Trends in cause-specific mortality among persons with Alzheimer's disease in South Carolina: 2014 to 2019.

Introduction: Inconsistencies of reports contributes to the underreporting of Alzheimer's disease (AD) on death certificates. Whether underreporting exists within South Carolina has not been studied. Methods: We conducted a prospective, population-based study on a cohort of persons (N = 78,534) previously diagnosed with AD and died between 2014-2019. We linked vital records with the South Carolina Alzheimer's Disease and Related Dementias Registry to investigate their cause of death and survival rates. Descriptive analyses calculated frequencies of demographic and health-related characteristics. Turnbull's method estimated the survival probabilities for different subgroups of patients. Hazard ratios were computed from the Cox proportional hazards model, adjusting for the following confounding variables of age at diagnosis, education level, gender, and race. Results: The top immediate cause of death was Alzheimer's disease among all racial groups, except for Native American/American Indian. More females (60.3%) were affected by AD compared to males (39.7%). There is a 25% probability of survival, beyond 5 years, after AD diagnosis. Black/African American AD patients have the smallest risk of all-cause mortality across all racial/ethnic groups (HR 0.87; 95% CI, 0.85-0.89). Individuals with lower education had a lower likelihood of mortality. Conclusion: Although AD was not underreported in the state of South Carolina further research is needed to develop protocols around classification of deaths among those diagnosed with dementia and comorbidities, including cardiovascular disease, to ensure dementia is properly reported as we move to prevent and treat Alzheimer's disease by 2025 and beyond.

Influence of Obesity on the Relationship of Cardiometabolic Risks Factors With Cardiovascular Disease in Older African and European Americans.

PURPOSE: This study evaluated the impact of obesity on cardiometabolic risk factors (CRF) interrelationships and predictive efficiency of CVD development in older African (AA) and European Americans (EA). DESIGN: A comparative research design evaluated CRF risk profile differences between participant groups. SETTING: Seven neighborhoods in a southern US city. SUBJECTS: A sample of 179 older AA (n = 128) and EA (n = 51) adults. MEASURES: Non-fasting blood samples were evaluated for lipids and lipoproteins, glycosylated hemoglobin, systolic -(SBP) and diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF%) and physical function. ANALYSIS: Data were analysis with descriptive statistics, t-tests, and correlations. RESULTS: AA were heavier than EA although all had above average age-appropriate fitness. Means and relationships between CRF and other variables were different (P < .05) based on race. Both AA (41.3 + 5.8) and EA (38.6 + 6.4) BF% were CRF risks. Holding BMI constant, CRF were generally not related, and the relationships were different for AA and EA. AA had a range of 13.0 to 27.2% more favorable values for cholesterol, HDL-C, and triglyceride. EA had favorable A1c (EA 5.8 vs AA 6.2%) values. CONCLUSIONS: A limitation of this report is the small sample size. Although further research is warranted, these findings suggest population specific CRF selections would improve CVD prediction in AA.

Keepers of the House: A documentary.

BACKGROUND: Our documentary, Keepers of the House, highlights ways that hospital housekeepers, typically unnoticed care team members, provide emotional support for patients and their families. This film addresses a gap in education by emphasizing the importance of valuing and reflecting on the unique lived experiences of others. APPROACH: We created this documentary to expose students to the experiences and perceptions of hospital housekeepers. A focus group with six hospital housekeepers informed an interview script for the film's creation. Nine additional housekeepers were then interviewed, which developed into a 15-min documentary. Healthcare students and educators from five disciplines viewed the documentary during their institution's Medical Education Day. EVALUATION: To expose students and educators to housekeepers' experiences, we designed our post-viewing survey to address whether the housekeepers' stories impacted their understanding of the role and value of these workers. Viewers were surprised by the depth and breadth of patient-housekeeper interactions, the trauma housekeepers experienced from patient loss and the pride housekeepers take in their work. The stories that touched the viewers varied but centred on connections between housekeepers and patients. Lessons learned focused on recognizing the contributions of unseen team members. IMPLICATIONS: This innovative documentary amplifies the perspectives of voices rarely heard in healthcare. We aim to use this film, alongside its associated learning session, in education and grand round settings to foster discussion around empathy, valuing underrecognised team members and applying these insights in practice. This work can be disseminated to other institutions, further amplifying underrepresented narratives in healthcare.

Women Veterans Experience with the VA MOVE! Weight Management Program.

Background: Obesity prevalence is higher in women veterans overall than their civilian counterparts considering 44% of women veterans are obese. Thus, there is a critical need to understand the facilitators and barriers to women veterans' participation in weight management programs. The objective of this study is to explore facilitators and barriers to weight loss for women veterans enrolled in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (VA MOVE!) weight management program and gather feedback on the design and delivery of the MOVE! PROGRAM: Materials and Methods: Primary qualitative data were collected from women veterans who completed at least one MOVE! visit via semistructured telephone interviews. Two authors independently reviewed transcripts for data-derived codes. A content analysis approach was used within the software to code the transcripts. Results: The mean age of participants was 52 years. Sixty-eight percent (N = 17/25) were black, and 52% (N = 13/25) lived >64 kilometers from the location of the MOVE! PROGRAM: Facilitators to participation included both intrinsic (e.g., drive to become healthy) and extrinsic (e.g., drive to improve laboratories) motivating factors. Women expressed difficulty with learning in a group setting and applying lessons to their everyday lives. Others reported the setup of group classes triggered their post-traumatic stress disorder and prevented them from fully participating in the program. Additional barriers included distance traveled to group sessions and lack of access to exercise space. Conclusions: Our results illuminate barriers and facilitators to engagement in the MOVE! PROGRAM: Many of the barriers highlighted by these women veterans mirror barriers civilian women face, highlighting the possibility that our results could be applied to other programs designed to target weight loss in women.

Developing Predictors of Long-Term Adherence to Exercise Among Older Veterans and Spouses.

Behavior change theory was used to explore predictors of long-term adherence (≥2 years) to exercise. A retrospective analysis of data from participants (N = 97) who reached a 6-month follow-up, which served as the baseline, was evaluated for completion of yearly follow-up surveys. Variables examined at baseline, which included age, race, gender, body mass index (BMI), and self-report of comorbidities, symptoms, physical function, and a Barriers Specific Self-Efficacy Scale, were examined with significance set at p < .05. Lower BMI (29.1 ± 5.1 vs. 31.6 ± 6.5, p = .047) and higher self-efficacy to overcome environmental barriers (p = .016) and social isolation (p = .05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers, such as inclement weather, access to exercise site, and opportunities for group-based exercise, should be addressed to promote long-term adherence to exercise among older adults.

Motivation Regulation among Black Women Triathletes.

There is a paucity of information on motivation among U.S. minority triathletes. This study aimed to understand the extrinsic motivation and regulators of Black women triathletes using a modified version of the valid Motivations of Marathoners Scale and semi-structured interviews, for triathletes. The Self Determination Theory guided the dual method assessment of the extrinsic motivators and the regulators external, introjection, and integrated. Using MANOVA, data from (N = 121) triathletes were compared across participant categories of age, body mass index, and distance. Results showed a significant age difference with younger women displaying more motivation. Descriptive means indicated integration as the greatest regulator of motivation. The statements 'to compete with myself' and 'to be more fit,' had the highest means among the women. A sub-sample of 12 interviews were conducted revealing 16 extrinsic themes. Six were related to the regulator integration and two unexpectantly related to the regulator, identified. Integrated themes, including coping mechanisms, finishing course, improvement, accomplishment, and physical awareness were most represented. This research fills gaps of understanding extrinsic motivation and the regulators of a group not previously explored. Future research on motivation among triathletes may benefit knowing how motivations are regulated, as to promote personalized training and participation.

Effect of gabapentin on sexual function in vulvodynia: a randomized, placebo-controlled trial.

BACKGROUND: Sexual dysfunction is common in women with vulvodynia. OBJECTIVE: The purpose of this study was (1) to evaluate whether extended-release gabapentin is more effective than placebo in improving sexual function in women with provoked vulvodynia and whether there is a relationship between treatment outcome and pelvic pain muscle severity that is evaluated by palpation with standardized applied pressure and (2) to evaluate whether sexual function in women with provoked vulvodynia would approach that of control subjects who report no vulvar pain either before or after treatment. STUDY DESIGN: As a secondary outcome in a multicenter double-blind, randomized crossover trial, sexual function that was measured by the Female Sexual Function Index was evaluated with gabapentin (1200-3000 mg/d) compared with placebo. Pain-free control subjects, matched by age and race, also completed Female Sexual Function Index for comparison. RESULTS: From August 2012 to January 2016, 230 women were screened at 3 academic institutions, and 89 women were assigned randomly to treatment. Gabapentin was more effective than placebo in improving overall sexual function (adjusted mean difference, 1.3; 95% confidence interval, 0.4-2.2; P=.008), which included desire (mean difference, 0.2; 95% confidence interval, 0.0-3.3; P=.04), arousal (mean difference, 0.3; 95% confidence interval, 0.1-0.5; P=.004), and satisfaction (mean difference, 0.3; 95% confidence interval, 0.04-0.5; P=.02); however, sexual function remained significantly lower than in 56 matched vulvodynia pain-free control subjects. There was a moderate treatment effect among participants with baseline pelvic muscle pain severity scores above the median on the full Female Sexual Function Index scale (mean difference, 1.6; 95% confidence interval, 0.3-2.8; P=.02) and arousal (mean difference, 0.3; 95% confidence interval, 0.1-0.6; P=.01) and pain domains (mean difference, 0.4; 95% confidence interval, 0.02-0.9; P=.04). CONCLUSION: Gabapentin improved sexual function in this group of women with provoked vulvodynia, although overall sexual function remained lower than women without the disorder. The most statistically significant increase was in the arousal domain of the Female Sexual Function Index that suggested a central mechanism of response. Women with median algometer pain scores >5 improved sexual function overall, but the improvement was more frequent than the pain domain. We hypothesize that gabapentin may be effective as a pharmacologic treatment for those women with provoked vulvodynia and increased pelvic muscle pain on examination.

The use of poetry in qualitative post-hoc analysis.

In this brief report three poems stemming from previously completed research into the motivations of 12 Black women who participate in triathlons, are presented. A review of the transcripts revealed impactful stories from the previously identified themes Competition, Triathlete Lifestyle, and Lifespan Participation. A phenomenological approach to this post-hoc qualitative analysis provides an outlet for poetic expression. The poems, each representative of the words and life world sensations recorded within the transcripts, are of varying styles. The first is free form allowing for inconsistency in the poem pattern. The second provides comic relief in a limerick. The last is a sonnet with words that can be put to music. The reexamination of the previous research and development of the poems revealed a theme not previously cited. 'Time' is a catalyst for the triathletes and its importance is illuminated in the prose.

The Impact of Multiple Dimensions of Socioeconomic Status on Physical Functioning Across the Life Course.

Objective: We used the Physical Performance Across the LifeSpan Study to investigate the relationships of multiple indicators of socioeconomic status (SES), both in early life and late life, with physical function. Method: We examined associations between multiple early and late life SES indicators with physical function measured by aerobic endurance, gait speed, and lower body strength. Results: Higher participant education and household income were associated with increased physical function. In our age-stratified analysis, we observed widening SES disparities with increasing age among those in the two younger strata with lower SES associated with worse physical function. Finally, we observed an association between socioeconomic trend and gait speed, aerobic endurance, and lower body strength. There was also an association between lower aerobic endurance and being in a downward socioeconomic trend. Discussion: These findings highlight the significance of considering multiple dimensions of the social environment as important correlates of physical functioning across the life course.

Gabapentin for the Treatment of Vulvodynia: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether extended-release gabapentin is more effective than placebo among women with vulvodynia. METHODS: In a multicenter double-blind, placebo-controlled randomized crossover trial, gabapentin (1,200-3,000 mg/d) was compared with a placebo. The primary outcome was mean pain intensity (0, no pain at all to 10, worst pain ever) on the tampon test (a standardized tampon insertion and removal test used as a surrogate marker for dyspareunia) during the last 7 days of the maintenance phase. Secondary outcomes included sexual intercourse pain and daily pain. A sample size of 53 provided 90% power to detect a 1-point reduction on the tampon test (.05 level, two-sided) between the two treatment phases. RESULTS: From August 2012 to January 2016, 230 women were screened at three academic institutions and 89 (mean age 37 years; 65% black) were randomized: 45 to gabapentin first and then placebo and 44 to placebo first and then gabapentin. Tampon test pain with gabapentin was not different compared with the placebo (adjusted mean 4.0, 95% CI 3.0-4.9 vs 4.3, 95% CI 3.4-5.2, difference -0.3, 95% CI -0.7 to 0.0; P=.07). Gabapentin also did not improve pain over placebo for sexual intercourse pain (adjusted mean 3.9, 95% CI 2.4-5.3 vs 4.0, 95% CI 2.5-5.4, difference -0.1, 95% CI -0.9 to 0.6; P=.76) and daily pain (adjusted mean 2.7, 95% CI 1.8-3.6 vs 2.9, 95% CI 2.0-3.8, difference -0.2, 95% CI -0.5 to -0.2; P=.36). Subset analyses found that longer pain duration and oral contraceptive nonuse were associated with minimal improvement in tampon test pain with gabapentin. CONCLUSION: In this cohort, extended-release gabapentin, as compared with a placebo, did not reduce tampon test pain. These data do not support the recommendation of gabapentin alone as treatment for vulvodynia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01301001.

Identifying Motives of Midlife Black Triathlete Women Using Survey Transformation to Guide Qualitative Inquiry.

Demonstrating health disparities related to race, age, and gender, older Black women (BW) are the most sedentary demographic group in the United States. Increasing PA in mid-life is important, as it improves health as BW age into their later years. Advancing our understanding of the exercise motives of BW triathletes presents a "reverse engineering" opportunity to identify motives that could influence sedentary mid-life BW to increase their activity. The purposes of this study were to: (a) utilize an innovative survey transformation method to adapt a measure developed primarily in Caucasian males, i.e., the Motivations of Marathoners Scale for Triathletes (MOMS-T) into a qualitative interview guide for use with BW triathletes; (b) use this interview guide to identify culturally based motives for triathlon participation among BW not previously addressed by the MOMS-T and; (c) interpret the novel motivational domains of the MOMS-T discovered, in order to gain understanding and influence subsequent interventions. Purposive sampling was used to select 12 interview participants from 121 self-identified Black female US residents aged ≥36 years with recent experience completing or training for a triathlon. The interviews identified four culturally based themes, including improving body composition to become "more lean", physical attractiveness, triathlete family, and camaraderie. These novel themes were related to existing MOMS-T scales, but the current MOMS-T questions did not illuminate their culturally distinct aspects. The process of survey transformation provides a viable approach to identify important culturally based characteristics and to adapt surveys to cultural minority populations, particularly when study resources are limited.

Recruitment methods in a clinical trial of provoked vulvodynia: Predictors of enrollment.

BACKGROUND: Successful recruitment in clinical trials for chronic pain conditions is challenging, especially in women with provoked vulvodynia due to reluctance in discussing pain associated with sexual intercourse. The most successful recruitment methods and the characteristics of women reached with these methods are unknown. OBJECTIVE: To compare the effectiveness and efficiency of four recruitment methods and to determine socioeconomic predictors for successful enrollment in a National Institutes of Health-sponsored multicenter clinical trial evaluating a gabapentin intervention in women with provoked vulvodynia. METHODS: Recruitment methods utilized mass mailing, media, clinician referrals and community outreach. Effectiveness (number of participants enrolled) and efficiency (proportion screened who enrolled) were determined. Socioeconomic variables including race, educational level, annual household income, relationship status, age, menopausal status and employment status were also evaluated regarding which recruitment strategies were best at targeting specific cohorts. RESULTS: Of 868 potential study participants, 219 were enrolled. The most effective recruitment method in enrolling participants was mass mailing ( p < 0.001). There were no statistically significant differences in efficiency between recruitment methods ( p = 0.11). Relative to clinician referral, black women were 13 times as likely to be enrolled through mass mailing (adjusted odds ratio 12.5, 95% confidence interval, 3.6-43.1) as white women. There were no differences in enrollment according to educational level, annual income, relationship status, age, menopausal status, or employment status and recruitment method. CONCLUSION: In this clinical trial, mass mailing was the most effective recruitment method. Race of participants enrolled in a provoked vulvodynia trial was related to the recruitment method.

"My hair or my health:" Overcoming barriers to physical activity in African American women with a focus on hairstyle-related factors.

Physical activity disparities among African American (AA) women may be related to sociocultural barriers, including difficulties with restyling hair after exercise. We sought to identify physical activity barriers and facilitators in AA women with a focus on sociocultural factors related to hairstyle maintenance. Participants (n = 51) were AA women aged 19-73 years who completed valid surveys and participated in structured focus groups, stratified by age and physical activity levels, from November 2012 to February 2013. The Constant Comparison method was used to develop qualitative themes for barriers and facilitators. The most frequently reported general physical activity barrier among exercisers was "lack of money" (27%) and among non-exercisers was "lack of self-discipline" (57%). A hairstyle-related barrier of "sweating out my hairstyle" was reported by 7% of exercisers and 29% of non-exercisers. This hairstyle-related barrier included the need for extra time and money to restyle hair due to perspiration. Hairstyle-related facilitators included: prioritizing health over hairstyle and high self-efficacy to restyle hair after perspiration. Participants were interested in resources to simplify hairstyle maintenance. AA women whose hairstyle is affected by perspiration may avoid physical activity due to time and financial burdens. Increasing self-efficacy to restyle hair after perspiration may help to overcome this barrier.

Presenting Symptoms Among Black and White Women with Provoked Vulvodynia.

BACKGROUND: The prevalence of vulvodynia has been reported to be lower in black compared to white and Latina women. Use of different terminology to describe vulvar pain symptoms may play a role in lower prevalence. The objectives were to compare pain descriptors used by black and white women with provoked vulvodynia (PVD) to determine the effect of race on symptom reporting. METHODS: Ninety-two women, self-identified as black (n = 55) and white (n = 37) with clinically confirmed PVD completed a questionnaire containing demographic information and vulvar pain characteristics. Variables that were significant with race retained in the logistic regression model were included in multivariate analysis to determine the effect of race on reporting of vulvar pain symptoms. RESULTS: Of statistical significance, white women more often described their pain as burning as compared with black women (84% vs. 22%, p ≤ 0.0001). White women more frequently reported their pain as stinging (51% vs. 29%, p = 0.03) and itching (32% vs. 15%, p = 0.04) as well, whereas there was a trend for black women to more often describe their pain as aching (67% vs. 49%, p = 0.07). Overall, white women were 19 times as likely to report their pain as burning (adjusted odds ratio [aOR] 18.51, 99% confidence interval [CI] 4.46-76.86). CONCLUSIONS: These data suggest that black women are less likely to self-report their vulvar pain as burning, the classic symptom of PVD. Cultural influences and different underlying pain mechanisms may contribute to differences in symptom reporting by race.

Reconceptualizing successful aging among black women and the relevance of the strong black woman archetype.

Although there are multiple pathways to successful aging, little is known of what it means to age successfully among black women. There is a growing body of literature suggesting that black women experience a number of social challenges (sexism and racism) that may present as barriers to aging successfully. Applying aspects of the Strong Black Women ideal, into theoretical concepts of successful aging, may be particularly relevant in understanding which factors impair or promote the ability of black women to age successfully. The Strong Black Women archetype is a culturally salient ideal prescribing that black women render a guise of self-reliance, selflessness, and psychological, emotional, and physical strength. Although this ideal has received considerable attention in the behavioral sciences, it has been largely absent within the gerontology field. Nevertheless, understanding the dynamics of this cultural ideal may enhance our knowledge while developing an appreciation of the black woman's ability to age successfully. Rather than summarize the social, physical, and mental health literature focusing on health outcomes of black women, this conceptual review examines the Strong Black Women archetype and its application to the lived experiences of black women and contributions to current theories of successful aging. Focusing on successful aging exclusively among black women enhances our understanding of this group by considering their identity as women of color while recognizing factors that dictate their ability to age successfully.

Potency and Stability of Intradermal Capsaicin: Implications for Use as a Human Model of Pain in Multicenter Clinical Trials.

Intradermally injected capsaicin has been used extensively both as a human pain model and to assess analgesic efficacy. Factors such as dose, formulation, route, and site are known to affect its sensitivity. We determined whether potency and stability of capsaicin solutions were further sources of variability when following strict manufacturing guidelines. Capsaicin solution (1.0 mg/mL) was prepared according to Current Good Manufacturing Practice (cGMP) guidelines and aseptically filled into sterile amber borosilicate vials and stored at 5°C, 25°C, and 30°C. All samples were analyzed at one, three, six, and twelve months. Chemical stability was determined using HPLC and physical stability was evaluated by visual inspection of color changes, clarity, particulate matter, and product/ container closure abnormalities during each sampling time. Capsaicin intradermal injection was found to be sterile and retained 95% of the initial concentration for at least one year, regardless of studied storage temperatures (P<0.0001). Visual inspection indicated no changes in color, clarity, particulate matter, and product/ container closure abnormalities in all samples. These data show that capsaicin solutions (1.0 mg/mL) maintain their potency and stability over one year when manufactured according to cGMP guidelines. These results suggest that in clinical trials manufacturing of capsaicin solutions is recommended over extemporaneous compounding.

A review of our roots: blacks in gerontology.

The historical underpinnings in the field of gerontology rest on the contributions of scholars across a myriad of racial and ethnic backgrounds. With the increasing diversity of the adult population, there is a need to increase the number of researchers who study older adults from diverse racial and ethnic populations in general and Black elderly people in particular. Furthermore, it is important to document the participation of Black older adults in our earliest and continuing research efforts. Understanding the historical context and the foundational influence of Black scholars in this field is critical. To realize its humble beginnings, one must become aware of the contributions by Black scholars who have a vested interest in the aging process. With universal similarities and unique differences among older adults, there is a need to acknowledge the past and current scholarship of those who study the aging processes of Blacks while marveling over the future possibilities. The purpose of this review is to elucidate the legacy and current contributions, philosophies, and research of Black scholars in the field of gerontology. In addition, exploration of the theoretical and conceptual frameworks used to establish national and organizational initiatives is reviewed. The impetus in initiating and continuing this work requires a "knowledge of our roots" while moving into the future. It is important to learn the history and significance of Black scholars in gerontology, the contributions of older Blacks, and appreciate the resiliency and marveled life course of this unique population.

Rationale and design of a multicenter randomized clinical trial of extended release gabapentin in provoked vestibulodynia and biological correlates of response.

INTRODUCTION: Few randomized controlled trials (RCTs) have been conducted to establish evidence-based management protocols for provoked vestibulodynia (PVD), a chronic vulvar pain condition affecting approximately 14 million women in the U.S. We describe the rationale and design of an NIH funded multicenter clinical trial utilizing an extended release formulation of gabapentin (G-ER), an intervention that preliminary data suggest may be efficacious for this condition. OBJECTIVES: 1) to determine if pain from tampon insertion (primary outcome measure) is lower in PVD patients when treated with G-ER compared to when treated with placebo and 2) to determine if G-ER reduces vulvar mechanical hyperalgesia, vaginal muscle pain to palpation, the number and intensity of somatic tenderpoints, spontaneous and provoked pain to intradermal capsaicin with an accompanying increase in cardiac beat-to-beat variability and to identify mechanistically-based PVD subtypes. Additional outcomes include subject reported intercourse pain and summative 24-hour pain. METHODS: This 16-week, randomized, double-blind, placebo-controlled, crossover study will enroll 120 women 18 years and older who report tenderness localized to the vulvar vestibule, pain with tampon insertion, and, when sexually active, insertional dyspareunia. Electronically entered daily diaries will be used to determine if pain is lower in PVD subjects when treated with G-ER (up to 3000 mg/d) compared to when treated with placebo. Psychophysiological measures will be obtained at baseline and after 2 weeks at the maximum tolerated dose. CONCLUSION: We will conduct the first multicenter RCT to confirm efficacy of an agent that is currently used in clinical practice for treating PVD.