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Li C, Kang L, Miles TP, Khan MM. Factors affecting academic performance of college students in China during COVID-19 pandemic: a cross-sectional analysis. Front Psychol 2023; 14:1268480. [PMID: 38022931 PMCID: PMC10657195 DOI: 10.3389/fpsyg.2023.1268480] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Understanding the factors that affected academic performance of students during the COVID-19 pandemic will help design effective interventions for improving students' academic performance during emergency situations as well as during regular academic environment. This cross-sectional study aimed to identify the factors that explain academic performance of students in China during the pandemic. Methods Data on college students from the 2020 China Family Panel Studies were used, and the final sample consisted of 728 students. Ordered probit regression models were estimated to explain students' relative performance in the semester when the in-person classes were suspended by using various student and household-related variables and characteristics. To compute missing values in selected variables, a multiple imputation technique was applied. Results The odds of poor academic performance declined with higher Internet use for academic purposes, but Internet use for entertainment increased the probability of being in the poor academic performance. College students who spent more time studying on college work were less likely to have poor academic performance. Discussion This study identified the factors (Internet use and study time) associated with academic performance among Chinese college students during the COVID-19 pandemic. These results can be used to design policies to improve educational outcomes and to address educational inequalities.
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Affiliation(s)
- Changle Li
- School of Health Management, Fujian Medical University, Fuzhou, China
- College of Public Health, University of Georgia, Athens, GA, United States
| | - Lili Kang
- School of Health Management, Fujian Medical University, Fuzhou, China
| | - Toni P. Miles
- Rosalynn Carter Institute for Caregivers, Atlanta, GA, United States
| | - M. Mahmud Khan
- College of Public Health, University of Georgia, Athens, GA, United States
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Li C, Miles TP, Shen Y, Bayakly R, Ido M, Khan MM. Measuring bereavement prevalence in a complex sampling survey: the 2019 Georgia Behavioral Risk Factor Surveillance System (BRFSS). BMC Med Res Methodol 2023; 23:138. [PMID: 37312061 DOI: 10.1186/s12874-023-01917-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 04/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The Behavioral Risk Factor Surveillance System (BRFSS) is an annual survey designed to identify trends in the public's health. In its 2019 field survey, the U.S. state of GA tested a new 3 - item module to measure the numbers of bereaved, resident adults aged 18 years and older. Participants were eligible if they answered 'Yes' to the item 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'. This analysis explores two research questions. Can estimates for bereavement prevalence be derived without large sampling errors, low precision, and small subsamples? Can multiple imputation techniques be applied to overcome non-response and missing data to support multivariate modeling? METHODS BRFSS is a non-institutionalized sample of adults aged 18 years and older living in the U.S. state of Georgia. Analyses in this study were conducted under two scenarios. Scenario 1 applies the complex sample weights created by the Centers for Disease Control and imputes values for missing responses. Scenario 2 treats the data as a panel - no weighting combined with removal of persons with missing data. Scenario 1 reflects the use of BRFSS data for public health and policy, while Scenario 2 reflects data as it is commonly used in social science research studies. RESULTS The bereavement screening item has a response rate (RR) of 69.1% (5206 of 7534 persons). Demographic subgroups and categories of health have RR of 55% or more. Under Scenario 1, the estimated prevalence of bereavement is 45.38%, meaning that 3,739,120 adults reported bereaved in 2018 or 2019. The estimated prevalence is 46.02% with Scenario 2 which removes persons with any missing data (4,289 persons). Scenario 2 overestimates the bereavement prevalence by 1.39%. An illustrative logistic model is presented to show the performance of exposure to bereavement under the two data scenarios. CONCLUSIONS Recent bereavement can be ascertained in a surveillance survey accounting for biases in response. Estimating bereavement prevalence is needed for measuring population health. This survey is limited to one US state in a single year and excludes persons aged 17 years and younger.
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Affiliation(s)
- Changle Li
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
| | - Toni P Miles
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA.
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
| | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, USA
| | - Moses Ido
- Georgia Department of Public Health, Atlanta, USA
| | - M Mahmud Khan
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
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Miles TP, Li C, Khan MM, Bayakly R, Carr D. Estimating Prevalence of Bereavement, Its Contribution to Risk for Binge Drinking, and Other High-Risk Health States in a State Population Survey, 2019 Georgia Behavioral Risk Factor Surveillance Survey. Int J Environ Res Public Health 2023; 20:ijerph20105837. [PMID: 37239563 DOI: 10.3390/ijerph20105837] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Binge drinking is a pattern of alcohol abuse. Its prevalence and associated risk factors are not well documented. Heavy drinking, on the other hand, has a well-documented association with bereavement. This report uses a cross-sectional, population-based survey to estimate prevalence of bingeing and its association with new bereavement. Bingeing is defined as 4 or more drinks (women) or 5 or more drinks (men) in a 2-4-h setting. For the first time in 2019, the Georgia Behavioral Risk Factor Surveillance Survey (BRFSS) included a bereavement item: 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?' METHODS Georgia BRFSS is a complex sampling survey administered annually. It is designed to represent the 8.1 million people aged 18 years and older in the U.S. state of Georgia. Alcohol consumption patterns are routinely measured in the common core. In 2019, the state added a new item probing for bereavement in the prior 24 months predating the COVID-19 pandemic. Imputation and weighting techniques were applied to yield the population prevalence rates of new bereavement, bingeing, and their co-occurrence with other high-risk health behaviors and outcomes. Multivariate models, adjusted for age, gender, and race, were used to estimate the risk for other unhealthy behaviors posed by the co-occurrence of bereavement and bingeing. RESULTS In Georgia, bereavement (45.8%), and alcohol consumption (48.8%) are common. Bereavement and alcohol use co-occurred among 1,796,817 people (45% of all drinkers) with a subset of 608,282 persons reporting bereavement combined with bingeing. The most common types of bereavement were death of a friend/neighbor (30.7%) or three plus deaths (31.8%). CONCLUSIONS While bingeing is a known risk to public health, its co-occurrence with recent bereavement is a new observation. Public health surveillance systems need to monitor this co-occurrence to protect both individual and societal health. In a time of global bereavement, documenting its influence on binge drinking can support the work towards Sustainable Development Goal #3-Good health and Well-Being.
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Affiliation(s)
- Toni P Miles
- Rosalynn Carter Institute for Caregivers, Atlanta, GA 31709, USA
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Changle Li
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
- School of Health Management, Fujian Medical University, Fuzhou 350122, China
| | - M Mahmud Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, GA 30303, USA
| | - Deborah Carr
- Center of Innovation in Social Science, Boston University, Boston, MA 02215, USA
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Miles TP. Reducing Disparities by Restructuring Health Care: Brazil's Family Health System Shows the Way! Am J Public Health 2021; 111:762-764. [PMID: 33826382 DOI: 10.2105/ajph.2021.306245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Toni P Miles
- Toni P. Miles is with the Epidemiology Department, College of Public Health, University of Georgia, Athens
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Smith BE, Miles TP, Elkins J, Barkin JL, Ebell MH, Ezeamama AE. The Impact of Stressful Life Events on the Incidence of Type 2 Diabetes in U.S. Adults From the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:640-649. [PMID: 29635530 DOI: 10.1093/geronb/gby040] [Citation(s) in RCA: 7] [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: 08/15/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We evaluated the association between cumulative stressful life events (SLE) and type of stress (lifetime vs recent) and incident diabetes (Type 2 diabetes mellitus [T2DM]) in middle-aged U.S. adults. METHODS Data from the 2006-2014 waves of the Health and Retirement Study (HRS) were analyzed (n = 7,956). Stress-related differences in age at T2DM diagnosis were estimated using Cox proportional hazards models. RESULTS The adjusted risk of T2DM significantly increased by 6% per unit increase in cumulative SLE (95% confidence interval [CI] = 1.03, 1.11), by 5% per unit increase in lifetime stress (95% CI = 1.00, 1.09), and by 23% per unit increase in recent stress (95% CI = 1.12, 1.36). Each level of cumulative SLE (1, 2, 3, and ≥4 events) and recent stress (1 and ≥2 events) compared to no stress was significantly associated with an increased risk of T2DM. Each level of lifetime stress compared to no stress was significantly associated with an elevated risk of T2DM except for 3 events. DISCUSSION Cumulative SLE and type of stress were associated with incident T2DM in middle-aged adults. Reducing the direct effect of stress with management interventions may reduce the indirect effect of developing T2DM and warrants further investigation.
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Affiliation(s)
- Betsy E Smith
- Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Toni P Miles
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Georgia, Athens
| | | | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Georgia, Athens
| | - Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing
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Abstract
Objective: This study investigated variables associated with physical functioning limitations among elderly African American women, controlling for genetics and common family environment. Method: Activities of daily living limitations (ADL) and instrumental activities of daily living limitations (IADL) are examined in 180 pairs of African American elderly twins using a co-twin control design. The association of chronic disease, other physical problems, lifestyle, and demographic factors with both measures are investigated. Results: Arthritis, hypertension, and more than 1 chronic disease are associated with ADL limitations and arthritis; diabetes, heart attack, and more than 1 chronic disease are associated with IADL limitations in univariate analyses. In multivariate analyses, a different set of additional variables is associated with the two measures. Discussion: Among elderly African American women, physical functioning limitations are influenced by the presence of chronic diseases, other physical problems, lifestyle, and demographics. These associations are not due to genetics or common family environment effects.
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Affiliation(s)
- Sylvia E Furner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, USA
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Abstract
Objectives: This article examines the impact of disability, cognitive status, and social support on nursing home use in a sample of older Mexican Americans. Method: We used four waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE), a longitudinal study of 3,050 older Mexican Americans living in the Southwest initially contacted in 1993 to 1994. Results: The findings reveal that advanced age, being a man, activities of daily living disability, and cognitive impairment are strong predictors of institutionalization and death. Living with family, arriving in the United States in late life, and access to social support independently decreased the probability of dying in a nursing home. Discussion: Although it is clear that adequate social support can make it possible for an impaired older person to remain in the community serious impairment can eventually overwhelm even a supportive network and result in the institutionalization of an impaired older person.
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Affiliation(s)
- Jacqueline L Angel
- Center on Health and Social Policy, University of Texas at Austin, Austin, TX, USA.
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Glaude-Hosch JA, Smith ML, Heckman TG, Miles TP, Olubajo BA, Ory MG. Sexual Behaviors, Healthcare Interactions, and HIV-Related Perceptions Among Adults Age 60 Years and Older: An Investigation by Race/Ethnicity. Curr HIV Res 2016; 13:359-68. [PMID: 25981706 DOI: 10.2174/1570162x13666150511124959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 03/14/2015] [Accepted: 03/30/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Older adults are remaining sexually active for longer periods of time, underscoring the need to assess sexual activity patterns in this group and identify differences by race/ethnicity, some of which may have implications for the development and implementation of sexual risk reduction interventions. METHODS Using data from the 2010 National Social Life, Health, and Aging Project, this study examined responses from 1,429 adults aged 60 years and older. Multinomial logistic regression compared sexual behaviors, health-related indicators, interactions with healthcare professionals, and HIV-related perceptions across participants' race/ethnicity. RESULTS Approximately 81% of participants self-reported as non-Hispanic white, 10.59% as African American, and 8.05% as Hispanic. On average, participants were 69.9 years of age. In the previous year, 49.3% of participants engaged in sexual intercourse; only 3% used condoms. The majority of participants (83.1%) visited a physician at least twice in the previous year, 30.9% had discussed sex with a physician since turning 50, and 14.2% had been tested for HIV. Relative to non-Hispanic whites, African Americans were more likely to be divorced (OR=3.23, P<0.001) or widowed (OR=2.90, P<0.001); have more lifetime sexually transmitted infection (STI) diagnoses (OR=1.67, P=0.030); and have paid for sex (OR=2.83, P=0.002). Although African Americans had greater perceived risk for HIV infection (OR=1.66, P=0.046), they were less likely to have discussed sex with a physician since turning 50 (OR=0.45, P=0.009). CONCLUSION Contextualized interventions to improve patient-provider communication and proactive screening behaviors in sexually-active and aging African Americans are needed.
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Affiliation(s)
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, The University of Georgia College of Public Health, Health Sciences Campus, #345E Wright Hall, Athens, GA 30602, USA.
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Ezeamama AE, Elkins J, Simpson C, Smith SL, Allegra JC, Miles TP. Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey. Qual Life Res 2015; 25:1007-15. [PMID: 26475139 DOI: 10.1007/s11136-015-1144-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70 years old enrolled in the US 2010 health and retirement survey. METHODS Multivariable logistic regression models estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2 years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5+ events. HCU included hospitalization (any vs. none) and physician visits (< 20 vs. ≥ 20) over 2 years. FINDINGS Hospitalization odds declined by 25 % (OR 0.75, 95 %CI 0.64-0.86), odds of ≥ 20 physician visits declined by 47 % (OR 0.53, 95 % CI 0.45-0.63) and the odds of SRH improvement increased by 49 % (OR 1.49, 95 % CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 % elevated for participants that reported 1-2, 3-4 and 5+ versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. CONCLUSION In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.
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Affiliation(s)
- Amara E Ezeamama
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA
| | - Jennifer Elkins
- School of Social Work, University of Georgia, Athens, GA, USA
| | | | - Shaniqua L Smith
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA
| | - Joseph C Allegra
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA
| | - Toni P Miles
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA.
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Davitt JK, Perez GA, Miles TP. Policy Advocacy to Promote Healthy Aging: The Time to Engage Is Now. Res Gerontol Nurs 2015. [PMID: 26225552 DOI: 10.3928/19404921-20150612-01] [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: 11/20/2022]
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Abstract
PURPOSE The purpose of this study was to explore approaches used by administrators to respond to grief and bereavement among staff after the death of a resident. METHODS Continuing care retirement community (CCRC) facilities (n = 10) were randomly selected from a larger study of 31 facilities. Open-ended interviews were conducted using a structured interview protocol. Qualitative methods, specifically thematic analysis, were used to analyze the interview data. FINDINGS Emergent themes suggest that LTC facilities have freedom in how to provide support for staff members, family members, and other residents after the death of a loved one. However, results show variations in methods for notifying staff of a resident's death, inclusion of direct care staff in caring for the deceased, providing memorial services, and offering grief/bereavement support. When speaking of the loss of a resident and ways to provide grief/bereavement support, only 3 of the 10 administrators discussed the importance of extending such services to the staff. IMPLICATIONS Causes of staff burnout in the CCRC workplace is an unresolved issue. Research has shown that inadequate grief and bereavement support for staff contributes to factors associated with staff burnout and retention. Although administrators hold formal services after a resident has died, there are differences among facilities. It may be that organizations could improve bereavement services for staff.
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Affiliation(s)
- Jasleen K Chahal
- Department of Sociology & Gerontology, Miami University, Oxford, OH
| | - Heidi H Ewen
- Institute of Gerontology, University of Georgia, Athens, GA.
| | - Keith Anderson
- School of Social Work, University of Montana, Missoula, MT
| | - Toni P Miles
- Institute of Gerontology, University of Georgia, Athens, GA
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Miles TP, Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR, Nevitt MC, Bloch DA, Marcus R, Kelsey JL. SPECIAL POPULATIONS IN GERIATRICS. J Am Geriatr Soc 2015. [DOI: 10.1111/j.1532-5415.1999.tb07443.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miles TP, Allegra JC, Ezeamama A, Simpson C, Gerst-Emerson K, Elkins J. In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years. Am J Hosp Palliat Care 2014; 33:41-6. [PMID: 25258335 DOI: 10.1177/1049909114552125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/17/2022] Open
Abstract
In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87%). A report of any loss increases risk of health care utilization by 20% to 30%. For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.
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Affiliation(s)
- Toni P Miles
- Institute of Gerontology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Joseph C Allegra
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Amara Ezeamama
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | - Kerstin Gerst-Emerson
- Institute of Gerontology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Jennifer Elkins
- School of Social Work, University of Georgia, Athens, GA, USA
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Abstract
Attention to ethical issues is a routine part of medical research. In this article, we propose that health policy development, like research, include a formal review of these issues. Ethical knowledge is a critical component of epistemology and inherent in development of laws and principles of justice. However, we cannot assume that new policies are subject to a formal ethics review. The Belmont Report of 1978 provides a platform for this process. Prior to the Belmont Report, there was no foundation defining this process in medical research. Based on this history, we propose that health care payment policy development include a formal assessment of risks and benefits using an approach that is familiar to all researchers.
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Miles TP. Does the death of middle aged and older adults influence public health? Eur J Public Health 2013. [DOI: 10.1093/eurpub/el_529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Toni P. Miles
- Professor and Director, College of Public Health, University of Georgia, Institute of Gerontology, 30602
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Abstract
OBJECTIVES We investigated the relationship between the number of times a woman has been pregnant and walking difficulty in later life. METHODS With data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a representative population-based cohort of Mexican Americans aged 65 years and older residing in 5 Southwestern states, we measured walking difficulty using 2 items from the performance-oriented mobility assessments: the timed walk and seated chair rise. RESULTS We observed significantly higher rates of ambulatory limitation among women with 6 or more pregnancies than among women with 4 or fewer pregnancies: 44.9% and 27.0%, respectively, were unable to perform or performed poorly in the seated chair rise and timed walk. Ordinal logistic regression models show that gravidity predicts level of performance in both mobility tasks and that higher gravidity is associated with worse performance, even after adjustment for both age and chronic disease. CONCLUSIONS Gravidity is a risk factor for ambulatory limitation in old age. A life course approach to reproduction in public health research and practice is warranted.
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Affiliation(s)
- Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs and the Population Research Center, University of Texas, Austin, TX 78713-8925, USA
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Nelson TL, Vogler GP, Pedersen NL, Hong Y, Miles TP. Genetic and environmental influences on body fat distribution, fasting insulin levels and CVD: are the influences shared? ACTA ACUST UNITED AC 2012. [DOI: 10.1375/twin.3.1.43] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractCentral body fat distribution has been shown to be related to hyperinsulinemia, insulin resistance, hypertriglyceridemia, and atherosclerosis to a greater degree than general obesity. There are known to be both genetic and environmental effects on all components of this clustering. Whether these genetic effects are due to one set of genes in common to the components or whether genetic influences on insulin resistance and/or general/abdominal fatness ‘turn on’ other genes that affect other components of the syndrome is not clear. We analyzed data from the Swedish Adoption/Twin Study of Aging (60% female; monozygotic = 116, dizygotic = 202; average age 65 years) to determine whether there were genetic and/or environmental factors shared among general body fat distribution, abdominal body fat distribution, fasting insulin levels and cardiovascular disease. We found additive genetic effects in males to be significantly different from those in females with genetic effects accounting for variance in waist–hip ratio (males = 28%; females = 49%), body mass index (males = 58%; females = 73%), fasting insulin levels (FI) (males = 27%; females = 49%), and cardiovascular disease (CVD) (males = 18%; females = 37%). There were also shared genetic and environmental effects among all the variables except CVD, but a majority of the genetic variance for these measures was trait specific. Twin Research (2000) 3, 43–50.
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Abstract
BACKGROUND UK guidelines recommend routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis. OBJECTIVE To examine critically the evidence behind this guideline. SEARCH STRATEGY Cochrane-style systematic review of the data and literature relevant to vaginal dilation and stenosis attributable to radiotherapy. SELECTION CRITERIA Any and every measure of vaginal or sexual function after radiotherapy. DATA COLLECTION AND ANALYSIS Numerous papers gave recommendations on dilation during or immediately after radiotherapy, but only seven contained relevant data. Case reports describe vaginal fistulas or psychological morbidity. Two trials showed that encouraging dilation increased compliance, but the first trial found no difference in sexual function scores. One comparative unmatched trial showed no advantage from inserting mitomycin C. A report of five women implied that stenosis can be treated by dilation many years after radiotherapy. One uncontrolled observational report involving 89 women showed that the median vaginal length 6-10 weeks after therapy was measured at 6 cm, but women tolerated a 9-cm measurer after 4 months of dilation experience. One retrospective report implied that dilation lowered stenosis rates, but the control group is not comparable. MAIN RESULTS Dilation during or immediately after radiotherapy can cause damage, and there is no evidence that it prevents stenosis. Dilation might stretch the vagina if commenced after the inflammatory phase. AUTHOR'S CONCLUSIONS Dilation might help treat the late effects of radiotherapy, but it must not be assumed that this applies to the acute toxicity phase. Routine dilation during treatment is not supported by good evidence.
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Affiliation(s)
- N Johnson
- Princess Anne Wing, Royal United Hospital, Bath, UK.
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Leey JA, McCabe S, Koch JA, Miles TP. Cost-effectiveness of genotype-guided warfarin therapy for anticoagulation in elderly patients with atrial fibrillation. ACTA ACUST UNITED AC 2009; 7:197-203. [DOI: 10.1016/j.amjopharm.2009.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2009] [Indexed: 11/24/2022]
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Murphy PJ, Miles TP. From the hospital to the nursing home: the 75% rule and the transfer process. J Ky Med Assoc 2007; 105:439-443. [PMID: 17941422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This has been a commentary on the implications of policy changes for nursing homes and rehabilitation hospital admissions. Only time will show how greatly this will affect the nursing home. However, since the 2004 implementation of the 75% Rule, nursing homes have already seen a jump in patients who are more acutely ill and have multiple medical needs. To lessen the potential burden of these changes on patient safety and comfort and to increase family satisfaction with care, we propose the following steps be considered. 1. We need better integration between hospital and nursing homes. Indeed, a strategic alliance between hospitals and nursing homes would be something that we should consider sooner rather than later. 2. All providers should understand that this is a continued push by both private and government insurance to get the patient out of the hospital sooner. As a result, patients will be discharged either to the rehab hospital or to the nursing home "sicker and quicker." 3. The implementation of the 75% Rule will probably result in a decreased use of rehab hospitals and an increased use of the nursing home. 4. In looking even further into the future, the nursing homes themselves are likely to be under continued pressure to get patients out of the nursing home more quickly. This in turn will result in what we consider the next big thing-home care.
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Affiliation(s)
- Patrick J Murphy
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
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Miles TP, Briscoe BT, Kim SH. Age, gender, and impaired clock drawing in the generalist primary care setting. J Ky Med Assoc 2007; 105:59-65. [PMID: 17390733] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Toni P Miles
- Department of Family and Geriatric Medicine, University of Louisville, KY 40202, USA.
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Kuppersmith NC, Miles TP. Effect of a BMI chart on weight management discussions in a primary care setting. J Ky Med Assoc 2006; 104:519-22. [PMID: 17175854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To measure whether the addition of a BMI chart to a patient's medical record at the time of the office visit would increase the likelihood of a physician discussing weight management with the patient. METHODS Office staff were instructed to place a BMI chart on the front of medical charts of all patients aged 21 years to 65 years who were seen during a 2-month period in two urban university-affiliated clinics. The staff were to plot the BMI on the chart. The medical records were audited for the presence of the BMI chart and any documentation of a discussion of weight management. RESULTS Of the 961 charts that were audited, 44% contained the BMI chart. A discussion of weight management issues was documented in 19% of those that contained a BMI chart and in 15% of those that did not contain a BMI chart. CONCLUSIONS Data presented here suggest that adding a BMI chart to the patient medical record may increase the attention of a physician to weight management issues.
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Affiliation(s)
- Nancy C Kuppersmith
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
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Garrett SL, O'Brien JG, Miles TP. Quality of care for vulnerable older patients. Ann Intern Med 2006; 144:219; author reply 219-20. [PMID: 16461971 DOI: 10.7326/0003-4819-144-3-200602070-00016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Espino DV, Bazaldua OV, Palmer RF, Mouton CP, Parchman ML, Miles TP, Markides K. Suboptimal Medication Use and Mortality in an Older Adult Community-Based Cohort: Results From the Hispanic EPESE Study. ACTA ACUST UNITED AC 2006; 61:170-5. [PMID: 16510861 DOI: 10.1093/gerona/61.2.170] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [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] [Indexed: 11/14/2022]
Abstract
BACKGROUND Numerous methods have been used to evaluate medication management quality in older adults; however, their predictive validities are unknown. Major medication quality indicators include polypharmacy, drug-drug interactions, and inappropriate medication use. To date, no study has attempted to evaluate the three approaches systematically or the effect of each approach on mortality in a Hispanic population. Our objective was to evaluate the relationship between polypharmacy, drug-drug interactions, and inappropriate medication use on the mortality of a community-based population of Mexican American older adults. METHODS We used a life table survival analysis of a longitudinal survey of a representative sample of 3,050 older Mexican Americans of whom 1,823 were taking prescription and over-the-counter medications. RESULTS After adjustment for relevant covariates, use of more than four different medications (polypharmacy) was independently associated with mortality. The presence of major drug interactions and the use of inappropriate medications were not significantly associated with mortality in our study sample. CONCLUSION Polypharmacy (>4 medications) is significantly associated with mortality in Mexican American older adults. This community-based study is the first to demonstrate a direct association between polypharmacy and mortality in this population.
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Affiliation(s)
- David V Espino
- Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, MC 7795, 7703 Floyd Curl Dr., 78229-3900, USA.
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Abstract
This article explores the hypothesis that medical policies and procedures represent immediately correctible causes of disparity in minority elders. Evidence of policies and procedures that have the unintended consequence of creating disparity is presented. The text is focused on one site, prostate, as a sample tumor to present a strategy for correcting sources of disparities in cancer morbidity and mortality. Specific prostate cancer issues with unintended effects include the prostate cancer screening controversy, access to diagnostic facilities in minority communities, and special needs of older adult cancer survivors. A summary of all recommendations and their implications across cancer sites is provided.
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Affiliation(s)
- Toni P Miles
- Department of Community and Geriatric Medicine, School of Medicine, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA.
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Jackson RA, Vittinghoff E, Kanaya AM, Miles TP, Resnick HE, Kritchevsky SB, Simonsick EM, Brown JS. Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study. Obstet Gynecol 2004; 104:301-7. [PMID: 15292003 DOI: 10.1097/01.aog.0000133482.20685.d1] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the prevalence of and risk factors for stress and urge incontinence in a biracial sample of well-functioning older women. METHODS We performed a cross-sectional analysis of 1,584 white and black women, aged 70-79 years, enrolled in a longitudinal cohort study. Participants were asked about incontinence, medical problems, and demographic and reproductive characteristics and underwent physical measurements. Using multivariable logistic regression, we compared women reporting at least weekly incontinence with those without incontinence. RESULTS Overall, 21% reported incontinence at least weekly. Of these, 42% reported predominantly urge incontinence, and 40% reported stress. Nearly twice as many white women as black women reported weekly incontinence (27% versus 14%, P <.001). Factors associated with urge incontinence included white race (odds ratio [OR] 3.1, 95% confidence interval [CI] 2.0-4.8), diabetes treated with insulin (OR 3.5, 95% CI 1.6-7.9), depressive symptoms (OR 2.7, 95% CI 1.4-5.3), current oral estrogen use (OR 1.7, 95% CI 1.1-2.6), arthritis (OR 1.7, 95% CI 1.1-2.6), and decreased physical performance (OR 1.6 per point on 0-4 scale, 95% CI 1.1-2.3). Factors associated with stress incontinence were chronic obstructive pulmonary disease (OR 5.6, 95% CI 1.3-23.2), white race (OR 4.1, 95% CI 2.5-6.7), current oral estrogen use (OR 2.0, 95% CI 1.3-3.1), arthritis (OR 1.6, 95% CI 1.0-2.4), and high body mass index (OR 1.3 per 5 kg/m2, 95% CI 1.1-1.6). CONCLUSION Urinary incontinence is highly prevalent, even in well-functioning older women, whites in particular. Many risk factors differ for stress and urge incontinence, suggesting differing etiologies and prevention strategies.
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Affiliation(s)
- R A Jackson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
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Espino DV, Palmer RF, Miles TP, Mouton CP, Lichtenstein MJ, Markides KP. Prevalence and severity of urinary incontinence in elderly Mexican-American women. J Am Geriatr Soc 2004; 51:1580-6. [PMID: 14687387 DOI: 10.1046/j.1532-5415.2003.51503.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [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] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To measure prevalence and characteristics of urinary incontinence in older Mexican-American women. DESIGN Cross-sectional analysis of a longitudinal survey of a representative sample of older Mexican Americans. SETTING Five southwestern states in the United States. PARTICIPANTS A total of 1589 Mexican-American women, aged 65 and older who were part of the Hispanic Established Population for the Epidemiologic Study of the Elderly. MEASUREMENTS Self-reported psychosocial, demographic, and health variables; self-reported history of symptoms of urinary incontinence. RESULTS Two hundred thirty-nine (15%) of the 1589 Mexican-American women reported having urinary incontinence. Almost 33% reported urge incontinence symptoms, 10% reported stress incontinence symptoms, and 42% had symptoms suggestive of mixed incontinence. Thirty-five percent of subjects reported incontinence episodes with moderate to large amounts of urine loss, and 15% reported that their urinary symptoms kept them from engaging in social activities. Age and body mass index were risk factors for incontinence (P=.02 and P=.03, respectively). CONCLUSION This is the first community-based survey examining rates of urinary incontinence in Mexican-American women. The prevalence of urinary incontinence may be lower in older Mexican-American women than in the general population. They may also have a higher percentage of urge as opposed to stress incontinence symptoms and may suffer from moderate to large volumes of urine loss associated with their incontinence episodes.
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Affiliation(s)
- David V Espino
- Department of Family Practice, University of Texas Health Science Center, San Antonio, Texas 78229, USA.
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Dergance JM, Calmbach WL, Dhanda R, Miles TP, Hazuda HP, Mouton CP. Barriers to and benefits of leisure time physical activity in the elderly: differences across cultures. J Am Geriatr Soc 2003; 51:863-8. [PMID: 12757577 DOI: 10.1046/j.1365-2389.2003.51271.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [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] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to compare ethnic differences in attitudes toward barriers and benefits of leisure-time physical activity (LTPA) in sedentary elderly Mexican (MAs) and European Americans (EAs). An in-home, cross-sectional survey was performed on 210 community-dwelling elders from 10 primary care practices in south Texas that are part of the South Texas Ambulatory Research Network, a practice-based research network. Analytical variables included ethnicity, age, sex, income, education, marital status, and LTPA. Fisher exact test was used to analyze the 100 sedentary elders (LTPA <500 kcal/wk; 63 MAs and 37 EAs). Self-consciousness and lack of self-discipline, interest, company, enjoyment, and knowledge were found to be the predominant barriers to LTPA in both groups. Both groups held similar beliefs about benefits gained from exercise, such as improved self-esteem, mood, shape, and health, but the beliefs about the positive benefits of exercise were more prevalent in MAs. These findings remained after adjusting for age, income, education, marital status, and sex. Some might think that a major barrier lies in misconception about benefits of LTPA, but in this study, both ethnic groups were accurate in their perceived benefits of LTPA. When attempting to engage elderly in LTPA, it is important not only to consider what barriers exist but also what beliefs about the benefits exist.
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Affiliation(s)
- Jeannae M Dergance
- Department of Family and Community Medicine and Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284, USA.
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Espino DV, DelAguila D, Mouton CP, Alford C, Parker RW, Miles TP, Olivares O. Characteristics of Mexican-American elders with dementia presenting to a community-based memory evaluation program. Ethn Dis 2003; 12:517-21. [PMID: 12477137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE To determine sociodemographic characteristics associated with the initial presentation of Mexican-American elders to a community-based memory evaluation clinic. METHODS Retrospective review of the charts of 89 Mexican Americans presenting consecutively to an outpatient memory evaluation clinic in San Antonio, Texas. PRINCIPAL FINDINGS Mexican Americans presented for evaluation with more moderate-to-severe cognitive impairment than previously reported. They also tended to have high levels of IADL (83.1%) and gait/balance (52.3%) impairment, as well as high levels of depressive symptoms (63.1%). CONCLUSIONS Mexican Americans present for initial evaluation for memory decline with moderate-to-severe cognitive decline and significant dementia-associated co-morbidities. In Mexican Americans, caregiver burden, fall risks, depressive symptoms, and need for IADL support should be addressed on the initial visit for memory decline.
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Affiliation(s)
- David V Espino
- Division of Community Geriatrics, Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA.
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Newman AB, Haggerty CL, Goodpaster B, Harris T, Kritchevsky S, Nevitt M, Miles TP, Visser M. Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 2003; 51:323-30. [PMID: 12588575 DOI: 10.1046/j.1532-5415.2003.51105.x] [Citation(s) in RCA: 364] [Impact Index Per Article: 17.3] [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] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine whether lower lean mass and higher fat mass have independent effects on the loss of strength and muscle quality in older adults and might explain part of the effect of age. DESIGN Single-episode, cross-sectional analyses of a cohort of subjects in the Health, Aging and Body Composition (Health ABC) Study. SETTING Ambulatory clinic and research laboratory. PARTICIPANTS Two thousand six hundred twenty-three men and women aged 70 to 79 from the Health ABC Study. MEASUREMENTS Upper and lower extremity strength was measured using isokinetic (knee extension) and isometric (grip strength) dynamometers. Body composition (lean mass and fat mass) was determined by measuring lean mass of upper and lower extremities and the total body by dual-energy x-ray absorptiometry. Muscle quality was ascertained by taking the ratio of strength to muscle mass for both upper and lower extremities. RESULTS Upper and lower extremity strength and muscle quality decreased as age increased. Most of the explained variance in strength was due to differences in muscle mass, but, in those at the extremes of body fat and lower leg muscle quality, the association with body fat was independent of the effect of age. Although blacks had greater muscle strength and mass than whites, leg muscle quality tended to be lower in blacks than in whites. Upper extremity strength adjusted for lean mass and muscle quality were also associated inversely and independently with age, body fat, and black race. CONCLUSION In this older cohort, lower strength with older age was predominantly due to a lower muscle mass. Age and body fat also had significant inverse associations with strength and muscle quality. Both preservation of lean mass and prevention of gain in fat may be important in maintaining strength and muscle quality in old age.
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Affiliation(s)
- Anne B Newman
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, 3520 5th Avenue, Suite 300, Pittsburgh, PA 15213, USA.
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Abstract
A case is presented of an elderly patient with synchronous ureteral/bladder/urethral transitional cell carcinoma and prostatic adenocarcinoma. In a subsequent review of 1,104,269 cancer patients in the literature, the reported prevalence of multiple primary malignant neoplasms (MPMN) varies between 0.734% and 11.7%. It appears that MPMN might occur more frequently than can be explained on the basis of random chance. As expected, the incidence of developing MPMN is noted to rise with increasing age. In addition, the preponderance of men with MPMN is caused primarily by the high frequency of prostatic cancer. Current studies and research need to address the potential of older cancer patients being at higher risk of second primaries.
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Affiliation(s)
- Carlo Greg N Demandante
- Medical School, The University of Texas Health Science Center at San Antonio, Texas 78284-7795, USA
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Espino DV, Palmer RF, Mouton CP, Miles TP, Bayne NS, Markides KS. Patterns of prescription drug utilization in elder Mexican Americans: results from the Hispanic EPESE Study. Established Population for the Epidemiologic Study of the Elderly. Ethn Dis 2001; 10:218-23. [PMID: 10892828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The objective of this study was to determine the patterns of prescription medication usage among community-dwelling Mexican-American elders. This was a cross-sectional survey of a regional probability sample of 2,895 community-dwelling Mexican Americans, aged 65 and over. Of the sample, 58.1% used at least one prescribed medication within the two weeks prior to their participation in the study. Women were significantly more likely than men to use analgesics, non-steroidal anti-inflammatory agents, prescription nutritional supplements, and other central nervous system and endocrine medications. Subjects aged 75 and over were more likely to use cardiovascular medications, nutritional supplements, ophthalmic preparations and antihistamines, while those in the age groups 65-69 and 70-74 were more likely to use hypoglycemic and endocrine medications. Interestingly, there was a significantly decreased usage of hypoglycemic medications in the older age group (aged 75 and over) as compared with the younger age groups (65-69 and 69-74). This may indicate that Mexican American elders are dying at younger ages from complications related to diabetes mellitus and are not alive to use hypoglycemic medications at ages 75 and over. Also, men used more hypoglycemic medication than women (77% vs 70%). There was no relationship between use of medication and severity of diabetic illness.
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Affiliation(s)
- D V Espino
- Department of Family Practice, University of Texas Health Science Center at San Antonio, 78284-7794, USA.
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Miles TP, Palmer RF, Espino DV, Mouton CP, Lichtenstein MJ, Markides KS. New-onset incontinence and markers of frailty: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. J Gerontol A Biol Sci Med Sci 2001; 56:M19-24. [PMID: 11193227 DOI: 10.1093/gerona/56.1.m19] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urinary incontinence in older adults has many distinct etiologies and is associated with lower self-reported health. However, it is unclear whether the new onset of urinary incontinence marks newly emergent frailty. METHODS Using a longitudinal population-based survey of older Mexican Americans (N = 2660) across five south-western states, this study compared the strength of association between markers of physical frailty such as activities of daily living (ADLs), instrumental activities of daily living (IADLs), and performance (timed walk, timed chair rise, and tandem balance) with baseline incontinence (prevalent disease) and new-onset incontinence (incident disease). RESULTS We found that 14.1% of the participants (n = 329) were incontinent at baseline (prevalent cases) and 11.6% (n = 208) were newly incontinent 2 years later (incident cases). Controlling for other covariates, prevalent incontinence was only associated with a 60% increased risk of having difficulty walking 8 ft. Incident incontinence was associated with a twofold increased risk of impairment in ADLs and IADLs, and poor performance on all three physical measures. CONCLUSIONS Incident incontinence is associated with an increased risk of more global functional impairment. Thus, incident disease may be an important early marker for signaling the onset of frailty among persons who become incontinent after the age of 65 years.
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Affiliation(s)
- T P Miles
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, USA.
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Espino DV, Palmer RF, Miles TP, Mouton CP, Wood RC, Bayne NS, Markides KP. Prevalence, incidence, and risk factors associated with hip fractures in community-dwelling older Mexican Americans: results of the Hispanic EPESE study. Establish Population for the Epidemiologic Study for the Elderly. J Am Geriatr Soc 2000; 48:1252-60. [PMID: 11037012 DOI: 10.1111/j.1532-5415.2000.tb02598.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the rates and risk factors associated with hip fractures in the community-dwelling older Mexican-American population. DESIGN A prospective survey of a regional probability sample of older Mexican Americans aged 65 and over. SETTING The 1993-1996 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, aged 65 and over, living in the Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS In 1993-1994 and in 1995-1996, 2895 persons, aged 65 and over, considered Mexican American, were selected at baseline as a weighted probability sample. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest US. MEASUREMENTS Self-reported hip fracture and functional measures by in home interviews. RESULTS Hip fracture prevalence was 4.0% at baseline. The overall incidence of hip fractures for women was 9.1 fractures/1000 person-years. The incidence rate for men was 4.8 fractures/1000 person-years. Extrapolation from these data to the entire older Mexican American population indicated that approximately 5162 new fractures occurred in the population during the 2 year study period. In women, hip fractures were associated independently with advanced age, not being married/living alone, having had a stroke, limitations with activities of daily living and instrumental activities of daily living. In men, only the latter limitations were associated independently with hip fracture. CONCLUSIONS This study indicates that older Mexican American people may have hip fracture incidence rates that place them at highest risk among the Hispanic subgroups. In light of a sparse literature on this population, the fracture estimates derived from this work contributes to our understanding of the true fracture estimates in this population. Based on the extrapolated population rates, hip fracture in this population is a significant public health problem. Adequate preventive measures need to be implemented in this growing US population.
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Affiliation(s)
- D V Espino
- Division of Community Geriatrics, Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 78284-7795, USA
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Nelson TL, Vogler GP, Pedersen NL, Hong Y, Miles TP. Genetic and environmental influences on body fat distribution, fasting insulin levels and CVD: are the influences shared? Twin Res 2000; 3:43-50. [PMID: 10808240 DOI: 10.1375/136905200320565689] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Central body fat distribution has been shown to be related to hyperinsulinemia, insulin resistance, hypertriglyceridemia, and atherosclerosis to a greater degree than general obesity. There are known to be both genetic and environmental effects on all components of this clustering. Whether these genetic effects are due to one set of genes in common to the components or whether genetic influences on insulin resistance and/or general/abdominal fatness 'turn on' other genes that affect other components of the syndrome is not clear. We analyzed data from the Swedish Adoption/Twin Study of Aging (60% female; monozygotic = 116, dizygotic = 202; average age 65 years) to determine whether there were genetic and/or environmental factors shared among general body fat distribution, abdominal body fat distribution, fasting insulin levels and cardiovascular disease. We found additive genetic effects in males to be significantly different from those in females with genetic effects accounting for variance in waist-hip ratio (males = 28%; females = 49%), body mass index (males = 58%; females = 73%), fasting insulin levels (FI) (males = 27%; females = 49%), and cardiovascular disease (CVD) (males = 18%; females = 37%). There were also shared genetic and environmental effects among all the variables except CVD, but a majority of the genetic variance for these measures was trait specific.
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Affiliation(s)
- T L Nelson
- Department of Biobehavioral Health and Center for Developmental and Health Genetics, The Pennsylvania State University, PA, USA.
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Nelson TL, Vogler GP, Pedersen NL, Miles TP. Genetic and environmental influences on waist-to-hip ratio and waist circumference in an older Swedish twin population. Int J Obes (Lond) 1999; 23:449-55. [PMID: 10375046 DOI: 10.1038/sj.ijo.0800840] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [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: 11/09/2022]
Abstract
OBJECTIVE To investigate the genetic and environmental influences on waist-to-hip ratio (WHR) and waist circumference (WC) measurements in males and females. DESIGN Measurements taken from 1989-1991 as part of The Swedish Adoption/Twin Study of Aging (SATSA) were used for analysis. The SATSA sample contains both twins reared together as well as twins reared apart. SUBJECTS 322 pairs of twins (50 identical, 82 fraternal male pairs and 67 identical, 123 fraternal female pairs); age range: 45-85y (average age, 65y). MEASUREMENTS Waist-to-hip ratio (WHR), waist circumference (WC) and body mass index (BMI). RESULTS In males, additive genetic effects were found to account for 28% of the variance in WHR and 46% of the variance in WC. In females, additive genetic effects were found to account for 48% of the variance in WHR and 66% of the variance in WC. The remaining variance in males was attributed to unique environmental effects (WHR, 72%; WC, 54%) and in females the remaining variance was attributed to unique environmental effects (WHR, 46%; WC, 34%) and age (WHR, 6%). When BMI was added into these models it accounted for a portion of the genetic and environmental variance in WHR, and over half of the genetic and environmental variance in WC. CONCLUSION There are both genetic and environmental influences on WHR and WC, independent of BMI in both males and females, and the differences between the sexes are significantly different.
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Affiliation(s)
- T L Nelson
- Department of Biobehavioral Health and Center for Developmental and Health Genetics, The Pennsylvania State University, University Park 16802, USA.
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Abstract
OBJECTIVE Abdominal fat has been shown to be associated with several adverse outcomes including diabetes, cardiovascular disease, and hypertension. Risk factors for abdominal fatness include genetic effects, age, and gender. Most recently, it has been hypothesized that psychological factors, as well as behavioral factors, may play a part in where fat is distributed. The purpose of this study was to assess the longitudinal predictive power of psychological variables (cynicism, anger, anxiety, and depression) measured in 1987 on waist-hip ratio (WHR) measured from 1992 to 1994 among different age and gender groups, as well as to test if alcohol consumption or smoking (measured in 1990) would mediate any of the relationships found. RESEARCH METHODS AND PROCEDURES Data from the Swedish Adoption/Twin Study of Aging (n = 1392; average age: 58 years for middle-aged group and 74 years for older group; 58% female) were analyzed using a maximum-likelihood regression model where age, gender, and age by gender effects were assessed. RESULTS Cynicism and anxiety predicted WHR in middle-aged subjects regardless of gender. Cynicism explained 2.5% of the variance in WHR and anxiety explained 1.7% of the variance in WHR. Anger predicted WHR in males regardless of age, explaining 4.0% of the variance; depression predicted WHR only in middle-aged females, explaining 2.0% of the variance. All analyses adjusted for body mass index, and neither alcohol consumption or smoking status mediated the relationships. DISCUSSION These findings are suggestive with regard to the hypotheses that certain psychological states and behaviors may be associated with increased abdominal fatness.
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Affiliation(s)
- T L Nelson
- Department of Biobehavioral Health, The Pennsylvania State University, University Park 16802, USA.
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Schuit AJ, Schouten EG, Miles TP, Evans WJ, Saris WH, Kok FJ. The effect of six months training on weight, body fatness and serum lipids in apparently healthy elderly Dutch men and women. Int J Obes (Lond) 1998; 22:847-53. [PMID: 9756242 DOI: 10.1038/sj.ijo.0800671] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the effect of a six-months training program on changes in body weight and lipid concentrations, and their interrelationship in elderly people. DESIGN Intervention study. The elderly subjects were randomly assigned to a control group or one of two supervised aerobic training groups, either all round activities or ergometer cycling, both exercising 3-4 times a week for six months. SUBJECTS 229 elderly men and women, aged 60-80 y. MEASUREMENTS Various fatness parameters by anthropometry, serum lipids and peak power output. RESULTS During the intervention, no significant changes were observed in weight or body fatness in subjects of the training groups. Serum high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol and triglycerides tended to change in a favourable direction in the elderly of the intervention groups, but only triglyceride concentration in women of the cycle ergometer group (mean difference with controls: -0.24 mmol/L, 95% confidence interval (CI): -0.45, -0.03) and total serum cholesterol and HDL-cholesterol concentrations in subjects of the all-round activity group, (-0.32mmol/L, 95% CI: -0.63, -0.01 and -0.15mmol/L, 95% CI -0.25, -0.05, respectively) were significantly reduced as compared to controls. Regression analysis showed that the intervention-control difference in change of all lipids was independent of changes in weight, body fat and previous engagement in sport activity. CONCLUSION Regular physical exercise in an elderly population resulted in favourable changes in serum lipid concentrations that were not significant, but no change in body weight or fatness. Change in lipid concentration could not be attributed to change in weight or body fat.
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Affiliation(s)
- A J Schuit
- Department of Epidemiology and Public Health, Wageningen University, The Netherlands
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Miles TP, McBride D. The NRAMP1 gene and susceptibility to tuberculosis. N Engl J Med 1998; 339:200; author reply 200-1. [PMID: 9669916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Researchers throughout the United States have developed an increased interest in recruiting minority groups into studies. Such increased interests have been encouraged by the federal agencies that have mandated diversity in study populations. This editorial attempts to explore salient issues pertinent to the recruitment and retention of African Americans and cites culturally specific recruitment strategies that have been successfully applied by investigators. African Americans may have special concerns that may have to be addressed by the investigators prior to initiation of the study. Concerns may include the fear of being treated as a 'guinea pig' and the need for psychosocial programs. Such concerns require culturally sensitive strategies which may include trust-building and the provision of ancillary services. Although specific strategies are required to recruit and retain this special population in clinical studies, there are no guarantees that enrollment will be successful even with the inclusion of culturally sensitive mechanisms.
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Affiliation(s)
- G J Bonner
- Department of Neurological Sciences, Rush Medical College, Chicago, IL 60612, USA
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Whitfield KE, Seeman TE, Miles TP, Albert MS, Berkman LF, Blazer DG, Rowe JW. Health indices as predictors of cognition among older African Americans: MacArthur studies of successful aging. Ethn Dis 1997; 7:127-36. [PMID: 9386953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Using cross-sectional and longitudinal data from the MacArthur Successful Aging Study, this paper examines associations between cognition and indices of health in 224 elderly African Americans 70 to 79 years of age at initial interview. The results indicated that greater average peak expiratory flow was predictive of better cognitive performance at the first interview. One longitudinal analysis showed that gender was the only significant predictor of change (change as a continuous variable) with women tending to slightly improve their cognitive performance over time. When change was treated as a dichotomous variable (e.g., a decline of 6 or more points), lower levels of average peak expiratory flow and education were predictive of decline, and positive self-ratings of current health and changes in health in the past year were important factors in the improvement of cognitive performance. The results indicate that, in addition to education, health is an important predictor of the status and course of cognitive functioning in older African Americans.
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Affiliation(s)
- K E Whitfield
- Department of Biobehavioral Health, Pennsylvania State University, University Park 16802, USA.
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Abstract
Syphilis outbreaks and differentials have been an ongoing issue in modern preventive medicine and public health. Since the early 20th Century, a variety of approaches has been employed to explain demographic and temporal variations in the prevalence of syphilis in the U.S. Public health experts and physicians have tended to rely on case-by-case approaches to explain group-specific patterns. This study, however, shows that population-level disease dynamics cannot be ascertained from these individual-level studies. We offer a biohistorical methodology to study syphilis prevalence differentials in U.S. populations. Using historical health data, this study suggests that the social disruption brought on by World War I was the critical and unique environmental condition which ignited an epidemic of syphilis among black Americans. By establishing this beginning point for the epidemic, this study further shows the persistence of the epidemic for the next 40 years and its decline. This biohistorical methodology could be applied to the analysis of STD epidemics in other populations and regions experiencing mass exposure events.
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Affiliation(s)
- T P Miles
- Center for Special Populations and Health, Pennsylvania State University, University Park 16802-6500, USA
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Miles TP. Population-based, genetically informative sample for studies of physical frailty and aging: black elderly twin study. Hum Biol 1997; 69:107-20. [PMID: 9037899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this article 1 describe efforts to build a genetically informative, population-based sample of black twins to study physical frailty and aging in the United States. This project involves the use of governmental registries combined with sampling techniques developed to overcome limitations in the registry data. Two analytical approaches to measures of disability are included to illustrate the types of questions that can be addressed with this sample. These results suggest that physical disability in late life has both genetic and environmental determinants. Only with a genetically informative sample can evidence be collected indicating that frailty may be driven by fixed processes (i.e., disability resulting from activation of senescence genes), fluid processes (i.e., disability resulting from changes in the features of the environment), or a combination of both.
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Affiliation(s)
- T P Miles
- Biobehavioral Health Department, Pennsylvania State University, University Park 16802-6500, USA
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Goldberg J, Miles TP, Furner S, Meyer JM, Hinds A, Ramakrishnan V, Lauderdale DS, Levy PS. Identification of a cohort of male and female twins aged 65 years or more in the United States. Am J Epidemiol 1997; 145:175-83. [PMID: 9006314 DOI: 10.1093/oxfordjournals.aje.a009088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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] [Indexed: 02/03/2023] Open
Abstract
In this paper, a method with which to identify a national cohort of elderly twins is proposed. Record linkage algorithms were developed and applied to the > 30 million records contained in the Medicare beneficiary file. The matching algorithm for male/male pairs used race (black or white), last name, date of birth, and state of issuance of the Social Security number. Female/female and male/female pairs were selected with matching on race, date of birth, and the first seven digits of the Social Security number to compensate for the absence of maiden names. A stratified random sample of same-sex and opposite-sex white and black pairs (six groups) were selected and surveyed for determination of the actual prevalence of twins. On the basis of these results, the authors conclude that this method could identify an estimated 18,308 male/male, 7,544 female/female, and 204 male/female pairs of twins aged 65 years or more. This would be the largest sample of older twins ever assembled in the United States and represents a significant new resource for epidemiologic studies of the aging population.
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Affiliation(s)
- J Goldberg
- Division of Epidemiology-Biostatistics, School of Public Health, University of Illinois at Chicago 60612-7260, USA
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Abstract
Age comparisons of survival in cancer cohorts generally utilize relative survival rates, which are based on indicators of the probability of survival for a given number of years after diagnosis. Cancer relative survival rates for the same number of years tend to decline as age at diagnosis increases. However, the same number of years of survival reflects higher relative longevity at older ages than at younger ages. The realized probability of dying (RPD) is a survival measure that expresses individual survival time after diagnosis relative to the survival distribution of an age-, race-, and sex-specific reference population, in effect weighing individual survival time more heavily as age at diagnosis increases. The purpose of this study was to apply the RPD as a survival measure in cancer epidemiology. Two cohorts of cancer patients, white males with prostate cancer and white females with breast cancer, aged 55 years and over at diagnosis, were followed for 15 years. Although older subjects survived less time after diagnosis than younger subjects, they achieved more favorable RPD values. We present survival analysis methods for analyzing the RPD in this population, an approach not previously used with this measure. The implications for use of the RPD in cancer epidemiology are discussed.
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Affiliation(s)
- K S Blesch
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago 60612, USA
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Abstract
OBJECTIVE To examine the association between declining serum cholesterol and mortality in a sample of older nursing home residents. DESIGN A retrospective cohort study. SETTING A 203-bed nursing home. PARTICIPANTS Persons aged 65 and older, resident in the nursing home on January 1, 1988, or admitted through December 31, 1989, were eligible (n = 185) for the study. Follow-up for mortality was conducted until June 30, 1991. Fifty-five survivors with two or more cholesterol levels recorded before January 1, 1990, and the 76 decedents with two or more recorded cholesterol levels constituted the analytic sample (71% of eligible subjects). OUTCOME MEASURE Mortality of the nursing home residents. RESULTS Cholesterol declined 31.1 mg/dL/yr (95% confidence interval [CI], 19.7 to 42.6) among decedents, versus 4.2 mg/dL/yr (95% CI, -4.9 to 13.2) among survivors. The association between cholesterol decline (absolute or relative rates) and mortality was examined using logistic regression controlling for age, sex, and tube feeding. Compared with a referrent group with no change or increase, declining cholesterol greater than 45 mg/dL/yr was accompanied by an adjusted relative odds for death of 6.2 (95% CI, 2.1 to 18.4); declining cholesterol greater than 20% per year was accompanied by an adjusted relative odds for death of 7.3 (95% CI; 2.4 to 22.2). Extreme declines greater than 20% per year occurred in 47% of decedents but in only 15% of survivors. CONCLUSION Precipitously declining cholesterol appeared to be a marker for mortality in the sample and may help explain the low cholesterol-mortality association in older nursing home residents.
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Affiliation(s)
- M D Grant
- West Suburban Hospital Family Practice Residency, Oak Park, Illinois 60302, USA
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