bluuebunny/crossref_metadata_2025 huggingface dataset:
Specific serum IgE levels and FcɛRIβ genetic polymorphism in patients with penicillins allergy
Authors: Qiao H.‐L. , Yang J. , Zhang Y.‐W.
Published: October 2004

Background:  Numerous studies have suggested that both genetic and environmental influences are involved in the pathogenesis of allergic disease and atopy. The objective of this investigation is to elucidate the underlying mechanism of penicillins allergy and improve the diagnostic methods.

Methods:  Radioallergosorbent test was used to examine eight kinds of specific IgE antibodies, which included four kinds of major and minor antigenic determinants, respectively, in the sera of 448 patients with penicillins allergy and 101 healthy subjects. A restriction endonuclease fragment length polymorphism of a polymerase chain reaction product was used for analysis of the FcɛRIβ polymorphism.

Results:  The positive rate of specific IgE in 448 patients was 58.26% (261), in which 37.28% (167) patients had positive IgE to major antigenic determinants and 47.09% (211) patients had positive IgE to minor antigenic determinants. Of the 179 patients with allergic history, 70.83% (17/24) patients had positive antibodies within 30 days, while 45.28% (24/53) had positive antibodies after 5 years. The positive reaction degree of skin test was absolutely correlated with specific IgE (P = 0.047). Among patients with positive specific IgE, significant differences of E237G genotype were observed between patients with positive benzylpenicillanyl (BPA)‐, phenoxomethylpenicilloyl (PVO)‐ or ampicilloyl (APO)‐IgE and control group (P = 0.015, 0.015, and 0.008, respectively). There were significant differences in E237G genotype between positive and negative BPA‐, PVO‐ as well as APO‐IgE patients (P = 0.014, 0.02, and 0.011, respectively).

Conclusions:  The patients with penicillins allergy have positive specific IgE not only to major antigenic determinants but also to minor antigenic determinants. The E237G variant of the FcɛRIβ gene is involved in the development of penicillins allergy through the process for the production of specific IgE antibodies.
A prospective, randomized, double‐blind, placebo‐controlled multi‐centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen
Authors: Rolinck‐Werninghaus C. , Wolf H. , Liebke C. , Baars J. C. , Lange J. , Kopp M. V. , Hammermann J. , Leupold W. , Bartels P. , Gruebl A. , Bauer C. P. , Schnitker J. , Wahn U. , Niggemann B.
Published: October 2004

Background:  Especially in childhood, sublingual immunotherapy (SLIT) could offer advantages over subcutaneous therapy. However, limited data on its efficacy is available.

Methods:  In four German centres 97 children (age 3–14 years) with allergic rhinoconjunctivitis to grass pollen were enrolled in a prospective, double‐blind trial comparing SLIT (Pangramin SLIT®; ALK‐SCHERAX, 0.5 μg major allergens, three times per week, 32 months) with placebo. Primary endpoint was a multiple symptom‐medication score for changes in seasonal diary entries between the first and third year of the study (SLIT n = 39; placebo n = 38).

Results:  The multiple symptom‐medication score was significantly reduced by SLIT to 77.3% of the placebo group (P = 0.0498). The subsequent analysis of the single endpoints did not reveal significant differences for symptom scores in favour of SLIT (85.1% of placebo group; P = 0.22). However, the medication score improved significantly (67.1% of placebo group; P = 0.0025). Furthermore, secondary endpoints assessing in vivo immune responses did not differ significantly between the groups. However, retrospective analysis showed some inhomogeneity for clinical and in vitro parameters at the beginning of the study. Allergic side effects with possible relation to the study drug were reported in both groups (SLIT 49%, placebo 27%, P = 0.026).

Conclusion:  Our study indicates that SLIT had a positive effect on the reduction of a multiple symptom‐medication score, mainly by significantly reducing rescue medication use, but had no significant effect on symptoms alone in children with rhinoconjunctivitis to grass pollen compared with a placebo.
Chemokine receptor antagonists: a novel therapeutic approach in allergic diseases
Authors: Elsner J. , Escher S. E. , Forssmann U.
Published: October 2004

The aim of this review is to give an overview of the role of chemokines, particularly ligands of the CC chemokine receptor CCR3, in allergic diseases and to show the new concept in the treatment of allergies using chemokine receptor antagonists. Allergic diseases such as allergic asthma, allergic rhinitis and atopic dermatitis are characterized by a complex interaction of different cell types and mediators. Among this, Th2 cells, mast cells, basophils and eosinophils are found in the inflamed tissue due to the attraction of chemokines. Of all the known chemokine receptors, the chemokine receptor CCR3 seems to play the major role in allergic diseases which is supported by the detection of this receptor on the cell types mentioned above. Therefore, academic and industrial research focus on compounds to block this receptor. To date, certain chemokine receptor antagonists derived from peptides and small molecules exist to block the chemokine receptor CCR3. However, the in vivo data about these compounds and the mechanisms of receptor interaction are poorly understood, as yet. For the development of additional chemokine receptor antagonists, more details about the interaction between the ligands and their receptors are required. Therefore, additional studies will lead to the identification of novel CCR3 chemokine receptor antagonists, which can be therapeutically used in allergic asthma, allergic rhinitis, and atopic dermatitis.
Evolution of sex-biased maternal effects in birds: I. Sex-specific resource allocation among simultaneously growing oocytes
Authors: Young R. L. , Badyaev A. V.
Published: October 2004

Females in species that produce broods of multiple offspring need to partition resources among simultaneously growing ova, embryos or neonates. In birds, the duration of growth of a single egg exceeds the ovulation interval, and when maternal resources are limited, a temporal overlap among several developing follicles in the ovary might result in a trade-off of resources among them. We studied growth of oocytes in relation to their future ovulation order, sex, and overlap with other oocytes in a population of house finches (Carpodacus mexicanus) where strongly sex-biased maternal effects are favoured by natural selection. We found pronounced differences in growth patterns between oocytes that produced males and females. Male oocytes grew up to five times faster and reached their ovulation size earlier than female oocytes. Early onset and early termination of male oocytes’ growth in relation to their ovulation resulted in their lesser temporal overlap with other growing ova compared with female oocytes. Consequently, ovulation mass of female but not male oocytes was strongly negatively affected by temporal overlap with other oocytes. In turn, mass of male oocytes was mostly affected by the order of ovulation and by maternal incubation strategy. These results provide a mechanism for sex-biased allocation of maternal resources during egg formation and provide insights into the timing of the sex-determining meiotic division in relation to ovulation in this species.
Spite and the scale of competition
Authors: Gardner A. , West S. A.
Published: October 2004

In recent years there has been a large body of theoretical work examining how local competition can reduce and even remove selection for altruism between relatives. However, it is less well appreciated that local competition favours selection for spite, the relatively neglected ugly sister of altruism. Here, we use extensions of social evolution theory that were formulated to deal with the consequences for altruism of competition between social partners, to illustrate several points on the evolution of spite. Specifically, we show that: (i) the conditions for the evolution of spite are less restrictive than previously assumed; (ii) previous models which have demonstrated selection for spite often implicitly assumed local competition; (iii) the scale of competition must be allowed for when distinguishing different forms of spite (Hamiltonian vs. Wilsonian); (iv) local competition can enhance the spread of spiteful greenbeards; and (v) the theory makes testable predictions for how the extent of spite should vary dependent upon population structure and average relatedness.
Testing the status-dependent ESS model: population variation in fighter expression in the mite Sancassania berlesei
Authors: Tomkins J. L. , LeBas N. R. , Unrug J. , Radwan J.
Published: October 2004

The conditional evolutionarily stable strategy (ESS) with status-dependent tactics is the most commonly invoked ESS for alternative reproductive tactics within the sexes. Support for this model has recently been criticized as apparent rather than real. We address key predictions of the status-dependent ESS in three populations of the male dimorphic mite Sancassania berlesei. In S. berlesei‘fighter’ males are characterized by a thickened pair of legs used for killing rivals; ‘scramblers’ are benign. Most males in each population could be manipulated to become fighters by decreasing density, fulfilling the prediction that males make a ‘decision’. There was evidence of genetic covariance between sire status and offspring morph, but also a strong effect of sire morph on offspring morph ratio. This was consistent with considerable genetic variation for the status-dependent switch point as a breeding experiment found no support for single-locus inheritance. We also found evidence that switch points evolve independently of distributions of status. This study supports the current status-dependent ESS model.
Assessment of patient satisfaction of mentally ill patients hospitalized in Thailand
Authors: Thapinta Darawan , Anders Robert L. , Wiwatkunupakan Srinuan , Kitsumban Voranut , Vadtanapong Siriluck
Published: October 2004

Abstract Psychiatric patients’ satisfaction with their hospital care has not been reported in the Western literature. The concept of asking psychiatric patients about their perceptions of care is relatively new. The purpose of the present investigation was to assess the satisfaction of the care received by a group of acutely mentally ill hospitalized Thai patients. This post‐test design examined a random sample of 182 persons hospitalized between 1 March 2000 and 31 July 2000. Using a validated Perception of Care instrument, research assistants assessed patient satisfaction. Patients rated the care as average with none of the items achieving a very good or excellent score. The lowest scoring items were receiving information about their rights, consistency of information provided, and the ease of obtaining information. Women tended to be more satisfied with care as were patients over the age of 55 years (P = 0.02). Patients with a diagnosis of schizophrenia were more satisfied with the care than other patients (P = 0.05). It is unknown if satisfaction levels are similar in other institutions in Thailand. None of the areas received excellent or very good ratings. The findings of this study were shared with the staff at the study site. There appears to be a need to develop performance improvement activities designed to address the areas identified as needing improvement. Replication of this study in other Thailand sites would provide an opportunity for agencies to benchmark their findings. By consenting to be a part of this study the staff and patients have taken a positive step forward to improve patient satisfaction with care.
Perceptions of professional clinicians and non‐clinicians on their involvement in strategic planning in health care management: Implications for interdisciplinary involvement
Authors: Carney Marie
Published: October 2004

AbstractThere is increasing emphasis on interdisciplinary involvement by health care managers. The objective of the present paper was to identify the level of involvement that middle manager heads of department have in strategy development in acute care hospitals in Ireland, and to identify if professional clinicians were more involved than non‐clinicians. Twenty‐five interviews were undertaken. Findings indicated that middle managers were strategically involved and that non‐clinicians perceived that they were more involved in strategy development than professional clinicians. Strategic involvement appeared to result from a higher level of strategic awareness and confidence by non‐clinicians in the process. Professional clinicians perceived that their expertize was not recognized or appreciated by non‐clinicians or by senior management. Agreement of strategy amongst both groups is critical, as exclusion will lead to demotivation and consequent deterioration in health care delivery.
A NEWLY DEVELOPED ELECTRONIC 360° RADIAL SCANNING ECHOENDOSCOPE
Authors: Inui Kazuo , Yoshino Junji , Nakamura Yuta , Kato Yoshimichi
Published: October 2004

Background:  Development of an electronic radial scanning echoendoscope has been anticipated, because radial scanning images readily demonstrate features of anatomy while electronic scanning provides information about blood flow. Here we present images obtained with a newly developed 360° radial scanning electronic echoendoscope and consider its utility.

Methods:  Using an electronic radial scanning echoendoscope, developed in 2003, the XGF‐UE240‐AL5, B‐mode images were obtained at 5, 6, 7.5, and 10 MHz, while tissue harmonic images at 3.75 and 5 MHz; color Doppler and power Doppler functions also were used. Images obtained by the new echoendoscope were compared with those obtained by a conventional echoendoscope. We performed contrast‐enhanced endoscopic ultrasonography (EUS) with a galactose‐based contrast agent in patients with pancreatobiliary diseases.

Results:  Images at all frequencies and with the Doppler mode were excellent, being more clear than images obtained with a mechanical radial echoendoscope. Gastric wall structure, cystic areas, and tumor contours were visualized more clearly at 3.5 and 5 MHz by tissue harmonic imaging than by mechanical radial scanning echoendoscope, or by ordinary imaging with the electronic radial scanning echoendoscope. Contrast‐enhanced EUS should be helpful in hemodynamic analysis of gastrointestinal tumors.

Conclusions:  The electronic radial echoendoscope provides improved images and is highly useful for detailed diagnosis of digestive diseases.
ENDOSCOPIC ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY FOR THE DIAGNOSIS OF GASTROINTESTINAL SUBMUCOSAL TUMORS
Authors: Yamao Kenji , Sawaki Akira , Salem Ahmed
Published: October 2004

Gastrointestinal submucosal tumors (SMT) detected by barium meal study or endoscopy include various kinds of diseases and various degrees of malignancy. Endoscopic ultrasonography (EUS) can provide useful information about the differentiation of intra‐ and extra‐wall lesions, location and originating layer, presumption of their histological nature, measurement of the actual size of the lesion, and the possibility of differentiating between a benign and a malignant lesion. However, EUS alone does not reveal the complete pathology. EUS fine‐needle aspiration biopsy (EUS‐FNAB) has been reported to be a useful tissue sampling method for pancreatic mass lesions, lymph nodes swelling, posterior mediastinal masses and also gastrointestinal submucosal tumors. The EUS‐FNAB procedure is effective not only for the differential diagnosis of benignancy and malignancy, but also for the specific histopathological nature of gastrointestinal SMT using immunohistochemical staining. When used with MIB‐1 (Ki‐67) staining, and gene analysis in case of gastrointestinal stromal tumor, EUS‐FNAB may indicate its prognosis and influence decisions regarding therapeutic strategy. Thus, EUS‐FNAB is an indispensable procedure in the diagnosis of SMT.
NEWLY DEVELOPED ULTRASOUND ENDOSCOPE WITH AN ELECTRONIC RADIAL ARRAY TRANSDUCER
Authors: Yasuda Kenjiro , Ogawa Masami , Nakajima Masatsugu
Published: October 2004

A prototype electronic radial scan ultrasound endoscope has been developed by Olympus (Tokyo, Japan) for endoscopic ultrasound (EUS) study. The ultrasound view‐angle of this model is 360° vertical to the scope. Though the diameter of the scanner and the shaft of the scope is bigger than those of the present mechanical radial scan model, clinical manipulation of the new scope is the same as that of the present model. Image quality of the ultrasound picture demonstrated by the electronic radial model was as clear as those provided by the mechanical radial scan model. Ultrasound penetration was better and satisfactory because of less echoic reduction compared to the mechanical radial model. The newly developed electronic radial model can be evaluated as an ultrasound endoscope for the next generation. The advantage of this system is to facilitate the clinical use of color Doppler function and tissue harmonic imaging, and this system can be operated by the same monitor unit as a convex model of ultrasound endoscope.
IMPACT OF ULTRASONOGRAPHY ON DIAGNOSIS OF T1 ESOPHAGEAL CANCER AS A CANDIDATE FOR ENDOSCOPIC MUCOSAL RESECTION
Authors: Inoue Haruhiro , Sugaya Satoshi , Kudo Shin‐ei
Published: October 2004

To get the correction information to decide whether endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) should be performed, endoscopic examinations, including multiple modalities such as chromoendoscopy, magnifying endoscopy and ultrasonography, are routinely performed in one or two sessions of endoscopic examination. Ultrasonography provides a cross sectional view of the tumor, which is useful information in the decision between EMR or surgery. The final treatment strategy should be decided according to the histological analysis of the resected specimen.
NEW DEVICES FOR EUS STUDY
Authors: Hawes Robert H
Published: October 2004

It is likely that new endoscopic ultrasound (EUS)‐guided therapies, particularly those that aim to provide local therapy to a neoplastic lesion, will require more sophisticated instrumentation than currently available. In particular, current linear array echoendoscopes are able to image only in two dimensions. New EUS‐guided interventions to ablate tumors might benefit from the development of echoendoscopes which can provide three‐dimensional (3D) images of tumors or lymph nodes. This paper describes the development of such a system.
ENDOSCOPIC ULTRASOUND EDUCATION IN THE USA
Authors: Chang Kenneth J.
Published: October 2004

To maintain the high quality of endoscopic ultrasound (EUS) and EUS‐fine‐needle aspiration (EUS‐FNA) currently available in the United States and yet accommodate the increasing demand for EUS, the availability of and resources for EUS training must continue to increase. There are currently 28 formal EUS training centers in the US and one in Canada, which produce a total of approximately 30–35 expert endosonographers per year. In addition, there are an increasing number of endosonographers being trained through informal or non‐traditional methods. Training in EUS includes three aspects: cognitive (e.g. indications), pattern recognition (normal and pathologic EUS images), and manual dexterity (scope insertion, positioning, FNA). While all these aspects are readily addressed in a formal training setting, it becomes much more challenging in the informal setting. Case observation, but more importantly, hands‐on experience with patients is the rate‐limiting step for accelerated EUS training. Technology advancements (e.g. simulators, tele‐mentoring) may address some of these limitations. Collaborative efforts among different countries may also provide ‘win‐win’ solutions.
Oxazolone‐induced murine model of ulcerative colitis
Authors: WANG Xuan , OUYANG Qin , LUO Wen Jie
Published: October 2004

OBJECTIVE:  Animal models are useful for studying disease, but there is a shortage of suitable models of ulcerative colitis. The aim of the present study was to set up an oxazolone‐induced murine colitis model and use it to research the pathogenesis of inflammatory bowel disease.

METHODS:  BALB/c mice were presensitized by painting the skin with 0.2 mL 3% oxazolone in 100% ethanol on days 0 and 1 followed by intrarectal administration of 0.15 mL 1% oxazolone in 50% ethanol on day 7. The disease activity index (DAI), histological changes of the colon, myeloperoxidase (MPO) activity and production of cytokines (TNF‐α, IL‐4, IFN‐γ) by the mucosa were evaluated.

RESULTS:  There were obvious changes in the DAI, histology and MPO activity, and the production of interleukin‐4 was markedly increased compared with the concentrations of TNF‐α and IFN‐γ, which remained normal, in the lesions.

CONCLUSION:  Oxazolone colitis is Th2‐mediated and has similar histologic features and distribution of inflammation to ulcerative colitis (UC), which has important implications for the use of this model in the study of the pathogenesis and treatment of UC.
Human resources in China: the birth quota, returns to schooling, and migration
Authors: Schultz T. Paul
Published: October 2004

Abstract.  The rural elderly in China have 40% of the income of the urban elderly, spend a larger share of their income on food, are in worse health, work later into their lives and depend more on their children, lacking pensions and public services. The birth quota since 1980 has particularly restricted the childbearing of rural, less educated, women, who therefore have fewer children to rely on for support. This inequality is reinforced by increasing returns to schooling, especially beyond secondary school. Government restrictions on rural–urban migration reduces national efficiency, adds to the urban–rural wage gap and increases inequality.
Transformations in China's population policies and demographic structure
Authors: Yang Dennis Tao , Chen Dandan
Published: October 2004

Abstract.  We use data from a 1992 national fertility survey to analyze China's changing demographic patterns between 1970 and 1989, covering marriage, childbearing, fertility and the gender composition of children. The analysis focuses on the relationship between population control policies and the behavior of successive marriage cohorts. Adopting a regression approach, we characterize a set of stylized demographic features in China over the two decades, including new results on women's average age at first marriage and first births, number of children per couple, and sex ratios among children. China's changing demographic patterns differed significantly among urban, township and rural populations.
Effect of soy protein supplementation on the quality of ripening Cheddar‐type cheese
Authors: ATIA MAHDY , WENSHUI XIA , GUONONG ZHANG
Published: October 2004

The impact of soy protein isolate on the proteolysis and organoleptic properties of Cheddar‐type cheese during ripening was studied. Cheese was prepared from cow's milk (control) and cow's milk plus soy protein isolate by using a starter culture ofStreptococcus thermophilusandLactobacillus delbrueckiisubsp. bulgaricus,and then ripened at 12 ± 1°C for 3 and 5 months. The molecular weight range and peptide fraction in the cheeses were determined by high‐performance liquid chromatography (HPLC), and the microstructure was observed by scanning electron microscopy (SEM). Sensory evaluation was used to compare the flavour, body, texture and appearance of the cheeses. The results show that the molecular weight range (9924–9966 Da) in the control cheese was larger than that (6954–6957 Da) in the soy protein‐treated cheese and the microstructure in the latter was less compact than in the control cheese. In the sensory evaluation, higher scores were given for some experimental cheese than the control cheese. After 5 months of ripening, the organoleptic properties of the cheese had markedly improved and no bitter off‐flavour was detected in the treated cheeses. It was concluded that soy protein could be used to improve the quality of cheese and the addition of 5% soy protein isolate could be recommended for improving the flavour and texture of Cheddar‐type soy supplemented cheese.
Relationships between proteolytic and lipolytic activity and sensory properties (taste–odour) of traditional Turkish white cheese
Authors: GÜLER ZEHRA , URAZ TÜMER
Published: October 2004

Protein and lipid changes and their effects on the sensory properties (taste–odour) of Turkish white cheese were studied. Mean values for the chemical properties of white cheese were: total solids (TS) 44.39 g/100 g; titratable acidity 2.15% (as lactic acid); pH value 4.50; fat‐in‐dry matter 47.80 g/100 g; salt‐in‐dry matter 8.65 g/100 g; total nitrogen (TN) 2.50 g/100 g; water‐soluble nitrogen (WSN) 0.48 g/100 g; ripening index (RI) 18.98%; tyrosine 65.00 mg/100 g; acid degree value (ADV) 385.96 mg KOH/100 g fat; volatile fatty acids (VFA) 15.54 mL 0.1 N NaOH/100 g and total free fatty acids (TFFA) 1325.96 mg/100 g cheese. Sensory scores for taste and odour were 23.67 (out of 35) and 8.28 (out of 10), respectively. The chemical qualities of the cheeses, including acidity, dry matter, fat‐in‐dry matter and VFA had an effect on flavour (P < 0.05).
NIZO food research
Authors: JURIAANSE A C
Published: October 2004

NIZO food research is one of the few remaining independent centres of dairy expertise in the world. Founded in 1948, NIZO has built a track record of exploring new scientific frontiers and the application of new science and technology in industry. NIZO nowadays provides its R&D services to the dairy industry as well as to other food companies. Changes in the dairy industry are also reflected in the development of NIZO. Research has changed its focus, which was predominantly raw material driven, to a new approach where two activities dominate: (a) exploration of new areas of science (e.g. genomics or computational physics) to develop new technology driven opportunities for the dairy industry; and (b) confidential research to deliver technology to industry for new consumer benefits or improvements in the supply chain.
Effect of Person‐Centered Showering and the Towel Bath on Bathing‐Associated Aggression, Agitation, and Discomfort in Nursing Home Residents with Dementia: A Randomized, Controlled Trial
Authors: Sloane Philip D. , Hoeffer Beverly , Mitchell C. Madeline , McKenzie Darlene A. , Barrick Ann Louise , Rader Joanne , Stewart Barbara J. , Talerico Karen Amann , Rasin Joyce H. , Zink Richard C. , Koch Gary G.
Published: October 2004

Objectives: To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person‐centered showering and the towel bath (a person‐centered, in‐bed bag‐bath with no‐rinse soap).

Design: A randomized, controlled trial, with a usual‐care control group and two experimental groups, with crossover.

Setting: Nine skilled nursing facilities in Oregon and six in North Carolina.

Participants: Seventy‐three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them.

Measurements: Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora.

Results: All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person‐centered shower group (P<.001) and 60% in the towel‐bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person‐centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans.

Conclusion: Person‐centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia.
Inappropriate Medication Administration to the Acutely Ill Elderly: A Nationwide Emergency Department Study, 1992–2000
Authors: Caterino Jeffrey M. , Emond Jennifer A. , Camargo Carlos A.
Published: October 2004

Objectives: To determine the national rate and trend of inappropriate medication administration to elderly emergency department (ED) patients. Secondary objectives were to identify risk factors for receiving an inappropriate medication and to determine whether administration is sometimes justified based on diagnosis.

Design: Retrospective analysis of ED visits in the 1992–2000 National Hospital Ambulatory Medical Care Survey. Inappropriate medications identified using Beers' 1997 explicit criteria.

Setting: EDs of U.S. noninstitutionalized general and short‐stay hospitals.

Participants: ED survey patients aged 65 and older.

Measurements: Magnitude and rate of administration of 36 medications.

Results: Inappropriate medications were administered in an estimated 16.1 million (95% confidence interval (CI)=14.9–17.3 million) or 12.6% (95% CI=11.6–13.5%) of elderly ED visits from 1992 to 2000. The rate of inappropriate administration was unchanged throughout the study period (P=.40). Six drugs accounted for 70.8% of inappropriate administration: promethazine (22.2%), meperidine (18.0%), propoxyphene (17.2%), hydroxyzine (10.3%), diphenhydramine (7.1%), and diazepam (6.0%). In multivariate analysis, number of ED medications was the strongest predictor, with an odds ratio for two to three medications of 6.0 (95% CI=5.3–6.7) and for four to six medications of 8.1 (95% CI=7.2–9.2). Diagnoses indicating potentially appropriate uses of these medications were rarely present. For example, only 42.4% of patients receiving diphenhydramine and 7.4% receiving hydroxyzine were diagnosed with an allergic process.

Conclusion: Elderly ED patients are frequently administered inappropriate medications. Potentially appropriate uses of generally inappropriate drugs cannot account for such administrations. Inappropriate administration rates remain unchanged despite the 1997 publication of explicit criteria.
Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention
Authors: Coleman Eric A. , Smith Jodi D. , Frank Janet C. , Min Sung‐Joon , Parry Carla , Kramer Andrew M.
Published: October 2004

Objectives: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates.

Design: Quasi‐experimental design whereby subjects receiving the intervention (n=158) were compared with control subjects derived from administrative data (n=1,235).

Setting: A large integrated delivery system in Colorado.

Participants: Community‐dwelling adults aged 65 and older admitted to the study hospital with one of nine selected conditions.

Intervention: Intervention subjects received tools to promote cross‐site communication, encouragement to take a more active role in their care and assert their preferences, and continuity across settings and guidance from a transition coach.

Measurements: Rates of postdischarge hospital use at 30, 60, and 90 days. Intervention subjects' care experience was assessed using the care transitions measure.

Results: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 (95% confidence interval (CI)=0.28–0.96) at 30 days, 0.43 (95% CI=0.25–0.72) at 90 days, and 0.57 (95% CI=0.36–0.92) at 180 days. Intervention patients reported high levels of confidence in obtaining essential information for managing their condition, communicating with members of the healthcare team, and understanding their medication regimen.

Conclusion: Supporting patients and caregivers to take a more active role during care transitions appears promising for reducing rates of subsequent hospitalization. Further testing may include more diverse populations and patients at risk for transitions who are not acutely ill.
Biomechanical Properties of Shoes and Risk of Falls in Older Adults
Authors: Tencer Allan F. , Koepsell Thomas D. , Wolf Marsha E. , Frankenfeld Cara L. , Buchner David M. , Kukull Walter A. , LaCroix Andrea Z. , Larson Eric B. , Tautvydas Milda
Published: October 2004

Objectives: To determine the relationships between the biomechanical properties of shoes worn in a cohort of healthy older adults and the risk of falling.

Design: Nested case‐control study, comparing biomechanical measurements of shoes worn by those who reported a fall with measurements of shoes worn by age‐ and sex‐matched nonfallers engaged in broadly similar activities.

Setting:

On‐site measurements where falls occurred.

Participants:

A cohort of 1,371 older adults, of whom 327 reported a fall and 327 served as age‐ and sex‐matched controls.

Measurements: Shoe measurements related to lateral stability (heel height and width, critical tipping angle), foot position sense (heel‐collar height, sole thickness, and sole flexibility), and the shoe/surface interface (foresole material, shoe‐to‐ground coefficient of friction, sole contact area).

Results: Greater heel height was associated with increased risk of a fall (P for trend=.03), whereas greater sole contact area was associated with reduced risk (P for trend=.005). Shoe characteristics related to foot position sense bore little apparent relation to fall risk. Coefficients of friction of 0.5 or greater were observed in 93% of shoes measured, indicating that very few were excessively slippery.

Conclusion: Certain measurable properties of shoes were found to be significantly related to risk of falls in older adults. Wearing shoes with low heels and large contact area may help older adults reduce the risk of a fall in everyday settings and activities.
Translating Research into Clinical Practice: Making Change Happen
Authors: Bradley Elizabeth H. , Schlesinger Mark , Webster Tashonna R. , Baker Dorothy , Inouye Sharon K.
Published: October 2004

Objectives:

To describe the process of adoption of an evidence‐based, multifaceted, innovative program into the hospital setting, with particular attention to issues that promoted or impeded its implementation. This study examined common challenges faced by hospitals implementing the Hospital Elder Life Program (HELP) and strategies used to address these challenges.

Design: Qualitative study design based on in‐depth, open‐ended telephone interviews.

Setting: Nine hospitals implementing HELP throughout the United States.

Participants: Thirty‐two key staff members (physician, nursing, volunteer, and administrative staff) who were directly involved with the HELP implementation.

Measurements: Staff experiences implementing the program, including challenges and strategies they viewed as successful in overcoming challenges of implementation.

Results: Six common challenges faced hospital staff: (1) gaining internal support for the program despite differing requirements and goals of administration and clinical staff, (2) ensuring effective clinician leadership, (3) integrating with existing geriatric programs, (4) balancing program fidelity with hospital‐specific circumstances, (5) documenting positive outcomes of the program despite limited resources for data collection and analysis, and (6) maintaining the momentum of implementation in the face of unrealistic time frames and limited resources. Strategies perceived to be successful in addressing each challenge are described.

Conclusion: Translating research into clinical practice is challenging for staff across disciplines. Developing strategies to address common challenges identified in this study may facilitate the adoption of innovative programs within healthcare organizations.
Safety and Immunogenicity of Haemophilus Influenzae Type B Polysaccharide or Conjugate Vaccines in an Elderly Adult Population
Authors: Lottenbach Kathleen R. , Granoff Dan M. , Barenkamp Stephen J. , Powers Douglas C. , Kennedy Donald , Irby‐Moore Sharon , Homan Sharon M. , Mink ChrisAnna M.
Published: October 2004

Objectives: To evaluate the safety and immunogenicity of unconjugated Haemophilus influenzae type b (Hib) polysaccharide (PRP) vaccine and two PRP‐protein‐conjugated vaccines as a model for the comparison of protein‐conjugated versus plain polysaccharide vaccines in the elderly.

Design: Randomized, double‐blind, prospective study.

Setting: University‐based center for vaccine research and development.

Participants: A total of 125 adults, aged 64 to 92, who were judged to be in general good health and lacking any significant underlying medical conditions.

Intervention: Subjects were randomized to receive one of three vaccines: Group 1 (n=39), PRP; Group 2 (n=44), PRP conjugated to an outer‐membrane protein complex of Neisseria meningitidis (PRP‐OMP); and Group 3 (n=42), PRP conjugated to diphtheria toxoid (PRP‐D). Sera were obtained before immunization and 1 and 12 months later.

Measurements: Subjects maintained a diary of injection site and systemic reactions for 3 days after immunization. A radioantigen‐binding assay was used to measure total concentrations of serum anticapsular antibody, and an enzyme‐linked immunosorbent assay was used to measure immunoglobulin (Ig) G1 and IgG2 anticapsular antibody responses. Antibody functional activity was assessed using a complement‐mediated bactericidal assay.

Results: Before vaccination, the geometric mean serum anticapsular antibody concentration was 0.8 μg/mL, but fewer than 10% of subjects had detectable bactericidal activity (titer>1:4). The magnitude, subclass distribution, and bactericidal activity of antibody responses to unconjugated PRP vaccine were similar to those observed in previous studies of younger adults immunized with PRP. The OMP conjugate, which is highly immunogenic after one dose in 2‐month old infants, did not elicit anticapsular antibody responses in the elderly greater than those elicited by PRP vaccine (P=.43). In contrast, the D conjugate, which is poorly immunogenic in 2‐month old infants, elicited higher anticapsular antibody responses than PRP vaccine in the elderly (P=.01) and higher levels than the OMP‐conjugate 1 year after vaccination (P<.006).

Conclusion: Elderly adults develop protective anticapsular antibody responses to unconjugated and conjugated PRP vaccine. The higher anticapsular antibody responses to the D conjugate but not to the OMP conjugate in the elderly, which is the reverse of that observed in immunized infants, implies fundamental differences in the immunological mechanisms by which the two age groups respond to PRP and by which the OMP and D conjugates elicit anticapsular antibody responses.
Bathing Disability in Community‐Living Older Persons: Common, Consequential, and Complex
Authors: Naik Aanand D. , Concato John , Gill Thomas M.
Published: October 2004

Objectives: To identify the specific bathing subtasks that are affected in community‐living‐older persons with bathing disability and to determine the self‐reported reasons for bathing disability.

Design: Cross‐sectional study.

Setting: General community of greater New Haven, Connecticut.

Participants: A total of 626 community‐living persons, aged 73 and older, who completed a comprehensive assessment, including a detailed evaluation of bathing disability.

Measurements: Trained research nurses assessed bathing disability (defined as requiring personal assistance or having difficulty washing and drying the whole body), the specific bathing subtasks that were affected, and the main reasons (up to three) for bathing disability.

Results: Disability in bathing was present in 195 (31%) participants; of these, 97 required personal assistance (i.e., dependence), and 98 had difficulty bathing. Participants with bathing disability reported a mean±standard deviation of 4.0±2.4 affected subtasks. The prevalence rate of disability for the eight prespecified bathing subtasks ranged from 25% for taking off clothes to 75% for leaving the bathing position. The majority of participants (59%) provided more than one reason for bathing disability. The most common reasons cited by participants for their bathing disability were balance problems (28%), arthritic complaints (26%), and fall or fear of falling (23%).

Conclusion: For community‐living older persons, disability in bathing is common, involves multiple subtasks, and is attributable to an array of physical and psychological problems. Preventive and restorative interventions for bathing disability will need to account for the inherent complexity of this essential activity of daily living.
Does Self‐Rated Health Predict Survival in Older Persons with Cognitive Impairment?
Authors: Walker Jennifer D. , Maxwell Colleen J. , Hogan David B. , Ebly Erika M.
Published: October 2004

Objectives: To determine whether baseline self‐rated health (SRH) independently predicted survival in an older Canadian population and to investigate the role of cognition on the SRH‐mortality relationship.

Design: Population‐based prospective cohort study.

Setting: Ten Canadian provinces, community‐based.

Participants: A total of 8,697 community‐dwelling participants aged 65 and older.

Measurements: Self‐reported measures of overall health, physical function, comorbidities, and demographic characteristics were obtained by interview. Cognitive ability was ascertained using the Modified Mini‐Mental State Examination (3MS). Participants were followed for their survival status from the initial interview in 1991 until October 31, 1996.

Results: Subjects with reports of poor SRH were significantly more likely to die during follow‐up than those reporting good SRH, after adjusting for relevant covariates (adjusted hazard ratio (AHR)=1.38, 95% confidence interval (CI)=1.24–1.53). SRH was also related to other measures of health status across levels of cognitive impairment. SRH remained a significant predictor of mortality in subjects with mild to moderate cognitive impairment (AHR=1.26, 95% CI=1.01–1.59) but not in those with severe cognitive impairment (AHR=1.00, 95% CI=0.76–1.31).

Conclusion: This study supports the utility of SRH assessments in predicting survival of individuals with mild to moderate cognitive impairment. The findings highlight the potential role of complex cognitive processes underlying the SRH‐mortality relationship.
Association Between Visual Attention and Mobility in Older Adults
Authors: Owsley Cynthia , McGwin Gerald
Published: October 2004

Objectives: To examine the association between visual attention/processing speed and mobility in older adults.

Design: Cross‐sectional.

Setting: Clinical research unit of a department of ophthalmology.

Participants: Three hundred forty‐two older adults (aged 55–85) living independently in the community recruited from primary eye care practices.

Measurements: In addition to demographic, health, and functional information, the following variables were collected at the second annual visit of a prospective study on mobility: a test of visual attention/processing speed; a performance mobility assessment; and self‐reported measures of falls, falls efficacy, mobility/balance, and physical activity.

Results: Lower scores on visual attention/processing speed were significantly related to poorer scores on the performance mobility assessment, even after adjustment for age, sex, race, education, number of chronic medical conditions, cognitive status, depressive symptoms, visual acuity, and contrast sensitivity (P=.04). Scores on the visual attention/processing speed test were unrelated to the self‐reported measures of mobility.

Conclusion: Results imply that visual attention impairment/slowed visual processing speed in older adults is independently associated with mobility problems. Interventions to reverse or minimize the progression of mobility dysfunction in older adults should take this common aging‐related deficit in visual processing into account.
Unprovoked and Glyceryl Trinitrate–Provoked Head‐Up Tilt Table Test Is Safe in Older People: A Review of 10 Years' Experience
Authors: Gieroba Zbigniew J. , Newton Julia L. , Parry Steve W. , Norton Michael , Lawson Joanna , Kenny Rose Anne
Published: October 2004

Objectives: To test the safety of the head‐up tilt test (HUT) in older adults.

Design: Direct observation and measurements.

Setting: Tests performed in a quiet room with dim lighting in a laboratory setting.

Participants: One thousand ninety‐six subjects aged 60 to 74; 873 aged 75 and older.

Measurements: Blood pressure and pulse at baseline for 10 minutes and 70° tilt for maximum of 45 minutes. Subjects with unprovoked HUT had test repeated on a separate day after 800 mg glyceryl trinitrate (GTN).

Results: One thousand four hundred ninety‐five drug‐free and 474 GTN‐provoked HUTs were studied. In those aged 60 to 74, the proportion of hypotensive unprovoked HUT was 16% (27% in those aged ≥75); this was higher with GTN provocation (43% in those aged 60–74, 44% in those aged ≥75; P<.01). Systolic blood pressure decreased during provoked HUT (lowest mean±standard deviation=67±20 in those aged 60–74, 63±24 in those aged ≥75; P<.01). There was one cardiovascular and no neurological complications.

Conclusion: This study included 10 times as many people as previous studies and demonstrates the safety of HUT in older people.
Cruise Ship Care: A Proposed Alternative to Assisted Living Facilities
Authors: Lindquist Lee A. , Golub Robert M.
Published: October 2004

Options for elderly patients who can no longer remain independent are limited. Most choices involve assisted living facilities, 24‐hour caregivers, or nursing homes. State and federal assistance for payment for individual care is limited, and seniors usually pay for most costs out of pocket. For those patients who have the means to afford assisted living centers or nursing homes, “cruise ship care” is proposed. Traveling alongside traditional tourists, groups of seniors would live on cruise ships for extended periods of time. Cruise ships are similar to assisted living centers in the amenities provided, costs per month, and many other areas. This article begins with an examination of the needs of seniors in assisted living facilities and then explores the feasibility of cruise ship care in answering those needs. Similarities between cruise ship travel and assisted living care, as well as the monetary costs of both options, are defined. A decision tree with selections for nonindependent care for seniors was created including cruise ship care as an alternative. Using a Markov model over 20 years, a representative cost‐effectiveness analysis was performed that showed that cruises were priced similarly to assisted living centers and were more efficacious. Proposed ways that cruise ship companies could further accommodate the needs of seniors interested in this option are also suggested. Implementation for cruise ship care on the individual basis is also presented. Ultimately, it is wished to introduce a feasible and possibly more desirable option to seniors who can no longer remain independent.