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Cohen AB, Trentalange M, Benjamin AZ, Fried TR. Characteristics of Patients With Professional Guardians in the Department of Veterans Affairs Health Care System. JAMA Intern Med 2019; 179:107-108. [PMID: 30398533 PMCID: PMC6500761 DOI: 10.1001/jamainternmed.2018.4849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew B Cohen
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | - Mark Trentalange
- Department of Anesthesiology, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Andrea Z Benjamin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terri R Fried
- Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven
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Barcelos NM, Van Ness PH, Wagner AF, MacAvoy MG, Mecca AP, Anderson GM, Trentalange M, Hawkins KA, Sano M, Arnsten AFT, van Dyck CH. Guanfacine treatment for prefrontal cognitive dysfunction in older participants: a randomized clinical trial. Neurobiol Aging 2018; 70:117-124. [PMID: 30007160 DOI: 10.1016/j.neurobiolaging.2018.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/30/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
Abstract
This study evaluated the effect of the alpha-2A-adrenoceptor agonist guanfacine on prefrontally mediated cognitive functions, as well as quality of life and global function in healthy older participants. One hundred twenty-three participants aged 75 years and older were randomly assigned to guanfacine 0.5 mg, 0.1 mg, or placebo daily for 12 weeks. The primary outcome measure was the change in z-score for 6 prefrontal executive function tasks over 12 weeks (PEF6). Neither dose of guanfacine improved PEF6 z-score relative to placebo. The rate of mean change (95% confidence interval) in PEF6 z-score over 12 weeks was 0.270 (0.159, 0.380) for placebo, compared with 0.121 (0.011, 0.232) for guanfacine 0.1 mg (p = 0.06, compared to placebo) and 0.213 (0.101, 0.324) for 0.5 mg (p = 0.47). Neither dose of guanfacine improved the quality of life or global function relative to placebo. Among common adverse events, only dry mouth was significantly more frequent on guanfacine compared to placebo. Guanfacine failed to ameliorate prefrontal cognitive function in older individuals, who were cognitively normal for age.
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Affiliation(s)
- Nicole M Barcelos
- Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Peter H Van Ness
- Department of Medicine (Geriatrics), Yale University School of Medicine, New Haven, CT, USA
| | - Allison F Wagner
- Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Martha G MacAvoy
- Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Adam P Mecca
- Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - George M Anderson
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Mark Trentalange
- Department of Medicine (Geriatrics), Yale University School of Medicine, New Haven, CT, USA
| | - Keith A Hawkins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mary Sano
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Amy F T Arnsten
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher H van Dyck
- Alzheimer's Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
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Datta R, Trentalange M, Van Ness PH, McGloin JM, Guralnik JM, Miller ME, Walkup MP, Nadkarni N, Pahor M, Gill TM, Quagliarello V, Juthani-Mehta M. Serious adverse events of older adults in nursing home and community intervention trials. Contemp Clin Trials Commun 2017; 9:77-80. [PMID: 29696228 PMCID: PMC5898490 DOI: 10.1016/j.conctc.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background/Aims Clinical trials of older adults are increasingly common, but risks of serious adverse events (SAE) may vary. We describe the incidence of SAE in two randomized trials, one community-based and one nursing home-based. Methods We performed a secondary data analysis from two randomized clinical trials at one academic health center and 21 nursing homes involving 200 sedentary community dwellers aged 70–89 years and 185 female nursing home residents aged 65 years or older. Interventions included structured physical activity to reduce mobility disability in the Lifestyle Interventions and Independence for Elders (LIFE) study and oral cranberry capsules to reduce bacteriuria plus pyuria in nursing home residents (CRANNY) trial. We measured SAE incidence per 100 person-years and incidence of protocol-related unanticipated SAE per 100 person-years in LIFE and CRANNY trials. Results Mean age and proportion of patients with dementia in LIFE and CRANNY trials were 79.3 years and 86.4 years and 0% and 78%, respectively. There were 179 total SAE in LIFE including 8 (4%) deaths, and 116 total SAE in CRANNY including 33 (28%) deaths. SAE incidence was 33.7 (95% CI 27.2, 41.8) events per 100 person-years in LIFE and 69.4 (95% CI 49.1, 98.1) events per 100 person-years in CRANNY. No protocol-related unanticipated SAE occurred in either trial. Conclusions The frequency and severity of SAE vary in older adults. While SAE are common in nursing home residents, protocol-related, unanticipated SAE are rare in nursing home residents and community dwellers. This finding can inform trial monitoring protocols. Trial registration ClinicalTrials.gov identifiers: NCT01072500 and NCT01691430.
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Affiliation(s)
- Rupak Datta
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Mark Trentalange
- Yale School of Medicine, Department of Internal Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Peter H Van Ness
- Yale School of Medicine, Department of Internal Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Joanne M McGloin
- Yale School of Medicine, Department of Internal Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Jack M Guralnik
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD, USA
| | - Michael E Miller
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC, USA
| | - Michael P Walkup
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Winston-Salem, NC, USA
| | - Neelesh Nadkarni
- University of Pittsburgh, Department of Medicine, Division of Geriatric Medicine, Pittsburgh, PA, USA
| | - Marco Pahor
- University of Florida, Department of Aging and Geriatric Research, Institute on Aging, Gainesville, FL, USA
| | - Thomas M Gill
- Yale School of Medicine, Department of Internal Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Vincent Quagliarello
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Manisha Juthani-Mehta
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
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Juthani-Mehta M, Ness PV, Bianco L, Rink A, Rubeck S, Ginter S, Argraves S, Charpentier P, Acampora D, Trentalange M, Quagliarello V, Peduzzi P. Cranberry Capsules for Reduction of Bacteriuria Plus Pyuria in Nursing Home Women: A Randomized Clinical Trial. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manisha Juthani-Mehta
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
| | - Peter Van Ness
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Luann Bianco
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Andrea Rink
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Sabina Rubeck
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Sandra Ginter
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Stephanie Argraves
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Peter Charpentier
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Denise Acampora
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Mark Trentalange
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Vincent Quagliarello
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
| | - Peter Peduzzi
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, CT
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Juthani-Mehta M, Van Ness PH, Bianco L, Rink A, Rubeck S, Ginter S, Argraves S, Charpentier P, Acampora D, Trentalange M, Quagliarello V, Peduzzi P. Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial. JAMA 2016; 316:1879-1887. [PMID: 27787564 PMCID: PMC5300771 DOI: 10.1001/jama.2016.16141] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bacteriuria plus pyuria is highly prevalent among older women living in nursing homes. Cranberry capsules are an understudied, nonantimicrobial prevention strategy used in this population. OBJECTIVE To test the effect of 2 oral cranberry capsules once a day on presence of bacteriuria plus pyuria among women residing in nursing homes. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized, placebo-controlled efficacy trial with stratification by nursing home and involving 185 English-speaking women aged 65 years or older, with or without bacteriuria plus pyuria at baseline, residing in 21 nursing homes located within 50 miles (80 km) of New Haven, Connecticut (August 24, 2012-October 26, 2015). INTERVENTIONS Two oral cranberry capsules, each capsule containing 36 mg of the active ingredient proanthocyanidin (ie, 72 mg total, equivalent to 20 ounces of cranberry juice) vs placebo administered once a day in 92 treatment and 93 control group participants. MAIN OUTCOMES AND MEASURES Presence of bacteriuria (ie, at least 105 colony-forming units [CFUs] per milliliter of 1 or 2 microorganisms in urine culture) plus pyuria (ie, any number of white blood cells on urinalysis) assessed every 2 months over the 1-year study surveillance; any positive finding was considered to meet the primary outcome. Secondary outcomes were symptomatic urinary tract infection (UTI), all-cause death, all-cause hospitalization, all multidrug antibiotic-resistant organisms, antibiotics administered for suspected UTI, and total antimicrobial administration. RESULTS Of the 185 randomized study participants (mean age, 86.4 years [SD, 8.2], 90.3% white, 31.4% with bacteriuria plus pyuria at baseline), 147 completed the study. Overall adherence was 80.1%. Unadjusted results showed the presence of bacteriuria plus pyuria in 25.5% (95% CI, 18.6%-33.9%) of the treatment group and in 29.5% (95% CI, 22.2%-37.9%) of the control group. The adjusted generalized estimating equations model that accounted for missing data and covariates showed no significant difference in the presence of bacteriuria plus pyuria between the treatment group vs the control group (29.1% vs 29.0%; OR, 1.01; 95% CI, 0.61-1.66; P = .98). There were no significant differences in number of symptomatic UTIs (10 episodes in the treatment group vs 12 in the control group), rates of death (17 vs 16 deaths; 20.4 vs 19.1 deaths/100 person-years; rate ratio [RR], 1.07; 95% CI, 0.54-2.12), hospitalization (33 vs 50 admissions; 39.7 vs 59.6 hospitalizations/100 person-years; RR, 0.67; 95% CI, 0.32-1.40), bacteriuria associated with multidrug-resistant gram-negative bacilli (9 vs 24 episodes; 10.8 vs 28.6 episodes/100 person-years; RR, 0.38; 95% CI, 0.10-1.46), antibiotics administered for suspected UTIs (692 vs 909 antibiotic days; 8.3 vs 10.8 antibiotic days/person-year; RR, 0.77; 95% CI, 0.44-1.33), or total antimicrobial utilization (1415 vs 1883 antimicrobial days; 17.0 vs 22.4 antimicrobial days/person-year; RR, 0.76; 95% CI, 0.46-1.25). CONCLUSIONS AND RELEVANCE Among older women residing in nursing homes, administration of cranberry capsules vs placebo resulted in no significant difference in presence of bacteriuria plus pyuria over 1 year. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01691430.
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Affiliation(s)
- Manisha Juthani-Mehta
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Peter H. Van Ness
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Luann Bianco
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrea Rink
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sabina Rubeck
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sandra Ginter
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephanie Argraves
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Peter Charpentier
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Denise Acampora
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mark Trentalange
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vincent Quagliarello
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Peter Peduzzi
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, CT
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Abstract
The TAM receptors (Tyro3, Axl, and Mer) are a family of homologous receptor-tyrosine kinases that inhibit Toll-like receptor signaling to regulate downstream pathways and restore homeostasis. TAM triple mutant mice (Tyro3−/−, Axl−/−, Mer−/−) have elevated levels of pro-inflammatory cytokines and are prone to developing lymphoproliferative disorders and autoimmunity. Understanding differential expression of TAM receptors among human subjects is critical to harnessing this pathway for therapeutic interventions. We have quantified changes in TAM expression during the ontogeny of human macrophages using paired samples of monocytes and macrophages to take advantage of characteristic expression within an individual. No significant differences in levels of Tyro3 were found between monocytes and macrophages (flow cytometry: p=0.652, immunoblot: p=0.231, qPCR: p=0.389). Protein levels of Axl were reduced (flow cytometry: p=0.049, immunoblot: p<0.001) when monocytes matured to macrophages. No significant differences in the levels of Axl mRNA transcripts were found (qPCR: p=0.082), however, Tyro3 and Axl were proportionate. The most striking difference was upregulation of expression of Mer with both protein and mRNA being significantly increased when monocytes developed into macrophages (flow cytometry: p<0.001, immunoblot: p<0.001, qPCR: p=0.004). A fuller characterization of TAM receptor expression in macrophage ontogeny informs our understanding of their function and potential therapeutic interventions.
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Affiliation(s)
- Anna Malawista
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Xiaomei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Mark Trentalange
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Heather G Allore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06519, USA; Program on Human Translational Immunology, Yale University School of Medicine, New Haven, CT, 06519, USA
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7
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Pillai PS, Molony RD, Martinod K, Dong H, Pang IK, Tal MC, Solis AG, Bielecki P, Mohanty S, Trentalange M, Homer RJ, Flavell RA, Wagner DD, Montgomery RR, Shaw AC, Staeheli P, Iwasaki A. Mx1 reveals innate pathways to antiviral resistance and lethal influenza disease. Science 2016; 352:463-6. [PMID: 27102485 PMCID: PMC5465864 DOI: 10.1126/science.aaf3926] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/15/2016] [Indexed: 12/11/2022]
Abstract
Influenza A virus (IAV) causes up to half a million deaths worldwide annually, 90% of which occur in older adults. We show that IAV-infected monocytes from older humans have impaired antiviral interferon production but retain intact inflammasome responses. To understand the in vivo consequence, we used mice expressing a functional Mx gene encoding a major interferon-induced effector against IAV in humans. In Mx1-intact mice with weakened resistance due to deficiencies in Mavs and Tlr7, we found an elevated respiratory bacterial burden. Notably, mortality in the absence of Mavs and Tlr7 was independent of viral load or MyD88-dependent signaling but dependent on bacterial burden, caspase-1/11, and neutrophil-dependent tissue damage. Therefore, in the context of weakened antiviral resistance, vulnerability to IAV disease is a function of caspase-dependent pathology.
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Affiliation(s)
- Padmini S Pillai
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Ryan D Molony
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Kimberly Martinod
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Huiping Dong
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Iris K Pang
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Michal C Tal
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Angel G Solis
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Piotr Bielecki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Subhasis Mohanty
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Trentalange
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert J Homer
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Richard A Flavell
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA. Howard Hughes Medical Institute, Yale School of Medicine, New Haven, CT 06520, USA
| | - Denisa D Wagner
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruth R Montgomery
- Section of Rheumatology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Albert C Shaw
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Peter Staeheli
- Institut für Medizinische Mikrobiologie und Hygiene, Institute of Virology, University Medical Center Freiburg, Hermann-Herder-Strasse 11, 79104 Freiburg, Germany
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA. Howard Hughes Medical Institute, Yale School of Medicine, New Haven, CT 06520, USA.
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Trentalange M, Bielawski M, Murphy TE, Lessard K, Brandt C, Bean-Mayberry B, Maisel NC, Wright SM, Allore H, Skanderson M, Reyes-Harvey E, Gaetano V, Haskell S, Bastian LA. Patient Perception of Enough Time Spent With Provider Is a Mechanism for Improving Women Veterans' Experiences With VA Outpatient Health Care. Eval Health Prof 2016; 39:460-474. [PMID: 26908572 DOI: 10.1177/0163278716629523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We postulated that associations between two specific provider characteristics, class (nurse practitioner relative to physician) and primary care providers who are proficient and interested in women's health (designated women's provider relative to nondesignated) and overall satisfaction with provider, were mediated through women veterans' perception of enough time spent with the provider. A national patient experience survey was administered to 7,620 women veterans. Multivariable models of overall patient satisfaction with provider were compared with and without the proposed mediator. A structural equation model (SEM) of the mediation of the two provider characteristics was also evaluated. Without the mediator, associations of provider class and designation with overall patient satisfaction were significant. With the proposed mediator, these associations became nonsignificant. An SEM showed that the majority (>80%) of the positive associations between provider class and designation and the outcome were exerted through patient perception of enough time spent with provider. Higher ratings of overall satisfaction with provider exhibited by nurse practitioners and designated women's health providers were exerted through patient perception of enough time spent with provider. Future research should examine what elements of provider training can be developed to improve provider-patient communication and patient satisfaction with their health care.
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Affiliation(s)
- Mark Trentalange
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Terrence E Murphy
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Bevanne Bean-Mayberry
- Veterans Health Administration Health Services Research & Development, Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Natalya C Maisel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Steven M Wright
- Office of Performance Measurement, VHA Office of Analytics & Business Intelligence, Department of Veterans Affairs, Providence, RI, USA
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Evelyn Reyes-Harvey
- Office of Performance Measurement, VHA Office of Analytics & Business Intelligence, Durham, NC, USA
| | - Vera Gaetano
- VA Connecticut HSR&D Pain, Research, Informatics, Multimorbidities, and Education (Prime) Center, West Haven, CT, USA
| | - Sally Haskell
- Women's Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, CT, USA
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Allore HG, Zhan Y, Cohen AB, Tinetti ME, Trentalange M, McAvay G. Methodology to Estimate the Longitudinal Average Attributable Fraction of Guideline-recommended Medications for Death in Older Adults With Multiple Chronic Conditions. J Gerontol A Biol Sci Med Sci 2016; 71:1113-6. [PMID: 26748093 DOI: 10.1093/gerona/glv223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Persons with multiple chronic conditions receive multiple guideline-recommended medications to improve outcomes such as mortality. Our objective was to estimate the longitudinal average attributable fraction for 3-year survival of medications for cardiovascular conditions in persons with multiple chronic conditions and to determine whether heterogeneity occurred by age. METHODS Medicare Current Beneficiary Survey participants (N = 8,578) with two or more chronic conditions, enrolled from 2005 to 2009 with follow-up through 2011, were analyzed. We calculated the longitudinal extension of the average attributable fraction for oral medications (beta blockers, renin-angiotensin system blockers, and thiazide diuretics) indicated for cardiovascular conditions (atrial fibrillation, coronary artery disease, heart failure, and hypertension), on survival adjusted for 18 participant characteristics. Models stratified by age (≤80 and >80 years) were analyzed to determine heterogeneity of both cardiovascular conditions and medications. RESULTS Heart failure had the greatest average attributable fraction (39%) for mortality. The fractional contributions of beta blockers, renin-angiotensin system blockers, and thiazides to improve survival were 10.4%, 9.3%, and 7.2% respectively. In age-stratified models, of these medications thiazides had a significant contribution to survival only for those aged 80 years or younger. The effects of the remaining medications were similar in both age strata. CONCLUSIONS Most cardiovascular medications were attributed independently to survival. The two cardiovascular conditions contributing independently to death were heart failure and atrial fibrillation. The medication effects were similar by age except for thiazides that had a significant contribution to survival in persons younger than 80 years.
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Affiliation(s)
- Heather G Allore
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut. Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
| | - Yilei Zhan
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut. Department of Statistics and Biostatistics, Rutgers University, New Brunswick, New Jersey
| | - Andrew B Cohen
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mark Trentalange
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gail McAvay
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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10
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Connolly MA, Trentalange M, Zeiss CJ. Long-Term Clinical Outcomes in Diabetic Rhesus Macaques (Macaca mulatta) Treated with Medroxyprogesterone Acetate for Endometriosis. Comp Med 2016; 66:343-8. [PMID: 27538865 PMCID: PMC4983176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 06/06/2023]
Abstract
Depot medroxyprogesterone acetate (DMPA) is a common medical treatment for endometriosis in NHP. Because DMPA reportedly impairs glucoregulatory function in humans and rhesus macaques, as well as predisposes humans to diabetes mellitus (DM), we performed a retrospective study to further investigate its potential long-term clinical effects in animals with and without DM. Using a cohort of 29 rhesus macaques, we explored the hypotheses that DMPA treatment accelerates the onset of DM and that its use in rhesus macaques with endometriosis worsens clinical outcome measures (lifespan, body weight and body condition score). For both body weight and body condition score, a declining and statistically significant trend in mean values was evident as macaques developed either DM, or endometriosis or both. The addition of DMPA did not significantly alter this pattern. The presence of DM, endometriosis, or DMPA treatment statistically but not clinically significantly increased risk of death. Similarly, the presence of the 2 highly correlated variables endometriosis and DMPA treatment statistically but not clinically significantly increased the risk of incident DM. These results indicate that DMPA treatment was associated with worsening trends in lifespan and incident DM, however these trends did not achieve clinical significance in this cohort.
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Affiliation(s)
| | - Mark Trentalange
- Yale Program on Aging, Biostatistics Core, Yale University, New Haven, Connecticut, USA
| | - Caroline J Zeiss
- Section of Comparative Medicine, Yale University, New Haven, Connecticut, USA
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Tinetti ME, McAvay G, Trentalange M, Cohen AB, Allore HG. Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study. BMJ 2015; 351:h4984. [PMID: 26432468 PMCID: PMC4591503 DOI: 10.1136/bmj.h4984] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate the association between guideline recommended drugs and death in older adults with multiple chronic conditions. DESIGN Population based cohort study. SETTING Medicare Current Beneficiary Survey cohort, a nationally representative sample of Americans aged 65 years or more. PARTICIPANTS 8578 older adults with two or more study chronic conditions (atrial fibrillation, coronary artery disease, chronic kidney disease, depression, diabetes, heart failure, hyperlipidemia, hypertension, and thromboembolic disease), followed through 2011. EXPOSURES Drugs included β blockers, calcium channel blockers, clopidogrel, metformin, renin-angiotensin system (RAS) blockers; selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs); statins; thiazides; and warfarin. MAIN OUTCOME MEASURE Adjusted hazard ratios for death among participants with a condition and taking a guideline recommended drug relative to participants with the condition not taking the drug and among participants with the most common combinations of four conditions. RESULTS Over 50% of participants with each condition received the recommended drugs regardless of coexisting conditions; 1287/8578 (15%) participants died during the three years of follow-up. Among cardiovascular drugs, β blockers, calcium channel blockers, RAS blockers, and statins were associated with reduced mortality for indicated conditions. For example, the adjusted hazard ratio for β blockers was 0.59 (95% confidence interval 0.48 to 0.72) for people with atrial fibrillation and 0.68 (0.57 to 0.81) for those with heart failure. The adjusted hazard ratios for cardiovascular drugs were similar to those with common combinations of four coexisting conditions, with trends toward variable effects for β blockers. None of clopidogrel, metformin, or SSRIs/SNRIs was associated with reduced mortality. Warfarin was associated with a reduced risk of death among those with atrial fibrillation (adjusted hazard ratio 0.69, 95% confidence interval 0.56 to 0.85) and thromboembolic disease (0.44, 0.30 to 0.62). Attenuation in the association with reduced risk of death was found with warfarin in participants with some combinations of coexisting conditions. CONCLUSIONS Average effects on survival, particularly for cardiovascular study drugs, were comparable to those reported in randomized controlled trials but varied for some drugs according to coexisting conditions. Determining treatment effects in combinations of conditions may guide prescribing in people with multiple chronic conditions.
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Affiliation(s)
- Mary E Tinetti
- Department of Internal Medicine (Geriatrics), Yale School of Medicine, New Haven, CT 06520, USA
| | - Gail McAvay
- Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Mark Trentalange
- Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Andrew B Cohen
- Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Heather G Allore
- Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
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12
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Cohen AB, Trentalange M, Fried T. Surrogate Decision Making for Patients Without Nuclear Family. JAMA 2015. [PMID: 26219065 DOI: 10.1001/jama.2015.7253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew B Cohen
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mark Trentalange
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terri Fried
- VA Connecticut Health System, West Haven, Connecticut
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13
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Thakar J, Mohanty S, West AP, Joshi SR, Ueda I, Wilson J, Meng H, Blevins TP, Tsang S, Trentalange M, Siconolfi B, Park K, Gill TM, Belshe RB, Kaech SM, Shadel GS, Kleinstein SH, Shaw AC. Aging-dependent alterations in gene expression and a mitochondrial signature of responsiveness to human influenza vaccination. Aging (Albany NY) 2015; 7:38-52. [PMID: 25596819 PMCID: PMC4356402 DOI: 10.18632/aging.100720] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To elucidate gene expression pathways underlying age-associated impairment in influenza vaccine response, we screened young (age 21-30) and older (age ≥65) adults receiving influenza vaccine in two consecutive seasons and identified those with strong or absent response to vaccine, including a subset of older adults meeting criteria for frailty. PBMCs obtained prior to vaccination (Day 0) and at day 2 or 4, day 7 and day 28 post-vaccine were subjected to gene expression microarray analysis. We defined a response signature and also detected induction of a type I interferon response at day 2 and a plasma cell signature at day 7 post-vaccine in young responders. The response signature was dysregulated in older adults, with the plasma cell signature induced at day 2, and was never induced in frail subjects (who were all non-responders). We also identified a mitochondrial signature in young vaccine responders containing genes mediating mitochondrial biogenesis and oxidative phosphorylation that was consistent in two different vaccine seasons and verified by analyses of mitochondrial content and protein expression. These results represent the first genome-wide transcriptional profiling analysis of age-associated dynamics following influenza vaccination, and implicate changes in mitochondrial biogenesis and function as a critical factor in human vaccine responsiveness.
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Affiliation(s)
- Juilee Thakar
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA.,Department of Microbiology and Immunology, University of Rochester, Rochester, NY 14642, USA.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester NY 14642, USA
| | - Subhasis Mohanty
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - A Phillip West
- Department of Pathology and Genetics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Samit R Joshi
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Ikuyo Ueda
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jean Wilson
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Hailong Meng
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Tamara P Blevins
- Center for Vaccine Development, Saint Louis University, St. Louis, MO 63104, USA
| | - Sui Tsang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Mark Trentalange
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Barbara Siconolfi
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Koonam Park
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Robert B Belshe
- Center for Vaccine Development, Saint Louis University, St. Louis, MO 63104, USA
| | - Susan M Kaech
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Gerald S Shadel
- Department of Pathology and Genetics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Steven H Kleinstein
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA.,Interdepartmental Program in Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, CT 06520, USA.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Albert C Shaw
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicince, New Haven, CT 06520, USA
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14
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Barakat LA, Juthani-Mehta M, Allore H, Trentalange M, Tate J, Rimland D, Pisani M, Akgün KM, Goetz MB, Butt AA, Rodriguez-Barradas M, Duggal M, Crothers K, Justice AC, Quagliarello VJ. Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia. HIV Med 2015; 16:421-30. [PMID: 25959543 DOI: 10.1111/hiv.12244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear. METHODS Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models. RESULTS Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714). CONCLUSION Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.
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Affiliation(s)
- L A Barakat
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Juthani-Mehta
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - H Allore
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Trentalange
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Tate
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - D Rimland
- Infectious Disease, VA Medical Center, Decatur, GA, USA
| | - M Pisani
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - K M Akgün
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - M B Goetz
- Infectious Disease, VA Greater Los Angles Healthcare System, Los Angelos, CA, USA
| | - A A Butt
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Rodriguez-Barradas
- Infectious Diseases (MS 111G), Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - M Duggal
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - K Crothers
- Pulmonary Disease and Critical Care, University of Washington, Seattle, WA, USA
| | - A C Justice
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - V J Quagliarello
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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15
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Allore HG, Zhan Y, Tinetti M, Trentalange M, McAvay G. Longitudinal average attributable fraction as a method for studying time-varying conditions and treatments on recurrent self-rated health: the case of medications in older adults with multiple chronic conditions. Ann Epidemiol 2015; 25:681-686.e4. [PMID: 26033374 DOI: 10.1016/j.annepidem.2015.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 02/06/2015] [Accepted: 03/04/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective is to modify the longitudinal extension of the average attributable fraction (LE-AAF) for recurrent outcomes with time-varying exposures and control for covariates. METHODS We included Medicare Current Beneficiary Survey participants with two or more chronic conditions enrolled from 2005 to 2009 with follow-up through 2011. Nine time-varying medications indicated for nine time-varying common chronic conditions and 14 of 18 forward-selected participant characteristics were used as control variables in the generalized estimating equations step of the LE-AAF to estimate associations with the recurrent universal health outcome self-rated health (SRH). Modifications of the LE-AAF were made to accommodate these indicated medication-condition interactions and covariates. Variability was empirically estimated by bias-corrected and accelerated bootstrapping. RESULTS In the adjusted LE-AAF, thiazide, warfarin, and clopidogrel had significant contributions of 1.2%, 0.4%, 0.2%, respectively, to low (poor or fair) SRH; whereas there were no significant contributions of the other medications to SRH. Hyperlipidemia significantly contributed 4.6% to high SRH. All the other conditions except atrial fibrillation contributed significantly to low SRH. CONCLUSIONS Our modifications to the LE-AAF method apply to a recurrent binary outcome with time-varying factors accounting for covariates.
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Affiliation(s)
- Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT; Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT.
| | - Yilei Zhan
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT
| | - Mary Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT; Department of Chronic Disease, Yale School of Public Health, Yale University, New Haven, CT
| | - Mark Trentalange
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Gail McAvay
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
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16
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Affiliation(s)
- Andrew B. Cohen
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | | | - Terri Fried
- VA Connecticut Health System, West Haven, CT
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17
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Hartaigh BÓ, Allore HG, Trentalange M, McAvay G, Pilz S, Dodson JA, Gill TM. Elevations in time-varying resting heart rate predict subsequent all-cause mortality in older adults. Eur J Prev Cardiol 2015; 22:527-34. [PMID: 24445263 PMCID: PMC4156557 DOI: 10.1177/2047487313519932] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND An increased resting heart rate (RHR) has long been associated with unhealthy life. Nevertheless, it remains uncertain whether time-varying measurements of RHR are predictive of mortality in older persons. DESIGN The purpose of this study was to assess the relationship between repeated measurements of RHR and risk of death from all causes among older adults. METHODS We evaluated repeat measurements of resting heart rate among 5691 men and women (aged 65 years or older) enrolled in the Cardiovascular Health Study. RHR was measured annually for six consecutive years by validated electrocardiogram. All-cause mortality was confirmed by a study-wide Mortality Review Committee using reviews of obituaries, death certificates and hospital records, interviews with attending physicians, and next-of-kin. RESULTS Of the study cohort, 974 (17.1%) participants died. Each 10 beat/min increment in RHR increased the risk of death by 33% (adjusted hazard ratio, 95% confidence interval (CI) = 1.33, 1.26-1.40). Similar results were observed (adjusted hazard ratio, 95% CI = 2.21, 1.88-2.59) when comparing the upper-most quartile of RHR (mean = 81 beats/min) with the lowest (mean = 53 beats/min). Compared with participants whose RHR was consistently ≤65 beats/min during the study period, the risk of death increased monotonically for each 10 beat/min (consistent) increment in RHR, with adjusted hazard ratios (95% CI) ranging from 1.30 (1.23-1.37) for 75 beats/min to 4.78 (3.49-6.52) for 125 beats/min. CONCLUSIONS Elevations in the RHR over the course of six years are associated with an increased risk of all-cause mortality among older adults.
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Affiliation(s)
- Bríain ó Hartaigh
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, USA
| | - Heather G Allore
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, USA
| | - Mark Trentalange
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, USA
| | - Gail McAvay
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, USA
| | - Stefan Pilz
- Department of Internal Medicine, Medical University of Graz, Austria
| | - John A Dodson
- Department of Internal Medicine, Brigham and Women's Hospital, USA
| | - Thomas M Gill
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, USA
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18
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Fodeh SJ, Trentalange M, Allore HG, Gill TM, Brandt CA, Murphy TE. Baseline cluster membership demonstrates positive associations with first occurrence of multiple gerontologic outcomes over 10 years. Exp Aging Res 2015; 41:177-92. [PMID: 25724015 DOI: 10.1080/0361073x.2015.1001655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: The potential of cluster analysis (CA) as a baseline predictor of multivariate gerontologic outcomes over a long period of time has not been previously demonstrated. METHODS Restricting candidate variables to a small group of established predictors of deleterious gerontologic outcomes, various CA methods were applied to baseline values from 754 nondisabled, community-living persons, aged 70 years or older. The best cluster solution yielded at baseline was subsequently used as a fixed explanatory variable in time-to-event models of the first occurrence of the following outcomes: any disability in four activities of daily living, any disability in four mobility measures, and death. Each outcome was recorded through a maximum of 129 months or death. Associations between baseline ordinal cluster level and first occurrence of all three outcomes were modeled over a 10-year period with proportional hazards regression and compared with the associations yielded by the analogous latent class analysis (LCA) solution. RESULTS The final cluster-defining variables were continuous measures of cognitive status and depressive symptoms, and dichotomous indicators of slow gait and exhaustion. The best solution yielded by baseline values of these variables was obtained with a K-means algorithm and cosine similarity and consisted of three clusters representing increasing levels of impairment. After adjustment for age, sex, ethnic group, and number of chronic conditions, baseline ordinal cluster level demonstrated significantly positive associations with all three outcomes over a 10-year period that were equivalent to those from the corresponding LCA solution. CONCLUSION These findings suggest that baseline clusters based on previously established explanatory variables have potential to predict multivariate gerontologic outcomes over a long period of time.
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Affiliation(s)
- Samah J Fodeh
- a VA Connecticut Healthcare System , West Haven , Connecticut , USA
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19
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Fried TR, O'Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 2015; 62:2261-72. [PMID: 25516023 DOI: 10.1111/jgs.13153] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons. DESIGN Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014). SETTING Community. PARTICIPANTS Observational studies examining health outcomes according to number of prescription medications taken. MEASUREMENTS Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding. RESULTS Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor. CONCLUSION Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide.
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Affiliation(s)
- Terri R Fried
- Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University
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20
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Ng R, Allore HG, Trentalange M, Monin JK, Levy BR. Increasing negativity of age stereotypes across 200 years: evidence from a database of 400 million words. PLoS One 2015; 10:e0117086. [PMID: 25675438 PMCID: PMC4326131 DOI: 10.1371/journal.pone.0117086] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 12/17/2014] [Indexed: 11/18/2022] Open
Abstract
Scholars argue about whether age stereotypes (beliefs about old people) are becoming more negative or positive over time. No previous study has systematically tested the trend of age stereotypes over more than 20 years, due to lack of suitable data. Our aim was to fill this gap by investigating whether age stereotypes have changed over the last two centuries and, if so, what may be associated with this change. We hypothesized that age stereotypes have increased in negativity due, in part, to the increasing medicalization of aging. This study applied computational linguistics to the recently compiled Corpus of Historical American English (COHA), a database of 400 million words that includes a range of printed sources from 1810 to 2009. After generating a comprehensive list of synonyms for the term elderly for these years from two historical thesauri, we identified 100 collocates (words that co-occurred most frequently with these synonyms) for each of the 20 decades. Inclusion criteria for the collocates were: (1) appeared within four words of the elderly synonym, (2) referred to an old person, and (3) had a stronger association with the elderly synonym than other words appearing in the database for that decade. This yielded 13,100 collocates that were rated for negativity and medicalization. We found that age stereotypes have become more negative in a linear way over 200 years. In 1880, age stereotypes switched from being positive to being negative. In addition, support was found for two potential explanations. Medicalization of aging and the growing proportion of the population over the age of 65 were both significantly associated with the increase in negative age stereotypes. The upward trajectory of age-stereotype negativity makes a case for remedial action on a societal level.
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Affiliation(s)
- Reuben Ng
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Heather G. Allore
- Yale School of Public Health, New Haven, Connecticut, United States of America
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Mark Trentalange
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Joan K. Monin
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Becca R. Levy
- Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
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21
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Yao Y, Liu R, Shin MS, Trentalange M, Allore H, Nassar A, Kang I, Pober JS, Montgomery RR. CyTOF supports efficient detection of immune cell subsets from small samples. J Immunol Methods 2014; 415:1-5. [PMID: 25450003 DOI: 10.1016/j.jim.2014.10.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/18/2022]
Abstract
Analysis of immune cell states is paramount to our understanding of the pathogenesis of a broad range of human diseases. Immunologists rely on fluorescence cytometry for cellular analysis, and while detection of 8 markers is now well established, the overlap of fluorescent signals limits efficiency. Mass cytometry or CyTOF (Cytometry by Time-Of-Flight) is a new technology for multiparameter single cell analysis that overcomes many limitations of fluorescence-based flow cytometry and can routinely detect as many as 40 markers per sample. This technology provides tremendous detail for cellular analysis of multiple cell populations simultaneously and is a powerful technique for translational investigations. Here we present reproducible detection of immune cell subsets starting with as few as 10,000 cells. Our study provides methods to employ CyTOF for small samples, which is especially relevant for investigation of limited patient biopsies in translational and clinical research.
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Affiliation(s)
- Yi Yao
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Rebecca Liu
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, United States
| | - Min Sun Shin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Mark Trentalange
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Heather Allore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Ala Nassar
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Insoo Kang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Jordan S Pober
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States; Department of Immunobiology, Yale University School of Medicine, New Haven, CT, United States; Human and Translational Immunology Program, Yale University School of Medicine, New Haven, CT, United States
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States; Human and Translational Immunology Program, Yale University School of Medicine, New Haven, CT, United States.
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22
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Walke LM, Rosenthal RA, Trentalange M, Perkal MF, Maiaroto M, Jeffery SM, Marottoli RA. Restructuring Care for Older Adults Undergoing Surgery: Preliminary Data from the Co-Management of Older Operative Patients En Route Across Treatment Environments (CO-OPERATE) Model of Care. J Am Geriatr Soc 2014; 62:2185-90. [DOI: 10.1111/jgs.13098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa M. Walke
- Department of Medicine; School of Medicine; Yale University; New Haven Connecticut
| | - Ronnie A. Rosenthal
- Department of Surgery; School of Medicine; Yale University; New Haven Connecticut
- Department of Surgery; Veterans Affairs Connecticut Healthcare System; West Haven Connecticut
| | | | - Melissa F. Perkal
- Department of Medicine; School of Medicine; Yale University; New Haven Connecticut
- Department of Surgery; School of Medicine; Yale University; New Haven Connecticut
| | - Maria Maiaroto
- Geriatrics and Extended Care; Veterans Affairs Connecticut Healthcare System; West Haven Connecticut
| | - Sean M. Jeffery
- School of Pharmacy; University of Connecticut; Storrs Connecticut
| | - Richard A. Marottoli
- Department of Medicine; School of Medicine; Yale University; New Haven Connecticut
- Geriatrics and Extended Care; Veterans Affairs Connecticut Healthcare System; West Haven Connecticut
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Mohanty S, Joshi SR, Ueda I, Wilson J, Blevins TP, Siconolfi B, Meng H, Devine L, Raddassi K, Tsang S, Belshe RB, Hafler DA, Kaech SM, Kleinstein SH, Trentalange M, Allore HG, Shaw AC. Prolonged proinflammatory cytokine production in monocytes modulated by interleukin 10 after influenza vaccination in older adults. J Infect Dis 2014; 211:1174-84. [PMID: 25367297 DOI: 10.1093/infdis/jiu573] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We evaluated in vivo innate immune responses in monocyte populations from 67 young (aged 21-30 years) and older (aged ≥65 years) adults before and after influenza vaccination. CD14(+)CD16(+) inflammatory monocytes were induced after vaccination in both young and older adults. In classical CD14(+)CD16(-) and inflammatory monocytes, production of tumor necrosis factor α and interleukin 6, as measured by intracellular staining, was strongly induced after vaccination. Cytokine production was strongly associated with influenza vaccine antibody response; the highest levels were found as late as day 28 after vaccination in young subjects and were substantially diminished in older subjects. Notably, levels of the anti-inflammatory cytokine interleukin 10 (IL-10) were markedly elevated in monocytes from older subjects before and after vaccination. In purified monocytes, we found age-associated elevation in phosphorylated signal transducer and activator of transcription-3, and decreased serine 359 phosphorylation of the negative IL-10 regulator dual-specificity phosphatase 1. These findings for the first time implicate dysregulated IL-10 production in impaired vaccine responses in older adults.
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Affiliation(s)
| | - Samit R Joshi
- Section of Infectious Diseases, Department of Internal Medicine
| | - Ikuyo Ueda
- Section of Infectious Diseases, Department of Internal Medicine
| | - Jean Wilson
- Section of Infectious Diseases, Department of Internal Medicine
| | - Tamara P Blevins
- Department of Center for Vaccine Development, Saint Louis University, Missouri
| | | | | | | | | | - Sui Tsang
- Section of Infectious Diseases, Department of Internal Medicine
| | - Robert B Belshe
- Department of Center for Vaccine Development, Saint Louis University, Missouri
| | | | | | - Steven H Kleinstein
- Department of Pathology Department of Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut
| | | | | | - Albert C Shaw
- Section of Infectious Diseases, Department of Internal Medicine
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Bastian LA, Trentalange M, Murphy TE, Brandt C, Bean-Mayberry B, Maisel NC, Wright SM, Gaetano VS, Allore H, Skanderson M, Reyes-Harvey E, Yano EM, Rose D, Haskell S. Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics. Womens Health Issues 2014; 24:605-12. [PMID: 25442706 DOI: 10.1016/j.whi.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers. METHODS Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs. FINDINGS Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01-1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs. CONCLUSIONS The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics.
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Affiliation(s)
- Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut; University of Connecticut Health Center, Farmington, Connecticut.
| | | | | | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Bevanne Bean-Mayberry
- Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Natalya C Maisel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Steven M Wright
- Office of Performance Measurement, Department of Veterans Affairs, Providence, Rhode Island
| | - Vera S Gaetano
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Heather Allore
- University of Connecticut Health Center, Farmington, Connecticut
| | | | - Evelyn Reyes-Harvey
- Office of Performance Measurement, Office of Analytics & Business Intelligence, Durham, North Carolina
| | - Elizabeth M Yano
- Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Danielle Rose
- Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Sally Haskell
- Women's Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, Connecticut
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Buurman BM, Trentalange M, Nicholson N, McGloin JM, Gahbauer EA, Allore HG, Gill TM. Residential relocations among older people over the course of more than 10 years. J Am Med Dir Assoc 2014; 15:521-526. [PMID: 24794829 PMCID: PMC4189178 DOI: 10.1016/j.jamda.2014.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to describe the rates of residential relocations over the course of 10.5 years and evaluate differences in these relocation rates according to gender and decedent status. DESIGN Prospective, longitudinal study with monthly telephone follow-up for up to 126 months. SETTING Greater New Haven, CT. PARTICIPANTS There were 754 participants, aged 70 years or older, who were initially community-living and nondisabled in their basic activities of daily living. MEASUREMENTS Residential location was assessed during monthly interviews and included community, assisted living facility, and nursing home. A residential relocation was defined as a change of residential location for at least 1 week and included relocations within (eg, community-community) or between (community- assisted living) locations. We calculated the rates of relocations per 1000 patient-months and evaluated differences by gender and decedent status. RESULTS Sixty-six percent of participants had at least one residential relocation (range 0-12). Women had lower rates of relocations from nursing home to community (rate ratio [RR] 0.59, P = .02); otherwise, there were no gender differences. Decedents had higher rates of relocation from community to assisted living (RR 1.71, P = .002), from community to nursing home (RR 3.64, P < .001), between assisted living facilities (RR 3.65, P < .001), and from assisted living to nursing home (RR 2.5, P < .001). In decedents, relocations from community to nursing home (RR 3.58, P < .001) and from assisted living to nursing home (RR 3.3, P < .001) were most often observed in the last year of life. CONCLUSIONS Most older people relocated at least once during 10.5 years of follow-up. Women had lower rates of relocation from nursing home to community. Decedents were more likely to relocate to a residential location providing a higher level of assistance, compared with nondecedents. Residential relocations were most common in the last year of life.
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Affiliation(s)
- Bianca M. Buurman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Trentalange
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Joanne M. McGloin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Evelyne A. Gahbauer
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Heather G. Allore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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26
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Sauler M, Leng L, Trentalange M, Haslip M, Shan P, Piecychna M, Zhang Y, Andrews N, Mannam P, Allore H, Fried T, Bucala R, Lee PJ. Macrophage migration inhibitory factor deficiency in chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol 2014; 306:L487-96. [PMID: 24441872 PMCID: PMC3949087 DOI: 10.1152/ajplung.00284.2013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/15/2014] [Indexed: 01/28/2023] Open
Abstract
The pathogenesis of chronic obstructive pulmonary disease (COPD) remains poorly understood. Cellular senescence and apoptosis contribute to the development of COPD; however, crucial regulators of these underlying mechanisms remain unknown. Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine that antagonizes both apoptosis and premature senescence and may be important in the pathogenesis of COPD. This study examines the role of MIF in the pathogenesis of COPD. Mice deficient in MIF (Mif(-/-)) or the MIF receptor CD74 (Cd74(-/-)) and wild-type (WT) controls were aged for 6 mo. Both Mif(-/-) and Cd74(-/-) mice developed spontaneous emphysema by 6 mo of age compared with WT mice as measured by lung volume and chord length. This was associated with activation of the senescent pathway markers p53/21 and p16. Following exposure to cigarette smoke, Mif(-/-) mice were more susceptible to the development of COPD and apoptosis compared with WT mice. MIF plasma concentrations were measured in a cohort of 224 human participants. Within a subgroup of older current and former smokers (n = 72), MIF concentrations were significantly lower in those with COPD [8.8, 95%CI (6.7-11.0)] compared with those who did not exhibit COPD [12.7 ng/ml, 95%CI (10.6-14.8)]. Our results suggest that both MIF and the MIF receptor CD74 are required for maintenance of normal alveolar structure in mice and that decreases in MIF are associated with COPD in human subjects.
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Affiliation(s)
- Maor Sauler
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale Univ. School of Medicine, PO Box 208057, 300 Cedar St., New Haven, CT 06520-8057.
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27
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Mannam P, Shinn AS, Srivastava A, Neamu RF, Walker WE, Bohanon M, Merkel J, Kang MJ, Dela Cruz CS, Ahasic AM, Pisani MA, Trentalange M, West AP, Shadel GS, Elias JA, Lee PJ. MKK3 regulates mitochondrial biogenesis and mitophagy in sepsis-induced lung injury. Am J Physiol Lung Cell Mol Physiol 2014; 306:L604-19. [PMID: 24487387 DOI: 10.1152/ajplung.00272.2013] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Sepsis is a systemic inflammatory response to infection and a major cause of death worldwide. Because specific therapies to treat sepsis are limited, and underlying pathogenesis is unclear, current medical care remains purely supportive. Therefore targeted therapies to treat sepsis need to be developed. Although an important mediator of sepsis is thought to be mitochondrial dysfunction, the underlying molecular mechanism is unclear. Modulation of mitochondrial processes may be an effective therapeutic strategy in sepsis. Here, we investigated the role of the kinase MKK3 in regulation of mitochondrial function in sepsis. Using clinically relevant animal models, we examined mitochondrial function in primary mouse lung endothelial cells exposed to LPS. MKK3 deficiency reduces lethality of sepsis in mice and by lowering levels of lung and mitochondrial injury as well as reactive oxygen species. Furthermore, MKK3 deficiency appeared to simultaneously increase mitochondrial biogenesis and mitophagy through the actions of Sirt1, Pink1, and Parkin. This led to a more robust mitochondrial network, which we propose provides protection against sepsis. We also detected higher MKK3 activation in isolated peripheral blood mononuclear cells from septic patients compared with nonseptic controls. Our findings demonstrate a critical role for mitochondria in the pathogenesis of sepsis that involves a previously unrecognized function of MKK3 in mitochondrial quality control. This mitochondrial pathway may help reveal new diagnostic markers and therapeutic targets against sepsis.
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Affiliation(s)
- Praveen Mannam
- Pulmonary, Critical Care and Sleep Medicine, Dept. of Internal Medicine, Yale Univ. School of Medicine, 333 Cedar St., P.O. Box 208057, New Haven, CT 06520-8057.
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Bacon GS, Rich T, Long ML, Trentalange M. Operation Desert Shield sequel: experience aboard the USNS Comfort during the Persian Gulf conflict. J Clin Anesth 1991; 3:478-9. [PMID: 1760172 DOI: 10.1016/0952-8180(91)90097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Affiliation(s)
- G S Bacon
- National Naval Medical Center, Bethesda, MD 20889
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