Perceived burdensomeness may explain the relation between depression and suicide ideation. Clinicians seeing older adults should assess for depression and perceived burdensomeness when determining suicide risk. Future research directions include treatment studies for perceived burdensomeness as a way to reduce suicide ideation.

In Alzheimer Disease (AD), non-verbal skills often remain intact for far longer than verbally mediated processes. Four (1 female, 3 males) participants with early-stage Clinically Diagnosed Dementia of the Alzheimer Type (CDDAT) and eight neurotypicals (NTs; 4 females, 4 males) completed the emotional valence determination test (EVDT) while undergoing BOLD functional magnetic resonance imaging (fMRI). We expected CDDAT participants to perform just as well as NTs on the EVDT, and to display increased activity within the bilateral amygdala and right anterior cingulate cortex (r-ACC). We hypothesized that such activity would reflect an increased reliance on these structures to compensate for on-going neuronal loss in frontoparietal regions due to the disease. We used diffusion tensor imaging (DTI) to determine if white matter (WM) damage had occurred in frontoparietal regions as well. CDDAT participants had similar behavioral performance and no differences were observed in brain activity or connectivity patterns within the amygdalae or r-ACC. Decreased fractional anisotropy (FA) values were noted, however, for the bilateral superior longitudinal fasciculi and posterior cingulate cortex (PCC). We interpret these findings to suggest that emotional valence determination and non-verbal skill sets are largely intact at this stage of the disease, but signs foreshadowing future decline were revealed by possible WM deterioration. Understanding how non-verbal skill sets are altered, while remaining largely intact, offers new insights into how non-verbal communication may be more successfully implemented in the care of AD patients and highlights the potential role of DTI as a presymptomatic biomarker.

Face-labeling refers to the ability to classify faces into social categories. This plays a critical role in human interaction as it serves to define concepts of socially acceptable interpersonal behavior. The purpose of the current study was to characterize, what, if any, impairments in face-labeling are detectable in participants with early-stage clinically diagnosed dementia of the Alzheimer type (CDDAT) through the use of the sex determination test (SDT). In the current study, four (1 female, 3 males) CDDAT and nine (4 females, 5 males) age-matched neurotypicals (NT) completed the SDT using chimeric faces while undergoing BOLD fMRI. It was expected that CDDAT participants would have poor verbal fluency, which would correspond to poor performance on the SDT. This could be explained by decreased activation and connectivity patterns within the fusiform face area (FFA) and anterior cingulate cortex (ACC). DTI was also performed to test the association of pathological deterioration of connectivity in the uncinate fasciculus (UF) and verbally-mediated performance. CDDAT showed lower verbal fluency test (VFT) performance, but VFT was not significantly correlated to SDT and no significant difference was seen between CDDAT and NT for SDT performance as half of the CDDAT performed substantially worse than NT while the other half performed similarly. BOLD fMRI of SDT displayed differences in the left superior frontal gyrus and posterior cingulate cortex (PCC), but not the FFA or ACC. Furthermore, although DTI showed deterioration of the right inferior and superior longitudinal fasciculi, as well as the PCC, it did not demonstrate significant deterioration of UF tracts. Taken together, early-stage CDDAT may represent a common emerging point for the loss of face labeling ability.

began offering preventive services for international travel in 1996.Local demand for such services has steadily increased, especially among families who need services for multi-generation members on the same itinerary. This paper discusses our clinic operation; the clients we serve and their destinations; and the specific services and counseling we provide. We feel many such needs could be met by more family medicine practitioners, as the volume of international travel continues to increase. Introduction: Each year more United States citizens travel abroad; this trend is expected to continue as the population increases, and larger proportions are expatriates. In 2015, U.S. citizens made more than 32,789,000 trips outside of North America, most during May through August. 1 As of November 30, 2016, U.S. citizens completed more than 72,550,000 trips outside the country, an 8.0% increase over 2015, year-to-date; trips outside of North America accounted for approximately 44.0%. 2 More "new" infectious diseases are being recognized; recent examples: influenza A (avian) H5N1, first recognized in humans in Viet Nam in 2004,became a widespread zoonotic disease by 2008; influenza A (pandemic) H1N1 was first identified and became a global concern in 2009; Lassa, Ebola, and Marburg viruses "reappeared" as human disease risks in Africa in 2012 through 2015. 3,4,5,6 Middle East respiratory syndrome corona virus (MERS-CoV) first appeared in 2013 and continues as a regional risk to human health; the ongoing risk of influenza A (avian) H7N9 in the Orient was first recognized in 2013, and, by the end of 2014, the H5N6 strain had appeared in China. 5,6 Since then, Chikungunya and Zika viruses have become human disease risks in the Western Hemisphere. 7,8 These agents have only added to, not replaced, already-existing infectious disease risks for international travelers.