Does purpose in life or ethnic identity moderate the association for racial discrimination and suicide ideation in racial/ethnic minority emerging adults?

OBJECTIVE: To examine purpose in life (PIL) and ethnic identity (EI) as buffers to suicide ideation for Asian American, Hispanic, and Black emerging adults who perceive racial discrimination. METHOD: Two-hundred eighty-nine undergraduate students enrolled at a large university in the southwestern region of the United States (40.8% Asian American, 32.5% Hispanic, 26.6% Black; 61.2% women; mean age = 20.47, SD = 1.83) reported on experiences of racial discrimination, PIL, EI, and suicidal thoughts. Covariates were intrinsic religiosity, gender, and age. RESULTS: Regression analysis showed that EI was not a significant moderator for the association between perceived racial discrimination (PRD) and suicidal ideation (ß = -.08, p = .13; 95% confidence interval (CI) [-.19, .03]). However, PIL was a significant moderator (ß = -.11, p = .025; CI [-.20, -.01]). A hierarchical regression showed that PIL as a moderator explained additional variance (ΔR2 = 0.11, p < .001) in suicide ideation above and beyond EI. CONCLUSIONS: These findings provide some insight into how life purpose might ameliorate the impact of social stressors above and beyond a positive cultural identity for young racial/ethnic minority adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Longitudinal study of the feasibility of using ecological momentary assessment to study teacher stress: Objective and self-reported measures.

There is a lack of comprehensive research on Ecological Momentary Assessment (EMA) feasibility to study occupational stress, especially its long-term sustainability. EMA application in education contexts has also been sparse. This study investigated the feasibility of using EMA to study teacher stress over 2 years using both objective compliance data and a self-reported feasibility survey. It also examined the influence of individual and school factors on EMA feasibility. Participants were 202 sixth through eighth grade teachers from 22 urban middle schools in the southern United States. EMA was implemented via an iPod-based Teacher Stress Diary (TSD). Teachers recorded demands, stress responses, and resources during 12 days (6 waves) over 2 years. Feasibility was assessed via compliance data generated by the TSD (e.g., entry completion) and an EMA Feasibility Survey of self-reported user-friendliness and EMA interference. The results showed high compliance regarding entry and item completion, and completion time, which was sustained over time. User-friendliness was appraised as very high and EMA interference as low. Initial difficulties regarding timing and length of assessments were addressed via EMA method refinement, resulting in improved feasibility. Teachers' ethnicity, age, marital status, grade/course taught, class size, class load, and daily workload impacted feasibility. The results supported the feasibility of using EMA to study work stress longitudinally and the value of continued feasibility monitoring. They also support EMA use to study teacher stress and inform EMA implementation in schools. Some teacher and school factors need to be taken into consideration when deciding on EMA implementation in education contexts. (PsycINFO Database Record

A composite likelihood approach for estimating HIV prevalence in the presence of spatial variation.

Since 1990, the World Health Organization has recommended HIV surveillance among pregnant women as an essential surveillance activity for countries with generalized HIV epidemics. Despite the widespread availability and potential usefulness of antenatal HIV surveillance, analyses of such data present important challenges. Within an individual clinic, the HIV status of its attendees may be correlated because of similarities in HIV risk among women close in age. Between-clinic correlation may also arise as women often seek antenatal care at clinics located close to their home, and individuals living in nearby communities may share important characteristics or behaviours related to susceptibility. A general estimating equation-based approach for spatially-correlated, binary data such as that antenatal HIV surveillance based on a pairwise composite likelihood has been described. We present an extended version of this model that can accommodate penalized spline estimators and apply it to antenatal HIV surveillance data collected in 2011 in Botswana to estimate the effects of proximity to the 'hotspot' of the country's HIV epidemic and age on HIV prevalence. Finally, we compare the results with a logistic regression analysis, which ignores potential correlation of responses.

Peripheral defocus and myopia progression in myopic children randomly assigned to wear single vision and progressive addition lenses.

PURPOSE: To determine the effect of progressive addition lenses (PALs) and single vision lenses (SVLs) on peripheral defocus in myopic children, and to compare the effect of myopic versus hyperopic peripheral defocus on foveal myopia progression. METHODS: Eighty-four myopic children aged 6 to 11 years with spherical equivalent (SE) cycloplegic autorefraction between -0.75 diopters (D) and -4.50 D were randomly assigned to wear SVLs or PALs. Aberrometry measurements of the eye and spectacles were made centrally, 30° nasally, temporally, and superiorly, and 20° inferiorly on the retina using a Complete Ophthalmic Analysis System for Vision Research (COAS-VR). The association between peripheral defocus and the 1-year change in central myopia was investigated. RESULTS: SVLs caused a hyperopic shift in peripheral defocus at all locations (all P ≤ 0.0003). PALs caused a myopic shift in peripheral defocus in three of four locations measured (all P ≤ 0.01) with the greatest shift superiorly due to the PAL addition (-1.04 ± 0.30 D). Superior retinal defocus when wearing either SVLs or PALs was associated with the 1-year change in central myopia. The adjusted 1-year change in central SE myopia was -0.38 D for children with absolute superior myopic defocus (n = 67) and -0.65 D for children with absolute superior hyperopic defocus (n = 17; difference = 0.27 D; P = 0.002). CONCLUSIONS: PALs caused a myopic shift in peripheral defocus. Superior myopic defocus was associated with less central myopia progression. These data support the continued investigation of optical designs that result in peripheral myopic defocus as a potential way to slow myopia progression. (ClinicalTrials.gov number, NCT00335049.).

Short communication: effect of short-course antenatal zidovudine and single-dose nevirapine on the BED capture enzyme immunoassay levels in HIV type 1 subtype C infection.

Cross-sectional prevalence studies based on immunoassays that discriminate between recent and long-term infections, such as the BED assay, have been widely used to estimate HIV incidence. However, individuals receiving highly active antiretroviral therapy tend to have lower BED levels and are associated with a higher risk for being mistakenly classified as recent infections. To assess the effect of short-term antenatal zidovudine (ZDV) and single-dose nevirapine (sdNVP) on the BED levels in HIV-1C infection, we measured longitudinal BED normalized optical density (OD-n) levels using stored plasma samples collected prenatally and postnatally from 159 pregnant HIV-infected women in Botswana who participated in the randomized clinical Mother-to-Child-Prevention study, the Mashi study. All women received ZDV from 34 weeks gestation through delivery and were randomized to receive either sdNVP or placebo during labor. Among 159 subjects, the OD-n levels decreased from baseline to delivery in 93 subjects (p=0.039), suggesting that short-course ZDV may decrease OD-n levels. sdNVP at delivery did not affect longitudinal BED OD-n levels postdelivery. However, sdNVP appeared to modify the association between CD4 count at delivery and OD-n levels postdelivery. When estimating HIV incidence with the BED assay, special care may be required regarding women who received short-term ZDV for prevention of mother-to-child transmission.

Comprehensive smoking bans and acute myocardial infarction among Medicare enrollees in 387 US counties: 1999-2008.

Restrictions on smoking in public places have become increasingly widespread in the United States, particularly since the year 2005. National-scale studies in Europe and local-scale studies in the United States have found decreases in hospital admissions for acute myocardial infarction (AMI) following smoking bans. The authors analyzed AMI admission rates for the years 1999-2008 in 387 US counties that enacted comprehensive smoking bans across 9 US states, using a study population of approximately 6 million Medicare enrollees aged 65 years or older. Effects of smoking bans on AMI admissions were estimated by using Poisson regression with linear and nonlinear adjustment for secular trend and random effects at the county level. Under the assumption of linearity in the secular trend of declining AMI, smoking bans were associated with a statistically significant ban-associated decrease in admissions for AMI in the 12 months following the ban. However, the estimated effect was attenuated to nearly zero when the assumption of linearity in the underlying trend was relaxed. This analysis demonstrates that estimation of potential health benefits associated with comprehensive smoking bans is challenged by the need to adjust for nonlinearity in secular trend.

A meta-analysis and multisite time-series analysis of the differential toxicity of major fine particulate matter constituents.

Health risk assessments of particulate matter less than 2.5 µm in diameter (PM(2.5)) often assume that all constituents of PM(2.5) are equally toxic. While investigators in previous epidemiologic studies have evaluated health risks from various PM(2.5) constituents, few have conducted the analyses needed to directly inform risk assessments. In this study, the authors performed a literature review and conducted a multisite time-series analysis of hospital admissions and exposure to PM(2.5) constituents (elemental carbon, organic carbon matter, sulfate, and nitrate) in a population of 12 million US Medicare enrollees for the period 2000-2008. The literature review illustrated a general lack of multiconstituent models or insight about probabilities of differential impacts per unit of concentration change. Consistent with previous results, the multisite time-series analysis found statistically significant associations between short-term changes in elemental carbon and cardiovascular hospital admissions. Posterior probabilities from multiconstituent models provided evidence that some individual constituents were more toxic than others, and posterior parameter estimates coupled with correlations among these estimates provided necessary information for risk assessment. Ratios of constituent toxicities, commonly used in risk assessment to describe differential toxicity, were extremely uncertain for all comparisons. These analyses emphasize the subtlety of the statistical techniques and epidemiologic studies necessary to inform risk assessments of particle constituents.

Geographic disparities in the incidence and outcomes of hospitalized myocardial infarction: does a rising tide lift all boats?

BACKGROUND: Improvements in prevention have led to declines in incidence and mortality of myocardial infarction (MI) in selected populations. However, no studies have examined regional differences in recent trends in MI incidence, and few have examined whether known regional disparities in MI care have narrowed over time. METHODS AND RESULTS: We compared trends in incidence rates of MI, associated procedures and mortality for all US Census Divisions (regions) in Medicare fee-for-service patients between 2000-2008 (292 773 151 patient-years). Two-stage hierarchical models were used to account for patient characteristics and state-level random effects. To assess trends in geographic disparities, we calculated changes in between-state variance for outcomes over time. Although the incidence of MI declined in all regions (P<0.001 for trend for each) between 2000-2008, adjusted rates of decline varied by region (annual declines ranging from 2.9-6.1%). Widening geographic disparities, as measured by percent change of between-state variance from 2000-2008, were observed for MI incidence (37.6% increase, P=0.03) and percutaneous coronary intervention rates (31.4% increase, P=0.06). Significant declines in risk-adjusted 30-day mortality were observed in all regions, with the fastest declines observed in states with higher baseline mortality rates. CONCLUSIONS: In a large contemporary analysis of geographic trends in MI epidemiology, the incidence of MI and associated mortality declined significantly in all US Census Divisions between 2000-2008. Although geographic disparities in MI incidence may have increased, regional differences in MI-associated mortality have narrowed.

Clinical and pathologic features of vulvar intraepithelial neoplasia in premenopausal and postmenopausal women.

OBJECTIVE: To explore the clinical and pathologic differences between vulvar intraepithelial neoplasia (VIN) in premenopausal and postmenopausal women cared for in a tertiary referral center. METHODS: Between January 1997 and June 2008, 145 women received care at our institution for VIN and VIN-associated squamous cell carcinoma (SCC). All patients' demographic characteristics and recurrence histories were recorded throughout the study period and were retrieved retrospectively. Menopausal status was self-reported at the time of initial diagnosis. χ, odds ratio, and logistic regression analyses were used. RESULTS: The median age was 50 years (range = 19-91 y) with 77% (111/145) of patients white, 20% (29/145) African American, and 3% (5/145) other ethnicity. Sixty percent of patients diagnosed with VIN were current smokers, 18% (26/145) were immunocompromised (positive for human immunodeficiency virus/transplant/steroids), and 30% (44/145) had concomitant or previous lower genital tract dysplasia. Vulvar intraepithelial neoplasia or VIN-related cancer recurred in 57 (39%) of 145 patients; of these, 40 (71%) had recurrence of VIN and 18 (29%) had recurrence of cancer. Fifty-one percent (74/145) of patients were menopausal at initial VIN diagnosis. Among women with VIN, the odds of initially presenting with a VIN-related SCC was 3.2 times greater in postmenopausal than in premenopausal women (confidence interval = 1.5-7.1, p < .01), and postmenopausal women were more likely to present with stage II to IV SCC (p = .021). Recurrence risk of SCC, but not VIN, was associated with menopause status (p < .05). CONCLUSIONS: Among women with VIN, the risk of SCC is higher in postmenopausal than in premenopausal women both initially and at recurrence. Excisional therapies to identify occult invasion are especially important for postmenopausal women with VIN.

Protecting human health from air pollution: shifting from a single-pollutant to a multipollutant approach.

To date, the assessment of public health consequences of air pollution has largely focused on a single-pollutant approach aimed at estimating the increased risk of adverse health outcomes associated with the exposure to a single air pollutant, adjusted for the exposure to other air pollutants. However, air masses always contain many pollutants in differing amounts, depending on the types of emission sources and atmospheric conditions. Because humans are simultaneously exposed to a complex mixture of air pollutants, many organizations have encouraged moving towards "a multipollutant approach to air quality." Although there is general agreement that multipollutant approaches are desirable, the challenges of implementing them are vast.

Cognitive effects of pegylated interferon in individuals with primary brain tumors.

Cognitive changes associated with interferon treatment include impaired verbal memory, attention, processing speed, and executive functioning. Pegylated interferon is a relatively new, long-lasting form of interferon alpha, but data regarding its cognitive effects in brain tumor patients are limited. Participants in this study were 35 primary brain tumor patients who received pegylated interferon at tumor recurrence. A neuropsychological battery assessed verbal memory, executive functioning, attention, information processing speed, and language functioning. Individual growth curve analyses were used to estimate cognitive change throughout treatment with interferon. Results revealed performance declined on a task of psychomotor speed and upper extremity dexterity. Although decline in a few tests was found, its degree may have been reduced because individuals were tested after tumor recurrence where a substantial amount of cognitive change had already potentially occurred due to surgery, radiation therapy, and chemotherapy. Thus, participants may not have been starting at their baseline cognitive status and the potential neurotoxic effects of interferon may have been obscured by prior treatments. An alternative explanation, however, is that treatment with pegylated interferon did not produce further impairment and patients experienced stability in their cognitive functioning.

Too stressed out to participate? Examining the relation between stressors and survey response behavior.

Despite the use of survey-based organizational data in many studies of organizational behavior, survey response behavior and nonresponse are rarely studied phenomena. This study expands on previously proposed survey response and nonresponse frameworks by integrating the job stress literature. The authors investigated whether overload, role ambiguity, and role conflict experienced by individuals relate to survey response behavior. Using organizational citizenship behavior theory and social exchange theory as theoretical frameworks, the authors proposed that nonrespondents experience higher levels of stressors than respondents. Data collected in a longitudinal field study partially supported the hypotheses. As hypothesized, overload increased the likelihood of nonresponse. Contrary to hypotheses, role ambiguity decreased the likelihood of nonresponse. Role conflict was not significantly related to nonresponse.