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PubMed1996

Use of prescription medications in an elderly rural population: the MoVIES Project.

OBJECTIVE: To determine the pharmacoepidemiology of prescription drug use in a rural elderly community sample, specifically the numbers and categories of medications taken and the factors associated with them. DESIGN: Cross-sectional community survey. SETTING: The mid-Monongahela Valley of southwestern Pennsylvania. PARTICIPANTS: An age-stratified random sample of 1360 community-dwelling individuals, aged 65 years and older. MEASURES: Self-reported use of prescription drugs demographic characteristics, and use of health services. RESULTS: Nine hundred sixty-seven participants (71%) reported regularly taking at least one prescription medication and 157 (10%) reported taking five or more medications (median 2.0, range 0-13). Women took significantly more medications than men (median 2.0, range 0-13 and median 1.0, range 0-9, respectively; p = 0.01). The use of a greater number of medications was independently and statistically significantly associated with older age, hospitalization within the previous 6 months, home health care in previous year, visit to a physician within the previous year, and insurance coverage for prescription medication. Individuals older than 85 years were significantly more likely to be taking cardiovascular agents, anticoagulants, vasodilating agents, diuretics, and potassium supplements. Significantly more women than men were taking nonsteroidal antiinflammatory drugs, antidepressants, potassium supplements, and thyroid replacement medications. CONCLUSIONS: Both the number and the types of prescription medications vary with age and gender. The demographic and health service use variables associated with greater medication use in the community may help define high-risk groups for polypharmacy and adverse drug reactions. Longitudinal studies are needed.

Age Factors↗
PubMed2000

If a population crashes in prehistory, and there is no paleodemographer there to hear it, does it make a sound?

Catastrophic episodes (e.g., epidemics, natural disasters) strike with only limited regard for age. A large percentage of catastrophic mortality in a population can lead to a death distribution that resembles the living distribution, which includes greater numbers of older children, adolescents, and young adults than typical mortality profiles. This paper examines both the population implications of a large catastrophic mortality event, based on the Black Death as it ravaged medieval Europe, and its long-term effects on age-at-death distributions. An increased prevalence of epidemic disease is a common feature of reconstructions of the shift to agriculture and the rise of urban centers. The model begins with a hypothetical Medieval living population. This population is stable and characterized by slow growth. It has fertility and mortality rates consistent with a natural-fertility, agrarian population. The effects of catastrophic episodes are simulated by projecting the model population and subjecting it to one large (30% mortality) catastrophic episode as part of a 100-year population projection. A pair of Leslie matrices forms the basis of the projection. The catastrophic episode has important, long-term effects on both the living population and the cumulative distribution of death. The living population fails to recover from plague losses; at the end of the projection, population is still less than 75% its pre-plague level. The age-at-death distribution takes on the juvenile-young adult-heavy profile characteristic of many archaeological samples. The cumulative death profile based on the projection differs from that produced by the stable model significantly (P < 0.05) for 25-50 years after the plague episode, depending on sample size.

Adolescent↗
PubMed1989

Brainstem projections to the major respiratory neuron populations in the medulla of the cat.

Efferent and afferent connections of the dorsal and ventral respiratory groups in the medulla of the cat were mapped by axonal transport of wheat germ agglutinin conjugated to horseradish peroxidase. Injections of wheat germ agglutinin-horseradish peroxidase into the dorsal respiratory group and the three principal subdivisions of the ventral respiratory group (caudal, rostral, and Bötzinger Complex) revealed extensive interconnections between these regions and with a limited number of other brainstem neuron populations. Major neuron populations with efferent projections to the regions of the dorsal and ventral respiratory groups include the parabrachial nuclear complex (medial parabrachial, lateral parabrachial, and Kölliker-Fuse nuclei), subregions of the lateral paragigantocellular reticular nucleus, subregions of the lateral and magnocellular tegmental fields, inferior central and postpyramidal nuclei of the raphe, and sensory trigeminal nuclei. A previously unidentified neuron population with extensive efferent projections to the dorsal and ventral respiratory groups was found near the ventral surface of the rostral medulla; we refer to this group as the retrotrapezoid nucleus. The results suggest that the dorsal and ventral respiratory groups form an extensively interconnected neuronal system receiving convergent inputs from the same brainstem nuclear groups, consistent with the hypothesis that the dorsal and ventral groups are primarily sites for integration of sensory and premotor respiratory drive inputs. Neuron populations in the rostral ventrolateral medulla with projections to both the dorsal and ventral respiratory groups, particularly the retrotrapezoid nucleus and neighboring subregions of the lateral paragigantocellular reticular nucleus, are candidate sites for participation in respiratory rhythmogenesis or other critical functions of the brainstem respiratory control system such as intracranial chemoreception.

Action Potentials↗
PubMed2005

Laterodorsal tegmental projections to identified cell populations in the rat ventral tegmental area.

Projections from the laterodorsal tegmentum (LDT) to the ventral tegmental area (VTA) contribute to the activity of dopamine (DA) and GABA cells and, hence, to the affective and cognitive functions of this region. LDT afferents arise from neurochemically diverse cell types and mediate multiple functional influences. However, the VTA cell populations that receive LDT afferents are unknown and were investigated here by anterograde and retrograde tract-tracing in combination with immunocytochemistry to distinguish DA and GABA cells. Approximately 50% of the LDT to VTA pathway formed asymmetric, presumably excitatory synapses that innervated DA and GABA cells in rough proportion to their representation within the VTA. This portion of the LDT innervation appeared to selectively target DA but not GABA mesoaccumbens neurons and provide a relatively nonselective input to both DA and GABA mesoprefrontal cells. The remaining LDT axons formed symmetric, presumably inhibitory synapses with a different pattern of cellular targets that included a preferential input to GABA neurons of both mesoaccumbens and mesoprefrontal populations and an apparently selective innervation of mesoprefrontal and not mesoaccumbens DA neurons. These data suggest that the LDT mediates a convergent excitatory and inhibitory influence on both mesoprefrontal DA and GABA cells but a divergent impact on mesoaccumbens neurons that is likely to excite DA cells and inhibit GABA neurons. Combined with our previous description of prefrontal cortical afferents, our data also indicate that mesoaccumbens DA neurons receive putative excitatory drive from the LDT, whereas mesoprefrontal DA cells receive convergent excitation from both cortical and brainstem sources.

Acetylcholine↗
PubMed2005

The Western Australian gestational breast cancer project: a population-based study of the incidence, management and outcomes.

This descriptive population-based study estimates the incidence, and describes the management and outcomes for women diagnosed with gestational breast cancer (GBC) aged 15-44 years in Western Australia between January 1982 and December 2000. Gestational breast cancer accounted for 6.25% of breast cancers in Western Australian women less than 45 years of age, and complicated 23.6 per 100,000 pregnancies. Two thirds were diagnosed postpartum and a third while pregnant. The median time from first symptom to diagnosis was less than four weeks. Women diagnosed during pregnancy were more likely to have a pregnancy termination. Over 50% of women were lymph node positive and those diagnosed postpartum were more likely to have a mastectomy. Five-year survival was better than reported previously (73%). The incidence of GBC was lower than previously reported. Significant differences in pregnancy outcome and management exist between the pregnant and postpartum groups.

Adolescent↗
PubMed1999

Mu- and delta-opioid receptor agonists inhibit DARPP-32 phosphorylation in distinct populations of striatal projection neurons.

In the striatum, DARPP-32 (dopamine- and cAMP-regulated phosphoprotein of 32 kDa) is highly expressed by virtually all projection medium-sized spiny neurons. cAMP-dependent phosphorylation of DARPP-32 is stimulated via activation of dopamine D1 receptors in striatonigral neurons, and via activation of adenosine A2A receptors in striatopallidal neurons. In this study, we have examined the contribution of mu-, delta- and kappa-opioid receptors to the regulation of DARPP-32 phosphorylation, in rat striatal slices. The results show that, at low concentrations (100 pm-1 nm), the mu-opioid agonist, Tyr-D-Ala-Gly-N-Me-Phe-glycinol (DAMGO), inhibits the increase in DARPP-32 phosphorylation induced by activation of D1, but not by activation of A2A receptors. Conversely, the delta-receptor agonist, Tyr-D-Pen-Gly-Phe-D-Pen (DPDPE), inhibits DARPP-32 phosphorylation induced by activation of A2A, but not by activation of D1 receptors. The kappa-receptor agonist, U50488, does not affect DARPP-32 phosphorylation induced by either D1 or A2A agonists. Thus, mu-opioid receptors interact with dopamine D1 receptors on striatonigral neurons, whereas delta-opioid receptors interact with adenosine A2A receptors on striatopallidal neurons. These results suggest that regulation of DARPP-32 phosphorylation is involved in mediating some of the effects exerted by enkephalin on striatal medium-sized spiny neurons.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1997

Historical dose reconstruction project: estimating the population at risk.

This paper discusses methods used to estimate the size and location of the populations that lived around the Feed Materials Production Center near Ross, Ohio, from 1950 through 1990. This information will support an historical dose reconstruction for environmental exposures to radionuclides from this facility that is currently being done by the Centers for Disease Control and Prevention through a contract with Radiological Assessments Corporation. Available sources of data include (1) the U.S. Census, Ohio Township data; (2) the U.S. Census, Ohio Township block data; and (3) U.S. Geological Survey topographical maps that show structures. A distribution of age and sex is estimated that, together with population estimates, will provide information needed to estimate collective dose rates over time and to examine the feasibility of studying the relationship between exposure to radionuclides released from the Feed Materials Production Center and adverse health outcomes.

Animal Feed↗
PubMed2003

Genetic polymorphism of the renin-angiotensin-aldosterone system and arterial hypertension in the Italian population: the GENIPER Project.

OBJECTIVE: To detect the association of single polymorphisms of the renin-angiotensin-aldosterone system (RAAS), or different combinations thereof, with hypertension. DESIGN AND METHODS: The GENIPER database is the result of a collaborative effort of 13 Italian research centres to collect genomic DNA in subjects well characterized in terms of blood pressure status. A total of 2461 subjects (normotensive = 611; hypertensive = 1850) were selected and genotyped for the angiotensin-converting enzyme insertion/deletion (ACE I/D), angiotensinogen (AGT) T/C704, angiotensin receptor type 1 (AT1) A/C1166 and aldosterone synthase (ALDO) T/C-344 genetic variants. RESULTS: Allele frequencies were homogeneous over the Italian territory, with the relevant exception of the ACE I/D, the D allele being significantly less frequent in the northern region (61%) than in the rest of the country (67%; P < 0.0001). When comparing allele and genotype distributions in normotensives and hypertensives, the latter presented a small but statistically significant increase of the C allele of AGT T/C704, the A allele of AT1 A/C1166 and the T allele of ALDO T/C-344 polymorphisms (P = 0.018, P = 0.037 and P = 0.015, respectively), with similar trends all over the country. A step-wise logistic regression analysis confirmed these findings, by entering in the model as independent predictors of blood pressure status of AGT T/C704 (P = 0.013), ALDO T/C-344 (P = 0.032) and AT1 A/C1166 polymorphisms (P = 0.075), but not ACE I/D (P = 0.996). We also found some evidence of an additive effect of individual genetic variants of the RAAS, modulating at different levels the same functional pathway, on the risk of developing hypertension, but no synergistic interaction was observed. CONCLUSIONS: Our results suggest that some allelic variants of RAAS genes carry a small but identifiable risk of developing arterial hypertension.

Databases, Genetic↗
PubMed1993

Cognitive impairment and the use of health services in an elderly rural population: the MoVIES project. Monongahela Valley Independent Elders Survey.

OBJECTIVE: To describe the patterns of use of health and human services by elderly rural individuals and to determine whether cognitively impaired persons had a distinctive pattern of service utilization. DESIGN: An epidemiological survey and cognitive screening of an age-stratified random community sample. SETTING: The mid-Monongahela Valley, a rural community in Southwestern Pennsylvania. PARTICIPANTS: 1366 non-institutionalized persons aged 65 years and older, fluent in English, and with at least a sixth grade education. MEASUREMENTS: We administered a battery of cognitive screening tests (the Mini-Mental State Examination; Immediate and Delayed Recall of a Story; Immediate and Delayed Recall of a Word List; CERAD modification of the Boston Naming Test; Verbal Fluency for initial letters P and S and for names of Fruits and Animals; Temporal Orientation; Praxis; Clock Drawing; and Trailmaking Tests A and B.) We also obtained basic demographic information and inquired about the use of health and human services in the previous year. RESULTS: Approximately 10% of the sample was classified (by operational criteria) as cognitively impaired. In univariate analyses, cognitive impairment was found to be significantly associated with the use of certain health services: hospitalization in the previous 6 months (odds ratio, OR = 2.1; 95% CI = 1.3, 3.3), previous nursing home use (OR = 9.3; 95% CI = 3.8, 22.9), home health care (OR = 4.6; 95% CI = 2.7, 8.0), social services (OR = 6.5; 95% CI = 3.4, 12.4), mental health services (OR = 2.8; 95% CI = 1.2, 6.2), and the regular use of prescription medications (OR = 2.0; 95% CI = 1.3, 3.2). Visits to physicians were not significantly different between the impaired and unimpaired groups. In a multiple regression model, which included age and educational level, the use of home health care (OR = 3.4; 95% CI = 1.8, 6.4) and social services (OR = 2.3; 95% CI = 1.1, 4.9) remained significantly associated with cognitive impairment. CONCLUSIONS: The association of cognitive impairment with the use of these health and human services underscores the general frailty of the impaired group. These findings also point to potential target groups in the community for further evaluation and services for dementia. The findings support the need for education regarding cognitive impairment and dementia to be made available to providers of these services, particularly informal social services such as those provided by church groups.

Aged↗
PubMed1987

Application of echocardiography to population-based research projects.

The value of echocardiography as a tool for the epidemiologic investigation of hypertension has not yet been determined. Since echocardiography is considerably more sensitive than electrocardiography in the detection of left ventricular hypertrophy, the development and regression of left ventricular hypertrophy assessed by echocardiography may be extremely useful in determining prognosis in hypertension and the efficiacy of therapeutic interventions. Its use may free clinical trials of dependence on total mortality and coronary incidence as the only end points.

Cardiomegaly↗
PubMed2005

Community outreach program for child victims of traumatic events: a community-based project for underserved populations.

Behavioral and cognitive behavioral treatment interventions have been shown to be effective for the treatment of trauma-related problems in children. However, many children and families in need of treatment do not have adequate access to services and do not have access to effective, evidence-based treatment services. The present article describes a community-based program that provides in-home and in-school treatment services, based on behavioral and cognitive behavioral approaches to addressing trauma-related emotional and behavioral problems in children.

Adaptation, Psychological↗
PubMedDate not supplied

[The Bambuí Project: a population-based study of factors associated with regular utilization of dental services in adults].

A cross-sectional study was conducted in Bambuí, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambuí dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.

Adolescent↗
PubMed1989

The global epidemiology and projected short-term demographic impact of AIDS.

This paper summarizes the natural history, surveillance, and global patterns of infections with the human immunodeficiency virus (HIV), the etiologic agent of AIDS The focus is primarily on HIV-1 because surveillance of HIV-2, which has recently been recognized as a separate type of the virus, is only just beginning. The natural progress of the disease is described, from acute infection through asymptomatic phase to the clinical illness phase. Available evidence on the speed of progression from infection to AIDS and possible co-factors in that progression are reviewed. The 3 patterns of AIDS which are described characterize the experience of different regions according to the types of transmission ( i.e., homosexual versus heterosexual, contaminated blood, drug use) and demographic characteristics of the affected persons. An epidemiologically based short-term forecasting model for AIDS cases is presented and used to project the demographic impact of AIDS in a hypothetical central African country. In that hypothetical setting, the impact of AIDS is shown to be disproportionately felt in urban areas, where the projected increase in population will decrease by 30% due to AIDS deaths by 1997; the growth rate of the rural population will be only slightly affected. In conclusion, the global prevalence of the disease, and prospects and implications for the future are discussed. Without effective drugs for treatment and no vaccine for prevention of HIV infections, the short-term outlook is not good. HIV/AIDS is expected to be an increasing public-health problem in the next 2 decades.

Acquired Immunodeficiency Syndrome↗