bluuebunny/crossref_metadata_2025 huggingface dataset:
The utility of the revised elderly persons disability scale (REPDS) in an Asian psychogeriatric patient group
Authors: Sim K. , Ng L.L.
Published: December 2008

Objective: The Revised Elderly Persons Disability Scale (REPDS) was developed in Australia as a measure of disability in psychogeriatric patients. We sought to test its utility in an Asian psychiatric hospital.

Method: The study involved 33 patients, 65 years or older, and admitted for the first time to an acute psychogeriatric ward at Woodbridge Hospital, Singapore

Results: The total REPDS score was significantly higher in male patients and in patients with dementia, due to there being more male patients with dementia and with dementia generating high disability Itvels. There was no significant difference in the total disability score between those referred from nursing homes and other sources. REPDS scores decreased during hospital stay, with decreases significant on several scales.

Conclusions: The REPDS appeared to have utility in an Asian psychogeriatric unit in allowing disability components to be profiled, while scale score differences and changes over time indicated that the measure was sensitive to change. The measure identified the core problem areas in the disability profile of a psychogeriatric population and of sub‐groups with and without dementia, results which can assist clinical service delivery and staff training activities.
The probability of using an aged care home over a lifetime (1999–00)
Authors: Rowland Frieda , Liu Zhibin , Braun Peter
Published: December 2008

Objective: This paper aims to project the probability of using an aged care home over a lifetime for Australian men and women at various ages.

Method: This paper applies life table models [1] to 1999–00 residential aged care data to estimate the probability of using an aged care home over a lifetime. Results: Women are more likely than men to enter an aged care home for permanent care over their lifetime. Based on current patterns of use of aged care homes, a woman at age 65 faces a probability as high as 0.46 of using an aged care home for permanent care before her death compared with 0.28 for a man at the same age.

Conclusion: A much larger proportion of older people than has often been recognised are likely to be admitted to an aged care home at some point in their lives.
The health and social needs of recently widowed older women in Australia
Authors: Feldman Susan , Byles Julie , Mishra Gita , Powers Jenny
Published: December 2008

Objective: To identify women's health and social needs immediately following the death of their husband.

Method: A cross‐sectional survey of 430 widowed women participating in the Australian Longitudinal Study on Women's Health was undertaken.

Results: Surveys were returned by 340 women (79%) and 231 of these women had been widowed three years or less. While 82 % of the 231 women still lived in their own homes, 19% had moved house since being widowed for financial or social reasons. There were needs for legal services (44%), and home maintenance (55%). Assistance from medical practitioners included understanding (64%), support (38%) and information (23%). Thirty percent said they had received medication to assist their bereavement, and 30% had taken medication to help them sleep or “for their nerves” within the four weeks prior to survey. Most women (85%) felt they had maintained or increased their level of social contact since becoming widowed.

Conclusion: Widowed women have broad needs for practical help and advice. Appropriate services for widowed women need to encompass the social context in which widowed women are attempting to reconstruct their lives.
Hearing and vision loss within residential care facilities ‐the need for improved service delivery
Authors: Flynn Mark C. , Kennedy Esther J. , Johns Julianne , Stanbridge Rachael
Published: December 2008

Objective: To assess the level of hearing impairment within residential care facilities and to determine the efficacy of providing aural rehabilitation services within the facility.

Method: 178 elderly residents participated in this project. The procedures included case history, pure‐tone screening, otoscopic examination, vision screening, hearing aid assessment and sentence identification.

Results: Despite 87.1% of participants having a significant hearing impairment only 43.3% currently wore hearing aids. Linked to poor hearing aid use was the fact that 43.9% of hearing aids required some degree of maintenance. Otoscopic examination revealed 42.1% of ear canals to be occluded with cerumen to a degree that medical intervention was required. Sentence identification revealed the importance of aiding and access to contextual and visual cues (lip‐reading) for this population.

Conclusions: This study confirms the high prevalence of hearing impairment amongst the elderly and makes a case for increased rehabilitation services being directed towards this population particularly in the areas of hearing aid maintenance, cerumen removal and delivery of communication skills training to residential care workers.
Ageing and the economy: costs and benefits
Authors: Ranzijn Rob , Harford Jane , Andrews Gary
Published: December 2008

Objectives: The purpose of this study was to estimate the financial value of the productive contributions that older adults make to South Australian society and to compare this to the cost of maintaining them in good health and well‐being.

Method: 391 participants aged between 65 and 101 years were interviewed over the telephone about the number of hours per week engaged in a comprehensive list of activities in the previous week, and half of the sample also completed a week‐long inventory of goods and services which they produced. The goods and services were converted into financial values using current market rates. The costs of health and aged care were obtained from official sources like the Australian Bureau of Statistics.

Results: The total value of productive activities was estimated to be between A4.9 and A8.1 billion, and the value of work performed for other people was estimated at between 0.82 and 1.38bn (the South Australian older population is about 200,000). The cost of health and aged care was calculated to be about 1.8bn.

Conclusions: It was concluded that older South Australians make essential contributions to society, contributions which have a very large economic value.
The relation between unpaid support and the use of formal health services: the Sydney Older Persons Study
Authors: Edelbrock Dorothy , Waite Louise M. , Broe G. Anthony , Grayson David A. , Creasey Helen
Published: December 2008

Objectives: To examine the inter‐relationships between formal and informal unpaid services in an elderly population.

Methods: 537 community‐dwelling elderly (75 or older) were interviewed about use of community and medical services and the provision of unpaid support. Disease and disability were assessed by medical practitioners. The relationship between service use and unpaid support among persons with the same disease/disability profile was examined.

Results: Unpaid network support for instrumental activities of daily living (IADL) needs was utilised when community services were not. Unpaid ADL and IADL network support is used in conjunction with medical services. Higher socioeconomic status, female gender and having fewer coresidents predicted higher use of community services. Males spent more days in hospital.

Conclusions: Community IADL services and unpaid IADL network support work in a compensatory fashion. In contrast, higher users of medical services were greater users of unpaid network support.
Resident‐staff interactions: a challenge for quality residential aged care
Authors: Edwards Helen , Gaskill Deanne , Sanders Fran , Forster Elizabeth , Morrison Paul , Fleming Rosanne , McClure Sandra , Chapman Helen
Published: December 2008

Objectives: This paper describes one facet of a study to develop and implement a “best practice model” of residential care for older people. The purpose of this facet of the larger study was to describe the current interactional context of a residential aged care facility.

Method: A total of 2,848 observations of resident‐staff interactions were made and coded according to Baltes' observational schedule. Coder inter‐rater reliability was maintained at 90% (Cohen's Kappa).

Results: Residents were alone 40% of the time they were observed. The dominant pattern of staff interaction with residents was to not engage in direct verbal or nonverbal communication or physical contact. The dominant response by staff to resident independence was to make no response. The dominant staff response to resident dependence was to support that dependence.

Conclusions: Residential aged care practice continues to be focused on technology, and tasks and interactions between residents and staff continue to be dependency‐supporting.
Leah Wilson
Authors: Kirby Neil
Published: December 2008

Objective: To survey resident, joint resident/staff, family and staff committees in South Australian aged care hostels.

Method: The managers of all 159 South Australian aged care hostels were surveyed concerning different types of committees, with 106 hostels participating.

Results: Ninety percent of hostels had resident information meetings, 75% had staff committees but only 65% had resident committees and only 12% had joint resident/staff and/or family committees. While nearly all managers thought that their hostels provided adequate means for residents to express their wishes and concerns, some also indicated that additional committees would be beneficial. Greater participation of committee members was the most common suggestion for improvement.

Conclusion: There is scope for more resident, joint resident/staff and family committees in aged care hostels. There is also a need for research to determine the relative benefits of each kind of committee and their optimum combination, and to identify ways of increasing participation in such committees.
Volunteering and health among older people: a review
Authors: Onyx Jenny , Warburton Jeni
Published: December 2008

This paper presents a review of the available literature on the relationship between volunteering and health among older people. There is consistent evidence that morbidity rates, functional health indices, self reported health and life satisfaction are affected by formal and informal volunteering. Some studies suggest that the benefits of volunteering are reciprocal, in that both those who give and those who receive assistance benefit. The evidence is consistent with the proposal that social capital is generated through volunteering. It is likely that the presence of high levels of social capital supports and maintains the health of older persons, provides informal support in times of sickness and stress and thus enhances quality of life as well as reducing or delaying the onset of illness and death.
Does the résumé open the door to age discrimination for older workers?
Authors: Bennington Lynne , Wein Ruth
Published: December 2008

Objective: This exploratory study examined the amount of information provided in résumés that could form the basis for unlawful discrimination.

Method: The covering letters and résumés of secretarial job applicants were examined and coded under strict ethical guidelines.

Results: Substantial information upon which unlawful discrimination could be based was provided by applicants, particularly by older applicants.

Conclusion: Applicants may reduce their chances of an interview and aid and abet unlawful discrimination by including personal information in their résumés. Suggestions to minimize this problem are offered.
Promoting mental health in rural elders: a pilot program
Authors: Gattuso Suzy
Published: December 2008

Objective: This paper reports on the development and trial of a mental health promotion program for older people in rural north‐east Victoria entitled Healthy & Wise. The objective of the program was to increase mental health literacy among older adults referred to Aged Psychiatry who were not diagnosed with a psychiatric disorder but who were experiencing difficulties in dealing with the stresses of later life. A further objective of the program was to assist older adults develop skills in adapting to these stresses.

Method: Delivery of the program was in a small‐group format. Evaluation utilised both quantitative and qualitative assessment of outcomes. In this report the focus is on assessment based on the Geriatric Depression Scale self‐administered to participants before the program began, post program, and at a 6‐month follow‐up.

Results: There was a significant reduction in GDS score over time (pre/post) which was maintained at follow up. The program was successful in attracting participants experiencing a number of risk factors associated with poorer mental health (e.g. chronic illness).

Conclusion: Adoption of Healthy & Wise, a trialed and evaluated community mental health program for older adults, could extend the delivery of mental health services in rural areas in an economic and effective way. At a time when smaller rural communities are ageing more rapidly than Australia as a whole, and funding constraints continue, it is recommended as a valuable addition to current programming. Because the study does not include a control group and because participants self selected for the program, generalisation to other populations and settings needs to be cautious. However, because of the success of this trial, it is recommended that the program be tested with other populations. Target groups might include hostel residents and carers of people with dementia.
Using a driving simulator to identify older drivers at risk of traffic infringements
Authors: Lee Hoe C. , Lee Andy H. , Cameron Don
Published: December 2008

Objectives: To determine the internal consistency of assessment criteria measuring the simulated driving performance of older drivers and the criterion validity of the assessment protocol related to traffic infringements.

Method: One hundred and twenty‐nine older drivers residing in metropolitan Perth volunteered to participate in the study. Using a driving simulator, specific driving tasks were devised to test the participants, whose performances were measured by ten assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that may be related to the event of incurring at least one demerit point during the previous two years.

Results: As expected, driving skill of older drivers was found to decline with age. The Cronbach alpha coefficient among the assessment criteria was 0.742. Forty six participants incurred at least one demerit point within the previous two years. Adjusting for age in the logistic regression, the functional abilities associated with traffic infringements were decision and judgement under pressure of time, confidence in driving with high speed and compliance to traffic regulation.

Conclusions: For the present study sample, the identified assessment criteria measuring the simulated driving performance of older drivers were shown to be reliable, and their significant association with the event of incurring a demerit point further confirmed the criterion validity of using the laboratory‐based driving simulator to identify older drivers at risk of traffic infringements incurring demerit points.
The economic consequences of introducing deep brain stimulation for the treatment of advanced Parkinson's disease in Australia
Authors: Hollingsworth Bruce P. , Harris Anthony H.
Published: December 2008

Objectives: Parkinson's disease is a debilitating condition, which is increasing in prevalence as elderly populations increase in the developed world. As such, resource consumption will also increase. For advanced Parkinsons, where drug therapy is no longer effective, there are two surgical options ‐ ablative surgery, a one‐off procedure which destroys part of the brain, and deep brain stimulation (DBS), which uses electrodes to stimulate part of the brain. The specific question to be answered here is what the costs to the community of DBS are compared to ablative surgery (thalmotomy or pallidotomy) in potentially relieving the symptoms of advanced Parkinson's disease, and if there is any improvement in patients' quality of life.

Design: A cost effectiveness study is undertaken. UK and Australian data are made use of and cost‐effectiveness estimated in terms of cost per change in functional ability.

Setting: Hospital, community and home care.

Patients: Those with advanced Parkinson's Disease.

Main outcome measures: Frenchay index of functional ability.

Results: It is estimated that the incremental extra cost for a small change in ability to undertake daily tasks is at least 23,559.

Conclusions: As outcomes evidence is of low quality, at this stage it is not possible to establish that Deep Brain Stimulation offers substantial improvements in quality of life. Extra costs over ablative surgery are estimated to be in the range of 17,830 to 51,385 per patient over a five year period.
Retirement villages: an alternative place to live
Authors: Grant Sevan C.
Published: December 2008

Although one's home may be endowed with memories and meanings increasing numbers of people 65 years and over are changing their place of residence and/or community in search of an alternative lifestyle. One type of community attracting considerable interest is a retirement village. Over the past decade New Zealand has witnessed a rapid increase in the number of such communities designed to provide an idyllic and hassle‐free lifestyle in a clean well maintained and secure environment. But in spite of ‘relatively trouble free existence’ that is supposedly associated with these purpose built environments there are a number of social, economic and political issues that warrant further comment. After all, retirement villages are more than just a place to live.
Evaluation of donepezil in Alzheimer's disease ‐Experience from an Australian memory clinic
Authors: Mador Julie , Hecker Jane , Clark Michael
Published: December 2008

Objectives: To describe our experience using cholinesterase inhibitors for mild‐moderate Alzheimer's disease in a memory clinic. In particular we reviewed response in cognition, activities of daily living and quality of life for patients.

Design: A prospective descriptive study with patients and carers being assessed before and 3–6 months after commencing treatment with a cholinesterase inhibitor. Setting: Memory clinic at Repatriation General Hospital, Adelaide.

Subjects: Sixty‐four consecutive patients with mild‐moderate Alzheimer's disease commencing treatment with a cholinesterase inhibitor and their carers.

Outcome Measures The primary outcome was a change in cognition as measured by the Mini‐Mental Status Examnination (MMSE). Secondary outcomes were The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS), patient self‐assessed measures of quality of life (Dementia Quality of Life Instrument (DQOL) with sub‐scales in self‐esteem, positive affect, negative affect, belonging and aesthetics, and a five point likert scale of overall quality of life (QOL)) and carer assessed proxy direct scaling of patient quality of life.

Results: All patients were commenced on Donepezil. Fifty‐four (84%) patients remained on drug treatment and completed the study with follow‐up at an average of 13 weeks. Ten patients (16%) stopped treatment due to side‐effects or non‐compliance. There was a mean change of 1.1 points on the MMSE (p< 0.05) and a small but significant (p<0.05) improvement in the positive affect sub‐scale of the DQOL. There were no improvements in other sub‐scales of the DQOL or overall quality of life. A similar number of patients improved 14 (26%) in activities of daily living as those who deteriorated 12 (22%) with the majority 28 (52%) remaining unchanged.

Conclusion: Donepezil has a beneficial effect on cognition and affect when used in the setting of a memory clinic. There was little evidence to suggest an improvement in activities of daily living and overall quality of life.
Falls in older persons in Australia: screening instruments for general practitioners
Authors: Westwood Barbara , Westwood Geoff
Published: December 2008

Falls are a relatively common problem in older people in Australia causing significant morbidity including restricted activities of daily living and increased mortality. Falls may initiate institutionalisation and will increase in significance with the rapidly ageing population profile.

Falls in older people are attributed to multiple factors and are potentially preventable with early detection and intervention. General practitioners, as the primary community medical care providers, are in an ideal position to screen all older patients for falls risk. A detailed history to identify falls risk factors should be complemented by screening with a simple and easy to use screening instrument.

The requirements of a reliable and validated falls screening instrument are explored along with a review of available instruments. Although the literature is inconclusive, a suitable falls screening instrument is identified for use by general practitioners.
Survey of New Zealand older driver assessment practices
Authors: Ciesionik Anita , Alpass Fiona M. , Pachana Nancy A.
Published: December 2008

Objectives: Data on current practices regarding assessment of fitness to drive in older adults in New Zealand were collected, including current instruments, decision processes and referral sources employed by GPs when assessing fitness to drive.

Method: In order to examine GPs' assessment strategies in older driver assessment, a national survey using a randomly selected subset of 350 GPs was conducted.

Results: Results indicate a wide range of evaluative processes and referral procedures among GPs in their management of older drivers.

Conclusions: Standardised evaluative processes and referral procedures are lacking in the driver assessment process among New Zealand GPs.
Why do physicians choose to train in geriatric medicine?
Authors: Hilmer Sarah N. , Naganathan Vasi , Couteur David G. Le
Published: December 2008

Objective: There is a shortage of geriatricians in Australia and a need for more trainees in geriatric medicine but training positions are difficult to fill. To address this issue, we investigated when and why current trainees in geriatric medicine chose the subspecialty.

Method: A survey was conducted on advanced trainees in geriatric medicine in Australia in 2001.

Results: Current trainees chose geriatric medicine at stages extending from undergraduate training to post‐Fellow of the Royal Australian College of Physcians (FRACP) with 35% deciding on the sub speciality after passing their FRACP exams. Major influences in choosing geriatric medicine include exposure to the term as a registrar, specialist geriatrician role models, interest in general medicine, holistic medicine and teamwork, and the lifestyle and flexibility associated with a career in geriatric medicine.

Conclusion: This study has identified some of the issues that influence the decision to undertake geriatric medicine training and the time that such decisions are made.
Reducing abuse of older people with dementia and their carers
Authors: Koch Susan , Nay Rhonda
Published: December 2008

Objectives: The objective of this study was to identify and investigate the issue of elder abuse amongst older people with dementia and their carers.

Methods: An expert reference group was established and a comprehensive literature review was undertaken. Discussion forums and in‐depth interviews were held with interested stakeholders to identify issues regarding abuse, and any related strategies that are ‘currently in place, being developed or required.

Results: Attempting to develop one concise definition of abuse can be unhelpful, and cases should instead be assessed in relation to their unique contexts. Participants expressed a need for better education and availability of information about elder abuse related to dementia. Strategies to reduce abuse were identified.

Conclusion: Participants clearly identified that a preventative approach is integral in the successful reduction of abuse and that any formal intervention needs to reflect the unique set of circumstances pertaining to abuse of each person with dementia and/or their carers.
The future aged: new projections of Australia. ‘s elderly population
Authors: Booth Heather , Tickle Leonie
Published: December 2008

Objectives: To use new methodology to forecast mortality for use in projections of the elderly population of Australia and to compare them with official projections.

Method: The Lee‐Carter method is applied to data for Australian females and males for 1968–2000 to forecast mortality to 2031. These forecasts are used with standard population projection methods to produce projections of the elderly population.

Results: By 2027, forecast life expectancy is 88.1 and 82.9 years for females and males, compared with official projections of 85.4 and 81.4 years. Over the period to 2031, the populations aged 65+ and 85+ are forecast to increase by factors of 2.3 and 3.4 respectively. Compared with official projectrons, the forecast elderly population is substantially larger and has higher old‐age dependency ratios, higher proportions aged 85+ and lower sex ratios.

Conclusion: Official projections underestimate the size of the future elderly population especially the female and ola'est‐old populations.
Discharge summaries in aged care: improving communication between an aged care unit and general practitioners
Authors: Johnstone Kevin , Bagnall Felicity , Chan Daniel Kam Yin
Published: December 2008

Objective: Discharge summaries (DSs) allow communication between hospitals and general practitioners and are essential for continuity of patient care. Despite this important function, the most junior doctor on the medical team usually writes them. An internal audit and survey of general practitioners (GPs) and aged care facilities within the Bankstown sector of the South Western Sydney Area Health Service revealed significant shortcomings with DSs from the aged care unit at Bankstown‐Lidcombe Hospital

Method: A new DS form was designed specifically for aged care patients, and junior medical officers (JMOs) received training at the beginning of term with regular review and feedback throughout the term.

Results: After three months a second survey was performed which revealed a significant improvement in the quality of DSs from the unit. Satisfaction with the pre‐intervention DS form compared to the post‐intervention form increased from 22% to 79%. JMOs benefited from extra education and the development of a problem based approach to writing DSs.
Driving and dementia: a prospective audit of clients referred to an aged care assessment team
Authors: Bunt Robert , Lipski Peter S.
Published: December 2008

Objective: Many people with dementia or cognitive Impairment continue to drive. Given Australia's ageing population, this raises safety concerns for the driver in the community. This paper presents data collected by the NS W Central Coast Aged Care Assessment Team (ACAT), outlining the extent of the problem on the Central Coast and offers some suggestions about dealing with this issue.

Method: A prospective audit of clients referred to Central Coast ACAT over a seven month period. Data describing the clients' cognitive state and also their driving habits were collected during routine ACAT assessments.

Results: 1203 people were referred to ACAT during the study period. 100 (8%) of these were driving and 34% of those driving had some form of cognitive impairment. In some cases the impairment was quite severe. Most of these drivers were male. In a majority of the cases, concerns were expressed by someone familiar with the person, regarding their capacity to drive safely.

Conclusion: The results support findings from other studies, which suggest there is a small but significant number of elderly people with cognitive impairment who are still driving. We propose that a safety first policy should be adopted and where there is doubt about the persons ability to drive safely, an Occupationul Therapy driving test in conjunction with a detailed cognitive assessment needs to be performed.
Management of Erectile Dysfunction in General Practice
Authors: De Berardis Giorgia , Pellegrini Fabio , Franciosi Monica , Pamparana Franco , Morelli Patrizia , Tognoni Gianni , Nicolucci Antonio
Published: December 2008

Introduction

In recent years, the availability of effective oral pharmacological treatment for erectile dysfunction (ED) has revolutionized its management; however, it is still unclear how everyday clinical practice has changed in response to this evolving scenario.

Aim

The aim of this study is to describe general practitioners’ (GPs) beliefs and attitudes toward the management of ED.

Methods

Each GP was asked to recruit consecutive men aged ≥18 years and sexually active, with already known erectile problems or with newly diagnosed ED.

Main Outcomes Measures

A written questionnaire was used to investigate GPs’ sociodemographic characteristics and their beliefs toward the management of ED.

Results

Overall, 127 GPs (53.4%) returned the questionnaire and 124 enrolled patients for the study. Only 9.5% of the GPs reported routinely inquiring about ED of patients >40 years of age, whereas 45.7% did it only when the patient raised the problem. GPs’ gender and age were associated with their beliefs about ED treatment and referral to specialist care. Overall, 932 patients were enrolled, of whom 38% had newly diagnosed ED. The problem came to light for initiative of patient in 80% of cases, and 84.8% of men were prescribed a treatment. Patients who on their own initiative discussed of their condition had an almost 3-fold increased probability to be treated than those whose GP began the discussion about ED (odds ratio [OR] = 2.6, confidence interval [CI] 95% 1.5–4.5). Patients followed by female physicians were significantly more likely to be referred to a specialist than those followed by male physicians (OR = 3.3, CI 95% 1.4–5.0).

Conclusions

The management of ED has become an integral component of clinical practice in primary care. Nevertheless, barriers in addressing sexual issues still persist. Appropriate training is needed for a proactive approach to ED screening and management in men over 40s.
Associations Among Physiological and Subjective Sexual Response, Sexual Desire, and Salivary Steroid Hormones in Healthy Premenopausal Women
Authors: Van Anders Sari M. , Brotto Lori , Farrell Janine , Yule Morag
Published: December 2008

Introduction

Few studies have examined how sexual arousal influences healthy premenopausal women’s hormones, limiting our understanding of basic physiology and our ability to transfer knowledge from clinical and nonhuman populations.

Aim

To examine how sexual arousal and steroid hormones (testosterone [T], cortisol [C], estradiol [E]) were linked, to see whether hormone levels influenced and/or changed in response to sexual arousal elicited via visual erotic stimuli in healthy women.

Methods

Participants included 40 healthy premenopausal women not using exogenous hormones.

Main Outcome Measures

Change in genital sexual arousal (vaginal pulse amplitude), change in subjective sexual arousal, sexual desire (via the Sexual Desire Inventory and Female Sexual Function Index scales), as well as T, C, and E via saliva samples taken before and following viewing of erotic stimuli as genital arousal was recorded via a vaginal photoplethysmograph.

Results

E increased in response to sexual stimuli but this was not statistically associated with genital sexual arousal, whereas C decreased in association with genital sexual arousal, and T showed no statistically significant change. Relationship status was linked to genital but not subjective sexual arousal such that dating women exhibited higher genital sexual arousal than single or partnered women. Results indicated that all three hormones were associated with self-reported genital arousal (via the Detailed Assessment of Sexual Arousal scales) and sexual desire in different domains, and both T and E were associated with self-reported orgasms.

Conclusion

Findings point to the need to examine multiple hormones in multiple ways (e.g., baseline, changes, stimulated) and question using erotic stimuli-induced arousal as a model for women’s endocrine responses to sexuality.
Epidemiology, screening and diagnosis of breast cancer in the Asia–Pacific region: Current perspectives and important considerations
Authors: GREEN Michael , RAINA Vinod
Published: December 2008

Because the Asia–Pacific region contains approximately 25% of the world's population, the rapidly rising incidence of breast cancer in this area represents a serious global health problem. Epidemiologic and biologic profiles of breast cancer in the Asia–Pacific region differ from those in Western countries. Compared with the West, breast cancer occurs more frequently among young premenopausal women and women in urban areas. Breast cancer is also more frequently diagnosed in advanced stages than in Western countries, and tumors are more likely to be estrogen receptor‐ and progesterone receptor‐negative. These differences can impact treatment selection, response to treatment, and outcomes, including morbidity and mortality. Breast cancer mortality in some countries of the Asia–Pacific region is two‐fold higher than in Western countries. The screening, diagnosis, and management of patients with breast cancer in the Asia–Pacific region are associated with a number of unique challenges. These include patient misperceptions about the disease and its treatment, a lack of access to imaging equipment and diagnostic testing, inconsistencies in the implementation of breast cancer screening programs and limited access to expensive treatments. Whereas some of the more Westernized countries within this region have established screening programs, many areas are still lacking in adequate breast cancer screening facilities. Various cultural and economic barriers must be addressed to improve treatment and outcomes for Asian‐Pacific patients with breast cancer.
Current treatment of locally advanced and metastatic breast cancer in the Asia–Pacific region: Challenges and limitations
Authors: CHOW Louis WC , IM Young‐Hyuck
Published: December 2008

Over the past decade, the management of breast cancer has improved substantially with advances in understanding the tumor biology and the introduction of several new, more effective agents. As a result, the performance of breast‐conservation surgery has increased, and the use of neoadjuvant therapy to downstage locally advanced breast cancer has become more common in the Asia–Pacific region. For patients with metastatic breast cancer, treatment typically follows Western clinical experience, but the use of specific drugs and regimens is variable throughout the region. Anthracycline‐based and/or taxane‐based regimens are commonly used for the first‐line treatment of locally advanced and metastatic breast cancer. However, a number of challenges and barriers have emerged that are unique to the treatment of patients with breast cancer in the Asia–Pacific region. These include differences in the safety and tolerability profiles of standard chemotherapeutic agents between Asian–Pacific and Western women; the variable availability of, and cost of anticancer agents; the high prevalence of Chinese herbal medicines and alternative therapies used by women with breast cancer, and the prohibitive costs of conducting clinical trials in some countries in the region.
Expression Sites of Colligin 2 in Glioma Blood Vessels
Authors: Mustafa Dana , Van Der Weiden Marcel , Zheng PingPin , Nigg Alex , Luider Theo M. , Kros Johan M.
Published: December 2008

In a previous study using state‐of‐the‐art proteomic techniques, we identified colligin 2 (HSP47) as a glioma blood vessel‐specific protein. In the present study we precisely localized the expression of colligin 2 in the blood vessels of diffusely infiltrating gliomas and relate the expression to the distinct cellular components of the vessels by using multiple immunolabeling and confocal microscopy. We grouped the glioma blood vessels into morphological categories ranging from normal looking capillaries to vessels with hypertrophic and sclerotic changes. The expression patterns of various markers of endothelial and pericytic differentiation were correlated with the position of the cells in the vessels and the expression of colligin 2. We found that colligin 2 is expressed in all categories of glioma blood vessels in cells with endothelial and pericytic lineage. Expression of colligin 2 was also found in cells scattered around blood vessels and in few glial fibrillary acidic protein‐positive cells within the blood vessels. There is overlap in the expression of colligin 2 and the collagens type I and IV for which colligin 2 is a chaperon. We conclude that colligin 2 is expressed in all cellular components of glioma blood vessels and may serve as a general marker for active angiogenesis.
Comparison of Ultrafiltration, Nesiritide, and Usual Care in Acute Decompensated Heart Failure
Authors: Bartone Cheryl , Saghir Syed , Menon Santosh G. , Brosmer Jayna , Kereiakes Dean J. , Mazur Wojciech , Chung Eugene S.
Published: December 2008

To study the short‐term effects of initial treatment strategies for acute decompensated heart failure, 25 patients treated with ultrafiltration (UF) were retrospectively compared with 25 patients treated with usual care (UC) and 25 patients treated with UC plus adjunctive nesiritide infusion (UN), matched for age, sex, ejection fraction, etiology, and serum creatinine. The median length of hospitalization was 6 days for UF, 4 days for UC, and 6 days for UN. All‐cause 30‐day readmissions tended to be fewer in the UF (16%) compared with the UN (24%) or UC (24%) groups. All groups lost weight, although to a greater extent in the UF group (15.8 lb vs 6.3 lb in UC and 4.7 lb in UN). Concomitantly, UF manifested the greatest increase in serum urea nitrogen, creatinine, and the number of patients with creatinine increases of >0.5 mg/dL (44% vs 24% in UC and 20% in UN). In acute decompensated heart failure, UF appears to be more effective for volume removal and possibly prevention of all‐cause hospital readmission to 30 days than UC or UN. These findings, as well as the effects on renal function and length of stay, need to be further evaluated in a prospective randomized study.
Increases in Heart Failure Visits After Christmas and New Year’s Day
Authors: Reedman Lisa Armstrong , Allegra John R. , Cochrane Dennis G.
Published: December 2008

The authors hypothesized increased emergency department (ED) visits for heart failure (HF) during a 2‐week Christmas holiday period similar to a recent study showing increased cardiac death rates. A retrospective analysis was performed from a database of 18 EDs in New Jersey and New York from January 1, 1996, to November 30, 2004, analyzing HF visits from December 1 to January 31. The authors compared the mean daily visits for the 2‐week holiday period of December 25 to January 7, as well as December 26 to December 30 and January 2 to January 5, using the Student t test. A total of 4.7 million patients were studied, 65,646 with an ED diagnosis of HF and 11,525 during January and December. There was a 23% (95% confidence interval [CI], 14%–31%; P<.001) increase in daily visits for December 25 to January 7 and a 33% (95% CI, 16%–51%; P=.007) and 30% (95% CI, 22%–38%; P<.01) increase in the 4 days following Christmas and New Year’s, respectively. The authors found a significant increase in daily HF visits in the 2‐week holiday period and the 4 days following the holidays, even greater than that reported for sudden cardiac death.
Prognostic Characteristics of Cardiopulmonary Exercise Testing in Caucasian and African American Patients With Heart Failure
Authors: Arena Ross , Myers Jonathan , Abella Joshua , Peberdy Mary Ann , Bensimhon Daniel , Chase Paul , Guazzi Marco
Published: December 2008

Peak oxygen consumption (VO2) and ventilatory efficiency (minute ventilation/carbon dioxide output [VE/VCO2] slope) are prognostically important in heart failure (HF). The purpose of the present study was to compare the prognostic characteristics of these variables between Caucasian and African American patients. A total of 662 HF patients (455 Caucasian/207 African American) underwent cardiopulmonary exercise testing and were tracked for major cardiac events. The VE/VCO2 slope was the strongest prognostic marker (chi‐square ≥18.9, P<.001), irrespective of race. While peak VO2 was a significant univariate predictor in both Caucasian (chi‐square 42.0, P<.001) and African American (5.2, P=.02) subgroups, it was only retained in the Caucasian multivariate regression. The lack of predictive value of peak VO2 in the African American subgroup was due to its lack of prognostic significance in female patients. While the VE/VCO2 slope was the most robust prognostic marker in both Caucasian and African American patients, the predictive ability of peak VO2 seems to be influenced by race and sex.
Results of an Olmesartan Medoxomil–Based Treatment Regimen in Hypertensive Patients
Authors: Oparil Suzanne , Chrysant Steven G. , Kereiakes Dean , Xu Jianbo , Chavanu Kathleen J. , Waverczak William , Dubiel Robert
Published: December 2008

The efficacy and safety of an olmesartan medoxomil (OM)–based treatment algorithm was tested in a double‐blind, randomized, placebo‐controlled titration study in 276 patients with stage 1 or 2 hypertension. After placebo run‐in, patients were randomized to placebo (12 weeks) or OM 20 mg/d (weeks 1–3). OM was up‐titrated to 40 mg/d (weeks 4–6), then OM/hydrochlorothiazide (HCTZ) 40/12.5 mg/d (weeks 7–9) and OM/HCTZ 40/25 mg/d (weeks 10–12) were started if blood pressure (BP) remained ≥120/80 mm Hg at each time interval. End points were change from baseline in mean systolic BP (primary) and mean diastolic BP (secondary). OM‐based treatment was well tolerated and changed BP by −22.3/−12.1 mm Hg from baseline vs −0.1/+0.8 mm Hg for placebo (P<.0001). Cumulative goal BP (<140/90 mm Hg) was achieved in 74.1% and 30.7% of OM‐ compared with placebo‐treated patients, respectively (P<.0001). BP normalized (<120/80 mm Hg) in 44.8% of OM‐ vs 1.4% of placebo‐treated patients with stage 1 hypertension (P<.0001).
Sex Differences in Short‐Term Heart Rate Variability in Patients With Newly Diagnosed Essential Hypertension
Authors: Pavithran Purushothaman , Madanmohan Trakroo , Nandeesha Hanumanthappa
Published: December 2008

The authors report the results of the analysis of heart rate variability (HRV) indices during 5 minutes of supine rest and 5 minutes of standing and conventional indices of autonomic function in 69 men and 51 women with untreated newly diagnosed hypertension matched for body mass index and resting blood pressure. Mean RR interval, standard deviation of normal‐to‐normal RR intervals, low‐frequency RR spectral power, HRV during deep breathing at 6 breaths per minute, and the 30:15 ratio (maximum RR interval 30th beat/minimum RR interval 15th beat) were significantly lower in women (P=.01, .02, .001, .04, .01, respectively) compared with men. Low frequency RR in normalized units was lower in women in the supine position alone (P=.03). HRV was significantly lower in women with untreated newly diagnosed hypertension compared with men. The authors interpret these results as indicating an increase in baseline cardiac sympathovagal balance in female hypertensive patients.
Divergent Transcription from Active Promoters
Authors: Seila Amy C. , Calabrese J. Mauro , Levine Stuart S. , Yeo Gene W. , Rahl Peter B. , Flynn Ryan A. , Young Richard A. , Sharp Phillip A.
Published: December 2008

Transcription initiation by RNA polymerase II (RNAPII) is thought to occur unidirectionally from most genes. Here, we present evidence of widespread divergent transcription at protein-encoding gene promoters. Transcription start site–associated RNAs (TSSa-RNAs) nonrandomly flank active promoters, with peaks of antisense and sense short RNAs at 250 nucleotides upstream and 50 nucleotides downstream of TSSs, respectively. Northern analysis shows that TSSa-RNAs are subsets of an RNA population 20 to 90 nucleotides in length. Promoter-associated RNAPII and H3K4-trimethylated histones, transcription initiation hallmarks, colocalize at sense and antisense TSSa-RNA positions; however, H3K79-dimethylated histones, characteristic of elongating RNAPII, are only present downstream of TSSs. These results suggest that divergent transcription over short distances is common for active promoters and may help promoter regions maintain a state poised for subsequent regulation.
The Antisense Transcriptomes of Human Cells
Authors: He Yiping , Vogelstein Bert , Velculescu Victor E. , Papadopoulos Nickolas , Kinzler Kenneth W.
Published: December 2008

Transcription in mammalian cells can be assessed at a genome-wide level, but it has been difficult to reliably determine whether individual transcripts are derived from the plus or minus strands of chromosomes. This distinction can be critical for understanding the relationship between known transcripts (sense) and the complementary antisense transcripts that may regulate them. Here, we describe a technique that can be used to (i) identify the DNA strand of origin for any particular RNA transcript, and (ii) quantify the number of sense and antisense transcripts from expressed genes at a global level. We examined five different human cell types and in each case found evidence for antisense transcripts in 2900 to 6400 human genes. The distribution of antisense transcripts was distinct from that of sense transcripts, was nonrandom across the genome, and differed among cell types. Antisense transcripts thus appear to be a pervasive feature of human cells, which suggests that they are a fundamental component of gene regulation.
RNA Exosome Depletion Reveals Transcription Upstream of Active Human Promoters
Authors: Preker Pascal , Nielsen Jesper , Kammler Susanne , Lykke-Andersen Søren , Christensen Marianne S. , Mapendano Christophe K. , Schierup Mikkel H. , Jensen Torben Heick
Published: December 2008

Studies have shown that the bulk of eukaryotic genomes is transcribed. Transcriptome maps are frequently updated, but low-abundant transcripts have probably gone unnoticed. To eliminate RNA degradation, we depleted the exonucleolytic RNA exosome from human cells and then subjected the RNA to tiling microarray analysis. This revealed a class of short, polyadenylated and highly unstable RNAs. These promoter upstream transcripts (PROMPTs) are produced ∼0.5 to 2.5 kilobases upstream of active transcription start sites. PROMPT transcription occurs in both sense and antisense directions with respect to the downstream gene. In addition, it requires the presence of the gene promoter and is positively correlated with gene activity. We propose that PROMPT transcription is a common characteristic of RNA polymerase II (RNAPII) transcribed genes with a possible regulatory potential.
Human Fetal Hemoglobin Expression Is Regulated by the Developmental Stage-Specific Repressor
BCL11A
Authors: Sankaran Vijay G. , Menne Tobias F. , Xu Jian , Akie Thomas E. , Lettre Guillaume , Van Handel Ben , Mikkola Hanna K. A. , Hirschhorn Joel N. , Cantor Alan B. , Orkin Stuart H.
Published: December 2008

Differences in the amount of fetal hemoglobin (HbF) that persists into adulthood affect the severity of sickle cell disease and the β-thalassemia syndromes. Genetic association studies have identified sequence variants in the gene
BCL11A
that influence HbF levels. Here, we examine
BCL11A
as a potential regulator of HbF expression. The high-HbF
BCL11A
genotype is associated with reduced
BCL11A
expression. Moreover, abundant expression of full-length forms of
BCL11A
is developmentally restricted to adult erythroid cells. Down-regulation of
BCL11A
expression in primary adult erythroid cells leads to robust HbF expression. Consistent with a direct role of
BCL11A
in globin gene regulation, we find that
BCL11A
occupies several discrete sites in the β-globin gene cluster.
BCL11A
emerges as a therapeutic target for reactivation of HbF in β-hemoglobin disorders.