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Objective: Low perceived risk for type 2 diabetes (T2DM) may be a barrier to lifestyle change in women with recent gestational diabetes (GDM). We assessed perceived risk for T2DM at delivery and postpartum. Methods: We used a validated diabetes risk perception instrument to survey women with GDM at delivery and postpartum. We compared women with low perceived risk for T2DM at delivery to those with high perceived risk. Results: The majority ( N = 43 of 70, 61%) perceived high risk at delivery. Women who perceived low risk were younger (30.76.3 versus 35.04.5 years, p = 0.003) than women who perceived high risk. Although knowledge of risk factors for T2DM was poor (mean 6.01.9, of 11 points), 95% correctly identified GDM as a risk factor. Perceived risk was maintained in most ( N = 51 of 58, 88%) who returned for their postpartum visit. Low perceived risk was not associated with loss to follow up, however correct identification of GDM as a risk factor was protective (OR 0.05, 95% CI 0.005, 0.56). Conclusions: Risk perception is accurate in most women with GDM at delivery and postpartum. Further study is needed to translate perceived risk into preventive behaviors in women with recent GDM. [ABSTRACT FROM AUTHOR]

Objectives This study focuses on examining the relations of religious participation and affiliation to mental health status among older primary care patients, and to the use and clinical outcomes of mental health services. Methods A sample of older adults participating in a clinical study (PRISM-E) to treat their depression with or without co-morbid anxiety (n = 1610) were queried about their religious affiliation and the frequency of their participation in religious activities. The diagnoses of depressive and anxiety disorders were made based on the MINI-International Neuropsychiatric Interview. Severity of depressive disorders was assessed by emotional distress using the CES-D. Results Those attending religious activities on a weekly, monthly, or occasional basis were significantly less likely to have suicidal ideation (p < 0.02) and emotional distress (p < 0.0001) than those who never participated or participated on a less frequent basis. Frequency of religious participation was not associated with mental health service utilization (p = 0.16), but it was predictive of a lower CES-D score at the end of the study intervention (p < 0.001). Conclusions Religious participation is positively associated with older adults' mental health status and treatment effects, but results regarding mental health service utilization were inconclusive. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We present the evaluation of a pilot videotape training program for older African American women in constructive conflict resolution. The program was developed because research shows: (a) older African American women suffer disproportionately from hypertension, (b) hypertension is linked to anger inhibition, and (c) older African American women tend to inhibit their anger in interpersonal conflict. Community-dwelling and institutionalized older women participated in the training. Evaluation findings indicate that the training led to increased knowledge of health-promoting skills for handling conflict, and that providing a brief group intervention in a familiar, non-stigmatizing setting may be an effective means of mental health promotion for older African American women. [ABSTRACT FROM PUBLISHER]

Dementia is a major concern in serving the older population. Understanding it has become essential to the curriculum in geriatrics education in Japan. Given the untreatable nature of the disease, the goal of care is often to maximize independence of dementia-impaired elders in community-based long-term care settings by preventing disabilities caused by an excess of care that might exacerbate the symptoms of dementia. To prepare future front-line health professionals who will work in the allied health professions, we provided students from three associate degree colleges in Japan with a two-week summer institute at Harvard Medical School which trains them to become dementia specialists. The training experience increased participants' knowledge and interests in dementia care. Implications of these training efforts for future interdisciplinary care for dementia are discussed. [ABSTRACT FROM PUBLISHER]

This study examines whether the aged and the middle aged differ in their self-appraisal of health. Data were obtained through interviews and medical records from a probability sample of 460 individuals aged 45 to 89 years old. The aged evaluated their health more pessimistically than the middle aged, after controlling for physical health, psychological distress, gender, and education. The aged's perception of health was significantly worse than the middle aged's for persons having diagnoses in each of the following diagnostic categories: rheumatism and musculoskeletal deformities, nervous system and sense disorders, and digestive problems. A stronger association was found between perceived poor health and depressive symptoms among the aged than the middle aged. The importance of psychological distress on the aged's health assessment and subsequent illness behaviors is discussed. [ABSTRACT FROM PUBLISHER]

Objective: The objective of this study was to determine empirically how many patients are identified as delirious or nondelirious according to DSM-III, DSM-III-R, and ICD-10 criteria. Method: Daily, a trained research assistant using a structured instrument to detect the presence of symptoms of delirium evaluated 325 elderly patients who were admitted to a general hospital for acute medical problems. Each patient's symptoms were then compared with these diagnostic criteria sets to determine if the patient met criteria for delirium. Results: DSM-III criteria were the most inclusive: they identified 125 patients as delirious. DSM-III-R identified a somewhat different group of 106 patients as delirious. ICD-10 criteria identified only 30 patients as delirious. Conclusions: The development of new criteria for delirium (e.g., DSM-IV) will have to balance the need to define a pure group of patients for research purposes with the need to include cases of clinical interest. Changes in criteria should be based on data such as those presented in this paper. [ABSTRACT FROM AUTHOR]

Background— Delirium is a common outcome after cardiac surgery. Delirium prediction rules identify patients at risk for delirium who may benefit from targeted prevention strategies, early identification, and treatment of underlying causes. The purpose of the present prospective study was to develop a prediction rule for delirium in a cardiac surgery cohort and to validate it in an independent cohort. Methods and Results— Prospectively, cardiac surgery patients ≥60 years of age were enrolled in a derivation sample (n=122) and then a validation sample (n=109). Beginning on the second postoperative day, patients underwent a standardized daily delirium assessment, and delirium was diagnosed according to the confusion assessment method. Delirium occurred in 63 (52%) of the derivation cohort patients. Multivariable analysis identified 4 variables independently associated with delirium: prior stroke or transient ischemic attack, Mini Mental State Examination score, abnormal serum albumin, and the Geriatric Depression Scale. Points were assigned to each variable: Mini Mental State Examination ≤23 received 2 points, and Mini Mental State Examination score of 24 to 27 received 1 point; Geriatric Depression Scale >4, prior stroke/transient ischemic attack, and abnormal albumin received 1 point each. In the derivation sample, the cumulative incidence of delirium for point levels of 0, 1, 2, and ≥3 was 19%, 47%, 63%, and 86%, respectively (C statistic, 0.74). The corresponding incidence of delirium in the validation sample was 18%, 43%, 60%, and 87%, respectively (C statistic, 0.75). Conclusions— Delirium occurs frequently after cardiac surgery. Using 4 preoperative characteristics, clinicians can determine cardiac surgery patients’ risk for delirium. Patients at higher delirium risk could be candidates for close postoperative monitoring and interventions to prevent delirium.

The number of people with Alzheimer's disease and related dementias (ADRD) in the United States is steadily increasing, with minoritized populations having a disproportionate burden of disease. One strategy to address the racial and ethnic disparities in aging is to diversify scholars in the field of aging, to increase dynamic solution development and create cultural congruence among researchers and participants. The National Institute on Aging has a committed effort to increase and diversify the number of scientists who conduct aging and ADRD research, placing a call for Centers to focus on this effort. In response to the National Institute on Aging call, the Carolina Center for Alzheimer's Disease and Minority Research, housed at the University of South Carolina, proposed a dual approach to addressing these gaps through a joint national conference and mentorship program for underrepresented minoritized faculty. After one year of the program, the participating scholars were surveyed, and successes and growth points of the program were identified to help guide the improvement of this dual approach to addressing gaps in scholar diversity in aging research.

Objective: To examine the association between biochemical markers of brain injury (MBI) and the inflammatory response in relation to neurocognitive deficiency (NCD) after cardiopulmonary bypass (CPB)., Summary Background Data: In cardiac surgery, NCD is a common but underdiagnosed complication with an unclear pathophysiology leading to significant morbidity. Despite extensive investigation, identification of a MBI for clinical use and clarifying the pathophysiology of NCD have not been achieved., Methods: Forty patients undergoing CABG and/or valve procedures using CPB were administered a validated neurocognitive battery preoperatively and postoperatively at day 4 and 3 months. S-100b, neuron specific enolase (NSE), and tau protein were assayed as MBIs preoperatively and postoperatively at 6 hours and day 4. C-reactive protein (CRP), interleukin (IL)-6, C3a, and total peroxide levels were also quantified from serum. Impact of cardiotomy suction and antifibrinolytics on markers of brain injury was assessed., Results: The incidence of early NCD was 40% (16 of 40). NSE and tau protein at the 6-hour time point were both significantly elevated in the presence of NCD (NCD group) compared with those without NCD (NORM group) (8.69 +/- 0.82 vs. 5.98 +/- 0.61; P = 0.018 and 68.8 vs. 29.2%; P = 0.015; respectively). S-100b increase was not different between the NCD and NORM groups. Cardiotomy suction significantly elevated S-100b levels, whereas NSE and tau were not significantly influenced. Aprotinin did not have an effect on NCD or levels of MBIs. Also, the NCD group had significantly elevated CRP and peroxide levels compared with the NORM group at postoperative day 4 while C3a was significantly elevated at 6 hours., Conclusion: NSE and tau are better associated with NCD and less influenced by cardiotomy suction compared with S-100beta. Inflammatory and oxidative stress is associated with NCD post-CPB.

Objective: To explore the relationship between the mental health status and coping strategies among the dementia patients' caregivers of diverse ethnicities., Methods: A survey of questionnaire, including sub-questionnaires related to the perceived living ability and cognitive damage, activities of daily living, instrumental activities of daily living, of the patients, and the mental health, coping strategies, and depression status of the CGs, was conducted among 121 caregivers (CGs) of dementia patients in the US, including 4 ethnicities: Chinese-Americans (CN, n = 29), African-Americans (BK, n = 29), Caucasians (WT, n = 32), and Latinos (LT, n = 31)., Results: The primary CGs were daughters in the BK, WT, and LT groups, while the spouses, sons, and daughters shared the caregiving role in the CN group. No significant difference in depression status and health status and physical and mental health were detected among the 4 groups (all P < 0.05). The CGs of different ethnicities origins presented different coping strategies. The subtotal scores of accepting the current situation and seeking for positive profiles were significantly different among the 4 ethnic groups with BK > WT > LT > CN (all P < 0.05). Regression analysis suggested that the CGs' depression status was associated with the background characteristics of the CGs and the care receivers and the coping strategies of the CGs were cross-ethnic differences of coping patterns relevant to the CGs' depressive experiences., Conclusion: Mental health status is associated with the coping strategies among the dementia patients' CGs, and there is cross-ethnic difference of coping strategies relevant to the CGs' depressive experience. Culturally appropriate training on coping strategies and care service is needed to improve the quality of care and quality of life for the dementia patients and their caregivers.