bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Healthcare Costs of Sarcopenia in the United States
Authors: Janssen Ian , Shepard Donald S. , Katzmarzyk Peter T. , Roubenoff Ronenn 
Published: December 2003

Objectives: To estimate the healthcare costs of sarcopenia in the United States and to examine the effect that a reduced sarcopenia prevalence would have on healthcare expenditures.Design: Cross‐sectional surveys.Setting: Nationally representative surveys using data from the U.S. Census, Third National Health and Nutrition Examination Survey, and National Medical Care and Utilization Expenditure Survey.Participants: Representative samples of U.S. adults aged 60 and older.Measurements: The healthcare costs of sarcopenia were estimated based on the effect of sarcopenia on increasing physical disability risk in older persons. In the first step, the healthcare cost of disability in older Americans was estimated from national surveys. In the second step, the proportion of the disability cost due to sarcopenia (population‐attributable risk) was calculated to determine the healthcare costs of sarcopenia. These calculations relied upon previously published relative risk values for disability in sarcopenic individuals and sarcopenia prevalence rates in the older population.Results: The estimated direct healthcare cost attributable to sarcopenia in the United States in 2000 was $18.5 billion ($10.8 billion in men, $7.7 billion in women), which represented about 1.5% of total healthcare expenditures for that year. A sensitivity analysis indicated that the costs could be as low as $11.8 billion and as high as $26.2 billion. The excess healthcare expenditures were $860 for every sarcopenic man and $933 for every sarcopenic woman. A 10% reduction in sarcopenia prevalence would result in savings of $1.1 billion (dollars adjusted to 2000 rate) per year in U.S. healthcare costs.Conclusion: Sarcopenia imposes a significant but modifiable economic burden on government‐reimbursed healthcare services in the United States. Because the number of older Americans is increasing, the economic costs of sarcopenia will escalate unless effective public health campaigns aimed at reducing the occurrence of sarcopenia are implemented.
Achieving Goals in Geriatric Assessment: Role of Caregiver Agreement and Adherence to Recommendations
Authors: Bogardus Sidney T. , Bradley Elizabeth H. , Williams Christianna S. , Maciejewski Paul K. , Gallo William T. , Inouye Sharon K. 
Published: December 2003

Objectives: To determine predictors of recommendation adherence and goal attainment of family caregivers of patients at a geriatric assessment center.Design: One‐year prospective cohort study.Setting: Outpatient geriatric assessment center in Connecticut.Participants: Two hundred consecutive new patients and their family caregivers.Measurements: Family caregivers were interviewed after geriatric assessment to ascertain their treatment goals for the patient. Medical records were reviewed to identify treatment recommendations. Family caregivers were interviewed 1 year later to assess adherence to recommendations and attainment of goals.Results: Follow‐up interviews were completed with 176 (88%) family caregivers. Common recommendations pertained to physician referral (71%), medications (46%), counseling/education (31%), diagnostic tests (30%), residential planning (26%), healthcare planning (21%), and community services (21%). Goal attainment was reported in 44% to 67% of the patient cases, depending on goal category. Caregiver agreement with recommendations predicted adherence to recommendations (adjusted relative risk (ARR)=1.99, 95% confidence interval (CI)=1.04–5.92) after adjusting for available clinical and demographic factors. In addition, adherence to recommendations predicted goal attainment in adjusted analyses (ARR=1.70, 95% CI=1.09–2.64).Conclusion: This study revealed a broad range of treatment recommendations in geriatric assessment and suggests that agreeing with recommendations can promote adherence and that adherence can promote goal attainment. Taken together, the results imply that articulating shared treatment recommendations may improve the quality of health care.
Effect of Depression on Diagnosis, Treatment, and Survival of Older Women with Breast Cancer
Authors: Goodwin James S. , Zhang Dong D. , Ostir Glenn V. 
Published: December 2003

Objectives: To assess the effect of a prior diagnosis of depression on the diagnosis, treatment, and survival of older women with breast cancer.Design: Retrospective analysis of records from Surveillance, Epidemiology and End Results (SEER) and Medicare claims.Setting: Registries from seven major cities and five states.Participants: A total of 24,696 women aged 67 to 90 diagnosed with breast cancer between 1993 and 1996 and included in the SEER Medicare linked database were studied.Measurements: Information on patient demographics, tumor characteristics, treatment received, and survival were obtained from SEER, and the Medicare inpatient and professional charges for the 2 years before diagnosis were searched for a diagnosis of depression.Results: A total of 1,841 of the 24,696 women (7.5%) had been given a diagnosis of depression sometime in the 2 years before the diagnosis of breast cancer. There was no difference in tumor size or stage at diagnosis between depressed and nondepressed women. Women diagnosed with depression were less likely to receive treatment generally considered definitive (59.7% vs 66.2%, P< .0001), and this difference remained after controlling for age, ethnicity, comorbidity, and SEER site. Also, women with a prior diagnosis of depression had a higher risk of death (hazard ratio=1.42; 95% confidence interval= 1.13–1.79) after controlling for other factors that might affect survival. The higher risk of death associated with a prior diagnosis of depression was also seen in analyses restricted to women who received definitive treatment.Conclusion: Women with a recent diagnosis of depression are at greater risk for receiving nondefinitive treatment and experience worse survival after a diagnosis of breast cancer, but differences in treatment do not explain the worse survival.
Effect of a Comprehensive, Multidisciplinary, Educational Program on the Use of Antibiotics in a Geriatric University Hospital
Authors: Lutters Monika , Harbarth Stephan , Janssens Jean‐Paul , Freudiger Hans , Herrmann François , Michel Jean‐Pierre , Vogt Nicole 
Published: December 2003

Objectives: To assess the effect of a comprehensive, educational antibiotic management program designed to improve antibiotic use and reduce treatment costs in elderly patients with suspected urinary or respiratory tract infection.Design: Interventional cohort study with 12 cross‐sectional drug utilization reviews of antibiotic use before, during, and after the multifaceted intervention.Setting: A 304‐bed university hospital for geriatric patients.Participants: A total of 3,383 elderly patients.Interventions: An educational program including distribution of guidelines on the diagnosis and treatment of urinary and respiratory tract infections; lectures on geriatric infectious diseases; weekly ward rounds for patients with suspected infection; and targeted, individual counseling on diagnosis and antibiotic treatment of infections.Measurements: Antibiotic utilization data were collected from the patients' records. Antimicrobial costs were calculated using 1998 hospital wholesale prices.Results: Of 3,383 screened patients, 680 (20%) received at least one antibiotic. During the study period, the mean number of prescribed drugs per patient increased from 5.9 to 7.6 (29%; P<.001). In contrast, a reduction of 15% was observed in the proportion of patients exposed to antibiotic agents (P=.08) and a drop of 26% in the number of antibiotics administered (P<.001). This resulted in a 54% decrease in cumulative daily antibiotic costs. In 83 (75%) of 110 surveyed patients, the guidelines were correctly implemented. The intervention had no measurable negative clinical effect.Conclusion: A comprehensive, multifaceted educational program for treating urinary and respiratory tract infections in the elderly was a safe and practical method to change physicians' antibiotic prescribing practice and significantly reduce the consumption and costs of antibiotics in a geriatric hospital.
Agreement Between Self‐Report of Disease Diagnoses and Medical Record Validation in Disabled Older Women: Factors That Modify Agreement
Authors: Simpson Crystal F. , Boyd Cynthia M. , Carlson Michelle C. , Griswold Michael E. , Guralnik Jack M. , Fried Linda P. 
Published: December 2003

Objectives: To determine the agreement between self‐report of chronic disease and validated evidence of disease using multiple ascertainment methods and to assess effects of cognition, education, age, and comorbidity.Design: Cross‐sectional analysis.Setting: Community Baltimore, Maryland.Participants: One thousand two community‐dwelling disabled women aged 65 and older.Measurements: Kappa statistics were calculated to determine the relationship between self‐report of 14 diseases and standardized algorithms. Analyses were stratified using Mini‐Mental State Examination score, education, number of chronic diseases, and age.Results: Kappa was excellent for hip fracture (HF), Parkinson's disease (PD), diabetes mellitus (DM), cancer, stroke, and disc disease (DD); fair to good for angina pectoris, congestive heart failure, and myocardial infarction; and poor for peripheral arterial disease, spinal stenosis, osteoporosis, arthritis, and lung disease. Overall, kappa decreased with decreasing cognition and education, increasing age, and four or more diseases.Conclusion: In disabled older women, self‐report of physician diagnosis of HF, PD, DM, cancer, stroke, and DD appears valid. In general, increasing comorbidity and age and decreasing cognition and education do not reduce validity for diseases where agreement was excellent overall.
Reproducibility of the Jumping Mechanography As a Test of Mechanical Power Output in Physically Competent Adult and Elderly Subjects
Authors: Rittweger Jörn , Schiessl Hans , Felsenberg Dieter , Runge Martin 
Published: December 2003

Objectives: To compare the reproducibility of the newly developed jumping mechanography with other physical tests.Design: Study 1: Repeated testing with an interval of 2 weeks to assess the short‐term repetition error. Study 2: Testing on 5 successive days to assess learning effects.Setting: Geriatric clinic, Esslingen, Germany.Participants: Study 1 had 36 subjects aged 24 to 88; Study 2 had 22 subjects aged 19 to 86. Locomotor competence in all subjects was assessed using the ability to walk unaided and to perform a tandem stand and tandem walk.Measurements: The test battery consisted of timed up and go, freely chosen gait speed, maximum gait speed, chair‐rising test, and maximum power in jumping mechanography.Results: All subjects performed the jumping mechanography without major problems. Study 1: Of all tests, maximum power in jumping mechanography depicted the smallest intrasubject short‐term error (3.6%), the largest intersubject coefficient of variation (45.4%), and the greatest test‐retest correlation coefficient (r=0.99). Study 2: The only tests for which the learning effects were confined to the 1% range were the maximum gait speed test and the maximum power in jumping mechanography.Conclusion: Assessment of maximum power in jumping mechanography appears to have good test‐retest reliability with negligible learning effects. Moreover, it results in a comparatively large intersubject variability, which makes it an interesting method in the assessment of aging effects in middle‐aged to older subjects and patients.
Curricular Framework: Core Competencies in Multicultural Geriatric Care
Authors: Xakellis George , Brangman Sharon A. , Ladson Hinton W. , Jones Vida Y. , Masterman Donna , Pan Cynthia X. , Rivero Jorge , Wallhagen Margaret , Yeo Gwen 
Published: December 2003

Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework.The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.
Older Driver Safety: A Report from the Older Drivers Project
Authors: Wang Claire C. , Carr David B. ,   for the Older Drivers Project
Published: December 2003

Older driver safety is a growing public health concern for which interventions are currently being sought. Statistics show that older drivers suffer a disproportionately high rate of motor vehicle fatalities compared with other adult drivers. This disproportion is due to two factors: an increased crash rate per vehicle mile driven and an increased risk of fatality in the event of a crash.Traditionally, traffic safety efforts for the older population have focused on methods to identify unsafe drivers to enforce driving cessation, but driving cessation deprives the majority of older Americans of their primary form of transportation and has been associated with an increase in depressive symptoms. In response to these concerns, the Older Drivers Project, created by the American Medical Association in partnership with the National Highway Traffic Safety Administration, describes and advocates a more acceptable approach to traffic safety.The primary objective of this approach involves helping older drivers stay on the road safely to preserve their mobility and independence. This can be accomplished through three methods: (1) optimizing the driver, (2) optimizing the driving environment, and (3) optimizing the vehicle. In this approach, driving cessation is recommended only after the safety of the driver cannot be secured through any other means.
Sensitive Enzyme Immunoassay for Measuring Plasma and Intracellular Nevirapine Levels in Human Immunodeficiency Virus-Infected Patients
Authors: Azoulay Stéphane , Nevers Marie-Claire , Créminon Christophe , Heripret Laurence , Durant Jacques , Dellamonica Pierre , Grassi Jacques , Guedj Roger , Duval Danièle 
Published: December 2003

ABSTRACT

We have developed an enzyme immunoassay to measure nevirapine (NVP) in plasma and peripheral blood mononuclear cells. Anti-NVP polyclonal antibodies were raised in rabbits by using a synthetic NVP derivative coupled to keyhole limpet hemocyanin as the immunogen, and the enzyme tracer was prepared by chemically coupling the NVP derivative with acetylcholinesterase. These reagents were used to develop a sensitive competitive enzyme immunoassay performed in microtitration plates with a 100-pg ml
−1
limit of detection and thus ∼100 times more sensitive than previously published techniques. The plasma assay was performed directly without extraction (in this case, a 500-pg ml
−1
limit of detection was observed) on a minimum of 30 μl of plasma. This assay shows good precision and efficiency, since recovery from human plasma and cell extracts spiked with NVP ranged between 87 and 104%, with coefficients of variation of <10%. A pharmacokinetic analysis of plasma NVP was performed for seven patients infected with human immunodeficiency virus (HIV), and it gave results similar to published findings. Intracellular concentrations of NVP were measured in cultured human T-lymphoblastoid cells and peripheral blood mononuclear cells from HIV-infected patients. The results indicated a very low intracellular/extracellular concentration ratio (0.134), thus demonstrating the absence of intracellular drug accumulation. This is the first intracellular assay of a nonnucleoside reverse-transcriptase inhibitor, and this method could be useful in monitoring plasma and intracellular NVP levels in HIV-infected patients.
Human Salivary Histatin 5 Fungicidal Action Does Not Induce Programmed Cell Death Pathways in
Candida albicans
Authors: Wunder David , Dong Jin , Baev Didi , Edgerton Mira 
Published: December 2003

ABSTRACT

Salivary histatins (Hsts) are potent candidacidal proteins that induce a nonlytic form of cell death in
Candida albicans
accompanied by loss of mean cell volume, cell cycle arrest, and elevation of intracellular levels of reactive oxygen species (ROS). Since these phenotypes are often markers of programmed cell death and apoptosis, we investigated whether other classical markers of apoptosis, including generation of intracellular ROS and protein carbonyl groups, chromosomal fragmentation (laddering), and cytochrome
c
release, are found in Hst 5-mediated cell death. Increased intracellular levels of ROS in
C. albicans
were detected in cells both following exogenous application of Hst 5 and following intracellular expression of Hst 5. However, Western blot analysis failed to detect specifically increased protein carbonylation in Hst 5-treated cells. There was no evidence of chromosomal laddering and no cytochrome
c
release was observed following treatment of
C. albicans
mitochondria with Hst 5. Superoxide dismutase enzymes of
C. albicans
and
Saccharomyces cerevisiae
provide essential protection against oxidative stress; therefore, we tested whether
SOD
mutants have increased susceptibility to Hst 5, as expected if ROS mediate fungicidal effects. Cell survival of
S. cerevisiae SOD1/SOD2
mutants and
C. albicans SOD1
mutants following Hst 5 treatment (31 μM) was indistinguishable from the survival of wild-type cells treated with Hst 5. We conclude that ROS may not play a direct role in fungicidal activity and that Hst 5 does not initiate apoptosis or programmed cell death pathways.
Six-Week Randomized Controlled Trial To Compare the Tolerabilities, Pharmacokinetics, and Antiviral Activities of GW433908 and Amprenavir in Human Immunodeficiency Virus Type 1-Infected Patients
Authors: Wood Robin , Arasteh Keikawus , Stellbrink Hans-Jürgen , Teofilo Eugenio , Raffi François , Pollard Richard B. , Eron Joseph , Yeo Jane , Millard Judith , Wire Mary Beth , Naderer Odin J. 
Published: December 2003

ABSTRACT

This study compared the plasma amprenavir pharmacokinetics of the human immunodeficiency virus (HIV) protease inhibitors amprenavir (Agenerase) 1,200 mg twice daily (BID) and the amprenavir prodrug GW433908, a formulation that substantially reduces the number of tablets per dose compared with amprenavir, at doses of 1,395 mg and 1,860 mg BID, in combination with abacavir 300 mg BID and lamivudine 150 mg BID in patients with HIV infection. Overall, 78 patients received study treatment. Compared with amprenavir 1,200 mg BID, both GW433908 1,395 mg BID and GW433908 1,860 mg BID delivered equivalent steady-state (ss) values for area under the plasma amprenavir concentration-time curve (AUC) at the end of a dosing interval (τ), lower maximum plasma amprenavir concentrations (30% lower), and higher plasma amprenavir concentrations at the end of a dosing interval (28% higher for GW433908 1,395 mg BID and 46% higher for GW433908 1,860 mg BID). Time-variant plasma amprenavir pharmacokinetics were observed with reductions in plasma amprenavir exposure over the first 4 weeks of dosing; the decrease in plasma amprenavir AUC
τ,ss
versus the AUC from 0 h to ∞ was 27% for GW43308 1,395 mg, 45% for GW433908 1,860 mg, and 23% for amprenavir 1,200 mg. All three regimens reduced plasma HIV-1 RNA (∼2 log
10
copies/ml) and increased CD4
+
cell counts (∼100 cells/mm
3
) over the initial 28 days. Adverse event profiles were consistent with those previously reported for amprenavir. Although not statistically tested, the GW433908 groups appeared to have fewer gastrointestinal symptoms. In conclusion, the protease inhibitor GW433908 delivered comparable plasma amprenavir concentrations to those delivered by amprenavir 1,200 mg BID. GW433908, in combination with abacavir and lamivudine, demonstrated potent antiviral activity and was generally well tolerated over a 4-week period.
Single-Dose and Steady-State Pharmacokinetics of Tenofovir Disoproxil Fumarate in Human Immunodeficiency Virus-Infected Children
Authors: Hazra Rohan , Balis Frank M. , Tullio Antonella N. , DeCarlo Ellen , Worrell Carol J. , Steinberg Seth M. , Flaherty John F. , Yale Kitty , Poblenz Marianne , Kearney Brian P. , Zhong Lijie , Coakley Dion F. , Blanche Stephane , Bresson Jean Louis , Zuckerman Judith A. , Zeichner Steven L. 
Published: December 2003

ABSTRACT

Tenofovir disoproxil fumarate (DF) is a potent nucleotide analog reverse transcriptase inhibitor approved for the treatment of human immunodeficiency virus (HIV)-infected adults. The single-dose and steady-state pharmacokinetics of tenofovir were evaluated following administration of tenofovir DF in treatment-experienced HIV-infected children requiring a change in antiretroviral therapy. Using increments of tenofovir DF 75-mg tablets, the target dose was 175 mg/m
2
; the median administered dose was 208 mg/m
2
. Single-dose pharmacokinetics were evaluated in 18 subjects, and the geometric mean area under the concentration-time curve from 0 h to ∞ (AUC
0-∞
) was 2,150 ng · h/ml and the geometric mean maximum concentration (
C
max
) was 266 ng/ml. Subsequently, other antiretrovirals were added to each patient's regimen based upon treatment history and baseline viral resistance results. Steady-state pharmacokinetics were evaluated in 16 subjects at week 4. The steady-state, geometric mean AUC for the 24-h dosing interval was 2,920 ng · h/ml and was significantly higher than the AUC
0-∞
after the first dose (
P
= 0.0004). The geometric mean
C
max
at steady state was 302 ng/ml. Tenofovir DF was generally very well tolerated. Steady-state tenofovir exposures in children receiving tenofovir DF-containing combination antiretroviral therapy approached values seen in HIV-infected adults (AUC, ∼3,000 ng · h/ml;
C
max
, ∼300 ng/ml) treated with tenofovir DF at 300 mg.