Browsing by Subject "Geriatrics"
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Item Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community - A Six Month Follow-Up(1999-12-01) Coustasse, Alberto; Antonio Rene; Doug A. Mains; Gilbert RamirezCoustasse, Alberto, Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community – A Six Month Follow-up. Master of Public Health Track, Public Health Administration, December 1999, 22 pp., 9 tables, 9 illustrations, bibliography, 7 titles. The health fair approach was used as a method to establish individual and population health status baselines and to provide a mechanism to follow-up with an elderly population in a rural Texas community. A controlled trial sample of forty-four seniors was initially screened in a primary care clinic in August 1998. Patients were reevaluated at six months and results demonstrated a 46% increase in BMI [Body Mass Index]; 62% remained obese; 62% maintained elevated cholesterol or increased cholesterol values to abnormal values; 61% maintained or increased their BP [blood pressure] to abnormal values. A significant finding was that a change of one unit in the BMI correlated with a change of 19.88 mmHg [millimeter mercury] of SBP [systolic blood pressure] and 18.59 mmHg of DBP [diastolic blood pressure]. The societal economic impact of mortality and morbidity (without the benefit of target interventions) for the initial forty-four seniors was projected at & 74,949. Keywords: Health fairs; obesity; cardiovascular; cost; case management.Item Auditory Impairment and Falls: Investigating the Link Between Hearing Loss and Falls among Elderly Individuals(2013-08-01) Villarreal, Adrian R.; Nicoleta BugnariuRecent studies show that hearing acuity correlates with postural balance, a prerequisite for mobility, and impaired hearing is associated with greater risk for falls. A possible connection between impaired hearing and falls in elderly adults could be that awareness resources may be taxed as cognitive load is increased when people with hearing impairment try to interpret what they hear. This practicum report investigated if an increased cognitive load due to auditory impairments in elderly individuals with hearing loss leads to imbalance while walking. Subjects are placed in a virtual reality world and subjects with and without hearing loss, wearing or not wearing their hearing aids will be monitored as they stand, walk, and listen under various conditions. The outcome measures analyzed were gait speed, medial-lateral and vertical displacement of an estimated center of mass, and average hearing scores. The overall goal was to gain a better understanding of the link between hearing and balance to offer new insight into prevention of falls among the elderly. Although no significant comparisons were observed between hearing impaired subjects on gait speed and center of mass displacement measures, it is important to note that not enough subjects have been observed with their hearing aids to make accurate comparisons. In addition to the experimental study, this practicum report briefly discussed the managerial tasks observed in ensuring the study follows the required guidelines involving human subjects.Item Chemokine CXCL8 Mediated Intercellular Interactions in HIV-1 associated Dementia(2013-12-01) Mamik, Manmeet K.; Ghorpade, AnujaThis dissertation explores the role of chemokine CXCL8 during human immune deficiency virus (HIV)-1 infection in the brain. Chemokine CXCL8 is an important neutrophil chemoattractant implicated in various neurodegenerative disorders. It is upregulated in the brains and cerebrospinal fluid of HIV-1 infected individuals suggesting its potential role in HIV-1 associated neuroinflammation. Astrocytes are known to be the major contributors to the CXCL8 pool. Interleukin (IL)-1β activated astrocytes exhibit significant upregulation of CXCL8. In order to determine the signaling pathways involved in CXCL8 regulation in astrocytes, we employed pharmacological inhibitors for non-receptor Src homology-2 domain-containing protein tyrosine phosphatase (SHP) 2 and mitogen-activated protein kinases (MAPK) pathway and observed reduced expression of CXCL8 following IL-1β stimulation. Thus, our findings suggest an important role for SHP2 in CXCL8 expression in astrocytes during inflammation, as SHP2, directly or indirectly, modulates p38 and extracellular signal regulated kinase (ERK) MAPK in the signaling cascade leading to CXCL8 production. In the post-antiretroviral therapy (ART) era, low level of productive replication of HIV-1 in brain is a critical component of neuropathogenesis regulation. HIV-1 replication is a complex mechanism involving both host and viral factors. The majority of viral replication in brain occurs in perivascular macrophages and/or 2 microglia. In this study, we investigated the effect of CXCL8 on productive infection of HIV-1 in human monocytes-derived macrophages (MDM) and primary human microglia. The results show that CXCL8 mediates productive infection of HIV-1 in MDM and microglia via receptors CXCR1 and CXCR2 and induces HIV-1 long terminal repeat (LTR) promoter activity. Detailed understanding of astrocyte signaling and HIV-1 replication, as presented in the thesis, will be relevant to glial-neuronal interactions, which are central to neuroinflammation in HIV-1 and many other neurodegenerative conditions. Also, modulation of levels of CXCL8 can be a therapeutic strategy for control of productive HIV-1 replication in the brain.Item Demographics of a University Based Geratric Medicine House Call Program(1999-05-01) Dunn, Leslie K.There has been a steady decline in the frequency of house calls by physicians during the 20th century. The reasons most commonly given for not making house calls are time constraints and poor reimbursements for the amount of time spent (1). Unlike younger age groups, those 65 and older tend to have physical limitations that prohibit routine visits to clinics (2). In a university based geriatric practice, there is a subgroup of individuals who are unable to access health care or see a physician without considerable expense and effort via ambulance transportation services. Without a physician house call visit, these older adults would not have routine access to health care (3). The Gerontology Assessment and Planning Program (GAP) at the University of North Texas Health Science Center at Fort Worth (UNTHSC) is involved in providing a physician directed house call program. By 2030, it is estimated that the older adults will comprise 25% of the total population (4). Encouraging independent living supported by community-based services will result in a greater number of homebound older adults requiring house calls by physicians (5). The challenge is to determine those likely to require house call services and the medical conditions and physical disabilities leading to the need for in home services. To understand the conditions and needs of these geriatric patients, a retrospective chart review was conducted. The study reviewed the demographic characteristics of the patients seen through the house call program, prevalent sources of referrals, health assessment at the point of admission into the house call program, profile of primary care givers and factors in the decision making process that physicians used to place patients on the service. Outcome data are presented including hospital admissions and deaths while on the house call program.Item Enhancing the Care of the Elderly; An Educational Intervention to Improve Nutritional Knowledge of Nursing Home Staff(1998-06-01) Cummings, Dana; Gilbert Ramirez; Claudia Coggin; Antonio ReneCummings, Dana M., Enhancing the Care of Elderly; an Educational Intervention to Improve Nutritional Knowledge of Nursing Home Staff. Master of Public Health, June 1998, 81 p.p., 5 tables, bibliography, 15 titles. Gross deficiencies exist in the quality and quantity of health care personnel taking care of the aged (Hersch, 1989). Eighty to ninety percent of nursing home staff are untrained aides paid the minimum wage to care for one of the sickest and frailest populations in the United States (Patenaude, 1997). The purpose of this study was to determine if short term nutrition education, utilizing principles for adult learners, would result in knowledge improvement in nursing home staff. An interactive, participatory instructional model was implemented into an existing structure of regular staff inservices to answer this question. To test the effectiveness of the intervention a questionnaire was developed using items from previously validated instruments. Using three nursing homes in the Dallas-Fort Worth metroplex, a total of 157 pre-test and 132 post-test questionnaires were completed. A significant increase in overall knowledge from 80.6% at baseline to 96.1% at post-test was found (p [less than] .001). Participants also showed a significant (p [less than] 0.001) overall increase in knowledge for each of the three learning domains; patient care related to nutrition, food and fluid intake of residents, and eating. These findings suggest that employing short-term education to nursing home staff, using principles for adult learners, can improve nutritional knowledge significantly.Item Gracy, Robert, PhD.(1994-01-26) Gracy, Robert; Hailey, BlakeDr. Gracy, Associate Dean of Basic Sciences and Research, recounts the process of bringing TCOM and North Texas together. Interviewed by Blake Hailey, January 26, 1994Item Hooper Visual Organization Test (VOT) as a Predictor of Driving Status of Individuals with Dementia(2004-04-01) Budd, Margaret Anne; Doug A. Main; Susan FranksHooper Visual Organization Test (VOT) (Hooper, 1983) items were correlated with driving status of geriatric individuals with dementia to help screen for high-risk drivers. A retrospective review of 87 medical chart on patients, 60-91 years, who underwent a neurocognitive evaluation at the University of North Texas Health Science Center in Fort Worth, Texas, with a complete VOT, driving status, dementia diagnosis, and demographic descriptors (age, gender, marital status) were selected for analysis. Of the 55.2% participants who reported a current driving status, VOT scores ranged: 20.8% normal, 43.8% mildly impaired, 31.3% moderately impaired, and 4.2% severely impaired. An item analysis was followed by direct logistic regression analysis which correctly predicted 85% of the drivers and 74% of the nondrivers with an overall success rate of 80.5% (p=.001). The Wald criterion selected 4 VOT items as reliably predicting driving status: items 6 (hammer), 19 (teapot/pitcher), 22 (mouse), and 25 (block). Models run with gender and/or marital status was not reliably different. These 4 items may add to a brief screening test to identify drivers with dementia potentially at risk. In addition, the large number of current drivers scoring in the impaired range suggests that individuals, their families and others are not intervening with driving behavior, possibly placing the individuals and public at risk.Item Knebl, Janice, D.O.(1994-04-15) Knebl, Janice; Hailey, BlakeDr. Knebl is Associate Professor of Medicine for the Department of Medicine and Chief for the Geriatrics Division. She discusses her current and future work with the Health Science Center. Interviewed by Blake Hailey, April 15, 1994Item Lifelong vs. Late Life Tocopherol on Learning and Memory in Mice(2004-05-01) McDonald, Shelley R.; Michael Forster; Glenn DillonMcDonald, Shelley R., Lifelong vs. late life tocopherol on learning and memory in mice. Doctor of Philosophy (Biomedical Sciences), May, 2004, 132 pp., 1 table, 14 figures, bibliography, 122 titles. The purpose of these studies was to determine if vitamin E supplementation, a well-studied antioxidant, could improve the cognitive functions of old mice either by preventing age-dependent impairments or reversing age-related dysfunction. Cellular oxidative stress is believed to be a causal factor in senescence, and the brain appears to be particularly susceptible to oxidative damage because of a relatively high rate of reactive oxygen species generation without commensurate levels of antioxidant defenses. If oxidative stress indeed plays a role in age-related brain dysfunction, then it can be predicted that experimental interventions capable of lowering oxidative stress would either prevent or restore function. This was tested using apolipoprotein E-deficient mice, which have an increased susceptibility to neuronal oxidative damage, maintained on 3 different doses (2 mg/kg, 20 mg/kg, or 200 mg/kg/day) of dl-α-tocopheryl acetate (vitamin E) via supplemented food pellets from 8 weeks of age throughout behavioral testing when 6 or 18 mo of age. A separate experiment used wild type mice 24 months of age to examine whether or not a combination of vitamin E (123 mg/kg/day) with coenzyme Q10 (200 mg/kg/day) which leads to higher tissue levels of vitamin E, could improve brain functions in old mice. Mice were tested on multiple behavioral tasks that required utilization of various components of memory and learning, as well as sensorimotor testing. The highest dose of vitamin E prevented the decline of spatial memory in old apolipoprotein E-deficient mice, but did not prevent age-related impairments in learning and memory for discriminated escape. When old wild type mice were treated with the combined vitamin E and coenzyme W10, the mice learned and remembered to avoid a preemptive shock significantly more than old mice treated with vitamin E or coenzyme Q10 alone. A followup experiment with higher doses of coenzyme Q10 alone (250 or 500 mg/kg/day) resulted in no cognitive improvements. No treatments improved sensorimotor performance.Item Neuroprotective properties of Phytoestrogens(2012-12-01) Brock, Courtney Anne; Singh, MeharvanWomen make up nearly two thirds of total Alzheimer’s cases in the United States. It has been speculated that the loss of endogenous estradiol during menopause is, at least in part, what renders the post-menopausal brain more vulnerable to the effects of aging and Alzheimer’s Disease. While hormone therapy can potentially thwart some of the undesirable consequences and increased risks associated with menopause, women are increasingly rejecting hormone therapy and seeking alternative therapy. There is a strong in interest in phytoestrogens as an alternative to traditional hormone therapy. Phytoestrogens are naturally occurring estrogen like compounds derived from plants which have been shown to have a variety of health benefits. Their effects in the brain however are not fully understood. It was my goal to evaluate the effect of phytoestrogens on brain cells as it relates to neuroprotection. We initially assessed the ability of genistein, the most abundant phytoestrogen found in soy, to protect brain cells against age-associated insults in vitro using the hippocampal cell line (HT22 cells), a cortical cell line (HCN-1A cells), and primary slice cultures of the cerebral cortex. The results of these experiments were such that genistein was protective in the explant model and HCN-1A cells, but not in the HT22 cells suggesting that certain key players must be present for genistein to elicit neuroprotective effects. Based on the known estrogen receptor (ER) profiles for the models used in our study, we hypothesized that ER profiles may dictate the effects of phytoestrogens on brain cells. As such, we evaluated male and female C57/Bl6 mice at 3 different ages for ER expression profile and the effects that a phytoestrogen diet had on BDNF, used in this study as a surrogate marker of neuroprotection. Results showed that phytoestrogens’ effects on the brain differ between the cortex and the hippocampus and are dependent upon the sex of the animal and age at which the diet was initiated. From our results we have proposed a mechanism by which phytoestrogens differentially elicit their effects in the brain. The data presented herein provides valuable insight into phytoestrogens’ effects on the brain.Item Nutrition, Dementia and Depression in an Ambulatory Geriatric Care Center(2005-05-01) Birmingham, John F.; Daisha Cipher; Douglas A. Mains; Thomas J. FairchildBirmingham, John F., Nutritional Risk, Dementia Factors and Depression in an Ambulatory Geriatric Care Center. Master’s of Public Health (Clinical Research), May 2005, 60pp., 7 tables, 2 figures, reference list, 56 titles. Dementia is a major public health problem in the aging population. Depression, nutritional risk and declining self-efficacy are broadly listed risk factors for dementia. Cross-sectional patient data was obtained by chart review of ambulatory community-dwelling elderly patients screened for depression, dementia factors, levels of independence in activities associated with daily living and nutritional risk. The statistical coefficients of the correlational relationships between nutritional risks, dementia factors, depression levels and levels of functional capacity were examined using path analysis. Two models depicted the composite of instrumental activities of daily living items (IADLs), as they related to the dependent variables models, nutritional risk, dementia factors, and depression levels. The model which regressed the IADLs composite variable against depression and dementia factors indicated a good fit (X2=0.00, p=0.01). Attempts to match screening data with diagnostic follow-up data were unsuccessful. Only 12 matches occurred between the GAP and CARE databases (N=256, N=1470).Item Sowa, Philip(1994-04-22) Sowa, Philip; Hailey, BlakeAs Chief Executive Officer for the Osteopathic Medical Center of Texas, Mr. Philip Sowa discusses the long relationship between TCOM and the hospital. Interviewed by Blake Hailey, April 22, 1994Item Synergy 2007: Annual Research Report(2007-01-01)Item Synergy 2008: Annual Research Report(2008-01-01)Item Synergy 2011: Annual Research Report(2011-01-01)Item Using a Database to Facilitate the Accrual of Geriatric Subjects with Dementia for Clinical Research Studies(2007-04-23) Alexander, Jessica; Patricia Gwirtz; Janice Knebl; Barbara HartyThe internship and practicum project activities took place in an established geriatric practice that provides care to more than 2,000 patients over the age of 65. Research studies and clinical trials conducted at this site are specifically aimed at either testing the efficacy of medications and treatments in the elderly or researching disease processes predominantly found within the older population. This geriatric practice is led by Dr. Janice Knebl with the assistance of Barbara Harty, who is a seasoned geriatric nurse practitioner, IRB board member, clinical coordinator, and my mentor during the internship. The overall objective of the internship was to build a functional knowledge of how to manage research with human subjects. The internship experience spanned several domains within the field of clinical research management: clinical coordination, contract management, institutional research management, and data/records management. Within the course of the internship and implementation of the practicum project there were more than 1040 hours logged working within these areas of concentration in order to achieve that goal. The following is a narrative account of those experiences that details the Internship/Activity Log submitted as Appendix A of this report.