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3-beta-hydroxysteroid-Delta(8),Delta(7)-isomerase (EC (Cholestenol Delta-isomerase) (Delta(8)-Delta(7) sterol isomerase) (D8-D7 sterol isomerase) (Emopamil-binding protein)


National dissemination of multiple evidence-based disease prevention programs: reach to vulnerable older adults.

Older adults, who are racial/ethnic minorities, report multiple chronic conditions, reside in medically underserved rural areas, or have low incomes carry a high burden of chronic illness but traditionally lack access to disease prevention programs. The Chronic Disease Self-Management Program (CDSMP), A Matter of Balance/Volunteer Lay Leader (AMOB/VLL), and EnhanceFitness (EF) are widely disseminated evidence-based programs (EBP), but the extent to which they are simultaneously delivered in communities to reach vulnerable populations has not been documented. We conducted cross-sectional analyses of three EBP disseminated within 27 states throughout the United States (US) (2006-2009) as part of the Administration on Aging (AoA) Evidence-Based Disease and Disability Prevention Initiative, which received co-funding from the Atlantic Philanthropies. This study measures the extent to which CDSMP, AMOB/VLL, and EF reached vulnerable older adults. It also examines characteristics of communities offering one of these programs relative to those simultaneously offering two or all three programs. Minority/ethnic participants represented 38% for CDSMP, 26% for AMOB/VLL, and 43% for EF. Rural participation was 18% for CDSMP, 17% for AMOB/VLL, and 25% for EF. Those with comorbidities included 63.2% for CDSMP, 58.7% for AMOB/VLL, and 63.6% for EF while approximately one-quarter of participants had incomes under $15,000 for all programs. Rural areas and health professional shortage areas (HPSA) tended to deliver fewer EBP relative to urban areas and non-HPSA. These EBP attract diverse older adult participants. Findings highlight the capability of communities to serve potentially vulnerable older adults by offering multiple EBP. Because each program addresses unique issues facing this older population, further research is needed to better understand how communities can introduce, embed, and sustain multiple EBP to ensure widespread access and utilization, especially to traditionally underserved subgroups.


  • aging health
  • community intervention
  • evidence-based programs
  • minority adults
  • older adults

Roles for education in development and implementation of evidence-based practices for community programs for older adults.

It is essential for key stakeholders in evidence-based practice (EBP) to be informed about barriers and achievements in EBP and collaborate in developing and implementing EBP. This article provides information to assist educators, students, practitioners, clients, and researchers who are stakeholders in use of EBP in community-based aging programs to understand barriers to EBP and approaches for developing and implementing EBP. Highlighting roles of education in EBP, the authors describe barriers to EBP; use of education to address gaps among research, education, and practice for EBP; cultural competence; and educational approaches for community-based implementation. EBP has been central to development of quality health and social services for older adults, but challenges remain in translation of research findings into EBP. Examples of programs in which research, education, and practice are linked for provision of EBP, as well as educational resources and tools for developing and implementing EBP, are identified.

MeSH Terms

  • Communication Barriers
  • Community Health Services
  • Community Networks
  • Evidence-Based Practice
  • Geriatrics
  • Health Services for the Aged
  • Humans
  • Inservice Training
  • Needs Assessment
  • Quality Improvement
  • Translational Medical Research


  • EBP
  • community-based aging services
  • evidence-based practice
  • gerontology education
  • gerontology practice

Methods for streamlining intervention fidelity checklists: an example from the chronic disease self-management program.

Maintaining intervention fidelity should be part of any programmatic quality assurance (QA) plan and is often a licensure requirement. However, fidelity checklists designed by original program developers are often lengthy, which makes compliance difficult once programs become widely disseminated in the field. As a case example, we used Stanford's original Chronic Disease Self-Management Program (CDSMP) fidelity checklist of 157 items to demonstrate heuristic procedures for generating shorter fidelity checklists. Using an expert consensus approach, we sought feedback from active master trainers registered with the Stanford University Patient Education Research Center about which items were most essential to, and also feasible for, assessing fidelity. We conducted three sequential surveys and one expert group-teleconference call. Three versions of the fidelity checklist were created using different statistical and methodological criteria. In a final group-teleconference call with seven national experts, there was unanimous agreement that all three final versions (e.g., a 34-item version, a 20-item version, and a 12-item version) should be made available because the purpose and resources for administering a checklist might vary from one setting to another. This study highlights the methodology used to generate shorter versions of a fidelity checklist, which has potential to inform future QA efforts for this and other evidence-based programs (EBP) for older adults delivered in community settings. With CDSMP and other EBP, it is important to differentiate between program fidelity as mandated by program developers for licensure, and intervention fidelity tools for providing an "at-a-glance" snapshot of the level of compliance to selected program indicators.


  • Chronic Disease Self-Management Program
  • aging
  • evidence-based programs
  • expert consensus
  • intervention fidelity
  • quality assurance

Prevalence and risk factors of undetected elevated blood pressure in an elderly Southeast Asian population.

Data on the prevalence of Hypertension (HTN) among elderly Asians is limited. We investigated the prevalence of elevated blood pressure (EBP) and its risk factors in a multiracial Southeast Asian elderly population who participated in the National Kidney Foundation Singapore nationwide screening programme. Among 19,848 subjects > or =65 years (approximately 6% of the total Singapore population), the mean age was 70.6 /- 5.26 yrs. After excluding 36.6% with known HTN, analysis revealed that 5,889 (46.8%) of the remaining population had previously undetected EBP > 140/90. Increasing age, male gender, BMI > or =23 kg/m2 and pre-existing diabetes were significantly associated with previously undetected EBP on multivariate analysis. 6% of cases with undetected EBP had proteinuria suggestive of longstanding EBP and renal damage. We conclude that there is a high prevalence of undetected EBP in elderly Asians, suggesting the need for increased efforts in screening in the elderly population.

MeSH Terms

  • Aged
  • Asia, Southeastern
  • Continental Population Groups
  • Female
  • Geriatrics
  • Humans
  • Hypertension
  • Male
  • Mass Screening
  • Prevalence
  • Proteinuria
  • Risk Factors
  • Surveys and Questionnaires

Role of the serum estrogen-binding protein in the control of tissue estradiol levels during postnatal development of the female rat.

The role of the serum estrogen-binding protein (EBP) in the control of tissue estradiol levels during postnatal development of the female rat was examined. The estradiol-binding capacity of serum from the 1-day-old rats far exceeded the physiological level of estradiol in serum. The binding capacity decreased exponentially during the first 5 weeks of life to reach the low adult level at about the time of vaginal opening on day 37. From these observations one would predict that EBP would bind estradiol in the serum of the neonate, thereby preventing tissue uptake of the hormone. As the levels of EBP decline with advancing age, there should be a corresponding shift in the distribution of estradiol from serum to tissues. We have taken in vivo and in vitro approaches to evaluate these proposals. Female rats of various ages (1 day to 1 yr old) were sacrificed 1 h after [3H]estradiol injection and the radioactivity in serum and tissues was determined. During the first 11 days of life, the concentration of [3H]estradiol in serum was greater than the concentration of this hormone in estrogen-sensitive (uterus) and insensitive (lung, cerebral cortex, and diaphragm) tissues. Tissue to serum ratios of [3H]estradiol increased progressively between 13-34 days and then plateaued at about the time of puberty (37 days of age) at levels which were 50- to 150-fold greater than those observed in the neonate. The increase in tissue to serum ratios of [3H]estradiol during postnatal development probably resulted from the decline in serum EBP, since injection of neonatal serum into 28-day-old rats reduced tissue to serum ratios of [3H]estradiol to levels which were similar to those observed in 16-day-old animals. To determine the effects of EBP on uterine uptake of estradiol in vitro, uteri from 21-day-old rats were incubated with [3H]estradiol and serum obtained from rats of various ages. As the concentration of serum EBP declined with advancing serum donor age, there was a corresponding increase in the uterine uptake of [3H]estradiol. These results suggest that the decline in EBP is responsible for the progressive increase in tissue to serum ratios of estradiol during the first 5 weeks of life. It is suggested that the increase in tissue to serum ratios of estradiol between days 13-37 postpartum is an important factor in the initiation of estrogenic events during postnatal sexual maturation in the female rat.

MeSH Terms

  • Aging
  • Animals
  • Carrier Proteins
  • Estradiol
  • Female
  • Rats
  • Uterus
  • alpha-Fetoproteins