Ethnic differences in mini-mental state examination (MMSE) scores: where you live makes a difference.

OBJECTIVES: To examine differences in correlates of the Mini-Mental State Examination (MMSE) in a population-based sample of older Mexican Americans and European Americans and to provide empirical validation of the MMSE as an indicator of cognitive impairment in survey research in older Mexican Americans by comparing MMSE classification against performance on timed tasks with varying levels of cognitive demand. DESIGN: A population-based cross-sectional study. SETTING: Trained bilingual staff administered the MMSE as part of the San Antonio Longitudinal Study of Aging (SALSA) home-based assessment battery. PARTICIPANTS: 827 community-dwelling Mexican Americans and European Americans, 65 and older, residing in three socioeconomically and culturally distinct neighborhoods (barrio, transitional, suburban). MEASUREMENTS: The MMSE was compared against a variety of demographic, biomedical, and sociocultural variables ascertained by self-report and against performance-based measures of functional tasks representing varying levels of cognitive demand (Structured Assessment of Independent Living Skills (SAILS) subscales for food manipulation and money management). RESULTS: Mexican Americans were 2.2 times more likely than European Americans to have MMSE scores <24. Multiple logistic regression analysis revealed that neighborhood was an independent predictor of low MMSE scores in Mexican Americans, with the relationship between ethnic group and MMSE explained by neighborhood. After adjusting for neighborhood type, no differences were noted between Mexican Americans and European Americans. Independent of other factors examined, low education was associated with low MMSE scores in both Mexican Americans and European Americans. Mexican Americans with MMSE scores <24 took significantly longer to complete four out of five performance-based food manipulation tasks and all three money management tasks. CONCLUSIONS: Neighborhood type was a predictor of cognitive impairment. Education affected MMSE scores similarly in both ethnic groups. MMSE scores <24, indicative of cognitive impairment, were uniformly associated with functional impairment in both the Mexican Americans and European Americans. Among older Mexican Americans, MMSE-classified cognitive impairment was significantly associated with poorer performance on timed tasks with varying levels of cognitive demand independent of other correlates. A similar pattern of association was observed in European Americans. Thus, the MMSE appears to be a valid indicator of cognitive impairment in survey research in both older Mexican Americans and European Americans.

New-onset incontinence and markers of frailty: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly.

BACKGROUND: Urinary incontinence in older adults has many distinct etiologies and is associated with lower self-reported health. However, it is unclear whether the new onset of urinary incontinence marks newly emergent frailty. METHODS: Using a longitudinal population-based survey of older Mexican Americans (N = 2660) across five south-western states, this study compared the strength of association between markers of physical frailty such as activities of daily living (ADLs), instrumental activities of daily living (IADLs), and performance (timed walk, timed chair rise, and tandem balance) with baseline incontinence (prevalent disease) and new-onset incontinence (incident disease). RESULTS: We found that 14.1% of the participants (n = 329) were incontinent at baseline (prevalent cases) and 11.6% (n = 208) were newly incontinent 2 years later (incident cases). Controlling for other covariates, prevalent incontinence was only associated with a 60% increased risk of having difficulty walking 8 ft. Incident incontinence was associated with a twofold increased risk of impairment in ADLs and IADLs, and poor performance on all three physical measures. CONCLUSIONS: Incident incontinence is associated with an increased risk of more global functional impairment. Thus, incident disease may be an important early marker for signaling the onset of frailty among persons who become incontinent after the age of 65 years.

Prevalence, incidence, and risk factors associated with hip fractures in community-dwelling older Mexican Americans: results of the Hispanic EPESE study. Establish Population for the Epidemiologic Study for the Elderly.

OBJECTIVES: To determine the rates and risk factors associated with hip fractures in the community-dwelling older Mexican-American population. DESIGN: A prospective survey of a regional probability sample of older Mexican Americans aged 65 and over. SETTING: The 1993-1996 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, aged 65 and over, living in the Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: In 1993-1994 and in 1995-1996, 2895 persons, aged 65 and over, considered Mexican American, were selected at baseline as a weighted probability sample. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest US. MEASUREMENTS: Self-reported hip fracture and functional measures by in home interviews. RESULTS: Hip fracture prevalence was 4.0% at baseline. The overall incidence of hip fractures for women was 9.1 fractures/1000 person-years. The incidence rate for men was 4.8 fractures/1000 person-years. Extrapolation from these data to the entire older Mexican American population indicated that approximately 5162 new fractures occurred in the population during the 2 year study period. In women, hip fractures were associated independently with advanced age, not being married/living alone, having had a stroke, limitations with activities of daily living and instrumental activities of daily living. In men, only the latter limitations were associated independently with hip fracture. CONCLUSIONS: This study indicates that older Mexican American people may have hip fracture incidence rates that place them at highest risk among the Hispanic subgroups. In light of a sparse literature on this population, the fracture estimates derived from this work contributes to our understanding of the true fracture estimates in this population. Based on the extrapolated population rates, hip fracture in this population is a significant public health problem. Adequate preventive measures need to be implemented in this growing US population.

Patterns of prescription drug utilization in elder Mexican Americans: results from the Hispanic EPESE Study. Established Population for the Epidemiologic Study of the Elderly.

The objective of this study was to determine the patterns of prescription medication usage among community-dwelling Mexican-American elders. This was a cross-sectional survey of a regional probability sample of 2,895 community-dwelling Mexican Americans, aged 65 and over. Of the sample, 58.1% used at least one prescribed medication within the two weeks prior to their participation in the study. Women were significantly more likely than men to use analgesics, non-steroidal anti-inflammatory agents, prescription nutritional supplements, and other central nervous system and endocrine medications. Subjects aged 75 and over were more likely to use cardiovascular medications, nutritional supplements, ophthalmic preparations and antihistamines, while those in the age groups 65-69 and 70-74 were more likely to use hypoglycemic and endocrine medications. Interestingly, there was a significantly decreased usage of hypoglycemic medications in the older age group (aged 75 and over) as compared with the younger age groups (65-69 and 69-74). This may indicate that Mexican American elders are dying at younger ages from complications related to diabetes mellitus and are not alive to use hypoglycemic medications at ages 75 and over. Also, men used more hypoglycemic medication than women (77% vs 70%). There was no relationship between use of medication and severity of diabetic illness.

Effects of a psychosocial intervention on survival among patients with stage I breast and prostate cancer: a matched case-control study.

CONTEXT: Psychosocial factors have been linked to the development and progression of cancer and shown to be relevant in cancer care. However, the evidence that psychosocial interventions affect cancer survival is less conclusive. Few methodologically sound studies have addressed this issue. OBJECTIVE: To investigate the effects of a 6-week psychosocial intervention on survival among patients with stage I breast and prostate cancer. DESIGN: Matched case-control. SETTING: 3 rural hospitals or cancer centers in central Pennsylvania. PATIENTS: 21 breast and 29 prostate stage I cancer patients (treatment group) matched with 74 breast and 65 prostate stage I cancer patients from the same hospitals who did not receive the intervention (control group). INTERVENTION: Six 2-hour health psychology classes conducted by a licensed staff psychologist. MAIN OUTCOME MEASURES: Survival time was compared between the 2 groups and with national norms. RESULTS: The intervention group lived significantly longer than did matched controls. At 4- to 7-year follow-up (median = 4.2 years), none of the breast cancer patients in the intervention group died, whereas 12% of those in the control group died. Twice as many matched-control prostate cancer patients died compared with those in the intervention group (28% vs 14%). Control group survival was similar to national norms. CONCLUSIONS: These results are consistent with prior clinical trials and suggest that short-term psychosocial interventions that encourage the expression of emotions, provide social support, and teach coping skills can influence survival among cancer patients. However, self-selection bias cannot be ruled out as an alternative explanation for the results. These interventions merit further consideration and research.

Psychological and behavioral predictors of body fat distribution: age and gender effects.

OBJECTIVE: Abdominal fat has been shown to be associated with several adverse outcomes including diabetes, cardiovascular disease, and hypertension. Risk factors for abdominal fatness include genetic effects, age, and gender. Most recently, it has been hypothesized that psychological factors, as well as behavioral factors, may play a part in where fat is distributed. The purpose of this study was to assess the longitudinal predictive power of psychological variables (cynicism, anger, anxiety, and depression) measured in 1987 on waist-hip ratio (WHR) measured from 1992 to 1994 among different age and gender groups, as well as to test if alcohol consumption or smoking (measured in 1990) would mediate any of the relationships found. RESEARCH METHODS AND PROCEDURES: Data from the Swedish Adoption/Twin Study of Aging (n = 1392; average age: 58 years for middle-aged group and 74 years for older group; 58% female) were analyzed using a maximum-likelihood regression model where age, gender, and age by gender effects were assessed. RESULTS: Cynicism and anxiety predicted WHR in middle-aged subjects regardless of gender. Cynicism explained 2.5% of the variance in WHR and anxiety explained 1.7% of the variance in WHR. Anger predicted WHR in males regardless of age, explaining 4.0% of the variance; depression predicted WHR only in middle-aged females, explaining 2.0% of the variance. All analyses adjusted for body mass index, and neither alcohol consumption or smoking status mediated the relationships. DISCUSSION: These findings are suggestive with regard to the hypotheses that certain psychological states and behaviors may be associated with increased abdominal fatness.

Smoker reactions to a "radio message" that Light cigarettes are as dangerous as Regular cigarettes.

The purpose of this study was to examine in a systematic, controlled fashion the reactions of smokers to scientifically correct information about the risks of smoking Light cigarettes (about 6-15 mg tar by the FTC method). Random-digit dialing, computer-assisted telephone interviews were used to locate daily smokers of Light cigarettes. In an experimental design, smokers were randomly assigned to listen (n = 293) or not (n = 275) to a persuasive simulated radio message on the risks of Light cigarettes; 108 of those who did not listen to the message in the first part of the interview were played the message in the second part, to evaluate some repeated-measures effects. Those who heard the message were more likely to report that one Light cigarette could give a smoker the same amount of tar as one Regular cigarette and that Light cigarettes were more dangerous: 55% said the message made them think more about quitting and 46% said the message increased the amount they wanted to quit; 42% said that after hearing the message they thought Light cigarettes were more dangerous. Using the Theory of Planned Behavior, structural equation modeling analysis indicated that the message acted to increase intention to quit smoking by increasing the desire to quit smoking. Seventy-three per cent of the smokers agreed that it was important to play such messages widely on the radio; 77% agreed that there should be a warning on packs that vent blocking increases tar; 61% agreed that the location of filter vents should be marked. The majority of smokers of Light cigarettes seem to value being informed that Light cigarettes are as dangerous for them as Regular cigarettes, and this information increases their intentions to quit smoking.

Applying multilevel analytic strategies in adolescent substance use prevention research.

BACKGROUND: School-based drug prevention programs have been criticized on methodologic grounds because the unit of analysis is often not the unit of randomization, thus increasing the likelihood of Type I errors. Application of multilevel analytic strategies appropriately corrects this biasing tendency. This study demonstrates the practical use of such analysis. METHODS: Data from 2,370 seventh-grade students participating in a substance use prevention trial were analyzed using a multilevel strategy. We examined the effectiveness of a social pressure resistance training and a normative education (NORM) intervention against an information-only control group. RESULTS: The NORM condition revealed 1-year program effects for cigarette and marijuana use with individuals as the unit of analysis and only marginal effects with classroom as the unit of analysis. No program effects were found using school as the analysis unit. A multilevel strategy revealed program effects for cigarettes and marijuana with both class and school as grouping levels. The effect for alcohol use was significant at the 2-year follow-up. CONCLUSIONS: Interventions establishing conservative drug use norms in classrooms may be an effective strategy in reducing substance use onset among adolescents. Utilization of appropriate analytic strategies is important in the analysis and interpretation of data containing nested structures.

Street youth, their peer group affiliation and differences according to residential status, subsistence patterns, and use of services.

This study characterizes subcultural differences within an inner-city street youth population. Variations in residential status, subsistence patterns, and service utilization according to peer group affiliation were explored. A brief structured interview was administered to 752 youth, ages 12 to 23 years, who had been living on the streets for two or more consecutive months, or who were fully integrated into the "street economy." Subjects were recruited for the study using a stratified probability sampling design, with 30% recruited from community-based service sites and 70% from street locations and at natural "hang-outs." Five street youth groups were identified: "punks/skinheads," "druggies," "hustlers," "gang members," and "loners." The results demonstrated unique patterns with respect to places stayed/slept, means of financial support and economic subsistence, and use of available services according to peer group affiliation. The implications of these findings and recommendations for future research and service provision are discussed.

Drug use, needle sharing, and HIV risk among injection drug-using street youth.

Infection drug use is the second most common HIV risk behavior in the United States, but little is known about injection drug use and needle-sharing behavior among street youth, a group at high risk for HIV infection. This study investigates the drug use histories, injection drug use behaviors, and needle-sharing practices of 106 injection drug using youth in Los Angeles, California. Respondents report high rates of injection drug use and needle sharing, indicating that these youth are at particularly high risk for HIV infection. Results suggest a need for outreach services tailored to the unique needs of injection drug-using adolescents.

A measurement model of adolescent smoking.

Self report measures of smoking may contain substantial measurement error. If these errors are nonrandom, then they may be correlated with substantive variables in epidemiologic or intervention studies, thus confounding and biasing estimates of structural relations. In efforts to circumvent such bias, investigators have supplemented questionnaires with biological indicators of exposure to tobacco smoke. However, errors in biological indicators may also include systematic errors that produce biased estimates. The current study was designed to estimate the variance of systematic and random errors in self report and two biologic measures of smoking in adolescents. A linear model was fit to data from 342 males and 250 females with repeated measures separated by 1 year. Thiocyanate and self report were found to have substantial nonrandom error components that were correlated with psychosocial variables. In contrast, errors in carbon monoxide in expired air were not autocorrelated, and were uncorrelated with psychosocial variables.

Comparison of prorenoate potassium and spironolactone after repeated doses and steady state plasma levels of active metabolites.

1 After repeated single daily doses, the aldosterone antagonists prorenoate potassium and spironolactone were compared with regard to renal antimineralocorticoid activity, plasma potassium concentration and steady state plasma levels of their active metabolites, prorenone and canrenone respectively, in a balanced crossover study of twelve healthy subjects. 2 Following challenge with the mineralocorticoid, fludrocortisone, best estimates of the potency of prorenoate potassium relative to spironolactone were 3.6 (95% confidence limits 1.6-10.4) for urinary sodium excretion and 3.4 (95% confidence limits 2.0-6.5) for urinary log10 10Na/K. Estimates with respect to urinary potassium excretion and plasma potassium concentration were imprecise, confirming the limitations of the fludrocortisone model in the evaluation of aldosterone antagonists at steady state. 3 Both compounds exhibited directly proportional relationships between daily dose and steady state plasma levels of active metabolites. The approximate mean terminal elimination half-life of prorenone at steady state was 32.6 h (range 18-80 h).

Haloperidol pharmacokinetics: a preliminary study in rhesus monkeys using a new radioimmunoassay procedure.

The development, validation, and application of a new radioimmunoassay for haloperidol in biological fluids is described. The antiserum, raised against N-amino-butyl chlorophenyl piperidine bovine albumin conjugate, could not distinguish between haloperidol and its reduced metabolite, but it could discriminate against chlorophenyl piperidine (cross-reaction 2.6%). The fluorophenyl metabolites of haloperidol were not recognized by the antiserum. Haloperidol determinations were made on less than 100 microliter aliquots of human and rhesus monkey plasma or diluted urine without prior extraction of the sample. The radioimmunoassay was applied to the study of the pharmacokinetics of intravenous haloperidol administration to two male rhesus monkeys. Salient features of the results are as follows. As with man, the plasma concentration versus time curve could be resolved into three compartments, but there were differences in the distribution of haloperidol between the compartments. The apparent volume of distribution for the two monkeys examined was 5.87 L kg-1 and 7.37 L kg-1, considerably smaller than in man, a difference almost entirely due to a much smaller tissue compartment. The biological half-life of 15.97 hr and 7.56 hr was similar to man. The mean hepatic extraction ratio was calculated to be 0.032 and 0.056, and the data suggested that hepatic metabolism of haloperidol may be of lesser importance in rhesus monkey than in man. An insignificant proportion (0.01%) of the administered dose was excreted as haloperidol in the urine.

Effects of inhaled diesel emissions and coal dust in rats.

Rats were exposed to coal dust and diesel exhaust emissions, separately and in combination, for 20 months to evaluate the potential health effects of these specific mine air materials. The diesel exhaust was produced by an engine operated in a load, no-load mode and acceleration, deceleration cycle. It was also modified to simulate an inefficiently tuned engine. Exposure to coal dust was performed in a whole-body rodent inhalation system. Mortality, body weight and hematologic parameters examined were normal compared with those of control rats. Lesions observed were primarily restricted to the lungs and were similar to those described for simple coal workers' pneumoconiosis (CWP). Lesion progression and severity was related to exposure duration and exposure material. Alveolar bronchiolization, though not reported in human CWP, was present in the lungs of some rats in all exposure groups except the control animals.

The metabolism of canrenone in vitro by rat liver preparations.

1. The metabolism of [1-3H]canrenone, a primary metabolite of spironolactone and potassium canrenoate, by rat liver preparations in vitro has been investigated. 2. Canrenone was metabolized by 3-oxo-delta 4-reduction to give 3 alpha-hydroxy-5 beta-spirolactones, and also by a number of O2 and NADPH-dependent microsomal hydroxylation reactions. 3. A major metabolic route requiring the presence of a microsomal fraction, but apparently independent of oxygen and NADPH, led to the formation of a number of compounds tentatively identified as trihydroxy-spirolactones.