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Nearly half of care home residents with advanced dementia have clinically significant agitation. Little is known about costs associated with these symptoms toward the end of life. We calculated monetary costs associated with agitation from UK National Health Service, personal social services, and societal perspectives.
Prospective cohort study.
Thirteen nursing homes in London and the southeast of England.
Seventy-nine people with advanced dementia (Functional Assessment Staging Tool grade 6e and above) residing in nursing homes, and thirty-five of their informal carers.
Data collected at study entry and monthly for up to 9 months, extrapolated for expression per annum. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Health and social care costs of residing in care homes, and costs of contacts with health and social care services were calculated from national unit costs; for a societal perspective, costs of providing informal care were estimated using the resource utilization in dementia (RUD)-Lite scale.
After adjustment, health and social care costs, and costs of providing informal care varied significantly by level of agitation as death approached, from £23,000 over a 1-year period with no agitation symptoms (CMAI agitation score 0–10) to £45,000 at the most severe level (CMAI agitation score >100). On average, agitation accounted for 30% of health and social care costs. Informal care costs were substantial, constituting 29% of total costs.
With the increasing prevalence of dementia, costs of care will impact on healthcare and social services systems, as well as informal carers. Agitation is a key driver of these costs in people with advanced dementia presenting complex challenges for symptom management, service planners, and providers.
We performed a study to determine rates of reinfection in three groups followed for 2 years after successful treatment: American Indian/Alaska Native (AI/AN) persons living in urban (group 1) and rural (group 2) communities, and urban Alaska non-Native persons (group 3). We enrolled adults diagnosed with H. pylori infection based on a positive urea breath test (13C-UBT). After successful treatment was documented at 2 months, we tested each patient by 13C-UBT at 4, 6, 12 and 24 months. At each visit, participants were asked about medication use, illnesses and risk factors for reinfection. We followed 229 persons for 2 years or until they became reinfected. H. pylori reinfection occurred in 36 persons; cumulative reinfection rates were 14·5%, 22·1%, and 12·0% for groups 1, 2, and 3, respectively. Study participants who became reinfected were more likely to have peptic ulcer disease (P = 0·02), low education level (P = 0·04), or have a higher proportion of household members infected with H. pylori compared to participants who did not become reinfected (P = 0·03). Among all three groups, reinfection occurred at rates higher than those reported for other US populations (<5% at 2 years); rural AI/AN individuals appear to be at highest risk for reinfection.
Castor (Ricinus communis L.) is an important non-edible oilseed crop that can potentially be used as feedstock for biodiesel production. There are 1033 accessions in the United States Department of Agriculture (USDA) castor germplasm collection. The range of oil content in these accessions has never been surveyed. For exploiting castor as a feedstock for biodiesel production, the entire USDA castor collection was procured from the National Plant Germplasm System (Germplasm Resources Information Network) and the oil content was measured with nuclear magnetic resonance. The variation of oil content among all castor accessions ranged from 37.2 to 60.6% with an average of 48.2%. One hundred seed weights were determined and seed-coat colour was also recorded from each accession. One hundred seed weight ranged from 10.1 to 73.3 g with an average of 28.3 g. There was a significant correlation between seed weight and oil content but the correlation value was low (r = 0.1572, P < 0.0001). Fifty accessions with a wide range of oil content were selected to be field grown for further evaluation. The results obtained from this survey will be useful for castor breeders seeking germplasm accessions with high oil content in the collection.
Flavonoid content was quantified by high performance liquid chromatography (HPLC) and seed-coat colour was recorded from different legume seeds. Soybean seeds generally contained significantly higher amounts of daidzein (315–354 μg/g), genistein (438–458 μg/g), kaempferol (38–68 μg/g) and total measured flavonoids (892–917 μg/g), while cowpea and peanut seeds contained a significantly higher amount of quercetin (214–280 μg/g and 133–289 μg/g, respectively) than the other legumes tested. Significant variation for flavonoid content existed among and within legume species. Daidzein was significantly correlated with genistein and kaempferol (r = 0.92, P < 0.0001; r = 0.68, P < 0.0001), respectively. Genistein was also significantly correlated with kaempferol (r = 0.84, P < 0.0001). Due to differences in genetic background, no consistent relationship was observed between seed-coat colour and flavonoid content. Variation observed in flavonoid content and seed-coat colour would be useful for legume breeding programmes and consumer use.
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