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Laura M Struble,1 Kathleen Potempa,2 Peter A Lichtenberg,3 Raina L Croff,4,5 Alexis Ellis,1 Hiroko H Dodge6 1Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA; 2Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA; 3Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA; 4Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA; 5Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA; 6Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USACorrespondence: Laura M Struble, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building, Room 2150 400NIB, Ann Arbor, MI, 48109-5482, USA, Tel +1 734 615 5750, Fax + 734 936 5525, Email lstruble@umich.eduObjective: This study describes strategies for the recruitment of socially isolated older old Black individuals to participate in the “Internet-based conversational engagement clinical trial (I-CONECT)” (Clinical Trial.gov: NCT02871921) and lessons learned in this critical population segment.Methods: Best practice strategies to recruit the target population included mass mailings, advertisements, and direct community outreach, including the collaboration with a community group created to reach Black individuals interested in research participation. We also made protocol changes to measure recruitment criteria for older old Black adults more accurately and to increase their participation.Results: Descriptive data related to the challenges and successes in recruiting Black participants compared to the White participants is presented. The primary site contacted 17,523 primarily White potential participants and enrolled/randomized 145 White and 2 Asian/mixed race participants (0.8%). The Midwest site contacted 12,141 Black potential participants and enrolled/randomized 39 (0.3%) participants.Discussion: While best practices were employed, several factors complicated recruitment, including the need to adjust recruitment criteria, navigate regional regulations, and respect diverse community preferences.Conclusion: Older old African Americans are reachable and willing to participate in research when considering their beliefs and practices, influenced by their community and experience.Keywords: engagement, minority, outreach, age, enrollment, strategies, community

There is a shortage of adequate screening instruments for dementia in poorly educated populations and non-English-speaking groups. An epidemiological survey was conducted in a population-based, largely illiterate, sample of 5,126 individuals aged 55 and older in 28 villages in the rural community of Ballabgarh in northern India. All participants were administered a general mental status test, the Hindi Mental State Examination (HMSE), and a brief battery of neuropsychological tests. Their informants answered a questionnaire assessing functional ability, the Everyday Abilities Scale for India (EASI). Six hundred thirty-two participants underwent clinical diagnostic evaluation for dementia. We investigated whether the sensitivity, specificity, and predictive value for dementia of the mental status test could be improved by the addition of the brief neuropsychological test battery or the functional questionnaire, comparing the instruments alone and in combination. In participants who could be tested cognitively, the HMSE, the neuropsychological battery, and EASI had sensitivities of 81.3%, 81.3%, and 62.5%, respectively, with specificities of 60.2%, 74.5%, and 89.7%, respectively. The combination of all three was 93.8% sensitive and 41.8% specific. The sensitivity of the HMSE alone was nonsignificantly improved by the addition of either the EASI or the neuropsychological battery, whereas its specificity was significantly decreased by either addition. An advantage of the EASI was that it could also be administered to informants of subjects who were cognitively untestable. In this largely illiterate community, with a low prevalence of dementia, the combination of cognitive tests and a functional ability questionnaire had substantial value for population screening. [ABSTRACT FROM AUTHOR]

Assesses the importance of consumer involvement in hospital advertising. Impact of advertising on health care provider; Factors influencing delivery of advertising messages by physicians; Role of physicians in the advertising program of hospital.

Examines the importance attached to specific incentives by physicians in making an affiliation decision and health care administrators. Differences in importance ratings by different types of physicians; Development of different compensation packages to appeal to segments of physicians.

To measure depressive symptomatology in a largely illiterate elderly population in India, using a new Hindi version of the Geriatric Depression Scale (GDS-H), and to examine its distribution and associations with age, gender, literacy, cognitive impairment and functional impairment. A Hindi version of the Geriatric Depression Scale was developed and administered to participants along with measures of demographic characteristics, cognitive functioning and functional ability. The rural community of Ballabgarh in northern India. A community sample of 1554 mostly illiterate Hindi-speaking residents of Ballabgarh aged 55+. The Hindi version of the Geriatric Depression Scale (GDS-H); the Hindi Mental State Exam (HMSE); the Everyday Abilities Scale for India (EASI); age, gender and literacy. The GDS-H had high internal consistency and a factor structure comparable to the original English language version. The overall distribution of scores was higher than reported from other populations. Greater numbers of depressive symptoms, as measured by higher scores on the GDS-H, were associated with older age and illiteracy. Among the illiterate, there was no gender difference while among the literate, higher GDS-H scores were found among women. Cognitive impairment and functional disability were independently associated with higher scores on the GDS-H after adjustment for age, gender and literacy. A reliable and valid Hindi version of the GDS has been developed. Depressive symptoms as measured by the GDS-H were prominent in this elderly illiterate northern Indian population and strongly associated with both cognitive and functional impairment. [ABSTRACT FROM AUTHOR]

Background: Survey rates are known to decline with age. Survey results can be affected by response bias if nonresponders are more, or less, likely than participants to suffer from the condition being studied. For instance, it is possible that older adults with dementia would be less likely to participate in a study of dementing disorders.Methods: A random sample of a rural U.S. population aged 65+ years yielded 1,422 participants and 912 refusers in addition to others who were ineligible, inaccessible, or untestable. Participants and refusers were compared on age, sex, 5-year mortality, and causes of death suggestive of dementia as listed on death certificates.Results: Compared to participants, refusers were significantly older and more likely to be women, with mortality similar to that of participants at approximately 5-year follow-up. Death certificate data revealed no significant differences in reported causes of death indicating or suggesting dementia.Conclusions: In this population, those who refused to participate in a dementia survey were not more likely to be ill or demented than those who did participate. [ABSTRACT FROM AUTHOR]

Background: Selection methods vary greatly in ease and cost-effectiveness. The effects of selection factors associated with subjects' recruitment into studies can introduce bias and seriously limit the generalizability of results.Methods: For an epidemiologic study, we recruited an age-stratified random sample of 1,422 community-dwelling individuals aged 65+ years from the voter registration lists in a rural area of southwestern Pennsylvania. The first 1,366 of these were accrued through intensive recruitment efforts; the last 56 of them responded to a single mailing. To increase sample size for future risk factor analyses, we also recruited by direct advertisement a sample of 259 volunteers from the same area. The three groups were compared on selected baseline characteristics and subsequent mortality.Results: The two subgroups of the random sample were not significantly different on any of the variables we examined. Compared to the random sample, in cross-sectional analyses, volunteers were significantly more likely to be women, more educated, and less likely to have used several health and human services. Volunteers also had higher cognitive test scores and Instrumental Activities of Daily Living (IADL) ability. Over 6-8 years (10,861 person-years) of follow-up, volunteers had significantly lower mortality rates than randomly selected subjects.Conclusions: Health-related studies with populations composed partly or entirely of volunteers should take potential volunteer bias into account when analyzing and interpreting data. [ABSTRACT FROM AUTHOR]

Objective: To investigate mitral regurgitation occurring early in the course of acute myocardial infarction with respect to its incidence, the impact of infarct size and location, the accuracy of clinical detection, the contribution of global and regional left ventricular performance, and its influence on prognosis.Design: Prospective observational study derived from patients entering Phase I of the Thrombolysis in Myocardial Infarction (TIMI) trial.Setting: Multicenter trial involving 13 university-affiliated medical centers.Patients: A total of 206 patients studied within 7 hours of symptom onset during their first myocardial infarction.Measurements: Contrast left ventriculography was used to document mitral regurgitation.Results: Mitral regurgitation was present in 27 patients (13%). Although the presence of regurgitation correlated with the site of infarction (20 of 27 had anterior infarctions) and the number of akinetic chords, it was not statistically related to the peak creatine kinase value or to left ventricular chamber size or filling pressure. A murmur of mitral regurgitation was heard in only 2 patients (1 incorrectly). The presence of early mitral regurgitation predicted cardiovascular mortality at 1 year by univariate (relative risk, 12.2; 95% Cl, 3.5 to 42; P less than 0.0001) and multivariate (relative risk, 7.5; Cl, 2.0 to 28.6; P = 0.0008) analyses.Conclusions: Mitral regurgitation in early myocardial infarction is generally clinically "silent," is more common in anterior infarction, is associated with regional dysfunction but not early ventricular dilation or peak enzyme release, and is an important predictor of cardiovascular mortality. [ABSTRACT FROM AUTHOR]

The relationship between regional and global left ventricular (LV) function in acute myocardial infarction (MI) was determined from the contrast ventriculograms of 84 patients. Motion was measured at 100 chords perpendicular to a centerline drawn midway between the end-systolic and end-diastolic endocardial contours and expressed in units of standard deviations from normal. Hypokinesis was computed as the mean motion of chords in the part of the infarct artery territory with most depressed function. Function in the noninfarct region was computed as the mean motion of chords in the most contractile part. Hypokinesis correlated poorly (r = 0·47) with the ejection fraction (EF) due to the effect of hyperkinesis or hypokinesis in the noninfarct region. Net abnormality, the algebraic sum of motion abnormalities in the infarct and noninfarct regions, correlated much better with the EF(r = 0·85).The extent to which regional myocardial performance is depressed at the site of acute MI cannot be assessed from the EF due to the influence of function in the noninfarct region. The method presented allows quantitative assessment of regional wall motion in both regions in a manner that allows calculation of their net contributions to global LV function. Assessment of LV dysfunction in acute infarction, or of change in function following infarction, should be performed by measuring regional wall motion. [ABSTRACT FROM PUBLISHER]

A national sample of 532 consumers was assessed on 15 different scenarios that reflect questionable behaviors by consumers. The results indicate that consumers are ethically predisposed as they generally express little tolerance for behavioral transgressions on the part of the customer. Factor analysis identified two latent dimensions for the scenarios: direct economic consequences and indirect economic consequences. Respondents expressed greater intolerance of those actions that comprise the indirect economic consequences factor. One-way analysis of variance identified several instances where age, gender, education, and income were related to specific responses. © 1996 John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

Presents a study which compares the serum uric acid values in a group of normal healthy business executives, who were attending the University of Michigan for a summer course with values in an age-matched general population. Factors that have been considered in the comparison of serum levels between executives and the reference population in Tecumseh, Michigan; Relationship between age and the serum uric acid levels; Influence of body fatness in the value of serum uric acid.

Discusses the functional characteristics of the left ventricle in heart disease. Determination of the normal values for left ventricular volumes and weight; Role of determining pressure-volume data in determining left ventricular volume curves; Details on ventricular hypertrophy in chronic heart disease.