Racial/ethnic and gender differences in the association between self-reported experiences of racial/ethnic discrimination and inflammation in the CARDIA cohort of 4 US communities

Inflammation is etiologically implicated in cardiometabolic diseases for which there are known racial/ethnic disparities. Prior studies suggest there may be an association between self-reported experiences of racial/ethnic discrimination and inflammation, particularly C-reactive protein (CRP). It is not known whether that association is influenced by race/ethnicity and gender. In separate hierarchical linear models with time-varying covariates, we examined that association among 901 Black women, 614 Black men, 958 White women, and 863 White men in the Coronary Artery Risk Development in Young Adults (CARDIA) study in four US communities. Self-reported experiences of racial/ethnic discrimination were ascertained in 1992-93 and 2000-01. Inflammation was measured as log-transformed CRP in those years and 2005-06. All analyses were adjusted for blood pressure, plasma total cholesterol, triglycerides, homeostatic model assessment for insulin resistance (HOMA-IR), age, education, and community. Our findings extend prior research by suggesting that, broadly speaking, self-reported experiences of racial/ethnic discrimination are associated with inflammation; however, this association is complex and varies for Black and White women and men. Black women reporting 1 or 2 experiences of discrimination had higher levels of CRP compared to Black women reporting no experiences of discrimination (β = 0.141, SE = 0.062, P < 0.05). This association was not statistically significant among Black women reporting 3 or more experiences of discrimination and not independent of modifiable risks (smoking and obesity) in the final model. White women reporting 3 or more experiences of discrimination had significantly higher levels of CRP compared to White women reporting no experiences of discrimination independent of modifiable risks in the final model (β = 0.300, SE = 0.113, P < 0.01). The association between self-reported experiences of racial/ethnic discrimination and CRP was not statistically significant among Black and White men reporting 1 or 2 experiences of discrimination. Further research in other populations is needed.     

Density gradient separation of peripheral blood stem cells: comparison of an automated cell processing device and manual methods

Peripheral blood stem cells were collected from normal donors by leukapheresis on a cell separator. The leukapheresis product contained 1.5 x 10(10) mononuclear cells (MNCs) and was divided into two aliquots that underwent either automated or manual density gradient separation with ficoll-hypaque and subsequent washing. In the automated process, recovery of MNCs was 85 percent, reduction in platelet content was 64 percent, and the final hematocrit (Hct) was less than 1 percent. The manual separation resulted in 76-percent MNC recovery, a 79-percent reduction in platelet content, and a final Hct of less than 1 percent. The purified MNCs were then placed in methylcellulose culture at a concentration of 4 x 10(5) MNCs per mL. Quadruplicate 1-mL aliquots were cultured, and colonies were counted and classified on Day 14. Comparison of automated and manual ficoll-hypaque separations demonstrated no differences in the total, erythroid, or granulocyte-macrophage colony numbers. The cell processor used is fast, reliable, uncomplicated, and provides a sterile product containing progenitor cells that are not adversely affected by the automated ficoll-hypaque separation.     

Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: the Work, Family, and Health Network study

Objectives. We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees.Methods. Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work–family spillover (preoccupation with work-related concerns while at home and vice versa).Results. Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work–family spillover (OR = 3.22; 95% CI = 1.11, 9.35).Conclusions. Household financial strain, food insufficiency, and work–family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families.Depression is among the most commonly experienced disorders and is a leading cause of disability worldwide.1 Increasing evidence suggests that depression is a leading cause of sickness-related absence in the labor force and is a concern for employers and employees alike.2 Women, people in lower socioeconomic positions, and racial/ethnic minorities have higher rates of depression than the general population, whether they are in the workforce or not.3 Some evidence suggests, however, that the higher prevalence of depression observed in disadvantaged groups may stem from stressors associated with their common experiences rather than from race/ethnicity, income, or gender per se.3–5Several studies have established that the presence of persistent negative and stressful experiences may lead to depression.6–9 Evidence shows that work-related strain, specifically job strain (high demand/low control) and emotional strain, is associated with depression, especially among caregiving workers.7–9 The work–family literature suggests that work–family spillover (preoccupation with work impinging on home life or preoccupation with personal responsibilities impinging on work) may be correlated with depression.10 Fewer studies, however, have explored the contribution of both household- and work-related stressors to depression.The inability to provide for one''s family despite working full time could be a significant source of stress.11 Indeed, household financial strain and food insufficiency (sometimes or often not having enough food to eat) are considered particularly stressful,12–15 especially for low-income populations.16,17 Studies have found separate associations between financial strain and food insufficiency and adverse mental health outcomes.12,17–22 However, these studies concentrated on populations with obvious disadvantages, such as the unemployed and elderly people with disabilities. Thus, the extent and deleterious effects of both household financial strain and food insufficiency—along with work–family spillover—on working-class households have not been fully examined.Nursing home workers are a growing part of the workforce who may face higher rates of household food insufficiency, financial strain, and work–family spillover.23,24 Among nursing assistants—the biggest work group in nursing homes, and among the lowest paid—the proportion of women is estimated to be 80% to 90%; most are single mothers and are thus the primary wage earners for their families.23,25 Nursing home workers are more likely to be recent immigrants who may not be aware of or eligible for government benefits.24 A majority of these low-wage earners are also members of racial/ethnic minority groups.25Research has not fully explored the relationship between household- and work-related stressors and mental health outcomes, particularly among working-class households. We examined work and home conditions—household financial strain, food insufficiency, and work–family spillover—associated with depressive symptoms in a low-wage, multiethnic group of women and men employed in the long-term care industry. Because previous studies did not examine these factors jointly, our first objective was to assess the multivariate association of each exposure with depressive symptoms. We then determined whether the association between these exposures remained in a model incorporating all 3 main variables. We hypothesized that depressive symptoms associated with these variables would be more significant and stronger for people who were the primary income providers for their households than for nonprimary wage earners.     

Association of educational level with inflammatory markers in the Framingham Offspring Study

Socioeconomic position consistently predicts coronary heart disease; however, the biologic mechanisms that may mediate this association are not well understood. The objective of this study was to determine whether socioeconomic position (measured as educational level) is associated with inflammatory risk factors for coronary heart disease, including C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, monocyte chemoattractant protein-1, and P-selectin. The study sample included 2,729 participants (53.4% women; mean age, 62 +/- 10 years) from the US Framingham Offspring Study cohort who attended examination cycles 3 (1984-1987) and 7 (1998-2001) and provided educational attainment data. Inflammatory markers were measured in fasting serum samples. Multivariable linear regression analyses were performed, adjusting for potential confounders including age, sex, and clinical risk factors. In age- and sex-adjusted analyses, educational attainment was significantly inversely associated with C-reactive protein (p < 0.0001), interleukin-6 (p < 0.0001), soluble intercellular adhesion molecule-1 (p < 0.0001), and monocyte chemoattractant protein-1 (p = 0.0004). After further adjustment for clinical risk factors, educational level remained significantly associated with C-reactive protein (p = 0.0002), soluble intercellular adhesion molecule-1 (p = 0.01), and monocyte chemoattractant protein-1 (p = 0.01). In conclusion, educational attainment is associated with inflammatory risk factors for coronary heart disease. The association provides evidence suggestive of a biologic pathway by which socioeconomic position may predispose to coronary heart disease.     

Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE.

OBJECTIVES: There is considerable evidence that social networks are strongly related to survival and other health outcomes. However, findings regarding the effect of social networks on disability outcomes have been inconsistent. This study examines this relationship with respect to the risk of developing disability and recovering from disability. METHODS: Data come from a community-based sample of the New Haven population aged 65 years and older, with nine annual interviews conducted between 1982 and 1991. Disability was measured by a 6-item index of activities of daily living (ADL), and a 3-item Rosow-Breslau index, with disability defined as impairment in one or more tasks on each measure. Social network variables were constructed for each of four domains of ties: children, relatives, friends, and a confidant, and a summary measure of total social networks. A Markov model was used to estimate one-year disability transitions averaged across all 8 intervals, after controlling for sociodemographic and health-related variables. RESULTS: Total social networks was associated with a significantly reduced risk of developing ADL disability (beta = -0.009, p < .01), and a significantly increased likelihood of ADL recovery (beta = 0.017, p < .01). Emotional and instrumental support did not affect the protective effect of social networks against disability, but partially accounted for their effect on enhanced recovery. Network variables related to relatives and friends were significantly associated with disability and recovery risks, but those related to children or a confidant were not. The associations with disability transitions as measured by the Rosow-Breslau index were generally smaller and nonsignificant. DISCUSSION: The findings lend further support for the role of social relationships in important health outcomes in old age. They suggest that being "embedded" in a social network of relatives and friends reduces risk for ADL disability, and enhances recovery from ADL disability.     

Laparoscopic evaluation of metastatic ovarian cancer: a case report

OBJECTIVE AND CASE: Both noninvasive and invasive methods have limited value in the diagnosis of metastatic ovarian cancer. We present a case with the initial complaint of abdominal distention in whom primary and metastatic tumor sites were safely diagnosed by using laparoscopy: a gastric tumor with ovarian metastasis. DISCUSSION: Diagnostic laparoscopy by the open technique provides a safe and effective diagnostic option in patients with metastatic ovarian cancer.     

Retrospective Chart Analysis of Concussion Discharge Instructions in the Emergency Department

Background

Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions.