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1.  Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress 
American journal of public health  2013;104(1):117-123.
We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults.
We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n=3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models.
Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range=0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR]=1.04; 95% confidence interval [CI]=1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR=1.05; 95% CI=0.99, 1.12), and Whites showed no association (OR=0.95; 95% CI=0.87, 1.03).
Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.
PMCID: PMC3910029  PMID: 24228644
2.  Elucidating the Role of Place in Health Care Disparities: The Example of Racial/Ethnic Residential Segregation 
Health Services Research  2012;47(3 Pt 2):1278-1299.
To develop a conceptual framework for investigating the role of racial/ethnic residential segregation on health care disparities.
Data Sources and Settings
Review of the MEDLINE and the Web of Science databases for articles published from 1998 to 2011.
Study Design
The extant research was evaluated to describe mechanisms that shape health care access, utilization, and quality of preventive, diagnostic, therapeutic, and end-of-life services across the life course.
Principal Findings
The framework describes the influence of racial/ethnic segregation operating through neighborhood-, health care system-, provider-, and individual-level factors. Conceptual and methodological issues arising from limitations of the research and complex relationships between various levels were identified.
Increasing evidence indicates that racial/ethnic residential segregation is a key factor driving place-based health care inequalities. Closer attention to address research gaps has implications for advancing and strengthening the literature to better inform effective interventions and policy-based solutions.
PMCID: PMC3417310  PMID: 22515933
Racial/ethnic residential segregation; health care disparities; health care access; social determinants of health
3.  Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer 
Health Services Research  2012;47(3 Pt 2):1255-1277.
To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example.
Principal Findings
SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management.
Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities.
PMCID: PMC3418828  PMID: 22568674
Health care disparities; smoking; lung cancer; race/ethnicity; socioeconomic status; gender
4.  Focal damage to macaque photoreceptors produces persistent visual loss 
Experimental eye research  2013;119:88-96.
Insertion of light-gated channels into inner retina neurons restores neural light responses, light evoked potentials, visual optomotor responses and visually-guided maze behavior in mice blinded by retinal degeneration. This method of vision restoration bypasses damaged outer retina, providing stimulation directly to retinal ganglion cells in inner retina. The approach is similar to that of electronic visual protheses, but may offer some advantages, such as avoidance of complex surgery and direct targeting of many thousands of neurons. However, the promise of this technique for restoring human vision remains uncertain because rodent animal models, in which it has been largely developed, are not ideal for evaluating visual perception. On the other hand, psychophysical vision studies in macaque can be used to evaluate different approaches to vision restoration in humans. Furthermore, it has not been possible to test vision restoration in macaques, the optimal model for human-like vision, because there has been no macaque model of outer retina degeneration. In this study, we describe development of a macaque model of photoreceptor degeneration that can in future studies be used to test restoration of perception by visual prostheses. Our results show that perceptual deficits caused by focal light damage are restricted to locations at which photoreceptors are damaged, that optical coherence tomography (OCT) can be used to track such lesions, and that adaptive optics retinal imaging, which we recently used for in vivo recording of ganglion cell function, can be used in future studies to examine these lesions.
PMCID: PMC4329982  PMID: 24316158
retina; light damage; ganglion cells; macaque; adaptive optics
5.  Unequally Distributed Psychological Assets: Are There Social Disparities in Optimism, Life Satisfaction, and Positive Affect? 
PLoS ONE  2015;10(2):e0118066.
Socioeconomic status is associated with health disparities, but underlying psychosocial mechanisms have not been fully identified. Dispositional optimism may be a psychosocial process linking socioeconomic status with health. We hypothesized that lower optimism would be associated with greater social disadvantage and poorer social mobility. We also investigated whether life satisfaction and positive affect showed similar patterns. Participants from the Midlife in the United States study self-reported their optimism, satisfaction, positive affect, and socioeconomic status (gender, race/ethnicity, education, occupational class and prestige, income). Social disparities in optimism were evident. Optimistic individuals tended to be white and highly educated, had an educated parent, belonged to higher occupational classes with more prestige, and had higher incomes. Findings were generally similar for satisfaction, but not positive affect. Greater optimism and satisfaction were also associated with educational achievement across generations. Optimism and life satisfaction are consistently linked with socioeconomic advantage and may be one conduit by which social disparities influence health.
PMCID: PMC4324648  PMID: 25671665
6.  Self-Reported Experiences of Discrimination and Cardiovascular Disease 
Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011–2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.
PMCID: PMC3980947  PMID: 24729825
Racial; Ethnic; Discrimination; Cardiovascular disease
7.  Noninvasive two-photon fluorescence microscopy imaging of mouse retina and RPE through the pupil of the eye 
Nature medicine  2014;20(7):785-789.
Two-photon excitation microscopy (TPM) can image retinal molecular processes in vivo. Intrinsically fluorescent retinyl esters in sub-cellular structures called retinosomes are an integral part of the visual chromophore regeneration pathway. Fluorescent condensation products of all–trans–retinal accumulate in the eye with age and are also associated with age-related macular degeneration (AMD). Here we report repetitive, dynamic imaging of these compounds in live mice, through the pupil of the eye. Leveraging advanced adaptive optics we developed a data acquisition algorithm that permitted the identification of retinosomes and condensation products in the retinal pigment epithelium (RPE) by their characteristic localization, spectral properties, and absence in genetically modified or drug-treated mice. This imaging approach has the potential to detect early molecular changes in retinoid metabolism that trigger light and AMD-induced retinal defects and to assess the effectiveness of treatments for these conditions.
PMCID: PMC4087080  PMID: 24952647
8.  Endogenous Fluorophores Enable Two-Photon Imaging of the Primate Eye 
Noninvasive two-photon imaging of a living mammalian eye can reveal details of molecular processes in the retina and RPE. Retinyl esters and all-trans-retinal condensation products are two types of retinoid fluorophores present in these tissues. We measured the content of these two types of retinoids in monkey and human eyes to validate the potential of two-photon imaging for monitoring retinoid changes in human eyes.
Two-photon microscopy (TPM) was used to visualize excised retina from monkey eyes. Retinoid composition and content in human and monkey eyes were quantified by HPLC and mass spectrometry (MS).
Clear images of inner and outer segments of rods and cones were obtained in primate eyes at different eccentricities. Fluorescence spectra from outer segments revealed a maximum emission at 480 nm indicative of retinols and their esters. In cynomolgus monkey and human retinal extracts, retinyl esters existed predominantly in the 11-cis configuration along with notable levels of 11-cis-retinol, a characteristic of cone-enriched retinas. Average amounts of di-retinoid-pyridinium-ethanolamine (A2E) in primate and human eyes were 160 and 225 pmol/eye, respectively.
These data show that human retina contains sufficient amounts of retinoids for two-photon excitation imaging. Greater amounts of 11-cis-retinyl esters relative to rodent retinas contribute to the fluorescence signal from both monkey and human eyes. These observations indicate that TPM imaging found effective in mice could detect early age- and disease-related changes in human retina.
Two-photon excitation tracks early changes in primate retina.
PMCID: PMC4106253  PMID: 24970255
rod photoreceptors; cone photoreceptors; retinoid cycle; two-photon microscopy; primate retina
9.  Miles to Go Before We Sleep: Racial Inequities in Health 
Large, pervasive and persistent racial inequalities exist in the onset, course and outcomes of illness. A comprehensive understanding of the patterning of racial disparities indicates that racism in both its institutional and individual forms remains an important determinant. Despite our extensive knowledge of the magnitude, trends and determinants of these social inequalities in health, there is still much that we need to learn about the forces that drive them. There is also an even greater opportunity to build the science base that would identify how to trigger the conditions that would facilitate needed societal change, and identify the optimal interventions that would confront and dismantle the societal conditions that create and sustain health inequalities.
PMCID: PMC3712789  PMID: 22940811
10.  Mental health service use from a religious or spiritual advisor among Asian Americans 
Asian journal of psychiatry  2013;6(6):10.1016/j.ajp.2013.03.009.
Asian Americans experience significant underuse of mental health treatment. Religious clergy and spiritual advisors play a critical role in delivering mental health care in the United States. Limited knowledge exists about their use among Asian Americans.
We describe mental health service use from a religious/spiritual advisor among Asian Americans.
We analyzed data from 2095 respondents in the 2002–2003 National Latino and Asian American Study.
Lifetime and 12-month prevalence of mental health service use from a religious/spiritual advisor (5.5% and 1% overall, respectively) was generally higher among U.S.-born Asians and those with a 12-month mental disorder (23.6% and 7.5%, respectively). Religious/spiritual advisors were seen by 35% of treatment-seeking Asian Americans with a lifetime mental disorder. They were seen as commonly as psychiatrists but less commonly than a mental health specialist or general medical provider. Approximately 70% of those seeking treatment had a mental disorder, significant proportions of whom sought treatment in the absence of a psychiatrist, a mental health specialist or even a healthcare provider. A significant majority with 12-month use perceived the care as helpful, felt accepted/understood and satisfied (71–86%). However, only 31% rated the care as excellent, 28% quit completing care, and referral rates for specialty mental health treatment were low, even among those with a mental disorder (9.5%).
Religious/spiritual advisors are a key source of treatment-seeking for Asian Americans with a mental disorder. Quality of care and low referral rates for specialty mental health treatment warrant further attention and need for increased collaboration with the mental health system.
PMCID: PMC3855663  PMID: 24309881
Asian Americans; Religious and spiritual advisor; Mental health service use; Mental disorder; Ethnicity; Nativity
11.  Correlates of Cortisol in Human Hair: Implications for Epidemiologic Studies on Health Effects of Chronic Stress 
Annals of epidemiology  2013;23(12):797-811.e2.
Assessment of cortisol concentrations in hair is one of the latest innovations for measuring long-term cortisol exposure. We performed a systematic review of correlates of cortisol in human hair to inform the design, analysis and interpretation of future epidemiologic studies. Relevant publications were identified through electronic searches on PubMed, WorldCat, and Web of Science using keywords, “cortisol” “hair” “confounders” “chronic” “stress” and “correlates.” Thirty-nine studies were included in this review. Notwithstanding scarce data and some inconsistencies, investigators have found hair cortisol concentrations to be associated with stress-related psychiatric symptoms and disorders (e.g., PTSD), medical conditions indicating chronic activation of the hypothalamic-pituitary-adrenal axis (e.g., Cushing´s syndrome) and other life situations associated with elevated risk of chronic stress (e.g., shiftwork). Results from some studies suggest that physical activity, adiposity, and substance abuse may be correlates of hair cortisol concentrations. In contrast to measures of short-term cortisol release (saliva, blood, and urine), cigarette smoking and use of oral contraceptives appear to not be associated with hair cortisol concentrations. Studies of pregnant women indicate increased hair cortisol concentrations across successive trimesters. The study of hair cortisol presents a unique opportunity to assess chronic alterations in cortisol concentrations in epidemiologic studies.
PMCID: PMC3963409  PMID: 24184029
hair; cortisol; chronic stress; correlates; assessment; analysis; determinants; psychiatric disorders
12.  Long-Term Reduction in Infrared Autofluorescence Caused by Infrared Light Below the Maximum Permissible Exposure 
Many retinal imaging instruments use infrared wavelengths to reduce the risk of light damage. However, we have discovered that exposure to infrared illumination causes a long-lasting reduction in infrared autofluorescence (IRAF). We have characterized the dependence of this effect on radiant exposure and investigated its origin.
A scanning laser ophthalmoscope was used to obtain IRAF images from two macaques before and after exposure to 790-nm light (15-450 J/cm2). Exposures were performed with either raster-scanning or uniform illumination. Infrared autofluorescence images also were obtained in two humans exposed to 790-nm light in a separate study. Humans were assessed with direct ophthalmoscopy, Goldmann visual fields, multifocal ERG, and photopic microperimetry to determine whether these measures revealed any effects in the exposed locations.
A significant decrease in IRAF after exposure to infrared light was seen in both monkeys and humans. In monkeys, the magnitude of this reduction increased with retinal radiant exposure. Partial recovery was seen at 1 month, with full recovery within 21 months. Consistent with a photochemical origin, IRAF decreases caused by either raster-scanning or uniform illumination were not significantly different. We were unable to detect any effect of the light exposure with any measure other than IRAF imaging. We cannot exclude the possibility that changes could be detected with more sensitive tests or longer follow-up.
This long-lasting effect of infrared illumination in both humans and monkeys occurs at exposure levels four to five times below current safety limits. The photochemical basis for this phenomenon remains unknown.
Exposure to infrared illumination at irradiances well below current safety limits can cause a long-lasting decrease in infrared autofluorescence from the retina. It is unclear whether this effect is benign or indicative of a subcellular change that could be cumulatively harmful.
PMCID: PMC4068866  PMID: 24845640
retina; light damage; radiation damage; scanning laser ophthalmoscopy; retinal pigment epithelium
13.  Role of common mental and physical disorders in partial disability around the world 
The British Journal of Psychiatry  2012;200(6):454-461.
Mental and physical disorders are associated with total disability, but their effects on days with partial disability (i.e. the ability to perform some, but not full-role, functioning in daily life) are not well understood.
To estimate individual (i.e. the consequences for an individual with a disorder) and societal effects (i.e. the avoidable partial disability in the society due to disorders) of mental and physical disorders on days with partial disability around the world.
Respondents from 26 nationally representative samples (n = 61 259, age 18+) were interviewed regarding mental and physical disorders, and day-to-day functioning. The Composite International Diagnostic Interview, version 3.0 (CIDI 3.0) was used to assess mental disorders; partial disability (expressed in full day equivalents) was assessed with the World Health Organization Disability Assessment Schedule in the CIDI 3.0.
Respondents with disorders reported about 1.58 additional disability days per month compared with respondents without disorders. At the individual level, mental disorders (especially post-traumatic stress disorder, depression and bipolar disorder) yielded a higher number of days with disability than physical disorders. At the societal level, the population attributable risk proportion due to physical and mental disorders was 49% and 15% respectively.
Mental and physical disorders have a considerable impact on partial disability, at both the individual and at the societal level. Physical disorders yielded higher effects on partial disability than mental disorders.
PMCID: PMC3365273  PMID: 22539779
14.  Imaging Light Responses of Foveal Ganglion Cells in the Living Macaque Eye 
The Journal of Neuroscience  2014;34(19):6596-6605.
The fovea dominates primate vision, and its anatomy and perceptual abilities are well studied, but its physiology has been little explored because of limitations of current physiological methods. In this study, we adapted a novel in vivo imaging method, originally developed in mouse retina, to explore foveal physiology in the macaque, which permits the repeated imaging of the functional response of many retinal ganglion cells (RGCs) simultaneously. A genetically encoded calcium indicator, G-CaMP5, was inserted into foveal RGCs, followed by calcium imaging of the displacement of foveal RGCs from their receptive fields, and their intensity-response functions. The spatial offset of foveal RGCs from their cone inputs makes this method especially appropriate for fovea by permitting imaging of RGC responses without excessive light adaptation of cones. This new method will permit the tracking of visual development, progression of retinal disease, or therapeutic interventions, such as insertion of visual prostheses.
PMCID: PMC4012315  PMID: 24806684
calcium imaging; in vivo adaptive optics imaging; intrinsic signal imaging; primate fovea; retinal ganglion cells
15.  Research on Discrimination and Health: An Exploratory Study of Unresolved Conceptual and Measurement Issues 
American Journal of Public Health  2012;102(5):975-978.
Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination.
We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods.
More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts.
Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.
PMCID: PMC3329155  PMID: 22420798
16.  Racial and nonracial discrimination and smoking status among South African adults ten years after apartheid 
Tobacco control  2014;23(0):e114-e121.
Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa.
This analysis examined chronic (day to day) and acute (lifetime) experiences of racial and nonracial (e.g., age, gender, or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health Study (SASH). Logistic regression models were constructed using SAS-Callable SUDAAN.
Both chronic racial discrimination (RR=1.45, 95%CI: 1.14–1.85) and chronic nonracial discrimination (RR=1.69, 95%CI: 1.37–2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and nonracial) chronic discrimination (RR=1.46, 95%CI: 1.20–1.78) and total acute discrimination (RR=1.28, 95%CI: 1.01–1.60) predicted a higher risk of current smoking.
Racial and nonracial discrimination may be related to South African adults’ smoking behavior, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalizability, and consider the implications of these findings for smoking cessation approaches in South Africa.
PMCID: PMC4214915  PMID: 24789604
discrimination; racism; smoking; bias; South Africa
17.  Association of Race Consciousness With the Patient–Physician Relationship, Medication Adherence, and Blood Pressure in Urban Primary Care Patients 
American Journal of Hypertension  2013;26(11):1346-1352.
Race consciousness (the frequency with which one thinks about his or her own race) is a measure that may be useful in assessing whether racial discrimination negatively impacts blood pressure (BP). However, the relation between race consciousness and BP has yet to be empirically tested, especially within the context of the patient–physician relationship and medication adherence.
Race-stratified generalized estimating equations were used to assess the relationship of race consciousness on BP, measures of the patient–physician relationship, and self-reported medication adherence, controlling for patients being nested within physicians and for patient age and sex.
The mean age of the patients was 61.3 years, 62% were black, and 65% were women. Black patients were more likely to ever think about race than were white patients (49% vs. 21%; P < 0.001). Race-conscious blacks had significantly higher diastolic BP (79.4 vs. 74.5mm Hg; P = 0.004) and somewhat higher systolic BP (138.8 vs. 134.7mm Hg; P = 0.13) than blacks who were not race conscious. Race-conscious whites were more likely to perceive respect from their physician (57.1% vs. 25.8%; P = 0.01) but had lower medication adherence (62.4% vs. 82.9%; P = 0.05) than whites who were not race-conscious.
Among blacks, race consciousness was associated with higher diastolic BP. In contrast, among whites, there was no association between race consciousness and BP, but race consciousness was associated with poor ratings of adherence, despite more favorable ratings of the patient–physician relationship. Future work should explore disparities in race consciousness and its impact on health and health-care disparities.
PMCID: PMC3790452  PMID: 23864583
adherence; blood pressure; blood pressure discrimination; disparities; hypertension; perceived quality of care; race; racism.
18.  Lewy- and Alzheimer-type pathologies in Parkinson’s disease dementia: which is more important? 
Brain : a journal of neurology  2011;134(0 5):1493-1505.
The relative importance of Lewy- and Alzheimer-type pathologies to dementia in Parkinson’s disease remains unclear. We have examined the combined associations of α-synuclein, tau and amyloid-β accumulation in 56 pathologically confirmed Parkinson’s disease cases, 29 of whom had developed dementia. Cortical and subcortical amyloid-β scores were obtained, while tau and α-synuclein pathologies were rated according to the respective Braak stages. Additionally, cortical Lewy body and Lewy neurite scores were determined and Lewy body densities were generated using morphometry. Non-parametric statistics, together with regression models, receiver-operating characteristic curves and survival analyses were applied. Cortical and striatal amyloid-β scores, Braak tau stages, cortical Lewy body, Lewy neurite scores and Lewy body densities, but not Braak α-synuclein stages, were all significantly greater in the Parkinson’s disease-dementia group (P < 0.05), with all the pathologies showing a significant positive correlation to each other (P < 0.05). A combination of pathologies [area under the receiver-operating characteristic curve = 0.95 (0.88–1.00); P < 0.0001] was a better predictor of dementia than the severity of any single pathology. Additionally, cortical amyloid-β scores (r = −0.62; P = 0.043) and Braak tau stages (r = −0.52; P = 0.028), but not Lewy body scores (r = −0.25; P = 0.41) or Braak α-synuclein stages (r = −0.44; P = 0.13), significantly correlated with mini-mental state examination scores in the subset of cases with this information available within the last year of life (n = 15). High cortical amyloid-β score (P = 0.017) along with an older age at onset (P = 0.001) were associated with a shorter time-to-dementia period. A combination of Lewy- and Alzheimer-type pathologies is a robust pathological correlate of dementia in Parkinson’s disease, with quantitative and semi-quantitative assessment of Lewy pathology being more informative than Braak α-synuclein stages. Cortical amyloid-β and age at disease onset seem to determine the rate to dementia.
PMCID: PMC4194668  PMID: 21596773
lewy bodies; amyloid-β; tau; Parkinson’s disease; dementia
19.  Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: A prospective study of middle-aged adults in the United States 
Cancer causes & control : CCC  2013;24(10):1849-1863.
Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9–10 years among adults in the United States (N=4938, ages 25–74).
Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work-family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.
High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time-points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.
Interventions to address psychosocial stress may be important components within smoking cessation efforts.
PMCID: PMC3776130  PMID: 23860953
cigarette smoking; smoking cessation; smoking persistence; psychosocial stress; longitudinal; Midlife in the United States (MIDUS)
20.  Parkinsonian Syndromes 
Continuum : Lifelong Learning in Neurology  2013;19(5 Movement Disorders):1189-1212.
Supplemental Digital Content is available in the text.
Purpose of Review
The different parkinsonian conditions can be challenging to separate clinically. This review highlights the important clinical features that guide the diagnosis of Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD). Strategies for treatment and disease management are also discussed.
Recent Findings
Over the past decade there has been an increasing recognition of the broad clinical presentations of the neurodegenerative forms of parkinsonism. Nonmotor symptoms in these diseases, including psychiatric, cognitive, autonomic, and gastrointestinal dysfunction, appear to have a major impact on quality of life and disability. PSP and CBD are now considered pathologic diagnoses, with several different and varied clinical phenotypes, that overlap and share features with PDand frontotemporal dementia syndromes. PD is distinguished by its excellent response to dopaminergic medications that is maintained over many years, in contrast to the response seen in patients with MSA and PSP. New diagnostic criteria have been proposed for CBD. No new therapeutic interventions have emerged for PSP, MSA, or CBD. Infusional therapies and deep brain stimulation surgery are established therapies for advanced PD.
The “parkinsonian syndromes” encompass a number of nosologic entities that are grouped together on the basis of their shared clinical features but are separated on the basis of their different pathologies. Overall, the consideration of clinical signs, mode of disease onset, and nature of disease progression are all important to make a timely and definitive diagnosis.
PMCID: PMC4234134  PMID: 24092286
21.  Contextualizing nativity status, social ties, and ethnic enclaves: Implications for understanding immigrant and Latino health paradoxes 
Ethnicity & health  2013;18(6):586-609.
Researchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their U.S.-born counterparts, may be the strength of their social ties and social support among immigrants.
We examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study’s Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used Ordinary Least Squares [OLS] regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed effects regression models, we estimated the association between Latino/immigrant neighborhood composition on our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants’ length of time in the United States.
After controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their U.S.-born counterparts for all our outcomes, except for informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for U.S.-born Latinos than for immigrant Latinos. U.S.-born Latinos maintained a significant socialties advantage compared to immigrants—regardless of length of time in the United States—for informal social integration, network diversity, and network size.
At the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their U.S.-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.
PMCID: PMC4176765  PMID: 23947776
Social support; Social networks; Latinos; Immigrants; Nativity; Immigrant Status; Length of Time in the United States; Ethnic Enclaves; Neighborhood Context; USA
Research conducted predominantly in the developed world suggests that there is an association between trauma exposure and suicidal behaviour. However, there are limited data available investigating whether specific traumas are uniquely predictive of suicidal behaviour, or the extent to which traumatic events predict the progression from suicide ideation to plans and attempts. A national survey was conducted with 4351 adult South Africans between 2002 and 2004 as part of the WHO World Mental Health Surveys. Data on trauma exposure and subsequent suicidal behaviour were collected. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and lifetime suicidal behaviour. A range of traumatic events are associated with lifetime suicide ideation and attempt; however, after controlling for all traumatic events in a multivariate model, only sexual violence (OR=4.7, CI 2.3-9.4) and having witnessed violence (OR=1.8, 1.1-2.9) remained significant predictors of life-time suicide attempts. Disaggregation of the associations between traumatic events and suicide attempts indicates that they are largely due to traumatic events predicting suicide ideation rather than to the progression from suicide ideation to attempt. This paper highlights the importance of traumatic life events in the occurrence of suicidal thoughts and behaviours and provides important information about the nature of this association. Future research is needed to better understand how and why such experiences increase the risk of suicidal outcomes.
PMCID: PMC4148626  PMID: 22134450
23.  Mortality Rates Among Arab Americans in Michigan 
The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.
PMCID: PMC4149176  PMID: 21318619
Arab; Mortality rates; Surnames
24.  Closed-loop optical stabilization and digital image registration in adaptive optics scanning light ophthalmoscopy 
Biomedical Optics Express  2014;5(9):3174-3191.
Eye motion is a major impediment to the efficient acquisition of high resolution retinal images with the adaptive optics (AO) scanning light ophthalmoscope (AOSLO). Here we demonstrate a solution to this problem by implementing both optical stabilization and digital image registration in an AOSLO. We replaced the slow scanning mirror with a two-axis tip/tilt mirror for the dual functions of slow scanning and optical stabilization. Closed-loop optical stabilization reduced the amplitude of eye-movement related-image motion by a factor of 10–15. The residual RMS error after optical stabilization alone was on the order of the size of foveal cones: ~1.66–2.56 μm or ~0.34–0.53 arcmin with typical fixational eye motion for normal observers. The full implementation, with real-time digital image registration, corrected the residual eye motion after optical stabilization with an accuracy of ~0.20–0.25 μm or ~0.04–0.05 arcmin RMS, which to our knowledge is more accurate than any method previously reported.
PMCID: PMC4230869  PMID: 25401030
(110.1080) Active or adaptive optics; (120.3890) Medical optics instrumentation; (170.3880) Medical and biological imaging; (170.4470) Ophthalmology; (330.2210) Vision - eye movements
25.  Social Determinants: Taking the Social Context of Asthma Seriously 
Pediatrics  2009;123(Suppl 3):S174-S184.
While asthma has emerged as a major contributor to disease and disability in American children, the burden of this disease is unevenly distributed within the population. This paper provides a brief overview of social status variables that predict variation in asthma risks and social exposures such as stress and violence that are emerging as important risk factors. However, the central focus of the paper is on the distal social variables that have given rise to unhealthy residential environments in which the risk factors for asthma and other diseases are clustered. Effective initiatives for the prevention and treatment of childhood asthma need to address these non-medical determinants of the prevalence of asthma.
PMCID: PMC3489274  PMID: 19221161
childhood asthma prevalence; low-income population; poverty; race; risk factors

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