Commentary on "Embracing complexity: A consideration of hypertension in the very old".
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
B Grab
Publications and source records attributed to B Grab.
Prognosis of functional recovery 1 year after hip fracture: typical patient profiles through cluster analysis.
BACKGROUND: Many investigators have identified distinct medical, demographic and psychosocial prefracture conditions that influence the functional outcome of patients surgically treated for a fracture of the hip. However, to design efficient intervention care programs addressing the needs of these patients, at optimal economic and social costs, more information is required on the typical combinations of prognostic determinants actually encountered. METHODS: Data on specific descriptors of the prefracture status and on mobility and functioning 1 year after surgical intervention were collected by interview from 253 consecutive patients hospitalized for a fracture of the proximal femur. Cluster analysis was used to form homogeneous groups of patients with similar profiles in terms of the 13 predictive variables and the 7 outcome variables significantly interrelated. The modeling procedure generated four clusters of patients with a typical profile sharply contrasted by their structure. RESULTS: Subjects of two clusters could walk without difficulty and were functionally independent prior to their hip fracture. One year later, however, mobility and functioning were only fully recovered by the members of one cluster. The majority of predictors were of less favorable prognostic value for the members of the second cluster. The other two clusters regrouped patients with impaired prefracture mobility that were either unaltered or even aggravated 1 year later. CONCLUSIONS. Cluster analysis identified typical profiles of elderly hip fracture patients. Close scrutiny of their respective global structure, in terms of combined prognostic determinants and outcomes, may help to develop specific management strategies that are more efficiently adapted to these different groups of patients.
Activities of Daily Living↗
Risk of hospitalization in undernourished home health care patients: prognostic value of serum albumin level.
Explore the source record for details and available documents.
Aged↗
Promotion of fibroblast adhesion by triple-helical peptide models of type I collagen-derived sequences.
The dissection of the activities mediated by type I collagen requires an approach by which the influence of triple-helical conformation can be evaluated. The alpha 1 beta 1 and alpha 2 beta 1 integrin binding sites within type I collagen are dependent upon triple-helical conformation and contained within residues 14-822 from alpha 1(I). Seven alpha 1(I)-derived triple-helical peptides (THPs) were synthesized based on charge clustering (alpha 1(I)256-270, alpha 1(I)385-396, alpha 1(I)406-417, alpha 1(I)415-423, alpha 1(I)448-456, alpha 1(I)496-507, and alpha 1(I)526-537). Three additional THPs were synthesized (alpha 1(I)85-96, alpha 1(I)433-441, and alpha 1(I)772-786) based on previously described or proposed activities (Kleinman, H. K., McGoodwin, E.B., Martin, G. R., Klebe, R. J., Fietzek, P. P., and Wooley, D. E. (1978) J. Biol. Chem. 253, 5642-5646; Staatz, W. D., Foik, K. F., Zutter, M. M., Adams, S. P., Rodriquez, B. A., and Santoro, S. A. (1991) J. Biol. Chem. 266, 7363-7367; San Antonio, J. D., Lander, A. D., Karnovsky, M. J., and Slayter, H. S. (1994) J. Cell Biol. 125, 1179-1188). Of the ten THPs, alpha 1(I)772-786 THP had the greatest activity, with half-maximal normal dermal fibroblast adhesion occurring at a peptide concentration of 1.6 microM. Triple-helicity was essential for activity of this sequence, as the non-triple-helical peptide analog (alpha 1(I)772-786 SSP) exhibited considerably lower levels of cell adhesion promotion even at peptide concentrations as high as 100 microM. Within the sequence itself, residues 784-786 (Gly-Leu-Hyp) were important for cellular recognition, as the alpha 1(I)772-783 THP had greatly reduced cell adhesion activity compared with alpha 1(I)772-786 THP. Preliminary studies indicate that the beta 1 integrin subunit mediates fibroblast adhesion to alpha 1(I)772-786 THP. The identification of fibroblast integrin binding sites within type I collagen may have important implications for understanding collagen metabolism.
Amino Acid Sequence↗
Purification and analysis of synthetic, triple-helical "minicollagens" by reversed-phase high-performance liquid chromatography.
To better study collagen-mediated cellular and enzymatic activities, a generally applicable solid-phase methodology has been developed by which aligned triple-helical peptides (designated THPs or "minicollagens") ranging from 79 to 124 residues can be assembled. Reversed-phase HPLC is typically the purification method of choice following chemical synthesis of small proteins of this size, as well as one of the analytical techniques used to verify product purity. We have thus compared the effects of different stationary phases (C18, C4, or diphenyl), organic modifiers (acetonitrile or isopropanol), support pore sizes (120 angstroms, 300 angstroms, or nonporous), and counterions for the reversed-phase HPLC analysis of THPs. Large pore C18 or C4 reversed-phase HPLC gave broad peaks, resulting in poor resolution of the desired THP from synthetic impurities. Broad peaks were presumably due to conformational instability of THPs to reversed-phase conditions and subsequent slow cis-trans isomerization of the peptide bonds. Peak sharpness was improved greatly by use large-pore diphenyl reversed-phase HPCL. We found that THPs can be best resolved from synthetic impurities by diphenyl or non-porous C18 reversed-phase HPLC using water-acetonitrile gradients. These results most likely reflect conditions which maintain the native conformation of collagen-like triple-helices.
Amino Acid Sequence↗
[Prospective evaluation of specialized consultations in a geriatric university hospital].
In a prospective study carried out over a 3 month period we analysed the views of consultants and residents taking part in 771 consultations to patients admitted to the Geriatric University Hospital of Geneva with the help of visual analogue scales. 27 medical subspecialties were involved. Both consultants and residents agreed that most of the consultations were useful for the elderly patient and for postgraduate teaching and learning. But the residents thought that consultations were more important for the patients' welfare than for the residents' education. Residents showed a tendency to underestimate crucial aspects of geriatric medicine (in particular the autonomy of the elderly patient) in preference to more "classical" medical preoccupations (diagnosis and treatment). Consultants were aware of the specificity of geriatric pathology but restricted their teaching during the intervention to what was requested by the resident.
Aged↗
[Postmortem diagnosis of cardiac amyloidosis in the aged. Anatomoclinical correlation].
The absence of specific clinical signs makes the diagnosis of cardiac amyloidosis difficult. Moreover, it is established that this condition, the prevalence of which increases with age, aggravates the prognosis of cardiac failure. The present study was undertaken to identify the clinical or paraclinical signs enabling more accurate diagnosis of this disease. Analysis of 2589 autopsy reports from the University Institutes of Geriatrics of Geneva between January 1972 and January 1990 recensed 58 cases of microscopic cardiac amyloidosis, but this diagnosis was not made in any of these patients before death. Of the potential indicators, the good specificity but poor sensitivity of atrial fibrillation and low voltage electrocardiogram was confirmed. On the other hand, the author's research found the association of radiological cardiomegaly and a raised erythrocyte sedimentation rate in nearly 70% of cases of cardiac amyloidosis with a false positive rate of only 10% in a control group.
Aged↗
Pini as a mortality index in the hospitalized elderly patient.
Explore the source record for details and available documents.
Aged↗
[Grief and health in older persons].
Explore the source record for details and available documents.
Aged↗
[Health survey in the elderly using home interviews: study of various indicators].
Questions asked on the occasion of health survey at home usually refer to frequency of medical consultations and prescribed drugs, but often also to reported somatic symptoms and self-evaluated general health status. Interview data collected in a population of aged widows and widowers revealed a high degree of concordance between these various health indicators, justifying in particular the value assigned to the subjective appreciation of the level of general health.
Aged↗
High density lipoprotein (HDL) subfractions in cardiovascular patients with low levels of HDL-cholesterol. Influence of hypertriglyceridaemia on subfraction concentration and composition.
The major high density lipoprotein (HDL) subfractions were examined in angiographically defined cardiovascular patients with low HDL-cholesterol (HDL-C) levels. The aims were to study subfraction concentration and composition, and the extent to which hypertriglyceridaemia (HTG) modified these variables. Normotriglyceridaemic (NTG)-low HDL-C patients showed similar subfraction composition to age-matched healthy controls. However, these groups showed notable differences in subfraction composition compared to HTG-low HDL-C patients, particularly with regard to the HDL2 subfraction. HDL subfraction mass was significantly reduced in both cardiovascular groups; the HTG group showed a greater reduction in HDL2, whilst the NTG group showed a greater reduction in HDL3. The major HDL apoprotein (apo A-I) was lower in both subfractions of the cardiovascular patients. Apo A-II showed significant reductions only in the HTG patients.
Apolipoprotein A-I↗
The transmission potential of monkeypox virus in human populations.
Data on monkeypox in Zaire over the five years 1980-1984 are analysed to assess the protection imparted by past smallpox vaccination and the transmission potential of the virus in unvaccinated communities. Attack rates in individuals with and without vaccination scars indicated that smallpox vaccination (discontinued in 1980) imparted approximately 85% protection against monkeypox. It is predicted that monkeypox virus will continue to be introduced into human communities from animal sources, and that the average magnitude and duration of monkeypox epidemics will increase as vaccine-derived protection declines in the population. On the other hand, current evidence indicates that the virus is appreciably less transmissible than was smallpox, and that it will not persist in human communities, even in the total absence of vaccination. The findings thus support the recommendation of the Global Commission for the Certification of Smallpox Eradication to cease routine smallpox vaccination in monkeypox endemic areas, but to encourage continued epidemiological surveillance.
Democratic Republic of the Congo↗
Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire.
Human monkeypox is a zoonosis that occurs sporadically in the tropical rainforest of western and central Africa. This article presents the results of epidemiological features of 91 monkeypox patients reported in Bumba zone in northern Zaire during the period 1981 to 1985. Their age ranged from 7 months to 29 years (93% below 15 years of age). 11% of patients had visible smallpox vaccination scars. Deaths occurred sporadically; the overall case-fatality rate was 9%. 91 patients arose in 61 separate outbreaks; 42 of them consisted of only a single case. The source of infection was suspected to be animal for 70 cases, and human for the remaining 21 cases. The illness occurred in all months of the year. There was a considerable clustering of cases in the northern part of the zone. The average annual incidence rate in the observed zone was 0.63 cases per 10,000 population with marked differences in age, time and place. The average annual primary attack rate among unvaccinated individuals (1.7/10,000) sharply contrasted with those vaccinated (0.04/10,000). The secondary attack rate for contacts without vaccination scar (4.3%) differed significantly from those who had been vaccinated in past (0.7%). Many unvaccinated contacts living under conditions of maximal exposure to index cases escaped not only the disease but also infection. The low incidence rate of human monkeypox indicates its limited public health importance even in a well-known enzootic area.
Adolescent↗
Clinico-epidemiological features of monkeypox patients with an animal or human source of infection.
Clinical and laboratory examinations were carried out on a total of 338 monkeypox patients in Zaire from 1981 to 1986. An animal source of infection was suspected in 245 (72%) and interhuman transmission for the remaining 93 patients. Among those whose infection was presumably acquired from an animal source, the most affected groups were children aged 3-4 years (27%) and 5-6 years (20%), while only 4% of cases were over 15 years old; there was a considerable preponderance of males (58%) over females (42%), especially in the age group 5-14 years. Among those presumably infected by person-to-person transmission, the age distribution was more uniform, adult patients tending to be relatively more common, and there were more females (57%) than males (43%).Based on comparisons of the frequency and intensity of clinical signs and symptoms among patients infected from an animal source and those who were infected by another patient, there was no evidence that the disease becomes more severe and the transmitted virus more virulent or more easily transmissible from person to person after one or more passages through human hosts.
Adolescent↗
Human monkeypox: secondary attack rates.
Data on human monkeypox collected in Zaire during the six years 1981-86 were analysed to assess the extent of interhuman transmission of monkeypox virus. Among the 2278 persons who had close contact with 245 monkeypox patients infected from an animal source, 93 fell ill and were presumed to have been infected from the known human source: 69 of these were spread in the first generation, 19 in the second generation, and the remaining five cases in the third and fourth generation.The secondary attack rates were correlated with the age, sex, place of residence, and vaccination status of the contacts. There was an overall 3% probability of becoming ill following infection from a known human source. The affected household was the main focal point for interhuman transmission of monkeypox virus. The highest attack rate (11.7%) occurred among unvaccinated household contacts in the age group 0-4 years. However, the majority of susceptible persons who had been close to patients in the confined space of poorly ventilated huts failed to develop illness. There was no evidence of an increase in the secondary attack rate between 1970-80 and 1981-86.The inefficient spread from person to person, even in conditions of maximum exposure, supports the concept that monkeypox virus is poorly adapted for sustained transmission between humans and that such transmission does not pose a significant health problem.
Adolescent↗
Human monkeypox: confusion with chickenpox.
Human monkeypox is a zoonosis occurring sporadically in the tropical rain forest of western and central Africa. The exact incidence and geographical distribution are unknown, since many cases are not recognized. Special surveillance was established in three regions in Zaire in 1981 that led to a substantial increase in reported cases. The question arose as to the possibility that clinical diagnostic errors cause some cases of monkeypox to be misdiagnosed as other eruptive diseases. This paper presents the results of a study assessing the extent of and reasons for these clinical diagnostic errors in areas where health staff as well as the general public are aware of human monkeypox. In Zaire in the period 1981-1986, 977 persons with skin eruption not clinically diagnosed as human monkeypox were laboratory tested. 3.3% of human monkeypox cases were found among 730 patients diagnosed as cases of chickenpox, 7.3% among cases diagnosed as "atypical chickenpox" and 6.1% among cases with skin rash for which clinical diagnosis could not be established. The diagnostic difficulties were mainly based on clinical features characteristic of chickenpox: regional pleomorphism (in 46% of misdiagnosed cases), indefinite body-distribution of skin eruptions (49%), and centripetal distribution of skin lesions (17%). Lymph-node enlargement was observed in 76% of misdiagnosed patients. In the absence of smallpox, the main clinical diagnostic problem is the differentiation of human monkeypox from chickenpox. The presence of lymphadenopathy, pre-eruptive fever and slower maturation of skin lesions are the most important clinical signs supporting correct diagnosis of monkeypox.
Adolescent↗
[Apoprotein E (apo E) phenotype and serum lipids in diabetics].
Apo E isoforms have been determined among diabetics. The allele distribution epsilon 2, epsilon 3 and epsilon 4 does not differ from the control population. Diabetics with epsilon 2 allele have increased serum triglycerides compared to diabetics with epsilon 3 and epsilon 4 alleles. In diabetics with E2/2 phenotype both serum cholesterol and serum triglycerides are elevated. The phenotype of apoprotein E does influence serum lipids in diabetics.
Alleles↗
Stochastic model for interhuman spread of monkeypox.
With the eradication of smallpox, systematic routine vaccination with vaccinia has ceased and an increasing proportion of the human population in tropical rain forest areas of central and western Africa lacks vaccinia-derived immunity to monkeypox virus. This raises the question of the ability of monkeypox virus to establish and maintain itself in an unvaccinated population through continuous man-to-man transmission. A computerized stochastic model of Monte Carlo type was constructed to assess this potential risk. Simulated series were repeated 100 times to obtain distributions of predicted outcomes for decreasing levels of vaccination coverage (70 per cent, 50 per cent, and 0 per cent). The results revealed a substantial increase in new secondary cases in the total absence of vaccinia-induced immunity. Nevertheless, none of the simulated series did lead to an "explosive" epidemic. The model clearly indicated diminishing numbers of cases in successive generations and eventual cessation of transmission. Therefore, it appears highly improbable that the virus could maintain itself permanently in communities by interhuman transmission. After the eradication of smallpox, human monkeypox constitutes the most important orthopoxvirus infection in man, but analysis of information collected up to this time suggests that it does not represent currently a serious public health problem or a challenge to the achieved eradication of smallpox.
Adolescent↗