73 results on '"Rosaly Correa-de-Araujo"'
Search Results
2. Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study
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David A. Ganz, Albert L. Siu, Jay Magaziner, Nancy K. Latham, Thomas G. Travison, Nancy P. Lorenze, Charles Lu, Rixin Wang, Erich J. Greene, Cynthia L. Stowe, Lea N. Harvin, Katy L. B. Araujo, Jerry H. Gurwitz, Yuri Agrawal, Rosaly Correa-De-Araujo, Peter Peduzzi, Thomas M. Gill, and on behalf of the STRIDE Investigators
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Falls ,Injuries ,Adjudication ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background This paper describes a protocol for determining the incidence of serious fall injuries for Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), a large, multicenter pragmatic clinical trial with limited resources for event adjudication. We describe how administrative data (from participating health systems and Medicare claims) can be used to confirm participant-reported events, with more time- and resource-intensive full-text medical record data used only on an “as-needed” basis. Methods STRIDE is a pragmatic cluster-randomized controlled trial involving 5451 participants age ≥ 70 and at increased risk for falls, served by 86 primary care practices in 10 US health systems. The STRIDE intervention involves a nurse falls care manager who assesses a participant’s underlying risks for falls, suggests interventions using motivational interviewing, and then creates, implements and longitudinally follows up on an individualized care plan with the participant (and caregiver when appropriate), in partnership with the participant’s primary care provider. STRIDE’s primary outcome is serious fall injuries, defined as a fall resulting in: (1) medical attention billable according to Medicare guidelines with a) fracture (excluding isolated thoracic vertebral and/or lumbar vertebral fracture), b) joint dislocation, or c) cut requiring closure; OR (2) overnight hospitalization with a) head injury, b) sprain or strain, c) bruising or swelling, or d) other injury determined to be “serious” (i.e., burn, rhabdomyolysis, or internal injury). Two sources of data are required to confirm a serious fall injury. The primary data source is the participant’s self-report of a fall leading to medical attention, identified during telephone interview every 4 months, with the confirmatory source being (1) administrative data capturing encounters at the participating health systems or Medicare claims and/or (2) the full text of medical records requested only as needed. Discussion Adjudication is ongoing, with over 1000 potentially qualifying events adjudicated to date. Administrative data can be successfully used for adjudication, as part of a hybrid approach that retrieves full-text medical records only when needed. With the continued refinement and availability of administrative data sources, future studies may be able to use administrative data completely in lieu of medical record review to maximize the quality of adjudication with finite resources. Trial registration ClinicalTrials.gov (NCT02475850).
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- 2019
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3. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging
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Rosaly Correa-de-Araujo, Odessa Addison, Iva Miljkovic, Bret H. Goodpaster, Bryan C. Bergman, Richard V. Clark, Joanne W. Elena, Karyn A. Esser, Luigi Ferrucci, Michael O. Harris-Love, Steve B. Kritchevsky, Amanda Lorbergs, John A. Shepherd, Gerald I. Shulman, and Clifford J. Rosen
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myosteatosis ,intermuscular adipose tissue ,intramuscular adipose tissue ,intramyocellular lipids ,skeletal muscle function deficit ,muscle quality ,Physiology ,QP1-981 - Abstract
Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis’ impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.
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- 2020
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4. Nurses’ Working Conditions: Implications for Infectious Disease
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Patricia W. Stone, Sean Clarke, Jeannie Cimiotti, and Rosaly Correa-de-Araujo
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nurse working conditions ,patient safety ,healthcare-associated infections ,occupational injuries ,emerging infectious disease ,synopsis ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Staffing patterns and nurses’ working conditions are risk factors for healthcare-associated infections as well as occupational injuries and infections. Staffing shortages, especially of nurses, have been identified as one of the major factors expected to constrain hospitals’ ability to deal with future outbreaks of emerging infections. These problems are compounded by a global nursing shortage. Understanding and improving nurses’ working conditions can potentially decrease the incidence of many infectious diseases. Relevant research is reviewed, and policy options are discussed.
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- 2004
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5. Challenges in Healthcare Systems and Women's Caregiving Roles
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Rosaly Correa-de-Araujo, Patricia Stone, and Sean Clarke
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women ,caregiving roles ,conference summary ,United States ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2004
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6. Public Health Need, Molecular Targets, and Opportunities for the Accelerated Development of Function-Promoting Therapies: Proceedings of a National Institute on Aging Workshop
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Rosaly Correa-de-Araujo and Shalender Bhasin
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Aging ,THE JOURNAL OF GERONTOLOGY: Medical Sciences ,National Institute on Aging (U.S.) ,Humans ,Public Health ,Geriatrics and Gerontology ,United States ,Aged - Abstract
Background People ≥ 65 years are expected to live a substantial portion of their remaining lives with a limiting physical condition and the numbers of affected individuals will increase substantially due to the growth of the population of older adults worldwide. The age-related loss of muscle mass, strength, and function is associated with an increased risk of physical disabilities, falls, loss of independence, metabolic disorders, and mortality. The development of function-promoting therapies to prevent and treat age-related skeletal muscle functional limitations is a pressing public health problem. Methods On March 20–22, 2022, the National Institute on Aging (NIA) held a workshop entitled “Development of Function-Promoting Therapies: Public Health Need, Molecular Targets, and Drug Development.” Results The workshop covered a variety of topics including advances in muscle biology, novel candidate molecules, findings from randomized trials, and challenges in the design of clinical trials and regulatory approval of function-promoting therapies. Leading academic investigators, representatives from the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA), professional societies, pharmaceutical industry, and patient advocacy organizations shared research findings and identified research gaps and strategies to advance the development of function-promoting therapies. A diverse audience of 397 national and international professionals attended the conference. Conclusions Function-promoting therapies to prevent and treat physical disabilities associated with aging and chronic diseases are a public health imperative. Appropriately powered, well-designed clinical trials and synergistic collaboration among academic experts, patients and stakeholders, the NIH and the FDA, and the pharmaceutical industry are needed to accelerate the development of function-promoting therapies.
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- 2022
7. Muscle Quality in Older Adults: A Scoping Review
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Charles Phillipe de Lucena Alves, Samuel Brito de Almeida, Danielle Pessoa Lima, Pedro Braga Neto, Ana Lúcia Miranda, Todd Manini, Lara Vlietstra, Debra L. Waters, Renata Moraes Bielemann, Rosaly Correa-de-Araujo, Ana Paula Fayh, and Eduardo Caldas Costa
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Health Policy ,General Medicine ,Geriatrics and Gerontology ,General Nursing - Published
- 2023
8. Sarcopenia Definition & Outcomes Consortium Defined Low Grip Strength in Two Cross‐Sectional, Population‐Based Cohorts
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Douglas P. Kiel, Anne B. Newman, Karol M. Pencina, Kate A. Duchowny, Sheena Patel, Rosaly Correa-de-Araujo, Jay Magaziner, Todd M. Manini, Qian Li Xue, Thomas G. Travison, Peggy M. Cawthon, Adam J. Santanasto, Shalender Bhasin, and Roger A. Fielding
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Weakness ,education.field_of_study ,business.industry ,010102 general mathematics ,Population ,Muscle weakness ,Population based ,medicine.disease ,01 natural sciences ,Gait ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Sarcopenia ,medicine ,030212 general & internal medicine ,0101 mathematics ,Geriatrics and Gerontology ,medicine.symptom ,business ,education ,Body mass index ,Demography - Abstract
BACKGROUND/OBJECTIVES: The extent to which the prevalence of muscle weakness in the US population varies by different putative grip strength constructs developed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) has not been described. DESIGN: Cross-sectional analysis. SETTING: Two nationally representative cohorts-2010 and 2012 waves of the Health and Retirement Survey and round 1 (2011) of the National Health and Aging Trends Survey. PARTICIPANTS: Adults aged 65 years and older (n = 12,984) were included in these analyses. MEASUREMENTS: We analyzed three constructs of muscle weakness developed by the SDOC, and found to be associated with mobility disability for men and women, respectively: absolute grip strength (
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- 2020
9. Application of <scp>Cut‐Points</scp> for Low Muscle Strength and Lean Mass in <scp>Mobility‐Limited</scp> Older Adults
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Peggy M. Cawthon, Gregory J. Grosicki, Jay Magaziner, Hao Zhu, Todd M. Manini, Shalender Bhasin, Denise Orwig, Marco Pahor, Thomas G. Travison, Roger A. Fielding, Rosaly Correa-de-Araujo, Joseph M. Massaro, Ellen F. Binder, Susan L. Greenspan, Sheena Patel, and Adam J. Santanasto
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Sarcopenia ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Risk Assessment ,Article ,law.invention ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,Muscle Strength ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,Muscle weakness ,Odds ratio ,medicine.disease ,Preferred walking speed ,Nutrition Assessment ,Lean body mass ,Physical therapy ,Geriatrics and Gerontology ,medicine.symptom ,business - Abstract
BACKGROUND The Sarcopenia Definitions and Outcomes Consortium (SDOC) is a collaborative initiative seeking to develop and evaluate cut-points for low muscle strength and lean mass that predict an increased risk for slowness (usual walking speed
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- 2020
10. Sarcopenia Definition: The Position Statements of the Sarcopenia Definition and Outcomes Consortium
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Karol M. Pencina, Ralph B. DʼAgostino, Greg Gorsicki, Brian C. Clark, Todd M. Manini, Peggy M. Cawthon, Roger A. Fielding, Jack M. Guralnik, Jane A. Cauley, Jay Magaziner, Jean Woo, Hidenori Arai, Thomas G. Travison, Quian Li Xue, Douglas P. Kiel, Daniel Rooks, Sheena Patel, Rosaly Correa-de-Araujo, Laura A. Schaap, Suzette L. Pereira, Ellen F. Binder, Todd T. Brown, Denise Orwig, Francesco Landi, Cyrus Cooper, Linda J. Woodhouse, Anne B. Newman, Michelle Shardell, Shalender Bhasin, Nutrition and Health, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, and AMS - Musculoskeletal Health
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Weakness ,medicine.medical_specialty ,lean mass cut points ,Population ,030209 endocrinology & metabolism ,law.invention ,sarcopenia ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Physical medicine and rehabilitation ,Randomized controlled trial ,law ,consensus definition of sarcopenia ,Medicine ,030212 general & internal medicine ,education ,mobility disability ,education.field_of_study ,business.industry ,grip strength cut points ,SDG 10 - Reduced Inequalities ,medicine.disease ,Sarcopenia ,Lean body mass ,Position (finance) ,Geriatrics and Gerontology ,medicine.symptom ,business ,human activities ,Cohort study - Abstract
Objectives To develop an evidence-based definition of sarcopenia that can facilitate identification of older adults at risk for clinically relevant outcomes (eg, self-reported mobility limitation, falls, fractures, and mortality), the Sarcopenia Definition and Outcomes Consortium (SDOC) crafted a set of position statements informed by a literature review and SDOC's analyses of eight epidemiologic studies, six randomized clinical trials, four cohort studies of special populations, and two nationally representative population-based studies. Methods Thirteen position statements related to the putative components of a sarcopenia definition, informed by the SDOC analyses and literature synthesis, were reviewed by an independent international expert panel (panel) iteratively and voted on by the panel during the Sarcopenia Position Statement Conference. Four position statements related to grip strength, three to lean mass derived from dual-energy x-ray absorptiometry (DXA), and four to gait speed; two were summary statements. Results The SDOC analyses identified grip strength, either absolute or scaled to measures of body size, as an important discriminator of slowness. Both low grip strength and low usual gait speed independently predicted falls, self-reported mobility limitation, hip fractures, and mortality in community-dwelling older adults. Lean mass measured by DXA was not associated with incident adverse health-related outcomes in community-dwelling older adults with or without adjustment for body size. Conclusion The panel agreed that both weakness defined by low grip strength and slowness defined by low usual gait speed should be included in the definition of sarcopenia. These position statements offer a rational basis for an evidence-based definition of sarcopenia. The analyses that informed these position statements are summarized in this article and discussed in accompanying articles in this issue of the journal. J Am Geriatr Soc 68:1410-1418, 2020.
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- 2020
11. What Cut-Point in Gait Speed Best Discriminates Community-Dwelling Older Adults With Mobility Complaints From Those Without? A Pooled Analysis From the Sarcopenia Definitions and Outcomes Consortium
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Magnus Karlsson, Karol M. Pencina, Douglas P. Kiel, Eric S. Orwoll, Anne B. Newman, Thomas G. Travison, Michelle Shardell, Östen Ljunggren, Nancy E Lane, Sheena Patel, Qian Li Xue, Timothy Kwok, Stephen B. Kritchevsky, Dan Mellström, Claes Ohlsson, Shalender Bhasin, Peggy M. Cawthon, Vasant Hirani, Adam J. Santanasto, Rosaly Correa-de-Araujo, Roger A. Fielding, John T. Schousboe, Steven R. Cummings, Joanne M. Jordan, Todd M. Manini, Jay Magaziner, Kate A. Duchowny, and Le Couteur, David
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Male ,Sarcopenia ,Aging ,Clinical Sciences ,THE JOURNAL OF GERONTOLOGY: Medical Sciences ,Walking ,Gait speed ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,Medicine ,Humans ,Classification and regression trees ,030212 general & internal medicine ,Mobility Limitation ,Self report ,Gait ,Aged ,business.industry ,medicine.disease ,Mobility limitation ,Impaired mobility ,Walking Speed ,Preferred walking speed ,Pooled analysis ,Female ,Independent Living ,Geriatrics and Gerontology ,business ,human activities ,Gerontology ,030217 neurology & neurosurgery ,Cut-point ,Demography - Abstract
Background Cut-points to define slow walking speed have largely been derived from expert opinion. Methods Study participants (13 589 men and 5043 women aged ≥65years) had walking speed (m/s) measured over 4–6 m (mean ± SD: 1.20 ± 0.27 m/s in men and 0.94 ± 0.24 m/s in women.) Mobility limitation was defined as any self-reported difficulty with walking approximately 1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not. Results Among 5043 women, CART analysis identified 2 cut-points, classifying 4144 (82.2%) with walking speed ≥0.75 m/s, which we labeled as “fast”; 478 (9.5%) as “intermediate” (walking speed ≥0.62 m/s but Conclusions Cut-points in walking speed of approximately 0.60 m/s and 0.75 m/s discriminate those with self-reported mobility limitation from those without.
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- 2021
12. Establishing the Link Between Lean Mass and Grip Strength Cut Points With Mobility Disability and Other Health Outcomes: Proceedings of the Sarcopenia Definition and Outcomes Consortium Conference
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Xue Quian-Li, Todd M. Manini, Steve Cummings, Joseph P. Menetski, Roger A. Fielding, Denise Orwig, Nancy K. Latham, Jack M. Guralnik, Daniel Rooks, Ellen F. Binder, Makoto Kashiwa, Todd T. Brown, Ralph B. D'Agostino, Jay Magaziner, Douglas P. Kiel, Suzette L. Pereira, Peggy M. Cawthon, Karol M. Pencina, Thomas G. Travison, Sheena Patel, Shalender Bhasin, Francesco Landi, Marco Pahor, Anne B. Newman, Michelle Shardell, Moises Torres-Gonzalez, Vasant Hirani, Rosaly Correa-de-Araujo, Laura A. Schaap, Timothy Kwok, Linda J. Woodhouse, Eric S. Orwoll, Nutrition and Health, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, and AMS - Musculoskeletal Health
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Male ,Gerontology ,Sarcopenia ,Aging ,Consensus ,SDG 16 - Peace ,Activities of daily living ,THE JOURNAL OF GERONTOLOGY: Medical Sciences ,Body Mass Index ,law.invention ,Disability Evaluation ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Randomized controlled trial ,law ,Activities of Daily Living ,medicine ,Humans ,030212 general & internal medicine ,Mobility Limitation ,Aged ,Evidence-Based Medicine ,Hand Strength ,business.industry ,SDG 16 - Peace, Justice and Strong Institutions ,medicine.disease ,Justice and Strong Institutions ,body regions ,Preferred walking speed ,Body Composition ,Lean body mass ,Female ,Observational study ,Geriatrics and Gerontology ,business ,human activities ,Body mass index ,030217 neurology & neurosurgery - Abstract
Background Lack of consensus on how to diagnose sarcopenia has limited the ability to diagnose this condition and hindered drug development. The Sarcopenia Definitions and Outcomes Consortium (SDOC) was formed to develop evidence-based diagnostic cut points for lean mass and/or muscle strength that identify people at increased risk of mobility disability. We describe here the proceedings of a meeting of SDOC and other experts to discuss strategic considerations in the development of evidence-based sarcopenia definition. Methods Presentations and panel discussions reviewed the usefulness of sarcopenia as a biomarker, the analytical approach used by SDOC to establish cut points, and preliminary findings, and provided strategic direction to develop an evidence-based definition of sarcopenia. Results The SDOC assembled data from eight epidemiological cohorts consisting of 18,831 participants, clinical populations from 10 randomized trials and observational studies, and 2 nationally representative cohorts. In preliminary assessments, grip strength or grip strength divided by body mass index was identified as discriminators of risk for mobility disability (walking speed Conclusions International consensus on an evidence-based definition of sarcopenia is needed. Grip strength—absolute or adjusted for body mass index—is an important discriminator of mobility disability and other endpoints. Additional research is needed to develop a predictive risk model that takes into account sarcopenia components as well as age, sex, race, and comorbidities.
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- 2019
13. Social and Structural Determinants of Health Inequities in Maternal Health
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Elizabeth Neilson, Joia Crear-Perry, Rosaly Correa-de-Araujo, Tamara Lewis Johnson, Maeve Wallace, and Monica R. McLemore
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Special Issue Articles ,medicine.medical_specialty ,Economic growth ,Social Determinants of Health ,media_common.quotation_subject ,Maternal Health ,Context (language use) ,Commission ,Racism ,Medical and Health Sciences ,03 medical and health sciences ,Politics ,0302 clinical medicine ,structural determinants of health ,Medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,media_common ,health equity ,Oppression ,African Americans ,030219 obstetrics & reproductive medicine ,business.industry ,maternal mortality ,Public health ,Health Policy ,s health ,General Medicine ,Health Status Disparities ,women's health ,womens health ,Black maternal health ,Health equity ,United States ,Black or African American ,Female ,Public Health ,business ,women&apos - Abstract
Since the World Health Organization launched its commission on the social determinants of health (SDOH) over a decade ago, a large body of research has proven that social determinants-defined as the conditions in which people are born, grow, live, work, and age-are significant drivers of disease risk and susceptibility within clinical care and public health systems. Unfortunately, the term has lost meaning within systems of care because of misuse and lack of context. As many disparate health outcomes remain, including higher risk of maternal mortality among Black women, a deeper understanding of the SDOH-and what forces underlie their distribution-is needed. In this article, we will expand our review of social determinants of maternal health to include the terms "structural determinants of health" and "root causes of inequities" as we assess the literature on this topic. We hypothesize that the addition of structural determinants and root causes will identify racism as a cause of inequities in maternal health outcomes, as many of the social and political structures and policies in the United States were born out of racism, classism, and gender oppression. We will conclude with proposed practice and policy solutions to end inequities in maternal health outcomes.
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- 2021
14. Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study
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Eleni A. Skokos, Jocelyn Wiggins, Maureen Fagan, Susan L. Greenspan, Pamela W. Duncan, Patricia C. Dykes, Neil B. Alexander, Can Meng, Fred C. Ko, Lillian Min, Jeremy N. Rich, Todd M. Manini, Lori Goehring, Heather G. Allore, Siobhan K McMahon, Thomas M. Gill, Joanne M. McGloin, Jeanne A. Teresi, David B. Reuben, Peter Peduzzi, Albert W. Wu, Shehzad Basaria, Rosaly Correa-de-Araujo, Denise Esserman, Chad Boult, Nancy K. Latham, Neil M. Resnick, Erich J. Greene, Elena Volpi, Thomas G. Travison, Katy L. B. Araujo, Martha B. Carnie, Carri Casteel, Michael E. Miller, Jay Magaziner, Charles Lu, Stephen C. Waring, Robert B. Wallace, Thomas W. Storer, Peter Charpentier, David A. Ganz, Jerry H. Gurwitz, Catherine Hanson, Priscilla K. Gazarian, Shalender Bhasin, and James Dziura
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Male ,Aging ,Poison control ,030204 cardiovascular system & hematology ,Anxiety ,Suicide prevention ,Medical and Health Sciences ,0302 clinical medicine ,7.1 Individual care needs ,well-being ,80 and over ,Medicine ,030212 general & internal medicine ,Depression (differential diagnoses) ,Cancer ,Aged, 80 and over ,Depression ,Rehabilitation ,Injuries and accidents ,Mental Health ,Female ,Independent Living ,Patient Safety ,medicine.symptom ,fall injury prevention ,Patients ,Clinical Trials and Supportive Activities ,STRIDE ,Risk Assessment ,Nurse's Role ,Article ,03 medical and health sciences ,Clinical Research ,Intervention (counseling) ,Injury prevention ,Humans ,Patient Reported Outcome Measures ,Aged ,Primary Health Care ,business.industry ,Prevention ,Confidence interval ,Brain Disorders ,pragmatic trials ,Geriatrics ,older persons ,Injury (total) Accidents/Adverse Effects ,Accidental Falls ,Management of diseases and conditions ,Geriatrics and Gerontology ,business ,Demography - Abstract
Author(s): Gill, Thomas M; Bhasin, Shalender; Reuben, David B; Latham, Nancy K; Araujo, Katy; Ganz, David A; Boult, Chad; Wu, Albert W; Magaziner, Jay; Alexander, Neil; Wallace, Robert B; Miller, Michael E; Travison, Thomas G; Greenspan, Susan L; Gurwitz, Jerry H; Rich, Jeremy; Volpi, Elena; Waring, Stephen C; Manini, Todd M; Min, Lillian C; Teresi, Jeanne; Dykes, Patricia C; McMahon, Siobhan; McGloin, Joanne M; Skokos, Eleni A; Charpentier, Peter; Basaria, Shehzad; Duncan, Pamela W; Storer, Thomas W; Gazarian, Priscilla; Allore, Heather G; Dziura, James; Esserman, Denise; Carnie, Martha B; Hanson, Catherine; Ko, Fred; Resnick, Neil M; Wiggins, Jocelyn; Lu, Charles; Meng, Can; Goehring, Lori; Fagan, Maureen; Correa-de-Araujo, Rosaly; Casteel, Carri; Peduzzi, Peter; Greene, Erich J | Abstract: Background/objectivesIn the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability.DesignPragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries.SettingA total of 86 primary care practices within 10 U.S. healthcare systems.ParticipantsA random subsample of 743 persons aged 75 and older.MeasurementsThe well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument.ResultsParticipants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference.ConclusionsSTRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.
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- 2021
15. Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age
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Sung Sug Sarah Yoon and Rosaly Correa-de-Araujo
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Postpartum depression ,Adult ,Male ,Special Issue Articles ,medicine.medical_specialty ,Pregnancy, High-Risk ,pregnancy outcomes ,Disease ,advanced maternal age ,Abortion ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,parasitic diseases ,medicine ,adverse maternal outcomes ,Humans ,030212 general & internal medicine ,Advanced maternal age ,health equity ,030219 obstetrics & reproductive medicine ,Ectopic pregnancy ,Obstetrics ,business.industry ,maternal mortality and morbidity ,Infant, Newborn ,Pregnancy Outcome ,General Medicine ,medicine.disease ,Gestational diabetes ,Risk perception ,Pregnancy Complications ,beliefs and behaviors ,Premature Birth ,Female ,business ,Maternal Age - Abstract
Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.
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- 2020
16. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging
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John A. Shepherd, Steve B. Kritchevsky, Joanne W. Elena, Clifford J. Rosen, Michael O. Harris-Love, Amanda L. Lorbergs, Iva Miljkovic, Gerald I. Shulman, Bret H. Goodpaster, Bryan C. Bergman, Luigi Ferrucci, Richard V. Clark, Rosaly Correa-de-Araujo, Karyn A. Esser, and Odessa Addison
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0301 basic medicine ,Gerontology ,medicine.medical_specialty ,Physiology ,Calorie restriction ,intermuscular adipose tissue ,030209 endocrinology & metabolism ,Context (language use) ,Review ,muscle quality ,Myostatin ,lcsh:Physiology ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,skeletal muscle function deficit ,myosteatosis ,Physiology (medical) ,medicine ,Intramyocellular lipids ,Geriatrics ,mobility-disability ,lcsh:QP1-981 ,biology ,business.industry ,aging ,Skeletal muscle ,intramyocellular lipids ,medicine.disease ,intramuscular adipose tissue ,030104 developmental biology ,medicine.anatomical_structure ,Sarcopenia ,biology.protein ,business - Abstract
Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis’ impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.
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- 2020
17. A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
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Thomas M. Gill, Peter Peduzzi, Rich Eder, Denise Esserman, Susan L. Greenspan, Heather G. Allore, Lori Goehring, Dorothy I. Baker, Robert B. Wallace, David A. Ganz, Thomas G. Travison, Martha B. Carnie, Jerry H. Gurwitz, Neil B. Alexander, Siobhan K McMahon, Charles Lu, David B. Reuben, Can Meng, Joanne M. McGloin, Fred C. Ko, Patricia C. Dykes, Katy L. B. Araujo, Michael E. Miller, Carri Casteel, Peter Charpentier, Jay Magaziner, Albert L. Siu, Erich J. Greene, Eleni A. Skokos, Thomas W. Storer, James Dziura, Priscilla K. Gazarian, Nancy K. Latham, Stephen C. Waring, Albert W. Wu, Rosaly Correa-de-Araujo, Jeremy N. Rich, Shalender Bhasin, Shehzad Basaria, Chad Boult, Neil M. Resnick, Elena Volpi, Brooke Brawley, Haseena Rajeevan, Jocelyn Wiggins, Maureen Fagan, and Pamela W. Duncan
- Subjects
Male ,Aging ,Comparative Effectiveness Research ,STRIDE Trial Investigators ,Poison control ,030204 cardiovascular system & hematology ,Suicide prevention ,Medical and Health Sciences ,Occupational safety and health ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,80 and over ,030212 general & internal medicine ,Precision Medicine ,Aged, 80 and over ,Accidental Injuries ,Incidence ,food and beverages ,Human factors and ergonomics ,Injuries and accidents ,General Medicine ,Health Services ,fractures ,mobility ,Hospitalization ,Female ,Patient Safety ,Independent Living ,Risk assessment ,medicine.medical_specialty ,Physical Injury - Accidents and Adverse Effects ,Clinical Trials and Supportive Activities ,frailty ,Risk Assessment ,Article ,03 medical and health sciences ,Clinical Research ,General & Internal Medicine ,Injury prevention ,medicine ,Humans ,Intensive care medicine ,Aged ,business.industry ,Prevention ,fungi ,aging ,Patient Care Management ,Good Health and Well Being ,Multicenter study ,Accidental Falls ,business - Abstract
BackgroundInjuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.MethodsWe conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.ResultsThe demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups.ConclusionsA multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).
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- 2020
18. Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods
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Lawrence Garber, Peter Peduzzi, Shehzad Basaria, Elena Volpi, Denise Esserman, Catherine Hanson, James Dziura, David A. Ganz, Peter Charpentier, Thomas G. Travison, Martha B. Carnie, Jerry H. Gurwitz, Thomas M. Gill, Patricia C. Dykes, Charles Lu, Haseena Rajeevan, Neil B. Alexander, Fred C. Ko, Richard Eder, Heather G. Allore, Stephen C. Waring, David B. Reuben, Dorothy I. Baker, Shalender Bhasin, Albert W. Wu, Steven B. Clauser, Katy L. B. Araujo, Rosaly Correa-de-Araujo, Jocelyn Wiggins, Albert L. Siu, Carri Casteel, Maureen Fagan, Thomas W. Storer, Eleni A. Skokos, Jeremy N. Rich, Erich J. Greene, Michael E. Miller, Jay Magaziner, Pamela W. Duncan, Scott Margolis, Susan L. Greenspan, Siobhan K McMahon, Joanne M. McGloin, Nancy K. Latham, and Robert B. Wallace
- Subjects
Male ,Gerontology ,and promotion of well-being ,Comparative Effectiveness Research ,Aging ,Nurse falls care managers ,Poison control ,01 natural sciences ,Suicide prevention ,law.invention ,010104 statistics & probability ,0302 clinical medicine ,Randomized controlled trial ,law ,Health care ,80 and over ,Fall prevention ,030212 general & internal medicine ,Injuries and Accidents ,Aged, 80 and over ,Rehabilitation ,Head injury ,Health Services ,The Journal of Gerontology: Medical Sciences ,Female ,Patient Safety ,medicine.symptom ,medicine.medical_specialty ,Clinical Trials and Supportive Activities ,Clinical Sciences ,and over ,Motivational Interviewing ,Risk Assessment ,03 medical and health sciences ,Clinical Research ,Injury prevention ,medicine ,Humans ,Patient and stakeholders in fall injury prevention research ,0101 mathematics ,Aged ,business.industry ,Prevention ,Prevention of disease and conditions ,medicine.disease ,Good Health and Well Being ,Clinical effectiveness ,Falling (accident) ,Injury (total) Accidents/Adverse Effects ,Physical therapy ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Wounds and Injuries ,Accidental Falls ,Geriatrics and Gerontology ,business ,3.1 Primary prevention interventions to modify behaviours or promote well-being - Abstract
Author(s): Bhasin, Shalender; Gill, Thomas M; Reuben, David B; Latham, Nancy K; Gurwitz, Jerry H; Dykes, Patricia; McMahon, Siobhan; Storer, Thomas W; Duncan, Pamela W; Ganz, David A; Basaria, Shehzad; Miller, Michael E; Travison, Thomas G; Greene, Erich J; Dziura, James; Esserman, Denise; Allore, Heather; Carnie, Martha B; Fagan, Maureen; Hanson, Catherine; Baker, Dorothy; Greenspan, Susan L; Alexander, Neil; Ko, Fred; Siu, Albert L; Volpi, Elena; Wu, Albert W; Rich, Jeremy; Waring, Stephen C; Wallace, Robert; Casteel, Carri; Magaziner, Jay; Charpentier, Peter; Lu, Charles; Araujo, Katy; Rajeevan, Haseena; Margolis, Scott; Eder, Richard; McGloin, Joanne M; Skokos, Eleni; Wiggins, Jocelyn; Garber, Lawrence; Clauser, Steven B; Correa-De-Araujo, Rosaly; Peduzzi, Peter | Abstract: Background:Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods:Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results:Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions:The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.
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- 2017
19. Putative Cut-Points in Sarcopenia Components and Incident Adverse Health Outcomes: An SDOC Analysis
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Timothy Kwok, Eva L. Ribom, Shalender Bhasin, Karol M. Pencina, Todd M. Manini, Anne B. Newman, Kristine M. Erlandson, Michelle Shardell, Magnus Karlsson, Sheena Patel, Rosaly Correa-de-Araujo, Jay Magaziner, Roger A. Fielding, Douglas P. Kiel, Dan Mellström, Thomas G. Travison, Vasant Hirani, Claes Ohlsson, Adam J. Santanasto, Qian Li Xue, Peggy M. Cawthon, Kristine E. Ensrud, and Kate A. Duchowny
- Subjects
Male ,medicine.medical_specialty ,Sarcopenia ,Consensus ,030209 endocrinology & metabolism ,Article ,Body Mass Index ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Absorptiometry, Photon ,Medicine ,Humans ,030212 general & internal medicine ,Muscle Strength ,Prospective Studies ,Mobility Limitation ,Aged ,Hip fracture ,Muscle Weakness ,Hand Strength ,business.industry ,Hip Fractures ,Hazard ratio ,Muscle weakness ,Odds ratio ,medicine.disease ,Walking Speed ,Preferred walking speed ,Physical therapy ,Lean body mass ,Body Composition ,Accidental Falls ,Female ,Independent Living ,Geriatrics and Gerontology ,medicine.symptom ,business ,human activities - Abstract
OBJECTIVES: Analyses performed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) identified cut-points in several metrics of grip strength for consideration in a definition of sarcopenia. We describe the associations between the SDOC-identified metrics of low grip strength (absolute or standardized to body size/composition); low dual-energy x-ray absorptiometry (DXA) lean mass as previously defined in the literature (appendicular lean mass [ALM]/ht2); and slowness (walking speed
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- 2019
20. Application of SDOC Cut Points for Low Muscle Strength for Recovery of Walking Speed After Hip Fracture
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Michelle Shardell, Denise Orwig, Roger A. Fielding, Shalender Bhasin, Hao Zhu, Todd M. Manini, Ellen F. Binder, Sheena Patel, Peggy M. Cawthon, Thomas G. Travison, Rosaly Correa-de-Araujo, and Jay Magaziner
- Subjects
Male ,Aging ,medicine.medical_specialty ,Weakness ,Sarcopenia ,THE JOURNAL OF GERONTOLOGY: Medical Sciences ,Sensitivity and Specificity ,Cohort Studies ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Hip fracture ,Muscle Weakness ,Hand Strength ,business.industry ,Hip Fractures ,Muscle weakness ,Recovery of Function ,medicine.disease ,Walking Speed ,Preferred walking speed ,Baltimore ,Lean body mass ,Physical therapy ,Female ,Independent Living ,Geriatrics and Gerontology ,medicine.symptom ,business ,Body mass index ,human activities ,030217 neurology & neurosurgery - Abstract
Background Sarcopenia is often conceptualized as a precursor to loss of mobility, but its effect on recovery of mobility after a hip fracture is unknown. We determined the prevalence of low muscle strength (weakness) after hip fracture using putative sarcopenia metrics (absolute grip strength, and grip strength normalized to body mass index, total body fat, arm lean mass, and weight) identified by the Sarcopenia Definitions and Outcomes Consortium (SDOC). Methods We examined two well-characterized hip fracture cohorts of community-dwelling older adults from the Baltimore Hip Studies (BHS). The prevalence of muscle weakness was assessed using the SDOC cut points compared to published definitions at 2 and 6 months postfracture. We assessed associations of 2-month weakness with 6-month walking speed Results Two hundred and forty-six participants (192 women; 54 men) were included; mean (SD) age of 81 (8) for women and 78 (7) for men. At 2 months, 91% women and 78% men exhibited slow walking speed (< 0.6 m/s). SDOC grip strength standardized by weight ( Conclusions SDOC cut points for grip strength standardized to weight provided consistent indication of poor walking speed performance post-hip fracture.
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- 2019
21. Application of Selected Muscle Strength and Body Mass Cut Points for the Diagnosis of Sarcopenia in Men and Women With or at Risk for HIV Infection
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Frank J. Palella, Lawrence A. Kingsley, Peggy M. Cawthon, Phyllis C. Tien, Hao Zhu, Michael T. Yin, Jordan E. Lake, Roger A. Fielding, Thomas G. Travison, Shalender Bhasin, Kristine M. Erlandson, Todd M. Manini, Anjali Sharma, Rosaly Correa-de-Araujo, Kathleen M. Weber, Jay Magaziner, and Todd T. Brown
- Subjects
Adult ,Male ,Aging ,Weakness ,medicine.medical_specialty ,Sarcopenia ,Multicenter AIDS Cohort Study ,THE JOURNAL OF GERONTOLOGY: Medical Sciences ,HIV Infections ,Body Mass Index ,Cohort Studies ,Predictive Value of Tests ,Internal medicine ,medicine ,Prevalence ,Humans ,Slowness ,Gait ,Aged ,Muscle Weakness ,Hand Strength ,business.industry ,Muscle weakness ,Middle Aged ,medicine.disease ,Preferred walking speed ,Lean body mass ,Body Composition ,Accidental Falls ,Female ,Geriatrics and Gerontology ,medicine.symptom ,business ,Body mass index - Abstract
BackgroundPersons with HIV may experience greater mobility limitations than uninfected populations. Accurate tools are needed to identify persons at greatest risk of decline. We evaluated the performance of novel muscle weakness metrics (grip, grip/body mass index [BMI], grip/weight, grip/total body fat, grip/arm lean mass) and association with slowness and falls in older persons with or at risk for HIV infection as part of the work of the Sarcopenia Definitions and Outcomes Consortium (SDOC).MethodsWe assessed the prevalence of sarcopenia among 398 men (200 HIV+, 198 HIV−) from the Multicenter AIDS Cohort Study and 247 women (162 HIV+, 85 HIV−) from the Women’s Interagency HIV Study using previously validated muscle weakness metrics discriminative of slowness. Sensitivity and specificity were used to compare new muscle weakness and slowness criteria to previously proposed sarcopenia definitions.ResultsThe prevalence of muscle weakness ranged from 16% to 66% among men and 0% to 47% among women. Grip/BMI was associated with slowness among men with HIV only. Grip/BMI had low sensitivity (25%–30%) with moderate to high specificity (68%–89%) for discriminating of slowness; all proposed metrics had poor performance in the discrimination of slowness (area under the curve [AUC] < 0.62) or fall status (AUC < 0.56). The combination of muscle weakness and slowness was not significantly associated with falls (p ≥ .36), with a low sensitivity in identifying those sustaining one or more falls (sensitivity ≤ 16%).DiscussionClinical utility of new sarcopenia metrics for identification of slowness or falls in men and women with or at risk for HIV is limited, given their low sensitivity.
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- 2019
22. Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study
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Julie Weldon, Bridget M. Mignosa, Jocelyn Wiggins, Scott Margolis, Maureen Fagan, Molly Lukas, Heather G. Allore, Obafemi Okuwobi, David Buchner, Pamela W. Duncan, Abby C. King, Jocelyn Nunez, Lawrence Garber, Jeffrey Reist, Albert W. Wu, Sajida Saeed Chaudry, Neil B. Alexander, Cindy Stowe, Kevin P. High, Rosaly Correa-de-Araujo, Haseena Rajeevan, Fred C. Ko, Nancy K. Latham, Katy Araujo, Anita Leveke, Luann Bianco, Crysta Collins, Rixin Wang, Ariela R. Orkaby, Christian Espino, Carol Gordon, Linda V. Nyquist, Lori Goehring, Rosanne M. Leipzig, La Toya Edwards, Cathy Foskett, Deborah Matza, Roxana Hirst, Mukaila Raji, Robert B. Wallace, Scott Feeser, Mary Anne Sterling, Christine Moore, David B. Reuben, Mara Abella, Michael Albert, Geraldine Hawthorne-Jones, Steven B. Clauser, Susan L. Greenspan, Bimal Ashar, Brian Funaro, Patricia C. Dykes, Bernard Birnbaum, Evan C. Hadley, Siobhan K McMahon, Denise Esserman, Erich J. Greene, Amy Shelton, Jonathan F. Bean, Thomas R. Prohaska, Joanne M. McGloin, Marcel Salive, Bonita Lynn Beattie, Sabina Rubeck, Deborah West, Ravishankar Ramaswamy, Peggy Preusse, Thomas G. Travison, Mary Anne Ferchak, Azraa Amroze, Kenneth Rando, Martha B. Carnie, Susan S. Ellenberg, Vivian Chavez, Cynthia J. Brown, Alice Lee, Patti L. Ephraim, Charles Lu, Richard Eder, Amy Larson, Terry Fulmer, Rosario Garcia, Alejandra Salazar, Janelle Howe, Laurence Z. Rubenstein, Peter Peduzzi, Yan Chen, Samuel Ho, Erica Chopskie, Sui Tang, Thomas W. Storer, Teresita Pennestri, Charles Keller, Sergei Romashkan, Taylor Christiansen, Amrish Joseph, Eleni A. Skokos, Lea Harvin, Catherine Hanson, Tiffany Campbell, Liliya Katsovich, Joseph Bianco, Stephen C. Waring, Shalender Bhasin, Kimberly Larsen, James Goodwin, Thomas M. Gill, Angela Shanahan, Allison Richards, David A. Ganz, Anne McDonald, Karen Burek, Jerry H. Gurwitz, Leo Sherman, Dorothy I. Baker, Madeline Rigatti, Albert L. Siu, Nancy Gallagher, Hilary Stenvig, Margaret Hoberg, Joseph Madia, Jeremy N. Rich, Barbara Foster, Michael Miller, Nancy P. Lorenze, Rina Castro, Katy L. B. Araujo, Carri Casteel, Lyndon Joseph, Tara Scheck, Todd M. Manini, Laurence Friedman, Karen Wu, Laura Frain, Jay Magaziner, Yvette Wells, Allise Taran, Eloisa Martinez, Jeremy D. Walston, Tina Ledesma, James Dziura, Margaret Doyle, Naaz Hussain, Lea N. Harvin, Priscilla K. Gazarian, Brooke Brawley, Charles Boult, Yuri Agrawal, Peter Charpentier, Kety Florgomes, Shehzad Basaria, Elena Volpi, Cynthia L. Stowe, David Nock, and Heather Larsen
- Subjects
Physical Injury - Accidents and Adverse Effects ,Clinical Trials and Supportive Activities ,Poison control ,Suicide prevention ,Occupational safety and health ,Study Protocol ,03 medical and health sciences ,STRIDE Investigators ,0302 clinical medicine ,Clinical Research ,030225 pediatrics ,Injury prevention ,medicine ,030212 general & internal medicine ,Adjudication ,Injuries ,business.industry ,lcsh:Public aspects of medicine ,Medical record ,Head injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,lcsh:RA1-1270 ,Injuries and accidents ,lcsh:RC86-88.9 ,General Medicine ,Health Services ,medicine.disease ,3. Good health ,Good Health and Well Being ,Telephone interview ,Public Health and Health Services ,Falls ,Patient Safety ,Medical emergency ,business - Abstract
Background This paper describes a protocol for determining the incidence of serious fall injuries for Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), a large, multicenter pragmatic clinical trial with limited resources for event adjudication. We describe how administrative data (from participating health systems and Medicare claims) can be used to confirm participant-reported events, with more time- and resource-intensive full-text medical record data used only on an “as-needed” basis. Methods STRIDE is a pragmatic cluster-randomized controlled trial involving 5451 participants age ≥ 70 and at increased risk for falls, served by 86 primary care practices in 10 US health systems. The STRIDE intervention involves a nurse falls care manager who assesses a participant’s underlying risks for falls, suggests interventions using motivational interviewing, and then creates, implements and longitudinally follows up on an individualized care plan with the participant (and caregiver when appropriate), in partnership with the participant’s primary care provider. STRIDE’s primary outcome is serious fall injuries, defined as a fall resulting in: (1) medical attention billable according to Medicare guidelines with a) fracture (excluding isolated thoracic vertebral and/or lumbar vertebral fracture), b) joint dislocation, or c) cut requiring closure; OR (2) overnight hospitalization with a) head injury, b) sprain or strain, c) bruising or swelling, or d) other injury determined to be “serious” (i.e., burn, rhabdomyolysis, or internal injury). Two sources of data are required to confirm a serious fall injury. The primary data source is the participant’s self-report of a fall leading to medical attention, identified during telephone interview every 4 months, with the confirmatory source being (1) administrative data capturing encounters at the participating health systems or Medicare claims and/or (2) the full text of medical records requested only as needed. Discussion Adjudication is ongoing, with over 1000 potentially qualifying events adjudicated to date. Administrative data can be successfully used for adjudication, as part of a hybrid approach that retrieves full-text medical records only when needed. With the continued refinement and availability of administrative data sources, future studies may be able to use administrative data completely in lieu of medical record review to maximize the quality of adjudication with finite resources. Trial registration ClinicalTrials.gov (NCT02475850). Electronic supplementary material The online version of this article (10.1186/s40621-019-0190-2) contains supplementary material, which is available to authorized users.
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- 2019
23. Additional file 2: of Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study
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Ganz, David, Siu, Albert, Magaziner, Jay, Latham, Nancy, Travison, Thomas, Lorenze, Nancy, Lu, Charles, Rixin Wang, Greene, Erich, Stowe, Cynthia, Harvin, Lea, Araujo, Katy, Gurwitz, Jerry, Agrawal, Yuri, Rosaly Correa-De-Araujo, Peduzzi, Peter, and Gill, Thomas
- Abstract
Rules for Adjudicating. (PDF 266 kb)
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- 2019
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24. Additional file 3: of Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study
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Ganz, David, Siu, Albert, Magaziner, Jay, Latham, Nancy, Travison, Thomas, Lorenze, Nancy, Lu, Charles, Rixin Wang, Greene, Erich, Stowe, Cynthia, Harvin, Lea, Araujo, Katy, Gurwitz, Jerry, Agrawal, Yuri, Rosaly Correa-De-Araujo, Peduzzi, Peter, and Gill, Thomas
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STRIDE Acknowledgements. (DOCX 32 kb)
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- 2019
- Full Text
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25. Enhancing Data Access and Utilization: Federal Big Data Initiative and Relevance to Health Disparities Research
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Rosaly Correa-de-Araujo
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Government ,Data access ,business.industry ,Political science ,Health care ,Big data ,Public relations ,business ,Private sector ,Health equity ,Wearable technology ,Variety (cybernetics) - Abstract
High value health and healthcare data are available from both the U.S. Federal Government and the private sector. Advancements in technology and networking capabilities, as well as the rise in wearable devices and consumer health care applications, have led to a considerable increase in the volume and variety of these data. While very large databases are being combined within electronic health records systems (EHRs), information reflecting nursing and potentially other relevant interprofessional notes is still to be integrated. Numerous federal initiatives are ongoing to improve access to and use of big data, and enhance and develop new analytical tools to maximize and accelerate the integration of big data and data science into biomedical research. Nurse practitioners and researchers have the opportunity to use big data to support clinical decisions, increase understanding of patient self-reported data, and expand the emerging research field of symptoms management to ultimately contribute to elimination of health and health care disparities and promote health equity.
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- 2017
26. Skeletal Muscle Function Deficit: A New Terminology to Embrace the Evolving Concepts of Sarcopenia and Age-Related Muscle Dysfunction
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Evan Hadley and Rosaly Correa-de-Araujo
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Sarcopenia ,Aging ,Weakness ,medicine.medical_specialty ,media_common.quotation_subject ,Terminology ,Special Article ,Physical medicine and rehabilitation ,Terminology as Topic ,medicine ,Humans ,Muscle Strength ,Muscle, Skeletal ,Function (engineering) ,media_common ,Conceptualization ,business.industry ,Age Factors ,Skeletal muscle ,Muscle weakness ,medicine.disease ,United States ,medicine.anatomical_structure ,Geriatrics and Gerontology ,medicine.symptom ,Construct (philosophy) ,business - Abstract
BACKGROUND Concerns remain as to the best terminology to embrace sarcopenia's evolving conceptualization. Many of these concerns stem from the fact that age-related decrements in muscle performance associated with physical impairment are only partially explained by decreases in muscle mass and that other pathophysiologic factors contribute to age-related impairments in muscle performance. METHODS Review of literature on the evolving conceptualization of sarcopenia since its early definition in 1989 and concerns with terminology. RESULTS Early definitions of sarcopenia were based solely on muscle mass in relationship to the range of muscle within a reference population. Subsequent definitions added performance criteria to muscle mass alone. The Foundation for the National Institutes of Health Sarcopenia Project identified criteria for clinically relevant low muscle strength (weakness) and low lean mass. Progress on the sarcopenia's evolving definitions has not been accompanied by recommendations on specific terminologies that address the lack of sufficient specificity from the use of an anatomic term to define a functional condition with numerous now known nonanatomic contributory factors. Skeletal Muscle Function Deficit is a broader construct that accommodates a set of diagnoses that includes both sarcopenia and other age-related muscle dysfunctions. CONCLUSIONS Skeletal Muscle Function Deficit is proposed as a new terminology to embrace the evolving conceptualization of sarcopenia and other age-related muscle dysfunctions. It comprises a variety of contributory etiologies and has the potential to provide a framework for developing diagnostic categories that are useful for both clinical practice and research.
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- 2014
27. The Need for Standardized Assessment of Muscle Quality in Skeletal Muscle Function Deficit and Other Aging-Related Muscle Dysfunctions: A Symposium Report
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Rosaly Correa-de-Araujo, Todd M. Manini, Brian W. Anthony, Michael O. Harris-Love, Iva Miljkovic, Maren S. Fragala, Massachusetts Institute of Technology. Department of Mechanical Engineering, Massachusetts Institute of Technology. Laboratory for Manufacturing and Productivity, and Anthony, Brian
- Subjects
0301 basic medicine ,Muscle tissue ,medicine.medical_specialty ,Basic science ,Physiology ,Context (language use) ,Review ,muscle quality ,sarcopenia ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Physical medicine and rehabilitation ,skeletal muscle function deficit ,Physiology (medical) ,myosteatosis ,medicine ,Intramyocellular lipids ,muscle power ,Specific force ,business.industry ,Skeletal muscle ,imaging ,medicine.disease ,3. Good health ,030104 developmental biology ,medicine.anatomical_structure ,Sarcopenia ,Physical therapy ,muscle strength ,business ,030217 neurology & neurosurgery - Abstract
A growing body of scientific literature suggests that not only changes in skeletal muscle mass, but also other factors underpinning muscle quality, play a role in the decline in skeletal muscle function and impaired mobility associated with aging. A symposium on muscle quality and the need for standardized assessment was held on April 28, 2016 at the International Conference on Frailty and Sarcopenia Research in Philadelphia, Pennsylvania. The purpose of this symposium was to provide a venue for basic science and clinical researchers and expert clinicians to discuss muscle quality in the context of skeletal muscle function deficit and other aging-related muscle dysfunctions. The present article provides an expanded introduction concerning the emerging definitions of muscle quality and a potential framework for scientific inquiry within the field. Changes in muscle tissue composition, based on excessive levels of inter- and intra-muscular adipose tissue and intramyocellular lipids, have been found to adversely impact metabolism and peak force generation. However, methods to easily and rapidly assess muscle tissue composition in multiple clinical settings and with minimal patient burden are needed. Diagnostic ultrasound and other assessment methods continue to be developed for characterizing muscle pathology, and enhanced sonography using sensors to provide user feedback and improve reliability is currently the subject of ongoing investigation and development. In addition, measures of relative muscle force such as specific force or grip strength adjusted for body size have been proposed as methods to assess changes in muscle quality. Furthermore, performance-based assessments of muscle power via timed tests of function and body size estimates, are associated with lower extremity muscle strength may be responsive to age-related changes in muscle quality. Future aims include reaching consensus on the definition and standardized assessments of muscle quality, and providing recommendations to address critical clinical and technology research gaps within the field., United States. Dept. of Veterans Affairs. Rehabilitation Research and Development Service (1IK2RX001854-01)
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- 2016
28. Health Disparities: Access and Utilization
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Rosaly Correa-de-Araujo
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medicine.medical_specialty ,education.field_of_study ,business.industry ,education ,010102 general mathematics ,Population ,Ethnic group ,01 natural sciences ,Health equity ,03 medical and health sciences ,Health services ,0302 clinical medicine ,Clinical research ,Guidelines recommendations ,Family medicine ,Health care ,medicine ,030212 general & internal medicine ,0101 mathematics ,Unavailability ,business - Abstract
This chapter focuses on disparities in access and utilization of health services by older adults of racial and ethnic backgrounds. It highlights the data challenges associated with frequent exclusion of this population from clinical research and consequent irrelevance or unavailability of evidence-based information to support clinical practice guidelines recommendations, and how this affects clinical practice and systems of care. Systematic approaches to identify, analyze, and address disparities; change providers and systems; and educate health care professionals are discussed.
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- 2016
29. Clinical trials for conditions of low muscle mass and strength
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Stephanie A. Studenski, Rosaly Correa-de-Araujo, and Luigi Ferrucci
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Clinical trial ,medicine.medical_specialty ,Low muscle mass ,business.industry ,Internal medicine ,Sarcopenia ,medicine ,Cardiology ,medicine.disease ,business ,Muscle mass - Published
- 2016
30. Integrated health care for women of color with disabilities
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Rosaly Correa-de-Araujo
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Nursing ,business.industry ,Health care ,Medicine ,Women of color ,business - Published
- 2016
31. Gender Disparities in Managed Care
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Rosaly Correa-de-Araujo, Allen Fremont, and Sharonne N. Hayes
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Gerontology ,Health (social science) ,business.industry ,Maternity and Midwifery ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Managed care ,Medicine ,Disease ,business ,Health equity ,Health care quality - Abstract
vidence that cardiovascular disease (CVD) and itsrisk factors are common in women has grownrapidly in recent decades. During the same period,numerous studies have demonstrated gender dispar-ities in the detection, prevention, care, and outcomesof CVD as well as in conditions that contribute toCVD, such as diabetes (Correa-de-Araujo & Clancy,2006; Mosca et al., 2005; Bird et al., 2003). Yet recog-nition of CVD prevalence and its risk factors amongwomen remains low and gender disparities remain“below the radar” for many key stakeholders. Conse-quently, gender disparities are not routinely assessedor acted upon. The set of four studies on genderdifferences in the quality of CVD and diabetes care inthis issue of
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- 2007
32. Risk Factors Associated with the Occurrence of Fractures in U.S. Nursing Homes: Resident and Facility Characteristics and Prescription Medications
- Author
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D. E. B. Potter, Rosaly Correa-de-Araujo, Thomas J. Shaffer, William D. Spector, and M. Rhona Limcangco
- Subjects
Medication review ,Gerontology ,medicine.medical_specialty ,business.industry ,Medical record ,Medication administration ,Family medicine ,Medicine ,Geriatrics and Gerontology ,Medical prescription ,Risk factor ,Nursing homes ,business ,Medical Expenditure Panel Survey ,Veterans Affairs - Abstract
OBJECTIVES: To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs). DESIGN: Panel study with 1-year follow-up. SETTING: A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS). PARTICIPANTS: Residents aged 65 and older who were in sample NHs on January 1, 1996. MEASUREMENTS: Health status measures were collected from facility records and abstracted using a computer-assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources. RESULTS: In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures. CONCLUSION: The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures.
- Published
- 2007
33. Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions
- Author
-
Rosaly Correa-de-Araujo
- Subjects
Evidence-based practice ,MEDLINE ,Scientific literature ,Health outcomes ,Nurse's Role ,Article ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Health care ,Humans ,030212 general & internal medicine ,Cooperative Behavior ,Patient Care Team ,Patient care team ,Evidence-Based Medicine ,030504 nursing ,Primary Health Care ,business.industry ,United States ,Women's Health Services ,General Health Professions ,Key (cryptography) ,Women's Health ,Female ,Nursing Staff ,Cooperative behavior ,0305 other medical science ,Psychology ,business - Abstract
Scientific literature demonstrates that advances in evidence-based nursing have improved systems of care and women's health outcomes. Experts agree that nurses worldwide can play a key role in building such evidence and working with interdisciplinary health care teams and systems to accelerate its implementation.
- Published
- 2015
34. Persons with disabilities as an unrecognized health disparity population
- Author
-
Deborah Klein Walker, Rosaly Correa-De-Araujo, and Gloria L. Krahn
- Subjects
Gerontology ,Adult ,medicine.medical_specialty ,Transition to Adult Care ,Inclusion (disability rights) ,Adolescent ,Health Behavior ,Environment ,Race and health ,Health Services Accessibility ,Young Adult ,Health care ,medicine ,Humans ,Disabled Persons ,Health policy ,Crime Victims ,Aged ,Aged, 80 and over ,business.industry ,Public health ,Framing Health Matters ,Public Health, Environmental and Occupational Health ,Health Status Disparities ,Middle Aged ,Health equity ,Health promotion ,Socioeconomic Factors ,Health education ,business ,Public Health Administration ,Prejudice - Abstract
Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness.
- Published
- 2015
35. Cultural Considerations for Exercise in Older Adults
- Author
-
Rosaly Correa-de-Araujo
- Subjects
Gerontology ,Cultural history ,Low literacy ,Culturally sensitive ,Ethnic group ,Physical activity ,Pacific islanders ,Exercise prescription ,Psychology ,Family values - Abstract
Awareness of cultural history, values, and beliefs allows tailoring of exercise recommendations to diverse older adults. Language and low literacy present barriers to understanding an exercise prescription. A culturally sensitive approach can elicit an older adult’s preferences and concerns about potential inhibitors and motivators to physical activity. Community-based participation, with strong emphasis on social supports and family values, is an effective approach for all racial and ethnic groups. “Fitness deserts” limit the ability of many older adults from minority cultures to exercise safely.
- Published
- 2015
36. Preventive health examinations: A comparison along the rural–urban continuum
- Author
-
Sharon Larson and Rosaly Correa-de-Araujo
- Subjects
Adult ,Health (social science) ,Health Promotion ,Rural Health ,Health Services Accessibility ,Nursing ,Environmental health ,Preventive Health Services ,Maternity and Midwifery ,Humans ,Medicine ,Physical Examination ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Urban Health ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Preventive health ,Retrospective cohort study ,Middle Aged ,Patient Acceptance of Health Care ,Metropolitan area ,Colon cancer screening ,United States ,Women's Health Services ,Health promotion ,Health Care Surveys ,Female ,Breast exams ,Health Expenditures ,Medical Expenditure Panel Survey ,business ,Rural urban continuum - Abstract
In this analysis, Medical Expenditure Panel Survey data from 2000 were used to examine differences in reports of preventive health service utilization in 4 types of counties: large metropolitan counties, small metropolitan counties, counties adjacent to metropolitan places, and counties not adjacent to metropolitan areas or with fewer than 10,000 residents. Women from counties with 10,000 or fewer residents and not adjacent to a metropolitan county, classified as rural residents, were less likely to report a number of preventive health examinations during the previous 2 years. Rural women were less likely to obtain blood cholesterol tests, dental exams, and mammograms during the previous 2 years when compared to women from large metropolitan counties. Rural women were more likely to obtain blood pressure checks during the previous year when compared to the metropolitan women. Findings for exams that occurred during the preceding 1- and 2-year periods are reported for blood pressure checks, blood cholesterol checks, physical exams, colon cancer screening, dental exams, breast exams, mammograms, and Pap smears.
- Published
- 2006
37. Suboptimal Prescribing in Elderly Outpatients: Potentially Harmful Drug-Drug and Drug-Disease Combinations
- Author
-
Daniel Stryer, Arlene S. Bierman, Marlene R. Miller, Judy Sangl, Stephen W. Wickizer, Chunliu Zhan, and Rosaly Correa-de-Araujo
- Subjects
Geriatrics ,Pediatrics ,medicine.medical_specialty ,business.industry ,Warfarin ,Retrospective cohort study ,Patient safety ,Ambulatory care ,Emergency medicine ,Ambulatory ,Medicine ,Geriatrics and Gerontology ,Medical prescription ,business ,Adverse effect ,medicine.drug - Abstract
Objectives: To assess the prevalence and correlates of potentially harmful drug-drug combinations and drug-disease combinations prescribed for elderly patients at outpatient settings. Design: Retrospective analysis of the 1995–2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). Setting: Physician offices and hospital outpatient departments. Participants: Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203). Measurements: Incidences of six drug-drug combinations and 50 drug-disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels. Results: Overall, 0.74% (95% confidence interval (CI)=0.65–0.83) of visits with two or more prescriptions had at least one inappropriate drug-drug combination, and 2.58% (95% CI=2.44–2.72) of visits with at least one prescription had one or more inappropriate drug-disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46–7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06–5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug-drug and drug-disease combinations. Conclusion: Potentially harmful drug-drug and drug-disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety.
- Published
- 2005
38. Gender Differences in Drug Use and Expenditures in a Privately Insured Population of Older Adults
- Author
-
Jessica S. Banthin, G. Edward Miller, Yen Trinh, and Rosaly Correa-de-Araujo
- Subjects
Male ,Drug ,Gerontology ,Prescription drug ,Quality Assurance, Health Care ,media_common.quotation_subject ,Population ,Medicare ,Drug Prescriptions ,Insurance Coverage ,Health care ,Fees, Pharmaceutical ,Humans ,Medicine ,Sex Distribution ,Medical prescription ,education ,Aged ,Retrospective Studies ,media_common ,Aged, 80 and over ,education.field_of_study ,business.industry ,Health technology ,General Medicine ,Insurance, Pharmaceutical Services ,Drug Utilization ,United States ,Aggregate expenditure ,Health Care Surveys ,Female ,Private Sector ,Health Expenditures ,business ,Medical Expenditure Panel Survey - Abstract
We examine gender differences in use and expenditures for prescription drugs among Medicare and privately insured older adults aged 65 and over, using data on a nationally representative sample of prescription drug purchases collected for the Medical Expenditure Panel Survey Household Component. Overall, women spent about $1,178 for drugs, about 17% more than the $1,009 in average expenditures by men. Older women constituted 50.7% of the population and had average annual aggregate expenditures for prescribed medicines of $6.93 billion compared to $5.77 billion for men. Women were more likely than men to use drugs from a number of therapeutic classes-analgesics, hormones and psychotherapeutic agents-and therapeutic subclasses-thyroid drugs, COX-2 inhibitors and anti-depressants. Women also had higher average prescriptions per user for a number of therapeutic classes-hormones, psychotherapeutic agents and analgesics-and therapeutic subclasses-anti-diabetic drugs and beta blockers. Prescribed medications are, arguably, the most important healthcare technology in preventing illness, disability, and death in older adults. It is critical that older women and men have proper access to prescribed medicines. Given the financial vulnerability of this priority population, particularly women, the expanded drug coverage available under the Medicare Modernization Act is of particular relevance in meeting this goal.
- Published
- 2005
39. TGF-β1 increases microbial clearance but worsens lung injury during Escherichia coli pneumonia in rats
- Author
-
Eric Gerstenberger, Peter Q. Eichacker, Anita B. Roberts, Robert L. Danner, Xizhong Cui, Sharon M. Wahl, Yvonne Fitz, Steven M. Banks, Marcello Quezado, Fabrice Zeni, Yoram Vodovitz, Rosaly Correa-de-Araujo, and Charles Natanson
- Subjects
Male ,Neutrophils ,Immunology ,Colony Count, Microbial ,Vascular Cell Adhesion Molecule-1 ,Cell Count ,Lung injury ,Pharmacology ,Biochemistry ,Rats, Sprague-Dawley ,Transforming Growth Factor beta1 ,Route of administration ,Transforming Growth Factor beta ,Macrophages, Alveolar ,Escherichia coli ,Pneumonia, Bacterial ,Animals ,Humans ,Immunology and Allergy ,Medicine ,Lymphocyte Count ,Lung ,Molecular Biology ,Survival rate ,Escherichia coli Infections ,Nitrites ,Nitrates ,Tumor Necrosis Factor-alpha ,business.industry ,Bacterial pneumonia ,Hematology ,Intercellular Adhesion Molecule-1 ,medicine.disease ,Immunohistochemistry ,Rats ,Oxygen ,Survival Rate ,Pneumonia ,Treatment Outcome ,medicine.anatomical_structure ,Ceftriaxone ,Tumor necrosis factor alpha ,Inflammation Mediators ,business ,Bronchoalveolar Lavage Fluid ,medicine.drug - Abstract
We investigated the effects of either intravenous (IV) or intrabronchial (IB) treatment with transforming growth factor beta1 (TGF-beta1) during bacterial pneumonia in rats. Immediately following IB Escherichia coli inoculation (T0), animals (n=270) were randomized to receive a single treatment with human recombinant TGF-beta1 either via IV or IB, or via both IV and IB routes, or to receive placebo (human serum albumin, HSA) only. Blood and lung analysis was done at 6 and 168 h after E. coli inoculation. Other animals (n=40) were administered IV TGF-beta1 or HSA at T0 and 6, 12 and 24 h after E. coli inoculation to investigate the effects of multiple treatments also on survival rates alone. All animals received ceftriaxone daily. Route of administration did not influence TGF-beta1 (p=ns for the effect of TGF-beta1 comparing IV vs IB routes) and we averaged over this variable in analysis. The relative risk of death (mean +/- sem) was not altered by either single treatments administered at T0 (-0.18 +/- 0.25, p=0.47) or multiple treatments (0.40 +/- 0.50, p=0.66) of TGF-beta1. Single treatment with TGF-beta1 first decreased and then increased vascular leukocytes at 6 and 168 h, respectively, but increased alveolar leukocytes at both time points (p=0.02 comparing the differing effects of TGF-beta1 on vascular and alveolar leukocytes at 6 and 168 h). Although TGF-beta1 decreased blood and lung bacteria counts at 6 and 168 h, it also increased serum tumor necrosis factor levels and lung injury scores at these time points (p
- Published
- 2003
40. Consumers and Clinical Decision Support
- Author
-
Nananda Col and Rosaly Correa-de-Araujo
- Subjects
Decision support system ,Knowledge management ,Decision engineering ,business.industry ,Business decision mapping ,Decision aids ,Medicine ,Decision-making ,Marketing ,business ,Clinical decision support system ,R-CAST ,Decision analysis - Abstract
Patients (consumers) are increasingly interested in being more involved in decisions about their health and increasingly search for online health information. A variety of clinical decision support tools have been developed to assist consumers with everything from choosing a health insurance plan or specific treatment to learning their risk for future events, to finding others with a shared health concern. These tools can potentially help consumers be more engaged and informed in managing their health, but physicians’ role in facilitating the shared decision making process remains critical. Emerging evidence suggests that people who are more involved in decisions about their health make more informed decisions about treatment, but the specific impact of clinical decision making (CDS) on health outcomes and cost has not been well established. There is a pressing need for quality standards to help consumers identify robust CDS tools and for more rigorous evaluations of these tools.
- Published
- 2014
41. Contributors
- Author
-
Joan S. Ash, David W. Bates, Paul Biondich, Aziz A. Boxwala, Steven H. Brown, James J. Cimino, Nananda Col, Rosaly Correa-de-Araujo, Joseph F. Coyle, Issa J. Dahabreh, Brian E. Dixon, Steve Downs, Brian Drohan, Jon Duke, Floyd Eisenberg, R. Scott Evans, Guilherme Del Fiol, Amy Franklin, Hamish Fraser, Emory Fry, John Glaser, Arturo González-Ferrer, Shaun Grannis, Robert A. Greenes, Adi V. Gundlapalli, Timothy H. Hartzog, Tonya Hongsermeier, Stanley M. Huff, Kevin S. Hughes, Robert A. Jenders, Kensaku Kawamoto, Michael A. Krall, Joseph Lau, Donald Levick, Burke Mamlin, Michael E. Matheny, Saverio M. Maviglia, Randolph A. Miller, Lucila Ohno-Machado, Thomas A. Oniki, Jerome Osheroff, Craig G. Parker, Vimla L. Patel, Mor Peleg, Alan Rector, Roberto A. Rocha, Beatriz H. Rocha, Matthew H. Samore, Margarita Sordo, Christopher H. Schmid, Edward H. Shortliffe, Davide Sottara, Blaine Takesue, William Tierney, Thomas A. Trikalinos, Byron C. Wallace, Brandon M. Welch, Adam Wright, Jeremy Wyatt, Hong Yu, and Jiajie Zhang
- Published
- 2014
42. Catalyzing quality of care improvements for women
- Author
-
Carolyn M. Clancy and Rosaly Correa-de-Araujo
- Subjects
Receipt ,medicine.medical_specialty ,Health (social science) ,Quality Assurance, Health Care ,business.industry ,Public Health, Environmental and Occupational Health ,Ethnic group ,Obstetrics and Gynecology ,Disease ,medicine.disease ,United States ,Women's Health Services ,Pharmacotherapy ,Heart failure ,Family medicine ,Diabetes mellitus ,Maternity and Midwifery ,Health care ,medicine ,Humans ,Women's Health ,Female ,Comprehensive Health Care ,Quality of care ,business - Abstract
i p k c o C q c w r b c everal epidemiologic studies, survey data, and a growing body of literature confirm the persistence f disparities in health care associated with women’s ace, ethnicity, income, education, and other factors Institute of Medicine, 2002; Kaiser Family Foundaion, 2004, 2005; National Women’s Law Center 2004; gency for Healthcare Research and Quality [AHRQ], 003a,b, 2004a,b, 2005a,b). Differences also remain etween men and women in the receipt of evidenceased health care. However, despite the amount of ata available, in-depth analysis of gender differences n the quality of health services provided in the United tates is still limited. In this special issue, gender isparities across race and ethnicity are discussed in he management of 2 key chronic conditions and in reventive care. This special issue begins with Correa-de-Araujo et l., (2006) showing that women with acute myocardial nfarction or congestive heart failure continue to fare orse than men in the receipt of drug therapy. Also, ates of counseling to quit smoking are low among omen and men of any race and ethnicity, but worse or Hispanic and black men. Further, the existence of omorbidities (e.g., diabetes, hypertension/end-stage enal disease) associated with acute myocardial infarcion or congestive heart failure does not imply better uality of care for either women or men. Correa-de raujo et al. also report that only 28.9% of women and
- Published
- 2006
43. Chapter 7. Women with Disabilities and Cities
- Author
-
Rosaly Correa-de-Araujo
- Subjects
Gender studies ,Sociology ,Social science - Published
- 2011
44. The health of women and girls determines the health and well-being of our modern world: A white paper from the International Council on Women's Health Issues
- Author
-
Jacquelyn C. Campbell, Solina Richter, DeAnne K. Hilfinger Messias, Michelle DiGiacomo, Anne M. Teitelman, Yingjuan Cao, Hazel N. Brown, Patricia M. Davidson, Sarah J. McGrath, Marilyn S. Sommers, Carolyn M. Sampselle, Phyllis Noerager Stern, Josefina A. Tuazon, Rosaly Correa-de-Araujo, Marilyn Stringer, Afaf Ibrahim Meleis, Siriorn Sindhu, Eleanor Krassen Covan, Doris Schaeffer, Tessa Dharmendra, Margarethe Hochleitner, Karen Reesman, and Debra Anderson
- Subjects
Adult ,Economic growth ,medicine.medical_specialty ,Adolescent ,health care facilities, manpower, and services ,International Cooperation ,Interprofessional Relations ,education ,Health Promotion ,Global Health ,Community Networks ,Article ,Political science ,Health care ,medicine ,Global health ,Humans ,Cooperative Behavior ,Health policy ,health care economics and organizations ,Reproductive health ,business.industry ,Public health ,International health ,Public relations ,Women's Health Services ,Health promotion ,General Health Professions ,Women's Health ,Women's Rights ,Health law ,Female ,business ,Societies - Abstract
The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.
- Published
- 2011
45. Overcoming social and health inequalities among U.S. women of reproductive age - challenges to the nation's health in the 21st century
- Author
-
Shahul H. Ebrahim, Rosaly Correa-de-Araujo, Hani K. Atrash, Samuel F. Posner, and John E. Anderson
- Subjects
Gerontology ,Adult ,Health Knowledge, Attitudes, Practice ,Inequality ,Offspring ,media_common.quotation_subject ,Psychological intervention ,Context (language use) ,Health Services Accessibility ,Health care ,Medicine ,Humans ,Health policy ,media_common ,Reproductive health ,business.industry ,Health Policy ,Health Status Disparities ,United States ,Diet ,Reproductive Medicine ,Socioeconomic Factors ,Women's Health ,Female ,business ,Social capital ,Demography - Abstract
Objective To frame the discussion of the nation's health within the context of maternal and child health. Methods We used national data or estimates to assess the burden of 46 determinants. Results During 2002–2004, U.S. women of reproductive age experienced significant challenges from macrosocial determinants, to health care access, and to their individual health preservation. Two-thirds of women do not consume recommended levels of fruits and vegetables. Overall, 29% experienced income poverty, 16.3% were uninsured. About one in four women of reproductive age lived with poor social capital. Compared with white women of reproductive age, non-white women reported higher levels of dissatisfaction with the health care system and race-related discrimination. Among all U.S. women, chronic diseases contributed to the top nine leading causes of disability adjusted life years. About one-third of women had no prophylactic dental visits in the past year, or consumed alcohol at harmful levels and smoked tobacco. One in three women who had a child born recently did not breast feed their babies. Demographics of women who are at increased risk for the above indicators predominate among the socioeconomically disadvantaged. Conclusions At least three-fourths of the U.S. women of reproductive age were at risk for poor health of their own and their offspring. Social intermediation and health policy changes are needed to increase the benefits of available health and social sector interventions to women and thereby to their offspring.
- Published
- 2008
46. Gender disparities in managed care: it's time for action
- Author
-
Allen M, Fremont, Rosaly, Correa-de-Araujo, and Sharonne N, Hayes
- Subjects
Male ,Women's Health Services ,Sex Factors ,Cardiovascular Diseases ,Health Care Reform ,Managed Care Programs ,Humans ,Women's Health ,Female ,Health Services Accessibility ,United States ,Quality Indicators, Health Care - Published
- 2007
47. Risk factors associated with the occurrence of fractures in U.S. nursing homes: resident and facility characteristics and prescription medications
- Author
-
William, Spector, Thomas, Shaffer, D E B, Potter, Rosaly, Correa-de-Araujo, and M, Rhona Limcangco
- Subjects
Aged, 80 and over ,Male ,Psychotropic Drugs ,Diphosphonates ,Drug-Related Side Effects and Adverse Reactions ,Cathartics ,Sodium Chloride Symporter Inhibitors ,Statistics as Topic ,Health Surveys ,United States ,Nursing Homes ,Fractures, Bone ,Cross-Sectional Studies ,Nursing Assistants ,Risk Factors ,Homes for the Aged ,Humans ,Female ,Mobility Limitation ,Geriatric Assessment ,Iron Compounds ,Aged - Abstract
To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs).Panel study with 1-year follow-up.A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS).Residents aged 65 and older who were in sample NHs on January 1, 1996.Health status measures were collected from facility records and abstracted using a computer-assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources.In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures.The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures.
- Published
- 2007
48. Serious gaps: how the lack of sex/gender-based research impairs health
- Author
-
Rosaly Correa-de-Araujo
- Subjects
Gerontology ,Male ,Gender identity ,Evidence-Based Medicine ,business.industry ,Health Policy ,Health Status ,MEDLINE ,Gender Identity ,General Medicine ,United States ,Cardiovascular Diseases ,Research Design ,Sex gender ,Medicine ,Health Status Indicators ,Humans ,Women's Health ,Female ,business ,Health policy - Published
- 2007
49. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium
- Author
-
Wendy Nelson, Rosaly Correa-de-Araujo, Angela Coulter, David R. Rovner, Margaret Holmes-Rovner, Glyn Elwyn, Michael Pignone, and Annette M. O'Connor
- Subjects
Decision support system ,Evidence-Based Medicine ,business.industry ,Management science ,Health Policy ,Implementation Science [NCEBP 3] ,Evidence-based medicine ,Public relations ,Congresses as Topic ,R-CAST ,Decision Support Techniques ,Quality of Care [EBP 4] ,Massachusetts ,Health care ,Decision aids ,Medicine ,Humans ,Patient participation ,Patient Participation ,business ,Expected utility hypothesis ,Decision analysis - Abstract
Contains fulltext : 51648.pdf (Publisher’s version ) (Closed access) This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against.
- Published
- 2007
50. Gender disparities in the quality of cardiovascular disease care in private managed care plans
- Author
-
Sarah Hudson Scholle, Arlene S. Bierman, Carol S. Weisman, Ann F. Chou, Lori Mosca, and Rosaly Correa-de-Araujo
- Subjects
Male ,medicine.medical_specialty ,Health (social science) ,Psychological intervention ,Health Services Accessibility ,Sex Factors ,Ambulatory care ,Risk Factors ,Maternity and Midwifery ,Health care ,Confidence Intervals ,Odds Ratio ,Medicine ,Humans ,Practice Patterns, Physicians' ,Socioeconomic status ,Quality Indicators, Health Care ,business.industry ,Managed Care Programs ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Healthcare Effectiveness Data and Information Set ,Odds ratio ,Confidence interval ,United States ,Women's Health Services ,Cardiovascular Diseases ,Physical therapy ,Managed care ,Women's Health ,Female ,Private Sector ,business ,Demography - Abstract
Background. Studies have shown that women with cardiovascular disease (CVD) are screened and treated less aggressively than men and are less likely to undergo cardiac procedures. Research in this area has primarily focused on the acute setting, and there are limited data on the ambulatory care setting, particularly among the commercially insured. To that end, the objective of this study is to determine if gender disparities in the quality of CVD care exist in commercial managed care populations. Methods. Using a national sample of commercial health plans, we analyzed member-level data for 7 CVD quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS ® ) collected in 2005. We used hierarchical generalized linear models to estimate these HEDIS measures as a function of gender, controlling for race/ethnicity, socioeconomic status, age, and plans’ clustering effects. Results. Results showed that women were less likely than men to have low-density lipoprotein (LDL) cholesterol controlled at
- Published
- 2006
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