Falls as a mental health risk among Korean-American residents in subsidized senior housing: mediating effect of fall-related self-efficacy.

OBJECTIVES: The study examined the mediating role of fall-related self-efficacy in the association between falls and mental health among older Korean Americans living in subsidized senior housing in the greater Los Angeles area. We focused on serious fall incidents (i.e. multiple falls or any fall with a fracture) and used symptoms of depression and anxiety as indicators of mental health. METHOD: Survey data from 315 participants (M age = 79.4 years) were used to examine the direct effects of serious fall incidents on mental health symptoms, as well as indirect effects through fall-related self-efficacy. RESULTS: The mediating effect of fall-related self-efficacy was found to be significant in both models for depressive symptoms (B [SE] = 0.15 [0.07], bias-corrected 95% CI = [0.03, 0.31]) and anxiety symptoms (B [SE] = 0.11 [0.05], bias-corrected 95% CI = [0.02, 0.23]). CONCLUSION: The mental health impact of serious fall incidents was shaped by older individuals' perceived concerns about falls and confidence in performance. The findings highlight the importance of addressing fall-related psychological responses in preventing falls and promoting mental health among senior housing residents.

Perceived discrimination and depressive symptoms: a study of Vietnamese women who migrated to South Korea due to marriage.

International migrants are one group that is vulnerable to discrimination and mental health problems. This study examined the experience of perceived discrimination and its impact on depressive symptoms among women who migrated in the specific context of marriage. Using social constructionism and the stress appraisal model, this study conceptualized perceived discrimination as a potential source of stress and hypothesized that it would negatively impact the mental health of migrant women. A survey sample of 212 Vietnamese marriage migrant women in South Korea was used for the final analysis. Perceived discrimination was measured using the adapted Everyday Discrimination Scale (EDS). Overall, approximately 62% of the sample reported having at least one discriminatory encounter based on the nine items of the EDS. The results of the multivariate analyses indicated that perceived discrimination posed a significant risk to mental health (ß = 0.43, p < .001). The experience of perceived discrimination increased the amount of explained variance of depressive symptoms by 17%. Findings highlighted the adverse mental health consequences of daily unfair treatment and disrespect in interpersonal contexts and the importance of social policies and programs that promote respect for cultural diversity.

Transcriptomic and histopathological analysis of cholangiolocellular differentiation trait in intrahepatic cholangiocarcinoma.

BACKGROUND & AIMS: Intrahepatic cholangiocarcinoma (iCCA) is a heterogeneous entity with diverse aetiologies, morphologies and clinical outcomes. Recently, histopathological distinction of cholangiolocellular differentiation (CD) of iCCA has been suggested. However, its genome-wide molecular features and clinical significance remain unclear. METHODS: Based on CD status, we stratified iCCAs into iCCA with CD (n=20) and iCCA without CD (n=102), and performed an integrative analysis using transcriptomic and clinicopathological profiles. RESULTS: iCCA with CD revealed less aggressive histopathological features compared to iCCA without CD, and iCCA with CD showed favourable clinical outcomes of overall survival and time to recurrence than iCCA without CD (P<.05 for all). Transcriptomic profiling revealed that iCCA with CD resembled an inflammation-related subtype, while iCCA without CD resembled a proliferation subtype. In addition, we identified a CD signature that can predict prognostic outcomes of iCCA (CD_UP, n=486 and CD_DOWN, n=308). iCCAs were subgrouped into G1 (positivity for CRP and CDH2, 7%), G3 (positivity for S100P and TFF1, 32%) and G2 (the others, 61%). Prognostic outcomes for overall survival (P=.001) and time to recurrence (P=.017) were the most favourable in G1-iCCAs, intermediate in G2-iCCAs and the worst in G3-iCCAs. Similar result was confirmed in the iCCA set from GSE26566 (n=68). CONCLUSIONS: CD signature was identified to predict the prognosis of iCCA. The combined evaluation of histology of CD and protein expression status of CRP, CDH2, TFF1 and S100P might help subtyping and predicting clinical outcomes of iCCA.

Increased expression of stathmin and elongation factor 1α in precancerous nodules with telomere dysfunction in hepatitis B viral cirrhotic patients.

BACKGROUND: Telomere dysfunction is important in carcinogenesis, and recently, stathmin and elongation factor 1α (EF1α) were reported to be up-regulated in telomere dysfunctional mice. METHODS: In the present study, the expression levels of stathmin and EF1α in relation to telomere length, telomere dysfunction-induced foci (TIF), γ-H2AX, and p21WAF1/CIP1 expression were assessed in specimens of hepatitis B virus (HBV)-related multistep hepatocarcinogenesis, including 13 liver cirrhosis specimens, 14 low-grade dysplastic nodules (DN), 17 high-grade DNs, and 14 hepatocellular carcinomas (HCC). Five normal liver specimens were used as controls. TIF were analyzed by telomere fluorescent in situ hybridization (FISH) combined with immunostaining, while the protein expressions of stathmin, EF1α, γ-H2AX, and p21WAF1/CIP1 were detected by immunohistochemistry. RESULT: The expressions of stathmin and EF1α gradually increased as multistep hepatocarcinogenesis progressed, showing the highest levels in HCC. Stathmin mRNA levels were higher in high-grade DNs than normal liver and liver cirrhosis, whereas EF1α mRNA expression did not show such a difference. The protein expressions of stathmin and EF1α were found in DNs of precancerous lesions, whereas they were absent or present at very low levels in normal liver and liver cirrhosis. Stathmin histoscores were higher in high-grade DNs and low-grade DNs than in normal liver (all, P<0.05). EF1α histoscores were higher in high-grade DNs than in normal liver and liver cirrhosis (all, P<0.05). Stathmin mRNA levels and histoscores, as well as EF1α histoscores (but not mRNA levels), were positively correlated with telomere shortening and γ-H2AX labeling index (all, P<0.05). EF1α histoscores were also positively correlated with TIF (P<0.001). Significantly greater inactivation of p21WAF1/CIP1 was observed in low-grade DNs, high-grade DNs, and HCC, compared to liver cirrhosis (all, P<0.05). p21WAF1/CIP1 labeling index was inversely correlated with TIF, stathmin mRNA level, and EF1α histoscore (all, P<0.05). CONCLUSION: Stathmin and EF1α are suggested to be closely related to telomere dysfunction, DNA damage, and inactivation of p21WAF1/CIP1 in HBV-related multistep hepatocarcinogenesis. Accordingly, assessment of stathmin and EF1α levels as a reflection of telomere dysfunction may be helpful in evaluating the biological characteristics of precancerous hepatic nodules in hepatitis B viral cirrhotic patients.

Differential expression of clusterin according to histological type of endometrial carcinoma.

OBJECTIVE: Clusterin expression has been associated with various malignancies. Endometrial carcinoma is divided into endometrioid and papillary serous type carcinoma according to the histological characteristics and regarding to the unopposed estrogenic stimulation. In this study, we investigated the expression profiles of clusterin according to the histological types and the effect of estrogen stimulation on its expression in endometrial carcinoma. METHOD: Clusterin expression in endometrial carcinoma tissues was examined by RT-PCR, Western blot analysis, and immunohistochemistry. 63 endometrioid and 10 papillary serous types of fresh cases and 81 endometrioid and 7 papillary serous types of paraffin-embedded cases were studied. Regulation of clusterin expression by beta-estradiol in HEC-1B and HEC-1A cells was investigated using RT-PCR and Western blot analysis. Cell proliferative function of clusterin was examined in 293T cells. RESULTS: We found higher expression of clusterin in endometrioid compared to papillary serous carcinoma using both immunohistochemistry (p=0.033) and Western blot analysis (p=0.024). The mRNA and protein expressions of clusterin in endometrioid carcinoma were higher than in benign endometrium (p=0.002). Forced expression of clusterin promoted 293T cell survival in a concentration-dependent manner, and estradiol treatment increased clusterin expression in HEC-1B but not in HEC-1A cells. CONCLUSIONS: These data suggest that clusterin expression is related to endometrioid carcinoma of endometrium, in which estrogen is involved in the regulatory network of clusterin.

Acculturation, Acculturative Stress, and Depressive Symptoms in International Migrants: A Study with Vietnamese Women in South Korea.

Globally, there have been increasing numbers of migrant women; these women are at an increased risk for depressive symptoms. The purpose of this study was to examine the associations among acculturation, acculturative stress and depressive symptoms in Vietnamese women who migrated to South Korea through marriages. We hypothesized that acculturative stress would serve as a mediator in the relationship between acculturation and depressive symptoms. Our findings from surveys with 217 Vietnamese immigrant women showed that the indirect effect of acculturation on depressive symptoms, mediated through acculturative stress [- .15 (.04)], was significant (bias corrected 95% confidence interval for the indirect effect = - .25, - .08). Low levels of acculturation increased acculturative stress, which in turn led to the elevated symptoms of depression. Our findings not only illuminate the adaptation processes of international, female migrants but also suggest avenues to protect and promote their mental well-being.

Mental health literacy in religious leaders: a qualitative study of Korean American Clergy.

Although religious leaders in ethnic minority communities are often the first point of contact for mental health needs, little is known about their mental health literacy. The aim of the current study was to explore the knowledge and beliefs about depression held by Korean American clergy, using a qualitative approach. The Gateway Provider Model (GPM) and Jorm's conceptualisation of mental health literacy served as a framework for the enquiry. Seventeen clergy members serving in Korean communities in two U.S. metropolitan cities participated in an individual in-depth interview during the spring of 2013. Using the constant comparison method, the research team coded the data independently, compared and modified codes, and derived major categories and themes in consensus approach. Eight themes emerged from the interviews, and they were grouped into five categories: (i) the ability to identify the problem; (ii) knowledge about causes and risk factors; (iii) knowledge and beliefs about treatment; (iv) knowledge about resources and services; and (v) contextual factors. Despite some variations, a majority of the participants acknowledged that depression is an important issue in the Korean American community and felt a sense of responsibility for the well-being of their community members. The findings highlight the need for mental health education and training for religious leaders in ethnic minority communities to help them properly respond to community mental health needs.

Factors Affecting Willingness to Use Hospice in Racially/Ethnically Diverse Older Men and Women.

Racial/ethnic minorities tend to underutilize hospice services. Guided by Andersen behavioral health model, the purpose of this study was to explore the predictors of the willingness to use hospice services in racially/ethnically diverse older men and women. Data were drawn from the Survey of Older Floridians: 504 non-Hispanic whites, 360 African Americans, 328 Cuban Americans, and 241 non-Cuban Hispanics. In each group, logistic regression models of the willingness to use hospice were estimated. A greater likelihood of willingness was observed among younger non-Hispanic whites and among African Americans with fewer functional disabilities. In non-Cuban Hispanics, English proficiency increased the willingness by 3.1 times. Findings of the study identified group-specific factors contributing to the willingness to use hospice services and hold implications for tailored intervention programs.

An empirical typology of social networks and its association with physical and mental health: a study with older Korean immigrants.

OBJECTIVES: In the context of social convoy theory, the purposes of the study were (a) to identify an empirical typology of the social networks evident in older Korean immigrants and (b) to examine its association with self-rated health and depressive symptoms. METHOD: The sample consisted of 1,092 community-dwelling older Korean immigrants in Florida and New York. Latent class analyses were conducted to identify the optimal social network typology based on 8 indicators of interpersonal relationships and activities. Bivariate and multivariate analyses were conducted to examine how the identified social network typology was associated with self-rating of health and depressive symptoms. RESULTS: Results from the latent class analysis identified 6 clusters as being most optimal, and they were named diverse, unmarried/diverse, married/coresidence, family focused, unmarried/restricted, and restricted. Memberships in the clusters of diverse and married/coresidence were significantly associated with more favorable ratings of health and lower levels of depressive symptoms. DISCUSSION: Notably, no distinct network solely composed of friends was identified in the present sample of older immigrants; this may reflect the disruptions in social convoys caused by immigration. The findings of this study promote our understanding of the unique patterns of social connectedness in older immigrants.

[Clinical factors associated with response to biofeedback therapy for patients with chronic constipation].

BACKGROUND/AIMS: Biofeedback therapy has been widely used for the treatment of constipated patients. However, there are only a few reports about the clinical factors that can predict the effectiveness of biofeedback therapy. The aim of this study was to evaluate prognostic factors before the initiation of biofeedback treatment in constipated patients. METHODS: Biofeedback treatment was performed in 114 patients with constipation. After classifying the patients into two groups, responder and non-responder by subjective and objective parameters, univariate and multivariate analysis were performed to evaluate the factors associated with effectiveness of biofeedback therapy. RESULTS: Eighty-five patients (74.6%) responded to biofeedback therapy. Pre-treatment balloon expulsion test, paradoxical contraction on manometry, defecation index and anal residual pressure during straining were the factors that influenced the results of biofeedback treatment. On multivariate analysis, defecation index (odds ratio=67.5, p<0.05) and paradoxical contraction on manometry (odds ratio=0.053, p<0.05) were the factors that showed significant difference between the responders and non-responders. CONCLUSIONS: This study suggests that several pre-treatment prognostic factors are associated with response to biofeedback for the constipated patients. Using prognostic factors, we may be able to evaluate the patterns of pelvic floor dysfunction and responsiveness of biofeedback therapy for the patients with constipation.

[Clinical characteristics of patients with chronic constipation after radical hysterectomy or delivery].

BACKGROUND/AIMS: This study was aimed to analyze the clinical characteristics of patients who developed constipation after radical hysterectomy or delivery and to investigate the results of biofeedback therapy for these patients. METHODS: Thirty-five chronic constipation patients with radical hysterectomy (radical hysterectomy group), 27 chronic constipation patients with delivery (delivery group) and 27 constipation patients with no history of hysterectomy or delivery (control group) were included. Clinical characteristics of these patients, including the results of biofeedback therapy, were analyzed. RESULTS: The delivery group showed higher rates of pelvic floor dyssynergia than the control group (14/27, 52% vs. 6/27, 22%; p<0.05). The prevalence of slow transit constipation was lower in the radical hysterectomy group and delivery group than in the control group (7/35, 20% and 5/27, 19% vs. 12/27, 44%; p<0.05). The prevalence of anatomical abnormalities was not different between the groups. The radical hysterectomy group showed higher rate of obstructive sensation and the delivery group showed higher rate of hard stool and digital maneuvers. The biofeedback therapy was effective in 10 out of 12 patients (91%) among the radical hysterectomy and delivery group. CONCLUSIONS: Radical hysterectomy and delivery seem to induce functional constipation, which may be caused by anorectal dysfunction such as pelvic floor dyssynergia. The biofeedback treatment was effective in functional constipation after radical hysterectomy or delivery.

Neighborhood effects on the self-rated health of older adults from four racial/ethnic groups.

Building upon the sizable literature on individual-level predictors of self-rated health, this study examined the impact of neighborhood characteristics, using older adult samples of four racial/ethnic groups. The considered neighborhood characteristics include (a) the proportion of individuals age 65 and older, (b) the proportion of individuals below poverty, and (c) the proportion of individuals from the same racial/ethnic background in the Census-block group. The samples were drawn from the 2004-2005 Survey of Older Floridians, which includes Whites (n = 488), Blacks (n = 345), Cubans (n = 319), and non-Cuban Latinos (n = 230). Using the reported residential address, each participant was linked to the 2000 Census at block-group level to retrieve the above-mentioned neighborhood characteristics. Multilevel analysis of self-rated health was estimated for each racial/ethnic group, considering individual-level variables (e.g., age, gender, marital status, education, financial strain, and chronic conditions) and each of the neighborhood characteristics. Regardless of racial/ethnic groups, those living in the neighborhood with a higher proportion of residents below poverty were likely to report poorer health. The proportion of older adults in the neighborhood was significant only in Cubans, and the proportion of residents with the same ethnic background was only in Whites. The findings show the overall importance of neighborhood context in the health of older adults and indicate different implications of neighborhood characteristics for diverse racial/ethnic groups.

Recalled attributes of parents with Alzheimer's disease: relevance for caregiving.

Health psychology has long been involved in studies of factors that lead to more effective caregiving. Drawing on the theory of distributive justice, the underlying hypothesis of this paper was that perceptions of what a demented parent was like, prior to becoming ill, influence an adult child caregiver's provision of care, as well as the caregiver's own well-being. A secondary question dealt with the nature of retrospective ratings by caregiver informants. The sample consisted of triads of two adult children (N = 385) and a parent (N = 201) diagnosed with Alzheimer's disease, although in a few instances only one adult child was interviewed. Both retrospective and current ratings of the parent were made by caregivers, who were administered a semantic differential instrument twice over a 10-month period. Comparison of ratings from first and second interview waves suggested that perceptions of what a parent was like, prior to the onset of dementia, were more stable over time than perceptions of what the parent was currently like, at each interview. Ratings of premorbid attributes were more strongly related to ratings of the present for those parents who displayed the least evidence of cognitive decline. Regression analyses supported the hypothesized relationship between adult children's perceptions and both provision of care and well-being variables. Results have implications for projections of caregiver burden and for placement into long-term care.

The impact of social resources on depressive symptoms in racially and ethnically diverse older adults: variations by groups with differing health risks.

The objectives of this study were (1) to develop an empirical typology of physical health risks in racially and ethnically diverse older adults and (2) to examine whether the impact of social resources on depressive symptoms differs across the identified health risk groups (low, moderate, and high risks). The data source was the Survey of Older Floridians, a statewide survey of older adults aged 65 and older (n = 1,432). Latent profile analysis with multiple indicators of physical health (chronic conditions, functional disability, and self-rated health) was used to identify three health risk groups (low, moderate, and high risks). The direct and interactive effects of the health risk group membership and social resources (social support and religious service attendance) on depressive symptoms were found. Of particular interest was that the positive impact of social support was most pronounced in the moderate health risk group.

Increased expression of CCN2, epithelial membrane antigen, and fibroblast activation protein in hepatocellular carcinoma with fibrous stroma showing aggressive behavior.

Tumor behavior is affected by the tumor microenvironment, composed of cancer-associated fibroblasts (CAFs). Meanwhile, hepatocellular carcinomas (HCC) with fibrous stroma reportedly exhibit aggressive behavior suggestive of tumor-stroma interaction. However, evidence of the crosstalk remains unclear. In this study, CCN2, epithelial membrane antigen (EMA), fibroblast activation protein (FAP), and keratin 19 (K19) expression was studied in 314 HCCs (cohort 1), 42 scirrhous HCCs (cohort 2), and 36 chronic hepatitis/cirrhosis specimens by immunohistochemistry. Clinicopathological parameters were analyzed according to the expressions of these markers. In tumor epithelial cells from cohort 1, CCN2 and EMA were expressed in 15.3% and 17.2%, respectively, and their expressions were more frequent in HCCs with fibrous stroma (≥5% of tumor area) than those without (P<0.05 for all); CCN2 expression was well correlated with K19 and EMA expression. In tumor stromal cells, FAP expression was found in 6.7%. In cohort 2, CCN2, EMA, and FAP expression was noted in 40.5%, 40.5%, and 66.7%, respectively, which was more frequent than that in cohort 1 (P<0.05 for all). Additionally, EMA expression was associated with the expression of K19, CCN2, and FAP (P<0.05 for all); EMA expressing tumor epithelial cells showed a topographic closeness to FAP-expressing CAFs. Analysis of disease-free survival revealed CCN2 expression to be a worse prognostic factor in both cohort 1 (P = 0.005) and cohort 2 (P = 0.023), as well as EMA as a worse prognostic factor in cohort 2 (P = 0.048). In conclusion, expression of CCN2, EMA, and FAP may be involved in the activation of CAFs in HCC, giving rise to aggressive behavior. Significant correlation between EMA-expressing tumor cells and FAP-expressing CAFs and their topographic closeness suggests possible cross-talk between tumor epithelial cells and stromal cells in the tumor microenvironment of HCC.

Amino acid residues in RAG1 responsible for the interaction with RAG2 during the V(D)J recombination process.

The V(D)J recombinase, a complex of RAG1 and RAG2, carries out a gene rearrangement process that is required for the achievement of diverse antigen receptor repertoires during the early developmental stage of lymphocytes. It recognizes a specific site spanning the coding DNA region of antigen receptor genes and produces double-stranded DNA breaks at the board between coding and signal sequences. Two broken DNA ends are joined by a double-stranded break repair system. Both RAG (recombination activation gene) 1 and RAG2 proteins are absolutely required for this process although the catalytic residues of V(D)J recombinase are exclusively located at RAG1 according to recent mutational analyses. In this study we identified some acidic amino acid residues in RAG1 responsible for the interaction with RAG2. Mutation on these residues caused a decrease of cleavage activity in vitro and failure of RAG-RSS DNA synaptic complex formation. This result is complementary to previous reports in which positively charged amino acids in RAG2 play an important role in RAG1 binding.

Comparative analysis of nuclear proteins of B cells in different developmental stages.

The developmental stage-specific regulation of V(D)J recombination, a gene rearrangement process of antigen receptor gene segments, is tightly controlled in cells. Here we screened proteins uniquely or differentially expressed among three developmentally distinguishable B cells (pro-B, pre-B and mature B cells) using two-dimensional gel electrophoresis and mass spectrometry. Chromatin assembly factor 1 was uniquely expressed in pro-B cells. Purine nucleotide phosphorylase, LCK, E2A and many other unidentified proteins were dominantly present in the nucleus at the early stage of B cell development where the V(D)J recombination process occurs. Also, few proteins including guanidine nucleotide binding proteins were exclusively expressed in pre-B cell. Such findings can provide some information to help understand the developmental regulation of gene rearrangement occurring during B cell development.