bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional population dynamics define the local genetic structure in Sorbus torminalis
Authors: ANGELONE S. , HILFIKER K. , HOLDEREGGER R. , BERGAMINI A. , HOEBEE S. E.
Published: February 2007

Recent changes in sylvicultural practices in Central Europe have created forests with closed canopies, and tree species preferring open and sunny forests have declined in area and abundance. This led to increased isolation of populations of many rare insect‐pollinated, fleshy‐fruited species with a naturally scattered distribution. To gain insight into the regional population dynamics of such species, we investigated the consequences of spatial isolation, population size and density on the genetic structure of Sorbus torminalis and simultaneously considered the relationship between fecundity and habitat quality. Genotype data for biparentally (ISSRs) and maternally inherited (cpDNA PCR‐RFLPs) molecular markers were generated for 26 Swiss populations of S. torminalis. We applied analyses of molecular variance (amova) to both marker types and separated the relative contributions of pollen and seed dispersal to historical gene flow. amova detected significant differentiation among populations (ΦST ISSR = 0.107; ΦST cpDNA = 0.370) in both marker types. The relative rate of pollen to seed gene flow was low (r = 2.919) and significantly different from equality. Isolation by distance was weak within Eastern and Western Switzerland, although populations were substantially differentiated. Within‐population molecular variance was not explained by population size, whereas habitat quality (openness) positively influenced the percentage of fruiting trees and the degree of fruiting per tree, indicating that more open forests enhance sexual reproduction. Our findings of significant genetic differentiation in the absence of clear geographical structuring can be explained by the distinct ecology of S. torminalis and nondirectional colonization events in metapopulation‐like dynamics.
Strength Training and Hemodynamic Responses to Exercise
Authors: Vincent Kevin R. , Vincent Heather K. , Braith Randy W. , Bhatnagar Vineesh , Lowenthal David T.
Published: February 2007

Sixty‐two older adults (68.4±6 years) were randomized into a control group (n=16), low‐intensity exercise group (n=22, LEX; 50% 1‐repetition maximum; 13 repetitions per exercise), or a high‐intensity exercise group (n=24, HEX; 80% 1‐repetition maximum; eight repetitions per exercise) group. Subjects trained for 24 weeks, performing 1 set for each of 13 exercises. Subjects performed a graded exercise test (GXT) at baseline and after 24 weeks of strength training. Heart rate, systolic, and diastolic blood pressures were measured at rest, during the GXT and 1, 3, and 5‐min post‐GXT. Mean arterial pressure was also calculated. Post‐training, time to peak systolic and diastolic blood pressures and heart rate was increased in the LEX and HEX groups by 22.9% and 44.5%, respectively (p<0.05). Diastolic blood pressure, heart rate, and mean arterial pressure during the GXT were significantly decreased (p<0.05) in the HEX group following training. Post‐GXT heart rate was lower in the HEX and LEX groups compared to control (p<0.05) indicating a more rapid recovery. Resistance exercise prolongs the onset of peak cardiovascular responses, decreases the cardiovascular response to exertion, and improves recovery from maximal exertion.
Treatment of Hypertension in Older Patients: An Updated Look at the Role of Calcium Antagonists
Authors: Kostis John B.
Published: February 2007

Hypertension is common in adults aged 60 years or older. Apart from age, hypertension is the most powerful predictor of cardiovascular end‐organ damage and its associated morbidity and mortality. Although diastolic blood pressure is regarded as an important risk factor, it is now clear that systolic blood pressure, especially prevalent among older adults, is a better predictor of cardiovascular morbidity and mortality. Fewer than 30% of hypertensive patients have blood pressure levels controlled to <140/90 mm Hg as recommended by current guidelines. Controlled trials have demonstrated the benefits of lowering blood pressure for all hypertensive individuals, including those aged 65 years or older. Calcium antagonists of the dihydropyridine subclass, which include nifedipine, amlodipine, felodipine, and nitrendipine, as well as other drug classes, are potent antihypertensive agents that may be suitable for treatment of hypertension in older adults. However, as with all antihypertensive agents, adverse effects may limit their use; peripheral edema is particularly troublesome for dihydropyridines. Newer dihydropyridine calcium antagonists expected to be approved for use soon, including lercanidipine and lacidipine, have been associated with efficacy comparable to currently available calcium antagonists but with a lower incidence of adverse effects, especially ankle edema. Antihypertensive agents with improved tolerability profiles offer the potential for improved blood pressure control.
Long‐Term Prognostic Value of Triiodothyronine Concentration in Elderly Patients With Heart Failure
Authors: Rays Jairo , Wajngarten Mauricio , Gebara Otavio C.E. , Nussbacher Amit , Telles Renata Martinho , Pierri Humberto , Rosano Giuseppe , Serro‐Azul João Batista
Published: February 2007

In this study the authors sought to determine the prevalence and long‐term prognostic value of low triiodothyronine levels in elderly patients with heart failure and no thyroid disease. Lower levels of triiodothyronine are more prevalent in patients with advanced heart failure without thyroid disease, and this may have prognostic implications. However, this hormonal milieu has not been investigated in elderly patients. The authors prospectively followed a consecutive sample of 69 elderly patients aged 76.5±5.9 years with heart failure and 44 age‐matched controls without heart failure between March 1997 and September 2000 at the Geriatric Cardiology Outpatient Clinic of the Heart Institute of São Paulo, Brazil. Events analyzed included death, hospitalization, and the combined end point of death or hospitalization. The study revealed that levels of triiodothyronine were lower in heart failure patients than in controls (89±23 vs. 101 ±16 ng/dL, p=0.001). During the follow‐up period of 14.3±8.1 months there were 19 deaths and 33 hospitalizations in the heart failure group. The combined end point of death or hospitalization occurred in 38 patients. Triiodothyronine levels were lower in heart failure patients who had a cardiovascular event than in event‐free patients (82.7±24.8 vs. 96.7±19.2 ng/dL, p=0.012). The odds ratio for events was 9.8 (95% confidence interval, 2.2–43, p=0.004) for patients in the lowest tertile of triiodothyronine, that is, lower than 80 ng/dL, compared with patients with levels above 80 ng/dL. The authors conclude that among elderly patients with heart failure, lower triiodothyronine concentrations are more prevalent and are associated with a worse prognosis.
Enhanced External Counterpulsation in the Management of Angina in the Elderly
Authors: Linnemeier Georgiann , Michaels Andrew D. , Soran Ozlem , Kennard Elizabeth D.
Published: February 2007

This study was undertaken to determine whether enhanced external counterpulsation is a safe and effective treatment for angina in octogenarians. In this prospective observational study, demographic and clinical outcome data on patients consecutively enrolled in the International EECP Patient Registry was examined. Of the 3037 patients analyzed, 249 (8%) were ≥80 years old. Octogenarians were more likely to be female and have a history of congestive heart failure (41% vs. 29%; p<0.001). They were less likely to have had previous revascularization. Fewer patients in the octogenarian group (76% vs. 84%; p<0.01) completed a course of treatment. Of those octogenarian patients who completed treatment, 76% reported a reduction in angina and quality of life improved significantly. Adverse events related to treatment were low. At 6‐month follow‐up, 81% reported maintenance of angina improvement. Thus, enhanced external counterpulsation is a low‐risk intervention that offers octogenarians the ability to return to more normal activity and a better quality of life.
Cardiovascular Physiology—Changes With Aging
Authors: Cheitlin Melvin D.
Published: February 2007

With aging there are changes in the cardiovascular system, which result in alterations in cardiovascular physiology. The changes in cardiovascular physiology must be differentiated from the effects of pathology, such as coronary artery disease, that occur with increasing frequency as age increases. The changes with age occur in everyone but not necessarily at the same rate, therefore accounting for the difference seen in some people between chronologic age and physiologic age. The changes in the cardiovascular system associated with aging are a decrease in elasticity and an increase in stiffness of the arterial system. This results in increased afterload on the left ventricle, an increase in systolic blood pressure, and left ventricular hypertrophy, as well as other changes in the left ventricular wall that prolong relaxation of the left ventricle in diastole. There is a dropout of atrial pacemaker cells resulting in a decrease in intrinsic heart rate. With fibrosis of the cardiac skeleton there is calcification at the base of the aortic valve and damage to the His bundle as it perforates the right fibrous trigone. Finally there is decreased responsiveness toβ adrenergic receptor stimulation, a decreased reactivity to baroreceptors and chemoreceptors, and an increase in circulating catecholamines. These changes set the stage for isolated systolic hypertension, diastolic dysfunction and heart failure, atrioventricular conduction defects, and aortic valve calcification, all diseases seen in the elderly.
Ethical Issues in the Management of Geriatric Cardiac Patients
Authors: Basta Lofty L.
Published: February 2007

Ethical Issue: A 69‐year‐old woman dying of severe ischemic cardiomyopathy and peripheral arterial disease is developing gangrene of her toes without pain or overt signs of infection. Should you perform an arteriogram, attempt repeat angioplasty of either or both lower limbs?
Thrombolysis in Elderly Patients With Acute Myocardial Infarction
Authors: Berger Alan K.
Published: February 2007

The efficacy of thrombolytic therapy in the elderly remains a topic of ongoing debate. Although elderly patients account for a disproportionate amount of cardiovascular mortality, they have typically been underrepresented in randomized clinical trials. A meta‐analysis of these trials suggests a survival benefit, albeit small, of thrombolytic therapy in the elderly. Thrombolytic therapy, in combination with either glycoprotein IIb/IIIa inhibitors or low‐molecular weight heparin, poses an increased hazard in the elderly. Observational studies of thrombolytic therapy in the elderly portray a far worse outcome than the randomized clinical trials and raise the possibility of increased mortality. To date, no randomized trial has compared thrombolytic and primary coronary intervention in the elderly. However, multiple observational studies indicate a low risk of intracerebral hemorrhage and improved survival when a strategy of primary coronary intervention is employed. Future trials and observational studies should elucidate the ideal reperfusion strategy in the elderly.
Pathophysiology of Valvular Aortic Stenois in the Elderly
Authors: Cheitlin Melvin D.
Published: February 2007

Aortic stenosis in the elderly is related to calcification of either a bicuspid valve or a morphologically normal tricuspid valve. There is increasing evidence that factors relating to atherosclerosis are involved in valvular calcification and that it is an actively regulated process rather than a degenerative one. With severe aortic stenosis left ventricular hypertrophy occurs, decreasing wall stress and supporting the left ventricular ejection fraction. However, with pathologic hypertrophy there is a dropout of myocardial cells, subendocardial ischemia, and fibrosis. Eventually, symptoms of angina, non‐Q wave myocardial infarction, exertional syncope, and heart failure occur. Once symptoms begin, the prognosis is poor, with sudden death occurring in about one third of patients who die. In the elderly, symptoms can be recognized very late in the course of the disease since they can be attributed to other problems and since the elderly patient may have reduced physical activity to a minimum. The more comorbidities that exist, the greater the risk of valve replacement. Symptomatic patients with severe aortic stenosis even over age 80 can be operated upon with a relatively low mortality and morbidity. In patients over age 80, prolongation of life for any meaningful length of time is not as important as relief of symptoms and improvement in the quality of life. Thus, it is unlikely that any truly asymptomatic patient over age 80, even with severe aortic stenosis, should be sent to surgery.
Are Statins Indicated for the Primary Prevention of CAD in Octogenarians? Angagonist Viewpoint
Authors: Foody JoAnne Micale , Krumholz Harlan M.
Published: February 2007

Statin therapy (3‐hydroxy‐3methylglutaryl coenzyme A reductase inhibitor) is beneficial for primary prevention of cardiovascular events in patients younger than age 65 years with hyperlipidemia, yet there is uncertainty about using these agents for primary prevention in octogenarians. We present the case that can be made for not treating octogenarians with statins for the primary prevention of cardiovascular disease. This case is built on three points: 1) cholesterol levels are not associated with cardiovascular disease events in octogenarians without overt coronary artery disease; 2) no randomized, controlled trials have assessed the role of statins in reducing events in octogenarians without coronary artery disease; and 3) statins may increase risks of myositis, rhabdomyolysis, and cancer in the elderly. In view of gaps in the current evidence and the resulting clinical uncertainty, it is unclear whether the balance of risk and benefit favors treatment for the primary prevention of coronary artery disease in octogenarians. The use of statins in this age group should be based on patient preference.
Thrombolytic Therapy Is Indicated for Patients Over 75 Years of Age With ST‐Elevation Acute Myocardial Infarction: Protagonist Viewpoint
Authors: Rich Michael W.
Published: February 2007

Although the benefits of thrombolytic therapy are well established in patients younger than age 75 years with acute ST‐elevation myocardial infarction, the value of thrombolytic treatment in patients 75 years of age or older remains controversial. This is due in part to conflicting data from clinical trials and observational studies and in part because of concerns about increased risk for major bleeding complications in the very elderly, particularly intracranial hemorrhage. However, in a recent meta‐analysis based on data from 3322 patients aged 75 years or older presenting with ST‐elevation myocardial infarction within 6 hours of symptom onset, thrombolytic therapy was associated with an absolute mortality reduction of 3.4% (26.0% vs. 29.4%), an effect similar to that seen in younger patients. In addition, although the risk of stroke increased with age, the absolute excess risk of stroke in patients older than age 75 years receiving thrombolytic treatment was <1%, and there was no age‐associated excess in the risk of other major bleeding complications. These findings indicate that thrombolytic therapy is beneficial in carefully selected elderly patients with acute myocardial infarction and that the risk of major adverse events is acceptably low.
Are Statins Indicated for the Primary Prevention of Coronary Heart Disease in Octogenarians? Protagonist Viewpoint
Authors: Stone Neil J.
Published: February 2007

Statins should be given to octogenarians for primary prevention of coronary heart disease. There is a substantial burden of disease and disability in this population that statin treatment can address in an effective manner. It has been shown that statin treatment is both effective and safe, and details of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial are reviewed. It may be useful to “tease out” those at particularly high risk who would benefit from statin treatment. In this regard, a low high‐density lipoprotein cholesterol level, high‐sensitivity C‐reactive protein level, and subclinical measures of atherosclerosis may be particularly useful.
Alcohol Consumption and Abnormalities of Brain Structure and Vasculature
Authors: Mukamal Kenneth J.
Published: February 2007

Research on how alcohol consumption influences the structure and blood supply of the brain has generally focused on two primary areas of interest: the atrophic effect of heavy drinking on brain structure and the effects of moderate and heavy drinking on the risk of stroke. Heavy alcohol consumption results in atrophy of gray and white matter, particularly in the frontal lobes, cerebellum, and limbic structures. Heavy drinking also raises the risk of ischemic and hemorrhagic stroke, while light drinking is associated with a lower risk of ischemic stroke. Recently, the author and his colleagues studied alcohol consumption and prevalence of subclinical abnormalities detected by magnetic resonance imaging of the brain among 3376 older adults enrolled in the Cardiovascular Health Study. They found that alcohol consumption was positively associated with measures of brain atrophy and inversely associated with subclinical infarcts in a dose‐dependent manner. Alcohol consumption and white matter lesions had a U‐shaped relationship, with the lowest prevalence among those who consumed 1–6 drinks per week. Further research is needed to determine how these associations interact to influence overall brain function.
Atrial Myxomas in the Elderly: A Case Report and Review of the Literature
Authors: Vasquez Alejandro , Sethi Gulshan , Maximov Michael , Marcus Frank I.
Published: February 2007

Although rare, atrial myxomas constitute the most common benign cardiac tumor. The diagnosis of myxomas in the elderly has traditionally been considered an even more unusual phenomenon. Most recently, with the advent of more accurate imaging techniques, their incidence in the elderly has been noted to be higher than originally described. Atrial myxomas should be included in the differential diagnosis of elderly patients presenting with progressive, nonspecific constitutional complaints, since early diagnosis and surgical removal can lead to quick resolution of symptoms and avoidance of devastating complications like peripheral embolism and valve dysfunction.
Diastolic Heart Failure: A Difficult Problem in the Elderly
Authors: Banerjee Prithwish , Clark Andrew L. , Cleland John G.F.
Published: February 2007

Heart failure with normal systolic function has been equated to diastolic heart failure (DHF). DHF appears to be quite common in the elderly, especially in elderly women with hypertension. Recent epidemiologic studies suggest that 30%–50% of patients with heart failure may have DHF. Morbidity for DHF is considerable and comparable to that of heart failure with left ventricular systolic dysfunction. Both groups of patients have similar rates of recurrent hospitalization and cost of care. Long‐term mortality also appears to be similar in the two groups of patients. With the aging of the population, the numbers of patients with DHF will continue to rise and are likely to contribute significantly to the burden of disease caused by heart failure. Unfortunately, as yet, no reliable definition has been found for DHF. Currently the diagnosis of DHF is often made by exclusion, and treatment is empirical and unsatisfactory because of the lack of large‐scale, randomized, controlled trials in this area; however, several large and other smaller trials are currently in progress that will hopefully provide some answers.
Subclinical Cardiovascular Disease in Older Adults: Insights From the Cardiovascular Health Study
Authors: Chaves Paulo H.M. , Kuller Lewis H. , O'Leary Daniel H. , Manolio Teri A. , Newman Anne B.
Published: February 2007

Knowledge about the epidemiology of subclinical cardiovascular disease (SCVD) in older adults may hold the key for improved opportunities for primary prevention of cardiovascular disease (CVD), a top clinical and public health priority. This review reports findings on the prevalence of SCVD and the ability of SCVD measures to predict incident and adverse outcomes from one of the largest (N=5888) and most comprehensive prospective observational studies on SCVD in older adults, the Cardiovascular Health Study. According to a composite index that combined SCVD measures from different vascular beds, the overall prevalence of SCVD was 37%, making it as common as clinically overt CVD in older adults. SCVD measures strongly predicted incident CVD, stroke, mortality, frailty, and physical and cognitive decline, even after adjustment for traditional CVD risk factors. Ongoing research will address the potential use of SCVD for clinical decision making in older adults.
Congestive Heart Failure in the Elderly: The Cardiovascular Health Study
Authors: Mathew Sunil T. , Gottdiener John S. , Kitzman Dalane , Aurigemma Gerard , Gardin Julius M.
Published: February 2007

Congestive heart failure in the elderly is recognized as a national public health priority; however, clinical diagnosis can be problematic in elderly persons, many of whom have a history of heart failure in the presence of normal or only minimally decreased ejection fraction. Findings of the Cardiovascular Health Study have underscored the common substrate and predictors underlying heart failure both with decreased ejection fraction and with normal ejection fraction (i.e., diastolic heart failure). Coronary heart disease, systolic blood pressure, and C‐reactive protein (a measure of inflammation) are predictive of heart failure independent of ejection fraction. Left atrial size, arguably a marker of the effects of impaired diastolic filling over time, is increased in both systolic and diastolic heart failure of the elderly, as is atrial natriuretic peptide. The outcome of heart failure in elderly persons is poor both for systolic and diastolic heart failure. Moreover, many community‐dwelling elderly persons have decreased ejection fraction without heart failure. In these persons the chance of death is similar to that of participants with diastolic heart failure. Since most clinical trials have studied younger patients with predominantly systolic heart failure, the appropriate therapy for heart failure in elderly persons remains to be determined.
Lifestyles of Older Adults: Can We Influence Cardiovascular Risk in Older Adults?
Authors: Mozaffarian Dariush , Fried Linda P. , Burke Gregory L. , Fitzpatrick Annette , Siscovick David S.
Published: February 2007

Influences of lifestyle habits on cardiovascular disease risk among older adults are not well established. The authors present evidence from the Cardiovascular Health Study that dietary, physical activity, and smoking habits assessed late in life are associated with cardiovascular disease risk among adults aged 65 years or older. Persons consuming fatty fish twice per week had a 47% lower risk of coronary death compared with those who consumed fatty fish less than once per month, while cereal fiber intake (about two whole‐grain bread slices per day) was associated with a 14% lower risk of myocardial infarction or stroke. Modest alcohol intake (1–6 drinks per week) predicted the fewest subclinical cerebrovascular abnormalities. Compared with little activity, moderate and high leisure‐time activity predicted 28% and 44% lower mortality, respectively, while compared with nonexercisers, low, moderate, and high exercise intensity predicted 30%, 37%, and 53% more years of healthy life, respectively. Former and current smokers had 25% and 44% fewer years of healthy life than those who never smoked; lifetime smoking (pack‐years) predicted higher mortality. Clinical practice and public health implications, gaps in knowledge, and future research directions are summarized.
Traditional and Novel Risk Factors in Older Adults: Cardiovascular Risk Assessment Late in Life
Authors: Mukamal Kenneth J. , Kronmal Richard A. , Tracy Russell P. , Cushman Mary , Siscovick David S. ,   for the Cardiovascular Health Study
Published: February 2007

As a population‐based, longitudinal study of nearly 6000 older American adults, the Cardiovascular Health Study provides an excellent opportunity to assess the roles of traditional and novel cardiovascular risk factors in the development of coronary heart disease. Cardiovascular Health Study investigators have analyzed both traditional risk factors, such as diabetes, hypertension, and smoking, and new risk factors, such as hemostatic factors, inflammatory markers, exposure to infectious agents, and genetic determinants. These analyses have led to several important conclusions. First, older adults without previous cardiovascular events have a tremendous burden of subclinical vascular disease, which may change how physicians view risk factor modification in this age group. Second, some traditional cardiovascular risk factors lose importance as predictors of cardiovascular disease among older adults. Third, even modest elevations in fasting blood glucose or systolic blood pressure—below the levels used to define diabetes or hypertension—may have prognostic implications. Fourth, novel cardiovascular risk factors may add further information about cardiovascular disease risk in older adults. Promising potential candidates identified in the Cardiovascular Health Study include markers of hemostatic activation, fibrinogen, factor VIII coagulant activity, C‐reactive protein, and exposure to herpes simplex virus‐1 and possibly chlamydia. Future Cardiovascular Health Study investigations will help to clarify which combination of traditional and newer risk factors provides the best estimate of cardiovascular risk for older adults.
Medications and Cardiovascular Health in Older Adults: Room for Improvement in Prevention and Treatment
Authors: Rhoads Caroline S. , Psaty Bruce M. , Olson Jean L. , Furberg Curt D.
Published: February 2007

While cardiovascular disease remains the most common cause of death in older adults, treatments are now available that are associated with significant improvements in both morbidity and mortality. The Cardiovascular Health Study trials of drug use in older adults reviewed here show that in a racially and geographically diverse cohort of community‐dwelling elders, effective treatments were underused during the 1990s. Most participants with hyperlipidemia, atrial fibrillation, and congestive heart failure did not receive therapies known to reduce morbidity and mortality, and when treatment was initiated, those at highest risk were no more likely to start treatment than those at lower risk. The use of drugs with evidence of efficacy in the prevention of stroke and congestive heart failure in hypertensive participants decreased with time, and control of hypertension and hyperlipidemia were particularly low in diabetics. The impact of this undertreatment on older persons and on society is likely to be substantial.
Cardiopulmonary Resuscitation Programs Revisited: Results of a Community Study Among Older African Americans
Authors: Demirovic Jasenka
Published: February 2007

Early cardiopulmonary resuscitation (CPR) performed by a layperson and prompt defibrillation in the field are critical links in the chain of survival of out‐of‐hospital sudden cardiac arrest. It has been suggested that minorities, women, and elderly persons are often left out of CPR training programs. To examine knowledge and attitudes toward CPR and automatic external defibrillation among African Americans, the author and colleagues conducted home interviews in a population sample of 425 older men and women in Miami‐Dade County, FL. It was found that 25% of the participants did not know what CPR was. Only 18% of men and 28% of women had ever taken CPR classes. Mean age the time of CPR training was for men 36 years and for women 46 years. About 74% of all subjects did not know whom to contact for CPR training, and fewer than 5% knew about the American Heart Association Heartsaver Program (including automatic external defibrillation performed by laypersons). The majority of participants suggested churches or community organizations as organizers of CPR training. This study shows that there is a major need for improving knowledge and intensifying CPR training programs among older African Americans. Community organizations and churches may play a critical role in reaching this goal.
Usefulness of Live Three‐Dimensional Transthoracic Echocardiography in Aortic Valve Stenosis Evaluation
Authors: Vengala Srinivas , Nanda Navin C. , Dod Harvinder S. , Singh Vikramjit , Agrawal Gopal , Sinha Ashish , Khanna Deepak , Upendram Sailendra K. , Chockalingam Anand , McGiffin David C. , Kirklin James K. , Pacifico Albert D.
Published: February 2007

Aortic valve stenosis (AS) severity can be estimated by various modalities. Due to some of the limitations of the currently available methods, the usefulness of live three‐dimensional transthoracic echocardiography (3D TTE) in the assessment of AS was explored. Live 3D TTE was able to visualize the aortic valve orifice in all 11 patients studied. Live 3D TTE correctly estimated the severity of AS in all 10 patients in whom AS severity could be evaluated at surgery. These included eight patients with severe AS and two with moderate AS. Two of these 10 patients with AS had associated hypertrophic cardiomyopathy and underwent myectomy at the time of aortic valve replacement. Aortic valve orifice area measurements by live 3D TTE correlated well with intraoperative three‐dimensional transesophageal echocardiographic reconstruction measurements (r=0.85) but not as well with two‐dimensional transesophageal echocardiography measurements (r=0.64). Live 3D TTE measurements of the aortic valve orifice area also did not correlate well with two‐dimensional transthoracic echocardiography measurements (r=0.46) but the number of patients studied with two‐dimensional transthoracic echocardiography was smaller (only seven) and four of these did not undergo two‐dimensional transthoracic echocardiography at the authors' institution. Altogether, four patients with severe AS by live 3D TTE, and subsequently confirmed at surgery, were misdiagnosed as having moderate AS by two‐dimensional transthoracic echocardiography. Because it is completely noninvasive and views the aortic valve in three dimensions, 3D TTE could be a useful complement to the existing modalities in the evaluation of AS severity.
Depression and Health Status in Elderly Patients With Heart Failure: A 6‐Month Prospective Study in Primary Care
Authors: Sullivan Mark D. , Newton Katherine , Hecht Julia , Russo Joan E. , Spertus John A.
Published: February 2007

To determine the prevalence and effects of depression on health status among elderly outpatients with heart failure, the authors conducted a 6‐month prospective cohort study of 139 older outpatients with heart failure managed in primary care and 80 of their spouses. Primary care heart failure diagnosis was confirmed through chart review. The Primary Care Evaluation of Mental Disorders psychiatric diagnostic interview and Hamilton Depression Rating Scale were administered by phone. EQ‐5D feeling thermometer, Medical Outcomes Study Short Form 36‐Item Questionnaire, Kansas City Cardiomyopathy Questionnaire, and heart failure symptom severity questionnaires were administered by self‐report. Depression diagnoses at baseline were: major depression and/or dysthymia (n=12, 9%), minor depression (n=14, 10%), and no depression (n=113, 81%). After adjusting for age, gender, and medical comorbidity, these depression groups differed by repeated measures analysis of covariance on most health status measures including the EQ‐5D feeling thermometer; Medical Outcomes Study Short Form 36‐Item Questionnaire general health and physical role function subscales; Kansas City Cardiomyopathy Questionnaire total score, symptom total, physical limitations, and quality of life subscales; as well as severity of chest pain and fatigue. Depression has significant and persistent effects on health status of elderly patients with heart failure, including heart failure symptoms, physical and role function, and quality of life. This may help explain why depression has been associated with increased health care utilization and costs in this population.
A Case‐Control Study on the Prevalence of Electrocardiographic Rhythms and Ischemic Changes in Elderly Patients With Acute Cerebrovascular Disease
Authors: Ngeh Joseph K.T.
Published: February 2007

Electrocardiographic (ECG) abnormalities have been observed in acute cerebrovascular events. This case‐control study investigated the prevalence of ECG rhythms and ischemic changes in elderly stroke and medical patients. The ECG rhythms and ischemic changes of 97 elderly patients admitted with acute stroke or transient ischemic attack (TIA) were compared with those of 70 medical controls admitted during the same study period. Patients' median age was 80 years. Atrial fibrillation occurred in 26 stroke/TIA patients (27%) and 17 control patients (24%). Ischemic ECG changes occurred in 54 stroke/TIA patients (56%) and 32 control patients (46%) (odds ratio, 1.52; 95% confidence interval, 0.82–2.83; p=0.18). Seventeen stroke/TIA patients (18%) vs. 19 (27%) control patients had a history of ischemic heart disease. After adjustment for ischemic heart disease, the odds ratio for ischemic ECG changes was 1.80 (95% confidence interval, 0.93–3.45; p=0.079). Atrial fibrillation accounted for a quarter of ECG rhythms in elderly acute stroke/TIA patients and elderly medical patients. The high frequency of ischemic ECG changes found in the stroke/TIA patients was not significantly different from that in the control patients. After adjustment for ischemic heart disease, there emerged a trend of borderline significance to suggest that ischemic ECG changes were more strongly associated with elderly acute stroke/TIA patients than elderly control patients. Larger outcome study will be required to determine the significance of ischemic ECG changes following acute cerebrovascular events in older patients.
Presenting Symptoms, Admission Electrocardiogram, Management, and Prognosis in Acute Coronary Syndromes: Differences by Age
Authors: Stern Shlomo , Behar Solomon , Leor Jonathan , Harpaz David , Boyko Valentina , Gottlieb Shmuel ,   for the Israeli Working Group on Intensive Cardiac Care, Israel Heart Society
Published: February 2007

In a nationwide survey conducted in all 26 hospitals in Israel during February and March 2000, data were collected on 2133 consecutive acute coronary syndrome patients. The patients were divided into three age subgroups: <65years (n=974), 65–74 years (n=500), and ≥75years (n=639). The frequency of no anginal pain/atypical symptoms on presentation increased with age for all acute coronary syndrome patients (14%, 21%, and 32%, in the three age subgroups, respectively; p for trend <0.0001). The frequency of ST‐elevation on admission electrocardiogram decreased with advancing age (59%, 46%, and 42%, in the three age subgroups, respectively; p for trend <0.0001), whereas ST‐depression gradually increased (14%, 24%, and 28%, respectively; p for trend <0.0001). In multivariate analysis, variables associated with no anginal pain/atypical symptoms on presentation (in decreasing order) were: history of heart failure, age, lack of past angina, diabetes, and nonsmoking. ST‐elevation was inversely associated with no anginal pain/atypical symptoms on admission (odds ratio, 0.48; 95% confidence interval, 0.37–0.63). The use of acute reperfusion therapy significantly declined with advancing age. Seven‐day, 30‐day, and 1‐year mortality increased with advancing age. No anginal pain/atypical symptoms on presentation were associated with an increased early and late mortality in all three age subgroups.
Treatment of Elderly Hypertensive Patients With a Delayed‐Release Verapamil Formulation in a Community‐Based Trial
Authors: Weber Michael A. , Prisant L. Michael , Black Henry R. , Messerli Franz H.
Published: February 2007

This report of a practice‐based clinical trial describes an open‐label, multicenter dose‐titration study of an elderly (age ≥65 years) subset of patients (N=628) with systolic blood pressures between 140 and 179 mm Hg or diastolic blood pressures between 90 and 109 mm Hg, to assess the effects of the Chronotherapeutic Oral Drug Absorption System (CODAS) formulation of verapamil hydrochloride. After starting 200 mg/d at bedtime, dosing was titrated to a maximum of 400 mg/d at 4‐week intervals to achieve a target blood pressure of <140/<90 mm Hg using morning blood pressure measurements. Target blood pressure was reached in 57.1% of the elderly patients with CODAS verapamil monotherapy. A diastolic response (<90 mm Hg or a 10 mm Hg reduction from baseline) was achieved in 89.5% of these subjects, and a systolic blood pressure response (<140 mm Hg or 10% reduction from baseline) was attained in 75.5%. The percentages of patients achieving target blood pressure or the diastolic and systolic blood pressure responses were comparable to those previously reported for younger patients. It is notable that although 359 of the 628 patients reached control on treatment, 182 of the remaining 269 noncontrolled patients were not titrated to higher doses, indicating that even with a well tolerated drug there may be reluctance among clinicians to increase doses. CODAS verapamil was found to be efficacious and well tolerated among elderly hypertensive patients in this community trial.
Angiotensin II Receptor Blockers in Older Patients
Authors: Weber Michael A.
Published: February 2007

Older patients with hypertension are often inadequately treated due to misconceptions regarding reasonable goal blood pressures or concerns about treatment side effects. Adequately treating hypertension can yield impressive benefits in terms of improved morbidity and enhanced quality of life in persons of any age. Antagonists of the renin‐angiotensin‐aldosterone system are especially effective in older persons, many of whom have concomitant conditions such as diabetes mellitus, renal dysfunction, and other cardiovascular risk factors. Treatment with angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers has been shown to improve many of the complications of hypertension, including left ventricular hypertrophy and renal disease. Results of recent key studies such as Losartan Intervention For Endpoint Reduction in Hypertension (LIFE), Valsartan in Heart Failure Trial (Val‐HeFT), Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM), and Valsartan in Acute Myocardial Infarction (VALIANT) add to the evidence that angiotensin II receptor blockers are well suited for the treatment of hypertension in older patients. These trials also indicate that they are appropriate therapy for heart failure patients and for patients who have experienced acute myocardial infarction, particularly those who are unable to tolerate an angiotensin‐converting enzyme inhibitor.
Breaking the “Bad” News to Patients and Families: Preparing to Have the Conversation About End‐of‐Life and Hospice Care
Authors: Arnold Robert L. , Egan Kathleen
Published: February 2007

The ability to compassionately communicate difficult or “bad news” to a patient and family is essential to the provision of quality care at the end‐of‐life. Preparing to have these conversations requires a deliberate multilevel approach that includes: 1) becoming comfortable with end‐of‐life issues; 2) understanding the scope of the experiences from the patient's and family's perspectives; 3) understanding the full range of choices and options you can offer patients and families regarding their care (including hospice care); 4) developing a “can do” approach toward your involvement with end‐of‐life care; and 5) learning to effectively share and receive information in a compassionate manner. The following article explores this multilevel approach in an effort to assist physicians and other health care professions in supporting patients and families in their transition from curative care to hospice and palliative care.
Immunological evaluation of personalized peptide vaccination with gemcitabine for pancreatic cancer
Authors: Yanagimoto Hiroaki , Mine Takashi , Yamamoto Koutaro , Satoi Sohei , Terakawa Naoyoshi , Takahashi Kanji , Nakahara Kimika , Honma Shigenori , Tanaka Masahiro , Mizoguchi Junko , Yamada Akira , Oka Masaaki , Kamiyama Yasuo , Itoh Kyogo , Takai Soichiro
Published: February 2007

The aim of the present study was to investigate the safety and immune responses of personalized peptide vaccination when administered with gemcitabine (GEM) in advanced pancreatic cancer (APC) patients. Thirteen patients with APC were enrolled. Pre‐vaccination with peripheral blood mononuclear cells and plasma was carried out to examine cellular and humoral responses to 25 or 23 peptides in human leukocyte antigen A24++ or A2+++ patients, respectively. Only the reactive peptides (maximum of four) were then administered weekly at three different dose settings: 1, 2 and 3 mg of peptide. GEM was administered at 1000 mg/m2 per week for 3 weeks, followed by 1 week of rest. The combination therapy was well tolerated. Grade 3 toxicities were: anemia (three patients), neutropenia (two patients) and thrombocytopenia (two patients). Of these 13 patients, 11 (85%) showed clinical responses, such as reduction in tumor size and/or level of tumor markers. Augmentation of peptide‐specific cytotoxic T lymphocyte activity against pancreatic cancer cells was observed at each dose level, whereas the increment of peptide‐specific IgG antibodies was dependent on peptide dose. GEM did not inhibit the immune responses induced by personalized peptide vaccinations, and this new type of immunochemotherapy combination is recommended for further clinical study in APC patients. (Cancer Sci 2007; 98: 605–611)
Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment
Authors: Karno Mitchell P. , Longabaugh Richard
Published: February 2007

Aims  This study assessed the predictive validity of the level of matching and mismatching between patients' personal attributes and aspects of outpatient psychotherapy they received.

Design and participants  On the basis of patient‐by‐treatment interactions observed for this sample in previous research, patients with alcohol abuse or dependence (n = 137) were designated retrospectively as being matched, unmatched or mismatched on each of four patient and treatment variable pairings. These pairings included (1) patient depressive symptoms and therapy emotion focus, (2) patient trait anger and therapy confrontation, (3) patient interpersonal reactance and therapy confrontation and (4) patient interpersonal reactance and therapy structure.

Measurements  Analyses of variance and logistic regression were used to assess the individual and additive effects of being matched and mismatched on the percentage of abstinent days (PDA) and recovery status in the year after treatment.

Findings  Being mismatched on any of the four patient–treatment pairings was a significant predictor of more frequent alcohol use post‐treatment. Being matched on only two pairings predicted less frequent alcohol use, namely matches on therapy emotion focus with patient depressive symptoms and therapy structure with patient reactance. Matches appeared to optimize otherwise good outcomes, while mismatches had larger effect sizes and tended to predict relatively poor outcomes. The data supported the presence of an additive effect for mismatches on post‐treatment PDA. The group with the most mismatches fared considerably worse than a group with fewer mismatches. Several matches and mismatches also predicted recovery status, with some support found for additive effects.

Conclusions  Mismatches between patient attributes and treatment appear to have serious consequences, and this effect is magnified with multiple mismatches. Matches, on the other hand, while beneficial, may not be necessary to achieve good outcomes.
Child welfare workers who are exhausted yet satisfied with their jobs: how do they do it?
Authors: Stalker Carol A. , Mandell Deena , Frensch Karen M. , Harvey Cheryl , Wright Margriet
Published: February 2007

In response to a study of Canadian child welfare workers that unexpectedly found participants scoring high on a measure of emotional exhaustion (burnout) and, at the same time, high on overall job satisfaction, this paper reviews research that has investigated these constructs in the social work literature as well as in selected studies from sociology, social psychology, management and women’s studies. The review reveals that some previous studies also report the coexistence of high levels of emotional exhaustion and strong job satisfaction in child welfare and social worker samples. Several studies have suggested that individual characteristics, including finding reward in helping others, having a commitment to the mandate of child welfare and believing that one’s labour is ‘making a difference’, contribute to satisfaction with child welfare work in spite of work overload and emotional exhaustion. Attributions regarding causes of exhaustion, coping strategies and goal orientation may also attenuate the expected negative effects of emotional exhaustion. Considerable evidence supports the positive influence of variables organizational managers can control, including job autonomy, supportive supervisors, workload, promotional opportunities and perception of personal safety. The degree to which this phenomenon is associated with female socialization and the ‘ethic of care’ underlying social work is discussed. Implications for child welfare research, practice and policy are offered.
Congruence and co‐operation in social workers’ assessments of children in need
Authors: Platt Dendy
Published: February 2007

This paper examines the concepts of congruence and co‐operation in social work practice with children and families. It describes findings from the author’s own research and attempts to deconstruct the interaction of the two phenomena. Using material from other published research, the paper proposes a model and suggests methods for analysing congruence and co‐operation in the practice context. The key implication is that the depth of a social worker’s understanding of a family situation may affect his or her assessment of parental co‐operation.