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Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Community-based participatory research (CBPR) is an important framework for partnering with communities to reduce health disparities. Working in partnership with community incurs additional costs, some that can be represented in a budget summary page and others that are tied to the competing demands placed on community and academic partners. These cost considerations can inform development of community-academic partnerships. We calculated costs from a case study based on an ongoing CBPR project involving a Community Planning Group (CPG) of community co-researchers in rural Alaska and a bicultural liaison group who help bridge communication between CPG and academic co-researchers. Budget considerations specific to CBPR include travel and other communication-related costs, compensation for community partners, and food served at meetings. We also identified sources of competing demands for community and academic partners. Our findings can inform budget discussions in community-academic partnerships. Discussions of competing demands on community partners' time can help plan timelines for CBPR projects. Our findings may also inform discussions about tenure and promotion policies that may represent barriers to participation in CBPR for academic researchers.

With growing knowledge about the role of genetics in health, genetics education for health care professionals has taken on increasing importance. Many efforts are under way to develop new genetics curricula. Although such efforts are primarily the responsibility of health professional schools and professional societies, the public health system is an important stakeholder, and different sectors of public health have opportunities to enhance educational efforts. These include the development of authoritative information sources about the clinical utility of genetic susceptibility and pharmacogenetic tests, creation of networks that link professionals in underserved regions to educational materials and consultative backup, and sponsorship of forums for multidisciplinary discussion of controversial issues. Public health input can help to ensure an appropriate emphasis on health outcomes as new genomic tests and technologies come into use, thus helping to protect society from the social and medical costs of genetic tests with limited clinical value.

A significant number of senior citizens (aged 65+) spend their leisure time in gambling casinos in this country. For some older adults eager for a stimulating social outlet, casino gambling can become a virulent and destructive addiction. While prevalence studies have examined the incidence of problem gambling in other age groups, little attention has been paid to the impact of casino gambling on older adults. This study investigated the prevalence of casino gambling as a social activity for active senior citizens (aged 65+). Activity directors from residential and assisted-care facilities as well as from senior and retirement centers completed mailed surveys of eleven different types of social activities available to older adults. Results of the survey of activity directors found bingo the most highly frequented on-location-type social activity and casino gambling the most highly frequented day-trip-type social activity for 6,957 active senior citizens represented in the activity directors' survey. On average, 16 percent of the senior citizens were reported by the activity directors to have taken part in facility-sponsored trips to the casino on at least a once-a-month basis. In addition, the casinos themselves had offered additional gambling day-trips to 66 percent of the facilities, which were accepted in 58 percent of the cases. These findings suggest the need for greater awareness of the impact casino gambling may have on senior citizens in this country.

Background: Telemedicine has been increasingly used in some areas to provide consultation for isolated populations that might otherwise have difficulty accessing specialty care. Little information exists on what types of patients or diseases are being seen in dermatology telemedicine consultation services., Objective: To review our consultations done over a regional telemedicine network with an emphasis on looking at what type of patient, cutaneous diseases, and diagnostic or therapeutic recommendations were made., Results: Between August 1992 and December 1997, 796 teleconsultations were done. The most common diagnoses made were eczemas, follicular based diseases, skin infections, and skin tumours. Steroids were the most commonly recommended therapy, along with antibiotics, antihistamines, and antifungal therapy. Diagnostic recommendations commonly made were a skin biopsy and potassium hydroxide preparation., Conclusions: Common skin problems were seen by our dermatology teleconsultation service. A significant number of diagnostic biopsies and potassium hydroxide preparations were recommended. The efficacy of telemedicine in the delivery of dermatologic care is reviewed.

Delirium is a common complication of dementia and may produce considerable morbidity. In addition to psychotic symptoms such as hallucinations and delusions, delirium may produce considerable agitation, which may be refractory to conventional medications such as antipsychotics and benzodiazepines. The main approach to delirium is to treat any underlying medical problem that could cause the delirium. However, delirium is not always reversible, and there is no specific treatment for persistent delirium. The authors present a case of delirium complicating a preexisting dementia that resolved rapidly following initiation of the cholinesterase inhibitor donepezil, suggesting that cholinergic dysfunction may have played a role in the etiology of this patient's delirium. Future research needs to be directed at the issue of cholinergic activity in delirium through monitoring of serum anticholinergic activity and its response to procholinergic therapy.