"I Can Never Feel Safe": Latinx Youth Voices on Psychosocial Impacts of 287(g) in Georgia.

Increasingly, immigration policies are understood as structural determinants, rooted in racism, nativism, and ethnocentrism, which raise serious public health concerns for Latinx adolescents' mental health. Our objective was to examine how immigration policy enforcement affects mental health of Latinx youth raised in a county with an aggressive interior immigration enforcement program. From 2009 to 2021, Gwinnett County, GA, led the nation in deportations under the 287(g) program as a "universal enforcement model," where local law enforcement were deputized to detain undocumented immigrants, primarily through traffic violations. From June to July 2022, we followed a participatory action research approach with two groups of Latinx youth who grew up in Gwinnett County. In total, 10 youth took photos related to the research question, and engaged in facilitated dialogue using photovoice guide SHOWED/VENCER for four, 2-hour sessions that were audio-recorded and transcribed. Transcripts were analyzed following grounded theory principles to arrive at a conceptual model codeveloped and validated by youth. Youth described how 287(g) led to policing and deportation in their communities, fueling stereotypes, and discrimination that criminalized Latinx immigrants. Youth linked immigration enforcement policies like 287(g) to exclusionary systems that contributed to fear, marginalization, and loss in their communities, bringing experiences of sadness, grief, isolation, hopelessness, and low self-worth. From youth-driven research, we identified mental health implications of the 287(g) program among Latinx youth. The cascading harms of immigration enforcement policies highlight the need to address these policies and identify immediate strategies to promote Latinx youth mental health.

Parent and Well-Sibling Communication in Families With a Child Who Has a Life-Limiting Condition: Quantitative Survey Data.

OBJECTIVE: Living with a child with a life-limiting condition (LLC), for which there is no hope of cure and premature death is expected, places much stress on a family unit. Familial communication has the potential to serve as a buffer when children are faced with stressful situations. The overall aim of the study was to learn more about illness-related communication between parents and well-siblings, giving particular consideration to the amount of illness-related communication, and sibling satisfaction with familial communication. METHODS: Participants included 48 well-siblings (aged 6-21 years) of children with LLCs and their parents. Parents and well-siblings independently completed validated measures of familial communication and sibling functioning. Parents also provided demographic information and completed a questionnaire assessing amount of illness-related information provided to well-siblings. RESULTS: Parents reported that 47.8% of well-siblings never or rarely initiated conversations about their sibling's illness. Moreover, 52.2% of well-siblings never or rarely spoke about death. Amount of illness-related communication between parents and well-siblings was most strongly predicted by parental resilience and well-sibling age. Parents engaged in significantly more illness-related communication with girls than boys (t(44)=-2.28, p = .028). Well-siblings (p < .01) and parents (p < .05) rated satisfaction with familial communication significantly higher than published norms. The only significant predictor of well-sibling satisfaction with familial communication was greater familial cohesion. Family communication variables were not significantly correlated with measures of sibling functioning (all p's>.05). CONCLUSIONS: This study provides new information regarding parent and well-sibling communication in families who have a child with a LLC.

Living with a child who has a life-limiting condition: The functioning of well-siblings and parents.

BACKGROUND: Living with a child who has a life-limiting condition (LLC) is likely to have a major impact on all family members. There is a need to have a clearer understanding of the nature and extent of this impact on parents and well-siblings. The current study aimed to investigate the psychosocial functioning of well-siblings and parents living with a child with an LLC. Further, the study aimed to assess the resilience resources of both well-siblings and parents, giving consideration to how these relate to psychosocial functioning. METHODS: Participants included 48 well-siblings (6-21 years) and 42 parents of children with LLCs. Parents and well-siblings independently completed validated measures of child and adult functioning and personal resilience. Parents provided demographic information about the patient and family. RESULTS: The emotional, social and school functioning of well-siblings in the current study was found to be significantly poorer than published norms (all p's < .01). Parental self-reported depression, anxiety and stress scores were also all significantly poorer than published norms (all p's < .01). There was negligible agreement between well-sibling self-reported functioning and parental proxy-report of the well-siblings functioning (all r's < .126, all p's > .464). Sibling self-reported resilience was positively correlated with each of the measures of psychosocial functioning (all r's > .318, p's < .05). Parental resilience was significantly negatively correlated with depressive symptoms (r = -.369, p < .05) and anxiety symptoms (r = -.473, p < .01) but not stress scores (r = -.074, p = .644). CONCLUSION: Family members living with a child who has an LLC were found to have significantly poorer psychosocial functioning than published norms. Although one cannot infer a causal direction from the current study, greater self-reported well-sibling and parental resilience were associated with aspects of better self-reported psychosocial functioning. Future studies should assess the impact of psychosocial interventions aimed at enhancing the resilience and functioning of both well-siblings and parents.

Characterisation of Physical Frailty and Associated Physical and Functional Impairments in Mild Cognitive Impairment.

OBJECTIVE: To characterize the physical frailty phenotype and its associated physical and functional impairments in mild cognitive impairment (MCI). METHOD: Participants with MCI (N = 119), normal low cognition (NLC, N = 138), and normal high cognition (NHC, N = 1,681) in the Singapore Longitudinal Ageing Studies (SLAS-2) were compared on the prevalence of physical frailty, low lean body mass, weakness, slow gait, exhaustion and low physical activity, and POMA balance and gait impairment and fall risk. RESULTS: There were significantly higher prevalence of frailty in MCI (18.5%), than in NLC (8.0%) and NHC (3.9%), and pre-frailty in MCI (54.6%), NLC (52.9%) than in NHC (48.0%). Age, sex, and ethnicity-adjusted OR (95% CI) of association with MCI (versus NHC) for frailty were 4.65 (2.40-9.04) and for pre-frailty, 1.67 (1.07-2.61). Similar significantly elevated prevalence and adjusted ORs of association with MCI were observed for frailty-associated physical and functional impairments. Further adjustment for education, marital status, living status, comorbidities, and GDS significantly reduced the OR estimates. However, the OR estimates remained elevated for frailty: 3.86 (1.83-8.17), low body mass: 1.70 (1.08-2.67), slow gait: 1.84 (1.17-2.89), impaired gait: 4.17 (1.98-8.81), and elevated fall risk 3.42 (1.22-9.53). CONCLUSION: Two-thirds of MCI were physically frail or pre-frail, most uniquely due to low lean muscle mass, slow gait speed, or balance and gait impairment. The close associations of frailty and physical and functional impairment with MCI have important implications for improving diagnostic acuity of MCI and targetting interventions among cognitively frail individuals to prevent dementia and disability.

Insomnia and daytime neuropsychological test performance in older adults.

OBJECTIVES/BACKGROUND: There is good documentation of the impact of insomnia on daytime cognitive function based on self-reports, but not on neuropsychological test performance. The study investigated the association of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) complaints with daytime domain-specific neuropsychological performance in older adults. PARTICIPANTS/METHODS: Participants were 859 older adults (mean 71.9 years) in the Singapore Longitudinal Ageing Studies. They were interviewed and assessed at community-based eldercare activity centres and completed a sleep survey questionnaire and a battery of neuropsychological tests (Digit span, Rey Auditory Verbal Learning Test, Story memory, Brief Visuospatial Memory Test-Revised, Color Trails Test (1 and 2), Block design, and Verbal fluency). RESULTS: Insomnia complaints were present in 18.0% (n = 155) of participants. Controlling for the presence of other insomnia complaints, psychosocial and medical variables, and depression, EMA was independently and significantly associated with worse executive functioning (p = 0.031). DIS and DMS were not independently associated with poorer performance on any cognitive domain. CONCLUSION: The association of EMA among older adults with decreased executive functioning and underlying mechanistic factors should be further investigated.

Vascular Health Indices and Cognitive Domain Function: Singapore Longitudinal Ageing Studies.

BACKGROUND: Few studies have comprehensively evaluated the relationship between vascular disease and cognition of older adults without cardiac disease. OBJECTIVE: We explored the associations of structural atherosclerosis, vascular stiffness, and reactivity with global, memory, attention, language, visuospatial ability, and executive function in community-dwelling, non-demented older Asians without cardiac diseases. METHODS: Cognition was assessed by Mini-Mental State Examination (MMSE) (n = 308) and detailed neuropsychological tests (n = 155). Vascular measures included carotid intima-media thickness; aortic stiffness [carotid-femoral pulse wave velocity (CFPWV), aortic augmentation index (AI), and aortic pulse pressure (PP)]; carotid stiffness [elasticity modulus (Ep), beta index (ß), arterial compliance (AC), carotid AI]; and endothelial function [reactive hyperemia index (RHI)]. Multivariable analyses controlled for potential confounding by demographics, apolipoprotein E genotype and cardiovascular risk factors. RESULTS: The participants' mean age was 63.0 ± 6.1 years. Inverse associations with MMSE were found for AC (ß= 0.128, p = 0.019), Ep (ß= -0.151, p = 0.008), ß index (ß= -0.122, p = 0.029), carotid stiffness z-score (ß= -0.154, p = 0.007); with executive function for CFPWV (ß= -0.209, p = 0.026), AC (ß= 0.214, p = 0.005), Ep (ß= -0.160, p = 0.050), ß index (ß= -0.165, p = 0.041), and both aortic (ß= -0.229, p = 0.010) and carotid (ß= -0.208, p = 0.010) stiffness z-scores; with verbal memory for AI (ß= -0.229, p = 0.004) and aortic (ß= -0.263, p = 0.004) stiffness z-score; with language for AI (ß= -0.155, p = 0.025), aortic stiffness z-score (ß= -0.196, p = 0.011). RHI positively correlated with visuospatial ability (ß= 0.195, p = 0.013) and executive function (ß= 0.151, p = 0.045). CONCLUSION: The results support a link between systemic vascular health and neurocognitive function in older Asian adults. Subclinical noninvasive measures of arterial stiffness and reactivity may identify individuals vulnerable to cognitive impairment.

The Minimum Clinically Important Difference in the Repeatable Battery for the Assessment of Neuropsychological Status.

OBJECTIVE: There is no established minimum clinically important difference (MCID) for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) index and total scale scores. This study aimed to estimate the MCID for the RBANS index scores and total scale score. METHOD: Participants included 1,856 ethnic Chinese, older adults. Distribution- and anchor-based methods were used to estimate values for the MCID. Distribution-based estimates were calculated as the standard error of measurement (SEM) and .5 standard deviations (SD). For anchor-based estimates, we compared RBANS scores between the clinical dementia rating (CDR) scale no dementia and very mild dementia groups and between the clinical assessment of dementia (CAD) cognitively normal and mild cognitive impairment groups using regression models adjusting for demographic characteristics. RESULTS: Estimates from the CDR anchor were 7.79, 8.63, 10.74, 9.74, 5.61, and 3.77 for the total scale score, language, immediate memory, delayed memory, visuospatial/constructional, and the attention index, respectively. Estimates from the distribution-based methods were similar to the estimates based on the CDR, except for the language and attention indexes. Estimates from the CAD anchor were larger. CONCLUSIONS: We estimated the MCID for the total scale score, language, immediate memory, delayed memory, visuospatial/constructional, and attention indexes of the RBANS as 8, 9, 10, 10, 6, and 4 points, respectively. These estimates are best suited to discriminate between patient groups, for example, in a clinical trial setting. Further research is needed using longitudinal data to assess their applicability to assess within patient differences.

The Equivalence and Difference between the English and Chinese Language Versions of the Repeatable Battery for the Assessment of Neuropsychological Status.

OBJECTIVE: Chinese is the most commonly spoken language in the world. The availability of Chinese translations of assessment scales is useful for research in multi-ethnic and multinational studies. This study aimed to establish whether each of the Chinese translations (Mandarin, Hokkien, Teochew, and Cantonese) of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) achieved measurement equivalence to the English version. METHOD: Participants included 1856 ethnic Chinese, older adults. The RBANS was administered in the language/dialect according to the participants' preference by interviewers who were fluent in that language/dialect. Multiple regression analysis was used to adjust for demographic and clinical differences between participants who spoke different languages/dialects. Equivalence (practical equivalence) was declared if the 90% confidence interval for the adjusted mean difference fell entirely within the pre-specified equivalence margin, ±.2 (±.4) standard deviations. RESULTS: The delayed memory index was at least practically equivalent across languages. The Mandarin, Hokkien, and Teochew versions of the immediate memory, language, and total scale score were practically equivalent to the English version; the Cantonese version showed small differences from the English version. Equivalence was not established for the Hokkien and Teochew versions of the visuospatial/constructional index. The attention index was different across languages. CONCLUSIONS: Data from the English and Chinese versions for the total scale score, language, delayed, and immediate memory indexes may be pooled for analysis. However, analysis of the attention and visuospatial/constructional indexes from the English and Chinese versions should include a covariate that represents the version in the statistical adjustment.