Relationship between Cerebral Microinfarcts and Dementia by Sex: Findings from a community-based Autopsy Study

Cerebral microinfarcts are common in older adults and are associated with cognitive impairment. Less is known about sex-related variation in the relationship between cerebral microinfarcts and dementia in older adults, the examination of which was the objective of this study. This case-control study was based on the 727 participants (419 women) in the Adult Changes in Thought (ACT) autopsy data. Microinfarcts were ascertained by blinded board-certified neuropathologists, and dementia diagnoses were made by the ACT Consensus Diagnosis Conference per DSM-IV. Multivariable logistic regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). Microinfarcts were present in 49% (356/727) of the participants, which was numerically higher in women: 51% (213/419) vs 46% (143/308). aOR (95% CI) for dementia associated with any microinfarct for female and male participants were 1.45 (0.91-2.30) and 1.24 (0.75-2.06), respectively (p for interaction, 0.34). Respective aORs (95%CIs) associated with ≥2 microinfarcts were 1.37 (0.79-2.36) and 1.53 (0.84-2.78), with interaction p, 0.84. Subcortical microinfarcts were present in 36% (138/381) and 23% (78/346) of patients with and without dementia (aOR, 1.65; 95% CI, 1.14-2.38). Respective aOR (95% CI) in female and male participants were 1.70 (1.03-2.82) and 1.59 (0.90-2.80), (p for interaction, 0.55). There was no association with cortical microinfarcts (aOR, 1.19; 95% CI, 0.83-1.69). These findings suggest that association between microinfarcts and dementia is primarily mediated by subcortical microinfarcts, but we found no evidence of sex-related variation. Future studies with greater power are needed to determine if the associations we found are replicable.

Anti-Amyloid Therapy, AD, and ARIA: Untangling the Role of CAA

Anti-amyloid therapies (AATs), such as anti-amyloid monoclonal antibodies, are emerging treatments for people with early Alzheimer's disease (AD). AATs target amyloid β plaques in the brain. Amyloid-related imaging abnormalities (ARIA), abnormal signals seen on magnetic resonance imaging (MRI) of the brain in patients with AD, may occur spontaneously but occur more frequently as side effects of AATs. Cerebral amyloid angiopathy (CAA) is a major risk factor for ARIA. Amyloid β plays a key role in the pathogenesis of AD and of CAA. Amyloid β accumulation in the brain parenchyma as plaques is a pathological hallmark of AD, whereas amyloid β accumulation in cerebral vessels leads to CAA. A better understanding of the pathophysiology of ARIA is necessary for early detection of those at highest risk. This could lead to improved risk stratification and the ultimate reduction of symptomatic ARIA. Histopathological confirmation of CAA by brain biopsy or autopsy is the gold standard but is not clinically feasible. MRI is an available in vivo tool for detecting CAA. Cerebrospinal fluid amyloid β level testing and amyloid PET imaging are available but do not offer specificity for CAA vs amyloid plaques in AD. Thus, developing and testing biomarkers as reliable and sensitive screening tools for the presence and severity of CAA is a priority to minimize ARIA complications.

Relationships between Late-Life Blood Pressure and Cerebral Microinfarcts in Octogenarians: An Observational Autopsy Study

Mid-life high blood pressure (BP) is a risk factor for cerebral microinfarcts. Less is known about the relationship between late-life BP and cerebral microinfarcts, the examination of which is the objective of the current study. This case-control study analyzed data from 551 participants (94.6% aged ≥80 years; 58.6% women) in the Adult Changes in Thought (ACT) study who had autopsy data on microinfarcts and four values of systolic and diastolic blood pressure (SBP and DBP) before death. Using the average of four values, SBP was categorized using 10 mmHg intervals; a trend was defined as a ≥10 mmHg rise or fall from the first to fourth values (average gap of 6.5 years). Multivariable-adjusted regression models were used to examine the associations of BP and microinfarcts, adjusting for age, sex, last BP-to-death time, APOE genotype, and antihypertensive medication use. Microinfarcts were present in 274 (49.7%) participants; there were multiple in 51.8% of the participants, and they were located in cortical areas in 40.5%, subcortical areas in 29.6%, and both areas in 29.9% of the participants. All SBP categories (reference of 100-119 mmHg) and both SBP trends were associated with higher odds of both the presence and number of microinfarcts. The magnitude of these associations was numerically greater for subcortical than cortical microinfarcts. Similar associations were observed with DBP. These hypothesis-generating findings provide new information about the overall relationship between BP and cerebral microinfarcts in octogenarians.

Upper extremity weakness: A novel risk factor for non-cardiovascular mortality among community-dwelling older adults

BACKGROUND

Aging-associated upper extremity weakness has been shown to be associated with adverse health outcomes in older adults, but less is known about the association between impaired upper extremity function and cause-specific mortalities.

METHODS

Among the 5512 prospective community-based longitudinal Cardiovascular Health Study participants, 1438 had difficulty with one of the three upper extremity functions of lifting, reaching, or gripping. We assembled a propensity score-matched cohort in which 1126 pairs of participants with and without difficulty with upper extremity function, balanced on 62 baseline characteristics including geriatric and functional variables such as physical and cognitive function. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortalities associated with upper extremity weakness were estimated in the matched cohort.

RESULTS

Matched participants had a mean age of 73.1 years, 72.5% were women, and 17.0% African American. During 23 years of follow-up, all-cause mortality occurred in 83.7% (942/1126) and 81.2% (914/1126) of participants with and without upper extremity weakness, respectively (HR, 1.11; 95% CI, 1.01-1.22; p = 0.023). Upper extremity weakness was associated with a higher risk of non-cardiovascular mortality, occurring in 595 (52.8%) and 553 (49.1%) of participants, respectively (HR, 1.17; 95% CI, 1.04-1.31; p = 0.010), but had no association with cardiovascular mortality (30.8% vs 32.1% in those with and without upper extremity weakness, respectively; HR, 1.03; 95% CI, 0.89-1.19; p = 0.70).

CONCLUSION

Among community-dwelling older adults, upper extremity weakness had a weak, albeit independent, significant association with all-cause mortality, which was primarily driven by a higher risk of non-cardiovascular mortality. Future studies need to replicate these findings and understand the underlying reasons for the observed associations.

Relationships between Cerebral Vasculopathies and Microinfarcts in a Community-Based Cohort of Older Adults

Cerebral microinfarcts are associated with cognitive impairment and dementia. Small vessel diseases such as cerebral arteriolosclerosis and cerebral amyloid angiography (CAA) have been found to be associated with microinfarcts. Less is known about the associations of these vasculopathies with the presence, numbers, and location of microinfarcts. These associations were examined in the clinical and autopsy data of 842 participants in the Adult Changes in Thought (ACT) study. Both vasculopathies were categorized by severity (none, mild, moderate, and severe) and region (cortical and subcortical). Odds ratios (OR) and 95% CIs for microinfarcts associated with arteriolosclerosis and CAA adjusted for possible modifying covariates such as age at death, sex, blood pressure, APOE genotype, Braak, and CERAD were estimated. 417 (49.5%) had microinfarcts (cortical, 301; subcortical, 249), 708 (84.1%) had cerebral arteriolosclerosis, 320 (38%) had CAA, and 284 (34%) had both. Ors (95% CI) for any microinfarct were 2.16 (1.46-3.18) and 4.63 (2.90-7.40) for those with moderate (n = 183) and severe (n = 124) arteriolosclerosis, respectively. Respective Ors (95% CI) for the number of microinfarcts were 2.25 (1.54-3.30) and 4.91 (3.18-7.60). Similar associations were observed for cortical and subcortical microinfarcts. Ors (95% Cis) for the number of microinfarcts associated with mild (n = 75), moderate (n = 73), and severe (n = 15) amyloid angiopathy were 0.95 (0.66-1.35), 1.04 (0.71-1.52), and 2.05 (0.94-4.45), respectively. Respective Ors (95% Cis) for cortical microinfarcts were 1.05 (0.71-1.56), 1.50 (0.99-2.27), and 1.69 (0.73-3.91). Respective Ors (95% Cis) for subcortical microinfarcts were 0.84 (0.55-1.28), 0.72 (0.46-1.14), and 0.92 (0.37-2.28). These findings suggest a significant association of cerebral arteriolosclerosis with the presence, number, and location (cortical and subcortical) of microinfarcts, and a weak and non-significant association of CAA with each microinfarct, highlighting the need for future research to better understand the role of small vessel diseases in the pathogenesis of cerebral microinfarcts.

Characteristics and Predictors of Alzheimer's Disease Resilience Phenotype

Alzheimer's disease (AD) is characterized by cognitive impairment in the presence of cerebral amyloid plaques and neurofibrillary tangles. Less is known about the characteristics and predictors of resilience to cognitive impairment in the presence of neuropathological evidence of AD, the focus of this study. Of 3170 adults age ≥65 years in the National Alzheimer's Coordinating Center (NACC) brain autopsy cohort, 1373 had evidence of CERAD level moderate to frequent neuritic plaque density and Braak stage V-VI neurofibrillary tangles. Resilience was defined by CDR-SOB and CDR-Global scores of 0-2.5 and 0-0.5, respectively, and non-resilience, CDR-SOB and CDR-Global scores >2.5 and >0.5, respectively. Multivariable logistic regression models were used to examine the independent associations of patient characteristics with resilience. There were 62 participants (4.8%) with resilience. Those with resilience were older (mean age, 88.3 vs. 82.4 years), more likely to be women (61.3% vs. 47.3%) and had a lower prevalence of the APOE-e4 carrier (41.9% vs. 56.2%). They also had a higher prevalence of hypertension, heart failure, atrial fibrillation, diuretic use, beta-blocker use, and APOE-e2 carrier status. Greater age at death, diuretic use, and APOE-e2 were the only characteristics independently associated with higher odds of the AD resilience phenotype (adjusted OR, 1.09; 95% CI, 1.05-1.13; p < 0.01; 2.00 (1.04-3.87), p = 0.04, 2.71 (1.31-5.64), p < 0.01, respectively). The phenotype of resilience to cognitive impairment is uncommon in older adults who have neuropathological evidence of AD.

PREVALENCE, BURDEN, AND LOCATION OF CEREBRAL MICROINFARCTS AND THEIR ASSOCIATION WITH LATE-LIFE BLOOD PRESSURE

Little is known about the relationship of late-life blood pressure (BP) profiles (level, trend and variability) with the presence, number and regional distribution (cortical vs subcortical) of cerebral microinfarcts. We examined these associations in older adults (age ≥65) using the Adult Changes in Thought (ACT) data. 551 participants (94.6% ≥80 years, 58.6% women, 94.2% white) had complete data on microinfarcts and 4 BP measures. Late-life BP, defined by the four BP values before death (2 year-time gap between measures), was treated using 3 different approaches: (1) categories (based on mean of 4 values); (2) trend (based on the difference between values 1 and 4); and (3) variability (based on standard deviation of the mean of the changes in 4 BP values from 1 to 4). Multivariable-adjusted logistic regression models were used to examine the associations of the late-life BP with microinfarcts, adjusting for relevant covariates. Each of the 5 systolic BP categories between 120 and 169 mmHg (reference: 110–119 mmHg) had significant twice higher odds (4 times for SBP ≥170) of presence and number of microinfarcts, which was only significant for subcortical region. Similar higher odds were observed for systolic BP trend (increase/decrease/no change), which was significant for both cortical and subcortical microinfarcts. Systolic BP variability had no significant association with microinfarcts. Similar associations were observed with diastolic BP. In conclusion, the presence (especially for subcortical regions) and number of microinfarcts were more likely to be in those with higher mean BP and those whose BP changed over the study.

Constipation Management in Parkinson Disease

ABSTRACT

BACKGROUND: Constipation is the most frequently reported nonmotor gastrointestinal symptom of Parkinson disease and can precede motor symptoms by up to 20 years. The causes of constipation can be multifactorial, but the implications can lead to life-threatening complications. Early recognition of constipation can lead to better health outcomes and quality of life. MANAGEMENT CONSIDERATIONS: The combination of nonpharmacological management through screening tools, nursing assessment, and patient education as well as pharmacological management is considered best practice. IMPLICATIONS FOR PRACTICE: Nurses who are knowledgeable on the current treatment options for constipation in Parkinson disease will be better equipped as active multidisciplinary team players to provide optimal care to their patients and achieve the best health outcomes.

Use of Electronic Health Records at Federally Qualified Health Centers: a Potent Tool to Increase Viral Hepatitis Screening and Address the Climbing Incidence of Liver Cancer

Viral hepatitis B and C are among the leading causes of acute and chronic liver disease in the USA. The nature of chronic liver disease is often asymptomatic. This is problematic because the majority of individuals living with chronic hepatitis B and chronic hepatitis C do not know that they are infected and can communicate the disease to others. Furthermore, early disease recognition and treatment have been shown to improve long-term outcomes and decrease healthcare cost. These diseases affect vulnerable populations disproportionately. Asian Americans and Pacific Islanders are more likely than the general US population to have CHB, and the baby boomer generation is more likely than any other age group to have CHC. Federally Qualified Health Centers play a vital role in providing comprehensive primary care to medically underserved populations. Utilization of electronic health records reminders in Federally Qualified Health Centers results in increased screening, reduced provider screening bias and improved opportunity for management of patients living with chronic viral hepatitis. Electronic health records technology is a potent tool kit to aggressively screen, treat, and prevent viral hepatitis, ultimately, leading to decreased incidence of liver cancer.

Depression and Anxiety Management in Parkinson Disease

ABSTRACT

BACKGROUND: Depression and anxiety are common but underrecognized and undertreated nonmotor symptoms of Parkinson disease (PD) due to their diagnostic criteria overlapping with other PD symptoms, limited randomized controlled studies in this specific population, and the need for multidisciplinary expertise. The purpose of this article is to offer evidence-based solutions for managing comorbid depression and anxiety in patients with PD through a case study analysis. CASE STUDY: A case study is used to illustrate the somatic manifestations of anxiety in PD that leads to diagnostic challenge and multidisciplinary management. MANAGEMENT CONSIDERATIONS: The appropriate use of screening tools, pharmacological and nonpharmacological management, and education are important interventions to consider when treating depression and anxiety in PD. CONCLUSION: Effective management requires accurate assessments, individualized treatment modalities, and patient education. Nurses who are knowledgeable about the effects and management of mood disorders in PD can play an integral role in the multidisciplinary team approach for assessment, patient and caregiver education, and treatment plan implementation.

Perceptions of support by nursing faculty of color

BACKGROUND

Racial and ethnic minority faculty members within nursing academia are critical to the recruitment and training of a diverse health care workforce. Effective strategies and opportunities for the success of minorities within nursing faculty must be identified and explored.

PURPOSE

The purpose of this paper is to identify strategies for support being utilized by nursing faculty of color, and support systems that practicing faculty of color believe would aid their success in academia.

METHOD

This descriptive survey used an 18-item online survey distributed to faculty of color in nursing academic institutions throughout the United States. Of the completed surveys, 116 responses met inclusion criteria.

RESULTS

Common themes from faculty of color emerged regarding the importance of mentorship, faculty development, networking and acknowledgement.

CONCLUSION

Respondents noted their experience with successful support systems and strategies and support systems they found to be lacking. Strategies were recommended for promoting faculty of color in schools and colleges of nursing.

Serum Cholesterol and Incident Alzheimer's Disease: Findings from the Adult Changes in Thought Study

OBJECTIVES

To evaluate associations between high-density lipoprotein cholesterol (HDL) and non-HDL-C levels at specific ages and subsequent Alzheimer's disease (AD) risk.

DESIGN

Prospective population-based cohort study.

SETTING

Adult Changes in Thought (ACT) Study.

PARTICIPANTS

Individuals aged 65 and older with no dementia at ACT Study entry. We identified separate, partially overlapping subcohorts of ACT participants who were eligible for each age band-specific analysis (50-59, n = 1,088; 60-69, n = 2,852; 70-79, n = 2,344; 80-89, n = 537).

MEASUREMENTS

Exposure consisted of clinical measures of total cholesterol (TC) and HDL-C from laboratory data during a given age band. Outcomes of incident AD were assessed post-age band using standard research diagnostic criteria. Statistical analyses used adjusted Cox proportional hazards regression models for each exposure and outcome pair within an age band. Cholesterol exposures were modeled using cubic splines.

RESULTS

For non-HDL-C, we found a statistically significant association with AD risk in the 60 to 69 (omnibus p = .005) and 70 to 79 (omnibus p = .04) age bands, suggesting a potential U-shaped relationship (greater risk at low and high levels). For example, in people aged 60 to 69, those with an average non-HDL-C level of 120 mg/DL had a 29% greater AD hazard (hazard ratio (HR)=1.29, 95% confidence interval (CI)=1.04-1.61) than those with an average non-HDL-C level of 160 mg/dL, whereas those with an average non-HDL-C level of 210 mg/dL had a 16% greater hazard (HR=1.16, 95% CI=1.01-1.33). We did not find a statistically significant association between HDL-C and AD risk.

CONCLUSION

People with low (120 mg/dL) and high (210 mg/dL) non-HDL-C levels during their 60s and 70s had modestly higher risk of AD than those with intermediate (160 mg/dL) levels. The extreme age bands (50s and 80s) had small sample sizes. J Am Geriatr Soc 66:2344-2352, 2018.

Sociocultural Barriers to Lung Cancer Screening Among Korean Immigrant Men

Lung cancer is a commonly occurring cancer among Korean American men. Korean Americans have lower rates of cancer screening participation than other Asian American sub-groups. However, little is known about factors that influence the cancer screening behavior of Korean immigrants. The purpose of this study was to explore facilitators of and barriers to lung cancer screening (i.e., low dose CT of the chest) among Korean immigrant men, using qualitative individual interviews and focus groups. A convenience sample of 24 Korean men who were immigrants, Washington State residents, able to speak Korean, aged 55-79, and eligible for lung cancer screening (based on current guidelines) were recruited from Korean churches and senior centers. Five focus groups (that included between two and five men) and nine individual interviews were conducted. Content analysis was used to analyze the qualitative data. Facilitators of lung cancer screening included perceptions about positive aspects of the health care system in South Korea, recommendations from others (physicians, family members, and community organizations), existing health problems and respiratory symptoms, interest in health, and the health consequences of aging. Barriers included costs of health care in the US, lack of time, lack of knowledge (about lung cancer and screening), attitudes about prevention, and lack of physician recommendation. This study adds new knowledge to a field where little information is available. It also lays the groundwork for developing culturally relevant lung cancer screening interventions for Korean Americans and the health care providers who serve them.

Lung cancer disparities and African-Americans

African-Americans, as historically disadvantaged minorities, have more advanced stages of cancer when diagnosed, lower survival rates, and lower rates of accessing timely care than do Caucasians. Lung cancer incidence and mortality, in particular, are high among African-Americans. The U.S. Preventive Services Task Force recently released an evidence-based lung cancer screening technology called low-dose computerized tomography. High-risk African-Americans might benefit greatly from such screening but not many are aware of this technology. Public health nurses can play a key role in increasing awareness of the technology among African-American communities and encouraging qualified African-Americans to obtain screening. This study discusses issues with lung cancer and smoking among African-Americans, a recently released evidence-based lung cancer screening technology, and implications for public health nurses to enhance uptake of the new screening technology among high-risk African-Americans.

A qualitative analysis of stress and coping in Korean immigrant women in middle-age and older-adulthood

This qualitative grounded theory study explored stress-coping mechanisms in 14 Korean immigrant women (age ≥40) in the USA, by analyzing existing focus group data about relevant concepts that had been collected in a parent study. Using content analysis, stressors related primarily to socioenvironmental changes following immigration: language barriers, lack of trusting human relationships, and role changes were identified. Both healthy (activities, church, staying busy) and unhealthy (being alone and keeping negative feelings inside) coping strategies were reported by participants. The findings reveal unique aspects of stress-coping among Korean women who had immigrated after being culturally engrained with Confucian influences.

Characteristics and outcomes of patients with advanced chronic systolic heart failure receiving care at the Veterans Affairs versus other hospitals: insights from the Beta-blocker Evaluation of Survival Trial (BEST)

BACKGROUND

Characteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported.

METHODS AND RESULTS

In the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ≤35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94-1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86-1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80-1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction <20%, and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation, and right ventricular ejection fraction <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant.

CONCLUSIONS

Patients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals.

CLINICAL TRIAL REGISTRATION URL

http://www.clinicaltrials.gov. Unique identifier: NCT00000560.

Barriers and facilitators to colorectal cancer screening in Vietnamese Americans: a qualitative analysis

Vietnamese Americans are the fourth largest Asian ethnic group in the USA. Colorectal cancer (CRC) ranks as one of the most common cancers in Vietnamese Americans. However, CRC screening rates remain low among Vietnamese Americans, with 40 % of women and 60 % of men reporting never having a sigmoidoscopy, colonoscopy, or fecal occult blood test (FOBT). We partnered with a Federally Qualified Health Center (FQHC) in Seattle, WA, to conduct focus groups as part of a process evaluation. Using interpreters, we recruited and conducted three focus groups comprised of six women screened for CRC, six women not screened for CRC, and seven men screened for CRC, which made up a total of 19 FQHC patients of Vietnamese descent between 50 and 79 years old. Three team members analyzed transcripts using open coding and axial coding. Major themes were categorized into barriers and facilitators to CRC screening. Barriers include lack of health problems, having comorbidities, challenges with medical terminology, and concerns with the colonoscopy. Participants singled out the risk of perforation as a fear they have toward colonoscopy procedures. Facilitators include knowledge about CRC and CRC screening, access to sources of information and social networks, and physician recommendation. Our focus groups elicited information that adds to the literature and has not been previously captured through published surveys. Findings from this study can be used to develop more culturally appropriate CRC screening interventions and improve upon existing CRC screening programs for the Vietnamese American population.

Medication use in community-residing older adults in Taiwan: a comparison between conventional and complementary and alternative medications

Older adults are at risk of problems of medication use including underuse, overuse, and misuse. The purposes of this study were to investigate the prevalence of the use of conventional and complementary and alternative medications (CAM) in older adults and to explore which factors related to their medication use. For this descriptive correlational study, 1,427 citizens who were 65 years old or older from two towns in Yilan County, Taiwan were interviewed by ten trained public health nurses between June and September, 2013. Instruments in this study were physical functional capacity, depressive symptoms, and medication use. Pearson product-moment correlation analysis and the Chi-square test were used to detect relationships among research variables. Of the 1,427 participants, 75.4 % used at least one type of conventional medication, and the average number of medications used was 2.9 (SD = 2.1). Polypharmacy (the use of five or more medications) was identified in 20.1 % of participants. Significant factors related to conventional medications use were older age (χ(2) = 41.7***), female (χ(2) = 7.6**), bad memory (χ(2) = 11.2**), defect cognition status (χ(2) = 7.8**), lost the interest to do anything depressive symptoms (χ(2) = 7.2**), and independent in their daily activities (χ(2) = 41.3***). We found that sociodemographic characteristics and factors pertaining to health status determine the difference between the use of conventional medications and CAM by rural older adults. Our study results suggested that health professionals in Taiwan must be educated and trained in how to integrate CAM into current conventional treatment.

Personal characteristics predictive of depressive symptoms in Hispanics with heart failure

Depression is a significant problem in heart failure (HF). The purposes of this study were to assess the prevalence of depressive symptoms in Hispanics with HF and to examine the personal characteristics predicting depressive symptoms at baseline and at 6-months follow-up in a telephone case management intervention. In this secondary data analysis based on 87 subjects, patient characteristics hypothesized to influence depressive symptoms included age, gender, education, living situation, co-morbidity, social support, New York Heart Association (NYHA) class, and acculturation. DSM-IV major depression was present in 39.1% (n = 35) of the participants at baseline and 1.1% (n = 1) at the 6-month follow-up. In regression analysis, factors associated with depressive symptoms at baseline were gender and NYHA class. At 6-month follow-up, acculturation, co-morbidity, and NYHA were significantly related to the presence of depressive symptoms. Depressive symptoms were highly prevalent in Hispanics with HF. Easily identifiable personal characteristics can be useful in designing interventions to reduce depression associated with HF.

Perceptions of depression in korean american immigrants

Despite its high prevalence, depression is often unrecognized and untreated in minority immigrants. Culture and environment influence perceptions of depression. The purpose of this study was to understand perceptions of depression (knowledge and coping mechanisms) in Korean American immigrants using focus group discussions. A convenience sample (n = 28) was recruited from Korean communities in the Puget Sound region of Washington State. Participants lacked an understanding of depression. Difficulties from immigration-related environmental changes were the main sources of stress. Immigration-related environmental changes resulted in changes in coping resources. Culture-friendly education and coping resources might benefit this minority group.

Using photovoice to understand cardiovascular health awareness in Asian elders

Photovoice, a qualitative methodology using photography by study participants, is an ideal tool for collecting information on awareness of cardiovascular health from the perspective of persons of different cultural backgrounds and English-speaking abilities who are often subject to health disparities. Participants of Chinese, Vietnamese, and Korean ethnicity were provided disposable cameras to photograph their perceptions of scenes promoting or acting as barriers to cardiovascular health. After the pictures were developed, they returned for a discussion in their native languages to contextualize the stories told in their photographs. Group facilitators spoke the respective native languages and transcribed sessions into English. Twenty-three adults participated (7 to 9 persons per ethnicity), ranging in age from 50 to 88 (mean 71.6) years; 48% were women. The photographs stimulated conversations of knowledge, beliefs, and concerns regarding heart disease and stroke. Issues surrounding food and exercise were most dominant across ethnic groups, focusing on fat and salt intake and the need to remain active. Cultural beliefs and issues of emotional health, including stress and loneliness related to living in a new country, were also depicted. Photovoice provided insight into perceptions of cardiovascular health that is vital for developing health promotion and education interventions in limited-English-speaking communities.

Cardiovascular health perceptions in multigenerational Korean immigrants

Cardiovascular disease is prevalent in the Korean immigrants. Success of any health interventions depends heavily on our understanding of how health issues are perceived by the recipients. This study describes cardiovascular health perceptions using Photovoice, a qualitative methodology utilizing photography to initiate discussion, in multigenerational Korean immigrants (older adults, teenagers, children). Twenty Korean Americans (7 adults aged >or=50 years, 6 teenagers aged 13 to 19 years, 7 children aged 9 to 12 years) were recruited from the Korean communities in Seattle, Washington. Each subject was given a camera and asked to take 24 pictures of objects, scenes, and environments that represented their perceptions of cardiovascular health and related risk factors. Subjects were asked to pick 2 photos and present their thoughts about them in a tape-recorded group meeting. Key concepts were identified from the discussions. Themes identified promoting cardiovascular health included good diet, exercise, a clean environment, and spirituality. The themes identified as the risk factors for cardiovascular diseases included bad diet, smoking, pollution, and stress. Expression of the risk factors differed by the age group. The shared cultural background also influenced the perception of the risk factors. These observations support the findings that the culture and age-specific interventions may augment intervention effectiveness.

Comparison of body composition, handgrip strength, functional capacity, and physical activity in elderly Koreans and Korean immigrants

Immigration to a foreign country has a significant impact on a person's health status and health management behavior. The purpose of this pilot study was to examine body composition (body mass index and muscle area of the mid-upper arm and mid-calf), handgrip strength, functional capacity, and physical activity in elderly Koreans and Korean immigrants. In this cross-sectional study, a convenience sample of 87 elderly Korean immigrants and 294 elderly Koreans were recruited from senior centers and senior apartments in the United States and Korea. Compared with elderly Koreans, elderly Korean immigrants had higher mid-calf muscle area (p = 0.06), handgrip strength (p = 0.01), and functional capacity (p = 0.01) and less physical activity (p < 0.01). Older men were more physically active and had more muscle areas, greater handgrip strength, and better functional capacity than older women, whereas older women had higher BMI scores than older men. This study provides motives for the development of health promotion intervention studies (e.g., culturally relevant exercise programs incorporating strength training). Future studies could identify culturally relevant strategies to promote physical activity in elderly Korean immigrants and especially elderly Korean women in both groups.

Evaluation of a community-based exercise program for elderly Korean immigrants

OBJECTIVE

To evaluate feasibility and effectiveness of a modified exercise program for elderly Korean immigrants (EKIs).

DESIGN AND SAMPLE

Intervention study with EKI residents of a senior house (n = 13, age range 67-86 years, mean age 77 years), recruited through posted fliers and with help from a Korean social worker.

INTERVENTION

A Korean-American instructor taught a modified version of an evidence-based exercise program 3 times weekly, 50 min per session, for 12 weeks. Program was evaluated with the Quality Health Outcomes Model. System and client characteristics were taken into consideration because elderly Koreans have their own values and beliefs, which influence their health management behaviors. Evaluation measures included exercise adherence, preintervention and postintervention health outcomes, and satisfaction with the exercise program. Group discussion was used to evaluate satisfaction with the exercise program.

RESULTS

Participants showed improved health outcomes on muscle strength, agility/balance, and blood pressure after the exercise program. All participants were satisfied with the exercise program, and participation rates were good (nine participants attended > or = 80% of classes).

CONCLUSIONS

The exercise program was feasible for this sample and should be evaluated in a larger population of EKIs and in populations of other ethnic minorities.

Relationships of asthma knowledge, self-management, and social support in African American adolescents with asthma

Despite nationwide efforts to manage asthma, the adverse outcomes of asthma continue to increase, especially in African American adolescents. The purpose of this study was to examine the relationships among asthma knowledge, self-management, and social support in African American adolescents with asthma. A correlational descriptive study was conducted using a convenience sample of 53 identified asthmatic adolescents from the Southern metropolitan school system in Alabama. Asthma knowledge was measured by the Parcel Knowledge about Asthma Questionnaire, social support by the Norbeck Social Support Questionnaire, and asthma self-management behaviors by the Asthma Behavioral Assessment Questionnaire. Both asthma knowledge and social support had significant positive relationships (r=0.31, r=0.30, respectively) with asthma self-management behaviors and accounted for 14% of self-management behaviors variability. Further studies are needed to understand how to better manage asthma in adolescents.

Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants

The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participant's adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.

Factors influencing exercise participation and quality of life among elderly Korean Americans

The purpose of this study was to identify factors influencing exercise participation and quality of life among elderly Korean Americans. This study used a focus group design. Elderly Korean Americans age 60 and older residing in Seattle, Washington were recruited from a senior house, which serves low-income elderly. Thirteen older adults participated in a focus group discussion. Data analysis used content analysis. Factors influencing exercise participation included health status, advancing age, cultural self-consciousness, and lack of transportation. Factors influencing quality of life included health status, socioeconomic isolation, and spirituality. This study provides useful knowledge for designing future health promotion programs for this cultural minority group.