Kinless Older Adults with Dementia: Qualitative Analysis of Data from the Adult Changes in Thought (ACT) Study

OBJECTIVES

To examine the circumstances and needs of older adults who were "kinless," defined as having no living spouse or children, when they developed dementia.

METHODS

We conducted a secondary analysis of information from the Adult Changes in Thought (ACT) Study. Among 848 participants diagnosed with dementia between 1992 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants' medical records.

RESULTS

In this community dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one-third lived with unrelated persons. Through inductive content analysis we identified four themes that describe their circumstances and needs: 1) life trajectories, 2) caregiving resources, 3) care needs and gaps, and 4) turning points in caregiving arrangements.

DISCUSSION

Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of non-family caregivers, and participants' own roles as caregivers. Our findings suggest that providers and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.

CD101 genetic variants modify regulatory and conventional T cell phenotypes and functions

We recently reported that the risk of sexually acquired HIV-1 infection is increased significantly by variants in the gene encoding CD101, a protein thought to modify inflammatory responses. Using blood samples from individuals with and without these variants, we demonstrate that CD101 variants modify the prevalence of circulating inflammatory cell types and show that CD101 variants are associated with increased proinflammatory cytokine production by circulating T cells. One category of CD101 variants is associated with a reduced capacity of regulatory T cells to suppress T cell cytokine production, resulting in a reduction in the baseline level of immune quiescence. These data are supported by transcriptomics data revealing alterations in the intrinsic regulation of antiviral pathways and HIV resistance genes in individuals with CD101 variants. Our data support the hypothesis that CD101 contributes to homeostatic regulation of bystander inflammation, with CD101 variants altering heterosexual HIV-1 acquisition by facilitating increased prevalence and altered function of T cell subsets.

An Interactive Computer Tutorial to Teach Pain Assessment

Under-treated pain is a significant problem. Health care institutions are under increasing pressure from patients and accreditation bodies to improve staff training in pain management. Pain assessment, a necessary pre-cursor to good pain management, is a complex multi-step process requiring sophisticated understanding and superior communication skills. This article describes the development and usability testing of an interactive, Internet-deliverable, multimedia tutorial to teach best practice pain assessment. The software platform allowed non-programmers to create multimedia tutorials and included the capability to simulate role-plays. The tutorial was designed to actively engage and respond to the learner and to include skills practice. Twenty-five nurses took the tutorial and rated it positively on a usability questionnaire in terms of ease-of-use and learning method.

Estimating the size of populations at high risk for HIV using respondent-driven sampling data

The study of hard-to-reach populations presents significant challenges. Typically, a sampling frame is not available, and population members are difficult to identify or recruit from broader sampling frames. This is especially true of populations at high risk for HIV/AIDS. Respondent-driven sampling (RDS) is often used in such settings with the primary goal of estimating the prevalence of infection. In such populations, the number of people at risk for infection and the number of people infected are of fundamental importance. This article presents a case-study of the estimation of the size of the hard-to-reach population based on data collected through RDS. We study two populations of female sex workers and men-who-have-sex-with-men in El Salvador. The approach is Bayesian and we consider different forms of prior information, including using the UNAIDS population size guidelines for this region. We show that the method is able to quantify the amount of information on population size available in RDS samples. As separate validation, we compare our results to those estimated by extrapolating from a capture-recapture study of El Salvadorian cities. The results of our case-study are largely comparable to those of the capture-recapture study when they differ from the UNAIDS guidelines. Our method is widely applicable to data from RDS studies and we provide a software package to facilitate this.

Estimating hidden population size using Respondent-Driven Sampling data

Respondent-Driven Sampling (RDS) is n approach to sampling design and inference in hard-to-reach human populations. It is often used in situations where the target population is rare and/or stigmatized in the larger population, so that it is prohibitively expensive to contact them through the available frames. Common examples include injecting drug users, men who have sex with men, and female sex workers. Most analysis of RDS data has focused on estimating aggregate characteristics, such as disease prevalence. However, RDS is often conducted in settings where the population size is unknown and of great independent interest. This paper presents an approach to estimating the size of a target population based on data collected through RDS. The proposed approach uses a successive sampling approximation to RDS to leverage information in the ordered sequence of observed personal network sizes. The inference uses the Bayesian framework, allowing for the incorporation of prior knowledge. A flexible class of priors for the population size is used that aids elicitation. An extensive simulation study provides insight into the performance of the method for estimating population size under a broad range of conditions. A further study shows the approach also improves estimation of aggregate characteristics. Finally, the method demonstrates sensible results when used to estimate the size of known networked populations from the National Longitudinal Study of Adolescent Health, and when used to estimate the size of a hard-to-reach population at high risk for HIV.

Evaluation of an intervention to increase human immunodeficiency virus testing among youth in Manzini, Swaziland: a randomized control trial

There is an urgent need for effective HIV prevention programs for adolescents in Swaziland, given the high prevalence of HIV and lack of HIV-related knowledge and skills among Swazi youth. This study set out to determine whether an HIV education intervention designed in the United States, and adapted for Swaziland, would be effective in changing participants' HIV-related knowledge, attitudes, and protective behaviors including HIV testing. We also explored whether the components of Self-Efficacy Theory are associated with these behaviors. Data were obtained from 135 students who participated in a school-based program. The study found significant differences between the intervention and control groups regarding HIV knowledge, self-efficacy for abstinence, condom use, and getting HIV test results, outcome expectations for knowing one's own HIV status, and the protective behavior of getting an HIV test. This is evidence that school-based HIV education programs can successfully increase HIV testing among in-school youth in Swaziland.

The structure of schizophrenic symptoms: a meta-analytic confirmatory factor analysis

To quantitatively review all presently available evidence about the interrelations between positive and negative schizophrenic symptoms, we created an aggregate matrix of the intercorrelations among schizophrenic symptoms by combining data from 28 independent samples using meta-analytic procedures (net bivariate dfs ranging from 683 to 1657). Using confirmatory factor analyses, we then statistically compared four theoretically derived models of the structure of schizophrenic symptoms. Although a three-factor model (Liddle, 1987) best fit the data, results suggest that either more factors or different symptoms are required to account well for the latent structure underlying schizophrenic symptomatology. The nature of such augmented approaches, the opportunities and constraints inherent to multifactorial models, and the limitations of current instruments are discussed.

Behavioural vigilance in schizophrenia. Evidence for hyperattentional processing

BACKGROUND

Despite 30 years of research, some surprisingly fundamental gaps remain in our understanding of schizophrenic input dysfunctions.

METHOD

In a provisional test of a 'hyperattention' hypothesis, schizophrenic patients and control subjects performed a behavioural test that was adapted from a paradigm originally developed for characterising vigilance or sustained attention in animals. On this computerised operant testing procedure, subjects discriminated between signals of various salience and non-signal presentations. Hits and correct rejections resulted in monetary rewards while misses and false alarms entailed monetary costs.

RESULTS

Data from in-patients with schizophrenia and age, education and gender-matched controls support hypotheses not only about hyperattentional dysfunctions in schizophrenia with respect to overall signal detectability but also in terms of resistance to the vigilance decrement that normally occurs over trials.

CONCLUSIONS

The theoretical importance of impairments of this sort are discussed with respect to the cognitive and perceptual consequences of hypervigilance and 'input dysfunction'.

Alternative Strategies for Cross-Validation of Covariance Structure Models

Alternative strategies for two-sample cross-validation of covariance structure models are described and investigated. The strategies vary according to whether all (tight strategy) or some (partial strategy) of the model parameters are held constant when a calibration sample solution is re-fit to a validation sample covariance matrix. Justification is provided for three partial strategies. Conventional and alternative strategies for cross-validation are discussed as methods for evaluating overall discrepancy of a model fit to a particular sample, where overall discrepancy arises from the combined influences of discrepancy of approximation and discrepancy of estimation (Cudeck & Henly, 1991). Results of a sampling study using empirical data show that for tighter strategies simpler models are preferred in smaller samples. However, when partial cross-validation is employed, a more complex model may be supported even in a small sample. Implications for model comparison and evaluation, as well as the issues of model complexity and sample size are discussed.

Infant temporal contrast sensitivity at low temporal frequencies

The data on infant temporal contrast sensitivity functions (TCSFs) are scarce and contradictory. Earlier studies suggest that critical flicker frequency (CFF) is adultlike at 2-3 months postnatal (Regal, D. M., 1981 Vision Research, 21, 549-555), while contrast sensitivity at low temporal frequencies remains poor. If both of these findings are true, then infant TCSFs are much flatter than those of adults. In the present study, we have re-investigated 2-month-olds' contrast thresholds at low temporal frequencies. To match the conditions of Regal's CFF study, test fields were embedded in a luminance-matched surround. As in previous studies, low contrast sensitivities were found. Models of infants' flat TCSFs are discussed.