Genetic polymorphisms related to delirium tremens: a systematic review.

Background: Delirium tremens (DT) is one of the more severe complications of alcohol withdrawal (AW), with a 5 to 10% lifetime risk for alcohol-dependent patients. The 2 most important neurosystems involved in AW are gamma-aminobutyric acid and glutamate. It is unknown whether these neurosystems are involved in the pathophysiology of DT as well.

A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline.

Aims And Objectives: To determine a valid, reliable and clinical user-friendly instrument, based on predictors of functional decline, to identify older patients at risk for functional decline. The predictors of functional decline are initially considered and, subsequently, the characteristics and psychometric qualities of existing screening instruments are investigated.

Background: Functional decline is a common and serious problem in older hospitalized patients, resulting in a change in quality of life and lifestyle.

Cortisol responses to psychological stress in adults after prenatal exposure to the Dutch famine.

Experimental studies in animals show that prenatal undernutrition leads to lifelong alterations in the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Some studies have shown associations between low birth weight and an increased HPA response to psychological stress. We tested the hypothesis that prenatal exposure to the Dutch 1944-1945 famine leads to an elevated HPA response to psychological stress in adult life.

A possible link between prenatal exposure to famine and breast cancer: a preliminary study.

In a study of 475 women born around the 1944-1945 Dutch famine, women exposed to prenatal famine more often reported a history of breast cancer than nonexposed women (hazard ratio, 2.6; 95% confidence interval, 0.9-7.

Delirium subtype identification and the validation of the Delirium Rating Scale--Revised-98 (Dutch version) in hospitalized elderly patients.

Background: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the DRS-R-98 and to study clinical subtypes of delirium using the DRS-R-98.

Blood pressure response to psychological stressors in adults after prenatal exposure to the Dutch famine.

Objective: There is increasing evidence that restricted prenatal growth is associated with exaggerated blood pressure responses to stress. We investigated the effect of maternal undernutrition on the adult offspring's stress response.

Design: A historical cohort study.

Reduced intima media thickness in adults after prenatal exposure to the Dutch famine.

Background: Restricted prenatal growth is associated with an increased risk of coronary heart disease morbidity and mortality. We studied the effects of exposure to famine during gestation on intima media thickness (IMT) in later life.

Methods And Results: We studied 730 people aged 58 years who were born as term singletons around the time of the 1944-45 Dutch famine.

Early onset of coronary artery disease after prenatal exposure to the Dutch famine.

Background: Limited evidence suggests that maternal undernutrition at the time of conception is associated with increased cardiovascular disease risk in adult offspring.

Objective: We investigated whether persons conceived during the Dutch famine of World War II had an early onset of coronary artery disease (CAD).

Design: We compared the age at onset and cumulative incidence of CAD between persons born as term singletons who were exposed to the 1944-1945 Dutch famine during late (n = 160), mid- (n = 138), or early (n = 87) gestation and 590 unexposed subjects at age 50 or 58 y.

The Dutch famine and its long-term consequences for adult health.

Small size at birth is linked with an increased risk of chronic diseases in later life. Poor maternal nutrition during gestation may contribute to restricted fetal growth, leading to increased disease susceptibility in later life. Animal studies have shown that undernutrition during gestation is associated with reduced life span and increased disease susceptibility.

Impaired insulin secretion after prenatal exposure to the Dutch famine.

Objective: We previously reported that people prenatally exposed to famine during the Dutch Hunger Winter of 1944-1945 have higher 2-h glucose concentrations after an oral glucose tolerance test in later life. We aimed to determine whether this association is mediated through alterations in insulin secretion, insulin sensitivity, or a combination of both.

Research Design And Methods: We performed a 15-sample intravenous glucose tolerance test in a subsample of 94 normoglycemic men and women from the Dutch Famine Birth Cohort.

Hypothalamic-pituitary-adrenal axis activity in adults who were prenatally exposed to the Dutch famine.

Objective: The hypothalamic-pituitary-adrenal (HPA) axis has been proposed to be susceptible to fetal programming, the process by which an adverse fetal environment elicits permanent physiological and metabolic alterations predisposing to disease in later life. It is hypothesized that fetal exposure to poor circumstances alters the set point of the HPA axis, leading to increased HPA axis activity and subsequent increased cortisol concentrations. In this study, we tested the hypothesis that prenatal exposure to famine during different periods of gestation is associated with increased activity of the HPA axis.

Short-term and long-term mortality in very elderly patients admitted to an intensive care unit.

Objective: To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortality

Design And Setting: Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital.

Patients: 578 consecutive ICU patients aged 80 years or older.

Results: Demographic, physiological, and laboratory values derived from the first 24h after ICU admission.

The effects of the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-gamma2 gene on glucose/insulin metabolism interact with prenatal exposure to famine.

Objective: An adverse fetal environment may permanently modify the effects of specific genes on glucose tolerance, insulin secretion, and insulin sensitivity. In the present study, we assessed a possible interaction of the peroxisome proliferator-activated receptor (PPAR)-gamma2 Pro12Ala polymorphism with prenatal exposure to famine on glucose and insulin metabolism.

Research Design And Methods: We measured plasma glucose and insulin concentrations after an oral glucose tolerance test and determined the PPAR-gamma2 genotype among 675 term singletons born around the time of the 1944-1945 Dutch famine.

Glucose tolerance at age 58 and the decline of glucose tolerance in comparison with age 50 in people prenatally exposed to the Dutch famine.

Aims/hypothesis: People who were small at birth have an increased risk of type 2 diabetes in later life. People who were in utero during the Dutch famine had decreased glucose tolerance and raised insulin concentrations at age 50. We aimed to evaluate whether prenatal famine exposure leads to more rapid progression of impaired glucose/insulin homeostasis with increasing age.

[Diagnosis of vitamin B12 deficiency revised].

Vitamin B12 (cobalamin) deficiency is a common disorder with potential irreversible haematological and neurological consequences. Currently used diagnostic tests such as the evaluation of serum vitamin B12 and the Schilling test are insufficient, e.g.

[Admission of elderly patients to intensive care].

Elderly patients have an increased probability of dying after treatment in an intensive care unit (ICU), compared with younger patients. The risk of dying is largely determined by the admission type (patients with planned admissions have a better prognosis than those with unplanned admissions), severity of illness and functional status prior to admission. Elderly patients surviving ICU often experience a decline in functional status.

Factors that predict outcome of intensive care treatment in very elderly patients: a review.

Introduction: Advanced age is thought to be associated with increased mortality in critically ill patients. This report reviews available data on factors that determine outcome, on the value of prognostic models, and on preferences regarding life-sustaining treatments in (very) elderly intensive care unit (ICU) patients.

Methods: We searched the Medline database (January 1966 to January 2005) for English language articles.

Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review.

Background: Delirium is a disorder that besides four essential features consists of different combinations of symptoms. We reviewed the clinical classification of clusters of symptoms in two or three delirium subtypes. The possible implications of this subtype classification may be several.

Risk factors for delirium in acutely admitted elderly patients: a prospective cohort study.

Background: Delirium is a neuropsychiatric syndrome frequently observed in elderly hospitalised patients and can be found in any medical condition. Due to the severe consequences, early recognition of delirium is important in order to start treatment in time. Despite the high incidence rate, the occurrence of delirium is not always identified as such.

Flood-risk management strategies for an uncertain future: living with Rhine River floods in The Netherlands?

Social pressure on alluvial plains and deltas is large, both from an economic point of view and from a nature conservation point of view. Gradually, flood risks increase with economic development, because the expected damage increases, and with higher dikes, because the flooding depth increases. Global change, changing social desires, but also changing views, require a revision of flood-risk management strategies for the long term.

Circadian rest-activity rhythm disturbances in Alzheimer's disease.

Previous studies showed circadian rhythm disturbances in patients with Alzheimer's disease. Rest-activity rhythm disturbances manifest themselves through a fragmentation of the rhythm, a weak coupling with Zeitgebers, and high levels of activity during the night. The aim of the present study was to investigate which factors contribute to the presence of these disturbances.

[Low serum vitamin B 12 level and vitamin B 12 deficiency in the elderly. When should supplement be provided?].

Low serum vitamin B12 levels and vitamin B12 deficiencies are frequently found in the elderly. The full syndrome of a vitamin B12 deficiency is rather simple to diagnose. The large applicability of the vitamin B12 assay also gives rise to many probably incomplete features.