212 research outputs found
Health and the Transition from Employment to Retirement
The relationship between employment and retirement is changing dramatically. In contrast to an earlier pattern of relatively stable career employment leading to retirement around age 65, increasing numbers of men and women are leaving their major employment situation earlier. The process of retirement therefore takes on new meaning and duration. The segment of a person's life between stable career employment and permanent retirement at pensionable age can be quite disruptive, involving difficult job searches, employment at lower levels than before, lower wages and repeated job displacement. There is virtually no research about the effects of life course instability in mid- to late-life on health, but limited research on instability early in the working life shows that instability leads to increased mortality. The possibility that labour force instability later in life has adverse health consequences is great and merits further investigation.health; employment; retirement
The Modern Profile of Tuberculosis: Developing the TB Social Survey to understand contemporary social patterns in tuberculosis
Social disparities in tuberculosis have been documented for decades, yet to date there has not been a comprehensive study to examine the contemporary causes of these disparities. Local public health departments, and particularly public health nursing staff are charged with delivering directly observed therapy to individuals with tuberculosis disease. As a result of the frequency and duration of treatment, practitioners delivering therapy are often wellāacquainted with the lives and challenges of their constituents. Thus, through these practitioners there exists a deep repository of knowledge on the drivers of social disparities in tuberculosis disease. Partnering with local public health departments, we developed a survey instrument aimed at understanding the social profile of individuals with tuberculosis disease in metropolitan Detroit, Michigan. We discuss the development and implementation of the survey instrument as well as challenges in developing partnerships between academic researchers and local public health practitioners. This study can serve as a framework for both academic researchers and public health practitioners interested in addressing social disparities in infectious disease.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141046/1/phn12372_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141046/2/phn12372-sup-0001-SupInfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141046/3/phn12372.pd
Use of Medicines by Community Dwelling Elderly in Ontario
OBJECTIVE: Prescription medicine use by the elderly is of growing concern as indicated by a large literature focused on rising costs, patient compliance and the appropriateness of use. However, prescriptions account for only a portion of medicines used by the elderly, who have increasing access to non-prescription medicines and natural health products. The objective of this paper is to describe overall medicine use among the elderly in Ontario. METHODS: Using the National Population Health Survey (1996/97), we describe self-reported use of prescription, non-prescription and alternative medicines among elderly Ontarians aged 65+, and we compare use among four age sub-groups and by gender. Analysis is focused on the prevalence of, and the relative balance of use of different types of medicines. RESULTS: About one quarter of the respondents reported using no prescription or non-prescription medicines in the two days prior to being surveyed; a large majority reported using two or fewer medicines only, and use of non- prescription medicines was reported more often than prescription medicines (56% vs 48%). Use of natural health products by seniors is relatively low, but we observe a trend toward increased use in younger age groups. DISCUSSION: The findings place the consumption of prescription medicines by the elderly into a broader context that reveals that much of medicine use by the elderly involves non-prescribed products. We highlight the need to better understand seniors' decision-making regarding the different types of medicines available, and the financial costs and health risks of the medicine regimes of elderly persons.elderly, medicine-use, prescription medicines, over-the-counter medicines, natural health products, NPHS
Violence exposure and young peopleās vulnerability, mental and physical health
Objectives
To analyse the impact of being affected by domestic and/or relationship violence in early adolescence on indicators of health and wellbeing.
Methods
Secondary data analysis of a cross-sectional survey of 13-14 year-old pupils attending schools in north-west England; with variables relating to vulnerability, violence, mental and physical health. The sample of 9,626 represented 71% of the eligible population. Chi-squared tests and logistic regression were used to analyse demographic exposure to violence and outcomes.
Results
Pupils affected by domestic and/or relationship violence had significantly worse outcomes and experiences than non-affected peers. Odds ratios demonstrated higher risks of being lonely, being bullied or having deliberately self-harmed. They were also more likely to report an enduring health condition, poorer health practices and worse access to and experiences of health services.
Conclusions
Exposure to violence in domestic and/or relationships is detrimental to children and young peopleās mental and physical health and vulnerability. Health risks and inequalities reported by CYP in this study provide compelling intelligence for renewed strategic policy level consideration in the design and delivery of young peoplesā health services
Validity of environmental audits using GigaPanĀ® and Google Earth Technology
Abstract
Background
Health behaviors are shaped by the context in which people live. However, documenting environmental context has remained a challenge. More specifically, direct observation techniques require large investments in time and resources and auditing the environment through web-based platforms has limited stability in spatio-temporal imagery. This study examined the validity of a new methodology, using GigaPanĀ® imagery, where we took photos locally and, stitched them together using GigaPanĀ® technology, and quantified environmental attributes from the resulting panoramic photo. For comparison, we examined validity using Google Earth imagery.
Methods
A total of 464 street segments were assessed using three methods: GigaPanĀ® audits, Google Earth audits, and direct observation audits. Thirty-seven different attributes were captured representing three broad constructs: land use, traffic and safety, and amenities. Sensitivity (i.e. the proportion of true positives) and specificity (i.e. the proportion of true negatives) were used to estimate the validity of GigaPanĀ® and Google Earth audits using direct observation audits as the gold standard.
Results
Using GigaPanĀ®, sensitivity was 80% or higher for 6 of 37 items and specificity was 80% or higher for 31 of 37 items. Using Google Earth, sensitivity was 80% or higher for 8 of 37 items and specificity was 80% or higher for 30 of 37 items. The validity of GigaPanĀ® and Google Earth was similar, with significant differences in sensitivity and specificity for 7 items and 2 items, respectively.
Conclusion
GigaPanĀ® performed well, especially when identifying features absent from the environment. A major strength of the GigaPanĀ® technology is its ability to be implemented quickly in the field relative to direct observation. GigaPanĀ® is a method to consider as an alternative to direct observation when temporality is prioritized or Google Earth imagery is unavailable.https://deepblue.lib.umich.edu/bitstream/2027.42/144541/1/12942_2018_Article_147.pd
Destinations That Older Adults Experience Within Their GPS Activity Spaces: Relation to Objectively Measured Physical Activity
Identifying the relevant geography is an ongoing obstacle to effectively evaluate the influence of neighborhood built environment on physical activity. We characterized density and diversity of destinations that 77 older adults experienced within individually representative GPS activity spaces and traditional residential buffers and assessed their associations with accelerometry-measured physical activity. Traditional residential buffers had lower destination density and diversity than activity spaces. Activity spaces based only on pedestrian and bicycling trips had higher destination densities than all-mode activity spaces. Regardless of neighborhood definition, adjusted associations between destinations and physical activity generally failed to reach statistical significance. However, within pedestrian and bicycling-based activity spaces each additional destination type was associated with 243.3 more steps/day (95% confidence interval (CI) 36.0, 450.7). Traditional buffers may not accurately portray the geographic space or neighborhood resources experienced by older adults. Pedestrian and bicycling activity spaces elucidate the importance of destinations for facilitating active transportation
Unexpected retirement from full time work after age 62: consequences for life satisfaction in older Americans
Recent policy shifts in the United States have resulted in an increase in the number of older workers remaining in the labor force. Increases in the retirement age for receiving full Social Security benefits coupled with declining pension funds and the erosion of employer retiree health benefits, mean that current cohorts of older workers may fully expect to work longer than previous generations. Yet, working longer may not always be possible due to health problems, outdated skills, economic insecurity, and competing obligations. We examine the consequences of unmet expectations for full time work after age 62 for life satisfaction in a nationally representative sample of older Americans. With longitudinal data from the Health and Retirement Study (1998ā2008), this paper uses repeated measures of expectations for later life work among a cohort of Americans (N=1684) gathered prospectively over an eight year period, and examines the effects of unfulfilled expectations on subsequent life satisfaction. Using generalized growth mixture modeling three latent classes of individuals were identified with distinct trajectories of later life work expectations (low expectations, high expectations, and neutral expectations for full time work after age 62). A majority of men had generally high expectations to work full time past age 62, whereas the majority of women reported a low probability of working full time after age 62. When comparing expectations to actual full time work past age 62, we found no effects of unmet expectations for women. But men with less job stability (reflected by shorter job tenure and lower incomes) generally had high expectations to work longer, and their life satisfaction scores were significantly lower when these expectations were not realized. The hazards of missed expectations for later life work have consequences for subjective well-being in older adults
Morphogenesis underlying the development of the everted teleost telencephalon
Background: Although the mechanisms underlying brain patterning and regionalization are very much conserved, the morphology of different brain regions is extraordinarily variable across vertebrate phylogeny. This is especially manifest in the telencephalon, where the most dramatic variation is seen between ray-finned fish, which have an everted telencephalon, and all other vertebrates, which have an evaginated telencephalon. The mechanisms that generate these distinct morphologies are not well understood. Results: Here we study the morphogenesis of the zebrafish telencephalon from 12 hours post fertilization (hpf) to 5 days post fertilization (dpf) by analyzing forebrain ventricle formation, evolving patterns of gene and transgene expression, neuronal organization, and fate mapping. Our results highlight two key events in telencephalon morphogenesis. First, the formation of a deep ventricular recess between telencephalon and diencephalon, the anterior intraencephalic sulcus (AIS), effectively creates a posterior ventricular wall to the telencephalic lobes. This process displaces the most posterior neuroepithelial territory of the telencephalon laterally. Second, as telencephalic growth and neurogenesis proceed between days 2 and 5 of development, the pallial region of the posterior ventricular wall of the telencephalon bulges into the dorsal aspect of the AIS. This brings the ventricular zone (VZ) into close apposition with the roof of the AIS to generate a narrow ventricular space and the thin tela choroidea (tc). As the pallial VZ expands, the tc also expands over the upper surface of the telencephalon. During this period, the major axis of growth and extension of the pallial VZ is along the anteroposterior axis. This second step effectively generates an everted telencephalon by 5 dpf. Conclusion: Our description of telencephalic morphogenesis challenges the conventional model that eversion is simply due to a laterally directed outfolding of the telencephalic neuroepithelium. This may have significant bearing on understanding the eventual organization of the adult fish telencephalon
Biological expressions of early life trauma in the immune system of older adults
Background
Poor immune function is associated with increased risk for a number of age-related diseases, however, little is known about the impact of early life trauma on immune function in late-life.
Methods
Using nationally representative data from the Health and Retirement Study (n = 5,823), we examined the association between experiencing parental/caregiver death or separation before age 16 and four indicators of immune function in late-life: C-reactive Protein (CRP), Interleukin-6 (IL-6), soluble Tumor Necrosis Factor (sTNFR), and Immunoglobulin G (IgG) response to cytomegalovirus (CMV). We also examined racial/ethnic differences.
Findings
Individuals that identified as racial/ethnic minorities were more likely to experience parental/caregiver loss and parental separation in early life compared to Non-Hispanic Whites, and had poorer immune function in late-life. We found consistent associations between experiencing parental/caregiver loss and separation and poor immune function measured by CMV IgG levels and IL-6 across all racial/ethnic subgroups. For example, among Non-Hispanic Blacks, those that experienced parental/caregiver death before age 16 had a 26% increase in CMV IgG antibodies in late-life (Ī² = 1.26; 95% CI: 1.17, 1.34) compared to a 3% increase in CMV antibodies among Non-Hispanic Whites (Ī² = 1.03; 95% CI: 0.99, 1.07) controlling for age, gender, and parental education.
Interpretation
Our results suggest a durable association between experiencing early life trauma and immune health in late-life, and that structural forces may shape the ways in which these relationships unfold over the life course
Automated electroencephalographic discontinuity in cooled newborns predicts cerebral MRI and neurodevelopmental outcome
BACKGROUND AND HYPOTHESIS:
Prolonged electroencephalographic (EEG) discontinuity has been associated with poor neurodevelopmental outcomes after perinatal asphyxia but its predictive value in the era of therapeutic hypothermia (TH) is unknown. In infants undergoing TH for hypoxic-ischaemic encephalopathy (HIE) prolonged EEG discontinuity is associated with cerebral tissue injury on MRI and adverse neurodevelopmental outcome.
METHOD:
Retrospective study of term neonates from three UK centres who received TH for perinatal asphyxia, had continuous two channel amplitude-integrated EEG with EEG for a minimum of 48ā
h, brain MRI within 6ā
weeks of birth and neurodevelopmental outcome data at a median age of 24ā
months. Mean discontinuity was calculated using a novel automated algorithm designed for analysis of the raw EEG signal.
RESULTS:
Of 49 eligible infants, 17 (35%) had MR images predictive of death or severe neurodisability (unfavourable outcome) and 29 (59%) infants had electrographic seizures. In multivariable logistic regression, mean discontinuity at 24ā
h and 48ā
h (both p=0.01), and high seizure burden (p=0.05) were associated with severe cerebral tissue injury on MRI. A mean discontinuity >30ā
s/min-long epoch, had a specificity and positive predictive value of 100%, sensitivity of 71% and a negative predictive value of 88% for unfavourable neurodevelopmental outcome at a 10ā
ĀµV threshold.
CONCLUSIONS:
In addition to seizure burden, excessive EEG discontinuity is associated with increased cerebral tissue injury on MRI and is predictive of abnormal neurodevelopmental outcome in infants treated with TH. The high positive predictive value of EEG discontinuity at 24ā
h may be valuable in selecting newborns with HIE for adjunctive treatments
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