RESUMO
Older men are less likely than older women to receive depression treatment. Latino older men in particular have been found to have significantly lower rates of depression treatment than their white-non-Mexican (WNM) counterparts. Prior research has shown that men are less likely than women to express overt affect and/or report depression symptoms that may prompt primary care physicians' inquiry about depression. Previous studies have overlooked the idioms of distress common among older men. This study investigates: a) the range of idioms of distress that emerge in the narratives of depressed older men, and b) the use of these idioms among depressed WNM and Mexican-origin older men. The present report is based on qualitative data collected through the Men's Health and Aging Study (MeHAS), a mixed-method study of clinically depressed WNM and Mexican-origin older (65 and above) men recruited in primary care settings. Qualitative analysis of 77 interviews led to identification of idioms of distress and informed idiom categories. Study findings show that: a) both groups of men utilized a range of idioms of distress that met current DSM criteria for depression, b) both groups were also likely to utilize idioms that feel outside clinical depression criteria, and c) there were similarities as well as differences between WNM and Mexican-origin men. This study provides a larger vocabulary that clinicians might consider in recognizing depression and initiating depression care for older men from diverse ethnic backgrounds. This is important to improve depression care among older men in general and those of Mexican-origin in particular.
Assuntos
Comunicação , Depressão/etnologia , Depressão/psicologia , Americanos Mexicanos/psicologia , População Branca/psicologia , Idoso , Envelhecimento , California , Humanos , Entrevistas como Assunto , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Narração , Pesquisa Qualitativa , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
INTRODUCTION: Folate receptor-α regulates cellular uptake of folates and antifolates (eg, pemetrexed) and is frequently expressed in pulmonary adenocarcinoma. EGFR is an established therapeutic target in NSCLC. Therapies targeting FRA or EGFR are available. The association between FRA and EGFR expression in advanced NSCLC has not been explored. Combining therapeutic FRA antibodies with an EGFR inhibitor might be beneficial, if both of the targets are significantly coexpressed. PATIENTS AND METHODS: Specimens from 160 advanced NSCLC patients receiving pemetrexed-based chemotherapy were assessed for membranous FRA and EGFR protein expression using immunohistochemistry and the Hybrid (H)-score. EGFR (exons 18-21) and Kirsten RNA-associated rat sarcoma 2 virus (exon 2) mutations were determined. Results were correlated to patients' clinicopathological data, progression-free survival (PFS), and overall survival (OS). RESULTS: Forty-seven patients (29%) had tumors with strong FRA and EGFR expression, but no statistically significant correlation was seen between protein levels of FRA and EGFR. High membranous FRA expression (H-score ≥ 20) was associated with prolonged PFS (5.5 vs. 3.4 months; hazard ratio [HR], 0.6060; P = .0254) and improved OS (12.1 vs. 6.4 months; HR, 0.5726; P = .0076). CONCLUSION: Survival times are improved in NSCLC patients whose tumors show strong membranous FRA expression. No statistical correlation between membranous FRA and EGFR expression was demonstrated in advanced NSCLC, but 47 patients (29%) had higher expression of both of the receptors and could be suitable for combined targeted therapies.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Glutamatos/uso terapêutico , Guanina/análogos & derivados , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Intervalo Livre de Doença , Receptores ErbB/genética , Feminino , Receptor 1 de Folato/genética , Regulação Neoplásica da Expressão Gênica , Guanina/uso terapêutico , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Pemetrexede , Estudos Retrospectivos , Taxa de Sobrevida , Adulto JovemRESUMO
OBJECTIVES: This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders. METHODS: This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire. RESULTS: The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression. CONCLUSIONS: Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.