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We examined race differences in the DSM-IV clinical significance criterion (CSC), an indicator of depressive role impairment, and its impact on assessment outcomes in older white and black women with diagnosed and subthreshold depression.
We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression.
Lower-income neighborhoods in a Midwestern city.
411 community-dwelling depressed and non-depressed women ≥ 65 years (45.3% Black; mean age = 75.2, SD = 7.2) recruited through census tract-based telephone screening.
SCID interview for DSM-IV to assess major depression and dysthymia; Center for Epidemiologic Studies-Depression Scale to define subthreshold depression (≥16 points); Mini-Mental State Examination, count of medical conditions, activities of daily living, and mental health treatment to assess health factors.
Black participants were less likely than Whites to endorse the CSC (11.8% vs. 24.1%; p = .002). There were few race differences in depressive symptom type, severity, or count. Blacks with subthreshold depression endorsed more symptoms, though this comparison was not significant after adjustments. Health factors did not account for race differences in CSC endorsement. Disregarding the CSC-eliminated differences in diagnosis rate, race was a significant predictor of CSC endorsement in a logistic regression.
Race differences in CSC endorsement are not due to depressive symptom presentations or health factors. The use of the CSC may lead to underdiagnosis of depression among black older adults. Subthreshold depression among Blacks may be more severe compared to Whites, thus requiring tailored assessment and treatment approaches.
Objectives: Prior research has identified numerous genetic (including sex), education, health, and lifestyle factors that predict cognitive decline. Traditional model selection approaches (e.g., backward or stepwise selection) attempt to find one model that best fits the observed data, risking interpretations that only the selected predictors are important. In reality, several predictor combinations may fit similarly well but result in different conclusions (e.g., about size and significance of parameter estimates). In this study, we describe an alternative method, Information-Theoretic (IT) model averaging, and apply it to characterize a set of complex interactions in a longitudinal study on cognitive decline. Methods: Here, we used longitudinal cognitive data from 1256 late–middle aged adults from the Wisconsin Registry for Alzheimer’s Prevention study to examine the effects of sex, apolipoprotein E (APOE) ɛ4 allele (non-modifiable factors), and literacy achievement (modifiable) on cognitive decline. For each outcome, we applied IT model averaging to a set of models with different combinations of interactions among sex, APOE, literacy, and age. Results: For a list-learning test, model-averaged results showed better performance for women versus men, with faster decline among men; increased literacy was associated with better performance, particularly among men. APOE had less of an association with cognitive performance in this age range (∼40–70 years). Conclusions: These results illustrate the utility of the IT approach and point to literacy as a potential modifier of cognitive decline. Whether the protective effect of literacy is due to educational attainment or intrinsic verbal intellectual ability is the topic of ongoing work. (JINS, 2019, 25, 119–133)
Objectives: A major challenge in cognitive aging is differentiating preclinical disease-related cognitive decline from changes associated with normal aging. Neuropsychological test authors typically publish single time-point norms, referred to here as unconditional reference values. However, detecting significant change requires longitudinal, or conditional reference values, created by modeling cognition as a function of prior performance. Our objectives were to create, depict, and examine preliminary validity of unconditional and conditional reference values for ages 40–75 years on neuropsychological tests. Method: We used quantile regression to create growth-curve–like models of performance on tests of memory and executive function using participants from the Wisconsin Registry for Alzheimer’s Prevention. Unconditional and conditional models accounted for age, sex, education, and verbal ability/literacy; conditional models also included past performance on and number of prior exposures to the test. Models were then used to estimate individuals’ unconditional and conditional percentile ranks for each test. We examined how low performance on each test (operationalized as <7th percentile) related to consensus-conference–determined cognitive statuses and subjective impairment. Results: Participants with low performance were more likely to receive an abnormal cognitive diagnosis at the current visit (but not later visits). Low performance was also linked to subjective and informant reports of worsening memory function. Conclusions: The percentile-based methods and single-test results described here show potential for detecting troublesome within-person cognitive change. Development of reference values for additional cognitive measures, investigation of alternative thresholds for abnormality (including multi-test criteria), and validation in samples with more clinical endpoints are needed. (JINS, 2019, 25, 1–14)
Objectives: Intraindividual cognitive variability (IICV) has been shown to differentiate between groups with normal cognition, mild cognitive impairment (MCI), and dementia. This study examined whether baseline IICV predicted subsequent mild to moderate cognitive impairment in a cognitively normal baseline sample. Methods: Participants with 4 waves of cognitive assessment were drawn from the Wisconsin Registry for Alzheimer’s Prevention (WRAP; n=684; 53.6(6.6) baseline age; 9.1(1.0) years follow-up; 70% female; 74.6% parental history of Alzheimer’s disease). The primary outcome was Wave 4 cognitive status (“cognitively normal” vs. “impaired”) determined by consensus conference; “impaired” included early MCI (n=109), clinical MCI (n=11), or dementia (n=1). Primary predictors included two IICV variables, each based on the standard deviation of a set of scores: “6 Factor IICV” and “4 Test IICV”. Each IICV variable was tested in a series of logistic regression models to determine whether IICV predicted cognitive status. In exploratory analyses, distribution-based cutoffs incorporating memory, executive function, and IICV patterns were used to create and test an MCI risk variable. Results: Results were similar for the IICV variables: higher IICV was associated with greater risk of subsequent impairment after covariate adjustment. After adjusting for memory and executive functioning scores contributing to IICV, IICV was not significant. The MCI risk variable also predicted risk of impairment. Conclusions: While IICV in middle-age predicts subsequent impairment, it is a weaker risk indicator than the memory and executive function scores contributing to its calculation. Exploratory analyses suggest potential to incorporate IICV patterns into risk assessment in clinical settings. (JINS, 2016, 22, 1016–1025)
Previously, it has been shown that strawberry (SB) or blueberry (BB) supplementations, when fed to rats from 19 to 21 months of age, reverse age-related decrements in motor and cognitive performance. We have postulated that these effects may be the result of a number of positive benefits of the berry polyphenols, including decreased stress signalling, increased neurogenesis, and increased signals involved in learning and memory. Thus, the present study was carried out to examine these mechanisms in aged animals by administering a control, 2 % SB- or 2 % BB-supplemented diet to aged Fischer 344 rats for 8 weeks to ascertain their effectiveness in reversing age-related deficits in behavioural and neuronal function. The results showed that rats consuming the berry diets exhibited enhanced motor performance and improved cognition, specifically working memory. In addition, the rats supplemented with BB and SB diets showed increased hippocampal neurogenesis and expression of insulin-like growth factor 1, although the improvements in working memory performance could not solely be explained by these increases. The diverse polyphenolics in these berry fruits may have additional mechanisms of action that could account for their relative differences in efficacy.
The system of weekly psychiatric ward rounds is being challenged and multi-disciplinary team meetings (MDTMs) involving inpatients have been developed. These aim to improve integration between medical and social services and increase patient involvement in their care. However, such large meetings are potentially threatening to the patient. This survey aimed to examine inpatient experience of MDTMs and identify factors that significantly alter this experience.
In this cross-sectional survey we assessed patient opinion regarding patient inclusive MDTMs in a psychiatric inpatient unit. A total of 27 participants (response rate 90%) were included. We utilised descriptive statistics and Fisher’s exact test for non-parametric data where appropriate.
In all, 85% (n=23) of patients identified the consultant psychiatrist as a member that they would like to have present at the MDTM. The ward nurse was identified by 63% (n=17) of patients. In all, 48% (n=13) of patients reported feeling anxious/threatened at the MDTM. In all, 70% (n=19) of patients stated that they would have felt less threatened at the MDTM if there were fewer people in attendance. A significant number of voluntary patients (n=11) felt threatened/anxious at the MDTM compared with involuntary patients (n=2) (χ2=4.921, df=1, p=0.026).
The central findings of this study are that patients would prefer fewer people at the MDTM and would feel less threatened/anxious if they participated in selecting those in attendance. These findings suggest that greater patient involvement in preparation for the MDTM could result in a less anxiety filled experience for them.
In January and February 2009, a series of water samples were collected from streams on Byers Peninsula. These samples were analysed for major elements and δ18O to determine the role of lithology and landscape position on stream geochemistry, and to understand better the hydrology (i.e. residence time of water) of these systems. Precipitation chemistry is enriched in Na+, as are the streams located close to the coast. Streams originating from inland locations have much higher percentages of Ca2+. In contrast, Mg2+ varied little, though streams that are in greater contact with volcanic-derived soils have slightly higher concentrations. Anion percentages varied greatly between streams with SO42- ranging from 5% to 45% of the anion composition. Dissolved Si concentrations as high as 141 μM were observed. All these data suggest that active chemical weathering is occurring in this region. A time series over 13 days at one stream showed little variation in major element geochemistry. The δ18O of precipitation samples collected over this same period varied by ∼10‰ while the majority of stream samples varied less than ∼1.5‰. These data indicate that the stream waters represent mixtures of precipitation events, melting snow and water from the subsurface that had gained solutes through chemical weathering.
Previous comet flyby missions enabled detailed studies of the photometric properties of several cometary nuclei from disk-resolved images, including 9P/Tempel 1, 19P/Borrelly, and 81P/Wild 2. Two recent missions, DIXI and Stardust-NExT, encountered Comets 103P/Hartley 2 and Tempel 1 respectively, expanding the pool of sampled cometary nuclei in their unique ways: Hartley 2 is a hyperactive comet; Tempel 1 was visited and impacted by the Deep Impact dual-spacecraft during its previous perihelion passage. Photometric modeling shows that the global photometric properties of the nuclei of Hartley 2 and Tempel 1 are similar to those of other cometary nuclei. The photometric variation of the hyperactive nucleus of Hartley 2 is about 15%, similar to that of weakly active comets Tempel 1 and Wild 2. The photometric properties of Tempel 1 measured by NExT suggest little change from those measured by DI. These results, together with the photometric properties of Wild 2 and Borrelly, indicate that the photometric properties of cometary nuclei are independent of the activity level and gross geomorphology of cometary nuclei. Instead, cometary nucleus photometric properties might be determined by its outgassing, which leaves low-albedo deposit on the surface and forms similar photometric texture. The time scale for the photometric alteration on cometary nuclei due to outgassing should be much shorter than the dynamic time scale.
There have been fundamental changes in the intergenerational family, and yet families continue to be an important part of people's lives. We use the convoy model to describe the factors that influence supportive relations within intergenerational families, beginning with a description of the changing structure of the intergenerational family. We next outline support exchanges, detailing how personal characteristics, especially gender, race, age and socio-economic status, and situational characteristics, in particular family structure and intergenerational context, influence support exchanges. Instrumental and emotional family exchanges are described, with special attention to the unique circumstances of care-giving in intergenerational families. We also examine the importance of recognising differences in the quality of intergenerational relations, again noting the influence of personal and situational characteristics. Variations in support quality, e.g. positive, negative and ambivalent, and its influence on wellbeing are discussed. As families and individuals change, differences emerge at the individual, family and societal levels. We consider the implications of changes and stability in intergenerational relations and make recommendations about how best to envisage and plan future intergenerational family support. Societies with fewer resources as well as individuals and families with diverse individual histories must be innovative and creative in meeting the needs of older people as well as those of all family members.
Annie is born at full term with good Apgar scores, but weighs only 2350 grams. On physical exam, she is alert but has somewhat low tone. She has abnormal facial features, a short sternum, and over-riding digits. After failure to pass a nasogastric tube, a tracheal–esophageal fistula (TEF) is diagnosed. Chromosome studies confirm trisomy 18, and an echocardiogram shows a moderate ventricular septal defect (VSD) and moderate pulmonary valvular dysplasia.
Ellen, the neonatologist, and Mary, the surgeon, meet Annie’s parents, Bill and Liz, to discuss treatment options. They explain that trisomy 18 is a lethal condition and that most children die within the first few weeks to months. The team does not recommend surgery, explaining that surgery is not in the child’s best interest and will result in unnecessary suffering for Annie. They offer the services of the neonatal palliative care team and reassure Bill and Liz that the palliative care team can assist the family in the grieving process. They can provide comfort care for Annie by keeping an IV in place for hydration and pain relief.
Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).
Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.
Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.
Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007–2009.
Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.
Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths.
Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group (P = .03 vs controls), 55% of those in the mupirocin and chlorhexidine group (P = .05), and 63% off those in the mupirocin and bleach group (P = .006). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group (P = .40 vs controls), 54% in the mupirocin and chlorhexidine group (P = .51), and 71% in the mupirocin and bleach group (P = .02). At 1 and 4 months, recurrent SSTIs were reported by 20% and 36% of participants, respectively.
An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over a 4-month period. High rates of recurrent SSTI suggest that factors other than endogenous colonization are important determinants of infection.
‘We cannot have peace of mind if we do not know what happened to our husbands and brothers.’
statement by a wife of a ‘disappeared’ man to an unnamed Amnesty International official.
‘But the truth will not necessarily be believed and it is putting too much faith in truth to believe that it can heal.’
Michael Ignatieff (quoted in Minow 1998: 52)
In the preceding chapter we mentioned Sudan as a ‘forgotten country’. Although a fair amount of publicity has been given to the massive levels of human rights violations that have afflicted this country, no humanitarian intervention has taken place, and the UN peacekeeping force (UNAMID) was strongly rejected by Sudan as a foreign invasion. Still, some day the violence will stop and soon thereafter the world's attention will turn to another crisis. However, efforts to bring truth, justice and a stable government to Sudan in these difficult circumstances will most assuredly not be given anywhere near the same level of attention by the world's media as putting an end to the physical violence. Yet achieving these goals is vital to the long-term prospects for peace, and arguably this will be a much more difficult and a much more complicated undertaking than stopping physical violence.
In this chapter we focus on the way in which countries that have suffered gross human rights violations attempt to deal with their past. How can society be rebuilt and made functional in the wake of such abuses?