Ethnically diverse older adults' beliefs about staying mentally sharp

This study examined diverse older adults' (n = 396, ages 50+) views about how to stay mentally sharp. We conducted 42 focus groups in four languages at nine United States locations using a standardized discussion guide and methods. The groups represented African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos, and Vietnamese Americans. All groups mentioned benefits of social interaction. All groups, especially Chinese and African Americans, mentioned benefits of community engagement. Participants in all groups expressed their belief that mental stimulation, particularly reading, promoted cognitive health; African Americans and Whites were especially likely to say that mental exercises (e.g.; puzzles) were useful. Results suggest opportunities for education about potential cognitive health benefits of being socially connected through senior center activities and volunteer programs.     

Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes

OBJECTIVES: Family caregiving is an integral part of the care system for persons with dementing disorders, such as Alzheimer's disease. This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving. DESIGN: Training effectiveness was tested in a trial in which family care receiver dyads were randomly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months, following completion of data collection. SETTING: A community-based 14-hour training program provided in seven weekly 2-hour sessions. The training program curriculum was built on a stress and coping theory base. Recruitment and randomization were ongoing. Programs were begun every 2 months over a two and one half-year period for a total of 16 programs. PARTICIPANTS: Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate. MEASUREMENTS: Data reported in this paper were gathered from each participating family at entry to the study and 5 months later. Standard measures of beliefs about caregiving, burden, depression, and reaction to care receiver behavior were administered to caregivers. A standard measure of mental status was administered to the person with dementia and standardized instruments were used to gather information from caregivers concerning care receivers' behavior and abilities to perform activities of daily living (ADLs). RESULTS: Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data. Treatment and control caregivers and care receivers were similar at baseline, and care receivers in both groups declined similarly over the 5-month period. Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving (P = .044) and reaction to behavior (P = .001). When outcomes were compared, treatment group caregivers were significantly different (in the expected direction) from those in the control group on measures of the stress mediator, beliefs (P = .025), and key outcomes, response to behavior (P = .019), depression (P = .040), and burden (P = .051). There was a significant positive association between the strengthened mediator, the caregivers' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities, and the outcome, namely improvements in burden (P = .019) and depression (P = .007). CONCLUSION: A caregiver training intervention focused on the work of caregiving and targeted at knowledge, skills, and beliefs benefits caregivers in important outcome dimensions. The results suggest the benefits of providing information, linkage, and role coaching to dementia family caregivers.     

Ethnic differences in older americans: awareness, knowledge, and beliefs about hypertension

BACKGROUND: Hypertension is often uncontrolled and contributes to health disparities, especially among individuals >or=50 years old. Ethnic differences in awareness, knowledge, and beliefs about hypertension may contribute to these disparities, but information is limited. METHODS: To address this gap, data from a national telephone survey on 1503 Americans 50 years and older were used to assess ethnic differences in awareness, knowledge, and beliefs about hypertension and the relationship of the responses to self-reported blood pressure (BP) control. RESULTS: Overall there were no ethnic differences in knowledge and beliefs about hypertension; however, there were differences in responses to specific questions. African Americans were more knowledgeable about the definition of hypertension and were more aware that hypertension can cause kidney failure than Hispanics and whites (64.2% v 54.8% and 46.3%, P<.0001). African American and Hispanics were more likely to perceive medications as the only way to control BP (50.5% and 55.5% v 23.3%, P<.0001), whereas whites reported lifestyle changes as more important than African Americans in BP control. Comparing self-reported BP control between ethnic groups, belief that medications are not the only way to treat BP (odds ratio [OR] 2.37, 95% confidence interval [CI] 1.43-3.95) and knowledge that moderation of alcohol use can lower BP (OR 2.34, 95% CI 1.20-4.57) were significantly associated with higher BP control rates. CONCLUSIONS: Ethnic differences in specific dimensions of knowledge and beliefs about hypertension exist and account for some of the disparities in BP control. Culturally appropriate educational programs that address these deficiencies may reduce disparities.     

Knowledge and beliefs about influenza,pneumococcal disease,and immunizations among older people

OBJECTIVES: Despite the burden of disease caused by influenza and pneumococcus, immunization rates are moderate and have not reached national goals set for 2010. This study's objective was to identify patient knowledge, attitudes, and beliefs that serve as facilitators of and barriers to influenza and pneumococcal vaccination. DESIGN: A survey conducted in 2000 by computer-assisted telephone interviewing. SETTING: To encounter a broad spectrum of patients and healthcare systems, we sampled patients at inner-city health centers, Department of Veterans Affairs outpatient clinics, and rural and suburban practices. PARTICIPANTS: Inclusion criteria were patients aged 66 and older and an office visit after September 30, 1998. MEASUREMENTS: Responses to questionnaire. RESULTS: Overall, 1,007 (82%) interviews were completed among 1,234 people contacted by phone. Vaccination against pneumococcal disease was significantly related to being able to accurately describe one or more classic symptoms of pneumonia (P =.05). Vaccination against influenza and pneumococcal disease was significantly related to belief that vaccination was the best way to prevent these diseases (P <.001). The unvaccinated reported that they felt they were not likely to contract influenza and that they did not know they needed the pneumococcal vaccine. Access was not related to vaccination status. CONCLUSIONS: Educational campaigns to increase vaccination rates among older adults should focus on symptoms of, risk for, and severity of influenza and pneumococcal diseases and encouraging physicians to recommend the vaccines to their patients.     

Personality, family history, and alcohol use among older men: the VA Normative Aging Study

BACKGROUND: We examined personality traits (Sociability, Impulsivity, Neuroticism) as mediators of the effects of family history on alcohol outcomes. METHODS: A sample of 485 men reported on family history of alcohol problems in 1973, completed the Eysenck Personality Inventory in 1976, and responded to a survey on alcohol use in 1982. RESULTS: Using structural equation modeling, family history was found to have direct effects on number of drinks per day and on the number of alcohol problems, as well as indirect effects mediated through Neuroticism. There were no effects of Sociability or Impulsivity on either alcohol outcome. CONCLUSIONS: In this sample of older men, family history had both direct and indirect effects, and personality traits found to affect alcohol outcomes were different from those that have been found in younger men.     

Mammography-related beliefs of older women. A survey of an HMO population

Although breast cancer risk increases with age, most studies show that mammography use decreases. A 15-minute telephone survey of 548 women health maintenance organization (HMO) members aged 65 to 74 who had not obtained a mammogram within the past year was undertaken to identify sociodemographic factors as well as knowledge, belief, and attitudinal characteristics associated with mammography history. Women who had never had a mammogram were less likely to have received a physician's recommendation and more likely to express negative attitudes about mammography, such as having a mammogram means "looking for trouble" and "makes me nervous." In addition, they expressed doubts about their need to have a mammogram and reported that "other problems" prevented them from having a mammogram. These results suggest that women who have never had a mammogram may require more intensive interventions to encourage them to obtain mammograms. In addition to receiving a mammography recommendation from their physicians, they might benefit from individual or small group educational sessions where negative attitudes about mammography could be explored and modified.     

Ras and relatives--job sharing and networking keep an old family together

Many members of the Ras superfamily of GTPases have been implicated in the regulation of hematopoietic cells, with roles in growth, survival, differentiation, cytokine production, chemotaxis, vesicle-trafficking, and phagocytosis. The well-known p21 Ras proteins H-Ras, N-Ras, K-Ras 4A, and K-Ras 4B are also frequently mutated in human cancer and leukemia. Besides the four p21 Ras proteins, the Ras subfamily of the Ras superfamily includes R-Ras, TC21 (R-Ras2), M-Ras (R-Ras3), Rap1A, Rap1B, Rap2A, Rap2B, RalA, and RalB. They exhibit remarkable overall amino acid identities, especially in the regions interacting with the guanine nucleotide exchange factors that catalyze their activation. In addition, there is considerable sharing of various downstream effectors through which they transmit signals and of GTPase activating proteins that downregulate their activity, resulting in overlap in their regulation and effector function. Relatively little is known about the physiological functions of individual Ras family members, although the presence of well-conserved orthologs in Caenorhabditis elegans suggests that their individual roles are both specific and vital. The structural and functional similarities have meant that commonly used research tools fail to discriminate between the different family members, and functions previously attributed to one family member may be shared with other members of the Ras family. Here we discuss similarities and differences in activation, effector usage, and functions of different members of the Ras subfamily. We also review the possibility that the differential localization of Ras proteins in different parts of the cell membrane may govern their responses to activation of cell surface receptors.     

IRAK-4: a novel member of the IRAK family with the properties of an IRAK-kinase

Toll/IL-1 receptor family members are central components of host defense mechanisms in a variety of species. One well conserved element in their signal transduction is Ser/Thr kinases, which couple early signaling events in a receptor complex at the plasma membrane to larger signalosomes in the cytosol. The fruit fly Drosophila melanogaster has one member of this family of kinases, termed Pelle. The complexity of this pathway is vastly increased in vertebrates, and several Pelle homologs have been described and termed IL-1 receptor-associated kinase (IRAK). Here we report the identification of a novel and distinct member of the IRAK family, IRAK-4. IRAK-4 is the closest human homolog to Pelle. Endogenous IRAK-4 interacts with IRAK-1 and TRAF6 in an IL-1-dependent manner, and overexpression of IRAK-4 can activate NF-kappa B as well as mitogen-activated protein (MAP) kinase pathways. Most strikingly, and in contrast to the other IRAKs, IRAK-4 depends on its kinase activity to activate NF-kappa B. In addition, IRAK-4 is able to phosphorylate IRAK-1, and overexpression of dominant-negative IRAK-4 is blocking the IL-1-induced activation and modification of IRAK-1, suggesting a role of IRAK-4 as a central element in the early signal transduction of Toll/IL-1 receptors, upstream of IRAK-1.     

家属参与糖尿病教育管理临床分析

目的 在医生、家属、患者、护士参与（MUST）的糖尿病教育模式研究基础上,观察不同家属与患者组合对糖尿病患者长期治疗依从性的影响.方法 选择2010年3至5月在山东省滨州市人民医院门诊就诊的居住于本市的2型糖尿病患者,按就诊顺序确定入选患者及其家属300对.按照不同的家属与患者关系分为妻管夫型、夫管妻型、晚辈管长辈型以及长辈管晚辈型4组.采用改良的Deborah糖尿病自我管理评价表进行24个月的患者依从性测定,分析依从性的影响因素.两组间均数比较采用独立样本t检验,多组均数比较采用方差分析.结果 家属中女性明显多于男性（60％比40％,x2=24.00,P＜0.05）,主要来源于妻管夫型组（31.0％）.各分组家属和患者年龄、家属主动联系次数和自愿参加糖尿病教育次数差异均有统计学意义（x2=61.18、107.77、35.45、44.79,均P ＜0.05）,其中最高的主动联系次数比例出现在妻管夫型（12.3％）,而主动联系医护人员的夫管妻型中的丈夫只有1.0％.家属主动参加糖尿病教育次数总体偏少,大部分为两年只参加了不到3次.24个月的观察期间,夫管妻型完全从医率呈持续上升趋势,各观察时期与观察前（33.9％）比较差异均有统计学意义（第6、12、18、24个月分别为60.3％、67.9％、70.9％、74.1％,x2=6.762、9.626、12.131、11.707,均P＜0.05）.晚辈管长辈型和妻管夫型完全从医率呈现上升并维持高平台趋势.长辈管晚辈患者完全从医率呈“∧”形分布.观察结束时,完全从医率以夫管妻型患者最高（74.1％）,其次为晚辈管长辈型（60.8％）、妻管夫型（48.3％）和长辈管晚辈型（29.0％）.所有患者的完全从医率为52.3％.以观察结束时完全从医为因变量分析影响因素显示,与患者完全从医相关的家属因素为性别、年龄、主动联系次数和分组（OR=3.593、0.251、2.734、0.692,均P＜0.05）.与患者自身相关的完全从医影响因素为性别、文化程度和分组（OR=0.497、2.558、0.443,均P＜0.05）.结论 夫管妻型长期完全从医率最佳.同等辈分中女性作为监管者比男性效果好,不同辈分中晚辈监管长辈效果好,这种良好的效果与家属联系医护人员的主动性有关.     

Measuring resident and family member determinants of satisfaction with assisted living

PURPOSE: This study developed measures of satisfaction with assisted living from residents' and family members' perspectives. DESIGN AND METHODS: We collected survey data from 204 residents and 232 family members associated with 11 assisted living facilities. We used confirmatory factor analysis to evaluate the goodness of fit of a priori measurement models. RESULTS: Iterative analysis to improve measurement models resulted in a multifaceted unidimensional model of resident satisfaction and a 5-factor model of family member satisfaction. The scales are both comprehensive and parsimonious and display strong scalar properties. IMPLICATIONS: These scales provide tools for estimating the impact of assisted living on various relevant domains for residents and their family members. These measures should prove useful to administrators attempting to meet the needs of their clients and to potential clients of assisted living attempting to judge the appropriateness of specific assisted living facilities.     

Another Swedish family with complete properdin deficiency: association with fulminant meningococcal disease in one male family member

Inherited deficiency of the complement component properdin is described in a Swedish family without any previous history of meningococcal infections. The properdin-deficient index patient died from a fulminant infection caused by Neisseria meningitidis serogroup Y. Family investigation revealed properdin deficiency in the patient's half-brother and in the maternal grandfather. The half-brother had a history of pneumococcal pneumonia and meningitis probably caused by Borrelia burgdorferi. Opsonic and bactericidal functions of serum were examined in the half-brother after immunization with tetravalent meningococcal vaccine. Vaccination promoted opsonization of N. meningitidis serogroups C and Y but not of serogroups A and W-135. The serum bactericidal activity increased against serogroup C and to some extent against serogroup W-135. This report emphasizes the importance of investigating the complement system even in families with single cases of fulminant meningococcal disease. Individuals with properdin deficiency might be protected from infection by immunization.     

Challenges of cross-national housing research with older persons: lessons from the ENABLE-AGE project

Although it is generally acknowledged that housing is a major issue regarding health in old and very old age, most empirical research still tends to treat the role of the housing environment in a rather superficial manner. The cross-national project Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing (ENABLE-AGE) seeks to make a substantial contribution to this shortcoming. The main objective of the project is to examine subjective and objective aspects of housing and their impact on health in very old age, while health is understood mainly in terms of autonomy, participation and well-being. The project involves five European Union member countries, i.e. Sweden (coordinating unit), Germany, the United Kingdom, Latvia and Hungary. The total sample includes 1,918 older adults in the age range of 75–89 years and living in single households. We provide a systematic analysis of major challenges coming with cross-national research in the housing and ageing domain based on the experience of the ENABLE-AGE Project. Treated are: challenges related to sampling and data collection procedures, challenges related to inclusion and exclusion criteria based on housing characteristics, challenges related to differences in housing legislation, norms, and guidelines, challenges related different availability of professional expertise for person-environment assessments, challenges related to valid and reliable person-environment assessments, and challenges related to the interpretation of housing-related findings.     

Food impaction in older age:Think about an eosinophilic esophagitis

Eosinophilic esophagitis is an inflammatory condition of esophagus.It is generally seen in childhood and young population.Men are more commonly affected than women.However,it is not common in an advanced age.Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodation against foods.Therefore,the major symptom in adults with eosinophilic esophagitis is difficulty in swallowing solid food(dysphagia).Specifically,the food gets stuck in the esophagus after it is swallowed.Less common symptoms include heartburn and chest pain.Because of this,it may be incorrectly diagnosed as a gastroesophageal reflux disease.Here,we reported a case presented with food impaction at advanced age.As a conclusion,eosinophilic esophagitis is a rare entity that must be remembered in advance aged patients presenting with food impaction.     

Isolation of an additional member of the fibroblast growth factor receptor family, FGFR-3.

The fibroblast growth factors are a family of polypeptide growth factors involved in a variety of activities including mitogenesis, angiogenesis, and wound healing. Fibroblast growth factor receptors (FGFRs) have previously been identified in chicken, mouse, and human and have been shown to contain an extracellular domain with either two or three immunoglobulin-like domains, a transmembrane domain, and a cytoplasmic tyrosine kinase domain. We have isolated a human cDNA for another tyrosine kinase receptor that is highly homologous to the previously described FGFR. Expression of this receptor cDNA in COS cells directs the expression of a 125-kDa glycoprotein. We demonstrate that this cDNA encodes a biologically active receptor by showing that human acidic and basic fibroblast growth factors activate this receptor as measured by 45Ca2+ efflux assays. These data establish the existence of an additional member of the FGFR family that we have named FGFR-3.     

Isolation and characterization of fra-2, an additional member of the fos gene family.

Antiserum raised against a Fos peptide (amino acids Lys-127 to Arg-140 of chicken c-Fos) recognizes a 46-kDa Fos-related protein in cell lysates of growth-stimulated chicken embryo fibroblasts. Induction of the 46-kDa protein is transient but is slightly prolonged relative to c-Fos following growth stimulation. Using a mixed oligonucleotide probe encoding the peptide antigen, we have cloned the chicken genomic locus that encodes this protein and have determined its gene structure. This locus consists of four exons, each of which has some homology with the corresponding exons of the chicken c-fos gene, and it expresses a 6-kilobase mRNA after growth stimulation. The deduced amino acid sequence of the gene (323 amino acids) contains a "leucine zipper" and includes five distinct regions that exhibit strong sequence homology to the recently identified fos-related antigens Fra-1 (rat) and FosB (mouse) as well as c-Fos. Since the other regions of the gene have little homology to any of these three proteins, this gene was named "fra-2." When the fra-2 gene was overexpressed by an avian retrovirus vector, it caused transformation of chicken embryo fibroblasts. The fra-2 gene product formed a complex in cells with the c-Jun protein, indicating that c-fos and fra-2 share biological and biochemical functions.     

Dependent behaviours and beliefs: a qualitative study of older long-term smokers with arterial disease

Aims. To examine the reasons for continuing to smoke provided by a sample of long-term older smokers who have arterial disease (a smoking-related condition) and the implications of those beliefs for current smoking behaviour and future smoking intent.
Design. Qualitative semi-structured interview study with face-to-face interviews using 'life grids'.
Setting and participants. Twenty-two long-term older smokers, with arterial disease, who were participants of a larger qualitative study of Life Course Influences on Patterns of Persistent Smoking.
Measurement. Qualitative semi-structured interviews explored how respondents' described their relationship to smoking, using life grids to capture changes in patterns of cigarette usage across the life course.
Findings. Older smokers with arterial disease defined their relationship to smoking in either dependent terms or functional terms (to fulfil specific purposes). The two types of relationship appeared to be associated more with different degrees of control smokers described exercising over their habit than with their levels and patterns of usage. Some older smokers with arterial disease who showed dependent patterns of behaviour did not believe they were dependent, and some who showed non-dependent patterns of usage did not think of themselves as smokers even though they smoked. The immediate, functional and material benefits which these smokers attributed to smoking appeared to outweigh anticipated immediate and/or long term health-related benefits of quitting.
Conclusions. How smokers define their relationship to cigarettes does not necessarily correspond to levels and patterns of usage.