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While the field of vocational rehabilitation has become increasingly focused on the goal of returning participants to competitive employment, it is not clear that the nearly 10% of participants aged 55 and older desire this goal. Archival data for 27,799 adults entering the Veterans Health Administration's Compensated Work Therapy program between 1994 and 2000 were analyzed. Nine percent of participants were over the age of 55 and the annual percentage increased each year since 1994. Older participants were less likely to be participating in order to obtain a competitive job and gave a range of other goals for participation unrelated to employment. Despite the fact that their length of stay was significantly longer, older adults earned lower wages and were more likely to drop out or to earn an 'unsuccessful' discharge. These data suggest that rehabilitation services need to be reorganized to meet the divergent needs of many older adults

There is often a substantial delay between the time when an individual first begins to experience symptoms characteristic of Alzheimer's Disease and the time that they receive an appropriate medical diagnosis and begin treatment. The institution of certain treatments earlier on in the course of the illness may reduce overall cognitive decline. However, individuals with the disease often come to professional attention in the moderate stages of the illness when treatments are less effective. This is an exploratory study to investigate whether personality styles in the caregiver, as measured by the NEO-FFI, show a correlation with treatment lags/delays. We hypothesize that personality styles high in Neuroticism, and low in Extraversion, Openness to Experience, Agreeableness and Conscientiousness may be associated with greater delays.

Family caregivers play an important role in initiating the process of evaluation, diagnosis, and treatment of adults with Alzheimer's disease. We examined progression through the pathways to diagnosis and treatment in a sample of 30 community-dwelling adults with Alzheimer's disease, who live alone and have no family caregiver coordinating their care. All were given a complete dementia workup and met NINCDS-ADRDA criteria for possible or probable Alzheimer's disease. Despite the fact that all had on-going medical care, only 30% percent had previously been diagnosed with Alzheimer's disease. An additional 20% had been diagnosed with dementia NOS, 10% with 'memory loss', and 40% had no mention of any dementia symptoms or diagnosis. Only 30% were receiving any active form of treatment, i.e. pharmacological, psychological, or social, for dementia symptoms. Without the input from an involved family caregiver, medical providers often fail to recognize, diagnose and treat Alzheimer's disease.

In a sample of 30 community-dwelling adults with Alzheimer's disease who live alone and have no family caregiver coordinating their care, we examined the degree of consensus between four groups of informants: family members, neighbors, medical providers and social service providers. For each subject, informants from at least three of these groups were interviewed. Medical records were reviewed, the adult with AD was interviewed, and a final rating on all scales was made at a consensus meeting of study staff. Concordance was generally low for this isolated group and varied widely as a function of the type of information and informant. The highest degree of concordance for medical and social service utilization and for safety risk was found for social service providers. Medical providers were the least likely of the four informant groups to either state that they knew the answers to questions or to agree with other informants.

With the are hundreds of studies about caregiver burden related to family caregivers that exist, little has been written about caregiver burden as it pertains to professional caregivers. The purpose of this study was to explore professional caregivers' perception and meaning associated with their caring for patients with Alzheimer's disease (AD). Twenty-two professional caregivers were interviewed. Content analysis was used to clarify respondents' interview data. Several themes emerged from the data related to beliefs about choosing and maintaining AD caregiving role, beliefs about self-efficacy, commitment and self-satisfaction, nature of family interaction of individuals with AD, grieving responses, and ability to maintain self-care through social support as well as solitary time. Implications include AD professional burden measurement; study related to recruitment, orientation, and staffing patterns; and effect on the quality of care provided to patients and their families. [ABSTRACT FROM AUTHOR]

The Acupuncture Pilot Study for Persons with Dementia is the first study in the United States to examine acupuncture as a treatment for Alzheimer's disease (AD) and vascular dementia (VD). Funded by the Helen Bader Foundation, the study was conducted from 1997 to 1999 at Wellesley College's Center for Research on Women. The study, which included 11 treatment participants and no controls, demonstrated that acupuncture may be a feasible and effective treatment for depression and anxiety in Americans with AD or VD. All enrolled participants completed at least 22 acupuncture needling treatments and every required evaluation. Using paired sample t-tests, statistically significant improvements were found in three of the four scales used to assess the effect of acupuncture on mood. [ABSTRACT FROM AUTHOR]

Problem gambling is a common, highly destructive disorder which is often overlooked by clinicians. Levels of clinical training, clinical experience, and professional competence for providing clinical services for problem gambling were examined in a survey of 181 clinical psychologists working in the Veterans Healthcare Administration (VHA). The results suggest that the majority of clinical psychologists have little or no formal training and little or no past or current clinical experience in the treatment of disordered gambling, nor do they see themselves as competent to evaluate or treat patients with disordered gambling. Most have not referred patients for treatment of problem gambling and do not know of a competent provider to whom they can refer. There is an identifiable subgroup, representing 9% of respondents, who do have more training, provide services, and see themselves as competent to provide care for patients with problem gambling. The amount of formal training is positively correlated with care provided and self-ratings of competence. Despite the lack of training and experience, most respondents expressed interest in receiving additional training. These data suggest that to improve rates of diagnosis and treatment of patients with problem gambling in mental health settings, additional training needs to be made available for mental health providers as a group, with specialized training for clinicians interested in specializing in this area. [ABSTRACT FROM AUTHOR]

Despite the availability of effective treatments for coping with traumatic experiences, a large percentage of military veterans in need do not seek help. The "I Was There" model is a new filmmaking program which is a creative-expressive tool, developed to enable veterans to reflect on their experiences and jointly create short artistic films. These artistic films articulate, often metaphorically, aspects of the veterans' service experiences, traumatic events, and reintegration challenges. The current study employed a qualitative methodology to explore participants' subjective experience of the program. We interviewed 50 participants following the intervention, focusing specifically on their perceptions of the filmmaking process, the aspects they viewed as meaningful, and whether and how the process affected them. Most participants reported their experience as positive and empowering. Three overarching themes emerged as significant in describing the benefits of participation: Gaining a new sense of agency, regaining a sense of affiliation, and processing the trauma. The findings are illustrated and discussed within the context of narrative therapy, as is the potential of video-based therapy, especially regarding non-articulated, sensory traumatic memories, and for the process of (re)construction of the trauma narrative.

Purpose: The influx of young adult veterans with mental health challenges from recent wars combined with newly expanded veteran education benefits has highlighted the need for a supported education service within the Veterans Administration. However, it is unknown how such a service should be designed to best respond to these needs. This study undertook a qualitative needs assessment for education supports among veterans with post-9/11 service with self-reported PTSD symptoms., Methods: Focus groups were held with 31 veterans, 54% of whom were under age 30. Transcripts were analyzed and interpreted using a thematic approach and a Participatory Action Research team., Results: Findings indicate a need for age relevant services that assist with: education planning and access, counseling for the G.I. Bill, accommodations for PTSD symptoms, community and family re-integration, and outreach and support., Conclusions and Implications for Practice: The veterans recommended that supported education be integrated with the delivery of mental health services, that services have varied intensity, and there be linkages between colleges and the Veterans Health Administration.

The α7 nicotinic acetylcholine receptor is known to regulate a wide variety of developmental and secretory functions in neural and non-neural tissues. The mechanisms that regulate its transcription in these varied tissues are not well understood. Epigenetic processes may play a role in the tissue-specific regulation of mRNA expression from the α7 nicotinic receptor subunit gene, CHRNA7. Promoter methylation was correlated with CHRNA7 mRNA expression in various tissue types and the role of DNA methylation in regulating transcription from the gene was tested by using DNA methyltransferase (DNMT1) inhibitors and methyl donors. CHRNA7 mRNA expression was silenced in SH-EP1 cells and bisulfite sequencing PCR revealed the CHRNA7 proximal promoter was hypermethylated. The proximal promoter was hypomethylated in the cell lines HeLa, SH-SY5Y, and SK-N-BE which express varying levels of CHRNA7 mRNA. Expression of CHRNA7 mRNA was present in SH-EP1 cells after treatment with the methylation inhibitor, 5-aza-2-deoxycytidine (5-Aza-CdR), and increased in SH-EP1 and HeLa cells using another methylation inhibitor, zebularine (ZEB). Transcription from the CHRNA7 promoter in HeLa cells was increased when the methyl donor methionine (MET) was absent from the media. Using methylation-sensitive restriction enzyme analysis (MSRE), there was a strong inverse correlation between CHRNA7 mRNA levels and promoter DNA methylation across several human tissue types. The results support a role for DNA methylation of the proximal promoter in regulation of CHRNA7 transcription.

Supported housing is a service model that couples provision of independent housing with provision of community-based supports for individuals with psychiatric disabilities at risk of homelessness. Despite its promise as an alternative to traditional sequential residential rehabilitation programs, supported housing has not been evaluated to an extent that supports firm conclusions concerning the efficacy of specific program elements. We conducted a comprehensive review of the literature on supported housing and similarly labeled programs, to determine the degree of clarity in the supported housing model and the degree of fidelity to that model within the empirical literature, and to determine whether lack of clarity or fidelity are barriers to widespread, systematic program implementation and evaluation. We encountered a number of limitations in the literature, including conflicting use of program labels, inconsistent definitions of supported housing and its elements, and use of inadequate measurement indices in assessing adherence to program elements. Our findings suggest that greater model clarity, better specification of model elements, and greater standardization in measurement of program dimensions would aid in supported housing program implementation and evaluation. We present a number of recommendations for the field and suggestions for future research., (Published by Elsevier Ltd.)

One of the shortcomings of the pathways-to-care literature is the lack of empirical support for the validity of the data collection methods. This study uses three common formats to collect retrospective pathways-to-care data for adults who have been diagnosed with possible or probable Alzheimer's disease (AD) and compares indicators to evaluate their relative validity. Forty family caregivers of adults diagnosed with possible or probable AD were recruited from the caregiver registry of the Boston University Alzheimer's Disease Core Center (BU ADCC). In each of three formats (questionnaire, structured interview, and medical record review), data were collected regarding four key events in the pathway to dementia care: first appearance of symptoms, first verbalized recognition of symptoms, first effort to seek professional help, and first diagnosis by a professional. In addition to the dates of these events, researchers attempted to determine: the first verbalized concern about the symptoms, who first sought professional help, what professional was first approached, and what professional made the first diagnosis. In a consensus meeting, data collected in all three formats were reviewed, and a consensus on the most likely answers to all questions was recorded and compared to data collected in each format. The results suggest that the three formats are not equivalent in terms of concurrent validity. While substantial agreement is found among data collection methods, the validity of the structured interview format and the medical record review is most consistently supported by the data in this study. Questionnaire data resulted in underestimates of delays and correlated poorly with other data sources, including the consensus judgment. Recommendations for pathways-to-care data collection procedures that maximize validity are discussed.

The hypothesis that the 15q13-15 region of chromosome 15 contains a gene that contributes to the etiology of schizophrenia is supported by multiple genetic linkage studies. The alpha7 neuronal nicotinic acetylcholine receptor (CHRNA7) gene was selected as the best candidate gene in this region for molecular investigation, based on these linkage findings and biological evidence in both human and rodent models. CHRNA7 receptors are decreased in expression in postmortem brain of schizophrenic subjects. A dinucleotide marker, D15S1360, in intron two of the CHRNA7 gene is genetically linked to an auditory gating deficit found in schizophrenics and half of the first-degree relatives of patients. Single strand conformation polymorphism (SSCP) and sequence analyses of DNA from schizophrenic and control individuals identified 33 variants in the coding region and intron/exon borders of the CHRNA7 gene and its partial duplication, dupCHRNA7; common polymorphisms were mapped. Twenty-one variants were found in the exons, but non-synonymous changes were rare. Although the expression of CHRNA7 is decreased in schizophrenia, the general structure of the remaining receptors is likely to be normal., (Copyright 2003 Wiley-Liss, Inc.)

Background: The alpha7 neuronal nicotinic acetylcholine receptor subunit gene (CHRNA7) has been implicated as a candidate gene for schizophrenia, and for an auditory sensory processing deficit found in the disease, by both genetic linkage at 15q14 and biochemical data. The expression of CHRNA7 is reduced in several brain regions in schizophrenic subjects compared with control subjects. This study presents DNA sequence analysis of the core promoter region for CHRNA7 in schizophrenic and control subjects., Methods: Single-strand conformation polymorphism analysis and DNA sequencing were used for mutation screening of the core promoter in the CHRNA7 gene. The sample included subjects from 166 schizophrenic families and 165 controls. Controls had no evidence of current or past psychosis and had auditory evoked potentials recorded., Results: Multiple polymorphic patterns were identified in the CHRNA7 core promoter in both schizophrenic and control subjects. Functional analysis of polymorphisms indicated that transcription was reduced. The prevalence of functional promoter variants was statistically greater in schizophrenic subjects than in the controls. Presence of an alpha7 promoter polymorphism in controls was associated with failure to inhibit the P50 auditory evoked potential response., Conclusions: Although linkage disequilibrium with other genetic alterations cannot be excluded, the CHRNA7 core promoter variants, found in this study, may contribute to a common pathophysiologic feature of schizophrenia.

The purpose of this study is to identify what factors predict job and career commitment among professional caregivers working with patients with dementia. A secondary analysis was completed using data collected from 77 professional caregivers working in residential dementia special care programs. The findings suggest that professional caregivers' commitment to their jobs and careers is most closely related to their level of involvement in the interpersonal aspects of the work, the degree to which they feel personal growth or benefit, and the level of burden that their work generates. Strategies are suggested for improving job and career longevity among professional caregivers by enhancing attachment to patients and families, fostering professional identity and personal growth, and monitoring and managing professional caregiver burden.

Objective: The authors sought to determine the relationship between receipt of disability compensation and participants' success in a vocational rehabilitation program., Methods: Administrative data for 22,515 individuals who participated in the Veterans Health Administration compensated work therapy program between 1993 and 1998 were analyzed. Six dependent variables were compared between participants who were receiving disability compensation and those who were not: duration of participation in compensated work therapy, number of hours worked per week, mean hourly earnings, total income from compensated work therapy, dropout rate, and competitive employment status at discharge. Regression equations were determined for each dependent variable to assess associations with the degree of disability, the amount of disability compensation, and the type of compensation program., Results: Participants who were receiving disability benefits worked fewer hours in compensated work therapy each week, earned less income, had a higher dropout rate, and were less likely to be competitively employed at discharge. The amount of compensation and the type of program were modestly but significantly associated with participation in compensated work therapy and with outcome., Conclusions: Unintended effects of disability compensation programs discourage full participation in vocational rehabilitation and result in poorer rehabilitation outcomes.

Objective: The study examined whether climate has an impact on inpatient psychiatric length of stay in Veterans Health Administration hospitals (VHA)., Method: Data from the National Weather Service for eight climate variables for the locations of 134 VHA hospitals nationwide were factor analyzed, resulting in two climate factors representing temperature and precipitation. Factor scores were correlated with psychiatric mean lengths of stay from 1994 to 1998 for 99 VHA hospitals with inpatient psychiatric services and for the 22 VHA regional divisions (Veterans Integrated Service Networks)., Results: Climate factors correlated modestly but significantly with length of stay, with correlations ranging from -0. 25 to -0.37 at the hospital level and from -0.38 to -0.45 at the VHA regional level; hospitals in warmer and drier climates had shorter lengths of stay. Medical centers in colder climates had the longest lengths of stay in winter and fall. The significant correlation between climate and length of stay was not affected by recent reductions in length of stay in VHA hospitals., Conclusions: Higher clinical costs associated with longer lengths of stay in colder climates have implications for budget planning. Climate factors must also be recognized for their potential effect on performance monitoring systems focused on hospital utilization. Researchers must continue to consider broader contextual variables such as climate if they are to fully understand the determinants of health care utilization and psychiatric hospitalization costs.

Research into the experience of caregiving for patients with Alzheimer disease continues to grow steadily both in the number of studies and the scope of investigation. A review of the current trends in the content and methodology of research into caregiving is provided as a guide for new investigators entering this field. Whereas most studies continue to focus on the stress and burden associated with caregiving, increased study into topics such as treatment utilization, clinical decision-making, and caregivers and early detection will continue to broaden and enrich the scope of investigation. Positive trends in research methodology, including improved sampling procedures, more frequent inclusion of control groups, the use of improved measurement techniques, and the use of more sophisticated designs and statistics, will all continue. Despite the many contributions of past research into caregiving, future studies promise to make a critical contribution to a number of fields of study.

A deficit in the recognition of facial affect has been well documented in people with schizophrenia. Our 1995 research with normal subjects showed that hemispheric bias for processing facial affect is related to accuracy of recognition of facial affect. We tested whether this relationship holds in a sample of 25 people with schizophrenia who completed tasks of identification of facial affect and chimeric facial affect. Subjects with a left visual-field bias were significantly more accurate in identifying one facial emotion (sad) than were other subjects. Individual differences in hemispheric advantage for processing affect appears to be an important variable related to functional brain capacity within different populations.

The human alpha7 neuronal nicotinic acetylcholine receptor gene (HGMW-approved symbol CHRNA7) has been characterized from genomic clones. The gene is similar in structure to the chick alpha7 gene with 10 exons and conserved splice junction positions. The size of the human gene is estimated to be larger than 75 kb. A putative promoter 5' of the translation start in exon 1 has been cloned and sequenced. The promoter region lacks a TATA box and has a high GC content (77%). Consensus Sp1, AP-2, Egr-1, and CREB transcription factor binding sites appear to be conserved between bovine and human genes. The alpha7 nAChR gene was found to be partially duplicated, with both loci mapping to the chromosome 15q13 region. A yeast artificial chromosome contig was constructed over a genetic distance of 5 cM that includes both alpha7 loci and the region between them. Four novel exons are described, located in genomic clones containing the partially duplicated gene. The duplicated sequences, including the novel exons, are expressed in human brain., (Copyright 1998 Academic Press.)

Objective: Two hypotheses were tested: (1) In a sample of adult men, past experience of child abuse (sexual, physical, or emotional) will be related to higher levels of reported alienation from religion and God as shown in lower rates of current religious behavior, higher frequency of spiritual "injury," and lower stability of religious behavior and experiences; (2) More "severe" forms of abuse will be associated with higher indicators of alienation., Method: Data were collected from 1,207 male veterans, 527 (43.7%) of whom reported being abused as a child. Each subject completed the Spiritual Issues Assessment, a large survey which includes data about: (1) KASL Religiosity Index; (2) The Spiritual Injury Scale; and (3) Religious items from the Westberg Personal Health Inventory., Results: A history of sexual abuse was related to significantly greater spiritual injury and lower stability of spiritual behaviors and experiences, but not to overall rate of current religious behavior. Surprisingly, abuse was related to increased frequency of prayer and of "spiritual experience." Multivariate analyses indicate that the effect size is relatively small and the type of abuse was less important than the presence of any form of abuse., Conclusions: The findings suggest that the impact of childhood abuse is more complex than initially hypothesized. While abuse seems to be related to continuing spiritual injury and distress, it is also related to higher levels of some spiritual activities and experiences which are usually associated with positive spirituality.

The current study extends previous findings of a left visual-field bias in chimeric face tasks, by using a new procedure which incorporates chimeric stimuli depicting both positive and negative target affects and requires the identification of affect in individually presented faces. This new procedure is more representative of the types of judgements made in daily social interaction. Results with this new procedure are consistent with previous findings, indicating a significant left visual-field bias for both positive and negative affects in the majority of subjects. Handedness was significantly related to lateralization scores, with dextrals showing greater left visual-field biases than sinistrals. Among sinistrals, a left visual-field bias was noted only for happy chimera.

Neuronal nicotinic acetylcholine receptors are expressed in the human central nervous system. A specific subtype of this receptor family, the alpha7 nicotinic acetylcholine receptor, is thought to be the principal alpha-bungarotoxin (alphaBTX)-binding protein in mammalian brain. Although the expression of this receptor subtype has been characterized in rat, no study has specifically compared the expression of both the alpha7 gene and the localization of BTX binding sites in human brain. Expression of alpha7 mRNA and receptor protein in human postmortem brain tissue was examined by in situ hybridization and [125I]-alpha-bungarotoxin autoradiography, respectively, with particular emphasis on regions associated with sensory processing. Regions with high levels of both alpha7 gene expression and [125I]-alphaBTX binding include the nucleus reticularis of the thalamus, the lateral and medial geniculate bodies, the basilar pontine nucleus, the horizontal limb of the diagonal band of Broca, the nucleus basalis of Meynert, and the inferior olivary nucleus. High-to-moderate levels of alpha7 probe hybridization were also seen in the hippocampus and the cerebral cortex; however, there was a reduced or variable degree of [125I]-alphaBTX binding in these regions compared with the level of probe hybridization. In most brain regions, [125I]-alphaBTX binding was localized to neuronal cell bodies similar in morphology to those that exhibited alpha7 hybridization, suggesting that the high-affinity [125I]-alphaBTX binding sites in the human brain are likely to be principally composed of alpha7 receptor subtypes.

The current study examines the Dream in midlife women and its impact on mental health functioning. Ninety midlife women filled out a questionnaire examining Dream Status, Dream Success, Dream Content, and Dream Support, as well as mental health factors of depression, anxiety, and purpose-in-life. Neither early nor current Dream Status was not found to be significantly related to mental health factors. Partial support was found for the hypothesis that Dream Success is related to mental health factors. Early Dream Content related to career and current Dream Content related to both marriage/intimacy and career are related to positive performance on mental health factors. Dream Support is positively related both to Dream Success and to mental health factors while resistance to the Dream is not. The results are discussed in light of gender differences in the developmental function and impact of the Dream.

This study explored the relationship between three indices of intersubtest scatter and level of cognitive deterioration in a sample of 104 patients with dementia of Alzheimer's type, who ranged in age between 52 and 84 years. Scatter was highly related to education and premorbid level of functioning. Advancement of dementia was shown to be associated with decrease in scatter, which suggests caution in interpretation of high magnitude of inter-subtest scatter as an indication of brain dysfunction. Easy-to-calculate range of scatter proved to be adequate measure of scatter. Calculation of more complex indices, such as PVI, provides only minimal incremental gain.

The study explored differential patterns of deficits in different memory components as a function of dementia severity. Three groups of 58 subjects each were used: (1) highly functioning elderly who are free of neurological or psychiatric symptoms; (2) individuals with early signs of memory disturbance, whose MMSE scores were > or = 24; and (3) individuals with MMSE scores below 24, who meet criteria for DAT. Performance on the tests that assess different memory components was compared for the three groups. Results suggest pronounced change in acquisition component of memory at the onset of dementia, whereas retrieval from remote memory discriminates well between the mild and the more advanced phases of the disease. Retrieval from recent memory deteriorates more gradually. Based on these results, efficiency of different memory mechanisms was discussed.