Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to... more Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to identify high-, medium-, and low-risk impairment among older drivers and to explore high-risk drivers' reactions to being told their results. Of 67 adults screened from a convenience sample of older drivers, nine high-risk participants, four completed in-depth follow-up qualitative interviews. The quantitative assessment algorithm identified 13% as high risk, 30% as medium risk, and 57% as low risk, and only Trails B distinguished the medium- and high-risk impairment groups. Although the assessment tests did not predict future crash involvement over a 7-month period, four participants in the medium- and high-risk impairment categories had been involved in a crash during the 5 years prior to the study compared with none of those who screened low risk. Only three participants (1 high risk) voluntarily surrendered their driver's licenses after the assessment, and one participant in the in-depth interviews reported that the assessment influenced the decision to stop driving. There may be some benefit in using driving record history and assessment results to determine driving risk impairment level. However, more research is needed to determine the best combination of tools to predict risk level. How to best communicate risk levels remains to be determined, although results from the older drivers in this study underscore the need for great sensitivity when identifying areas of concern about driving ability.
One in five undergraduate women have reported experiencing sexual assault since entering college.... more One in five undergraduate women have reported experiencing sexual assault since entering college. This study aimed to: 1) review the literature on evaluated interventions addressing sexual assault on college campuses, 2) provide an analysis of this literature using the Haddon Matrix as an organising framework, and 3) identify gaps in the evidence and opportunities for research and practice. A systematic literature review was conducted in October 2016 using Pubmed, PsycINFO, and SCOPUS. Included studies were published in a peer-reviewed journal between January 2001 and September 2016, used an experimental or quasi-experimental design, were conducted with English speaking college undergraduate students in the US and reported on sexual assault, sexual violence, and/or rape experiences, knowledge, beliefs, and behaviours. Full text articles were reviewed, coded and categorised in the Haddon Phase-Factor Matrix. 194 abstracts were initially identified. After removing duplicates, 170 were reviewed for potential inclusion, and 29 articles were included. 21 studies were RCTs, 8 were quasi-experimental designs. Interventions varied across the studies, although many (n=14) involved bystander interventions. Most interventions were categorised as addressing the host (victim/potential victim) and the social environment (bystanders), and across all phases (pre-event, event, and post-event) of an assault. Impacts were typically assessed by self-report measures administered before the program and at least at one follow up point. Most studies reported a statistically significant change in at least one outcome measure, such as decreased rape myth acceptance and increased bystander efficacy and intentions. Few evaluated interventions were identified in the peer-reviewed literature. Few focused on the agent (perpetrator), and none addressed the physical environment (e.g., presence of security). These results can be used by professionals working to reduce sexual assault on college campuses to draw from the evidence about what works. A number of conceptual and practical gaps for future research are identified.
Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty d... more Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty death is heart attacks. Previous programs designed to improve the health of firefighters have primari...
The choice of coronary artery bypass grafting (CABG) as an intervention for coronary artery disea... more The choice of coronary artery bypass grafting (CABG) as an intervention for coronary artery disease has been clouded by concerns about postoperative cognitive decline. Long-term cognitive decline after CABG has been reported, but without appropriate control subjects, it is not known whether this decline is specific to CABG or related to other factors such as cerebrovascular disease. This prospective, observational study of patients with diagnosed coronary artery disease included 152 CABG and 92 nonsurgical cardiac comparison patients from one institution. The main outcome measure was within-patient change in cognitive performance for eight cognitive domains from baseline to 12- and 72-month follow-up. Mild late cognitive decline was observed for both study groups, but despite greater than 80% power to detect a 0.2 standard deviation difference, there were no statistically significant differences between the surgical and nonsurgical patients in the degree of change from 12 to 72 months for any cognitive domain. There was also no difference between groups in the degree of change from baseline to 72 months or in the number of patients with a Mini-Mental State Examination score in the clinically impaired range at 72 months. Late cognitive decline does occur in patients who have undergone CABG surgery, but the degree of this decline does not differ from that observed in patients of similar age with coronary artery disease who have not undergone CABG. Therefore, late cognitive decline after CABG is not specific to the use of cardiopulmonary bypass.
Abstract. Background and purpose: Impaired cardiac function can adversely affect the brain via de... more Abstract. Background and purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF) is associated with cognitive performance, and whether this is modified by low blood pressure. Methods: Neuropsychological testing evaluating multiple cognitive domains, measurement of mean arterial pressure (MAP), and measurement of EF were performed in 234 individuals with coronary artery disease. The association between level of EF and performance within each cognitive domain was explored, as was the interaction between low MAP and EF. Results: Adjusted global cognitive performance, as well as performance in visuoconstruction and motor speed, was significantly directly associated with cardiac EF. This relationship was not entirely linear, with a steeper association between EF and cognition at lower levels of EF than at higher levels. Patients with low EF and low MAP at the time of testing ha...
Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty d... more Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty death is heart attacks. Previous programs designed to improve the health of firefighters have primari...
Data Revues 00283878 V65i7 S0028387805603202, Aug 22, 2011
It is widely assumed that decline in cognition after coronary artery bypass grafting (CABG) is re... more It is widely assumed that decline in cognition after coronary artery bypass grafting (CABG) is related to use of the cardiopulmonary bypass pump. Because most studies have not included comparable control groups, it remains unclear whether postoperative cognitive changes are specific to cardiopulmonary bypass, general aspects of surgery, or vascular pathologies of the aging brain. This nonrandomized study included four groups: CABG patients (n = 140); off-pump coronary surgery (n = 72); nonsurgical cardiac controls (NSCC) with diagnosed coronary artery disease but no surgery (n = 99); and heart healthy controls (HHC) with no cardiac risk factors (n = 69). Subjects were evaluated at baseline (preoperatively), 3 months, and 12 months. Eight cognitive domains and a global cognitive score, as well as depressive and subjective symptoms were analyzed. At baseline, patients with coronary artery disease (CABG, off-pump, and NSCC) had lower performance than the HHC group in several cognitive domains. By 3 months, all groups had improved. From 3 to 12 months, there were minimal intrasubject changes for all groups. No consistent differences between the CABG and off-pump patients were observed. Compared with heart healthy controls (HHC), the groups with coronary artery disease had lower cognitive test scores at baseline. There was no evidence that the cognitive test performance of coronary artery bypass grafting (CABG) patients differed from that of control groups with coronary artery disease over a 1-year period. This study emphasizes the need for appropriate control groups for interpreting longitudinal changes in cognitive performance after CABG.
Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to... more Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to identify high-, medium-, and low-risk impairment among older drivers and to explore high-risk drivers' reactions to being told their results. Of 67 adults screened from a convenience sample of older drivers, nine high-risk participants, four completed in-depth follow-up qualitative interviews. The quantitative assessment algorithm identified 13% as high risk, 30% as medium risk, and 57% as low risk, and only Trails B distinguished the medium- and high-risk impairment groups. Although the assessment tests did not predict future crash involvement over a 7-month period, four participants in the medium- and high-risk impairment categories had been involved in a crash during the 5 years prior to the study compared with none of those who screened low risk. Only three participants (1 high risk) voluntarily surrendered their driver's licenses after the assessment, and one participant in the in-depth interviews reported that the assessment influenced the decision to stop driving. There may be some benefit in using driving record history and assessment results to determine driving risk impairment level. However, more research is needed to determine the best combination of tools to predict risk level. How to best communicate risk levels remains to be determined, although results from the older drivers in this study underscore the need for great sensitivity when identifying areas of concern about driving ability.
One in five undergraduate women have reported experiencing sexual assault since entering college.... more One in five undergraduate women have reported experiencing sexual assault since entering college. This study aimed to: 1) review the literature on evaluated interventions addressing sexual assault on college campuses, 2) provide an analysis of this literature using the Haddon Matrix as an organising framework, and 3) identify gaps in the evidence and opportunities for research and practice. A systematic literature review was conducted in October 2016 using Pubmed, PsycINFO, and SCOPUS. Included studies were published in a peer-reviewed journal between January 2001 and September 2016, used an experimental or quasi-experimental design, were conducted with English speaking college undergraduate students in the US and reported on sexual assault, sexual violence, and/or rape experiences, knowledge, beliefs, and behaviours. Full text articles were reviewed, coded and categorised in the Haddon Phase-Factor Matrix. 194 abstracts were initially identified. After removing duplicates, 170 were reviewed for potential inclusion, and 29 articles were included. 21 studies were RCTs, 8 were quasi-experimental designs. Interventions varied across the studies, although many (n=14) involved bystander interventions. Most interventions were categorised as addressing the host (victim/potential victim) and the social environment (bystanders), and across all phases (pre-event, event, and post-event) of an assault. Impacts were typically assessed by self-report measures administered before the program and at least at one follow up point. Most studies reported a statistically significant change in at least one outcome measure, such as decreased rape myth acceptance and increased bystander efficacy and intentions. Few evaluated interventions were identified in the peer-reviewed literature. Few focused on the agent (perpetrator), and none addressed the physical environment (e.g., presence of security). These results can be used by professionals working to reduce sexual assault on college campuses to draw from the evidence about what works. A number of conceptual and practical gaps for future research are identified.
Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty d... more Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty death is heart attacks. Previous programs designed to improve the health of firefighters have primari...
The choice of coronary artery bypass grafting (CABG) as an intervention for coronary artery disea... more The choice of coronary artery bypass grafting (CABG) as an intervention for coronary artery disease has been clouded by concerns about postoperative cognitive decline. Long-term cognitive decline after CABG has been reported, but without appropriate control subjects, it is not known whether this decline is specific to CABG or related to other factors such as cerebrovascular disease. This prospective, observational study of patients with diagnosed coronary artery disease included 152 CABG and 92 nonsurgical cardiac comparison patients from one institution. The main outcome measure was within-patient change in cognitive performance for eight cognitive domains from baseline to 12- and 72-month follow-up. Mild late cognitive decline was observed for both study groups, but despite greater than 80% power to detect a 0.2 standard deviation difference, there were no statistically significant differences between the surgical and nonsurgical patients in the degree of change from 12 to 72 months for any cognitive domain. There was also no difference between groups in the degree of change from baseline to 72 months or in the number of patients with a Mini-Mental State Examination score in the clinically impaired range at 72 months. Late cognitive decline does occur in patients who have undergone CABG surgery, but the degree of this decline does not differ from that observed in patients of similar age with coronary artery disease who have not undergone CABG. Therefore, late cognitive decline after CABG is not specific to the use of cardiopulmonary bypass.
Abstract. Background and purpose: Impaired cardiac function can adversely affect the brain via de... more Abstract. Background and purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF) is associated with cognitive performance, and whether this is modified by low blood pressure. Methods: Neuropsychological testing evaluating multiple cognitive domains, measurement of mean arterial pressure (MAP), and measurement of EF were performed in 234 individuals with coronary artery disease. The association between level of EF and performance within each cognitive domain was explored, as was the interaction between low MAP and EF. Results: Adjusted global cognitive performance, as well as performance in visuoconstruction and motor speed, was significantly directly associated with cardiac EF. This relationship was not entirely linear, with a steeper association between EF and cognition at lower levels of EF than at higher levels. Patients with low EF and low MAP at the time of testing ha...
Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty d... more Over 80% of firefighters are classified as overweight or obese and the primary cause of on-duty death is heart attacks. Previous programs designed to improve the health of firefighters have primari...
Data Revues 00283878 V65i7 S0028387805603202, Aug 22, 2011
It is widely assumed that decline in cognition after coronary artery bypass grafting (CABG) is re... more It is widely assumed that decline in cognition after coronary artery bypass grafting (CABG) is related to use of the cardiopulmonary bypass pump. Because most studies have not included comparable control groups, it remains unclear whether postoperative cognitive changes are specific to cardiopulmonary bypass, general aspects of surgery, or vascular pathologies of the aging brain. This nonrandomized study included four groups: CABG patients (n = 140); off-pump coronary surgery (n = 72); nonsurgical cardiac controls (NSCC) with diagnosed coronary artery disease but no surgery (n = 99); and heart healthy controls (HHC) with no cardiac risk factors (n = 69). Subjects were evaluated at baseline (preoperatively), 3 months, and 12 months. Eight cognitive domains and a global cognitive score, as well as depressive and subjective symptoms were analyzed. At baseline, patients with coronary artery disease (CABG, off-pump, and NSCC) had lower performance than the HHC group in several cognitive domains. By 3 months, all groups had improved. From 3 to 12 months, there were minimal intrasubject changes for all groups. No consistent differences between the CABG and off-pump patients were observed. Compared with heart healthy controls (HHC), the groups with coronary artery disease had lower cognitive test scores at baseline. There was no evidence that the cognitive test performance of coronary artery bypass grafting (CABG) patients differed from that of control groups with coronary artery disease over a 1-year period. This study emphasizes the need for appropriate control groups for interpreting longitudinal changes in cognitive performance after CABG.
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