Does Forgiveness Enhance Or Detract From Relationship Quality Among Sexual Abuse Survivors?

Many women experience childhood sexual abuse (CSA) during their childhood and CSA often negatively impacts adult's romantic relationships. Consequently, it is important to understand the protective factors that buffer against the detrimental impact of CSA on the quality of women's romantic relationships. Forgiveness may be one such factor. The current study looked at trait forgiveness as a moderator of CSA and overall relationship quality, positive relationship quality, and negative relationship quality. A sample of 171 women completed an online survey. Using hierarchical regression, forgiveness was found to moderate the association between CSA and overall relationship quality and negative relationship quality, but not positive relationship quality. Findings indicate that the interaction between CSA and forgiveness was significant, but higher levels of forgiveness actually decreased overall relationship quality and increased negative relationship quality. The relationship between CSA and overall reports of relationship quality and negative relationship quality were stable at low levels of forgiveness, but when forgiveness was high overall relationship quality decreased and negative relationship quality increased. CSA was also directly associated with lower levels of positive relationship quality. Findings from the study indicate continued conceptual refinement when considering CSA, forgiveness, and relationship quality.

Validation of a Surgical Objective Structured Clinical Examination (S-OSCE) Using Convergent, Divergent, And Trainee-Based Assessments of Fidelity.

OBJECTIVE: Describe the validation of a surgical objective structured clinical examination (S-OSCE) for the purpose of competency assessment based on the Royal College of Canada's Can-MEDS framework. DESIGN: A surgical OSCE was developed to evaluate the management of common orthopedic surgical problems. The scores derived from this S-OSCE were compared to Ottawa Surgical Competency Operating Room Evaluation (O-SCORE), a validated entrustability assessment, to establish convergent validity. The S-OSCE scores were compared to Orthopedic In-Training Examination (OITE) scores to evaluate divergent validity. Resident evaluations of the clinical encounter with a standardized patient and the operative procedure were scored on a 10-point Likert scale for fidelity. SETTING: A tertiary level academic teaching hospital. PARTICIPANTS: 21 postgraduate year 2 to 5 trainees of a 5-year Canadian orthopedic residency program creating 160 operative case performances for review. RESULTS: There were 5 S-OSCE days, over a 4-year period (2016-2019) encompassing a variety of surgical procedures. Performance on the S-OSCE correlated strongly with the O-SCORE (Pearson correlation coefficient 0.88), and a linear regression analysis correlated moderately with year of training (R²â€¯= 0.5345). The Pearson correlation coefficient between the S-OSCE and OITE scores was 0.57. There was a significant increase in the average OITE score after the introduction of the surgical OSCE. Resident fidelity ratings were available from 16 residents encompassing 8 different surgical cases. The average score for the overall simulation (8.0±1.6) was significantly higher than the cadaveric surgical simulation (6.5 ± 0.8) (p < 0.001) CONCLUSIONS: The S-OSCE scores correlate strongly with an established form of assessment demonstrating convergent validity. The correlation between the S-OSCE and OITE scores was less, demonstrating divergent validity. Although residents rank the overall simulation highly, the fidelity of the cadaveric simulation may need improvement. Administration of a surgical OSCE can be used to evaluate preoperative and intraoperative decision making and complement other forms of assessment.

Considering the Relevance of Childhood Religious Experiences Through Centenarian Oral Histories.

The current study explored a sub-sample of 57 narrative focused on childhood religious experiences from the Oklahoma Oral History Project. Analyses identified three primary themes connected to childhood religiosity, including transmission, accessibility, and socializing. First, transmission of religiosity during childhood dependent upon a parent or grandparent. A second theme involved accessibility, which highlighted various advantages and disadvantages regarding child and family ability to attend religious services. Such opportunities and barriers were centered upon three subthemes involving rurality, transportation, and infrastructure. Finally, socializing represented a third theme. In particular, church attendance during childhood created unique opportunities for early-life socializing with family, friends, and neighbors. As a whole, key themes indicate that religiosity during childhood may be vital to the early formation of social opportunities and connections that may support positive and adaptive developmental processes in human longevity. Findings have implications relative to advancing conceptual understanding of the impact of childhood religious experience on developmental outcomes among long-lived adults.

Gerontological Inquiry of Religiosity and Spirituality: Remembered or Forgotten Variables in the Study of Aging and Human Development?

This is submission is the introduction to complement the special issue on "Forgotten Variables in Religiosity and Spirituality Inquiry".

Forgotten Variables and Older Men in Custody: Negative Childhood Events, Forgiveness, and Religiosity.

The study tested a mediational model linking negative childhood events through forgiveness of self and social support to religiosity using data from a convenience sample of 261 men aged 45-82 years residing behind prison walls. The Developmental Model of Adaptation provided the study's conceptual model for investigating the associations among the study variables. The study tested a mediational model linking the distal past (negative childhood events) to the outcome, religiosity, through forgiveness, and social support. The final model demonstrated the association of negative childhood events with religiosity through forgiveness of self (not forgiveness of others or situation) and social support. The study's findings suggest that at intake and during time in confinement, middle-aged and older men in prison should be assessed for and offered interventions aimed at helping them cope with the trauma of childhood events, achieve self-forgiveness, seek social support, and express religiosity as important for sustaining their well-being.

Remaining Socially Connected at 100 and Beyond Reduces Impact of Loneliness on Nutritional Status.

BACKGROUND: Understanding factors influencing centenarians' nutritional status can offer insight into effective nutrition interventions to improve quality of life among this population. OBJECTIVE: This cross-sectional study was conducted to evaluate the role of social support and loneliness on nutritional status among Oklahoma centenarians (N = 151). METHODS: Nutritional status was assessed with the Short Form Mini Nutrition Assessment (MNA-SF). Perceived social support was assessed with the 24-item Social Provisions Scale. Loneliness was examined with the 10-item UCLA loneliness scale. RESULTS: Ordinal logistic regression revealed that those who lacked social support were at increased risk of poor nutritional status (OR = 2.28, p < .05). Further, the model revealed that centenarians who reported lack of social support and loneliness had almost 2.8 times higher likelihood of being at risk of poor nutritional status compared to their socially connected counterparts (p < .01). CONCLUSIONS AND IMPLICATIONS: Findings have implications for geriatric dietitians, social workers, and clinical counselors seeking to implement services and programs aimed at helping long-lived adults feel socially connected and maintain proper nutritional well-being.

Examining the Influence of Early-Life and Recent Traumatic Events on Loneliness in Centenarians.

Early-life traumatic experiences have lasting implications for late-life socio-emotional development, contributing to a greater prevalence of poor mental health in very old age. The purpose of this study was to examine the influence of early-life and recent traumatic life experiences on loneliness among centenarians. A total of 154 centenarians participated in a semistructured interview. The time of traumatic occurrence and type of trauma experienced influence loneliness in centenarians. Experiencing a natural disaster 70 or more years ago significantly predicted loneliness. Terror management theory proposes that coming to terms with one's mortality represents an underlying source of anxiety that can influence human behavior to create both immediate and future defenses. Evidence from this study can be used to improve how aging service practitioners integrate reminiscence or life-review therapy or counseling within clinical or educational settings.

Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression.

BACKGROUND: Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs. OBJECTIVE: To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults. DESIGN: The cross-sectional study was conducted from February 2017 to May 2017. PARTICIPANTS/SETTING: A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated. MAIN OUTCOME MEASURES: Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form). STATISTICAL ANALYSES PERFORMED: Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications. RESULTS: Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04). CONCLUSIONS: Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.

Targeted Treatment of Yaws With Household Contact Tracing: How Much Do We Miss?

Yaws is a disabling bacterial infection found primarily in warm and humid tropical areas. The World Health Organization strategy mandates an initial round of total community treatment (TCT) with single-dose azithromycin followed either by further TCT or active case-finding and treatment of cases and their contacts (the Morges strategy). We sought to investigate the effectiveness of the Morges strategy. We employed a stochastic household model to study the transmission of infection using data collected from a pre-TCT survey conducted in the Solomon Islands. We used this model to assess the proportion of asymptomatic infections that occurred in households without active cases. This analysis indicated that targeted treatment of cases and their household contacts would miss a large fraction of asymptomatic infections (65%-100%). This fraction was actually higher at lower prevalences. Even assuming that all active cases and their households were successfully treated, our analysis demonstrated that at all prevalences present in the data set, up to 90% of (active and asymptomatic) infections would not be treated under household-based contact tracing. Mapping was undertaken as part of the study "Epidemiology of Yaws in the Solomon Islands and the Impact of a Trachoma Control Programme," in September-October 2013.

Nutritional Status of Rural Older Adults Is Linked to Physical and Emotional Health.

BACKGROUND: Although nutritional status is influenced by multidimensional aspects encompassing physical and emotional well-being, there is limited research on this complex relationship. OBJECTIVE: The purpose of this study was to examine the interplay between indicators of physical health (perceived health status and self-care capacity) and emotional well-being (depressive affect and loneliness) on rural older adults' nutritional status. DESIGN: The cross-sectional study was conducted from June 1, 2007, to June 1, 2008. PARTICIPANTS/SETTING: A total of 171 community-dwelling older adults, aged 65 years and older, residing within nonmetro rural communities in the United States participated in this study. MAIN OUTCOME MEASURES: Participants completed validated instruments measuring self-care capacity, perceived health status, loneliness, depressive affect, and nutritional status. STATISTICAL ANALYSES PERFORMED: Structural equation modeling was employed to investigate the complex interplay of physical and emotional health status with nutritional status among rural older adults. The χ2 test, comparative fit index, root mean square error of approximation, and standardized root mean square residual were used to assess model fit. RESULTS: The χ2 test and the other model fit indexes showed the hypothesized structural equation model provided a good fit to the data (χ2 (2)=2.15; P=0.34; comparative fit index=1.00; root mean square error of approximation=0.02; and standardized root mean square residual=0.03). Self-care capacity was significantly related with depressive affect (γ=-0.11; P=0.03), whereas self-care capacity was not significantly related with loneliness. Perceived health status had a significant negative relationship with both loneliness (γ=-0.16; P=0.03) and depressive affect (γ=-0.22; P=0.03). Although loneliness showed no significant direct relationship with nutritional status, it showed a significant direct relationship with depressive affect (ß=.4; P<0.01). Finally, the results demonstrated that depressive affect had a significant negative relationship with nutritional status (ß=-.30; P<0.01). The results indicated physical health and emotional indicators have significant multidimensional associations with nutritional status among rural older adults. CONCLUSIONS: The present study provides insights into the importance of addressing both physical and emotional well-being together to reduce potential effects of poor emotional well-being on nutritional status, particularly among rural older adults with impaired physical health and self-care capacity.

Does Depressive Affect Mediate the Relationship between Self-Care Capacity and Nutritional Status Among Rural Older Adults? : A Structural Equation Modeling Approach.

This study examined the relationships of self-care capacity and depressive affect on nutritional status and whether depressive affect mediated the relationship of self-care capacity on nutritional status. A convenience sample of 171 rural community-dwelling older adults, 65 years and above, participated. Structural equation modeling (SEM) was conducted to test a mediation model. The hypothesized SEM model was supported with adequate fit (χ2 (1) = 1.87, p = 0.17; CFI = 0.94; RMSEA = 0.07; SRMR = 0.03). SEM analysis revealed a significant positive direct effect of self-care capacity on nutritional status (γ = 0.14, p = 0.042). Significant negative direct effects were observed for self-care capacity on depressive affect (γ = -0.15, p = 0.027) and for depressive affect on nutritional status (ß = -0.27, p < 0.01). Depressive affect was also observed to partially mediate the relationship of self-care capacity on nutrition status (γ = 0.04, p = 0.046). Findings highlight the importance of emotional well-being on rural older adults' nutritional status, particularly those with decreased ability to engage in self-care practices.

Plasma Lipidomic Profiling in a Military Population of Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder with Apolipoprotein E ɛ4-Dependent Effect.

In the military population, there is high comorbidity between mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) due to the inherent risk of psychological trauma associated with combat. These disorders present with long-term neurological dysfunction and remain difficult to diagnose due to their comorbidity and overlapping clinical presentation. Therefore, we performed cross-sectional analysis of blood samples from demographically matched soldiers (total, n = 120) with mTBI, PTSD, and mTBI+PTSD and those who were considered cognitively and psychologically normal. Soldiers were genotyped for apolipoprotein E (APOE) ɛ4, and phospholipids (PL) were examined using liquid chromatography/mass spectrometry analysis. We observed significantly lower levels of several major PL classes in TBI, PTSD, and TBI+PTSD, compared with controls. PTSD severity analysis revealed that significant PL decreases were primarily restricted to the moderate-to-severe PTSD group. An examination of the degree of unsaturation showed that monounsaturated fatty acid-containing phosphatidylcholine (PC) and phosphatidylinositol (PI) species were lower in the TBI and TBI+PTSD groups. However, these PLs were unaltered among PTSD subjects, compared with controls. Similarly, ether PC (ePC) levels were lower in PTSD and TBI+PTSD subjects, relative to controls. Ratios of arachidonic acid (AA) to docosahexaenoic acid (DHA)-containing species were significantly decreased within PC and phosphatidylethanolamine (PE) classes. APOE ɛ4 (+) subjects exhibited higher PL levels than their APOE ɛ4 (-) counterparts within the same diagnostic groups. These findings suggest that PL profiles, together with APOE genotyping, could potentially aid to differentiate diagnosis of mTBI and PTSD and warrant further validation. In conclusion, PL profiling may facilitate clinical diagnosis of mTBI and PTSD currently hindered by comorbid pathology and overlapping symptomology of these two conditions.

Consideration of forgiveness to enhance the health status of older male prisoners confronting spiritual, social, or emotional vulnerability.

Participants in this study included 261 men, aged 45 and older, residing within state-managed correctional facilities in Oklahoma. Path analysis was used to examine an integrated mediation model. Spiritual ambivalence, loneliness, and depressive affect had direct negative associations with forgiveness, controlling for age, race, education, and type of crime. Forgiveness also maintained a direct positive association with perceived health status, whereas depressive affect maintained a direct negative association with perceived health status. In addition, a significant indirect effect of depressive affect on perceived health through forgiveness emerged. Overall, the model explained 38% of the variance in forgiveness and 23% in perceived health. Greater spiritual ambivalence, loneliness, and depressive affect diminish forgiveness among older male prisoners, yet higher levels of forgiveness, are associated with greater perceived health.

Direct and indirect effects of religiosity on valuation of life through forgiveness and social provisions among older incarcerated males.

PURPOSE OF THE STUDY: Few studies have investigated the influence of religiosity (REL), forgiveness, and social resources on incarcerated individuals' attachment to their lives, or valuation of life (VOL). We tested a model linking REL to VOL through 3 subscales of the Heartland Forgiveness Scale (Self, Others, and Situations) and social provisions (SPS). DESIGN AND METHODS: Cross-sectional data were collected from 261 male prison inmates, aged 45-82, incarcerated in 8 state-managed correctional facilities. Participants were sampled from the prison census database (Oklahoma Department of Corrections or DOC). Exclusion criteria, per the Oklahoma DOC, were those housed in medical or psychiatric units, currently in solitary confinement, or sentenced to death row. RESULTS: To account for possible violations of multivariate normality, we used the Satorra-Bentler chi-square statistic. The final model fit the data well, explaining 57% of the variance in VOL: χ(2) (N = 261; df = 3) = 7.40; p = .06; Comparative Fit Index = .99; root mean squared error of approximation = .08; standardized root mean squared residual = .02. Significant indirect effects of REL on VOL were present through Forgiveness of Others and SPS, and of REL on SPS through Forgiveness of Others. Analyses controlled for age, race, education, perceived physical health, and depressive symptoms. IMPLICATIONS: Implications of the findings for those involved with prisoner care are discussed, particularly therapeutic interventions including process models of forgiveness.

Social resources and change in functional health: comparing three age groups.

This study examined the mediating and moderating role of social resources on the association between age and change in functional health for three age groups of older adults. Data were provided by those in their 60s, 80s, and 100s who participated in the first two phases of the Georgia Centenarian study. Analyses confirmed the study's hypothesis that social resources moderated the relationship between age group and change in functional health; in particular, centenarians who experienced the greatest decline in IADLs scored the highest on social resources at time 1. No evidence was found for mediation by social resources or a directional influence by either level of social resources or functional health on change in the other resource. Evidence from this study challenges researchers and service providers to consider the heterogeneity in resources among older adults.

Lipidomic profiling of phosphocholine-containing brain lipids in mice with sensorimotor deficits and anxiety-like features after exposure to Gulf War agents.

The central nervous system (CNS)-based symptoms of Gulf War Illness (GWI) include motor dysfunction, anxiety, and cognitive impairment. Gulf War (GW) agents, such as pyridostigmine bromide (PB), permethrin (PER), N,N-diethyl-meta-toluamide (DEET), and stress, are among the contributory factors to the pathobiology of GWI. This study characterizes disturbances in phosphocholine-containing lipids that accompany neurobehavioral and neuropathological features associated with GW agent exposure. Exposed mice received PB orally, dermal application of PER and DEET and restraint stress daily for 28 days, while controls received vehicle during this period. Neurobehavioral studies included the rotarod, open field, and Morris water maze tests. Histopathological assessments included glial fibrillary acid protein, CD45, and Nissl staining. Liquid chromatography/mass spectrometry with source collision-induced dissociation in negative and positive ionization scanning modes was performed to characterize brain phosphatidylcholine (PC) and sphingomyelin (SM). A significant increase in ether containing PC (ePC34:0, ePC36:2, and ePC36:1) or long-chain fatty acid-containing PC (38:1, 40:4, 40:2) was observed in exposed mice compared with controls. Among differentially expressed PCs, levels of those with monounsaturated fatty acids were more affected than those with saturated and polyunsaturated fatty acids. Sensorimotor deficits and anxiety, together with an increase in astrocytosis, were observed in exposed mice compared with controls. These lipid changes suggest that alterations in peroxisomal pathways and stearoyl-CoA desaturase activity accompany neurobehavioral and neuropathological changes after GW agent exposure and represent possible treatment targets for the CNS symptoms of GWI.

Prisoner health and valuation of life, loneliness, and depressed mood.

OBJECTIVE: To examine valuation of life, loneliness, and depressed mood as mediating the association between age and race/ethnicity and health outcomes among older adult male prisoners. METHODS: Survey of 261 male prisoners ages 45-80 from 8 Oklahoma correctional facilities. RESULTS: African American prisoners report fewer health conditions than White prisoners - a finding mediated by significantly greater valuation of life, less loneliness, and lower depressed mood among African American prisoners. Older prisoners reported more health conditions than younger prisoners independent of other study variables. CONCLUSION: Results suggest improving inmates' internal states will reduce incidence of illness and disease among older male offenders and associated healthcare costs.

Reliable and reproducible murine models for commonly used abdominal plastic surgical flaps.

Animal models have been used for many years in surgical research to develop different surgical techniques, improve understanding of anatomy and physiology and hone surgical skills. The benefit of such models has been particularly important in developing relatively young specialties like plastic surgery and many plastic surgical techniques are designed and studied in animals long before they are used in humans. We describe techniques for raising several reliable and reproducible abdominal flaps in rodents, including transverse rectus abdominis myocutaneous flaps in rats and mice, superficial inferior epigastric artery flaps in rats and perforator flaps in rats. The intention of this paper is to act as a point of reference for any microvascular or plastic surgeon who is planning to perform abdominal plastic surgical flap research or further microvascular skills.

Identification of plasma biomarkers of TBI outcome using proteomic approaches in an APOE mouse model.

The current lack of diagnostic and prognostic biomarkers for traumatic brain injury (TBI) confounds treatment and management of patients and is of increasing concern as the TBI population grows. We have generated plasma proteomic profiles from mice receiving TBI by controlled cortical impact at either 1.3 mm or 1.8 mm depth, comparing these against those of sham injured-animals to identify plasma biomarkers specific to mild or severe TBI at 24 hours, 1 month, or 3 months post-injury. To identify possible prognostic biomarkers, we used apolipoprotein E (APOE)3 and APOE4 transgenic mice, which demonstrate relatively favorable and unfavorable outcomes respectively, following TBI. Using a quantitative proteomics approach (isobaric tagging for relative and absolute quantitation--iTRAQ) we have identified proteins that are significantly modulated as a function of TBI and also in response to the TBI*APOE genotype interaction, the latter representing potential prognostic biomarkers. These preliminary data clearly demonstrate plasma protein changes that are not only injury dependent but also interaction dependent. Importantly, these results demonstrate the presence of TBI-dependent and interaction-dependent plasma proteins at a 3-month time point, which is a considerable time post-injury in the mouse model, and will potentially be of significance for combat veterans receiving assessment at extended periods post-injury. Furthermore, our identification of clusters of functionally related proteins indicates disturbance of particular biological modules, which potentially increases their value beyond that of solitary biomarkers.

Age differences and changes in resources essential to aging well: a comparison of sexagenarians, octogenarians, and centenarians.

THIS STUDY EXAMINED CHANGE OVER TIME IN FIVE RESOURCES ASSESSED BY THE DUKE OARS MULTIDISCIPLINARY FUNCTIONAL ASSESSMENT QUESTIONNAIRE: social, economic, mental, physical, and functional resources. Two hundred and one participants in the Georgia Centenarian Study provided data for this longitudinal study: 70 sexagenarians, 63 octogenarians, and 68 centenarians. Those in their 60s and 80s were followed up within 60 months; due to mortality attrition, centenarians were followed up within 20 months. Centenarians experienced the lowest levels of resources relative to those in their 80s and 60s. Over time they primarily experienced loss in activities of daily living, highlighting that the ability to maximize gains and mitigate losses over time for older adults is highly associated with various resources essential to well-being. Findings suggest that older adults'-especially the very old-resources should be concurrently assessed in a multidimensional analysis by researchers and practitioners who work with older adults in various settings.