Hydrogen Bonds and In-situ Photoinduced Metallic Bi0/Ni0 Accelerating Z-scheme Charge Transfer of BiOBr@NiFe-LDH for Highly Efficient Photocatalysis.

For heterojunction system, the lack of stable interfacial driving force and definite charge transfer channel makes the charge separation and transfer efficiency unsatisfactory. The photoreaction mechanism occurring at the interface also receives less attention. Herein, a 2D/2D Z-scheme junction BiOBr@NiFe-LDH with large-area contact featured by abundant interfacial hydrogen bonds and a strong interfacial electric field (IEF) is synthesized, and in-situ photoinduced metallic species assisting charge transfer mechanism is demonstrated. The hydrogen bonds between O atoms from BiOBr and H atoms from NiFe-LDH induce a significant interfacial charge redistribution, establishing a robust IEF. Notably, during photocatalytic reaction, Bi0 and Ni0 are in-situ isolated from BiOBr and NiFe-LDH in heterojunction, which separately act as electron transport mediator and electron trap to further accelerate charge transfer efficiency up to 71.2%. Theoretical calculations further demonstrate that the existence of Bi0 strengthens the IEF. Therefore, high-speed spatial charge separation is realized in Bi0/BiOBr@Ni0/NiFe-LDH, leading to a prominent photocatalytic activity with a tetracycline removal ratio of 88.3% within 7 minutes under visible-light irradiation and the presence of persulfate, far exceeding majority of photocatalysts reported previously. This study provides valid insights for designing hydrogen bonding heterojunction systems, and advances mechanistic understanding on in-situ photoreaction at interfaces.

Quality of Relationships and Caregiver Burden: A Longitudinal Study of Caregivers for Advanced Cancer Patients.

OBJECTIVES: In a longitudinal design, this study investigates the role of the quality of relationships in the well-being of caregivers for a family member with advanced cancer, specifically, the quality of relations among family members and the caregiver's commitment to caregiving. Following the stress process model, good quality of relations and caregiver's high commitment should be resources mitigating caregiver burden, even though overinvestment in the caregiver role may lead to the opposite outcome. METHODS: Data were drawn from a longitudinal study of 336 caregivers of advanced cancer patients in an urban community, who were interviewed shortly after patient diagnosis and again 3 months later. Caregiver burden is measured by 4 subscales (17 items) of the Caregiver Reaction Assessment. We used a random-effect model to investigate the association between caregiver burden and the 2 focused contributing factors-caregiver commitment and family relationship quality-when other covariates were controlled. A fixed-effect model then examines the association between the changes in caregiver burden and related time-varying factors, including caregiver commitment, when family relationship quality was used as a moderator. RESULTS: Both the random and fixed-effect models consistently show that a cancer caregiver's positive commitment to the patient reduces caregiver burden, and family relationship quality provides an overall moderating influence that reduces the felt burden. DISCUSSION: The quality of relations between the caregiver and patient and with others in the family network is critical in understanding caregiver burden in advanced cancer and should be viewed as part of long-term family dynamics.

Leisure activities and cognitive impairment in old age: The role of life course socioeconomic status.

In the current literature on cognitive function, life course socioeconomic status (SES) and engaging in leisure activities are often viewed as parallel measures of cognitive reserve that independently affect cognitive impairment in old age. Some studies also suggest that leisure activity mediates the effect of SES on cognitive impairment. What is less examined is the modification effect of SES on the association between engaging in leisure activities and cognitive impairment, especially from a life course perspective. In this study, we focus on the interaction effects of specific measures of SES and leisure activities on cognitive impairment.We use data from the Chinese Longitudinal Healthy Longevity Survey, which includes five waves of interviews with adults aged 65 and older between 2002 and 2014. Cognitive impairment is measured by the Chinese version of the Mini-Mental Status Examination. Childhood and adulthood SES and participation in seven leisure activities are included in this analysis. We adopt a lagged independent variable approach and the Generalized Linear Mixed Model to conduct the analysis.Findings confirm that higher SES in both childhood and adulthood are associated with low levels of cognitive impairment in the older Chinese population. Furthermore, there are significant interaction effects between specific life course SES and leisure activities with a consistent pattern: Those of higher life course SES enjoy extra benefits from engaging in leisure activities.The findings point to a modification mechanism that connects life course SES, leisure activities, and cognitive health inequality among older adults.

Is Transition in Living Arrangements Associated With Older Adults' Life Satisfaction When Preference Is Considered?

OBJECTIVES: In a longitudinal design, the objective is to investigate the association between transitions in living arrangements and life satisfaction with special consideration for preferred living arrangement, and to assess whether such associations are moderated by age among Chinese older adults. METHODS: Data were from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, 2005-2014. Living arrangement transitions (N = 12,654) distinguished coresidence with children and non-coresidence and matched preference. Random effect ordinal logistic models predicted life satisfaction by transitions in living arrangements between baseline and follow-up, transitions in matched living arrangement preferences between baseline and follow-up, and these transitions interacted with age at baseline, adjusting for life satisfaction at baseline. Predicted probabilities for the highest level of life satisfaction for several transition combinations were calculated and the difference was tested for significance. RESULTS: Although matching actual and preferred living arrangement transition is an important factor in determining life satisfaction, actual coresidence with children remains positively significant. Moreover, results show significant interaction effects of the two transitions with age: while the association of life satisfaction with consistent matching gradually declines into older ages, the association of life satisfaction with consistent coresidence increases with age. DISCUSSION: While preference-matched living arrangement is critical for life satisfaction, especially for the young-old, the role of coresidence becomes more prominent at very old ages when various needs are likely to arise. It is too early to dismiss the role of coresidence with children in the Chinese context.

Double Jeopardy Versus Double Benefit: The Role of Age and Leisure Activities in the Incidence of Disability Among Chinese Older Adults.

Objectives: This paper analyzes the double jeopardy effect of age and double benefit of leisure activities in the incidence of disability. Methods: This study uses data from the Chinese Longitudinal Healthy Longevity Survey between 2002 and 2014. Disability status is measured by activities of daily living. Leisure activities include physical and social activities. A generalized linear mixed model with a time-lag design is used to analyze the trajectory of being disabled. Results: Older ages are associated with double jeopardy of disability: higher initial probability and faster pace. The double benefit of leisure activities is confirmed: lower initial probability and a slower pace of change in disability over time. The age pattern is substantially alleviated when leisure activities and other covariates are present. Discussion: Although the risk of disability rises with advancing age, the over-time trajectory can be flattened by engagement in leisure activities and other factors.

Air pollution, economic development of communities, and health status among the elderly in urban China.

In Western societies, the impact of air pollution on residents' health is higher in less wealthy communities. However, it is not clear whether such an interaction effect applies to developing countries. The authors examine how the level of community development modifies the impact of air pollution on health outcomes of the Chinese elderly using data from the third wave of the Chinese Longitudinal Health Longevity Survey in 2002, which includes 7,358 elderly residents aged 65 or more years from 735 districts in 171 cities. The results show that, compared with a 1-point increase in the air pollution index in urban areas with a low gross domestic product, a similar increase in the air pollution index in areas with a high gross domestic product is associated with more difficulties in activities of daily living (odds ratio = 1.41, 95% confidence interval (CI): 1.09, 1.83), instrumental activities of daily living (linear coefficient = 0.98, 95% CI: 0.58, 1.37), and cognitive function (linear coefficient = 2.67, 95% CI: 1.97, 3.36), as well as a higher level of self-rated poor health (odds ratio = 2.20, 95% CI: 1.68, 2.86). Contrary to what has been found in the West, Chinese elderly who live in more developed urban areas are more susceptible to the effect of air pollution than are their counterparts living in less developed areas.

Assessment of pneumonia in older adults: effect of functional status.

OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS: Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS+/-standard deviation (5.62+/-0.51 days) than the FD group (11.42+/-2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24+/-12.9 vs 4.72+/-6.55, P<.001). CONCLUSION: Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.

Financial consequences of rural hospital long-term care strategies.

Data for 540 rural hospitals from 1982 to 1997 were analyzed to determine whether adoption of long-term-care (LTC) strategies improved hospital financial performance. Adoption of external and internal LTC strategies (other than swing-beds) was generally, but not unambiguously, associated with higher profits, increased occupancy, and/or lower costs.

Incidence of four-generation family lineages: is timing of fertility or mortality a better explanation?

OBJECTIVES: This article estimates the percentage of lineages that include four or more generations for a sample of the U.S. population and explores how social status and race are related to lineage depth. METHODS: We assembled data from Waves 1 and 2 of the National Survey of Families and Households in order to estimate the proportion of adults in four or more generations for the Wave 2 sample (1992-1994). When necessary, we used various decision rules to overcome an absence of information about specific generations. We examine relationships between lineage depth and sociodemographic variables by using logistic regressions. RESULTS: The data show that 32% of the respondents were in lineages comprising four or more generations. Blacks and individuals of lower social class were more likely to be in four-generation lineages, especially shorter-gapped lineages. Whites and individuals of higher social class were not more likely to be in longer-gapped, four-generation lineages. DISCUSSION: The majority of the adult population in the early 1990s was in three-generation lineages. The verdict is still out on whether population aging results in the wholesale verticalization of lineages. Social differentials in four-generation lineages in the early 1990s were mainly due to differences in the timing of fertility, rather than mortality.

Mortality of the oldest old in China.

OBJECTIVE: This study investigates the role of customary activities, both social and solitary, in mortality among the oldest old in China. METHODS: The data come from the Chinese Longitudinal Healthy Longevity Survey. Weibull hazard models analyze the mortality risk of those 80 years of age and older within a 2-year period between 1998 and 2000. RESULTS: Results show that solitary activities, either active or sedentary, are significantly associated with lower mortality risk. The effect of social activities on mortality gradually diminishes with age and is reversed at very old ages when physical exercise, health status, and sociodemographic characteristics are controlled. DISCUSSION: Customary activities, which are less physically demanding, show independent effects on the elderly's survival. Withdrawal from social contacts may be an adaptive response to challenges faced at very advanced ages. It is important to recognize the unique characteristics of this rapidly growing population.

Diversity and structure of intergenerational relationships: elderly parent-adult child relations in Korea.

Korean society has undergone a rapid demographic transition that has challenged traditional patterns of family exchanges. The structure and directions of support flows have become more complex as multiple generations coexist. This article examines the complexity of contemporary Korean intergenerational relationships. The study analyzed two different samples to address anticipated differences in perceptions of and attitudes toward relationships between adult children and elderly parents. The researchers used maximum likelihood latent structure analysis to discover the latent patterns of the association among three main subdimensions of intergenerational relationships: geographic proximity, exchange of support, and cultural norms of family support. Results show that the perspectives on intergenerational relationships differ significantly between middle-aged children and elderly parents. Intergenerational relationships among middle-aged adults comprise five distinct patterns: strong reciprocal, strong traditional, intermediate normative, intermediate circumstantial, and weak. The interpretation of intergenerational relationships from the elders' perspectives is more straightforward, with only three patterns: traditional, reciprocal, and weak. Along with significant socioeconomic differences in the prevalent patterns of intergenerational relationships, these results emphasize the complex interplay of contingency and path dependency in diversifying the value and support exchanges of intergenerational relationships.

Introduction of a waterless alcohol-based hand rub in a long-term-care facility.

OBJECTIVE: To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF). METHODS: Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub. RESULTS: Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P = .002) and less drying (P = .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P = .04). HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB P =.03) and S. aureus (P = .003). Nosocomial infection rates did not change. CONCLUSION: The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs.

Community-acquired pneumonia in older veterans: does the pneumonia prognosis index help?

OBJECTIVES: Mortality rates from pneumonia increase steadily with age. Recently, a disease severity model (the Pneumonia Prognosis Index (PPI)) has been developed to predict mortality from community-acquired pneumonia (CAP). PPI ranks severity of pneumonia from 1 to 5, with 5 being most severe. This retrospective study utilizes the PPI to address the prognosis of CAP in older adults. DESIGN: Retrospective review of medical charts. SETTING: Department of Veterans Affairs Medical Center. PARTICIPANTS: All adults aged 60 and older admitted to a Veterans Affairs Medical Center with CAP between January 1 and December 31, 1998. MEASUREMENTS: PPI was calculated using subjects' demographics, comorbidities, presenting symptoms, and laboratory measurements. RESULTS: Eighty-two patients aged 60 and older were admitted with 101 episodes of CAP. The mean age +/- standard deviation was 72 +/- 9. Seventy-four episodes were admitted from the emergency room, 20 from another hospital, seven from nursing homes, and five from outpatient clinics. Mean length of stay was 7.1 +/- 6 days. Comorbid conditions included coronary artery disease, diabetes mellitus, congestive heart failure, neoplasm, stroke, and renal failure. Most episodes fell into higher PPI classes, with 20% in Class 3, 46% in Class 4, and 32% in Class 5. PPI score was significantly related to length of stay (P < .001), intensity of care (P < .0001), and presence of complications (P <.001). Mortality was 14% at 30 days: 0.5% in Class 3,10.8% in Class 4, and 25% in Class 5. CONCLUSION: The PPI was effective in identifying older adults with CAP who were at risk of a poor outcome, but the practical utility of this index remains to be determined.Further prospective studies are required to elucidate the importance of comorbidities, severity at presentation, and premorbid functional status on clinical and functional outcomes of CAP in older adults.