bluuebunny/crossref_metadata_2025 huggingface dataset:
PROMISING POLICY AND PRACTICE SUPPORTING FAMILY CAREGIVERS AND RECOMMENDATIONS FOR THE FUTURE
Authors: Reinhard Susan , Caldera Selena , Houser Ari , Choula Rita
Published: December 2023

There have been significant federal and state policy developments since the 2019 update of Valuing the Invaluable. Many inroads have been made in recognizing and supporting family caregivers, but additional steps can be taken at the federal and state levels, and even in the private sector. The National Strategy to Support Family Caregivers, released in September 2022, lays out a unified approach in five organizing goals to achieving this improvement in support for family caregivers. The policy and practice recommendations highlighted in the Valuing the Invaluable: 2023 Update reflect the National Strategy goals. In this presentation, recent policy changes will be summarized that support caregivers and their care recipients in the health care and LTSS systems, which provide financial relief for caregiving, and help working caregivers stay in the workforce. Then the increasing visibility of the family caregiving experience in media and the arts will be explored. This visibility is essential for bringing broader attention to all aspects of caregiving, normalizing the care experience, and eliminating stigma around disability and dementia. Lastly, policy recommendations for building on the National Strategy and bolstering support for family caregivers and care recipients will be detailed for discussion.
SOCIAL INEQUITIES AND THE IMPAIRMENT PARADOX IN LATER LIFE
Authors: Engelman Michal , Jackson Heide
Published: December 2023

Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities. Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally representative sample of 8464 older adults between 1994 and 2016. We employ nonparametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition. As expected, exposures to disadvantages are associated with poorer functional health in midlife and mortality. However, we find that a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for White men and women and for Black women, and the impact of educational attainment, occupation, wealth, and marriage on later-life health differs across race and gender groups. We conclude that the observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.
ASSOCIATION OF MANAGED CARE ORGANIZATION HCBS QUALITY AND HEALTH CARE UTILIZATION
Authors: Jutkowitz Eric , Mulcahy John , Huckfeldt Peter , Frenier Christopher , Shippee Tetyana
Published: December 2023

Providing high quality home and community-based services (HCBS) to older adults is a priority, but surprisingly little is known about the association between HCBS quality and client health care utilization. We linked data from the 2018 wave of the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey for participants in the State of Minnesota enrolled in the Elderly Waiver (n=1,449) to their Centers for Medicare and Medicaid Services (i.e., claims data). We attributed respondents in our sample to 1 of 8 managed care organizations (MCOs) responsible for managing the health and HCBS of beneficiaries. For each MCO, we calculated overall plan level HCBS quality using a validated approach based on items in NCI-AD with subdomains of care experience, security and inclusion. Plan quality was the independent variable in a series of multivariate regressions that controlled for county and beneficiary characteristics. Outcomes (yes/no for any utilization in year) included: 1) hospitalizations, 2) emergency department, 3) home health, 4) durable medical equipment, 5) personal care assistance, 6) transportation, 7) case management, 8) home services, and 9) adult day. Quality was positively associated with case management utilization, but no other measure. As the market share of the highest quality plan in a county increased, all beneficiaries (regardless of MCO) in the county used more durable medical equipment, case management services, and adult day care. In conclusion, MCO quality may be driven by client encounters with plans via case managers. A next step is to determine the causal relationship between quality and outcomes.
THE STATE OF THE DIGITAL DIVIDE
Authors: Boot Walter
Published: December 2023

Over the past few decades, the age-related digital divide has narrowed. For example, since the year 2000 in the United States, the percentage of older adults (65+) online has increased dramatically from 14% to 75%. However, compared to the 96% of individuals 50 to 64 years of age online, this still represents a substantial divide. Similar trends are observed in terms of social media usage and smartphone adoption, and even for older adults who own a smartphone, on average, smartphone proficiency can be substantially lower relative to younger people. This divide can put older adults at a substantial disadvantage and lock them out of the many benefits of existing and emerging technologies. This session will tackle issues surrounding the age-related digital divide. S. Cotten will provide a broad overview of the digital divide and theoretical perspectives that can help explain it. J. Chung will describe how the digital divide impacted social connectivity during the pandemic in low-income communities. S. Pace will discuss African American older adults, ICT use, and loneliness. S. Zhang will discuss attitudinal contributions to technology use and adoption relevant to the digital divide. Finally, W. Boot will discuss technology access and adoption and intersectionality and will discuss potential solutions to close or eliminate the gap in technology adoption and proficiency between younger and older people.
NIA DIVISION OF EXTRAMURAL ACTIVITIES
Authors: Santora Kenneth
Published: December 2023

Dr. Santora will discuss the work of the NIA Division of Extramural Activities. Dr. Santora will also be available for small group discussion.
THE INCREASING INVOLVEMENT OF AAAS IN ADDRESSING THE HOUSING NEEDS AND HOMELESSNESS OF OLDER ADULTS
Authors: Graham Robert , Karmacharya Isha , Wilson Traci , French Molly
Published: December 2023

While services addressing the housing needs and homelessness of older adults are not a core service of the OAA, the Aging Network is adapting to the levels of growing housing insecurity facing older adults. The need for affordable and accessible housing has increased in recent years. In the 2019 National Survey of AAAs, 30% of agencies reported a desire for training and technical assistance on better addressing housing/homelessness issues; by 2022 that interest increased to 46% of agencies. Further, 81% of AAAs said that they are now providing one or more housing/homelessness programs and services. AAA involvement in housing and homeless programs and services may range from providing home modifications, supportive housing, or even owning senior housing. Community partnerships play a critical role in meeting the housing needs of older adults. This presentation shows how AAAs have adapted to address these needs, including programs, services, community partnerships, and advocacy efforts.
GRANDPARENTS’ ACTIVITY ENGAGEMENT WITH GRANDCHILDREN AS A FUNCTION OF CAREGIVER STATUS
Authors: Stephan Abigail , Chan Athena Chung Yin
Published: December 2023

Though the grandparent population varies across virtually all sociodemographic characteristics, caregiver status (i.e., whether grandparents are raising grandchildren), may be most salient in how grandparents engage in activities and perceive their roles in relation to their grandchildren. Informed by the bioecological process-person-context-time model, this mixed-methods study explores how activity engagement varies by caregiver status and whether activity engagement with grandchildren is related to grandparents’ perceived roles. A convenience sample of 86 mid-life and older adults (Mage=65.12 years, range=42-82) completed an online survey with open- and closed-ended items related to their grandparenting experience. 22% of grandparents self-identified as grandparent caregivers (GC), or those who have been raising their grandchildren for six months or longer; the remaining 78% self-identified as non-caregiving grandparents (NCG). Comparative analyses did not yield statistically significant results, revealing GCs and NGCs largely engaged in similar activities with their grandchildren. However, activity engagement intervals differed by group (i.e., daily basis for GCs vs. weekly or monthly basis for NGCs), and a greater proportion of NCGs reported digital activity engagement with their grandchildren. Both GCs and NGCs identified their roles as emotional supporters to their grandchildren, though GCs also identified with instrumental roles (e.g., surrogate parent, anchor, financial supporter). These findings shed light on the connection between self-reported activity engagement and subjective role perceptions across just one sociodemographic characteristic—caregiver status—and suggest both groups share a similar grandparenting foundation, with an additional, “dual-roles” component for GCs. Implications for future research and practice will be discussed.
RACIAL/ETHNIC DISPARITIES IN HEALTH: THE ROLE OF PHYSICALLY DEMANDING WORK
Authors: Park Sung , Pebley Anne , Goldman Noreen , Pratt Borianna , Sheftel Mara
Published: December 2023

Work is an important contributor to racial/ethnic health disparities. Because older-age functional limitations are associated with accumulated physical wear and tear, investigating work-related mechanisms that differentially expose Black and Hispanic Americans to difficult work conditions over time is an important step towards understanding these disparities. Using data on lifetime work histories, this study investigates the role of accumulated years of physically demanding work (PDW) in young and middle adulthood on the number of functional limitations at age 60 (FL60). It also assesses whether cumulative PDW accounts for the observed racial/ethnic differences in FL60 among U.S.-born Black, Hispanic, and White respondents. Results show cumulative PDW is strongly associated with FL60 and that it accounts for a part of the racial/ethnic gap in FL60 in the presence of extensive control variables. The findings illustrate the importance of work as a dynamic process that ultimately influences the health of a diverse, aging population. Policy implications are addressed.
DYADIC LONELINESS, AGE, AND COGNITIVE FUNCTIONING AMONG MID-LIFE AND OLDER BLACK COUPLES
Authors: Stokes Jeffrey E , Farmer Heather
Published: December 2023

Cognitive health is a growing concern for the older Black population, whose risk for dementia is about twice that of White older adults. Moreover, close relationships, such as marriage, are critical for well-being in later life. Within older adults’ marriages, loneliness has been linked with individuals’ own and their partners’ mental, physical, and cognitive health. Yet little research has examined these relationships within the older Black population, and even less work has situated Black older adults within a relational, dyadic context. Lastly, research is needed on the circumstances under which partners’ loneliness may be influential for cognition, including potential variation by individuals’ age or their own level of cognitive functioning. This study used longitudinal dyadic data from the Health and Retirement Study (2010-2016; n=1,270 participants from 635 couples) from both partners in opposite-sex midlife and older married couples where at least one partner reported being Black or African American. Lagged dependent variable (LDV) structural equation modeling (SEM) addressed our research questions. Results indicated that (1) loneliness was not associated with participants’ own cognitive functioning 4-years later, yet (2) husbands’ loneliness was associated with worse cognitive functioning 4-years later for wives who had high baseline cognitive functioning themselves, and (3) wives’ loneliness was associated with worse cognitive functioning 4-years later only for oldest-old husbands. Findings indicate that loneliness has dyadic consequences for cognitive functioning among older Black couples, but that context is crucial for determining which older partners are at greatest risk of experiencing harmful cognitive repercussions from a partner’s loneliness.
A WEAK ECONOMY AND AGE DISCRIMINATION DRIVES JOB UNCERTAINTY AMONG OLDER WORKERS
Authors: Choi-Allum Lona
Published: December 2023

Older workers have experienced disruptions in the workplace over the past five years, with recent studies showing that a reduction in hours as the most commonly cited reason. Not surprising, the COVID-19 pandemic was a primary contributor, leading to reduced hours or leaving a job involuntarily (laid off or fired). The AARP Value of Experience survey sought to understand the experiences of 2,000 workers ages 40 and older, weighted to be nationally representative by gender, race/ethnicity, age, income, and other variables. Results showed that a weak economy is the main driver of why older workers anticipate losing their job within a year. Those under 50 (37%) are just as likely as those ages 50+ (34%) to say that they could lose their job due to a weak economy. When asked how confident those in the labor force are in finding a new job within three months, one in four workers say they are not confident while nearly half of those who are looking for a job say the same. Those age 50+ (29%) are more likely than those under age 50 (14%) to report low confidence in finding a similar job within three months. The main reasons for low confidence include age discrimination and a weak economy. Workers ages 50+ (40%) are twice as likely as those under age 50 (19%) to say age discrimination is a factor in not being able to find another similar job. This study highlights the perceived difficulties that older workers face in continued employment.
LOW SENSORY RESPONSIVENESS IS ASSOCIATED WITH ACCELERATED AGING IN MID LIFE
Authors: Asher Merav , Agmon Maayan
Published: December 2023

The rate of aging is affected by genetic, behavioral, and emotional mechanisms; one possibly additional mechanism is the ability of the nervous system to sense and react appropriately to stimuli. This ability, called sensory responsiveness, may be a factor in shaping the aging mechanism and could be used as a marker of aging. The aim of this study was to examine the association between sensory responsiveness levels and rate of aging in midlife. A total of 97 participants born between 1974-1976 (age 45.63±0.67 at end point, 46% women) were included. Biological age was estimated at age ~32 and ~45 using the Klemera-doubal method and a set of biomarkers. Rate of aging was calculated by the difference in estimated biological age scores divided by passing years, reflecting temporal change in biological age. Sensory responsiveness was evaluated using the Sensory Responsiveness Questionnaire Scale, identifying high or low sensory responsiveness subtypes. We found that low sensory responsiveness was positively associated with rate of aging while controlling for chronological age, social engagement, and physical performance (linear regression, r=0.211; p=0.038). High sensory responsiveness subtype was not significantly associated with rate of aging (linear regression, r=-0.02; p=0.843). To conclude, low sensory responsiveness subtype may have a significant role in identifying the rate of aging in midlife. These findings highlight the importance of sensory responsiveness evaluations as a marker for rate of aging and the need for interventions focusing on sensory responsivity difficulties, as a mean of supporting healthier aging.
RURAL–URBAN DISPARITIES IN COGNITIVE PERFORMANCE IN BRAZIL AND MEXICO
Authors: Goncalves Natalia Gomes , Avila Jaqueline , Bertola Laiss , Obregon Alejandra , Ferri Cleusa , Wong Rebeca , Suemoto Claudia
Published: December 2023

Latin America (LA) has the highest dementia burden globally among people 60 years or older, with a prevalence of 8.5%. However, there is little evidence of the disparities in cognitive performance in rural and urban areas in LA. We use nationally representative data from the two largest countries in LA, Brazil and Mexico, to assess if rurality is associated with cognitive impairment, and assess how education and country modify this relationship. The sample included 9,412 participants from the Brazilian Longitudinal Study of Aging (ELSI) and 14,779 participants from the Mexican Health and Aging Study (MHAS). Participants were classified as cognitively impaired or not impaired using cognitive performance scores and a regression-based approach. Logistic regression models were used to estimate the association between rural/urban residency and cognitive function. The modifying effect of education and country was investigated by adding an interaction term in the fully adjusted model. ELSI participants had a mean age 62.5±9.8 years, 54% were women, 13.3% were illiterate, and 6% had cognitive impairment. MHAS participants from had a mean age 64.8±9.7 years, 55% were women, 18% were illiterate, and 5% were cognitively impaired. In Mexico, those living in rural areas were more likely to have cognitive impairment than those in urban areas (OR=1.43, 95%CI=1.20;1.71), but this difference was not seen in Brazil (OR=1.10, 95%CI=0.87;1.36). The three-way interaction of rurality with country and education showed that rural residents of Mexico had lower odds of cognitive impairment compared to rural residents of Brazil with the same level of education (p<0.001).
THE EFFECT OF AGE ON EMOTION REGULATION PATTERNS IN DAILY LIFE: FINDINGS FROM AN EXPERIENCE SAMPLING STUDY
Authors: Mikkelsen Mai , O’Toole Mia , Elkjær Emma , Mehlsen Mimi
Published: December 2023

The aim of the present experience sampling study was to examine how age affects emotion regulation patterns and their impact on well-being in daily life. A sample of 406 adults (age range: 18-81, 62.8 % female) were prompted five times a day for seven days to rate their momentary emotions, emotion regulation strategy use, and emotion regulation strategy effectiveness. Based on these ratings, indicators of emotion regulation variability and differentiation were calculated. Well-being outcomes included daily positive and negative emotions as well as symptoms of anxiety and depression assessed at baseline. The findings revealed reduced emotion regulation variability with age and a negative association between emotion regulation variability and well-being. There was no effect of age on emotion regulation effectiveness or differentiation. Emotion regulation effectiveness was associated with more positive and less negative daily emotions, and this association was stronger for young adults than older adults. The findings may indicate that older adults rely on a smaller set of effective emotion regulation strategies that are adapted to their specific context and resources, leading to reduced variability in emotion regulation and ultimately greater well-being. Concerning emotion regulation effectiveness, the findings suggest that effectiveness is less important for well-being in daily life for older adults, possibly because well-being is determined by other factors (e.g., less frequent and more predictable stressors) in older age.
CELLULAR IMMUNE AGING AND PHYSICAL DISABILITY: RESULTS FROM THE HEALTH AND RETIREMENT STUDY
Authors: Noppert Grace , Duchowny Kate
Published: December 2023

Given long-standing inequities in physical disability, we leveraged data from the nationally-representative Health and Retirement Study to investigate gender differences in the association between advanced immune aging and physical disability. Among women, we found a one standard deviation increase in the CD8+:CD4+ ratio, a marker of advanced immune aging, was associated with a 24% greater prevalence of ADL disability (PR= 1.24, 95% CI: 1.23, 1.25). No association was observed among men. Results suggest that among women, advanced immune aging may serve as a salient risk factor in shaping physical disability.
ESTIMATING THE EFFECTS OF A POTENTIAL VACCINE FOR CYTOMEGALOVIRUS ON DISABILITIES AMONG OLDER ADULTS IN THE US
Authors: He Yuelin , Faul Jessica , Duchowny Kate , Li Chihua , Stebbins Rebecca , Noppert Grace
Published: December 2023

Cytomegalovirus (CMV) infection has been identified as contributing to the development several aging-related diseases, such as disabilities. However, the development of CMV vaccines has been slow, particularly of those targeting older individuals. With few studies that have investigated the potential effects of a CMV vaccine on disabilities among older adults, we aim to study such effects on mobility disabilities by tasks. We use longitudinal data from the Health and Retirement Study (HRS) from 2016 to 2020 to quantify what proportion of disabilities could be prevented in the United States with a viable CMV vaccine. The analytic sample includes N=5,855 individuals aged 65 or above. Under the assumption that a hypothetical vaccine would shift CMV levels from seropositive to seronegative, we construct a binary indicator based on the continuous IgG antibody measure of serum CMV. Using a novel logistic regression-based approach that allows adjustment for continuous age, we estimate attributable fractions (AF) to seropositive CMV levels for five dichotomous outcomes about difficulty with activities of daily living (ADLs), including walking across a room, dressing, bathing, eating, getting in and out of bed, and using the toilet, and stratify the analyses by sex and race/ethnicity. The findings will implicate the potential impact of a vaccine for CMV on mobility disability in older adults, laying the groundwork for future studies to examine the impact of vaccines on disabilities at different time points with varying efficacy levels among the elderly.
MULTIFACETED LINKS BETWEEN SOCIAL RELATIONSHIPS AND THE DISABLEMENT PROCESS IN LATER LIFE
Authors: Zhang Yuan
Published: December 2023

While a negative association between social relationships and physical limitations or disability has been reported persistently, the possible reciprocal relationships and pathways through which social relationships affect physical function and disability remain to be explored. This study used longitudinal data from the US Health and Retirement Study (HRS) and the National Social Life, Health, and Aging Project (NSHAP) to examine the multifaceted links between different dimensions of social relationships and physical limitations/disability among older adults in the US. We used Structural Equation Models to explore pathways between social relationships and physical limitations in the HRS and longitudinal residual change models to examine the effects of social relationships on changes in physical limitations between two waves in NSHAP. Results show that for men, greater social integration may lower subsequent physical limitations, whereas, for women, social support may prevent declines in physical function. For both genders, greater physical limitations and disability significantly lower subsequent social integration. This work tested the potential causal benefits of the social relationship hypothesis and selection processes and incorporated different aspects of social relationships. As such, our findings advance the explanations of the association between social relationships and later-life health and help better understand the determinants of the disablement process.
USING TRANSDISCIPLINARY CO-PRODUCTION TO GAIN INSIGHTS INTO SPATIAL JUSTICE AND AGE-FRIENDLY CITIES
Authors: Doran Patty
Published: December 2023

Globally, a popular policy approach to address the two interrelated challenges of population ageing and urbanisation has been to adopt the World Health Organization’s Age-Friendly City framework, a model that can help to identify and address barriers to the well-being and participation of older people. This paper reports early findings from the ‘Ageing in Place in Cities’ project. The research was conducted from a critical gerontology perspective and embedded a spatial justice perspective by centring the concepts of equity, diversity and co-production in our underpinning theoretical framework. Discussing findings from seven case study cities (all who were early adopters of the Age-Friendly Cities framework), this paper discusses how a transdisciplinary co-production approach has been used to gain greater understanding of age-friendly initiatives in each city. Using mixed methods, we first developed descriptive profiles for each city using both census and other local demographic data to explore how the populations have changed over time, and narratives and policy documents detailing the initiatives used to support ageing in place. Second, we conducted semi-structured interviews with a variety of actors in each city to examine how the cities delivered age-friendly change. We integrated the data using a comparative case study approach to draw out insights across the cities. Our findings reveal the role of key leaders and stakeholders in age-friendly cities and will be of interest to policy makers and academics interested in population ageing and urban change. Further, our transdisciplinary co-production methods present a novel approach to conducting age-friendly research.
ESTIMATION OF WORKING LIFE EXPECTANCY: APPLICATION OF A MULTISTATE MARKOV MODEL
Authors: Chungkham Holendro Singh
Published: December 2023

Longer life expectancy in Western countries has led to concerns about sustainable workforces amid the rising costs of securing aging populations. Retirement age is no more a good indicator of the end of the working life, because many older workers move in-and-out of workforce. A more useful measure is working life expectancy (WLE), which is the expected number of remaining years from a given age that a person will work. This measure considers transitions across different employment states. The method adopted for estimation of WLE is along the same line to estimate health expectancy (HE) based on cross-sectional data without considering transitions in different states of work over time. A better approach is based on multi-state survival models considering transitions among states over time using longitudinal data. These models assume a Markov Process to estimate transition probabilities. WLE is the weighted sum of duration of stay in a state weighted by the transition probabilities. The method adopted in IDEAR consortium is a multistate survival model assuming a first-order Markov process in continuous time to estimate transition probabilities. Transition probabilities are estimated by the msm package. This model takes care of interval censoring where the exact dates of transitions from one state to another is not known. WLEs are estimated by using the package elect (van den Hout, 2019) incorporating age as a time dependent variable by using a Gompertz model instead of the exponential model. The method is demonstrated to estimate WLE using Swedish Longitudinal Occupational Survey of Health (SLOSH).
THE QUALITY OF NURSING CARE PROVIDED TO PATIENTS LIVING WITH DEMENTIA: FROM COMMUNICATION- TO FUNCTION-FOCUSED CARE
Authors: Resnick Barbara
Published: December 2023

Although shortages in nursing abound across all levels of care, it is important that the little time nurses have to engage with patients living with dementia while hospitalized be optimal. The Function Focused Care for Acute Care intervention helps nurses interact with patients living with dementia in a way that engages them in physical activity during all care interactions. This includes such things as walking a patient to the bathroom instead of using a commode chair or bedpan, role modeling for patients and having them wash their face and upper body, walking patients in the hallway when agitated, or doing hand over hand feeding and bathing if the patient is totally dependent. Function focused care provides staff with ways in which to interact with patients living with dementia to be more positive and encouraging with regard to activity and engagement versus neutral or negative. Positive interactions are beneficial in that they encourage participation and engagement in care, neutral interactions are brief and indifferent and provide no encouragement, and negative interactions restrict patients often due to inappropriate safety concerns or for the convenience of the health care team. This symposium will provide an overview of the way in which nurses provide function focused care to patients living with dementia when hospitalized, the quality of care interactions provided and the interventions used in our Function Focused Care work that have helped to improve the percentage of time function focused is provided and the quality of care interactions.
WHAT DO NURSES NEED TO IMPLEMENT FUNCTION-FOCUSED CARE IN THE HOSPITAL?
Authors: Boltz Marie
Published: December 2023

The intervention, FFC-AC-EIT, is a theoretically based intervention that includes the implementation of four steps: (1) Environment and policy assessments; (2) Education of staff; (3) Establishing patient goals; and (4) Mentoring and motivating of staff, patients, and families. The nurse interventionist works with a unit-based stakeholder team to develop function-focused goals for the unit and an action plan to meet the goals, while considering barriers to implementation. Based on content analysis of field notes we will describe stakeholder goals established, action plans, and barriers and facilitators to meeting goals in five hospital units. Goals focused on improving staff competency in increasing mobility and physical activity in persons with dementia, integrating mobility assessment and plans into workflows, and improving patient outcomes including decreased falls and less use of constant observation. Common barriers included unstable staffing, inconsistent prioritization among staff and managers, family attitudes, and lack of operating procedures and resources to provide function-focused care. Facilitators at the unit level included administrative support, nurse managers being actively involved in all aspects of planning and oversight, engagement of families, effective communication strategies, involvement of nursing assistants, interdisciplinary collaboration, and access to necessary supplies and equipment. Key implementation strategies included multiple approaches to staff training and communication, the use of champions, clear operating procedures, hardwiring assessment and plans into the electronic record, the use of a feedback loop, and alignment of functional-focused care with other hospital and unit quality initiatives.
PERCEPTIONS OF HOME HEALTH AIDES (HHA) CARING FOR PERSONS LIVING WITH DEMENTIA (PLWD) ABOUT ADOPTION OF TELEHEALTH
Authors: Osakwe Zainab Toteh , Odlum Michelle , Céspedes Amarilis , Perez Sasha
Published: December 2023

Home healthcare agencies serve a large and growing population of Persons living with Dementia (PLWD). The COVID-19 pandemic led to rapid adoption and use of telehealth services in the delivery of home healthcare, allowing patients to visit with home healthcare clinicians remotely using virtual technology. Yet, concerns remain about feasibility of telehealth for PLWD on HHC, who largely depend on home health aides to communicate their care concerns with the health care teams. We interviewed 25 HHAs to PLWD between June and August 2020 about their experiences with telehealth as part of a larger study focused on HHA informed care plans for PLWD. Interviews were recorded, transcribed, translated and analyzed using conventional content analysis. We interviewed 25 HHAs employed by 4 unique home healthcare agencies. HHAs had a mean age of 49.8 (± 9.1), 24 (97%) female, 11 (44%) Black, 12 (48%) Hispanic. Twelve HHAs were interviewed in Spanish. The main themes identified were: (1) preference for telehealth platforms that include video conferencing to enhance human interactions, (2) preference for telehealth as a supplement, not substitute, for nursing visits, (3) additional burden of using the tablet or computer while care for PLWD and (4) concerns about inadequate training needed to use telehealth. HHAs expressed concerns about the need to not substitute in person home visits with Telehealth. As home healthcare agencies consider best approaches to integrate telehealth into their care delivery models, communication with HHAs remains key to develop strategies that prioritize the care needs of PLWD.
A new inversion-free iterative algorithm for the discrete algebraic Riccati equation
Authors: Wang Li , Zhu Yuli
Published: December 2023

In this paper, by the transformation form of the discrete algebraic Riccati equation (DARE), we propose a new inverse-free iterative algorithm to obtain the positive definite solution of the DARE. Furthermore, the monotone convergence is proved and convergence rate analysis is presented for the derived algorithm. Compared with some existing algorithms, numerical examples demonstrate the feasibility and effectiveness of our algorithm.
Prevalence and Predictors of Oral Treponema pallidum Detection by Quantitative Polymerase Chain Reaction in Early Syphilis
Authors: Dionne Jodie A , Giacani Lorenzo , Tamhane Ashutosh , Workowski Kimberly , Lieberman Nicole A P , Greninger Alexander L , Perlowski Charlotte , Newman Lori , Hook Edward W
Published: December 2023

Background

Treponema pallidum prevalence and burden at oral and lesion sites in adults with early syphilis were assessed by quantitative polymerase chain reaction (qPCR). Factors associated with oral shedding were also examined.

Methods

Pretreatment oral and lesion swabs were collected from adults with early syphilis in a US multicenter syphilis treatment trial. Oral swabs were collected in the presence and absence of oral lesions. Following DNA extraction, qPCR and whole-genome sequencing (WGS) were performed to assess burden and strain variability.

Results

All 32 participants were male, mean age was 35 years, and 90.6% with human immunodeficiency virus (HIV). T. pallidum oral PCR positivity varied by stage: 16.7% primary, 44.4% secondary, and 62.5% in early latent syphilis. Median oral T. pallidum burden was highest in secondary syphilis at 63.2 copies/µL. Lesion PCR positivity was similar in primary (40.0%) and secondary syphilis (38.5%). Age 18–29 years was significantly associated with oral shedding (vs age 40+ years) in adjusted models. WGS identified 2 distinct strains.

Conclusions

T. pallidum DNA was directly detected at oral and lesion sites in a significant proportion of men with early syphilis. Younger age was associated with oral shedding. Ease of oral specimen collection and increased PCR availability suggest opportunities to improve syphilis diagnostic testing.

Clinical Trials Registration. NCT03637660.
Hybrid Immunity to SARS-CoV-2 During Pregnancy Provides More Durable Infant Antibody Responses Compared to Natural Infection Alone
Authors: LaCourse Sylvia M , Wetzler Erica A , Aurelio Morgan C , Escudero Jaclyn N , Selke Stacy S , Greninger Alexander L , Goecker Erin A , Barnes Sarina R , Arnould Isabel S , Pérez-Osorio Ailyn C , Richardson Barbra A , Kachikis Alisa , Englund Janet A , Drake Alison L
Published: December 2023

Background

Hybrid immunity (infection plus vaccination) may increase maternally derived SARS-CoV-2 antibody responses and durability versus infection alone.

Methods

Prospective cohort of pregnant participants with prior SARS-CoV-2 infection (anti-nucleocapsid IgG, RT-PCR, or antigen positive) and their infants had blood collected in pregnancy, at delivery/birth, and postpartum tested for anti-spike (anti-S) IgG and neutralizing antibodies (neutAb).

Results

Among 107 participants at enrollment, 40% were unvaccinated and 60% were vaccinated (received ≥1 dose); 102 had previous SARS-CoV-2 infection in pregnancy (median, 19 weeks’ gestation); 5 were diagnosed just prior to pregnancy (median, 8 weeks). At delivery, fewer unvaccinated participants (87% anti-S IgG+, 86% neutAb) and their infants (86% anti-S IgG+, 75% neutAb) had anti-S IgG+ or neutAb compared to vaccinated participants and their infants (100%, P ≤ .01 for all). By 3–6 months postpartum, 50% of infants of unvaccinated participants were anti-S IgG+ and 14% had neutAb, versus 100% among infants of vaccinated participants (all P < .01), with lower median antibody responses (anti-S IgG log10 1.95 vs 3.84 AU/mL, P < .01; neutAb log10 1:1.34 vs 1:3.20, P = .11).

Conclusions

In pregnant people with prior SARS-CoV-2, vaccination before delivery provided more durable maternally derived antibody responses than infection alone in infants through 6 months.
Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications
Authors: Mudenda Steward , Matafwali Scott Kaba , Mukosha Moses , Daka Victor , Chabalenge Billy , Chizimu Joseph , Yamba Kaunda , Mufwambi Webrod , Banda Patrick , Chisha Patience , Mulenga Florence , Phiri McLawrence , Mfune Ruth Lindizyani , Kasanga Maisa , Sartelli Massimo , Saleem Zikria , Godman Brian
Published: December 2023

Introduction

Antifungal resistance (AFR) is a growing global public health concern. Little is currently known about knowledge, attitudes and practices regarding AFR and antifungal stewardship (AFS) in Zambia, and across the globe. To address this evidence gap, we conducted a study through a questionnaire design starting with pharmacy students as they include the next generation of healthcare professionals.

Methods

A cross-sectional study among 412 pharmacy students from June 2023 to July 2023 using a structured questionnaire. Multivariable analysis was used to determine key factors of influence.

Results

Of the 412 participants, 55.8% were female, with 81.6% aged between 18 and 25 years. Most students had good knowledge (85.9%) and positive attitudes (86.7%) but sub-optimal practices (65.8%) towards AFR and AFS. Overall, 30.2% of students accessed antifungals without a prescription. Male students were less likely to report a good knowledge of AFR (adjusted OR, AOR = 0.55, 95% CI: 0.31–0.98). Similarly, students residing in urban areas were less likely to report a positive attitude (AOR = 0.35, 95% CI: 0.13–0.91). Fourth-year students were also less likely to report good practices compared with second-year students (AOR = 0.48, 95% CI: 0.27–0.85).

Conclusions

Good knowledge and positive attitudes must translate into good practices toward AFR and AFS going forward. Consequently, there is a need to provide educational interventions where students have low scores regarding AFR and AFS. In addition, there is a need to implement strategies to reduce inappropriate dispensing of antifungals, especially without a prescription, to reduce AFR in Zambia.
Skin-sharing Augmentation Mastopexy for Reconstruction of an Adult Female Breast After Severe Childhood Scalds: A Case Report
Authors: Mahrhofer Maximilian , Weitgasser Laurenz , Schoeller Thomas
Published: December 2023

This case report describes our treatment of a 37-year-old female, Caucasian patient with a severe unilateral breast deformity after childhood scald trauma. Thermal injuries of the breast in female children pose a challenge for breast reconstruction after puberty since they impede normal development and can lead to psychological trauma. To achieve satisfactory results, a combination of different reconstructive techniques and a multistage approach is required. The patient was initially treated with an augmentation mastopexy of the left breast and a reverse abdominoplasty to correct the asymmetry and replace resected scar tissue. Following the surgery, skin necrosis of the lower breast pole due to insufficient perfusion of the skin occurred. A full-thickness skin graft, using the resected tissue from the healthy right breast after mastopexy, was used for reconstruction. This resulted in a successful outcome and proved to be a possible primary choice as well as a helpful option for salvage procedures. To our knowledge, this is the first case report describing the use of a contralateral mastopexy using the full-thickness skin graft for reconstruction of a burned breast.
Protection of data under unfair competition law in Japan and Korea—a case of asymmetric convergence?
Authors: Lee Nari
Published: December 2023

This article explores the question of overlap in unfair competition law in Japan and Korea and discusses whether the introduction of a general clause could address the problem of overlap. Positive laws regulating unfair competition in Japan and Korea have adopted a similar set of rules based on specific conduct regulation, with some variation. Notably, Korean law now prohibits the unfair use of another’s achievement based on an open clause, complementing the specific list of prohibited conduct. The article first presents an overview of unfair competition law in Japan and Korea, highlighting the requirements for protection and limitations, and then explores the problem of overlapping claims surrounding data misappropriation. Contrasting the legislative techniques used by Japan and Korea, this article notes that an open norm may provide the judiciary with an interpretative tool to dynamically address emerging unfair conduct. However, as there is a danger of limiting free competition and potential internal inconsistencies, to avoid asymmetric convergence, open norms should be carefully coordinated with specific conduct prohibitions, with clear prioritization.
Survivorship care in breast cancer: understanding implementation barriers through the lens of the Theoretical Domains Framework
Authors: Brauer Eden R , Petersen Laura , Ganz Patricia A
Published: December 2023

Background

Breast cancer survivorship guidelines with specific recommendations on managing long-term effects are available, but uptake in clinical practice remains low. Using the lens of the Theoretical Domains Framework, we aimed to understand key factors in guideline-concordant management of long-term effects to inform future implementation efforts in clinical practice contexts.

Methods

As part of a broader survey of oncologists, a theory-guided questionnaire was developed. Oncologists were asked to report level of agreement with Theoretical Domains Framework–based statements, current usage and perceived value of survivorship resources, and frequency of managing long-term effects in routine care. Data analyses included psychometric assessment of the questionnaire, descriptive summaries of theoretical domains and survivorship resources, and multivariable logistic regression models.

Results

In total, 217 oncologists completed the Theoretical Domains Framework–based questionnaire; 54% of oncologists reported “always or almost always” evaluating physical effects at routine survivorship appointments, while 34% did so for psychosocial effects. In regression models, Environmental Context and Resources was the only theoretical domain found to be statistically significantly associated with “always or almost always” evaluating both physical (odds ratio = 0.29, 95% confidence interval = 0.09 to 0.80) and psychosocial (odds ratio = 0.09, 95% confidence interval = 0.02 to 0.35) effects.

Conclusions

Findings support application of the Theoretical Domains Framework in understanding oncologists’ behaviors and perceived barriers in managing long-term effects in breast cancer survivors. In future implementation efforts, this theory-informed approach can be used to target relevant domains and strategies focused on embedding guideline recommendations in the clinical context through structured resources and environmental supports.
Advances in virus-induced flowering in tomato
Authors: Bellinazzo Francesca
Published: December 2023

This article comments on:

Deng Y, Yarur-Thys A, Baulcombe DC. 2024. Virus-induced overexpression of heterologous FLOWERING LOCUS T for efficient speed breeding in tomato. Journal of Experimental Botany 75, 36–44.
IL-6 expression-suppressingLactobacillus reuteristrains alleviate gut microbiota-induced anxiety and depression in mice
Authors: Ma Xiaoyang , Shin Jeong-Woo , Cho Jae-Hyun , Han Seung-Won , Kim Dong-Hyun
Published: December 2023

Fecal microbiota transplantation from patients with depression/inflammatory bowel disease (PDI) causes depression with gut inflammation in mice. Here, we investigated the effects of six Lactobacillus reuteri strains on brain-derived neurotropic factor (BDNF), serotonin, and interleukin (IL)-6 expression in neuronal or macrophage cells and PDI fecal microbiota-cultured microbiota (PcM)-induced depression in mice. Of these strains, L6 most potently increased BDNF and serotonin levels in corticosterone-stimulated SH-SY5Y and PC12 cells, followed by L3. L6 most potently decreased IL-6 expression in lipopolysaccharide (LPS)-stimulated macrophages. When L1 (weakest in vitro), L3, and L6 were orally administered in mice with PcM-induced depression, L6 most potently suppressed depression-like behaviors and hippocampal TNF-α and IL-6 expression and increased hippocampal serotonin, BDNF, 5HT7, GABAARα1, and GABABR1b expression, followed by L3 and L1. L6 also suppressed TNF-α and IL-6 expression in the colon. BDNF or serotonin levels in corticosterone-stimulated neuronal cells were negatively correlated with depression-related biomarkers in PcM-transplanted mice, while IL-6 levels in LPS-stimulated macrophage were positively correlated. These findings suggest that IL-6 expression-suppressing and BDNF/serotonin expression-inducing LBPs in vitro, particularly L6, may alleviate gut microbiota-involved depression with colitis in vivo.
CVID With Unusual Peripheral Mononeuropathy and Associated IL-7 Receptor Mutation
Authors: Baxter Joseph , Waters Aubri
Published: December 2023

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It is characterized by hypogammaglobulinemia and can present with a broad range of symptoms including recurrent bacterial infections, autoimmunity, and malignancy. Rarely, it has been implicated with peripheral neuropathy. We present a case of CVID with peripheral neuropathy and a pathogenic heterozygous variant of IL-7 receptor gene. The patient is a 38-year-old female with a history of recurrent infections since childhood including pneumonia and sinus infections status post tonsillectomy and sinus surgery. She subsequently developed severe left leg and lower back pain that progressed to left foot drop and decreased sensation over the left leg. She was found to have severe hypogammaglobulinemia and poor polysaccharide and protein response, thus meeting criteria for CVID. Mononeuropathy is a rare finding in CVID. Genetic panel was performed and was significant for a single pathogenic variant in IL-7 receptor. Disruptions in the IL-7 and IL-7 receptor signaling pathway have been associated with autoimmunity such as rheumatoid arthritis and multiple sclerosis. Further investigation is indicated to determine the clinical significance of this variant.