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The present study used factor analytic procedures to examine the factor structure of the CES-D among Filipino-American adolescents residing in rural and small town Hawaii. A total of 243 Filipino-American high school students completed the 20-item scale, and maximum likelihood analyses were employed to obtain a final solution. The results indicated that two factors provide a reasonably good fit: factor I combined depressed affect, somatic-retardation and interpersonal items, and factor II consisted of the remaining four positive affect items. The overlap of depressed affect and somatic symptoms support previous findings found among Asian American adults and other ethnic minority adolescents. The loading of the interpersonal items on the first factor is more unusual and suggests that interpersonal factors are not distinguished from depressed affect for the Filipino-American adolescent group. The usefulness of the CES-D as a tool to gain an understanding of the concept of depression across cultures is discussed. [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted on mild cognitive impairment without dementia among older adults in the U.S. It is mentioned that mild cognitive impairment might affect attention, language, judgment, and memory, but it doesn't severely impair activities of daily living. In the study, many neuropsychological tests were done on 856 people above 71 years. The researchers found that about 22% of the older people had cognitive impairment that did not develop into dementia.

This article reports on the psychometric properties of a newly constructed Hawaiian Culture Scale--Adolescent Version. A total of 2,272 Native Hawaiian and 1,170 non-Hawaiian adolescents were administered this 50-item inventory that measures the source of learning the Hawaiian way of life, how much Hawaiian beliefs are valued and important to maintain, how much non-Hawaiian beliefs are valued, Hawaiian blood quantum, and specific cultural traditions (seven subscales = Lifestyles, Customs. Activities, Folklore, Causes-Locations, Causes-Access, and Language Proficiency). The results strongly supported the internal consistency and validity of the measures for both the Hawaiian and non-Hawaiian groups. On the basis of the demographic data, partial support was offered for cross-cultural theories of ethnic identity. More consistent support was found for multiculturalism in Hawai'i's adolescents. Further research is needed to link these measures with indicators of psychological adjustment (e.g., depression, anxiety, substance use). [ABSTRACT FROM AUTHOR]

BACKGROUND Older adults who are discharged following emergency department evaluation are at increased risk for functional decline and health care utilization, and are likely to benefit from close follow-up and additional care services. Understanding factors associated with a return emergency department visit within 30 days among older fee-for-service Medicare beneficiaries discharged to the community may assist in identifying patients at greatest need for interventions. METHOD Predictors from Medicare data and public sources were evaluated in a retrospective data analysis of North and South Carolina residents (2011-2012) aged ≥ 65 years using Cox regression proportion hazards ratios (HR) and 95% confidence intervals (CI) for time-to-30-day return events. RESULTS 30-day return rates varied markedly among the 167 emergency department facilities studied (18%-39%). Predictors of 30-day return included: age (85+ versus 65-74; HR, 1.24; 95% CI, 1.22-1.27); male sex (HR, 1.11; 95% CI, 1.14-1.10); non-white race (HR, 1.07; 95% CI, 1.05-1.09); Medicaid eligibility (HR, 1.20; 95% CI, 1.18-1.22); Charlson Score (3+ vs. 0; HR, 1.33; 95% CI, 1.30-1.36); and prior emergency department encounter (3+ vs. 0; HR, 2.35; 95% CI 2.30-2.41). LIMITATIONS This study was limited to Medicare beneficiaries in North Carolina and South Carolina, 2011-2012. Administrative claims data are limited to information required for financial reimbursement. Because we limited our study to older fee-for-service patients, our findings may not be generalizable to managed care patients and other age groups. Patients transferred to another emergency department or facility were not included in the analysis. CONCLUSION Factors predicting 30-day return to the emergency department or hospitalization suggest the potential for care transition improvement efforts to better meet patient needs, thereby potentially improving post-emergency department outcomes., (©2019 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Quality Improvement Organizations (QIOs) are an unbiased source of quality improvement support and expertise for health care professionals and institutions across the nation. The Carolinas Center for Medical Excellence, the QIO in North Carolina and South Carolina, is supporting the advancement of the National Quality Strategy.

Background: Heart failure (HF) is a common clinical syndrome resulting in high morbidity and mortality. We examined the spectrum of ventricular dysfunction, and investigated the predictors of angiotensin-converting enzyme (ACE) inhibitor, beta-blocker, and spironolactone prescription in 1613 managed care patients with HF., Methods and Results: The diagnosis of HF was made by a HF discharge diagnosis or at least 3 physician encounters with a HF diagnosis during 2000. Logistic regression was used to identify predictors of medication prescription. Preserved systolic function was documented in 37%, moderate-severe systolic dysfunction in 31%, mild systolic in 14%, and 18% had inadequate documentation. The mean age was 69 years, 58% were women, 24% African American, and 60% were Medicare patients. Patients without HF type documented were the least aggressively treated. Coronary artery disease, hypertension, and diabetes predicted increased utilization of ACE inhibitor and beta-blocker therapies. History of nephropathy was associated with less ACE inhibitor prescription. Advancing age predicted less utilization of beta-blockers and spironolactone. Neither ethnicity nor gender influenced medication prescription., Conclusion: Preserved left ventricular function was common. Documentation of significant systolic dysfunction was associated with improved quality of care. Interventions to encourage documentation of HF type and further study of HF with preserved systolic function are warranted.

The analyses upon which this publication is based were performed under Contract No. 500-99-NC03, entitled "Utilization and Quality Control Peer Review Organization for the State of North Carolina," sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.

We report three recent cases of severe acute cerebral accident which occurred in the puerperium in women who received bromocriptine for milk suppression. Two patients experienced mild pregnancy-induced hypertension antepartum. Marked blood pressure elevation, above that which had prevailed previously, occurred postpartum in each case. The cerebral accidents manifested between the 6th and 14th days of the puerperium, the typical time for the occurrence of severe side effects from bromocriptine. These complications entailed lasting neurological sequelae in the three mothers who, based on their age, medical history and general state of health, were not significantly predisposed to cerebral accidents.

Recent literary case reports indicate that bromocriptine mesylate, when used for the suppression of lactation in the puerperium, can cause serious and even lethal side effects. The untoward sequelae are attributed to generalized or focal vasospasm affecting the cardiac and/or cerebral bold vessels. Apart from pre-existing hypertension and use in association with other ergot derivatives, the factors predisposing to such complications have not been elucidated, The authors present three atypical bromocriptine related postpartum accidents which may expand the understanding both of the predisposing factors and the potential consequences of bromocriptine related severe side effects. One of the cases raises the suspicion that the manifestations of hyperthyroidism may be aggravated by this method of pharmacologic ablactation. Another observation appears to imply that the drug may trigger the onset of chronic hypertension in women so predisposed. The development of cerebral infarcts, identified by MRI, in a clinically asymptomatic woman, exemplifies the threat of recurrent seizure activity in cases of bromocriptine related stroke.