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Maria Devita,1,2 Rossella De Salvo,1 Adele Ravelli,2 Marina De Rui,2 Alessandra Coin,2 Giuseppe Sergi,2 Daniela Mapelli1 1Department of General Psychology (DPG), University of Padua, Padua, Italy; 2Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, ItalyCorrespondence: Maria Devita, Department of General Psychology, Via Venezia 8, Padua, 35128, Italy, Tel +390498218949, Email maria.devita@unipd.itAbstract: Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible “pocket” guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly.Keywords: late-life depression, older adults, mood disorders, geriatric depression

Addresses the Wallace-Reader's Digest Funds' experiences working with school libraries and the lessons learned from the Library Power initiative, including: how school libraries can support national education goals, particularly in meeting the challenges outlined in the No Child Left Behind Act of 2001; current threats to library reform; and how foundations can help support reform. (MES)

Objective: Staff burnout is a frequent problem for mental health providers and may be associated with negative outcomes for providers, consumers, and organizations. This study tested an intervention to reduce staff burnout.Methods: Community mental health providers were invited to participate in a day-long training session to learn methods to reduce burnout. A Web-based survey was given at time of registration, before the intervention, and again six weeks later.Results: Eighty-four providers participated in the training, and follow-up data were available for 74. Six weeks after the day-long training, staff reported significant decreases in emotional exhaustion and depersonalization and significant increases in positive views toward consumers. There were no significant changes in providers' sense of personal accomplishment, job satisfaction, or intention to leave their position. Ninety-one percent of the staff reported the training to be helpful.Conclusions: This brief intervention is feasible, is acceptable to staff, and may improve burnout and staff attitudes. [ABSTRACT FROM AUTHOR]

Background: Patients on hemodialysis are at high risk for cardiovascular disease (CVD). Aspirin is an established therapy for primary and secondary prevention of CVD that may be underutilized in hemodialysis patients. To better understand the use of aspirin in hemodialysis patients, we examined the experience of an urban hemodialysis center. Guidelines for use as well as associated risks and benefits are reviewed. Methods: Medical records for patients receiving hemodialysis treatment at our center (New York City, USA) in May 2004 were reviewed for aspirin use, presence of CVD, and potential contraindications to aspirin therapy. CVD was defined as a history of coronary artery disease, ischemic stroke, transient ischemic attack, or peripheral vascular disease. Potential contraindications to aspirin therapy included history of clinically significant bleeding or increased risk of bleeding, aspirin allergy and routine treatment with other anticoagulants. Results: 176 patients were eligible for the study and 172 (98%) were included. Although 74 patients had a history of CVD, only 38(51%) of these were treated with aspirin. Among patients with a history of CVD who were not treated with aspirin, 19 (53%) had no identifiable contraindications to aspirin therapy for secondary prevention of CVD. Ninetyeight patients had no history of CVD, and 18 (18%) of these were treated with aspirin. Of patients without a history of CVD who were not treated with aspirin, 57 (7 1%) had no identifiable contraindications to aspirin therapy for primary prevention of CVD. Conclusions: Aspirin is underutilized in hemodialysis patients for the primary and secondary prevention of CVD. Given the high risk of CVD in hemodialysis patients, therapy with aspirin may be of significant benefit and prospective studies of aspirin therapy are needed. [ABSTRACT FROM AUTHOR]

Background: Idiopathic focal segmental glomerulosclerosis (FSGS) is one of the leading causes of the nephrotic syndrome in adults and an important cause of end-stage renal disease. Its incidence has dramatically increased in the last two decades and it is especially prevalent among black patients. The trend of FSGS incidence has not been reported beyond 1997. Methods: We retrospectively reviewed all renal biopsies performed at our institution between 1986 and 2002 and identified patients with diagnoses consistent with primary glomerulopathy (PG), which included: minimal-change disease (MCD), idiopathic focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MGN), IgA nephropathy (IgA), membranoproliferative glomerulonephritis (MPGN) and mesangioproliferative glomerulonephritis. Patients with possible secondary causes for their renal disease were excluded. Clinical data at the time of biopsy and follow-up data were collected and analyzed. Results: During the period from January 1986 - December 2002, 299 renal biopsies were performed and 132 patients were diagnosed with PG. FSGS was the most common form of PG representing 37.8% of all PG followed by IgA 27.3%, MGN 16.6% and MCD 9.1%. Among FSGS patients 59% were females, 64% had nephrotic range proteinuria and 54% had the nephrotic syndrome. Mean serum creatinine was 2.0 ± 0.2 mg/dl and mean protein excretion was 6.1 ± 1.0 g/day. The incidence of FSGS increased from 19.3% (1986 - 1991) and 16.6% (1992 - 1997) to 58.5% in the period from 1998 - 2002. The increase occurred among black and Hispanic patients (33.3 - 79.2%) as well as white patients (12.5 - 51.5%). Black and Hispanic patients with PG presented for renal biopsy at a significantly younger age than white patients (p = 0.003), with mean age 37.5 ± 2.0 years vs. 50.3 ± 1.8 years. White FSGS patients were significantly older than white non-FSGS patients (mean age 56.4 ± 3.2 years vs. 48.0 ± 2.0 years, p = 0.03). Black and Hispanic FSGS patients were also older when compared to their non-FSGS counterparts (mean age 40.6 ± 2.8 years vs. 32.1 ± 2.0 years, p = 0.04). When patients were stratified by age (< 45 years and &ges; 45 years), FSGS was the most common diagnosis in both age groups among black and Hispanic patients (55.1% and 88.8%) but only among older white patients (36.2%). Conclusions: The incidence of FSGS as a proportion of PG in our population has increased markedly in the most recent time period analyzed (1998 - 2002). The increase has occurred among both white and black and Hispanic patients. We also found that FSGS was most prevalent in patients &ges; 45 years. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The most appropriate type of surgery for hyperparathyroidism secondary to renal failure remains controversial. We report a 5-year experience of patients with hyperparathyroidism secondary to end-stage renal disease who underwent subtotal parathyroidectomy. We believe that this is the procedure of choice, offering several advantages over total parathyroidectomy with and without reimplantation.Study Design: Retrospective review.Methods: Review of 14 consecutive renal failure patients who underwent subtotal parathyroidectomy by one surgeon (A.K.) was performed. Follow-up ranged from 4 to 54 months. All patients were receiving chronic maintenance dialysis. All patients came to surgery with clinical symptoms of parathyroid bone disease, elevated serum calcium levels (10.1-12.4 mg/dL), and intact parathyroid hormone levels (619-4160 pg/mL), despite maximal medical therapy. At exploration four glands were identified in all patients and three and a half were removed.Results: All patients experienced symptomatic relief postoperatively with normalization or near-normalization of serum calcium concentration and intact parathyroid hormone concentrations. One patient developed recurrent disease 4 months after surgery, and on re-exploration a supernumerary substernal gland was identified. A second patient developed recurrent symptoms 4 years after surgery and at the time of this writing was awaiting re-exploration.Conclusions: All patients had either resolution of or marked improvement in their subjective complaints. There have been no cases of permanent hypoparathyroidism. We believe that subtotal parathyroidectomy is the best procedure for patients with refractory symptoms of secondary hyperparathyroidism. [ABSTRACT FROM AUTHOR]