Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change.

INTRODUCTION: Individuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia-related neuropathologies is unknown. METHODS: This cross-sectional study included 469 autopsy cases from 2011 to 2023. The relationships between neighborhood disadvantage measured by Area Deprivation Index (ADI) percentiles categorized into tertiles, cognition evaluated by the last Mini-Mental State Examination (MMSE) scores before death, and 10 dementia-associated proteinopathies and cerebrovascular disease were assessed using regression analyses. RESULTS: Higher ADI was significantly associated with lower MMSE score. This was mitigated by increasing years of education. ADI was not associated with an increase in dementia-associated neuropathologic change. Moreover, the significant association between ADI and cognition remained even after controlling for changes in major dementia-associated proteinopathies or cerebrovascular disease. DISCUSSION: Neighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia-associated neuropathologies.

The Multi-dimensional Assessment of Suicide Risk in Chronic illness-20 (MASC-20): Development and validation.

BACKGROUND: We developed and tested the psychometric properties of the Multi-dimensional assessment of suicide risk in chronic illness-20 (MASC-20), which assess suicidal behavior (SB), and its associated distress in chronic physical illness (CPI). METHODS: Items were developed by incorporating inputs from patient interviews, a review of existing instruments, and expert consultations. Pilot testing with 109 patients and field testing with 367 patients with renal, cardiovascular, and cerebrovascular diseases were conducted. We analyzed Time (T) 1 data to select items and T2 data to examine psychometric properties. RESULTS: Forty preliminary items were selected through pilot testing; 20 were finalized from field testing. Optimal internal consistency (α = 0.94) and test-retest reliability (Intra class correlation coefficient = 0.92) of the MASC-20 supported reliability. Good fit of the four-factor model (physical distress, psychological distress, social distress, and SB) from exploratory structural equation modeling demonstrated factorial validity. Its correlations with MINI suicidality (r = 0.59) and the Schedule of Attitudes Toward Hastened Death-abbreviated scores (r = 0.62) indicated convergent validity. Higher MASC-20 scores in patients with clinical levels of depression and anxiety and low health status demonstrated known-group validity. The MASC-20 distress score predicted SB beyond known SB risk factors, supporting incremental validity. A cutoff score of 16 was optimal for identifying suicide risk. The area under the curve was within a moderately accurate range. The sum of sensitivity and specificity (1.66) indicated diagnostic utility. LIMITATIONS: MASC-20's applicability to other patient populations and its sensitivity to change requires testing. CONCLUSIONS: The MASC-20 appears to be a reliable and valid tool for assessing SB in CPI.

Analysis of Major Factors Affecting the Quality of Life of the Elderly in Korea in Preparation for a Super-Aged Society.

In preparation for the expected super-aged society in 2025, this study attempted to prepare basic data that can help design development measures for the welfare of the elderly so that everyone can prepare for a healthy and happy retirement. Accordingly, the major factors affecting the quality of life of the elderly in Korea were verified. To this end, the questionnaire consisted of 22 questions in total, and a mobile survey was conducted between September and October 2021; in total, 250 copies were used for the final analysis, and the following conclusions are derived. The major factors that were found to determine the quality of life of the elderly were age, subjective health status, monthly household income, leisure activities, and health inequality fairness. It was found that the higher the age, the lower the quality of life. Further, the higher the subjective health status, monthly household income, participation in leisure activities, and perceptions of health inequality as fair, the more the quality of life of the elderly was affected. Therefore, policy support such as leisure activity, health programs, and medical welfare services for the elderly and sufficient attention from our society are all required.

Effect of Practicing Health Behaviors on Unmet Needs among Patients with Chronic Diseases: A Longitudinal Study.

With the growing prevalence of chronic diseases, the proportion of unmet needs is increasing. In this study, we investigated the effect of practicing health behaviors on unmet needs among patients with chronic diseases, using data from the Korea Health Panel Survey conducted between 2014-2017. Participants (n = 4069) aged 19 or older, with at least one chronic disease (hypertension, diabetes mellitus, dyslipidemia, or arthrosis) and with existing follow up data were selected. Health behaviors combined three variables: not presently smoking, not belonging to high-risk drinking group, and indulging in moderate- or high-intensity exercise. Those who met all three criteria were classified as the practicing health behaviors group. Generalized Estimating Equation analysis was performed to consider correlated data within a subject. Of the participants, 23.9% practiced health behaviors. Participants who did not practice health behaviors were significantly more likely to have unmet needs compared with those who did (OR: 1.24, 95% CI: 1.10-1.39). Further research would be needed to verify the impact of practicing health behavior on unmet needs.

Asian American Women's Recall of Conversations With Their Mothers About Sexual Health: A Secondary Analysis of Qualitative Data.

ABSTRACT: Between 2010 and 2016, Asian Americans (AA) had a 35% increase in HIV diagnosis. Although mother-daughter sexual communication was found to be protective in minority populations, the opposite is true among AAs. The purpose of this study was to explore AA women's experiences of sexual communication with their mothers. Secondary qualitative analysis using analytic expansion with a phenomenological approach was used. Thematic analysis was used to search for common patterns and themes that emerged using qualitative description methodology. Twenty East and Southeast AA cisgender women, ages 18-33 years, were interviewed. The primary finding was an intergenerational gap with two themes: (a) mothers' attitudes about sexual communication and (b) content of sexual communication. Indirect sexual communication included cautionary messages consistent with previous studies. AA mothers' strong cultural beliefs created a barrier to communication. Future research should focus on the young women who want open sexual communication and could influence the next generation.

Invisible Minority: HIV Prevention Health Policy for the Asian American Population.

There has been a 72% increase in the Asian American population from approximately 12 million in 2000 to 21 million in 2015. By 2050, there will be 33.4 million Asian Americans living in the United States, making this population the most rapidly growing ethnic group in the country. There is a myth that Asian Americans are a model conservative minority group in terms of sexual behavior and safe sexual practices and are not at risk of sexually transmitted infections including HIV. However, they are the only ethnic group in the United States that had a continuous increase in HIV infection rates from 4.9 per 100,000 in 2011 to 5.5 per 100,000 in 2016. Due to state and national methods of data collection for race and ethnicity with regard to sexually transmitted infection and HIV, the Asian American population's data are often limited. The purpose of this article is to identify the potential historical and political reasons why the Asian American population's HIV or sexual risk has not been fully documented and to propose potential health policy solutions.

Life Space Assessment in Stroke Patients.

OBJECTIVE: To evaluate the reliability of the practical life space in post-stroke patients using the Korean version of the Life-Space Assessment (K-LSA) questionnaire and to assess the relationships between the K-LSA and physical function, daily activity, quality of life, and post-stroke depression. METHODS: The LSA questionnaire was translated into Korean, and the translated version was authorized by the author of the LSA questionnaire. In a cross-sectional study, the performance of the K-LSA was evaluated in 34 stroke patients (20 males and 14 females; mean age 65.11±2.39 years) who were receiving physical and occupational therapy at the outpatient clinic in the rehabilitation medicine department of a university medical center at the time of evaluation. Performances were assessed twice by one examiner at a 2-week interval to test the reliability. The patients were evaluated using the Functional Ambulation Category (FAC) scale, Functional Independence Measure (FIM) scale, and mobility subscale of the FIM to assess their relationships with the K-LSA. They were also evaluated using the EuroQol 5 Dimensions questionnaire (EQ-5D) and Geriatric Depression Scale (GDS) to determine the relationship with quality of life and post-stroke depression. RESULTS: Test-retest reliability at the first (62.20±32.14) and second (63.15±32.22) assessment was 0.993 (p<0.01). The K-LSA showed significant correlations with the FAC (r=0.848, p<0.01), FIM (r=0.765, p<0.01), mobility category of the FIM (r=0.764, p<0.01), GDS (r=-0.657, p<0.01), and EQ-5D (r=0.506, p<0.01). CONCLUSION: This study suggests that the practical life space of post-stroke patients, assessed by the K-LSA, has a significant correlation with patients' functional mobility, independence in daily activity, quality of life, and depression.

The assessment of electrophysiological activity in human-induced pluripotent stem cell-derived cardiomyocytes exposed to dimethyl sulfoxide and ethanol by manual patch clamp and multi-electrode array system.

INTRODUCTION: Recently, electrophysiological activity has been effectively measured in human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) to predict drug-induced arrhythmia. Dimethyl sulfoxide (DMSO) and ethanol have been used as diluting agents in many experiments. However, the maximum DMSO and ethanol concentrations that can be effectively used in the measurement of electrophysiological parameters in hiPSC-CMs-based patch clamp and multi-electrode array (MEA) have not been fully elucidated. METHODS: We investigated the effects of varying concentrations of DMSO and ethanol used as diluting agents on several electrophysiological parameters in hiPSC-CMs using patch clamp and MEA. RESULTS: Both DMSO and ethanol at concentrations>1% in external solution resulted in osmolality >400mOsmol/kg, but pH was not affected by either agent. Neither DMSO nor ethanol led to cell death at the concentrations examined. However, resting membrane potential, action potential amplitude, action potential duration at 90% and 40%, and corrected field potential duration were decreased significantly at 1% ethanol concentration. DMSO at 1% also significantly decreased the sodium spike amplitude. In addition, the waveform of action potential and field potential was recorded as irregular at 3% concentrations of both DMSO and ethanol. Concentrations of up to 0.3% of either agent did not affect osmolality, pH, cell death, or electrophysiological parameters in hiPSC-CMs. DISCUSSION: Our findings suggest that 0.3% is the maximum concentration at which DMSO or ethanol should be used for dilution purposes in hiPSC-CMs-based patch clamp and MEA.

Using Objective Structured Clinical Examination (OSCE) as Education in Advanced Practice Registered Nursing Education.

Approximately 3 million nurses make up the U.S. health care workforce. The Robert Wood Johnson Foundation and the Institute of Medicine (2011) supported the call to strengthen the nursing profession by establishing global standards of educational criteria and outcomes. Throughout the world, health education is affected by fundamental inadequacies related to static, fragmented, and content-oriented curricula. There are inadequacies in our curricula, and nursing faculties are facing challenges with clinical placements (both the number and quality of these placements); therefore, alternative methods of providing practice to students need to be considered. A transformative agenda comprising changes in the way students are taught fully harnessing the potential of information and communications technology (i.e., simulation) is necessary. Simulated patient encounters and Objective Structured Clinical Examinations are 2 means to achieve needed practice in a safe environment. The purpose of this article is to show, by using simulation, how students can practice and be evaluated within their clinical practice role in a safe, controlled environment. In addition, this practice can (a) enable students to increase the complexity of their understanding and their autonomy and (b) educate students about social accountability, health and gender equity, social justice, and human rights.

Trajectories of mothers' emotional availability: relations with infant temperament in predicting attachment security.

The present study examined observations of parenting quality (mothers' emotional availability - EA) during infant bedtimes at 4 points across the infants' first year, assessing relations between levels and trajectories of EA and infant attachment at 12 months and the role of infant temperament in moderating these associations. The sample (N = 128) was predominantly Euro-American (82.5%) and at low socioeconomic risk. Latent growth curve modeling with latent basis coefficients indicated substantial individual differences in initial levels and slopes in EA trajectories across the first year. Both levels of maternal EA and EA trajectories across the first year predicted 12-month infant attachment security. Although maternal EA tended to decrease across the first year in the full sample, EA trajectories that showed a "bounce-back" between 6 and 12 months, suggesting more successful maternal adaptation to an expanding infant developmental repertoire, predicted greater infant security at 12 months. In addition, linkages between latent EA trajectories and 12-month attachment were moderated by 3-month infant temperamental reactivity and regulation. These findings indicate that infant attachment security is sensitive to both static and dynamic aspects of parenting quality across the first year, and that infant temperament can interact with both in predicting infant attachment.

Sleep arrangements, parent-infant sleep during the first year, and family functioning.

The present longitudinal study addressed the ongoing debate regarding the benefits and risks of infant-parent cosleeping by examining associations between sleep arrangement patterns across the first year of life and infant and parent sleep, marital and family functioning, and quality of mothers' behavior with infants at bedtime. Patterns of infant sleep arrangements across the infants' first year were derived from information obtained from 139 families at 1, 3, 6, 9, and 12 months of infant age in a central Pennsylvania sample. Linkages between these patterns and parent-infant sleep, marital and coparenting stress, and maternal behavior at bedtime (from video-recordings) were assessed. Compared with families whose infants were solitary sleepers by 6 months, persistent cosleeping was associated with sleep disruption in mothers but not in infants, although mothers in persistent cosleeping arrangements reported that their infants had more frequent night awakenings. Persistent cosleeping was also associated with mother reports of marital and coparenting distress, and lower maternal emotional availability with infants at bedtime (from home observations). Persistent cosleeping appeared to be a marker of, though not necessarily a cause of, heightened family stress, although the present design did not enable strong tests of causal processes, and results may be particular to cultures that are not supportive of cosleeping. Findings are discussed in terms of cultural contexts of infant sleep and the need for further investigations into the role of the health of the family system in influencing how parents structure infant sleep. (PsycINFO Database Record

Household chaos, sociodemographic risk, coparenting, and parent-infant relations during infants' first year.

Household chaos is a construct often overlooked in studies of human development, despite its theoretical links with the integrity of individual well-being, family processes, and child development. The present longitudinal study examined relations between household chaos and well-established correlates of chaos (sociodemographic risk, major life events, and personal distress) and several constructs that, to date, are theoretically linked with chaos but never before assessed as correlates (quality of coparenting and emotional availability with infants at bedtime). In addressing this aim, we introduce a new measure of household chaos (the Descriptive In-home Survey of Chaos--Observer ReporteD, or DISCORD), wholly reliant on independent observer report, which draws from household chaos theory and prior empirical work but extends the measurement of chaos to include information about families' compliance with a home visiting protocol. Household chaos was significantly associated with socioeconomic risk, negative life events, less favorable coparenting, and less emotionally available bedtime parenting, but not with personal distress. These findings emphasize the need to examine household chaos as a direct and indirect influence on child and family outcomes, as a moderator of intervention attempts to improving parenting and child development, and as a target of intervention in its own right.

Infant emotion regulation: relations to bedtime emotional availability, attachment security, and temperament.

The present study examines the influences of mothers' emotional availability toward their infants during bedtime, infant attachment security, and interactions between bedtime parenting and attachment with infant temperamental negative affectivity, on infants' emotion regulation strategy use at 12 and 18 months. Infants' emotion regulation strategies were assessed during a frustration task that required infants to regulate their emotions in the absence of parental support. Whereas emotional availability was not directly related to infants' emotion regulation strategies, infant attachment security had direct relations with infants' orienting toward the environment and tension reduction behaviors. Both maternal emotional availability and security of the mother-infant attachment relationship interacted with infant temperamental negative affectivity to predict two strategies that were less adaptive in regulating frustration.

Korean version of the scale for the assessment and rating of ataxia in ataxic stroke patients.

OBJECTIVE: To investigate the intra-rater and inter-rater reliability and usefulness of the Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) in ataxic stroke patients. METHODS: The original SARA was translated into Korean, back translated to English, and compared to the original version. Stroke patients (n=60) with ataxia were evaluated using the K-SARA by one physiatrist and one occupational therapist. All subjects were rated twice. We divided the subjects into 5 groups by Functional Ambulation Category (FAC) and 3 groups based on the ataxia subscale of the National Institutes of Health Stroke Scale (NIHSS). The mean K-SARA scores representing each group of FAC and the ataxia subscale of NIHSS were compared. RESULTS: The test-retest correlation coefficient of the K-SARA was 0.997 by the therapist and 1.00 by the physiatrist (p<0.001). The inter-rater correlation coefficient of the K-SARA was 0.985 (p<0.001). The ataxia subscale of NIHSS did not correlate with K-SARA. There was a significant difference in the mean K-SARA score by FAC (p<0.001). CONCLUSION: K-SARA is a reliable and valid measure of ataxia in stroke patients in Korea.

Use of the international classification of functioning, disability and health as a functional assessment tool for breast cancer survivors.

PURPOSE: To develop a patient self-completed questionnaire from the items of the Brief Core Set Questionnaire for Breast Cancer (BCSQ-BC) and to investigate the prevalence of specific dysfunctions throughout the course of cancer and treatments. METHODS: From January 2010 to February 2011, 96 breast cancer patients were evaluated with BCSQ-BC developed for clinical application of International Classification of Functioning, Disability and Health (ICF). Quality of life and upper limb dysfunction using disabilities of arm, shoulder and hand (DASH) were assessed. Content validity was evaluated using correlations between BCSQ-BC and European Organization for Research and Treatment of Cancer (EORTC) QLQ and DASH scores. Construct validity was computed using exploratory factor analysis. Kappa statistics were computed for agreement between test-retest ICF data. The level of significance and odds ratios were reported for individuals with early post-acute and long-term context and with total mastectomy and breast conservative surgery. RESULTS: There was consistently good test-retest agreement in patient-completed questionnaires (kappa value, 0.76). Body function, activity and participation subscales are significantly related with EORTC QLQ and DASH. Problems with activity and participation were strongly associated with physical functional domains of EORTC QLQ (r=-0.708, p<0.001) and DASH (r=0.761, p<0.001). The prevalence of dysfunctions varied with type of surgery and time after cancer. Immobility of joint (15% vs. 7%) and lymphatic dysfunction (17% vs. 3%) were indexed more frequently in extensive surgery cases than in conservative surgery. Muscle power (16% vs. 8%), exercise tolerance functions (12% vs. 4%) and looking after one's health (10% vs. 2%) were impaired within 1 year after surgery, while sleep dysfunction (8% vs. 14%) was a major problem over 1 year after surgery. CONCLUSION: The BCSQ-BC identifies the problems comprehensively in functioning of patients with breast cancer. We revealed the interaction with the ICF framework adopting a multifactor understanding of function and disability.

The quantitative assessment of risk factors to overstress at adjacent segments after lumbar fusion: removal of posterior ligaments and pedicle screws.

STUDY DESIGN: Finite element method. OBJECTIVE: To investigate the changes in the disc stress and range of motion (ROM) at adjacent segments after lumbar fusion based on whether or not pedicle screws are removed and whether or not the continuity of the proximal posterior ligament complex (PLC) is preserved. SUMMARY OF BACKGROUND DATA: The ablation of proximal PLC continuity and the presence of pedicle screws have been reported to affect the biomechanics at adjacent segments after lumbar fusion. However, there have been few studies regarding the quantitative assessment of their contribution to overstress at adjacent segments after lumbar fusion. METHODS: In the validated intact lumbar finite element model (L2-L5), four types of L3-L4 fusion models were simulated. These models included the preservation of the PLC continuity with pedicle screws (Pp WiP), the preservation of PLC continuity without pedicle screws (Pp WoP), the sacrifice of PLC with pedicle screws (Sp WiP), and the sacrifice of PLC without pedicle screws (Sp WoP). In each scenario, the ROM, maximal von Mises stress of discs, and the facet joint contract force at adjacent segments were analyzed. RESULTS.: Among the four models, the Sp WiP yielded the greatest increase in the ROM and the maximal von Mises stress of the disc at adjacent segments under four moments. Following the SP WiP, the order of increase of the ROM and the disc stress was Pp WiP, Sp WoP, and Pp WoP. Furthermore, the increase of ROM and disc stress at the proximal adjacent segment was more than at the distal adjacent segment under all four moments in each model. The facet joint contact was also most increased in the Sp WiP under extension and torsion moment. CONCLUSION: The current study suggests that the preservation of the PLC continuity or the removal of pedicle screws after complete fusion could decrease the stress at adjacent segments, and their combination could act synergistically.

The risk assessment of a fall in patients with lumbar spinal stenosis.

STUDY DESIGN: A prospective case control study. OBJECTIVES: To investigate the risk of a fall by using functional mobility tests in patients with lumbar spinal stenosis (LSS) via a comparison with patients with knee osteoarthritis (KOA). SUMMARY OF BACKGROUND DATA: LSS is a degenerative arthritic disease in the spine that results in decreasing function, impaired balance, and gait deficit, with increased levels of leg and back pain. This physical impairment may result in an increased risk of fall later in the disease process, as shown in KOA. However, there has been no study regarding the association between the risk of a fall and LSS. METHODS: The study was an age- and weight-matched case control study consisting of two groups: one group consisting of 40 patients with LSS who were scheduled to undergo spine surgery (LSS group) and the other group consisting of 40 patients with advanced osteoarthritis in both knees, scheduled to undergo TKA on both knees (KOA group). For both groups, four functional mobility tests, such as a Six-Meter-Walk Test (SMT), Sit-to-Stand test (STS), Alternative-Step Test (AST), and Timed Up and Go Test (TUGT), were performed. RESULTS: There was no difference in demographic data between both groups except for body mass index. For the SMT and STS, the patients in the LSS group spent significantly more time performing these tests than the patients in the KOA. For the AST, however, patients in the KOA group presented a statistically worse performance in functional mobility, compared with the LSS group. The mean TUGT time was not statistically different between the two groups. CONCLUSIONS: The current study highlights that patients with symptomatic LSS have a risk of a fall comparable with the patients who had degenerative KOA based on the results of functional mobility tests (SMT, STS, AST, and TUGT).

Usefulness of the Scale for the Assessment and Rating of Ataxia (SARA) in Ataxic Stroke Patients.

OBJECTIVE: To examine the usefulness of the Scale for the Assessment and Rating of Ataxia (SARA) in ataxic stroke patients. METHOD: This was a retrospective study of 54 patients following their first ataxic stroke. The data used in the analysis comprised ambulation status on admission and scores on the SARA, the Korean version of the Modified Barthel Index (K-MBI) and the Berg Balance Scale (BBS). The subjects were divided into four groups by gait status and into five groups by level of dependency in activities of daily living (ADLs) based on their K-MBI scores. Data were subjected to a ROC curve analysis to obtain cutoff values on the SARA for individual gait status and levels of activity dependency. The correlations between the SARA, K-MBI and BBS scores were also computed. RESULTS: There was significant correlation between the SARA and the K-MBI scores (p<0.001), and this correlation (r=-0.792) was higher than that found between the BBS and the K-MBI scores (r=0.710). The SARA scores of upper extremity ataxia categories were significantly related to the K-MBI scores of upper extremity related function (p<0.001). The SARA scores were also significantly correlated negatively with ambulation status (p<0.001) and positively with ADL dependency (p<0.001). In the ROC analysis, patients with less than 5.5 points on the SARA had minimal dependency in ADL, while those with more than 23 points showed total dependency. CONCLUSION: SARA corresponds well with gait status and ADL dependency in ataxic stroke patients and is considered to be a useful functional measure in that patient group.