Racial and ethnic differences in cognitive health appraisals: a comparison of non-Hispanic White, non-Hispanic Black, and Hispanic older adults.

OBJECTIVES: To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables. METHOD: The sample (N = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016-2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE). RESULTS: The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed. CONCLUSION: Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.

Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis.

Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cut-off point of > 5000 µg/ dl.

Associations of a social network typology with physical and mental health risks among older adults in South Korea.

OBJECTIVES: The objectives of this study were to (1) develop an empirical typology of social networks in older Koreans; and (2) examine its effect on physical and mental health. METHOD: A sample of 6900 community-dwelling older adults in South Korea was drawn from the 2014 Korean National Elderly Survey. Latent profile analysis (LPA) was conducted to derive social network types using eight common social network characteristics (marital status, living arrangement, the number and frequency of contact with close family/relatives, the number and frequency of contact with close friends, frequency of participation in social activities, and frequency of having visitors at home). The identified typologies were then regressed on self-rated health and depressive symptoms to explore the health risks posed by the group membership. RESULTS: The LPA identified a model with five types of social network as being most optimal (BIC = 153,848.34, entropy = .90). The groups were named diverse/family (enriched networks with more engagement with family), diverse/friend (enriched networks with more engagement with friends), friend-focused (high engagement with friends), distant (structurally disengaged), and restricted (structurally engaged but disengaged in family/friends networks). A series of regression analyses showed that membership in the restricted type was associated with more health and mental health risks than all types of social networks except the distant type. CONCLUSION: Findings demonstrate the importance of family and friends as a source of social network and call attention to not only structural but also non-structural aspects of social isolation. Findings and implications are discussed in cultural contexts.

Seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population.

OBJECTIVE: To describe seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population. DESIGN: A longitudinal observational study. SETTING: Most of the study participants were recruited from a health maintenance organization (HMO) in central Massachusetts, USA. Additional individuals of Hispanic descent were recruited from outside of the HMO population to increase the ethnic diversity of this sample. SUBJECTS: Data from 593 participants, aged 20-70, were used for this investigation. Each participant was followed quarterly (five sampling points: baseline and four consecutive quarters) for 1-year period. Body weight measurements and three 24-h dietary and physical activity recalls were obtained on randomly selected days (including 2 weekdays and 1 weekend day) per quarter. Sinusoidal regression models were used to estimate peak-to-trough amplitude and phase of the peaks. RESULTS: Daily caloric intake was higher by 86 kcal/day during the fall compared to the spring. Percentage of calories from carbohydrate, fat and saturated fat showed slight seasonal variation, with a peak in the spring for carbohydrate and in the fall for total fat and saturated fat intake. The lowest physical activity level was observed in the winter and the highest in the spring. Body weight varied by about 1/2 kg throughout the year, with a peak in the winter (P<0.001 winter versus summer). Greater seasonal variation was observed in subjects who were male, middle aged, nonwhite, and less educated. CONCLUSIONS: Although there is seasonal variation in diet, physical activity and body weight, the magnitude of the change is generally small in this population. SPONSORSHIP: US National Heart, Lung and Blood Institute.

PDA-assisted low glycemic index dietary intervention for type II diabetes: a pilot study.

BACKGROUND: Epidemiological and dietary intervention studies suggest that a low-glycemic index (GI) diet is beneficial for blood glucose control; however, long-term clinical utility of the low GI diet has not been fully investigated. OBJECTIVES: To evaluate the feasibility and efficacy of a nutritionist-delivered low-GI dietary intervention, with the support of a personal digital assistant (PDA), for adult patients with poorly controlled type II diabetes. METHOD: The low-GI intervention consisted of six counseling sessions and the use of a PDA-based food database with GI scores for 6 months. Study outcomes included feasibility measures, glycosylated hemoglobin levels (HbA1c), GI and glycemic load (GL) score of self-reported dietary intake, body weight, depression and quality of life (QOL). Measures were obtained at baseline, 3 and 6 months. RESULTS: Of 31 adult patients approached, 15 met study eligibility criteria and were enrolled in the study. Thirteen patients (87%) completed all study assessments. Findings included decreases in average HbA1c (-0.5% P = 0.02), body weight, hip circumference, blood pressure, dietary GI and daily caloric intake. Diabetes impact scores also decreased. All but one participant completed all components of the intervention. There were mixed reports regarding the usefulness of the PDAs; however, participants offered helpful suggestions for further development. CONCLUSIONS: Results of this pilot study support the feasibility of implementing a nutritionist-delivered, PDA-assisted low-GI dietary intervention for patients with poorly controlled type II diabetes. Encouraging initial efficacy data require further testing in the context of a randomized clinical trial.

Gender differences in the treatment of patients with acute myocardial infarction. A multihospital, community-based perspective.

OBJECTIVE: As part of a community-wide study examining temporal trends in the incidence and survival rates of acute myocardial infarction, we examined differences between the sexes in overall utilization rates and changes over time, therein, of various therapies used in the management of acute myocardial infarction. DESIGN: Nonconcurrent prospective study. PATIENTS: Three thousand three hundred sixty-one men and 2119 women hospitalized with validated acute myocardial infarction in 16 hospitals in the Worcester, Mass, metropolitan area during 1975, 1978, 1981, 1984, 1986, 1988, and 1990. RESULTS: After controlling, by means of a logistic regression analysis, for a variety of patient-related factors that could affect physician prescribing patterns, women were significantly more likely to receive diuretics during hospitalization for acute myocardial infarction, whereas men were significantly more likely to receive antiplatelet agents, lidocaine, and other antiarrhythmic agents. No statistically significant differences were seen between men and women with regard to the use of anticoagulants, beta-blockers, calcium channel blockers, digoxin, nitrates, and thrombolytic agents. Marked increases over time (1975 through 1990) were seen in the use of anticoagulants, antiplatelet agents, beta-blockers, lidocaine, and nitrates in each of the sexes, while declines were seen in the use of digoxin and diuretics. Use of thrombolytic therapy increased between 1986 and 1990, whereas use of calcium channel blockers decreased over this period for both men and women. CONCLUSIONS: The results of this multihospital, population-based, observational study suggest that physician practice patterns in the pharmacologic treatment of men and women hospitalized with acute myocardial infarction are very similar.

A community-wide perspective of gender differences and temporal trends in the use of diagnostic and revascularization procedures for acute myocardial infarction.

This study compares the overall use, as well as temporal trends, of various diagnostic and revascularization procedures for acute myocardial infarction (AMI) in men and women. The study sample comprised a total of 2,924 men and 1,838 women with validated AMI admitted to any of the 16 teaching and community hospitals in the Worcester, Massachusetts, metropolitan area during 1975, 1978, 1981, 1984, 1986 and 1988. During the period under study there was a significant increase in use of each of the examined procedures during hospitalization for AMI in both men and women. Increasing use of multiple procedures was also seen for each of the sexes. After controlling for a variety of demographic and clinical factors that might affect utilization rates, men were marginally more likely to undergo radionuclide ventriculography, and significantly more likely to undergo Holter monitoring, exercise treadmill testing, cardiac catheterization, and percutaneous transluminal coronary angioplasty than women. However, there were no gender differences in the use of coronary artery bypass grafting. On the other hand, men were significantly less likely to undergo echocardiography. The results of this multihospital, population-based study suggest sex differences in the use of several diagnostic and revascularization procedures during hospitalization for AMI. These differences may be attributed to physicians' practice patterns, although gender bias in the delivery of medical care cannot be excluded. Temporal trends in increased overall use of these procedures raise questions about cost-effectiveness that need to be further addressed.

The demand for dental health.

This study evaluates the determinants of demand for dental health in the context of an econometric model where dental health and dental care are jointly endogenous. The theoretical analysis is based on the application of economic theory to production activities occurring at the individual or household level. A number of hypotheses concerning the change in demand for home and market dental care with respect to price and income changes are posited and empirically tested. Additional hypotheses concerning the relation between dental care and dental health are also examined statistically while controlling for a variety of sociodemographic and economic factors. One of the key empirical findings is that the net price elasticity for dental services is quite low (-0.2) for this sample of individuals with high dental insurance coverage.

The empty nest process in mid-life men and women.

A combined clinical and field investigation studied the effects of the empty-nest phase of parenthood on morale and activity level. Data from the clinical study were obtained from two psychotherapy groups conducted for mid-life women, and the field data were obtained from a 5-yr longitudinal study of life stages. Results indicated an increase in morale during the unfolding of the empty nest and suggested that the so-called "crisis" of the empty nest may be more myth than reality.

Divorce at midlife: psychic dangers of the liminal period. Part II. Clinical considerations.

This paper presents the results of a clinical investigation into middle divorce. The second of a two part series, it explores the impact of liminality: the "betwixt and between" state often found among a newly-separated of all ages. This state may occur at more than one point in the divorce process, and is associated with heightened trauma. A therapeutic intervention procedure, the divorce ritual, is suggested as a means of ameliorating the effects of liminality.

Divorce at midlife: psychic dangers of the liminal period. Part I. Empirical considerations.

The literature suggests that those in the second half of life may be more vulnerable to the traumas associated with divorce. In this paper a rites of passage model derived from anthropology was used to help explicate their greater vulnerability. The focus was on liminality, a quality of ambiguity and disconnectedness in life often manifest when persons are leaving the married state but are not as yet divorced. The subjects were newly-separated men and women aged 20--26. When indicators of liminality were quantified, it was found that they were strongly associated with maladaptation, and that the middle aged subjects showed evidence of greater liminality than was the case with younger respondents.

Adult children as caregivers: egocentric biases in judgments of sibling contributions.

This study examined filial caregivers' views of their own and their siblings' costs and contributions to the care of their parents. The respondents viewed their siblings' responses to the parents' needs as remarkably similar to their own, in spite of there being no actual similarity. Despite these perceived similarities, however, respondents perceived their siblings as contributing less than themselves, gaining less satisfaction, feeling freer to alter their caregiving, and being resistant to increasing their relative contributions. In order of importance, the extent of contact between the siblings, their feelings of closeness, the extent of parents' needs, their gender, the extent of resources spent, and personal regard for their siblings were significant predictors of these egocentrically biased perceptions. As expected, these egocentrically biased perceptions were important predictors of personal regard for their siblings.

Disability in older adults. 3: Policy implications.

Several models of disability proposed in recent years share many common elements and are helping to direct research and inform practice. One new development is that disablement, a concept that emphasizes the impairments--handicap continuum, is now being implemented by concepts related to enablement. Enablement focuses attention on the capacity for rehabilitation. Coincidentally, a new generation of functional assessment measures has evolved that allow greater sensitivity not only to levels of disability but also to levels of ability. Together, the new models and tools hold promise of providing a more sensitive evaluation of rehabilitation efforts and a more accurate forecasting of future needs.

An educational intervention for advance directives.

In spite of the passage of the Patient Self-Determination Act in 1991, research indicates that providing information alone has not brought about a significant increase in the completion rates of advance directive (AD) documents. The purpose of this pilot study was to design, implement, and evaluate an interactive multimedia CD-ROM educational program on AD. Study subjects consisted of 31 volunteer elderly men and women in a senior citizens center. An interactive multimedia CD-ROM program was developed in phase I of the study. Subjects were administered on-line pretests and posttests. The effectiveness of the CD-ROM intervention was measured by AD attitude and knowledge changes. A program satisfaction scale was used, and an observer rated the subjects' use of the computer program. Subjects had a statistically significant change in posttest knowledge scores and a high degree of satisfaction and ease in using the computer program. The use of an interactive multimedia CD-ROM program with a touch-sensitive monitor to operate a computer-based AD program for senior citizens shows future promise.