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Background and Objectives Advancing automation technologies are replacing certain occupations such as those involving simple food preparation more than occupations such as those in STEM fields (e.g. engineering and health care). Older workers generally face higher job automation risks in part due to their lower levels of digital skills. A better understanding of the associations between job automation risk, digital skills, and type of occupation (e.g. STEM vs non-STEM) can facilitate preparations for job automation and workforce population aging. Research Design and Methods We analyzed a nationally representative sample (N  = 1,560) of middle-aged and older U.S. workers aged 50–74 years from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted-use file. The estimated job automation risks (i.e. percentage of jobs to be automated in the next decades) were derived from the previous studies. PIAAC digital problem-solving skills proficiency (measured on a scale of 0–500 points) was assessed based on a series of practical digital tasks (e.g. finding a job research website that does not require registration). Results Linear regression analysis showed that greater digital skill proficiency (b  = −0.04, p  < .05) and STEM occupations (b  = −17.78, p  < .001) each were associated with lower job automation risks, even after adjusting for a series of demographic, socioeconomic, and civic engagement characteristics. Discussion and Implications Education and labor policy interventions to promote digital skills among older workers and non-STEM workers may better prepare an aging workforce for the dynamic labor market needs in the United States. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This study aims to fill the knowledge gap regarding the effects of high frequency facial neuromuscular electrical stimulation (fNMES) on facial aging, using a device equipped with CERTEC (Cell Energy Regeneration Technology) operating between 40 and 190 kHz.This prospective split‐face study was conducted at Tokyo University Hospital between March and May 2023 with 24 healthy adult women aged 30–59. The intervention group used the fNMES device along with basic skin care on one side of the face, and basic skin care alone on the other side for 8 weeks. Evaluations included changes in skin wrinkles, sagging, and blood flow.This study found significant improvements in skin elasticity and degree of wrinkles in the areas intervened with fNMES (p < 0.05, respectively). In addition, the intervention resulted in significant improvements in jawline angle (p < 0.01), submental volume (p < 0.05), cheek volume (p < 0.05), maximum nasolabial fold depth (p = 0.03), and total volume of the nasolabial folds (p = 0.03). The fNMES intervention also showed improvement in blood flow (p < 0.05). These improvements were also subjectively assessed by the participants in subject questionnaires at 8 weeks after the intervention (p < 0.05).This study suggests that high frequency fNMES effectively improves facial skin elasticity, reduces wrinkles and sagging, promotes blood flow, and contributes to overall facial appearance rejuvenation. Although further studies are needed, high frequency fNMES appeared promising as a noninvasive anti‐aging therapy. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Rarefaction of blood and lymphatic vessels in the skin has been reported in systemic sclerosis (SSc) (scleroderma). E26 transformation–specific–related factor (ERG) and Friend leukemia virus–induced erythroleukemia 1 (FLI‐1) are important regulators of angiogenesis, but their role in lymphatic vasculature is lesser known. The goal of this study was to determine the role of ERG and FLI‐1 in postnatal lymphangiogenesis and SSc lymphatic system defects.Immunofluorescence was used to detect ERG and FLI‐1 in skin biopsy samples from patients with SSc and healthy controls. Transcriptional analysis of ERG or FLI‐1–silenced human dermal lymphatic endothelial cells (LECs) was performed using microarrays. Effects of ERG and FLI‐1 deficiency on in vitro tubulogenesis in human dermal LECs were examined using a Matrigel assay. ERG and FLI‐1 endothelial–specific knockouts and ERG lymphatic–specific knockouts were generated to examine vessel regeneration in mice.ERG and FLI‐1 protein levels were reduced in the blood and lymphatic vasculature in SSc skin biopsy samples. ERG levels were shown to regulate genes involved in lymphatic vessel specification, including vascular endothelial growth factor receptor 3/FLT‐4, lymphatic vessel endothelial hyaluronan receptor 1, SOX‐18, and prospero homeobox 1 (PROX‐1), whereas FLI‐1 enhanced the function of ERG. The ERG–FLT‐4 pathway regulated in vitro tubulogenesis in human LECs. Deficiency of ERG or FLI‐1 similarly impaired the function of blood vessels in mice. However, only ERG deficiency affected the regeneration of lymphatic vessels during wound healing.ERG and FLI‐1 are essential regulators of blood and lymphatic vessel regeneration. Deficiency of ERG and FLI‐1 in SSc endothelial cells may contribute to the impairment of blood and lymphatic vasculature in patients with SSc. [ABSTRACT FROM AUTHOR]

Objectives Despite the cultural importance of marriage as a social support system and its well-established link to mental health, older Hispanic adult populations, which are the largest racial and ethnic minoritized groups, remain understudied. The current study examined how positive and negative dimensions of marital quality are associated with depressive symptoms. Methods Data from Hispanic adults aged 51 years and older (n = 1,012) were obtained from the 2016 and 2018 Health and Retirement Study waves. The Center for Epidemiological Studies—Depression scale (0–8 symptoms) was modeled as a function of positive and negative marital quality measures (1–4), as well as the relevant covariates. Results Results from a negative binomial regression model showed that a 1-unit change in positive and negative marital quality was associated with a 23.61% reduction and a 23.74% increase, respectively, in depressive symptoms. The interaction terms with marital quality and gender, as well as marital quality and religion, were not statistically significant. Discussion In the United States, a large percentage of older Hispanic adults are immigrants, and their extended family tends to reside in their countries of origin. As such, older Hispanic adults may have smaller social networks, and marital quality most likely represents a culturally important social support network in later life. Significant associations between depressive symptoms and marital quality among older Hispanic adults should receive more attention in family and public health policy discussions, particularly given the increasing diversity in U.S. society. [ABSTRACT FROM AUTHOR]

The subpopulation of adults depends on non-online health information sources including their social networks and health professionals, to the exclusion of online sources. In view of the digital divide and health information disparities, the roles of race/ethnicity and digital skills are yet to be explored. A nationally representative sample of 6,830 adults from the Program for the International Assessment of Adult Competencies (PIAAC) was analyzed, using binary logistic regression. Black adults and adults with higher digital skills were less likely to be reliant on non-online health information sources, compared to White adults and those with lower digital skills, respectively. Differences in non-online health information source reliance by race/ethnicity and digital skills might be further nuanced by the relevant demographic and socioeconomic characteristics. Increasing digital skills may expand one's health information sources to include reliable online sources and empower adults to promote their health. [ABSTRACT FROM AUTHOR]

In recent years, the medical use of cannabinoids has attracted growing attention worldwide. In particular, anti‐inflammatory properties of cannabinoids led to their emergence as potential therapeutic options for autoimmune and inflammatory disorders. Recent studies have also shown that cannabinoid receptors are widely expressed and have endogenous ligands in the skin, suggesting that the skin has its own endocannabinoid system. The aim of this review is to discuss the potential therapeutic effects of cannabinoids in autoimmune and inflammatory skin diseases. Following an overview of cannabinoids and the endocannabinoid system, we describe the cellular and molecular mechanisms of cannabinoids in skin health and disease. We then review the clinical studies of cannabinoids in autoimmune and inflammatory skin diseases including systemic sclerosis (SSc), dermatomyositis (DM), psoriasis (Pso) and atopic dermatitis (AD). A primary literature search was conducted in July 2023, using PubMed and Web of Science. A total of 15 articles were included after excluding reviews, non‐human studies and in vitro studies from 389 non‐duplicated articles. Available evidence suggests that cannabinoids may be beneficial for SSc, DM, Pso and AD. However, further studies, ideally randomized controlled trials, are needed to further evaluate the use of cannabinoids in autoimmune and inflammatory skin diseases. [ABSTRACT FROM AUTHOR]

Few studies have made direct comparisons between treatments for palmoplantar pustulosis (PPP); therefore, it is difficult to select the best treatment for each patient. To determine the best therapy and to compare reported measures of efficacy in clinical trials of systemic treatments for PPP in this systematic review and network meta‐analysis. Six databases were used to perform database search on 10 July 2022. Randomized controlled trials (RCTs) were identified through a systematic literature search. The titles and abstracts of articles were initially screened for inclusion by two authors independently using our predetermined criteria. The full texts of selected articles were then independently assessed for inclusion in a blinded fashion. Disagreement between the authors was resolved by consensus. Data were abstracted in duplicate. Random‐effects model was accepted to perform network meta‐analysis. Assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence were performed according to the PRISMA guidelines. The analysis was completed in July 2022. The primary outcome was the change of PPP Area and Severity Index (PPPASI) from baseline and the secondary outcome was the achievement of PPPASI‐50 response. Seven RCTs with 567 patients were included. Guselkumab 100 mg was the one with the highest probability of reaching the proposed outcomes (mean difference [MD], −8.00; 95% confidence interval [CI], 4.88–11.11), while the achievement of PPPASI‐50 response did not show a significant difference (odds ratio [OR], 3.79; 95% CI, 0.51–28.37). Guselkumab 200 mg was next to 100 mg of reaching the proposed outcomes (MD, −4.71; 95% CI, 2.12–7.30), while the achievement of PPPASI‐50 response did not show a significant difference (OR, 2.34; 95% CI, 0.48–11.43). Network meta‐analysis showed guselkumab 100 mg was the treatment with the highest probability of reaching both PPPASI and PPPASI‐50 outcomes. Absolute PPPASI may be more appropriate as an outcome than PPPASI‐50. [ABSTRACT FROM AUTHOR]

Volunteering, STEM education and occupation, and information-processing skills such as literacy, numeracy, and digital problem-solving skills are important indicators of a nation's well-being as they represent civic engagement, economic development, and the human capital of the population. Although these critical social indicators have been previously examined in silos, the interrelationships are yet to be examined in the adult populations in the United States. The current study analyzed the 2012/2014/2017 U.S. Program for the International Assessment of Adult Competencies (PIAAC) data of adults aged between 25 and 65 years old (n = 8,330). Results from the structural equation model showed that STEM education and occupation as well as information-processing skills independently promote volunteer participation. Also, STEM education and occupation are positively associated with information-processing skills. Yet, when simultaneously examining the mediation relationship, STEM education and occupation are no longer the promoters of volunteering. Findings from the current study can provide preliminary education, labor, and social policy implications for promoting the nation's economy and well-being, and inform future research to disentangle complex interrelationships across the important social indicators. [ABSTRACT FROM AUTHOR]

In patients with unresectable non-small cell lung cancer, histological diagnosis is frequently based on small biopsy specimens unsuitable for histological diagnosis when they are severely crushed and do not retain their morphology. Therefore, establishing a novel diagnostic method independent of tissue morphology or conventional immunohistochemistry (IHC) markers is required. We analyzed the lipid profiles of resected primary lung adenocarcinoma (ADC) and squamous cell carcinoma (SQCC) specimens using liquid chromatography-tandem mass spectrometry. The specimens of 26 ADC and 18 SQCC cases were evenly assigned to the discovery and validation cohorts. Non-target screening on the discovery cohort identified 96 and 13 lipid peaks abundant in ADC and SQCC, respectively. Among these 109 lipid peaks, six and six lipid peaks in ADC and SQCC showed reproducibility in target screening on the validation cohort. Finally, we selected three and four positive lipid markers for ADC and SQCC, demonstrating high discrimination abilities. In cases difficult to diagnose by IHC staining, [cardiolipin(18:2_18:2_18:2_18:2)-H]− and [triglyceride(18:1_17:1_18:1) + NH4]+ showed the excellent diagnostic ability for ADC (sensitivity: 1.00, specificity: 0.89, accuracy: 0.93) and SQCC (sensitivity: 0.89, specificity: 0.83, accuracy: 0.87), respectively. These novel candidate lipid markers may contribute to a more accurate diagnosis and subsequent treatment strategy for unresectable NSCLC. [ABSTRACT FROM AUTHOR]

Volunteer participation benefits societies and individuals. The objective of this study was to examine the roles of education and adult literacy in formal volunteering among a nationally representative sample of the U.S. middle-aged and older adults (45–74 years) by race and ethnicity (Whites, Blacks, Hispanics). Using cross-sectional data (n = 3,770) from the 2012/2014/2017 Program for the International Assessment of Adult Competencies (PIAAC), structural equation models were used to determine mediation relationships among educational attainment, literacy, and volunteering. The effect of educational attainment on formal volunteering was significantly greater among middle-aged and older Black adults compared to their Hispanic counterparts, as well as among middle-aged and older White adults compared to their Hispanic counterparts. However, literacy was the education-volunteering mediator among White adults only. Suggested policy implications include support for volunteer participation through culturally and socioeconomically sensitive approaches along with human capital development in adult life stages. [ABSTRACT FROM AUTHOR]

Adult numeracy is one of the essential skill sets to navigate through numeric information-rich labour markets in general, and STEM industries in particular. Yet, relatively little is known about how numeracy skills are used in different settings in the USA. This study examined numeracy skill use patterns of STEM and non-STEM workers at work and home. Data were obtained from the 2012/2014/2017 Program for International Assessment of Adult Competencies, USA restricted-use file. Adults who were employed and aged between 25 and 65 years old (n = 5,220) were included in this study. Latent class analysis revealed four numeracy skill use patterns: non-users, non-occupational (i.e. at home) simple numeracy users, ubiquitous numeracy users, and occupational numeracy users. Additional multinomial logistic regression analysis showed that the STEM occupation was associated with a greater likelihood of being ubiquitous users than being non-occupational simple users. Results also showed that numeracy proficiency, socioeconomic statuses (i.e. educational attainment and income), as well as demographic characteristics (i.e. gender and race/ethnicity), were predictive of the numeracy skill use patterns in terms of the level of engagement and settings. Findings from this study inform policies and interventions which promote skill engagement and improvement among workers in the USA. [ABSTRACT FROM AUTHOR]

The ability to effectively use digital technology and problem-solve are critical skills for maintaining democratic health, particularly as civil society and the modern digital landscape continuously evolve. However, information on whether individuals have the critical problem-solving skills to use digital technology and confidently affect change is yet to be further explored. Using data from the 2017 Program for International Assessment of Adult Competencies (n = 2749), we examined the associations between digital problem-solving skills and the three levels (low, neutral, high) of external political efficacy in the U.S. adult population. We used multinomial logistic regression and found a positive association between digital problem-solving skills and external political efficacy, while explanations for the three levels of efficacy are nuanced. Continuous development of digital problem-solving skills through adult education has implications for political efficacy, and ultimately for the promotion of a variety of civic engagement in the adult life stages. [ABSTRACT FROM AUTHOR]

Key message: Light‐chain deposition disease is accompanied not only by characteristic CT findings but also by characteristic gross findings of the visceral pleura. Medical thoracoscopy could diagnose LCDD by the findings of the thoracic cavity. [ABSTRACT FROM AUTHOR]

While postsecondary education appears to promote civic mindedness and engagement, relatively little is known about the association between civic outcomes and types of postsecondary education, as well as across different academic programs. Using a convenience sample from two postsecondary education institutions in the Mid-Atlantic U.S., this research examines the differences in civic mindedness and civic engagement between 2-year community college and 4-year university students, as well as students in different majors. Despite no significant difference between 2- and 4-year institutions, social science majors have greater civic outcomes in the specific areas compared to other majors. [ABSTRACT FROM AUTHOR]

Prostitution clients' attitudes toward gender equality are important indicators of how masculinity relates to the demand for commercial sexual services. Research on male client misogyny has been inconclusive, and few studies compare men in different markets. Using an online survey of 519 clients of sexual services, we examine whether male client attitudes toward gender role equality are related to the main methods customers used to access prostitution services (i.e., through print or online media vs. in-person contact). We found no differences among men in these markets in attitudes toward gender role equality in the workplace and home. This is in a context where all clients had more egalitarian attitudes toward women's roles than the U.S. male population in the General Social Survey (GSS). However, clients in in-person markets were less supportive of affirmative action than in online markets in a context where all clients were less supportive compared to the national average. These findings point to need to rethink how masculinity and gender role attitudes affect patterns of male demand for paid sex. [ABSTRACT FROM AUTHOR]

We analyze six waves of data (2006–2016) from the Health and Retirement Study (n = 4,342) to examine how marital quality is associated with depressive symptom trajectories among a group of continuously married older adults. Results show gender parity in how own perceptions of positive and negative dimensions of marital quality are related to depressive symptom trajectories. In addition, spousal perceptions of negative marital quality are positively associated with growth in depressive symptomatology regardless of gender. Spousal perceptions of positive marital quality, however, are associated with lower depressive symptoms only for women. [ABSTRACT FROM AUTHOR]

Although praying mantises rely mainly on vision for predatory behaviours, olfaction also plays a critical role in feeding and mating behaviours. However, the receptive processes underlying olfactory signals remain unclear. Here, we identified olfactory sensory neurons (OSNs) that are highly tuned to detect aldehydes in the mantis Tenodera aridifolia. In extracellular recordings from OSNs in basiconic sensilla on the antennae, we observed three different spike shapes, indicating that at least three OSNs are housed in a single basiconic sensillum. Unexpectedly, one of the three OSNs exhibited strong excitatory responses to a set of aldehydes. Based on the similarities of the response spectra to 15 different aldehydes, the aldehyde-specific OSNs were classified into three classes: B, S, and M. Class B broadly responded to most aldehydes used as stimulants; class S responded to short-chain aldehydes (C3–C7); and class M responded to middle-length chain aldehydes (C6–C9). Thus, aldehyde molecules can be finely discriminated based on the activity patterns of a population of OSNs. Because many insects emit aldehydes for pheromonal communication, mantises might use aldehydes as olfactory cues for locating prey habitat. [ABSTRACT FROM AUTHOR]

Background and Objectives The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States. Research Design and Methods The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)'s supplemental module (Health Behaviors) and the RAND version of the HRS fat file. Results Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p <.05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p <.05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p <.05). Discussion and Implications While more research is needed to clarify the purposes (e.g. prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults. [ABSTRACT FROM AUTHOR]

Photoinduced polymerization reactions are an energy‐saving and environmentally friendly technology used in applications such as curing and coating. Photo initiators are one of the key materials which generate active species by photoirradiation. Many types of radical and cationic photo initiators (photoacid generators) have been developed. However, anionic photo initiators (photobase generators), which are more advantageous in terms of corrosion and lack of deactivation, remain under development. Cyclic amidine compounds, such as DBU® (1,8‐Diazabicyclo[5.4.0]undec‐7‐ene) and DBN (1,5‐Diazabicyclo[4.3.0]non‐5‐ene), are strong organic bases, widely used as catalysts in organic, polymerization, and crosslinking reactions. Developing a photobase initiator that can generate such a strong base is important, because there are few photobase generators with strong basicity and high reactivity for practical applications. In this study, we investigated the elementary mechanism of photolysis of quaternary amidinium borate salts by transient absorption measurements. We confirm that photoinduced electron transfer is a key step in the photo decomposition of quaternary amidinium borate salts and that the position of the sensitizing chromophore in the molecules significantly affects the decomposition efficiency. [ABSTRACT FROM AUTHOR]

The objective of this study is to examine the associations between the motivation to learn, basic skills (i.e. literacy and numeracy), and organised adult education and training (AET) participation among the middle-aged and older adults in the USA. Rapid technological advancement and globalisation necessitate individuals to engage in lifelong learning to actively participate in society. However, little is known about the roles of motivation to learn and basic skills in the AET participation in the U.S. adult population. We obtained the data from the 2012/2014 Programme for International Assessment of Adult Competencies restricted-use file and adults aged 50 years and older (n = 2,580) are included. Structural equation models are used to examine (1) any AET, (2) formal AET and (3) non-formal AET participation as a function of the motivation to learn latent construct, literacy, numeracy, and other covariates. Results showed that the motivation to learn, literacy and numeracy are all positive predictors of non-formal AET participation. Only motivation to learn is associated with formal AET participation. Findings from this study may inform future interventions as well as policy changes to promote specific types of organised AET programmes among older adult population in the USA. [ABSTRACT FROM AUTHOR]

Automation and advanced technologies have increased the need for a better understanding of the skills necessary to have a globally competitive workforce. This study used data from the Program for the International Assessment of Adult Competencies to compare problem-solving skills in technology-rich environments among adults in South Korea, Germany, Singapore, Japan, Canada, Estonia, the United Kingdom, the United States, and Australia. Overall, the United States had the lowest scores among all countries, and in all countries scores declined with age. The United States had higher proportions of survey participants in the lowest skill category and lower proportions in the top-skill categories. The results of this study suggest changes in the U.S. educational and lifelong learning systems, and policies may be necessary to ensure all adults have the necessary skills in a competitive workforce. [ABSTRACT FROM AUTHOR]

Background and Objectives The encore years, or later life stages when adults enjoy health and free time, are the prime opportunity for leisure to maximize the overall quality of life. Physically active leisure is widely known to be linked to overall subjective well-being (SWB). However, experienced SWB or momentary emotion during active leisure as well as passive leisure has yet to be examined. Research Design and Methods Data were derived from the 2012/2013 American Time Use Survey Well-being modules. Propensity score matching (PSM) was used to identify comparable matched samples of older adults. Results The PSM identified 211 older adults who reported a series of emotions (i.e. happy, meaningful, tired, sad, stressed, pain) during active leisure, and the comparable counterpart (n = 211) during passive leisure. Results from the Wilcoxon Rank Sum tests showed that active leisure was associated with greater levels of experienced happiness and meaningfulness, as well as with lower levels of sadness (p <.05). Discussion and Implications Physically active leisure is linked to greater levels of experienced SWB among older adults. Although more detailed roles of active and passive leisure for experienced SWB are yet to be verified, choices that older adults make in their free time may significantly impact their experienced SWB and, in turn, their overall quality of life. Aging and public health policies should enhance accessibility to active leisure to promote older adults' SWB. [ABSTRACT FROM AUTHOR]

Backgrounds: Stratified epithelia have caught much attention as potential contributors to the development of dermal and oesophageal fibrosis in systemic sclerosis (SSc). Galectin‐7 is a marker of all types of stratified epithelia, which is involved in the maintenance of epidermal homeostasis. So far, the role of galectin‐7 has not been studied in SSc. Objectives: To investigate the potential contribution of galectin‐7 to the development of clinical manifestations in SSc. Methods: Galectin‐7 expression was examined in skin samples and cultured keratinocytes by immunostaining and/or quantitative reverse transcription PCR. Serum galectin‐7 levels were determined by enzyme‐linked immunosorbent assay in 63 SSc and 20 healthy subjects. Results: Galectin‐7 expression was markedly decreased in the epidermis of SSc lesional skin compared with that of healthy control skin. Serum galectin‐7 levels were significantly lower in SSc patients than in healthy controls and inversely correlated with skin score. In addition, SSc patients with diffuse pigmentation and those with oesophageal dysfunction had significantly decreased serum galectin‐7 levels as compared to those without each symptom. Importantly, endothelin‐1 stimulation suppressed galectin‐7 expression in normal human keratinocytes, and bosentan, a dual endothelin receptor antagonist, reversed circulating galectin‐7 levels and epidermal galectin‐7 expression in SSc patients. Conclusions: Galectin‐7 downregulation in stratified epithelia, which is mediated at least partially by autocrine endothelin stimulation, may contribute to the development of cutaneous manifestations and oesophageal dysfunction in SSc patients. [ABSTRACT FROM AUTHOR]

We examine complex pathways that link health information seeking behavior with education and health literacy (decomposed into general literacy and numeracy), and how these pathways differ by perceived health status (need) among a nationally representative sample of Americans age 50 and older (n = 2,750). Data come from the Program for International Assessment of Adult Competencies (PIAAC). Multi-group structural equation models were used to examine the use of eight health information sources (newspapers, magazines, internet, radio, TV, books, friends/family, and health professionals). Findings partially support the long-standing notion that health seeking behaviors are directly linked to educational attainment, and provide some of the first nationally representative evidence for how education functions through distinct health literacy components to shape health information seeking behaviors by health status. Findings from this moderated mediation analysis point to the importance of examining, and addressing, health literacy disparities in access to and use of health information. [ABSTRACT FROM AUTHOR]

Abstract Background Aquaporin-1 (AQP1), a water channel protein controlling the water contents of cells and tissues, exerts pleiotropic effects on various biological activities, including inflammation, angiogenesis, and extracellular matrix remodeling, by regulating cell behaviors and tissue water balance. Objective To investigate AQP1 roles in systemic sclerosis (SSc) which is characterized by autoimmune inflammation, vasculopathy, and tissue fibrosis. Methods AQP1 expression was evaluated by immunohistochemistry and quantitative reverse transcription PCR in skin samples from human and animal models and by immunoblotting in cultured cells. Fli1 binding to the AQP1 promoter was evaluated by chromatin immunoprecipitation. Cell migration was assessed by scratch assay. Results Dermal fibroblasts and endothelial cells highly expressed AQP1 in SSc lesional skin, and AQP1 expression in dermal fibroblasts and endothelial cells positively correlated with the degrees of tissue fibrosis and edema, respectively. Consistently, SSc dermal fibroblasts up-regulated AQP1 compared with normal dermal fibroblasts in vitro. Furthermore, TGF-β stimulation induced AQP1 expression in normal dermal fibroblasts, while TGF-β1 antisense oligonucleotide suppressed AQP1 expression in SSc dermal fibroblasts. In endothelial cells, Fli1 deficiency resulted in AQP1 up-regulation in vivo and in vitro and Fli1 bound to the AQP1 promoter. Importantly, SSc dermal fibroblasts and FLI1 siRNA-treated endothelial cells had a pro-migratory property, which was remarkably diminished by gene silencing of AQP1. Conclusion AQP1 is up-regulated in SSc dermal fibroblasts and SSc endothelial cells at least partially due to autocrine TGF-β stimulation and Fli1 deficiency, respectively, possibly contributing to inflammation, vasculopathy, and tissue fibrosis by regulating tissue edema and cell migration. [ABSTRACT FROM AUTHOR]

Health literacy skills are known to be a key mediator of the relationship between education and health in the general population. However, one aspect of health literacy skills—individuals' actual literacy activities—remains understudied, especially among older adults. Health disparities that are driven by inequalities in education and level of health literacy skills are particularly problematic for older adults since they are exacerbated in old age by disadvantages that accumulate over the life course. This study examined a nationally representative sample of US adults age 50 years and older (n = 2,573) using data from the 2014 Program for International Assessment of Adult Competencies (PIAAC). Parallel mediation analysis was conducted to examine the partial mediation effects of health literacy skills and literacy activity (i.e., reading at home) on the relationship between education and health. Results showed that both health literacy skills and literacy activity mediated the education-health relationship. On average, literacy skills mediated 31.89% and literacy activities mediated 9.59% of the effect of education of self-rated health. Literacy activity, such as reading, is an easily accessible, autonomous, and sustainable option for promoting health in later life. Policies that support the intersection of public health and education may promote lifelong learning and well-being among US adults. [ABSTRACT FROM AUTHOR]

Objectives: Latinos have poorer health outcomes among certain conditions (e.g. diabetes, obesity, mental health) compared to non-Latino Whites in the U.S., in part due to difference in the amount of physical activity, which are heavily influenced by sociocultural factors such as educational attainment and acculturation. Vigorous-intensity leisure time physical activity (VLTPA) may provide health benefits with a shorter amount of time than moderate-to-light physical activity. However, VLTPA has been significantly understudied compared to LTPA in general. The purpose of this study is to examine the associations between educational attainment, acculturation, and VLTPA by gender among Latino adults in the U.S. Design: Nationally representative samples of Latino adults aged 25 years and older (n = 4393) from the 2010 National Health Interview Survey were analyzed. VLTPA was measured as the number of hours per week of VLTPA consisting of heavy sweating or large increases in breathing and heart rate. Acculturation was measured as the degree to which the English language versus the Spanish language was spoken most often. The zero-inflated Poisson regression model was constructed using the full information maximum likelihood estimation and controlling for a series of sociodemographic characteristics and relevant health behaviors. Results: Educational attainment was positively associated with VLTPA among Latino adults [exp(b) = 1.09, p < 0.05)]. Similarly, greater acculturation was associated with greater hours/week of VLTPA [exp(b) = 1.10, p < 0.05)]. Lastly, the effect of educational attainment on VLTPA significantly varied by gender. Conclusions: Education had a positive association and acculturation had negative association with the hours/week of VLTPA among Latinos. Also, the association between education and VLTPA was significantly stronger among women than men. These findings inform culturally and socially sensitive approaches to improve the health of Latinos, in hopes to address health disparities by race/ethnicity the U.S. [ABSTRACT FROM AUTHOR]

The Third Age is an emerging postretirement life stage characterized by better health and greater independence than previous cohorts have experienced, and recognized as an ideal time for personal growth and leisure. Yet the same demographic force that is partially responsible for this new life stage-population aging-is also driving an increased need for long-term services and supports, and Third Agers often find themselves fulfilling these caregiving roles. Thus, data from the 2013 American Time Use survey were analyzed to assess elder-caregivingrelated barriers to leisure among Third Agers. While, caregivers were found to report more total leisure time and social activities, they reported less time on physical activities than noncaregivers. Results were found to differ by weekday or weekend status. Future research needs to consider specific types of leisure time use, as well as timing of leisure activities, to promote quality of life among caregivers in their Third Age. [ABSTRACT FROM AUTHOR]

Gerontological educators are increasingly interested in reducing college students’ negative, and promoting their positive, attitudes toward older adults. Over the course of a semester, students from six 4-year institutions viewed three life story videos (documentaries) of older adults and completed pre- and posttest surveys that assessed their positive (Allophilia Scale) and negative (Fraboni Scale of Ageism) attitudes. The authors assessed changes in attitudinal scales between treatment (with videos, n = 80) and control (no video, n = 40) groups. Change score analysis with 95% bias-corrected bootstrap confidence intervals estimated the effects of the documentaries on students’ attitudes. The treatment group showed significant increases in kinship, engagement, and enthusiasm, and decreases in antilocution and avoidance (all ps <.05). There was no significant change in affect, comfort, or discrimination. This study demonstrated how video stories impact students’ attitudes about older adults. [ABSTRACT FROM AUTHOR]

Education, lifelong learning activities, and well-being are positively associated. However, significantly less is known about types of learning activities such as participation in organized adult education programs and self-learning among older adults in the same context. Data from 420 older adults from the Osher Lifelong Learning Institute (OLLI) were analyzed. Results showed that additional participation in organized education programs was positively associated with life satisfaction among OLLI members. Given the beneficial effects of additional participation in organized adult education programs on life satisfaction, older learners are encouraged to be engaged in more learning activities. [ABSTRACT FROM AUTHOR]

In recent years, volunteering has received increasing attention as a unique form of learning, one which may complement lifelong learning programs for older adults. This study examined the underlying volunteer motivations as well as formal volunteer behaviors among older adult lifelong learners. Data from 277 members of the Osher Lifelong Learning Institute in an urban community in the western part of the United States were analyzed using exploratory factor analysis and binary logistic regression models. Results showed that generativity (i.e., a desire to help next generations or communities), personal development, and well-being are salient underlying volunteer motivators. However, only generativity was associated with actual volunteering among older lifelong learners (odds ratio = 1.55; standard error = .17; p < .05). These findings suggested that existing lifelong learning programs might consider incorporating volunteer-based service learning components into their curricula in order to further promote the benefits of lifelong learning among older adults. [ABSTRACT FROM AUTHOR]

This study examined whether household income mediates the relationship between acculturation and vegetable consumption among Latino adults in the U.S. Data from the 2009 to 2010 National Health and Nutrition Examination Survey were analyzed. Vegetable consumption index was created based on the frequencies of five kinds of vegetables intake. Acculturation was measured with the degree of English language use at home. Path model with bootstrapping technique was employed for mediation analysis. A significant partial mediation relationship was identified. Greater acculturation [95 % bias corrected bootstrap confident interval (BCBCI) = (0.02, 0.33)] was associated with the higher income and in turn, greater vegetable consumption. At the same time, greater acculturation was associated with lower vegetable consumption [95 % BCBCI = (−0.88, −0.07)]. Findings regarding the income as a mediator of the acculturation-dietary behavior relationship inform unique intervention programs and policy changes to address health disparities by race/ethnicity. [ABSTRACT FROM AUTHOR]

The branching ratios of positron reemission, positronium emission, positronium negative ion emission and capture to the surface state for thermalized positrons at polycrystalline tungsten surfaces coated with Na, K and Cs have been measured. The data shows that the ratios depend on the coverage of the alkali-metal coating. The fraction of the emitted positronium increases with the coverage of the coating up to 90%. [ABSTRACT FROM AUTHOR]

As East Asians are, on average, less happy than those in economically developed Western nations, more insights regarding the associations between work, income and happiness are needed. This study analyzes data from the 2010 East Asian Social Survey to investigate these associations in China, Japan, South Korea and Taiwan, and is framed in a similar context as previous studies that utilize data from Western nations and through the lens of social comparison theory. Path analysis is used to model the associations between happiness and its predictors while taking correlations between the predictors into account. Results show that working hours are negatively associated with happiness in China, Japan and Taiwan, but such an association is not observed in South Korea. At the same time, relative income is significantly associated with happiness in all four East Asian nations, but it only mediates the association between working hours and happiness in China. These results suggest that careful consideration of economic and labour policies are critical to promote the happiness of East Asian workers. Findings from this study are useful for further inquiries with regard to specific explanatory factors of the associations between working hours, relative income and happiness in East Asia. [ABSTRACT FROM AUTHOR]

Cathepsin L ( CTSL) is a lysosomal proteolytic enzyme involved in inflammation and vascular and extracellular matrix remodelling, which are the three cardinal pathological events associated with systemic sclerosis ( SSc). To elucidate the potential role of CTSL in the development of SSc, we here investigated CTSL expression in the lesional skin of patients with SSc and SSc animal models and the clinical correlation of serum CTSL levels. CTSL expression was elevated in dermal small vessels of SSc patients compared with those of healthy controls. Consistently, CTSL mRNA levels were increased in SSc lesional skin samples, but not in cultivated SSc dermal fibroblasts, compared with corresponding control samples from healthy individuals. Serum CTSL levels were significantly higher in SSc patients than in healthy controls and inversely correlated with skin score. Furthermore, the elevation of serum CTSL levels was linked to SSc vasculopathy. Supporting these results, Ctsl mRNA levels were decreased in the skin of bleomycin-treated mice, an SSc animal model recapitulating its fibrotic aspect, and CTSL expression was enhanced in dermal small vessels of endothelial cell-specific Fli1 knockout mice, reminiscent of SSc vasculopathy. Importantly, gene silencing of FLI1 induced CTSL mRNA expression and Fli1 occupied the CTSL promoter in human dermal microvascular endothelial cells. Collectively, these results suggest that endothelial CTSL up-regulation partially due to Fli1 deficiency may contribute to the development of vasculopathy, while the decrease in dermal CTSL expression is likely associated with dermal fibrosis in SSc. [ABSTRACT FROM AUTHOR]

Lifelong learning is receiving greater attention due to population aging in modern societies. Lifelong learning benefits individuals by supporting their physical, psychological, social, and economic well-being. However, older adults generally have lower motivation for learning than younger adults, and facilitating long-term participation in learning activities is still challenging. Previous studies mainly identified negative factors such as barriers and obstacles to individuals’ initial participation in lifelong learning programs. As such, less is known about positive factors that promote long-term participation. To address this gap, data were collected from 330 older adults who participated in the Osher Lifelong Learning Institute program in an urban community in the United States. Results from proportional odds ordinal logistic regression analysis demonstrated that gender, number of household members, income, religious affiliation, self-rated health, and number of courses taken were associated with satisfaction with the program. In hopes to promote true lifelong learning, possible explanations about the findings are explored and several recommendations for existing lifelong learning programs are derived in this study. [ABSTRACT FROM PUBLISHER]

Background: There has been a growing interest in understanding relationships between educational attainment of an individual and his or her spouse's health. However, the issue has not been extensively studied, particularly in East Asian nations. Purpose: We investigated the relation between individuals' specific dietary behaviors and their spouses' educational attainment in China. Method: A total of 2071 individuals were surveyed in the 2012 Zhuzhou Healthy City Project, in China. Multivariate logistic regressions were used to model two specific individual dietary behaviors (i.e., oil intake and salt intake) as a function of own and their spouses' educational attainment. The models were also constructed by gender. Results: Spouses' education was positively associated both with individuals' oil intake and salt intake after adjusting for the demographic characteristics, socioeconomic status, and health knowledge. Also, females (i.e., wives) were more likely to benefit from her spouse's education in terms of healthy dietary behaviors. When his or her spouse's level of education were greater, an individual was more likely to meet the dietary guidelines of salt and oil intakes. This Chinese study supports the male dominance hypothesis (i.e., males are more influential on female's health behavior) and the highest status dominance hypothesis (i.e., individuals with higher socioeconomic status are more influential on those with lower status). In terms of the social cognitive theory, married couples exchange health knowledge and share health behaviors. Conclusion: Spouses' educational attainment and health knowledge should be incorporated into the design of health promotion programs targeting married couples in China. Finally, additional theoretical explanations and implications are evaluated in this article. [ABSTRACT FROM AUTHOR]

Insects, as well as vertebrates, possess morphological, physiological and behavioural sexual dimorphisms. Because they are commonly bigger and produce eggs, female insects usually require more and specific energy intake. In addition to quantitative and qualitative requirements in food for reproduction, animals also have to avoid eating lethal toxins. The praying mantis Tenodera aridifolia is a good model to investigate sexual differences in feeding behaviour because its sexual dimorphism is marked in terms of morphology and behaviour. Here, we observed that females ate approximately four times as much prey as males. We then investigated the attacking and feeding behaviours of praying mantises by presenting mealworms injected with bitter solutions (quinine hydrochloride dihydrate or denatonium benzoate at 50 or 500 mM) as prey. We observed that males had a low level of acceptance for bitter prey: unlike females, they reduced consumption of mealworms injected with 50 mM of these bitter solutions. However, they showed higher motivation (unlike females, their rate of attack on prey increased when they reduced their consumption of mealworms). This difference in ingestion between the sexes did not seem to be due to different sensitivities for these bitter solutions (there was no detectable difference between the sexes in time taken to drink drops of these bitter solutions). Instead, this seems related to males and females having different feeding strategies based on different nutritive requirements. The possible effects of nutritional composition of prey on avoidance behaviours in predatory insects are discussed. [ABSTRACT FROM AUTHOR]

The relationship between education and health is well-established, but theoretical pathways are not fully understood. Economic resources, stress, and health behaviors partially explain how education influences health, but further study is needed. Previous studies show that health literacy mediates the education–health relationship, as do general literacy skills. However, little is known whether such mediation effects are consistent across different societies. This study analyzed data from the International Assessment of Adult Literacy and Life Skills Survey conducted in Canada, the United States, Italy, Norway, Switzerland, and Bermuda to investigate the mediation effects of literacy on the education–health relationship and the degree of such mediation in different cultural contexts. Results showed that literacy skills mediated the effect of education on health in all study locations, but the degree of mediation varied. This mediation effect was particularly strong in Bermuda. This study also found that different types of literacy skills are more or less important in each study location. For example, numeracy skills in the United States and prose (reading) literacy skills in Italy were stronger predictors of health than were other literacy skills. These findings suggest a new direction for addressing health disparities: focusing on relevant types of literacy skills. [ABSTRACT FROM PUBLISHER]

Context: Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS).Objective: This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns.Design: GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence.Results: Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts.Conclusion: Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy. [ABSTRACT FROM AUTHOR]

Domain satisfaction, a relatively under-researched topic in subjective well-being research, is designed to capture satisfaction in multiple aspects of life (e.g., family, health). In view of the life course perspective, perceptions toward such different domains of life are most likely influenced by the historical and social climate that individuals uniquely experience over their life span. However, little is known about whether domain satisfaction is a valid measure across cohorts, which reflect differing life experiences at each life stage. This study examines the psychometric properties (e.g., validity and reliability) of a domain satisfaction measure across seven theoretically meaningful cohorts (e.g., Baby Boomers) using a nationally representative sample of American adults from multiple waves of the General Social Survey (n = 15,302). Results from confirmatory factor analysis showed that the validity of the domain satisfaction measure was not consistent across cohorts; unlike when all samples (e.g., cohorts were not considered) were analyzed together. A series of follow-up analyses also revealed that temporally proximate cohorts that were born around the same time were more likely to be psychometrically comparable, while temporally distant cohorts were not. In summary, this study provides empirical evidence suggesting that the validity of domain satisfaction is sensitive to cohort effects, and researchers need careful consideration when comparing cohorts chronologically further apart. [ABSTRACT FROM AUTHOR]

Purpose of the Study: The majority of resident satisfaction surveys available for use in assisted living settings have been developed in the United States; however, empirical assessment of their measurement properties remains limited and sporadic, as does knowledge regarding their applicability for use in settings outside of the United States. This study further examines the psychometric properties of the Ohio Department of Aging-Resident Satisfaction Survey (ODA-RSS) and explores its applicability within a sample of Canadian assisted living facilities. Design and Methods: Data were collected from 9,739 residential care facility (RCF) residents in Ohio, United States and 938 assisted-living residents in British Columbia, Canada. Confirmatory factor analysis was used to assess the instrument’s psychometric properties within the 2 samples. Results: Although the ODA-RSS appears well suited for assessing resident satisfaction in Ohio RCFs, it is less so in British Columbia assisted living settings. Adequate reliability and validity were observed for all 8 measurable instrument domains in the Ohio sample, but only 4 (Care and Services, Employee Relations, Employee Responsiveness, and Communications) in the British Columbia sample. Implications: The ODA-RSS performs best in an environment that encompasses a wide range of RCF types. In settings where greater uniformity and standardization exist, more nuanced questions may be required to detect variation between facilities. It is not sufficient to assume that rigorous development and empirical testing of a tool ensures its applicability in states or countries other than that in which it was initially developed. [ABSTRACT FROM PUBLISHER]

Leisure satisfaction is positively associated with quality of life (QOL), more specifically, subjective QOL, which is often expressed as happiness. Compared to industrial nations in North America and Europe, however, significantly less is known about Asian nations. The purpose of this study is to examine the understudied areas of China, Japan and South Korea, all of which share cultural values and practices (e.g., Confucianism). Internationally representative 2006 AsiaBarometer data from Mainland China (n = 2,000), Japan (n = 1,003) and South Korea (n = 1,023) are employed to examine the concept of QOL, and the association between leisure satisfaction and QOL in these specific Asian populations. Results of confirmatory factor analysis demonstrate the validity of the QOL concept based on a series of satisfaction measures (i.e., leisure, income, health, family, spirituality, and friendship). Subsequently, generalized ordinal logistic regression was used to model QOL as a function of leisure satisfaction and covariates. Results show that leisure satisfaction is independently positively associated with QOL only in South Korea, although other satisfaction measures including income, health and spiritual satisfactions are consistently significant in all three nations. These findings may be useful for developing locally-sensitive policies and services to improve/maintain QOL in each nation. Possible explanations about the diverse relationships between leisure satisfaction and QOL are discussed in view of the different stage of societal development, common Confucian values, as well as each nation's unique characteristics. [ABSTRACT FROM AUTHOR]

Background. Health literacy, the set of skills for locating, understanding, and using health-related information, is associated with various health outcomes through health behaviors and health care service use. While health literacy has great potential for addressing health disparities stemming from the differing educational attainment in diverse populations, knowledge about subpopulations that share the same risk factors is useful. Objective. This study employed a logistic regression tree algorithm to identify subpopulations at risk of limited health literacy in Canadian adults. Design. The nationally representative data were derived from the International Adult Literacy and Skills Survey (n = 20,059). The logistic regression tree algorithm splits the samples into subgroups and fits logistic regressions. Results. Results showed that the subpopulation comprised of individuals 56 years and older, with household income less than $50,000, no participation in adult education programs, and lack of reading activities (i.e., newspaper, books) was at the greatest risk (82%) of limited health literacy. Other identified subgroups were displayed in an easily interpreted tree diagram. Conclusions. Identified subpopulations organized in tree diagrams according to the risk of limited health literacy inform not only intervention programs targeting unique subpopulations but also future health literacy research. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is known to contribute to health disparities in the U.S. and failure to adhere to recommended self-care behaviors is a contributing factor. Intervention programs face difficulties as a result of patient diversity and limited resources. With data from the 2005 Behavioral Risk Factor Surveillance System, this study employs a logistic regression tree algorithm to identify characteristics of sub-populations with type 2 diabetes according to their reported frequency of adherence to four recommended diabetes self-care behaviors including blood glucose monitoring, foot examination, eye examination and HbA1c testing. Using Andersen's health behavior model, need factors appear to dominate the definition of which sub-groups were at greatest risk for low as well as high adherence. Findings demonstrate the utility of easily interpreted tree diagrams to design specific culturally appropriate intervention programs targeting sub-populations of diabetes patients who need to improve their self-care behaviors. Limitations and contributions of the study are discussed. [ABSTRACT FROM AUTHOR]

Purpose of the Study: A novel logistic regression tree-based method was applied to identify fall risk factors and possible interaction effects of those risk factors. Design and Methods: A nationally representative sample of American older adults aged 65 years and older (N = 9,592) in the Health and Retirement Study 2004 and 2006 modules was used. Logistic Tree with Unbiased Selection, a computer algorithm for tree-based modeling, recursively split the entire group in the data set into mutually exclusive subgroups and fit a logistic regression model in each subgroup to generate an easily interpreted tree diagram. Results: A subgroup of older adults with a fall history and either no activities of daily living (ADL) limitation and at least one instrumental activity of daily living or at least one ADL limitation was classified as at high risk of falling. Additionally, within each identified subgroup, the best predictor of falls varied over subgroups and was also evaluated. Implications: Application of tree-based methods may provide useful information for intervention program design and resource allocation planning targeting subpopulations of older adults at risk of falls. [ABSTRACT FROM PUBLISHER]

Research on factors associated with motivation to learn (MtL) is limited, particularly among middle-aged adults and immigrants. This study examines educational attainment, literacy skills, and nativity (foreign-born vs. native-born) as predictors of MtL in middle-aged adults living in the United States. Nationally representative data of middle-aged adults between the ages of 40 and 65 years were obtained from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). Structural equation models were used to assess the validity of the latent MtL construct and to examine the associations with the selected determinants in middle-aged adults. Postsecondary education degrees and higher literacy skills were linked with greater MtL. However, foreign-born individuals had lower MtL than their US-born counterparts. Educators and researchers should be aware of lower educational attainment, limited literacy skills, and being an immigrant as possible demoting factors of MtL, and in turn, barriers to lifelong learning participation among middle-aged adults. [ABSTRACT FROM AUTHOR]

The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education. [ABSTRACT FROM PUBLISHER]

The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults. Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927). Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care ( R = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week. No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients' assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy. [ABSTRACT FROM AUTHOR]