bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geriatricians Health Survey 2000
Authors: Watts David , Damasco‐Ty Edeson , Ryan Frank , Goodman Brian 
Published: March 2003

OBJECTIVES: To characterize geriatricians' preventive health behaviors including vitamin/supplement use, exercise, smoking, alcohol use, and weight control.DESIGN: Mailed questionnaire.SETTING: United States.PARTICIPANTS: Two thousand six hundred eleven U.S. physicians certified as having added qualifications in geriatric medicine and who were members in the American Geriatrics Society; 1,524 returned completed questionnaires (58%).MEASUREMENTS: Rates of supplement use and recommendations, preventive health visits, advance directive completion, exercise, religious service attendance, smoking, alcohol use, and amount of adult weight gain.RESULTS: Most responding geriatricians took at least one vitamin supplement: 50% vitamin E, 50% a multivitamin (MVI), and 31% vitamin C. Calcium ingestion was common among women. Other supplement use was uncommon: ginkgo compounds were consumed by 47 (3%), and 77 (5%) took a variety of other nonvitamin supplements. Over 90% recommended vitamins, especially multivitamins and vitamin E, at least sometimes. Recommendations for ginkgo (38%) and St. John's wort (33%) were also common. Almost half of respondents had completed a formal advance directive. Exercise was practiced at least weekly by 88%. Cigarette smoking was rare (1%), but at least occasional alcohol use was common (85%). Most of respondents were men (74%), and 35% had completed fellowship training.CONCLUSION: Vitamin/supplement use was common among responding geriatricians but not universal. Respondents often recommended MVI, vitamin E, and vitamin C, but were less likely to consume or recommend other supplements. The most common preventive health behavior among our respondents was exercise.
Persistent Mobility Deficit in the Absence of Deficits in Activities of Daily Living: A Risk Factor for Mortality
Authors: Khokhar Shafiq R. , Stern Yaakov , Bell Karen , Anderson Karen , Noe Enrique , Mayeux Richard , Albert Steven M. 
Published: March 2003

OBJECTIVES:To investigate the extent to which self‐reported mobility deficit in the absence of impairment in activities of daily living (ADL) is associated with elevated mortality risk.DESIGN:Prospective cohort study, with annual assessments of mobility and ADL status and ongoing monitoring of vital status.SETTING:Population‐based cohort drawn from Medicare enrollees in New York City.PARTICIPANTS:One thousand two hundred ninety‐eight older adults reporting functional status at baseline (1992–1994) and 2 years later.MEASUREMENTS:Subjects reported mobility (e.g., walking, climbing stairs, and rising from a chair) and ADL (e.g., bathing, toilet use, dressing, grooming, and feeding) limitations. Two‐year functional status trajectories were noted. We used two additional follow‐up periods, at 2 and 4 years, to examine the likelihood that older people with mobility deficit may face an increased risk of death without first passing through a state of enduring ADL disability.RESULTS:At 2 years, 12.7% had incident mobility deficit without ADL disability, and 21.3% were persistently disabled in mobility without ADL disability. Relative to subjects free of disability at baseline and follow‐up, risk of mortality in the incident mobility deficit group was elevated at 2 and 4 years but did not achieve statistical significance. By contrast, for subjects with persistent mobility impairment who did not report ADL impairment, the mortality risk was significantly elevated both at 2 years (relative risk (RR) = 2.5; 95% confidence interval (CI) = 1.1–5.7)) and 4 years (RR = 2.9; 95% CI = 1.7–4.9)) of follow‐up. Mortality was significantly elevated in this group in analyses restricted to respondents with no or only one comorbid condition.CONCLUSION:Continuing, self‐reported mobility impairment in the absence of ADL deficit is a risk factor for mortality. Older people with self‐reported mobility deficit face an increased risk of mortality without first passing through enduring states of ADL disability. J Am Geriatr Soc 49:1539–1543, 2001.
A Decision Aid for Long‐Term Tube Feeding in Cognitively Impaired Older Persons
Authors: Mitchell Susan L. , Tetroe Jacqueline , O'Connor Annette M. 
Published: March 2003

OBJECTIVE: To describe the development and evaluation of a decision aid for long‐term tube feeding in cognitively impaired older people. DESIGN: Before‐and‐after study. SETTING: Acute care hospitals in Ottawa, Canada. PARTICIPANTS: Substitute decision makers for 1.5 cognitively impaired inpatients 6.5 years and older being considered for placement of a percutaneous endoscopic gastrostomy tube. MEASUREMENTS: Questionnaires were used to compare the substitute decision makers' knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to the decision aid. The acceptability of the decision aid was also assessed. RESULTS: Substitute decision makers significantly increased their knowledge (P= .004) and decreased their decisional conflict (P= .004) regarding long‐term tube feeding after using the decision aid. The impact of the decision aid on predisposition toward the intervention was greatest for those who were unsure of their preferences at baseline. All substitute decision makers found the decision aid helpful and acceptable despite very difficult and emotional circumstances. CONCLUSIONS: A decision aid improves the decisionmaking process for long‐term tube feeding in cognitively impaired older patients by decreasing decisional conflict and by promoting decisions that are informed and consistent with personal values. There are particular challenges for developing and evaluating these tools in the context of end‐of‐life decisions.
The Effects of Mammographic Detection and Comorbidity on the Survival of Older Women with Breast Cancer
Authors: McPherson Carol P. , Swenson Karen K. , Lee Martin W. 
Published: March 2003

OBJECTIVES: To determine an upper age limit or quantifiable level of comorbidity that would render mammography screening ineffectual in decreasing mortality in women aged 65 and older.DESIGN: Retrospective cohort study.SETTING: Upper midwestern United States.PARTICIPANTS: Five thousand one hundred eighty‐six predominantly Caucasian women aged 65 to 101 diagnosed with invasive breast cancer from 1986 through 1994. Data were obtained from The Upper Midwest Tumor Registry System, a regional consortium database in Minnesota, North Dakota, and South Dakota.MEASUREMENTS: Relative risks (RRs) of death were computed for patients with mammographically detected tumors, stratified by age and comorbidity. Survival analysis was performed, stratified by level of comorbidity and method of tumor detection.RESULTS: Patients with mammographically detected tumors and no comorbidity experienced significantly lower RRs of death in every age group (range P < .001 to P = .039). Women with mammographically detected tumors and mild to moderate comorbidity had RRs of death as follows: age 65 to 69 (RR = 0.32, 95% confidence interval (CI) = 0.15–0.69), age 70 to 74, (RR = 0.45, 95% CI = 0.22–0.91); age 75 to 79 (RR = 0.47, 95% CI = 0.25–0.88), age 80 and older (RR = 0.52, 95% CI = 0.33–0.80). Women with severe or multiple comorbidities experienced no improvement in survival with mammographically detected tumors.CONCLUSIONS: Mammographic detection of breast cancer may be associated with a significantly decreased risk of death for older women of all ages, even for women with mild to moderate levels of comorbidity, but for older women with severe or multiple comorbidities, mammography is not associated with improvement in overall survival.
Tuberculosis in Older People: A Retrospective and Comparative Study from Hong Kong
Authors: Leung Chi C. , Yew Wing W. , Chan Chi K. , Chau Chi H. , Tam Cheuk M. , Lam Chak W. , Tam Wai O. , Lau Kam S. , Liu Wai T. 
Published: March 2003

OBJECTIVES: To compare tuberculosis (TB) in older and younger patients.DESIGN: A retrospective and comparative observational study.SETTING: Four chest clinics and two chest hospitals in Hong Kong.PARTICIPANTS: All notifications from the participating hospitals and clinics in 1996 were extracted from the TB notification registry. The characteristics of patients aged 65 and older were compared with a one‐in‐three random sampling of those aged 16 to 64.MEASUREMENTS: Demographic, clinical, radiological, and laboratory data of the two groups were compared alongside treatment and outcomes.RESULTS: Older people with TB were more likely to be male, to smoke, to have had TB previously, to have coexisting medical diseases, to be socioeconomically disadvantaged, and to weigh less than younger people with TB. Dyspnea, weight loss, and malaise were more common, whereas extrathoracic lymph node enlargement was less common. Chest radiograph showed more extensive disease and lower zone involvement. Positive tuberculin test was present in only 61.9%. Sputum bacteriology was more likely to be positive. There was a longer delay in presentation and commencement of treatment, and 77.2% required at least one admission. Adverse effects of treatment, notably hepatic dysfunction, occurred more commonly. Fluoroquinolones appeared well tolerated. Only 72.5% of the older people were cured or completed their treatment. Mortality was 16%. Age of 65 and older, comorbidity, socioeconomic disadvantage, moderate‐extensive disease, positive sputum smear, and poor adherence were factors independently associated with unfavorable outcomes (P < .001 to P = .01; odds ratios = 1.61–27.02).CONCLUSION: Substantial differences were found between older and younger TB patients. Many of these were associated with unfavorable outcome. Increased awareness in disease recognition and better medical and social support are therefore needed in addressing the growing problem of TB in older people.
Corrected Arm Muscle Area: An Independent Predictor of Long‐Term Mortality in Community‐Dwelling Older Adults?
Authors: Miller Michelle D. , Crotty Maria , Giles Lynne C. , Bannerman Elaine , Whitehead Craig , Cobiac Lynne , Daniels Lynne A. , Andrews Gary 
Published: March 2003

OBJECTIVES: Older people are at risk of undernutrition because of a number of physiological conditions and lifestyle factors. The purpose of this study was to explore the predictive relationship of corrected arm muscle area (CAMA) with 8‐year mortality in a representative sample of older Australians.DESIGN: Prospective cohort study: The Australian Longitudinal Study of Ageing.SETTING: Community.PARTICIPANTS: One thousand three hundred ninety‐six participants aged 70 and older.MEASUREMENTS: Trained observers measured baseline weight, height, mid upper arm circumference, and triceps skinfold thickness using standard techniques. Body mass index (BMI) and CAMA were calculated. Baseline BMI and CAMA measurements were categorized according to cutoff values proposed by Garrow et al. and Friedman et al., respectively. Subsequent analyses were undertaken using Cox proportional hazards regression.RESULTS: After adjustment for potential confounders (baseline age, gender, marital status, smoking, self‐rated health, ability to conduct activities of daily living, comorbidity, cognition performance, and presence of depression), those older Australians with a low CAMA (≤21.4 cm2 for men and ≤21.6 cm2 for women) had an increased risk of mortality at 8‐year follow‐up (hazard ratio = 1.94, 95% confidence interval = 1.25–3.00, P = .003). There was no increased risk in 8‐year mortality identified for those with a high or low BMI.CONCLUSION: CAMA is a useful assessment of undernutrition in older adults that has better prognostic value than BMI in predicting death in older, community‐living Australians.
Prescription Drug Costs for Dually Eligible People in a Medicaid Home‐ and Community‐Based Services Program
Authors: Phillips Victoria L. , Atherly Adam 
Published: March 2003

This study examined the prescription drug costs of Medicare beneficiaries participating in a Medicaid home‐ and community‐based services (HCBS) program and discussed possible implications of providing a prescription drug benefit under Medicare. The study examined Medicaid pharmaceutical claims data using two random samples (n = 766) of dually eligible Medicare beneficiaries in a HCBS program from four regions in Georgia. The average total monthly Medicaid prescription drug expenditure was determined.Annual prescription expenditures for this group averaged more than $1,500 per person. Prescription drugs intended for the treatment of cancer and circulatory disorders combined to account for 61% of total program drug expenditures. Multivariate analysis found that drug expenditures were higher for those who died during the observation period, the young‐old, Caucasians, and those who self‐selected into the program. Higher drug expenditures for the self‐selected group, even after frailty adjustments, suggest the presence of adverse selection. Medicare prescription drug benefit proposals that rely on voluntary enrollment may also experience adverse selection from frail, low‐income beneficiaries.
The Relationship Between Weight Loss and All‐Cause Mortality in Older Men and Women With and Without Diabetes Mellitus: The Rancho Bernardo Study
Authors: Wedick Nicole M. , Barrett‐Connor Elizabeth , Knoke James D. , Wingard Deborah L. 
Published: March 2003

OBJECTIVES: To examine the relationship between measured weight change over an approximate 10‐year time period on all‐cause mortality over the following 12 years in 1,801 community‐dwelling men and women (mean age 71 at the beginning of mortality follow‐up) with and without diabetes mellitus.DESIGN: A longitudinal cohort study.SETTING: A geographically defined community in southern California.PARTICIPANTS: One thousand eight hundred one older men and women with and without diabetes mellitus.MEASUREMENTS: Weight, body mass index (BMI), blood pressure, and fasting plasma glucose were measured in 1972–74 (Visit 1) when participants were aged 40 to 79 and again in 1984–87 (Visit 2). Lifetime weight history and dieting for weight control were ascertained in 1985 using a mailed questionnaire. Vital status was determined for the next 12 years, from Visit 2 (1984–87) through 1996. The Cox proportional hazards model was used to assess the age‐ and multiply adjusted effect of weight change on mortality.RESULTS: At Visit 1, diabetic men (n = 140) and women (n = 90) were more overweight than nondiabetic men (n = 633) and women (n = 938). Weight gain between Visits 1 and 2 was not a significant predictor of mortality in this cohort. Men and women losing 10 or more pounds between visits had higher age‐adjusted death rates during the following 12 years than those with stable weight or weight gain. Weight loss was associated with an increased hazard ratio (HR) for all‐cause mortality in nondiabetic men (HR = 1.38, 95% confidence interval (CI) = 1.06–1.80) and women (HR = 1.76, 95% CI = 1.33–2.34) and diabetic men (HR = 3.66, 95% CI = 2.15–6.24) and women (HR = 1.65, 95% CI = 0.70–3.87) after adjustment for age, smoking, and sedentary lifestyle. Significant associations persisted in analyses excluding cigarette smokers and those with depressed mood and low baseline BMI. After excluding those who died within 5 years of the weight loss, the increased HR was statistically significant in men and women with and without diabetes mellitus. Stratified analyses comparing those who reported dieting for weight control with those not dieting showed similar trends, with a higher mortality risk for weight loss in those who lost weight without dieting.CONCLUSION: In this population of older individuals, weight loss predicted increased all‐cause mortality risk not explained by covariates.
Development of a batch‐processed, passive latex agglutination test for cytomegalovirus
Authors: Spindler J. H. , Kerowgan M. , Goldmann S. F. 
Published: March 2003

BACKGROUND: The passive latex agglutination test is commonly used for the identification of cytomegalovirus IgG and IgM antibodies. This test is used because of its sensitivity, specificity, speed, and ease of performance, but it is unsuitable for large numbers of samples or for batch processing.STUDY DESIGN AND METHODS: To solve this problem, comparative studies to assess the cytomegalovirus passive latex agglutination test on microtiter plates were done with a new photometric particle agglutination method (PPAM) and an enzyme‐linked immunosorbent assay as a control.RESULTS: A total of 3430 sera were tested using both the PPAM and enzyme‐linked immunosorbent assay. A high degree (97.6%) of correspondence between the results of the tests was observed. The new PPAM was easier and faster to use (96 wells in 25 min).CONCLUSION: These results, as well as the possibility of adapting this method to a fully automated system, suggest that the PPAM could be an important contribution to the field of infection serology.
Human T‐lymphotropic virus type II in Panamanian Guaymi Indians
Authors: Feigenbaum F. , Fang C. , Sandler S.G. 
Published: March 2003

Background: Currently, human T‐lymphotropic virus type II (HTLV‐II) is the most prevalent human retrovirus, detected in persons presenting to donate blood in the United States. Only scant information is available with which to counsel HTLV‐II‐seropositive deferred donors or other persons about the ways in which they may spread HTLV‐II to others.Study Design and Methods: To increase understanding of the modes of transmission of HTLV‐II, a seroepidemiologic study was conducted among Panamanian Guaymi Indians, a recently identified focus of endemic HTLV‐ II infection. Subjects were tested for serologic evidence of infection by HTLV‐II, HTLV type I, hepatitis B virus, and nine other infectious agents by enzyme immunoassays and specific confirmatory tests.Results: Nine (8.3%) of 109 persons tested HTLV‐II‐seropositive. HTLV‐II seropositivity was more likely in persons with serologic evidence of prior hepatitis B virus infection. Sexual contact with HTLV‐II‐ seropositive partners, but neither parenteral exposure nor breast‐ feeding, was identified as a risk factor for HTLV‐II.Conclusion: In Guaymi Indians, HTLV‐II appears to be spread primarily through sexual transmission.
In vitro evaluation of platelet concentrates, prepared from pooled buffy coats, stored for 8 days after filtration
Authors: Boomgaard M.N. , Joustra‐Dijkhuis A.M. , Gouwerok C.W.N. , Steneker I. , Reesink H.W. , Loos J.A. , Pietersz R.N.I. , De Korte D. 
Published: March 2003

Background: Posttransfusion complications can be prevented by pretransfusion removal of donor white cells from platelet concentrate. The filtration used for this removal seems to have little effect on platelet function and activation, but more information is needed on its effect on function during subsequent long‐term storage of concentrate.Study Design and Methods: The effect of prestorage filtration of buffy coat‐prepared platelet concentrates (PCs) on platelet function, metabolism, and activation was investigated. A pool of three PCs, each made of four buffy coats, was split into three equal volumes; two were filtered over two different filters and the third served as a control. Variables monitored immediately after filtration and during the subsequent 8‐day storage period at 22°C included aggregation upon stimulation with collagen and/or ADP, platelet adhesion capacity to collagen and fibrinogen in flowing blood, nucleotide content of and nucleobase release by the platelets, expression of activation‐dependent antigens, and β‐thromboglobulin release by the platelets.Results: No differences were observed between the PCs filtered over two different filters and the nonfiltered control PCs immediately after filtration and during storage, except for a selective removal (20%) of β‐thromboglobulin by one filter.Conclusion: PCs prepared from a pool of four buffy coats can be filtered and subsequently stored for 8 days (starting +/− 24 hours after whole blood collection) without detriment to platelet function, metabolism, or activation.
Red cell loss following orthopedic surgery: the case against postoperative blood salvage
Authors: Umlas J. , Foster R.R. , Dalal S.A. , O'Leary S.M. , Garcia L. , Kruskall M.S. 
Published: March 2003

BACKGROUND: Expensive devices have been developed for the collection and transfusion of blood salvaged after hip or knee arthroplasty.STUDY DESIGN AND METHODS: The volume of salvaged red cells was measured for the first 6 hours after operation. This volume was compared to total red cell loss during hospitalization and to the volume of allogeneic red cells transfused.RESULTS: Mean postoperative red cell loss in 31 patients following hip replacement was 55 ± 29 mL and that in 20 patients following knee replacement was 121 ± 50 mL. The 6‐hour wound drainage represented 8.7 and 16.8 percent of overall red cell loss during hospitalization for hip and knee replacement, respectively. The transfusion of postoperatively salvaged red cells would have supplanted transfusion of less than one‐third of a unit of allogenic blood after hip replacement and two‐thirds of a unit after knee replacement. Only three patients (5.9%) lost red cell volume in the drainage equivalent to or in excess of 1 unit of red cells (180 mL). The volume of red cells salvaged postoperatively bore no relationship to perioperative red cell losses as a whole.CONCLUSION: The relatively small red cell loss in the postoperative period in most arthroplasty patients does not appear to justify the routine use of this technique for the recovery of autologous blood.
Frequency of human platelet antigens among blood donors in northeastern Thailand
Authors: Urwijitaroon Y. , Barusrux S. , Romphruk A. , Puapairoj C. 
Published: March 2003

BACKGROUND: Platelet transfusions have been widely used in Thailand, but little is known about the phenotyping of human platelet antigens.STUDY DESIGN AND METHODS: Whole blood was collected from 483 blood donors for preparation of platelets. An improved mixed passive hemagglutination assay was used for this study.RESULTS: Frequencies demonstrated were 100 percent for HPA‐1a (PlA1), 15.94 percent for HPA‐ 2b (Siba), 60.25 percent for HPA‐3a (Baka), 98.76 percent for HPA‐4a (Yukb), 1.86 percent for HPA‐4b (Yuka), 5.38 percent for HPA‐5b (Br(a)), and 97.72 percent for Naka.CONCLUSION: HPA‐1a was found in 100 percent of Thais, which is the same frequency as in other Asian populations but somewhat different from that in whites (97.9%). Therefore, HPA‐1a will not cause neonatal alloimmune thrombocytopenia or post‐transfusion purpura in Thais. According to the frequencies of HPA‐2b, HPA‐3a, HPA‐4a, HPA‐4b, HPA‐5b, and Naka antigens, they may induce neonatal alloimmune thrombocytopenia, posttransfusion purpura, and platelet refractoriness in Thais.