Neighborhood effects on the self-rated health of older adults from four racial/ethnic groups

Building upon the sizable literature on individual-level predictors of self-rated health, this study examined the impact of neighborhood characteristics, using older adult samples of four racial/ethnic groups. The considered neighborhood characteristics include (a) the proportion of individuals age 65 and older, (b) the proportion of individuals below poverty, and (c) the proportion of individuals from the same racial/ethnic background in the Census-block group. The samples were drawn from the 2004-2005 Survey of Older Floridians, which includes Whites (n = 488), Blacks (n = 345), Cubans (n = 319), and non-Cuban Latinos (n = 230). Using the reported residential address, each participant was linked to the 2000 Census at block-group level to retrieve the above-mentioned neighborhood characteristics. Multilevel analysis of self-rated health was estimated for each racial/ethnic group, considering individual-level variables (e.g., age, gender, marital status, education, financial strain, and chronic conditions) and each of the neighborhood characteristics. Regardless of racial/ethnic groups, those living in the neighborhood with a higher proportion of residents below poverty were likely to report poorer health. The proportion of older adults in the neighborhood was significant only in Cubans, and the proportion of residents with the same ethnic background was only in Whites. The findings show the overall importance of neighborhood context in the health of older adults and indicate different implications of neighborhood characteristics for diverse racial/ethnic groups.

Recalled attributes of parents with Alzheimer's disease: relevance for caregiving

Health psychology has long been involved in studies of factors that lead to more effective caregiving. Drawing on the theory of distributive justice, the underlying hypothesis of this paper was that perceptions of what a demented parent was like, prior to becoming ill, influence an adult child caregiver's provision of care, as well as the caregiver's own well-being. A secondary question dealt with the nature of retrospective ratings by caregiver informants. The sample consisted of triads of two adult children (N = 385) and a parent (N = 201) diagnosed with Alzheimer's disease, although in a few instances only one adult child was interviewed. Both retrospective and current ratings of the parent were made by caregivers, who were administered a semantic differential instrument twice over a 10-month period. Comparison of ratings from first and second interview waves suggested that perceptions of what a parent was like, prior to the onset of dementia, were more stable over time than perceptions of what the parent was currently like, at each interview. Ratings of premorbid attributes were more strongly related to ratings of the present for those parents who displayed the least evidence of cognitive decline. Regression analyses supported the hypothesized relationship between adult children's perceptions and both provision of care and well-being variables. Results have implications for projections of caregiver burden and for placement into long-term care.

Genetic polymorphisms of CCND1 and PTEN in progression of esophageal squamous carcinoma

Cyclin D1 (CCND1) plays a significant role in G1-S transition of cell cycle, and phosphatase and a tensin homologue (PTEN) negatively regulate cell cycle through phosphatidylinositol 3-kinase (PI3K)/AKT signaling. CCND1 and PTEN genetic polymorphisms might induce susceptibility to the occurrence of esophageal squamous cell carcinoma (ESCC). Three hundred and four ESCC patients and 413 healthy controls from Anyang, China, were enrolled in this study. All genotyping at CCND1 (807 G/A) and PTEN (rs701848 T/C and rs2735343 C/G) were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Unconditional logistic regression model was used to analyze the correlation between the polymorphisms and the susceptibility to develop ESCC. Statistically significant differences were observed between cases and controls in distribution of genotypes or alleles at PTEN rs701848 T/C and rs2735343 C/G, with either haplotype TG or CG possessing notably higher proportion in cases than in the controls. However, such difference could not be found in the distribution of the polymorphisms at CCND1 807 G/A. In summary, the polymorphisms of PTEN rs701848 T/C and rs2735343 C/G might represent crucial modifying factors for development of ESCC.

A randomised, double-blind, parallel design, multi-institutional, non-inferiority phase IV trial of imidafenacin versus fesoterodine for overactive bladder

AIMS

Our objective was to compare the efficacy and safety of imidafenacin over fesoterodine in patients with overactive bladder (OAB).

METHODS

This study is a randomised, double-blind, parallel-group, fesoterodine-controlled study in patients with continuous OAB symptoms for ≥ 3 months, daily mean voiding frequency (DMVF) ≥ 8, and daily mean urgency or urgency incontinence frequency ≥ 2. A twice-daily 0.1 mg imidafenacin with placebo, or once-daily 4 mg fesoterodine with placebo were administered for 12 weeks. The primary efficacy end-point was the difference in DMVF at 12 weeks. The secondary efficacy end-points were differences in daily mean: (i) voiding frequency at 4 and 8 weeks; (ii) urgency frequency; (iii) urgency incontinence frequency; (iv) incontinence frequency; (v) nocturia frequency; and (vi) quality of life score. The variables for safety analysis were adverse events, vital signs, residual urine volume and clinical laboratory tests. An efficacy analysis was conducted in per-protocol patients and the safety analysis was conducted in all randomised patients.

RESULTS

The differences in DMVF at 12 weeks were -3.38 ± 3.63 and -2.45 ± 3.73 in the imidafenacin and fesoterodine groups, respectively, and the difference was not significant between the two groups. Imidafenacin was non-inferior to fesoterodine, and the lower limit of 95% two-sided confidence intervals was -0.53. The other six secondary end-points and variables for safety analysis showed no difference between the two groups.

CONCLUSIONS

Imidafenacin was non-inferior to fesoterodine in terms of efficacy, and showed no significant difference in terms of safety.

An empirical typology of social networks and its association with physical and mental health: a study with older Korean immigrants

OBJECTIVES

In the context of social convoy theory, the purposes of the study were (a) to identify an empirical typology of the social networks evident in older Korean immigrants and (b) to examine its association with self-rated health and depressive symptoms.

METHOD

The sample consisted of 1,092 community-dwelling older Korean immigrants in Florida and New York. Latent class analyses were conducted to identify the optimal social network typology based on 8 indicators of interpersonal relationships and activities. Bivariate and multivariate analyses were conducted to examine how the identified social network typology was associated with self-rating of health and depressive symptoms.

RESULTS

Results from the latent class analysis identified 6 clusters as being most optimal, and they were named diverse, unmarried/diverse, married/coresidence, family focused, unmarried/restricted, and restricted. Memberships in the clusters of diverse and married/coresidence were significantly associated with more favorable ratings of health and lower levels of depressive symptoms.

DISCUSSION

Notably, no distinct network solely composed of friends was identified in the present sample of older immigrants; this may reflect the disruptions in social convoys caused by immigration. The findings of this study promote our understanding of the unique patterns of social connectedness in older immigrants.

The Impact of Social Resources on Depressive Symptoms in Racially and Ethnically Diverse Older Adults

The objectives of this study were (1) to develop an empirical typology of physical health risks in racially and ethnically diverse older adults and (2) to examine whether the impact of social resources on depressive symptoms differs across the identified health risk groups (low, moderate, and high risks). The data source was the Survey of Older Floridians, a statewide survey of older adults aged 65 and older ( n = 1,432). Latent profile analysis with multiple indicators of physical health (chronic conditions, functional disability, and self-rated health) was used to identify three health risk groups (low, moderate, and high risks). The direct and interactive effects of the health risk group membership and social resources (social support and religious service attendance) on depressive symptoms were found. Of particular interest was that the positive impact of social support was most pronounced in the moderate health risk group.

Telecounseling for the linguistically isolated: a pilot study with older Korean immigrants

PURPOSE

Responding to the critical needs of the linguistically isolated, this pilot study tested the use of telehealth technology in providing access to culturally and linguistically appropriate mental health services. The goal of the study was to explore the feasibility and preliminary efficacy of a telecounseling program in the client's native language.

DESIGN AND METHODS

Using a small sample of older Korean immigrants living in a low-income housing facility in Orlando, Florida, who had concerns about depressive moods (n = 14), the pilot telecounseling program was implemented via videoconferencing. Four weekly sessions were conducted by 4 Korean mental health counselors based in New York.

RESULTS

A high level of completion (86%) and overall satisfaction with the program were observed. Participants also exhibited a significant reduction in depressive symptom severity shortly after completion of the program. At the 3-month follow-up, the participants' depressive symptom scores remained significantly lower than those at the initial assessment.

IMPLICATIONS

The findings support the value of telecounseling for linguistically isolated populations and suggest further efforts to extend such programs.

Anatomical investigations for appropriate needle positioning for thoracic paravertebral blockade in children

OBJECTIVE

Clinicians hesitate to perform thoracic paravertebral blockade (TPVB) in children due to the potential high risk of adverse effects. No paediatric anatomical guidelines for TPVB exist. This study aimed to estimate the appropriate depth and distance for safe needle positioning in children.

METHODS

The depth (D) from the skin to the paravertebral space and the distance (A) from the spinous process to the needle entry point on the skin were measured using chest computed tomography (CT) in children aged between 1 and 9 years. Correlations between age, gender, weight, height, body mass index (BMI) and each of the anatomical measurements were analysed.

RESULTS

Each measurement correlated significantly with age, weight and height, but not with BMI (n = 373 children). Measurements A and D could be calculated by: A = 13.56 + (0.33 × age [years]) + (0.06 × weight [kg]) + 0.47 × (gender [female = 0, male = 1]); and D = 17.49 - (0.35 × age [years]) + (0.55 × weight [kg]).

CONCLUSION

These anatomical guidelines for TPVB are recommended to help prevent anaesthetic complications such as pneumothorax, when ultrasonography and CT are unavailable.

Satisfaction with care: the role of patient-provider racial/ethnic concordance and interpersonal sensitivity

OBJECTIVE

This study examined how patients' satisfaction with their care is affected by racial/ethnic concordance and patients' perceived interpersonal sensitivity of their providers. The sample consisted of non-Hispanic Whites, African Americans/Blacks, Hispanics/Latinos, and Asian Americans age 50 and older.

METHOD

Data came from the population-based Commonwealth Fund 2001 Health Care Quality Survey (n=2,075). A hierarchical regression model of satisfaction was estimated for each racial/ethnic group with a sequential entry of variables: demographic and health-related variables, racial/ethnic concordance between patient and provider, and interpersonal sensitivity.

RESULTS

The influence of patient-provider racial/ethnic concordance on satisfaction with care was negligible, but the influence of interpersonal sensitivity was substantial (p<.001) in all racial/ethnic groups.

DISCUSSION

Findings suggest that racial/ethnic concordance may not be universally effective for diverse older populations, but perceived interpersonal sensitivity of the provider has a strong influence on older adults' satisfaction with care regardless of their racial/ethnic background.

Diabetes and depressive symptoms among Korean American older adults: the mediating role of subjective health perceptions

PURPOSE

In recognition of the impact of chronic diseases on mental health and the lack of research on Asian American subgroups, the present study examined subjective perceptions of health as a potential mediator in the association between diabetes and depressive symptoms in Korean American older adults.

METHODS

Multivariate analysis with data from 672 Korean American older adults in Florida explored the mediation model of health perceptions.

RESULTS

The presence of diabetes was associated with negative perceptions of health and elevated symptoms of depression. The proposed mediation model was also supported: negative perceptions of health served as an intervening step between diabetes and depressive symptoms.

CONCLUSIONS

The intervening role of health perceptions yields implications for developing health promotion interventions targeting older individuals with diabetes. Results suggest that even in the presence of chronic health conditions, mental well-being of older adults can be maintained by having optimistic beliefs and positive attitudes towards their own health.

The mediating role of loneliness in the relation between social engagement and depressive symptoms among older Korean Americans: do men and women differ?

OBJECTIVES

This study conceptualized loneliness as a mediator in the relation between social engagement and depressive symptoms and explored gender differences in the mediation model. Various indices of social engagement were considered including living arrangement, social network, and activity participation.

METHOD

Using data from 674 community-dwelling Korean American older adults, we first examined the mediation effect of loneliness in the relation between each of 3 indices of social engagement (not living alone, social network, and activity participation) and depressive symptoms. Subsequently, gender differences in the mediation model were examined.

RESULTS

As hypothesized, loneliness was found to mediate the relation between each of the indices of social engagement and depressive symptoms in both men and women. We also observed gender differences in the strength of mediating effects; the effect of living alone was more likely to be mediated by loneliness among men, whereas women showed greater levels of mediation in the models with social network and activity participation.

DISCUSSION

Our findings suggest that loneliness may explain the mechanism by which deficits in social engagement exerts its effect on depressive symptoms and that gender differences should be considered in interventions targeting social engagement for mental health promotion.

The association between self-rated mental health and symptoms of depression in Korean American older adults

OBJECTIVE

The study examined the association of self-rated mental health (SRMH) with three measures of depressive symptoms (the short form CES-D, GDS-SF, and PHQ-9) in Korean American older adults.

METHOD

The sample consisted of 420 community-dwelling Korean American older adults (M(age) = 71.6, SD = 7.59) in the New York City metropolitan area. Hierarchical regression models of SRMH were estimated with an array of predictors: (a) sociodemographic characteristics, (b) physical health-related variables, and (c) each of the three depressive symptom measures.

RESULTS

The three measures of depressive symptoms were interrelated, and each of them made a significant contribution to the multivariate models of SRMH. The amount of variance explained by the short-form CES-D, GDS-SF, and PHQ-9 was 11%, 10%, and 16%, respectively.

CONCLUSION

Findings show a moderately strong linkage between the measures of depressive symptoms and SRMH and invite further research on SRMH in diverse populations.

Patients' perceptions of the interpersonal sensitivity of their healthcare providers: the potential role of patient-provider racial/ethnic concordance

BACKGROUND

Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services.

OBJECTIVE

This study examined factors that helped to explain patients' perceptions of their providers' interpersonal sensitivity - one component of cultural competence.

METHODS AND PARTICIPANTS

The respondents were 2075 racially/ethnically diverse adults, aged 50 years and older, who responded to a national telephone survey.

RESULTS

Results indicate that one of the main factors predicting interpersonal sensitivity is self-rated physical health: those who reported better health were more likely to see their provider as exhibiting higher levels of sensitivity. This was true for Hispanic/Latino patients. The results also suggest that having a provider of the same race/ethnicity was a significant factor only for Hispanic/Latino patients.

CONCLUSION

Despite findings from previous research, racial/ethnic concordance may not be universally effective in improving interpersonal sensitivity in healthcare settings for all racial/ethnic groups.

Racial/Ethnic Differences in Predictors of Self-Rated Health

The present study examined how self-rated health was influenced by sociodemographic characteristics, physical health indicators, and sociocultural resources among four racial/ethnic groups of older adults. The data source was the Survey of Older Floridians, a statewide sample of Whites ( n = 503), African Americans ( n = 360), Cubans ( n = 328), and non-Cuban Hispanics ( n = 241) who were age 65 and older. Hierarchical regression models of self-rated health were estimated to explore the direct effects of the predictor variables as well as their interactive roles in each racial/ethnic group. Compared to Whites, racial/ethnic minority older adults rated their health more poorly. Although physical health indicators were significant predictors of self-rated health across all groups, the authors found group-specific predictors and interactions. Findings show similarities and differences in predictors of self-rated health across diverse racial/ethnic groups and suggest the importance of understanding group-specific factors in efforts to improve older adults’ perceived and actual health.

Perceived neighborhood environment affecting physical and mental health: a study with Korean American older adults in New York City

This study examined how subjective perceptions of the neighborhood environment (e.g., perceived ethnic density, safety, social cohesion, and satisfaction) influenced the physical and mental health of Korean American older adults. Using data from 420 residents of the New York City metropolitan area (M(age) = 71.6, SD = 7.59), health perceptions and depressive symptoms were estimated with hierarchical regression models entered in the order of (1) demographics and acculturation, (2) health-related variables, and (3) perceived neighborhood environment. After controlling for the effects of the individual-level variables, perceived neighborhood environment was found to make a significant contribution to both outcomes. Individuals less satisfied with their overall neighborhood environment were more likely to have negative perceptions of health and depressive symptoms. A strong linkage between perceived neighborhood safety and depressive symptoms was also observed. Findings from the study highlight the importance of subjective evaluations of neighborhood environment and provide implications for health promotion.

Overweight and its association with aortic pressure wave reflection after exercise

BACKGROUND

Obesity is associated with arterial stiffening, left ventricular (LV) hypertrophy, and diastolic dysfunction. However, there is no data regarding dynamic changes in arterial hemodynamics with exercise in overweight subjects. We hypothesized that overweight women would show a different exercise response in wave reflection compared with lean women.

METHODS

A total of 59 overweight and 68 lean nondiabetic women (mean age 63 ± 7 years) underwent symptom-limited supine bicycle exercise testing with simultaneous two-dimensional and Doppler echocardiography. Central hemodynamics including central aortic pressure and augmentation index (AIx) were obtained at rest and immediately after peak exercise using radial artery tonometry.

RESULTS

Overweight women showed a higher LV mass index (lean vs. overweight; 40.2 ± 10.2 vs. 45.3 ± 11.0 g/m(2.7), P = 0.007) and a lower early diastolic mitral annular velocity (6.3 ± 1.8 vs. 5.5 ± 1.6 cm/s, P = 0.013) than lean women. Although the two groups did not differ in peripheral and central hemodynamics including AIx (36.3 ± 11.7 vs. 36.8 ± 10.2%, P = 0.830) and AIx normalized for heart rate 75/min (AIx@75, 30.4 ± 11.5 vs. 30.1 ± 9.9%, P = 0.885) at rest, AIx (20.9 ± 11.5 vs. 27.6 ± 10.4%, P = 0.004) and AIx@75 (25.8 ± 10.2 vs. 31.6 ± 7.7%, P = 0.002) at peak exercise were significantly higher in overweight women. In simple correlation analysis, body mass index (BMI) showed significant correlations with AIx, and AIx@75 at peak exercise, whereas no relationships were found with those parameters at rest. Multiple regression analysis showed that BMI was an independent determinant of AIx@75 at peak exercise (β = 0.28, P = 0.004).

CONCLUSIONS

Despite similar resting peripheral and central hemodynamics, the wave reflection in overweight women after exercise differed from that in lean women. These findings suggest that being overweight is related to higher wave reflection after exercise.