Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led ...to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.
Loneliness Predicts Increased Blood Pressure Hawkley, Louise C; Thisted, Ronald A; Masi, Christopher M ...
Psychology and aging,
03/2010, Letnik:
25, Številka:
1
Journal Article
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Loneliness is a prevalent social problem with serious physiological and health implications. However, much of the research to date is based on cross-sectional data, including our own earlier finding ...that loneliness was associated with elevated blood pressure (
Hawkley, Masi, Berry & Cacioppo, 2006
). In this study, we tested the hypothesis that the effect of loneliness accumulates to produce greater increases in systolic blood pressure (SBP) over a 4-year period than are observed in less lonely individuals. A population-based sample of 229 50- to 68-year-old White, Black, and Hispanic men and women in the Chicago Health, Aging, and Social Relations Study was tested annually for each of 5 consecutive years. Cross-lagged panel analyses revealed that loneliness at study onset predicted increases in SBP 2, 3, and 4 years later (
B
= 0.152,
SE
= 0.091,
p
< .05, one-tailed). These increases were cumulative such that higher initial levels of loneliness were associated with greater increases in SBP over a 4-year period. The effect of loneliness on SBP was independent of age, gender, race or ethnicity, cardiovascular risk factors, medications, health conditions, and the effects of depressive symptoms, social support, perceived stress, and hostility.
Objectives. The objective of this study was to test a conceptual model of loneliness in which social structural factors are posited to operate through proximal factors to influence perceptions of ...relationship quality and loneliness. Methods. We used a population-based sample of 225 White, Black, and Hispanic men and women aged 50 through 68 from the Chicago Health, Aging, and Social Relations Study to examine the extent to which associations between sociodemographic factors and loneliness were explained by socioeconomic status, physical health, social roles, stress exposure, and, ultimately, by network size and subjective relationship quality. Results. Education and income were negatively associated with loneliness and explained racial/ethnic differences in loneliness. Being married largely explained the association between income and loneliness, with positive marital relationships offering the greatest degree of protection against loneliness. Independent risk factors for loneliness included male gender, physical health symptoms, chronic work and/or social stress, small social network, lack of a spousal confidant, and poor-quality social relationships. Discussion. Longitudinal research is needed to evaluate the causal role of social structural and proximal factors in explaining changes in loneliness.
A population-based sample of Caucasians, African Americans, and Latino Americans, 50- 68 years of age (
M
= 57.5), from Cook County, Illinois (
N
= 229), was tested to examine how loneliness and ...co-occurring psychosocial factors (depressive symptoms, perceived stress, social support, and hostility) were related to indices of cardiovascular and endocrine functioning. Extending prior research, the authors found that loneliness was associated with elevated systolic blood pressure (SBP) and age-related increases in SBP, net of demographic variables, health behavior variables, and the remaining psychosocial factors. Loneliness was not associated with differences in autonomic or endocrine functioning. Although the results are limited by the cross-sectional methods used, they are consistent with the hypothesis that cardiovascular disease contributes to increased morbidity and mortality among lonely individuals.
Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, ...but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health system-level factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities.
We report the discovery of a massive planet (image ; total mass = image), large planet in a transiting, eccentric orbit around a 10th magnitude F5 V star in the constellation Camelopardalis. We ...designate the planet XO-3b and the star XO-3, also known as GSC 03727-01064. The orbital period of XO-3b is image days. XO-3 lacks a trigonometric parallax; we estimate its distance to be image pc. The radius of XO-3 is image, its mass is image, its image km s super(-1), and its metallicity is image. This system is unusual for a number of reasons. XO-3b is one of the most massive planets discovered around any star for which the orbital period is less than 10 days. The mass is near the deuterium-burning limit of 13 image, which is a proposed boundary between planets and brown dwarfs. Although Burrows et al. propose that formation in a disk or formation in the interstellar medium in a manner similar to stars is a more logical way to differentiate planets and brown dwarfs, our current observations are not adequate to address this distinction. XO-3b is also unusual in that its eccentricity is large given its relatively short orbital period. Both the planetary radius and the inclination are functions of the spectroscopically determined stellar radius. Analysis of the transit light curve of XO-3b suggests that the spectroscopically derived parameters may be overestimated. Though relatively noisy, the light curves favor a smaller radius in order to better match the steepness of the ingress and egress. The light curve fits imply a planetary radius of image, which would correspond to a mass of image. A precise trigonometric parallax measurement or a very accurate light curve is needed to resolve the uncertainty in the planetary mass and radius.
Prior research has established associations between pregnancy outcomes and specific neighborhood characteristics, including economic disadvantage, violent crime, and racial/ethnic segregation. ...Recently, associations have also been found between various health outcomes and group density, the degree to which an individual is a racial or ethnic majority in his or her local community. The objective of this study was to determine the extent to which census tract economic disadvantage, violent crime rate, and group density are associated with pregnancy outcomes among White, Black, and Hispanic infants in a large metropolitan setting. This cross-sectional study utilized 1990 census data, 1991 crime data, and 1991 birth certificate information for singleton live births in Chicago, Illinois. Results show substantial racial segregation in Chicago, with 35% of census tracts having more than 90% Black residents and 45% of census tracts having fewer than 10% Black residents. After stratifying by maternal race/ethnicity, we used multilevel analyses to model pregnancy outcomes as a function of individual and census tract characteristics. Among all racial/ethnic groups, violent crime rate accounted for most of the negative association between tract economic disadvantage and birth weight. Group density was also associated with birth weight but this association was stronger among Whites and Hispanics than among Blacks. Further analysis revealed that group density was more strongly associated with preterm birth while violent crime rate was more strongly associated with small for gestational age. These results suggest that group density and violent crime may impact birth weight via different mechanisms.
The Emory Diabetes Management Program is a chronic care management model aimed to reduce the proportion (%) of adult patients with HbA1c >9% within the Emory Healthcare System. We report the ...proportion of patients with poor glycemic control (HbA1c >9% or missing values for 6 months) before and during the Covid-pandemic, from 02/01/18 to 10/30/2021.Among 27,061 patients with diabetes before COVID-pandemic, the % of patients with poor glycemic control decreased from 19.5% to 14.35% in 12/2019. During the COVID-pandemic, the % of patients with poor control rapidly increase to 21.70% (Fig 1A) by 2/1/21, primarily due to a 275% increased of patients with missing HbA1c testing and a minor increase in % of patients with HbA1c >9% (Fig 1B) . Expansion of telemedicine programs, access to care and resource implementation to identify and facilitate HbA1c testing reduced the % of patients with poor control to pre-pandemic levels. Conclusion: At a population-health level, COVID-pandemic had a significant negative impact in % of patients with poor control primarily due to HbA1c testing (3-fold increase) rather than worsening A1c values. Innovative solutions to increase access to A1C testing in future pandemics may help to maintain undisrupted glucose monitoring and control in individuals with diabetes in large academic health systems.
Disclosure
G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. A.Adiga: None. B.Wylde: None. M.Gurtu: None. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. T.Thompson: None. C.M.Masi: None. P.A.Castellano: None. F.E.Turton: None.
Abstract Purpose The goal of this study was to develop a technology-based strategy to identify patients with undiagnosed hypertension in 23 primary care practices and integrate this innovation into a ...continuous quality improvement initiative in a large, integrated health system. Methods In phase 1, we reviewed electronic health records (EHRs) using algorithms designed to identify patients at risk for undiagnosed hypertension. We then invited each at-risk patient to complete an automated office blood pressure (AOBP) protocol. In phase 2, we instituted a quality improvement process that included regular physician feedback and office-based computer alerts to evaluate at-risk patients not screened in phase 1. Study patients were observed for 24 additional months to determine rates of diagnostic resolution. Results Of the 1,432 patients targeted for inclusion in the study, 475 completed the AOBP protocol during the 6 months of phase 1. Of the 1,033 at-risk patients who remained active during phase 2, 740 (72%) were classified by the end of the follow-up period: 361 had hypertension diagnosed, 290 had either white-coat hypertension, prehypertension, or elevated blood pressure diagnosed, and 89 had normal blood pressure. By the end of the follow-up period, 293 patients (28%) had not been classified and remained at risk for undiagnosed hypertension. Conclusions Our technology-based innovation identified a large number of patients at risk for undiagnosed hypertension and successfully classified the majority, including many with hypertension. This innovation has been implemented as an ongoing quality improvement initiative in our medical group and continues to improve the accuracy of diagnosis of hypertension among primary care patients.
Abstract
We compared rates of emergency department visits or hospitalizations among ambulatory coronavirus disease 2019 (COVID-19) patients treated with monoclonal antibody (mAb) therapy (n = 305) vs ...untreated patients (n = 6354). Treatment was associated with decreased encounters within 30 days (adjusted odds ratio, 0.23 95% confidence interval, .15–.36). Our findings support treatment of acute COVID-19 with mAbs.
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