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BACKGROUND: A gap in research about the trajectories of function among men and women aging with functional limitations because of multiple sclerosis (MS) hinders ability to plan for future needs. OBJECTIVES: Using a biopsychosocial model, we characterize how men and women with MS report changes over time in their function and test how person-level differences in age, diagnosis duration, and sex influence perceived function. METHODS: A longitudinal study with multiple waves of surveys was used to collect data on participant perceptions of function, as well as demographic and contextual variables. Self-reported functional limitation was measured over a decade. The study participants were community residing with physician-diagnosed MS. RESULTS: The people with MS had a diagnosis duration of about 13 years and were around 51 years of age, on average, at the start of the study. They were primarily women and non-Hispanic White. We analyzed the data using mixed-effects models. Subject-specific, functional limitation trajectories were described best with a quadratic growth model. Relative to men, women reported lower functional limitation and greater between-person variation and rates of acceleration in functional limitation scores. DISCUSSION: Results suggest function progressed through two pathways for over a decade, particularly closer to diagnoses. Variability in trajectories between individuals based on sex and years since diagnosis of disease indicates that men and women with MS may experience perceptions of their function with age differently. This has implications for clinician advice to men and women with MS.

Background: While longitudinal designs can provide significant advantages compared to single measurement/cross sectional designs, they require careful attention to study infrastructure and the risk of attrition among the sample over multiple time points. Objective: The strategies used to design and manage an appropriate infrastructure for a longitudinal study and approaches to retain samples are explored using examples from 2 studies, a 25-year study of persons living with multiple sclerosis and a 10-year longitudinal follow-up of breast cancer survivors. Results: Key strategies (developing appropriate infrastructure, minimizing costs to participants, and maximizing rewards of study participation) have helped address the serious threat of attrition in these longitudinal samples. Conclusion: Implementation of these strategies can help mitigate some of the disadvantages and leverage the strengths of longitudinal research to produce reliable, insightful, and impactful outcomes. [ABSTRACT FROM AUTHOR]

Understanding how persons aging with a chronic condition view their health is essential for planning and delivering person‐centered care. The purpose of this study was to explore how persons aging with the chronic and disabling condition multiple sclerosis (MS) describe their health and how this has changed over time using data from Years 1 to 26 of an ongoing longitudinal survey study of health promotion and quality of life for persons with MS. The survey included measures of perceived meaning of health, self‐rated health, health behaviors and quality of life outcomes. The sample included 168 persons with MS who returned the survey at Time 1 (1996) and again at Time 26 (2022). In 2022, participants had a mean age of 70.13 (SD = 8.19) and had been diagnosed with MS for an average of 34.47 years (SD = 6.27). Sixty percent of participants rated their overall health as good or excellent. Decreases in health self‐ratings over time were not significant. Participants consistently agreed more strongly with items reflecting a wellness‐oriented view of health than those reflecting a more clinical/biomedical model. At both time points, clinical definitions of health were negatively related and wellness definitions were positively related to reported frequency of health behaviors. Findings suggest that persons aging with the chronic condition of MS may be more responsive to health messages that emphasize function in daily living, carrying out normal responsibilities, and adjusting to changes in environment and demands. Patient or Public Contribution: Persons with MS provided study data, input on design, and construct measurement. [ABSTRACT FROM AUTHOR]

BackgroundMultiple sclerosis (MS), a chronic neurological disease typically diagnosed in young adulthood, presents with a wide variety of symptoms, impairments and functional limitations. Given the chronic, unpredictable and long-term nature of this disease, preserving function is essential.ObjectiveThe purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS.MethodsParticipants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year.ResultsAfter adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11.ConclusionFindings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.

The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit's acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH., Author(s): Lorraine O. Walker [sup.1] , Bobbie S. Sterling [sup.1] , Heather Becker [sup.1] , Sherry Hendrickson [sup.1] , Bo Xie [sup.1] [sup.2] Author Affiliations: (Aff1) 0000 0004 1936 9924, [...]

Objectives: Examine acculturation and psychological, lifestyle, and physiological factors based on gender and country of origin (U.S. vs. Mexico). Methods: Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed – acculturation (language), psychological factors (depression), lifestyle factors (sedentary behaviors), and diabetes-related physiological outcomes (insulin resistance). MANOVA and linear regression were used to examine variable relationships based on gender and country of origin and identify predictors of depression and insulin resistance. Results: Participants were: predominantly female (73%); 51 years of age, on average; born in Mexico (71%); and Spanish-speaking. Individuals spent 11 of their waking hours (range = 0–18 h) in sedentary activities. Compared to females, more males spoke English and reported fewer hours in sedentary activities. Compared to participants born in Mexico, those born in the U.S. were more likely to: speak English; report depressive symptoms; and exhibit elevated BMI and insulin resistance rates. Two distinct models significantly predicted depression (R2 = 14.5%) and insulin resistance (R2 = 26.8%), with acculturation-language entering into both models. Discussion: Significant gender and country-of-origin differences were found. Future research on diabetes prevention should examine other Hispanic subgroups and strategies for addressing individual differences, while employing cost-effective group interventions that incorporate these differences and reach more at-risk individuals. [ABSTRACT FROM AUTHOR]

Abstract AIM The aim of this study was to assess learning outcomes from a simulation on providing care to a critically ill patient from whom care is ultimately withdrawn. BACKGROUND [...]

Purpose: Cognitive training improves mental abilities in older adults, but the benefit to minority elders is unclear. We conducted a subgroup analysis of subjects in the SeniorWISE (Wisdom Is Simply Exploration) trial to examine this issue. Design and Methods: SeniorWISE was a Phase 3 randomized trial that enrolled 265 nondemented community-dwelling older adults aged 65 years and older between 2001 and 2006. Participants were randomly assigned to 12 hr of either memory or health training. Results: The sample was 79% female, 71% Caucasian, 17% Hispanic, and 12% African American. On the Rivermead Behavioural Memory Test (RBMT), 28% of the sample scored normal, 47% scored poor, and 25% impaired. Memory performance changed differently over time depending on the demographic characteristics of participants. Both Hispanics and Blacks performed better than Whites on visual memory, and Blacks performed better over time on instrumental activities of daily living. On all performance measures, lower pretest scores were associated with relatively greater improvements over time. Implications: Our analyses suggested that minority participants received differential benefits from the memory training; however, this remains speculative because the 3 ethnic groups in the sample were not equivalent in size. The question of why Black and Hispanic participants often made greater improvements needs further exploration.

Purpose: The original version of the Direct Assessment of Functional Status (DAFS), a measure of instrumental activities of daily living (IADLs), was found to have a ceiling effect in older adults living independently in the community. This suggested that the tasks measured, although relevant, do not require full use of this population's abilities, and thus, the instrument may not be sensitive to the early decrements in IADLs that can signal initial cognitive impairment and may not detect improvements in IADLs over time, which is especially important in intervention research. Design and Methods: By removing items with little to no variation and adding more difficult subscales that emphasized medication management skills, we designed the DAFS-Extended (Direct Assessment of Functional Status-Revised [DAFS-R]) to be more challenging for elders living independently. Results: Analysis with a sample of 45 older adults suggested that scores on the DAFS-R appear to be more normally distributed than on the original version. The DAFS was able to differentiate individuals with varying standard profile scores on the Rivermead Behavioural Memory Test memory performance instrument (normal, poor, and impaired). In addition, the reliability and validity of the DAFS-R were supported in this sample. Implications: Given the large number of older adults who regularly take multiple prescription medications, deficits in medication management skills can have serious consequences. A performance measure that emphasizes these higher level daily living skills can help providers screen for initial signs of functional decline.

While many researchers have studied the etiology of autism, possible racial/ethnic differences in prevalence of the autism diagnosis have received much less attention. Using the Texas Education Agency Public Education Information Management System (PEIMS) data set for 2006, we examined the prevalence of an educational diagnosis of autism among Black, White, and Hispanic students. The percentage of all Texas children served under the autism label in 2006 was 0.43% (n = 19, 813). White and Black children were more likely than Hispanic children to receive an autism educational diagnosis (0.62%, 0.44%, and 0.27% respectively). The percentage of students diagnosed with autism varied by geographic area and income level, as well. Possible reasons for the disparity in prevalence of autism diagnoses are discussed.

The purpose of this study is to compare Mexican American adolescent mothers with and without childhood sexual abuse (CSA) histories to examine the influence of CSA on dissociation, selection of infant feeding method, and intimate parenting anxiety. Participants are 78 English-speaking adolescents between 15 and 19 years of age and recruited from the southwestern United States. Nearly one third of the sample ( n = 24, 30.77%) reports CSA histories. There is no correlation between CSA history and intimate parenting anxiety, no difference between breast-feeding and formula-feeding mothers in CSA severity, and intimate parenting anxiety does not predict dissociation. These findings are inconsistent with previous research. Supportive resources may explain the inconsistency and play a role in adolescent mothers' responses to CSA. Further research is necessary to explore these possibilities. (Contains 1 table.)

This paper describes strategies developed to recruit and retain an ethnically diverse sample in a longitudinal intervention of 246 participants in the SeniorWISE study. The ethnic and socioeconomic differences of these participants necessitated the use of different methods of effectively communicating with this population. Recruitment benefited from the use of focus groups, media attention, and personal appearances in the community. Educational strategies included modification of language and examples. Testing sessions were called interviews, and team members were available to answer questions and to read the instruments to participants, when desired. Participants were sent birthday cards and a monthly newsletter. The study is 90% completed.