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Howrey B.T.,Sealy Center on Aging | Kuo Y.-F.,Sealy Center on Aging | Kuo Y.-F.,University of Texas Medical Branch | Lin Y.-L.,Sealy Center on Aging | And 2 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background.The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer.Methods.We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007.Results.Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p <. 001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results.Conclusions.PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing. © 2012 The Author.


PubMed | DuPont Company, University of Texas Medical Branch and Sealy Center on Aging
Type: Journal Article | Journal: The Journal of nutrition | Year: 2016

Previous work demonstrated that a soy-dairy protein blend (PB) prolongs hyperaminoacidemia and muscle protein synthesis in young adults after resistance exercise.We investigated the effect of PB in older adults. We hypothesized that PB would prolong hyperaminoacidemia, enhancing mechanistic target of rapamycin complex 1 (mTORC1) signaling and muscle protein anabolism compared with a whey protein isolate (WPI).This double-blind, randomized controlled trial studied men 55-75 y of age. Subjects consumed 30 g protein from WPI or PB (25% soy, 25% whey, and 50% casein) 1 h after leg extension exercise (8 sets of 10 repetitions at 70% one-repetition maximum). Blood and muscle amino acid concentrations and basal and postexercise muscle protein turnover were measured by using stable isotopic methods. Muscle mTORC1 signaling was assessed by immunoblotting.Both groups increased amino acid concentrations (P < 0.05) and mTORC1 signaling after protein ingestion (P < 0.05). Postexercise fractional synthesis rate (FSR; P 0.05), fractional breakdown rate (FBR; P 0.05), and net balance (P = 0.08) did not differ between groups. WPI increased FSR by 67% (mean SEM: rest: 0.05% 0.01%; postexercise: 0.09% 0.01%; P < 0.05), decreased FBR by 46% (rest: 0.17% 0.01%; postexercise: 0.09% 0.03%; P < 0.05), and made net balance less negative (P < 0.05). PB ingestion did not increase FSR (rest: 0.07% 0.03%; postexercise: 0.09% 0.01%; P 0.05), tended to decrease FBR by 42% (rest: 0.25% 0.08%; postexercise: 0.15% 0.08%; P = 0.08), and made net balance less negative (P < 0.05). Within-group percentage of change differences were not different between groups for FSR, FBR, or net balance (P 0.05).WPI and PB ingestion after exercise in older men induced similar responses in hyperaminoacidemia, mTORC1 signaling, muscle protein synthesis, and breakdown. These data add new evidence for the use of whey or soy-dairy PBs as targeted nutritional interventions to counteract sarcopenia. This trial was registered at clinicaltrials.gov as NCT01847261.


PubMed | Preventive Medicine and Community Health and, DuPont Company, University of Texas Medical Branch and Sealy Center on Aging
Type: Journal Article | Journal: The Journal of nutrition | Year: 2016

To our knowledge the efficacy of soy-dairy protein blend (PB) supplementation with resistance exercise training (RET) has not been evaluated in a longitudinal study.Our aim was to determine the effect of PB supplementation during RET on muscle adaptation.In this double-blind randomized clinical trial, healthy young men [18-30 y; BMI (in kg/m(2)): 25 0.5] participated in supervised whole-body RET at 60-80% 1-repetition maximum (1-RM) for 3 d/wk for 12 wk with random assignment to daily receive 22 g PB (n = 23), whey protein (WP) isolate (n = 22), or an isocaloric maltodextrin (carbohydrate) placebo [(MDP) n = 23]. Serum testosterone, muscle strength, thigh muscle thickness (MT), myofiber cross-sectional area (mCSA), and lean body mass (LBM) were assessed before and after 6 and 12 wk of RET.All treatments increased LBM (P < 0.001). ANCOVA did not identify an overall treatment effect at 12 wk (P = 0.11). There tended to be a greater change in LBM from baseline to 12 wk in the PB group than in the MDP group (0.92 kg; 95% CI: -0.12, 1.95 kg; P = 0.09); however, changes in the WP and MDP groups did not differ. Pooling data from combined PB and WP treatments showed a trend for greater change in LBM from baseline to 12 wk compared with MDP treatment (0.69 kg; 95% CI: -0.08, 1.46 kg; P = 0.08). Muscle strength, mCSA, and MT increased (P < 0.05) similarly for all treatments and were not different (P > 0.10) between treatments. Testosterone was not altered.PB supplementation during 3 mo of RET tended to slightly enhance gains in whole-body and arm LBM, but not leg muscle mass, compared with RET without protein supplementation. Although protein supplementation minimally enhanced gains in LBM of healthy young men, there was no enhancement of gains in strength. This trial was registered at clinicaltrials.gov as NCT01749189.


Raji M.A.,University of Texas Medical Branch | Lowery M.,Sealy Center on Aging | Lin Y.-L.,Sealy Center on Aging | Kuo Y.-F.,Sealy Center on Aging | And 2 more authors.
Annals of Pharmacotherapy | Year: 2013

BACKGROUND: Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low. In 2008, the Medicare Part D program was expanded to pay for medications for Medicare enrollees. OBJECTIVE: To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. METHODS: This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in 2007 and at least 1 diagnosis in 2008. All subjects had continuous Medicare Part D prescription coverage in 2008. Statistical analysis using χ2 was used to examine differences in warfarin use by patient characteristics (age, ethnicity, sex, Medicaid eligibility, comorbidities, contraindications to warfarin, and whether they visited a cardiologist or a primary care physician [PCP]), CHADS2 score (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack; higher scores indicate higher risks of stroke), and geographic regions. Using hierarchical generalized linear models restricted to subjects without warfarin contraindications (n = 34,947), we examined the effect of patient characteristics and geographic regions on warfarin use. RESULTS: The overall warfarin use rate was 66.8%. The warfarin use rates varied between hospital referral regions, with highest rates in the Midwestern states and lowest rates in the South. The regional variation persisted even after adjustment for patient characteristics. Multivariable analysis showed that the odds of being on warfarin decreased significantly with age and increasing comorbidity, in blacks, and among those with low income. Seeing a cardiologist (OR 1.10; 95% CI 1.05-1.16), having a PCP (OR 1.23; 95% CI 1.17-1.29), and CHADS2 score of 2 or greater (OR 1.09; 95% CI 1.01-1.17) were associated with increased odds of warfarin use. CONCLUSIONS: Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use. © 1967-2013 Harvey Whitney Books Co. All rights reserved.


Dickinson J.M.,Arizona State University | Volpi E.,Sealy Center on Aging | Rasmussen B.B.,Sealy Center on Aging | Rasmussen B.B.,University of Texas Medical Branch
Exercise and Sport Sciences Reviews | Year: 2013

The loss of skeletal muscle size and function with aging and sarcopenia may be related, in part, to an age-related muscle protein synthesis impairment. In this review, we discuss to what extent aging affects skeletal muscle protein synthesis and how nutrition and exercise can be used strategically to overcome age-related protein synthesis impairments and slow the progression of sarcopenia. © 2013 by the American College of Sports Medicine.


Berges I.-M.,University of Texas Medical Branch | Berges I.-M.,Sealy Center on Aging | Seale G.S.,University of Texas Medical Branch | Seale G.S.,Transitional Learning Center | And 2 more authors.
Disability and Rehabilitation | Year: 2012

Purpose: To examine the association between positive affect and social participation in adults with first-time stroke after in-patient medical rehabilitation. Methods: A prospective cohort design using information from the Stroke Recovery in Underserved Populations database (SRUP) for the years 20052006. Data were collected at discharge from in-patient medical rehabilitation and 3 months post-discharge. Participants were aged 50 and older with first-time stroke (n = 605) and admitted to 1 of 11 in-patient medical rehabilitation facilities across the United States. Primary measures included a positive affect scale and a home and community social participation instrument. Results: The mean age was 71.6 years, 50.3% were women, and 56.5% were married. Results of cumulative logit models showed each 1 point increase in positive affect was significantly associated with a 17% odds of higher social participation (OR: 1.17, 95% CI 1.10, 1.25), after adjusting for demographics, clinical characteristics, and negative affect. Conclusions: High positive affect at discharge from in-patient medical rehabilitation was associated with higher levels of social participation 3 months post-discharge. The significant association between higher positive affect and higher levels of social participation adds to accumulating evidence linking positive affect with beneficial physical and psychological outcomes after an acute event such as stroke. Implications for Rehabilitation This study shows positive affect associated with greater social participation 3 months post-discharge from in-patient medical rehabilitation. Positive affect may be a critical factor in the recovery trajectory of the stroke patient. The assessment of positive affect during in-patient medical rehabilitation may identify those at risk for poor social participation post-discharge and may lead to the design of innovative interventions aimed at the re-integration of stroke individuals into the community. © 2012 Informa UK, Ltd.


Peterson M.D.,University of Michigan | McGrath R.,University of Michigan | Zhang P.,University of Michigan | Markides K.S.,University of Texas Medical Branch | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2016

Background: The risk of cardiovascular problems due to diabetes mellitus is highest among older Mexicans, and yet what remains to be determined is the association between muscle weakness and diabetes in this population. Therefore, the purpose of this study was to determine the association between muscle strength and diabetes among Mexican adults greater than 50 years of age. Design: Cross-sectional. Setting: National sample of households in both urban and rural areas. Participants: A subsample of 1841 individuals aged 50 years and older was included from the 2012 Mexican Health and Aging Study. Measurements: Strength was assessed using a hand-held dynamometer, and the single largest reading from either hand was normalized to body mass (normalized grip strength [NGS]). Conditional inference tree analyses were used to identify sex-specific NGS weakness thresholds. Linear regression was used to examine the association between NGS and HbA1c, and logistic regression was used to assess the association between weakness and risk of diabetes (HbA1c ≥ 6.5% [≥48 mmol/mol]), after controlling for age, sex, and waist circumference. Results: NGS was inversely associated with HbA1c (β = -1.56; . P < .001). Optimal sex-specific NGS weakness thresholds to detect diabetes were ≤0.46 and ≤0.30 for men and women, respectively. Weakness was associated with significantly increased odds of diabetes (odds ratio, 1.69; 95% confidence interval, 1.37-2.10), even after adjusting for age, sex, and waist circumference. Conclusions: NGS was robustly associated with diabetes and other cardiometabolic risk factors in older Mexicans. This simple screen may serve as a valuable tool to identify adults that are at risk for negative health consequences or early mortality and who might benefit from lifestyle interventions to reduce risk. © 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.


Ostir G.V.,Sealy Center on Aging | Ostir G.V.,University of Texas Medical Branch | Berges I.-M.,Sealy Center on Aging | Berges I.-M.,University of Texas Medical Branch | And 3 more authors.
Journal of the American Geriatrics Society | Year: 2011

Objective: To provide estimates of change in depressive symptoms and determine how changes in depressive symptom influence recovery of functional status. Design: Prospective cohort study. Setting: Eleven inpatient medical rehabilitation facilities located across the United States. Participants: Five hundred forty-four persons with a first-time stroke. Measurements: General linear regression model estimates assessed associations between depressive symptom change and functional status 3 and 12 months after discharge. Results: The majority of persons with stroke were aged 75 and older, white, female, and married. The most prevalent stroke type was ischemic. For participants without depression at discharge, those who reported fewer depressive symptoms 12 months after stroke than before had an adjusted functional status score of 108.2, whereas those with more symptoms had an adjusted functional status score of 104.6. For participants who were depressed at discharge, those who reported fewer depressive symptoms 12 months after stroke than before had an adjusted functional status score of 100.3, whereas those with more symptoms had an adjusted functional status score of 88.0. Conclusion: Tracking depressive symptom change in the hospital and after discharge is clinically relevant and is an important component of patient care and recovery of functional status. © 2011 The American Geriatrics Society.


PubMed | University of Texas Medical Branch and Sealy Center on Aging
Type: | Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery | Year: 2016

To determine the demographics and seasonal and geographic variation of epistaxis in the United States.Retrospective cohort analysis based on data from Medicare claims.Emergency department visits.We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states.In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients <65 years old, patients who were 66 to 76, 76 to 85, and >85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States.Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.


PubMed | Sealy Center on Aging
Type: Journal Article | Journal: Disability and rehabilitation | Year: 2012

To examine the association between positive affect and social participation in adults with first-time stroke after in-patient medical rehabilitation.A prospective cohort design using information from the Stroke Recovery in Underserved Populations database (SRUP) for the years 2005-2006. Data were collected at discharge from in-patient medical rehabilitation and 3 months post-discharge. Participants were aged 50 and older with first-time stroke (n = 605) and admitted to 1 of 11 in-patient medical rehabilitation facilities across the United States. Primary measures included a positive affect scale and a home and community social participation instrument.The mean age was 71.6 years, 50.3% were women, and 56.5% were married. Results of cumulative logit models showed each 1 point increase in positive affect was significantly associated with a 17% odds of higher social participation (OR: 1.17, 95% CI 1.10, 1.25), after adjusting for demographics, clinical characteristics, and negative affect.High positive affect at discharge from in-patient medical rehabilitation was associated with higher levels of social participation 3 months post-discharge. The significant association between higher positive affect and higher levels of social participation adds to accumulating evidence linking positive affect with beneficial physical and psychological outcomes after an acute event such as stroke.

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