Late life disability and experienced wellbeing: Are economic resources a buffer?

BackgroundDisablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.ObjectiveDrawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.MethodsWe use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.ResultsWe find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.ConclusionsFuture research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.     

Evaluation of Abortion Stigma in the Workforce: Development of the Revised Abortion Providers Stigma Scale

Objectives

We report on the development of a scale measuring abortion providers’ experiences of stigma.

Urinary metals and metal mixtures in midlife women: The Study of Women's Health Across the Nation (SWAN)

BackgroundLittle is known about the extent of exposure to metals and metal mixtures among midlife women.ObjectivesWe assessed exposure to multiple metals in the Study of Women's Health Across the Nation (SWAN), a multi-site, multi-racial/ethnic cohort of women at midlife.MethodsWe measured urinary concentrations of 21 metals (arsenic, barium, beryllium, cadmium, cobalt, chromium, cesium, copper, mercury, manganese, molybdenum, nickel, lead, platinum, antimony, tin, thallium, uranium, vanadium, tungsten and zinc) using high-resolution inductively coupled plasma-mass spectrometry among 1335 white, black, Chinese and Japanese women aged 45–56 years at the third SWAN annual visit (1999–2000). Least squared geometric mean concentrations were compared across race/ethnicity, education, financial hardship, smoking, secondhand smoking, seafood intake and rice intake groups. Overall exposure patterns of multiple metals were derived using k-means clustering method.ResultsThe percentage of women with detectable concentrations of metals ranged from 100% for arsenic, cesium, molybdenum and zinc, to less than 5% for platinum; 15 metals had detection rates of 70% or more. Asian women, both Chinese and Japanese, had higher urinary concentrations of arsenic, cadmium, copper, mercury, molybdenum, lead and thallium, compared with other race/ethnic groups, independent of sociodemographic, lifestyle, dietary, and geographic characteristics. Seafood and rice intake were important determinants of urinary arsenic, cesium, mercury, molybdenum and lead levels. Two distinct overall exposure patterns- “high” vs. “low” -- were identified. Women in the “high” overall exposure pattern were more likely to be Asians, current smokers, and to report high consumption of seafood and rice. Black women were less likely to have the high exposure pattern.ConclusionsMetal exposure of midlife women differs by racial/ethnic, sociodemographic, lifestyle, dietary, and geographic characteristics. Asian women may be experiencing the highest exposures to multiple metals compared with other racial/ethnic groups in the United States.     

Medical students'' evaluations of different levels of medical ethics teaching: implications for curricula

Although medical ethics has become a part of the curriculum of almost every medical school, medical students' perceptions of the value of medical ethics have not been documented. This paper reports the evaluations given by 137 preclinical and 216 clinical medical students to different levels of medical ethics teaching at the College of Human Medicine and the College of Osteopathic Medicine of Michigan State University. The results indicate (1) that students' satisfaction with medical ethics teaching is directly linked to how much they receive, (2) that students overwhelmingly prefer the input of both ethicists and doctors to teaching by either alone, and (3) that a preclinical medical ethics course followed by explicit medical ethics teaching in clinical training is a promising model for achieving an adequate level of medical ethics teaching within medical education.     

The reliability of a hypothesis generation and testing task

The purpose of this paper is to present results of initial experience with a clinical reasoning task which assesses two clearly defined aspects of clinical problem solving. Fourteen senior and 40 junior medical students at the University of Michigan Medical School participated in this study. They were given three clinical reasoning problems--the hypothesis generation and testing tasks (HG & T). As suggested by the name, two specifically defined components of clinical problem-solving, developing the initial hypotheses or differential and then testing hypotheses, were evaluated by these tasks. The findings of this study indicate that hypothesis generation and testing can be reliably evaluated with between seven and ten tasks. The results of this study suggest that reliable assessments of specific components of clinical problem-solving can be developed.     

Deconstructing the Family Meal: Are Characteristics of the Mealtime Environment Associated with the Healthfulness of Meals Served?

BackgroundMultiple studies and guidelines emphasize the benefits associated with family meals. However, family meals are not well defined and little research has been conducted to determine whether mealtime characteristics are associated with the healthfulness of foods served.ObjectiveThe objective of this study was to define and measure specific mealtime characteristics and examine whether these characteristics are associated with the healthfulness of meals served to young children from low-income families, as measured by the Healthy Meal Index (HMI).Participants/settingStudy participants included 272 young children from low-income families residing in southeast Michigan during 2011 to 2013.DesignFor this cross-sectional study, parents videorecorded 757 mealtimes that were coded for four mealtime variables and meal healthfulness using the HMI. Mealtime characteristics included Eating at a Table (vs not), Served Family-Style (vs not), TV Off (vs not), and Parent Partakes (sits and eats or drinks with child) (vs not). A Family Meal was defined as a meal that had all four measured mealtime characteristics.Main outcome measuresAll meals were scored using the HMI, which has two components: the HMI Adequacy score (based on the presence of foods that are recommended for a healthy diet) and the HMI Moderation score (based on the absence of foods recommended to be consumed in moderation). The scores are summed to obtain the HMI Total score.Statistical analyses performedGeneralized estimating equations tested the associations of mealtime characteristics with HMI scores, controlling for child sex and age, and parent education and race/ethnicity.ResultsIn adjusted models, Family Meals were positively associated with HMI Adequacy (P=0.02) and Total (P=0.05) scores. Eating at a Table was positively associated with HMI Moderation (P=0.01) and HMI Total (P=0.01) scores. Served Family-Style was positively associated with HMI Adequacy scores (P=0.04). TV Off was associated with higher HMI Total scores (P=0.05). Parent Partakes was not associated with HMI scores.ConclusionsFamily Meals were associated with greater healthfulness of the foods served. Characteristics of mealtime that are commonly utilized to define Family Meal were differentially associated with meal healthfulness.     

Associations between Sleep and Dietary Patterns among Low-Income Children Attending Preschool

BackgroundSleep disturbances and low-quality diets are prevalent among children in low-income settings, yet the nature of their relationship remains unclear. In particular, whether aspects other than sleep duration, including timing and quality, are associated with dietary patterns has rarely been examined, especially among preschool-aged children.ObjectiveTo evaluate whether nightly and total sleep duration, sleep timing, differences in timing and duration from weekdays to weekends, and sleep quality were related to dietary patterns.DesignA cross-sectional analysis of children attending preschool. Parents completed questionnaires about children’s sleep habits as well as a semiquantitative food frequency questionnaire.Participants/settingThree hundred fifty-four English-speaking children (49.9% boys) with no serious medical conditions aged 3 to 5 years who were enrolled in Head Start in Michigan (2009-2011) with complete information on sleep and diet.Main outcome measuresDietary pattern scores derived from food frequency questionnaire.Statistical analyses performedPrincipal component analysis was used to identify dietary patterns. Separate linear regression models with dietary pattern scores as the dependent variable and continuous sleep measures as independent variables were used to evaluate associations between sleep and diet, adjusting for sex, age, parent education level, and sleep hygiene.ResultsThree dietary patterns were identified: Vegetables, Healthy Proteins, and Sides; Breads and Spreads; and Processed and Fried. Longer average weekend sleep duration and a greater difference in weekend-to-weekday sleep duration was related to lower Vegetables, Healthy Proteins, and Sides pattern scores. Later sleep midpoint during weekdays was related to lower Vegetables, Healthy Proteins, and Sides pattern scores, whereas later sleep midpoint on the weekend was associated with higher Processed and Fried pattern scores. Similarly, a larger weekend–weekday midpoint difference was associated with higher Processed and Fried pattern scores.ConclusionsLater sleep timing and differences in sleep duration and timing from weekends to weekdays were related to less-optimal dietary pattern scores in young children.     

Use of intramuscular prostaglandin for failure of mid-trimester abortion by another method

Eight investigators, using a common protocol, studied the use of intramuscular (15S)-15-methyl prostaglandin F2 to abort midtrimester pregnancies which had failed treatment by other methods in 398 cases. Results of treatment of 3 subgroups, defined by reason for primary treatment failure, are presented.

The combined efficacy rate was 96.2% with 79.6% of the abortions being complete. The mean time from starting intramuscular therapy to successful abortion was 7.35 hours.

The incidence of gastrointestinal side-effects was lower than that previously reported for systemically administered prostaglandins. Serious complications were not appreciably different from those reported for commonly used methods of second trimester abortion except for a slightly higher incidence of excessive bleeding requiring blood replacement.

Advantages of this method over currently used methods of treating failures of primary attempts to induce midtrimester abortion by pharmacologie means are discussed.     

A study of the distribution pattern of lead in the leaves of banyan trees (Ficus benghalensis) from different traffic density regions of Calcutta

The accumulation of lead from motor vehicle exhaust on leaves of banyan trees (Ficus benghalensis) growing on roadsides from different traffic density regions of Calcutta has been investigated and the values have been compared with a few samples from remote areas. The analysis has been performed during the summer (April-July) and winter (November-January) months to study the effect of seasonal variations, if any. The results indicate that in high and medium traffic regions, lead content of banyan leaves is high and is more prominent in winter months than in summer months. Such changes due to seasonal variations are not marked in low and zero traffic density regions. This preliminary investigation demonstrates a general indication of the distribution pattern of lead in plants exposed to motor vehicle exhaust along a relatively busy thoroughfare of the city of Calcutta.     

Methylmercury and elemental mercury differentially associate with blood pressure among dental professionals

Methylmercury-associated effects on the cardiovascular system have been documented though discrepancies exist, and most studied populations experience elevated methylmercury exposures. No paper has investigated the impact of low-level elemental (inorganic) mercury exposure on cardiovascular risk in humans. The purpose of this study was to increase understanding of the association between mercury exposure (methylmercury and elemental mercury) and blood pressure measures in a cohort of dental professionals that experience background exposures to both mercury forms. Dental professionals were recruited during the 2010 Michigan Dental Association Annual Convention. Mercury levels in hair and urine samples were analyzed as biomarkers of methylmercury and elemental mercury exposure, respectively. Blood pressure (systolic, diastolic) was measured using an automated device. Distribution of mercury in hair (mean, range: 0.45, 0.02–5.18 μg/g) and urine (0.94, 0.03–5.54 μg/L) correspond well with the US National Health and Nutrition Examination Survey. Linear regression models revealed significant associations between diastolic blood pressure (adjusted for blood pressure medication use) and hair mercury (n = 262, p = 0.02). Urine mercury results opposed hair mercury in many ways. Notably, elemental mercury exposure was associated with a significant systolic blood pressure decrease (n = 262, p = 0.04) that was driven by the male population. Associations between blood pressure and two forms of mercury were found at exposure levels relevant to the general population, and associations varied according to type of mercury exposure and gender.     

A partially self-instructional system that any teacher can develop and implement

Some authors have suggested that the teacher has two basic choices of style which can be used to influence learning: he/she can manage learning resources or he/she can function as such a resource. Part of the appeal for the authors of the course format described here is the blurring of that distinction. Functioning both as a manager and a resource appears to us a near optimal role for the teacher.     

“It’s a Feeling That One Is Not Worth Food”: A Qualitative Study Exploring the Psychosocial Experience and Academic Consequences of Food Insecurity Among College Students

BackgroundThe issue of food insecurity is one of growing concern among institutions of higher learning in the United States. In addition to studies on the prevalence and risk factors, research is needed to better understand the mechanisms by which food insecurity affects students' health and well-being.ObjectiveTo critically explore the experience of food insecurity among college students and its impact on psychosocial health and academic performance.DesignIn-depth qualitative interviews were conducted with college students to gain a better understanding of the mechanisms by which food insecurity affects their psychosocial health and academic performance.Participants/settingTwenty-five undergraduate students from a large public university in California who were recruited from a campus food pantry.ResultsStudents discussed several themes related to the psychosocial effects of food insecurity: the stress of food insecurity interfering with daily life, a fear of disappointing family, resentment of students in more stable food and financial situations, an inability to develop meaningful social relationships, sadness from reflecting on food insecurity, feeling hopeless or undeserving of help, and frustration directed at the academic institution for not providing enough support. Students also discussed how food insecurity affected their academic performance through physical manifestations of hunger and the mental trade-off between focusing on food and focusing on academics.ConclusionThese findings contribute to the understanding of what it means to experience food insecurity in higher education and can inform how universities support students’ basic needs.     

Multicenter clinical trial of implanted norethindrone pellets for long-acting contraception in women

Long-acting, biodegradable, subcutaneous implants of fused pellets composed of norethindrone (NET) and pure cholestrol were evaluated in 50 healthy, normally menstruating volunteers from five clinics. Evaluation of serum NET levels indicated a steady release rate over the 6-cycle follow-up period. There were no serious local reactions to the pellets. Menstrual cycle length remained unchanged, but the incidence of intermenstrual bleeding and/or spotting was higher during the initial 2–3 months of pellet use. Following pellet removal menstrual cycle parameters returned to their pre-pellet implantation values. Serum gonadotropin assays indicated the incidence of ovulatory cycles increased over the follow-up period. No significant changes in serum lipoproteins, SMAC-12 or enzyme profiles were observed. Although women were advised to use additional methods of contraception, three became pregnant while using the implants. Fibrous tissue was noted to form around the pellets, thus limiting the release of NET. Additional trials of higher NET doses are being evaluated.     

The Association between Food Insecurity and Diet Quality Varies by Race/Ethnicity: An Analysis of National Health and Nutrition Examination Survey 2011-2014 Results

BackgroundFood insecurity is believed to influence the quality and quantity of foods consumed; however, studies examining food insecurity and diet quality have been inconclusive and few studies have explored variability in these associations by sex and race/ethnicity.ObjectiveThis study examined associations between food insecurity and diet quality, and variations by sex and race/ethnicity.DesignCross-sectional analysis of data from the 2011-2014 National Health and Nutrition Examination Surveys.ParticipantsThe study population was composed of 4,393 adults (aged 20 to 65 years) with family incomes ≤300% of the federal poverty level with complete data on household food security and dietary intake via two 24-hour dietary recalls.Main outcome measuresDiet quality was assessed using the Healthy Eating Index-2015.Statistical analyses performedAssociations between food insecurity and Healthy Eating Index-2015 total and component scores were examined using linear regression models and generalized linear models. Models adjusted for sociodemographic and health covariates.ResultsCompared with food-secure adults, food-insecure adults reported a 2.22-unit lower Healthy Eating Index-2015 score (95% CI –3.35 to –1.08). This association was most pronounced among non-Hispanic whites and adults of Asian or other races/ethnicities. There were no associations among non-Hispanic black or Hispanic adults, and no differences by sex. Among non-Hispanic whites, food insecurity was associated with lower scores for total protein foods, seafood and plant proteins, and added sugar. Among Asians, food insecurity was associated with lower scores for whole fruit.ConclusionsFood insecurity was associated with lower diet quality primarily among non-Hispanic whites; Asians; and other adults, a group composed of American Indian or Alaska Natives, Native Hawaiian or Other Pacific Islanders, and multiracial adults. Further research is needed to better understand the nature of this association among understudied racial/ethnic groups.     

Examining Household Changes in Produce Purchases Among New Parents

ObjectiveTo measure whether parenthood is associated with changes in produce purchasing behavior, overall and stratified by income.DesignRetrospective examination of retail grocery purchases in the Nielsen Consumer Panel, a nationally representative sample of US households, 2007–2015.Participants and SettingA total of 21,939 households in the US, aged 25–49 years, observed ≤ 8 years; 508 households initiated parenthood during the study period.Main Outcome MeasurePercentage of household grocery budget spent on produce each year.AnalysisDifference-in-differences design was used to measure change in the percentage of the grocery budget spent on produce after becoming a parent, relative to households that did not become parents, overall and stratified by income level. Ordinary least-squares regressions was used to adjust for confounders.ResultsPercentage of the grocery budget spent on produce increased by 1.7 percentage points (15.7%) after initiating parenthood. Among higher-income households, produce purchases increased by 1.9 percentage points; no detectable change was found among low-income households.Conclusions and ImplicationsInitiation of parenthood increased grocery expenditures on produce. Because new parenthood is a critical time in a person's life, this behavior change could create the opportunity for interventions with long-term effects. However, heterogeneous impacts by income indicated that lower-income households need more support and reveal 1 mechanism for income-related disparities in childhood nutrition.     

A pilot study to examine the effects of a nutrition intervention on nutrition knowledge, behaviors, and efficacy expectations in middle school children

BACKGROUND: This was a pilot study to determine the impact of the Michigan Model (MM) Nutrition Curriculum on nutrition knowledge, efficacy expectations, and eating behaviors in middle school students. METHODS: The study was conducted in a large metropolitan setting and approved by the Institutional Review Board. The participants for this study were divided into an intervention group (n = 407) and a control group (n = 169). An MM instructor trained health teachers in the use of the curriculum, and the teacher subsequently taught the curriculum to students in the intervention group. A valid and reliable questionnaire was used to determine pre-post differences. It consisted of 3 subscales assessing eating habits, nutrition knowledge, and efficacy expectations toward healthy eating. Subscale scores were analyzed using a 2 groups (intervention vs control) x 2 times (pre vs post) analysis of variance. RESULTS: The intervention group increased their nutrition knowledge at post. There was also a significant main effect for groups in the subscales "Eating Behaviors" and "Efficacy Expectations Regarding Healthy Eating." Subsequent post hoc analysis revealed that the intervention group was significantly more likely to eat fruits and vegetables and less likely to eat junk food than the control group. Students in the intervention group also felt more confident that they could eat healthy. CONCLUSIONS: The results of this pilot study suggest that the MM Nutrition Curriculum delivered by trained professionals resulted in significant positive changes in both nutrition knowledge and behaviors in middle school children. Further research needs to be conducted to determine the long-term impact.     

Risk of spontaneous abortion among women exposed to polybrominated biphenyls

Accidental contamination of livestock in Michigan in 1973 with polybrominated biphenyls (PBBs) led to the establishment of a registry of exposed individuals in 1976. At the time of enrollment, serum was collected and analyzed for PBBs and polychlorinated biphenyls (PCBs). In 1997, women aged 18 years or older and active in the registry were invited to participate in a telephone interview about their health. Using generalized estimating equations to account for correlated outcomes within the same woman, we assessed the risk of spontaneous abortion among 529 women with 1344 potentially exposed pregnancies. PBB and PCB exposure were not associated with risk of spontaneous abortion after adjusting for maternal age at conception, age at menarche, and prior infertility. Compared to pregnancies with PBB exposure below the limit of detection, those with levels above 2.9 ppb had a non-significant reduced odds of spontaneous abortion (adjusted OR=0.73; 95% CI=0.47-1.13). Compared to pregnancies with PCB exposure below the limit of detection, those with levels above 6.5 ppb had little difference in risk (adjusted OR=0.91; 95% CI=0.59-1.41). Maternal age at conception above 34 years was significantly associated with elevated risk of spontaneous abortion (OR=2.46; 95% CI=1.10-5.49). The effect of prior infertility was of borderline significance (OR=1.52; 95% CI=0.98-2.38). Older age at menarche was associated with decreased risk of spontaneous abortion (adjusted OR=0.58; 95% CI: 0.38-0.89, comparing menarche at 12-13 with menarche <12). Our results do not support an association between exposure to PBBs or PCBs and risk of spontaneous abortion.