Older Adults Without Close Kin in the United States

Objectives: We document the size and characteristics of the population of older adults without close kin in the contemporary United States. Methods: Using the Health and Retirement Study, we examine the prevalence of lacking different types and combinations of living kin, examine how kinless-ness is changing across birth cohorts, and provide estimates of kinless-ness for sociodemographic and health groups. Results: In 1998–2010, 6.6% of U.S. adults aged 55 and above lacked a living spouse and biological children and 1% lacked a partner/spouse, any children, biological siblings, and biological parents. Kinless-ness, defined both ways, is becoming more common among adults in their 50s and 60s for more recent birth cohorts. Lacking close kin is more prevalent among women than men, native born than immigrants, never-married, those living alone, college-educated women, those with low levels of wealth, and those in poor health. Discussion: Kinless-ness should be of interest to policy makers because it is more common among those with social, economic and health risks; those who live alone, with low levels of wealth, and disability. Aging research should address the implications of kinless-ness for public health, social isolation, and the demand for institutional care

Projections of White and Black Older Adults without Living Kin in the United States, 2015-2060

Close kin provide many important functions as adults age, affecting health, financial well-being, and happiness. Those without kin report higher rates of loneliness and experience elevated risks of chronic illness and nursing facility placement. Historical racial differences and recent shifts in core demographic rates suggest that white and black older adults in the United States may have unequal availability of close kin and that this gap in availability will widen in the coming decades. Whereas prior work explores the changing composition and size of the childless population or those without spouses, here we consider the kinless population of older adults with no living close family members and how this burden is changing for different race and sex groups. Using demographic microsimulation and the United States Census Bureau’s recent national projections of core demographic rates by race, we examine two definitions of kinlessness: those without a partner or living children, and those without a partner, children, siblings, or parents. Our results suggest dramatic growth in the size of the kinless population as well as increasing racial disparities in percentages kinless. These conclusions are driven by declines in marriage and are robust to different assumptions about the future trajectory of divorce rates or growth in nonmarital partnerships. Our findings draw attention to the potential expansion of older adult loneliness, which is increasingly considered a threat to population health, and the unequal burden kinlessness may place on black Americans

Siblings, friends, course-mates, club-mates: How adolescent health behavior homophily varies by race, class, gender, and health status

Many unhealthy behaviors develop during adolescence, and these behaviors can have fundamental consequences for health and mortality in adulthood. Social network structure and the degree of homophily in a network affect how health behaviors and innovations are spread. However, the degree of health behavior homophily across different social ties and within subpopulations is unknown. This paper addresses this gap in the literature by using a novel regression model to document the degree of homophily across various relationship types and subpopulations for behaviors of interest that are related to health outcomes. These patterns in health behavior homophily have implications for which behaviors and ties should be the subjects of future research and for predicting how homophily may shape health programs focused on specific subpopulations (gender, race, class, health status) or a specific social context (families, peer groups, classrooms, or school activities)

Native American student perspectives on tribally affiliated osteopathic medical school education

Background: As the first tribally affiliated medical school, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation (OSUCOM-CN) presents a landmark opportunity for Native American (NA) students. Little research has been conducted regarding NA students’ sense of belonging in university settings and no research investigates this in the medical school environment. Students’ sense of belonging is linked to positive academic outcomes, including higher grades, higher engagement, self- confidence, and acceptance. In addition to sense of belonging, documenting NA medical students’ perspective of culture, relationships, or closeness with their own tribe, and what it means to them to be medical students in the inaugural class of a tribally affiliated college of medicine is important. Thus, our objective is to evaluate NA students’ sense of belonging at OSUCOM-CN through a sense of belonging survey, interviews, and essay responses through this mixed-methods study.Methods: A social constructivist approach using qualitative methods was adopted to gain an understanding of medical students’ perspectives on sense of belonging in the inaugural class at OSUCOM-CN. Data were gathered via mixed methods using a sense of belonging survey, semi-structured interviews, and essay prompts. Participants were recruited from a sampling of all medical students in the inaugural class at OSUCOM-CN identifying as tribally enrolled or of tribal descendancy alone or in combination with other race(s). Sense of belonging surveys and short-answer essays were collected via electronic and paper-copy. Interviews were audio-recorded and transcribed. (Rev, Austin, TX) Thematic analysis was conducted using Braun and Clarke’s six-phase framework. MAXQDA software was used for data categorization and management. MH generated inductive codes with themes identified from the coded data. AG and RT reviewed transcripts individually and coded the data; after which, dissolving discrepancies until 100% inter-reviewer reliability was met.Results: Seven medical students meeting eligibility for participation criteria enrolled in this study. Data were categorized into four main themes: 1.) Psychosocial and Personal Identity: identity, personality, affiliation, or mental or physical health that affect students’ learning, engagement, and attainment, particularly stereotyping, stigma, and historical trauma. 2.) Native Culture and Heritage: family origin, heritage, participation in tribal ceremonies, oppression, stigma with specific notation of past, present, or historical oppression against engagement. 3.) Community Perception: tribe or community's change in pride or stigma over time in general or related to medicine. 4.) Tribal Affiliation: affiliation with first tribally affiliated college of medicine (TA-COM) related to the campus, faculty, other medical students, community, and the importance of being tribally affiliated.Conclusion: This is the first study exploring NA medical students’ perspectives on sense of belonging in a tribally affiliated medical school. NA medical students in this study reported a sense of belonging related to their NA heritage, expressed the importance of bridging past and present cultural involvement, and discussed positive changes in personal and community perception of NA culture and medicine. All students placed personal and community-level importance on tribal affiliation for their sense of belonging and ability for success in becoming NA osteopathic physicians

Probiotics: current landscape and future horizons

In recent years there has been a rapid rise in interest for the application of probiotic supplements to act as mediators in health and disease. This appeal is predominantly due to ever-increasing evidence of the interaction of the microbiota and pathophysiological processes of disease within the human host. This narrative review considers the current landscape of the probiotic industry and its research, and discusses current pitfalls in the lack of translation from laboratory science to clinical application. Future considerations into how industry and academia must adapt probiotic research to maximize success are suggested, including more targeted application of probiotic strains dependent on individual capabilities as well as application of multiple advanced analytical technologies to further understand and accelerate microbiome science. Lay abstract: The global market for probiotic supplements is continually expanding. Despite the public perception of benefits provided by probiotics, the evidence to conclusively link probiotic strains to improved characteristics of health or disease is lacking. This is owing, in part, to the lack of large-scale research trials, but also to the insufficient understanding of the interactions occurring within the human system following supplementation. More in-depth research into individual probiotic strains, combined with the application of multiple advanced measurement techniques will provide a future direction for probiotic research and, in turn, aim to provide useful data to translate into routine healthcare practice

Clinical and budget impacts of changes in oral anticoagulation prescribing for atrial fibrillation

OBJECTIVE: To assess temporal clinical and budget impacts of changes in atrial fibrillation (AF)-related prescribing in England. METHODS: Data on AF prevalence, AF-related stroke incidence and prescribing for all National Health Service general practices, hospitals and registered patients with hospitalised AF-related stroke in England were obtained from national databases. Stroke care costs were based on published data. We compared changes in oral anticoagulation prescribing (warfarin or direct oral anticoagulants (DOACs)), incidence of hospitalised AF-related stroke, and associated overall and per-patient costs in the periods January 2011-June 2014 and July 2014-December 2017. RESULTS: Between 2011-2014 and 2014-2017, recipients of oral anticoagulation for AF increased by 86.5% from 1 381 170 to 2 575 669. The number of patients prescribed warfarin grew by 16.1% from 1 313 544 to 1 525 674 and those taking DOACs by 1452.7% from 67 626 to 1 049 995. Prescribed items increased by 5.9% for warfarin (95% CI 2.9% to 8.9%) but by 2004.8% for DOACs (95% CI 1848.8% to 2160.7%). Oral anticoagulation prescription cost rose overall by 781.2%, from £87 313 310 to £769 444 028, (£733,466,204 with warfarin monitoring) and per patient by 50.7%, from £293 to £442, giving an incremental cost of £149. Nevertheless, as AF-related stroke incidence fell by 11.3% (95% CI -11.5% to -11.1%) from 86 467 in 2011-2014 to 76 730 in 2014-2017 with adjustment for AF prevalence, the overall per-patient cost reduced from £1129 to £840, giving an incremental per-patient saving of £289. CONCLUSIONS: Despite nearly one million additional DOAC prescriptions and substantial associated spending in the latter part of this study, the decline in AF-related stroke led to incremental savings at the national level

Asthma call back survey results: a need for increase of asthma actions plans and allowance to carry medication

Purpose of Research: Asthma is the most common chronic disease affecting children in the United States. Goals for asthma management include symptom control, ability to maintain a normal activity level, and minimizing adverse events.Research Question: Our objective is to analyze the amount of children with asthma that are permitted to carry medications at school and without an asthma action plan.Methods: In this study we analyzed the Center for Disease Control and Prevention’s Asthma Call Back Survey to assess the prevalence of children in school allowed to carry medication and with asthma action plans. Using sampling weights provided, we estimated population prevalence by age group and urbanicity.Results: Results showed that, overall, 34.8% of students reported that they were not allowed to carry asthma medications in school. Specifically, nearly 51% of children ages 5 - 9 and 33% of children ages 10-14 were reported not to be allowed to carry medications at school (Figure 2). Further, 58.2% of children did not have a written asthma action plan. Reported urbanity was not significantly associated with access to medication at school (P=.46) or having an asthma action plan (P=.57).Conclusions: In our study, more than one-third of students were not permitted to carry asthma medications and nearly three-fifths did not have a written asthma action plan. Osteopathic Principles and Practices should guide asthma management. Therefore, we recommend partnerships between schools, healthcare students, and physicians to increase access to asthma action plans and medication in schools

Concert recording 2018-10-22

[Track 1]. Ballade / Frank Martin -- [Track 2]. Suite for four trombones, op. 82. I. Entrata [Track 3]. II. Lied [Track 4]. III. Dans / Flor Peeters -- [Track 5]. America the beautiful / Samuel Ward arranged by Robert Elkjer -- [Track 6]. Elegy for Mippy II / Leonard Bernstein -- [Track 7]. In memorium / Raymond Premru -- [Track 8]. Anything goes / Cole Porter arranged by Al Cobine -- [Track 9]. Suite for four trombones. I. Moderato maestoso [Track 10]. II. Andantino [Track 11]. III. Choral [Track 12]. IV. Scherzo / Desire Dondeyne -- [Track 13]. That\u27s a plenty / Lew Pollack arranged by Jack Gale