bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prestroke Factors Associated with Poststroke Mortality and Recovery in Older Women in the Women's Health Initiative
Authors: Bell Christina L. , LaCroix Andrea , Masaki Kamal , Hade Erinn M. , Manini Todd , Mysiw W. Jerry , Curb Jess David , Wassertheil‐Smoller Sylvia 
Published: July 2013

ObjectivesTo examine prestroke lifestyle factors associated with poststroke mortality and recovery in older women.DesignLongitudinal prospective cohort study.SettingThe Women's Health Initiative (WHI, clinical trials and observational study), 40 clinical centers in the United States.ParticipantsWHI participants, women aged 50 to 79, who were stroke‐free at baseline (1993/98), with incident stroke before 2005.MeasurementsParticipants were followed for mortality through 2010. Prestroke characteristics were from the last examination before the stroke event. Annual follow‐up for clinical events ascertained hospitalization for stroke that was subsequently physician adjudicated with medical records. Multivariable regression models were used to analyze factors associated with poststroke mortality and poststroke recovery at hospital discharge (poststroke Glasgow score), adjusting for stroke type.ResultsOf 3,173 women with incident stroke, 1,111 (35%) died. Individuals who were overweight or obese before stroke had lower poststroke mortality than those who were normal weight (obese: hazard ratio (HR) = 0.69, 95% confidence interval (CI) = 0.53–0.88; overweight: HR = 0.72, 95% CI = 0.58–0.90); individuals who were underweight before stroke had nonsignificantly greater poststroke mortality (HR = 2.02, 95% CI = 0.98–4.16, P = .06). Other prestroke factors associated with poststroke mortality included diabetes mellitus (HR = 1.28, 95% CI = 1.01–1.64), current smoking (vs nonsmoker, HR = 2.13, 95% CI = 1.53–3.00), physical inactivity (vs >150 min of exercise per week, HR = 1.39, 95% CI = 1.09–1.78), and lowest physical function quartile (vs highest, HR = 1.54, 95% CI = 1.18–2.02). Prestroke diabetes mellitus was associated with lower odds of good recovery after stroke (odds ratio (OR) = 0.60, 95% CI = 0.44–0.82). Current hormone use before stroke was associated with greater odds of moderate than of severe disability after stroke (OR = 1.29, 95% CI = 1.00–1.66).ConclusionPotentially modifiable factors before stroke, including smoking, diabetes mellitus, and being underweight, were associated with greater poststroke mortality in older women. Being overweight or obese and physical activity before stroke were associated with lower poststroke mortality in older women.
Caregiver Outcomes of Partners in Dementia Care: Effect of a Care Coordination Program for Veterans with Dementia and Their Family Members and Friends
Authors: Bass David M. , Judge Katherine S. , Lynn Snow A. , Wilson Nancy L. , Morgan Robert , Looman Wendy J. , McCarthy Catherine A. , Maslow Katie , Moye Jennifer A. , Randazzo Ronda , Garcia‐Maldonado Maurilio , Elbein Richard , Odenheimer Germaine , Kunik Mark E. 
Published: July 2013

The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care‐coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimer's Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6‐ and 12‐ month follow‐up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e‐mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimer's Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more‐limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more‐severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimer's Disease and a proposed amendment to the Older Americans Act.
Dental Caries in Older Adults in the Last Year of Life
Authors: Chen Xi , Clark Jennifer J. , Preisser John S. , Naorungroj Supawadee , Shuman Stephen K. 
Published: July 2013

ObjectivesTo examine dental caries severity (measured by number of carious teeth) in older adults in the last year of life.DesignCross‐sectional study based on dental records.SettingCommunity‐based geriatric dental clinic.ParticipantsOne thousand two hundred sixteen individuals aged 65 and older, including 168 individuals in the last year of life (e.g., individuals died within 1 year after their new‐patient examinations).MeasurementsInformation on socioeconomic, medical history, medication, functional status, and oral health measures, including number of carious teeth, was abstracted from dental records. End‐of‐life status was determined using the National Death Index. Propensities of death were calculated using a logistic regression and then adjusted together with mobility and oral care function in the multivariable regression model to examine the effect of end‐of‐life status on dental caries.ResultsCaries severity differed in end‐of‐life participants with different oral care function. Of those needing help with oral care, end‐of‐life participants had only a slightly higher and nonstatistically significant risk (7.5 vs 6.1, adjusted incidence density ratio (IDR) = 1.12, 95% confidence interval (CI) = 0.85–1.48) of having more carious teeth than those not in the last year of life. On the other hand, caries severity was lower in end‐of‐life participants without impaired oral care function (IDR = 0.53, 95% CI = 0.30–0.92).ConclusionOral care function modifies the association between caries severity and end‐of‐life status. Individuals who could maintain oral hygiene independently had a low level of caries at the end of life, however, dental caries had increased before functionally dependent individuals entered their last year of life.
Implementing Physician Orders for Life‐Sustaining Treatment in California Hospitals: Factors Associated with Adoption
Authors: Sugiyama Takehiro , Zingmond David , Lorenz Karl A. , Diamant Allison , O'Malley Kate , Citko Judy , Gonzalez Victor , Wenger Neil S. 
Published: July 2013

Physician Orders for Life‐Sustaining Treatment (POLST) is a tool to document and ensure continuity of end‐of‐life treatment decisions across healthcare settings that became a legal document in California in January 2009. Hospitals were surveyed to evaluate factors associated with uptake of this intervention and whether a grassroots community coalition intervention facilitated dissemination. A mail and telephone survey of all acute care hospitals in California was conducted between August 2011 and January 2012, and community coalition reports of interaction with hospitals and hospital characteristics from the California Office of Statewide Planning and Development and Census ZIP Code Tabulation Areas were analyzed. Of 349 hospitals, 286 (81.9%) responded to the survey. Sixty‐five percent of hospitals had a policy about POLST, 87% had available blank POLST forms, 84% had educated staff, and 94% reported handling POLST properly in the emergency department and on admission. In multivariable analyses, hospitals in poor areas and for‐profit (vs nonprofit) hospitals were less likely to stock blank POLST forms and to have educated staff, and hospitals with community coalition interaction and in wealthier areas were more likely to handle POLST forms correctly. Although POLST is widely used in California, a significant minority of hospitals remain unprepared 3 years after implementation. Efforts to improve implementation should emphasize dissemination in poorer areas and in for‐profit hospitals.
Systematic Review: Effective Characteristics of Nursing Homes and Other Residential Long‐Term Care Settings for People with Dementia
Authors: Zimmerman Sheryl , Anderson Wayne L. , Brode Shannon , Jonas Dan , Lux Linda , Beeber Anna S. , Watson Lea C. , Viswanathan Meera , Lohr Kathleen N. , Sloane Philip D. 
Published: July 2013

ObjectivesIn response to the need for an evidence‐based review of factors within long‐term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long‐term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes.DesignDatabases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia.ResultsFourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial. Overall, low or insufficient strength of evidence was found regarding the effect of most organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate strength of evidence indicate that pleasant sensory stimulation reduces agitation for people with dementia. Also, although the strength of evidence is low, protocols for individualized care and to improve function result in better outcomes for these individuals. Finally, outcomes do not differ between nursing homes and residential care or assisted living settings for people with dementia except when medical care is indicated.ConclusionGiven the paucity of high‐quality studies in this area, additional research is needed to develop a sufficient evidence base to support consumer selection, practice, and policy regarding the best settings and characteristics of settings for residential long‐term care of people with dementia.
Fecal Transplantation for Recurrent Clostridium difficile Infection in Older Adults: A Review
Authors: Burke Kristin E. , Lamont John T. 
Published: July 2013

Recurrent Clostridium difficile infection (CDI) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long‐term care facilities. Because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second‐line therapy for treatment of recurrent CDI. A comprehensive literature search of PubMed, Embase, and Web of Science regarding fecal transplantation for CDI was performed to further evaluate the efficacy and side effects of this promising therapy in older adults. Data were extracted from 10 published articles from 1984 to the present that met inclusion criteria, including nine open‐label reports and one randomized controlled trial. Baseline characteristics and outcomes of individuals undergoing fecal transplantation and effects of fecal transplantation on the fecal microflora were reviewed. Methods of fecal transplantation and donor selection were reviewed. Fecal transplantation was performed in 115 individuals aged 60 to 101, with a female predominance. CDI cure was achieved in 103 (89.6%) individuals over a follow‐up period of 2 months to 5 years (mean 5.9 months). There was no significant difference in cure rate between older and younger participants in included studies. Most failed transplantation occurred in individuals infected with the aggressive NAP1/027 strain of C. difficile. Microbiological studies of fecal biodiversity before and after fecal transplantation demonstrated greater bacterial diversity and shift in flora species to resemble donor flora after transplantation that correlated with clinical remission. Fecal transplantation provides a safe and durable cure for older adults with recurrent CDI.
Effect of Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital Admissions of Elderly Adults: A Multicenter Study
Authors: van den Bemt Patricia M. L. A. , van der Schrieck‐de Loos Erica M. , van der Linden Christien , Theeuwes Annemiek M. L. J. , Pol Albert G. ,   The Dutch CBO WHO High 5s Study Group
Published: July 2013

ObjectivesTo investigate the effect of pharmacy‐based medication reconciliation on the frequency of unintentional medication discrepancies in acutely admitted individuals aged 65 and older.DesignMulticenter intervention study with pre–post design.SettingTwelve Dutch hospitals.ParticipantsOne thousand five hundred forty‐three individuals aged 65 and older with an acute hospital admission through the emergency department.MeasurementsThe intervention consisted of the Best Possible Medication History (BPMH), based on combining information from the community pharmacy record, the information provided by a structured interview with participants about their medication use, and medication containers. In nine hospitals, pharmacy technicians obtained the BPMH, and in three hospitals, a mixed model was used (physicians or pharmacy technicians obtained the BPMH). Primary outcome measure was the proportion of participants with one or more unintentional medication discrepancies. The primary outcome measure was stratified according to type of intervention (pharmacy based vs mixed model).ResultsThe proportion of participants with one or more unintentional medication discrepancies was reduced from 62% to 32% [odds ratio (OR) = 0.29, 95% confidence interval (CI) = 0.23–0.37]. These results remained statistically significant after adjustment for type of department and hospital (OR = 0.20, 95% CI = 0.15–0.26), and this effect remained stable for 6 months. Stratified analysis showed that no effect from the intervention was evident in the three hospitals with a mixed‐model intervention, in contrast to the hospitals with a pharmacy‐based intervention. The medication discrepancy types “omission” and “dosage or strength” occurred most frequently and were the main types that the intervention influenced.ConclusionPharmacy‐based medication reconciliation leads to a substantial reduction in medication discrepancies in acutely admitted elderly adults.
Maternal supportive and interfering control as predictors of adaptive and social development in children with and without developmental delays
Authors: Green S. , Caplan B. , Baker B. 
Published: July 2013

AbstractBackgroundParents of children with developmental delays (DD) have been found to use more controlling behaviour with their children than parents of children with typical development (TD). While controlling behaviour is related to poorer developmental outcomes in TD children, there is little research on how it predicts outcomes in DD children. Furthermore, existing research tends to use inconsistent or non‐specific definitions of controlling behaviour, often combining parent control which follows the child's goal (e.g. supportive direction) and that which interferes with the child's goal (e.g. interference).MethodsParticipants were 200 mother–child dyads observed at child age 3, with follow‐up assessments of adaptive behaviour and social skills administered at child ages 5 and 6, respectively. We coded the frequency of both types of controlling behaviour based on mothers' interactions with their children with TD (n = 113) or DD (n = 87) at age 3.ResultsMothers in the DD group used more interfering but not more supportive directive acts compared to mothers in the TD group. Adaptive behaviour was assessed at child age 5 and social skills were assessed at age 6. Higher frequency of supportive directive acts predicted better adaptive functioning for the TD group and better social skills for the DD group. Higher frequency of interfering acts predicted lower adaptive and social skills for children with DD but not with TD.ConclusionsResults are discussed in terms of the differential developmental needs of children with and without DD as well as implications for early intervention.
Outcomes in young adulthood: are we achieving community participation and inclusion?
Authors: Gray K. M. , Piccinin A. , Keating C. M. , Taffe J. , Parmenter T. R. , Hofer S. , Einfeld S. L. , Tonge B. J. 
Published: July 2013

AbstractBackgroundDespite recognition of the importance of integrated community living and support, there is evidence that parents remain the primary caregivers of young adults with intellectual disability (ID). In addition, employment rates remain low in this population. This study aimed to investigate the changes in living arrangements and participation in daytime activities over time in a community population of young people with ID.MethodThe sample consisted of 536 participants aged 4.0–18.9 years at Wave 1, followed up at Wave 5 when aged 20.5–37.6 years. Information was collected on their living arrangements and daytime activities at both time points, along with living skills and information on community social inclusion at Wave 5. For parents still caring for their adult child with ID, information was also collected on parental ratings of their own mental and physical health, and their satisfaction with the long‐term care arrangements for their adult child.ResultsA significant proportion of young people were still living with their parents at Wave 5. A greater proportion of those with a severe–profound degree of ID were living in residential care. Parents caring for their adult child reported high levels of mental health problems and dissatisfaction with the long‐term care arrangements for their child. A small proportion of young people were in paid employment, and the majority was engaged in structured activities provided for those with an ID. Over one‐third of the sample participated in a structured daytime activity for 10 or fewer hours per week, and 7% were not engaged in any structured daytime activity.ConclusionsThese results suggest that adequate provision of accommodation and employment services for young adults with an ID is lacking. In many cases the responsibility of care continues to reside with parents as their children transition from childhood to adulthood. Greater attention is needed to address these issues and facilitate social inclusion and integration for young people with ID.
Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders
Authors: Mingarelli A. , Casagrande M. , Di Pirchio R. , Nizzi S. , Parisi C. , Loy B. C. , Solano L. , Rampello A. , Di Paolo C. 
Published: July 2013

SummaryTemporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro‐facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty‐three patients received a diagnosis of TMD and completed the 20‐item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia.
High Performance Liquid Chromatographic Determination of Residual Monomer Released from Heat‐Cured Acrylic Resin. An In Vivo Study
Authors: Singh Raghuwar D. , Gautam Rupali , Siddhartha Ramashanker , Singh Balendra P. , Chand Pooran , Sharma Vinod P. , Jurel Sunit K. 
Published: July 2013

AbstractPurposeHeat‐polymerized acrylic resins are used in dentistry for complete denture fabrication. Despite the polymerization method, conversion of monomer into polymer is often incomplete with free or unreacted residual monomer remaining in the polymerized resin. The aim of this study was to determine the amount of residual monomeric methyl methacrylate (MMA) leaching in the saliva of patients wearing complete dentures in their postinsertion period.Materials and MethodsThirty edentulous participants as first‐time complete denture wearers (age 60 to 65 years) were selected. All the prostheses were fabricated using a similar standard technique with a heat‐cured acrylic resin denture base material. Saliva samples were collected at time intervals of 1 hour, 1 day, and 3 days postdenture insertion. Participants were asked to discharge saliva every 30 seconds into a pre‐weighed screw‐capped container for a 5‐minute period. MMA levels were measured using high performance liquid chromatography. Data were analyzed by ANOVA and Tukey‐HSD.ResultsThe maximum concentration of monomer released into saliva peaked 1 day after insertion of the complete dentures. The mean (SD) MMA content was 0.04 ± 0.01 (μg/ml) 1 hour after insertion, and 0.3 ± 0.09 (μg/ml), and 0.05 ± 0.01 (μg/ml) on the first and third days postinsertion, respectively.ConclusionsAlthough the released monomeric MMA was not at toxic levels, it could potentially sensitize complete denture patients or elicit an allergic reaction. The risk of the residual material as a primary irritant for a sensitizing reaction could be minimized by immersion of the denture in water for 24 hours before insertion.