Vision impairment and food insecurity in the national health and aging trends study.

Introduction: Vision impairment (VI) may further exacerbate older adults' vulnerability to experiencing food insecurity and may be a unique and important target for policies addressing access to nutritional food. The purpose of this study is to determine the association of VI in older adults with food insecurity. Methods: This is a cross-sectional analysis of round 11 (2021) of the National Health and Aging Trends Study (NHATS), a nationally representative survey of U.S. Medicare beneficiaries ages 65 and older. Participants include 2,815 older adults with complete data on at least one objective measure of vision (distance, near or contrast sensitivity) and food insecurity. Food insecurity was assessed using a previously developed indicator of food insecurity in NHATS. VI was defined as binocular visual acuity (VA) worse than 0.3 logMAR (Snellen equivalent 20/40) at distance or its near equivalent, or contrast sensitivity (CS) worse than 1.55 logUnits. Continuous VI measures included distance and near VA (per 0.1 logMAR), and CS (per 0.1 logCS). Results: Participants were majority White (82%) and female (55%), and 3% had food insecurity. Older adults with any VI had a greater prevalence of food insecurity than adults without VI (5.0% vs. 2.0%, p < 0.05). In fully adjusted regression analyses, individuals with any VI experienced double the odds of food insecurity than individuals without VI (OR: 2.1, 95% CI: 1.2-3.6). Distance VI (measured continuously) was associated with 1.2 times the odds of food insecurity (OR = 1.2; 95% CI: 1.0-1.3, per 0.1 logMAR). All other vision measures trended towards higher odds of food insecurity, though not statistically significant. Discussion: Older adults with VI experience higher rates of food insecurity than their peers. Interventions to improve food security should be targeted towards addressing the specific barriers faced by visually impaired older adults.

Assessing Sleep Concerns in Individuals With Acquired Brain Injury: The Feasibility of a Smartpad Sleep Tool.

OBJECTIVE: The investigators examined the presence of disrupted sleep in acquired brain injury (ABI) and the utility of a mobile health program, MySleepScript, as an effective clinical tool to detect sleep disturbances. METHODS: A cross-sectional pilot study of MySleepScript, a customizable electronic battery of validated sleep questionnaires, was conducted. Participants were recruited at the Acquired Brain Injury Clinic at Johns Hopkins Bayview Medical Center. RESULTS: Sixty-eight adults with ABI (mean age, 46.3 years [SD=14.8]) participated in the study, with a mean completion time of 16.6 minutes (SD=5.4). Time to completion did not differ on individual completion or staff assistance. The mean score on the Pittsburgh Sleep Quality Index was 9.2 (SD=4.7); 83.9% of individuals had poor sleep quality (defined as a score >5). Insomnia Severity Index scores indicated moderate to severe insomnia in 45% of participants; 36.5% of participants screened positive for symptoms concerning sleep apnea, while 39.3% of individuals screened positive for restless legs syndrome. CONCLUSIONS: Poor sleep quality was highly prevalent in this ABI cohort. MySleepScript may be an effective method of assessing for sleep disturbance in ABI. Further efforts to identify sleep disorders in this patient population should be pursued to optimize ABI management.

Visual Impairment and Frailty: Examining an Understudied Relationship.

BACKGROUND: Older adults with visual impairments are at increased risk of negative health outcomes. Here, we investigate the association between visual impairment and frailty. METHODS: Cross-sectional and longitudinal relationships between visual impairment (distance visual acuity) and frailty (frailty phenotype criteria) were examined using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2002, ≥60 years) and the Women's Health and Aging Studies (WHAS III). Imbalance of potential confounders, particularly age, was addressed using propensity score-based adjustment. Multinomial logistic regression determined the odds of prefrailty and frailty at baseline in NHANES and ordinal logistic regression examined the odds of baseline and incident frailty over 3 years in WHAS III after adjustment for confounders and probability weighting (survey weights × inverse propensity scores). RESULTS: In NHANES (n = 2,639, 9% vision impairment), participants with visual impairment were more likely to be prefrail (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.9-5.3) and frail (OR = 3.7; 95% CI: 1.5-9.2) than those without visual impairment. In WHAS III (n = 796, 26% mild, 37% moderate/severe vision impairment), participants with mild and moderate/severe vision impairment were more likely to be frail (OR = 2.0; 95% CI: 1.5-2.5; OR = 5.5; 95% CI: 4.2-7.2, respectively). A one-line worse visual acuity (0.1 logMAR increase) was associated with greater odds of frailty (OR = 1.5; 95% CI: 1.4-1.7). Of those non-frail at baseline (n = 549), moderate/severe visual impairment and one-line worse visual acuity was associated with greater odds of incident frailty (OR = 3.5; 95% CI: 1.4-8.4; OR = 1.3; 95% CI: 1.1-1.5, respectively) over 3 years. CONCLUSIONS: Visual impairment may be an important, yet understudied risk factor for frailty.

Aging With Vision Loss: A Framework for Assessing the Impact of Visual Impairment on Older Adults.

There is limited research examining the impact of visual impairment (VI) on older adults while considering the complexities of aging, leaving gaps in our understanding of how health consequences of VI might be averted. We created a framework integrating concepts from disability, geriatrics, and ophthalmology that conceptualizes how VI challenges successful aging. Here, VI influences multiple functional domains, and increases the risk of negative health outcomes. This model acknowledges that common causes, such as risk factors that affect eyes and other systems simultaneously, may also drive the relationship between VI and health outcomes. Finally, the model highlights how the impact of VI on aging outcomes can be addressed at multiple intervention points.

Vitamin D for the Immune System in Cystic Fibrosis (DISC): a double-blind, multicenter, randomized, placebo-controlled clinical trial.

BACKGROUND: Patients with cystic fibrosis (CF) have increased risk of vitamin D deficiency owing to fat malabsorption and other factors. Vitamin D deficiency has been associated with increased risk of pulmonary exacerbations of CF. OBJECTIVES: The primary objective of this study was to examine the impact of a single high-dose bolus of vitamin D3 followed by maintenance treatment given to adults with CF during an acute pulmonary exacerbation on future recurrence of pulmonary exacerbations. METHODS: This was a multicenter, double-blind, placebo-controlled, intent-to-treat clinical trial. Subjects with CF were randomly assigned to oral vitamin D3 given as a single dose of 250,000 International Units (IU) or to placebo within 72 h of hospital admission for an acute pulmonary exacerbation, followed by 50,000 IU of vitamin D3 or an identically matched placebo pill taken orally every other week starting at 3 mo after random assignment. The primary outcome was the composite endpoint of the time to next pulmonary exacerbation or death within 1 y. The secondary outcomes included circulating concentrations of the antimicrobial peptide cathelicidin and recovery of lung function as assessed by the percentage of predicted forced expiratory volume in 1 s (FEV1%). RESULTS: A total of 91 subjects were enrolled in the study. There were no differences between the vitamin D3 and placebo groups in time to next pulmonary exacerbation or death at 1 y. In addition, there were no differences in serial recovery of lung function after pulmonary exacerbation by FEV1% or in serial concentrations of plasma cathelicidin. CONCLUSIONS: Vitamin D3 initially given at the time of pulmonary exacerbation of CF did not alter the time to the next pulmonary exacerbation, 12-mo mortality, serial lung function, or serial plasma cathelicidin concentrations. This trial was registered at clinicaltrials.gov as NCT01426256.

Impacts of Message Framing and Social Distance in Health Campaign for Promoting Regular Physical Exercise.

We investigated effects of message framing and social distance on individuals' attitude toward health campaign and behavioral intention. Individuals who read a gain-framed message had better attitude toward the campaign and higher level of behavioral intention than those who read a loss-framed message. Perceived benefits mediated the relationship between message framing and behavioral intention. Perceived severity mediated the relationship between social distance and behavioral intention only in the loss framing condition. Theoretical and practical implications were discussed.

Application of Optical Coherence Tomography in the Detection and Classification of Cognitive Decline.

AIM: This review aims to critically analyze the current literature on the relationship of optical coherence tomography (OCT) measures to cognition and dementia. BACKGROUND: Optical coherence tomography, a noninvasive method of imaging neuroretinal layers, and OCT angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases. There is now an increasing body of evidence relating the structural and microvascular changes of the retina to cognitive impairment. REVIEW RESULTS: In general, several studies have found decreased retinal nerve fiber layer (RNFL) thickness in Alzheimer's disease (AD) and mild cognitive impairment (MCI) and an association between RNFL thickness and continuous measures of cognitive ability, though findings were inconsistent across studies. In many studies, associations were found for specific regions of the RNFL but not with overall thickness. Studies linking OCT measures to non-Alzheimer's dementia were lacking, and limited work has been done on persons with past cognitive decline but who remain cognitively normal (the ideal stage at which to target treatment). Common limitations of prior studies include a failure to account for intraocular pressure (IOP) and axial length. CONCLUSION: Current research suggests a potential association between retinal findings observed on OCT and cognitive impairment. Methodologically robust research accounting for important covariates and looking at changes in OCT and/ or cognition is needed to better characterize the association between OCT and cognitive ability. CLINICAL SIGNIFICANCE: Further research is warranted to determine whether OCT findings can help identify the etiology of cognitive decline and/or serve as objective markers of AD. If this is the case, OCT may also help identify the presence of disease processes in cognitively normal individuals.How to cite this article: Lee MJ, Abraham AG, Swenor BK, Sharrett AR, Ramulu PY. Application of Optical Coherence Tomography in the Detection and Classification of Cognitive Decline. J Curr Glaucoma Pract 2018;12(1):10-18.

College Students' Responses to Emotional Anti-Alcohol Abuse Media Messages: Should We Scare or Amuse Them?

This study examined college students' responses to emotional anti-alcohol abuse media messages (i.e., fear vs. humor appeal) aimed at discouraging heavy/binge drinking. An experiment was conducted with 94 college students. As expected, college students generally expressed higher levels of interest in anti-alcohol abuse media messages when watching fear appeal than those watching humor appeal. However, college binge drinkers who watched the fear appeal reported lower levels of readiness to change their drinking behavior than those who watched the humor appeal. This pattern was the opposite among college nonbinge drinkers, in that college nonbinge drinkers were more likely to say they would change their drinking behaviors when exposed to fear appeal than those who were exposed to humor appeal or those who did not watch any media messages. Conventional fear appeal to scare college binge drinkers seems ineffective and even counterproductive while humor appeal, if well designed, could offer alternative ways to communicate with college binge drinkers.

Designing Skin Cancer Prevention Messages: Should We Emphasize Gains or Losses? Message Framing, Risk Type, and Prior Experience.

PURPOSE: To test whether message framing (ie, gain vs. loss) and risk type (ie, health vs appearance risk) in skin cancer prevention messages interact with one's prior experience. DESIGN: Two experiments with a 2 (message framing: gain vs loss) × 2 (risk type: health vs appearance risk) factorial design were conducted. SETTING: The participants were given a URL to the experiment website via e-mail. On the first page of the website, the participants were told that they would be asked to evaluate a skin cancer print public service announcement (PSA): Online experiments. PARTICIPANTS: A total of 397 individuals participated (236 for experiment 1 and 161 for experiment 2). Apparatus: Four versions of the skin cancer print PSAs were developed. Four PSAs were identical except for the 2 manipulated components: message framing and risk type. MEASURES: Measures were adopted from Cho and Boster (message framing), Jones and Leary and Kiene et al. (risk type), De Vries, Mesters, van't Riet, Willems, and Reubsaet and Knight, Kirincich, Farmer, and Hood (prior experience), and Hammond, Fong, Zanna, Thrasher, and Borland and Hoffner and Ye (behavioral intent). ANALYSIS: General linear models were used to test hypotheses. RESULTS: Three-way interactions among message framing, risk type, and prior experience were found: When the intent of the message was to encourage sunscreen use, the effects of message framing and risk type were shown to be the exact opposite directions from when the intent was to discourage indoor/outdoor tanning. CONCLUSION: To discourage tanning among those with prior experience, messages emphasizing losses in terms of one's health will work better. For those with no prior experience, messages emphasizing potential appearance losses will work better for discouraging tanning while messages emphasizing gains like improving appearance will do a better job in encouraging sunscreen use.

Designing Anti-Binge Drinking Prevention Messages: Message Framing vs. Evidence Type.

We investigated whether presenting anti-binge drinking health campaign messages in different message framing and evidence types influences college students' intention to avoid binge drinking, based on prospect theory (PT) and exemplification theory. A 2 (message framing: loss-framed message/gain-framed message) X 2 (evidence type: statistical/narrative) between-subjects factorial design with a control group was conducted with 156 college students. College students who were exposed to the loss-framed message condition exhibited a higher level of intention to avoid binge drinking in the near future than those who did not see any messages (the control group). This finding was mainly among non-binge drinkers. Regardless of evidence type, those who were exposed to the messages exhibited a higher level of intention to avoid binge drinking than those in the control group. This is also mainly among non-binge drinkers. We also found the main effects of message framing and evidence type on attitude toward the message and the main effect of message framing on attitude toward drinking.

Promoting HPV Vaccination Online: Message Design and Media Choice.

We investigated the effects of message framing and online media channel on young adults' perceived severity of human papillomavirus (HPV), perceived barriers and benefits of getting HPV vaccination, and behavioral intention to get vaccinated. An experiment was conducted with 142 college students. We found an interaction effect: The loss-framed message posted on Facebook was more effective in increasing the number of people who expressed their willingness to get HPV vaccination than the gain-framed message presented on Facebook. However, this framing effect was not found when the identical message was presented on an online newspaper. People's perceptions of severity of HPV and barriers of getting HPV vaccination were also influenced, depending on which media channel the information was circulated.

Prospective, Randomized, Double-Blind, Parallel-Group, Comparative Effectiveness Clinical Trial Comparing a Powder Vehicle Compound of Vitamin D With an Oil Vehicle Compound in Adults With Cystic Fibrosis.

BACKGROUND: There is little consensus on the most efficacious vehicle substance for vitamin D supplements. Fat malabsorption may impede the ability of patients with cystic fibrosis (CF) to absorb vitamin D in an oil vehicle. We hypothesized that vitamin D contained in a powder vehicle would be absorbed more efficiently than vitamin D contained in an oil vehicle in patients with CF. METHODS: In this double-blind, randomized controlled trial, hospitalized adults with CF were given a one-time bolus dose of 100,000 IU of cholecalciferol (D3) in a powder-based or oil-based vehicle. Serum D3, 25-hydroxyvitamin D, and parathyroid hormone concentrations were analyzed at 0, 12, 24, and 48 hours posttreatment. The area under the curve for serum D3 and the 12-hour time point were also assessed as indicators of D3 absorption. RESULTS: This trial was completed by 15 patients with CF. The median (interquartile range) age, body mass index, and forced expiratory volume in 1 second were 23.7 (19.9-33.2) years, 19.9 (18.6-22.6) kg/m2, and 63% (37%-80%), respectively. The increase in serum D3 and the area under the curve was greater in the powder group ( P = .002 and P = .036, respectively). Serum D3 was higher at 12 hours in the powder group compared with the oil group ( P = .002), although levels were similar between groups by 48 hours. CONCLUSIONS: In adults with CF, cholecalciferol is more efficiently absorbed in a powder compared with an oil vehicle. Physicians should consider prescribing vitamin D in a powder vehicle in patients with CF to improve the absorption of vitamin D from supplements.

Circulating Humorous Antitobacco Videos on Social Media.

We investigated whether exposure to same humorous antitobacco videos via different types of social media platforms and contexts (health vs. humor) influences individual's health risk perceptions, attitudes, and behavioral intents. An experiment with a 2 (social media types: YouTube and Facebook) × 2 (message contexts: health-focused and humor-focused contexts) factorial design was conducted. It was found that those who watched the humorous antitobacco videos on Facebook in the health-context exhibited a higher level of risk perception of smoking, less positive attitude toward smokers, and a higher level of intention to avoid smoking in the future than the participants who viewed the same videos on YouTube in the health-context or on Facebook in the humor-context. These findings provide useful practical guidelines in using social media for health communication/promotion. Humorous health promotion messages are best circulated on social networking sites such as Facebook accompanied by others' support for the given health topic (i.e., in health-contexts). Practical/theoretical implications and limitations of the study were further discussed in this article.

Portrayals of Eating and Drinking in Popular American TV Programs: A Comparison of Scripted and Unscripted Shows.

This study investigated portrayals of eating and drinking behaviors in popular American TV programs and compared scripted and unscripted (i.e., reality) shows. Through a content analysis of 95 episodes, the prevalence and nature of food/alcohol consumption that accompanied depictions of eating and drinking behaviors in 461 scenes were measured. Various foods were portrayed, but only 9% of foods portrayed were healthy (e.g., low in calories/fat content, such as fruits, vegetables, etc.). Approximately half of eating or drinking scenes either were accompanied by alcohol or contained solely alcoholic beverages. Significant differences between the scripted and unscripted shows were also found.

Thyroid Function in Patients with Cystic Fibrosis: No Longer a Concern?

BACKGROUND: Development of goiter and hypothyroidism has been reported in patients with cystic fibrosis (CF) since the 1970s, especially when treated with iodine-based expectorants. With iodine-containing expectorants no longer in routine use, the prevalence of thyroid dysfunction in CF patients is unknown. This cross-sectional study assessed thyroid function status in a large cohort of CF patients. METHODS: Sera from ambulatory subjects were obtained from an Institutional Review Board (IRB)-approved biorepository of patients seen at the Emory CF Center between January 1, 2011, and December 31, 2014. Sera from hospitalized subjects were obtained from banked specimens from an IRB-approved inpatient clinical trial. Demographics, forced expiratory volume in one second (FEV1), and medication use were assessed from medical records. Thyroid function tests were measured from the stored sera. Multivariate regression models assessed associations between covariates and thyrotropin (TSH), free thyroxine (fT4), and thyroid dysfunction risk. RESULTS: A total of 89 subjects (54% male, 91% white, Mage = 24.4 years, median FEV1 63%) were included in the analyses. One subject was on thyroid hormone replacement, 93% were on pancreatic enzyme replacement, and 68% received antibiotics within six months. None had computed tomography scans with intravenous contrast within six months. One patient had positive thyroid peroxidase (TPO) antibodies. Of the 87 subjects with measured TSH values, seven (8%) had abnormal levels (range 0.2-7.6 µIU/mL; one overt, four subclinical hypothyroidism, and two subclinical hyperthyroidism). Of the 56 subjects with measured fT4 values, 19 (34%) had slightly low levels (range 0.49-0.79 ng/dL; 17 isolated mild hypothyroxinemia). A positive correlation between age and body mass index (BMI; p < 0.001) and a negative correlation between age and FEV1 (p = 0.041) were seen. Age, sex, race/ethnicity, BMI, FEV1, hospitalization status, use of pancreatic enzyme or thyroid hormone replacement, recent antibiotic use, and TPO antibody positivity were not predictive of TSH, fT4, or thyroid dysfunction risk. Stratified analyses by hospitalization did not predict TSH or fT4. CONCLUSIONS: Although 24 (27%) of the patients had abnormal serum thyroid function tests, overt thyroid dysfunction was rare in this cohort of 89 patients with CF. The degree of hypothyroxinemia was marginal, likely due to nonthyroidal illness. There were no significant predictors of thyroid dysfunction.

Potential Motivators and Barriers for Encouraging Health Screening for Cardiovascular Disease Among Latino Men in Rural Communities in the Northwestern United States.

Cardiovascular disease (CVD) is the leading cause of death across all races and ethnicities. In particular, Latino men suffer disproportionately from conditions that lead to CVD such as hypertension, high cholesterol, and diabetes. There are easy and inexpensive ways to screen for certain cardiovascular conditions, yet Latino men are not benefiting from these. It is important to identify motivators and barriers to screening among this population. The purpose of this qualitative, descriptive study was to determine what motivates Latino men to participate in health screening for diabetes, high blood pressure, and high cholesterol. Self-identified Latino men (n = 17) were interviewed following a community health screening targeting Latinos. Individual semi-structured interviews were conducted in either Spanish or English after giving written consent. Trained interpreters were used for Spanish interviews. Emerging themes include motivating factors and barriers to participate in screening. Data findings direct future studies and provide culturally meaningful and relevant strategies to reduce health disparities.

Do Online Comments Influence the Public's Attitudes Toward an Organization? Effects of Online Comments Based on Individuals' Prior Attitudes.

The authors investigated the effects of reading different types of online comments about a company on people's attitude change based on individual's prior attitude toward the company. Based on Social Judgment Theory, several hypotheses were tested. The results showed that the effects of online comments interact with individuals' prior attitudes toward a corporation. People with a strong negative attitude toward a corporation were less influenced by other's online comments than people with a neutral attitude in general. However, people with a prior negative attitude were more affected by refutational two-sided comments than one-sided comments. The results suggest that the effects of user generated content should be studied in a holistic manner, not only by investigating the effects of online content itself, but also by examining how others' responses to the content shape or change individuals' attitudes based on their prior attitudes.

Underage drinkers' responses to negative-restrictive versus proactive-nonrestrictive slogans in humorous anti-alcohol abuse messages: are humorous responsible drinking campaign messages effective?

This study examined underage drinkers' responses to negative-restrictive versus proactive-nonrestrictive slogans in humorous anti-alcohol abuse advertisements. The authors conducted a posttest-only control group experiment with 91 teenagers and college-aged participants. For underage moderate drinkers, the negative-restrictive slogans (e.g., "Don't drink") increased participants' perceived risk of excessive drinking and increased a level of intention to change their drinking behavior. However, for underage binge drinkers, the negative-restrictive slogans lowered participants' risk perception of excessive drinking and intention to change their drinking behavior.

Fear versus humor: the impact of sensation seeking on physiological, cognitive, and emotional responses to antialcohol abuse messages.

This study investigates the differences in physiological, cognitive, and emotional responses to existing emotional antialcohol abuse advertisements (fear vs. humor appeal) between high and low sensation seekers. A 2 (Message Type) x 2 (Sensation-Seeking Tendency) x 4 (Message Repetition) mixed-model experiment with repeated measures was conducted with 71 college students. The results, based on self-reports, indicated that fear messages generated more interest and perceived danger of excessive drinking regardless of sensation-seeking tendency, whereas humorous messages were rated as more likeable than fear messages, and the difference was bigger among low sensation seekers than among high sensation seekers. One interesting finding was that for both fear and humor appeals, low sensation seekers showed greater emotional responses (greater corrugators activities and greater zygomatic activities) than high sensation seekers overall. The implications of the current study as well as suggestions for future study were discussed.

The effects of self-efficacy statements in humorous anti-alcohol abuse messages targeting college students: who is in charge?

This study examined the effect of self-efficacy statements in humorous anti-alcohol abuse television advertisements on college students. A posttest only group design experiment was conducted with 124 college students. It was found that highly rebellious individuals who watched ads with a self-efficacy statement (i.e., "You Are in Control of the Situation") indicated lower alcohol expectancies, higher risk perceptions, and higher intentions to change their drinking behaviors than those in the non-self-efficacy condition. The findings suggest that health promotional messages should be tailored to rebellious college students, particularly those who are at risk, in a manner that not only gains their attention but also minimizes possible defensive reactions to the given messages. Humorous messages with self-efficacy statements could offer ways to communicate with rebellious college students regarding their drinking problems.