Robert Kaplan

All Publications

• An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods. Contemporary clinical trials Irvin, V., Kile, M. L., Lucas-Woodruff, C., Cude, C., Anderson, L., Baylog, K., Hovell, M. F., Choun, S., Kaplan, R. M. 2024: 107497

  Abstract

  The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water.This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels.The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES.Pre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys.The results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations.NCT05395663.

  View details for DOI 10.1016/j.cct.2024.107497

  View details for PubMedID 38471641

• TEMPORARY REMOVAL: PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria. Seminars in arthritis and rheumatism Gibson, K. A., Kaplan, R. M., Pincus, T., Li, T., Luta, G. 2024: 152361

  View details for DOI 10.1016/j.semarthrit.2024.152361

  View details for PubMedID 38360468

• Examining American attitudes toward vaccination during the COVID-19 pandemic from the perspective of negative and positive rights. Politics and the life sciences : the journal of the Association for Politics and the Life Sciences Koong, A., McDermott, R., Kaplan, R. 2023; 42 (2): 291-305

  Abstract

  We examine the likely acceptance of the COVID-19 vaccine in the period prior to political polarization around vaccine mandates. Two representative cross-sectional surveys of 1,000 respondents were fielded in August and December 2020. The surveys included items about the COVID-19 vaccine and vaccine mandates. Respondents self-identifying as liberal were the least likely to believe the vaccine had undisclosed harmful effects (p< .001), conservatives were the most likely (p < .001), and moderates fell in between. Individuals with a bachelor's degree were less likely to think the vaccine had undisclosed harmful effects than individuals without a bachelor's degree (p < .001), and 60.5% of those individuals did not support a government vaccine mandate. Political ideology was more often strongly associated with avoiding government involvement compared to education level. In summary, both liberal political ideology and higher education were significantly associated with endorsing intended vaccine uptake. We discuss these results in terms of positive versus negative rights.

  View details for DOI 10.1017/pls.2023.17

  View details for PubMedID 37987573

• Review of Evidence Supporting 2022 US Food and Drug Administration Drug Approvals. JAMA network open Kaplan, R. M., Koong, A. J., Irvin, V. 2023; 6 (8): e2327650

  Abstract

  This cross-sectional study examines the design and funding of studies, nd evidence available on ClinicalTrials.gov for drugs approved in 2022.

  View details for DOI 10.1001/jamanetworkopen.2023.27650

  View details for PubMedID 37552481

• The Use of Ontologies to Accelerate the Behavioral Sciences: Promises and Challenges CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE Sharp, C., Kaplan, R. M., Strauman, T. J. 2023

  View details for DOI 10.1177/09637214231183917

  View details for Web of Science ID 001026764200001

• Letter to the editor. Vaccine Fraiman, J., Erviti, J., Jones, M., Greenland, S., Whelan, P., Kaplan, R. M., Doshi, P. 2023

  View details for DOI 10.1016/j.vaccine.2023.06.035

  View details for PubMedID 37331839

  View details for PubMedCentralID PMC10272990

• Explanations for variations in hospital expenditures among four large California counties. BMC health services research Lansdale, A. J., Kaplan, R. M. 2023; 23 (1): 389

  Abstract

  To investigate competing explanations for why Medicare Fee for Service (FFS) and private sector payments lead to hospital cost variations in Californian counties.Ratios of private to Medicare hospital costs were obtained from state-based all-payer claims databases. Demographics were estimated from the U.S. Census Bureau and the California Health Interview Survey. Medicaid and Medicare spending was obtained from Kaiser Family Foundation. Medicare Advantage enrollment was obtained from the California Department of Health Care Services and market consolidation was estimated using the Herfindahl-Hirschman Index (HHI).Per capita costs, demographics, Medicaid and Medicare spending, Medicare Advantage enrollment, and HHI scores were compared for San Francisco (SF), Sacramento, Los Angeles (LA), and San Diego (SD).LA hospitals had the lowest per capita private insurer costs, but the highest Medicare FFS costs. The findings might be explained by a lower HHI for LA, indicating a more competitive market, than SD, SF, and Sacramento.Medicare FFS hospital costs do not provide an accurate representation of health care spending in Californian counties. In more competitive markets, private insurance companies can negotiate lower prices, while oversupply may allow facilities to increase volume in Medicare FFS.

  View details for DOI 10.1186/s12913-023-09390-y

  View details for PubMedID 37087458

  View details for PubMedCentralID PMC10122808

• Depression trial results: A cross-sectional study of ClinicalTrials.gov. Journal of psychiatric research Schmaling, K. B., Kaplan, R. M. 2023; 161: 461-466

  Abstract

  Published clinical trials represent a subsample of the objective information needed to appraise treatments for depression. We characterize the extent of selective and delayed reporting in a systematic review (PROSPERO #CRD42020173606) of depression trial results registered on ClinicalTrials.gov. Inclusion criteria were studies registered on ClinicalTrials.gov with depression as the condition, had enrolled ages 18 and over, were completed between January 1, 2008 and May 1, 2019, and had posted results by February 1, 2022. Cox regression analyses of time to result posting from registration and from study completion included enrollment as a covariate. Among 442 protocols, median result posting occurred over two years after study completion and five years after registration. Among protocols with incomplete results, effect sizes (d or W) were calculated for 134 protocols. Median effect sizes for protocols with incomplete results were small (0.16, 95% CI 0.08, 0.21). For 28% of protocols, observed effects were contrary to the expected direction. Between-group effect size calculations were based on post-treatment data as pre-treatment data were inconsistently provided. Although drug and device trials in the U.S. are required to register on ClinicalTrials.gov, compliance is imperfect, and submissions are not peer reviewed. For depression treatment trials, long intervals between study completion and posting of results are common. Further, investigators often fail to report the results of statistical tests. Failure to post trial results in a timely manner and omission of statistical test reporting may lead to overestimates of treatment effects in systematic literature reviews.

  View details for DOI 10.1016/j.jpsychires.2023.04.004

  View details for PubMedID 37059031

• MOVING BEYOND EFFICACYTRIALSTO REAL WORLD IMPLEMENTATION Wilson, D. K., Kaplan, R. M., Wippold, G. M., Resnicow, K. OXFORD UNIV PRESS INC. 2023: S108

  View details for Web of Science ID 001042977900213

• NOT SO FAST: THE CONSEQUENCES OF PREMATURE IMPLEMENTATION Kaplan, R. M., Schmaling, K. OXFORD UNIV PRESS INC. 2023: S109

  View details for Web of Science ID 001042977900215

• Caring for People With Depression: Costs Among 43 Million Commercially Insured Patients With or Without Comorbid Illnesses. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Glassman, J. R., Jauregui, A., Milstein, A., Kaplan, R. M. 2023

  Abstract

  Depression is a common comorbidity for patients with chronic medical conditions. Although the costs of treating chronic medical illness in combination with depression are believed to be significantly higher than the costs of treating each condition independently, few studies have formally modeled the cost consequences of mental health comorbidity.To estimate the relative magnitude of the independent and synergistic contributions to health care costs from depression diagnosis and other chronic physical health conditions.Cross-sectional, observational study using all individuals >18 years of age in the national Blue Cross Blue Shield (BCBS) Axis claims database (N = 43,872,144) from calendar year 2018. General linear models with and without interaction terms were used to assess the relative magnitude of independent and synergistic contributions to total annual health care costs of depression alone and in combination with coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes (both types 1 and 2), hypertension, and arthritis.The incremental annual cost associated with having a diagnosis of depression was $2,951 compared to $1,986-$6,251 for the other chronic physical conditions. The interaction between depression and chronic conditions accounted for less than one-hundredth of the amount of variation in costs explained by the main effects of depression and each chronic physical condition.The independent increase in total annual health care costs associated with a depression diagnosis was comparable to that of many common physical chronic conditions. This finding underscores the importance of health care service and payment models that acknowledge depression as an equal contributor to overall health care costs. The combination of depression and another chronic condition did not synergistically increase total annual health care costs beyond the increases in costs associated with each condition independently. This finding has implications for simplifying risk adjustment models.

  View details for DOI 10.1093/abm/kaac063

  View details for PubMedID 37001050

• Continuous monitoring of eating and sleeping behaviors in the home environments of older adults: a case study demonstration. Frontiers in public health Narayan, A., Goncharova, M., Goncharov, M., Gostine, A., Shah, N. R., Kaplan, R. M. 2023; 11: 1277714

  Abstract

  Accurate observation of patient functioning is necessary for rigorous clinical research and for improving the quality of patient care. However, clinic or laboratory environments systematically differ from the contexts of everyday life. Further, assessments that are completed in a single institutional session may not be generalizable. Here, we describe a computer vision methodology that measures human functioning continuously in the environments where patients live, sleep, and eat.

  View details for DOI 10.3389/fpubh.2023.1277714

  View details for PubMedID 38283288

  View details for PubMedCentralID PMC10811267

• who is protecting pharma consumers? PERSPECTIVES IN BIOLOGY AND MEDICINE Kaplan, R. M. 2023; 66 (2): 327-343

  View details for DOI 10.1353/pbm.2023.0018

  View details for Web of Science ID 000999299500009

• An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health Needs AMERICAN JOURNAL OF MANAGED CARE Placzek, H. D., Darby, B., Kaplan, R. M., Glassman, J., Garcia-Huynh, M., Bearse, P. 2022; 28 (12): 644-652

  Abstract

  To evaluate changes in health care spending and utilization associated with a telehealth-based care coach-supported and behavioral health (BH) provider referral intervention in the United States.Observational retrospective cohort study with propensity score matching of treated and control groups.Difference-in-differences (DID) analysis was used to calculate per-member per-month (PMPM) savings and changes in utilization in a treated group relative to matched controls over 36 months. The study included 1800 adults with substance use disorder (SUD), anxiety, or depression who were eligible for the intervention. Treated members (n = 900) graduated from the program. Matched control members (n = 900) were eligible but never enrolled. Primary outcomes included all-cause and disease-attributable health care cost and utilization PMPM, categorized by place of service.There were statistically significant reductions in total all-cause medical costs of $485 PMPM (P < .001) and a 66% pre-post reduction in inpatient encounters, with $488 PMPM DID savings for inpatient admissions (P < .001) among the treated cohort compared with the control cohort over 36 months. Conversely, there were statistically significant cost increases ($110 PMPM; P < .001) for all-cause office visits in the treated cohort compared with the control cohort. Similar results were seen in SUD-attributable and BH-attributable costs.Although the results could be affected by unmeasured confounding, they suggest that care coaching interventions that offer BH provider referrals may produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat BH conditions. Rigorous evaluations are needed to confirm these findings.

  View details for DOI 10.37765/ajmc.2022.89274

  View details for Web of Science ID 000899141200001

  View details for PubMedID 36525657

• Service discharges among US Army personnel with selected musculoskeletal and skin conditions: a retrospective cohort study. BMJ open Nelson, D. A., Kaplan, R. M., Weisman, M. H., Kurina, L. M. 2022; 12 (10): e063371

  Abstract

  OBJECTIVES: To determine the probability of discharge from military service among soldiers following an incident diagnosis of ankylosing spondylitis (AS), rheumatoid arthritis (RA), psoriasis or systemic lupus erythematous.METHODS: All soldiers on active duty in the US Army between January 2014 and June 2017 were included in a retrospective cohort analysis. Termination from service was ascertained using personnel records. Diagnostic codes were used to identify incident cases of the four musculoskeletal and skin diseases and, for comparison, diabetes mellitus (DM). Time to discharge was modelled using sex stratified multivariate survival analysis.RESULTS: The analysis included 657417 individuals with a total of 1.2 million person-years of observation. An elevated risk of discharge was observed in association with each of the five chronic conditions studied. The increase in adjusted risk of discharge was highest among soldiers with AS (men, HR=2.5, 95%CI 2.1 to 3.0; women, HR=2.1, 95%CI 1.4 to 3.2) and with DM (men, HR=2.4, 95%CI 2.2 to 2.7; women, HR=2.2, 95%CI 1.8 to 2.5), followed by those with RA (men, HR=1.8, 95%CI 1.5 to 2.2; women, HR=1.8, 95%CI 1.4 to 2.4).CONCLUSIONS: Military discharges are consequential for the service and the service member. The doubling in risk of discharge for those with AS or RA was comparable to that for personnel with DM. Conditions that affect the spine and peripheral joints may often be incompatible with military readiness. Nevertheless, a substantial fraction of service members with these diagnoses continued in service.

  View details for DOI 10.1136/bmjopen-2022-063371

  View details for PubMedID 36241350

• Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults. Vaccine Fraiman, J., Erviti, J., Jones, M., Greenland, S., Whelan, P., Kaplan, R. M., Doshi, P. 2022

  Abstract

  INTRODUCTION: In 2020, prior to COVID-19 vaccine rollout, the Brighton Collaboration created a priority list, endorsed by the World Health Organization, of potential adverse events relevant to COVID-19 vaccines. We adapted the Brighton Collaboration list to evaluate serious adverse events of special interest observed in mRNA COVID-19 vaccine trials.METHODS: Secondary analysis of serious adverse events reported in the placebo-controlled, phase III randomized clinical trials of Pfizer and Moderna mRNA COVID-19 vaccines in adults (NCT04368728 and NCT04470427), focusing analysis on Brighton Collaboration adverse events of special interest.RESULTS: Pfizer and Moderna mRNA COVID-19 vaccines were associated with an excess risk of serious adverse events of special interest of 10.1 and 15.1 per 10,000 vaccinated over placebo baselines of 17.6 and 42.2 (95% CI -0.4 to 20.6 and -3.6 to 33.8), respectively. Combined, the mRNA vaccines were associated with an excess risk of serious adverse events of special interest of 12.5 per 10,000 vaccinated (95% CI 2.1 to 22.9); risk ratio 1.43 (95% CI 1.07 to 1.92). The Pfizer trial exhibited a 36% higher risk of serious adverse events in the vaccine group; risk difference 18.0 per 10,000 vaccinated (95% CI 1.2 to 34.9); risk ratio 1.36 (95% CI 1.02 to 1.83). The Moderna trial exhibited a 6% higher risk of serious adverse events in the vaccine group: risk difference 7.1 per 10,000 (95% CI -23.2 to 37.4); risk ratio 1.06 (95% CI 0.84 to 1.33). Combined, there was a 16% higher risk of serious adverse events in mRNA vaccine recipients: risk difference 13.2 (95% CI -3.2 to 29.6); risk ratio 1.16 (95% CI 0.97 to 1.39).DISCUSSION: The excess risk of serious adverse events found in our study points to the need for formal harm-benefit analyses, particularly those that are stratified according to risk of serious COVID-19 outcomes. These analyses will require public release of participant level datasets.

  View details for DOI 10.1016/j.vaccine.2022.08.036

  View details for PubMedID 36055877

• A Novel Explainability Approach for Technology-Driven Translational Research on Brain Aging. Journal of Alzheimer's disease : JAD Turnbull, A., Kaplan, R., Adeli, E., Lin, F. V. 2022

  Abstract

  Brain aging leads to difficulties in functional independence. Mitigating these difficulties can benefit from technology that predicts, monitors, and modifies brain aging. Translational research prioritizes solutions that can be causally linked to specific pathophysiologies at the same time as demonstrating improvements in impactful real-world outcome measures. This poses a challenge for brain aging technology that needs to address the tension between mechanism-driven precision and clinical relevance. In the current opinion, by synthesizing emerging mechanistic, translational, and clinical research-related frameworks, and our own development of technology-driven brain aging research, we suggest incorporating the appreciation of four desiderata (causality, informativeness, transferability, and fairness) of explainability into early-stage research that designs and tests brain aging technology. We apply a series of work on electrocardiography-based "peripheral" neuroplasticity markers from our work as an illustration of our proposed approach. We believe this novel approach will promote the development and adoption of brain aging technology that links and addresses brain pathophysiology and functional independence in the field of translational research.

  View details for DOI 10.3233/JAD-220441

  View details for PubMedID 35754280

• Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial. JAMA internal medicine Shlipak, M. G., Sheshadri, A., Hsu, F., Chen, S., Jotwani, V., Tranah, G., Fielding, R. A., Liu, C. K., Ix, J., Coca, S. G., LIFE Investigators, Pahor, M., Guralnik, J. M., Leeuwenburgh, C., Caudle, C., Crump, L., Holmes, L., Leeuwenburgh, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Lovato, L., Roberson, W., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W. J., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K. V., Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Berra, K., Yank, V., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Beard, V. E., Tsiroyannis, E. X., Hau, C., Manini, T. M., Anton, S. D., Nayfield, S., Buford, T. W., Marsiske, M., Sandesara, B. D., Knaggs, J. D., Lorow, M. S., Marena, W. C., Korytov, I., Morris, H. L., Fitch, M., Singletary, F. F., Causer, J., Radcliff, K. A., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Glynn, N. W., Lopez, O., Nadkarni, N. K., Williams, K., Newman, M. A., Grove, G., Bonk, J. T., Rushing, J., Kost, P., Ives, D. G., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Wu, K. C., Shepard, D. M., Fennelly, B., Iannone, L. P., Mautner, R., Sweeney Barnett, T., Halpin, S. N., Brennan, M. J., Bugaj, J. A., Zenoni, M. A., Mignosa, B. M., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Vaz Fragoso, C. A., Groessl, E. J., Kaplan, R. M. 2022

  Abstract

  Importance: Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.Objective: To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.Design, Setting, and Participants: This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022.Interventions: Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers.Main Outcomes and Measures: The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y.Results: Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97).Conclusions and Relevance: Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.Trial Registration: ClinicalTrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jamainternmed.2022.1449

  View details for PubMedID 35499834

• THE NEED FOR ADAPTION: A CALL FOR PROMOTING THE VALUE OF BEHAVIORAL SCIENTISTS IN PUBLIC HEALTH CHALLENGES AND POLICIES Sweeney, A., Freedland, K. E., Resnicow, K., Wilson, D. K., Kaplan, R. M. OXFORD UNIV PRESS INC. 2022: S92

  View details for Web of Science ID 000788118600200

• Health-Related Quality of Life Measurement in Public Health. Annual review of public health Kaplan, R. M., Hays, R. D. 2021

  Abstract

  Patient-reported outcomes are recognized as essential for the evaluation of medical and public health interventions. Over the last 50 years, health-related quality of life (HRQoL) research has grown exponentially from 0 to more than 17,000 papers published annually. We provide an overview of generic HRQoL measures used widely in epidemiological studies, health services research, population studies, and randomized clinical trials [e.g., Medical Outcomes Study SF-36 and the Patient-Reported Outcomes Measurement Information System (PROMIS)-29]. In addition, we review methods used for economic analysis and calculation of the quality-adjusted life year (QALY). These include the EQ-5D, the Health Utilities Index (HUI), the self-administered Quality of Well-being Scale (QWB-SA), and the Health and Activities Limitation Index (HALex). Furthermore, we consider hybrid measures such as the SF-6D and the PROMIS-Preference (PROPr). The plethora of HRQoL measures has impeded cumulative science because incomparable measures have been used in different studies. Linking among different measures and consensus on standard HRQoL measurement should now be prioritized. In addition, enabling widespread access to common measures is necessary to accelerate future progress. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  View details for DOI 10.1146/annurev-publhealth-052120-012811

  View details for PubMedID 34882431

• Incidence of Ankylosing Spondylitis Among Male and Female United States Army Personnel. Arthritis care & research Nelson, D. A., Kaplan, R. M., Kurina, L. M., Weisman, M. H. 2021

  Abstract

  OBJECTIVE: Incidence rates of ankylosing spondylitis (AS) among males versus females are poorly understood. Results of prior research have been mixed, including findings of a 3:1 incidence ratio for males vs. females, but increasing AS rates among females.METHODS: We estimated the incidence of AS in a retrospective cohort study of diverse, working-age US military service members during March 2014 - June 2017 (N = 728,556) who underwent clinical practice guideline-directed screening for chronic back pain. Incident AS cases were identified using diagnostic codes from electronic medical and administrative records.RESULTS: In contrast to some prior studies, AS incidence was similar among males and females (incidence rate ratio: 1.16, p = 0.23; adjusted odds ratio [aOR] = 0.79, 95% confidence interval: 0.61 - 1.02; p = 0.072). AS rates increased approximately monotonically with age. Consistent with prior research, the AS incidence rate was greater in the White population than the Black population (aOR = 1.39, 95% CI 1.01 - 1.66, p = 0.04).CONCLUSION: In this study population, the incidence of AS was similar for the sexes. Previous observations of male predominance have typically been derived from clinic populations that are less representative of the US race/ethnicity distribution and based on disease ascertainment tools that may have identified subjects later in their disease course. Our study population also differed in being subject to organized screenings for musculoskeletal complaints. Our findings suggest that sex may not predict AS incidence in the US population.

  View details for DOI 10.1002/acr.24774

  View details for PubMedID 34459565

• Mobilizing the U.S. Military's TRICARE Program for Value-Based Care: A Report From the Defense Health Board. Military medicine Schaettle, P. R., Kaplan, R. S., Lee, V. S., Parkinson, M. D., Gorman, G. H., Browne, M. 2021

  Abstract

  The U.S. Military Health System spends about $50 billion annually to provide care to 9.6 million active duty service members, retirees, and their families through its TRICARE health plans. TRICARE follows the predominant payment model in the USA-fee-for-service-although the Department of Defense (DoD) and Congress encourage and mandate a move toward alternative payment models-mainly, fee-for-value. For the next TRICARE contracts which will begin in 2023, the DoD asked its health-focused federal advisory committee, the Defense Health Board (DHB), to recommend how best to assess and prioritize leading value-based healthcare initiatives identified from private, public, and employer-based health plans. The November 2020 report, 'Modernization of the TRICARE Benefit', specifies a rubric to evaluate these value-based care initiatives not only in traditional measures of effectiveness but also in terms of the Defense Health Agency's Quadruple Aim with its focus on readiness. The goal of TRICARE's move toward value-based care is to leverage its size and focus on prevention of disease and injury to maintain the readiness of the U.S. Armed Forces in addition to delivering great outcomes and value to the DoD's nearly 10 million beneficiaries. The DHB emphasizes that TRICARE's size and focus on providing quality care at lower cost will incentivize providers to participate in the shift toward value-based care despite the potential challenges in transitioning to this system. This shift also aims to motivate other large government and private payors to accelerate the adoption of value-based care through TRICARE's example.

  View details for DOI 10.1093/milmed/usab271

  View details for PubMedID 34244754

• Transparency of results reporting for depression treatment studies in ClinicalTrials.gov: a cross-sectional study. BMJ evidence-based medicine Schmaling, K. B., Landon, H. S., Nguyen, T. B., Kaplan, R. M. 2021

  Abstract

  OBJECTIVES: Depression affects an estimated 7% of the adult population at an estimated cost of over US$200billion/year in the USA. Complete, transparent reporting of clinical trial data facilitates valid estimates of treatment efficacy. In the USA, ClinicalTrials.gov increases transparency through mandatory prospective trial registration and outcome reporting. We examined characteristics of the transparent reporting of depression treatment studies registered in ClinicalTrials.gov.DESIGN: Cross sectional.SETTING AND PARTICIPANTS: US-based studies identified in a search of ClinicalTrials.gov with depression as the condition, enrolling ages 18 and older, and completed between 1 January 2008 and 1 May 2019.INTERVENTIONS: All interventions were included.MAIN OUTCOMES AND MEASURES: The main outcome was whether any results were reported prior to 1 May 2020. Data were extracted regarding inclusion and exclusion criteria, publications related to the study and specification of hypotheses.RESULTS: 725 studies involving 156634 patients met inclusion criteria. 416 (57.4%) of the studies posted some results. However, statistical test results were not included in 230 studies (55.3%). Most studies had data that could have been analysed and reported. Compared with studies without results, studies with any results were more likely to have hypotheses, include drug treatment conditions, and to have publications related to the study.CONCLUSIONS: Required study registration does not always result in transparent outcome reporting. Better compliance with mandated reporting and improved reporting standards would facilitate a more comprehensive representation of depression treatment research.

  View details for DOI 10.1136/bmjebm-2020-111641

  View details for PubMedID 33785513

• Influence of a COVID-19 vaccine's effectiveness and safety profile on vaccination acceptance. Proceedings of the National Academy of Sciences of the United States of America Kaplan, R. M., Milstein, A. 2021; 118 (10)

  Abstract

  Although a safe and effective vaccine holds the greatest promise for resolving the COVID-19 pandemic, hesitancy to accept vaccines remains common. To explore vaccine acceptance decisions, we conducted a national survey of 1,000 people from all US states in August of 2020 and a replication in December of 2020. Using a 3 * 3 * 3 factorial experimental design, we estimated the impact of three factors: probability of 1) protection against COVID-19, 2) minor side effects, and 3) a serious adverse reactions. The outcome was respondents' reported likelihood of receiving a vaccine for the coronavirus. Probability of vaccine efficacy (50%, 70%, or 90%) had the largest effect among the three factors. The probability of minor side effects (50%, 75%, 90%) including fever and sore arm, did not significantly influence likelihood of receiving the vaccine. The chances of a serious adverse reaction, such as temporary or permanent paralysis, had a small but significant effect. A serious adverse reaction rate of 1/100,000 was more likely to discourage vaccine use in comparison to rates of 1/million or 1/100 million. All interactions between the factors were nonsignificant. A replication following the announcement that vaccines were 95% effective showed small, but significant increases in the likelihood of taking a vaccine. The main effects and interactions in the model remained unchanged. Expected benefit was more influential in respondents' decision making than expected side effects. The absence of interaction effects suggests that respondents consider the side effects and benefits independently.

  View details for DOI 10.1073/pnas.2021726118

  View details for PubMedID 33619178

• Covid-19 pandemic lessons: uncritical communication of test results can induce more harm than benefit and raises questions on standardized quality criteria for communication and liability. Health psychology and behavioral medicine Porzsolt, F., Pfuhl, G., Kaplan, R. M., Eisemann, M. 2021; 9 (1): 818-829

  Abstract

  The COVID-19 pandemic is characterized by both health and economic risks. A 'safety loop' model postulates risk-related decisions are not based on objective and measurable risks but on the subjective perception of those risks. We here illustrate a quantification of the difference between objective and subjective risks.The objective risks (or chances) can be obtained from traditional 2 × 2 tables by calculating the positive (+LR) and negative (-LR) likelihood ratios. The subjective perception of objective risks is calculated from the same 2 × 2 tables by exchanging the X- and Y-axes. The traditional 2 × 2 table starts with the hypothesis, uses a test and a gold standard to confirm or exclude the investigated condition. The 2 × 2 table with inverted axes starts with the communication of a test result and presumes that the communication of bad news (whether right or false) will induce 'Perceived Anxiety' while good news will induce 'Perceived Safety'. Two different functions (confirmation and exclusion) of both perceptions (Perceived Anxiety and Safety) can be quantified with those calculations.The analysis of six published tests and of one incompletely reported test on COVID-19 polymerase chain reactions (completed by four assumptions on high and low sensitivities and specificities) demonstrated that none of these tests induces 'Perceived Safety'. Eight of the ten tests confirmed the induction of 'Perceived Anxiety' with + LRs (range 3.1-5900). In two of these eight tests, a -LR (0.25 and 0.004) excluded the induction of 'Perceived Safety'.Communication of test results caused perceived anxiety but not perceived safety in 80% of the investigated tests. Medical tests - whether true or false - generate strong psychological messages. In the case of COVID-19 tests may induce more perceived anxiety than safety. Risk communication has to balance objective and subjective risks.

  View details for DOI 10.1080/21642850.2021.1979407

  View details for PubMedID 34567838

  View details for PubMedCentralID PMC8462930

• The terminology conflict on efficacy and effectiveness in healthcare. Journal of comparative effectiveness research Porzsolt, F., Wiedemann, F., Phlippen, M., Weiss, C., Weiss, M., Schmaling, K., Kaplan, R. M. 2020

  Abstract

  Designers and architects created the rule 'form follows function (FFF)' for their own profession. Our paper demonstrates thatthis FFF rule applies equally well to the designers of clinical studies. Four examples present are as follows: disregarding this FFF rule causes an inconsistent terminology to differentiate between efficacy and effectiveness, inconsistent differentiation of efficacy and effectiveness interferes with the consistent interpretation of the results of clinical studies, inconsistent interpretation of clinical studies results in an unexpectedly variance of recommendations in clinical guidelines and the fusion of the FFF designer rule and of the demands of Cochrane and Bradford Hill ('can it work?', 'does it work?' and 'is it worth it?') avoids the terminology problem and its misleading consequences. This strategy is presented.

  View details for DOI 10.2217/cer-2020-0149

  View details for PubMedID 33314965

• Efficacy and effectiveness studies of depression are not well-differentiated in the literature: a systematic review. BMJ evidence-based medicine Schmaling, K., Kaplan, R. M., Porzsolt, F. 2020

  Abstract

  BACKGROUND: In the literature on the treatment of depression, efficacy and effectiveness research have different purposes and should apply different research methodologies.OBJECTIVE: The purpose of the study was to review characteristics of depression treatment studies identified using efficacy or effectiveness search terms. We considered subject inclusion and exclusion criteria; numbers of subjects enrolled and the proportion in the primary analyses; inclusion of a Consolidated Standards of Reporting Trials (CONSORT) flow diagram; use of random assignment; use of placebo control conditions; lengths of treatment and follow-up; primary outcome variable; trial registration; journal impact factor.STUDY SELECTION: Studies indexed as efficacy AND 'real-world' AND depression or effectiveness AND 'real-world' AND depression in PubMed up to 18 May 2019.FINDINGS: 27 studies met the inclusion criteria: 13 effectiveness studies, 6 efficacy studies and 8 studies indexed as both effectiveness and efficacy. Studies identified as effectiveness, efficacy, or both differed on three outcome measures: the inclusion criteria were lengthier for efficacy than for effectiveness studies; efficacy studies were more likely to have a placebo control condition than effectiveness studies; and the journal impact factor was lower for effectiveness studies than for studies from the efficacy search or studies identified by both searches.CONCLUSIONS: Efficacy and effectiveness research hypothetically use different methodologies, but the efficacy and effectiveness literatures in the treatment of depression were comparable for most of the coded characteristics. The lack of distinguishable characteristics suggests that variably applied terminology may hinder efforts to narrow the gap between research and practice. PROSPERO REGISTRATION NUMBER: #CRD42019136840.

  View details for DOI 10.1136/bmjebm-2020-111337

  View details for PubMedID 32188642

• Questioning the Benefit of Statins for Low-Risk Populations-Medical Misinformation or Scientific Evidence?-Reply JAMA CARDIOLOGY Abramson, J., Kaplan, R. M., Redberg, R. F. 2020; 5 (2): 233

  View details for DOI 10.1001/jamacardio.2019.5123

  View details for Web of Science ID 000526818400020

  View details for PubMedID 31876926

• Association Between HEDIS Performance and Primary Care Physician Age, Group Affiliation, Training, and Participation in ACA Exchanges. Journal of general internal medicine Glassman, J. R., Hopkins, D. S., Bundorf, M. K., Kaplan, R. M., Ragavan, M. V., Glaseroff, A. n., Milstein, A. n. 2020

  Abstract

  There are a limited number of studies investigating the relationship between primary care physician (PCP) characteristics and the quality of care they deliver.To examine the association between PCP performance and physician age, solo versus group affiliation, training, and participation in California's Affordable Care Act (ACA) exchange.Observational study of 2013-2014 data from Healthcare Effectiveness Data and Information Set (HEDIS) measures and select physician characteristics.PCPs in California HMO and PPO practices (n = 5053) with part of their patient panel covered by a large commercial health insurance company.Hemoglobin A1c testing; medical attention nephropathy; appropriate treatment hypertension (ACE/ARB); breast cancer screening; proportion days covered by statins; monitoring ACE/ARBs; monitoring diuretics. A composite performance measure also was constructed.For the average 35- versus 75-year-old PCP, regression-adjusted mean composite relative performance scores were at the 60th versus 47th percentile (89% vs. 86% composite absolute HEDIS scores; p < .001). For group versus solo PCPs, scores were at the 55th versus 50th percentiles (88% vs. 87% composite absolute HEDIS scores; p < .001). The effect of age on performance was greater for group versus solo PCPs. There was no association between scores and participation in ACA exchanges.The associations between population-based care performance measures and PCP age, solo versus group affiliation, training, and participation in ACA exchanges, while statistically significant in some cases, were small. Understanding how to help older PCPs excel equally well in group practice compared with younger PCPs may be a fruitful avenue of future research.

  View details for DOI 10.1007/s11606-020-05642-3

  View details for PubMedID 31974901

• Long-Term Physical Exercise and Mindfulness Practice in an Aging Population. Frontiers in psychology Tang, Y., Fan, Y., Lu, Q., Tan, L., Tang, R., Kaplan, R. M., Pinho, M. C., Thomas, B. P., Chen, K., Friston, K. J., Reiman, E. M. 2020; 11: 358

  Abstract

  Previous studies have shown that physical exercise and mindfulness meditation can both lead to improvement in physical and mental health. However, it is unclear whether these two forms of training share the same underlying mechanisms. We compared two groups of older adults with 10 years of mindfulness meditation (integrative body-mind training, IBMT) or physical exercise (PE) experience to demonstrate their effects on brain, physiology and behavior. Healthy older adults were randomly selected from a large community health project and the groups were compared on measures of quality of life, autonomic activity (heart rate, heart rate variability, skin conductance response, respiratory amplitude/rate), immune function (secretory Immunoglobulin A, sIgA), stress hormone (cortisol) and brain imaging (resting state functional connectivity, structural differences). In comparison with PE, we found significantly higher ratings for the IBMT group on dimensions of life quality. Parasympathetic activity indexed by skin conductance response and high-frequency heart rate variability also showed more favorable outcomes in the IBMT group. However, the PE group showed lower basal heart rate and greater chest respiratory amplitude. Basal sIgA level was significantly higher and cortisol concentration was lower in the IBMT group. Lastly, the IBMT group had stronger brain connectivity between the dorsal anterior cingulate cortex (dACC) and the striatum at resting state, as well as greater volume of gray matter in the striatum. Our results indicate that mindfulness meditation and physical exercise function in part by different mechanisms, with PE increasing physical fitness and IBMT inducing plasticity in the central nervous systems. These findings suggest combining physical and mental training may achieve better health and quality of life results for an aging population.

  View details for DOI 10.3389/fpsyg.2020.00358

  View details for PubMedID 32300317

• Recommendations for cancer screening would be different if we measured endpoints that are valid, reliable, specific, and important to patients. Cancer causes & control : CCC Porzsolt, F. n., Matosevic, R. n., Kaplan, R. M. 2020

  Abstract

  Despite enthusiasm for cancer screening, systematic reviews consistently fail to show that screening reduces all-cause mortality. This narrative review explores conceptual issues, and inconsistencies between evidence and opinion about screening.We examined the interpretation of screening studies in relation to three intellectual traditions: (1) The relationship between prevention and cure; (2) Confirmation bias and the challenge of incorporating new data: less care may produce better outcomes than more care; (3) The answers to three structured questions about efficacy, effectiveness, and value of treatments proposed by Sir Archie Cochrane and Sir Austin Bradford Hill.When considering extensions of life expectancy or all-cause mortality, systematic reviews typically show cancer screening to have only small effects and often non-significant effects on all-cause mortality. Early diagnosis does not assure application of an intervention that alters the pathway toward demise. The interpretation of screening results is also affected by several known biases. Investigators and advocates are encumbered by an over focus on studies designed to determine if a treatment can work under ideal circumstances. To advance the field, we need a greater emphasis on evaluations that ask 'Does the treatment work under real-world conditions?', and 'Is the treatment worth it?' in terms of outcomes that are meaningful to patients.

  View details for DOI 10.1007/s10552-020-01309-w

  View details for PubMedID 32415530

• Health Care Is Failing the Most Vulnerable Patients: Three Underused Solutions. Public health reports (Washington, D.C. : 1974) Rochlin, D. H., Lee, C. M., Scheuter, C. n., Platchek, T. n., Kaplan, R. M., Milstein, A. n. 2020: 33354920954496

  View details for DOI 10.1177/0033354920954496

  View details for PubMedID 32962512

• Questioning the Benefit of Statins for Low-risk Populations-Medical Misinformation or Scientific Evidence? JAMA cardiology Abramson, J., Kaplan, R. M., Redberg, R. F. 2019

  View details for DOI 10.1001/jamacardio.2019.5117

  View details for PubMedID 31876932

• Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. Journal of the American Geriatrics Society Glynn, N. W., Gmelin, T., Santanasto, A. J., Lovato, L. C., Lange-Maia, B. S., Nicklas, B. J., Fielding, R. A., Manini, T. M., Myers, V. H., de Rekeneire, N., Spring, B. J., Pahor, M., King, A. C., Rejeski, W. J., Newman, A. B., Lifestyle Interventions and Independence for Elders Study Group, Pahor, M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Manini, T. M., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W. J., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Chen, S., Pierce, J. J., Chen, H., Hadley, E. C., Romashkan, S., Patel, K. V., Bethesda, Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M. N., McGucken, A. P., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Manini, T. M., Pahor, M., Anton, S. D., Buford, T. W., Marsiske, M., Nayfield, S. G., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M. P., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Glynn, N. W., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Sink, K. M., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Gill, T. M., Hankinson, J. L., Vaz Fragoso, C. A., Groessl, E. J., Kaplan, R. M. 2019

  Abstract

  OBJECTIVES: Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study.DESIGN: Prospective cohort of individuals aged 65years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6years.SETTING: LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD.PARTICIPANTS: Study participants (N=1591) at baseline were 78.9±5.2years of age, with low PA and at risk for mobility impairment.MEASUREMENTS: Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher=more fatigue (N=856) and lower than 2=less fatigue (N=735). Participants performed a usual-paced 400-m walk every 6months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates.RESULTS: Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD=.71; 95% confidence interval [CI] =.57-.90; P=.004) and PMMD (HR=.60; 95% CI=.44-.82; P=.001). For those with lower baseline fatigue, no group differences in MMD (P=.36) or PMMD (P=.82) were found. Results of baseline fatigue by intervention interaction was MMD (P=.18) and PMMD (P=.05).CONCLUSION: A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue.

  View details for DOI 10.1111/jgs.16274

  View details for PubMedID 31867713

• Effects of Mental Health on the Costs of Care for Chronic Illnesses: In Reply. Psychiatric services (Washington, D.C.) Kaplan, R. M., Glassman, J. R., Milstein, A. 2019; 70 (12): 1183

  View details for DOI 10.1176/appi.ps.701203

  View details for PubMedID 31787061

• Comparison of Rating Scale, Time Tradeoff, and Conjoint Analysis Methods for Assessment of Preferences in Prostate Cancer. Medical decision making : an international journal of the Society for Medical Decision Making Kaplan, R. M., Crespi, C. M., Dahan, E., Saucedo, J. D., Pagan, C., Saigal, C. S. 2019: 272989X19873667

  Abstract

  Background. Conjoint analysis is widely used in studies of consumer preference but has only recently been applied to measure patient utilities for health outcomes. We compared the reliability, feasibility, and internal and predictive validity of conjoint scaling methods against better established rating scale and time tradeoff methods for assessing prostate cancer utilities in men at risk for prostate cancer. Methods. In total, 194 men who were biopsy negative for prostate cancer were randomly assigned to complete 2 preference assessment modules, either conjoint analysis and a rating scale module or conjoint analysis and a time tradeoff module. Each participant's most important attribute was identified and evaluated in relation to age group (age <65, age 65 and older), education (high school, some college, college graduate), race/ethnicity (white, black, Latino), and relationship status (in significant relationship v. not). The methods were also evaluated in terms of ease of use and satisfaction. Results. Rating scales were rated as easiest to use and respondents were more satisfied with rating scales and conjoint in comparison to time tradeoffs. Rating scales and conjoint measures demonstrated significantly higher internal validity compared to time tradeoff when evaluated through R2 of the fitted utility function. The 3 methods were similar in terms of predictive validity, but conjoint analysis outperformed the rating scale method when patients were presented with novel combinations of attribute levels (68% correct v. 43%, P = 0.003). Conclusions. Rating scales and conjoint analysis exercises offer greater ease of use and higher satisfaction when measuring patient preferences in men biopsied for prostate cancer in comparison to time tradeoff exercises. Conjoint analysis may be a more robust approach to preference measurement for men at risk for prostate cancer.

  View details for DOI 10.1177/0272989X19873667

  View details for PubMedID 31556793

• A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care JOURNAL OF GENERAL INTERNAL MEDICINE Lee, C., Scheuter, C., Rochlin, D., Platchek, T., Kaplan, R. M. 2019; 34 (9): 1693–94

  View details for DOI 10.1007/s11606-019-04998-5

  View details for Web of Science ID 000483539200011

• Effects of Mental Health on the Costs of Care for Chronic Illnesses. Psychiatric services (Washington, D.C.) Kaplan, R. M., Glassman, J. R., Millstein, A. 2019: appips201900098

  Abstract

  OBJECTIVE: The study examined whether comorbid low mental health functioning inflates the cost of treating a chronic disease.METHODS: Data were from the 2015 Medical Expenditure Panel Survey (N=33,893). Costs were estimated from medical records and self-reported health care use. The mental component summary (MCS) score of the 12-item Short Form (SF-12) was used as a measure of mental health status. A general linear model estimated costs with fixed effects for chronic disease (present or absent) and mental health functioning (lowest, middle, and highest MCS score tertiles indicating low, middle, and high levels of mental health functioning, respectively). The SF-12 physical component summary score was a covariate. Eight conditions (arthritis, chronic obstructive pulmonary disease [COPD], high cholesterol, cancer, diabetes, stroke, coronary heart disease, and asthma) were analyzed separately.RESULTS: For each analysis, presence or absence of the chronic condition had a strong impact on cost. Lower mental health functioning also had a significant impact on cost. However, the interaction between mental health functioning and chronic disease diagnoses was statistically significant for only three conditions and accounted for only a small variation in cost. Sensitivity analyses using MCS score as a continuous variable, using a log10 transformation of the cost variable, and focusing only on persons with scores on the extreme low end did not significantly alter the conclusions.CONCLUSIONS: Contrary to expectation, the combination of poor mental functioning and chronic disease diagnosis did not have a strong synergistic effect on cost. Mental and general medical conditions appear to have independent effects on health care costs.

  View details for DOI 10.1176/appi.ps.201900098

  View details for PubMedID 31378194

• The role of economic analyses in promoting adoption of behavioral and psychosocial interventions in clinical settings. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Jacobsen, P. B., Prasad, R., Villani, J., Lee, C., Rochlin, D., Scheuter, C., Kaplan, R. M., Freedland, K. E., Manber, R., Kanaan, J., Wilson, D. K. 2019; 38 (8): 680–88

  Abstract

  In this report, we offer three examples of how economic data could promote greater adoption of behavioral and psychosocial interventions in clinical settings where primary or specialty medical care is delivered to patients. The examples are collaborative care for depression, chronic pain management, and cognitive-behavioral therapy for insomnia. These interventions illustrate differences in the availability of cost and cost-effectiveness data and in the extent of intervention adoption and integration into routine delivery of medical care. Collaborative care has been widely studied from an economic perspective, with most studies demonstrating its relative cost-effectiveness per quality-adjusted life year (QALY) and some studies demonstrating its potential for cost neutrality or cost savings. The success of collaborative care for depression can be viewed as a model for how to promote greater adoption of other interventions, such as psychological therapies for chronic pain and insomnia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000774

  View details for PubMedID 31368752

• Economic analysis in behavioral health: Toward application of standardized methodologies. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Kaplan, R. M., Gold, M., Duffy, S. Q., Miller, N., Glassman, J. R., Chambers, D. A., Ganiats, T. G., Berndt, S., Wilson, D. K. 2019; 38 (8): 672–79

  Abstract

  Health care remains the most expensive sector in the U.S. economy, now accounting for nearly 1 in every 5 dollars spent. The purpose of health care is to improve the health of populations. However, formal medical care is one of many alternatives for improving health. In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources. Standardized cost-effectiveness methodologies are now commonly used in the evaluation of medical therapies and new technologies. However, these methods have rarely been employed for the evaluation of behavioral interventions. Behavioral interventions often use measures that are not generally applied in other areas of health outcomes research. A consequence of neglecting to employ standardized cost-effectiveness analysis is that behavioral, psychological, and environmental interventions may be left out of resource allocation discussions. The purpose of this paper is to review standardized approaches to cost-effectiveness analysis and to encourage their use for the evaluation of behavioral intervention programs. Application of standardized methods of cost-effectiveness analysis will allow direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000769

  View details for PubMedID 31368751

• Standards for economic analyses of interventions for the field of health psychology and behavioral medicine. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Wilson, D. K., Christensen, A., Jacobsen, P. B., Kaplan, R. M. 2019; 38 (8): 669–71

  Abstract

  Behavioral interventions can be offered within a wide range of contexts, including public health, medicine, surgery, physical rehabilitation, nutrition, and other health services. These differing services compete for the same resources and it is difficult to compare their value. Systematic standardized methodologies for valuing outcomes are available and are being applied by economists and health services researchers, but are not widely used in our field. With support from the Society for Health Psychology, the National Cancer Institute (NCI), and the Office for Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health, two working group meetings were held to consider the use of well-established cost-effectiveness methodologies for the evaluation of behavioral and public health interventions. In this special section, we acknowledge a wide range of variability in terms of behavioral interventions typically delivered in nonclinical versus more traditional clinical settings. Three articles address (1) standardizing methods for conducting cost-effectiveness and cost-utility analyses, (2) providing examples to illustrate progress in applying these methods to evaluate interventions delivered in whole or in part in clinical settings, and (3) providing nonclinical intervention examples selected to highlight the challenges and opportunities for evaluating the cost-effectiveness of interventions in more diverse settings. The ability of our field to communicate cost-effectiveness data to policy makers, employers, and insurers that incorporates implementation costs is central to the likelihood of our interventions being adopted by practitioners and reimbursed by payers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000770

  View details for PubMedID 31368750

• Cost impact of sobering centers on national health care spending in the United States. Translational behavioral medicine Scheuter, C., Rochlin, D. H., Lee, C., Milstein, A., Kaplan, R. M. 2019

  Abstract

  Acute alcohol intoxication is responsible for a sizable share of emergency department visits. Intoxicated individuals without other medical needs may not require the high level of care provided by an emergency department. We estimate the impact on U.S. health care spending if individuals with uncomplicated, acute alcohol intoxication were treated in sobering centers instead of the emergency department. We performed a budget impact analysis from the perspective of the U.S. health care system based on published and gray literature reports. Ninety-five percent confidence intervals (CI) were estimated using Monte Carlo modeling with random variation for three variables (cost of an emergency department visit, cost of a sobering center visit, and start-up costs per sobering center visit) and the percentage of cases diverted from emergency departments to sobering centers. Outcomes were expressed in terms of national savings in 2017 U.S. dollars. Assuming a diversion rate of 50% based on previous studies, national savings range from $230 million to $1.0 billion annually. In the Monte Carlo modeling, we found annual national savings of $99.02 million (95% CI: $95.89-$102.19 million), $792.34 million (95% CI: $767.09-$817.58 million), and $1,185.51 million (95% CI: $1,150.64-$1,226.37 million) with diversion rates of 5%, 40%, and 60%, respectively. Implementing sobering centers as a treatment alternative for individuals with uncomplicated acute alcohol intoxication could yield substantial cost savings for the U.S. health care system.

  View details for DOI 10.1093/tbm/ibz075

  View details for PubMedID 31116401

• Contributions of Health Care to Longevity: A Review of 4 Estimation Methods. Annals of family medicine Kaplan, R. M., Milstein, A. 2019; 17 (3): 267–72

  Abstract

  PURPOSE: Health care expenditures and biomedical research funding are often justified by the belief that modern health care powerfully improves life expectancy in wealthy countries. We examined 4 different methods of estimating the effect of health care on health outcomes.METHODS: We reviewed the contributions of medical care to health outcomes using 4 methods: (1) analyses by McGinnis and Schroeder, (2) Wennberg and colleagues' studies of small area variation, (3) Park and colleagues' analysis of County Health Rankings and Roadmaps, and (4) the RAND Health Insurance Experiment.RESULTS: The 4 methods, using different data sets, produced estimates ranging from 0% to 17% of premature mortality attributable to deficiencies in health care access or delivery. Estimates of the effect of behavioral factors ranged from 16% to 65%.CONCLUSIONS: The results converge to suggest that restricted access to medical care accounts for about 10% of premature death or other undesirable health outcomes. Health care has modest effects on the extension of US life expectancy, while behavioral and social determinants may have larger effects.

  View details for PubMedID 31085531

• Contributions of Health Care to Longevity: A Review of 4 Estimation Methods ANNALS OF FAMILY MEDICINE Kaplan, R. M., Milstein, A. 2019; 17 (3): 267–72

  View details for DOI 10.1370/afm.2362

  View details for Web of Science ID 000467759600011

• A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care. Journal of general internal medicine Lee, C. M., Scheuter, C., Rochlin, D., Platchek, T., Kaplan, R. M. 2019

  View details for PubMedID 31011978

• Economic Benefit of "Modern" Nonemergency Medical Transportation That Utilizes Digital Transportation Networks AMERICAN JOURNAL OF PUBLIC HEALTH Rochlin, D. H., Lee, C., Scheuter, C., Milstein, A., Kaplan, R. M. 2019; 109 (3): 472–74

  View details for DOI 10.2105/AJPH.2018.304857

  View details for Web of Science ID 000457864000048

• Systems Delivery Innovation for Alzheimer Disease AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Bott, N. T., Sheckter, C. C., Yang, D., Peters, S., Brady, B., Plowman, S., Borson, S., Leff, B., Kaplan, R. M., Platchek, T., Milstein, A. 2019; 27 (2): 149–61

  View details for DOI 10.1016/j.jagp.2018.09.015

  View details for Web of Science ID 000455373700006

• Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Wanigatunga, A. A., Gill, T. M., Marsh, A. P., Hsu, F., Yaghjyan, L., Woods, A. J., Glynn, N. W., King, A. C., Newton, R. L., Fielding, R. A., Pahor, M., Manini, T. M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Rejeski, W., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K., Bonds, D., McDermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kirn, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Marsiske, M., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Fragoso, C., Groessl, E. J., Kaplan, R. M., Lifestyles Intervention Independen 2019; 67 (2): 261–68

  View details for DOI 10.1111/jgs.15631

  View details for Web of Science ID 000459714900011

• Economic Benefit of "Modern" Nonemergency Medical Transportation That Utilizes Digital Transportation Networks. American journal of public health Rochlin, D. H., Lee, C., Scheuter, C., Milstein, A., Kaplan, R. M. 2019: e1–e3

  Abstract

  OBJECTIVES: To determine the economic benefit of "modern" nonemergency medical transportation (NEMT) that utilizes digital transportation networks compared with traditional NEMT in the United States.METHODS: We used the National Academies' NEMT cost-effectiveness model to perform a baseline cost savings analysis for provision of NEMT for transportation-disadvantaged Medicaid beneficiaries. On the basis of a review of the literature, commercial information, and structured expert interviews, we performed a sensitivity analysis to determine the incremental economic benefit of using modern NEMT. We estimated confidence intervals (CIs) by using Monte Carlo simulation.RESULTS: Total annual net savings for traditional NEMT in Medicaid was approximately $4 billion. For modern NEMT, estimated savings on ride costs varied from 30% to 70%. In comparison with traditional, modern NEMT was estimated to save $268 per expected user (95% CI=$248, $288 per member per year) and $537 million annually (95% CI=$496 million, $577 million) when scaled nationally.CONCLUSIONS: Modern NEMT has the potential to yield greater cost savings than traditional NEMT while also improving patient experience. Public Health Implications: Barriers to NEMT are a health risk affecting high-need, economically disadvantaged patients. Economic arguments supporting modern NEMT are important given decreased support for human services spending. (Am J Public Health. Published online ahead of print January 24, 2019: e1-e3. doi:10.2105/AJPH.2018.304857).

  View details for PubMedID 30676791

• Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability AMERICAN JOURNAL OF PREVENTIVE MEDICINE Groessl, E. J., Kaplan, R. M., Rejeski, W., Katula, J. A., Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C., Reid, K., Spring, B., Pahor, M. 2019; 56 (1): 141–46

  View details for DOI 10.1016/j.amepre.2018.09.006

  View details for Web of Science ID 000453383700020

• METHODS FOR QUANTIFYING EFFICACY-EFFECTIVENESS GAP OF RANDOMIZED CONTROLLED TRIALS: EXAMPLES IN ARDS Adibuzzaman, M., Jung, Y., Bareinboim, E., Griffin, P., Kethireddy, S., Bikak, M., Kaplan, R. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000498593400292

• Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. American journal of preventive medicine Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A., Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C., Reid, K., Spring, B., Pahor, M. 2019; 56 (1): 141–46

  Abstract

  INTRODUCTION: Older adults are a rapidly growing segment of the U.S.POPULATION: Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability.METHODS: Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017.RESULTS: The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time.CONCLUSIONS: Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.

  View details for PubMedID 30573142

• Neural correlates of perceived physical and mental fatigability in older adults: A pilot study EXPERIMENTAL GERONTOLOGY Wasson, E., Rosso, A. L., Santanasto, A. J., Rosano, C., Butters, M. A., Rejeski, W., Boudreau, R. M., Aizenstein, H., Gmelin, T., Glynn, N. W., Pahor, M., Guralnik, J. M., Anton, S. D., Buford, T. W., Leeuwenburgh, C., Nayfield, S. G., Manini, T. M., Caudle, C., Crump, L., Holmes, L., Lee, J., Lu, C., Miller, M. E., Espeland, M. A., Ambrosius, W. T., Applegate, W., Beavers, D. P., Byington, R. P., Cook, D., Furberg, C. D., Harvin, L. N., Henkin, L., Hepler, J., Hsu, F., Joyce, K., Lovato, L., Pierce, J., Roberson, W., Robertson, J., Rushing, J., Rushing, S., Stowe, C. L., Walkup, M. P., Hire, D., Katula, J. A., Brubaker, P. H., Mihalko, S. L., Jennings, J. M., Hadley, E. C., Romashkan, S., Patel, K., Bonds, D., Mcdermott, M. M., Spring, B., Hauser, J., Kerwin, D., Domanchuk, K., Graff, R., Rego, A., Church, T. S., Blair, S. N., Myers, V. H., Monce, R., Britt, N. E., Harris, M., McGucken, A., Rodarte, R., Millet, H. K., Tudor-Locke, C., Butitta, B. P., Donatto, S. G., Cocreham, S. H., King, A. C., Castro, C. M., Haskell, W. L., Stafford, R. S., Pruitt, L. A., Yank, V., Berra, K., Bell, C., Thiessen, R. M., Youngman, K. P., Virgen, S. B., Maldonado, E., Tarin, K. N., Klaftenegger, H., Prosak, C. A., Campero, I., Garcia, D. M., Soto, J., Chio, L., Hoskins, D., Fielding, R. A., Nelson, M. E., Folta, S. C., Phillips, E. M., Liu, C. K., McDavitt, E. C., Reid, K. F., Kim, D. R., Pasha, E. P., Kim, W. S., Krol, J. M., Beard, V. E., Tsiroyannis, E. X., Hau, C., Marsiske, M., Sandesara, B. D., Black, M. L., Burk, W. L., Hoover, B. M., Knaggs, J. D., Marena, W. C., Korytov, I., Curtis, S. D., Lorow, M. S., Goswami, C. S., Lewis, M. A., Kamen, M., Bitz, J. N., Stanton, B. K., Hicks, T. T., Gay, C. W., Xie, C., Morris, H. L., Singletary, F. F., Causer, J., Yonce, S., Radcliff, K. A., Smith, M., Scott, J. S., Rodriguez, M. M., Fitch, M. S., Dunn, M. C., Schllesinger, J. Q., Newman, A. B., Studenski, S. A., Goodpaster, B. H., Lopez, O., Nadkarni, N. K., Ives, D. G., Newman, M. A., Grove, G., Williams, K., Bonk, J. T., Rush, J., Kost, P., Vincent, P., Gerger, A., Romeo, J. R., Monheim, L. C., Kritchevsky, S. B., Marsh, A. P., Brinkley, T. E., Demons, J. S., Sink, K. M., Kennedy, K., Shertzer-Skinner, R., Wrights, A., Fries, R., Barr, D., Gill, T. M., Axtell, R. S., Kashaf, S. S., de Rekeneire, N., McGloin, J. M., Mautner, R., Huie-White, S. M., Bianco, L., Zocher, J., Wu, K. C., Shepard, D. M., Fennelly, B., Castro, R., Halpin, S., Brennan, M., Barnett, T., Iannone, L. P., Zenoni, M. A., Bugaj, J. A., Bailey, C., Charpentier, P., Hawthorne-Jones, G., Mignosa, B., Lewis, L., Williamson, J., Hendrie, H. C., Rapp, S. R., Verghese, J., Woolard, N., Espeland, M., Jennings, J., Wilson, V. K., Pepine, C. J., Ariet, M., Handberg, E., Deluca, D., Hill, J., Szady, A., Chupp, G. L., Flynn, G. M., Hankinson, J. L., Fragoso, C., Groessl, E. J., Kaplan, R. M., LIFE Study Grp 2019; 115: 139–47

  Abstract

  This pilot work examined associations of brain grey matter volumes (GMV) with perceived fatigability in older adults to elucidate disablement mechanisms. A subsample (n = 29; age = 77.2 ± 5.5; 86% female) of participants from the Lifestyle Interventions and Independence for Elders (LIFE) Study was utilized to quantify GMV for regions of interest in the basal ganglia and limbic system normalized to intracranial volume. The Pittsburgh Fatigability Scale measured physical and mental fatigability (score 0-50; higher physical fatigability ≥ 15; higher mental fatigability ≥ 13). We used an exploratory alpha level of p < 0.1. Nineteen (66%) participants had higher physical fatigability, 19 (66%) had higher mental fatigability, of these, 17 (57%) had both. Right hippocampal volumes/ICV were smaller in participants with higher verses lower physical fatigability (0.261 ± 0.039 vs. 0.273 ± 0.022, p = 0.07); associations were similar for right putamen and bilateral thalamus. Higher mental fatigability was associated with smaller right hippocampus, thalamus, and posterior cingulum and bilateral amygdala. Higher fatigability in older adults may be associated with smaller volumes of the basal ganglia and limbic system, indicating mechanisms for further exploration.

  View details for DOI 10.1016/j.exger.2018.12.003

  View details for Web of Science ID 000455223100016

  View details for PubMedID 30528639

  View details for PubMedCentralID PMC6331252

• Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults. Journal of the American Geriatrics Society Wanigatunga, A. A., Gill, T. M., Marsh, A. P., Hsu, F., Yaghjyan, L., Woods, A. J., Glynn, N. W., King, A. C., Newton, R. L., Fielding, R. A., Pahor, M., Manini, T. M., Lifestyles Intervention and Independence for Elders Study Investigators 2018

  Abstract

  OBJECTIVES: To evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education.DESIGN: Secondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013.PARTICIPANTS: Sedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341).MEASUREMENTS: Participants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (<100 counts/min; ≥1, ≥10, ≥30, ≥60 minute lengths) and activity (≥100 counts/min; ≥1, ≥2, ≥5, ≥10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment.RESULTS: Hospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ≥4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (≥1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ≥4 cumulative hospital days; ≥2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ≥4 cumulative hospital days; ≥5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ≥4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p >.41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p >.26).CONCLUSION: Participating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization.

  View details for PubMedID 30452084

• Systems Delivery Innovation for Alzheimer Disease. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Bott, N. T., Sheckter, C. C., Yang, D., Peters, S., Brady, B., Plowman, S., Borson, S., Leff, B., Kaplan, R. M., Platchek, T., Milstein, A. 2018

  Abstract

  OBJECTIVE: The authors describe a comprehensive care model for Alzheimer disease (AD) that improves value within 1-3 years after implementation by leveraging targeted outpatient chronic care management, cognitively protective acute care, and timely caregiver support.METHODS: Using current best evidence, expert opinion, and macroeconomic modeling, the authors designed a comprehensive care model for AD that improves the quality of care while reducing total per capita healthcare spending by more than 15%. Cost savings were measured as reduced spending by payers. Cost estimates were derived from medical literature and national databases, including both public and private U.S. payers. All estimates reflect the value in 2015 dollars using a consumer price index inflation calculator. Outcome estimates were determined at year 2, accounting for implementation and steady-state intervention costs.RESULTS: After accounting for implementation and recurring operating costs of approximately $9.5 billion, estimated net cost savings of between $13 and $41 billion can be accomplished concurrently with improvements in quality and experience of coordinated chronic care ($0.01-$6.8 billion), cognitively protective acute care ($8.7-$26.6 billion), timely caregiver support ($4.3-$7.5 billion), and caregiver efficiency ($4.1-$7.2 billion).CONCLUSION: A high-value care model for AD may improve the experience of patients with AD while significantly lowering costs.

  View details for PubMedID 30477913

• One In Five Fewer Heart Attacks: Impact, Savings, And Sustainability In San Diego County Collaborative HEALTH AFFAIRS Fremont, A., Kim, A. Y., Bailey, K., Hanley, H., Thorne, C., Dudl, R., Kaplan, R. M., Shortell, S. M., DeMaria, A. N. 2018; 37 (9): 1457–65

  View details for DOI 10.1377/hlthaff.2018.0443

  View details for Web of Science ID 000463962900016

• Does information from ClinicalTrials.gov increase transparency and reduce bias? Results from a five-report case series SYSTEMATIC REVIEWS Adam, G. P., Springs, S., Trikalinos, T., Williams, J. W., Eaton, J. L., Von Isenburg, M., Gierisch, J. M., Wilson, L. M., Robinson, K. A., Viswanathan, M., Middleton, J., Forman-Hoffman, V. L., Berliner, E., Kaplan, R. M. 2018; 7: 59

  Abstract

  We investigated whether information in ClinicalTrials.gov would impact the conclusions of five ongoing systematic reviews.We considered five reviews that included 495 studies total. Each review team conducted a search of ClinicalTrials.gov up to the date of the review's last literature search, screened the records using the review's eligibility criteria, extracted information, and assessed risk of bias and applicability. Each team then evaluated the impact of the evidence found in ClinicalTrials.gov on the conclusions in the review.Across the five reviews, the number of studies that had both a registry record and a publication varied widely, from none in one review to 43% of all studies identified in another. Among the studies with both a record and publication, there was also wide variability in the match between published outcomes and those listed in ClinicalTrials.gov. Of the 173 total ClinicalTrials.gov records identified across the five projects, between 11 and 43% did not have an associated publication. In the 14% of records that contained results, the new data provided in the ClinicalTrials.gov records did not change the results or conclusions of the reviews. Finally, a large number of published studies were not registered in ClinicalTrials.gov, but many of these were published before ClinicalTrials.gov's inception date of 2000.Improved prospective registration of trials and consistent reporting of results in ClinicalTrials.gov would help make ClinicalTrials.gov records more useful in finding unpublished information and identifying potential biases. In addition, consistent indexing in databases, such as MEDLINE, would allow for better matching of records and publications, leading to increased utility of these searches for systematic review projects.

  View details for PubMedID 29661214

• AN UPDATE ON THE COST-EFFECTIVENESS WORKING GROUP ON METHODOLOGY, COLLABORATIVE CARE AND DISSEMINATION Wilson, D. K., Kaplan, R. M., Jacobsen, P., Riley, W. OXFORD UNIV PRESS INC. 2018: S430

  View details for Web of Science ID 000431185201257

• Effect of Physical Activity on Frailty Secondary Analysis of a Randomized Controlled Trial ANNALS OF INTERNAL MEDICINE Trombetti, A., Hars, M., Hsu, F., Reid, K. F., Church, T. S., Gill, T. M., King, A. C., Liu, C. K., Manini, T. M., McDermott, M. M., Newman, A. B., Rejeski, W., Guralnik, J. M., Pahor, M., Fielding, R. A., LIFE Study Investigators 2018; 168 (5): 309-+

  Abstract

  Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults. Definitive data from large long-term randomized trials are lacking.To determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability (MMD) risk.Multicenter, single-blind, randomized trial.8 centers in the United States.1635 community-dwelling adults, aged 70 to 89 years, with functional limitations.A structured, moderate-intensity physical activity program incorporating aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercises.Frailty, as defined by the SOF (Study of Osteoporotic Fractures) index, at baseline and 6, 12, and 24 months, and MMD, defined as the inability to walk 400 m, for up to 3.5 years.Over 24 months of follow-up, the risk for frailty (n = 1623) was not statistically significantly different in the physical activity versus the health education group (adjusted prevalence difference, -0.021 [95% CI, -0.049 to 0.007]). Among the 3 criteria of the SOF index, the physical activity intervention was associated with improvement in the inability to rise from a chair (adjusted prevalence difference, -0.050 [CI, -0.081 to -0.020]). Baseline frailty status did not modify the effect of physical activity on reducing incident MMD (P for interaction = 0.91).Frailty status was neither an entry criterion nor a randomization stratum.A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary, community-dwelling older adults. The beneficial effect of physical activity on the incidence of MMD did not differ between frail and nonfrail participants.National Institute on Aging, National Institutes of Health.

  View details for PubMedID 29310138

• One In Five Fewer Heart Attacks: Impact, Savings, And Sustainability In San Diego County Collaborative. Health affairs (Project Hope) Fremont, A., Kim, A. Y., Bailey, K., Hanley, H. R., Thorne, C., Dudl, R. J., Kaplan, R. M., Shortell, S. M., DeMaria, A. N. 2018; 37 (9): 1457–65

  Abstract

  Before 2011 rates of hospitalization for heart attacks were about the same in San Diego County as they were in the rest of California. In 2011 a multistakeholder population health collaborative consisting of partners at the federal, state, and local levels launched Be There San Diego. The collaborative's goal was to reduce cardiovascular events through the spread of best practices aimed at improving control of hypertension, lipid levels, and blood sugar and through patient and medical community activation. Using hospital discharge data for the period 2007-16, we compared acute myocardial infarction (AMI) hospitalization rates in San Diego County and the rest of the state before and after the demonstration project started. AMI hospitalization rates decreased by 22percent in San Diego County versus 8percent in the rest of the state, with an estimated 3,826 AMI hospitalizations avoided and $86million in savings in San Diego. Results show that a science-based health collaborative can improve outcomes while lowering costs, and efforts are under way to ensure the collaborative's sustainability.

  View details for PubMedID 30179541

• Educational Attainment and Health Outcomes: Data From the Medical Expenditures Panel Survey HEALTH PSYCHOLOGY Kaplan, R. M., Fang, Z., Kirby, J. 2017; 36 (6): 598–608

  Abstract

  Using data from the nationally representative Medical Expenditures Panel Survey (MEPS), we explored the extent to which health care utilization and health risk-taking, together with previously examined mediators, can explain the education-health gradient above and beyond what can be explained by previously examined mediators such as age, race, and poverty status.Health was measured using the Physical Component Score (PCS) from the Medical Outcomes Study 12-Item Short Form (SF-12). Educational attainment was self-reported and categorized as 1 (less than high school), 2 (high school graduate or GED), 3 (some college), 4 (bachelor's degree), and 5 (graduate degree).In bivariate analysis, we found systematic graded relationships between educational attainment and health including, SF-12 PCS scores, self-rated health, and activity limitations. In addition, education was associated with having more office visits and outpatient visits and less risk tolerance. Those with less education were also more likely to be uninsured throughout the year. Multivariate regression analysis suggested that adjustment for age, race, poverty status and marital status explained part, but not nearly all, of the relationship between education and health. Adding a variety of variables on health care and attitudes to the models provided no additional explanatory power. This pattern of results persisted even after stratifying on the number of self-reported chronic conditions.Our findings provide no evidence that access to and use of health care explains the education-health gradient. However, more research is necessary to conclusively rule out medical care as a mediator between education and health. (PsycINFO Database Record

  View details for DOI 10.1037/hea0000431

  View details for Web of Science ID 000402052300010

  View details for PubMedID 28383926

• Dynapenia and Metabolic Health in Obese and Nonobese Adults Aged 70 Years and Older: The LIFE Study JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Aubertin-Leheudre, M., Anton, S., Beavers, D. P., Manini, T. M., Fielding, R., Newman, A., Church, T., Kritchevsky, S. B., Conroy, D., McDermott, M. M., Botoseneanu, A., Hauser, M. E., Pahor, M. 2017; 18 (4): 312-319

  Abstract

  The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults.A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions.A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = 92.2 ± 11.2, P ≤ .01); and higher in NDYN-O compared with DYN-O (P = .008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared with DYN-O (70.9 ± 10.1 vs 67.7 ± 9.7, P ≤ .001). No significant differences were found across dynapenia and obesity status for all other metabolic components (P > .05). The odds of having MetS or its individual components were similar in obese and nonobese, combined or not with dynapenia (nonsignificant odds ratio [95% confidence interval]).Nonobese dynapenic older adults had fewer metabolic disease risk factors than nonobese and nondynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting MetS criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or nonobese older adults.

  View details for DOI 10.1016/j.jamda.2016.10.001

  View details for Web of Science ID 000398947400007

• BEHAVIORAL INTERVENTIONS FOR OBESITY: A DEBATE ON THE STATE OF THE EVIDENCE Wilson, D. K., Kaufmann, P., Kaplan, R. M., Davidson, K. OXFORD UNIV PRESS INC. 2017: S1571

  View details for Web of Science ID 000398947202129

• Reply to E.C. Winkler et al. Journal of clinical oncology Kaplan, R. M., Milstein, A. 2017; 35 (4): 468-?

  View details for DOI 10.1200/JCO.2016.69.4570

  View details for PubMedID 28129520

• NIH behavioral and social sciences research support: 1980-2016. The American psychologist Kaplan, R. M., Johnson, S. B., Kobor, P. C. 2017; 72 (8): 808–21

  Abstract

  The history of behavioral and social science research funding at the National Institutes of Health (NIH) between 1980 and 2016 is reviewed. Noncommunicable diseases are now the primary cause of death worldwide and most are strongly linked to behavior. Developed under the prevailing zeitgeist of the biomedical model, behavioral and social science has often been underfunded at NIH. In 1990, the Senate Appropriations Committee, recognizing that behavior may contribute to about half of all premature deaths, recommended that funding for behavioral and social sciences research should be about 10% of the NIH budget. NIH and American Psychological Association efforts to address this goal are described. Data from several sources suggest that this goal has never been realized. Patterns of federal funding for research may have a significant influence on scientific disciplines. Fields of study that have received more extramural funding are associated with greater growth in faculty and higher faculty salaries. A renewed effort to increase the federal investment in behavioral and social sciences research is necessary. (PsycINFO Database Record

  View details for PubMedID 29172582

• Effect of Structured Physical Activity on Overall Burden and Transitions Between States of Major Mobility Disability in Older Persons Secondary Analysis of a Randomized Trial ANNALS OF INTERNAL MEDICINE Gill, T. M., Guralnik, J. M., Pahor, M., Church, T., Fielding, R. A., King, A. C., Marsh, A. P., Newman, A. B., Pellegrini, C. A., Chen, S., Allore, H. G., Miller, M. E. 2016; 165 (12): 833-?

  Abstract

  The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone.To compare the effect of a long-term, structured physical activity program with that of a health education intervention on the proportion of patient assessments indicating major mobility disability (MMD) (that is, MMD burden) and on the risk for transitions into and out of MMD.Single-blinded, parallel-group, randomized trial. (ClinicalTrials.gov: NCT01072500).8 U.S. centers between February 2010 and December 2013.1635 sedentary persons, aged 70 to 89 years, who had functional limitations but could walk 400 m.Physical activity (n = 818) and health education (n = 817).MMD, defined as the inability to walk 400 m, was assessed every 6 months for up to 3.5 years.During a median follow-up of 2.7 years, the proportion of assessments showing MMD was substantially lower in the physical activity (0.13 [95% CI, 0.11 to 0.15]) than the health education (0.17 [CI, 0.15 to 0.19]) group, yielding a risk ratio of 0.75 (CI, 0.64 to 0.89). In a multistate model, the hazard ratios for comparisons of physical activity with health education were 0.87 (CI, 0.73 to 1.03) for the transition from no MMD to MMD; 0.52 (CI, 0.10 to 2.67) for no MMD to death; 1.33 (CI, 0.99 to 1.77) for MMD to no MMD; and 1.92 (CI, 1.15 to 3.20) for MMD to death.The intention-to-treat principle was maintained for MMD burden and first transition out of no MMD, but not for subsequent transitions.A structured physical activity program reduced the MMD burden for an extended period, in part through enhanced recovery after the onset of disability and diminished risk for subsequent disability episodes.National Institute on Aging, National Institutes of Health.

  View details for DOI 10.7326/M16-0529

  View details for Web of Science ID 000391236900011

  View details for PubMedID 27669457

• Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability. journals of gerontology. Series A, Biological sciences and medical sciences Groessl, E. J., Kaplan, R. M., Castro Sweet, C. M., Church, T., Espeland, M. A., Gill, T. M., Glynn, N. W., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Reid, K. F., Rushing, J., Pahor, M. 2016; 71 (5): 656-662

  Abstract

  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

  View details for DOI 10.1093/gerona/glw001

  View details for PubMedID 26888433

• Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Groessl, E. J., Kaplan, R. M., Sweet, C. M., Church, T., Espeland, M. A., Gill, T. M., Glynn, N. W., King, A. C., Kritchevsky, S., Manini, T., McDermott, M. M., Reid, K. F., Rushing, J., Pahor, M. 2016; 71 (5): 656-662

  Abstract

  Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

  View details for DOI 10.1093/gerona/glw001

  View details for Web of Science ID 000376398400015

• Financial Strain and Cancer Outcomes. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Kaplan, R. M., Milstein, A. n. 2016; 34 (15): 1711–12

  View details for PubMedID 27022120

• GENETIC MODERATORS OF THE IMPACT OF PHYSICAL ACTIVITY ON DEPRESSIVE SYMPTOMS JOURNAL OF FRAILTY & AGING Dotson, V. M., Hsu, F. C., Langaee, T. Y., McDonough, C. W., King, A. C., Cohen, R. A., Newman, A. B., Kritchevsky, S. B., Myers, V., Manini, T. M., Pahor, M., LIFE Study Grp 2016; 5 (1): 6–14

  Abstract

  Converging evidence suggests that physical activity is an effective intervention for both clinical depression and sub-threshold depressive symptoms; however, findings are not always consistent. These mixed results might reflect heterogeneity in response to physical activity, with some subgroups of individuals responding positively, but not others.1) To examine the impact of genetic variation and sex on changes in depressive symptoms in older adults after a physical activity (PA) intervention, and 2) to determine if PA differentially improves particular symptom dimensions of depression.Randomized controlled trial.Four field centers (Cooper Institute, Stanford University, University of Pittsburgh, and Wake Forest University).396 community-dwelling adults aged 70-89 years who participated in the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P).12-month PA intervention compared to an education control.Polymorphisms in the serotonin transporter (5-HTT), brain-derived neurotrophic factor (BDNF), and apolipoprotein E (APOE) genes; 12-month change in the Center for Epidemiologic Studies Depression Scale total score, as well as scores on the depressed affect, somatic symptoms, and lack of positive affect subscales.Men randomized to the PA arm showed the greatest decreases in somatic symptoms, with a preferential benefit in male carriers of the BDNF Met allele. Symptoms of lack of positive affect decreased more in men compared to women, particularly in those possessing the 5-HTT L allele, but the effect did not differ by intervention arm. APOE status did not affect change in depressive symptoms.Results of this study suggest that the impact of PA on depressive symptoms varies by genotype and sex, and that PA may mitigate somatic symptoms of depression more than other symptoms. The results suggest that a targeted approach to recommending PA therapy for treatment of depression is viable.

  View details for DOI 10.14283/jfa.2016.76

  View details for Web of Science ID 000449826700002

  View details for PubMedID 26980363

  View details for PubMedCentralID PMC4905714

• Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ (Clinical research ed.) Gill, T. M., Pahor, M., Guralnik, J. M., McDermott, M. M., King, A. C., Buford, T. W., Strotmeyer, E. S., Nelson, M. E., Sink, K. M., Demons, J. L., Kashaf, S. S., Walkup, M. P., Miller, M. E. 2016; 352: i245-?

  Abstract

  To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations.Multicenter, single blinded randomized trial (Lifestyle Interventions and Independence for Elders (LIFE) study).Eight centers across the United States, February 2010 to December 2011.1635 sedentary adults aged 70-89 years with functional limitations, defined as a short physical performance battery score ≤ 9, but who were able to walk 400 m.A permuted block algorithm stratified by field center and sex was used to allocate interventions. Participants were randomized to a structured, moderate intensity physical activity program (n=818) conducted in a center (twice a week) and at home (3-4 times a week) that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching exercises.Serious fall injuries, defined as a fall that resulted in a clinical, non-vertebral fracture or that led to a hospital admission for another serious injury, was a prespecified secondary outcome in the LIFE Study. Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment. All participants were included in the analysis.Over a median follow-up of 2.6 years, a serious fall injury was experienced by 75 (9.2%) participants in the physical activity group and 84 (10.3%) in the health education group (hazard ratio 0.90, 95% confidence interval 0.66 to 1.23; P=0.52). These results were consistent across several subgroups, including sex. However, in analyses that were not prespecified, sex specific differences were observed for rates of all serious fall injuries (rate ratio 0.54, 95% confidence interval 0.31 to 0.95 in men; 1.07, 0.75 to 1.53 in women; P=0.043 for interaction), fall related fractures (0.47, 0.25 to 0.86 in men; 1.12, 0.77 to 1.64 in women; P=0.017 for interaction), and fall related hospital admissions (0.41, 0.19 to 0.89 in men; 1.10, 0.65 to 1.88 in women; P=0.039 for interaction).In this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations. These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men.Trial registration ClinicalsTrials.gov NCT01072500.

  View details for DOI 10.1136/bmj.i245

  View details for PubMedID 26842425

  View details for PubMedCentralID PMC4772786

• An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter? INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY King, A. C., Salvo, D., Banda, J. A., Ahn, D. K., Gill, T. M., Miller, M., Newman, A. B., Fielding, R. A., Siordia, C., Moore, S., Folta, S., Spring, B., Manini, T., Pahor, M. 2015; 12

  Abstract

  Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability.The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence.Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4 %) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4 %) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis.The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation.Clinicaltrials.gov Identifier =  NCT01072500.

  View details for DOI 10.1186/s12966-015-0322-1

  View details for Web of Science ID 000366820000001

  View details for PubMedID 26684894

  View details for PubMedCentralID PMC4683911

• Effects of a one-year physical activity program on serum C-terminal Agrin Fragment (CAF) concentrations among mobility-limited older adults JOURNAL OF NUTRITION HEALTH & AGING Bondoc, I., Cochrane, S. K., Church, T. S., Dahinden, P., Hettwer, S., Hsu, F., Stafford, R. S., Pahor, M., Buford, T. W. 2015; 19 (9): 922-927

  Abstract

  C-terminal Agrin Fragment (CAF) has been proposed as a potential circulating biomarker for predicting changes in physical function among older adults. To determine the effect of a one-year PA intervention on changes in CAF concentrations and to evaluate baseline and longitudinal associations between CAF concentrations and indices of physical function.Ancillary study to the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P), a multi-site randomized clinical trial designed to evaluate the effects of chronic exercise on the physical function of older adults at risk for mobility disability.Four academic research centers within the U.S.Three hundred thirty three older adults aged 70 to 89 with mild to moderate impairments in physical function.A 12-month intervention of either structured physical activity (PA) or health education promoting successful aging (SA).Serum CAF concentrations and objectives measures of physical function - i.e. gait speed and performance on the Short Physical Performance Battery (SPPB).The group*time interaction was not significant for serum CAF concentrations (p=0.265), indicating that the PA intervention did not significantly reduce serum CAF levels compared to SA. Baseline gait speed was significantly correlated with baseline CAF level (r = -0.151, p= 0.006), however the association between CAF and SPPB was not significant. Additionally, neither baseline nor the change in CAF concentrations strongly predicted the change in either performance measure following the PA intervention.In summary, the present study shows that a one-year structured PA program did not reduce serum CAF levels among mobility-limited older adults. However, further study is needed to definitively determine the utility of CAF as a biomarker of physical function.

  View details for DOI 10.1007/s12603-015-0474-3

  View details for Web of Science ID 000364577300008

  View details for PubMedID 26482694

  View details for PubMedCentralID PMC4682669

• Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults The LIFE Randomized Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Sink, K. M., Espeland, M. A., Castro, C. M., Church, T., Cohen, R., Dodson, J. A., Guralnik, J., Hendrie, H. C., Jennings, J., Katula, J., Lopez, O. L., McDermott, M. M., Pahor, M., Reid, K. F., Rushing, J., Verghese, J., Rapp, S., Williamson, J. D. 2015; 314 (8): 781-790

  Abstract

  Epidemiological evidence suggests that physical activity benefits cognition, but results from randomized trials are limited and mixed.To determine whether a 24-month physical activity program results in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program.A randomized clinical trial, the Lifestyle Interventions and Independence for Elders (LIFE) study, enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011. Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m.A structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching.Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding (DSC) task subtest of the Wechsler Adult Intelligence Scale (score range: 0-133; higher scores indicate better function) and the revised Hopkins Verbal Learning Test (HVLT-R; 12-item word list recall task) assessed in 1476 participants (90.3%). Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months.At 24 months, DSC task and HVLT-R scores (adjusted for clinic site, sex, and baseline values) were not different between groups. The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group (mean difference, -0.01 points [95% CI, -0.80 to 0.77 points], P = .97). The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group (mean difference, -0.03 words [95% CI, -0.29 to 0.24 words], P = .84). No differences for any other cognitive or composite measures were observed. Participants in the physical activity group who were 80 years or older (n = 307) and those with poorer baseline physical performance (n = 328) had better changes in executive function composite scores compared with the health education group (P = .01 for interaction for both comparisons). Incident MCI or dementia occurred in 98 participants (13.2%) in the physical activity group and 91 participants (12.1%) in the health education group (odds ratio, 1.08 [95% CI, 0.80 to 1.46]).Among sedentary older adults, a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function.clinicaltrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jama.2015.9617

  View details for Web of Science ID 000360017200018

  View details for PubMedCentralID PMC4698980

• Associations Between Ankle-Brachial Index and Cognitive Function: Results From the Lifestyle Interventions and Independence for Elders Trial JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Espeland, M. A., Newman, A. B., Sink, K., Gill, T. M., King, A. C., Miller, M. E., Guralnik, J., Katula, J., Church, T., Manini, T., Reid, K. F., McDermott, M. M. 2015; 16 (8): 682-689

  Abstract

  The objective of this study was to evaluate cross-sectional and longitudinal associations between ankle-brachial index (ABI) and indicators of cognitive function.Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial).Eight US academic centers.A total of 1601 adults ages 70-89 years, sedentary, without dementia, and with functional limitations.Baseline ABI and interviewer- and computer-administered cognitive function assessments were obtained. These assessments were used to compare a physical activity intervention with a health education control. Cognitive function was reassessed 24 months later (interviewer-administered) and 18 or 30 months later (computer-administered) and central adjudication was used to classify individuals as having mild cognitive impairment, probable dementia, or neither.Lower ABI had a modest independent association with poorer cognitive functioning at baseline (partial r = 0.09; P < .001). Although lower baseline ABI was not associated with overall changes in cognitive function test scores, it was associated with higher odds for 2-year progression to a composite of either mild cognitive impairment or probable dementia (odds ratio 2.60 per unit lower ABI; 95% confidence interval 1.06-6.37). Across 2 years, changes in ABI were not associated with changes in cognitive function.In an older cohort sedentary individuals with dementia and with functional limitations, lower baseline ABI was independently correlated with cognitive function and associated with greater 2-year risk for progression to mild cognitive impairment or probable dementia.

  View details for DOI 10.1016/j.jamda.2015.03.010

  View details for Web of Science ID 000358423400010

  View details for PubMedCentralID PMC4516564

• The MAT-sf: Identifying Risk for Major Mobility Disability JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Rejeski, W. J., Rushing, J., Guralnik, J. M., Ip, E. H., King, A. C., Manini, T. M., Marsh, A. P., McDermott, M. M., Fielding, R. A., Newman, A. B., Tudor-Locke, C., Gill, T. M. 2015; 70 (5): 641-646

  Abstract

  The assessment of mobility is essential to both aging research and clinical geriatric practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations as an innovative method to improve measurement accuracy/precision. The primary aim of the current study was to evaluate whether MAT-sf scores can be used to identify risk for major mobility disability (MMD).This article is based on data collected from the Lifestyle Interventions and Independence for Elders study and involved 1,574 older adults between the ages of 70-89. The MAT-sf was administered at baseline; MMD, operationalized as failure to complete the 400-m walk ≤ 15 minutes, was evaluated at 6-month intervals across a period of 42 months. The outcome of interest was the first occurrence of MMD or incident MMD.After controlling for age, sex, clinic site, and treatment arm, baseline MAT-sf scores were found to be effective in identifying risk for MMD (p < .0001). Partitioning the MAT-sf into four groups revealed that persons with scores <40, 40-49, 50-59, and 60+ had failure rates across 42 months of follow-up of 66%, 52%, 35%, and 22%, respectively.The MAT-sf is a quick and efficient way of identifying older adults at risk for MMD. It could be used to clinically identify older adults that are in need of intervention for MMD and provides a simple means for monitoring the status of patients' mobility, an important dimension of functional health.

  View details for DOI 10.1093/gerona/glv003

  View details for PubMedID 25680917

• Light Intensity Physical Activity and Sedentary Behavior in Relation to Body Mass Index and Grip Strength in Older Adults: Cross-Sectional Findings from the Lifestyle Interventions and Independence for Elders (LIFE) Study PLOS ONE Bann, D., Hire, D., Manini, T., Cooper, R., Botoseneanu, A., McDermott, M. M., Pahor, M., Glynn, N. W., Fielding, R., King, A. C., Church, T., Ambrosius, W. T., Gill, T. 2015; 10 (2)

  Abstract

  Identifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time-assessed both objectively and by self-report-with body mass index (BMI) and grip strength in a large sample of older adults.We used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3-7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression.Greater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength.In this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.

  View details for DOI 10.1371/journal.pone.0116058

  View details for PubMedID 25647685

• Association of objectively measured physical activity with cardiovascular risk in mobility-limited older adults. Journal of the American Heart Association Fitzgerald, J. D., Johnson, L., Hire, D. G., Ambrosius, W. T., Anton, S. D., Dodson, J. A., Marsh, A. P., McDermott, M. M., Nocera, J. R., Tudor-Locke, C., White, D. K., Yank, V., Pahor, M., Manini, T. M., Buford, T. W. 2015; 4 (2)

  Abstract

  Data are sparse regarding the impacts of habitual physical activity (PA) and sedentary behavior on cardiovascular (CV) risk in older adults with mobility limitations.This study examined the baseline, cross-sectional association between CV risk and objectively measured PA among participants in the Lifestyle Interventions and Independence for Elders (LIFE) study. The relationship between accelerometry measures and predicted 10-year Hard Coronary Heart Disease (HCHD) risk was modeled by using linear regression, stratified according to CVD history. Participants (n=1170, 79±5 years) spent 642±111 min/day in sedentary behavior (ie, <100 accelerometry counts/min). They also spent 138±43 min/day engaging in PA registering 100 to 499 accelerometry counts/min and 54±37 min/day engaging in PA ≥500 counts/min. Each minute per day spent being sedentary was associated with increased HCHD risk among both those with (0.04%, 95% CI 0.02% to 0.05%) and those without (0.03%, 95% CI 0.02% to 0.03%) CVD. The time spent engaging in activities 100 to 499 as well as ≥500 counts/min was associated with decreased risk among both those with and without CVD (P<0.05). The mean number of counts per minute of daily PA was not significantly associated with HCHD risk in any model (P>0.05). However, a significant interaction was observed between sex and count frequency (P=0.036) for those without CVD, as counts per minute was related to HCHD risk in women (β=-0.94, -1.48 to -0.41; P<0.001) but not in men (β=-0.14, -0.59 to 0.88; P=0.704).Daily time spent being sedentary is positively associated with predicted 10-year HCHD risk among mobility-limited older adults. Duration, but not intensity (ie, mean counts/min), of daily PA is inversely associated with HCHD risk score in this population-although the association for intensity may be sex specific among persons without CVD.www.clinicaltrials.gov Unique identifier: NCT01072500.

  View details for DOI 10.1161/JAHA.114.001288

  View details for PubMedID 25696062

• Prevalence of Metabolic Syndrome and Its Association with Physical Capacity, Disability, and Self-Rated Health in Lifestyle Interventions and Independence for Elders Study Participants JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Botoseneanu, A., Ambrosius, W. T., Beavers, D. P., De Rekeneire, N., Anton, S., Church, T., Folta, S. C., Goodpaster, B. H., King, A. C., Nicklas, B. J., Spring, B., Wang, X., Gill, T. M. 2015; 63 (2): 222-232

  Abstract

  To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self-rated health in older adults at high risk of mobility disability, including those with and without diabetes mellitus.Cross-sectional analysis.Lifestyle Interventions and Independence for Elders (LIFE) Study.Community-dwelling sedentary adults aged 70 to 89 at high risk of mobility disability (Short Physical Performance Battery (SPPB) score ≤9; mean 7.4 ± 1.6) (N = 1,535).Metabolic syndrome was defined according to the 2009 multiagency harmonized criteria; outcomes were physical capacity (400-m walk time, grip strength, SPPB score), disability (composite 19-item score), and self-rated health (5-point scale ranging from excellent to poor).The prevalence of MetS was 49.8% in the overall sample (83.2% of those with diabetes mellitus, 38.1% of those without). MetS was associated with stronger grip strength (mean difference (Δ) = 1.2 kg, P = .01) in the overall sample and in participants without diabetes mellitus and with poorer self-rated health (Δ = 0.1 kg, P < .001) in the overall sample only. No significant differences were found in 400-m walk time, SPPB score, or disability score between participants with and without MetS, in the overall sample or diabetes mellitus subgroups.Metabolic dysfunction is highly prevalent in older adults at risk of mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, or self-reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high-risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group.

  View details for DOI 10.1111/jgs.13205

  View details for Web of Science ID 000349893300002

  View details for PubMedID 25645664

  View details for PubMedCentralID PMC4333053

• Combined Reduced Forced Expiratory Volume in 1 Second (FEV1) and Peripheral Artery Disease in Sedentary Elders With Functional Limitations JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Fragoso, C. A., Hsu, F., Brinkley, T., Church, T., Liu, C. K., Manini, T., Newman, A. B., Stafford, R. S., McDermott, M. M., Gill, T. M. 2014; 15 (9): 665-670

  Abstract

  Because they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1 second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations.Cross sectional.Lifestyle Interventions and Independence in Elder (LIFE) Study.A total of 1307 sedentary community-dwelling persons, mean age 78.9, with functional limitations (Short Physical Performance Battery [SPPB] <10).A reduced FEV1 was defined by a z-score less than -1.64 (

  View details for DOI 10.1016/j.jamda.2014.05.008

  View details for Web of Science ID 000341167700011

  View details for PubMedID 24973990

  View details for PubMedCentralID PMC4145029

• Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults The LIFE Study Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Groessl, E. J., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Miller, M. E., Newman, A. B., Rejeski, W. J., Sink, K. M., Williamson, J. D. 2014; 311 (23): 2387-2396

  Abstract

  In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability.The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m.Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises.The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m.Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]).A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults.clinicaltrials.gov Identifier: NCT01072500.

  View details for DOI 10.1001/jama.2014.5616

  View details for Web of Science ID 000337301500019

• Sleep-Wake Disturbances in Sedentary Community-Dwelling Elderly Adults with Functional Limitations JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Fragoso, C. A., Miller, M. E., Fielding, R. A., King, A. C., Kritchevsky, S. B., McDermott, M. M., Myers, V., Newman, A. B., Pahor, M., Gill, T. M. 2014; 62 (6): 1064-1072

  Abstract

  To evaluate sleep-wake disturbances in sedentary community-dwelling elderly adults with functional limitations.Cross-sectional.Lifestyle Interventions and Independence in Elder (LIFE) Study.Community-dwelling persons (mean age 78.9) who spent fewer than 20 min/wk in the previous month engaged in regular physical activity and fewer than 125 min/wk of moderate physical activity, and had a Short Physical Performance Battery (SPPB) score of <10 (N = 1,635).Mobility was evaluated according to 400-m walk time (slow gait speed defined as <0.8 m/s) and SPPB score (≤ 7 defined moderate to severe mobility impairment). Physical inactivity was defined according to sedentary time, as a percentage of accelerometry wear time with activity of <100 counts/min; participants in the top quartile of sedentary time were classified as having a high sedentary time. Sleep-wake disturbances were evaluated using the Insomnia Severity Index (ISI) (range 0-28; ≥ 8 defined insomnia), Epworth Sleepiness Scale (ESS) (range 0-24; ≥ 10 defined daytime drowsiness), Pittsburgh Sleep Quality Index (PSQI) (range 0-21; >5 defined poor sleep quality), and Berlin Questionnaire (high risk of sleep apnea).Prevalence rates were 43.5% for slow gait speed and 44.7% for moderate to severe mobility impairment, with 77.0% of accelerometry wear time spent as sedentary time. Prevalence rates were 33.0% for insomnia, 18.1% for daytime drowsiness, 47.8% for poor sleep quality, and 32.9% for high risk of sleep apnea. Participants with insomnia had a mean ISI score of 12.1, those with daytime drowsiness had a mean ESS score of 12.5, and those with poor sleep quality had a mean PSQI score of 9.2. In adjusted models, measures of mobility and physical inactivity were generally not associated with sleep-wake disturbances, using continuous or categorical variables.In a large sample of sedentary community-dwelling elderly adults with functional limitations, sleep-wake disturbances were prevalent but only mildly severe and were generally not associated with mobility impairment or physical inactivity.

  View details for DOI 10.1111/jgs.12845

  View details for Web of Science ID 000337624300008

  View details for PubMedID 24889836

  View details for PubMedCentralID PMC4057978

• Respiratory Impairment and Dyspnea and Their Associations with Physical Inactivity and Mobility in Sedentary Community-Dwelling Older Persons JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Fragoso, C. A., Beavers, D. P., Hankinson, J. L., Flynn, G., Berra, K., Kritchevsky, S. B., Liu, C. K., McDermott, M., Manini, T. M., Rejeski, W. J., Gill, T. M. 2014; 62 (4): 622-628

  Abstract

  To evaluate the prevalence of respiratory impairment and dyspnea and their associations with objectively measured physical inactivity and performance-based mobility in sedentary older persons.Cross-sectional.Lifestyle Interventions and Independence for Elders Study.Community-dwelling older persons (n = 1,635, mean age 78.9) who reported being sedentary (<20 min/wk of regular physical activity and <125 min/wk of moderate physical activity in past month).Respiratory impairment was defined as low ventilatory capacity (forced expiratory volume in 1 second less than lower limit of normal (LLN)) and respiratory muscle weakness (maximal inspiratory pressure

  View details for DOI 10.1111/jgs.12738

  View details for Web of Science ID 000334289900004

  View details for PubMedCentralID PMC3989438

• Genetic influence on exercise-induced changes in physical function among mobility-limited older adults PHYSIOLOGICAL GENOMICS Buford, T. W., Hsu, F., Brinkley, T. E., Carter, C. S., Church, T. S., Dodson, J. A., Goodpaster, B. H., McDermott, M. M., Nicklas, B. J., Yank, V., Johnson, J. A., Pahor, M. 2014; 46 (5): 149-158

  Abstract

  To date, physical exercise is the only intervention consistently demonstrated to attenuate age-related declines in physical function. However, variability exists in seniors' responsiveness to training. One potential source of variability is the insertion (I allele) or deletion (D allele) of a 287 bp fragment in intron 16 of the angiotensin-converting enzyme (ACE) gene. This polymorphism is known to influence a variety of physiological adaptions to exercise. However, evidence is inconclusive regarding the influence of this polymorphism on older adults' functional responses to exercise. This study aimed to evaluate the association of ACE I/D genotypes with changes in physical function among Caucasian older adults (n = 283) following 12 mo of either structured, multimodal physical activity or health education. Measures of physical function included usual-paced gait speed and performance on the Short Physical Performance Battery (SPPB). After checking Hardy-Weinberg equilibrium, we used using linear regression to evaluate the genotype*treatment interaction for each outcome. Covariates included clinic site, body mass index, age, sex, baseline score, comorbidity, and use of angiotensin receptor blockers or ACE inhibitors. Genotype frequencies [II (19.4%), ID (42.4%), DD (38.2%)] were in Hardy-Weinberg equilibrium (P > 0.05). The genotype*treatment interaction was statistically significant for both gait speed (P = 0.002) and SPPB (P = 0.020). Exercise improved gait speed by 0.06 ± 0.01 m/sec and SPPB score by 0.72 ± 0.16 points among those with at least one D allele (ID/DD carriers), but function was not improved among II carriers. Thus, ACE I/D genotype appears to play a role in modulating functional responses to exercise training in seniors.

  View details for DOI 10.1152/physiolgenomics.00169.2013

  View details for Web of Science ID 000332245700001

  View details for PubMedID 24423970

  View details for PubMedCentralID PMC3949106

• Performance of a computer-based assessment of cognitive function measures in two cohorts of seniors INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Espeland, M. A., Katula, J. A., Rushing, J., Kramer, A. F., Jennings, J. M., Sink, K. M., Nadkarni, N. K., Reid, K. F., Castro, C. M., Church, T., Kerwin, D. R., Williamson, J. D., Marottoli, R. A., Rushing, S., Marsiske, M., Rapp, S. R. 2013; 28 (12): 1239-1250

  Abstract

  Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials; however, its performance in these settings has not been systematically evaluated.The Seniors Health and Activity Research Program pilot trial (N = 73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Elders investigators incorporated this battery in a full-scale multicenter clinical trial (N = 1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intraclass correlations [ICC]).Computer-based assessments of cognitive function had consistent relationships across the pilot and full-scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the Lifestyle Interventions and Independence for Elders cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures; however, rates of missing data were higher among older participants (odds ratio = 1.06 for each additional year; p < 0.001) and those who reported no current computer use (odds ratio = 2.71; p < 0.001). ICCs among clinics were at least as low (ICC < 0.013) as for interviewer measures (ICC < 0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance.Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals.

  View details for DOI 10.1002/gps.3949

  View details for Web of Science ID 000326466800004

  View details for PubMedID 23589390

  View details for PubMedCentralID PMC3775886

• Promoting physical activity for elders with compromised function: the Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity intervention CLINICAL INTERVENTIONS IN AGING Rejeski, W. J., Axtell, R., Fielding, R., Katula, J., King, A. C., Manini, T. M., Marsh, A. P., Pahor, M., Rego, A., Tudor-Locke, C., Newman, M., Walkup, M. P., Miller, M. E. 2013; 8: 1119-1131

  Abstract

  The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial (Clinicaltrials.gov identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70-89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants' motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31.4% of participants noted slight conflict with being able to meet the demands of the program and 6.4% indicated that the degree of conflict would be moderate. Accelerometry data collected during PA training revealed that the average intensity - 1,555 counts/minute for men and 1,237 counts/minute for women - was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults. Also, a sizable subgroup required one or more rest stops. These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function. Moreover, the concept of what constitutes "moderate" exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription.

  View details for DOI 10.2147/CIA.S49737

  View details for Web of Science ID 000324170300001

  View details for PubMedID 24049442

  View details for PubMedCentralID PMC3775623

• Determinants of Racial/Ethnic Disparities in Incidence of Diabetes in Postmenopausal Women in the U.S. The Women's Health Initiative 1993-2009 DIABETES CARE Ma, Y., Hebert, J. R., Manson, J. E., Balasubramanian, R., Liu, S., LaMonte, M. J., Bird, C. E., Ockene, J. K., Qiao, Y., Olendzki, B., Schneider, K. L., Rosal, M. C., Sepavich, D. M., Wactawski-Wende, J., Stefanick, M. L., Phillips, L. S., Ockene, I. S., Kaplan, R. C., Sarto, G. E., Garcia, L., Howard, B. V. 2012; 35 (11): 2226-2234

  Abstract

  To examine determinants of racial/ethnic differences in diabetes incidence among postmenopausal women participating in the Women's Health Initiative.Data on race/ethnicity, baseline diabetes prevalence, and incident diabetes were obtained from 158,833 women recruited from 1993-1998 and followed through August 2009. The relationship between race/ethnicity, other potential risk factors, and the risk of incident diabetes was estimated using Cox proportional hazards models from which hazard ratios (HRs) and 95% CIs were computed.Participants were aged 63 years on average at baseline. The racial/ethnic distribution was 84.1% non-Hispanic white, 9.2% non-Hispanic black, 4.1% Hispanic, and 2.6% Asian. After an average of 10.4 years of follow-up, compared with whites and adjusting for potential confounders, the HRs for incident diabetes were 1.55 for blacks (95% CI 1.47-1.63), 1.67 for Hispanics (1.54-1.81), and 1.86 for Asians (1.68-2.06). Whites, blacks, and Hispanics with all factors (i.e., weight, physical activity, dietary quality, and smoking) in the low-risk category had 60, 69, and 63% lower risk for incident diabetes. Although contributions of different risk factors varied slightly by race/ethnicity, most findings were similar across groups, and women who had both a healthy weight and were in the highest tertile of physical activity had less than one-third the risk of diabetes compared with obese and inactive women.Despite large racial/ethnic differences in diabetes incidence, most variability could be attributed to lifestyle factors. Our findings show that the majority of diabetes cases are preventable, and risk reduction strategies can be effectively applied to all racial/ethnic groups.

  View details for DOI 10.2337/dc12-0412

  View details for Web of Science ID 000311424100024

  View details for PubMedID 22833490

  View details for PubMedCentralID PMC3476929

• The Lifestyle Interventions and Independence for Elders Study: Design and Methods JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Fielding, R. A., Rejeski, W. J., Blair, S., Church, T., Espeland, M. A., Gill, T. M., Guralnik, J. M., Hsu, F., Katula, J., King, A. C., Kritchevsky, S. B., McDermott, M. M., Miller, M. E., Nayfield, S., Newman, A. B., Williamson, J. D., Bonds, D., Romashkan, S., Hadley, E., Pahor, M. 2011; 66 (11): 1226-1237

  Abstract

  As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

  View details for DOI 10.1093/gerona/glr123

  View details for Web of Science ID 000296102100011

  View details for PubMedID 21825283

• A Cost Analysis of a Physical Activity Intervention for Older Adults JOURNAL OF PHYSICAL ACTIVITY & HEALTH Groessl, E. J., Kaplan, R. M., Blair, S. N., Rejeski, W. J., Katula, J. A., King, A. C., Fielding, R. A., Glynn, N. W., Pahor, M. 2009; 6 (6): 767-774

  Abstract

  We examined the costs of a physical activity (PA) and an educational comparison intervention. 424 older adults at risk for mobility disability were randomly assigned to either condition. The PA program consisted of center-based exercise sessions 3x weekly for 8 weeks, 2x weekly for weeks 9 to 24 and weekly behavioral counseling for 10 weeks. Optional sessions were offered during maintenance weeks (25-52). The comparison intervention consisted of weekly education meetings for 24 weeks, and then monthly for 6 months. Cost analyses were conducted from the "payer's" perspective, with a 1-year time horizon. Intervention costs were estimated by tracking personnel activities and materials used for each intervention and multiplying by national unit cost averages. The average cost/participant was $1134 and $175 for the PA and the comparison interventions, respectively. A preliminary cost/effectiveness analysis gauged the cost/disability avoided to be $28,206. Costs for this PA program for older adults are comparable to those of other PA interventions. The results are preliminary and a longer study is required to fully assess the costs and health benefits of these interventions.

  View details for Web of Science ID 000282842100012

  View details for PubMedID 20101920

  View details for PubMedCentralID PMC3091594

• The impact of cognitive behavioral group training on event-free survival in patients with myocardial infarction: The ENRICHD experience JOURNAL OF PSYCHOSOMATIC RESEARCH Saab, P. G., Bang, H., Williams, R. B., Powell, L. H., Schneiderman, N., Thoresen, C., Burg, M., Keefe, F. 2009; 67 (1): 45-56

  Abstract

  Although the Enhancing Recovery in Coronary Heart Disease (ENRICHD) treatment was designed to include individual therapy and cognitive behavioral group training for patients with depression and/or low perceived social support, only 31% of treated participants received group training. Secondary analyses classified intervention participants into two subgroups, (1) individual therapy only or (2) group training (i.e., coping skills training) plus individual therapy, to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care.Secondary analyses of 1243 usual care, 781 individual therapy only, and 356 group plus individual therapy myocardial infarction (MI) patients were performed. Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; low perceived social support was determined by the ENRICHD Social Support Instrument. Psychosocial treatment followed MI, and for participants with severe or unremitting depression, was supplemented with a selective serotonin reuptake inhibitor. Cox proportional hazards regression was used to estimate intervention effects on time to first occurrence of the composite end point of death plus nonfatal MI. To control for confounding of group participation with survival (because individual sessions preceded group), we used risk set sampling to match minimal survival time of those receiving or not receiving group training.Analyses correcting for differential survival among comparison groups showed that group plus individual therapy was associated with a 33% reduction (hazard ratio=0.67; 95% confidence interval, 0.49-0.92, P=.01) in medical outcome compared to usual care. No significant effect on event-free survival was associated with individual therapy alone. The group training benefit was reduced to 23% (hazard ratio=0.77; 95% confidence interval: 0.56-1.07, P=.11) in the multivariate-adjusted model.Findings suggest that adding group training to individual therapy may be associated with reduction in the composite end point. A randomized controlled trial is warranted to definitively resolve this issue.

  View details for DOI 10.1016/j.jpsychores.2009.01.015

  View details for Web of Science ID 000267625300008

  View details for PubMedID 19539818

• Physical activity in prefrail older adults: Confidence and satisfaction related to physical function JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Rejeski, W. J., King, A. C., Katula, J. A., Kritchevsky, S., Miller, M. E., Walkup, M. P., Glynn, N. W., Pahor, M. 2008; 63 (1): P19-P26

  Abstract

  We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70+ years of age who have deficits in mobility. We randomized a total of 412 adults aged 70-89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months. Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention. Gender, age, and scores on a short physical performance battery did not moderate these effects. Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning. This is an important finding in light of the importance of these process variables in behavior change and quality of life.

  View details for Web of Science ID 000255893500005

  View details for PubMedID 18332190

• QUALITY OF LIFE IN SEDENTARY OLDER ADULTS PARTICIPATING IN A PHYSICAL ACTIVITY INTERVENTION Groessl, E. J., Kaplan, R. M., Rejeski, W., Katula, J. A., King, A. C., Frierson, G., Hsu, F., Walkup, M., Pahor, M. SPRINGER. 2007: S36

  View details for Web of Science ID 000261185300136

• Health-related quality of life in older adults at risk for disability AMERICAN JOURNAL OF PREVENTIVE MEDICINE Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A., King, A. C., Frierson, G., Glynn, N. W., Hsu, F., Walkup, M., Pahor, M. 2007; 33 (3): 214-218

  Abstract

  The number of older adults living in the United States continues to increase, and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability. The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study.The Lifestyle Interventions and Independence for Elders-Pilot study (LIFE-P) was a randomized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability. Baseline data (collected in April-December 2004, analyzed in 2006) included demographics, medical history, the Quality of Well-Being Scale (QWB-SA), a timed 400-m walk, and the Short Physical Performance Battery (SPPB). Descriptive health-related quality of life (HRQOL) data are presented. Hierarchical linear regression models were used to examine correlates of HRQOL.The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 (death) to 1.0 (asymptomatic, optimal functioning). The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults. The variables associated with lower HRQOL included white ethnicity, more comorbid conditions, slower 400-m walk times, and lower SPPB balance and chair stand scores.Older adults who are at risk for disability had reduced HRQOL. Surprisingly, however, mobility was a stronger correlate of HRQOL than an index of comorbidity, suggesting that interventions addressing mobility limitations may provide significant health benefits to this population.

  View details for DOI 10.1016/j.amerpe.2007.04.031

  View details for Web of Science ID 000249452700008

  View details for PubMedID 17826582

  View details for PubMedCentralID PMC1995005