Combined effects of social isolation and loneliness on patient-reported outcomes in older adults with HIV.

Social isolation exists when one has limited contact with others and is distinct from loneliness, an affective state on the perception of isolation. Less is known about the combined effects of social isolation and loneliness (SI/L) in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50; N = 146), we assessed the overlap between SI/L and the separate and combined effects of SI/L on patient-reported outcomes (quality-of-life [QoL], HIV-related stigma, and depressive symptoms). Social isolation and loneliness were assessed using Social Network Index and the PROMIS-Social Isolation Scale, respectively, and based on each score, participants were grouped into four categories: "lonely only", "isolated only", "lonely+isolated", or "neither". Among participants (mean age = 56.53), 26.7% were considered "lonely only", 12.3% were "isolated only", 15.1% were "lonely+isolated", and 45.9% were "neither". Adjusted regression models showed that lonely+isolated group had more depressive symptoms and lower QoL than those considered "neither" or "isolated only" (p < .001) and that. The adjusted proportional odds model showed that the odds of stigma were 1.22 and 6.06 higher than those considered "neither" (p < .001) or "lonely only" (p = .016). Results demonstrate the combined effects of SI/L on patient-reported outcomes among OPWH. Findings highlight the need for approaches targeting OPWH who are lonely and isolated.

Brief virtual intervention associated with increased social engagement and decreased negative affect among people aging with HIV.

Virtual Villages-online communities that deliver supports to promote aging in place-are proposed to mitigate isolation and support the health of aging populations. Using a community-engaged approach, we developed and pilot-tested a Virtual Village intervention tailored for people living with HIV (PLWH) aged 50+ . The intervention employed a Discord server featuring social interaction, regional and national resources, expert presentations, and mindful meditation exercises. In 2022, a sample of PLWH aged 50+ from three U.S. study sites participated in a four-week pilot. Pre- and post-intervention surveys assessed participants' demographic characteristics; degree of loneliness, social connectedness, HIV-related stigma, and technology acceptance; mental wellbeing and physical health outcomes; and user experience. Participants (N = 20) were socioeconomically and racially/ethnically diverse, aged 51-88 years, and predominantly identified as gay or bisexual men (75%). Paired t-tests revealed a significant increase in participants' mean social engagement scores and a significant decrease in participants' mean negative affect scores, following the intervention. User experience scores were acceptable and participants reported a positive sense of connectedness to the Virtual Village community. Results suggest that a virtual community can be accessible to older PLWH and may enhance social engagement and improve aspects of mental wellbeing.

Economic and social determinants of health care utilization during the first wave of COVID-19 pandemic among adults in Ghana: a population-based cross-sectional study.

BACKGROUND: The COVID-19 pandemic had socioeconomic effects in Africa. This study assessed the social and economic determinants of healthcare utilization during the first wave of COVID-19 among adults in Ghana. METHODS: Information about individuals residing in Ghana was derived from a survey conducted across multiple countries, aiming to evaluate the impact of the COVID-19 pandemic on the mental health and overall well-being of adults aged 18 and above. The dependent variable for the study was healthcare utilization (categorized as low or high). The independent variables were economic (such as financial loss, job loss, diminished wages, investment/retirement setbacks, and non-refunded travel cancellations) and social (including food scarcity, loss of financial support sources, housing instability, challenges affording food, clothing, shelter, electricity, utilities, and increased caregiving responsibilities for partners) determinants of health. A multinomial logistic regression was conducted to identify factors associated with healthcare utilization after adjusting for confounders (age, gender, access to medical insurance, COVID-19 status, educational background, employment, and marital status of the participants). RESULTS: The analysis included 364 responses. Individuals who encountered a loss of financial support (AOR: 9.58; 95% CI: 3.44-26.73; p < 0.001), a decrease or loss of wages (AOR: 7.44, 95% CI: 3.05-18.16, p < 0.001), experienced investment or retirement setbacks (AOR: 10.69, 95% CI: 2.60-43.88, p = 0.001), and expressed concerns about potential food shortages (AOR: 6.85, 95% CI: 2.49-18.84, p < 0.001) exhibited significantly higher odds of low healthcare utilization during the initial phase of the pandemic. Contrastingly, participants facing challenges in paying for basic needs demonstrated lower odds of low healthcare utilization compared to those who found it easy to cover basic expenses (AOR: 0.19, 95% CI: 0.06-0.67, p = 0.001). CONCLUSION: Economic and social factors were associated with low healthcare utilization in Ghana during the first wave of the pandemic. Investment or retirement loss and financial support loss during the pandemic had the largest effect on healthcare utilization. Further research is needed to understand the connection between concerns about food shortages, welfare losses during pandemics and healthcare utilization during pandemics in Ghana.

Social network size and its relationship to domains of quality-of-life among older persons living with HIV.

Gerontological research suggests that social network characteristics are key elements of successful aging as they are related to a positive quality-of-life (QoL). Less is known about the social networks of persons aging with HIV. To describe social network characteristics and assess the effect of social network size on QoL, a sample of 146 OPWH (age ≥50) was recruited from an outpatient HIV clinic in Atlanta, GA. Social network size was assessed using Cohen's social network index (SNI). Domains of QoL (physical, emotional, and social) were assessed using the RAND-36. Descriptive analyses were used to determine the frequency of contact within social networks and multivariable regression models were used to assess the relationship between SNI and three domains of QoL controlling for potential covariates. Participants were predominantly male (60%), heterosexual (63%), and African American (86%). Regular contact occurred most frequently with friends (82%) and relatives (77%). Multivariable modeling revealed that SNI explained 58% of the variance in emotional QoL (R2 = 0.58, F(8, 137) = 25.48, p < .001). Findings provide basis for potential interventions focused on the specific social network to improve emotional QoL of this vulnerable population.

Comparing advance care planning between older adults with and without HIV.

We compared completion of advance directives (AD), designation of a healthcare proxy, and stage in the advance care planning process (pre-contemplation/contemplation, preparation/action) between older adults with (N = 110) and without (N = 50) HIV. Participants' mean age was 61.3, most identified as male (82%) and sexual minorities (74%), were racially/ethnically diverse (44% white, 28% Latinx, 16% Black); 37% had an AD and 44% had a healthcare proxy. In adjusted logistic regressions, HIV- individuals had higher odds of being in preparation/action for having an AD (aOR: 2.6) and healthcare proxy (aOR: 3.6) compared to people living with HIV. Older age (aOR: 1.1) and having a sense of greater purpose in life (aOR: 2.1) were also positively associated with being in the preparation/action stage for having a healthcare proxy.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic.

BACKGROUND: Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures. METHODS: We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect. RESULTS: Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries. CONCLUSION: The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.

A multi-country survey on access to healthcare and treatment services among individuals with critical medical care needs during the first wave of the pandemic.

BACKGROUND: Healthcare services were significantly interrupted during the early phase of the COVID-19 pandemic. The aim of the present study was to determine the associations between sociodemographic factors and healthcare access during the first wave of the COVID-19 pandemic among individuals with critical care needs. METHODS: This was a secondary analysis of the data of 5,156 participants recruited from 152 countries during the first wave of the COVID-19 pandemic. The dependent variables were self-reported difficulty of access to health care, challenges with obtaining medication, and the use of alternative medical services. The independent variables were age at last birthday; sex at birth, level of education, employment status and the macro-social vulnerability status. The confounding variable was the country income level. Three multivariable logistic regression analyses were conducted to determine the associations between the dependent variables and the independent variables after adjusting for the confounder. RESULTS: Difficulty accessing health care services and obtaining medications was experienced by 1922 (37.3%) and 3746 (72.7%) participants respectively. Also, 1433 (27.8%) used alternative medical care. Retirees (AOR:1.59), unemployed (AOR:1.198), people living with HIV (AOR:2.36) and at increased risk of COVID-19 (AOR:2.10), people who used drugs (AOR:1.83) and transacted sex (AOR:1.971) had significantly higher odds for reporting difficulty with access to health care. Males (AOR:1.23), respondents with secondary level of education (AOR:1.39), retirees (AOR:2.19), unemployed (AOR:1.47), people living with HIV (AOR:2.46), people who used drugs (AOR:1.79), transacted sex (AOR:2.71) and those who might be (AOR: 1.66) and were at (AOR: 2.3) increased risk of severe COVID-19 had significantly higher odds for reporting difficulty with access to medications. People who used drugs (AOR:2.093) transacted sex (AOR:1.639), who might be (AOR: 1.211) and were at (AOR: 1.511) increased risk of severe COVID-19, and who had difficulty accessing usual healthcare (AOR: 9.047) and obtaining medications (AOR:2.16) had significantly higher odds of reporting alternative medical care use. People living with HIV (AOR:0.562) had significantly lower odds of using alternative medical care. CONCLUSION: We identified populations who had challenges with access to healthcare and obtaining medications used alternative medical care except for people living with HIV. Priority attention should be given to alternative medical care use during future health pandemics.

A multi-country study of the associations between HIV vulnerability status, perception of COVID-19 related stigma and post-traumatic stress symptoms during the first wave of the pandemic.

BACKGROUND: This study investigated the associations between COVID-19 related stigma and post-traumatic stress symptoms (PTSS); and the associations between PTSS and COVID-19 related stigma, HIV status, COVID-19 status and key HIV population status. METHODS: This was a secondary analysis of data of 12,355 study participants generated through an online survey that recruited adults from 152 countries between July and December 2020. The dependent variables were COVID-19-related stigma and PTSS. The independent variables were HIV status (positive/negative), transaction sex (yes/no), use of psychoactive drugs (yes/no), and vulnerability status (transaction sex workers, people who use psychoactive drugs, living with HIV, and COVID-19 status). The confounding variables were age, sex at birth (male/female), level of education, sexual minority individuals (yes/no) and country income level. Multivariable logistic regression analyses were conducted to determine associations between the dependent and independent variables after adjusting for confounders. RESULTS: There were 835 (6.8%) participants who experienced COVID-19 related stigma during the pandemic and 3,824 (31.0%) participants reported PTSS. Respondents who were living with HIV (AOR: 1.979; 95%CI: 1.522-2.573), tested positive for COVID-19 (AOR: 3.369; 95%CI: 2.692-4.217), engaged in transactional sex (AOR: 1.428; 95%CI: 1.060-1.922) and used psychoactive drugs (AOR: 1.364; 95%CI: 1.053-1.767) had significantly higher odds of experiencing COVID-19 related stigma. Individuals with vulnerability status (AOR:4.610; 95%CI: 1.590-13.368) and who experienced COVID-19 related stigma (AOR: 2.218; 95%CI: 1.920-2.561) had significantly higher odds of PTSS. CONCLUSION: Individuals with vulnerability status may be at increased risk for COVID-19 related stigma. Key and vulnerable populations who were living with HIV and who experienced stigma may be at a higher risk of experiencing PTSS. Populations at risk for PTSS should be routinely screened and provided adequate support when they contract COVID-19 to reduce the risk for poor mental health during COVID-19 outbreaks and during future health crisis with similar magnitude as the COVID-19 pandemic.

The impact of life stress, psychological resources, and proactive behaviors on quality of life among people living with HIV.

OBJECTIVES: Quality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL. METHODS: Secondary analyses were performed (N = 128 PWH). Participants' mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses. RESULTS: In series 1, greater stress was associated with poorer life satisfaction (p < 0.001), lower self-rated successful aging (p < 0.001), and greater depression (p < 0.001). Functional impairment was associated with lower successful aging (p = 0.017) and greater depression (p = 0.001). In series 2, which accounted for mastery, resilience, social support, as well as demographic covariates, mastery was associated with greater life satisfaction (p = 0.038). In series 3, stress, functional impairment, leisure activities, and ART management were added to the model and social support was associated with engagement in leisure activities (p < 0.001), which was associated with better successful aging (p = 0.006). Fit indices suggested adequate relative fit. In bootstrapped analyses of indirect effects, social support was indirectly associated with successful aging through leisure activities (p = 0.020). CONCLUSIONS: QoL, as captured by self-rated successful aging, is threatened by stress but positively influenced by social support and engaging in leisure activities. Findings support a model of proactive successful aging for PWH.

Interpersonal dysfunction predicts subsequent financial exploitation vulnerability in a sample of adults over 50: a prospective observational study.

OBJECTIVES: The goal of this study was to test whether interpersonal dysfunction, characterized by loneliness and/or dissatisfaction with relationships, is an imminent predictor of financial exploitation vulnerability (FEV) among adults age 50+ within a 6-month observation period. This study also tests whether FEV prospectively predicts interpersonal dysfunction. METHODS: Twenty-six adults aged 50 or older completed a study involving baseline data collection and 13 follow-ups over 6 months. Linear mixed models were used for primary analyses. RESULTS: After adjustment for demographic, psychological and cognitive covariates, there were between-person effects of FEV and interpersonal dysfunction across follow-ups, suggesting that those with generally higher interpersonal dysfunction compared to other participants also reported greater FEV (B(SE) = 1.09(.33), p = .003). There was a within-person effect (B(SE) = .08(.03), p = .007) of elevated interpersonal dysfunction predicting greater FEV two weeks later across all follow-ups. Within-person effect of FEV was not predictive of interpersonal dysfunction (B(SE) = .25(.15), p = .10). There was also a significant effect of age (B(SE) = -.06(.02), p = .007), such that older individuals had lower FEV throughout follow-ups. CONCLUSION: Among adults age 50+, individuals with higher interpersonal dysfunction relative to others in the study reported greater FEV throughout the 6-month observation period. Increased loneliness and social dissatisfaction, relative to one's average level, predicts subsequent increases in FEV, and may be an imminent risk factor for exploitation.

Risk indicators for oral ulcers among people living with HIV during the first wave of the pandemic: a cross sectional study.

BACKGROUND: Little is currently known about HIV-related parameters that may increase the risk for oral ulcers during the COVID-19 pandemic. This study aimed to overcome this gap in research by assessing the associations between HIV viral load, antiretroviral adherence profile, co-morbidity status, SARS-CoV-2 infection and oral ulcers among people living with HIV (PLHIV). METHODS: This was a secondary analysis of data generated from 21,206 to 18 years and above, recruited from 152 countries through an online survey between July and December 2020. Data were extracted for 874 people who reported living with HIV. The dependent variable was reporting having oral ulcer. The independent variables were the viral load, adherence to antiretroviral treatment and a history of SARS-CoV-2 infection. The confounding variables were age at last birthday and sex at birth. A multivariable logistic regression analysis was conducted to determine the associations between the dependent and independent variables after adjusting for the confounding variables. RESULTS: Of the 874 participants, 99 (11.3%) reported having oral ulcers during the first wave of the COVID-19 pandemic. The odds of PLHIV having oral ulcers during the first wave of the COVID-19 pandemic was significantly higher for people who did not know their viral load than those who had undetectable viral load (AOR: 2.036; 95% CI: 1.204-3.443; p = 0.008); and people who did not adhere to the use of antiretroviral treatment than those who adhered (AOR: 4.113; 95% CI: 2.567-6.589; p < 0.001). Also, PLHIV who had SARS-CoV-2 infection had significantly higher odds of having oral ulcers than those who did not have the infection (AOR: 14.556; 95% CI: 4.500-47.078; p < 0.001). PLHIV who had co-morbidities had non-significantly higher odds of having oral ulcers than those without co-morbidities (AOR: 1.170; 95% CI: 0.656-2.085; p = 0.595). CONCLUSION: Oral ulcers may be an indicator of poor adherence to antiretroviral therapy and unsuppressed viral load among PLHIV. It may also be an indicator of SARS-CoV-2 infection and a signal to take prompt and critical care of affected individuals because of the risk for severe COVID-19 for these individuals.

The Cognitive Correlates of Financial Literacy in Older Adults.

OBJECTIVES: This study examined the cognitive correlates of financial literacy using a comprehensive neuropsychological battery, and whether education modifies the relationship between cognition and financial literacy. METHODS: Sixty-six participants completed sociodemographic questionnaires, an assessment of financial literacy, and a neuropsychological assessment. Multiple linear regression models that controlled for age, sex, and education examined the main effects of cognitive measures that showed a significant bivariate association with financial literacy. RESULTS: After correcting for multiple comparisons, the Crystallized Composite score (p = .002) and the Picture Vocabulary test (p = .002) from the NIH Toolbox, and the Multilingual Naming Test (p > .001) from the Uniform Data Set 3 were associated with financial literacy. Contrary to our hypothesis, education did not interact with cognitive measures when considering financial literacy scores. CONCLUSIONS: Findings suggest that vocabulary knowledge and semantic memory may play an important role in financial literacy in older age. CLINICAL IMPLICATIONS: Assessing vocabulary knowledge and semantic processes may help to identify older adults with lower financial literacy skills. Additionally, financial literacy interventions may consider targeting individuals with lower vocabulary knowledge and semantic processing skills.

The association between benzodiazepine use and greater risk of neurocognitive impairment is moderated by medical burden in people with HIV.

Benzodiazepine use is linked to neurocognitive impairment (NCI) in the general population and people with HIV (PWH); however, this relationship may depend on age-related factors such as medical comorbidities, which occur at an elevated rate and manifest earlier in PWH. We retrospectively examined whether chronological age or medical burden, a clinical marker for aging, moderated the relationship between benzodiazepine use and NCI in PWH. Participants were 435 PWH on antiretroviral therapy who underwent neurocognitive and medical evaluations, including self-reported current benzodiazepine use. A medical burden index score (proportion of accumulated multisystem deficits) was calculated from 28 medical deficits. Demographically corrected cognitive deficit scores from 15 neuropsychological tests were used to calculate global and domain-specific NCI based on established cut-offs. Logistic regressions separately modeled global and domain-specific NCI as a function of benzodiazepine x age and benzodiazepine x medical burden interactions, adjusting for current affective symptoms and HIV disease characteristics. A statistically significant benzodiazepine x medical burden interaction (p = .006) revealed that current benzodiazepine use increased odds of global NCI only among those who had a high medical burden (index score > 0.3 as indicated by the Johnson-Neyman analysis), which was driven by the domains of processing speed, motor, and verbal fluency. No age x benzodiazepine interactive effects on NCI were present. Findings suggest that the relationship between BZD use and NCI among PWH is specific to those with greater medical burden, which may be a greater risk factor for BZD-related NCI than chronological age.

Elder abuse in the COVID-19 era based on calls to the National Center on Elder Abuse resource line.

BACKGROUND: The COVID-19 pandemic has exacerbated circumstances that place older adults at higher risk for abuse, neglect, and exploitation. Identifying characteristics of elder abuse during COVID-19 is critically important. This study characterized and compared elder abuse patterns across two time periods, a one-year period during the pandemic, and a corresponding one-year period prior to the start of the pandemic. METHODS: Contacts (including social media contacts, and email; all referred to as "calls" for expediency) made to the National Center on Elder Abuse (NCEA) resource line were examined for differences in types of reported elder abuse and characteristics of alleged perpetrators prior to the pandemic (Time 1; March 16, 2018 to March 15, 2019) and during the pandemic (Time 2; March 16, 2020 to March 15, 2021). Calls were examined for whether or not abuse was reported, the types of reported elder abuse, including financial, physical, sexual, emotional, and neglect, and characteristics of callers, victims, and alleged perpetrators. Chi-square tests of independence compared frequencies of elder abuse characteristics between time periods. RESULTS: In Time 1, 1401 calls were received, of which 795 calls (56.7%) described abuse. In Time 2, 1009 calls were received, of which 550 calls (54.5%) described abuse. The difference between time periods in frequency of abuse to non-abuse calls was not significant ([Formula: see text]). Time periods also did not significantly differ with regard to caller, victim, and perpetrator characteristics. Greater rates of physical abuse ([Formula: see text] and emotional abuse ([Formula: see text] were reported during Time 2 after adjustment for multiple comparisons. An increased frequency of multiple forms of abuse was also found in Time 2 compared to Time 1 ([Formula: see text]. CONCLUSIONS: Findings suggest differences in specific elder abuse subtypes and frequency of co-occurrence between subtypes between time periods, pointing to a potential increase in the severity of elder abuse during COVID-19.

Emotional health outcomes are influenced by sexual minority identity and HIV serostatus.

For people living with HIV (PLWH) and sexual minorities (SM), the intersection of identities can compound experiences like stigma and discrimination resulting in poor emotional health. We investigated the separate and interactive associations of HIV serostatus and sexual identity with emotional health. Our dataset included 371 participants. Emotional health was assessed by the NIH Toolbox emotion battery which yields negative affect, social satisfaction, and psychological well-being. Regressions were conducted for each composite, with HIV serostatus, sexual identity, and their interaction as independent variables along with covariates. The HIV serostatus x SM identity interaction was statistically significant in the regression of Negative Affect (p = .01): heterosexuals living with HIV had worse Negative Affect compared to heterosexual HIV-persons (p = .01). The interaction terms were for social satisfaction and psychological well-being were not significant. However, among PLWH, sexual minorities reported better Social Satisfaction (p = .03) and marginally better psychological well-being (p = .07) compared to heterosexuals.

Physical and mental health correlates of perceived financial exploitation in older adults: Preliminary findings from the Finance, Cognition, and Health in Elders Study (FINCHES).

Objectives: Financial exploitation (FE) in old age is poorly understood, particularly among those without significant cognitive impairment. The Finance, Cognition, and Health in Elders Study (FINCHES) aims to identify factors associated with FE among cognitively-healthy older adults. Preliminary findings regarding physical and mental health correlates in the pilot phase of FINCHES are reported.Method: Sixteen older adults who self-reported FE were demographically-matched on age, education, sex, and race/ethnicity to eighteen older adults who did not report past FE.Results: Those who believed they were exploited endorsed significantly greater symptoms of depression (p = 0.014) and marginally greater symptoms of anxiety (p = 0.062). Participants trended towards lower perceived successful aging (p = 0.094). Perceived FE participants also endorsed greater medical conditions (p = 0.047), but follow-up individual item analyses suggest that this was driven by problems with sleep (p = 0.030).Conclusions: These preliminary findings from the pilot phase of FINCHES highlight negative mental health factors associated with perceived FE among cognitively-intact older adults.

High-fidelity mapping of repetition-related changes in the parietal memory network.

fMRI studies of human memory have identified a "parietal memory network" (PMN) that displays distinct responses to novel and familiar stimuli, typically deactivating during initial encoding but robustly activating during retrieval. The small size of PMN regions, combined with their proximity to the neighboring default mode network, makes a targeted assessment of their responses in highly sampled subjects important for understanding information processing within the network. Here, we describe an experiment in which participants made semantic decisions about repeatedly-presented stimuli, assessing PMN BOLD responses as items transitioned from experimentally novel to repeated. Data are from the highly-sampled subjects in the Midnight Scan Club dataset, enabling a characterization of BOLD responses at both the group and single-subject level. Across all analyses, PMN regions deactivated in response to novel stimuli and displayed changes in BOLD activity across presentations, but did not significantly activate to repeated items. Results support only a portion of initially hypothesized effects, in particular suggesting that novelty-related deactivations may be less susceptible to attentional/task manipulations than are repetition-related activations within the network. This in turn suggests that novelty and familiarity may be processed as separable entities within the PMN.

Caregiving preferences and advance care planning among older adults living with HIV.

With the increase in the US of the number of older adults living with HIV, more research is needed to understand the caregiving and advance care planning needs of this population. This descriptive study examined the relationship between social support and caregiving preferences and advance care planning. Older adults living with HIV were recruited from clinics in Los Angeles, CA and New Orleans, LA to complete cross-sectional surveys (n = 154). Logistic regression analyses were modeled to determine the characteristics associated with 1) preference for formal short-term term care, 2) preference for formal long-term care, 3) having at least one contact for emergency care, 4) having an advance directive or living will, and 5) having a healthcare proxy or agent. The mean age was 56.8 years. The majority of participants indicated a preference for informal support for both short-term (73.4%) and long-term care (66.2%), 13.2% had no one they could call for emergency care, 26.0% had an advance directive/living will, and 30.5% had a healthcare proxy/agent. In adjusted models, greater social support was associated with preference for informal short-term care and with having at least one emergency contact. Findings suggest that older adults living with HIV prefer informal sources of support for their caregiving needs despite having small social networks and individuals with limited social networks are particularly vulnerable due to lack of access to caregivers in sudden or unexpected health situations.

Behavioral interventions for reducing head motion during MRI scans in children.

A major limitation to structural and functional MRI (fMRI) scans is their susceptibility to head motion artifacts. Even submillimeter movements can systematically distort functional connectivity, morphometric, and diffusion imaging results. In patient care, sedation is often used to minimize head motion, but it incurs increased costs and risks. In research settings, sedation is typically not an ethical option. Therefore, safe methods that reduce head motion are critical for improving MRI quality, especially in high movement individuals such as children and neuropsychiatric patients. We investigated the effects of (1) viewing movies and (2) receiving real-time visual feedback about head movement in 24 children (5-15 years old). Children completed fMRI scans during which they viewed a fixation cross (i.e., rest) or a cartoon movie clip, and during some of the scans they also received real-time visual feedback about head motion. Head motion was significantly reduced during movie watching compared to rest and when receiving feedback compared to receiving no feedback. However, these results depended on age, such that the effects were largely driven by the younger children. Children older than 10 years showed no significant benefit. We also found that viewing movies significantly altered the functional connectivity of fMRI data, suggesting that fMRI scans during movies cannot be equated to standard resting-state fMRI scans. The implications of these results are twofold: (1) given the reduction in head motion with behavioral interventions, these methods should be tried first for all clinical and structural MRIs in lieu of sedation; and (2) for fMRI research scans, these methods can reduce head motion in certain groups, but investigators must keep in mind the effects on functional MRI data.

Persistent reduction in sialylation of cerebral glycoproteins following postnatal inflammatory exposure.

BACKGROUND: The extension of sepsis encompassing the preterm newborn's brain is often overlooked due to technical challenges in this highly vulnerable population, yet it leads to substantial long-term neurodevelopmental disabilities. In this study, we demonstrate how neonatal neuroinflammation following postnatal E. coli lipopolysaccharide (LPS) exposure in rat pups results in persistent reduction in sialylation of cerebral glycoproteins. METHODS: Male Sprague-Dawley rat pups at postnatal day 3 (P3) were injected in the corpus callosum with saline or LPS. Twenty-four hours (P4) or 21 days (P24) following injection, brains were extracted and analyzed for neuraminidase activity and expression as well as for sialylation of cerebral glycoproteins and glycolipids. RESULTS: At both P4 and P24, we detected a significant increase of the acidic neuraminidase activity in LPS-exposed rats. It correlated with significantly increased neuraminidase 1 (Neu1) mRNA in LPS-treated brains at P4 and with neuraminidases 1 and 4 at P24 suggesting that these enzymes were responsible for the rise of neuraminidase activity. At both P4 and P24, sialylation of N-glycans on brain glycoproteins decreased according to both mass-spectrometry analysis and lectin blotting, but the ganglioside composition remained intact. Finally, at P24, analysis of brain tissues by immunohistochemistry showed that neurons in the upper layers (II-III) of somatosensory cortex had a reduced surface content of polysialic acid. CONCLUSIONS: Together, our data demonstrate that neonatal LPS exposure results in specific and sustained induction of Neu1 and Neu4, causing long-lasting negative changes in sialylation of glycoproteins on brain cells. Considering the important roles played by sialoglycoproteins in CNS function, we speculate that observed re-programming of the brain sialome constitutes an important part of pathophysiological consequences in perinatal infectious exposure.