"Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women

Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.

Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke

BACKGROUND

To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs).

OBJECTIVES

To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke.

METHODS

Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA).

RESULTS

Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables.

CONCLUSIONS

Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.

DISENTANGLING KNOWLEDGE AND BIAS: COMBATING AGEISM WITH THE REVISED FACTS ON AGING QUIZ

The Facts on Aging Quiz (FoAQ) was developed in 1977 as a 25-item True/False test of knowledge about older adults. Since that time, it has been utilized in hundreds of studies involving clarifying misconceptions, measuring factual knowledge across different groups, and assessing bias toward older adults. The current study examines the psychometric properties of a revision to the FoAQ created in 2015 that modified the original items and added 25 more to better reflect contemporary aging research. Participants were sampled using Qualtrics and MTurk platforms and targeted to equally represent the following four age groups: 18-34, 35-49, 50-64, and 65 and older. Exploratory factor analysis (n=956) did not support a multi-factor structure, contrary to previous theories of it having cognitive, physical, societal, and psychological health factors. A single factor model was forced which contained 28 items that only accounted for 26% of the variance in scores. The reliability reached satisfactory levels in the younger three age groups with the 28-item version but remained inadequate among those 65 and older. Small associations with the Expectations Regarding Aging-12 and Aging Semantic Differential scales were observed. In its present format, the FoAQ is not sufficient for research use but remains a useful tool in provoking discussion about age bias and areas in which people of all ages lack factual information. Researchers suggest an expansion in response options and further clarifying the use of this instrument as a measure of knowledge or bias.

ALEXA, ASSESS MY MEMORY: THE FEASIBILITY OF EXTENDED HEALTH MONITORING IN AN OLDER-ADULT-LIVING COMMUNITY

The goal of most older adults is to live independently in their own homes, for as long as possible. There are many advantages to aging in place for the individual, but also challenges as changes in cognitive and physical health can occur over time. Especially for older adults living alone, tracking these changes is critical for early intervention and prevention. The relatively easy availability of consumer technology may provide one mechanism for monitoring older adults in their homes. We designed a pilot study to test the feasibility and acceptability of using wearable sensors (Fitbit sensors), in conjunction with automated interactive voice recognition technology (Amazon Echo), to monitor older adults’ physical and cognitive health during daily activities. Participants (7 females, 2 males; 65-80 years of age) were recruited from a housing complex for older adults with low income. They were interviewed about health monitoring technology before and after a 2-week measurement period during which they were expected to wear the Fitbit daily and interact with the Amazon Echo for 8 consecutive days. Feasibility challenges included limited skill in Echo interactions, remembering to do the assessments, and charging/uploading Fitbit data. Qualitative analysis of interviews revealed generally positive attitudes about technology, but low comfort operating the devices. These preliminary findings suggest that with additional training for older adults, sensors and voice recognition technologies could have significant roles in maintaining older adult quality of life by contributing to early detection of decline and timely intervention.

Computer-Based Executive Function Training for Combat Veterans With PTSD: A Pilot Clinical Trial Assessing Feasibility and Predictors of Dropout

Background: While evidence-based PTSD treatments are often efficacious, 20-50% of individuals continue to experience significant symptoms following treatment. Further, these treatments do not directly target associated neuropsychological deficits. Here, we describe the methods and feasibility for computer-based executive function training (EFT), a potential alternative or adjunctive PTSD treatment. Methods: Male combat veterans with full or partial PTSD (n = 20) and combat-exposed controls (used for normative comparison; n = 20) completed clinical, neuropsychological and functional neuroimaging assessments. Those with PTSD were assigned to EFT (n = 13) or placebo training (word games; n = 7) at home for 6 weeks, followed by repeat assessment. Baseline predictors of treatment completion were explored using logistic regressions. Individual feedback and changes in clinical symptoms, neuropsychological function, and neural activation patterns are described. Results: Dropout rates for EFT and placebo training were 38.5 and 57.1%, respectively. Baseline clinical severity and brain activation (i.e., prefrontal-insula-amygdala networks) during an emotional anticipation task were predictive of treatment completion. Decreases in clinical symptoms were observed following treatment in both groups. EFT participants improved on training tasks but not on traditional neuropsychological assessments. All training completers indicated liking EFT, and indicated they would engage in EFT (alone or as adjunctive treatment) if offered. Conclusion: Results provide an initial framework to explore the feasibility of placebo-controlled, computerized, home-based executive function training (EFT) on psychological and neuropsychological function and brain activation in combat veterans with PTSD. Clinical severity and neural reactivity to emotional stimuli may indicate which veterans will complete home-based computerized interventions. While EFT may serve as a potential alternative or adjunctive PTSD treatment, further research is warranted to address compliance and determine whether EFT may benefit functioning above and beyond placebo interventions.

PTSD and cognitive symptoms relate to inhibition-related prefrontal activation and functional connectivity

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with reduced executive functioning and verbal memory performance, as well as abnormal task-specific activity in prefrontal cortex (PFC) and anterior cingulate cortices (ACC). The current study examined how PTSD symptoms and neuropsychological performance in combat veterans relates to (1) medial PFC and ACC activity during cognitive inhibition, and (2) task-independent PFC functional connectivity.

METHODS

Thirty-nine male combat veterans with varying levels of PTSD symptoms completed the multisource interference task during functional magnetic resonance imaging. Robust regression analyses were used to assess relationships between percent signal change (PSC: incongruent-congruent) and both PTSD severity and neuropsychological performance. Analyses were conducted voxel-wise and for PSC extracted from medial PFC and ACC regions of interest. Resting-state scans were available for veterans with PTSD. Regions identified via task-based analyses were used as seeds for resting-state connectivity analyses.

RESULTS

Worse PTSD severity and neuropsychological performance related to less medial PFC and rostral ACC activity during interference processing, driven partly by increased activation to congruent trials. Worse PTSD severity related to reduced functional connectivity between these regions and bilateral, lateral PFC (Brodmann area 10). Worse neuropsychological performance related to reduced functional connectivity between these regions and the inferior frontal gyrus.

CONCLUSIONS

PTSD and associated neuropsychological deficits may result from difficulties regulating medial PFC regions associated with "default mode," or self-referential processing. Further clarification of functional coupling deficits between default mode and executive control networks in PTSD may enhance understanding of neuropsychological and emotional symptoms and provide novel treatment targets.

Comparison of remedial and compensatory approaches in memory dysfunction: a comprehensive literature review

ABSTRACT Memory is a cognitive process of information storage and retrieval that is essential to performing daily functional activities efficiently. Occupational therapists regularly help individuals with memory impairment to manage their memory deficits. The purpose of this paper was to review the main memory strategies and instructional methods used to improve or manage memory. Studies were identified by searching for the relevant literature published between 1980 and 2007 through the use of several databases with the inclusion criteria that the study must identify at least one specific memory rehabilitation method with an outcome measure representative of the specific method. The reviewed studies included three reviews, 10 randomized control trials, 17 quasi-experimental studies, and five single subjects' designs. The results suggest that there is empirical evidence to support the effectiveness of certain remedial and compensatory memory rehabilitation methods with healthy populations, but weaker evidence can be identified for the memory-impaired populations. In general, remedial methods are effective in lab settings with primarily healthy populations, yet effectiveness in daily activities is less clear. Compensatory methods are generally more efficient than remedial ones and more easily generalized to daily activities, even with memory-impaired populations.

Learning to ignore distracters

Eye tracking has indicated that older and young adults process distracters similarly when reading single sentences. The present study extended this approach by presenting short paragraphs, sentence by sentence. Eye tracking measures included reading times per word, and the duration of the first fixation and total fixations to the distracters and target words. Comprehension was tested following each paragraph, and recognition of distracters and target words was assessed. The results indicated that young adults were able to learn to ignore the distracters as they read through the paragraphs, whereas older adults were less successful at learning to ignore the distracters.

The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia

The aim of this paper is to explore the links among verbal memory, processing speed, negative symptoms, and functional capacity, using structural equation modeling techniques. Model A is a multiple regression model with cognitive and symptom variables as predictors and functional capacity as the latent outcome variable. Model B consists of three two mediator models that assess the ability of each variable to mediate the effect of the other variable on outcome conditional on the inclusion of the other mediator in the model. Ninety-eight community-dwelling patients with schizophrenia (mean age=35.8years, S.D.=10.1) participated in the study. Results indicate that verbal memory, processing speed and negative symptoms significantly contributed to functional status. Verbal memory was at least partially mediated by processing speed in its effect on outcome, while the impact of processing speed on outcome was mediated by both verbal memory and negative symptoms. The influence of negative symptoms on functional capacity was partially mediated by processing speed. These findings enrich our understanding of the direct and indirect effects of these three interrelated variables and provide a basis for the development of intervention strategies.

The use of illustration to improve older adults' comprehension of health-related information: is it helpful?

OBJECTIVE

To examine whether explanatory illustrations can improve older adults' comprehension of written health information.

METHODS

Six short health-related texts were selected from websites and pamphlets. Young and older adults were randomly assigned to read health-related texts alone or texts accompanied by explanatory illustrations. Eye movements were recorded while reading. Word recognition, text comprehension, and comprehension of the illustrations were assessed after reading.

RESULTS

Older adults performed as well as or better than young adults on the word recognition and text comprehension measures. However, older adults performed less well than young adults on the illustration comprehension measures. Analysis of readers' eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults, yet had poorer comprehension of the illustrations.

CONCLUSION

Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text.

PRACTICE IMPLICATIONS

Health practitioners should not assume that illustrations will increase older adults' comprehension of health information.

'Show me, don't tell me'; is this a good approach for rehabilitation?

Objective: To assess the possible memory advantages of the subject-performed task (SPT) and experimenter-performed task (EPT) encoding method in rehabilitation settings.

Design: Controlled quasi-experimental trial.

Setting: University research laboratory and community setting.

Subjects: Eighteen stroke survivors and 18 age-, education- and gender-matched controls.

Intervention: Participants were instructed to study three lists of 20 action phrases (such as 'ring the bell') by either reading, performing or observing others perform the tasks for later memory assessment.

Main measure: After the phrases had been studied, verbal and written memory tests were implemented and responses were recorded.

Results: The memory performance of stroke survivors and control groups was significantly better under the SPT method (mean (SD) 7.95 (2.7)) and EPT method (mean (SD) 7.95 (2.5)) relative to the baseline verbal task method (mean (SD) 4.2 (1.9)), (P<0.001 ANOVA). Participants also remembered functional tasks better than clinical tasks (P<0.001 ANOVA).

Conclusion: Encoding by the SPT and EPT methods are significantly more effective than receiving verbal instructions. The SPT and EPT encoding methods show promise and therapists may be able to use them in the clinic to facilitate the memory performance of stroke survivors.

Young and Older Adults' Reading of Distracters

We used eye-tracking technology to examine young and older adults' performance in the reading with distraction paradigm. One-, 2- and 4-word distracters that formed meaningful phrases were used. There were marked age differences in fixation patterns. Young adults' fixations to the distracters and targets increased with distracter length, suggesting that they were attempting to integrate the distracters with the sentence and had more and more difficulty doing so as the distracters increased in length. Young adults did have better comprehension of the sentences than older adults and also better recognition memory for target words and distracters.

Revealing language deficits following stroke: the cost of doing two things at once

The costs of doing two things were assessed for a group of healthy older adults and older adults who were tested at least 6 months after a stroke. A baseline language sample was compared to language samples collected while the participants were performing concurrent motor tasks or selective ignoring tasks. Whereas the healthy older adults showed few costs due to the concurrent task demands, the language samples from the stroke survivors were disrupted by the demands of doing two things at once. The dual task measures reveal long-lasting effects of strokes that were not evident when stroke survivors were assessed using standard clinical tools.

Eye movements of young and older adults while reading with distraction

The authors used eye-tracking technology to examine young and older adults' online performance in the reading in distraction paradigm. Participants read target sentences and answered comprehension questions following each sentence. In some sentences, single-word distracters were presented in either italic or red font. Distracters could be related or unrelated to the target text. Online measures, including probability of fixation, fixation duration, and number of fixations to distracting text, revealed no age differences in text processing. However, young adults did have an advantage over older adults in overall reading time and text comprehension. These results provide no support for an inhibition deficit account of age differences in the reading in distraction paradigm, but are consistent with J. Dywan and W. E. Murphy's (1996) suggestion that older adults are less able than the young to distinguish target and distracter information held in working memory.

Visuospatial Inattention and Daily Life Performance in People With Alzheimer’s Disease

OBJECTIVE. The purpose of this study was to examine the relationship between visual inattention and daily life performance in people with Alzheimer’s disease.

METHODS. Twenty persons with Alzheimer’s disease (Mini Mental Status Exam [MMSE] &gt; 20) and 21 community dwelling persons (MMSE &gt;26) voluntarily participated in this study. One line bisection test and two cancellation tests were used for testing attention abilities. The Functional Spatial Abilities Questionnaire (FSAQ), the Disability Assessment for Dementia (DAD), and the behavioral subtests of the Behavioral Inattention Test (BIT) were used to assess daily functioning. The presence of visuospatial neglect in people with Alzheimer’s disease was determined by comparing performance on the three attention tests with the control group.

RESULTS. People with Alzheimer’s disease who omitted more targets on the symbol cancellation test showed more deficits on the behavioral subtests of the BIT (p = .02). They also used less systematic searching strategies (p = .001), spent more time looking for targets (p = .001), and made more commission errors (p = .007) than controls on the cancellation test. However, those with Alzheimer’s disease who had visuospatial neglect did not differ from those without neglect on the FSAQ, DAD, and most of the BIT behavioral subtests.

CONCLUSION. People with Alzheimer’s disease have visual inattention problems; however, visuospatial neglect did not interfere with their performance in daily activities as measured in this study. Further research focusing on the relationship between visual attention and daily life function as the disease progresses is suggested.

Ineffectiveness of visual distinctiveness in enhancing immediate recall

Glenberg (1984) and others have theorized that greater recency effects are obtained with auditory as opposed to visual presentation because of greater temporal distinctiveness of items in auditory sequences. We tested a number of ways of enhancing visual distinctiveness, including the use of color, spatial location, and minimized visual interference. None of the seven experiments provided any evidence of improved recall from enhanced visual distinctiveness. In particular, no increase in recency effects was obtained with increased distinctiveness. Additional analyses of pairwise dependency in recall across serial positions also failed to show any evidence of the near-independence of recall of the terminal item that characterizes recall of auditory sequences. Visual-perceptual distinctiveness does not get mapped in any simple way onto memorial distinctiveness in an immediate-serial-recall task.

Rote and gist memory in relation to type of information, sensory mode, and age

This study compared groups aged 20 to 29, 60 to 69, and 70 to 79 years. In Part 1, the comparison was of recall of meaningful prose content items classified as either more amenable to gist recall or more amenable to rote recall. The youngest group demonstrated the best recall for both types of items. The recall itself was classified as gist or rote. The age groups were similar in gist but not rote recall. In Part 2, the age comparisons were in relation to prose paragraphs and word lists. The young group performed best with both types. Visual displays permitting review were better for recall than visual displays or auditory input permitting less or no review. Part 3 examined study time. Those in their 60s took less time than their other two age groups did; their recall performances were no worse than those in their 70s, but they recalled less than the younger subjects did.