Physical health impairment and depression among older adults

We studied the effect of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interferon-gamma (IFN-gamma) on the function of thyroid cells and pituitary thyrotrophs. In FRTL-5 rat thyroid cells, both human and murine TNF-alpha inhibited basal and TSH-stimulated [125I]iodide transport. IL-1 shared this action with TNF-alpha, but was less potent. IL-1 and IFN-gamma did not cause a further reduction of TNF-alpha-induced inhibition of [125I]iodide transport. TNF-alpha, phorbol ester 12-myristate 13-acetate (PMA), and calcium ionophore (CI) A23817 all inhibited [125I]iodide transport, but high doses of PMA and CI also blocked the inhibitory action of TNF-alpha on [125I]iodide transport. Inhibition of protein kinase A and protein kinase C by H7 or HA inhibited TSH-stimulated iodide transport, but did not block the TNF-alpha action, suggesting that the mechanism of TNF-alpha action on thyroid cells is independent of protein kinase A and C. In pituitary cells, both human and murine TNF-alpha did not affect basal TSH secretion, but TNF-alpha reduced TRH-stimulated TSH secretion. This study provides further in vitro evidence that TNF-alpha inhibits the function of the hypothalamus-pituitary-thyroid axis acting directly on both the pituitary and thyroid glands.     

Symptoms of depression among community-dwelling elderly African-American and white older adults

BACKGROUND: Few studies have explored the variance in individual symptoms by race in older adults. METHODS: Data were analysed from the Duke site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), a community sample of persons 65 years-of-age and older, 54% of whom were African-Americans. Of the 3401 subjects with adequate data on depressive symptomatology, confirmatory factor analysis and LISREL were first used to confirm the presence of the factor structure previously reported for the CES-D. Next, bivariate analysis was performed to determine the prevalence of individual symptoms by race. Finally, LISREL analysis was performed to control for potential confounding variables. RESULTS: When bivariate comparisons of specific symptoms by race were explored, African-Americans were more likely to report less hope about the future, poor appetite, difficulty concentrating, requiring more effort for usual activities, less talking, feeling people were unfriendly, feeling disliked by others and being more 'bothered' than usual. When LISREL analyses were applied to these data (controlling for education, income, cognitive impairment, chronic health problems and disability and other factors) racial differences in somatic complaints and life satisfaction disappeared, yet differences in interpersonal relations persisted. CONCLUSIONS: This study confirms earlier findings of minimal overall differences in symptom frequency between African-American and non-African-American community-dwelling older adults in controlled studies.     

Daily well-being of older adults with friends and family.

Investigated the inconsistency that, even though family members are the major source of physical and emotional support for older adults, friendships have a stronger bearing on subjective well-being. 92 55–88 yr old retired adults provided self-reports on their subjective states at random moments during a typical week. Analyses of these reports confirmed the prediction that older adults have more favorable experiences with their friends than with family members. The difference is partly attributable to the greater frequency of active leisure activities with friends, but is also due to unique qualities of interactions with friends that facilitate transcendence of mundane daily realities. It is proposed that friends provide an immediate situation of openness, reciprocity, and positive feedback that engenders enjoyment and subjectively meaningful exchanges. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social facilitation of eating among friends and strangers

In a series of studies to investigate the basic structural features and characteristics of the biological apatite crystals using a transmission electron microscope, we examined the ultrastructure of the human enamel, dentin, and bone crystals through the cross and longitudinal sections at near atomic resolution. Subsequently, using the same approach, we have been able to directly examine the images of the lattice imperfections in the crystal lattices of the human tooth and bone crystals, and the images of the fusion of the crystals. In this research, furthermore, using transmission and scanning electron microscopes, we examined the dissolution of the enamel crystals caused by the carious enamel from the same viewpoint. The material used for the observation of the dissolution of the enamel crystals was obtained from the region which corresponds to the middle layer of the enamel at the portion near the wall of a carious cavity caused by the fissure caries on the occlusal surface of the lower first molars. Small cubes of the materials used for the observation by transmission electron electron microscope were fixed in glutaraldehyde and osmium tetroxide and embedded in epoxy resin using the routine methods. The ultrathin sections were cut with a diamond knife without decalcification. The sections were examined with the HITACHI H-800H type transmission electron microscope operated at 200 kV. Each crystal was observed at an initial magnification of 300,000 times and at a final magnification of 10,000,000 times and over. The material used for the observation by the scanning electron microscope was the fractured surface obtained from the carious enamel. The fractured carious enamel surfaces were coated with carbon and gold and observed with the HITACHI HHS-2R type scanning electron microscope operated at 25 kV. The crystals were observed at a final magnification of 50,000 times. As a result, we have confirmed that the dissolution of the enamel crystals caused by a caries occurs in the units of "hexagonal cell". We sincerely believe that the electron micrographs shown in this report are the first to show the images of the dissolution of the enamel crystals caused by a caries at near atomic resolution.     

Social support from family and friends as a buffer of low spousal support among mothers of critically ill children: A multilevel modeling approach.

Objective: To investigate whether social support from family and friends (family/friend support) attenuated ("buffered") adverse effects of having low spouse support (spousal support) among mothers of children undergoing hematopoietic stem cell transplantation (HSCT). Design: One hundred sixty-three married mothers who were their child's primary caregiver during treatment completed assessments during the child's hospitalization for HSCT and 3-, 6-, and 12-months post-HSCT. Measures: Family/friend support and spousal support were assessed during hospitalization. Maternal physical and mental health-related functioning (the main outcome measures) were assessed at all timepoints. Results: Multilevel modeling was used to analyze trajectories of maternal functioning. Findings indicated that mothers with low spousal support and low family/friend support demonstrated the worst functioning across all timepoints. Mothers with low spousal support and high family/friend support demonstrated significantly better functioning, supporting the hypothesized buffering effect. Their functioning compared to the functioning of mothers with high spousal support. Moreover, mothers with high family/friend support demonstrated trajectories of physical health-related functioning that were more stable than the trajectories of mothers with low family/friend support. Conclusion: These findings have clinical implications in addition to advancing knowledge of social support processes among couples coping with the shared stressor of a child's life-threatening illness and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of symptoms of depression with diagnostic test charges among older adults

BACKGROUND: Previous studies have documented greater use of health services by depressed persons and have postulated that health care costs could be reduced overall through better recognition and treatment of depression. OBJECTIVE: To determine whether a greater burden of medical illness contributes to excess charges for diagnostic tests among older adults with symptoms of depression. DESIGN: Prospective cohort study. SETTING: A primary care group practice at an academic institution. PATIENTS: 3767 patients 60 years of age and older who completed testing on the Centers for Epidemiologic Studies Depression Scale (CES-D) during routine office visits. MEASUREMENTS: Charges for all inpatient and ambulatory diagnostic testing for 2 years, including clinical pathology, diagnostic imaging, and special procedures; number of visits to the ambulatory care center or emergency department; and number of hospitalizations. The Ambulatory Care Group case-mix approach, which is based on ambulatory diagnoses, was used as a measure of health status and expected resource consumption. RESULTS: Patients with symptoms of depression (CES-D scores > or = 16) were significantly younger (66.6 compared with 68.1 years; P < 0.001), more likely to be white (50.5% compared with 33.9%; P = 0.001), and more likely to be female (75.8% compared with 67.6%; P = 0.001) than were those without these symptoms (CES-D scores < 16). They also had more nonpsychiatric comorbid conditions, had more visits to the ambulatory care center (9.2 compared with 7.8; P < 0.001), were more likely to use the emergency department (52.3% compared with 40%; P = 0.001), were more likely to be hospitalized (22.4% compared with 17%; P = 0.002), and had greater median total diagnostic test charges for a period of 1 year ($583 compared with $387; P < 0.001). The difference in charges, most of which were clinical pathology charges (54.2%), persisted into the second year. Ambulatory Care Group assignment was independently associated with diagnostic test charges. The CES-D summary score was not independently associated with diagnostic test charges when controlling for Ambulatory Care Group assignment. CONCLUSIONS: Patients with symptoms of depression accrue greater average diagnostic test charges. However, these data suggest that such patients also have a greater burden of comorbid nonpsychiatric illness. Efforts to improve outcome and decrease cost for patients who have late-life depression must target interventions to improve the care of psychiatric and medical illness concurrently.     

Social support and the well-being of persons with spinal cord injury living in the community.

100 men and 40 women (all aged 19–77 yrs) with spinal cord injury completed a social support questionnaire, the Center for Epidemiologic Studies Depression Scale, the Life Satisfaction Index Form A, and a single-item self-assessment of health status. A physician assessed the presence or absence of urinary tract infection from laboratory findings and determined the absence, presence, and severity of pressure ulcers from physical examination. Amount of social support was positively related to life satisfaction and physical well-being. Satisfaction with one's support network was associated negatively with depressive symptomatology and positively with life satisfaction. There were significant differences in the correlations between life satisfaction and total social support for men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support among African-American adults with diabetes, Part 2: A review

STUDY OBJECTIVE: To study differences in cardiovascular lifestyle risk factors and biological risk markers in early adult life, with special attention to age and sex differences. Lifestyle cardiovascular risk factors included dietary habits, physical inactivity, smoking, alcohol habits, psychosocial strain, and mental stress. Biological risk markers included anthropometric variables, arterial blood pressure, and serum cholesterol concentration. DESIGN: A combined individual and community based preventive programme, including health examinations. SETTING: All communities in the County of Skaraborg in south western Sweden. PARTICIPANTS: Altogether 12,982 men and women aged 30 or 35 years who underwent health examinations over seven years. MAIN RESULTS: In both sexes, biological risk markers studied were worse in 35 year old subjects than in 30 year olds. Furthermore, a larger proportion of men aged 35 years were smokers and were physically inactive compared with 30 year old men. However, dietary habits were better in both sexes in the upper age group. At both ages there were also significant differences between men and women. Women, compared with men, had better dietary habits and lower alcohol consumption but smoked more and experienced greater mental stress and psychosocial strain. All biological risk markers were worse in men than in women at both ages studied. During the observation period, some improvement of the health profile of the participants was observed, indicating a beneficial effect of the intervention programme. CONCLUSIONS: The results indicate that the risk of cardiovascular disease, as assessed from studying lifestyle and biological risk markers, increases early in life, suggesting that preventive measures should start early.     

Social support, AIDS-related symptoms, and depression among gay men.

Examined the impact of social support and human immunodeficiency virus (HIV)-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men (aged 25–54 yrs). The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 yr later. Satisfaction with each of 3 types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 yr later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the acquired immune deficiency syndrome (AIDS) crisis and have important practical implications for designing mental health services to meet those needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support among African-American adults with diabetes. Part 1: Theoretical framework

BACKGROUND: Atypical squamous cells of undetermined significance (ASCUS) is a cytopathologic term used to describe cases without specific pathologic substratum. Between 10-60% of ASCUS cases correspond to squamous intraepithelial lesions (SIL). METHODS: The objectives of this study were: 1) to detect the pathologic significance of ASCUS in study patients, 2) to determine whether PAPNET identifies these cases, and 3) to compare the results of PAPNET with those of a second conventional screening. One hundred and sixty-three consecutive patients with the cytologic diagnosis of ASCUS and adequate follow-up were selected. Of these, 111 patients had colposcopic lesions and biopsies were performed; in the remaining 52 cases colposcopy was negative, as were 3 consecutive annual Papanicolaou smears. In a blind review, all 163 cases were rescreened using PAPNET. A second manual screening was performed for comparison. RESULTS: One hundred and twenty-six of the 163 cases (77.3%) showed no SIL on biopsy or follow-up. Of the 37 pathologic cases, the diagnosis was koilocytosis (flat condyloma) in 13 cases (8%), cervical intraepithelial neoplasia (CIN) type I in 11 cases (6.8%) low grade SIL [LSIL] in a total of 24 cases [14.8%]), and CIN II-III or high grade SIL (HSIL) in 11 cases (6.8%). In the review using PAPNET, 57 previous ASCUS cases were classified correctly as negative, and 7 of 13 koilocytosis cases (54%), 9 of 11 CIN I cases (82%), and 7 of 11 CIN II-III cases (64%) were diagnosed correctly. In the second conventional screening, 74 cases were negative and 77 cases were ASCUS; only 3 of 13 koilocytosis cases (23%), 4 of 11 CIN I cases (36.4%) and 5 of 11 CIN II-III cases (45.5%) were reclassified correctly. CONCLUSIONS: Among 163 patients with ASCUS, 77.3% had no precancerous squamous lesions. Concordance with definitive diagnosis was more accurate in our study using PAPNET analysis (Kappa index [K] = 0.7158) than by second conventional screening (K = 0.4537). Furthermore, we reclassified 35% of smears as negative and 15% as SIL.     

Social support as a mediator in the relation between functional status and quality of life in older adults.

The relations among physical functioning, social support, depressive symptoms, and life satisfaction were examined in a national sample of 4,734 adults age 65 and older. Regression analyses were used to examine the relative importance of objective and subjective support measures in understanding the relation between physical impairment and quality of life. Impairment was associated with fewer friendship contacts, fewer family contacts, less perceived belonging support, and less perceived tangible aid, but only measures of perceived support predicted depressive symptomatology. A structural equation modeling approach was then used to explore the mediational role of perceived social support in the relation between impairment and quality of life variables. Results are consistent with the hypothesis that lower reported social support is an important reason for decreases in life satisfaction and increases in depressive symptoms found among older adult populations. Implications for understanding the role of social support in attenuating the effects of physical disability in older adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic financial strain, social support, and depressive symptoms among older adults.

The purpose of this study is twofold: one, to determine whether chronic financial strain is related to depressive symptoms among a random community sample of older adults, and two, to assess whether social support counterbalances or buffers the deleterious effects of financial strain. The findings suggest that elderly people suffering from financial strain are more likely to be depressed than are older adults with fewer financial problems. In addition, the data support the stress-buffering hypothesis, that is, that older people who have more informational support and who provide support to others, more often report fewer symptoms of depression as a result of financial strain than do elderly respondents who have less informational support and who do not provide support to others. Tangible and emotional support are found to be less effective coping resources when financial strain is present. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support sources among older women with heart failure: continuity versus loss over time

In the mosquito Culex pipiens one of the major resistance mechanisms to organophosphorous pesticides (OPs) is increased detoxification of insecticide. This resistance is the consequence of overproduction of two types of esterases, esterases A and B, coded at two loci, Est-3 (A esterase) and Est-2 (B esterase). We have analysed the genomic structure of these genes in different strains resistant to OPs and have attempted to characterize the different types of mutations leading to the resistant phenotypes. It is shown that, concerning the more frequent resistant phenotypes, mutations leading to resistance are of two main types. First, overproduction of one A esterase present in Southern France results from a regulatory mechanism. The second type of mutation is gene amplification which involves events that have initially generated the duplication of both the A and B esterase or only the B esterase locus. We report the point that the most frequent esterase overproductions are the results of eight different mutations and that, given the range of distribution of these genotypes, mutation leading to an efficient resistance gene is one of the most limiting factors for the evolution toward resistance in Culex pipiens.     

Treatment of depression in older adults: Personality considerations.

Discusses 2 personality variables—dependency and autonomy—as they relate to treatment of depression in older adults. The personality mode, dependent or autonomous, is seen as an influence on the causes and symptomatology of depression. The treatment implications are outlined. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human menstrual synchrony in families and among close friends: Examining the importance of mutual exposure.

Human menstrual synchrony was examined in a sample of 73 urban households with a relatively high degree of mutual contact and interaction but less than that of a previously studied, possibly unique sample of Bedouin families with an extremely high degree of contact, interaction, and sexual segregation (A. Weller and L. Weller; see record 1997-06365-004). In addition, for the first time, menstrual synchrony was studied among best friends who did not live together and among sisters who did versus did not share a bedroom. A very high degree of synchrony was found among families (51%) and among sisters (51%), and a relatively high degree of synchrony was found among close friends (30%). The results suggest that synchrony can be attained without sleeping in the same bedroom or even in the same house. The findings also suggest that an effective range of mutual exposure is an attribute of human menstrual synchrony; below or above this range, the phenomenon may not occur. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age and the sense of control among older adults

Older adults are expected and frequently found to report less control than younger adults. In this study, we decompose this negative relationship between age and sense of control using nested multivariable linear regression models that serially introduce sociodemographic characteristics, socioeconomic factors, health status, and subjective religiosity and religious beliefs in a sample of 1,051 older adults attending the general medicine clinics of a major medical center. The results indicate that the effect of age is suppressed in the bivariable model. In the final multivariable model, educational attainment has the largest relative effect (i.e., beta; .253), followed by age (-.210), mental health (.174), subjective religiosity (.113), being an African American (-.100), perceived health (.082), and being Catholic (.068). Future research should focus on the inflection point in the relationship between age and the sense of control that apparently occurs at about 50 years of age.     

Compensatory patterns of support among children's peer relationships: A test using school friends, nonschool friends, and siblings.

Examined the extent to which isolated and aggressive 6th graders compensate for unsatisfying school friendships by deriving support from siblings and nonschool friends and whether this support protects such children from poor socioemotional outcomes. Results were as follows: (1) When compared with average and aggressive children, isolated children perceived their school friendships as least supportive and their favorite sibling relationships as most supportive; (2) isolated, aggressive, and average children did not differ in their perceptions of support from nonschool friends; and (3) high support from a favorite sibling was associated with better adjustment among isolated children on select outcomes. Despite the somewhat ameliorating role of siblings for isolated children, isolated children with high sibling support remained less well adjusted than did average children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Informal exchanges with non-kin among retired sunbelt migrants: a case study of a Finnish American retirement community

OBJECTIVES: This study examined informal exchanges with non-kin among retired Sunbelt migrants, with special emphasis on the impact of ethnic enclaves in generating exchanges of instrumental assistance and emotional support among elderly European Americans. METHODS: Data were collected through interviews with four samples of elders: Finnish Americans who migrated to an ethnic retirement community in Florida; European Americans who migrated to the same community but are not part of an ethnic enclave; Finnish Americans living in an age-integrated setting in Minnesota; and retired European Americans living in the same Minnesota community. RESULTS: Migrants were less likely than elders aging-in-place to report informal exchanges with non-kin. Finnish American migrants were less likely than other European American migrants to provide instrumental assistance to non-kin but were more likely to anticipate relying on informal long-term care support, regardless of proximity to kin. There were no differences in the two migrant samples in exchanges of emotional support. DISCUSSION: Evidence regarding substitution of non-kin for geographically distant kin is mixed. Results are consistent with a strategy of "banking" support, at the community level among the Finnish American migrants and at the network level among other European American migrants.     

Accounting for changes in social support among married older adults: Insights from the MacArthur Studies of Successful Aging.

Using longitudinal, community-based data from the MacArthur Studies of Successful Aging, the authors examined determinants of changes in social support receipt among 439 married older adults. In general, social support increased over time, especially for those with many preexisting social ties, but those experiencing more psychological distress and cognitive dysfunction reported more negative encounters with others. Gender affected social support receipt: Men received emotional support primarily from their spouses, whereas women drew more heavily on their friends and relatives and children for emotional support. Discussion centers on the importance of social support provision to those with the greatest needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)