Total Years Of Education Research Articles

The Relationship Between Dietary Patterns, Cognition, and Cardiometabolic Health in Healthy, Older Adults.

Healthy dietary patterns can support the maintenance of cognition and brain health in older age and are negatively associated with cardiometabolic risk. Cardiometabolic risk factors are similarly important for cognition and may play an important role in linking diet to cognition. This study aimed to explore the relationship between dietary patterns and cognition and to determine whether cardiometabolic health markers moderate these relationships in older adulthood. A cross-sectional analysis of observational data from the baseline of the ACTIVate study. The cohort included 426 cognitively normal adults aged 60-70 years. The Australian Eating Survey (AES) Food Frequency Questionnaire was used to collect data on usual dietary intake, along with additional questions assessing intake of dietary oils. Principal component analysis (PCA) was applied to reduce the dimensionality of dietary data. Cardiometabolic risk was quantified using the metabolic syndrome severity score (MetSSS). Tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to derive composite scores on four cognitive domains: processing speed, executive function, short-term memory, and long-term memory. Three dietary patterns were identified using PCA: a plant-dominant diet, a Western-style diet, and a meat-dominant diet. After controlling for age, sex, total years of education, energy intake, and moderate-to-vigorous physical activity (MVPA), there was a small, negative association between the meat-dominant diets and long-term memory. Subsequent moderation analysis indicated that MetSSS significantly moderated this relationship. Findings highlight the link between diet, cardiometabolic health, and cognitive function in older, cognitively healthy adults. However, longitudinal studies are needed to confirm observations and evaluate the dynamics of diet, cardiometabolic health, and cognitive function over time.

Exploring risk factors and their differences on suicidal ideation and suicide attempts among depressed adolescents based on decision tree model

BackgroundSuicide has been recognized as a major global public health issue. Depressed adolescents are more prone to experiencing it. We explore risk factors and their differences on suicidal ideation and suicide attempts to further enhance our understanding of suicidal behavior. Methods2343 depressed adolescents aged 12–18 from 9 provinces/cities in China participated in this cross-sectional study. We utilized decision tree model, incorporating 32 factors encompassing participants' suicidal behavior. The feature importance of each factor was measured using Gini coefficients. ResultsThe decision tree model demonstrated a good fit with high accuracy (SI = 0.86, SA = 0.85 and F-Score (SI = 0.85, SA = 0.83). The predictive importance of each factor varied between groups with suicidal ideation and with suicide attempts. The most significant risk factor in both groups was depression (SI = 16.7 %, SA = 19.8 %). However, factors such as academic stress (SI = 7.2 %, SA = 1.6 %), hopelessness (SI = 9.1 %, SA = 5.0 %), and age (SI = 7.1 %, SA = 3.2 %) were more closely associated with suicidal ideation than suicide attempts. Factors related to the schooling status (SI = 3.5 %, SA = 10.1 %), total years of education (SI = 2.6 %, SA = 8.6 %), and loneliness (SI = 2.3 %, SA = 7.4 %) were relatively more important in the suicide attempt stage compared to suicidal ideation. LimitationsThe cross-sectional design limited the ability to capture changes in suicidal behavior among depressed adolescents over time. Possible bias may exist in the measurement of suicidal ideation. ConclusionThe relative importance of each risk factor for suicidal ideation and attempted suicide varies. These findings provide further empirical evidence for understanding suicide behavior. Targeted treatment measures should be taken for different stages of suicide in clinical interventions.

THE CURIOUS CASE OF CONSCIENTIOUSNESS AND DEPRESSION: FINDINGS FROM THE IOWA UNMARRIED SURVIVORS STUDY

Abstract The purpose of this study was to analyze the association between personality traits, coping, social support, stress, and loneliness relative to depression reported by N = 227 (M = 78.2, SD = 8.1) participants from the Iowa Unmarried Survivors Study. Using the Development Adaptation Model as a conceptual framework, a series of blocked multiple regression analyses were conducted. In the first block, age, gender, ethnicity, total years of education, and current marital status were included. The second block contained total life events and childhood poverty, whereas the third block included activities of daily living and total number of illnesses. The fourth block contained the aforementioned personality variables, and the fifth block included coping, social support, stress, and loneliness. Lifetime illnesses emerged as a significant predictor of depression, β = .158, p < .01. The more illnesses over one’s lifetime, the higher the levels of depression. In addition, both Neuroticism and Conscientiousness were significant predictors of depression, β = .453, p < .00, β = .139, p < .05 respectively. Finally, stress served as a significant predictor of depression, β = .200, p < .01. This model explained 58% of the variance in depression scores. Being unmarried and navigating through late adulthood presents a challenge to sustaining positive mental health. Results from this study have implications relative to how clinically trained counselors, geriatric social workers, and aging service providers develop interventions and programming to improve mental health and quality of life for persons who remain unmarried throughout later life.

55 Health literacy mediates racial differences in cognitive functioning among people with and without HIV

Objective:Health disparities among African Americans (AAs) in the United States are evident, especially among older adults and people living with HIV (PLWH). These health disparities include worse cognitive functioning among AAs than White counterparts. Though disparities in health literacy among AAs impact health outcomes across clinical populations, less is known on the mechanistic role health literacy may play in explaining racial differences in cognitive functioning among older PLWH. The current study investigated the association between health literacy and global cognitive functioning among middle-aged and older AA and White adults with and without HIV in the Deep South.Participants and Methods:Two hundred and seventy-three people (170 PLWH: 146 AA, 24 White; 103 HIV-negative: 67 AA, 36 White) were enrolled in an observational study and completed measures of sociodemographic characteristics, as well as the reading subtest of the Wide Range Achievement Test-3rd Edition to assess verbal IQ. A composite score of socioeconomic status (SES) was created using total years of education and annual household income. Neurocognitive functioning was assessed using a comprehensive cognitive battery (i.e., verbal, attention/working memory, executive function, learning, recall, speed of processing, and motor), from which a sample-based global Z-score composite was created. Health literacy was measured using a sample-based composite Z-score derived from the Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults Reading Comprehension, Newest Vital Sign, and Expanded Numeracy Scale. First, multivariable linear regression analyses were performed within both PLWH and HIV-negative samples examining the association between race, SES, verbal IQ, and health literacy with cognitive functioning. These results informed two bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and global cognitive functioning.Results:In both PLWH and HIV-negative individuals, linear regressions showed that Whites had better global cognitive functioning, health literacy, and verbal IQ than AAs. Linear regressions showed that health literacy had an independent association with cognitive function when accounting for verbal IQ and SES. Mediations showed that health literacy significantly mediated the association between race and global cognitive functioning in both samples, independent of verbal IQ (PLWH: b = .07, 95% CI [0.0096, 0.2149]; HIV-negative: b = .15, 95% CI [0.0518, 0.2877]), indicating that Whites were expected to obtain higher global cognitive Z-scores than AAs in both PLWH and HIV-negative samples, through the mediating effect of better health literacy.Conclusions:Health literacy significantly mediated the association between race and global cognitive functioning among middle-aged and older adults with and without HIV, underscoring the importance of health literacy in explaining racial disparities in cognitive outcomes among AAs in the Deep South. Findings have implications for guiding clinicians and healthcare providers in developing interventions that promote health literacy in these underserved populations, which may have downstream impacts on cognitive functioning. Future work is needed to examine mechanisms whereby health literacy impacts neurocognition among AA PLWH.

The Raven’s Standard Progressive Matrices Performance is Associated with Premorbid Intelligence, Functioning or Adjustment in Patients with Schizophrenia

Objective: The assessment of premorbid intelligence and adjustment/functioning in schizophrenia is quite important for clinical evaluation. Several methods can be used to estimate premorbid functioning. However, these methods may be affected by retrospective bias, verbal skills, and the disorder itself. This study aimed to investigate whether the Raven’s Standard Progressive Matrices Test (RSPM) performance is related to premorbid intelligence/functioning, or adjustment in schizophrenia. Methods: Schizophrenia patients (n=31) and healthy controls (n=30) were included in the study. The Premorbid Adjustment Scale (PAS), the Positive and Negative Syndrome Scale (PANSS), and the Personal and Social Performance Scale (PSPS) were applied to patients with schizophrenia, while the WAIS-R and the RSPM were applied to all participants. Results: No statistically significant differences were observed between the groups in terms of age, sex, and total years of education (p=0.86, p=0.06 and p=0.10, respectively). Healthy controls performed significantly better than the patient group in terms of intellectual abilities as measured by the RSPM and the WAIS-R. The RSPM performance was correlated with all WAIS-R scores, total years of education, and the academic subscale of the PAS, while it was not correlated with the PAS-developmental scores or the PSPS and PANSS scores of patients with schizophrenia. Conclusion: The results of the study support the validity of the RSPM which is an easily applied tool that is not affected by verbal skills as a good measure of premorbid intelligence, and adjustment/ functionality in patients with schizophrenia.

Lipid oxidation as a marker of apathy and executive dysfunction in patients at risk of vascular cognitive impairment

AbstractBackgroundApathy and executive function decline are hallmarks of vascular dysfunction in neurodegeneration and cognitive impairment. People with mild vascular cognitive impairment (mVCI) display a combined etiology of both cognitive impairment and vascular comorbidities; hence, patients with vascular risk factors are at risk for mVCI. The co‐occurrence of apathy and executive dysfunction is prevalent; however, the physiological pathway underlying these manifestations is yet to be investigated. Oxidative stress is often present in vascular dysfunction. This study investigated the relationship between oxidative stress, specifically markers of lipid oxidation, apathy, and executive dysfunction in patients at risk of mVCI.MethodPatients at risk of mVCI were recruited from a population of patients with coronary artery disease in a Cardiac Rehabilitation Program. Apathy was assessed using the Apathy Evaluation Scale and executive function with Trial Making Test B, phonemic fluency test and animal naming test. Fasting blood was collected and serum concentrations of early and late lipid oxidation markers, lipid hydroperoxides (LPH) and 8‐isoprostane (8‐ISO) respectively, were measured.ResultParticipants (n=206, Age= 63.0±7.5, 80% men, total years of education= 15.9±3.4, AES score= 28.3±8.8, composite z score for EF= 0±1) demonstrated significantly different ratios of late to early lipid oxidation markers (8‐ISO/LPH) between groups (F(3, 202) = 10.915, p <0.001) with increasing levels in the following order: no apathy or executive dysfunction, only executive dysfunction, only apathy, and both apathy and executive dysfunction. A multivariate linear regression model adjusting for demographics found that lipid oxidation was significantly associated with apathy (B= 4.63, p < 0.001) and executive function (B= ‐0.19, p= 0.018); however, when controlling for both demographics and vascular risk factors, lipid oxidation was significantly associated with apathy alone (B= 3.11, p= 0.002).ConclusionThe results highlight an important involvement of lipid oxidation in the co‐occurrence of apathy and executive dysfunction in patients at risk of mVCI. Our results show that increased oxidative stress may contribute to the development of apathy, which may relate to why apathy is a strong risk factor for progression to dementia in at‐risk populations.

Lipid Peroxidation as a Marker of Apathy and Executive Dysfunction in Patients at Risk for Vascular Cognitive Impairment.

The co-occurrence of apathy and executive dysfunction, a correlate of vascular cognitive impairment (VCI), is highly prevalent, yet facilitating factors are largely unknown. This study investigates the relationship between lipid peroxidation, apathy, and executive dysfunction in patients at risk for VCI. In participants with coronary artery disease, who are at a high risk of VCI, apathy (Apathy Evaluation Scale), and executive function (composite z-score based on age and education population norms from trails making test B, animal naming, and phonemic fluency tests) were assessed. Serum concentrations of an early (lipid hydroperoxide (LPH)) and late (8-isoprostane (8-ISO)) lipid peroxidation marker, were measured and the 8-ISO/LPH ratio was calculated. Participants (n = 206, age±SD = 63.0±7.5, 80% men, total years of education = 15.9±3.4, AES score = 28.3±8.8, executive function = 0±1) demonstrated significantly different 8-ISO/LPH ratios between groups (F(3, 202) = 10.915, p < 0.001) with increasing levels in the following order: no apathy or executive dysfunction, only executive dysfunction (executive function composite score≤-1), only apathy (AES≥28), and both apathy and executive dysfunction. A model adjusting for demographics showed that lipid peroxidation was associated with both apathy (B(SE) = 4.63 (0.954), t = 4.852, p < 0.001) and executive function (B(SE) = -0.19 (0.079), t = -2.377, p = 0.018). However, when controlling for both demographics and vascular risk factors, lipid peroxidation was associated with only apathy (B(SE) = 3.11 (0.987), t = 3.149, p = 0.002). The results highlight a potentially important involvement of lipid peroxidation in the co-occurrence of apathy and executive dysfunction in those at risk for VCI.

The enduring gap in educational attainment in schizophrenia according to the past 50 years of published research: a systematic review and meta-analysis

Educational attainment is associated with wellbeing and health, but patients with schizophrenia achieve lower levels of education than people without. Several effective interventions can ameliorate this situation. However, the magnitude of the education gap in schizophrenia and its change over time are unclear. We aimed to reconstruct the trajectories of educational attainment in patients with schizophrenia and, if reported, their healthy comparator controls. We did a systematic review and meta-analysis including all studies reporting on patients with schizophrenia (of mean age ≥18 years) and describing the number of years of education of the participants, with or without healthy controls. There were no other design constraints on studies. We excluded studies that included only patients with other schizophrenia spectrum disorders and studies that did not specify the number of years of education of the participants. 22 reviewers participated in retrieving data from a search in PubMed and PsycINFO (Jan 1, 1970, to Nov 24, 2020). We estimated the birth date of participants from their mean age and publication date, and meta-analysed these data using random-effects models, focusing on educational attainment, the education gap, and changes over time. The primary outcome was years of education. The protocol was registered on PROSPERO (CRD42020220546). From 32 593 initial references, we included 3321 studies reporting on 318 632 patients alongside 138 675 healthy controls (170 941 women and 275 821 men from studies describing sex or gender; data on ethnicity were not collected). Patients' educational attainment increased over time, mirroring that of controls. However, patients with schizophrenia in high-income countries had 19 months less education than controls (-1·59 years, 95% CI -1·66 to -1·53; p<0·0001), which is equivalent to a Cohen's d of -0·56 (95% CI -0·58 to -0·54) and implies an odds ratio of 2·58 for not completing 12 years of education (ie, not completing secondary education) for patients compared with controls. This gap remained stable throughout the decades; the rate of change in number of total years of education in time was not significant (annual change: 0·0047 years, 95% CI -0·0005 to 0·0099; p=0·078). For patients in low-income and middle-income countries, the education gap was significantly smaller than in high-income countries (smaller by 0·72 years, 0·85 to 0·59; p<0·0001), yet there was evidence that this gap was widening over the years, approaching that of high-income countries (annual change: -0·024 years, -0·037 to -0·011; p=0·0002). Patients with schizophrenia have faced persistent inequality in educational attainment in the last century, despite advances in psychosocial and pharmacological treatment. Reducing this gap should become a priority to improve their functional outcomes. Ciencia y Tecnología para el Desarrollo (CYTED) to the Latin American Network for the Study of Early Psychosis (ANDES).

Comparison of the Rowland University Dementia Assessment Scale and Mini-Mental State Examination cognitive screening tools among older people in Nigeria

Introduction and objectives: Dementia is progressive neuro-degeneration characterized by ongoing deterioration in cognition and capacity for independent living. Empirical evidence is lacking on the best screening tool because of the cultural and linguistic diversities of Nigerians. This study screened for dementia and described the differences between the Rowland University Dementia Assessment Scale (RUDAS) and Mini-Mental State Examination (MMSE) tools among older people at the University College Hospital (UCH), Ibadan, Nigeria.&#x0D; Materials and Methods: Cross-sectional hospital-based descriptive study of 96 older people ≥60years at UCH, Ibadan. Dementia was assessed with the RUDAS and MMSE tools. Socio-demographic characteristics and memory issues were also assessed. Descriptive and inferential statistics were done and the level of significance was set at 5%.&#x0D; Results: The mean age was 70.5±7.4 years and 57(59.4%) were female respondents. The overall mean score on RUDAS was 22.8±4.0 points and MMSE was 24.2±4.8 points. Point prevalence of dementia on RUDAS and MMSE were 6.2% and 4.2% respectively. Using MMSE as the standard, the AUROC for the RUDAS was 85.9% (95% CI:60.4-99.8), and its sensitivity and specificity were75.0% and 96.7% respectively. Both RUDAS and MMSE were associated with age and residence. MMSE, but not the RUDAS, scores were influenced by total years of education (p&lt;0.001).&#x0D; Conclusion: RUDAS was as accurate as MMSE for the screening of dementia in our setting. Contrary to the MMSE, RUDAS was not influenced by the years of education for dementia. Our finding supports the use of RUDAS as an effective alternative test to MMSE for dementia screening in older Nigerians.

Comparison of the Rowland University Dementia Assessment Scale and Mini-Mental State Examination cognitive screening tools among older people in Nigeria

Introduction and objectives: Dementia is progressive neuro-degeneration characterized by ongoing deterioration in cognition and capacity for independent living. Empirical evidence is lacking on the best screening tool because of the cultural and linguistic diversities of Nigerians. This study screened for dementia and described the differences between the Rowland University Dementia Assessment Scale (RUDAS) and Mini-Mental State Examination (MMSE) tools among older people at the University College Hospital (UCH), Ibadan, Nigeria.&#x0D; Materials and Methods: Cross-sectional hospital-based descriptive study of 96 older people ≥60years at UCH, Ibadan. Dementia was assessed with the RUDAS and MMSE tools. Socio-demographic characteristics and memory issues were also assessed. Descriptive and inferential statistics were done and the level of significance was set at 5%.&#x0D; Results: The mean age was 70.5±7.4 years and 57(59.4%) were female respondents. The overall mean score on RUDAS was 22.8±4.0 points and MMSE was 24.2±4.8 points. Point prevalence of dementia on RUDAS and MMSE were 6.2% and 4.2% respectively. Using MMSE as the standard, the AUROC for the RUDAS was 85.9% (95% CI:60.4-99.8), and its sensitivity and specificity were75.0% and 96.7% respectively. Both RUDAS and MMSE were associated with age and residence. MMSE, but not the RUDAS, scores were influenced by total years of education (p&lt;0.001).&#x0D; Conclusion: RUDAS was as accurate as MMSE for the screening of dementia in our setting. Contrary to the MMSE, RUDAS was not influenced by the years of education for dementia. Our finding supports the use of RUDAS as an effective alternative test to MMSE for dementia screening in older Nigerians.

The use of performance validity tests among inpatient forensic monolingual Spanish-speakers

Performance validity tests (PVTs) are an integral part of neuropsychological assessments. Yet no studies have examined how Spanish-speaking forensic inpatients perform on PVTs, making it difficult to interpret these tests in this population. The present study examined archival data collected from monolingual Spanish-speaking forensic inpatients (n = 55; M age = 49.6 years, SD = 12.0; 84.9% male; 93.5% diagnosed with a Psychotic Spectrum Disorder) to determine how this population performs on several PVTs. Most participants’ scores on the Dot Counting Test (DCT; 82.2%; n = 45), Repeatable Battery for Assessment of Neuropsychological Status-Effort Index (RBANS EI; 84.4%; n = 33), and Test of Memory Malingering (TOMM; 79.1%; n = 43) were indicative of valid performance. Few participants, however, had Rey-15 Item Test (FIT) scores in the valid range (24.5% to 48.0%; Recall n = 50 and Combined n = 49, respectively); although FIT Recall specificity was improved when cutoff scores were lowered. Total years of education, but not other educational factors, were significantly associated with performance on PVTs (r = .33–.40, p = .01–.03). Study results suggest the DCT, TOMM, and RBANS EI may be more appropriate PVTs for Spanish-speaking forensic inpatients compared to the FIT.

525 A population-based study of phenoconversion to parkinsonism from REM sleep behavior: a Population-based Study in the CLSA

Abstract Introduction To date, studies have estimated the phenoconversion rate from sleep clinics, using polysomnography proven RBD. However, no population-based estimates have been reported, testing to what degree possible RBD, screened by questionnaire is associated with increased risk of neurodegeneration. Methods We included those aged 45–85 years, living in one of 10 Canadian provinces in between 2012–2015 (at the baseline), recruited via three population-based sampling methods. Dream enactment behavior/possible RBD was screened using the RBD1Q single question-questionnaire. De-novo parkinsonism was defined as free of pre-existing diagnosis at the baseline with a ‘new’ diagnosis at the follow-up (205–2019). Relative risk (log-binomial regression), hazard ratio (Cox regression), incidence rate (Poisson regression) between the affected group and the symptom naïve group were assessed, adjusting for age and sex (and total years of education and language). Results Overall, 58 participants phenoconverted into parkinsonism and 53 into dementia at the follow-up (mean intervals=3.06±0.37 years). Participants with dream enactment behavior had 2.75 times higher risk to phenoconvert into parkinsonism than the symptom-free. Similarly, those with dream enactment behavior at the baseline possessed higher risk to screening positive of parkinsonism. No difference in time to phenoconversion was found between groups, The results remained robust after excluding non-RBD related symptoms, such as apnea and non-REM sleep parasomnia. Conclusion Compared to symptom-free, those with pRBD had higher risk to developing parkinsonism in near future. Support (if any):

Endostatin as a Mediator Between Endothelial Function and Cognitive Performance in Those at Risk for Vascular Cognitive Impairment

Background:Patients with coronary artery disease have an increased risk for developing vascular cognitive impairment. Endothelial function is often diminished and has been associated with lower cognitive performance in these patients. The link between endothelial function and cognition in coronary artery disease is not fully understood. Angiogenesis may play a role in mediating the association between endothelial function and cognition since angiogenic processes rely heavily on the endothelium.Objective:The aim of this study was to determine if markers of angiogenesis mediate the relationship between endothelial function and cognition in coronary artery disease patients.Methods:In 50 participants with coronary artery disease, endothelial function was assessed using peripheral arterial tonometry. Vascular endothelial growth factor (pro-angiogenic) and endostatin (anti-angiogenic) were measured in peripheral serum samples. Cognition was assessed using the Montreal Cognitive Assessment. A mediation analysis, using a bias corrected inferential bootstrapping method with 10,000 permutations, was used to determine if vascular endothelial growth factor or endostatin mediated an association between peripheral arterial tonometry measures and cognitive performance on the Montreal Cognitive Assessment.Results:Endostatin, but not vascular endothelial growth factor, mediated a relationship between endothelial function and cognitive performance when controlling for total years of education, body mass index, coronary artery bypass graft, stent, diabetes, and diuretic use. This analysis was also significant when delayed recall was substituted for the overall score on the Montreal Cognitive Assessment.Conclusion:These results suggest that endostatin mediates an association between endothelial function and cognitive performance in coronary artery disease.

Understanding Parental education and health of Pacific families: Background and study protocol

Nakiro'anga ite au meitaki o tei 'āpi'i ia no te ora'anga pu'apinga no tātou te Vakevake a Te Moana Nui o Kiva e no'o nei i Aotearoa (Meitaki o te ‘Api'i) is a programme of research examining the benefits of education to health outcomes for Pacific families in Aotearoa using the Integrated Data Infrastructure (IDI) and it is an Health Research Council Pacific post-doctoral project. As a part of Meitaki o te ‘Api'i, the present study plans to investigate the relationship between parental education and child health outcomes in Pacific families. &#x0D; Using linked health, income, and Census data, the present study will model the influence of parental education levels on child health outcomes adjusted for other key factors. In this methodological paper, we provide details about this project that is in a relatively new data space for Pacific research and we describe our participants.&#x0D; Most children in the study were born in New Zealand and nearly all could speak English. Pacific children were slightly younger, more likely to be able to speak a Pacific or other languages, and most likely to live in areas of socio-ecenomic deprivation compared to non-Pacific children. Pacific children who identified with solely Pacific and Pacific with other ethnicities. Parents of children with solely Pacific ethnicity, more than a third of whom were born in New Zealand, over 60% spoke a Pacific language and four out of five held christian beliefs. By comparison, parents of children with Pacific with other ethnicities were; younger, New Zealand born, less likely to speak another language and half held christian beliefs. Compared with parents of children from Other ethnicities, parents of Pacific children had lower median incomes, were less likely to own their home and had fewer total years of education.&#x0D; It is important to note that the overall purpose of this study is not to highlight the differences between Pacific and other non Pacific families, but to look at the relationship between parental education and the health of children.

Posttraumatic Stress Disorder and Neurocognitive Impairment in a U.S. Military Cohort of Persons Living with HIV

Objective: Neurocognitive impairment (NCI) is a well-known complication of human immunodeficiency virus (HIV) infection and may be influenced by a number of psychological factors. We examined the relationship between NCI and mental health disorders, including posttraumatic stress disorder (PTSD), in a cohort of 189 active-duty and retired U.S. military men living with HIV. Methods: Participants completed selected modules of the Composite International Diagnostic Interview (CIDI) to ascertain the presence of PTSD, major depressive disorder, and other mental health diagnoses. We also obtained demographic data, including history of head trauma, via personal interview. NCI was assessed with a comprehensive battery of standardized neuropsychological tests. Results: The median age of study subjects was 36 years (interquartile range [IQR] 28 to 43) and median total years of education was 14 (IQR 12 to 16). NCI was diagnosed in 19% of subjects. Individuals with and without a history of PTSD were similar with respect to most HIV-related characteristics; however, the former were significantly more likely to have a prior acquired immunodeficiency syndrome (AIDS) diagnosis. In multivariate analysis, lifetime history of PTSD was independently associated with NCI (odds ration [OR] = 6.12; 95% confidence interval [CI] = 1.85, 20.27), while a history of head of trauma was negatively associated (OR = 0.37 95% CI = 0.15,0.92). Conclusions: Our findings demonstrate that PTSD is an important predictor of NCI in this U.S. military cohort. HIV-infected individuals with cognitive difficulties should be screened for mental health disorders, including PTSD, and prospective studies of the longitudinal relationship between PTSD and NCI, as well as the impact of PTSD treatment on future NCI, are warranted.

Social determinants and cardiovascular disease mortality in Panama, 2012\u20132016

BackgroundThe aims of this study were to determine the geographic and time variation of social determinants of health (SDH) and cardiovascular disease (CVD) mortality in Panama from 2012 to 2016, and to identify which of the SDH has the strongest correlation with a socioeconomic index (SEI).MethodsWe conducted an ecological study obtaining mortality from the National Mortality Register and socioeconomic variables derived from the National Household Survey (NHS). The International Classification of Diseases 10th revision codes I20–I25 and I60–I69 were used for ischemic heart disease (IHD) and stroke, respectively. Standardized age-adjusted mortality rates were calculated by direct method. Mortality rates and socioeconomic variables were evaluated together in a panel data model. A SEI was developed from factorial analysis by principal components with a polychoric correlation matrix. Provinces and regions were categorized in tertiles according to median value of the SEI score.ResultsThe NHS evaluated an average of 15,919 households per year. The mean of age throughout the study period was 41 years. The average monthly income increased, from US$ (SD) 331.94 (5.38) in 2012, to 406.24 (5.81) in 2016, whereas the social security health coverage remained in a range of 57–58%. The mean number of school years was twelve. Significant geographical and temporal variations in social determinants and mortality rates were observed throughout the country. Colon, categorized in the middle tertile according to the SEI, presented higher IHD mortality rates. Darién (in the lowest SEI tertile) Colón and Herrera had higher stroke mortality rates. The SEI categorized indigenous territories in the lowest tertile. Total years of education was the strongest correlated variable with the SEI, when we excluded the population living in indigenous territories. However, when this population was included, social security coverage had the strongest correlation with the SEI.ConclusionWe observed geographical and temporal disparities in SDH and CVD mortality rates. Further epidemiological studies are warranted in the provinces of Colón, Darien, Herrera and Los Santos to explore in-depth the higher CVD mortality rates observed in these provinces.

Association of Educational Attainment and Cardiovascular Risk in Hispanic Individuals

Hispanic individuals are the fastest growing ethnic group in the United States and face lower socioeconomic status compared with non-Hispanic white (NHW) individuals. However, Hispanic individuals tend to experience better health outcomes than expected, a phenomenon known as the Hispanic paradox. Little is known about how higher socioeconomic status is associated with Hispanic cardiovascular risk factor burden and outcomes. To determine cardiovascular risk and outcomes among highly educated Hispanic vs NHW individuals in a preventive medicine clinic. Retrospective cohort analysis of participants from the Cooper Center Longitudinal Study who underwent preventive medical examinations at the Cooper Clinic in Dallas, Texas, from October 1972 to November 2017. Analysis began April 2018. Ethnicity, self-defined as Hispanic or NHW. Prevalence of major metabolic risk factors and cardiorespiratory fitness were compared, as were changes among participants with at least 2 visits. Ethnic differences adjusted for age, examination year, and educational attainment were estimated using regression models. Age-matched comparisons of coronary artery calcium scores were performed. All-cause mortality was summarized using the Kaplan-Meier method. This study included 1351 Hispanic and 43 736 NHW participants aged 20 to 80 years, body mass index between 18.5 and 50.0, and were not missing key cardiometabolic or fitness variables. Both Hispanic and NHW participants had high educational attainment, with a mean of more than 15 years of total education. Hispanic women and men had a higher prevalence of metabolic syndrome (71 of 518 [13.1%] vs 1477 of 13 732 [10.8%] for women and 255 of 833 [30.6%] vs 7902 of 30 004 [26.3%] for men, respectively). Although Hispanic individuals were twice as likely to have diabetes, there was no difference in calculated 10-year atherosclerotic cardiovascular disease risk scores by ethnicity. Both Hispanic and NWH individuals experienced a statistically significant worsening in cardiometabolic parameters during follow-up, although this was not statistically significantly different between groups. In age-matched analyses, there were no significant differences in the prevalence of coronary artery calcium scores between Hispanic and NWH individuals. During a mean (SD) follow-up of 12.9 (7.5) years, there was no difference in mortality between Hispanic and NHW individuals. Hispanic and NHW men and women with high educational attainment had similar atherosclerotic cardiovascular disease risk, subclinical coronary atherosclerosis, and mortality during follow-up. These findings do not support the Hispanic paradox in a highly educated Hispanic population.

The Association Between Commonly Investigated User Factors and Various Types of eHealth Use for Self-Care of Type 2 Diabetes: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway.

BackgroundSociodemographic and health-related factors are often investigated for their association with the active use of electronic health (eHealth). The importance of such factors has been found to vary, depending on the purpose or means of eHealth and the target user groups. Pakistanis are one of the biggest immigrant groups in the Oslo area, Norway. Due to an especially high risk of developing type 2 diabetes (T2D) among this population, knowledge about their use of eHealth for T2D self-management and prevention (self-care) will be valuable for both understanding this vulnerable group and for developing effective eHealth services.ObjectiveThe aim of this study was to examine how commonly were the nine types of eHealth for T2D self-care being used among our target group, the first-generation Pakistani immigrants living in the Oslo area. The nine types of eHealth use are divided into three broad categories based on their purpose: information seeking, communication, and active self-care. We also aimed to investigate how sociodemographic factors, as well as self-assessment of health status and digital skills are associated with the use of eHealth in this group.MethodsA survey was carried out in the form of individual structured interviews from September 2015 to January 2016 (N=176). For this study, dichotomous data about whether or not an informant had used each of the nine types of eHealth in the last 12 months and the total number of positive answers were used as dependent variables in a regression analysis. The independent variables were age, gender, total years of education, digital skills (represented by frequency of asking for help when using information and communication technology [ICT]), and self-assessment of health status. Principal component analyses were applied to make categories of independent variables to avoid multicollinearity.ResultsPrincipal component analysis yielded three components: knowledge, comprising total years of education and digital skills; health, comprising age and self-assessment of health status; and gender, as being a female. With the exception of closed conversation with a few specific acquaintances about self-care of T2D (negatively associated, P=.02) and the use of ICT for relevant information-seeking by using search engines (not associated, P=.18), the knowledge component was positively associated with all the other dependent variables. The health component was negatively associated with the use of ICT for closed conversation with a few specific acquaintances about self-care of T2D (P=.01) but not associated with the other dependent variables. Gender component showed no association with any of the dependent variables.ConclusionsIn our sample, knowledge, as a composite measure of education and digital skills, was found to be the main factor associated with eHealth use regarding T2D self-care. Enhancing digital skills would encourage and support more active use of eHealth for T2D self-care.

Vestibular migraine patients are more anxious than migraine patients without vestibular symptoms

The link between vertigo and anxiety is well known. The aim of this study is to compare anxiety disorders in 3 groups: patients with vestibular migraine (VM), patients with migrainebut without vertigo (MO) and healthy controls (HC).We performed cross-sectional analysis of following tests: (a) Hamilton Anxiety Rating Scale (HAMA); (b) State-Trait Anxiety Inventory (STAI-X1 and STAI-X2); (c) Beck Depression Inventory (BDI); (d) Panic-Agoraphobic Scale and (e) Penn State Worry Questionnaire (PSWQ). ANOVA, Kruskal-Wallis and Chi-square tests were used for comparisons and least significant difference was used for further post-hoc analysis. There were 35 definite VM patients, 31 MO patients and 32 volunteer HC. There were no significant differences between three groups in age, total years of education or duration of headaches in VM and MO patients. On the other hand, vertigo severity was moderately and positively correlatedwith headache severity and with headache duration. There were significant differences in scores of HARS, BDI, PSWQ, and various PAS-R sub-scales between the three groups. Our study shows that VM patients are significantly more anxious and agoraphobic than MO patients and HC, displaying higher sensitivity to separation and being more prone to seeking medical reassurance.

Language background in early life may be related to neuropsychiatry symptoms in patients with Alzheimer disease

BackgroundThe relationship between early life experience and the occurrence of neuropsychiatry symptoms (NPSs) in patients with Alzheimer disease (AD) is unclear.MethodsFrom 2012 to 2014, we prospectively recruited 250 patients with probable AD from the memory clinic of Taipei Veterans General Hospital. All patients underwent standard assessments, including brain magnetic resonance imaging or computed tomography, neuropsychological tests, neuropsychiatry inventory (NPI-Q) and related blood tests. A linear regression analysis was performed to investigate the relationship between NPSs and age, gender, disease severity, depression, language background (with or without Japanese education).ResultsAmong the 250 participants, 113 (45.2%) were women. Their average age was 82.6 years. Of all the participants, 93 (37.2%) had received formal Japanese education, whereas 157 (62.8%) did not receive Japanese education. The participants with Japanese education were slightly younger (83.1 ± 3.6 vs. 81.4 ± 3.4, P = 0.006), with a higher proportion of them were women (30.5% vs. 69.8%, P < 0.001) and fewer years of total education (10.8 ± 4.5 vs. 7.7 ± 3.2, P < 0.001), compared to the participants without Japanese education. NPI-Q scores significantly differed between the two groups (15.8 vs. 24.1, P = 0.024). Both disease severity and language background predicted NPI-Q scores.ConclusionsLanguage background in early life may be related to NPSs in patients with AD, and this effect is more significant in patients with a lower education level than in those with a higher education level. More NPSs may be the result of negative effects on dominant language or early life experiences.