Neural activity patterns evoked by a spouse's incongruent emotional reactions when recalling marriage-relevant experiences.

Resonance with the inner states of another social actor is regarded as a hallmark of emotional closeness. Nevertheless, sensitivity to potential incongruities between one's own and an intimate partner's subjective experience is reportedly also important for close relationship quality. Here, we tested whether perceivers show greater neurobehavioral responsiveness to a spouse's positive (rather than negative) context-incongruent emotions, and whether this effect is influenced by the perceiver's satisfaction with the relationship. Thus, we used fMRI to scan older long-term married female perceivers while they judged either their spouse's or a stranger's affect, based on incongruent nonverbal and verbal cues. The verbal cues were selected to evoke strongly polarized affective responses. Higher perceiver marital satisfaction predicted greater neural processing of the spouse's (rather than the strangers) nonverbal cues. Nevertheless, across all perceivers, greater neural processing of a spouse's (rather than a stranger's) nonverbal behavior was reliably observed only when the behavior was positive and the context was negative. The spouse's positive (rather than negative) nonverbal behavior evoked greater activity in putative mirror neuron areas, such as the bilateral inferior parietal lobule (IPL). This effect was related to a stronger inhibitory influence of cognitive control areas on mirror system activity in response to a spouse's negative nonverbal cues, an effect that strengthened with increasing perceiver marital satisfaction. Our valence-asymmetric findings imply that neurobehavioral responsiveness to a close other's emotions may depend, at least partly, on cognitive control resources, which are used to support the perceiver's interpersonal goals (here, goals that are relevant to relationship stability).

Refractory nausea and vomiting in the setting of well-controlled idiopathic intracranial hypertension.

Summary A 27-year-old woman with a history of recurrent nausea and vomiting in the setting of idiopathic intracranial hypertension (IIH) was admitted for control of unremitting nausea and vomiting. Initial antiemetic therapy included optimisation of IIH therapy by titrating acetazolamide, in addition to using ondansetron and metoclopramide as needed, with minimal relief. She was ultimately treated with palonosetron with complete resolution of her acute nausea. Nausea, often treated with 5-hydroxytryptamine (5-HT3) receptor antagonists, approved for perioperative and chemotherapy-induced nausea, are used off-label to treat nausea and vomiting outside of those settings. The efficacy of different regimens has been compared in the literature and continues to remain controversial. When choosing from different 5-HT3 antagonists there are other considerations, in addition to efficacy to consider: dosing schedule, half-life, time of onset, duration and cost-to-benefit ratio, and although one 5-HT3 antagonist may not have been effective, another one may be. In our case palonosetron, with a significantly longer half-life than other 5-HT3 antagonists, was effective in resolving nausea when compared with the more commonly used ondansetron.

Primary care physicians and elder abuse: current attitudes and practices.

CONTEXT: while estimates suggest that between 1.4% and 5.4% of older adults experience abuse, only 1 of 14 cases of elder abuse or neglect is ever reported to authorities. It is critical for clinicians to be aware of elder abuse in order to improve primary care. OBJECTIVE: to understand Michigan primary care physicians' knowledge of and reporting practices for elder abuse, including the type of elder abuse education they received, the nature of their clinical practice, and the barriers that prevent them from reporting elder abuse. METHODS: a 17-item survey was mailed to 855 primary care physicians in Michigan in 2 waves between October 2007 and December 2007. RESULTS: Of the 855 surveys mailed, 222 were returned for a response rate of 26%. The majority of physicians (131 [67%] of 197 physicians) believed that their training about elder abuse was not very adequate or not adequate at all. Physicians with fewer than 10 hours of training were more likely to rate their training as not adequate when compared to those who had more than 10 hours of clinical training (χ(2)=64.340, P<.001). Whether abuse was reported was highly correlated with whether it was suspected (χ(2)=26.195, P<.001). Those physicians who reported receiving formal training on the topic of elder abuse in residency programs and those who reported participating in CME activities while in practice were less likely to identify not recognizing abuse at time of patient visits as a barrier to reporting. CONCLUSION: recognizing the subtle signs of elder abuse continues to be a barrier for physicians who treat older adult patients. However, education may improve primary care physicians' ability to detect and recognize elder abuse.

Elder abuse education in residency programs: how well are we doing?

PURPOSE: To understand whether education is at the heart of underreporting elder abuse by surveying Michigan residency program directors to learn about their elder abuse curricula. METHOD: In 2006, a questionnaire was mailed to 71 residency program directors in Michigan. Participants responded to closed-ended or Likert-type items about program demographics, elder abuse curricula, desire for additional related program materials, and related clinical experience. RESULTS: Results are based on 41 usable responses, for a response rate of 58%. Elder abuse education played a major role in residency curricula in more than a third of all programs (15/41). Of the 31 programs that had elder abuse lectures, 77% (24/31) required attendance at lectures. Sixty-one percent (25/41) expressed a need to learn more about screening tools, and more than half (23/41) did not use a screening assessment tool in their clinical care. Of desired additional materials, respondents most frequently requested screening tools at 63.4% (26/41). With elder abuse reporting, 61% (25/41) rated their experience with Adult Protective Services (APS) as "poor." Those curricula with the most elder abuse content topics experienced a more positive relationship with APS than those with fewer. CONCLUSIONS: Elder abuse education is not a consistent or highly prioritized topic in many primary care residency programs. Standardized educational goals and clinical experiences would help educate residents. Many participants voiced a need for additional educational materials, especially around screening, suggesting that future research should focus on the development of valid reliable elder abuse screening tools or protocols specific to medical settings.

Elder abuse education in primary care residency programs: a cluster group analysis.

BACKGROUND AND OBJECTIVES: Elder abuse is a serious issue, affecting up to 10% of community-dwelling older adults. This project sought to understand if elder abuse under-reporting was related to physician specialty and residency training. METHODS: A 17-item survey focusing on program demographics, current curriculum, priority of elder abuse education, clinical and didactic experiences, and triage resources was mailed to directors of all Michigan primary care residencies approved by the Accreditation Council for Graduate Medical Education. RESULTS: Clustering by program type, family medicine programs were primarily represented in the high-intensity group (standard residual -1.6), while internal medicine programs were primarily represented in the low-intensity group (standard residual 2.5, X2=14.80, df=6). Emergency medicine comprised the mid-intensity groups. The high- intensity group scored very high or high on areas including knowledge of elder abuse facts, elder abuse curriculum and training, and awareness of community resources related to elder abuse. CONCLUSIONS: Family medicine residency programs appear to address elder abuse more comprehensively than do emergency medicine and internal medicine programs. These programs may need to consider additional curriculum and clinical experience in elder abuse.