebound and various factors. Significant factors were age, history of hypertension, history of mental disease, incompetence of ADLs (walking, eating, toileting, bathing, dressing), interpersonal dependency, subjective health, 'ikigai' (meaningfulness of life), life style (cooking, cleaning, reading newspaper or magazine, watching TV, exercise, associate with friend) and TMIG (Tokyo Metropolitan Institute of Gerontology) index of competence. The present study reveals that daily activities in community elderly residents is related to not only physical factors but also psychosocial factors. Using the significant variables in univariate analysis, multiple logistic regression analysis controlling for age was performed. Significant factors for homebound were incompetence of ADLs (walking, toileting), subjective health and TMIG index of competence. 3. Three out of 214 non-homebound elderly persons in 1995 changed to homebound in 1996.     

Development of a modified Winchester disability scale--the elderly at risk rating scale

OBJECTIVE: To show that the elderly at risk rating scale (EARRS) satisfies the requirements of an assessment tool for routine health checks in people over 75 and would also be suitable as a method of collecting epidemiological data on the needs of the elderly in a locality. DESIGN: Development and validation of a questionnaire based on a modification of the Winchester rating scale, by a series of prospective, comparative studies before the use of the instrument in a community survey. SETTING: Elderly care day hospital and the community. SUBJECTS: Elderly patients referred to an elderly care day hospital; population survey of subjects over 75 living at home. MAIN OUTCOME MEASURES: Reliability of responses using the kappa statistic; comparison of the scale with the Barthel index of daily living. RESULTS: EARRS has satisfactory validity and reliability when repeated by the same observer or a different observer, with a mean weighted kappa score above 0.80 in both instances. As a measure of disability in the community, it is better than the Barthel score in that it avoids the ceiling effect. The score is correlated with age, social situation, and receipt of support services, and individual questions scale appropriately to adverse outcomes. CONCLUSION: The EARRS satisfies the requirements of an assessment tool for health checks in the elderly, It is suitable for both population surveys and routine practice in primary care, has proved popular with practice nurses, and is easy to complete.     

Ocular surface damage and tear lactoferrin in dry eye syndrome

Because falls are common among the elderly and are associated with high morbidity and mortality, community surveillance has been recommended. The purpose of this study was to characterize the impact of falls among the elderly on emergency medical transport services (EMS) and to explore the potential for community surveillance of falls through the use of computerized EMS data. Computerized EMS data and United States census data for 1990 for persons aged > or = 65 in Forsyth County, NC, were used to produce EMS transport rates for falls and to make comparisons by age, gender, race, and residence (nursing home vs community). A fall was reported as the cause for EMS summons in 15.1% (613 of 4,058) of cases. Transport rates in 1990 for falls were 7.8 per 1,000, 25.4 per 1,000, and 58.5 per 1,000 for the age groups of 65 to 74 years, 75 to 84 years, and 85 years and older. Rates were higher for females than for males (17.1 per 1,000 v 8.1 per 1,000) and higher for whites than for African-Americans (14.3 per 1,000 v 10.3 per 1,000). Rates for nursing home residents were four times that of community residents (70.6 per 1,000 v 16.0 per 1,000). Over 50% of nursing home fallers were transported between midnight and 0400 compared with 25% of community dwellers. EMS summons for older adults reporting a fall accounts for a significant portion (15%) of all transports in this county. Computerized EMS data demonstrated patterns of falls among the elderly that are consistent with known demographic factors. The potential for using computerized EMS data as a practical means of community surveillance should be further explored.     

Familial glucocorticoid deficiency: one syndrome, but more than one gene

BACKGROUND: Functional status differs among populations of elderly, although the extent of differences in types of functions among groups has not been closely examined. This study identifies and compares characteristics among different populations of elderly, using a screening test that measures self-assessment of multiple areas of function. The screening tool used was the Dartmouth COOP Charts, developed for and primarily tested in office medical practices. It has not been used to systematically compare office patients with other groups of elderly. METHODS: Dartmouth COOP Charts were administered to five groups of elderly drawn from convenience samples of individuals age 65 and older, including elderly living in senior apartments, those attending community activities, mentally oriented nursing home patients, office patients, and elderly patients not visiting the doctor within the past 6 months. Demographic data, as well as COOP chart results, were obtained. RESULTS: There were multiple differences in COOP chart scores among the samples of elderly individuals. The greatest differences were in self-reported physical fitness and in the level of difficulty in performing daily activities. Medical office patients not visiting in 6 months had the highest fitness levels. On the other hand, the "social support" availability scale showed no differences among groups. Results from other scales were intermediate among these extremes. CONCLUSIONS: Different samples of elderly yield varying results on several measures of reported physical and emotional health. All convenience samples of the elderly may have somewhat poorer health than the average person age 65 and older. Of the groups studied, those with the poorest function were either older adults in nursing homes or those visiting the doctor's office for treatment.     

Medicare spending for elderly beneficiaries who need long-term care

To better understand how elderly people with long-term care needs might be affected by Medicare's greater reliance on risk plans, we examine Medicare spending for this population using data from the Medicare Current Beneficiary Survey. Medicare spending for elderly people with functional limitations is substantially greater than for other beneficiaries, but highly variable. Medicare spends more, however, for community residents with moderate to severe functional limitations than for nursing home residents with similar degrees of limitation. These results raise concerns about the incentives of Medicare risk plans in caring for enrollees with long-term care needs.     

Management of moderate to severe hypertension and proteinuria by nifedipine retard and perindopril after renal transplantation

The following analysis describes selected aspects of Saxonian social and medical care for people in need of help and elderly, via "community social service units". Almost 16% of people are older than 65 years in Saxonia, whereas the number of women is twice the number of men. To secure the social and medical care "community social service units" were founded partly from former municipal nursing stations of the former GDR and partly from newly founded institutions. Basic and medical care is an essential part of the supply in "community social service units". To approximate an all-embracing social and medical care, so-called "other tasks" complete the general service from a qualitative point of view.     

Self-care ability in a group of elderly Swedish people: a phenomenological study

The aims of this study were to describe self-care ability in a group of Swedish elderly and to elucidate the meaning of actualizing this self-care ability into self-care activity. Two different phenomenological methods were applied in the analyses of 11 self-reports written by home dwelling elderly in the community. The eidetic structure of self-care ability was twofold; it entailed, first, being present to the opportunity to act on certain perceived influences on the body and, second, alone or with support from somebody else to be able to bring about a change in attitude towards one's personal lifestyle or life situation. The meaning of actualizing this ability was interpreted as self-realization or self-transcendence.     

Risk management at the margins: less-familiar topics in psychiatric malpractice

Hypertension is a major risk factor for stroke and heart disease in the elderly. Eighty-one hypertensive subjects with mild cognitive impairement, aged over 70 years, were drawn from a community screening programme and randomized to either 12.5 mg captopril twice daily or 2.5 mg bendrofluazide daily in a double-blind trial. Subjects were excluded if they had previously received antihypertensive treatment. The mean blood pressure was reduced from 193/101 mmHg to 154/87 mmHg by captopril and from 188/102 mmHg to 151/89 mmHg by bendrofluazide after 24 weeks; there was no significant difference between the two drugs. Seven subjects withdrew due to adverse events. Adverse events occurred more frequently during the 2-week placebo phase than during active treatment with either drug. The only significant detrimental changes in pre-existing conditions were in 3 subjects (2 captopril, 1 bendrofluazide) who were noted to have worsening of their cataracts. One subject on captopril and 4 subjects on bendrofluazide became hypokalaemic. The trial results support the use of captopril as an alternative to bendrofluazide as a first-line antihypertensive agent in the community for elderly people, but large studies are required to measure accurately effects on significant morbidity and mortality.