Alzheimer's Disease and Related Dementias in Muslim Women: Recommendations for Culturally Sensitive Care.

Alzheimer's disease and related dementias (ADRD) present significant challenges including cognitive and functional loss, behavioral disruption, emotional distress, and significant financial burden. These stressors are amplified in minority groups, who experience higher rates of ADRD but less frequent and later diagnosis. There is therefore a critical need to identify tangible approaches to culturally informed dementia assessment and care for patients from diverse communities. Muslim patients and particularly Muslim women are among the populations most understudied in the ADRD space. Muslim patients may hold unique religious, spiritual, and cultural beliefs and practices that can impact care-seeking for dementia symptoms, diagnostic accuracy, and treatment uptake. This paper outlines culturally informed approaches to assessing and treating Muslim women and families at each stage of ADRD care, though many recommendations extend to the broader Muslim community and others of diverse racial-ethnic backgrounds. We provide concrete suggestions for building rapport within and leveraging common family structures, respecting principles of modesty and privacy for all women including those who observe hijab or niqab, and communicating dementia diagnosis and care in the context of spiritual and ethical beliefs. While not intended as a comprehensive and prescriptive guide, this review provides important points of consideration and discussion with patients of Muslim backgrounds.

Healthcare utilization and behavior changes following workplace genetic testing at a large U.S. healthcare system.

PURPOSE: This study explored employee health behavior changes and healthcare utilization following workplace genetic testing (wGT). Wellness program-associated wGT seeks to improve employee health, but related health implications are unknown. METHODS: Employees of a large U.S. healthcare system offering wGT (cancer, heart disease, and pharmacogenomics - PGx) were sent electronic surveys. Self-reported data from those who received test results were analyzed. Descriptive statistics characterized responses, while logistic regression analyses explored correlates of responses to wGT. RESULTS: 53.9% (n=418/776) of respondents (88.3% female, mean age = 44 years) reported receiving wGT results. 12.0% (n=48/399) received results indicating increased risk (IR) of cancer, 9.5% (n=38/398) had IR of heart disease, and 31.4% (n=125/398) received informative PGx results. IR results for cancer and/or heart disease (n=67) were associated with health behavior changes (aOR 3.23; 95% CI 1.75, 6.13; p<0.001) and healthcare utilization (aOR 8.60; 95% CI 4.43, 17.5; p<0.001). Informative PGx results (n=125) were associated with medication changes (PGx - informative: 15.2%; PGx - uninformative: 4.8%; p=0.002). CONCLUSION: This study explored employee responses to wGT, contributing to the understanding of the ethical and social implications of wGT. Receiving IR results from wGT may promote health behavior changes and healthcare utilization in employees.

Evaluation of the Uniform Data Set version 3 teleneuropsychological measures.

OBJECTIVE: Few studies have evaluated in-home teleneuropsychological (teleNP) assessment and none, to our knowledge, has evaluated the National Alzheimer's Coordinating Center's (NACC) Uniform Data Set version 3 tele-adapted test battery (UDS v3.0 t-cog). The current study evaluates the reliability of the in-home UDS v3.0 t-cog with a prior in-person UDS v3.0 evaluation. METHOD: One hundred and eighty-one cognitively unimpaired or cognitively impaired participants from a longitudinal study of memory and aging completed an in-person UDS v3.0 and a subsequent UDS v3.0 t-cog evaluation (∼16 months apart) administered either via video conference (n = 122) or telephone (n = 59). RESULTS: We calculated intraclass correlation coefficients (ICCs) between each time point for the entire sample. ICCs ranged widely (0.01-0.79) but were generally indicative of "moderate" (i.e., ICCs ranging from 0.5-0.75) to "good" (i.e., ICCs ranging from 0.75-0.90) agreement. Comparable ICCs were evident when looking only at those with stable diagnoses. However, relatively stronger ICCs (Range: 0.35-0.87) were found between similarly timed in-person UDS v3.0 evaluations. CONCLUSIONS: Our findings suggest that most tests on the UDS v3.0 t-cog battery may serve as a viable alternative to its in-person counterpart, though reliability may be attenuated relative to the traditional in-person format. More tightly controlled studies are needed to better establish the reliability of these measures.

A Parent-focused Child Sexual Abuse Prevention Program: Development, Acceptability, and Feasibility.

OBJECTIVES: Child sexual abuse (CSA) affects nearly 60,000 children in the U.S. annually. Although prevention efforts targeting adults in the community and school-aged children have been somewhat successful, there is a clear gap in the current prevention efforts: parents. Generalized parent-education (PE) programs have effectively reduced the rates of physical abuse and neglect; however, currently no PE program targets risk factors for CSA specifically. We sought to develop a brief module to be added onto existing PE programs thereby leveraging the skills and implementation infrastructure to ensure sustainability. METHODS: In three phases, we developed the curriculum, refined content and presentation while simultaneously developing and psychometrically evaluating a measurement tool, and conducted an acceptability and feasibility pilot. These phases are described in detail such that intervention scientists wishing to develop a module to be added onto existing programs can follow our procedures. RESULTS: The results of each phase are described so that the reader can see how information gleaned in one part of a phase informed subsequent phases of research. This was an iterative process of development, refinement, and piloting. CONCLUSIONS: The resultant module is designed to be added onto extant evidence-based PE programs. The module, and the additive approach of the intervention, will be evaluated in a future randomized controlled trial.

Is Sexual Abuse a Unique Predictor of Sexual Risk Behaviors, Pregnancy, and Motherhood in Adolescence?

This study tested sexual abuse as a unique predictor of subsequent adolescent sexual behaviors, pregnancy, and motherhood when in company with other types of maltreatment (physical abuse, neglect) and alternative behavioral, family, and contextual risk factors in a prospective, longitudinal study of maltreated (n = 275) and comparison (n = 239) nulliparous females aged 14-19 years old assessed annually through 19 years old. Hierarchical regression was used to disentangle risk factors that account for the associations of maltreatment type on risky sexual behaviors at 19 years old, adolescent pregnancy, and adolescent motherhood. Findings indicate that sexual and physical abuse remain significant predictors of risky sexual behaviors, and that sexual abuse remains a significant predictor of adolescent motherhood when alternative explanatory variables are controlled.

Cognitions about infant sleep: Interparental differences, trajectories across the first year, and coparenting quality.

This study examined mothers' and fathers' beliefs about responding to infant night wakings across the first year of life, changes in those beliefs, and how individual maternal and paternal beliefs and interparental discrepancy in beliefs about responding to infant night wakings related to parents' perceptions of coparenting quality. Participants were 167 mothers and 155 fathers who reported on their own beliefs about responding to infant night wakings and perceptions of coparenting quality when infants were 1, 3, 6, 9, and 12 months old. As predicted, mothers endorsed stronger beliefs about responding more immediately to infant night wakings than fathers, but for both parents these beliefs declined over the first year. Troubled beliefs about responding to infant night wakings predicted worse coparenting quality. In addition, the discrepancy between mothers' and fathers' beliefs predicted coparenting quality such that a larger discrepancy in parents' beliefs about responding to infant night wakings significantly predicted poorer perceptions of coparenting, particularly in the early months, but only when mothers endorsed stronger beliefs than fathers. Results emphasize the importance of communication and concordance in nighttime parenting practices for aspects of parents' coparenting relationship. Future research should consider the importance of examining domain-specific parenting practices and cognitions as well as interparental discrepancies when assessing coparenting quality. (PsycINFO Database Record