Cohabitation Status Research Articles

Relationship Between Vaginal and Gut Microbiome on Stress and Depression in Pregnancy [ID 2683607

INTRODUCTION: Pregnancy is a period of significant stress and weight gain; however, the effect of the vaginal and gut microbiome on pregnancy, depression, stress, and the neonate is not completely understood. METHODS: An IRB-approved prospective cohort study was performed for pregnant individuals and their neonates. The Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CES-D) surveys were administered in the antepartum and postpartum patient, vaginal and fecal microbiome samples were collected, and neonate umbilical cord blood and fecal specimens were also collected. Using full-length 16S rRNA sequencing, fecal and vaginal community composition was characterized. Additionally, possible covariates such as body mass index, cohabitation status, educational attainment, dietary intake, public/private insurance status, chronic health conditions, and pregnancy complications were captured. RESULTS: The study sample consisted of 35 pregnant individuals, average age 30 years, and half primiparous. Increased early pregnancy stress (PSS greater than or equal to 14) was associated with increased abundance of fecal taxa, and increased stress from late pregnancy through postpartum was associated with increased abundance of fecal microbial pathogens. Depressed participants (CES-D greater than or equal to 16) experienced steeper decreases in prenatal vaginal microbiome diversity. In late pregnancy, maternal stress and depression scores were associated with elevated maternal inflammatory markers (CCL2). At delivery, neonatal umbilical CCL2 concentration was negatively correlated with relative abundance of maternal fecal lactobacilli. CONCLUSION: These findings highlight the relationship between stress and depression in pregnancy, the microbiome of the pregnant patient, and inflammatory markers in the pregnant patient and the neonate.

Sleep Quality among Medical Students of a Portuguese University

Introduction: Sleep is a complex physiological process shared by most living beings. Sleep disorders have been increasing exponentially. University students, particularly medical students, are especially vulnerable to this problem. However, the existing literature on the subject is scarce, especially in Portugal. The aim of this study is to assess the quality of sleep among medical students attending the University of Beira Interior, Covilhã, Portugal and to analyse the differences and existing relationships according to age, gender, cohabitation status and academic year. Method: This is a cross-sectional study in which the students completed the Pittsburgh Sleep Quality Index (PSQI) that was previously validated for the Portuguese population. The values obtained for each component of the PSQI were initially analysed for the total sample, and then coupled with sociodemographic variables, in order to obtain statistically significant relationships. Results: Two hundred and ninety-six students completed the questionnaire. A percentage of 62.2% of them stated that their sleep was good; 42.4% scored 2 in the component 2; 50% admitted that they usually sleep between 6 and 7 hours; 73.9% of the participants showed adequate sleep efficiency; 85.5% reported little or no sleep disturbance; 83.8% reported never having used sleep medications; and 60.8% mentioned little or no daytime disturbance. As for global PSQI score, 72.6% of the students’ scores were greater than 5, which indicates poor sleep quality. 74.7% of the female participants and 67.7% of the male respondents showed poor sleep quality. 91.3% of the students who were living alone at the time also revealed poor sleep quality. Of the 1st year students, 82.4% reported poor sleep quality, as did 77.5% of the 2nd year students, 72.1% of the 3rd year students, 77.8% of the 4th year students, 65.8% of the 5th year students, and 71.4% of those attending the 6th year. Conclusion: Generally speaking, the students who took part in this study showed a poor sleep quality, with a PSQI score superior to 5. However, the ratings in each of the components are not so negative. Most of the participants rated their sleep as good or very good, almost half of the participants reported sleeping more than 7 hours and the majority had a sleep efficiency of more than 85%. Similarly, 83.8% had never used sleep medication. Since this is not a robust result, it is imperative to carry out more studies that unequivocally prove it. Moreover, such studies will also be essential to identify situations in which therapeutic intervention will improve such parameters.

Safety of low weight gain or weight loss in pregnancies with class 1, 2, and 3 obesity: a population-based cohort study

There are concerns that current gestational weight gain recommendations for women with obesity are too high and that guidelines should differ on the basis of severity of obesity. In this study we investigated the safety of gestational weight gain below current recommendations or weight loss in pregnancies with obesity, and evaluated whether separate guidelines are needed for different obesity classes. In this population-based cohort study, we used electronic medical records from the Stockholm-Gotland Perinatal Cohort study to identify pregnancies with obesity (early pregnancy BMI before 14 weeks' gestation ≥30 kg/m2) among singleton pregnancies that delivered between Jan 1, 2008, and Dec 31, 2015. The pregnancy records were linked with Swedish national health-care register data up to Dec 31, 2019. Gestational weight gain was calculated as the last measured weight before or at delivery minus early pregnancy weight (at <14 weeks' gestation), and standardised for gestational age into z-scores. We used Poisson regression to assess the association of gestational weight gain z-score with a composite outcome of: stillbirth, infant death, large for gestational age and small for gestational age at birth, preterm birth, unplanned caesarean delivery, gestational diabetes, pre-eclampsia, excess postpartum weight retention, and new-onset longer-term maternal cardiometabolic disease after pregnancy, weighted to account for event severity. We calculated rate ratios (RRs) for our composite adverse outcome along the weight gain z-score continuum, compared with a reference of the current lower limit for gestational weight gain recommended by the US Institute of Medicine (IOM; 5 kg at term). RRs were adjusted for confounding factors (maternal age, height, parity, early pregnancy BMI, early pregnancy smoking status, prepregnancy cardiovascular disease or diabetes, education, cohabitation status, and Nordic country of birth). Our cohort comprised 15 760 pregnancies with obesity, followed up for a median of 7·9 years (IQR 5·8-9·4). 11 667 (74·0%) pregnancies had class 1 obesity, 3160 (20·1%) had class 2 obesity, and 933 (5·9%) had class 3 obesity. Among these pregnancies, 1623 (13·9%), 786 (24·9%), and 310 (33·2%), respectively, had weight gain during pregnancy below the lower limit of the IOM recommendation (5 kg). In pregnancies with class 1 or 2 obesity, gestational weight gain values below the lower limit of the IOM recommendation or weight loss did not increase risk of the adverse composite outcome (eg, at weight gain z-score -2·4, corresponding to 0 kg at 40 weeks: adjusted RR 0·97 [95% CI 0·89-1·06] in obesity class 1 and 0·96 [0·86-1·08] in obesity class 2). In pregnancies with class 3 obesity, weight gain values below the IOM limit or weight loss were associated with reduced risk of the adverse composite outcome (eg, adjusted RR 0·81 [0·71-0·89] at weight gain z-score -2·4, or 0 kg). Our findings support calls to lower or remove the lower limit of current IOM recommendations for pregnant women with obesity, and suggest that separate guidelines for class 3 obesity might be warranted. Karolinska Institutet and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Risk of depression and anxiety in 7.302 patients with sarcoidosis: a nationwide cohort study.

The aim was to investigate the association between sarcoidosis and anxiety and/or depression (A/D) in patients with sarcoidosis and comparators matched on age, gender, residency, and cohabitation status. Patients with newly diagnosed sarcoidosis between 2001 and 2015 were identified in the Danish National Patient Register. Cases were matched 1:4 with non-sarcoidosis comparators. We estimated the cumulative incidence of A/D using the Cumulative Incidence Function and the subdistribution hazard ratio (sHR) for A/D using the Fine-Gray subdistribution hazard model. Estimates were adjusted for socio-economic status and Deyo-Charlson Comorbidity Index. We identified 7.302 cases and 26.145 matched comparators. The cumulative incidence of A/D after five years was 6.0% (95%CI 5.5-6.4) for cases and 4.2% (95%CI 4.0-4.4) for matched comparators. The cumulative incidence was higher among cases for both males and females and in all age-groups compared with the matched comparators. The adjusted-sHR for A/D was 1.38 (95%CI 1.24-1.53). The adjusted-sHR for A/D was 1.51 (95%CI 1.30-1.75) for male cases and 1.25 (95%CI 1.08-1.45) for female cases compared with the matched comparators. The adjusted-sHR for A/D was higher for cases in all age-groups compared with the matched comparators, although not statistically significant among cases aged 30-39 years (a-sHR 1.15; 95%CI 0.92-1.44). Sarcoidosis cases had a higher risk of A/D compared with matched comparators during 18 years of follow-up. The risk of developing A/D was greater for male and female cases and within all age-groups compared with the matched comparators.

Socio-economic position, multimorbidity, and health care utilization among Danish left ventricular assist device patients.

Increasing numbers of patients with advanced heart failure and significant comorbidity and social barriers are considered for left ventricular assist devices (LVADs). We sought to examine health care utilization post-LVAD implantation, including the influence of individual-level socio-economic position and multimorbidity. We conducted a Danish nationwide cohort study linking individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish national medical and administrative registries. Socio-economic position included cohabitation status, educational level, and employment status. Multimorbidity was defined as two or more chronic conditions from at least two chronic disease groups. Health care utilization (hospital activity, general practice activity, and redeemed medical prescriptions) within 2years post-discharge after LVAD implantation was evaluated using descriptive statistics at 0.5year intervals. We identified 119 patients discharged alive with first-time LVAD implanted between 2006 and 2018. The median age of the patients was 56.1years, and 88.2% were male. Patients were followed until heart transplantation, LVAD explantation, death, 31 December 2018, or for 2years. The median follow-up was 0.8years. The highest median use of health care services was observed 0-0.5years post-LVAD discharge compared with the subsequent follow-up intervals: 0.5-1, 1-1.5, and 1.5-2years, respectively. The median (interquartile range) number of hospitalizations was 10 (7-14), bed days 14 (9-28), outpatient visits 8 (5-12), telephone contacts with a general practitioner 4 (2-8), and total redeemed medical prescriptions 26 (19-37) within 0-0.5years post-LVAD discharge compared with the median utilization within the consecutive follow-up periods [e.g. within 0.5-1year: hospitalizations 5 (3-8), bed days 8 (4-14), outpatient visits 5 (3-8), telephone contacts 2 (0-5), and redeemed medical prescriptions 24 (18-30)]. The median use of health care services was stable from 0.5years onwards. The median number of hospitalizations and bed days was slightly higher in patients living alone with a low educational level or low employment status within 0-0.5years post-LVAD implantation. Finally, the median number of in-hospital days and redeemed prescriptions was higher among patients with pre-existing multimorbidity. Among patients who underwent LVAD implantation, health care utilization was high in the early post-LVAD discharge phase and was influenced by socio-economic position. Multimorbidity influenced the number of in-hospital days and redeemed prescriptions during the 2year follow-up.

Cooperative coparenting and the associations with adolescent behavioral problems and delinquency in unmarried families.

Coparenting in unmarried families is a protective factor for positive adolescent adjustment. Although the relations between coparenting and adolescent outcomes have been investigated, it remains unclear whether the specific patterns of maternal and paternal coparenting are associated with adolescent behavioral outcomes. The present study includs a longitudinal cohort of 1143 triads of unmarried parents and their adolescents to examine the associations between different patterns of coparenting and adolescent behavioral problems and delinquency. The data were drawn from the Future of Families and Child Wellbeing Study in the United States. Our study used six waves of publicly available data at children's birth, ages 1, 3, 5, 9, and 15. The latent profile analyses identified four coparenting profiles of maternal and paternal coparenting perceived by the other unmarried parent. Comparing average levels of coparenting between mothers and fathers, the profiles were entitled Low Mom-Low Dad, High Mom-Medium Dad, Low Mom-Medium Dad, and High Mom-High Dad. Parentscharacteristics, such as cohabitation and marital status, predicted the likelihood of being in cooperative coparenting profiles. Furthermore, all the identified coparenting profiles predicted adolescent externalizing behavioral problems; only the high mom cooperative coparenting profiles predicted adolescent internalizing behavioral problems; none of the coparenting profiles predicted adolescent delinquency. Our study adds empirical evidence for coparenting research by revealing that coparenting patterns vary in unmarried families and that cooperative coparenting benefits child behavioral outcomes. The findings encourage introducing different coparenting training programs targeting unmarried parents'diverse needs, thus promoting positive adolescent adjustment.

Total hip arthroplasty performed in summer is not associated with increased risk of revision due to prosthetic joint infection: a cohort study on 58 449 patients with osteoarthritis from the Danish Hip Arthroplasty Register.

Aims: Danish surveillance data indicated a higher risk of revision due to prosthetic joint infection (PJI) following total hip arthroplasty (THA) performed during the summer season. We investigated the association between summer and revision risk following primary THA. Methods: This study identified 58 449 patients from the Danish Hip Arthroplasty Register (DHR) with unilateral primary THA due to osteoarthritis from 2010-2018. From Danish Health Registries, we retrieved information on Charlson Comorbidity Index (CCI), immigration, and death and microbiological data on intraoperative biopsies and cohabitation status. Meteorological data were received from the Danish Meteorological Institute. Summer was defined as June-September, and THAs performed during October-May were used as controls. The primary outcome was revision due to PJI: the composite of revision with culture-positive biopsies or reported PJI to the DHR. The secondary outcome was any revision. The cumulative incidences of revision and the corresponding adjusted relative risk (RR) with 95 % confidence intervals (CI) were calculated by season of the primary THA. Results: A total of 1507 patients were revised, and 536 were due to PJI. The cumulative incidence for THAs performed during summer and the rest of the year was 1.1 % (CI 1.0-1.3) and 1.1 % (CI 1.0-1.2) for PJI revision and 2.7 % (CI 2.5-3.0) and 2.5 % (CI 2.4-2.7) for any revision, respectively. The adjusted RR for THAs performed during summer vs. the rest of the year for PJI revision and any revision was 1.1 (CI 0.9-1.3) and 1.1 (CI 1.0-1.2), respectively. Conclusion: We found no association between summer and the risk of PJI revision or any revision in a northern European climate.

Romantic relationship configurations and their correlates among LGBTQ+ persons: A latent class analysis.

Research comparing monogamous and non-monogamous relationships on well-being indicators across diverse populations have yielded inconsistent findings. The present study investigates sociodemographic characteristics, as well as personal and relational outcomes, across different relationship configurations. Data were drawn from an online community-based sample of 1,528 LGBTQ+ persons aged 18 years and older in Quebec, Canada. A latent class analysis was performed based on legal relationship status, relationship agreement, cohabitation status, and the seeking of extradyadic sexual and romantic partners on the internet. Class differences on sociodemographic characteristics and well-being and relationship quality indicators were examined. A five-class solution best fit the data, highlighting five distinct relationship configurations: Formalized monogamy (59%), Free monogamy (20%), Formalized open relationship (11%), Monogamous considering alternatives (7%) and Free consensual non-monogamies (3%). Cisgender women were more likely to engage in monogamous relationships than cisgender men, who were overrepresented in open relationships. Lower levels of perceived partner support were observed in both free monogamous and consensually non-monogamous relationships, the latter of which also showed lower levels of well-being. Consensual non-monogamy researchers exploring relationship outcomes should examine relationship facets that go beyond relationship structure or agreement. Variations in monogamies and non-monogamies, both consensual and non-consensual, may be present within each broad relationship configuration, as reflected in different personal and relational needs, which can then translate to better or poorer outcomes.

EXPLORING THE RELATIONSHIP BETWEEN HOPELESSNESS AND DISABILITY IN ELDERLY INDIVIDUALS WITH DIABETES

Introduction: This study aimed to investigate the association between hopelessness and disability in elderly individuals with diabetes. Materials and Method: The study involved 500 elderly patients diagnosed with diabetes who were registered with family health centers. Data were collected via the Socio-demographic Information Questionnaire, the Beck Hopelessness Scale, and the Brief Disability Questionnaire. Analysis methods included calculating numbers, percentages, means, standard deviations, and conducting correlation and regression analyses. The statistical significance level was accepted as p &lt; 0.05. Results: The mean age of the participants was 70.98 ± 6.63 years. On the Beck Hopelessness Scale, participants scored an average of 9.93 ± 1.48 total points, while on the Brief Disability Questionnaire, they scored 12.27 ± 5.43 total points. It was found that 90.4% of the participants had a disability, with 50.8% classified as having a severe disability. There was a statistically significant difference between disability and various factors including gender, cohabitation status, educational attainment, employment status, income level, duration of diabetes, and the presence of other chronic diseases (p &lt; 0.05). Conclusion: The study findings revealed that participants had a moderate level of hopelessness, with only a small proportion having no disability, while approximately half of the participants experienced severe disability. Additionally, a very weak positive relationship was observed between participants’ disability levels and their scores on the Beck Hopelessness Scale (p = 0.005). Based on these results, suggestions were formulated to address the implications of the findings in the study. Keywords: Cognitive Dysfunction; Diabetes Mellitus; Aged.

PHYSICAL ACTIVITY BARRIERS AND INTENTIONS OF ALZHEIMER’S DISEASE (AD) AND RELATED DEMENTIAS (AD/ADRD) CAREGIVERS

Abstract Caregivers of people living with AD/ADRD often experience negative biopsychosocial health outcomes and have reduced capacity to engage in healthy behaviors (e.g., exercise). Physical activity is an established intervention for promoting physical and mental health across many populations. This research explored physical activity intentions and barriers among AD/ADRD caregivers, as well as potential relationships between physical activity intentions, cohabitation status, and caregiver/care recipient relationship. Data were collected via online survey from family caregivers of people living with AD/ADRD (n=117). The sample was predominantly women (n=89; 76.1%), white (n= 89, 76.1%), and averaged 55.3 (SD= 16.45) years old. Participants averaged 56.31 (SD= 49.15) hours per week on care responsibilities. Caregivers expressed strong desire to be more active (M=4.42 / 5; SD= .71) and that caregiving demands were a strong barrier (M=3.85 / 5; SD= 1.15). Significant differences were observed between caregivers who lived, or did not live with, care recipients across both physical activity intention (p= .022) and burden perceptions (p=.002), measured by the short form Burden Scale for Family Caregivers (BSFC-SF). No differences were observed based on caregiver-care recipient relationship (e.g., parent, partner). Primary themes among open-ended responses to physical activity barriers included: lack of time and energy, inability to leave care recipient, and competing responsibilities. Our findings suggest a need for behavioral interventions to facilitate physical activity among AD/ADRD caregivers, particularly those who live with their care recipient. Social network interventions that leverage social connections to support caregivers may increase physical activity by reducing barriers associated with care responsibilities.

UTILIZATION OF ELDER CARE AMONG PEOPLE LIVING WITH DEMENTIA IN SWEDEN: A REGISTER-BASED STUDY

Abstract The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare at different stages of the disease. This study aims to investigate the utilization of eldercare among people with and without dementia in Sweden during the last five years of life and what social-background factors influence the use of eldercare. Data were derived from four linked Swedish national registers comprising all decedents aged 70+ in Sweden as of November 2019 (n=6294). The primary outcome variable was the utilization of eldercare (no care, homecare, residential care). Following the study sample retrospective from death, data analysis was performed using multinomial and linear logistic regression models. Results showed that (1) nearly a quarter of all PlwD did not use any eldercare, primarily people who were newly diagnosed with dementia and living with partners; (2) three out of four PlwD used residential care in the last years of life; and (3) age, gender, and cohabitation status were important social-background factors determining utilization of eldercare for PlwD. This study provides unique insight that many Swedes with a dementia diagnosis do not receive any eldercare and that the utilization of eldercare increases with time since dementia diagnosis. We suggest more research to investigate why a substantial part of PlwD does not have any eldercare at all and what the policy implications of this might be.

Cumulative incidence of second primary cancers in a large nationwide cohort of Danish cancer survivors: a population-based retrospective cohort study

A new primary cancer is a serious late effect of a pre-existing cancer diagnosis, and can be attributed to hereditary cancer syndromes, immune or hormonal factors, cancer treatment, or modifiable lifestyle or environmental factors. We investigated the absolute and relative incidence of second primary cancers in a large cohort of Danish cancer survivors. Furthermore, we examined the association between alcohol-related, smoking-related, virus-related, and hormone-related first and second primary cancers. In this retrospective cohort study, we identified a cohort of Danish adults (aged ≥40 years) diagnosed with cancer from Jan 1, 1997, to Dec 31, 2014 and alive 1 year after diagnosis. Follow-up was from date of first cancer diagnosis and lasted up to 24 years, ending on Dec 31, 2020. Cohort identification and information on second primary cancers was obtained from the Danish Cancer Registry, and comorbidity and sociodemographic information was obtained from Danish population-based registries. Overall, and for 27 cancer types, cumulative incidence functions and Cox proportional hazard regression models were used to estimate the incidence of second primary cancer and death, and hazard ratios (HRs) and 95% CIs of second primary cancer adjusted for sex, age and year of diagnosis, cohabitation status, income, and comorbidity. 457 334 Danish adults were included in our study (230 150 [50·3%] male individuals and 227 184 [49·7%] female individuals; median age at diagnosis 68·3 years, IQR 59·7-76·6; median follow-up 3·6 years, IQR 0·6-9·3). The cumulative incidence of second primary cancer increased over time from 6·3% (95% CI 6·2-6·4) 5 years after diagnosis to 10·5% (10·4-10·6) 10 years after diagnosis and to 13·5% (13·4-13·7) 15 years after diagnosis. The highest cumulative incidence of second primary cancer 10 years after diagnosis was observed in survivors of cancers in the larynx (21·8%, 20·5-23·1), oropharynx and oral cavity (19·5%, 18·7-20·3), and bladder and urinary tract (18·5%, 18·0-19·0). Survivors of cancers related to alcohol (HR 1·09, 95% CI 1·06-1·13), smoking (1·73, 1·68-1·78), diet high in red or processed meat (1·32, 1·24-1·39), or virus (1·23, 1·13-1·35) were at increased risk of developing a second cancer with the same aetiology, whereas having had a hormone-related first cancer was associated with lower risk of a second hormone-related cancer (0·77, 0·73-0·81). Our results could help optimise prevention efforts targeting modifiable risk factors to reduce risk of developing a second primary cancer. Nordic Cancer Union and The Health Foundation (Helsefonden).

Differences in Overall Survival for Non-Western Immigrant Patients Compared to Danish-Born Patients with Diffuse Large B-Cell Lymphoma

Background The overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL) have increased in the last decades, but non-Western immigrants with DLBCL may be at risk of poorer OS due to a lower socioeconomic position compared to citizens of the host population. While cancer treatment in Denmark is accessible in a tax-based healthcare system, treatment outcomes may still be affected by factors affecting the patient trajectory prior to treatment, possibly resulting in diagnostic delays, worse clinical features at diagnosis, and prolonged time from diagnosis to treatment. Aims The study aimed to compare OS between non-Western immigrant and Danish-born patients with DLBCL and to investigate differences in clinical and socioeconomic variables. Furthermore, mediators of possible OS differences were investigated to disentangle the causal effect of being a non-Western immigrant (immigration status) on OS. Methods In this Danish retrospective cohort study, patients with newly diagnosed DLBCL in 2000-2020 were identified in the Danish National Lymphoma Registry. Danish citizens born outside Denmark were defined as immigrants, while all citizens born in Denmark, and those immigrants with at least one Danish-born parent with a Danish citizenship, were considered Danish-born citizens. The study did not include second generation immigrants. Patients were followed from diagnosis of DLBCL until death or censoring (31 December 2021 or emigration from Denmark), whichever came first. Crude OS was computed using the Kaplan-Meier estimator and differences in crude OS were tested using the log-rank test. An inverse probability weighted (IPW) Cox model considering age, sex, and calendar year as confounders were used to obtain the total causal effect of immigration status on OS. Furthermore, a mediation analysis on the effect of immigration status on survival was performed using a natural effects Cox model considering age-adjusted International Prognostic Index (aaIPI), Income quartile, and cohabitation status as mediators, while controlling for confounders. Results A total of 254 non-Western immigrant and 7,901 Danish-born patients with DLBCL were included. Median age at diagnosis was 58 and 69, and the proportion of low-risk patients (aaIPI 0) was 29.8 % and 24.3%, respectively. No clinically significant differences in time-to-treatment were found, with a median of 21 days (IQR; 10 - 28) for non-Western immigrant patients and 17 days (IQR; 9 - 27) for Danish-born patients (Table 1). Crude 5-year OS was 68% (95% CI; 63 - 74) and 57% (56 - 58) for non-Western immigrant and Danish-born patients, respectively (P &amp;lt; 0.001, Figure 1). The IPW Cox model yielded a hazard ratio (HR) for all-cause mortality for non-Western immigrants compared to Danish-born patients of 1.02 (0.94 - 1.11, P = 0.541), indicating an insignificant causal effect of immigration status on OS. By considering the indirect effect on OS mediated through aaIPI, difference in aaIPI between non-Western immigrant and Danish-born patients did not significantly impact OS with a HR of 0.98 (0.88 - 1.09, P = 0.713). Similarly, the indirect effect mediated through cohabitation was insignificant with a HR of 1.00 (0.90 - 1.12, P = 0.987). Lastly, the indirect effect mediated through income quartile was significant with a HR of 1.19 (1.06 - 1.32, P = 0.002). The direct effect of immigration status, which was not mediated through any of the above mediators, was 0.88 (0.78 - 0.99, P = 0.035). This implies that the income disparity between non-Western immigrant and Danish-born patients (indirect effect) has a significant negative effect on the survival of the non-Western immigrant patients, and that there is an unexplained (direct) positive effect of being a non-Western immigrant patient on OS compared to Danish-born patients. Conclusion We found that non-Western immigrant patients were younger, had similar aaIPI risk scores and time-to-treatment, and superior crude OS compared to Danish-born patients, with differences in crude OS most likely driven by age differences. The indirect effect of immigration status mediated through income was found significantly negative for the non-Western immigrants, while the unexplained (direct) effect was found significantly positive, seemingly cancelling each other out, resulting in an insignificant total causal effect.

Cooking skills, living alone, and mortality: JAGES cohort study

BackgroundLiving alone without someone to cook meals for them can happen more frequently in aging due to bereavement, divorce, or other family changes. Health risks to older adults due to poor cooking skills may be more pronounced among those living alone. We aimed to examine whether cooking skills are associated with mortality according to cohabitation status in older Japanese people.MethodsParticipants in the Japan Gerontological Evaluation Study, a population-based cohort of independent older adults, were followed for three years (n = 10,647). Cooking skill was assessed using a scale with good validity and modified for Japanese people in the baseline survey. After stratification by living alone or together, participants with high and low cooking skills were matched on demographic, socioeconomic, health-related factors, and availability of food stores using propensity score matching. All-cause mortality risks were compared between high and low cooking skills using Cox regression models.ResultsDuring the follow-up, 520 of the 10,647 participants died. One hundred and seventy-one pairs of high and low cooking skills were matched among those living alone, and 2,161 pairs among those living with others were matched as well. The hazard ratio of the low level of cooking skills (vs. high) was 2.50 (95% confidence interval [CI]: 1.10–5.68) among those living alone, while 1.05 (95% CI: 0.82–1.33) among those living with others.ConclusionLower cooking skills were associated with a higher risk of mortality only among those living alone. Cooking skills may be important for older adults who live alone to reduce mortality risk.

37 The Influence of Informant Characteristics on Reports of Participant Functioning and Associations Between Reported Functioning and Neuropsychological Performance among Non-Hispanic Black Adults

Objective:Assessing one’s functional capacity– in addition to neuropsychological performance– is essential for determining neurocognitive status, and functional assessment is often provided via informant report. While informant characteristics have been shown to influence reports of participant functioning, the degree to which they moderate relationships between reported functioning and participant performance on neuropsychological testing is unclear. Moreover, associations among informant characteristics, reported functioning, and neuropsychological performance have not been directly examined with non-Hispanic Black (NHB) samples, despite this population’s disproportionately high risk for dementia.Participants and Methods:In this cross-sectional observational study, we examined the influence of informant characteristics on (1) informant reports of participant functioning (assessed via the Functional Activity Questionnaire [FAQ]), and (2) associations between reported functioning and participant performance on neuropsychological testing, among NHB adult participants in the National Alzheimer’s Coordinating Center cohort (n=1024).Results:Younger age, female sex/gender, higher education, longer relationships with participants, and cohabitation were informant characteristics associated with poorer reported functioning (ps&lt;.01). Moreover, poorer reported functioning was associated with poorer performance on (1) memory and language tests, particularly for participants with male (versus female) informants, and (2) the Multilingual Naming Test, particularly for participants with cohabitating (versus non-cohabitating) informants (ps&lt;.01).Conclusions:Within the context of neurocognitive evaluation of NHB adults, informant age, sex/gender, education, relationship length, and cohabitation status influence informant reports of participant functioning, and informant sex/gender and cohabitation status in turn moderate associations between reported functioning and participant performance on comprehensive neuropsychological testing.

Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia.

The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis. This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use. Results showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women. Among people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and used residential care for a longer time compared to people without dementia and people living alone, respectively.

Loneliness is associated with health behaviour: A Danish population study of 122.258 individuals

Abstract Background Loneliness is steadily being recognized as a public health concern due to its association with increased morbidity and mortality. Health behaviour has been proposed as a key mechanism that influences this association. The objective of the present study is to provide a comprehensive account of the relationship between loneliness and adverse health behaviour, including daily smoking, alcohol consumption, physical inactivity, unhealthy dietary habits and obesity. Methods We conducted a cross-sectional study using data from the 2017 Danish National Health Survey. Loneliness was assessed using a Danish version of the Three-Item Loneliness Scale. We analysed the association between loneliness and multiple forms of adverse health behaviour in 122.258 individuals aged 16 years and older using logistic regression models adjusting for sex, age, educational attainment, country of origin and cohabitation status. Stratified analyses was conducted to investigate potential differences by sex and age. Results Loneliness was associated with a greater risk of smoking (AOR=1.30; 95% CI: 1.21-1.40), physical inactivity (AOR=1.87; 95% CI: 1.75-1.99), unhealthy diet (AOR=1.58; 95% CI: 1.47-1.70), and obesity (AOR=1.60; 95% CI: 1.49-1.72). Conversely, loneliness was associated with a lower risk of weekly alcohol consumption (AOR=0.91; 95% CI: 0.83-0.98). Conclusions Our study provides evidence that loneliness is associated with an increased risk of adverse health behaviour, such as smoking, physical inactivity and unhealthy dietary intake, across the life span. These results suggest that adverse health behaviors may influence the association between loneliness and poor health. Longitudinal studies are needed to clarify causal relationships underlying these associations. Key messages • Loneliness is strongly associated with adverse health behaviour across the life span. • Our study supports the theory that health behaviour is a key mechanism on the relationship between loneliness and morbidity.

Long-Term Medical Treatment and Adherence in Patients With Left Ventricular Assist Devices: A Danish Nationwide Cohort Study.

The use of a left ventricular assist device (LVAD) in treating advanced heart failure has increased. However, data regarding medical treatment and adherence following LVAD implantation is sparse, particularly whether socioeconomic factors (cohabitation status, educational level, employment status, and income) and multimorbidity influence these aspects, which are known to impact adherence in heart failure patients. We performed a nationwide cohort study of 119 patients with LVAD implanted between January 1, 2006, and December 31, 2018, who were discharged alive with LVAD therapy. We linked individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish medical and administrative registers. Medical treatment 90-day pre-LVAD and 720-day post-LVAD were assessed using descriptive statistics in 90-day intervals. Medication adherence (proportion of days covered ≥80%) was assessed 181- to 720-day post-LVAD. The proportions of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (88.7%), beta-blockers (67.0%), mineralocorticoid receptor antagonists (62.9%), warfarin (87.6%), and aspirin (55.7%) within 90-day post-LVAD were higher than pre-LVAD and were stable during follow-up. Medication adherence ranged from 86.7% (aspirin) to 97.8% (warfarin). Socioeconomic factors and multimorbidity did not influence medical medication use and adherence. Among LVAD patients, medical treatment and adherence are at high levels, regardless of socioeconomic background and multimorbidity.

Association between Subjective Health Perception and Cohabitation Status of the Elderly

The purpose of this research is for verifying the association between subjective health status and cohabitation status of elderly group in Korea. the 8th National Health and Nutrition Examination Survey (KNHANES Ⅷ-2) raw data used for analysis. The respondents of this research were 2,314 people aged 60 and older. Data analysis was performed by SPSS. Chi-square analysis was performed for differences of subjective health perception and general characteristics. Logistic regression analysis was performed for to analyze factors related to subjective health perception and cohabitation status. In 60s age group, gender, household income, education level, cohabitation status, drinking were related to subjective health perception. In 70s, gender, education level, walking were related to subjective health perception. In 80 and older, household income, walking were related to subjective health perception, In logistic regression analysis, subjective health perception in 60s age group was 2.1 times higher in the case of cohabitation (yes) compared to cohabitation (no). Subjective health status have been related to successful aging. This research' result would be used for basic data for the developing an intervention program to improve subjective health perception in the elderly.

What do people look for in a potential partner after the age of 50?

The intimate relationships of the older population have seldom been analyzed from a sociological perspective. This study provides novel information on what is desired in a partner after the age of 50 in Spain. The academic debate on this topic has been limited. Therefore, the contribution of this article is mainly an exploration of the empirical data. The database used is the Spanish General Social Survey prepared by the Sociological Research Center. The results indicate that personality is the most valued factor, followed by values and physical appearance. The variables with the greatest explanatory power in the estimated multinomial logit model are age, sex, level of education and cohabitation status. Educational homogamy appears among those with higher levels of education, with men more interested in physical appearance and women more interested in values and education. These last two characteristics are also more highly valued among those who are older.