Is Occupational Complexity Associated with Cognitive Performance or Decline? Results from the Australian Longitudinal Study of Ageing.

BACKGROUND: Long-term protective associations proposed between previous complex occupational tasks and cognitive functioning in later life point to work roles contributing to cognitive reserve. OBJECTIVE: To examine occupational complexity involving data, people, and things in relation to the level of, and rate of change in, cognitive functioning. METHODS: Participants were 1,290 members of the Australian Longitudinal Study of Ageing and initially aged 65-102 years (mean = 79). Information about main lifetime occupation was collected retrospectively. Cognition was assessed 4 times over a 13-year interval. RESULTS: In multilevel models adjusted for demographics, medical conditions, and depressive symptoms, higher complexity involving data was associated with faster speed (ß = 0.73, p < 0.001), better memory (ß = 0.32, p < 0.05), and mental status (ß = 0.40, p < 0.001) at baseline. These associations remained statistically reliable after adjusting for complexity with people and things, sedentary and heavy physical work, retirement age, and leisure activity. Complexity with things was associated with slower speed (ß = -0.50, p < 0.001) and poorer mental status (ß = -0.26, p < 0.01) and was not explained by other variables. There were no associations of occupational complexity with rates of cognitive decline over time. CONCLUSION: Older individuals retired from occupations characterized by higher complexity with data maintain their cognitive advantage over those with lower complexity into older adulthood, although without additional moderation of this advantage in terms of less postretirement cognitive decline. Complexity of work with things confers a negative relation to cognition whilst also not affecting postretirement cognitive change. Although the relative contributions of occupation or other early life influences for cognition remain to be established, it nevertheless may be beneficial to promote workplace design strategies and interventions that incorporate complex activities, particularly tasks involving data.

Cross-sectional associations of neighborhood third places with social health among community-dwelling older adults.

Social health is a key aspect of active ageing. The objectives of this study are to investigate whether and what type of neighborhood third places are associated with positive social health among community dwelling older adults, and explore whether the associations vary by gender. Neighborhood third places are those spaces that have a social function and are located within a neighborhood, but outside the home (first place) and work (second place). Cross-sectional data were from 981 adults aged 55 years and older who responded to a survey conducted in 2018 in three Singapore neighborhoods. The neighborhoods were selected because they have a high percentage of older residents, different housing typologies, and heterogeneity of built environment qualities. Social health was measured using the six-item Lubben Social Network Scale. Attributes of participants' physical environment included residential density, pedestrian-friendly street design, access to public transport, and were objectively assessed using geographic information systems data. Covariates included age, sex, ethnic group, highest educational qualification, marital status, number of people living in dwelling, years living at current address, dwelling unit type, and number of diagnosed medical conditions and IADLs. Regression analysis was performed using Stata version 15 and indicated that female respondents who live in closer proximity to a wet market were more likely to have higher levels of social health independently of individual demographic and physical health characteristics, physical environment qualities, and other destination types. In a time of heightened concern about social isolation and loneliness among older age groups, this study contributes evidence that older people, particularly females, who live in closer proximity to a wet market self-reported better social health. Wet markets are spaces where people can mingle while purchasing or bargaining for fresh produce and household necessities. The mechanisms via which neighborhood third places may contribute to social health requires examination.

Association of Neighborhood Social Capital With Quality of Life Among Older People in Singapore.

Objective: To examine how neighborhood-based cognitive and structural social capital are associated with individual quality of life among a sample of community-dwelling older adults in Singapore. Method: Using survey data from 981 older adults (aged 55 years and above) in nine residential neighborhoods, multilevel models simultaneously estimated the effects of independent variables at the individual and neighborhood levels on quality of life (CASP-12). Results: Social cohesion (ß = 1.39, p < .01) and associational membership (ß = 19.16, p < .01) were associated with higher quality of life in models adjusted for neighborhood facilities and individual sociodemographics, social networks, functional limitations, global cognitive status, and medical conditions. Discussion: The results suggest that place-based or neighborhood social capital may be important for older person's well-being. It identifies the contribution of structural (associational membership) and cognitive (social cohesion) social capital to the well-being of community-dwelling older adults in Singapore.

Including Health in Environmental Assessments of Major Transport Infrastructure Projects: A Documentary Analysis.

BACKGROUND: Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia. METHODS: We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included. RESULTS: We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise. CONCLUSION: Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant limitation, and there is a need for health issues to be considered when earlier, fundamental decisions about the project are being made.

Social determinants of health and local government: understanding and uptake of ideas in two Australian states.

OBJECTIVE: To examine the awareness and perceptions of local government staff about the social determinants of health (SDoH) and health inequity and use of these ideas to shape policy and practice. METHODS: 96 staff at 17 councils in South Australia or New South Wales responded to questions in a pilot online survey concerning: sources of knowledge about, familiarity with the evidence on, attitudes towards, and uses of ideas about the social determinants of health. Eight of 68 SA councils and 16 of 152 NSW councils were randomly selected stratified by state and metropolitan status. Differences between states and metropolitan/non-metropolitan status were explored. RESULTS: The majority of respondents (88.4%) reported some familiarity with ideas about the broad determinants of health and 90% agreed that the impact of policy action on health determinants should be considered in all major government policy and planning initiatives. Research articles, government/professional reports, and professional contacts were rated as important sources of knowledge about the social determinants of health. CONCLUSION: Resources need to be dedicated to systematic research on practical implementation of interventions on social determinants of health inequities and towards providing staff with more practical information about interventions and tools to evaluate those interventions. IMPLICATIONS: The findings suggest there is support for action addressing the social determinants of health in local government. The findings extend similar research regarding SDoH and government in NZ and Canada to Australian local government.

Defining and managing expectations for early immunotherapy cancer trials.

This review discusses the concept of expectations in assessing direct benefit to participants in phase I immunotherapy studies. With the push toward a faster assessment of clinical benefit or efficacy, limiting phase I studies to safety determination only is now viewed as obsolete and has been replaced by designs that draw attention to therapeutic benefit or efficacy. While this approach is touted as being more flexible in trial conduct, these designs are particularly problematic for immunotherapy studies. Defining and managing expectations is paramount on understanding the key axioms that emerge that include i) understanding bias in models and mechanistic results, ii) that no test is perfect, iii) it is difficult to select a good predictive biomarker in the absence of clinical data, even for targeted therapies, iv) markers predictive for monotherapy may not be predictive for combination therapy, and v) all about improved patient selection. Considering the heterogeneity of cancers and the immune response of the host, we think that immunotherapy should be developed in parallel with the identification of different clinico-pathological models of immune response to cancer. This approach would accomplish two important goals: 1) provide a biological understanding of the complete in vivo environment, thereby giving investigators the opportunity to optimize and maximize the effect of a specific immunotherapy agent and 2) addressing host environment issues simultaneously so that safety data and perceived benefit can be achieved more quickly.