Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa

BACKGROUND

The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries.

METHODS

Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa.

RESULTS

This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa.

CONCLUSIONS

Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs.

Topiramate and metabolic acidosis in pediatric epilepsy

PURPOSE

Topiramate (TPM) has been widely used as an adjunctive therapy for treating epilepsy. TPM is reported to have multiple mechanisms of action, including inhibition of carbonic anhydrase, which may result in metabolic acidosis from decreased serum bicarbonate (HCO3-).

METHODS

Clinical data from 30 children who received TPM as adjunctive therapy for medically refractory epilepsy were reviewed at Children's Hospital, Boston. Serum HCO3- levels were assessed before, during, and after discontinuing TPM (n = 9). When multiple data were available, mean values were used for analysis.

RESULTS

Of the 30 patients, 21 had a >10% decrease in HCO3- levels. The mean decrease in HCO3- among the 21 patients was 4.7 mEq/L, and maximum was 10 mEq/L. No clinical symptoms occurred, and HCO3- supplement was not needed, except for one patient who developed tachypnea from worsened acidosis after prolonged status epilepticus during a suspected viral illness. Among the 21 patients, TPM was discontinued in seven children because of a lack of efficacy, and in two because of anorexia. After discontinuing TPM, the serum HCO3- returned to the previous level before starting TPM in all nine.

CONCLUSIONS

Decreased HCO3- levels occurred in the majority of patients reviewed, usually only to a small to moderate extent, but by 8 and 10 mEq/L in two cases. In patients at risk for acidosis, the decrease in HCO3- may cause significant consequences, such as severe acidosis or renal calculi. Monitoring HCO3- levels before and during TPM therapy may be indicated, especially with conditions that predispose to acidosis.

Functional measuring of muscle tone

Testing muscle fields requires functional conditions. The procedure for measuring has to put the musculature under conditions as they occur in physiological functioning. Furthermore a measuring instrument should be economical and easy to handle in the course of the daily routine. The Myofunctional Therapist presently has a number of measuring instruments available. Some of them need to be adjusted before every operation. Others give only comparative readings, having no absolute reference. Others measure states which do not represent normal functions of the musculature and therefore do not allow conclusions about the state of the muscle in relation to function. Some apparatuses are highly sensitive and can only be handled by highly trained persons. In this category we find the highly precise electronic equipment being highly expensive to purchase and to repair. It seems that the Function Tonometer is in all points compatible when waging the pros and cons. It directly reads the actual muscle tone under conditions which occur during normal function. The device can be used for diagnostics and documentation as well as in functional training. The output is a defined mechanical range (pressure in mbar) and needs not be adjusted before each measurement. Used in treatment, it motivates by visual feedback. The results are reproducible at any time, at any location, and by any person, even young patients. The instrument has an easy handling, favorable costs in purchase and operation, and is not easily damaged. The assembly is not electrically operated and thus is not under restrictive rules nor the need of an energy supply. The Function Tonometer is indeed a flexible and useful tool to aid in diagnosis, documentation, and treatment procedures.

[Chronic aspecific respiratory tract diseases in workers of pig-breeding farms]

To study chronic nonspecific respiratory diseases of people working in industrial swine confinement buildings, a cross sectional study was initiated. Based on history of diseases, clinical and parameters of ventilatory screening in 238 swine producers a frequency of chronic respiratory symptoms were found in 25.6%. The possible dependence on age, sex, smoking history, working conditions and duration of activity was investigated. The influence of professional and non professional factors had different intensity. The results of investigations of working conditions did not exceed the permitted maximal working place concentrations. So they could not prove the large frequency of respiratory diseases.

Prospective study of the incidence of ultrasound-detected hepatic hematomas 2 and 24 hours after percutaneous liver biopsy

Recently, a high incidence of hepatic hematomas following percutaneous liver biopsy was reported. This induced us to undertake this prospective ultrasound examination before, as well as 2 and 24 h after, percutaneous liver biopsy, using a Menghini needle (O 1.4 mm), in 93 patients for diagnostic purposes. Two hours after biopsy a small subcapsular fluid margin was found in one patient (1.1%) which disappeared within 24 h. We conclude that hepatic hematomas are not frequent following percutaneous liver biopsy and that it remains a safe diagnostic procedure to find out the reason for chronically elevated liver enzymes and evaluate suspected diffuse parenchymal lesions of the liver.

[Permissible dermal exposure dose and safety level for herbicide residues as an occupational hygiene standard for the evaluation of exposure]

At preparing mixtures for spraying, application of pesticides and entering treated areas workers are subject of potential exposure, more than 90% via skin. The limitation of dermal exposure requires hygiene-toxicological threshold limit values. On the basis of toxicity data from experiments with animals a permissible dermal exposure dose for pesticide residues is determined. For that a safety and a resorption factor are used, which are fixed in dependence on the toxic effects. The permissible dermal exposure dose is the basis of the calculation of a safety value for residues on plant surfaces and reentry time.

[Results of occupational medicine pesticide research]

The conditions of the pesticide exposition in agriculture are described, including results of analyses of acute consequences of expositions to selected agents as well as in workers exposed to pesticide application for several years.

[Epidemiological study on the demonstration of precipitating antibodies against Micropolyspora faeni in agricultural workers]

The authors report on the frequency (as determined by the double diffusion test according to Ouchterlony) of circulating precipitating antibodies against thermophil actinomycetes of the genus Micropolyspora faeni in 1666 blood samples from 1376 agricultural workers. These workers belonged to the main professional categories in two districts of the German Democratic Republic and were examined by members of the Research Group on Occupational Medicine in Agriculture of the Ernst Moritz Arndt University during the years 1972-1975. 290 workers were examined twice or three times in a longitudinal study. Positive serological findings were obtained from 5.1% of the subjects under investigation. There were no statistically significant differences with regard to occupational category, sex, age, and season. Nevertheless, there were marked regional differences. The results obtained show that there is no need for special medical supervision of the agricultural workers with regard to thoracic actinomycosis (farmers' lung). Further examinations are of course necessary in case of suspected or clinically manifest affection.

[70. Performance diagnostic studies for the determination of the condition and health risks of managers in comparison with other exposed and inexposed professional workers]

By screening examinations of 1,287 persons fit to work from 9 professions altogether 208 persons of risk were selected who were classified into a group of managers and into a group of workers who were professionally increasedly exposed or demanded and who were-in comparison to a control group-comprehensively after-examined, including complex ergometry. The managers have an increased risk of health by hypertension and cardial ischaemia and at the same time an unfavourable condition. The increasedly exposed or demanded workers have an increased risk by hypertension and bronchitis despite favourable condition. The results confirm the necessity of a prevention of persons from professional and dispositional risk of health according to a graduated health control programme.