Resilience to urban poverty: theoretical and empirical considerations for population health

Mental health index of the elderly population in Medellín (Colombia)-2021: a factorial analysis

Introduction

There are several risk factors associated with developing mental disorders among people over 60 years of age. Mental health encompasses multiple domains or capacities, which can comprise the psychological wellbeing of older people. Therefore, resilient coping, self-compassion, self-esteem, hopelessness, quality of life, and depression are considered the characteristics and adaptive mechanisms that bring together the main risk and protective factors for imbalance in mental wellbeing.

Objective

This study aimed to establish the demographic, social, and family factors, as well as the clinical characteristics and lifestyle habits that influence the mental health of the elderly people in the city of Medellín, in the year 2021, to build a mental health index.

Methodology

This study adopts a quantitative approach, employs retrospective temporality, and utilizes secondary sources. A cross-sectional survey was carried out with the SABAM Project (health and mental wellbeing of older adults from five cities in Colombia in 2021 by its Spanish acronym) database (secondary source), which is part of the research group "Public Health Observatory" of CES University (Medellín, Colombia). The database comprised 500 records of people aged over 60 years from the city of Medellín in 2021. While constructing the index, a principal component analysis was used, along with the Varimax method for factor analysis rotation.

Results

The median age of the general population was 67 years (IQR 63-72); for men, the median age was 66 years (IQR 63-71) and for women, the median age was 67 years (IQR 63-72). An association was found between low socioeconomic levels, alcohol consumption, and the level of higher education (university-postgraduate) with low levels of the Mental Health Index in people over 60 years of age in Medellín during the year 2021.

Conclusion

A quantitative model was developed to predict either a positive or negative prognosis in the mental wellbeing of the population over 60 years of age in the city of Medellín. The model was also used for the development of a sociodemographic profile highlighting the impact on mental health among people over 60 years of age with limited economic resources.

Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review

OBJECTIVE

To identify common resilience factors against non-communicable diseases (dental caries, diabetes type II, obesity and cardiovascular disease) among healthy individuals exposed to chronic adversity.

MATERIALS AND METHODS

The databases MEDLINE (via PubMed), Scopus and CINAHL were searched. Observational studies in English assessing resilience factors among populations living in chronic adversity were included. Intervention studies, systematic reviews, non-original articles and qualitative studies were excluded. There were no restrictions regarding publication year or age. No meta-analysis could be done. Quality assessments were made with the Newcastle-Ottawa scale (NOS).

RESULTS

A final total of 41 studies were included in this systematic review. The investigated health resilience factors were divided into the following domains: environmental (community and family) and individual (behavioural and psychosocial). A narrative synthesis of the results was made according to the domains.

CONCLUSIONS

Individual psychosocial, family and environmental factors play a role as health resilience factors in populations living in chronic adversity. However, the inconclusive results suggest that these factors do not act in isolation but interplay in a complex manner and that their interaction may vary during the life course, in different contexts, and over time.

Caregiver role strain in caring for vulnerable persons living with HIV: correlates of caregiver and care recipient reports

Informal care of family and friends is important for the health and well-being of disadvantaged persons living with HIV (PLWH). Caregiver role strain may threaten the function and continuity of their main relationships and their health impacts. Data were from a disadvantaged, primarily African American, sample of PLWH care recipients. Caregiver role strain was operationalized as a latent factor measured by variables including PLWH's perceptions of their caregiver not wanting or complaining about helping them or wanting a break. We found that greater caregiver role strain was associated with higher levels of HIV-related stigma and depressive symptoms. Lower role strain was associated with more collaborative problem solving and shared medical treatment decision-making. Caregiver role strain was linked to disadvantaged PLWHs' worse stigma and mental health; collaborative engagement in care and coping assistance were protective of role strain. Caregiving relationship-focused research and interventions are needed for resourcing and sustaining disadvantaged African American communities' caregiving and health.

An Assessment of Social Resilience against Natural Hazards through Multi-Criteria Decision Making in Geographical Setting: A Case Study of Sarpol-e Zahab, Iran

The aim of this study was to propose an approach for assessing the social resilience of citizens, using a locative multi-criteria decision-making (MCDM) model for an exemplary case study of Sarpol-e Zahab city, Iran. To do so, a set of 10 variables and 28 criteria affecting social resilience were used and their weights were measured using the Analytical Hierarchy Process, which was then inserted into the Weighted Linear Combination (WLC) model for mapping social resilience across our case study. Finally, the accuracy of the generated social resilience map, the correlation coefficient between the results of the WLC model and the accuracy level of the social resilience map were assessed, based on in-situ data collection after conducting a survey. The outcomes revealed that more than 60% of the study area falls into the low social resilience category, categorized as the most vulnerable areas. The correlation coefficient between the WLC model and the social resilience level was 79%, which proves the acceptability of our approach for mapping social resilience of citizens across cities vulnerable to diverse risks. The proposed methodological approach, which focuses on chosen data and presented discussions, borne from this study can be beneficial to a wide range of stakeholders and decision makers in prioritizing resources and efforts to benefit more vulnerable areas and inhabitants.

Dietary health in the context of poverty and uncertainty around the social determinants of health

Lower household income has been consistently associated with poorer diet quality and poorer dietary health outcomes. Households experiencing poverty find themselves unable to afford enough food, and the food that they can afford is often poor quality, energy dense and low in nutrients. However, the relationship between diet, poverty and health is complex. Not everyone on a low income has a poor diet. Poverty is about more than low incomes and it is not a uniform experience. Particular aspects of the experience of poverty have implications for diet and dietary health. It is increasingly apparent that uncertainty is one of those aspects. Recession, welfare policy, employment trends and widening inequality have created more uncertainty for those on low incomes. In the context of heightened uncertainty, all aspects of household food provisioning - including budgeting, shopping, storage, meal planning and cooking - are more difficult and sometimes impossible. This review will draw on research about food practices and dietary health in low-income neighbourhoods to explore the ways in which experiences of prolonged uncertainty shape dietary practices and impact health and well-being.

Financial Strain and Health Status Among European Workers: Gender and Welfare State Inequalities

Objectives: Although in-work poverty has been increasing, in Europe policy about poverty and social exclusion tends to focus on labor market participation, independently of the level of remuneration and the quality of work, and studies about financial strain among workers, as well as on its relationship with health status, are still scarce. The objectives of this study were: (1) to compare the prevalence of financial strain among workers among different welfare state typologies, and (2) to examine whether the relationship between financial strain and health status differs by welfare state regime. For both objectives we examined whether there were gender differences. Methods: We conducted a cross-sectional study using data from the 6th European Working Conditions Survey of 2015 and selected a subsample of all employees from the EU28 aged 16-64 years (13,156 men and 13,225 women). Results: There were large differences in the prevalence of financial strain between welfare state typologies, which were not explained by individual factors. Additionally, differences across welfare regimes were greater among women. Nordic countries had the lowest prevalence (12.1% among men and 12.3% among women) whereas Southern European countries had the highest (49.5% among men and 47.9% among women). In both sexes and in all welfare state typologies, financial strain was associated with poor self-perceived health status and poor psychological well-being. Whereas, Southern European countries had the highest prevalence of financial strain, the magnitude of the association with health status was smaller than in other country typologies. Conclusion: In Europe, policies are needed to address the specific structural factors leading to financial strain as well as its relationship with health status among workers.

Sustainability of religious communities

This article focuses on the relationship between church population and sustainability. We carried out the study on a sample of Presbyterian churches in South Korea, and implemented dynamic optimization of the church population based on the Susceptible-Infected-Recovered (SIR) epidemic model. In particular, System Dynamics (SD) and Agent-Based Model (ABM) simulations are performed for a prototype model with key parameters that contribute to church growth. Potential parameters reflecting sustainability for churches trigger dramatic growth in church populations. We categorized five dimensions of sustainability with various multi-dimensional indicators in order to measure the level of sustainability, and we obtained the values of the indicators by analyzing a number of news articles searched with a text mining technique. As time-dependent values of sustainability are imposed on the generic SD model for church population dynamics as sustainable potential parameters, the optimized result reproduces specific features for the church population. We discuss the roles of key parameters for sustainable church growth, and the contributions of the churches to sustainability.

A workshop report on the causes and consequences of sleep health disparities

Sleep deficiencies, which include insufficient or long sleep duration, poor sleep quality, and irregular timing of sleep, are disproportionately distributed among populations that experience health disparities in the United States. Sleep deficiencies are associated with a wide range of suboptimal health outcomes, high-risk health behaviors, and poorer overall functioning and well-being. This report focuses on sleep health disparities (SHDs), which is a term defined as differences in one or more dimensions of sleep health on a consistent basis that adversely affect designated disadvantaged populations. SHDs appear to share many of the same determinants and causal pathways observed for health outcomes with well-known disparities. There also appears to be common behavioral and biological mechanisms that connect sleep with poorer health outcomes, suggesting a link between SHDs and other health disparities observed within these designated populations. In 2018, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research convened a workshop with experts in sleep, circadian rhythms, and health disparities to identify research gaps, challenges, and opportunities to better understand and advance research to address SHDs. The major strategy to address SHDs is to promote integration between health disparity causal pathways and sleep and circadian-related mechanisms in research approaches and study designs. Additional strategies include developing a comprehensive, integrative conceptual model, building transdisciplinary training and research infrastructure, and designing as well as testing multilevel, multifactorial interventions to address SHDs.

Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the MECA Study

Background

Cardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience.

Methods and Results

The MECA (Morehouse‐Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to “resilience” in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine “at‐risk” and “resilient” neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and microRNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement.

Conclusions

The MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms.

REGISTRATION

URL: https://www.clini​caltr​ials.gov. Unique identifier: NCT03308812.

Chronic Stress and Unhealthy Dietary Behaviors among Low-Income African-American Female Caregivers

BACKGROUND

Chronic stress increases the risk of excess intake of calorie-dense foods. Low-income minority caregivers in the United States are cumulatively exposed to stressors and unhealthy foods, but evidence of this association is limited in this population group. The objective of the current study was to assess the association between chronic stress and unhealthy dietary behaviors among low-income African-American caregivers in Detroit, Michigan.

METHODS

Data came from Detroit Dental Health Project, a longitudinal study of pairs of African-American caregivers and children during 2002-2007. A sample of 912 female caregivers were included and their baseline (2002-2003) survey responses were analyzed to identify those with chronic stress and patterns of dietary behaviors. The likelihood of having unhealthy dietary behaviors was compared between chronically stressed caregivers and others, and the mediator role of depressive symptoms or current smoking was tested.

RESULTS

Approximately 10% of caregivers experienced chronic stress as they all reported discrimination, residential movement, and lack of social support. Twenty-five percent of the caregivers were found to have an unhealthy dietary pattern characterized by excess intake of high fatty foods and soda. Chronically stressed caregivers were more likely to exhibit unhealthy dietary behaviors (prevalence ratio: 1.39; 95% CI: 1.05, 1.84), and this relation was significantly mediated by depressive symptoms, not current smoking.

CONCLUSIONS

These findings suggest that chronic stress played a role in negatively influencing dietary behaviors. As this association might be mediated by depressive symptoms, an intervention to reduce depressive symptoms can be considered as an effective strategy to promote healthy dietary behaviors among chronically stressed minority caregivers.

Relation of the Psychological Constructs of Resilience, Mindfulness, and Self-Compassion on the Perception of Physical and Mental Health

Purpose

Health factors that enhance an individual’s ability to perceive and maintain health and well-being are referred to as “health assets”. Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population.

Patients and methods

A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables.

Results

The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense.

Conclusion

The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.

Health Inequalities amongst People of African Descent in the Americas, 2005-2017: A Systematic Review of the Literature

Ethnic inequalities are often associated with social determinants of health. This study seeks to identify the latest scientific evidence on inequalities in the health of people of African descent in the Americas. For this, a systematic review of the literature on health and people of African descent in the Americas was carried out in the LILACS, PubMed, MEDLINE, and IBECS databases. Institutional and academic repositories were also consulted. Evidence was obtained on the presence and persistence of health inequalities in the population of African descent in the Americas from the identification of five types of quantitative and qualitative evidence: (1) ethnic/racial concept and variables; (2) relations with other social determinants; (3) health risks; (4) barriers and inequalities in health services; and, (5) morbi-mortality from chronic diseases. Studies with qualitative methods revealed invisibility, stereotypes, and rejection or exclusion as main factors of inequality. This review evidenced the existence of health inequalities, its interconnection with other adverse social determinants and risk factors, and its generation and perpetuation by discrimination, marginalization, and social disadvantage. These conditions make people of African descent a priority population group for action on equity, as demanded by the 2030 Agenda for Sustainable Development.

Genotype, resilience and function and physical activity post hip fracture

BACKGROUND

Individuals who are resilient are more likely to engage in functional tasks and exercise post hip fracture. There may be a genetic predisposition to being resilient.

OBJECTIVES

This study tested the direct and indirect association of 10 candidate genes, age, cognition, gender, comorbidities, pain and social activity on resilience, function and exercise post hip fracture.

METHOD

This was a descriptive study including 172 community dwelling older adults. Measures included: age, gender, cognition (Modified Mini Mental Status Exam), comorbidities, social activities (self-report), DNA (GRM1, NTRK1, NTRK2, GNB3, NPY, SLC6A15. SLC6A4, BDNF, CR1TR1, FKBP5), pain (areas of pain and Numeric Rating Scale), function (Physical and Instrumental Activities of Daily Living; Lower Extremity Gains Score; Short Physical Performance Battery; Grip Strength) and exercise (Yale Physical Activity Scale).

RESULTS

The majority of participants were Caucasian (93%), 50% were women and the average age was 81.09 (SD = 7.42). There were significant associations between resilience and single nucleotide polymorphisms from GRM1, NTRK1, NTRK2, GNB3, NPY and SLC6A15. Resilience, age, cognition, social activity, pain and genetic variability were directly and/or indirectly associated with exercise and/or function.

DISCUSSION

This study highlights the importance of resilience for engagement in exercise and function after hip fracture and provides preliminary evidence for a genetic role for resilience.

Protective psychosocial factors and dental caries in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Psychosocial protective factors include dispositional and family attributes that may reduce the occurrence of dental caries.

AIM

This review analysed the evidence on the relationship between protective psychosocial factors and dental caries in children and adolescents.

DESIGN

Primary studies involving children and adolescents were searched in the following electronic databases: Medline, SCOPUS, LILACS, SciELO, and Web of Science. The reference lists were also screened. Protective psychosocial factor descriptors were in accordance with the salutogenic theory. The outcome was clinical measure of dental caries. Quality assessments were performed using the Newcastle-Ottawa scale.

RESULTS

The final search resulted in 35 studies, including 7 cohort, one case-control, and 27 cross-sectional studies. Most studies were of moderate quality. Meta-analyses revealed that low parental internal locus of control (cohort studies: OR = 1.42, 95% CI: 1.20-1.64; cross-sectional studies: OR = 1.30, 95% CI: 1.19-1.41), high parental external chance (OR = 1.20, 95% CI: 1.10-1.29), and high maternal sense of coherence (OR = 0.77, 95% CI: 0.62-0.93) were associated with dental caries in children. High social support (OR = 0.81, 95% CI: 0.68-0.93) and greater self-efficacy (OR = 1.50, 95% CI: 1.12-1.22) were also associated with dental caries in adolescents.

CONCLUSIONS

The current evidence suggests that some salutogenic factors are important protective factors of dental caries during childhood and adolescence.

Premature mortality resilience and wellbeing within urban Māori communities

Māori (the indigenous peoples of Aotearoa New Zealand) experience of colonisation has negatively affected access to many of the resources (e.g. income, adequate housing) that enable health and well-being. However Māori have actively responded to the challenges they have faced. With the majority of the Māori population now living in urban settings this exploratory study aimed to understand factors contributing to mortality resilience despite exposure to socio-economic adversity with reference to Māori well-being. Resilient urban neighborhoods were defined as those that had lower than expected premature mortality among Māori residents despite high levels of socio-economic adversity. Selected resilience indicators theoretically linked to a Māori well-being framework were correlated with the novel Māori_RINZ resilience index. Of the selected indicators, only exposure to crime showed a clear gradient across the resilience index as predicted by the Māori well-being framework. Future research is needed as unclear trends for other indicators may reflect limitations in the indicators used or the need to develop a more comprehensive measure of well-being.

Contextual socioeconomic determinants of tooth loss in adults and elderly: a systematic review

OBJECTIVE

To perform a systematic review regarding studies that investigated the association between contextual socioeconomic factors and tooth loss.

METHODS

MEDLINE, Embase, and LILACS databases were searched and no language or date restrictions were applied for this research. The search was also carried out at the Brazilian Library of Theses and Dissertations (BDTD), with the objective of seeking unpublished studies. We evaluated the bibliographical and methodological characteristics of the studies, as well as the findings.

RESULTS

We found 348 articles, out of which only 6 were included in this study after revision by 2 independent researchers. We also identified an unpublished thesis. In general, these results show that the socioeconomic context interferes in tooth loss. We found an association between the highest number of missing teeth with less favorable contextual variables, despite the weak evidence, due to the fact that all selected studies had a cross-sectional design.

CONCLUSION

We suggest the standardization of outcome formats and exposures in order to favor the comparison between studies and their quantitative analysis.

Contextual and individual indicators associated with the presence of teeth in adults

OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present. METHODS This cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract's mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested. RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time. CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.

The Impact of Genetics on Physical Resilience and Successful Aging

Objective: To better understand the impact of genetics on resilience and successful aging, we tested a model of successful aging. Method: This was a descriptive study with a single interview and blood draw done with residents in a continuing care retirement community. Five genes associated with resilience were included in the model. The hypothesis was tested using structural equation modeling. Results: A total of 116 participants completed the survey. Two SNPs from SLC6A4 (rs25533 and rs1042173) and age were the only variables associated with physical resilience and explained 9% of the variance. Cognitive status, age, and depression were directly associated with successful aging; variance in rs25532 or rs1042173, resilience, and pain were indirectly associated with successful aging through depression. Discussion: Continued research to replicate these findings is needed so as to be able to recognize older adults at risk of low physical resilience and implement appropriate interventions.

Dental caries development among African American children: results from a 4-year longitudinal study

OBJECTIVE

To examine dental caries development and caries risk factors among preschool African American children from low-income families in Detroit, Michigan, over a 4-year window.

METHODS

Data came from a representative sample of 1021 children (0-5 years) and their caregivers in Detroit. The baseline participants in 2002-2003 (W1) were re-examined in 2004-2005 (W2) and 2007 (W3). Caries was measured using the International Caries Detection and Assessment System. Bivariate and multivariate analyses for repeated data were conducted to explore associations between caries increment outcomes and demographics, access to dental care, oral health-related behaviours, and social and physical environments.

RESULTS

The mean number of new noncavitated caries lesions (NCCL) was 2.8 between W1 and W2 and 2.6 between W2 and W3, while the mean number of new cavitated caries lesions (CCL) was 2.0 and 2.0, respectively, during the same time periods. In younger children (<3 years old in W1), higher number of new NCCL than new CCL was observed in both W1-W2 and W2-W3. The risk of new NCCL was associated with child's soda intake and caregiver's age. For the risk of new CCL, significant risk factors included baseline NCCL, baseline CCL, as well as child's age. Baseline caries and child's soda intake were also associated with the risk of developing new decayed, missing and filled tooth surfaces.

CONCLUSIONS

Higher number of new NCCL relative to CCL was developed among low-income African American children during early childhood. New caries development was associated with baseline caries and child's soda intake.

Are resilience and maternal sense of coherence associated with gingival status in adolescents from low-income families?

BACKGROUND

The capacity to overcome social disadvantages and maintain oral health through psychosocial processes remains poorly understood in children.

AIM

This study assessed the relationship of children's resilience and maternal sense of coherence (SOC) with gingival status in children from low-income families.

METHODS

A cross-sectional study was conducted on 190 schoolchildren aged 11-12 years and their mothers. Family socioeconomic characteristics and housing conditions, maternal and children's oral cleanliness behaviours (tooth brushing and dental floss use), maternal SOC, children's resilience, and demographic data were collected through interviews with children and their mothers. Validated versions of Antonovsky's scale and the resilience scale were used to assess mother's SOC and children's resilience. Gingival status and dental plaque of children were evaluated through clinical examinations using bleeding on probing index and plaque index. Statistical analysis included Pearson's correlation and hierarchical multinomial ordinal logistic regression analyses.

RESULTS

The mean frequency of gingival bleeding in the sample was 8.4% (SD: 8.5). Children with higher levels of resilience showed 31% lower odds of gingival bleeding (OR: 0.7; 95% CI: 0.4-0.9) after adjustment for socioeconomic characteristics, children's and mothers' use of dental floss.

CONCLUSIONS

Children's resilience was a psychosocial factor associated with gingival conditions.

Review and recommendations for zero-inflated count regression modeling of dental caries indices in epidemiological studies

Over the past 5-10 years, zero-inflated (ZI) count regression models have been increasingly applied to the analysis of dental caries indices (e.g. DMFT, dfms). The main reason for that is linked to the broad decline in children's caries experience, such that dmf and DMF indices more frequently generate low or even zero counts. This article specifically reviews the application of ZI Poisson and ZI negative binomial regression models to dental caries, with emphasis on the description of the models and the interpretation of fitted model results given the study goals. The review finds that interpretations provided in the published caries research are often imprecise or inadvertently misleading, particularly with respect to failing to discriminate between inference for the class of susceptible persons defined by such models and inference for the sampled population in terms of overall exposure effects. Recommendations are provided to enhance the use as well as the interpretation and reporting of results of count regression models when applied to epidemiological studies of dental caries.

Resilience: thoughts on the value of the concept for critical gerontology

This article examines the utility of the concept of resilience to the field of critical gerontology. Resilience is an increasingly popular concept within the social sciences. We explore some key ideas about individual and social resilience from varied fields, and propose new ways to conceptualise these in relation to resilience in later life. This article examines the history of the concept of resilience; explores some of the diverse ways that gerontologists are attempting to apply it to later life; and discusses the strengths and weaknesses of using resilience as a conceptual framework within critical ageing research. We also suggest ways of conceptualising resilience and ageing, highlighting the different scales of resilience that impact on the ability of older people to negotiate adversity, and some key areas of resilience relevant to later life. The example of mobility resilience is used to illustrate how different scales of resilience operate within an area of resilience central to the ageing experience. Finally, some key principles for the use of resilience within critical gerontology are outlined, providing guidance on how to maximise the potential of the concept whilst avoiding some of the limitations associated with its historical usage.

Overweight in childhood: the role of resilient parenting in African-American households

BACKGROUND

Some low-income minority children in the U.S. remain at normal weight throughout their childhood despite high risk of obesity.

PURPOSE

This study examined whether resilient caregiving accounted for children's healthy weight maintenance and dietary compliance over a 4-year period among poverty-stricken African-American families.

METHODS

A representative sample of 317 African-American caregiver-children (aged 3-5 years) pairs from low-income areas of Detroit MI was examined in 2002-2003 with a follow-up assessment in 2007. Capacity for resilience among caregivers was defined using five individual and environmental protective factors. A BMI score for the children was computed from recorded height and weight, and converted into one of three categories (normal weight, overweight, obese) using age- and gender-specific national references. Dietary information was collected using the Block Food Frequency Questionnaire (FFQ) and Block Kids FFQ. Data were analyzed in 2010 to test whether children's weight transition and dietary compliance varied according to their caregivers' capacity for resilience.

RESULTS

In all, 95 caregivers (29%) were identified as having capacity for resilience. They were younger, had higher levels of educational attainment, and had lower levels of daily soda consumption. The children of these caregivers had a lower likelihood of remaining overweight or obese than being of normal weight (relative risk ratio=0.5, 95% CI=0.2, 0.9) and had persistently lower soda consumption over 4 years compared with other children.

CONCLUSIONS

This finding demonstrates that some caregivers positively influence children's health weight management and dietary compliance despite material deprivation. Interventions to initiate and promote resilient caregiving could benefit the health and health-related behaviors of low-income African-American children.

The Resilience Scale: psychometric properties and clinical applicability in older adults

Resilience is described as the ability to achieve, retain, or regain a level of physical or emotional health after illness or loss. The Resilience Scale was specifically developed to measure personality characteristics of resilience in older adults. The purposes of this article are to provide additional support for the psychometric properties of the Resilience Scale and to consider the clinical applicability of this tool. Data from two independent samples of older adults were used. Most of the participants were Caucasian women, between 80 and 90 years of age, widowed, single, or divorced, and they had on average approximately three comorbid medical problems. Psychometric testing included confirmatory factor analysis, Rasch analysis, and test criterion relationships for validity testing, and internal consistency and estimates of R(2) for reliability testing. Although there was some support for the reliability and validity of the 25-item Resilience Scale, there was a poor fit of Items 3-6, 9, 11, 20, and 22 in the 25-item measure. Overall, participants in both samples scored high in resilience, and item mapping indicated that additional items are needed on the measure to differentiate those who are particularly resilient. Although revisions are recommended, use of the Resilience Scale can help identify older adults low in resilience and expose these individuals to interventions to improve resilience and facilitate successful aging.