Previous research has identified long-term exposure to stress as a risk factor for negative mental and physical health outcomes. This pattern of findings suggests that environmental stimuli that ...evoke feelings of stress or strain may also result in physiological responses, which may accumulate over the life course and ultimately increase the overall risk of various physical health conditions. This physiological “wear and tear” resulting from sustained levels of stress or strain has been previously operationalized as allostatic load (AL), a comprehensive indicator of stress exposure.
The current study examines the association between one potential environmental stressor—perceived inequality—and AL with a research design aimed at addressing both observed and unobserved sources of confounding; it also employs a more comprehensive AL measure (comprised of 24 biomarkers tapping seven physiological systems) than previous studies.
The biomarker twin sample from the Midlife Development in the United States (MIDUS) study was used to estimate a series of twin comparison models, which include controls for latent sources of influence that cluster within families. The sibling comparison models also included additional controls for lifestyle choices, overall physical health, and demographics which may confound the examined associations.
The results revealed significant associations between greater perceptions of inequality and greater overall levels of AL. The association persisted even after including controls for both observed and unobserved influences that may confound the examined associations but was limited to more recent measures of perceived inequality. Associations involving earlier measures of perceived inequality, along with a lifetime measure, failed to reach conventional levels of significance.
Perceived inequality appears to be a robust predictor of AL and potentially contributes to subsequent physical health problems, particularly for more proximate forms of perceived inequality.
•Social inequality is associated with negative physical health outcomes.•Social stressors can accumulate and increase allostatic load (AL) over time.•AL was positively linked with perceived inequality.•Findings persisted after estimating within-family effects using twin comparison models.
The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic.
...This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th–April 24th 2020) at a large medical center in NYC (n = 657).
Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest.
NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.
Few studies have identified factors that may promote criminal persistence. One such influence may be acquired neuropsychological deficits, or subtle changes to brain structure or functioning stemming ...from detrimental experiences. Head injuries represent one source of acquired neuropsychological deficits that have been linked to increased levels of offending and are differentially concentrated within justice involved populations. Making use of the Pathways to Desistance study (1,336 individuals across 84 months), this study examines the impact of head injuries on criminal persistence. The results of multilevel longitudinal models revealed that within-individual changes in head injury were associated with increases in self-reported offending, and violent offending in particular. A less consistent pattern was observed for arrest and nonviolent offending, indicating that head injury may differentially impact specific forms of criminal persistence. These results provide preliminary evidence suggesting acquired neuropsychological deficits, and head injuries more directly, result in prolonged periods of criminal persistence.
Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the ...magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10
years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.
► The risk of death for unemployed persons was 63% higher than the risk of death for employed persons. ► The relative mortality risk associated with unemployment was 37% higher for men than for women. ► The relative mortality risk associated with unemployment was significantly lower for workers approaching retirement age (50-65 years of age). ► The relative mortality risk associated with unemployment remained elevated among studies with lengthy follow-up periods, suggesting that becoming unemployed induces a long-term change in the underlying mortaity risk.
Physical activity studies often utilize wearable devices to measure participants' habitual activity levels by averaging values across several valid observation days. These studies face competing ...demands-available resources and the burden to study participants must be balanced with the goal to obtain reliable measurements of a person's longer-term average. Information about the number of valid observation days required to reliably measure targeted metrics of habitual activity is required to inform study design.
To date, the number of days required to achieve a desired level of aggregate long-term reliability (typically 0.80) has often been estimated by applying the Spearman-Brown Prophecy formula to short-term test-retest reliability data from studies with single, relatively brief observation windows. Our work, in contrast, utilizes a resampling-based approach to quantify the long-term test-retest reliability of aggregate measures of activity in a cohort of 79 participants who were asked to wear a FitBit Flex every day for approximately one year.
The conventional approach can produce reliability estimates that substantially overestimate the actual test-retest reliability. Six or more valid days of observation for each participant appear necessary to obtain 0.80 reliability for the average amount of time spent in light physical activity; 8 and 10 valid days are needed for sedentary time and moderate/vigorous activity respectively.
Protocols that result in 7-10 valid observation days for each participant may be needed to obtain reliable measurements of key physical activity metrics.
Platelet transfusion refractoriness Hod, Eldad; Schwartz, Joseph
British journal of haematology,
August 2008, Volume:
142, Issue:
3
Journal Article
Peer reviewed
Summary
The platelet, a fascinating anucleate cell, is critically important for haemostasis. Platelet transfusions have greatly reduced the incidence of major haemorrhagic complications associated ...with the management of haematological and oncological disorders. However, some patients fail to receive the full benefit of platelet transfusions because they do not achieve the appropriate platelet count increment following transfusion. This review will discuss the aetiology, diagnosis, and management of refractoriness to platelet transfusion, a complicated problem for both the treating physicians and the transfusion services supporting these patients. Although advances have been made in the diagnosis and treatment of immune‐mediated platelet refractoriness, which is usually caused by anti‐human leucocyte antigen antibodies, non‐immune causes, such as sepsis, remain problematic.
Psychological well-being (WB) includes a person's overall appraisal of his or her life (Global WB) and affective state (Hedonic WB), and it is considered a key aspect of the health of individuals and ...groups. Several cross-sectional studies have documented a relation between Global WB and age. Little is known, however, about the age distribution of Hedonic WB. It may yield a different view of aging because it is less influenced by the cognitive reconstruction inherent in Global WB measures and because it includes both positive and negative components of WB. In this study we report on both Global and Hedonic WB assessed in a 2008 telephone survey of 340,847 people in the United States. Consistent with prior studies, Global WB and positive Hedonic WB generally had U-shaped age profiles showing increased WB after the age of 50 years. However, negative Hedonic WB variables showed distinctly different and stronger patterns: Stress and Anger steeply declined from the early 20s, Worry was elevated through middle age and then declined, and Sadness was essentially flat. Unlike a prior study, men and women had very similar age profiles of WB. Several measures that could plausibly covary with the age-WB association (e.g., having children at home) did not alter the age-WB patterns. Global and Hedonic WB measures appear to index different aspects of WB over the lifespan, and the postmidlife increase in WB, especially in Hedonic WB, deserves continued exploration.
Abstract Objectives Ecological validity refers to the degree to which instruments faithfully capture information in respondents' natural environments. We examined the ecological validity of eight ...instruments from the Patient Reported Outcomes Measurement Information System (PROMIS), most of which use 7-day reporting periods, by comparing PROMIS scores with daily diary data as a standard. Study Design and Setting Five groups of approximately 100 respondents each completed daily diaries and weekly PROMIS instruments for 4 consecutive weeks: community residents; osteoarthritis patients; women experiencing premenstrual syndrome; men undergoing hernia surgery; and breast cancer patients receiving chemotherapy. The last three groups experienced events (menses, surgery, or chemotherapy, respectively) at standardized times in the protocol to examine symptom changes attributable to these events. Results We examined the ability of the PROMIS scales to replicate between-group differences in diaries, to replicate week-to-week changes in diaries, and the correlation between diary and PROMIS scales. As a secondary aim, we examined known-group differences with the PROMIS measures. All three types of ecological validity were strongly confirmed, as was known-group validity for the PROMIS recall scales. Conclusion This study adds to the growing literature supporting the reliability and validity of the family of PROMIS instruments.
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