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Traditional non‐participatory research methodologies have struggled to address the needs of multicultural populations in the United States (U.S.). Community‐based participatory research (CBPR) is a research paradigm offering a unique opportunity for culturally appropriate research and improving health equity. CBPR is an equitable, strength‐based approach involving all stakeholders throughout the research process. We investigate the field of psychology's utilization of CBPR as an approach for working with multicultural populations to collaboratively address relevant and impactful research questions. A total of 1912 CBPR‐related articles, from 2004 to 2014, were identified using PsycINFO, PubMed, and CINAHL Complete databases. Of these, approximately 16% (n = 311) met our criteria for psychology‐related CBPR articles accounting for a negligible amount (<1%) of peer‐reviewed publications in mainstream psychological journals during the same time period. Among U.S. psychology‐related CBPR articles, 86% focused on multicultural and marginalized populations. Prominent topics of investigation included physical health, mental and behavioral health, and theoretical or methodological articles. Features of publications, including authors' training, types of journals, study populations, and topics under investigation, were explored for all 1912 publications. Findings highlight an opportunity for further utilization of CBPR within psychology, with key implications for health equity. Recommendations for increasing CBPR uptake within the discipline are also offered. Highlights: We examine the field of psychology's utilization of CBPR and review 1912 CBPR articles.Approximately 16% of manuscripts (n = 311) met our criteria for psychology‐related CBPR articles.Of these, only 21% were published in mainstream psychology journals.Racial/ethnic and marginalized communities account for 85% of all U.S. CBPR‐related study samples.Additional efforts could increase the use of CBPR within the field of psychology. [ABSTRACT FROM AUTHOR]

BACKGROUND American Indians have excess risk of depression, which can contribute to cerebrovascular and cognitive disability, with effects on memory, processing speed, executive function, and visuospatial ability. However, studies examining depression and cognition in American Indians are limited; this study aims to report associations of depression with general cognition, verbal fluency and memory, and processing speed. DESIGN Cohort study. SETTING The Cerebrovascular Disease and its Consequences in American Indians study was an ancillary examination of Strong Heart Study participants from 3 U.S. regions. PARTICIPANTS All eligible were included in this analysis (N=818). MEASUREMENTS Participants completed evaluations for depressive symptomology, cognition, and physical function—including Center for Epidemiologic Studies Depression (CESD), Modified Mini‐Mental State Examination (3MSE), Wechsler Adult Intelligence Scale‐Fourth Edition coding (WAIS), Controlled Oral Word Association (COWA), California Verbal and Learning Test, Halstead finger tapping, grip strength, and Short Physical Performance Battery (SPPB) tests. Linear mixed models were adjusted for site, age, sex, education, income, marital status, alcohol, smoking, diabetes, hypertension, obesity, cholesterol, stroke, infarct, and hemorrhage. RESULTS: Symptoms of depression were common, with 20% (N=138) endorsing CES‐D scores of 16+. More depressive symptoms were associated with older age, female sex, lower education, lower income, non‐married status, not using alcohol, not smoking, hypertension, diabetes, and stroke. In adjusted analyses, processing speed (WAIS: β −0.13, 95%CI −0.25, −0.03), general cognition (3MSE: β −0.10, 95%CI −0.17, −0.03), verbal fluency (COWA: β −0.10, 95%CI −0.19, −0.01), and motor function (SPPB: β −0.05, 95%CI −0.07, −0.03) were significantly associated with more symptoms of depression. CONCLUSION: These findings maybe informative for health disparities populations, especially those with depressive risk. Clinicians may require particular training in cultural humility. Future studies should validate use of the CES‐D scale in this population; longitudinal studies may focus on causal mechanisms and potential secondary prevention, such as social support. J Am Geriatr Soc 68:1739‐1747, 2020. [ABSTRACT FROM AUTHOR]

Research has demonstrated that bilingualism impacts neuropsychological performance, but the findings on its effects on verbal fluency have been mixed. This study compared the verbal fluency performance of non-Hispanic White monolingual speakers with a Hispanic bilingual population. Ninety-nine Spanish-English bilingual Hispanic and thirty English-speaking monolingual non-Hispanic White undergraduates completed the Controlled Oral Word Association Test (COWAT). Students also completed a general cognitive and English reading measure. Bilingual students completed an in-depth language questionnaire to gauge language dominance, age of acquisition of second language (AoA), and first language learned. Results revealed that both language dominance and AoA influence phonemic fluency performance in bilingual Hispanics. English-dominant and balanced bilingual students performed similarly to monolingual students. Spanish-dominant bilingual students scored lower than monolinguals or the other bilingual groups. Bilingual students with early AoA (<7 years) performed on par with monolingual students. Late AoA bilinguals performed significantly lower than early AoA bilinguals. Results illustrate the clinical importance of obtaining a full linguistic history of bilingual clients in order to accurately interpret verbal fluency performance, as this is essential for proper diagnoses and treatments. [ABSTRACT FROM AUTHOR]

As the Farsi-speaking Iranian population continues to grow in the United States, examination of their cognitive performance is an imperative first step to providing this group with culturally competent services. Thirty-six healthy primarily Farsi-speaking Iranian adults completed Farsi-translated and adapted versions of three frequently used measures of executive/subcortical functioning: Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Color Trails Test (CTT). Participants' performance on each measure was compared to published normative data resulting in 0-85% of cognitively and medically healthy individuals being classified as impaired depending on the executive/subcortical test score examined, with the highest impairment rates for specific WCST outcome scores. These findings raise questions for the use of published norms with Farsi-speaking Iranians residing in the US. The present study provided normative data from this group of Farsi-speaking Iranians on the Farsi-translated and adapted versions of the WCST, TMT, and CTT. [ABSTRACT FROM AUTHOR]

Objective: Health literacy is critical for understanding information from health-care providers and correct use of medications and includes the capacity to filter other information in navigating health care systems. Older adults with low health literacy exhibit more chronic health conditions, worse physical functioning, and poorer mental health. This study examined the relationship between sociodemographic variables and health literacy, and the impact of cognitive training on change in health literacy over 10 years in older adults.Methods: Participants (N = 2,802) aged 65 years and older completed assessments, including reading and numeracy health literacy items, as part of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. We evaluated baseline sociodemographic variables and change in health literacy over a 10-year period in individuals exposed to cognitive training in reasoning, processing speed, memory, or a no-contact control condition.Results: Age, sex, race, education level, and general cognitive functioning at baseline were all associated with baseline health literacy in older adults. Predictors of change in health literacy over the 10-year follow-up were age, race, education level, general cognitive functioning, and neighborhood income; disparities in health literacy because of race attenuated over time, while the effect of age increased over time. Health literacy was generally stable across the ACTIVE intervention groups over 10 years.Conclusions: The present study showed important disparities in health literacy level and change over 10 years. Cognitive training did not significantly impact health literacy, suggesting that alternative approaches are needed to reduce the disparities. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy affects 3.4 million people in the United States and 70 million globally. A third have intractable epilepsy, epilepsy that is not well-controlled by medication. Understanding memory and cognitive functioning in this population will further comprehension of cognitive changes in this population. However, few neuropsychological measures can be administered on a regular basis without compromising reliability. This study investigated experimental and standardized memory measures in patients with intractable epilepsy. Methods: Individuals with intractable epilepsy (n = 188; mean age = 37.5 years) scheduled to undergo depth electrode surgery were given a comprehensive neuropsychological battery including Rey-Auditory Verbal Learning Test (RAVLT) or California Verbal Learning Test (CVLT). During their stay in the hospital following surgery, participants were also given an experimental computerized verbal list learning test multiple times throughout their stay. Results: The experimental task and standardized task were significantly associated on total recall (r = 0.348, p < 0.01) and immediate learning (r = 0.383, p < 0.01). Conclusions: Understanding memory in individuals with epilepsy will help further clinical treatment and outcomes for these individuals. A task such as our experimental verbal list learning task that can be administered frequently and consistently could make serial testing possible. This would be particularly helpful in situations where rapid change occurs, or regular monitoring of symptoms is needed. Clinically, this type of testing could lead to better understanding of cognitive symptoms over time. [ABSTRACT FROM AUTHOR]

American Indians and Alaska Natives (AI/ANs) have a unique, traumatic, and alienating history of education in the U.S., which may be directly related to overall health and well-being. Community engagement is critical in well-being research with Native communities, especially when investigating culturally sensitive topics, such as early education experiences. This study investigates the value of a community-based participatory research approach in gaining valuable culturally sensitive information from Native people in a respectful manner. Assessment participation and feedback are analyzed and presented as indicators of Native participant engagement success in a potentially sensitive research project exploring early education experiences. [ABSTRACT FROM AUTHOR]

The roles of culture and ethnicity are crucial for understanding the relevance of personal and social factors involved in the drinking patterns of individuals. Research has shown that acculturative stress is associated with poorer health outcomes and may be linked to problematic drinking. This article briefly outlines issues including the construct of acculturation, measuring acculturation, and understanding the implications that it has with alcohol use in ethnic minorities. A study is presented that illustrates the association between acculturation and drinking patterns in older White and Hispanic veterans. Greater levels of past drinking were associated with more acculturation into the mainstream U.S. society for the Hispanic veterans. For the White veterans, greater levels of past drinking were associated with greater perceived discrimination and less comfort in mainstream U.S. society. Based on the literature, implications for clinical treatment are presented. Clinicians are called upon to understand the worldview of their clients and engage in culturally sensitive alcohol treatments. [ABSTRACT FROM AUTHOR]

Early visual information processing impairment has consistently been found on the backward masking task in patients with schizophrenia, but the nature of this impairment remains unclear. Pupillometry was used to measure attentional allocation during visual backward masking task performance in patients with schizophrenia (n=16) and nonpsychiatric controls (n=16). The extent of pupil dilation recorded during a cognitive task reflects the processing load placed on the nervous system by the task. Schizophrenia patients detected significantly fewer targets than controls only when the stimulus onset asynchrony (SOA) between targets and masks reached 317 ms. For both groups, peak pupil dilation responses were also significantly larger in the 317 ms SOA condition relative to a no-mask condition, suggesting that the processing load of the 317 SOA masking condition was greater than the no-mask condition. In addition, a principal components analysis of pupillary response waveforms identified time-related factors that appeared to differentially index attentional allocation to targets vs. masks. Patients with schizophrenia showed less dilation than controls on a middle factor that appeared to index attentional allocation to targets, but patients showed greater dilation than controls on a late factor that appeared to index attentional allocation to masks. That is, controls attended more to targets than to masks, but patients attended more to masks than to targets. These findings suggest that masking impairments at SOA intervals greater than 100–200 ms may be due abnormalities in attentional allocation mechanisms. [Copyright &y& Elsevier]

Cognitive processing efficiency requires both an ability to attend to task-relevant stimuli with quickness and accuracy, also while filtering distracting or task-irrelevant stimuli. This study investigated cognitive processing efficiency by using pupillary responses as an index of attentional allocation to relevant target and irrelevant masks on a visual backward masking task. The relationship between attentional allocation on this task and general cognitive ability on the scholastic aptitude test (SAT) was examined in college students (n=67). A principle components analysis of the pupillary response waveform isolated a late component that appeared to index the attentional demands associated with processing masks on the backward masking task. This pupillary response index of wasteful resource allocation to the mask accounted for significant variance in SAT scores over and above that accounted for by socio-economic status and target detection accuracy scores. Consistent with the neural efficiency hypothesis, individuals who allocated more resources to processing irrelevant information performed more poorly on cognitive ability tests. [Copyright &y& Elsevier]

Task-evoked pupillary responses were recorded during a visual backward masking task as an index of resource allocation. Increased pupillary dilation indicates increased allocation of processing resources to the task. Consistent with numerous studies, detection accuracy increased with longer interstimulus intervals and approximated no-mask accuracy in the 300-ms condition. Pupillary dilation responses were significantly greater during task performance (cognitive load) than during a passive stimulus viewing condition (no-load) and were significantly greater in the 300-ms condition than the no-mask condition. Consistent with models of early visual information processing, the results suggest that the mask demanded extra processing resources when it followed the target by more than 100 ms. Pupillography methods may be useful in evaluating the contribution and timing of resource-demanding processes during early visual information processing. [ABSTRACT FROM AUTHOR]

Addressing systemic injustices and racism in training and clinical service provision are key next steps in clinical science. While the American Psychological Association Multicultural Guidelines and accreditation standards have long emphasized this need, most graduate programs offer a single course on diversity, equity, and inclusion topics, which is inadequate to train and sustain culturally humble providers and redress systemic injustices and racism within psychology. Few "real-world" examples exist to guide the development of training models. We provide background on the development and components of a specialty clinic, the University of New Mexico's Cultural Counseling Center, whose mission is providing culturally informed clinical services to diverse clientele, and to infuse multicultural training throughout the graduate program. Informed by the racial–spatial framework for psychology and critical race theory, we describe our approach intended to (a) offer applications for the operationalization and delivery of multicultural and antiracist training, (b) enhance supervisory models, and (c) increase awareness of structural competence. Our clinic, developed collaboratively among students and faculty, serves as a safe forum for dialogue around structural injustices and seeks to improve treatment for diverse clients and those underserved in mental health care. We discuss issues of student and faculty engagement and offer the perspectives of faculty and students of color, case examples illustrating our services, and current efforts to expand and formalize community collaborations. We offer a model that integrates coursework, informal activities, and multicultural supervision for comprehensive student training and that promotes a departmental culture of dialogue and support around equity, diversity, and justice. Public Significance Statement: We provide background on the development of a specialty clinic, the University of New Mexico Cultural Counseling Center, as a training model and "real-world" example of operationalization and delivery of multicultural and antiracist training and clinical services. Program description and recommendations based on our experience can inform the development and implementation of similar centers in other departments and aid in the training of the next generation of clinicians equipped to provide culturally informed care. [ABSTRACT FROM AUTHOR]

Objective: Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians. Methods: We recruited 818 American Indians aged 65–95 for 3MSE examinations in 2010–2013; 403 returned for a repeat examination in 2017–2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models. Results: This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small. Conclusion: These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist. [ABSTRACT FROM AUTHOR]

Objectives: Insulin resistance is a substantial health issue for American Indians, with type 2 diabetes overrepresented in this population as compared with non-Hispanic whites. Insulin resistance and its related conditions in turn increase risk for dementia and cognitive impairment. The aim of the current study was to determine whether type 2 diabetes and insulin resistance at midlife was associated with later-life cognitive testing in a large sample of older American Indians, aged 65 and older.Methods: American Indian participants who underwent both fasting blood draw as part of the Strong Heart Study and had subsequent cognitive testing as part of the later adjunct Cerebrovascular Disease and its Consequences in American Indians study were included (n = 790). Regression models examined type 2 diabetes and impaired fasting glucose and subsequent cognitive test performance as part of a longitudinal study design. The relationship between a continuous measure of insulin resistance and later cognitive test performance was assessed using generalized estimating equations.Results: Controlling for demographic and clinical factors, verbal fluency and processing speed/working memory were significantly negatively associated with having type 2 diabetes and with insulin resistance, but not with impaired fasting glucose.Conclusion: In this sample of American Indians, type 2 diabetes at midlife was associated with subsequent lower performance on measures of executive function. These results may have important implications for future implementation of diagnostic and intervention services in this population. [ABSTRACT FROM AUTHOR]

Intersectionality and minority stress frameworks were used to guide examination and comparisons of psychological distress (depression, anxiety, posttraumatic stress disorder symptoms) and protective factors (religiosity, spirituality, social support) among 673 Black, Latinx, and White lesbian and bisexual women with and without histories of sexual assault. Participants were from Wave 3 of the 21-year longitudinal Chicago Health and Life Experiences of Women (CHLEW) study. More than one-third (38%) of participants reported having experienced adolescent or adult sexual assault (i.e., rape or another form of sexual assault) since age 14. Confirmatory factor analysis, structural equation modeling, and multivariate analyses of covariance were used to analyze the data. Results revealed that levels of religiosity/spirituality and psychological distress varied by race/ethnicity and by sexual identity (i.e., Black lesbian, Black bisexual, Latinx lesbian, Latinx bisexual, White lesbian, White bisexual). Black lesbian women reported the highest level of religiosity/spirituality whereas White lesbian women reported the lowest level. White bisexual women reported the highest level of psychological distress whereas White lesbian women reported the lowest level. We found no significant differences in reports of sexual assault or in social support (i.e., significant other, family, friend, and total social support). However, White lesbian women had higher friend, significant other, and total social support relative to the other five groups of women with minoritized/marginalized sexual identities. Future work should examine whether religiosity, spirituality, and social support serve as protective factors that can be incorporated into mental health treatment for lesbian and bisexual who have experienced sexual assault to reduce psychological distress. [ABSTRACT FROM AUTHOR]

Information about the equality of psychometric properties of the medical outcomes study (MOS) Short Form-36 (SF-36), a health status measure, across gender and across the lifespan for American Indian adults is lacking. We tested measurement invariance (configural, metric, scalar invariance) of the physical and mental components between gender and over time in a sample of 2,709 (1,054 men, 1,654 women) American Indian older adults at three time points, and across a 6-year time frame. Measurement invariance of a 2-factor higher-order model was demonstrated between gender at each time point. Tests of longitudinal invariance indicated longitudinal measurement invariance over time. Multiple-group latent means analysis indicated men had significantly higher physical and mental component latent means compared to women at each time point, and longitudinal latent means analysis found physical and mental component latent means decreased over time. The 2-factor higher-order model SF-36 is valid for American Indian older adults over a 6-year time frame. Public Significance Statement: The medical outcomes study (MOS) Short Form-36 (SF-36) is a valid assessment for American Indian older adults. Men had significantly higher physical and mental scores compared to women, and physical and mental components scores decreased over time in the total sample. [ABSTRACT FROM AUTHOR]

Allocation of attentional resources during early visual processing was investigated in schizophrenia. Pupillary responses were recorded during a backward masking task as an index of resource allocation in schizophrenia patients ( n=51) and nonpsychiatric controls ( n=51). Two time-linked components of pupillary response waveforms appeared to differentially index resource allocation to targets versus masks. Two patient subgroups were identified: One with normal overall pupillary responses (resource allocation), but greater allocation on mask relative to target components, and another with abnormally small overall pupillary responses and similar allocation between target and mask components. Thus, misallocation of resources to masks contributed to masking deficits in one subgroup, whereas reduced resource allocation contributed to deficits in the other. The nature of resource-related deficits can vary across schizophrenia subgroups. [ABSTRACT FROM AUTHOR]

The validation of the assessment of depression across ethnic groups is critical yet deficient for American Indian (AI) adults. Therefore, we assessed the psychometric properties of the Center for Epidemiological Studies-Depression (CES-D) in AI elders and tested differences in depression constructs between gender. Participants were 817 AI adults (68% women), mean age 73.2 years (SD = 6.1, range: 64–95) for women and 72.6 years (SD = 5.3, range: 65–90) for men., in the Cerebrovascular Disease and Its Consequences in AIs Study. We evaluated the factor structure of the 20-item and 12-item CES-D and tested measurement invariance between gender. Results demonstrated a poor fit for the 20-item CES-D and partial gender measurement invariance of the 12-item CES-D. AI female elders had significantly higher depression levels than AI male elders on the Depressed Affect subscale, the Somatic Symptoms subscale, and the Well-Being (reverse-coded) subscale. Further replication is needed, and we recommend future psychometric work with the 12-item CES-D with AI elders. Public Significance Statement: An abbreviated 12-item Center for Epidemiological Studies-Depression scale assesses depression in American Indian female and male elders. Female AI elders had higher levels on the Depressed Affect and Somatic Symptoms, and lower levels of Well-Being, than AI male elders. [ABSTRACT FROM AUTHOR]

Background: American Indian elders, aged 55 years and older, represent a neglected segment of the United States (U.S.) health care system. This group is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other aging populations in the country. Despite the U.S. government's federal trust responsibility to meet American Indians' health-related needs through the Indian Health Service (IHS), elders are negatively affected by provider shortages, limited availability of health care services, and gaps in insurance. This qualitative study examines the perspectives of professional stakeholders involved in planning, delivery of, and advocating for services for this population to identify and analyze macro- and meso-level factors affecting access to and use of health care and insurance among American Indian elders at the micro level.Methods: Between June 2016 and March 2017, we undertook in-depth qualitative interviews with 47 professional stakeholders in two states in the Southwest U.S., including health care providers, outreach workers, public-sector administrators, and tribal leaders. The interviews focused on perceptions of both policy- and practice-related factors that bear upon health care inequities impacting elders. We analyzed iteratively the interview transcripts, using both open and focused coding techniques, followed by a critical review of the findings by a Community Action Board comprising American Indian elders.Results: Findings illuminated complex and multilevel contextual influences on health care inequities for elders, centering on (1) gaps in elder-oriented services; (2) benefits and limits of the Affordable Care Act (ACA); (2) invisibility of elders in national, state, and tribal policymaking; and (4) perceived threats to the IHS system and the federal trust responsibility.Conclusions: Findings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve upon this funding situation and fulfill the federal trust responsibility. [ABSTRACT FROM AUTHOR]

Objective: American Indians experience substantial health disparities relative to the US population, including vascular brain aging. Poorer cognitive test performance has been associated with cranial magnetic resonance imaging findings in aging community populations, but no study has investigated these associations in elderly American Indians. Methods: We examined 786 American Indians aged 64 years and older from the Cerebrovascular Disease and its Consequences in American Indians study (2010–2013). Cranial magnetic resonance images were scored for cortical and subcortical infarcts, hemorrhages, severity of white matter disease, sulcal widening, ventricle enlargement, and volumetric estimates for white matter hyperintensities (WMHs), hippocampus, and brain. Participants completed demographic, medical history, and neuropsychological assessments including testing for general cognitive functioning, verbal learning and memory, processing speed, phonemic fluency, and executive function. Results: Processing speed was independently associated with the presence of any infarcts, white matter disease, and hippocampal and brain volumes, independent of socioeconomic, language, education, and clinical factors. Other significant associations included general cognitive functioning with hippocampal volume. Nonsignificant, marginal associations included general cognition with WMH and brain volume; verbal memory with hippocampal volume; verbal fluency and executive function with brain volume; and processing speed with ventricle enlargement. Conclusions: Brain-cognition associations found in this study of elderly American Indians are similar to those found in other racial/ethnic populations, with processing speed comprising an especially strong correlate of cerebrovascular disease. These findings may assist future efforts to define opportunities for disease prevention, to conduct research on diagnostic and normative standards, and to guide clinical evaluation of this underserved and overburdened population. [ABSTRACT FROM AUTHOR]

Background Inorganic arsenic at high and prolonged doses is highly neurotoxic. Few studies have evaluated whether long-term, low-level arsenic exposure is associated with neuropsychological functioning in adults. Objectives To investigate the association between long-term, low-level inorganic arsenic exposure and neuropsychological functioning among American Indians aged 64–95. Methods We assessed 928 participants in the Strong Heart Study by using data on arsenic species in urine samples collected at baseline (1989–1991) and results of standardized tests of global cognition, executive functioning, verbal learning and memory, fine motor functioning, and speed of mental processing administered during comprehensive follow-up evaluations in 2009–2013. We calculated the difference in neuropsychological functioning for a 10% increase in urinary arsenic with adjustment for sex, age, education, and study site. Results The sum of inorganic and methylated arsenic species (∑As) in urine was associated with limited fine motor functioning and processing speed. A 10% increase in ∑As was associated with a .10 (95% CI −.20, −.01) decrease on the Finger Tapping Test for the dominant hand and a .13 decrease (95% CI −.21, −.04) for the non-dominant hand. Similarly, a 10% increase in ∑As was associated with a .15 (95% CI −.29, .00) decrease on the Wechsler Adult Intelligence Scale–Fourth Edition Coding Subtest. ∑As was not associated with other neuropsychological functions. Conclusions Findings indicate an adverse association between increased urinary arsenic fine motor functioning and processing speed, but not with other neuropsychological functioning, among elderly American Indians. [ABSTRACT FROM AUTHOR]

Abstract: A growing body of literature indicates that rats prefer to navigate in the direction of a goal in the environment (directional responding) rather than to the precise location of the goal (place navigation). This paper provides a brief review of this literature with an emphasis on recent findings in the Morris water task. Four experiments designed to extend this work to humans in a computerized, virtual Morris water task are also described. Special emphasis is devoted to how directional responding and place navigation are influenced by room and apparatus cues, and how these cues control distinct components of navigation to a goal. Experiments 1 and 2 demonstrate that humans, like rats, perform directional responses when cues from the apparatus are present, while Experiment 3 demonstrates that place navigation predominates when apparatus cues are eliminated. In Experiment 4, an eyetracking system measured gaze location in the virtual environment dynamically as participants navigated from a start point to the goal. Participants primarily looked at room cues during the early segment of each trial, but primarily focused on the apparatus as the trial progressed, suggesting distinct, sequential stimulus functions. Implications for computational modeling of navigation in the Morris water task and related tasks are discussed. [Copyright &y& Elsevier]

Background: Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.Methods: This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.Discussion: The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.Trial Registration: This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018. [ABSTRACT FROM AUTHOR]