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24 Associations Between Positive Psychological Factors and Neurocognitive Functioning in Older Adults
- Jacqueline E Maye, Colin A Depp, Ellen E Lee, Ho-Cheol Kim, Dilip V Jeste, Elizabeth W Twamley
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 337
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Objective:
Psychological wellness and strong cognitive skills are both important to successful aging. Although there are well-established relationships between psychiatric illness (e.g., depression, anxiety, PTSD) and cognitive dysfunction, few studies have focused on the relationships between positive psychological factors and neurocognitive function in older adults. Our goal was to explore associations between these two sets of measures in older adults.
Participants and Methods:Participants (n=111) were part of a longitudinal study of biopsychosocial functioning in independently living older adult residents of a Continuing Care Senior Housing Community. Participants were administered a cognitive screening test (Montreal Cognitive Assessment; MoCA), a comprehensive neuropsychological battery, and a set of published self-report scales measuring positive emotional and psychological function. Neuropsychological scores were appropriately normed, and composite scores were calculated for the following domains: language (Boston Naming Test, Delis-Kaplan Executive Function System [D-KEFS] Verbal Fluency), attention/working memory (Wechsler Adult Intelligence Scale-IV [WAIS-IV] Digit Span, DKEFS Visual Scanning), learning and delayed recall (Brief Visuospatial Memory Test-Revised, Hopkins Verbal Learning Test-Revised), processing speed (WAIS-IV Coding, D-KEFS Trails Number and Letter Sequencing, D-KEFS Color-Word Interference Test Color and Word Naming), and executive function (D-KEFS Color-Word Inhibition and Inhibition/Switching, DKEFS Letter/Number Switching). Self-Report scales included the Perceived Stress Scale, Center for Epidemiological Studies in Depression Scale, Emotional Support Scale, Connor-Davidson Resilience Scale, Coping Humor and Self-Efficacy Scales, Personal Mastery Scale, Meaning in Life Scale, Self-Rated Successful Aging, Satisfaction with Life, Cognitive Failures Questionnaire, and Lifetime Orientation Test-Revised. Due to the large number of psychological functioning measures, dimension reduction was undertaken via principal component analysis, resulting in a two-factor solution. Bivariate Pearson correlations were then computed between the two factor scores and each neurocognitive variable.
Results:Factor 1 consisted of variables reflecting Positive Subjective Functioning. A higher score on Factor 1 (indicating higher self-rating of successful aging, fewer perceived cognitive failures, fewer reported depressive symptoms, less perceived stress/anxiety, more perceived emotional support, more satisfaction with life, more meaningfulness in life, and more search for meaning in life) was associated with better attention/working memory (r=0.226, p=0.049) and executive function (r=0.242, p=0.035). Factor 2 consisted of variables that reflected Positive Coping Skills. A higher score on Factor 2 (indicating more happiness, higher optimism, greater resilience, higher sense of personal mastery, more use of humor as a coping strategy, and greater coping self-efficacy) was associated with better performance on tests of language (r=0.325, p=0.004), learning (r=0.313, p=0.006) and delayed recall (r=0.241, p=0.035) of visual and verbal information, and better MoCA performance (r=0.440, p<0.001). Neither factor was associated with processing speed.
Conclusions:Higher levels of subjective functioning and positive outlook/coping skills were associated with better neuropsychological performance. Given that late life is a time of risk for cognitive decline, future research should consider the influence of positive psychological functioning on neurocognitive outcomes and vice versa, as these relationships may have neurobiological and therapeutic implications for overall function in later life.
51 Importance of Using Baseline Verbal Abilities When Interpreting the MOCA Test Performance
- Se Yun (Jacqueline) Kim, Caroline Altaras, Margaret O’Connor
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 729-730
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Objective:
The Montreal Cognitive Assessment (MOCA) is widely used as a mental status screening test to detect cognitive impairment in adults over 55 years of age. Performance on this test ranges from 0 to 30. One point is given to individuals with 12 or lower years of education. This accommodation is based on the fact that low education may be a risk factor for dementia (Milani et al., 2018). However, studies suggest the one-point adjustment may not be sufficient to address the impact of low education on test performance (Malek-Ahmadi et al., 2015). The aim of this study is to compare the effects of educational achievement versus baseline verbal abilities on MOCA performance.
Participants and Methods:Fifty patients (25 male; mean age=72.78, SD = 8.11; mean education=16.18, SD = 2.73) with cognitive concerns were referred to Massachusetts General Brigham. All underwent neuropsychological evaluation, including screening with the MOCA. Total MOCA scores were calculated. In this patient group, the MOCA scores ranged from 10 to 29 (mean=22, SD=5.129). Measures of literacy (Wechsler Test of Adult Reading or Test of Premorbid Functioning) were used to estimate baseline verbal abilities. Educational achievement was based on self-reported years of education.
Results:Correlational analyses included the Total MOCA scores, measures of literacy, and years of education. Performance on the MOCA significantly correlated with measures of literacy, r(43)=.578, p< .001, and a stepwise regression analysis revealed that literacy predicted performance on the MOCA, R2=.041, F(3,139)= 9.172, p<.001. Years of education correlated with measures of literacy, r(44)=.494, p< .001, but not with performance on the MOCA.
Conclusions:Findings suggest that education-adjusted scoring on the MOCA may not be sufficient to “level the playing field” in terms of MOCA performance. Years of education had less of an effect on the Total MOCA scores than did baseline verbal abilities. It may be the case that literacy has a more robust effect on MOCA performance due to the inherent verbal nature of the MOCA. Data from this study highlight the importance of considering a patient’s baseline verbal abilities in the interpretation of their MOCA performance.
7 The MOCA Versus Neuropsychological Testing in Assessing Presence of Memory Impairment and MCI
- Caroline S Altaras, Se Yun (Jacqueline) Kim, Margaret G O’Connor
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 692-693
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Objective:
The Montreal Cognitive Assessment (MOCA) is a brief cognitive screener, widely used by providers to detect mild cognitive impairment (MCI). It encompasses 30 questions, assessing executive functioning, visuospatial skills, language, memory, attention, and orientation. Although the MOCA has been shown to have high sensitivity (90%) and specificity (87%) for detecting MCI, existing studies have primarily included participants who were already diagnosed with amnestic MCI via neuropsychological testing. Since several factors beyond the presence of MCI can contribute to low performance on the MOCA (e.g., premorbid IQ, fatigue, mood symptoms), over-reliance on the MOCA runs the risk of falsely identifying individuals as having cognitive impairment. The MOCA’s memory subtest raises particular concern as there are several language-based tasks between the learning and delay trials, introducing the potential for interference effects. Thus, the MOCA’s ability to accurately identify those at risk for MCI in the community remains unclear. The objective of the present study was to evaluate: (1) the MOCA’s association with neuropsychological memory measures; and (2) its ability to distinguish between neurocognitive groups (intact vs. MCI vs. dementia).
Participants and Methods:This study involved a retrospective analysis of fifty-one patients (M age=72.58 [7.90]; M education= 16.37 [16.37]) who underwent neuropsychological evaluation. Standardized scores for total list-learning (HVLT; CVLT-bf) were used to capture memory encoding; retention % scores were used to capture memory storage. MOCA scores included Total MOCA, MOCA-Orientation, and the MOCA Memory Index (MOCA-MEM). MOCA-MEM was calculated based on Julayanont et al., 2014— (Free-Delayed Recall*3) + (Category-Cued Recall*2) + Multiple Choice-Cued Recall. Bivariate correlations were conducted for the MOCA and neuropsychological test scores. Participants were divided into three diagnostic groups, classified by the neuropsychologist: (1) Cognitive Intact (CI; n=13); (2) MCI (n=26); and (3) Major Neurocognitive Disorder/Dementia (MNCD; n=11). Analysis of covariance was used to analyze differences between the cognitive groups on Total MOCA, MOCA-Orientation, and MOCA-MEM.
Results:Total MOCA correlated with word-list learning (r=.434, p=.004) and retention% (r=.306, p=.049). MOCA-MEM was correlated with word-list learning (r=.367, p=.042); it did not significantly correlate with retention%. MOCA-Orientation had the strongest correlation with retention0/) (r=.406, p=.009). Means of Total MOCA significantly differed between CI (25.31[2.56]), MCI (22.04[4.14]), and MNCD (15.44[4.13]). MOCA-MEM only differentiated CI (10[3.66]) and MNCD (5.71[2.14]); it did not differentiate MCI (6.94[3.13]) from either CI or MNCD.
Conclusions:Our findings suggest that the MOCA has limitations in accurately classifying memory deficits in older adults. First, our study suggests that the MOCA-MEM reflects encoding rather than memory storage. Given that deficiency in encoding may be secondary to other cognitive deficits, such as attention and executive dysfunction, performance on MOCA-MEM cannot readily delineate the presence of an amnestic process. Second, the findings show that MOCA-MEM does not differentiate between patient groups with intact cognition versus MCI, nor those with MCI versus MNCD. These findings argue the importance of neuropsychological evaluation in deciphering patterns of memory performance and the presence of an amnestic process.
Community participation in the health system: analyzing the implementation of community health committee policies in Kenya
- Robinson Karuga, Marjolein Dieleman, Patrick Mbindyo, Kim Ozano, Judy Wairiuko, Jacqueline E.W. Broerse, Maryse Kok
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- Journal:
- Primary Health Care Research & Development / Volume 24 / 2023
- Published online by Cambridge University Press:
- 28 April 2023, e33
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Background:
Community health committees (CHCs) are a mechanism for communities to voluntarily participate in making decisions and providing oversight of the delivery of community health services. For CHCs to succeed, governments need to implement policies that promote community participation. Our research aimed to analyze factors influencing the implementation of CHC-related policies in Kenya.
Methods:Using a qualitative study design, we extracted data from policy documents and conducted 12 key informant interviews with health workers and health managers in two counties (rural and urban) and the national Ministry of Health. We applied content analysis for both the policy documents and interview transcripts and summarized the factors that influenced the implementation of CHC-related policies.
Findings:Since the inception of the community health strategy, the roles of CHCs in community participation have been consistently vague. Primary health workers found the policy content related to CHCs challenging to translate into practice. They also had an inadequate understanding of the roles of CHCs, partly because policy content was not adequately disseminated at the primary healthcare level. It emerged that actors involved in organizing and providing community health services did not perceive CHCs as valuable mechanisms for community participation. County governments did not allocate funds to support CHC activities, and policies focused more on incentivizing community health volunteers (CHVs) who, unlike CHCs, provide health services at the household level. CHVs are incorporated in CHCs.
Conclusion:Kenya’s community health policy inadvertently created role conflict and competition for resources and recognition between community health workers involved in service delivery and those involved in overseeing community health services. Community health policies and related bills need to clearly define the roles of CHCs. County governments can promote the implementation of CHC policies by including CHCs in the agenda during the annual review of performance in the health sector.
Building better global data governance – CORRIGENDUM
- Jacqueline Kuzio, Mohammad Ahmadi, Kyoung-Cheol Kim, Michael R. Migaud, Yi-Fan Wang, Justin Bullock
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- Data & Policy / Volume 4 / 2022
- Published online by Cambridge University Press:
- 26 August 2022, e27
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Building better global data governance
- Jacqueline Kuzio, Mohammad Ahmadi, Kyoung-Cheol Kim, Michael R. Migaud, Yi-Fan Wang, Justin Bullock
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- Data & Policy / Volume 4 / 2022
- Published online by Cambridge University Press:
- 08 August 2022, e25
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In this article, we explore the challenges of global governance and the particular challenge presented by global data governance. We discuss a range of challenges to developing meaningful global governance institutions for regulating how companies and governments around the world manage and utilize consumer data. These challenges are compounded by their global nature and the complexities of Internet-based technologies. We argue that the following gaps exist for effective global data governance: (a) there is no overarching global framework for protecting consumer data, and it is partial and incomplete; (b) there is a lack of data protection for international data transfers, as much of the regulation that is being developed is not global in scale; and (c) new areas of data collection and use compound concerns to effective data governance in a globalized digital world. Moreover, we highlight important needs in terms of both global governance and impending challenges related to current and new uses of data. Any global governance framework should recognize the need for an iterative process where communication is ongoing between the necessary stakeholders. Agreements should incorporate common goals to maximize the potential development of global data governance norms. However, goals must remain flexible to the different data environments across nation-states while maintaining a global scope to ensure data protection. In addition, any agreement should consider the emerging challenges in this area. These challenges include new methods of data collection and use, as well as protecting individuals from manipulation and undue influence based on how their data are being used, processed, and collected.
Rates of Cognitive and Functional Impairments in Older Adults Residing in a Continuing Care Senior Housing Community
- Ryan Van Patten, Zanjbeel Mahmood, Tanya T. Nguyen, Jacqueline E. Maye, Ho-Cheol Kim, Dilip V. Jeste, Elizabeth W. Twamley
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- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 1 / January 2022
- Published online by Cambridge University Press:
- 22 March 2021, pp. 62-73
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Objective:
The current cross-sectional study examined cognition and performance-based functional abilities in a continuing care senior housing community (CCSHC) that is comparable to other CCSHCs in the US with respect to residents’ demographic characteristics.
Method:Participants were 110 older adult residents of the independent living unit. We assessed sociodemographics, mental health, neurocognitive functioning, and functional capacity.
Results:Compared to normative samples, participants performed at or above expectations in terms of premorbid functioning, attention span and working memory, processing speed, timed set-shifting, inhibitory control, and confrontation naming. They performed below expectation in verbal fluency and verbal and visual learning and memory, with impairment rates [31.4% (>1 SD below the mean) and 18.49% (>1.5 SD below the mean)] well above the general population (16% and 7%, respectively). Within the cognitive test battery, two tests of delayed memory were most predictive of a global deficit score. Most cognitive test scores correlated with performance-based functional capacity.
Conclusions:Overall, results suggest that a subset of older adults in the independent living sector of CCSHCs are cognitively and functionally impaired and are at risk for future dementia. Results also argue for the inclusion of memory tests in abbreviated screening batteries in this population. We suggest that CCSHCs implement regular cognitive screening procedures to identify and triage those older adults who could benefit from interventions and, potentially, a transition to a higher level of care.
Behavioral and electrophysiological indices of inhibitory control in maltreated adolescents and nonmaltreated adolescents
- Jacqueline Bruce, Hyoun K. Kim
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- Development and Psychopathology / Volume 34 / Issue 3 / August 2022
- Published online by Cambridge University Press:
- 22 December 2020, pp. 1054-1063
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Early adverse experiences are believed to have a profound effect on inhibitory control and the underlying neural regions. In the current study, behavioral and event-related potential (ERP) data were collected during a go/no-go task from adolescents who were involved with the child welfare system due to child maltreatment (n = 129) and low-income, nonmaltreated adolescents (n = 102). The nonmaltreated adolescents were more accurate than the maltreated adolescents on the go/no-go task, particularly on the no-go trials. Paralleling the results with typically developing populations, the nonmaltreated adolescents displayed a more pronounced amplitude of the N2 during the no-go trials than during the go trials. However, the maltreated adolescents demonstrated a more pronounced amplitude of the N2 during the go trials than during the no-go trials. Furthermore, while the groups did not differ during the go trials, the nonmaltreated adolescents displayed a more negative amplitude of the N2 than the maltreated adolescents during no-go trials. In contrast, there was not a significant group difference in amplitude of the P3. Taken together, these results provide evidence that the early adverse experiences encountered by maltreated populations impact inhibitory control and the underlying neural activity in early adolescence.
Transmission of Listeriosis in a Neonatal Intensive Care Unit Supported by Whole-Genome Sequencing
- Janice Kim, Hilary Rosen, Kristen Angel, Azarnoush Maroufi, Samantha Tweeten, Jacqueline Lui, John Crandall, Tracy Lanier, Jane Siegel, Akiko Kimura
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s53
- Print publication:
- October 2020
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Background: Listeriosis is a rare but serious infectious disease caused by Listeria monocytogenes (LM) and predominantly transmitted through contaminated food. Moreover, 15% of listeriosis cases in the United States are pregnancy associated; nosocomial neonatal transmission in hospitals is extremely rare. In July 2018, the California Department of Public Health (CDPH) was notified of 4 patients, a mother–neonate pair and twin neonates, with listeriosis at the same hospital. The CDPH and San Diego County Health and Human Services Agency initiated an investigation to determine transmission and prevent additional infections. Methods: We reviewed medical records of the neonates and their mothers, interviewed the mothers with a detailed food exposure questionnaire, interviewed healthcare personnel (HCP), and performed an infection control assessment of the neonatal intensive care unit (NICU). CDPH performed whole-genome sequencing (WGS) on LM isolates that were then analyzed by whole-genome multilocus sequence typing (wgMLST) by the Centers for Diseases Control and Prevention (CDC) to assess relatedness in PulseNet, a public health laboratory database. The CDC also performed testing for LM on formalin-fixed placentas from the mother of the twins. Results: During a 1-week period, 4 patients with LM were identified at the hospital. A mother was admitted at 31 weeks gestation with acute abdominal and back pain that progressed with precipitous vaginal delivery and postpartum sepsis. Her neonate was resuscitated, transported to the NICU, underwent a sepsis evaluation, received antibiotics, and was transferred to another hospital within 6 hours. Maternal blood, placenta, and neonatal blood cultures grew LM. Twin neonates, born to an asymptomatic mother and present in the NICU during the index neonate’s stay, developed acute infection 4 and 6 days after the index neonate’s transfer; blood cultures confirmed LM. The LM isolates from the 4 patients were indistinguishable by wgMLST and were not related to other PulseNet isolates. LM was not detected in the twin placentas. There were no common food exposures between the mothers. At least 1 common HCP cared for all 3 neonates. Infection control lapses included lack of proper hand hygiene during the index neonate’s resuscitation and potentially after cleaning and disinfection of the neonate’s incubator. Conclusions: This report provides supportive evidence that nosocomial transmission of LM can occur during a brief NICU stay due to lapses in infection control practices. Strict adherence to standard precautions in the delivery room and NICU is imperative to prevent cross transmission.
Disclosures: None
Funding: None
Effects of a school readiness intervention on hypothalamus–pituitary–adrenal axis functioning and school adjustment for children in foster care
- Alice M. Graham, Katherine C. Pears, Hyoun K. Kim, Jacqueline Bruce, Philip A. Fisher
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- Journal:
- Development and Psychopathology / Volume 30 / Issue 2 / May 2018
- Published online by Cambridge University Press:
- 18 September 2017, pp. 651-664
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Maltreated children in foster care are at high risk for dysregulated hypothalamus–pituitary–adrenal (HPA) axis functioning and educational difficulties. The present study examined the effects of a short-term school readiness intervention on HPA axis functioning in response to the start of kindergarten, a critical transition marking entry to formal schooling, and whether altered HPA axis functioning influenced children's school adjustment. Compared to a foster care comparison group, children in the intervention group showed a steeper diurnal cortisol slope on the first day of school, a pattern previously observed among nonmaltreated children. A steeper first day of school diurnal cortisol slope predicted teacher ratings of better school adjustment (i.e., academic performance, appropriate classroom behaviors, and engagement in learning) in the fall of kindergarten. Furthermore, the children's HPA axis response to the start of school mediated the effect of the intervention on school adjustment. These findings support the potential for ameliorative effects of interventions targeting critical transitional periods, such as the transition of formal schooling. This school readiness intervention appears to influence stress neurobiology, which in turn facilitates positive engagement with the school environment and better school adjustment in children who have experienced significant early adversity.
Contributors
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- By Naila A. Ahmad, Dua M. Anderson, Jennifer Aunspaugh, Sabrina T. Bent, Adam Broussard, Staci Cameron, Rahul Dasgupta, Ravinder Devgun, Ofer N. Eytan, Sean H. Flack, Terry G. Fletcher, Charles James Fox, Mary Elise Fox, Scott Friedman, Louise K. Furukawa, Sonja Gennuso, Stanley M. Hall, Hani Hanna, Jacob Hummel, James E. Hunt, Ranu Jain, Joe R. Jansen, Deepa Kattail, Alan David Kaye, David J. Krodel, Gregory J. Latham, Sungeun Lee, Michael G. Levitzky, Alexander Y. Lin, Carl Lo, Hoa N. Luu, Camila Lyon, Kelly A. Machovec, Lizabeth D. Martin, Maria Matuszczak, Patrick S. McCarty, Brenda C. McClain, J. Grant McFadyen, Helen Nazareth, Dolores B. Njoku, Christina M. Pabelick, Shannon M. Peters, Amit Prabhakar, Michael Richards, Kasia Rubin, Joel A. Saltzman, Lisgelia Santana, Gabriel Sarah, Katherine Stammen, John Stork, Kim M. Strupp, Lalitha V. Sundararaman, Rosalie F. Tassone, Douglas R. Thompson, Nicole C. P. Thompson, Paul A. Tripi, Jacqueline L. Tutiven, Navyugjit Virk, Stacey Watt, B. Craig Weldon, Maria Zestus
- Edited by Alan David Kaye, Louisiana State University, Charles James Fox, Tulane University School of Medicine, Louisiana, James H. Diaz, Louisiana State University
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- Book:
- Essentials of Pediatric Anesthesiology
- Published online:
- 05 November 2014
- Print publication:
- 16 October 2014, pp ix-xii
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Physical impairments in cognitively impaired older people: implications for risk of falls
- Morag E. Taylor, Kim Delbaere, Stephen R. Lord, A. Stefanie Mikolaizak, Jacqueline C. T. Close
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- Journal:
- International Psychogeriatrics / Volume 25 / Issue 1 / January 2013
- Published online by Cambridge University Press:
- 26 July 2012, pp. 148-156
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Background: Cognitively impaired older people fall twice as often as their cognitively intact counterparts. There is, however, limited information on factors that increase the risk of falls in this population. This study aimed to determine whether a group of cognitively impaired older people (CIG) perform worse than a matched group of cognitively intact older people (NCIG) on a profile of physical performance and mobility tests.
Methods: One hundred and thirty-eight cognitively impaired and 276 age and gender matched cognitively intact community-dwelling older adults (>60 years) took part in the study. Participants completed a detailed physical performance battery from which composite fall risk scores were derived. Falls were measured prospectively for 12 months with monthly falls diaries, telephone calls, and by regularly contacting participants’ “person responsible.”
Results: The CIG performed worse than the NCIG in tests of reaction time, muscle strength (grip and quadriceps), balance (sway on floor, sway on foam, controlled leaning balance and near tandem standing ability), and mobility (sit to stand, timed up and go (TUG) and steps required to turn 180 degrees). The CIG had significantly higher composite fall risk scores than the NCIG and fell significantly more during follow-up (Multiple falls (2+): CIG 43%; NCIG 21%).
Conclusions: Fall risk in the CIG was significantly increased due to multiple physical impairments. Physical profiles provide a means of quantifying the extent of impairment in older people with cognitive impairment and potential direction for targeting interventions for reducing fall risk.
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- By J. Todd Arnedt, Nazem Atassi, Judith Bebchuk, Devin L. Brown, Rickey E. Carter, Rick Chappell, William R. Clarke, Christopher S. Coffey, Peter G. Como, Merit Cudkowicz, Jeffrey Cummings, Gary R. Cutter, Gerald J. Dal Pan, E. Ray Dorsey, Susan S. Ellenberg, Jordan Elm, Changyong Feng, Elizabeth Fisher, Jacqueline A. French, Jean-Michel Germain, Joshua D. Grill, Robert G. Holloway, Karen C. Johnston, S. Claiborne Johnston, Cornelia L. Kamp, Russell Katz, Kathryn M. Kellogg, Karl Kieburtz, Scott Y. H. Kim, Jonathan Kimmelman, Bruce Levin, Michael P. McDermott, Eric A. Mann, John Markman, D. Troy Morgan, Gilmore N. O’Neill, Yuko Y. Palesch, John R. Pollard, R. Michael Poole, Mary E. Putt, Bemard Ravina, Richard A. Rudick, David Schoenfeld, Andrew D. Siderowf, Janet Wittes, Robert F. Woolson, Michael E. Yurcheshen
- Edited by Bernard Ravina, Jeffrey Cummings, Michael McDermott, R. Michael Poole
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- Book:
- Clinical Trials in Neurology
- Published online:
- 05 May 2012
- Print publication:
- 12 April 2012, pp ix-xii
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EVALUATION OF AN INTERVENTION TO IMPROVE QUALITY OF CARE IN FAMILY PLANNING PROGRAMME IN THE PHILIPPINES
- ANRUDH K. JAIN, SAUMYA RAMARAO, JACQUELINE KIM, MARILOU COSTELLO
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- Journal:
- Journal of Biosocial Science / Volume 44 / Issue 1 / January 2012
- Published online by Cambridge University Press:
- 21 September 2011, pp. 27-41
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This paper presents the results of a longitudinal intervention study carried out in the Davao del Norte province of the Philippines. The intervention, tested through a quasi-experimental design, consisted of training of family planning service providers in information exchange and training of their supervisors in facilitative supervision. The training intervention significantly improved providers' knowledge and quality of care received by clients. Moreover, good quality care received by clients at the time of initiating contraception use increased the likelihood of contraceptive continuation and decreased the likelihood of both having an unintended pregnancy and an unwanted birth. However, comparison of women in the experimental group with those in the control group did not show any significant effect of provider-level training intervention on these client-level outcomes. The reasons for this conundrum and the implications for quality of care are discussed.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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A Viral Gastroenteritis Outbreak Associated with Person-to-Person Spread Among Hospital Staff
- Victor M. Cáceres, David K. Kim, Joseph S. Bresee, John Horan, Jacqueline S. Noel, Tamie Ando, Connie J. Steed, J. John Weems, Stephan S. Monroe, James J. Gibson
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 19 / Issue 3 / March 1998
- Published online by Cambridge University Press:
- 02 January 2015, pp. 162-167
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- March 1998
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Objective:
To identify the etiologic agent and risk factors associated with a hospital ward outbreak of gastroenteritis.
Setting:A regional referral hospital in upstate South Carolina.
Methods:We reviewed patient charts, surveyed staff, and tested stool from acutely ill persons. A case was defined as diarrhea and vomiting in a staff member or patient from January 5 to 13, 1996.
Results:The initial case occurred on January 5 in a staff nurse who subsequently was hospitalized on the ward and visited by many staff colleagues. The staff were at a significantly greater risk for gastroenteritis than were patients (28/89 [31%] vs 10/91 [11%]; relative risk [RR], 2.9; 95% confidence interval [CI95], 1.5-5.5). All 10 case-patients had been exposed to case-nurses (assigned nurses who were primary caretakers), and eight had documented exposure to case-nurses 1 to 2 days before their illness. Patients exposed to case-nurses had a significantly increased risk of illness (8/57 [14%] vs 0/32; RR, >4.5; CI95, undefined). Neither staff nor patients had significantly increased risk from food, water, ice, or exposure to case-patients. Electron microscopy identified small round-structured viruses (SRSVs) in nine of nine stool samples.
Conclusion:This nosocomial outbreak of gastroenteritis was likely caused by SRSVs introduced by a staff member and spread via person-to-person transmission from and among staff. The potential for spread of SRSV-associated gastroenteritis from and among staff should be considered in developing strategies to prevent similar outbreaks in hospital settings