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The upper lip is a functionally and aesthetically important area of the face. Therefore, reconstruction of an upper lip defect needs sufficient consideration to ensure functional and aesthetic recovery. Several methods, such as wedge resection, rotation flaps, advancement flaps, and myomucosal advancement flaps, have been used to reconstruct vermilion defects. However, it is challenging to reconstruct a vermilion defect because of the possibility of residual asymmetry or scars and restrictions to normal lip movement after the reconstruction. We present the case of a 51-year-old female that had an upper lip vermilion defect caused by a dog bite. The lip defect was reconstructed using a mucosal V-Y advancement flap. This mucosal flap was based on the orbicularis oris muscle with a branch of the superior labial artery to ensure sufficient blood supply. Therefore, flap survival was excellent, and there was no constriction of the flaps. Moreover, the color and contour were matched to the adjacent lip tissue, and re-establishment of the white roll and adequate lip volume were achieved. This mucosal V-Y advancement flap technique represents a reliable method to repair mucosal defects without vascular compromise of the flap.

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OBJECTIVES: To examine the impact of social and emotional support on serious psychological distress (SPD) in individuals with type 2 diabetes (T2DM) and functional disabilities after controlling for socio-demographic factors and health status. Findings provide information for healthcare providers to enhance patients' psychological well-being. METHODS: Data from 529 adults were obtained from the 2021 National Health Interview Survey, including those who had T2DM and also reported significant difficulty or inability to perform an activity in any of the following domains: seeing, hearing, walking or climbing stairs, communicating, remembering or concentrating, or practicing self-care. Descriptive analysis and a hierarchical regression model of SPD were used. RESULTS: The mean age of participants was 67.88 years old, and the mean duration of diabetes diagnosis was 16.88 years. Notably, 12.5% of individuals reported SPD. A decreased likelihood of reporting SPD occurrence was associated with older age (odds ratio (OR) = 0.95), a longer duration of T2DM diagnosis (OR = 0.97), having at least a high school education (OR = 0.54), and receiving social and emotional support. DISCUSSION: Social and emotional support likely mitigates psychological distress, suggesting that social and emotional support resources should be enhanced, especially among individuals who are younger and those more recently diagnosed with T2DM.

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Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.

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Highly educated immigrants are part of the growing population of immigrants who are impacted by the increasingly hostile migration policies in the U.S. This qualitative study used a phenomenological approach and inductive reasoning to explore the possible impacts of migration integration policies as social determinants of health among this group. Data was collected through 31 semi-structured interviewees with highly educated immigrants who had an intention and interest to stay in the U.S. at the time of the interview. Data were analyzed using reflexive thematic analysis and four main themes emerged: (1) a life overshadowed by silent worries, (2) living through uncertainties and forced decisions as the result of migration integration policies, (3) complexities and challenges of living on a work visa, and (4) shared recommendations by interviewees. Documented narratives as part of this study suggest high rates of stress and anxiety as well as negative mental and physical health outcomes among the participants. Results also suggest high levels of internalized vulnerabilities. Participants shared that migration policies can be enhanced in the U.S. to support highly educated immigrants' growth by creating a better and more transparent communication system, replacing random review processes for applications with systematic procedures, creating expedited pathways to citizenship based on merit, and granting access to work as a basic human right.

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The present study explored how individual- and neighborhood-level factors contribute to predicting the use of preventive health care in a sample of Asian Americans. The cross-level interaction between individual- and neighborhood-level factors was also examined. We found a significant interaction between individual-level health insurance coverage and neighborhood health care providers' availability. Those who were uninsured and living in areas with limited health care provider availability (bottom 20%) were the most disadvantaged. This study adds to the growing literature on the effect of neighborhood-level factors on health care as sources of disparities. For health care policy, identifying individuals without health insurance coverage and living in a neighborhood with limited health care providers should be a priority to diminish disparities in access to care.

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Objectives: The objective is to examine how older Korean Americans' perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants (egos) and their healthcare partners (alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of burdensomeness, the study suggests strategies to promote their health and healthcare use.

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The COVID-19 pandemic and related physical distancing measures have posed a significant threat to the mental health of adults, particularly those living alone. Accordingly, the World Health Organization implemented the #HealthyAtHome program, encouraging people to keep in regular contact with loved ones, stay physically active, and keep a regular routine. The current study aims to examine a micro-longitudinal link between behavioral activation coping strategies (exercise, meditation, relaxation, and social connection) and depressive symptoms among adults who lived alone during the COVID-19 pandemic. We used 21 biweekly waves of longitudinal data from the Understanding America Study (UAS) collected between April 2020 and February 2021 (N = 1,280). The multilevel models with correlated random effects were estimated to examine lagged effects of coping strategies (t-1) on depressive symptoms (t). The results showed that exercise was predictive of lower depressive symptoms even after controlling for time-invariant and time-varying covariates. The results showed that modifiable lifestyle factors, such as taking time to exercise, may be beneficial for the mental health of Americans living in single-person households.

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OBJECTIVES: To examine the associates of bridging potential in networks of friends and its impact on cognitive function in older Korean Americans. METHODS: Data came from 308 participants in Central Florida who were part of the Study of Older Korean Americans (SOKA). Using data from a name generator of three close friends in local Korean communities, non-overlapping networks were quantified for bridging potential. Linear regression models for bridging potential and cognitive function were examined. RESULTS: Bridging potential was greater among those with stronger social ties with friends in general and higher levels of activity engagement. The direct benefit of bridging potential on cognitive function was also confirmed. In addition, bridging potential was found to mediate the effect of social ties with friends on cognitive function. DISCUSSION: Findings underscore the interconnectedness of older immigrants' social and cognitive function and shed light on interventions.

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Given the importance of understanding the connection between physical and mental health in old age, the study examined the mediating role of subjective health perception in the relationship between chronic conditions and psychological distress among older Asian Americans. Using data from 533 Asian Americans aged 60 and over in the 2016 Asian American Quality of Life Study, the direct and indirect effect models were tested with multivariate linear regressions and the PROCESS macro. Results show that chronic conditions pose significant risks to psychological distress and that subjective health perception mediates their association. The observed role of subjective health perception as an intervening step between physical and mental health offers implications for gerontological social work research and practice by highlighting the importance of positive self-appraisals for the health and well-being in later years of life.

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INTRODUCTION: The present study investigated a model on how neighborhood walkability influences individual's active travel behavior, which in turn is associated with overall health status among Asian Americans. Given that English proficiency uniquely represents racial/ethnic minorities' ability to access resources and benefits in the host society, we also examined the moderating effects of English proficiency in the relationship. METHODS: Using data from the Asian American Quality of Life Survey (N= 1,447), Structural Equation Modeling (SEM) was conducted to examine the proposed mediation model of active travel in the relationship between neighborhood walkability and health. The moderating effect by English proficiency was tested using a multiple-group analysis. RESULTS: For the entire sample, neighborhood walkability was significantly associated with a higher level of active travel (ß = .269, p < .001). However, the mediation effect of active travel was not significant (indirect effect = .004, p = .111, 95% bias-corrected CI = -.003 - .026). The results of the multiple group analysis showed that the neighborhood walkability was positively associated with active travel for both the English proficiency group (ß =.329, p < .001) and the group with limited English proficiency (ß =.201, p < .001). However, the mediation effect of active travel on health status was only significant in the English proficiency group (ß = .110, p < .05), indicating that active travel influenced by the neighborhood walkability was positively associated with better health status only for the English proficiency group. CONCLUSIONS: Our findings add to the growing literature on the influence of the neighborhood walkability on individual's active travel and health status. In addition, findings provide implications for tailored interventions to promote Asian Americans' health with respect to English proficiency.

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OBJECTIVES: Inspired by the notion of double jeopardy positing the dual disadvantage in the coexistence of different sources of vulnerability, the present study examined health risks posed by social and linguistic isolation in older Korean Americans. DESIGN: A cross-sectional study, using a four-cell classification to compare isolation types (no isolation, social isolation only, linguistic isolation only, and dual isolation) and to examine their impacts on physical (self-rated health), mental (mental distress), and cognitive (cognitive performance) health. SETTING AND PARTICIPANTS: Data are from the Study of Older Korean Americans survey of Korean immigrants aged 60 or older (n = 2032), conducted in five states in the United States (California, New York, Texas, Hawaii, and Florida). MEASUREMENT: Social isolation was indexed by the Lubben Social Network Scale-6; linguistic isolation, by a question on English-speaking ability. Physical, mental, and cognitive health were indicated by a single-item self-rating of health, the Kessler Psychological Distress Scale 6, and the Mini-Mental State Examination, respectively. RESULTS: The dual-isolation group exhibited notable sociodemographic and health disadvantages. The odds of having fair/poor health, mental distress, and cognitive impairment were 2.21-3.17 times higher in the dual-isolation group than in the no-isolation group. CONCLUSION: Our findings confirm that both social relationships and language proficiency are key elements for older immigrants' social connectedness and integration, the deprivation of which puts them at heightened risk in multiple dimensions of health.

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In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans. Using harmonized data (N = 5,063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we tested direct and indirect effect models. In both groups, chronic diseases and functional disability were closely associated with negative ratings of health and symptoms of depression. Analyses with the PROCESS macro showed that the effect of chronic diseases and functional disability on depressive symptoms was mediated by self-rated health in both groups; the indirect effect was greater in the Korean American sample than in the Chinese American sample. These findings contribute to the understanding of the psychological mechanisms that underlie the mind-body connection and highlight the potential importance of subjective health assessment as a useful tool for health promotion.

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Guided by the models of health assessment and social determinants of health, we examined predictors of self-rated physical, mental, oral, and cognitive health of older Korean immigrants. Data came from the Study of Older Korean Americans (SOKA; N = 2,061, Mean age = 73.2). Multivariate regression models of self-ratings of health were tested with health indicators (both domain-specific and other health indicators including chronic disease, functional disability, mental distress, problems with teeth or gums, and cognitive function) and sociocultural factors (acculturation, social network, and ethnic community social cohesion). For self-rated physical, mental, and oral health, indicators specific to the targeted domain played a primary role, with those of other health domains playing a secondary role. Acculturation and social network were significant predictors of all four measures. Findings highlight the importance of holistic health assessment that considers a wide range of health domains as well as sociocultural contexts.

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OBJECTIVES: The gap between mental health needs and service use in racial/ethnic minorities continues to be a major public health concern. Focusing on older Korean immigrants, the present study examined linkages among mental distress, self-rated mental health (SRMH), and the use of professional mental health services. We hypothesized that SRMH would play a mediating role in the relationship between mental distress and the use of professional mental health services. METHOD: Using data from the Study of Older Korean Americans (SOKA; N = 2,150, Mean age = 73.4), the direct and indirect effect models were tested. RESULTS: Nearly 30% of the sample fell within the category of experiencing mental distress, but only a small proportion (5.7%) had used professional mental health services. Supporting our hypothesis, the pathway from mental distress to the use of professional mental health services was influenced by an individual's subjective perception of mental health status: the indirect effect of mental distress on service use through SRMH (.04 [.01]) was significant (bias-corrected 95% confidence interval for the indirect effect = .02, .06). CONCLUSION: The findings of this study not only contribute to our understanding of help-seeking processes in a group at high mental health risk but also suggest avenues to promote their use of mental health services.

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Objectives: The present study examined the associations between immigration-related factors and objective and subjective cognitive status with older Korean Americans' concern about developing Alzheimer's Disease (AD). It was hypothesized that (1) AD concern would be associated with immigration-related factors and (2) self-rated cognitive status would mediate the relationship between cognitive performance (Mini Mental State Examination (MMSE) scores) and concern about AD.Method: Using data from the Study of Older Korean Americans (n = 2061, mean age = 73.2; 66.8% female), the direct and indirect effect models were tested.Results: Korean American immigrants with a higher level of acculturation had better cognitive performance, more positive self-ratings of cognitive status, and a lower level of concern about AD. Both poor cognitive performance and negative self-ratings of cognitive status were associated with increased concern about AD. Supporting the mediation hypothesis, the indirect effect of cognitive performance on AD concern through self-rated cognitive status was significant (bias corrected 95% confidence interval for the indirect effect = -.012, -.003).Conclusion: The mediation model not only helps us better understand the psychological mechanisms that underlie the link between cognitive status and AD concern but also highlights the potential importance of subjective perceptions about cognitive status as an avenue for interventions.

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The present study examined the trends in internet use among older adults (60+ years) in the United States from 2011 to 2016 by considering not only the entire study sample as a whole but also specific subgroups by age, gender, race/ethnicity, and education. Using data from 107,500 older adults in the California Health Interview Survey between 2011 and 2016, the significance of linear trends was tested by including the survey year as a continuous variable in the logistic regression. Findings confirm the general knowledge that an increased number of the older U.S. population used the internet over the period of 2011-2016. Furthermore, closer inspection indicates that this upward trend does not apply to all, but specifically to those with advanced age, male gender, racial/ethnic minority background, and low educational attainment. Findings provide implications for identifying and prioritizing a target group for internet technology training.

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Objectives: The present study examined factors associated with the preference for patient-provider ethnic concordance in Asian Americans.Design: With data drawn from the 2015 Asian American Quality of Life Survey (N = 2535), a logistic regression model of the preference for patient-provider ethnic concordance was tested with demographic (age, gender, ethnicity, marital status, education), health and access (chronic medical conditions, self-rated health, health insurance coverage), immigration-related (place of birth, length of stay in the US, English proficiency, acculturation), and adverse experience (perceived discrimination, communication problems in healthcare settings) variables.Results: Over half (52.4%) of those in the sample preferred to be treated by a healthcare provider from their own ethnic background. In a multivariate model, the odds for preferring ethnic concordance were 1.52-1.64 times higher among individuals in earlier stages of immigration, language acquisition, and acculturation. Individuals who had experienced communication problems in healthcare settings presented 3.74 times higher odds for preferring ethnic concordance than did counterparts without such experience.Conclusions: The results emphasized the value of paying attention to patient-provider concordance when treating Asian Americans either relatively new to the country or who have had previous problems communicating with health professionals. The findings also provide implications for improving workforce diversity in healthcare delivery and medical education.

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The purpose of the study was to investigate factors associated with Alzheimer's Disease (AD)-related knowledge and service awareness in older Korean Americans. Considering the importance of social resources in the lives of older immigrants, the focus was on exploring the role of social capital-related factors (e.g., prior exposure to AD, social network, activity participation, and community social cohesion) on AD knowledge and service awareness. Data were drawn from the Study of Older Korean Americans (SOKA; N = 2,150; Mage = 73.41, SD = 7.97). Findings highlight the critical roles of prior exposure to AD and social network influencing both AD knowledge and service awareness, with activity participation also being associated with the latter. Results suggest that particular attention should be paid to individuals who are culturally and socially isolated when considering interventions.

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Studies indicate that the benefits of volunteering may extend to biological risk factors in disease development including chronic inflammation, though the pathway through which volunteer activity predicts chronic inflammation remains unclear. The current project focuses on the link between volunteering and C-reactive protein (CRP) as a measure of chronic inflammation, while paying a particular attention to sleep quality as a pathway. Using panel data from the National Social Life, Health, and Aging Project (N = 1,124), the present study examined whether sleep quality operates indirectly linking volunteer activity and CRP (indirect pathway), compensates for the lack of volunteerism (moderation-compensation), or regulates the benefits of volunteering on CRP (moderation-regulation). The findings suggest sleep quality as a compensatory pathway, in that sufficient sleep buffers the inflammatory effect of lack of volunteerism. The findings show that helping others may be beneficial for the helpers in terms of chronic inflammation and sleep quality as interconnected health outcomes.

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Using data from surveys with Korean Americans aged 60 years or above (n = 2,150), the level of healthcare navigation self-sufficiency was assessed, and its related factors were explored. The overall status of self-sufficiency was low; for example, over half of the sample needed assistance with reading and filling out medical documents, and nearly half needed someone to interpret during medical visits. Diminished self-sufficiency in healthcare navigation was associated with disadvantaged social status (e.g., advanced age, female gender, and low education), early stages of immigration (short length of stay in the U.S. and low English proficiency), and lack of personal health resources (e.g., poor health condition and lack of health insurance). The findings shed light on older immigrants' challenges in the use of health services in a broad sense and help identify areas of patient burden and avenues for interventions.

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