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Wang E, Wroblewski KE, McClintock MK, Witt LJ, Pinto JM. Examining the Longitudinal Relationship Between Olfactory Dysfunction and Frailty in Community-Dwelling, older US Adults. Otolaryngol Head Neck Surg 2024. [PMID: 38660882 DOI: 10.1002/ohn.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Olfactory dysfunction is a "canary in the coalmine" for aging conditions. We evaluated olfactory dysfunction as a biomarker of early frailty in older adults living in the United States. STUDY DESIGN Prospective, longitudinal, nationally representative study. SETTING National Social Life, Health and Aging Project (NSHAP). METHODS We examined data from 1061 community-dwelling older US adults. Odor identification (5-item Sniffin' Stick) and frailty scores were measured at baseline and 5-year follow-up. Multivariate logistic regressions evaluated the association between olfactory dysfunction and frailty at baseline in cross-section and over time in the transition from robust to prefrail to frail, adjusting for confounding factors measured at baseline. RESULTS Older US adults who were anosmic at baseline were more likely to be frail 5 years later compared to normosmic peers (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 1.10-13.31, P = .035). Examining changes in frailty stage over time, we found that anosmics were more likely to transition from prefrail to frail over 5 years (OR: 3.25, 95% CI: 1.31-8.08, P = .011). Interestingly, hyposmics did not show a similar trajectory toward frailty (P > .05). In contrast, olfactory dysfunction was not associated with frailty in cross-section (OR: 0.90, 95% CI: 0.43-1.89, P = .787, hyposmia; OR: 0.72, 95% CI: 0.15-3.35, P = .673, anosmia). CONCLUSION Older US adults with anosmia face higher odds of becoming frail over 5 years, especially those in the prefrail stage. Olfactory dysfunction may serve as a surrogate marker for early-stage neurodegenerative diseases, which are strong contributors to frailty.
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Affiliation(s)
- Esther Wang
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Martha K McClintock
- Department of Psychology, The Institute for Mind and Biology, The University of Chicago, Chicago, Illinois, USA
| | - Leah J Witt
- Divisions of Geriatrics and Pulmonary, Critical Care, Allergy and Sleep Medicine, The University of California, San Francisco, San Francisco, California, USA
| | - Jayant M Pinto
- Department of Surgery, Section of Otolaryngology, The University of Chicago Medicine, Chicago, Illinois, USA
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Wang E, Wroblewski KE, McClintock MK, Pinto JM, Witt LJ. Olfactory decline develops in parallel with frailty in older US adults with obstructive lung diseases. Int Forum Allergy Rhinol 2024; 14:819-827. [PMID: 37747949 PMCID: PMC10961252 DOI: 10.1002/alr.23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Frailty is prevalent among older adults with asthma or chronic obstructive pulmonary disease (obstructive lung diseases [OLDs]). Frailty and OLD's co-occurrence is associated with increased hospitalization/mortality. Chemosensory dysfunction is closely connected to both OLD and frailty. We evaluated the utility of olfactory decline as a biomarker of frailty in the setting of OLD. METHODS We performed a prospective, longitudinal, nationally representative study of community-dwelling older US adults in the National Social Life, Health and Aging Project, an omnibus in-home survey. Respondents reported a physician's diagnosis of OLD. Decline in odor identification and sensitivity over 5 years and frailty (adapted fried frailty phenotype criteria) were measured using standard tools. Multivariate logistic regressions evaluated the association between OLD status, olfactory decline, and frailty. RESULTS We compared individuals with OLD (n = 98; mean age 71.2 years, 59.2% women) and those without OLD (n = 1036; mean age 69.5 years, 58.9% women). Olfactory identification decline was associated with developing frailty over the 5-year follow-up period in individuals with OLD (odds ratio [OR] = 9.1, 95% confidence interval [CI] = 2.1-38.6, p = 0.003). Olfactory decline predicted incidence of frailty in individuals with OLD (identification: OR = 4.8, 95% CI = 1.3-17.5, P = 0.018; sensitivity: OR = 6.1, 95%CI = 1.2-31.0, p = 0.030) but not in those without OLD adjusting for demographics, heavy alcohol use, current smoking, and comorbidity. Results were robust to different thresholds for olfactory decline and frailty development. CONCLUSIONS Older adults with OLD who experience olfactory decline face higher odds of developing frailty. Use of olfactory decline as a biomarker to identify frailty could allow earlier intervention and decrease adverse outcomes for high-risk older adults with OLD.
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Affiliation(s)
- Esther Wang
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Martha K McClintock
- Department of Psychology and The Institute for Mind and Biology, The University of Chicago, Chicago, Illinois, USA
| | - Jayant M Pinto
- Department of Surgery, Section of Otolaryngology, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Leah J Witt
- Divisions of Geriatrics and Pulmonary, Critical Care, Allergy and Sleep Medicine, The University of California, San Francisco, San Francisco, California, USA
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Ochoa Scussiatto H, Wroblewski KE, Pagel KL, Schumm LP, McClintock MK, Ramanathan M, Suh HH, Pinto JM. Reply to: "Air pollution exposure is associated with rhinitis in older US adults via specific immune mechanisms". Int Forum Allergy Rhinol 2024; 14:745-746. [PMID: 38018794 DOI: 10.1002/alr.23289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Affiliation(s)
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Kristina L Pagel
- Department of Social and Behavioral Sciences, Colorado Mesa University, Grand Junction, Colorado, USA
| | - L Philip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Martha K McClintock
- Department of Comparative Human Development, The University of Chicago, Chicago, Illinois, USA
| | - Murray Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Helen H Suh
- Department of Civil and Environmental Engineering, Tufts University, Boston, Massachusetts, USA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
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Scussiatto HO, Wroblewski KE, Pagel KL, Schumm LP, McClintock MK, Ramanathan M, Suh HH, Pinto JM. Air pollution exposure is associated with rhinitis in older US adults via specific immune mechanisms. Int Forum Allergy Rhinol 2024; 14:68-77. [PMID: 37357822 DOI: 10.1002/alr.23225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Pathophysiology of rhinitis in older adults is largely unknown. We tested whether air pollution is associated with this condition and how immune mechanisms may play a role in this relationship. METHODS We analyzed cross-sectional data from the National Social Life, Health, and Aging Project, a nationally representative study of older adults born between 1920 and 1947. Particulate matter ≤2.5 μm (PM2.5 ) air pollution exposure estimates were generated using validated spatiotemporal models. Presence of rhinitis was defined based on medication use (≥1: intranasal medications: steroids, antihistamines, lubricants, and/or decongestants, and/or oral medications: antihistamines and/or decongestants). K-means cluster analysis (Jaccard method) was used to group 13 peripheral blood cytokines into 3 clusters to facilitate functional determination. We fitted multivariate logistic regressions to correlate PM2.5 exposure with presence of rhinitis, controlling for confounders, and then determined the role of cytokines in this relationship. RESULTS Long- (but not short-) term exposure to PM2.5 was associated with presence of rhinitis: 3-year exposure window, odds ratio (OR) = 1.32, 95% confidence interval (CI): 0.98, 1.80, per 1 standard deviation (SD) PM2.5 increase. Inclusion of cytokine cluster in the model led to a modestly stronger effect of PM2.5 exposure on rhinitis (OR = 1.37; 95% CI: 1.00, 1.87; 3-year exposure window). The particular immune profile responsible for this result was composed of elevated IL-3, IL-12, and IFN-γ (OR = 4.86, 95% CI: 1.10, 21.58, immune profile-PM2.5 exposure interaction term). CONCLUSION We show for the first time that IL-3, IL-12, and IFN-γ explain in part the relationship between PM2.5 exposure and rhinitis in older US adults. If confirmed, these immune pathways may be used as therapeutic targets.
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Affiliation(s)
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Kristina L Pagel
- Department of Social and Behavioral Sciences, Colorado Mesa University, Grand Junction, Colorado, USA
| | - L Phillip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Martha K McClintock
- Department of Comparative Human Development, The University of Chicago, Chicago, Illinois, USA
| | - Murray Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Helen H Suh
- Department of Civil and Environmental Engineering, Tufts University, Boston, Massachusetts, USA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
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Tung EL, Wroblewski KE, Makelarski JA, Glasser NJ, Lindau ST. Childhood Parental Incarceration and Adult-Onset Hypertension and Cardiovascular Risk. JAMA Cardiol 2023; 8:927-935. [PMID: 37647038 PMCID: PMC10469273 DOI: 10.1001/jamacardio.2023.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/30/2023] [Indexed: 09/01/2023]
Abstract
Importance Parental incarceration is an adverse childhood experience that disproportionately affects racially minoritized individuals and has been associated with long-term health risks. Although cardiovascular disease remains the primary cause of mortality differences between Black and White individuals in the US, the association between parental incarceration and cardiovascular risk remains poorly understood. Objective To examine the association between parental incarceration during childhood and incident cardiovascular risk in adulthood. Design, Setting, and Participants This population-based cohort study included data from waves IV (2008-2009) and V (2016-2018) of the US National Longitudinal Study of Adolescent to Adult Health. Participants represented US adults transitioning from young adulthood to adulthood. Data were analyzed from October 28, 2021, to May 1, 2023. Main Outcomes and Measures Parental incarceration was defined as a parent or parent-like figure going to jail or prison when participants were aged younger than 18 years. Outcome measures included self-reported diagnoses of obesity, hyperlipidemia, hypertension, diabetes, or heart disease as well as serum elevations in non-high-density lipoprotein cholesterol (≥160 mg/dL) and high-sensitivity C-reactive protein (hsCRP >3 mg/L), a marker of inflammation used to estimate risk of future coronary events. Using sampling weights, incident development of each outcome was modeled as a function of parental incarceration, adjusting for participant- and neighborhood-level characteristics. Results This study included 9629 participants representing 16 077 108 US adults. Approximately half of participants were women (5498 [weighted 50.3%]) and the majority (5895 [weighted 71.4%]) were White. The mean participant age was 37.8 years (95% CI, 37.5 to 38.0 years) in wave V compared with 28.9 years (95% CI, 28.6 to 29.1 years) in wave IV. In wave V, those with childhood exposure to parental incarceration had lower educational attainment (91 [weighted 8.2%] vs 245 [weighted 4.2%] completing less than high school), had higher rates of public insurance (257 [weighted 20.6%] vs 806 [weighted 11.0%]), and were disproportionately Black (374 [weighted 22.5%] vs 1488 [weighted 13.6%]). Parental incarceration was associated with 33% higher adjusted odds (95% CI, 1.05 to 1.68) of developing hypertension and 60% higher adjusted odds (95% CI, 1.03 to 2.48) of developing elevated hsCRP. Associations between childhood parental incarceration and other diagnoses (ie, obesity, hyperlipidemia, diabetes, or heart disease) and serum lipid levels were not observed. Conclusions and Relevance In this cohort study of US adults transitioning from young adulthood to adulthood, an increased incidence of hypertension and high-risk hsCRP, but not other cardiovascular risk factors, was observed among those exposed to parental incarceration during childhood. These findings suggest possible transgenerational health consequences of mass incarceration.
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Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | | | | | | | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
- Department of Medicine-Geriatrics, MacLean Center on Clinical Medical Ethics and Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
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GoodSmith MS, Wroblewski KE, Schumm LP, McClintock MK, Pinto JM. Association of APOE ε4 Status With Long-term Declines in Odor Sensitivity, Odor Identification, and Cognition in Older US Adults. Neurology 2023; 101:e1341-e1350. [PMID: 37495381 PMCID: PMC10558172 DOI: 10.1212/wnl.0000000000207659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/02/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The APOE ε4 allele confers susceptibility to faster decline in odor identification and subsequently to Alzheimer disease (AD). Odor identification requires recognizing and naming odors and detecting them (odor sensitivity). Whether APOE ε4 is associated with decline of odor sensitivity and whether such decline serves as a harbinger of cognitive decline and AD remains unclear. We determined whether and when APOE ε4 affects decline in odor sensitivity, odor identification, and cognition in the National Social Life Health and Aging Project (NSHAP). METHODS We used data from NSHAP, a nationally representative survey study of home-dwelling US older adults. Olfaction was measured over time (odor identification in 2005, 2010, and 2015; odor sensitivity in 2010 and 2015; both using validated tests). Cognition was measured with a modified version of the Montreal Cognitive Assessment in 2010 and 2015. Genotyping was performed using DNA samples collected in 2010. Odor sensitivity and identification were compared among APOE ε4 carriers and noncarriers stratified by age. Relationships between APOE ε4, odor sensitivity, odor identification, and cognition were analyzed in cross-section using ordinal logistic regression and longitudinally using mixed-effects models adjusted for confounders. RESULTS Odor sensitivity was measured in 865 respondents, odor identification in 1,156 respondents, and cognition in 864 respondents; all these respondents had genetic data available. Odor sensitivity deficits in APOE ε4 carriers were apparent at ages 65-69 years, whereas odor identification deficits did not appear until ages 75-79 years. Subsequently, odor sensitivity did not decline more rapidly with aging in APOE ε4 carriers compared with that in noncarriers (carrier status and aging interaction: odds ratio [OR] 1.44, 95% CI 0.94-2.19, p = 0.092), whereas odor identification declined more rapidly in carriers (aging 10 years interaction: OR 0.26, 95% CI 0.13-0.52, p < 0.001). As expected, and in parallel to odor identification, cognition declined more rapidly in APOE ε4 carriers (interaction: OR 0.55, 95% CI 0.34-0.89, p = 0.015). DISCUSSION APOE ε4 affects decline of odor sensitivity earlier than odor identification or cognition. Thus, testing odor sensitivity may be useful to predict future impaired cognitive function. Identifying the mechanism underlying these relationships will elucidate the key role of olfaction in neurodegeneration during aging.
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Affiliation(s)
- Matthew S GoodSmith
- From the Internal Medicine-Pediatrics Residency Program (M.S.G.), Departments of Medicine and Pediatrics, Department of Public Health Sciences (K.E.W., L.P.S.), Department of Psychology and Institute for Mind and Biology (M.K.M.), and Section of Otolaryngology-Head and Neck Surgery (J.M.P.), Department of Surgery, The University of Chicago, IL.
| | - Kristen E Wroblewski
- From the Internal Medicine-Pediatrics Residency Program (M.S.G.), Departments of Medicine and Pediatrics, Department of Public Health Sciences (K.E.W., L.P.S.), Department of Psychology and Institute for Mind and Biology (M.K.M.), and Section of Otolaryngology-Head and Neck Surgery (J.M.P.), Department of Surgery, The University of Chicago, IL
| | - L Philip Schumm
- From the Internal Medicine-Pediatrics Residency Program (M.S.G.), Departments of Medicine and Pediatrics, Department of Public Health Sciences (K.E.W., L.P.S.), Department of Psychology and Institute for Mind and Biology (M.K.M.), and Section of Otolaryngology-Head and Neck Surgery (J.M.P.), Department of Surgery, The University of Chicago, IL
| | - Martha K McClintock
- From the Internal Medicine-Pediatrics Residency Program (M.S.G.), Departments of Medicine and Pediatrics, Department of Public Health Sciences (K.E.W., L.P.S.), Department of Psychology and Institute for Mind and Biology (M.K.M.), and Section of Otolaryngology-Head and Neck Surgery (J.M.P.), Department of Surgery, The University of Chicago, IL
| | - Jayant M Pinto
- From the Internal Medicine-Pediatrics Residency Program (M.S.G.), Departments of Medicine and Pediatrics, Department of Public Health Sciences (K.E.W., L.P.S.), Department of Psychology and Institute for Mind and Biology (M.K.M.), and Section of Otolaryngology-Head and Neck Surgery (J.M.P.), Department of Surgery, The University of Chicago, IL
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Winslow VA, Jagai JS, Makelarski JA, Wroblewski KE, Lindau ST, Vu M. Social Risk and Smoking Among Women Smokers Early in the COVID-19 Pandemic: The Role of Mental Health. J Womens Health (Larchmt) 2023; 32:960-969. [PMID: 37379463 PMCID: PMC10510694 DOI: 10.1089/jwh.2023.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Background: We examined patterns of smoking in relation to health-related socioeconomic vulnerability (HRSV) among U.S. women early in the pandemic and whether mental health symptoms mediated these relationships. Materials and Methods: Data were obtained from the April 2020 National U.S. Women's Health COVID-19 Study (N = 3200). Among current smokers, adjusted odds of increased smoking since the start of the pandemic (vs. same or less) by incident and worsening HRSVs were modeled. Structural equation modeling was used to assess anxiety, depression, and traumatic stress symptoms as mediators of the relationship between six HRSVs (food insecurity; housing, utilities, and transportation difficulties; interpersonal violence; financial strain) and increased smoking early in the pandemic. Results: Nearly half (48%) of current smokers reported increased smoking since the pandemic started. Odds of increased smoking were higher among women with incident financial strain (aOR = 2.0, 95% CI 1.2-3.3), incident food insecurity (aOR = 2.9, 95% CI 1.7-5.1), any worsening HRSV (aOR = 2.2, 95% CI 1.5-3.0), and worsening food insecurity (aOR = 1.9, 95% CI 1.3-3.0). Anxiety symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (proportion mediated = 0.17, p = 0.001) and worsening food insecurity (0.19, p = 0.023), specifically. Depression symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (0.15, p = 0.004) and incident financial strain (0.19, p = 0.034). Traumatic stress was not a significant mediator of any tested relationship. Conclusions: Anxiety and depression symptoms partially explain the relationship between rising socioeconomic vulnerability and increased smoking among women early in the pandemic. Addressing HRSVs and mental health may help reduce increased smoking during a public health crisis.
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Affiliation(s)
- Victoria A. Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Jyotsna S. Jagai
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago and The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Milkie Vu
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
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Zhong S, Wroblewski KE, Laumann EO, McClintock MK, Pinto JM. Assessing how Age, Sex, Race, and Education Affect the Relationships Between Cognitive Domains and Odor Identification. Alzheimer Dis Assoc Disord 2023; 37:128-133. [PMID: 36989106 PMCID: PMC10238630 DOI: 10.1097/wad.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The associations between cognitive domains and odor identification are well established, but how sociodemographic variables affect these relationships is less clear. PURPOSE Using the survey-adapted Montreal Cognitive Assessment instrument (MoCA-SA), we assess how age, sex, race, and education shape these relationships. METHODS We first used cluster analysis and multidimensional scaling to empirically derive distinct cognitive domains from the MoCA-SA as it is unclear whether the MoCA-SA can be disaggregated into cognitive domains. We then used ordinal logistic regression to test whether these empirically derived cognitive domains were associated with odor identification and how sociodemographic variables modified these relationships. STUDY POPULATION Nationally representative sample of community-dwelling US older adults. RESULTS We identified 5 out of the 6 theoretical cognitive domains, with the language domain unable to be identified. Odor identification was associated with episodic memory, visuospatial ability, and executive function. Stratified analyses by sociodemographic variables reveal that the associations between some of the cognitive domains and odor identification varied by age, sex, or race, but not by education. CONCLUSIONS These results suggest that (1) the MoCA-SA can be used to identify cognitive domains in survey research and (2) the performance of smell tests as a screener for cognitive decline may potentially be weaker in certain subpopulations.
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Affiliation(s)
| | | | | | - Martha K. McClintock
- Department of Psychology and Institute for Mind and Biology, University of Chicago
| | - Jayant M. Pinto
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago
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Lindau ST, Jagai JS, Abramsohn EM, Fuller CM, Wroblewski KE, Pinkerton EA, Makelarski JA. Unwanted sexual activity among United States women early in the COVID-19 pandemic. Am J Obstet Gynecol 2023; 228:209.e1-209.e16. [PMID: 36241078 PMCID: PMC9553968 DOI: 10.1016/j.ajog.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female sexual activity and, accordingly, birth rates tend to decline in times of stress, such as a pandemic. In addition, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security. OBJECTIVE This study aimed to describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among US women early in the COVID-19 pandemic. STUDY DESIGN The National US Women's Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3200 English-speaking women (88% cooperation rate) aged 18 to 90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely, racial and ethnic subgroups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying "how the coronavirus pandemic is affecting your sex life" were assessed using conventional content analysis. Logistic regression analyses-adjusting for sociodemographic characteristics, self-reported health, and prepandemic health-related socioeconomic risk factors, including food insecurity, housing instability, utilities and transportation difficulties, and interpersonal violence-were used to model the odds of unwanted sex by a pandemic-related change in health-related socioeconomic risk factors. RESULTS The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months before the pandemic (52%), although 7% of women became active, and 7% of women became inactive. Overall, 11% of sexually active women were having unwanted sex in the early pandemic. The rates of anxiety, depression, traumatic stress symptoms, and each of the 5 health-related socioeconomic risk factors assessed were about 2 times higher among women having unwanted sex than other women (P<.001). Women having unwanted sex were also 5 times more likely than other women to report an increased frequency of sex since the pandemic (65% vs 13%; P<.001) and 6 times more likely to be using emergency contraception (18% vs 3%; P<.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about the transmission of the virus because of sex, and having sex to meet the partner's needs. Among sexually active women, the odds of unwanted sex (adjusting for demographic, reproductive, and health factors) were higher among women with 1 prepandemic health-related socioeconomic risk factor (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.8) and 2 or more prepandemic health-related socioeconomic risk factors (adjusted odds ratio, 6.0; 95% confidence interval, 3.4-10.6). Among sexually active women with any prepandemic health-related socioeconomic risk factor, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (adjusted odds ratio, 2.7; 95% confidence interval, 1.7-4.3). CONCLUSION More than 1 in 10 sexually active US women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems because of the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.
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Affiliation(s)
- Stacy T Lindau
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL; Medicine Geriatrics, The University of Chicago, Chicago, IL.
| | - Jyotsna S Jagai
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Emily M Abramsohn
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Charles M Fuller
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | | | - El A Pinkerton
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Jennifer A Makelarski
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL; College of Science and Health, Benedictine University, Lisle, IL
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Kern DW, Kaufmann GT, Hummer TA, Schumm LP, Wroblewski KE, Pinto JM, McClintock MK. Androstadienone sensitivity is associated with attention to emotions, social interactions, and sexual behavior in older U.S. adults. PLoS One 2023; 18:e0280082. [PMID: 36638090 PMCID: PMC9838868 DOI: 10.1371/journal.pone.0280082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
Δ 4,16-androstadien-3-one (androstadienone) is a putative human pheromone often linked to sexual attraction in young adults, although specific associations with sexual behavior are not yet established. Androstadienone also serves a broader social-emotional function beyond the sexual domain, specifically tuning the brain to efficiently process emotional information. Whether these effects persist throughout the lifespan into post-reproductive life is unknown. In a laboratory study of older adults, those with greater androstadienone odor sensitivity paid greater attention to subliminal emotional information, specifically, angry faces (p = 0.05), with a similar relationship to happy faces. In contrast, the physical odor n-butanol (a control) did not affect emotional attention (p = 0.49). We then extended this laboratory research and determined whether sensitivity to androstadienone affects the everyday lives of older adults by measuring their social and sexual behavior. In this second study, we surveyed in a nationally representative sample of US older adults living in their homes (National Social Life and Aging Project, 62-90 years; n = 2,086), along with their sensitivity to androstadienone, general olfactory function, health and demographics. Greater sensitivity to androstadienone was associated with richer social lives: having more friends, increased communication with close friends and family, and more participation in organized social events and volunteer activities (all p's ≤ 0.05, generalized linear models, adjusted for age and gender). It was also associated with more recent sexual activity, more frequent sexual thoughts, and viewing sex as an important part of life (all p's ≤ 0.05). General olfactory function did not explain these associations, supporting a specialized function for this pheromone during everyday life, and expanding its role to social life as well as sexual behavior, likely mediated by enhanced attention to emotional information.
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Affiliation(s)
- David W. Kern
- Isidore Newman School, New Orleans, Louisiana, United States of America
| | - Gabriel T. Kaufmann
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Tom A. Hummer
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - L. Philip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, United States of America
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, United States of America
| | - Jayant M. Pinto
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, United States of America
| | - Martha K. McClintock
- Department of Psychology, The Institute for Mind and Biology, The University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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11
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Zhang A, Wroblewski KE, Imbery TE, McClintock MK, Hawkley LC, Pinto JM. Can digital communication protect against depression for older adults with hearing and vision impairment during COVID-19? J Gerontol B Psychol Sci Soc Sci 2022; 78:629-638. [PMID: 36512652 PMCID: PMC10066739 DOI: 10.1093/geronb/gbac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES During social isolation imposed by the COVID-19 pandemic, older adults with impaired hearing and vision potentially experienced more communication challenges, increasing their risk for poor mental health. Digital communication (e.g. video calls, email/text/social media) may alleviate in-person isolation and protect against depression. We addressed this question using data from the National Social Life, Health, and Aging Project, a nationally representative panel study of community-dwelling older adults. METHOD 2558 adults aged 55+ comprised the analytic sample. Interviewer rating at baseline (2015-16) classified those with vision impairment (VI) or hearing impairment (HI). Olfactory impairment (OI) was measured by objective testing. During COVID-19 (2020-21), respondents reported how often they contacted non-household family or friends and whether this was by phone, email/text/social media, video, or in-person. They also quantified frequency of depressive feelings. RESULTS Older adults with VI or HI but not OI at baseline were significantly less likely to report regular use of video calling and email/text/social media during the pandemic compared to those without impairment. Sensory impairments did not affect frequency of phone or in-person communication. Adults with VI or HI were more likely to experience frequent depressive feelings during COVID. Video calls mitigated this negative effect of VI- and HI-associated depressive feelings in a dose-dependent manner. DISCUSSION Among communication modalities, video calling had a protective effect against depressive feelings for people with sensory impairment during social isolation. Improving access to and usability of video communication for older adults with sensory impairment could be a strategy to improve their mental health.
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Affiliation(s)
- Amanda Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Terence E Imbery
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, IL, USA
| | - Martha K McClintock
- Department of Comparative Human Development, The Institute for Mind and Biology, University of Chicago, Chicago, IL, USA
| | | | - Jayant M Pinto
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, IL, USA
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12
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Hlubocky FJ, Daugherty CK, Peppercorn J, Young K, Wroblewski KE, Yamada SD, Lee NK. Utilization of an Electronic Patient-Reported Outcome Platform to Evaluate the Psychosocial and Quality-of-Life Experience Among a Community Sample of Ovarian Cancer Survivors. JCO Clin Cancer Inform 2022; 6:e2200035. [PMID: 35985004 PMCID: PMC9470143 DOI: 10.1200/cci.22.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/20/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Novel distress screening approaches using electronic patient-reported outcome (ePRO) measurements are critical for the provision of comprehensive quality community cancer care. Using an ePRO platform, the prevalence of psychosocial factors (distress, post-traumatic growth, resilience, and financial stress) affecting quality of life in ovarian cancer survivors (OCSs) was examined. METHODS A cross-sectional OCS sample from the National Ovarian Cancer Coalition-Illinois Chapter completed web-based clinical, sociodemographic, and psychosocial assessment using well-validated measures: Hospital Anxiety/Depression Scale-anxiety/depression, Post-traumatic Growth Inventory, Brief Resilience Scale, comprehensive score for financial toxicity, and Functional Assessment of Cancer Therapy-Ovarian (FACT-O/health-related quality of life [HRQOL]). Correlational analyses between variables were conducted. RESULTS Fifty-eight percent (174 of 300) of OCS completed virtual assessment: median age 59 (range 32-83) years, 94.2% White, 60.3% married/in domestic partnership, 59.6% stage III-IV, 48.8% employed full-time/part-time, 55.2% had college/postgraduate education, 71.9% completed primary treatment, and median disease duration 6 (range < 1-34) years. On average, OCS endorsed normal levels of anxiety (mean ± standard deviation = 6.9 ± 3.8), depression (4.1 ± 3.6), mild total distress (10.9 ± 8.9), high post-traumatic growth (72.6 ± 21.5), normal resilience (3.7 ± 0.72), good FACT-O-HRQOL (112.6 ± 22.8), and mild financial stress (26 ± 10). Poor FACT-O emotional well-being was associated with greater participant distress (P < .001). Partial correlational analyses revealed negative correlations between FACT-O-HRQOL and anxiety (r = -0.65, P < .001), depression (r = -0.76, P < .001), and total distress (r = -0.92, P < .001). Yet, high FACT-O-HRQOL was positively correlated with post-traumatic coping (r = 0.27; P = .006) and resilience (r = 0.63; P < .001). CONCLUSION ePRO assessment is feasible for identification of unique psychosocial factors, for example, financial toxicity and resilience, affecting HRQOL for OCS. Future investigation should explore large-scale, longitudinal ePRO assessment of the OCS psychosocial experience using innovative measures and community-based advocacy populations.
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Affiliation(s)
- Fay J. Hlubocky
- Department of Medicine, Section of Hematology/Oncology, MacLean Center for Clinical Medical Ethics, Cancer Research Center, Supportive Oncology Program, The University of Chicago Medicine, Chicago, IL
- Department of Gynecology/Obstetrics, Section of Gynecologic Oncology, The University of Chicago Medicine, Chicago, IL
| | - Christopher K. Daugherty
- Department of Medicine, Section of Hematology/Oncology, MacLean Center for Clinical Medical Ethics, Cancer Research Center, Supportive Oncology Program, The University of Chicago Medicine, Chicago, IL
| | - Jeffery Peppercorn
- Division of Medicine, Hematology and Oncology, Dana Farber Partners, Massachusetts General Hospital, Boston, MA
| | - Karen Young
- Illinois Chapter of the National Ovarian Cancer Coalition (NOCC), Chicago, IL
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago Medicine, Chicago, IL
| | - Seiko Diane Yamada
- Department of Gynecology/Obstetrics, Section of Gynecologic Oncology, The University of Chicago Medicine, Chicago, IL
| | - Nita K. Lee
- Department of Gynecology/Obstetrics, Section of Gynecologic Oncology, The University of Chicago Medicine, Chicago, IL
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13
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Yan K, Lin J, Albaugh S, Yang M, Wang E, Cyberski T, Abasiyanik MF, Wroblewski KE, O'Connor M, Klock A, Tung A, Shahul S, Kurian D, Tay S, Pinto JM. Measuring SARS-CoV-2 aerosolization in rooms of hospitalized patients. Laryngoscope Investig Otolaryngol 2022; 7:1033-1041. [PMID: 35942422 PMCID: PMC9350181 DOI: 10.1002/lio2.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Airborne spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a significant risk for healthcare workers. Understanding transmission of SARS-CoV-2 in the hospital could help minimize nosocomial infection. The objective of this pilot study was to measure aerosolization of SARS-CoV-2 in the hospital rooms of COVID-19 patients. Methods Two air samplers (Inspirotec) were placed 1 and 4 m away from adults with SARS-CoV-2 infection hospitalized at an urban, academic tertiary care center from June to October 2020. Airborne SARS-CoV-2 concentration was measured by quantitative reverse transcription polymerase chain reaction and analyzed by clinical parameters and patient demographics. Results Thirteen patients with COVID-19 (eight females [61.5%], median age: 57 years old, range 25-82) presented with shortness of breath (100%), cough (38.5%) and fever (15.4%). Respiratory therapy during air sampling varied: mechanical ventilation via endotracheal tube (n = 3), high flow nasal cannula (n = 4), nasal cannula (n = 4), respiratory helmet (n = 1), and room air (n = 1). SARS-CoV-2 RNA was identified in rooms of three out of three intubated patients compared with one out of 10 of the non-intubated patients (p = .014). Airborne SARS-CoV-2 tended to decrease with distance (1 vs. 4 m) in rooms of intubated patients. Conclusions Hospital rooms of intubated patients had higher levels of aerosolized SARS-CoV-2, consistent with increased aerosolization of virus in patients with severe disease or treatment with positive pressure ventilation through an endotracheal tube. While preliminary, these data have safety implications for health care workers and design of protective measures in the hospital. Level of Evidence 2.
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Affiliation(s)
- Kenneth Yan
- Department of Head and Neck SurgeryUniversity of California Los AngelesCaliforniaLos AngelesUSA
| | - Jing Lin
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Shaley Albaugh
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Meredith Yang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Esther Wang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Thomas Cyberski
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Mustafa Fatih Abasiyanik
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | | | - Michael O'Connor
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Allan Klock
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Avery Tung
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Sajid Shahul
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Dinesh Kurian
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Savaş Tay
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Jayant M. Pinto
- Section of Otolaryngology‐Head and Neck Surgery, Department of SurgeryThe University of ChicagoChicagoIllinoisUSA
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14
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Pacyna RR, Han SD, Wroblewski KE, McClintock MK, Pinto JM. Rapid olfactory decline during aging predicts dementia and GMV loss in AD brain regions. Alzheimers Dement 2022; 19:1479-1490. [PMID: 35899859 DOI: 10.1002/alz.12717] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/23/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Longitudinal multivariable analyses are needed to determine if the rate of olfactory decline during normal cognition predicts subsequent Alzheimer's disease (AD) diagnoses and brain dysmorphology. METHODS Older adults (n = 515) were assessed annually for odor identification, cognitive function and dementia clinical diagnosis (max follow-up 18 years). Regional gray matter volumes (GMV) were quantified (3T MRI) in a cross-sectional subsample (n = 121). Regression models were adjusted for APOE-ε4 genotype, dementia risk factors and demographics. RESULTS Faster olfactory decline during periods of normal cognition predicted higher incidence of subsequent MCI or dementia (OR 1.89, 95% CI: 1.26, 2.90, p < 0.01; comparable to carrying an APOE-ε4 allele) and smaller GMV in AD and olfactory regions (β = -0.11, 95% CI -0.21, -0.00). DISCUSSION Rapid olfactory decline during normal cognition, using repeated olfactory measurement, predicted subsequent cognitive impairment, dementia, and smaller GMVs, highlighting its potential as a simple biomarker for early AD detection. HIGHLIGHTS Rate of olfactory decline was calculated from olfactory testing over ≥3 time points. Rapid olfactory decline predicted impaired cognition and higher risk of dementia. Neurodegeneration on 3T magnetic resonance imaging was identical in those with olfactory decline and Alzheimer's disease.
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Affiliation(s)
- Rachel R Pacyna
- Pritzker, School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - S Duke Han
- Departments of Family Medicine, Neurology, Psychology, and Gerontology, University of Southern California, Alhambra, California, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | | | - Jayant M Pinto
- Department of Surgery, and Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
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15
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Witt LJ, Wroblewski KE, Pinto JM, Wang E, McClintock MK, Dale W, White SR, Press VG, Huisingh-Scheetz M. Beyond the Lung: Geriatric Conditions Afflict Community-Dwelling Older Adults With Self-Reported Chronic Obstructive Pulmonary Disease. Front Med (Lausanne) 2022; 9:814606. [PMID: 35237627 PMCID: PMC8884078 DOI: 10.3389/fmed.2022.814606] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/14/2022] [Indexed: 12/27/2022] Open
Abstract
Rationale Chronic obstructive pulmonary disease (COPD) predominantly affects older adults. However, the co-morbid occurrence of geriatric conditions has been understudied. Objective Characterize the prevalence of geriatric conditions among community-dwelling U.S. older adults with self-reported COPD. Methods We conducted a nationally representative, cross-sectional study of 3,005 U.S. community-dwelling older adults (ages 57–85 years) from the National Social Life, Health, and Aging Project (NSHAP). We evaluated the prevalence of select geriatric conditions (multimorbidity, functional disability, impaired physical function, low physical activity, modified frailty assessment, falls, polypharmacy, and urinary incontinence) and psychosocial measures (frequency of socializing, sexual activity in the last year, loneliness, cognitive impairment, and depressive symptoms) among individuals with self-reported COPD as compared to those without. Using multivariate logistic and linear regressions, we investigated the relationships between COPD and these geriatric physical and psychosocial conditions. Main Results Self-reported COPD prevalence was 10.7%, similar to previous epidemiological studies. Individuals with COPD had more multimorbidity [modified Charlson score 2.6 (SD 1.9) vs. 1.6 (SD 1.6)], more functional disability (58.1 vs. 29.6%; adjusted OR 3.1, 95% CI 2.3, 4.3), falls in the last year (28.4 vs. 20.8%; adjusted OR 1.4, 95% CI 1.01, 2.0), impaired physical function (75.8 vs. 56.6%; adjusted OR 2.1, 95% CI 1.1, 3.7), more frequently reported extreme low physical activity (18.7 vs. 8.1%; adjusted OR 2.3, 95% CI 1.5, 3.5) and higher frailty prevalence (16.0 vs. 2.7%; adjusted OR 6.3, 95% CI 3.0,13.0) than those without COPD. They experienced more severe polypharmacy (≥10 medications, 37.5 vs. 16.1%; adjusted OR 2.9, 95% CI 2.0, 4.2). They more frequently reported extreme social disengagement and were lonelier, but the association with social measures was eliminated when relationship status was accounted for, as those with COPD were less frequently partnered. They more frequently endorsed depressive symptoms (32.0 vs. 18.9%, adjusted OR 1.9, 95% CI 1.4, 2.7). There was no noted difference in cognitive impairment between the two populations. Conclusions Geriatric conditions are common among community-dwelling older adults with self-reported COPD. A “beyond the lung” approach to COPD care should center on active management of geriatric conditions, potentially leading to improved COPD management, and quality of life.
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Affiliation(s)
- Leah J Witt
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Jayant M Pinto
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, United States
| | - Esther Wang
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| | - Martha K McClintock
- Department of Comparative Human Development, The Institute for Mind and Biology, University of Chicago, Chicago, IL, United States
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Steven R White
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Valerie G Press
- Department of Medicine, The University of Chicago, Chicago, IL, United States
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16
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Kumar S, Lee NK, Pinkerton E, Wroblewski KE, Lengyel E, Tobin M. Resilience: a mediator of the negative effects of pandemic-related stress on women's mental health in the USA. Arch Womens Ment Health 2022; 25:137-146. [PMID: 34651237 PMCID: PMC8516405 DOI: 10.1007/s00737-021-01184-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/23/2021] [Indexed: 12/23/2022]
Abstract
The role of resilience in mediating the negative effects of the COVID-19 pandemic on the mental health of US women is poorly understood. We examined socioeconomic factors associated with low resilience in women, the relationship of low resilience with psychiatric morbidity, and the mediating role of resilience in the relationship between pandemic-related stress and other coincident psychiatric morbidities. Using a quota-based sample from a national panel, we conducted a web-based survey of 3200 US women in April 2020. Weighted, multivariate logistic regression was used to model the odds of pandemic-related stress, and coincident depression and anxiety symptoms among those with and without low resilience. Structural equation modeling was used to evaluate resilience as a mediator of the relationship between pandemic-related stress and other coincident psychiatric morbidities. Risk factors for low resilience included younger age, lower household income, lower education, unemployment, East/Southeast Asian race, unmarried/unpartnered status, and higher number of medical comorbidities. Low resilience was significantly associated with greater odds of depression symptoms (OR = 3.78, 95% CI [3.10-4.60]), anxiety symptoms (OR = 4.17, 95% CI [3.40-5.11]), and pandemic-related stress (OR = 2.86, 95% CI [2.26-3.26]). Resilience acted as a partial mediator in the association between pandemic-related stress and anxiety symptoms (proportion mediated = 0.23) and depression symptoms (proportion mediated = 0.28). In the early days of the COVID-19 pandemic, low resilience mediated the association between pandemic-related stress and psychiatric morbidity. Strategies proven to enhance resilience, such as cognitive behavioral therapy, mindfulness-based stress reduction, and addressing socioeconomic factors, may help mitigate mental health outcomes.
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Affiliation(s)
- Shivani Kumar
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL, MC307760637, USA
| | - Nita Karnik Lee
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, IL, USA
| | - Elizabeth Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, IL, USA
| | - Marie Tobin
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL, MC307760637, USA.
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17
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Wong JS, Howe MJK, Breslau H, Wroblewski KE, McSorley VE, Waite LJ. Elder Mistreatment Methods and Measures in Round 3 of the National Social Life, Health, and Aging Project. J Gerontol B Psychol Sci Soc Sci 2021; 76:S287-S298. [PMID: 34918146 PMCID: PMC8678432 DOI: 10.1093/geronb/gbab106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elder mistreatment has negative consequences for older adults' health and well-being. As such, scholars aim to understand its causes, the contexts in which it occurs, how to prevent victimization, and how to design interventions for mistreated older adults. This paper provides a detailed overview of the 2015-2016 National Social Life, Health, and Aging Project (NSHAP) Round 3 Elder Mistreatment Module (EMM) to encourage further research on the topic. METHOD This paper reviews previous elder mistreatment scholarship, describes the EMM, provides descriptive analyses of elder mistreatment among community-dwelling older adults, and discusses promising approaches and limitations to future research with these data. RESULTS The EMM includes 10 stem questions to measure elder mistreatment behaviors experienced since age 60 and 2 follow-up questions about perceived severity and the identity of the perpetrator. The stem questions can be analyzed individually or combined into a scale, and researchers can account for severity as a robustness check. Analysts can also group the measures into specific types of elder mistreatment. A major strength of the EMM is its ability to identify perpetrators in victims' core social networks. DISCUSSION The NSHAP Round 3 EMM provides scholars an opportunity to study older Americans' mistreatment experiences, particularly as they relate to their physical and mental health, their social networks and personal relationships, and their broader social contexts.
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Affiliation(s)
- Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia, USA
| | - Melissa J K Howe
- Academic Research Centers, NORC at the University of Chicago, Illinois, USA
| | - Hannah Breslau
- Academic Research Centers, NORC at the University of Chicago, Illinois, USA
| | | | - V Eloesa McSorley
- Rush University Medical Center, Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - Linda J Waite
- Academic Research Centers, NORC at the University of Chicago, Illinois, USA
- Department of Sociology, University of Chicago, Illinois, USA
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18
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Vu M, Makelarski JA, Winslow VA, Christmas MM, Haider S, Lee NK, Pinkerton EA, Wroblewski KE, Lindau ST. Racial and Ethnic Disparities in Health-Related Socioeconomic Risks During the Early COVID-19 Pandemic: A National Survey of U.S. Women. J Womens Health (Larchmt) 2021; 30:1375-1385. [PMID: 34529520 DOI: 10.1089/jwh.2021.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Nearly half of U.S. women experienced new or worsening health-related socioeconomic risks (HRSRs) (food, housing, utilities and transportation difficulties, and interpersonal violence) early in the COVID-19 pandemic. We sought to examine racial/ethnic disparities in pandemic-related changes in HRSRs among women. Materials and Methods: We conducted a cross-sectional survey (04/2020) of 3200 women. Pre- and early pandemic HRSRs were described by race/ethnicity. Weighted, multivariable logistic regression models generated odds of incident and worsening HRSRs by race/ethnicity. Results: The majority of Black, East or Southeast (E/SE) Asian, and Hispanic women reported ≥1 prepandemic HRSR (51%-56% vs. 38% of White women, p < 0.001). By April 2020, 68% of Black, E/SE Asian, and Hispanic women and 55% of White women had ≥1 HRSR (p < 0.001). For most HRSRs, the odds of an incident or worsening condition were similar across racial/ethnic groups, except Black, E/SE Asian and Hispanic women had 2-3.6 times the odds of incident transportation difficulties compared with White women. E/SE Asian women also had higher odds of worsening transportation difficulties compared with White women (adjusted odds ratios = 2.5, 95% confidence interval 1.1-5.6). In the early pandemic, 1/19 Hispanic, 1/28 E/SE Asian, 1/36 Black and 1/100 White women had all 5 HRSRs (extreme health-related socioeconomic vulnerability). Conclusions: Prepandemic racial/ethnic disparities in HRSRs persisted and prevalence rates increased for all groups early in the pandemic. Disparities in transportation difficulties widened. White women were much less likely than others to experience extreme health-related socioeconomic vulnerability. An equitable COVID-19 response requires attention to persistent and widening racial/ethnic disparities in HRSRs among women.
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Affiliation(s)
- Milkie Vu
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA.,Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Victoria A Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Monica M Christmas
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - El A Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences and The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
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Siegel JK, Yuan X, Wroblewski KE, McClintock MK, Pinto JM. Sleep-Disordered Breathing Is Associated With Impaired Odor Identification in Older U.S. Adults. J Gerontol A Biol Sci Med Sci 2021; 76:528-533. [PMID: 33313784 DOI: 10.1093/gerona/glaa276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a common, underdiagnosed condition in older adults with major health consequences, including disrupted central nervous system functioning. Whether SDB may affect sensory function is unclear. We sought to address this question by comparing 2 forms of olfactory testing which measure peripheral and central olfactory processing. METHODS We assessed SDB (survey-reported snoring frequency, nighttime apneic events, or diagnosis of sleep apnea) in the National Social Life, Health, and Aging Project, a nationally representative sample of older U.S. adults. Odor sensitivity (peripheral) and odor identification (central) were assessed with validated instruments. Logistic regression was used to test the relationship between SDB and olfaction, accounting for relevant covariates, including demographics, cognition, and comorbidity. RESULTS Twenty-nine percent of older U.S. adults reported symptoms of SDB (apneic events or nightly snoring). Of these, only 32% had been diagnosed with sleep apnea. Older adults with SDB (those who reported symptoms or have been diagnosed with sleep apnea) were significantly more likely to have impaired odor identification (odds ratio 2.13, 95% confidence interval 1.19-3.83, p = .012) in analyses that accounted for age, gender, race/ethnicity, education, cognition, comorbidities (including depression), and body mass index. Presence of SDB was not associated with impaired odor sensitivity (odds ratio 1.03, 95% confidence interval 0.75-1.43, p = .84). CONCLUSION SDB is highly prevalent but underdiagnosed in older U.S. adults and is associated with impaired odor identification but not odor sensitivity. These data support the concept that SDB affects pathways in the central nervous system which involve chemosensory processing.
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Affiliation(s)
- Jesse K Siegel
- Pritzker School of Medicine, The University of Chicago, Illinois
| | - Xiandao Yuan
- Department of Otolaryngology-Head and Neck Surgery, Beijing An Zhen Hospital, Capital Medical University, China
| | | | - Martha K McClintock
- Department of Psychology and The Institute for Mind and Biology, The University of Chicago, Illinois
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Illinois
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20
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Hlubocky FJ, Sher TG, Cella D, Wroblewski KE, Peppercorn J, Daugherty CK. Anxiety Shapes Expectations of Therapeutic Benefit in Phase I Trials for Patients With Advanced Cancer and Spousal Caregivers. JCO Oncol Pract 2021; 17:e101-e110. [PMID: 33567241 DOI: 10.1200/op.20.00646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Advanced cancer patients (ACP) hope to receive significant therapeutic benefit from phase I trials despite terminal disease and presumed symptom burdens. We examined associations between symptom burdens and expectations of therapeutic benefit for ACP and spousal caregivers (SC) during phase I trials. PATIENTS AND METHODS A prospective cohort of ACP-SC enrolled in phase I trials was assessed at baseline and one month using symptom burden measures evaluating depression, state-trait anxiety, quality of life, global health, post-traumatic coping, and marital adjustment. Interviews evaluated expectations of benefit. RESULTS Fifty-two phase I ACP and 52 SC (N = 104) were separately assessed and interviewed at baseline and one month. Total population demographics included the following: median age 61 years (28-78), 50% male, 100% married, 90% White, and 46% ≥ college education. At T1, ACP reported symptoms of mild state anxiety, mild trait anxiety, poor global health, and quality of life. SC reported moderate state and mild trait anxiety and good global health with little disability at baseline. State anxiety was a significant predictor of ACP expectations for phase I producing the following therapeutic benefits: stabilization (P = .01), shrinkage (P < .01), and remission (P = .04). Regression analyses also revealed negative associations between SC expectation for stabilization and SC anxiety: state (P = .01) and trait (P = .02). ACP quality of life was also negatively associated with SC expectations for stabilization (P = .02) and shrinkage (P = .01). CONCLUSION Anxiety, both state and trait, impacts couples' beliefs regarding the likelihood of therapeutic benefit from phase I trial participation.
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Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Hematology/Oncology, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
| | - Tamara G Sher
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - David Cella
- Departments of Medical Social Sciences, Psychiatry Behavioral Sciences, Northwestern University, Chicago, IL
| | | | - Jeffery Peppercorn
- Division of Medicine, Hematology & Oncology, Massachusetts General Hospital, Dana Farber Partners, Boston, MA
| | - Christopher K Daugherty
- Department of Medicine, Hematology/Oncology, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
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21
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Xu L, Liu J, Wroblewski KE, McClintock MK, Pinto JM. Odor Sensitivity Versus Odor Identification in Older US Adults: Associations With Cognition, Age, Gender, and Race. Chem Senses 2021; 45:321-330. [PMID: 32406505 DOI: 10.1093/chemse/bjaa018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The ability to identify odors predicts morbidity, mortality, and quality of life. It varies by age, gender, and race and is used in the vast majority of survey and clinical literature. However, odor identification relies heavily on cognition. Other facets of olfaction, such as odor sensitivity, have a smaller cognitive component. Whether odor sensitivity also varies by these factors has not been definitively answered. We analyzed data from the National Social Life, Health, and Aging Project, a nationally representative study of older US adults (n = 2081). Odor identification was measured using 5 validated odors presented with Sniffin' Stick pens as was odor sensitivity in a 6-dilution n-butanol constant stimuli detection test. Multivariate ordinal logistic regression modeled relationships between olfaction and age, gender, race, cognition, education, socioeconomic status, social network characteristics, and physical and mental health. Odor sensitivity was worse in older adults (P < 0.01), without gender (P = 0.56) or race (P = 0.79) differences. Odor identification was also worse in older adults, particularly men (both P ≤ 0.01), without differences by race. Decreased cognitive function was associated with worse odor identification (P ≤ 0.01) but this relationship was weaker for odor sensitivity (P = 0.02) in analyses that adjusted for other covariates. Odor sensitivity was less strongly correlated with cognitive ability than odor identification, confirming that it may be a more specific measure of peripheral olfactory processing. Investigators interested in associations between olfaction and health should consider both odor sensitivity and identification when attempting to understand underlying neurosensory mechanisms.
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Affiliation(s)
- Lucy Xu
- Pritzker School of Medicine, The University of Chicago, Chicago, USA
| | - Jia Liu
- Beijing An Zhen Hospital, Capital Medical University, An Zhen Hospital, Beijing, China
| | | | - Martha K McClintock
- Department of Comparative Human Development, The University of Chicago, Chicago, USA.,Center on Demography and Aging, The University of Chicago, Chicago, USA.,Institute for Mind and Biology, The University of Chicago, Institute for Mind and Biology, Chicago, USA
| | - Jayant M Pinto
- Section of Otolaryngology, Head and Neck Surgery, The University of Chicago, Chicago, USA.,Institute for Population and Precision Health, The University of Chicago, Chicago, USA
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22
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Lindau ST, Makelarski JA, Boyd K, Doyle KE, Haider S, Kumar S, Lee NK, Pinkerton E, Tobin M, Vu M, Wroblewski KE, Lengyel E. Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women. J Womens Health (Larchmt) 2021; 30:502-513. [PMID: 33818123 DOI: 10.1089/jwh.2020.8879] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.
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Affiliation(s)
- Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Benedictine University, College of Education and Health Services, Lisle, Illinois, USA
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kate E Doyle
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Shivani Kumar
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Nita Karnik Lee
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA
| | - El Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Marie Tobin
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Milkie Vu
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA
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23
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Wong JS, Breslau H, McSorley VE, Wroblewski KE, Howe MJK, Waite LJ. The Social Relationship Context of Elder Mistreatment. Gerontologist 2021; 60:1029-1039. [PMID: 31688922 DOI: 10.1093/geront/gnz154] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Elder mistreatment victims at risk of poor physical and psychological health may benefit from increased social support. This article identifies mistreatment victims among community-dwelling older Americans and maps their social networks to guide the design of social support interventions. RESEARCH DESIGN AND METHODS Using nationally representative survey data from Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (N = 2,334) and descriptive, latent class, and regression analyses, we estimate the prevalence of mistreatment since age 60, identify the alleged perpetrators' relationships to the victims, and examine victims' social networks. RESULTS Self-reported lifetime prevalence of elder mistreatment is as high as 21%, depending on the mistreatment behavior measured. Latent class analysis reveals two mistreatment classes: 12% of older adults experienced multiple types of mistreatment (polyvictimization), and 6% experienced primarily financial mistreatment. Although alleged perpetrators are unlikely to appear in older adults' core social networks, the most commonly reported perpetrators are children and relatives. Regression analyses show that experiencing mistreatment since age 60 is associated with having less current social support, more social strain, and fewer kin in the core social network. Older adults reporting polyvictimization also have less-dense core networks. DISCUSSION AND IMPLICATIONS Increasing family support should be done cautiously because children and relatives are frequently named as mistreatment perpetrators. Increasing communication across polyvictimization victims' network members may support their well-being. Providing outside assistance with financial management could benefit financial mistreatment victims.
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Affiliation(s)
- Jaclyn S Wong
- Department of Sociology, University of South Carolina, Columbia
| | - Hannah Breslau
- Academic Research Centers, NORC at the University of Chicago, Illinois
| | | | | | - Melissa J K Howe
- Academic Research Centers, NORC at the University of Chicago, Illinois
| | - Linda J Waite
- Department of Sociology, University of Chicago, Illinois
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24
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Zeytinoglu M, Wroblewski KE, Vokes TJ, Huisingh-Scheetz M, Hawkley LC, Huang ES. Association of Loneliness With Falls: A Study of Older US Adults Using the National Social Life, Health, and Aging Project. Gerontol Geriatr Med 2021; 7:2333721421989217. [PMID: 33614830 PMCID: PMC7868456 DOI: 10.1177/2333721421989217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Falls represent a significant cause of morbidity and mortality in older adults, and are more common among those living alone. We aimed to determine if there is an association between loneliness and falls. Methods: Participants were surveyed in three waves separated by 5 years. We used the three-item UCLA Loneliness Scale to measure loneliness. Results: Data from 2337 respondents, with both loneliness and fall data in at least two consecutive waves, were included. Over three waves, 51% respondents reported a fall and 23% reported ≥ two falls. In multivariate analysis, the odds of having ≥ one fall 5 years later increased by a factor of 1.11 per one point increase on the loneliness scale (OR = 1.11, 95% CI 1.04, 1.19; p < .01). Discussion: Lonely older adults have increased odds of future falls. Strategies for combating loneliness in older adults may help reduce fall-related morbidity and mortality.
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25
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Eliyan Y, Wroblewski KE, McClintock MK, Pinto JM. Olfactory Dysfunction Predicts the Development of Depression in Older US Adults. Chem Senses 2020; 46:5983672. [PMID: 33197253 DOI: 10.1093/chemse/bjaa075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neuroanatomic connections link the olfactory and limbic systems potentially explaining an association between olfactory dysfunction and depression. Some previous studies have demonstrated that olfactory dysfunction is associated with increased depressive symptoms. However, these studies were cross-sectional and unable to establish which develops first. We used longitudinal data to determine if impaired odor identification increased subsequent depressive symptoms or vice versa. We assessed olfaction and depression in the National Social Life, Health, and Aging Project, a nationally representative, 15-year longitudinal study of older US adults. Olfaction was measured using a validated odor identification test (Sniffin' Sticks). Depressive symptoms were measured using a modified version of the validated Center for Epidemiological Studies Depression Scale. Multivariable logistic regression models examined the temporal relationships between developing olfactory dysfunction and depression while accounting for demographics, disease comorbidities, alcohol use, smoking, and cognition. Older adults with olfactory dysfunction had concurrent frequent depressive symptoms (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.00-1.43). Among healthy adults at baseline, those who had olfactory dysfunction were more likely to develop frequent depressive symptoms 5 or 10 years later (OR = 2.22, 95% CI = 1.13-4.37). Conversely, those with frequent depressive symptoms at baseline were not more likely to develop olfactory dysfunction 5 or 10 years later. We show for the first time that olfactory dysfunction predicts subsequent development of depression in older US adults. These data support screening for depression in older adults with chemosensory impairment and set the stage for disentangling the relationship between olfaction and depression.
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Affiliation(s)
- Yazan Eliyan
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Martha K McClintock
- Department of Comparative Human Development, The University of Chicago, Chicago, IL, USA.,Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
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26
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Darnell EP, Wroblewski KE, Pagel KL, Kern DW, McClintock MK, Pinto JM. IL-1Rahigh-IL-4low-IL-13low: A Novel Plasma Cytokine Signature Associated with Olfactory Dysfunction in Older US Adults. Chem Senses 2020; 45:407-414. [PMID: 32369568 PMCID: PMC7320218 DOI: 10.1093/chemse/bjaa029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Inflammation has been implicated in physical frailty, but its role in sensory impairment is unclear. Given that olfactory impairment predicts dementia and mortality, determining the role of the immune system in olfactory dysfunction would provide insights mechanisms of neurosensory decline. We analyzed data from the National Social Life, Health and Aging Project, a representative sample of home-dwelling older US adults. Plasma levels of 18 cytokines were measured using standard protocols (Luminex xMAP). Olfactory function was assessed with validated tools (n-butanol sensitivity and odor identification, each via Sniffin' Sticks). We tested the association between cytokine profiles and olfactory function using multivariate ordinal logistic regression, adjusting for age, gender, race/ethnicity, education level, cognitive function, smoking status, and comorbidity. Older adults with the IL-1Rahigh-IL-4low-IL-13low cytokine profile had worse n-butanol odor sensitivity (odds ratio [OR] = 1.61, 95% confidence interval [CI] 1.19-2.17) and worse odor identification (OR = 1.42, 95% CI 1.11-1.80). Proinflammatory, Th1, or Th2 cytokine profiles were not associated with olfactory function. Moreover, accounting for physical frailty did not alter the main findings. In conclusion, we identified a plasma cytokine signature-IL-1Rahigh-IL-4low-IL-13low-that is associated with olfactory dysfunction in older US adults. These data implicate systemic inflammation in age-related olfactory dysfunction and support a role for immune mechanisms in this process, a concept that warrants additional scrutiny.
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Affiliation(s)
- Eli P Darnell
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Kristina L Pagel
- Department of Comparative Human Development, The University of Chicago, Chicago, IL, USA
- Center on Demography and Aging, The University of Chicago, Chicago, IL, USA
- Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - David W Kern
- Department of Comparative Human Development, The University of Chicago, Chicago, IL, USA
| | - Martha K McClintock
- Department of Comparative Human Development, The University of Chicago, Chicago, IL, USA
- Center on Demography and Aging, The University of Chicago, Chicago, IL, USA
- Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - Jayant M Pinto
- Center on Demography and Aging, The University of Chicago, Chicago, IL, USA
- Section of Otolaryngology—Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
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27
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Siegel JK, Wroblewski KE, McClintock MK, Pinto JM. Olfactory dysfunction persists after smoking cessation and signals increased cardiovascular risk. Int Forum Allergy Rhinol 2019; 9:977-985. [PMID: 31365791 PMCID: PMC6730657 DOI: 10.1002/alr.22357] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Olfaction plays a critical role in health and function in older adults, and impaired sense of smell is a strong predictor of morbidity and mortality. Smoking cigarettes causes olfactory impairment, but the mechanism of damage and ability to recover after cessation are unknown. We investigated the relationship between time since quitting and olfactory dysfunction in order to elucidate the mechanism(s) by which smoking damages the olfactory system and to inform patient counseling. METHODS Using longitudinal data from the National Social Life Health and Aging Project (n = 3528 older adults, including 1526 former smokers), we analyzed the association between odor identification performance and time since smoking cessation using multivariate ordinal logistic regression, adjusting for cognition and demographic variables. To test whether vascular disease plays a role, we also assessed the relationship between olfactory decline and incidence of heart attack and heart disease. RESULTS Former smokers who quit ≤15 years before testing had significantly impaired olfaction compared to never smokers (p = 0.04), but those who quit >15 years prior did not. Olfactory decline over 5 years showed modest evidence toward predicting increased incidence of heart attack or heart disease (p = 0.08). CONCLUSION Olfactory impairment in smokers persists 15 years after quitting, which is consistent with a vascular mechanism of impairment. Indeed, olfactory decline is a predictor of the development of cardiovascular disease. Taken together, these data suggest that olfactory loss may be a useful sign of underlying vascular pathology. Further investigation of olfactory loss as an early biomarker for cardiovascular disease is warranted.
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Affiliation(s)
| | | | - Martha K. McClintock
- Department of Comparative Human Development and The Institute for Mind and Biology, The University of Chicago
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
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28
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Gerlach RM, Shahul S, Wroblewski KE, Cotter EK, Perkins BW, Harrison JH, Ota T, Jeevanandam V, Chaney MA. Intraoperative Use of Nondepolarizing Neuromuscular Blocking Agents During Cardiac Surgery and Postoperative Pulmonary Complications: A Prospective Randomized Trial. J Cardiothorac Vasc Anesth 2019; 33:1673-1681. [DOI: 10.1053/j.jvca.2018.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Indexed: 01/13/2023]
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29
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Lee WW, Alkureishi ML, Isaacson JH, Mayer M, Frankel RM, London DA, Wroblewski KE, Arora VM. Impact of a brief faculty training to improve patient-centered communication while using electronic health records. Patient Educ Couns 2018; 101:2156-2161. [PMID: 30007764 DOI: 10.1016/j.pec.2018.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/31/2018] [Accepted: 06/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue. METHODS Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop. RESULTS Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool. CONCLUSION A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills. PRACTICE IMPLICATIONS Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners.
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Affiliation(s)
- Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, USA.
| | | | - J Harry Isaacson
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, USA
| | - Mark Mayer
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, USA
| | - Richard M Frankel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Daniel A London
- Department of Orthopedics, Mount Sinai Hospital System, New York, USA
| | | | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, USA
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30
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Hlubocky FJ, Sachs GA, Larson ER, Nimeiri HS, Cella D, Wroblewski KE, Ratain MJ, Peppercorn JM, Daugherty CK. Do Patients With Advanced Cancer Have the Ability to Make Informed Decisions for Participation in Phase I Clinical Trials? J Clin Oncol 2018; 36:2483-2491. [PMID: 29985748 DOI: 10.1200/jco.2017.73.3592] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Patients with advanced cancer (ACPs) participating in phase I clinical trials inadequately understand many elements of informed consent (IC); however, the prevalence and impact of cognitive impairment has not been described. Patients and Methods ACPs enrolled onto phase I trials underwent neuropsychological assessment to evaluate cognitive functioning (CF) covering the following domains: memory (Hopkins Verbal Learning Test), executive functioning (Trail Making Test B), language (Boston Naming Test-Short Version and Controlled Oral Word Association Test), attention (Trail Making Test A and Wechsler Adult Intelligenence Scale-IV Digit Span), comprehension (Wechsler Adult Intelligence Scale-IV), and quality of life (Functional Assessment of Cancer Therapy-Cognitive Function). Structured interviews evaluated IC and decisional capacity. Psychological measures included distress (Hospital Anxiety Depression Scale) and depression (Beck Depression Inventory-II). Results One hundred eighteen ACPs on phase I trials were evaluated, with CF ranging from mild impairment to superior performance. Only 45% of ACPs recalled physician disclosure of the phase I trial purpose. The 50% of ACPs who correctly identified the phase I research purpose had greater CF compared with ACPs who did not, as revealed by the mean T scores for memory (37.2 ± 5.6 v 32.5 ± 5.1, respectively; P = .001), attention (29 ± 2.7 v 26.9 ± 2.4, respectively; P < .001), visual attention (35.2 ± 6.6 v 31.5 ± 6.2, respectively; P = .001), and executive function (38.9 ± 7.5 v 34 ± 7.1, respectively; P < .001). Older ACPs (≥ 60 years) were less likely to recall physician disclosure of phase I purpose than younger ACPs (30% v 70%, respectively; P = .02) and had measurable deficits in total memory (34.2 ± 5.0 v 37.3 ± 5.6, respectively; P = .002), attention (24.5 ± 2.6 v 28 ± 2.8, respectively; P < .001), and executive function (32.8 ± 7.3 v 36.4 ± 7.6, respectively; P = .01). Older ACPs, compared with younger ACPs, also had greater depression scores (10.6 ± 9.2 v 8.1 ± 5.2, respectively; P = .03) and lower quality-of-life scores (152 ± 29.6 v 167 ± 20, respectively; P = .03). After adjustment by age, no psychological or neuropsychological variable was further significantly associated with likelihood of purpose identification. Conclusion CF seems to play a role in ACP recall and comprehension of IC for early-phase clinical trials, especially among older ACPs.
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Affiliation(s)
- Fay J Hlubocky
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Greg A Sachs
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Eric R Larson
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Halla S Nimeiri
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - David Cella
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Kristen E Wroblewski
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Mark J Ratain
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Jeffery M Peppercorn
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Christopher K Daugherty
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
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Bestvina CM, Wroblewski KE, Daly B, Beach B, Chow S, Hantel A, Malec M, Huber MT, Polite BN. A Rules-Based Algorithm to Prioritize Poor Prognosis Cancer Patients in Need of Advance Care Planning. J Palliat Med 2018; 21:846-849. [DOI: 10.1089/jpm.2017.0408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Bobby Daly
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brittany Beach
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Selina Chow
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrew Hantel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Monica Malec
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Michael T. Huber
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Blase N. Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
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Hlubocky FJ, Kass NE, Roter D, Larson S, Wroblewski KE, Sugarman J, Daugherty CK. Investigator Disclosure and Advanced Cancer Patient Understanding of Informed Consent and Prognosis in Phase I Clinical Trials. J Oncol Pract 2018; 14:e357-e367. [PMID: 29787333 DOI: 10.1200/jop.18.00028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Advanced cancer patients (ACPs) who participate in phase I clinical trials often report a less-than-ideal understanding of the required elements of informed consent (IC) and unrealistic expectations for anticancer benefit and prognosis. We examined phase I clinical trial enrollment discussions and their associations with subsequent ACP understanding. METHODS Clinical encounters about enrollment in phase I trials between 101 ACPs and 29 oncologists (principal investigators [PIs] and fellows) at three US academic medical institutions were recorded. The Roter Interaction Analysis System was used for analysis. ACPs completed follow-up questionnaires to assess IC recall. RESULTS PIs disclosed the following phase I IC elements to ACPs in encounters: trial purpose in 40%; specific physical risks in 60%; potential specific medical benefits gained by trial participation (eg, disease stabilization) in 48.2%; and alternatives to phase I trial participation in 47.1%, with 1.1% of encounters containing palliative and 2.3% hospice information. PIs provided ACP-specific prognoses in 29.0% of encounters but used precise terms of death in only 4.7% and terminal in 1.2%. A significant association existed between PI disclosure of the trial purpose as dosage/toxicity, and ACPs subsequently correctly recalled trial purpose versus PIs who did not disclose it (85% v 13%; P < .05). CONCLUSION Many oncologists provide incomplete disclosures about phase I trials to ACPs. When disclosure of certain elements of IC occurs, it seems to be associated with better recall, especially with regard to the research purpose of phase I trials.
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Affiliation(s)
- Fay J Hlubocky
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | - Nancy E Kass
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | - Debra Roter
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | - Susan Larson
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | | | - Jeremy Sugarman
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
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Tung EL, Wroblewski KE, Boyd K, Makelarski JA, Peek ME, Lindau ST. Police-Recorded Crime and Disparities in Obesity and Blood Pressure Status in Chicago. J Am Heart Assoc 2018; 7:e008030. [PMID: 29574461 PMCID: PMC5907588 DOI: 10.1161/jaha.117.008030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/22/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. METHODS AND RESULTS We analyzed cross-sectional data (N=14 799 patients) from 3 primary care clinics at an academic medical center in Chicago, IL. Patient-level health data were obtained from the electronic health record (June 1, 2014-May 31, 2015), including body mass index and BP, and linked to the City of Chicago Police Data Portal. Geocoded crime counts were aggregated to census tract and calculated as the annual crime rate per 1000 population. Generalized linear mixed models were used to assess obesity and BP status as a function of crime rate quartile, controlling for patient, clinic, and neighborhood characteristics. Median violent crime rates in each quartile ranged from 15 to 84 per 1000 population. Median age was 56 years (interquartile range, 38-72 years); 42% of patients were obese and 33% had elevated BP. Compared with patients living in the lowest quartile, patients living in the highest quartile for violent crime had 53% higher adjusted odds of obesity (95% confidence interval, 1.15-2.03) and 25% higher adjusted odds of elevated BP (95% confidence interval, 1.01-1.56). In subanalyses examining homicide, a relatively rare event, exposure was not associated with obesity and was inconsistently associated with elevated BP. CONCLUSIONS In a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
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Affiliation(s)
- Elizabeth L Tung
- Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, IL
| | | | - Kelly Boyd
- Department of Obstetrics and Gynecology, University of Chicago, IL
| | | | - Monica E Peek
- Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, IL
- MacLean Center for Clinical Medical Ethics, University of Chicago, IL
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, IL
- Department of Medicine-Geriatrics, MacLean Center on Clinical Medical Ethics and Comprehensive Cancer Center, University of Chicago, IL
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34
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Yesensky JA, Hasina R, Wroblewski KE, Bellairs J, Gooi Z, Saloura V, Cipriani NA, Vokes EE, Portugal LG, Seiwert TY, Blair ED, Agrawal N. Role of dental hardware in oral cavity squamous cell carcinoma in the low-risk nonsmoker nondrinker population. Head Neck 2018; 40:784-792. [PMID: 29356169 DOI: 10.1002/hed.25059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/25/2017] [Accepted: 11/22/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Oral cavity squamous cell carcinoma (SCC) arising in nonsmokers and nondrinkers remains poorly characterized. We hypothesized that these patients had prior exposure to metallic dental hardware. METHODS We utilized a questionnaire querying the lifetime oral health status of 54 patients. Demographics and extensive oral health history were collected. RESULTS The majority of patients (74%) had prior exposure to metallic dental hardware. The younger population with almost exclusively oral tongue cancer had a high prevalence of metallic orthodontic braces (40%) within 15 years before diagnosis. In the 51+ year age group, 82% had crowns, dental implants, and/or dentures with metallic elements. CONCLUSION Exposure to metallic dental hardware has increased in the past few decades given the rise of orthodontic braces and older adults retaining more teeth. Although this study does not prove a causal relationship between oral cavity SCC and dental hardware, this is a step toward identifying and investigating their role.
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Affiliation(s)
| | - Rifat Hasina
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Joseph Bellairs
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Zhen Gooi
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Vassiliki Saloura
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Everett E Vokes
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Louis G Portugal
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Tanguy Y Seiwert
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | | | - Nishant Agrawal
- Department of Surgery, The University of Chicago, Chicago, Illinois
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Adams DR, Kern DW, Wroblewski KE, McClintock MK, Dale W, Pinto JM. Olfactory Dysfunction Predicts Subsequent Dementia in Older U.S. Adults. J Am Geriatr Soc 2017; 66:140-144. [PMID: 28944467 DOI: 10.1111/jgs.15048] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To investigate the relationship between olfactory dysfunction and subsequent diagnosis of dementia. DESIGN Longitudinal study of a population representative of U.S. older adults. SETTING Home interviews (National Social Life, Health, and Aging Project). PARTICIPANTS Men and women aged 57 to 85 (N = 2,906). MEASUREMENTS Objective odor identification ability was measured at baseline using a validated five-item test. Five years later, the respondent, or a proxy if the respondent was too sick to interview or had died, reported physician diagnosis of dementia. The association between baseline olfactory dysfunction and an interval dementia diagnosis was tested using multivariate logistic regression, controlling for age, sex, race and ethnicity, education, comorbidities (modified Charlson Comorbidity Index), and cognition at baseline (Short Portable Mental Status Questionnaire). RESULTS Older adults with olfactory dysfunction had more than twice the odds of having developed dementia 5 years later (odds ratio = 2.13, 95% confidence interval = 1.32-3.43), controlling for the above covariates. Having more odor identification errors was associated with greater probability of an interval dementia diagnosis (P = .04, 1-degree of freedom linear-trend test). CONCLUSION We show for the first time in a nationally representative sample that home-dwelling older adults with normal cognition and difficulty identifying odors face higher odds of being diagnosed with dementia 5 years later, independent of other significant risk factors. This validated five-item odor identification test is an efficient, low-cost component of the physical examination that can provide useful information while assessing individuals' risk of dementia. Use of such testing may provide an opportunity for early interventions to reduce the attendant morbidity and public health burden of dementia.
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Affiliation(s)
- Dara R Adams
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - David W Kern
- Department of Psychology, Northeastern Illinois University, Chicago, Illinois
| | | | - Martha K McClintock
- Department of Comparative Human Development, University of Chicago, Chicago, Illinois.,Institute for Mind and Biology, University of Chicago, Chicago, Illinois
| | - William Dale
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois
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Pinto JM, Wroblewski KE, Huisingh-Scheetz M, Correia C, Lopez KJ, Chen RC, Kern DW, Schumm PL, Dale W, McClintock MK. Global Sensory Impairment Predicts Morbidity and Mortality in Older U.S. Adults. J Am Geriatr Soc 2017; 65:2587-2595. [PMID: 28942611 DOI: 10.1111/jgs.15031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate global sensory impairment (GSI, an integrated measure of sensory dysfunction) as a predictor of physical function, cognition, overall health, and mortality. DESIGN Prospective study. SETTING The National Social Life, Health, and Aging Project. PARTICIPANTS A national probability sample of 3,005 home-dwelling older U.S. adults assessed at baseline (2005-06) and 5-year follow-up (2010-11). MEASUREMENTS Gait speed, activity, disability, cognition, overall health, 5-year mortality. RESULTS At baseline, older adults with worse GSI were slower (Timed Up and Go times: odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.17-1.50) and had more activity of daily living deficits (≥2: OR = 1.26, 95% CI = 1.10-1.46). Five years later, they were still slower (timed walk: OR = 1.22, 95% CI = 1.05-1.42), had more disabilities (≥2 instrumental activities of daily living; OR = 1.45, 95% CI = 1.23-1.70), were less active (daytime activity according to accelerometry: β = -2.7, 95% CI = -5.2 to -0.2), had worse cognitive function (Montreal Cognitive Assessment; β = -0.64, 95% CI = -0.84 to -0.44), more likely to have poorer overall health (OR = 1.16, 95% CI = 1.03-1.31) and lose weight (>10%: OR = 1.31, 95% CI = 1.04-1.64), and have died (OR = 1.45, 95% CI = 1.19-1.76). All analyses were adjusted for relevant confounders at baseline, including age, sex, race and ethnicity, education, smoking, problem drinking, body mass index, comorbidities, and cognitive function. CONCLUSION GSI predicts impaired physical function, cognitive dysfunction, significant weight loss, and mortality 5 years later in older U.S. adults. Multisensory evaluation may identify vulnerable individuals, offering the opportunity for early intervention to mitigate adverse outcomes.
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Affiliation(s)
- Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois.,Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois
| | | | - Megan Huisingh-Scheetz
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois.,Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Camil Correia
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois
| | - Kevin J Lopez
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois
| | - Rachel C Chen
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - David W Kern
- Department of Psychology, Northeastern Illinois University, Chicago, Illinois
| | - Philip L Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - William Dale
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois.,Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Martha K McClintock
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois.,Department of Comparative Human Development, University of Chicago, Chicago, Illinois.,Institute for Mind and Biology, University of Chicago, Chicago, Illinois
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Adams DR, Wroblewski KE, Kern DW, Kozloski MJ, Dale W, McClintock MK, Pinto JM. Factors Associated with Inaccurate Self-Reporting of Olfactory Dysfunction in Older US Adults. Chem Senses 2017; 42:223-231. [PMID: 28007787 DOI: 10.1093/chemse/bjw108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Self-reported olfactory function has poor sensitivity (i.e., people with measured olfactory dysfunction are unlikely to accurately report it). We aimed to identify factors associated with lack of awareness of smell dysfunction. Objective odor identification was evaluated using a validated 5-item test in respondents from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling, US adults ages 57-85 (n = 1468). Self-reported olfaction was assessed with a 5-point Likert scale. Using multivariate logistic regression, we tested factors that might influence inaccuracy of self-reported olfaction, including age, gender, race/ethnicity, education, marital status, cognition, comorbidity, smoking, depression, anxiety, self-rated mental and physical health, and social activity. Among older US adults, 12.4% reported their sense of smell as fair or poor, while 22.0% had objective olfactory dysfunction (≤3 items correct out of 5). Among those with measured olfactory dysfunction, 74.2% did not recognize it; these individuals were more likely to be older, Black, never married, and to have worse cognitive function compared to individuals who recognized their dysfunction (P < 0.05, all). Individuals who lacked awareness of their olfactory dysfunction had the greatest cognitive impairment at 5-year follow-up, followed by individuals aware of their dysfunction and finally normosmics (P < 0.001). Older Americans with measured olfactory dysfunction are unlikely to report it, and those who lack awareness of this dysfunction have distinct demographic, social, and cognitive characteristics. Therefore, clinicians should objectively test patients. Individuals who lack awareness of their olfactory dysfunction have poor cognitive outcomes and should receive additional clinical scrutiny.
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Affiliation(s)
- Dara R Adams
- Pritzker School of Medicine, The University of Chicago, 924 E 57th St, Chicago, IL 60637, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - David W Kern
- Department of Psychology, Northeastern Illinois University, 5500 North St. Louis Avenue, Chicago, IL 60625, USA
| | - Michael J Kozloski
- National Opinion Research Center, 1155 East 60th Street, 3rd Floor, Chicago, IL 60637, USA
| | - William Dale
- Section of Geriatrics and Palliative Medicine, Department of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Martha K McClintock
- Department of Comparative Human Development and the Institute for Mind and Biology, The University of Chicago, 5736 South Woodlawn Avenue #102, Chicago, IL 60637, USA and
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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Ajmani GS, Suh HH, Wroblewski KE, Pinto JM. Smoking and olfactory dysfunction: A systematic literature review and meta-analysis. Laryngoscope 2017; 127:1753-1761. [PMID: 28561327 PMCID: PMC6731037 DOI: 10.1002/lary.26558] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS A systematic review and meta-analysis of the literature was undertaken, examining the association between tobacco smoking and olfactory function in humans, utilizing PubMed and Web of Science (1970-2015) as data sources. STUDY DESIGN Systematic literature review and meta-analysis. METHODS This database review of studies of smoking and olfaction, with a focus on identifying high-quality studies (based on modified versions of the Newcastle-Ottawa Scale), used validated olfactory tests among the generally healthy population. RESULTS We identified 11 studies meeting inclusion criteria. Of 10 cross-sectional studies, two were excluded from meta-analysis because the cohorts they studied were included in another article in the review. In meta-analysis, current smokers had substantially higher odds of olfactory dysfunction compared to never smokers (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.37-1.85). In contrast, former smokers were found to have no difference in risk of impaired olfaction compared to never smokers (OR = 1.05, 95% CI = 0.91-1.21). The single longitudinal study reviewed found a trend toward increased risk of olfactory decline over time in ever smokers; this trend was stronger in current as compared to former smokers. CONCLUSIONS Current smoking, but not former smoking, is associated with significantly increased risk of olfactory dysfunction, suggesting that the effects of smoking on olfaction may be reversible. Future studies that prospectively evaluate the impact of smoking cessation on improvement in olfactory function are warranted. LEVEL OF EVIDENCE N/A. Laryngoscope, 127:1753-1761, 2017.
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Affiliation(s)
- Gaurav S. Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| | - Helen H. Suh
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, IL, United States
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Tallman JE, Packiam VT, Wroblewski KE, Paner GP, Eggener SE. Influence of pathologist experience on positive surgical margins following radical prostatectomy. Urol Oncol 2017; 35:461.e1-461.e6. [PMID: 28302349 DOI: 10.1016/j.urolonc.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/10/2017] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. METHODS We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. RESULTS Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all P<0.05). Univariate logistic regression showed that surgeon experience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all P<0.05). Multivariable regression analysis confirmed that decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). CONCLUSIONS Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist.
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Affiliation(s)
- Jacob E Tallman
- Pritzker School of Medicine, The University of Chicago, Chicago, IL.
| | - Vignesh T Packiam
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | | | - Gladell P Paner
- Department of Pathology, The University of Chicago Medicine, Chicago, IL
| | - Scott E Eggener
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
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Ajmani GS, Wroblewski KE, Baroody FM, Naclerio RM, Pinto JM. Allergy and asthma medication use in home-dwelling U.S. older adults. Int Forum Allergy Rhinol 2017; 7:192-198. [PMID: 27696770 PMCID: PMC6057748 DOI: 10.1002/alr.21856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 08/01/2016] [Accepted: 08/30/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known about the use of allergy and asthma medications in older adults. This study aimed to assess the prevalence of use of these medications in older adults and evaluate predictors of their use. METHODS Cross-sectional study using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling, U.S. adults 57 to 85 years (n = 2976) collected in 2005-2006. We determined prevalence of medication use and used logistic regression to evaluate sociodemographic and health factors associated with their use. RESULTS Overall prevalence of allergy medication usage was 8.4% (most commonly antihistamines), and prevalence of asthma medication usage was 8.0% (most commonly bronchodilators). Allergy medication use was significantly associated with history of asthma (odds ratio [OR] 2.37; 95% confidence interval [CI], 1.52 to 3.69), chronic obstructive pulmonary disease (COPD) (OR 2.35; 95% CI, 1.58 to 3.51), or nasal surgery (OR 1.97; 95% CI, 1.00 to 3.86). Older age was associated with decreased allergy medication use (per decade, OR 0.80; 95% CI, 0.66 to 0.98). Although increased education was associated with increased overall allergy medication use, it was associated with decreased use of allergy medications generally contraindicated in the elderly. In contrast, the only significant predictors of asthma medication use were history of asthma (OR 19.66; 95% CI, 3.18 to 121.70) or COPD (OR 4.25; 95% CI, 0.88 to 20.44). CONCLUSION Allergy and asthma medication use is prevalent among older adults and driven mostly by history of asthma or COPD. Additional sociodemographic factors predict allergy (but not asthma) medication use. Further studies are needed to evaluate efficacy of these drugs in the elderly.
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Affiliation(s)
- Gaurav S. Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, United States
| | - Kristen E. Wroblewski
- Department of Public Health Sciences,The University of Chicago, Chicago, Illinois, United States
| | - Fuad M. Baroody
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, United States
| | - Robert M. Naclerio
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, United States
| | - Jayant M. Pinto
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, United States
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Lee WW, Alkureishi ML, Wroblewski KE, Farnan JM, Arora VM. Incorporating the human touch: piloting a curriculum for patient-centered electronic health record use. Med Educ Online 2017; 22:1396171. [PMID: 29103366 PMCID: PMC5678228 DOI: 10.1080/10872981.2017.1396171] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/17/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND Integrating electronic health records (EHRs) into clinical care can prevent physicians from focusing on patients. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use. OBJECTIVE We piloted a 'Patient-centered EHR use' curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s). DESIGN During the lecture, students watched a trigger tape video, engaged in a reflective observation exercise, and learned best practices. During the GOSCE, one of four MS2s interacted with a standardized patient (SP) while using the EHR. Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. All students completed post-GOSCE/OSCE surveys. The SP evaluated GOSCE/OSCE performance. RESULTS In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Eighty MS2s (90%) and 88 MS3s (92%) post-GOSCE/OSCE surveys were analyzed. Compared to MS3s, significantly more MS2s rated their knowledge (19% vs 55%) and training (14% vs 39%) as good (≥4/5 point scale, P < .001 for both). Most learners (85% MS2s and 70% MS3s) thought training should be required for all students. SP ratings on GOSCE/OSCE performance was higher for the 20 MS2s compared to the 88 MS3 controls (73.5 [SD = 4.5] vs 58.1 [SD = 13.1] on 80 point scale, P < .001). CONCLUSIONS A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is now a permanent part of our Clinical Skills course. Clerkship students who did not receive our curriculum may have been exposed to negative role-modeling on the wards. To address this, training residents and faculty on patient-centered EHR use skills should be considered. ABBREVIATIONS EHR: Electronic health record; EHR: Electronic health record; SP: Standardized patient.
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Affiliation(s)
- Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | | | - Vineet M. Arora
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Ajmani GS, Suh HH, Wroblewski KE, Kern DW, Schumm LP, McClintock MK, Yanosky JD, Pinto JM. Fine particulate matter exposure and olfactory dysfunction among urban-dwelling older US adults. Environ Res 2016; 151:797-803. [PMID: 27692900 PMCID: PMC5554594 DOI: 10.1016/j.envres.2016.09.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/16/2016] [Indexed: 05/03/2023]
Abstract
OBJECTIVES The olfactory nerve is anatomically susceptible to injury from pollution in inspired air, but there are no large-scale epidemiologic studies investigating this relationship. METHODS Cross-sectional study using data from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling US adults age 57-85 years. Olfactory function was tested using a validated 5-item odor identification test (Sniffin' Sticks). Exposure to fine particulate matter (PM2.5) at each respondent's home was estimated as 1-12 month moving averages prior to olfactory assessment using validated spatio-temporal models. RESULTS Olfactory dysfunction was significantly associated with PM2.5 exposures averaged over 3-12 months in urban-dwelling respondents. The strongest effect was for 6 month average exposure (per 1-IQR increase in PM2.5: OR 1.28, 95% CI 1.05, 1.55) adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and the season. Interestingly, the most deleterious effects were observed among the youngest respondents, 57-64 years old, and those living in the northeast and south. CONCLUSIONS We show for the first time that air pollution exposure is associated with poor olfaction among urban-living, older US adults.
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Affiliation(s)
- Gaurav S Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Helen H Suh
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - David W Kern
- Department of Comparative Human Development and the Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - L Philip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Martha K McClintock
- Department of Comparative Human Development and the Institute for Mind and Biology, The University of Chicago, Chicago, IL, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, IL, USA.
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Lee WW, Alkureishi MA, Ukabiala O, Venable LR, Ngooi SS, Staisiunas DD, Wroblewski KE, Arora VM. Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study. J Gen Intern Med 2016; 31:1315-1322. [PMID: 27400921 PMCID: PMC5071284 DOI: 10.1007/s11606-016-3774-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/27/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. OBJECTIVE We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. DESIGN This was a prospective mixed-methods study. PARTICIPANTS Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. APPROACH In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. RESULTS In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. CONCLUSIONS Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors "physical focus" when using the EMR to redirect towards the patient.
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Affiliation(s)
- Wei Wei Lee
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA.
| | | | - Obioma Ukabiala
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Laura Ruth Venable
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
| | - Samantha S Ngooi
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
| | - Daina D Staisiunas
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
| | | | - Vineet M Arora
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
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Adams DR, Ajmani GS, Pun VC, Wroblewski KE, Kern DW, Schumm LP, McClintock MK, Suh HH, Pinto JM. Nitrogen dioxide pollution exposure is associated with olfactory dysfunction in older U.S. adults. Int Forum Allergy Rhinol 2016; 6:1245-1252. [PMID: 27620703 DOI: 10.1002/alr.21829] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Olfactory dysfunction has profound effects on quality of life, physical and social function, and mortality itself. Nitrogen dioxide (NO2 ) is a pervasive air pollutant that is associated with respiratory diseases. Given the olfactory nerve's anatomic exposure to airborne pollutants, we investigated the relationship between NO2 exposure and olfactory dysfunction. METHODS The ability to identify odors was evaluated using a validated test in respondents from the National Social Life, Health, and Aging Project (NSHAP), a representative probability sample of home-dwelling, older U.S. adults age 57 to 85 years. Exposure to NO2 pollution was assessed using measurements obtained from the U.S. Environmental Protection Agency (EPA) Aerometric Information Retrieval System (AIRS) ambient monitoring site closest to each respondent's home. We tested the association between NO2 exposure and olfactory dysfunction using multivariate logistic regression. RESULTS Among older adults in the United States, 22.6% had impaired olfactory function, defined as ≤3 correct (out of 5) on the odor identification test. Median NO2 exposure during the 365 days prior to the interview date was 14.7 ppb (interquartile range [IQR], 10.8 to 19.7 ppb). An IQR increase in NO2 exposure was associated with increased odds of olfactory dysfunction (OR, 1.35; 95% CI, 1.07 to 1.72), adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and season of the home interview (n = 1823). CONCLUSION We show for the first time that NO2 exposure is associated with olfactory dysfunction in older U.S. adults. These results suggest an important role for NO2 exposure on olfactory dysfunction, and, potentially, nasal disease more broadly.
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Affiliation(s)
- Dara R Adams
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Gaurav S Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Vivian C Pun
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
| | | | - David W Kern
- Department of Psychology, Northeastern Illinois University, Chicago, IL
| | - L Philip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Martha K McClintock
- Department of Comparative Human Development and the Institute for Mind and Biology, The University of Chicago, Chicago, IL
| | - Helen H Suh
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, IL
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Correia C, Lopez KJ, Wroblewski KE, Huisingh-Scheetz M, Kern DW, Chen RC, Schumm LP, Dale W, McClintock MK, Pinto JM. Global Sensory Impairment in Older Adults in the United States. J Am Geriatr Soc 2016; 64:306-313. [PMID: 26889840 DOI: 10.1111/jgs.13955] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether there may be a common mechanism resulting in global sensory impairment of the five classical senses (vision, smell, hearing, touch, and taste) in older adults. DESIGN Representative, population-based study. SETTING National Social Life, Health, and Aging Project. PARTICIPANTS Community-dwelling U.S. adults aged 57 to 85. MEASUREMENTS The frequency with which impairment co-occurred across the five senses was estimated as an integrated measure of sensory aging. It was hypothesized that multisensory deficits would be common and reflect global sensory impairment that would largely explain the effects of age, sex, and race on sensory dysfunction. RESULTS Two-thirds of subjects had two or more sensory deficits, 27% had just one, and 6% had none. Seventy-four percent had impairment in taste, 70% in touch, 22% in smell, 20% in corrected vision, and 18% in corrected hearing. Older adults, men, African Americans, and Hispanics had greater multisensory impairment (all P < .01). Global sensory impairment largely accounted for the effects of age, sex, and race on the likelihood of impairment in each of the five senses. CONCLUSION Multisensory impairment is prevalent in older U.S. adults. These data support the concept of a common process that underlies sensory aging across the five senses. Clinicians assessing individuals with a sensory deficit should consider further evaluation for additional co-occurring sensory deficits.
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Sivam A, Wroblewski KE, Alkorta-Aranburu G, Barnes LL, Wilson RS, Bennett DA, Pinto JM. Olfactory Dysfunction in Older Adults is Associated with Feelings of Depression and Loneliness. Chem Senses 2016; 41:293-9. [PMID: 26809485 PMCID: PMC5006107 DOI: 10.1093/chemse/bjv088] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Olfactory dysfunction is a common complaint among physician visits. Olfactory loss affects quality of life and impairs function and activities of daily living. The purpose of our study was to assess the degree of odor identification associated with mental health. Olfactory function was measured using the brief smell identification test. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale. Loneliness was assessed by the de Jong-Gierveld Loneliness Scale. Cognition was measured by a battery of 19 cognitive tests. The frequency of olfactory dysfunction in our study was ~40%. Older subjects had worse olfactory performance, as previously found. More loneliness was associated with worse odor identification. Similarly, symptoms of depression were associated with worse olfaction (among men). Although better global cognitive function was strongly associated with better odor identification, after controlling for multiple factors, the associations with depression and loneliness were unchanged. Clinicians should assess these mental health conditions when treating older patients who present with olfactory deficits.
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Affiliation(s)
- Anita Sivam
- Scripps Mercy Hospital, 4077 5th Avenue, San Diego, CA 92103, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Gorka Alkorta-Aranburu
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, 5841 S. Maryland Ave MC 1035, Chicago, IL 60637, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612, USA and
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612, USA and
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612, USA and
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, 5841 S. Maryland Ave MC 1035, Chicago, IL 60637, USA, Center on the Demography and Economics of Aging, The University of Chicago, 1155 E. 60th Street, Suite 341, Chicago, IL 60637, USA
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Pinto JM, Wroblewski KE, Kern DW, Schumm LP, McClintock MK. The Rate of Age-Related Olfactory Decline Among the General Population of Older U.S. Adults. J Gerontol A Biol Sci Med Sci 2015; 70:1435-41. [PMID: 26253908 DOI: 10.1093/gerona/glv072] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/24/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Age-related olfactory loss (presbyosmia) is a prevalent sensory impairment with a large public health impact. In cross-sectional analyses, we found striking health disparities in olfactory function among older U.S. adults. Here, we report a 5-year follow-up to determine the magnitude of within-person olfactory decline. METHODS The National Social Life, Health, and Aging Project (NSHAP) interviewed a probability sample of home-dwelling older U.S. adults (57-85 years) in 2005-2006 (Wave 1) and reinterviewed them in 2010-2011 (Wave 2), assessing demographics, social life, and health, including olfaction. Odor identification was measured with a 5-item version of the Sniffin' Sticks (0-5 correct). Fourteen hundred and thirty-six respondents provided olfaction data in both waves. Multivariate linear and logistic regression were used to model the association between change in olfactory performance and demographic, health, and psychosocial factors. RESULTS Odor identification declined most rapidly among older individuals (0.25 additional errors per 5 years for each decade of age, p < .001) and in men (0.17 additional errors per 5 years compared to women, p = .005). Among those with perfect scores in Wave 1, African Americans declined more rapidly than Whites (p = .04). Neither socioeconomic status, health conditions, cognition, mental health, alcohol use nor smoking was associated with change in olfaction (p > .05, all). CONCLUSIONS The rate of olfactory decline increases with age and is greater among men than women despite adjusting for differences in psychosocial and health conditions, indicating physiologic factors as drivers. African Americans are more likely to experience initial olfactory decline, consistent with an earlier onset of aging among this subgroup.
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Affiliation(s)
- Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery,
| | | | - David W Kern
- Department of Comparative Human Development and Institute for Mind and Biology, The University of Chicago, Illinois
| | | | - Martha K McClintock
- Department of Comparative Human Development and Institute for Mind and Biology, The University of Chicago, Illinois
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Thurber BW, Carmody D, Tadie EC, Pastore AN, Dickens JT, Wroblewski KE, Naylor RN, Philipson LH, Greeley SAW. Age at the time of sulfonylurea initiation influences treatment outcomes in KCNJ11-related neonatal diabetes. Diabetologia 2015; 58:1430-5. [PMID: 25877689 PMCID: PMC4641523 DOI: 10.1007/s00125-015-3593-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/27/2015] [Indexed: 12/28/2022]
Abstract
AIMS/HYPOTHESIS Individuals with heterozygous activating mutations of the KCNJ11 gene encoding a subunit of the ATP-sensitive potassium channel (KATP) can usually be treated with oral sulfonylurea (SU) pills in lieu of insulin injections. The aim of this study was to test our hypothesis that younger age at the time of initiation of SU therapy is correlated with lower required doses of SU therapy, shorter transition time and decreased likelihood of requiring additional diabetes medications. METHODS We performed a retrospective cohort study using data on 58 individuals with neonatal diabetes due to KCNJ11 mutations identified through the University of Chicago Monogenic Diabetes Registry ( http://monogenicdiabetes.uchicago.edu/registry ). We assessed the influence of age at initiation of SU therapy on treatment outcomes. RESULTS HbA1c fell from an average of 8.5% (69 mmol/mol) before transition to 6.2% (44 mmol/mol) after SU therapy (p < 0.001). Age of initiation of SU correlated with the dose (mg kg(-1) day(-1)) of SU required at follow-up (r = 0.80, p < 0.001). Similar associations were observed across mutation subtypes. Ten participants required additional glucose-lowering medications and all had initiated SU at age 13 years or older. No serious adverse events were reported. CONCLUSIONS/INTERPRETATION Earlier age at initiation of SU treatment is associated with improved response to SU therapy. Declining sensitivity to SU may be due to loss of beta cell mass over time in those treated with insulin. Our data support the need for early genetic diagnosis and appropriate personalised treatment in all cases of neonatal diabetes.
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Affiliation(s)
- Brian W. Thurber
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - David Carmody
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Elizabeth C. Tadie
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Ashley N. Pastore
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Jazzmyne T. Dickens
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | | | - Rochelle N. Naylor
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Louis H. Philipson
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
| | - Siri Atma W. Greeley
- Departments of Medicine and Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes, & Metabolism, University of Chicago, Chicago, IL, USA
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Kern DW, Schumm LP, Wroblewski KE, Pinto JM, Hummel T, McClintock MK. Olfactory thresholds of the U.S. Population of home-dwelling older adults: development and validation of a short, reliable measure. PLoS One 2015; 10:e0118589. [PMID: 25768291 PMCID: PMC4359123 DOI: 10.1371/journal.pone.0118589] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/21/2015] [Indexed: 11/23/2022] Open
Abstract
Current methods of olfactory sensitivity testing are logistically challenging and therefore infeasible for use in in-home surveys and other field settings. We developed a fast, easy and reliable method of assessing olfactory thresholds, and used it in the first study of olfactory sensitivity in a nationally representative sample of U.S. home-dwelling older adults. We validated our method via computer simulation together with a model estimated from 590 normosmics. Simulated subjects were assigned n-butanol thresholds drawn from the estimated normosmic distribution and based on these and the model, we simulated administration of both the staircase and constant stimuli methods. Our results replicate both the correlation between the two methods and their reliability as previously reported by studies using human subjects. Further simulations evaluated the reliability of different constant stimuli protocols, varying both the range of dilutions and number of stimuli (6–16). Six appropriately chosen dilutions were sufficient for good reliability (0.67) in normosmic subjects. Finally, we applied our method to design a 5-minute, in-home assessment of older adults (National Social Life, Health and Aging Project, or NSHAP), which had comparable reliability (0.56), despite many subjects having estimated thresholds above the strongest dilution. Thus, testing with a fast, 6-item constant stimuli protocol is informative, and permits olfactory testing in previously inaccessible research settings.
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Affiliation(s)
- David W. Kern
- Institute for Mind and Biology and Department of Comparative Human Development, The University of Chicago, Chicago, IL, United States of America
- * E-mail:
| | - L. Philip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States of America
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States of America
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, IL, United States of America
| | - Thomas Hummel
- Interdisciplinary Center Smell & Taste, ENT Clinic, TU Dresden, Germany
| | - Martha K. McClintock
- Institute for Mind and Biology and Department of Comparative Human Development, The University of Chicago, Chicago, IL, United States of America
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Ajmani GS, Wroblewski KE, Naclerio RM, Baroody FM, Pinto JM. Allergy and Asthma Medication Use in US Older Adults: Insights from the National Social Life, Health, and Aging Project. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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