bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Medicated Chewing Gums on Oral Health in Frail Older People: A 1‐Year Clinical Trial
Authors: Simons Debra , Brailsford Susan R. , Kidd Edwina A. M. , Beighton David 
Published: August 2002

OBJECTIVES: To determine the effects of a medicated chewing gum on the oral health of frail older people.DESIGN: A controlled, double‐blind trial using three groups based on random allocation of residential homes.SETTING: Sixteen residential homes in West Hertfordshire, England.PARTICIPANTS: One hundred eleven dentate subjects aged 60 and older who completed the 12‐month study.INTERVENTION: Subjects were assigned to a chlorhexidine acetate/xylitol gum (ACHX) group, a xylitol gum (X) group, or a no‐gum (N) group. Subjects in the gum groups chewed two pellets for 15 minutes twice daily for 12 months.MEASUREMENTS: Primary outcome measures were salivary flow rate, denture debris score, prevalence of angular cheilitis, and denture stomatitis; secondary outcome measures were salivary levels of caries‐associated microorganisms. A single examiner, who was blinded to group allocation, made all measurements at baseline before gum usage and at subsequent examinations after 3, 6, 9, and 12 months. Separate analyses were performed for subjects with dentures.RESULTS: Subjects in the three groups were similar in most of their baseline characteristics. The stimulated whole saliva flow rate ± standard deviation increased significantly for the ACHX (1.4 ± 0.7 mL/min) and X (1.6 ± 0.9 mL/min) groups (P < .01) over baseline (ACHX = 0.9 ± 0.6 mL/min, X = 0.8 ± 0.6 mL/min) and N group levels (0.6 ± 0.9 mL/min). The levels of mutans streptococci, lactobacilli, and yeasts significantly increased (P < .05) in the X and N groups. Denture debris status was significantly lower in the ACHX and X groups than at baseline or in the N group (P < .01). The reductions of 91% and 75% in denture stomatitis and angular cheilitis prevalence, respectively, that occurred in the ACHX group were significantly greater (P < .01) than the reductions in the X group (denture stomatitis 62%, angular cheilitis 43%). Prevalence of denture stomatitis and angular cheilitis were not significantly changed in the N group.CONCLUSION: The use of a medicated chewing gum significantly improved oral health in older occupants of residential homes. Chewing gums should be considered as a potential adjunct to other oral hygiene procedures in older subjects.
Improving Patient Outcomes of Home Health Care: Findings from Two Demonstration Trials of Outcome‐Based Quality Improvement
Authors: Shaughnessy Peter W. , Hittle David F. , Crisler Kathryn S. , Powell Martha C. , Richard Angela A. , Kramer Andrew M. , Schlenker Robert E. , Steiner John F. , Donelan‐McCall Nancy S. , Beaudry James M. , Mulvey‐Lawlor Kendra L. , Engle Karen 
Published: August 2002

OBJECTIVES: To evaluate effects on patient outcomes of Outcome‐Based Quality Improvement (OBQI), a continuous quality improvement methodology for home health care (HHC).DESIGN: A quasi‐experimental design with prospective pre/post and study/control components within two multiyear demonstration trials (occurring from 1995 to 2000) in which 73 home health agencies implemented OBQI, receiving several annual cycles of outcome reports to evaluate and enhance patient outcomes.SETTING: New York and 27 other states.PARTICIPANTS: The study involved 157,548 predominantly older adult patients admitted over 3 years to 54 OBQI agencies from 27 states in the National Demonstration Trial, 105,917 patients admitted over 4 years to 19 OBQI agencies in the New York State Trial, and 248,621 patients admitted over 3 years to non‐OBQI control agencies in the 27 demonstration states.INTERVENTION: As a clinical management and administrative intervention, OBQI involves collecting, encoding, and transmitting patient‐level health status data to a central source that provides each OBQI agency with a risk‐adjusted outcome report comparing the agency's patient outcomes with those from a reference population and with its own outcomes from the prior period. Target outcomes are selected and focused plans of action implemented to change care behaviors. Outcome changes are evaluated through the next report cycle.MEASUREMENTS: Outcome measures include hospitalization rates and improvement and stabilization outcome rates in functional, physiological, emotional/behavioral, and cognitive health.RESULTS: For the National and New York State Demonstration Trials, the risk‐adjusted relative rates of decline in hospitalization of 22% and 26%, respectively, for OBQI patients over the 3‐year and 4‐year demonstration periods were significant (P < .001) and unparalleled by considerably smaller rates of decline for the non‐OBQI patients in the 27 states. The risk‐adjusted rates of improvement in OBQI target outcome measures of health status averaged 5% to 7% per year in both demonstration trials and were significantly greater (P < .05) than analogous improvement rates for nontarget comparison outcomes, which averaged about 1% per year.CONCLUSION: It is feasible to integrate the programmatic, data collection, data transmission, and outcome enhancement components of OBQI into the day‐to‐day operations of home health agencies. The aggregate findings and the agency‐level evidence available from site‐specific communications suggest that OBQI had a pervasive effect on outcome improvement for home health patients. OBQI appears to warrant expansion and refinement in HHC and experimentation in other healthcare settings.
Suboptimal Duration of Antidepressant Treatments in the Older Ambulatory Population of Quebec: Association with Selected Physician Characteristics
Authors: Moride Yola , Du Fort Guillaume Galbaud , Monette Johanne , Ducruet Thierry , Boivin Jean‐François , Nathalie Champoux MD , Crott Ralph 
Published: August 2002

OBJECTIVES: To assess the association between selected physician characteristics and suboptimal duration of antidepressant use in the older outpatient population.DESIGN: Follow‐up of patients who were prescribed an antidepressant treatment by a cohort of physicians in Quebec.SETTING: Community‐based older outpatient population in Quebec.PARTICIPANTS: Retrospective cohort of 1,301 general practitioners (GPs) and 236 psychiatrists followed from 1991 to 1997.MEASUREMENTS: Treatment duration of less than 180 days in 1996/97.RESULTS: Premature interruption of antidepressant treatment was very frequent (44.7%). GPs, physicians who practice in metropolitan or urban regions, and those who have a proportion of older patients in their practice of less than 50% show a higher rate of premature interruption. These associations could not be accounted for by the choice of products, dosage, or patient characteristics.CONCLUSION: We have identified physician characteristics that are associated with suboptimal duration of antidepressant use and conclude that further interventions should target subgroups of physicians.
Cost‐Effectiveness of Preventive Occupational Therapy for Independent‐Living Older Adults
Authors: Hay Joel , LaBree Laurie , Luo Roger , Clark Florence , Carlson Mike , Mandel Deborah , Zemke Ruth , Jackson Jeanne , Azen Stanley P. 
Published: August 2002

OBJECTIVES:To evaluate the cost‐effectiveness of a 9‐month preventive occupational therapy (OT) program in the Well‐Elderly Study: a randomized trial in independent‐living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.DESIGN:A randomized trial.SETTING:Two government‐subsidized apartment complexes.PARTICIPANTS:One hundred sixty‐three culturally diverse volunteers aged 60 and older.INTERVENTION:An OT group, a social activity group (active control), and a nontreatment group (passive control).MEASUREMENTS:Use of healthcare services was determined by telephone interview during and after the treatment phase. A conversion algorithm was applied to the RAND 36‐item Short Form Health Survey to derive a preference‐based health‐related quality of life index, quality‐adjusted life years (QALYs), and the incremental cost‐effectiveness ratio for preventive OT relative to the combined control group.RESULTS:Costs for the 9‐month OT program averaged $548 per subject. Postintervention healthcare costs were lower for the OT group ($967) than for the active control group ($1,726), the passive control group ($3,334), or a combination of the control groups ($2,593). The quality of life index showed a 4.5% QALY differential (OT vs combined control),P< .001. The cost per QALY estimates for the OT group was $10,666 (95% confidence interval = $6,747–$25,430). For the passive and active control groups, the corresponding costs per QALY were $13,784 and $7,820, respectively.CONCLUSION:In this study, preventive OT demonstrated cost‐effectiveness in conjunction with a trend toward decreased medical expenditures.
Effect of Statin (HMG‐Co‐A‐Reductase Inhibitor) Use on 1‐Year Mortality and Hospitalization Rates in Older Patients with Cardiovascular Disease Living in Nursing Homes
Authors: Eaton Charles B. , Lapane Kate L. , Murphy John B. , Hume Anne L. 
Published: August 2002

OBJECTIVES: To quantify the effect of statins on 1‐year mortality, hospitalizations, and decline in physical function among patients with cardiovascular disease (CVD) aged 65 and older living in nursing homes.DESIGN: Retrospective cohort study.SETTING: All Medicare/Medicaid certified nursing homes (N = 1,492) in Maine, New York, Mississippi, and South Dakota.PARTICIPANTS: We identified 51,559 older patients with CVD from a population database that merged sociodemographic data and functional, clinical, and drug treatments from more than 300,000 newly admitted nursing home residents from 1992 to 1997. Statin users (n = 1,313) were matched with nonusers (n = 1,313) in the same facilities.MEASUREMENTS: All‐cause mortality, hospitalization, combined endpoint of mortality or hospitalization, and decline in physical function were determined at 1 year, and survival analysis was performed.RESULTS: Prevalence of statin use in this frail older cohort with CVD was 2.6%. Statin use varied by age, gender, comorbid condition, medication use, and cognitive and physical function. One‐year mortality was 229/1,000 person‐years in the statin group and 404/1,000 person‐years in the nonusers, with an adjusted hazard rate ratio (HRR) of 0.69, 95% confidence interval (CI) = 0.58–0.81. The estimated number needed to treat was seven (95% CI = 5–13). This association with improved all‐cause mortality was evident for women and men and for age groups 75 to 84, and 85 and older.CONCLUSION: Statin therapy is associated with improved clinical outcomes, including reduction in 1‐year all‐cause mortality, and the combined endpoint of death or hospitalization in a frail older population with CVD. Some caution should be taken in interpreting these results because potential bias from residual confounding could affect these results.
Otosclerosis and Stapedoplasty in Older Adults
Authors: Salvinelli Fabrizio , Casale Manuele , Trivelli Maurizio , Di Peco Valerio , Greco Fabio 
Published: August 2002

OBJECTIVES: To evaluate the efficacy of stapedoplasty in patients aged 60 and older, based on audiometric data and a questionnaire about quality of life.DESIGN: A retrospective (1994–2000) study.SETTING: People living in southern and central Italy.PARTICIPANTS: Sixty‐three patients: 32 consecutive patients aged 60 and older (group 1) and 31 consecutive patients younger than 60 (group 2).MEASUREMENTS: In each patient, we evaluated the pre‐ and postoperative auditory thresholds. Each patient answered a questionnaire about postoperative quality of life.RESULTS: When comparing the pre‐ and postoperative air conduction thresholds and air‐bone gap in the patients aged 60 and older, a statistically significant (P < .001) improvement at each frequency was observed. When elaborating the answers to the questionnaire about postoperative quality of life, we noticed that the older patients experienced a greater improvement.CONCLUSION: The results show that stapedoplasty offers greater improvement in quality of life for selected adults aged 60 and older than for younger adults. The operation also appears to be as safe for adults aged 60 and older as for younger adults. Stapedoplasty provides subjects with satisfactory social hearing level (hearing capacity sufficient for normal social relations) and slows the progression of otosclerosis. Providing older patients with good auditory functionality improves their state of health, quality of life, and cognitive processes.
Is Low‐Dose Oral Cobalamin Enough to Normalize Cobalamin Function in Older People?
Authors: Angela Garcia MD , Alicia Paris‐Pombo MD , Evans Lisa , Day Andrew , Freedman Morris 
Published: August 2002

OBJECTIVES: To investigate whether the use of low‐dose oral cobalamin (Cbl) supplements by older persons, as frequently found in multivitamin preparations, affects their Cbl serum concentrations and function, determined by measurements of the serum Cbl‐related metabolites methylmalonic acid (MMA), homocysteine (HCYS), and methylcitric acid (MCTR).DESIGN: Cross‐sectional study.SETTING: Community.PARTICIPANTS: Two hundred forty‐two independent, active, community‐living, older adult volunteers recruited from community events and activities for seniors.MEASUREMENTS: We systematically collected data on vitamin supplement intake, diet, medications, and medical and surgical history. Serum was obtained for Cbl, MMA, HCYS, and MCTR, and creatinine and hematological parameters.RESULTS: Serum levels of Cbl were significantly higher in subjects on oral Cbl supplements (2–37.5 μg/day). Similarly, serum levels of the metabolites MMA, HCYS, and MCTR were also lower in subjects on Cbl supplementation. Intake of low‐dose oral supplements of Cbl significantly reduced the odds of low Cbl levels or high MMA. The relationship between Cbl supplement dosage and the biochemical parameters was dose dependent.CONCLUSION: Oral Cbl (2–37.5 μg/day) intake by community‐dwelling healthy older adults is associated with higher serum levels of Cbl and improved or normalized Cbl function, as indicated by lower concentrations of the metabolites MMA, HCYS, and MCTR. Use of low‐dose oral Cbl replacement therapy might be sufficient to prevent Cbl deficiency in a large proportion of this population.
Common Chronic Diseases and General Impairments as Determinants of Walking Disability in the Oldest‐Old Population
Authors: Der Wiel Annetje Bootsma‐van , Gussekloo Jacobijn , De Craen Anton J.M. , Van Exel Eric , Bloem Bastiaan R. , Westendorp Rudi G.J. 
Published: August 2002

OBJECTIVES: Walking disability affects older people's autonomy and well‐being. We investigated the relative effect of common chronic diseases and general impairments on walking disability in the general oldest‐old population.DESIGN: Population‐based cohort study.SETTING: Leiden 85‐plus Study, the Netherlands.PARTICIPANTS: Five hundred ninety‐nine persons aged 85, response rate 87%.MEASUREMENTS: Walking disability was assessed using a 6‐meter walking test. Persons with a walking time below the 25th percentile and those who were physically unable to perform the walking test were categorized as having a walking disability. Information on common chronic diseases was obtained from records of subjects' general practitioners and pharmacies. General impairments were assessed with functional tests and standardized questions during face‐to‐face interviews. We expressed the effect of common chronic diseases and general impairments as the population attributable risk (PAR), indicating how much disability can be prevented when the identified risk factor is eliminated from the population.RESULTS: One hundred ninety‐two persons (33%) had a walking disability. This disability was highly associated with poor mobility in daily life, recurrent falls, and poor well‐being (all P < .001). Of the common chronic diseases, stroke, angina pectoris, diabetes mellitus, and hip fracture but not arthritis contributed most (PARs from 6% to 15%) to walking disability in the population at large. General impairments had higher prevalence rates and higher PARs than common chronic diseases. Cognitive impairment, depressive symptoms, and dizziness upon rising contributed most (PARs between 22 to 27%) to walking disability. In multivariate regression analyses of all common chronic diseases and general impairments, associations remained significant.CONCLUSION: Within the general oldest‐old population, general impairments contribute more substantially to walking disability than do common chronic diseases. The diagnosed diseases did not explain the impairments that led to walking disability. Especially in the oldest old, clinicians should focus not merely on common chronic diseases but particularly on general impairments as targets for diagnostic analysis and treatment to decrease walking disability.
Factors Influencing the Use of Computer Technology in the Collection of Clinical Data in a Predominantly African‐American Population
Authors: Izquierdo‐Porrera Anna Maria , Manchanda Roopak , Powell Claudia C. , Sorkin John D. , Bradham Douglas D. 
Published: August 2002

OBJECTIVES: To determine the cognitive and demographic factors that affect the performance of a predominantly African‐American population in the use of a computerized version of the Center for Epidemiologic Studies Depression Scale (CES‐D).DESIGN: Cross‐sectional.SETTING: University Medical Center and Veterans Affairs Medical Center in Baltimore, Maryland.PARTICIPANTS: Forty‐three healthy community‐dwelling adults from a predominantly African‐American Apostolic church; mean age ± standard deviation 57 ± 14 (range 29–83).MEASUREMENTS: Cognitive measurements (Mini‐Mental State Examination, digits span, word list learning, letter number sequencing, executive interview, and clock‐drawing task), education level, computer experience, and age. The CES‐D was administered on three occasions: a paper form CES‐D once and a computerized version twice. Time to completion the computer CES‐D (Time 1), differential in time to completion of both computer tests (delta‐time) and scores of the CES‐D with both forms of administration were recorded.RESULTS: There was no difference between the scores from the paper and the computer CES‐D or between the two computer forms. Computer experience predicted Time 1 (partial correlation R = 15%, P = .017) and delta‐time (partial correlation R = 10%, P = .048). Age, education, and cognitive function did not affect performance.CONCLUSION: Computerized assessment techniques are valid and unaffected by age, education level, or cognitive factors in healthy individuals.
Indicators of the Quality of Nursing Home Residential Care
Authors: Saliba Debra , Schnelle John F. 
Published: August 2002

OBJECTIVES: To identify quality indicators (QIs) that can be used to measure nursing home (NH) residential care processes.DESIGN: Modified‐delphi panel process to rate potential QIs that were identified through reported interviews with residents and families and through a review of the scientific literature.SETTING: Meetings of panel of experts.PARTICIPANTS: A national panel of nine experts in NH care rated potential QIs. A content expert and a clinical oversight committee performed external reviews.MEASUREMENTS: Panelists' median validity and importance ratings for each QI choice.RESULTS: The panel considered 64 choices for QI content and rated 28 of these as valid and important for measuring residential care quality. These 28 choices translated into 18 QIs. The external review process resulted in the addition of one QI that was not considered by the NH panel. The 19 indicators address areas identified as important by residents and proxies. Ten of these QIs were rated feasible to implement with current resources in average community NHs, and nine were rated feasible only in better NHs. The panelists identified nine as being measured most reliably by direct observations of care.CONCLUSION: Experts identified 19 specific care processes as valid and important measures of the quality of NH residential care. Nine of these QIs may be measured best by direct observation of NH care, rather than by interviews or review of existing NH records. Almost half of the QIs were viewed as discriminating between better and average NHs. The panel deemed that only well‐staffed nursing homes could consistently implement nine of the QIs.
NAT for HBV and anti‐HBc testing increase blood safety
Authors: Roth W. Kurt , Weber Marijke , Petersen Detlev , Drosten Christian , Buhr Sylvia , Sireis Walid , Weichert Wolfgang , Hedges Doris , Seifried Erhard 
Published: September 2002

BACKGROUND: Routine HBV PCR screening of blood donations to our institutes was introduced in January 1997 to complete the NAT screening program for transfusion‐relevant viruses. Testing was successively extended to customer transfusion services with a total of 1,300,000 samples tested per year. STUDY DESIGN AND METHODS: Minipools of 96 blood donation samples were formed by automatic pipettors. HBsAg‐reactive samples were included. HBV particles were enriched from the minipools by centrifugation. Conventional and in‐house TaqMan PCRs were successively applied for HBV amplification. Sensitivity reached 1000 genome equivalents per mL for each individual donation. Confirmatory single‐sample and single‐sample enrichment PCRs were established with sensitivities of 300 and 5 to 10 genome equivalents per mL, respectively. RESULTS: After screening of 3.6 million donor samples, 6 HBV PCR‐positive, HBsAg‐negative donations were identified. Two samples were from infected donors who had not seroconverted and four were from chronic anti‐HBc‐positive low‐level HBV carriers. Retesting by single‐sample PCR of 432 samples confirmed positive for HBsAg identified 37 donations that were negative in minipool PCR. Donor‐directed look‐back procedures indicated that no infected donor who had not yet seroconverted was missed by minipool PCR. However, recipient‐directed look‐back procedures revealed two anti‐HBc‐positive recipients of HBsAg‐negative minipool PCR‐negative, anti‐HBc‐positive and single‐sample PCR‐positive blood components. After testing randomly selected 729 HBsAg‐negative minipool PCR‐negative, anti‐HBc‐positive donors by single‐sample enrichment PCR, 7 were identified with ≤10 HBV particles per mL of donor plasma. CONCLUSION: Minipool PCR testing after virus enrichment was sensitive enough to identify HBsAg‐negative donors who had seroconverterd and HBsAg‐negative, anti‐HBc‐positive chronic HBV carriers. HBV NAT in conjunction with anti‐HBc screening would reduce the residual risk of transfusion‐transmitted HBV infection.