Psychiatric Residents’ Perceptions of Cultural Competency Training for Mental Health Care Delivery

Considering and respecting patients’ cultural needs is integral in providing culturally competent mental health care. In 2013, an urban community hospital conducted the Community Health Needs Assessment with patients, community stakeholders, and health care providers. The assessment revealed the need to address a more diverse patient population with culturally different health needs through training culturally diverse health care providers. Thus, the focus of this qualitative case study was on how the academic training of psychiatric residents in cultural competency affected the delivery of culturally responsive mental health patient care. The conceptual framework of Jeffery’s cultural competence and confidence model grounded this study in understanding the process of teaching and learning cultural competence. The research question related to how psychiatry residents perceived their cultural competency training in the delivery of culturally appropriate mental health care. Data was collected from eight psychiatric residents. Through a qualitative data analysis of the focus group, field notes, and review of training materials, the findings provided a detailed description of the residents’ perspectives of their cultural competency training. The focus group discussion with the residents was transcribed, coded, and analyzed for themes in the impact of the cultural competency training. Residents’ perceptions suggested training enhancements in an understanding of the diverse patient’s culture, language differences, and community are weaved into the cultural competency clinical training. This study supports social change in its benefit to culturally diverse patient populations in understanding the importance of cultural competency training in the delivery of quality mental health care

Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study

Background: Few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people. Method: The postcodes of the 2424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years. Results: Higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated. Conclusion: Features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies

An investigation of the population impact of variation in HbA1c levels in older people in England and Wales: from a population based multi-centre longitudinal study.

BACKGROUND: Diabetes is common in the older population and is increasing. Glycated hemoglobin (HbA1c) is an indicator of average blood glucose concentration over the past three months. The HbA1c test is currently one of clinical methods used to check diabetes control. Recent studies have suggested diabetes is a risk factor for dementia, cognitive dysfunction and physical disability. In addition, there have reported the relationship between HbA1c and mortality on all cause, cardiovascular disease and cognitive function, but few studies have investigated the relationship concentrating on the older population. The aim of this study is to investigate the association between the level of HbA1c and mortality from all causes, incident cardiovascular disease, cognitive decline and physical disability in people aged 65 and over in England and Wales. METHODS: 1139 men and women aged 69 years and over who were participants in a ten year population based ageing multi-centre, longitudinal study who had HbA1c measurements after 5-6 years of follow up. All participants were flagged for death notification including causes at the Office of National Statistics. Information on health including vascular conditions, cognitive status, physical function and dementia were available from the study both before and after the HbA1c measurement. Survival analyses and logistic regression were conducted. RESULTS: Mortality from all causes, cardiovascular and ischaemic heart disease increased with increasing HbA1c. Participants with diagnosed diabetes or who had HbA1c > or = 7% but no self-reported diabetes had increased mortality risk from all causes and cardiovascular diseases. The respondents in the group HbA1c > or = 7% who had not been diagnosed with diabetes had a significantly higher risk (odds ratio = 4.8 95% CI: 1.1 to 21.6) of developing dementia. Individuals who had self-reported diabetes but a HbA1c level < 7% had mortality and dementia incidence comparable to individuals without diabetes and HbA1c < 7%. CONCLUSION: The findings support previous reports that bio-markers of glucose metabolism are associated with long term outcomes, such as mortality and dementia

Cohort differences in disease and disability in the young-old: findings from the MRC Cognitive Function and Ageing Study (MRC-CFAS).

BACKGROUND: Projections of health and social care need are highly sensitive to assumptions about cohort trends in health and disability. We use a repeated population-based cross-sectional study from the Cambridgeshire centre of the UK Medical Research Council Cognitive Function and Ageing Study to investigate trends in the health of the young-old UK population METHODS: Non-overlapping cohorts of men and women aged 65-69 years in 1991/2 (n = 689) and 1996/7 (n = 687) were compared on: self-reported diseases and conditions; self-rated health; mobility limitation; disability by logistic regression and four-year survival by Cox Proportional Hazards Regression models, with adjustments for differences in socio-economic and lifestyle factors. RESULTS: Survival was similar between cohorts (HR: 0.91, 95% CI: 0.62 to 1.32). There was a significant increase in the number of conditions reported between cohorts, with more participants reporting 3 or more conditions in the new cohort (14.2% vs. 10.1%). When individual conditions were considered, there was a 10% increase in the reporting of arthritis and a significant increase in the reporting of chronic airways obstruction (OR: 1.36, 95% CI: 1.04 to 1.78). CONCLUSION: This study provides evidence of rising levels of ill-health, as measured by the prevalence of self-reported chronic conditions, in the newer cohorts of the young-old. Though changes in diagnosis or reporting of disease cannot, as yet, be excluded, to better understand whether our findings reflect real increases in ill-health, investment should be made into improved population-based databases, linking self-report and objective measures of health and function, and including those in long-term care

Advanced Aerobots for Scientific Exploration

The Picosat and Uninhabited Aerial Vehicle Systems Engineering (PAUSE) project is developing balloon-borne instrumentation systems as aerobots for scientific exploration of remote planets and for diverse terrestrial purposes that can include scientific exploration, mapping, and military surveillance. The underlying concept of balloon-borne gondolas housing outer-space-qualified scientific instruments and associated data-processing and radio-communication equipment is not new. Instead, the novelty lies in numerous design details that, taken together, make a PAUSE aerobot smaller, less expensive, and less massive, relative to prior aerobots developed for similar purposes: Whereas the gondola (including the instrumentation system housed in it) of a typical prior aerobot has a mass of hundreds of kilograms, the mass of the gondola (with instrumentation system) of a PAUSE aerobot is a few kilograms

The Relationship Between Cumulative Unfair Treatment and Intima Media Thickness and Adventitial Diameter: The Moderating Role of Race in The Study of Women’s Health Across the Nation

Objective: Unfair treatment may have a detrimental effect on cardiovascular health. However, little research on chronic health outcomes employs cumulative measures of unfair treatment. We tested whether cumulative unfair treatment was associated with greater subclinical cardiovascular disease in a diverse sample of African American, Caucasian, Chinese, and Hispanic women. We also examined whether this relationship varied by race. Method: The Study of Women’s Health Across the Nation is a longitudinal study of midlife women. Cumulative unfair treatment was calculated as the average of unfair treatment assessed over 10 years at 6 time points. Subclinical cardiovascular disease, specifically carotid intima media thickness and adventitial diameter, was assessed via carotid ultrasound conducted at study year 12 in 1056 women. We tested whether cumulative unfair treatment was related to subclinical cardiovascular disease via linear regression, controlling for demographic factors including socioeconomic status and cardiovascular risk factors. Results: The relation between unfair treatment and subclinical cardiovascular disease significantly varied by race (ps \u3c .05), with unfair treatment related to higher intima media thickness (B = .03, SE = .01, p = .009) and adventitial diameter (B = .02, SE = .009, p = .013) among Caucasian women only. No significant relations between unfair treatment and subclinical cardiovascular disease outcomes were observed for African American, Hispanic, and Chinese women. Conclusions: Our findings indicate that cumulative unfair treatment is related to worse subclinical cardiovascular disease among Caucasian women. These findings add to the growing literature showing that Caucasian women’s experience of unfair treatment may have detrimental health implications

The Relationship Between Cumulative Unfair Treatment and Intima Media Thickness and Adventitial Diameter: The Moderating Role of Race in The Study of Women’s Health Across the Nation

Objective: Unfair treatment may have a detrimental effect on cardiovascular health. However, little research on chronic health outcomes employs cumulative measures of unfair treatment. We tested whether cumulative unfair treatment was associated with greater subclinical cardiovascular disease in a diverse sample of African American, Caucasian, Chinese, and Hispanic women. We also examined whether this relationship varied by race. Method: The Study of Women’s Health Across the Nation is a longitudinal study of midlife women. Cumulative unfair treatment was calculated as the average of unfair treatment assessed over 10 years at 6 time points. Subclinical cardiovascular disease, specifically carotid intima media thickness and adventitial diameter, was assessed via carotid ultrasound conducted at study year 12 in 1056 women. We tested whether cumulative unfair treatment was related to subclinical cardiovascular disease via linear regression, controlling for demographic factors including socioeconomic status and cardiovascular risk factors. Results: The relation between unfair treatment and subclinical cardiovascular disease significantly varied by race (ps \u3c .05), with unfair treatment related to higher intima media thickness (B = .03, SE = .01, p = .009) and adventitial diameter (B = .02, SE = .009, p = .013) among Caucasian women only. No significant relations between unfair treatment and subclinical cardiovascular disease outcomes were observed for African American, Hispanic, and Chinese women. Conclusions: Our findings indicate that cumulative unfair treatment is related to worse subclinical cardiovascular disease among Caucasian women. These findings add to the growing literature showing that Caucasian women’s experience of unfair treatment may have detrimental health implications

Older people, the natural environment and common mental disorders: cross-sectional results from the Cognitive Function and Ageing Study.

OBJECTIVES: To explore the hypothesis that higher exposure to natural environments in local areas is associated with a lower odds of depression and anxiety in later life. DESIGN: A cross-sectional study based on the year-10 interview of the Medical Research Council Cognitive Function and Ageing Study (CFAS), a population-based study of ageing in the UK. Postcodes of the CFAS participants were mapped onto small geographic units, lower-layer super output areas (LSOAs) and linked to environmental data from government databases. The natural environment was characterised as the percentage of green space and private gardens in each LSOA based on the UK Generalised Land Use 2001 Dataset. PARTICIPANTS: 2424 people aged 74 and over in the CFAS year-10 follow-up interview (2001) from 4 English centres (Cambridgeshire, Nottingham, Newcastle and Oxford). MAIN OUTCOME MEASURES: Depression and anxiety; clinical and subthreshold cases were identified using the Geriatric Mental State Examination (GMS) package and its associated diagnostic algorithm: the Automated Geriatric Examination for Computer Assisted Taxonomy. RESULTS: Compared with the lowest quartile, living in the highest quartile of neighbourhood natural environment provision was associated with a reduced odds of subthreshold depression (OR 0.66, 95% CI 0.46 to 0.95), anxiety symptoms (OR 0.62, 95% CI 0.46 to 0.83) and their co-occurrence (OR 0.55, 95% CI 0.35 to 0.84) after adjusting for individual-level factors. Controlling for area deprivation attenuated the strength of associations for subthreshold depression by 20% but not for anxiety symptoms or for co-occurrence of the conditions. CONCLUSIONS: A high exposure to natural environments (green space and gardens) in communities was associated with fewer mental disorders among older people. Increasing provision of green environments in local areas could be a potential population-level intervention to improve mental health among older people.The Cognitive Function and Ageing Studies (CFAS) were funded by the Department of Health and the Medical Research Council [grant number G9901400]. Yu-Tzu Wu received a PhD scholarship from the Cambridge Trust, University of Cambridge. Fiona E. Matthews and A. Matthew Prina were supported by the Medical Research Council [grant number U105292687 and MR/K021907/1].This is the final version of the article. It first appeared from BMJ via http://dx.doi.org/10.1136/bmjopen-2015-00793

Relocation at older age: results from the Cognitive Function and Ageing Study.

BACKGROUND: Community environment might play an important role in supporting ageing in place. This paper aims to explore relocation at older age and its associations with individual and community level factors. METHODS: The postcodes of the 2424 people in the year-10 interview of the Cognitive Function and Ageing Study (CFAS) in England were mapped onto Enumeration Districts and linked to their corresponding Townsend deprivation score and the 2011 rural/urban categories. Multilevel logistic regression was conducted to examine the influence of the baseline individual (age, gender, education and social class) and community (rural/urban categories and area deprivation) level factors on relocation over 10 years. RESULTS: One-third of people moved residence after the age of 65 years and over. Older age, low education, low social class and living in rural areas at baseline were associated with higher probability of moving later in life. The likelihood of relocation in later life increased from least to most deprived areas (odds ratio: 2.0, 95% confidence interval: 1.4, 2.8). CONCLUSIONS: Urban/rural contexts and area deprivation are associated with relocation at older age and indicate that community environment may be relevant to ageing in place.Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) was funded by the Department of health and the Medical Research Council (grant number G9901400); F.E.M. and A.M.P. are supported by the Medical Research Council (grant number U105292687 and MR/K021907/1); Y.-T.W. received a PhD scholarship from Cambridge Trust, University of Cambridge. We thank the participants, their families, general practitioners and their staff, and the primary care trusts for their cooperation and support.This is the final version of the article. It first appeared from Oxford University Press via http://dx.doi.org/10.1093/pubmed/fdv05