bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depressive Disorder as a Predictor of Physical Disability in Old Age
Authors: Kivelá Sirkka‐Liisa , Pahkala Kimmo 
Published: March 2003

OBJECTIVES: To determine whether the occurrence of depression predicts physical disability in older people. DESIGN: A longitudinal epidemiological study with a follow‐up of 5 years. SETTING: A comparison between depressed and nondepressed participants. PARTICIPANTS: The series consisted of the persons who participated in the longitudinal epidemiological study on depression in old age performed in Ähtäri, Finland. The first round of interviews and examinations was performed in 1984/1985 and the second round in 1989/1990. The study series (N = 786) was composed of persons functionally independent in activities of daily living (ADLs) during the first round and alive and participating in both rounds. MEASUREMENTS: Depression was determined according to DSM‐III criteria. Physical functional abilities were measured with self‐assessments of ability to manage ADLs. RESULTS: In bivariate analyses, depression at the baseline did not predict lowering of functional abilities during follow‐up, but the occurrence of depression with a long term or relapsing course during follow‐up and the onset of depression during follow‐up in persons not depressed at the baseline predicted lowering of functional abilities during follow‐up. The logistic regression analyses showed the presence of the following variables measured during the first round—older age, low basic education, poor self‐perceived health, and occurrence of a physical disease—and the onset of the following diseases during follow‐up—any physical disease, neurological disease, cerebrovascular disease, or depressive symptoms (in persons nondepressed at the baseline)—predicted lowered functional abilities after a follow‐up of 5 years. CONCLUSION: Depression that developed during the follow‐up in previously nondepressed persons was associated with an increased risk for lowering of functional abilities, even when controlling for age, sociodemographic factors, physical diseases, and baseline disabilities. Depressed older people are at high risk for physical disability, and an individually planned program to maintain their functional abilities by training in ADLs and instrumental activities of daily living (IADLs) and physical exercise should be included in their treatment.
Gaps in Asthma Care of the Oldest Adults
Authors: Wolfenden Linda L. , Diette Gregory B. , Skinner Elizabeth Ann , Steinwachs Donald M. , Wu Albert W. 
Published: March 2003

OBJECTIVES: To assess the adequacy of asthma care reported by a group of older adults who were subsequently hospitalized for their asthma.DESIGN: Prospective cohort study.SETTING: Fifteen managed care organizations in the United States.PARTICIPANTS: Adults with asthma, enrolled in managed care.MEASUREMENTS: Patient survey of demographics, asthma symptoms, health status, comorbid conditions, asthma treatment, asthma knowledge, and asthma self‐management at baseline and 1 year later.RESULTS: Of 254 older adults, 38 (15.0%) reported being hospitalized for asthma at 1‐year follow‐up. Of these, 22.9% owned a peak flow meter (PFM). Of those with allergies, only about half (56.0%) had been told how to avoid allergens and had been referred for formal allergy testing. Adrenergic drug use was high in some patients. Nearly all (94.6%) used β‐agonist metered‐dose inhalers (MDIs); 60.0% reported theophylline; 17.1% reported β‐agonist MDI overuse (>8 puffs per day); 10.5% reported β‐agonist MDI over‐use and theophylline; and 13.2% reported both β‐agonist MDI over‐use and oral β‐agonist use. Only 18.4% of respondents rated their overall asthma attack knowledge as excellent. Compared with nonhospitalized older adults, the hospitalized group reported care that was more consistent with guidelines, but also higher rates of potentially toxic combinations of adrenergic drugs. Compared with younger hospitalized adults, older hospitalized adults had clear deficiencies, including lower use of PFMs (55.3% vs 22.9%) and worse asthma self‐management knowledge.CONCLUSIONS: There are many opportunities to improve both the pharmacologic and non‐pharmacologic care of older adults with asthma. Overuse of and potentially toxic combinations of inhaled and oral sympathomimetics should probably be avoided. Older asthmatics may also benefit from increased specialty referral, PFM use, allergy testing, and asthma teaching.
Prevalence of Impaired Swallowing in Institutionalized Older People in Taiwan
Authors: Lin Li‐Chan , Wu Shiao‐Chi , Chen Hwa Shen , Wang Tyng‐Guy , Chen Miao‐Yen 
Published: March 2003

OBJECTIVES: To investigate the prevalence of impaired swallowing in residents at long‐term care facilities (LTCFs) in Taiwan.DESIGN: A chart review, a structured questionnaire completed at interview, a neurological examination, and a timed swallowing test were used to assess impairment and to gather demographic data.SETTING: Nine skilled nursing facilities and nine intermediate‐care facilities in metropolitan Taipei.PARTICIPANTS: One thousand two hundred twenty‐one conscious and unconscious residents with a mean age of 77.07.MEASUREMENTS: Impaired swallowing was defined when a subject met two or more of the following criteria: self‐report of swallowing difficulty, a score of 2 or more derived from a swallowing questionnaire combined with a neurological examination investigating symptoms and signs of impairment, and coughing/choking during a timed swallowing test or a measured swallowing rate (volume swallowed per second) below the 10th percentile as derived from a gender‐based study of an older community in Taipei.RESULTS: Of the 1,221 subjects, 356 (29.2%) were fed by tube. The prevalence rates for impaired swallowing as estimated were 97.5% and 31.9% for tube‐fed and non‐tube‐fed subjects respectively, whereas the overall prevalence for tube‐fed and non‐tube‐fed subjects altogether was 51.0%.CONCLUSIONS: The findings may serve to increase awareness of this problem among healthcare professionals in LTCFs. Further research is contemplated to investigate whether early identification makes a difference in treatment choices and outcomes.
Clinical Features of Influenza A Virus Infection in Older Hospitalized Persons
Authors: Walsh Edward E. , Cox Christopher , Falsey Ann R. 
Published: March 2003

OBJECTIVES: To determine the value of clinical parameters in predicting influenza in older persons and those with underlying cardiopulmonary conditions hospitalized with respiratory illnesses.DESIGN: Prospective evaluation of hospitalized persons from November 15, 1999, to April 15, 2000.SETTING: A 450‐bed general medical‐surgical hospital in Rochester, New York.PARTICIPANTS: Patients aged 65 and older or those with underlying cardiopulmonary conditions admitted to the hospital with respiratory diagnoses.MEASUREMENTS: The ability to discriminate influenza from noninfluenza cases using clinical parameters. Influenza infection was documented by culture, rapid antigen detection, reverse transcription‐polymerase chain reaction, or serology.RESULTS: Sixty‐one influenza A infections (mean age ± standard deviation = 79 ± 10) were identified in 332 evaluated illnesses (18.3%). Fifty‐six cases occurred in 168 patients (33%) during a 9‐week epidemic period; 40 were considered contagious on the basis of a positive culture or antigen test. Neither single clinical parameters nor logistic regression analysis using all parameters clearly discriminated influenza from noninfluenza cases. The complex of cough, temperature of 38°C or higher, and illness duration of 7 days or less provided the best discrimination between infected and uninfected subjects; during the epidemic period, 53% of subjects with this symptom complex had influenza, compared with 18% without these symptoms (relative risk = 2.99, 95% confidence interval = 1.85–4.83). This symptom complex had a sensitivity of 78% and a specificity of 73% for contagious influenza during the epidemic period.CONCLUSIONS: In older persons and those with underlying cardiopulmonary conditions admitted with acute respiratory illness during influenza epidemics, the presence of fever, cough, and brief illness should be useful for institution of respiratory isolation and for design of antiviral trials.
Standardization of Plasma Brain Natriuretic Peptide Concentrations in Older Japanese—Relationship to Latent Renal Dysfunction and Ischemic Heart Disease
Authors: Nomura Hideki , Hayashi Toshio , Esaki Teiji , Kanda Shigeru , Kano Hatsuyo , Hattori Ayako , Iguchi Akihisa 
Published: March 2003

OBJECTIVES: To determine the contributors to elevating plasma brain natriuretic peptide (BNP) concentrations in older people with normal systolic function. To investigate the relationship between cyclic guanosine monophosphate (cGMP) and BNP in older people with and without ischemic heart disease (IHD).DESIGN: Observational study.SETTING: Hospitalized patients in Nagoya University Hospital from November 1997 to May 2000.PARTICIPANTS: Younger patients (<65) without IHD (n = 31), older patients (≥65) without IHD (n = 37), and older patients with stable IHD (n = 32). All participants showed 45% or greater of their left ventricular ejection fraction (LVEF).MEASUREMENTS: LVEF, peak atrial velocity/peak early velocity (A/E) ratio at the mitral valve, and left ventricular mass volume were measured using transthoracic echocardiogram. Plasma BNP level, cGMP, and serum creatinine (Scr) were measured. Creatinine clearance (CLcr) was calculated based on 24‐hour urine collection.RESULTS: Plasma BNP levels in older people with and without IHD were significantly greater than in younger patients (mean ± standard deviation = 76.4 ± 96.0 (P < .001), 165.2 ± 200.6 (P < .001), and 8.1 ± 7.0, respectively). By simple regression analysis, in the groups without IHD, the logarithm of plasma BNP (Log BNP) concentrations had a significant positive relationship with age (R = 0.657, P < .001), Scr (R = 0.449, P < .001), and A/E ratio (R = 0.326, P = .003) and a significant negative relationship with CLcr (R = −0.663, P < .001). A stepwise multiple regression analysis with Log BNP level as the dependent variable and age, Scr, CLcr, and A/E ratio as independent variables showed that CLcr was a significant independent contributor in groups without IHD (R = −0.766, P < .001). In this analysis, the regression coefficient of the intercept was 2.006, and that of CLcr was −0.010. The cGMP/BNP ratio in older subjects with stable IHD tended to be lower than in those without IHD (P = .063).CONCLUSIONS: Elevated BNP levels in older patients with normal systolic function may be in part due to latent renal dysfunction, despite normal Scr levels. In healthy older people, it is important to exclude the effects of latent renal function in assessing cardiac function according to BNP level. In older subjects with stable IHD, the cGMP/BNP ratio tended to be lower than in those without IHD. This may be a reflection of a poor response of cGMP to BNP.
Chlamydia Trachomatis in Older Los Angeles County Residents, 1991–1998: Implications and Recommendations for the Detection of Sexually Transmitted Infections in Older Age Groups
Authors: Smith Lisa V. , Malmgren Roberta , Dyer Irene E. , Sorvillo Frank , Vaughn Gregory S. , Visscher Barbara 
Published: March 2003

OBJECTIVES: This study examined the incidence and implications of reported chlamydia cases in Los Angeles County residents aged 50 and older.DESIGN: Observational study of passive surveillance data submitted to the Los Angeles County Sexually Transmitted Disease Program.SETTINGS: Private and public health facilities in Los Angeles County.PARTICIPANTS: Los Angeles County residents aged 50 and older.MEASUREMENTS: Chlamydia cases were identified from the Los Angeles County Sexually Transmitted Disease Program passive surveillance system reports received from 1991 to 1998.RESULTS: Between 1991 and 1998, 1,421 cases of chlamydia were reported in persons aged 50 and older in Los Angeles County, accounting for 1% of total chlamydia cases. The average annual incidence rate for this period was 9.3 per 100,000, and appeared relatively stable. The mean age ± standard deviation was 59.0 ± 9.2 years, with a range of 50 to 96 years. Rates for older women were 1.1 to 3.0 times higher than in older men, similar to rate ratios for 20‐ to 35‐year‐olds. Rates among older African Americans appear to be substantially higher than any other older racial/ethnic group.CONCLUSIONS: Our data show that there are no age barriers for sexually transmitted infections. Although this population is highly unlikely to experience adverse reproductive outcomes, transmission to younger sex partners and contribution to the overall chlamydia epidemic are serious concerns. Surveillance and prevention strategies aimed at older persons will be needed as this population continues to grow.
Response of Elevated Methylmalonic Acid to Three Dose Levels of Oral Cobalamin in Older Adults
Authors: Rajan Suparna , Wallace Jeffrey I. , Brodkin Kayla I. , Beresford Shirley A. , Allen Robert H. , Stabler Sally P. 
Published: March 2003

OBJECTIVES: Because the effects of lower‐dose oral cobalamin (Cbl) supplements on older people with cobalamin deficiency are not known, we determined whether oral Cbl supplements at three different dose levels would normalize elevated serum methylmalonic acid (MMA) and total homocysteine (tHcy) concentrations.DESIGN: Sequential nonrandomized intervention study of three dose levels.SETTINGS: Two university‐based senior care clinics.PARTICIPANTS: Twenty‐three older adults (aged ≥65) with serum Cbl levels of 221 pmol/L (300 pg/mL) or lower and serum MMA greater than 271 nmol/L who had been enrolled in a previous screening study for Cbl deficiency (mean age 79 ± 9; 17 male, 6 female; 17 white, 6 other).INTERVENTION: Sequential daily treatment with 25 μg oral cobalamin, followed by 100 μg and 1,000 μg cobalamin each for a 6‐week period.MEASUREMENTS: Serum MMA, tHcy, and other metabolites at baseline and after each 6‐week dosing interval.RESULTS: Treatment with 25 μg and 100 μg lowered but did not normalize MMA levels in most subjects. A dose of 1,000 μg/day proved to be the most effective in lowering MMA levels to within normal limits. Serum tHcy was normalized in six of 11 subjects who had elevated tHcy pretreatment with oral Cbl alone and in one subject in combination with a multivitamin.CONCLUSIONS: Most Cbl‐deficient older people require more than 100 μg of oral Cbl to normalize serum MMA, which is a larger dose than is available in most standard multivitamins and Cbl supplements.
The Yield, Reliability, and Validity of a Postal Survey for Screening Community‐Dwelling Older People
Authors: Alessi Cathy A. , Josephson Karen R. , Harker Judith O. , Pietruszka Fern M. , Hoyl M. Trinidad , Rubenstein Laurence Z. 
Published: March 2003

OBJECTIVES: To assess the yield, reliability, and validity of a postal survey developed to identify older persons in need of outpatient geriatric assessment and follow‐up services.DESIGN: A longitudinal cohort study.SETTING: Outpatient primary care clinic at a Department of Veterans Affairs teaching ambulatory care center.PARTICIPANTS: Patients (N = 2,382) aged 65 and older who returned a Geriatric Postal Screening Survey (GPSS) that screened for common geriatric conditions (depression, cognitive impairment, urinary incontinence, falls, and functional status impairment). Validity and reliability testing was performed with subsamples of patients classified as high or lower risk based on responses to the GPSS.MEASUREMENTS: Test‐retest reliability was measured by percentage agreement and kappa statistic. The diagnostic validity of the 10‐item GPSS was tested by comparing single GPSS items to standardized geriatric assessment instruments for depression, mental status and functional status, as well as direct questions regarding falls, urinary incontinence, and use of medications. Validity was also tested against clinician evaluation of the specific geriatric conditions. Predictive validity was tested by comparing GPSS score with 1‐year follow‐up data on functional status, survival, and healthcare use.RESULTS: Respondents identified as high risk by the GPSS had scores that indicated significantly greater impairment on structured assessment instruments than those identified as lower risk by GPSS. The overall mean percentage agreement between the test and retest surveys was 88.3%, with a mean weighted kappa of 0.70. In comparison with a structured telephone interview and with a clinical assessment, individual items of the GPSS showed good accuracy (range 0.71–0.78) for identifying symptoms of depression, falls, and urinary incontinence. Over a 1‐year follow‐up period, the GPSS‐identified high‐risk group had significantly (P < .05) more hospital admissions, hospital days and nursing home admissions than the lower‐risk group.CONCLUSION: A brief postal screening survey can successfully target patients for geriatric assessment services. In screening for symptoms of common geriatric conditions, the GPSS identified a subgroup of older outpatients with multiple geriatric syndromes who were at increased risk for hospital use and nursing home admission and who could potentially benefit from geriatric intervention.
Addition of sodium bicarbonate to lidocaine decreases the duration of peripheral nerve block in rat. (Harvard Medical School, Boston, MA) Anesthesiology 2000;93:1045–1052.
Authors: Sinnott Catherine J. , Garfield Joseph M. , Thalhammer Johannes G. , Strichartz: Gary R. 
Published: March 2003

This study evaluated the effect of adding sodium bicarbonate to lidocaine with and without epinephrine versus equivalent alkalinization by sodium hydroxide (NaOH) on onset, degree, and duration of peripheral nerve block. The study was broken up into two parts. Part I examined alkalinization by sodium bicarbonate versus NaOH to pH 7.8 on 0.5% lidocaine, with and without epinephrine prepared from crystalline salt. Part II examined 0.5% and 1.0% commercial lidocaine solutions, with and without epinephrine, either unalkalinized or alkalinized with sodium bicarbonate or NaOH. The study concluded that with 1% commercial lidocaine without epinephrine, sodium bicarbonate decreases the degree and duration of the block. However, in solutions with epinephrine, sodium bicarbonate hastens onset, without effecting degree or duration.Comment by Octavio Calvillo, M.D., Ph.D. There is evidence that adding sodium bicarbonate to lidocaine without epinephrine improves the quality of epidural block, whereas adding sodium bicarbonate to lidocaine with epinephrine does not. The addition of 8.4% sodium bicarbonate to 2% lidocaine without epinephrine was shown to decrease the onset time and enhance the depth of the epidural block. When bicarbonate was added to 2% lidocaine with epinephrine neither onset time nor depth of the epidural block was affected. Most investigators have used epidural block as their paradigm. The authors in this study used the sciatic nerve block of the rat.
Management of an Epidural Abscess After Continuous Epidural Catheter Infusion
Authors: Malak Osama A. , Mossad Sherif B. , Mekhail Nagy A. 
Published: March 2003

Abstract: Objective:  • To increase awareness of the possibility of epidural infection after continuous epidural infusion.• Outline the salient diagnostic features of epidural infection.• Outline a strategy to manage epidural infection and minimize morbidity. Setting: Academic multidisciplinary pain clinic Patient: A patient with a left knee meniscal tear with a history of Chronic Regional Pain Syndrome Type I (CRPS I) of the left foot. Interventions: Attempted control of CRPS I symptoms with a tunnelled epidural catheter infusion. Results and Conclusions: The patient developed an epidural abscess diagnosed on the 11th postoperative day. The catheter was removed and the patient was treated successfully with intravenous antibiotics.
Amitriptyline and fluphenazine in the treatment of postherpetic neuralgia. (UCLA Pain Management Center, Los Angeles, CA) Clin J Pain 2000;16:188–192.
Authors: Graff‐Radford Steven B. , Shaw Leon R. , Naliboff: Bruce N. 
Published: March 2003

In this double‐blinded, placebo‐controlled study, 49 patients with postherpetic neuralgia (PHN) were randomly assigned to 4 treatment groups: Group 1, amitriptyline; Group 2, amitriptyline and fluphenazine; Group 3, fluphenazine; Group 4, a placebo. An active placebo was used to mimic the anticholinergic side effects of dry mouth. The study lasted 8 weeks, with weekly progress evaluations with the use of visual analog scales, the McGill Pain Questionnaire, and a side‐effects scale. A statistically significant decrease was seen in pain Groups 1 and 2, and no significant changes were seen in Groups 3 and 4. There was no significant difference when fluphenazine was added to amitriptyline. Conclude that these data support the effectiveness of amitriptyline in the treatment of PHN, but do not support the addition of fluphenazine.Comment by Lian‐Kah Ti, M.D. Amitriptyline is an established modality of treatment for postherpetic neuralgia. It is believed to exert its effect by its analgesic properties, rather than its antidepressant effect. It has been shown to raise the pain threshold, brought about by its prevention of serotonin re‐uptake.Although isolated case studies suggested a role for fluphenazine in combination with amitriptyline in the treatment of postherpetic neuralgia, the authors could not demonstrate this benefit. This study highlights the difficulties in the treatment of this condition. The use of amitriptyline reduced the intensity of pain, but did not eliminate it (VAS scores decreased from 55.9 to 26.6). When MPQ scores were compared, there was no difference, suggesting that the qualitative aspect of the pain was not reduced. More importantly, the authors noted a ceiling effect for amitriptyline, effectively limiting its potency. Combining therapies may be the answer, but as this study clearly shows, a combination with fluphenazine is not.
Fibromyalgia Syndrome, Idiopathic Widespread Persistent Pain or Syndrome of Myalgic Encephalomyelopathy (SME): What Is Its Nature?
Authors: Mehendale Anand W. , Goldman Mark P. 
Published: March 2003

Abstract: Context: Fibromyalgia is a disorder that is appearing more and more in the clinical practice but is poorly understood.Objective:  This paper attempts to look at all available and reliable data on these conditions and will outline current, scientifically sound understanding of these disorders, treatment modalities and future directions for research. It also attempts to analyze the social and cultural implications. Data Sources/Study Selection: Various terms used to describe these syndromes are fibromyalgia (FMS), and myalgic encephalomyelitis (ME). PubMed search was performed. Pertinent articles published in past 25 years and The National Academy of Sciences colloquium on Neurobiology of Pain was also reviewed. In addition, news‐articles in the lay press as well as the Internet were monitored for material posted by sufferers of these disorders. Data Extraction: Studies were reviewed for clinical presentations, history of these disorders, comorbid conditions, etiology, biochemical and microbiologic abnormalities, abnormalities found on neuroimaging and functional neurophysiologic techniques. In addition patient postings on the Internet and articles appearing in lay press were reviewed and social implications are discussed. Data Synthesis: Upon analysis of these materials the review was organized based on the quality of data and it's contextual scientific, cultural and political meaning for this disorder. This review appears to be pointing towards an entirely new paradigm in pain disorders; therefore, a hypothesis and future direction of research is repeatedly suggested.Conclusion:  This study proposes an entirely new paradigm in these disorders based on scientific and cultural data.