Growing evidence has linked positive psychological attributes like optimism to a lower risk of poor health outcomes, especially cardiovascular disease. It has been demonstrated in randomized trials that optimism can be learned. If associations between optimism and broader health outcomes are established, it may lead to novel interventions that improve public health and longevity. In the present study, we evaluated the association between optimism and cause-specific mortality in women after considering the role of potential confounding (sociodemographic characteristics, depression) and intermediary (health behaviors, health conditions) variables. We used prospective data from the Nurses' Health Study (n = 70,021). Dispositional optimism was measured in 2004; allcause and cause-specific mortality rates were assessed from 2006 to 2012. Using Cox proportional hazard models, we found that a higher degree of optimism was associated with a lower mortality risk. After adjustment for sociodemographic confounders, compared with women in the lowest quartile of optimism, women in the highest quartile had a hazard ratio of 0.71 (95% confidence interval: 0.66, 0.76) for all-cause mortality. Adding health behaviors, health conditions, and depression attenuated but did not eliminate the associations (hazard ratio = 0.91, 95% confidence interval: 0.85, 0.97). Associations were maintained for various causes of death, including cancer, heart disease, stroke, respiratory disease, and infection. Given that optimism was associated with numerous causes of mortality, it may provide a valuable target for new research on strategies to improve health. health psychology; optimism; psychological well-being; resilience Abbreviations: CI, confidence interval; HR, hazard ratio; MET, metabolic equivalent of task.

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Background Posttraumatic stress disorder (PTSD) has been linked to cognitive decline, but research in women is generally lacking. We examined whether trauma and elevated PTSD symptoms were associated with worse cognitive function in middle-aged civilian women. A secondary objective was to investigate the possible role of depression in the relation of PTSD symptoms to cognitive function. Methods The sample comprised 14,029 middle-aged women in the Nurses’ Health Study II. Lifetime trauma exposure, lifetime PTSD symptoms, and past-week depressive symptoms were measured in 2008. Cognitive function was measured in 2014–2016 using the Cogstate Brief Battery, a self-administered online cognitive battery that assesses psychomotor speed, attention, learning, and working memory. We used linear regression models to estimate mean differences in cognition across PTSD symptom levels. Results Compared to no trauma, elevated PTSD symptoms consistent with probable PTSD (i.e., 4+ symptoms on a screening questionnaire) were associated with worse performance on psychomotor speed/attention (b=−0.08 standard units, p=.001) and learning/working memory (b=−0.09, p<.001) composites, after adjusting for socio-demographics. Although attenuated, associations remained significant when adjusted for depressive symptoms and other cognitive risk factors. We found the strongest associations among women with comorbid probable PTSD and depression. Conclusions PTSD symptoms were negatively related to measures of psychomotor speed/attention and learning/working memory in middle-aged women. Our study adds to a growing literature that suggests that mental disorders are associated with worse cognitive function over the life course.

Objective To estimate how symptom severity, extent of bother, and quality of life differ across urinary incontinence (UI) subtypes. Methods We evaluated prevalent UI cases from the Nurses' Health Studies, including women aged 41–83 years. Women with UI (leaking more than once a month) were subclassified according to reported symptoms as stress (leakage with activity), urgency (leakage with urgency), or mixed UI (stress and urgency co-occurring equally). UI severity was assessed in 102,418 women, based on the Sandvik severity index. In a subset of older women with weekly UI, we asked about bother (n=1,697) and quality of life (Incontinence Impact Questionnaire; n=1,748). UI severity, bother, and quality of life were compared across subtypes using polytomous logistic regression, adjusting for other characteristics. Results The distribution of UI subtypes was 51% stress, 27% urgency, and 22% mixed UI. About half had slight UI, 26% had moderate, and 23% had severe UI. Severe UI was more common in women reporting mixed (37%), than urgency (27%) or stress UI symptoms (15%) (P<0.001). More women with severe mixed (21%, P=0.02) and urgency UI symptoms (13%, P=0.1) reported being “greatly” bothered by their UI, compared with stress UI (10%). Women with severe mixed (mean 18.0, P<0.001) and urgency UI symptoms (mean 13.4, P=0.004) had higher mean Incontinence Impact scores compared with stress UI (mean 9.8). Conclusion Women reporting mixed UI symptoms describe more severe and bothersome incontinence, with higher effect on quality of life.

Background & Aims Studies have reported associations between proton pump inhibitor (PPI) use and dementia. However, data are lacking on long-term PPI use and cognitive function. We therefore examined associations between PPI use and performance in tests of cognitive function. Because of shared clinical indications, we examined associations for H2 receptor antagonists (H2RAs) as a secondary aim. Methods We used prospectively collected data on medication use and other potential risk factors from 13,864 participants in the Nurses’ Health Study II who had completed a self-administered computerized neuropsychological test battery. Multi-variable linear regression models were used to examine associations between medication use and composite scores of psychomotor speed and attention, learning and working memory, and overall cognition. Results We observed a modest association between duration of PPI use and scores for psychomotor speed and attention (mean score difference for PPI use of 9–14 yrs vs never users, −0.06; 95% CI, −0.11 to 0.00; Ptrend = .03). After controlling for H2RA use, the magnitude of this score difference was attenuated. Among individuals who did not regularly use PPIs, duration of H2RA use was associated with poorer cognitive scores, with the strongest association apparent for learning and working memory (mean score difference for H2RA users of 9–14 years vs never users, −0.20; 95% CI, −0.32 to −0.08; Ptrend < .001). Conclusions In an analysis of data from the Nurses’ Health Study II, we did not observe a convincing association between PPI use and cognitive function. Our data do not support the suggestion that PPI use increases dementia risk. Since our primary hypothesis related to PPI use, our findings for H2RAs should be interpreted with caution.

Background The frailty syndrome is associated with higher risk of disability and death after accounting for multimorbidity. Therefore, the determinants of frailty need to be identified to ensure older adults live not only longer but also healthier lives. However, the effect of diet quality on frailty is mostly unknown. Objectives We aimed to evaluate the alternate Mediterranean diet (AMED), the Dietary Approaches to Stop Hypertension (DASH) diet, and the alternate Healthy Eating Index-2010 (AHEI-2010) in association with frailty risk among older women. Methods We analyzed data from 71,941 women aged ≥60 y participating in the Nurses’ Health Study. The AMED, DASH, and AHEI-2010 were computed from validated FFQs in 1990 and repeated every 4 y until 2010. Frailty was defined as having ≥3 of the following 5 criteria from the FRAIL scale: fatigue, reduced resistance, reduced aerobic capacity, having ≥5 illnesses, and weight loss ≥5%. The occurrence of frailty was assessed every 4 y. Results During follow-up we identified 11,564 incident cases of frailty. After adjusting for potential confounders, the RRs (95% CIs) of frailty per 1-SD increase in the AMED, DASH, and AHEI-2010 scores were 0.87 (0.85, 0.90), 0.93 (0.91, 0.95), and 0.90 (0.88, 0.92), respectively. All diet quality scores were associated with lower risk of the individual frailty criteria fatigue, reduced resistance, reduced aerobic capacity, and weight loss. Lower consumption of red and processed meat, a lower sodium intake, a higher ratio of monounsaturated to saturated fat, vegetables, and moderate alcohol intake were components of the diet quality scores independently associated with lower risk of frailty. Conclusions Adherence to a healthy diet, as defined by the AMED, DASH, and AHEI-2010 scores, was associated with reduced risk of frailty in older women.

In this large cohort of older women, a healthier diet was associated with a lower risk of developing impairments in physical function.

Most women with incident urinary incontinence continued to experience symptoms over 10 years; few had complete remission. Identification of risk factors for urinary incontinence progression, such as body mass index and physical activity, could be important for reducing symptoms over time.