Marital status and gender differences in managing a chronic illness: the function of health-related social control

Clinical and sociodemographic determinants of older breast cancer survivors' reports of receiving advice about exercise

PURPOSE

Exercise offers various clinical benefits to older breast cancer survivors. However, studies report that healthcare providers may not regularly discuss exercise with their patients. We evaluated clinical and sociodemographic determinants of receiving advice about exercise from healthcare providers among older breast cancer survivors (aged ≥65 years).

METHODS

We used data from the Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare Health Outcomes Survey (MHOS) from 2008 to 2015. We included female breast cancer survivors, aged ≥65 years, who completed the MHOS survey ≥2 years after a breast cancer diagnosis in a modified Poisson regression to identify clinical and sociodemographic determinants of reportedly receiving advice about exercise from healthcare providers.

RESULTS

The sample included 1,836 breast cancer survivors. The median age of the sample was 76 years (range: 72-81). Overall, 10.7% of the survivors were non-Hispanic Black, 10.1% were Hispanic, and 69.3% were non-Hispanic White. Only 52.3% reported receiving advice about exercise from a healthcare provider. Higher body mass index (BMI) and comorbid medical history that included diabetes, cardiovascular, or musculoskeletal disease were each associated with a higher likelihood of receiving exercise advice. Lower education levels, lower BMI, and never having been married were each associated with a lower likelihood of receiving exercise advice.

CONCLUSIONS

Nearly half of breast cancer survivors aged ≥65 years did not report receiving exercise advice from a healthcare provider, suggesting interventions are needed to improve exercise counseling between providers and survivors, especially with women with lower educational attainment who have never been married.

Lack of social support, gender and colorectal cancer screening participation across Europe: How do screening programmes mitigate the effect of social support for men and women?

This study investigates how a lack of social support differentially affects men and women's colorectal cancer (CRC) screening participation, considering different screening strategies implemented across European countries. Although health sociology has stressed gender differences in social support and its effects on health behaviours, this was overlooked by cancer screening research. Using a data set of 65,961 women and 55,602 men in 31 European countries, we analysed the effect of social support variables on CRC screening uptake. We found that living alone and lower perceived social support were associated with lower screening uptake for both men and women. These effects were, however, stronger among men. Population-based screening programmes mitigated these effects, particularly for women, but not for men living alone. In countries with opportunistic screening programmes, social support variables remained associated with screening uptake. We conclude that cancer screening interventions should pay attention to social support and its gender-differentiated effects.

Quality of Life With Cochlear Implantation Using the CIQOL-35 at a Tertiary Urban Medical Center: Our Experience

OBJECTIVE

Assessment of quality-of-life (QOL) outcomes after cochlear implantation (CI) using the Cochlear Implant Quality of Life-35 questionnaire (CIQOL-35).

STUDY DESIGN

Retrospective cohort.

SETTING

Single-institution tertiary care center.

PATIENTS

Patients 18 years and older who have undergone CI and CIQOL-35 survey.

INTERVENTIONS

Implementing CIQOL-35 from 2019 to 2022 to measure change in QOL after CI. Statistical analysis included nonparametric, univariate, and multivariate analyses. Significance was set at 0.05.

MAIN OUTCOME MEASURES

Differences in QOL among CI patients in each of the CIQOL-35 domains.

RESULTS

Ninety-three patients (40 female, 53 male) aged 20 to 93 years (median 70 years) turned in 164 QOL surveys (68 preactivation, 96 postactivation). Postactivation median QOL was 5 to 15 points higher across all domains ( p < 0.001). QOL score distributions among unilateral CI only, bilateral CI, and unilateral CI with contralateral hearing aid users were not statistically different ( p > 0.05). Multivariate analysis identified that male sex ( β = -2.0; 95% confidence interval, -3.9 to -0.1) was a negative predictor for environment scores and not being married ( β = 2.0; 95% confidence interval, 0.02 to 4.0) was a positive predictor for entertainment scores. Median follow-up time was 13 months post-CI (interquartile range [IQR], 7.1-21.5 months).

CONCLUSIONS

CI patients experienced improved QOL postactivation among all QOL domains, whereas specific CI use pattern in regard to unilateral, bilateral, or bimodal did not affect QOL. Multivariate analysis identified marital status and sex as possible QOL predictors.

Barriers to accessing care for cardiometabolic disorders in Malawi: partners as a source of resilience for people living with HIV

BACKGROUND

People living with HIV (PLWH) are at increased risk of cardiometabolic disorders (CMD). Adequate access to care for both HIV and CMD is crucial to improving health outcomes; however, there is limited research that have examined couples' experiences accessing such care in resource-constrained settings. We aimed to identify barriers to accessing CMD care among PLWH in Malawi and the role of partners in mitigating these barriers.

METHODS

We conducted a qualitative investigation of barriers to CMD care among 25 couples in Malawi. Couples were eligible if at least one partner was living with HIV and had hypertension or diabetes (i.e., the index patient). Index patients were recruited from HIV care clinics in the Zomba district, and their partners were enrolled thereafter. Interviews were conducted separately with both partners to determine barriers to CMD care access and how partners were involved in care.

RESULTS

Participants framed their experiences with CMD care by making comparisons to HIV treatment, which was free and consistently available. The main barriers to accessing CMD care included shortage of medications, cost of tests and treatments, high cost of transportation to health facilities, lengthy wait times at health facilities, faulty or unavailable medical equipment and supplies, inadequate monitoring of patients' health conditions, some cultural beliefs about causes of illness, use of herbal therapies as an alternative to prescribed medicine, and inadequate knowledge about CMD treatments. Partners provided support through decision-making on accessing medical care, assisting partners in navigating the healthcare system, and providing financial assistance with transportation and treatment expenses. Partners also helped manage care for CMD, including communicating health information to their partners, providing appointment reminders, supporting medication adherence, and supporting recommended lifestyle behaviors.

CONCLUSIONS

Couples identified many barriers to CMD care access, which were perceived as greater challenges than HIV care. Partners provided critical forms of support in navigating these barriers. With the rise of CMD among PLWH, improving access to CMD care should be prioritized, using lessons learned from HIV and integrated care approaches. Partner involvement in CMD care may help mitigate most barriers to CMD care.

A scoping review of web-based, interactive, personalized decision-making tools available to support breast cancer treatment and survivorship care

PURPOSE

We reviewed existing personalized, web-based, interactive decision-making tools available to guide breast cancer treatment and survivorship care decisions in clinical settings.

METHODS

The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched PubMed and related databases for interactive web-based decision-making tools developed to support breast cancer treatment and survivorship care from 2013 to 2023. Information on each tool's purpose, target population, data sources, individual and contextual characteristics, outcomes, validation, and usability testing were extracted. We completed a quality assessment for each tool using the International Patient Decision Aid Standard (IPDAS) instrument.

RESULTS

We found 54 tools providing personalized breast cancer outcomes (e.g., recurrence) and treatment recommendations (e.g., chemotherapy) based on individual clinical (e.g., stage), genomic (e.g., 21-gene-recurrence score), behavioral (e.g., smoking), and contextual (e.g., insurance) characteristics. Forty-five tools were validated, and nine had undergone usability testing. However, validation and usability testing included mostly White, educated, and/or insured individuals. The average quality assessment score of the tools was 16 (range: 6-46; potential maximum: 63).

CONCLUSIONS

There was wide variation in the characteristics, quality, validity, and usability of the tools. Future studies should consider diverse populations for tool development and testing.

IMPLICATIONS FOR CANCER SURVIVORS

There are tools available to support personalized breast cancer treatment and survivorship care decisions in clinical settings. It is important for both cancer survivors and physicians to carefully consider the quality, validity, and usability of these tools before using them to guide care decisions.

Men With Type II Diabetes in Peru: The Role of Masculine Gender Norms in the Perception of Family Support

Type II diabetes is increasingly becoming a problem in Latin American countries such as Peru. People living with diabetes must incorporate several behavioral changes in their everyday lives, which are done outside the purview of medical professionals. Support from friends and family members is essential to the successful management of any chronic condition. Our study discusses the role of family involvement in supporting the management of diabetes among Peruvian men and examines how masculine norms play a role in the way such support is received and perceived, and their influence in motivation to adhere to treatment recommendations. In-depth interviews with 20 men from a low socioeconomic status, aged 27 to 68 with a diagnosis of Type II diabetes were conducted. Our analysis suggests the importance of the close, complex, and integrated experience that connects family members and patients with a chronic condition. Participant accounts demonstrate they receive multiple forms of support from a diverse range of social relationships. The overwhelming majority of the people giving the support were female and were especially significant in supporting management practices. The participants' accounts were able to demonstrate how living with a chronic condition, such as diabetes, affects the whole family-physically, mentally, and emotionally-and they experience the disease as one unit. Our study demonstrates the need for a family health experience approach that considers masculine gender norms around health and provides relevant insights to inform family-based treatments and therapies to allow for more and better targeted health care for men.

Do men adapt to lower urinary tract symptoms? An 11-year longitudinal study of male urinary urgency and associated bother

OBJECTIVE

The study objective is to evaluate prognosis and predictors of bother caused by urinary urgency among middle-aged and older men.

MATERIAL AND METHODS

A population-based sample of men born in 1974, 1964, 1954, 1944, 1934 and 1924 was followed-up from 2004 to 2015. The course of urgency and associated bother was evaluated with the Danish Prostatic Symptom Score at baseline and follow-up. Logistic regression was utilized to explore risk factors of increased bother at follow-up.

RESULTS

A total of 2,480 men (39%) who had responded at baseline and follow-up were included in the study. Of them, 1,056 men (43%) had persistent mild urgency and 132 men (5%) persistent moderate or severe urgency at follow-up. The proportions of men experiencing at least moderate bother due to persistent urgency at follow-up were 6% (95% confidence interval 4.5-7.3) of those with mild and 79% (71.7-85.9) of the men with moderate or severe urgency. In multivariable-adjusted logistic regression, moderate to severe urgency was strongly associated with bother (odds ratio, OR 55.2, 95% CI 32.1-95.2). Other predictors of bother included cardiac disease (OR 1.8, 95% CI 1.0-31.1), pulmonary disease (OR 1.9, 95% CI 1.1-3.5) and medical treatment (OR 2.7, 95% CI 1.6-4.6).

CONCLUSIONS

Most men with urinary urgency have mild symptoms and bother. Only one out of five men with persistent moderate or severe urgency adapt to the symptoms. Men with a history of medical treatment for lower urinary tract symptoms (LUTS) or impaired cardiopulmonary health are more likely to experience bother from urinary urgency.

"I too have a responsibility for my partner's life": Communal coping among Malawian couples living with HIV and cardiometabolic disorders

RATIONALE

HIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.

METHODS

This study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness.

RESULTS

Most participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was "our problem." In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence.

CONCLUSION

We conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.

Gender differences in vitiligo: psychological symptoms and quality of life assessment description

Objective

Assuming that the difference exist in the manifestation of psychological suffering among genders, the purpose of this review is to summarize the current knowledge on gender differences in vitiligo quality of life and psychological assessment.

Methods

We searched in PubMed, Scopus, and Web of Science databases for original articles in English language. Results were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA checklist).

Results

The study yielded 107 results; 12 articles have been evaluated as eligible. Each eligible study has been screened and analyzed. The study's qualitative evaluation revealed that 8 papers were classifiable as satisfactory, 4 were classifiable as unsatisfactory. The agreement between the coders was high (% agreement = 84.6%; Cohen's kappa = 0.79). All considered researches (100%) were cross-sectional studies, based on self-report questionnaires. From our analysis, women with vitiligo had a higher risk to experience lower quality of life, and worse mental health in a wide range of psychopathology symptoms than men. A wide heterogeneity of tools is used to investigate the quality of life and psychological symptoms among these patients.

Conclusion

Unfortunately, there are few explanatory models proposed in the literature to rationalize these findings. It will be important to investigate in further researches the specific influence of known risk factors for psychopathology in this population to better explore these phenomena.

Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters

BACKGROUND

Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control.

METHOD

Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators.

RESULTS

Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (β =  - 3.00, p = 0.02; β =  - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect =  - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters.

CONCLUSION

These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.

Marital Histories and Associations With Later-Life Dementia and Mild Cognitive Impairment Risk in the HUNT4 70+ Study in Norway

Objectives: Earlier studies suggest that being married in later life protects against dementia, and that being single in old age increases the risk of dementia. In this study, we examine midlife marital status trajectories and their association with dementia and mild cognitive impairment (MCI) at ages 70 plus using a large population based sample from Norway. Methods: Based on a general population sample linked to population registries (N = 8706), we used multinomial logistic regression to examine the associations between six types of marital trajectories (unmarried, continuously divorced, intermittently divorced, widowed, continuously married, intermittently married) between age 44 and 68 years from national registries and a clinical dementia or a MCI diagnosis after age 70. We estimated relative risk ratios (RRR) and used mediation analyses adjusting for education, number of children, smoking, hypertension, obesity, physical inactivity, diabetes, mental distress, and having no close friends in midlife. Inverse probability weighting and multiple imputations were applied. The population attributable fraction was estimated to assess the potential reduction in dementia cases due to marital histories. Results: Overall, 11.6% of the participants were diagnosed with dementia and 35.3% with MCI. Dementia prevalence was lowest among the continuously married (11.2%). Adjusting for confounders, the risk of dementia was higher for the unmarried (RRR = 1.73; 95% CI: 1.24, 2.40), continuously divorced (RRR = 1.66; 95% CI: 1.14, 2.43), and intermittently divorced (RRR = 1.50; 95% CI: 1.09, 2.06) compared to the continuously married. In general, marital trajectory was less associated with MCI than with dementia. In the counterfactual scenario, where all participants had the same risk of receiving a dementia diagnosis as the continuously married group, there would be 6.0% fewer dementia cases. Discussion: Our data confirm that staying married in midlife is associated with a lower risk of dementia and that divorced people account for a substantial share of dementia cases.

Quantitative measurement of empathy and analysis of its correlation to clinical factors in korean patients with chronic diseases

BACKGROUND

Empathy is the core of the physician-patient relationship. The Consultation and Relational Empathy (CARE) measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in chronic disease patients in Korea. We aim to evaluate empathy using the Korean CARE measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with chronic disease.

METHODS

Data were collected from patients with chronic diseases. Patients were from primary, secondary, and tertiary clinics. Characteristics of the patients, physicians, and disease status were collected. The difference in CARE score was studied according to the clinical factors.

RESULTS

A total of 162 patients with chronic diseases were included. About 60% of patients were male. The mean age was 62 years. They had an average number of 2.6 diseases. More than half of patients experienced overt cardiovascular disease. About half of them had a history of hospitalization due to cardiovascular disease. The overall average CARE score was 45.6 ± 7.0. The CARE score was not significantly different according to the characteristics of the patient, physician, or disease status. Regarding marital status, the CARE score was significantly lower for the small number of patients (n = 4, 2.5%) who refused to provide their marital status than for other groups. Except for four patients, there was no significant difference in the CARE score among married, unmarried, or divorced groups. This trend was maintained in hypertensive patients.

CONCLUSIONS

The Korean CARE measure could assess patient-rated empathy in various clinical practices. The empathy of patients was high regardless of multiple factors.

Reactance to Healthy Eating and Physical Activity Messages: Face Threat and Face Management Strategies in Memorable Daily Conversations Among Couples

Most adults in the United States (U.S.) fail to meet guidelines for physical activity (PA) and nutrition outlined by the Centers for Disease Control. One important predictor of engagement in healthy behavior is support from one's romantic partner. However, messages from partners may fail to motivate healthy behavior if they threaten recipients' face and cause reactance. The present study examines face-threatening acts (FTAs) and face management strategies (FMSs) in conversations between romantic couples and their associations with reactance, healthy eating, and PA behaviors. Cohabitating couples (N = 70) were recruited, and one member of the couple completed a 10-day diary survey in which they reported on daily memorable conversations they had with their partner about PA and/or healthy eating. Participants completed measures of positive and negative face threat, as well as the extent to which they engaged in healthy eating and PA that day. Trained raters assessed reported conversations for positive and negative face threat as well as positive and negative FMSs. Results indicate that both participant and trained raters' reports of positive face threat were associated with increased reactance, whereas only participants' reports of negative face threat were associated with increased reactance. Both positive and negative FMSs were associated with reduced reactance. Reactance was negatively associated with healthy eating and PA. Results are discussed in terms of implications for reactance and politeness theories, as well as pragmatic implications for the millions of partnered individuals in the U.S. seeking to improve their health.

Exploring typologies of appraisals, involvement, and distress in type 2 diabetes family members

The present study conducted a latent profile analysis from a US national sample of 446 family members to identify and predict unique clusters of family members' PWD illness appraisals, involvement, and psychological distress. Time since diagnosis, diabetes adherence, the relationship with the PWD, age, gender, race/ethnicity, income, and economic pressure were included as predictors. Class membership was used to predict the family members' own health behaviors (sleep quality, days of physical activity, and diet quality). Results revealed four distinct classes: Moderately Concerned, Involved, and Distressed (32.51%), Least Concerned, Distressed, and Involved (27.13%), Less Concerned and Distressed, Moderately Involved (23.77%), and Most Concerned, Involved, and Distressed (16.82%). The significant predictors and outcomes of class membership revealed interesting patterns in associations with class membership. Consequently, in addition to involving family members, health promotion and intervention efforts must consider the psychological health and illness appraisals of family members rather than a one-size-fits-all approach.

Motives for spousal involvement in a Partner's diabetes management: Considering the role of gender and links to diet-related involvement

Using data from 148 middle-aged and older adult spouses whose partners had type 2 diabetes, we sought to examine spouses' motives for involvement in their partners' diabetes management and whether these motives were related to common types of diabetes-related spousal involvement; we also sought to understand gender differences in these dynamics. Spouses indicated being motivated to be involved in their partners' diabetes management due to altruistic motives to the greatest extent and egoistic motives to the least extent. Results from multivariable regression analyses that controlled for gender, marital quality, and spouses' own conditions requiring dietary changes revealed that all types of motives were related to the frequency of providing diet-related spousal support, whereas only egoistic motives were related to the frequency of exerting diet-related spousal control. We did not find gender differences in any motives nor in associations with spousal involvement. Findings have potential implications for couples-oriented chronic illness interventions.

Family support in the management of diabetes patients' perspectives from Limpopo province in South Africa

BACKGROUND

Family support is linked with improved diabetes outcomes, whereas lack thereof is associated with complications. Living together with people in the same household doesn't guarantee support in diabetes management. Hence it is critical to comprehend patient's lived experiences regarding family support.

OBJECTIVES

To explore family support in diabetes management.

METHODOLOGY

Qualitative method and phenomenological exploratory descriptive design were used to collect data from 17 patients with 6 months or more living with diabetes and getting treatment in clinics of Senwabarwana, Limpopo province. Purposive sampling was used to select participants. One-on-one interviews were conducted using voice recorders and field notes for non-verbal cues were observed. Unstructured interview guide with principal question which enabled probing was used. Data were analysed using 8 Steps of Tesch's inductive, descriptive, and open coding technique. Trustworthiness was ensured.

RESULTS

Participants get support from family members with regards to food, exercise, and collection of medication. Diabetic men with sexual dysfunction also reported getting similar support from their wives whereas, in contrary diabetic women do not get sufficient supports from their husbands. Loss of income among diabetic men has been reported as a source of martial conflicts and unsatisfactory support from wives.

CONCLUSION

Family members of diabetic patients collect medication for patients, including cooking and serving meals to them. Wives of diabetic men outpace husbands of diabetic women in responsiveness to the health needs of their partners, respectively. Diabetic men with impaired sexual function get support from their wives, whilst female patients do not get similar support from their husbands. On the other hand, patients who lost income get inadequate spousal support, which compromises diabetes management and adherence to treatment. This study identifies gender disparities in spousal support as crucial issue requiring an urgent attention, hence the need for gender-biased family-centred diabetes care.

Mealtime Behavior and Depressive Symptoms in Late-Life Marriage

This study examined whether one spouse's mealtime behaviors were associated with their own and their partner's depressive symptoms among older, married couples. We examined gender differences in these associations and tested marital satisfaction as a mediator of these associations. 101 couples self-reported mealtime behavior (number of meals, snacks, fast-food meals, and meals eaten alone), depressive symptoms, and marital satisfaction. Results of the Actor Partner Interdependence Model revealed a statistically significant actor effect of number of fast-food meals on depressive symptoms and a significant partner effect of number of fast-food meals and number of meals eaten alone on depressive symptoms. There were gender differences. Husbands' marital satisfaction mediated the effect of meals eaten alone on depressive symptoms. Wife's marital satisfaction mediated the effect of the husband's meals eaten alone, and wife's number of fast-food meals on the wife's depressive symptoms. Findings have implications for dyadic interventions to improve depressive symptoms.

The use of SCL-k-9 to measure general psychopathology in women and men with skin conditions

Objectives

To measure general psychopathology in dermatologic outpatients using the Symptom-Checklist-K-9 (SCL-K-9); to investigate whether the SCL-K-9 is able to categorize patients with and without significant non-psychotic disorders; and to perform a single-item analysis of the SCL-K-9, with a focus on gender differences.

Methods

Cross-sectional study on consecutive dermatological patients. We used two self-administered questionnaires to assess general psychopathology symptoms: General Health Questionnaire-12 (GHQ-12) and SCL-K-9. Sociodemographic information was collected with standardized forms. The performance of the SCL-K-9 in classifying patients according to their current emotional distress severity was assessed using a ROC procedure. Finally, we measured differences in scores obtained among women and men in SCL-K-9 single items.

Results

A total of 292 patients were studied (71.2% women). We observed statistically significant differences in SCL-K-9 total mean scores and in most single items among genders. We found that it would be more appropriate to use gender-specific cut-offs when using SCL-K-9 to screen dermatological patients for general psychopathology.

Conclusion

The SCL-K-9, with its compact format could provide, in a short time, a wide range of information related to critical areas that challenge the mental health of patients with skin diseases.

Factors Associated With Control of Diabetes and Hypertension Among Patients Seen as Part of a Longitudinal Medical School Service-Learning Program From 2018-2019: An Exploratory Analysis

Introduction

The Florida International University (FIU) Green Family Neighborhood Health Education Learning Program (NeighborhoodHELP) in Miami-Dade County serves communities impacted by adverse social determinants of health. This study identified sociodemographic factors affecting control of diabetes and hypertension among NeighborhoodHELP patients.

Methods

This non-concurrent cohort study evaluated NeighborhoodHELP patients who received care at mobile health centers (MHCs) utilizing de-identified data extracted from the MHCs' clinical quality metrics data set for the 2018-2019 fiscal year. A total of 143 eligible adults with diabetes and 222 adults with hypertension were identified. Condition control was defined as blood pressure ≤ 130 mmHg (systolic) and ≤ 80 mmHg (diastolic) or hemoglobin A1c (HbA1c) ≤ 7% (diabetes). Association with age, gender, ethnicity, marital status, language, service area, income per-capita, and medical student assignment was explored using logistic regression.

Results

The model showed decreased diabetes control likelihood among Haitian-Creole speakers (OR: 0.13; 95% CI: 0.02-0.75). Odds of diabetes control were greater in two discrete areas serviced by the program, one known as Hippocrates (OR: 4.9; 95% CI: 1.23-19.37) and the other Semmelweis (OR: 3.71; 95% CI: 1.07-12.83). Income greater than $10,000 increased hypertension control likelihood (OR: 2.22; 95% CI: 1.03-4.8).

Conclusions

Among NeighborhoodHELP patients, geographic region and language impact diabetes control, while income affects hypertension control. Further research is warranted to identify the role of other factors.

Experiences of living with type 2 diabetes in Pakistan: the role of culture and family in physical activity

Background

Diabetes-related guidelines recommend lifestyle changes for people living with type 2 diabetes (PLwD). In South Asian (SA) families, cultural and contextual expectations often influence people’s decisions. However, broad explanations provided in the existing literature and theories concerning family involvement can increase the chance of health professionals overlooking the complexities of family roles within SA communities. Previous literature has identified the need to examine the perspectives of PLwD and their family members in Pakistan to shed light on factors perceived to support and hinder recommended physical activity (PA) to manage type 2 diabetes. This study explored (1) the enablers of and barriers to PA in the context of PLwD in Pakistan and (2) family involvement regarding PLwD’s engagement with PA.

Methods

Semi-structured interviews were conducted with 30 PLwD and 17 family members of PLwD who were recruited in metropolitan Lahore (Pakistan) and primarily used state health services available to relatively disadvantaged populations. Interviews were transcribed and analysed using thematic analysis.

Results

Three themes were identified: (1) Going for a walk as a feasible PA; (2) the role of family members in influencing PA; and (3) gender differences and cultural acceptability of an activity. PA enablers for PLwD consist of gender-specific opportunities for activity facilitated by peers and family members. Culturally acceptable opportunities for PA in Pakistan for specific genders and age groups within the socio-cultural context constituted an essential factor. In this study, all women with diabetes described walking as the only acceptable form of PA, whereas some men mentioned other activities such as running, playing cricket, and cycling.

Conclusions

Medical guidelines must consider patients’ daily routines, account for cultural and familial expectations of different genders and age groups, and address social and physical barriers encountered by these different groups to encourage PA among PLwD in SA cultures.

Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality

OBJECTIVES

Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults.

METHODS

Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff.

RESULTS

Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages.

DISCUSSION

Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.

Examining foodwork and eating behaviors among heterosexual and gay male couples

OBJECTIVES

Spouses play an important role in their partner's eating behaviors, including both promoting and impeding healthy eating. The division of foodwork in the relationship (i.e., if there is individual or shared responsibility for food roles) may vary as a function of gender or sexual orientation and may be important in understanding eating behaviors.

METHOD

Using cross-sectional, dyadic data from 462 heterosexual and gay married couples (N = 921 individuals) residing in the United States, we accordingly sought to examine which partner was most responsible for two food roles, food shopping and meal preparation (Aim 1); whether these roles differed by gender (Aim 1a) and sexual orientation (Aim 1b); whether these food roles were related to the frequency of eating healthy and unhealthy foods (Aim 2); and whether these associations differed by gender (Aim 2a) and sexual orientation (Aim 2b).

RESULTS

We found that one individual was responsible for these roles in a majority of couples, although meal preparation was more likely to be shared in gay than in heterosexual couples. We also found that, in general, the person responsible for these food roles ate healthy more frequently compared to when their partner was responsible; findings for shared responsibility were more equivocal. These associations did not differ, however as a function of gender or sexual orientation.

CONCLUSION

Our findings contribute to a further understanding of food dynamics among heterosexual and gay male couples and have important implications for health promotion and intervention efforts.

Psychological profiles of individuals with type 2 diabetes and their association with physical and psychological outcomes: a cluster analysis

OBJECTIVES

This study aimed to identify clusters of participants with Type 2 diabetes mellitus (T2DM) at risk for developing psychological and somatic distress symptoms. Moreover, we investigated whether the different clusters were associated with glycemic control, sleep, and physical activity levels.Design and main outcome measures. In a cross-sectional design, participants with T2DM (n = 269) completed questionnaires on psychological and somatic distress, sleep disorders and physical activity.

RESULTS

Cluster analyses yielded three groups: a) "high self-confident and low demoralised"; b) "low support and low involvement"; c) "high consequences, high demoralisation and nagging". The groups were distinguished by the social, cognitive, and vital exhaustion variables and significant differences in diabetes-related psychological distress and physical activity. The measure of glycemic control did not differ between clusters. The "high self-confident and low demoralised" group displayed the lowest scores on psychological distress compared to the other clusters.

CONCLUSIONS

Results suggest that social cognitive dimensions and affective states play a key role in defining clusters in participants with T2DM. Thus, we need to consider the psychological profiles of participants with T2DM when designing interventions to improve self-management strategies.

Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples

OBJECTIVES

Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms.

METHODS

The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006-2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner's baseline report of negative marital quality and number of chronic conditions in each wave.

RESULTS

Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions.

DISCUSSION

Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.

Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability

BACKGROUND

Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability.

PURPOSE

We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability.

METHODS

The U.S. sample included 3,991 couples drawn from nine waves (1998-2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner's baseline depressive symptoms, and each partner's number of chronic conditions across waves.

RESULTS

Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels.

CONCLUSIONS

Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.

Feasibility and preliminary effects of a theory-based self-management program for kidney transplant recipients: A pilot study

Self-care activities are important to prevent transplant-related side effects and complications among kidney transplant recipients. Therefore, we developed a theory-based self-management program for kidney transplant recipients hospitalized after surgery. This study aimed to examine the feasibility of the program and to identify its preliminary effects on autonomy, competence, and self-care agency. We assessed feasibility using quantitative data collected based on a single group repeated-measures design, along with qualitative data such as patients' feedback on satisfaction during patient counseling. The program comprised video education and individual counseling by nurses. Thirty patients completed this program. Outcome variables were measured thrice: before education, immediately following the first week of video education, and after two consecutive weeks of counseling. A repeated measures ANOVA showed a statistically significant increase in autonomy (F = 5.03, p = .038), competence (F = 17.59, p < .001), and self-care agency (F = 24.19, p < .001). Our pilot study provided preliminary evidence supporting the feasibility for implementation of the theory-based self-management program, and suggesting its preliminary effects in improving autonomy, competence, and self-care agency among kidney transplant recipients. Further research is needed to examine the short- and long-term effects of this program in a longitudinal, randomized control study with a larger sample.

Examining the effects of multiple chronic conditions on cognitive decline and potential moderators among older Koreans: Findings from the Korean Longitudinal Study of Ageing 2006-2016

BACKGROUND

More than half of older Koreans have two or more chronic conditions, known as multiple chronic conditions (MCC). Successful self-management (e.g., diet control, exercise, taking medications) is critical to prevent worsening of condition or acquisition of additional chronic conditions. This study investigated the effects of MCC on cognitive decline and risk factors in each chronic condition group over a 10-year period.

METHODS

Six waves (2006-2016) of the Korean Longitudinal Study of Ageing were used, featuring 2,198 older adults who were cognitively healthy at baseline. MCC were categorized into three groups: no chronic condition (n=831), one chronic condition (n=813), and two or more chronic conditions (n=554). Linear mixed-effects model analyses were conducted using SAS 9.4.

RESULTS

Individuals with MCC showed greater cognitive decline than those with no or one chronic condition. Different factors were associated with cognition in each group. Among those with no chronic condition, age, income, education, and functional limitation were associated with cognitive decline. Among those with one chronic condition, age, marital status, working status, self-rated health, and arthritis were associated with cognitive decline. Among those with two or more chronic conditions, age, income, marital status, and living arrangement were associated with cognitive decline. Listed factors have p-values less than .05.

CONCLUSIONS

Findings indicate MCC is significantly related with cognitive decline. Risk factors for cognitive decline differed across three chronic condition groups. Self-management programs that target each group can be a promising strategy to mitigate cognitive decline among older Koreans.

Spousal Influence on Diabetes Self-care: Moderating Effects of Distress and Relationship Quality on Glycemic Control

BACKGROUND

Spouses often attempt to influence patients' diabetes self-care. Spousal influence has been linked to beneficial health outcomes in some studies, but to negative outcomes in others.

PURPOSE

We aimed to clarify the conditions under which spousal influence impedes glycemic control in patients with type 2 diabetes. Spousal influence was hypothesized to associate with poorer glycemic control among patients with high diabetes distress and low relationship quality.

METHODS

Patients with type 2 diabetes and their spouses (N = 63 couples) completed self-report measures before patients initiated a 7-day period of continuous glucose monitoring. Mean glucose level and coefficient of variation (CV) were regressed on spousal influence, diabetes distress, relationship quality, and their two- and three-way interactions.

RESULTS

The three-way interaction significantly predicted glucose variability, but not mean level. Results revealed a cross-over interaction between spousal influence and diabetes distress at high (but not low) levels of relationship quality, such that spousal influence was associated with less variability among patients with low distress, but more among those with high distress. Among patients with high distress and low relationship quality, a 1 SD increase in spousal influence predicted a difference roughly equivalent to the difference between the sample mean CV and a CV in the unstable glycemia range.

CONCLUSIONS

This was the first study to examine moderators of the link between spousal influence and glycemic control in diabetes. A large effect was found for glucose variability, but not mean levels. These novel results highlight the importance of intimate relationships in diabetes management.

[The prevalence of severe falls and associated factors among elderly Brazilians: Results of the 2013 National Health Survey]

The scope of this study was to estimate the prevalence and factors associated with severe falls among elderly Brazilians. It included a transversal study of 10,537 elderly individuals who participated in the National Health Survey (2013). The dependent variable was a report of severe falls in the past year. The independent variables comprised, hierarchically, socio-demographic factors, behavior, health status and functional capacity. Logistic regression was used to obtain the odds ratio (OR) and the confidence interval (95%CI), using the 13.1 Stata program. The prevalence of severe falls was 7.5% (95%CI: 6.7-8.3) and the highest odds were among women (OR: 1.35; 95%CI: 1.03-1.77), 70 to 79 years of age (OR: 1.47; 95%CI: 1.12-1.95) and 80 years and above (OR: 2.00; 95%CI: 1.46-2.74), living without a spouse/partner (OR: 1.37; 95%CI: 1.08-1.74), sedentary in leisure time (OR: 1.55; 95%CI: 1.06-2.26), having multimorbities (OR: 1.54; 95%CI: 1.19-2.00), sleeping difficulties (OR: 2.18; 95%CI: 1.65-2.88), limitations in daily activities (OR: 2.25; 95%CI 1.63 -3.10) and use of a walking aid (OR: 1.89; 95%CI: 1.30-2.73). The prevalence of severe falls was high and multifactorial, enabling the identification of profiles of greater vulnerability, which should be considered in public policies for specific interventions.

Type 2 diabetes: patient assessment of chronic illness care

Objective

We tried to assess perception of chronic illness care in people with type 2 diabetes and to determine whether demographic variables, self-care behavior, as well as affective variables were related with perception of chronic illness care.

Methods

We conducted a secondary analysis of the previously published cross-sectional study in 441 Iranian people with type 2 diabetes. Chronic illness care was assessed with the validated tool of patient assessment of chronic illness care (PACIC). Different aspects of care according to the chronic care model are measured on a scale of 1-5, with 5 being highest perception of care. The association between perception of chronic illness care and measured variables were tested using spearman correlation test as well as univariate and multiple linear regression analysis.

Results

Finally, 380 filled out the PACIC questionnaire, completely (53.4% female, mean age: 54.73 ± 8.0 years, mean PACIC score: 2.52 ± 0.87). In spearman correlation test, considering PACIC score as the dependent variable, chronic illness care was inversely associated with level of education and distress, whereas, insulin treatment, wellbeing, family-social support and self-management were positively associated with chronic care (All p value<0.05). In the multiple linear regression analysis, family-social support was positively related to chronic care while level of education, marital status, diabetes-related distress, and high density lipoprotein had significant negative relationship with PACIC score (All p value<0.05).

Conclusions

Family-social support, level of education, marital status, and diabetes-related distress are the major determinants of patient experience of chronic illness care in people with type 2 diabetes.

Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder

BACKGROUND

Social relationships may serve as both protective factors and risk factors for opioid use (nonmedical prescription opioid or illicit opioid use) among patients receiving methadone for opioid use disorder (OUD). Yet little is known about how relationship quality is linked to outcomes among couples receiving methadone. We evaluated the links between relationship quality and risk of opioid use among couples in which both partners received methadone.

METHODS

Participants included 53 heterosexual married or cohabiting couples aged 18 and older who were drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both members of the couple completed a self-administered survey assessing their sociodemographic information, relationship and treatment characteristics, and risk of opioid use.

RESULTS

Roughly half of women (47.2%) and men (52.8%) had a moderate to high risk of nonmedical prescription opioid use and almost two-thirds (64.2%) had a moderate to high risk of street opioid use. Risk of street opioid use was highly correlated within couples. Actor-partner interdependence models revealed that when women reported higher positive relationship quality, they had a lower risk of nonmedical prescription opioid use and their partners had a lower risk of street opioid use. Negative relationship quality was not significantly linked to risk of opioid use.

CONCLUSIONS

Couples in which both partners receive methadone for OUD may be at risk of return to use, and positive partner relationships may play a role in lowering this risk. Women's perceptions of relationship quality might be a particularly important target for clinical care and interventions.

Family embeddedness and older adult mortality in the United States

Do different operationalizations of family structure offer different understandings of the links between family structure and older adult mortality? Using the American Health and Retirement Study (N = 29,665), we examine mortality risks by three measures of family structure: whether respondents have different family statuses (e.g. married vs. unmarried), volume of family members available (e.g. having one vs. two living immediate family members), and family embeddedness (e.g. having neither spouse nor child vs. having spouse but no child). We focus on three kin types: partner/spouse, children, and siblings. We find that differences in empirical estimates across measures of family structure are not dramatic, but that family embeddedness can show some additional heterogeneity in mortality patterns over family status variables or the volume of ties. This paper tests different ways of operationalizing family structure to study mortality outcomes and advances our understanding of how family functions as a key social determinant of health.

Chronic diseases: An added burden to income and expenses of chronically-ill people in Sri Lanka

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.

Effect of Disclosure on Receiving Spousal Support in Korean Immigrants With Type 2 Diabetes

PURPOSE

The purpose of this study was to investigate factors associated with receiving diabetes spousal support in a sample of Korean immigrants with type 2 diabetes (T2DM) and to test whether disclosure (culture-specific factor) is a significant predictor of spousal support receipt in this group.

METHODS

A cross-sectional survey was conducted with a convenience sample of 136 US community-dwelling Korean immigrants with T2DM ages 46 to 89 years old. Potential predictors were sociodemographic factors (age, gender, education, years in US), personal characteristics (quality of marriage and depression), diabetes severity (duration of diabetes, A1C, insulin use), diabetes self-management, diabetes worries/concerns (psychological factor), and disclosure of worries (cultural factor). The study used validated survey instruments including Diabetes Care Profile for spousal support received, Summary of Diabetes Self-Care Activities, Problem Area in Diabetes, and Diabetes Distress Disclosure Index. Descriptive statistics, correlations, and hierarchical multivariable linear regression models were conducted.

RESULTS

Six predictors (education level, years spent in the US, glucose control status, diabetes self-management level, diabetes worries/concerns, and disclosure of diabetes worries) were significantly related to receiving spousal support. At least some college education, less time in the US, better glucose control (lower A1C), poor self-management, more diabetes worries, and more disclosure of diabetes worries/distress were associated with receiving higher level of spousal support. Disclosure was the strongest predictor.

CONCLUSION

Receiving spousal support for diabetes self-management among Korean immigrants is influenced by 6 factors identified in this study. Disclosing diabetes worries (cultural factor) is most impactful.

Older adults' physical activity-related social control and social support in the context of personal norms

This study investigated whether perceived physical activity norms moderated the effects of physical activity-related social interactions on intentions to engage in physical activity among community-residing older adults (N = 217). Structural equation modeling tested whether two types of social support and social control interacted with personal norms in predicting intentions to be active. Emotional and informational support were associated with higher intentions, and negative social control was associated with lower intentions to engage in activity. Each of these effects was more prominent in the context of weak personal norms, suggesting future research and interventions should consider joint effects of support and norms.

Invisible Social Support and Invisible Social Control in Dual-smoker Couple's Everyday Life: A Dyadic Perspective

BACKGROUND

Invisible exchange processes (i.e., invisible support, invisible control) are commonly operationalized as support or control provided by a partner, but unnoticed by the recipient, and have been reported to be beneficially related to affect. However, studies have almost exclusively focused on affect as an outcome and rather neglected other outcomes, such as health behavior. One study so far demonstrated a coupling of invisible support and increased unhealthy behavior.

PURPOSE

The present study aimed to investigate differences in invisible exchanges within a dyadic context of heterosexual, romantic dual-smoker couples. We tested whether women's and men's invisible exchanges were associated with negative affect and smoking in everyday life of dual-smoker couples.

METHODS

In a dyadic daily diary study, invisible emotional and instrumental support, invisible positive and negative control, negative affect, and daily smoking were independently assessed in both partners of 83 dual-smoker couples after a joint self-set quit date.

RESULTS

Analyses based on the two-intercept model revealed that at the between-person level invisible support and control were both related to less negative affect, albeit in men only, and were unrelated to smoking behavior. At the within-person level, invisible exchanges were on the whole unrelated to negative affect and smoking.

CONCLUSIONS

Invisible support and invisible control may serve as protective buffers for negative affect in a health-behavior change context for male partners of dual-smoker couples. Future research should clarify under what conditions invisible exchanges unfold positive effects on partners' well-being and health behavior in different health contexts.

Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992-2011

Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.

Are Spouses' Sleep Problems a Mechanism Through Which Health is Compromised? Evidence Regarding Insomnia and Heart Disease

BACKGROUND

Symptoms of insomnia have been widely identified as risk factors for health, including heart disease. Despite the expansive and growing literature on health concordance among coupled individuals, few studies have examined insomnia as a shared risk factor for heart disease among middle-aged and older couples.

PURPOSE

This study examined the association between insomnia and incident heart disease among couples. A dyadic modeling approach was employed to investigate the relationships between one's own insomnia and partners' insomnia for the risk of incident heart disease for each partner.

METHODS

Data from the 2010, 2012, and 2014 Health and Retirement Study were utilized in a prospective research design (N = 3,221 couples). Actor-partner interdependence models were employed to estimate actor and partner effects of insomnia symptoms for incident heart disease over the 4 year observation period.

RESULTS

Insomnia symptoms measured at baseline were related to an increased risk for heart disease for husbands, whereas for wives the association was attenuated after other health measures were controlled. Wives' insomnia was related to an increased risk of incident heart disease for husbands but husbands' insomnia was not related to wives' risk of heart disease.

CONCLUSIONS

This study showed how subjective insomnia symptoms among middle-aged and older adults in intimate partnerships are associated with their heart disease risk. Further research is needed to verify the results with objective measures of sleep problems and heart disease.

Living alone is associated with visit-to-visit HbA1c variability in men but not in women in people with type 2 diabetes: KAMOGAWA-DM cohort study

The purpose of this study was to evaluate the association between living alone and glycemic parameters, especially glycemic variability, in men and women with type 2 diabetes. Lifestyle factors, including living alone, were assessed by a questionnaire in this cross-sectional study. Average, standard deviation (SD), and coefficient of variation (CV) of HbA1c were calculated using the values of HbA1c, which were extracted from the medical record for 1 year. Eighteen percent of men (35/198) and 17% of women (18/103) were living alone. In men, the average of HbA1c (59.9 mmol/mol [11.0] vs. 55.7 mmol/mol [9.1], 7.6% [1.0] vs. 7.2% [0.8], p = 0.018), and CV of HbA1c (0.06 [0.03-0.08] vs. 0.03 [0.02-0.05], p < 0.001) were all significantly higher in men who were living alone than in men who weren't. However, there were no differences in the average (53.2 mmol/mol [11.4] vs. 56.0 mmol/mol [8.8], 7.0% [1.0] vs. 7.3% [0.8], p = 0.252) or CV (0.03 [0.02-0.05] vs. 0.03 [0.02-0.04], p = 0.845) between women who were living alone and women who weren't. Multiple regression analyses revealed that living alone was associated with CV of HbA1c after adjusting for covariates in men (β = 0.180, p = 0.005), but not in women (β = 0.085, p = 0.369). We showed that living alone is associated with visit-to-visit HbA1c variability in men, but not women, with type 2 diabetes. In clinical practice, it is necessary to pay attention to glycemic control in men who are living alone.

Partner presence in the emergency department and adherence to daily cardiovascular medications in patients evaluated for acute coronary syndrome

Stressful health situations may compromise spouses'/partners' ability to provide patients with support. We tested whether partner status/partner presence in the emergency department (ED) were associated with patients' adherence to daily cardiovascular medications and whether effects differed by age/gender. Participants were 189 patients evaluated for acute coronary syndrome at an urban academic ED (M_Age = 62.18; 57.1% male; 58.7% Hispanic). Participants self-reported partner status/partner presence. Medication adherence was measured using an electronic pillcap. For male patients, having a partner was associated with increased adherence in the first month post-discharge, OR 1.94, p < .001, but having a partner present in the ED was associated with lower adherence, OR 0.33, p < .001. The opposite effect was evident for female patients. Partner status/partner presence in the ED are associated with medication adherence during the first month post discharge, with opposing effects for male and female patients.

Social Support and Preventive Healthcare Behaviors Among Couples in Later Life

BACKGROUND AND STUDY OBJECTIVES

Intimate partners and close friends represent two major sources of social support that are central to one's health and health behaviors in later life. The aim of this study was to examine dyadic linkages between perceived social support (from spouses and friends) and preventive healthcare behaviors among coupled-individuals.

DESIGN AND METHODS

Prospective data from the Health and Retirement Study (2010, 2012) were used to analyze a sample of coupled-individuals (dyad N = 1,902). A series of multilevel logistic regression (actor-partner interdependence) models were estimated to evaluate whether perceived social support from spouses and friends was associated with the likelihood of using two common forms of preventive healthcare services (i.e., influenza vaccination and cancer screenings).

RESULTS

Apart from the role of perceived support from spouse on flu vaccinations, wives' preventive healthcare behaviors were unrelated to perceived social support. In contrast, husbands' preventive healthcare behaviors showed consistent associations with perceived social support from friends for the 2-year observation period. Further, husbands' receipt of prostate cancer screening was associated with wives' perceptions of social support from spouse as well as friends.

DISCUSSION AND IMPLICATIONS

These findings contributed to our understanding of the health advantages associated with being in a marital relationship for preventive healthcare behaviors, especially for men. Future research should unpack the pathways through which social support of various forms is associated with obtaining needed preventive health services.

Myocardial infarction and death findings from a 22-year follow-up of a cohort of 980 employed Swedish men

OBJECTIVES

In this article, we present death and myocardial infarction (MI) incidences over 22 years in relation to possible risk factors and their explanatory value.

STUDY DESIGN

In 1993, 980 middle-aged Swedish men in an automotive industry were surveyed at a health checkup as part of the Renault-Volvo Coeur project. The Swedish cohort was revisited in 2015.

METHODS

In 2015, incident MIs were identified using postal questionnaires, hospital records, and the Swedish national MI and death registers. The statistical results were given as odds ratios (ORs) and pseudo-R² (PR²), showing the proportion of variation in risk explained by logistic models.

RESULTS

One hundred and four deaths (4.6 per 1000 person-years) and 89 first MIs (4.2 per 1000 person-years) were identified. The Framingham risk index showed the strongest association with MI (OR = 23; 95% confidence interval [CI] = 5.42, 96.9), comparing the fifth quintile with the first. The all-cause death showed an OR of 3.2 (95% CI = 1.65, 6.08), with a suggested U-shape over quintiles. The percentages of PR² for MI and death were 8.8% and 6.6%, respectively. All risk factors together explained 22% of the variation in risk of MI. Comparing mortality in men living alone with those married yielded an OR of 3.78, which was found to be statistically significant. The corresponding OR for MI was not significant.

CONCLUSIONS

Traditional risk factors were confirmed but explained a modest proportion of the risk variation.

Are We Choosing Wisely? Older Adults' Cancer Screening Intentions and Recalled Discussions with Physicians About Stopping

BACKGROUND

National guidelines recommend against cancer screening for older individuals with less than a 10-year life expectancy, but it is unknown if this population desires ongoing screening.

OBJECTIVE

To determine (1) if older individuals with < 10-year life expectancy have future intentions for cancer screening, (2) if they recall a doctor previously suggesting that screening is no longer needed, and (3) individual characteristics associated with intentions to seek screening.

DESIGN

National Social life Health and Aging Project (2015-2016), a nationally representative, cross-sectional survey.

PARTICIPANTS

Community-dwelling adults 55-97 years old (n = 3816).

MAIN MEASURES

Self-reported: (1) mammography and PSA testing within the last 2 years, (2) future intentions to be screened, and (3) discussion with a doctor that screening is no longer needed. Ten-year life expectancy was estimated using the Lee prognostic index. Multivariate logistic regression analysis examined intentions to pursue future screening, adjusting for sociodemographic and health covariates.

KEY RESULTS

Among women 75-84 with < 10-year life expectancy, 59% intend on future mammography and 81% recall no conversation with a doctor that mammography may no longer be necessary. Among men 75-84 with < 10-year life expectancy, 54% intend on future PSA screening and 77% recall no discussions that PSA screening may be unnecessary. In adjusted analyses, those reporting recent cancer screening or no recollection that screening may not be necessary were more likely to want future mammography or PSA screening (p < 0.001).

CONCLUSION

Over 75% of older individuals with limited life expectancy intend to continue cancer screening, and less than 25% recall discussing with physicians the need for these tests. In addition to public health and education efforts, these results suggest that older adults' recollection of being told by physicians that screening is not necessary may be a modifiable risk factor for reducing overscreening in older adults with limited life expectancy.

Correlates, Facilitators and Barriers of Healthy Eating Among Primary Care Patients with Prediabetes in Singapore-A Mixed Methods Approach

Healthy diet remains the primary means to prevent chronic diseases among those with prediabetes. We conducted a mixed methods study, consisting of a cross-sectional survey and in-depth interviews to assess factors associated with fulfilling the healthy plate recommendation, and to explore reasons for the behaviour among primary care patients with prediabetes in Singapore. The prevalence of meeting the recommendation was 57.3%. This was positively associated with being married and negatively associated with being Malay, frequency of eating out weekly and frequency of deep-fried food consumption weekly. The recurrent themes for not meeting the recommendation included family influence, perception of healthy food being not tasty, lack of skills to prepare or choose healthy food, difficulty in finding healthier options when eating out, and healthy food being costly. The recurrent themes for meeting the recommendation included family influence, self-discipline, fear of disease complications, education by healthcare professionals, mass media influence and health promotion campaigns. Much more remains to be done to promote healthy eating among these patients. There were different levels of facilitators and barriers to healthy eating. Apart from the individual and interpersonal levels, practitioners and policy makers need to work together to address the organisational, community and policy barriers to healthy eating.

Associations of marital status with diabetes, hypertension, cardiovascular disease and all-cause mortality: A long term follow-up study

Background

To investigate the associations of marital status with major clinical outcomes including type 2 diabetes (T2D), hypertension, cardiovascular disease (CVD) and all-cause mortality.

Methods

The study cohort (1999–2014) included 9,737 (45% male) Iranian adults with a mean age of 47.6 years. Marital status was defined as married versus never married, divorced and widowed. The relationship between marital status and the four above mentioned outcomes were investigated using Cox regression models adjusted for the main confounders, specific to each outcome.

Results

After more than 12 years of follow-up, 1,889 (883 men) individuals developed hypertension, 1,038 (468 men) T2D, 1015 (597 men) CVD and 668 (409 men) all-cause mortality. Compared with married, being never married in men was associated with higher risk of hypertension [hazard ratio (HR): 1.55; 95% confidence interval (CI), 1.11–2.16] and all-cause mortality (2.17; 0.95–5.00; p-value = 0.066) after adjusting for confounders. Among women, compared with married status, widowed status was associated with a lower risk of T2D (0.74; 0.56–0.97) in the confounders adjusted model. Moreover, never married women had a lower risk of hypertension (0.58; 0.37–0.90) compared to married ones in the age adjusted model, a finding that did not achieve significance, after further adjustment for confounders.

Conclusion

We found that the relationship between marital status and health outcomes varied by gender. Being never married was an important risk factor for hypertension and tended to be a significant risk factor for mortality in men. However, among women, being widowed was associated with a lower risk of T2D.