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Background Assessing depression symptoms in Hispanic/Latin American (H/Ls) older adults, a group at high risk for depression, is nuanced due to the influence of cultural characteristics in symptom expression and manifestation. Little is known about the psychometric properties of available measures when used with this population. Methods We conducted a two-stage systematic review of available depression assessment tools. We first identified self-report measures designed for use with adults. We then identified studies where at least one of such measures was used with older H/Ls that reported psychometric properties for the measure(s) used. Results Only 3 measures were identified for use with older H/Ls: the BDI, GDS, and CES-D. However, few data were found to support the validity of the BDI, and the CES-D was not consistently valid across cultural groups. The GDS was found appropriate, though its performance varied based on race/ethnicity, nationality, and cutoff scores. The CES-D and GDS also demonstrated varying psychometric properties based on study setting (research versus clinical) and target population (inpatient psychiatric patients versus community-dwelling individuals). Limitations The number of articles that met criteria for inclusion in our review was small, and there was variation among samples of the few studies included. Conclusions Currently available self-report depression screening measures have acceptable applicability among older H/Ls, but their utility may vary based on their intended use. Modified cutoff scores may be beneficial in maximizing the utility of these measures when given to diverse older adults.

Background Evaluating measurement bias is vital to ensure equivalent assessment across diverse groups. One approach for evaluating test bias, differential item functioning (DIF), assesses item-level bias across specified groups by comparing item-level responses between groups that have the same overall score. Previous DIF studies of the Beck Anxiety Inventory (BAI) have only assessed bias across age, sex, and disease duration in monolingual samples. We expand this literature through DIF analysis of the BAI across age, sex, education, ethnicity, cognitive status, and test language. Methods BAI data from a sample (n = 527, mean age=61.4 ± 12.7, mean education=10.9 ± 4.3, 69.3% female, 41.9% Hispanic/Latin American) from rural communities in West Texas, USA were analyzed. Item response theory (IRT) / logistic ordinal regression DIF was conducted across dichotomized demographic grouping factors. The Mann-Whitney U test and Hedge's g standardized mean differences were calculated before and after adjusting for the impact of DIF. Results Significant DIF was demonstrated in 10/21 items. An adverse impact of DIF was not identified when demographics were assessed individually. Adverse DIF was identified for only one participant (1/527, 0.2%) when all demographics were aggregated. Limitations These results might not be generalizable to a sample with broader racial representation, more severe cognitive impairment, and higher levels of anxiety. Conclusions Minimal item-level bias was identified across demographic factors considered. These results support prior evidence that the BAI is valid for assessing anxiety across age and sex while contributing new evidence of its clinical relevance across education, ethnicity, cognitive status, and English/Spanish test language.

In sleep apnea, airway obstruction causes intermittent hypoxia (IH). In animal studies, IH-dependent hypertension is associated with loss of vasodilator hydrogen sulfide (H(2)S), and increased H(2)S activation of sympathetic nervous system (SNS) activity in the carotid body. We previously reported that inhibiting cystathionine γ-lyase (CSE) to prevent H(2)S synthesis augments vascular resistance in control rats. The goal of this study was to evaluate the contribution of IH-induced changes in CSE signaling to increased blood pressure and vascular resistance. We hypothesized that chronic IH exposure eliminates CSE regulation of blood pressure (BP) and vascular resistance. In rats instrumented with venous catheters, arterial telemeters, and flow probes on the main mesenteric artery, the CSE inhibitor dl-propargylglycine (PAG, 50 mg/kg/day i.v. for 5 days) increased BP in Sham rats but decreased BP in IH rats [in mmHg, Sham (n = 11): 114 ± 4 to 131 ± 6; IH (n = 8): 131 ± 8 to 115 ± 7 mmHg, P < 0.05]. PAG treatment increased mesenteric vascular resistance in Sham rats but decreased it in IH rats (day 5/day 1: Sham: 1.50 ± 0.07; IH: 0.85 ± 0.19, P < 0.05). Administration of the ganglionic blocker hexamethonium (to evaluate SNS activity) decreased mesenteric resistance in PAG-treated Sham rats more than in saline-treated Sham rats or PAG-treated IH rats. CSE immunoreactivity in IH carotid bodies compared with those from Sham rats. However, CSE staining in small mesenteric arteries was less in arteries from IH than in Sham rats but not different in larger arteries (inner diameter > 200 µm). These results suggest endogenous H(2)S regulates blood pressure and vascular resistance, but this control is lost after IH exposure with decreased CSE expression in resistance size arteries. IH exposure concurrently increases carotid body CSE expression and relative SNS control of blood pressure, suggesting both vascular and carotid body H(2)S generation contribute to blood pressure regulation. NEW & NOTEWORTHY These results suggest that CSE’s protective role in the vasculature is impaired by simulated sleep apnea, which also upregulates CSE in the carotid body. Thus, this enzyme system can exert both pro- and antihypertensive effects and may contribute to elevated SNS outflow in sleep apnea.

We translated the Medication Management Ability Assessment (MMAA) from English to Spanish for use via tele-assessment and examined its reliability and validity. Following International Test Commission Guidelines for Translating and Adapting Tests, we used translation/back-translation and a small focus group (n = 6) to adapt a Spanish version of the MMAA. Eighty-six Spanish-speaking adults completed the adapted MMAA via tele-assessment at baseline and at a two-week follow-up visit. Participants also completed several self-report and performance-based cognitive and functional measures. The internal consistency of the MMAA was excellent (standardized Cronbach’s α = 0.90). Performance-based functional assessments (PBFAs) and objective cognition were positively associated with the MMAA at small to medium effect sizes. Self-report measures of daily function and cognition, measures of health literacy, and estimates of premorbid intellectual functioning were not significantly associated with MMAA performance. The test-retest reliability of the MMAA was good (CCC = 0.73, 95% CI [0.62, 0.81]; rs = 0.37, p < 0.001) and demonstrated a small practice effect (Cohen's d = 0.36, p = 0.001). Preliminary evidence for the construct validity of a Spanish-language MMAA administered via tele-assessment further expands the potential clinical utility of PBFAs in culturally diverse, Spanish-speaking populations.

Obstructive sleep apnea is characterized by recurrent episodes of pharyngeal collapse during sleep, resulting in intermittent hypoxia (IH), and is associated with a high incidence of hypertension and accelerated renal failure. In rodents, endothelin (ET)-1 contributes to IH-induced hypertension, and ET-1 levels inversely correlate with glomerular filtration rate in patients with end-stage chronic kidney disease (CKD). Therefore, we hypothesized that a dual ET receptor antagonist, macitentan (Actelion Pharmaceuticals), will attenuate and reverse hypertension and renal dysfunction in a rat model of combined IH and CKD. Male Sprague-Dawley rats received one of three diets (control, 0.2% adenine, and 0.2% adenine + 30 mg·kg−1·day−1macitentan) for 2 wk followed by 2 wk of recovery diet. Rats were then exposed for 4 wk to air or IH (20 short exposures/h to 5% O2-5% CO27 h/day during sleep). Macitentan prevented the increases in mean arterial blood pressure caused by CKD, IH, and the combination of CKD + IH. However, macitentan did not improve kidney function, fibrosis, and inflammation. After CKD was established, rats were exposed to air or IH for 2 wk, and macitentan feeding continued for 2 more wk. Macitentan reversed the hypertension in IH, CKD, and CKD + IH groups without improving renal function. Our data suggest that macitentan could be an effective antihypertensive in patients with CKD and irreversible kidney damage as a way to protect the heart, brain, and eyes from elevated arterial pressure, but it does not reverse toxin-induced tubule atrophy.

Inhibiting cystathionine gamma-lyase (CSE) to prevent H 2 S synthesis augments constriction in isolated mesenteric and renal arteries, but H 2 S regulation of resistance in these vascular beds in vivo is unknown. This study evaluated regulation of blood flow and resistance in the mesenteric and renal vascular beds in chronically instrumented rats. Based on studies in isolated arteries, we hypothesized that endogenous production of H 2 S by CSE decreases vascular resistance more in mesenteric than in renal arteries. Rats were anesthetized with inhaled isofluorane (2%) and instrumented with femoral vein catheters, a telemeter blood pressure device and a pulsed Doppler flow probe (Crystal Biotech) on either the superior mesenteric artery or the renal artery (after denervation of the renal artery by removing all visible nerves and painting the surface of the artery with 10% phenol). After five to seven days of recovery from surgery, arterial pressure (AP), heart rate (HR) and relative blood flow (Q) was recorded. Rats then received a daily injection of the irreversible CSE inhibitor, propargylglycine (PAG, 50 mg/kg/day). After five injections, AP was significantly increased in rats with mesenteric flow probes (110±3 start to 122±4 mmHg post PAG, p2 S is an important regulator of vascular resistance in both the mesenteric and renal circulations and that the contribution may be larger in the renal bed than in the mesenteric bed.

The relationship between calcium oxalate kidney stone formation and inflammatory bowel disease (IBD) was first noted in two large retrospective case series from the 1960s. In over 1,400 patients with inflammatory bowel disease, 92 of 1,468 patients (6%) were identified to have developed renal stones, an occurrence that appeared as frequent as other systemic complications of this disease process [1, 2]. The mechanisms behind this high stone incidence were confirmed in the 1970s to be a complication of fat malabsorption and chronic diarrhea, which resulted in enteric hyperoxaluria, decreased urine citrate concentration and pH, and decreased urine volumes [3, 4]. Since those early descriptions, other malabsorptive intestinal disease states have also been added to the IBD/stone- associated list, including jejunoileal bypass (historical) and Roux-en-Y gastric bypass for obesity, chronic mesenteric ischemia, and small bowel ostomies [5, 6]. In general, patients with ileocolonic disease (9–17%) tend to be more commonly affected than those with ileal (6–8%) or colonic disease (3–5%) alone, and stone composition varies between calcium oxalate (malabsorptive diseases, ileocolonic Crohn’s disease) and uric acid (copious diarrhea, small bowel ostomies) depending on the disease state and amount of volume loss/diarrhea. This chapter will highlight the urinary abnormalities seen in modern bariatric surgical patients and in patients with the two most common forms of IBD (Crohn’s, ulcerative colitis) with a focus on the nutritional aspects that can be improved in these stone-forming populations.