The Life-Long Mortality Risks Of World War II Experiences.

OBJECTIVE: This longitudinal study of American veterans investigated the mortality risks of five World War II military experiences (i.e., combat exposure) and their variation among veterans in the post-war years.

Uncertainty, symptoms, and quality of life in persons with chronic hepatitis C.

Background: Chronic hepatitis C (CHC) is the most common blood-borne infection in the United States, but little is known about illness uncertainty in these patients.

Objective: The authors examined the constructs of illness uncertainty.

Method: In this cross-sectional study, Mishel's Uncertainty in Illness Scale was used to examine these constructs (ambiguity, complexity, inconsistency, unpredictability) and their relationships with fatigue, pain, depressive symptoms, comorbidity, and quality of life (QOL) in 126 CHC patients undergoing a watchful-waiting protocol.

Effect of physical activity guidelines on physical function in older adults.

Objectives: To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa.

Design: Pooled data.

Setting: Two 6-month randomized controlled trials aimed at increasing PA in adults.

Community-based service use by elders with dementia and their caregivers: a latent class analysis.

Background: With the increase in the number of older adults with dementia, research efforts have focused on increasing community-based support service (CBSS) use to improve older adult and caregiver outcomes. However, the research on factors that may explain CBSS use has been focused on individual characteristics, and how the care recipient and caregiver as a pair influence CBSS use has not been accounted for.

Objective: To classify care recipients with dementia and their caregivers who shared similar patterns of CBSS use and to identify predictors of class membership.

Regularity of preventive foot care in persons with diabetes: results from the Nord-Trøndelag Health Study.

The purpose of the present study was to examine the regularity of preventive care for persons with diabetes in the Nord-Trøndelag Health Study to identify associated demographic, lifestyle, and disease-related factors. Among 1,972 persons with diabetes, 1,459 (74%) answered questions related to preventive foot care. The final sample included 1,312 persons with known diabetes, but without a self-reported history of foot ulcer.

History of and factors associated with diabetic foot ulcers in Norway: the Nord-Trøndelag Health Study.

Aims: To determine the proportion of people with diabetes mellitus reporting a history of foot ulcer and to investigate factors associated with this adverse outcome.

Methods: All inhabitants aged 20 years and older residing in a large geographic region were invited to participate in the Nord-Trøndelag Health Study, 71% (n=65,604) attended. Those reporting diabetes (n=1,972) were invited to take part in an ancillary study on diabetes.

Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway.

Aim: To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population.

Methods: The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65-102 years with at least six months' residence and a representative population sample of 1137 Norwegian citizens aged 65-102 years.

Post-traumatic stress outcomes in non-Hodgkin's lymphoma survivors.

Purpose: A large body of evidence suggests that being diagnosed with and treated for cancer adversely affects functioning and quality of life, yet less is known about longer term outcomes. Therefore, this study aims to estimate the prevalence of post-traumatic stress disorder (PTSD) symptoms in survivors of adult non-Hodgkin's lymphoma (NHL) who are at least 2 years postdiagnosis and identify the risk factors associated with PTSD symptoms, with a focus on those that are amenable for screening and modifiable.

Patients And Methods: A total of 886 NHL survivors identified from the cancer registries of two hospitals in North Carolina participated, ranging in age from 25 to 92 years old and ranging from 2 to 44 years postdiagnosis.

Identification of dementia: agreement among national survey data, medicare claims, and death certificates.

Objective: To estimate the proportion of seniors with dementia from three independent data sources and their agreement.

Data Sources: The longitudinal Asset and Health Dynamics among the Oldest Old (AHEAD) study (n=7,974), Medicare claims, and death certificate data.

Study Design: Estimates of the proportion of individuals with dementia from: (1) self- or proxy-reported cognitive status measures from surveys, (2) Medicare claims, and (3) death certificates.

Childhood cancer survivors' perceived barriers to improving exercise and dietary behaviors.

Purpose/objectives: To determine childhood cancer survivors' barriers to increasing exercise and consuming less fat and more fruits and vegetables, whole grains, and calcium-rich foods.

Design: Mailed survey.

Setting: Cases from a comprehensive cancer center.

Identifying trajectories of depressive symptoms for women caring for their husbands with dementia.

Objectives: To use an innovative statistical method, Latent Class Trajectory Analysis (LCTA), to identify and describe subgroups (called trajectories) of caregiver depressive symptoms in a national sample of wives providing informal care for their husbands with dementia.

Design: Longitudinal.

Setting: Community.

Understanding the role of cancer worry in creating a "teachable moment" for multiple risk factor reduction.

The manuscript examines the influence of contextual factors on whether and for whom a colon polyp diagnosis might be a teachable moment, as indicated by engagement with a proactively delivered intervention. Baseline and 8-month follow-up data were analyzed from a two-site behavioral intervention trial with patients in Massachusetts and North Carolina, USA who had recently undergone polypectomy for pre-cancerous colon polyps and were randomized to a behavior change intervention condition (N=591). Intervention "buy-in" was used as an indicator of response consistent with the polyp identification serving as a teachable moment.

Measuring the quality of dying in long-term care.

Objectives: To describe two versions of a new measure, The Quality of Dying in Long-Term Care, for postdeath administration to surrogate respondents (staff and family caregivers) of all decedents (QOD-LTC) and of cognitively intact decedents (QOD-LTC-C) who die in nursing homes (NHs) and residential care or assisted living (RC/AL) facilities.

Design: Using two levels of exploratory factor analysis, 15 candidate items for the QOD-LTC and 36 candidate items for the QOD-LTC-C were tested using multiple criteria to determine factor structure and interpretability of the quality of dying in long-term care (LTC).

Setting: One hundred seventeen RC/AL facilities and 31 NHs in FL, MD, NC, and NJ.

The Diet Quality Index-Revised: a tool to promote and evaluate dietary change among older cancer survivors enrolled in a home-based intervention trial.

Objective: To utilize the Diet Quality Index-Revised (DQI-R) as a framework for delivering and evaluating an intervention to improve overall diet quality among older cancer survivors.

Design: As part of a randomized controlled trial to improve lifestyle behaviors among older cancer survivors, we sought a dietary measure that could serve as both an intervention framework and a means to evaluate global dietary quality. The DQI-R measures overall diet quality by summing 10 subscales that relate to national guidelines.

Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors.

Purpose: Cancer survivors are at increased risk for cardiovascular disease, diabetes, osteoporosis, and second primary tumors. Healthful lifestyle practices may improve the health and well-being of survivors. The FRESH START trial tested the efficacy of sequentially tailored versus standardized mailed materials on improving cancer survivors' diet and exercise behaviors.

Congregational health ministries: a national study of pastors' views.

Objectives: Since the 1980s, there has been a growing, but little studied, movement that organizes church-based health services under the direction of a coordinator, usually a registered nurse. These Congregational Health Ministries (CHMs) emphasize health promotion and disease prevention. We compared the perceptions of pastors with and without organized CHMs and the characteristics of their congregations' health ministries.

Identifying, recruiting, and retaining seriously-ill patients and their caregivers in longitudinal research.

Background: In order to improve the state of science in palliative care, we must increase our ability to document the real-time experience of patients and families as they traverse the end of life. Yet, frequently, prospective measurement is impeded by difficulty with patient identification, recruitment, enrollment, and retention. The palliative care literature is replete with descriptions of studies unable to meet enrollment goals, and that as a result, do not have adequate power to test hypotheses or draw conclusions.

Evaluation of agreement between physicians' notation of 'no evidence of disease' (NED) and patients' report of cancer status.

This study examines extent of agreement between oncologists' and cancer patients' reports of current cancer status. Participants with history of cancer were given a comprehensive geriatric assessment in which they were asked whether they had cancer at the present time. This was compared to cancer status concurrently recorded by their physicians in the chart.

Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.

Objective: This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination.

Methods: Data were drawn from the 1998 National Longitudinal Caregiver Survey.

Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD.

Purpose: Declines in physical functioning (PF) among elderly cancer patients threaten quality of life and the ability to maintain independence. Adherence to healthy lifestyle behaviors may prevent functional decline.

Patients And Methods: Project Leading the Way in Exercise and Diet (LEAD), an intervention development study of the Pepper Older Americans Independence Center, aimed to determine whether breast and prostate cancer survivors (age 65+ years) assigned to a 6-month home-based diet and exercise intervention experienced improvements in PF when compared with an attention control arm receiving general health information.

Measuring quality of life at the end of life: validation of the QUAL-E.

Objectives: To validate the QUAL-E, a new measure of quality of life at the end of life.

Methods: We conducted a cross-sectional study to assess the instrument's psychometric properties, including the QUAL-E's associations with existing measures, evaluation of robustness across diverse sample groups, and stability over time. The study was conducted at the VA and Duke University Medical Centers, Durham, North Carolina, in 248 patients with stage IV cancer, congestive heart failure with ejection fraction < or = 20%, chronic obstructive pulmonary disease with FEV1 < or = 1.

Caregivers' reasons for nursing home placement: clues for improving discussions with families prior to the transition.

Purpose: This study identifies the relative importance of reasons for institutionalization endorsed by caregivers of patients with dementia; examines the relationship between caregivers' reasons for institutionalization and indicators of caregiver and patient physical and emotional functioning measured in the prior year; and compares, on these indicators, caregivers who institutionalized their care recipients with caregivers who did not.

Design And Methods: Participants were 2,200 caregivers from the National Longitudinal Caregiver Study, including 580 who institutionalized their care recipient during the 3-year interval. Caregivers' reason(s) for institutionalization were examined and correlated with indicators of caregiver and patient physical and emotional functioning.

"Are you at peace?": one item to probe spiritual concerns at the end of life.

Background: Physicians may question their role in probing patients' spiritual distress and the practicality of addressing such issues in the time-limited clinical encounter. Yet, patients' spirituality often influences treatment choices during a course of serious illness. A practical, evidence-based approach to discussing spiritual concerns in a scope suitable to a physician-patient relationship may improve the quality of the clinical encounter.

The association between oral health and general health and quality of life in older male cancer patients.

Objectives: To describe the long-term effects of oral health problems on quality of life (QoL), functional status, pain, and general health in older male cancer patients.

Design: Secondary analysis of a prospective observational study.

Setting: Community dwelling cancer patients served by a Department of Veterans Affairs hospital.

Project PREVENT: a randomized trial to reduce multiple behavioral risk factors for colon cancer.

Background: This report examines the outcome data for Project PREVENT, a two-site randomized control trial designed to reduce behavioral risk factors for colorectal cancer among individuals who have been diagnosed with adenomatous colon polyps.

Methods: The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone, and were randomized to either Usual Care (UC) or the PREVENT intervention, which was designed to target multiple risk factors.