Comparing cognitive function in white Mexican & non-Hispanic white Americans with/without diabetes.

Objectives: An association between type-2 diabetes mellitus and cognitive decline is well known. Additionally, type 2 diabetes is known to be more physically burdensome for minorities. However, the combined impact of both ethnicity and diabetes on cognition is still not clear. Methods: Data from the 2014 Health and Retirement Study (HRS) was used in this study to compare the cognitive functioning of non-Hispanic White (n = 10,658) and White Mexican/Mexican American (n = 847) individuals, age 50+ years, with or without type 2 diabetes. Cognitive functioning was measured by a composite of three constructs (serial 7 s, immediate, delayed recall). Ethnic groups and diabetes status were examined concerning cognitive functioning. Results: A Multivariate Analysis of Covariance (MANCOVA) indicated significant main effects for ethnicity (F(3,11,496) = 11.15, p < .001) and diabetes status (F(3,11,496) = 3.15, p < .024), with Mexican Americans and those with diabetes exhibiting worse cognitive performance than non-Hispanic Whites and individuals without diabetes. There were significant effects for all covariates. A step-wise multiple regression indicated that education, age, depression, ethnicity and diabetes status accounted for a combined 28.4% variance in the cognitive performance composite. Conclusions: Results found that education contributes significantly to variation of cognitive performance. The impact of education could be related to various possibilities. However, the impact of health literacy is a likely component, which has a positive relationship with level of education. Individuals with higher health literacy are more conscientious in health actions (e.g., exhibit regular self-care, glucose monitoring, and foot care). Therefore, the study results indicate it is likely that the duration of diabetes, and diabetes management (e.g., effective control of blood glucose, blood pressure, and lipids), contributing to cognitive decline. Cognitive screening at routine doctor visits is encouraged, particularly for Mexican/Mexican Americans, as the current study found support for ethnic minority vulnerability to the negative impacts of diabetes.

Theory of planned behavior and college student 24-hour dietary recalls.

Objective: The transition to college is marked by poorer eating behaviors, making emerging adulthood a particularly salient intervention point for improving lifelong health. The present study aims to better understand what psychosocial factors predict eating behaviors of college students using the Theory of Planned Behavior (TPB). Participants & Methods: Dietary recalls were analyzed the Healthy Eating Index (HEI)-2015 scoring system for 67 university students between the ages of 18 and 25 (70.1% female; 49.3% White, 20.9% Black/African American, 13.4% Asian). Results: Haye's PROCESS Model 6 was used. The full model accounted for a significant amount of variance in HEI-2015 scores (F[3, 63] = 3.09, p = .033, R2 = .12). The final model suggested a significant indirect effect of PBC on the relation between ATT and HEI-2015 (ß = .859, SE = .637, 95% CI [.009, 2.482]). Conclusions: Although some college students might have favorable attitudes, only those who believe this is within their control actually ate a (somewhat) healthier diet.

Self-determination theory and motivational interviewing interventions for type 2 diabetes prevention and treatment: A systematic review.

Treatment of those with obesity, prediabetes, and type 2 diabetes often yields initial health improvements, but gains erode over time. A systematic search of self-determination theory and motivational interviewing papers for the above populations was conducted, yielding 54 publications and 42 independent samples. Interventions to treat overweight and obesity (n = 15), prediabetes (n = 4), and type 2 diabetes (n = 23) are summarized and evaluated using the Quality Rating Scale. While the results of these studies are mixed, the majority of the interventions resulted in health benefits. Suggestions for future research are discussed.

The five-factor model of personality and self-reported versus biomarker diabetic control.

Five-factor personality was examined as an element of self-report diabetic control accuracy versus biomarker control (HbA1c) for 1474 diabetics in the 2006 and 2008 Health and Retirement Study. Correlations of extraversion and self-reported control (r = -.06, p < .01), and extraversion and HbA1c (r = .03, non-significant), were significantly different (t = 2.87, p < .01). Correlations of openness and self-reported control (r = -.05, p < .05), and openness and HbA1c (r = .01, non-significant), were significantly different (t = 1.91, p < .05). Associations were found between self-reported control and conscientiousness (r = -.05, p < .05), neuroticism (r = .04, p < .05), and openness (r = -.05, p < .05). Neuroticism was associated with self-reports that diabetes was worse (r = .07, p < .01). Other correlations and comparisons were non-significant.

The Pillbox Test: an ecological measure of executive functioning and estimate of medication management abilities.

Studies indicate that executive functioning (EF) is a strong predictor of everyday function. However, assessment can be problematic as no single standardized instrument is known to measure all EF domains simultaneously. Thus, the Pillbox Test was developed as a new measure tapping four EF factors through the real-time assessment of medication management, a complex instrumental activity of daily living. The Pillbox Test showed good criterion-related validity and was effective in differentiating graduated levels of executive dysfunction between a mixed neurological group, medical control group, and healthy community control group. This test also showed good convergent validity as it correlated significantly in expected directions with established EF measures in all four of selected EF domains and the Direct Assessment of Functional Status. Finally, a receiver operator characteristic curve found a sensitivity of 75% and specificity of 87.5%, suggesting that the Pillbox Test is a promising new ecological measure of EF.

Repetitive nonsuicidal self-injury as experiential avoidance among a community sample of adolescents.

OBJECTIVE: This study examined the relationship between experiential avoidance, functionally equivalent behaviors, and repetitive nonsuicidal self-injury (NSSI/RNSSI) among adolescents. METHOD: Self-report questionnaires from adolescents (N = 211) from 3 school-based samples were employed to assess three forms of experiential avoidance (thought suppression, alexithymia, and avoidance/cognitive fusion), various aspects of self-mutilating behaviors, and the existence of functionally equivalent behaviors (disordered eating, substance abuse, suicidal ideation/behaviors). RESULTS: Results indicated one third of participants reported a history of NSSI and 16% reported engaging in RNSSI in the past 6 months. Female adolescents were twice as likely as males to report a history of RNSSI. Unwanted inner experiences, thought suppression, and alexithymia differentiated adolescents with a history of NSSI from their counterparts. Functionally equivalent behaviors occurred more frequently among those with a history of NSSI and increased in severity as NSSI increased, particularly suicidal ideation and behaviors. However, results for patterns of avoidance were not as consistent for males as females, which questions the broad application of this model. CONCLUSIONS: NSSI continues to be surprisingly common among adolescents in the community. NSSI, particularly repetitive forms, appears to be strongly related to common forms of experiential avoidance, moreso for female adolescents. Results also illustrate the importance of conceptualizing and treating self-injury as a form of experiential avoidance.

Activities of daily living, social support, and future health of older Americans.

The authors investigated the relation of activities of daily living (ADL) and social support satisfaction to illness status 10 years later among 4,870 married older adults in the Health and Retirement Study (F. Juster & R. Suzman, 1995). The authors tested the direct and indirect effects of 1992 ADL, as well as family and friends support satisfaction and spousal social support satisfaction on 2002 illness status. The hierarchical multiple regressions found, controlling for 1992 illness status, ADL protected against future illness, and family and friends and spousal support satisfaction had small, surprisingly positive, effects on greater 2002 illness. The ADL x Family and Friends Support Satisfaction and the ADL x Spousal Support Satisfaction crossproduct interactions were also small positive predictors of later illness. The authors discuss several possible mechanisms that explained this unexpected result. The authors concluded that, depending on whether the recipient is in need of support and depending on the source of the support, the older adults do or do not benefit from the support.

Caregivers' differing needs across key experiences of the advanced cancer disease trajectory.

OBJECTIVES: Familial caregivers are providing increasing amounts of care to advanced cancer patients. Increased understanding of caregivers' needs is vital in providing necessary support to lessen caregiver burden and morbidity. Current literature has identified caregiver and patient needs at broad stages of the cancer trajectory; however, such broad stages may be too general to inform a practice of targeting specific interventions when they have the greatest utility. This study examines a variety of particular needs across a number of more discrete illness-related transition experiences specifically in the advanced cancer disease trajectory. METHODS: One hundred fifty-nine female informal caregivers of people with advanced cancer completed a needs assessment survey. RESULTS: Analyses of these cross-sectional retrospective-report data reveal that cancer caregiver needs vary across specific key experiences occurring within the broader stages of illness identified by current literature. Furthermore, caregivers have unique needs during bereavement. SIGNIFICANCE OF RESULTS: Although the sample characteristics are demographically limited, this study provides preliminary evidence that the broad stages are not specific enough increments for effectively examining caregiver needs and supports the need for more precise distribution of cancer-related information at more discrete times in the illness course.

Assessing adults' difficulty in coping with funerals.

The death of a loved one requires many adults to make decisions about a variety of details regarding funeral arrangements. Based upon data collected from 348 adults (M age = 34.21) who had attended the funeral of a loved one within the last year, a scale consisting of 50 items regarding the difficulties each had experienced with regard to events prior to, during, and after the funeral, was developed. Cronbach's Alpha coefficient for this measure of difficulty was .96. Principal components analysis of these data indicated that difficulty in coping with funerals could be understood in light of six factors explaining 56% of the common variance among relationships between items: 1) protocol/mechanics of the funeral; 2) general personal and interpersonal difficulties related to the death/funeral; 3) trust in the funeral industry; 4) concerns regarding the cemetery; 5) issues pertaining to grief; and 6) post-funeral personal responsibilities. With regard to both overall difficulty and the above six factors, older adults experienced fewer difficulties, as did those who more actively participated in funeral rituals. In contrast, those who reported more personal and bereavement-related distress experienced more difficulties. Findings of the current study have value both in identifying persons for whom funerals may undermine bereavement adjustment and in identifying appropriate intervention and aftercare services for such individuals.

Change in depression of spousal caregivers of dementia patients following patient's death.

Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse's death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.

Family environments of women seeking BRCA1/BRCA2 genetic mutation testing: an exploratory analysis.

Although there is some understanding of the shared characteristics and predictors of psychological distress of women participating in hereditary breast and ovarian cancer registries, these same characteristics are only beginning to be identified in research on community women seeking genetic testing for BRCA1/BRCA2 gene mutations. This study provides an initial exploration of characteristics associated with family environments for 51 community women waiting to receive such genetic testing results. Thirty-four of the 36 women classified on family environment type of the Family Environment Scale (FES) were from Personal Growth-Oriented families. Comparisons of women with and without personal cancer histories resulted in a trend for women with personal cancer histories to be classified as from Independence-Oriented families. Reported distress appears to vary for different family emphases based on family and personal cancer history. A moral-religious family emphasis consistently appeared to be associated with decreased psychological distress. Preliminary analyses comparing these community women (who were not part of a hereditary registry but were self- or physician-referred) seeking genetic testing with normal and distressed family means found that increased cohesion and expressiveness may be related to decreased conflict, indicative of potentially supportive family environments for these women. When compared with normative data, a subset consisting of the Ashkenazi Jewish women showed a trend of less cohesion than normal families, but similar cohesion levels as distressed families.

Two models of caregiver strain and bereavement adjustment: a comparison of husband and daughter caregivers of breast cancer hospice patients.

PURPOSE: Caregiver bereavement adjustment literature suggests opposite models of impact of role strain on bereavement adjustment after care-recipient death-a Complicated Grief Model and a Relief Model. This study tests these competing models for husband and adult-daughter caregivers of breast cancer hospice patients. DESIGN AND METHODS: This study used secondary data from the National Hospice Study ( Greer & Mor, 1987). Stepwise multiple regression analyses, using caregiver's age and two formulations of prebereavement caregiver role strain as independent variables, predicted grief and despair bereavement adjustment as dependent variables. RESULTS: Data from husbands supported a Complicated Grief Model, as greater empirically derived (anxiety and depression symptoms) and theoretically derived (psychological and health strain) caregiver role strain formulations both predicted more difficult bereavement adjustment for husbands. Neither model was supported for adult daughters, as neither formulation of caregiver role strain predicted daughters' bereavement adjustment. Older caregiver age predicted better bereavement adjustment for both husbands and daughters. Adult daughters experienced more caregiver role strain than husbands did. IMPLICATIONS: The family role relationship between caregiver and patient (husband-wife vs. daughter-mother relationship) affects how caregiving factors influence bereavement adjustment.