Elderly people's technique in using dry powder inhalers. New inhaler devices are rarely used by older people in the community.
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Biomedical subjects
Publications and source records attributed to L Dow.
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Twelve patients with hemispatial neglect and two control groups were tested to examine the effects of the Müller-Lyer and Judd illusions on bisection behaviour. The studies were designed to investigate whether neglect patients were indeed unaware of the left sides of the illusory figures. In Experiment 1, participants were asked to describe the illusory figures prior to bisection, whereas in Experiment 2, they compared two illusions whose fins, in the critical condition, differed on the left and then performed the bisection. It was found that the illusions worked equally well in all three groups. Interestingly, apart from one exception, almost all neglect patients explicitly reported the left-sided fins in Experiment 1. Only five patients failed to do so but only on an average of 16% of trials. In Experiment 2, six patients made errors in the comparison task but four of these patients did not neglect any left-sided fins in Experiment 1 (with the exception of three overall trials for LC and EdR). This finding seems a good indication that the two tasks differ in their requirements. The comparison task may be perceived as harder as it requires discrimination rather than detection and thus lead to more neglect type errors than the bisection task. In one neglect patient, the illusions consistently failed to work. This patient presented with an occipito-temporal and basal ganglia lesion and the mechanisms responsible for the processing of simple visual features might have possibly been impaired in her case.
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BACKGROUND: A study was undertaken to estimate the prevalence of untreated asthma in older adults. METHODS: A cross sectional population based survey of 6000 men and women aged 65 years and over was performed in 21 general practices in north Bristol, south west England. The main outcome measure was untreated asthma as defined by a two stage process comprising a respiratory questionnaire (symptoms suggestive of asthma or doctor diagnosed asthma not receiving respiratory treatment) followed by lung function tests (significant reversibility following bronchodilators or corticosteroids and/or significant within day variability in peak expiratory flow). RESULTS: 4792 of the 6000 participants (80%) completed the respiratory questionnaire and, of those not receiving respiratory treatment, 55 reported a previous doctor diagnosis of asthma and a further 696 had symptoms suggestive of asthma. Lung function testing in 280 of 501 randomly selected individuals from these groups resulted in 38 being defined as having asthma and an estimated population prevalence for untreated asthma of 2.4% (95% CI 1.6% to 3.6%) in men and 1.2% (95% CI 0.7% to 2.1%) in women. Most subjects (84%) with untreated asthma had moderate or severe disease. Untreated asthma was most common in individuals with doctor diagnosed asthma (21%) and those with breathlessness or wheeze (13-20%). CONCLUSION: Untreated asthma in the elderly is a common and important problem. Opportunistic use of appropriate lung function tests in older people with a history of doctor diagnosed asthma or wheeze or breathlessness at rest could identify untreated asthmatics who might benefit from treatment.
Many everyday tasks require that we use our hands co-operatively, for example, when unscrewing a jar. For tasks where both hands are required to perform the same action, a common motor programme can be used. However, where each hand needs to perform a different action, some degree of independent control of each hand is required. We examined the coordination of bimanual movement kinematics in a female patient recovering from a cerebrovascular accident involving anterior regions of the parietal lobe of the right hemisphere, which resulted in a dense hemianaesthesia of her left arm. Our results indicate that unimanual movements executed by our patient using her non-sensate hand are relatively unimpaired. In contrast, during bimanual movements, reaches executed by our patient using her non-sensate hand show gross directional errors and spatiotemporal irregularities, including the inappropriate coupling of movement velocities. These data are discussed with reference to the role played by limb proprioception in the planning and control of prehension movements.
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BACKGROUND: Studies in children and young women have indicated an increased risk of respiratory illness in association with the use of domestic gas appliances, possibly caused by oxides of nitrogen generated when gas is burned. It is not known whether risks are similarly increased in older subjects. METHODS: A questionnaire about respiratory symptoms in the past year and potential risk factors for respiratory disease was mailed to 6000 men and women aged 65 years and older who were selected at random from the lists of general practices in North Bristol, UK. Associations between symptoms and the use of gas appliances were examined by logistic regression with adjustment for age, sex, social class, and smoking habits. RESULTS: Questionnaires were completed by 4792 (80%) of those mailed. The most common symptoms were exercise induced breathlessness, wheeze, or chest tightness (51%); wheeze (27%); morning phlegm (20%); and daytime breathlessness at rest (19%). In an analysis that included all subjects only weak associations were found with use of gas appliances, odds ratios all being 1.2 or less. The risks associated with use of a gas hob tended to be higher in women, with odds ratios of 1.36 (95% CI 1.01 to 1.83) for wheeze and 1.33 (95% CI 0.56 to 3.17) for morning chest tightness, but were lower than had been reported previously in younger women. CONCLUSION: The absence of stronger associations cannot readily be explained by bias or confounding. Gas cookers and fires are unlikely to be an important cause of respiratory illness in the elderly. If they do cause such illness, the largest risks are likely to be in women who use gas hobs.
Although food handlers are often implicated as the source of infection in outbreaks of food-borne viral gastroenteritis, little is known about the timing of infectivity in relation to illness. We investigated a gastroenteritis outbreak among employees of a manufacturing company and found an association (RR = 14.1, 95% CI = 2.0-97.3) between disease and eating sandwiches prepared by 6 food handlers, 1 of whom reported gastroenteritis which had subsided 4 days earlier. Norwalk-like viruses were detected by electron microscopy or reverse transcriptase-polymerase chain reaction (RT-PCR) in stool specimens from several company employees, the sick food handler whose specimen was obtained 10 days after resolution of illness, and an asymptomatic food handler. All RT-PCR product sequences were identical, suggesting a common source of infection. These data support observations from recent volunteer studies that current recommendations to exclude food handlers from work for 48-72 h after recovery from illness may not always prevent transmission of Norwalk-like viruses because virus can be shed up to 10 days after illness or while exhibiting no symptoms.
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From the clinical perspective, asthma in the older patient may be difficult to diagnose because of the non-specificity of presentation and the wide range of differential diagnoses. Prior to confirmation of asthma in the older patient, both respiratory and cardiac investigation may be necessary. Polypharmacy is inherent in treating older people and accurate drug histories are essential in order to identify patients with drug-induced bronchospasm and avoid interactions with asthma medication. Patient and carer education is vital, and a structured approach to follow-up which includes measurement of lung function and assessment of inhaler technique should be carried out in every asthmatic regardless of age. Finally, there is a great need for health services and those in the commercial sector that are involved in asthma care to ensure that future research and development rises to the challenge of an ageing population.
Spatial neglect has been explained as an impairment in the representation of extrapersonal space. One account suggests that representations of extrapersonal space are spatially compressed following neglect. In support of this view it has been demonstrated that neglect patients systematically underestimate the size of stimuli presented in their left hemifield. In the current study we investigated this phenomena by obtaining an indirect measure of perceived object size - the scaling of grip force during prehension. We demonstrate for the first time that neglect patients show increased levels of grip force for objects presented in their left hemifield. This finding is discussed with reference to a proposed distinction between visual processing used for object recognition, and visual processing used to guide action.
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Antioxidants in the lung have a protective role against oxidative damage. We have investigated whether dietary antioxidant intake in elderly people is related to lung function. Dietary intakes of ascorbic acid (vitamin C) and alpha-tocopherol (vitamin E) and lung function were assessed in 178 men and women aged 70 to 96 yr selected on the basis of reported respiratory symptoms. After adjustment for age, gender, height, smoking habits, total energy intake, and vitamin C intake by multiple linear regression, vitamin E intake was significantly associated with FEV1 p = 0.012 and FVC p = 0.003. There was no evidence of any interaction between vitamin E intake and current tobacco smoking as determinants of lung function. For every extra milligram increase in vitamin E in the daily diet, FEV1 increased by an estimated 42 ml and FVC by an estimated 54 ml. These results suggest that dietary intake of vitamin E may influence lung function in the elderly, but food frequency questionnaires in this study were not of sufficient sensitivity to explore this hypothesis further.
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We have performed a 4-yr prospective survey of the association of allergen skin test positivity, total serum immunoglobulin E (IgE), and bronchial responsiveness to methacholine, with longitudinal decline in FEV1, in subjects over 65 yr of age. In 1987, 324 subjects completed a respiratory questionnaire, and underwent measurement of FEV1 and FVC, methacholine challenge, skin prick testing (to Dermatophagoides pteronyssinus, cat fur, mixed grasses, and Aspergillus fumigatus) and estimation of total serum IgE. After an interval of 4 yr, 212 subjects were reexamined. The mean annual decline in FEV1 was significantly higher in males than in females, but was not significantly influenced by smoking habits defined at the start of the study. The relation of atopy (skin test reaction to allergen > or = 3 mm greater than saline control), increased bronchial responsiveness (PD20FEV1 < or = 6.4 mumoles methacholine) and serum IgE > 80 IU/ml, to annual decline in FEV1 was examined for each risk factor individually with adjustment for age, sex, height, and initial FEV1, by multiple linear regression. Both atopy and bronchial responsiveness were significantly associated with accelerated decline in FEV1. Elevated IgE was correlated with faster FEV1 decline in subjects who were current smokers at the start of the study. In a multiple regression model examining the mutually adjusted associations of all relevant variables with annual decline in FEV1, male sex was the most important predictor (B = 38.6 ml/yr, 95% Cl = 4.3, 72.9). Increased bronchial responsiveness also tended to be associated with accelerated decline in FEV1. In further analyses incorporating the same variables, but restricted to specific smoking categories, age was the only significant factor in the never-smokers, whereas both atopy (B = 44.5 ml/yr, 95% Cl = 3.8, 85.3) and increased bronchial responsiveness (B = 43.5 ml/yr, 95% Cl = 4.6, 82.3) were significant predictors of accelerated FEV1 decline in former and current smokers combined.(ABSTRACT TRUNCATED AT 250 WORDS)
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