Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and alter... more Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and altered diurnal or stress-induced secretion of the hormone cortisol could predispose older adults to negative health outcomes. We propose that psychological resilience may interact with diurnal cortisol to affect health outcomes later in life. Emotion regulation and social support are two constructs that contribute to resilience and exhibit age-specific patterns in older adults. Determining how the use of resilience resources interacts with age-related diurnal cortisol will improve our understanding of the pathways between stress, resilience, and well-being. In this review, we assess published studies evaluating diurnal cortisol in older adults to better understand differences in their HPA axis functioning. Evidence thus far suggests that diurnal cortisol may increase with age, although cross-sectional studies limit the conclusions that can be drawn. We also review extant evidence connecting age-specific signatures of emotion regulation and social support with diurnal cortisol. Conclusions are used to propose a preliminary model demonstrating how resilience resources may modulate the effects of cortisol on health in aging.
In 2012, US organizations released updated cervical cancer screening guidelines calling for less ... more In 2012, US organizations released updated cervical cancer screening guidelines calling for less frequent screening. We surveyed practicing gynecologists in the Pacific Northwest region to understand their screening practices, gauge their uptake of the new guidelines, and identify reasons why they may not follow the new guidelines. Gynecologists from Washington, Oregon, Montana, and Idaho were sent an online survey on behalf of their state's medical association. The survey consisted of 9 questions on sex, practice setting, community size, cervical cancer screening practices, and reasons for not following the 2012 guidelines. Of 947 gynecologists, 123 (13.0%) completed the survey. Sixty-four respondents (52.0%) reported that they follow or plan to follow the new guidelines. Reasons cited for not following the new guidelines included concern over missed opportunities for women's health education (43 respondents or 72.9%), patients wanting more frequent screening (39 respondents or 66.1%), and concern about missing dysplasia or cancerous lesions (28 respondents or 47.5%). Although the new guidelines call for a 3-year interval between routine Pap tests or a 5-year interval between routine Pap/human papillomavirus cotests, 75 gynecologist respondents (61.0%) still recommended annual or biannual Pap screening for patients younger than 30 years, and 55 respondents (67.9%) recommended rescreening within 3 years for women 30 years and older with negative cotest results. While over half of the gynecologist survey respondents reported adherence or planned adherence to the 2012 guidelines, over half also reported using screening schedules that are more frequent than recommended by new guidelines. Concerns highlighted by survey participants provide an opportunity for physician and patient education on the evidence supporting the new guidelines.
Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and alter... more Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and altered diurnal or stress-induced secretion of the hormone cortisol could predispose older adults to negative health outcomes. We propose that psychological resilience may interact with diurnal cortisol to affect health outcomes later in life. Emotion regulation and social support are two constructs that contribute to resilience and exhibit age-specific patterns in older adults. Determining how the use of resilience resources interacts with age-related diurnal cortisol will improve our understanding of the pathways between stress, resilience, and well-being. In this review, we assess published studies evaluating diurnal cortisol in older adults to better understand differences in their HPA axis functioning. Evidence thus far suggests that diurnal cortisol may increase with age, although cross-sectional studies limit the conclusions that can be drawn. We also review extant evidence connecting age-specific signatures of emotion regulation and social support with diurnal cortisol. Conclusions are used to propose a preliminary model demonstrating how resilience resources may modulate the effects of cortisol on health in aging.
In 2012, US organizations released updated cervical cancer screening guidelines calling for less ... more In 2012, US organizations released updated cervical cancer screening guidelines calling for less frequent screening. We surveyed practicing gynecologists in the Pacific Northwest region to understand their screening practices, gauge their uptake of the new guidelines, and identify reasons why they may not follow the new guidelines. Gynecologists from Washington, Oregon, Montana, and Idaho were sent an online survey on behalf of their state's medical association. The survey consisted of 9 questions on sex, practice setting, community size, cervical cancer screening practices, and reasons for not following the 2012 guidelines. Of 947 gynecologists, 123 (13.0%) completed the survey. Sixty-four respondents (52.0%) reported that they follow or plan to follow the new guidelines. Reasons cited for not following the new guidelines included concern over missed opportunities for women's health education (43 respondents or 72.9%), patients wanting more frequent screening (39 respondents or 66.1%), and concern about missing dysplasia or cancerous lesions (28 respondents or 47.5%). Although the new guidelines call for a 3-year interval between routine Pap tests or a 5-year interval between routine Pap/human papillomavirus cotests, 75 gynecologist respondents (61.0%) still recommended annual or biannual Pap screening for patients younger than 30 years, and 55 respondents (67.9%) recommended rescreening within 3 years for women 30 years and older with negative cotest results. While over half of the gynecologist survey respondents reported adherence or planned adherence to the 2012 guidelines, over half also reported using screening schedules that are more frequent than recommended by new guidelines. Concerns highlighted by survey participants provide an opportunity for physician and patient education on the evidence supporting the new guidelines.
Uploads
Papers by Allison Gaffey