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The literature on late-life anxiety has grown exponentially in the last two decades, and a wide array of research questions are being explored by an ever-growing cadre of clinicians and scientists internationally. In fact, in the last decade, there have been several special journal issues devoted to aspects of anxiety in later life – for example, American Journal of Geriatric Psychiatry (2011, vol. 19, issue 4), Journal of Anxiety Disorders (2013, vol. 27, issue 6), International Psychogeriatrics (2015, vol. 27, issue 7), and Clinical Gerontologist (2017, vol. 40, issue 3). All have made the point that while our understanding of the etiology, diagnosis, assessment, and treatment of such disorders has grown and continues to increase, there are still many areas requiring further research attention. In addition, experimental techniques to study the biological mechanisms underpinning anxiety continue to grow in sophistication and access.
Historically, clinicians and researchers interested in the mental health of older people have focused on depression and dementia and have given little attention to anxiety except as a complication of depression or dementia. Over recent years, however, research into anxiety in older people has increased substantially, leading to both a burgeoning scientific literature and increasing clinical interest in the field.
Anxiety disorders in later life have historically been overshadowed by strong clinical and epidemiological interest in mood disorders and cognitive disorders. This chapter reviews the key scientific literature on the epidemiology of anxiety disorders in older people and putative risk and protective factors.
Although behavioural and psychological interventions are considered first-line treatments for anxiety disorders in older people (National Institute for Health and Care Excellence, 2014), psychotropic medications are also widely prescribed (Hollingworth & Siskind, 2010). Drugs from a range of psychotropic classes have been used to treat anxiety disorders, including benzodiazepines, antidepressants, anticonvulsants, and antipsychotics (Reinhold et al., 2011). While there is clinical trial evidence for the short-term efficacy of drugs from each of these classes, particularly for generalized anxiety disorder (GAD), there is scant evidence for long-term effectiveness. Psychotropic drugs exhibit a wide range of adverse effects, including some that pose particular hazards in later life.
Historically, clinicians and researchers have focused on depression and dementia in older people, paying little attention to anxiety except as a complication of these disorders. However, increased research into late-life anxiety has seen a growth in scientific literature and clinical interest. This important book brings together international experts to provide a comprehensive overview of current knowledge in relation to anxiety in older people, highlighting gaps in both theory and practice, and pointing towards the future. Early chapters cover the broader aspects of anxiety disorders, including epidemiology, risk factors, diagnostic issues, association with insomnia, impaired daily functioning, suicidality, and increased use of healthcare services. The book then explores cross-cultural issues, clinical assessment, and pharmacological and psychological interventions across a variety of settings. An invaluable resource for mental health professionals caring for older people including researchers, psychiatrists, psychologists, specialist geriatric nurses and social workers.
This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters.
Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management.
A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol.
Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care.
Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.
Verbal working memory (VWM) deficits are common in individuals with developmental language disorder (DLD) but are not well understood. This study evaluated how both memory and language production factors influence VWM performance in children and adults with DLD, focusing on the influence of serial position, phonological activation (PA), and lexical frequency. Participants were 30 children with DLD and 26 with typical language, and 21 adults with DLD and 23 with typical language. The participants completed a listening span task in which they were asked to recall the final words of sentences in sets of increasing size. Responses (dependent variable) were coded as correct, incorrect, or no response. Final words were coded for frequency, serial position within the set, and PA (number of occurrences of the initial phoneme, vowel, and whole word in the task). These variables, along with age and language status, were entered as predictors in mixed-effects multinomial regression models. Extreme serial position, greater PA, and higher frequency reduced incorrect and no responses. These effects were attenuated for the DLD group, and the effect of greater PA varied with set size. The findings suggest that for individuals with DLD, VWM performance is affected by more limited effective language experience and by the dynamic task demands.
The purpose of this study was to examine whether self-efficacy predicted pediatric concussion symptom severity and explore whether affective mood states (e.g., depression) influenced this relationship.
Children (8–17 years) who were diagnosed with a concussion within 30 days of injury participated in the study (n = 105). Following a clinical assessment, participants and caregivers completed questionnaires that assessed overall concussion symptom severity and current depression symptoms. Participants also completed ratings capturing self-efficacy for managing concussion recovery.
Linear regression models revealed that greater levels of self-efficacy predicted lower parent- (R2 = 0.10, p = .001) and youth-rated (R2 = 0.23, p < .001) concussion symptom severity. Interestingly, depression symptoms moderated the relationship between self-efficacy and concussion symptom severity.
Findings provide initial support for a relationship between self-efficacy and concussion outcomes and highlight the influence of depressive symptoms. Interventions that optimize youth’s self-efficacy have the potential to increase treatment adherence, reduce concussion symptom severity, and improve recovery prognosis.
Percutaneous closure of atrial septal defect is recognised as a safe and effective procedure, however, in some patients complications may occur. Although chest pain has been sporadically reported, its exact aetiology has been poorly studied. Herein, a 14-year-old female with an atypical and long-lasting chest pain after percutaneous atrial septal defect closure is described.
On the eve of its foundation in 1954, the Republic of Vietnam had five motorised fishing boats; 20 years later, that figure had swelled to over sixty thousand. This conversion to fossil fuels, along with associated developments like the intensified exploitation of marine ecologies and the use of new synthetic materials, form part of what has come to be called the ‘Great Acceleration’. This article follows a Japanese fisheries expert who spent six years in Vietnam in the early 1960s to explore the physical and conceptual work this process entailed, its entanglement with projects of war-making and nation-building, and the way it was both a product of and producer of the collapse of local ecologies.
China implemented an unprecedented expansion of higher education along with excellence initiatives that propelled more universities into the global rankings. Yet, the international influence of the higher education system pales in comparison to its economy. This paper argues that governance reforms in higher education only partially address the increasingly complex social and geopolitical realities. With more institutional and professional autonomy, universities and the academic research enterprise would be better placed and more inclined to find innovative solutions to urgent problems of domestic and global sustainability.
Treatment for major depressive disorder (MDD) is imprecise and often involves trial-and-error to determine the most effective approach. To facilitate optimal treatment selection and inform timely adjustment, the current study investigated whether neurocognitive variables could predict an antidepressant response in a treatment-specific manner.
In the two-stage Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) trial, outpatients with non-psychotic recurrent MDD were first randomized to an 8-week course of sertraline selective serotonin reuptake inhibitor or placebo. Behavioral measures of reward responsiveness, cognitive control, verbal fluency, psychomotor, and cognitive processing speeds were collected at baseline and week 1. Treatment responders then continued on another 8-week course of the same medication, whereas non-responders to sertraline or placebo were crossed-over under double-blinded conditions to bupropion noradrenaline/dopamine reuptake inhibitor or sertraline, respectively. Hamilton Rating for Depression scores were also assessed at baseline, weeks 8, and 16.
Greater improvements in psychomotor and cognitive processing speeds within the first week, as well as better pretreatment performance in these domains, were specifically associated with higher likelihood of response to placebo. Moreover, better reward responsiveness, poorer cognitive control and greater verbal fluency were associated with greater likelihood of response to bupropion in patients who previously failed to respond to sertraline.
These exploratory results warrant further scrutiny, but demonstrate that quick and non-invasive behavioral tests may have substantial clinical value in predicting antidepressant treatment response.
Single-particle reconstruction can be used to perform three-dimensional (3D) imaging of homogeneous populations of nano-sized objects, in particular viruses and proteins. Here, it is demonstrated that it can also be used to obtain 3D reconstructions of heterogeneous populations of inorganic nanoparticles. An automated acquisition scheme in a scanning transmission electron microscope is used to collect images of thousands of nanoparticles. Particle images are subsequently semi-automatically clustered in terms of their properties and separate 3D reconstructions are performed from selected particle image clusters. The result is a 3D dataset that is representative of the full population. The study demonstrates a methodology that allows 3D imaging and analysis of inorganic nanoparticles in a fully automated manner that is truly representative of large particle populations.