The role of carers in evaluating mental health services for older people

OBJECTIVES: To examine, using the published literature and local service experience, the contributions that carers can make to the development and evaluation of specialist mental health services for the elderly. METHODS: MEDLINE search for relevant papers about carers and the elderly, especially with mental disorders; review of recent experience of service planning, implementation and evaluation in the Cambridge area. RESULTS: Increased emphasis on the role of carers in recent literature, extending into acknowledgement of the carer perspective in official publications; few papers on the role of carers specifically in evaluating services, with only one study looking solely at an old age psychiatry service. CONCLUSIONS: There is considerable scope for involving carers in the development and evaluation of services, though there are also some potential concerns, not least that carers and users may have different perspectives. These issues are discussed, along with possible future developments, such as the need for a standardized assessment of carer satisfaction.     

BDNF is required for the normal development of taste neurons in vivo

The vallate gustatory epithelium of neonatal trkB null mutant mice (-/-) lacked innervation. This prompted the evaluation of null mutant mice corresponding to the three neurotrophin ligands for tyrosine kinase receptor B (TrkB): brain-derived neurotrophic factor (BDNF), neurotrophin (NT)3, NT4. The vallate gustatory epithelium of nt3-/- mice and of nt4-/- mice appeared normal. Only bdnf-/- mice had a vallate papilla that was stunted, sparsely innervated, and lacked up to 98% of its taste buds. All three defects persisted. For example, the vallate papilla of 12-day-old bdnf-/- mice remained markedly less well innervated than the vallate of 7-day-old or newborn bdnf+/+ mice. The foliate taste papillae of neonatal bdnf-/- mice had similar defects. We conclude that the normal development of taste neurons requires BDNF.     

Conditional logistic regression with sandwich estimators: application to a meta-analysis

Motivated by a meta-analysis of animal experiments on the effect of dietary fat and total caloric intake on mammary tumorigenesis, we explore the use of sandwich estimators of variance with conditional logistic regression. Classical conditional logistic regression assumes that the parameters are fixed effects across all clusters, while the sandwich estimator gives appropriate inferences for either fixed effects or random effects. However, inference using the standard Wald test with the sandwich estimator requires that each parameter is estimated using information from a large number of clusters. Since our example violates this condition, we introduce two modifications to the standard Wald test. First, we reduce the bias of the empirical variance estimator (the middle of the sandwich) by using standardized residuals. Second, we approximately account for the variance of these estimators by using the t-distribution instead of the normal distribution, where the degrees of freedom are estimated using Satterthwaite's approximation. Through simulations, we show that these sandwich estimators perform almost as well as classical estimators when the true effects are fixed and much better than the classical estimators when the true effects are random. We achieve simulated nominal coverage for these sandwich estimators even when some parameters are estimated from a small number of clusters.     

Crohn''s disease in infancy: a case report

We present a patient with pure alexia following a hemorrhagic infarction in the left fusiform gyrus. The symptom began with alexia preferentially disturbed for kana, but during the course of recovery slight agraphia for kanji became pronounced. In the earlier phase, alexia was more severe than agraphia and he could write kanji that he could not read. Furthermore, kinesthetic reading was effective. These findings are consistent with the symptoms of pure alexia, although the fact that a writing disturbance for kanji persisted resembles the profile of alexia with agraphia for kanji due to a posterior inferior temporal lesion. Based on the fact that the posterior inferior temporal lesion showed more severe agraphic symptom and more frequent nonresponse writing errors of kanji, and that our patient's lesion was mainly located in the fusiform gyrus that is medial to the inferior temporal gyrus, we believe that alexia occurred when the inferior temporal gyrus was disconnected from the fusiform gyrus, as a result, visual information could not reach the inferior temporal gyrus in which the visual images of individual kanji are stored.     

The federal budget and the New Federalism: Trends affecting mental health.

Outlines the Congressional budget process and its effects in 1981 on health and mental health issues, using federal aid to community health centers as a case illustration. The anticipated impact of the Reagan "New Federalism" proposal is assessed, and alternatives to block grants are mentioned. (PsycINFO Database Record (c) 2010 APA, all rights reserved)