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This study explores whether cross-level interaction between individual and neighbourhood socioeconomic status (SES) is associated with social trust. A cross-sectional questionnaire survey was conducted with 4123 randomly selected people aged 20 years and older from 72 districts in the city of Kashiwa in 2009, and 1720 questionnaires were analysed. People of low SES tended to have higher trust in the national government and lower trust in neighbours as residential district SES increased. By contrast, people of high SES had relatively constant levels of both general and local aspects of social trust, despite local district SES. We found that perceptions of trust among people of low SES are more likely to be influenced by district-level SES than among people of high SES. This highlights the importance of considering the cross-level interaction of individual and neighbourhood SES as this interaction can either raise or lower social trust in communities.

The Philippine government is facing a burden of improving health and social services for both the growing elderly and young population. The extent of discussion on aging issues and concerns, however, is minimal at best. Therefore, this study aimed to examine the perceptions of unmet needs and to explore the coping mechanisms of senior citizens across local stakeholders in an urban area in the Philippines. In this qualitative study, we collected data using focus group discussions among senior citizens (n = 4) and health providers (n = 4) as well as in-depth interviews among local administrators (n = 7). We analyzed the data through thematic analysis using the social determinants of health as the theoretical framework. We used qualitative research software NVivo10® to track the coding and manage the data. Four major themes related to unmet needs emerged in the analyses: (1) financial security, (2) health care services, (3) age-friendly environment, and (4) family support. Senior citizens responded either positively or negatively to cope with the challenges associated with aging. The government must then revisit existing national policies to address their unmet needs. Actions should be taken to strengthen positive coping and modifying the negative coping mechanisms, with a particular focus on community and family interventions.

Abstract

Background
Low socioeconomic position (SEP) has been linked to an increased risk of dementia. However, little is known about the association between SEP trajectory and regional brain volumes related to dementia.


Methods
A random sample of community-dwelling older adults (n = 428, age = 73.1 ± 5.5) living in Tokamachi City (Niigata Prefecture, Japan) without medical histories of dementia, Parkinson's disease, and depression who underwent automated assessment of brain volumes on magnetic resonance imaging and responded to a self-administered questionnaire survey in 2017. We measured SEP in childhood (household SEP at age 15), young adulthood (education), mid-adulthood (the longest occupation), and late adulthood (current wealth), and further performed group-based trajectory analysis to identify lifetime trajectory patterns on SEP. Multivariate regression models were employed to investigate the association between SEP trajectories and 4 regional brain volumes related to the development of Alzheimer's disease (ie, entorhinal cortex, hippocampus, amygdala, and the parahippocampus), the most common type of dementia.


Results
We found 3 distinct SEP trajectories (stable middle class [68%], downward [23%], and upward [9%]). Compared to those who experienced stable middle class, older adults who experienced the upward SEP mobility had significantly larger hippocampus (β: 213.2, 95% confidence interval: 14.7, 411.8). On the other hand, older adults who experienced downward SEP mobility showed no significant differences in any of the 4 brain structural volumes.


Conclusions
Our findings indicate that upward life-course SEP mobility is associated with larger volumes of hippocampus in old age. SEP trajectory may offer us a useful lens to enhance our understanding of the etiology of dementia.

Objectives: This study aimed to clarify the relationship between the institution and resident with respect to accessibility to acute ischemic stroke (AIS) treatment in Hokkaido and to propose new methodology monitoring for accessibility to healthcare resources. Methods: This study involves the use of geographic information system (GIS) network analysis. We established hospital/clinic with one of the following conditions as resources for AIS treatment: (1) medical facility practicing AIS treatment, (2) having computed tomography (CT) equipment, (3) having angiography equipment, and (4) having AIS specialists (neurosurgeons). We evaluated the coverage of population resources using transport time between ambulance departure and arrival at the healthcare facility. Furthermore, we compared the population coverage rate using available resources and calculated a Gini coefficient to analyze its relation with inequality. Empirical analysis was performed, and public database for data collection was utilized. We calculated the rate of population coverage with a transport time within 10 min as an indicator of accessibility to medical resources by GIS. Results: The Gini coefficients of practicable facilities, CT, angiography, and neurosurgeons are 0.35, 0.16, 0.18, and 0.30, respectively. The inequality of accessibility differs depending on the resources, and Gini coefficients indicate that hospital/clinic and neurosurgeons were considered to have higher allocation inequalities than CT and angiography. Conclusions: Combining Gini coefficient and GIS network analysis in accessibility can be useful in quantifying and monitoring variation by region. We propose this combination as a new method for helping the government to make evidence-based healthcare planning. (C) 2019 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.

Abstract

Objectives
It is well known that low educational attainment is associated with cognitive function decline in older age. Childhood book availability may help to preserve cognitive function in older adults with low education. The study objective was to examine the association between childhood book availability and cognitive function among older adults with low educational attainment, and to investigate the mediating effect of the volume of reading-related brain regions (e.g., superior temporal cortex).


Methods
A cross-sectional study of community-dwelling older Japanese adults aged 65–84 years was conducted (n = 474). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Childhood book availability was assessed using a retrospective questionnaire. Brain region volume was measured using magnetic resonance imaging. Multivariate regression modeling and structural equation modeling were used for analysis.


Results
Both high educational attainment and childhood book availability were independently associated with high MMSE score. Stratification of educational level showed that childhood book availability was positively associated with MMSE score among participants with low educational attainment (coefficient = 1.48, 95% confidence interval [CI]: 0.31 to 2.66), but not among those with moderate or high educational attainment (coefficient = −0.01, 95% CI: −1.44 to 1.42 and −1.21, 95% CI: −3.85 to 1.42, respectively). Among participants with low educational attainment, left superior temporal cortex volume mediated the association between childhood book availability and MMSE score.


Discussion
The availability of books in childhood helps to preserve cognitive function in older adults with low education via left superior temporal cortex volume. Further research is needed to replicate these findings.