Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study.

Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. This study examined the association of an MSBR index with cancer mortality. The sample included n = 13,628 adults aged 20-90 from the NHANES III Linked Mortality File (1988-1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HOMAir, triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13-2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07-1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05-1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92-1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies

Evidence-Based Program to Reduce Fall-Related Risk Among Older Adults: A Comparison of Program Efficacy by Ethnicity

Despite rapid growth among the Hispanic population in the United States, seniors within this ethnic group are typically underrepresented in evidence-based programs. The purpose of this study is to examine the relative efficacy of A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL), an eight session fall risk prevention program, for non-Hispanic White and English-speaking Hispanic participants on key study outcomes. Data were collected from 1,233 seniors enrolled in AMOB/VLL in Texas. Compared to non-Hispanic White participants, a significantly larger proportion of Hispanic participants were younger (?2=50.23, df=3, p<0.001), had less than a high school education (?2=200.31, df=2, p<0.001), and resided in less affluent areas. From baseline to post-intervention, significant improvements in falls efficacy (t=- 9.13, df=167, p<0.001), days limited from usual activity (t=1.99, df=164, p=0.049), and unhealthy mental days (t=2.51, p=0.013) were seen among Hispanic participants. Significant improvements among nonHispanic White participants were observed for falls efficacy (t=-15.90, df=868, p<0.001). Although significant improvements were found for each ethnic group, the magnitude of improvement among Hispanic participants exceeded that of non-Hispanic Whites in some aspects. Identifying participant characteristics and positive outcomes specific to Hispanics can inform strategies to maximize program reach and effectiveness among this vulnerable and underserved population

Otago Exercise Program in the United States: Comparison of 2 Implementation Models

Author(s): Shubert, TE; Smith, ML; Goto, L; Jiang, L; Ory, M

Influence of Work on Elevated Blood Pressure in Hispanic Adolescents in South Texas.

Literature supports an association between work and cardiovascular disease in adults. The objective of this study was to examine the relationship between current work status and elevated blood pressure in Hispanic adolescents. Participants were students in Hidalgo County, located along the Texas-Mexico border. Participants enrolled in the cohort study in ninth grade with assessments completed once a year for up to three years. Participants completed a self-report survey, while staff measured height, weight, waist circumference, blood pressure, and were screened for acanthosis nigricans. A generalized linear regression model with a logit link function was constructed to assess current work status and elevated blood pressure. Of the 508 participants, 29% had elevated blood pressure, which was associated with being male and other chronic disease indicators (e.g., acanthosis nigricans, overweight/obesity). The mean probability for elevated blood pressure was higher among currently working adolescents compared to those who were not. Findings were statistically significant (p < 0.05) at baseline. The findings illustrate that a large proportion of adolescents along the Texas-Mexico border may have elevated blood pressure and that working may be associated with it. Subsequent research is needed to confirm these findings, as well as to identify the mechanism for how work may increase hypertension in adolescents

Rural-Urban Differences in Health Care Expenditures: Empirical Data from US Households

Purpose. To estimate the rural-urban differences in expenditures of outpatient care, hospital inpatient care, hospital emergency room services, medications, and total services. Methods. This cross-sectional study used data from the 2010 Medical Expenditure Panel Survey. The overall sample size for the study was 22,772. Weighted frequencies, means, or percentages were estimated to illustrate the distribution of each variable. Five two-part utilization models were then fit to determine the likelihood of having nonzero expenses and to identify how residence in a rural versus urban area affected expenditures in our five expense categories. Quantile regressions were estimated to further explore relationships between residence and each quantile of nonzero expenditure. Results. The results of two-part model suggest that rural populations spent more on medications, while urban populations spent more on emergency care. However, no rural-urban difference was found in total health expenditures. The results of quantile regressions suggest that the highest users (at the upper quantiles) of medication and total expenditure experienced the strongest positive effects of living in rural areas. Conclusions. Total health expenditures do not seem to vary significantly across urban and rural areas. However, rurality does have important effects on those who make the most use of outpatient care and prescription medications. Reviewing total health expenditures for urban and rural populations is not enough. Policymakers should monitor the effects of geographic differences, especially in the highest expenditure quantiles, for specific types of health expenditures. Differences in the influence of rurality across this distribution of health expenditures may provide important guidance for interventions

Associations of Amyloid Burden, White Matter Hyperintensities, and Hippocampal Volume With Cognitive Trajectories in the 90+ Study

Background and objectivesAmyloid pathology, vascular disease pathology, and pathologies affecting the medial temporal lobe are associated with cognitive trajectories in older adults. However, only limited evidence exists on how these pathologies influence cognition in the oldest old. We evaluated whether amyloid burden, white matter hyperintensity (WMH) volume, and hippocampal volume (HV) are associated with cognitive level and decline in the oldest old.MethodsThis was a longitudinal, observational community-based cohort study. We included participants with 18F-florbetapir PET and MRI data from the 90+ Study. Amyloid load was measured using the standardized uptake value ratio in the precuneus/posterior cingulate with eroded white matter mask as reference. WMH volume was log-transformed. All imaging measures were standardized using sample means and SDs. HV and log-WMH volume were normalized by total intracranial volume using the residual approach. Global cognitive performance was measured by the Mini-Mental State Examination (MMSE) and modified MMSE (3MS) tests, repeated every 6 months. We used linear mixed-effects models with random intercepts; random slopes; and interaction between time, time squared, and imaging variables to estimate the associations of imaging variables with cognitive level and cognitive decline. Models were adjusted for demographics, APOE genotype, and health behaviors.ResultsThe sample included 192 participants. The mean age was 92.9 years, 125 (65.1%) were female, 71 (37.0%) achieved a degree beyond college, and the median follow-up time was 3.0 years. A higher amyloid load was associated with a lower cognitive level (βMMSE = -0.82, 95% CI -1.17 to -0.46; β3MS = -2.77, 95% CI -3.69 to -1.84). A 1-SD decrease in HV was associated with a 0.70-point decrease in the MMSE score (95% CI -1.14 to -0.27) and a 2.27-point decrease in the 3MS score (95% CI -3.40 to -1.14). Clear nonlinear cognitive trajectories were detected. A higher amyloid burden and smaller HV were associated with faster cognitive decline. WMH volume was not significantly associated with cognitive level or decline.DiscussionAmyloid burden and hippocampal atrophy are associated with both cognitive level and cognitive decline in the oldest old. Our findings shed light on how different pathologies contributed to driving cognitive function in the oldest old

Psychosocial Predictors of Weight Loss among American Indian and Alaska Native Participants in a Diabetes Prevention Translational Project

The association of psychosocial factors (psychological distress, coping skills, family support, trauma exposure, and spirituality) with initial weight and weight loss among American Indians and Alaska Natives (AI/ANs) in a diabetes prevention translational project was investigated. Participants (n = 3,135) were confirmed as prediabetic and subsequently enrolled in the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project implemented at 36 Indian health care programs. Measures were obtained at baseline and after completing a 16-session educational curriculum focusing on weight loss through behavioral changes. At baseline, psychological distress and negative family support were linked to greater weight, whereas cultural spirituality was correlated with lower weight. Furthermore, psychological distress and negative family support predicted less weight loss, and positive family support predicted greater weight loss, over the course of the intervention. These bivariate relationships between psychosocial factors and weight remained statistically significant within a multivariate model, after controlling for sociodemographic characteristics. Conversely, coping skills and trauma exposure were not significantly associated with baseline weight or change in weight. These findings demonstrate the influence of psychosocial factors on weight loss in AI/AN communities and have substantial implications for incorporating adjunctive intervention components