bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Vascular Risk Factor‐Mediating Medications and Cognition and Dementia Diagnosis in a Community‐Based Sample of African‐Americans
Authors: Richards Stephanie S. , Emsley Christine L. , Roberts John , Murray Michael D. , Hall Kathleen , Gao Sujuan , Hendrie Hugh C. 
Published: April 2015

OBJECTIVE: To determine the association between medications that ameliorate vascular risk factors and the prevalence of cognitive impairment and dementia in an older African‐American population.DESIGN: A community‐based survey to identify subjects with and without evidence of cognitive impairment and subsequent diagnostic evaluation of a stratified sample of these subjects using formal diagnostic criteria for dementia and Alzheimer's disease (AD).SETTING: Urban neighborhoods in Indianapolis, Indiana.SUBJECTS: A random sample of 2212 African‐American adults aged 65 years and older residing in 29 contiguous census tracts.MEASUREMENTS: Subjects' scores on the Community Screening Instrument for Dementia (CSID), formal diagnostic and clinical assessments for dementia, current medication use and history of medical illnesses, both self‐report and, where possible, from an informant.Four outcome measures were defined by the following criteria: (1) cognitive impairment as defined by the subject's performance on the CSID cognitive scale; (2) cognitive/functional impairment as defined by the total CSID score that included a relative's assessment of the subject's functional abilities; (3) dementia as defined by explicit diagnostic criteria; and (4) possible or probable Alzheimer's Disease as defined by explicit criteria.RESULTS: The vascular risk factor mediating medications, when analyzed together, were associated with a significantly decreased risk of diagnosis of cognitive impairment after controlling for age, education, and stroke (OR 0.73, P = .01) and also a significantly decreased risk of cognitive/functional impairment (OR 0.66, P = .02). Antihypertensive agents, excluding centrally acting sympatholytic drugs were associated with a significantly reduced risk of diagnosis of cognitive impairment (OR 0.56, P < .01) and cognitive/functional impairment (OR 0.64, P = .01).Centrally acting sympatholytic agents were associated with an increased risk of diagnosis of cognitive impairment (OR 2.24, P < .01). There was a trend toward protection from a diagnosis of AD and dementia for the vascular risk factor mediating medications and for the antihypertensive medication, but this did not reach significant levels.CONCLUSIONS: These data suggest that the use of medications to ameliorate vascular risk factors, particularly antihypertensive medication, may also be useful in reducing the risk of cognitive impairment in older subjects. However, they also suggest that physicians should be cautious in prescribing antihypertensive drugs with centrally acting sympatholytic properties to older subjects.
A Clinimetric Evaluation of Specialized Geriatric Care for Rural Dwelling, Frail Older People
Authors: Rockwood Kenneth , Stadnyk Karen , Carver Daniel , MacPherson Kathleen M. , Beanlands Hope E. , Powell Colin , Stolee Paul , Thomas Vince Salazar , Tonks Robert S. 
Published: April 2015

OBJECTIVE: To test Comprehensive Geriatric Assessment (CGA) as an adjunct to usual care.DESIGN: A randomized controlled trial with 3, 6, and 12 months follow‐up.SETTING: Rural communities.PATIENTS: A total of 182 of 265 frail older patients (52 refused, 2 withdrawn, 27 ineligible, 2 deaths) referred by family practitioners with allocation to intervention (n = 95) or usual care (n = 87).INTERVENTION: Three‐month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow‐up assessments at 3, 6, and 12 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment.MAIN OUTCOME MEASURE: Goal Attainment Scaling (GAS).RESULTS: Baseline characteristics were comparable between groups. At 3 months, the intervention group was more likely to attain their goals (GAS total: X̄ = 46.4 ± 5.9; GAS outcome X̄ = 48.0 ± 6.6) compared with controls (total: X̄ = 38.7 ± 4.1; outcome X̄ = 40.8 ± 5.6) (P < .001). Standard assessments of function (Barthel index, instrumental activities of daily living), cognition (Mini‐Mental State Examination), and quality of life (modified Spitzer quality of life index) showed no difference over 12 months. No difference in survival (intervention: X̄ = 320 days, SE = 6; control: X̄ = 294 days, SE = 6; P = .257) or time to institutionalization (intervention: 340 days, SE = 9; control: 342 days, SE = 8; log rank = 0.661; P = .416) were observed.CONCLUSIONS: A MGAT can target rural dwelling, frail older persons, perform in‐home CGA, and develop an intervention strategy. Although the intervention did not prolong life or delay institutionalization, clinically important benefits were observed.
Chiropractic Care for Patients Aged 55 Years and Older: Report from a Practice‐Based Research Program
Authors: Hawk Cheryl , Long Cynthia R. , Boulanger Karen T. , Morschhauser Elaine , Fuhr Arlan W. 
Published: April 2015

OBJECTIVE: To characterize patients aged 55 years and older and features of chiropractic care provided to them.DESIGN: Observational, practice‐based research study.SETTING: Chiropractic offices in the United States and Canada, 1997–1998.PARTICIPANTS: Chiropractors in 96 practices in 32 states and two Canadian provinces collected data on 805 eligible patients aged 55 years and older during a 12‐week study period.MEASUREMENTS: In addition to questionnaires on practice characteristics, patient demographics, chief complaints, and health habits, two standardized instruments were administered: for general health status, the Medical Outcomes Study 12‐Item Short‐Form Health Survey (SF‐12); and for disability related to chronic pain, the Pain Disability Index (PDI).RESULTS: Of 805 study patients, 60.1% were women and 94.7% were white. Overweight patients comprised 38.6% and obese 20.6% (n = 656) of the total; 9.7% of patients were hypertensive (n = 590). Smoking was reported by 12.7% and 50.2% reported regular exercise. The Physical Component Summary scores of the SF‐12 seemed somewhat lower than population norms, whereas the Mental Component Summary scores differed very little from norms. Chief complaints were predominantly pain‐related (72.3%), most commonly back pain (32.9%). The PDI mean baseline score for chronic patients was 16.3 (scale, 0–70), and 40.6% of study patients reported using at least one pain medication (prescription or nonprescription) more than three times per week. More than half of complaints (54.9%) had onsets more than 6 weeks before the baseline visit. For 66.6% of subjects, a chiropractor was the only provider for their current complaint. In addition to manipulation, most common features of care were recommendations on exercise (41.0%), heat or cold applications (40.8%), and food supplements (24.5%). At 4 weeks, 19.6% were discharged, 58.8% continued treatment, and 20.1% had discontinued care (self‐discharged). For these three groups, those with higher PDI mean baseline scores showed more change at 4 weeks. For patients who were discharged by the doctor, the proportion of reported pain medication use decreased 7.3% from baseline to 4 weeks, increased for patients who discontinued care, and remained about the same for those continuing care.CONCLUSIONS: Further investigation of the PDI and a decrease in pain medication use as outcome measures seems warranted. The descriptive information in this study may assist providers of care to older adults to better understand their patients' use of chiropractic care. J Am Geriatr Soc 48: 534–545, 2000.
Care for Depression in HMO Patients Aged 65 and Older
Authors: Unützer Jürgen , Simon Gregory , Belin Thomas R. , Datt Moctar , Katon Wayne , Patrick Donald 
Published: April 2015

OBJECTIVE: To examine treatment for depression among older adults in a large staff model health maintenance organization (HMO).DESIGN: A 4‐year prospective cohort study (1989–1993).SETTING: Four primary care clinics of a large staff model HMO in Seattle, Washington.PATIENTS: A total of 2558 Medicare enrollees aged 65 and older.MAIN OUTCOME MEASURES: Treatment of depression was defined as primary care visits resulting in depression diagnoses, use of antidepressant medications, or specialty mental health services.MAIN RESULTS: The older adults in our sample had low rates of treatment for depression, ranging from 4 to 7% in the entire sample and from 12 to 25% among those with probable depressive disorders. Predictors of treatment included female gender, severity, and persistence of depressive symptoms, and severity of comorbid medical illness. Even when patients were treated for depression, the intensity of treatment was very low. Overall likelihood of treatment for depression increased somewhat from 1989 to 1993, but among those treated, the rate of adequate antidepressant use remained below 30%.CONCLUSIONS: There is still considerable need to improve care for older adults with depression in primary care. J Am Geriatr Soc 48:871–878, 2000.
Attrition in an Exercise Intervention: A Comparison of Early and Later Dropouts
Authors: Schmidt Julia A , Gruman Cynthia , King Mary B , Wolfson Leslie I 
Published: April 2015

OBJECTIVE: To identify reasons for dropout and factors that may predict dropout from an exercise intervention aimed at improving physical function in frail older persons.DESIGN/SETTING: An 18‐month randomized controlled intervention in a community setting. The intervention comprised 2 groups: class‐based and self‐paced exercise.PARTICIPANTS: 155 community‐dwelling older persons, mean age 77.4, with mildly to moderately compromised mobility.MEASUREMENTS: The primary outcome measure was dropout. Dropouts were grouped as: D0, dropout between baseline and 3‐month assessment, and D3, dropout after 3‐month assessment.MEASUREMENTS: Measurements of demographics, health, and physical performance included self‐rated health, SF‐36, disease burden, adverse events, PPT‐8, MacArthur battery, 6‐minute walk, and gait velocity.RESULTS: There were 56 dropouts (36%), 31 in first 3 months. Compared with retained subjects (R), the D0 group had greater disease burden (P = .011), worse self‐perceived physical health (P = .014), slower usual gait speed (P = .001), and walked a shorter distance over 6 minutes (P < .001). No differences were found between R and D3. Multinomial logistic regression showed 6‐minute walk (P < .001) and usual gait velocity (P < .001) were the strongest independent predictors of dropout. Controlling for all other variables, adverse events after randomization and 6‐minute walk distance were the strongest independent predictors of dropout, and self‐paced exercise assignment increased the risk of dropout.CONCLUSIONS: We observed baseline differences between early dropouts and retained subjects in disease burden, physical function, and endurance, suggesting that these factors at baseline may predict dropout. Improved understanding of factors that lead to and predict dropout could allow researchers to identify subjects at risk of dropout before randomization. Assigning targeted retention techniques in accordance with these factors could result in decreased attrition in future studies. Therefore, the results of selective attrition of frailer subjects, such as decreased heterogeneity, restricted generalizability of study findings, and limited understanding of exercise effects in this population, would be avoided. J Am Geriatr Soc 48:952–960, 2000.
Mitral Balloon Valvotomy for the Treatment of Mitral Stenosis in Octogenarians
Authors: Sutaria Nilesh , Elder Andrew T. , Shaw Thomas R. D. 
Published: April 2015

OBJECTIVES: To study the safety and benefit of mitral balloon valvotomy (MBV) in patients aged ≥ 80 years.SETTING: A tertiary cardiac centreDESIGN: A retrospective study of 20 octogenarians (mean age 83, range 80–89 years) in whom percutaneous MBV was performed as a definitive or palliative treatment for severe mitral stenosis. All were in New York Heart Association (NYHA) symptom class III or IV. Fourteen had been judged unfit for cardiac surgery. Hemodynamic data was recorded before and after MBV. Symptomatic outcome was documented at 1 month for all patients. Outcome at 1 year was available for 16 patients.RESULTS: Dilatation of the mitral valve was achieved in all patients without major complications. Mean mitral valve area increased 106% from 0.81 (± 0.3) to 1.67 (± 0.8) cm2, transvalvular gradient decreased from 11.8 (± 4.8) to 5.6 (± 2.9) mm Hg, cardiac output increased from 3.1 (± 0.6) to 4.1 (± 1.4) 1/min (all P < .01). Eight of these 20 patients obtained a valve area ≥ 1.5 cm2, and 16 obtained an area ≥ 1.2 cm2. One month after BMV, all patients were alive, and 16 of the 20 patients were improved by at least one NYHA class. This improvement was sustained in 7 of 16 patients followed up for 1 year. More severe mitral valve degenerative change, determined by echocardiography, was associated with poorer outcome.CONCLUSIONS: In this group of very old and frail patients, MBV was safe and resulted in significant immediate improvement. Sustained symptomatic benefit at 1 year was obtained in those with less extensive leaflet and subvalvular disease. In patients with severe degenerative valve disease on echocardiography, but unacceptable surgical risk, MBV offers short‐term palliation. J Am Geriatr Soc 48:971–974, 2000.
Agreement Between Older Subjects and Proxy Informants on History of Surgery and Childbirth
Authors: Robbins Jessica M. , Wolfson Christina M. , Bergman Howard , Clarfield A. Mark , Kleiman Simcha , Bilker Warren , Baumgarten Mona 
Published: April 2015

OBJECTIVES: To assess the agreement between proxy informants' reports of history of surgery and childbirth and older index subjects' own recall.DESIGN: Interrater reliability study.SETTING: An outpatient family medicine clinic and a provincial electoral district in Montreal, Canada.PARTICIPANTS: Eighty‐two subjects aged 65 years and older without cognitive impairment, identified from clinic and community settings, and each index subject's proxy respondent.MEASUREMENTS: Identical questionnaires were administered to index subjects and proxies.RESULTS: Proxies failed to report 39% of non‐childbirth surgeries reported by index subjects, but failed to report only 10% of childbirths. Female proxies were significantly less likely than male proxies to underreport non‐childbirth surgeries after controlling for age of index subject and interval since surgery. Longer interval since surgery was significantly associated with greater underreporting, whereas age of the index subject and relationship between proxy and index subject were not. Agreement between proxies and index subjects on date of surgery was much higher for childbirths than for non‐childbirth surgeries.CONCLUSIONS: Our findings suggest that proxy respondents can provide reliable information on older women's history of childbirth but that use of proxy respondents for history of non‐childbirth surgeries may result in substantial underreporting. J Am Geriatr Soc 48:975–979, 2000.
GERIATRICS IN MANAGED CARE
Authors: Brummel‐Smith Kenneth V. , Boult Chad , Rassen Joshua , Rassen Amy , Moore Richard J. , Robison Stephanie 
Published: April 2015

OBJECTIVE: To measure the effects of case management on an older population's costs of health care.DESIGN: A 1‐year randomized controlled trial.SETTING: Multiple sites of care in San Francisco, California.PARTICIPANTS: Patients aged 65 or older of primary care physicians in a large provider organization bearing financial risk for their care (n = 6409).INTERVENTION: Screening for high risk and provision of social work‐based case management.OUTCOME MEASURES: Volume and cost of hospital, physician, case management, and other health‐related services.RESULTS: The experimental group used more case management services than the control group (0.09 vs 0.02 months per person, P < .001). The experimental group's average total payments for health care were slightly lower ($3148 vs $3277, P = .40).CONCLUSIONS: This study provides no statistically significant evidence that social work‐oriented case management reduces the use or the cost of health care for high‐risk older people. Other potentially favorable effects of this type of case management need to be evaluated, as do the effects of other types of case management. J Am Geriatr Soc 48:996–1001, 2000.
Long‐Term Home Health Care for the Impoverished Frail Homebound Aged: A Twenty‐Seven‐Year Experience
Authors: Kellogg F. Russell , Brickner Philip W. 
Published: April 2015

The Chelsea‐Village Program (CVP) is a long‐term home healthcare program for a largely isolated and impoverished frail homebound aged population, based at Saint Vincent's Hospital in New York City. Since January 1973, our CVP teams of physicians, nurses, and social workers have cared for the homebound aged over the long term. Twenty‐seven years later, we have made 42,866 home visits to 2264 persons in lower Manhattan, an area of New York City housing a high concentration of older people. Our purpose is to help our patients remain in their own homes and community at the maximum possible level of personal control and to maintain the best attainable health. Additionally, the program is a valuable component of the Hospital's Primary Care Adult Medicine residency program. It also serves as a laboratory for the study of health problems faced by the homebound aged and the solutions to these problems. The program, a medical‐social model, has required modest philanthropic investments, dedicated service by physicians, nurses, and social workers, and the support of a hospital with a strong charitable mission.The CVP experience has encouraged the creation of other long‐term home healthcare programs across the country, including the Medicaid‐supported Nursing Home Without Walls program that spans New York State. Thus, the CVP can be viewed as a model rather than an idiosyncratic non‐replicable phenomenon. As such, the program has established that multidisciplinary healthcare teams, in collaboration with a teaching hospital, can provide long‐term home health care to homebound older people in the local community. Moreover such a practice is mutually beneficial. J Am Geriatr Soc 48:1002–1011, 2000.
Polymorphism of M3AlX Phases (M = Ti, Zr, Hf; X = C, N) and Thermomechanical Properties of Ti3AlN Polymorphs
Authors: Zhang Yanhui , Franke Peter , Seifert Hans Jürgen , Wang Jingyang 
Published: April 2015

M3AlX (M = Ti/Zr/Hf, X = C/N) compounds are promising high‐temperature structural ceramics. However, their interesting polymorphism, thermomechanical stabilities, and thermal and mechanical properties were not fully understood. In this work, the polymorphisms of M3AX phases are investigated by combining first‐principles and lattice dynamics calculations. Only Ti3AlN shows polymorphic transition between the cubic and orthorhombic phases at around 1105 K; but other M3AlX phases do not display similar polymorphic phase transition. Furthermore, the temperature‐dependent heat capacity, thermal expansion, and elastic stiffness of Ti3AlN polymorphic phases are reported for the first time to explore the relationship between crystal structures, and mechanical and thermal properties. Ti3AlN polymorphs show anisotropic thermal expansion and elastic stiffness; and the orthorhombic Ti3AlN is suggested as a promising damage tolerant nitride, which has similar properties with the previously reported Zr3AlN and Hf3AlN.
Are we failing to prepare nursing and midwifery students to deal with domestic abuse? Findings from a qualitative study
Authors: Bradbury‐Jones Caroline , Broadhurst Karen 
Published: April 2015

AbstractAimsTo investigate student nurses’ and midwives’ knowledge, confidence and educational needs regarding recognition and responses to domestic abuse.BackgroundDomestic abuse is a serious global problem and has greater, negative effects on long‐term health than more obvious diseases, such as diabetes. Nurses and midwives are well‐placed to recognize and respond to domestic abuse but many lack confidence in this area. There is firm evidence that training can increase the confidence of Registered Nurses and midwives in responding to domestic abuse. But the issue of undergraduate preparation is significantly under‐investigated.DesignA qualitative study.MethodsNursing and midwifery students were recruited using purposive sampling. We facilitated eight focus groups with a total of 55 students (student midwives N = 32; student nurses n = 23). Data were collected between May–November 2014.FindingsStudents in the study viewed the issue of domestic abuse as important and they possessed sound theoretical knowledge of its nature and consequences. However, they lacked confidence in recognizing and responding to abuse and were concerned about the implications of this for their future practice as registered practitioners. Interactive learning opportunities that engaged with service users and involved experts from practice were viewed as important educational requirements.ConclusionMost students in the study felt insufficiently prepared to deal with the issue of domestic abuse. They perceived this as a cyclical state of disempowerment that would impact negatively on their practice and on their own ability to support nursing and midwifery students of the future.
First report of Chilo partellus in Turkey, a new invasive maize pest for Europe
Authors: Bayram A. , Tonğa A. 
Published: April 2015

AbstractThe spotted stem borer, Chilo partellus (Swinhoe, 1885) (Lepidoptera: Crambidae), an invasive pest of wild and cultivated grasses in Asia and Africa, was found for the first time during periodic surveys of maize fields in the East Mediterranean region of Turkey in September and October 2014. The pest was recorded in maize fields of three of four provinces surveyed (Adana, Hatay and Osmaniye; it was not detected in Icel province). The Mediterranean corn stalk borer, Sesamia nonagrioides Lefebvre (Lepidoptera: Noctuidae), is the dominant maize pest in the East Mediterranean region of Turkey, followed by the European corn borer, Ostrinia nubilalis (Hübner) (Lepidoptera: Crambidae). The new invasive species comprised 4.9% of the total number of collected lepidopteran pests collected from maize stems and cobs in locations infested by C. partellus. No natural enemies of the new pest were recorded during our surveys. We discuss possible interactions among these three lepidopteran pests sharing the same habitat, prospects for control of C. partellus by the control methods currently used against S. nonagrioides and O. nubilalis, and also speculate on the path of invasion taken by C. partellus into Turkey.