Awareness and Knowledge of HIV-Associated Neurocognitive Disorder Among Middle-Aged and Older People Living With HIV/AIDS in Southern Nevada: Implications for HIV/AIDS Community-Based Education Programs

Although a significant amount of biomedical research has been conducted to study HIV-associated neurocognitive disorder (HAND), there has been scant research done to assess the awareness and knowledge of this public health concern among middle-aged and older people living with HIV/AIDS (PLWH). Our qualitative community-based participatory research study sought to address this research gap by examining the awareness and knowledge of HAND among relevant stakeholders in southern Nevada, USA. We conducted 15 semistructured interviews with middle-aged and older PLWH to examine their awareness and knowledge of HAND and access to pertinent resources. After our thematic analysis of our interviews, we identified two overarching themes: (1) limited awareness and knowledge of HAND among PLWH, and (2) southern Nevada social determinants of health. Our findings underscore the importance of raising awareness and knowledge of HAND among PLWH through community-based education programs, and improving access to resources related to social determinants of health.

Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias

Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.

RECRUITMENT OF TRANSGENDER, NONBINARY, AND GENDER DIVERSE OLDER ADULTS IN HEALTH RESEARCH: A SYSTEMATIC REVIEW

Despite the urgency reported by the National Institutes of Health and National Academy of Sciences to advance health knowledge about transgender, nonbinary, and gender diverse (TNGD) older adults, TNGD populations remain underrepresented in aging research. This review examines TNGD older adult recruitment approaches in health-related research. PubMed, CINHAL, and PsychINFO databases were searched using key terms/subject headings related to TNGD and aging/older adults to identify health-related, U.S.-based empirical studies published since 2011. Twenty-four studies met inclusion criteria (quantitative=15, qualitative=8, mixed-methods=1). Most (n=13) focused recruitment efforts on the broader LGBTQ community, whereas 9 studies (qualitative, n=5) specifically targeted TNGD older adults. One study that recruited from Amazon Mechanical Turk, but most TNGD-specific recruitment efforts used community-engaged approaches, including snowball and purposive sampling via listservs; groups, organizations, and events serving the transgender/nonbinary community; and outreach through researchers’ personal and professional networks. Novel approaches are needed to increase TNGD representation in aging research.

A COMPARISON OF SUBJECTIVE COGNITIVE DECLINE AND RELATED LIMITATIONS AMONG TRANSGENDER COMMUNITIES IN THE US

Background

The transgender population is composed of subgroups that are diverse in gender identity (e.g., transgender women[TW], transgender men[TM], nonbinary[NB] individuals). Compared to cisgender adults, transgender adults are more likely to report subjective cognitive decline (SCD). It remains unclear if SCD prevalence and related limitations vary by transgender subgroups.

Methods

2015-2020 Behavioral Risk Factor Surveillance System data, representing 38 U.S. states that assessed SCD (confusion/memory loss happening more often/getting work over previous 12months) and gender identity were used to examine differences in SCD prevalence and SCD-related limitations by transgender subgroups, TW(n=442), TM(n=298), and NB(n=183). Age-adjusted odds ratios (OR) along with 95% confidence intervals (CI) were calculated to investigate group differences in SCD prevalence. Separate analyses compared SCD-related limitations, demographics, and health across groups among participants reporting SCD.

Results

SCD prevalence was highest among NB(21.3%), followed by TW(16.3%) and TM(14.1%). After accounting for age, subgroup differences remained; odds of SCD were 1.6x higher among TW compared to TM (CI:1.1–2.4, p=0.012). Among those with SCD, TW were less likely to receive help they needed with day-to-day activities when compared to TM (OR=7.9; CI:0.1–0.2, p< 0.001) and NB (OR=5.0; CI:0.1–0.4, p=0.001); and TW were more likely to be deaf (OR=4.2; CI:1.7–10.1, p=0.002) and have asthma (OR=2.8; CI:1.4–5.7, p=0.005) when compared to NB adults. No other differences were found.

Conclusion

Health and social inequities are not uniformly experienced across transgender subgroups, and it is important to understand how these factors impact the brain health of TW, TM, and NB adults.

EQUALITY IN CAREGIVING: RATIONALE AND DESIGN FOR AN INTERVENTION ON CAREGIVER MASTERY AMONG LGB CAREGIVERS

Compared to heterosexual and cisgender caregivers, lesbian, gay, bisexual, transgender and queer (LGBTQ+) caregivers face unique challenges (e.g., physical, emotional, financial strain). The initial purpose of this pilot study was to assess an existing evidence-based intervention, the Savvy Caregiving Program, according to context-specific challenges faced by LGBTQ+ caregivers of people with Alzheimer’s disease and related dementias (ADRD), improve caregiver mastery and mood, while reducing caregiver burden and physiological stress biomarkers. Given the inability to perform research in-person due to COVID-19, we redirected our research efforts. Trial modifications included: national vs local participation, shift to social media recruitment, virtual SCP classes and focus groups, addition of cross sectional health and caregiving data collection for all LGBTQ caregivers, and removal of biomarker collection. We will present survey results from a national sample of 49 LGBTQ caregivers. Descriptive statistics and non-parametric tests were used to assess differences between ADRD and non-ADRD caregivers.

THE RELATIONSHIP BETWEEN ADULT DAY HEALTH CENTER OWNERSHIP, STAFFING, AND PARTICIPANT OUTCOMES

Growing demands for specialized care for older adults living with disabilities, including those with Alzheimer’s Disease and related dementia (ADRD), and for caregiver respite have resulted in rising use of adult day health centers (ADHCs). ADHCs vary in size, ownership, participant demographics, and services offered, with a many operated by multi-site chain organizations and with for-profit ownership. This study examines whether ADHC ownership is associated with their scope of services, staffing models, and outcomes. We used facility-level data from the restricted-use 2014 National Post-Acute and Long-Term Care Study (NPALs) Adult Day Services Center module, which collects primary data on ADHCs through a nationally representative survey. Key outcome variables were measures of ADHC staffing, and rates of participants’ emergency department visits, hospitalizations, and falls. The first part of the analysis was descriptive, focused on participant and staffing patterns. We then estimated ordinary least squares multivariate regressions to learn whether staffing differences exist holding other ADHC characteristics constant, such as size, region, and other services offered. We also estimated Poisson regression models to learn whether there are differences in rates of emergency room visits, hospitalizations, and falls. We found little difference in staffing or participant outcomes between for-profit vs. not-for-profit ADHCs. We found that chain-affiliated ADHCs had different participant populations and sources of revenue. They also had lower levels of staffing in general and for licensed nurses, activity staff, and social workers. Rates of falls and emergency department visits were higher in chain-affiliated versus independent ADHCs when controlling for other characteristics.

RECRUITMENT AND ENGAGEMENT OF LGBTQIA+ OLDER ADULTS INTO AGING RESEARCH

Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual (LGBTQIA+) older adults are a growing population that has been traditionally underrepresented in aging research. Due to stigma and discrimination, many LGBTQIA+ may be reluctant to disclose their sexual orientation and gender identity, which makes it difficult to recruit and engage LGBTQIA+ populations in aging research. In this symposium, we explore current efforts to recruit LGBTQIA+ older adults via social media, snowball sampling, or other novel methods, as well as ways engage LGBTQIA+ subgroups (e.g., caregivers, racial/ethnic minorities, transgender, intersex and other underrepresented groups). Two presentations focus on the recruitment of gender minorities including transgender and intersex older adults. Ethan Cicero will present a systematic review that highlights currents efforts to recruit older gender minority populations include those who identify as racial/ethnic minorities. Next, Nick Lampe will share methodological approaches for effectively recruiting and engaging transgender, non-binary, and intersex (TNBI) older respondents. Then Austin Oswald will highlight barriers and facilitators to engaging LGBTQ+ elders of color in participatory action research during the Covid-19 pandemic. Kasim Ortiz will examine correlates of survey response participation among older sexual minorities (LGB+) using internet-based sampling via the Census Household Pulse Survey. Finally, Krystal Kittle will highlight a three-stage, pilot intervention that aimed to recruit LGBTQ+ caregivers during COVID-19 pandemic restrictions. Jason Flatt, an expert in LGBTQIA+ aging research will facilitate a conversation about these results and place them in the context of current efforts to recruit and engage LGBTQIA+ populations in aging research.

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective

Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.

Serial Mediation Analysis of the Association of Familiarity with Transgender Sports Bans and Suicidality among Sexual and Gender Minority Adults in the United States

BACKGROUND

Discriminatory laws and policies are a form of structural stigma that is associated with increased suicidality among sexual and gender minority (SGM) people. Unfortunately, in the United States, there has been an increase in state-level discriminatory laws and policies targeting SGM people in 2021 and 2022, particularly, transgender sports bans. The purpose of this study was to (1) determine if familiarity with transgender sports bans was associated with suicidality among SGM adults; and (2) determine if interpersonal stigma and/or individual stigma mediated this association.

METHODS

This was a cross-sectional study of data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and serial mediator models were used in this analysis.

RESULTS

The increased suicidality was associated with familiarity with state-level transgender sports bans among SGM adults (p-value = 0.0150). Even after interpersonal and individual stigma mediated this relationship, the association between suicidality and familiarity with state-level transgender sports bans remained (p-value = 0.0106).

CONCLUSION

State-level transgender sports bans appear to exacerbate existing disparities in mental health, especially for individuals who are familiar with the bans. They directly discriminate against people who are transgender and indirectly stigmatize the broader SGM community.

Evaluation of the Savvy Caregiver Program for LGBTQIA Adults Living With Alzheimer's Disease and Related Dementias

Approximately 350,000 LGBTQIA+ older adults in the U.S. currently have Alzheimer’s disease and related dementias (ADRD), with projections nearing 1 million by 2030. LGBTQIA+ older adults face challenges in receiving adequate and inclusive care and caregiving support due to the inability to rely on traditional family networks, greater disability, and discrimination when seeking aging services. Working with the Los Angeles LGBT Center Aging in Community Initiative, we evaluated the: 1) Adaptation of the Savvy caregiver training program for care providers of LGBTQIA+ persons living with ADRD; and 2) Feasibility and acceptability of the program. Care providers were very satisfied with the program, strategies, information, and activities of the tailored Savvy program. For psychosocial outcomes, there were trends in greater care planning, increases in asking friends/family for support, and decreased loneliness. Additional research is needed on culturally-relevant aging services and behavioral interventions for care providers of LGBTQIA+ persons living with ADRD.

Health Concerns for LGBTQ+ Caregivers of People With Alzheimer’s Disease and Related Dementias

We examined four states with data on LGBTQ+ identity and the ADRD caregiving modules from the 2019 Behavioral Risk Factor Surveillance System. Multivariable regression models examined the associations between LGBTQ+ identity and health outcomes. Among the ADRD caregivers, 55,920 (4.7%) identified as LGBTQ+. Compared with non-LGBTQ+ caregivers, LGBTQ+ caregivers were younger and more likely to live in rural counties. Half of LGBTQ+ caregivers spent 20+ hours per week providing care, and nearly 72% reported helping with personal care. LGBTQ+ caregivers reported more days when their mental health was not good than non-LGBTQ+ caregivers (B = 8.01;95% CI= 2.32-13.75). Female caregivers overall were twice as likely than males to experience depression (OR = 2.11;95% CI=1.29-3.45). These findings provide insight into characteristics of LGBTQ+ caregivers and their health concerns. Interventions that promote mental health and reach diverse LGBTQ+ caregivers in rural communities are crucial in supporting LGBTQ+ caregivers of people with ADRD.

Memory-Related Limitations and Care Needs of Gender Minority BIPOC Adults

Limited research exists investigating cognitive impairment and Alzheimer’s disease and related dementias (ADRD) among gender minority (GM) adults (transgender/non-binary/, including examining memory-related challenges among GMs who also identify as Black, Indigenous, or People of Color (BIPOC). 2015-2019 Behavioral Risk Factor Surveillance System data were used to explore care needs of GM and cisgender (CG) adults with subjective cognitive decline (SCD, N=441), which may be the first clinical manifestations of ADRD. Regression models examined SCD-associated functional limitations and care needs among GM-BIPOC, GM-White, CG-BIPOC, and CG-White adults. GM-BIPOC and GM-White were 2-4x more likely to have SCD-related limitations, require assistance with daily tasks, be unable to do day-to-day or social activities when compared to CG-White. GM-BIPOC were 2-5x more likely to be uninsured and experience cost-related healthcare barriers compared to GM-White and CG-White/BIPOC. Additional research is needed to improve care and well-being for this understudied population.

Greater Social Engagement and Greater Gray Matter Microstructural Integrity of Aging Adults

Social engagement reflects habitual social roles in aging adults and may protect against dementia. Cross-sectional associations of social engagement (SE) index with gray matter (GM) microstructure was studied in regions of interest relevant to social cognition among community-dwelling older adults [n=293, mean age: 82.8 years (SD: 2.8), 43% males] using linear regression models. Greater SE was significantly related to lower mean diffusivity (MD) (greater GM microstructural integrity) [shown as standardized estimate (p-value)] in: left middle frontal gyrus-orbital part: -0.168 (0.005), left caudate nucleus: -0.141 (0.02), left temporal pole-middle temporal gyrus: -0.136 (0.03), right middle frontal gyrus: -0.160 (0.006), right superior frontal gyrus-orbital part: -0.187 (0.002), right middle frontal gyrus, orbital part: -0.124 (0.04), adjusted for demographic attributes. Associations were robust to adjustment for hearing or ADL difficulty. Findings were generally stronger in females than in males. Social engagement may prevent GM integrity loss and build brain reserve in dementia-related regions. Part of a symposium sponsored by Brain Interest Group.

Leveraging Digital Methods to Engage Sexual and Gender Minority Caregivers of People With Dementia

Digital methods are a way to engage marginalized populations, such as sexual and gender minority (SGM) adults. No study to date has leveraged these methods to engage SGM caregivers of people with dementia. We used digital methods to access SGM caregivers of people with dementia in our study of psychosocial measures of caregiving for recruitment and data collection. Posts on social media and online registries targeted SGM caregivers. The study landing page received 2201 views; 285 caregivers completed the survey. Participants learned of the study most frequently from Facebook (45%). The sample was 84% white, with gay (52%), lesbian (32%), bisexual (11%), and other sexual orientations (5%) and transgender (17%) caregivers represented. While we exceeded goals for inclusion of Latinx (26%) and Native American (4%) caregivers, the number of African American SGM caregivers was lower than projected (7%). Digital methods are effective for engaging SGM caregivers of people with dementia.

The Epidemiology of Dementia in LGBTQ Older Adults

Over 3 million or more adults aged 60 + live in the US who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). Less is known about dementia risk in LGBTQ older adults. We will discuss dementia risk and related risk factors among LGBTQ adults from multiple population-based and cohort studies. We found higher rates of subjective memory problems among lesbian, bisexual and transgender adults compared to both gay men and heterosexual men and women. Using medical record data, 8% (343) of LGB adults aged 60+ were diagnosed with dementia. They were more likely to identify as male (63% vs. 44%), had a higher education level (college degree+ 63% vs. 40%) and were younger than their non-LGB counterparts. These findings highlight dementia risk and related problems among LGBTQ older adults. Future studies are needed to better understand dementia risk and recruiting, screening and improving dementia-related outcomes in LGBTQ older adults.

The CoGenT3 Study: Examining Gender’s Impact on Education and Cognition Trends in Three American Generations

How older adults protect their cognitive health, reduce their risk for cognitive decline, and manage cognitive changes vary for men and women. To advance what is known about these differences and to promote inclusion of sexual and gender minorities in research, we are developing an empirically-informed research framework for studying gender effects in aging and Alzheimer’s research. In this presentation, we describe the framework informing our approach and present results from analyses of gender effects in The Health and Retirement Study that examine gender differences in the associations observed between education and cognitive measures in older adults. Our findings show gender’s effects on education vary in direction and magnitude as gender norms changed over time. Although college education serves as a factor protective against cognitive decline, characteristics of who achieves a four-year college degree change over time. We discuss the implications of our results for aging and Alzheimer’s disease research.

Alzheimer’s Staffing, Services, and Outcomes in Adult Day Health Centers

Growing demand for care for Alzheimer’s Disease and related Dementia (ADRD) has resulted in rising use of adult day health centers (ADHCs), which employ teams of professionals including licensed nurses, nursing aides, social workers, and activity directors. This study evaluates the scope of services and staffing models of ADHCs that provide care to persons with ADRD compared to ADHCs that do not, and examines whether there is an association between staffing and client outcomes, measured as rates of hospitalizations, falls, and emergency department visits. We used facility-level data from the 2014 National Study of Long-Term Care Providers (NSLTCP) Adult Day Services Center module. We conducted bivariate comparisons and estimated multivariate regressions to identify ADHC characteristics associated with staffing and client outcomes. ADHCs that offered ADRD services had higher average daily attendance, greater shares of revenue from Medicaid and self-payment, and greater proportions of Blacks and females. They also had greater percentages of enrollees with depression, cardiovascular disease, diabetes, and needing assistance with activities of daily living. There were also greater numbers of registered nurse, licensed practical nurse, and social worker hours per enrollee day, but fewer activity staff hours per enrollee day. Multivariate regressions focused on ADHCs that offered skilled nursing services and revealed that total staff hours per enrollee day were not higher in ADHCs that provided ADRD services, controlling for other characteristics. However, staffing was greater in chain-affiliated ADHCs. Higher staffing levels were associated with lower rates of falls and emergency department visits.

Cognitive Function in Sexual and Gender Minority Older Adults

Nearly 3.5 million sexual and gender minority (SGM) adults aged 60+ in the U.S. identify as lesbian, gay, bisexual, transgender, and/or queer. We recruited over 50 diverse SGM older adults from the community to better understand correlates of their cognitive function. The Telephone Interview for Cognitive Status, an 11‐item screening test of global cognition was used over the phone or in-person. We will describe relationships among cognition and several sociodemographic and health variables (age, sex assigned at birth, SGM identities, race/ethnicity, and health). Past research has highlighted higher rates of perceived memory problems among lesbian, bisexual and transgender adults compared to both gay men and heterosexual men and women. These rates were also higher among those who identify as women. We highlight implications for researching gender identity and cognition in late life, such as the influence of gender roles on cognition and the assessment of gender expression and related constructs.

Exploring the Risk and Protective Factors for the Mental Health of Sexual Minority Asian Americans

This study characterizes the mental health of Asian American older adults (aged 60+) who identify as sexual minorities (SM or lesbian, gay, bisexual) and compare to their non-Asian American and non-SM counterparts. Data were from the Research Program on Genes, Environment and Health (Aged 60+; N=185,478), a representative sample of healthcare members from Northern California. It includes SM (N=447) and heterosexual/non-SM (N=15,772) older adults who identify as Asian American (Chinese, Japanese, Filipino, and South Asian) and non-Asian American SM (N=3,890). Rates of dementia, anxiety, and PTSD were similar for both SM and non-SM Asian Americans. However, older lesbian and gay Asian Americans were more likely to have a depression diagnosis (30% vs. 18%, p=0.002) compared to non-SM. Overall, mental health outcomes were lower for Asian American SM compared to non-Asian American SM. We discuss need for understanding protective factors for mental health and implications for future interventions.

Sexual and Gender Minority Caregivers of People With Dementia and Their Care Recipients

Little is known about the unique experiences of sexual and gender minority (SGM) caregivers of people with dementia or their care recipients. We used an electronic survey to assess psychosocial measures within this caregiving population, including measures related to the care recipient. The majority of caregivers (N=285) were gay men (62%). Most respondents were white (80%), with a quarter identifying as Latinx. The majority of caregivers were a spouse/partner (59.3%) and were providing care for someone who identified as LGB (70%), with 20% caring for someone transgender. Half of care recipients did not have an advance directive. The majority of care recipients needed assistance with ≥5 instrumental activities of daily living (83%) and ≥1basic activities of daily living (74%). This study is the first to provide data regarding the unique needs of SGM caregivers of someone with dementia and will support the development of targeted interventions for this population.

Risk of dementia and mild cognitive impairment among older adults in same-sex relationships

INTRODUCTION

Sexual minority discrimination might lead to a higher risk of mild cognitive impairment (MCI) and dementia. The aim of this study was to assess the risk of MCI and dementia between older adults in same-sex relationships (SSR) and opposite-sex relationships (OSR).

METHODS

We analyzed longitudinal data from the National Alzheimer's Coordinating Center up to September 2017. Analyses included cognitively normal individuals 55+ at baseline who had a spouse, partner, or companion as study partner at any assessment. Associations were calculated using survival analysis adjusting for demographics and APOE-e4 carrier status.

RESULTS

Hazard ratios of MCI and dementia did not differ statistically between SSR and OSR individuals in the total sample nor stratified by sex.

CONCLUSION

The lack of association between SSR and MCI and dementia warrants future research into their potential resilience mechanisms and the inclusion of sexual minority status questions in research and surveillance studies. The potential recruitment bias caused by nonprobabilistic sampling of the cohort and the reporting and ascertainment bias caused by using SSR to infer sexual minority status may have influenced our findings.

Assessing the quality of a non-randomized pragmatic trial for primary prevention of falls among older adults

Current approaches to falls prevention mostly rely on secondary and tertiary prevention and target individuals at high risk of falls. An alternative is primary prevention, in which all seniors are screened, referred as appropriate, and educated regarding falls risk. Little information is available on research designs that allow investigation of this approach in the setting of aging services delivery, where randomization may not be possible. Healthy Steps for Older Adults, a statewide program of the Pennsylvania (PA) Department of Aging, involves a combination of education about falls and screening for balance problems, with referral to personal physicians and home safety assessments. We developed a non-randomized statewide trial, Falls Free PA, to assess its effectiveness in reducing falls incidence over 12 months. We recruited 814 seniors who completed the program (503 first-time participants, 311 people repeating the program) and 1,020 who did not participate in the program, from the same sites. We assessed the quality of this non-randomized design by examining recruitment, follow-up across study groups, and comparability at baseline. Of older adults approached in senior centers, 90.5 % (n = 2,219) signed informed consent, and 1,834 (82.4 %) completed baseline assessments and were eligible for follow-up. Attrition in the three groups over 12 months was low and non-differential (<10 % for withdrawal and <2 % for other loss to follow-up). Median follow-up, which involved standardized monthly assessment of falls, was 10 months in all study groups. At baseline, the groups did not differ in measures of health or falls risk factors. Comparable status at baseline, recruitment from common sites, and similar experience with retention suggest that the non-randomized design will be effective for assessment of this approach to primary prevention of falls.

Perspectives on expedited partner therapy for chlamydia: a survey of health care providers

There is a lack of research on health care providers' use of and perspectives on expedited partner therapy in a state where expedited partner therapy is not prohibited or explicitly allowed. The aim of our study was to understand if and how health care providers use expedited partner therapy, if specific demographic factors and knowledge contribute to increased use of expedited partner therapy, and to describe barriers and facilitators to the use of expedited partner therapy in Pittsburgh, Pennsylvania. A convenience sample of 112 health care providers from diverse disciplines who treat young women at risk for chlamydia completed an online survey. About 11% of health care providers used expedited partner therapy consistently. Those who self-reported that they were knowledgeable about expedited partner therapy were more likely to use expedited partner therapy (73% vs. 49%, p = .009) as were those who said no or were unsure about their institution's guidelines for expedited partner therapy (35% vs. 22%, p = 0.01) (62% vs. 57%, p = 0.01). The most commonly reported facilitator of expedited partner therapy was having clear legal guidelines (86%). This study finds that in a setting where expedited partner therapy is not expressly permitted, health care providers still use the practice but also experience barriers that limit uptake. Legislation expressly endorsing expedited partner therapy in the state and in medical institutions is needed to increase expedited partner therapy use.

Humor and laughter in persons with cognitive impairment and their caregivers

PURPOSE

The purpose of this study was to describe humor and laughter in persons with cognitive impairment (PWCI) and caregivers who were recalling a shared experience in a focus group.

DESIGN

Twenty participants attended an Art Engagement Activity at the Andy Warhol Art Museum, which included a guided tour and an art project. All PWCI had medically diagnosed cognitive disorders and all caregiver participants did not. Four focus groups were conducted and transcripts of audio-recorded sessions were transferred to a qualitative software program.

METHOD

Words, phrases, and episodes of humor and laughter were used to construct codes, which were refined during group analysis using constant comparison.

FINDINGS

Humor and laughter were present in all four focus groups. Emerging themes of humor included silliness, sarcasm, and commenting about hardships of dementia. Laughter was identified in segments with and without humor. Some PWCI were unable to follow social cues.

CONCLUSIONS

Humor and laughter played a role in creating a safe social environment. PWCI were able to engage in humor during social interactions, yet some had difficulty recognizing social cues. Further study may reveal roles of humor and laughter in adaptation to cognitive decline and holistic interventions for improved quality of life.

Breast cancer survivors' perception of survivorship

PURPOSE/OBJECTIVES

To explore (a) how women who were diagnosed with breast cancer (BC) defined themselves as survivors and when this occurred, and (b) the types of benefits they derived from their experiences.

RESEARCH APPROACH

An exploratory, qualitative approach.

PARTICIPANTS

112 women who had BC (response rate = 70%).

SETTING

Participants were recruited from two cancer survivor organizations in a northeastern U.S. city.

METHODOLOGIC APPROACH

Responses to open-ended questions in telephone interviews were examined by age at diagnosis using thematic analysis. Chi squares were used to conduct analyses by age (younger than 51 years; aged 51 years or older).

MAIN RESEARCH VARIABLES

Meaning of survivorship, defining moment, benefits derived from surviving from breast cancer.

FINDINGS

Participants' perceptions of survivorship included two main components, a defining moment and the meaning attached to being a survivor. Becoming a survivor is an active process, except in the case of those participants who realized they were survivors when informed by a third party. Meanings differed by age at diagnosis. Most participants listed at least one benefit from surviving cancer.

CONCLUSIONS

The definitions of survivorship and benefits outlined here suggest that many positive aspects of the survivorship experience exist that may inform future interventions' designs.

IMPLICATIONS FOR PRACTICE

Providers should acknowledge the strength survivors show in the process of meaning-making and finding benefits in their adverse experiences. The use of expressive and supportive interventions may hold promise for women facing difficulties in coping with their diagnosis.

Activation-induced T-cell death is cell cycle dependent and regulated by cyclin B

Developing thymocytes and some T-cell hybridomas undergo activation-dependent programmed cell death. Although recent studies have identified some critical regulators in programmed cell death, the role of cell cycle regulation in activation-induced cell death in T cells has not been addressed. We demonstrate that synchronized T-cell hybridomas, irrespective of the point in the cell cycle at which they are activated, stop cycling shortly after they reach G2/M. These cells exhibit the diagnostic characteristics of apoptotic cell death. Although p34cdc2 levels are not perturbed after activation of synchronously cycling T cells, cyclin B- and p34cdc2-associated histone H1 kinase activity is persistently elevated. This activation-dependent induction of H1 kinase activity in T cells is associated with a decrease in the phosphotyrosine content of p34cdc2. We also demonstrate that transient inappropriate coexpression of cyclin B with p34cdc2 induces DNA fragmentation in a heterologous cell type. Finally, in T cells, cyclin B-specific antisense oligonucleotides suppress activation-induced cell death but not cell death induced by exposure to dexamethasone. We therefore conclude that a persistent elevation of the level of cyclin B kinase is required for activation-induced programmed T-cell death.