bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Pattern of Epilepsy in India
Authors: Sridharan R. , Murthy B. N. 
Published: November 2007

Summary: Purpose: To estimate the prevalence of epilepsy in India by meta‐analysis of previously published and unpublished studies and to determine patterns of epilepsy by using community‐based studies. Methods: We attempted to identify as many previously published and unpublished studies as possible on the prevalence of epilepsy in India. The studies were assessed with regard to methods and definitions. The prevalence rates for rural and urban populations and for men and women were calculated with a 95% confidence interval (CI). The studies that provided details on age structure, age‐specific rates, and patterns of epilepsy were chosen for meta‐analysis. Both crude values and age‐standardized prevalence rates were calculated after accounting for heterogeneity. Results: Twenty studies were found involving a sample population of 598,910, among whom 3,207 had epilepsy. This resulted in a crude prevalence of 5.35/1,000. After a correction for heterogeneity due to interstudy variation, the overall prevalence per 1,000 (and its 95% CI) was 5.33 (4.25‐6.41); with urban areas at 5.11 (3.49‐6.73); rural areas, 5.47 (4.04–6.9); men, 5.88 (3.89‐7.87); and women 5.51 (3.49‐7.53). After correction for Ihe variability in estimates of heterogeneity, agestandardized rates (from five studies) revealed that the prevalence rates per 1,000 (and the 95% CI), were as follows: overall, 5.59 (4.15‐7.03); men, 6.05 (3.79‐8.31); women, 5.18 (3.04–7.32); urban, 6.34 (3.43‐9.25); rural, 4.94 (3.12‐6.76). Urban men and women had a higher prevalence of epilepsy compared with rural ones, however the difference was not statistically significant. Age‐specific prevalence rates were higher in the younger age group, with the onset of epilepsy reported mostly in the first three decades of the sample population's lives. The treatment gap (i.e., the percentage of those with epilepsy who were receiving no or inadequate treatment) was more than 70% in the rural areas. Conclusions: Based on the total projected population of India in the year 2001, the estimated number of people with epilepsy would be 5.5 million. Based on a single study on the incidence of epilepsy, the number of new cases of epilepsy each year would be close to half a million. Because rural population constitutes 74% of the Indian population, the number of people with epilepsy in rural areas will be 4.1 million, three fourths of whom will not be getting any specific treatment as per the present standard.
What is nonconvulsive status epilepticus, and what are its subtypes?
Authors: Shorvon Simon 
Published: October 2007

SummaryProlonged nonconvulsive seizures have been recognized at least since the 19th century, although their inclusion within the rubric of status epilepticus was only formalized by Gastaut and colleagues after the Xth Marseilles Colloquium, held in 1962 (Gastaut et al., 1967). This was the first ever large meeting devoted to the topic of status epilepticus, and the concept that there were status forms for every seizure type was formulated there. The classification of status epilepticus derived from the 1962 colloquium thus mirrored exactly the newly evolved International Classification of Seizure Type (Gastaut, 1970). The main disadvantage of a classification based on seizure type is that it does not take into account the broader range of phenomenology of epilepsy, which is especially significant in regard to nonconvulsive seizures. A seizure type classification does not do justice to the variety of forms and to their widely varying pathophysiological basis, prognosis, or clinical setting.
Intensive care unit management of patients with status epilepticus
Authors: Bleck Thomas P. 
Published: October 2007

Summary The intensive care unit management of status epilepticus focuses on patients who are refractory to initial treatment, who have an underlying condition that require critical care management, or who experience respiratory or cardiovascular complications of their therapies. The available data suggest that failure of a first‐line anticonvulsant agent to terminate status should lead to the use of a definitive therapy in general anesthetic doses. Midazolam, propofol, and phenobarbital have been used most frequently; the place of newer agents (e.g., valproate, levetiracetam, or topiramate) remains to be determined.
Mechanisms of drug resistance in status epilepticus
Authors: Löscher Wolfgang 
Published: October 2007

Summary Refractory status epilepticus (RSE) is a major medical emergency, defined as severe form of SE that does not respond to first (benzodiazepines) and second (phenytoin, phenobarbital) treatment efforts with antiepileptic drugs (AEDs). Understanding the mechanisms of RSE is important to prevent or reverse its development. Based on both clinical experience and data from rat models of SE, seizures that last more than 30 min become very hard to control by AEDs. Experimental studies have shown that the prolonged seizures of SE lead to progressive alterations of GABAA receptors, including reduced surface expression of these receptors by receptor trafficking, which would explain the loss of efficacy of benzodiazepines. In addition to AED target alterations, SE‐induced overexpression of drug efflux transporters, such as P‐glycoprotein (Pgp), in the brain may be involved in the resistance to AEDs (including phenytoin and phenobarbital) that are Pgp substrates. However, recent experiments of our group did not indicate that Pgp plays any important role in drug resistance of SE. Improved understanding the molecular mechanisms underlying AED resistance in SE will ultimately provide new treatment options for RSE.
The epidemiology of convulsive and nonconvulsive status epilepticus
Authors: Rosenow Felix , Hamer Hajo M. , Knake Susanne 
Published: October 2007

Summary Epidemiologic studies of status epilepticus (SE) depend on clear definitions of terms. Such a definition is available for convulsive generalized SE, but clear definitions of nonconvulsive SE (NCSE) are lacking. This as well as clinical difficulties to diagnose NCSE are one source of underascertainment. The minimal incidence of SE in the Caucasian population of industrialized countries is about 20/100,000/year. It depends on age, ethnic background and possibly gender. Case fatality rates lie between 1.9 and 40% depending on age, etiology and duration of the SE. Effective treatment can improve and focal SE itself may impair case fatality. Clearly increased rates of long term case fatality in patients with symptomatic SE suggest that these patients should be considered a population at high risk.
Lower Risk of Hypoglycemia with Insulin Detemir than with Neutral Protamine Hagedorn Insulin in Older Persons with Type 2 Diabetes: A Pooled Analysis of Phase III Trials
Authors: Garber Alan J. , Clauson Per , Pedersen Claus B. , Kølendorf Klaus 
Published: October 2007

OBJECTIVES: To compare the safety and efficacy of insulin detemir with that of neutral protamine Hagedorn (NPH) insulin in older (aged ≥65) and younger (aged 18–64) persons with type 2 diabetes mellitus (DM).DESIGN: Pooled, post hoc analysis of data from three open‐label, randomized studies.SETTING: Three multinational Phase III trials.PARTICIPANTS: Four hundred sixteen older and 880 younger persons with DM, treated for 22 to 26 weeks with basal insulin plus mealtime insulin or oral agents.MEASUREMENTS: Hemoglobin A1c (HbA1c), fasting plasma glucose, glucose variability, hypoglycemic episodes.RESULTS: Mean treatment difference for HbA1c (insulin detemir–NPH insulin) indicated that insulin detemir was not inferior to NPH insulin for both age groups (0.035%, 95% confidence interval (CI)=−0.114–0.183 and 0.100%, 95% CI=−0.017–0.217, for older and younger persons, respectively). Relative risk of all hypoglycemic episodes (insulin detemir/NPH insulin) was 0.59 (95% CI‐0.42–0.83) for older persons and 0.75 (95% CI‐0.59–0.96) for younger persons. Adverse events were similar between treatments. Fasting plasma glucose was similar between treatments (mean treatment difference 0.97 mg/dL, 95% CI=−8.01–9.95, and 4.69 mg/dL, 95% CI=−2.30–11.67, for older and younger persons, respectively). Mean treatment difference for weight was −1.02 kg (95% CI −1.61 to −0.42) and −1.13 (95% CI −1.58 to −0.69) for older and younger persons, respectively.CONCLUSION: Previously reported benefits of insulin detemir, particularly less hypoglycemia and less weight gain, compared with NPH insulin, were the same for older and younger persons with DM at similar levels of HbA1c.
Association Between Apolipoprotein E4 and Cognitive Decline in Elderly Adults
Authors: Packard Chris J. , Westendorp Rudi G.J. , Stott David J. , Caslake Muriel J. , Murray Heather M. , Shepherd James , Blauw Gerard J. , Murphy Michael B. , Bollen Edward L.E.M. , Buckley Brendan M. , Cobbe Stuart M. , Ford Ian , Gaw Allan , Hyland Michael , Jukema J. Wouter , Kamper Adriaan M. , Macfarlane Peter W. , Jolles Jellemer , Perry Ivan J. , Sweeney Brian J. , Twomey Cillian ,   for the Prospective Study of Pravastatin in the Elderly at Risk Group
Published: October 2007

OBJECTIVE: To determine the influence of apolipoprotein E on cognitive decline in a cohort of elderly men and women.DESIGN: Prospective study.SETTING: Scotland, Ireland, and the Netherlands.PARTICIPANTS: Five thousand eight hundred four subjects aged 70 to 82 from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).MEASUREMENTS: Subjects were assessed at baseline and over a mean 3.2‐year (range 0.7–4.2) follow‐up for memory (Picture‐Word Recall), speed of information processing (Stroop and Letter‐Digit Coding), global cognitive function (Mini‐Mental State Examination), and activities of daily living.RESULTS: At baseline, subjects with apolipoprotein E4 versus those without E4 had poorer memory performance (mean score difference −0.20 (95% confidence interval (CI)=−0.31 to −0.09) for immediate recall and −0.32 (95% CI=−0.48 to −0.16) for delayed recall and slower information processing (difference in Stroop, 2.79 seconds, (95% CI=1.20–4.28); Letter‐Digit score, −0.36, (95% CI=−0.77–0.05). Subjects with apolipoprotein E4 showed a greater decline in immediate (−0.22, 95% CI=−0.33 to −0.11) and delayed (−0.30, 95% CI=−0.46 to −0.15) memory scores but no significant change in speed of information processing (Stroop, P=.17; Letter‐Digit, P=.06). Memory scores decreased 2.5% from baseline in those without E4, 4.3% in E4 heterozygotes (P=.01 for immediate and P=.03 for delayed, vs no E4) and 8.9% to 13.8% in E4 homozygotes (P=.04 for immediate and P=.004 for delayed, vs heterozygotes). Apolipoprotein E4 was associated with greater decline in instrumental activities of daily living (P<.001). Cognitive decline was not associated with lipoprotein levels.CONCLUSION: Findings in PROSPER indicate that E4 is associated with more‐rapid cognitive decline and may, therefore, predispose to dementia.
The Relationship Between Glycemic Control and Falls in Older Adults
Authors: Nelson Joan M. , Dufraux Kimberly , Cook Paul F. 
Published: October 2007

OBJECTIVES: To determine whether glycemic control contributes to fall risk in frail and nonfrail elderly adults with diabetes mellitus.DESIGN: Retrospective, case‐controlled design.SETTING: Health maintenance organization in the Denver, Colorado, metropolitan area.PARTICIPANTS: One hundred eleven community‐dwelling adults aged 75 and older who receive care through Kaiser Permanente of Colorado. All subjects had been diagnosed with diabetes mellitus, had at least one hemoglobin A1C (HbA1c) measurement in the previous 12 months, and were using oral hypoglycemic medication or insulin to control their diabetes mellitus.MEASUREMENTS: Measurements of risk factors (Vulnerable Elders Survey (VES‐13) with a cutpoint of 3 to determine frailty status, self‐reported number of falls over the prior 12‐month period, HbA1c, fasting low‐density lipoprotein cholesterol, average blood pressure, and other factors related to fall risk) were obtained through telephone interview and medical chart review. The outcome measure was falls.RESULTS: Bivariate analyses to assess correlations between falls and risk factors determined that only HbA1c, frailty, and peripheral neuropathy were significantly associated with falls. A stepwise logistic regression determined that fall risk markedly increased when HbA1c was 7 or below, regardless of frailty status.CONCLUSION: In this retrospective study of a convenience sample of frail older adults with diabetes mellitus, tighter glycemic control was associated with greater risk of falling. Prospective studies that further evaluate the risks and benefits of relaxed glucose control in high‐risk older adults are needed to confirm this finding.
Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders
Authors: Arora Vineet M. , Johnson Martha , Olson Jared , Podrazik Paula M. , Levine Stacie , DuBeau Catherine E. , Sachs Greg A. , Meltzer David O. 
Published: October 2007

OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).DESIGN: Prospective cohort study.SETTING: Single academic medical center.PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey‐13 (VES‐13), a validated tool based on age, self‐reported health, and functional status.MEASUREMENTS: Inpatient interview and chart review using ACOVE‐based process‐of‐care measures referring to 16 QIs in general hospital care and geriatric‐prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse).RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES‐13 score. Three hundred twenty‐eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3–83.7% vs 75.8%, 95% CI=70.5–81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3–83.7 vs 31.4% 95% CI=27.5–35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission.CONCLUSION: Adherence to geriatric‐specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol‐driven care.
Postacute Care for Older People in Community Hospitals: A Multicenter Randomized, Controlled Trial
Authors: Young John , Green John , Forster Anne , Small Neil , Lowson Karin , Bogle Sue , George James , Heseltine David , Jayasuriya Tilak , Rowe Jed 
Published: November 2007

OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care.DESIGN: Randomized, controlled trial.SETTING: Seven community hospitals and five general hospitals in the midlands and north of England.PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness.INTERVENTION: Multidisciplinary team care for older people in community hospitals.MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6‐month residence status, and satisfaction with services.RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P=.03). The results for the secondary outcome measures were similar for the two groups.CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.
Consistency of Labial Finish Line Preparation for Metal Ceramic Crowns: An Investigation of a New Bur
Authors: Seymour Kevin G. , Cherukara George P. , Samarawickrama Dayananda Y.D. , Zou Lifong 
Published: October 2007

Abstract Purpose: Previous studies have reported on the difficulties inherent in preparing the labial aspect of teeth for metal ceramic crowns with consistency and also the implications for the definitive restoration of underprepared and overangled finish lines. In this study, a bur designed to prepare a 1.2‐mm deep chamfer was tested and compared with two other bur kits. Materials and Methods: Seventy‐two teeth were prepared to receive metal ceramic crowns in vitro by students using one of the two bur kits or the new bur. Using a coordinate measuring machine (CMM), replicas of the prepared teeth were scanned in the mid‐labial plane, and shoulder width and cavosurface angles were measured. Results: The new bur produced preparations with a mean shoulder width and cavosurface angle of 1.146 ± 0.241 mm and 108 ± 11°, respectively, compared with 0.626 ± 0.234 mm and 128 ± 14° produced by a commercially available standardized crown cutting bur system and 0.626 ± 0.218 mm and 124 ± 15° produced by the bur kit in use at our center at the time of the study. These differences were statistically significant at the 5% level, using Tukey's comparison of means. Conclusions: Teeth prepared by the new bur had wider shoulders and lower cavosurface angles than teeth prepared either with a standardized crown cutting system or locally selected bur kit. The quality of labial preparations produced by the new bur in terms of closeness to the postulated “ideal” width and angulation warrants further investigation.
Guidelines for Maxillary Incisal Edge Position—A Pilot Study: The Key Is the Canine
Authors: Misch Carl E. 
Published: October 2007

Abstract Purpose: The purpose of this pilot study was to evaluate the relationship between the vertical position of the maxillary central incisal edge and the maxillary canine relative to the maxillary lip line in repose of dentate patients. This may be beneficial for clinicians in establishing guidelines for the rehabilitation of edentulous patients. Materials and Methods: One hundred and four Caucasian dentate patients (59 men and 45 women) between the ages of 30 and 59 years were evaluated. A millimeter ruler was used to measure the maxillary right central incisor edge and the maxillary right canine tip to the maxillary lip in repose. Data were collected in reference to sex and age. Results: For the female group, average central incisor exposure in relation to the relaxed maxillary lip line was 3.8 mm, and the range of exposure was –1 to +8 mm. In the 30‐ to 39‐year olds (17 patients), the average was 4.1 mm with a range of 0 to 8 mm. The average in the 40‐ to 49‐year‐old group (16 patients) was 2.8 mm with a range of –1 to +6 mm. In 50‐ to 59‐year olds (12 patients), the average was 1.8 mm with a range of –1 to +5 mm. In the male group, the average central incisor exposure was 2.5 mm, and the range was –3 to +7 mm. The average for the 30‐ to 39‐year‐old group (20 patients) was 3.2 mm with a range of 0 to 7 mm. For the 40‐ to 49‐year group (18 patients), the average was 2.4 mm and for 50 to 61 years (21 patients), it was 1.4 mm with a range of –3 to +5 mm in both latter age groups. The canine position for the female group average exposure was 0 mm, with a range of –2 to +2 mm. For the 30‐ to 39‐year old group, average exposure was 1 mm with a range of –1 to +2 mm. The 40‐ to 49‐year‐old group exposed an average of 0.4 mm with a range of –1 to +2 mm. For the 50‐ to 59‐year old group, canine exposure was –0.5 mm with a range of –2 to +1 mm. The male average canine exposure was –0.5 mm, and the range was –3 to +2 mm. For the 30‐ to 39‐year old group, the average was 0.9 mm with a range of –1 to +2 mm. The 40‐ to 49‐year‐old group exposed an average of 0.2 mm, with a range of –1 to +2 mm. For the 50‐ to 59‐year old group, average was –0.9 mm with a range of –2 to +1 mm. Conclusions: There was a large range of maxillary central incisal exposure in relation to the maxillary lip line. The average dimension of central incisor exposure represented less than 30% of the subjects in the study and could not be used predictably to assess incisal edge position. The range of canine exposure was narrower. The average dimensions of canine exposure to the lip were within 1 mm for both men and women in all age groups. Further studies are needed to confirm these preliminary results. The average dimensions for the different sex and age groups related to canine exposure represented a greater proportion of the subjects. Therefore, it is suggested that the average canine exposure dimension can be used clinically to assess anterior incisor edge position when restoring edentulous patients.
Influence of Microwave Polymerization Method and Thickness on Porosity of Acrylic Resin
Authors: Pero Ana Carolina , Barbosa Débora Barros , Marra Juliê , Ruvolo‐Filho Adhemar Colla , Compagnoni Marco Antonio 
Published: October 2007

Abstract Purpose: This study evaluated the influence of polymerization cycle and thickness of maxillary complete denture bases on the porosity of acrylic resin. Materials and Methods: Two heat‐activated denture base resins—one conventional (Clássico) and one designed for microwave polymerization (Onda‐Cryl)—were used. Four groups were established, according to polymerization cycles: A (Onda‐Cryl, short microwave cycle), B (Onda‐Cryl, long microwave cycle), C (Onda‐Cryl, manufacturing microwave cycle), and T (Clássico, water bath). Porosity was evaluated for different thicknesses (2.0, 3.5, and 5.0 mm; thicknesses I, II, and III, respectively) by measurement of the specimen volume before and after its immersion in water. The percent porosity data were submitted to Kruskal–Wallis for comparison among the groups. Results: The Kruskal–Wallis test detected that the combinations of the different cycles and thicknesses showed significant differences, and the mean ranks of percent porosity showed differences only in the thinnest (2.0 mm) microwave‐polymerized specimens (A = 53.55, B = 40.80, and C = 90.70). Thickness did not affect the results for cycle T (I = 96.15, II = 70.20, and III = 82.70), because porosity values were similar in the three thicknesses. Conclusions: Microwave polymerization cycles and the specimen thickness of acrylic resin influenced porosity. Porosity differences were not observed in the polymerized resin bases in the water bath cycle for any thickness.