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Gitlin LN, Roth DL, Marx K, Parker LJ, Koeuth S, Dabelko-Schoeny H, Anderson K, Gaugler JE. Embedding Caregiver Support Within Adult Day Services: Outcomes of a Multisite Trial. Gerontologist 2024; 64:gnad107. [PMID: 37549428 PMCID: PMC10943495 DOI: 10.1093/geront/gnad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adult day services (ADS) provide quality-of-life benefits to people with dementia, but few provide systematic caregiver support. We report outcomes of a multisite, national trial testing a staff-delivered caregiver program, ADS Plus. RESEARCH DESIGN AND METHODS Cluster-randomized trial involving 34 ADS: 18 sites provided ADS (controls) and 16 provided ADS and ADS Plus (intervention). Trained staff met with caregivers to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12 months. Main outcomes included depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and well-being at 6 and 12 months, and client attendance over 12 months. RESULTS Of 203 caregivers (Intervention = 102; Control = 101), 5.9% at 3 months, 12.8% at 6 months, and 22.7% at 12 months were lost to follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as White/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had ≥college education and were 65.0 years old (SD = 13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (≥16 CES-D) at baseline. By 6 months, 43.6% control versus 34.2% ADS Plus caregivers had ≥16 scores (odds ratio = 0.38, p = .072). By 12 months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p = .013) and lower depressed affect scores (p = .015). Of 18 sites providing 12-month client attendance data, 9 intervention sites reported 126.05 days attended versus 78.49 days for 9 control sites (p = .079). DISCUSSION AND IMPLICATIONS Compared with ADS alone, by 12 months, ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance ADS benefits. CLINICAL TRIAL REGISTRATION NCT02927821.
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Affiliation(s)
- Laura N Gitlin
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - David L Roth
- Center on Aging and Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine Marx
- Center for Equity in Aging, School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Lauren J Parker
- Department of Health, Behavior and Society, School of Public Health, Johns Hopkins Bloomberg, Baltimore, Maryland, USA
| | - Sokha Koeuth
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Holly Dabelko-Schoeny
- Age-Friendly Innovation Center, College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Keith Anderson
- Department of Social Work, School of Applied Sciences, University of Mississippi, Oxford, Mississippi, USA
| | - Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Judge PK, Staplin N, Mayne KJ, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Ng SYA, Roddick AJ, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Massey D, Landray MJ, Baigent C, Haynes R, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Parker L, Marx K, Knimbeng M, Johnson E, Koeuth S, Gaugler J, Gitlin L. CULTURAL ADAPTATION OF THE ADULT DAY SERVICE PLUS PROGRAM FOR HISPANIC/LATINO DEMENTIA CAREGIVERS. Innov Aging 2022. [PMCID: PMC9770116 DOI: 10.1093/geroni/igac059.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Although Hispanic/Latinos are at disproportionate and increased risk for Alzheimer’s disease and related dementias, few evidence-based supportive care interventions have been specifically developed for or adapted for this population. Adapting a supportive care intervention requires more than Spanish language translation and necessitates an understanding of cultural nuances and care preferences of Hispanic/Latino families and staff who implement the intervention. This paper reports on the cultural adaptation of the Adult Day Service Plus (ADS Plus) intervention for delivery by staff to Hispanic/Latino caregivers which was guided by the Cultural Adaptation Process Model. Also, using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME),we discuss: 1) when modifications were made, 2) who determined modifications needed, 3) what aspects of the intervention were modified, 4) the relationship to fidelity and how fidelity was maintained, and 5) reasons for modifications. Modifications to the delivery and content were changed to reflect values and norms of both the Hispanic/Latino staff and the caregivers they serve. As supportive interventions for dementia caregivers are developed and implemented into real world settings, inclusion of cultural elements may enhance research participation from Hispanic/Latino provider sites and caregivers. We suggest in this paper that cultural adaptation is an essential consideration in developing an intervention as well as adapting evidence-based previously tested interventions, and in implementation science. Cultural adaptation offers an important lens by which to identify contextual factors impacting intervention adoption interventions and needed adaptations to assure equity in the reach of evidence-based programs.
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Affiliation(s)
- Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Katherine Marx
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Manka Knimbeng
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Elma Johnson
- University of Minnesota School of Public Health, Minneapolis, Minnesota, United States
| | - Sokha Koeuth
- Drexel University, Philadelphia, Pennsylvania, United States
| | - Joseph Gaugler
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Laura Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
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Grossman ER, Greenthal E, Marx K, Ruffin M, Lucas S, Benjamin-Neelon SE. Are Students Paid to Market Sugar-Sweetened Beverages to Peers? A Review of University Pouring Rights Contracts. Child Obes 2022; 18:533-539. [PMID: 35325554 DOI: 10.1089/chi.2021.0267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Many university students regularly consume sugar-sweetened beverages (SSBs), which are associated with obesity and related chronic diseases. Moreover, students are strongly influenced by both their peers and product marketing. Our exploratory study examined pouring rights contracts between universities and beverage companies, focusing on provisions establishing campus/brand ambassador positions and marketing/merchandising manager positions whose jobs are to market SSBs on campus. Methods: For this cross-sectional study conducted in late 2020, two independent coders reviewed 131 pouring rights contracts between Coca-Cola or Pepsi and 124 unique public universities with 20,000 or more students enrolled. Contracts were active in 2018 or 2019. Results: Twenty-six contracts (20%) contained provisions specifically establishing either campus/brand ambassador positions (n = 16), marketing/merchandising manager positions (n = 7), both (n = 1), or unclear language related to these positions (n = 2). Thirteen contracts (10%) required that the position be filled by a current student. The objectives for both types of positions included increasing revenue and driving beverage sales. When stated in the contracts (n = 5), the payments allocated for these positions ranged between $5,000 and $10,000 per year. Conclusions: Given the association between SSBs and obesity and other related health outcomes, combined with the influence that peers and product marketing may have on adolescents' and young adults' attitudes toward consumption of these beverages, universities should be more transparent when these provisions are included in their pouring rights contracts and should carefully consider whether it is appropriate for these contracts to include funding for students to market SSBs.
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Affiliation(s)
- Elyse R Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eva Greenthal
- Center for Science in the Public Interest, Washington, DC, USA
| | - Katherine Marx
- Center for Science in the Public Interest, Washington, DC, USA
| | - Martha Ruffin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie Lucas
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Gitlin LN, Marx K, Piersol CV, Hodgson NA, Parker LJ, Cidav T, Roth DL. Differential race effects of the tailored activity program (TAP) on dementia-related behaviors: A randomized controlled trial. J Am Geriatr Soc 2022; 70:3105-3115. [PMID: 35932186 PMCID: PMC10414755 DOI: 10.1111/jgs.17981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although nonpharmacological approaches are considered first-line treatments for dementia-related behaviors, it is unclear as to their effectiveness for different racial groups. We evaluated the effects of the Tailored Activity Program (TAP) on agitated and aggressive behaviors in Black and White families. METHODS We conducted a single-blind, two-arm randomized controlled trial involving Black (N = 90) and White (N = 145) families. TAP involved eight home sessions by occupational therapists who provided activities tailored to abilities and interests and instructed caregivers in their use over 3 months. An attention control group received eight sessions by research assistants who provided disease education and home safety tips. Measures included caregiver ratings of frequency by severity for the agitation and aggression subscales of the Neuropsychiatric Inventory-Clinician (NPI-C) at 3 months (main trial primary outcome), number of completed sessions and time spent, changes in behavioral subcomponents of the subscales (frequency, severity, caregiver distress), and percent improving/worsening. RESULTS Black and White families completed similar numbers of treatment sessions, but White dyads averaged nearly two contact hours more than Black dyads (p = 0.008). At 3 months, an interaction effect (treatment by race) indicated significantly greater reductions in frequency by severity scores for the agitation and aggression subscales for Black TAP dyads versus White TAP dyads and White and Black attention control dyads. Also, significant interaction effects favoring TAP Black dyads were observed for select behavioral components. For TAP dyads with elevated baseline agitation/aggression levels (N = 71), 34.5% of Black versus 11.9% of White dyads improved; whereas 2.6% of Black versus 16.7% of White dyads had worsened agitation/aggression scores. CONCLUSION Black families compared to White families derived greater behavioral benefits from TAP for PLWD at 3 months despite having less treatment exposure. Examining differential race effects may enhance precision in using nonpharmacological approaches and promote equity in dementia care for underserved populations.
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Affiliation(s)
- Laura N. Gitlin
- Drexel University, College of Nursing and Health Professions, Philadelphia, PA
| | - Katherine Marx
- Johns Hopkins University, School of Nursing, Baltimore, Maryland
| | | | | | - Lauren J. Parker
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Tom Cidav
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - David L. Roth
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
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Alsaad M, Lawrenz T, Marx K, Stellbrink C. Influence of pacemaker leads on the severity of tricuspid regurgitation after successful mitral valve edge to edge repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
After percutaneous mitral-valve edge-to-edge repair (MVER) for mitral regurgitation (MR) in patients with baseline tricuspid regurgitation (TR), about one third of patients shows improvement in TR severity. It is unknown whether this improvement may depend on the presence of a right ventricular (RV) pacemaker (PM) lead.
Aim
We investigated whether the presence of an existing RV PM lead influences TR severity after successful MVER due to symptomatic secondary MR.
Methods and results
We retrospectively analyzed 115 consecutive patients with symptomatic secondary high-grade MR (age 78.1±9.4 years, 50 women (43%) and baseline TR grade > or =1 (semiquantitative grading from 0 to 5) treated with MVER using the MitraClipTM device (Abbott, Cardiovascular, USA) and separated them in 2 groups, 43 patients with a PM lead compared to 72 pts without (see Table). TR grading by echocardiography was performed before and 3 months after MVER. (median follow up duration was 3 months). Procedural success with reduction of MR to < or =2/4 grades was 100% in both groups (p<0,001 vs. baseline). There was an overall significant change in TR grade after MVER in 46 pts (p 0,032): but both increase in TR in 17 pts (16.7%, p=0.58), in 10 pts with and in 7 pts without PM lead (58.8% vs. 41.2%, respectively; p=0.84) was not significant; the decrease in TR in 29 patients (28.4%, p=0.57), in 20 pts with and in 9 pts without PM lead (69% and 31%, respectively; p=0.47) also failed to reach statistical significance. TR reduction was associated with RV dilatation at baseline (p=0.006) but not the presence of pulmonary hypertension (p=0.83).
Conclusion
There was an overall significant change in TR after successful MVER. Although there was a trend towards an increase in TR after MVER in pts with PM lead there was no overall significant correlation between changes in TR severity and the presence of an RV PM lead but rather with baseline RV dilatation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Alsaad
- Clinic Bielefeld , Bielefeld , Germany
| | - T Lawrenz
- Clinic Bielefeld , Bielefeld , Germany
| | - K Marx
- Clinic Bielefeld , Bielefeld , Germany
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Lawin D, Stellbrink C, Marx K, Danielsmeier NB, Poudel MR, Lawrenz T. Gender-disparities in patients undergoing alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Alcohol septal ablation (ASA) improves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM) but gender-disparities have only rarely been investigated.
Purpose
To assess gender-disparities regarding outcome and procedure-related aspects in HOCM patients undergoing ASA.
Methods and results
1,367 consecutive ASAs between 2002 and 2020 were retrospectively analyzed for sex-differences. Females (47.2%) had more advanced age at the timing of ASA (66.0 years [IQR 55.0–74.0] vs. 54.0 years [IQR 45.0–62.0]; p<0.0001), had more severe symptoms (NYHA class 2.8±0.6 vs. 2.5±0.8 in males; p<0.0001) and shorter distances walked in 6-min-walk-test at baseline (359.0m [IQR 272.3–442.0] vs. 464.4m [IQR 400.0–524.0] in males; p<0.0001). The baseline interventricular septal diameter (IVSD) was higher in males (21.0mm [IQR 19.0–24.0] vs. 20.0mm [IQR 18.0–23.0] in females; p<0.0001). However, the IVSD was higher in females when it was indexed to the body-surface-area (10.9 mm/m2 [IQR 9.7–12.7] vs. 10.2 mm/m2 [IQR 9.0–11.7] in males; p<0.0001). The resting and exercise-induced left ventricular outflow tract gradients (LVOTG) were lower in females when calculated 1–4 days after ASA (resting: 20.0 mmHg [IQR 12.0–37.5] vs. 22.0 mmHg [IQR 13.0–40.0] in males; p=0.0062; exercise-induced: 55.0 mmHg [IQR 30.0–109.0] vs. 71.0 mmHg [IQR 37.0–115.0] in males; p=0.0006). At 6 months follow-up females had lower exercise-induced LVOTG (34.0 mmHg [IQR 21.0–70.0] vs. 43.5 mmHg [IQR 25.0–74.8]; p=0.0072). More females had complete heart block after ASA (20.3% vs. 13.3% in men; p=0.0005) and, hence, more females (17.4%) than males (10.4%; p=0.0002) needed a pacemaker. There were no differences regarding mortality.
Conclusion
Female HOCM patients had more advanced age, more severe symptoms and a higher IVSD when indexed to BSA at the timing of ASA. However, early hemodynamic response was better in females, but procedure-related complete heart block was more often found in women. Gender-disparities in clinical characteristics and procedural outcome of ASA should be taken into consideration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Lawin
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld , Bielefeld , Germany
| | - C Stellbrink
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld , Bielefeld , Germany
| | - K Marx
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld , Bielefeld , Germany
| | - N B Danielsmeier
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld , Bielefeld , Germany
| | - M R Poudel
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld , Bielefeld , Germany
| | - T Lawrenz
- University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld , Bielefeld , Germany
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Benjamin-Neelon SE, Grossman ER, Greenthal E, Lucas SA, Marx K, Ruffin M. Pouring rights contracts between universities and beverage companies: Provisions related to scientific research. Prev Med Rep 2022; 28:101897. [PMID: 35855921 PMCID: PMC9287474 DOI: 10.1016/j.pmedr.2022.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/12/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022] Open
Abstract
Pouring rights contracts between universities and beverage companies are common and grant companies the exclusive right to serve, sell, and market specific beverages on campuses. In exchange, universities receive financial payments and other incentives. At the same time, beverage industry-sponsored research at universities has increased. Pouring rights contracts may include provisions that allocate funds for or place limitations on scientific research. In this cross-sectional study, we assessed whether pouring rights contracts contained provisions that allocated funds for or placed limitations on scientific research. From 2019 to 2020, we obtained contracts through requests under public records laws from US universities (public, 4-year, ≥ 20,000 students) with contracts active 2018–2019. Of the 143 requests, 6 did not have contracts and 9 declined to provide contracts. Our final sample included 131 contracts from 124 universities in 38 states. Thirty contracts (22.9%) referenced research (18 Coke; 12 Pepsi). Three contracts (2.3%) included provisions that made direct grants or gifts of research funding, 3 (2.3%) permitted the university to acknowledge funding from competitors, and 26 (19.8%) allowed for research using beverages from competing companies. Given increases in industry-sponsored research, the absence of provisions that made direct grants or gifts of research funding suggests that sponsorship of research is occurring through other mechanisms. Additionally, universities must be able to acknowledge funding and conduct research on any beverage and should not need permission via contract provisions to do so. Future studies should consider practical implications of these provisions in pouring rights contracts and assess whether they facilitate or hinder research.
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Affiliation(s)
- Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Department of International Health, Division of Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Corresponding author.
| | - Elyse R. Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Eva Greenthal
- Center for Science in the Public Interest, Washington, DC 20005, United States
| | | | - Katherine Marx
- Center for Science in the Public Interest, Washington, DC 20005, United States
| | - Martha Ruffin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
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Greenthal E, Marx K, Grossman ER, Ruffin M, Lucas SA, Benjamin-Neelon SE. Incentives and penalties tied to sales volume in contracts between beverage companies and public universities in the United States. J Am Coll Health 2022:1-10. [PMID: 35623032 DOI: 10.1080/07448481.2022.2076098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 03/16/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess whether and how beverage companies incentivize universities to maximize sugar-sweetened beverage (SSB) sales through pouring rights contracts. METHODS Cross-sectional study of contracts between beverage companies and public U.S. universities with 20,000 or more students active in 2018 or 2019. We requested contracts from 143 universities. The primary measures were presence of financial incentives and penalties tied to sales volume. RESULTS 124 universities (87%) provided 131 unique contracts (64 Coca-Cola, 67 Pepsi). 125 contracts (95%) included at least one provision tying payments to sales volume. The most common incentive type was commissions, found in 104 contracts (79%). Nineteen contracts (15%) provided higher commissions or rebates for carbonated soft drinks compared to bottled water. CONCLUSIONS Most contracts between universities and beverage companies incentivized universities to market and sell bottled beverages, particularly SSBs. Given the health risks associated with consumption of SSBs, universities should consider their role in promoting them.
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Affiliation(s)
- Eva Greenthal
- Center for Science in the Public Interest, Washington, DC
| | - Katherine Marx
- Center for Science in the Public Interest, Washington, DC
| | - Elyse R Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Martha Ruffin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stephanie A Lucas
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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11
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Hu K, Perez-Matos MC, Argemi J, Vilar-Gomez E, Shalaurova I, Bullitt E, Landeen L, Sugahara G, Deng H, Mathur K, Tran S, Cai H, He H, Yalcin Y, Vieira Barbosa J, Ventura-Cots M, Marx K, Gad AP, Niezen S, Izunza Barba S, Ang LH, Popov YV, Fricker Z, Lai M, Curry M, Afdhal N, Szabo G, Mukamal KJ, Sanyal AJ, Otvos JD, Malik R, Saito T, Connelly MA, Chalasani NP, Bataller R, Jiang ZG. Lipoprotein Z, a hepatotoxic lipoprotein, predicts outcome in alcohol-associated hepatitis. Hepatology 2022; 75:968-982. [PMID: 34662439 PMCID: PMC9299888 DOI: 10.1002/hep.32203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Lipoprotein Z (LP-Z) is an abnormal free cholesterol (FC)-enriched LDL-like particle discovered from patients with cholestatic liver disease. This study aims to define the diagnostic value of LP-Z in alcohol-associated hepatitis (AH) and interrogate the biology behind its formation. APPROACH AND RESULTS We measured serum levels of LP-Z using nuclear magnetic resonance spectroscopy, a well-established clinical assay. Serum levels of LP-Z were significantly elevated in four AH cohorts compared with control groups, including heavy drinkers and patients with cirrhosis. We defined a Z-index, calculated by the ratio of LP-Z to total apolipoprotein B-containing lipoproteins, representing the degree of deviation from normal VLDL metabolism. A high Z-index was associated with 90-day mortality independent from the Model for End-Stage Liver Disease (MELD) and provided added prognosticative value. Both a Z-index ≤ 0.6 and a decline of Z-index by ≥0.1 in 2 weeks predicted 90-day survival. RNA-sequencing analyses of liver tissues demonstrated an inverse association in the expression of enzymes responsible for the extrahepatic conversion of VLDL to LDL and AH disease severity, which was further confirmed by the measurement of serum enzyme activity. To evaluate whether the FC in LP-Z could contribute to the pathogenesis of AH, we found significantly altered FC levels in liver explant of patients with AH. Furthermore, FC in reconstituted LP-Z particles caused direct toxicity to human hepatocytes in a concentration-dependent manner, supporting a pathogenic role of FC in LP-Z. CONCLUSIONS Impaired lipoprotein metabolism in AH leads to the accumulation of LP-Z in the circulation, which is hepatotoxic from excessive FC. A Z-index ≤ 0.6 predicts 90-day survival independent from conventional biomarkers for disease prognostication.
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Affiliation(s)
- Kunpeng Hu
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA.,Division of General SurgeryThe Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
| | - Maria C Perez-Matos
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Josepmaria Argemi
- Division of Gastroenterology, Hepatology, and NutritionUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA.,Hepatology ProgramCentro de Investigacion Medica Aplicada, Liver UnitClinica Universidad de NavarraInstituto de Investigacion de NavarraUniversity of NavarraPamplonaSpain
| | - Eduardo Vilar-Gomez
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Irina Shalaurova
- Laboratory Corporation of America HoldingsMorrisvilleNorth CarolinaUSA
| | - Esther Bullitt
- Department of Physiology and BiophysicsBoston University School of MedicineBostonMassachusettsUSA
| | | | - Go Sugahara
- Division of Gastrointestinal and Liver DiseasesKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA.,Research and Development DepartmentPhoenixBio, Co., LtdHigashi-Hiroshima, HiroshimaJapan
| | - Huiyan Deng
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Karan Mathur
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Stephanie Tran
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Huimei Cai
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Hanchang He
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Yusuf Yalcin
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Joana Vieira Barbosa
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA.,Division of Gastroenterology and HepatologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Meritxell Ventura-Cots
- Division of Gastroenterology, Hepatology, and NutritionUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Katherine Marx
- Transplant InstituteDepartment of SurgeryBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Aniket P Gad
- Confocal Imaging Core facilityBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Sebastian Niezen
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Sofia Izunza Barba
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Lay-Hong Ang
- Confocal Imaging Core facilityBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Yury V Popov
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Zachary Fricker
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Michelle Lai
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael Curry
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Nezam Afdhal
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Gyongyi Szabo
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Kenneth J Mukamal
- Division of General MedicineDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and NutritionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - James D Otvos
- Laboratory Corporation of America HoldingsMorrisvilleNorth CarolinaUSA
| | - Raza Malik
- Liver CenterDivision of GastroenterologyTufts Medical CenterBostonMassachusettsUSA
| | - Takeshi Saito
- Division of Gastrointestinal and Liver DiseasesKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Naga P Chalasani
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology, and NutritionUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Z Gordon Jiang
- Division of Gastroenterology, Hepatology, and NutritionDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
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12
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Marx K, Greenthal E, Ribakove S, Grossman ER, Lucas S, Ruffin M, Benjamin-Neelon SE. Marketing of sugar-sweetened beverages to youth through U.S. university pouring rights contracts. Prev Med Rep 2022; 25:101688. [PMID: 35127363 PMCID: PMC8800013 DOI: 10.1016/j.pmedr.2021.101688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022] Open
Abstract
Coca-Cola, Pepsi, and Gatorade partner with universities to market beverages. 16% of university beverage contracts targeted marketing at youth under 18 years old. Nearly all youth-targeted beverage marketing was tied to university athletics. Contracts noted that they may be affected by laws limiting advertising to children.
Child-targeted marketing can influence children’s food preferences and childhood consumption of sugar-sweetened beverages (SSBs) is associated with negative health outcomes in both childhood and adulthood. This study explores how beverage companies are using pouring rights contracts (PRCs) with U.S. public universities to market SSBs to youth under 18 years of age. We obtained 139 PRCs (64 Coca-Cola, 67 Pepsi, 8 Gatorade) from 132 universities between June 2019 and August 2020. Each contract was coded by two reviewers who extracted quotes relevant to youth-targeted marketing activities. Twenty-two contracts in our sample (16%) contained a total of 25 provisions related to youth-targeted marketing. Nearly all youth-targeted marketing provisions (n = 24 of 25) were tied to university athletics. Most provisions (n = 19) described the marketing of specific beverages or involved the use of brand names that are also beverages (e.g., “Gatorade,” “Coca-Cola”). Fifteen contracts included advertising or support for youth summer camps; five contracts allowed the beverage company to sponsor free experiences for children at university athletic events; three contracts allowed advertising at high school athletic events hosted at university facilities; and two contracts established programs for “underprivileged” or “disadvantaged” youth. Five contracts acknowledged that their provisions may be affected by laws or self-regulatory policies that limit advertising to children. Beverage companies should reconsider marketing to youth through PRCs, universities should carefully consider PRCs with youth-targeted provisions, and the government should further regulate and prevent youth-targeted marketing.
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13
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Johnson E, Marx K, Nkimbeng M, Gaugler J, Gitlin L, Parker L. Adapting the ADS Plus Program and Study for a Spanish Speaking Population. Innov Aging 2021. [PMCID: PMC8680126 DOI: 10.1093/geroni/igab046.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
While Hispanic/Latinos are at increased risk for Alzheimer’s Disease, they are often cited as a “difficult-to-reach population” to engage in community-based research or clinical trials. One reason may be that many community-based supportive interventions for dementia caregivers are not adapted for Spanish-speaking populations. The purpose of this presentation is to describe the process of adapting the Adult Day Services Plus (ADS Plus) program for this population. In addition to translating ADS Plus into Spanish, staff, familiar with the program from four sites, which serve a predominantly Hispanic population, participated in a set of three focus groups that reviewed recruitment and intervention materials. Emerging themes included, Hispanic caregivers do not refer to themselves as caregivers but as the familial relationship (e.g. daughter, son, wife), and Hispanics often view research as a waste of resources. Future studies should consider these cultural elements towards caregiving in developing programs for Spanish-speaking dementia caregivers.
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Affiliation(s)
- Elma Johnson
- University of Minnesota School of Public Health, University of Minnesota/ Minneapolis, Minnesota, United States
| | - Katherine Marx
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Manka Nkimbeng
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Joseph Gaugler
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Laura Gitlin
- Drexel University, College of Nursing and Health Professions, Drexel University, Pennsylvania, United States
| | - Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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14
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Gaugler J, Marx K, Dabelko-Schoeny H, Parker L, Anderson K, Albers E, Gitlin L. Adult Day Services as an Essential Service and Support. Innov Aging 2021. [PMCID: PMC8969427 DOI: 10.1093/geroni/igab046.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Throughout the COVID-19 pandemic, the significant challenges and gaps related to the care of older people in the U.S. were made distressingly apparent. This summary presentation will consider the effects of COVID-19 and associated shutdowns on older persons who use ADS programs, their family caregivers, and programs/staff themselves. Among recommendations to consider are the classification of adult day services and similar community-based long-term care providers as essential (and clarifying their difference from senior centers). In addition, considering new financing approaches and utilizing ADS or similar community-based programs as incubators of evidence-based innovation are options to consider to better align ADS with optimal dementia care.
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Affiliation(s)
- Joseph Gaugler
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Katherine Marx
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | | | - Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Keith Anderson
- University of Texas at Arlington, Arlington, Texas, United States
| | | | - Laura Gitlin
- Drexel University, College of Nursing and Health Professions, Drexel University, Pennsylvania, United States
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15
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Marx K, Parker L, Gaugler J, Dabelko-Schoeny H, Gitlin L. Caring for a Family Member Living With Dementia When Adult Day Services Close. Innov Aging 2021. [PMCID: PMC8969124 DOI: 10.1093/geroni/igab046.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Adult Day Service (ADS) centers play an important role in community services that help families keep a person living with dementia (PLWD) at home. We interviewed 33 family caregivers about their experience during the COVID-19 Pandemic and the shutdown of the ADS centers where the PLWD attends. All 33 (100%) reported that the ADS center was shut for a period of time (range: 2 weeks – remain closed). Caregivers reported a decline in their physical health (33%,n=11) and mental health (52%,n=17) and an increase in feelings of loneliness (48%,n=16). For the PLWD, the caregivers noted, a decline in physical (48%,n=16) and mental (55%,n=18) health and an increase in behaviors (39%,n=13). The shutdown of most ADS centers across the country due to the COVID-19 pandemic has had implications not only for the ADS sites but for the families that entrust them with the care for a family member.
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Affiliation(s)
- Katherine Marx
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Joseph Gaugler
- University of Minnesota, Minneapolis, Minnesota, United States
| | | | - Laura Gitlin
- Drexel University, College of Nursing and Health Professions, Drexel University, Pennsylvania, United States
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16
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Parker L, Marx K, Aranda M. Cultural Adaptations to Recruitment Strategies and Community-Based Interventions for Dementia Caregivers. Innov Aging 2021. [PMCID: PMC8679633 DOI: 10.1093/geroni/igab046.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Nearly 30 years after the 1993 National Institute of Health Revitalization Act, minority groups’ low participation in research remains (which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials). This is particularly the case for participation in research on Alzheimer’s Disease and related dementias (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large persist as barriers to low-participation of minorities (i.e. Black/African American, Hispanic/Latino) and immigrants in research studies, who remain at disparate risk for adverse ADRD health outcomes and expedited mortality. The use of culturally adapted approaches in recruitment strategies and community-based interventions might be helpful to encourage the participation of underrepresented groups into research. As such, this presentation highlights three studies that seek to use cultural adaptation to inform recruitment strategies and community-based interventions. First, Dr. Parker will present how tenets from Critical Race Theory can be used to inform culturally-adapted recruitment strategies of Black/African American caregivers into community-based research by drawing upon two ongoing studies: a randomized trial providing caregiver support through Adult Day Services (ADS) and the evaluation of impact of ADS on stress levels of Black/African American using biomarker measures. Next, Ms. Johnson will present results on cultural adaptions to the ADS-Plus Program for Spanish-speaking populations. Finally, Dr. Nkimbeng will present on the process of culturally-tailoring dementia education for African immigrants in Minnesota. Findings from this presentation identify opportunities for researchers to use cultural adaptations to encourage participation of underrepresented populations into ADRD research.
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17
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Gaugler J, Marx K, Parker L, Anderson K, Dabelko-Schoeny H, Johnson E, Albers E, Gitlin L. Challenges in Implementing Evidence-Based Dementia Care Programs in Community-Based Settings: ADS Plus. Innov Aging 2021. [PMCID: PMC8969623 DOI: 10.1093/geroni/igab046.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The Adult Day Service Plus Program (ADS Plus) augments the usual care provided by ADS programs by integrating education, referrals, and problem-solving strategies for family caregivers of persons with dementia. Utilizing a mixed-methods, hybrid effectiveness design, we were in the process of conducting a national evaluation of ADS Plus across xx geographically and culturally diverse programs across the U.S. when the COVID-19 pandemic resulted in the shutdown of almost all of the programs participating in ADS Plus. Qualitative and quantitative data collected during the evaluation suggested that a more robust incorporation of implementation domains and measures (e.g., organizational readiness to change) may have helped avoid some of the challenges related to staff training, fidelity, and other critical intervention delivery aspects. Incorporating implementation science frameworks and measures as early as possible in intervention design may have helped to overcome some of the challenges experienced in ADS Plus.
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Affiliation(s)
- Joseph Gaugler
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Katherine Marx
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Lauren Parker
- University of Texas at Arlington, Arlington, Texas, United States
| | - Keith Anderson
- The Ohio State University, The Ohio State University, Ohio, United States
| | - Holly Dabelko-Schoeny
- University of Minnesota School of Public Health, University of Minnesota/ Minneapolis, Minnesota, United States
| | - Elma Johnson
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Elizabeth Albers
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Laura Gitlin
- Drexel University, College of Nursing and Health Professions, Drexel University, Pennsylvania, United States
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18
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Parker L, Marx K, Gaugler J, Gitlin L. The Impact of COVID-19 on Adult Day Services' Closures and Programming. Innov Aging 2021. [PMCID: PMC8969433 DOI: 10.1093/geroni/igab046.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Nationally, adult day services (ADS) were forced to closed due to the COVID-19 pandemic. The forced closure of ADS programming consequentially impacted the services provided to clients. Many ADS continued to provide telephonic/remote services to clients, despite limited reimbursement from national and state sources for these services. Using data from ADS sites participating in the ADS-Plus Program (n= 22), this presentation examines the effects of COVID-19 on ADS closures and programming provided during the closure. About 86% (n=19) of the centers reported having to closed due to COVID-19. One-hundred percent of the sites reported offering telephone support to clients. Nearly 45% (n=10) of the centers reported not being reimbursed for this service. As ADS is a vital community-based resource for many families, it is important to demonstrate the crucial services provided by ADS to inform policymakers of the essentiality of day centers.
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Affiliation(s)
- Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Katherine Marx
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Joseph Gaugler
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Laura Gitlin
- Drexel University, College of Nursing and Health Professions, Drexel University, Pennsylvania, United States
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19
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Parker LJ, Marx K, Gaugler JE, Gitlin LN. Implications of the COVID-19 Pandemic on Adult Day Services and the Families They Serve. Am J Alzheimers Dis Other Demen 2021; 36:15333175211050152. [PMID: 34647482 PMCID: PMC8745481 DOI: 10.1177/15333175211050152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic forced adult day services (ADS) to close and abruptly end in-person services to clients. To understand the effect of the pandemic on ADS, a 20-item survey was used to examine services provided, staffing, finances, and plans to reopen. Data came from 22 sites participating in the Adult Day Service Plus a national randomized controlled trial. Of the 22 ADS sites responding to the survey, most (86.4%, n = 19) closed due to COVID-19 with nearly half closing due to a state mandate (52.6%, n = 10). Most sites reported the need to furlough or terminate staff (63.6%, n = 14). Services that sites continued to provide included telephone support (n = 22, 100%), delivery of food (n = 8, 36.4%), medical check-ins (n = 9, 40.1%), and activity via Zoom or YouTube (n = 14, 63.6%). Most of these services were provided without reimbursement. Adult day services have considerable potential as a platform for service innovation in community-based services.
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Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior and Society, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine Marx
- 15851Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura N Gitlin
- 15775College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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20
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Gaugler JE, Marx K, Dabelko-Schoeny H, Parker L, Anderson KA, Albers E, Gitlin LN. COVID-19 and the Need for Adult Day Services. J Am Med Dir Assoc 2021; 22:1333-1337. [PMID: 34044009 PMCID: PMC8103140 DOI: 10.1016/j.jamda.2021.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
COVID-19 has shone a harsh light on the inequities of health care in the United States, particularly in how we care for older people. We summarize some of the effects of lockdown orders on clients, family caregivers, and staff of adult day service programs throughout the United States, which may serve as a counterpoint to scientific evidence suggesting a lack of efficacy of these programs. Given the ramifications of state lockdown orders for users and staff of the long-term services and support system, we provide recommendations to better support community-based programs and those they serve. Specifically, (1) adult day programs should be classified as essential, (2) a focus on the value of adult day and similar programs is needed, and (3) an exploration of new ways to finance home and community-based services is warranted. Such advances in policy and science would help to integrate adult day services more effectively into the broader health care landscape.
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Katherine Marx
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lauren Parker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Keith A Anderson
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Elizabeth Albers
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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21
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Jutkowitz E, Pizzi LT, Popp J, Prioli KK, Scerpella D, Marx K, Samus Q, Piersol CV, Gitlin LN. A longitudinal evaluation of family caregivers' willingness to pay for an in-home nonpharmacologic intervention for people living with dementia: results from a randomized trial. Int Psychogeriatr 2021; 33:419-428. [PMID: 33757615 PMCID: PMC8635284 DOI: 10.1017/s1041610221000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the willingness-to-pay (WTP) of family caregivers to learn care strategies for persons living with dementia (PLwD). DESIGN Randomized clinical trial. SETTING Community-dwelling PLwD and their caregivers (dyads) in Maryland and Washington, DC. PARTICIPANTS 250 dyads. INTERVENTION Tailored Activity Program (TAP) compared to attention control. TAP provides activities tailored to the PLwD and instructs caregivers in their use. MEASUREMENT At baseline, 3 and 6 months, caregivers were asked their WTP per session for an 8-session 3-month in-home nonpharmacologic intervention to address behavioral symptoms and functional dependence. RESULTS At baseline, 3 and 6 months, caregivers assigned to TAP were willing to pay $26.10/session (95%CI:$20.42, $33.00), $28.70 (95%CI:$19.73, $39.30), and $22.79 (95%CI: $16.64, $30.09), respectively; attention control caregivers were willing to pay $37.90/session (95%CI: $27.10, $52.02), $30.92 (95%CI: $23.44, $40.94), $27.44 (95%CI: $20.82, $35.34), respectively. The difference in baseline to 3 and 6 months change in WTP between TAP and the attention control was $9.58 (95%CI: -$5.00, $25.47) and $7.15 (95%CI: -$5.72, $21.81). The difference between TAP and attention control in change in the proportion of caregivers willing to pay something from baseline to 3 and 6 months was -12% (95%CI: -28%, -5%) and -7% (95%CI:-25%, -11%), respectively. The difference in change in WTP, among caregivers willing to pay something, between TAP and attention control from baseline to 3 and 6 months was $17.93 (95%CI: $0.22, $38.30) and $11.81 (95%CI: -$2.57, $28.17). CONCLUSIONS Family caregivers are willing to pay more for an intervention immediately following participation in a program similar to which they were asked to value.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
- Providence Veterans Affairs (VA) Medical Center, Center of Innovation in Long Term Services and Supports, Providence, RI, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Jonah Popp
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Katherine K Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Danny Scerpella
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Katherine Marx
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Loggetto P, Ritter J, Lam C, Marx K, Metzger M. Equity as a consideration in National Cancer Control Plans from the American continent: a comparative content analysis. The Lancet Global Health 2021. [DOI: 10.1016/s2214-109x(21)00116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Marx K, Parker L, Gitlin L. Adaptations for TAP in a Long-Term Care Setting. Innov Aging 2020. [PMCID: PMC7741950 DOI: 10.1093/geroni/igaa057.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
One of the most difficult aspects of caring for people living with dementia is managing neuropsychologic symptoms and functional decline. Although there are hundreds of efficacious non-pharmacologic interventions tested in homes, few are adapted for and tested in long-term care. The purpose of this pilot study was to identify the adaptations needed for the Tailored Activity Program (TAP) to make it feasible and acceptable in a long-term care facility. TAP provides tailored activities matched to interests and abilities to address dementia-related clinical symptoms. Two sites, under the umbrella of one company, participated. A total of five persons living with dementia, their family caregivers, two direct care staff and an interventionist participated, and occupational therapist who contracts with the site on a regular basis. Adaptations included shorter sessions and changes to forms to fit with workflows and documentation. Additional considerations challenging implementation of TAP included staff turn-over and training. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.
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Affiliation(s)
- Katherine Marx
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Lauren Parker
- Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Laura Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
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Koeuth S, Marx K, Gitlin L, Piersol C. Scaling an Evidence-Based Program: The Case of the Tailored Activity Program. Innov Aging 2020. [PMCID: PMC7742148 DOI: 10.1093/geroni/igaa057.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Tailored Activity Program (TAP) is a proven program delivered primarily by occupational therapists addressing dementia-related clinical symptoms including caregiver well-being. Although used in 9 countries including the United States, scaling and widespread dissemination is challenging. We discuss key revisions to TAP to facilitate dissemination including matching assessments to those used in different practice settings, translation of materials into different languages, providing worksheets to help trainees adapt TAP to local contexts and a training/certification online experience using story board, an interactive media integrated onto the Blackboard learn management system, to provide on-demand training modules. The learning platform allows learners to engage with others, preview modules and share experiences. Revisions enable greater flexibility for program adaptation yet adherence to its core principles. With over 150 trainees, we use REAIM to evaluate effectiveness of modifications and to understand implications for its reach. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.
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Affiliation(s)
- Sokha Koeuth
- Drexel University, Philadelphia, Pennsylvania, United States
| | - Katherine Marx
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
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25
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Marx K, Gitlin L. Where to Begin: Assessing Caregiver Readiness. Innov Aging 2020. [PMCID: PMC7742673 DOI: 10.1093/geroni/igaa057.2414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There have been many interventions targeting family caregivers for people living with dementia (PLwD) that have been found to have efficacy and effectiveness. However, very few of these interventions have been widely adopted. One reason may be that clinicians and other professionals working with caregivers are unsure of what intervention to use. One measure that may help with where to begin is Caregiver Readiness. This presentation will provide case studies on the use of the Caregiver Readiness Scale in one intervention, the Tailored Activity Program (TAP). We will highlight three cases that have low, moderate and high readiness scores and how the TAP interventionists use the readiness scores to tailor the intervention to match the caregiver’s need. Knowing a caregiver’s readiness to receive an intervention may help clinicians and providers identify where to being in helping the caregiver.
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Affiliation(s)
- Katherine Marx
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
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26
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Anderson KA, Dabelko-Schoeny H, Koeuth S, Marx K, Gitlin LN, Gaugler JE. The use of community advisory boards in pragmatic clinical trials: The case of the adult day services plus project. Home Health Care Serv Q 2020; 40:16-26. [PMID: 32865476 DOI: 10.1080/01621424.2020.1816522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Community advisory boards (CABs) have become increasingly common and important in translational research in health care including studies focusing on home and community-based services. CABs are composed of stakeholders who share interest in research projects and typically include patients/clients, practitioners, community members, policymakers, and researchers. CABs advise researchers on issues ranging from research design and recruitment to implementation and dissemination. In this article, the researchers detail their experiences with the CAB for a pragmatic clinical trail of Adult Day Services (ADS) Plus, an education and support intervention for family caregivers of older adults with dementia using adult day services. Lessons learned, guidelines, and best practices are then presented for developing and working with a CAB in healthcare research.
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Affiliation(s)
- Keith A Anderson
- Cheryl Milkes Moore Endowed Professor, School of Social Work, University of Texas at Arlington , Arlington, Texas, USA
| | | | - Sokha Koeuth
- College of Nursing and Health Professions, Drexel University , Philadelphia, Pennsylvania, USA
| | - Katherine Marx
- Center for Innovative Care in Aging, Johns Hopkins University , Baltimore, Maryland, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University , Philadelphia, Pennsylvania, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota , Minneapolis, Minnesota, USA
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Jutkowitz E, Scerpella D, Prioli K, Marx K, Gitlin LN, Pizzi L, Popp J. CHANGE IN DEMENTIA FAMILY CAREGIVERS’ WILLINGNESS TO PAY FOR A NONPHARMACOLOGIC INTERVENTION. Innov Aging 2019. [PMCID: PMC6846847 DOI: 10.1093/geroni/igz038.2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Family caregivers provide a majority of care for persons with dementia (PwD); however, little is known about caregiver’s willingness to pay (WTP) for an intervention to help them manage dementia symptoms. To fill this gap, caregiver/PwD dyads (n=223) were recruited to participate in a randomized trial evaluating tailored activities to minimize behavioral symptoms and functional decline. At baseline and 6-months caregivers were asked their WTP per session for the 8-session 3-month program compared to caregiver education/support only. At baseline, treatment caregivers were WTP $26.20, which was $11.50 (95%CI:-$12.70, -$10.3) less per session compared to control group caregivers WTP $37.30. At 6-months, treatment caregivers were WTP $22.90 and control caregivers $27.30. From baseline to 6-months, a change in WTP was $7.00 (95%CI:$5.80, $8.30) greater than the change in WTP for control group caregivers. Caregivers WTP slightly decreases over time in both groups but decrease is less for TAP following program participation.
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Affiliation(s)
- Eric Jutkowitz
- Brown University, Providence, Rhode Island, United States
| | | | | | - Katherine Marx
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura N Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
| | - Laura Pizzi
- Rutgers University, Piscataway, Maryland, United States
| | - Jonah Popp
- Brown University, Providence, Rhode Island, United States
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Gitlin LN, Marx K, Scerpella D, Dabelko-Schoeny H, Anderson KA, Huang J, Pizzi L, Jutkowitz E, Roth DL, Gaugler JE. Embedding caregiver support in community-based services for older adults: A multi-site randomized trial to test the Adult Day Service Plus Program (ADS Plus). Contemp Clin Trials 2019; 83:97-108. [PMID: 31238172 PMCID: PMC7069225 DOI: 10.1016/j.cct.2019.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
There are over five million people in the United States living with dementia. Most live at home and are cared for by family. These family caregivers often assume care responsibilities without education about the disease, skills training, or support, and in turn become at risk for depression, burden, and adverse health outcomes when compared to non-dementia caregivers. Despite over 200 caregiver interventions with proven benefits, many caregivers lack access to these programs. One approach to enhance access is to embed evidence-based caregiver support programs in existing community-based services for people with dementia such as adult day services (ADS). Here we describe the protocol for an embedded pragmatic trial designed to augment standard ADS known as ADS Plus. ADS Plus provides family caregivers with support via education, referrals, and problem-solving techniques over 12 months, and is delivered on-site by existing ADS staff. Embedding a program in ADS requires an understanding of outcomes and implementation processes in that specific context. Thus, we deploy a hybrid design involving a cluster randomized two-group trial to evaluate treatment effects on caregiver wellbeing, ADS utilization, as well as nursing home placement. We describe implementation practices in 30 to 50 geographically and racially/ethnically diverse participating sites. Clinical trial registration #: NCT02927821.
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Affiliation(s)
- Laura N Gitlin
- Drexel University, 1601 Cherry Street, 10th Floor, Room 1092, Philadelphia, PA 19102, United States of America.
| | - Katherine Marx
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 N. Broadway, Room 214, Baltimore, MD 21205, United States of America.
| | - Daniel Scerpella
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 North Broadway, 2nd Floor, Baltimore, MD 21205, United States of America.
| | - Holly Dabelko-Schoeny
- College of Social Work, 207 Stillman Hall, 1947 College Rd N., Columbus, OH 43210, United States of America.
| | - Keith A Anderson
- University of Montana, School of Social Work, 014 Jeannette Rankin Hall, 32 Campus Drive, Missoula, MT 59812-4392, United States of America.
| | - Jin Huang
- Johns Hopkins School of Medicine, Center on Aging and Health, 2024 East Monument Street, Baltimore, MD 21205, United States of America.
| | - Laura Pizzi
- University Ernest Mario School of Pharmacy, Center for Health Outcomes, Policy, and Economics, 160 Frelinghuysen Road - Suite 417, Piscataway, NJ 08854, United States of America.
| | - Eric Jutkowitz
- Brown University School of Public Health, Department of Health Services, Policy & Practice, BoxG-S121 (6), 121 S Main Street, Providence, RI 02912, United States of America.
| | - David L Roth
- Johns Hopkins School of Medicine, Center on Aging and Health, 2024 East Monument Street, Baltimore, MD 21205, United States of America.
| | - Joseph E Gaugler
- University of Minnesota, School of Nursing, 308 SE Harvard St, Minneapolis, MN 55455, United States of America.
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Scerpella DL, Adam A, Marx K, Gitlin LN. Implications of Geographic Information Systems (GIS) for targeted recruitment of older adults with dementia and their caregivers in the community: A retrospective analysis. Contemp Clin Trials Commun 2019; 14:100338. [PMID: 30899836 PMCID: PMC6412022 DOI: 10.1016/j.conctc.2019.100338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/30/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
5.5 million Americans are living with Alzheimer's dementia (AD) or related dementias. Developing evidence-based interventions for these people and their caregivers (dyads) is a public health priority, and is highly dependent on recruiting representatives from the community. Precision recruitment methodologies are needed to improve the efficiency of this process. Geographic Information Systems (GIS) offer the potential to determine location trends of an older adult population of people living with dementia in the community and their caregivers. American Community Survey (ACS) 2015 5-year estimates were analyzed at the census tract level in ESRI ArcMap v. 10.5.1. Datasets included summarized estimates of age, gender, income, and education in Maryland. Using a two-step process, geographic regions were identified in ArcMap that contained various combinations of available data variables. These areas were compared to participant locations from a previously completed traditional recruitment effort to determine overlap (Dementia Behavior Study - R01AGO41781). The largest number of existing participants were identified in derived regions defined by combining age, education, gender, and income variables; predicting 184 (79%) of 234 participants regardless of the population density within census tracts. 208 (89%) were identified when matching this variable combination to the highest density census tracts (city/urban), and 66 (28%) in regions with the lowest population density (rural). This study successfully defined specific geographic regions in the state of Maryland that overlapped with a large number of known dementia dyad locations obtained via traditional recruitment efforts. Implications for these findings allow for more targeted recruitment efforts of difficult to recruit populations, and less utilization of resources for doing so.
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Affiliation(s)
- Danny L. Scerpella
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 N. Broadway, Baltimore, MD, 21205, USA
- Corresponding author.
| | - Atif Adam
- Johns Hopkins Bloomberg School of Public Health, Center on Aging and Health, 624 N. Broadway, Room 390, Baltimore, MD, 21205, USA
| | - Katherine Marx
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 N. Broadway, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Drexel University, 1601 Cherry Street, 10th Floor, Room 1092, Philadelphia, PA, 19102, USA
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Jutkowitz E, Scerpella D, Pizzi LT, Marx K, Samus Q, Piersol CV, Gitlin LN. Dementia Family Caregivers' Willingness to Pay for an In-home Program to Reduce Behavioral Symptoms and Caregiver Stress. Pharmacoeconomics 2019; 37:563-572. [PMID: 30877638 PMCID: PMC6465140 DOI: 10.1007/s40273-019-00785-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Our objective was to determine whether family caregivers of people with dementia (PwD) are willing to pay for an in-home intervention that provides strategies to manage behavioral symptoms and caregiver stress and to identify predictors of willingness-to-pay (WTP). METHODS During baseline interviews of a randomized trial and before treatment assignment, caregivers were asked how much they were willing to pay per session for an eight-session program over 3 months. We stratified the sample into those who refused to provide a WTP, those willing to pay $US0, and those willing to pay > $US0. We used a two-part model, controlling for demographic characteristics, to predict adjusted mean WTP and to examine associations between WTP, clinical features (cognition, function, behavioral symptoms), and time spent assisting PwD with daily activities. First, we used logistic regression to model the probability a caregiver was willing to pay > $US0. Second, we used a generalized linear model (log link and Gamma distribution) to estimate the amount caregivers were willing to pay conditional on WTP > $US0. RESULTS Of 250 dyads enrolled, 226 (90%) had complete data and were included in our analyses. Of 226 dyads, 26 (11%) refused to provide a WTP value, 72 (32%) were willing to pay $US0, and 128 (57%) were willing to pay > $US0. In the combined model, mean adjusted WTP was $US36.00 (95% confidence interval [CI] 26.72-45.27) per session. Clinical features were not significantly associated with WTP. One additional hour providing PwD assistance was associated with a $US1.64 (95% CI 0.23-3.04) increase in WTP per session. CONCLUSION As caregivers spend more time assisting with daily activities, they are willing to pay more for a supportive program. CLINICAL TRIAL REGISTRATION NUMBER NCT01892579.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Box G-S121-6, 121 S. Main Street, 6th Floor, Providence, RI, 02912, USA.
| | - Danny Scerpella
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Katherine Marx
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Laura N Gitlin
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Samus Q, Scerpella DL, Waligora K, Marx K, Mahfouz S, Plaat K, Roth D, Gitlin L. FEASIBILITY OF A HOME-BASED VIDEO MONITORING TO ASSESS BEHAVIORAL SYMPTOMS AMONG PERSONS WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Q Samus
- JHU, Baltimore, Maryland, United States
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Jutkowitz E, Pizzi L, Scerpella D, Marx K, Samus Q, Piersol C, Gitlin L. A LONGITUDINAL EVALUATION OF DEMENTIA INFORMAL CAREGIVER’S WILLINGNESS TO PAY FOR AN IN-HOME INTERVENTION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Jutkowitz
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - L Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University
| | - D Scerpella
- Johns Hopkins Center for Innovative Care in Aging
| | | | | | | | - L Gitlin
- College of Nursing and Health Professions, Drexel University
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Marx K, Scerpella DL, Duffort N, Gitlin LN, Samus QM. MENTAL HEALTH IN ASSISTED LIVING: KEY STAKEHOLDER PERSPECTIVES FROM FORMAL AND INFORMAL CAREGIVERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Marx
- JHU, Baltimore, Maryland,United States
| | - D L Scerpella
- Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - N Duffort
- Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - L N Gitlin
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Q M Samus
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Marx K, Gaugler JE, Scerpella D, Duffort N, Mitchell L, Gitlin LN. RECRUITMENT AND ENROLLMENT IN A PRAGMATIC TRIAL: ADS PLUS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Marx
- Baltimore, Maryland, United States
| | - J E Gaugler
- Center on Aging, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - D Scerpella
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - N Duffort
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - L Mitchell
- Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA
| | - L N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Marx K, Scerpella DL, Gitlin LN. EXAMINING THE UTILITY OF A WEB-BASED PLATFORM TO MANAGE BEHAVIORS IN THE ASSISTED LIVING SETTING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Marx
- JHU Baltimore, Maryland, United States
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Marx K, Hodgson N, Gitlin LN. RECRUITMENT OF FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA: METHODS AND OUTCOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Marx
- Johns Hopkins University, Baltimore, Maryland, United States
| | - N Hodgson
- University of Pennsylvania, Philadelphia, PA, USA
| | - L N Gitlin
- Drexel University, Philadelphia, PA, USA
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Parker L, Marx K, Gitlin L. FACTORS ASSOCIATED WITH INFORMED CONSENT AMONG PERSONS WITH DEMENTIA: THE DEMENTIA BEHAVIOR STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Parker
- Johns Hopkins Bloomberg School of Public Health
| | | | - L Gitlin
- College of Nursing and Health Professions, Drexel University
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Kales HC, Gitlin LN, Stanislawski B, Myra Kim H, Marx K, Turnwald M, Chiang C, Lyketsos CG. Effect of the WeCareAdvisor™ on family caregiver outcomes in dementia: a pilot randomized controlled trial. BMC Geriatr 2018; 18:113. [PMID: 29747583 PMCID: PMC5946471 DOI: 10.1186/s12877-018-0801-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are universal and associated with multiple negative outcomes. This pilot randomized controlled trial (RCT) evaluated the effect of using the WeCareAdvisor, an innovative web-based tool developed to enable family caregivers to assess, manage, and track BPSD. METHODS This RCT enrolled 57 dementia family caregivers from community and clinical settings in Ann Arbor, Michigan and Baltimore, Maryland. Participants were randomly assigned to immediate use of the WeCareAdvisor tool (WCA, n = 27) or a Waitlist control group (n = 30) that received the tool after a one-month waiting period. Outcomes for the caregiver and the person they were caring for were assessed at baseline (T0) and one-month followup for both the WCA (T1) and Waitlist control (T2) groups. RESULTS Caregiver mean age was 65.9 ± 14.0 years old. About half (49%) were spouses. Baseline characteristics were comparable between groups except for mean caregiver confidence which was higher in the control group (WCA 35.0 ± 10.0 vs. Waitlist control 39.7 ± 6.9, p = 0.04). There were no significant differences between the WCA and control groups in characteristics of the person with dementia. After their one-month of tool use (T1), WCA caregivers showed significant within group improvement in caregiver distress (- 6.08 ± 6.31 points, t = - 4.82, p < 0.0001) and behavioral frequency (- 3.60 ± 5.05, t = - 3.56, p = 0.002), severity (- 3.24 ± 3.87, t = - 4.19, p = 0.0003) and total behavioral score (- 6.80 ± 10.73, t = - 3.17, p = 004). In the same timeframe, Waitlist control caregivers showed a significant decrease in confidence (- 6.40 ± 10.30, t = - 3.40, p = 0.002). The WCA group showed greater improvement in distress compared to the Waitlist group (T0-T1; t = - 2.49, p = 0.02), which remained significant after adjusting for site and baseline distress. There were no significant between-group differences in caregiver confidence or other secondary outcomes. After their one month of tool use (T2), the Waitlist group also showed significant improvement in caregiver distress (- 3.72 ± 7.53, t = - 2.66, p = 0.013), stress (- 0.41 ± 1.02, t = - 2.19, p = 0.037), confidence (4.38 ± 5.17, t = 4.56, p < 0.0001), burden (- 2.76 ± 7.26, t = - 2.05, p = 0.05), negative communication (- 1.48 ± 2.96, t = - 2.70, p = 0.012) and behavioral frequency (- 1.86 ± 4.58, t = - 2.19, p = 0.037); distress remained significant after adjustment. CONCLUSIONS In this pilot RCT, WCA use resulted in a significant decrease in caregiver distress. Future research will identify whether longer use of WCA can impact other caregiver and behavioral outcomes. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02420535 (Date of registry: 4/20/2015, prior to the start of the clinical trial).
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Affiliation(s)
- Helen C. Kales
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109 USA
- Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI USA
| | - Laura N. Gitlin
- Department of Community Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD USA
- Division of Geriatrics and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
- Center for Innovative Care on Aging, Johns Hopkins University, Baltimore, MD USA
| | - Barbara Stanislawski
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109 USA
- Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI USA
| | - H. Myra Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, USA
| | - Katherine Marx
- Center for Innovative Care on Aging, Johns Hopkins University, Baltimore, MD USA
| | - Molly Turnwald
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109 USA
| | - Claire Chiang
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109 USA
- Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI USA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD USA
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Abstract
SummaryAim: This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.
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Kales HC, Gitlin LN, Stanislawski B, Marx K, Turnwald M, Watkins DC, Lyketsos CG. WeCareAdvisor™: The Development of a Caregiver-focused, Web-based Program to Assess and Manage Behavioral and Psychological Symptoms of Dementia. Alzheimer Dis Assoc Disord 2017; 31:263-270. [PMID: 27849639 PMCID: PMC5432421 DOI: 10.1097/wad.0000000000000177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVES Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia and associated with multiple negative outcomes. Current real-world management is largely pharmacologic, despite poor risk/benefit. The WeCareAdvisor was designed to enable family caregivers to assess, manage, and track BPSD using nonpharmacologic strategies. DESIGN In-depth qualitative data were collected from family caregivers of people with dementia to inform: (1) style of approach and "look and feel" of the tool, and (2) the types of psychoeducation most needed by caregivers. RESULTS We conducted 4 focus groups and a technology survey (n=26) as well as additional individual semistructured interviews (n=12) with family caregivers. Main themes of the qualitative work included: (1) need to minimize difficulty and training time; (2) importance of "one-stop shopping" for information; and (3) necessity for information to be tailored to the caregiver and person with dementia. This information was then combined with effective existing evidence-based behavioral strategies to create a web-based tailored caregiver-support tool. CONCLUSIONS The WeCareAdvisor was designed with input on functionality and content by end-users, family caregivers. The randomized controlled trial of WeCareAdvisor will test whether the tool improves outcomes including caregiver upset and burden and frequency and severity of BPSD.
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Affiliation(s)
- Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann
Arbor, Michigan
- Department of Veterans Affairs, HSR&D Center for
Clinical Management Research (CCMR), Ann Arbor, Michigan
- Geriatric Research, Education and Clinical Center (GRECC),
VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Laura N. Gitlin
- Department of Community Public Health, School of Nursing,
Johns Hopkins University, Baltimore, Maryland
- Division of Geriatrics and Gerontology, School of Medicine,
Johns Hopkins University, Baltimore, Maryland
- Center for Innovative Care on Aging, Johns Hopkins
University, Baltimore, Maryland
| | - Barbara Stanislawski
- Department of Psychiatry, University of Michigan, Ann
Arbor, Michigan
- Department of Veterans Affairs, HSR&D Center for
Clinical Management Research (CCMR), Ann Arbor, Michigan
| | - Katherine Marx
- Center for Innovative Care on Aging, Johns Hopkins
University, Baltimore, Maryland
| | - Molly Turnwald
- Department of Psychiatry, University of Michigan, Ann
Arbor, Michigan
| | - Daphne C. Watkins
- Department of Psychiatry, University of Michigan, Ann
Arbor, Michigan
- School of Social Work, University of Michigan, Ann Arbor,
Michigan
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins Bayview and Johns Hopkins University, Baltimore, Maryland
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Gitlin LN, Piersol CV, Hodgson N, Marx K, Roth DL, Johnston D, Samus Q, Pizzi L, Jutkowitz E, Lyketsos CG. Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial. Contemp Clin Trials 2016; 49:92-102. [PMID: 27339865 PMCID: PMC4969112 DOI: 10.1016/j.cct.2016.06.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
Abstract
Among over 5million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategies to address care challenges. The comparison group controls for time and attention and involves 8 in-home sessions delivered by health educators who provide dementia education, home safety recommendations, and advanced care planning. We are randomizing 250 racially diverse families (person with dementia and primary caregiver dyads) recruited from community-based social services, conferences and media announcements. The primary outcome is change in agitation/aggression at 3 and 6months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS.
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Affiliation(s)
- Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Nancy Hodgson
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine Marx
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - David L Roth
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Deidre Johnston
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Quincy Samus
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Pizzi
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Eric Jutkowitz
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
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Marx K. Esssetting Familie – Warum soziokulturelle Faktoren in ernährungsbezogenen Maßnahmen verstärkt berücksichtigt werden müssen. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gitlin LN, Marx K, Stanley IH, Hodgson N. Translating Evidence-Based Dementia Caregiving Interventions into Practice: State-of-the-Science and Next Steps. Gerontologist 2015; 55:210-26. [PMID: 26035597 DOI: 10.1093/geront/gnu123] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/03/2014] [Indexed: 11/12/2022] Open
Abstract
Over the past 3 decades, more than 200 dementia caregiver interventions have been tested in randomized clinical trials and found to be efficacious. Few programs have been translated for delivery in various service contexts, and they remain inaccessible to the 15+ million dementia family caregivers in the United States. This article examines translational efforts and offers a vision for more rapid advancement in this area. We summarize the evidence for caregiver interventions, review published translational efforts, and recommend future directions to bridge the research-practice fissure in this area. We suggest that as caregiver interventions are tested external to service contexts, a translational phase is required. Yet, this is hampered by evidentiary gaps, lack of theory to understand implementation challenges, insufficient funding and unsupportive payment structures for sustaining programs. We propose ways to advance translational activities and future research with practical applications.
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Affiliation(s)
- Laura N Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Katherine Marx
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Ian H Stanley
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Nancy Hodgson
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Serclová Z, Ryska O, Dytrych P, Marvan J, Marx K, Konecná E, Miksíková A, Antos F. [Fascial closure of the abdominal wall by dynamic suture after topical negative pressure laparostomy treatment of severe peritonitis--results of a prospective randomized study]. Rozhl Chir 2012; 91:26-31. [PMID: 22746075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Severe peritonitis is a frequent condition characterized by high morbidity and mortality rates. Topical negative pressure (TNP) laparostomy could improve the results of the treatment, provided that the adverse events of this method are reduced. The aim of our study was to prove, in a prospective randomized study, that the primary use of TNP laparostomy reduces morbidity and mortality when compared to primary abdominal wall closure after the index surgery for severe peritonitis. The possibility of the abdominal wall fascial closure significantly influencing morbidity was the main topic of this study. MATERIAL AND METHODS Between 9/2009 and 9/2011,57 patients with severe peritonitis were included in the study at the Department of Surgery of the Bulovka Faculty Hospital; 28 of them were randomized to the TNP laparostomy group and 29 to the primary closure group. The two groups did not differ in age, gender, polymorbidity and severity of peritonitis. RESULTS The length of hospital stay was similar in both groups (median: 22 days; range 10-171 days) in the intervention group and 23 days (range 3-71) in the control group (p = 0.89). The mortality rate was significantly lower in the TNP laparostomy group in comparison with the primary closure group (3 patients, 11% vs. 12 patients, 41%; p = 0.01). A complete closure of the abdominal wall including fascia and complete abdominal wall healing was achieved in 80% of survivors in the TNP group, compared to 29% in the primary closure group (p = 0.01). No enteral fistula occurred in any surviving patients from both groups. The overall length of abdominal wall healing was significantly shorter in the TNP group (median: 7; 7-94 days, versus 30; 7-223; p = 0.04). CONCLUSIONS Primary TNP laparostomy is an effective and safe method in the treatment of severe peritonitis. Keeping good clinical practice, especially using dynamic suture as early as after the index surgery and the timely closure of laparostomy as soon as the indication disappears (according to relevant criteria) leads to a significantly higher abdominal wall healing rate, icluding fascial closure, than after peritonitis treatment without laparostomy.
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Kissler S, Marx K, Scholtes M, Pfeiffer S, Meier W, Neulen J. Predisposition of subtle endometriotic lesions predominantly on the left side assessed by transvaginal hydrolaparoscopy (THL). Eur J Obstet Gynecol Reprod Biol 2011; 158:285-8. [DOI: 10.1016/j.ejogrb.2011.04.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/04/2011] [Accepted: 04/30/2011] [Indexed: 11/16/2022]
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Hammermann J, Böhm A, Marx K. 27 Who wants sweat tests and why? J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kissler S, Verhoeven H, Marx K, Behler M, Emde T, Unterhorst E, Kohl J, Wiegratz I, Meier W, Scholtes M. Die transvaginale Hydrolaparoskopie (TVHL) – deutsche Erfahrungen über ein neues Verfahren in der ambulanten Sterilitätsdiagnostik. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-2008-1039247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kobe C, Eschner W, Sudbrock F, Weber I, Marx K, Dietlein M, Schicha H. Graves' disease and radioiodine therapy. Is success of ablation dependent on the achieved dose above 200 Gy? Nuklearmedizin 2008; 47:13-17. [PMID: 18278207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. PATIENTS, METHODS A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. RESULTS Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. CONCLUSION To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.
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Affiliation(s)
- C Kobe
- Department of Nuclear Medicine, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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Grundler W, Dirscherl P, Beisker W, Marx K, Stampfl A, Maier K, Zimmermann I, Nüsse M. Early functional apoptotic responses of thymocytes induced by Tri-n-butyltin. Cytometry 2001; 44:45-56. [PMID: 11309808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Programmed cell death, also termed apoptosis, is the main focus of interest in a variety of scientific and clinical areas. For a better understanding of the mechanisms of apoptosis, from the onset of the cellular death program to the late stages of apoptosis or apoptotic necrosis, very early functional events have to be quantified because they might be involved in temporal and causal relationships between apoptosis-related key processes. METHODS We have established a flow cytometric technique to quantify time-dependent signals simultaneously with high temporal resolution (Deltat = 1 s) in living cells. With this technique, the response of cells to apoptosis-stimulating agents can be analyzed over 15 min. For this purpose, a thermostatted sample tube holder for repeatable interruption-free injection of substances into the cell suspension was developed. Early detectable fluorescence and scatter parameters were related to intracellular free Ca2+ concentration, [Ca2+]i (Indo-1 fluorometry), membrane permeability (propidium iodide [PI] influx), and cell volume (forward scatter). RESULTS A T-cell line (Jurkat) served as a model system. Apoptosis was induced by the biozid Tri-n-butyltin (TBT). Dependent on the TBT concentration (0.3-10 microM), the mean free [Ca2+]i increased by a factor of 1.2-6 during a short time interval of just 2 min. Especially after low TBT concentrations (< 0.5 microM), this [Ca2+]i increase was nearly transient during the observation time of 15 min. Higher TBT concentrations (0.5-10 microM), however, induced a transient increase of [Ca2+]i (Ca-TR) only in a fraction of the cells; in another subpopulation, a steady-state Ca2+ signal (Ca-SST) was observed. The analysis of the simultaneously registered PI signals of the Ca-SST cells showed a shift to increasing PI fluorescence (by a factor of about 4) with increasing Ca2+ concentrations. In Ca-TR cells, the PI fluorescence remained nearly unchanged. These apoptosis-related changes (increase in [Ca(2+)]i and membrane permeability) could be confirmed by the additional observation of a TBT concentration-dependent decrease in cell volume measured during the same early time period. CONCLUSIONS The simultaneously analyzed parameters (i.e., [Ca2+]i, membrane permeability, and cell volume) suggested that, in our model system of Jurkat T-cells treated with TBT, an apoptotic cell fate was indicated very early (within 15 min) by the steady-state [Ca2+]i level.
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Affiliation(s)
- W Grundler
- Flow Cytometry Group, GSF-National Research Center for Environment and Health, Neuherberg, Germany.
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Abstract
Base treatment of the pyridinium bromides 11a-e gives rise to the formation of the dihydropyridoazepines 14a-e as the only monomolecular products. The reaction takes place by initial deprotonation to the ylides 12, which undergo 8pi-electrocyclization affording the seven-membered-ring systems; no products of a dipolar 6pi-cyclization were detected. On the basis of quantum mechanical calculations a rationalization of the periselectivity of the electrocyclization process is given.
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Affiliation(s)
- K Marx
- Institut fur Organische Chemie und Biochemie der Universitat Freiburg, Germany
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