Regional Disparities in Cognitive Functioning of Rural and Urban Older Adults in Costa Rica

Prior research examining health disparities by region (urban vs. rural) on dementia and cognition have been studied using screening tools mostly, with conflicting results. Some studies support a rural health disadvantage, while other consider that urban dwellers are at greater risk of dementia and cognitive impairment. Latin American (LA) countries are underrepresented in these studies. Full neuropsychological assessment batteries have been administered in a limited number of studies, without addressing measurement equivalence of the tests across regions. The present study situates within a larger research project called EDAD (Epidemiology and Development of Alzheimer’s Disease) with Costa Rican older adults. The EDAD included a group of 16 neuropsychological tests among other health-related measurement tools. The purpose of the present study was to (a) identify the cognitive dimensions of the EDAD neuropsychological battery, (b) examine the comparability of the measures and cognitive constructs across the urban and rural sample of EDAD participants from Costa Rica, (c) determine whether group differences exists in the cognitive constructs, and (d) evaluate the contribution of age and education in the group differences. An exploratory/confirmatory factor analytic approach was implemented to identify the baseline model for the EDAD neuropsychological measures. Then, based on multiple-group confirmatory factor analysis, measurement invariance was examined. Once measurement invariance was established, group comparisons of the latent cognitive factors were conducted to explore regional disparities. Three cognitive constructs were identified in the factor model: Verbal Memory, Spatial Reasoning and Cognitive Flexibility. The findings showed that most of the neuropsychological tests in EDAD can be directly compared across the groups, allowing for latent mean comparisons. The rural sample of Costa Rican older adults had a disadvantage in the Spatial Reasoning and Cognitive Flexibility abilities. When age and education were included in the models, no differences between the regions were found. The results of the present study suggested that norms for Costa Rican older adults should consider age and education adjustments. This study contributes to the growing are of measurement invariance in neuropsychological assessment as it highlights the importance of examining the comparability of assessment measures across different cultural groups

A systematic review of the relationship between familism and mental health outcomes in Latino population

Background: Familismo or familism is a cultural value frequently seen in Hispanic cultures, in which a higher emphasis is placed on the family unit in terms of respect, support, obligation, and reference. Familism has been implicated as a protective factor against mental health problems and may foster the growth and development of children. This study aims at measuring the size of the relationship between familism and mental health outcomes of depression, suicide, substance abuse, internalizing, and externalizing behaviors. Methods: Thirty-nine studies were systematically reviewed to assess the relationship between familism and mental health outcomes. Data from the studies were comprised and organized into five categories: depression, suicide, internalizing symptoms, externalizing symptoms, and substance use. The Cohen’s d of each value (dependent variable in comparison to familism) was calculated. Results were weighted based on sample sizes (n) and total effect sizes were then calculated. It was hypothesized that there would be a large effect size in the relationship between familism and depression, suicide, internalizing, and externalizing symptoms and substance use in Hispanics. Results: The meta-analysis showed small effect sizes in the relationship between familism and depression, suicide and internalizing behaviors. And no significant effects for substance abuse and externalizing behaviors. Discussion: The small effects found in this study may be explained by the presence of moderator variables between familism and mental health outcomes (e.g., communication within the family). In addition, variability in the Latino samples and in the measurements used might explain the small and non-significant effects found.Support from NIA Developmental Grant R21TW009665 and the University of Kansas Open Access Author Fund.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Health-Related Quality of Life of Older Adults in Costa Rica as Measured by the Short-Form-36 Health Survey

Objective: To test the validity of a common measure of health-related quality of life (Short-Form-36 [SF-36]) in cognitively healthy older adults living in rural and urban Costa Rica. Method: Confirmatory factor analysis was applied to SF-36 data collected in 250 older adults from San Jose and Guanacaste, Costa Rica. Results: The best fitting model for the SF-36 was an eight first-order factor structure. A high correlation between the Mental Component Summary and Physical Component Summary scores was found. Region differences indicated that rural dwellers perceive a poorer health-related quality of life compared with the urban group. Discussion: Costa Rican older adults perceived health as a unidimensional construct. Age and urbanity of older adult Costa Ricans should be appreciated when trying to measure self-reported physical and mental health. Cultural context of the individuals should be considered when studying health-related quality of life.Fogarty International Center/[R21TW009665]/FIC/Estados UnidosNational Institute on Aging/[P30AG010129]/NIA/Estados UnidosResource Centers for Minority Aging Research/[P30AG043097]/RCMAR/Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro de Investigación en Ciencias del Movimiento Humano (CIMOHU)UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Conocimiento sobre Esquizofrenia en Estudiantes Universitarios de El Salvador y los Estados Unidos de América

The present study tested the hypothesis that E.S. college students will show less knowledge, recognition, and help seeking attitudes, and more social distance and negative attributions toward schizophrenia than will U.S. students. It is also of interest in this study to investigate if El Salvador college students would have lower mental health literacy and thus, more social distance attitudes toward schizophrenia, than would U.S. students. Discriminant function analysis (DFA) was used. The predicted variable was country of membership: El Salvador and the U.S. The predictors were recognition, knowledge, social distance, help seeking attitudes, and negative attribution toward schizophrenic patients. The participants (N = 340) were students from a university in E.S. and in California. Through a survey, participants were asked to diagnose a person described in a case vignette. Knowledge of schizophrenia and social distance attitudes were measured. Principal component analyses (PCA) using oblimin rotation were conducted to build composite factors from the observed variables. The discriminant function accurately predicted 74.4% of the participants’ country of membership, 2(1) = 75.23, p < .001. At the individual level, 69.9% of individuals from the U.S. and 77.5% of individuals from E.S. were correctly classified. Furthermore, results indicated that U.S. students recognized schizophrenia at a higher rate, compared to E.S. students. In the E.S. group, social distance attitudes differed with level of MHL. These findings are troublesome in that social distance attitudes inhibit help-seeking behavior. Education programs aimed at promoting mental health awareness among the E.S. population are indicated.El presente estudio investigó la diferencia en conocimiento sobre esquizofrenia, su identificación, actitudes de búsqueda de ayuda, distanciamiento social y atribuciones negativas entre estudiantes universitarios salvadoreños y estadounidenses. También fue de interés en este estudio explorar si los estudiantes universitarios salvadoreños con menor nivel de conocimiento buscarían mayor distanciamiento social hacia una persona con esquizofrenia, que los estudiantes estadounidenses. Se utilizó análisis de función discriminante (DFA). La variable predicha fue país de pertenencia: El Salvador y Estados Unidos. Los predictores fueron el reconocimiento, el conocimiento, la distancia social, la actitud hacia búsqueda de ayuda y la atribución negativa a las personas con esquizofrenia. Los participantes (N = 340) fueron estudiantes de una universidad en E.S. y en California. A través de una encuesta, se pidió a los participantes que diagnosticaran a una persona, a través de una historia de caso. Se midió el conocimiento sobre la esquizofrenia y las actitudes de distanciamiento social. Se utilizó análisis de componentes principales (PCA) con rotación oblimin para construir factores compuestos de las variables observadas. La función discriminante predijo con precisión el 74.4% del país de pertenencia de los participantes, c2(1) = 75.23, p < 0.001. A nivel individual, el 69.9% de los individuos de los Estados Unidos y el 77.5% de los individuos de E.S. fueron clasificados correctamente. Los resultados indicaron que los estudiantes estadounidenses reconocían la esquizofrenia a una tasa más alta, en comparación con los estudiantes salvadoreños. En el grupo de E.S., las actitudes de distancia social diferían con el nivel de conocimiento sobre esquizofrenia. Estos hallazgos son problemáticos porque las actitudes de distancia social (estigma) obstaculizan la búsqueda de ayuda. Se recomiendan programas educativos dirigidos a promover la concientización sobre salud mental entre la población salvadoreña

Conocimiento sobre Esquizofrenia en Estudiantes Universitarios de El Salvador y los Estados Unidos de América

The present study tested the hypothesis that E.S. college students will show less knowledge, recognition, and help seeking attitudes, and more social distance and negative attributions toward schizophrenia than will U.S. students. It is also of interest in this study to investigate if El Salvador college students would have lower mental health literacy and thus, more social distance attitudes toward schizophrenia, than would U.S. students. Discriminant function analysis (DFA) was used. The predicted variable was country of membership: El Salvador and the U.S. The predictors were recognition, knowledge, social distance, help seeking attitudes, and negative attribution toward schizophrenic patients. The participants (N = 340) were students from a university in E.S. and in California. Through a survey, participants were asked to diagnose a person described in a case vignette. Knowledge of schizophrenia and social distance attitudes were measured. Principal component analyses (PCA) using oblimin rotation were conducted to build composite factors from the observed variables. The discriminant function accurately predicted 74.4% of the participants’ country of membership, 2(1) = 75.23, p < .001. At the individual level, 69.9% of individuals from the U.S. and 77.5% of individuals from E.S. were correctly classified. Furthermore, results indicated that U.S. students recognized schizophrenia at a higher rate, compared to E.S. students. In the E.S. group, social distance attitudes differed with level of MHL. These findings are troublesome in that social distance attitudes inhibit help-seeking behavior. Education programs aimed at promoting mental health awareness among the E.S. population are indicated.El presente estudio investigó la diferencia en conocimiento sobre esquizofrenia, su identificación, actitudes de búsqueda de ayuda, distanciamiento social y atribuciones negativas entre estudiantes universitarios salvadoreños y estadounidenses. También fue de interés en este estudio explorar si los estudiantes universitarios salvadoreños con menor nivel de conocimiento buscarían mayor distanciamiento social hacia una persona con esquizofrenia, que los estudiantes estadounidenses. Se utilizó análisis de función discriminante (DFA). La variable predicha fue país de pertenencia: El Salvador y Estados Unidos. Los predictores fueron el reconocimiento, el conocimiento, la distancia social, la actitud hacia búsqueda de ayuda y la atribución negativa a las personas con esquizofrenia. Los participantes (N = 340) fueron estudiantes de una universidad en E.S. y en California. A través de una encuesta, se pidió a los participantes que diagnosticaran a una persona, a través de una historia de caso. Se midió el conocimiento sobre la esquizofrenia y las actitudes de distanciamiento social. Se utilizó análisis de componentes principales (PCA) con rotación oblimin para construir factores compuestos de las variables observadas. La función discriminante predijo con precisión el 74.4% del país de pertenencia de los participantes, c2(1) = 75.23, p < 0.001. A nivel individual, el 69.9% de los individuos de los Estados Unidos y el 77.5% de los individuos de E.S. fueron clasificados correctamente. Los resultados indicaron que los estudiantes estadounidenses reconocían la esquizofrenia a una tasa más alta, en comparación con los estudiantes salvadoreños. En el grupo de E.S., las actitudes de distancia social diferían con el nivel de conocimiento sobre esquizofrenia. Estos hallazgos son problemáticos porque las actitudes de distancia social (estigma) obstaculizan la búsqueda de ayuda. Se recomiendan programas educativos dirigidos a promover la concientización sobre salud mental entre la población salvadoreña

Measurement invariance of a neuropsychological battery across urban and rural older adults in Costa Rica

This study evaluated the measurement invariance of a neuropsychological battery across rural and urban older adults from Costa Rica. Rural and urban older adults (N = 295) from the Epidemiology and Development of Alzheimer’s Disease (EDAD) study in Costa Rica were assessed. The baseline factor model for the EDAD neuropsychological measures was identified with nine neuropsychological measures and three cognitive constructs: Verbal Memory, Spatial Reasoning, and Cognitive Flexibility. Measurement and structural invariance were established, and, then, group comparisons of the latent cognitive factors were conducted to explore regional disparities. The findings showed that most of the neuropsychological tests in EDAD can be directly compared across the groups, allowing for cognitive constructs comparisons. The rural sample showed a disadvantage in the Spatial Reasoning and Cognitive Flexibility abilities. When age and education were included in the models, differences between the regions disappeared. Having more years of education was associated with higher cognitive abilities, with a larger effect for the rural group. Norms for Costa Rican older adults should consider age and education adjustments. This study contributes to the growing area of measurement invariance in neuropsychological assessment as it highlights the importance of examining the comparability of assessment measures across different cultural groups.Fogarty International Center/[]/FIC/Estados UnidosEpidemiology and Development of Alzheimer’s Disease in Costa Rica/[R21 TW009665]/EDAD/Costa RicaNational Institute on Aging/[P30 AG010129]/NIA/Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Health and Fitness Differences Between Urban and Rural Costa Rican Older Adults

Proyecto 723-B3-339 (FUNDEVI # 2791-01). Edad, Fase1: envejecimiento saludable en zonas urbanas y rurales. (EDAD, Phase 1: Healthy Aging in Urban and Rural Areas. EDAD "The Epidemiology and Development of Alzheimer´s Disease)". NIH –Fogarty Grant Number: 1R21TW009665 – 01. Fogarty International Center (FIC), National Institute of Health (NIH). Universidad de Kansas-Universidad de Costa RicaCosta Rica has one of the highest life expectancies in America, even higher than the United States. Studies addressing health and fitness in Latin American urban and rural older adults are scarce. PURPOSE: The purpose of the study was to test the hypothesis that older adults from rural areas present fewer negative health conditions and higher fitness than older adults from urban zones. METHODS: 298 participants aged 60 to 85 ( Urban n =18, Rural n = 110) completed a 29- item chronic diseases que stionnaire and performed the Senior Fitness Test: a) 6- min walking test (6 - MWT), b) 30-s Chair to-Stand Test, c) 30-s Arm Curl Test, d) timed up- and go test (TU G), balance time, and handgrip strength (HGS). Categorical variables were analyzed with non-parametric Chi2 and continuous variables with 2 x2 AN O V A (residency z one x gender). RESULTS: Urban women reported more chest pain (χ2 = 6.05, p = 0.014), more pacemakers (χ2 = 4.70, p = 0.030), diabetes (χ2 = 3.98, p = 0.046 ), and osteoarthritis (χ2 = 5.08, p = 0.024) than rural women. Urban men reported more chronic low back pain (χ2 = 5.65, p = 0.017) and depression (χ2 = 3.90, p = 0.048) than rural men. A higher diastolic blood pressure was observed in urban compared to rural older adults (Urban = 76.2 ± 0.9 mmHg kg vs. Rural = 70.2 ± 1.3 mmHg; p ≤ 0.001). Urban older adults showed better balance time than rural older adults (Urban = 22.8 ± 0.8 s vs. Rural = 18.4 ± 1.2 s; p = 0.003). Performance was similar between urban and rural older adults on the 6- MWT, 30-s Chair to-Stand, 30-s Arm Curl, TUG, and HGS tests (p > 0.05) . CONCLUSION: In spite of having similar physical fitness performance, Costa Rican urban men and women showed an overall negative health profile compared to rural older adults. Balance was the only functional variable positively observed in urban older adults.Universidad de Costa Rica/[723-B3-339]/UCR/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP)UCR::Vicerrectoría de Docencia::Ciencias Sociales::Facultad de Educación::Escuela de Educación Físic