Extending cognitive-behavioral therapy for late-life anxiety to home care: program development and case examples

Data suggesting that cognitive-behavioral therapy (CBT) is efficacious for late-life anxiety are accumulating; however, effectiveness has not been well established. Incorporating CBT for anxiety into home care is needed to facilitate access to evidenced-based treatment for a growing population of community-dwelling, functionally impaired elderly people. In this article, the authors describe the development of a home-based CBT program for late-life anxiety, outlining their experience partnering with a community care management organization. They also describe the CBT protocol and present data form two participants who completed the treatment. The two case examples illustrate multiple barriers to achieving successful treatment outcomes with this population. Future research needs to determine the extent to which adaptations are necessary to optimize the success of CBT for anxiety in a home care setting.     

The Relationship Between Language and Cognitive Development and Emotional-Behavioral Problems in Financially-Disadvantaged Preschoolers: A Longitudinal Investigation

Over the past couple of decades, several studies have documented a significant relationship between language disorders and emotional-behavioral disorders in children. Unfortunately, only a few studies have examined this relationship while accounting for differences in children's overall cognitive functioning. The current study examined the relationship between language and cognitive development and emotional-behavioral problems #opmeasured concurrently and at 5- and 17-month follow-up#cp in a sample of non-referred four-year-olds from financially-disadvantaged families #opN equals; 680#cp. Results of stepwise multiple regression analyses indicated that language delays were significantly related to emotional-behavioral problems. However, when cognitive differences were controlled, delayed language development no longer significantly predicted emotional-behavioral problems, either concurrently or at any follow-up assessment. These results support those of previous studies that suggest that the relationship between serious emotional-behavioral problems and language development in young children may be more a function of factors associated with complex cognitive functioning or neurological maturity, rather than specific language functioning.     

Chromosome 12-linked autosomal dominant scapuloperoneal muscular dystrophy

Scapuloperoneal syndromes are characterized by their distribution of muscle weakness and wasting. The reported pattern of inheritance has been variable. Both neurogenic and myopathic forms of autosomally dominantly inherited scapuloperoneal syndrome have been described. It has been suggested that these are variants of other neuromuscular diseases. We examined 44 members from a family with 14 members affected with a scapuloperoneal syndrome. Physiological and histological analysis implied that this condition is predominantly myopathic. Linkage analysis was done to confirm the genetic etiology of the disease in this family and to evaluate the possibility that it is an allelic variant of other neuromuscular diseases. Genetic analysis demonstrated linkage of the disease to chromosome 12, which makes it genetically distinct from other loci known to cause neuromuscular disease. Muscle fibers with hyaline desmin-containing cytoplasmic inclusions in combination with focal myopathic changes may be a disease-specific morphological marker of the disease.     

Heparitinase treatment of rat embryos during cranial neurulation

Summary Heparan sulphate has been reported to be present in rat embryos. It is covalently linked to a core protein as heparan sulphate proteoglycan (HSPG). Heparitinase specifically degrades heparan sulphate, thus treatment of rat embryos with this enzyme in vitro should result in the perturbation of any tissue interactions which involve heparan sulphate proteoglycan. In this study heparitinase was either added to the culture medium or microinjected directly into the amniotic cavity.Heparitinase treatment resulted in abnormal development of the whole embryo, but the earliest effects were observed in the cranial region. Forebrain development was grossly abnormal: the neural folds remained widely open, with beak-like outgrowths rostrally. Optic sulci failed to develop. The midbrain and rostral hindbrain neural folds also remained widely open. In the trunk, where the pattern of neurulation is less complex than in the cranial region, rostral neural tube closure did occur although the morphology of the closed region was far from normal. These results suggest that heparan sulphate proteoglycan is essential for normal neurulation.Epithelial somite formation was perturbed, but neural crest cell emigration, otic pit formation and pharyngeal arch formation, all important morphogenetic events which occur during this period of development, were not inhibited by heparitinase treatment. Prolonged (44h) exposure to the enzyme resulted in the conversion of the embryonic structure to a much simpler form: mesenchymal cells (stellate or spindle-shaped) enclosed within a simple epithelial coating.     

Acceptability of a patient decision aid for women aged 70 and older with stage I,estrogen receptor-positive,HER2-negative breast cancer

ObjectivesA comprehensive decision aid (DA) for women ≥70 years with Stage I ER+/HER2-negative breast cancer was developed to support locoregional and systemic treatment decision-making. We aimed to test the acceptability of this novel DA in women newly-diagnosed with breast cancer.Materials and MethodsWomen ≥70 diagnosed with Stage I, ER+/HER2- breast cancer were recruited from three Boston-area hospitals. They underwent baseline interviews after initial surgical consultation, reviewed the DA, and were surveyed <2 weeks later to determine DA acceptability (e.g., was it helpful?), changes in decisional conflict, stage of decision-making, and knowledge. Participants could optionally complete a three-month follow-up. Paired t-tests and McNemar's tests were used for statistical comparisons, and thematic analyses were conducted to identify themes in participants' open-ended comments.ResultsThirty-three of 56 eligible patients approached completed the baseline and acceptability surveys, and 25 completed the three-month follow-up. Participants' mean age was 74.7 years (±3.8). Nearly all participants (n = 31, 94%) strongly agreed that the DA was helpful and felt that the DA prepared them for treatment decision-making, with a mean decision preparation score of 4.1 (out of 5.0); 6% (n = 2) found it very anxiety provoking. Knowledge improved with a mean of 9.0 out of 14 questions correct at baseline to 10.6 correct on the acceptability survey (p < 0.0001).ConclusionsA DA tailored to women ≥70 with Stage I, ER+, HER2- breast cancer increased knowledge and was perceived to be helpful by older women. A randomized controlled trial is needed to evaluate its efficacy.