Engaged scholarship and gerontological program relevance: opportunities and challenges.

Engaged scholarship promotes contribution to the academic body of knowledge through equal partnership between academic scholars and community representatives in education, research, and public service or intervention. Such partnerships can expand our notions of service learning and applied research. In this article, the authors discuss the potential contribution of engaged scholarship to the relevance of gerontological education and research programs. The authors discuss the role of engaged scholarship in the philosophy of education, in the promotion of social justice, and its relevance for the civic responsibility and accountability of educational institutions. Finally, the authors describe benefits and barriers to participation in engaged scholarship and challenges in the recruitment of engaged scholars.

Eating disorder symptomatology in normal-weight vs. obese individuals with binge eating disorder.

Although normal-weight individuals comprise a substantial minority of the binge eating disorder (BED) population, little is known about their clinical presentation. This study sought to investigate the nature and severity of eating disturbances in normal-weight adults with BED. We compared 281 normal-weight (n = 86) and obese (n = 195) treatment-seeking adults with BED (mean age = 31.0; s.d. = 10.8) on a range of current and past eating disorder symptoms using ANOVA and χ(2) analyses. After controlling for age and sex, normal-weight participants reported more frequent use of a range of healthy and unhealthy weight control behaviors compared to their obese peers, including eating fewer meals and snacks per day; exercising and skipping meals more frequently in the past month; and avoiding certain foods for weight control. They also endorsed more frequent attempts at dieting in the past year, and feeling more frequently distressed about their binge eating, at a trend level. There were no group differences in binge eating frequency in the past month, age at onset of binge eating, overvaluation of shape/weight, or likelihood of having used certain weight control behaviors (e.g., vomiting, laxative use) or having sought treatment for an eating disorder in the past. Based on our findings, normal-weight individuals appear to be a behaviorally distinct subset of the BED population with significantly greater usage of both healthy and unhealthy weight control behaviors compared to their obese peers. These results refute the notion that distress and impairment in BED are simply a result of comorbid obesity.

Continuing education modules and the scholarship of engagement.

Economic and political trends underscore the importance of engaged scholarship as evidence that colleges and universities are serving their constituencies. Set in a background of debate about pure versus applied social science this article describes a planned approach to continuing gerontological education grounded firmly in the principles of the scholarship of engagement. The description includes efforts to ascertain through a two-phase state-wide survey continuing education needs and preferred venue in a segment of the North Carolina aging services workforce. Subsequent surveys were used to define and prioritize modular continuing education topics suitable for web-based delivery.

The aging farm population and rural aging research.

This article explores the potential and the promise of convergence between gerontological and occupational health researchers to better understand challenges faced by aging farmers including declining economic viability of family farms, the aging of the population of working farmers, and probability of work-related injury or disability among older farmers. Although the need for research seems obvious, the economic, demographic, and psychosocial dynamics of continued work among aging farmers is under-studied in the occupational health literature and absent in the gerontological literature. Following examination of studies of aging farmers drawn from the occupational health literature, we review studies of rural aging in the gerontological literature. First, we compare varying definitions of rural across federal agencies that impact the ability of researchers using these data to examine variability across rural places. Next, we review studies based upon primary data that include rural residence among their independent variables. We describe different definitions of rural residence across federal agencies with an eye toward their methodological and conceptual impact on the rural aging literature. Then we describe inadequate and incomplete definition and measurement of rural residence across published studies of primary data. Following discussion of the implications of these shortcomings for rural aging research including farmers and others engaged in extractive activities, we discuss the potential for joint work among gerontologists and occupational health researchers to better understand the significance of aging for transition in the agricultural economy and the viability of family farms. We recommend attention to the definition and measurement of rural residence to include variability in rural farm and non-farm populations and refocusing the occupational health literature on aging farmers to include a life course perspective from gerontological theory applied through longitudinal research designs.

Differences in breast self-examination techniques between Caucasian and African American elderly women.

BACKGROUND: The efficacy of breast self-examination (BSE) is controversial, recommendations to women are mixed, and reported differences by race in BSE are contrary to what is expected. We attribute this, in part, to measurement error in studies assessing the effectiveness of BSE. We assess differences by race in self-reported BSE while controlling selected sociodemographic indicators, BSE training, embarrassment, and perceived competence. METHODS: Data are from personal interviews with 1011 women ages 50 and older, with approximately equal numbers of African Americans and Caucasians reporting that they examine their own breasts. RESULTS: African American women are more likely than Caucasians to report examining their breasts visually, whereas Caucasian women are more likely than African Americans to report tactile examination of breast tissue, consistent with recommended BSE procedure. CONCLUSIONS: BSE measures must be multidimensional to detect differences by race to guide interventions promoting self-detection of breast lumps, early presentation, and mortality reduction.

Human genomic DNA analysis using a semi-automated sample preparation, amplification, and electrophoresis separation platform.

The growing importance of analyzing the human genome to detect hereditary and infectious diseases associated with specific DNA sequences has motivated us to develop automated devices to integrate sample preparation, real-time PCR, and microchannel electrophoresis (MCE). In this report, we present results from an optimized compact system capable of processing a raw sample of blood, extracting the DNA, and performing a multiplexed PCR reaction. Finally, an innovative electrophoretic separation was performed on the post-PCR products using a unique MCE system. The sample preparation system extracted and lysed white blood cells (WBC) from whole blood, producing DNA of sufficient quantity and quality for a polymerase chain reaction (PCR). Separation of multiple amplicons was achieved in a microfabricated channel 30 microm x 100 microm in cross section and 85 mm in length filled with a replaceable methyl cellulose matrix operated under denaturing conditions at 50 degrees C. By incorporating fluorescent-labeled primers in the PCR, the amplicons were identified by a two-color (multiplexed) fluorescence detection system. Two base-pair resolution of single-stranded DNA (PCR products) was achieved. We believe that this integrated system provides a unique solution for DNA analysis.

Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa.

BACKGROUND: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN). METHOD: The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies. TREATMENT RECOMMENDATIONS: It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.

A needs assessment of medical school faculty: caring for the caretakers.

INTRODUCTION: We conducted an assessment of need for faculty development and mentoring in a medical school to guide program planning and use of scarce resources. METHODS: A multifaceted approach included semi-structured interviews, nominal group process, and a 36-item questionnaire to reach all faculty in the school, including senior administrators. RESULTS: With a 72% response rate, we validated the questionnaire and, using principal components analysis, identified and prioritized the eight interpretable subdimensions: personal growth, achieving balance, teaching, professional networking, research, administrative skills, career progression, and diversity/ethics. All groups of faculty prioritized learning for sustaining their vitality, balancing their personal and professional lives, finding meaning in their work, relationships, and personal growth. Senior administrators prioritized the following for faculty: time management, an institutional outlook, teamwork, and improved performance in teaching, research, and clinical practice. Junior faculty expressed the need for mentoring, scholarship, research, and career planning. DISCUSSION: Attention to faculty humanistic needs and the disparity between the perceived needs by faculty and senior administrators may help explain the attrition of faculty in academic medicine.

Direct and retrospective assessment of factors contributing to compulsive buying.

Compulsive buying is a disorder that has begun to receive attention from researchers in recent years. The results of a handful of studies suggest that compulsive buying occurs in response to negative emotions and results in a decrease in the intensity of the negative emotions. In this investigation, we used interview and self-monitoring methods to evaluate the antecedents and consequences of compulsive buying in a sample of women who met criteria for compulsive buying on the compulsive buying scale (J. Consumer Res. 19 (1992) 459). As a group, the participants reported negative emotions as the most common antecedents to compulsive buying, and euphoria or relief from the negative emotions as the most common consequence of compulsive buying. These findings were consistent across the interview and self-monitoring assessment methods. The implications for assessment and treatment are discussed.

Impacting cultural attitudes in African-American women to decrease breast cancer mortality.

BACKGROUND: Over the past decade breast cancer mortality has decreased 1% or 2% per year in white women, but not in African-American women. The resulting "mortality gap" is a serious national problem, and it must be a high priority to understand the reasons for it and develop solutions. METHODS: The literature is reviewed to elucidate reasons for the mortality gap and the current status of possible solutions to the problem. In addition, new results of large population-based surveys in North Carolina are presented that may shed light on the problem. RESULTS: The most important reason for the mortality gap is that African-American women tend to be diagnosed with more advanced stage breast cancer than white women. This is due both to lower utilization of screening mammography and to delayed presentation for women with palpable lumps. This is related both to socioeconomic factors that influence access to medical care and to cultural factors that tend to discourage women from seeking care early for breast problems. CONCLUSIONS: Understanding the cultural beliefs that influence patient behavior will greatly aid physicians in caring for their African-American patients, and ultimately may help reduce the racial gap in breast cancer mortality.

The doctor as God's mechanic? Beliefs in the Southeastern United States.

Spiritual practice and beliefs related to healing are described using data from a telephone survey. Questions in the survey address the practice of prayer and spiritual beliefs related to healing. Questions explore belief in miracles, that God acts through religious healers, the importance of God's will in healing, and that God acts through physicians. Questions also ask whether people discuss spiritual concerns with their physician and whether they would want to if seriously ill. We create a composite index to compare religious faith in healing across race, gender, education, income denomination, and health status. Logistic regression predicts types of patients who believe God acts through physicians and those inclined to discuss spiritual concerns when ill. The most important findings are that: 80% of respondents believe God acts through physicians to cure illness, 40% believe God's will is the most important factor in recovery, and spiritual faith in healing is stronger among women. African-Americans, Evangelical Protestants, the poorer, sicker, and less educated. Those who believe that God acts through physicians are more likely to be African-American than White (OR = 1.9) and 55 or older (OR = 3.5). Those who discuss spiritual concerns with a physician are more likely to be female (OR = 1.9) and in poor health (OR = 2.1). Although 69% say they would want to speak to someone about spiritual concerns if seriously ill, only 3% would choose to speak to a physician. We conclude that religious faith in healing is prevalent and strong in the southern United States and that most people believe that God acts through doctors. Knowledge of the phenomena and variation across the population can guide inquiry into the spiritual concerns of patients.

Religious beliefs and breast cancer screening.

BACKGROUND: The mechanisms underlying a reported tendency for women who hold strong religious beliefs to seek medical help at more advanced stages of breast cancer are unknown. This study investigates further the effect of religious beliefs with other variables on breast cancer screening and the intended presentation of a self-discovered breast lump. METHODS: The study included 682 eastern North Carolina women aged 40 and over who were interviewed in their homes about religious and other beliefs about breast cancer, screening, and intended actions with a self-discovered breast lump. RESULTS: Principal components factor analysis results suggested that a majority of women believe that God works through doctors to cure breast cancer. We labeled this dimension "religious intervention with treatment." A minority believed that medical treatment was unnecessary because only God could cure breast cancer. We labeled this dimension "religious intervention in place of treatment." The first dimension correlated with self-reported mammography but not clinical breast examination or women's intention to delay presentation of a self-discovered breast lump. The second dimension, significantly more common in African American women who were less educated and older, correlated strongly with the intention to delay presentation of a self-discovered breast lump. CONCLUSIONS: Belief in "religious intervention in place of treatment" may help to explain why African American women delay presentation of palpable breast lumps, contributing to advanced-stage cancer diagnosis. We suggest that clinicians and clergy work together within the context of religious beliefs to enhance early detection and survival from breast cancer.