bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal and Regional Variability in the Surgical Treatment of Cancer Among Older People
Authors: Farrow Diana C. , Hunt William C. , Samet Jonathan M.
Published: April 2015

OBJECTIVES: Numerous studies have documented that older individuals with cancer have been treated less aggressively than younger individuals. We utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program to assess geographic variation in the effects of age on the surgical treatment of cancer and to examine temporal trends in the treatment of older people between 1973 and 1991.

DESIGN: Ecological analyses comparing time trends of treatment in nine regions over a 19‐year period.

SETTING: Population‐based data for nine geographic areas of the United States.

PARTICIPANTS: Persons with incident cancer of the breast, colon, rectum, lung, ovary, uterus, pancreas, and stomach residing in these regions during the selected years. RESULTS: After age 64, the percentage of patients treated surgically decreased with increasing age for every cancer site studied. Between 1973 and 1991, the likelihood of receiving surgery for cancers of the uterus, colon, rectum, ovary, and breast increased more rapidly among patients ages 65 years and older than among those under age 65. This relative decrease occurred consistently across most geographic areas should For cancers of the lung, stomach, and pancreas, the effect of age of age on the likelihood of receiving surgery did not diminish through the period under study.: CONCLUSIONS: Although older people remain less likely to receive surgical therapy than younger persons, for some important cancer sites the gap between the treatment of older and younger individuals narrowed from 1973 through 1991.
Factors Associated with Institutionalization of Older People in Canada: Testing a Multifactorial Definition of Frailty
Authors: Rockwood Kenneth , Stolee Paul , McDowell Ian
Published: April 2015

OBJECTIVES: To test a model of frailty by examining factors associated with institutionalization of older people in Canada; to assess whether diagnostic data provided information about risk beyond that provided by data on functional capacity and demographic variables.

METHODS: Cross‐sectional study of 1258 institutional subjects and 9113 community‐dwelling older adults from the Canadian Study of Health and Aging.

RESULTS: Multiple logistic regression analysis showed that female gender, being unmarried, absence of a caregiver, presence of cognitive impairment (including all types of dementia), functional impairment, diabetes mellitus, stroke, and Parkinson's disease were independently associated with being in a long‐term care facility.

CONCLUSION: Frailty appears to be a multidimensional construct, and not simply a synonym for dependence in Activities of Daily Living. Studies of health outcomes in older people should include diagnostic data as well as demographic information and data on functional capacity.
Gender Differences in the Behavioral Manifestations of Alzheimer's Disease
Authors: Ott Brian R. , Tate Charlene A. , Gordon Norman M. , Heindel William C.
Published: April 2015

OBJECTIVE: To examine the relationship between gender and specific types of behavior problems that occur in patients with Alzheimer's disease.

DESIGN: This was an observational study using the Dementia Behavior Disturbance Scale to quantify and define behavioral problems encountered by caregivers. Multiple regressions were used to control for the possible influence of dementia severity as measured by the Mini‐Mental State Examination and the duration of dementia.

SETTING: Patients were sampled from the outpatient dementia clinics of Roger Williams Hospital and Miriam Hospital in Providence, Rhode Island.

PARTICIPANTS: A total of 125 patients with probable Alzheimer's disease, defined by NINCDS‐ADRDA diagnostic criteria, were included in the study. There were 75 women and 50 men.

MAIN OUTCOME MEASURES: Caregivers rated the presence and frequency of 28 different behavior problems from the Dementia Behavior Disturbance Scale. Domains of behavior disturbance were then defined by a factor analysis of the data.

RESULTS: Male and female groups were comparable for the demographic variables of age, education, and duration of dementia, as well as severity of depression, degree of cognitive impairment and overall severity of behavior disturbance. Among the six behavior factors that were defined, two were significantly related to gender. One factor, which included apathy and vegetative signs, was related to male gender; a second factor, which included reclusiveness and emotional lability, was related to female gender.

CONCLUSIONS: Although overall severity of behavior disturbance in Alzheimer's disease may be related primarily to severity of dementia, significant differences in the types of behaviors manifested exist between males and females with the disease.
MODELS OF GERIATRICS PRACTICE: Decreased Hospital Utilization By Older Adults Attributable to a Home Hospitalization Program
Authors: Reuben David B. , Stessman Jochanan , Ginsberg Gary , Hammerman‐Rozenberg Robert , Friedman Reuven , Ronen David , Israeli Avi , Cohen Aaron
Published: April 2015

OBJECTIVE: To evaluate the cost effectiveness of a short‐term home health care program for older people, Home Hospitalization (HH), compared with the alternative of regular ambulatory care with general or geriatric hospitalization as necessary.

SETTING: Our HH was initiated in November 1991 to serve Jerusalem residents. Program staff included physicians, nurses, and paramedical professionals. Other medical/hospital services were provided nonselectively by the general medical personnel of the various hospitals in Jerusalem.

STUDY DESIGN: Patients over the age of 65 were either referred to the HH program (study group; n = 36,500) or to routine medical care (control group; n = 9000) depending on their Sick Fund assignment. Hospital utilization rates per enrollee were studied prospectively and compared both between the two groups and with hospitalization rates in the year before the initiation of the program.

RESULTS: During the first 26 months of operation, the HH program cared for 741 older persons for a total of 37,290 days' care at an average daily cost of $30.06 (1992) and $23.64 (1993). Annual general hospitalization rates per person declined in the study group from 2.80 days in the 1991 baseline period to 2.65 days in 1992 and to 2.54 days in 1993. Hospitalization rates in the control group increased from 2.62 in 1991 to 2.70 days/member and 2.71 days/member in 1992 and 1993, respectively. Annual geriatric hospitalization rates declined considerably in the study group from the 1991 baseline of 1.49 to 1.34 (1992) to 1.33 (1993). The control group experienced a small decrease from 1.64 (1991) to 1.58 (1992) and then a rise to 1.68 days per member in 1993.

For the 26‐month duration of the program, estimated savings of 20,773 general hospital days ($5.54 million) and 8486 geriatric hospital days ($0.98 million) exceeded its costs ($0.97 million), providing a cost/benefit ratio of 5.7/1. In addition, patient satisfaction was high.

CONCLUSION: The HH program provided a cost effective substitute for care in a geriatric or general hospital for Jerusalem's elderly.
Hepatitis B Virus Vaccination for Older Adults
Authors: Bennett Richard G. , Powers Douglas C. , Remsburg Robin E. , Scheve Ann , Clements Mary Lou
Published: April 2015

OBJECTIVE: To compare in adults more than 50 years old the tolerability and immunogenicity of vaccination with recombinant hepatitis B surface antigen (HBs) compared with vaccination with recombinant hepatitis B protein PreS2+S, and to investigate the safety and immunogenicity of a fourth vaccine dose in poor and non‐responders.

DESIGN: Randomized, double‐blind prospective study.

SETTING: General clinical research center for outpatient evaluation and vaccination.

SUBJECTS: Adults older than age 50 who were in general good health and with no known risk factors for acquiring or serologic evidence of hepatitis B virus infection.

INTERVENTION: Subjects were randomized to receive 10 mcg HBs (Recombivax®, Merck, Sharp and Dohme), 12 mcg PreS2+S, or 24 mcg PreS2+S vaccine at 0, 1, and 6 months. Poor and non‐responders (anti‐Hbs < 10 mIU/mL at month 9 and/or 12) were encouraged to receive a fourth vaccine injection.

MEASUREMENTS: Diary records of temperature and local and systemic reactions following each vaccination were maintained by all subjects. Anti‐HBs levels were measured by radioimmunoassay before the first injection, at 1, 2, 3, 6, 7, 9, and 12 months after for all subjects, and 1 month after the fourth injection for the group of poor and non‐responders.

MAIN RESULTS: Twenty men and nine women (mean age ± SD, 66 ± 8.0 years) were enrolled. Ten subjects received HBs vaccine, nine received 12 mcg PreS2+S vaccine, and 10 received 24 mcg PreS2 + S vaccine. One subject in the HBs group dropped out, and data were analyzed for the remaining 28 subjects. There were no differences in rates of side effects reported by each of the three groups. Overall, minor local adverse reactions occurred in 12 (40%) after at least one of the first three vaccinations. Systemic side effects occurred in five (17%) after the first vaccination, in one after the second, but in none after the third. The 24‐mcg PreS2+S vaccine was not more immunogenic than the HBs vaccine, and the 12‐mcg PreS2+S vaccine was judged inadequate. Nineteen of 22 (86%) poor and non‐responders received a fourth vaccination. Minor local adverse reactions were reported by six (32%), and none reported a systemic side effect. For the 12 subjects receiving a fourth injection of HBs or 24 mcg PreS2 + S vaccine, the proportion of responders 1 month following the fourth injection was greater than for 1 month following the third injection (11 of 12 [92%] versus 12 of 19 [63%], respectively, P < .05).

CONCLUSION: For adults more than 50 years of age who have low anti‐HBs levels after three vaccine injections, a fourth injection is well tolerated and results in improved immunogenic response.
Geriatric Targeting Criteria as Predictors of Survival and Health Care Utilization
Authors: Satish Shiva , Winograd Carol Hutner , Chavez Catherine , Bloch Daniel A.
Published: April 2015

OBJECTIVE: To assess the utility of geriatric targeting criteria in predicting survival and health care utilization in a cohort of hospitalized older veterans.

DESIGN: A prospective cohort study assessing geriatric targeting criteria, e.g., polypharmacy, falls, or confusion, with respect to adverse outcomes at 12 months.

SETTING

A Tertiary Care VA Medical Center.

PATIENTS: 507 acutely hospitalized male veterans aged 65 years or more.

MAIN OUTCOME MEASURES: Survival status, nursing home placement, and total hospital days during 12 months following hospital admission.

RESULTS: Patients who had a higher number of targeting criteria at admission showed a significantly increasing trend toward death (P ≤ .001), nursing home placement (P ≤ .01), and longer hospital stays (P ≤ .01) at 12 months. In univariate analyses, weight loss (relative hazard 3.8, 95% CI 2.4, 5.9), appetite loss (relative hazard 3.3, 95% CI 1.9, 5.8), depression (relative hazard 2.5, 95% CI 1.4, 4.5), falls (relative hazard 2.2, 95% CI 1.2, 4.1), confusion (relative hazard 2.2, 95% CI 1.2, 4.0), and socioeconomic problems (relative hazard 1.6, 95% CI 1.0, 2.5) predicted death. Polypharmacy (OR 3.4, 95% CI 1.3, 8.8), confusion (OR 4.4, 95% CI 1.5, 13.0), and prolonged bedrest (OR 7.6, 95% CI 1.5, 39.3) predicted nursing home placement. Confusion (Beta 12.0, 95% CI 2.9, 21.3), falls (Beta 14.2, 95% CI 4.2, 24.3), and prolonged bedrest (Beta 22.4, 95% CI 3.9, 41.0) predicted total hospital days. In multivariate analyses, weight loss, depression, and socioeconomic problems predicted death; confusion and polypharmacy predicted nursing home placements; and falls predicted total hospital days.

CONCLUSION: This prospective cohort study of hospitalized older veterans demonstrated geriatric targeting criteria as predictors of adverse hospital outcomes. Our findings suggest screening acutely hospitalized patients using chart abstracted geriatric targeting criteria is useful in identifying patients at risk for adverse outcomes of hospitalization. J Am Geriatr Soc 44:914–921, 1996.
Life Values, Resuscitation Preferences, and the Applicability of Living Wills in an Older Population
Authors: Schonwetter Ronald S. , Walker Robert M. , Solomon Marcy , Indurkhya Alka , Robinson Bruce E.
Published: April 2015

OBJECTIVES: To determine whether life values are related to resuscitation preferences and living will completion in an older population and to assess beliefs about the applicability of living wills.

DESIGN: Individual structured interviews.

SETTING: An independent retirement community.

PARTICIPANTS: One hundred thirty‐two subjects older than 63 years of age.

MEASUREMENTS: Resuscitation preferences were elicited in five hypothetical scenarios. Subjects with living wills were asked whether their living will would play a role in the scenarios. Subjects rated the importance of 13 life value statements.

RESULTS: The percentage of subjects desiring CPR in each scenario was as follows: current condition (66%); acute illness (33%); terminal disease (8%); functional impairment (8%); and dementia (7%). The percentage of those with a living will who thought their living wills would play a role in the scenarios was as follows: acute illness (84%); terminal disease (93%); functional impairment with intact cognition (66%); and dementia (91%). Factor analysis of the life value statements revealed five meaningful factors: quality of life; capacity/autonomy; family relations; physical comfort; and treatment philosophy. Multiple correlations were found between four of five life value factors and hypothetical resuscitation preferences or the presence of a living will.

CONCLUSION: Subjects misinterpreted the applicability of living wills in nonterminal illness scenarios. A relationship between life values and resuscitation preferences was noted, which emphasizes the importance of eliciting and including life values when discussing advance directives. J Am Geriatr Soc 44:954–958, 1996.
Spouse Caregivers' Attitudes Toward Obtaining a Diagnosis of a Dementing Illness
Authors: Connell Cathleen M , Gallant Mary P.
Published: April 2015

OBJECTIVES: To examine attitudes of spouse caregivers about the process of obtaining a diagnosis of a dementing illness, including perceived benefits and obstacles to obtaining a diagnosis and suggestions for improving the process.

DESIGN: A mail survey of spouse caregivers of dementia patients followed by the Michigan Alzheimer's Disease Research Center.

PARTICIPANTS: The 233 spouse caregivers of dementia patients who returned a completed questionnaire.

RESULTS: More than three‐fourths of the sample rated the following benefits of obtaining a diagnosis as very or extremely important: ruling out other causes of memory or behavior problems, allowing family members to get information about dementia, may qualify my spouse for drug treatment, and will allow me to plan for the future. Primary obstacles included the time required to obtain a diagnosis, the cost of procedures, lack of access to physicians trained to diagnose dementing illnesses, and not receiving a referral from a primary care physician (41.6%, 41.0%, 40.8%, and 24.1 % of the sample, respectively, agreed or strongly agreed that the factor posed a barrier to obtaining a diagnosis). Content analysis of responses to two open‐ended questions identified problematic or stressful aspects of obtaining a diagnosis and suggestions for making the process easier for the patient and family.

CONCLUSION: Results suggest the need to provide an orientation to the diagnosis and assessment process for patients and family members, develop a training session for physicians to better prepare them to address the emotional needs of patients and families and to disclose the diagnosis in an informative and compassionate manner, and provide outreach education to primary care physicians to increase knowledge and awareness of dementing illnesses and to increase referrals to community‐based services and health professionals able to address the concerns of family members. J Am Geriatr Soc 44:1003–1009, 1996.
Nocturnal Enuresis in Community‐Dwelling Older Adults
Authors: Burgio Kathryn L. , Locher Julie L. , Ives Diane G. , Hardin J. Michael , Newman Anne B. , Kuller Lewis H.
Published: April 2015

OBJECTIVE: To investigate the prevalence and characteristics of nocturnal enuresis in community‐dwelling older adults and to identify potential predisposing variables.

DESIGN: Interview survey.

SETTING: Five rural counties in northwestern Pennsylvania.

PARTICIPANTS: Subjects were 3884 community‐dwelling older adults aged 65 to 79 years who volunteered for a health promotion demonstration.

MEASUREMENTS: The dependent variable was self‐reported accidental loss of urine during sleep. Independent variables included demographic variables, self‐reported disease history and symptomatology, and standardized screening instruments for depression (CES‐D), dementia (MMSE), and functional status (ADLs).

MAIN RESULTS: Prevalence of nocturnal enuresis was 2.1%, and was significantly higher among women (2.9%) compared with men (1.0%; P < .0001). Compared with subjects with daytime incontinence only, those with nocturnal enuresis reported greater severity and impact of incontinence on several parameters. Enuretics were more likely to have received treatment; treatment outcome, however, was significantly less successful. In univariate analyses, enuresis was significantly associated with symptoms of congestive heart failure (CHF), impairment in activities of daily living, depression, and use of sleep medications at least once per week. In stepwise logistic regression modeling, two symptoms of congestive heart failure and regular use of sleep medication entered the model.

CONCLUSIONS: Nocturnal enuresis appears to be uncommon among older adults, but it may be associated with i poorer therapeutic outcomes compared with the more common forms of daytime incontinence. The findings are consistent with the hypothesis that daytime fluid accumulation followed at night by mobilization of excess fluid is a contributor to enuresis in older adults. J Am Geriatr Soc 44:139–143, 1996.
Prevalence of Use of Beta Blockers and of Calcium Channel Blockers in Older Patients with Prior Myocardial Infarction at the Time of Admission to a Nursing Home
Authors: Aronow Wilbert S.
Published: April 2015

OBJECTIVE

To investigate the prevalence of beta blocker use and calcium channel blocker use in older patients with prior myocardial infarction at the time of admission to a nursing home.

DESIGN

In a prospective study of 500 consecutive patients aged 60 years or older admitted to a nursing home, 202 (40%) had electrocardiographic evidence of Q‐wave myocardial infarction at the time of admission. The prevalence of beta blocker use and of calcium channel blocker use was investigated in these 202 patients with previous myocardial infarction. The prevalence of beta blocker use and of calcium channel blocker use was also investigated in patients with myocardial infarction and abnormal left ventricular (LV) ejection fraction.

SETTING

A large long‐term health care facility.

PATIENTS

The patients included 344 women and 156 men, mean age 81 ± 8 years (range 60 to 100).

MEASUREMENTS AND MAIN RESULTS

Of 500 patients, 202 (40%) had Q‐wave myocardial infarction at the time of admission to the nursing home. Seventeen (8%) of these 202 patients with myocardial infarction were receiving beta blockers and 74 (37%) were receiving calcium channel blockers at the time of admission. Of 171 patients with myocardial infarction who had technically adequate measurements of LV ejection fraction, 59 (35%) had an abnormal LV ejection fraction (<50%). Of the 59 patients with previous myocardial infarction and abnormal LV ejection fraction, four (7%) were receiving beta blockers and 19 (32%) were receiving calcium channel blockers at the time of admission.

CONCLUSIONS

Beta blockers are underutilized, and calcium channel blockers are overutilized in the treatment of older patients with a history of myocardial infarction at the time of admission to a nursing home.
Impact of a 12‐Month Exercise Program on the Physical and Psychological Health of Osteopenic Women
Authors: Bravo Gina , Gauthier Pierre , Roy Pierre‐Michel , Payette Hélène , Gaulin Philippe , Harvey Monique , Péloquin Lucie , Dubois Marie‐France
Published: April 2015

OBJECTIVE: To describe the effect of a supervised physical activity program on the physical and psychological health of osteopenic women.

DESIGN: A randomized controlled trial.

SETTING: Sherbrooke, Quebec, Canada.

PARTICIPANTS: A total of 124 community‐living postmenopausal women, between 50 and 70 years of age, with low bone mass took part in the study.

INTERVENTION: Subjects allocated to the experimental group performed weight‐bearing exercises (walking, stepping up and down from benches), aerobic dancing, and flexibility exercises for 60 minutes, three times a week, over a period of 12 months. All subjects were invited to attend bi‐monthly educational seminars covering topics related to osteoporosis.

OUTCOME MEASURES: Spinal and femoral bone mineral density (BMD), functional fitness (flexibility, coordination, agility, strength/endurance, cardiorespiratory endurance), psychological well‐being, back pain intensity, and self‐perceived health.

RESULTS: Spinal BMD stabilized in the exercisers while decreasing significantly in the controls (P = .031). No change in femoral BMD was observed in either group (P = .597). Four of the five parameters chosen to evaluate functional fitness, namely flexibility, agility, strength, and endurance, were affected positively by the exercise program (all P < .01). Adjusting for prescores by means of an analysis of covariance revealed a significant difference between the groups in psychological well‐being, which favored the exercisers (P = .012). After 12 months, back pain reported by exercisers was lower than that reported by controls (P = .008). Finally, self‐perceived health increased in the exercise group, whereas no difference was observed in the control group (P = .790).

CONCLUSION: These results suggest that after 12 months, exercising can produce a significant increase above initial levels in the functional fitness, well‐being, and self‐perceived health of osteopenic women. Intensity of back pain can also be lowered by exercise. The exercise program succeeded in stabilizing spinal BMD but had no effect on femoral BMD.
Systemic Oxidative Stress and Its Relationship with Age and Illness
Authors: Mezzetti Andrea , Lapenna Domenico , Romano Ferdinando , Costantini Fabrizio , Pierdomenico Sante D. , De Cesare Domenico , Cuccurullo Franco , Riario‐Sforza Giuseppe , Zuliani Giovanni , Fellin Renato ,   Associazione Medica “Sabin”
Published: April 2015

OBJECTIVE: It has recently been proposed that increased oxidative stress may play a role in the aging process and age‐associated degenerative diseases.

DESIGN AND MEASUREMENTS: A cross‐sectional study was carried out to assess the relationship of circulating antioxidants, namely vitamins E and C, β‐carotene, proteic thiols (P‐SH) and ceruloplasmin, and of lipid peroxides, with both aging and aging with disability, i.e., unsuccessful aging.

PARTICIPANTS: One hundred healthy free living and 62 disabled octo‐nonagenarians and 91 healthy adults were enrolled in the study.

RESULTS: Free living and disabled older adults had lower antioxidant and higher lipid peroxide levels than healthy adults, as well as the disabled older adults compared with free living older persons. Using logistic regression, we observed that plasma concentrations of vitamins E and C, P‐SH, and lipid peroxides were independently associated with either aging or aging with disability, apparently representing biochemical indicators of patient status. In particular, aging and unsuccessful aging were associated with higher levels of lipid peroxides independently of circulating levels of vitamins C and E, suggesting that the increased oxidative stress was not merely an effect of a lower dietary intake of antioxidants. Serum ceruloplasmin was significantly higher in free living older adults than in healthy adults, and in the disabled compared with free living octo‐nonagenarians.

CONCLUSIONS: Our findings are consistent with the presence of systemic oxidant load in older adults, and this phenomenon is far more evident in unsuccessful aging.
Characterization of Older Adults Who Attribute Functional Decrements to “Old Age”
Authors: Williamson Jeff D. , Fried Linda P.
Published: April 2015

OBJECTIVE: Understanding the contributors to physical disability in older adults is an important component of the national health objective of expanding disability‐free life by the year 2000. The purpose of this study was to determine the frequency with which older adults attribute their difficulty performing a number of common daily tasks to “old age” and to identify specific conditions and diseases associated with this attribution. Finally we sought to determine the characteristics that might differentiate persons able to attribute their disability to specific conditions from those who cite old age as the etiology of their disability.

DESIGN: A cross‐sectional, observational, study.

SETTING: The Johns Hopkins Functional Status Laboratory.

PARTICIPANTS: Two hundred thirty community‐dwelling volunteers 60 years of age and older who could stand unassisted for ≥1 minute and who were without cognitive impairment.

MEASUREMENTS: A 1‐day evaluation included physical performance evaluations, both performance‐based and self‐reported function for 27 tasks, and self‐report of physician‐diagnosed diseases. Those with difficulty in a task and those who denied difficulty but had changed the method of task performance (modification) because of an underlying health or physical condition were identified and asked to name the cause of their difficulty or task modification; options were specific diseases/medical conditions or “old age.” The prevalence of “old age” citation as a cause of functional limitation, as well as its associated characteristics and medical conditions, was determined.

MAIN RESULTS: Twenty percent of the 230 participants cited “old age” as the cause of their disability in two or more tasks. Tasks for which difficulty was most frequently attributed to “old age” were dressing oneself (31%), walking around the home (25%), walking 1/2 mile (5–6 blocks) (25%), cutting toenails (16%), getting in or out of a bed or chair or out a car (14% each), and ascending/descending stairs (13%). Significantly higher levels of arthritis, heart disease, and hearing loss were reported in persons attributing their disability to “old age” than in those not reporting “old age” as the cause of their disability. We found no differences in age, gender, race, education, or cognitive status for the two groups. However, individuals citing “old age” as the cause of functional decrements walked more slowly than those who cited a specific disease.

CONCLUSIONS: These data suggest that a significant proportion of functional decline attributed to “aging” in older adults may be associated with specific conditions. Identifying and reducing the impact of these conditions may prove to be a useful approach to preventing or minimizing functional loss.
Long Latency Ankle Responses to Dynamic Perturbation in Older Fallers and Non‐Fallers
Authors: Smith Britta N. , Segal Richard L. , Wolf Steven L.
Published: April 2015

OBJECTIVE: The purpose of this study was to examine the effects of falling history and aging on the latency and magnitude of long latency responses in the lateral gastrocnemius (LG) and tibialis anterior (TA) muscles of older adults.

DESIGN: Single observation study.

SETTING: Emory University School of Medicine, Center for Rehabilitation Medicine, serving the greater Atlanta, Georgia, area.

PARTICIPANTS: There were 62 community‐dwelling adults aged 60 or older, 32 with a history of two or more unexplained falls in the past year and 30 with no history of falls in the past year.

MEASUREMENTS: The electromyographic activity of the gastrocnemius and tibialis anterior muscles was recorded bilaterally during repeated 10 degree dorsiflexion perturbations to standing subjects at the acceleration of gravity and a velocity of approximately 100 deg/sec. The latency and magnitude of the long latency EMG responses (LLR) of both muscles were determined and compared between individuals by falls history and by decades of age.

MAIN RESULTS: No significant differences between falls status groups existed for mean LLR latencies or magnitudes of either LG or TA. Attenuation of the LLR throughout the trials was significantly different between groups. Non‐fallers demonstrated attenuation of the LG magnitude over the first five stretches. Fallers showed maladaptation of the LG response, with the latency becoming shorter over 25 trials. More than half of the subjects in both groups had one or more instances of temporal reversal of the response latencies, with the TA response occurring earlier than the LG response during the first five stretches. No differences existed in the LLR between age decades within faller or non‐faller groups. A timed measure of mobility (Up & Go) showed a significant difference between falls status, but not between age decades in either group.

CONCLUSIONS: Lack of differences between falls status and age decade groups over all trials suggests that LLRs remain intact between older fallers and non‐fallers and between older age groups. The mechanism of perturbation is a distinguishing feature of this study and probably contributes to our findings. The appearance of an atypical response strategy in both groups, where the TA response often occurs before the LG response, has raised the question of whether there is always a stereotypical pattern of LLRs during postural perturbations outside the experimental setting. J Am Geriatr Soc 44:1447–1454, 1996.
Immunizations in Long‐Term Care Facilities: Policies and Practice
Authors: Nichol Kristin L. , Grimm Mary Beth , Peterson Diane C.
Published: April 2015

PURPOSE: The present study was conducted to assess the policies and practices of nursing homes in regard to immunizations for residents and employees.

METHODS: A 20‐item, cross‐sectional survey was mailed to all 445 Minnesota nursing homes from May through July 1993. Questions asked were about facility characteristics and their policies, practices, and attitudes regarding immunizations for residents and employees. Second and third mailings were sent to nonresponding institutions.

RESULTS: The median size of the 399 (90%) responding institutions was 88 beds and 110 employees. The median number of residents on December 1, 1992, was 84. Although 99% of the facilities had an influenza vaccination program, only 69.3% had written policies. The mean influenza vaccination rate for residents was 84%, with higher rates in institutions having written policies, facility‐wide standing orders for vaccine administration, and in institutions that did not require written consent for vaccination. One‐third of the facilities had written policies for pneumococcal vaccination, and 16.3% had policies for tetanus/diphtheria. Twelvemonth immunization rates for these vaccines were 11.9% and 2.9%, respectively. Most facilities had an influenza vaccination program for employees with a mean vaccination rate of 33%. These rates were higher if the facility offered vaccine onsite, free of charge, and provided special inservice education to employees. Employee 12‐month vaccination rates for hepatitis B and tetanus/diphtheria were 23.2% and 1.7%, respectively. Few of the institutions included evaluation of immunization activities in their quality assurance programs.

CONCLUSION: Many long‐term care facilities have inadequate policies and practices for ensuring their residents and employees immunity to important vaccine preventable diseases. These institutions, as caretakers for a vulnerable population, should develop and implement organized programs to immunize their residents and employees. By doing so, they will be able to take advantage of important opportunities to prevent illness and protect the health of their residents and employees. J Am Geriatr Soc 44:349–355, 1996.
Characteristics of Rural Homebound Older Adults: A Community‐Based Study
Authors: Ganguli Mary , Fox Andrea , Gilby Joanne , Belle Steven
Published: April 2015

OBJECTIVE: To determine the frequency and characteristics of homebound older adults in a rural community.

DESIGN: An epidemiological survey of an age‐stratified random community sample.

SETTING: The rural mid‐Monongahela Valley in Southwestern Pennsylvania.

PARTICIPANTS: A total of 878 noninstitutionalized persons aged 68 years and older, fluent in English, and with at least grade 6 education.

MEASUREMENTS: The frequency with which subjects left their homes, the Mini‐Mental State Examination (MMSE) score, and additional information on demographics, self‐reported health problems, health services utilization, IADLs, depression, and social support were measured.

RESULTS: 10.3% of the sample was classified as home‐bound. In univariate analyses, being homebound was found to be associated significantly (P < .001) with being older, female, and widowed and with MMSE and IADL impairment, with more depressive symptoms and worse social supports, fair to poor self‐rated general health, weight loss, and histories of stroke, angina, arthritis of the spine, and falls. In a multiple regression model, variables associated independently with homebound status were gender (odds ratio = 9.4, 95% confidence interval = 3.6 − 24.9), weight loss (OR = 3.7, CI = 1.7 − 8.2), IADL impairment (OR = 2.6, CI = 2.1 − 3.1), and depressive symptoms (OR = 2.1, CI = 1.3 − 3.2). Being homebound was also associated with recent acute hospitalization and use of home health and social services.

CONCLUSIONS: These data provide evidence that homebound older adults have a disproportionate share of morbidity and disability and suggest a sociodemographic and clinical profile to help identify those older people at risk of being or becoming homebound. They also point to the need for home‐based health services for the older adults, particularly in medically underserved communities such as rural areas. J Am Geriatr Soc 44:363–370, 1996.
HEALTH SERVICES RESEARCH
Authors: Sivaram Chittur A. , Ahmed Naveed , Lestina Joseph R. , Rubenstein Laurence Z.
Published: April 2015

OBJECTIVE: To assess the value of the routine electrocardiogram (EKG) in the management of older (> 65 years) patients with cardiac disease during return visits to the ambulatory clinic.

DESIGN: Retrospective chart analysis.

SUBJECTS: Seventy‐one patients older than 65 years of age, with cardiac diagnoses, presenting for follow‐up visits.

METHODS: Chart notes from 254 encounters with 71 patients in a cardiology clinic were analyzed. Excluded were new patients as well as patients followed in special arrhythmia clinics for pacemakers or significant arrhythmias. All patients underwent an EKG during each clinic visit, irrespective of their clinical status, according to the clinic's protocol. The frequency and nature of therapeutic decisions made in the clinic, the contribution of the EKG to the decision‐making process, the appropriateness of the EKG, and physician response to the EKG were assessed.

MAIN RESULTS: Therapeutic decisions, the most common of which (28%) was medication changes, were made in 78 (31%) patients. The routine EKG was considered inappropriate in 60%. Unexpected diagnostic information not obtained from history or examination was not present in any encounter. EKG findings were not addressed by physicians in 22%.

CONCLUSIONS: Most older patients seen in the cardiology clinic for return visits with stable symptoms do not benefit from EKGs. Unexpected diagnostic information from the EKG leading to major therapeutic decisions is rare in older people with stable symptoms. J Am Geriatr Soc 44:452–455, 1996.
Embedded Macroeconomic Institutions: Italy's Fiscal U‐Turn in the 1990s and Beyond
Authors: Marzinotto Benedicta
Published: April 2015

Short‐term theories on the determinants of fiscal consolidation underestimate that fiscal regimes are as entrenched as any other institution of a political economy. The case of Italy's fiscal adjustment in the run‐up to EMU is used to show that external constraints and well‐functioning institutions may well be just auxiliary. The success factor in the country's macroeconomic stabilization was that competing socio‐economic interests, while all in favour of disinflation, could eventually agree on the size and composition of the adjustment thanks to side‐payments in the form of a devalued currency. These are unavailable under EMU, which explains why the fiscal reform momentum slowed down, notwithstanding EU fiscal rules. Domestic preference formation goes back a long way: it is associated with an incremental process of institutional change that started in 1981 with the enhanced independence of the Bank of Italy and continued with labour market and budget reform in the late 1980s.
Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study
Authors: Ozonoff Sally , Young Gregory S. , Landa Rebecca J. , Brian Jessica , Bryson Susan , Charman Tony , Chawarska Katarzyna , Macari Suzanne L. , Messinger Daniel , Stone Wendy L. , Zwaigenbaum Lonnie , Iosif Ana‐Maria
Published: April 2015

Background

The diagnosis of autism spectrum disorder (ASD) made before age 3 has been found to be remarkably stable in clinic‐ and community‐ascertained samples. The stability of an ASD diagnosis in prospectively ascertained samples of infants at risk for ASD due to familial factors has not yet been studied, however. The American Academy of Pediatrics recommends intensive surveillance and screening for this high‐risk group, which may afford earlier identification. Therefore, it is critical to understand the stability of an ASD diagnosis made before age 3 in young children at familial risk.

Methods

Data were pooled across seven sites of the Baby Siblings Research Consortium. Evaluations of 418 later‐born siblings of children with ASD were conducted at 18, 24, and 36 months of age and a clinical diagnosis of ASD or Not ASD was made at each age.

Results

The stability of an ASD diagnosis at 18 months was 93% and at 24 months was 82%. There were relatively few children diagnosed with ASD at 18 or 24 months whose diagnosis was not confirmed at 36 months. There were, however, many children with ASD outcomes at 36 months who had not yet been diagnosed at 18 months (63%) or 24 months (41%).

Conclusions

The stability of an ASD diagnosis in this familial‐risk sample was high at both 18 and 24 months of age and comparable with previous data from clinic‐ and community‐ascertained samples. However, almost half of the children with ASD outcomes were not identified as being on the spectrum at 24 months and did not receive an ASD diagnosis until 36 months. Thus, longitudinal follow‐up is critical for children with early signs of social‐communication difficulties, even if they do not meet diagnostic criteria at initial assessment. A public health implication of these data is that screening for ASD may need to be repeated multiple times in the first years of life. These data also suggest that there is a period of early development in which ASD features unfold and emerge but have not yet reached levels supportive of a diagnosis.
Estimation of serum malondialdehyde and assessment of DNA damage using comet assay in patients with oral submucous fibrosis
Authors: Paulose Swetha , Rangdhol Vishwanath , Ramesh Ramasamy , Jeelani Siccandar Ali , Brooklyin Sivakumar
Published: April 2015

Aim

To quantify the level of serum malondialdehyde and extent of DNA damage using comet assay in patients with oral submucous fibrosis (SMF) in comparison to normal individuals and to correlate the extent of DNA damage with MDA levels.

Methods

Study included 30 cases of SMF (n = 30) and equal number of healthy volunteers. Serum malondialdehyde was measured using the thiobarbituric–trichloroacetitic acid (TBA–TCA) method. Comet assay was used to assess the DNA damage. Association between the extent of DNA damage and serum MDA levels was analyzed in SMF statistically.

Results

Comet assay results showed that there was an increase in tail length, percentage of tail DNA and tail moment among SMF subjects (P < 0.05). Serum MDA levels were elevated in SMF patients compared with healthy subjects. A significant positive correlation was observed between serum MDA levels and comet tail length in SMF group (r = 0.56; P < 0.05).

Conclusions

Patients with SMF have increased DNA damage and elevated levels of lipid peroxidation compared with healthy controls. Evaluation of MDA levels as an oxidative biomarker along with comet assay analysis will serve as a diagnostic tool to identify patients with high risk of malignant potential in SMF.
Cytotoxicity of arctigenin and matairesinol against the T-cell lymphoma cell line CCRF-CEM
Authors: Su Shan , Cheng Xinlai , Wink Michael
Published: April 2015

Objectives

Arctigenin and matairesinol possess a diversity of bioactivities. Here we investigated the cytotoxicity of arctigenin and matairesinol against a T-cell lymphoma cell line CCRF-CEM and the underlying mechanisms that have not been explored before.

Methods

The cytotoxic activity was investigated using MTT assay. The cell cycle arrest and reactive oxygen species (ROS) accumulation were determined by flow cytometric analysis. The apoptosis induction was assessed using Annexin V/Propidium Iodide assay. The gene quantification analysis was measured through real-time polymerase chain reaction.

Key findings

Arctigenin and matairesinol exhibited significant antiproliferative activity against CCRF-CEM cells after 72 h treatment with IC50 values of 1.21 ± 0.15 μm and 4.27 ± 0.41 μm, respectively. In addition, both lignans arrest CCRF-CEM cells in the S phase. Furthermore, they could induce apoptosis in CCRF-CEM cells in a concentration- and time-dependent manner. Interestingly, the lignans differentially regulated the expression of several key genes involved in apoptosis pathways, including Bax, Bad and caspase-9. Moreover, both lignans could increase ROS levels in CCRF-CEM cells.

Conclusions

Our study provides an insight into the potential of arctigenin and matairesinol as good candidates for the development of novel agents against T-cell lymphoma.
Antimicrobial activity and synergy of antibiotics with two biphenyl compounds, protosappanins A and B from Sappan Lignum against methicillin-resistant Staphylococcus aureus strains
Authors: Zuo Guo-Ying , Han Zong-Qi , Han Jun , Hao Xiao-Yan , Tang Hua-Shu , Wang Gen-Chun
Published: April 2015

Objectives

This study aims to investigate antimicrobial ingredients from Sappan Lignum and to evaluate their synergy on methicillin-resistant Staphylococcus aureus strains with antibiotics.

Methods

Bioactivity-guided phytochemical procedures were used to screen the active compounds. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) were assayed by broth microdilution. The synergy was evaluated through checkerboard microdilution and loss of viability assays.

Key findings

Protosappanins A (PsA) and B (PsB) were identified from Sappan Lignum extracts. They showed active against both S. aureus and MRSA with MIC or MIC50 at 64 (PsA) and 128 (PsB) mg/L alone. When they were used in combination with antibiotics, they showed best synergy with amikacin and gentamicin with MIC50 (mg/L) of amikacin reduced more significantly from 32 to four (with PsA) and eight (with PsB), and the fractional inhibitory concentration index (FICI) ranged between 0.078 and 0.500 (FICI50 = 0.375). Moreover, the resistance of MRSA towards amikacin and gentamicin could be reversed by the Clinical and Laboratory Standards Institute criteria. The combined bactericidal mode could as well be synergy. PsA and PsB showed very low cytotoxicity in comparison with their promising activity against MRSA.

Conclusions

Protosappanins A and B showed both alone activities and resistance reversal effects of amikacin and gentamicin against MRSA, which warrant further investigations for potential combinatory therapy of MRSA infection.
Does Surgical Menopause Affect Sexual Performance Differently from Natural Menopause?
Authors: Kokcu Arif , Kurtoglu Emel , Bildircin Devran , Celik Handan , Kaya Aysegul , Alper Tayfun
Published: April 2015

Introduction

Hysterectomy is the most common major gynecologic operation, together with bilateral salpingo-oophorectomy in the majority of women over the age of 45.

Aim

To investigate whether surgical menopause affects female sexual performance differently from natural menopause.

Methods

The study included 121 women who had undergone surgical menopause and 122 women who had undergone natural menopause. All the women had similar economic, sociocultural, and personal demographic profiles, had been postmenopausal for at least 1 year, and were between the ages of 45 and 65. The women were asked to complete a six-question survey of sexual performance parameters (sexual desire, coital frequency, arousal, orgasm frequency, dyspareunia, and vaginal lubrication). These sexual performance parameters were compared between the surgical and natural menopause groups.

Results

With the exception of vaginal lubrication, sexual performance parameters were not statistically different between the two groups (P > 0.05). Vaginal lubrication in the surgically menopausal group was lower than in the naturally menopausal group (P < 0.05). Serum dehydroepiandrosterone sulphate, prolactin, and thyrotropin levels were not statistically different between the groups (P > 0.05), whereas serum estradiol and total testosterone levels in the surgically menopausal group were lower than those of the naturally menopausal group (P < 0.05).

Conclusion

The results of this study showed that surgical menopause did not affect female sexual performance differently from natural menopause, with the exception of vaginal lubrication.
Diet of Haplognathia ruberrima (Gnathostomulida) in a Caribbean marine mangrove
Authors: Pascal Pierre‐Yves , Bellemare Claude , Sterrer Wolfgang , Boschker Henricus T. S. , Gonzalez‐Rizzo Silvina , Gros Olivier
Published: April 2015

Haplognathia ruberrima is a cosmopolitan gnathostomulid species found in sulfur bacterial mats in mangroves in Guadeloupe (French West Indies). Haplognathia ruberrima presents a δ13C value lower than all measured meiofaunal grazers and lower than the available measured food sources of this environment. This low δ13C value can not be due to specific ingestion of 13C‐depleted methanogenic bacteria because abundances of those bacteria are reduced in surficial and deep sediments as revealed by δ13C of bacterial fatty acid. According to scanning electron microscope observations, no bacterial ectosymbionts were observed at the surface of the gnathostomulids, and transmission electron microscope views revealed the absence of bacterial endosymbionts. Energy‐dispersive X‐ray spectroscopy analysis detected low levels of sulfur (0.32%±0.8) in biological tissues of H. ruberrima, confirming the absence of thioautotrophic bacterial symbionts in these animals. Consequently, the low δ13C value of H. ruberrima can not be due to the presence of sulfur‐oxidizing symbionts but more probably to the selective and exclusive consumption of free‐living, sulfur‐oxidizing bacteria.