Drinking behavior among older adults in a planned retirement community: results from The Villages survey.

OBJECTIVES: Research indicates increasing trends among older adults toward heavy and abusive drinking, often associated with depressive symptoms. Possible exceptions are residents of planned retirement communities, whose drinking may be associated with social activities. To better understand these relationships, this study examined the relationship of depressive symptoms and drinking in a large retirement community. METHODS: The Villages, a retirement community in central Florida with a focus on healthy, active living, has almost 90,000 residents. In 2012, a population-based needs assessment was conducted in partnership with University of South Florida Health. In the present study, 11,102 surveys were completed and returned. A structural equation model was utilized to analyze the relationship between depressive symptoms and alcohol use as measured by the three-item Alcohol Use Disorders Identification Test (AUDIT-C). RESULTS: Hazardous drinking was reported in 15.4% of respondents, somewhat higher than the general population of older adults (around 10%). Variables of depressive symptoms, physical activity, total health problems, and poor general health loaded significantly into the factor of depression indicators, which was shown to have a significant, negative correlation with risk of hazardous drinking (λ = 0.16, p < 0.000, R(2) = 0.02). CONCLUSIONS: Results suggest at-risk drinking among respondents was not associated with depression, in contrast to studies of older adults living alone where alcohol abuse was often associated with depression. Implications for successful aging are discussed.

One-Visit Behavioral Intervention for Older Primary Care Patients with Mild to Moderate Depressive Symptoms.

OBJECTIVES: We pilot tested a one-visit behavioral intervention with telephone follow-up for older primary care patients with mild to moderate depressive symptoms. METHODS: A total of 16 English-speaking primary care patients aged 60 years and older who scored 5 to 14 on the Patient Health Questionnaire-9 (PHQ-9) engaged in the intervention visit. Outcomes were assessed at baseline and 4 weeks: activity goals, readiness to change (University of Rhode Island Change Assessment), PHQ-9, Generalized Anxiety Disorder-7, World Health Organization Disability Assessment Schedule 2.0, and satisfaction. RESULTS: The 14 participants who completed the study met or exceeded 73% of activity goals on average. They also improved on all outcomes (P < 0.05) with medium (University of Rhode Island Change Assessment, GAD-7) to large effect sizes (PHQ-9, World Health Organization Disability Assessment Schedule 2.0), and they were satisfied. CONCLUSIONS: This pilot study provided preliminary evidence that a one-visit behavioral activation intervention is acceptable and feasible and improves outcomes. If findings are confirmed, then this intervention could be integrated into existing collaborative care programs.

Seduction, deception and technology.

This paper proposes that exploring the use of internet pornography creates a potentially beneficial, albeit defensive liminal space that can be used therapeutically. The content of compelling sexual scenes can be viewed as the psyche's way of mastering internal trauma and masking an inner emptiness. However, from a Jungian perspective, the use of internet pornography can also be seen as a patient's distorted way of trying to make dissociated affects more bearable by triumphing over them. The sexual use of technology can express intrapsychic conflict encapsulated in what Stoller called 'microdots'. Stoller's microdots are unique scripts - a kind of emotional code that gives clinicians an opportunity to reveal unconscious processes and transcend them through meaning making. Wood's work at the Portman Clinic on the chosen 'compelling scenarios' of pornography-addicted patients is also examined with this Jungian lens. Jung's idea of the transcendent function is used to show the value of holding the tension of fantasy and frustration provoked by intimacy. The paper illustrates how they come together within the therapeutic relationship to stimulate something new.

Cet article suggère qu'étudier l'utilisation de la pornographie sur internet crée un espace potentiellement bénéfique, même s'il est défensif, et qui peut être utilisé de manière thérapeutique. Le contenu de scènes sexuelles impressionnantes peut être compris comme la manière dont la psyché maitrise le traumatisme interne et masque le vide intérieur. Mais d'un point de vue Jungien, l'utilisation de la pornographie sur internet peut également être pensée comme la manière, certes perturbée, du patient pour tenter de rendre plus supportables des affects dissociés en prenant le dessus sur ces fameux affects. L'utilisation sexuelle de la technologie peut exprimer le conflit intrapsychique encapsulé dans ce que Stoller a appelé les 'micropoints'. Les micropoints de Stoller sont des scénarios uniques - une sorte de code émotionnel qui donne aux cliniciens l'occasion de révéler les processus inconscients et de les transcender en y donnant du sens. Le travail de Wood à la Portman Clinic - sur les 'scénarios fascinants' des patients dépendants à la pornographie - est également étudié à travers la perspective Jungienne. L'idée Jungienne de la fonction transcendante est utilisée pour montrer qu'il est précieux de tenir la tension entre fantasme et frustration, tension qui provient de l'intimité. Cet article illustre comment ils se rejoignent dans la relation thérapeutique pour stimuler quelque chose de nouveau.

El presente trabajo propone que la exploración del uso de pornografía por internet crea un beneficio potencial, aún siendo un espacio liminal defensivo, que puede ser usado terapéuticamente. El contenido de atractivas escenas sexuales puede percibirse como el modo de la psique de dominar el trauma interno y de enmascarar el vacío interior. Sin embargo, desde una perspectiva Junguiana, el uso de pornografía por internet puede considerarse como un modo distorsionado del paciente de tratar de hacer más tolerables emociones disociadas triunfando sobre las mismas. El uso sexual de tecnología puede expresar conflicto intrapsíquico encapsulado en lo que Stoller llamó `micropuntos`. Los `micropuntos`de Stoller son guiones únicos - una especie de código emocional que le da al clínico una oportunidad para revelar procesos inconscientes y trascenderlos a través de darles sentido. También se examina con este lente Junguiano el trabajo de Wood en la Clínica Portman sobre los elegidos `escenarios cautivantes` de pacientes con adicción a la pornografía. La idea de Jung sobre la Función Trascendente es utilizada para mostrar el valor de sostener la tensión entre fantasía y frustración provocada por la intimidad. El trabajo ilustra cómo ambas coinciden en la relación terapéutica para estimular algo nuevo.

Cricopharyngeal dilatation for the long-term treatment of dysphagia in oculopharyngeal muscular dystrophy.

Oculopharyngeal muscular dystrophy (OPMD) is a rare autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. The aim of this study was to evaluate the safety and efficacy of repeated endoscopic dilatation for OPMD over a 15-year period. All patients seen at our Regional Swallowing Clinic with OPMD confirmed by genetic analysis were included. Cricopharyngeal dilatation was performed as an outpatient procedure using a wire-guided 18-mm (54 Fr) Savary-Gilliard bougie with the patient under sedation. Patients were offered repeat endoscopic dilatation when symptoms recurred. Symptom severity prior to initial dilatation and at follow-up was evaluated using the Sydney Swallow Questionnaire (SSQ). Nine patients (7 female, 2 male) were included for analysis. Median total treatment period was 13 years (range = 3-15), median number of dilatations per patient was 7.2 (range = 1-16), and median interval between treatments was 15 months (range = 4.5-45). All patients recorded sustained symptom improvement. Mean SSQ score (out of 1,700) was 1,108.11 (SD ± 272.85) prior to first dilatation and 297.78 (SD ± 189.14) at last follow-up, representing a 73% decrease (95% CI = 52-94) in degree of dysphagia symptoms (paired t-test, P = 0.0001). All mean scores for individual questions also showed significant improvement (P < 0.05). No adverse events were reported with all patients maintaining oral feeding at last follow-up. Repeated cricopharyngeal dilatation is a safe, effective, well-tolerated, and long-lasting treatment for dysphagia in OPMD.

Close Margins Less Than 2 mm Are Not Associated With Higher Risks of 10-Year Local Recurrence and Breast Cancer Mortality Compared With Negative Margins in Women Treated With Breast-Conserving Therapy.

PURPOSE: The 2014 Society of Surgical Oncology-American Society for Radiation Oncology consensus suggested "no ink on tumor" is a sufficient surgical margin for invasive breast cancer treated with breast-conserving surgery (BCS). Whether close margins <2 mm are associated with inferior outcomes remains controversial. This study evaluated 10-year outcomes by margin status in a population-based cohort treated with BCS and adjuvant radiation therapy (RT). METHODS AND MATERIALS: The subjects were 10,863 women with invasive cancer categorized as pT1 to T3, any N, and M0 referred from 2001 to 2011, an era in which the institutional policy was to re-excise close or positive margins, except in select cases. All women underwent BCS and whole-breast RT with or without boost RT. Local recurrence (LR) and breast cancer-specific survival (BCSS) were examined using competing-risk analysis in cohorts with negative (≥2 mm; n = 9241, 85%), close (<2 mm; n = 1310, 12%), or positive (tumor touching ink; n = 312, 3%) margins. Multivariable analysis and matched-pair analysis were performed. RESULTS: The median follow-up period was 8 years. Systemic therapy was used in 87% of patients. Boost RT was used in 34.1%, 76.9%, and 79.5% of patients with negative, close, and positive margins, respectively. In the negative, close, and positive margin cohorts, the 10-year cumulative incidence of LR was 1.8%, 2.0%, and 1.1%, respectively (P = .759). Corresponding BCSS estimates were 93.9%, 91.8%, and 87.9%, respectively (P < .001). On multivariable analysis, close margins were not associated with increased LR (hazard ratio, 1.25; 95% confidence interval 0.79-1.97; P = .350) or reduced BCSS (hazard ratio, 1.25; 95% confidence interval 0.98-1.58, P = .071) relative to negative margins. On matched-pair analysis, close margin cases had similar LR (P = .114) and BCSS (P = .100) to negative margin controls. CONCLUSIONS: Select cases with close or positive margins in this population-based analysis had similar LR and BCSS to cases with negative margins. While these findings do not endorse omitting re-excision for all cases, the data support a policy of accepting carefully selected cases with close margins for adjuvant RT without re-excision.

"You can't get a side of willpower": nutritional supports and barriers in The Villages, Florida.

Good nutrition in late life is key to the health of older adults and demands the attention of health promoters. To assess how the social lives and community environmental supports and barriers affect older adults' nutritional health, we conducted 29 focus groups with 144 residents of The Villages, Florida. Participants reside in one of the largest retirement communities in the United States. Thematic analysis revealed that the high social connectedness of residents confers both positive and negative influences on the nutritional lives of residents. Neighbors and friends are essential to a resident's ability to access foods in times of need. Conversely, many social functions in the community revolve around the consumption of foods of low nutrient density. Friends and neighbors may provide the best point of entry for nutritional interventions, such as food assistance strategies and health promotion and education. Policy and practice implications are also discussed.

Temporary tattoos to simulate skin disease: report and validation of a novel teaching tool.

PURPOSE: Dermatology is a visual specialty requiring examination and description of skin lesions and the development of analytic skills to establish a diagnosis. Student education in dermatology is challenged by several factors. Although 10% to 15% of a general practitioner's consultations are related to the skin, dermatology is often underrepresented in undergraduate medical curriculums. In addition, more serious lesions, such as malignant melanoma (MM), are promptly biopsied and may not be available for students' examination. The authors carried out this study to learn whether a novel educational tool, a temporary tattoo, could successfully simulate an MM. METHOD: Eighty-one dermatologists and 14 dermatology residents participated in this validity study of a tattoo applied to the arm of a standardized patient (SP) to simulate an MM. The study was conducted at the 82nd Annual Canadian Dermatology Association Conference held in June 2007 in Toronto, Canada. RESULTS: A correct diagnosis was made by 93.8% (76/81) of the dermatologists and 90.5% of the participants (86/95) overall. The tattoo was also evaluated as being very realistic on a five-point Likert scale. CONCLUSIONS: The validation of the tattoo shows potential for use in medical education, such as SP visits and examinations. This teaching tool can be used to simulate a variety of skin lesions, providing a way to visually examine a lesion on the skin of an SP, which would enhance the medical student's learning experience.

alpha- and beta-secretase: profound changes in Alzheimer's disease.

The amyloid plaque, a neuropathological hallmark of Alzheimer's disease, is produced by the deposition of beta-amyloid (Abeta) peptide, which is cleaved from Amyloid Precursor Protein (APP) by the enzyme beta-secretase. Only small amounts of Abeta form in normal brain; more typically this is precluded by the processing of APP by alpha-secretase. Here, we describe a decrease in alpha-secretase (81% of normal) and a large increase in beta-secretase activity (185%) in sporadic Alzheimer's disease temporal cortex. Since alpha-secretase is present principally in neurons known to be vulnerable in Alzheimer's disease, and there is known competition between alpha- and beta-secretase for the substrate APP, it is significant that the majority of Alzheimer samples tested here were low in alpha-secretase. Eighty percent of Alzheimer brains examined had an increase in beta-secretase, a decrease in alpha-secretase, or both; which may account for the means by which the majority of people develop Alzheimer's disease.