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An update on acupuncture point injection


This overview reports the global research advances in acupuncture point injection in the last 5 years. Acupuncture point injection can be applied to a wide range of curable diseases, predominantly those involving pain, but it has poor clinical evidence. Progress has been attained in the mechanism research on acupuncture point injection, but further studies remain necessary. With the reported adverse effects of acupuncture point injection, the need to standardize its clinical procedure has become urgent.

Social deprivation and the rate of emergency medical admission for older persons


Background: Deprivation Status increases the annual admission incidence of emergency medical admissions; the extent to which deprivation influences the admission of older persons is less well known.

Aim: To examine whether deprivation within a hospital catchment area influences emergency medical admissions for the elderly population.

Design: The relationship between Deprivation Status, Dependency Ratio (population proportion of non-working age (<15 or ≥65 years) and age for all emergency admissions (82 368 episodes of 44 628 patients), over a 13-year period, were examined and ranked by quintile.

Methods: Univariate and multi-variable risk estimates (incidence rate ratios) were calculated, using truncated Poisson regression.

Results: The Dependency Ratio and the Deprivation index independently predicted the annual incidence rate of medical emergencies; however, when calculated for older persons, the corresponding incidence rate ratios showed a falling trend with increasing Deprivation Status—Q2 0.51 (95% confidence interval [CI]: 0.50, 0.52), Q3 0.59 (95% CI: 0.58, 0.60), Q4 0.51 (95% CI: 0.50, 0.52) and Q5 0.37 (95% CI: 0.36, 0.38). Thus, with increasing Deprivation Status, the proportion of total admission from the ≥65-year cohort fell substantially.

Conclusion: The admission incidence rate for emergency medical patients is strongly influenced by the catchment area Deprivation Status. However, because of its greater impact on the younger population, increasing deprivation alters the ratio of younger to older persons as a proportion of total emergency admissions.

Cognitive impairment and reduced quality of life among old-age groups in Southern Urban India: home-based community residents, free and paid old-age home residents


Aim: The purpose of the study were (i) to screen for cognitive impairment using Mini-Mental Status Examination among three old-age groups based on dwelling types in Chennai, India i.e. residential paid old-age homes, residential free (charitable) homes and home-based community-dwelling residents; (ii) secondly to investigate factors (demographic, psychological, medical and disability) associated with cognitive impairment in the these old-age; (iii) third, to investigate the independent association between cognitive impairment and health-related quality of life (QOL) among elderly across aged care dwelling types.

Methods: A total of 499 elderly from three old-age groups were interviewed in this cross-sectional study (173 elderly home-based community-dwellers, 176 paid-home and 150 free-home residents). All the participants were interviewed for their socio-economic condition, medical morbidity, self-reported worry and anxiety, disability and QOL.

Results: 42.7% free-home elderly residents were found to have cognitive impairment, whereas 32.4% of paid-home and 21.9% of community-dwelling elderly had cognitive impairment. The residents of free-home were less educated, had lower income and reported higher incidence of worry, anxiety, disability and poor QOL than community-dwelling or paid-home residents. Increasing age, low education, female gender, high blood pressure and disability were associated with cognitive impairment. Cognitive impairment had significant negative effect on their health-related QOL (b = –0.10, P = 0.01), independent of age, gender, education, chronic illness and dwelling type.

Conclusion: The burden of cognitive impairment was high in all aged-care dwelling types in urban India; with free charitable home residents being worse affected. Cognitive impairment was associated with disability and poor health-related QOL in these age-care settings.

The natural history of acute Q fever: a prospective Australian cohort


Background: A detailed description of the natural history of acute Q fever, caused by infection with Coxiella burnetii,

Aim: To significantly increase understanding of the illness.

Design: Subjects with provisional acute Q fever (n = 115) were recruited from primary care in rural Australia, and followed prospectively by interview and blood collection including for serological confirmation. A nested series of subjects with prolonged illness (cases), and those without (controls), were investigated in detail.

Methods: Total phase I and phase II anti-C. burnetii antibodies were detected by complement fixation test; and IgG, IgM and IgA phase I and phase II titres by immunofluorescence. Flow cytometric analysis was conducted to enumerate circulating T cells subsets, B cells, monocytes and natural killer cells.

Results: Serological testing confirmed acute Q fever in 73 subjects (63%). The acute illness featured fever, headache, sweats, fatigue and anorexia; and varied widely in severity, causing an average of 8 days in bed and 15 days out of work or other role in the first month of illness. The illness course varied from 2 days to greater than a year. No cases of chronic, localized Q fever infection, such as endocarditis, were identified. Neither severe nor prolonged illness were associated with persistence of C. burnetii DNA, altered patterns of C. burnetii-specific IgG, IgM or IgA antibody production, or altered leucocyte subsets.

Conclusions: The severity of acute Q fever alone predicted prolonged duration. Further studies are warranted to better understand the pathophysiology of prolonged illness after acute Q fever.

Associations between heart failure and physical function in US adults


Background: There is a paucity of nationally representative data in the area of heart failure (HF) and physical function (PF).

Aim: Examine the relationship(s) between HF and PF in a nationally representative sample of United States (US) adults.

Design: Cross-section analysis of US adults.

Methods: Sample (n = 6623) included adult (≥40 years of age) participants from the 1999–2006 National Health and Nutrition Examination Survey. Participants reporting HF answered questions related to their abilities to accomplish specific upper extremity and lower extremity tasks, and household chores.

Results: Prevalence estimates of reporting much difficulty or the inability to stand from an armless chair was 9.9% and 4.3% (P = 0.002) in those with and without HF, respectively. Similar estimates were revealed for much difficulty or inability to lift or carry 10 pounds (16.8% and 8.6%, P = 0.0004) and much difficulty or inability to do household chores (13.3% and 6.1%, P = 0.0008). Following adjustments participants reporting HF had significantly greater odds of reporting much difficulty or the inability to stand from an armless chair [odds ratio (OR) 1.93; 95% confidence intervals (CI) 1.25, 2.96], much difficulty or the inability to lift or carry 10 lbs (OR 1.90; 95% CI 1.36, 2.65) and much difficulty or inability to do household chores (OR 2.06; 95% CI 1.41, 3.02) compared with participants not reporting HF.

Conclusions: Findings suggest US adults reporting HF are more likely to report poorer PF.

Influence of social deprivation, overcrowding and family structure on emergency medical admission rates


Background: Patients from deprived backgrounds have a higher in-patient mortality following emergency medical admission.

Aim: To evaluate the influence of Deprivation Index, overcrowding and family structure on hospital admission rates.

Design: Retrospective cohort study.

Methods: All emergency medical admissions from 2002 to 2013 were evaluated. Based on address, each patient was allocated to an electoral division, whose small area population statistics were available from census data. Patients were categorized by quintile of Deprivation Index, overcrowding and family structure, and these were evaluated against hospital admission rate, calculated as rate/1000 population. Univariate and multivariable risk estimates (Odds Ratios or Incidence Rate Ratios) were calculated, using logistic or zero truncated Poisson regression as appropriate.

Results: There were 66 861 admissions in 36 214 patients over the 12-year study period. Deprivation Index quintile independently predicted the admission rate, with rates of Q1 12.0 (95% CI 11.8–12.2), Q2 19.5 (95% CI 19.3–19.6), Q3 33.7 (95% CI 33.3–34.0), Q4 31.4 (95% CI 31.2–31.6) and Q5 38.1 (95% CI 37.7–38.5). Similarly the proportions of families with children <15 years old, was an independent predictor of the admission rate with rates of Q1 20.8 (95% CI 20.4–21.1), Q2 23.0 (95% CI 22.7–23.3), Q3 32.2 (95% CI 31.9–32.5), Q4 32.4 (95% CI 32.2–32.7) and Q5 37.2 (95% CI 36.6–37.8). The proportion of families with children ≥15-years old was also predictive but quintile of overcrowding was only predictive in the univarate model.

Conclusion: Deprivation Index and family structure strongly predict emergency medical hospital admission rates.

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