17 CROSS-SECTIONAL AND LONGITUDINAL RELATIONSHIPS BETWEEN MOBILITY, NEUROPSYCHOLOGICAL PERFORMANCE AND FALLS IN COMMUNITY-DWELLING OLDER ADULTS: DATA FROM TUDA

Background

Impaired mobility is associated with incident cognitive impairment and dementia. However, the complex bi-directional temporal relationships between subtle impairments in neuropsychological performance, mobility trajectories and falls is poorly understood.

Methods

Using data from the Trinity, Ulster Department of Agriculture (TUDA/TUDA5+) study, we evaluated cross-sectional and longitudinal relationships between impaired mobility, neuropsychological performance and falls using regression models adjusted for important clinical confounders. Older adults with potential cognitive impairment (Mini-Mental State Examination score <25) were excluded. Detailed neuropsychological assessment was performed using the RBANS (Repeatable Battery for Neuropsychological Assessment) and FAB (Frontal Assessment Battery). Impaired mobility was assessed using Irish population-specific age/sex/height-specific Timed-Up-and-Go (TUG) cut-offs.

Results

Of 4,103 participants (72.9 ± 7.9 years; 67.4% female), just under one-fifth (17.5%) met criteria for impaired mobility. Older adults with impaired mobility had significantly greater likelihood of impaired neuropsychological performance, in particular for language (OR 1.77; 1.35-2.31; p<0.001) and attention (OR 1.69; 1.37-2.08; p<0.001) domains. In 953 participants followed for a median 5.2 (IQR: 4.83-7.26) years, impaired mobility at baseline significantly predicted incident impairment in immediate memory (OR 2.56; 1.33-4.95; p<0.001). Stronger relationships were seen for impaired neuropsychological performance predicting mobility decline rather than impaired mobility predicting cognitive decline (all p<0.001). Both impaired mobility and neuropsychological performance were associated with incident falls, particularly for impairments in executive function and attention (all p<0.001). Impaired mobility in isolation had poor performance as a sole test to predict incident cognitive impairment (AUC: 0.55-0.65).

Conclusion

In both cross-sectional and longitudinal analyses, impaired mobility is associated with subtle impairments in neuropsychological performance. Whilst impaired neuropsychological performance was a greater predictor of impaired mobility rather than vice versa, our findings highlight the complex relationship between mobility and cognitive trajectories in older adults, emphasising the need for comprehensive cognitive and falls assessment in those presenting with new-onset subtle impairments in mobility and cognition.

16 SARS-COV-2 INFECTION AND VACCINATION PATTERNS DETERMINE LONG-TERM ANTIBODY RESPONSES IN NURSING HOME RESIDENTS: DATA FROM NH-COVAIR

Background

Older Nursing Home Residents (NHRs) are at greatest risk of morbidity and mortality from SARS-CoV-2, particularly in the context of both waning vaccine efficacy and the emergence of Variants-of-Concern (VOCs). However, the determinants of long-term vaccine-induced protective antibody responses are yet to be determined in this group.

Methods

NH-COVAIR recruited older NHRs for comprehensive clinical and frailty (NH-FRAIL) assessment. Blood samples were obtained pre-vaccination, at 6-weeks and 6-months following primary vaccination and 6-months following booster vaccination. Antibody titres were measured using both an electrochemiluminescence assay and a custom bead-based array (Luminex™) to measure antibody titre and avidity for Wuhan strain/major VOC antigens. Stepwise adjusted linear regression (log-transformed) assessed longitudinal determinants of vaccine-induced antibody responses.

Results

Of 86 participants (81.1 ± 10.8 years; 65% female), just under half (45.4%) had evidence of previous SARS-CoV-2 infection. All NHRs mounted a significant antibody-response to vaccination at 5 weeks followed by a significant decrease in antibody titre by 6 months. Previous SARS-CoV-2 infection was the strongest predictor of antibody waning at all timepoints (β: 3.59; 2.89, 4.28; P < 0.001 for 6-months). Independent of infection history, both age (β: –0.05; –0.08, –0.02; p<0.001) and frailty (β: –0.22; –0.33, –0.11; p<0.001) were associated with faster antibody waning at 6-months. Cross-reactivity and avidity were significantly lower for Beta (B.1.351) and Gamma (P.1) VOC strains (all p<0.001). Additionally, there was faster antibody waning and significantly reduced antibody avidity to Beta and Gamma VOCs in SARS-CoV-2 naïve NHRs.

Conclusion

Older NHRs are capable of mounting protective antibody responses to SARS-CoV-2 vaccination. Responses were more durable, with a greater cross-reactivity to and avidity for VOCs in those with previous SARS-CoV-2 infection. Increasing age and greater frailty in NHRs was associated with faster antibody waning. Our findings support ongoing serological surveillance and use of additional vaccine doses in older NHRs, particularly in those without previous SARS-CoV-2 exposure.

356 OLDER PERSONS LIVING ALONE IN INTEGRATED CARE: DEPRESSION, LOW EDUCATION AND FUEL POVERTY

Background

An important consequence of population ageing has been the increasing number of older adults who live alone. According to TILDA data, older adults with the lowest levels of education tend to experience most social isolation and there is a strong association between living alone and loneliness. We sought to compare the cohort of patients open to the Integrated Care for Older Persons (ICPOP) team in a University Teaching Hospital serving a community area of approx. 300,000 population, to this national dataset.

Methods

A convenience sample of 174 patients who underwent comprehensive geriatric assessment via domiciliary visit between July 2021-May 2022 by was analysed. Data was anonymised and analysis was performed using SPSS v.27.

Results

The average age was 81.5 (±8.1) with 63% women in the sample. Eighty-five older adults i.e. 49% of the sample either lived alone or spent more than 21 hours alone per 24-hour period. Compared to those who live with someone, those who lived alone had higher rates of likely depression as determined by Geriatric Depression Score (6.6 vs 4.8 p=0.007). They were also likely to have less educational attainment, as determined by years spent in full time education (11.81 vs 10.42 42 p= 0.0016) and those living alone had overall less central heating in their homes than those not living alone (64/85 vs 81/89 p=0.0109). There were no significant differences in the rates of polypharmacy, falls, dementia and home ownership between groups. There were higher levels of frailty in the group living with someone than those living alone as determined by Clinical Frailty Scale (6.14 vs 5.23 p&lt;0.001).

Conclusion

A high proportion of patients seen by our ICPOP team live alone and have complex care needs that require an innovative, multidisciplinary approach. Financial vulnerability in this group is likely to compound isolation and loneliness.

136 DIABETES IS ASSOCIATED WITH IMPAIRED PERIPHERAL AND CEREBRAL HAEMODYNAMIC RESPONSES IN OLDER ADULTS

Background

Diabetes is associated with slower gait speed and adverse brain health outcomes in older adults. However, the putative mechanisms underlying these associations remain poorly explored. One such mechanism is via altered cerebral perfusion, which may represent an important intermediate phenotype in the association between diabetes and slower gait. We assessed the impact of diabetes on peripheral and cerebral haemodynamic responses during active stand as part of The Irish Longitudinal Study of Ageing (TILDA).

Methods

We assessed: (i) peripheral haemodynamic responses (heart rate, blood pressure, cardiac output) using finometry and (ii) Tissue Saturation Index (TSI) using Near-Infrared Spectroscopy (NIRS) during active stand in older adults.

Function-on-scalar regressions were used to model the impact of diabetes on the dynamic response to standing. Subsequently, multivariable linear models were used to model usual gait speed.

Results

Of 3,011 older adults (mean age: 64.2; 55.2% female) completing active stand, diabetes (n =193, 6.4%) was associated with significantly higher heart rate (mean 3.2, s.e. 0.02 bpm), higher cardiac output (mean 0.16, s.e. 0.04 L/min) and lower systolic blood pressure (mean –6.9, s.e. 1.8 mmHg) during standing. Additionally, diabetes was associated with significantly lower TSI from 10 seconds post-stand (mean –1.2%, s.e. 0.49%). Associations persisted following robust covariate adjustment. Diabetes was associated with significantly slower gait speed (-5.3 cm/s, CI (-8.4,-2.1)). In analysing the relationship between cerebral perfusion and gait speed, poorer recovery of TSI at 60-120 seconds post standing was associated with slower gait speed (0.53 cm/s slower gait speed per unit increase in TSI, p = 0.007).

Conclusion

Diabetes is associated with impaired peripheral and cerebral haemodynamic responses in addition to slower gait speed in community-dwelling older adults. Neuro-cardiovascular instability and altered cerebral perfusion may represent an important intermediate phenotype between diabetes and adverse health outcomes in older adults.

953 PREVIOUS SARS-COV2 INFECTION, AGE AND FRAILTY PREDICT 6-MONTH BNT162B2 VACCINE-INDUCED ANTIBODY TITRE IN NURSING HOME RESIDENTS

Introduction

Older nursing home residents are the population at greatest risk of morbidity and mortality from SARS-CoV-2 infection. No studies have examined the determinants of long-term antibody responses post-vaccination in this group.

Method

Longitudinal cohort study in residents of 5 nursing homes assessed prior to vaccination and at both 5-weeks and 6-months post SARS-CoV2 vaccine (BNT162b2). Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty (NH-FRAIL) and SARS-CoV-2 infection history. Serum Nucleocapsid and Anti-Spike Receptor Binding Domain (RBD) antibodies were analysed at all timepoints and an in vitro Angiotensin Converting Enzyme (ACE2) Receptor-Spike RBD neutralisation assay used to assess serum neutralisation capacity.

Results

Of 86 participants (81.1 ± 10.8 years; 65% female), just-under half (45.4%; 39/86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5-weeks and a significant decline in this response by 6-months. SARS-CoV-2 infection history was the strongest predictor of antibody titre (log-transformed) at both 5-weeks (β: 3.00; 95% CI [Confidence Interval]: 2.32, 3.70; p &lt; 0.001) and 6-months (β: 3.59; 95% CI: 2.89, 4.28; p &lt; 0.001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05; 95% CI: −0.08, −0.02; p &lt; 0.001) and frailty (β: -0.22; 95% CI: −0.33, −0.11; p &lt; 0.001) were associated with a lower antibody titre at 6-months. Antibody titres at both 5-weeks and 6-months significantly correlated with in vitro neutralisation capacity.

Conclusion and Implications

In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titres at 6-months, whilst age and frailty were independently associated with lower titres at 6-months. Antibody titres significantly correlated with in vitro neutralisation capacity. Whilst older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titres, SARS-CoV-2 infection and clinical outcomes remains to be fully elucidated in this cohort.

42 EXPLORING THE IMPACT OF AGE AND FRAILTY STATUS ON THE IMMUNE RESPONSE TO COVID-19 ILLNESS USING DETAILED IMMUNO-PHENOTYPING

Background

Methods

Results

Conclusion

43 REDUCED KIDNEY FUNCTION IS ASSOCIATED WITH POORER GLOBAL AND DOMAIN-SPECIFIC COGNITIVE PERFORMANCE IN COMMUNITY-DWELLING OLDER ADULTS

Background

Chronic Kidney Disease (CKD) is an important risk factor in the development of cognitive impairment. However, the association between reduced estimated Glomerular Filtration Rate (eGFR) and performance on domain-specific cognitive and neuropsychological assessments is less clear and may represent an important target in the promotion of optimal brain health in older adults.

Methods

Participants from the Trinity, Ulster and Department of Agriculture cohort study underwent detailed assessment of cognitive and neuropsychological function using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Mixed-effects Poisson and linear regression was used to assess the relationship between eGFR strata and cognitive/neuropsychological test performance.

Results

4,887 participants were included (73.94 ± 8.25 years; 67.7% female). Reduced eGFR was associated with poorer performance on all three cognitive assessments, most pronounced in those with eGFR &lt;45 mL/mL/1.73m2 (IRR: 1.19; 95% CI: 1.09, 1.29; p &lt; 0.001 for MMSE/IRR: 1.14; 95% CI 1.04, 1.24; p &lt; 0.001 for the FAB/β: -3.23; 95% CI -5.18, −1.30; p = 0.001 for RBANS, fully adjusted). Reduced eGFR was associated with poorer performance on immediate memory, visual–spatial and attention RBANS domains. Associations were strongest in the youngest old (&lt;70 years) with no association observed in those aged &gt;80 years.

Conclusion

Reduced kidney function was associated with poorer global and domain-specific function in community-dwelling older adults. Associations were strongest for those with eGFR &lt;45 mL/min/1.73m2 and the youngest-old, suggesting that this group may be most at risk and may benefit from potential preventative interventions.

18 SEDATIVE LOAD IN COMMUNITY-DWELLING OLDER ADULTS WITH MILD–MODERATE ALZHEIMER’S DISEASE: LONGITUDINAL RELATIONSHIPS WITH ADVERSE EVENTS, DELIRIUM AND FALLS

Background

Older adults are frequently prescribed medications with sedative effects, which are associated with numerous adverse consequences. However, the use and longitudinal associations of sedative medication use in older adults with mild–moderate Alzheimer Disease (AD), has not been explored to date.

Methods

The association between Sedative Load (SL) and adverse events, unscheduled healthcare utilisation, delirium and falls over 18 months was assessed in older adults with mild–moderate AD from 9 Countries. Additionally, the impact of SL on dementia progression was evaluated.

Results

Over half (52.35%; 267/510) of those with mild–moderate ad (72.8 ± 8.26 years, 61.89%) were prescribed a regular medication with sedation as a primary effect or prominent side effect with 17.65% (90/510) having a high SL (≥3). The most common medications contributing to SL were antidepressants, antipsychotics, anxiolytics and hypnotics. Over 18 months, greater SL was associated with adverse events (IRR 1.18, 1.14–1.23, p &lt; 0.001)/serious adverse events (IRR 1.32, 1.18–1.49, p &lt; 0.001) and unscheduled GP visits (IRR 1.26, 1.15–1.38, p &lt; 0.001). Further, increasing SL was associated with greater likelihood of incident delirium (IRR 1.47, 1.25–1.73, p &lt; 0.001) and falls (IRR 1.25, 1.06–1.48, p = 0.007) which persisted after covariate adjustment. SL was not associated with accelerated cognitive decline or ad progression.

Conclusion

Most adults with mild–moderate ad are prescribed at least one drug with a sedative effect and a significant minority have a high SL. Increasing SL was associated with a greater likelihood of experiencing adverse events, delirium and falls, highlighting the need for optimal prescribing in this vulnerable cohort.

239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING?

Background

Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS).

Methods

Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates.

Results

Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p &lt; 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p &lt; 0.001). Cerebral perfusion levels differed for those with OH compared to those without.

Conclusion

OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.

Management of erectile dysfunction after prostate cancer treatment: cross-sectional surveys of the perceptions and experiences of patients and healthcare professionals in the UK

OBJECTIVES

Erectile dysfunction (ED) is known to be a common consequence of radical treatment for prostate cancer (PCa) but is often under-reported and undertreated. This study aimed to explore how ED in patients with PCa is managed in real-life clinical practice, from the perspective of patients and healthcare professionals (HCPs).

DESIGN AND SETTING

This is a UK-wide cross-sectional survey of men with ED after treatment for PCa which covered assessment and discussion of erectile function, provision of supportive care and satisfaction with management. Parallel surveys of primary and secondary HCPs were also conducted.

RESULTS

Responses were received from 546 men with ED after PCa treatment, 167 primary (general practitioners and practice nurses) and 94 secondary care HCPs (urologists and urology clinical nurse specialists). Survey findings revealed inadequate management of ED in primary care, particularly underprescribing of effective management options. A fifth of men (21%) were not offered any ED management, and a similar proportion (23%) were not satisfied with the way HCPs addressed their ED concerns. There was poor communication between HCPs and men, including failure to initiate discussions about ED and/or involve partners, with 12% of men not told that ED was a risk factor of PCa treatment. These issues seemed to reflect poor access to effective ED management or services and lack of primary HCP confidence in managing ED, as well as confusion over the roles and responsibilities among both HCPs and men.

CONCLUSIONS

This study confirms the need for better support for men from HCPs and more tailored and timely access to effective ED management after treatment for PCa. A clearly defined pathway is required for the discussion and management of ED, starting from the planning stage of PCa treatment. Improved adherence to ED management guidelines and better education and training for primary care HCPs are areas of priority.

Expression, purification and metal utilization of recombinant SodA from Borrelia burgdorferi

Borrelia are microaerophilic spirochetes capable of causing multisystemic diseases such as Lyme disease and Relapsing Fever. The ubiquitous Fe/Mn-dependent superoxide dismutase (SOD) provides essential protection from oxidative damage by the superoxide anion. Borrelia possess a single SOD enzyme - SodA that is essential for virulence, providing protection against host-derived reactive oxygen species (ROS). Here we present a method for recombinant expression and purification of Borrelia burgdorferi SodA in E. coli. Metal exchange or insertion into the Fe/Mn-SOD is inhibited in the folded state. We therefore present a method whereby the recombinant Borrelia SodA binds to Mn under denaturing conditions and is subsequently refolded by a reduction in denaturant. SodA purified by metal affinity chromatography and size exclusion chromatography reveals a single band on SDS-PAGE. Protein folding is confirmed by circular dichroism. A coupled enzyme assay demonstrates SOD activity in the presence of Mn, but not Fe. The apparent molecular weight determined by size exclusion corresponds to a dimer of SodA; a homology model of dimeric SodA is presented revealing a surface Cys distal to the dimer interface. The method presented of acquiring a target metal under denaturing conditions may be applicable to the refolding of other metal-binding proteins.

Screening for frailty in older emergency department patients: the utility of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument

BACKGROUND

Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for at-risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) frailty measure, developed for use in the community, has also been used in the emergency department (ED).

AIM

To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts.

DESIGN

Patient characteristics were recorded using symphony® electronic data systems. SHARE-FI assessed frailty. Cognition, delirium and 6 and 12 months outcomes were reviewed.

METHODS

A prospective cohort study was completed of those aged ≥70 presenting to ED over 24 h, 7 days a week.

RESULTS

Almost half of 198 participants (46.7%, 93/198) were classified as frail, but this was not associated with a significant difference in mortality rates (OR 0.89, 95% CI 0.58-1.38, P = 0.614) or being alive at home at 12 months (OR 1.07, 95% CI 0.72-1.57, P = 0.745). Older patients were more likely to die (OR 2.34, 95% CI 1.30-4.21, P = 0.004) and less likely to be alive at home at 12 months (OR 0.49, 95% CI 0.23-0.83, P = 0.009). Patients with dementia (OR 0.24, P = 0.005) and on ≥5 medications (OR 0.37, 95% CI 0.16-0.87, P = 0.022) had a lower likelihood of being alive at home at 12 months.

CONCLUSIONS

Almost half of the sample cohort was frail. Older age was a better predictor of adverse outcomes than frailty as categorized by the SHARE-FI. SHARE-FI has limited predictability when used as a frailty screening instrument in the ED.

Dementia in the acute hospital: the prevalence and clinical outcomes of acutely unwell patients with dementia

BACKGROUND

Studies have demonstrated that a significant minority of older persons presenting to acute hospital services are cognitively impaired; however, the impact of dementia on long-term outcomes is less clear.

AIM

To evaluate the prevalence of dementia, both formally diagnosed and hitherto unrecognised in a cohort of acutely unwell older adults, as well as its impact on both immediate outcomes (length of stay and in-hospital mortality) and 12-month outcomes including readmission, institutionalisation and death.

DESIGN

Prospective observational study.

METHODS

190 patients aged 70 years and over, presenting to acute hospital services underwent a detailed health assessment including cognitive assessment (standardised Mini Mental State Examination, AD8 and Confusion Assessment Method for the Intensive Care Unit). Patients or informants were contacted directly 12 months later to compile 1-year outcome data. Dementia was defined as a score of 2 or more on the AD8 screening test.

RESULTS

Dementia was present in over one-third of patients (73/190). Of these patients, 36% (26/73) had a prior documented diagnosis of dementia with the remaining undiagnosed before presentation. The composite outcome of death or readmission to hospital within the following 12 months was more likely to occur in patients with dementia (73% (53/73) vs. 58% (68/117), P = 0.043). This finding persisted after controlling for age, gender, frailty status and medical comorbidities, including stroke and heart disease.

CONCLUSION

A diagnosis of dementia confers an increased risk of either death or further admission within the following 12 months, highlighting the need for better cognitive screening in the acute setting, as well as targeted intervention such as comprehensive geriatric assessment.

Body-related attentional biases in patients with posttraumatic stress disorder resulting from childhood sexual abuse with and without co-occurring borderline personality disorder

BACKGROUND AND OBJECTIVES

Disturbed body perception is a common characteristic of patients with posttraumatic stress disorder (PTSD) after childhood sexual abuse (CSA). We examined the extent to which biased information processing of body related stimuli was related to CSA.

METHODS

Patients with PTSD after CSA (PTSD group; n = 61) were compared to healthy controls (HC group; n = 30). The PTSD group was subdivided into patients with comorbid Borderline Personality Disorder (BPD; PTSD+ group) and patients without BPD (PTSD-group). We used an emotional Stroop task (EST) with body-related words to assess biased information processing.

RESULTS

Only patients in the PTSD+ group but not in the PTSD-group showed a significantly stronger attentional bias to body related words compared to the HC group (p = .009).

LIMITATIONS

Recruitment in in-patient setting might have led to a non-representative sample of PTSD patients. The PTSD patients were not characterized regarding anything other than the mentioned mental disorders. Potentially, the body related words may have been associated with offenders' body areas, but not with the patients.

CONCLUSION

We found that patients with PTSD and comorbid BPD had a stronger attentional bias towards body related stimuli in comparison to other groups. This suggests that the observed attentional bias is a product of CSA combined with the emotion regulation difficulties characteristic of BPD. Future studies should test whether directly targeting body-related abnormalities in information processing can improve existing treatments for patients with CSA and BPD.

Configural processing enables discrimination and categorization of face-like stimuli in honeybees

We studied whether honeybees can distinguish face-like configurations by using standardized stimuli commonly employed in primate and human visual research. Furthermore, we studied whether, irrespective of their capacity to distinguish between face-like stimuli, bees learn to classify visual stimuli built up of the same elements in face-like versus non-face-like categories. We showed that bees succeeded in discriminating both face-like and non-face-like stimuli and categorized appropriately novel stimuli in these two classes. To this end, they used configural information and not just isolated features or low-level cues. Bees looked for a specific configuration in which each feature had to be located in an appropriate spatial relationship with respect to the others, thus showing sensitivity for first-order relationships between features. Although faces are biologically irrelevant stimuli for bees, the fact that they were able to integrate visual features into complex representations suggests that face-like stimulus categorization can occur even in the absence of brain regions specialized in face processing.

Methodological issues in weight cycling

Recent studies have suggested that weight changes may be related to disease risk independent of weight status. A critical step in testing this assertion is the measurement of weight change and so-called "weight cycling". However intuitive the concept of weight cycling may appear, research in this area is hampered by complex methodological issues. This article discusses various measures of nominal weight cycling, including the standard deviation, coefficient of variation, regression techniques, and cycles. A cycle is a sequence of a gain followed by a loss or vice versa. The various measures are compared in seven hypothetical cases created to illustrate their strengths and weaknesses. Superior performance of the cycles measure over the coefficient of variation, number of fluctuations, and simple regression methods is argued. The linkage of the cycles measure with the statistical theory of runs also provides a basis for testing the significance of weight fluctuations or other variables that may cycle, such as blood lipids, etc. The cycles measure and runs test provide a viable definition for identifying weight cycling and a tool for evaluating the critical amount of weight gained and/or lost in relationship to risk.

Effect of lobectomy on survival in early-stage small cell lung cancer: A retrospective analysis

7585

Background: Small cell lung cancer (SCLC) rarely presents as I/II Disease. In order to assess the incidence, treatment and prognosis of this early-stage SCLC, we used the Surveillance, Epidemiology and End Results database. Furthermore, since some investigators are irradiating growing and/or PET Scan positive nodules without biopsy, presenting characteristics of surgically-resected Stage I SCLC were compared to those of non-small cell lung cancer (NSCLC). Methods: The SEER 17 Database from 1988–2003 was accessed for all patients with early-stage SCLC. Presenting characteristics of surgically-resected Stage I SCLC were compared to those of resected Stage I NSCLC using chi-square and Wilcoxon Rank Sum tests. The logrank test was used to compare the differences in Survival(S) resulting from the various treatments options for early-stage SCLC. Results: 1,615 patients were identified with early-stage SCLC with greater than 3 months of follow-up. The median S was 20 months for the entire group. Over the time period of our study, the incidence of early stage SCLC as a percentage of all SCLCs and all lung cancers (SCLCs and NSCLCs) remained stable and ranged from 3.00–4.96% and 0.09–0.16% respectively. Surgically-resected Stage I SCLC did not differ from NSCLC in regards to patient characteristics (age, sex, race) or tumor location, but SCLC was found to have significantly smaller tumor size (p< 0.0001). Lobectomy or greater resections without radiotherapy were associated with a greater median S than those treated with segmental/wedge resections and those treated with radiotherapy alone (44 vs 29 months, p=0.03 and 20 months, p <0.0001). Furthermore, when lobectomy or greater resection was performed, adjuvant radiotherapy was associated with a shorter, but not significantly different median S (32 vs 44 months, p = 0.17). Segmental/wedge resections without radiotherapy were associated with significantly better S than patients who received radiotherapy alone, but no difference in S was found with the use of adjuvant radiotherapy (29 vs 20 months, p =0.003, and 35 months, p=0.31). Conclusions: The incidence of stage I/II small cell lung cancer was stable over the years of our study. Anatomic lobectomy without adjuvant radiotherapy appears to be the optimal therapy for patients without mediastinal nodal metastases.

No significant financial relationships to disclose.

Dialectical Behavioral Therapy for Patients with Borderline Features and Posttraumatic Stress Disorder After Childhood Sexual Abuse (DBT-P)

Several randomised clinical trials (RCT) have demonstrated the efficacy of cognitive behavioral therapy in the treatment of Posttraumatic Stress Disorder (PTSD). However, the external validity of these studies is limited with regard to PTSD related to childhood sexual abuse which often results in severe and complex sympomatology accompanied by a variety of concurrent disorders or symptoms, for example self-mutilation, suicidal ideation, or severe dissociation. Nearly 30% of patients with PTSD have a co-occuring borderline personality disorder (BPD). The prevalence rates of PTSD in patients with BPD vary between 40% and 60%.

Several RCTs have shown the efficacy of Dialectical Behavioral Therapy (DBT) in the treatment of borderline patients, who exaggerate severe behavioural dyscontrol. However specific treatment for co-occuring PTSD has been lucking.

Clinical lore suggests that exposure to trauma-relevant memories can potentially aggravate dysfunctional behaviour in patients with BPD. Empirical research however reports discrepant results with two studies documenting deleterious effects of comorbid BPD on treatment outcome, whereas one study did not find an impact.

DBT-P was specifically tailored to treat patients with PTSD after sexual abuse during childhood. DBT-P includes training in emotion regulation and mindfulness, cognitive interventions and exposure elements, usually in combination with the use of skills. To evaluate the efficacy of DBT-P as compared to a wait list control group a RCT is currently carried out. Preliminary data, which will be presented, revealed large between effect sizes for the primary outcome measures (PDS, CAPS).

Development of a nursing home vision-targeted health-related quality of life questionnaire for older adults

PURPOSE

To develop a questionnaire assessing vision-targeted health-related quality of life in older adults residing in nursing homes.

METHODS

Using content previously identified through structured interviews with nursing home residents, the 57-item Nursing Home Vision-Targeted Health-Related Quality of Life questionnaire (NHVQoL) was drafted with nine subscales - general vision, reading, ocular symptoms, mobility, psychological distress, activities of daily living, activities/hobbies, adaptation/coping and social interaction. Construct validity and internal consistency and test-retest reliability of subscales were evaluated in a sample of adults >or=60 years old residing in nursing homes in Birmingham, Alabama, who had Mini Mental State Exam (MMSE) scores of >or=13.

RESULTS

Participants (n=189) had a mean age of 82 years (SD=7.7), were 84% women and 16% men, 24% African-American and 76% Caucasian and had resided in a nursing home for two years on average. All NHVQoL subscales were correlated with subscales from other vision-targeted and generic health-related quality of life instruments (ADVS, 0.43 to 0.85; VF-14, 0.46 to 0.84; SF-36, 0.19 to 0.43). Lower scores were associated with increased depressive symptomatology by the Geriatric Depression Scale (-0.23 to -0.59), increased mobility problems (-0.17 to -0.54), worse distance and near acuity (-0.21 to -0.51) and worse contrast sensitivity (0.20 to 0.50). All subscales had Cronbach alpha>0.95. Test-retest reliability (two-week period) for subscales ranged from 0.57 to 0.84. Subscale scores did not differ as a function of MMSE scores.

CONCLUSIONS

The NHVQoL has subscales with good internal consistency reliability and validity. Test-retest reliability is comparable to other questionnaires designed for the nursing home population. This questionnaire may ultimately be useful in understanding the personal burden of visual impairment and eye disease on quality of life and mental health in older nursing home residents and for evaluating the impact of psychosocial and eye care interventions on health-related quality of life in this population.

Postload plasma glucose concentration and 27-year prostate cancer mortality (United States)

OBJECTIVE

Findings from epidemiologic studies on the association between diabetes and prostate cancer risk are inconsistent. However, data from at least three studies suggest that the direction and strength of this association differs according to duration of diabetes. To determine the potential effects of early-stage abnormal glucose metabolism on risk, we assessed the relationship of postload glycemia in the absence of self-reported diabetes with risk of prostate cancer mortality.

METHODS

Data from the Chicago Heart Association Detection Project in Industry were used to examine this relationship. Between 1967 and 1973 some employees of 84 Chicago area organizations underwent a health screening examination. Blood was drawn for measurement of plasma glucose concentration approximately 1 h after a 50-g oral glucose load among 20,433 men. After a mean length of follow-up of 27 years, 176 men died of prostate cancer. Cox regression was used to compute adjusted relative risks (RRs) and 95% confidence intervals (CIs).

RESULTS

After controlling for age, body mass index, heart rate, education, and race, the RRs of prostate cancer mortality for postload plasma glucose levels of 6.7-8.8, 8.9-11, and > or = 11.1 mmol/L compared to < or = 6.6 mmol/L were 1.64, 1.37, and 1.64. respectively (p for trend=0.19). The RR (95% CI) associated with a 2.2 mmol/L (1 standard deviation) higher glucose concentration was 1.1 (0.95-1.2).

CONCLUSIONS

These results provide weak evidence of an association between hyperglycemia and prostate cancer mortality.

Quantitative TaqMan PCR without a real-time thermal cycler: an assay for fish insulin-like growth factor I messenger RNA

The reverse transcriptase-polymerase chain reaction, more commonly known as RT-PCR, has become a widely used tool in molecular biology and is now frequently used in monitoring gene expression levels. A number of variations in the RT-PCR technique now exist including TaqMan PCR (5' nuclease assay), which is a useful nonisotopic detection method for the quantification of PCR products. To monitor the formation of these fluorescent amplification products a "real-time" thermal cycler is normally required. In this study, repeated scanning of PCR products in a 96-well plate format showed that a conventional fluorescent plate reader can be used to generate similar results. To demonstrate the power of this approach, the nutritional regulation of insulin-like growth factor I (IGF-I) was investigated in a marine finfish, the snapper (Pagrus auratus). Hepatic IGF-I messenger RNA levels were shown to significantly decrease after 2 weeks of fasting and returned to fed control levels on refeeding. These results demonstrated that a real-time PCR machine was not required to generate this type of quantitative data and that this technology can be adapted for use in most molecular biology laboratories.

The use of zeolites as slow release anthelmintic carriers

This work examines the ability of commercial zeolite Y to act as a slow release agent for a number of anthelmintic drugs. Administration to rats, dosed with Nippostrongylus brasiliensis, of pyrantel and/or fenbendazole and pigs, dosed with Ascaris and Oesophagostomum, of dichlorvos (DDVP) loaded onto zeolite Y was more successful in killing adult worms than administration of the pure drug alone. The zeolite Y was used as supplied for initial studies and then later dealuminated for further studies. The drug loadings were monitored by thermal analysis and the loaded zeolites were used in several field trials. The results indicate that zeolite Y is a suitable vehicle for the slow release of some anthelmintics. The slow release of drug from the zeolite matrix improved its efficacy.

Abnormal glucose metabolism and pancreatic cancer mortality

CONTEXT

Previous studies reported an increased risk of pancreatic cancer among persons with diabetes. Few data exist, however, on the association of postload plasma glucose concentration with pancreatic cancer, which could provide insight into the role of abnormal glucose metabolism in the etiology of pancreatic cancer.

OBJECTIVE

To determine the independent association between postload plasma glucose concentration and risk of pancreatic cancer mortality among persons without self-reported diabetes.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

Employees of 84 Chicago-area organizations, with an average age of 40 years at baseline, were screened from 1963 to 1973 and followed up for an average of 25 years. A total of 96 men and 43 women died of pancreatic cancer among 20,475 men and 15,183 women, respectively.

MAIN OUTCOME MEASURES

Relationship of pancreatic cancer mortality with postload plasma glucose levels.

RESULTS

Compared with a postload plasma glucose level of 6.6 mmol/L (119 mg/dL) or less and after adjusting for age, race, cigarette smoking, and body mass index, the relative risks (95% confidence intervals) of pancreatic cancer mortality were 1.65 (1.05-2.60) for postload plasma glucose levels between 6.7 (120) and 8.8 (159) mmol/L (mg/dL); 1.60 (0.95-2.70) for levels between 8.9 (160) and 11.0 (199); and 2.15 (1.22-3.80) for levels of 11.1 (200) or more; P for trend=.01. An association appeared to be stronger for men than women. Estimates were only slightly lower after excluding 11 men and 2 women who died of pancreatic cancer during the first 5 years of follow-up. In men only, higher body mass index and serum uric acid concentration also were independently associated with an elevated risk of pancreatic cancer mortality.

CONCLUSION

These results suggest that factors associated with abnormal glucose metabolism may play an important role in the etiology of pancreatic cancer. JAMA. 2000;283:2552-2558

Urinary biochemical markers of dietary intake in the INTERSALT study

The INTERSALT Study, an international, collaborative, cross-sectional investigation of the relation between blood pressure and dietary and other factors, used quality-controlled, standardized procedures and assessment of multiple possible confounding factors to study 10,079 men and women in 52 population-based samples in 32 countries. In this study 24-h urinary excretion data were used as biochemical markers of intakes of sodium, potassium, and protein, with repeat examinations done in a randomly selected 8% of participants to asses reliability and correct for regression-dilution bias. INTERSALT showed that high salt intake, low potassium intake, excess alcohol consumption, and energy imbalance resulting in overweight are critically involved in the origins of the high blood pressure prevalent among a majority of adult populations. The findings also show that obtaining accurate estimates of associations between dietary intake and blood pressure requires large population-based samples, high-quality dietary information, control for multiple confounding variables, and modern multivariate methods of data analyses, including correction of observed associations for within-person variation in intake.

Long-term effects of antidepressants on balance, equilibrium, and postural reflexes

To assess the long-term effects of antidepressant medication on balance, equilibrium, and postural reflexes, we studied 30 patients, ages 20-76 years, who had a diagnosis of depressive disorder (as defined by DSM-III-R criteria) and had been treated with tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) for > or = 1 year. They were assessed by a Balance Master System. The assessment included three tasks: static balance, rhythmic weight shift, and limits of stability. When compared with 30 nonhospitalized healthy controls (of comparable age and the same sex), patients who took TCAs showed impaired balance function in all main indices. The results suggest that the impairment of balance function includes motor coordination, fine-motor control, postural reflexes, maintaining equilibrium, and reaction time. No obvious impairment of balance function was observed in patients who took SSRIs.

Dietary salt, nitrate and stomach cancer mortality in 24 countries. European Cancer Prevention (ECP) and the INTERSALT Cooperative Research Group

BACKGROUND

High salt and nitrate intake are considered as risk factors for stomach cancer, but little is known about possible interactions. This ecological study examines the respective importance of both factors for stomach cancer mortality at the population level using data obtained under standardized conditions and with biochemical analyses performed in the same laboratories.

METHODS

Randomly selected 24-hour urine samples from 39 populations, sampled from 24 countries (N = 5756 people for sodium, 3303 for nitrate) were obtained from the INTERSALT study. Median sodium and nitrate levels were age- and sex-standardized between ages 20-49 years and averaged per country. Ecological correlation-regression analyses were done in relation to national stomach cancer mortality rates.

RESULTS

The Pearson correlation of stomach cancer mortality with sodium for the 24 countries was: 0.70 in men and 0.74 in women (both P < 0.001) and with nitrate: 0.63 (P = 0.001) in men and (P < 0.005) in women. In multiple regression of stomach cancer mortality, using sodium and nitrate as independent variables the adjusted R2 was 0.61 in men and 0.54 in women (both P < 0.001). Addition of the interaction term (sodium x nitrate) to the previous model increased the adjusted R2 to 0.77 in men, and to 0.63 in women. The analysis of this model showed that the importance of nitrate as risk factor for stomach cancer mortality increased markedly with higher sodium levels. However, the relationship of stomach cancer mortality with sodium was always stronger than with nitrate.

CONCLUSIONS

Salt intake, measured as 24-hour urine sodium excretion, is likely the rate-limiting factor of stomach cancer mortality at the population level.