A smartphone app effectively facilitates mothers' mind-mindedness: A randomized controlled trial.

The efficacy of a smartphone app intervention (BabyMind©) in facilitating mind-mindedness was investigated in a randomized controlled trial, assigning mothers and their 6-month-olds (N = 152; 72 girls, 146 White) to intervention or active control conditions. Mothers who had received the BabyMind© app intervention scored higher for appropriate (d = .61, 95% CI .28, .94) and lower for non-attuned (d = -.55, 95% CI -.92, -.18) mind-related comments at follow-up (age 12 months), compared with their control group counterparts. Adjusting for missing data did not alter this pattern of findings. Mothers' baseline parental reflective functioning did not moderate these relations. Results are discussed in terms of the benefits of early intervention and exploring the efficacy of the app in more diverse populations.

Feasibility of a Telephone-Delivered Group Meditation Intervention for Chronically Ill Socially Isolated Older Adults.

OBJECTIVES: This pilot study assessed the feasibility of a group-based telephone-delivered meditation intervention to reduce social isolation in older adults. It included weekly training sessions and daily practices of loving-kindness meditation in small groups via telephone conferences for six weeks and an extended group meditation practice for another six weeks. METHODS: Community-living older adults (age 60+) with multiple chronic conditions and experiencing social isolation were recruited. Each participant was assessed at the pretest, posttest, and follow-up (6 and 12 weeks after pretest). Outcome measures included social interaction, loneliness, and depressive symptoms. Open-ended questions were asked in the posttest and follow-up. RESULTS: Sixteen individuals enrolled, and fourteen completed the program (87.5% retention). Completers showed high levels of adherence (95% attendance to training) and acceptability and a statistically significant increase in social interaction at follow-up. Qualitative data suggest that participants experienced changes in emotion regulation, motivation and confidence, and sense of belonging. CONCLUSIONS: A group-based telephone-delivered meditation intervention targeting chronically ill older adults who experience social isolation is technically feasible, very acceptable, and potentially beneficial to them. CLINICAL IMPLICATIONS: Older adults enjoy learning meditation. Telephone conferencing is a low-cost tool for engaging socially isolated older adults in social interactions and group meditation.

Trajectories of social isolation and depressive symptoms in mid- and later life: a parallel process latent growth curve analysis.

OBJECTIVES: Social isolation has subjective and objective dimensions. This study explored the change trajectories of both dimensions of isolation and depressive symptoms and their interrelationships in terms of levels and changes over time. METHODS: Data were drawn from the 2006-2018 Health and Retirement Study, involving a nationally representative sample of middle-aged and older adults (N = 7890). Parallel process latent growth curve models were used. RESULTS: Over time, objective isolation displayed a non-linear upward trend, subjective isolation displayed a non-linear downward trend, and depressive symptoms remained relatively stable. More objectively isolated people experienced smaller increases in objective isolation and more subjectively isolated people experienced smaller decreases in subjective isolation. Such negative intercept-slope associations were not observed for depressive symptoms. Net of sociodemographic characteristics, physical disabilities, functional limitations, and chronic diseases, each isolation dimension was associated with the level of depressive symptoms. But only the rate of change in subjective isolation was positively associated with that of depressive symptoms. CONCLUSION: The initial level of objective isolation may be one of the common origins of subjective isolation and depressive symptoms. Recognition of such shared origins is important in mitigating the synergistic and deleterious effects of loneliness and depression in middle-aged and older adults.

Sociodemographic dynamics and age trajectories of depressive symptoms among adults in mid- and later life: a cohort perspective.

OBJECTIVES: This study explored the age trajectories of depressive symptoms across multiple cohort groups who were in middle and late adulthood; examined sociodemographic differences in these trajectories; and investigated how relevant factors contributed to depressive symptoms trends of different cohorts. METHODS: Drawing on data from the 1994-2016 Health and Retirement Study (HRS), we used growth curve models to examine the age patterns of depressive symptoms, changes in sociodemographic gaps in depressive symptoms trajectories, and predictors of changes in depressive symptoms. RESULTS: In general, adults' depressive symptoms started high in middle-adulthood, declined in young-old life, increased moderately in mid-old life, and peaked in old-old life; In detail, more nuanced cohort-specific age trajectories of depressive symptoms were observed, challenging the prevailing assumption of a common age trajectory of depressive symptoms. Later-born cohorts displayed higher levels of depressive symptoms than earlier-born cohorts at observed ages. Second, we found intra-cohort sociodemographic differences in levels of depressive symptoms, but these differences' growth rates varied by specific factors. Regardless of the cohort group, as people age, the gender gap in depressive symptoms persisted but the partnership gap reduced. A widening educational gap across cohorts was observed, but it declined with age in some cohorts. CONCLUSION: Results suggest more evidence for the persistent inequality and age-as-leveler hypotheses rather than the cumulative (dis-)advantage hypothesis.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.2010182 .

Dyadic effects on depressive symptoms of spouse caregivers and their care recipients: evidence from China.

OBJECTIVES: The likelihood of providing care to a spouse in middle and older ages has increased as life expectancy increases, but knowledge about how the caregiver and care recipient influence each other's mental health is limited. This study examined whether a partner's physical, cognitive, and mental health in a spousal caregiving dyad are associated with the other partner's depressive symptoms in China and whether the dyadic effects vary by gender. METHODS: This study used data from Wave 3 (2015) and Wave 4 (2018) follow-up surveys of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample featured 1,245 dyads of care recipients aged 45 or older and their spouse caregivers. The Actor-Partner Interdependence Model was used to test the dyadic effects among all couples in the analytic sample, couples with wife caregivers and couples with husband caregivers, respectively. RESULTS: We found that caregiver's depressive symptoms at Wave 3 were significantly associated with care recipient's depressive symptoms at Wave 4 in the full sample. Regardless of caregiver or care recipient roles, wives' mental health was impacted by their husbands' depressive symptoms, but not vice versa. Wife recipient's cognitive impairment was associated with husband caregiver's lower depressive symptoms. CONCLUSION: This study sheds light on the mental health of couples in the context of caregiving in China. The findings indicate that interventions to support couples in a caregiving dyad need to consider the influence they have on each other, and the gender and health conditions of each in the dyad.

Interventions to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents: a systematic review and meta-analysis.

The psychosocial health of children and adolescents has been particularly affected by the COVID-19 pandemic. Containment measures have restricted social development, education and recreational activities, may have increased family conflicts and, in many cases, led to feelings of loneliness, sleep disturbances, symptoms of anxiety and depression. We conducted a systematic review to identify interventions that seek to ameliorate these detrimental effects of the COVID-19 pandemic and to build resilience in children and adolescents. Literature searches were conducted in the databases MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO COVID-19 Global literature on coronavirus disease and Cochrane COVID-19 Study Register (up to 30 June 2022). The searches retrieved 9557 records of which we included 13 randomized-controlled trials (RCTs) for evidence synthesis. Included studies predominantly implemented online group sessions for school-aged children with either a psychological component, a physical activity component, or a combination of both. A meta-analysis of seven studies on anxiety and five on depressive symptoms provided evidence for a positive effect of interventions by reducing anxiety (Standardized Mean Difference (SMD) (95% CI): - 0.33 (- 0.59; - 0.06)) and depressive symptoms (SMD (95% CI): - 0.26 (- 0.36; - 0.16)) compared to the control interventions. Studies also showed improvements in positive mental health outcomes, such as resilience (n = 2) and mental and psychological wellbeing (n = 2). Exploratory subgroup analyses suggested a greater effectiveness of interventions that (i) are of higher frequency and duration, (ii) enable personal interaction (face-to-face or virtually), and (iii) include a physical activity component. Almost all studies were judged to be at high risk of bias and showed considerable heterogeneity. Further research may focus on the contribution of different intervention components or distinct subgroups and settings, and should examine children and adolescents over longer follow-up periods.

Early psychosocial risk factors and postnatal parental reflective functioning.

Psychosocial factors have been found to relate to parental reflective functioning (PRF), a parent's ability to mentalize about themselves and their child. Relations between maternal psychosocial risk factors and PRF were investigated in a community sample. A sample of mothers (n = 146) was assessed for risk factors when infants were 6 months, infant temperament was assessed using an observational measure, and PRF was assessed with the Parent Development Interview-Revised (PDI). PRF was measured again with the Parental Reflective Functioning Questionnaire (PRFQ) when children were 4 years (n = 105) and 5 years (n = 92), with an additional sample of mothers (n = 48) tested at these two timepoints. Results showed that in infancy, total maternal psychosocial risk related to lower PDI-PRF; regression analyses highlighted low socioeconomic status, unplanned pregnancy, and low maternal anxiety as independent predictors of lower PDI-PRF. PDI-PRF scores at 6 months did not relate to PRFQ scores, but PRFQ subscales showed stability over time from age 4-5. Results are discussed with regard to the impact of maternal psychosocial risk and infant temperament on PRF and the stability and concordance of PRF measures.

[Epidemiology of mental well-being in childhood and adolescence. Results from three epidemiological studies before and during the COVID-19 pandemic]. / Epidemiologie seelischen Wohlbefindens von Kindern und Jugendlichen in Deutschland. Ergebnisse aus 3 Studien vor und während der COVID-19-Pandemie.

BACKGROUND: Continuous nationwide health monitoring is important to track the well-being of children and adolescents and to map developmental trajectories. Based on the results of three selected epidemiological studies, developments in child well-being over the past 20 years are presented. METHODS: Data are based on (1) the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (BELLA study, 2003-2017, N = 1500 to 3000), which is a module of the KiGGS study; (2) the COvid-19 and PSYchological Health Study (COPSY, 2020-2022, N = 1600-1700), which is based on the BELLA Study; and (3) the International Health-Behaviour in School-aged Children Study (HBSC, 2002-2018, N = 4300-7300). Well-being was assessed in 7­ to 17-year-olds using indicators of health-related quality of life (KIDSCREEN-10), life satisfaction (Cantril Ladder), and mental health problems (Strenghts and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC)). RESULTS: Overall, children and adolescents show consistently high health-related quality of life and high overall life satisfaction pre-pandemic (2002-2018), which initially worsened with the onset of the 2020 COVID-19-pandemic. Two years later, improvements are evident but have not yet reached baseline levels. Psychological problems, as well as symptoms of anxiety and depression, increased by up to 12 percentage points at the beginning of the pandemic and are still higher two years after the onset of the pandemic compared to pre-pandemic studies. CONCLUSION: The epidemiology of child well-being provides a necessary data basis to assess the support needs of children and adolescents and to use this as a basis for developing measures of health promotion, prevention, and intervention.

A Systematic Review of the Impact of Select Mindfulness Interventions on Psychological Outcomes among Older Adults with Chronic Health Conditions.

OBJECTIVES: Chronic medical conditions can increase the likelihood of experiencing psychological distress and mental health problems among older adults. Mindfulness interventions (MIs) are evidence-based treatment approaches that can improve psychological outcomes. This systematic literature review examines MI studies that focused on older adults (≥60 years old) with chronic health conditions. METHODS: Five databases were systematically searched for intervention studies that involved older adults with chronic health conditions who received acceptance and commitment therapy, mindfulness-based cognitive therapy, or mindfulness-based stress reduction and that included psychological outcomes. RESULTS: A total of 17 studies were identified that met criteria for inclusion. These studies involved interventions for a range of chronic health conditions including chronic pain, stroke, type 2 diabetes, insomnia, cancer, and chronic obstructive pulmonary disease. CONCLUSIONS: Early evidence for MIs impact on psychological outcomes is promising, though more work involving randomized control trials is needed. Current studies generally lack methodological rigor and have a high risk of bias. Given the high rates of chronic pain in older adults and the emerging evidence for MIs, future work in this area is of particular value. CLINICAL IMPLICATIONS: Practitioners should be guardedly optimistic about the value of MIs and ACT for older adults with chronic health conditions.

Effectiveness of integrated care for older adults with depression and hypertension in rural China: A cluster randomized controlled trial.

BACKGROUND: Effectiveness of integrated care management for common, comorbid physical and mental disorders has been insufficiently examined in low- and middle-income countries (LMICs). We tested hypotheses that older adults treated in rural Chinese primary care clinics with integrated care management of comorbid depression and hypertension (HTN) would show greater improvements in depression symptom severity and HTN control than those who received usual care. METHODS AND FINDINGS: The study, registered with ClinicalTrials.gov as Identifier NCT01938963, was a cluster randomized controlled trial with 12-month follow-up conducted from January 1, 2014 through September 30, 2018, with analyses conducted in 2020 to 2021. Participants were residents of 218 rural villages located in 10 randomly selected townships of Zhejiang Province, China. Each village hosts 1 primary care clinic that serves all residents. Ten townships, each containing approximately 20 villages, were randomly selected to deliver either the Chinese Older Adult Collaborations in Health (COACH) intervention or enhanced care-as-usual (eCAU) to eligible village clinic patients. The COACH intervention consisted of algorithm-driven treatment of depression and HTN by village primary care doctors supported by village lay workers with telephone consultation from centrally located psychiatrists. Participants included clinic patients aged ≥60 years with a diagnosis of HTN and clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10). Of 2,899 eligible village residents, 2,365 (82%) agreed to participate. They had a mean age of 74.5 years, 67% were women, 55% had no schooling, 59% were married, and 20% lived alone. Observers, older adult participants, and their primary care providers (PCPs) were blinded to study hypotheses but not to group assignment. Primary outcomes were change in depression symptom severity as measured by the Hamilton Depression Rating Scale (HDRS) total score and the proportion with controlled HTN, defined as systolic blood pressure (BP) <130 mm Hg or diastolic BP <80 for participants with diabetes mellitus, coronary heart disease, or renal disease, and systolic BP <140 or diastolic BP <90 for all others. Analyses were conducted using generalized linear mixed effect models with intention to treat. Sixty-seven of 1,133 participants assigned to eCAU and 85 of 1,232 COACH participants were lost to follow-up over 12 months. Thirty-six participants died of natural causes, 22 in the COACH arm and 14 receiving eCAU. Forty COACH participants discontinued antidepressant medication due to side effects. Compared with participants who received eCAU, COACH participants showed greater reduction in depressive symptoms (Cohen's d [±SD] = -1.43 [-1.71, -1.15]; p < 0.001) and greater likelihood of achieving HTN control (odds ratio [OR] [95% CI] = 18.24 [8.40, 39.63]; p < 0.001). Limitations of the study include the inability to mask research assessors and participants to which condition a village was assigned, and lack of information about participants' adherence to recommendations for lifestyle and medication management of HTN and depression. Generalizability of the model to other regions of China or other LMICs may be limited. CONCLUSIONS: The COACH model of integrated care management resulted in greater improvement in both depression symptom severity and HTN control among older adult residents of rural Chinese villages who had both conditions than did eCAU. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01938963 https://clinicaltrials.gov/ct2/show/NCT01938963.

Social isolation trajectories in midlife and later-life: patterns and associations with health.

OBJECTIVES: Social isolation has objective and subjective dimensions. Few studies have simultaneously examined trajectories of both dimensions. We integrated multiple indicators of both dimensions to identify social isolation trajectory patterns and investigated how different patterns were related to adults' physical, mental, cognitive, and self-rated health. METHODS: We used latent class growth modeling to examine social isolation trajectory patterns, based on data from the 2008-2016 waves of the Health and Retirement Study (N = 6457). Mixed-effect linear models were used to examine how trajectory patterns were associated with functional limitations, depressive symptoms, memory deficits, and self-rated health over the 8-year study period. RESULTS: Four social isolation trajectory patterns were identified: severe isolation (15.4%), moderate isolation (37.6%), some objective and rare subjective isolation (35.4%), and rare objective and low subjective isolation (11.6%). Social isolation trajectory patterns showed a gradient in all health domains. The rare objective and low subjective isolation group had the best health (i.e., the fewest functional limitations, depressive symptoms, and memory deficits and the best self-rated health); the some objective and rare subjective isolation group had the next best health; the moderate isolation group had the second worst health; and the severe isolation group had the worst health. CONCLUSIONS: The prevalence and stability of severe and moderate social isolation suggest it may be necessary to address social isolation at the national level. The most favorable health outcomes associated with the rare objective and low subjective isolation group supports interventions to strengthen social networks and engagement midlife and later-life.

Identification of a Thiol-Disulfide Oxidoreductase (SdbA) Catalyzing Disulfide Bond Formation in the Superantigen SpeA in Streptococcus pyogenes.

Mechanisms of disulfide bond formation in the human pathogen Streptococcus pyogenes are currently unknown. To date, no disulfide bond-forming thiol-disulfide oxidoreductase (TDOR) has been described and at least one disulfide bonded protein is known in S. pyogenes. This protein is the superantigen SpeA, which contains 3 cysteine residues (Cys 87, Cys90, and Cys98) and has a disulfide bond formed between Cys87 and Cys98. In this study, candidate TDORs were identified from the genome sequence of S. pyogenes MGAS8232. Using mutational and biochemical approaches, one of the candidate proteins, SpyM18_2037 (named here SdbA), was shown to be the catalyst that introduces the disulfide bond in SpeA. SpeA in the culture supernatant remained reduced when sdbA was inactivated and restored to the oxidized state when a functional copy of sdbA was returned to the sdbA-knockout mutant. SdbA has a typical C46XXC49 active site motif commonly found in TDORs. Site-directed mutagenesis experiments showed that the cysteines in the CXXC motif were required for the disulfide bond in SpeA to form. Interactions between SdbA and SpeA were examined using cysteine variant proteins. The results showed that SdbAC49A formed a mixed disulfide with SpeAC87A, suggesting that the N-terminal Cys46 of SdbA and the C-terminal Cys98 of SpeA participated in the initial reaction. SpeA oxidized by SdbA displayed biological activities suggesting that SpeA was properly folded following oxidation by SdbA. In conclusion, formation of the disulfide bond in SpeA is catalyzed by SdbA and the findings represent the first report of disulfide bond formation in S. pyogenes. IMPORTANCE Here, we reported the first example of disulfide bond formation in Streptococcus pyogenes. The results showed that a thiol-disulfide oxidoreductase, named SdbA, is responsible for introducing the disulfide bond in the superantigen SpeA. The cysteine residues in the CXXC motif of SdbA are needed for catalyzing the disulfide bond in SpeA. The disulfide bond in SpeA and neighboring amino acids form a disulfide loop that is conserved among many superantigens, including those from Staphylococcus aureus. SpeA and staphylococcal enterotoxins lacking the disulfide bond are biologically inactive. Thus, the discovery of the enzyme that catalyzes the disulfide bond in SpeA is important for understanding the biochemistry of SpeA production and presents a target for mitigating the virulence of S. pyogenes.

Implementing collaborative care for older people with comorbid hypertension and depression in rural China.

BACKGROUND: Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team-village doctor (VD), aging worker (AW), and psychiatrist consultant-provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation. METHODS: Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis. RESULTS: COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders' support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members' caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs. CONCLUSIONS: COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.

The Longitudinal Associations between Physical Health and Mental Health among Older Adults.

OBJECTIVES: This study examines the lead-lag relationship between physical and mental health among older adults. METHOD: Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated. RESULTS: Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health. CONCLUSION: This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.

Cumulative exposure to air pollution and subsequent mortality among older adults in China.

BACKGROUND: Research on the health effects of exposure to air pollution is growing. However, relatively little attention has been paid to the effects of long-term and cumulative exposure to air pollutants. Individual-level studies on the health consequences of air pollution in China are especially scarce. The purpose of this study is to examine the effect of cumulative exposure to sulfur dioxide (SO2), an air pollutant of particular concern in China, on all-cause mortality in older Chinese adults. METHODS: Using a nationally representative sample of older adults in China (N = 11 199), we tracked mortality over an 11-year period (2000-11). Air pollution data were linked to respondents using provincial identifiers. To examine the effect of cumulative SO2 exposure on mortality, we employed multilevel multinomial logistic regression models that account for within subject clustering of observations over time and clustering at the province level. RESULTS: We found that every 10-µg/m3 increase in cumulative exposure to SO2 increased the odds of death by nearly 1% (OR = 1.008; 95% CI: 1.002-1.014), controlling for province- and individual-level social and economic characteristics. CONCLUSIONS: Our analysis shows that air pollution is a risk factor for morality in older Chinese adults. Findings suggest that stronger SO2 regulations may enhance longevity.

Association of Self-Reported Discrimination and Suicide Ideation in Older Chinese Americans.

OBJECTIVE: This study examines racial discrimination as a potential novel risk factor for suicide ideation among older Chinese Americans. DESIGN: In a cross-sectional analysis, this study drew on data collected in the Population-based Study of Chinese Elderly in Chicago on Chinese older adults age 60 + in the Greater Chicago area (N = 3,157). Thirty-day suicide ideation was a dichotomous variable, derived from items of the Physical Health Questionnaire and the Geriatric Mental State Examination-Version A. Self-reported discrimination was dichotomously coded, based on the Experiences of Discrimination instrument, which asks respondents whether they have ever experienced discrimination in nine situations because of their race/ethnicity/color. RESULTS: About 4.1% of the sample reported 30-day suicide ideation and 21.5% reported discrimination. Self-reported discrimination was significantly associated with suicide ideation before and after adjusting for covariates including sociodemographic characteristics; neuroticism; social relationships; and physical, cognitive and mental health. In the fully adjusted model, those who reported discrimination had 1.9 times higher odds (OR: 1.9; 95% CI: 1.18-3.08; Wald χ2 = 6.9, df = 1, p = 0.01) of suicide ideation than those who did not. CONCLUSION: Chinese American seniors who reported discrimination had an almost twofold greater odds of 30-day suicide ideation compared with those who did not. Clinicians need to recognize the impact of discrimination on ethnic minority elders. For those who report experiencing discrimination, assessment of suicide risk may be necessary. Efforts to promote civil rights and reduce discrimination may also be a form of primary prevention of suicide.

Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study.

BACKGROUND: Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. METHODS: The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village's Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects' electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. DISCUSSION: The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT01938963 ; First posted: September 10, 2013.

The prevalence of depressive symptoms among older patients with hypertension in rural China.

OBJECTIVE: The comorbidity of depression and hypertension (HTN) is common and complicates the management of both conditions. This study investigated the prevalence of depressive symptoms among older patients with HTN in rural China and explored the relationship between the two conditions. METHODS: The baseline data of older patients diagnosed with HTN included in the depression/HTN in Chinese Older Adults-Collaborations for Health Study were used for the analysis. The Chinese Older Adults-Collaborations for Health Study was conducted in rural villages of Tonglu County, Zhejiang Province, China. In all, 10 389 older village residents had HTN (57.2% female, mean age 71.5 ± 8.1 years). Blood pressure was measured by using a calibrated manual sphygmomanometer and stethoscope. Depressive symptom was measured by using the Chinese version of the nine-item Patient Health Questionnaire. RESULTS: Among 10 389 patients with HTN, 12.8% had significant depressive symptoms (nine-item Patient Health Questionnaire ≥ 10). Rates of significant depressive symptoms were 5.3% and 32.8% among patients with controlled and uncontrolled HTN (systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90), respectively (χ2 = 8.701, p < 0.001). Logistic regression analysis indicated that those in older age group (≥70 years) and with uncontrolled HTN have higher rates of significant depressive symptoms than those who are younger (age 60 to <70) and with controlled HTN. CONCLUSION: Our findings show high rates of depressive symptoms among patients with HTN in rural China and higher rates of depressive symptoms among patients with uncontrolled HTN. These support the development and dissemination of integrative care approaches for older adults with HTN and depression in rural China. Copyright © 2016 John Wiley & Sons, Ltd.

Divergent effects of Porcupine and Wntless on WNT1 trafficking, secretion, and signaling.

Loss-of-function studies have identified Porcupine (PORCN) and Wntless (WLS) as essential mediators of Wnt secretion and signaling. Whereas PORCN is thought to palmitoylate Wnt proteins, WLS is believed to transport palmitoylated Wnt proteins to the cell surface. However, little is known about how these two proteins cooperate to regulate Wnt palmitoylation, trafficking, secretion, and signaling. We first investigated possible interactions between PORCN, WLS, and WNT1, by carrying out co-immunoprecipitation studies. These studies demonstrate the existence of a complex containing PORCN and WLS. They further show that PORCN and WLS compete for binding to WNT1. Then, we used gain-of-function studies to investigate the cooperation between PORCN and WLS as well as possible biochemical interactions between PORCN, WLS, and WNT1. Consistent with the proposed roles for PORCN and WLS, we show that overexpression of PORCN promotes palmitoylation of WNT1 while overexpression of WLS does not. Overexpression of PORCN enhances the ability of WLS to promote WNT1 trafficking to the cell surface as well as secretion, but decreases the ability of WLS to activate WNT1 signaling in target cell. These observations suggest that the levels of WNT1 on the cell surface and in the media are not the sole determinants of the activation of Wnt signaling in target cells.

"How Would We Deserve Better?" Rural-Urban Dichotomy in Health Seeking for the Chronically Ill Elderly in China.

As China's older adult population has rapidly increased, the attending increase in chronic disease poses serious concerns regarding disparities in medical care utilization for elders. Drawing on 48 semistructured interviews with elders with chronic conditions and their caregivers in China, this article analyzes two opposite patterns of health-seeking behavior in urban and rural areas. Presenting the findings as a relational model, we argue that the interplay between structures of medical care and cultural discourses about health and (un)worthiness generates different habitus as sets of practices and beliefs that facilitate or hinder elders' and their caregivers' decisions to engage with medical care. By demonstrating the Chinese state's social health insurance reform's failure to improve health-seeking behavior on the ground, our findings suggest that efforts to understand and promote health-seeking behavior need to address the intersections of structural and cultural factors.