Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults.

Background/Study Context: Magnetic resonance imaging (MRI) markers of cerebrovascular disease and atrophy are common in older adults and are associated with cognitive and medical burden. However, the extent to which they are related to health care expenditures has not been examined. We studied whether increased Medicare expenditures were associated with brain markers of atrophy and cerebrovascular disease in older adults. METHODS: A subset of participants (n = 592; mean age = 80 years; 66% women) from the Washington Heights Inwood Columbia Aging Project (WHICAP), a community-based observational study of aging in upper Manhattan, received high-resolution MRI and had Medicare expenditure data on file. We examined the relationship of common markers of cerebrovascular disease (i.e., white matter hyperintensities and presence of infarcts) and atrophy (i.e., whole brain and hippocampal volume) with Medicare expenditure data averaged over a 10-year period. Main outcome measures were (a) mean Medicare payment per year across the 10-year interval; (b) mean payment for outpatient care per year; and (c) mean payment for inpatient care per year of visit. In addition, we calculated the ratio of mean inpatient spending to mean outpatient spending as well as the ratio of mean inpatient spending to mean total Medicare spending. RESULTS: Increased Medicare spending was associated with higher white matter hyperintensity volume, presence of cerebral infarcts, and smaller total brain volume. When examining specific components of Medicare expenditures, we found that inpatient spending was strongly associated with white matter hyperintensity volume and that increased ratios of inpatient to outpatient and inpatient to total spending were associated with infarcts. CONCLUSION: Medicare costs are related to common markers of "silent" cerebrovascular disease and atrophy.

Enhanced N170 to outgroup faces: Perceptual novelty or prejudice?

Habituation to ethnic ingroup members has been reported to be greater than to ethnic outgroup members. This pattern could be due to the lack of perceptive experience (familiarity) with outgroup facial morphs or, alternatively, to the prejudice held toward that outgroup. We explored this disjunctive in 71 participants, all Spanish, who were experimentally habituated to faces from their Ingroup and to faces from two unfamiliar outgroups, one for which there is low probability of prejudice in this population (Non-prejudiced Outgroup), and one for which the probability of prejudice is higher (Prejudiced Outgroup). We indexed habituation through event-related potentials, concretely as the differential amplitude of the face-sensitive N170 component from Initial to Final trials of each group. Afterward, participants completed several prejudice measures. N170 showed significant habituation to all faces, though it did not differ among groups. However, a regression analysis revealed that individual habituation to the Outgroup faces was inversely related to implicit prejudice scores. Importantly, N170 amplitudes were maximal for the Prejudiced Outgroup in both Initial and Final trials. We conclude that these effects are explained by the prejudice held toward a specific outgroup rather than perceptive experience.

Prejudice drives exogenous attention to outgroups.

Exogenous attention allows the automatic detection of relevant stimuli and the reorientation of our current focus of attention towards them. Faces from an ethnic outgroup tend to capture exogenous attention to a greater extent than faces from an ethnic ingroup. We explored whether prejudice toward the outgroup, rather than lack of familiarity, is driving this effect. Participants (N = 76) performed a digit categorization task while distractor faces were presented. Faces belonged to (i) a prejudiced outgroup, (ii) a non-prejudiced outgroup and (iii) their ingroup. Half of the faces were previously habituated in order to increase their familiarity. Reaction times, accuracy and event-related potentials (ERPs) were recorded to index exogenous attention to distractor faces. Additionally, different indexes of explicit and implicit prejudice were measured, the latter being significantly greater towards prejudiced outgroup. N170 amplitude was greater to prejudiced outgroup-regardless of their habituation status-than to both non-prejudiced outgroup and ingroup faces and was associated with implicit prejudice measures. No effects were observed at the behavioral level. Our results show that implicit prejudice, rather than familiarity, is under the observed attention-related N170 effects and that this ERP component may be more sensitive to prejudice than behavioral measures under certain circumstances.

Optimismo Disposicional Y Estrés: Claves Para Promover El Bienestar Psicológico / Dispositional Optimism And Stress: Keys To Promoting Psychological Well-Being

Numerosos estudios señalan que los factores psicológicos afectan de forma importante al funcionamiento fisiológico del organismo. El optimismo disposicional considerado un rasgo unidimensional de personalidad, se relaciona con las expectativas de éxito futuro según la Self-Regulatory Behavior Theory. En diversos estudios, el optimismo se propone como factor modulador de la respuesta de estrés tanto crónico como agudo ya que altos niveles en la dimensión se asocian con bajos niveles de estrés percibido y cortisol. Además, el optimismo parece ser una variable clave en la regulación del ritmo circadiano del eje Hipotálamo-Hipófiso Adrenal (HHA). Esta influencia se ha estudiado con datos de cortisol en pelo, la respuesta matutina de cortisol y el nivel de cortisol a lo largo del día, encontrando resultados inconsistentes hasta el momento. En el presente trabajo se analiza la relación entre el optimismo y la respuesta de estrés acorde al eje HHA que ha mostrado ser relevante en la promoción del bienestar físico y psicológico. Asimismo, se reflexiona sobre la incorporación del optimismo disposicional en los programas de intervención psicológica como estrategia para promover el bienestar psicológico y prevenir la enfermedad en la población dada su relación con el desarrollo de alteraciones físicas y psicológicas como resultado de estados disfuncionales de estrés. (AU)

Numerous studies indicate that psychological factors significantly affect the physiological functioning of the body. Dispositional optimism, considered a one-dimensional personality trait, is related to expectations of future success according to self-regulatory behavior theory. In various studies, optimism is proposed as a modulating factor of both the chronic and acute stress response, since high levels in optimism have been associated with low levels of perceived stress and cortisol. Furthermore, optimism appearsto be a key variable in the regulation of the circadian rhythm of the hypothalamic-pituitary-adrenal (HPA) axis. This influence has been studied with data on hair cortisol, the awakening cortisol response, and the cortisol level throughout the day, with inconsistent results being found so far. In the present work, the relationship between optimism and the stress response according to the HPA axis is analyzed, which has been shown to be relevant in promoting physical and psychological well-being. Likewise, the incorporation of dispositional optimism in psychological intervention programs is considered as a strategy to promote psychological well-being and prevent disease in the population, given its relationship with the development of physical and psychological alterations as a result of dysfunctional states of stress. (AU)

El duelo perinatal por muerte gestacional tardía / Perinatal bereament for late gestational loss

El presente trabajo trata del duelo perinatal, concretamente, aquel que se da tras una muerte gestacional tardía. Las reflexiones que presentamos se enmarcan en el trabajo de interconsulta psicológica en un Hospital Materno-infantil. Los padres que pierden a un hijo antes del nacimiento se enfrentan a la difícil tarea de un duelo con ciertas particularidades. En la pérdida perinatal vida y muerte aparecen al mismo tiempo, no hay una historia compartida con el hijo esperado, no existe un reconocimiento social de esta pérdida y, a pesar de todo ello, se da un movimiento simbólico en la estructura familiar, quedando un lugar vacío, aquel que habría ocupado el recién nacido. Se señala la importancia de los primeros momentos en el acompañamiento a estos padres y su influencia en la elaboración posterior

This work deals with the perinatal bereavement, but with a particular one that comes after a late gestational death. The reflections we present are framed in the work of psychological interconsultation in a Maternal and Child Hospital. Parents who lose a child before birth face the difficult bereament task with certain peculiarities. In the perinatal loss life and death appear at the same time, there is no shared history with the expected child, there is no social recognition of this loss and, despite all this, there is a symbolic movement in the family structure, leaving an empty place, that would have occupied the newborn. The importance of the first moments in the accompaniment to these parents and their influence in the later elaboration is indicated