Life Expectancy in Pre-Frail and Frail States with and without Disability: 18-Years of Follow-Up Data from the HEPESE Study Using the Markov Chain Method.

We estimated the total life expectancy (TLE), frailty-free life expectancy (FFLE), frail life expectancy (FLE), pre-frail life expectancy (PFLE), and FLE with and without disability among 2,000 Mexican Americans aged ≥67 years over an 18-year period. Frailty was defined as the presence of ≥2 criteria (weight loss, weakness, self-reported exhaustion, slowness). We used the Markov chain method to estimate the TLE, FFLE, FLE, PFLE, and FLE with and without disability by age and gender. TLE at age 67 was 17.49 years (women) and 15.54 years (men); FFLE was 6.50 years (women) and 6.45 years (men); PFLE was 6.48 years (women) and 5.42 years (men); FLE was 4.51 years (women) and 3.67 years (men); and FLE with disability was 2.13 years (women) and 1.13 years (men). In conclusion, Mexican American older women had fewer years of non-frail LE, more pre-frail or frail years, and more years with disability than men.

The Burden of Functional Disabilities for Middle-Aged and Older Adults in the United States.

OBJECTIVES: Understanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States. DESIGN: Longitudinal-Panel. SETTING: Core interviews were often performed in person or over the telephone. PARTICIPANTS: A sub-sample of 31,055 participants aged at least 50 years from the 1998-2014 waves of the Health and Retirement Study who reported having a functional disability were included. MEASUREMENTS: Ability to perform IADLs and ADLs were self-reported at each wave. The National Death Index was used to ascertain date of death. The number of years of life that were lost (YLLs) and years lived with a disability (YLDs) were summed for the calculation of disability-adjusted life years (DALYs). Sampling weights were used in the analyses to make the DALYs nationally-representative. The results for YLLs, YLDs, and DALYs are reported in thousands. RESULTS: Of the participants included, 14,990 had an IADL disability and 13,136 had an ADL disability. Men and women with an IADL disability had 236,037 and 233,772 DALYs, respectively; whereas, there were 178,594 DALYs for males and 253,630 DALYs for females with an ADL disability. Collectively, there were 469,809 years of healthy life lost from IADL impairments, and 432,224 years of healthy life lost from ADL limitations. CONCLUSIONS: These findings should be used to inform healthcare providers and guide interventions aiming to preserve the functional capacity of aging adults. Prioritizing health-related resources for mitigating the burden of functional disabilities may help aging adults increase their quality of life and life expectancy over time.

Prevalence and social determinants of smoking in the adult Greek Cypriot population.

BACKGROUND: Smoking remains a major public health concern in Europe. In the current study, we investigate the prevalence and socioeconomic factors that contribute to smoking disparities in Greek Cypriot adults.  Material and methods: In 2009, using the Countrywide Integrated Noncommunicable Disease Intervention questionnaire a representative sample of Greek Cypriot adults was surveyed (response rate 100%).  Socioeconomic and demographic data were collected and analyzed. RESULTS: The prevalence of smoking in Greek Cypriot adults was 50.8 % among men and 21.2 % among women. Sociodemographic disparities in smoking prevalence were identified, characterized by higher prevalence in urban vs rural centers (especially among women), and higher prevalence among employed women vs housewives. Socioeconomic inequalities in prevalent smoking were gender-specific, with occupational social class showing an inverse association among men and a direct among women, with income showing an inverse association (mostly among men), and educational attainment showing a clear inverse gradient among men and a direct gradient among women. CONCLUSION: Striking gender-specific bidirectional associations between socioeconomic factors and smoking prevalence were identified among Greek Cypriot adults, which may promote targeted intervention programmes aiming at halting and reversing smoking behaviors in Cyprus. Hippokratia 2016, 20(4): 284-291.

Frailty and cognitive impairment as predictors of mortality in older Mexican Americans.

OBJECTIVE: Examine the association between frailty and cognitive impairment as predictors of mortality over a 10-year period in a selected sample of older Mexican Americans. DESIGN: Longitudinal analyses using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1995-96/2004-05). SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: Mexican Americans aged 67 and older with complete information on the frailty index and the Mini Mental State Examination (MMSE) (n=1,815). MEASUREMENTS: Cognitive impairment determined by a score in the MMSE < 21. Frailty defined as three or more of the following components: 1) weight-loss, 2) weakness, 3) self-reported exhaustion, 4) slow walking speed, and 5) low physical activity level. Sociodemographic characteristics and chronic medical conditions were used as covariates. Mortality was determined using the National Death Index or by proxy. RESULTS: As MMSE score declines over time, the percent of frail individuals increases in a linear fashion. Frailty and cognitive impairment are independent risk factors for mortality after controlling for all covariates (HR 2.03 95% CI 1.57-2.62; HR 1.26 95% CI 1.05-1.52, respectively). When both cognitive impairment and frailty were added to the model, HR for individuals with cognitive impairment was no longer statistically significant. CONCLUSION: The relation between frailty and cognitive impairment needs careful analysis in this population to establish pathways increasing mortality and decreasing quality of life. Our results suggest frailty is a stronger predictor of mortality for older Mexican Americans than cognitive impairment.

Predictive Demi-Span Equations for Estimation of Stature in Aged Mexican Americans.

OBJECTIVES: To develop demi-span height predictive equations for older Mexican Americans. DESIGN: Cross-sectional study. SETTING: Data files housed by the Sociomedical Division in the department of Community Health and Preventive Medicine at the University of Texas Medical Branch in Galveston, Texas. PARTICIPANTS: 1,078 (700 females, 378 males) Southwest U.S.A. community-dwelling older Mexican Americans, aged 80-102 years. MEASUREMENTS: Demi-span, height, weight, BMI, demi-span equivalent height (DSEH), DSEH derived BMI (DS-BMI). Bland and Altman agreement analysis on: height and DSEH; BMI and DS-BMI. Paired t-test comparing derived and actual measures by single-age units and sex. RESULTS: DSEH with Bassey equations (DSEHBassey) are significantly different than actual measures. DSEHBassey derived BMIs (DSBasseyBMIs) are significantly different than BMIs computed from actual measures. DSEH with Mexican equations (DSEHMexican) are not significantly different than real measures. DSEHMexican derived BMIs (DSMexicanBMIs) are not significantly different than real measures. CONCLUSIONS: These findings provide evidence that both DSEHBassey and DSBasseyBMIs estimates are significantly different from measured height and BMI. Both DSEHMexican and DSMexicanBMIs estimates are shown to produce similar height and BMI estimates to those obtained from real measures. .

Self-reported urge urinary incontinence (UUI) among older Mexican-American men: risk factors and psycho-social consequences.

Extant literature on Urge Urinary Incontinence (UUI) focuses on women and non-Hispanic Whites and little is known about ethnic minority men. We analyzed 700 Mexican-American men aged 75 and older from the fifth Wave (2004/5) of the Hispanic Established Population for the Epidemiologic Study of the Elderly. Logistic regression analyses examined risk factors for self-reported UUI and the impact of UUI on mental health and social support. Twenty-nine percent reported having difficulty holding their urine until they could get to a toilet. Men with more co-morbid conditions and men with prostate problems were more likely to report UUI symptoms. Men with UUI were less likely to report having a confidant and had a higher risk of high depressive symptoms. This study is the first to examine risk factors for and consequences of self-reported UUI among older Mexican-American men using a large community-based survey.

Depression and mental health among older Mexican American spouses.

Although the association between marriage and well-being is well established, few studies have focused on learning more about the context of marriage and mental health. Recent research studying the mechanisms of marriage and health has focused on contagion of well-being among spouses. This study examined the association of depression with self-esteem, social support, life satisfaction, concern for independence, and cognitive function using baseline data for 553 older, Mexican American couples. Overall, we found evidence to suggest an interdependent relationship between husbands' and wives' emotional states, but the association was not equal for couples. Husbands' depression was significantly associated with the well-being of their wife, but the wife's depression was rarely associated with the husband's well-being. The findings from this study add to the increasing literature on spousal contagion by focusing on an under studied minority group, examining how depression affects well-being, and highlighting unequal effects of marriage on spousal well-being.

Determination of metabolic stability of positron emission tomography tracers by LC-MS/MS: an example in WAY-100635 and two analogues.

A method is presented for determination of microsomal metabolic stability of potential positron emission tomography (PET) tracers by LC-MS/MS in the lower nm range. The PET tracers used for the study were the serotonin receptor antagonist WAY-100635 and two potential tracer analogues. The sensitivity permitted the substrates to be directly collected from PET radiolabelling batches, containing very low amounts of substance (0.3-7 microg), for subsequent metabolic stability incubations. Sample preparation was minimal, with addition of internal standard, acetonitrile and a fast centrifugation step, as a result of the low protein concentration of the microsome solutions. Linearity (R2 > or = 0.99), precision (inter-assay R.S.D. < 7%) and accuracy (bias < or = 8%) for the tested concentration range 0.5-5 nM proved to be well within accepted limits. No significant differences in metabolic rates were detected using substrates from cold (non-labelling) chemistry syntheses and PET labelling batches, indicating the validity of using substrates from the latter source. A para-methoxy-benzamide analogue (MeO-WAY) displayed a significantly lower rate of metabolism compared to WAY-100635, whereas a para-iodo-benzamide analogue was more susceptible to metabolic transformation. LC-MS/MS Analysis of formed metabolites from WAY-100635 and MeO-WAY suggested similar metabolic pathways, with hydroxylation, demethylation and dearylation reactions. The main metabolic route in humans, amide hydrolysis, was not observed with the rat liver microsome assay.

Higher church attendance predicts lower fear of falling in older Mexican-Americans.

Several studies have shown that involvement in religious activity appears to benefit health. To estimate the association between church attendance and fear of falling, we used a sample of 1341 non-institutionalized Mexican-Americans aged 70 and over from the third wave (1998-1999) of the Hispanic Established Population for the Epidemiological Study of the Elderly, followed until 2000-2001. Baseline potential predictors of fear of falling were church attendance, socio-demographics, history of falls, summary measure of lower body performance (tandem balance, eight-foot walk, and repeated chair stands), functional status, depressive symptoms, cognitive status, and medical conditions. Fear of falling at the two-year follow-up was measured as no fear, somewhat afraid, fairly afraid, and very afraid. Chi-square statistic and multiple logistic regression analysis were used to estimate associations between the outcome and the potential predictors. Multiple logistic regression analysis showed that frequent church attendance was an independent predictor of lower fear of falling (odds ratio = 0.73, 95% confidence interval 0.58-0.92, P = 0.008) two years later. Other independent predictors of fear of falling were female gender, poorer objective lower body performance, history of falls, arthritis, hypertension, and urinary incontinence. Frequent church attendance is associated with decreased fear of falling in older Mexican-Americans.

Interferon-beta affects the tryptophan metabolism in multiple sclerosis patients.

Tryptophan and its metabolites are of great interest in understanding the pathogenesis of multiple sclerosis (MS). The total levels of tryptophan and its metabolites, kynurenine and kynurenic acid were determined in plasma by capillary liquid chromatography electrospray ionisation tandem mass spectrometry. This is the first report of the plasma levels of these analytes in healthy controls and relapsing-remitting MS patients receiving long-term and acute interferon-beta (IFN-beta) treatment. Twenty-four hours post-administration increased kynurenine levels (first IFN MS versus healthy, P = 0.042) and kynurenine/tryptophan ratio (K/T; first IFN MS versus healthy, P =0.027; first IFN MS versus long-term IFN MS, P = 0.036) were found. The long-term IFN MS group had higher K/T ratios at 4 and 12 h post-administration (P = 0.015 and 0.009, respectively). The increase of K/T ratio in the first IFN MS group indicate an induction of the enzyme indolamine-2,3-dioxygenase (IDO), as reported earlier in experimental allergic encephalomyelitis. As IDO is participating in both inflammatory and neurodegenerative processes, further knowledge of its involvement in the pathogenesis of MS is of great importance.

Determination of flumazenil in human plasma by liquid chromatography-electrospray ionisation tandem mass spectrometry.

A liquid chromatography-electrospray ionisation-tandem mass spectrometry (LC-ESI-MS/MS) method was developed to determine unlabelled flumazenil (Ro 15-1788) in human plasma in [11C]flumazenil positron emission tomography (PET) studies. N-Methyl tri-deuterated flumazenil was used as an internal standard. The analyte and internal standard were extracted from plasma samples using solid-phase extraction, with a recovery of 78%. This was determined through the convenience of radioactivity measurements of 11C-labelled flumazenil. The evaporated and reconstituted eluate was analysed by LC-ESI-MS/MS. The calibration curve was linear over the tested concentration range of 0.05-0.5 nM (15-150 pg/ml) with a correlation coefficient, R2, of 0.998+/-0.001. A high precision was achieved, with mean intra-assay and inter-assay relative standard deviations of at most 6 and 7%, respectively. The accuracy of the method ranged from 95 to 104%. As a proof of concept, the validated method was applied in the determination of flumazenil in plasma from two healthy volunteers participating in a PET study with three repeated investigations. A bolus-infusion protocol was used to achieve a constant concentration level of flumazenil. The average plasma concentrations ranged from 0.11 and 0.19 nM and all measurements were within the calibration standard range. The flumazenil concentrations were relatively constant within each scan and the average intra-scan precision was 15%.

Analysis of microsomal metabolic stability using high-flow-rate extraction coupled to capillary liquid chromatography-mass spectrometry.

A method is described for on-line high-speed extraction of microsomal samples and analysis by capillary liquid chromatography-mass spectrometry (LC-MS) for the determination of metabolic stability in connection with the development of positron emission tomography (PET) tracers. The method allowed direct injections of large sample volumes at a fast extraction rate, providing a gain in both sensitivity and sample preparation time. The calibration curve of the test compound flumazenil (Ro 15-1788) was linear in the concentration range of 1-150 nM, with a correlation coefficient exceeding 0.999. The accuracy of the method ranged from 98 to 101%. A high precision was obtained, with mean intra-assay and inter-assay relative standard deviations of at most 1.4 and 1.5%, respectively, for quality control (QC) samples. The extraction efficiency was determined to be 99.4%, the total recovery 96% and the carryover to

Neighbourhood composition and depressive symptoms among older Mexican Americans.

STUDY OBJECTIVE: Research suggests that economically disadvantaged neighbourhoods confer an increased risk of depression to their residents. Little research has been reported about the association between ethnic group concentration and depression. This study investigated the association between neighbourhood poverty and neighbourhood percentage Mexican American and depressive symptoms for older Mexican Americans in the south western United States. DESIGN: A population based study of older non-institutionalised Mexican Americans from the baseline assessment (1993/94) of the Hispanic established population for the epidemiologic study of the elderly (H-EPESE) merged with 1990 census data. SETTING: Five south western states in the United States. PARTICIPANTS: 3050 Mexican Americans aged 65 years or older. MAIN RESULTS: There was a strong correlation between the percentage of neighbourhood residents living in poverty and the percentage who were Mexican American (r = 0.62; p<0.001). Percentage neighbourhood poverty and percentage Mexican American had significant and opposite effects on level of depressive symptoms among older Mexican Americans. After adjusting for demographic and other individual level factors, each 10% increase in neighbourhood population in poverty was associated with a 0.763 (95% CI 0.06 to 1.47) increase in CES-D score, while each 10% increase in Mexican American neighbourhood population was associated with a -0.548 (95% CI -0.96 to -0.13) unit decrease in CES-D score among older Mexican Americans residing in their neighbourhoods. CONCLUSIONS: The findings suggest a sociocultural advantage conferred by high density Mexican American neighbourhoods, and suggest the need to include community level factors along with individual level factors in community based epidemiological health studies.

Phosphate buffers in capillary electrophoresis/mass spectrometry using atmospheric pressure photoionization and electrospray ionization.

Capillary electrophoresis (CE) has been combined with atmospheric pressure photoionization (APPI) and electrospray ionization (ESI) for mass spectrometric (MS) detection. Separation conditions using potassium phosphate buffer and ammonium formate buffer have been compared for analysis of eleven pharmaceutical bases. The results showed improvements in separation efficiency and peak symmetry when phosphate buffer was used. The low flow in CE may enable utilization of these advances with MS detection. Compared with ESI, the APPI technique provided a cluster-free background. The enhanced signal-to-noise ratio in the total ion current (TIC) and the reduced spectral background indicated that the APPI process is less affected by non-volatile salts in the CE buffers. This results in a wider range of choice of CE buffers in CE/MS analysis when APPI is the ionization method.

Evaluations of the stability of sheathless electrospray ionization mass spectrometry emitters using electrochemical techniques.

The processes that cause the failure of sheathless electrospray ionization (ESI) emitters, based on different kinds of gold coatings on fused-silica capillaries, are described and explained. The methods chosen for this study include electrochemical methods, ICPMS analysis of the electrolytes used, SEM studies, and electrospray experiments. Generally, the failure occurs by loss of the conductive coating. It is shown that emitters with sputter-coated gold lose their coatings because of mechanical stress caused by the gas evolution accompanying water oxidation or reduction. Emitters with gold coatings on top of adhesion layers of chromium and nickel alloy withstand this mechanical stress and have excellent durability when operating as cathodes. When operating as anodes, the adhesion layer is electrochemically dissolved through the gold film, and the gold film then flakes off. It is shown that the conductive coating behaves as a cathode even in the positive electrospray mode when the magnitude of a superimposed reductive electrophoretic current exceeds that of the oxidative electrospray current. Fairy-dust coatings developed in our laboratory (see Barnidge, D. R.; etal.Anal. Chem. 1999, 71, 4115-4118,) bygluing gold dust onto the emitter, are unaffected by the mechanical stress due to gas evolution. When oxidized, the fairy-dust coatings show an increased surface roughness and decreased conductivities due to the formation of gold oxide. The resistance of this oxide layer is however negligible in comparison with that of the gas phase in ESI. Furthermore, since no flaking and only negligible electrochemical etching of gold was found, practically unlimited emitter lifetimes may be achieved with fairy-dust coatings.

The use of herbal medicine by older Mexican Americans.

BACKGROUND: Little is known about use of herbal medicines by older Mexican Americans. The objective of this study was to determine the characteristics among older Mexican Americans that correlate with use of herbal medicines. METHODS: We administered a cross-sectional regional sample survey, the 1993-1994 Hispanic Established Populations for the Epidemiologic Study of the Elderly of Mexican Americans, by in-home interviews of noninstitutionalized older Mexican Americans age 65 and over living in Texas, New Mexico, Colorado, Arizona, and California. RESULTS: The use of herbal medicine in the 2 weeks prior to the interview was reported by 9.8% of the sample. Chamomile and mint were the two most commonly used herbs. Users of herbal medicines were more likely to be women, born in Mexico, over age 75, living alone, and experiencing some financial strain. Having arthritis, urinary incontinence, asthma, and hip fracture were also associated with an elevated use of herbal medicines, whereas heart attacks were not. We found that herbal medicine use was substantially higher among individuals reporting any disability in activities of daily living, poor self-reported health, and depressive symptoms. Herbal medicine use was associated with the use of over-the-counter medications but not with prescription medications. Herbal medicine use was particularly high among respondents who had over 24 physician visits during the year prior to interview. CONCLUSIONS: Herbal medication use is common among older Mexican Americans, particularly among those with chronic medical conditions, those who experience financial strain, and those who are very frequent users of formal health care services.

A simple and robust conductive graphite coating for sheathless electrospray emitters used in capillary electrophoresis/mass spectrometry.

A graphite-polyimide mixture was used as a conductive coating for sheathless electrospray emitters. The coating procedure described is simple and inexpensive compared to previously described methods. An investigation of the stability of the conductive coating carried out by electrochemical methods revealed good performances during oxidative stress. In addition, no decrease in emitter performance was seen during continuous electrospray in the positive electrospray mode for two weeks. Fast capillary electrophoresis with attomole sensitivity demonstrated the excellent performance of the described sheathless interface when used in conjunction with an orthogonal time-of-flight mass spectrometer. The overall simplicity, stability and low cost of this type of sheathless emitter make the described approach highly suitable for any on-column coupling of low flow rate separation techniques to a mass spectrometer.

Prevalence and associated factors of cancer screening: why are so many older Mexican American women never screened?

OBJECTIVES: The aim of this study was to identify patterns of mammogram and Papanicolaou (Pap) screenings among Mexican American women ages 67 and over. METHODS: Data on 1,403 Mexican American women from the Hispanic Established Population for the Epidemiological Study of the Elderly, a cohort study of community-dwelling Mexican Americans ages 65 years or over from the southwestern United States, were analyzed. RESULTS: Mexican American women age 75 or older were less likely to ever have had breast or cervical screening than women ages 67 to 74, even controlling for sociodemographic, cultural, and selected health factors. Overall, fewer medical conditions and never having had a hysterectomy were found to be associated with a decreased chance of ever having had a mammogram or a Pap test. Women who lacked insurance coverage and had fewer doctor visits were less likely to ever have had a mammogram, whereas women with low education, low acculturation, and lower cognitive status scores were less likely to ever have had a Pap test. CONCLUSIONS: If these results withstand more detailed studies (e.g., with the addition of important variables such as awareness), better communication with health professional doctors and improvement of access to heath care services should increase rates of both mammogram and Pap screenings.

Pressurized-fluid extraction (PFE) of chlorinated paraffins from the biodegradable fraction of source-separated household waste.

A method is presented in which pressurized-fluid extraction (PFE) is used for the extraction of chlorinated paraffins (CP) from the biodegradable fraction of source-separated household waste. The conditions that were optimized for high recovery in the extraction procedure were extraction time, temperature, and the use of different solvents and different sample particle sizes, Recoveries of CP from fortified household waste material were over 90%, with only few interferences when cyclohexane was used as solvent. Extraction yields from contaminated samples containing CP were further compared with recoveries obtained by use of Soxtec extraction. The results showed that PFE is a rapid, low-solvent-consuming technique, giving high yields.

Postmenopausal hormone replacement therapy use by older Mexican-American women.

OBJECTIVES: To determine the prevalence of current hormone replacement therapy (HRT) use and describe its correlates among community-dwelling, Mexican-American women aged 67 and older. DESIGN: A population-based survey of older Mexican-Americans conducted in 1995/1996. SETTING: Five Southwestern states: Texas, New Mexico, California, Arizona, and Colorado. PARTICIPANTS: An area probability sample of 1,424 noninstitutionalized Mexican-American women aged 67 and older (mean age = 75.1) completed the survey instrument via a 90-minute in-home interview, which included examination and recording of all medications taken. MEASUREMENTS: Current use of HRT. RESULTS: In this sample of older Mexican-American women, 4.7% were current users of HRT. Controlling for sociodemographic characteristics (age, marital status, living arrangements, years of education, income, language of interview), current HRT use is significantly related to years of education (per each year) (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.05-1.20), having had a hysterectomy (OR = 4.37; 95% CI 2.50-7.64), a diagnosis of osteoporosis (OR = 3.40, 95% CI = 1.58-7.33), age at menopause (per each year) (OR = 1.07; 95% CI = 1.03-1.12), ever having a mammogram (OR = 3.72; 95% CI = 1.66-8.37), ever having a Pap test/pelvic examination (OR = 2.11; 95% CI = 1.08-4.12), having spoken with a pharmacist within the past year regarding health conditions (OR = 1.96; 95% CI = 1.06-3.65), and having Medicare plus private insurance (OR = 2.13; 95% CI = 1.14-3.97). CONCLUSION: The prevalence of HRT use is lower than that reported in the older non-Hispanic white female population. In general, these findings indicate that access to and utilization of the traditional U.S. health care system are indicators of HRT use.