Pilot Use of Selected Measures from the Patient-Reported Outcomes Measurement Information System Social and Mental Health Domains with Young Adult Cancer Patients During the Transition to Survivorship Care

Social reintegration is an important part of young adult cancer patients' transition to survivorship care. As part of a mixed methods study exploring the social functioning of young adult cancer patients during this transition process, participants (N = 13) completed four selected measures from the Patient-Reported Outcomes Measurement Information System (PROMIS) social and mental health domains within ∼6 months of completion of active treatment and 3 months later. The majority of participants (n = 10) had T-scores within normal limits on all measures. Three participants had T-scores in the mild or moderate impairment range across time points. No significant differences were found between groups at Time 1 and Time 2 on any of the four measures.

Perceived racial discrimination and mental distress in older Korean Americans: the moderating role of ethnic resources

OBJECTIVES

To examine associations among perceived racial discrimination, ethnic resources, and mental distress in older Korean Americans. Ethnic resources included ethnic identity (how closely individuals identify themselves with other members of the same ethnic background) and sense of community (individuals' feelings of belonging to their ethnic group). We examined the direct effect of perceived racial discrimination and these ethnic resources, as well as their interactions, hypothesizing that mental distress associated with perceived racial discrimination would be reduced by ethnic resources.

DESIGN

Using survey data from the Study of Older Korean Americans (N = 2,150), linear regression models of mental distress were examined for direct and interactive roles of perceived racial discrimination and ethnic resources.

RESULTS

Mental distress was directly associated with perceived racial discrimination (B = 1.90, SE = .20, p < .001), ethnic identity (B = -.41, SE = .13, p < .01), and sense of community (B = -.45, SE = .12, p < .001). Perceived racial discrimination interacted significantly with sense of community (B = -1.86, SE = .28, p < .001). Subgroup analyses suggested that in the context of experiencing racial discrimination, a high sense of community can serve as a buffer against mental distress.

CONCLUSIONS

Ethnic resources are a benefit in coping with experiences of discrimination. The moderating role of sense of community suggests the value of fostering social capital in ethnic communities to protect and promote older immigrants' mental health.

Physical Health Constraints and Psychological Distress in Older Asian Americans: The Role of Perceived Health

Given the importance of understanding the underlying dynamics of physical and mental health in old age, the present study explored the roles of physical health constraints in predicting subjective health perception and psychological distress among older Asian Americans. Guided by the Health Belief Model, we also examined whether subjective health perception would function as a mediator in the link between physical health constraints and psychological distress. Using data from 533 Asian Americans aged 60 and over (mean age=69.4, SD=6.88) in the 2016 Asian American Quality of Life Study, the direct and indirect effect models were tested with multivariate linear regressions and the PROCESS macro. Advanced age, unmarried status, lower levels of acculturation, and more chronic physical conditions were significant predictors of psychological distress. When subjective health perception was added to the model, an additional 5% of the variance was accounted for, resulting in 25% of the total variance explained by the estimated model. Negative health perception was a significant predictor of increased level of psychological distress. Supporting the mediation hypothesis, all direct paths among physical health constraints, subjective health perception, and psychological distress were significant. The indirect effect of physical health constraints on psychological distress through subjective health perception status was significant, as evidenced by the 95% bootstrap confidence interval for the indirect effect not containing zero (.07, .28). The findings not only help better understand the psychological mechanisms that underlie physical health constraints and psychological distress but also suggest avenues for interventions.

The Relations of Social Network Types With Mental Distress Among Older Korean Americans: The Interactive Role of Living Arrangement

The purpose of this study is to identify social network types in older Korean Americans and to examine their direct associations, as well as interactions with living arrangement, on mental distress. Drawn from the Study of Older Korean Americans (SOKA), participants were aged 60 or over and lived in five states. Analyses included 2,140 cases surveyed during 2017-2018. To identify social network types, latent profile analyses were conducted using 10 network-related criterion variables. A model with five social network types was identified as best fit. The groups were labeled as diverse, moderately diverse, family deficit, friend deficit, and restricted. As hypothesized, greater mental distress was associated with belonging to more deprived networks such as family deficit and restricted groups. Interaction effects also suggest that members of the restricted group were more distressed when they lived alone than when they lived with others. Implications based on the results are discussed.

Relationship of social isolation with mental distress among older Korean Americans: The moderating role of social cohesion

Social isolation has been associated with poor mental health outcomes, particularly for older immigrants who do not have a protective social environment. The purpose of this study was to investigate the relationship of social isolation (living alone, marginal family ties and marginal friend ties) with mental distress and to examine the moderating role of social cohesion (family cohesion and community cohesion). We hypothesised that social isolation and social cohesion would be directly associated with mental distress and that social cohesion would buffer the influence of social isolation on mental distress. Data were drawn from the Study of Older Korean Americans (SOKA), which included 2150 older Korean Americans aged 60 or over in multiple areas, collected during 2017-2018. A series of hierarchical regression models of mental distress examined the direct and interactive role of social isolation and social cohesion. Approximately one-third of the sample lived alone, 20% had marginal family ties and 27% had marginal friend ties. All three indicators of social isolation had a significant direct effect on mental health; however, living alone lost its statistical significance with the inclusion of social cohesion variables. Both indicators of family and community cohesion were significantly associated with lower levels of mental distress. In addition, family cohesion buffered the negative effects of marginal ties to family and friends on mental distress. The significant role of a positive social environment must be considered when addressing the needs of older immigrants who are socially isolated.

The Mental Health Benefit of Friend Networks in Older Korean Americans: The Conditioning Effect of Family Type

OBJECTIVES

We identified types of family relationships of older Korean Americans and examined how the mental health benefit of friend networks might be conditioned by family type.

METHODS

Data were from 2,070 participants in the Study of Older Korean Americans, a multistate survey of Korean immigrants aged 60 and older (Mage = 73.3, standard deviation [SD] = 8.01). To identify family types, latent profile analysis (LPA) was performed with marital status, living arrangement, family network, positive and negative interactions with family members, and family mistreatment. Linear regression models examined how mental distress was associated with friend networks and family types, as well as their interactions.

RESULTS

LPA identified 5 family types: close-knit, intimate but distant, detached, connected but dysfunctional, and dysfunctional. Greater distress was associated with smaller friend networks and belonging to the detached, connected but dysfunctional, and dysfunctional family types in comparison to the close-knit type. The interaction model showed that people in the connected but dysfunctional and dysfunctional groups had a stronger association between friend networks and mental distress than the counterparts in the close-knit group.

DISCUSSION

We not only confirmed the health-promoting role of friend networks and the value of a close-knit family but also found that the benefit of friend networks was pronounced when quality of the family relationship was impaired. Our findings called renewed attention to older immigrants' social convoys of family and friends, suggesting that the enhancement of friend networks could be particularly advantageous for older immigrants with dysfunctional family relationships.

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.

Clinical and electrophysiological characteristics in Korean patients with WPW syndrome

This study was designed to investigate the clinical and electrophysiologic characteristics of WPW syndromes in Korea. A total of 400 symptomatic WPW syndrome patients were consecutively recruited. The most common documented symptomatic tachyarrhythmia was orthodromic atrioventricar reentrant tachycardia (75.3%), followed by atrial fibrillation (31.3%), and antidromic atrioventricular reentrant tachycardia (6.2%). There was a higher incidence of multiple bypass tract in patients with antidromic tachycardia than in those with orthodromic tachycardia (30.4 vs 4.3%, P < 0.001). The inducibility of tachyarrhythmia with electrophysiologic study in this study population was 95.8%. The most frequent location of the accessory pathway was the left free wall (48.0%), followed by the right free wall (29.1%), posterior septum (17.5%) and anterior septum (3.5%). These results indicated that 1) clinical and electrophysiological characteristics of Korean patients with WPW syndrome were similar to those of western countries and 2) the electrophysiologic study was important in the evaluation of patients with WPW syndrome.

Hemodynamic effects of the geometric dimensions of graft vessels in coronary artery bypass graft models

The objectives of this investigation are to evaluate the rheologic properties in atherosclerotic disease treated with the various coronary artery bypass graft (CABG) models by numerical analysis, we used four different CABG models for the assessment of spatial fluctuation in wall shear stress, pressure variation and mass flow rate with Carreau model and Navier-Stokes equation. Wall shear stress was higher in a naturally tapered model (model 1) and a constant (non-tapered) diameter of the graft vessel the same as the distal LAD (model 4) than in others. Pressure variation along the native coronary artery and graft vessels was higher in a model 4, model 1 than in a reverse tapering model (model 2) and a constant diameter of the graft vessel the same as the proximal LAD (model 3). The mass flow rate of the distal part (kg/sec,.m(o)) was the highest in model 3. This study suggests that in vitro spatial simulation following CABG revealed that small caliber or tapered graft vessels have adverse hemodynamic effects on the native and graft vessels. By this technique it is possible to simulate the optimal distribution of local hemodynamic variables in patients treated with CABG, also to minimize the degeneration of graft vessel.

Racial and ethnic differences in cognitive health appraisals: a comparison of non-Hispanic White, non-Hispanic Black, and Hispanic older adults

OBJECTIVES

To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables.

METHOD

The sample (N = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016-2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE).

RESULTS

The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed.

CONCLUSION

Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.

Older Korean Americans' concern about Alzheimer's disease: the role of immigration-related factors and objective and subjective cognitive status

Objectives: The present study examined the associations between immigration-related factors and objective and subjective cognitive status with older Korean Americans' concern about developing Alzheimer's Disease (AD). It was hypothesized that (1) AD concern would be associated with immigration-related factors and (2) self-rated cognitive status would mediate the relationship between cognitive performance (Mini Mental State Examination (MMSE) scores) and concern about AD.Method: Using data from the Study of Older Korean Americans (n = 2061, mean age = 73.2; 66.8% female), the direct and indirect effect models were tested.Results: Korean American immigrants with a higher level of acculturation had better cognitive performance, more positive self-ratings of cognitive status, and a lower level of concern about AD. Both poor cognitive performance and negative self-ratings of cognitive status were associated with increased concern about AD. Supporting the mediation hypothesis, the indirect effect of cognitive performance on AD concern through self-rated cognitive status was significant (bias corrected 95% confidence interval for the indirect effect = -.012, -.003).Conclusion: The mediation model not only helps us better understand the psychological mechanisms that underlie the link between cognitive status and AD concern but also highlights the potential importance of subjective perceptions about cognitive status as an avenue for interventions.

Cultural adaptation of the savvy caregiver program for Korean Americans with limited English proficiency: a feasibility and acceptability study

Background

Limited English proficiency (LEP) of dementia caregivers poses a critical barrier to these caregivers’ access to evidence-based interventions. In an effort to make such interventions available and accessible to dementia caregivers with LEP, in the present study we use Barrera and colleagues’ (2011) three-step model of cultural adaptation: (1) information gathering, (2) preliminary adaptation, and (3) full adaptation. Selecting Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target intervention, we demonstrate the sequential process of cultural adaption and report the outcomes on feasibility and acceptability.

Methods

Preliminary adaptation with linguistic attunement was conducted by translating the SCP manual into Korean and certifying two lay individuals who were bilingual in English and Korean as Savvy trainers. The 6-week online SCP program was delivered by the two trainers in Korean with six to seven caregiver participants per trainer (N = 13). Feasibility and acceptability of the SCP for both caregiver participants and trainers were assessed using mixed methods, and their data then informed full adaptation.

Results

Findings not only showed the initial efficacy of the linguistically attuned SCP but also suggested areas for further modification. Data-driven assessment yielded a list of recommended changes for full adaptation, which was reviewed by the SCP developer to ensure fidelity and by community and research partners to confirm contextual and cultural relevance.

Conclusions

The adopted changes are broadly summarized as representing logistical, technical, and cultural issues. Given our refined set of educational materials and implementation guidelines, we discuss future directions for research and development.

Real-time determination of left ventricular ejection fraction by automatic boundary detection in patients with dilated cardiomyopathy: a comparison with radionuclide ventriculography

Echocardiographic automatic boundary detection (ABD) is a new on-line technique which automatically outlines the left ventricular endocardial border and instantly calculates the left ventricular area and volume from two dimensional echocardiographic images. To determine if left ventricular ejection fraction (LVEF) can be derived using the ABD method, 25 consecutive patients with dilated cardiomyopathy, aged 52.1 +/- 15.2 (range 14 approximately 75), underwent complete echocardiographic examination with both the ABD method and radionuclide ventriculography (RVG). End-diastolic and end-systolic left ventricular areas were obtained on-line from the apical four chamber view. Left ventricular length was also measured from an apical view. Left ventricular volumes and ejection fraction were calculated using the single plane area-length method. ABD measurements could be obtained in all patients. Linear regression analysis compared ejection fraction derived by ABD and RVG. The mean radionuclide LVEF was 20.9 +/- 6.8% and mean ABD-derived LVEF was 22.7 +/- 5.8%. Linear regression analysis revealed that the ABD-derived LVEF is closely correlated with the RVG-derived LVEF (r = 0.87, p < 0.001). In conclusion, ABD echocardiography is a new on-line technique which may be used to accurately calculate LVEF in patients with dilated cardiomyopathy.

Influence of arachidonic acid on catecholamine secretion in the perfused rat adrenal medulla

The present study was conducted to investigate the influence of arachidonic acid, which is known to be an important unsaturated fatty acid component of membrane phospholipids and to be liberated by phospholipase A2 action, on secretion of catecholamines (CA) from the isolated perfused rat adrenal glands and to clarify the mechanism of its action. Arachidonic acid (10 uM) perfused into an adrenal gland of the rat for 20 min caused a significant inhibition of CA secretion evoked by ACh (5.32 x 10(-3) M), DMPP (10(-4) M) and muscarine (10(-4) M) while it did not affect that induced by excess K+ (5.6 x 10(-2) M). Arachidonic acid, in the presence of ouabain (100 uM), an inhibitor of Na+, K(+) -ATPase, also produced a marked inhibitory effect of CA secretion evoked by ACh, DMPP and muscarine but did not modify the secretory effect of excess K+. The perfusion of arachidonic acid along with indomethacin (30 uM), which is an inhibitor of cyclooxygenase, for 20 min attenuated markedly CA secretory effect evoked by ACh, DMPP and muscarine while it did not influence that by excess K+. Prostaglandin F2 alpha perfused in a retrograde direction for 20 min inhibited greatly the CA secretion evoked by DMPP but did not affect the effect evoked by excess K+. All of arachidonic acid, ouabain, indomethacin and prostaglandin F2 alpha used in the present study did not affect the spontaneous basal release of CA in the perfused rat adrenal glands. Taken together, these experimental results suggest that arachidonic acid, as well as prostaglandin F2 alpha, cause the inhibitory action of CA secretion evoked by cholinergic receptor-mediated stimulation, but not by membrane depolarization, and also play a modulatory role in regulating CA secretion from the rat adrenal medulla.

Allelic frequencies and heterozygosities of microsatellite markers covering the whole genome in the Korean

Microsatellite markers are an essential tool for genetic linkage analysis because of their high polymorphism content. Four hundred commercially available markers covering the entire genome were genotyped from 578 sib individuals from 249 Korean families. Allelic frequencies and heterozygosities were determined for each marker loci and compared between Korean, Taiwanese, Japanese and Caucasian populations. In the three Asian populations, 10-13% of the markers had less than 0.6 heterozygosity, whereas in the Caucasian population, only 0.5% of the markers had less than 0.6 heterozygosity. Mean identical by descent (IBD) values were calculated for 578 sib individuals. Analysis of IBD values greater than 0.5 suggested that markers with low heterozygosity can also provide positive linkages, at least for the IBD sharing method of model-free linkage analysis. The data presented in this study will be a useful reference for genome-wide screens of Koreans and comparative studies with other ethnic populations.

Changes in Depressive Symptoms of Korean American Dementia Caregivers After Attending the Savvy Caregiver Program: Preliminary Findings with a Pilot Sample

OBJECTIVES

Language accommodation is indispensable in making evidence-based interventions available and accessible to ethnic minorities with limited English proficiency. As part of the larger effort to culturally adapt the Savvy Caregiver Program for Korean American dementia caregivers, we first conducted linguistic adaptation, and the present study reports the preliminary findings on participants' changes in depressive Symptoms.

METHODS

The linguistically adapted program was delivered to two small groups of Korean American dementia caregivers (total n = 13) by two Savvy-certified Korean-speaking trainers. Participants' depressive symptoms were assessed at three time points (pre-intervention, immediate post-intervention, and 6-month follow-up).

RESULTS

Following the intervention, participants exhibited lowered depressive symptoms (t = 8.64, p < .001, Cohen's d = .89). This benefit was sustained at 6-month follow-up.

CONCLUSIONS

Findings suggest that the therapeutic benefit of the Savvy Caregiver Program could potentially be shared with linguistic minorities when delivered in their native language.

CLINICAL IMPLICATIONS

Although limited in its scope and nature, the pilot study with linguistic adaptation sheds light on efforts to close the gap in the evidence-based intervention delivery.