Understanding the concept of trust and other factors related to COVID-19 vaccine intentions among Black/African American older adults prior to vaccine development.

Background: Black/African Americans are receiving COVID-19 vaccines at much lower rates than whites. However, research is still evolving that explains why these vaccination rates are lower. The aim of this study was to examine the effects of the pandemic among older Black/African Americans, with an emphasis on trust and vaccine intention prior to vaccine development. Methods: Data were collected between July and September 2020 from 8 virtual focus groups in Detroit, MI and San Francisco Bay Area, CA with 33 older African Americans and 11 caregivers of older African Americans with cognitive impairment, supplemented by one virtual meeting with the project's Community Advisory Board. Inductive/deductive content analysis was used to identify themes. Results: Five major themes influenced the intention to be vaccinated: uncertainty, systemic abandonment, decrease in trust, resistance to vaccines, and opportunities for vaccination. The last theme, opportunities for vaccination, emerged as a result of interaction with our CAB while collecting project data after the vaccines were available which provided additional insights about potential opportunities that would promote the uptake of COVID-19 vaccination among older Black/African Americans. The results also include application of the themes to a multi-layer framework for understanding precarity and the development of an Integrated Logic Model for a Public Health Crisis. Conclusions: These findings suggest that trust and culturally relevant information need to be addressed immediately to accelerate vaccine uptake among older Black/African Americans. New initiatives are needed to foster trust and address systemic abandonment from all institutions. In addition, culturally relevant public health campaigns about vaccine uptake are needed. Thus, systemic issues need immediate attention to reduce health disparities associated with COVID-19.

Return Migration in Later Life in Mainland China: Motivations, Patterns, and Influences.

This study focuses on patterns and influences of return migration behavior in mainland China, (n = 468 individuals ages 50 and above) from a life-course perspective, using the 2011 China Health and Retirement Longitudinal Study (CHARLS). Utilizing spatial analysis, we found return migration geographic patterns mainly from the frontier and urban centers to central provinces, involving migrant workers returning to their rural homes. We used logistic linear modeling to examine the correlations between personal attributes (e.g., age, gender, marital status), environmental aspects (e.g., community characteristics, housing conditions, geographic attributes), and return migration. Historical and socioeconomic factors affected return migration, including availability parents to provide care, declining personal health, improved housing infrastructures, and better access to community services. Our findings also show the productive social role of caregiving as a reason for migration, calling for flexible policies in China's social welfare system, comprehensive senior living facilities, and adequate support systems in rural communities.

Intersections of Home, Health, and Social Engagement in Old Age: Formal Volunteering as a Protective Factor to Health After Relocation.

This study aims to further our understanding of formal volunteering as a protective mechanism for health in the context of housing relocation and to explore race, gender, and education as moderators. A quasi-experimental design evaluated the effects of volunteering on older adults' health (self-report health, number of instrumental activities of daily living [IADLs], and depressive symptoms) among individuals who relocated but did not volunteer at Time 1 ( N = 682) in the Health and Retirement Study (2008-2010). Propensity score weighting examined health differences at Time 2 between 166 volunteers (treated) and 516 nonvolunteers (controlled). Interaction terms tested moderation. Individuals who moved and engaged in volunteering reported higher levels of self-rated health and fewer IADL difficulties compared to the control group. Race moderated the relationship between volunteering and depressive symptoms, while gender moderated the relationship between volunteering and self-assessed health. Formal volunteering protects different dimensions of health after relocation. Volunteering was particularly beneficial for females and older Whites.

Gokyo Khumbu/Ama Dablam Trek 2012: effects of physical training and high-altitude exposure on oxidative metabolism, muscle composition, and metabolic cost of walking in women.

PURPOSE: We investigated the effects of moderate-intensity training at low and high altitude on VO2 and QaO2 kinetics and on myosin heavy-chain expression (MyHC) in seven women (36.3 yy ± 7.1; 65.8 kg ± 11.7; 165 cm ± 8) who participated in two 12- to 14-day trekking expeditions at low (598 m) and high altitude (4132 m) separated by 4 months of recovery. METHODS: Breath-by-breath VO2 and beat-by-beat QaO2 at the onset of moderate-intensity cycling exercise and energy cost of walking (Cw) were assessed before and after trekking. MyHC expression of vastus lateralis was evaluated before and after low-altitude and after high-altitude trekking; muscle fiber high-resolution respirography was performed at the beginning of the study and after high-altitude trekking. RESULTS: Mean response time of VO2 kinetics was faster (P = 0.002 and P = 0.001) and oxygen deficit was smaller (P = 0.001 and P = 0.0004) after low- and high-altitude trekking, whereas ˙ QaO2 kinetics and Cw did not change. Percentages of slow and fast isoforms of MyHC and mitochondrial mass were not affected by low- and high-altitude training. After training altitude, muscle fiber ADP-stimulated mitochondrial respiration was decreased as compared with the control condition (P = 0.016), whereas leak respiration was increased (P = 0.031), leading to a significant increase in the respiratory control ratio (P = 0.016). CONCLUSIONS: Although training did not significantly modify muscle phenotype, it induced beneficial adaptations of the oxygen transport-utilization systems witnessed by faster VO2 kinetics at exercise onset.

Addressing Heart Failure Challenges through Illness-Informed Social Work.

This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care. Findings suggest that health care social workers perceive heart failure as characterized by an uncertain illness trajectory, frequent hospitalizations, and difficulties accessing formal and informal care. These findings suggest the importance of what we term illness-informed social work, a practice that combines heart failure knowledge with social work competencies to address the complex psychosocial issues in heart failure care.

Mitochondrial coupling in humans: assessment of the P/O2 ratio at the onset of calf exercise.

Coupling of oxidation to ATP synthesis (P/O2 ratio) is a critical step in the conversion of carbon substrates to fuel (ATP) for cellular activity. The ability to quantitatively assess mitochondrial coupling in vivo can be a valuable tool for basic research and clinical purposes. At the onset of a square wave moderate exercise, the ratio between absolute amount of phosphocreatine split and O2 deficit (corrected for the amount of O2 released from the body O2 stores and in the absence of lactate production), is the mirror image of the P/O2 ratio. To calculate this value, cardiac output (Q), whole body O2 uptake (VO2), O2 deficit (O2(def)) and high-energy phosphates concentration (by 31P-NMR spectroscopy) in the calf muscles were measured on nine healthy volunteers at rest and during moderate intensity plantar flexion exercise (3.44 +/- 0.73 W per unit active muscle mass). Q and VO2 increased (from 4.68 +/- 1.56 to 5.83 +/- 1.59 l min(-1) and from 0.28 +/- 0.05 to 0.48 +/- 0.09 l min(-1), respectively), while phosphocreatine (PCr) concentration decreased significantly (22 +/- 6%) from rest to steady-state exercise. For each volunteer, "gross" O2(def) was corrected for the individual changes in the venous blood O2 stores (representing 49.9 +/- 9.5% of the gross O2(def)) yielding the "net" O2(def). Resting PCr concentration was estimated from the appropriate spectroscopy data. The so calculated P/O2 ratio amounted on average to 4.24 +/- 0.13 and was, in all nine subjects, very close to the literature values obtained directly on intact skeletal muscle. This unfolds the prospect of a non-invasive tool to quantitatively study mitochondrial coupling in vivo.

Clinical predictors of short-term outcome in electroconvulsive therapy.

OBJECTIVES: Electroconvulsive therapy (ECT) remains one of the most effective biological treatments for major depression. However, there is little information on the clinical use of ECT, and most studies were conducted before the introduction of newer antidepressants and before improvements in ECT delivery. This study examined ECT use in a university teaching hospital to determine predictors of short-term ECT outcome. METHODS: This was a retrospective chart review of ECT over the period 1994-1996. Data extracted from the chart included demographic information, clinical features of depression, and documented antidepressant trials. Outcome measures, based on the chart notes, included Clinical Global Impression (CGI) and cognitive side effects of ECT at 1 week post-ECT or at discharge if sooner. RESULTS: Of 174 patients who received ECT, 130 had a diagnosis of unipolar major depressive disorder. Of these 130 patients, 92% were refractory to at least 1 antidepressant medication. After a clinical course of ECT, 87% were rated as "much" or "very much" improved on the CGI. Moderate side effects were noted in 16% of patients, while only 7% had marked side effects. Medication resistance was not related to ECT response. No significant clinical predictors (symptoms, chronicity, number of antidepressant trials) of ECT outcome were found on a stepwise multiple-regression analysis. CONCLUSIONS: These results support previous studies showing that ECT results in very good short-term response in major depressive disorder and that the cognitive side effects of ECT are reasonable. Despite the limitations of this study (retrospective, chart review, global measures), the results will inform clinicians who are recommending ECT for their patients.

Patterns of violent incidents by patients in a general hospital psychiatric facility.

Reports of attempted or actual physical assaults by patients in the inpatient, outpatient, and emergency settings of a psychiatric facility within a general hospital were prospectively surveyed during a one-year period. Among 397 patients discharged during the period, 46 patients were responsible for 133 violent incidents. Most incidents occurred on the locked inpatient unit during the daytime and after the first week of admission. Schizophrenia was the only diagnosis significantly associated with violence. Hitting was the most prevalent form of violence, and nurses were the most frequent targets.