Cognitive aging is characterized by large heterogeneity, which may be due to variations in childhood socioeconomic conditions (CSC). Although there is substantial evidence for an effect of CSC on levels of cognitive functioning at older age, results on associations with cognitive decline are mixed. We examined by means of an accelerated longitudinal design the association between CSC and cognitive trajectories from 50 to 96 years. Cognition included two functions generally found to decline with aging: delayed recall and verbal fluency. Data are from six waves of the Survey of Health, Aging, and Retirement in Europe (SHARE), conducted between 2004 and 2015 (n = 24,066 at baseline; 56% female, age 50+). We found a consistent CSC pattern in levels of cognitive functioning in later life. Older people with disadvantaged CSC had lower levels of cognitive functioning than those with more advantaged CSC. We also find that decline is almost 1.6 times faster in the most advantaged group compared with the most disadvantaged group. The faster decline for people with more advantaged CSC becomes less pronounced when we additionally control for adulthood socioeconomic conditions and current levels of physical activity, depressive symptoms, and partner status. Our findings are in line with the latency, pathway, and cumulative model and lend support to theories of cognitive reserve, stating that neuronal loss can no longer be repaired in people with more cognitive reserve once the underlying pathology is substantial and speed of decline is accelerated. Significance There is increasing evidence that socioeconomic conditions early in life have an impact on cognitive functioning in later life. Based on the large longitudinal sample from SHARE we find a clear pattern in cognitive functioning in old age, related to childhood socioeconomic conditions: Those from more affluent households show higher levels of fluid intelligence in old age and experience stronger decline over time in executive functions. The latter phenomenon is not often documented. Although modifications in cognitive functioning with aging are inevitable, life course socioeconomic circumstances impact the timing of this process. We conclude that the etiology of cognitive aging is the result of multiple social processes, defined by the socioeconomic conditions in childhood and all along the life course.
1 March 2019 in Mayo Clinic Proceedings: Innovations, Quality & Outcomes
To explore professionals' experiences and perceptions of whether, how, and what types of conflicts affected the quality of patient care. We conducted 82 semistructured interviews with randomly selected health care professionals in a Swiss teaching hospital (October 2014 and March 2016). Participants related stories of team conflicts (intra-/interprofessional, among protagonists at the same or different hierarchical levels) and the perceived consequences for patient care. We analyzed quality of care using the dimensions of care proposed by the Institute of Medicine Committee on Quality of Health Care in America (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity). Seventy-seven of 130 conflicts had no perceived consequences for patient care. Of the 53 conflicts (41%) with potential perceived consequences, the most common were care not provided in a timely manner to patients (delays, longer hospitalization), care not being patient-centered, and less efficient care. Intraprofessional conflicts were linked with less patient-centered care, whereas interprofessional conflicts were linked with less timely care. Conflicts among protagonists at the same hierarchical level were linked with less timely care and less patient-centered care. In some situations, perceived unsatisfactory quality of care generated team conflicts. Based on participants' assessments, 4 of 10 conflict stories had potential consequences for the quality of patient care. The most common consequences were failure to provide timely, patient-centered, and efficient care. Management of hospitals should consider team conflicts as a potential threat to quality of care and support conflict management programs.
Objectives: Seroprevalence studies to assess the spread of SARS-CoV-2 infection in the general population and subgroups are key for evaluating mitigation and vaccination policies and for understanding the spread of the disease both on the national level and for comparison with the international community. Methods: Corona Immunitas is a research program of coordinated, population-based, seroprevalence studies implemented by Swiss School of Public Health (SSPH+). Over 28,340 participants, randomly selected and age-stratified, with some regional specificities will be included. Additional studies in vulnerable and highly exposed subpopulations are also planned. The studies will assess population immunological status during the pandemic. Results: Phase one (first wave of pandemic) estimates from Geneva showed a steady increase in seroprevalence up to 10.8% (95% CI 8.2–13.9, n = 775) by May 9, 2020. Since June, Zurich, Lausanne, Basel City/Land, Ticino, and Fribourg recruited a total of 5973 participants for phase two thus far. Conclusions: Corona Immunitas will generate reliable, comparable, and high-quality serological and epidemiological data with extensive coverage of Switzerland and of several subpopulations, informing health policies and decision making in both economic and societal sectors. ISRCTN Registry: https://www.isrctn.com/ISRCTN18181860.
Purpose: The self-rated health (SRH) item is frequently used in health surveys but variations of its form (wording, response options) may hinder comparisons between versions over time or across surveys. The objectives were to determine (a) whether three SRH forms are equivalent, (b) the form with the best construct validity and (c) the best coding scheme to maximize equivalence across forms. Methods: We used data from 58,023 respondents of the Swiss Health Survey. Three SRH forms were used. Response options varied across forms and we explored four coding schemes (two considering SRH as continuous, two as dichotomous). Construct validity of the SRH was assessed using 34 health predictors to estimate the explained variance. Results: Distributions of response options were similar across SRH forms, except for the “good” and “very good” options (“good” in form 1: 58.6%, form 2: 65.0% and form 3: 44.1%). Explained variances differed across SRH forms, with form 3 providing the best overall explained variance, regardless of coding schemes. The linear coding scheme maximised the equivalence across SRH forms. Conclusion: The three SRH forms were not equivalent in terms of construct validity. Studies examining the evolution of SRH over time with surveys using different forms should use the linear coding scheme to maximise equivalence between SRH forms.
This study aimed to test whether the level of cognitive resources explains engagement in physical activity across aging and whether the age-related decline of cognitive resources precede the decline in physical activity. Data from 105,206 adults aged 50 to 90 years from the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used in adjusted linear mixed models to examine whether the engagement in moderate physical activity and its evolution across aging were dependent on cognitive resources. Cognitive resources and physical activity were measured 5 times over a 12-year period. Delayed recall, verbal fluency, and the level of education were used as indicators of cognitive resources. The frequency of engagement in moderate physical activity was self-reported. Dynamic structural equation models (SEM) were used to assess the temporal precedence of changes in cognitive resources and physical activity. Lower cognitive resources were associated with lower levels and steeper decreases in moderate physical activity across aging. Results further revealed a time-ordered effect with a stronger influence of cognitive resources (delayed recall and verbal fluency) on subsequent changes in moderate physical activity than the opposite. These findings suggest that, after age 50, the level of engagement in moderate physical activity and its trajectory depend on the availability of cognitive resources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).