Impairment of aryl hydrocarbon receptor signalling promotes hepatic disorders in cancer cachexia.

BACKGROUND: The aryl hydrocarbon receptor (AHR) is expressed in the intestine and liver, where it has pleiotropic functions and target genes. This study aims to explore the potential implication of AHR in cancer cachexia, an inflammatory and metabolic syndrome contributing to cancer death. Specifically, we tested the hypothesis that targeting AHR can alleviate cachectic features, particularly through the gut-liver axis. METHODS: AHR pathways were explored in multiple tissues from four experimental mouse models of cancer cachexia (C26, BaF3, MC38 and APCMin/+ ) and from non-cachectic mice (sham-injected mice and non-cachexia-inducing [NC26] tumour-bearing mice), as well as in liver biopsies from cancer patients. Cachectic mice were treated with an AHR agonist (6-formylindolo(3,2-b)carbazole [FICZ]) or an antibody neutralizing interleukin-6 (IL-6). Key mechanisms were validated in vitro on HepG2 cells. RESULTS: AHR activation, reflected by the expression of Cyp1a1 and Cyp1a2, two major AHR target genes, was deeply reduced in all models (C26 and BaF3, P < 0.001; MC38 and APCMin/+ , P < 0.05) independently of anorexia. This reduction occurred early in the liver (P < 0.001; before the onset of cachexia), compared to the ileum and skeletal muscle (P < 0.01; pre-cachexia stage), and was intrinsically related to cachexia (C26 vs. NC26, P < 0.001). We demonstrate a differential modulation of AHR activation in the liver (through the IL-6/hypoxia-inducing factor 1α pathway) compared to the ileum (attributed to the decreased levels of indolic AHR ligands, P < 0.001), and the muscle. In cachectic mice, FICZ treatment reduced hepatic inflammation: expression of cytokines (Ccl2, P = 0.005; Cxcl2, P = 0.018; Il1b, P = 0.088) with similar trends at the protein levels, expression of genes involved in the acute-phase response (Apcs, P = 0.040; Saa1, P = 0.002; Saa2, P = 0.039; Alb, P = 0.003), macrophage activation (Cd68, P = 0.038) and extracellular matrix remodelling (Fga, P = 0.008; Pcolce, P = 0.025; Timp1, P = 0.003). We observed a decrease in blood glucose in cachectic mice (P < 0.0001), which was also improved by FICZ treatment (P = 0.026) through hepatic transcriptional promotion of a key marker of gluconeogenesis, namely, G6pc (C26 vs. C26 + FICZ, P = 0.029). Strikingly, these benefits on glycaemic disorders occurred independently of an amelioration of the gut barrier dysfunction. In cancer patients, the hepatic expression of G6pc was correlated to Cyp1a1 (Spearman's ρ = 0.52, P = 0.089) and Cyp1a2 (Spearman's ρ = 0.67, P = 0.020). CONCLUSIONS: With this set of studies, we demonstrate that impairment of AHR signalling contributes to hepatic inflammatory and metabolic disorders characterizing cancer cachexia, paving the way for innovative therapeutic strategies in this context.

A Single Dose of Oral ATP Supplementation Improves Performance and Physiological Response During Lower Body Resistance Exercise in Recreational Resistance-Trained Males.

Freitas, MC, Cholewa, JM, Gerosa-Neto, J, Gonçalves, DC, Caperuto, EC, Lira, FS, and Rossi, FE. A single dose of oral ATP supplementation improves performance and physiological response during lower body resistance exercise in recreational resistance-trained males. J Strength Cond Res 33(12): 3345-3352, 2019-The aim of this study was to investigate the acute effect of adenosine-5'-triphosphate (ATP) supplementation on performance and physiological responses during resistance exercise in recreationally resistance-trained males. Eleven men (age = 27.5 ± 5.5 years, mass = 83.4 ± 9.8 kg, height = 182 ± 0.04 cm) completed 2 randomized, double-blind trials: ATP supplement condition (ATP = 400 mg) or a placebo condition. Thirty minutes after supplement consumption, subjects performed 4 sets of half-squats until momentary muscular failure at 80% of the 1 repetition maximum with 2 minutes of recovery between sets. The total number of repetitions, blood pressure, heart rate, blood lactate, and oxygen consumption were evaluated. The total weight lifted were higher for the ATP condition compared with placebo (Placebo = 3,995.7 ± 1,137.8, ATP = 4,967.4 ± 1,497.9 kg; p = 0.005). Heart rate was higher at set-4 for ATP compared with placebo (p < 0.001) and oxygen consumption during exercise was greater for ATP (p = 0.021). There were no differences between conditions for lactate and blood pressure. In summary, a single oral dose of ATP supplementation improved lower-body resistance training performance and energy expenditure in recreational resistance-trained males.

Reverse Cholesterol Transport: Molecular Mechanisms and the Non-medical Approach to Enhance HDL Cholesterol.

Dyslipidemia (high concentrations of LDL-c and low concentrations of HDL-c) is a major cause of cardiovascular events, which are the leading cause of death in the world. On the other hand, nutrition and regular exercise can be an interesting strategy to modulate lipid profile, acting as prevention or treatment, inhibiting the risk of diseases due to its anti-inflammatory and anti-atherogenic characteristics. Additionally, the possibility of controlling different training variables, such as type, intensity and recovery interval, can be used to maximize the benefits of exercise in promoting cardiovascular health. However, the mechanisms by which exercise and nutrients act in the regulation of cholesterol and its fractions, such as reverse cholesterol transport, receptors and transcription factors involved, such as PPARs and their role related to exercise, deserve further discussion. Therefore, the objective of this review is to debate about non-medical approaches to increase HDL-c, such as nutritional and training strategies, and to discuss the central mechanisms involved in the modulation of lipid profile during exercise, as well as that can be controlled by physical trainers or sports specialists in attempt to maximize the benefits promoted by exercise. The search for papers was performed in the databases: Medline (Pubmed), Science Direct, Scopus, Sport Discus, Web of Science, Scielo and Lilacs until February 2016.

Acute Capsaicin Supplementation Improves Resistance Training Performance in Trained Men.

Conrado de Freitas, M, Cholewa, JM, Freire, RV, Carmo, BA, Bottan, J, Bratfich, M, Della Bandeira, MP, Gonçalves, DC, Caperuto, EC, Lira, FS, and Rossi, FE. Acute capsaicin supplementation improves resistance training performance in trained men. J Strength Cond Res 32(8): 2227-2232, 2018-The purpose of this study was to investigate the acute effect of capsaicin supplementation on performance, rate of perceived exertion (RPE), and blood lactate concentrations during resistance exercise in healthy trained young men. Ten resistance-trained men (age = 22.7 ± 4.0 years, mass = 82.3 ± 9.6 kg, and height = 175 ± 0.1 cm) completed 2 randomized, double-blind trials: capsaicin condition (12 mg) or a placebo condition. Forty-five minutes after supplement consumption, subjects performed 4 sets until movement failure in the squat exercise at 70% of 1 repetition maximum with 90 seconds of rest interval between sets. The total mass lifted (total repetitions × mass lifted) was calculated. The RPE was recorded after the last set. Blood lactate was analyzed after each set of exercise, immediately postexercise, and after 3, 5, and at 30 minutes during recovery. The number of repetitions in each set decreased significantly after all sets compared with set-1 and after set-3 and set-4 in relation to set-2 (p < 0.001); however, total mass lifted was higher in capsaicin compared with placebo (3,919.4 ± 1,227.4 kg vs. 3,179.6 ± 942.4 kg, p = 0.002). Blood lactate increased significantly after each set (p < 0.001); however, there were no differences between conditions. Rate of perceived exertion was significantly less for the capsaicin condition than placebo (17.2 ± 1.0 vs. 18.3 ± 1.7, p = 0.048). In summary, acute capsaicin supplementation improves lower-body resistance training performance in trained young men.

Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments.

BACKGROUND: Despite the enormous potential for adverse events in primary care, the knowledge base about patient safety in this context is still sparse. The lack of appropriate measurement methods is a key factor limiting the development of research in this field. OBJECTIVE: To identify and characterize available patient reported instruments to measure patient safety in primary care. METHODS: We conducted a systematic literature review. We searched in bibliographic sources for empirical studies describing the development, evaluation or use of patient reported instruments assessing patient safety in primary care. Study selection and data extraction were independently conducted by two researchers. RESULTS: We identified 28 studies reporting on 23 different instruments. Fifteen instruments were designed for paper-based self-administration, six for phone interview and two consisted in electronic reporting systems. Most instruments focused on specific aspects of patient safety, most commonly on experiences of adverse drug reactions. Face validity was assessed for 10 instruments (43%), three reported construct validity (13%) and three described reliability (13%). Responsiveness was not ascertained. CONCLUSIONS: Although there is evidence of good psychometric properties for a reduced number of patient reported instruments, currently available instruments do not offer a comprehensive set of resources to measure the effects of interventions to improve patient safety in primary care from a patient perspective. Future research in the field should prioritize (i) the evaluation of the performance of already available instruments and (ii) the development of new instruments that enable an comprehensive assessment of patient safety at general practices.

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression.

BACKGROUND: It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs' characteristics associated with greater success. METHODS: We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies. RESULTS: We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated. CONCLUSIONS: Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.

The use of healthcare services for mental health problems by middle-aged and older adults.

Although mental disorders occur commonly in later life, it has been reported that older adults are reluctant to seek help for their mental health problems. The purpose of this research study was to analyze the contact with healthcare professionals, self-perceived mental health problems and unmet needs, as reported by a nationally representative sample of community-dwelling adults. We report a cross-sectional analysis of all the respondents of the Australian National Survey of Mental Health and Wellbeing aged 55 years and older (N=3178). Results indicated that 306 (9.6%) participants had a DSM-IV classifiable mental disorder based on self-identified symptoms over the preceding 12 months. Of these, 146 (48%) reported that they had not consulted a healthcare professional to deal with their mental health problems. Among those who consulted with a healthcare professional, the general practitioner was the main point of contact. Medication and psychotherapy/counseling were the most frequent form of help obtained. Informational and instrumental help, such as help to sort out practical problems and to look after oneself, were the most reported unmet needs. These results suggest a gap in the provision of healthcare services for mental health problems directed toward the specific needs of aging adults. The reported unmet needs might be met by increasing awareness amongst healthcare professionals regarding mental health problems in later stages of life and by improving the access of older people to the services commonly provided by multidisciplinary teams.

Improving diabetes care in rural areas: a systematic review and meta-analysis of quality improvement interventions in OECD countries.

BACKGROUND AND AIMS: Despite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success. METHODS: We conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis. RESULTS: Twenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%). CONCLUSIONS: This work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.

Who worries most? Worry prevalence and patterns across the lifespan.

OBJECTIVE: To examine the age-related worry patterns in a population-based sample of self-reported worriers. METHODS: The National Survey of Mental Health and Well-Being is a multistage stratified epidemiologic survey of mental health conducted in Australia in 2007. Participants were surveyed using the Composite International Diagnostic Interview. All participants who reported a period of pervasive worry were included in this study (N = 3735, 16-85 years of age, 61% female). RESULTS: Compared with younger adults (16-29 years of age; N = 860), older adults (65-85 years of age; N = 639) reported fewer worries [odds ratio (OR) = 0.36, p < 0.01] and a lower likelihood of worrying about interpersonal relations (OR = 0.66, p < 0.01), health (OR = 0.65, p < 0.05), work (OR = 0.39, p < 0.01), and miscellaneous topics (OR = 0.57, p < 0.01), but a higher likelihood of worrying about the health and welfare of loved ones (OR = 2.46, p < 0.01) after adjusting for socio-demographic and clinical factors. Similar patterns were seen in older persons with and without a lifetime history of generalized anxiety disorder as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders. CONCLUSIONS: The findings indicated an overall decrease in worry count with advancing age, as well as a developmental distribution of worry content, and a quantitative but not qualitative distinction between normal and pathological worriers. Overall, these findings might contribute to the understanding of worry processes and the phenomenology of generalized anxiety disorder in older cohorts.

Interventions for generalized anxiety disorder in older adults: systematic review and meta-analysis.

INTRODUCTION: Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in later life, with widespread consequences for individuals and society. OBJECTIVE: To perform a systematic review of the efficacy of controlled interventions for GAD in adults aged 55 years and older. METHOD: Direct search of digital databases and the main publications on aging and iterative searches of the references from retrieved articles. RESULTS: Twenty-seven trials (14 pharmacological, 13 psychotherapeutic) fulfilled the inclusion criteria, reporting results from 2373 baseline participants. There were no differences between trials in their overall quality. Pooled treatment effects for pharmacological (OR=0.32, 95% CI: 0.18, 0.54) and psychotherapeutic (OR=0.33, 95% CI: 0.17, 0.66) trials were similar, with findings in each case favoring active interventions over control conditions. CONCLUSIONS: Older adults with GAD benefited from both pharmacological and psychotherapeutic interventions. Future studies should investigate combined treatment with medication and psychotherapy.

Sooner or later: age at onset of generalized anxiety disorder in older adults.

BACKGROUND: Generalized anxiety disorder (GAD) is a common disorder in older adults, with widespread and long-lasting consequences. In this study, we assessed the characteristics associated with lifetime GAD in community-dwelling adults according to their age at onset of the disorder. METHODS: Study sample was extracted from the 2007 National Survey of Mental Health and Well Being, a nationally representative cross-sectional survey that interviewed 8,841 Australians aged between 16 and 85 years using the Composite International Diagnostic Interview. Of the 3,178 participants aged 55-85 years, there were 227 (M = 63.7 years; 65% female) with a lifetime diagnosis of GAD who were the focus of our analyses. RESULTS: Age at onset was defined as early (<26 years) or late (≥ 26 years), based on the median age at onset for the entire sample. The weighted prevalence estimates for 12-month and lifetime GAD were 2.8% (95% CI: 2.0, 3.7) and 7.0% (95% CI: 5.7, 8.3), respectively, with less than one-tenth of the participants being diagnosed after the age of 60 years. Having the first GAD episode earlier in life was significantly associated with physical abuse during childhood (OR = 0.34, 95% CI: 0.16, 0.75), lifetime diagnosis of dysthymia (OR = 0.34, 95% CI: 0.18, 0.67), and number of GAD episodes (OR = 0.29, 95% CI: 0.14, 0.58), after adjusting for current age and 12-month GAD. CONCLUSION: In older adults, an earlier age at onset of GAD was associated with childhood physical abuse and worse clinical outcomes, thus appearing to be a marker for increased vulnerability to GAD.

Prevalence and correlates of generalized anxiety disorder among older adults in the Australian National Survey of Mental Health and Well-Being.

BACKGROUND: Generalized anxiety disorder (GAD) occurs commonly, with widespread consequences including decreased functioning and wellbeing, and increased consumption of health resources. Notwithstanding its prevalence and impact, knowledge about GAD in older adults is still scarce. Accordingly, the main goals of this study were to estimate the prevalence and analyze the correlates of 12-month DSM-IV GAD in older community-residing adults. METHODS: The sample was drawn from the 2007 Australian National Survey of Mental Health and Well-Being and consisted of 3035 participants aged between 55 and 85years, assessed by lay interviewers with the fully-structured Composite International Diagnostic Interview. RESULTS: Eighty-four participants were diagnosed with GAD, equivalent to a weighted 12-month population prevalence of 2.8% (95% CI: 2.0, 3.7). In a multivariate logistic regression model older age (OR=0.24, p=0.006), functional limitations (OR=1.07, p=0.001), lifetime depression comorbidity (OR=5.31, p<0.001), concerns about having a serious illness despite doctor's reassurance (OR=2.29, p=0.021), and family history of anxiety or depression (OR=2.41, p=0.007) were the most significant predictors of 12-month GAD in older adults. LIMITATIONS: This was a cross sectional study, limiting causal inferences. CONCLUSIONS: In community-residing older adults GAD is highly prevalent and strongly associated with functional limitations, psychiatric comorbidity and increased medication intake. These findings suggest the need for greater clinical awareness of GAD among older adults.

Case finding in dementia: comparative utility of three brief instruments in the memory clinic setting.

BACKGROUND: The principal goal of this study was to compare the diagnostic accuracy of three brief instruments in memory clinic attendees. Two of the instruments were based on face-to-face clinical assessment (Standardized Mini-mental State Examination and Rowland Universal Dementia Assessment Scale), whereas the third group used proxy information from an informant (Informant Questionnaire on Cognitive Decline in the Elderly). Dementia diagnosis as provided by a specialist physician (geriatrician, psychiatrist or neurologist) was used as the reference standard. METHODS: This was a cross-sectional study. Data were collected from 204 consecutive memory clinic attendees (M = 76.90, 56% female) and their family caregivers. Comparative utility was assessed through receiver operating characteristic (ROC) analyses. RESULTS: One hundred and fifty-two patients (75%) were diagnosed as having dementia. Diagnostic accuracy, as indicated by the area under the ROC curve (AUC), was similar for the three instruments as follows: SMMSE (AUC = 0.82, 95% CI = 0.76, 0.87, p < 0.0001) and RUDAS (AUC = 0.83, 95% CI = 0.77, 0.88, p < 0.0001), and slightly lower for IQCODE (AUC = 0.77, 95% CI = 0.71, 0.83, p < 0.0001). There was no significant difference between the areas under the curve (χ2 = 2.57, df = 2, p = 0.28). CONCLUSIONS: Diagnostic accuracy was similar for the three instruments, which all proved to be moderately useful tools for initial screening for cognitive impairment in the memory clinic environment. Being a proxy measure, the IQCODE had specific practical use in this context, where the patient might not be able to provide information. The RUDAS exhibited high specificity and proved to be less dependent upon cultural factors than the SMMSE, making it particularly valuable in a multicultural setting.

Attitudes, knowledge, and interest: preparing university students to work in an aging world.

BACKGROUND: The underlying goals of the present study were (i) to assess knowledge of and attitudes towards aging in a sample of Portuguese undergraduate students undertaking various degrees in health and welfare subjects, and (ii) to analyze the extent to which knowledge, attitudes and other factors were associated with interest in working with older adults. METHODS: The study was cross-sectional in design. The sample comprised 460 Portuguese undergraduate students enrolled in degrees in nursing, social work, and psychology. They were asked to complete questionnaires and quizzes, which were analyzed using contingency tables and one way analysis of variance for inter-group comparison, and then subjected to multivariate logistic regression analysis. RESULTS: Significant differences emerged between groups on knowledge, attitudes towards aging and interest in working with older adults, with both nursing and social work students displaying more positive attitudes, knowledge, and interest in working with older adults, when compared with psychology students. A regression analysis indicated that attitudes, knowledge, and previous formal contact were significant predictors of interest. CONCLUSION: Interest in working with older adults was significantly related to positive attitudes, more knowledge and formal previous contact. Positive attitudes towards older adults can be promoted through interaction with faculty members and experts, knowledge acquisition about normative changes with age, and contact with healthy and impaired older adults.

Conjugated Linoleic Acid: good or bad nutrient.

Conjugated linoleic acid (CLA) is a class of 28 positional and geometric isomers of linoleic acid octadecadienoic.Currently, it has been described many benefits related to the supplementation of CLA in animals and humans, as in the treatment of cancer, oxidative stress, in atherosclerosis, in bone formation and composition in obesity, in diabetes and the immune system. However, our results show that, CLA appears to be not a good supplement in patients with cachexia.

Psychometric properties of the Reminiscence Functions Scale for the Portuguese population: a preliminary report.

The aim of the present study was to assess the psychometric properties of a version in Portuguese of the Reminiscence Functions Scale. Total sample was composed of 628 participants aged between 18 and 92 years, divided into three groups according to their age (18-24 years, n = 249; 26-54 years, n = 174; 55 and older, n = 205). Results indicated a five-factor solution for the Portuguese version of the Reminiscence Functions Scale, which accounted for 54% of the variance with good internal consistency (mean alpha = 0.86). Age and gender differences emerged regarding reminiscence functions. These results demonstrate that, while significant cultural differences exist, the psychometric properties of the Reminiscence Functions Scale are adequate for the Portuguese population.

Working family carers in Portugal: between the duty and the burden of caring for old vulnerable people.

This paper intends to reflect on some of the predominant traits of caring for older vulnerable people in Portugal, where the most common care model is a mix of informal home-based provision and support from the public and private sectors. We shall address some issues concerning the risks and limits of informal caretaking of older dependent people based on a case study of a woman who has to fulfil multiple roles, pushing her to the limit of her ability to cope. Evidence indicates that solutions to the challenges of caring for an ageing population, especially those in a vulnerable condition, require a consideration of material, social, cultural, and psychological measures. On the basis of the nature of the links between these areas, the quality of the care provided and the consequences for the working family carers, we can define standards of caring solutions for older people and hence derive policies for preventive and optimized interventions. Our final aim is to emphasize the importance of palliative care settings to improve the quality of life and minimize the suffering of both older people and their carers.

Comparative use of complementary medicine, allied health, and manual therapies by middle-aged and older Australian women.

We compared use of Complementary and Alternative Medicines (CAM) and therapies, Allied Health interventions (AH), and Manual Therapies (MT) in middle-aged and older Australian women. Cross-sectional data from the 2007 phase of the Longitudinal study of Aging in Women (LAW study) was analyzed. Self-reported 12-month usage patterns of CAM, AH, and MT were determined by mailed questionnaire. Results revealed that 56.2% of the middle-aged group, and 55.0% of the older group used CAM, AH, and MT services in the previous 12 months (a nonsignificant difference). In contrast, there was a highly significant difference between the overall use of CAM products by middle-aged women (88.2%) and older women (67.7%: p = .002).

Specific phobias in older adults: characteristics and differential diagnosis.

BACKGROUND: Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. METHODS: A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. RESULTS: Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. CONCLUSIONS: First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.