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Shaw R, Pengelly C, Crinnin C, Amina E, Wutz AV, King PR. Scoping review of the role of social support in women veterans' psychosocial and health outcomes. J Women Aging 2024:1-25. [PMID: 39252402 DOI: 10.1080/08952841.2024.2395111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/04/2024] [Accepted: 07/16/2024] [Indexed: 09/11/2024]
Abstract
Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans' health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans' roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.
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Affiliation(s)
- Rachael Shaw
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Charlotte Crinnin
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Education & Human Services, Canisius College, Buffalo, New York, USA
| | - Evodie Amina
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | | | - Paul R King
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
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2
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Gil A, Schuman D, Chang KY, Liu Z, Hwang CL. Implications of Physical Activity in Reducing Alcohol Use for Women Veterans: A Narrative Review. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:554-564. [PMID: 39035145 PMCID: PMC11257116 DOI: 10.1089/whr.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 07/23/2024]
Abstract
Women veterans (WV) are a fast-growing population in the United States with concerning health disparities. Reports of increased risks of cardiovascular disease (CVD) and poorer health are evident in WV compared with their civilian counterparts. The transition from active duty to veteran poses additional life stressors, causing changes in health behaviors such as unhealthy alcohol consumption and decreased physical activity, which may explain health disparities in WV. The changes in these two health risk behaviors may be influenced by each other, and emerging evidence suggests that physical activity aids in managing alcohol consumption during alcohol use treatment. In this general narrative review, we summarized findings from studies involving WV on (1) the associations between alcohol consumption and physical activity and (2) the effect of physical activity on reducing alcohol use. We also discussed the clinical consideration of adding physical activity to alcohol use interventions for WV. Most of the literature included in this review has been based on predominantly veteran men populations. This knowledge gap highlights the importance of continued efforts and research studies targeting WV to eliminate health disparities among them.
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Affiliation(s)
- Alfredo Gil
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas, USA
| | - Donna Schuman
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Keng-Yu Chang
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas, USA
| | - Zhaoli Liu
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, USA
| | - Chueh-Lung Hwang
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas, USA
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3
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Garcia-Davis S, Tyagi P, Bouldin ED, Hansen J, Brintz BJ, Noel P, Rupper R, Trivedi R, Kinosian B, Intrator O, Pugh MJ, Leykum LK, Dang S. Sex differences in unmet needs between male and female older veterans. J Women Aging 2024:1-16. [PMID: 38976516 DOI: 10.1080/08952841.2024.2375480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health management, and social. We calculated weighted estimates and compared sex differences using age-adjusted prevalence ratios. On average, female Veterans were younger, more were Non-Hispanic Black and unmarried. Females and males reported a similar prevalence of problems across all domains. However, compared to males, female Veterans had a lesser prevalence of missed appointments due to transportation (aPR 0.49; 95% CI: 0.26-0.92), housework unmet needs (aPR: 0.44; 95% CI: 0.20-0.97), and medication management unmet needs (aPR: 0.33; 95% CI: 0.11-0.95) but a higher prevalence of healthcare communication unmet needs (aPR: 2.40; 95% CI: 1.13-5.05) and monitoring health conditions unmet needs (aPR: 2.13, 95% CI: 1.08-4.20). Female Veterans' common experience of unmet needs in communicating with their healthcare teams could result in care that is less aligned with their preferences or needs. As the number of older female Veterans grows, these data and additional work to understand sex-specific unmet needs and ways to address them are essential to providing high-quality care for female Veterans.
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Affiliation(s)
- Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Pranjal Tyagi
- South Florida Veterans Affairs Foundation for Research and Education (SFVAFRE), Miami, Florida, USA
| | - Erin D Bouldin
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
| | - Jared Hansen
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Polly Noel
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Randall Rupper
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Salt Lake City Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Salt Lake City, Utah, USA
| | - Ranak Trivedi
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Bruce Kinosian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Orna Intrator
- Canandaigua VA Medical Center Geriatrics and Extended Care Data Analysis Center (GECDAC), Canandaigua, New York, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luci K Leykum
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
- Harbor Health, Austin, Texas, USA
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Stuti Dang
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, US Department of Veterans Affairs, Washington, DC, USA
- Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Miami, Florida, USA
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida, USA
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Sulandari S, Coats RO, Taufik T, Johnson J. What Does It Mean to "Age Well" Among British and Javanese Older Adults? A Cross-Cultural Qualitative Study. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae085. [PMID: 38761106 PMCID: PMC11200188 DOI: 10.1093/geronb/gbae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES This study aimed to investigate perceptions of what it means to "age well" and to explore similarities and differences between a Western and non-Western culture (Britain and Java). METHODS Qualitative interviews explored how Javanese and British older adults defined aging well, establishing the similarities and differences between cultures. Javanese (n = 14) and British (n = 15) adults aged 61-80 (mean age = 68) participated. The data were analyzed using reflexive thematic analysis and organized with NVivo. RESULTS Four themes were identified that captured what it means to age well across cultures: (a) good health is a springboard for aging well; (b) holding a positive outlook is a decisive factor in aging well; (c) "having enough" and "feeling safe" provide peace of mind; and (d) spirituality and religiosity provide tranquility. Although both cultures mentioned similar factors, there were variations in the interpretations and emphasis within themes. For example, Javanese participants emphasized the importance of the social environment whereas British participants highlighted the physical environment. DISCUSSION Differences between cultures are important for understanding how best to support people as they age. For example, in Java, aging well may be best supported by providing a vibrant social environment. For people in Britain, having a safe and secure physical environment may be more important.
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Affiliation(s)
- Santi Sulandari
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
- Faculty of Psychology, Universitas Muhammadiyah Surakarta, Surakarta, Central Java, Indonesia
| | - Rachel O Coats
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
| | - Taufik Taufik
- Faculty of Psychology, Universitas Muhammadiyah Surakarta, Surakarta, Central Java, Indonesia
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
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Buckheit K, Savage A, King PR, Buchholz LJ, Wade M, Wray LO. Relationships among age, motivation, and exercise among women Veterans. J Women Aging 2024:1-11. [PMID: 38850542 DOI: 10.1080/08952841.2024.2351621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/30/2024] [Indexed: 06/10/2024]
Abstract
Physical activity (PA) and exercise are central to maintaining health, however research has shown steep declines in PA and exercise among women Veterans as they age. Though motivation may be an important contributor to initiating and sustaining exercise that may change across the lifespan, little is known about exercise motivation and its relation to age and exercise behavior among women Veterans. This cross-sectional study sought to describe exercise motivations, examine relationships among exercise motivations and age, and explore the degree to which age and motivation predict self-reported exercise behavior among women Veterans. We conducted a secondary data analysis from a regional mail survey of 197 women Veterans (mean age = 51; SD = 10.5) enrolled in Veterans Health Administration primary care in a northeastern region (N = 180 in analysis). Measures included demographics (age, body mass index), self-reported exercise motivation, and an estimate of average weekly exercise. Participants endorsed multiple motivators for exercise, most prominently fitness and health management. Age was significantly negatively related to amount of exercise and with socializing as an exercise motivation. After accounting for body mass index, age was a significant predictor of exercise behavior, and exercise motivations accounted for an additional 7.3% of variance in self-reported weekly exercise. Our results suggest that although motivation is a potentially important predictor of exercise, factors beyond motivation may better predict exercise in women Veterans. Further research is needed on personal and practical facilitators and barriers to exercise in this population.
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Affiliation(s)
- Katherine Buckheit
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Abigail Savage
- Behavioral VA Careline, VA Western New York Healthcare System, Buffalo, NY, USA
| | - Paul R King
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA
- Department of Rehabilitation Science, School of Public Health and Health Professions, Buffalo, NY, USA
| | - Laura J Buchholz
- Behavioral VA Careline, VA Western New York Healthcare System, Buffalo, NY, USA
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA
| | - Michael Wade
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Laura O Wray
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA
- Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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6
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Gray KE, Silvestrini M, Ma EW, Nelson KM, Bastian LA, Voils CI. Gender differences in social support for diabetes self-management: A qualitative study among veterans. PATIENT EDUCATION AND COUNSELING 2023; 107:107578. [PMID: 36463824 DOI: 10.1016/j.pec.2022.107578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Describe the role of social support in veterans' diabetes self-management and examine gender differences. METHODS We conducted semi-structured interviews among veterans with diabetes from one Veterans Health Administration Health Care System. Participants described how support persons influenced their diabetes self-management and perspectives on a proposed self-management program incorporating a support person. We used thematic analysis to identify salient themes and examine gender differences. RESULTS Among 18 women and 18 men, we identified four themes: 1) women felt responsible for their health and the care of others; 2) men shared responsibility for managing their diabetes, with support persons often attempting to correct behaviors (social control); 3) whereas both men and women described receiving instrumental and informational social support, primarily women described emotional support; and 4) some women's self-management efforts were hindered by support persons. Regarding programs incorporating a support person, some participants endorsed including family/friends and some preferred programs including other individuals with diabetes. CONCLUSIONS Notable gender differences in social support for self-management were observed, with women assuming responsibility for their diabetes and their family's needs and experiencing interpersonal barriers. PRACTICE IMPLICATIONS Gender differences in the role of support persons in diabetes self-management should inform support-based self-management programs.
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Affiliation(s)
- Kristen E Gray
- Health Services Research & Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
| | - Molly Silvestrini
- Health Services Research & Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Erica W Ma
- Health Services Research & Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Karin M Nelson
- Health Services Research & Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; General Medicine Service, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Administration Hospital, Madison, WI, USA; Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
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Sullivan JL, Engle RL, Shin MH, Davila H, Tayade A, Bower ES, Pendergast J, Simons KV. Social Connection and Psychosocial Adjustment among Older Male Veterans Who Return to the Community from VA Nursing Homes. Clin Gerontol 2021; 44:450-459. [PMID: 32852256 DOI: 10.1080/07317115.2020.1812141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The goal of this study was to examine psychosocial adjustment following transition from the nursing home (NH) to community and understand the ways in which adjustment intersects with social connection. METHODS We conducted interviews with community-dwelling older male Veterans after they were discharged from an NH. Interviews focused on Veterans' experience during the transition process. We utilized conventional content analysis to inductively code the interviews. We reviewed evidence in each identified domain for common themes. RESULTS We interviewed 13 NH residents after recent transitions from the NH back to the community. Four themes were identified: (1) access to and quality of social support network are important for social connection, (2) engagement in meaningful activities with family and friends improves well-being, (3) service providers form link to social connection, and (4) external stressors affect the quality of social connections. CONCLUSIONS Identified themes aligned with respondents' social connectedness and perceived psychosocial and physical well-being. Our results suggest that social connectedness is one part of the larger milieu of healthy aging including the importance of engagement with social opportunities and having a purpose. CLINICAL IMPLICATIONS Social connectedness is critical to assess for older adults transitioning between care settings. Developing screening tools and other interventions focused on social isolation are needed.
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Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ryann L Engle
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Heather Davila
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Arti Tayade
- Puget Sound VA Healthcare System, Seattle, Washington, USA
| | - Emily S Bower
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jacquelyn Pendergast
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kelsey V Simons
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Lin YH, Chen YC, Tseng YC, Tsai ST, Tseng YH. Physical activity and successful aging among middle-aged and older adults: a systematic review and meta-analysis of cohort studies. Aging (Albany NY) 2020; 12:7704-7716. [PMID: 32350152 PMCID: PMC7244057 DOI: 10.18632/aging.103057] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
Background: We aimed to investigate the association between physical activity and successful aging among middle-aged and older adults and study how this association changes with age and time. Results: The mean score of Newcastle-Ottawa Scale assessment was 8.0±0.8. Physically active middle-aged and older adults were more likely to age successfully than sedentary adults (OR=1.64, 95%CI: 1.40–1.94). The effect of physical activity was stronger in the younger group (OR=1.71, 95%CI: 1.41–2.08) than on the older group (OR=1.54, 95%CI: 1.13–2.08). However, the protective effect of physical activity reduced annually by approximately 3%. Conclusions: Physical activity promotes successful aging among middle-aged and older adults especially in the younger population. Being physically active at middle and old age is beneficial to successful aging. Methods: We searched for the relevant studies in three online databases: Pubmed, Web of Science, and Embase. Fifteen community-based cohort studies were included. The Newcastle-Ottawa Scale assessment Form was used for quality assessment. Overall, 189,192 participants aged 43.9-79.0 years were analyzed. The odds ratio for successful aging of the most physically active group compared with sedentary group was analyzed. Subgroup analysis was conducted by age group. Univariate Meta-regression was performed according to follow-up years.
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Affiliation(s)
- Yi-Hsuan Lin
- Department of Family Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.,Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Chun Chen
- Department of Family Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.,Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Chiang Tseng
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Tzu Tsai
- Department of Family Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yen-Han Tseng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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9
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Duan-Porter W, Martinson BC, Greer N, Taylor BC, Ullman K, McKenzie L, Rosebush C, MacDonald R, Falde S, Wilt TJ. Evidence Review-Social Determinants of Health for Veterans. J Gen Intern Med 2018; 33:1785-1795. [PMID: 30030735 PMCID: PMC6153229 DOI: 10.1007/s11606-018-4566-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/07/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans. METHOD MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation. RESULTS We screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence). DISCUSSION Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
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Affiliation(s)
- Wei Duan-Porter
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA.
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA.
| | - Brian C Martinson
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- HealthPartners Institute, Bloomington, MN, USA
- School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA
| | - Kristen Ullman
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Lauren McKenzie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Christina Rosebush
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Samuel Falde
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
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10
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Ippoliti R, Falavigna G, Montani F, Rizzi S. The private healthcare market and the sustainability of an innovative community nurses programme based on social entrepreneurship - CoNSENSo project. BMC Health Serv Res 2018; 18:689. [PMID: 30185186 PMCID: PMC6125879 DOI: 10.1186/s12913-018-3513-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022] Open
Abstract
Background CoNSENSo is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship on the healthcare market, and this work highlights the necessary conditions for the successful implementation of these entrepreneurial initiatives. Methods Considering municipalities in the Piedmont Region and those aged 65 or older as target population, the authors propose several negative binomial regression models to estimate the effectiveness of current private healthcare services in supporting the active aging process. Such effectiveness may represent the ex-ante (positive) reputation of these new social entrepreneurial initiatives on the market. Results According to our results, the private supply of healthcare services can effectively support the aging process. Indeed, given that the other predictor variables in the model are held constant, there are statistically significant negative relations between the number of hip fractures and the private supply of healthcare services by dental practitioners and psychologists (p-value < 0.05), as well as the private supply of opportunities for social interaction by coffee bars (p-value < 0.05). Conclusions The authors expect a favourable environment for the entrepreneurial initiatives of community nurses in mountain areas. Accordingly, policy makers cannot reject the hypothesis that the goals reached by the CoNSENSo project may be maintained for the sake of the future generations, avoiding its collapse as soon as public funding shifts to new programmes.
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Affiliation(s)
| | - Greta Falavigna
- Istituto di ricerca sulla crescita economica sostenibile (IRCrES) - Consiglio Nazionale delle Ricerche (CNR), Moncalieri, Italy
| | | | - Silvia Rizzi
- Direzione Sanità - Regione Piemonte, Torino, Italy
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11
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Ippoliti R, Allievi I, Falavigna G, Giuliano P, Montani F, Obbia P, Rizzi S, Moda G. The sustainability of a community nurses programme aimed at supporting active ageing in mountain areas. Int J Health Plann Manage 2018; 33:e1100-e1111. [PMID: 30052282 DOI: 10.1002/hpm.2591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/24/2018] [Accepted: 06/29/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Community Nurse Supporting Elderly iN a changing SOciety is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship, and this work highlights the necessary conditions for the existence of these entrepreneurial initiatives on the market, with community nurses' services purchased by the public health care system. METHODS The authors propose a sustainability framework for this project based on three relevant dimensions (ie, health, organisation, and context), highlighting the necessary conditions for continued provision of health services beyond project conclusion. Then, considering the Piedmont Region and those aged 65 or older as target population, health outcomes are analysed, proposing a break-even analysis to calculate expected levels. RESULTS According to our results, in order to care for 191 977 elderly people for 3 years, a successful pro-active approach is needed to prevent 1657 falls with hip fracture, reducing the prevalence of this adverse outcome by 36%. These are the expected health outcome levels for the existence of a social market, which can be achieved through the successful involvement of local public health organisations and stakeholders. CONCLUSIONS Policy makers need clear information on the economic impact of extending this new intervention to the whole target population and on the required preconditions for its financial sustainability in terms of health outcomes. However, a participatory process involving all relevant local stakeholders and organisations is crucial to extend current achievements beyond project conclusion.
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12
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Daskalopoulou C, Stubbs B, Kralj C, Koukounari A, Prince M, Prina AM. Associations of smoking and alcohol consumption with healthy ageing: a systematic review and meta-analysis of longitudinal studies. BMJ Open 2018; 8:e019540. [PMID: 29666127 PMCID: PMC5905752 DOI: 10.1136/bmjopen-2017-019540] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The number of older people is growing across the world; however, quantitative synthesis of studies examining the impact of lifestyle factors on the ageing process is rare. We conducted a systematic review and meta-analysis of longitudinal studies to synthesise the associations of smoking and alcohol consumption with healthy ageing (HA). METHODS Major electronic databases were searched from inception to March 2017 (prospectively registered systematic reviews registration number CRD42016038130). Studies were assessed for methodological quality. Random-effect meta-analysis was performed to calculate pooled ORs and 95% CI. RESULTS In total, we identified 28 studies (n=184 543); 27 studies reported results on smoking, 22 on alcohol consumption. 23 studies reported a significant positive association of never or former smoking with HA and 4 non-significant. 12 studies reported a significant positive association of alcohol consumption with HA, 9 no association and 1 negative. Meta-analysis revealed increased pooled OR of HA for never smokers compared with current smokers (2.36, 95% CI 2.03 to 2.75), never smokers compared with former smokers (1.32, 95% CI 1.23 to 1.41), former or never smokers compared with current smokers (1.72, 95% CI 1.20 to 2.47), never smokers compared with past or current smokers (1.29, 95% CI 1.16 to 1.43); drinkers compared with non-drinkers (1.28, 95% CI 1.08 to 1.52), light drinkers compared with non-drinkers (1.12, 95% CI 1.03 to 1.22), moderate drinkers compared with non-drinkers (1.35, 95% CI 0.93 to 1.97) and high drinkers compared with non-drinkers (1.25, 95% CI 1.09 to 1.44). There was considerable heterogeneity in the definition and measurement of HA and alcohol consumption. CONCLUSIONS There is consistent evidence from longitudinal studies that smoking is negatively associated with HA. The associations of alcohol consumption with HA are equivocal. Future research should focus on the implementation of a single metric of HA, on the use of consistent drinking assessment among studies and on a full-range of confounding adjustment. Our research also highlighted the limited research on ageing in low-and-middle-income countries.
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Affiliation(s)
- Christina Daskalopoulou
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Carolina Kralj
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Artemis Koukounari
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Martin Prince
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - A. Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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13
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Song Y, Washington DL, Yano EM, McCurry SM, Fung CH, Dzierzewski JM, Rodriguez JC, Jouldjian S, Mitchell MN, Alessi CA, Martin JL. Caregiving-Related Sleep Problems and Their Relationship to Mental Health and Daytime Function in Female Veterans. Behav Sleep Med 2018; 16:371-379. [PMID: 27690634 PMCID: PMC5378653 DOI: 10.1080/15402002.2016.1228640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/BACKGROUND To identify caregiving-related sleep problems and their relationship to mental health and daytime function in female Veterans. PARTICIPANTS Female Veterans (N = 1,477) from cross-sectional, nationwide, postal survey data. METHODS The survey respondent characteristics included demographics, comorbidity, physical activity, health, use of sleep medications, and history of sleep apnea. They self-identified caregiving- related sleep problems (i.e., those who had trouble sleeping because of caring for a sick adult, an infant/child, or other respondents). Patient Health Questionnaire (PHQ-4) was used to assess mental health, and daytime function was measured using 11 items of International Classification of Sleep Disorders-2 (ICSD-2). RESULTS Female Veterans with self-identified sleep problems due to caring for a sick adult (n = 59) experienced significantly more symptoms of depression and anxiety (p < 0.001) and impairment in daytime function (e.g., fatigue, daytime sleepiness, loss of concentration, p < 0.001) than those with self-identified sleep problems due to caring for an infant or child (n = 95) or all other respondents (n = 1,323) after controlling for the respondent characteristics. CONCLUSIONS Healthcare providers should pay attention to assessing sleep characteristics of female Veterans with caregiving responsibilities, particularly those caregiving for a sick adult.
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Affiliation(s)
- Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | - Donna L. Washington
- David Geffen School of Medicine, University of California, Los Angeles, California. VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M. Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California. Fielding School of Public Health, University of California, Los Angeles, California
| | - Susan M. McCurry
- Department of Psychosocial and Community Health, University of Washington, School of Nursing, Seattle, Washington
| | - Constance H. Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Juan Carlos Rodriguez
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N. Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A. Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennifer L. Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
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Gonsoulin ME, Durazo-Arvizu RA, Goldstein KM, Cao G, Zhang Q, Ramanathan D, Hynes DM. A Health Profile of Senior-Aged Women Veterans: A Latent Class Analysis of Condition Clusters. Innov Aging 2017; 1. [PMID: 29202104 PMCID: PMC5710757 DOI: 10.1093/geroni/igx024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives This study characterizes the multiple morbidities experienced by senior-aged women Veterans so that the Veterans Health Administration (VHA) and other health care systems may be better prepared to meet the health care needs of this growing cohort. Research Design and Methods Using the VHA’s Corporate Data Warehouse, we conducted a retrospective observational study of the 38,597 female veteran patients who were at least 65 years old and received care in the VHA during 2013 and 2014. We use a latent class analysis model to cluster diagnoses associated with inpatient and outpatient events over the years. Results The senior-aged women Veterans are characterized by six major classes of disease clusters. We defined these classes as: Healthy (16.24% of the cohort); Ophthalmological Disorders (13.84%); Musculoskeletal Disorders (14.22%); At Risk for Cardiovascular Disease (37.53%); Diabetic with Comorbidities (9.05%); and Multimorbid (9.12%). The patterns and prevalence of these condition classes vary by race, age, and marital status. Discussion and Implications Each of the six clusters can be used to develop clinical practice guidelines that are appropriate for senior-aged women Veterans. Consistent with past literature, the most common conditions in this cohort are hypertension and hyperlipidemia; together they form the most common class, “At Risk of Cardiovascular Disease (CVD)”. Results also show evidence of race-related disparities, with Blacks being more likely to be in the highest risk classes. Also, members of the cohort who are currently married having improved chances of being in the healthy class. And finally, we see a “healthy survivor” effect with the oldest women in our cohort having low overall rates of disease.
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Affiliation(s)
- Margaret E Gonsoulin
- VA Information Resource Center, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs Hines, Illinois
| | - Ramon A Durazo-Arvizu
- Public Health Services, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Karen M Goldstein
- Durham VA Medical Center, Department of Veterans Affairs, Durham, North Carolina.,Duke University School of Medicine, Division of General Internal Medicine
| | - Guichan Cao
- VA Information Resource Center, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs Hines, Illinois.,Public Health Services, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Qiuying Zhang
- VA Information Resource Center, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs Hines, Illinois
| | - Dharani Ramanathan
- VA Information Resource Center, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs Hines, Illinois
| | - Denise M Hynes
- VA Information Resource Center, Edward Hines Jr. VA Hospital, US Department of Veterans Affairs Hines, Illinois.,Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL.,Department of Medicine, College of Medicine and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago, Illinois
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15
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Hoy-Ellis CP, Shiu C, Sullivan KM, Kim HJ, Sturges AM, Fredriksen-Goldsen KI. Prior Military Service, Identity Stigma, and Mental Health Among Transgender Older Adults. THE GERONTOLOGIST 2017; 57:S63-S71. [PMID: 28087796 DOI: 10.1093/geront/gnw173] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults. DESIGN AND METHODS We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics. RESULTS Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology. IMPLICATIONS By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed.
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Affiliation(s)
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | | | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Daskalopoulou C, Stubbs B, Kralj C, Koukounari A, Prince M, Prina AM. Physical activity and healthy ageing: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 2017. [PMID: 28648951 DOI: 10.1016/j.arr.2017.06.003] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older people constitute a significant proportion of the total population and their number is projected to increase by more than half by 2030. This increasing probability of late survival comes with considerable individual, economic and social impact. Physical activity (PA) can influence the ageing process but the specific relationship with healthy ageing (HA) is unclear. METHODS We conducted a systematic review and meta-analysis of longitudinal studies examining the associations of PA with HA. Studies were identified from a systematic search across major electronic databases from inception as January 2017. Random-effect meta-analysis was performed to calculate a pooled effect size (ES) and 95% CIs. Studies were assessed for methodological quality. RESULTS Overall, 23 studies were identified including 174,114 participants (30% men) with age ranges from 20 to 87 years old. There was considerable heterogeneity in the definition and measurement of HA and PA. Most of the identified studies reported a significant positive association of PA with HA, six reported a non-significant. Meta-analysis revealed that PA is positively associated with HA (ES: 1.39, 95% CI=1.23-1.57, n=17) even if adjusted for publication bias (ES: 1.27, 95% CI=1.11-1.45, n=20). CONCLUSIONS There is consistent evidence from longitudinal observational studies that PA is positively associated with HA, regardless of definition and measurement. Future research should focus on the implementation of a single metric of HA, on the use of objective measures for PA assessment and on a full-range of confounding adjustment. In addition, our research indicated the limited research on ageing in low-and-middle income countries.
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Affiliation(s)
- C Daskalopoulou
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK.
| | - B Stubbs
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - C Kralj
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - A Koukounari
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Prince
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - A M Prina
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
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Earle KA, Ng L, White S, Zitouni K. Sex differences in vascular stiffness and relationship to the risk of renal functional decline in patients with type 2 diabetes. Diab Vasc Dis Res 2017. [PMID: 28622745 DOI: 10.1177/1479164116687237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recent data suggest that the higher risk of end-stage renal disease in women compared with men is associated with waist circumference. We investigated whether vascular stiffness which is linked to visceral fat accumulation is gender specific and associated with a loss in renal function. METHODS We studied 166 patients with type 2 diabetes at high risk of progressive renal disease. A vascular stiffness index was derived from measurement of the peripheral arterial pulse waveform using infrared finger photoplethysmography. Multiple regression analysis was used to examine the relationship between vascular stiffness and traditional clinical and biochemical renal disease risk factors. RESULTS Women were of similar mean (standard deviation) age [61.6 (6.8) vs 60.0 (8.3) years; p = 0.444] and duration of diabetes [9.8 (7.2) vs 10.9 (8.1) years; p = 0.885] compared to men. Waist circumference was significantly associated with vascular stiffness [regression coefficient B = 0.15 (95% confidence interval: 0.06-2.24); p = 0.001]. There was a negative slope parameter for the relationship between glomerular filtration rate and vascular stiffness [ B = -0.15 (95% confidence interval: -0.22 to -0.09); p < 0.001] in women only. CONCLUSION In this cohort, early renal functional decline in women is linked to increased vascular stiffness which may be associated with visceral fat accumulation as determined by waist circumference.
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Affiliation(s)
- Kenneth A Earle
- 1 Thomas Addison Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- 2 St George's, University of London, London, UK
| | - Lauren Ng
- 2 St George's, University of London, London, UK
| | - Sarah White
- 3 Population Health Research Institute, St George's, University of London, London, UK
| | - Karima Zitouni
- 3 Population Health Research Institute, St George's, University of London, London, UK
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18
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Bastian LA, Hayes PM, Haskell SG, Atkins D, Reiber GE, LaCroix AZ, Yano EM. Improving Our Understanding of Health Issues in Older Women Veterans. THE GERONTOLOGIST 2017; 56 Suppl 1:S10-3. [PMID: 26768383 DOI: 10.1093/geront/gnv672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven. Department of Medicine, University of Connecticut Health Center, Farmington.
| | - Patricia M Hayes
- Women's Health Services, Veterans Health Administration, Washington, District of Columbia
| | - Sally G Haskell
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven. Women's Health Services, Veterans Health Administration, Washington, District of Columbia. Department of Medicine, Yale University, New Haven
| | - David Atkins
- Department of Veterans Affairs, Health Services Research and Development Service, Washington, District of Columbia
| | - Gayle E Reiber
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington. Department of Health Services and Department of Epidemiology, University of Washington School of Public Health, Seattle
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California. Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles
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