Supporting well-being in retirement through meaningful social roles: Systematic review of intervention studies

Context The marked demographic change toward greater proportions of older people in developed nations poses significant challenges for health and social care. Several studies have demonstrated an association between social roles in later life and positive health and well-being outcomes. After retiring from work, people may lose roles that provide purpose and social contacts. The outcomes of interventions to promote social roles in retirement have not been systematically reviewed. Methods We examined three research questions: (1) What kinds of intervention have been developed to promote social roles in retirement? (2) How much have they improved perceived roles? (3) Have these roles improved health or well-being? We included those studies that evaluated the provision of social roles; used a control or comparison group; targeted healthy retirement-transition adults who were living in the community; provided an abstract written in English; took place in a highly developed nation; and reported social role, health, or well-being outcomes. We searched eight electronic databases and combined the results with hand searches. Findings Through our searches, we identified 9,062 unique publications and eleven evaluative studies of acceptable quality, which reported seven interventions that met our inclusion criteria. These interventions varied in year of inception and scope, but only two were based outside North America. The studies rarely reported the quality or meaning of roles. Only three studies used random allocation, thus limiting inferences of causality from these studies. Interventions providing explicit roles and using supportive group structures were somewhat effective in improving one or more of the following: life satisfaction, social support and activity, physical health and activity, functional health, and cognition. Conclusions Social role interventions may improve health and well-being for people in retirement transition. Future research should improve the quality of intervention and assessment and look at which interventions are most effective and acceptable in facilitating social roles for diverse older populations. © 2013 Milbank Memorial Fund

Recent climate-driven ecological change across a continent as perceived through local ecological knowledge

Documenting effects of climate change is an important step towards designing mitigation and adaptation responses. Impacts of climate change on terrestrial biodiversity and ecosystems have been well-documented in the Northern Hemisphere, but long-term data to detect change in the Southern Hemisphere are limited, and some types of change are generally difficult to measure. Here we present a novel approach using local ecological knowledge to facilitate a continent-scale view of climate change impacts on terrestrial biodiversity and ecosystems that people have perceived in Australia. We sought local knowledge using a national web-based survey, targeting respondents with close links to the environment (e.g. farmers, ecologists), and using a custom-built mapping tool to ask respondents to describe and attribute recent changes they had observed within an area they knew well. Results drawn from 326 respondents showed that people are already perceiving simple and complex climate change impacts on hundreds of species and ecosystems across Australia, significantly extending the detail previously reported for the continent. While most perceived trends and attributions remain unsubstantiated, \u3e35 reported anecdotes concurred with examples in the literature, and \u3e20 were reported more than once. More generally, anecdotes were compatible with expectations from global climate change impact frameworks, including examples across the spectrum from organisms (e.g. increased mortality in \u3e75 species), populations (e.g. changes in recruitment or abundance in \u3e100 species, phenological change in \u3e50 species), and species (e.g. \u3e80 species newly arriving or disappearing), to communities and landscapes (e.g. \u3e50 examples of altered ecological interactions). The overarching pattern indicated by the anecdotes suggests that people are more often noticing climate change losers (typically native species) than winners in their local areas, but with observations of potential ‘adaptation in action’ via compositional and phenological change and through arrivals and range shifts (particularly for native birds and exotic plants). A high proportion of climate change-related anecdotes also involved cumulative or interactive effects of land use. We conclude that targeted elicitation of local ecological knowledge about climate change impacts can provide a valuable complement to data-derived knowledge, substantially extending the volume of explicit examples and offering a foundation for further investigation

Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV

Background: There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function. Objective: The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work. Methods: We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6%) apps that were either not in English (10/112, 8.9%), not HIV focused (32/112, 28.9%), or focused only on HIV prevention (2/112, 7.8%); targeted health care providers (26/112, 23.2%); provided information only on conference schedules and events (7/112, 6.3%), fundraisers (7/112, 6.3%), specific clinics (7/112, 6.3%), international or narrow local resources (3/112, 2.7%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work. Results: Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: communication with providers and/or peers (4/15, 27%), medication reminders (6/15, 40%), medication logs (7/15, 47%), lab reports (5/15, 33%), pharmacy information (4/15, 27%), resources (7/15, 47%), settings (11/15, 73%), and search function (6/15, 40%). No apps included nutrition or fitness information. Conclusions: Currently, there are only a small number of apps that have been designed for PLWH to manage their health. Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH’s desired functional specifications

Genome-wide association study using family-based cohorts identifies the WLS and CCDC170/ESR1 loci as associated with bone mineral density.

BACKGROUND: Osteoporosis is a common and debilitating bone disease that is characterised by a low bone mineral density (BMD), a highly heritable trait. Genome-wide association studies (GWAS) have proven to be very successful in identifying common genetic variants associated with BMD adjusted for age, gender and weight, however a large portion of the genetic variance for this trait remains unexplained. There is evidence to suggest significant genetic correlation between body size traits and BMD. It has also recently been suggested that unintended bias can be introduced as a result of adjusting a phenotype for a correlated trait. We performed a GWAS meta-analysis in two populations (total n = 6,696) using BMD data adjusted for only age and gender, in an attempt to identify genetic variants associated with BMD including those that may have potential pleiotropic effects on BMD and body size traits. RESULTS: We observed a single variant, rs2566752, associated with spine BMD at the genome-wide significance level in the meta-analysis (P = 3.36 × 10(-09)). Logistic regression analysis also revealed an association between rs2566752 and fracture rate in one of our study cohorts (P = 0.017, n = 5,654). This is an intronic variant located in the wntless Wnt ligand secretion mediator (WLS) gene (1p31.3), a known BMD locus which encodes an integral component of the Wnt ligand secretion pathway. Bioinformatics analyses of variants in moderate LD with rs2566752 produced strong evidence for a regulatory role for the variants rs72670452, rs17130567 and rs1430738. Expression quantitative trait locus (eQTL) analysis suggested that the variants rs12568456 and rs17130567 are associated with expression of the WLS gene in whole blood, cerebellum and temporal cortex brain tissue (P = 0.034-1.19 × 10(-23)). Gene-wide association testing using the VErsatile Gene-based Association Study 2 (VEGAS2) software revealed associations between the coiled-coil domain containing 170 (CCDC170) gene, located adjacent to the oestrogen receptor 1 (ESR1) gene, and BMD at the spine, femoral neck and total hip sites (P = 1.0 × 10(-06), 2.0 × 10(-06) and 2.0 × 10(-06) respectively). CONCLUSIONS: Genetic variation at the WLS and CCDC170/ESR1 loci were found to be significantly associated with BMD adjusted for only age and gender at the genome-wide level in this meta-analysis