Longitudinal Regression Models Research Articles

Financial Hardship Among Patients With Early-Stage Colorectal Cancer

The degree of cancer patients' financial hardship is dynamic and can change over time. To assess longitudinal changes in financial hardship among patients with early-stage colorectal cancer. In this prospective longitudinal cohort study, English-speaking adult patients with a new diagnosis of stage I to III colorectal cancer being treated with curative intent at National Cancer Institute (NCI) Community Oncology Research Program (NCORP) practices between May 2018 and July 2020 and who had not started chemotherapy and/or radiation were included. Data analysis was conducted from March to December 2023. Patients completed surveys at baseline as well as at 3, 6, 12, and 24 months after enrollment. Cost-related care nonadherence and material hardship, as adopted by Medical Expenditure Panel Survey, were measured. Factors associated with financial hardship were assessed using longitudinal multivariable logistic regression models with time interaction. A total of 451 patients completed baseline questions, with 217 (48.1%) completing the 24-month follow-up. Mean (SD) age was 61.0 (12.0) years (210 [46.6%] female; 33 [7.3%] Black, 380 [84.3%] White, and 33 [7.3%] American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or Other Pacific Islander individuals or those who did not report race or who had unknown race). Among 217 patients with data at baseline and 24 months, 19 (8.8%) reported cost-related care nonadherence at baseline vs 20 (9.2%) at 24 months (P = .84), and 125 (57.6%) reported material hardship at baseline vs 76 (35.0%) at 24 months (P < .001). In multivariable analysis, lower financial worry (odds ratio [OR], 0.90; 95% CI, 0.87-0.93), higher education (OR, 0.34; 95% CI, 0.15-0.77), and older age (OR, 0.94; 95% CI, 0.91-0.98) were associated with lower nonadherence. Receipt of chemotherapy was associated with higher material hardship (OR, 2.68; 95% CI, 1.15-6.29), while lower financial worry was associated with lower material hardship (OR, 0.83; 95% CI, 0.80-0.96). Over 24 months, female sex was associated with lower nonadherence (OR, 0.90; 95% CI, 0.85-0.96), while higher education was associated with higher nonadherence (OR, 1.09; 95% CI, 1.03-1.17). Being employed was associated with lower material hardship (OR, 0.85; 95% CI, 0.78-0.93), while receipt of care at safety-net hospitals was associated with higher hardship (OR, 1.09; 95% CI, 1.01-1.17). In patients with early-stage colorectal cancer, material hardship was more common than cost-related cancer care nonadherence and decreased over time, while nonadherence remained unchanged. Early and longitudinal financial screening and referral to intervention are recommended to mitigate financial hardship.

Examining the Relationship Between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020.

Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories. To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics. Longitudinal analysis from 2017 to 2020. United States counties. 3126 counties. The primary study outcome was county overdose death rates per 100000 population taken from the Centers for Disease Control and Prevention. The main predictor of interest was the per capita average of local governmental expenditures in public health, social service, and education drawn from the U.S. Census of Governments, categorized into quartiles. Covariates included county-level socioeconomic and demographic characteristics as well as county-level SUD services from the AHRQ SDOH Database. In longitudinal multivariate linear regression models with state and year fixed effects, counties in the highest 3 quartiles of SDOH spending had significantly lower rates of overdose deaths compared with counties in the lowest quartile of SDOH spending; in particular, counties in quartile 2 had an average of 9.09 fewer overdose deaths per 100000 population (95% CI: -12.58, -5.60), counties in quartile 3 had an average of 13.18 fewer deaths per 100000 population (95% CI: -17.56; -8.80), and counties in quartile 4 had an average of 13.92 deaths per 100000 population (95% CI: -19.16, -8.68). Our findings demonstrate that higher levels of local governmental investments in SDOH were associated with significantly lower rates of overdose death in U.S. counties after controlling for socioeconomic and demographic characteristics. Going forward, research should focus on determining causality in this relationship, the mechanisms through which this relationship occurs, as well as assess the impact of local public health expenditures allocated toward SUD prevention and treatment specifically on substance use outcomes at the local level.

The association between erythema nodosum and pyoderma gangrenosum and pediatric inflammatory bowel disease.

The objectives of this study is to estimate rates and identify factors associated with erythema nodosum (EN) and pyoderma gangrenosum (PG) in pediatric patients with inflammatory bowel disease (IBD). This cohort study examined longitudinal visits of patients aged ≤ 21 years from the ImproveCareNow (ICN) registry. We evaluated the association of factors at the patient-level (demographics and IBD diagnosis age) and visit-level (IBD severity scores, markers and phenotypes, comorbidities, and treatment) with the presence of EN and PG, using longitudinal logistic regression models adjusted for time and within-patient clustering. A total of 285,913 visits from 32,497 patients aged ≤ 21 years from the ICN registry were analyzed. The occurrence of EN was 1.57% (95% confidence interval [95% CI]: 1.43%-1.71%) and the occurrence of PG was 0.90% (95% CI: 0.80%-1.00%). Co-occurrence of EN and PG was reported in 0.30% (95% CI: 0.25%-0.37%) patients. Both EN and PG were associated (p < 0.0001) with worse intestinal disease, lower remission, higher inflammatory markers, and extraintestinal manifestations (EIMs) arthritis and uveitis. EN and PG were associated with increased disease severity and other noncutaneous EIMs (arthritis and uveitis). A small subset of patients had developed both EN and PG.

Association of Baseline Depression and Anxiety with Longitudinal Health Outcomes in Parkinson's Disease.

Anxiety and depression are common non-motor symptoms in Parkinson's disease (PD) but remain under-recognized and under-treated. To evaluate functional outcomes associated with baseline anxiety or depression and effects related to the initiation of new psychiatric treatment. We analyzed 7 years of data from patients with de novo PD enrolled in the Parkinson's Progression Markers Initiative. Longitudinal regression models evaluated the association between baseline anxiety and depression with Schwab and England (SE) and MDS-UPDRS total scores over time. Cox proportional hazard models assessed effects of baseline anxiety and depression on time to initiation of dopaminergic therapy. Piecewise linear regression models examined the association of treatment initiation for anxiety and depression with SE and MDS-UPDRS. 490 participants with baseline depression and anxiety data were included. Anxiety and depression were associated with lower SE (anxiety: β = -1.31, P = 0.038, depression: β = -1.96, P = 0.012, co-morbid: β = -2.70, P = 0.003) and higher MDS-UPDRS scores (anxiety: β = 5.37, P < 0.001, depression: β = 9.17, P < 0.001, co-morbid: β = 10.50, P < 0.001) longitudinally. Anxiety was associated with faster time to dopamine replacement therapy initiation (HR 1.30, 95% CI 1.03-1.66, P = 0.03). 16 participants with anxiety initiated treatment for anxiety, which was associated with subsequent lower levodopa daily dose (slope change = -218.49, P = 0.018). 10 participants with depression initiated treatment of depression, which was associated with reduced MDS-UPDRS total scores (slope change = -8.3, P < 0.001) and higher SE scores (slope change = 5.99, P = 0.004). Anxiety and depression at PD onset are associated with multiple negative longitudinal trajectories. However, preliminary findings suggest that anxiety and depression treatment may be linked with improved motor and non-motor outcomes.

Examining Coping Strategies and Mental Health during the COVID-19 Pandemic: Evidence for the Protective Role of Problem-Focused Coping.

Early in the COVID-19 pandemic, studies documented a marked decline in mental health and well-being when compared with prepandemic levels. This study examined how different coping styles were associated with anxiety, depression, and sleep problems among U.S. adults March-April 2020 during the COVID-19 pandemic. Data from 535 U.S. adults across three time points were analyzed using longitudinal multilevel logistic and linear regression modeling. Avoidant-emotional coping was associated with greater odds of experiencing anxiety (OR = 1.65, p < .001). Both avoidant- and active-emotional coping were associated with greater odds of experiencing depression (OR = 1.67, p < .001, and OR = 1.09, p = .022, respectively) and sleep problems (b = 0.05, p < .001, and b = 0.01, p = .005, respectively). Alternatively, problem-focused coping was associated with lower odds of depression (OR = 0.86, p < .001). Results converge with previous evidence suggesting the perniciousness of avoidant-emotional coping during the pandemic, but also underscore that problem-focused coping strategies may represent one important source of resilience for adults to adapt despite such challenges.

Assessing heterogeneity in treatment initiation guidelines in longitudinal randomized controlled trials

Treatment initiation guidelines are essential in healthcare, dictating when patients begin therapy. These guidelines are typically assessed through randomized controlled trials (RCTs) to measure their average effect on a population. However, this method may not fully account for patient heterogeneity. We introduce a refined analysis methodology that accounts for diverse times to treatment initiation (TTI) arising from these guidelines. We offer a more detailed perspective on the guidelines’ impact by analyzing homogeneous subpopulations based on their TTI. We develop a longitudinal regression model with smooth time functions to capture dynamic changes in average guideline effects on subpopulations (AGES). A unique weighting mechanism creates pseudo-subpopulations from RCT data, enabling consistent and precise estimation of smooth functions. The efficacy of our approach is validated through theoretical and numerical studies, underscoring its capacity to provide insightful statistical inferences. We exemplify the utility of our methodology by applying it to an RCT of the World Health Organization (WHO) guideline for adults with HIV. This analysis promises to enhance the evaluation of treatment initiation guidelines, leading to more personalized and efficient patient care.

Prevalence and Risk Factors for the Development of Bulimia Nervosa and Binge Eating Disorder in a Large U.S. Military Cohort.

While bulimia nervosa (BN) and binge eating disorder (BED) are prevalent in military populations, an understanding of risk and protective factors is limited by a lack of longitudinal population-based epidemiological research. This study examined the prevalence of BN and BED among active duty service members and identified military and psychosocial factors associated with their development. Millennium Cohort Study participants were followed for up to 15 years and prevalence was ascertained using survey and electronic medical record data. Longitudinal multivariable logistic regression models evaluated risk factors associated with the development of bulimia nervosa (n=96,245) or binge eating disorder (n=113,733). Weighted prevalence estimates from survey data (range, 0.80%-4.80%) were higher than those from medical records (0.04%-0.14%). Military factors significantly associated with increased risk for BN and BED included active duty component (vs Reserve/Guard); serving in the Army, Marines, or Navy/Coast Guard (vs Air Force); and combat deployment (vs deployment without combat). Associated psychosocial factors included lack of social support, experiencing at least one life stressor, and screening positive for posttraumatic stress disorder or problem drinking. Findings highlight the critical need for disordered eating screening and prevention efforts that bolster coping skills, which can ultimately improve service member functioning and readiness.

Reclaiming employment: A pilot study of online entrepreneurship training for individuals with psychiatric disabilities

BACKGROUND: Many individuals with psychiatric disabilities face workplace challenges that motivate them to pursue self-employment, but accessible self-employment support is lacking. Using participatory action research, Reclaiming EmploymentTM (RE), an online interactive platform that provides self-employment education for people who experience mental health-related challenges around work, was developed to address these gaps. OBJECTIVE: An observational pilot study of RE examined usage, usability, self-efficacy, and self-employment income. METHODS: Participants (N = 97) used RE for six months; survey data was collected at three timepoints to measure entrepreneurial self-efficacy (ESE) and income generated from self-employment. Usability was assessed post-intervention using the System Usability Scale. RESULTS: More than 70% of participants used RE; there was no association between non-usage and demographic characteristics, nor prior use of other self-employment supports. RE users rated the platform at above average usability, although those who experienced long-term unemployment rated the platform significantly lower compared to wage or self-employed users. In longitudinal regression models, we found use of RE was significantly associated with increases in some ESE subscales and mean ESE. Use of RE was not associated with gains in income. CONCLUSION: This pilot study demonstrates acceptability, feasibility, and preliminary effectiveness of an online entrepreneurship training for individuals with psychiatric disabilities.

Model of performance indicators for the evaluation of state public health expenditures in Brazil

Objective: To present a proposal on a set of performance indicators that can be used in audits of state audit courts to assess the effectiveness of budget spending on public health. Methodology: This is quantitative research, with the application of statistical techniques related to Data Envelopment Analysis (DEA) in two stages and estimation of linear longitudinal regression models for strongly balanced short panel data, on the budget expenditures made in the period from 2015 to 2019 by the States and the Federal District on public health. Results: It was found that there is no use of performance indicators in the elaboration and execution of Multi-Annual Plans (MAPs) by governments to evaluate the effectiveness of spending on public actions; that the mention of "performance indicators" refers exclusively to percentages to compare what was accomplished in relation to what was predicted; that records of duplicate public actions were found in the MAPs by some entities, and that overvaluation was identified in the records of the resources provided for in most of the MAPs. The degree of statistical explanation of the proposed set of indicators reached an average of 87% of statistical confidence. None of the public entities was 100% effective in the expenditures made. 69% of the auditors of the Courts of Auditors legitimized the set of indicators proposed to evaluate the effectiveness of state public health spending. Finally, it is concluded that the proposed performance evaluation indicators can be used to verify the effectiveness of state public health spending. Contributions of the study: It presents performance indicators, created by means of a statistical method, to evaluate the effectiveness of spending on state public health, since the specialized literature indicates little or no discussion about it. It indicates that the actions included in the MAPs are not audited by the courts of auditors and that the legislative branch is silent in the supervision between what is foreseen and what is carried out, considering that there are repeated and overvalued actions.

Risk of otitis media in offspring following maternal prenatal stress exposure

ObjectivesThere is limited but consistent evidence that suggests prenatal factors, including maternal stress, may contribute to susceptibility for otitis media. We aimed to determine the effect of multiple life stress events during pregnancy on risk of acute and recurrent otitis media in offspring at three and five years of age. MethodsExposure data on stressful life events were collected from pregnant women in a longitudinal prospective pregnancy cohort study, at 18 and 34 weeks’ gestation. We used longitudinal regression models stratified by offspring sex to examine associations between the number, type and timing of maternal prenatal stress events and the likelihood of any OM in addition to recurrent OM infection at age three and five years, adjusting for pre-specified prenatal sociodemographic and environmental confounders. ResultsEach additional stressful life event in pregnancy was associated with increased risk of any OM at both ages (3 years: OR = 1.07, 95%CI = 1.02, 1.12; 5 years: OR = 1.07, 95%CI = 1.02, 1.12), with larger effect sizes for recurrent otitis media (3 years: OR = 1.11, 95%CI = 1.05, 1.17; 5 years: OR = 1.09, 95%CI = 1.04, 1.14). Risk of offspring otitis media did not differ with timing of stress nor by offspring sex. Specific types of stress (pregnancy and relationship problems, issues with other children) were each associated with increased risk of recurrent OM at age three and five years. ConclusionsWe observed a dose-response relationship between maternal stressful life events in pregnancy and the risk for offspring otitis media in the preschool years, most marked for recurrent otitis media.

Diabetes and Financial Well-Being: Differential Hardship Among Vulnerable Populations.

The purpose of the study was to examine financial well-being among a diverse population of individuals with and without diabetes. Data from the Understanding America Survey, a nationally representative, longitudinal panel, were utilized to identify adults with self-reported diabetes diagnoses between 2014 and 2020. We used longitudinal mixed effects regression models to assess the association between diabetes and financial well-being score (FWBS) among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, employment, and health insurance, incorporating individual- and household-level fixed effects. Racial and ethnic differentials were captured using group-condition interactions. Black participants (17.06%) had the highest prevalence of diabetes, followed by White participants (12.2%), "other" racial groups (10.7%), and Hispanic participants (10.0%). In contrast, White participants (M = 67.66, SD = 22.63) and other racial groups (M = 67.99, SD = 18.45) had the highest FWBSs, followed by Hispanic participants (M = 59.31, SD = 22.78) and Black participants (M = 55.86, SD = 25.67). Compared to White participants, Black participants (β = -5.49, SE = 0.71) and Hispanic participants (β = -2.06, SE = 0.63) have significantly lower FWBSs. Compared to males, females (β = -3.25, SE = 0.41) had lower FWBSs among individuals with diabetes. FWBSs of individuals with diabetes was 2.71 points lower (SE = 0.52), on average, than those without diabetes. Education, household size, age, marital status, and income were also significantly associated with FWBSs. Findings suggest potential disparities in the financial ramifications of diabetes among socially marginalized populations.

Feeling older, feeling pain? Reciprocal between-person and within-person associations of pain and subjective age in the second half of life.

Experiencing pain in middle adulthood and old age might be interpreted as a sign of aging and make people feel older, whereas feeling older has behavioral, motivational, and physiological consequences that might increase the risk of pain. We investigated between-person and within-person associations between pain, subjective age, and chronological age in middle-aged and older adults. Data from the German Ageing Survey were used (n = 13,874 who provided more than 32,000 observations, baseline mean age = 62.3 years). The observation period comprised up to 13 years (M = 4 years) and five (M = 2.4) measurement occasions. Based on the longitudinal multilevel regression models, we found significant between-person and within-person effects in both directions, which were small but robust when controlling for sociodemographic variables, depressive symptoms, and number of chronic diseases. At the between-person level, participants reporting overall more severe pain also felt older than others. Likewise, those who felt overall older than others reported more pain. At the within-person level, when participants experienced more pain than they usually do, they also reported feeling older than usual. Likewise, on measurement occasions when participants reported feeling older than usual, they reported more pain than usual. Additionally, those with overall stronger pain exhibited steeper age-related increases in their subjective age than those with less severe pain. Our findings suggest that an older subjective age may operate as both antecedent and consequence of pain, and pain might prompt a steeper increase in subjective age over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A stepped wedge trial of a healthcare provider–focused intervention to increase human papillomavirus (HPV) vaccine initiation among survivors of childhood cancer.

10010 Background: Childhood cancer survivors are at increased risk for human papillomavirus (HPV)-related cancers. HPV vaccination is highly protective against HPV acquisition. However, we have previously shown that initiation rates among survivors are low, primarily due to lack of healthcare provider recommendation for the vaccine. Methods: We conducted a stepped wedge trial from 2021 to 2023 to evaluate the effectiveness of an evidence-based healthcare provider-focused intervention (HPV PROTECT; NCT04469569) in increasing HPV vaccine initiation rates 1y following implementation. The intervention includes provider communication training to enhance vaccine recommendation skills, audit/feedback regarding clinic vaccination rates, and patient-directed resources in multiple languages tailored to pediatric oncology settings. We measured the effectiveness of the intervention in a racially, ethnically, and geographically diverse sample of HPV vaccine naïve childhood cancer survivors, aged 9-17y, and ≥1y post-completion of therapy returning to pediatric oncology clinics for follow-up care at 6 sites. The primary outcome of interest was HPV vaccine initiation rates (abstracted from state vaccine registries) at end of each study year. Baseline data were collected for all sites in Y1, three sites were randomly selected to receive the intervention in Y2, and the remaining three in Y3. The intervention effect was tested using a longitudinal logistic regression model for initiation with intervention as the main fixed effect, adjusting for survivor age, cancer diagnosis, time off-therapy, sex, race, ethnicity, and receipt of hematopoietic cell transplantation. The secular trend (estimated using pre-intervention data from Y1 and Y2) was included as an offset, and site was included as a random effect. The intervention effect was reported as odds ratio (OR) for initiation with 95% confidence intervals (CI). Results: A total of 1779 unique vaccine naïve survivors (47.1 % leukemia; 55.1% male; 51.5% non-Hispanic white) completed 2689 clinic visits across 6 sites. Median (range) age at diagnosis was 5.1y (0-16.5), at study entry was 12.3y (9-17.9), and median time off-therapy was 5.5y (1.0-17.3). Overall incident HPV vaccine initiation was 16.0% at baseline. The adjusted odds of vaccine initiation were 1.3-fold (95%CI, 1.03-1.6; p = 0.03) higher post-intervention vs. pre-intervention, accounting for secular trend OR of 1.1. Overall prevalence of vaccine initiation increased from 51.9% pre-intervention to 61.3% post-intervention. Conclusions: The improvement in childhood cancer survivor HPV vaccine initiation rates in a diverse sample following implementation of a healthcare provider-focused intervention underscores the potential for pediatric oncology providers to positively impact HPV vaccine uptake in this vulnerable population. Clinical trial information: NCT04469569 .

Occurrence and characteristics of suicidal ideation in psychiatrically healthy individuals based on ecological momentary assessment.

Decedents with no known mental disorder comprise 5-40% of suicides, suggesting that suicide ideation (SI) and behavior may occur in the psychiatrically healthy with important implications for suicide risk screening. Healthy Volunteers (HV) and patients with Major Depressive Disorder (MDD) provided 7 days of Ecological Momentary Assessment (EMA) data about SI and stressors. Longitudinal mixed effects logistic regression models compared HV and patient SI and stressors. Mixed effects linear regression models compared HVs' and patients' SI score change from the previous epoch's SI score when each stressor occurred. HVs (n = 42) reported less frequent (p < 0.001) and less intense SI (p < 0.003) than patients (n = 80), yet did endorse SI and/or SI-related items in 44% of EMA epochs, endorsing SI items in 25% of epochs with non-zero SI scores. For 7 of 8 stressors, patients reported stressors more often than HVs (all p < 0.001) responding to them with increased SI (0.0001 < p < 0.0472). HVs were relatively resilient to stressors, reporting SI increases only in response to neglect (p < 0.0147). Although SI and SAs are documented among psychiatrically healthy individuals, scientific attention to these observations has been scant. Real-time SI measurement showed that HVs' SI was less pronounced than MDD patients', but was endorsed, nonetheless. Patients were more likely to report stressors than HVs, perhaps due to greater sensitivity to the environment, and reported SI in response to stressors, which was less common in HVs. Both MDD patients and HVs most often manifested passive SI (viz, "decreased wish to live"). However, passive SI (viz, "desire for death"), may predict suicide, even absent SI per se (thinking about killing yourself). This study validates the utility of real-time SI assessment, showing that HVs endorse SI items in 11% of epochs, which implies that suicide risk screening focused on those with mental disorders may be too narrow an approach.

Working Time and the Environmental Intensity of Well-Being

There are serious questions about the viability of economic growth for achieving development goals aimed at improving social and environmental outcomes. Research suggests that structural change away from the growth model is needed to reduce climate-change-causing emissions, decrease the overconsumption of environmental resources, and address inequalities in human well-being. An alternative approach is working-time reduction. Proponents present it as a multi-dividend sustainable-development policy that can improve both environmental and social outcomes. We test this proposition using two indicators, carbon intensity of well-being (CIWB) and ecological intensity of well-being (EIWB). We estimate longitudinal regression models with data from 34 high-income OECD countries from 1970 to 2019. We find that longer working hours are positively associated with higher CIWB and EIWB, suggesting that shorter working hours would decrease CIWB and EIWB, a desirable outcome in terms of sustainability. These results provide direct support for the idea that working-time reduction could improve both social and environmental outcomes simultaneously. These results have important practical and theoretical implications.

The Association Between Cardiometabolic Risk and Cognitive Function Among Older Americans and Chinese.

Cardiometabolic risk (CMR) is associated with cognitive health, but the association can be affected by broader social, economic, and medical contexts. The United States and China have very different developmental and epidemiological histories, and thus CMR among older people could be linked to cognitive function differently in the 2 countries. Cross-sectional and longitudinal ordinary least squares regression models were estimated for each country using nationally representative samples of populations over age 50: 7430/4474 Americans and 6108/3655 Chinese in the cross-sectional/longitudinal samples. In the United States, higher CMR is associated with worse cognitive function (b = -0.08, p < .016). Longitudinally, CMR increase is associated with worse cognitive function at a marginally significant level (b = -0.10, p = .055). No relationship between CMR level or change and cognitive function is observed in China. Higher education levels are linked to better cognitive function and slower cognitive decline in both countries. Unlike older Americans, relative to those with very low education levels, among older Chinese with the highest education level, a higher CMR links to better cognitive function (b = 0.63, p = .013) and slower cognitive decline (b = 0.35, p = .062); Nevertheless, a rapid increase in CMR is additionally harmful (b = -0.54, p = .050) for cognitive function and may lead to faster cognitive decline (b = -0.35, p = .079). The significant relationship between CMR and cognitive function in the United States suggests the importance of monitoring and controlling CMR factors at older ages. The insignificant relationship in China may be explained by the high CMR among those with high education levels, highlighting the need for improving cardiometabolic health through education and promoting healthy lifestyles.

Postponing old age: Evidence for historical change toward a later perceived onset of old age.

"At what age would you describe someone as old?" Perceptions of when old age begins might be prone to upward shifts because of historical increases in life expectancy and in retirement age, as well as because of better psychosocial functioning in later life. We investigated historical changes in within-person trajectories of the perceived onset of old age using data from 14,056 participants who entered the German Ageing Survey at age 40-85 years and who completed up to eight assessments across 25 years. Using longitudinal multilevel regression models, we found that at age 64, the average perceived onset of old age is at about age 75 years. Longitudinally, this perceived onset age increased by about 1 year for every 4-5 years of actual aging. We also found evidence for historical change. Compared to the earliest-born cohorts, later-born cohorts reported a later perceived onset of old age, yet with decelerating trend among more recent birth cohorts. Within-person increases of the perceived onset of old age were steeper in later-born cohorts. The described cohort trends were only slightly reduced when controlling for covariates. Being younger, male, living in East Germany, feeling older, reporting more loneliness, more chronic diseases, and poorer self-rated health were each associated with a perceived earlier onset of old age. Our results suggest that there is a nonlinear historical trend toward a later perceived onset of old age, which might have meaningful implications for individuals' perspectives on aging and old age. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparison of Early Postoperative Step and Stair Counts With the Direct Anterior Approach Versus the Posterior Approach for Total Hip Arthroplasty

BackgroundThe purpose of this study was to evaluate the impact of direct anterior approach (DAA) or posterior approach (PA) on step and stair counts after total hip arthroplasty using a remotely monitored mobile application with a smartwatch while controlling for baseline characteristics. MethodsThis is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year. Step and stair counts were available for 1,501 and 847 patients, respectively. Longitudinal regression models were created to control for baseline characteristics. ResultsPatients in the DAA group had significantly lower body mass index (P = .049) and comorbidities (P = .028), but there were no significant differences in age (P = .225) or sex (P = .315). The DAA patients had a higher average and improvement from baseline in step count at 2 and 3 weeks postoperatively after controlling for patient characteristics (P = .028 and P = .044, respectively). The average stair counts were higher for DAA patients at one month postoperatively (P = .035), but this difference was not significant after controlling for patient demographics. Average stair ascending speeds and changes from baseline were not different between DAA and PA patients. Descending stair speed was higher at 2 weeks postoperatively for DAA patients, but was no longer higher after controlling for baseline demographics. ConclusionsAfter controlling for baseline characteristics, DAA patients demonstrate earlier improvement in step count than PA patients after total hip arthroplasty. However, patient selection and surgeon training may continue to influence outcomes through a surgical approach.

Effect of a Comprehensive School-Based Health Center on Academic Growth in K-8th Grade Students

ObjectiveSchool-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism. MethodsParticipants were students enrolled in 2 co-located Title I schools from 2015–19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends. ResultsMore than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076]). ConclusionsSBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees.

Improved patient reported outcomes with the direct anterior approach versus the posterior approach for total hip arthroplasty in the early post-operative period.

Patients undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA) may experience faster recovery but may also have better baseline health than those who undergo THA with the posterior approach (PA). This study aimed to compare patient-reported outcome measures (PROMs) between the DAA and PA while controlling for baseline factors. This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform following THA. The primary outcomes were HOOS JR and EQ-5D-5L through 1 year and change from baseline. Longitudinal regression models were created to control for baseline characteristics and investigate the impact of surgical approach on PROMs. Of 1364 THAs evaluated, 731 (53.6%) were female, and 840 (61.6%) used the PA. Patients in the PA group were of similar age but had higher body mass index and comorbidity scores. Pre-operative HOOS JR and EQ-5D-5L were comparable, but higher post-operatively in the DAA group through 6months (p = 0.03 and p = 0.005). At 1 year post-operatively, HOOS JR and EQ-5D-5L did not vary between groups (p = 0.48 and p = 0.56), nor did changes from baseline (p = 0.47 and p = 0.11). After controlling baseline characteristics, DAA was significantly associated with higher average HOOS JR through 6months (p = 0.03) and EQ-5D-5L through 3months (p = 0.005), but not at 12months (p = 0.89 and p = 0.56). THA patients undergoing DAA demonstrate earlier improvements in HOOS JR and EQ-5D-5L. However, these differences may not be clinically significant and are not evident at 1-year post-operative. Patient selection and surgeon training may continue to affect outcomes by surgical approach.