Knowledge and beliefs of African-American and American Indian parents and supporters about infant safe sleep.

To investigate, by using qualitative methods, beliefs among African-American and American Indian families about infant safe sleep practices, barriers to acceptance of prevention recommendations, and more effective messaging strategies. Seventy-three mothers and supporters participated in focus groups. Participants discussed infant sleep practices and effectiveness of safe sleep messages. Data were coded, and themes were developed and revised in an iterative manner as patterns became more apparent. Themes included reasons for and influences on sleep decisions, and concerns about safe sleep recommendations. Parental sleep decisions seemed to be driven by perceptions of what would make their infant most comfortable and safe, and what would be most convenient. Parents were aware of safe sleep recommendations but unaware of the rationale. Because they generally did not believe that their infants were at risk for a sleep-related death, day-to-day decisions seemed to focus on what was most effective in getting their infant to sleep. There appeared to be no distinctions in opinions among African-American and American Indian families. African-American and American Indian families seemed to have similar concerns about infant comfort and safety, and their perceptions about what would be most effective in achieving these goals appeared to be important influences on their sleep practices. Adherence with safe sleep recommendations may be enhanced if health care providers and educational materials discussed rationale underlying recommendations and addressed common parental concerns. It may be beneficial to target educational interventions towards fathers, as they may be untapped sources in implementing safe sleep practices.

Identification of alternative transcripts of rat CD9 expressed by tumorigenic neural cell lines and in normal tissues.

CD9 is the best-studied member of the tetraspanin family of transmembrane proteins. It is involved in various fundamental cellular processes and its altered expression is a characteristic of malignant cells of different origins. Despite numerous investigations confirming its fundamental role, the heterogeneity of CD9 or other tetraspanin proteins was considered only to be caused by posttranslational modification, rather than alternative splicing. Here we describe the first identification of CD9 transcript variants expressed by cell lines derived from fetal rat brain cells. Variant mRNA-B lacks a potential translation initiation codon in the alternative exon 1 and seems to be characteristic of the tumorigenic BT cell lines. In contrast, variant mRNA-C can be translated from a functional initiation codon located in its extended exon 2, and substantial amounts of this form detected in various tissues suggest a contribution to CD9 functions. From the alternative sequence of variant C, a different membrane topology (5 transmembrane domains) and a deviating spectrum of functions can be expected.

Medium-sized deletion in the BRCA1 gene: Limitations of Sanger sequencing and MLPA analyses.

We describe a family with a history of breast and ovarian cancer in which MLPA analysis of the BRCA1 gene pointed to a deletion including a part of exon 11. Further characterization confirmed a loss of 374 bp in a region completely covered by conventional sequencing which had not revealed the deletion. Because this alteration was only detected serendipitously with an MLPA probe, we calculated the probabilities of detecting medium-sized deletions in large exons by methods including initial PCR amplification. This showed that a considerable fraction of medium-sized deletions are undetectable by currently used standard methods of mutation analyses. We conclude that long, widely overlapping amplicons should be used to minimize the risk of missing medium-sized deletions. Alternatively, large exons could be completely covered by narrow-spaced MLPA probes.

Medium-sized deletion in the BRCA1 gene: limitations of Sanger sequencing and MLPA analyses

We describe a family with a history of breast and ovarian cancer in which MLPA analysis of the BRCA1 gene pointed to a deletion including a part of exon 11. Further characterization confirmed a loss of 374 bp in a region completely covered by conventional sequencing which had not revealed the deletion. Because this alteration was only detected serendipitously with an MLPA probe, we calculated the probabilities of detecting medium-sized deletions in large exons by methods including initial PCR amplification. This showed that a considerable fraction of medium-sized deletions are undetectable by currently used standard methods of mutation analyses. We conclude that long, widely overlapping amplicons should be used to minimize the risk of missing medium-sized deletions. Alternatively, large exons could be completely covered by narrow-spaced MLPA probes.

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.

Translating infant safe sleep evidence into nursing practice.

The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals. An approach was developed for creating sustainable change in nursing practice by implementing nursing practice policies that could be monitored through quality improvement processes already established within the hospital organization. Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.

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.

Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students.

A cross-sectional survey was designed to assess interest in geriatric medicine of allopathic and osteopathic medical students and to determine whether their career interests were related to past experiences with and current attitudes toward older adults. The study was conducted at an allopathic and osteopathic medical school with 231 first-year medical students. Experiences with elderly people were measured using survey questions assessing amount and quality of experiences with grandparents, as well as experiences caring for, volunteering with, or having a paid position working with older adults. Attitudes were measured using the University of California at Los Angeles Geriatric Attitudes Scale, revised for applicability to medical students. Interest in geriatrics was measured using a 4-point scale. Overall, students expressed positive attitudes toward older adults. Past experiences, including positive relationships with older relatives (P<.001) and experiences providing care for older adults (P<.001), were related to more-positive attitude scores toward elderly people. Students had low interest in geriatric medicine, but those with more-positive attitudes were more likely to consider geriatrics as a career (odds ratio=8.18, P<.001). Furthermore, having prior experience caring for older persons increased interest in the field (P=.001). No significant differences were found between allopathic and osteopathic student interest in geriatrics or attitudes toward older adults. Efforts toward increasing the pool of future geriatricians and increasing positive attitudes toward older patients could be improved by providing quality experiences caring for and interacting with older adults before medical school training.

Sense of community in clubhouse programs: member and staff concepts.

Psychological sense of community within psychosocial rehabilitation clubhouse programs was examined using concept mapping with 18 members and 18 staff from 10 programs. Members identified four concepts: Recovery, social connections, membership, and tasks and roles. Members described hope and healing as aspects of recovery. Members' views on sense of community focused on the rehabilitation and social nature of the program. Staff also identified four concepts: Affiliation and support for members, shared experiences, clubhouse organization, and task and roles. The staff concept of clubhouse organization, which incorporated the ideas of leadership and organization of physical space and the concept of task and roles, was based on ideas of shared responsibility and clubhouse procedures. Staffs' views on sense of community strongly reflected their formal training in clubhouse principles. The relation of these concepts to McMillan and Chavis' theoretical framework for sense of community is discussed and recommendations for practice provided.

Involvement in 12-step programs among persons with dual diagnoses.

Although many people with substance use problems are referred to Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), few studies have examined characteristics of persons who comply with such referrals. In particular, little is known about self-help meeting attendance by persons with dual diagnoses. This study examined rates of AA and NA attendance among 351 persons with dual diagnoses who were treated in a hospital setting. It also explored the relationship between diagnosis and meeting attendance. Ten months after hospitalization, the study participants demonstrated rates of AA or NA attendance that were similar to those of persons who were diagnosed as having substance use disorders without severe mental illness. However, patients with schizophrenia or schizoaffective disorders reported significantly fewer days of AA or NA meeting attendance.