Do Divine Struggles Moderate the Association Between Interpersonal Conflict at Work and Worker Well-Being in Singapore?

The purpose of this study is to examine how divine struggles moderate the association between interpersonal workplace conflict and worker well-being in Singapore. Using data from the Work, Religion, and Health survey (2021), the analyses show that interpersonal workplace conflict is positively associated with psychological distress and negatively associated with job satisfaction. Although divine struggles fail to function as a moderator in the former, these moderate its association in the latter. Specifically, the negative association between interpersonal conflict at work and job satisfaction is stronger for those with higher levels of divine struggles. These findings support the idea of stress amplification, indicating that troubled relationships with God may exacerbate the deleterious psychological effects of antagonistic interpersonal relationships at work. Ramifications of this aspect of religion, job stressor, and worker well-being will be discussed.

How Helping You Helps Me: A Longitudinal Analysis of Volunteering and Pathways to Quality of Life Among Older Adults in Singapore

OBJECTIVES

Volunteering is known to be associated with well-being among older adults. However, less is known about the psychosocial pathways (e.g., personal mastery, social support) through which this occurs, with past studies tending to rely on cross-sectional data, which are susceptible to selection biases. This study, using longitudinal data, investigates how formal and informal volunteering may affect older adults' quality of life through personal mastery, perceived social support, and received social support.

METHODS

Data are from 2 waves of a nationally representative study of older adults aged 60 years and older in Singapore, conducted between 2016 and 2019 (N = 2,887). We estimate indirect effects using a 2-wave mediation model, relying on bootstrapped confidence intervals for significance testing.

RESULTS

We find indirect effects from volunteering to quality of life through perceived social support and personal mastery, but not through received social support. While any type (formal/informal) and frequency (regular/nonregular) of volunteering promotes quality of life through perceived social support, indirect effects through personal mastery are limited to regular volunteering in formal settings.

DISCUSSION

Results provide longitudinal evidence for perceived social support as a key pathway from volunteering to quality of life. Volunteering may be an effective way to improve quality of life by helping older adults feel more supported, even if it may not affect the actual help that they receive. Further, a structured and sustainable environment may be required for volunteering to promote personal mastery (and through it, quality of life) among older volunteers.

Exploring Rural-Urban Differences in the Association Between Internet Use and Cognitive Functioning Among Older Adults in China

OBJECTIVES

We examine rural-urban differences between internet use and cognitive functioning among older Chinese adults and the mediating role of perceived social support networks across rural and urban areas.

METHODS

Data were from the 2016 and 2018 waves of the Chinese Longitudinal Aging Social Survey (N = 9,591). Ordinary least squares regression and mediation analyses were used to examine the specific hypotheses.

RESULTS

General internet use was significantly associated with improved cognitive functioning among older adults in the overall sample. Social support networks mediated the relationship between general internet use and cognitive functioning, but only for older adults living in rural areas. After disaggregating internet use into specific online activities, watching shows was associated with better cognitive functioning for older adults living in urban areas. For those in rural areas, chatting was positively associated with cognitive functioning, while playing games was negatively associated with cognitive functioning.

DISCUSSION

We showed that social support mediates the relationship between internet use and cognitive functioning differently in rural and urban areas. Cognitive benefits derived from specific types of online activities also depend on their residence. These findings suggest that efforts aimed at improving internet use among rural older adults may be more fruitful if they focus on building social opportunities for older adults.

Older Adults' and Family Caregivers' Technological Arrangements on Risk of Institutionalization

Internet-enabled resources could facilitate older adults' ability to live in the community longer, but studies have often overlooked how family caregivers utilize the internet to assist older care recipients. We examined whether different family-level arrangements of internet use may affect the risk of institutionalization among older adults. Using the National Health and Aging Trends Study (2015-2020) and National Study on Caregiving (2015), we estimated multinominal logistic regression and inverse-probability weighted Cox proportional hazard models to investigate the determinants of technological arrangements in 2015 (i.e., no internet use, only caregiver use, only care recipient use, both caregiver and care recipient internet use) and how they may affect the risk of moving to an assisted living or nursing facility between 2015 and 2020. The most prevalent technological arrangement in 2015 was the one where neither the care recipient nor their caregiver reported using the internet. Relatively disadvantaged older care recipients (e.g., people of color, fewer years of education, less income, worse cognitive functioning) and caregivers (e.g., older, fewer years of education) were more likely to be in a non-internet use arrangement. Compared to older adults in other categories, older adults who were internet users and had a family caregiver who also used the internet in their caregiving tasks had a much lower risk of relocation during the study period. Findings suggest that digital interventions aimed at serving the older adult population should assess the gap in access and utilization at a family level and consider the role of older adults' social partners.

Older Adults With Functional Limitations and Their Use of Telehealth During COVID-19

We investigated the association between functional limitations and telehealth use among older Medicare beneficiaries in 2020. We use logistic regression models to estimate associations between functional limitations and the use of technological tools (i.e., computers, Internet, telehealth). We consider Internet use and informal technological support as moderators for telehealth use. Respondents (N = 3151; Mage = 78.31) with more functional limitations were more likely to use video-based telehealth. Net of functional limitations, those with a consistent Internet use were more likely to use emails/texts/portal messages to communicate with a healthcare provider. Further, more functional limitations were associated with a higher probability of using emails/texts/portal messages, but only among respondents who received informal technological support. Healthcare access may have been more difficult for older adults with functional limitations during the COVID-19 pandemic, especially for those with little prior experience with the Internet, or those without friends/family to provide technological support.

Volunteering, religiosity, and quality of life in later life: evidence from Singapore

OBJECTIVES

We examine the association of the frequency of formal and informal volunteering with quality of life (QoL) among older adults in Singapore. We also assess if private (private prayer) or public (religious service attendance) aspects of personal religiosity moderate this association. In examining the moderating role of religiosity, we adjudicate between two competing theoretical views-the value-congruence and resource-compensation perspectives.

METHODS

Ordinary least squares regression models were estimated using cross-sectional data from a national survey of older Singaporeans, aged 60 and above, in 2016.

RESULTS

The frequency of both informal and formal volunteering was associated with better QoL. While private prayer did not moderate this association, religious attendance did-the positive association was stronger among those attending religious services less frequently.

CONCLUSION

Volunteering is beneficial for well-being in later life, especially so for older adults with less religious service attendance. These observations dovetail with the resource-compensation perspective, underscoring that the benefits of volunteering are amplified for older adults who are less integrated into their religious congregations. Hence, targeting those with lower levels of religious attendance might be useful in maximizing the benefits experienced by older volunteers.

TRAJECTORIES OF INFORMAL AND FORMAL SOCIAL PARTICIPATION AFTER RETIREMENT

Literature suggests that social participation, a component of successful ageing, declines on average after retirement, but to whom does this experience apply? We sought to identify contrasting longitudinal trajectories of social participation after retirement, and their associated individual-level correlates. Seven waves of the Korean Longitudinal Study of Ageing provided data on the informal and formal social participation, measured by frequencies of meeting a friend and attending a group respectively, of individuals 45 years and older who left work. Group-based trajectory modeling captured heterogenous changes over time in social participation after retirement. Multinomial logit regressions estimated individual-level correlates of the trajectories, including whether the individual returns to work. While a sizeable minority of respondents did experience decreasing trajectories of informal (17%) and formal (23%) participation, a majority exhibited stable trajectories of either type of social participation, and some experienced increasing formal (9%) participation. Employment type, age, gender, education, marital status, region, health, and economic satisfaction were associated with the trajectories. Returning to work, versus stopping work for an extended period, was associated with moderate stable or increasing trajectories of social participation. The findings challenge the belief that decline in social participation is the norm after retirement. They underscore the presence of heterogenous experiences of social participation after retirement, and identify vulnerable sub-groups that do experience decline. Furthermore, as returning to work may be beneficial for social participation, future studies should examine ways in which bridge employment can support successful aging.

Internet use and cohort change in social connectedness among older adults

Social connections are an integral part of living in society, and trends in social connectedness are thus closely scrutinized. The phenomenon of networked individualism argues that densely knit communities organized around formal social groups such as households and workplaces are becoming less common. Due to advances in technology, individuals are able to develop personalized communities that are more diverse and less geographically-bound. The objective of this study was to determine how both average levels and the variability of social connectedness have changed across cohorts, and how much of this is due to increased internet use. Data from 2006, 2008, 2016, and 2018 waves of the Health and Retirement Study were used to investigate cohort changes in various indicators of social connectedness. The analytical sample consisted of older adults aged 58-69 from the Silent Generation (born 1920-1947) and Baby Boomers (born 1948-1965). Heteroscedastic regression models and decomposition methods were used to investigate the role of increased internet use in driving some of these changes. Findings suggest that increases in internet use was associated with increases in the variance of social participation (i.e., contact with friends and family) in the United States. However, evidence around more subjective measures of social connectedness (i.e., social support, loneliness) was less clear. Future research should seek to understand how cohort change in technological use may affect objective and subjective aspects of social connectedness in different ways.

Receiving Social Support From Diverse Helpers: Associations With Quality of Life

More older adults now live in non-family-based households, even as the provision of support to older adults within the domestic setting becomes more salient. This study examines the determinants of having non-immediate family or non-coresident helpers in older adults' received social support networks, and its associations with quality of life. Data were from a nationally representative study of Singaporeans aged 60 and above (N = 2248) who did not live alone. Findings show that those who received help solely from persons other than their spouse or child report a lower quality of life compared to other kinds of networks. However, those who had more non-coresident helpers than co-resident helpers experienced a higher quality of life compared to those who relied mainly on co-resident helpers. We suggest that policymakers should consider supporting a wider range of informal social support arrangements and providers, as networks of received social support become increasingly diverse.

Is the Effect Larger in Group A or B? It Depends: Understanding Results From Nonlinear Probability Models

Demographers and other social scientists often study effect heterogeneity (defined here as differences in outcome-predictor associations across groups defined by the values of a third variable) to understand how inequalities evolve between groups or how groups differentially benefit from treatments. Yet answering the question "Is the effect larger in group A or group B?" is surprisingly difficult. In fact, the answer sometimes reverses across scales. For example, researchers might conclude that the effect of education on mortality is larger among women than among men if they quantify education's effect on an odds-ratio scale, but their conclusion might flip (to indicate a larger effect among men) if they instead quantify education's effect on a percentage-point scale. We illuminate this flipped-signs phenomenon in the context of nonlinear probability models, which were used in about one third of articles published in Demography in 2018-2019. Although methodologists are aware that flipped signs can occur, applied researchers have not integrated this insight into their work. We provide formal inequalities that researchers can use to easily determine if flipped signs are a problem in their own applications. We also share practical tips to help researchers handle flipped signs and, thus, generate clear and substantively correct descriptions of effect heterogeneity. Our findings advance researchers' ability to accurately characterize population variation.

The filial piety paradox: Receiving social support from children can be negatively associated with quality of life

RATIONALE

Despite strong norms of filial obligation in Asian countries, little is known about whether child-provided support promotes older adults' well-being.

OBJECTIVE

This study sought to examine whether and how the source (e.g., child/non-child providers) and the form (e.g., financial, instrumental) of received social support are associated with older adults' quality of life.

METHODS

Data are from two waves of a longitudinal survey of older adults in Singapore (N = 2887). Two-wave mediation analyses were conducted to determine associations of the source and form of received social support with quality of life, and the extent to which personal mastery mediated these associations.

RESULTS

We find that, although receiving financial assistance from more children promotes older men's quality of life, older women's quality of life is eroded when receiving housework help from more children. These relationships are partially mediated through increase (for men) or decline (for women) in personal mastery.

CONCLUSIONS

The findings suggest that both the form and source of help provided to older adults matter. Receiving social support from children may not always benefit older adults - more attention is needed on how best to support older adults while giving them sufficient control to maintain a high quality of life.

Changing relationships between social contact, social support and depressive symptoms during the COVID-19 pandemic

Objectives

Given the longstanding consensus that social contact can promote older adult well-being, many have focused on how social contact changed during the pandemic. Less is known, however, about whether the link between social contact and health changed during the pandemic. This study sought to understand how associations between social contact, social support, and depressive symptoms changed during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Data from 2 waves of the Health and Retirement Study were used. Respondents reported both virtual and in-person social contact, as well as perceived positive and negative social support. Path models were used to estimate relationships between social contact, social support, and depressive symptoms. Bootstrapping was used to estimate the change in associations between 2016 and 2020.

Results

Estimates show that associations between positive social support and depressive symptoms, as well as between in-person social contact and depressive symptoms, attenuated during the pandemic. Virtual social contact played a relatively minor role in determining outcomes such as social support and depressive symptoms, compared to in-person social contact.

Discussion

Findings suggest that researchers and policymakers should not only focus on the changing quantity of social interactions when events such as the COVID-19 pandemic happen, but also the changing content and efficacy of the social interactions that remain.

Western Australian adolescent emotional wellbeing during the COVID-19 pandemic in 2020

BACKGROUND

The impacts of the COVID-19 pandemic have been vast and are not limited to physical health. Many adolescents have experienced disruptions to daily life, including changes in their school routine and family's financial or emotional security, potentially impacting their emotional wellbeing. In low COVID-19 prevalence settings, the impact of isolation has been mitigated for most young people through continued face-to-face schooling, yet there may still be significant impacts on their wellbeing that could be attributed to the pandemic.

METHODS

We report on data from 32,849 surveys from Year 7-12 students in 40 schools over two 2020 survey cycles (June/July: 19,240; October: 13,609), drawn from a study of 79 primary and secondary schools across Western Australia, Australia. The Child Health Utility Index (CHU9D) was used to measure difficulties and distress in responding secondary school students only. Using comparable Australian data collected six years prior to the pandemic, the CHU9D was calibrated against the Kessler-10 to establish a reliable threshold for CHU9D-rated distress.

RESULTS

Compared to 14% of responding 12-18-year-olds in 2013/2014, in both 2020 survey cycles almost 40% of secondary students returned a CHU9D score above a threshold indicative of elevated difficulties and distress. Student distress increased significantly between June and October 2020. Female students, those in older Grades, those with few friendships or perceived poor quality friendships, and those with poor connectedness to school were more likely to score above the threshold.

CONCLUSIONS

In a large dataset collected during the first year of the COVID-19 pandemic, the proportion of secondary school students with scores indicative of difficulties and distress was substantially higher than a 2013/2014 benchmark, and distress increased as the pandemic progressed, despite the low local prevalence of COVID-19. This may indicate a general decline in social and emotional wellbeing exacerbated by the events of the pandemic.

TRIAL REGISTRATION

ANZCTRN (ACTRN12620000922976). Retrospectively registered 17/08/2020. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380429&isReview=true .

Fear of crime is associated with loneliness among older adults in Singapore: Gender and ethnic differences

Fear of crime is a complex perception and has underlying psychological, social and health repercussions. The influence of fear of crime on psychosocial outcomes, however, may be moderated by various social factors. This study examined how fear of crime influences loneliness among low-income older adults attending a Senior Activity Centre (SAC) in multiethnic Singapore. In addition, we tested whether these associations were moderated by gender and ethnicity. We analysed cross-sectional data (N = 1,266) from The SAC Study, a survey conducted with older adults who were attending a SAC between March 2015 and August 2015. Multilevel models were used to test whether fear of crime was associated with loneliness; and whether the association was moderated by gender and ethnicity. We found that fear of crime was positively associated with loneliness, and that this association was stronger among men than women, but ethnicity did not moderate this relationship. Findings from our study suggest that fear of crime may have a stronger negative effect on men's psychological well-being, even though they report lower fear of crime. This highlights the importance of sociocultural context when examining the psychosocial implications of fear of crime in the population.

Patterns of family support exchange and personal mastery in later life: a longitudinal study

Objectives: The association between family support exchange and personal mastery among older adults remains unclear. The present study addresses this gap.Methods: We utilized two waves of data from the Panel on Health and Ageing of Singaporean Elderly (N = 1398). Latent class analysis was conducted to identify distinct patterns of family support exchange. Regression analysis was then used to assess whether the identified patterns predicted personal mastery four years later.Results: Four and three prevalent patterns of family support exchange emerged for males and females, respectively. Males who received monetary and material support from their kin developed lower personal mastery than those who only received monetary support. Females who provided and received monetary support developed higher personal mastery than those who lacked support exchange.Conclusion: Our latent class approach has captured the reality of family support exchange and thus provided a valid picture of the implication of such exchange for personal mastery. Our data suggest that support provision may elevate personal mastery. This observation is discussed with reference to the self-enhancement perspective and notion of valence of support provision.

Marriage and Union Formation in the United States: Recent Trends Across Racial Groups and Economic Backgrounds

Family formation in the United States has changed dramatically: marriage has become less common, nonmarital cohabitation has become more common, and racial and economic inequalities in these experiences have increased. We provide insights into recent U.S. trends by presenting cohort estimates for people born between 1970 and 1997, who began forming unions between 1985 and 2015. Using Panel Study of Income Dynamics data, we find that typical ages at marriage and union formation increased faster across these recent cohorts than across cohorts born between 1940 and 1969. As fewer people married at young ages, more cohabited, but the substitution was incomplete. We project steep declines in the probability of ever marrying, declines that are larger among Black people than White people. We provide novel information on the intergenerational nature of family inequalities by measuring parental income, wealth, education, and occupational prestige. Marriage declines are particularly steep among people from low-income backgrounds. Black people are overrepresented in this low-income group because of discrimination and opportunity denial. However, marriage declines are larger among Black people than White people across parental incomes. Further, most racial differences in marriage occur among people from similar socioeconomic backgrounds. Family inequalities increasingly reflect both economic inequalities and broader racial inequalities generated by racist structures; in turn, family inequalities may prolong these other inequalities across generations.

Women's Work-Family Histories and Cognitive Performance in Later Life

Long-term exposures to the stress and stimulation of different work, parenting, and partnership combinations might influence later life cognition. We investigated the relationship between women's work-family life histories and cognitive functioning in later life. Analyses were based on data from women born between 1930 and 1957 in 14 European countries, from the Survey of Health, Ageing and Retirement in Europe (2004-2009) (n = 11,908). Multichannel sequence analysis identified 5 distinct work-family typologies based on women's work, partnership, and childrearing statuses between ages 12 and 50 years. Multilevel regressions were used to test the association between work-family histories and later-life cognition. Partnered mothers who mainly worked part-time had the best cognitive function in later life, scoring approximately 0.63 (95% confidence interval (CI): 0.18, 1.07) points higher than mothers who worked full-time on a 19-point scale. Partnered mothers who were mainly unpaid caregivers or who did other unpaid activities had cognitive scores that were 1.19 (95% CI: 0.49, 1.89) and 0.93 (95% CI: 0.20, 1.66) points lower than full-time working mothers. The findings are robust to adjustment for childhood advantage and educational credentials. This study provides new evidence that long-term exposures to certain social role combinations after childhood and schooling are linked to later-life cognition.

Productive Activities and Risk of Cognitive Impairment and Depression: Does the Association Vary by Gender?

We examine how labor together with social participation protects against cognitive impairment and depression, with a focus on gender differences. Data are drawn from four waves of the Korean Longitudinal Study of Aging (2006-2012). Both paid work and unpaid work are considered labor participation. Social participation includes the frequency of participation in formal social institutions, religious groups, grandparenting, and interactions with family and friends. Using growth curve models, we find that social and labor participation are independently associated with outcomes and effects vary by gender. Religious group activity was beneficial only for women, whereas inability to work was detrimental for men only. Informal social gatherings and labor participation, paid or unpaid, were beneficial for both genders. Findings on gender differences highlight how social identities can shape social roles and confine activity space, and productive engagement, affecting outcomes for mental health in later life.

DIGITAL INDEPENDENCE: HEALTH-RELATED DIFFICULTY IN INTERNET USE AND HOW IT AFFECTS OLDER ADULTS’ QUALITY OF LIFE

Using the internet is increasingly a necessity. However, older adults may not do so due to either non-health reasons (e.g., lack of digital literacy or internet access) or health-related reasons. While researchers have studied internet use among older adults, most do not discriminate whether non-use is due to health reasons or otherwise. Recent studies also reveal that older adults use the internet to keep in touch with family and friends, highlighting that limitations in internet use may be detrimental for their well-being. We therefore, examine the key correlates of health-related difficulty in internet use, and how it may affect quality of life by reducing the size of their social support networks. Data were from a national survey of older Singaporeans (n=3966) conducted in 2016-17. Multinomial logistic regression and mediation analysis were used to identify older adult subgroups more likely to experience health-related difficulty in internet use, and whether such difficulty affected older adults’ quality of life through their social support networks. Results showed that males, those of Malay ethnicity, those with less education, and those with more instrumental activity of daily living (IADL) limitations were more likely to experience health-related difficulty in internet use. Social support networks mediated the relationship between health-related difficulty in internet use and quality of life. These findings suggest that other than managing the health conditions of older adults who face health-related difficulty in internet use, offline modes of keeping them socially connected may promote their quality of life.

Going Online to Stay Connected: Online Social Participation Buffers the Relationship Between Pain and Depression

OBJECTIVES

Maintaining offline social participation (i.e., face-to-face social interaction) is key for healthy aging, but older adults who experience pain tend to restrict their social activity outside of the home. The onset of pain may set off a downward spiral where lowered social participation increases the risk of depression and vice versa. This study thus assesses whether online social participation (i.e., the use of online social network sites) moderates the effect of pain on depression, possibly functioning as a compensatory mechanism for reduced offline social participation for those in pain.

METHOD

Logistic regression models with a lagged dependent variable were used with panel data from the National Health and Aging Trends Study. An interaction term was included to assess the moderating effect of online social participation.

RESULTS

We find that online social participation buffers the detrimental effect of pain on depression. However, the effect of pain on online social participation was not statistically significant.

DISCUSSION

Findings show that online social participation can alleviate the negative effects of pain on mental well-being, and suggest that online social participation can supplement attempts to maintain offline social participation in later life, especially for those whose social activity may be limited by pain.

Social Participation and Mortality Among Older Adults in Singapore: Does Ethnicity Explain Gender Differences?

Objectives

Social participation has been consistently associated with lower risk of all-cause mortality, but studies have been ambivalent about how this association differs between men and women. The present study investigates if ethnicity accounts for gender differences in (a) the types of social activities older adults participate in and (b) the association between social participation and 4-year mortality.

Methods

Data from 4,482 Singaporean older adults who participated in a nationally representative longitudinal survey were analyzed. Stepwise logistic regressions and Cox proportional hazard models with inverse probability of treatment weights were used.

Results

Men were more likely to engage in social activities compared with women, but this gender difference varied by ethnicity for three activities. Whereas going out to eat was associated with a lower risk of mortality for men only, playing sports was found to be protective for women only, but these associations did not vary by ethnicity.

Discussion

Findings suggest that although ethnicity may account for gender differences in the content of social activity participation, it does not explain gender differences in the association between social participation and mortality. More consideration should be given to whether each activity provides an appropriate milieu for the social interaction of each gender.

Intersectional cohort change: Disparities in mobility limitations among older Singaporeans

Mobility is fundamental to independent living, but past research on physical function and mobility in older adults has not considered both intersectional social identities and cohort change in tandem. This paper utilizes data on mobility limitations from older adults in multi-ethnic Singapore to test whether cohort change varies simultaneously by gender and ethnicity. Panel data (n = 9334 person-years) collected over six years (2009-2015) were used to estimate aging vector models. Findings show that after adjusting for all covariates, Malay and Indian males in later-born cohorts have an increased number of mobility limitations compared to earlier-born cohorts. While a similar trend was also found for Chinese males and females in unconditional models, these were fully mediated by sociodemographic and health variables. These results highlight the importance of considering cohort change at the intersection of gender and ethnicity, bringing attention to possible inequities between ethnic groups.

Family reciprocity of older Singaporeans

Reciprocity is a powerful motivation in social life. We study what older people give to their family for help received. Data are from the Panel on Health and Aging of Singaporean Elderly, Wave 2 (2011; persons aged 62+; N = 3103). Giving and receiving help are with family members other than spouse in the same household, in the past year. Types of help given and received are money, food/clothes/other material goods, housework/cooking, babysitting grandchildren, emotional support/advice, help for personal care, and help for going out. Multivariate models predict each type of giving help, with independent variables about the older person's resources, needs, and help received. Reciprocity is demonstrated by positive relationships between receiving and giving help. Results show two kinds of reciprocity: "nontangibles for tangibles" and "same for same." First, older people give their time and effort in return for money and material goods. This aligns with contemporary Singapore circumstances, in that older people tend to have ample time but limited financial resources, while family members (often midlife children) have the reverse. Second, same-for-same exchanges, such as housework both given and received, are shared tasks in families or normative behaviors in Singapore society. The results replicate and extend prior ones for Singapore. We discuss prospects for change in frequency and shape of family reciprocity as the state continues to modernize.

Social participation and health over the adult life course: Does the association strengthen with age?

RATIONALE

Studies have consistently found positive associations between social participation and health, but it is unclear if they vary across the life course. Younger individuals are likely to initiate and benefit from social participation in different ways from older individuals, which may in turn alter its overall influence on health outcomes. Age-varying associations, if present, may then attenuate or amplify the health consequences stemming from changes in social participation over the adult life course.

OBJECTIVE

To assess the strength of the association between social participation and health across the life course, and whether it increases with age.

METHODS

I use five waves of panel data (N = 11202 person-year observations) from the Americans' Changing Lives Survey, collected over 25 years (1986-2011), to examine the association of formal and informal social participation with (1) the number of chronic health conditions and (2) depressive symptoms, focusing on whether these associations become stronger with age. Growth curve models (stratified by gender) with an accelerated longitudinal design were used to construct age trajectories of the dependent variables. An interaction term was then included to test for age-varying effects for each health outcome.

RESULTS

Results show that the association between formal social participation and depressive symptoms grew stronger with age, but only for men. For women, positive associations between social participation and health were found, but seemed to remain consistent over the life course.

CONCLUSION

Findings suggest that the social participation and health association over the life course is likely to be contingent on gender, the type of social participation, and the specific health outcome being considered.

Expressive social support buffers the impact of care-related work interruptions on caregivers' depressive symptoms

OBJECTIVE

To assess if expressive and instrumental social support from family and friends moderate the association of care-related work interruptions (e.g. leaving work for the older adult's doctor appointment) with depressive symptoms among working family caregivers of older adults.

METHODS

Data were from the Singapore Survey on Informal Caregiving (SSIC). A subsample of 662 dyads, each comprising an older care-recipient [home-dwelling Singaporean aged 75 and older receiving human assistance for at least one activity of daily living (ADL)] and his/her working family caregiver, was analysed. Caregiver depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Care-related work interruptions were scaled through the Mokken scaling procedure. Expressive social support was assessed using a scale by Pearlin and co-workers. Instrumental social support was based on the hours of ADL help provided to the care-recipient by any family member or friend, on behalf of the primary caregiver. A linear regression model, with interaction terms, assessed expressive and instrumental social support as moderators of the association of care-related work interruptions with caregiver depressive symptoms.

RESULTS

More care-related work interruptions were associated with more caregiver depressive symptoms. And, this association was moderated by expressive, but not instrumental, social support.

CONCLUSION

Our findings conform to previous qualitative work suggesting that caregivers' mental health may not benefit from instrumental support, but from receiving expressive support instead. Initiatives for improving the care experience of working caregivers of older adults should focus on promoting expressive support from their friends and family.

How Social Participation Benefits the Chronically Ill: Self-Management as a Mediating Pathway

Objective: Few studies have tested the purported causal mechanisms between social participation and health, especially among those in poor health. This study aimed to determine whether self-management of chronic disease operates as a pathway through which social participation affects health-related quality of life. Method: I utilized causal mediation analysis among 600 low-income older Singaporeans living with chronic conditions, to test whether self-management mediates the association between social participation and health-related quality of life. Results: Results show that self-management fully mediated the positive effect of informal social participation on health-related quality of life. Formal social participation was found to have a negative direct effect on health-related quality of life. Discussion: These findings reiterate the primacy of family and friends for older adults, but highlight that a better understanding of formal engagement with the low-income population is still needed.

Normative Values of Hand Grip Strength for Elderly Singaporeans Aged 60 to 89 Years: A Cross-Sectional Study

OBJECTIVES

What are normative values for hand grip strength (HGS) for elderly Singaporeans? Which elderly characteristics influence the normative values of HGS for elderly Singaporeans?

DESIGN

Nationally representative, cross-sectional observational study.

SETTING

Singapore.

PARTICIPANTS

A total of 2664 community-dwelling elderly Singaporeans aged 60 to 89 years.

MEASUREMENTS

HGS was measured in a standing position with elbows extended twice for each hand; a Smedley spring-type dynamometer was used. Elderly characteristics known to affect HGS, including age, sex, hand dominance, height, weight, occupation, education, and ethnicity, were also assessed.

RESULTS

We present single-year age, sex-, and hand-specific graphs for normative values (5th, 20th, and 50th percentiles) of HGS. The influence of specific elderly characteristics on the normative values of HGS varies by sex, hand, and considered percentile. We present equations for considered percentiles of HGS that account for such influences.

CONCLUSIONS

This study uses a large, nationally representative sample to establish normative values for HGS for elderly Singaporeans aged 60 to 89 years. These results will facilitate the interpretation of HGS measurements conducted using Smedley spring-type dynamometers in clinical and research settings in Singapore, and potentially other Asian countries.

Preliminary assessment of the SensiumVitals®: A low-cost wireless solution for patient surveillance in the general wards

This paper presents SensiumVitals(®) - an FDA cleared and CE marked wireless wearable vital signs monitoring system, developed for frequent surveillance of in-hospital patients. A number of in-house evaluations with artificial data and healthy volunteers were carried out in different stages to assess the reliability of two crucial vital signs measured by the system - respiration and heart rate. In order to illustrate the potential of the system in hospital, a subset of data collected from acutely-ill patients during a separate clinical trial was also analyzed. In all cases the results revealed satisfactory agreement between the values reported by SensiumVitals(®) and those recorded simultaneously by a clinically-approved bedside monitor. However, further work will be required to improve the reliability of the system under certain clinical conditions; which, although not crucial for our intended population (i.e. patients in general ward), pose interesting challenges for upgrading our technology for future use in these types of patients.

Association of received social support with depressive symptoms among older males and females in Singapore: Is personal mastery an inconsistent mediator?

RATIONALE

Personal mastery has been shown to be a mediator of the relationship between perceived social support and depressive symptoms. Less is known about its role in the context of received social support. While there is some evidence that received social support may improve one's sense of personal mastery, other studies highlight that received social support may induce dependence and lower one's sense of personal mastery. In addition, less is known about structural factors such as gender that may alter this relationship.

OBJECTIVE

To examine gender differences in how personal mastery mediates the relationship between received social support and depressive symptoms.

METHODS

Using data from a nationally representative study of community dwelling older adults in Singapore, we test the hypothesis that personal mastery is an inconsistent mediator of the received social support-depressive symptoms association using mediation analysis and that gender is associated with this inconsistent mediation.

RESULTS

We find support for our hypothesis of personal mastery as an inconsistent mediator, and observe both the direct and indirect effects of received social support on depressive symptoms to be stronger in females than in males.

CONCLUSION

Depressive symptoms for females may be more sensitive to received social support than males, which may be due to gendered pathways and expectations of support. This study highlights the need to further examine both the beneficial and detrimental effects of received social support on psychological health in tandem, considering the effect of mediating variables such as personal mastery to understand its nuanced pathways.

Infliximab reverses inflammatory muscle wasting (sarcopenia) in Crohn's disease

BACKGROUND

Muscle wasting or sarcopenia arising from chronic inflammation is found in 60% of patients with Crohn's disease. Transcriptional protein NF-κB reduces muscle formation through MyoD transcription and increases muscle breakdown by proteolysis.

AIM

As TNF is a potent activator of NF-κB, and anti-TNF agent infliximab (IFX) prevents NF-κB activation, to determine whether or not Crohn's patients treated with IFX gain muscle volume and strength.

METHODS

We performed a prospective, repeated-measures cohort study in adult Crohn's disease patients with an acute disease flare. Patients were instructed not to vary diet or activity. Concomitant medications were kept stable. At week 1 (pre-treatment), week 16 (post-IFX induction) and week 25 (post-first IFX maintenance dose), we assessed (i) MRI volume of quadriceps femoris at anatomical mid-thigh; (ii) maximal concentric quadriceps contractions strength at three specific speeds of contraction; (iii) physical activity by validated instrument (IPAQ); (iv) Three-day food record of intake and composition (food-weighing method); (v) Serum levels of IL6.

RESULTS

Nineteen patients (58% female; mean age 33.2 ± 10.7 years) were recruited. IFX increased muscle volume in both legs from baseline (right, 1505 cm(3) ) to week 25 (right, 1569 cm(3) ; P = 0.010). IFX also increased muscle strength in both legs from baseline (right 30°/s, 184.8 Nm) to week 25 (right 30°/s, 213.6 Nm; P = 0.002). Muscle volume gain correlated with male gender (P = 0.003). Significant gains in muscle volume and strength were unrelated to prednisolone use. Serum IL6 levels decreased by week 25 (P = 0.037).

CONCLUSION

The anti-TNF agent infliximab reverses inflammatory sarcopenia in patients with Crohn's disease.

The Singapore liver cancer recurrence (SLICER) score for relapse prediction in patients with resected hepatocellular carcinoma

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Background: Hepatocellular carcinoma (HCC) is a common worldwide cancer associated with extremely poor survival, with surgery the only option for cure in patients with localized disease. Current prognostic models for HCC are algorithms developed on datasets of mainly patients with metastatic or unresectable cancer, and may be less relevant to resectable HCC. Nomograms provide individualized outcome estimates. We constructed a postoperative nomogram, the Singapore liver cancer recurrence (SLICER) score, to predict outcomes of HCC patients who have undergone surgical resection.

Methods: Records for Singaporean patients undergoing first-line curative surgery for localized HCC in one institution between 1992 and 2007 were retrospectively reviewed (n=405). Freedom from relapse (FFR) was the primary outcome measure. An outcome-blinded modeling strategy including clustering, data reduction and transformation, was used. Calibration was tested with bootstrapping (n=200). We compared the performance of this model with other alternative models including CLIP, CUPI, BCLC, and Okuda scores using c-indices and likelihood analysis.

Results: A nomogram (SLICER score) predicting FFR was designed, incorporating vascular invasion, tumor size, multifocality, ECOG status, pre-operative AFP, Childs-Pugh score and cirrhosis. Bootstrap estimates show good calibration at 1, 2, 3, and 5 years postsurgery Comparison of the SLICER score with alternative prognostic models shows superior performance (Table).

Conclusions: The SLICER score enables individualized relapse predictions for patients following curative resection of localized HCC. It permits optimal patient selection for adjuvant therapy trials, biomarker development, and individual counseling.

[Table: see text]

No significant financial relationships to disclose.

Severity of CIND and MCI predict incidence of dementia in an ischemic stroke cohort

BACKGROUND

The utility of poststroke cognitive status, namely dementia, cognitive impairment no dementia (CIND), mild cognitive impairment (MCI), and no cognitive impairment (NCI), in predicting dementia has been previously examined. However, no studies to date have compared the ability of subtypes of MCI and CIND to predict dementia in a poststroke population.

METHODS

A cohort of ischemic stroke patients underwent neuropsychological assessment annually for up to 5 years. Dementia was defined using the DSM-IV criteria. Univariate and multivariable Cox proportional regression was performed to determine the ability of MCI subtypes, CIND severity, and individual domains of impairment to predict dementia.

RESULTS

A total of 362 patients without dementia were followed up for a mean of 3.4 years (17% drop out), with 24 developing incident dementia. Older age, previous and recurrent stroke, and CIND and MCI subtypes were significant predictors of dementia. In multivariable analysis controlling for treatment allocation, patients who were older, had previous or recurrent stroke, and had either CIND moderate or multiple domain MCI with amnestic component were at elevated risk for dementia. In multivariable domain analysis, recurrent strokes, age, and previous strokes, verbal memory, and visual memory were significant predictors of dementia. Receiver operating characteristic curve analysis showed that CIND moderate (area under the curve: 0.893) and multiple domain MCI with amnestic component (area under the curve: 0.832) were significant predictors of conversion to dementia. All other classifications of cognitive impairment had areas under the curve less than 0.7.

CONCLUSION

Stroke patients with cognitive impairment no dementia (CIND) moderate are at higher risk of developing dementia, while CIND mild patients are not at increased risk of developing dementia.

The palmar locking compression plate is biomechanically comparable to the dorsal pi plate for dorsally comminuted, intraarticular wrist fractures

A clinically appropriate fracture model and testing regimen were used to test the null hypothesis that a palmarly applied locking plate was inferior to a dorsally applied Pi plate in the stabilisation of dorsally comminuted intraarticular wrist fractures. Sixteen standardised fractures of Synbone models of the radius were stabilised using either a palmar locking compression T plate (the experimental group) (n=8) or a dorsally applied Pi plate (the control group) (n=8). The constructs were tested on an Instron materials testing machine. Deformation was monitored during 500 loading cycles to 200 N. The mean permanent deformation and stiffness favoured the palmar locking compression T plate over the dorsal Pi plate (P=0.036). However, the absolute difference was only 0.5 mm. Such a small difference is unlikely to be clinically detectable and, therefore, we conclude that there is no clinically significant difference between the two types of fixation.

Deregulation of lens epithelial cell proliferation and differentiation during the development of TGFbeta-induced anterior subcapsular cataract

Normal lens development and growth is dependent on the tight spatial and temporal regulation of lens cell proliferation and fiber cell differentiation. The present study reports that these same cellular processes contribute to lens pathology as they become deregulated in the process of anterior subcapsular cataract development in a transgenic mouse model. During the formation and growth of transforming growth factor (TGF)beta-induced subcapsular plaques, lens epithelial cells lose key phenotypic markers including E-cadherin and connexin 43, they multilayer and subsequently differentiate into myofibroblastic and/or fiber-like cells. Growth of the subcapsular plaques in the transgenic mouse is sustained by an ordered process of cell proliferation, exit from the cell cycle and differentiation. As reiterating ordered growth and differentiation patterns is atypical of the direct effects of TGFbeta on lens cells in vitro, we propose that other growth factors in the eye, namely fibroblast growth factor, may also play a role in the establishment and regulation of the key cellular processes leading to lens pathology. Obtaining a better understanding of the molecular aspects and cellular dynamics of cataract formation and growth is central to devising strategies for slowing or preventing this disease.

The role of RsmA in the regulation of swarming motility in Serratia marcescens

Swarming motility is a multicellular phenomenon comprising population migration across surfaces by specially differentiated cells. In Serratia marcescens, a network exists in which the flhDC flagellar regulatory master operon, temperature, nutrient status, and quorum sensing all contribute to the regulation of swarming motility. In this study, the rsmA (repressor of secondary metabolites) gene (hereafter rsmA(Sm)) was cloned from S. marcescens. The presence of multicopy, plasmid-encoded rsmA(Sm) expressed from its native promoter in S. marcescens inhibits swarming. Synthesis of N-acylhomoserine lactones, presumably by the product of smaI (a luxI homolog isolated from S. marcescens), was also inhibited. Knockout of rsmA(Sm) on the S. marcescens chromosome shortens the time before swarming motility begins after inoculation to an agar surface. A single copy of the chromosomal PrsmA(Sm)::luxAB reporter of rsmA(Sm) transcription was constructed. Using this reporter, the roles of the flhDC flagellar regulatory master operon, temperature and autoregulation in the control of rsmA(Sm) expression were determined. Our findings indicate that RsmA(Sm) is a component of the complex regulatory network that controls swarming.

Acid-induced gene expression in Helicobacter pylori: study in genomic scale by microarray

To understand the RNA expression in response to acid stress of Helicobacter pylori in genomic scale, a microarray membrane containing 1,534 open reading frames (ORFs) from strain 26695 was used. Total RNAs of H. pylori under growth conditions of pH 7.2 and 5.5 were extracted, reverse transcribed into cDNA, and labeled with biotin. Each microarray membrane was hybridized with cDNA probe from the same strain under two different pH conditions and developed by a catalyzed reporter deposition method. Gene expression of all ORFs was measured by densitometry. Among the 1,534 ORFs, 53 ORFs were highly expressed (> or = 30% of rRNA control in densitometry ratios). There were 445 ORFs which were stably expressed (<30% of rRNA in densitometry) under both pH conditions without significant variation. A total of 80 ORFs had significantly increased expression levels at low pH, while expressions of 4 ORFs were suppressed under acidic condition. The remaining 952 ORFs were not detectable under either pH condition. These data were highly reproducible and comparable to those obtained by the RNA slot blot method. Our results suggest that microarray can be used in monitoring prokaryotic gene expression in genomic scale.

Role of flhDC in the expression of the nuclease gene nucA, cell division and flagellar synthesis in Serratia marcescens

We investigated in Serratia marcescens the functions of the flhDC operon, which controls motility and cell division in enteric bacteria. Included in our evaluations were investigation of cell division, flagellar synthesis and regulation of the expression of nuclease (encoded by the nucA(Sm) gene, one of the virulence factors). Interruption of the chromosomal flhDC operon in S. marcescens CH-1 resulted in aberrant cell division and loss of nuclease and flagella. Expression of nucA(Sm) and other mutated phenotypes was restored in the flhDC mutant by the induction of overexpression of flhDC in a multicopy plasmid. Multicopied flhDC also induced the formation of differentiated cells (polyploid aseptate cells with oversynthesis of peritrichous flagella) in broth culture using minimal growth medium. Expression of the flhDC operon showed positive autoregulation, and was growth phase dependent (upregulated in early log phase). In addition, flhDC expression was inhibited when the temperature increased from 30 to 37 degrees C, and when osmolarity was increased, but was not influenced by glucose catabolite repression. These results show that FlhD/FlhC is a multifunctional transcriptional activator involved in the process of cell differentiation, swarming and virulence factor expression.

HNF3beta and Lim1 interact in the visceral endoderm to regulate primitive streak formation and anterior-posterior polarity in the mouse embryo

Recent embryological and genetic experiments have suggested that the anterior visceral endoderm and the anterior primitive streak of the early mouse gastrula function as head- and trunk-organising centers, respectively. Here, we report that HNF3beta and Lim1 are coexpressed in both organising centers suggesting synergistic roles of these genes in regulating organiser functions and hence axis development in the mouse embryo. To investigate this possibility, we generated compound HNF3beta and Lim1 mutant embryos. An enlarged primitive streak and a lack of axis formation were observed in HNF3beta (−)(/)(−);Lim1(−)(/)(−), but not in single homozygous mutant embryos. Chimera experiments indicate that the primary defect in these double homozygous mutants is due to loss of activity of HNF3beta and Lim1 in the visceral endoderm. Altogether, these data provide evidence that these genes function synergistically to regulate organiser activity of the anterior visceral endoderm. Moreover, HNF3beta (−)(/)(−);Lim1(−)(/)(−) mutant embryos also exhibit defects in mesoderm patterning that are likely due to lack of specification of anterior primitive streak cells.

Cell autonomous and non-cell autonomous functions of Otx2 in patterning the rostral brain

Previous studies have shown that the homeobox gene Otx2 is required first in the visceral endoderm for induction of forebrain and midbrain, and subsequently in the neurectoderm for its regional specification. Here, we demonstrate that Otx2 functions both cell autonomously and non-cell autonomously in neurectoderm cells of the forebrain and midbrain to regulate expression of region-specific homeobox and cell adhesion genes. Using chimeras containing both Otx2 mutant and wild-type cells in the brain, we observe a reduction or loss of expression of Rpx/Hesx1, Wnt1, R-cadherin and ephrin-A2 in mutant cells, whereas expression of En2 and Six3 is rescued by surrounding wild-type cells. Forebrain Otx2 mutant cells subsequently undergo apoptosis. Altogether, this study demonstrates that Otx2 is an important regulator of brain patterning and morphogenesis, through its regulation of candidate target genes such as Rpx/Hesx1, Wnt1, R-cadherin and ephrin-A2.

Alfentanil co-induction for laryngeal mask insertion

We assessed the effect of two different doses of alfentanil (5 and 10 micrograms.kg-1) on the conditions for laryngeal mask airway insertion in ASA 1 and 2 patients who received propofol for induction of anaesthesia. One hundred and fifty unpremedicated patients were randomly allocated to receive either propofol 2.5 mg.kg-1 only (Group P), alfentanil 5 micrograms.kg-1 and propofol 2.5 mg.kg-1 (Group A5), or alfentanil 10 micrograms.kg-1 and propofol 2.5 mg.kg-1 (Group A10). The addition of alfentanil to propofol resulted in a greater ease of insertion and a better quality of airway patency. Pretreatment with alfentanil also resulted in a significantly higher success rate during the first attempt at inserting the laryngeal mask airway compared with Group P (Group P 58%, Group A5 96%, Group A10 94%). Patients in Group P were apnoeic for a mean (+/- SD) time of 3.3(+/- 1.9) min, 4.71 (+/- 2.2) min in Group A5, and 7.32(+/- 4.3) min in Group A10. The use of alfentanil 10 micrograms.kg-1 with propofol, however, led to a significant decrease in mean arterial pressure and heart rate. We concluded that pretreatment with intravenous alfentanil 5 micrograms.kg-1 prior to propofol provides excellent conditions for insertion of laryngeal mask with minimal adverse haemodynamic changes.