Adele Csima

Utilization of Home-Delivered Meals by Recipients 75 Years of Age or Older

OBJECTIVE To compare the effects of gender, age, and living situation on utilization of home-delivered meals by elderly recipients. DESIGN Cross-sectional cohort study. SETTING The sample was recruited from five meals-on-wheels agencies in southern Ontario, Canada, representing both rural and urban settings. SUBJECTS Participants were 150 white, independently living recipients of meals-on-wheels who were older than 75 years and able to communicate in English and who had access to a telephone. Of these, 137 (90 women and 47 men) completed the study (attrition rate = 9%). MAIN OUTCOME MEASURES Meal utilization: the energy and nutrient content and the amounts of specific foods in the consumed portions of delivered meals calculated as percentages of the total received from the service agencies. STATISTICAL ANALYSES PERFORMED Two-factor analysis of variance. RESULTS Meal utilization in terms of energy of the consumed portion of the delivered meals was 81 +/- 18%. Nutrient utilization ranged from 83% (vitamin A) to 77% (vitamin C). For specific foods, utilization ranged from 67% (miscellaneous) to 83% (protein sources and soups). Utilization levels for energy, eight nutrients, and specific foods were significantly higher for men than for women. Women living alone showed higher utilization values for energy and 11 nutrients compared with those living with others. Age had no effect on meal utilization. CONCLUSIONS Monitoring and consultation procedures are necessary to ensure maximum nutritional benefits to clients and cost-effectiveness of the meal service.

A comparative study on the effects of brotizolam and flurazepam on sleep and performance in the elderly.

This study was undertaken to compare the effects of 0.25 mg of brotizolam, 15 mg of flurazepam, and placebo on the sleep and performance of elderly subjects with chronic insomnia during a 2-week period of administration. Thirty-six male and female subjects who ranged in age from 60-72 years were divided into three treatment groups. All groups received placebo on the first three study nights, the active drug or placebo on the next 14 nights, and placebo again on the two following withdrawal nights. Sleep was assessed by means of questionnaires, and residual effects during the day were studied by means of the multiple sleep latency test and a variety of memory, performance, and vigilance tests. Sleep improved with all treatments. Rebound insomnia was noted on brotizolam withdrawal; flurazepam withdrawal had a milder impact. At the end of this 19-night study, only the placebo-treated group was sleeping significantly longer than at baseline. Both drug treatments increased daytime sleepiness and impaired performance on the first day after their administration. These effects waned after 2 weeks of treatment with brotizolam, but not flurazepam. The results of this study affirm the increased sensitivity of elderly subjects to benzodiazepine hypnotics and their indication for acute or intermittent insomnia, rather than for the more chronic forms of this disorder.

A Comparative 25‐Night Sleep Laboratory Study on the Effects of Quazepam and Triazolam on Chronic Insomniacs

Abstract: The short‐ and intermediate‐term actions, as well as the carryover and withdrawal effects, of quazepam, a new benzodiazepine hypnotic with a half‐life of 60 to 100 hours, were compared with those of triazolam, a triazolodiazepine hypnotic with a half‐life of 2 to 3 hours. Both the subjective effects of these drugs as well as their objective actions on the sleep EEG were sought. The study was conducted on two groups of six subjects with chronic insomnia who ranged in age from 32 to 56 years. Each subject was studied for 25 consecutive nights. Placebo was administered at bedtime on the first four nights, followed by 30 mg quazepam or 0.5 mg triazolam on the next 14 nights and by placebo again on the ensuing seven withdrawal nights. Both drugs increased the total sleep time during their administration and improved the subjective quality of sleep. Major differences, however, were observed on withdrawal. A significant and marked decrease in the total sleep time occurred with triazolam on the first withdrawal night. With quazepam, rebound insomnia was not observed at any time during the seven‐day withdrawal period.

Studies of Male Survivors of Myocardial Infarction IV. Serum Lipids and Five-Year Survival

This study examined life expectancy and serum lipids in 120 men with atherosclerotic coronary heart disease. Five-year survival from onset of infarction was 79 per cent. No relationship could be demonstrated between survival and the level of the total serum cholesterol, Std. Sf 0–12, 12–20, 20–100, and 100–400 lipoproteins. Survival for patients with an infarct less than 6 months before entry into the study was shorter, despite serum lipid levels the same as the remainder of the group.Although the age of onset of coronary disease is influenced by serum lipid levels, survival subsequent to infarction is not. This paradox suggests that serum lipids affect rate of atherogenesis in the long preclinical stage but in the short clinical stage other factors determine survival.

Spectral EEG Correlates of Dream Recall

Recent studies have shown that dreaming is not limited to rapid eye movement (REM) sleep, but can be found to varying degrees in any stage of sleep. This study attempted to quantify the EEG correlations of dreaming during Stage 2 sleep. Six normal volunteers were studied for 24 nights in the sleep laboratory. Electroencephalogram (EEG) recording prior to awakening from Stage 2 sleep and from other stages without awakening were subjected to computer spectral analysis. Although awakenings associated with dream recall tended to have lower total power, mean frequency in the beta band proved to be the best correlate of mental activity in Stage 2 sleep. Mean frequency had its highest values in REM sleep and wakefulness and declined in Stage 2 and Stage 4 sleep, in keeping with the decline in mental activity reported from these stages. Implications of these findings are discussed with regard to models of dream recall and clinical states.

The effects of a single night's dosing with triazolam on sleep the following night.

This study was undertaken to determine whether a single nights use of triazolam by normal healthy sleepers leads to withdrawal insomnia on the subsequent night, and whether there is a dose response relationship to this phenomenon. Thirty normal sleepers of both sexes were randomly assigned to three parallel treatment groups. All subjects were studied for five consecutive nights by means of pre‐ and post‐sleep questionnaires and all night polysomnography. Multiple sleep latency tests were conducted on the days following the second, third, and fourth nights in the laboratory. All subjects received placebo capsules on the first, second, fourth, and fifth nights in the laboratory and either placebo, 0.25 mg triazolam or 0.5 mg triazolam according to their assigned group on the third night. Both doses of the drug increased subjective estimates of sleep duration, but no objective increase was found. Neither dose altered daytime measures of sleepiness. No changes were found in any of the sleep parameters on withdrawal of the 0.25 mg dose of triazolam. However, discontinuation of the 0.5 mg dose did lead to significant objective and subjective withdrawal effects. It was concluded that higher doses of triazolam could lead to withdrawal effects in normal sleepers even when this drug was used for only a single night.

Studies of Male Survivors of Myocardial Infarction VIII. The Electrocardiogram and Ten-Year Survival*

Abstract The relation of electrocardiographic findings to survival over a ten year period was studied in 101 men aged 30 to 70 years, who had a myocardial infarction at least three months previous to entry into the study and were free of other disease. Age at onset of clinical coronary disease did not influence the electrocardiographic pattern, nor was it related to prognosis. A rate greater than 90 was associated with a poorer prognosis only after 80 months. Ventricular premature beats tended to be associated with a better prognosis for the first five years and a worse one thereafter. Survival was not affected by the complete disappearance of previous electrocardiographic abnormalities, by the site of infarction, anterior or posterior, or by its type, transmural or non-transmural. It is concluded that the electrocardiogram is of little help in predicting long term prognosis in survivors of myocardial infarction.

Serum and Quantitative Electroencephalographic Pharmacokinetics of Loprazolam in the Elderly

This study was undertaken to determine the serum pharmacokinetic parameters of loprazolam, a new benzodiazepine hypnotic, in elderly subjects and to compare these with the kinetics of the drug as determined by quantitative EEG analysis. In addition, a 14‐day study was undertaken to determine the steady‐state serum levels achieved in this population with repeated drug administration. The study was conducted on 16 male and female subjects between the ages of 62 and 72 years, randomly assigned to two groups treated with 0.5 or 1.0 mg of loprazolam. The serum half‐life of loprazolam was found to be 5 hours, and the peak serum concentration was reached after 2 hours. Quantitative EEG changes were observed after 30 minutes suggesting rapid access of the drug into the nervous system. Quantitative EEG changes were evident for 9.5 hours, suggesting the persistent effects of an active metabolite. The 14‐day study indicated that loprazolam did not accumulate with continued use.