Taiwan

Aspiration Pneumonia Risks Premature Death in Alzheimer’s.

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The risk of dying of aspiration pneumonia among people with Alzheimer’s disease and related dementias (ADRD) is higher for men than women and, in the United States, is higher for younger elderly compared with those 85 years or older, according to a survey of death certificates.

Presenting his analysis here at the Alzheimer’s Disease International (ADI) 28th International Conference, Tsung-Hsueh Lu, MD, PhD, from the Department of Public Health at National Cheng Kung University Hospital in Tainan, Taiwan, told delegates that death certificates list a disease or condition directly leading to death and then other antecedent conditions as contributing causes, but often those latter causes are lost in analyses.

For example, a death certificate may list sepsis as the direct cause, but if aspiration pneumonia and Alzheimer’s disease are listed as antecedent causes, only sepsis may be considered for purposes of vital statistics. So he and a colleague looked for occurrences of listings of aspiration pneumonia, which can be a preventable cause of premature death, with ADRD.

Between 2002 and 2009, 6% of death certificates in the United States and 3.6% of those in Taiwan that listed ADRD as a cause of death also listed aspiration pneumonia.

Men in the United States were at a 78% greater risk for aspiration pneumonia if they had ADRD than were women (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.776 – 1.80). Similarly, men in Taiwan were 71% more likely than women there to die with aspiration pneumonia with ADRD (OR, 1.71; 95% CI, 1.36 – 2.14).

Compared with people aged 65 to 74 years in the United States, residents with ADRD had a decreasing risk for aspiration pneumonia as they aged (at 75 to 84 years: OR, 0.92 [95% CI, 0.90 – 0.94]; at ≥85 years: OR, 0.84 [95% CI, 0.82 – 0.86]). An interesting finding that Dr. Lu could not explain was that Taiwan residents trended in the direction of a nonsignificant increased risk with age.

In both countries, the proportion of people dying with aspiration pneumonia and ADRD decreased during the study period, from 6.9% in 2002 to 2003 to 5.0% in 2008 to 2009 in the United States (OR, 0.72 [95% CI, 0.70 – 0.73] for later period vs earlier) and (nonsignificantly) from 3.9% to 3.5% in Taiwan for the same periods (OR, 0.86 [95% CI, 0.63 – 1.17]).

Dr. Lu cautioned that aspiration pneumonia may be underreported as a cause of death, so the true figures may be even higher than that found from death certificates. And in the United States, different states may have different systems for determining and reporting the causes of deaths.

Preventing Premature Death

Aspiration of food is a major cause of pneumonia, but the risk can be reduced. “Speech therapists should be consulted to evaluate the swallowing ability in such a patient, training of the swallowing, or preparing of food to prevent this premature death,” Dr. Lu advised.

Session moderator David Troxel, MPH, a long-term care consultant and writer in the field of dementia in Sacramento, California, commented to Medscape Medical News that swallowing issues and food aspiration are recognized as big problems among elderly patients with dementia.

“Where I’d say we aren’t doing a good job is I think that families don’t know to go to a speech pathologist. Doctors may not think about referring to a speech pathologist who can maybe help with that and assess [the patient],” he said. “Certainly in home settings I doubt families know much about how to prepare foods or go to different kinds of puréed foods.”

He said he believes families are not getting much support in this area, so problems persist. He suggests that professionals in the elder care field talk to physicians about recognizing problems contributing to aspiration, about referring to speech pathologists, and “to really do more education with the families about different dos and don’ts about food.”

Source: medscape.com

 

LED streetlamp aims to improve public’s view of stars.

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Researchers believe they have come up with a new type of LED-powered streetlamp that could radically reduce light pollution.

Current designs “leak” large amounts of light in unwanted directions, obscuring views of the stars, wasting energy and making it harder for drivers to see.

The team, based in Mexico and Japan, said they believed their solution was the “best ever reported”.

However, they have yet to turn their theory into a working prototype.

The study – carried out by scientists in Mexico and Taiwan – appears in the open-access journal Optics Express.

LED lens

According to the researchers, conventional street lamps – which use high-pressure sodium or mercury vapour – scatter up to 20% of their energy horizontally or vertically because it is difficult to control their beams.

It is easier to direct light from LEDs because it is being emitted from a smaller area.

So, while manufacturers controlled the direction of the light rays from older lamps using a reflector typically made out of polished aluminium, they can now take advantage of lenses to be more precise.

The researchers say the best LED (light-emitting diode) streetlamps on the market direct about 10% of their energy horizontally or vertically.

But they claim their own invention could further reduce the amount to just 2%.

Their proposed lamp uses three features to ensure the vast majority of its light is limited to a pre-determined rectangular shape covering the road:

The researchers suggest that the set-up would also save on electricity costs since it should require between 10 and 50% less power to illuminate a section of road than current LED streetlamps.

They added that they were now working to build a prototype and hoped to have it completed by October.

LED revolution

London-based light design firm Speirs and Major unveiled anLED-based streetlamp design of its own last year.

The firm’s associate director, Andrew Howis, said the latest study was just one of several efforts under way aimed at tackling the problem of stray light.

“As a result of LEDs it is now possible to place light exactly where it is needed and to greatly reduce spill light and energy wastage,” he said.

“This new research is an example of the innovation in LED optics – of which there are many – which uses a fairly sophisticated optical system to produce an optimised distribution for street lighting.

“It sounds like an advance on what is already available, but of itself is not revolutionary. The change from conventional light sources to LED is the revolution.”

The Campaign to Protect Rural England (CPRE) also gave the new work a qualified welcome.

The lobby group carries out an annual star count to publicise the problem of light pollution which it says disrupts wildlife and people’s sleep.

It noted that the new technology would only be of use if councils were willing to invest in it.

“From 1993 to 2000, light pollution in England increased by 26%, which shows the huge amount of energy and money wasted,” said campaigner Emma Marrington.

“It should be seen as an investment for local authorities to install more efficient street lighting, which will save money and energy waste in the long-term.

“Design is great but councils have to follow through with investment.”

Source:BBC

Psychotropic Drug Use Associated with Increased Risk for Car Crashes .

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Antidepressants, benzodiazepines, and so-called “Z-drugs” such as zolpidem (Ambien) and zaleplon (Sonata) are associated with increased risk for motor vehicle accidents, according to a case-control study in the British Journal of Clinical Pharmacology.

Using registry and claims data from Taiwan, researchers assessed use of psychotropic drugs among 5200 people who were drivers during motor vehicle accidents and 31,000 matched controls who were not in accidents.

Relative to nonusers, the risk for motor vehicle accidents was higher among patients who had taken the following classes of drugs within the previous month: antidepressants (adjusted odds ratio, 1.73), benzodiazepines (1.56), and Z-drugs (1.42), but not antipsychotics. Even relatively low doses of antidepressants and benzodiazepines conferred increased risks.

The authors conclude that clinicians should “choose safer, alternative treatments and advise patients not to drive, especially while taking medications, to minimize the risk of causing [traffic accidents] under the influence of psychotropic medications.”

Source: British Journal of Clinical Pharmacology

Statins’ Benefits Outweigh Diabetes Hazard in High-Risk Patients .

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Use of statins is associated with increased risk for developing diabetes, according to a retrospective cohort study in the Journal of the American College of Cardiology. However, the authors say the benefits of statins outweigh the dangers in high-risk and secondary-prevention groups.

Researchers from Taiwan examined medical records of 8400 statin users and 34,000 controls who did not use statins. Over 7.2 years’ median follow-up, the annual rate of incident diabetes was higher among statin users than nonusers (2.4% vs. 2.1%). However, patients taking statins had reduced risk for myocardial infarction (HR, 0.82) and in-hospital death (HR, 0.61).

The authors conclude: “Continuous surveillance of signals of dysglycemia should be incorporated into the care program to optimize overall risk management.”

Source: JACC

 

Good practice in EBUS-guided transbronchial biopsy.

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Radial probe endobronchial ultrasound (EBUS) employs a flexible catheter housing an ultrasound transducer which produces a 360-degree ultrasound image, and was first applied to guide transbronchial biopsy (TBB) by Herth et al. in 2002. EBUS-guided TBB has an advantage over conventional bronchoscopic…

Abstract

Background Although endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of biopsy specimens required has not been thoroughly investigated.
Objectives We sought to examine whether the number of biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions.
Methods The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of biopsy specimens, with the diagnostic yield was analysed.
Results A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p < 0.001). When the number of biopsy specimens was determined based on their adequacy, it was an insignificant factor in predicting the diagnostic yield.
Conclusions Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of biopsy specimens should be decided on a case-by-case basis.

Chun-Ta Huanga, b, Yi-Ju Tsaic, Wei-Yu Liaoa, Pei-Chen Wud, Chao-Chi Hoa, Chong-Jen Yua, Pan-Chyr Yanga

Departments of
aInternal Medicine and
bTraumatology, National Taiwan University Hospital,
cSchool of Medicine, College of Medicine, Fu-Jen Catholic University, and
dCenter for Genomic Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC

Source: www. getinsidehealth.com