Utilization of Standardized Mental Health Assessments in Anthropological Research: Possibilities and Pitfalls

In the past decade anthropologists working the boundary of culture, medicine, and psychiatry have drawn from ethnographic and epidemiological methods to interdigitate data and provide more depth in understanding critical health problems. But rarely do these studies incorporate psychiatric inventories with ethnographic analysis. This article shows how triangulation of research methods strengthens scholars’ ability (1) to draw conclusions from smaller data sets and facilitate comparisons of what suffering means across contexts; (2) to unpack the complexities of ethnographic and narrative data by way of interdigitating narratives with standardized evaluations of psychological distress; and (3) to enhance the translatability of narrative data to interventionists and to make anthropological research more accessible to policymakers. The crux of this argument is based on two discrete case studies, one community sample of Nicaraguan grandmothers in urban Nicaragua, and another clinic-based study of Mexican immigrant women in urban United States, which represent different populations, methodologies, and instruments. Yet, both authors critically examine narrative data and then use the Center for Epidemiologic Studies Depression Scale to further unpack meaning of psychological suffering by analyzing symptomatology. Such integrative methodologies illustrate how incorporating results from standardized mental health assessments can corroborate meaning-making in anthropology while advancing anthropological contributions to mental health treatment and policy.     

名贵中药穿山甲的规范化养殖技术

穿山甲是一种常用作传统中药的珍稀动物,由于人为的滥捕,穿山甲已成为一种濒危动物.开展穿山甲的人工饲养,扩大物种繁殖和保护,已成为保护穿山甲资源的有效途径.本文通过对穿山甲生活习性和人工繁养的多年研究,总结制定出一整套优质高产养殖技术规范化操作规程:场地的选择与建造、种苗来源、饲料调配、饲养管理、日常管理、疾病防治和出栏时间等,以利于进一步快速有效地扩大穿山甲资源.     

An association study of cyclase-associated protein 2 and frailty

Frailty is a geriatric syndrome that results from multisystem impairment caused by age-associated accumulation of deficits. The frailty index is used to define the level of frailty. Several studies have searched for molecular biomarkers associated with frailty, to meet the needs for personalized care. Cyclase-associated protein 2 (CAP2) is a multifunctional actin-binding protein involved in various physiological and pathological processes, that might reflect frailty's intrinsic complexity. This study aimed to investigate the association between frailty index and circulating CAP2 concentration in 467 community-dwelling older adults (median age: 79; range: 65–92 years) from Milan, Italy. The selected robust regression model showed that circulating CAP2 concentration was not associated with chronological age, as well as sex and education. However, circulating CAP2 concentration was significantly and inversely associated with the frailty index: a 0.1-unit increase in frailty index leads to ~0.5-point mean decrease in CAP2 concentration. Furthermore, mean CAP2 concentration was significantly lower in frail participants (i.e., frailty index ≥0.25) than in non-frail participants. This study shows the association between serum CAP2 concentration and frailty status for the first time, highlighting the potential of CAP2 as a biomarker for age-associated accumulation of deficits.     

Social vulnerability, frailty and mortality in elderly people

Background

Social vulnerability is related to the health of elderly people, but its measurement and relationship to frailty are controversial. The aims of the present study were to operationalize social vulnerability according to a deficit accumulation approach, to compare social vulnerability and frailty, and to study social vulnerability in relation to mortality.

Methods and Findings

This is a secondary analysis of community-dwelling elderly people in two cohort studies, the Canadian Study of Health and Aging (CSHA, 1996/7–2001/2; N = 3707) and the National Population Health Survey (NPHS, 1994–2002; N = 2648). Social vulnerability index measures that used self-reported items (23 in NPHS, 40 in CSHA) were constructed. Each measure ranges from 0 (no vulnerability) to 1 (maximum vulnerability). The primary outcome measure was mortality over five (CHSA) or eight (NPHS) years. Associations with age, sex, and frailty (as measured by an analogously constructed frailty index) were also studied. All individuals had some degree of social vulnerability. Women had higher social vulnerability than men, and vulnerability increased with age. Frailty and social vulnerability were moderately correlated. Adjusting for age, sex, and frailty, each additional social ‘deficit’ was associated with an increased odds of mortality (5 years in CSHA, odds ratio = 1.05, 95% confidence interval: 1.02–1.07; 8 years in the NPHS, odds ratio = 1.08, 95% confidence interval: 1.03–1.14). We identified a meaningful survival gradient across quartiles of social vulnerability, and although women had better survival than men, survival for women with high social vulnerability was equivalent to that of men with low vulnerability.

Conclusions

Social vulnerability is reproducibly related to individual frailty/fitness, but distinct from it. Greater social vulnerability is associated with mortality in older adults. Further study on the measurement and operationalization of social vulnerability, and of its relationships to other important health outcomes, is warranted.     

Incorporation of inter-individual heterogeneity into the multistage carcinogenesis model: approach to the analysis of cancer incidence data

We investigate a multistage carcinogenesis frailty model to incorporate inter-individual heterogeneity into carcinogenic response. Attention is focused on inference concerning the effects of different sources of population heterogeneity on cancer rates. The authors consider unobserved variability arising from either carcinogen exposure or background characteristics. Gamma and Inverse-Gaussian distributions are selected for frailty models, and the baseline hazard function is the generalized Armitage-Doll model (i.e. non-frailty model) in which exposure effects shift the age scale instead of acting multiplicatively on cancer rates. For illustration, we apply the method to solid cancer data from a cohort of atomic bomb survivors to examine some features of proposed models. The results show that the Gamma frailty model for the heterogeneity of baseline rates provides the best goodness-of-fit of the model and a non-zero frailty variance. Parameter estimates are, for the most part, comparable between the Gamma and Inverse-Gaussian frailty models. In a heterogeneous population the exposure effects on young adulthood cancer rates might be underestimated for the non-frailty model. Meaningful information regarding each source of heterogeneity has been provided by the proposed method. Therefore, the multistage carcinogenesis frailty model approach is useful for analyses of epidemiological cancer data to assess population heterogeneity and heterogeneity-influenced exposure effects.     

Bioarcheology has a “health” problem: Conceptualizing “stress” and “health” in bioarcheological research

This article provides a critical historical overview of the stress concept in bioarcheological research and critically evaluates the term “health” in reference to skeletal samples. Stress has a considerable history in 20th century physiological research, and the term has reached a critical capacity of meaning. Stress was operationalized around a series of generalized physiological responses that were associated with a deviation from homeostasis. The term was incorporated into anthropological research during the mid-20th century, and further defined in bioarcheological context around a series of skeletal indicators of physiological disruption and disease. Emphases on stress became a predominate area of research in bioarcheology, and eventually, many studies utilized the terms “health” and “stress” interchangeably as part of a broader, problem-oriented approach to evaluating prehistoric population dynamics. Use of the term “health” in relation to skeletal samples is associated with the intellectual history of bioarcheological research, specifically influences from cultural ecology and processualist archeology and remains problematic for two reasons. First, health represents a comprehensive state of well-being that includes physiological status and individual perception, factors that cannot be readily observed in skeletal samples. Second, the categorization of populations into relative levels of health represents a typological approach, however unintentional. This article advocates for the integration of methodological and theoretical advances from human biology and primatology, while simultaneously incorporating the theoretical constructs associated with social epidemiology into bioarcheological research. Such an approach will significantly increase the applicability of bioarcheological findings to anthropological and evolutionary research, and help realize the goal of a truly relevant bioarcheological paradigm. Am J Phys Anthropol 155:186–191, 2014. © 2014 Wiley Periodicals, Inc.     

Relative Contributions of Geographic,Socioeconomic, and Lifestyle Factors to Quality of Life,Frailty, and Mortality in Elderly

Background

To date, few studies address disparities in older populations specifically using frailty as one of the health outcomes and examining the relative contributions of individual and environmental factors to health outcomes.

Methodology/Principal Findings

Using a data set from a health survey of 4,000 people aged 65 years and over living in all regions of Hong Kong, we examined regional variations in self-rated health, frailty, and four-year mortality, and analyzed the relative contributions of lifestyle, socioeconomic status, and geographical location of residence to these outcomes using path analysis. We hypothesize that lifestyle, socioeconomic status, and regional characteristics directly and indirectly through interactions contribute to self-rated physical and psychological health, frailty, and four-year mortality.District variations directly affect self-rated physical health, and also exert an effect through socioeconomic position as well as lifestyle factors. Socioeconomic position in turn directly affects self-rated physical health, as well as indirectly through lifestyle factors. A similar pattern of interaction is observed for self-rated mental health, frailty, and mortality, although there are differences in different lifestyle factors and district associations. Lifestyle factors also directly affect physical and mental components of health, frailty, and mortality. The magnitude of direct district effect is comparable to those of lifestyle and socioeconomic position.

Conclusions/Significance

We conclude that district variations in health outcomes exist in the Hong Kong elderly population, and these variations result directly from district factors, and are also indirectly mediated through socioeconomic position as well as lifestyle. Provision and accessibility to health services are unlikely to play a significant role. Future studies on these district factors would be important in reducing health disparities in the older population.     

A comparison of laboratory and field studies of cold response

The recent application of physiological techniques to anthropological studies of cold stress in different human groups has produced evidence of considerable variation in response to cold. The usual anthropological procedure has been to compare the adult males of two different ethnic groups under standardized laboratory conditions, and then to generalize the conclusions in an evolutionary or ecological context. Several assumptions behind this procedure are examined. Four studies of response to cold in the same Quechua Indian group of Southern Peru are discussed. Two of the studies deal with variation in response to cold in a standardized laboratory situation. The other two describe responses as detected under actual cold conditions experienced by the subjects as they go about their daily routines. The results of the laboratory and field studies are compared. It is suggested that adult males studied in the laboratory may represent only a minor part of the variation which exists in the group and that their responses may not be indicative of those of the entire population. It is also proposed that the validity of laboratory studies for an evolutionary interpretation may be limited by the laboratory approximation of the actual cold stress experienced by the group.     

Fragiele ouderen: De identificatie van een risicovolle populatie

Frail elderly. Identification of a population at risk In the future the number of frail independently living older people will continue to increase. It is unclear however, which people are meant exactly by those frail elderly. The aim of this article is to discuss the concept of frailty and its adequacy in identifying the frail elderly population. To this end, a literature search has been performed regarding the conceptual and operational definitions of frailty. The results show that frailty often is put on a continuum opposite to vitality. It is emphasised that the process of frailty can be modified or (partly) reversed. Focusing on this reversibility is important because frail elderly have a higher risk for adverse outcomes such as dependence, hospitalization, falls and mortality. After studying the conceptual and operational definitions it is concluded that no actual definition meets the criteria for a successful definition of frailty. Frailty is predominantly defined in terms of physical loss. This may lead to fragmentation of care with lack of an integral approach. In a follow-up study it will be tried to develop consensus on a conceptual and operational definition of frailty. Tijdschr Gerontol Geriatr 2007; 38:65-76     

Paleobiology of Etruscan populations

A research project on the population biology of ancient Etruscans has recently started. The aim of this multidisciplinary research is the anthropological definition of Etruscan populations, about which little is known. The study of the skeletal remains is expected to lead to the identification of characteristics typical of this group, which will be used to establish affinities and differences with other contemporary Italic populations, as well as with previous and subsequent groups. An outline of the project is presented here, together with an indication of the problems concerning the availability of material. A summary of previous research on Etruscans is also given. In the final section, preliminary results are presented on one aspect of the research presently under way, namely the odontometric study of different groups of Etruscan populations. These results suggest a homogeneity within the groups described under the common label “Etruscans”.     

A genome‐wide association study of the frailty index highlights brain pathways in ageing

Frailty is a common geriatric syndrome and strongly associated with disability, mortality and hospitalization. Frailty is commonly measured using the frailty index (FI), based on the accumulation of a number of health deficits during the life course. The mechanisms underlying FI are multifactorial and not well understood, but a genetic basis has been suggested with heritability estimates between 30 and 45%. Understanding the genetic determinants and biological mechanisms underpinning FI may help to delay or even prevent frailty. We performed a genome‐wide association study (GWAS) meta‐analysis of a frailty index in European descent UK Biobank participants (n = 164,610, 60–70 years) and Swedish TwinGene participants (n = 10,616, 41–87 years). FI calculation was based on 49 or 44 self‐reported items on symptoms, disabilities and diagnosed diseases for UK Biobank and TwinGene, respectively. 14 loci were associated with the FI (p < 5*10⁻⁸). Many FI‐associated loci have established associations with traits such as body mass index, cardiovascular disease, smoking, HLA proteins, depression and neuroticism; however, one appears to be novel. The estimated single nucleotide polymorphism (SNP) heritability of the FI was 11% (0.11, SE 0.005). In enrichment analysis, genes expressed in the frontal cortex and hippocampus were significantly downregulated (adjusted p < 0.05). We also used Mendelian randomization to identify modifiable traits and exposures that may affect frailty risk, with a higher educational attainment genetic risk score being associated with a lower degree of frailty. Risk of frailty is influenced by many genetic factors, including well‐known disease risk factors and mental health, with particular emphasis on pathways in the brain.     

Optimal Foraging Theory and the Racecar Driver: The Impact of Student-Centered Learning on Anthropological Pedagogy

This article contributes to the field of anthropological pedagogy, adding to recent articles regarding needed change in anthropology teaching methods. All have in common the practice of anthropology in the classroom. The author used the theory of optimal foraging to encourage students to operationalize human behavior. The economic benefit that students reaped warrants discussion. Students rapidly and measurably improved several areas of their lifestyle including health, finance, and home. Pursuing an anthropology degree thus becomes a personal journey.     

Genetic epidemiological studies of eastern Adriatic Island isolates, Croatia: objective and strategies

In this paper, the authors discuss why isolate island populations represent a particularly helpful model for genetic epidemiological studies. A thorough previous anthropological research carried out in Eastern Adriatic island isolates, Croatia, in terms of ethnohistory, geography and current demography is reviewed. The major results of the studies of population genetic structure of those populations, including model-bound and model-free approaches, the analyses of serogenetic polymorphisms and most recent studies using HLA class II, VNTR and STR DNA polymorphisms, are briefly presented. The organization of health care on the islands is analyzed and some relevant details of specific medical problems and some autochtonous diseases in these island populations is noted. The authors present in outline four illustrative examples of research opportunities which are afforded by the unique circumstances found in these isolate communities. These relate to hereditary dwarfism on Krk island, Mal de Meleda on Mljet island, extreme inbreeding on Susak island and population genetics of cancer on the islands of Brac, Hvar, Korcula, Vis and Lastovo. Finally, the authors develop objectives and strategies for a long-term genetic epidemiological research of these populations and suggest that such a programme of investigation would further our understanding of the causes of (rare) diseases which are uniquely important to these communities but also of common diseases which are important contributors to the burden of disease both in these islands and throughout the world.     

内蒙古和林格尔县土城子遗址战国时期人群的体质量

体质量推算作为体质人类学的一项重要研究方法,为衡量古代居民体型提供了新的途径,同时也为解决考古学、历史学问题提供了新的研究思路。本文通过"生物力学"和"形态测量学"两种方法对内蒙古和林格尔县土城子遗址2005年出土的34例战国时期人骨标本进行了体质量推算。统计分析结果表明,该组男性居民的平均体质量约为67.21kg,女性居民的平均体质量约为54.63kg,男女两性之间的差异显著。通过与战国时期内蒙古长城地带井沟子居民的比较分析,土城子男性居民在平均体质量上明显大于井沟子男性居民,并且体质量值整体分布偏高,而女性组则差异不显著。结合考古学、历史学相关研究材料,该数据为土城子居民为戍边军士的身份提供了进一步的证据。     

Bayesian semiparametric dynamic frailty models for multiple event time data

Many biomedical studies collect data on times of occurrence for a health event that can occur repeatedly, such as infection, hospitalization, recurrence of disease, or tumor onset. To analyze such data, it is necessary to account for within-subject dependency in the multiple event times. Motivated by data from studies of palpable tumors, this article proposes a dynamic frailty model and Bayesian semiparametric approach to inference. The widely used shared frailty proportional hazards model is generalized to allow subject-specific frailties to change dynamically with age while also accommodating nonproportional hazards. Parametric assumptions on the frailty distribution are avoided by using Dirichlet process priors for a shared frailty and for multiplicative innovations on this frailty. By centering the semiparametric model on a conditionally conjugate dynamic gamma model, we facilitate posterior computation and lack-of-fit assessments of the parametric model. Our proposed method is demonstrated using data from a cancer chemoprevention study.     

Population size influences amphibian detection probability: implications for biodiversity monitoring programs

Monitoring is an integral part of species conservation. Monitoring programs must take imperfect detection of species into account in order to be reliable. Theory suggests that detection probability may be determined by population size but this relationship has not yet been assessed empirically. Population size is particularly important because it may induce heterogeneity in detection probability and thereby cause bias in estimates of biodiversity. We used a site occupancy model to analyse data from a volunteer-based amphibian monitoring program to assess how well different variables explain variation in detection probability. An index to population size best explained detection probabilities for four out of six species (to avoid circular reasoning, we used the count of individuals at a previous site visit as an index to current population size). The relationship between the population index and detection probability was positive. Commonly used weather variables best explained detection probabilities for two out of six species. Estimates of site occupancy probabilities differed depending on whether the population index was or was not used to model detection probability. The relationship between the population index and detectability has implications for the design of monitoring and species conservation. Most importantly, because many small populations are likely to be overlooked, monitoring programs should be designed in such a way that small populations are not overlooked. The results also imply that methods cannot be standardized in such a way that detection probabilities are constant. As we have shown here, one can easily account for variation in population size in the analysis of data from long-term monitoring programs by using counts of individuals from surveys at the same site in previous years. Accounting for variation in population size is important because it can affect the results of long-term monitoring programs and ultimately the conservation of imperiled species.     

Hematopoietic progenitor cell liabilities and alarmins S100A8/A9‐related inflammaging associate with frailty and predict poor cardiovascular outcomes in older adults

Frailty affects the physical, cognitive, and social domains exposing older adults to an increased risk of cardiovascular disease and death. The mechanisms linking frailty and cardiovascular outcomes are mostly unknown. Here, we studied the association of abundance (flow cytometry) and gene expression profile (RNAseq) of stem/progenitor cells (HSPCs) and molecular markers of inflammaging (ELISA) with the cardiorespiratory phenotype and prospective adverse events of individuals classified according to levels of frailty. Two cohorts of older adults were enrolled in the study. In a cohort of pre‐frail 35 individuals (average age: 75 years), a physical frailty score above the median identified subjects with initial alterations in cardiorespiratory function. RNA sequencing revealed S100A8/A9 upregulation in HSPCs from the bone marrow (>10‐fold) and peripheral blood (>200‐fold) of individuals with greater physical frailty. Moreover higher frailty was associated with increased alarmins S100A8/A9 and inflammatory cytokines in peripheral blood. We then studied a cohort of 104 more frail individuals (average age: 81 years) with multidomain health deficits. Reduced levels of circulating HSPCs and increased S100A8/A9 concentrations were independently associated with the frailty index. Remarkably, low HSPCs and high S100A8/A9 simultaneously predicted major adverse cardiovascular events at 1‐year follow‐up after adjustment for age and frailty index. In conclusion, inflammaging characterized by alarmin and pro‐inflammatory cytokines in pre‐frail individuals is mirrored by the pauperization of HSPCs in frail older people with comorbidities. S100A8/A9 is upregulated within HSPCs, identifying a phenotype that associates with poor cardiovascular outcomes.