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Schrack J.A.,U.S. National Institute on Aging | Schrack J.A.,Center on Aging and Health | Simonsick E.M.,U.S. National Institute on Aging | Ferrucci L.,U.S. National Institute on Aging
PLoS ONE | Year: 2010

Background and Aims: Recent introduction of the Cosmed K4b2 portable metabolic analyzer allows measurement of oxygen consumption outside of a laboratory setting in more typical clinical or household environments and thus may be used to obtain information on the metabolic costs of specific daily life activities. The purpose of this study was to assess the accuracy of the Cosmed K4b2 portable metabolic analyzer against a traditional, stationary gas exchange system (the Medgraphics D-Series) during steady-state, submaximal walking exercise. Methods:Nineteen men and women (9 women, 10 men) with an average age of 39.8 years (±13.8) completed two 400 meter walk tests using the two systems at a constant, self-selected pace on a treadmill. Average oxygen consumption (VO2) and carbon dioxide production (VCO 2) from each walk were compared. Results: Intraclass Correlation Coefficient (ICC) and Pearson correlation coefficients between the two systems for weight indexed VO2 (ml/kg/min), total VO2 (ml/min), and VCO2 (ml/min) ranged from 0.93 to 0.97. Comparison of the average values obtained using the Cosmed K4b2 and Medgraphics systems using paired t-tests indicate no significant difference for VO2 (ml/kg/min) overall (p = 0.25), or when stratified by sex (p = 0.21 women, p = 0.69 men). The mean difference between analyzers was - 0.296 ml/kg/min (±0.26). Results were not significantly different for VO2 (ml/min) or VCO 2 (ml/min) within the study population (p = 0.16 and p = 0.08, respectively), or when stratified by sex (VO2: p = 0.51 women, p = 0.16 men; VCO2: p = .11 women, p = 0.53 men). Conclusion: The Cosmed K4b2 portable metabolic analyzer provides measures of VO2 and VCO2 during steady-state, submaximal exercise similar to a traditional, stationary gas exchange system. Source

Parrinello C.M.,Welch Center for Prevention | Rastegar I.,Welch Center for Prevention | Rastegar I.,Baltimore Polytechnic Institute | Godino J.G.,Welch Center for Prevention | And 5 more authors.
Diabetes Care | Year: 2015

OBJECTIVE: Controversy surrounds appropriate risk factor targets in older adults with diabetes. We evaluated the proportion of older adults with diabetes meeting different targets, focusing on possible differences by race, and assessed whether demographic and clinical characteristics explained disparities. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study of 5,018 participants aged 67-90 years (1,574 with and 3,444 without diagnosed diabetes) who attended visit 5 of the Atherosclerosis Risk in Communities (ARIC) study (2011-2013). Risk factor targets were defined using both stringent (and less stringent) goals: hemoglobin A1c (HbA1c) <7%, <53 mmol/mol (<8%, <64 mmol/mol); LDL cholesterol (LDL-c) <100 mg/dL (<130 mg/dL); and blood pressure (BP) <140/90 mmHg (<150/90 mmHg). We used Poisson regression to obtain prevalence ratios (PRs). RESULTS: Most older adults with diabetes met stringent (and less stringent) targets: 72% (90%) for HbA1c, 63% (86%) for LDL-c, and 73% (87%) for BP; but only 35% (68%) met all three. A higher proportion of whites than blacks met targets, however defined. Among people treated for risk factors, racial disparities in prevalence of meeting stringent targets persisted even after adjustment: PRs (whites vs. blacks) were 1.03 (95% CI 0.91, 1.17) for HbA1c, 1.21 (1.09, 1.35) for LDL-c, 1.10 (1.00, 1.21) for BP, and 1.28 (0.99, 1.66) for all three. Results were similar but slightly attenuated using less stringent goals. Black women were less likely than white women to meet targets for BP and all three risk factors; this disparity was not observed in men. CONCLUSIONS: Black-white disparities in risk factor control in older adults with diabetes were not fully explained by demographic or clinical characteristics and were greater in women than men. Further study of determinants of these disparities is important. © 2015 by the American Diabetes Association. Source

Cohen A.A.,Universite de Sherbrooke | Milot E.,Universite de Sherbrooke | Yong J.,Universite de Sherbrooke | Seplaki C.L.,University of Rochester | And 3 more authors.
Mechanisms of Ageing and Development | Year: 2013

Previous studies have identified many biomarkers that are associated with aging and related outcomes, but the relevance of these markers for underlying processes and their relationship to hypothesized systemic dysregulation is not clear. We address this gap by presenting a novel method for measuring dysregulation via the joint distribution of multiple biomarkers and assessing associations of dysregulation with age and mortality. Using longitudinal data from the Women's Health and Aging Study, we selected a 14-marker subset from 63 blood measures: those that diverged from the baseline population mean with age. For the 14 markers and all combinatorial sub-subsets we calculated a multivariate distance called the Mahalanobis distance (MHBD) for all observations, indicating how " strange" each individual's biomarker profile was relative to the baseline population mean. In most models, MHBD correlated positively with age, MHBD increased within individuals over time, and higher MHBD predicted higher risk of subsequent mortality. Predictive power increased as more variables were incorporated into the calculation of MHBD. Biomarkers from multiple systems were implicated. These results support hypotheses of simultaneous dysregulation in multiple systems and confirm the need for longitudinal, multivariate approaches to understanding biomarkers in aging. © 2013 Elsevier Ireland Ltd. Source

Palta P.,Center on Aging and Health | Page G.,Johns Hopkins University | Piferi R.L.,Johns Hopkins University | Gill J.M.,George Mason University | And 3 more authors.
Journal of Urban Health | Year: 2012

Hypertension affects a large proportion of urban African-American older adults. While there have been great strides in drug development, many older adults do not have access to such medicines or do not take them. Mindfulness-based stress reduction (MBSR) has been shown to decrease blood pressure in some populations. This has not been tested in low-income, urban African-American older adults. Therefore, the primary purpose of this pilot study was to test the feasibility and acceptability of a mindfulness-based program for low income, minority older adults provided in residence. The secondary purpose was to learn if the mindfulness-based program produced differences in blood pressure between the intervention and control groups. Participants were at least 62 years old and residents of a low-income senior residence. All participants were African-American, and one was male. Twenty participants were randomized to the mindfulness-based intervention or a social support control group of the same duration and dose. Blood pressure was measured with the Omron automatic blood pressure machine at baseline and at the end of the 8-week intervention. A multivariate regression analysis was performed on the difference in scores between baseline and post-intervention blood pressure measurements, controlling for age, education, smoking status, and anti-hypertensive medication use. Effect sizes were calculated to quantify the magnitude of the relationship between participation in the mindfulness-based intervention and the outcome variable, blood pressure. Attendance remained >80%in all 8 weeks of both the intervention and the control groups. The average systolic blood pressure decreased for both groups post-intervention. Individuals in the intervention group exhibited a 21.92-mmHg lower systolic blood pressure compared to the social support control group post-intervention and this value was statistically significant (p=0.020). The average diastolic blood pressure decreased in the intervention group postintervention, but increased in the social support group. Individuals in the intervention group exhibited a 16.70-mmHg lower diastolic blood pressure compared to the social support group post-intervention, and this value was statistically significant (p=0.003). Older adults are at a time in life when a reflective, stationary intervention, delivered in residence, could be an appealing mechanism to improve blood pressure. Given our preliminary results, larger trials in this hypertensive study population are warranted. © 2012 The New York Academy of Medicine. Source

Boyd C.M.,Center on Aging and Health | Lucas G.M.,Johns Hopkins University
Current Opinion in HIV and AIDS | Year: 2014

PURPOSE OF REVIEW: The purpose of this review is to consider a patient-centred approach to the care of people living with HIV (PLWH) who have multimorbidity, irrespective of the specific conditions. RECENT FINDINGS: Interdisciplinary care to achieve patient-centred care for people with multimorbidity is recognized as important, but the evaluation of models designed to achieve this goal are needed. Key elements of such approaches include patient preferences, interpretation of the evidence, prognosis as a tool to inform patient-centred care, clinical feasibility and optimization of treatment regimens. SUMMARY: Developing and evaluating the best models of patient-centred care for PLWH who also have multimorbidity is essential. This challenge represents an opportunity to leverage the lessons learned from the care of people with multimorbidity in general, and vice versa. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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