Bathroom modifications among community-dwelling older adults who experience falls in the United States: A cross-sectional study.

Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, we examined factors associated with bathroom modifications among older adults with at least one fall in the United States. We analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.

Prescription drug coverage satisfaction, cost-reducing behavior, and medication nonadherence among Medicare beneficiaries with type 2 diabetes.

BACKGROUND: Medication nonadherence in individuals with type 2 diabetes can lead to poor glycemic control, resulting in increased risk for diabetes-related complications. OBJECTIVE: To examine associations between factors (ie, drug coverage satisfaction and cost-reducing behavior) and medication nonadherence among Medicare beneficiaries with type 2 diabetes. METHODS: We analyzed the 2016 Medicare Current Beneficiary Survey Public Use File for beneficiaries aged 65 years and older with reported type 2 diabetes (n=1,430; weighted n=5,846,943). Medicare beneficiaries were considered to have medication nonadherence if they reported skipping doses or taking smaller doses than prescribed. A survey-weighted logistic model, adjusted for sociodemographics and comorbidities, was conducted to examine associations of drug coverage satisfaction and cost-reducing behavior with medication nonadherence. RESULTS: Among Medicare beneficiaries aged 65 years and older with type 2 diabetes, 10.3% reported medication nonadherence. In the adjusted analysis, the risk for medication nonadherence was higher among those who were dissatisfied with the amount paid for medications (OR = 2.43; P = 0.002) compared with those who were satisfied, and those who spent less on basic needs to save for medications were more likely to report medication nonadherence (OR = 2.23; P = 0.011) than those who did not. CONCLUSIONS: Our findings suggest that medication nonadherence among Medicare beneficiaries with type 2 diabetes is associated with dissatisfaction with the amount paid for medications and cost-reducing behavior. Interventions that lower medication costs for Medicare beneficiaries may help to improve medication adherence among this at-risk population. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to disclose.

Characteristics Associated With School Health Services for the Management of Chronic Health Conditions.

It is unknown how health services staff (school nurse or school physician) or school characteristics are associated with the number of services provided for chronic health conditions in schools. Using data from the 2014 School Health Policies and Practices Study, four services (identification or school-based management, tracking, case management, and referrals) were analyzed using a multivariable ordered logistic regression. Approximately 57.2% of schools provided all four, 17.5% provided three, 10.1% provided two, 5.8% provided one, and 9.4% did not provide any such services. Schools with a school nurse were 51.5% (p < .001) more likely to provide all four, and schools with access to consult with a school physician were 15.4% (p < .05) more likely, compared to schools without one. Schools comprised of mostly racial/ethnic minority students (less than or equal to 50% non-Hispanic White) were 14.7% (p < .05) less likely to provide all four, compared to schools with greater than 50% White students.

Hiring Requirements and Qualifications of School Food Authority Directors Changed in Some Districts After Implementation of US Department of Agriculture Professional Standards.

BACKGROUND: In 2015, the US Department of Agriculture set minimum education and training requirements (ie, professional standards) to ensure that school nutrition professionals have the knowledge and experience to operate school meal programs. No study to date has examined whether hiring requirements and qualifications of school food authority (SFA) directors have changed since 2015. OBJECTIVE: To assess changes in hiring requirements and qualifications of SFA directors since the US Department of Agriculture professional standards were established, overall and by district size. DESIGN: Cross-sectional analysis of nationally representative district-level data from the 2012 and 2016 cycles of the School Health Policies and Practices Study. PARTICIPANTS/SETTING: In 2012, 660 sampled districts completed the School Health Policies and Practices Study Nutrition Services questionnaire. In 2016, 599 sampled districts completed the questionnaire. MAIN OUTCOME MEASURES: Hiring requirements for newly hired SFA directors and reported qualifications of SFA directors. STATISTICAL ANALYSES PERFORMED: Differences in prevalence estimates from 2012 to 2016 for all districts and by district size were assessed with χ2 tests. RESULTS: Significant increases were found for 3 hiring requirements: degree in nutrition or related field, registered dietitian credential, and food safety certification. Significant changes in 4 of the 5 reported qualifications were found including an increase in the percentage of district directors with a degree in nutrition or a related field and decreases in the percentage of directors with a School Nutrition Specialist credential from the School Nutrition Association, School Nutrition Association certifications, and certified dietary managers. Changes were found in small and medium districts, but not large districts. CONCLUSIONS: District hiring requirements and SFA director qualifications have changed since the implementation of the US Department of Agriculture professional standards, including some differences by district size. Future research could identify challenges facing districts in hiring directors who have a degree in nutrition or related fields or who have specialized nutrition credentials or certificates (eg, registered dietitians).

Health-Related Behaviors and Academic Achievement Among High School Students - United States, 2015.

Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors (1-4). However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths.

Protein levels of heat shock proteins 27, 32, 60, 70, 90 and thioredoxin-1 in amnestic mild cognitive impairment: an investigation on the role of cellular stress response in the progression of Alzheimer disease.

Heat shock proteins (HSPs) are highly regulated proteins that are involved in normal cellular activity and are up-regulated when the cell is exposed to stress such as heat or excess reactive oxygen species (ROS) production. HSPs are molecular chaperones that mediate the proper folding of proteins and promote recovery of the native conformations of proteins lost due to stress. Improperly folded or denatured proteins tend to aggregate and accumulate in cells. A number of neurodegenerative diseases such as Parkinson disease (PD) and Alzheimer disease (AD) have been called "protein misfolding disorders" due their characteristic pathology. Until now the exact mechanism(s) of AD progression and pathogenesis largely remains unknown. Reasoning that stress is present in brain in AD, we tested the suggestion that HSP levels would be increased in amnestic mild cognitive impairment (aMCI), a transition stage between normal aging and AD. Accordingly, in the present study we measured the levels of HSPs in hippocampus, inferior parietal lobule (IPL) and cerebellum of subjects with aMCI. The results show a general induction of HSPs and decreased levels of Thioredoxin 1 in aMCI brain suggesting that alteration in the chaperone protein systems might contribute to the pathogenesis and progression of AD. The results also are consistent with the notion that targeting HSP could be a therapeutic approach to delay the progression of aMCI to AD.