Dimensions of physical frailty and cognitive function in older adults with amnestic mild cognitive impairment.

OBJECTIVE: The objective of this study was to examine relationships between dimensions of physical frailty and severity of cognitive impairment in older adults with amnestic mild cognitive impairment (aMCI). PATIENTS AND METHODS: The prevalence of physical frailty dimensions including slow gait speed, low physical activity, and low grip strength was examined among 201 sedentary older adults with aMCI. Associations between dimensions of physical frailty and severity of cognitive impairment, as measured with the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and individual dimensions of cognitive function were examined using multiple linear regression models. RESULTS: Greater than 50% of participants met physical frailty criteria on dimensions of slow gait speed, low physical activity and low grip strength. Slower gait speed was associated with elevated severity of cognitive impairment. Both gait speed and physical activity were associated with individual dimensions cognitive function. CONCLUSIONS: Dimensions of physical frailty, particularly gait speed, were associated with severity of cognitive impairment, after adjusting for age, sex and age-related factors. Further studies are needed to investigate mechanisms and early intervention strategies that assist older adults with aMCI to maintain function and independence.

The relationship between infant lung function and the risk of wheeze in the preschool years.

RATIONALE: There is evidence that perinatal lung development predicts childhood wheeze. However, very few studies have examined whether preschool wheeze is associated with lower premorbid lung function in early infancy, and as yet there is no information relating atopic and non-atopic preschool wheeze to early lung development. OBJECTIVE: To examine the association between premorbid infant lung function and preschool wheeze, and to explore associations with atopic and non-atopic wheeze phenotypes. METHODS: Infant lung function was measured in 147 healthy term infants aged 5-14 weeks. Rapid thoracoabdominal compression was performed during tidal breathing and at raised volume to measure maximal expiratory flow at functional residual capacity (V' max FRC) and forced expiratory volume in 0.4 sec (FEV(0.4)). Atopic status was determined by skin prick testing at 3 years and wheeze ascertained from parental questionnaires (1 and 3 years). MEASUREMENTS AND MAIN RESULTS: Lower early infancy V' max FRC was associated with wheeze in both the first and third years of life (P=0.002 and 0.006, respectively). Lower early infancy FEV(0.4) was associated with wheeze in the first year (P=0.03). Compared to non-atopic children who did not wheeze, non-atopic children who wheezed in their third year of life had lower FEV(0.4) (P=0.02), while FEV(0.4) values of atopic children who wheezed were not significantly different (P=0.4). CONCLUSIONS: Lower premorbid infant lung function was present in infants who subsequently wheezed during the first and third years of life. Lower FEV(0.4) in early infancy was associated with non-atopic wheeze but not atopic wheeze at 3 years of age.

Developmental mismatch: consequences for later cardiorespiratory health.

Clinical and epidemiological studies have established that people who were small at birth and had poor infant growth have an increased risk of adult cardiovascular and respiratory disease, particularly if their restricted early growth is followed by accelerated childhood weight gain. This relationship extends across the normal range of infant size in a graded manner. The 'mismatch hypothesis' proposes that ill health in later life originates through developmental plastic responses made by the fetus and infant; these responses increase the risk of adult disease if the environment in childhood and adult life differs from that predicted during early development.

Immediate post intervention effects of two brief youth suicide prevention interventions.

This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview--Counselors CARE (C-CARE)--and C-CARE plus a 12-session Coping and Support Training (CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from seven high schools (N = 341). Students were assigned randomly to C-CARE plus CAST, C-CARE only, or "intervention as usual." The predicted patterns of change were assessed using trend analyses on data available from three repeated measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.

Evaluation of indicated suicide risk prevention approaches for potential high school dropouts.

OBJECTIVES: This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up. METHODS: Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up. RESULTS: Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. CONCLUSIONS: School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.

Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival.

BACKGROUND: Although psychosocial therapy has been shown to reduce mortality after myocardial infarction, it is unknown whether the benefits of psychosocial therapy on mortality reduction extend to out-of-hospital sudden cardiac arrest, a main cause of cardiovascular mortality. OBJECTIVE: Describe efficacy of psychosocial therapy on two-year cardiovascular mortality in sudden cardiac arrest survivors. METHOD: Survivors of out-of-hospital ventricular fibrillation or asystole (N = 129), documented by electrocardiograms from registries of a citywide Medic One unit and two countywide emergency units, were randomized into a two group, experimental, longitudinal design. The intervention consisted of 11 individual sessions, implementing three components: physiologic relaxation with biofeedback training focused on altering autonomic tone; cognitive behavioral therapy aimed at self-management and coping strategies for depression, anxiety, and anger; and cardiovascular health education. The primary outcome measure was cardiovascular mortality. RESULTS: Risk of cardiovascular death was significantly reduced 86% by psychosocial therapy, p = .03. Six of the seven cardiovascular deaths in the control group were caused by ventricular arrhythmias. The cardiovascular death in the therapy group was due to stroke. Controlling for depression, previous myocardial infarction, low ejection fraction, decreased heart rate variability, and ventricular ectopic beats had little impact on estimated treatment effect. The risk of all-cause mortality was reduced by 62% in the therapy group, p = .13. There were a total of three deaths in the therapy group and eight deaths in the control group. CONCLUSIONS: Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors.

Social support and network conflict in firefighters and paramedics.

The relationship(s) between self-rated social support network conflict (both at work and off-work) and self-report measures of occupational stressors, job satisfaction, and health outcomes were examined in samples of currently employed professional firefighters (n = 1,730) and paramedics (n = 253). In both samples, perceived social support and network conflict at work were more strongly correlated with job satisfaction and work morale, as well as a measure of their appraised occupational stressors, than with their comparable home (off-work) satisfaction/conflict ratings. The path analysis generated suggested that, with only one exception, social support and relational conflict in the combined respondent sample could be conceptualized as direct sources of stress influencing the respondents' appraisal of their occupational stressors. The path model further suggested that firefighter/paramedics' appraisal of their occupational stressors mediated the network variables' influences on self-reported job dissatisfaction and stress symptom health outcome measures.

Firefighters and paramedics: years of service, job aspirations, and burnout.

1. Data were collected from an anonymous mail survey of over 2,000 paramedics and firefighters to determine the relationships among years of service and four occupational outcomes, including burnout. 2. Paramedics had poorer outcomes than firefighters. Job title, not percent of emergency service runs per se, significantly differentiated the groups with respect to burnout and job aspiration variables. 3. After adjusting for age, years of service correlated negatively with three measures of job aspirations: job satisfaction, work related morale, and career goal attainment in both groups. 4. If signs and symptoms of burnout occur throughout the worker's life cycle rather than with increasing years of experience, the findings have implications for both prevention and intervention strategies.