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Introduction: We examined the influence of special healthcare needs, onset of the COVID-19 pandemic, and their interaction on receiving transition services to prepare for future adult care among US adolescents, and whether social determinants of health moderated the relationship of these factors with receiving transition services., Methods: We analyzed the National Survey of Children's Health (2019, 2020-2021) using adjusted multivariable logistic regression models. We assessed a repeated cross-sectional, nationally representative sample of adolescents aged 12-17 years old. Sampling weights were used to generalize samples to the populations of interest. The main outcome was receipt of transition services to prepare for future adult healthcare. Measures included pre vs. post COVID-19 onset, special healthcare needs, and social determinants of health (health insurance, food sufficiency, neighborhood safety, household language, race/ethnicity, and household poverty level). Sex and two-parent households were included as covariates., Results: A total of 45,935 adolescents were included, with N =12,230 in the pre COVID-19 group and N =33,705 in the post COVID-19 group. We found statistically significant higher odds of receiving transition services among adolescents with special healthcare needs ( 95 CI = 1.23, 1.58), females ( 95 CI = 1.09, 1.39), and during pre COVID-19 ( 95 CI = 1.14, 1.45). Private insurance ( 95 CI = 1.03, 1.37), English as primary household language ( 95 CI = 1.19, 2.27), and race/ethnicity were significant predictors of receipt of transition services. Neighborhood safety significantly moderated ( 95 CI = 1.70, 6.60) the relationship between special healthcare needs and receipt of transition services., Discussion: This population-based study identified significant disparities in receipt of transition services provided to US adolescents via the differential impact of social determinants of health, special healthcare needs, and COVID-19 onset on receipt of services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Girdwood, Silva, Maslow and Docherty.)

Background: Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway., Methods: This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway., Results: Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant.  CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty., (© 2024 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Pain is one of the most common symptoms affecting patients with systemic sclerosis; however, little is known about the relationship between self-efficacy and pain and changes in pain over time., Objectives: The purpose of this study was to describe the relationships between self-efficacy and pain in patients with systemic sclerosis, as well as determine whether changes in self-efficacy mediate changes in pain., Methods: A prospective longitudinal study was conducted using data from the Scleroderma Patient-Centered Intervention Network Cohort. The baseline sample included 1,903 adults, with a trajectory subsample of 427 who completed 3-month assessments across 3 years. Hierarchical (sequential) forward multivariable regression, covarying for participant characteristics, was conducted to determine the association between self-efficacy and patient characteristics on pain outcomes. Trajectory models, covarying for participant characteristics, were used to examine changes in self-efficacy and pain outcomes across time and whether self-efficacy mediated the pain trajectories., Results: Mean time since diagnosis was 9.5 years, with 39.2% diagnosed with diffuse cutaneous systemic sclerosis. Greater self-efficacy was associated with less pain interference and intensity. Increasing age, female gender, finger ulcers, and small joint contractures were related to greater pain interference and intensity. Esophageal gastrointestinal symptoms were associated with more pain interference. Self-efficacy and pain trajectories remained stable across time, and self-efficacy did not mediate the pain trajectories., Discussion: This study identified self-efficacy, age, gender, finger ulcers, small joint contractures, and esophageal gastrointestinal symptoms as important correlates associated with pain in patients with systemic sclerosis. In addition, this study found that self-efficacy and pain outcomes remained stable over time, providing important insights into the longitudinal pain experiences of patients with systemic sclerosis., Competing Interests: The authors do not have any conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The goal of this exploratory study was to delineate health differences among transgender subpopulations (transgender women/TW, transgender men/TM, gender nonbinary/GNB adults). 2015 Behavioral Risk Factor Surveillance System data were analyzed to compare the health of three groups (TW:N = 369; TM:N = 239; GNB:N = 156). Logistic regression and adjusted odds ratios were used to determine whether health outcomes (fair/poor health, frequent physical and mental unhealthy days, chronic health conditions, and health problems/impairments) are related to group and its interaction with personal characteristics and socioeconomic position. Group was a significant predictor of fair/poor health and frequent mental unhealthy days, revealing significant health differences between the transgender groups. The odds of poor/fair health were approximately 2.5 times higher in TM and GNB adults relative to TW. The odds of frequent mental unhealthy days for TM were approximately 1.5-2 times greater than TW and GNB adults. Among those with health insurance, the odds of fair/poor health for GNB adults was more than 1.5-2 times higher that of TM and TW. Among those without health insurance, TM had over 7 times greater odds of fair/poor health than TW. This study underscores the importance of classifying and examining the health of the transgender population as unique subpopulations, as notable health differences were discovered. TM and GNB adults have significant health concerns, requiring the attention of clinical interventions aimed at promoting health and preventing illness., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To estimate the effect of radiation therapy (RT) on nonbreast second malignant neoplasms (SMNs) in young women survivors of stage I-IIIA breast cancer., Methods and Materials: Women aged 20 to 44 years who received a diagnosis of stage I-IIIA breast cancer (1988-2008) were identified in the Surveillance, Epidemiology, and End Results 9 registries. Bootstrapping approach and competing-risk proportional hazards models were used to evaluate the effect of RT on nonbreast SMN risk. The analysis was repeated in racial subgroups. Radiotolerance score analysis of normal airway epithelium was performed using Gene Expression Omnibus (GEO) data sets., Results: Within records of 30,003 women with primary breast cancer, 20,516 eligible patients were identified, including 2,183 African Americans (AAs) and 16,009 Caucasians. The 25-year cumulative incidences of SMN were 5.2% and 3.6% (RT vs no-RT) for AAs, with 12.8-year and 17.4-year (RT vs no-RT) median follow-up (hazard ratio [HR] = 1.81; 95% bootstrapping confidence interval [BCI], 1.02-2.50; P < .05), respectively, and 6.4% and 5.9% (RT vs no-RT) for Caucasians with 14.3-year and 18.1-year (RT vs no-RT) median follow-up (HR = 1.10; 95% BCI, 0.61-1.40; P > .05), respectively. The largest portion of excess RT-related SMN risk was lung cancer (AA: HR = 2.08, 95% BCI, 1.02-5.39, P < .05; Caucasian: HR = 1.50, 95% BCI, 0.84-5.38, P > .05). Subpopulation Treatment Effect Pattern Plot (STEPP) analysis revealed higher post-RT nonbreast SMN risk in those 20 to 44 years of age, with larger HRs for RT in AAs. Radiotolerance score (RTS) of normal airway epithelium from young AA women was significantly lower than that from young Caucasian women (P = .038)., Conclusions: With a projected 25-year follow-up, RT is associated with elevated risk of nonbreast SMNs, particularly second lung cancer, in young women survivors of stage I-IIIA breast cancer. Nonbreast SMNs associated with RT are higher in AA women than Caucasian women., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This integrated literature review, framed by the gender affirmation framework, sought to contextualize the experiences of transgender adults interfacing with health care after the release of Healthy People 2020. The constructs of the gender affirmation framework represented 4 a priori themes used to organize the findings. The 23 articles synthesized (quantitative, n = 13; qualitative, n = 7; case studies, n = 2; and mixed methods, n = 1) revealed numerous obstacles accessing health care, discrimination from health care professionals and clinicians, restricted health insurance benefits for medically necessary care, and barriers to medically necessary care, such as cross-sex hormones, as well as primary and preventative health care.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.

The purpose of this study was to verify the self-selected intensity during resistance training (RT) in older women. Twenty healthy women (mean age, 65.6 years) underwent a 2-week familiarization period followed by 3 experimental sessions. During the first session, anthropometric measurements were taken. The second session involved completion of a 1 repetition maximum (1RM) test for the following exercises: chest press, leg press, lat pull-down, leg extension, lateral shoulder raise, leg curl, biceps curl, and triceps pushdown. Last, a single RT session was performed at a self-selected intensity. During the RT session, participants were instructed to self-select a load for performing 3 sets of 10-15 repetitions. Data were analyzed by mean (SD) and analysis of variance with repeated measures (p < 0.05). Global mean of the 3 sets was bench press 41.0% 1RM (11.9), leg press 43.0% 1RM (17.2), lat pull-down 47.2% 1RM (11.1), leg extension 33.0% 1RM (8.1), lateral shoulder raise 51.1% 1RM (12.1), leg curl 43.5% 1RM (8.8), biceps curl 48.0% 1RM (15.5), and triceps pushdown 51.7% 1RM (13.3); there were no significant differences between the sets (p > 0.05). These results indicate that inactive older women self-selected an intensity exercise during RT below the recommendation for improvements on muscle fitness in apparently healthy older adults. However, this intensity is recommended for very deconditioned individuals. Nevertheless, the use of self-selection strategy during an exercise program can have greater advantages because of its easy applicability, its positive relation with exercise adherence, and for promoting initial muscle conditioning in older adults. Furthermore, it is crucial to gradually increase the RT load to guarantee better and sustainable effects on muscle fitness. Finally, future studies are needed to establish the chronic effects of RT at self-selected intensity on muscle fitness and the functional health of older adults.

Background: Stress reduction is a focus of healthcare management in Veterans who often faced extreme stressors during military service., Objective: A quality improvement project to evaluate the implementation and effects of a brief mindfulness course delivered to Veterans, Mindful-Veteran (M-Vet), with self-reported mild to severe depressive symptoms in an outpatient setting., Design: A within-subjects design was used to determine whether depressed Veterans enrolled in a 6-week M-Vet course report improvements in perceived stress, depressive symptoms, and quality of life., Results: Mental health, general health, emotional role, and social functioning quality of life subscales significantly improved over the 6-week course. Severity of stress and depressive symptom scores, however, did not significantly decrease., Conclusion: The findings suggest that this brief, simplified mindfulness program designed for military Veterans, seen within a community based outpatient clinic, has clinically beneficial effects on psychiatric outcomes., (Published by Elsevier Ltd.)

Fall prevention is a major area of concern in inpatient settings. This article reports on the feasibility of implementing a daily exercise program that features line dancing to promote stability, balance, and flexibility in adult psychiatric patients and describes the impact of that program. Six hundred sixty-five patient charts drawn from before and after the practice change were reviewed. The fall rate after the introduction of line dancing was 2.8% compared with 3.2% before implementation. In a setting that treats both men and women of many ages and with varying levels of mobility, line dancing offers a viable approach to exercise in a secure setting.

The purpose of this cross-sectional study was to generate a functional-fitness profile for older women from the south of Brazil and to compare their functional profile with an age-matched cohort of American women. The Fullerton Functional Fitness Test (body-mass index, 6-min-walk test, chair sit-and-reach, chair stand, arm curl, and 8-ft up-and-go) was administered to 1,033 participants. Z scores indicate that older American women performed better in all functional tests than age-matched Brazilians. This fact could be explained by the delayed establishment of specific health policies for older adults in Brazil. In conclusion, the findings provide guidelines about the normal variation of functional fitness in older women from the southern region of Brazil. In addition, these data can be used to help identify older women with functional losses, thereby assisting in the diagnosis of early disability.