Baltimore, MD, United States
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Weiss C.O.,Michigan State University | Weiss C.O.,Advantage Health | Weiss C.O.,Johns Hopkins University | Segal J.B.,Johns Hopkins University | And 2 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2012

Purpose: To propose methods for the quantitative assessment of the applicability of evidence from a trial to a target sample using individual data. Methods: Demonstration was with a trial of drug therapy to prevent mortality and an accompanying registry of people with heart failure. Principal components analysis with biplots did not identify measurement discrepancies. Multiple imputation with chained equations addressed missing predictor values. A proportional hazards model with interaction term, including graphical interpretation and a multivariate interaction test, identified heterogeneity of treatment effect. An interval of homogeneity of treatment effect was the interval of the baseline risk of outcome in which no two treatment effects were statistically significantly different. Absolute risk reduction for individuals was estimated for both benefit and harm outcomes and presented in a bivariate treatment effects scatterplot. Results: Overall, the trial evidence applied to most of the registry according to overlapping distributions of estimated benefit and harm. However, 52% of trial and 33% of registry participants were estimated to have net benefit, and 14% of trial and 36% of registry participants were estimated to have strong net harmful treatment effect, that is, the individual estimate of harm was more than twice the estimate of benefit. Conclusions: The proposed methods provide quantitative assessment of the applicability of trial evidence to a target sample. They combine the strengths of different study designs, namely, unbiased effects estimation from trials and representation in observational studies, while addressing the practical challenges of combining information, namely, measurement discrepancies and missing data. © 2012 John Wiley & Sons, Ltd.


Gross A.L.,Johns Hopkins Center on Aging and Health | Jones R.N.,Johns Hopkins Center on Aging and Health | Jones R.N.,Brown University | Fong T.G.,Johns Hopkins Center on Aging and Health | And 5 more authors.
Neuroepidemiology | Year: 2014

Objective: To evaluate a new approach for creating a composite measure of cognitive function, we calibrated a measure of general cognitive performance from existing neuropsychological batteries. Methods: We applied our approach in an epidemiological study and scaled the composite to a nationally representative sample of older adults. Criterion validity was evaluated against standard clinical diagnoses. Convergent validity was evaluated against the Mini-Mental State Examination (MMSE). Results: The general cognitive performance factor was scaled to have a mean of 50 and standard deviation of 10 in a nationally representative sample of older adults. A cutoff point of approximately 45, corresponding to an MMSE of 23/24, optimally discriminated participants with and without dementia (sensitivity = 0.94, specificity = 0.90, area under the curve = 0.97). The general cognitive performance factor was internally consistent (Cronbach's = 0.91) and provided reliable measures of functional ability across a wide range of cognitive functioning. It demonstrated minimal floor and ceiling effects, which is an improvement over most individual cognitive tests. Conclusions: The cognitive composite is a highly reliable measure, with minimal floor and ceiling effects. We calibrated it using a nationally representative sample of adults over the age of 70 in the USA and established diagnostically relevant cutoff points. Our methods can be used to harmonize neuropsychological test results across diverse settings and studies. © 2014 S. Karger AG, Basel.


Tan E.J.,Corporation for National and Community Service | McGill S.,Greater Homewood Community Corporation | Tanner E.K.,Johns Hopkins Center on Aging and Health | Rebok G.W.,Johns Hopkins Center on Aging and Health | And 2 more authors.
Gerontologist | Year: 2014

Purpose: Experience Corps Baltimore City (EC) is a product of a partnership between the Greater Homewood Community Corporation (GHCC) and the Johns Hopkins Center on Aging and Health (COAH) that began in 1998. EC recruits volunteers aged 55 and older into high-impact mentoring and tutoring roles in public elementary schools that are designed to also benefit the volunteers. We describe the evolution of the GHCC-COAH partnership through the "Courtship Model." Design and Methods: We describe how community-based participatory research principals, such as shared governance, were applied at the following stages: (1) partner selection, (2) getting serious, (3) commitment, and (4) leaving a legacy. Results: EC could not have achieved its current level of success without academic-community partnership. In early stages of the "Courtship Model," GHCC and COAH were able to rely on the trust developed between the leadership of the partner organizations. Competing missions from different community and academic funders led to tension in later stages of the "Courtship Model" and necessitated a formal Memorandum of Understanding between the partners as they embarked on a randomized controlled trial. Implications: The GHCC-COAH partnership demonstrates how academic-community partnerships can serve as an engine for social innovation. The partnership could serve as a model for other communities seeking multiple funding sources to implement similar public health interventions that are based on national service models. Unified funding mechanisms would assist the formation of academic-community partnerships that could support the design, implementation, and the evaluation of community-based public health interventions. © 2013 The Author.


Weiss C.O.,Michigan State University | Weiss C.O.,Johns Hopkins University | Varadhan R.,Johns Hopkins University | Varadhan R.,Johns Hopkins Center on Aging and Health | And 4 more authors.
Journal of General Internal Medicine | Year: 2014

Most people with a chronic disease actually have more than one, a condition known as multimorbidity. Despite this, the evidence base to prevent adverse disease outcomes has taken a disease-specific approach. Drawing on a conference, Improving Guidelines for Multimorbid Patients, the goal of this paper is to identify challenges to the generation of evidence to support the care of people with multimorbidity and to make recommendations for improvement. We identified three broad categories of challenges: 1) challenges to defining and measuring multimorbidity; 2) challenges related to the effects of multimorbidity on study design, implementation and analysis; and 3) challenges inherent in studying heterogeneity of treatment effects in patients with differing comorbid conditions. We propose a set of recommendations for consideration by investigators and others (reviewers, editors, funding agencies, policymaking organizations) involved in the creation of evidence for this common type of person that address each of these challenges. The recommendations reflect a general approach that emphasizes broader inclusion (recruitment and retention) of patients with multimorbidity, coupled with more rigorous efforts to measure comorbidity and comorbidity burden and the influence of multimorbidity on outcomes and the effects of therapy. More rigorous examination of heterogeneity of treatment effects requires careful attention to prioritizing the most important comorbid-related questions, and also requires studies that provide greater statistical power than conventional trials have provided. Relatively modest changes in the orientation of current research along these lines can be helpful in pointing to and partially addressing selected knowledge gaps. However, producing a robust evidence base to support patient-centered decision making in complex individuals with multimorbidity, exposed to many different combinations of potentially interacting factors that can modify the risks and benefits of therapies, is likely to require a clinical research enterprise fundamentally restructured to be more fully integrated with routine clinical practice. © Society of General Internal Medicine 2013.


Lin F.R.,Johns Hopkins Center on Aging and Health | Yaffe K.,University of California at San Francisco | Xia J.,Johns Hopkins Center on Aging and Health | Xue Q.-L.,Johns Hopkins Center on Aging and Health | And 6 more authors.
JAMA Internal Medicine | Year: 2013

Background: Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown. Methods: We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥ 80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixedeffects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. Results: In total, 1162 individuals with baseline hearing loss (pure-tone average ≲γτ∀ 25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were -0.65 (95% CI, -0.73 to -0.56) vs -0.46 (95% CI,-0.55 to-0.36) points per year (P=.004). On the Digit Symbol Substitution test, the annual score changes were-0.83 (95% CI,-0.94 to-0.73) vs-0.63 (95% CI,-0.75 to-0.51) points per year (P=.02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss. Conclusions: Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.. © 2013 American Medical Association. All rights reserved.


PubMed | U.S. National Institute on Aging, Johns Hopkins University, Duke University and Johns Hopkins Center on Aging and Health
Type: | Journal: Journal of the neurological sciences | Year: 2016

Type II diabetes mellitus (DM) increases risk for cognitive decline and is associated with brain atrophy in older demented and non-demented individuals. We investigated (1) the cross-sectional association between fasting blood glucose level and cortical thickness in a sample of largely middle-aged, cognitively normal adults, and (2) whether these associations were modified by genes associated with both lipid processing and dementia. To explore possible modifications by genetic status, we investigated the interaction between blood glucose levels and the apolipoprotein E (APOE) 4 allele and the translocase of the outer mitochondrial membrane (TOMM) 40 523 genotype on cortical thickness. Cortical thickness measures were based on mean thickness in a subset of a priori-selected brain regions hypothesized to be vulnerable to atrophy in Alzheimers disease (AD) (i.e., AD vulnerable regions). Participants included 233 cognitively normal subjects in the BIOCARD study who had a measure of fasting blood glucose and cortical thickness measures, quantified by magnetic resonance imaging (MRI) scans. After adjustment for age, sex, race, education, depression, and medical conditions, higher blood glucose was associated with thinner parahippocampal gyri (B=-0.002; 95% CI -0.004, -0.0004) and temporal pole (B=-0.002; 95% CI -0.004, -0.0001), as well as reduced average thickness over AD vulnerable regions (B=-0.001; 95% CI -0.002, -0.0001). There was no evidence for greater cortical thinning in 4 carriers of the APOE gene or in APOE 3/3 individuals carrying the TOMM40 VL/VL genotypes. When individuals with glucose levels in the diabetic range (126mg/dL), were excluded from the analysis, the associations between glucose levels and cortical thickness were no longer significant. These findings suggest that glucose levels in the diabetic range are associated with reduced cortical thickness in AD vulnerable regions as early as middle age.


News Article | November 15, 2016
Site: www.eurekalert.org

November 15, 2016 - New York, NY - Linda P. Fried, Dean and DeLamar Professor at the Columbia University Mailman School of Public Health, will receive the 2016 Inserm International Prize, a scientific honor presented annually by the French National Institute of Health and Medical Research [Inserm], France's equivalent of the U.S. National Institutes of Health. The Prize will be presented along with five other Inserm awards at a December 8 ceremony held at Collège de France in Paris. "Throughout my career, my interest in the science of healthy aging has been guided by a belief that science and society, working in concert, can optimize our innate capacity for good health," Fried said. "I am grateful to Inserm for this honor and for the light it will shine on this body of scientific breakthroughs. My collaborators and I believe that such science can be the basis for the opportunities of our now-longer lives. Science offers enormous potential to build health for older people around the world and create the foundations to benefit all of us. Worldwide, the number of people aged 65 or older will almost triple by 2050, climbing from about 524 million in 2010 to nearly 1.5 billion. Fried, who has actively collaborated with global leaders to help realize the potential of large older populations, recently led an international summit on aging and health in Shanghai. The most populous nation on earth will be home to as many as 330 million people over age 60 by 2050. In designing the summit, Fried included representation from global academia, government, and private industry, all of which will be called upon to meet the demands of this demographic transformation. . John W. Rowe, Julius B. Richmond Professor of Health Policy and Aging Health Policy and Management at Columbia, suggested Inserm's selection marks a milestone for those within public health who study aging. "The importance of the Inserm Prize relates to its truly international scope and its focus not on a particular discovery but on a scholar's systematic body of work in an important area," he said. "Recognition of Linda Fried's research has special significance as it shows that research on aging, long neglected, has come of age." A highly regarded figure in international public health, Fried has dedicated her career to interventions that equip societies to transition to a world in which greater longevity benefits people of all ages. Her research creating the science of frailty, defining frailty as a clinical syndrome and illuminating its causes, consequences and the potential for preventing it has had great impact. Fried's scientific discoveries have transformed science as well as medical care and public health globally, and catalyzed greater interest in helping older populations thrive. Fried was cited by publisher Thompson Reuters in 2014 as among the top one percent of influential scientific minds of the prior decade. She is also the designer and co-founder of Experience Corps, a program that places senior volunteers in public schools in cities in the United States and around the world. Serving in both tutoring and mentoring roles, Experience Corps' older volunteers help enrich students' academic achievements while bolstering their own health through continued activity and community interaction. In a randomized, controlled trial, Fried successfully demonstrated Experience Corps' success preventing physical disability and cognitive decline among older adults, while raising child literacy. Before coming to Columbia in 2008 Fried founded the Johns Hopkins Center on Aging and Health, directed the Division of Geriatric Medicine and Gerontology, and held joint appointments at Hopkins' schools of medicine, nursing, and public health. Prior winners of the International Prize include Chen Zhu, China's former Minister of Health, Nora Volkow, Director of the National Institutes of Drug Abuse, and Harvey Alter, whose work led to the discovery of hepatitis-C. Last year, the Prize was awarded to Peter Piot, who is currently Director of the London School of Hygiene and Tropical Medicine. The 2008 winner, Tomas Lindahl, former Director of Clare Hall Laboratories at Cancer Research in the United Kingdom, went on to win the Nobel Prize in Chemistry in 2015. Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www. .


Chuang Y.-F.,Johns Hopkins University | Eldreth D.,Johns Hopkins University | Erickson K.I.,University of Pittsburgh | Varma V.,Johns Hopkins University | And 9 more authors.
Neurobiology of Aging | Year: 2014

Cardiovascular (CV) risk factors, such as hypertension, diabetes, and hyperlipidemia are associated with cognitive impairment and risk of dementia in older adults. However, the mechanisms linking them are not clear. This study aims to investigate the association between aggregate CV risk, assessed by the Framingham general cardiovascular risk profile, and functional brain activation in a group of community-dwelling older adults. Sixty participants (mean age: 64.6years) from the Brain Health Study, a nested study of the Baltimore Experience Corps Trial, underwent functional magnetic resonance imaging using the Flanker task. We found that participants with higher CV risk had greater task-related activation in the left inferior parietal region, and this increased activation was associated with poorer task performance. Our results provide insights into the neural systems underlying the relationship between CV risk and executive function. Increased activation of the inferior parietal region may offer a pathway through which CV risk increases risk for cognitive impairment. © 2014 Elsevier Inc.


Kamil R.J.,Johns Hopkins Center on Aging and Health | Genther D.J.,Johns Hopkins University | Lin F.R.,Johns Hopkins University
Ear and Hearing | Year: 2015

DESIGN: We examined 3557 participants aged 50 and older in the National Health and Nutrition Examination Survey cycles 1999-2006 and 2009-2010. We examined the relationship between objective and subjective hearing impairment using percent correct classification and misclassification bias in analyses stratified by gender, age group, race/ethnicity, and education.RESULTS: We found that younger participants tended to overestimate and older participants underestimate their hearing impairment. Older women, blacks, and Hispanics were less accurate in self-reporting than their respective younger age groups.CONCLUSION: The association between subjective and objective hearing differs across gender, age, race/ethnicity, and education, and this observation should be considered by clinicians and researchers employing self-reported hearing.OBJECTIVES: Self-reported hearing impairment is often used to gauge objective hearing loss in both clinical settings and research studies. The aim of this study was to examine whether demographic factors affect the accuracy of subjective, self-reported hearing in older adults. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Buta B.,Johns Hopkins Center on Aging and Health
Health promotion practice | Year: 2011

The Fostering African American Improvement in Total Health! (FAITH!) Nutrition Education Program is a theory-based, multicomponent health intervention developed and operated in partnership with an East Baltimore church. The program aims to improve eating habits, as well as knowledge and beliefs about healthy eating, among African American adults in order to prevent diseases related to dietary choices. This article addresses the development, design, and formative research that informed the FAITH! program. The main program components are also discussed. Program design used a framework for strategic intervention planning (PRECEDE-PROCEED), and health education theories informed the evaluation process. Formative research was conducted to incorporate the needs and assets of the priority population. The main program components are culturally tailored educational materials, lectures and discussions on diet and related diseases, video presentations on healthy eating, healthy cooking demonstrations/food samples, evaluation, and a church-run healthy food pantry.

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