Abstract

China’s recent constitutional changes have led to international headlines and debate. However, the founding of a new ministry-level agency—the China International Development Cooperation Agency (CIDCA)—has attracted little attention, despite the effect it might have on China’s foreign aid policy and global health strategy.

Abstract

Introduction: Valid and low-cost quality assessment tools examining care quality are not readily available. The unannounced standardised patient (USP), the gold standard for assessing quality, is costly to implement while the validity of clinical vignettes, as a low-cost alternative, has been challenged. Computerised virtual patients (VPs) create high-fidelity and interactive simulations of doctor-patient encounters which can be easily implemented via smartphone at low marginal cost. Our study aims to develop and validate smartphone-based VP as a quality assessment tool for primary care, compared with USP.

Abstract

Importance: Spousal involvement in diabetes care is recommended theoretically, but effectiveness in clinical settings and among diverse populations is unclear.

Objective: To test the effect of a couple-based intervention among Chinese older patients with type 2 diabetes and their spouses.

Abstract

We examined whether between-persons differences and within-person changes in levels of social support were associated with age-related cognitive decline and whether these associations varied by sex and by relationship type. Executive function and memory scores over 8 years (2002-2010) were analyzed by mixture models among 10,241 adults aged ≥50 years in the English Longitudinal Study of Ageing. Between-persons differences and within-person changes in positive social support and negative social support were independently associated with cognitive decline in different ways according to sex and relationship type. Among men, higher-than-average positive social support from a spouse/partner was associated with slower cognitive decline (for executive function, βperson-mean×time-in-study = 0.005, 95% CI: 0.001, 0.010; for memory, βperson-mean×time-in-study = 0.006, 95% CI: 0.000, 0.012); whereas high negative social support from all relationship types was associated with accelerated decline in executive function (for all relationships combined, βperson-mean×time-in-study = -0.005, 95% CI: -0.008, -0.002). For women, higher-than-average positive social support from children (β = 0.037, 95% CI: 0.010, 0.064) and friends (β = 0.115, 95% CI: 0.081, 0.150)-but not from a spouse/partner (β = -0.034, 95% CI: -0.059, -0.009) or extended family (β = -0.035, 95% CI: -0.064, -0.006)-was associated with higher executive function. Associations between social support and age-related cognitive decline vary across different relationship types for men and women.

Abstract

Objective: To investigate the reciprocity of social support and cognitive function in late life.

Method: Analyses were based on three parallel repeat measures of social support and cognition from the Whitehall II cohort, providing 10-year follow-up of 6,863 participants (mean age 55.8 years, SD 6.0 at baseline). Alternative hypotheses were evaluated via four bivariate dual change score models: Full coupling model estimated mutual influences of social support and cognition on subsequent changes in each other; social causation model assumed a unidirectional influence from social support onto changes in cognition, while the opposite assumption was tested by health selection model; last, no coupling model suggested independent growth of these two sets of variables.

Abstract

This study investigates gender differences in trajectories of support from close relationships among adults in the transition from middle to old age, taking into account stability and change in the identity of the closest persons. Multi-level modelling was used to estimate gendered age-trajectories in three dimensions of support: emotional support, practical support and negative encounters, which were repeatedly measured over ten years amongst 6,718 Whitehall II participants. Men were more likely than women to nominate their partner as their closest person throughout follow-up; whereas women drew support from a wider range of sources. Gender differences were only evident in age-related trajectories of emotional support, and were contingent on stability and change in the closest relationships. Men reported increased emotional support from closest relationships with age, except for those who transitioned out of a partnership. For women, emotional support was stable among those whose closest person remained consistent, but decreased among those who changed their closest person. Further, emotional support increased with age for all married men, which was only the case for married women who nominated their partner as their closest person. Our analysis highlights gender-specific trajectories of perceived support from adults’ closest relationships in late life, and indicate more pronounced socio-emotional selectivity in older men than women.

Abstract

Purpose: To evaluate the relative importance of structural and functional social relationships for quality of life (QoL) and the extent to which diagnosed chronic disease modifies these associations.

Methods: Multivariate linear regression was used to investigate time-lagged associations between structural and functional measures of social relationships and QoL assessed 5 years apart by CASP-19, in 5925 Whitehall II participants (mean age 61, SD 6.0). Chronic disease was clinically verified coronary heart disease, stroke, diabetes or cancer.

Abstract

The extent to which social relationships influence cognitive aging is unclear. In this study, we investigated the association of midlife quality of close relationships with subsequent cognitive decline. Participants in the Whitehall II Study (n = 5,873; ages 45-69 years at first cognitive assessment) underwent executive function and memory tests 3 times over a period of 10 years (1997-1999 to 2007-2009). Midlife negative and positive aspects of close relationships were assessed twice using the Close Persons Questionnaire during the 8 years preceding cognitive assessment. Negative aspects of close relationships, but not positive aspects, were associated with accelerated cognitive aging. Participants in the top third of reported negative aspects of close relationships experienced a faster 10-year change in executive function (-0.04 standard deviation, 95% confidence interval: -0.08, -0.01) than those in the bottom third, which was comparable with 1 extra year of cognitive decline for participants aged 60 years after adjustment for sociodemographic and health status. Longitudinal analysis found no evidence of reverse causality. This study highlights the importance of differentiating aspects of social relationships to evaluate their unique associations with cognitive aging.

Abstract

Objective: The evidence on whether there is work stress related dysregulation of the hypothalamic-pituitary-adrenal axis is equivocal. This study assessed the relation between work stress and diurnal cortisol rhythm in a large-scale occupational cohort, the Whitehall II study.