Avoidance-Endurance Model in Older Black Men with Low Back Pain: Exploring Relationships

OBJECTIVE

The objective of the study was to investigate functional performance and pain intensity outcomes for associations with negative cognitive orientations, avoidance behaviors, and fear of pain in older Black men with low back pain (LBP).

METHODS

Sixty Black men aged 60 and older (70 years[Formula: see text]) with LBP completed the Short Physical Performance Battery (SPPB), the 400-m walk test, and subjective measures of avoidance behaviors, back performance, pain intensity, and pain catastrophizing (i.e., rumination, magnification, and helplessness). Multiple regression models were used to examine associations.

RESULTS

Higher helplessness scores were associated with worse back performance (ß = 0.55, p = 0.02), slower walking speed (ß = 0.30, p = 0.02), and higher average pain intensity (ß = 0.22, [Formula: see text] p = 0.03). Higher rumination scores were associated with better back performance (ß =  - 0.36, p = 0.04). Avoidance behaviors, fear of pain, and magnification were not significantly associated with any of the variables included in the tested models.

CONCLUSION

Negative cognitive internalization is associated with limitations in functional performance in older Black men with LBP. Additional research is needed to further examine the cognitive orientations for understanding experienced pain and function in this population. Such research may inform the development of interventions for improving functional performance outcomes of older Black men with LBP.

Antipseudomonal activity enhancement of luminescent iridium(iii) dipyridylamine complexes under visible blue light

Cyclometallated iridium(iii) dipyridylamine complexes present antibacterial activity against P. aeruginosa, a highly resistant pathogenic bacterium. This activity is increased when the complex is conjugated to biotin, a bacterial nutrient, and a MIC of 4 μM (4 μg mL^-1) has been observed. The irradiation of P. aeruginosa cultures with blue LED light potentiates the anti-bacterial activities of these iridium(iii) complexes when they are conjugated to a glycoside.

Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients

BACKGROUND

Use of anticholinergic (ACH) medications is a biologically plausible and potentially modifiable risk factor of delirium, but research findings are conflicting regarding its association with delirium.

OBJECTIVES

To evaluate the longitudinal association between use of ACH medications and severity of delirium symptoms and to determine whether this association is modified by the presence of dementia.

PATIENTS AND METHODS

A total of 278 medical inpatients 65 years and older with diagnosed incident or prevalent delirium were followed up with repeated assessments using the Delirium Index for up to 3 weeks. Exposure to ACH and other medications was measured daily. The association between change in medication exposure in the 24 hours preceding a Delirium Index assessment was assessed using a mixed linear regression model.

RESULTS

During follow-up (mean +/- SD, 12.3 +/- 7.0 days), 47 medications with potential ACH effect were used in the population (mean, 1.4 medications per patient per day). Increase in delirium severity was significantly associated with several measures of ACH medication exposure on the previous day, adjusting for dementia, baseline delirium severity, length of follow-up, and number of non-ACH medications taken. Dementia did not modify the association between ACH medication use and delirium severity.

CONCLUSION

Exposure to ACH medications is independently and specifically associated with a subsequent increase in delirium symptom severity in elderly medical inpatients with diagnosed delirium.

Prevalence and detection of delirium in elderly emergency department patients

BACKGROUND

Delirium is a complex medical disorder associated with high morbidity and mortality among elderly patients. The goals of our study were to determine the prevalence of delirium in emergency department (ED) patients aged 65 years and over and to determine the sensitivity and specificity of a conventional clinical assessment by an ED physician for the detection of delirium in the same population.

METHODS

All elderly patients presenting to the ED in a primary acute care, university-affiliated hospital who were triaged to the observation room on a stretcher because of the severity of their illness were screened for delirium by a research psychiatrist using the Mini-Mental State Examination and the Confusion Assessment Method. The diagnosis of "delirium" or an equivalent term by the ED physician was determined by 2 methods: completion of a mental status checklist by the ED physician and chart review. The prevalence of delirium and the sensitivity and specificity of the ED physician's clinical assessment were calculated with their 95% confidence intervals. The demographic and clinical characteristics of patients with detected delirium and those with undetected delirium were compared.

RESULTS

A sample of 447 patients was screened. The prevalence of delirium was 9.6% (95% confidence interval 6.9%-12.4%). The sensitivity of the detection of delirium by the ED physician was 35.3% and the specificity, 98.5%. Most patients with delirium had neurologic or pulmonary diseases, and most patients with detected delirium had neurologic diseases.

INTERPRETATION

Despite the relatively high prevalence of delirium in elderly ED patients, the sensitivity of a conventional clinical assessment for this condition is low. There is a need to improve the detection of delirium by ED physicians.

Delirium risk factors in elderly hospitalized patients

OBJECTIVE

Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients.

MEASUREMENTS AND MAIN RESULTS

First, MEDLINE/CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

CONCLUSIONS

Despite methodologic limitations, certain risk factors for delirium seem to be consistent and could help identify high-risk patients. These risk factors include dementia, advanced age, and medical illness. Other risk factors appear to play a contributory role in the development of delirium in elderly hospitalized patients.

Chronic subdural hematoma in the elderly: a case report

A previously healthy 82-year-old male presented with depressive and paranoid symptoms of 3 months' duration. Physical examination and cognitive functions were normal. Poor response to treatment and continuing weight loss lead to medical investigations that ultimately showed a large, left frontoparietal, chronic subdural hematoma. Following drainage, the patient showed some improvement in paranoid features but still required pharmacologic treatment for depression. The psychiatric features of chronic subdural hematoma as well as the management of this neurologic condition in the elderly patient are reviewed and discussed.

Canine immune-mediated diabetes mellitus: a case report

A four-year-old, spayed female toy fox terrier presented with hyperglycemia and severe anemia. A diagnosis of immune-mediated diabetes mellitus was made based upon the finding of beta-cell specific antibodies. Immune-mediated hemolytic anemia was diagnosed based on findings of a regenerative anemia, spherocytosis, hyperbilirubinemia, hemoglobinuria, and bilirubinuria. The anemia resolved following two months of immunosuppressive therapy. The diabetes was treated with insulin for four months, after which time treatment was no longer necessary. However, the dog remained positive for beta-cell antibodies which may be a predictive marker for the recurrence of diabetes mellitus in the future.