bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Genetic Analysis of SLC3A1 and SLC7A9 Genes in Czech and Slovak Cystinuric Patients
Authors: Škopková Zuzana , Hrabincová Eva , Štástná Sylvie , Kozák Libor , Adam Tomáš
Published: September 2005

Cystinuria is a frequently inherited metabolic disorder in the Czech population (frequency 1/5,600) caused by a defect in the renal transport of cystine and dibasic amino acids (arginine, lysine and ornithine). The disease is characterized by increased urinary excretion of the amino acids and often leads to recurrent nephrolithiasis. Cystinuria is classified into two subtypes (type I and type non‐I). Type I is caused predominantly by mutations in the SLC3A1 gene (2p16.3), encoding heavy subunit (rBAT) of the heterodimeric transporter. Cystinuria non‐I type is caused by mutations in the SLC7A9 gene (19q13.1). In this study, we present results of molecular genetic analysis of the SLC3A1 and the SLC7A9 genes in 24 unrelated cystinuria families. Individual exons of the SLC3A1 and SLC7A9 genes were analyzed by direct sequencing. We found ten different mutations in the SLC3A1 gene including six novel ones: three missense mutations (G140R), D179Y and R365P), one splice site mutation (1137‐2A>G), one deletion (1515_1516delAA), and one nonsense mutation (Q119X). The most frequent mutation, M467T; was detected in 36% of all type I classified alleles. In the SLC7A9 gene we found six mutations including three new ones: one missense mutation (G319R), one insertion (611_612insA) and one deletion (205_206delTG). One patient was compound heterozygote for one SLC3A1 and one SLC7A9 mutation. Our results confirm that cystinuria is a heterogeneous disorder at the molecular level, and contribute to the understanding of the distribution and frequency of mutations causing cystinuria in the Caucasian population.
Using Tree‐Based Recursive Partitioning Methods to Group Haplotypes for Increased Power in Association Studies
Authors: Yu Kai , Xu Jun , Rao DC , Province Michael
Published: September 2005

Motivated by the increasing availability of high‐density single nucleotide polymorphism (SNP) markers across the genome, various haplotype‐based methods have been developed for candidate gene association studies, and even for genome‐wide association studies. Although haplotype approaches dramatically reduce the multiple comparisons problem (as compared to single SNP analysis), even the number of existing haplotypes is relatively large, which increases the degrees of freedom and decreases the power for the corresponding test statistic. Grouping haplotypes is a way to reduce the degrees of freedom. We propose a procedure that uses a tree‐based recursive partitioning algorithm to group haplotypes into a small number of clusters, and conducts the association test based on groups of haplotypes instead of individual haplotypes. The method can be used for both population‐based and family‐based association studies, with known or ambiguous phase information. Simulation studies suggest that the proposed method has the right type I error rate, and is more powerful than some existing haplotype‐based tests.
The Genetics of the Pre‐Roman Iberian Peninsula: A mtDNA Study of Ancient Iberians
Authors: Sampietro M. L. , Caramelli D. , Lao O. , Calafell F. , Comas D. , Lari M. , Agustí B. , Bertranpetit J. , Lalueza‐Fox C.
Published: September 2005

The Iberians developed a surprisingly sophisticated culture in the Mediterranean coast of the Iberian Peninsula from the 6th century BC until their conquest by the Romans in the 2nd century BC. They spoke and wrote a non‐Indo‐European language that still cannot be understood; their origins and relationships with other non‐Indo‐European peoples, like the Etruscans, are unclear, since their funerary practices were based on the cremation of bodies, and therefore anthropology has been unable to approach the study of this people. We have retrieved mitochondrial DNA (mtDNA) from a few of the scarce skeletal remains that have been preserved, some of them belonging to ritualistically executed individuals. The most stringent authentication criteria proposed for ancient DNA, such as independent replication, amino‐acid analysis, quantitation of template molecules, multiple extractions and cloning of PCR products, have been followed to obtain reliable sequences from the mtDNA hypervariable region 1 (HVR1), as well as some haplogroup diagnostic SNPs. Phylogeographic analyses show that the haplogroup composition of the ancient Iberians was very similar to that found in modern Iberian Peninsula populations, suggesting a long‐term genetic continuity since pre‐Roman times. Nonetheless, there is less genetic diversity in the ancient Iberians than is found among modern populations, a fact that could reflect the small population size at the origin of the population sampled, and the heterogenic tribal structure of the Iberian society. Moreover, the Iberians were not especially closely related to the Etruscans, which points to considerable genetic heterogeneity in Pre‐Roman Western Europe.
Evidence by Expression Analysis of Candidate Genes for Congenital Heart Defects in the NF1 Microdeletion Interval
Authors: Venturin M. , Bentivegna A. , Moroni R. , Larizza L. , Riva P.
Published: September 2005

It was recently reported that congenital heart disease is significantly more frequent in patients with NF1 microdeletion syndrome than in those with classical NF1. The outcome of congenital heart disease in this subset of patients is likely caused by the haploinsufficiency of gene/s in the deletion interval. Following in silico analysis of the deleted region, we found two genes known to be expressed in adult heart, the Joined to JAZF1 (SUZ12) and the Centaurin‐alpha 2 (CENTA2) genes, and seven other genes with poorly defined patterns of expression and function. With the aim of defining their expression profiles in human fetal tissues (15th–21st weeks of gestation), expression analysis by RT‐PCR and Northern blotting was performed. C17orf40, SUZ12 and CENTA2 were found to be mainly expressed in fetal heart, and following RT‐PCR on mouse embryos and embryonic heart and brain at different stages of development, we found that the orthologous genes C17orf40, Suz12 and Centa2 are also expressed in early stages of development, before and during the formation of the four heart chambers.

The presence of binding sites for Nkx2‐5, a transcription factor expressed early in heart development, in all three mouse orthologous genes was predicted by bioinformatics, thus reinforcing the hypothesis that these genes might be involved in heart development and may be plausible candidates for congenital heart disease.
After Adoption: Sustaining the Innovation A Case Study of Disseminating the Hospital Elder Life Program
Authors: Bradley Elizabeth H. , Webster Tashonna R. , Baker Dorothy , Schlesinger Mark , Inouye Sharon K.
Published: September 2005

Objectives: To examine key factors that influence sustainability in the diffusion of the Hospital Elder Life Program (HELP) as an example of an evidence‐based, multifaceted, innovative program to improve care for hospitalized older adults.

Design: Longitudinal, qualitative study between November 2000 and November 2003 based on 102 in‐depth interviews every 6 months during HELP implementation.

Setting: Thirteen hospitals implementing HELP.

Participants: Forty‐two hospital staff members (physician, nursing, volunteer, and administrative staff) implementing HELP, conducted 102 interviews.

Measurements: Staff experiences sustaining the program, including challenges and strategies that they viewed as successful in addressing these challenges.

Results: Of the 13 hospitals studied, 10 were sustaining HELP at the end of the study period; three terminated the program (after 24 months, 12 months, and 6 months). Critical factors were identified as influencing whether the program was sustained: the presence of clinical leadership, the ability and willingness to adapt the original HELP protocols to local hospital circumstances and constraints, and the ability to obtain longer‐term resources and funding for HELP.

Conclusion: Recognizing the need for sustained clinical leadership and funding as well as the inevitable modifications required to sustain innovative programs can promote more‐realistic goals and expectations for health services researchers, clinicians, and policy makers in their laudable efforts to translate research into practice.
The Association Between Oral Health and General Health and Quality of Life in Older Male Cancer Patients
Authors: Ingram Sally S. , Seo Pearl H. , Sloane Richard , Francis Thomas , Clipp Elizabeth C. , Doyle Martha E. , Montana Gustavo S. , Cohen Harvey J.
Published: September 2005

Objectives: To describe the long‐term effects of oral health problems on quality of life (QoL), functional status, pain, and general health in older male cancer patients.

Design: Secondary analysis of a prospective observational study.

Setting: Community dwelling cancer patients served by a Department of Veterans Affairs hospital.

Participants: One hundred fifty male cancer patients responded to the question “Do you have tooth or mouth problems making it hard to eat?” The relationship between patients answering “yes” and the following parameters was assessed: demographics, comorbid conditions, habits, activities of daily living, pain, anxiety, depression, social support, spirituality, QoL, and overall health ratings.

Measurements: Chi‐square contingency tables for dichotomous variables, Cochran‐Mantel‐Haenszel for ordered categorical variables, and t tests for associations with continuous variables.

Results: The median age of respondents was 67. Those reporting tooth or mouth problems had had their cancer diagnosed on average 2.9 years before, and 83.3% were found clinically to be cancer free. Patients with these problems had significantly lower global (P=.003) and subscale scores on QoL analysis and higher levels of anxiety (P<.001) and depression (P=.01) than those without tooth or mouth problems; they also had significantly more pain (P<.001) and lower physical functioning (P<.001) and were more impaired in activities of daily living (P<.001). Those with tooth or mouth problems were more likely to describe their overall health as fair or poor (P=.01). Having cancer located in the head and neck region related significantly to having mouth or tooth problems (P=.005), but these problems were not associated with race, education, income, insurance coverage, age, comorbid conditions, alcohol consumption, tobacco or medication usage, type of cancer treatment, tumor stage at diagnosis or follow‐up, perceived social support, or spirituality.

Conclusion: Older male cancer patients with mouth or tooth problems making it hard to eat are more likely to have a lower QoL, poorer emotional health, lower levels of physical functioning, and greater pain than patients without these problems.
Functional Outcomes for Older Adults with Cognitive Impairment in a Comprehensive Outpatient Rehabilitation Facility
Authors: Yu Fang , Evans Lois K. , Sullivan‐Marx Eileen M.
Published: September 2005

The purpose of the study was to examine functional outcomes of a nurse‐managed, community‐based Comprehensive Outpatient Rehabilitation Facility (CORF) for frail older adults and to compare the outcomes between two groups: older adults with cognitive impairment and those with intact cognition. A retrospective cohort design using healthcare record abstraction was used for the study. Two hundred and one older adults who were admitted to the CORF from the end of 1997 to early 1999 were included in the study. Data were abstracted from healthcare records, including clinician‐generated Mini‐Mental State Examination, Geriatric Depression Scale, and Functional Independence Measure scores from the healthcare records and investigator‐constructed measures of functional gain, rehabilitation efficiency, days of service, and discharge location. Multivariate regression analyses were performed to compare rehabilitation outcomes between the two groups. Regardless of cognitive status, all subjects improved significantly in their levels of functional dependence through participating in this outpatient rehabilitation program (P<.001). Subjects with cognitive impairment exhibited more functional dependence at baseline and discharge than did their cognitively intact counterparts. Nevertheless, there was no difference between the two groups in functional gain (P=.63), rehabilitation efficiency (P=.66), days of service (P=.83), or discharge location (P=.69). Therefore, despite their greater degree of functional dependence on admission, older adults with cognitive impairment benefited from this CORF without requiring more days of service and should thus be referred for rehabilitation services.
The Intersection Between Geriatrics and Palliative Care: A Call for a New Research Agenda
Authors: Goldstein Nathan E. , Morrison R. Sean
Published: September 2005

Palliative care is interdisciplinary treatment focused on the relief of suffering and achieving the best possible quality of life for patients and their caregivers. It differs for geriatric patients from what is usually appropriate in a younger population because of the nature and duration of chronic illness during old age. In spite of the fact that death occurs far more commonly in older people than in any age group, the evidence base for palliative care in older adults is sparse. Over the coming years, the research foci in the field of geriatrics and palliative care that must be addressed include establishing the prevalence of symptoms in patients with chronic disease; evaluating the association between treatment of symptoms and outcomes; increasing the evidence base for treatment of symptoms; understanding psychological well‐being, spiritual well‐being, and quality of life of patients and elucidating and alleviating sources of caregiver burden; reevaluating service delivery; adapting research methodologies specifically for geriatric palliative care; and increasing the number of geriatricians trained as investigators in palliative care research. This article discusses specific methods to improve the current situation within each of these seven areas.
Cognitive Status, Muscle Strength, and Subsequent Disability in Older Mexican Americans
Authors: Raji Mukaila A. , Kuo Yong‐Fang , Snih Soham Al , Markides Kyriakos S. , Kristen Peek M. , Ottenbacher Kenneth J.
Published: September 2005

Objectives: To examine the association between Mini‐Mental State Examination (MMSE) score and subsequent muscle strength (measured using handgrip strength) and to test the hypothesis that muscle strength will mediate any association between impaired cognition and incident activity of daily living (ADL) disability over a 7‐year period in elderly Mexican Americans who were initially not disabled.

Design: A 7‐year prospective cohort study (1993–2001).

Setting: Five southwestern states (Texas, New Mexico, Colorado, Arizona, and California).

Participants: Two thousand three hundred eighty‐one noninstitutionalized Mexican‐American men and women aged 65 and older with no ADL disability at baseline.

Measurements: In‐home interviews in 1993/1994, 1995/1996, 1998/1999, and 2000/2001 assessed social and demographic factors, medical conditions (diabetes mellitus, stroke, heart attack, and arthritis), body mass index (BMI), depressive symptomatology, handgrip muscle strength, and ADLs. MMSE score was dichotomized as less than 21 for poor cognition and 21 or greater for good cognition. Main outcomes measures were mean and slope of handgrip muscle strength over the 7‐year period and incident disability, defined as new onset of any ADL limitation at the 2‐, 5‐, or 7‐year follow‐up interview periods.

Results: In mixed model analyses, there was a significant cross‐sectional association between having poor cognition (MMSE<21) and lower handgrip strength, independent of age, sex, and time of interview (estimate=−1.41, standard error (SE)=0.18; P<.001). With the introduction of a cognition‐by‐time interaction term into the model, there was also a longitudinal association between poor cognition and change in handgrip strength over time (estimate=−0.25, SE=0.06; P<.001), indicating that subjects with poor cognition had a significantly greater decline in handgrip strength over 7 years than those with good cognition, independent of age, sex, and time. This longitudinal association between poor cognition and greater muscle decline remained significant (P<.001) after controlling for age, sex, education, and time‐dependent variables of depression, BMI, and medical conditions. In general estimation equation models, having poor cognition was associated with greater risk of 7‐year incident ADL disability (odds ratio=2.01, 95% confidence interval (CI)=1.60–2.52); the magnitude of the association decreased to 1.66 (95% CI=1.31–2.10) when adjustment was made for handgrip strength.

Conclusion: Older Mexican Americans with poor cognition had steeper decline in handgrip muscle strength over 7 years than those with good cognition, independent of other demographic and health factors. A possible mediating effect of muscle strength on the association between poor cognition and subsequent ADL disability was also indicated.
Underutilization of Environmental Adaptations for Bathing in Community‐Living Older Persons
Authors: Naik Aanand D. , Gill Thomas M.
Published: September 2005

Objectives: To determine the prevalence and utilization of environmental adaptations (home modifications and assistive devices) for bathing in community‐living older persons with and without bathing disability.

Design: Cross‐sectional study.

Setting: General community of greater New Haven, Connecticut.

Participants: Five hundred sixty‐six community‐living persons aged 73 and older.

Measurements: Trained research nurses performed a comprehensive assessment of bathing function, including an in‐home evaluation of the bathing environment and self‐reported utilization of environmental adaptations for bathing.

Results: The prevalence of most environmental adaptations for bathing was less than 50% and was only modestly greater in participants with bathing disability (range 6–54%) than in those without bathing disability (2–44%), although important differences in prevalence and utilization were observed according to the type of bathing disability. Participants who had difficulty (without dependence) with bathing were significantly less likely to have most of the environmental adaptations than participants who needed personal assistance (dependence) with bathing. These differences persisted in analyses that specifically evaluated the utilization of environmental adaptations for bathing transfers according to the type of disability with bathing transfers (59% of those with difficulty vs 88% of those with dependence, P<.001).

Conclusion: Potentially valuable environmental adaptations are absent from the homes of many older persons with bathing disability and may be particularly underused by older persons reporting difficulty with bathing. To ameliorate or delay the progression of disability in community‐living older persons, assessment and remediation strategies should be better targeted to bathing function across the continuum of disability.
Long‐Term Exercise Therapy Resolves Ethnic Differences in Baseline Health Status in Older Adults with Knee Osteoarthritis
Authors: Foy Capri Gabrielle , Penninx Brenda W. H. , Shumaker Sally A. , Messier Stephen P. , Pahor Marco
Published: September 2005

Objectives: To determine whether ethnicity was associated with baseline and 18‐month health status within a merged sample of older adults with knee osteoarthritis (OA) from the Fitness Arthritis in Seniors Trial and the Arthritis, Diet, and Activity Promotion Trial.

Design: Cross‐sectional and prospective study.

Setting: Center‐based exercise therapy at two universities.

Participants: A total of 584 African‐American (n=143) and Caucasian‐American (n=441) adults aged 60 and older with knee OA were examined for baseline and 18‐month health status.

Measurements: Six‐minute‐walk distance, 36‐item Short Form General Health Scale (SF‐36 GHS), and Physical Functioning Questionnaire index score. Ethnicity was obtained via self‐report.

Results: Analyses of covariance testing the effect of ethnicity, adjusted for demographic and health status covariates, revealed significant effects for ethnicity upon baseline 6‐minute‐walk distance and SF‐36 GHS, with Caucasian Americans reporting better scores (P=.001), although these differences were not significant after 18 months of exercise therapy.

Conclusion: Ethnicity and baseline function are important factors that should not be overlooked in knee OA research involving exercise interventions. Moreover, not only should physical activity be recommended to improve functional outcomes, it may also be a useful strategy in reducing health disparities.
Effect of Individualized Social Activity on Sleep in Nursing Home Residents with Dementia
Authors: Richards Kathy Culpepper , Beck Cornelia , O'Sullivan Patricia S. , Shue Valorie M.
Published: September 2005

Objectives: To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost.

Design: Pretest/posttest randomized with an experimental and control group.

Setting: Seven nursing homes.

Participants: One hundred forty‐seven residents with dementia.

Intervention: One to 2 hours of individualized social activities for 21 consecutive days.

Measurements: Twenty‐four‐hour sleep/wake patterns using an Actigraph.

Results: The ISAI group had significantly less daytime sleep (P=.001) and a lower day/night sleep ratio (P=.03) than the control group, after adjusting for baseline values. Because 40% of the sample slept 7 or more hours at night, a secondary analysis was conducted. When only those residents with a sleep efficiency of less than 50% (n=50) were included, the ISAI group (n=20) had less daytime sleep (P=.005), a lower day/night sleep ratio (P=.02), fell asleep faster (P=.03), and were awake less at night (P=.04) than the control group (n=30), after adjusting for baseline values. The weekly cost of the ISAI was roughly $70 per participant. Initial training and supply costs were $1,944.

Conclusion: The ISAI provides an alternative to medications, without side effects.
Long‐Term Care Liability for Pressure Ulcers
Authors: Voss Anne Coble , Bender Stacy A. , Ferguson Maree L. , Sauer Abby C. , Bennett Richard G. , Hahn Peter W.
Published: September 2005

More than 20% of residents who have been in long‐term care (LTC) facilities for 2 or more years will develop at least one pressure ulcer (PU). Residents suffer pain, disfigurement, and decreased quality of life, and their risk of illness and death increases. LTC facilities face censure from residents, their families, and surveyors and the threat of expensive lawsuits. Lawsuits are typically based on contentions of residents with a PU—or their advocates—that the LTC facility was negligent and failed to provide the care that, by industry standards, it must provide to prevent or manage such wounds (managing pressure, incontinence, and nutrition). In this article, data from 1999 and 2002 are presented, showing that lawsuits related to PUs are increasingly common and costly for LTC owners and care providers. Residents realized some type of recovery against the facility in 87% of the cases (verdicts for the resident plus settlements) and were awarded amounts as high as $312 million in damages. Even LTC administrators who believe that care in their facility equals or exceeds industry standards often settle lawsuits out of court to avoid jury verdicts. The data also show that jury awards were highest for PUs caused by multiple factors and that the highest awards for PUs caused by a single factor were seen when that factor was inadequate nutrition. LTC providers can help improve the health and quality of life of their residents, improve survey results, and minimize their risk of expensive lawsuits by developing, implementing, and documenting a plan of basic measures to prevent PUs.
Impact of Pain on Outcomes in Long‐Term Care Residents with and without Multiple Sclerosis
Authors: Newland Pamela K. , Wipke‐Tevis Deidre D. , Williams Donna A. , Rantz Marilyn J. , Petroski Gregory F.
Published: September 2005

Objectives: To compare long‐term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine the impact of MS and pain on outcomes 90 and 180 days after LTC admission.

Design: Retrospective analysis of a large data set.

Setting: LTC facilities in Missouri.

Participants: Residents admitted to non‐hospital‐based LTC facilities.

Measurements: Minimum Data Set/Resident Assessment Instrument, Version 2.0; Activities of Daily Living Scale; Cognitive Performance Scale.

Results: Residents with and without MS had similar pain prevalence and intensity after admission, with daily pain more frequent in residents with MS (P=.03). On admission, residents with MS had more physical disability (P<.001) and a greater prevalence of pressure ulcers (P=.004) and depression (P<.001) than residents without MS. In all LTC residents, initial pain status was associated with physical disability (P<.001), pressure ulcers (P<.001), depression (P<.001), and cognitive performance (P<.001) 90 and 180 days after admission. A diagnosis of MS was associated with physical disability (P<.001) 90 and 180 days after admission and pressure ulcer development 180 days after admission (P=.02).

Conclusion: Residents with MS were more physically disabled and had more frequent pain and a higher prevalence of pressure ulcers and depression on admission than residents without MS. Pain, or lack thereof, in residents with and without MS on admission may warn of problems that could occur within 6 months after admission to a LTC facility.
Efficacy of a Comprehensive Geriatric Intervention in Older Patients Hospitalized for Hip Fracture: A Randomized, Controlled Trial
Authors: Vidán Maite , Serra José A. , Moreno Concepción , Riquelme Gerardo , Ortiz Javier
Published: September 2005

Objectives: To evaluate whether an early multidisciplinary geriatric intervention in elderly patients with hip fracture reduced length of stay, morbidity, and mortality and improved functional evolution.

Design: Randomized, controlled intervention trial.

Setting: Orthopedic ward in a university hospital.

Participants: Three hundred nineteen patients aged 65 and older hospitalized for hip fracture surgery.

Intervention: Participants were randomly assigned to a daily multidisciplinary geriatric intervention (n=155) or usual care (n=164) during hospitalization in the acute phase of hip fracture.

Measurements: Primary endpoints were in‐hospital length of stay and incidence of death or major medical complications. Secondary endpoints were the rate of recovery of previous activities of daily living and ambulation ability at 3, 6, and 12 months.

Results: Median length of stay was 16 days in the geriatric intervention group and 18 days in the usual care group (P=.06). Patients assigned to the geriatric intervention showed a lower in‐hospital mortality (0.6% vs 5.8%, P=.03) and major medical complications rate (45.2% vs 61.7%, P=.003). After adjustment for confounding variables, geriatric intervention was associated with a 45% lower probability of death or major complications (95% confidence interval=7–68%). More patients in the geriatric intervention group achieved a partial recovery at 3 months (57% vs 44%, P=.03), but there were no differences between the groups at 6 and 12 months.

Conclusion: Early multidisciplinary daily geriatric care reduces in‐hospital mortality and medical complications in elderly patients with hip fracture, but there is not a significant effect on length of hospital stay or long‐term functional recovery.
The Effects of Lingual Exercise on Swallowing in Older Adults
Authors: Robbins JoAnne , Gangnon Ronald E. , Theis Shannon M. , Kays Stephanie A. , Hewitt Angela L. , Hind Jacqueline A.
Published: September 2005

Objectives: To determine the effects of an 8‐week progressive lingual resistance exercise program on swallowing in older individuals, the most “at risk” group for dysphagia.

Design: Prospective cohort intervention study.

Setting: Subjects were recruited from the community at large.

Participants: Ten healthy men and women aged 70 to 89.

Intervention: Each subject performed an 8‐week lingual resistance exercise program consisting of compressing an air‐filled bulb between the tongue and hard palate.

Measurements: At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume.

Results: All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%.

Conclusion: The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age‐related conditions. The potential effect of lingual exercise on reducing dysphagia‐related comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging.
Systemic Inflammatory Markers, Periodontal Diseases, and Periodontal Infections in an Elderly Population
Authors: Bretz Walter A. , Weyant Robert J. , Corby Patricia M. , Ren Dianxu , Weissfeld Lisa , Kritchevsky Stephen B. , Harris Tamara , Kurella Manjula , Satterfield Suzanne , Visser Marjolein , Newman Anne B.
Published: September 2005

Objectives: To study the levels of systemic markers for inflammation with parameters of periodontal diseases in older people.

Design: A cross‐sectional study was conducted in a cohort that is being followed prospectively on the effects of aging and body composition on morbidity.

Setting: University of Pittsburgh, Pittsburgh, and University of Tennessee, Memphis.

Participants: One thousand one hundred thirty‐one participants (mean age±standard deviation 72.7±2.8); 66% white and 50% male.

Measurements: Periodontal examination, including probing depth and attachment loss, was performed. Periodontal disease extent was divided into 0% of sites with probing depth of 6 mm or more, 1% to 10% of sites with probing depth of 6 mm or more and more than 10% of sites with probing depth of 6 mm or more. Subgingival plaque samples were collected from four molar teeth, and the levels of periodontal pathogens were determined using the benzoyl‐DL‐arginine‐naphthylamide (BANA) test. Plasma interleukin‐6 (IL‐6), C‐reactive protein (CRP), plasminogen activator inhibitor type‐1 (PAI‐1), and tumor necrosis factor alpha (TNF‐α) levels were measured in all participants. Assessments of risk factors associated with elevated levels of markers of systemic inflammation were also determined. Multiple regression analysis was employed to analyze the data.

Results: IL‐6 levels were significantly higher in participants with more‐extensive periodontal disease than in other participants. Periodontal disease extent was significantly associated with higher TNF‐α plasma levels, controlling for established risk factors for elevated TNF‐α levels. Participants with BANA‐positive species had significantly higher CRP plasma levels when controlling for risk factors for elevated CRP levels.

Conclusion: Periodontal disease and infection may be modifiable risk indicators for elevated levels of systemic inflammatory markers in older people.
Interventions from Home‐Based Geriatric Assessments of Adult Protective Service Clients Suffering Elder Mistreatment
Authors: Heath John M. , Kobylarz Fred A. , Brown Merle , Castaño Susan
Published: September 2005

Objectives: To describe the interventions for adult protective service (APS) clients referred for geriatric assessment.

Design: Retrospective cohort study.

Setting: In‐home geriatric assessments conducted in two New Jersey counties.

Participants: Two hundred eleven APS clients; 74% female; mean age 77.

Measurements: Cognition, affect, nutrition, prevalence of selected medical diagnoses and functional conditions, and categories of interventions.

Results: Home health agency services were initiated for 46% of APS clients suffering from all forms of mistreatment. Institutional placements (36%) and guardianship interventions (36%) were correlated with caregiver neglect, especially in female APS clients and those diagnosed with dementia. Urgent medications (25%) were prescribed across all mistreatment classifications, and acute hospitalization (20%) was correlated with circumstances of physical abuse.

Conclusion: An in‐home geriatric assessment service was able to contribute at least one relevant intervention for 81% of referred APS clients to collaboratively help mitigate elder mistreatment circumstances.
The Executive Interview as a Screening Test for Executive Dysfunction in Patients with Mild Dementia
Authors: Stokholm Jette , Vogel Asmus , Gade Anders , Waldemar Gunhild
Published: September 2005

Objectives: To validate the Executive Interview (EXIT25) as a screening instrument for executive cognitive dysfunction in patients with mild dementia.

Design: Validation using group comparison and correlation studies.

Setting: The Copenhagen University Hospital Memory Clinic, a multidisciplinary outpatient clinic based in a neurological setting.

Participants: Thirty‐three patients with mild dementia (MMSE score ≥20) and 30 healthy controls.

Measurements: The EXIT25, a 25‐item screening instrument for executive dysfunction, was administered to all participants. Global cognitive function was measured using the MMSE. Patients were evaluated using traditional neuropsychological tests for executive dysfunction (Wisconsin Card Sorting Test, Trail Making Part B, Stroop Test, verbal fluency, design fluency, and verbal abstraction). Changes in behavior and functional impairment in activities of daily living were assessed using the Frontal Behavioral Inventory (FBI) and the Disability Assessment for Dementia Scale.

Results: EXIT25 scores were significantly higher in patients than in the healthy controls; MMSE scores could not account for the differences. Thirteen of the 25 items separated the two groups. EXIT25 was found to correlate significantly with the Stroop Test, the verbal fluency tests, and the FBI.

Conclusion: The EXIT25 is able to capture executive cognitive deficits not primarily related to the general level of intellectual reduction in patients with mild dementia. In clinical practice, the EXIT25 might be a valuable supplement to the MMSE.
Nursing Home Resident and Facility Characteristics Associated with Pneumococcal Vaccination: National Nursing Home Survey, 1995–1999
Authors: Bardenheier Barbara , Shefer Abigail , Tiggle Ronald , Marsteller Jill , Remsburg Robin E.
Published: September 2005

Objectives: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination.

Design: Cross‐sectional national sample surveys of nursing homes and nursing home residents with a two‐stage probability design, stratified on size and Medicare and Medicaid certification status.

Setting: U.S. nursing homes during 1995, 1997, and 1999.

Participants: Six current residents were randomly selected from each facility (n=approximately 8,000 each year).

Measurements: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: “Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?” Vaccination status was coded as yes, no, and unknown.

Results: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999.

Conclusion: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.
Interleukin‐6 Modulates Plasma Cholesterol and C‐Reactive Protein Concentrations in Nonagenarians
Authors: Lehtimäki Terho , Ojala Petri , Rontu Riikka , Goebeler Sirkka , Karhunen Pekka J. , Jylhä Marja , Mattila Kari , Metso Saara , Jokela Hannu , Nikkilä Matti , Wuolijoki Erkki , Hervonen Antti , Hurme Mikko
Published: September 2005

Objectives: To establish whether the relationship between interleukin‐6 (IL‐6) and plasma lipid and C‐reactive protein (CRP) concentrations is different in Finnish nonagenarians than in middle‐aged subjects with lower inflammatory status.

Design: Cross‐sectional.

Setting: Observational cohort study concentrating on the oldest old.

Participants: Nonagenarians (n=291, mean age±standard deviation 90±1; 68 men, 223 women) who lived in the Tampere municipality in southern Finland and a middle‐aged control population from the same area (n=227, aged 44±8).

Measurements: Plasma high sensitive CRP and lipid concentrations were analyzed using an automatic analyzer and IL‐6 levels using enzyme‐linked immunosorbent assay.

Results: Plasma concentrations of IL‐6 (4.39±5.25 vs 1.88±1.98 pg/mL) and CRP (3.54±4.98 vs 1.53±1.91 mg/L) were significantly higher in nonagenarians than in middle‐aged subjects (P<.001). In nonagenarians, plasma CRP levels increased (P<.001) and plasma total cholesterol (P=.006), low‐density lipoprotein cholesterol (P=.02), and high‐density lipoprotein cholesterol (P=.002) levels decreased according to IL‐6 quartiles. In middle‐aged subjects, similar associations were not found.

Conclusion: The relationship between IL‐6 and plasma CRP and cholesterol levels in nonagenarians with enhanced systemic inflammation differs from that of middle‐aged subjects.
Health, Healthcare Utilization, and Satisfaction with Service: Barriers and Facilitators for Older Korean Americans
Authors: Jang Yuri , Kim Giyeon , Chiriboga David A.
Published: September 2005

The present study assessed predictive models of subjective perception of health, healthcare utilization (hospital visits), and satisfaction with healthcare service using a sample of 230 older Korean Americans. Predisposing characteristics (age, sex, and education), health needs (chronic conditions, functional disability, and number of sick days), and a variety of enabling factors (health insurance, English speaking ability, transportation, living arrangement, trust in Western medicine, and reported experience of disrespect in medical settings) were considered. After controlling for predisposing and need factors, health insurance coverage was found to be a significant enabling factor for hospital visits. Subjective perception of health was found to be significant not only for healthcare utilization, but also for satisfaction with service. A greater likelihood of satisfaction was also observed in individuals with health insurance, better English‐speaking ability, and greater trust in Western medical care. The reported experience of disrespect or discrimination in medical settings significantly reduced the odds of satisfaction with service.
Unnecessary Drug Use in Frail Older People at Hospital Discharge
Authors: Hajjar Emily R. , Hanlon Joseph T. , Sloane Richard J. , Lindblad Catherine I. , Pieper Carl F. , Ruby Christine M. , Branch Laurence C. , Schmader Kenneth E.
Published: September 2005

Objectives: To determine the prevalence and predictors of unnecessary drug use at hospital discharge in frail elderly patients.

Design: Cross‐sectional.

Setting: Eleven Veterans Affairs Medical Centers.

Participants: Three hundred eighty‐four frail older patients from the Geriatric Evaluation and Management Drug Study.

Measurements: Assessment of unnecessary drug use was determined by the consensus of a clinical pharmacist and physician pair applying the Medication Appropriateness Index to each regularly scheduled medication at hospital discharge. Those drugs that received an inappropriate rating for indication, efficacy, or therapeutic duplication were defined as unnecessary.

Results: Forty‐four percent of patients had at least one unnecessary drug, with the most common reason being lack of indication. The most commonly prescribed unnecessary drug classes were gastrointestinal, central nervous system, and therapeutic nutrients/minerals. Factors associated (P<.05) with unnecessary drug use included hypertension (adjusted odds ratio (AOR)=0.61, 95% confidence interval (CI)=0.38–0.96), multiple prescribers (AOR=3.35, 95% CI=1.16–9.68), and nine or more medications (AOR=2.24, 95% CI=1.25–3.99).

Conclusion: A high prevalence of unnecessary drug use at discharge was found in frail hospitalized elderly patients. Additional studies are needed to identify predictors and prevalence of unnecessary drug use in nonveteran populations so that interventions can be designed to reduce the problem.
The Johns Hopkins Geriatric Summer Scholars Program: A Model to Increase Diversity in Geriatric Medicine
Authors: Simpson Crystal F. , Durso Samuel C. , Fried Linda P. , Bailey Thomasina , Boyd Cynthia M. , Burton John
Published: September 2005

The Division of Geriatric Medicine and Gerontology at the Johns Hopkins University strives to create a workforce that represents the racial, ethnic, and sex diversity of U.S. society. To that end, the division has developed a summer program for underrepresented minority first‐year medical students to expose them to geriatric medicine and research. The ultimate aim of this initiative is to recruit students to academic medicine, specifically geriatric medicine, where they are drastically underrepresented. Nineteen students participated in the program from the summer of 2002 to the summer of 2004. The participants have continued on to win seven other research fellowships, participate in the National Institute on Aging Technical Assistance Workshop, and present at four national conferences, including the American Geriatrics Society conference and the Gerontological Society of America meeting. One of the students, who is completing medical school in May 2005, is returning to begin the internal medicine residency program at Johns Hopkins Bayview, where the majority of the geriatric faculty practice medicine. Another student who is also graduating is obtaining her Masters in Public Health with a concentration in epidemiology from the Johns Hopkins Bloomberg School of Public Health before starting residency. This article describes the outcomes of the first 3 years of the program, with an emphasis on curriculum development and the recruitment and retention of underrepresented minority medical students.
A case‐control study on risk factors for nuclear, cortical and posterior subcapsular cataract: The Casteldaccia Eye Study
Authors: Giuffrè Giuseppe , Dardanoni Gabriella , Lodato Gaetano
Published: September 2005

Purpose:  To investigate risk factors for nuclear, cortical and posterior subcapsular age‐related cataract.

Methods:  A case‐control study was carried out on subjects aged 40 years and older, living in Casteldaccia, Sicily. Twenty‐seven potential risk factors were investigated. Nuclear, cortical and posterior subcapsular opacities of the lens were classified according to the Lens Opacities Classification System II. Subjects with advanced lens opacities represented the cases, while an identical number of subjects without or with early cataract, matched for sex and age, were recruited as controls from within the same population.

Results:  Univariate analysis showed that myopia and iris atrophy were significantly associated with nuclear cataract. Iris atrophy, use of corticosteroids, pseudoexfoliation syndrome and familial occurrence of cataract were positively correlated with cortical cataract. Myopia, iris atrophy, use of corticosteroids and familial occurrence of cataract presented an association with posterior subcapsular cataract. After multivariate analysis, the variables that remained significantly associated were myopia and iris atrophy for nuclear cataract; iris atrophy, pseudoexfoliation syndrome and familial occurrence of cataract for cortical cataract; and myopia, iris atrophy and familial occurrence of cataract for posterior subcapsular cataract.

Conclusion:  In addition to well known risk factors such as myopia or use of corticosteroids, the Casteldaccia case‐control study shows that iris atrophy represents a previously unrecognized risk factor for each of the three types of cataract.
Retinal function following transpupillary thermotherapy for occult choroidal neovascularization in age‐related macular degeneration: a short‐term study by focal electroretinography
Authors: Pirozzi Enza , Manganelli Chiara , Piccardi Marco , Minnella Angelo , Fadda Antonello , Ziccardi Lucia , Coccimiglio Francesca , Falsini Benedetto
Published: September 2005

Purpose:  To assess short‐term changes in macular function after transpupillary thermotherapy (TTT) in patients with occult subfoveal choroidal neovascularization (CNV) secondary to age‐related macular degeneration (AMD), using focal electroretinography (FERG).

Methods:  Twenty‐five patients with occult subfoveal CNV due to AMD were treated with TTT delivered using an infrared (810 nm) diode laser (spot size 3.0 mm, laser power 400–600 mW, duration 60 seconds). All patients were clinically evaluated before, 1 and 6 weeks after treatment. Snellen visual acuity (VA) was measured at each visit. Fluorescein angiography (FA) was performed at baseline and 6 weeks after TTT. Focal ERGs were recorded in all patients immediately before and 1 week after TTT in response to an 18‐degree diameter, 41 Hz flickering spot (630 nm) centred on the fovea, presented on a steady background in Maxwellian view. A subgroup of 12 patients was also re‐tested by FERG at 6‐weeks post‐TTT.

Results:  No significant changes in mean FERG amplitude and phase were observed across the different recording sessions before and after TTT. One week after TTT, four patients had significant (>2 SD from baseline variability) increases in FERG amplitude and/or phase advances, one had a decrease in amplitude and four had phase delays, compared to baseline. The remaining 15 patients had stable FERGs. Six weeks after TTT, four patients had significant increases in FERG amplitude and/or phase advances, four had decreases in amplitude and/or phase delays, and four had stable FERGs, compared to baseline. Improvement in FERG parameters after TTT was always associated with an improvement in VA and a decrease in exudation. Patients with post‐TTT FERG deterioration had stable or deteriorated clinical pictures. At either 1 or 6 weeks post‐TTT, the FERG amplitude increase was inversely correlated (p < 0.05) with the baseline FERG amplitude and VA.

Conclusions:  Three major conclusions can be drawn: in a short‐term follow‐up, TTT was not found to be associated with significant changes in macular function; FERG improvement was associated with VA improvement, and the increase in FERG amplitude was greatest in patients with the worst baseline acuity.