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PubMed2005

Evolutionary nursing: the case of infectious diseases.

AIM: The aim of this paper is to examine the effect of evolution on infectious diseases nursing, and propose a model that may help to increase understanding of how hosts and microorganisms co-exist and how humans can alter the delicate balance between them. BACKGROUND AND RATIONALE: Infectious diseases occur as the result of interactions between hosts and microorganisms. There is an increasing acceptance that the evolution of host and parasite is important in the development of infectious diseases. However, such views have made little impact in nursing, and the use of evolutionary interventions remains controversial. METHOD: The Medline database was searched from 1966 to present using the terms pathogen$, virulen$, evolution, bacteria, and all combinations of these. Additionally reference lists of text books and papers were hand searched for relevant papers. Papers were selected from a variety of disciplines, including infectious diseases, microbiology, evolutionary biology, and ecology. Recurrent themes from these papers were identified and a model of evolutionary nursing constructed. RESULTS: Microorganisms are plentiful, ubiquitous, and rapidly evolving by comparison with humans and other animals. As a result of this, attempts to 'outwit' them have been, and are, doomed to failure. However, through careful management of public and personal health, a balance encouraging co-existence may be possible. A number of specific interventions is proposed. CONCLUSIONS: There are a number of key interventions that may reduce the virulence of microorganisms. With an increasing world population, antibiotic resistance and international travel, such an approach may be one way of reducing the morbidity associated with infectious diseases.

Biological Evolution↗
PubMedDate not supplied

Continuing education: Comprehensive menopausal assessment: an approach to managing vasomotor and urogenital symptoms in breast cancer survivors.

PURPOSE/OBJECTIVES: To describe the development and implementation of a comprehensive menopausal assessment (CMA) and intervention program for women with a history of breast cancer. DATA SOURCES: Published articles selected from computerized databases, conference proceedings, bibliographies of pertinent articles and books, and lay publications. DATA SYNTHESIS: The CMA program consisted of a structured, comprehensive assessment of three symptoms (hot flashes, vaginal dryness, and stress urinary incontinence) and an individualized plan of education, counseling, nonestrogen treatments, psychosocial support, referrals, and follow-up. CONCLUSIONS: A structured approach to evaluating and managing vasomotor and urogenital symptoms with, for example, the CMA, may help breast cancer survivors with severe symptoms more effectively manage these symptoms than "usual care." IMPLICATIONS FOR NURSING: Nurses providing care for women with a history of breast cancer can incorporate the key elements of the CMA program into their practice to facilitate more effective management of three common menopausal symptoms that often are undertreated in this patient population.

Administration, Topical↗
PubMed2006

The evolution of female orgasm: adaptation or byproduct?

Do women experience orgasm because this trait was shaped by natural selection to augment female fitness? Or are women merely the lucky recipients of developmental patterns favored by selection to produce orgasm in males? A recent and widely publicized book by Elisabeth Lloyd (2005a) contends that there is insufficient evidence to validate any of the adaptive explanations yet proposed for female orgasm. We agree. But our reading of the data differs from Lloyd's. In this essay, we outline why, unlike Caton (2006), whose review of Lloyd's book appeared previously in this journal, we are not persuaded by Lloyd's argument that female orgasm is a nonadaptive byproduct of orgasm in men. We hold this view because we disagree with the criteria Lloyd uses to evaluate evolutionary hypotheses, and because we believe Lloyd defines female orgasm too narrowly, ignoring critical information about its affective aspects.

Adaptation, Physiological↗
PubMed2004

[Common problems during lactation and their management].

OBJECTIVE: To present an updated review on common problems associated with breastfeeding and their management. SOURCE OF DATA: A comprehensive bibliographic review on the issue was performed by searching publications from the MEDLINE database and from national and international organizations. Books and some key articles cited in other sources were also selected. SUMMARY OF THE FINDINGS: Several common problems that may arise during the breastfeeding period, such as breast engorgement, plugged milk duct, breast infection and insufficient milk supply, originate from conditions that lead the mother to inadequate empty the breasts. Incorrect techniques, not frequent breastfeeding and breastfeeding on scheduled times, pacifiers and food suppliers are important risk factors that can predispose to lactation problems. The adequate management of those conditions is fundamental, as if not treated they frequently lead to early weaning. There are specific measures that should be taken to empty the breasts effectively. Besides, the emotional support and actions that yield more comfort to the lactating mother can not be neglected. CONCLUSIONS: Most common problems associated with breastfeeding can be prevented if the mother empties her breasts effectively. If they occur, they should be carefully and adequately approached, thus avoiding the early weaning resultant from painful and stressing situations the mother may face.

Bottle Feeding↗
PubMed1999

Familiarity and pronounceability of nouns and names.

Ratings of familiarity and pronounceability were obtained from a random sample of 199 surnames (selected from over 80,000 entries in the Purdue University phone book) and 199 nouns (from the Kucera-Francis, 1967, word database). The distributions of ratings for nouns versus names are substantially different: Nouns were rated as more familiar and easier to pronounce than surnames. Frequency and familiarity were more closely related in the proper name pool than the word pool, although both correlations were modest. Ratings of familiarity and pronounceability were highly related for both groups. A production experiment showed that rated pronounceability was highly related to the time taken to produce a name. These data confirm the common belief that there are differences in the statistical and distributional properties of words as compared to proper names. The value of using frequency and the ratings of familiarity and pronounceability for predicting variations in actual pronunciations of words and names are discussed.

Adult↗
PubMedDate not supplied

[The psychodynamics of deafness].

OBJECTIVE: Deafness generates psychological conflicts for the deaf as well as for others in their environment. Our purpose is to obtain a panorama of the topic based on the available bibliography. INFORMATION: Relevant articles were located in Medline and in unlisted journals, accessible at the National Institute of the Human Communication and at the Juan N. Navarro Hospital of Mexico City. The books were located at the National Institute of the Human Communication. SELECTION OF THE MATERIAL: The articles were selected by the authors, based in their apparent internal consistency and relation to our purpose. Two different concepts became apparent: one which recognizes a "personality of the deaf" that would predispose to emotional damage, and the other that denies that concept, explaining the distinctive features of deaf people as due to basically environmental factors. CONCLUSION: We think that this review sustains the premise that the psychological damages of deafness are real, not inherent to it, but caused by the social, occupational, pedagogical and familiar conflicts that are generated. Those damages vary with the age at the presentation of deafness the personal adjustment to the deficiency and acceptance by the community. The mitigation of deafness, damage depends on educated parents, adequate instruction programs (scholastic as well as occupational), and when needed, appropriate supportive psychotherapy based on the specific needs of each deaf person and this/her environment. We consider highly desirable to promote the elaboration and publication of interdisciplinary studies related to this topic.

Adolescent↗
PubMed1990

An overview of the FDA publication Approved Drug Products with Therapeutic Equivalence Evaluations.

The history, purpose, and content of FDA's Approved Drug Products with Therapeutic Equivalence Evaluations (the "Orange Book") are described. When cost guidelines established in the 1970s for Medicare reimbursement prompted most states to permit generic drug product selection, an official list of interchangeable drug products was needed. Regulations for determining bioavailability and bioequivalence were published in 1977, and FDA first published Approved Drug Products in 1980. The Orange Book includes products that have been fully reviewed by FDA for both safety and effectiveness and for which new drug applications (NDAs) or abbreviated new drug applications (ANDAs) and special applications (From 5s or 6s) for antibiotics have been approved. Pursuant to the 1984 Drug Price Competition and Patent Term Restoration Act, FDA added approved nonprescription products to the Orange Book along with information about patents and periods of marketing exclusivity. Orphan drug products and certain testing and application procedures are also provided. Equivalence evaluations are provided in the Orange Book only for multisource prescription drug products that contain the same active ingredients and can be expected to have the same clinical effect when administered to patients under the conditions specified in the labeling. A coding system is used to indicate the products' equivalence evaluations according to FDA criteria, and indexes by product name and manufacturer are included. Monthly Cumulative Supplements are issued. The Orange Book contains public information and advice, but it is not an official national compendium; FDA has no position on state regulation of drug product selection by pharmacists. The equivalence evaluations do not relieve practitioners from exercising care in prescribing and dispensing products according to patients' individual needs.

Drug Information Services↗
PubMed2005

Availability of accessible publications: designing a methodology to provide reliable estimates for the Right to Read Alliance.

OBJECTIVES: To establish reliable estimates of the proportion of books available in formats accessible to visually impaired people; to recommend a practical method of updating the estimates. METHODS: The project had two stages. Stage one estimated the overall availability of all categories of books. The British National Bibliography (BNB) for 1999-2003 was chosen as the sampling frame. A sample of 2069 titles over the 5 years was selected using a systematic sample design. These titles were then checked for availability against the catalogues of four major producer/suppliers of materials in accessible formats. The second stage involved checking the availability of books in six genres; about 400 titles for each genre were examined. RESULTS: Of the titles selected for the overall estimate, 92 (4.4%) were found to be available in one or more accessible formats. Availability of titles in accessible formats varied greatly between categories. Adult fiction had the highest number of available publications (26.3%), least represented were cookery (1.9%) and gardening (1.8%). CONCLUSIONS: This study provided baseline figures and a methodology for the Right to Read Alliance to monitor their progress in campaigning for more books to be accessible to visually impaired people.

Blindness↗
PubMed1989

Midwifery in The Netherlands. The Wormerveer study; selection, mode of delivery, perinatal mortality and infant morbidity.

Between 1969 and 1983 a group of 7980 pregnant women, booked consecutively at a practice of freestanding midwives in Wormerveer, the Netherlands, was studied. They gave birth to 8055 children. Perinatal mortality in the total group was low (11.1 per 1000) compared with national figures of 14.5 per 1000 between 1969 and 1983. The highest mortality (51.7 per 1000) was found in the group of 1430 infants born after maternal referral during pregnancy to a specialist obstetrician. The perinatal mortality in the group selected during pregnancy as low-risk cases was very low (2.3 per 1000). The caesarean section rate in the total group was 1.4% and 0.4% in the selected low-risk group. Of the 5985 infants born alive under sole care of a midwife, 3.8% were admitted to hospital. Emergency admission because of birth asphyxia occurred in 0.4%. Convulsions within 48 h of birth at term occurred in seven (0.9 per 1000) in the total group and in five infants born in the selected group (0.8 per 1000). Selection of pregnant women into groups with high and with low risk is possible with the relatively modest means available to the midwife.

Cesarean Section↗
PubMed1997

Self-directed patient education in soft-tissue rehabilitation: rationale and analysis of a pilot project.

OBJECTIVES: To determine the compliance level and topic choice selection frequency of rehabilitation patients in a self-directed education program offered in conjunction with a rehabilitation exercise program. DESIGN: Descriptive study. SETTING: Soft-tissue injury rehabilitation clinic located within a chiropractic college. SUBJECTS: Twenty-four rehabilitation patients with injured spines who were enrolled in a daily in-clinic program. OUTCOME MEASURES: Data was collected from patient log-book pages, which recorded frequency of use, topic, medium and personal satisfaction for each selected resource. Clinic attendance data was collected by the clinical staff. RESULTS: Eighty-one percent (81%) of the patient group voluntarily used the learning center. Average frequency of use was approximately one visit per patient per week. Of the 13 subject areas included in the resource center collection, back injury care (30), nutrition (22) and fitness/exercise (14) received the most use. Patient satisfaction with the resources' value/interest averaged 78.4%. CONCLUSIONS: Most (81%) patients in this group were willing to spend some of their own time learning information that they thought was important. The results may allow for patient education program designs that put more responsibility for learning with the patient and allow for more efficient clinician time allocation.

Adult↗
PubMedDate not supplied

[Simple obesity in children. A study on the role of nutritional factors].

UNLABELLED: Excessive amount of adipose tissue in children and adolescents and simple obesity in particular constitute a growing health problem throughout the world. Adverse health effects of obesity of children justify the need to look for efficient treatments, among them the dietary treatment. THE AIM OF THE STUDY was to examine the effectiveness of dietary treatment in children with simple obesity on the basis of thorough analysis of their state of nutrition, method of nutrition and eating habits and the impact of other environmental factors. Four research hypotheses were formulated: 1. simple obesity of children is influenced by selected environmental factors such as parents' level of education, familial inclination to obesity and health habits, 2. chosen and accepted by the child and/or its mother/parents programme of dietary treatment in the form of low-energy diet with elements of low glycemic index results in the loss of body mass in children, 3. implemented dietary treatment translates into the modification of basic anthropometric features--body mass, body height, thickness of skin and adipose folds on arm, below shoulder blade (scapula), on abdomen as well as arm circumference and anthropometric parameters of examined children--body mass index BMI, waste-hip ratio, body fat content, 4. implemented dietary treatment has an impact on modification of certain biochemical indicators--lipid profile of children with increased indicators of lipid metabolism. MATERIAL AND METHODS: The research concerned 236 children living in the Mazowsze region with diagnosed simple obesity (relative body mass index rel BMI =20%), directed to Gastroenterological and Endocrinological Unit of the Institute of Mother and Child, after the children and/or their mothers/parents had accepted participating in a ten-week long research programme. The state of nutrition was evaluated on the basis of the examination of 8 basic features and 5 anthropometric parameters and basic biochemical indicators of metabolism of carbohydrates and fats, before and after the beginning of dietary treatment. The assessments of the method of nutrition, including eating habits, proportions of food products in the food ration and nutritional value of daily food rations was conducted on the basis of 10-14-day records of the child's diet before the implementation of dietary treatment and on the basis of randomly selected 3-day records of the child's diet from the diet book after the dietary treatment was introduced. The environmental data were collected on the basis of a questionnaire, constructed for this study. RESULTS: The main risk factors for simple obesity in examined children (n=236) aged 3-15 yrs were familial and environmental conditions. A significant correlation was found between the children's obesity expressed by a normalized body mass index BMI z-score, unrelated to age and sex, and mother's level of education and father's obesity (Chi(2) test, p<0.05). A positive correlation was demonstrated between the normalized relative body mass index (BMI z-score) and children's anthropometrical parameters--thickness of skin and adipose folds on the arm, below the shoulder blade (scapula), on the abdomen and their sum, arm circumference, waste-hip ratio and body fat content and the children's parents body mass index (father's BMI, mother's BMI). In boys with simple obesity the tendency to central obesity was observed since early childhood. In the examined group of children no distortions of metabolism of carbohydrates were observed (correct fasting levels of glucose), while in children with obesity the irregularities of metabolism of fats were noted. The implemented dietary treatment (low energy diet with elements of low glycemic index) had a significant impact on improvement of lipid metabolism in all children in whom the irregularities of metabolism of fats were noted. Modification of the diet of children aged 3-6 by implementing dietary recommendations, including the increased frequency of meals and the choice of products with low glycemic index, did not have a significant impact on the decrease of the body mass index in 95% of examined children. A considerable number of children aged 3-6 (n=12) continued to eat only three meals a day and their model of nutrition, including the selection of products, was not significantly modified. The introduced low energy diet with elements of low glycemic index in children of school age (7-15 years) with simple obesity positively influenced the decrease of analyzed features and parameters (p<0.0001). During dietary treatment statistically significant decrease of the children's body mass was observed as well as a decrease of the thickness of skin and adipose folds on the arm, below the shoulder blade (scapula), on the abdomen and a decrease of arm circumference and body fat content. The change of the energy content of a daily food ration, the amount of consumed carbohydrates and products from the group of sugar and sweets, cereal foodstuffs and fat and products from the group of other fats was positively correlated with body mass loss expressed as the difference between z-score BMI before and after the dietary treatment. The modification of the eating habits--increased frequency of meals and reduction or elimination of eating between the meals during the nutrition intervention were not significantly linked to the change of normalized body mass index in the examined children. Only the frequency of eating sweets was related to the change of z-score BMI (p<0.05). The implemented dietary treatment in obese children aged 7-15 yrs significantly influenced the body mass loss. In children (n=38/236) with lipid metabolism abnormalities, the low energy diet with elements of low glycemic index had a favorable impact on the lipid profile. The increased levels of total cholesterol, LDL cholesterol and triglycerides returned to normal. CONCLUSIONS: 1. Simple obesity in children aged 3-15 yrs is connected with familial and environmental factors, including incorrect eating habits. 2. Dietary treatment consisting in the lowering of energetic value of the diet through the reduction of fat consumption and quantity and quality changes with respect to carbohydrates consumption decreased the children's obesity, and was more effective in the older age group (7-15 yrs). Dietary treatment normalizes the lipid profile in children. 3. Significant body mass loss has been observed in children in whose diet the amount of proteins and their share in the total energy value only slightly differs from the level before the dietary treatment. The amount of proteins in the children's diet was within the range of physiological recommendations.

Adolescent↗
PubMed2005

Routine intraoperative ureteric stenting for kidney transplant recipients.

BACKGROUND: Major urological complications (MUCs) after kidney transplantation contribute to patient morbidity and compromise graft function. The majority arise from the vesico-ureteric anastomosis and present early after transplantation. Ureteric stents have been successfully used to treat such complications. A number of centres have adopted a policy of universal prophylactic stenting, at the time of graft implantation, to reduce the incidence of urine leaks and ureteric stenosis. Stents are associated with specific complications and some centres advocate a policy of only stenting selected anastomoses. OBJECTIVES: To examine the benefits and harms of routine ureteric stenting to prevent urological complications in kidney transplant recipients. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE, EMBASE, reference lists of articles, books and abstracts and contacted companies, authors and experts to identify relevant randomised controlled trials (RCTs). SELECTION CRITERIA: All RCTs and quasi-RCTs were included in our meta-analysis. DATA COLLECTION AND ANALYSIS: Four reviewers assessed the trials for quality against four criteria (allocation concealment, blinding, intention-to-treat and completeness of follow-up). The primary outcome was the incidence of MUCs. Further outcomes of interest were graft and patient survival and the incidence of adverse events (urinary tract infection (UTI), haematuria, irritative symptoms, pain and stent migration). Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). MAIN RESULTS: Seven RCTs (1154 patients) of low or moderate quality were identified. The incidence of MUCs was significantly reduced (RR 0.24, 95% CI 0.07 to 0.77, P = 0.02, NNT 13) by universal prophylactic stenting. This was dependent on whether the same surgeon performed, or was in attendance, during the operations. Two patients lost their grafts to infective urinary tract complications in the stented group. UTIs, in general, were more common in stented patients (RR 1.49, 95% CI 1.04 to 2.15) unless the patients were prescribed cotrimoxazole 480 mg/d: in which case the incidence was equivalent (RR 0.97, 95% CI 0.71 to 1.33). Stents appeared generally well tolerated, although trials using longer stents (>/= 20 cm) for longer periods (> 6 weeks) had more problems with encrustation and migration. AUTHORS' CONCLUSIONS: Routine prophylactic stenting reduces the incidence of MUCs. Trials comparing selective stenting and universal prophylactic stenting, whilst difficult to design and analyse, would address the unresolved quality of life and economic issues.

Hematuria↗
PubMed1994

Pathological fire-setting 1951-1991: a review.

The purpose of this article is to review the whole literature on pathological fire-setting and related fields since 1951 in order to present a state of the art picture of our contemporary knowledge about this phenomenon. Papers were initially selected by using a Medline search. From the articles obtained in this way the references had to be pursued, because many relevant papers and books in this research field of different scientific and practical disciplines are not listed in conventional literature services. Finally, only those contributions were selected which provided new information when published, by original research, theoretical interpretation or practical implications. The last forty years have brought a growing body of data and understanding--especially concerning pathological fire-setting by children--etiology, and therapy, which often proves successful. The situation remains unclear for arson by psychologically disturbed adults and we still have a poor understanding of arson without apparent motive. There is a conflict of opinion as to whether adult fire-setters are suitable for therapy and therapeutic efforts dealing with psychologically disturbed adults are rare. With increasing knowledge about child fire-setting and its successful treatment, etiological and therapeutic models for adult fire-setting behaviour may be developed. Research into the latter area should focus on both biographical and social conditions of development from childhood on as well as biological measures. Both will be reviewed here.

Adolescent↗
PubMed1998

Gas chromatography.

This review of the fundamental developments in gas chromatography (GC) includes articles published from 1996 and 1997 and an occasional citation prior to 1996. The literature was reviewed principally using CA Selects for Gas Chromatography from Chemical Abstracts Service, and some significant articles from late 1997 may be missing from the review. In addition, the online SciSearch Database (Institute for Scientific Information) capability was used to abstract review articles or books. As with the prior recent reviews, emphasis has been given to the identification and discussion of selected developments, rather than a presentation of a comprehensive literature search, now available widely through computer-based resources. During the last two years, several themes emerged from a review of the literature. Multidimensional gas chromatography has undergone transformation encompassing a broad range of activity, including attempts to establish methods using chromatographic principles rather than a totally empirical approach. Another trend noted was a comparatively large effort in chromatographic theory through modeling efforts; these presumably became resurgent with inexpensive and powerful computing tools. Finally, an impressive level of activity was noted through the themes highlighted in this review, and this was particularly true with detectors and field instruments.

Chemistry Techniques, Analytical↗
PubMed2000

Carl Düsing (1884) on the regulation of the sex-ratio.

In three publications in 1883 and 1884 Carl Düsing of Jena gave a mathematical account of the influence of natural selection on the sex ratio based on the same argument that Darwin had advanced in The Descent of Man (1871). The argument thus became quite well known, being included in the principal books on the subject around the turn of the century, as well as in the Encyclopaedia Britannica, references to Düsing being given. By 1930, when Fisher gave a verbal account of the argument in The Genetical Theory of Natural Selection, he saw no need to give references, and no other book of the period treated the subject, as a result of which Düsing's contribution became lost to view. We here give the important paragraphs of Düsing's mathematical account, translated into English.

Animals↗
PubMed1996

The clinical value of computerized information services. A review of 98 randomized clinical trials.

OBJECTIVE: To review all randomized clinical trials addressing the efficacy of clinical information systems and to determine the clinical settings, types of interventions, and effects studied. DATA SOURCES: Extensive and systematic MEDLINE searches were conducted using a combination of medical subject headings (MeSH) and textword terms to collect trial reports. Manual searches of books and monographs as well as informal contacts were also used. STUDY SELECTION: The eligibility criteria were (1) randomized controlled clinical trial, (2) computerized information intervention in the study group, and (3) effect measured on the process or outcome of care. DATA EXTRACTION: Two research assistants independently abstracted from the selected reports the following structured information: trial sites, computerized interventions, effect variables, and outcomes. Three investigators evaluated the combined list of trial features for setting, intervention, and effect. The statistical analysis included an evaluation of agreement in developing classifications and an analysis of the ratio of positive trial outcomes. DATA SYNTHESIS: Most information services were tested in outpatient care (82%), particularly in primary care (66%). The information intervention targeted the provider in 64% of the trials. The effect was primarily measured for the process of care (76%). Provider prompt/reminder, computer-assisted treatment planner, interactive patient education/therapy, and patient prompt/reminder were significantly successful interventions (sign test, P < .05). CONCLUSIONS: Randomized clinical trials confirm that four generic information interventions are active ingredients of computer systems and can make a significant difference in family medicine (physician and patient reminders, treatment planner, and patient education). To manage care and improve quality, primary care computer systems should incorporate these effective information services.

Information Systems↗
PubMed2002

Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis.

CONTEXT: The effects of home visitation programs to prevent functional decline in elderly persons have been inconsistent, and the value of these programs is controversial. OBJECTIVE: To evaluate the effect of preventive home visits on functional status, nursing home admission, and mortality. DATA SOURCES: Studies published in English, French, German, Italian, or Spanish reporting randomized trials of the effects of preventive in-home visits in older people (mean age >70 years) living in the community were identified through searches of MEDLINE, PSYCHINFO, and EMBASE (January 1985--November 2001). We also searched the Cochrane Controlled Trials Register, checked reference lists of earlier reviews and book chapters, searched conference proceedings and specialty journals, and contacted experts. STUDY SELECTION: We screened 1349 abstracts and excluded those that did not test in-home interventions or in which the mean age of the study population was younger than 70 years. After further exclusions, 17 articles describing 18 trials were analyzed. DATA EXTRACTION: Two reviewers independently screened abstracts. Discrepancies were resolved by consensus with a third reviewer. For each included trial, we extracted data on the study population and the characteristics of the intervention. Two of us extracted information on 3 end points: nursing home admissions, mortality, and functional status. One of us assessed trial quality, including an examination of the method of randomization, blinding of caregivers and research staff ascertaining outcomes, and proportion of patients included in analyses of the 3 end points. DATA SYNTHESIS: The 18 trials included 13 447 individuals aged 65 years and older. The effect on nursing home admissions depended on the number of visits performed during follow-up. The pooled relative risk (RR) was 0.66 (95% confidence interval [CI], 0.48-0.92) for trials in the upper tertile (>9 visits) but was 1.05 (95% CI, 0.85-1.30) in the lower tertile (0-4 visits). Functional decline was reduced in trials that used multidimensional assessment with follow-up (RR, 0.76; 95% CI, 0.64-0.91) but not in other trials (RR, 1.01; 95% CI, 0.92-1.11). Functional decline was reduced (RR, 0.78; 95% CI, 0.64-0.95) in trials with a control group mortality rate in the lower tertile (3.4%-5.8%) but not (RR, 0.98; 95% CI, 0.84-1.13) in those with a control-group mortality rate in the upper tertile (8.3%-10.7%). A beneficial effect on mortality was evident in younger study populations (RR, 0.76; 95% CI, 0.65-0.88 for ages 72.7-77.5 years) but not in older study populations (RR, 1.09; 95% CI, 0.92-1.28 for ages 80.2-81.6 years). CONCLUSION: Preventive home visitation programs appear to be effective, provided the interventions are based on multidimensional geriatric assessment and include multiple follow-up home visits and target persons at lower risk for death. Benefits on survival were seen in young-old rather than old-old populations.

Activities of Daily Living↗
PubMed2003

Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence.

CONTEXT: Atherosclerotic vascular disease is an enormous public health problem. A number of emerging risk factors for atherosclerosis have recently been proposed to help identify high-risk individuals. OBJECTIVE: To review the epidemiological, basic science, and clinical trial evidence concerning 4 emerging risk factors: C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine. DATA SOURCES: Using the terms atherosclerosis, cardiovascular disease, risk factors, prevention, screening, C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine, we searched the MEDLINE database from January 1990 to January 2003. Conference proceedings, abstract booklets, bibliographies of pertinent articles and books, and personal files were hand searched to identify additional articles. STUDY SELECTION: Original investigations and reviews of the epidemiology of atherosclerosis and the association of conventional and novel risk factors with vascular risk were selected. On the basis of the search strategy, 373 relevant studies were identified. DATA EXTRACTION: A diverse array of studies were examined, including randomized controlled trials, prospective cohort studies, systematic overviews, case-control, cross-sectional, and mechanistic studies. Data extraction was performed by one of the authors. DATA SYNTHESIS: The available epidemiological and basic science evidence supports, to varying degrees, independent associations between these 4 candidate risk factors and atherosclerotic vascular disease. However, there is relatively little data regarding the additive yield of screening for these factors over that of validated global risk assessment strategies currently in use. Furthermore, controlled intervention studies targeting individuals with these factors for proven risk-reduction therapies, or specifically treating these factors with available therapies, are few. The explanatory power of the major, established cardiovascular risk factors has been systematically underestimated. CONCLUSIONS: Although C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine are associated with vascular disease risk, their optimal use in routine screening and risk stratification remains to be determined.

Arteriosclerosis↗