Using clinical signs of neglect to identify elder neglect cases.

Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual's residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.

The Effects of the Moms and Teens for Safe Dates Program on Dating Abuse: a Conditional Process Analysis.

Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed to domestic violence. In a randomized controlled trial (RCT), MTSD prevented certain types of DA victimization (psychological and physical) and perpetration (psychological and cyber) among teens with higher, but not lower, exposure to domestic violence. We built on these findings by using moderated mediation analysis to examine whether level of teen exposure to domestic violence conditioned the indirect effects of MTSD on these types of DA through targeted mediators. MTSD consisted of six mailed activity booklets. Mothers who had been former victims of domestic violence delivered the program to their teens. Mother and teen pairs were recruited into the RCT through community advertising and completed baseline and 6-month follow-up interviews (N = 277 pairs). As expected, MTSD had significant favorable effects for teens with higher but not lower exposure to domestic violence on several mediators that guided program content, including teen conflict management skills and mother-perceived severity of DA, self-efficacy for enacting DA prevention efforts, and comfort in communicating with her teen. MTSD had significant main effects on other mediators including teen feeling of family closeness and cohesion and mother-perceived susceptibility of her teen to DA. As expected, all significant indirect effects of MTSD on DA outcomes through mediators were for teens with higher exposure to domestic violence. Findings have implications for developing DA victimization and perpetration prevention programs for teens with high exposure to domestic violence.

The effects of moms and teens for safe dates: a dating abuse prevention program for adolescents exposed to domestic violence.

Adolescents exposed to domestic violence are at high risk for dating abuse. This randomized controlled trial evaluated a dating abuse prevention program designed specifically for this risk group. Moms and Teens for Safe Dates consisted of six mailed booklets of dating abuse prevention information and interactive activities. Mothers who had been victims of domestic violence but no longer lived with the abuser delivered the program to their adolescents who had been exposed to the abuse. Mother and adolescent pairs (N = 409) were recruited through community advertising; the adolescents ranged from 12 to 16 years old and 64 % were female. Mothers and adolescents completed baseline and 6-month follow-up telephone interviews. Booklet completion in the treatment group ranged from 80 % for the first to 62 % for the last booklet. The analyses first tested whether program effects on dating abuse varied by four a priori identified moderators (mother's psychological health, the amount of adolescent exposure to domestic violence, and adolescent sex and race/ethnicity). Main effects of the program were examined when there were no differential program effects. Program effects on psychological and physical victimization and psychological and cyber perpetration were moderated by the amount of adolescent exposure to domestic violence; there were significant favorable program effects for adolescents with higher, but not lower levels of exposure to domestic violence. There were no moderated or main effects on sexual violence victimization and perpetration or cyber victimization. The findings suggest that a dating abuse prevention program designed for adolescents exposed to domestic violence can have important positive effects.

The process of adapting a universal dating abuse prevention program to adolescents exposed to domestic violence.

Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated dating abuse prevention programs have been designed specifically for this high-risk population. This article describes the process of adapting Families for Safe Dates (FSD), an evidenced-based universal dating abuse prevention program, to this high-risk population, including conducting 12 focus groups and 107 interviews with the target audience. FSD includes six booklets of dating abuse prevention information, and activities for parents and adolescents to do together at home. We adapted FSD for mothers who were victims of domestic violence, but who no longer lived with the abuser, to do with their adolescents who had been exposed to the violence. Through the adaptation process, we learned that families liked the program structure and valued being offered the program and that some of our initial assumptions about this population were incorrect. We identified practices and beliefs of mother victims and attributes of these adolescents that might increase their risk of dating abuse that we had not previously considered. In addition, we learned that some of the content of the original program generated negative family interactions for some. The findings demonstrate the utility of using a careful process to adapt evidence-based interventions (EBIs) to cultural sub-groups, particularly the importance of obtaining feedback on the program from the target audience. Others can follow this process to adapt EBIs to groups other than the ones for which the original EBI was designed.

Establishment of a university academic spine center: from concept to reality.

In fewer than five years, the University of Kansas Hospital Spine Center became the largest and most comprehensive spine care facility in the greater metropolitan Kansas City area. The 22,000-square-foot facility has 27 exam rooms, four specialized diagnostic rooms, 11 pre-/post-interventional procedure rooms, and a 4000-square-foot outpatient rehabilitation gym. Patients can meet with their physicians, undergo diagnostic tests and treatment, and attend therapy sessions in one location. The multidisciplinary Spine Center brings together orthopedic surgeons, neurosurgeons, neurologists, physical medicine and rehabilitation physicians, psychiatrists, psychologists, pain-management anesthesiologists, radiologists, and physical and occupational therapists. The Spine Center became successful because a group of physicians bought into the philosophy of a comprehensive interdisciplinary program, were willing to sacrifice some territorial claims, and were willing to put patient care and the good of the institution above individual egos.

PYM50028, a novel, orally active, nonpeptide neurotrophic factor inducer, prevents and reverses neuronal damage induced by MPP+ in mesencephalic neurons and by MPTP in a mouse model of Parkinson's disease.

Many experimental data support the enhancement of neurotrophic factors as a means to modify neurodegeneration in Parkinson's disease. However, the translation of this to the clinic has proven problematic. This is likely due to the complex nature of the surgical gene delivery and cell-based approaches adopted to deliver proteinaceous neurotrophic factors to targets within the central nervous system. We investigated the ability of a novel, orally active, nonpeptide neurotrophic factor inducer, PYM50028 (Cogane), to restore dopaminergic function after 1-methyl-4-phenylpyridinium (MPP(+)) -induced damage to mesencephalic neurons in vitro and in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) -lesioned mice. In rat mesencephalic neurons, administration of PYM50028, either before or after MPP(+), significantly prevented and reversed both MPP(+)-induced neuronal atrophy and cell loss. These effects were potent and of a magnitude equivalent to those achieved by a combination of brain-derived neurotrophic factor (BDNF) and glial-derived neurotrophic factor (GDNF). Oral administration of PYM50028 (10 mg/kg/day for 60 days) to MPTP-lesioned mice, commencing after a striatal impairment was evident, resulted in a significant elevation of striatal GDNF (297%) and BDNF (511%), and attenuated the loss of striatal dopaminergic transporter levels and dopaminergic neurons in the substantia nigra. PYM50028 did not inhibit monoamine oxidase B in vitro, nor did it alter brain levels of MPP(+) in vivo. PYM50028 has neuroprotective and neurorestorative potential and is in clinical development for the treatment of neurodegenerative disorders, including Parkinson's disease.

Correlates of intimate partner violence among female patients at a North Carolina emergency department.

OBJECTIVE: This paper identifies comorbid factors among female emergency department (ED) patients who have experienced intimate partner violence (IPV). METHODS: 321 adult female patients completed self-administered questionnaires while in an urban North Carolina emergency department. IPV was assessed by questioning whether the patient had ever been afraid of a partner, physically hurt or threatened by a partner, or forced to have sex by a partner. RESULTS: One third of all female patients reported at least one form of IPV in their lifetimes. IPV was associated with a low self-rating of physical and mental health, frequent visits to the ED, and problems with alcohol, drugs, and mental health. In multivariate analysis, only a history ofalcohol and mental health problems and a low self-rating of mental health remained significant. CONCLUSIONS: The findings illustrate the need for IPVscreening protocols that address mental health and substance abuse and also emphasize the importance ofscreening all women for IPV

Autonomic efferents affect intake of imbalanced amino acid diets by rats.

An anorectic response occurs following ingestion of imbalanced amino acid (IMB) diets. There are three phases to this response: 1, recognition of the IMB diet; 2, conditioned development of an aversion to the IMB diet; and 3, adaptation. Blockade of peripheral serotonin-3 (5-HT3) receptors or vagotomy attenuates Phase 2 of the anorectic response. We investigated whether sympathetic efferents interact with the ventral gastric branch (VGB), by cutting it (X), or with the 5-HT3 receptor in these responses. First, VGBX and sham-operated (SHAM) groups were injected with vehicle or phenoxybenzamine (alpha-blocker), or nadolol (beta-blocker) before introducing the IMB diet. At 3 h suppression of the IMB diet ingestion was unchanged, showing no sympathetic efferent effect on Phase 1. Intake of the IMB diet increased 12-24 h later only in the SHAM+phenoxybenzamine group, so the VGB was necessary for alpha-blockade to enhance IMB diet intake during Phase 2 or possibly Phase 3. On days 2-5, intakes by the SHAM+phenoxybenzamine, VGBX+phenoxybenzamine and VGBX+nadolol groups were elevated. Therefore, alpha-blockade enhanced adaptation alone, but VGBX was necessary for beta-receptor blockade to augment Phase 3 adaptation. Both sympathetic efferents and the VGB are involved in Phases 2-3. Second, rats received vehicle or nadolol or scopolamine (nonselective muscarinic blocker) or pirenzepine (muscarinic M-1 receptor blocker),w+/-tropisetron (5-HT3 blocker). Pirenzepine attenuated the tropisetron effect between 6-9 h, but then pirenzepine and nadolol enhanced the tropisetron effect between 9-12 h. Scopolamine attenuated the tropisetron effect between 9-12 h. While neither experiment showed effects during the recognition phase, the autonomic and serotonergic systems interact in the learned and adaptive responses to IMB diets.