Methods. In a community population of 110 older African Americans with type 2 diabetes, the investigators administered surveys that assess present time orientation (PTO), future time orientation (FTO), and religiosity, as well as exercising habits, reading food labels, and checking blood glucose.

Results. Participants who reported regularly exercising had significantly lower PTO scores and higher FTO and religiosity scores than participants who did not regularly exercise. Similarly, participants who reported reading food labels had lower PTO scores and higher FTO scores but did not differ in religiosity. Participants who reported checking blood glucose levels tended to have higher FTO scores but did not differ in PTO or religiosity. Participants who engaged in all three diabetes self-management behaviors had significantly lower PTO scores and higher FTO and religiosity scores.

Conclusion. These data indicate that cultural diversity within older African Americans may influence DSM behaviors and contribute to disparities in diabetes outcomes in this high-risk population. Efforts to prevent complications of diabetes might benefit from consideration of these cultural factors.

BACKGROUND

•Takotsubo cardiomyopathy (TCM) is a transient, reversible acute cardiac syndrome that mimics acute MI

•Reportedly frequently precipitated by an emotionally stressful event

•Excessive catecholamine release is a possible pathophysiologic mechanism¹

•Prevalence of anxiety and mood disorders in TCM patients varies among studies, ranging from 21-40%^2,3

•Takotsubo cardiomyopathy (TCM):

•transient left ventricular dysfunction

•ECG changes and symptoms mimicking acute MI

•often precipitated by emotional stressor

•Catatonia is a psychomotor syndrome most commonly seen in mood disorders

•This is the first known reported case of TCM co-occurring with catatonia in the setting of acute psychological trauma and bereavement

Design: Descriptive design to evaluate feasibility of a clinical innovation.

Setting: ED of an urban tertiary care children’s hospital.

Participants: Non-acute, non-critical 14-18 year olds presenting with non-psychiatric complaints.

Intervention: ED clinical staff initiated the BHS-ED which assesses depression, suicide, post-traumatic stress, substance use, and violence exposure. Treating clinicians reviewed results and followed routine care practices thereafter.

Outcome Measures: Adoption rate of the BHS-ED by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before and 9 months during implementation.

Results: Of 3979 eligible patients, 1327 (33%) were approached by clinical staff to complete the BHS-ED; of these, 857 (64.6%) completed the BHS-ED, and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems significantly increased (4.2% vs. 2.5%, OR=1.70, 95% CI 1.38, 2.10) as did ED assessments by a social worker or psychiatrist (2.5% vs. 1.7%, OR 1.47, 95% CI 1.13, 1.90). Of the 857 subjects who completed the BHS-ED, 10.5% were identified (OR=4.58, 95% CI 3.53, 5.94) and 8.3% were assessed (OR 5.12, 95% CI 3.80, 6.88).

Conclusions: In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice and can lead to small but significant increases in the identification of unrecognized psychiatric problems.

RESULTS: Twenty-three subjects (14.4%) declined cognitively. Age, sex, education, decline in visual acuity, and number of dropped activities were associated with cognitive decline; each additional dropped activity increased the risk by 58%. Subjects who relinquished three activities were 3.87 times (95% confidence interval, 1.95-7.76) more likely to become demented than subjects who relinquished no activities; those who relinquished five activities were 9.54 times (95% confidence interval, 3.05-30.43) more likely. A multivariate model demonstrated that number of dropped activities was a powerful predictor of cognitive decline after controlling for relevant risk factors, particularly for subjects younger than 80 years of age.

CONCLUSIONS: Relinquishing valued activities is associated with an increased risk of cognitive decline in older patients with vision loss caused by AMD. These data suggest the importance of promoting optimal cognitive and physical health in patients with AMD and perhaps other chronic diseases.