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Introduction Nonoperative management of calcific insertional Achilles tendinopathy (CIAT) may fail in 10–30% of patients, and various operative procedures have been described to manage those. Methods A modified Zadek (dorsal closing wedge) calcaneal osteotomy, without removing the calcific deposits and without detaching the insertion of the Achilles tendon, was performed between November 2016 and December 2017 in 25 consecutive patients (mean age 53.5 years), who were followed for at least 2 years. Results The osteotomies had united at an average of 5 weeks. Two superficial wound infections (8%) were documented. Patients had returned to their normal activities at an average time of 23 ± 7.7 weeks. Three out of four patients, who practised recreational sport activity, returned to their pre-injury level. VAS and VISA-A scores had significantly improved at 3 months postoperatively (p Conclusion The modified Zadek osteotomy, without excision of the intra-tendinous calcification, was safe, and significantly improved clinical outcome in patients with CIAT at 2 years after surgery. Level of evidence IV.

Emerging research has linked psychological well-being with many physiological markers as well as morbidity and mortality. In this analysis, the relationship between components of eudaimonic well-being and serum sphingolipids levels was investigated using data from a large national survey of middle-aged American adults (Midlife in the United States). Health behaviors (i.e., diet, exercise, and sleep) were also examined as potential mediators of these relationships. Serum levels of total ceramides - the main molecular class of sphingolipids previously associated with several disease conditions - were inversely linked with environmental mastery. In addition, significant correlations were found between specific ceramide, dihydroceramide, and hexosylceramides species with environmental mastery, purpose in life, and self-acceptance. Using hierarchical regression and mediation analyses, health behaviors appeared to mediate these associations. However, the link between ceramides and environmental mastery was partially independent of health behaviors, suggesting the role of additional mediating factors. These findings point to sphingolipid metabolism as a novel pathway of health benefits associated with psychological well-being. In particular, having a sense of environmental mastery may promote restorative behaviors and benefit health via improved blood sphingolipid profiles.

Background High-density lipoprotein (HDL) plays a critical role in protection against atherosclerosic and cardiovascular disease (ASCVD). In addition to contributing to clearing excess vascular cholesterol, HDL particles exhibit antioxidative functions, helping to attenuate adverse effects of oxidized low-density lipoproteins. However, these beneficial properties can be undermined by oxidative stress, inflammation, and unhealthy lifestyles and diet, as well as influenced by race and sex. Thus, when assessing cardiovascular risk, it is important to consider multifactorial aspects of HDL, including antioxidant activity rather than just total amount and type of HDL-cholesterol (HDL-C) particles. Because prior research showed HDL peroxide content (HDLperox) can be inversely associated with normal anti-oxidant HDL activity, elevated HDLperox may serve as a bioindicator of HDL dysfunction. Methods In this study, data from a large national cohort of Americans was utilized to determine the impact of sex, race, and diabetes status on HDLperox in middle-aged and older adults. A previously developed cell-free fluorometric method was utilized to quantify HDLperox in serum depleted of apo-B containing lipoproteins. Results In keeping with predictions, white men and diabetics exhibited HDLperox in the atypical upper range, suggestive of less functional HDL. White men had higher HDLperox levels than African American males (13.46 ± 6.10 vs. 10.88 ± 5.81, p p Conclusion This research helps to provide a more comprehensive understanding of HDL function in a racially and metabolically diverse adult population. HDLperox content was significantly different in adults with type 2 diabetes, and distinctive in nondiabetic White males, and suggests other processes account for the higher prevalence of ASCVD among African Americans.

BackgroundBoth compartmental knee arthroplasty (CKA) and open-wedge high tibial osteotomy (HTO) may be used to treat patients older than 50 years of age with advanced compartmental osteoarthritis (OA) secondary to leg axis deformities. A meta-analysis was conducted to clarify the role of open-wedge HTO versus CKA for patients older than 50 years with advanced compartmental knee OA. The present investigation aimed to analyse the clinical outcomes, implant failure and survivorship.MethodsThis meta-analysis was performed in accordance with the PRISMA guidelines. In September 2020, the main online databases were accessed. All clinical trials comparing the outcomes of open-wedge HTO versus CKA for compartmental knee OA were considered. Data analysis was performed through the Review Manager Software 5.3 (the Nordic Cochrane Collaboration, Copenhagen). Implant survivorship was analysed with a Kaplan-Meier (KM) curve that was performed using the STATA/MP software (StataCorp, College Station, TX).ResultsData from 618 (HTO, 307; CKA, 311) patients were collected. Good baseline comparability among patient age, BMI and gender was detected. The Tegner Activity Scale was higher in the CKA group (P= 0.04), as were the Lysholm score (P= 0.001), the International Knee Documentation Committee (P= 0.0001) and the Knee injury and Osteoarthritis Outcome Score (P= 0.05). At a mean follow-up of 5 years, revisions were less in the CKA cohort (OR, 2.27;P= 0.004). The Kaplan-Meier curve evidenced longer implant survivorship in favour of the CKA group (P= 0.01).ConclusionIn patients older than 50 years of age with compartmental knee OA secondary to frontal axis leg deformities, CKA performed better than open-wedge HTO.

Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-Achilles questionnaire score improved from 53.8 preoperatively to 85.3 postoperatively (p .001). After a mean follow-up period of 40.5 months, 41 patients had resumed sporting activities at an average of 3.5 months postoperatively. A sural nerve injury was recorded in 5 patients (10.6%), and all 5 complications occurred during the first 12 cases. As a result, the technique was slightly modified, and no sural nerve neuropathy was observed subsequently. One superficial infection (2.1%) was recorded. Minimally invasive Achilles tendon stripping seems to be an effective, technically simple, and inexpensive treatment of Achilles tendinopathy. Further randomized controlled trials involving more patients are needed to confirm these outcomes.

Introduction Very distal tears of the Achilles tendon are uncommon, and poor quality tendinous tissue of the calcaneal stump can compromise healing. Little has been published about the characteristics and surgical management of such injuries. We present a surgical technique, developed by the senior author, to restore continuity of the gastrosoleus-Achilles tendon-calcaneus complex using a free ipsilateral semitendinosus graft, and clinical outcomes of a case series of 28 consecutive patients. Our hypothesis was that this is a safe technique, and patients can return to pre-injury occupation and athletic activities. Patients and Methods A total of 28 patients (mean age 46 years) underwent minimally invasive reconstruction using a free ipsilateral semitendinosus graft for acute insertional rupture of tendo Achillis. The procedure required two small incisions along the course of the Achilles tendon, and one posteromedial incision at level of the ipsilateral knee to harvest the semitendinosus tendon. Patients were assessed at minimum 2 years (range, 2–2.5 years) following the index procedure. Results The median Achilles tendon Rupture Score (ATRS) at the latest follow-up was 88. Two patients developed a superficial wound infection. All patients returned to their preinjury occupation, whilst 22 out of 28 patients (79%), returned to their preinjury level of physical activity at a mean of 6.7 months after surgery, reporting good or excellent overall satisfaction in 88.5% of cases. Conclusion This minimally invasive technique was safe, and allowed most of patients to return to preinjury daily and sport activities within 9 months from surgery.

A landmark article published in the American Psychologist (Adler et al., 1994) encouraged psychologists to engage in research on socioeconomic inequality and health. Numerous contributions followed to fill in psychosocial and behavioral pathways. Specifically, we review advances on health inequalities research from a large public-use study (Midlife in the United States [MIDUS]). The Great Recession of 2007 to 2009 and its lingering effects are then reviewed to underscore widening inequality in access to education, employment, and income. Two MIDUS national samples of same-aged adults recruited 2 decades apart are then compared to assess historical changes in socioeconomic, physical health, and well-being profiles from the 1990s to postrecession. Despite historical gains in educational attainment over time, we show that indicators of socioeconomic status, health, and well-being are more compromised in the postrecession sample relative to the 1990s sample. Building on these preliminary findings, we elaborate opportunities for further inquiry by the scientific community to examine whether widening socioeconomic inequalities exacerbated by the Great Recession translate to widening health inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Healthy eating is important for physical health. Using large probability samples of middle-aged adults in the United States and Japan, we show that fitting with the culturally normative way of being predicts healthy eating. In the United States, a culture that prioritizes and emphasizes independence, being independent predicts eating a healthy diet (an index of fish, protein, fruit, vegetables, reverse-coded sugared beverages, and reverse-coded high fat meat consumption; Study 1) and not using nonmeat food as a way to cope with stress (Study 2a). In Japan, a culture that prioritizes and emphasizes interdependence, being interdependent predicts eating a healthy diet (Studies 1 and 2b). Furthermore, reflecting the types of agency that are prevalent in each context, these relationships are mediated by autonomy in the United States and positive relations with others in Japan. These findings highlight the importance of understanding cultural differences in shaping healthy behavior and have implications for designing health-promoting interventions.

OBJECTIVES: The purpose of this study was to determine if participant diagnosis, as determined by a health care provider, is associated with dietary supplement (DS) use. DESIGN/SETTING: Surveys from 1255 study participants aged 34–84, part of the Midlife in the US Study (MIDUS 2 Survey) Biomarker Project, were reviewed. Participant data included pharmaceutical use (prescription and overthe- counter medications (OTC)), clinical symptoms and diagnosis, and laboratory results. Associations were calculated between the above participant characteristics and DS use. MAIN OUTCOME MEASURES: Frequency of DS use for physician-reported diagnoses. RESULTS: Overall prevalence of DS use was 32.4%. Participants taking DS were more often female (p = .048), white (p < 0.001), and older (mean age 57 years, p < 0.001). Participants taking DS reported taking more OTC (p < .001) and prescription medications (p=.024), and had an increased number of chronic conditions (p = .004). Participants reporting physician-diagnosed diabetes were significantly less likely to be taking DS (p = .0066), while participants with eye disease (p = .001), high cholesterol (p = 0.041), cancer (p = 0.042), and arthritis (p = 0.044) were more likely to be taking DS than those without those conditions. No difference in DS use was found between patients with and without other identified medical conditions. After adjusting for age, race/ethnicity, and gender, only diabetes remained a significant predictor of decreased DS use (OR 0.588, CI 0.388–0.873, p = .01). CONCLUSIONS: Some physician-reported participant diagnoses were associated, positively or negatively, with DS use.

Current theorizing on socioeconomic status (SES) focuses on the availability of resources and the freedom they afford as a key determinant of the association between high SES and stronger orientation toward the self and, by implication, weaker orientation toward others. However, this work relies nearly exclusively on data from Western countries where self-orientation is strongly sanctioned. In the present work, we predicted and found that especially in East Asian countries, where other-orientation is strongly sanctioned, high SES is associated with stronger other-orientation as well as with self-orientation. We first examined both psychological attributes (Study 1, N = 2,832) and socialization values (Study 2a, N = 4,675) in Japan and the United States. In line with the existent evidence, SES was associated with greater self-oriented psychological attributes and socialization values in both the U.S. and Japan. Importantly, however, higher SES was associated with greater other orientation in Japan, whereas this association was weaker or even reversed in the United States. Study 2b (N = 85,296) indicated that the positive association between SES and self-orientation is found, overall, across 60 nations. Further, Study 2b showed that the positive association between SES and other-orientation in Japan can be generalized to other Confucian cultures, whereas the negative association between SES and other-orientation in the U.S. can be generalized to other Frontier cultures. Implications of the current findings for modernization and globalization are discussed. (PsycINFO Database Record

OBJECTIVE To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy. DESIGN Case series study; Level of evidence, 4. SETTING All tertiary referrals, public, and private healthcare. PATIENTS Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included. INTERVENTION Tendon injection of a mixture of 10 mL of 0.5% bupivacaine hydrochloride, 62 500 international units of aprotinin, and 40 mL of normal saline solution. MAIN OUTCOME MEASURES The Victorian Institute of Sport Assessment-patellar tendon (VISA-P), visual analogue scale, and Roles and Maudsley were assessed at baseline and at the last follow-up. RESULTS The baseline VISA-P score of 46 ± 18.2 (range, 28-75) improved to 75.3 ± 19.2 (range, 68-100) by 15 months (P = 0.003). The mean pain visual analogue scale changed from 91 mm (range, 66-92 mm) before the injection to 28 mm (2-52 mm) (P = 0.01). Of 32 physically active patients, 23 (72%) had returned to sport at the same level practiced before the onset of symptoms. Thirty-five of the 44 patients (80%) rated their condition as good or excellent. CONCLUSIONS High-volume injection at the interface between the deep surface of the patellar tendon and Hoffa body improves in the short-term symptoms and function of the knee. CLINICAL RELEVANCE This procedure is minimally invasive, safe, and effective in the short term in athletes.

Open surgery for patellar tendinopathy allows patients with unilateral and bilateral tendinopathy to return to high levels of physical activity.Two groups of 23 athletes each underwent open surgical exploration for management of patellar tendinopathy. One group suffered from unilateral patellar tendinopathy (unilateral group), and the other group had bilateral (bilateral group) patellar tendinopathy. Maximum voluntary isometric contraction and anthropometric measures were assessed pre-operatively and at an average follow-up of seven years. The Victorian Institute of Sport Assessment (VISA)-P scoring system was also administered; functional outcomes were classified from excellent to poor according to a modification of Kelly's criteria.At the final follow-up, in both groups, VISA-P scores were significantly improved compared with preoperative values, with no intergroup differences. Clinical results were excellent or good in 21 patients in the unilateral and 19 in the bilateral group. Twenty of 23 patients in the unilateral group and 17 of 23 in the bilateral group were still active in sports (p = 0.2). In the unilateral group, at the last follow-up, thigh volume and strength were significantly improved compared with baseline, with significant difference between operated and nonoperated limbs. In the bilateral group, there were no significant differences in thigh volume and strength between the dominant and nondominant limbs both before and after the index procedure.This procedure is not technically demanding and provides a high rate of good and excellent outcomes in the long term.

Individuals with lower social status have been reported to express more anger, but this evidence comes mostly from Western cultures. Here, we used representative samples of American and Japanese adults and tested the hypothesis that the association between social status and anger expression depends on whether anger serves primarily to vent frustration, as in the United States, or to display authority, as in Japan. Consistent with the assumption that lower social standing is associated with greater frustration stemming from life adversities and blocked goals, Americans with lower social status expressed more anger, with the relationship mediated by the extent of frustration. In contrast, consistent with the assumption that higher social standing affords a privilege to display anger, Japanese with higher social status expressed more anger, with the relationship mediated by decision-making authority. As expected, anger expression was predicted by subjective social status among Americans and by objective social status among Japanese. Implications for the dynamic construction of anger and anger expression are discussed.

Previous studies conducted in Western cultures have shown that negative emotions predict higher levels of pro-inflammatory biomarkers, specifically interleukin-6 (IL-6). This link between negative emotions and IL-6 may be specific to Western cultures where negative emotions are perceived to be problematic and thus may not extend to Eastern cultures where negative emotions are seen as acceptable and normal. Using samples of 1044 American and 382 Japanese middle-aged and older adults, we investigated whether the relationship between negative emotions and IL-6 varies by cultural context. Negative emotions predicted higher IL-6 among American adults, whereas no association was evident among Japanese adults. Furthermore, the interaction between culture and negative emotions remained even after controlling for demographic variables, psychological factors (positive emotions, neuroticism, extraversion), health behaviors (smoking status, alcohol consumption), and health status (chronic conditions, BMI). These findings highlight the role of cultural context in shaping how negative emotions affect inflammatory physiology and underscore the importance of cultural ideas and practices relevant to negative emotions for understanding of the interplay between psychology, physiology, and health.

Objectives Several substances are routinely injected in and around tendons. The present study evaluated the long term effects of high volume image guided injection (HVIGI) of normal saline, local anaesthetic and aprotinin in athletic patients with resistant tendinopathy of the main body of the Achilles tendon. Design Case series. Methods The study included a series of 94 athletes (69 men and 25 women; average age 37.5 years, range 22–63) with ultrasound confirmed tendinopathy of the main body of the Achilles tendon. All the patients had not improved after at least three months of conservative management. Patients were injected with 10 mL of 0.5% Bupivacaine Hydrochloride, 25 mg aprotinin, and up to 40 mL of injectable normal saline. We prospectively administered the Victorian Institute of Sport Assessment–Achilles tendon (VISA-A) to assess the short- and long-term pain and functional improvement. Results At baseline ( n = 94), the VISA-A score was 41.7 ± 23.2 (range 11–60), and had improved to 74.6 ± 21.4 (range 71–100) by 12 months ( n = 87) ( p = 0.003), with no significant difference between sexes. Conclusion HVIGI with aprotinin significantly reduces pain and improves function in patients with chronic Achilles tendinopathy in the short- and long-term follow up.

Objective: The objective of this study was to consider race differences in age-trends of autonomic nervous system functioning, using a national data set with a broad age range. Methods: Measures of baseline heart rate variability (HRV) and HRV reactivity were derived from electrocardiograph (ECG) recordings taken at rest and during cognitive stress tasks. Age-trends in HRV and HRV reactivity were compared among 204 African Americans and 833 Whites ages 34 to 83 years ( M = 53.7, SD = 11.4), before and after controlling for socioeconomic status (SES). Results: For HRV-reactivity, age-trends were steeper among African Americans and lower SES participants than Whites and higher SES participants. For baseline HRV, age-trends varied by SES but not race. Discussion: Results relating to HRV-reactivity (but not baseline HRV) were consistent with hypotheses suggesting that African Americans are exposed to higher levels of stress and experience accelerated declines in health across the life span. The relevance of the findings to research on social stress and health disparities is discussed.

Surgical management of chronic Tendo Achillis (TA) ruptures usually requires tendon grafting procedures. Several techniques have been described. We examined the outcome of three different less invasive (incisions length less than 3 cm) tendon transfer techniques in the management of patients with a chronic rupture of the TA.Of 62 patients (39 males and 23 females; mean age 44.8 years; range 29.3-62 years) with chronic TA ruptures managed operatively, 21 patients had a ≥6cm gap and underwent free ipsilateral semitendinosus (ST) graft (21 patients), whereas patients with smaller gaps had either ipsilateral peroneus brevis (PB) (20 patients) or ipsilateral flexor hallucis longus (FHL) transfer (21 patients). Outcome measures included maximum calf circumference, isometric plantar flexion strength, and the Achilles tendon total rupture score (ATRS), preoperatively and at the last follow up. We also recorded the time to return to activities of daily living (ADL) and sports, and the number of single-leg heel lifts on the affected leg at the last follow up, at an average of 35.4 months.Patient characteristics between groups were similar. All outcome measures significantly improved after surgery (p0.001), without differences between the three groups. Return to ADL was possible at an average of 4.5 months. Patients undergoing PB transfer had a slower return to sports compared to the other groups, at 6.9±0.5months versus 6.1±0.8 for the FHL and 5.8±0.6 for the ST groups (t-test p=0.005 and p0.001, respectively). However, 13/14 patients (90%) in the PB group returned to high impact sports, compared to 9/12 (75%) in the FHL and 6/11 (55%) in the ST groups (Fisher's test, p=0.31 and p=0.056, respectively).All three techniques produced significant functional improvement, and return to sports was possible in most patients. This study does not demonstrate a clear advantage of one technique over the others.

Objective High frequency (HF) heart rate variability (HRV) has long been accepted as an index of cardiac vagal control. Recent studies report relationships between HF-HRV and indices of positive and negative affect, personality traits and well-being but these studies generally are based on small and selective samples. Method These relationships were examined using data from 967 participants in the second Midlife in the U.S. (MIDUS II) study. Participants completed survey questionnaires on well-being and affect. HF-HRV was measured at rest. A hierarchical series of regression analyses examined relationships between these various indices and HF-HRV before and after adjustment for relevant demographic and biomedical factors. Results Significant inverse relationships were found only between indices of negative affect and HF-HRV. Relationships between indices of psychological and hedonic well-being and positive affect failed to reach significance. Conclusions These findings raise questions about relationships between cardiac parasympathetic modulation, emotion regulation, and indices of well-being. (PsycINFO Database Record

Background Recently, researchers have proposed that psychological resources might be key concept in explaining the association between social class and health. However, empirical examinations of the extent to which psychological resources to social class in health are still few. Purpose This study investigated mediating effects of selected psychological resources (sense of control, self-esteem, optimism, and neuroticism) on the association of social class [education and subjective social status (SSS)] with current health status (self-rated health and the number of chronic conditions). Method This sample consisted of 1,805 Americans (818 males and 987 females) from the Midlife in the United States (MIDUS) survey, 2004–2006 and 1,027 Japanese (505 males and 522 females) from the Midlife in Japan (MIDJA) survey in Tokyo, Japan, 2008–2010. Information on social class, psychological resources, and health status was obtained using telephone interviews or written questionnaires. Results A mediation analysis was conducted separately for males and females in Japan and the USA. Neuroticism significantly mediated the association of education and SSS with self-rated health and chronic conditions among males and females in both countries, with one exception (not for chronic conditions among Japanese females). Sense of control significantly mediated the association of education and SSS with self-rated health among males and females in both countries. Ashypothesized,self-esteemsignificantlymediatedalmostall of the associations of education and SSS with self-rated health and chronic conditions among men and women in the USA, but very few such associations in Japan. Optimism significantly mediated most associations of social class and health status in both countries, but only among females. Conclusions Overall, the findings underscore important culture- and gender specificity in the ways in which psychosocial resources mediate the links between social class and health.

Although it is commonly assumed that social support positively predicts health, the empirical evidence has been inconsistent. We argue that three moderating factors must be considered: (1) support-approving norms (cultural context); (2) support-requiring situations (stressful events); and (3) support-accepting personal style (low neuroticism). Our large-scale cross-cultural survey of Japanese and US adults found significant associations between perceived support and health. The association was more strongly evident among Japanese (from a support-approving cultural context) who reported high life stress (in a support-requiring situation). Moreover, the link between support and health was especially pronounced if these Japanese were low in neuroticism.

Greater levels of conscientiousness have been associated with lower levels of negative affect. We focus on one mechanism through which conscientiousness may decrease\ud negative affect: effective emotion regulation, as reflected by greater recovery from negative stimuli. In 273 adults who were 35 - 85 years old, we collected self-report measures of personality including conscientiousness and its self-control facet, followed\ud on average 2 years later by psychophysiological measures of emotional reactivity and recovery. Among middle-aged adults (35 - 65 years old), the measures of\ud conscientiousness and self-control predicted greater recovery from, but not reactivity to, negative emotional stimuli. The effect of conscientiousness and self-control on recovery was not driven by other personality variables or by greater task adherence on the part of high conscientiousness individuals. In addition, the effect was specific to negative emotional stimuli and did not hold for neutral or positive emotional stimuli.

This study investigated age differences in multiple aspects of psychological well-being among midlife and older adults in Japan ( N = 482) and the United States ( N = 3,032) to test the hypothesis that older Japanese adults would rate aspects of their well-being (personal growth, purpose in life, positive relations with others) more highly that older U.S. adults. Partial support was found: older adults in Japan showed higher scores on personal growth compared to midlife adults, whereas the opposite age pattern was found in the United States. However, purpose in life showed lower scores for older adults in both cultural contexts. Interpersonal well-being, as hypothesized, was rated significantly higher, relative to the overall well-being, among Japanese compared to U.S. respondents, but only among younger adults. Women in both cultures showed higher interpersonal well-being, but also greater negative affect compared with men. Suggestions for future inquiries to advance understanding of aging and well-being in distinct cultural contexts are detailed.

The pleiotropic cytokine, interleukin-6 (IL-6), has emerged as a key factor in the biology of aging and the physiology of inflammation. Yet much of what we know about the normal functioning of IL-6 has been generated primarily from research on European populations and Americans of European descent. Our analyses compared IL-6 levels in 382 middle-aged and older Japanese to the values found in 1209 Caucasian- and African-Americans from the Midlife in the United States survey (MIDUS). Across the life span from 30 to 80 years of age, mean IL-6 levels were strikingly lower in Japanese individuals. Significantly lower levels of C-reactive protein (CRP) and fibrinogen (FBG) provided confirmatory evidence for a population difference in proinflammatory activity. Because IL-6 release has been associated with obesity, differences in body mass index (BMI) were taken into consideration. Japanese had the lowest, and African-Americans had the highest overall BMIs, but significant group differences in IL-6 persisted even after BMI was included as a covariate in the analyses. Additional support for distinct variation in IL-6 biology was generated when systemic levels of the soluble receptor for IL-6 (sIL-6r) were evaluated. Serum sIL-6r was higher in Japanese than Americans, but was most notably low in African-Americans. Our cytokine data concur with national differences in the prevalence of age-related illnesses linked to inflammatory physiology, including cardiovascular disease. The findings also highlight the importance of broadening the diversity of people included in population studies of health and aging, especially given the relative paucity of information for some Asian countries and on individuals of Asian heritage living in the US.

Objectives: Midlife in the United States (MIDUS) is a national study of health and aging among individuals aged 25 to 74 at baseline (1995-1996). Longitudinal survey assessments (2004-2005), were followed by biological assessments on a subsample (aged 35-85).To facilitate public use, we describe the protocol, measures, and sample. Method: Respondents traveled to clinics for a 2-day data-collection protocol that included fasting blood specimens, 12-hr urine specimen, medical history, physical exam, bone densitometry, and a laboratory challenge (heart rate variability, blood pressure, respiration, salivary cortisol). Results: Response rates for the biological protocol ( N = 1,255) were 39.3% or 43.1% (adjusting for those who could not be located or contacted). Reasons for nonparticipation were travel, family obligations, and being too busy. Respondents were comparable to the recruitment pool on most demographic characteristics and health assessments. Discussion: Strengths of the protocol vis-à-vis similar studies include opportunities to link biological factors with diverse content from other MIDUS projects.

The aim of this study is to evaluate the results of percutaneous repair of an acute AT rupture in diabetic patients.The study included 39 subjects who were operated at our institution. We performed pre-operative evaluations the day of surgery, and report the results of post-operative evaluation at the final follow-up.The Achilles tendon total rupture score had a post-operative average rating of 70.4 ± 13 (range 55-92). All patients were able to fully weight bear on the operated limb by the end of the eighth post-operative week. Eight patients suffered from a superficial infection of the surgical wound.In conclusion, percutaneous repair of the AT is a viable option for diabetic patients.

The current study examined age differences in daily stressors, positive events (uplifts), and their associations with emotional experience among healthy older women. Women (N = 101, 63--93 years old) reported their daily experiences across 1 week. Older age was related to fewer stressors and less frequent negative affect. However, the association between negative affect and age was no longer significant after accounting for the occurrence of daily stressors. Older age was not significantly related to positive affect, although positive uplifts were reported less frequently with age. Findings provide a contextual explanation for emotional experience in very late life, where reduced exposure to stressors partially explains age-related reductions in negative affect. Copyright 2010, Oxford University Press.

Objective: This study investigated whether different psychosocial factors predicted levels of glycosylated hemoglobin (HbA 1c ) over time, after adjusting for covariates and baseline level of HbA 1c . Design: These questions were investigated with a longitudinal sample (N = 97, age = 61-91) of older women without diabetes. HbA 1c levels and psychosocial measures were obtained at baseline and 2-year follow-up. Main Outcome Measures: Coping strategies, positive affect, medical history, and health behaviors were assessed using self-administered questionnaires. HbA 1c were obtained during the respondents' overnight stay at the General Clinical Research Center (GCRC) at the University of Wisconsin-Madison. Results and Conclusion: Regression analyses showed that higher levels of problem-focused coping, venting, and positive affect predicted lower levels of HbA 1c , after controlling for baseline HbA 1c and sociodemographic and health factors. Furthermore, positive affect was found to moderate the effects of problem-focused coping (active, instrumental social support, suppressing competing activities). The pattern of interaction showed that the adverse effects of low problem-focused coping on cross-time changes in HbA 1c were amplified among those who also had low levels of positive affect.

The objective of the study was to investigate how self-enhancing evaluations, obtained via positive social comparisons and reflected appraisals, were related to mental health in a later life transition. The sample consisted of 266 women who were interviewed once before and 3 times after the experience of community relocation. Results extended prior findings suggesting the dynamic impact of self-enhancing evaluative processes on psychological well-being and depressive symptoms. Additional analyses showed evidence for reverse causality, that is, that mental health also influenced self-evaluative processes. This study underscores the significance of holding a positive view of self vis-à-vis others in negotiating life challenges as well as the reciprocal influence of well-being on social self-evaluative processes.

Expression of anger is associated with biological health risk (BHR) in Western cultures. However, recent evidence documenting culturally divergent functions of the expression of anger suggests that its link with BHR may be moderated by culture. To test this prediction, we examined large probability samples of both Japanese and Americans using multiple measures of BHR, including pro-inflammatory markers (interleukin-6 and C-reactive protein) and indices of cardiovascular malfunction (systolic blood pressure and ratio of total to HDL cholesterol). We found that the link between greater expression of anger and increased BHR was robust for Americans. As predicted, however, this association was diametrically reversed for Japanese, among whom greater expression of anger predicted reduced BHR. These patterns were unique to the expressive facet of anger and remained after we controlled for age, gender, health status, health behaviors, social status, and reported experience of negative emotions. Implications for sociocultural modulation of bio-physiological responses are discussed.

Objective This article addresses the question of biological pathways through which social integration and support may affect morbidity and mortality risks. A new concept of cumulative biological risk, allostatic load, is used to test the hypothesis that social experiences affect a range of biological systems. Data from two community-based cohorts are examined to evaluate the consistency of findings across two different age groups. Methods One cohort included older adults aged 70 to 79 years (N = 765); the other cohort included persons aged 58 to 59 years (N = 106). Allostatic load was assessed using identical protocols in the two cohorts. Measures of social experience were similar but not identical, reflecting levels of social integration and support for the older cohort vs. childhood and adult experiences of loving/caring relationships with parents and spouse for the younger cohort. Gender-specific analyses were examined to evaluate possible gender differences in patterns of association. Results In the younger cohort, positive cumulative relationship experiences were associated with lower allostatic load for men and women. In the older cohort, men who were more socially integrated and those reporting more frequent emotional support from others had lower allostatic load scores; similar but nonsignificant associations were seen for women. Conclusions Evidence from two cohorts provides support for the hypothesis that positive social experiences are associated with lower allostatic load. These findings are consistent with the hypothesis that social experiences affect a range of biological systems, resulting in cumulative differences in risks that in turn may affect a range of health outcomes.

Objective: To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life. Design: Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. Source of Sample: Records from two Seattle hospitals. Patients: Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level. Main Outcome Measures: The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form. Results: Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables. Conclusions: The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.

Background: Achilles tendon ruptures represent more than 40% of all tendon ruptures requiring surgical management. About 20% of acute Achilles tendon tears are not diagnosed at the time of injury and become chronic, necessitating more complicated management than fresh injuries. Several techniques for the reconstruction of chronic tears of the Achilles tendon have been described, but the superiority of one technique over the others has not been demonstrated. Hypothesis: Mini-invasive reconstruction of the Achilles tendon, with a gap lesion larger than 6 cm, using the ipsilateral free semitendinosus tendon graft will result in improvement of the overall function with a low rate of complications. Study Design: Case series; Level of evidence, 4. Methods: Between 2008 and 2010, the authors prospectively enrolled 28 consecutive patients (21 men and 7 women; median age, 46 years) with chronic closed ruptures of the Achilles tendon who had undergone reconstruction with a free semitendinosus tendon graft. They assessed the Achilles tendon Total Rupture Score (ATRS), maximum calf circumference, and isometric plantarflexion strength before surgery and at the last follow-up. Outcome of surgery and rate of complications were also recorded. The median follow-up after surgery was 31.4 months. Results: The overall result of surgery was excellent/good in 26 (93%) of 28 patients. The ATRS improved from 42 (range, 29-55) to 86 (range, 78-95) ( P < .0001). In the operated leg, the maximum calf circumference and isometric plantarflexion strength were significantly improved after surgery ( P < .0001); however, their values remained significantly lower than those of the opposite side ( P < .0001). All patients were able to walk on tiptoes and returned to their preinjury working occupation. No infections were recorded. Conclusion: Mini-invasive reconstruction of the Achilles tendon, with a gap lesion larger than 6 cm, using the ipsilateral free semitendinosus tendon graft provides a significant improvement of symptoms and function, although calf circumference and ankle plantarflexion strength do not recover fully.

Background: Less-extensive and gentler exposure and dissection of deep soft tissues could reduce the times of recovery and rehabilitation after Achilles tendon reconstruction. Hypothesis: A minimally invasive semitendinosus autologous graft reconstruction of the Achilles tendon preserves skin integrity and reduces wound breakdown. Study Design: Case series; Level of evidence, 4. Methods: A total of 26 patients underwent minimally invasive semitendinosus autologous graft reconstruction for chronic ruptures to the Achilles tendon. Patients underwent a comparison of preoperative versus postoperative maximum calf circumference and isometric plantarflexion strength and evaluation of postoperative complications. The Achilles Tendon Total Rupture Score (ATRS) was administered at the final follow-up appointment. Results: All patients were reviewed at an average of 8.2 years (range, 7-10 years) from surgery. No patient was lost to follow-up. At final follow-up, the maximum calf circumference was significantly higher than preoperatively but significantly lower than the contralateral side. The isometric plantarflexion strength in the operated leg was lower than in the uninjured one. The mean ATRS was 88. Two patients developed a superficial wound infection, both healing within 2 months from the index surgery after systemic antibiotics and local dressings. One patient developed scar adhesion to the distal wound. All patients returned to their preinjury working occupation; 22 patients returned to their preinjury level of activity at a mean of 6.7 months after surgery. Conclusion: This technique is minimally invasive, is safe, and allows most of the patients to return to preinjury daily and sport activities within 9 months from surgery.

A laboratory study was performed to evaluate the histopathological features of the macroscopically intact portion of the Achilles tendon in patients undergoing surgery for an acute rupture of the Achilles tendon. Tendon samples were harvested from 29 individuals (21 men, 8 women; mean age: 46 ± 12) who underwent repair of an Achilles tendon tear tear, and from 11 male patients who died of cardiovascular events (mean age: 61). Three pieces of tendon were harvested: at the rupture site, 4 cm proximal to the site of rupture, 1 cm proximal to the insertion of the Achilles tendon on the calcaneum. Slides were assessed using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. Intra-observer reliability of the subscore readings was calculated. The pathological features were significantly more pronounced in the samples taken from the site of rupture than in the samples taken proximally and distal to it (0.008 < P < 0.01). There were no significant differences in the mean pathologic sum-scores in the samples taken proximally and distal to the site of rupture. Unruptured Achilles tendons, even at an advanced age, and ruptured Achilles tendons are clearly part of two distinct populations, with the latter demonstrating histopathological evidence of failed healing response even in areas macroscopically normal.

The purpose of this investigation was to examine changes in the sleep quality of older women over time and to determine whether dimensions of psychological well-being, health (subjective health and number of illnesses), and psychological distress (depression and anxiety) predict these changes. A secondary analysis was conducted using a longitudinal sample of aging women (Kwan, Love, Ryff, & Essex, 2003). Of 518 community-dwelling elderly women in the parent study, 115 women (baseline M age = 67, SD = 7.18) with data at baseline, 8 years, and 10 years were used for this investigation. Participants completed self-administered questionnaires and participated in in-home interviews and observations. Growth curve modeling (GCM) was used to examine the overall linear trajectories of sleep quality. Growth mixture modeling (GMM) was used to examine whether there were different patterns of change in sleep quality over time and to examine baseline predictors of each pattern. Sleep quality declined over time but not for all women. Two distinctly different sleep patterns emerged: good but declining sleep quality (GS) and disrupted sleep (DS) quality. Higher psychological well-being (positive relations with others, environmental mastery, personal growth, purpose in life, and self-acceptance), fewer illnesses, and lower depression scores at baseline predicted reduced odds for membership in the DS group. Future research is needed to examine whether interventions focused on maintaining or enhancing psychological well-being could minimize later life declines in sleep quality.

The effect of early enteral nutrition on length of stay (LOS) in hospitalized surgical patients has been previously documented. In this study, a sample of a large medical population (stroke patients) was examined to determine if early enteral nutrition affected LOS. A retrospective review of the medical records of nonsurgical stroke patients receiving enteral nutrition, discharged between January 1, 1988 and January 31, 1991, was undertaken. Time to initiation of enteral feeding and LOS were recorded. In patients fed within 72 hours of admission (N = 20), LOS was 20.14 (SD 12.87) days. The LOS for patients fed later than 72 hours from the time of admission (N = 32) was 29.76 (SD 20.05) days. The difference between the groups in LOS was statistically significant (p = 0.036). Although further study is warranted, we concluded that early enteral nutrition may be a factor in shortening LOS in stroke patients.

Objective: To investigate whether socioeconomic status and psychological well-being (eudaimonic and hedonic aspects) predicted nondiabetic levels of glycosylated hemoglobin (HbA1c) over time, after adjusting for covariates and baseline level of HbA1c. Methods: These questions were investigated with a longitudinal sample (n = 97; age = 61–91 years) of older women without diabetes. Socioeconomic status, well-being, and health behaviors were assessed using self-administered questionnaires. Fasting blood samples for assays of HbA1c were obtained before 7 AM during the respondents’ overnight stay at the General Clinical Research Center at the University of Wisconsin-Madison. All measurements were obtained at baseline and 2-year follow-up. Results: Regression analyses showed that higher income and positive affect predicted lower levels of HbA1c, after controlling for baseline HbA1c and health factors. Additionally, three well-being measures (purpose in life, personal growth, and positive affect) moderated the relationship between income and HbA1c. Conclusion: These results suggest that psychological well-being and socioeconomic status interact in important ways in influencing nondiabetic glucose metabolism.

Objective: To test the hypothesis that socioeconomic status (SES) would be associated with sleep quality measured objectively, even after controlling for related covariates (health status, psychosocial characteristics). Epidemiological studies linking SES and sleep quality have traditionally relied on self-reported assessments of sleep. Methods: Ninety-four women, 61 to 90 years of age, participated in this study. SES was determined by pretax household income and years of education. Objective and subjective assessments of sleep quality were obtained using the NightCap sleep system and the Pittsburgh Sleep Quality Index (PSQI), respectively. Health status was determined by subjective health ratings and objective measures of recent and chronic illnesses. Depressive symptoms and neuroticism were quantified using the Center for Epidemiological Studies Depression Scale and the Neuroticism subscale of the NEO Personality Inventory, respectively. Results: Household income significantly predicted sleep latency and sleep efficiency even after adjusting for demographic factors, health status, and psychosocial characteristics. Income also predicted PSQI scores, although this association was significantly attenuated by inclusion of neuroticism in multivariate analyses. Education predicted both sleep latency and sleep efficiency, but the latter association was partially reduced after health status and psychosocial measures were included in analyses. Education predicted PSQI sleep efficiency component scores, but not global scores. Conclusions: These results suggest that SES is robustly linked to both subjective and objective sleep quality, and that health status and psychosocial characteristics partially explain these associations. Key words: socioeconomic status, sleep, health, neuroticism.

Objective: This study tested the hypothesis that psychological well-being would predict lower plasma levels of inflammatory factors in aging women. Design: One hundred thirty-five women ages 61-91 years (M = 74.5 years) participated in this study. After completing self-administered questionnaires in their homes, participants stayed overnight at the General Clinical Research Center (GCRC) at the University of Wisconsin-Madison. Blood samples for cytokine analyses were obtained in participants' homes after the GCRC visit. Main Outcome Measures: Psychological well-being and ill-being, history of health problems, and health behaviors were assessed via self-administered questionnaires. Detailed medical history and concurrent health measures were obtained during the GCRC stay. Enzyme-linked immunosorbent assays were used to determine interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) concentrations in plasma. Results and Conclusion: Regression analyses showed that plasma IL-6 levels were lower in women scoring higher on positive relationships, whereas sIL-6R levels were lower in women scoring higher on purpose in life, even after a variety of sociodemographic and health factors were controlled. These outcomes, combined with the absence of significant links with other measures of well-being and ill-being, suggest selective patterns of association between later life inflammatory processes and psychological factors, particularly those focused on positive ties with others and purposeful engagement.

Background: Increasingly, researchers attend to both positive and negative aspects of mental health. Such distinctions call for clarification of whether psychological well-being and ill-being comprise opposite ends of a bipolar continuum, or are best construed as separate, independent dimensions of mental health. Biology can help resolve this query – bipolarity predicts ‘mirrored’ biological correlates (i.e. well-being and ill-being correlate similarly with biomarkers, but show opposite directional signs), whereas independence predicts ‘distinct’ biological correlates (i.e. well-being and ill-being have different biological signatures). Methods: Multiple aspects of psychological well-being (eudaimonic, hedonic) and ill-being (depression, anxiety, anger) were assessed in a sample of aging women (n = 135, mean age = 74) on whom diverse neuroendocrine (salivary cortisol, epinephrine, norepinephrine, DHEA-S) and cardiovascular factors (weight, waist-hip ratio, systolic and diastolic blood pressure, HDL cholesterol, total/HDL cholesterol, glycosylated hemoglobin) were also measured. Results: Measures of psychological well-being and ill-being were significantly linked with numerous biomarkers, with some associations being more strongly evident for respondents aged 75+. Outcomes for seven biomarkers supported the distinct hypothesis, while findings for only two biomarkers supported the mirrored hypothesis. Conclusion: This research adds to the growing literature on how psychological well-being and mental maladjustment are instantiated in biology. Population-based inquiries and challenge studies constitute important future directions.

This study examined the interplay of social engagement, sleep quality, and plasma levels of interleukin-6 (IL-6) in a sample of aging women ( n = 74, aged 61-90, M age = 73.4). Social engagement was assessed by questionnaire, sleep was assessed by using the NightCap in-home sleep monitoring system and the Pittsburgh Sleep Quality Index, and blood samples were obtained for analysis of plasma levels of IL-6. Regarding subjective assessment, poorer sleep (higher scores on the Pittsburgh Sleep Quality Index) was associated with lower positive social relations scores. Multivariate regression analyses showed that lower levels of plasma IL-6 were predicted by greater sleep efficiency ( P < 0.001), measured objectively and by more positive social relations ( P < 0.05). A significant interaction showed that women with the highest IL-6 levels were those with both poor sleep efficiency and poor social relations ( P < 0.05). However, those with low sleep efficiency but compensating good relationships as well as women with poor relationships but compensating high sleep efficiency had IL-6 levels comparable to those with the protective influences of both good social ties and good sleep.

This study investigates the influence of personality on adjustment to a particular life transition, community relocation. Participants were 285 women (average age = 69.5) who were interviewed once before they moved, and then multiple times after the move. Within the context of this multiwave design, personality traits were used to predict changes in depressive symptoms (DS) and self-esteem (SE) across the move. Neuroticism and Openness to Experience predicted increases in DS over time, whereas Extraversion and Openness predicted increases in SE. Stressful reactions to the move and sense of mastery about the move partially mediated these effects. The study documents the dynamic influence of personality on positive and negative aspects of adjustment and investigates differing routes through which such effects occur.

Background: Farmers are at increased risk of contracting tetanus. However, no difference in immunity to tetanus has been reported between rural and urban dwellers in large epidemiological studies. We hypothesized that tetanus antibody concentrations would be lower in farmers than in nonfarmers within the rural population. Methods: We recruited 102 adult subjects attending an agribusiness trade show who identified themselves as farmers in Wisconsin. The nonfarmer group (n = 120) was composed of adults attending the agribusiness show who were not engaged in farming or were participating in another research study.1 Concentrations of antibody to tetanus toxin (antiTT) in sera were measured by an enzyme-linked immunosorbent assay (IBL, Hamburg). AntiTT levels of >0.15 IU/mL were considered protective. Results: The antiTT concentrations for the farmer population (median = 2.74 IU/mL) were much higher than those for the nonfarmer group (median = 1.82 lU/mL) (P

This article focuses on the variability in well-being of 102 women in continuous recovery from addiction for 1 to 5 years. Univariate and bivariate analyses of cross-sectional data on recent depressive symptomatology, and psychosocial stress and coping strategies before and during recovery yielded the following findings: (a) Nearly a third of the sample reported scores above the 16-point cut-off on the Center for Epidemiologic Studies Depression Scale, indicating risk for depression; (b) over half had a history of diagnosed depression; (c) perceived stress in 16 life domains significantly decreased from prerecovery to recovery; (d) by recovery, participants significantly increase their use of positive strategies, but they continued use some negative ones; and (e) risk for high depressive symptomatology was greatest among those who were married or cohabiting, had a history of clinical of depression, high perceived stress in areas of money and emotional and physical health. Findings are discussed in terms of their implications for treatment and aftercare.

An accurate and reliable method of determining resting energy expenditure in the critical care setting is crucial because inadequate caloric intake and excessive caloric intake are both associated with a number of complications. Energy requirements were determined by three different methods in a group of 25 post-cardiac surgery patients in the intensive care unit. Patients were intubated and had a thermodilution pulmonary artery catheter in place. The first method measured resting energy expenditure by indirect calorimetry. For the second method, the results of blood gases drawn at the same time that indirect calorimetry was measured were used in the Fick equation. In the third method, a registered dietitian assessed each patient by using the Harris-Benedict equation with stress factor modification. Indirect calorimetry was considered the standard with which the other two methods were compared. The results showed that, compared with calorimetry, both the Fick equation and the Harris-Benedict equation underestimated resting energy needs. Statistically, only the difference between the Fick equation method and indirect calorimetry was significant. Clinically, however, both methods seem to have applicability.

Data provided by case managers in community support programs are used to analyze the problems of families providing shelter to mentally ill relatives. Factors affecting complaints in 345 family households are contrasted with factors leading to complaints in a subsample of 622 other residential alternatives. Behavioral problems are the best predictors of complaints from all households regardless of type, but some causal factors identified are unique to family residences, notably failure to perform household chores and infrequently socializing with friends. Active and passive rule violations, encompassing both do's and don'ts, are more important than clinical history and social background in understanding complaints.

Periodic parenteral hyperalimentation, the interruption of feeding for a period of time each day, parallels the fasted vs fed state in the meal eater. The fasted state appears to be more physiologic and seems to be associated with an increase of visceral proteins. Intravenous hyperalimentation data that have been published seem to confirm this fact. The purpose of this study was to compare the effect of continuous enteral hyperalimentation and interrupt enteral hyperalimentation on the visceral protein compartment. Two groups of 10 afebrile matched control patients (group 1) were on continuous enteral hyperalimentation for 19 +/- 6 days with no improvement in serum albumin or serum transferrin levels. No changes were made in the feeding schedules of 10 of the patients. Feeding schedules of the other 10 patients were changed to an 8-hr interrupt enteral hyperalimentation with calories, protein, and volume being provided remaining the same. Repeat serum albumin and transferrin levels were obtained after 10 days. There was a significant increase in albumin and transferrin levels (p less than 0.005) in those patients changed to an interrupt feeding schedule.

As life expectancy increases, so do the problems of the elderly population. One major problem is that of protein calorie malnutrition; another is the susceptibility of this population to pressure sores. The purpose of this study was to determine if a correlation exists between deteriorating nutritional status and the development of pressure sores. The nutritional status of 232 nursing home patients (mean age 72.9 +/- 12 years) was determined using biochemical and anthropometric measurements. Overall, the incidence of some degree of malnutrition was 59%. Seventeen of the patients were found to have pressure sores and were all malnourished. When classified as mild, moderate, or severe malnutrition, the patients with pressure sores were in the severe group. There was a significant difference (P less than .001) between the nutritional status of pressure sore patients and the malnourished patients. It appears that the development of pressure sores correlates with nutritional deficiencies. The authors' findings suggest a need for more aggressive nutritional support in the elderly, especially those with pressure sores.