The mental health and mortality impact of death of a partner with dementia

Objective Caring for a partner with dementia and partner bereavement are independently associated with poor health. An understanding of the health effects of living with a partner dying with dementia can help optimise support. We describe health in the year before and after loss of a partner with dementia compared with other bereavements. Methods In a UK primary care database, 2624 older individuals whose partner died with dementia during 2005–2012 were matched with 7512 individuals experiencing bereavement where the deceased partner had no dementia recorded. Results Prior to bereavement, partners of the deceased with dementia were more likely to be diagnosed with depression (OR 2.31, 1.69–3.14) and receive psychotropic medication (OR 1.34, 1.21–1.49) than partners from bereavements without dementia. In contrast, psychotropic medication initiation two months after dementia bereavement was lower (HR 0.69, 0.56–0.85). Compared with other bereaved individuals, mortality after bereavement was lower in men experiencing a dementia bereavement (HR 0.68, 0.49–0.94) but similar in women (HR 1.02, 0.75–1.38). Prior to bereavement, those who died with dementia were less likely to receive palliative care (OR 0.47, 0.41–0.54). Conclusion In the year before bereavement, partners of individuals dying with dementia experience poorer mental health than those facing bereavement from other causes, and their partner is less likely to receive palliative care. In the year after, individuals whose partner died with dementia experience some attenuation of the adverse health effects of bereavement. Services need to address the needs of carers for individuals dying with dementia and improve access to palliative care. Copyright © 2016 John Wiley & Sons, Ltd

Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses

Background Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this ‘widowhood effect’ persists over time. Methods Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married. Results Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95% CI: 1.27, 2.75; OR for women = 1.47, 95% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95% CI: 0.90, 1.28), though the gender difference was non-significant. Conclusion The ‘widowhood effect’ was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex

First-generation college graduates have similar depressive symptoms in midlife as multi-generational college graduates

PurposeHigher education may protect an individual against depressive symptoms, yet, disadvantaged socioeconomic status (SES) during childhood, often measured by lower parental education, may put them at higher risk for depressive symptoms later in life. This study evaluates if midlife depression is similar for first-generation and multi-generation college graduates.MethodsFor US Health and Retirement Study (HRS) participants ages 55-63 (N = 16,752), we defined a 4-category exposure from parents' (highest of mother or father's) and participant's own years of education, with 16 years indicating college completion: multi-gen (both ≥ 16 years: reference); first-gen (parents <16; own ≥ 16); only parent(s) (parents ≥ 16; own <16); and neither (both <16) college graduates across three birth cohorts. We used linear regressions to evaluate relationships between college completion and depressive symptoms measured by an 8-item Center for Epidemiologic Studies - Depression (CES-D) scale. Models pooled over time evaluated differences by sex, race/ethnicity, and birthplace.ResultsFirst-gen and multi-gen college graduates averaged similar depressive symptoms in midlife (β: 0.01; 95% CI: 0.15, 0.13). Results were similar by sex and race/ethnicity.ConclusionConsistent with resource substitution theory, college completion may offset the deleterious effects of lower parental education on midlife depressive symptoms for first-generation graduates

Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study

Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992–2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes.Version of Recor

Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans

Background: The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated. Methods: Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent’s educational attainment in a subset of analyses. Results: Husband’s Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28). Conclusions: We found no evidence of a relationship between husband’s Korean War GI Bill eligibility and wives’ mental health in these data, however there may be a true effect that our analysis was underpowered to detect

Undergoing Transformation to the Patient Centered Medical Home in Safety Net Health Centers: Perspectives from the Front Lines

Objectives—Safety Net Health Centers (SNHCs), which include Federally Qualified Health Centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the Patient Centered Medical Home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. Design—This qualitative study characterizes early PCMH adoption experiences at SNHCs. Setting and Participants—We interviewed 98 staff,(administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative. Main Measures—We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH. Results—Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback. Conclusions—SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved healthcare delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation

Stress analysis of bonded joints by boundary element method

Boundary element method (BEM) has proven to have very good resolution of large stress gradients such as in front of cracks and in regions of stress concentration, yet its application in analysis of bonded joints is practically non-existent even though large stress gradients exist in the bonded region and bonded joints are one of the critical technology in modern design. This is because application of BEM to bonded joints is not simple or straight forward. This chapter describes the commonality and differences between BEM and other approximate methods, advantages of BEM application to bonded joints, the research challenges, BEM formulation, the discretization process and the sources of errors, the mesh refinement techniques, and some numerical results

Boundary element analysis of symmetrically laminated plates

Symmetrically laminated plates are analysed by the boundary element method. A common numerical scheme is devised for the linear, uncoupled plane stress and plate flexure problems. A generic formulation is based on adopting the stress function and the deflection as field variables in the respective problems. Their mathematical similarity allows the use of essentially the same fundamental solution and almost identical solution algorithms. The application of plane stress and flexure analyses to several benchmark problems illustrates the versatility of the formulations and the degree of accuracy achieved. In the case of flexure in particular, comparisons are made with results from earlier boundary element analyses