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In any stage of life, humans crave connection with other people. In midlife, transitions in social networks can relate to new leadership roles at work or becoming a caregiver for aging parents. Previous neuroimaging studies have pinpointed the medial prefrontal cortex (mPFC) to undergo structural remodelling during midlife. Social behavior, personality predisposition, and demographic profile all have intimate links to the mPFC according in largely disconnected literatures. Here, we explicitly estimated their unique associations with brain structure using a fully Bayesian framework. We weighed against each other a rich collection of 40 UK Biobank traits with their interindividual variation in social brain morphology in ~10,000 middle-aged participants. Household size and daily routines showed several of the largest effects in explaining variation in social brain regions. We also revealed male-biased effects in the dorsal mPFC and amygdala for job income, and a female-biased effect in the ventral mPFC for health satisfaction.

Objectives: Our goal was to evaluate the outcomes of fenestrated thoracic endovascular aortic repair of thoracic aortic lesions involving the distal aortic arch using single physician-modified stent grafts., Methods: This single-centre, retrospective study included 58 consecutive patients (mean age, 57 ± 14 years; 11 women) who underwent fenestrated thoracic endovascular aortic repair for thoracic aortic pathologies involving the distal aortic arch using single physician-modified stent grafts between November 2015 and December 2018. Indications included complicated acute type B dissection or intramural haematoma with an unfavourable proximal landing zone (n = 49), type Ia endoleak subsequent to thoracic endovascular aortic repair due to acute type B dissection (n = 1) and distal arch degenerative aneurysms <15 mm from the left subclavian artery (n = 8)., Results: The technical success rate was 94.8%. The 30-day mortality was 1.7%, and the perioperative ischaemic stroke rate was 1.7%. The incidence of perioperative complications was 10.3%. At a mean follow-up of 26.3 months (range, 7-44), all target vessels were patent. All-cause mortality was 5.2%. Estimated 1-, 2- and 3-year survival was 98.3 ± 1.7%, 96.4 ± 2.5% and 93.2 ± 3.9%, respectively., Conclusion: The single fenestrated stent graft technique is feasible and effective for endovascular repair of thoracic aortic pathologies involving the distal aortic arch., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Development is a cumulative, lifelong process, but strikingly little is known about development in midlife. As a consequence, many misconceptions exist about the nature of midlife and the developmental milestones and challenges faced by middle-aged adults. We first review dominant views and empirical research that has debunked false narratives. Next, we discuss major opportunities and challenges of midlife. This includes the unique constellation of roles and life transitions that are distinct from earlier and later life phases as well as shifting trends in mental and physical health and in family composition. We additionally highlight the importance of (historical shifts in) intergenerational dynamics of middle-aged adults with their aging parents, adult children, and grandchildren; financial vulnerabilities that emerge and often accrue from economic failures and labor market volatility; the shrinking social and health care safety net; and the rising costs of raising children. In doing so, we discuss issues of diversity and note similarities and differences in midlife experiences across race or ethnicity, sexual orientation, and socioeconomic status. We consider midlife as a pivotal period that includes a focus on balancing gains and losses, linking earlier and later life periods, and bridging generations. Finally, we propose possibilities for promoting reversibility and resilience with interventions and policy changes. The suggested agenda for future research promises to reconceptualize midlife as a key period of life, with a concerted effort to focus on the diversity of midlife experiences in order to meet the unprecedented challenges and opportunities in the 2020s and beyond. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Purpose: Pre-operative anaemia treatment has been associated with reduced morbidity in joint arthroplasty. This study examined the impact of a surgical prescription of epoetin (EPO) in contemporary total hip arthroplasty (THA)., Methods: We conducted a comparative study in a series of 1402 primary THAs performed in patients all having a pre-operative haemoglobin (Hb) level documented four to eight  weeks before THA surgery. In group A (647 hips), one subcutaneous injection of 40,000 IU EPO once a week for four weeks was prescribed at the discretion of anaesthetist during the pre-operative visit in patients with pre-operative Hb between 10 and 13 g/dl. In group S comprising the remaining 755 hips, an amended EPO therapy including two  injections of 20,000 to 40,000 IU was prescribed by the surgeon in patients with Hb less than 12 g/dl deemed at high risks to be transfused following THA. Primary study endpoint was the bleeding index (BI)., Results: EPO therapy was delivered in 43 patients (6.7%) in group A and in 26 patients (3.4%) in group S (p = 0.006). The mean total dose of EPO administrated was 115,349 IU in group A versus 75,200 IU in group S (p < 0.001). The mean BI were 2.7 ± 1.0 in group A and 2.8 ± 1.0 g/dl in group S (p = 0.375). No patient was blood-transfused up to post-operative day seven in group S versus five patients in group A (p = 0.021)., Conclusions: The amended protocol does not lead to increased peri-operative bleeding. Advances in intra-operative methods to reduce the bleeding allow changing indications of EPO in patients undergoing THA with a low level of Hb.

Background: Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men (MSM). A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM. Pay-it-forward offers an individual a gift (e.g., a free test) and then asks the same person if they would like to give a gift to another person. This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms - a pay-it-forward arm, a pay-what-you-want arm, and a standard of care arm., Methods: Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing. Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization. Eligible participants will be born biologically male, aged 16 years or older, reporting previous anal sex with another man, having never participated in the pay-it-forward program, without previous gonorrhea and chlamydia testing in the past 12 months, and residing in China. Following a cluster randomized design, every cluster of ten participants will be randomly allocated into one of three arms: (1) a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate ("pay it forward") toward testing for future testers; (2) a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test; (3) a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing. The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records. Secondary outcomes include incremental cost per test, incremental cost per diagnosis, community connectedness, and social cohesion. Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95% confidence intervals with a margin of 20% increase defined as superiority., Discussion: This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia. We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward. Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities., Trial Registration: ClinicalTrials.gov, NCT03741725 . Registered on 12 November 2018.

Objectives: Childhood abuse has long-term negative effects on adult psychological well-being. This study examined whether and how adults with a history of childhood abuse may experience poor psychological functioning partly due to aspects of current family relationships., Method: We estimated multilevel mediation models using 3 waves of longitudinal data from 3,487 participants in the study of Midlife Development in the United States. Outcomes measured included negative affect, life satisfaction, and psychological well-being. We included aspects of family relationships as mediators: perceived support, perceived strain, frequency of contact, and hours of providing instrumental and emotional support., Results: Multilevel mediation models showed that childhood verbal and physical abuse negatively affected diverse aspects of family relationships in later adulthood (i.e., less perceived support, more perceived strain, less frequent contact, and fewer hours of providing instrumental support). We also found that less perceived support and more family strain significantly mediated the associations between childhood abuse and all 3 psychological functioning outcomes., Discussion: Childhood abuse appears to hinder perceived availability of family support in adulthood, which may undermine the psychological functioning of adults with a history of childhood abuse. To improve their psychological health, interventions should focus on facilitating supportive and functional family relationships., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Physical capability, a key component of healthy aging, is associated with cardiovascular and other risk factors across life. We investigated whether midlife biomarkers of heart and kidney damage capturing the cumulative impact of long-term adverse exposures were associated with the level and decline in physical capability over 9 years of follow-up, taking account of systemic inflammatory biomarkers and conventional cardiovascular risk factors., Methods: We used data on 1736 men and women from the oldest British birth cohort study with walking speed, chair rise speed, balance time, and grip strength assessed at ages 60 to 64 and 69 years. We tested associations between logged and standardized measures of cystatin C, NT-proBNP (N-terminal pro-B-type natriuretic peptide), interleukin (IL)-6, and E-selectin at age 60 to 64 years with performance at age 69 years, adjusting for sex, height, and body mass index; then for performance at age 60 to 64 years. These biomarkers were mutually adjusted, and additionally adjusted for cardiovascular risk factors (pulse pressure, total/high density lipoprotein cholesterol, glycosylated hemoglobin), diabetes mellitus, cardiovascular and kidney disease, smoking status, and lifetime socioeconomic position., Results: Cystatin C, NT-proBNP, and IL-6 (but not E-selectin) were inversely associated with all outcomes, adjusted for sex, height, and body mass index. For example, a 1-SD increase in logged NT-proBNP was associated with weaker grip (-0.63 kg, 95% CI, -0.99 to -0.28); the equivalent association for cystatin C was -0.60 kg (95% CI, -0.94 to -0.25) and for IL-6 was -0.76 kg (95% CI, -1.11 to -0.41). Most associations remained, albeit attenuated, after adjustment for previous performance and mutual adjustment of the biomarkers. NT-proBNP and IL-6 (but not cystatin C) were more strongly associated with the outcomes than many of the conventional risk factors after mutual adjustment., Conclusions: Higher levels of NT-proBNP may identify those in midlife at risk of accelerated physical decline. Before considering the use of NT-proBNP for risk stratification, further research should untangle whether these associations exist because the biomarker is an integrated measure of cumulative exposures to relevant stressors across life, or whether it is marking additional risk pathways. Randomized trials to reduce the rate of decline in physical capability or delay incident disability could benefit from including middle-aged adults and adding NT-proBNP and IL-6 as intermediate outcomes.

Objectives: We measured carbon and nitrogen isotopic ratios in a contemporary population, and tested how the isotopic variability relates to measures of socioeconomic status (e.g., household wealth) and anthropometric measures (e.g., standardized height-for-age and weight-for-age z-scores)., Methods: Hair samples from individuals living in the Bosawas Biosphere Reserve in Nicaragua were analyzed for δ 13 C and δ 15 N, and these data were examined in relation to individual (e.g., age, sex, anthropometrics) and household (e.g., household size, wealth) variables., Results: We found through mixed-effects modeling that δ 13 C and δ 15 N varied predictably with individual age and household wealth. δ 13 C and δ 15 N did not, however, improve models predicting variation in individual anthropometric measures., Conclusion: These results indicate that, although there is a relationship between diet (δ 13 C and δ 15 N) and socioeconomic variables, these dietary differences are not the main cause of health differences in this population., (© 2018 Wiley Periodicals, Inc.)

Objectives　The purpose of this study was to provide normative data of middle-aged and older adults for the Japanese version of the Ten-Item Personality Inventory (TIPI-J), based on the Big Five model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness).Methods　We surveyed a random sample of community-dwelling middle-aged and older Japanese adults (aged 60-84 years, N=1,200, response rate: 70.8%) and used data from 776 participants (368 men and 408 women). We used the TIPI-J as a measure of the Big Five model of personality comprising ten items, which were measured on a seven-point Likert-type scale. We also assessed the socio-economic and health variables to describe the basic characteristics of participants.Results　Standard psychometric methods showed a near-normal score distribution across all subscales; there were significant sex differences in Neuroticism and Openness, and there was no significant difference with respect to age.Conclusion　This study provided a grand total table and normative data for the TIPI-J, and examined gender- and age-based differences in the TIPI-J among middle-aged and older adults using data from the general population of Japan. In the future, factors associated with the TIPI-J scores and predictive validity of the scale for health outcomes as external criteria should be examined to test the scale's usefulness for epidemiological surveys among middle-aged and older adults in community settings.

Objective: Older adults' motor sequencing performance is more reliant on executive functioning (EF) and more susceptible to complexity than that of younger adults. This study examined for which aspects of motor sequencing performance these relationships hold., Methods: Fifty-seven younger and 90 non-demented, community-dwelling, older adults completed selected subtests from the Delis-Kaplan Executive Function System as indices of EF and component processes (CP; graphomotor speed; visual scanning; etc.), as well as a computerized motor sequencing task (Push Turn Taptap task; PTT). The PTT requires participants to perform motor sequences that become progressively more complex across the task's four blocks, and is designed to assess action planning, action learning, and motor control speed and accuracy., Results: Hierarchical regressions using each discrete aspect of performance as the dependent variable revealed that action planning is the only aspect of motor sequencing that is uniquely related to EF (beyond the CP composite) for both age groups. Action learning and motor control accuracy are uniquely associated with EF for older adults only, and only if the sequences are complex. Component processes do not fully account for the unique relationships between motor sequencing and EF in older adults., Conclusions: These results clarify prior findings by showing (a) more aspects of motor sequencing relate to EF for older compared to younger adults and (b) for these unique relationships, EF is only related to action during the generation of sequences that are complex. These findings further our understanding of how aging shapes the links between EF and motor actions, and can be used in evidence-based and theoretically driven intervention programs that promote healthy aging.

Objectives: The "Great Recession" shocked the primary institutions that help individuals and families meet their needs and plan for the future. This study examines middle-aged adults' experiences of financial loss and considers how socioeconomic and interpersonal resources facilitate or hinder maintaining a sense of control in the face of economic uncertainty., Method: Using the 2006 and 2010 waves of the Health and Retirement Study, change in income and wealth, giving help to and receiving help from others, household complexity, and sense of control were measured among middle-aged adults (n = 3,850; age = 51-60 years)., Results: Socioeconomic resources predicted both the level of and change in the engagement of interpersonal resources prior to and during the Great Recession. Experiences of financial loss were associated with increased engagement of interpersonal resources and decreased sense of control. The effect of financial loss was dampened by education. Sense of control increased with giving help and decreased with household complexity., Discussion: Findings suggest that, across socioeconomic strata, proportional loss in financial resources resulted in a loss in sense of control. However, responses to financial loss differed by socioeconomic status, which differentiated the ability to maintain a sense of control following financial loss., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective:: To establish normative parameters for the F-A-S form of the phonemic verbal fluency test, in a population of Brazilian Portuguese speaking adults with high-level literacy., Methods:: The sample comprised 40 male and female volunteers aged 19 to 59 years, and at least 8 years of formal education. Volunteers were first submitted to the Mini-Mental State Examination and the Clock Drawing cognitive screening tests, then to the F-A-S Verbal Phonemic Fluency Test; in this test, examinees were given 60 seconds to generate as many words as possible beginning with each of the three test letters., Results:: The means for number of words beginning the letters F, A and S and for total number of words beginning with either letter generated per minute corresponded to 15.3, 14.4, 13.9 and 43.5, respectively., Conclusion:: Reference values obtained from young adults with high levels of literacy submitted to the F-A-S Verbal Phonemic Fluency Test in this study were similar to those reported in the international literature. These reference values can be used for clinical assessment of language disorder and neuropsychological evaluation., Objetivo:: Obter parâmetros de normalidade na tarefa de fluência verbal fonêmica, versão F-A-S, em uma população de alto letramento de adultos falantes do português brasileiro., Métodos:: A amostra foi constituída por 40 voluntários, de ambos os sexos, com idade entre 19 e 59 anos, e com mais de 8 anos de estudo. Todos os voluntários foram inicialmente submetidos ao Miniexame do Estado Mental e ao Teste do Desenho do Relógio, para fins de rastreio cognitivo, e, então, ao Teste de Fluência Verbal Fonêmica F-A-S. Neste último, os indivíduos foram orientados a produzirem o maior número de palavras que conseguissem, iniciadas com cada uma das três letras ditas pelo examinador, em um intervalo de 60 segundos cada., Resultados:: As médias das palavras produzidas com as letras F-A-S foram as seguintes: "F" = 15,3 palavras por minuto; "A" = 14,4 palavras por minuto; e "S" = 13,9 palavras por minuto. A média do total de palavras emitidas iniciada com todas as letras do teste foi de 43,5 palavras., Conclusão:: Foram obtidos valores de referência para o Teste de Fluência Verbal Fonêmica F-A-S para indivíduos adultos jovens de alto grau de letramento semelhantes aos de estudos internacionais. Tais valores podem ser utilizados na avaliação clínica de transtornos da linguagem e na avaliação neuropsicológica., Competing Interests: none.

The effects of age and gender on electroencephalographic (EEG) activity during a short-term memory task were assessed in a group of 40 healthy participants aged 22-63 years. Multi-channel EEG was recorded in 20 younger (mean = 24.65-year-old, 10 male) and 20 middle-aged participants (mean = 46.40-year-old, 10 male) during performance of a Sternberg task. EEG power and coherence measures were analyzed in different frequency bands. Significant interactions emerged between age and gender in memory performance and concomitant EEG parameters, suggesting that the aging process differentially influences men and women. Middle-aged women showed a lower short-term memory performance compared to young women, which was accompanied by decreasing delta and theta power and increasing brain connectivity with age in women. In contrast, men showed no age-related decline in short-term memory performance and no changes in EEG parameters. These results provide first evidence of age-related alterations in EEG activity underlying memory processes, which were already evident in the middle years of life in women but not in men., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: There is a rapid increase in the population of the elderly globally, and Malaysia is anticipated to become an ageing nation in 2030. Maintaining health, social participation, reducing institutionalization, and improving quality of life of the elderly are public health challenges of the 21(st) century. Quality of life among elderly in Elderly Homes in Malaysia is under researched. This study aims to determine the quality of life and its associated factors among the Elderly in Elderly Homes in Kuala Lumpur., Methods: This was a cross-sectional study among 203 residents aged 60 years or more in eight randomly selected Elderly Homes in Kuala Lumpur in September 2014. Stratified simple random sampling was used to select participants. Study instruments included World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF), Multidimensional Scale for Perceived Social Support, and a questionnaire for Socio-demographic variables. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant., Results: The mean (Standard deviation) for the physical domain was 14.3 (±2.7), 13.7 (±2.5) for the psychological domain, 10.8 (±3.4) for the social domain, and 13.0 (±2.5) for the environment domain. Factors significantly associated with quality of life included age, gender, level of education, economic status, outdoor leisure activity, physical activity, duration of residence, type of accommodation, co-morbidities, and social support., Conclusion: This study confirms that multiple factors are associated with quality of life among elderly in elderly homes. Social support, chronic co-morbidities, gender and outdoor leisure activity were significantly associated with all the domains of quality of life. Among the four domains of quality of life, the physical domain had the highest score while the social domain had the lowest score. This emphasizes the need for more social support-related interventions in these homes.

Rural Australians are less physically active than their metropolitan counterparts, and yet very little is known of the candidate intervention targets for promoting physical activity in rural populations. As rural regions are economically, socially and environmentally diverse, drivers of regular physical activity are likely to vary between regions. This study explored the region-specific correlates of daily walking among middle age and older adults in rural regions with contrasting dominant primary industries. Participants were recruited through print and electronic media, primary care settings and community organisations. Pedometers were worn by 153 adults for at least four days, including a weekend day. A questionnaire identified potential intra-personal, social and environmental correlates of physical activity, according to a social ecological framework. Regression modelling identified independent correlates of daily walking separately in the two study regions. In one region, there were independent correlates of walking from all levels of the social ecological framework. In the other region, significant correlates of daily walking were almost all demographic (age, education and marital status). Participants living alone were less likely to be physically active regardless of region. This study highlights the importance of considering region-specific factors when designing strategies for promoting regular walking among rural adults.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) has been recently proposed as a clinical-radiological syndrome. Several causes of MERS have been reported including infectious diseases. We present herein on a case of MERS induced by dengue fever in a Japanese traveler. A 48-year-old male returning from Thailand and Cambodia was admitted for an unknown fever. Following admission, the dengue virus was diagnosed with a positive RT-PCR result. On day 5 of the illness, regardless of reduced fever, weakness suddenly developed in both upper limbs. A cerebral MRI showed hyperintensities in the splenium of the corpus callosum on T2-weighted and diffusion-weighted images. The symptoms resolved completely within two days of onset. The patient was diagnosed as having MERS due to the MRI features and the mild clinical course. Although only a few cases of MERS caused by dengue fever have been reported, the condition is possibly underdiagnosed. It is hypothesized that dengue fever can induce MERS as dengue fever can cause increased endothelium permeability and hypo-sodium which have been proposed in the pathogenesis of MERS. However, there is currently limited evidence for this. Further research is recommended to demonstrate a causal association between dengue fever and MERS.

Objective: Cross-sectional studies in cancer have revealed the presence of clusters of symptoms (e.g., gastrointestinal, emotional) and of patients (e.g., low or high levels of symptoms), but not much is known about their longitudinal evolution. In addition, their relationships with medical factors (e.g., cancer sites, treatments) and possible consequences (e.g., functioning) have yet to be established. This prospective study assessed the presence of clusters of patients in 828 participants scheduled to undergo surgery for cancer., Methods: The patients completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, the Multidimensional Fatigue Inventory, the EORTC Quality-of-Life-Questionnaire-C30, and a physical symptoms questionnaire at baseline and 2, 6, 10, 14, and 18 months later., Results: Cluster analyses identified between five and eight clusters of patients depending on the time point. The "Low Symptoms" cluster was the most common (24.8 to 35.0% of the sample), whereas one with predominant nausea and vomiting symptoms was among the least common (1.6 to 3.5%). Significant differences were found between cancer sites, treatment regimens, quality of life, and functioning scores. Prostate cancer patients and those treated by surgery only were overrepresented in the "Low" cluster, whereas breast cancer patients were more likely to fall into the "Moderate - Night Sweats" cluster. Clusters with more severe psychological symptoms were associated with lower functioning and quality of life., Conclusions: This study revealed distinct clusters of patients that varied in number during cancer treatments. Findings also identified some clusters associated with lower quality of life and functioning, which should receive more clinical attention., ((PsycINFO Database Record (c) 2014 APA, all rights reserved).)

The objectives of this study were to delineate variation in mental and physical health outcomes over a 10-year period among parents with a child with special health needs as compared to parents of a typically developing child; and evaluate the possible protective effects of parental perceived control and social support. The sample consisted of 646 parents from the longitudinal Midlife Development in the United States (MIDUS) study. Nearly one-quarter of the sample (n = 128; 22.3%) reported having a child with a special health care need. Cross-sectional analyses indicated that parents of a child with special care needs reported poorer self-rated mental health, greater depressive symptoms, and more restrictions in instrumental activities of daily living (IADL). Parents of a child with special health care needs had greater increases in depressive symptoms over time and greater declines in instrumental activities of daily living than parents of typically developing children. Perceived control was a robust predictor of all health outcomes over time. The added stressors of parenting a child with special health needs may undermine the long-term health of parents. Behavioral interventions and clinical practices that facilitate parental perceived control may enable resilience and better health.

Aim: To evaluate the incidence of rectal toxicity in patients undergoing hypofractionated (2.2 Gy) image-guided intensity-modulated radiotherapy (IG-IMRT) for prostate cancer., Patients and Methods: We examined 117 consecutive patients with prostate cancer who underwent IG-IMRT from June 2007 to July 2009. The median follow-up time was 32 months (range 20-42 months). The clinical target volume (CTV) consisted of the prostate and seminal vesicles, and the planning target volume (PTV) consisted of the CTV plus a 5-mm expansion, not avoiding the rectum. The PTV received a dose of 72.6-74.8 Gy in 33-34 fractions (2.2 Gy/fraction). Megavoltage computed tomographic (MVCT) scans were performed before each treatment and corrected to the registered position for planning CT scans using prostate soft tissue matching., Results: Late rectal bleeding of grades 1, 2, and 3 (Common Terminology Criteria for Adverse Events v3.0) occurred in 19 (16%), five (4%), and four (3%) patients, respectively. Late urinary toxicities of grades 1 and 2 occurred in five (4.3%) and eight (6.8%) patients, respectively. We found a paradoxically increased risk of rectal bleeding with more accurate irradiation of the rectum using soft tissue matching, whereas only a small percentage was reported in other IMRT series., Conclusion: IG-IMRT using daily MVCT scans allowed for exact dose delivery, which resulted in an increased rectal dose and exceptionally high incidence of rectal toxicity. Therefore, careful PTV contouring and dose schedule settings are important for safe administration of IG-IMRT.

Background: The concepts of medication adherence and Treatment satisfactions are commonly used in clinical research for assessing pharmaceutical care and improving treatment outcomes. Generally, one would expect a positive relationship between the two concepts. The objectives of this study were to investigate the factors associated with adherence to antihypertensive therapy among hypertensive patients and to assess the relationship between antihypertensive medication adherence and treatment satisfaction., Methods: A cross-sectional study was conducted, adopting the Morisky eight-item Medication Adherence Scale (MMAS) for the assessment of medication adherence and using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) for the assessment of treatment satisfaction. Descriptive and comparative statistics were used to describe socio-demographic and disease-related characteristics of the patients. All analyses were performed using SPSS v 15.0., Results: Four hundred and ten hypertensive patients were enrolled in the study. The mean age of participants was 58.38 ± 10.65 years; 52% were female and 36.8% had low antihypertensive medication adherence. There was a significant difference in the mean scores in the Effectiveness (p < 0.001), Convenience (p < 0.001), and Global Satisfaction (p < 0.001) domains, but not in the Side Effects (p = 0.466) domain among patients with different levels of adherence. After adjustment for covariates using multiple linear regression, global treatment satisfaction was still statistically significantly (p = 0.001) associated with medication adherence., Conclusions: Low treatment satisfaction may be an important barrier for achieving high rates of adherence to treatment. These study findings could be helpful in clinical practice, mainly in the early treatment of hypertensive patients, at a point where improving treatment satisfaction is still possible.

Introduction: One research strategy that can be used with the cognitive reserve is to establish groups of elderly persons who differ in key variables that affect the cognitive reserve and then compare their performance in cognitive tests., Aims: To determine which of the variables that have an influence on the cognitive reserve (measured by means of the cognitive reserve questionnaire) are related with performance in the Boston Naming Test, and in the vocabulary and grammar comprehension tests from the ECCO&#95;Senior battery., Subjects and Methods: The sample consisted of 83 elderly persons aged between 60 and 75 years., Results and Conclusions: Schooling, parents' schooling, job and reading habits are closely related to the performance of the elderly in naming, grammar comprehension and vocabulary. Schooling affects the comprehension of sentences with a higher propositional density, and reading habits seem to be closely related with the comprehension of sentences that are more complex in terms of their syntax. Schooling and job affect the performance obtained when dealing with verbs in the vocabulary test.

Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, -7.4% (95% confidence interval (CI): -12.8, -2.8); chair rise, 2.1% (95% CI: -0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (-5.1%, 95% CI: -8.7, -1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals-for standing balance, as early as childhood.

Incorporating a life course perspective, this qualitative study used focus groups to explore the experiences of midlife adults who were simultaneously providing support to emerging adult children and aging parents. Results indicated that adults situated in middle generations held beliefs that endorsed family-based responsibility to both younger and older members. Parents gladly supported children despite their longer transition to adulthood. Often unanticipated but accepted, provisions of care to aging parents were experienced with ambivalence - a joy and a burden. The transition of their parents to greater dependence helped participants gain insights into the terrain of late life and encouraged reflections about the intersection of aging, independence, and family responsibility. Participants expressed intentions to preserve their own independence and spare their children of caregiving burdens through self-directed actions. Implications focused on negotiations of family relationships around issues of independence and family responsibilities as a way to reduce intergenerational ambivalence., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This study is a qualitative interview study about the household possessions that elderly women and men brought with them when moving into assisted living. The move implied a substantial reduction of their possessions since, in all cases, they had left a larger dwelling than the one they moved to. The study gives a glimpse into the everyday life of the oldest old in assisted living. The things the elderly participants brought were of three types; cherished objects, representations of who they were, and mundane objects. The most important objects indicated by the elderly often belonged to the third type, and were preferred for the significance they had for the everyday life of the individual. These objects revealed a circumscribed but dignified life in their private bed-sitting room, often in solitude, where the elderly individuals pursued various interests and small-scale activities. However, this life was organized and preferred by the individuals themselves, in accordance with the principles of resident autonomy and individual choice that are promoted in assisted living. The author suggests that these self-engaged pursuits can contribute to bridging the gap between disengagement and activity theories. The study results also contribute to making visible the private life of the oldest old in assisted living., (Copyright © 2012. Published by Elsevier Inc.)

Older people are often positioned as passive recipients of care and dependent on resources or as overly productive and active. In this paper, we seek a more nuanced, middle ground between such stereotypes, by exploring the question: what contributions do older people make to the places they live in? Drawing on qualitative research from Aotearoa New Zealand, involving focus groups and interviews, we examine the varied and active ways many older people are involved in and contribute to their neighbourhoods and communities, or what we term 'care for place'. In particular, we identify the different forms of older people's care for place, including volunteering, activism, advocacy, and nurturing, and consider how these efforts positively impact on older people and the communities in which they live. Whilst we caution against assumptions that all older people should be productively involved, we argue that greater understanding of older people's care for place is central to challenging stereotypes of older people as either passive and dependent, or highly active., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia., Objective: To assess the association between objectively measured midlife cardiorespiratory fitness ("fitness") levels and development of all-cause dementia in advanced age., Design: Prospective, observational cohort study., Setting: Preventive medicine clinic., Patients: 19 458 community-dwelling, nonelderly adults who had a baseline fitness examination., Measurements: Fitness levels, assessed using the modified Balke treadmill protocol between 1971 and 2009, and incident all-cause dementia using Medicare Parts A and B claims data from 1999 to 2009., Results: 1659 cases of incident all-cause dementia occurred during 125 700 person-years of Medicare follow-up (median follow-up, 25 years [interquartile range, 19 to 30 years]). After multivariable adjustment, participants in the highest quintile of fitness level had lower hazard of all-cause dementia than those in the lowest quintile (hazard ratio, 0.64 [95% CI, 0.54 to 0.77]). Higher fitness levels were associated with lower hazard of all-cause dementia with previous stroke (hazard ratio, 0.74 [CI, 0.53 to 1.04]) or without previous stroke (hazard ratio, 0.74 [CI, 0.61 to 0.90])., Limitations: Dementia diagnoses were based on Medicare claims, and participants generally were non-Hispanic white, healthy, and well-educated and had access to preventive health care. This study evaluated fitness levels, so a specific exercise prescription cannot be generated from results and the findings may not be causal., Conclusion: Higher midlife fitness levels seem to be associated with lower hazards of developing all-cause dementia later in life. The magnitude and direction of the association were similar with or without previous stroke, suggesting that higher fitness levels earlier in life may lower risk for dementia later in life, independent of cerebrovascular disease., Primary Funding Source: The Cooper Institute; University of Texas Southwestern Medical Center; National Heart, Lung, and Blood Institute; and American Heart Association.

Although it is well-documented that there are age differences between young and older adults in neural activity associated with successful memory formation (positive subsequent memory effects), little is known about how this activation differs across the lifespan, as few studies have included middle-aged adults. The present study investigated the effect of age on neural activity during episodic encoding using a cross-sectional lifespan sample (20-79 years old, N=192) from the Dallas Lifespan Brain Study. We report four major findings. First, in a contrast of remembered vs. forgotten items, a decrease in neural activity occurred with age in bilateral occipito-temporo-parietal regions. Second, when we contrasted forgotten with remembered items (negative subsequent memory), the primary difference was found between middle and older ages. Third, there was evidence for age equivalence in hippocampal regions, congruent with previous studies. Finally, low-memory-performers showed negative subsequent memory differences by middle age, whereas high memory performers did not demonstrate these differences until older age. Taken together, these findings delineate the importance of a lifespan approach to understanding neurocognitive aging and, in particular, the importance of a middle-age sample in revealing different trajectories., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Twelve weeks of resistance training (3 days/wk) combined with daily consumption of the cyclooxygenase-inhibiting drugs acetaminophen (4.0 g/day; n = 11, 64 ± 1 yr) or ibuprofen (1.2 g/day; n = 13, 64 ± 1 yr) unexpectedly promoted muscle mass and strength gains 25-50% above placebo (n = 12, 67 ± 2 yr). To investigate the mechanism of this adaptation, muscle biopsies obtained before and ∼72 h after the last training bout were analyzed for mRNA levels of prostaglandin (PG)/cyclooxygenase pathway enzymes and receptors [arachidonic acid synthesis: cytosolic phospholipase A(2) (cPLA(2)) and secreted phospholipase A(2) (sPLA(2)); PGF(2α) synthesis: PGF(2α) synthase and PGE(2) to PGF(2α) reductase; PGE(2) synthesis: PGE(2) synthase-1, -2, and -3; PGF(2α) receptor and PGE(2) receptor-4], cytokines and myokines involved in skeletal muscle adaptation (TNF-α, IL-1β, IL-6, IL-8, IL-10), and regulators of muscle growth [myogenin, myogenic regulatory factor-4 (MRF4), myostatin] and atrophy [Forkhead box O3A (FOXO3A), atrogin-1, muscle RING finger protein 1 (MuRF-1), inhibitory κB kinase β (IKKβ)]. Training increased (P < 0.05) cPLA(2), PGF(2α) synthase, PGE(2) to PGF(2α) reductase, PGE(2) receptor-4, TNF-α, IL-1β, IL-8, and IKKβ. However, the PGF(2α) receptor was upregulated (P < 0.05) only in the drug groups, and the placebo group upregulation (P < 0.05) of IL-6, IL-10, and MuRF-1 was eliminated in both drug groups. These results highlight prostaglandin and myokine involvement in the adaptive response to exercise in older individuals and suggest two mechanisms underlying the enhanced muscle mass gains in the drug groups: 1) The drug-induced PGF(2α) receptor upregulation helped offset the drug suppression of PGF(2α)-stimulated protein synthesis after each exercise bout and enhanced skeletal muscle sensitivity to this stimulation. 2) The drug-induced suppression of intramuscular PGE(2) production increased net muscle protein balance after each exercise bout through a reduction in PGE(2)-induced IL-6 and MuRF-1, both promoters of muscle loss.

Aim: The purpose of this study was to construct a scale that measures multidimensional attitudes regarding death in the middle-aged and elderly, using scale items for adolescents, and to examine its reliability and validity., Methods: Twenty-nine items which were selected from the scale of Attitudes toward Death (Tange, 1999) were administered to subjects, consisting of 2,223 community-living Japanese men and women aged 40-79 years. Both exploratory factor analysis and confirmatory factor analysis were performed to examine the factor structures. The reliability and validity of the scale were examined., Results: Exploratory factor analysis was performed to examine the factor structures of death attitudes, using the data from half of the subjects, indicated 5 factors. Confirmatory factor analysis, using the data from the remaining half, supported the goodness of fit of that model. Using this structure, the attitude toward death scale for the middle-aged and elderly (ATDS-A; five subscales) was constructed; "fear of death", "belief in existence of afterlife", "intention to live out own life", "meaning of death for life", "approval of death with dignity". For these subscales, the alpha coefficients ranged from 0.59-0.87. The validity of the subscales was suggested through the relation with the ego integration score., Conclusions: This study suggested that the ATDS-A was reliable and valid, and was useful for the measurement of death attitudes in the middle-aged and elderly.

The present study used longitudinal data on 182 adults between the ages of 20 and 54 (104 men, 78 women) from the Rochester Adult Longitudinal Study (RALS), assessed on four occasions, to test the hypothesis that identity and intimacy during the course of early and middle adulthood predict well-being at midlife. A cross-lagged panel model was estimated yielding the following findings: (a) Scores on both scales during the college years predicted midlife satisfaction-intimacy directly, and identity through the course of development from ages 20 to 54; moreover, identity in midlife, but not intimacy, was significantly linked with well-being at this same point in time; and (b) identity and intimacy unexpectedly did not predict one another over time, having been controlled for factor stability in identity and intimacy over time. The findings are discussed in terms of Erikson's psychosocial theory of development and the developmental moments and historical cohorts that characterize the present sample., (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Background: The rate of suicides markedly increased in 1998 and leveled off at approximately 30,000 per year thereafter. The aim of the current study was to evaluate the link between the different dimensions of depressive symptoms and suicidal ideation among the middle-aged population in Japan., Method: A sample of 6848 middle-aged (40-60years of age) working individuals completed the Center for Epidemiological Studies Depression Scale (CES-D) and a questionnaire measuring suicidal ideation. The responses on the four dimensions of depressive symptoms on the CES-D (depressed affect, lack of positive affect, somatic symptoms, and interpersonal problems) were entered into regression analyses that predicted the presence of suicidal ideation among the participants with probable depression (n=1704)., Results: The factor score of depressed affect was significantly higher in females than in males, whereas that of interpersonal problems was significantly higher in males than in females. Among both males and females, depressed affect was a significant predictor of suicidal ideation. Among males, interpersonal problems also significantly predicted suicidal ideation. Contrary to the results of a previous study among adolescents, we did not find a relationship between lack of positive affect and suicidal ideation., Conclusions: These findings indicate that the dimensions of depressive symptoms measured with the CES-D make different contributions to suicidal ideation. Although our results could not be generalizable to a clinical setting due to lacking clinical samples, the depressed affect dimension of CES-D might be useful for screening of suicide risk among community population. Furthermore, gender differences in the relationships between the dimensions of depressive symptoms in a middle-aged population were identified. Additional studies are needed to examine gender-specific relationships between the dimensions of depressive symptoms and suicidal ideation., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Physical activity has good influence on health. The physical activity of elderly people may decrease, because of the health problems or think that with aging sport activity should be reduced., Objective: The aim of the study was to assess a physical activity and energy expenditure of people in age 60 and more in the Koprzywnica district (Poland)., Material and Methods: 95 persons in age 60 and more (51 women and 44 men) participated in the study. All participants live alone or with family. The following data: total energy expenditure, active energy expenditure, physical activity duration (MET > 3,0), vigorous physical activity duration (MET > 6,0), number of steps, lying down duration were collected using SenseWear Pro3 Armband, Body Media Pittsburgh, USA. The measurement was conducted for 24 hours. Physical activity was also classified on the basis of the number of steps., Results: The median of the age of participants was 71 years. The median of BMI was 27,1 kg/m2. Age was correlated with BMI (R = -0,28, p = 0,005). Participants made on average 6335 steps daily, 42% of them made less than 5000 steps and 31,5% more than 10000 steps a day. The median of the total energy expenditure was 33,1 kcal/kg of body mass a day (2522 kcal a day), while the median of the active energy expenditure was 5,7 kcal/kg of body mass a day (482 kcal a day). The median of the physical activity duration was 1 hour and 22 minutes, and in most cases it was the moderate physical activity. In case of 17 women (33%) and 20 men (45,5%) the vigorous physical activity was detected, and duration of this physical activity was 1-22 minutes. The median of the lying down duration was 8 hours and 44 minutes. Older persons had shorter physical activity duration, made less steps and at the same time had lower active energy expenditure and total energy expenditure than younger ones. There were no differences between younger and older participants in the sedentary energy expenditure and lying down duration. Simultaneously participants with higher BMI compared with participants with lower BMI had shorter physical activity duration as well as lower active energy expenditure and total energy expenditure but there were no differences in number of steps, lying down duration and sedentary energy expenditure between them., Conclusions: In case of older persons the duration of physical activity was shorter and the active energy expenditure was lower than in case of younger persons. Both groups had the sedentary energy expenditure and the lying duration at the same level. Elderly people with higher BMI had lower total energy expenditure and lower intensity and shorter physical activity duration than elderly people with lower BMI.

Religiousness has been observed to have a beneficial relationship with blood pressure, however, specific aspects of religiousness that interact with physiological mechanisms to influence this relationship are not known. This study explored laboratory cardiovascular reactivity (blood pressure, heart rate) to psychological stress among middle aged community dwelling individuals grouped by religious motivation (Intrinsic, Pro-religious, Non-religious). Measures of personality, cynical hostility, aggression, sense of coherence, and compassion were administered. Results indicated that the Pro-religious group demonstrated dampened reactivity compared to the other research groups. However, the Pro-religious also demonstrated a less positive psychological profile (e.g., greater cynicism, aggression, and neuroticism; less compassion and sense of coherence) and poorer self-reported health compared with the Intrinsic group and behavioral observations demonstrated that the Pro-religious were unreliable in keeping appointments and appeared rushed during the experiment. These findings indicate a complicated interface between personality, coping, and religious motivation in response to stressors and emphasize the need for naturalistic and longitudinal investigations of individuals who vary in terms of religious motivation.

Background: As it is uncertain whether psychological treatments for depressive symptoms are effective in elderly inpatients with significant medical comorbidity, we aimed to assess the treatment effectiveness not only on depressive symptoms but also on somatic symptoms in these inpatients., Methods: We performed a meta-analysis of randomized controlled studies assessing the effects of psychological treatments in Chinese older inpatients with significant medical comorbidity based upon extensive searches of the most comprehensive computerized Chinese academic database., Results: The overall effect size for depressive symptoms of twelve studies which compared psychological treatments with a care-as-usual control group was d = 0.80 (95% Confidence Intervals (CI) = 0.60-0.99; p < 0.001). The relative risk of psychological intervention of being effective or not, compared to control condition, was 1.52 (95% CI = 1.25-1.85; p < 0.001)., Conclusions: We conclude that psychological treatments of depressive symptoms are effective for Chinese elderly inpatients with significant medical comorbidity which should receive more attention in medical settings.

We investigated associations between spouses' shared possible selves and well-being as a function of their perceptions of collaboration in 61 late-midlife (M = 60 years) and older (M = 72 years) couples dealing with prostate cancer. Spouses completed assessments of possible selves (with shared selves defined as possible selves portraying a similar goal across spouses), psychological well-being, and enjoyment and frequency of collaboration. Associations between shared selves and better well-being occurred through better enjoyment of collaboration regardless of age (after controlling for marital quality and subjective health). An interaction revealing that shared selves were associated with better well-being only with frequent collaboration was obtained with older couples but was not found in late-midlife couples.

Introduction: RAPID, a battery of rapid neuropsychological tests, includes neuropsychological tests calibrated for different populations according to diverse methodologies. This makes the comparison and interpretation of the results difficult. The aim of this study was to build comparative norms for the RAPID battery using a single methodology in a unique population., Population and Methods: The RAPID Battery includes nine different tests: the Memory Impairment Screen, the Isaacs Set Test, the Mini-Mental State Examination, the Free and Cued Recall Test, the Trail Making Test, a test for copying geometric figures as part of the BEC 96, a test for verbally naming images and a test for matching categories. A cohort of 476 subjects aged 50 to 89 were randomly selected from the medical records of 11 practitioners., Results: The norms were stratified according to age (50-59, 60-69, 70-79 and 80-89 years) and education level of the subjects. The first level includes subjects with the French Primary Education Certificate or lower. The second level includes subjects with the Certificate of Professional Aptitude or the Brevet (equivalent to the GCSE). The third level includes subjects with the Baccalaureate or higher. Given that most of the tests did not satisfy the normal distribution, percentiles (tenth, twenty-fifth, seventy-fifth, ninetieth percentile and median) were used to define age and education norms. The results show a high participation rate (75 %) and are similar to those obtained in the literature: The results decreased with age and improved in grade level. Nevertheless, the results exhibited great variability for the tenth percentile in comparison with results reported in the literature., Conclusion: The development of comparative norms for the RAPID battery from a same sample facilitates the interpretation of individual results in terms of cognitive profile.

Whether ageing is associated with increased fibrinogen concentration and production remains unclear. We measured fibrinogen fractional (FSR) and absolute synthesis (ASR) rates in male volunteers, of either young (mean age: 28 years, range: 22-34) or middle age (mean age: 57 years, range: 38-72), using a leucine-tracer isotope dilution technique. In the middle-age group, neither fibrinogen FSR (20.8 +/- 1.6%/day) nor ASR (1.8 +/- 0.1 g/day), or concentration (274 +/- 15 mg/dl), were different from those of the younger group (FSR: 20.2 +/- 1.4; ASR: 1.7 +/- 0.2; concentration: 265 +/- 8, respectively). Leucine Ra, an index of endogenous proteolysis, was approximately 20% lower in the older than in the younger group (P < 0.02). Thus, middle age in males is not associated with increased fibrinogen concentration and turnover, whereas endogenous protein breakdown in decreased. Factor(s) different from age per se are likely to be involved in the dysfibrinogenemia possibly occurring with ageing. Protein turnover is already reduced in middle-age males.

Objective: To assess self-esteem and affecting factors in a middle-aged Ecuadorian female population using the Rosenberg Self-Esteem Scale (RSES)., Study Design: This was a cross-sectional study in which 149 women (40-59 years) were requested to fill out the RSES and a general socio-demographic form containing personal and partner data., Results: Mean age of sample was 47.6+/-5.5 years, a 67.8% had less than 12 years of schooling and 33.6% were postmenopausal. At the moment of the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs. Mean total RSES score was 26.6+/-3.1 (median 26, range 17-35). A 35.6% and 18.1% of women respectively presented total RSES scores below 26 (median) and 25 (25th percentile) suggesting lower self-esteem. Total scores did not differ when comparing older age, menopausal phases or time since the menopause. Logistic regression analysis determined that women with lower parity and an unhealthy partner were related to lower total RSES scores (below the 25th percentile) suggesting lower self-esteem., Conclusions: In this mid-aged series lower self-esteem was not related to the aging process per se yet to socio-demographic female/male aspects. More research is needed in this regard that incorporates other sociological aspects., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: A high birth rate during the first two decades following World War II has increased the proportion of elderly people in present-day society and, consequently, the demand for health-care services. The impact on intensive care services may become dramatic because the age distribution of critically ill patients is skewed towards the elderly. We have used registry data and population statistics to forecast the demand for intensive care services in Norway up until the year 2025., Methods: Data collected by the Norwegian intensive care registry (NIR), showing the age distribution in Norwegian intensive care units (ICU) during the years 2006 and 2007, were used with three different Norwegian prognostic models of population growth for the years 2008-2025 to compute the expected increase in intensive care unit bed-days (ICU bed-days)., Results: The elderly were overrepresented in Norwegian ICUs in 2006-2007, with patients from 60 to 79 years of age occupying 44% of ICU bed-days. Population growth from 2008 to 2025 was estimated to be from 11.1 to 26.4%, depending on the model used. Growth will be much larger in the age group 60-79 years. Other factors kept unchanged, this will result in an increase in the need for intensive care (ICU bed-days) of between 26.1 and 36.9%., Conclusion: The demand for intensive care beds will increase markedly in Norwegian hospitals in the near future. This will have serious implications for the planning of infrastructure, education of health care personnel, as well as financing of our health care system.

Using daily telephone interviews, 82 midlife parents (mean age = 57.4) of children with disabilities (mean age = 29.9) were compared with a closely matched sample of unaffected parents (N = 82) to elucidate the daily experience of nonnormative parenting. In addition, salivary cortisol samples were obtained to examine whether parents of children with disabilities had dysregulated diurnal rhythms and the extent to which the amount of time spent with children was associated with divergent patterns of cortisol expression. We found that parents of children with disabilities had similar patterns of daily time use and similar likelihood of positive daily events as the comparison group, but they had elevated levels of stress, negative affect, and physical symptoms, all reported on a daily basis. In addition, their diurnal rhythm of cortisol expression differed significantly from the comparison group, a pattern that was strongest for parents of children with disabilities on days when they spent more time with their children.

Objectives: To examine whether measures of cognitive performance across life are related to physical performance at age 53 years, allowing for potential confounders., Methods: In a large representative British birth cohort of men and women (N = 2135) the associations between cognitive performance across life (i.e., standardized cognition scores at ages 15, 43, and 53 years and changes in verbal memory and search speed scores between 43 and 53 years) and measures of physical performance at age 53 years (i.e., standing balance, chair rising, and grip strength) were examined. Adjustments were made for body size, physical activity levels, health status, and socioeconomic conditions at age 53 years., Results: Higher cognitive scores on all childhood and adult tests, and a slower decline in verbal memory and search speed, were associated with better standing balance. Higher verbal fluency scores and a slower decline in verbal memory and search speed were more strongly related than scores on tests of general cognitive ability to chair rising. The relationships between cognitive performance and grip strength were inconsistent and weak., Conclusions: The differential patterns of association found are consistent with the degree to which each is dependent on central nervous system function. Our findings suggest that initial developmental differences as well as shared ageing processes may underlie associations found between cognitive and physical performance.

The primary purpose of this study was to determine whether current and midlife obesity status provide independent information on mortality risk in elderly persons. Analyses were based on 3,238 participants from the original Framingham Heart Study (FHS) cohort who lived to at least 70 years of age and who had BMI measures from when they were in their 50s. Within this group of 70-year olds, obesity based on current BMI was associated with a 21% increased risk of mortality (P = 0.019) whereas obesity in 70-year olds based on BMI measures obtained at around 50 years of age was associated with a 55% increased risk of mortality (P < 0.0001). Compared to 70-year olds who were nonobese at both 50 and 70 years of age, mortality risk was increased by 47% (P < 0.001) in those who were obese at both 50 and 70 years of age, increased by 56% (P < 0.001) in those who were obese at 50 years of age and nonobese at 70 years of age, and not significantly different (P > 0.9) in those who were nonobese at 50 years of age and obese at 70 years of age. In summary, in this cohort of elderly adults, midlife and current BMI had independent effects on mortality risk. Specifically, although mortality risk was increased in obese older adults who were already obese at midlife, this was not the case for newly obese older adults. Conversely, nonobese older adults who were obese at midlife had an increased mortality risk. These observations imply that it is imperative to consider an elderly adult's BMI in context of their BMI at midlife.

Objective: Group-based physical training interventions have been shown to be effective in increasing quality of life in cancer survivors. Until now, however, the impact of cohesion within the group on intervention outcome has not been investigated., Methods: We examined self-reported individual group cohesion ratings collected in the first half of a 12-week rehabilitation programme for cancer survivors (N=132). Four dimensions of group cohesion were measured, i.e. the bond with the group as whole, the bond with other members, cooperation within the group and the instrumental value. Quality of life, physical functioning and fatigue were assessed before and after the intervention using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Linear multiple multivariate regression analysis was conducted to explore the relationship between group cohesion and intervention outcome., Results: The relationship between group cohesion and outcome was significantly modified by gender. Higher ratings of cooperation within the group predicted better post-intervention quality of life and physical functioning and less fatigue in men, and better quality of life and physical functioning in women. Additionally, women who reported a stronger bond with other members showed a lower quality of life after the intervention. No relationship was found between the instrumental value and the outcome variables., Conclusion: Some dimensions of group cohesion seem to be associated with intervention outcome. The underlying mechanisms need to be unravelled., ((c) 2007 John Wiley & Sons, Ltd.)

Objective: Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs., Methods: The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases., Results: There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days., Conclusions: Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans. It is noteworthy that it could be delivered and implemented by case managers with little or no prior counseling experience.

Objective: To describe health and nutrition status in the elderly population in Mexico., Material and Methods: Information from 5,480 adults (>60 years) obtained by the National Health and Nutrition Survey (ENSANUT-2006) was analyzed. Frequencies, means, and confidence intervals at 95% were obtained and adjusted for design effect., Results: Forty percent of the adults reported a lack of social security, 2% suffered from malnutrition, women were affected two times more than men by anemia (34.8 vs. 17%), more than 60% of the population were overweight and had obesity, approximately 25% suffered from hypertension according to the survey, and between 15 and 20% were diabetic., Conclusions: The results of this study show that health and nutrition status among the Mexican elderly population is inadequate. This is a situation that urgently needs to be addressed in order to improve the quality of life of older adults in Mexico.

Inflammatory cytokines are important predictors of cardiovascular mortality especially in patients with chronic kidney disease. Here we explored the relationship of anemia and epoetin treatment to inflammatory cytokine levels in patients with chronic kidney disease. One hundred non-dialysis patients with chronic kidney disease over 18 years of age were evenly split into anemic and non-anemic cohorts. Of the 50 anemic patients, 23 were receiving erythropoiesis stimulating agents treatments. Levels of tumor necrosis factor (TNF)-alpha were found to be significantly higher and serum albumin was significantly lower with trends towards higher interleukin (IL)-6 and IL-8 in anemic compared to non-anemic patients. Further analysis by multiple logistic regression found that anemic patients treated with erythropoiesis stimulating agents had significantly higher odds for the upper two quartiles for IL-6, IL-8 and TNF-alpha compared to non-anemic patients. Our study found that the anemia of chronic kidney disease was associated with up regulation of TNF-alpha, and possibly IL-6 and IL-8 along with increased levels of these proinflammatory cytokines in patients treated with epoetin.