Health-Related Quality of Life of People Who Inject Drugs: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study.

OBJECTIVES: There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort of PWID in Australia. METHODS: Participants were enrolled in an observational cohort study (the Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study) from May 2018 to September 2019 (wave 1) and November 2019 to June 2021 (wave 2). Participants completed the EQ-5D-5L survey at enrolment. Two-part models were used to assess the association of clinical and socioeconomic characteristics with EQ-5D-5L scores. RESULTS: Among 2395 participants (median age, 43 years; 66% male), 65% reported injecting drug use in the past month, 20% had current hepatitis C virus (HCV) infection, and 68% had no/mild liver fibrosis (F0/F1). Overall, the mean EQ-5D-5L and EQ-visual analog scale scores were 0.78 and 57, respectively. In adjusted analysis, factors associated with significantly lower EQ-5D-5L scores include older ages, female (marginal effect = -0.03, P = .014), being homeless (marginal effect = -0.04, P = .040), and polysubstance use (marginal effect = -0.05, P < .001). Factors associated with significantly higher EQ-5D-5L scores were being Aboriginal/Torres Strait Islander (marginal effect = 0.03, P = .021) and recent injecting drug use in the past 12 months. Current HCV infection and liver fibrosis stage were not associated with reduced HRQoL among the study participants. CONCLUSIONS: PWID experienced a lower HRQoL compared with the general population. Further research is needed to understand HRQoL in this population to facilitate the development of multifaceted care models for PWID beyond HCV cure and inform health economic analyses for identifying optimal health strategies for PWID.

Disintegration at the Syntax-Semantics Interface in Prodromal Alzheimer's Disease: New Evidence from Complex Sentence Anaphora in Amnestic Mild Cognitive Impairment (aMCI).

Although diverse language deficits have been widely observed in prodromal Alzheimer's disease (AD), the underlying nature of such deficits and their explanation remains opaque. Consequently, both clinical applications and brain-language models are not well-defined. In this paper we report results from two experiments which test language production in a group of individuals with amnestic Mild Cognitive Impairment (aMCI) in contrast to healthy aging and healthy young. The experiments apply factorial designs informed by linguistic analysis to test two forms of complex sentences involving anaphora (relations between pronouns and their antecedents). Results show that aMCI individuals differentiate forms of anaphora depending on sentence structure, with selective impairment of sentences which involve construal with reference to context (anaphoric coreference). We argue that aMCI individuals maintain core structural knowledge while evidencing deficiency in syntax-semantics integration, thus locating the source of the deficit in the language-thought interface of the Language Faculty.

Discriminatory Experiences Among Black Youth: How Encounters and Expectations Explain Emotional Well-Being.

Research suggests that encounters with racism are related to depression in Black youth. However, less is known about how experienced racial discrimination can influence other aspects of well-being among Black youth including their socio-emotional development and behavior. In addition, emerging literature highlights the critical ways anticipated racial discrimination may impact the emotional well-being of Black youth. To address these gaps, the current study assessed whether experienced discrimination was associated with higher levels of internalizing problems (anxiety/depression, suicidal thoughts) and lower levels of socio-emotional development (emotion regulation, prosocial behavior). We then tested whether expected discrimination contributed to similar patterns. Lastly, this study examined how age and gender moderated this relationship. Across eight schools in three communities, 1435 Black youth (56.57% female; 56.40% 10th grade) in 10th and 12th grades responded to the Youth Experience Survey. Using a series of hierarchical linear and hierarchical binary logistic regressions, results found that those who experienced racial discrimination and expected discrimination demonstrated higher internalizing problems and lower socio-emotional development; however, expected discrimination often accounted for more variance than experienced. These findings suggest the multifaceted influence both experienced and expected racial discrimination have on the well-being of Black youth and can provide important insights to community prevention systems.

A National Snapshot of Introductory Chemistry Instructors and Their Instructional Practices.

The effectiveness of active learning on promoting students' academic outcomes and persistence has been established in the literature. However, despite the effort of purposeful change agents, the uptake of active learning in science, technology, engineering, and mathematics (STEM) is slow. While previous research from the chemistry education community has provided insights into the implementation of specific active learning strategies across the United States, the extent to which chemistry instructors leverage these strategies in general remains unknown. This article presents the results of a national survey aimed at exploring introductory chemistry instructors' knowledge and implementation of active learning, variations on this knowledge, and use across tenure statuses and institution types. This paper also aims to address the gap in the literature in our understanding of the characteristics of instructors of these courses. We thus provide a description of instructors' demographics, training, teaching experience, and teaching responsibilities. Our findings reveal that instructors in these courses are prominently males of European descent. Additionally, instructors come into their teaching position with minimal pedagogical training and participate mainly in short training once in their position. While the majority of instructors have knowledge of specific active learning strategies, their consistent implementation remains limited, with lecturing still being the instructional practice of choice. Variations were found between institution types and across tenure statuses within institutions in terms of pedagogical training, use of specific active learning strategies, and proportion of class time spent lecturing. The findings provide a baseline for future studies that aim to assess the effectiveness of interventions fostering the implementation of active learning in introductory chemistry courses and highlight the critical need for improved communication about teaching practices across institutions and tenure statuses.

Understanding community- and system-capacity change over time: A close look at changing social capital in Evidence2Success communities.

Evidence in majority White and low-population areas suggest that community prevention systems can create social capital that is needed to support high-quality implementation and sustainability of evidence-based programs. This study expands prior work by asking the question: How does community social capital change during the implementation of a community prevention system in low-income, highly populated communities of color? Data were collected from Community Board members and Key Leaders in five communities. Linear mixed effect models analyzed data on reports of social capital over time, first as reported by Community Board members then by Key Leaders. Community Board members reported social capital improved significantly over time during the implementation of the Evidence2Success framework. Key Leader reports did not change significantly over time. These findings suggest that community prevention systems implemented in historically marginalized communities may help communities build social capital that is likely to support the dissemination and sustainability of evidence-based programs.

Which Pain Treatment Goals Are Important to Community-Dwelling Older Adults?

OBJECTIVE: In this cross-sectional study of 237 older adults, we ascertained the importance of seven pain treatment goals and identified factors associated with their perceived importance. METHODS: Participants (mean age = 72 years) ranked each goal (e.g., pain reduction; finding a cure) on a 1 (not at all important) to 10 (extremely important) scale. We used general linear models to identify sociodemographic and pain factors independently associated with the perceived importance of each goal and repeated measures mixed models to examine their relative importance. RESULTS: The goal with the lowest adjusted score was "minimize harmful side effects from pain medications" with a mean (standard error [SE]) of 6.75 (0.239), while the highest ranked goals, "finding a cure," and "reducing my pain" had mean scores of 8.06 (0.237) and 7.89 (0.235), respectively. Pain reduction did not differ significantly from the average of the other 6 goals (P = .072) but was significantly different when compared with the goals of minimizing side effects (P < .0001) and finding a cause for the pain (P = .047), and different from the average of the five other goals excluding finding a cure (P = .021). We did not identify differences in the importance of the seven goals by gender or race/ethnicity. Age was inversely associated with the goals of minimizing harmful side effects and decreasing pain's effects on everyday activities. Pain reduction was rated more important than all other goals but finding a cure. CONCLUSIONS: Future research is needed to establish the benefits of eliciting treatment goals when delivering pain care to older adults.

Setting foot in private spaces: extending the hepatitis C cascade of care to automatic needle/syringe dispensing machines, a mixed methods study.

BACKGROUND: Global commitment to achieving hepatitis C virus (HCV) elimination has enhanced efforts in improving access to direct-acting antiviral (DAA) treatments for people who inject drugs (PWID). Scale-up of efforts to engage hard-to-reach groups of PWID in HCV testing and treatment is crucial to success. Automatic needle/syringe dispensing machines (ADMs) have been used internationally to distribute sterile injecting equipment. ADMs are a unique harm reduction service, affording maximum anonymity to service users. This paper explores the feasibility and acceptability of extending the HCV cascade of care to sites where ADMs are located. METHODS: The ADM users into Treatment (ADMiT) study was undertaken in a metropolitan region in Sydney, Australia. This mixed methods study involved analysis of closed-circuit television footage, ethnographic methods (fieldwork observation and in-depth interviews) and structured surveys. Researchers and peers conducted fieldwork and data collection over 10 weeks at one ADM site, including offering access to HCV testing and treatment. RESULTS: Findings from 10 weeks of fieldwork observations, 70 survey participants and 15 interviews highlighted that there is scope for engaging with this population at the time they use the ADM, and enhanced linkage to HCV testing and treatment may be warranted. Most survey participants reported prior HCV testing, 61% in the last 12 months and 38% had received HCV treatment. However, fieldwork revealed that most people observed using the ADM were not willing to engage with the researchers. Field work data and interviews suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. DISCUSSION: Enhanced linkage to HCV testing and treatment for people who use ADMs may be warranted. However, data suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. The current study raises important public health questions about the need to ensure interventions reflect the needs of affected communities, including their right to remain anonymous.

Progress Towards Elimination of Hepatitis C Infection Among People Who Inject Drugs in Australia: The ETHOS Engage Study.

BACKGROUND: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia. METHODS: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid). RESULTS: Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68; .48-.95), participants who were homeless (.59; .38-.96), and those injecting daily or more (.51; .31-.89). People aged ≥45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment. CONCLUSIONS: Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment.

Associations between unmet palliative care needs and cognitive impairment in a sample of diverse, community-based older adults.

OBJECTIVE: Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples. METHOD: Participants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants' cognitive status and PC needs. RESULTS: Our results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08. SIGNIFICANCE OF RESULTS: This study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.

Elder maltreatment in Europe and the United States: a transnational analysis of prevalence rates and regional factors.

We investigated the association between type and frequency of elder maltreatment (EM) and residential setting (rural, suburban, and urban settings in the U.S. and northern and southern cities in Europe). We used data on 7,225 participants from European and U.S. cross-sectional studies to estimate rates of EM in three domains in the five settings in logistic-linear models that included setting and demographic variables and tested prespecified contrasts on settings. Northern Europe is similar to the U.S. in rate of financial exploitation; the Mediterranean has higher rates than either of the other two. For emotional and physical maltreatment, the Mediterranean is similar to the U.S; Northern Europe has higher rates. EM differs between and within settings in the U.S. and Europe. There is a need for rigorous research to examine the effects of residential settings and environment on EM. Interventions to reduce EM should be explored.

New application of strontium isotopes reveals evidence of limited migratory behaviour in Late Cretaceous hadrosaurs.

Dinosaur migration patterns are very difficult to determine, often relying solely on the geographical distribution of fossils. Unfortunately, it is generally not possible to determine if a fossil taxon's geographical distribution is the result of migration or simply a wide distribution. Whereas some attempts have been made to use isotopic systems to determine migratory patterns in dinosaurs, these methods have yet to achieve wider usage in the study of dinosaur ecology. Here, we have used strontium isotope ratios from fossil enamel to reconstruct the movements of an individual hadrosaur from Dinosaur Provincial Park in Alberta, Canada. Results from this study are consistent with a range or migratory pattern between Dinosaur Provincial Park and a contemporaneous locality in the South Saskatchewan River area, Alberta, Canada. This represents a minimum distance of approximately 80 km, which is consistent with migrations seen in modern elephants. These results suggest the continent-wide distribution of some hadrosaur species in the Late Cretaceous of North America is not the result of extremely long-range migratory behaviours.

Redox chemistry changes in the Panthalassic Ocean linked to the end-Permian mass extinction and delayed Early Triassic biotic recovery.

The end-Permian mass extinction represents the most severe biotic crisis for the last 540 million years, and the marine ecosystem recovery from this extinction was protracted, spanning the entirety of the Early Triassic and possibly longer. Numerous studies from the low-latitude Paleotethys and high-latitude Boreal oceans have examined the possible link between ocean chemistry changes and the end-Permian mass extinction. However, redox chemistry changes in the Panthalassic Ocean, comprising ∼85-90% of the global ocean area, remain under debate. Here, we report multiple S-isotopic data of pyrite from Upper Permian-Lower Triassic deep-sea sediments of the Panthalassic Ocean, now present in outcrops of western Canada and Japan. We find a sulfur isotope signal of negative Δ33S with either positive δ34S or negative δ34S that implies mixing of sulfide sulfur with different δ34S before, during, and after the end-Permian mass extinction. The precise coincidence of the negative Δ33S anomaly with the extinction horizon in western Canada suggests that shoaling of H2S-rich waters may have driven the end-Permian mass extinction. Our data also imply episodic euxinia and oscillations between sulfidic and oxic conditions during the earliest Triassic, providing evidence of a causal link between incursion of sulfidic waters and the delayed recovery of the marine ecosystem.

Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis.

Background. Research has found a strong link between ageism, in the form of negative stereotypes, prejudice, and discrimination toward older people, and risks to their physical and mental health. Little is known, however, about the effectiveness of strategies to reduce ageism. Objectives. To assess the relative effects of 3 intervention types designed to reduce ageism among youths and adults-education, intergenerational contact, and combined education and intergenerational contact-by conducting a systematic review and meta-analysis. Search Methods. We searched PubMed, PsycINFO, AgeLine, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Index Medicus, Database of Abstracts of Reviews of Effects (DARE), Epistemonikos, Cochrane Database of Systematic Reviews, Campbell Collaboration, PROSPERO, GreyLit, and OpenGrey. We identified additional records by hand-searching reference lists of relevant review articles as well as records included in the meta-analysis. Two independent reviewers completed the search and screening process. Selection Criteria. Eligible studies were those that (1) evaluated an intervention designed to reduce ageism, (2) examined at least 1 ageism outcome in relation to older adults, (3) used a design with a comparison group (randomized or nonrandomized), and (4) were published after 1970, when the ageism concept was developed. Data Collection and Analysis. Two independent reviewers extracted study-level data from records using a common data collection spreadsheet. They also assessed study quality by using the Cochrane Risk of Bias Tool, and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool to assess quality of outcome evidence. Primary outcomes were attitudes toward older people and accuracy of knowledge about aging and older people. Secondary outcomes included comfort with older adults, anxiety about one's own aging, and interest in working in the field of geriatrics or gerontology. We carried out meta-analyses with statistical mixed models. Main Results. We identified 63 eligible studies (1976-2018) with a total sample of 6124 participants. Ageism interventions demonstrated a strongly significant effect on attitudes (differences of standardized mean differences [dD] = 0.33; P < .001), knowledge (dD = 0.42; P < .001), and comfort (dD = 0.50; P < .001), but no significant effect on anxiety (dD = 0.13; P = .33) or working with older adults (dD = -0.09; P = .40). Combined interventions with education and intergenerational contact showed the largest effects on attitudes. We found stronger effects for females and for adolescent and young adult groups. Authors' Conclusions. Interventions are associated with substantial reduction in ageism and should be part of an international strategy to improve perceptions of older people and the aging process. Additional research using more rigorous designs to examine the effects of interventions is strongly recommended. Public Health Implications. Ageism has well-established negative effects on the physical and mental health of older people. Findings suggest that relatively low-cost, feasible strategies involving education and intergenerational contact can serve as the basis of effective interventions to reduce ageism.

The carry-over effects of school gardens on fruit and vegetable availability at home: A randomized controlled trial with low-income elementary schools.

This group-randomized controlled trial examines the effects of a school garden intervention on availability of fruits and vegetables (FV) in elementary school children's homes. Within each region, low income U.S. schools in Arkansas, Iowa, New York, and Washington State were randomly assigned to intervention group (n = 24) or waitlist control group (n = 22). Children were in grades 2, 4, and 5 at baseline (n = 2768). The garden intervention consisted of both raised-bed garden kits and a series of grade-appropriate lessons. FV availability at home was measured with a modified version of the GEMS FJV Availability Questionnaire. The instrument was administered at baseline (Fall 2011) and throughout the intervention (Spring 2012, Fall 2012, Spring 2013). Analyses were completed using general linear mixed models. The garden intervention led to an overall increase in availability of low-fat vegetables at home. Among younger children (2nd grade at baseline), the garden intervention led to greater home availability of vegetables, especially, low-fat vegetables. Moreover, for the younger group, garden intervention fidelity (GIF) or robustness predicted home availability of fruit, vegetables, and low-fat vegetables. School gardens have potential to affect FV availability in the home environment.

Prevalence of Financial Fraud and Scams Among Older Adults in the United States: A Systematic Review and Meta-Analysis.

BACKGROUND: The financial exploitation of older adults was recently recognized by the Centers for Disease Control and Prevention as a serious public health problem. Knowledge of the prevalence of elder financial exploitation is mostly limited to the category of financial abuse, which occurs in relationships involving an expectation of trust. Little is known about the other major category of elder financial exploitation-elder financial fraud and scams, which is perpetrated by strangers. A valid estimate of elder financial fraud-scam prevalence is necessary as a foundation for research and prevention efforts. OBJECTIVES: To estimate the prevalence of elder financial fraud-scam victimization in the United States based on a systematic review and meta-analysis. SEARCH METHODS: Multiple investigators independently screened titles and abstracts and reviewed relevant full-text records from PubMed, Medline, PsycINFO, Criminal Justice Abstracts, Social Work Abstracts, and AgeLine databases. SELECTION CRITERIA: To maximize the validity and generalizability of prevalence estimation, we restricted eligibility to general population-based studies (English speaking, 1990 onward) using state- or national-level probability sampling and collecting data directly from older adults. DATA COLLECTION AND ANALYSIS: Information on elder financial fraud-scam prevalence and study-level characteristics was extracted independently by 2 investigators. Meta-analysis of elder financial fraud-scam prevalence used generalized mixed models with individual studies as levels of a random classification factor. MAIN RESULTS: We included 12 studies involving a total of 41 711 individuals in the meta-analysis. Overall pooled elder financial fraud-scam prevalence (up to 5-year period) across studies was 5.6% (95% confidence interval [CI] = 4.0%, 7.8%), with a 1-year period prevalence of 5.4% (95% CI = 3.2%, 7.6%). Studies using a series of questions describing specific fraud-scam events to measure victimization found a significantly higher prevalence (7.1%; 95% CI = 4.8%, 9.4%) than studies using a single, general-question self-report assessment approach (3.6%; 95% CI = 1.8%, 5.4%). AUTHOR'S CONCLUSIONS: Elder financial fraud and scams is a common problem, affecting approximately 1 of every 18 cognitively intact, community-dwelling older adults each year; it requires further attention from researchers, clinicians, and policymakers. Elder financial fraud-scam prevalence findings in this study likely underestimate the true population prevalence. We provide methodological recommendations to limit older adult participation and reporting bias in future population-based research. Public Health Implications. Elder financial exploitation victimization is associated with mortality, hospitalization, and poor physical and mental health. Health care professionals working with older adults likely routinely encounter patients who are fraud-scam victims. Validation of instruments to screen for elder financial fraud and scams in clinical settings is an important area of future research. Without effective primary prevention strategies, the absolute scope of this problem will escalate with the growing population of older adults.

Attachment-focused integrative reminiscence with older African Americans: a randomized controlled intervention study.

OBJECTIVES: Prior integrative reminiscence interventions have had a limited focus on attachment themes. The attachment-focused integrative reminiscence (AFIR) intervention differs from these in its central emphasis on attachment themes. The wide range of health benefits resulting from integrative reminiscence may be due in part to reminiscing about, mourning, and integrating unresolved attachment experiences. METHOD: Participants were randomized into treatment and wait-list control conditions, completed a pre-test, met for eight consecutive weekly two-hour sessions of largely attachment-focused reminiscence, then completed post-tests immediately following the intervention and again six months later. RESULTS: Results show treatment effects for depression (p = .01 and .05 at eight weeks and six months), perceived stress (p = .01 and .04), and emergency room (ER) visits at six months (p = .04), with the intervention group showing lower depression and stress and fewer ER visits. CONCLUSION: Integrative reminiscence interventions are cost effective, have rapid impact, and carry a certain appeal to older adults. Augmenting such interventions with a focus on attachment experiences may reduce perceived stress, an important health risk factor. Wider application of AFIRs may further reduce health disparities among US older adults.

Financial exploitation of older adults: a population-based prevalence study.

BACKGROUND: Financial exploitation is the most common and least studied form of elder abuse. Previous research estimating the prevalence of financial exploitation of older adults (FEOA) is limited by a broader emphasis on traditional forms of elder mistreatment (e.g., physical, sexual, emotional abuse/neglect). OBJECTIVES: 1) estimate the one-year period prevalence and lifetime prevalence of FEOA; 2) describe major FEOA types; and 3) identify factors associated with FEOA. DESIGN: Prevalence study with a random, stratified probability sample. PARTICIPANTS: Four thousand, one hundred and fifty-six community-dwelling, cognitively intact adults age ≥ 60 years. SETTING: New York State. MAIN MEASURES: Comprehensive tool developed for this study measured five FEOA domains: 1) stolen or misappropriated money/property; 2) coercion resulting in surrendering rights/property; 3) impersonation to obtain property/services; 4) inadequate contributions toward household expenses, but respondent still had enough money for necessities and 5) respondent was destitute and did not receive necessary assistance from family/friends. KEY RESULTS: One-year period FEOA prevalence was 2.7% (95% CI, 2.29-3.29) and lifetime prevalence was 4.7% (95% CI, 4.05-5.34). Greater relative risk (RR) of one-year period prevalence was associated with African American/black race (RR, 3.80; 95 % CI, 1.11-13.04), poverty (RR, 1.72; 95 % CI, 1.09-2.71), increasing number of non-spousal household members (RR, 1.16; 95 % CI, 1.06-1.27), and ≥ 1 instrumental activity of daily living (IADL) impairments (RR, 1.69; 95 % CI, 1.12-2.53). Greater RR of lifetime prevalence was associated with African American/black race (RR, 2.61; 95 % CI, 1.37-4.98), poverty (RR, 1.47; 95 % CI, 1.04-2.09), increasing number of non-spousal household members (RR, 1.16; 95 % CI, 1.12-1.21), and having ≥1 IADL (RR, 1.45; 95 % CI, 1.11-1.90) or ≥1 ADL (RR, 1.52; 95 % CI, 1.06-2.18) impairment. Living with a spouse/partner was associated with a significantly lower RR of lifetime prevalence (RR, 0.39; 95 % CI, 0.26-0.59) CONCLUSIONS: Financial exploitation of older adults is a common and serious problem. Elders from groups traditionally considered to be economically, medically, and sociodemographically vulnerable are more likely to self-report financial exploitation.

School gardens and physical activity: a randomized controlled trial of low-income elementary schools.

OBJECTIVE: This study examines effects of a school garden intervention on elementary school children's physical activity (PA). METHOD: Twelve schools in New York were randomly assigned to receive the school garden intervention (n=6) or to the waitlist control group that later received gardens (n=6). PA was measured by self-report survey (Girls Health Enrichment Multi-site Study Activity Questionnaire) (N=227) and accelerometry (N=124, 8 schools) at baseline (Fall 2011) and follow-up (Spring 2012, Fall 2012, Spring 2013). Direct observation (N=117, 4 schools) was employed to compare indoor (classroom) and outdoor (garden) PA. Analysis was by general linear mixed models. RESULTS: Survey data indicate garden intervention children's reports of usual sedentary activity decreased from pre-garden baseline to post-garden more than the control group children's (Δ=-.19, p=.001). Accelerometry data reveal that during the school day, children in the garden intervention showed a greater increase in percent of time spent in moderate and moderate-to-vigorous PA from baseline to follow-up than the control group children (Δ=+.58, p=.010; Δ=+1.0, p=.044). Direct observation within-group comparison of children at schools with gardens revealed that children move more and sit less during an outdoor garden-based lesson than during an indoor, classroom-based lesson. CONCLUSION: School gardens show some promise to promote children's PA. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov # NCT02148315.

Meeting the public health challenge of pain in later life: what role can senior centers play?

Interest in nonpharmacologic approaches for managing pain continues to grow. The aim of this study was to determine the types of pain-relevant programs offered by senior centers and whether the programs varied by clients' race/ethnicity status and center size. A telephone survey was conducted. Respondents were presented with a list of 15 programs and the option to choose "other" and asked (1) whether the activity was offered and, if so, how often; (2) if they believed the programs had value for seniors with pain; and (3) whether the classes were advertised as a means of achieving pain relief. Of 204 center staff contacted, 195 (95.6%) participated. The most common programs offered were movement-based, including exercise (by 91.8% of the centers), dance (72.3%), walking clubs (71.8%), yoga (65.6%), and Tai Chi (53.3%) classes. Creative arts programs were also frequently offered, including music (58.5%) and fine arts (47.7%). Programs such as stress management (27%) and relaxation (26%) classes were less commonly offered. Most respondents identified movement-based programs as helpful for seniors with pain, but few identified creative arts classes as potentially beneficial. The programs/classes offered were infrequently advertised as a means of helping seniors manage pain and varied by clients' race/ethnicity status and center size. Programs that have potential utility for older adults with pain are commonly offered by senior centers. Future research should determine optimal strategies for engaging older adults in these programs in the senior center setting.