bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aristida beyrichiana (Wiregrass) Establishment and Recruitment: Implications for Restoration
Authors: Mulligan Maureen K. , Kirkman L. Katherine , Mitchell R. J. 
Published: March 2003

AbstractRestoration of the longleaf pine ecosystems of the southeastern United States has focused interest on the regeneration and establishment of Aristida sp. (wiregrass) as a means to reestablish ecological function and structure of the ecosystem. This study examined dispersal distance from planted adults and canopy cover and density effects on establishment and reproduction. In 1994 wiregrass plugs were planted in two densities (500 seedlings/100 m2 and 49 seedlings/100 m2) and three canopy‐thinning treatments (25 m2 basal area/ha, 16 m2 basal area/ha, and 8 m2 basal area/ha) were implemented in a 20‐year‐old longleaf plantation in southwestern Georgia. Due to the intense site preparation and the density of pines planted, virtually no understory vegetation was present. The site was burned in June 1995, which promoted seed production of the planted wiregrass. Results indicate that the 8 m2 basal area/ha treatment results in larger plants that in turn produce a greater number of seedling recruits. No seedling recruitment occurred in control plots. Dispersal distances of up to 594 cm were recorded. Natural seedling recruitment occurred at low‐density transplanting (5 plants/10 m2), denoting that high‐density planting similar to natural density (5 plants/m2) is not required for successful establishment or reproduction. However, overstory thinning in dense pine plantations is required for reproduction and increases the survival of individual plants due to changes in the environmental conditions at the forest floor.
Effect Of Renal Denervation On Urinary TGF‐β1, Albuminuria And Renal Content Of Glut1 In Stz‐Induced Diabetic Rats
Authors: Schmid H , Schaan B , Bertolluci M , Lacchini S , Machado U , Irigoyen Mc 
Published: March 2003

In long‐term Diabetes Mellitus (DM) the progression of nephropathy has been related to the occurrence of autonomic neuropathy and hypertension. The STZ‐diabetic rat was previously described by us as an animal model that develops albuminuria, as well as increased expression of cortical renal GLUT1 and of Transforming Growth Factor 1 (TGF1) and increased urinary excretion of TGF1. The aim of this study was to evaluate the effect of renal denervation (RD) upon urinary TGF‐β1 (UTGF‐β1) and cortical renal GLUT1 protein levels, relating these parameters to blood pressure (BP) levels and metabolic control. Streptozotocin injected rats (group D; n=13) and control animals (group C; n=13) were compared for their urinary albumin (UA), UTGF‐1, BP and for their renal cortical and medullar GLUT1 protein abundance 45 days after the beginning of hyperglycemia. The animals were submitted to surgical RD or sham procedure within 30 days of STZ injection, and evaluations were done 15 days after the surgery. The effects of RD were confirmed by intra‐renal decrease of norepinephrine levels. Results showed that RD determined no changes in UA or UTGF‐β1, in both D and C rats. Blood pressure levels were similar between D and C and did not change as an effect of denervation. These results are shown in the table.In conclusion, in the STZ‐rat with albuminuria complicating diabetes, RD produces a normalization of previously elevated cortical GLUT1 protein and no effect upon UTGF ‐ β1 and UA, suggesting that these animals (with no hypertension) are protected from the deleterious effect of kidney denervation.
Alcohol Abuse, Cognitive Impairment, and Mortality Among Older People
Authors: Thomas Vince Salazar , Rockwood Kenneth J. 
Published: March 2003

OBJECTIVES: To estimate the prevalence of alcohol abuse, the association of alcohol abuse with cognitive impairment, and the contribution of alcohol abuse to short‐term mortality in a cohort of older people screened for dementia.DESIGN: Using the Canadian Study of Health and Aging (CSHA)—a representative, national cohort study of 10,268 older persons (≥65 years) from communities and long‐term care institutions conducted in 1991—alcohol abuse and dementia were diagnosed during clinical examinations. Death was determined by telephone interview 18 months after baseline and verified by vital statistics records.SETTING: 36 regional community and 17 regional institutional populations in Canada.PARTICIPANTS: The 2,873 individuals from the clinical sample of the CSHA.MEASUREMENTS: Diagnosis of alcohol abuse (questionable, definite, none), diagnosis of dementia.RESULTS: The prevalence of clinically detected definite alcohol abuse was 8.9% (95% confidence interval (CI) 7.9–9.9) and of questionable alcohol abuse was 3.7% (95% CI 3.0–4.4). Definite or questionable alcohol abuse was associated with a younger average age compared with no such abuse history, and men were significantly more likely than women to comprise definite and questionable diagnostic groups as compared with the group without alcohol abuse. The occurrence of all types of dementia except probable Alzheimer's disease was higher in those with definite or questionable alcohol abuse. Mortality at 18 months was higher among those with definite (14.8%, 95% CI 13.5–16.1) or questionable (20.0%, 95% CI 18.5–21.5) alcohol abuse, as compared with those with no alcohol abuse history (11.5%, 95% CI 10.3–12.7), and alcohol abuse (definite or questionable) conferred a 56% additional risk of short‐term mortality (odds ratio (OR) 1.56, 95% CI 1.11–2.20) after adjusting for age, sex, and a diagnosis of dementia.CONCLUSIONS: Alcohol abuse among older people is common and occurs more frequently among men. It is associated with cognitive impairment and independently with short‐term mortality. Physician screening for alcohol abuse can yield a group of older people at risk for adverse health outcomes.
Reducing Delirium After Hip Fracture: A Randomized Trial
Authors: Marcantonio Edward R. , Flacker Jonathan M. , Wright R. John , Resnick Neil M. 
Published: March 2003

DESIGN: Prospective, randomized, blinded.SETTING: Inpatient academic tertiary medical center.PARTICIPANTS: 126 consenting patients 65 and older (mean age 79 ± 8 years, 79% women) admitted emergently for surgical repair of hip fracture.MEASUREMENTS: Detailed assessment through interviews with patients and designated proxies and review of medical records was performed at enrollment to ascertain prefracture status. Subjects were then randomized to proactive geriatrics consultation, which began preoperatively or within 24 hours of surgery, or “usual care.” A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol. To ascertain study outcomes, all subjects underwent daily, blinded interviews for the duration of their hospitalization, including the Mini‐Mental State Examination (MMSE), the Delirium Symptom Interview (DSI), and the Memorial Delirium Assessment Scale (MDAS). Delirium was diagnosed using the Confusion Assessment Method (CAM) algorithm.RESULTS: The 62 patients randomized to geriatrics consultation were not significantly different (P> .1) from the 64 usual‐care patients in terms of age, gender, prefracture dementia, comorbidity, type of hip fracture, or type of surgical repair. Sixty‐one percent of geriatrics consultation patients were seen preoperatively and all were seen within 24 hours postoperatively. A mean of 10 recommendations were made throughout the duration of the hospitalization, with 77% adherence by the orthopedics team. Delirium occurred in 20  /62 (32%) intervention patients, versus 32  /  64 (50%) usual‐care patients (P = .04), representing a relative risk of 0.64 (95% confidence interval (CI) = 0.37–0.98) for the consultation group. One case of delirium was prevented for every 5.6 patients in the geriatrics consultation group. There was an even greater reduction in cases of severe delirium, occurring in 7/ 60 (12%) of intervention patients and 18  / 62 (29%) of usual‐care patients, with a relative risk of 0.40 (95% CI = 0.18–0.89). Despite this reduction in delirium, length of stay did not significantly differ between intervention and usual‐care groups (median ± interquartile range = 5 ± 2 days in both groups), likely because protocols and pathways predetermined length of stay. In subgroup analyses, geriatrics consultation was most effective in reducing delirium in patients without prefracture dementia or activities of daily living (ADL) functional impairment.CONCLUSIONS: Proactive geriatrics consultation was successfully implemented with good adherence after hip‐fracture repair. Geriatrics consultation reduced delirium by over one‐third, and reduced severe delirium by over one‐half. Our trial provides strong preliminary evidence that proactive geriatrics consultation may play an important role in the acute hospital management of hip‐fracture patients.
Ethnic Differences in Mini‐Mental State Examination (MMSE) Scores: Where You Live Makes a Difference
Authors: Espino David V. , Lichtenstein Michael J. , Palmer Raymond F. , Hazuda Helen P. 
Published: March 2003

OBJECTIVES: To examine differences in correlates of the Mini‐Mental State Examination (MMSE) in a population‐based sample of older Mexican Americans and European Americans and to provide empirical validation of the MMSE as an indicator of cognitive impairment in survey research in older Mexican Americans by comparing MMSE classification against performance on timed tasks with varying levels of cognitive demand.DESIGN: A population‐based cross‐sectional study.SETTING: Trained bilingual staff administered the MMSE as part of the San Antonio Longitudinal Study of Aging (SALSA) home‐based assessment battery.PARTICIPANTS: 827 community‐dwelling Mexican Americans and European Americans, 65 and older, residing in three socioeconomically and culturally distinct neighborhoods (barrio, transitional, suburban).MEASUREMENTS: The MMSE was compared against a variety of demographic, biomedical, and sociocultural variables ascertained by self‐report and against performance‐based measures of functional tasks representing varying levels of cognitive demand (Structured Assessment of Independent Living Skills (SAILS) subscales for food manipulation and money management).RESULTS: Mexican Americans were 2.2 times more likely than European Americans to have MMSE scores <24. Multiple logistic regression analysis revealed that neighborhood was an independent predictor of low MMSE scores in Mexican Americans, with the relationship between ethnic group and MMSE explained by neighborhood. After adjusting for neighborhood type, no differences were noted between Mexican Americans and European Americans. Independent of other factors examined, low education was associated with low MMSE scores in both Mexican Americans and European Americans. Mexican Americans with MMSE scores <24 took significantly longer to complete four out of five performance‐based food manipulation tasks and all three money management tasks.CONCLUSIONS: Neighborhood type was a predictor of cognitive impairment. Education affected MMSE scores similarly in both ethnic groups. MMSE scores <24, indicative of cognitive impairment, were uniformly associated with functional impairment in both the Mexican Americans and European Americans. Among older Mexican Americans, MMSE‐classified cognitive impairment was significantly associated with poorer performance on timed tasks with varying levels of cognitive demand independent of other correlates. A similar pattern of association was observed in European Americans. Thus, the MMSE appears to be a valid indicator of cognitive impairment in survey research in both older Mexican Americans and European Americans.
Associations of Demographic, Functional, and Behavioral Characteristics with Activity‐Related Fear of Falling Among Older Adults Transitioning to Frailty
Authors: Kressig Reto W. , Wolf Steven L. , Sattin Richard W. , O'Grady Michael , Greenspan Arlene , Curns Aaron , Kutner Michael 
Published: March 2003

OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity‐related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities‐Specific Balance Confidence Scale (ABC).DESIGN: Baseline cross‐sectional analysis in a prospective cohort intervention study.SETTING: Twenty independent senior living facilities in Atlanta.PARTICIPANTS: Seventeen male and 270 female subjects (n = 287), age 70 and older (mean ± standard deviation, 80.9 ± 6.2), with Mini‐Mental State Examination score ≥24, transitioning to frailty, ambulatory (with or without assistive device), medically stable, and having fallen in the past year.MEASUREMENTS: Activity‐related fear of falling was evaluated with the FES and ABC Scale. Because of the comparable data derived from each scale, associations with functional measures‐related analyses were expressed using the latter. Depression was measured by Center for Epidemiological Studies Depression Scale. Functional measurements included timed 360° turn, functional reach test, timed 10‐meter walk test, single limb stands, picking up an object, and three chair stands.RESULTS: No statistically significant association was found between activity‐related fear of falling and age. For the proposed activities, about half (ABC, 48.1%; FES, 50.1%) of the subjects were concerned about falling or showed lack of confidence in controlling their balance. A statistically significant inverse correlation was found between FES and ABC (r = −0.65; P < .001).CONCLUSIONS: Activity‐related fear of falling was present in almost half of this sample of older adults transitioning to frailty. The significant association of activity‐related fear of falling with demographic, functional, and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity‐related fear of falling in this population.
Healthcare Costs Associated with Percutaneous Endoscopic Gastrostomy Among Older Adults in a Defined Community
Authors: Callahan Christopher M. , Buchanan Nancy N. , Stump Timothy E. 
Published: March 2003

OBJECTIVES:The effectiveness of percutaneous endoscopic gastrostomy (PEG) in older adults remains controversial. Although prior studies have examined the safety of PEG and its impact on nutrition, there are limited data on the economic costs. The purpose of this study is to describe the healthcare costs associated with PEG tube feeding over 1 year.DESIGN:Prospective cohort study.SETTING:Small community of approximately 60,000 residents served by two hospital systems.PARTICIPANTS:One hundred five (70%) of 150 patients age 60 and older receiving PEG over a 24‐month period in the targeted community who permitted access to their medical records.MEASUREMENTS:Patients were interviewed at baseline and every 2 months for 1 year to obtain information on use of enteral formula, complication rates, and health services use. We obtained inpatient charge data for all hospitalizations and PEG procedures for 1 year.RESULTS:Censoring patients at death or 1 year post‐PEG, the mean number of days of PEG tube feeding was 180 (range 5–365). The average cost for PEG tube feeding for this cohort of patients was $7,488 (median $3,691) in 1997 and 1998. The average daily cost of PEG tube feeding was $87.21 (median $33.50). The estimated cost of providing 1 year of feeding via PEG is $31,832 (median $12,227). The main components of this cost include the initial PEG procedure (29.4%), enteral formula (24.9%), and hospital charges for major complications (33.4%).CONCLUSIONS:Direct charges associated with PEG tube feeding over 1 year are conservatively estimated at $31,832; there was considerable variation in charges because of the cost of rare but costly major complications. Also, feeding patients via PEG resulted in cost shifts in terms of the primary payor. The economic cost of PEG tube feeding is another consideration in decision making for long‐term enteral feeding among older adults. J Am Geriatr Soc 49:1525–1529, 2001.
Comparative Impact of Hearing and Vision Impairment On Subsequent Functioning
Authors: Wallhagen Margaret I. , Strawbridge William J. , Shema Sarah J. , Kurata John , Kaplan George A. 
Published: March 2003

OBJECTIVES: The purpose of this study was to compare independent impacts of two levels of self‐reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning.DESIGN: A 1‐year prospective cohort study.SETTING: San Francisco Bay Area, California.PARTICIPANTS: Two thousand four hundred forty‐two community‐dwelling men and women age 50 to 102 from the Alameda County Study (California).MEASUREMENTS: Hearing and vision impairment were assessed in 1994. Outcomes, measured in 1995, included physical disability (activities of daily living, instrumental activities of daily living, physical performance, mobility, and lack of participation in activities), mental health (self‐assessed, major depressive episode), and social functioning (feeling left out, feeling lonely, hard to feel close to others, inability to pay attention). All 1995 outcomes were adjusted for baseline 1994 values.RESULTS: Both impairments had strong independent impacts on subsequent functioning. Vision impairment exerted a more wide‐ranging impact on functional status, ranging from physical disability to social functioning. However, the results also highlighted the importance of hearing impairment, even when mild.CONCLUSIONS: These impairments can be partially ameliorated through prevention, assessment, and treatment strategies. Greater attention to sensory impairments by clinicians, patients, public health advocates, and researchers is needed to enhance functioning in older adults.
Healthcare Utilization and Costs in Managed Care Patients with Alzheimer's Disease During the Last Few Years of Life
Authors: McCormick Wayne C. , Hardy James , Kukull Walter A. , Bowen James D. , Teri Linda , Zitzer Sally , Larson Eric B. 
Published: March 2003

OBJECTIVES: To learn whether managed care patients with Alzheimer's disease (AD) are more or less costly to care for than patients with other forms of dementia or patients without dementia during the last few years of life.DESIGN: Case control study.SETTING: A health maintenance organization base population.PARTICIPANTS: Three groups of subjects (mean age 85) who were deceased members of a dementia registry obtained from a health maintenance organization base population: 263 subjects with clinically diagnosed probable AD, 133 subjects with other forms of dementia, and 100 cognitively intact controls.MEASUREMENTS: Utilization records were examined for the 3 years preceding death.RESULTS: In all subcategories and in aggregate, utilization and costs of care were either similar or lower for patients with AD than for the other groups, even after controlling for age, gender, and comorbidity.CONCLUSIONS: Persons with AD do not incur higher costs than persons with other types of dementia or age‐matched persons without dementia in a mature health maintenance organization during the last few years of life, when utilization is likely to be highest.
Progressive Trends in the Prevalence of Benzodiazepine Prescribing in Older People in Ontario, Canada
Authors: Tu Karen , Mamdani Muhammad M. , Hux Janet E. , Tu Jun‐bi 
Published: March 2003

OBJECTIVES:The extensive use of benzodiazepines has been a concern of healthcare providers and policy makers in Canada and around the world. The purpose of this study was to examine temporal trends in benzodiazepine prescriptions dispensed in older people from 1993–1998.DESIGN:Retrospective population‐based cross‐sectional study using administrative databases.SETTING:Ontario, Canada.PARTICIPANTS:The over 1 million residents of Ontario age 65 and older covered by the provincial universal drug benefit program.MEASUREMENTS:The main outcome measures were the prevalence, overall and with respect to age and gender, of benzodiazepine prescriptions dispensed and the ratio of the number of people to whom short‐ versus long‐acting benzodiazepine prescriptions were dispensed in each study year. The annual rates of switching to other psychotropic agents were examined for those patients that discontinued filling benzodiazepine prescriptions.RESULTS:The annual prevalence of benzodiazepine prescriptions dispensed decreased consistently over time (25.1% in 1993 to 22.5% in 1998; P < .001). Benzodiazepine dispensing prevalence increased with increasing age (approximately 20% of those age 65 to 69 to approximately 30% of those age ≥85; P < .001) and more females than males received the medication (relative risk = 1.50, 95% confidence interval = 1.49–1.51). The ratio of short‐ to long‐acting benzodiazepine prescriptions filled increased over time (3.6 in 1993 to 5.8 in 1998; P < .001), in line with guideline recommendations. Rates of switching to antidepressants increased over time (8.5% in 1993 to 10.2% in 1998; P < .001), whereas switching to barbiturates was consistently low (0.12%; P = .403).CONCLUSION:The prevalence of benzodiazepine therapy for older people in Ontario has steadily declined between 1993 and 1998. There is a trend of dispensing relatively more short‐acting than long‐acting benzodiazepines and of replacing benzodiazepines with antidepressants in older people without a remarkable increase in barbiturate consumption. These findings suggest that, without undue regulation, physicians are making progress in the prescribing of benzodiazepine therapy on the basis of current knowledge available. J Am Geriatr Soc 49:1341–1345, 2001.
Diabetes Mellitus in a Subgroup of Older Mexicans: Prevalence, Association with Cardiovascular Risk Factors, Functional and Cognitive Impairment, and Mortality
Authors: Rodríguez‐Saldaña Joel , Morley John E. , Reynoso Marco T. , Medina Carlos A. , Salazar Paulina , Cruz Eduardo , Torres A. L. Nayeli 
Published: March 2003

OBJECTIVES: To examine the prevalence and effects of diabetes mellitus in a subgroup of older Mexicans to allow comparisons to older persons of Mexican origin living in the United States.DESIGN: Longitudinal study.SETTING: High‐rise retirement housing in Mexico City.PARTICIPANTS: Seven hundred eighty‐five public servants and their family members aged 65 and older.MEASUREMENTS: Geriatric survey of function; mental status and depression; a physical examination; and blood samples for glucose and cholesterol.RESULTS: The prevalence of diabetes mellitus in this population was 15.1%, substantially lower than the prevalence reported in people of Mexican origin living in the United States. Nondiabetics were more obese than diabetics. Diabetes mellitus was more common in men than women. The mortality rate was greater in diabetics than nondiabetics (relative risk = 1.73, P < .05). Diabetics had more coronary artery disease and were more likely to die from myocardial infarction and neoplasms than nondiabetics. Diabetics were more likely to be functionally impaired (P < .0001) but no more likely to fall or to have fractures. Diabetics did not differ from nondiabetics in cognitive impairment or level of dysphoria.CONCLUSION: These studies highlight some important similarities and differences in comparing a middle class subgroup of older diabetics in Mexico City with diabetics of Mexican origin living in the United States.