bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographical knowledge and policy: the positive contribution of discourse studies
Authors: Rydin Yvonne
Published: March 2005

The ‘discursive turn’ has been blamed for a lack of engagement between geographers and policymakers. This paper argues that such a view is fundamentally flawed. It ignores the positive contribution that discourse analysis has made to policy studies and the particular role that geographers have played in developing such analyses. It is based on a misconceived view of the policy process and how knowledge can contribute to policy outcomes. A closer attention to policy discourses reveals exactly how knowledge is constructed within the policy process and can help identify how policy may be improved through discursive means.
Narrative analysis as a strategy for understanding interview talk in geographic research
Authors: Wiles Janine L , Rosenberg Mark W , Kearns Robin A
Published: March 2005

Narrative analysis produces strategies to inform the conduct, interpretation and presentation of interview talk, and encourages and enables researchers to take account of research participants’ own evaluations. We suggest this to be a useful method for geographers because it focuses on how people talk about and evaluate places, experiences and situations, as well as what they say. With an example from health geography, we show how it allows for interactive texts, thus providing a tool for geographers doing qualitative research to connect intimate details of experience to broader social and spatial relations.
Place‐based social exclusion: redlining in the Netherlands
Authors: Aalbers Manuel B
Published: March 2005

‘Redlining’ is a form of place‐based exclusion. It is widely documented in the US, but not in Europe. This paper focuses on a comparative analysis of redlining practices in the two largest cities of the Netherlands: Amsterdam and Rotterdam. It shows that redlining was common practice in Rotterdam in 1999. In 2001, no signs of redlining were found in Rotterdam. However, ‘yellowlining’ (lower loan‐to‐value ratios) was still common in some parts of Rotterdam. In Amsterdam, no neighbourhoods were faced with redlining in either 1999 or 2001. However, in 1999 some neighbourhoods were yellowlined. This paper aims to get a better understanding of the nature and the institutional context of redlining in the Netherlands by explaining how the differences in redlining practices between Amsterdam and Rotterdam, and between 1999 and 2001, can be explained. The National Mortgage Guarantee as well as socio‐historical, and housing and mortgage market differences and changes, are instrumental in explaining these differences in redlining practices.
The Course of Functional Decline in Older People with Persistently Elevated Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study
Authors: Lenze Eric J. , Schulz Richard , Martire Lynn M. , Zdaniuk Bozena , Glass Thomas , Kop Willem J. , Jackson Sharon A. , Reynolds Charles F.
Published: March 2005

Objectives: To examine the relationship between persistently high depressive symptoms and long‐term changes in functional disability in elderly persons.

Design: A community‐based, prospective, observational study.

Setting: Participant data from the Cardiovascular Health Study.

Participants: From the overall sample of 5,888 subjects, three types of participants were identified for this study: (1) persistently depressed individuals, who experienced an onset of depressive symptoms that persisted over 4 years (n=119); (2) temporarily depressed individuals, who experienced an onset of depressive symptoms that resolved over time (n=259); and (3) nondepressed individuals, with persistently low depressive symptoms throughout the follow‐up period who were matched on baseline activity of daily living (ADL) scores, sex, and age to the previous two groups combined (n=378).

Measurements: Four consecutive years of data were assessed: validated measures of depression (10‐item CES‐D), functional disability (10‐item ADL/instrumental ADL measure), physical performance, medical illness, and cognition.

Results: The persistently depressed group showed a greater linear increase in functional disability ratings than the temporarily depressed and nondepressed groups. This association between persistent depression and functional disability was robust even when controlling for baseline demographic and clinical/performance measures, including cognition. The persistently depressed group had an adjusted odds ratio (OR) of 5.27 (95% confidence interval (CI) 3.03–9.16) for increased functional disability compared with the nondepressed group over 3 years of follow‐up, whereas the temporarily depressed group had an adjusted OR of 2.39 (95% CI=1.55–3.69) compared with the nondepressed group.

Conclusion: Persistently elevated depressive symptoms in elderly persons are associated with a steep trajectory of worsening functional disability, generating the hypothesis that treatments for late‐life depression need to be assessed on their efficacy in maintaining long‐term functional status as well as remission of depressive symptoms. These results also demonstrate the need for studies to differentiate between persistent and temporary depressive symptoms when examining their relationship to disability.
The Effect of a Task‐Oriented Walking Intervention on Improving Balance Self‐Efficacy Poststroke: A Randomized, Controlled Trial
Authors: Salbach Nancy M. , Mayo Nancy E. , Robichaud‐Ekstrand Sylvie , Hanley James A. , Richards Carol L. , Wood‐Dauphinee Sharon
Published: March 2005

Objectives: To evaluate the efficacy of a task‐oriented walking intervention in improving balance self‐efficacy in persons with stroke and to determine whether effects were task‐specific, influenced by baseline level of self‐efficacy and associated with changes in walking and balance capacity.

Design: Secondary analysis of a two‐center, observer‐blinded, randomized, controlled trial.

Setting: General community.

Participants: Ninety‐one individuals with a residual walking deficit within 1 year of a first or recurrent stroke.

Intervention: Task‐oriented interventions targeting walking or upper extremity (UE) function were provided three times a week for 6 weeks.

Measurements: Activities‐specific Balance Confidence Scale, Six‐Minute Walk Test, 5‐m walk, Berg Balance Scale, and Timed “Up and Go” administered at baseline and postintervention.

Results: The walking intervention was associated with a significantly greater average proportional change in balance self‐efficacy than the UE intervention. Treatment effects were largest in persons with low self‐efficacy at baseline and for activities relating to tasks practiced. In the walking group, change in balance self‐efficacy correlated with change in functional walking capacity (correlation coefficient=0.45, 95% confidence interval=0.16–0.68). Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age, sex, comorbidity, time poststroke, and functional mobility on change in self‐efficacy.

Conclusion: Task‐oriented walking retraining enhances balance self‐efficacy in community‐dwelling individuals with chronic stroke. Benefits may be partially the result of improvement in walking capacity. The influence of baseline level of self‐efficacy, depressive symptoms, and prognostic variables on treatment effects are of clinical importance and must be verified in future studies.
Outcomes of Infection in Nursing Home Residents with and without Early Hospital Transfer
Authors: Boockvar Kenneth S. , Gruber‐Baldini Ann L. , Burton Lynda , Zimmerman Sheryl , May Conrad , Magaziner Jay
Published: March 2005

Objectives: To compare outcomes of infection in nursing home residents with and without early hospital transfer.

Design: Observational cohort study.

Setting: Fifty‐nine nursing homes in Maryland.

Participants: Two thousand one hundred fifty‐three individuals admitted to nursing homes between 1992 and 1995.

Measurements: Incident infection was recorded when a new infectious diagnosis was documented in the medical record or nonprophylactic antibiotic therapy was prescribed. Early hospital transfer was defined as transfer to the emergency department or admission to the hospital within 3 days of infection onset. Infection, resident, and facility characteristics were entered into a multivariate model to create a propensity score for early hospital transfer. Association between early hospital transfer and outcomes of infection, namely pressure ulcers and death between Days 4 and 34 after infection onset, were examined, controlling for propensity score.

Results: Four thousand nine hundred ninety infections occurred in 1,301 residents. Genitourinary (28%), skin (19%), upper respiratory (13%), and lower respiratory (12%) were the most common types. Three hundred seventy‐five episodes in which residents survived 3 days (7.6%) resulted in early hospital transfer. In multivariate regression, individuals with early hospital transfer had higher mortality (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.04–1.99) and, in 1‐month survivors, a greater occurrence of pressure ulcers (OR 1.61, 95% CI=1.17–2.20) than those without, after adjusting for propensity score.

Conclusion: Using observational data and propensity score methods, outcomes were worse in nursing home residents transferred to the hospital within 3 days of infection onset than in those who remained in the nursing home.
The Association Between Specific Nurse Case Management Interventions and Elder Health
Authors: Schein Constance , Gagnon Anita J. , Chan Lisa , Morin Isabelle , Grondines Justin
Published: March 2005

Objectives: To describe the association between specific nursing interventions performed in the context of nurse case management and older people's quality of life and functional ability.

Design: Longitudinal.

Setting: Nurse case management through a university hospital and two community health centers.

Participants: One hundred seventy‐five community‐dwelling frail older persons (≥70 and at risk for repeated hospitalizations).

Measurements: Specific groups of nursing interventions provided in the context of nurse case management over a 10‐month period—coping assistance, lifespan care, risk management, and physical comfort promotion—were focused on. These interventions were recorded using a standardized nursing language. Outcomes were measured using telephone and home interview and medical record review using the 36‐item Short Form and the Older American Resources and Services Multidimensional Functional Assessment Questionnaire.

Results: Older people receiving coping assistance interventions demonstrated an increase in instrumental activity of daily living functioning although they had lower general health, role‐emotional, and mental health scores.

Conclusion: Coping assistance is one nursing intervention of several provided in the context of nurse case management that is independently associated with improving the functional status of frail older persons even in the presence of declining health normally associated with aging over several months. Examining the relationships between specific nursing activities and health outcomes of frail older persons may be useful in furthering understanding of the results of randomized trials of nurse case management in this population.
Purchasing or Providing Nursing Home Care: Can Quality of Care Data Provide Guidance
Authors: Berlowitz Dan R. , Rosen Amy K. , Wang Fei , Tsilimingras Dionyssios , Tariot Pierre N. , Engelhardt Joe , Kader Boris , Mukamel Dana B.
Published: March 2005

Objectives: To examine whether quality of care differed for veterans in Department of Veterans Affairs (VA) nursing homes and those on contract in community nursing homes and whether the VA was contracting with nursing homes providing better quality of care than other nursing homes.

Design: Observational study using administrative databases from 1997 to 1999.

Setting: Ten VA and 650 community nursing homes in New York state.

Participants: Four thousand seven hundred sixty‐three veteran and 195,438 nonveteran residents of these nursing homes.

Measurements: Risk‐adjusted rates of pressure ulcer development, functional decline, behavioral decline, and mortality.

Results: Veterans in VA nursing homes were significantly (P<.05) less likely to develop a pressure ulcer (odds ratio (OR)=0.63) but more likely to experience functional decline (OR=1.6) than veterans in community nursing homes. Residents of community nursing homes with VA contracts were significantly (P<.05) less likely to develop a pressure ulcer (OR=0.91) but more likely to die than residents in noncontract homes. Few nursing homes were consistently among the best or worst performers on all measures; only seven of 650 nursing homes were in the top or bottom decile and 34 in the top or bottom quartile for each measure.

Conclusion: Large purchasers and providers of nursing home care such as the VA are unlikely to find information on quality of care useful in making decisions on whether they should “make” or “buy” care. Nursing homes performing well on one quality measure may perform poorly on another, and it is difficult to identify nursing homes that are consistently among the best or worst. Other consumers may encounter similar difficulties when using data on nursing home quality.
Coronary Artery Calcium: Associations with Brain Magnetic Resonance Imaging Abnormalities and Cognitive Status
Authors: Rosano Caterina , Naydeck Barbara , Kuller Lewis H. , Longstreth William T. , Newman Anne B.
Published: March 2005

Objectives: To evaluate the association between coronary atherosclerosis and subclinical brain magnetic resonance imaging (MRI) abnormalities and between coronary atherosclerosis and abnormal cognitive function (dementia/mild cognitive impairment).

Design: Cross‐sectional.

Setting: The Cardiovascular Health Study (CHS), an epidemiological study of risk factors for cardiovascular disease in older adults.

Participants: Four hundred nine men and women, mean age 79, recruited from the Pittsburgh center of the CHS.

Measurements: Coronary atherosclerosis was defined according to the level of coronary artery calcification (CAC), as measured using electronic beam tomography. Subclinical brain MRI abnormalities included ventricular enlargement, white matter hyperintensities, and number of subcortical brain infarcts. Brain MRI and CAC measurements were performed between 1998 and 2000 at the Pittsburgh center of the CHS. Prevalence of brain MRI abnormalities and abnormal cognitive status were examined across quartiles of the CAC score, before and after controlling for age. Multivariate logistic regression models were used to assess whether CAC level was associated with abnormalities of brain MRI or abnormal cognitive status.

Results: Older adults with high CAC scores were more likely to have more‐severe brain MRI abnormalities, including subcortical infarction and high white matter hyperintensities. The associations between CAC and ventricular enlargement showed a similar but not significant trend. The presence of any of the MRI abnormalities attenuated the association between CAC and abnormal cognitive status.

Conclusion: Older adults with higher levels of CAC were more likely to have more‐severe brain MRI abnormalities and abnormal cognitive status.
Subjective Cognitive Complaints and Cognitive Decline: Consequence or Predictor? The Epidemiology of Vascular Aging Study
Authors: Dufouil Carole , Fuhrer Rebecca , Alpérovitch Annick
Published: March 2005

Objectives: To explore whether more cognitive complaints are associated with previous or future cognitive decline.

Design: Longitudinal; epidemiology vascular aging study.

Setting: Community in Nantes, France.

Participants: Seven hundred thirty‐three subjects, aged 59 to 71.

Measurements: Subjective cognitive complaints were recorded at 4‐year follow‐up examination in a prospective study of people aged 59 to 71 at study entry. Participants' cognitive performances were assessed repeatedly at each wave (baseline, 4 years, and 6 years) of the study using a series of neuropsychological tests including the Mini‐Mental State Examination. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale. Subjects also had a cerebral magnetic resonance imaging scan at 4‐year follow‐up to evaluate presence and severity of white matter hyperintensities (WMHs).

Results: Subjects with more cognitive complaints had greater cognitive decline. This significant relationship persisted after adjusting for potential confounders, including depressive symptoms. Multivariate analysis also showed that, in subjects without measured cognitive decline between study entry and 4‐year follow‐up, those with more cognitive complaints at 4‐year follow‐up had significantly greater measured cognitive decline during the subsequent 2 years. In the presence of severe WMH, more cognitive complaints were an even stronger predictor of future cognitive decline.

Conclusion: Cognitive complaints reflect measured cognitive decline, but they also predict cognitive decline at an earlier stage than objective tests that are not able to detect cognitive deficits. They need to be taken into account in clinical practice.
Sex Steroid Level, Androgen Receptor Polymorphism, and Depressive Symptoms in Healthy Elderly Men
Authors: T'Sjoen Guy G. , De Vos Sara , Goemaere Stefan , Van Pottelbergh Inge , Dierick Michel , Van Heeringen Cees , Kaufman Jean‐Marc
Published: March 2005

Objectives: To determine the prevalence of depression in a cohort of elderly men as assessed using a 30‐item Geriatric Depression Scale (GDS) score and to describe the association between this score and sex steroids, androgen receptor (AR) polymorphism, and general health status.

Design: Observational study on the relationship between sex steroid status and health‐related parameters.

Setting: Community‐based.

Participants: Ambulatory men (n=236 in 1997, n=192 in 2000) aged 70 and older at inclusion in 1996, interviewed in 1997 and 2000.

Measurements: Serum levels of testosterone, estradiol, sex hormone binding globulin (SHBG), dehydroepiandrosterone‐sulfate (DHEAS), cortisol, and the AR gene cytosine, adenine, guanine (CAG)‐repeat length polymorphism were determined. Free testosterone and free estradiol were calculated. Questionnaires included GDS, 36‐item Short Form, and Rapid Disability Rating Scale—2.

Results: Median age was 75.3 years (interquartile range=73.5–78.5). A GDS score of 11 or greater was found in 30 (12.7%) men. Age and GDS score were significantly interrelated (P<.01), as were all health‐assessment scores. GDS scores were not related to (free) testosterone or AR polymorphism in 1997 or 2000. In 1997 only (n=236), higher GDS scores were related to higher estradiol, free estradiol, and DHEAS levels.

Conclusion: The data did not support a role for testosterone in depression in elderly community‐based men as assessed using the GDS.
Comparison of Brain Natriuretic Peptide and Probrain Natriuretic Peptide in the Diagnosis of Cardiogenic Pulmonary Edema in Patients Aged 65 and Older
Authors: Ray Patrick , Arthaud Martine , Birolleau Sophie , Isnard Richard , Lefort Yannick , Boddaert Jacques , Riou Bruno ,   the EPIDASA Study Group
Published: March 2005

Objectives: Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is difficult in elderly patients. The aim of this study was to compare the usefulness of B‐type natriuretic peptide (BNP) and amino‐terminal fragment BNP (proBNP), to diagnose CPE in patients aged 65 and older.

Design: Prospective study.

Setting: Medical emergency department of a 2,000‐bed urban teaching hospital.

Participants: Patients aged 65 and older presenting with acute dyspnea and a respiratory rate of 25 breaths/min or greater, a partial pressure of oxygen of 70 mmHg or less, or an oxygen saturation of 92% or less were included.

Measurements: Rapid BNP and proBNP assays, performed blind at admission, were compared with the final diagnosis (CPE or no CPE) as defined by an expert team.

Results: Two hundred two patients (mean age±standard deviation 80±9) were included; 88 (44%) had CPE. There was a strong correlation between proBNP and BNP values (correlation coefficient=0.91, P<.001). The median BNP and proBNP were higher in the group of patients with CPE (377 vs 74 pg/mL, P<.001, and 3,851 vs 495 pg/mL, P<.001, respectively). The best threshold values of BNP and proBNP were 250 pg/mL and 1,500 pg/mL, respectively. The area under the receiver operating characteristic curve was greater with BNP than with proBNP (0.85 vs 0.80, P<.05). BNP assay was more accurate in diagnosis than the emergency physician, whereas proBNP was not. Higher values of BNP and proBNP were associated with greater in‐hospital mortality.

Conclusion: BNP assay is a more useful diagnostic indicator for CPE than proBNP in patients aged 65 and older.
Subclinical Brain Magnetic Resonance Imaging Abnormalities Predict Physical Functional Decline in High‐Functioning Older Adults
Authors: Rosano Caterina , Kuller Lewis H. , Chung Hyoju , Arnold Alice M. , Longstreth William T. , Newman Anne B.
Published: March 2005

Objectives: To determine whether severity of subclinical brain magnetic resonance imaging (MRI) abnormalities predicts incident self‐reported physical impairment or rate of decline in motor performance.

Design: Longitudinal analysis, average follow‐up time: 4.0 years.

Setting: Cardiovascular Health Study (CHS).

Participants: CHS participants with modified Mini‐Mental State Examination (3MS) score of 80 or greater, no self‐reported disability, no history of stroke, and at least one assessment of mobility (n=2,450, mean age=74.4).

Measurements: Brain MRI abnormalities (ventricular enlargement, white matter hyperintensities, subcortical and basal ganglia small brain infarcts), self‐reported physical impairment (difficulty walking half a mile or with one or more activities of daily living), and motor performance (gait speed, timed chair stand).

Results: After adjusting for demographics, cardiovascular risk factors, and diseases, risk of incident self‐reported physical impairment was 35% greater for those with severe ventricular enlargement than for those with minimal ventricular enlargement, 22% greater for those with moderate white matter hyperintensities than for those with minimal white matter hyperintensities, and 26% greater for participants with at least one brain infarct than for those with no infarcts. Those with moderate to severe brain abnormalities experienced faster gait speed decline (0.02 m/s per year) than those with no MRI abnormalities (0.01 m/s per year). Further adjustment for incident stroke, incident dementia, and 3MS score did not substantially attenuate hazard ratios for incident self‐reported physical impairment or coefficients for decline in gait speed.

Conclusion: Subclinical structural brain abnormalities in high‐functioning older adults can increase the risk of developing physical disabilities and declining in motor performance.
People Aged Over 75 in Atrial Fibrillation on Warfarin: The Rate of Major Hemorrhage and Stroke in More Than 500 Patient‐Years of Follow‐Up
Authors: Johnson Christina E. , Lim Wen K. , Workman Barbara S.
Published: March 2005

Objectives: To determine the incidence of major hemorrhage and stroke in people aged 76 and older with atrial fibrillation on adjusted‐dose warfarin who had been recently been admitted to hospital.

Design: A retrospective observational cohort study.

Setting: A major healthcare network involving four tertiary hospitals.

Participants: Two hundred thirty‐five patients aged 76 and older admitted to a major healthcare network between July 1, 2001, and June 30, 2002, with atrial fibrillation on warfarin were enrolled.

Measurements: Information regarding major bleeding episodes, strokes, and warfarin use was obtained from patients, relatives, primary physicians, and medical records.

Results: Two hundred twenty‐eight patients (42% men) with a mean age of 81.1 (range 76–94) were included in the analysis. Total follow‐up on warfarin was 530 years (mean 28 months). There were 53 major hemorrhages, for an annual rate of 10.0%, including 24 (45.3%) life‐threatening and five (9.4%) fatal bleeds. The annual stroke rate after initiation of warfarin was 2.6%.

Conclusion: The rate of major hemorrhage was high in this old, frail group, but excluding fatalities, resulted in no long‐term sequelae, and the stroke rate on warfarin was low, demonstrating how effective warfarin treatment is.
Comorbidity and 1‐Year Mortality Risks in Nursing Home Residents
Authors: Van Dijk Pieter T. M. , Mehr David R. , Ooms Marcel E. , Madsen Richard , Petroski Greg , Frijters Dinnus H. , Margriet Pot Anne , Ribbe Miel W.
Published: March 2005

Objectives: To investigate the effect of chronic diseases and disease combinations on 1‐year mortality in nursing home residents.

Design: Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data.

Setting: Five hundred twenty‐two nursing homes in Missouri.

Participants: Forty‐three thousand five hundred ten nursing home residents with a full MDS assessment in 1999.

Measurements: Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS‐assessment in 1999.

Results: After adjustment for age and sex, eight variables were predictive for 1‐year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS‐ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables.

Conclusion: Several chronic diseases were associated with 1‐year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking.
Near Vision Impairment Predicts Cognitive Decline: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly
Authors: Reyes‐Ortiz Carlos A. , Kuo Yong‐Fang , DiNuzzo Anthony R. , Ray Laura A. , Raji Mukaila A. , Markides Kyriakos S.
Published: March 2005

Objectives: To estimate the association between sensory impairment and cognitive decline in older Mexican Americans.

Design: A prospective cohort study.

Setting: The Hispanic Established Populations for Epidemiologic Studies of the Elderly from five southwestern states.

Participants: The sample consisted of 2,140 noninstitutionalized Mexican Americans aged 65 and older followed from 1993/1994 until 2000/2001.

Measurements: The outcome, cognitive function decline, was assessed using the Mini‐Mental State Examination blind version (MMSE‐blind) at baseline and at 2, 5, and 7 years of follow‐up. Other variables were near vision, distance vision, hearing, demographics (age, sex, marital status, living arrangements, and education), depressive symptoms, hypertension, diabetes mellitus, stroke, heart attack, and functional status. A general linear mixed model was used to estimate cognitive decline at follow‐up.

Results: In a fully adjusted model, MMSE‐blind scores of subjects with near vision impairment decreased 0.62 points (standard error (SE)=0.29, P=.03) over 2 years and decreased (slope of decline) 0.13 points (SE=0.07, P=.045) more per year than scores of subjects with adequate near vision. Other independent predictors of cognitive decline were baseline MMSE‐blind score, age, education, marital status, depressive symptoms, and number of activity of daily living limitations.

Conclusion: Near vision impairment, but not distance vision or hearing impairments, was associated with cognitive decline in older Mexican Americans.
Identifying the Activities Affected by Chronic Nonmalignant Pain in Older Veterans Receiving Primary Care
Authors: Duong Bao D. , Kerns Robert D. , Towle Virginia , Reid M. Carrington
Published: March 2005

Objectives: To identify the specific types of activities affected by chronic pain in older persons and the extent to which older individuals modify, perform less frequently, or terminate activities because of pain.

Design: Cross‐sectional survey.

Setting: Primary care practice at a Veterans Affairs Medical Center in New England.

Participants: Two hundred forty‐four patients (aged 65–90) with chronic nonmalignant pain.

Measurements: Open‐ended questions were used to identify the activities affected by pain; participants' responses were subsequently organized into distinct categories (e.g., climbing stairs under higher‐order physical activities and going out to dinner under social/recreational activities). Participants were also asked to indicate whether they had modified, performed less frequently, or terminated these activities because of pain.

Results: Participants had a mean age±standard deviation of 75.4±5.2, were mostly male (84%), and had an average pain intensity score of 6.2±1.9 on a 0‐ to 10‐scale. Two hundred three participants (83%) reported that pain affected one or more higher‐order physical activities, and the corresponding percentages for the categories of social/recreational activities, instrumental activities of daily living, and basic activities of daily living were 74%, 57%, and 3%, respectively. The proportions of participants who modified, performed less frequently, or terminated one or more activities because of pain were 71%, 69%, and 22%, respectively.

Conclusion: Assessing the effects of chronic pain across multiple functional domains is indicated in older primary care patients, particularly higher‐order physical and social/recreational activities. Inquiring about whether the activities are modified, reduced, or terminated may also help to expand understanding of pain‐related disability in older persons.
The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment
Authors: Nasreddine Ziad S. , Phillips Natalie A. , Bédirian Valérie , Charbonneau Simon , Whitehead Victor , Collin Isabelle , Cummings Jeffrey L. , Chertkow Howard
Published: March 2005

Objectives: To develop a 10‐minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first‐line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia.

Design: Validation study.

Setting: A community clinic and an academic center.

Participants: Ninety‐four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini‐Mental State Examination (MMSE) score≥17), and 90 healthy elderly controls (NC).

Measurements: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD.

Results: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively).

Conclusion: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.
Assessing Environmentally Determined Mobility Disability: Self‐Report Versus Observed Community Mobility
Authors: Shumway‐Cook Anne , Patla Aftab , Stewart Anita L. , Ferrucci Luigi , Ciol Marcia A. , Guralnik Jack M.
Published: March 2005

Objectives: To examine the test‐retest reliability and concurrent validity of a new self‐report measure of mobility function by comparing it with observed mobility, self‐reported activity of daily living (ADL) function, and performance‐based measures of gait and balance.

Design: Cross‐sectional study involving two groups of older adults.

Setting: Community sites in Seattle, Washington, and Waterloo, Ontario, Canada.

Participants: Fifty‐four adults aged 70 and older, recruited.

Measurements: Subjects completed the Environmental Analysis of Mobility Questionnaire (EAMQ), reporting frequency of encounter and avoidance of 24 features of the physical environment, grouped into eight dimensions, on two occasions 1 week apart. Subjects were observed and videotaped during six trips into the community; frequency of encounters with environmental features within the eight dimensions was recorded. EAMQ encounter and avoidance scores were compared with observed environmental encounters, with disability in ADLs and instrumental ADLs (IADLs), and lower extremity functional measures including the Short Physical Performance Battery (SPPB) and the Berg Balance Test.

Results: EAMQ test‐retest reliability was high for all eight dimensions (intraclass correlation coefficient range=0.81–1.0) and for summary encounter (0.98) and avoidance (0.96) scores. Observed mobility was significantly correlated (Spearman correlation = r) with EAMQ summary encounter (r=0.66) and avoidance (r=−0.58) scores. Moderate correlations were present between the EAMQ (encounter or avoidance) and observed mobility in the distance, temporal, terrain, posture, load, and density dimensions but not in the attention and ambient dimensions. EAMQ encounter/avoidance was significantly associated with ADL and IADL ability and performance on the SPPB and Berg Balance Test.

Conclusion: Self‐reported frequency of encounter and avoidance of specific environmental features appears to be a valid method for determining environmentally specific mobility disability but needs to be confirmed in a larger sample.
The Influence of Spiritual Beliefs and Practices on the Treatment Preferences of African Americans: A Review of the Literature
Authors: Johnson Kimberly S. , Elbert‐Avila Katja I. , Tulsky James A.
Published: March 2005

Spirituality is an important part of African‐American culture and is often cited as an explanation for the more‐aggressive treatment preferences of some African Americans at the end of life. This paper reviews the literature on spiritual beliefs that may influence the treatment decisions of African Americans.

Medline 1966 to February 2003, Psych Info 1872 to February 2003, and CINAHL 1982 to February 2003 were searched for studies exploring spiritual beliefs that may influence the treatment preferences of African Americans. All candidate papers were examined for quality, and data were extracted on study population, design, analysis, and results to identify recurrent themes. Forty studies met inclusion criteria.

Recurrent themes describing spiritual beliefs that may influence the treatment preferences of African Americans throughout the course of illness include the following: spiritual beliefs and practices are a source of comfort, coping, and support and are the most effective way to influence healing; God is responsible for physical and spiritual health; and the doctor is God's instrument.

Spiritual beliefs specifically addressing treatment preferences at the end of life include: only God has power to decide life and death, there are religious prohibitions against physician‐assisted death or advance directives limiting life‐sustaining treatments, and divine intervention and miracles occur.

For some African Americans, spiritual beliefs are important in understanding and coping with illness and may provide a framework within which treatment decisions are made. Given the growing ethnic diversity of the United States, some understanding of the complexities of culture and spirituality is essential for healthcare providers.
Impact of UVR‐A on whole human lenses, supernatants of buffered human lens homogenates, and purified argpyrimidine and 3‐OH‐kynurenine
Authors: Kessel Line , Kalinin Stanislav , Soroka Vladislav , Larsen Michael , Johansson Lennart B‐Å.
Published: March 2005

Purpose:  Yellow chromophores and fluorescent compounds accumulate in the lens with age. Some of these compounds are photochemically active. The present study aimed to examine the photochemical effect of ultraviolet radiation‐A (UVR‐A) on the human lens.

Methods:  Intact human lenses and supernatants of buffered lens homogenates were exposed to UVR‐A. The effect of UVR‐A was evaluated by time‐resolved and steady‐state fluorescence spectroscopy, visual evaluation of colour and protein gel electrophoresis.

Results:  Intact lenses exposed to UVR‐A showed no changes in time‐resolved or steady‐state fluorescence properties but the yellow coloration was visibly attenuated. The supernatants of buffered lens homogenates exposed to UVR‐A demonstrated a reduction in time‐resolved and steady‐state fluorescent properties and protein cross‐linking.

Conclusions:  Exposure of the intact lens to UVR‐A causes chromophore bleaching without affecting fluorescence, indicating that non‐fluorescent chromophores have been destroyed. After homogenization, both chromophores and fluorophores from the lens suffer damage and proteins aggregate. This indicates that powerful mechanisms of protection against UVR‐A found in the intact lens are disturbed by homogenization of the lens, suggesting that isolated lens proteins cannot be used as a model system for studying cataractogenesis. Hypothetically, the protective mechanism could be related to the rigidly packed three‐dimensional structure of the lens proteins or to the abundance of antioxidative and free radical scavenging defence systems.
Intravitreal triamcinolone acetonide for treatment of cystoid macular oedema in patients with retinitis pigmentosa
Authors: Ozdemir Hakan , Karacorlu Murat , Karacorlu Serra
Published: March 2005

Purpose:  To evaluate the anatomic and visual outcomes of intravitreal triamcinolone acetonide injection in patients with cystoid macular oedema (CMO) secondary to retinitis pigmentosa (RP).

Methods:  Five eyes of five patients with CMO secondary to RP, aged 25–41 years (mean 33.2 years) made up the study population. All eyes had persistent CMO despite medical treatment with 250 mg of oral acetazolamide twice daily for 1 month. Intravitreal injection of 4 mg (0.1 ml) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed, as well as complications related to the injection procedure and corticosteroid medication.

Results:  Follow‐up periods varied between 6 and 8 months (mean 6.8 months); all patients completed 6 months of follow‐up. After intravitreal triamcinolone acetonide injection all patients showed good anatomic response. The baseline median central macular thickness was 418 µm (range 376–626 µm). At 1 month, the median central macular thickness had decreased to 224 µm (range 214–326 µm). At 3 and 6 months, the median central macular thicknesses were 275 µm (range 215–584 µm) and 312 µm (range 239–521 µm), respectively. Recurrent CMO was found in one patient at the 3‐month follow‐up and in two patients at the 6‐month follow‐up. Retreatment was performed in these patients. At the 1‐month follow‐up, no patient was found to have lost vision and two patients showed improvement. At the 3‐ and 6‐month follow‐ups, no patient had lost vision from baseline but no patient had maintained their improved visual acuity (VA).

Conclusions:  In our small series, all patients showed an anatomic improvement in CMO after intravitreal injection of triamcinolone acetonide. However, in three out of five patients, despite good anatomic results, no improvement in VA was achieved. Because of the limitations of this pilot study, it is difficult to explain why no improvement in VA was achieved despite good anatomic results in some patients. Further study with longer follow‐up periods and larger series is warranted to assess the efficacy of the treatment.
Molecular analysis of the NDP gene in two families with Norrie disease
Authors: Rivera‐Vega M Refugio , Chiñas‐Lopez Silvet , Vaca Ana Luisa Jimenez , Arenas‐Sordo M Luz , Kofman‐Alfaro Susana , Messina‐Baas Olga , Cuevas‐Covarrubias Sergio Alberto
Published: March 2005

Purpose:  To describe the molecular defects in the Norrie disease protein (NDP) gene in two families with Norrie disease (ND).

Methods:  We analysed two families with ND at molecular level through polymerase chain reaction, DNA sequence analysis and GeneScan.

Results:  Two molecular defects found in the NDP gene were: a missense mutation (265C > G) within codon 97 that resulted in the interchange of arginine by proline, and a partial deletion in the untranslated 3′ region of exon 3 of the NDP gene. Clinical findings were more severe in the family that presented the partial deletion. We also diagnosed the carrier status of one daughter through GeneScan; this method proved to be a useful tool for establishing female carriers of ND.

Conclusion:  Here we report two novel mutations in the NDP gene in Mexican patients and propose that GeneScan is a viable mean of establishing ND carrier status.
Efficacy of lidocaine 2% gel in pterygium surgery
Authors: Oksuz H. , Tamer C.
Published: March 2005

Purpose:  Anaesthesia during pterygium surgery is usually achieved with local injection of anaesthetic medications. The aim of this study was to determine whether lidocaine 2% gel is an effective topical anaesthetic agent for pterygium surgery.

Methods:  We conducted a prospective, randomized clinical trial. Fifty‐four consecutive patients who had primary pterygium underwent surgical excision of the lesion and conjunctival autograft. Patients were randomized into two groups. Group 1 received 1 ml of lidocaine 2% solution subconjunctivally and group 2 received lidocaine 2% gel topically. The primary outcome of interest was the pain experienced during anaesthetic administration and surgery. Following the dissection and excision of the pterygium, conjunctival autograft was transplanted in each of the patients. Immediately after the operation, pain and discomfort scores were determined using a 10‐point linear visual analogue scale.

Results:  The mean pain score during anaesthetic administration was 4.26 ± 1.18 in the injection group and 0.92 ± 0.56 in the gel group. The mean pain score during surgery was 3.96 ± 0.95 in the injection group and 4.0 ± 1.01 in the gel group. There was a statistically significant difference in mean pain scores experienced during anaesthetic administration (p = 0.01). There was no significant difference in mean pain scores experienced during surgery (p = 0.55). No adverse events were noted.

Conclusion:  In light of these results, we conclude that topical administration of lidocaine 2% gel can be used as an alternative method of anaesthesia in pterygium surgery, especially for patients with needle phobia.
YAG curios #1: repeat Nd:YAG laser posterior capsulotomy
Authors: Jayaram Hari , Uppal Gurmit , Hugkulstone Charles E. , Gibbens Mary V. , Watt Lynda
Published: March 2005

A descriptive case series of five patients identified either opportunistically or from a retrospective review of the laser register is presented. All underwent cataract surgery between 1995 and 1999 and required initial Nd:YAG laser posterior capsulotomy 15–30 months after surgery. They subsequently developed reclosure of the capsulotomy, necessitating repeat laser capsulotomy 11–82 months later. One patient, who received a hydrogel intraocular lens, required a third capsulotomy after a further 12 months. The rate of repeat Nd:YAG laser capsulotomy in our unit was 0.31%.
Cytomegalovirus retinitis in Wegener's granulomatosis: case report and review of the literature
Authors: Bertelmann Eckart , Liekfeld Anja , Pleyer Uwe , Hartmann Christian
Published: March 2005

Purpose:  To present the first case of cytomegalovirus (CMV) retinitis in a Wegener's granulomatosis patient on systemic cyclosporine A (CsA) therapy.

Methods:  A 41‐year‐old patient was treated with systemic CsA for c‐ANCA positive Wegener's granulomatosis. Four weeks later he presented with blurred vision and a retinitis was diagnosed in the right eye. After detection of CMV DNA by polymerase chain reaction (PCR), the patient was treated with intravenous gancyclovir. Due to bone marrow toxicity, systemic antiviral therapy was discontinued and an intravitreal gancyclovir pellet was implanted.

Results:  The retinitis lesions were scarified under this therapy and the patient's visual function was restored completely.

Conclusions:  Cytomegalovirus retinitis can occur under systemic monotherapy with CsA in patients with systemic vasculitis. Intraocular virus DNA detection by PCR is recommended to rule out retinal involvement of the underlying vasculitis in atypical cases and to preserve the patient's visual acuity.
Ascorbate in the guinea pig lens: dependence on drinking water supplementation
Authors: Mody Vino C. , Kakar Manoj , Elfving Åse , Söderberg Per G. , Löfgren Stefan
Published: March 2005

Purpose:  To investigate whether lens ascorbate concentration can be elevated with drinking water supplementation.

Methods:  Pigmented guinea pigs received drinking water supplemented with L‐ascorbate, concentration 0.00, 2.84, 5.68 or 8.52 mm for a duration of 4 weeks. In addition, the chow fed to all animals contained 125 mmol L‐ascorbate per kg of chow. At the end of the supplementation period, the guinea pigs were killed. Each lens was extracted. The lens was processed and ascorbate concentration was measured using high performance liquid chromatography (HPLC) with 254 nm ultraviolet radiation detection. The data were analysed with regression.

Results:  At the end of the test period, all lenses were devoid of cataract as observed by slit‐lamp examination. All lenses contained a detectable concentration of ascorbate. Estimated 95% confidence intervals for mean animal‐averaged lens ascorbate concentrations (µmol/g wet weight of whole lens) per group were 0.51 ± 0.04 (0.00 mm; n = 6), 0.70 ± 0.18 (2.84 mm; n = 6), 0.71 ± 0.11 (5.68 mm; n = 5), and 0.71 ± 0.06 (8.52 mm; n = 6). Animal‐averaged lens ascorbate concentration [Asclens] (µmol/g wet weight lens) increased with ascorbate supplementation in drinking water [Ascwater] (M), in agreement with the model:

Conclusion:  Lens ascorbate concentration increases with drinking water supplementation in the guinea pig without cataract development. The currently presented method for measurement of whole lens ascorbate content is suitable.
Combined phacoemulsification and pars plana vitrectomy for macular hole treatment
Authors: Theocharis Ioannis P. , Alexandridou Anastassia , Gili Nasser Jadidi , Tomic Zoran
Published: March 2005

Purpose:  To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole.

Methods:  A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy.

Results:  The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%).

Conclusion:  Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.