bluuebunny/crossref_metadata_2025 huggingface dataset:
Biocompatibility Study of Polymeric Biomaterials
Authors: Rogero Sizue O. , Malmonge Sônia M. , Lugão Ademar B. , Ikeda Tamiko I. , Miyamaru Lígia , Cruz Áurea S.
Published: May 2003

Abstract: Polymeric hydrogels are used as wound dressing material since these materials show advantages such as pain relief, exudates absorption, barrier to microorganisms, permeability, and others. This article shows the results obtained in a study aiming to know the biological performance of different polymeric materials to be used in contact with skin: PVP hydrogels and acrylate adhesive. The biocompatibility was determined by in vitro assay of cytotoxicity and in vivo assay by using the contact test of irritability in rabbits. All the tested samples presented no toxicity and no dermal irritation.
The Monomeric Formulation Optimization of Dental Composite: Mechanical and Kinetic Studies
Authors: Palacio Raúl Ernesto López , Zavaglia Cecília Amélia de Carvalho
Published: May 2003

Abstract: The optimization of the monomer composition, using a polymerization kinetic study and the mechanical behavior study of the composites, was the principal objective of this work. The monomeric mixture analyzed is a part of the composite that has been in development at the University of Campinas, Brazil. Parameters such as initiator, accelerator, and macro‐components composition were optimized. The infrared spectroscopy was the analytical technique used in the kinetic study. On the mechanical characterization, the stress strain, flexure stress and its modulus, were the properties analyzed. The dependency between the polymeric reaction and the physical behavior of the composites and the monomer composition was observed and studied. Finally, the monomer optimum composition was determined.
Bioreabsorbable Polymer Scaffold as Temporary Meniscal Prosthesis
Authors: Pezzin Ana Paula Testa , Cardoso Túlio Pereira , Rincón Maria do Carmo Alberto , Zavaglia Cecília Amélia de Carvalho , Duek Eliana Aparecida de Rezende
Published: May 2003

Abstract: Menisci have an important role in load bearing, shock absorption, knee joint stability, and joint lubrication. Meniscal lesions and meniscectomy are followed by osteoarthritis in a high percentage of patients. At present, there is no ideal prosthesis for meniscal substitution. In this work, a bioreabsorbable polymer scaffold made of poly(L‐lactic acid) (PLLA) and poly(p‐dioxanone) (PPD) blend was developed to be used as a temporary meniscal prosthesis to stimulate the formation of an in situ meniscal replication while the scaffold is reabsorbed by the organism. Total meniscectomy of medial meniscus and arthrotomy was made in both back knees of 34 adult New Zealand white rabbits by medial parapatellar incision. The scaffolds were sutured in one of the knees, and other was used as a control. A meniscal replica was developed, suggesting that this material has great potential to be used as a meniscal prosthesis, especially because the new meniscus promoted a significant protection of cartilage, and cartilage degeneration in the control condyles was observed.
Biomimetic Mineralization of Charged Collagen Matrices: In Vitro and In Vivo Study
Authors: Goissis Gilberto , Da Silva Maginador Silvana Vargas , Da Conceição Amaro Martins Virginia
Published: May 2003

Abstract: Polyanionic collagen matrix prepared by hydrolysis side chain amides of asparagine and glutamine was mineralized in vivo, without inflammatory response, biodegradation, or resorption, with calcium phosphate deposited in close resemblance to the D‐periodicity of collagen fibrils assembly. In vitro results with the same material produced mineralized collagen fibers with a similar morphology and chemical characteristics, suggesting that amide hydrolysis may have introduced into this matrix, signs for the controlled mineralization of collagen fiber. TEM indicated that amide hydrolysis occurred near the OVERLAP and GAP zones, as suggested by the significant reduction in inter‐band distances in these regions. The lack of an inflammatory response associated to the similar mineralization pattern observed in vivo and in vitro suggests not only the biomimetic behavior of polyanionic collagen matrix, but also its potential uses as scaffold for bone tissue reconstruction. Based on these results, a model for the in vitro mineralization was also proposed.
Growth Hormone Administration and Exercise Effects on Muscle Fiber Type and Diameter in Moderately Frail Older People
Authors: Hennessey James V. , Chromiak Joseph A. , DellaVentura Shirley , Reinert Steven E. , Puhl Jacqueline , Kiel Douglas P. , Rosen Clifford J. , Vandenburgh Herman , MacLean David B.
Published: May 2003

OBJECTIVE: Reduced muscle mass and strength are characteristic findings of growth hormone deficiency (GHD) and aging. We evaluated measures of muscle strength, muscle fiber type, and cross sectional area in response to treatment with recombinant human growth hormone (rhGH) with or without a structured resistance exercise program in frail older subjects.

DESIGN: Placebo‐controlled, randomized, double blind trial.

SETTING: Outpatient clinical research center at an urban university‐affiliated teaching hospital.

PARTICIPANTS: Thirty‐one consenting older subjects (mean age 71.3 ± 4.5 years) recruited as a subset of a larger project evaluating rhGH and exercise in older people, who underwent 62 quadricep‐muscle biopsies.

INTERVENTION: Random assignment to a 6‐month course of one of four protocols: rhGH administered subcutaneously daily at bedtime, rhGH and a structured resistance exercise program, structured resistance exercise with placebo injections, or placebo injections only.

MEASUREMENTS: Muscle biopsy specimens were obtained from the vastus lateralis muscle. Isokinetic dynamometry strength tests were used to monitor individual progress and to adjust the weights used in the exercise program. Serum insulin‐like growth factor‐I (IGF‐I) was measured and body composition was measured using a Hologic QDR 1000W dual X‐ray densitometer.

RESULTS: The administration of rhGH resulted in significant increase in circulating IGF‐I levels in the individuals receiving rhGH treatment. Muscle strength increased significantly in both the rhGH/exercise (+55.6%, P = .0004) as well as the exercise alone (+47.8%, P = .0005) groups. There was a significant increase in the proportion of type 2 fibers between baseline and six months in the combined rhGH treated subjects versus those not receiving rhGH (P = .027).

CONCLUSIONS: Our results are encouraging in that they suggest an effect of growth hormone on a specific aging‐correlated deficit. IGF‐I was increased by administrating rhGH and muscle strength was increased by exercise. The administration of rhGH to frail older individuals in this study resulted in significant changes in the proportions of fiber types. Whether changes in fiber cross‐sectional area or absolute number occur with long‐term growth hormone administration requires further study.
A Randomized Trial of Exercise Programs Among Older Individuals Living in Two Long‐Term Care Facilities: The FallsFREE Program
Authors: Nowalk Mary Patricia , Prendergast John M. , Bayles Constance M. , D'Amico Frank J. , Colvin Gerald C.
Published: May 2003

OBJECTIVE: To use two different exercise programs over a 2‐year period to reduce falls and their sequelae among residents of two long‐term care facilities.

DESIGN: Randomized, controlled trial.

SETTING: The study took place at two long‐term care facilities with services ranging from independent living to skilled nursing.

PARTICIPANTS: One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions.

INTERVENTION: Participants were randomized to one of two exercise groups (resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming) or to a control group (basic enhanced programming only). Exercise classes were held three times per week throughout the study.

MEASUREMENTS: Participants were evaluated for cognitive and physical functioning at baseline and 6, 12, and 24 months. Falls were determined from incident reports filed by the nursing staffs at the facilities.

RESULTS: Time to first fall, time to death, number of days hospitalized, and incidence of falls did not differ among the treatment and control groups (P> .05). Among all participants, those who fell had significantly lower baseline Folstein Mini‐Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2‐year program.

CONCLUSION: There were no significant differences in falls among the two exercise groups and the control group. Lack of treatment differences and low adherence rates suggest that residents of long‐term care facilities may require individualized exercise interventions that can be adapted to their changing needs.
Deriving a Risk‐Adjustment Model for Pressure Ulcer Development Using the Minimum Data Set
Authors: Berlowitz Dan R. , Brandeis Gary H. , Morris John N. , Ash Arlene S. , Anderson Jennifer J. , Kader Boris , Moskowitz Mark A.
Published: May 2003

OBJECTIVE: To use the Minimum Data Set (MDS) to derive a risk‐adjustment model for pressure ulcer development that may be used in assessing the quality of nursing home care.

DESIGN: Perspective observational study using MDS data from 1997.

SETTING: A large, for‐profit, nursing home chain.

PARTICIPANTS: Our unit of analysis was 39,649 observations made on 14,607 nursing home residents who were without a stage 2 or larger pressure ulcer on an index assessment.

MEASUREMENTS: Pressure ulcer status was determined at an outcome assessment approximately 90 days after an index assessment. Potential predictors of pressure ulcer development were examined for bivariate associations, contributing to the development of a multivariate logistic regression model.

RESULTS: A stage 2 or larger pressure ulcer developed in 2.3% of the observations. Seventeen resident characteristics were found to be associated with pressure ulcer development. These included dependence in mobility and transferring, diabetes mellitus, peripheral vascular disease, urinary incontinence, lower body mass index, and end‐stage disease. A risk‐adjustment model based on these characteristics was well calibrated and able to discriminate among residents with different levels of risk for ulcer development (model c‐statistic = 0.73).

CONCLUSION: A clinically credible risk‐adjustment model with good performance properties can be developed using the MDS. This model may be useful in profiling nursing homes on their rate of pressure ulcer development.
Evaluation of a Risk‐Adjustment Model for Pressure Ulcer Development Using the Minimum Data Set
Authors: Berlowitz Dan R. , Brandeis Gary H. , Anderson Jennifer J. , Ash Arlene S. , Kader Boris , Morris John N. , Moskowitz Mark A.
Published: May 2003

OBJECTIVE: To validate a previously derived risk‐adjustment model for pressure ulcer development in a separate sample of nursing home residents and to determine the extent to which use of this model affects judgments of nursing home performance.

DESIGN: Retrospective observational study using Minimum Data Set (MDS) data from 1998.

SETTING: A large, for‐profit, nursing home chain.

PARTICIPANTS: Twenty‐nine thousand and forty observations were made on 13,457 nursing home residents who were without a pressure ulcer on an index assessment.

MEASUREMENTS: We used logistic regression in our validation sample to calculate new coefficients for the 17 previously identified predictors of pressure ulcer development. Coefficients from this new sample were compared with those previously derived. Expected rates of pressure ulcer development were determined for 108 nursing homes. Unadjusted and risk‐adjusted rates of pressure ulcer development from these homes were also calculated and outlier identification using these two approaches was compared.

RESULTS: Predictors of pressure ulcer development in the derivation sample generally showed similar effects in the validation sample. The model c‐statistic was also unchanged at 0.73, but it was not calibrated as well in the validation sample. On applying the model to the nursing homes, expected rates of ulcer development ranged from 1.1% to 3.2% (P < .001). The observed rates ranged from 0% to 12.1% (P < .001). There were 12 outliers using unadjusted rates and 15 using adjusted performance. Ten nursing homes were identified as outliers using both approaches.

CONCLUSIONS: Our MDS risk‐adjustment model for pressure ulcer development performed well in this new sample. Nursing homes differ significantly in their expected rates of pressure ulcer development. Outlier identification also differs depending on whether unadjusted or risk‐adjusted performance is evaluated.
Serum and Urine Markers of Bone Metabolism During the Year After Hip Fracture
Authors: Yu‐Yahiro Janet A. , Michael Roger H. , Dubin Norman H. , Fox Kathleen M. , Sachs Myron , Hawkes William G. , Hebel J. Richard , Zimmerman Sheryl I. , Shapiro Jay , Magaziner Jay
Published: May 2003

OBJECTIVE: As part of a larger study to describe indices of recovery during the year after hip fracture, the current prospective study investigated longitudinal changes in serum and urine markers of bone metabolism for the year after hip fracture and related them to bone mineral density (BMD).

DESIGN: A representative subset of participants provided serum and urine samples and had bone density measured at 3, 10, 60, 180, and 365 days postfracture.

SETTING: Two Baltimore hospitals.

PARTICIPANTS: The subjects were 205 community‐dwelling, white women age 65 and older with fresh proximal femur fractures.

MEASUREMENTS: Samples were assayed for specific bone‐related proteins and bone turnover markers, including serum osteocalcin (OC), procollagen type 1 carboxy‐terminal extension peptide (PICP), bone‐specific alkaline phosphatase (BAP), and urinary deoxypyridinoline (DPD) cross‐links. Selected hormonal regulators of bone metabolism, including parathyroid hormone (PTH), calcitonin (CT), 1,25‐dihydroxy vitamin D3 (1,25 (OH)2D), and estrone (E1) were measured from serum samples. Repeated measures analyses were used to evaluate postfracture changes in each of the markers.

RESULTS: BAP, OC, and PICP were most active during the early postfracture period (3–60 days). BAP and OC remained elevated at 365 days compared with 3 days. DPD rose 48% from 3 days to 60 days, but this difference was not statistically significant. PTH and 1,25 (OH)2D increased steadily and significantly from 3 to 365 days. E1 was highest at baseline and decreased at each time point, whereas CT showed no significant changes. When subjects were stratified into high‐, medium‐, and low‐BMD groups based on their measurement at 3 days, both osteoclastic and osteoblastic markers in the low‐BMD group displayed exaggerated and different patterns over time compared with the other groups.

CONCLUSION: Currently, the standard treatment of care for hip fractures still results in high morbidity and mortality and failure to regain prefracture quality of life. Gaining an understanding of bone cell activity in these patients after hip fracture, derived by measuring markers longitudinally during recovery, provides a baseline by which to measure the effectiveness of new interventions to improve recovery from hip fracture.
Strength, Balance, and the Modifying Effects of Obesity and Knee Pain: Results from the Observational Arthritis Study in Seniors (OASIS)
Authors: Jadelis Kristen , Miller Michael E. , Ettinger Walter H. , Messier Stephen P.
Published: May 2003

OBJECTIVE: To examine the relationship between muscular strength and dynamic balance in a sample of older adults with knee pain and to determine the role that obesity and severity of knee pain play in the ability to maintain balance.

DESIGN: Cross‐sectional study designed to examine the association between strength and balance in a cohort of older adults with chronic knee pain.

SETTING: A university health and exercise science center.

PARTICIPANTS: A cohort of 480 adults age 65 and older with knee pain.

MEASUREMENTS: Force platform dynamic balance measure of the center of pressure excursion during a forward and subsequent backward lean. Isokinetic strength measures of concentric and eccentric knee flexion and extension and concentric ankle plantar flexion and dorsiflexion. Body mass index (BMI) and a knee pain scale were used to measure obesity and knee pain, respectively.

RESULTS: A regression model was developed to investigate the relationship between dynamic balance and muscular strength while controlling for gender, BMI, radiographic severity, knee pain, and foot length. Knee strength alone explained 18.4% of the variability in dynamic balance. The addition of knee pain, BMI, radiographic severity, gender, and foot length explained an additional 6.7%. When the knee‐ankle interaction, ankle strength, and knee strength–pain interaction variables were added to the regression model, 28.9% of the variability in dynamic balance was explained.

CONCLUSIONS: Strength appears to play a significant role in maintaining balance in an older, osteoarthritic population. We found that mean knee strength accounted for approximately 19% of the variability in dynamic balance. Hence, greater knee strength was associated with better dynamic balance. The best dynamic balance performances occurred in participants that had a combination of strong knees and strong ankles. However, knee osteoarthritic patients with weak knee strength could still maintain high levels of dynamic balance by having strong ankle strength. Moreover, we have shown that obesity is associated with attenuated dynamic balance performance and that poorer balance is associated with higher pain scores in the presence of weaker knees. For stronger knees, however, pain does not appear to be related to balance.
Self‐Reported Social and Emotional Impact of Urinary Incontinence
Authors: Fultz Nancy H. , Herzog A. Regula
Published: May 2003

OBJECTIVE: Incontinence‐specific and generic measures of well‐being were regressed on potential predictors to identify incontinent respondents at risk for psychosocial distress and to understand the relationship between urinary incontinence (UI) and other determinants of social and emotional status.

DESIGN: Survey data were collected May 1994 through April 1996.

SETTING: Telephone interviews as a supplement to a nationally representative monthly consumer survey.

PARTICIPANTS: Analyses were based on 1,116 continent and 206 incontinent respondents age 40 and older.

MEASUREMENTS: Incontinent respondents self‐reported the extent to which urine loss restricted social activities or affected their feelings about themselves. All respondents were asked whether they felt depressed, lonely, or sad. Covariates included sex, age, race, education, social desirability, health status, frequency of urine loss, quantity of loss, and urgency.

RESULTS: The majority of incontinent respondents reported that urine loss did not restrict activities or diminish self‐esteem. Incontinent respondents who were younger, male, less educated, lower in social desirability, in poorer health, or losing greater quantities of urine were more likely to report psychosocial distress, although these correlates were not consistently significant. Compared with continent respondents, significantly higher percentages of incontinent respondents reported feeling depressed, lonely, or sad. In the multivariate models, incontinence retained an independent association with loneliness, but not with sadness or depression.

CONCLUSION: Even though the direct psychosocial impact of urine loss may be minor in many cases, UI is associated with a constellation of physical and behavioral factors that can impose a social and emotional burden. This suggests that UI cannot be adequately evaluated or treated without consideration of the patient's overall quality of life.
Healthy Centenarians Do Not Exist, but Autonomous Centenarians Do: A Population‐Based Study of Morbidity Among Danish Centenarians
Authors: Andersen‐Ranberg Karen , Schroll Marianne , Jeune Bernard
Published: May 2003

OBJECTIVE: To assess the prevalence of common illnesses in an unselected population of centenarians.

DESIGN: A population‐based survey.

SETTING: Denmark.

PARTICIPANTS: All Danes who celebrated their 100th anniversary between April 1, 1995 and May 31, 1996: 276 persons.

MEASUREMENTS: All participants (including proxies) were visited at their domicile for an interview (sociodemographic characteristics, activities of daily living, living conditions, need of assistance from other people, former health and current diseases, current medication) and a clinical examination (dementia screening test, heart and lung auscultation, neurological assessment, height and weight, electrocardiogram, arm and ankle blood pressure, assessment of hearing and vision capacity, a short physical performance test, bio‐impedance, lung function test, blood test). Further health information was retrieved from medical files and national health registers.

RESULTS: Seventy‐five percent (207) of eligible subjects participated in the study. Cardiovascular disease was present in 149 (72%) subjects. Osteoarthritis (major joints) was present in 54%, hypertension (≥140/≥90) in 52%, dementia in 51%, and ischemic heart disease in 28%. The mean number of illness was 4.3 (standard deviation (SD) 1.86). Only one subject was identified as being free from any chronic condition or illness. Sixty percent had been treated for illness with high mortality. In 25 autonomous (nondemented, functioning well physically, living at home) and 182 nonautonomous centenarians, comorbidities were equivalent.

CONCLUSION: Because they have a high prevalence of several common diseases and chronic conditions, Danish centenarians are not healthy. However, a minor proportion was identified as being cognitively intact and functioning well.
Disability in the Oldest Old: “Can Do” or “Do Do”?
Authors: Der Wiel Annetje Bootsma‐van , Gussekloo J. , De Craen A. J. M. , Van Exel E. , Knook D. L. , Lagaay A. M. , Westendorp R. G. J.
Published: May 2003

OBJECTIVE: To investigate the discrepancies between outcomes for competence (can do) and actual performance (do do) in activities of daily living (ADLs).

DESIGN: Baseline measurements of a population‐based follow‐up study.

SETTING: Leiden 85‐Plus Study, the Netherlands.

PARTICIPANTS: Five hundred and ninety‐nine persons, age 85. The response rate was 86%.

MEASUREMENTS: Face‐to‐face interviews. Measurements of competence and actual performance were based on the Groningen Activity Restriction Scale. Help received was assessed for several domains. Prevalence rates for disability were assessed according to the concepts of both competence and actual performance. Analysis was performed separately for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs).

RESULTS: Seventy‐seven percent of the oldest old were competent to perform all the BADLs and performed them regularly. Fifteen percent were not competent to perform certain BADLs independently but performed them regularly with help from others. The prevalence of disability defined as inability in one or more BADLs was 22% for women and 10% for men. The prevalence of disability defined as inactivity in one or more BADLs was 16% for women and 17% for men. Only 5% of the oldest old were competent to perform all IADLs and performed them regularly. In spite of being competent, 70% did not perform certain IADLs regularly. The prevalence of disability defined as inability in one or more IADLs was 64% for women and 55% for men. The prevalence of disability defined as inactivity in one or more IADLs was 92% for women and 98% for men.

CONCLUSION: The structural discrepancies between the outcomes of competence and actual performance have important consequences when estimating disability in old people. Promoting actual performance in IADLs may reduce disability.
The Management of Adverse Clinical Events in Nursing Homes: A 1‐Year Survey Study
Authors: Bellelli Giuseppe , Frisoni Giovanni B. , Barbisoni Piera , Boffelli Stefano , Rozzini Renzo , Trabucchi Marco
Published: May 2003

OBJECTIVE: In Italian nursing homes (NHs), care delivery at night and during holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary physicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of different kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinical events.

DESIGN: Prospective, nonrandomized‐survey data collection.

SETTING: Ten nonprofit nursing facilities in Italy.

PARTICIPANTS: Three hundred and fifty‐two NH residents, staff physicians, temporary physicians, and NHS physicians.

MEASUREMENTS: Medical intervention during adverse clinical events occurring at night and during holidays.

RESULTS: Three hundred and fifty‐two residents experienced 551 adverse clinical events; 78 were hospitalized. The hospitalization rate of NHS physicians was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were appropriate in the majority of cases; NHS diagnosis and management were doubtful or incorrect in about one‐third of all cases.

CONCLUSIONS: NH residents frequently experience adverse clinical events; physician characteristics influence the rate of hospitalization and the quality of medical interventions.
An Intervention to Increase Fluid Intake in Nursing Home Residents: Prompting and Preference Compliance
Authors: Simmons Sandra F. , Alessi Cathy , Schnelle John F.
Published: May 2003

OBJECTIVE: To evaluate a three‐phase, behavioral intervention to improve fluid intake in nursing home (NH) residents.

DESIGN: Controlled clinical intervention trial.

SETTING: Two community NHs.

PARTICIPANTS: Sixty‐three incontinent NH residents.

INTERVENTION: Participants were randomized into intervention and control groups. The intervention consisted of three phases for a total of 32 weeks: (1) 16 weeks of four verbal prompts to drink per day, in between meals; (2) 8 weeks of eight verbal prompts per day, in between meals; and (3) 8 weeks of eight verbal prompts per day, in between meals, plus compliance with participant beverage preferences.

MEASUREMENTS: Between‐meal fluid intake was measured in ounces by research staff during all three phases of the intervention. Percentage of fluids consumed during meals was also estimated by research staff for a total of nine meals per participant (3 consecutive days) at baseline and at 8 and 32 weeks into the intervention. Serum osmolality, blood urea nitrogen, and creatinine values were obtained for all participants in one of the two sites at the same three time points.

RESULTS: The majority (78%) of participants increased their fluid intake between meals in response to the increase in verbal prompts (phase 1 to 2). A subset of residents (21%), however, only increased their fluid intake in response to beverage preference compliance (phase 3). There was a significant reduction in the proportion of intervention participants who had laboratory values indicative of dehydration compared with the control participants. Cognitive and nutritional status were predictive of residents' responsiveness to the intervention.

CONCLUSIONS: A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake among most of a sample of incontinent NH residents. Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired residents, whereas preference compliance was needed to increase fluid intake among less cognitively impaired NH residents.
Cognitive Impairment and Mortality in Older Primary Care Patients
Authors: Stump Timothy E. , Callahan Christopher M. , Hendrie Hugh C.
Published: May 2003

OBJECTIVE: To assess the impact of cognitive impairment on mortality in older primary care patients after controlling for confounding effects of demographic and comorbid chronic conditions.

DESIGN: Prospective cohort study.

SETTING: Academic primary care group practice.

PARTICIPANTS: Three thousand nine hundred and fifty‐seven patients age 60 and older who completed the Short Portable Mental Status Questionnaire (SPMSQ) during routine office visits.

MEASUREMENTS: Cognitive impairment measured at baseline using the SPMSQ, demographics, problem drinking, history of smoking, clinical data (including weight, cholesterol level, and serum albumin), and comorbid chronic conditions collected at baseline; survival time measured during the 5 to 7 years after baseline.

RESULTS: Eight hundred and eighty‐six patients (22.4%) died during the 5 to 7 years of follow‐up. Cognitive impairment was categorized as having no impairment (84.3%), mild impairment (10.5%), and moderate‐to‐severe impairment (5.2%) based on SPMSQ score. Chi‐square tests revealed that patients with moderate‐to‐severe impairment were significantly more likely to die compared with patients with mild impairment (40.8% vs 21.5%) and those with no impairment (40.8% vs 21.4%). No significant difference in crude mortality was found between patients with no impairment and those with mild impairment. After analyzing time to death using the Kaplan‐Meier method, patients with moderate‐to‐severe cognitive impairment were at increased risk of death compared with those with no or mild impairment (Log‐rank χ2 = 55.5; P < .0001). Even in multivariable analyses using Cox proportional hazards to control for confounding factors, compared with those with no impairment, moderately‐to‐severely impaired patients had an increased risk of death, with a hazard ratio (HR) of 1.70. Increased risk of death was also associated with older age (HR = 1.03 for each year), a history of smoking (HR = 1.48), having a serum albumin level <3.5 g/L (HR = 1.29), and weighing less than 90% of the ideal body weight (HR = 1.98). Outpatient diagnoses associated with increased mortality risk were diabetes mellitus, coronary artery disease, congestive heart failure, cerebrovascular disease, cancer, anemia, and chronic obstructive pulmonary disease (HR range 1.36–1.67). Factors protective of mortality risk included female gender (HR = 0.67) and black race (HR = 0.73).

CONCLUSIONS: Moderate‐to‐severe cognitive impairment is associated with an increased risk of mortality, even after controlling for confounding effects of demographic and clinical characteristics. Mild cognitive impairment is not associated with mortality risk, but a longer follow‐up period may be necessary to identify this risk if it exists.
Acculturation and the Prevalence of Depression in Older Mexican Americans: Baseline Results of the Sacramento Area Latino Study on Aging
Authors: González Hector M. , Haan Mary N. , Hinton Ladson
Published: May 2003

OBJECTIVE: HTo determine the association between acculturation, immigration, and prevalence of depression in older Mexican Americans.

DESIGN: Cross‐sectional analysis from a cohort study.

SETTING: Urban and rural counties of the Central Valley of Northern California.

PARTICIPANTS: One thousand seven hundred and eighty‐nine Latinos recruited from a population‐based sample (85% Mexican Americans) with a mean age of 70.6 (range 60–100; standard deviation (SD) = 7.13); 58.2% were women.

MEASUREMENTS: Depressive symptoms were assessed with the Center for Epidemiologic Studies—Depression scale (CES‐D). Acculturation was measured with the Acculturation Rating Scale for Mexican Americans—II. Psychosocial, behavioral, and medical histories were also obtained.

RESULTS: The prevalence of depression (CES‐D ≥ 16) was 25.4%. Women were at greater risk (32.0%) than men (16.3%; male/female odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.90–3.09). The prevalence of depression was higher among immigrants (30.4%, OR = 1.70, 95% CI = 1.36–2.13), bicultural participants (24.2%, OR = 1.66, 95% CI = 1.24–2.24), and less‐acculturated participants (36.1%, OR = 2.95, 95% CI = 2.22–3.93) compared with U.S.‐born (20.5%) and more‐acculturated groups (16.1%). When adjustments for education, income, psychosocial, behavioral, and health‐problem factors were made, the least‐acculturated participants were at significantly higher risk of depression than highly acculturated Mexican Americans (OR = 1.56, 95% CI = 1.06–2.31).

CONCLUSIONS: These findings are consistent with previously reported estimates of a higher prevalence of depression for older Mexican Americans than non‐Hispanic Caucasians and African Americans and are the first to report the prevalence and risk of depression for older U.S.‐born and immigrant Mexican Americans. The high prevalence of depression of the least acculturated group may be related to cultural barriers encountered by immigrants and less‐acculturated older Mexican Americans and to poorer health status.
Functional Ability and Oral Health Among Older People: A Longitudinal Study from Age 75 to 80
Authors: Avlund Kirsten , Holm‐Pedersen Poul , Schroll Marianne
Published: May 2003

OBJECTIVE: To examine whether functional ability at age 75 and age 80 is associated with oral health and use of dental services cross‐sectionally and whether changes in functional ability from age 75 to age 80 are associated with oral health and regular use of dental services at age 80.

DESIGN: The study included a random sample of 75‐year‐olds at baseline and a follow‐up study 5 years later. The data are treated as two cross‐sectional studies at age 75 and 80, respectively, and as a longitudinal study from age 75 to 80.

SETTING: The western part of Copenhagen County.

PARTICIPANTS: The two cross‐sectional studies of 75‐ and 80‐year‐old people included 411 and 321 persons, respectively. The longitudinal study from age 75 to 80 included the 326 persons who participated in both surveys.

MEASUREMENTS: Oral health status was measured roughly by number of teeth and chewing ability. Use of dental services was measured by frequency of visits to a dentist or denturist. Functional ability was measured by two scales on mobility in relation to tiredness and need of help. Changes in mobility from age 75 to 80 is described as (1) improved or sustained good, (2) decreased, and (3) sustained poor. Gender, chronic diseases, self‐rated health, socio‐demographic factors, living alone, and social relations were included as possible confounders.

RESULTS: The odds ratio of having no or few teeth was 1.7 (1.1–2.6) in 75‐year‐old individuals who felt tired in mobility, 1.7 (1.0–2.9) in 80‐year‐old persons who needed help with mobility, and 2.7 (0.94–7.5) in persons with sustained need of help with mobility from age 75 to 80. The odds ratio of chewing difficulties was 1.7 (1.1–2.8) in 80‐year‐old people in need of help, and 1.8 (1.1–3.0) in persons age 75 to 80 needing sustained help. Dentate 80‐year‐old persons who felt tired in mobility had an odds ratio of 2.0 (0.94–4.2) of not using dental services.

CONCLUSIONS: The results indicate that oral impairment (e.g., having no or few teeth), oral functional limitations (e.g., chewing problems), and general functional limitations (e.g., mobility problems) are interrelated and that prevention of disabilities should be aimed at both functional limitations and oral health problems if the intention is to promote a good life in old age. In addition, the results point to the importance of taking problems in mobility seriously in delivering preventive services to old people because people who are tired or dependent on help seem to be at a higher risk of not using dental services regularly.
Physician Confidence and Interest in Learning More About Common Geriatric Topics: A Needs Assessment
Authors: Robinson Bruce E. , Barry Patricia P. , Renick Nancy , Bergen Merlynn R. , Stratos Georgette A.
Published: May 2003

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics.

DESIGN: Written survey.

SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

PARTICIPANTS: Seven hundred and fifty‐eight physicians (547 ACP members, 211 AAFP members).

MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five‐point Likert scale.

RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee‐for‐service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r = .44, P < .0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified.

CONCLUSIONS: These findings provide useful information on the physician‐learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.
On the Use of Surrogate Respondents for Controls in a Case‐Control Study of Alzheimer's Disease
Authors: Debanne Sara M. , Petot Grace J. , Li Jingjin , Koss Elisabeth , Lerner Alan J. , Riedel Tatiana M. , Rowland Douglas Y. , Smyth Kathleen A. , Friedland Robert P.
Published: May 2003

OBJECTIVE: To examine the presence and extent of bias introduced by using surrogate respondents for healthy controls in a case‐control study of Alzheimer's disease (AD).

DESIGN: Comparative study of matched responses to questionnaire ascertaining lifestyle issues.

SETTING: University Hospitals/Case Western Reserve University Alzheimer Center.

PARTICIPANTS: Controls (n = 50) were identified through the Research Registry. Surrogates (n = 50) were their healthy relatives or friends.

MEASUREMENTS: Answers in the areas of demographic and occupational history, smoking habits, medical history, dietary intake, and leisure and work activities were recorded. The analysis was based on methods for paired data. Continuous variables were analyzed, focusing on paired differences between self and surrogate responses.

RESULTS: For occupations and exposures, over 80% of the surrogates agreed with the subjects on over 80% of the questions. On smoking history, over 90% of the surrogates agreed with the subjects on over 70% of the questions. On leisure and work activities, over 70% of the surrogates agreed with the subjects on over 50% of the questions. There was less agreement regarding medical history. For continuous variables, most paired t‐tests of zero mean difference between self and surrogate responses resulted in nonrejection of this hypothesis. Computed mean differences were not always positive or always negative.

CONCLUSION: We did not find systematic under‐ or overreporting by the surrogates of the controls. Therefore, if there are biases in the responses of surrogates of the AD cases in our case‐control study, they would not be canceled out by using surrogates for the controls.
Neuropsychological and Genetic Differences Between Age‐Associated Memory Impairment and Mild Cognitive Impairment Entities
Authors: Bartrés‐Faz David , Junqué Carme , López‐Alomar Antoni , Valveny Neus , Moral Pedro , Casamayor Robert , Salido Antoni , Bel Carme , Clemente Imma C.
Published: May 2003

OBJECTIVE: To neuropsychologically and genetically compare age‐associated memory impairment (AAMI) and mild cognitive impairment (MCI) entities and to determine what proportion of AAMI diagnosed individuals could also receive a MCI diagnosis. To compare the distribution of a previously known genetic risk factor for Alzheimer's disease (apolipoprotein E common polymorphism) associated with these two conditions with a sample of the normal aging.

DESIGN: Neuropsychological and genetic assessments in AAMI and MCI individuals. Genetic assessment in AAMI, MCI, and control subjects.

SETTING: General health centers and geriatric homes from northeastern Spain (Catalunya).

PARTICIPANTS: One hundred and four subjects presenting subjective memory complaints were selected and the AAMI and MCI criteria were applied. One hundred and twenty‐four healthy Spanish subjects age 50 and older were defined as controls.

MEASUREMENTS: Memory, language, and frontal lobe functions were assessed using standard neuropsychological tests. The apolipoprotein E (apo E) polymorphism was obtained by using polymerase chain reaction (PCR) and HhaI restriction endonuclease.

RESULTS: Sixty‐seven percent of previously diagnosed AAMI individuals could also be identified as MCI subjects. These MCI cases differed from those only‐AAMI individuals both in neuropsychological and genetic analyses, performing worse not only on memory but also on language and frontal lobe tests and presenting high and low prevalences of the apo E ε3/ε4 and ε3/ε3 genotypes, respectively. The general AAMI sample of 93 individuals also differed from controls in the apo E genotype and allele distributions but these differences were no longer present after subtracting the MCI cases (63 subjects). These findings reflect that the differences between the memory impaired sample and the control sample regarding the apo E polymorphism were mainly attributable to MCI individuals and not to those who received only a diagnosis of AAMI alone.

CONCLUSIONS: Our findings suggest that among AAMI subjects, those who also fulfill the MCI criteria present a neuropsychological and genetic profile closer to that previously related to Alzheimer's disease than those individuals only eligible for a diagnosis of AAMI. However, our findings also suggest that using only the AAMI criteria still appears to select a population that differs genetically from the normal older population.
Moderate deviation principles for trajectories of sums of independent Banach space valued random variables
Authors: Hu Yijun , Lee Tzong-Yow
Published: May 2003

Let

{

X
n

}

\{X_n\}

be a sequence of i.i.d. random vectors with values in a separable Banach space. Moderate deviation principles for trajectories of sums of

{

X
n

}

\{X_n\}

are proved, which generalize related results of Borovkov and Mogulskii (1980) and Deshayes and Picard (1979). As an application, functional laws of the iterated logarithm are given. The paper also contains concluding remarks, with examples, on extending results for partial sums to corresponding ones for trajectory setting.
Approximations for Gabor and wavelet frames
Authors: Han Deguang
Published: May 2003

Let

ψ
\psi

be a frame vector under the action of a collection of unitary operators

U

\mathcal U

. Motivated by the recent work of Frank, Paulsen and Tiballi and some application aspects of Gabor and wavelet frames, we consider the existence and uniqueness of the best approximation by normalized tight frame vectors. We prove that for any frame induced by a projective unitary representation for a countable discrete group, the best normalized tight frame (NTF) approximation exists and is unique. Therefore it applies to Gabor frames (including Gabor frames for subspaces) and frames induced by translation groups. Similar results hold for semi-orthogonal wavelet frames.
Stability of infinite-dimensional sampled-data systems
Authors: Logemann Hartmut , Rebarber Richard , Townley Stuart
Published: May 2003

Suppose that a static-state feedback stabilizes a continuous-time linear infinite-dimensional control system. We consider the following question: if we construct a sampled-data controller by applying an idealized sample-and-hold process to a continuous-time stabilizing feedback, will this sampled-data controller stabilize the system for all sufficiently small sampling times? Here the state space

X
X

and the control space

U
U

are Hilbert spaces, the system is of the form

x
˙

(
t
)
=
A
x
(
t
)
+
B
u
(
t
)

\dot x(t) = Ax(t) + Bu(t)

, where

A
A

is the generator of a strongly continuous semigroup on

X
X

, and the continuous time feedback is

u
(
t
)
=
F
x
(
t
)

u(t) = Fx(t)

. The answer to the above question is known to be “yes” if

X
X

and

U
U

are finite-dimensional spaces. In the infinite-dimensional case, if

F
F

is not compact, then it is easy to find counterexamples. Therefore, we restrict attention to compact feedback. We show that the answer to the above question is “yes”, if

B
B

is a bounded operator from

U
U

into

X
X

. Moreover, if

B
B

is unbounded, we show that the answer “yes” remains correct, provided that the semigroup generated by

A
A

is analytic. We use the theory developed for static-state feedback to obtain analogous results for dynamic-output feedback control.
West’s problem on equivariant hyperspaces and Banach-Mazur compacta
Authors: Antonyan Sergey
Published: May 2003

LetGGbe a compact Lie group,XXa metricGG-space, andexp⁡X\exp Xthe hyperspace of all nonempty compact subsets ofXXendowed with the Hausdorff metric topology and with the induced action ofGG. We prove that the following three assertions are equivalent: (a)XXis locally continuum-connected (resp., connected and locally continuum-connected); (b)exp⁡X\exp Xis aGG-ANR (resp., aGG-AR); (c)(exp⁡X)/G(\exp X)/Gis an ANR (resp., an AR). This is applied to show that(exp⁡G)/G(\exp G)/Gis an ANR (resp., an AR) for each compact (resp., connected) Lie groupGG. IfGGis a finite group, then(exp⁡X)/G(\exp X)/Gis a Hilbert cube wheneverXXis a nondegenerate Peano continuum. LetL(n)L(n)be the hyperspace of all centrally symmetric, compact, convex bodiesA⊂RnA\subset \mathbb {R}^n,n≥2n\ge 2, for which the ordinary Euclidean unit ball is the ellipsoid of minimal volume containingAA, and letL0(n)L_0(n)be the complement of the uniqueO(n)O(n)-fixed point inL(n)L(n). We prove that: (1) for each closed subgroupH⊂O(n)H\subset O(n),L0(n)/HL_0(n)/His a Hilbert cube manifold; (2) for each closed subgroupK⊂O(n)K\subset O(n)acting non-transitively onSn−1S^{n-1}, theKK-orbit spaceL(n)/KL(n)/Kand theKK-fixed point setL(n)[K]L(n)[K]are Hilbert cubes. As an application we establish new topological models for tha Banach-Mazur compactaL(n)/O(n)L(n)/O(n)and prove thatL0(n)L_0(n)and(exp⁡Sn−1)∖{Sn−1}(\exp S^{n-1})\setminus \{S^{n-1}\}have the sameO(n)O(n)-homotopy type.
Weierstrass functions with random phases
Authors: Heurteaux Yanick
Published: May 2003

Consider the function
\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="f Subscript theta Baseline left-parenthesis x right-parenthesis equals sigma-summation Underscript n equals 0 Overscript plus normal infinity Endscripts b Superscript minus n alpha Baseline g left-parenthesis b Superscript n Baseline x plus theta Subscript n Baseline right-parenthesis comma">

f
θ

(
x
)
=

∑

n
=
0

+
∞

b

−
n
α

g
(

b
n

x
+

θ
n

)
,

f_\theta (x)=\sum _{n=0}^{+\infty }b^{-n\alpha }g(b^nx+\theta _n),

\]
where

b
>
1

b>1

,

0
>
α
>
1

0>\alpha >1

, and

g
g

is a non-constant 1-periodic Lipschitz function. The phases

θ
n

\theta _n

are chosen independently with respect to the uniform probability measure on

[
0
,
1
]

[0,1]

. We prove that with probability one, we can choose a sequence of scales

δ
k

↘
0

\delta _k\searrow 0

such that for every interval

I
I

of length

|

I

|

=

δ
k

|I|=\delta _k

, the oscillation of

f
θ

f_\theta

satisfies

osc
⁡
(

f
θ

,
I
)
≥
C

|

I

|

α

\operatorname {osc}(f_\theta ,I)\geq C|I|^\alpha

. Moreover, the inequality

osc
⁡
(

f
θ

,
I
)
≥
C

|

I

|

α
+
ε

\operatorname {osc}(f_\theta ,I)\geq C|I|^{\alpha +\varepsilon }

is almost surely true at every scale. When

b
b

is a transcendental number, these results can be improved: the minoration

osc
⁡
(

f
θ

,
I
)
≥
C

|

I

|

α

\operatorname {osc}(f_\theta ,I)\geq C|I|^\alpha

is true for every choice of the phases

θ
n

\theta _n

and at every scale.
Local solvability and hypoellipticity for semilinear anisotropic partial differential equations
Authors: de Donno Giuseppe , Oliaro Alessandro
Published: May 2003

We propose a unified approach, based on methods from microlocal analysis, for characterizing the local solvability and hypoellipticity inC∞C^\inftyand GevreyGσG^\sigmaclasses of22-variable semilinear anisotropic partial differential operators with multiple characteristics. The conditions imposed on the lower-order terms of the linear part of the operator are optimal.