Biomedical subjects

Karen Bandeen-Roche

Publications and source records attributed to Karen Bandeen-Roche.

27 records · Page 2Linked to original sources

PubMed2004

Influenza vaccination by race among disabled community dwelling older women.

Disabled older adults have been shown to be at risk for underutilization of some preventive services relative to able-bodied individuals. The Women's Health and Aging Study surveyed female Medicare enrollees in Baltimore, Maryland, who were among the most disabled community-dwelling women at the start of the study. Longitudinal survey data from the study were used to test for the existence or emergence of racial variation in influenza vaccination rates, for which racial variation has been shown in the general population. The primary analysis, using data on the same women before and after Medicare flu shot coverage began, suggested that influenza vaccination rates increased after Medicare coverage began and that there was no difference by race. A secondary analysis using data on women who were interviewed only after Medicare flu shot coverage began showed some racial variation, although the difference may have been larger prior to coverage. The utilization rate did not approach the Healthy People 2010 target.

Aged↗

PubMed2003

Predictors of objective sleep tendency in the general population.

STUDY OBJECTIVES: Daytime sleepiness is a pervasive problem that is associated with a significant public-health burden. Although self-reported measures of daytime sleepiness may be useful in identifying at-risk individuals, there is significant controversy because there are no population-based data relating subjective and objective measures of daytime sleep tendency. The aims of this study were to examine the associations between the Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleep tendency, and self-reported information on the Epworth Sleepiness Scale (ESS) and nighttime sleep duration in the general population. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Population-based sample of 261 women and 371 men, mean age of 50.8 years, enrolled in the Wisconsin Sleep Cohort Study. MEASUREMENTS: MSLT, ESS, and self-reported sleep duration prior to the MSLT. RESULTS: Using survival analysis to model the time to sleep onset during the MSLT, we found that individuals with an intermediate (6-11) and high (> or = 12) ESS score had a 30% and 69% increase in risk for sleep onset during the MSLT, respectively, compared to individuals with a low ESS score (< or = 5). A dose-response relationship between self-reported duration of nighttime sleep and objective sleep tendency was also observed. Compared to individuals reporting more than 7.50 hours of sleep (highest tertile), individuals reporting 6.75 to 7.50 hours and less than 6.75 hours (lowest tertile) had a 27% and 73% increase in risk for sleep onset during the MSLT, respectively. CONCLUSIONS: Subjective reports of daytime sleep tendency on the ESS and the duration of nighttime sleep are associated with the results of the MSLT in the general population.

Adult↗

PubMed2002

The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep.

BACKGROUND: Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. STUDY OBJECTIVES: To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). DESIGN: Cross-sectional study. SETTING: University-based sleep disorders laboratory. PARTICIPANTS: Patients referred for polysomnography and daytime MSLT (n=1,821). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI < 8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95%CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95%CI: 1.01-1.46), 1.20 (95%CI: 1.05-1.37), and 1.10 (95%CI: 1.04-1.16), respectively. CONCLUSION: Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.

Adult↗

PubMed2002

How does visual impairment affect performance on tasks of everyday life? The SEE Project. Salisbury Eye Evaluation.

OBJECTIVE: To determine the association between performance on selected tasks of everyday life and impairment in visual acuity and contrast sensitivity. METHODS: Visual acuity and contrast sensitivity were obtained on a population-based sample of 2520 older African American and white subjects. Performance was assessed on mobility, daily activities with a strong visual component, and visually intensive tasks. Disability was defined as performance less than 1 SD below the mean. Receiver operating characteristic curve analyses were used to evaluate the sensitivity and specificity of thresholds in acuity and contrast loss for determining disability. RESULTS: Both visual acuity and contrast sensitivity loss were associated with decrements in function. The relationship of function to the vision measures was mostly linear, therefore, receiver operating characteristic curves were not helpful in identifying cutoff points for predicting disabilities. For mobility tasks, most persons were not disabled until they had significant acuity loss (logMAR visual acuity >1.0 or <20/200) or contrast sensitivity loss (0.9 log units contrast sensitivity). For heavily visually intensive tasks, like reading, visual acuity worse than 0.2 logMAR (20/30) or contrast sensitivity worse than 1.4 log units was disabling. CONCLUSIONS: Both contrast sensitivity and visual acuity loss contribute independently to deficits in performance on everyday tasks. Defining disability as deficits in performance relative to a population, it is possible to identify visual acuity and contrast loss where most are disabled. However, the cutoff points depend on the task, suggesting that defining disability using a single threshold for visual acuity or contrast sensitivity loss is arbitrary.

Activities of Daily Living↗

PubMed2002

Musculoskeletal pain and risk for falls in older disabled women living in the community.

OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (> or = 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25-2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02-1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons.

Accidental Falls↗

PubMed2002

Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels.

OBJECTIVES: To test whether accelerated sarcopenia in older persons with high interleukin (IL)-6 serum levels plays a role in the prospective association between inflammation and disability found in many studies. DESIGN: Cohort study of older women with moderate to severe disability. PARTICIPANTS: Six hundred twenty older women from the Women's Health and Aging Study in whom information on baseline IL-6 serum level was available. MEASUREMENTS: Self-report of functional status, objective measures of walking performance, and knee extensor strength were assessed at baseline and over six semiannual follow-up visits. Potential confounders were baseline age, race, body mass index, smoking, depression, and medical conditions. RESULTS: At baseline, women with high IL-6 were more often disabled and had lower walking speed. After adjusting for confounders, women in the highest IL-6 tertile (IL-6>3.10 pg/mL) were at higher risk of developing incident mobility disability (risk ratio (RR) = 1.50, 95% confidence interval (CI) = 1.01-2.27), disability in activities of daily living (RR = 1.41, 95% CI = 1.01-1.98), and severe limitation in walking (RR = 1.61, 95% CI = 1.09-2.38) and experienced steeper declines in walking speed (P <.001) than women in the lowest IL-6 tertile (IL-6 < or =1.78 pg/mL). Decline in knee extensor strength was also steeper, but differences across IL-6 tertiles were not significant. After adjusting for change over time in knee extensor strength, the association between high IL-6 and accelerated decline of physical function was no longer statistically significant. CONCLUSIONS: Older women with high IL-6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels, which are partially explained by a parallel decline in muscle strength.

Activities of Daily Living↗

PubMed2002

Short-term change in physical function and disability: the Women's Health and Aging Study.

OBJECTIVES: Although measures of physical function are predictive of future disability, little is known about the short-term impact of changes in physical function on disability. METHODS: Data from 93 of the 102 women who participated in the Weekly Substudy of the Women's Health and Aging Study (WHAS) were used to explore the association of changes in physical function with disability. The WHAS Substudy included 24 weekly assessments of three standard performance tests and self-reported disability in activities of daily living (ADLs) and basic mobility. RESULTS: Using random-effects models, we found small but significant (ps <.01) changes in ADL and mobility disability during weekly follow-up. Baseline performance scores were significantly associated with both ADL and mobility disability (ps <.001), accounting for 27% and 36% of the between-person variability in each type of disability, respectively. After adjustment for baseline scores, change in performance scores was significantly associated with ADL disability (beta = 0.08, p <.01) and mobility disability (beta = 0.12, p <.001), but accounted only for a small proportion (<10%) of the variability in the rate of change in disability outcomes. There was no evidence for an additional effect on either type of disability because of having a single episode of a higher or lower than usual performance score, or because of periods of at least 4 consecutive higher or lower than usual performance test scores. DISCUSSION: Basic physical functions account for a substantial proportion of the heterogeneity in ADL and mobility disability among older disabled women, but have a relatively small impact on short-term changes in either type of disability. Effective prevention of disability may require attention to a wider array of risk factors than just limitations in basic physical functions.

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PubMed2002

Combining complete multivariate outcomes with incomplete covariate information: a latent class approach.

This work was motivated by the need to combine outcome information from a reference population with risk factor information from a screened subpopulation in a setting where the analytic goal was to study the association between risk factors and multiple binary outcomes. To achieve such an analytic goal, this article proposes a two-stage latent class procedure that first summarizes the commonalities among outcomes using a reference population sample, then analyzes the association between outcomes and risk factors. It develops a pseudo-maximum likelihood approach to estimating model parameters. The performance of the proposed method is evaluated in a simulation study and in an illustrative analysis of data from the Women's Health and Aging Study, a recent investigation of the causes and course of disability in older women. Combining information in the proposed way is found to improve both accuracy and precision in summarizing multiple categorical outcomes, which effectively diminishes ambiguity and bias in making risk factor inferences.

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PubMed2002

Grating visual acuity using the preferential-looking method in elderly nursing home residents.

PURPOSE: To assess the performance of two approaches to visual acuity testing in a group of nursing home residents with cognitive impairment. The study was a cross-sectional comparison of the effectiveness of two tests of visual acuity. METHODS: Nursing home residents participating in a clinical trial were tested with both recognition acuity charts and grating acuity cards (Teller) by masked observers. RESULTS: Of the nursing home residents (n = 656) who participated in the study, 86% could respond to visual acuity testing in at least one eye. Eighty-four percent were testable using Teller cards versus 73% who were testable by Early-Treatment Diabetic Retinopathy Study (ETDRS) charts or Lea symbol charts. Forty-one percent of individuals with MiniMental Status Examination (MMSE) scores lower than 10 were testable by recognition acuity, whereas 61% were testable with grating acuity cards. Grating acuity correlated well with recognition acuity (R = 0.79; 95% CI, 0.75-0.98, intraclass correlation coefficient [ICC]). The correlation was slightly lower in individuals with decreased MMSE scores. Although grating acuity was one line better than recognition acuity on average and median acuities were the same, 24% of individuals had results that differed by three or more lines. CONCLUSIONS: Teller acuity cards can effectively test the vision in cognitively impaired individuals who are not testable by conventional means. Grating acuity results correlated well with those of recognition acuity, although differences of three or more lines were not uncommon. Wider use of grating acuity testing allows a more complete assessment of visual function in the cognitively impaired elderly.

Aged↗