Midazolam Ameliorates Hyperglycemia-Induced Glomerular Endothelial Dysfunction by Inhibiting Transglutaminase 2 in Diabetes.

Midazolam is an anesthetic widely used for anxiolysis and sedation; however, to date, a possible role for midazolam in diabetic kidney disease remains unknown. Here, we investigated the effect of midazolam on hyperglycemia-induced glomerular endothelial dysfunction and elucidated its mechanism of action in kidneys of diabetic mice and human glomerular microvascular endothelial cells (HGECs). We found that, in diabetic mice, subcutaneous midazolam treatment for 6 weeks attenuated hyperglycemia-induced elevation in urine albumin/creatinine ratios. It also ameliorated hyperglycemia-induced adherens junction disruption and subsequent microvascular leakage in glomeruli of diabetic mice. In HGECs, midazolam suppressed high glucose-induced vascular endothelial-cadherin disruption and endothelial cell permeability via inhibition of intracellular Ca2+ elevation and subsequent generation of reactive oxygen species (ROS) and transglutaminase 2 (TGase2) activation. Notably, midazolam also suppressed hyperglycemia-induced ROS generation and TGase2 activation in glomeruli of diabetic mice and markedly improved pathological alterations in glomerular ultrastructure in these animals. Analysis of kidneys from diabetic Tgm2-/- mice further revealed that TGase2 played a critical role in microvascular leakage. Overall, our findings indicate that midazolam ameliorates hyperglycemia-induced glomerular endothelial dysfunction by inhibiting ROS-mediated activation of TGase2.

Factors affecting high-grade hepatotoxicity of tyrosine kinase inhibitors in cancer patients: a multi-center observational study.

PURPOSE: Although several studies have examined tyrosine kinase inhibitor (TKI)-induced hepatotoxicity, the majority of patients in those studies displayed low-grade (grade I-II) hepatotoxicity. The purpose of this study was to investigate factors affecting high-grade (grade III-IV) hepatotoxicity of TKIs. METHODS: This multi-center, retrospective study used individual patient data from five studies that examined factors affecting hepatotoxicity by TKIs (crizotinib, erlotinib, gefitinib, imatinib, and lapatinib). Odds ratio (OR) and adjusted OR (AOR) were estimated from univariate and multivariate analyses, respectively. RESULTS: Data from 1279 patients treated with TKIs were analyzed. The rate of patients who experienced high-grade hepatotoxicity after TKI administration was 5.5%. In multivariable analysis, H2 blockers and CYP3A4 inducers increased high-grade hepatotoxicity 2.2- (95% CI 1.255-3.944) and 3.3-fold (95% CI 1.260-8.698), respectively. Patients with liver metastasis revealed a 3.4-fold (95% CI 1.561-7.466) higher risk of high-grade hepatotoxicity. Among underlying malignancies, pancreatic cancer and other cancers including acute lymphoblastic leukemia increased the risk of high-grade hepatotoxicity by 2.6- and 24.3-fold, respectively, whereas breast cancer decreased the risk (AOR 0.3, 95% CI 0.106-0.852), compared to non-small cell lung cancer. In patients who administrated TKIs which form reactive metabolites, use of CYP3A4 inducers and liver metastasis increased incidence of high-grade hepatotoxicity by 3.0- and 2.3-fold, respectively. In patients with EGFR mutation, exon 19 deletion and use of proton pump inhibitors were risk factors for high-grade hepatotoxicity in addition to liver metastasis and use of H2 blockers. CONCLUSION: The use of H2 blockers, presence of liver metastasis, and CYP3A4 inducers were associated with high-grade hepatotoxicity of TKIs. In subgroup analyses, presence of exon 19 deletion, and/or proton pump inhibitors, was additional risk factors for high-grade hepatotoxicity in special patients and use of specific TKIs. Close liver function monitoring is recommended, especially in patients with liver metastasis or using H2 blockers or CYP3A4 inducers.

Factors affecting time to reach and recover from gefitinib-induced hepatotoxicity.

Gefitinib is an oral tyrosine kinase inhibitor targeting the epidermal growth factor receptor (EGFR) for non-small-cell lung cancer with EGFR mutations. Although a few studies have analyzed the causes of gefitinib-induced hepatotoxicity, research focusing on the time intervals before and after hepatotoxicity has yet to be reported. Therefore, this study investigated two types of factors: the time to reach gefitinib-induced hepatotoxicity and the time for recovery. From January 2013 to December 2014, a retrospective study was carried out on 473 non-small-cell lung cancer patients who were treated with gefitinib. The following data were collected: sex, age, body weight, height, body surface area, underlying disease, Eastern Cooperative Oncology Group Performance Status, smoking history, gefitinib dose, EGFR mutation, and concomitant drugs. Multivariate models showed that patients with mutations in exon 19 had around two-fold higher hepatotoxicity (≥grade 2). Use of CYP3A4 inhibitors and smoking shortened time to hepatotoxicity ∼5-2-fold, respectively, whereas mutations in exon 21 prolonged time to hepatotoxicity by about 2.4-fold. Termination of gefitinib therapy showed 3.8-fold faster recovery. Our study showed that the concomitant use of CYP3A4 inhibitors, smoking, and exon 21 affected the time to reach gefitinib-induced hepatotoxicity. Among the factors examined in this study including hepatotonic use and gefitinib termination, only cessation of gefitinib therapy significantly accelerated recovery.

Depression Literacy and Depressive Symptoms: The Mediating Role of Self-Rated Mental Health Among Korean Americans.

OBJECTIVE: Depression literacy (DL) is increasingly recognized as an important predictor of mental health outcomes, but there remains a noticeable lack of scientific inquiry focusing on Korean Americans in this area. In addition, women are known to be more susceptible to depression, potentially affecting their DL and depressive symptoms differently than men. This study aimed to explore two primary objectives: (1) the potential role of self-rated mental health (SRMH) in mediating the association between DL and depressive symptoms in this population, and (2) whether gender differences exist in the presence and magnitudes of these mediation effects. METHOD: Data were drawn from a survey with 693 Korean Americans aged 18 and older residing in New York and New Jersey. The PROCESS macro was used to test the mediation effect of self-rated mental health on the relationship between depression literacy and depressive symptoms in men and women. RESULTS: Self-rated mental health was found to mediate the relation between depression literacy and depressive symptoms in women but not in men. CONCLUSIONS: Providing evidence-informed, culturally tailored and gender specific depression literacy education and programs for the KA communities may be an important strategy to reduce depressive symptoms in this group.

What Matters to Chinese and Korean American Dementia Caregivers: Navigating Cultural Influences in Dementia Care from Caregivers' Perspectives.

Background: Chinese and Korean Americans are among the fastest-growing minority groups in the US but face disparities in income and limited English proficiency, leading to health inequities in Alzheimer's disease and related dementias (ADRD) care. Objective: This study aims to understand cultural influences in ADRD care from the perspectives of Chinese and Korean American caregivers to inform culturally sensitive support for caregivers in Asian immigrant populations. Methods: We conducted a study that was part of a broader project aimed at informing the cultural adaptation of the NYU Caregiver Intervention-Enhanced Support (NYUCI-ES) program specifically for Chinese and Korean American caregivers managing multiple chronic conditions. In our interviews with 14 Chinese American and 11 Korean American caregivers, we focused on how their roles as primary caregivers were influenced by cultural and family expectations, the impact of caregiving on their personal and emotional well-being, and the specific barriers they face in accessing healthcare for themselves and their relatives with dementia. Results: Cultural beliefs and values significantly influenced the perceptions and utilization of support systems among Chinese and Korean American caregivers. Family stigma and adherence to cultural norms impacted their caregiving experiences. The study also highlighted the added burden during the pandemic and the potential benefits of telehealth and information technology in ADRD care. Conclusions: Developing culturally tailored, person-centered programs is crucial to meeting the unique needs of Chinese and Korean American caregivers. This research contributes to understanding and supporting this vulnerable population, promoting healthcare equity for ADRD patients and caregivers.

First detection of Bandavirus dabieense in ticks collected from migratory birds in the Republic of Korea.

The causative agent of severe fever with thrombocytopenia syndrome (SFTS) is Bandavirus dabieense, an emerging tick-borne zoonotic pathogen. Migratory birds have often been suggested as potential carriers of ticks that can transmit Bandavirus dabieense; however, their role remains unclear. The Republic of Korea (ROK) holds an important position as a stopover on the East Asian-Australasian Flyway. The present study aimed to investigate the potential involvement of migratory birds in the transmission of the SFTS virus (SFTSV) in the ROK. A total of 4,497 ticks were collected across various regions, including Heuksando and Daecheongdo, in the ROK, from bird migration seasons in 2022 and 2023. Genetic analysis of the SFTSV was performed for 96 ticks collected from 20 different species of migratory birds. Polymerase chain reaction (PCR) fragments of SFTSV were detected in one Haemaphysalis concinna nymph collected from a Black-faced Bunting (Emberiza spodocephala) and one Ixodes turdus nymph collected from an Olive-backed Pipit (Anthus hodgsoni) on Daecheongdo and Heuksando, respectively, during their northward migration in two spring seasons. This finding suggests that migratory birds can be considered as possible carriers and long-distance dispersers of ticks and associated tick-borne diseases. This study highlights the importance of clarifying the role and impact of migratory birds in the rapid expansion of tick-borne diseases, facilitating enhanced preparedness and the development of mitigation measures against emerging SFTS across and beyond East Asia.

Clinical utility of immature reticulocyte fraction for identifying early red blood cell regeneration in anemic dogs.

BACKGROUND: Evaluating regeneration is essential for the classification and differential diagnosis of anemia in dogs. Early detection of regeneration is challenging in anemic dogs. OBJECTIVES: This study assessed the value of immature reticulocyte fraction (IRF) in differentiating preregenerative anemia (PRA) from nonregenerative anemia (NRA) in dogs. ANIMALS: Ninety-four dogs: 49 controls and 45 with anemia. METHODS: Case-control study. Fractions of low-, medium- (MFR), and high-fluorescence reticulocytes (HFR), were measured using the ADVIA 2120i hematology analyzer. The IRF was calculated as the sum of percentages of MFR and HFR. Data from dogs with regenerative anemia (RA, n = 19), PRA (n = 11), and NRA (n = 15) were retrospectively analyzed. The value of IRF was compared with reticulocyte production index (RPI) using the receiver operating characteristic (ROC) curve. RESULTS: The median of IRF was significantly higher in dogs with RA (46.5%; range, 40.9-53.6%; P < .001) and PRA (40.6%; range, 27.7-47.1%; P = .01) than in controls (22.1%; range, 16.9-29.3%). The IRF in dogs with PRA showed no difference compared to dogs with RA (P > .99) but was higher than dogs with NRA (18.7%; range, 8.8-24%; P = .00). The area under the ROC curve of IRF was superior to that of RPI (0.897 vs 0.818, P = .00) in differentiating dogs with PRA from NRA. CONCLUSIONS AND CLINICAL IMPORTANCE: The IRF is a reliable variable for detecting early regeneration in anemic dogs without reticulocytosis. The study suggests that the measurement of IRF could be useful in classifying anemic dogs.

Serratus anterior plane block with ultrasound-guided hydrodissection for lateral thoracic pain caused by long thoracic nerve neuropathy - A case report.

BACKGROUND: Long thoracic nerve (LTN) neuropathy occasionally occurs in young people who engage in various sports. It may have a traumatic or non-traumatic etiology. The landmark manifestation of LTN neuropathy is scapular winging; however, it can also occur without scapular winging and specific magnetic resonance imaging findings. CASE: An 18-year-old male complained of right-sided lateral chest pain for 7 months. He was treated with medication, trigger point injection, and physical therapy but showed no improvement. Electromyelogram findings suggested LTN neuropathy in the right lateral chest. We performed a serratus anterior (SA) plane block with ultrasound (US)-guided hydrodissection and achieved pain relief. CONCLUSIONS: We report the successful treatment of LTN neuropathy with an SA plane block and US-guided hydrodissection.

Serum uromodulin in dogs with chronic kidney disease.

BACKGROUND: Serum uromodulin concentration has been described as a novel biomarker of chronic kidney disease (CKD) in humans but not dogs. OBJECTIVE: To evaluate the serum uromodulin concentration in dogs with CKD and assess its diagnostic performance in distinguishing dogs with CKD from healthy dogs. ANIMALS: Forty-nine dogs with CKD (International Renal Interest Society [IRIS] Stage 1, n = 23; Stage 2, n = 20; Stage 3-4, n = 6) and 25 healthy controls. METHODS: Prospective, observational study. Serum uromodulin concentration was measured using a canine-specific enzyme-linked immunosorbent assay (ELISA), and its correlation with conventional renal markers was analyzed. RESULTS: Serum uromodulin concentrations were significantly lower in the CKD group than in the control group (P < .001), but no significant difference was observed among stages of CKD. A negative correlation was observed between serum uromodulin concentration and conventional renal markers (blood urea nitrogen concentration, r = -.60, P < .0001; serum creatinine concentration, r = -.46, P < .0001; serum symmetric dimethylarginine concentration [SDMA], r = -.65, P < .0001). In receiver operating characteristic analysis, the area under the curve (AUC) of uromodulin (AUC, 0.97; 95% confidence interval [CI], 0.94-1.00) was higher than that of SDMA (AUC, 0.87; 95% CI, 0.79-0.95) for CKD diagnosis (P = .01). The AUC of uromodulin (AUC, 0.95; 95% CI, 0.89-1.00) also was higher than that of SDMA (AUC, 0.72; 95% CI, 0.58-0.87) in distinguishing dogs with Stage 1 CKD from controls (P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Serum uromodulin concentration is decreased in dogs with CKD. Thus, serum uromodulin may be a valuable diagnostic marker for CKD in dogs, particularly in identifying early-stage CKD.

Changes in pain scores and walking distance after epidural steroid injection in patients with lumbar central spinal stenosis.

ABSTRACT: Lumbar spinal stenosis is a common degenerative disorder that is characterized by pain and neurogenic claudication. Previous studies have evaluated the effects of an epidural steroid injection (ESI) on spinal stenosis, based on changes to the spinal canal diameter.This study aimed to examine the impact of the ESI on pain scores and walking distance in patients with lumbar central spinal stenosis, stratified based on disease severity, which was graded according to the degree of cauda equina separation.We reviewed the medical records of patients who received the ESI for lumbar spinal central canal stenosis. A total of 128 patients were divided into moderate and severe groups, based on the degree of cauda equina separation.Relative to baseline values, 2 weeks after the ESI, the moderate group showed a significant decrease in the numeric rating scale (NRS) scores and an increase in walking distance. Meanwhile, the severe group showed a significant decrease in the NRS scores and no significant change in walking distance. The moderate group had lower NRS scores and a longer walking distance than did the severe group 2 weeks after the ESI. The proportion of patients with improved levels of satisfaction was higher in the moderate group than in the severe group.Lumbar interlaminar ESI may reduce pain scores and increase walking distance in patients with moderate lumbar spinal central canal stenosis. Patients with moderate spinal stenosis achieved better outcomes than did patients with severe stenosis.

A Risk Scoring System Utilizing Machine Learning Methods for Hepatotoxicity Prediction One Year After the Initiation of Tyrosine Kinase Inhibitors.

Background: There is currently no method to predict tyrosine kinase inhibitor (TKI) -induced hepatotoxicity. The purpose of this study was to propose a risk scoring system for hepatotoxicity induced within one year of TKI administration using machine learning methods. Methods: This retrospective, multi-center study analyzed individual data of patients administered different types of TKIs (crizotinib, erlotinib, gefitinib, imatinib, and lapatinib) selected in five previous studies. The odds ratio and adjusted odds ratio from univariate and multivariate analyses were calculated using a chi-squared test and logistic regression model. Machine learning methods, including five-fold cross-validated multivariate logistic regression, elastic net, and random forest were utilized to predict risk factors for the occurrence of hepatotoxicity. A risk scoring system was developed from the multivariate and machine learning analyses. Results: Data from 703 patients with grade II or higher hepatotoxicity within one year of TKI administration were evaluated. In a multivariable analysis, male and liver metastasis increased the risk of hepatotoxicity by 1.4-fold and 2.1-fold, respectively. The use of anticancer drugs increased the risk of hepatotoxicity by 6.0-fold. Patients administered H2 blockers or PPIs had a 1.5-fold increased risk of hepatotoxicity. The area under the receiver-operating curve (AUROC) values of machine learning methods ranged between 0.73-0.75. Based on multivariate and machine learning analyses, male (1 point), use of H2 blocker or PPI (1 point), presence of liver metastasis (2 points), and use of anticancer drugs (4 points) were integrated into the risk scoring system. From a training set, patients with 0, 1, 2-3, 4-7 point showed approximately 9.8%, 16.6%, 29.0% and 61.5% of risk of hepatotoxicity, respectively. The AUROC of the scoring system was 0.755 (95% CI, 0.706-0.804). Conclusion: Our scoring system may be helpful for patient assessment and clinical decisions when administering TKIs included in this study.

The interactive role of chronic medical conditions and sleep disturbance in predicting depressive symptoms among Korean American older adults.

OBJECTIVES: This study examined the independent and interactive effects of chronic medical conditions and sleep disturbance on depressive symptomatology. The sample (N = 675) consisted of community-dwelling Korean American older adults, a group that has been found to be particularly high in depressive symptomatology. METHODS: A hierarchical regression model of depressive symptoms was estimated with an array of predictors: (a) demographic variables, including immigration history, (b) chronic medical conditions, (c) sleep disturbance, and (d) an interaction between chronic medical conditions and sleep disturbance. RESULTS: After controlling for the effects of demographic variables, both chronic medical conditions and sleep disturbance were identified as independent risk factors for depressive symptoms. Moreover, their interaction was significant, indicating that the coexistence of chronic medical conditions and sleep disturbance was significantly associated with higher levels of depressive symptoms (ß = 0.15, p < 0.01). CONCLUSION: Our findings call attention to sleep hygiene among older individuals with chronic medical conditions and recommend that sleep quality should be closely monitored and assessed by healthcare professionals.

The Role and Activities of Board-Certified Chaplains in Advance Care Planning.

BACKGROUND: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. OBJECTIVES: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. METHODS: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains' organizations in the U.S. The survey data included chaplains' demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. RESULTS: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. CONCLUSION: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Determinants of a sense of mastery in Korean American elders: a longitudinal assessment.

OBJECTIVES: Given the importance of sense of mastery for physical and psychological well-being in later life, this study examined the predictors of a sense of mastery among Korean American elders. METHOD: The sample included 141 community-dwelling Korean Americans aged 60 and older (M age = 68.5, SD = 6.40), who provided data in both 2003 and 2005. The model predicting sense of mastery at time 2 was estimated with sets of predictors that included (a) baseline sense of mastery, (b) other baseline characteristics (age, gender, education, length of stay in the United States, and baseline chronic conditions and functional disability), (c) non-health-related change (widowhood, decline in financial status and increased difficulty with transportation), (d) health-related change (increase in chronic conditions and increase in functional disability) and (e) an interaction term (increase in chronic conditions x increase in functional disability). RESULTS: After adjusting for baseline mastery, we found that baseline functional disability, decline in financial status and increased functional disability posed a significant threat to subsequent levels of mastery. Additionally, the interaction between increase in chronic conditions and increase in functional disability was significant: individuals who experienced increases in both chronic conditions and functional disability were at particular risk of a diminished sense of mastery. CONCLUSION: Findings underscore the need for intervention efforts to preserve and promote a sense of mastery among older adults facing health decline.

Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study.

BACKGROUND: Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dose, duration, and types of PPIs with CDI risk. METHODS: A single-center, cohort study was conducted on patients admitted to a hospital. The exposed cohort comprised patients who were prescribed PPIs at least once during the study period, and a control cohort was prepared by randomly assigning an index date to patients who did not use PPIs ensuring the same distribution of index dates as in the exposed cohort and matching sex, age, hospitalization period, and date of admission. RESULTS: PPI use increased the risk of CDI by 1.8-fold [95% confidence interval (CI) 1.5-2.2]. CDI risk increased by 1.8-fold with esomeprazole (95% CI 1.4-2.2) and 2.0-fold with pantoprazole (95% CI 1.5-2.8). Patients who used a high dose had a higher risk than those who used a medium dose [adjusted hazard ratio (HR) 2.0 vs 1.3]. The risk of CDI increased 4.2-fold when the PPI exposure period was 6 days or shorter than 6 days. CONCLUSIONS: Our study showed that PPI use was associated with an increased risk of developing CDI and the risk of CDI was dose dependent. Therefore, PPIs should only be used at proper doses and only for the necessary indications to avoid CDI risk.

Effects of Concomitant Medication Use on Gefitinib-Induced Hepatotoxicity.

Gefitinib is a drug used for the treatment of non-small cell lung cancer (NSCLC) patients. Severe hepatotoxicity was observed, but only a few cases have been reported on the hepatotoxicity of gefitinib. This study aimed to investigate the association between gefitinib-induced hepatotoxicity and various factors including concomitant medications in lung cancer patients. From January 2013 to December 2014, a retrospective study was performed with NSCLC patients who were treated with gefitinib. Associations between hepatotoxicity and various factors including concomitant drugs were analyzed. Based on multivariate models, it was found that H2 antagonists, proton pump inhibitors (PPIs), and H2 antagonists or PPIs increased hepatotoxicity by about 1.5- to 1.7-fold. Patients younger than 65 years showed 1.6 times higher hepatotoxicity than those older than 65 years. Patients with EGFR mutations had around 2-fold higher hepatotoxicity, and the percentage of incidence of hepatotoxicity because of exon 19 deletion was 32.7%. Our study showed that anti-acid-secreting agents in addition to age younger than 65 years and EGFR mutation were associated with gefitinib-induced hepatotoxicity. Thus, close monitoring of liver function is recommended, especially for patients using anti-acid-secreting agents.

Serious psychological distress, health risk behaviors, and diabetes care among adults with type 2 diabetes: the California Health Interview Survey 2007.

AIMS: To examine the association between type 2 diabetes and serious psychological distress (SPD) and to assess if SPD was an independent risk factor for health risk behaviors and diabetes care among adults with diabetes. METHODS: Cross-sectional analysis was performed using the 2007 California Health Interview Survey with adults in California. Multiple logistic models were used to examine the associations between the multiple risk and outcome factors. RESULTS: Of the participants, 6.9% of adults had diagnoses of type 2 diabetes. SPD was present in 7.0% of adults with diabetes but only in 3.5% of adults without diabetes. Multiple logistic regression analysis revealed that participants with diabetes were significantly more likely than those without diabetes to experience SPD (OR=1.81; 95% CI=[1.3-2.5], p=0.0002), adjusting for other factors. In addition, participants with diabetes and SPD were more likely to report insufficient physical activity and more current cigarette smoking than participants without SPD. SPD among participants with diabetes, however, did not significantly affect good diabetes care. CONCLUSIONS: The findings suggest that adults with diabetes are more likely to experience SPD than adults without diabetes. Further research is needed to explore the underlying mechanisms for this association among adults with both diabetes and SPD.

Diabetes and depressive symptoms among Korean American older adults: the mediating role of subjective health perceptions.

PURPOSE: In recognition of the impact of chronic diseases on mental health and the lack of research on Asian American subgroups, the present study examined subjective perceptions of health as a potential mediator in the association between diabetes and depressive symptoms in Korean American older adults. METHODS: Multivariate analysis with data from 672 Korean American older adults in Florida explored the mediation model of health perceptions. RESULTS: The presence of diabetes was associated with negative perceptions of health and elevated symptoms of depression. The proposed mediation model was also supported: negative perceptions of health served as an intervening step between diabetes and depressive symptoms. CONCLUSIONS: The intervening role of health perceptions yields implications for developing health promotion interventions targeting older individuals with diabetes. Results suggest that even in the presence of chronic health conditions, mental well-being of older adults can be maintained by having optimistic beliefs and positive attitudes towards their own health.

Provision of psychopharmacological services in nursing homes.

We examined the psychopharmacological services provided within 3 months of nursing home (NH) admission to a whole population of newly admitted Florida NH residents 65 years and older (N = 947) for a 1-year period via secondary analyses of selected variables from Medicaid and the Online Survey and Certification and Reporting System. Within 3 months of admission, 12% received nonpsychopharmacological mental health care. However, 71% of new residents received at least one psychoactive medication, and more than 15% were taking four or more psychoactive medications. Most of those being treated with psychoactive medication had not received psychopharmacological treatment 6 months prior to admission (64%) and had not received a psychiatric diagnosis 6 months preceding admission (71%). Blacks were less likely to receive medications than non-Hispanic Whites. Results expand on past research by identifying an increase in the amount of psychoactive medications prescribed to NH residents, a lack of prior psychiatric treatment and diagnoses for those currently receiving psychoactive medications, only limited provision of nonpsychopharmacological mental health care, and racial or ethnic differences in the use of medications by NHs.

Wives and daughters: the differential role of day care use in the nursing home placement of cognitively impaired family members.

PURPOSE: To expand knowledge concerning the significance of kin relationships in caregiving, this study assessed predictors of the timing of institutionalization for persons with dementia. The focus was on whether use of adult day care by wives and daughters holds the same implications for placement. DESIGN AND METHODS: Guided by a caregiving stress process model, primary objective and subjective stressors, secondary stressors, caregiver well-being, and use of day care services were included as predictors. Cox proportional hazards models were tested using a sample of 371 community-dwelling caregivers, including 141 wives and 230 daughters and daughters-in-law. RESULTS: The main effect of kinship was found to be significant before interactions were introduced. Adult day care use at Time 1, role captivity, role overload, and social impact were subsequently found to interact with kinship. Analyses indicated that wives who used adult day care placed their husbands to a nursing home earlier than their counterparts. Among daughters, however, those who used adult day care were more likely to postpone the placement. The influence of role overload was also stronger in wives than in daughters in predicting the timing of placement. A similar pattern was observed in the interaction between social impact and kinship. IMPLICATIONS: The results demonstrate that factors influencing nursing home placement may vary according to the caregiver's familial relationship to the relative. Different approaches may be needed when targeting wife vs. daughter caregivers, especially when designing adult day care programs.