Toxic adenoma: to biopsy or not to biopsy?

Toxic adenoma nodules rarely harbour cancer. Fine-needle aspiration (FNA) is often not done because of the rarity of these lesions being cancer, the difficulty in interpreting cytology in hyperthyroid patients and the rare precipitation of thyrotoxicosis. We present two young, Caucasian female patients aged 29 and 13 years who were each diagnosed with a toxic nodule categorised as benign and indeterminate respectively. They underwent hemithyroidectomy after being rendered euthyroid, however their histology unexpectedly revealed differentiated follicular cancer. Despite thyroid cancer being rare in patients with toxic adenomas, it should be considered when planning treatment, especially if there are risk factors for cancer, or suspicious features on ultrasound examination. A review of the literature shows that compared with adenomas in euthyroid patients, patients in this group are generally younger and predominately female. If an FNA is considered, it should be performed after the patient is rendered euthyroid.

Arithmetic Errors in Financial Contexts in Parkinson’s Disease

Research on dyscalculia in neurodegenerative diseases is still scarce, despite high impact on patients’ independence and activities of daily living function. Most studies address Alzheimer’s Disease; however, patients with Parkinson’s Disease (PD) also have a higher risk for cognitive impairment while the relation to arithmetic deficits in financial contexts has rarely been studied. Therefore, the current exploratory study investigates deficits in two simple arithmetic tasks in financial contexts administered within the Clinical Dementia Rating in a sample of 100 PD patients. Patients were classified as cognitively normal (PD-NC) or mildly impaired (PD-MCI) according to Level I consensus criteria, and assessed using a comprehensive neuropsychological test battery, neurological motor examination, and sociodemographic and clinical questionnaires. In total, 18% showed arithmetic deficits: they were predominately female, had longer disease duration, more impaired global cognition, but minor signs of depression compared to PD patients without arithmetic deficits. When correcting for clinical and sociodemographic confounders, greater impairments in attention and visuo-spatial/constructional domains predicted occurrence of arithmetic deficits. The type of deficit did not seem to be arbitrary but seemed to involve impaired place × value processing frequently. Our results argue for the importance of further systematic investigations of arithmetic deficits in PD with sensitive tests to confirm the results of our exploratory study that a specific subgroup of PD patients present themselves with dyscalculia.

Exploring adults as support persons for improved pre-exposure prophylaxis for HIV use among select adolescents and young adults in the Deep South

Purpose Pre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults’ (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA. Methods We surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP. Results 200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement. Conclusions Primary support persons are willing to support AYAs using PrEP.

Prevalence of Diagnosed Alzheimer’s Disease and Related Dementias in Medicare Advantage

A third of Medicare beneficiaries are enrolled in Medicare Advantage (MA); however, little is known about MA beneficiaries diagnosed with Alzheimer’s disease and related dementias (AD/ADRD). MA plans have incentives that may influence the type of beneficiaries who enroll/disenroll from plans and the documentation of diagnoses. We calculated the prevalence of diagnosed AD/ADRD in 2014 and 2016 in three MA plans representing ~30% of the MA market. We identified beneficiaries ≥65 years of age enrolled in the MA plans in 2014 and 2016. Among eligible beneficiaries, we identified individuals with AD/ADRD using ICD-9 (2014) and ICD-10 (2016) codes included in the Medicare Chronic Conditions Warehouse algorithms for AD/ADRD. We determined the age and sex of beneficiaries diagnosed with AD/ADRD, and whether they disenrolled from the MA plan for any reason (e.g., death, enrollment in a different MA plan, enrollment in traditional Medicare or discontinuation of a plan) within 364 days from the date they were first identified has having AD/ADRD (i.e., index date). In 2014 and 2016 the prevalence of AD/ADRD diagnoses was 5.7% and 6.5%, respectively. In 2016, AD/ADRD beneficiaries were on average 82.4 (SD=7.3) years of age, 61.8% female, and had multiple comorbidities. By 364 days post-index, 32% of beneficiaries with diagnosed AD/ADRD had disenrolled from their plan. The characteristics of 2014 beneficiaries with diagnosed AD/ADRD were similar to their 2016 counterparts. In conclusion, MA beneficiaries with AD/ADRD are predominately female, have multimorbidity, and the age-stratified prevalence of AD/ADRD diagnoses is lower than rates reported in traditional Medicare.

Comparison of in-person and telegeriatric follow-up consultations

Introduction Telehealth has the potential to support the care of older adults and their desire to age at home by providing a videoconferencing connection to specialist geriatric care. However, more information is needed to determine how telehealth services affect the care of older adults, and how telehealth services for older adults compare to traditional in-person methods of care provision. The aim of this study was to compare telegeriatric and in-person geriatric consultation methods with respect to outcomes and costs. Methods This was a retrospective chart analysis of consultation letters from patients’ first follow-up appointment with a geriatric specialist during the 2017/2018 fiscal year ( N = 95) in a health jurisdiction of a Western Canadian province. Results Patients seen through telehealth and in person were similar in mean age ( M = 79.1 and 78.1 years, respectively) and were predominately female. Telegeriatric consultations resulted in more requests for further testing and screening ( p = 0.003), new diagnoses ( p = 0.002), medication changes ( p = 0.009) and requests for follow-up ( p = 0.03) compared to in-person consultations. An average one-day clinic with one geriatric specialist providing consultations through telehealth cost Can$1684–$1859 less than an equivalent in-person clinic. Discussion Although additional research is needed to explain the differences in outcomes further between telehealth and in-person consultations found in this work, telehealth consultations cost substantially less than in-person consultations and are a promising way to improve access to geriatric care for older adults in underserved areas.

Barriers and facilitators to extended working life: a focus on a predominately female ageing workforce

Many countries are reforming their pension systems so people stay in work for longer to improve the long-term sustainability of public finances to support an increasing older population. This research aimed to explore the factors that enable or inhibit people to extend working life (EWL) in a large United Kingdom-based retail organisation. Semi-structured interviews were carried out with a purposive sample (N = 30): 15 employees aged ⩾60 and 15 supervisors supporting these employees. Older workers were predominately female, reflecting the gender profile of the older workers in the organisation. Older workers and supervisors reported that key facilitators to EWL were good health, the perception that older workers are of value, flexibility and choice, the need for an ongoing conversation across the lifecourse, the social and community aspect of work as a facilitator to EWL and the financial necessity to EWL. Perceived barriers to EWL included poor health, negative impacts of work on health, and a lack of respect and support.

Examining the Impact of Sexual Revictimization in a Sample of Veterans Undergoing Intensive PTSD Treatment

Sexual revictimization refers to exposure to more than one incident of rape and is a known risk factor for poor mental health among civilians. This construct has been understudied among veterans. In addition, although individuals who have experienced revictimization generally have greater symptom severity than those who have experienced one rape, it is unclear whether these differences persist following treatment. This study examined differences between veterans who reported histories of revictimization ( n =111) or a single rape ( n = 45), over the course of a 3-week intensive cognitive processing therapy (CPT)-based treatment program for veterans with posttraumatic stress disorder (PTSD). The sample consisted of predominately female (70.5%) post–9/11 veterans (82.7%). Self-reported PTSD and depression symptom severity were assessed regularly throughout the course of treatment. Controlling for non-interpersonal trauma exposure and whether veterans were seeking treatment for combat or military sexual trauma, sexual revictimization was generally associated with greater pretreatment distress and impairment. However, sexual revictimization did not impact rates of PTSD or depression symptom change over the course of intensive treatment, or overall improvement in these symptoms posttreatment. Our findings suggest that the rates of sexual revictimization are high among treatment-seeking veterans with PTSD. Although veteran survivors of sexual revictimization tend to enter treatment with higher levels of distress and impairment than their singly victimized peers, they are equally as likely to benefit from treatment.

VALIDATION OF A NEW FUNCTIONAL COGNITION SCREENING MEASURE

Identification of cognitive deficits that contribute to functional dependence in acute and post-acute care settings is important. The Menu Task (MT) is a brief cognitive 12 item screening measure designed to identify older adults at risk for IADL impairment in community settings. The objective was to compare the psychometric properties of the Menu Task a series of neurocognitive and functional cognitive performance measures including the Brief Interview of Mental Status (BIMS), the Montreal Cognitive Assessment (MoCA) the Weekly Calendar Planning Activity (WCPA) and the Performance Assessment of Self-Care Skills (PASS) in a sample of 200 community dwelling older adults. Participants were administered the MT, BIMS, MoCA, WCPA, and the PASS checkbook and shopping tasks. ROC analysis identified an MT cut score, sensitivity and specificity. We computed Cronbach’s alpha, correlations among study measures and t-tests between groups impaired or unimpaired on the MT. Mean age of participants was 70.44(SD 8.3), the sample was predominately female ((76%), and white (81%). Mean MT score was 8.22 (SD 2.01) and the mean completion time was 185.5 sec (SD 108.11). The Menu Task has moderate internal consistency (α= 0.65). The AUC statistic was 0.83 with an optimal MT cut score of “7” and sensitivity of .90 and specificity of .70. Significant differences (p < 0.01) were observed between impaired and not impaired MT groups on BIMS, MoCA, WCPA, and PASS. The Menu Task has moderate to strong evidence supporting its psychometric properties and the value of screening for functional cognitive deficits.

Women’s work? Altogether now

Women make up a large and increasing proportion of the global healthcare workforce. As an industry, healthcare seems to welcome more women than most industries, typically ranking alongside sectors such as education and childcare in female participation rates. Nursing and clerical roles within the sector have been predominately female for some time, so much of the recent growth has been driven by a steady rise in the number of female doctors. This worldwide phenomenon, which began in the 1970s, is dubbed the ‘feminization of medicine’. Yet despite such strong female representation in the health workforce there are wide inequalities between men and women within it. In the face of acute workforce shortages, efforts to tackle these issues to attract, engage, and retain female staff will become increasingly important to both employers and governments. This chapter argues that pursuing gender equality in healthcare is a moral necessity to create a prosperous society. It also argues that there is an overwhelming business case for gender equity in the workplace—countries and companies with greater equity are better off for it.

10-Year Outcome of Suicidal Behavior in Borderline Personality Disorder

Prospective predictors of suicide attempts were assessed in 118 subjects with borderline personality disorder (BPD) after 10 or more years of follow-up. Mean (SD) time to follow-up was 14.4 (4.7) years. Subjects were predominately female (78.8%), Caucasian (81.4%), and of lower socioeconomic status. Initial recruitment was evenly balanced between inpatient, outpatient, and non-patient (community) sources. In the 10-year interval, 55 subjects (46.6%) attempted suicide. Compared to baseline, suicidal ideation, number of attempts, and non-suicidal self-injury diminished markedly. Core symptoms of BPD, substance abuse, and alcohol use disorders decreased significantly; however, major depressive disorder (MDD) remained constant at 50%. Forty-four percent of subjects had poor psychosocial, vocational, and economic outcomes. Psychosocial outcome was independent of suicide history and any treatment. Increased risk was associated with interval hospitalization prior to any attempt (illness severity), as well as poor social, vocational, and psychosocial functioning at baseline.