Health Care Experience of Older Persons with Chronic Illness in Rural and Urban China: A Qualitative Study in Shandong, China

Background: China is undergoing rapid socioeconomic transitions. Demographically, its population is aging rapidly. Epidemiologically, it is shifting from infectious to chronic diseases. In addition, China is facing a widening income gap between the rural and urban population. This qualitative study focused on older persons with chronic illness living in rural and urban China. We aimed to understand and compare their healthcare experience. Methods: Twenty-four pairs of older persons with chronic illness and their caregivers were recruited from rural and urban areas in Shandong, China. Each participant was interviewed individually at his/her home in summer 2008 using a semi-structured, qualitative interview format. Content analysis was conducted. Results: Both rural and urban older adults had easy access to primary care but the quality of care they received differed. Rural elders relied on village doctors whose qualification and incentives could lead to problems. Their use of higher-level care was a family decision involving all adult children and was often on an emergency basis. Urban elders used their community health centers for chronic care management and were satisfied with the service, however they sought initial care from hospitals for any problems perceived to be serious and complained that those hospitals charged unreasonably high prices. Self-treatment was relatively common in both groups. For rural participants, this behavior was for cost saving whereas for urban participants, it was an attempt to change the course of a chronic condition. Conclusions: Rural elders in China were faced with more challenges in receiving quality primary care, accessing higher-level care, and affording healthcare in general, compared to their urban counterparts. The findings of this study provide a better understanding of healthcare utilization by and healthcare disparity between rural and urban elders, which is important for healthcare reform in China and other emerging economies.Office of Vice President for Research, Institute for Research on Women and Gender, and Center for Chinese Studies at the University of Michigan.http://deepblue.lib.umich.edu/bitstream/2027.42/116798/1/Healthcareexp_olderChinese.pdfDescription of Healthcareexp_olderChinese.pdf : Main articl

From Caregiving to Bereavement: Trajectories of Depressive Symptoms among Wife and Daughter Caregivers

This study examined the trajectory of depressive symptoms for wife and daughter caregivers during the transition from caregiving to bereavement, and investigated whether the trajectory varies by caregivers’ caregiving stress, social support, and background characteristics. Hierarchical linear modeling was used to analyze four-wave longitudinal data collected from 157 wife and daughter caregivers who lost elderly relatives to death. Results show that on average, caregivers experience increasing depressive symptoms as their care recipients are closer to death and decreasing symptoms after. Care recipients’ problematic behavior, caregivers’ feeling of overload, kinship, and income moderate the change in depressive symptoms during the transition. Services to support caregivers should target specific groups of caregivers, based on caregiving experience and background characteristics, at times when they are most in need.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65120/1/from_caregiving_to_bereavement-final.pd

Does widowhood affect cognitive function among Chinese older adults?

There is growing evidence from Western countries that widowhood may affect cognitive health in later life. However, little is known about whether widowhood isassociated with cognitive health in Eastern Asian countries such as China and what factors may explain the association between widowhood and cognitive health. Weadd to this line of research by investigating the effect of widowhood on 2-year change in cognitive function among Chinese adults ages 55 and older from 2011 to2013, using data from the China Health and Retirement Longitudinal Study. Cognitive function was measured by episodic memory and mental intactness (i.e.,attention and time orientation). Our results showed that Chinese older adults who were continually widowed at both waves had significantly lower episodic memoryscores at Wave 2 than their continually married counterparts, controlling for episodic memory at Wave 1, age, gender, education, and other sociodemographicvariables. This suggests that the continually widowed experienced greater decline in episodic memory than the continually married over the 2-year period. Afterfurther controlling for economic resources, health, and social engagement, the difference in memory decline between the continually widowed and the continuallymarried barely changed. The effect of widowhood on memory decline was similar for men and women. However, the continually widowed were not significantlydifferent from the continually married in the decline of mental intactness. In addition, newly widowed adults were not significantly different from the continuallymarried in the change of episodic memory and mental intactness. We conclude that staying widowed for 2 years or more may be an independent risk factor forepisodic memory decline in China. More research is needed to investigate the mediating and moderating mechanisms underlying the association between widowhoodand memory decline

Mental Health Status of Home Care Elderly in Michigan

This study describes the mental health status of community-living frail elders in Michigan and identifies subgroups who are vulnerable to mental health problems. We analyzed the baseline assessment data collected from older adults admitted to two community-based long-term care programs in Michigan (N = 18,939). Results show that 40.5% of the sample have recognized mental disorders, 39.6% use psychotropic medications, 24.5% have probable depression, and 1.4% have self-injury thoughts or attempts. Frail elders who are white, younger, and female--as well as those who experience more pain, disease burden, cognitive impairment and IADL limitations--are more prone to psychological distress. Mental health care is greatly needed by community-living frail elders.Dr. Li received support for this study from the University of Michigan Claude D. Pepper Older Americans Independence Center (AG024824). Dr. Conwell was supported in part by NIMH grants R25 MH68564-01 (Eric Caine, PI) and R24 MH07164 (Yeates Conwell, PI). The authors thank the Michigan Department of Community Health for making the data available, as well as Mary James, MA, Brant Fries, PhD, and Kristina Szafara, PhD, for their assistance in accessing and extracting the data.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65121/1/MentalhealthstatusTG-revfinal16-3-07.pd

Self‐Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141019/1/acr23262_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141019/2/acr23262.pd

Feasibility of a Randomized Controlled Trial of Self-Administered Acupressure for Symptom Management in Older Adults with Knee Osteoarthritis

Objectives: To assess the feasibility of a study to evaluate the efficacy of self-administered acupressure in pain and related symptom management for older people with symptomatic knee osteoarthritis. Feasibility with regard to (1) sample recruitment and retention, (2) treatment fidelity and adherence, and (3) tolerability and adverse events was examined. Methods: The study was a randomized controlled trial. Community-living older adults were recruited and randomly assigned to one of three groups: verum acupressure, sham acupressure, and usual care. Participants in the first two groups learned their respective acupressure protocol during their first center visit and from a set of materials. They were asked to practice the protocol at home once daily, 5 days a week, for 8 weeks. Participants attended three center visits and received weekly phone calls from a research assistant in an 8-week study period. Both quantitative and qualitative data collected from center visits and weekly phone calls were used to examine study feasibility. Results: A total of 150 participants (mean age, 73 years; 38% men) were enrolled; 83% completed all three center visits. Among those assigned to verum and sham acupressure groups, 94% passed a fidelity check at the second visit, more than 80% reported performing self-administered acupressure as instructed most of the time, and about 10% reported discomfort from performing the acupressure. Thirty adverse events were reported; most were related to pre-existing health conditions. Conclusions: It is feasible to conduct a study of self-administered acupressure for symptom management in community-living older adults with knee osteoarthritis, although sample recruitment may be challenging.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140088/1/acm.2015.0231.pd

Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study

Abstract Background Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. Methods The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person’s primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village’s Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects’ electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. Discussion The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. Trial registration ClinicalTrials.gov ID: NCT01938963 ; First posted: September 10, 2013.https://deepblue.lib.umich.edu/bitstream/2027.42/143862/1/12877_2018_Article_808.pd

Somatic Mutations of PIK3R1 Promote Gliomagenesis

The phosphoinositide 3-kinase (PI3K) pathway is targeted for frequent alteration in glioblastoma (GBM) and is one of the core GBM pathways defined by The Cancer Genome Atlas. Somatic mutations of PIK3R1 are observed in multiple tumor types, but the tumorigenic activity of these mutations has not been demonstrated in GBM. We show here that somatic mutations in the iSH2 domain of PIK3R1 act as oncogenic driver events. Specifically, introduction of a subset of the mutations identified in human GBM, in the nSH2 and iSH2 domains, increases signaling through the PI3K pathway and promotes tumorigenesis of primary normal human astrocytes in an orthotopic xenograft model. Furthermore, we show that cells that are dependent on mutant P85α-mediated PI3K signaling exhibit increased sensitivity to a small molecule inhibitor of AKT. Together, these results suggest that GBM patients whose tumors carry mutant PIK3R1 alleles may benefit from treatment with inhibitors of AKT

Depression is Associated with Myocardial Infarction within a Two-Year Period among Adults in China

We examined whether baseline depression is associated with MI within a two-year period among adults aged 45+ in China and whether the association varies by sociodemographic characteristics. Two-year longitudinal data from a nationally representative sample of people aged 45+ in China were analyzed (N = 15,226). MI within the 2-year period was coded dichotomously. Baseline depression, assessed by the 10-item Center for Epidemiological Studies Depression scale, was used as a dichotomous and a continuous variable. After adjusting for medical conditions, lifestyle and sociodemographic characteristics, the odds of having an MI within the 2-year period were 46% greater for respondents with clinically significant depression at baseline than those without. There was a dose-response relationship between symptom severity and the probability of having an MI. The association did not vary by sociodemographic characteristics. Findings suggest that depression screening and treatment may reduce MI cases in China and beyond

Inhibition of p70 S6 Kinase (S6K1) Activity by A77 1726 and Its Effect on Cell Proliferation and Cell Cycle Progress

AbstractLeflunomide is a novel immunomodulatory drug prescribed for treating rheumatoid arthritis. It inhibits the activity of protein tyrosine kinases and dihydroorotate dehydrogenase, a rate-limiting enzyme in the pyrimidine nucleotide synthesis pathway. Here, we report that A77 1726, the active metabolite of leflunomide, inhibited the phosphorylation of ribosomal protein S6 and two other substrates of S6K1, insulin receptor substrate-1 and carbamoyl phosphate synthetase 2, in an A375 melanoma cell line. A77 1726 increased the phosphorylation of AKT, p70 S6 (S6K1), ERK1/2, and MEK through the feedback activation of the IGF-1 receptor–mediated signaling pathway. In vitro kinase assay revealed that leflunomide and A77 1726 inhibited S6K1 activity with IC50 values of approximately 55 and 80 μM, respectively. Exogenous uridine partially blocked A77 1726–induced inhibition of A375 cell proliferation. S6K1 knockdown led to the inhibition of A375 cell proliferation but did not potentiate the antiproliferative effect of A77 1726. A77 1726 stimulated bromodeoxyuridine incorporation in A375 cells but arrested the cell cycle in the S phase, which was reversed by addition of exogenous uridine or by MAP kinase pathway inhibitors but not by rapamycin and LY294002 (a phosphoinositide 3-kinase inhibitor). These observations suggest that A77 1726 accelerates cell cycle entry into the S phase through MAP kinase activation and that pyrimidine nucleotide depletion halts the completion of the cell cycle. Our study identified a novel molecular target of A77 1726 and showed that the inhibition of S6K1 activity was in part responsible for its antiproliferative activity. Our study also provides a novel mechanistic insight into A77 1726–induced cell cycle arrest in the S phase