Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Caffrey C[original query] |
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End-of-life care planning and bereavement practices among adult day services centers, 2018
Lendon JP , Caffrey C , Lau DT . Am J Hosp Palliat Care 2024 41 (3) 262-269 Introduction: This study describes the end-of-life (EOL) care planning and bereavement practices among adult day services centers (ADSC) when an ADSC participant is dying or has died. Methods: Data are from the 2018 National Study of Long-term Care Providers' biennial survey of ADSCs. Respondents were asked about the following 4 practices: 1) honoring the deceased in some public way in this center; 2) offering bereavement services to staff and participants; 3) documenting in the care plan what is important to the individual at the end of life (EOL), such as the presence of family or religious or cultural practices; and 4) discussing spiritual needs at care planning conferences. ADSC characteristics included US Census region, metropolitan statistical area status, Medicaid authorization, electronic health records (EHR) use, for-profit status, employment of aides, services provision, and model type. Results: About 50% to 30% of ADSCs offered the EOL care planning or bereavement services. Honoring the deceased was the most common practice (53%), followed by bereavement services (37%), discussing spiritual needs (29%), and documenting what is important at EOL (28%). Fewer ADSCs in the West had EOL practices relative to the other regions. The EOL planning and bereavement practices were offered more often in ADSCs that used EHRs, accepted Medicaid, employed an aide, provided nursing, hospice, and palliative care services, and were categorized as medical models, compared with ADSCs without these characteristics. Conclusion: These results highlight the importance of understanding how ADSCs provide EOL and bereavement care to participants who are near EOL. |
A Million Persons, A Million Dreams: A Vision For A National Center Of Radiation Epidemiology And Biology
Boice JD Jr , Quinn B , Al-Nabulsi I , Ansari A , Blake PK , Blattnig SR , Caffrey EA , Cohen SS , Golden AP , Held KD , Jokisch DW , Leggett RW , Mumma MT , Samuels C , Till JE , Tolmachev SY , Yoder RC , Zhou JY , Dauer LT . Int J Radiat Biol 2021 98 (4) 1-50 BACKGROUND: Epidemiologic studies of radiation-exposed populations form the basis for human safety standards. They also help shape public health policy and evidence-based health practices by identifying and quantifying health risks of exposure in defined populations. For more than a century, epidemiologists have studied the consequences of radiation exposures, yet the health effects of low levels delivered at a low-dose rate remain equivocal. MATERIALS AND METHODS: The Million Person Study (MPS) of U.S. Radiation Workers and Veterans was designed to examine health effects following chronic exposures in contrast with brief exposures as experienced by the Japanese atomic bomb survivors. Radiation associations for rare cancers, intakes of radionuclides, and differences between men and women are being evaluated, as well as noncancers such as cardiovascular disease and conditions such as dementia and cognitive function. The first international symposium, held November 6, 2020, provided a broad overview of the MPS. Representatives from four U.S. government agencies addressed the importance of this research for their respective missions: U.S. Department of Energy (DOE), the Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense (DOD), and the National Aeronautical Space Agency (NASA). The major components of the MPS were discussed and recent findings summarized. The importance of radiation dosimetry, an essential feature of each MPS investigation, was emphasized. RESULTS: The seven components of the MPS are DOE workers, nuclear weapons test participants, nuclear power plant workers, industrial radiographers, medical radiation workers, nuclear submariners, other U.S. Navy personnel, and radium dial painters. The MPS cohorts include tens of thousands of workers with elevated intakes of alpha particle emitters for which organ-specific doses are determined. Findings to date for chronic radiation exposure suggest that leukemia risk is lower than after acute exposure; lung cancer risk is much lower and there is little difference in risks between men and women; an increase in ischemic heart disease is yet to be seen; esophageal cancer is frequently elevated but not myelodysplastic syndrome; and Parkinson's disease may be associated with radiation exposure. CONCLUSIONS: The MPS has provided provocative insights into the possible range of health effects following low-level chronic radiation exposure. When the 34 MPS cohorts are completed and combined, a powerful evaluation of radiation-effects will be possible. This final article in the MPS special issue summarizes the findings to date and the possibilities for the future. A National Center for Radiation Epidemiology and Biology is envisioned. |
Advance directives state requirements, center practices, and participant prevalence in adult day services centers: Findings from the 2016 National Study of Long-Term Care Providers
Lendon JP , Caffrey C , Lau DT . J Gerontol B Psychol Sci Soc Sci 2020 76 (8) 1673-1678 OBJECTIVES: Adult day service centers (ADSCs) may serve as an entree to advance care planning. This study examined state requirements for ADSCs to provide advance directives (AD) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs. METHODS: Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted. RESULTS: Nine states had a requirement to provide AD information. 80.8% of ADSCs provided AD information. 41.3% of participants had documented ADs. There were significant associations between state requirement, awareness, and providing information with AD prevalence. State requirement was mediated by awareness. DISCUSSION: This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements. |
Relationships between residential care community characteristics and overnight hospital stays and readmissions: Results from the National Study of Long-Term Care Providers
Caffrey C , Harris-Kojetin L , Rome V , Schwartz L . Seniors Hous Care J 2018 26 (1) 38-49 The Problem: Hospitalizations and subsequent readmissions can produce significant challenges when trying to reduce costs and improve quality of care. This study describes hospitalizations and readmissions using residential care community data from the 2012 National Study of Long-Term Care Providers. The Resolution: About 61.0% of residential care communities had hospitalizations, and among these communities, 39.3% had readmissions. Residential care communities in the Northeast were more likely to have had hospitalizations and readmissions. Residential care communities located in a continuing care retirement community (CCRC) had a lower likelihood of hospitalizations, and communities that provided therapeutic services had a lower likelihood of readmissions. Tips for Success: An association with a CCRC and provision of therapeutic services were found to be protective against hospitalizations and readmissions, respectively. |
Characteristics of residential care communities that use electronic health records
Park-Lee E , Rome V , Caffrey C . Am J Manag Care 2015 21 (12) e669-76 OBJECTIVES: Residential care communities' (RCCs) use of electronic health records (EHRs) has the potential to improve communication and facilitate care coordination. This study describes the use of, and examines characteristics associated with, any type of EHR system among RCCs in the United States, nationally and by Census division. STUDY DESIGN: This study examined organizational and geographic characteristics, as well as resident case-mix in association with the use of EHRs among RCCs. METHODS: Data from the 2012 National Study of Long-Term Care Providers were used for the analyses. Of 4694 sampled RCCs that completed the questionnaire, 3987 cases with complete data were included in the study. RESULTS: About 20.2% of RCCs used any type of EHR system and 3.1% used EHRs that had 6 selected computerized capabilities to meet this study's definition for a basic EHR system. Compared with the national rate of 20.2%, a higher percentage of RCCs in the following Census divisions used some type of an EHR system: New England (23.2%), East North Central (26.3%), and West North Central (32.9%). Larger size, being chain affiliated, owned by other organizations or part of a continuing care retirement community, and geographic location were independently associated with the use of any EHRs among RCCs. CONCLUSIONS: As RCCs serve increasingly less healthy and more disabled residents, improved communication and effective care coordination among RCC staff and across different care settings are critical. The estimates presented in this study can be used to establish a baseline for monitoring trends in EHR use among RCCs. |
A cysteine protease inhibitor rescues mice from a lethal cryptosporidium parvum infection
Ndao M , Nath-Chowdhury M , Sajid M , Marcus V , Mashiyama ST , Sakanari J , Chow E , Mackey Z , Land KM , Jacobson MP , Kalyanaraman C , McKerrow JH , Arrowood MJ , Caffrey CR . Antimicrob Agents Chemother 2013 57 (12) 6063-73 Cryptosporidiosis, caused by the protozoan parasite Cryptosporidium parvum, can stunt infant growth and can be lethal in immunocompromised individuals. The most widely used drugs for treating cryptosporidiosis are nitazoxanide and paromomycin, although both exhibit limited efficacy. To investigate an alternative approach to therapy, we demonstrate that the clan CA cysteine protease inhibitor N-methyl piperazine-Phe-homoPhe-vinylsulfone phenyl (K11777) inhibits C. parvum growth in mammalian cell lines in a concentration-dependent manner. Further, using the C57BL/6 gamma interferon receptor knockout (IFN-gammaR-KO) mouse model, which is highly susceptible to C. parvum, oral or intraperitoneal treatment with K11777 for 10 days rescued mice from otherwise lethal infections. Histologic examination of untreated mice showed intestinal inflammation, villous blunting, and abundant intracellular parasite stages. In contrast, K11777-treated mice (210 mg/kg of body weight/day) showed only minimal inflammation and no epithelial changes. Three putative protease targets (termed cryptopains 1 to 3, or CpaCATL-1, -2, and -3) were identified in the C. parvum genome, but only two are transcribed in infected mammals. A homology model predicted that K11777 would bind to cryptopain 1. Recombinant enzymatically active cryptopain 1 was successfully targeted by K11777 in a competition assay with a labeled active-site-directed probe. K11777 exhibited no toxicity in vitro and in vivo, and surviving animals remained free of parasites 3 weeks after treatment. The discovery that a cysteine protease inhibitor provides potent anticryptosporidial activity in an animal model of infection encourages the investigation and development of this biocide class as a new, and urgently needed, chemotherapy for cryptosporidiosis. |
Trends in length of hospice care From 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys
Sengupta M , Park-Lee E , Valverde R , Caffrey C , Jones A . Am J Hosp Palliat Care 2013 31 (4) 356-64 Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year. |
Oldest old long-term care recipients: findings from the National Center for Health Statistics’ long-term care surveys
Park-Lee E , Sengupta M , Bercovitz A , Caffrey C . Res Aging 2013 35 (3) 296-321 The purpose of this study was to examine socio-demographic and health characteristics of the oldest old receiving services from three types of long term care (LTC) providers. About 45% of nursing home residents in 2004 and 22% of home health care patients and 38% of discharged hospice care patients in 2007 were 85 years and older. The oldest old across the three LTC settings were predominantly White and women. More than two thirds of oldest old nursing home residents, home health care patients, and discharged hospice care patients needed assistance in performing three or more activities of daily living (ADLs) and were bladder incontinent. Hypertension and heart disease were the two most common chronic health conditions that the oldest old LTC recipients had across the care settings. Results provide a baseline that can be used to make comparisons with other new and emerging LTC providers like residential care and home care. |
Schistosomiasis: from drug deployment to drug development
Caffrey CR , Secor WE . Curr Opin Infect Dis 2011 24 (5) 410-7 PURPOSE OF REVIEW: Schistosomiasis is a chronic and morbid disease that affects hundreds of millions of the poorest individuals in (sub)tropical regions, particularly sub-Saharan Africa. Just one drug, praziquantel (PZQ), is available. As discussed, efforts to expand mass drug administration programs may accelerate the emergence of resistance. In addition, PZQ's peculiar pharmacological profile and undefined mechanism of action(s) complicate discriminating incomplete efficacy from true resistance. Accordingly, and in spite of the challenges associated with developing new antischistosomals as discussed herein, alternatives to PZQ should be identified. Various strategies to do this are highlighted here. RECENT FINDINGS: The last 2 years have witnessed more engagement of the necessary infrastructure combined with the application of the latest strategies and technologies to facilitate antischistosomal drug discovery. Preclinical and clinical evaluation of new chemistries has benefited from various consortia and institutions that underwrite drug development for antiparasitics in general. Drug repositioning, target-based drug design, improved automation for compound screening, genomics and functional genomics are just some of the tools now being applied to identify possible new drugs and drug targets. SUMMARY: The new momentum toward the discovery of alternatives to PZQ is encouraging but needs to be sustained by a stronger advocacy for drug development, in addition to drug deployment. |
Metabolic syndrome, testosterone, and cardiovascular mortality in men
Lin JW , Lee JK , Wu CK , Caffrey JL , Chang MH , Hwang JJ , Dowling N , Lin YS . J Sex Med 2011 8 (8) 2350-60 INTRODUCTION: Interactions among testosterone, metabolic syndrome (MetS), and mortality risk in men remain to be elucidated. AIM: To examine relationships among testosterone, MetS, and cardiovascular mortality risk in U.S. men, middle-aged and older. METHODS: The analysis included the men aged 40 years and above in Phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey (NHANES III). Serum testosterone and sex hormone binding globulin were measured, and free testosterone and bioavailable testosterone were calculated. MetS was determined according to the Adult Treatment Panel III (ATP-III) criteria. MAIN OUTCOME MEASURES: Cardiovascular and other causes of mortality were obtained from the NHANES III-linked follow-up file through December 31, 2006. Multivariate Cox regression models were applied to assess associations of interest. RESULTS: Of 596 men included in the analysis, 187 men were found to have MetS. During a median follow-up of 15.6 years, 97 men died of cardiovascular causes (cardiovascular mortality rate: 9.84 and 5.77 per 1,000 person-years for those with and without MetS, respectively). Higher calculated bioavailable testosterone (CBT) was associated with a lower odds of MetS (odds ratio: 0.80 for each ng/mL, 95% confidence interval [CI]: 0.76-0.84, P < 0.001) and lower risk of cardiovascular mortality (hazard ratios [HRs]: 0.72 for each log ng/mL, 95% CI: 0.54-0.96, P = 0.03) in subjects with MetS. The influence of CBT was not observed in those without MetS (HR: 0.84 for each log ng/mL, 95% CI: 0.68-1.04, P = 0.10). CONCLUSIONS: The combination of lower bioavailable testosterone and ATP-III-defined MetS is associated with an increased cardiovascular mortality in the men aged 40 years and above. |
Home health care and discharged hospice care patients: United States, 2000 and 2007
Caffrey C , Sengupta M , Moss A , Harris-Kojetin L , Valverde R . Natl Health Stat Report 2011 (38) 1-27 OBJECTIVES: This report presents national estimates on home health care patients and discharged hospice care patients. Information on characteristics, length of service, medical diagnoses, functional limitations, service use, advance care planning, and emergent and hospital care use are presented for home health care patients and hospice care discharges. A comparison of selected characteristics for 2000 and 2007 is also provided to highlight changes. METHODS: Estimates are based on data collected on agencies from the 2000 and 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are derived from data collected during interviews with administrators and staff designated by the administrators. RESULTS: Each day in 2007, there were an estimated 1,459,900 home health care patients. They were predominantly aged 65 years or over, female, and white. Their mean length of service was 315 days, and their most common primary diagnosis at admission was diabetes mellitus. About one-fourth of them had advance care planning and one-fifth had at least one overnight hospital stay since admission to the home health care agency. In 2007, there were 1,045,100 discharged hospice care patients. The majority of discharged patients were aged 65 or over, female, and white, and most were discharged deceased. Their mean length of service was 65 days, and the most common primary diagnosis at admission was malignant neoplasm. Most of them had advance care planning, and about one-fourth had three or more types of advance care planning instruments. |
Renal-related biomarkers and long-term mortality in the US subjects with different coronary risks
Wu CK , Chang MH , Lin JW , Caffrey JL , Lin YS . Atherosclerosis 2011 216 (1) 226-36 OBJECTIVE: The objective was to evaluate the association of a panel of renal biomarkers with long-term mortalities. METHODS: Participants in the Third National Health and Nutrition Examination Survey (NHANES III) aged 35 years and above were included and Framingham risk scores were calculated. Renal-related biomarkers, including creatinine-based estimated glomerular filtration rate (eGFR), cystatin C, uric acid, C-reactive protein (CRP), fibrinogen, urinary cadmium, albuminuria, homocysteine, and vitamin D were tested by Cox-regression model for their association with all-cause, cardiovascular (CV), and non-CV mortality obtained from the 2006 NHANES III-linked follow-up data, stratified by sex and Framingham risk. RESULTS: In the 4873 men and 5372 women, 36.3%, 28.1%, and 35.6% of men and 67.2%, 25.8%, and 7.0% of women were classified into low-, intermediate-, and high coronary risk groups. With an average follow-up of 13.2 years, a total of 3632 deaths and 1657 CV deaths were recorded. Albuminuria was associated with all-cause mortality in both sexes across coronary risk groups. Creatinine-based eGFR provided additional differential capacity only in the women with intermediate-to-high coronary risk. Cystatin C was associated with all-cause mortality in the men with intermediate-to-high coronary risk and with CV mortality in the women with low coronary risk. Urinary cadmium was positively related to non-CV mortality. High vitamin D was protective against cardiovascular mortality in a limited category of men and women. CONCLUSIONS: Albuminuria is associated with long-term all-cause mortalities independent of Framingham risks. Adding the panel of renal biomarkers provides limited advantages for predicting risk when compared to FRS alone. |
Cystatin C and long-term mortality among subjects with normal creatinine-based estimated glomerular filtration rates: NHANES III (Third National Health and Nutrition Examination Survey)
Wu CK , Lin JW , Caffrey JL , Chang MH , Hwang JJ , Lin YS . J Am Coll Cardiol 2010 56 (23) 1930-6 OBJECTIVES: The objective was to test the association of cystatin C (Cys-C) with long-term mortality risk in the subjects with normal creatinine-based estimated glomerular filtration rates (eGFR). BACKGROUND: Cys-C has been proposed as a sensitive indicator of renal dysfunction that is associated with cardiovascular events. The predictive value of Cys-C for mortality risk (both cardiovascular and noncardiovascular) and its utility among persons with normal kidney function remains unclear. METHODS: The analysis included 2,990 subjects over 40 years of age with normal eGFR who participated in NHANES III (Third National Health and Nutrition Examination Survey). Normal eGFR was defined by Modification of Diet in Renal Disease (MDRD) equation ≥60 ml/min/1.73 m(2). Serum Cys-C was categorized as high, medium, or low. In 1 analysis, the high and low groups were the top and bottom 10%, and in the second analysis, they were the upper and lower thirds. All-cause and cause-specific mortality were obtained from the NHANES III-linked follow-up file through December 31, 2006. Multivariate Cox regression models were applied to assess the association of interest. RESULTS: Within an average of 13.7 years follow-up, 488 cardiovascular and 719 noncardiovascular deaths occurred. When the first and last deciles were compared, the relative risks were all increased statistically as follows: all-cause, 4.36 (95% confidence interval [CI]: 2.52 to 7.82); cardiovascular, 7.44 (95% CI: 3.06 to 18.1); cancer, 2.45 (95% CI: 0.85 to 7.04); and noncardiovascular 3.15 (95% CI: 1.53 to 6.49) mortalities. Relative risks all moderated to lower values when the comparisons were expanded to include the upper and lower thirds. Similar associations were still present when Cys-C was modeled on a continuous scale, suggesting a linear relationship between Cys-C and mortality outcomes. CONCLUSIONS: Serum Cys-C is prognostic of long-term mortality in the subjects with relatively normal renal function, independent of MDRD eGFR and albuminuria. |
Sex, menopause, metabolic syndrome, and all-cause and cause-specific mortality--cohort analysis from the Third National Health and Nutrition Examination Survey
Lin JW , Caffrey JL , Chang MH , Lin YS . J Clin Endocrinol Metab 2010 95 (9) 4258-67 OBJECTIVE: This study assessed the mortality risk associated with metabolic syndrome (MetS) for participants from the Third National Health and Nutrition Examination Survey. DESIGN, SETTING AND PATIENTS: The study analyzed mortality data from 1364 men and 1321 women aged 40 yr and older based on their MetS status defined by National Cholesterol Education Program Adult Treatment Panel III. Subjects initially using insulin, oral hypoglycemic, antihypertensive, or lipid-lowering medications were excluded. MAIN OUTCOME MEASURES: All-cause, cardiovascular, cardiac, and noncardiovascular mortality were obtained from the Third National Health and Nutrition Examination Survey-linked mortality follow-up file through December 31, 2000. RESULTS: The prevalence of MetS was 33 and 29% for men and women, respectively. In the male subjects, there was no significant association between MetS and mortality. In the women, MetS was an independent risk factor for all-cause mortality [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.29-2.64, P = 0.001], cardiovascular mortality (HR 1.96, 95% CI 1.21-3.17, P = 0.007), cardiac mortality (HR 1.88, 95% CI 1.15-3.09, P = 0.01), and noncardiovascular mortality (HR 1.80, 95% CI 1.13-2.87, P = 0.01). The HR was stronger when postmenopausal women were analyzed separately and became nonsignificant in the premenopausal cohort. The sex-specific HR remained unchanged, regardless of the MetS criteria used or the inclusion of actively treated subjects. CONCLUSIONS: MetS poses a significant increase in mortality risk through an observation period as long as 12 yr, primarily in postmenopausal women, that is not apparent in men and premenopausal women. Sex is an important effect modifier of all-cause and cause-specific death. |
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