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Objective: In the USA, organ donor shortage is especially pronounced among minority ethnic populations such as Hispanics, who are 60% less likely to donate compared to non-Hispanic Whites. Recent evidence suggests that US Hispanics may consent to organ donation via a registry within a doctor's office. The objective of this study was to investigate the effectiveness of using "kiosks" to distribute organ donation educational material located within primary care clinics on US Hispanic donor registration rates. Design/setting: A prospective observational study was conducted at four clinics, located in Southern Californian neighbourhoods with a high percentage of Hispanics. Method: Kiosks containing organ donation educational material were set up at each clinic for a total of 7 weeks. The kiosks were unstaffed for 6 weeks, 3 weeks before and 3 weeks after a week that was staffed by individuals from OneLegacy, the local Organ Procurement Organisation (OPO). The number of patient encounters and the number of patients who registered were recorded and analysed. Registration rates per 1,000 patient encounters and 95% confidence interval (CI) were derived. Differences between the staffed and unstaffed kiosks were assessed. Results: During the 6-week unstaffed period, a total of 59,181 patient encounters occurred with a registration rate of 0.03 per 1,000 (95% CI: 0.0-0.1). During the 1-week staffed period, a total of 9,805 patient encounters occurred and 102 patients registered, which is a registration rate of 10 per 1,000 (95% CI: 8-13). Significance was reached when comparing staffed and unstaffed rates of registration (p < 0.0001). Conclusion: This study demonstrates that when compared with unstaffed kiosks, staffed kiosks are more effective in increasing organ donation registration among US Hispanics.

Objectives To examine in cognitively normal elderly adults whether vascular factors predict cognitive decline and whether these associations are mediated by magnetic resonance imaging ( MRI) measures of subclinical vascular brain injury. Design Prospective multisite longitudinal study of subcortical ischemic vascular diseases. Setting Memory and aging centers in California. Participants Seventy-four participants who were cognitively normal at entry and underwent at least two neuropsychological evaluations and two MRI examinations over an average follow-up of 6.9 years. Measurements Item response theory was used to create composite scores of global, verbal memory, and executive functioning. Volumetric MRI measures included white matter hyperintensities ( WMHs), silent brain infarcts ( SBIs), hippocampus, and cortical gray matter ( CGM). Linear mixed-effects models were used to examine the associations between vascular factors, MRI measures, and cognitive scores. Results History of coronary artery disease ( CAD) was associated with greater declines in global cognition, verbal memory, and executive function. The CAD associations remained after controlling for changes in WMHs, SBIs, and hippocampal and CGM volumes. Conclusion History of CAD may be a surrogate marker for clinically significant atherosclerosis, which also affects the brain. Structural MRI measures of WMHs and SBIs do not fully capture the potential adverse effects of atherosclerosis on the brain. Future longitudinal studies of cognition should incorporate direct measures of atherosclerosis in cerebral arteries, as well as more sensitive neuroimaging measures. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Previous studies have reported a high incidence of depression in neurology clinics, however areas where there are predominantly underserved immigrants have not been studied. Methods: Retrospective cohort study in an academic outpatient neurology clinic in Los Angeles, California. Newly referred patients (N =318) were assessed consecutively for depression using a PHQ-9 questionnaire, accompanied by review of the assessment of the depressive disorder. Results: The patient cohort consisted of 190 females (59%) and 130 males (41%), primarily of Hispanic descent (72%), with 8% Asian 11% white, and 5% African-American. Sixty-eight percent (68%) had depression, with 40% exhibiting moderate to severe depression. Patients who had moderate to severe depression (based on PHQ-9) were more likely to be unemployed (75.2% vs. 60.7%, p =0.008), dependent on government income (29.5% vs. 20.4%, p =0.06), and have headache or pain as the reason for referral (42.4% vs. 28.5%, p =0.03). Severity of depression also significantly correlated with current treatment by psychiatrist, current antidepressant use, and less independent living. Patients with moderate to severe depression were more likely to have made ER visits in the last 12 months (0.9 vs. 0.7, p =0.01) and were taking more medications (3.3 vs. 2.5, p =0.03), compared to patient with mild or no depression. Conclusion: The presence of moderate to severe depression significantly correlated with socioeconomic status, use of emergency room, and presence of headache/pain. Neurology clinics with predominantly underserved immigrant patients have a disproportionate amount of depression, which may be related to socioeconomic factors resulting in overutilization of scarce healthcare resources. [Copyright &y& Elsevier]

Objectives: To analyze the demographics, diagnosis, and treatment patterns in patients with headache-seeking treatment in one of the busiest emergency rooms (ER) of an academic medical center in the USA., Background: The past decade has seen tremendous improvement in acute and preventive management of headaches. However, there are very few data on how headache patients are managed by ER doctors., Methods: Retrospective analysis of 100 charts chosen at random for patients with a discharge diagnosis of headache (according to ICD-9 codes) from the University of Southern California + Los Angeles County Hospital ER., Results: The majority of patients were female (74%) and Hispanic (76%) with an age range of 15-68 years. The most common ER diagnoses were migraine (42%) and headache not otherwise specified (headache NOS - 42%). Fifty-one percent of patients received a head computerized tomography; 9% received a lumbar puncture. Medications most frequently used for acute treatment, whether migraine or headache NOS, were narcotics (25%), followed by antiemetics (24%), nonsteroidal anti-inflammatory drugs (19%), and acetaminophen (17%). Only 5% of migraine patients received migraine-specific triptans in the ER (2% overall). Thirty-one percent of migraineurs were given a prescription for a triptan upon discharge from the ER (17% of all patients). Eighteen percent of patients were admitted to the hospital with secondary headache. The final diagnosis in the ER matched the diagnosis of the neurologist in 79% of cases with a moderate degree of agreement., Conclusion: Narcotics remain the medications most often chosen for treatment of all acute headaches (including migraine) in the ER. There is very little use of migraine-specific medications in the ER. In addition, neurology consults are underutilized even in an academic setting in the ER. The data suggest a lack of clear standards of care for diagnosis and treatment of headache, especially migraines. Specific guidelines for headache management should be established keeping in mind the unique setting of the ER.