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To study the relationship between well-being and all-cause mortality, we estimated mortality among women in four classes of well-being using the well-being profile from the Women’s Health Initiative Study (WHI). Demographic characteristics were self-reported at enrollment (1993-98). All-cause mortality included death from any cause between 2012-2020. We used logistic regression to examine all-cause mortality risk across the classes, using Class 4 (highest hedonic and eudaemonic well-being scores) as the referent, adjusting for age and race. Compared to Class 4, all other classes had higher age- and race-adjusted odds of death. Highest risks were in Class 1 women (OR=2.61; 95% CI: 2.46-2.76) and Class 3 women (OR=1.62; 95% CI: 1.55-1.68). Women in Class 4 had the lowest risk of all-cause mortality over an 18-year follow-up. These results confirm the utility of a profile of well-being for predicting all-cause mortality while preserving ability to identify the differences among well-being indicators across classes.

Our aim was to develop a profile of well-being preserving the ability to estimate differential effects of both hedonic and eudaemonic dimensions of well-being on health outcomes. Numerous indicators of well-being from over 80,000 aging women included hedonic (enjoyment of life, happiness, satisfaction with life, quality of life) and eudaemonic (personal growth, purpose in life, environmental mastery, control, self mastery) dimensions. Using latent class analysis, we identified groups of women with distinct profiles of well-being. A four-class solution had both good statistical fit and made conceptual sense. Class 1 (n=9,146, 11%) had the lowest scores on hedonic and eudaemonic indicators, while Class 4 (n=38,246 47%) had the highest levels of all well-being indicators. Class 2 (n=7,106, 9%) had higher hedonic and lower eudaemonic scores and Class 3 (n=26,650, 33%) had lower hedonic and higher eudaemonic scores. These classes form a well-being profile useful for estimating differential effects on health outcomes.

Objectives To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales. Methods We analyzed baseline and postrandomization patient-reported data pooled across three randomized trials aimed at reducing vasomotor symptoms (VMS) in 899 midlife women. Trials were conducted across five MsFLASH clinical sites between July 2009 and October 2012. We eliminated HFRDIS items based on experts' content validity ratings and confirmatory factor analysis, and evaluated cut-points and established MIDs by mapping HFRDIS and HFI to other measures. Results The three-item HFI (interference with sleep, mood, and concentration) demonstrated strong internal consistency (alphas of 0.830 and 0.856), showed good fit to the unidimensional "hot flash interference factor," and strong convergent validity with HFRDIS scores, diary VMS, and menopausal quality of life. For both scales, cut-points of mild (0-3.9), moderate (4-6.9), and severe (7-10) interference were associated with increasing diary VMS ratings, sleep, and anxiety. The average MID was 1.66 for the HFRDIS and 2.34 for the HFI. Conclusions The HFI is a brief assessment of VMS interference and will be useful in busy clinics to standardize VMS assessment or in research studies where response burden may be an issue. The scale cut-points and MIDs should prove useful in targeting those most in need of treatment, monitoring treatment response, and interpreting existing and future research findings.

Author(s): Beasley, Jeannette M; LaCroix, Andrea Z; Neuhouser, Marian L; Huang, Ying; Tinker, Lesley; Woods, Nancy; Michael, Yvonne; Curb, J David; Prentice, Ross L | Abstract: ObjectivesTo evaluate the association between protein intake and incident frailty.DesignProspective cohort study.SettingSubset of the Women's Health Initiative Observational Study conducted at 40 clinical centers.ParticipantsTwenty-four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes (600-5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ).MeasurementsBaseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24-hour urinary nitrogen). After 3 years of follow-up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand-36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake.ResultsOf the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8-16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23-50%) lower risk of frailty.ConclusionHigher protein consumption, as a fraction of energy, is associated with a strong, independent, dose-responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.

Author(s): Woods, Nancy Fugate; LaCroix, Andrea Z; Gray, Shelly L; Aragaki, Aaron; Cochrane, Barbara B; Brunner, Robert L; Masaki, Kamal; Murray, Anne; Newman, Anne B; Women's Health Initiative | Abstract: ObjectivesTo define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability.DesignProspective study, the Women's Health Initiative Observational Study.SettingForty U.S. clinical centers.ParticipantsForty thousand six hundred fifty-seven women aged 65 to 79 at baseline.MeasurementsComponents of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up.ResultsBaseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions.ConclusionThese results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.

Women's issues of violence, mental health problems, and substance abuse have been noted to cooccur, but few studies have examined the interrelationship among the three. A chart review of 198 women (primarily African American) at an inner city substance abuse treatment center was performed to collect data related to physical and sexual abuse experiences before and after age 13. There were significant associations among all forms of physical and sexual abuse before and after age 13 and most of the types of substances abused and almost all of the presenting mental health problems, but most of the independent relationships became nonsignificant in multivariate analyses. However, the experience of both physical and sexual assault increased the risk of suicide attempts by a factor of 6.04. Physical assault was a borderline (p= .07) predictor of depression, while sedative use was significantly predictive of depression, anxiety, and suicide attempts.

This study aims to determine whether vitamin D levels are associated with menopause-related symptoms in older women.A randomly selected subset of 1,407 women, among 26,104 potentially eligible participants of the Women's Health Initiative Calcium and Vitamin D trial of postmenopausal women aged 51 to 80 years, had 25-hydroxyvitamin D [25(OH)D] levels measured at the Women's Health Initiative Calcium and Vitamin D trial baseline visit. Information about menopause-related symptoms at baseline was obtained by questionnaire and included overall number of symptoms and composite measures of sleep disturbance, emotional well-being, and energy/fatigue, as well as individual symptoms. After exclusions for missing data, 530 women (mean [SD] age, 66.2 [6.8] y) were included in these analyses.Borderline significant associations between 25(OH)D levels and total number of menopausal symptoms were observed (with P values ranging from 0.05 to 0.06 for fully adjusted models); however, the effect was clinically insignificant and disappeared with correction for multiple testing. No associations between 25(OH)D levels and composite measures of sleep disturbance, emotional well-being, or energy/fatigue were observed (P's0.10 for fully adjusted models).There is no evidence for a clinically important association between serum 25(OH)D levels and menopause-related symptoms in postmenopausal women.

To evaluate the association between protein intake and incident frailty.Prospective cohort study.Subset of the Women's Health Initiative Observational Study conducted at 40 clinical centers.Twenty-four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes (600-5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ).Baseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24-hour urinary nitrogen). After 3 years of follow-up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand-36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake.Of the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8-16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23-50%) lower risk of frailty.Higher protein consumption, as a fraction of energy, is associated with a strong, independent, dose-responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.

Author(s): Beasley, Jeannette M; LaCroix, Andrea Z; Neuhouser, Marian L; Huang, Ying; Tinker, Lesley; Woods, Nancy; Michael, Yvonne; Curb, J David; Prentice, Ross L | Abstract: ObjectivesTo evaluate the association between protein intake and incident frailty.DesignProspective cohort study.SettingSubset of the Women's Health Initiative Observational Study conducted at 40 clinical centers.ParticipantsTwenty-four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes (600-5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ).MeasurementsBaseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24-hour urinary nitrogen). After 3 years of follow-up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand-36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake.ResultsOf the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8-16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23-50%) lower risk of frailty.ConclusionHigher protein consumption, as a fraction of energy, is associated with a strong, independent, dose-responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.

Although more and more hospitals are implementing universal newborn hearing screening programs, there is still very little information available about the costs of newborn hearing screening programs. The few articles which have been published evaluate technologies or protocols which are no longer used, are incomplete, or are based on hypothetical estimates of the costs and time necessary to do screening. After briefly reviewing the extant literature, this article describes a cost analysis of a TEOAE-based universal newborn hearing screening program. Reasons why the cost per baby ($7.42) is lower than in previous reports are explained, and the benefits of having accurate cost analysis data are summarized.