Aluminum, fluoride and the prevention of Alzheimer's disease.

The evidence regarding the link between aluminum and Alzheimer's disease is summarized. This evidence suggests strongly that aluminum is one of the etiologic or contributing factors in the occurrence of Alzheimer's disease. One reported study suggests that relatively high fluoride in drinking water plays a preventive role in Alzheimer's disease. The rationale for this is the evidence that aluminum and fluoride compete for absorption in the gut. However, this study had methodologic limitations, and no firm conclusion can be drawn. Further investigation of relatively high fluoride in drinking water as a preventive measure for Alzheimer's disease should receive high priority.

Acute and chronic symptoms of mononucleosis.

BACKGROUND: The clinical symptoms and durations of illness of patients with infectious mononucleosis (IM) are variable and are poorly documented in the scientific literature. METHODS: Patients who presented for care at the Student Health Service of a Canadian university between September 1985 and May 1988 and had been diagnosed as having IM were surveyed. Health experience during the acute and convalescent phases of IM was compared with that of a group of patients matched for age, sex, date of diagnosis, and year of study, who had suffered acute upper respiratory tract infections (URI), other than Epstein-Barr virus (EBV)-induced, during the same period. RESULTS: Students were sicker for longer after IM than after non-EBV-induced URI. During the acute phase of illness, the symptoms of fatigue (P = less than .000001), night sweats (P = .000001), and painful neck swelling (P = .00003) were seen significantly more often in the IM group. The severity and duration of these symptoms were also significantly worse in IM patients. Getting tired easily (P = .002), diurnal somnolence (P = .002), and depression (P = .002) were significantly more common postacute symptoms. Eleven percent of IM patients reported persistence of symptoms longer than 100 days, and in 6% of patients the symptoms had persisted after 1 year. Convalescent cases showed a trend toward reduced alcohol intake and, perhaps, reduced alcohol tolerance. CONCLUSIONS: IM involves excessive morbidity in a student community compared with URI that was other than EBV-induced, during both the acute and the postacute phases of infection.

Abnormal eating attitudes: prevalance at a canadian university.

The authors conducted a survey of the prevalence of abnormal eating attitudes and behaviours among all women undergraduates living in on-campus residences at Queen's University and systematic samples of men and women undergraduates living in off-campus residences, using the Eating Attitudes Test-26 (EAT-26) as the study instrument. The results, although comparable to those of similar studies at other universities and colleges, are unusual in that they identify a group of high scoring respondents who did not return to Queen's University the year following the study.Of 1,982 students surveyed, 1,082 were women living in on-campus residences, 450 were women living in off-campus accommodation and 450 were men also living off-campus. The off-campus groups were matched with the on-campus groups for program and year.The response rate was 50.6%. Of these respondents, 14.7% had scores of 20 or more on the EAT-26; scores typical of those reached by persons sufferering from eating disorders. Both groups of women had the same prevalence of high scorers (16.8%), while the prevalence of high scores in male students was 2.7%. Of 16 high scorers clinically interviewed, 13 (81.3%) fulfilled diagnostic criteria for eating disorders.

Chronic home care in ontario: five year follow up.

The first 218 patients admitted to the Kingston Chronic Home Care program (CHC) after its inception in October, 1975 were followed to March 31, 1981. Their average number of admissions to CHC was 2.3, and they averaged 16 months in CHC. Twenty-eight percent died before any admission to a longterm care institution; 44% were admitted to such an institution at or after last separation from CHC. The study suggests that CHC results in a significant degree of prevention or delay of admission to institutions.

Economic aspects of geriatric care provided in family practice.

A mail survey among family physicians in three counties around Kingston, Ontario, concerning their opinions on the time required to care for elderly patients and the adequacy of fee schedules for such service, resulted in 69% response. The vast majority believe old patients require substantially more time per visit than younger patients. More than half acknowledged spending less time than needed on at least one important activity during office visits with old patients. More than half felt their fee schedule should more fairly reflect the time required for old patients, even if this would not increase their total income.

Patients who want to die: a survey of 1000 adults.

A representative sample of 1000 Ontario adults was surveyed by mail about: 1. their opinion on the desirability of legal and social changes to permit physicians to comply with requests by adult, hopelessly ill patients for measures to hasten their death, and 2. what they would prefer to do if ever faced with hopeless illness.A MAJORITY: a. favors changes to permit a doctor to carry out requests for withdrawing life-supporting equipment; b. favors rewording the law to clarify that it is legal for a doctor to carry out requests not to use forced feeding when patients refuse food; c. is against changes to permit a doctor to carry out requests for lethal drugs; d. feels that if faced with hopeless illness, they would choose to bring about their death, rather than carrying on as best as they could.

The impact of a new geriatric program in a hospital for the chronically ill.

Reports of the rapidly increasing proportion of persons aged 65 years and more in Canada and the resultant need for changes in the country's health care system prompted experimental changes in the operation and training procedures at St. Mary's of the Lake Hospital, Kingston, Ont. Aimed at better patient care and at better education of medical house staff in geriatrics and long-term care, the revised program is permeated with the philosophy of rehabilitation. It includes full-time staff, a geriatric outpatient clinic, a day hospital, a team approach to patient care (with regular team audits), problem-oriented medical records, a formal physical medicine section with a district inpatient unit, and an intensive inservice education program. After the first year of the program patient outcome had improved and more efficient use was being made of continuing care beds because of larger numbers of patinets being discharged home after shorter stays. This may be one avenue for deceleration of our country's dismal rate of institutionalization.

Patients who want to die: a survey.

Representative samples of Ontario physicians and nurses, plus first and fourth year medical and nursing students in Kingston, were surveyed concerning experiences with and attitudes toward patients who want to die.Many respondents had been asked by some hopelessly ill patients for help in hastening death. Over 25 percent had known at least one such patient commit suicide. Abstention from food and drink was a common method in such suicides, and was frequently thwarted by forced feeding.A majority of respondents were definitely in favor of legal and social changes to permit compliance with requests from hopelessly ill patients for no forced feeding when the patient stopped eating, and for withdrawal of life-supporting procedures, but a solid majority opposed changes to permit compliance with requests for lethal drugs. Student respondents were neither consistently more nor consistently less favorable toward these changes than practitioners.

Effect of chronic home care on admission to institutions providing long-term care.

Home care programs are operating throughout Ontario. In October 1975 pilot-test chronic home care (CHC) programs were added in three areas. Whether the Kingston CHC program prevented or delayed admission to an institution providing long-term care was studied in the 218 patients admitted to the program up to mid-March 1976. Forms were completed for all 218 patients admitted, for the 109 still in the program 6 months later, and for the 131 who had left the program by August 1976. Of the 218 patients 20% had applied for admission to an institution providing long-term care before applying for CHC, and another 22% had seriously considered applying to such an institution. The CHC staff judged that 61% would have needed institutional care without CHC. Only 12% of the 218 patients left the CHC program to enter an institution, only 1 of the 48 patients discharged to self-care at home was considering a move to an institution, and only 2 receiving CHC for 6 months applied to an institution during that time. CHC therefore seems to delay greatly admission to an institution providing long-term care for a substantial group of patients.

The health of the very aged.

Little information is available on the health status of persons 85 years or over. Recent United States data indicate that 20% of individuals 85 years of age or over reside in nursing and personal care homes and that among these institutional residents 31% are bedfast, 11% are chairfast and 71% manifest evidence of senility. An investigation into the health of persons 85 years of age or over in two Ontario counties revealed that 39% resided in long-stay institutions, and that one of the main differences between old people living independently in the community and those in institutions was the higher proportion of the latter needing help with the activities of daily living and showing mental disorientation. Of those individuals 85 years of age or over in institutions for 1 year, 26% acknowledged often feeling depressed and 18% acknowledged often wishing they were dead, but these tendencies were not more frequent in those 85 years of age or over than in those 65 to 84 years of age. These findings have implications for service and research needs and attitudes towards death.

Potential interest of the elderly in active euthanasia.

As part of a larger study, elderly applicants to institutions and elderly residents of the community were questioned on their potential interest in active euthanasia. Of these, 19 percent and 23 percent respectively said they would want a lethal injection. A further ten and nine percent respectively said they would want a lethal pill, if ever hopelessly ill. Most elderly community residents who would prefer to carry on as best as they could nevertheless thought that alternatives should be available to those wanting them.

Elderly applicants to long-term care institutions. II. The application process; placement and care needs.

As part of a study of long-term institutional care of the elderly, this report presents salient data concerning 193 elderly applicants. Physicians play an important role in decisions to apply for such care. More than half of the applicants and about 80% of their family members approved of the proposed move. The number applying to homes for the aged vs. other institutions seemed much greater than appropriate; many of these applicants appeared more elibible for placement in foster homes and specialized facilities for the demented, or for remaining in their own homes. About a fifth of the applicants could have continued living independently if they had received a reasonable amount of community assistance. Action implications include: 1) expansion and more informed use of community services, 2) more programs of supervised foster homes for the elderly, 3) construction of specialized institutions for the demented, and 4) a greater effort by institutions to satisfy the desire of many new residents to be involved there in useful tasks.

Elderly applicants to long-term care institutions. I. Their characteristics, health problems and state of mind.

As part of a study of long-term institutional care of the elderly, this report presents a comparison of the characteristics, health problems, and state of mind of 193 elderly applicants for such care (Group A) with those of 141 elderly persons living independently in the community (Group I). Group A members were older, living with a spouse less often, and had low incomes. They showed much more cerebrovascular disease, incontinence, recent loss of independence in the activities of daily living, dementia, recent hospitalization, loneliness, and depression. They had had much less recent involvement in social and recreational activities, although most had not been socially isolated. They had received more extensive help from relatives and friends, and it seemed unlikely that additional help from these sources would keep many more of these elderly persons out of institutions. Community agencies and services had been used by a relatively low proportion of Group A, and hardly at all by Group I.