Adolescent Predictors of Firearm Suicide Over Four Decades of Life in U.S. Men.

INTRODUCTION: There are meager individual-level data on long-term predictors of firearm suicide. METHODS: This was an analysis of males (N=189,558) in the Project Talent cohort, a national probability sample of high school schools in 1960 when students completed a baseline Project Talent self-report inventory. Mortality follow-up was contingent on survival until 1979, the onset of the National Death Index when the cohort had a mean age of 35.7 years. Mortality follow-up continued until death or age 75 years, reached by all surviving members by 2018. Analyses were conducted in 2022, with the main outcome being firearm suicide deaths (n=479). Factor analyses of Project Talent items yielded three key factors: (1) interests in firearm-related professions (i.e., military service, police force), (2) interests in hunting or fishing and knowledge of long guns, and (3) stereotypic masculinity. RESULTS: Survival analyses showed that long-term risk for firearm suicide was associated with 1-SD increases in firearm-related vocational interests in adolescence (adjusted hazard ratio [95% CI]=1.23 [1.09, 1.40]) and masculinity (adjusted hazard ratio [95% CI]=1.15 [1.04, 1.28]). Decreased long-term firearm suicide risk was associated with increased hunting interests and knowledge of long guns in adolescence (adjusted hazard ratio [95% CI]=0.86 [0.77, 0.96]) and competitive sports participation, an exploratory variable (adjusted hazard ratio [95% CI]=0.89 [0.80, 0.99]). CONCLUSIONS: Prevention efforts are needed to lower long-term firearm suicide risk among adolescent males with high stereotypic masculinity and those interested in military or police service. Potential protective effects of competitive sports participation and socialization to long guns through hunting require further study.

The relationship between adolescent reading habits and older adult social engagement - A longitudinal cohort analysis.

OBJECTIVES: To investigate an access point during youth with the potential to have a positive impact on social engagement in later-life. Our social selves begin long before older adulthood, a life-stage during which people face extensive changes to their social milieu. Adolescence is a sensitive period for sociocultural processing and adolescent activities have the potential to impact social engagement in older adulthood. We examine reading since, in adolescence, it promotes social-cognitive skills which facilitate social engagement. METHODS: Our main goal was to study the relationship between adolescent reading and older adult social engagement. We used longitudinal cohort data from Project Talent and ordered logistic regression as well as two-wave, cross-lagged panel model to analyze this relationship. Ancillary analyses examined recognized relationships between reading and social-cognition and between social-cognition and social engagement in both adolescence and older adulthood. RESULTS: Adolescent reading was related to more frequent older adult social engagement with both family and friends. This relationship was independent of reading during older adulthood, social engagement during adolescence, and social-cognition at both life-stages. Adolescent social engagement was not associated with older adult reading in the two-wave, cross-lagged model. Reading was positively related to social-cognition in adolescence, but was insignificant in older adulthood. And, social-cognition was positively related to social engagement in both adolescence and older adulthood. DISCUSSION: Reading is declining for both young and older Americans. Young Americans are also socializing less than in previous decades. These trends could have a detrimental influence on social engagement and social isolation in future cohorts of older adults. We recommend continuing to look for activities and experiences during youth, especially the sensitive period of adolescence, that could stimulate social engagement over the life-course and into older adulthood.

High school quality is associated with cognition 58 years later.

We leveraged a unique school-based longitudinal cohort-the Project Talent Aging Study-to examine whether attending higher quality schools is associated with cognitive performance among older adults in the United States (mean age = 74.8). Participants (n = 2,289) completed telephone neurocognitive testing. Six indicators of high school quality, reported by principals at the time of schooling, were predictors of respondents' cognitive function 58 years later. To account for school-clustering, multilevel linear and logistic models were applied. We found that attending schools with a higher number of teachers with graduate training was the clearest predictor of later-life cognition, and school quality mattered especially for language abilities. Importantly, Black respondents (n = 239; 10.5 percentage) were disproportionately exposed to low quality high schools. Therefore, increased investment in schools, especially those that serve Black children, could be a powerful strategy to improve later life cognitive health among older adults in the United States.

Make it or break it: On-time vaccination intent at the time of Covid-19.

On-time effective vaccination is critical to curbing a pandemic, but this is often hampered by citizens' hesitancy to get quickly vaccinated. This research concentrates on the hypothesis that, besides traditional factors in the literature, vaccination success would hinge on two dimensions: a) addressing a broader set of risk perception factors than health-related issues only, and b) securing sufficient social and institutional trust at the time of vaccination campaign launch. We test this hypothesis regarding Covid-19 vaccination preferences in six European countries and at the early stage of the pandemic by April 2020. We find that addressing the two roadblock dimensions could further boost Covid-19 vaccination coverage by 22%. The study also offers three extra innovations. The first is that the traditional segmentation logic between vaccine "acceptors", "hesitants" and "refusers" is further justified by the fact that segments have different attitudes: refusers care less about health issues than they are worried about family tensions and finance (dimension 1 of our hypothesis). In contrast, hesitants are the battlefield for more transparency by media and government actions (dimension 2 of our hypothesis). The second added value is that we extend our hypothesis testing with a supervised non-parametric machine learning technique (Random Forests). Again, consistent with our hypothesis, this method picks up higher-order interaction between risk and trust variables that strongly predict on-time vaccination intent. We finally explicitly adjust survey responses to account for possible reporting bias. Among others, vaccine-reluctant citizens may under-report their limited will to get vaccinated.

Intergenerational social mobility and suicide risk by firearm and other means in US males.

Firearms are the leading method of suicide in US men, and socioeconomic status (SES) is associated with suicide risk. In this 40-year mortality follow-up of a national cohort of US men, we examined if improved SES relative to one's family of origin, upward intergenerational social mobility (ISM), is associated with lowered risk for firearm suicide and suicide by other means in US men. Family of origin SES was assessed as part of Project Talent, a broad survey of US high school students in 1960. 42,766 men in the cohort completed follow-up surveys at age 29, assessing attained SES via education, occupation, and income. ISM was measured by change between harmonized SES composites. Mortality follow-up was conducted through age 70. Adjusting for baseline SES and race/ethnicity, a 1 standard deviation increase in SES was associated with a 31% reduction in firearm suicide risk later in the life course (HR [95% CI] = 0·69 [0·54, 0·88], P = 0·003), and a smaller, non-significant reduction in suicide by other means (HR [95% CI] = 0·80 [0·60, 1·07], P = 0·136). Traits associated with both suicide and SES attainment (cognitive ability, calm, impulsivity) only modestly attenuated this association. Upward ISM was more strongly associated with reduced firearm suicide risk in males with parents of low SES. The association between upward ISM and reduced firearm suicide mortality risk prevailed over ensuing decades. Policies improving social mobility in US males, particularly those of lower SES, may function as de-facto firearm suicide prevention strategies.

The relationship between health and political ideology begins in childhood.

We investigate whether childhood health status influences adult political ideology and whether health at subsequent life-stages, adolescent personality traits, or adolescent academic aptitude mediate this relationship. Using a national longitudinal cohort sample, we found that better health among children under age 10 was positively related to conservative political ideology among adults over age 64. Children with excellent health compared to very poor health were 16 percentage points more likely to report having a conservative political ideology in adulthood. Children with excellent health compared to very poor health were 13 percentage points less likely to report having a liberal political ideology in adulthood. Adults who had excellent health as children were 30 percentage points more likely to report conservative ideology than liberal ideology. However, the difference in ideological position for adults who had very poor childhood health was negligible. That is, the health and ideology relationship is being driven by those who were healthier early in life, after controlling for family income and material wealth. No evidence was found for mediation by adolescent heath, adult heath, adolescent personality traits, or adolescent academic aptitude. The magnitude of the coefficient for childhood health was substantively and statistically equivalent across race and sex. We discuss the possibility that, instead of being mediated, childhood health may actually be a mediator bridging social, environmental, and policy contexts with political ideology. We also discuss the potential of social policy to influence health, which influences ideology (and voting participation), which eventually circles back to influence social policy. It is important to understand the nexus of political life and population health since disparities in voice and power can exacerbate health disparities.

Postsecondary Education and Late-life Cognitive Outcomes Among Black and White Participants in the Project Talent Aging Study: Can Early-life Cognitive Skills Account for Educational Differences in Late-life Cognition?

BACKGROUND: Higher education consistently predicts improved late-life cognition. Racial differences in educational attainment likely contribute to inequities in dementia risk. However, few studies of education and cognition have controlled for prospectively measured early-life confounders or evaluated whether the education late-life cognition association is modified by race/ethnicity. METHODS: Among 2343 Black and White Project Talent Aging Study participants who completed telephone cognitive assessments, we evaluated whether the association between years of education and cognition (verbal fluency, memory/recall, attention, and a composite cognitive measure) differed by race, and whether these differences persisted when adjusting for childhood factors, including the cognitive ability. RESULTS: In fully adjusted linear regression models, each additional year of education was associated with higher composite cognitive scores for Black [ß=0.137; 95% confidence interval (CI)=0.068, 0.206] and White respondents (ß=0.056; CI=0.034, 0.078) with an interaction with race ( P =0.03). Associations between education and memory/recall among Black adults (ß=0.036; CI=-0.037, 0.109) and attention among White adults (ß=0.022; CI=-0.002, 0.046) were nonsignificant. However, there were significant race-education interactions for the composite ( P =0.03) and attention measures ( P <0.001) but not verbal fluency ( P =0.61) or memory/recall ( P =0.95). CONCLUSION: Education predicted better overall cognition for both Black and White adults, even with stringent control for prospectively measured early-life confounders.

What Is Genitourinary Syndrome of Menopause and Why Should We Care?

None: Genitourinary syndrome of menopause (GSM; previously known as vulvovaginal atrophy or atrophic vaginitis) involves symptoms of vaginal dryness, burning, and itching as well as dyspareunia, dysuria, urinary urgency, and recurrent urinary tract infections. It is estimated that nearly 60% of women in menopause experience GSM but the majority of these women do not bring up this concern with their health care provider. Studies also show that only 7% of health care providers ask women about this condition. This may be due to embarrassment or thinking this is a normal part of aging, both by patients and health care providers. This condition is progressive and may affect many aspects of a woman's physical, emotional, and sexual health. This article is intended to address the signs, symptoms, and significant impact this condition can have for women and help health care providers be more comfortable knowing how to ask about GSM, diagnosis it, and review the various treatment options that are available.

Association Between High School Personality Phenotype and Dementia 54 Years Later in Results From a National US Sample.

Importance: Personality phenotype has been associated with subsequent dementia in studies of older adults. However, neuropathologic changes often precede cognitive symptoms by many years and may affect personality itself. Therefore, it is unclear whether supposed dementia-prone personality profiles (high neuroticism and low conscientiousness) are true risk factors or merely reflections of preexisting disease. Objectives: To examine whether personality during adolescence-a time when preclinical dementia pathology is unlikely to be present-confers risk of dementia in later life and to test whether associations could be accounted for by health factors in adolescence or differed across socioeconomic status (SES). Design, Setting, and Participants: Cohort study in the United States. Participants were members of Project Talent, a national sample of high school students in 1960. Individuals were identified who received a dementia-associated International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code during any year between 2011 and 2013. The dates of our analysis were March 2018 to May 2019. Exposures: Ten personality traits were measured by the 150-item Project Talent Personality Inventory. Socioeconomic status was measured by a composite based on parental educational level, income, occupation, and property ownership. Participants were also surveyed on demographic factors and height and weight. Main Outcomes and Measures: Medicare records were collected, with dementia diagnoses in the period of 2011 to 2013 classified according to the US Centers for Medicare & Medicaid Services ICD-9-based algorithm. Cox proportional hazards regression models estimated the relative risk of dementia based on the 10 personality traits, testing interactions with SES and adjusting for demographic confounders. Results: The sample of 82 232 participants was 50.1% female, with a mean (SD) age of 15.8 (1.7) years at baseline and 69.5 (1.2) years at follow-up. Lower risk of dementia was associated with higher levels of vigor (hazard ratio for 1 SD, 0.93; 95% CI, 0.90-0.97; P < .001). Calm and maturity showed protective associations with later dementia that increased with SES. At 1 SD of SES, calm showed a hazard ratio of 0.89 (95% CI, 0.84-0.95; P < .001 for the interaction) and maturity showed a hazard ratio of 0.90 (95% CI, 0.85-0.96; P = .001 for the interaction). Conclusions and Relevance: This study's findings suggest that the adolescent personality traits associated with later-life dementia are similar to those observed in studies of older persons. Moreover, the reduction in dementia risk associated with a calm and mature adolescent phenotype may be greater at higher levels of SES. Personality phenotype may be a true independent risk factor for dementia by age 70 years, preceding it by almost 5 decades and interacting with adolescent socioeconomic conditions.

High school personality traits and 48-year all-cause mortality risk: results from a national sample of 26 845 baby boomers.

BACKGROUND: It is unclear if adolescent personality predicts mortality into late life, independent of adolescent socioeconomic status (SES). METHODS: Over 26 000 members of Project Talent, a US population cohort of high school students, completed a survey including 10 personality scales and SES in 1960. Multi-source mortality follow-up obtained vital status data through an average 48-year period ending in 2009. Cox proportional hazard models examined the relative risk associated with personality traits, as well as confounding by both a measure of SES and by race/ethnicity. RESULTS: Adjusted for sex and grade, higher levels of vigour, calm, culture, maturity and social sensitivity in high school were associated with reduced mortality risk (HRs=0.92 to. 96), while higher levels of impulsivity were associated with greater mortality risk. Further adjustment for SES and school racial/ethnic composition mildly attenuated (eg, 12%), but did not eliminate these associations. Final HRs for a 1 SD change in personality traits were similar to that for a 1 SD change in SES. CONCLUSIONS: Adaptive personality traits in high school are associated with all-cause mortality in the USA as far into the future as the seventh decade, and to a degree similar to high school socioeconomic disadvantage.

Evaluating the relationship between change in performance on training tasks and on untrained outcomes.

Training interventions for older adults are designed to remediate performance on trained tasks and to generalize, or transfer, to untrained tasks. Evidence for transfer is typically based on the trained group showing greater improvement than controls on untrained tasks, or on a correlation between gains in training and in transfer tasks. However, this ignores potential correlational relationships between trained and untrained tasks that exist before training. By accounting for crossed (trained and untrained) and lagged (pre-training and post-training) and cross-lagged relationships between trained and untrained scores in structural equation models, the training-transfer gain relationship can be independently estimated. Transfer is confirmed if only the trained but not control participants' gain correlation is significant. Modeling data from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study (Smith et al., 2009), transfer from speeded auditory discrimination and syllable span to list and text memory and to working memory was demonstrated in 487 adults aged 65-93. Evaluation of age, sex, and education on pretest scores and on change did not alter this. The overlap of the training with transfer measures was also investigated to evaluate the hypothesis that performance gains in a non-verbal speeded auditory discrimination task may be associated with gains on fewer tasks than gains in a verbal working memory task. Gains in speeded processing were associated with gains on one list memory measure. Syllable span gains were associated with improvement in difficult list recall, story recall, and working memory factor scores. Findings confirmed that more overlap with task demands was associated with gains to more of the tasks assessed, suggesting that transfer effects are related to task overlap in multimodal training.

Experimental modification of attribution processes.

Attributional style is hypothesized to be a causative factor in depression vulnerability; however, no studies to date have examined whether manipulation of attributional style influences depressed mood. The purpose of this study was to determine whether computer-based cognitive bias modification (CBM) procedures could modify attributional style and influence stress vulnerability. Participants were provided with multiple training trials that were intended to promote the use of either a positive or a negative attributional style. Compared with individuals in the negative attributional style condition, individuals in the positive attributional style condition showed decreased tendency to make self-deficient causal attributions for poor performance on a difficult anagram test. Furthermore, individuals in the positive attributional style condition reported less depressed mood in response to this academic stressor. These results suggest that attributional style is not invariable and can potentially be modified with CBM approaches.

Disseminated intravascular coagulopathy: manifestations after a routine dental extraction.

Clinical signs and symptoms of acute disseminated intravascular coagulopathy (DIC) include bleeding from body orifices, such as the nose, mouth, or ear, bleeding from an intravenous (IV) site, areas of ecchymosis, or blood in the urine or stool. The underlying disease triggering DIC usually determines the clinical presentation. However, patients with chronic DIC (compensated DIC) may possess subclinical signs and symptoms, and the bleeding disorder may only be identified through laboratory findings. In this compensated form, the triggering factor is exposed slowly and in small amounts (seen in malignancies and vasculitis), allowing replenishing of the augmented factors by the liver, adequate reticuloendothelial clearance of fibrin degradation products, and increased production of platelets, which prevent secondary fibrinolysis and the signs of bleeding. 1,4 We report a case of an 82-year-old male who presented to the emergency room 24 hours after a routine dental extraction with bleeding from the tooth socket, severe hypotension, and presence of ecchymosis on his chest. Clinical and radiographic exam revealed multiple thoracic and abdominal aortic aneurysms, as well as infrarenal and iliac aneurysms, continuous oral hemorrhage, and a unique presentation rarely documented in the literature: a bleeding tooth socket as the initial clinical sign and presentation of DIC.

Testosterone and chemosensory detection in male Syrian hamster.

Gonadal steroids stimulate both sexual motivation and performance. However, steroid facilitation of appetitive sexual behavior is poorly understood. The present study determined if castration impairs chemosensory detection in male hamsters. Chemosensory cues are the principal sensory modality to initiate mating in this species. We compared LiCl-induced conditioned taste avoidance to female hamster vaginal secretion (FHVS) in gonad-intact and castrated males. Following overnight water deprivation, males received FHVS for 15 min, followed by LiCl (2 ml of 0.15 M) or saline ip. The next day, fluid consumption in a two-bottle choice test was recorded for 5.5 h. Pairings were repeated 4x. Initially, discrimination of FHVS from estrous females (10 or 100 microg/ml) was compared with plain water. Subsequently, we determined if males could distinguish FHVS from Syrian vs. Djungarian females or from estrous vs. anestrous females. When 100 microg/ml FHVS was paired with saline, all gonad-intact and 86% of castrated males preferred FHVS over water. However, when 100 microg/ml FHVS was paired with LiCl, the preference was reversed: 12.5% of intact males and 25% of castrates preferred FHVS (P < 0.05 vs. saline pairing). When exposed to 10 microg/ml FHVS, neither gonad-intact nor castrated males expressed conditioned taste avoidance, suggesting that 10 microg/ml FHVS is below the threshold for detection. Comparing discrimination of FHVS from Syrian and Djungarian females, only castrated males developed a significant conditioned taste avoidance to Syrian FHVS paired with LiCl. While 71% of castrated males preferred Syrian FHVS after saline pairing, only 12.5% of castrates preferred Syrian FHVS after pairing with LiCl (P < 0.05). In gonad-intact males, 57% preferred Syrian FHVS after saline pairing, while 14% preferred Syrian FHVS following LiCl pairing (P > 0.05). Neither gonad-intact nor castrated males successfully discriminated between FHVS from estrous and anestrous females. These data demonstrate that castrated males perform as well as gonad-intact males in a test of LiCl-induced conditioned taste avoidance. Therefore, it is unlikely that steroids enhance detection of sexually relevant chemosensory cues.

Optimizing insulin therapy in pregnant women with type 1 diabetes mellitus.

Pregnancy complicated by type 1 diabetes mellitus is associated with an increased risk of complications in the mother and infant. Normal or near normal glycemic control prior to and during pregnancy reduces many of these risks to levels observed in the general population. This degree of glycemic control is generally achievable only with intensive insulin therapy: multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) via an insulin pump. These therapeutic regimens have been found to result in comparable glycemic control, although CSII provides increased flexibility in terms of patient lifestyle, and may reduce the incidence of hypoglycemia. Frequent home blood glucose monitoring is imperative during pregnancy in order to optimize glycemic control and reduce the risk of hypoglycemia. Furthermore, insulin requirements change significantly over the course of pregnancy. The new short-acting insulin analogs, insulin lispro and insulin aspart, have pharmacodynamic properties which make them ideal for use during pregnancy. Although the number of published studies evaluating the use of insulin lispro during pregnancy is limited, the majority support its safety. No studies of insulin aspart in pregnancy have been published in full. In addition to optimization of glycemic control, frequent assessment for development and/or progression of microvascular complications is necessary during pregnancy.