Older Women

Objective: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia. Methods: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-TrLndelag Health Study (HUNT) (the HUNT2 in 1995Y1997 and the HUNT3 in 2006Y2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2. Results: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors. Conclusions: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.

The effect that aerobic (AT) and/or strength training (ST) has on altering peak aerobic power (VO 2peak ), muscle strength, left ventricular (LV) morphology, and diastolic filling in healthy older women is not known. We assessed the effects of 12 weeks of AT, ST, combined aerobic and strength training (COMT), or no training (NT) on VO 2peak , muscle strength, LV morphology, and diastolic filling in 31 healthy women (68 6 4 years). Relative VO 2peak was significantly greater after 12 weeks of AT, ST, or COMT. Upper and lower extremity strength were significantly higher after 12 weeks of ST or COMT with no change after AT or NT. LV morphology and diastolic filling were not altered after 12 weeks of AT, ST, COMT, or NT. Twelve weeks of ST or COMT are as effective as 12 weeks of AT for increasing relative VO 2peak , however, ST and COMT are more effective than AT for improving overall muscle strength.

This article aims to map existing prevalence research on abuse and neglect of older people and to provide a critical overview of existing methodologies, which have been adopted to survey the prevalence rates of abuse against elders. This article is part of the prevalence study of Abuse and Violence against Older Women (AVOW) study, which was conducted in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal). The article provides an overview of the state of the art of prevalence data, survey designs and methods, instruments and results in Europe. Therefore, this draws on an extensive literature search and qualitative content analysis, which was conducted as an early part of the AVOW study. Results indicate that some EU countries have a rich history of prevalence research, whereas other countries have just begun to tackle this aspect of research on of elder abuse. One of the lacunae concerns reliable numbers on the prevalence rates of elder abuse. Research about where, when and how often elder abuse occurs, is inadequate and inconsistent. Data in some cases are based on professionals' reports rather than on information from older people themselves. Surveying elders about such a sensitive topic, however, implies the need for an adequate research instrument (questionnaire) and research design, and an adapted data collection method. In conclusion, substantial attention is paid to outlining possible guidelines for future research.

Bone density measurement plays a key role in the initial diagnostic assessment of osteoporosis and in targeting pharmacologic therapies. The impact of access to dual-energy X-ray absorptiometry (DXA) on physician prescribing habits is unclear, however. We were able to directly evaluate the change in physician osteoporosis testing and prescribing following introduction of a DXA testing service in a geographic region that had previously had very limited access. This evaluation was conducted in the province of Manitoba, Canada, which has a provincially based bone density testing program and maintains a population-based bone density database that can be linked with administrative health data sources including drug prescriptions. The province of Manitoba was geographically partitioned into the urban and rural health regions serviced by the new program (urban new and rural new ) and the remaining urban and rural health regions which had relatively unchanged DXA access during this period (urban control and rural control ). Regression models of DXA testing rates and osteoporosis prescription rates were created for all older women in these regions. There was a statistically significant increase in bone density testing and BMDguided osteoporosis treatment in the urban new and rural new regions following introduction of the DXA testing service, relative to the control regions. Although the overall rate of empiric postfracture and preventive osteoporosis treatment did not show a specific region effect, when analysis was limited to nonhormonal agents there was a significant reduction in preventive and empiric postfracture treatment in some subgroups of women. These results suggest that the local availability of the bone density testing service led to an increase in objective test-guided therapy with some reduction in the use of empiric and preventive strategies and had a neutral effect on overall use of these agents.

Whether recombinant gonadotrophin products do, indeed, represent progress for routine ovulation induction and IVF cycles, in comparison with urinary products, has remained controversial. Here we review published data with regard to respective risks, outcomes and cost for both medication options. Safety considerations favour recombinant products, while overall outcome and cost considerations favour urinary gonadotrophins. Outcome, however, appears to differ, based on age and ovarian function, with younger patients bene®ting from the FSH/LH combination offered by urinary products, while older women and young women with ovarian resistance, apparently bene®ting from pure FSH stimulation. Young women with poor ovarian reserve may be best stimulated with a pure FSH/ antagonist protocol. We conclude that under current pricing structures in the United States, recombinant gonadotrophins do not represent a major progress for the treatments of ovulation induction and IVF. They, however, allow for an improved selectivity of stimulation protocols. The creation of recombinant FSH/LH products and cost adjustments for recombinant products, may affect these conclusions in favour of recombinant products.

Using a cross-sectional design, this study determined the time course of aging effects on rapid discrete and reciprocal aiming movements in men and women. A total of 80 men and 61 women in good health were classified into six age groups (25, 35, 45, 55, 65, and 75 years). The discrete task required participants to make one discrete aiming movement, whereas the reciprocal task required a series of back-and-forth movements. Results indicated for both aiming tasks that greater age was strongly associated with slower movement times. The significant interaction between age and task indicated that the discrete task showed much larger aging effects (54%) than the reciprocal task (25%). This finding is tentatively interpreted in terms of a reduced efficiency of "on-line" control processes.

Literature data suggest that breast cancers occurring in young patients may be different from those arising in older women. In this study the clinicopathologic characteristics of 50 patients under 40 years of age were compared with those of patients aged over 60. Patients under 40 years old more frequently had a family history of breast cancer than did older patients (24% vs 17%) and had more often used oral contraceptives (29% vs 13%); on average they had experienced menarche 1 year earlier. For early onset breast carcinomas there was a higher frequency of grade 3 tumours (38% vs 17%) and oestrogen receptor negativity (46% vs 20%). In addition, in younger patients the carcinomas were mostly DNA aneuploid (78% vs 58%), with a higher proliferation rate (48% vs 26%) and more frequent c-erbB-2 overexpression (48% vs 26%) and p53 alteration (30% vs 8%). Our data demonstrate that breast cancers arising in young women have a significantly different biopathological profile from those in older patients, with a predominance of unfavourable prognostic parameters.

In the experimental arm of a randomised trial, women were tested both for liquid-based cytology and human papillomavirus (HPV) DNA and referred for colposcopy if cytology was ASCUS (atypical cells of undetermined significance) or more severe. We considered those with ASCUS (757) or LSIL (low-grade squamous intraepithelial lesions) (485) and a valid HPV test who received colposcopy. We computed sensitivity, specificity and ROC 0959-8049/$ -see front matter Ó ( 2 0 0 7 ) 4 7 6 -4 8 0 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e j c o n l i n e . c o m Keywords: Cervical cancer Human papillomavirus Screening Triage curves with different values of relative light units (RLU, that are related to viral load) as cut off, using cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) at blind histology review as the endpoint.

Background Today, the 5-year relative survival rate for cancer is 65% and there are 10.5 million survivors. The largest group of survivors are those of breast cancer. Reductions in mortality are occurring at a greater rate for women under age 50 at diagnosis than among older women. Aims Our goal was to design a socio-educational intervention for 5-year survivors aged 50 or younger at diagnosis and test the hypotheses that women in the intervention group would show greater improvement than controls with respect to (1) knowledge of breast cancer, its treatment, and long-term health concerns; (2) lifestyle habits (i.e., exercise and diet); and (3) communication with family and physicians. Methods Using a randomized controlled trial with a prepost design, 404 women who were 5 years from diagnosis and cancer-free (response rate 54%) were randomly assigned to an intervention or delayed intervention (control) group and were assessed at pre-test (baseline) and 6 months later (96% retention). The intervention consisted of three 6-h workshops over a 3 month period. Four series of workshops were held at different geographical areas in the greater San Francisco Bay Area. The workshops included activities and information to promote physical, social, emotional, and spiritual well-being. The intervention design was based on findings from focus groups and a survey of 185 cancer-free 5-year survivors that assessed changes since the early months after diagnosis in physical, social, emotional, and spiritual concerns (response rate 73%). Results Consistent with our first hypothesis, at post-test, women in the intervention group, on average, had greater knowledge regarding breast cancer, its treatment, and their own future health than did those in the control group (p= 0.015). Hypothesis 2 was partially supported as women in the intervention group were more likely than the control group to report an increased amount of physical activity (p=0.036), but not significant dietary changes. Social support was related to increased self report of physical activity. With the exception of the last series of workshops, the intervention group did not report improved communications with family, friends, and physicians (hypothesis 3). Conclusions A short-term intervention can affect knowledge levels and physical activity but not diet or communication in the family. Implications for Cancer Survivors The intervention was related to greater knowledge related to breast cancer, and increased report of physical activity. The program was not related to changes in reported diet or family communication.

All types of aerobic exercise are assumed to affect cardiovascular risk similarly. There are few studies of swimming, but complex responses to water-based exercise suggest its potential for differential effects. The aim of the study was to compare the effects of swimming and walking on fitness, body weight, lipids, glucose, and insulin in older women. Sedentary women aged 50 to 70 years (N = 116), randomly assigned to swimming or walking plus usual care or a behavioral intervention, completed 3 sessions per week of moderate-intensity exercise, supervised for 6 months then unsupervised for 6 months. After 6 months, 1.6-km walk time decreased in walkers and swimmers, with greater improvement in walkers (1.0 vs 0.6 minute, P = .001). In swimmers, but not walkers, distance swum in 12 minutes increased (78.1 vs −2.2 m, P = .021). Waist and hip circumferences (80.8 vs 83.1 cm and 101.8 vs 102.4 cm; P = .023 and P = .042, respectively) and insulin area under the curve (oral glucose tolerance test) (5128 vs 5623 μU/[L 120 min], P b .05) were lower with swimming. Lipids did not differ between groups. At 12 months, fitness was maintained. Relative to walking, swimming reduced body weight by (1.1 kg, P = .039) and resulted in lower total and low-density lipoprotein cholesterol (0.3 and 0.2 mmol/L; P = .040 and P = .049, respectively). The magnitude of the difference in the reduction of insulin area under the curve between swimming and walking was greater at 12 months; however, the significance was attenuated (4677 vs 5240 μU/[L 120 min], P = .052). Compared with walking, swimming improved body weight, body fat distribution, and insulin in the short term and, in the longer term, body weight and lipid measures. These findings suggest that the type of exercise can influence health benefits.

Purpose Stress urinary incontinence (SUI) is a major health problem that has substantial and important effects on health-related quality of life. In recent years, extracorporeal magnetic innervation (ExMI) has become a preferred method of treatment in urinary incontinence. This study presents the effects of ExMI treatment on pelvic floor muscle strength, urinary symptoms, incontinence conditions and quality of life of older women with SUI. Methods A total of 13 patients between the ages of 61 and 69 (mean 65.23 ± 2.8 years) were treated for SUI with ExMI. The following parameters were investigated: urinary symptoms, pelvic floor electromyographic (EMG) activity, 1-h pad test, incontinence conditions utilizing visual analog scale (VAS) and quality of life using Turkish version of the Urogenital Distress Inventory (UDI-6) and the Incontinence Quality of Life Instrument (I-QoL). All assessments were conducted at baseline and at the end of the study. Treatment lasted for 20 min, twice a week and for a total of 6 weeks. Results The urinary symptoms and incontinence conditions decreased after the ExMI treatment sessions. The pad test results indicated a reduction in urine loss (p = 0.016). EMG values were improved (p = 0.005). Scores of I-QoL, UDI-6 and VAS were reduced after the treatment, respectively (p = 0.002), (p = 0.002) and (p = 0.006). Conclusion Extracorporeal magnetic innervation can be considered as it is an alternative, non-invasive and painless treatment method with good compliance for treatment of SUI in older patients.

Being able to predict medical school performance is essential to help ensure the supply of quality physicians. The purpose of our study was to examine the influence of gender and age on academic performance (AP) and on academic difficulty (AD). The study involved all matriculants of 3 classes at one medical school. Independent variables included gender, age (categorized into younger and older than 23 years) and the gender by age interaction. Dependent variables included an AP scale score, a clinically based performance examination and AD. The Wilson AP Scale score was developed to assess both excellent and poor performance. The Wilson AP Scale included first-, second-, and third-year medical school grade-point-averages, USMLE Step 1score and USMLE Step 2 score. Older women as a group had the highest mean Wilson AP Scale score. Women performed better than men on the clinically based performance examinations. Younger men were least likely to have AD and younger women were most likely ...

This paper describes sex differences in spatial competencies among the Hadza, a mobile hunter-gatherer population in Tanzania. It addresses the following questions: (a) Is the usual male advantage in Euclidean spatial abilities found in this population, where both women and men are highly mobile? (b) Do Hadza women have better object location memory than men, as the gathering hypothesis predicts? (c) Do women who are nominated by others as being good at finding bushfoods excel at the object location memory task? We tested object location memory with a version of the memory game using cards of local plants and animals. This allowed us to also ask whether women and men would have better spatial memory for the plant and animal cards, respectively. We found that Hadza men were significantly better than women in three tests of spatial ability: the water-level test, targeting, and the ability to point accurately to distant locations (the latter only in the less mobile groups). There was a trend toward a male advantage at the object location memory task, in contrast to results found previously in nonforaging populations, and women's performance at the task deteriorated with age, while that of men did not. The women who were nominated by peers as being good at finding bushfoods were consistently older women. We discuss the probable hormonal causes and functional consequences of age changes in the spatial competencies of female foragers.

The microscopic classification of embryos, especially unipronuclear embryos, is not very precise. A number of undocumented and unipronuclear embryos were determined to be diploid following karyotyping and fluorescence in situ hybridization (FISH). Accelerated and asynchronous pronuclear dismantling at the time of checking for embryo fertilization accounts for this disparity. Diploid embryos were also observed among tripronuclear embryos. However, not all embryos ascertained as diploid by FISH were karyotypically normal following full karyotype analysis. By taking into account the "background" abnormality rate, the rate of diploid embryo wastage was estimated to be about 40% among undocumented embryos and about 58% in total. A high percentage of misclassification infers an unintended loss of otherwise transferable embryos. Such a discrepancy is particularly important to older women who have fewer embryos. If these are a woman's only embryos, preimplantation genetic diagnosis might be applicable in determining those that are diploid and suitable for transfer. This could potentially reduce the number of wasted embryos and cycles. The present study has also shown that mosaicism is common but it is still unclear whether mosaicism is indicative of embryonic abnormality or is a fairly common phenomenon among healthy embryos. Bipronuclear embryos that present with abnormal or delayed cleavage are often chaotic in their chromosomal constitution. Such embryos should not be transferred.

The form of the Fairy Tale, as is well established, provides a means by which cultural beliefs can be passed on from generation to generation. And precisely because it is such an effective form for communicating ideas and beliefs, it has offered a rich site for those who wish to change the messages that are passed down the generations. Feminist writers, spurred on by Marcia Lieberman's canonical essay on "Female Acculturation through the Fairy Tale" (1972), have been particularly active in their endeavours to offer new generations stories which question patriarchal hegemonies, the passivity of women, the importance of beauty and the dominance of the marriage plot. None of this will be news to critics familiar with fairy tale scholarship. And in many ways, Tender Morsels by the deservedly acclaimed Australian novelist, Margo Lanagan, falls into this well established revisionist paradigm. In her treatment of women, however, Lanagan draws attention to aspects of sexuality that receive scant attention, even in feminist revisionings of fairy tales. Lanagan does not focus exclusively on the transition into womanhood, she also opens up the world of the crone by exploring transitions from young womanhood into middle age and beyond.

The effect of increasing age on outcomes and type of treatment given to older women with ductal carcinoma in situ (DCIS) was assessed. 646 women !60 years old (654 cases) receiving surgery for DCIS at Memorial Sloan-Kettering Cancer Center between 2000 and 2007 (8 bilateral) had wide local excision (WLE; 37%), WLE plus radiotherapy (WLE þ RT; 41%), or mastectomy (22%). 45%, 38%, and 16% of patients 60e69 years, 70e79 years, and !80 years, respectively, received WLE þ RT (P < 0.001) and 25%, 20%, and 13%, received mastectomy, respectively (P < 0.001). Age (P < 0.001), grade (P < 0.001), and necrosis (P < 0.01) were highly associated with treatment. Four-year local recurrence was 3.6%. Overall local recurrence differed by treatment (mastectomy, 0%; WLE, 5%; WLE þ RT, 4%; P < 0.00001) but not age. It is possible to identify older women with DCIS in whom the risk of recurrence is acceptably low after WLE alone. WLE alone may be a viable treatment option for select older women with DCIS.

Objectives: To determine whether a functional-task exercise program and a resistance exercise program have different effects on the ability of community-living older people to perform daily tasks.Design: A randomized, controlled, single-blind trial.Setting: Community leisure center in Utrecht, the Netherlands.Participants: Ninety-eight healthy women aged 70 and older were randomly assigned to the functional-task exercise program (function group, n=33), a resistance exercise program (resistance group, n=34), or a control group (n=31). Participants attended exercise classes three times a week for 12 weeks.Measurements: Functional task performance (Assessment of Daily Activity Performance (ADAP)), isometric knee extensor strength (IKES), handgrip strength, isometric elbow flexor strength (IEFS), and leg extension power were measured at baseline, at the end of training (at 3 months), and 6 months after the end of training (at 9 months).Results: The ADAP total score of the function group (mean change 6.8, 95% confidence interval (CI)=5.2–8.4) increased significantly more than that of the resistance group (3.2, 95% CI=1.3–5.0; P=.007) or the control group (0.3, 95% CI=−1.3–1.9; P<.001). Moreover, the ADAP total score of the resistance group did not change significantly compared with that of the control group. In contrast, IKES and IEFS increased significantly in the resistance group (12.5%, 95% CI=3.8–21.3 and 8.6%, 95% CI=3.1–14.1, respectively) compared with the function group (−2.1%, 95% CI=−5.4–1.3; P=.003 and 0.3%, 95% CI=−3.6–4.2; P=.03, respectively) and the control group (−2.7%, 95% CI=−8.6–3.2, P=.003 and 0.6%, 95% CI=−3.4–4.6; P=.04, respectively). Six months after the end of training, the increase in ADAP scores was sustained in the function group (P=.002).Conclusion: Functional-task exercises are more effective than resistance exercises at improving functional task performance in healthy elderly women and may have an important role in helping them maintain an independent lifestyle.

This study reconsiders the "double standard of aging" hypothesis, which states that older women are judged as being less attractive than older men. We considered the subject's sexual orientation (i.e., heterosexual, gay, lesbian, bisexual) and showed that older women were not judged more negatively than older men per se. Male subjects exhibited a stronger youth bias than females, but only if the target picture was a potential sexual partner. Females showed an equal amount of preference for youthful faces, independent of the target's sex and regardless of whether the target was a potential sexual partner.

Basho-fu (Musa liukiuensis) weaving has long been part of the cultural identity of Ogimi villagers and has continued in the village as a cottage industry despite its almost complete disappearance throughout the rest of the Ryukyu archipelago. It has survived largely due to the concerted efforts of a few villagers and is now carried on mainly by middle-aged and older women. Almost every elderly woman in Ogimi has at least some experience in basho-fu weaving, and most still participate in some stage of the production process. Aged women form the bulk of the core group of workers that carries out the labor-intensive u-umi (spooling) and u-biki (fiber-cleaning) activities. Without this core group of elderly women, the whole production process would be in jeopardy. Thus, older women in Ogimi play a key role as valued workers in maintaining the basho-fu production process. In exchange for their continued participation, these elderly women receive symbolic capital in the form of respect and honors, as well as wages for their labor. We argue that participating in traditional basho-fu weaving helps these older women maintain an active engagement with life as healthy and productive members of society, a role that has been culturally sanctioned and has taken on moral import in Japan's rapidly aging society. Interestingly, "doing basho" may be considered one means to help achieve successful aging in this particular cultural context.

This study provides insight into the lives of eight married couples involved in an age-heterogamous relationship where the wife is ten or more years older than her husband. While there is a lot of information in the literature about men who date and marry younger women, the research on this subject is very limited or outdated. This exploratory study provides valuable information in several areas about couples in woman-older marriages. The interviews were conducted with each participant separately and explored three major topics of interest: The impact the age difference has on the relationship, the issues that arise for the couple, and any difference in husbands and wives experience. Implications for professionals working with such couples, as well as for further research, are discussed.

Objective: Lower urinary tract symptoms are common among older women. The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire was designed to assess a wide range of symptoms, including incontinence, and impact on sexual function and quality of life. This paper describes development and validation of a scored form BFLUTS questionnaire. Study design: Baseline and 6-month follow-up data from a randomized trial compared tensionfree vaginal tape with colposuspension for 344 women with urodynamically proven stress incontinence. Problematic and responsive items were identified and subjected to factor analysis to develop a scoring system. Results: Three domains were identified to assess symptoms: incontinence (5 items); voiding (3 items); and filling (4 items); with additional subscales for sexual function (2 items) and quality of life (5 items). All scales have simple additive scores. Conclusion: A scored form of the BFLUTS questionnaire is now available and should be useful in research and clinical practice in urology and gynecology.

The purpose of this research was to extend implicit personality theory in an attempt to explain further the inferred relationship between a person's physical characteristics and personal traits. Specifically, this study examined business and professional men's and women's perceptions of the professional image of women as a function of the women's physical characteristics, the type of garment worn, and the fashion detail of the garment. Participants (N = 207) viewed six black-and-white photographs of females wearing either suits or dresses. Responses to six 7-point, unipolar adjective checklists were then summed to obtain a score indicating the degree of professional image perceived. A 3 (age of model) &times; 3 (body type of model) &times; 3 (fashion detail) incomplete randomized block design was used. Men's and women's responses to models in suits and dresses were analyzed separately using analysis of variance. Results indicate that (a) suits convey a stronger professional image than dresses for women of any age or body type; (b) when judged by business and professional men, older women convey a stronger professional image than younger women when wearing dresses; (c) garments with innovative fashion detail contribute to a weaker professional image than garments with contemporary or classic fashion detail; and (d) thin women convey a stronger professional image than larger women.

The intent of Vascular Dementia: Cerebrovascular Mechanisms and Clinical Management is to address the many recent advances in cardiovascular and cerebrovascular medicine and the impact of these on the lives of older adults by examining the state-of-the-art research on vascular dementia (VaD). A distinguishing feature of this work is its interdisciplinary nature. We have assembled work from contributors in multiple related fields, including both human and animal studies, in order to advance our collective understanding of VaD. A second distinguishing feature is that we have devoted one-third of our text to the examination of the interactions between VaD and Alzheimer's disease (AD). We believe that this combined approach will enhance patient care, as well as promote future research. One may ask whether yet another summary of work in the field of VaD is necessary, given the number of review papers and recent texts devoted to the topic. However, it is important to note that research conducted over the recent "Decade of the Brain" has brought to light both consensus and controversy regarding the identity of VaD, and as a result the field is in constant flux. No better example of this could be scripted than the topics of discussion at a recent international conference on VaD. Attended by many prolific contributors to the field, the debates were charged and the range of discussion was provocative. In one open forum debate, the very existence of VaD as a construct was under question. Data from autopsy studies were presented which argued that pure VaD was such a rare phenomenon that the construct barely warranted clinical and research attention. By contrast, in a separate debate, the discussion focused on whether all cases of sporadic AD were manifestations of VaD. This bipolar conceptualization of VaD is the primary impetus behind our book. In addition, though AD has been the central focus of research for several decades, the pendulum has begun to move towards a greater interest in cerebrovascular disease. This likely reflects the ever-growing population of older adults with cerebrovascular disease, as well as studies conducted in recent years describing important interactions between vascular disease and the expression of cognitive deficits in AD. There is now a growing consensus that clear, clinical, and pathological distinctions between these two conditions sometimes cannot be made in individual patients. We are certainly not the first group to describe this pending paradigm shift, as others (i.e., Roman, Hachinski, et al.) have offered this observation in public forum. However, it is from our own observations and empirical studies that we came to appreciate this conceptualization of dementia research, and eventually concluded that the time was right to synthesize the literature in an effort to move science forward. Vascular Dementia: Cerebrovascular Mechanisms and Clinical Management is divided into six sections. Part I is focused on introducing VaD as a construct. Part II describes the basic mechanisms associated with aging that may have an important role in the development of VaD. Part III identifies the impact of VaD on cognitive status, psychiatric health, and the ability of patients to complete important activities of daily living. Part IV describes the application of neuroimaging methods to investigate VaD, with particular attention directed toward both functional and structural imaging methods. Part V is devoted to the topic of interactions between VaD and AD. Finally, Part VI reviews pharmacological management of VaD. This section also addresses the impact of VaD on perceived quality of life of patients and caregiver burden, two rarely addressed issues in the scientific community. We developed the book to be of interest to both clinicians and basic scientists. The topics covered are broad in nature and capture work from both the bench and the exam room. Chapters are also provided that address issues likely new to those who practice or conduct research within a circumscribed specialty area. The contributors have skillfully identified the important discoveries of the previous years, explored where this field of research is currently headed, and emphasized the critical topics that require a more intensive research focus. Overall, we hope the book will serve as a valuable reference for the current state of knowledge regarding VaD as well as a guide for future studies.

This study of 347 urban, self-identified lesbian (n ¼ 289) and bisexual (n ¼ 58) women examined women's engaging in 4 kinky sexual behaviors: bondage/domination, sadomasochism, photo/video exhibitionism, and asphyxiation/breath play. A cross-sectional, briefintercept survey was administered at 2 New York City gay, lesbian, and bisexual community events. Over 40% reported engaging in at least 1 of these behaviors, and 25% reported engaging in multiple behaviors. Bisexual women were more likely to have engaged in any kinky sexual behavior and photo/video exhibitionism. White women were more likely than women of color to have engaged in bondage/domination. Compared to older women, younger women were more likely to have engaged in photo/video exhibitionism and asphyxiation/breath play. Participants who were younger when they came out to others, and younger at their same-sex sexual debut, were more likely to have engaged in any and each of the behaviors compared to women who were older at those developmental events.

Narrative provides a window to experience in a way that is different from traditional research methods. In this study, narrative affords both a holistic vantage point on later life relationships, and at the same time, a "view from the inside"-older women's own accounts of single life, relationship development, and remarriage. The narratives were obtained in interviews with eight recently remarried women between the ages of sixty-five and eighty. A two-stage analysis addresses, first, the narrative content-the phenomenology of remarriage for these older women. The second stage focuses on process, analyzing how cultural-level narratives are drawn upon in the creation of the women's personal stories. Based upon these analyses, we discuss the ways that a narrative approach can inform our understanding of later life relationships, and we comment on the potential of narratives such as these to rewrite a script for older women's relationships.

Current North American sexual standards allow women to be sexual within committed relationships but may still restrict women's sexuality to a greater extent than men's. We investigated whether these gender double standards interact with an age double standard that describes the elderly as less sexual than the young, to create particularly limiting sexual standards for older women. 305 Canadian undergraduates completed a 2 (target age) × 2 (target gender) × 2 (participant gender) withinsubjects study measuring perceptions of younger (own age) and older (over 65 years old) men's and women's interest in traditional sex (e.g., cuddling, intercourse with main partner) and experimental sex (e.g., extra-relationship sex, viewing erotic materials). ANCOVAs controlling for ageist and sexist beliefs revealed the ageist double standard; the elderly were perceived to be less interested in sex overall than the young. There was also a sexual double standard; women were perceived to be more interested in traditional sex than men, and men more interested in experimental sex than women. For traditional sex, women perceived younger targets as more interested than the older targets, and women targets as more interested than men. For experimental sex, a three-way interaction showed the interplay between the sexual and ageist double standards. Elderly female targets were perceived as least interested, and young male targets as most interested. Results reinforce that the current sexual standards distinguish between sex for intimacy and sex for other reasons (e.g., pleasure) and that the standards are particularly restrictive for older women.

This article foregrounds the accounts of a cohort of clubbers who are largely ignored both by journalists and scholars alike. Grounded in the accounts of aging female clubbers and their participation in electronic dance music culture, it investigates the lived experience of being and performing the category of 'older woman' in this context. It examines the materiality of their participation and their tactical responses to being in an environment that has been associated traditionally with youth. In a landscape where scholarship on female participation in club cultures is, at best, scarce, research into the experiences of older women in dance music culture is virtually non-existent. As such this article represents a first step in addressing a significant gap in understanding women's engagement with dance cultures as they mature.

This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substanceabusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.

The aims were to compare the precision (reliability) in single X-ray (SXA) and dual X-ray (DXA) absorptiometry, and to compare smallest detectable difference (SDD). An additional aim was to examine determinants for precision in bone mineral density (BMD). BMD was measured by SXA (DTX-100, Osteometer) in the forearm and by DXA (Lunar Expert) in the forearm and in the hip. Two measurements were performed at each site/method, and 195 of 207 participants had complete datasets. Participants were aged 47-49 and 71-74 years. The precision was estimated by Root Mean Square Standard Deviation (RMS SD) with 95% Confidence Interval (95%CI) and the corresponding coefficients of variation (CV%). Determinants (age, gender, BMD) were analysed by multiple linear regression with log (SD) and log (CV) as dependent variables. RMS SD tended to be largest in older women and in those with low BMD. RMS SD for SXA and DXA forearm was 4.6 (4.2-5.1) and 6.8 (6.1-7.4) and the corresponding CVs 1.0% and 1.4%. RMS SD for DXA hip was 11.0 (9.9-12.0) with CV 1.2%. To detect a 3% change in BMD one would need two repeated measurements by DXA in the distal forearm at each of two consultations, but only one measurement by SXA in the distal forearm and also only one measurement by DXA in the hip. Precision differed by type of densitometer affecting the number of repeated measurements needed to detect a given BMD difference.

This study examined levels of technophobia in a sample of 150 older adults who are members of Active Retired Associations in Ireland and 291 undergraduate students. Technophobia was assessed using Rosen and Weil's Measuring Technophobia Instruments which determine anxiety, cognitions and attitudes towards computer technology. Technophobia levels were tested for differences between (1) the older adults and students, and (2) the genders. A significant difference in levels of technophobia was found between the two groups, with older adults having higher levels of technophobia than students. Some gender differences were also evident in the study, with older women showing higher levels of anxiety and technophobia than the female students.