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Purpose in life is an aspect of well-being associated with less subjective stress. The present research sought to expand this literature by testing the association between both dispositional and momentary purpose with stress in daily life using a micro-longitudinal study design. Participants (N = 303) reported their dispositional purpose at baseline and reported their momentary purpose and stress three times a day for 8 days. Between-person, dispositional purpose was associated with less momentary stress across the 8 days tested with linear regression (ß = -0.29, 95% CI = -0.39, -18, p < 0.001); it was unrelated to variability in stress (ß = 0.05, 95% CI = -0.05, 0.14, p = 0.310). In contrast, the within-person analysis tested with multilevel modelling indicated that in moments when participants felt more purpose-driven than their average, they felt more stressed (b = 0.09, 95% CI = 0.06, 0.12, SE = 0.01, p < 0.001). This association was slightly stronger among participants with relatively lower dispositional purpose (binteraction = -0.04, SE = 0.02, 95% CI = -0.08, -0.01, p = 0.032). This study replicated the negative association between dispositional purpose and subjective stress when stress was measured at moments in daily life. It also found that feeling more purpose-driven than usual in the moment is stressful, a counterintuitive finding that, if replicated, suggests that striving for purpose can be stressful in the moment, even if feeling more purposeful in general is associated with lower stress.
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BACKGROUND: Cockroach allergy contributes to morbidity among urban children with asthma. Few trials address the effect of subcutaneous immunotherapy (SCIT) with cockroach allergen among these at-risk children. OBJECTIVES: We sought to determine whether nasal allergen challenge (NAC) responses to cockroach allergen would improve following 1 year of SCIT. METHODS: Urban children with asthma, who were cockroach-sensitized and reactive on NAC, participated in a year-long randomized double-blind placebo-controlled SCIT trial using German cockroach extract. The primary endpoint was the change in mean Total Nasal Symptom Score (TNSS) during NAC after 12 months of SCIT. Changes in nasal transcriptomic responses during NAC, skin prick test wheal size, serum allergen-specific antibody production, and T-cell responses to cockroach allergen were assessed. RESULTS: Changes in mean NAC TNSS did not differ between SCIT-assigned (n = 28) versus placebo-assigned (n = 29) participants (P = .63). Nasal transcriptomic responses correlated with TNSS, but a treatment effect was not observed. Cockroach serum-specific IgE decreased to a similar extent in both groups, while decreased cockroach skin prick test wheal size was greater among SCIT participants (P = .04). A 200-fold increase in cockroach serum-specific IgG4 was observed among subjects receiving SCIT (P < .001) but was unchanged in the placebo group. T-cell IL-4 responses following cockroach allergen stimulation decreased to a greater extent among SCIT versus placebo (P = .002), while no effect was observed for IL-10 or IFN-γ. CONCLUSIONS: A year of SCIT failed to alter NAC TNSS and nasal transcriptome responses to cockroach allergen challenge despite systemic effects on allergen-specific skin tests, induction of serum-specific IgG4 serum production and down-modulation of allergen-stimulated T-cell responses.
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This article provides an overview of the findings obtained from the Vitamin D Antenatal Asthma Reduction Trial (VDAART) spanning a period of 15 years. The review covers various aspects, including the trial's rationale, study design, and initial intent-to-treat analyses, as well as an explanation of why those analyses did not achieve statistical significance. Additionally, the article delves into the post hoc results obtained from stratified intent-to-treat analyses based on maternal vitamin D baseline levels and genotype-stratified analyses. These results demonstrate a statistically significant reduction in asthma among offspring aged 3 and 6 years when comparing vitamin D supplementation (4400 IU/d) to the standard prenatal multivitamin with vitamin D (400 IU/d). Furthermore, these post hoc analyses found that vitamin D supplementation led to a decrease in total serum IgE levels and improved lung function in children compared to those whose mothers received a placebo alongside the standard prenatal multivitamin with vitamin D. Last, the article concludes with recommendations regarding the optimal dosing of vitamin D for pregnant women to prevent childhood asthma as well as suggestions for future trials in this field.
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Asthme , Vitamine D , Enfant , Femelle , Humains , Grossesse , Asthme/prévention et contrôle , Compléments alimentaires , Vitamine D/usage thérapeutique , Enfant d'âge préscolaire , Essais cliniques comme sujetRÉSUMÉ
Bereavement is a common and often challenging experience in late life. Evidence shows that while many older adults manage to adjust well and demonstrate resilience in response to the death of a close person, bereavement puts a substantial minority at risk of adverse mental and physical health impacts including mortality. Current research further indicates that 1) this is the case across different countries and cultures across the globe; 2) that the COVID-19 pandemic posed unprecedented challenges for coping with late-life bereavement; 3) that loneliness and social isolation among bereaved older adults tend to be prevalent and harmful, particularly under pandemic but also in nonpandemic circumstances; and, recently, 4) that bereavement may be a risk factor for cognitive decline in this population.
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Deuil (perte) , Veuvage , Femelle , Humains , Sujet âgé , Pandémies , Chagrin , Solitude/psychologieRÉSUMÉ
BACKGROUND AND OBJECTIVES: Proxy respondents are an important tool in survey research, especially among people with cognitive impairment. However, proxy respondents may be unable to accurately answer subjective survey instruments for cognitively impaired persons. This study investigates the mediating effect of proxy status on the relationship between cognitive impairment and subjectively rated health. RESEARCH DESIGN AND METHODS: Respondents from the 2018 wave of the Health and Retirement Study (Nâ =â 17,146) were included, and the Baron and Kenny method assessed the potential mediating role of having a proxy on subjectively rated health. Subjectively rated health and proxy status were dichotomously coded, and relationships between cognitive impairment, proxy status, and subjectively rated health were assessed using logistic regression. RESULTS: Findings indicate that cognitive impairment is inversely associated with subjectively rated health, and it is directly associated with having a proxy. They also indicate that having a proxy is inversely related to subjectively rated health. When including proxy status and cognitive impairment in the same model, cognitive impairment no longer predicted subjectively rated health. This indicates that proxy status perfectly mediated the relationship between cognitive impairment and subjectively rated health. DISCUSSION AND IMPLICATIONS: Measuring the experiences of people with cognitive impairment is challenging in survey research due to the limiting features of cognitive impairment. Although having a proxy respondent helps address attrition-related measurement challenges in survey research, findings indicate that proxies report worse subjectively rated health for people with cognitive impairment compared to individuals with comparable levels of cognitive impairment without a proxy. Future research may benefit from exploring optimal proxy-respondent characteristics.
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Dysfonctionnement cognitif , État de santé , Mandataire , Humains , Mâle , Femelle , Dysfonctionnement cognitif/psychologie , Sujet âgé , Adulte d'âge moyen , Cognition , Sujet âgé de 80 ans ou plus , Autorapport , Auto-évaluation diagnostiqueRÉSUMÉ
Objectives: Within marriages, loneliness has been linked with individuals' own and their partners' cognitive health. Yet little research has situated Black older adults within a relational, dyadic context.Method: This study analyzed longitudinal dyadic data from the Health and Retirement Study (2010-2016; n = 1270 participants from 635 couples) from both partners in opposite-sex midlife and older couples where at least one partner reported being Black or African American.Results: Results indicated (1) husbands' loneliness was associated with worse cognitive functioning 4 years later for wives who had high baseline cognitive functioning themselves; (2) wives' loneliness was associated with worse cognitive functioning 4 years later only for oldest-old husbands; and (3) wives' cognitive functioning was associated with slower increases to husbands' loneliness 4 years later.Conclusion: Findings indicate that loneliness has dyadic consequences for cognitive functioning among older Black couples, but that context is crucial for determining who is at greatest risk of harmful repercussions from a partner's loneliness.
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OBJECTIVES: To examine the influence of sociodemographic factors on employment changes among adult children following onset of parental Alzheimer's disease and related dementia (ADRD). METHODS: We used Health and Retirement Study (2010-2018; N = 20,110) data to examine adult child (ages 50-70) changes in employment and work hours at onset of parental ADRD and potential variation by gender, age, race, ethnicity, and education. RESULTS: Parental ADRD onset was not associated with changes in adult child employment overall, although associations differed substantially across subpopulations defined by education level. Sons with the lowest education were least likely to cease employment, while daughters with the lowest education were most likely to reduce work hours. Sons at older ages were increasingly likely to reduce work hours or end employment following parental ADRD onset. DISCUSSION: The potential impact of parental ADRD on adult child employment is complex and should be considered in the context of sociodemographic factors.
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Individuals with intellectual and developmental disabilities (IDD) face several barriers to healthcare, making them less likely to receive numerous routine preventive health screenings. Preventive healthcare is a critical aspect to maintaining health and wellness, particularly for people with complex health needs. This study examines individual- and state-level factors associated with mammogram and colonoscopy screenings in mid- and later-life foradults with IDD receiving state services. Multilevel logistic regression models analyzed data from the 2012-2013 and 2018-2019 waves of the National Core Indicators In-Person Survey (NCI-IPS). Results indicated that factors such as age, living situation, transportation access, and community involvement were associated with completion of both preventive screenings. Medicaid expansion was associated with a significantly greater likelihood of completing a colonoscopy screening only among younger persons in the sample (i.e., in their 50s). These findings may have implications for completion of preventive health screenings for adults with IDD.
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Incapacités de développement , Medicaid (USA) , États-Unis , Humains , Sujet âgé , Enfant , Incapacités de développement/diagnostic , Services de médecine préventive , Modèles logistiques , Prestations des soins de santéRÉSUMÉ
OBJECTIVES: Connections between social integration and health throughout the life span are well established, including at the neighborhood level and among older adults. Less explored is how pathways between neighborhood social cohesion and well-being may differ by race/ethnicity or by neighborhood disorder. This study investigates whether perceived neighborhood social cohesion is associated with loneliness in adults aged 50 and older, and whether this association is moderated by race/ethnicity or perceived neighborhood disorder. METHODS: We used pooled cross-sectional data from the 2016 and 2018 waves of the Health and Retirement Study and respondents to the Leave-behind Questionnaire age 50 and older, living in the community (N = 10,713). Data were analyzed using multivariate ordinary least squares regression. RESULTS: Perceived social cohesion was negatively associated with loneliness (B = -0.13, p < .001); however, this effect was strongest among White respondents, and significantly weaker for respondents who were Black (B = 0.02, p < .05), Hispanic (B = 0.03, p < .05), or of another race/ethnicity (B = 0.03, p < .05). Further, neighborhood disorder moderated the association between social cohesion and loneliness (B = 0.02, p < .001), reducing the strength of relationship for those in areas of high disorder. Inclusion of this interaction also attenuated the interaction between neighborhood cohesion and race for Black older adults. DISCUSSION: Findings show that neighborhood social cohesion matters for midlife and older adults' loneliness, but that this relationship varies by race/ethnicity and neighborhood disorder. As such, neighborhood racial/ethnic makeup and both social and objective neighborhood characteristics should be considered when designing interventions to reduce loneliness.
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Ethnies , Solitude , Humains , Adulte d'âge moyen , Sujet âgé , Cohésion sociale , Études transversales , Caractéristiques de l'habitatRÉSUMÉ
OBJECTIVES: Loneliness is associated with diminished health and cognition for older individuals. However, little research has examined dyadic loneliness-that is, loneliness of both partners in a relationship-and its potential consequences for cognitive functioning among both spouses, nor whether one partner's cognition may affect both partners' loneliness over time. METHODS: We analyze 3-wave dyadic Health and Retirement Study data (2010-2020; N = 1,061 dyads) to determine (a) whether loneliness predicts participants' own and/or their partners' episodic memory and verbal fluency over 8 years, and (b) whether cognitive functioning predicts older spouses' own or their partners' loneliness over the same period. RESULTS: Loneliness predicted participants' own and their partners' loneliness at follow-up, at both time points. Loneliness was also associated with own episodic memory at follow-up, but not with verbal fluency. Episodic memory and verbal fluency predicted one another over time. Neither episodic memory nor verbal fluency predicted loneliness at follow-up. Significant dyadic mediation was established such that Time 1 loneliness was linked with partner's Time 3 episodic memory via that partner's Time 2 loneliness. DISCUSSION: Lonelier older adults displayed worse trajectories of episodic memory over time, yet poor memory did not precede changes to loneliness. Further, having a lonely partner was linked with poorer episodic memory 8 years later, indicating that both one's own and-to a lesser extent-a partner's emotional well-being may be consequential for maintaining cognitive functioning with age. Associations were more clearly established with episodic memory than with verbal fluency, suggesting potential domain-specific effects of loneliness.
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Solitude , Conjoints , Humains , États-Unis/épidémiologie , Sujet âgé , Solitude/psychologie , Conjoints/psychologie , CognitionRÉSUMÉ
Loneliness is linked to many physiological and psychological issues and disproportionately affects older adults. Interpersonal goals (compassion and self-image) are essential to interpersonal relationships; however, how they relate to loneliness in older adults is unknown. We investigated the impact of interpersonal goals on loneliness using the Ecosystem-Egosystem Theory of Social Motivation. This study, adopting a descriptive cross-sectional correlational design, used data from the 2016 Health and Retirement Study. Participants (n = 3212) included people aged >65 years (mean age: 75; female: 60.1%). We performed exploratory factor analysis with principal axis factoring and varimax rotation to examine the suitability of compassionate and self-image goals as separate factors. The complex samples general linear model was used to assess the relationship between loneliness and interpersonal goals. Interpersonal goals were significantly negatively associated with loneliness. Respondents with higher compassion and self-image goals reported lower loneliness levels. Our results contribute to understanding how interpersonal goals relate to loneliness in older adults. These initial findings warrant further investigation.
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Objectifs , Solitude , Humains , Femelle , Sujet âgé , Solitude/psychologie , Études transversales , Écosystème , Relations interpersonnellesRÉSUMÉ
This study explores factors associated with participation in moderate physical activity and muscle strengthening activity in adults with autism receiving state services (age: 18-78 years). Researchers analyzed the National Core Indicators-In Person Survey (2017-2018) data using multilevel mixed effects logistic regression. Older adults on the autism spectrum engaged in both moderate physical activity and muscle strengthening activity less often than younger adults on the autism spectrum (OR 0.99; p < 0.05; OR 0.98; p < 0.001). Individuals reportedly in fair/poor health had 50% lower odds of engaging in moderate physical activity and 30% lower odds of engaging in muscle strengthening compared to those in good/ excellent health (OR 0.50; p < 0.001; OR 0.70; p < 0.001). Moderate physical activity/muscle strengthening initiatives may help foster this group's healthy aging.
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Trouble du spectre autistique , Trouble autistique , Humains , États-Unis , Sujet âgé , Adolescent , Jeune adulte , Adulte , Adulte d'âge moyen , Trouble du spectre autistique/thérapie , Exercice physique/physiologie , Traitement par les exercices physiques , VieillissementRÉSUMÉ
Caregiving may prove either beneficial or harmful for caregiver well-being, depending on the circumstances surrounding care provision. Using data from the two most recent waves of the National Survey of Midlife Development in the United States (MIDUS, 2004-2014; N = 1,100), we examine whether providing care for an adult at both time points (i.e., 8-10 years apart) is associated with changes to self-esteem over the ten-year period, in comparison with providing care at only one time point, or not at all. We also examine moderation by caregivers' age, parental status, and gender. Findings indicated (1) caregiving at both waves was associated with decreases in self-esteem among younger and midlife adults, but this effect weakened and even reversed with age; and (2) caregiving at both waves was associated with increased self-esteem among participants without children, but not among those with children. We discuss implications for identifying caregivers at greatest risk of diminished well-being.
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Parents , Concept du soi , Humains , États-Unis , AidantsRÉSUMÉ
Wheezing is common in childhood, although only a small percentage of these children develop asthma. The child's wheezing phenotype and asthma predictive indices help predict the likelihood of a future asthma diagnosis. Viral infections are common in childhood with most wheezing episodes due to respiratory syncytial virus and rhinovirus. Many treatment options exist for wheezing children including both those who wheeze persistently and those who wheeze intermittently due to viral infections.
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Asthme , Maladies virales , Enfant d'âge préscolaire , Humains , Bruits respiratoires/étiologie , Rhinovirus , Asthme/diagnostic , Asthme/épidémiologie , Asthme/étiologie , Maladies virales/complications , Maladies virales/diagnostic , Maladies virales/épidémiologie , Virus respiratoires syncytiauxRÉSUMÉ
BACKGROUND: Black and Hispanic children living in urban environments in the USA have an excess burden of morbidity and mortality from asthma. Therapies directed at the eosinophilic phenotype reduce asthma exacerbations in adults, but few data are available in children and diverse populations. Furthermore, the molecular mechanisms that underlie exacerbations either being prevented by, or persisting despite, immune-based therapies are not well understood. We aimed to determine whether mepolizumab, added to guidelines-based care, reduced the number of asthma exacerbations during a 52-week period compared with guidelines-based care alone. METHODS: This is a randomised, double-blind, placebo-controlled, parallel-group trial done at nine urban medical centres in the USA. Children and adolescents aged 6-17 years, who lived in socioeconomically disadvantaged neighbourhoods and had exacerbation-prone asthma (defined as ≥two exacerbations in the previous year) and blood eosinophils of at least 150 cells per µL were randomly assigned 1:1 to mepolizumab (6-11 years: 40 mg; 12-17 years: 100 mg) or placebo injections once every 4 weeks, plus guideline-based care, for 52 weeks. Randomisation was done using a validated automated system. Participants, investigators, and the research staff who collected outcome measures remained masked to group assignments. The primary outcome was the number of asthma exacerbations that were treated with systemic corticosteroids during 52 weeks in the intention-to-treat population. The mechanisms of treatment response were assessed by study investigators using nasal transcriptomic modular analysis. Safety was assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT03292588. FINDINGS: Between Nov 1, 2017, and Mar 12, 2020, we recruited 585 children and adolescents. We screened 390 individuals, of whom 335 met the inclusion criteria and were enrolled. 290 met the randomisation criteria, were randomly assigned to mepolizumab (n=146) or placebo (n=144), and were included in the intention-to-treat analysis. 248 completed the study. The mean number of asthma exacerbations within the 52-week study period was 0·96 (95% CI 0·78-1·17) with mepolizumab and 1·30 (1·08-1·57) with placebo (rate ratio 0·73; 0·56-0·96; p=0·027). Treatment-emergent adverse events occurred in 42 (29%) of 146 participants in the mepolizumab group versus 16 (11%) of 144 participants in the placebo group. No deaths were attributed to mepolizumab. INTERPRETATION: Phenotype-directed therapy with mepolizumab in urban children with exacerbation-prone eosinophilic asthma reduced the number of exacerbations. FUNDING: US National Institute of Allergy and Infectious Diseases and GlaxoSmithKline.
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Asthme , Poumon éosinophile , Anticorps monoclonaux humanisés , Asthme/traitement médicamenteux , Humains , États-Unis , Population urbaineRÉSUMÉ
Loneliness is an important determinant of health and mortality among the aging population, including for cardiometabolic health. Yet research has largely focused on individual experiences of loneliness, rather than taking intimate relationships into account. However, recent studies have highlighted that loneliness of a partner may have implications for one's own health and well-being as well. Indeed, this is particularly true among older couples, as life events and shifting time horizons (e.g., retirement, reduced social networks) can lead to greater prominence and salience of one's closest relationships. This study uses dyadic structural equation modeling (SEM) to estimate actor-partner interdependence models (APIM) examining associations between loneliness and HbA1c levels among 1331 older married couples from The Irish Longitudinal Study on Aging (TILDA, 2009-2011). Furthermore, we test whether any such actor or partner effects vary by employment status. Results indicated that one's own loneliness was not significantly linked with HbA1c, irrespective of employment status. However, loneliness of a dyadic partner was significantly associated with elevated HbA1c among retired persons only. These findings underscore that relationship and life course context are crucial when considering the dyadic implications of loneliness for health among the older population.
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Bereaved people suffer from loneliness and loneliness is associated with poor mental health. In this study, this topic is reviewed. An agenda is suggested for future research. Research that is theory-driven, addresses measurement consistency, correlates of loneliness in bereaved and non-bereaved, and treatment is necessary for prevention and intervention.
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Deuil (perte) , Solitude , Chagrin , HumainsRÉSUMÉ
The role of loneliness in the bereavement experience has been reported as substantial, with the death of a close person leaving a considerable void in the life of the bereaved. Yet, there is lack of agreement about its precise role and, notably, whether loneliness should be included as a core symptom for diagnosis of grief complications. The ongoing threat of heightened social isolation due to the COVID-19 pandemic underlines the need to understand the impact of loneliness, and to accurately chart its prevalence, intensity, duration, and associated difficulties in the context of bereavement. Assessment issues are central to this endeavor. In this article, we review the scientific literature to examine how loneliness after bereavement has been operationalized and measured. Sixty-three articles analyzing 51 independent datasets were reviewed. Results show major disparities: approximately half of the projects assessed loneliness by means of one of two validated scales (spanning different versions); the remainder included only single- or few-item measures. Diverse instructions, content and answer categories were used. While one size does not fit all, awareness of assessment options and dis/advantages may aid selection of the most appropriate measure, to suit the goals of a particular study and the specific groups under investigation. Our conclusion is that, in selecting a loneliness measure, health care professionals should come to their own well-informed decision, aided by the information provided in our review.
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Objectives: Both experiencing loneliness and having a lonely partner can be psychosocial stressors, with implications for health. Yet, marital support may buffer against the cardiometabolic effects of loneliness. This study examines (1) whether own and/or partner's loneliness predict changes in HbA1c over 4 years and (2) whether marital support moderates these effects. Methods: Actor-partner interdependence models analyzed data from 1,854 older couples who provided psychosocial and biomarker data at two timepoints (2008/2012 or 2010/2014) of the Health and Retirement Study. Results: Neither partner's loneliness predicted changes in HbA1c overall. However, significant interactions indicated that both own baseline loneliness and partner's baseline loneliness predicted significant increases to HbA1c over 4 years among those who reported below-average marital support. Discussion: Both the experience of loneliness and loneliness of a dyadic partner may have longitudinal consequences for cardiometabolic health. However, these effects are contingent upon perceived quality of the marriage, specifically marital support.
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Solitude , Mariage , Hémoglobine glyquée , Humains , ConjointsRÉSUMÉ
BACKGROUND AND OBJECTIVES: This study examined associations between exposure to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic and Chinese older adults' depression and inflammation 8 years after the crisis. Further, this study investigated the buffering effects of perceived social support and social participation. RESEARCH DESIGN AND METHODS: Data were drawn from the 2011 China Health and Retirement Longitudinal Survey, including N = 4,341 Chinese adults aged 60 years and older. For the survey, local officials identified whether the 2003 SARS outbreak was one of the major disasters in the history of their communities. Depression was assessed by the Center for Epidemiological Studies-Depression scale and inflammation was measured by C-reactive protein (CRP) collected from participants via venous blood draws. RESULTS: Results from multilevel logistic regression models revealed that Chinese older adults living in communities exposed to SARS were more likely to have elevated CRP compared to those not living in such communities. Moreover, community SARS exposure was associated with greater risks of depression for Chinese older adults who had no perceived social support. Among Chinese older adults who had low levels of social participation, community SARS exposure was more strongly related to elevated CRP. DISCUSSION AND IMPLICATIONS: Findings suggest community-level exposure to the SARS epidemic had enduring consequences for Chinese older adults' health. However, active social participation and supportive social ties provided important resources that may buffer against negative effects of exposure to the SARS epidemic.