Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users: A cross-sectional study.

ABSTRACT: Polypharmacy influences malnutrition and activities of daily living (ADL) in older individuals owing to side effects such as anorexia. This study aimed to examine whether polypharmacy (5 or more drugs) is associated with malnutrition and ADL disability among daycare facility users.This cross-sectional study was performed in a daycare facility specializing in rehabilitation. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition criteria and ADL disability according to the "criteria for determination of the daily life independence level (bedridden level) of elderly with disabilities."In total, 103 of the 134 included individuals were analyzed. Thirty-three (32.0%) participants were malnourished, 46 (44.7%) had ADL disability, 58 (56.3%) qualified as cases of polypharmacy, and 9 (8.7%) experienced loss of appetite. Multivariable logistic regression analysis showed that polypharmacy was independently associated with malnutrition and ADL disability. Separate analyses of each type of drug revealed that proton pump inhibitors (that impair protein absorption and assimilation), anticonstipation drugs, and antihypertensive drugs were associated with malnutrition, whereas proton pump inhibitors, anticonstipation drugs, antidyslipidemia drugs, and antidiabetic drugs were associated with ADL disability. The only factor related to anorexia was the loss of pleasure of eating, which in turn was related to psychological stress.The side effects of polypharmacy among individuals with malnutrition and ADL disability may include impaired protein absorption and assimilation caused by proton pump inhibitors, but not anorexia. Further multicenter prospective studies are required to confirm these findings.

Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component "body functions" and 21 from the component "activities and participation". This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. METHODS: The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters' feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. RESULTS: The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. CONCLUSIONS: In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.

Development and assessment of a home environment checklist to evaluate mismatch between patients' ability and home environment.

BACKGROUND: Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital. OBJECTIVES: We developed a simple screening scale - the home environment checklist (HEC) - to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC. METHODS: The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score. RESULTS: The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2=13.2, P=0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P<.01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC. CONCLUSIONS: The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.

On-line preconcentration of trace carcinogenic polycyclic aromatic hydrocarbons (PAHs) in microcolumn liquid chromatography via large volume injection.

The ability and efficiency of micro precolumns made of C30 particles, monolithic silica C18 stationary phase and quartz wool coated with C30, which act as novel solid phase absorbing materials, for the on-line enrichment of aqueous polycyclic aromatic hydrocarbons (PAHs) in microcolumn liquid chromatography (LC) was investigated. The enrichment unit was designed in such a way that micro precolumns were directly connected to a 6-port micro injection valve via fused-silica tubing (0.05 mm I.D.) in order to minimize band broadening of the samples, and the enrichment efficiency of the three materials was tested using 14 PAHs, which are selected by the US Environmental Protection Agency (US EPA), as the analytes. The separation of PAHs was evaluated by using laboratory-made C30 or ODS capillary columns and the results were compared. There were no significant differences showed from the separation of PAHs in terms of peak signal between the C30 and ODS capillary columns, but the C30 capillary column was chosen for the following experiment due to its ability to produce better repeatability than the ODS column. By using the three kinds of precolumn materials, results showed that the precolumn packed with C30 particles as well as the capillary monolithic C18 precolumns (0.1 or 0.2mm I.D.) provided better recovery than those of the quartz wool's. As long as the recovery and separation of the PAHs were concerned, 0.1mm I.D. monolithic C18 precolumn showed the best results and the R.S.D.s (N=7) for the retention time, peak area and peak height were between 0.70-1.5, 2.3-5.8 and 2.4-6.6%, respectively. Large volume injection up to 0.5 mL, i.e. 2500-fold enrichment, was possible and no negative effect on the separation profile was found. The LOD (S/N=3) were between 0.10 and 4.6 pg mL(-1), while the LOQ (S/N=10) were in the range of 0.32-15 pg mL(-1), which showed that the system is comparable to many major analytical techniques and is sensitive enough for the trace analysis of PAHs in environmental samples. The system was then applied to the determination of trace PAHs present in soil sample which was randomly taken from a nearby highway.