Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Design

  • accurate design
  • adaptive control design
  • adaptive design
  • adaptive two-stage design
  • algorithm design
  • alternative design
  • amplifier design
  • analytical design
  • antenna design
  • appropriate design
  • architectural design
  • array design
  • bandpass filter design
  • baseline design
  • behnken design
  • best design
  • bioreactor design
  • blind design
  • block design
  • building design
  • burman design
  • careful design
  • case control design
  • case study design
  • case study research design
  • case-control design
  • case-control study design
  • catalyst design
  • catheter design
  • cavity design
  • cell design
  • central composite design
  • central composite experimental design
  • central composite rotatable design
  • chamber design
  • chemical design
  • circuit design
  • clinical trial design
  • coating design
  • cohort design
  • cohort study design
  • coil design
  • column design
  • compact design
  • comparative design
  • comparison design
  • complete block design
  • complex design
  • complex survey design
  • component design
  • composite design
  • composite experimental design
  • composite rotatable design
  • computational design
  • computer-aided design
  • concept design
  • conceptual design
  • contract design
  • control design
  • control group design
  • control system design
  • controlled design
  • controlled trial design
  • controller design
  • conventional design
  • correlational design
  • course design
  • cross-layer design
  • cross-over design
  • cross-sectional descriptive design
  • cross-sectional design
  • cross-sectional study design
  • cross-sectional survey design
  • crossover design
  • current design
  • curriculum design
  • d-optimal design
  • de novo design
  • descriptive correlational design
  • descriptive design
  • descriptive survey design
  • detailed design
  • device design
  • different design
  • different study design
  • dominant design
  • double-blind crossover design
  • double-blind design
  • double-sampling design
  • drug design
  • economic design
  • effective design
  • efficient design
  • electrode design
  • engineering design
  • environmental design
  • enzyme design
  • equipment design
  • ethnographic design
  • evaluation design
  • existing design
  • experiment design
  • experimental design
  • experimental research design
  • explorative design
  • exploratory design
  • factorial design
  • factorial experimental design
  • family design
  • fatigue design
  • feedback design
  • filter design
  • final design
  • fire design
  • flap design
  • flexible design
  • fractional factorial design
  • fractional factorial experimental design
  • full factorial design
  • future design
  • geometric design
  • geometrical design
  • good design
  • group design
  • hybrid design
  • hydraulic design
  • implant design
  • improved design
  • industrial design
  • inhibitor design
  • initial design
  • innovative design
  • institutional design
  • instructional design
  • instrument design
  • intelligent design
  • interaction design
  • intervention design
  • inverse design
  • job design
  • joint design
  • latin square design
  • lattice design
  • layout design
  • learning design
  • library design
  • ligand design
  • longitudinal design
  • longitudinal research design
  • macromolecular design
  • market design
  • material design
  • mating design
  • measurement design
  • mechanical design
  • mechanism design
  • method design
  • methods design
  • mixed methods design
  • mixer design
  • mixture design
  • model design
  • modified design
  • modular design
  • module design
  • molecular design
  • multi-method design
  • multiple baseline design
  • multiple-baseline design
  • multivariate design
  • network design
  • new design
  • novel design
  • novo design
  • object-oriented design
  • observational design
  • observational study design
  • observer design
  • optical design
  • optimal design
  • optimization design
  • optimum design
  • organization design
  • organizational design
  • original design
  • orthogonal design
  • other design
  • package design
  • page design
  • panel design
  • parallel design
  • parallel group design
  • parallel-group design
  • parameter design
  • part design
  • physical design
  • plan design
  • plant design
  • plantation design
  • plot design
  • policy design
  • post-test design
  • posttest design
  • practical design
  • predictive control design
  • preliminary design
  • preparation design
  • primer design
  • priori design
  • probe design
  • process design
  • product design
  • program design
  • programme design
  • project design
  • proper design
  • proposed design
  • prospective cohort design
  • prospective cohort study design
  • prospective design
  • protein design
  • protocol design
  • qualitative descriptive design
  • qualitative design
  • qualitative research design
  • quasi-experimental design
  • random sampling design
  • randomized block design
  • randomized complete block design
  • randomized cross-over design
  • randomized crossover design
  • randomized design
  • rational design
  • rational drug design
  • reactor design
  • receiver design
  • repeated-measure design
  • research design
  • reserve design
  • response surface design
  • response-adaptive design
  • retrospective cohort design
  • retrospective design
  • robust controller design
  • robust design
  • rotatable design
  • safer design
  • same design
  • sample design
  • sampling design
  • sequential design
  • sequential trial design
  • series design
  • service design
  • several design
  • shape design
  • shell design
  • ship design
  • similar design
  • simple design
  • software design
  • spatial design
  • specific design
  • split-mouth design
  • split-plot design
  • square design
  • standard design
  • statistical design
  • statistical experimental design
  • stent design
  • structural design
  • structure design
  • study design
  • study research design
  • subject design
  • successful design
  • surface design
  • survey design
  • system design
  • test design
  • tip design
  • topology design
  • traditional design
  • training design
  • treatment design
  • trial design
  • twin design
  • two-period crossover design
  • two-phase design
  • two-stage design
  • unique design
  • universal design
  • urban design
  • vaccine design
  • various design
  • vector design
  • web design
  • within-subject design
  • workplace design

  • Terms modified by Design

  • design activity
  • design algorithm
  • design algorithms
  • design alternative
  • design analysis
  • design and construction
  • design and methods.
  • design application
  • design approach
  • design aspect
  • design case
  • design case report
  • design challenge
  • design change
  • design characteristic
  • design choice
  • design cluster
  • design code
  • design cohort study
  • design concept
  • design condition
  • design configuration
  • design consideration
  • design constraint
  • design course
  • design criterioN
  • design criterion
  • design curriculum
  • design curve
  • design data
  • design decision
  • design education
  • design effect
  • design effects
  • design element
  • design engineer
  • design environment
  • design equation
  • design example
  • design experiment
  • design factor
  • design feature
  • design flexibility
  • design formula
  • design framework
  • design goal
  • design guideline
  • design improvement
  • design information
  • design integration
  • design issues
  • design knowledge
  • design limitation
  • design management
  • design matrix
  • design method
  • design methodology
  • design methods
  • design model
  • design models
  • design modifications
  • design objective
  • design observational study
  • design optimization
  • design optimization problem
  • design option
  • design paradigm
  • design parameter
  • design pattern
  • design phase
  • design philosophy
  • design point
  • design population
  • design practice
  • design practitioner
  • design principle
  • design problem
  • design procedure
  • design process
  • design project
  • design prospective
  • design purpose
  • design requirement
  • design research
  • design retrospective
  • design review
  • design rule
  • design scheme
  • design software
  • design solution
  • design space
  • design specifications
  • design spectrum
  • design stage
  • design step
  • design storm
  • design strategy
  • design student
  • design studies
  • design study
  • design subject
  • design synthesis
  • design system
  • design target
  • design task
  • design team
  • design technique
  • design techniques
  • design test
  • design theory
  • design thinking
  • design tool
  • design tools
  • design used
  • design value
  • design variable

  • Selected Abstracts


    Dong H. Roh
    There have been many multi-item auction mechanisms. As it is not allowed for both sellers and buyers to submit bids and offers in nearly all existing multi-item auction mechanisms, the impartial profit distribution for both sellers and buyers cannot be realized in those mechanisms. Although it is possible for both sellers and buyers to submit bids and offers in a combinatorial exchange, the impartial profit distribution for all individual participants cannot be realized due to its pricing mechanism that focuses only on enforcing budget balance. This paper proposes an iterative multi-item unit-demand and unit-supply double-auction mechanism with a new winner determination and pricing mechanism for distributing profit impartially from the viewpoints of individual participants regardless of whether they are buyers or sellers. It also analyzes the theoretical features of the proposed auction mechanism, including those related to its strategic behavior and efficiency. [source]


    Floortje Alkemade
    Agent-based computational economics (ACE) combines elements from economics and computer science. In this article, the focus is on the relation between the evolutionary technique that is used and the economic problem that is modeled. In the field of ACE, economic simulations often derive parameter settings for the genetic algorithm directly from the values of the economic model parameters. This article compares two important approaches that are dominating in ACE and shows that the above practice may hinder the performance of the genetic algorithm and thereby hinder agent learning. More specifically, it is shown that economic model parameters and evolutionary algorithm parameters should be treated separately by comparing the two widely used approaches to social learning with respect to their convergence properties and robustness. This leads to new considerations for the methodological aspects of evolutionary algorithm design within the field of ACE. [source]

    Double-Blind, Randomized, Placebo-Controlled, Dose-Response Study of the Safety and Efficacy of Botulinum Toxin Type A in Subjects with Crow's Feet

    Nicholas J. Lowe MD
    Background Published evidence suggests that botulinum toxin type A (BTX-A) is an effective treatment for crow's feet. However, few dose-ranging studies have been performed. Objectives To assess the safety and efficacy of a single treatment with one of four doses of BTX-A (Botox/Vistabel, Allergan Inc) compared with placebo for the improvement of crow's feet. Methods Subjects received a single bilateral treatment of 18, 12, 6, or 3 U of BTX-A or placebo injected into the lateral aspect of the orbicularis oculi muscle (parallel-group, double,blind design). Investigators and subjects rated crow's feet severity at maximum smile on day 7 and at 30-day intervals from days 30 to 180. Results As observed by both investigators and subjects, all doses of BTX-A resulted in improvements in crow's feet severity when compared with placebo. A dose-dependent treatment effect for efficacy was observed, with higher doses having an increased magnitude and duration of effect. However, a clear differentiation between the 18 U and 12 U doses was not apparent. Few adverse events were reported, with no statistically significant differences between BTX-A and placebo in the incidence of subjects experiencing adverse events. Conclusion BTX-A is safe and effective in decreasing the severity of crow's feet, with 12 U per side suggested as the most appropriate dose. THIS STUDY WAS FUNDED BY ALLERGAN, WHICH WAS ALSO INVOLVED IN THE DESIGN AND CONDUCT OF THE STUDY; COLLECTION, MANAGEMENT, ANALYSIS, AND INTERPRETATION OF THE DATA; AND PREPARATION, REVIEW, AND APPROVAL OF THE MANUSCRIPT. DRS. LOWE AND FRACZEK ARE PAID CONSULTANTS FOR ALLERGAN, DRS. KUMAR AND EADIE ARE EMPLOYEES OF ALLERGAN, AND DRS. LOWE AND KUMAR HOLD STOCK OPTIONS. [source]


    Y. H. CHEUNG
    First page of article [source]


    EVOLUTION, Issue 6 2008
    Simone Immler
    Sperm competition is an important force driving the evolution of sperm design and function. Inter- and intraspecific variation in sperm design are strongly influenced by the risk of sperm competition in many taxa. In contrast, the variation among sperm of one male (intramale variation) is less well understood. We investigated intramale variation in sperm design in passerine birds and found that risk of sperm competition is negatively associated with intramale variation. This result is the first clear evidence that variation among sperm within an individual male is influenced by postcopulatory sexual selection. Our finding has important implications for male traits under pre- and postcopulatory sexual selection. [source]


    G. Prater Jr.
    First page of article [source]

    Family Needs Assessment in Cerebral Palsy Clinic

    Constance F. Buran
    PURPOSE. The dual purpose of this study was to identify areas of need as perceived by parents of children with cerebral palsy in three domains and to evaluate internal reliability of the Family Needs Assessment Tool (FNAT). DESIGN AND METHODS. The FNAT was distributed to parents and includes a demographic survey and three subscales: service, information, and obstacles to care. RESULTS. Parents identified services as their greatest need, followed by information and then obstacles to care. PRACTICE IMPLICATIONS. The FNAT may be utilized to evaluate parental perceptions of needs, and provide clinicians with information for program planning and assessing needs central to providing quality care. [source]

    Home Asthma Management for Rural Families

    Sharon D. Horner
    ISSUES AND PURPOSE. To assess home asthma management among rural families with a school-age child who has asthma. DESIGN AND METHODS. Exploratory analysis of baseline data of a tri-ethnic sample of rural families with school-age children who have asthma. RESULTS. Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications. PRACTICE IMPLICATIONS. Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan. [source]

    Relationships of Sexual Abuse, Connectedness, and Loneliness to Perceived Well-Being in Homeless Youth

    Lynn RewArticle first published online: 23 FEB 200
    ISSUES AND PURPOSE. To describe respondents' perceptions of connectedness, loneliness, and well-being; and to explore relationships among these variables. DESIGN AND METHOD. Survey data from 96 participants, focus group interviews with 32 participants, and 10 individual interviews were analyzed. RESULTS. Sixty percent of the sample reported sexual abuse, which was significantly related to loneliness and inversely related to connectedness and perceived well-being. Subjects felt lonely and disconnected. They perceived their well-being in terms of current health status. PRACTICE IMPLICATIONS. High rates of sexual abuse, lack of connectedness, and loneliness may help to explain poor perceived well-being in homeless youth. [source]

    Childrens'and Adolescents'Use of Diaries for Sickle Cell Pain

    Virginia Egbert Maikler
    ISSUES AND PURPOSE. To evaluate the characteristics of vaso-occlusive episodes, home management of pain and its impact on the daily activities, and a diary as a method of data collection. DESIGN AND METHODS. Forty-six adolescents and 75 children were asked to complete daily diaries during the intervention period of a larger study. RESULTS. Mild pain was recorded 95% of the time; moderate pain, 3%; and severe pain, 1%. The pattern and location of pain varied greatly. Adolescents used more interventions than did children. When pain intensity was mild, 80% of the children/adolescents maintained school, social, and home activities, but decreased play/sport activities. When pain intensity was high, they decreased their participation in all activities. PRACTICE IMPLICATIONS. Sickle cell pain episodes are unpredictable and highly variable. Diaries can enhance children's and adolescents'documentation and communication about their pain experiences. [source]

    Spirituality in African-American Mothers Coping With a Seriously Ill Infant

    Sonja M. Wilson
    ISSUES AND PURPOSE. To describe how African-American mothers' spirituality helped them cope during the time of their infants' hospitalization for a serious illness. DESIGN AND METHODS. Fourteen mothers whose infants were seriously ill in the early months of life were interviewed for this retrospective, descriptive study. RESULTS. The core theme related to prayer. Four mothers reported a strengthened faith, while two mothers continued to have difficulty relating to God or attending church. PRACTICE IMPLICATIONS. These findings support the importance of understanding and respecting the spiritual needs and expressions of spirituality in African-American mothers who are coping with a serious illness in one of their children. [source]

    Experiences of Students in Pediatric Nursing Clinical Courses

    Marilyn H. Oermann
    ISSUES AND PURPOSE. Learning may be inhibited if students experience undue stress in the clinical setting. This study described the stresses, challenges, and emotions experienced by pediatric nursing students. DESIGN AND METHODS. Students (n = 75) completed a modified Pagana Clinical Stress Questionnaire at the end of their pediatric nursing clinical course. The comparison group of students (n = 383) was enrolled in nonpediatric clinical courses in the same nursing programs. RESULTS. The most stressful aspect of clinical practice was giving medications to children. High stress scores were related to more fear and disappointment in clinical practice. Students who experienced high stress were less stimulated by their clinical activities and developed less confidence in practice. PRACTICE IMPLICATIONS. Knowledge of students' perceptions of clinical stress can help educators and clinicians promote a positive and rewarding clinical atmosphere. [source]

    Clinical and Economic Outcomes of Infants Receiving Breast Milk in the NICU

    Amy J. Barton
    ISSUES AND PURPOSE. This study compared clinical and economic outcomes for infants who were exclusively fed breast milk and infants who were fed commercial formula. DESIGN AND METHODS. A retrospective medical record review from a regional neonatal intensive care unit (N = 80) using consultation logs from the lactation coordinator and a matched sample of formula-fed infants. RESULTS. Neither clinical (weight gain, length of stay, days of parenteral nutrition) nor economic outcomes (direct variable costs, net revenue) differed significantly between the groups. PRACTICE IMPLICATIONS. While it may not be possible to demonstrate sufficient cost savings while the infant resides within the NICU to justify a lactation coordinator, long-term clinical and economic outcomes may be sensitive to this specialized nursing service. [source]

    Playground Injuries in Children: A Review and Pennsylvania Trauma Center Experience

    Lisa Marie Bernardo
    ISSUES AND PURPOSE. To describe patient demographics, injury characteristics, and circumstances of playground injuries in children admitted to Pennsylvania trauma centers and to identify injury prevention strategies. DESIGN AND METHODS. Retrospective, descriptive study of 234 children ages 1 to 18 years sustaining playground-related injuries and whose hospital data were entered into the Pennsylvania Trauma Outcome Study. RESULTS. Most of the injuries occurred between April and September (77%), and noon to 6 P.M. (69%). Falls from playground equipment constituted the highest proportion of incidents (73%). Of 421 injuries (M = 1.8/patient), most were upper extremity (n = 117) and head (n = 110) injuries. PRACTICE IMPLICATIONS. Nurses can advocate for playground safety by teaching children to play safely and recommending age-appropriate equipment and protective surfacing. [source]

    Insights on Immunizations From Caregivers of Children Receiving Medicaid-Funded Services

    Deborah B. Evers
    ISSUES AND PURPOSE. Despite numerous programs aimed at improving immunization rates among American children, under-immunization remains a significant problem. This study was conducted to gain insight into parents' /guardians' knowledge and attitudes regarding childhood immunizations. DESIGN AND METHODS. Thirteen African-American mothers and grandmothers participated in semistructured, audiotaped focus-group interviews. RESULTS. Four major themes emerged: health knowledge and beliefs about immunizations, system barriers that impede obtaining immunizations, facilitators that enhance obtaining immunizations, and suggestions for change. PRACTICE IMPLICATIONS. Immunizations are one of the most important health advantages available to children. Therefore, nurses must become aware of the problem of underimmunization and work to address some of the concerns caregivers have identified in this study. The health and lives of the nation's children depend on it. [source]

    Using Distraction to Reduce Reported Pain, Fear, and Behavioral Distress in Children and Adolescents: A Multisite Study

    Karen L. Carlson
    ISSUES AND PURPOSE. Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during venipuncture or intravenous insertion. DESIGN AND METHODS. A two-group randomized design with 384 children in 13 children's hospitals. RESULTS. Age was a significant factor in observed behavioral distress, reports of fear, and self-reported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or IV insertion. PRACTICE IMPLICATIONS. Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups. [source]

    Disclosing the Diagnosis of Pediatric HIV Infection: Mothers' Views

    Wendy M. Nehring
    ISSUES AND PURPOSE. The stigma of HIV infection creates barriers to disclosure. The purpose of this study was to identify to whom biological and foster mothers disclose the diagnosis of HIV infection, discuss their rationale, and describe the recipient's reactions. DESIGN AND METHODS. A descriptive, qualitative study included biological (n = 9) and foster (n = 11) mothers of children with HIV infection. RESULTS. Three themes emerged from the data: Telling for support, determining who should know, and telling children. These themes were present for both biological and foster mothers. PRACTICE IMPLICATIONS. It is important for nurses to realize that parental disclosure of the diagnosis of HIV infection is a long-term, age-appropriate process that will take place over many discussions and time, and should have the support of the interdisciplinary team. Additional psychological support also should be available. [source]

    Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder

    [See editorial comments by Dr. Soo Borson, pp 1797-1798]
    OBJECTIVES: To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH,, n=3,660), those with PH and no PTSD (PTSD,/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD,/PH,, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH, group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH, group as in the PTSD,/PH+ or PTSD,/PH, group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care. [source]

    Length of Stay for Older Adults Residing in Nursing Homes at the End of Life

    Anne Kelly MSW
    OBJECTIVES: To describe lengths of stay of nursing home decedents. DESIGN: Retrospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS: The mean age of decedents was 83.3±9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1,20) and 13.7±18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. [source]

    Dehydroepiandrosterone Combined with Exercise Improves Muscle Strength and Physical Function in Frail Older Women

    Anne M. Kenny MD
    OBJECTIVES: To investigate the effects of dehydroepiandrosterone (DHEA) combined with exercise on bone mass, strength, and physical function in older, frail women. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: A major medical institution. PARTICIPANTS: Ninety-nine women (mean age 76.6 ± 6.0) with low sulfated DHEA (DHEAS) levels, low bone mass, and frailty. INTERVENTION: Participants received 50 mg/d DHEA or placebo for 6 months; all received calcium and cholecalciferol. Women participated in 90-minute twice-weekly exercise regimens. MEASUREMENTS: Hormone levels, bone mineral density (BMD), bone turnover markers, body composition, upper and lower extremity strength, physical performance. RESULTS: Eighty-seven women (88%) completed 6 months. There were no significant changes in BMD or bone turnover markers. DHEA supplementation resulted in gains in lower extremity strength (from 459 ± 121 N to 484 ± 147 N; P=.01). There was also improvement in Short Physical Performance Battery score, a composite score that focuses on lower extremity function, in those taking DHEA (from 10.1 ± 1.8 to 10.7 ± 1.9; P=.02). There were significant changes in all hormone levels, including DHEAS, estradiol, estrone, and testosterone, and a decline in sex hormone-binding globulin levels in those taking DHEA. CONCLUSION: DHEA supplementation improved lower extremity strength and function in older, frail women involved in a gentle exercise program of chair aerobics or yoga. No changes were found in BMD either due to small sample size, short duration of study or no effect. The physical function findings are promising and require further evaluation as frail women are at high risk for falls and fracture. [source]

    The Cross-Sectional Relationship Between Body Mass Index, Waist,Hip Ratio, and Cognitive Performance in Postmenopausal Women Enrolled in the Women's Health Initiative

    Diana R. Kerwin MD
    OBJECTIVES: To determine whether body mass index (BMI) is independently associated with cognitive function in postmenopausal women and the relationship between body fat distribution as estimated by waist-hip ratio (WHR). DESIGN: Cross-sectional data analysis. SETTING: Baseline data from the Women's Health Initiative (WHI) hormone trials. PARTICIPANTS: Eight thousand seven hundred forty-five postmenopausal women aged 65 to 79 free of clinical evidence of dementia who completed the baseline evaluation in the WHI hormone trials. MEASUREMENTS: Participants completed a Modified Mini-Mental State Examination (3MSE), health and lifestyle questionnaires, and standardized measurements of height, weight, body circumference, and blood pressure. Statistical analysis was performed of associations between 3MSE score, BMI, and WHR after controlling for known confounders. RESULTS: With the exception of smoking and exercise, vascular disease risk factors, including hypertension, waist measurement, heart disease, and diabetes mellitus, were significantly associated with 3MSE score and were included as covariables in subsequent analyses. BMI was inversely related to 3MSE score; for every 1-unit increase in BMI, 3MSE score decreased 0.988 points (P<.001) after adjusting for age, education, and vascular disease risk factors. BMI had the most pronounced association with poorer cognitive functioning scores in women with smaller waist measurements. In women with the highest WHR, cognitive scores increased with BMI. CONCLUSION: Higher BMI was associated with poorer cognitive function in women with smaller WHR. Higher WHR, estimating central fat mass, was associated with higher cognitive function in this cross-sectional study. Further research is needed to clarify the mechanism for this association. [source]

    Heterogeneity in Serum 25-Hydroxy-Vitamin D Response to Cholecalciferol in Elderly Women with Secondary Hyperparathyroidism and Vitamin D Deficiency

    Andrea Giusti MD
    OBJECTIVES: To compare the effects on parathyroid hormone (PTH) and 25-hydroxy-vitamin D (25(OH)D) of two dosing regimens of cholecalciferol in women with secondary hyperparathyroidism (sHPTH) and hypovitaminosis D and to investigate variables affecting 25(OH)D response to cholecalciferol. DESIGN: Randomized-controlled trial with 6-month follow-up. SETTING: Two osteoporosis centers in northern Italy. PARTICIPANTS: Sixty community-dwelling women aged 65 and older with sHPTH and hypovitaminosis D, creatinine clearance greater than 65 mL/min and without diseases or drugs known to influence bone and vitamin D metabolism. INTERVENTION: Cholecalciferol 300,000 IU every 3 months, once at baseline and once at 3 months (intermittent D3 group) or cholecalciferol 1,000 IU/day (daily D3 group). MEASUREMENTS: Serum PTH, 25(OH)D, calcium, bone-specific alkaline phosphatase, ,-C-terminal telopeptide of type I collagen, phosphate, 24-hour urinary calcium excretion. RESULTS: The two groups had similar baseline characteristics. All participants had vitamin D deficiency [25(OH)D<20 ng/mL)], and 36 subjects (60%) had severe deficiency (<10 ng/mL), with no difference between the groups (severe deficiency: intermittent D3 group, n=18; daily D3 group, n=18). After 3 and 6 months, both groups had a significant increase in 25(OH)D and a reduction in PTH. Mean absolute increase±standard deviation of 25(OH)D at 6 months was higher in the intermittent D3 group (22.7±11.8 ng/mL) than in the daily D3 group (13.7±6.7 ng/mL, P<.001), with a higher proportion of participants in the intermittent D3 group reaching desirable serum concentration of 25(OH)D , 30 ng/mL (55% in the intermittent D3 group vs 20% in the daily D3 group, P<.001). Mean percentage decrease of PTH in the two groups was comparable, and at 6 months, a similar proportion of participants reached normal PTH values. 25(OH)D response to cholecalciferol showed a wide variability. In a logistic regression analysis, body mass index and type of treatment appeared to be significantly associated with normalization of 25(OH)D values. CONCLUSION: Cholecalciferol 300,000 IU every 3 months was more effective than 1,000 IU daily in correcting vitamin D deficiency, although the two groups achieved similar effects on PTH at 6 months. Only 55% of the higher-dose intermittent group reached desirable concentrations of 25(OH)D, suggesting that yet-higher doses will be required for adequate vitamin D repletion. [source]

    Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention Study

    Dominick L. Frosch PhD
    OBJECTIVES: To evaluate the effect of an activation intervention delivered in community senior centers to improve health outcomes for chronic diseases that disproportionately affect older adults. DESIGN: Two-group quasi-experimental study. SETTING: Two Los Angeles community senior centers. PARTICIPANTS: One hundred sixteen senior participants. INTERVENTION: Participants were invited to attend group screenings of video programs intended to inform about and motivate self-management of chronic conditions common in seniors. Moderated discussions reinforcing active patient participation in chronic disease management followed screenings. Screenings were scheduled over the course of 12 weeks. MEASUREMENTS: One center was assigned by coin toss to an encouragement condition in which participants received a $50 gift card if they attended at least three group screenings. Participants in the nonencouraged center received no incentive for attendance. Validated study measures for patient activation, physical activity, and health-related quality of life were completed at baseline and 12 weeks and 6 months after enrollment. RESULTS: Participants attending the encouraged senior center were more likely to attend three or more group screenings (77.8% vs 47.2%, P=.001). At 6-month follow-up, participants from either center who attended three or more group screenings (n=74, 64%) reported significantly greater activation (P<.001), more minutes walking (P<.001) and engaging in vigorous physical activity (P=.006), and better health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) mental component summary, P<.001; SF-12 physical component summary, P=.002). CONCLUSION: Delivering this pilot intervention in community senior centers is a potentially promising approach to activating seniors that warrants further investigation for improving chronic disease outcomes. [source]

    Changing Patterns in Medication Use with Increasing Probability of Death for Older Medicare Beneficiaries

    Thomas Shaffer MHS
    OBJECTIVES: To determine whether use of symptom relief drugs (e.g., antidepressants, anxiolytics, opioid analgesics, sleep aids) rises and use of two commonly prescribed classes of chronic medications (statins and osteoporosis drugs) falls with greater probability of death for older Medicare beneficiaries. DESIGN: Pooled cross-sectional study. SETTING: Noninstitutionalized older Medicare population in 2000 to 2005. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=20,233). MEASUREMENTS: Use of medications measured according to dichotomous flags; intensity of use by annual medication fills. Annual probability of death modeled using logistic regression and stratified into seven groups with predicted probabilities of death that range from less than 5% to greater than 50%. Prevalence of use and intensity (mean prescription fills per month) were computed for each class of medication. RESULTS: For symptom relief medications, there is relatively constant use with increasing probability of death, along with greater intensity of use. For the two chronic medications, there was a monotonic decrease in use but at a relatively constant intensity. Decline in statin use ranged from 34.4% in the lowest mortality stratum to 17.6% for those in the highest (P<.001). Use of osteoporosis drugs fell from 10.4% to 6.6% over the same range (P<.001). CONCLUSION: Greater intensity of use of symptom relief medications with increasing probability of death is consistent with hypothesized use. The different profile for chronic medications suggests that the time to benefit is being considered regarding therapy initiation, which results in lower use. [source]

    Association Between Dietary Quality of Rural Older Adults and Self-Reported Food Avoidance and Food Modification Due to Oral Health Problems

    Margaret R. Savoca PhD
    OBJECTIVES: To quantify the association between food avoidance and modification due to oral health problems, to examine the association between food practices and dietary quality, and to determine foods associated with these self-management behaviors. DESIGN: Cross-sectional. SETTING: Rural North Carolina. PARTICIPANTS: Six hundred thirty-five community-dwelling adults aged 60 and older. MEASUREMENTS: Demographic and food frequency data and oral health assessments were obtained during home visits. Avoidance (0, 1,2 foods, 3,14 foods) and modification (0,3 foods, 4,5 foods) due to oral health problems were assessed for foods representing oral health challenges. Food frequency data were converted into Healthy Eating Index-2005 (HEI-2005) scores. Linear regression models tested the significance of associations between HEI-2005 measures and food avoidance and modification. RESULTS: Thirty-five percent of participants avoided three to 14 foods, and 28% modified four to five foods. After adjusting for age, sex, ethnicity, poverty, education, and tooth loss, total HEI-2005 score was lower (P<.001) for persons avoiding more foods and higher for persons modifying more foods (P<.001). Those avoiding three to 14 foods consumed more saturated fat and energy from solid fat and added sugar and less nonhydrogenated fat than those avoiding fewer than three foods. Those who modified four to five foods consumed less saturated fat and solid fat and added sugar but more total grains than those modifying fewer than four foods. CONCLUSION: Food avoidance and modification due to oral health problems are associated with significant differences in dietary quality. Approaches to minimize food avoidance and promote food modification by persons having eating difficulties due to oral health conditions are needed. [source]

    Effect of a Disease-Specific Planning Intervention on Surrogate Understanding of Patient Goals for Future Medical Treatment

    Karin T. Kirchhoff PhD
    OBJECTIVES: To determine whether a disease-specific planning process can improve surrogate understanding of goals of patients with life-limiting illnesses for future medical treatments. DESIGN: A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007. SETTING: Six outpatient clinics of large community or university health systems in three Wisconsin cities. PARTICIPANTS: Competent, English-speaking adults aged 18 and older with chronic congestive heart failure or chronic renal disease and their surrogate decision-makers. INTERVENTION: Trained health professionals conducted a structured, patient-centered interview intended to promote informed decision-making and to result in the completion of a document clarifying the goals of the patient with regard to four disease-specific health outcome situations and the degree of decision-making latitude granted to the surrogate. MEASUREMENTS: Surrogate understanding of patient goals for care with regard to four expected, disease-specific outcomes situations and of the degree of surrogate latitude in decision-making. RESULTS: Three hundred thirteen patient,surrogate pairs completed the study. As measured according to kappa scores and in all four situations and in the degree of latitude, intervention group surrogates demonstrated a significantly higher degree of understanding of patient goals than control group surrogates. Intervention group kappa scores ranged from 0.61 to 0.78, whereas control group kappa scores ranged from 0.07 to 0.28. CONCLUSION: Surrogates in the intervention group had a significantly better understanding of patient goals and preferences than surrogates in the control group. This finding is the first step toward ensuring that patient goals for care are known and honored. [source]

    Randomized Trial of a Delirium Abatement Program for Postacute Skilled Nursing Facilities

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    OBJECTIVES: To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC). DESIGN: Cluster randomized controlled trial. SETTING: Eight skilled nursing facilities specializing in PAC within a single metropolitan region. PARTICIPANTS: Four hundred fifty-seven participants with delirium at PAC admission. INTERVENTION: The DAP consisted of four steps: assessment for delirium within 5 days of PAC admission, assessment and correction of common reversible causes of delirium, prevention of complications of delirium, and restoration of function. MEASUREMENTS: Trained researchers screened eligible patients. Those with delirium defined according to the Confusion Assessment Method were eligible for participation using proxy consent. Regardless of location, researchers blind to intervention status re-assessed participants for delirium 2 weeks and 1 month after enrollment. RESULTS: Nurses at DAP sites detected delirium in 41% of participants, versus 12% in usual care sites (P<.001), and completed DAP documentation in most participants in whom delirium was detected, but the DAP intervention had no effect on delirium persistence based on two measurements at 2 weeks (DAP 68% vs usual care 66%) and 1 month (DAP 60% vs usual care 51%) (adjusted P,.20). Adjusting for baseline differences between DAP and usual care participants and restricting analysis to DAP participants in whom delirium was detected did not alter the results. CONCLUSION: Detection of delirium improved at the DAP sites, but the DAP had no effect on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities. [source]

    Are All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia?

    Rebecca C. Rossom MD
    OBJECTIVES: To estimate mortality risk associated with individual commonly prescribed antipsychotics. DESIGN: Five-year retrospective study. SETTING: Veterans national healthcare data. PARTICIPANTS: Predominantly male, aged 65 and older, with a diagnosis of dementia and no other indication for an antipsychotic. Subjects who received an antipsychotic were compared with randomly selected controls who did not. Exposed and control cohorts were matched according to their date of dementia diagnosis and time elapsed from diagnosis to the start of antipsychotic therapy. MEASUREMENTS: Mortality during incident antipsychotic use. RESULTS: Cohorts who were exposed to haloperidol (n=2,217), olanzapine (n=3,384), quetiapine (n=4,277), or risperidone (n=8,249) had more comorbidities than their control cohorts. During the first 30 days, there was a significant increase in mortality in subgroups prescribed a daily dose of haloperidol greater than 1 mg (hazard ratio (HR)=3.2, 95% confidence interval (CI)=2.2,4.5, P<.001), olanzapine greater than 2.5 mg (HR=1.5, 95% CI=1.1,2.0, P=.01), or risperidone greater than 1 mg (HR=1.6, 95% CI=1.1,2.2, P=.01) adjusted for demographic characteristics, comorbidities, and medication history using Cox regression analyses. Greater mortality was not seen when a daily dose of quetiapine greater than 50 mg (HR=1.2, 95% CI=0.7,1.8, P=.50) was prescribed, and there was no greater mortality associated with a dose less than 50 mg (HR=0.7, 95% CI=0.5,1.0, P=.03). No antipsychotic was associated with greater mortality after the first 30 days. CONCLUSION: Commonly prescribed doses of haloperidol, olanzapine, and risperidone, but not quetiapine, were associated with a short-term increase in mortality. Further investigations are warranted to identify patient characteristics and antipsychotic dosage regimens that are not associated with a greater risk of mortality in elderly patients with dementia. [source]

    Hearing Impairment Affects Older People's Ability to Drive in the Presence of Distracters

    Louise Hickson PhD
    OBJECTIVES: To investigate the effects of hearing impairment and distractibility on older people's driving ability, assessed under real-world conditions. DESIGN: Experimental cross-sectional study. SETTING: University laboratory setting and an on-road driving test. PARTICIPANTS: One hundred seven community-living adults aged 62 to 88. Fifty-five percent had normal hearing, 26% had a mild hearing impairment, and 19% had a moderate or greater impairment. MEASUREMENTS: Hearing was assessed using objective impairment measures (pure-tone audiometry, speech perception testing) and a self-report measure (Hearing Handicap Inventory for the Elderly). Driving was assessed on a closed road circuit under three conditions: no distracters, auditory distracters, and visual distracters. RESULTS: There was a significant interaction between hearing impairment and distracters, such that people with moderate to severe hearing impairment had significantly poorer driving performance in the presence of distracters than those with normal or mild hearing impairment. CONCLUSION: Older adults with poor hearing have greater difficulty with driving in the presence of distracters than older adults with good hearing. [source]

    Old Age and Outcome After Primary Angioplasty for Acute Myocardial Infarction

    Menko-Jan De Boer MD
    OBJECTIVES: To assess the influence of age as an independent factor determining the prognosis and outcome of patients with acute myocardial infarction (AMI) treated using primary percutaneous coronary intervention (PCI). DESIGN: A retrospective analysis from a dedicated database. SETTING: A high-volume interventional cardiology center in the Netherlands. PARTICIPANTS: Four thousand nine hundred thirty-three consecutive patients with AMI. MEASUREMENTS: Baseline characteristics and clinical outcomes after 30 days and 1 year were compared according to age categorized in three groups: younger than 65, 65 to 74, and 75 and older. A more-detailed analysis was performed with six age groups, from younger than 40 to 80 and older. RESULTS: Of the 4,933 consecutive patients with AMI treated with PCI between 1992 and 2004, 643 were aged 75 and older. Multivariate analysis revealed that patients aged 65 to 75 had a greater risk of 1-year mortality than those younger than 65 (adjusted odds ratio (AOR)=1.57, 95% confidence interval (CI)=1.15,2.16) and that those aged 75 and older had a greater risk of 1-year mortality than those younger than 65 (AOR=3.03, 95% CI=2.14,4.29). CONCLUSION: In this retrospective analysis, older age was independently associated with greater mortality after PCI for AMI. Patients aged 65 and older had a higher risk of mortality than younger patients, and those aged 75 and older had the highest risk of mortality. [source]