Disparities in Physical and Psychological Symptoms in Hospitalized African American and White Persons with Dementia.
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ABSTRACT:
SUBMITTER: Boltz M
PROVIDER: S-EPMC8122036 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:In the US, the majority of cancer samples analyzed are from white people, leading to biases in racial and ethnic treatment outcomes. Colorectal cancer (CRC) incidence and mortality rates are high in Alabama African Americans (AAs) and Oklahoma American Indians (AIs). We hypothesized that differences between racial groups may partially explain these disparities. Thus, we compared transcriptomic profiles of CRCs of Alabama AAs, Oklahoma AIs, and white people from both states. Compared to CRCs of white people, CRCs of AAs showed (a) higher expression of cytokines and vesicle trafficking toward modulated antitumor-immune activity, and (b) lower expression of the ID1/BMP/SMAD axis, IL22RA1, APOBEC3, and Mucins; and AIs had (c) higher expression of PTGS2/COX2 (an NSAID target/pro-oncogenic inflammation) and splicing regulators, and (d) lower tumor suppressor activities (e.g., TOB2, PCGF2, BAP1). Therefore, targeting strategies designed for white CRC patients may be less effective for AAs/AIs. These findings illustrate needs to develop optimized interventions to overcome racial CRC disparities.
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Project description:BackgroundModerate to severe pain has been frequently reported in hospitalized older adults. Pain in hospitalized persons with dementia within the context of other common symptoms, functional decline, delirium, and behavioral and psychological symptoms of dementia (BPSD), has received little attention.AimsDescribe the incidence of pain, the pharmacologic management of pain, and the association of pain with physical function, delirium, and BPSD in hospitalized persons with dementia.DesignDescriptive, cross-sectional study.SettingSix medical units in three hospitals.ParticipantsBaseline data from 299 hospitalized persons with dementia enrolled in the Family-centered Function-focused Care (Fam-FFC) cluster randomized trial.MethodsDescriptive analyses of pain used the Pain Assessment in Advanced Dementia (PAINAD) scale and the use of medication for pain management. Linear regression analyses tested relationships between pain and:1) physical function (Barthel Index), 2) delirium severity (Confusion Assessment Method Severity Short Form) and 3) BPSD severity (Neuropsychiatric Inventory- Questionnaire).ResultsThe majority of the sample was female (61.9%), non-Hispanic (98%), and Black (53.2%), with a mean age of 81.58 (SD=8.54).Of the 299 patients, 166 (56%) received pain medication. Of the 108 individuals who demonstrated pain, 40% (n=43) did not receive pain medication. When controlling for age, gender, cognition, and comorbidities, pain was significantly associated with function, delirium severity, and BPSD severity.ConclusionsResults suggest that pain may be undertreated in hospitalized persons with dementia, and should be considered upon admission to optimize function, decrease delirium, and prevent or decrease BPSD.
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Project description:ObjectivesThe aims of this study were to: (1) describe the prevalence of behavioral and psychological symptoms of dementia in hospitalized older adults living with dementia and (2) examine the association of physical activity and behavioral and psychological symptoms of dementia among hospitalized older adults living with dementia, after controlling for covariates.MethodsPhysical activity was measured using the Physical Activity Survey and behavioral and psychological symptoms of dementia were measured using the Neuropsychiatric Inventory. Descriptive analysis and multiple linear regressions were run using baseline data on 294 older adults with dementia hospitalized on general medical units from an ongoing study entitled Function Focused Care for Acute Care Using the Evidence Integration Triangle.ResultsParticipants performed an average of 7.92 (SD = 4.49) of 34 possible activities "in the last 24 h" prior to the Physical Activity Survey administration. A total of 132 participants (45.5%) had at least one behavioral and psychological symptom of dementia. We found that physical activity was not associated with behavioral and psychological symptoms of dementia (b = 0.01; p = 0.56), after controlling for covariates.ConclusionsAlthough this study found no evidence of an association between physical activity and behavioral and psychological symptoms of dementia, evidence of physical activity did not exacerbate these behaviors. Thus, given the benefits of physical activity, it is important to continue to encourage patients living with dementia to engage in activity.
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Project description:Persons with dementia are at high risk for hospital-acquired disability, associated with low physical activity during hospitalizations. To determine the effectiveness of efforts to increase physical activity, a valid and reliable measurement approach is required. Data from an ongoing cluster randomized clinical trial examined the feasibility and validity of the MotionWatch 8 (MW8) triaxial actigraphy device. The sample included 321 participants of which 259 (81%) were willing to wear the MW8 for 24 hr. Regression analysis revealed that time in low activity, β = 0.17, t(255) = 2.9, p = .004, and time in moderate activity, β = 0.14, t(255) = 2.4, p = .017, measured by the MW8, were associated with participants' physical function. Engagement in moderate physical activity was associated with return to baseline function at discharge (Wald χ2 = 4.10, df = 1, p = .043). The study provides preliminary support for the feasibility and validity of the MW8 in hospitalized persons with dementia.
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Project description:ObjectiveTo examine whether health-related stressors and resources are associated with physical function, depression, and anxiety in Chinese American and White breast cancer survivors.MethodDuring 2011-2013, this cross-sectional study enrolled Chinese American and White women from California cancer registries diagnosed with Stage 0-III breast cancer between 2006 and 2012. Survivors completed a telephone survey assessing health-related factors including comorbidity, treatment-related symptoms, medical communication, perceived threat, use of coping, and social support resources. Outcomes were assessed using the Patient-Reported Outcome Measurement Information System® (PROMIS®) short forms. Chinese were classified as low- or high-acculturated based on English proficiency, years in the United States, and interview language. Analyses were conducted using Tobit regression models.ResultsLow-acculturated Chinese (n = 136) had worse physical functioning than Whites (n = 216), controlling for demographics, cancer stage, and time since diagnosis (β = -3.33, p = .01). This disparity was attenuated after adjusting for comorbidity and symptoms (β = -1.63, p = .18). Perceived threat, disengagement coping, and lack of social support were associated with poorer psychological outcomes, regardless of ethnicity. Although low-acculturated Chinese had lower scores on all health-related factors than Whites, the former reported significantly lower level of depression (β = -3.23) and anxiety (β = -5.8) after adjusting for covariates (both p < .05). High-acculturated Chinese (n = 84) did not differ from Whites except that the former had significantly lower anxiety.ConclusionLow-acculturated Chinese may benefit from interventions aimed to improve their physical problems. However, despite experiencing greater psychosocial stress, they reported better emotional functioning. Whether Chinese culture shapes this resiliency, or if it is a reporting bias will need further investigation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Project description:Residential area characteristics and discrimination have been associated with psychological distress. Differences in these relationships across racial groups are not well understood. We examined the relative role of perceived discrimination, neighborhood problems and neighborhood cohesion/trust in explaining differences in psychological distress (indicated by anxiety and depressive symptoms) between 224 African American and 225 White smokers (income ≤ 400% federal poverty level) in a smoking cessation intervention study. Surveys were linked to US census-tract data. We conducted random intercept Poisson multi-level regression models and examined interactions between race and neighborhood experiences. African Americans had greater risk of anxiety and depressive symptoms and greater individual and neighborhood disadvantage than Whites. Controlling for objective neighborhood characteristics, when perceived discrimination and perceived neighborhood characteristics were added to the regression models the association between anxiety symptoms and race were no longer statistically significant; the association between depressive symptoms and race decreased but remained statistically significant. Lower neighborhood social cohesion/trust and greater neighborhood problems increased depressive symptoms for African Americans, but not for Whites. Perceived discrimination and neighborhood social cohesion/trust outweighed the importance of race in explaining anxiety symptoms. These findings underscore the need for multi-level interventions addressing social and environmental contexts.
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Project description:In the US, the majority of cancer samples analyzed are from white people, leading to biases in racial and ethnic treatment outcomes. Colorectal cancer (CRC) incidence and mortality rates are high in Alabama African Americans (AAs) and Oklahoma American Indians (AIs). We hypothesized that differences between racial groups may partially explain these disparities. Thus, we compared transcriptomic profiles of CRCs of Alabama AAs, Oklahoma AIs, and white people from both states. Compared to CRCs of white people, CRCs of AAs showed (a) higher expression of cytokines and vesicle trafficking toward modulated antitumor-immune activity, and (b) lower expression of the ID1/BMP/SMAD axis, IL22RA1, APOBEC3, and Mucins; and AIs had (c) higher expression of PTGS2/COX2 (an NSAID target/pro-oncogenic inflammation) and splicing regulators, and (d) lower tumor suppressor activities (e.g., TOB2, PCGF2, BAP1). Therefore, targeting strategies designed for white CRC patients may be less effective for AAs/AIs. These findings illustrate needs to develop optimized interventions to overcome racial CRC disparities.
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Project description:ObjectiveTo test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits.Data sourcesSecondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011. We used the HCUP SEDD and SID. We obtained FQHC service data from the Uniform Data System.Study designThe psychiatric ED visit is the dependent variable. Logistic regression methods control for individual risk factors for ED use, as well as county-level health system factors and county and year fixed effects. Key independent variables include indicators of mental health service capacity in FQHCs in a county-year.Data extraction methodsWe extracted ED psychiatric visits for 3.3 million African American and white youth in nine states, 2006-2011, from the HCUP SEDD and SID, and FQHC data from the Uniform Data System.Principal findingsOverall mental health visits at FQHCs correlate positively with psychiatric ED visits among African American youth. However, increases in the number of mental health visits per FQHC patient corresponds with fewer outpatient psychiatric ED visits among African American youth, relative to white youth (odds ratio = 0.96; 95% CI = 0.94, 0.98).ConclusionsIncreases in the intensity of services offered per mental health patient at FQHCs-rather than increases in overall capacity-may reduce African American youth's overreliance on the ED for psychiatric care.
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