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Objectives: This study investigated the predictors of risk perception and its effect on older adults’ preventive behavior and/or medical care avoidance during the COVID-19 pandemic. Methods: Older respondents (age >50 years) from the MIT COVID-19 Preventive Health Survey reported their social distancing, hand washing, mask wearing, and medical care avoidance between July and October 2020 ( n = 4395). Structural equation models were used. Results: Significant predictors of higher risk perception were female gender, older age, poorer health, city residency, personally knowing someone who had COVID-19, and correct knowledge of vaccine/treatment. Higher risk perception was subsequently associated with higher frequency/probability of practicing preventive behavior and/or avoiding medical care. Knowledge had the strongest path coefficient with risk perception. Discussion: Disseminating correct information to older adults could help them evaluate infection risk accurately. Educational programs on the precautions implemented at clinical settings to ensure patient safety may encourage older adults to seek timely medical care.

Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period.Six waves of longitudinal data from the Health and Retirement Study (2006-2016) were used (Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women's chronic depression and men's emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92,Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions.

China has faced challenges related to the rapid growth of its ageing population, and sleep is one of the public health challenges to this demographic group. This study examines the socio-demographic and behavioural factors associated with status change of sleeping patterns among Chinese older adults, using longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Socio-demographic factors were selected from the 2012 wave of the CLHLS to examine the sleep status change in the 2014 wave. Multivariable logistic and multinomial regressions were used to study older adults’ changes of sleep quality and daily sleep duration. Older adults, 65 years old or above, were selected as study participants. A higher level of education was negatively associated with poor sleep quality and longer sleep duration (>8 hours). Increasing age was positively associated with both shorter and longer sleep duration. Being female was negatively associated with longer sleep duration. However, exercise status, smoking behaviour and alcohol use all were neither positively nor negatively associated with status change of sleeping patterns. Participants’ education, age and gender might be important factors associated with sleep status change. However, the effects of behavioural factors should be studied further. Policy implications and further research directions are discussed based on empirical results.

Background and aims Given the lack of effective therapies and high mortality in acute alcohol-associated hepatitis (AH), it is important to develop rationally designed biomarkers for effective disease management. Complement, a critical component of the innate immune system, contributes to uncontrolled inflammatory responses leading to liver injury, but is also involved in hepatic regeneration. Here, we investigated whether a panel of complement proteins and activation products would provide useful biomarkers for severity of AH and aid in predicting 90-day mortality. Approach and results Plasma samples collected at time of diagnosis from 254 patients with moderate and severe AH recruited from four medical centers and 31 healthy persons were used to quantify complement proteins by enzyme-linked immunosorbent assay and Luminex arrays. Components of the classical and lectin pathways, including complement factors C2, C4b, and C4d, as well as complement factor I (CFI) and C5, were reduced in AH patients compared to healthy persons. In contrast, components of the alternative pathway, including complement factor Ba (CFBa) and factor D (CFD), were increased. Markers of complement activation were also differentially evident, with C5a increased and the soluble terminal complement complex (sC5b9) decreased in AH. Mannose-binding lectin, C4b, CFI, C5, and sC5b9 were negatively correlated with Model for End-Stage Liver Disease score, whereas CFBa and CFD were positively associated with disease severity. Lower CFI and sC5b9 were associated with increased 90-day mortality in AH. Conclusions Taken together, these data indicate that AH is associated with a profound disruption of complement. Inclusion of complement, especially CFI and sC5b9, along with other laboratory indicators, could improve diagnostic and prognostic indications of disease severity and risk of mortality for AH patients.

Background The dietary landscape has changed rapidly in China in the past few decades. This research investigates the associations of older adults’ choices and consumption of staple foods and cooking oils with obesity-related measurements. Methods Panel data were extracted from the Chinese Longitudinal Health Longevity Survey from 3253 older participants with 6506 observations. Ordinary least squares and ordered logistic regression models were estimated with the outcomes of obesity determined by waist circumference (WC) and body mass index (BMI), respectively. Results Older men who consumed wheat had wider WCs (β=2.84 [95% confidence interval {CI} 1.55 to 4.13], p Conclusion Dieticians and nutritionists should design appropriate dietary plans to help reduce obesity and chronic diseases among older Chinese adults. Further clinical trials are needed to continue investigating this topic.

This study assesses the associations between primary sources of insurance coverage and out-of-pocket outpatient and inpatient medical expenses among Chinese older adults. The 2012 and 2014 waves of...

Background & Aims Acute alcoholic hepatitis (AAH) is a major cause of liver-related morbidity and mortality; there are no good blood biomarkers for diagnosis or determining magnitude of cell death. Keratin 18 (KRT18, also called K18), found in epithelial cells, is released from hepatocytes upon death. We investigated whether level of K18 is a better marker of hepatocyte death than standard biomarkers and might be used to identify patients with AAH at risk for death within 90 days. Methods We analyzed data from 173 participants in a large trial performed at 4 medical centers. Participants with AAH were classified as severe (n = 57, model for end-stage liver disease [MELD] scores above 20) or moderate (n = 27, MELD scores from 12 to 19); 38 participants had alcohol use disorder with mild (n = 28) or no liver injury (n = 10); 34 participants had nonalcoholic steatohepatitis; and 17 participants were healthy (controls). We quantified serum levels of K18 using ELISAs and APOPTOSENSE kits. Results Serum level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and the ratio of AST:ALT did not correlate with MELD scores. Patients with alcohol use disorder had higher serum levels of ALT than patients with severe AAH. Levels of K18M65 and K18M30 had statistically significant increases as liver disease worsened, as did the degree of necrosis (ratio of K18 M65:M30). The ratio of K18M65:ALT was increased in serum from patients with AAH compared with controls. Serum levels of K18 identified patients who died within 90 days with greater accuracy than commonly used static biomarkers. Conclusions There is a stronger association between serum level of keratin 18 and amount of hepatocyte death and liver disease severity than for other biomarkers (AST, ALT, and the AST:ALT ratio). The ratio of K18M65:M30 might be used as marker of mechanism of hepatocyte death, and the ratio of K18M65:ALT might be used to distinguish patients with AAH from patients with nonalcoholic steatohepatitis. Serum levels of K18 might be used to identify patients with severe AAH at risk for death. ClinicalTrials.gov identifier # NCT01922895 and NCT01809132 .

The health and social benefits of volunteering behaviours by older adults are well acknowledged. However, few review articles have been concerned with the correlates/dimensions of older adults’ volunteerism. Some focused only on the North American context or reviewed studies only up to 2008. This study reviewed the recent global literature in the past decade about the correlates of older adults’ volunteerism. We carried out a literature search in PsycINFO, Social Services Abstracts, Sociological Abstracts and Google Scholar to identify empirical journal publications about the correlates of older adults’ (age 60+) volunteerism from 2008 to 2019. Among 112 initially eligible papers, 41 were selected. Findings were synthesised using the framework of the Socioecological Model. Existing studies mainly have used quantitative methodologies and were conducted within the context of a single Western country. Motivations included higher education, morale and mentality, previous experiences, social network, community cohesion and organisational management. Major barriers were health and financial constraints. Few studies focused on macro-level correlates. Irrelevant and confounding correlates were also discussed. We suggest practitioners recruit and retain older volunteers by identifying their needs and optimising management within the organisation. Policy makers should create a supportive environment and increase resource accessibility. Future research could conduct cross-cultural comparisons, use diverse methodologies and embrace more correlates, especially at the macro-level.

Scientific research on the benefits of the Mahjong card game and social activity for sleep remains limited among older adults in China, although these two leisure behaviors are common among Chinese older adults. This study aims to examine this topic of interest in a single research effort. Applying panel data from the Chinese Longitudinal Healthy Longevity Survey from 4718 participants, a nationally representative sample, multivariable logistic regressions were performed to investigate the effects of the Mahjong card game and social activity on quality of sleep and recommended hours of sleep duration daily (between 7 and 8 h of sleep) among Chinese older adults. Of the study sample, approximately 62% of older adults reported good quality of sleep, but only 38% of them slept within the recommended range. Non-gamers had lower odds of reporting good quality of sleep (adjusted odds ratio [AOR] = 0.75, 95% CI 0.62, 0.90, p

We examined the effects of cigarette smoking, alcohol consumption, and use of both cigarettes and alcohol on changes in sleep quality and duration among Chinese older adults. Using four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we employed Cox two-state regression models to examine the changes in sleep quality and duration. The results showed the following: (1) Former users (cigarettes and/or alcohol), current alcohol users, current smokers, or users who used both cigarettes and alcohol all reported lower odds of worsening sleep quality (all p

Effective community food and nutrition programs are imperative for supporting older adults health and well-being. This three-part study examined to what extent the innovative congregate nutrition program (CNP), Encore Cafe, and targeted marketing campaign influenced CNP utilization, CNP program satisfaction, and overall CNP impact (e.g., nutritional risk, dietary practices, and loneliness). The Encore Cafe resulted in increases of 386% in meal distribution and 3,164% in CNP participants during a two-year period compared to a 20.8% reduction at traditional meal sites across the state. Total CNP satisfaction (food and dining) was high for both the Encore Cafe and Traditional CNP. Encore Cafe participants maintained their nutritional status and experienced significant reductions in emotional loneliness (p = 0.017) and dietary intake frequencies of processed meat (p = 0.027) compared to non-CNP participants. Utilizing a client-centered approach in marketing and programming for the Encore Cafe shows promising results for improving the utilization and effectiveness of the CNP.

This study examined the gap between need and provision of community services in China and its association with older adults' life satisfaction over time. Longitudinal data from the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014 were used (3 waves, N = 16,199). Respondents reported if they needed nine types of community service and if their community provided such service. Growth curve models analyzed whether individual- and/or province-level characteristics predicted the initial level and/or changes of life satisfaction over time. Results indicated the presence of major unmet service needs in China. Available community services were mismatched with older adults' perceived needs. Unmet service needs were associated with decreased life satisfaction at baseline. However, unmet service needs were not associated with changes in life satisfaction over time. Study findings highlighted the urgent need to optimize service design in accordance with older adults' needs, which ultimately could promote older adults' well-being.

Although mortality due to acute alcoholic hepatitis (AH) correlates with Model for End-Stage Liver Disease (MELD) scores, biomarkers are critically needed to manage this disease. Increases in inflammatory markers and macrophage activation are associated with acute AH and could be potential biomarkers of clinical events and/or mortality. We enrolled 89 clinically diagnosed AH patients in four US academic medical centers. Plasma from AH patients had a significant increase in gut microbial translocation indicators (endotoxin, bacterial 16S ribosomal DNA) and host response indicators (soluble cluster of differentiation 14 [sCD14] and lipopolysaccharide binding protein [LBP]) compared to controls. Patient MELD score and Glasgow Alcoholic Hepatitis score (GAHS) correlated with endotoxin levels. AH patients also had a significant increase in high mobility group protein 1 (HMGB1), a sterile danger signal molecule, and osteopontin (OPN), a multifunctional phosphoprotein involved in neutrophil activation, compared to controls. Increased levels of OPN positively correlated with increasing MELD score, GAHS, and LBP levels. Consistent with these results, AH patients had significantly increased circulating levels of macrophage activation (sCD163 and sCD206) markers compared to healthy controls, and sCD163 and sCD206 significantly and positively correlated with OPN, HMGB1, and LBP levels as well as with MELD score and GAHS. These findings indicate a connection between microbial translocation, immune cell activation, and AH severity. Plasma sCD14, OPN, sCD163, and sCD206 levels were significantly higher in nonsurvivors than survivors. In multivariate regression models, we identified sCD14, sCD163, and OPN as independent predictors of 90-day mortality, infection, and organ failure development, respectively. Conclusion: Our study suggests that sCD14, LBP, OPN, sCD163, and sCD206 are biomarkers to indicate severity and predict clinical outcomes in AH.

This research examined small farmers’ operational choice in converting to organic farming in the Southern region of the United States. A logistic model fitted to survey data from responses of 456 produce growers found the key determinants of the conversion choices of farmers and offered quantitative impacts of the major influential factors retained in the fitted model. Among them, barriers to the conversion were linked to farmer’s age, risk aversion, years of farming, and the lack of education as well as low yield of organic farming; nevertheless, the model also revealed the existence of stimuli reflecting on access to farmers markets, peer exemplars, and operational scale. The confluence of variables retained partially explained a slow but steady conversion to organic farming in the United States. Besides the broad implication for policy making in the agricultural sector, this study found that organic farming was closely tied to small farms and organic farming could be a back road to the future of small US farms.

Hepatocellular death contributes to progression of alcohol-associated (ALD-associated) and non-alcohol-associated (NAFL/NASH) liver diseases. However, receptor-interaction protein kinase 3 (RIP3), an intermediate in necroptotic cell death, contributes to injury in murine models of ALD but not NAFL/NASH. We show here that a differential role for mixed-lineage kinase domain-like protein (MLKL), the downstream effector of RIP3, in murine models of ALD versus NAFL/NASH and that RIP1-RIP3-MLKL can be used as biomarkers to distinguish alcohol-associated hepatitis (AH) from NASH. Phospho-MLKL was higher in livers of patients with NASH compared with AH or healthy controls (HCs). MLKL expression, phosphorylation, oligomerization, and translocation to plasma membrane were induced in WT mice fed diets high in fat, fructose, and cholesterol but not in response to Gao-binge (acute on chronic) ethanol exposure. Mlkl-/- mice were not protected from ethanol-induced hepatocellular injury, which was associated with increased expression of chemokines and neutrophil recruitment. Circulating concentrations of RIP1 and RIP3, but not MLKL, distinguished patients with AH from HCs or patients with NASH. Taken together, these data indicate that MLKL is differentially activated in ALD/AH compared with NAFL/NASH in both murine models and patients. Furthermore, plasma RIP1 and RIP3 may be promising biomarkers for distinguishing AH and NASH.

Up to 40% of patients with severe alcoholic hepatitis (AH) die within 6 months of presentation, making prompt diagnosis and appropriate treatment essential. We determined the associations between serum keratin-18 (K18) and histological features, prognosis, and differential response to prednisolone in patients with severe AH.Total (K18-M65) and caspase-cleaved K18 (K18-M30) were quantified in pretreatment sera from 824 patients enrolled in the Steroids or Pentoxifylline for Alcoholic Hepatitis trial (87 with suitable histological samples) and disease controls.K18 fragments were markedly elevated in severe AH and strongly predicted steatohepatitis (alcoholic steatohepatitis) on biopsy (area under receiver operating characteristics: 0.787 and 0.807). Application of published thresholds to predict alcoholic steatohepatitis would have rendered biopsy unnecessary in 84% of all AH cases. K18-M30 and M65 were associated with 90-day mortality, independent of age and Model for End-stage Liver Disease score in untreated patients. The association for K18-M65 was independent of both age and Model for End-stage Liver Disease in prednisolone-treated patients. Modelling of the effect of prednisolone on 90-day mortality as a function of pretreatment serum K18 levels indicated benefit in those with high serum levels of K18-M30. At low pretreatment serum K18 levels, prednisolone was potentially harmful. A threshold of K18-M30 5 kIU/L predicted therapeutic benefit from prednisolone above this level (odds ratio: 0.433, 95% confidence interval: 0.19-0.95, P = 0.0398), but not below (odds ratio: 1.271, 95% confidence interval: 0.88-1.84, P = 0.199). Restricting prednisolone usage to the former group would have reduced exposure by 87%.In a large cohort of patients with severe AH, serum K18 strongly correlated with histological severity, independently associated with 90-day mortality, and predicted response to prednisolone therapy. Quantification of serum K18 levels could assist in clinical decision-making.

China launched a comprehensive health reform in 2009, as part of the central government&rsquo, s plan to improve its healthcare system. This study investigates the associations of socioeconomic status with receiving adequate healthcare services among Chinese older adults following the 2009 health reform. Using the 6th and the 7th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a repeated cross-sectional study design was adopted (n = 9305). Firth&rsquo, s logistic regression models were used for statistical analysis. In the fully adjusted model, being non-married was negatively associated with adequate healthcare services (adjusted odds ratio (AOR) = 0.68, 95% confidence interval (CI): 0.54, 0.86). Higher levels of income were positively associated with adequate healthcare services (all ps &lt, 0.05). Participants who relied on non-urban social insurance plans all had lower odds of receiving adequate healthcare services (all ps &lt, 0.01), compared with older adults who used the urban employment basic medical insurance (UEBMI). However, disparities regarding education and urban-rural differences were not observed in the full model. As China is pushing for further reforms, vulnerable population groups, such as non-married or more impoverished older adults, should be assisted in receiving adequate healthcare services.

This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted in 2017. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR]1

This study examined the associations of four types of food consumption behaviors (fruits, vegetables, meat, and egg) on sleep-related measurements among Chinese older adults. Fruits, meat, and egg consumption behaviors were positively associated with sleep quality; nevertheless, vegetables consumption was associated only with sufficient sleep duration, but not with sleep quality. Older adults should be aware that sleep quality and duration might be related to their dietary habits. China has faced rapid growth of its older adult population, shifting dietary landscape, and sleep-related problems. However, knowledge regarding the associations of dietary behavior on sleep-related outcomes with longitudinal data remains limited. This study investigates the relationships of dietary habits with sleep quality and duration. Using data from the Chinese Longitudinal Health Longevity Survey (CLHLS), older adults were included in the 9-year span between 2005 and 2014 (age ≥ 60; n = 62,552). Self-reported dietary habits, sleep quality, and sleep duration (hours) were assessed. Four types of dietary behaviors were identified: vegetables, fruits, egg, and meat. Cox proportional hazard models were used to explore the potential association between dietary habits and sleep status. The outcomes were self-reported sleep quality and sufficient sleep duration (7–8 h daily). In the study sample, the median age was 87 years old, and approximately 57.2% of the study participants were female. More than 60% of the older adult population had good quality sleep, and almost 40% of participants slept 7–8 h a day. In the fully adjusted Cox models, daily fruits, meat, and egg consumption were positively associated with sleep quality (all p

Secondhand smoking (SHS) has become a critical challenge in Chinese society, and progress on SHS prevention remains unknown. There is little knowledge targeting Chinese older adults generally to investigate the associations between SHS exposure experiences during earlier life stages and health-related measurements. Using cross-sectional data from a nationally representative data set, the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (

This study examined the impact of the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program Fresh Conversations (FC) on the nutritional risk (NR) of older adults (OAs). A convenience sample of OAs (207 Treatment, 148 Control) completed questionnaires comprised of validated measures to assess NR, barriers to healthy eating self-efficacy (SE), food safety behaviors (FSB), and food security (FS) at three-time points over 9 months. Participants were mostly white (92.4%), older (age 81+ years, 40.1%), widowed (52.4%), and females (75.2%). Independent t-tests identified baseline differences among groups. Analysis of covariance assessed group changes at each time point for each measure. Block regression determined which variables influence baseline NR. Baseline NR risk was significantly predicted by SE (β = 0.21), education (β = 0.19) and age (β = 0.14) (p

Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending community-based nutrition education and physical activity programs. Most were white females aged 60-80 years. The majority (80.1%) were classified as "at NR" or "at possible NR." Participants had "low" lean protein, dairy, and processed meat DIF and "moderate" whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p ≤ .001) and vegetable (p = .021) DIF, age influenced processed meat DIF (p = .001), and gender influenced NR (p = .006), vegetable (p = .022), and processed meat (p = .033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and protein-rich foods to OA at NR.

Non-red meat protein provides essential nutrients to human beings with fewer health burdens. Nevertheless, little is known about the relationships of non-red meat protein sources and flavor preferences with sleeping patterns among the older adults and the oldest-old in China. Using a nationally representative database, the Chinese Longitudinal Healthy Longevity Survey (n = 5241, with 2407 males and 2834 females), older adults’ quality of sleep, daily hours of sleep, and recommended range of sleeping duration (7 to 8 h daily) were studied. Food consumption behaviors included fish, eggs, milk and bean products, nuts, and flavor preferences. Sex-stratified multivariable logistic and ordinary least squares regression models were performed for statistical analyses. Nearly 61% of older adults reported good quality of sleep, but only 39% slept within the recommended hours of sleep daily. In general, less frequent consumption of eggs was associated with lower odds of reporting good quality of sleep among both male and female older adults. Among male participants, monthly consumption of milk products was associated with lower odds of good quality of sleep (Adjusted odds ratio [AOR] = 0.60, 95% CI 0.41, 0.88; p

Background: This preliminary assessment evaluates the patterns of e-cigarette use and self-reported health outcomes in the United States. Methods: Multinomial logistic regressions were (baseline wa...

China has one of the world's largest populations using alcohol. With the trend of increasing alcohol consumption and the rapid growth of its aging population, China has faced imminent public health challenges in the past few decades. This research study aims to investigate determinants related to alcohol consumption behaviors or alcohol dependence among older adults (age ≥60) in China. Using the Chinese Longitudinal Healthy Longevity Survey from 2000 to 2014 waves (

Psychological and physiological stress experienced by astronauts can pose risks to mission success. In clinical settings, gradually increasing stressors help patients develop resilience. It is unclear whether graduated stress exposure can affect responses to acute stressors during spaceflight. This study evaluated psychophysiological responses to potentially catastrophic spaceflight operation, with and without graduated stress exposure, using a virtual reality environment. Twenty healthy participants were tasked with locating a fire on a virtual International Space Station (VR-ISS). After orientation, the treatment group ( n = 10) practiced searching for a fire while exposed to a low-level stressor (light smoke), while the control group ( n = 10) practiced without smoke. In the testing session, both groups responded to a fire while the VR-ISS unexpectedly filled with heavy smoke. Heart rate variability and blood pressure were measured continuously. Subjective workload was evaluated with the NASA Task Load Index, stress with the Short Stress State Questionnaire, and stress exposure with time-to-complete. During the heavy smoke condition, the control group showed parasympathetic withdrawal, indicating a mild stress response. The treatment group retained parasympathetic control. Thus, graduated stress exposure may enhance allostasis and relaxation behavior when confronted with a subsequent stressful condition.

With modern society’s increased pressures, problems arise regarding duration and quality of sleep. Many Chinese seniors report poor quality of sleep. With rapid urbanization, Chinese dietary patterns have shifted dramatically, with vegetables consumption declining rapidly. This research focuses on the associations between fruits and vegetables consumption with basic dietary behaviors and sleeping patterns. Using the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), multinomial logistic regression models predicted older adults’ (age > = 65) quality and duration of sleep. Predictors included fruits and vegetables consumption, types of cooking oil, staple foods, and meat. The mean age of the study sample was around 85 years. Approximately 56% of respondents consumed fresh vegetables daily. A majority of seniors consumed rice as their staple food. Only 14% of seniors consumed fresh fruits daily. Most seniors consumed meat weekly or more frequently. We found that seniors who consumed fruits and vegetables occasionally had lower odds of reporting good quality of sleep [Fruits: AOR (Adjusted odds ratio) = 0.77; Vegetables: AOR = 0.58] compared with daily consumers. Respondents who reported consuming wheat and half rice-half wheat had higher odds of reporting good quality of sleep (Wheat: AOR = 1.52; Half rice-half wheat: AOR = 1.28), compared with seniors who reported rice as their staple food. Chinese public health practitioners and nutritionists should design dietary plans with more frequent consumption of fruits, vegetables, and wheat to help older adults’ overall health including their sleeping patterns.

Background & aims To our knowledge, the interaction between alcohol consumption and PNPLA3 genotype on hepatic steatosis has not been explored in a representative sample. To examine the interaction between alcohol consumption and PNPLA3 genotype on hepatic steatosis in the US adult population. Methods Cross-sectional study of 4,674 adult participants of the Third National Health and Nutrition Examination Survey, Phase 2 (1991-1994) with data on PNPLA3 genotype, self-reported alcohol consumption, ultrasound-defined hepatic steatosis and socio-demographic characteristics. Results In 1991-1994 in the U.S. population, the weighted allele frequency of the G (risk) allele of the rs738409 at PNPLA3 was 25.4%. We confirmed both a J shaped association between alcohol consumption and hepatic steatosis among those with the CC genotype of PNPLA3, and a higher prevalence of hepatic steatosis among those with PNPLA3 gene G variant. We found evidence of an interaction of PNPLA3 G allele presence on the association between moderate alcohol consumption and hepatic steatosis on both the multiplicative (relative prevalence ratio [RPR]=1.95, 95% confidence interval [CI] 1.04-3.65) and additive scales (relative excess risk due to interaction=0.49, 95% CI 0.13-0.85). Compared to never drinkers, moderate alcohol drinking was associated with a 48% decreased risk of hepatic steatosis only among those without PNPLA3 G allele (PR=0.52, 95% CI 0.26-1.05), with no association among those with at least one copy of the PNPLA3 G allele (PR=1.02, 95% CI 0.68-1.54). Conclusions Our results suggest that a highly common and strong genetic susceptibility to liver disease is modifiable by the level of alcohol consumption. Keeping alcohol consumption low may offset genetic predisposition to liver disease.

Background and Objectives: Living arrangement is a crucial factor for older adults’ health. It is even more critical for Chinese older adults due to the tradition of filial piety. With the aging of China’s population, the prevalence of cognitive impairment among older adults has increased. This study examines the association between living arrangement transition and cognitive function among Chinese older adults. Materials and Methods: Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2008–2009, 2011–2012, and 2014), we analyzed data for older adults (age ≥ 65) who lived with other household members and reported good cognitive function or mild cognitive impairment when they participated in the survey. Multistate Cox regression was employed to study changes in cognitive function. Results: Older adults who transitioned to living alone had lower risk of cognitive impairment (hazard ratio (HR) = 0.66, 95% CI: 0.52, 0.83, p &lt, 0.01), compared with those who continued to live with other household members. Moving into an institution was also not associated with cognitive impairment. Conclusions: With older adults’ transition to living alone, public health practitioners or social workers might educate them on the benefits of such a living arrangement for cognitive function.

Recent research has examined the well-being of higher education faculty, but it has typically lacked a theoretical model. The present study used self-determination theory to model the well-being of 581 tenured and tenure-eligible faculty members at a large mid-Western university. Volitional autonomy, perceived competence, and perceived relatedness were hypothesized to partially mediate the relationships between several environmental factors (e.g., administrative support, research support, promotion and tenure support) and faculty well-being (i.e., teaching/service satisfaction and global satisfaction). Results of path analysis indicated that all relations between the environment and teaching/service satisfaction were fully mediated by volitional autonomy and perceived competence, whereas all relations between the environment and global satisfaction were partially mediated by perceived relatedness. These findings highlight the centrality of psychological needs in understanding the relations between the environment and faculty well-being. Additional implications and future directions for research are discussed.

This chapter puts forth a model of student-success–focused policy development at small colleges that elucidates the role of the institutional research (IR) professional, highlighting how the breadth of roles and responsibilities that IR professionals serve at these institutions intersect with traditional training and background.

BACKGROUND China has made major improvements to its health-care system since the early 21st century. However, the effectiveness of preventive care utilization on health-care costs remains limited. This study seeks to understand the effect of preventive care utilization on outpatient and inpatient health-care expenses. METHODS With the use of the Chinese Longitudinal Healthy Longevity Survey with older adults who were 65 years old or above (n = 2828), Tobit regression models were estimated to examine the association of preventive care utilization and expenses with medical treatments. Preventive care utilization in the previous wave was used to predict health-care costs for treatments in the next wave. Propensity score matching was used to reduce potentially confounding factors. FINDINGS Results indicated that preventive care utilization was positively associated with outpatient health care among Chinese older adults (β = 231.8, standard error [SE] = 71.5, P < .01). The association between preventive care utilization and inpatient health-care expenses was not significant. CONCLUSIONS Despite the results from previous studies suggesting that preventive care utilization can help reduce health-care expenses, this study does not support such a claim among Chinese older adults. The long-term association between preventive care utilization and health-care expenses for treatment should be studied further.

BACKGROUND With the rapid growth of the elderly population and public health challenges in China, concerns arise related to disability associated with activities of daily living (ADLs) and alcohol consumption status. This study assesses the relationships of alcohol consumption status with basic daily activities among Chinese older adults. METHODS A total of 5,133 participants aged 60 years or above from three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014) were analyzed. Independent ADL items included bathing, dressing, toileting, indoor moving, continence, and feeding (without others' assistance). Multilevel ordered logistic regression model estimation was used to examine the results of total scores based on the Katz index. Multilevel logistic regression models also were estimated to study each index item separately to examine differences across each of the six ADLs. Additional confirmatory factor analysis (CFA) was performed to examine the validity of the index. RESULTS Preliminary CFA showed that most items had good factor loadings (>0.700), except for continence (0.256) and feeding (0.481). Based on the ordered regression model, former (AOR = 0.412, 95% CI: 0.294, 0.579, p

Objective: This research investigates the associations between smoking frequency and body mass index (BMI) among older adults in China with and without the inclusion of food consumption behaviors. Method: Applying three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014), with 12,312 observations from 4,104 participants, gender-stratified panel ordered logistic regressions were performed. Food consumption included intake frequency and types of fruits, vegetables, staple food, cooking oil, and meat. Results: Among male older adults, more frequent smoking behavior was associated with lower BMI with the inclusion of food consumption behaviors. However, more frequent smoking behavior was not associated with BMI among female participants with the inclusion of food consumption behaviors. Former smoking status was not associated with BMI in all models. Discussion: The findings suggest the need of food consumption behaviors when researchers study the associations between smoking frequency and obesity. Gender gaps also should be considered.

OBJECTIVES: Recent reports indicate US students in higher education experience greater levels of food insecurity than the general populace. Chronic food insecurity can adversely affect health, dietary quality, and academic performance. The study objective was to describe student's food security level and diet, and determine associations with demographic characteristics, BMI, living arrangements, employment, year in school, and campus college. We hypothesized that: 1) students with high food security are consuming less healthy foods because of the price, availability and convenience of unhealthy options; 2) students living on campus are more food secure than those living off campus; 3) students who are employed are more likely to be food insecure than those unemployed. METHODS: An online survey with questions on demographics, food security, dietary intakes, purchasing habits, and shopping patterns was developed. All students in the College of Business and the College of Liberal Arts and Sciences, aged 18–34, were sent a direct email invitation to participate in the Survey Monkey (Palo Alto, CA) survey. RESULTS: Of the 946 responses received, 684 (72.3%) had complete data on the variables of interest. Few meet daily dietary recommendations for fruit and vegetable servings (11%), fiber (27%), and eating less than 36% of total calories from fat (50%). Over 31% of participants reported low or very low food security in contrast to 11.8% nationally. Significant findings include: students who are employed are more likely to be in the low and very low food secure category (P = .006), and those students with a higher BMI had lower food security (P = .030). Students using the university meal plans had higher fat diets than those students not using a meal plan (P = .001). Over 32% of students on campus have not, but are interested in receiving information on budgeting, and 16.2% would like to know who to talk to if they are facing problems accessing enough food. CONCLUSIONS: The majority of Iowa State University students consume too much dietary fat and do not meet fruit/vegetable, or fiber recommendations. There is a need to provide information, resources, and food options to students having difficulty accessing food. FUNDING SOURCES: Partial research support for the project was provided by the Iowa Agriculture and Home Economics Experiment Station, Project Number IOW04002, Ames, Iowa.

Background. The 2013 HIV Organ Policy Equity Act has increased liver transplantation (LT) in HIV+ patients; however, transplant centers may remain reluctant to perform LT in HIV/hepatitis C virus (HCV)-coinfected patients due to inferior outcomes. We aimed to assess how direct-acting antivirals (DAAs) have impacted HIV+/HCV+-coinfected LT recipient outcomes. Methods. national data including 70 125 adult LT recipients between 2008 and 2019 were analyzed. Kaplan-Meier survival analysis and Cox proportional hazards model were used to analyze outcomes. Results. LT for HIV+ individuals increased in the DAA era from 28 in 2014 to 64 in 2019 (23 had HIV+/HCV+ coinfection). In the pre-DAA era, HIV+/HCV+-coinfected LT recipients had an increased risk of graft failure compared with HIV−/HCV−-uninfected LT recipients (hazard ratio [HR], 1.85; P

Background Evidence supports the use of social marketing campaigns to improve nutrition knowledge and reinforce the effects of nutrition education programs. However, the additional effects of parent-focused social marketing with nutrition education have received little attention. Objective Our aim was to assess the impact of the Iowa Nutrition Network's school-based nutrition education program (Building and Strengthening Iowa Community Support for Nutrition and Physical Activity [BASICS]) and the benefits of adding a multichannel social marketing intervention (BASICS Plus) to increase parent-directed communication. Design and intervention A quasi-experimental design with three study conditions compared a school-based nutrition education program (BASICS) with a school-based and social marketing intervention (BASICS Plus) and a no-treatment comparison group. Participants/setting The study included 1,037 third-grade students attending 33 elementary schools and their parents. Main outcome measures Measures included parents' reports of their children's in-home consumption of fruits and vegetables (F/V) and use of low-fat/fat-free milk. Data on F/V were collected using a modified version of the University of California Cooperative Extension Food Behavior Checklist; and data on milk use were collected using two questions from the National Health and Nutrition Examination Survey. Statistical analyses Multilevel, mixed-effect regression models that account for correlation within repeated measures and children within school were used to compare the mean change over time in the outcome variable for one study group with the mean change over time for another study group. Results Children in BASICS increased mean consumption of fruit by 0.16 cups ( P =0.04) compared with children in the comparison group. Children in BASICS Plus increased mean consumption of fruit by 0.17 cups ( P =0.03) and mean consumption of vegetables by 0.13 cups ( P =0.02). Children in BASICS Plus were 1.3 times ( P =0.05) more likely to use low-fat/fat-free milk than children in either the BASICS group or the comparison group. Conclusions Gaining parents' attention and engaging them in healthy eating practices for their children can be a useful way to increase the effectiveness of school-based nutrition education programs. This study demonstrates the benefits of incorporating a parent-focused social marketing campaign in nutrition education interventions.

Heavy drinkers are at risk for a spectrum of histologic alcohol-related liver injury: steatosis, alcoholic steatohepatitis (ASH), alcohol-related fibrosis, and cirrhosis. Alcoholic hepatitis (AH), the clinical entity associated with severe ASH, has high short-term mortality. The standard-of-care therapy, prednisolone, has limited efficacy and many side effects; no other treatment has consistently shown survival benefit. The National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded Alcoholic Hepatitis Consortia carry out translational research on pathophysiologic mechanisms, genetic and environmental risk factors, phase II clinical trials, and development of biomarkers. The consortia members were convened by the National Institutes of Health to address diagnostic criteria and practical issues related to clinical AH research, and to develop a set of common data elements to harmonize ongoing and future trials. This was accomplished through 3 face-to-face meetings of the investigators and representatives of the National Institutes of Health, and subsequent electronic communications over the course of 6 months. Evidence for the recommendations was based on published trials and observational data from several of the consortia members. A draft manuscript was iteratively reviewed by members of the consortia. The goal was to reach agreements on recommendations and definitions that could facilitate trial design, and simultaneously be tested by research groups pooling their data. The recommendations made here are specifically directed to achieve better uniformity in clinical trials, rather than serving as clinical practice guidelines.

Background: This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. Method: A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Results: Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR] >1, p

Background/aims Despite high mortality of alcohol-associated hepatitis, there has been limited advancement in treatment strategies. Defeat Alcoholic Steatohepatitis (DASH) is a multicenter, randomized, double-blind controlled trial whose primary objective was to evaluate the safety and efficacy of a novel combination of 3 drugs targeting different perturbations in AH. Methods Severe AH was diagnosed by liver biopsy or clinical and biochemical criteria and model for end stage liver disease (MELD) score ≥ 20 stratified by MELD scores (20–25 and ≥ 26) and randomized to a combination of an interleukin receptor 1 antagonist, Anakinra(100 mg daily for 14 days) to suppress acute inflammation, pentoxifylline (400 mg three times a day for 28 days) to prevent hepatorenal syndrome, and zinc sulfate (220 mg orally once daily for 6 months) or the standard of care therapy including methylprednisolone 32 mg orally once daily for 28 days. The primary efficacy outcome was the unadjusted log-rank test of the Kaplan-Meier survival estimates for the two treatment groups at 180 days. Results Between July 2012 to March 2018, 500 subjects with severe AH were screened of which 104 subjects were enrolled with MELD score of 25.6 ± 3.2 (20.0–35.0) in the investigational arm and 25.8 ± 4.5 (20.0–40.0) in the standard of care arm. Causes of screen failures included not meeting eligibility criteria (n = 347), declining to participate (n = 39), and other reasons (n = 10). Conclusions Data from the DASH consortium studies will determine if a combination of drugs targeting multiple mechanisms of injury in the severe AH will improve clinical outcomes.

This study examined the regional and geographical disparities in body mass index (BMI) among Chinese older adults. Using panel data from the Chinese Longitudinal Healthy Longevity Survey, participants included 3,740 older adults (age ≥ 65 years) who answered all three waves of the survey (2009–2014). Sex-stratified and multistate Cox regression was used to examine the disparities in BMI change. Results showed that both older males and older females who resided in the central-south had lower rates of weight change from nonobese to obese, compared with those from the east. Older females from urban regions had higher rate of weight change from nonobese to obese, compared with rural participants (hazard ratio [HR]: 1.35, 95% confidence interval [CI] = [1.13, 1.60]; p < .01). However, there were no disparities between urban and rural areas among older males ( p > .05). These results provided practical implications for regional and geographical disparities in BMI among Chinese older adults.

OBJECTIVES We determined relationships between food behaviors and health-risk factors by acculturation among limited-income Hispanic and non-Hispanic white women. METHODS Women aged 18-49 years were recruited from income-based programs in metro-Phoenix, Arizona. Self-administered surveys in English or Spanish included demographics, a 10-item food behavior checklist, health-risk factors, food security, and acculturation. Differences by 4 acculturation/ethnicity categories were assessed with chi-square and analysis of variance (ANOVA). We created a food behavior scale. RESULTS Eighty-two percent self-identified as Hispanic (N = 358), with 45% Hispanic-dominant, 25% bicultural, 12% English-dominant, and 18% non-Hispanic white for acculturation status. Food behavior checklist results showed that English-dominant Hispanic and non-Hispanic white women were more likely to feed their children soon after waking, refrigerate meat/dairy promptly, not add salt to food, smoke cigarettes and be food insecure (p < .001). Education, not acculturation, was a significant predictor of the food behavior scale. BMI did not differ by acculturation, but 33% of Hispanic-dominant Latinas did not know their height and/or weight. These less acculturated Latinas had significantly greater food security, but lacked health insurance and years of education. CONCLUSIONS Program outreach tailored by acculturation that considers educational level is needed to emphasize existing positive behaviors and address knowledge gaps among low socioeconomic women to improve health and reduce disparities.

Objective Recent studies have suggested a critical role for toll-like receptor 4 (TLR4) in the development of alcoholic liver disease. As TLR4 is widely expressed throughout the body, it is unclear which TLR4-expressing cell types contribute to alcohol-induced liver damage. Methods We selectively ablated TLR4 in hepatocytes and myeloid cells. Male mice were fed a liquid diet containing either 5% alcohol or pair-fed a control diet for 4 weeks to examine chronic alcohol intake-induced liver damage and inflammation. In addition, mice were administered a single oral gavage of alcohol to investigate acute alcohol drinking-associated liver injury. Results We found that selective hepatocyte TLR4 deletion protected mice from chronic alcohol-induced liver injury and fatty liver. This result was in part due to decreased expression of endogenous lipogenic genes and enhanced expression of genes involved in fatty acid oxidation. In addition, mice lacking hepatocyte TLR4 exhibited reduced mRNA expression of inflammatory genes in white adipose tissue. Furthermore, in an acute alcohol binge model, hepatocyte TLR4 deficient mice had significantly decreased plasma alanine transaminase (ALT) levels and attenuated hepatic triglyceride content compared to their alcohol-gavaged control mice. In contrast, deleting TLR4 in myeloid cells did not affect the development of chronic-alcohol induced fatty liver, despite the finding that mice lacking myeloid cell TLR4 had significantly reduced circulating ALT concentrations. Conclusions These findings suggest that hepatocyte TLR4 plays an important role in regulating alcohol-induced liver damage and fatty liver disease., Highlights • Hepatocyte TLR4 ablated mice were protected from both chronic and acute alcohol-induced hepatic triglyceride accumulation. • Hepatocyte TLR4 ablated mice showed attenuated inflammation in the fat pad and the circulation after chronic alcohol intake. • Loss of TLR4 in myeloid cells did not affect alcohol-induced development of fatty liver.

The computer is part of the information and communication age, and the Internet today is the most used communication tool. Studies have shown that there is a relationship between problematic Internet use and loneliness. The aim of this study was to investigate the relationship between problematic Internet use sub-scales and loneliness. In this study, data were collected from the college students at an Anatolian University in Turkey. The participants of this study consisted of 392 undergraduates. Of the participants, 43% are male (n = 167) and 57% female (n = 225). The average age for the participants is 22 years old. The Problematic Internet Use Scale and the University of California, Los Angeles (UCLA) Loneliness Scale were used as data collection instruments. In the present study, structural equation modeling (SEM) procedures are used to explore the relationships that exist among the variables. The findings of the study revealed that while university students’ social benefit/social comfort of Internet has a direct effect on their excessive Internet use and negative consequences, it is related to the loneliness level indirectly. In addition, it is seen in the research model that with an increase in the negative consequences of the Internet, the loneliness level was raised. Another result from the study is that when university students’ excessive Internet use increased, their loneliness level decreased., Thecomputer is part of the information and communication age, and the Internet todayis the most used communication tool. Studies have shown that there is a relationshipbetween problematic Internet use and loneliness. The aim of this study was to investigatethe relationship between problematic Internet use sub-scales and loneliness. Inthis study, data were collected from the college students at an Anatolian Universityin Turkey. The participants of this study consisted of 392 undergraduates. Of theparticipants, 43% are male (n = 167) and 57% female (n = 225). The average age forthe participants is 22 years old. The Problematic Internet Use Scale and the Universityof California, Los Angeles (UCLA) Loneliness Scale were used as data collectioninstruments. In the present study, structural equation modeling (SEM) proceduresare used to explore the relationships that exist among the variables. The findings of the study revealed that whileuniversity students’ social benefit/social comfort of Internet has a direct effecton their excessive Internet use and negative consequences, it is related to theloneliness level indirectly. In addition, it is seen in the research model thatwith an increase in the negative consequences of the Internet, the loneliness levelwas raised. Another result from the study is that when university students’ excessiveInternet use increased, their loneliness level decreased.

The three major vascular disorders of the liver include obstruction to venous outflow (Budd-Chiari syndrome [BCS]), obstruction to venous inflow (portal vein thrombosis [PVT]), and obliteration of the small, terminal hepatic venules (sinusoidal obstruction syndrome [SOS]). A thrombotic diathesis is usually responsible for large vessel thrombosis (BCS and PVT), whereas toxic injury to the endothelial cells causes small vessel disease (SOS). If symptomatic, the clinical presentation is characterized by an acute or subacute increase in portal hypertension, with resulting ascites or variceal bleeding. The goal of treatment is to restore blood flow through the liver. Approaches include systemic anticoagulation or placement of a stent or transjugular intrahepatic portosystemic shunt (TIPS). Over time, provided the liver does not fail, thereby necessitating liver transplantation, collateral circulation will usually develop to bypass the area of obstruction in large vessel thrombosis

Alcohol consumption is increasing globally, as are complications of alcohol-related liver disease, including the most severe manifestation, alcoholic hepatitis. Despite the increased prevalence, many patients hospitalized with alcoholic hepatitis are either not diagnosed or inadequately treated leading to significant morbidity and high mortality rates. The purpose of this review is to discuss current challenges in the diagnosis and management of this frequently fatal condition.Recent studies and meta-analyses have improved our understanding of both the evaluation and treatment of alcoholic hepatitis including the diagnostic criteria, appropriate use of glucocorticoids and other therapeutic modalities including novel disease-specific therapeutic agents and indications for considering liver transplantation.Glucocorticoid therapy and enteral nutrition represent the best options for reducing short-term mortality in patients with the severe form of acute alcoholic hepatitis. The efficacy of other medications such as pentoxifylline as currently used does not support a role for use outside clinical trials. While the current management options for alcoholic hepatitis remain insufficient, improvements in diagnosis, determining prognosis and severity and the potential role of novel treatments provides encouragement that outcomes from this devastating condition will improve.