bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipoprotein Levels Are Associated with Incident Hypertension in Older Adults
Authors: Wildman Rachel P. , Sutton‐Tyrrell Kim , Newman Anne B. , Bostom Andrew , Brockwell Sarah , Kuller Lewis H. 
Published: May 2004

Objectives:To determine the relationship between baseline measures of serum lipoproteins and incident hypertension in older adults.Design:Prospective cohort study.Setting:Pittsburgh, Pennsylvania, site of Systolic Hypertension in the Elderly Program (SHEP).Participants:One hundred eighty‐seven men and women (mean age 71.3), normotensive (systolic blood pressure (SBP) <160 mmHg, diastolic blood pressure (DBP) <90 mmHg) at baseline, were followed annually over 8 years as an ancillary study to the SHEP.Measurements:Hypertension development, defined as initiation of antihypertensive therapy or SBP greater than 160 mmHg or DBP greater than 90 mmHg. Lipoprotein measures included total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol (HDL‐C), HDL2‐C, HDL3‐C, triglycerides, and apolipoproteins 1, 2, and B.Results:Over 8 years, 44 participants developed hypertension, for a Kaplan‐Meier cumulative incidence rate of 31% (95% confidence interval (CI)=23–39%). Cumulative incidence rates were highly associated with baseline SBP, ranging from 8% in those with baseline SBP less than 120 mmHg to 70% in those with SBP of 140 to 159 mmHg. Other univariate associations included higher DBP, pulse pressure (P< .01 for both), triglycerides (P=.03), apolipoprotein B (P=.03), and lower HDL‐C (P=.04) and HDL3‐C (P=.02). In multivariate Cox regression analysis, higher baseline SBP (relative risk (RR)=1.8 per 10 mmHg, 95% CI=1.5–2.3) and lower HDL3‐C (RR=0.8 per 5 mg/dL, 95% CI=0.42–1.0) remained significant independent predictors of time to hypertension.Conclusion:Older adults with abnormal serum lipoproteins are at increased risk of developing hypertension. Clinical trials exploring the effects of the modification of lipoprotein levels on hypertension incidence rates are needed.
Peripheral Arterial Disease in African Americans: Clinical Characteristics, Leg Symptoms, and Lower Extremity Functioning
Authors: Rucker‐Whitaker Cheryl , Greenland Philip , Liu Kiang , Chan Cheeling , Guralnik Jack M. , Criqui Michael H. , Taylor Lloyd , Pearce William H. , McGraeMcDermott Mary 
Published: May 2004

Objectives: The describe peripheral arterial disease (PAD) in African Americans, and compare findings in African Americans and whites with PAD.Design: Cross‐sectional.Setting: Three academic medical centers.Participants: Three hundred sixty‐six whites and 76 African Americans with PAD (as defined by an ankle brachial index (ABI) <0.90) aged 55 and older identified from lower extremity arterial studies performed between 1996 and the fall of 1999.Measurements: Comprehensive medical interview, body mass index, and neuropathy score. Functional measurements included the 6‐minute walk distance, 4‐m walking velocity, and the summary performance score.Results: Age‐ and sex‐adjusted results showed that African Americans had a lower mean ABI than whites (0.60 vs 0.66, P=.001), were less likely to be college graduates (13.7% vs 44.4%, P<.001), and had nearly twice the prevalence of diabetes mellitus (46.8% vs 28.0%, P=.001). After adjusting for age, sex, education level, and ABI, African Americans had a higher prevalence of no exertional leg pain (28.0% vs 18.2%, P=.044) and leg pain with exertion and rest (30.0% vs 17.3%, P=.023). African Americans had a shorter 6‐minute walk distance (989 vs 1,156 ft, P<.001), a slower normal‐pace 4‐m walking velocity (0.79 vs 0.89 m/s, P<.001), a slower fast‐pace 4‐m walking velocity (1.12 vs 1.20 m/s, P=.012), and a lower summary performance score (8.8 vs 9.6, P=.018) than whites. These differences in functioning were attenuated after adjusting for age, sex, ABI, education, and leg symptoms.Conclusion: Poorer lower extremity functioning in African Americans was largely explained by differences in leg symptoms and, to a somewhat lesser degree, lower ABI levels and poorer education in African Americans than in whites. Further study is needed to determine whether these findings affect racial treatment disparities and poorer outcomes previously reported in African Americans than in whites with PAD.
The Effects of Staffing on In‐Bed Times of Nursing Home Residents
Authors: Bates‐Jensen Barbara M. , Schnelle John F. , Alessi Cathy A. , Al‐Samarrai Nahla R. , Levy‐Storms Lené 
Published: May 2004

Objectives: To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents.Design: Descriptive, cross‐sectional study.Setting: Thirty‐four southern California NHs.Participants: A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test.Measurements: Cross‐sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests.Results: In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001).Conclusion: In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in‐bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in‐bed time should be considered, and further research should seek to inform the development of such recommendations.
Effects of Aging, Menopause, and Hormone Replacement Therapy on Forearm Skin Elasticity in Women
Authors: Sumino Hiroyuki , Ichikawa Shuichi , Abe Masatoshi , Endo Yukie , Ishikawa Osamu , Kurabayashi Masahiko 
Published: May 2004

Objectives: To investigate the decline per year in skin elasticity in postmenopausal women and how much hormone replacement therapy (HRT) increased elasticity over 12 months.Design:Observational study of convenience sample.Setting: The Cardiovascular Hospital of Central Japan, a cardiovascular medical center.Participants: One hundred seventy‐six postmenopausal subjects, mean age±standard deviation=61.3±9.1.Measurements: In Study 1, skin elasticity was measured in the right forearm using a suction device. Comparisons also were made with 45 premenopausal subjects (aged 34.5±9.9). Skin elasticity in the right forearm was measured using the same device at baseline and 12 months after initiation of HRT.Interventions: In Study 2, 12 postmenopausal subjects (mean age=57.1±7.4, range 49–71) received conjugated equine estrogen (0.625 mg/d) in combination with medroxyprogesterone acetate (2.5 mg/d) for 12 months.Results: In Study 1, significant negative correlations between skin elasticity and age and years since menopause were found (r=−0.60, P<.001 for each), as well as a 0.55% decline per year in skin elasticity. In Study 2, 12 months of HRT significantly increased skin elasticity in postmenopausal subjects, by 5.2%.Conclusion: After menopause, skin elasticity declined 0.55% per year; 12 months of HRT increased elasticity by 5.2%.
Identification of Strategies Used to Cope with Chronic Pain in Older Persons Receiving Primary Care from a Veterans Affairs Medical Center
Authors: Barry Lisa C. , Kerns Robert D. , Guo Zhenchao , Duong Bao D. , Iannone Lynne P. , Carrington Reid M. 
Published: May 2004

Objectives: To identify the strategies used by older persons to cope with chronic noncancer pain, determine the perceived effectiveness of the strategies, and ascertain factors associated with their use.Design: Cross‐sectional telephone survey.Setting: Primary care practice located at a Veterans Affairs Medical Center in New England.Participants: Two hundred forty‐five patients (aged 65–90) with chronic pain.Measurements: Qualitative methods were used to ascertain participants' coping strategies, and their effectiveness was determined using a five‐category response scale (1=not at all effective to 5=extremely effective). In multivariate analyses, associations between participants' demographic, medical, psychosocial, and pain characteristics and prevalent coping strategies were assessed.Results: Participants had a mean age±standard deviation of 75±5.1; 84% were male. Overall, 240 (98%) participants had employed at least one coping strategy in the previous month; the mean number used per participant was 2.8±1.4. Prevalent coping strategies included analgesic medications (used by 187/240=78% participants), exercise (35%), cognitive methods (37%), religious activities (21%), and activity restriction (20%). The proportion of participants who used a given strategy and rated it quite a bit or extremely effective exceeded 50% for only five of the 15 identified strategies. Women were more likely than men to use cognitive coping methods (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.5–6.8) and religious activities (OR=2.6, 95% CI=1.2–5.7). Participants with chronic pain due to a musculoskeletal cause were more likely to use analgesic medications than those with pain due to all other causes (OR=3.2, 95% CI=1.6–6.4), whereas those with trauma‐related pain were less likely to use exercise than those with pain due to all other causes (OR=0.2, 95% CI=0.1–0.7).Conclusion: Older primary care patients use a broad variety of coping strategies to cope with chronic pain. Studies are needed to confirm these findings in other older populations and to characterize the longitudinal effects of the coping strategies. Given the finding that the perceived effectiveness of most coping strategies was modest, efforts to increase their effectiveness in older persons are indicated.
Sleep‐Disordered Breathing and Nocturia in Older Adults
Authors: Endeshaw Yohannes W. , Johnson Theodore M. , Kutner Michael H. , Ouslander Joseph G. , Bliwise Donald L. 
Published: May 2004

Objectives: To investigate the relationship between sleep‐disordered breathing (SDB) and nocturia episodes in community‐dwelling older adults.Design: A cross‐sectional study.Setting: Community.Participants: Community‐dwelling older adults (N=72) recruited from independent living facilities and adult learning centers in Atlanta, Georgia.Measurements: Three‐day voiding diary, ambulatory sleep recording, focused physical examination, Epworth Sleepiness Scale, and Geriatric Depression Scale.Results: Fifty‐eight of the 72 subjects completed the study. The mean age±standard deviation was 77.7±6.7; 44 (76%) were female. Of the 58 subjects, 26 (45%) had an apnea‐hypopnea index (AHI) of less than 10 per hour of sleep, 21 (36%) had an AHI between 10 and 24 per hour sleep, and 11 (19%) had an AHI of 25 or higher per hour of sleep. The mean nocturia episodes were 1.7±1.1, 1.6±0.9, and 2.6±1.4 for subjects in these groups, respectively (F=3.82; P=.028). Those with an AHI of 25 or higher had more nocturia episodes, higher mean arterial blood pressure, and higher body mass index than those with a lower AHI.Conclusion: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.
Antihypertensive Medications and Differences in Muscle Mass in Older Persons: The Health, Aging and Body Composition Study
Authors: Di Bari Mauro , Van De Poll‐Franse Lonneke V. , Onder Graziano , Kritchevsky Stephen B. , Newman Anne , Harris Tamara B. , Williamson Jeff D. , Marchionni Niccoló , Pahor Marco 
Published: May 2004

Objectives: To evaluate whether older persons using angiotensin‐converting enzyme (ACE) inhibitors have a larger lower extremity muscle mass (LEMM) than users of other antihypertensive drugs.Design: Cross‐sectional analysis of data from the Health, Aging and Body Composition (Health ABC) Study.Setting: University of Tennessee, Memphis, and University of Pittsburgh clinics.Participants: A community‐based sample of 2,431 well functioning participants of the Health ABC, aged 70 to 79, who were free of heart failure, were selected according to use of antihypertensive medications: ACE inhibitors (n=197), β‐blockers (n=169), thiazides (n=216), calcium‐channel blockers (n=340), or none (n=1,509).Measurements: LEMM, assessed using dual‐energy x‐ray absorptiometry, compared by index drug in analysis of variance models unadjusted and adjusted for demographics, study site, height, body fat, physical activity, blood pressure, coronary artery disease, diabetes mellitus, and chronic pulmonary disease.Results: LEMM significantly differed across the study groups, being larger in users of ACE inhibitors than in users of other drugs (unadjusted and adjusted models). LEMM was comparable in users of ACE inhibitors and no drug users. A trend toward larger LEMM was also observed in sex‐ and ethnicity‐stratified analyses and in the subgroup of noncoronary hypertensive participants.Conclusion: In older persons, use of ACE inhibitors is associated cross‐sectionally with larger LEMM. This finding suggests a possible explanation of the benefits of ACE inhibitors in wasting syndromes. If confirmed in longitudinal studies, this pharmacological action might have important implications for the prevention of physical disability in older patients with hypertension.
Reliability of the 400‐M Usual‐Pace Walk Test as an Assessment of Mobility Limitation in Older Adults
Authors: Rolland Yves M. , Cesari Matteo , Miller Michael E. , Penninx Brenda W. , Atkinson Hal H. , Pahor Marco 
Published: May 2004

Objectives: To assess the test‐retest reliability of the 400‐m usual‐pace walk test (400‐MWT), and to determine whether the 4‐m walk test predicts inability to walk 400 m.Design: Observational.Setting: Community, 20‐m tract course.Participants: Sixty study participants (aged≥65) were enrolled from the community and met the following eligibility criteria: self‐reported difficulty in two or more of four functional domains (mobility and exercise tolerance, upper extremity function, basic self‐care, higher functional tasks of independent living) and a score of 18 or higher on the Mini‐Mental State Examination.Methods: The 400‐MWT and 4‐m walk test were each repeated within 7 days.Results: The mean age±standard deviation of the study population was 84.3±6.3; 88.3% were women. Nineteen participants (31.7%) failed both 400‐MWTs, and 41 successfully completed both tests (kappa=1). Mean walking speed for the 4‐m test was 0.87±0.18 m/s for those who completed the 400‐MWT and 0.53±0.17 m/s for those who failed (P<.001). The Spearman correlation coefficient between 4‐m and 400‐m walking speeds was 0.93. The estimated area under the receiver operating characteristic curve between 4‐m walking speed and the ability to perform the 400‐MWT was 0.91. The 4‐m gait speed averaged less than 0.6 m/s in 80% of subjects who failed the 400‐MWT.Conclusion: The test‐retest reliability for inability to complete the 400‐MWT is high. Four‐m walking speed is highly predictive of ability to perform the 400‐MWT. These findings may prove useful to future clinical trials and observational studies that involve assessment of mobility limitations in older adults.
Isokinetic Leg Muscle Strength in Older Americans and Its Relationship to a Standardized Walk Test: Data from the National Health and Nutrition Examination Survey 1999–2000
Authors: Ostchega Yechiam , Dillon Charles F. , Lindle Rosemary , Carroll Margaret , Hurley Ben F. 
Published: May 2004

Objectives: To describe isokinetic knee extensor muscle strength in older U.S. men and women by age and race/ethnicity and to ascertain its relationship to a standard, timed walking‐speed test.Setting: The U.S. National Health and Nutrition Examination Survey (NHANES) 1999–2000.Design: A cross‐sectional nationally representative health examination survey.Participants: All surveyed persons aged 50 and older (N=1,499) who performed muscle strength and timed walk examinations in the NHANES mobile examination center.Measurements: Concentric peak torque (strength) of the knee extensors at 1.05 rads/ s−1 velocity and a 6‐m walk timed in seconds.Results: Knee extensor strength was inversely associated with age (P<.01), and women had less knee extensor muscle strength than men (P<.01). After adjustment for standing height, no significant difference in muscle strength was found across the three race/ethnicity groups (Mexican Americans, non‐Hispanic blacks, and non‐Hispanic whites) for men or women. After adjustment for age, race/ethnicity, weight, and height, increasing knee extensor strength was associated with significant increases in meters walked per second (P<.01).Conclusion: Knee extensor muscle strength is affected by age and sex but not by race/ethnicity and it is significantly associated with timed walk.
Disciplinary Split: A Threat to Geriatrics Interdisciplinary Team Training
Authors: Reuben David B. , Levy‐Storms Lené , Yee Misty N. , Lee Ming , Cole Kenneth , Waite Martha , Nichols Linda , Frank Janet C. 
Published: May 2004

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters‐level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case‐study and cross‐case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs.This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team–training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline‐specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training.Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.
An immediate hemolytic reaction induced by repeated administration of oxaliplatin
Authors: Chen Vivien M.Y. , Thrift Karen M. , Morel‐Kopp Marie‐Christine , Jackson David , Ward Christopher M. , Flower Robert L. 
Published: May 2004

BACKGROUND:  Platinum‐based chemotherapy agents have been associated with potentially fatal acute immune‐mediated hemolytic anemia. The target antigen, cause of the positive direct antiglobulin test (DAT) and mechanism of hemolysis have been the subject of controversy.CASE REPORT:  We report a patient who developed a DAT‐positive hemolytic episode after a red cell (RBC) transfusion was delivered during the infusion of her 17th cycle of oxaliplatin. Standard pretransfusion testing was uncomplicated; however, after infusion, the serum was no longer compatible with the transfused units and a strong (4+) panreactive IgG antibody was detected.RESULTS:  The patient's serum from 10 days after the episode, only when therapeutic concentrations of oxaliplatin were added, reacted with all RBCs tested using the indirect antiglobulin test (IAT) (3+). The effect was retained with a purified IgG fraction and almost eliminated with IgG‐depleted serum. Immunoprecipitation analysis revealed a band with the molecular weight of the Band 3 anion channel only in the presence of the patient's serum and oxaliplatin.CONCLUSION:  Our investigations indicated that oxaliplatin interacted with both an IgG antibody and a RBC membrane epitope probably located on the Band 3 anion channel.
Decreased platelet aggregation of platelet concentrate during storage recovers in the body after transfusion
Authors: Miyaji Ryosuke , Sakai Michio , Urano Hajime , Nakata Koichi , Sakamoto Hisahi , Shirahata Akira 
Published: May 2004

BACKGROUND:  Previous reports have shown that storage decrease the ability of PLTs to aggregate in the form of PLT concentrate (PC). Nevertheless, there are few reports that have studied the PLT function in blood samples obtained from recipients after PLT transfusion. In this study, this issue was addressed by examining the ability of PLTs to aggregate after being transfused into the blood stream.STUDY DESIGN AND METHODS:  PC was transfused to the patients with extremely low PLT counts resulting from chemotherapy. The maximum extent of PLT aggregation and size of the aggregates were compared between PLT in stored PC before transfusion with the PLT‐rich plasma (PRP) from the recipients after transfusion and with PRP from patients with moderate decrease in PLT counts after chemotherapy.RESULTS:  The maximum extent of PLT aggregation was significantly higher in PRP collected from the patients after transfusion compared to the extent obtained before transfusion. There were no significant differences in the maximum extents of PLT aggregation between the PRP collected from the recipients after PC transfusion and, in the same patients, when PLT counts were moderately low.CONCLUSION:  These results suggest that the observed decreased in PLT aggregation after storage can improve in the body after transfusion, and transfused PLTs have similar aggregation ability compared to the PLTs derived from the patient.
Efficacy and safety of phlebotomy to reduce transfusional iron overload in adult, long‐term survivors of acute leukemia
Authors: Franchini Massimo , Gandini Giorgio , Veneri Dino , De Matteis Giovanna , Federici Francesca , Solero Pietro , Aprili Giuseppe 
Published: May 2004

BACKGROUND:  Transfusional iron overload is a frequent finding in long‐term survivors of acute leukemia (AL). Only a few studies have reported the results of iron depletion therapy in this category of patients.STUDY DESIGN AND METHODS:  Between January 1996 and July 2003, 26 consecutive adult patients who achieved complete remission of AL and developed transfusional iron overload underwent a weekly phlebotomy program at our transfusion center. Serum ferritin levels and transferrin saturation were monitored during the iron depletion therapy and the follow‐up period. These AL patients were also checked for the presence of 12 hereditary hemochromatosis (HH) gene mutations.RESULTS:  After a mean follow‐up of 57.8 months, therapeutic phlebotomy (mean number of units collected, 36.6) was effective in reducing mean ferritin concentration and transferrin saturation from 1726.9 to 93.0 mg per L and from 54.7 to 23.3 percent, respectively. The presence of a HH gene mutation did not influence initial iron status or response to treatment. The phlebotomy program was well tolerated and no adverse events were recorded during or after collection. In three cases the time between phlebotomies was increased because of patient's poor compliance or low Hb levels.CONCLUSION:  Our study shows that phlebotomies are a safe and effective method for reducing iron over‐load in multiply transfused long‐term AL survivors with secondary hemochromatosis.