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  • 1
    Online Resource
    Online Resource
    Acculturation and Cardiovascular Risk Factor Control among Hispanic Adults in the United States
    SAGE Publications ; 2009
    In:  Public Health Reports Vol. 124, No. 6 ( 2009-11), p. 818-824
    Details
    In: Public Health Reports, SAGE Publications, Vol. 124, No. 6 ( 2009-11), p. 818-824
    Abstract: We sought to determine whether low acculturation, based on language measures, leads to disparities in cardiovascular risk factor control in U.S. Hispanic adults. Methods. We studied 4,729 Hispanic adults aged 18 to 85 years from the National Health and Nutrition Examination Survey, 1999–2004. We examined the association between acculturation and control of low-density lipoprotein (LDL) cholesterol, blood pressure, and hemoglobin A1c based on national guidelines among participants with hypercholesterolemia, hypertension, and diabetes, respectively. We used weighted logistic regression adjusting for age, gender, and education. We then examined health insurance, having a usual source of care, body mass index, fat intake, and leisure-time physical activity as potential mediators. Results. Among participants with hypercholesterolemia, Hispanic adults with low acculturation were significantly more likely to have poorly controlled LDL cholesterol than Hispanic adults with high acculturation after multivariable adjustment (odds ratio [OR] = 3.4, 95% confidence interval [CI] 1.2, 9.5). Insurance status mildly attenuated the difference in LDL cholesterol control. After adjusting for diet and physical activity, the magnitude of the association increased. Other covariates had little influence on the observed relationship. Among those with diabetes and hypertension, we did not observe statistically significant associations between low acculturation and control of hemoglobin A1c (OR=0.5, 95% CI 0.2, 1.2), and blood pressure (OR=1.1, 95% CI 0.6, 1.7), respectively. Conclusions. Low levels of acculturation may be associated with increased risk of inadequate LDL cholesterol control among Hispanic adults with hypercholesterolemia. Further studies should examine the mechanisms by which low acculturation might adversely impact lipid control among Hispanic adults in the U.S.
    Type of Medium: Online Resource
    ISSN: 0033-3549 , 1468-2877
    URL: Article
    DOI: 10.1177/003335490912400609
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2017700-8
    SSG: 20,1
    SSG: 27
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  • 2
    Online Resource
    Online Resource
    Microemboli are not associated with delirium after coronary artery bypass graft surgery
    SAGE Publications ; 2009
    In:  Perfusion Vol. 24, No. 6 ( 2009-11), p. 409-415
    Details
    In: Perfusion, SAGE Publications, Vol. 24, No. 6 ( 2009-11), p. 409-415
    Abstract: Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery. Non-delirious patients (n=68) were prospectively enrolled and underwent intraoperative monitoring of the middle cerebral arteries with transcranial Doppler (TCD). TCD signals were saved and analyzed postoperatively for microemboli manually, according to established criteria. Postoperatively, patients were assessed for delirium with a standardized battery. Thirty-three patients (48.5%) developed delirium after surgery. Microemboli counts (mean ± SD) were not significantly different in those with and without delirium (303 ± 449 vs. 299 ± 350; p=0.97). While intraoperative microemboli were not associated with delirium after CABG, further investigation into the source and composition of microemboli can further elucidate the long-term clinical impact of microemboli.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/0267659109358207
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2029611-3
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  • 3
    Online Resource
    Online Resource
    Preoperative Cognitive Performance Dominates Risk for Delirium Among Older Adults
    SAGE Publications ; 2016
    In:  Journal of Geriatric Psychiatry and Neurology Vol. 29, No. 6 ( 2016-11), p. 320-327
    Details
    In: Journal of Geriatric Psychiatry and Neurology, SAGE Publications, Vol. 29, No. 6 ( 2016-11), p. 320-327
    Abstract: Cognitive impairment is a well-recognized risk factor for delirium. Our goal was to determine whether the level of cognitive performance across the nondemented cognitive ability spectrum is correlated with delirium risk and to gauge the importance of cognition relative to other known risk factors for delirium. Methods: The Successful Aging after Elective Surgery study enrolled 566 adults aged ≥70 years scheduled for major surgery. Patients were assessed preoperatively and daily during hospitalization for the occurrence of delirium using the Confusion Assessment Method. Cognitive function was assessed preoperatively with an 11-test neuropsychological battery combined into a composite score for general cognitive performance (GCP). We examined the risk for delirium attributable to GCP, as well as demographic factors, vocabulary ability, and informant-rated cognitive decline, and compared the strength of association with risk factors identified in a previously published delirium prediction rule for delirium. Results: Delirium occurred in 135 (24%) patients. Lower GCP score was strongly and linearly predictive of delirium risk (relative risk = 2.0 per each half standard deviation difference in GCP score, 95% confidence interval, 1.5-2.5). This effect was not attenuated by statistical adjustment for demographics, vocabulary ability, and informant-rated cognitive decline. The effect was stronger than, and largely independent from, both standard delirium risk factors and comorbidity. Conclusion: Risk of delirium is linearly and strongly related to presurgical cognitive performance level even at levels above the population median, which would be considered unimpaired.
    Type of Medium: Online Resource
    ISSN: 0891-9887 , 1552-5708
    URL: Article
    DOI: 10.1177/0891988716666380
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2094096-8
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  • 4
    Online Resource
    Online Resource
    Derivation and Confirmation of Scales Measuring Medical Directors’ Attitudes About the Hospitalization of Nursing Home Residents
    SAGE Publications ; 2006
    In:  Journal of Aging and Health Vol. 18, No. 6 ( 2006-12), p. 869-884
    Details
    In: Journal of Aging and Health, SAGE Publications, Vol. 18, No. 6 ( 2006-12), p. 869-884
    Abstract: Objectives: To derive and confirm scales measuring medical director’s attitudes about hospitalization of nursing home residents. Method: The authors surveyed nursing facility medical directors about the necessity of hospitalizing residents for eight clinical conditions and compared the ratings to those obtained from an expert panel to derive a relative hospitalization score. They also asked about factors that might influence hospitalization decisions. They performed a factor analysis to derive scales that measure attitudinal determinants of hospitalization and used the relative hospitalization score to confirm the scales. Results: The survey had a 79% response rate. The relative hospitalization score demonstrated that medical directors were slightly less likely to recommend hospitalization than expert panel physicians. Factor analyses yielded 10 scales focusing on nursing home functioning, economics, resident specific considerations, and physician attitudes. Eight of the 10 scales had significant bivariable associations with the relative hospitalization score, and 6 had significant multivariable associations. Discussion: Medical directors identify multiple determinants of hospitalization for nursing facility residents across several domains. Hospitalization decisions for nursing facility residents are complex and involve clinical and nonclinical factors.
    Type of Medium: Online Resource
    ISSN: 0898-2643 , 1552-6887
    URL: Article
    DOI: 10.1177/0898264306293617
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2006
    detail.hit.zdb_id: 2034469-7
    SSG: 5,2
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  • 5
    Online Resource
    Online Resource
    Deriving a Model of the Necessity to Hospitalize Nursing Home Residents
    SAGE Publications ; 2007
    In:  Research on Aging Vol. 29, No. 6 ( 2007-11), p. 606-625
    Details
    In: Research on Aging, SAGE Publications, Vol. 29, No. 6 ( 2007-11), p. 606-625
    Abstract: Although often important to recover from acute medical problems and exacerbations of chronic illness, hospitalizations can be traumatic for nursing home residents and costly for payers. It is important that unnecessary hospitalizations are avoided wherever possible. The authors derived and validated a diagnosis-based model to estimate the clinical necessity of hospitalizing nursing home residents with common conditions using data from an expert panel survey. Model validation involved a linked minimum data set—hospitalization claims data set. The expert panel of 12 experienced geriatricians rated the necessity of hospitalization for 1,948 clinical scenarios containing diagnoses, cognitive and functional status, age, gender, and advance directives. Primary diagnoses with the highest average necessity scores were respiratory failure, acute myocardial infarction, hip fracture, and brain injury. The secondary diagnosis-primary diagnosis interaction with the greatest impact was gastrointestinal bleed on gastroenteritis. Poor cognitive function and presence of an advance directive lowered the risk of hospitalization.
    Type of Medium: Online Resource
    ISSN: 0164-0275 , 1552-7573
    URL: Article
    DOI: 10.1177/0164027507305731
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
    detail.hit.zdb_id: 2030098-0
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  • 6
    Online Resource
    Online Resource
    Cerebral blood flow MRI in the nondemented elderly is not predictive of post-operative delirium but is correlated with cognitive performance
    SAGE Publications ; 2017
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 37, No. 4 ( 2017-04), p. 1386-1397
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 37, No. 4 ( 2017-04), p. 1386-1397
    Abstract: Three-dimensional Arterial Spin Labeling (ASL) MRI was performed before surgery in a cohort of 146 prospectively enrolled subjects ≥ 70 years old scheduled to undergo elective surgery. We investigated the prospective association between ASL-derived measures of cerebral blood flow (CBF) before surgery with postoperative delirium incidence and severity using whole-brain and globally normalized voxel-wise analysis. We also investigated the cross-sectional association of CBF with patients’ baseline performance on specific neuropsychological tests, and with a composite general cognitive performance measure (GCP). Out of 146 subjects, 32 (22%) developed delirium. We found no significant association between global and voxel-wise CBF with delirium incidence or severity. We found the most significant positive associations between CBF of the posterior cingulate and precuneus and the Hopkins Verbal Learning Test – Revised total score, Visual Search and Attention Test (VSAT) score and the GCP composite. VSAT score was also strongly associated with right parietal lobe CBF. ASL can be employed in a large, well-characterized older cohort to examine associations between CBF and age-related cognitive performance. Although ASL CBF measures in regions previously associated with preclinical Alzheimer’s Disease were correlated with cognition, they were not found to be indicators of baseline pathology that may increase risk for delirium.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1177/0271678X16656014
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2039456-1
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