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Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (

Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy. The utility of fluoroscopic imaging, CT, MRI, and FDG-PET for these indications are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

The aim of this study is to explore the current characteristics of people with chronic lower back (CLB) pain, and the sociodemographic and work-related predictors of this pain.The study design used in the study is a cross-sectional study.The 2018 National Health Interview Survey data were used. Chi-squared analysis was used to assess the sociodemographic characteristics, and logistic regression was used to analyze the risk factors after multiple imputation.Of the 72,831 respondents, 25,397 had provided data on CLB pain and were eligible for this study. People with CLB pain were more likely to be obese, white, female, older than 40 years, and did not have a college degree. They were more likely to carry out less than 150 min of moderate aerobic exercise per week. Age was the sociodemographic predictor of CLB pain (P-value0.001). After imputation and adjusting for covariates, construction and extraction and military-specific occupational groups were associated with an increased risk of CLB pain [odds ratios (OR): 1.32, confidence interval (CI): 1.10-1.59, P-value = 0.004; OR: 2.20, CI: 1.36-3.55, P-value = 0.001]. Working between 41 and 60 h/week significantly also had an increased risk of developing CLB pain (OR: 1.13, CI: 1.01-1.27, P-value 0.043; OR: 1.23, CI: 1.10-1.37, P-value0.001).Low socio-economic status, poor physical fitness, work-life imbalance, and the type of occupation contribute to the development of CLB pain. An improvement in preventive measures is needed to address this morbidity. More studies should be carried out to analyze the type of workplace movements that increase the risk of developing CLB.

Objective To estimate the potential influence of pre-operative patient condition on the benefit of earlier hip fracture surgery for elderly patients. Background Many studies emphasize the benefit of earlier hip fracture surgery for patient survival. However less is known regarding how this relationship is influenced by clinical factors which could serve as potential contra-indicators for earlier surgery. Rushed surgery of patients with contra-indications may even compromise their survival. Methods A retrospective study of patients aged 65 and above with an isolated hip fracture following trauma, based on data from 19 hospitals of the national trauma registry available for the years 2015–2016. Registry data was crossed with data on co-morbidities and medication intake from the biggest health insurance agency in the country, serving more than 50% of the country's population. Mediation analysis was performed on a wide list of co-morbidities, medications and clinical test results in order to establish the mediation of their relationship with inhospital mortality by earlier hip fracture surgery. Factors found significant in the mediation analysis were utilized to adjust a logistic regression for predicting inhospital mortality by function of waiting time to surgery and patient's sex and age. Results Anti-coagulant and anti-platelet intake; test results pointing to decreased kidney function and being diagnosed with diabetes or Ischemic Heart Disease were found to be significantly mediated in their influence on inhospital mortality by hip fracture surgery. Despite anti-platelet intake and kidney function having a significant impact on mortality in the multi-variate analysis, the positive effect of earlier hip surgery on survival remained unchanged after adjustment. Conclusions Earlier hip fracture surgery was found to be beneficial for elderly patients even when their co-morbidities and medication intake are taken into account.

CT colonography (CTC) is growing in its utilization and availability as a screening or diagnostic test for colorectal cancer detection. Its performance stands up to optical colonoscopy and it has become a growing alternative in many situations. This leaves a rising need for training and proficiency in how to perform and interpret CTC. Optimization of exam technique and colonic preparation raises the detection rate of colorectal lesions and renders interpretation easier. Since colorectal cancer remains the second most common cause of cancer death in the United States in men and women combined, the role for CTC is further fortified.

Aim To measure sound exposure in an Australian single-room configured, neonatal unit and compare findings to current sound level recommendations. Methods Sound meters were placed inside 51 internal environments (incubators or open cots), and within the surrounding environment of each occupied single room between September 15 and October 28, 2015. One-second incremental monitoring of decibels on an A-weighted scale (dBA), occurred over a minimum of 48 h. Results All equivalent continuous sound pressure levels (Leq) were significantly higher than the recommended 45 dBA for both incubators and open cots. Maximum sound levels (Lmax) were significantly higher than the recommended 65 dBA, peaking at 126.7 dBA inside the incubator and 124.7 dBA inside the open cot. Incubators were observed to have a higher total percentage of time above 45 dBA than open cots for both day (99.84% vs. 75.59%) and night (98.66% vs. 59.56%). Conclusion Sound levels exceeded the recommended maximum exposure levels outlined by the American Academy of Pediatrics (AAP). The long-term sequelae of adverse sensory exposure on preterm neurodevelopment remains unclear. Renewed attention on factors contributing to increased sound levels in neonatal units needs to be a clinical priority.

With over 7 million patients worldwide, Parkinson’s disease (PD) is becoming more prevalent as life span and industrialization increase. While the majority of cases are sporadic and present in individuals over 65, inherited mutations in Parkin can manifest in individuals as young as teenagers. The involvement of Parkin in neurodegeneration has been widely investigated and its role in mitophagy is undeniable. In the recent years, however, additional functions of the protein are beginning to come to light, which in turn may influence the way patients harboring Parkin mutations are treated. In the present article, we discuss the clinical and genetic aspects of Parkin-linked PD. For this purpose, we consulted the MDSGene database, which comprises the literature of more than 1000 patients with Parkin mutations. In addition, we provide insight into Parkin’s multifaceted role in mitochondrial clearance and maintenance. Finally, we discuss treatment strategies such as brain stimulation, small molecule drugs and dopaminergic cell replacement that could be tailored to improve the clinical phenotypes in Parkin-linked PD.

Objective Higher serum alkaline phosphatase (sALP) levels associate with a poor prognosis in maintenance hemodialysis patients. However, little is known about the meaning of lower sALP in this population. We hypothesized that lower sALP concentrations may express nutritional status and survival accordingly. Methods A retrospective, longitudinal cohort study of a clinical database containing the medical records of 554 patients (367 men and 187 women, mean age 67.6 ± 14.2 years) receiving maintenance hemodialysis from November 2007 to July 2018 in a single center was conducted. sALP, nutritional, bone turnover, and inflammatory marker levels were recorded at 0, 6, 12, 18, 24, 30,and 36 months followed by 58 additional months of clinical observations. Results The median sALP level was 90.0 (71.0-125.8) U/L. In a linear mixed effects model adjusted for baseline demographics and clinical parameters, each 1.0 U/L increase above the mean sALP at baseline was associated with 0.7% slower rate of decline in geriatric nutritional risk index per 3 years (P = .02 for sALP × time interaction). sALP remained associated with the rate of change in geriatric nutritional risk index, even after controlling for C-reactive protein and intact parathyroid hormone levels. For each 1.0 U/L increase in sALP over time, the fully adjusted all-cause mortality hazard ratio using Cox models with the time-varying risk effect was 0.996 (95% confidence interval 0.993-1.000, P = .04). Conclusions Increasing longitudinal levels of sALP associate with improved nutritional status and lower mortality rates. sALP can be used as an integrated marker, combining the properties of the nutritional marker, the marker of mineral-bone disease and inflammation, according to its levels.

CT colonography (CTC), also known as “virtual colonoscopy,” is a minimally invasive complementary screening method to optical colonoscopy (OC) that is growing in its availability and utilization. As a screening test, it is typically performed in outpatient radiology sites. Examinations are monitored by a radiologist trained in its performance. CTC is selectively performed in a hospital setting for patients with comorbidities that render them at a high risk for OC, such as cardiac disease or screening before organ transplantation. In cases where OC is unsuccessful for at complete colonic inspection, CTC can be performed the same day after OC or planned at a later date to evaluate the remainder of the colon. Candidates for CTC must be able to follow instructions and tolerate colonic insufflation. Patients who have fecal incontinence or significant rectal prolapse are not candidates for CTC because of limited ability to maintain colonic distension. Finally, strict adherence to the recommended colonic preparation before CTC is critical to the examination's success.

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images. Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age

Early application of tourniquets has reduced injury death rates. At the end of 2013, the Israel Defense Forces Medical Corps completed a military-wide introduction of the Combat Application Tourniquet as the standard-issued tourniquet. The accompanying clinical practice guideline encouraged combat soldiers and medical teams towards a liberal use of tourniquets for extremity injuries, even when in doubt.This study aimed to assess the effects of the wide introduction of advanced tourniquets on the rate of tourniquet applications, the type of tourniquet applied, and the differences in hospitalisation outcomes following the introduction.The study population was composed of hospitalised military casualties with an extremity injury treated by military medical teams between 2006 and 2015. Prehospital data were extracted from the Israel Defense Forces Trauma Registry and matched to corresponding hospital data from the Israeli National Trauma Registry. Two periods were compared: 2006-2013 "pre-intervention period" and 2014-2015 "post-intervention period".A total of 1,578 casualties were recorded during the study period. Of these, 320 (20.3%) occurred between 2014-2015. Characteristics of casualties in the post-intervention period were similar to those in the pre-intervention period including the rate of traumatic amputations (2.5% vs 2.2%, p = 0.93) and Injury Severity Score of 16 or above (12.8% vs 14.9%, p = 0.40). The rate of tourniquet application was more than four-fold in the post-intervention period compared to the pre-intervention period (22.8% vs 5.5%, p 0.001). Nevertheless, rates of in-hospital amputations (1.6% vs 1.6%, p = 1.00) and death (0.9% vs 1.3%, p = 0.53) were similar in the two periods.Following the IDF military-wide introduction of advanced tourniquets, the tourniquet application rate rose sharply, the use of old tourniquets ceased over time, and in-hospital amputation rate did not increase. These findings suggest that the awareness for haemorrhage control using advanced tourniquets rose.