bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid treatment for agitation in patients with advanced dementia
Authors: Manfredi Paolo L , Breuer Brenda , Wallenstein Sylvan , Stegmann Marian , Bottomley Gail , Libow Leslie 
Published: July 2003

AbstractBackgroundSome patients with advanced dementia cannot convey the experience of pain verbally and may react to pain with aggressive and agitated behaviors. We hypothesized that unrecognized pain could contribute to agitation and that low dose opioid therapy might reduce agitation by reducing pain. We therefore attempted to determine the effect of opioids on agitation in demented patients.MethodsWe administered placebo for 4 weeks and a long‐acting opioid for another 4 weeks to nursing home patients with advanced dementia and severe agitation despite treatment with psychotropic drugs. Patients and study nurses did not know if the medication administered was placebo or opioid. We measured the Cohen‐Mansfield Agitation Inventory (CMAI) score at baseline and every two weeks.ResultsAmong 47 patients who entered the study, 25 completed the two phases. The median age for the 25 patients was 85.5 years. Analyses of the data of these 25 patients and of the patients <85 years‐old showed no significant differences in agitation level between the placebo and opioid phases. However, among the 13 patients who completed the study and were ≥85 years old, the agitation level at the end of the opioid phase was significantly lower than at the end of the placebo phase (mean change in CMAI score: −6.4; 95% confidence interval (CI): −10.96, −1.8). The decrease in agitation in the patients ≥85 years old persisted after adjusting for sedation. The results remained unchanged when we expanded the analyses to include four ≥85 patients who dropped out of the study after the second week of the opioid phase.ConclusionLow dose, long‐acting opioids can lessen agitation that is difficult to control in very old (≥85) patients with advanced dementia. Copyright © 2003 John Wiley & Sons, Ltd.
Can IQCODE detect poststroke dementia?
Authors: Tang Wai Kwong , Chan Sandra S. M. , Chiu Helen F. K. , Wong Ka Sing , Kwok Timothy C. Y. , Mok Vincent , Ungvari Gabor S. 
Published: July 2003

AbstractBackgroundLittle is known about the performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in the screening of post‐stroke dementia (PSDE).MethodsAt 3 months after the index stroke, a research assistant administered the IQCODE to relatives of 189 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the IQCODE scores, interviewed all 189 patients and made DSM‐IV diagnosis of dementia, which served as the benchmark for judging the performance of IQCODE in screening PSDE.ResultsThe optimal cut‐off point of IQCODE was 3.40. The sensitivity, specificity, and positive and negative predictive values of IQCODE, and the area under the receiver operating characteristic curve, were 88%, 75%, 33%, 98%, and 0.88, respectively.ConclusionsWhen used as a sole instrument, IQCODE does not appear to be useful in screening PSDE in Chinese elderly. Copyright © 2003 John Wiley & Sons, Ltd.
Prevalence of dementia in a semi‐urban population in Sri Lanka: report from a regional survey
Authors: Silva H. A. de , Gunatilake S. B. , Smith A. D. 
Published: July 2003

AbstractBackgroundThe prevalence of dementia in Sri Lanka, which has a rapidly ageing population, is unknown.ObjectiveThis study aimed to determine the prevalence of Alzheimer's disease (AD) and other dementias in a semi‐urban elderly Sinhala‐speaking population in Ragama, Sri Lanka.MethodsThe study was conducted in two phases. Phase I: After informed consent 703 subjects aged ≥65 years from the study area (population 15 828) were screened for cognitive impairment using the Sinhalese Mini Mental State Examination. Subjects scoring ≤17 were regarded as suspected dementia cases. Phase II: All subjects who screened positive in phase I were included in phase II for detailed evaluation for dementia according DSM IV and NINCDS‐ADRDA criteria which included structured neuropsychiatric assessment, laboratory investigations, an axial CT scan of the brain and an informant interview.ResultsIn the study sample, 61% were female and 86% were between 65–75 years. 42 subjects screened positive in phase I. Of these, 28 subjects were diagnosed as having dementia, giving an overall prevalence rate of 3.98% (95% Confidence Intervals (CI) =2.6−5.7%). Of these, 20 (71.4%) had probable AD, four had vascular dementia (14.3%), two had mixed (vascular and AD) dementia (7.1%), one had Lewy body dementia, and one had dementia due to syphilis. Greater age, illiteracy and female gender were associated with higher prevalence of dementia.ConclusionComparison with other community studies performed in North India suggests that dementia prevalence is higher in Sri Lanka. This may be due to regional differences in disease incidence. Copyright © 2003 John Wiley & Sons, Ltd.
A UK survey of psychiatric services for older people in general hospitals
Authors: Holmes John , Bentley Kris , Cameron Ian 
Published: July 2003

AbstractBackgroundPsychiatric illness is common in older people in general hospitals, but little is known of the service models operating in the UK, or of the views of old age psychiatrists regarding service provision in this area. We set out to determine the range of UK old age psychiatry service models for older people in general hospital wards, and the opinions of clinicians on future service priorities and development.MethodA postal questionnaire survey of old age psychiatrists providing psychiatric services to older people in general hospital wards.Results73% of services were provided through a generic, sector‐based, consultation psychiatry model. The remaining 27% employed a range of general hospital‐based liaison psychiatry services for older people, involved in proactively seeking referrals and educating general hospital staff. Those providing a generic sector‐based model were significantly slower at responding to referrals. 89% of respondents were unhappy with their service to older people in general hospital wards, with only 11% preferring the generic sector‐based model. Organisational barriers to change identified included the management of mental health care and physical care by different organisations. Training, both of psychiatric staff in this specialist area, and of general hospital staff in the detection and basic management of common psychiatric conditions in the general hospital setting, was felt to be necessary.ConclusionsThe management of co‐morbid psychiatric and physical illness in older people is an important issue for health services. Old age psychiatrists are unhappy with the prevalent, reactive, consultation‐based model, preferring a range of liaison psychiatry models based in the general hospital. The most important barriers to service development in this area were the separate managerial arrangements for psychiatric and physical care services, and a lack of evidence for effective old age psychiatry services in this setting. Copyright © 2003 John Wiley & Sons, Ltd.
Gender, kinship and caregiver burden: the case of community‐dwelling memory impaired seniors
Authors: Chumbler Neale R. , Grimm James W. , Cody Marisue , Beck Cornelia 
Published: July 2003

AbstractBackgroundThis study examined whether there were gender and kinship (spouse, child, more distant relative) differences in caregiver burden. It further examined the constellation of gender and kinship by examining whether adult daughter caregivers experienced greater burden compared to wives, husbands, sons, and other more distant relatives.MethodsThe sample consisted of 305 family caregivers of memory‐impaired individuals who were age 70 years or older and resided in non‐institutional settings in Arkansas. A cross‐sectional design was employed using validated measures to assess both the memory‐impaired elders' and family caregivers' self‐reported physical and memory status.ResultsAfter controlling for the age and health status characteristics of the memory‐impaired elder, sociodemographic and health status characteristics of the family caregiver, and the caregiver coping response (measured by the sense of coherence), multiple regression analyses found kinship, but not gender differences in caregiver burden. Adult children experienced more caregiver burden than more distant relatives. There were no significant differences in caregiver burden between adult children and spouses. Adult daughters had greater caregiver burden scores compared to more distant relatives, but had comparable scores to wives, sons, and husbands. Other significant correlates of burden included caregiver personal characteristics (age and ethnicity) and the sense of coherence.ConclusionsThe study discusses the practice implications of adult children and adult daughters' propensity to suffer burden when caring for their memory‐impaired parents living in the community. It also discusses the relevance of caregiver personal characteristics and the sense of coherence as correlates of burden. Copyright © 2003 John Wiley & Sons, Ltd.
Performance on the CERAD Word List Memory task: a comparison of university‐based and community‐based groups
Authors: Andel Ross , McCleary Carol A. , Murdock Gail A. , Fiske Amy , Wilcox Rand R. , Gatz Margaret 
Published: July 2003

AbstractBackgroundEvaluation of patients for Alzheimer's disease often compares an individual's performance on cognitive tests to established norms. The purpose of this study was to compare performance on the CERAD Word List Memory tasks in normal controls from an Alzheimer's disease registry and in community volunteers.MethodsScores on Word List Memory tasks were evaluated in cognitively intact participants enrolled in a university‐based Alzheimer's disease registry (n=103) and in a sample of community volunteers (n=51). Scores for the two samples were also compared with previously published data from registry‐based normal controls and from a representative community‐based sample.ResultsUniversity‐based participants outperformed community volunteers, with most marked differences on Delayed Recall and on a Savings score that contrasted immediate to delayed recall. University‐based participants performed similarly to previously published scores for normal controls from another university‐based Alzheimer's disease registry, while community volunteers were consistent with published scores available from a representative community sample.ConclusionsAccurate neuropsychological assessment of Alzheimer's disease may require consideration of potentially subtle differences between older adults tested at university centers and those tested in the community. Copyright © 2003 John Wiley & Sons, Ltd.
Negative symptoms in Alzheimer's disease: a confirmatory factor analysis
Authors: de Jonghe Jos F. M. , Goedhart Arnold W. , Ooms Marcel E. , Kat Martin G. , Kalisvaart Kees J. , van Ewijk Wouter M. , Ribbe Miel W. 
Published: July 2003

AbstractObjectiveTo examine different conceptual models of negative symptoms in Alzheimer's disease.DesignConfirmatory factor analysis of cross‐sectional data.SubjectsAlzheimer patients (n=281) admitted to a psychogeriatric observation ward.MaterialsNurses' Behavioural observation scale for psychogeriatric inpatients (GIP). Global clinical ratings of severity of dementia and depression based on the Cambridge Examination for Mental Disorders of the Elderly‐Dutch version (CAMDEX‐N).ResultsA unidimensional model of dementia fitted the data poorly. Multidimensional models produced better results. In two‐ and three‐factor models negative symptoms were separated from cognitive impairment and mood disturbances. The more severe the memory impairment, the more socially withdrawn patients were. In this sense negative symptoms may have been secondary to cognitive decline. However, no association was found between negative symptoms and mood disturbances.ConclusionsNegative symptoms are a prominent clinical feature of Alzheimer's disease and they are related to memory impairment but not to mood disturbances. Copyright © 2003 John Wiley & Sons, Ltd.
Assessment of health economics in Alzheimer's disease (AHEAD): treatment with galantamine in the UK
Authors: Ward A. , Caro J. J. , Getsios D. , Ishak K. , O'Brien J. , Bullock R. 
Published: July 2003

AbstractObjectiveTo assess the long‐term health and economic impact of treating mild to moderate Alzheimer's disease (AD) with galantamine (16 mg or 24 mg per day) compared to no cholinesterase therapy in the UK.MethodsThe long‐term costs and outcomes were assessed using a model developed from longitudinal data on a cohort of AD patients. The model predicts the time until patients require full‐time care, defined as the consistent requirement for a significant amount of care and supervision each day. Efficacy data were obtained from three clinical trials comparing galantamine with placebo, forecasts were made for ten years. Costs were determined in 2001 British pounds (£) and discounted at 6% per annum, while outcomes such as time to full‐time care were discounted at 1.5%.ResultsWithout pharmacological treatment, patients are expected to incur costs of £28,134 over ten years, 70% of costs accrue from providing full‐time care. Galantamine (16 mg per day) is predicted to reduce the duration of the full‐time care state by 12%; approximately five patients need to be treated to avoid one year of full‐time care. The ten‐year incremental costs per month of full‐time care avoided average £192 per patient and £8,693 per QALY. Savings (£1380) are predicted for patients who continue treatment beyond six months and whose cognitive function is maintained or improved. Comparable results were estimated for the 24 mg dose.ConclusionIn addition to the clinical benefits associated with galantamine treatment, the savings predicted from delaying when full‐time care is needed may offset the treatment costs. Copyright © 2003 John Wiley & Sons, Ltd.
Editorial introduction: locating geographies of diaspora
Authors: Ní Laoire Caitríona 
Published: July 2003

AbstractThis special issue of the International Journal of Population Geography continues a theme raised in previous issues, that is, the perceived need for a greater engagement between population geography and other parts of the discipline and of the social sciences more generally. It is suggested that new approaches to the study of geographies of international migration, such as diaspora studies, may represent a valuable space of interdisciplinary connection. In this spirit, this special issue on Geographies of Diaspora aims to demonstrate the contribution that geographers can make to the study of diaspora, as well as the potential for geographies of diaspora to enable a greater engagement between population geography, human geography and other disciplines. Papers by Paul White, Kathy Burrell, Michael Samers, David Howard, Alison Blunt and Yvonne McKenna all contribute to our understandings of diasporic groups and processes, while engaging with current debates in the theorisation of diasporas and transnationalism. A particular contribution of this collection is its demonstration of the potential for approaches grounded in everyday practices or in political/economic structures to address critiques of postmodern approaches to diaspora, without losing the value of non‐essentialised approaches to identity. Furthermore, the papers demonstrate the need for approaches that can recognise the specificity of diasporic experiences and the contingency of historical and material processes that give rise to different diaspora spaces. The special issue, then, contributes to the ongoing re‐conceptualisation of the concept of diaspora, and reflects the contribution that can be made to this process by geographical approaches. Copyright © 2003 John Wiley & Sons, Ltd.
Geographies of diaspora and mixed descent: Anglo‐Indians in India and Britain
Authors: Blunt Alison 
Published: July 2003

AbstractThis paper explores geographies of diaspora for Anglo‐Indians (formerly known as ‘Eurasians’) through a focus on their ‘homing desire’ in two diaspora spaces: firstly, an imperial diaspora in British India, and secondly, a decolonised diaspora in Britain after independence in 1947. Before independence, although Anglo‐Indians were ‘country‐born’ and domiciled in India, many imagined Britain as home and identified with British life in India even though they were largely excluded from it. Britain was often imagined as the fatherland, embodied by the memory of a British paternal ancestor, as enacted by settlement at an independent homeland for Anglo‐Indians established at McCluskieganj in Bihar in 1933. By 1947, there were about 300,000 Anglo‐Indians in India, but a third had migrated by the 1970s. I explore the implications not only of independence but also the British Nationality Act of 1948, which required many Anglo‐Indians to prove the British origins of a paternal ancestor. The difficulties of tracing British ancestry are explored with reference to the work of the Society of Genealogists in London on behalf of Anglo‐Indians in the subcontinent. Drawing on these records, as well as material from the Anglo‐Indian press and interviews with women from one school who migrated after independence, I argue that ideas of Britain as home were intimately bound up with ideas of whiteness. Ideas about an Anglo‐Indian diaspora existed long before decolonisation, and the migration of Anglo‐Indians under the British Nationality Act led in many ways to a recolonisation of identity. Unlike studies that concentrate on ‘feminising the diaspora’, I argue that the diasporic ‘homing desire’ of Anglo‐Indians invoked ideas of imperial masculinity in both imaginative and material terms. Copyright © 2003 John Wiley & Sons, Ltd.
Forgotten migrants: Irish women religious in England, 1930s–1960s
Authors: McKenna Yvonne 
Published: July 2003

AbstractIn the post‐independence period, as emigration rates increased and the population of Ireland continued to decline, the number of women entering religious life rose substantially, reaching a peak in the late 1960s. Many of these women lived some or all of their lives outside Ireland. However, despite the recent growth of Irish migration or diaspora studies, very little attention has been given to the role or experiences of women religious, who themselves tend not to publish subjective accounts. Based on oral history testimonies, this article seeks to explore the experience of migration for a sample of women who left Ireland to live in religious congregations in England between the 1930s and the 1960s. Growing up in the newly established Irish state, Catholicism was a fundamental part of being Irish for these women. Post‐migration, the women's experience of Irishness was influenced both by their choice of congregation (none of which were Irish in origin) and the wider society in which those congregations were placed. Focusing on the experiences of two groups of women – those who entered congregations with a majority Irish population, and those who entered a middle‐class English congregation whose population was at most a third Irish – this article examines the space that was available within religious life for expressions of ethnicity and Irishness. Situated within the context of the second ‘great wave’ of Irish emigration, it examines the complex processes of inclusion and exclusion (being othered and othering) that occurred within the ‘diaspora space’ of religious community and English society. Religious life during this period was organised according to a strict code of rules and was especially designed to facilitate its transcendence over individual identities, including ethnicity. Notwithstanding this, however, and as this article will argue, ethnicity for the women of this study remained deeply significant within religious life and helped shape their experience of it. Copyright © 2003 John Wiley & Sons, Ltd.
The Japanese in Latin America: on the uses of diaspora
Authors: White Paul 
Published: July 2003

AbstractInternational migration only began to affect Japan in the late nineteenth century, but since then there have been three waves of emigration, two of them customarily regarded as diasporas. Recent discussions of the concept of diaspora have highlighted a tendency for the broadening of the definition to encompass many different migratory situations. This article considers the debate over the characteristics of diaspora and examines a set of five criteria for a definition that can be used, among other things, to distinguish diaspora from immigrant settlement and transnationalism. These criteria are then set against the case of the first Japanese diaspora which led to the establishment of significant communities of Nikkeijin in the Americas from the 1890s to the 1970s. The Nikkeijin are shown to be a model diasporic group, except for a lack of transnational contacts within the diaspora. The paper also considers further theoretical propositions concerning the evolution of ‘homeland’ society views of the diaspora. It is shown that these may have considerable importance in determining any ‘return’ migration that may occur. In the Japanese case, the migration of Nikkeijin to Japan since 1990 has been problematic. Constructions of the continuing Japanese‐ness of the diaspora population have been contested, and differences rather than similarities have been stressed. Copyright © 2003 John Wiley & Sons, Ltd.
Small‐scale transnationalism: homeland connections and the Polish ‘community’ in Leicester
Authors: Burrell Kathy 
Published: July 2003

AbstractThe concept of an implicitly national territory has an important influence on both the construction and maintenance of diasporic national identity and migrant transnational consciousness. Based on evidence collected through 31 in‐depth interviews, this article considers the homeland relationship and the transnational activities of a small and settled migrant group, namely the Polish community in Leicester. Taking these interviews as its base, and situating them within wider debates surrounding transnationalism, it concentrates on three key themes. Firstly, the nature of the break with the homeland is analysed to demonstrate how forced migration can foster a protective attitude towards the national territory from exile. Secondly, the differing types of participation within established transnational networks with Poland are outlined as evidence supporting the notion of ‘small‐scale transnationalism’. Finally, the concept of transnationalism itself is evaluated, highlighting its often exclusive characteristics, and debating the importance of memories and emotional ties as transnational connections. The overall findings of the research are two‐fold: that transnational activism is a highly personalised experience, ranging widely in form and intensity; and that the homeland territory continues to exert a powerful influence over migrant identity, providing strong ties to the native country which, although not immediately obvious or visible, are important nevertheless. Copyright © 2003 John Wiley & Sons, Ltd.