What's Love Got To Do With It? Marital Quality and Mental Health in Older Age

Thesis advisor: Sara M. MoormanThere is much prior research on the benefits of marriage for adults, including for mental and physical health (Carr and Springer 2010). Further research has demonstrated that the quality of one’s marriage provides benefits, and not merely the status itself (see Carr and Springer 2010; Proulx, Helms, and Buehler 2007). A close, salient relationship such as marriage is not experienced in isolation, but is rather an interpersonal system, where the characteristics, feelings, and opinions of each partner can influence the other (Berscheid and Ammazzalorso 2001; Carr et al. 2014; Moorman 2016). However, less research has been performed that takes advantage of dyadic data to determine whether and how a partner’s marital quality may affect one’s own well-being (Carr et al. 2014; Kenny 1996). Moreover, emotional experiences rarely remain truly private; individuals unconsciously signal and express their feelings to others, and can even transmit these emotional experiences to close social partners (Christakis and Fowler 2013; Hatfield, Cacioppo, and Rapson 1994). The present dissertation examines the associations among older husbands’ and wives’ marital quality and well-being, using two sources of dyadic data, a range of measures of marital quality and well-being, and advanced analytic strategies appropriate for longitudinal and cross-sectional data. Older couples can differ from their younger and midlife counterparts, as both men and women trim their broader social networks in later life and increasingly focus on their closest and most rewarding relationships, such as marriage (Carstensen, Isaacowitz, and Charles 1999; Mancini and Bonanno 2006). Gendered roles may shift in later life, as well, as older adults cease activities such as child-rearing and full-time employment (Bookwala 2012). Thus, potential differences according to gender are also explicitly tested. The results of this dissertation will shed greater light on how older couples’ perceptions of marital quality influence various aspects of spouses’ well-being, cross-sectionally and over time. Mutual Influence and Older Married Adults’ Anxiety Symptoms: Results from The Irish Longitudinal Study on Ageing analyzes cross-sectional dyadic data from 1,114 married older couples surveyed in the initial wave of The Irish Longitudinal Study on Ageing (TILDA; Kenny 2014), 2009-2011. Dyadic structural equation models (SEM) examined the direct and indirect associations between husbands’ and wives’ reports of marital strain and generalized anxiety symptoms in later life. Findings revealed that perceptions of marital strain were related with husbands’ and wives’ own generalized anxiety symptoms. Further, husbands’ anxiety symptoms were significantly related with wives’ anxiety symptoms, and vice versa, illustrating bi-directional feedback. Lastly, husbands’ and wives’ perceptions of marital strain were significantly indirectly related with their partners’ anxiety symptoms, with these associations being mediated by spouses’ own anxiety symptoms. These results suggest that emotional contagion may be the pathway for partner effects of marital strain on spouses’ well-being. Findings also suggest that efforts to reduce anxiety symptoms may be most effective when taking marital context and quality into account. Two-Wave Dyadic Analysis of Marital Quality and Loneliness in Later Life: Results From The Irish Longitudinal Study on Ageing analyzes dyadic reports of marital quality and loneliness over a two-year period, using longitudinal dyadic data collected from 932 older married couples who participated in both of the first two waves of The Irish Longitudinal Study on Ageing (TILDA), collected from 2009-2013. Two-wave lagged dependent variable (LDV) models tested the cognitive perspective on loneliness, emotional contagion theory, and actor-partner interdependence by examining whether husbands’ and wives’ reports of marital quality and loneliness at baseline predicted both spouses’ loneliness two years later. Results indicated that one’s own perceptions of negative marital quality at baseline were related with greater loneliness after two years, supporting the cognitive perspective on loneliness. Further, both spouses’ reports of loneliness at baseline were related with loneliness two years later, supporting emotional contagion theory. Partners’ reports of marital quality were not related with future loneliness, failing to support actor-partner interdependence. Do “His” and “Her” Marriage Influence One Another? Older Spouses’ Marital Quality Over Four Years uses two-wave longitudinal data from the Disability and Use of Time (DUST) supplement to the Panel Study of Income Dynamics (PSID) to examine associations between husbands’ and wives’ reports of marital quality over a four-year period. The sample consisted of 209 older married couples who participated in both the 2009 and 2013 waves of DUST. Lagged dependent variable (LDV) models tested whether older husbands’ and wives’ perceptions of marital quality are themselves subject to emotional contagion, by examining whether baseline reports of marital quality were related with one’s own and a partner’s marital quality after four years. Results indicated that (a) husbands reported better marital quality than their wives in both 2009 and 2013, (b) for both husbands and wives, baseline marital quality was significantly related with both one’s own and one’s partner’s marital quality four years later, and (c) there were no differences in effects according to gender. These findings offer support for the framework of “his” and “her” marriage, as well as emotional contagion theory. Together, these papers examine whether and how older spouses’ reports of marital quality and well-being are associated with one another, with a particular emphasis on assessing emotional contagion as a potential explanation and mechanism for dyadic partner effects. The results of these articles contribute empirically and theoretically to the literature(s) on marital quality and well-being; spousal interdependence; and emotional contagion. I discuss the implications of these articles for theory and future research concerning marriage and well-being in later life

Change in Marital Satisfaction Following the Death of a Parent in Adulthood: Do Intergenerational Relationships Matter?

Thesis advisor: Sara M. MoormanI examine how preloss relationship quality with a deceased parent and pre- to post-loss change in relationship quality with a surviving parent influence adult children's marital satisfaction over time. I also test gender interactions. Analyses are based on married or cohabiting adults who experienced the death of a parent (N = 316), drawn from the Longitudinal Study of Generations (LSOG), a longitudinal study of three-plus-generation families from Southern California. Three-level multilevel modeling (MLM) techniques reveal that improved relationship quality with a surviving parent is related to improved marital satisfaction. High preloss relationship quality with a deceased mother is related to improved post-loss marital satisfaction only for sons. These results support theories of linked lives and role context, and suggest that sons who lose mothers are particularly vulnerable relationally and may be especially sensitive to perceived support from their wives.Thesis (MA) — Boston College, 2013.Submitted to: Boston College. Graduate School of Arts and Sciences.Discipline: Sociology

A systematic review of loneliness in bereavement:Current research and future directions

Bereaved people suffer from loneliness and loneliness is associated with poor mental health. In this study, this topic is reviewed. An agenda is suggested for future research. Research that is theory-driven, addresses measurement consistency, correlates of loneliness in bereaved and non-bereaved, and treatment is necessary for prevention and intervention

Ninety-day Mortality Following Transoral Robotic Surgery or Radiation at Commission on Cancer-accredited Facilities

BACKGROUND: Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown. METHODS: NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities. RESULTS: 3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p \u3c 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality. CONCLUSIONS: There is minimal difference between 90-day mortality in patients treated with TORS or radiotherapy for early-stage OPSCC. While overall rates are low, for patients with expectation of cure, work is needed to identify optimal treatment

Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

<p>Abstract</p> <p>Background</p> <p>Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts.</p> <p>Methods</p> <p>A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery) during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions) was examined, and hospital costs and length of stay (LOS) were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS) regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE) were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals.</p> <p>Results</p> <p>A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates) was 6.0 days and ranged from 1.3 to 9.6 days for knee/hip replacement and non-cardiac thoracic, respectively. The incremental cost per hospitalization associated with bleeding-related complications and adjusted for covariates was highest for spinal surgery ($17,279) followed by vascular ($15,123), solid organ ($13,210), non-cardiac thoracic ($13,473), cardiac ($10,279), general ($4,354), knee/hip replacement ($3,005), and reproductive organ ($2,805).</p> <p>Conclusions</p> <p>This study characterizes the increased hospital LOS and cost associated with bleeding-related complications and/or transfusions occurring as a consequence of surgery, and supports implementation of blood-conservation strategies.</p

Non-Opsonic Phagocytosis of Legionella pneumophila by Macrophages Is Mediated by Phosphatidylinositol 3-Kinase

Background: Legionella pneumophila, is an intracellular pathogen that causes Legionnaires ’ disease in humans, a potentially lethal pneumonia. L. pneumophila has the ability to enter and replicate in the host and is essential for pathogenesis. Methodology/Principal Findings: Phagocytosis was measured by cell invasion assays. Construction of PI3K mutant by PCR cloning and expression of dominant negative mutant was detected by Western blot. PI3K activity was measured by 32 P labeling and detection of phospholipids products by thin layer chromatography. Infection of macrophages with virulent L. pneumophila stimulated the formation of phosphatidylinositol 3-phosphate (PIP3), a phosphorylated lipid product of PI3K whereas two structurally distinct phosphatidylinositol 3 kinase (PI3K) inhibitors, wortmannin and LY294002, reduced L. pneumophila entry into macrophages in a dose-dependent fashion. Furthermore, PI3K activation led to Akt stimulation, a serine/threonine kinase, which was also inhibited by wortmannin and LY294002. In contrast, PI3K and protein kinase B (PKB/Akt) activities were lower in macrophages infected with an avirulent bacterial strain. Only virulent L. pneumophila increased lipid kinase activity present in immunoprecipitates of the p85a subunit of class I PI3K and tyrosine phosphorylated proteins. In addition, macrophages expressing a specific dominant negative mutant of PI3K reduced L. pneumophila entry into these cells. Conclusion/Significance: Entry of L. pneumophila is mediated by PI3K/Akt signaling pathway. These results suggest an important role for PI3K and Akt in the L. pneumophila infection process. They point to possible novel strategies fo

Phase-specific and lifetime costs of cancer care in Ontario, Canada

BACKGROUND: Cancer is a major public health issue and represents a significant economic burden to health care systems worldwide. The objective of this analysis was to estimate phase-specific, 5-year and lifetime net costs for the 21 most prevalent cancer sites, and remaining tumour sites combined, in Ontario, Canada. METHODS: We selected all adult patients diagnosed with a primary cancer between 1997 and 2007, with valid ICD-O site and histology codes, and who survived 30 days or more after diagnosis, from the Ontario Cancer Registry (N = 394,092). Patients were linked to treatment data from Cancer Care Ontario and administrative health care databases at the Institute for Clinical and Evaluative Sciences. Net costs (i.e., cost difference between patients and matched non-cancer control subjects) were estimated by phase of care and sex, and used to estimate 5-year and lifetime costs. RESULTS: Mean net costs of care (2009 CAD) were highest in the initial (6 months post-diagnosis) and terminal (12 months pre-death) phases, and lowest in the (3 months) pre-diagnosis and continuing phases of care. Phase-specific net costs were generally lowest for melanoma and highest for brain cancer. Mean 5-year net costs varied from less than $25,000 for melanoma, thyroid and testicular cancers to more than$60,000 for multiple myeloma and leukemia. Lifetime costs ranged from less than $55,000 for lung and liver cancers to over$110,000 for leukemia, multiple myeloma, lymphoma and breast cancer. CONCLUSIONS: Costs of cancer care are substantial and vary by cancer site, phase of care and time horizon analyzed. These cost estimates are valuable to decision makers to understand the economic burden of cancer care and may be useful inputs to researchers undertaking cancer-related economic evaluations

Pre-synaptic modulation of quadriceps arthrogenic muscle inhibition

Arthrogenic muscle inhibition (AMI) impedes rehabilitation following knee joint injury by preventing activation of the quadriceps. AMI has been attributed to neuronal reflex activity in which altered afferent input originating from the injured joint results in a diminished efferent motor drive to the quadriceps muscles. Beginning to understand the mechanisms responsible for muscle inhibition following joint injury is vital to control or eliminate this phenomenon. Therefore, the purpose of this investigation is to determine if quadriceps AMI is mediated by a presynaptic regulatory mechanism. Eight adults participated in two sessions: in one session their knee was injected with saline and in the other session it was not. The maximum Hoffmann reflex (H-reflex), M-wave, reflex activation history, plasma epinephrine, and norepinephrine were recorded at: baseline, post needle stick, post lidocaine, and 25 and 45 min post effusion. Measures for the control condition were matched to the effusion condition. The percent of the unconditioned reflex amplitude for reflex activation history and the maximum H-reflex were decreased at 25 and 45 min post effusion as compared to measures taken at baseline, post needle stick, and post lidocaine ( P 0.05). No differences were detected at any time interval for any measure during the control admission ( P >0.05). Quadriceps AMI elicited via an experimental knee joint effusion is, at least in part, mediated by a presynaptic mechanism.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46099/1/167_2004_Article_547.pd

Persistently active neurons in human medial frontal and medial temporal lobe support working memory

Persistent neural activity is a putative mechanism for the maintenance of working memories. Persistent activity relies on the activity of a distributed network of areas, but the differential contribution of each area remains unclear. We recorded single neurons in the human medial frontal cortex and medial temporal lobe while subjects held up to three items in memory. We found persistently active neurons in both areas. Persistent activity of hippocampal and amygdala neurons was stimulus-specific, formed stable attractors and was predictive of memory content. Medial frontal cortex persistent activity, on the other hand, was modulated by memory load and task set but was not stimulus-specific. Trial-by-trial variability in persistent activity in both areas was related to memory strength, because it predicted the speed and accuracy by which stimuli were remembered. This work reveals, in humans, direct evidence for a distributed network of persistently active neurons supporting working memory maintenance