Background: Black, Asian and Minority Ethnic (BAME) people continue to present later to specialist care centres and services for memory problems. This poses significant concerns due to implications for poorer treatment outcomes and higher treatment cost among this population. While diverse interventions to support improved help seeking for dementia have been proffered for other BAME communities, there is a paucity of research involving the Black African and Caribbean community. Furthermore, whilst community health professionals like the doctors and community nurses have been involved in such interventions, no previous research has considered the role of the community pharmacist. This research explored opportunities for community pharmacists to support improved help seeking for dementia among the Black African and Caribbean population.

Methods: This research was a multi-stage project involving surveys and interviews with community pharmacists and Black Africans and Caribbeans as participants.

Results: Knowledge, attitude and beliefs around dementia and it’s causes appeared to be major barriers to help seeking among the Black African and Caribbean population. For example, beliefs that dementia is caused by ‘the spirits’ and dementia is a repercussion for past wrongdoing and therefore not amenable to medical intervention. The community pharmacists believe they are well positioned to spot initial signs of dementia among their clients and are therefore willing to offer help seeking support to this population.

Conclusions: To offer intervention for timely help-seeking for dementia, a culturally tailored dementia education for the Black African and Caribbean population should be considered. In addition, training on the impact of cultural beliefs on help seeking for dementia should be considered for the communitypharmacists.

Up to 60% of people with dementia living in care homes will ‘wander’ (i.e. walk without a clear purpose) at some point, which may occur due to cognitive changes, issues with orientation or lifelong habits. Nonpharmacological interventions are considered the best approach to supporting wandering as they aim to address underlying causes while posing minimal risk to the individual. However, there are many benefits to wandering safely in care homes, including physical benefits of exercise, retaining autonomy over location, and maintaining self-identity. This study aimed to develop evidence to understand the perspectives of care home staff around wandering as a meaningful activity. Specifically, we sought to identify: i) attitudes towards wandering; ii) the barriers and facilitators to supporting wandering in the care home; and iii) support needs to implement strategies across different care home contexts.

We conducted 20 semi-structured interviews with staff members including direct care staff, registered nurses, managers, and activities coordinators. Participants were recruited from a range of care homes across North England who provide care for older adults living with dementia, using purposive sampling to recruit participants with a range of experiences. Data were analyzed using framework analysis, a form of thematic analysis.

Four main themes were identified and refined by the wider research team. The impact of the environment on how residents moved around the care home, the importance of life history and personhood for staff to understand the motivations residents had for wandering, individual factors that contributed to each resident’s unique experiences and the importance of the care home culture to whether residents were supported. Participants also highlighted a range of strategies that they engage with to support residents to wander safely.

Although this was a small-scale study, conducted in one region of England, it has implications for the ways that wandering as a behavior is conceptualized and supported in care homes. The importance of language and vocabulary was highlighted and requires further consideration. The results of this study will be used to develop further work to test strategies in care homes and produce guidelines for supporting residents to wander safely.

As there is currently no cure for dementia, providing psycho-social support is imperative. Counselling and psychotherapeutic interventions offer a way to provide individualised support for people with dementia and their families. However, to date, there has not been a systematic review examining the research evidence for these interventions. This review aimed to examine the following research questions: (1) Are counselling/psychotherapeutic interventions effective for people with dementia?, (2) Are counselling/psychotherapeutic interventions effective for care-givers of people with dementia? and (3) Which modes of delivery are most effective for people with dementia and care-givers of people with dementia? A systematic literature search was conducted in MEDLINE (via PubMed), PsycINFO and CINAHL in March 2019. Keyword searches were employed with the terms ‘dement*’, ‘counsel*’, ‘psychotherapy’, ‘therap*’, ‘care’ and ‘outcome’, for the years 2000–2019. Thirty-one papers were included in the review, from seven countries. Twenty studies were randomised controlled trials (RCTs) or adopted a quasi-experimental design. The remaining studies were qualitative or single-group repeated-measures design. The review identified variation in the counselling/psychotherapeutic approaches and mode of delivery. Most interventions adopted either a problem-solving or cognitive behavioural therapy approach. Mixed effectiveness was found on various outcomes. The importance of customised modifications for people with dementia was highlighted consistently. Understanding the dyadic relationships between people with dementia and their care-givers is essential to offering effective interventions and guidance for practitioners is needed. Information about the cognitive impairment experienced by participants with dementia was poorly reported and is essential in the development of this research area. Future studies should consider the impact of cognitive impairment in developing guidance for counselling/psychotherapeutic intervention delivery for people with dementia.

The above article (Griffiths et al., 2019) published with an incorrect abstract.

The correct abstract is as follows:

Glucagon-like peptide (GLP)-1 is an incretin hormone with several antidiabetic functions including stimulation of glucose-dependent insulin secretion, increase in insulin gene expression and beta-cell survival. Despite the initial technical difficulties and profound inefficiency of direct gene transfer into the pancreas that seriously restricted in vivo gene transfer experiments with GLP-1, recent exploitation of various routes of gene delivery and alternative means of gene transfer has permitted the detailed assessment of the therapeutic efficacy of GLP-1 in animal models of type 2 diabetes (T2DM). As a result, many clinical benefits of GLP-1 peptide/analogues observed in clinical trials involving induction of glucose tolerance, reduction of hyperglycaemia, suppression of appetite and food intake linked to weight loss have been replicated in animal models using gene therapy. Furthermore, GLP-1-centered gene therapy not only improved insulin sensitivity, but also reduced abdominal and/or hepatic fat associated with obesity-induced T2DM with drastic alterations in adipokine profiles in treated subjects. Thus, a comprehensive assessment of recent GLP-1-mediated gene therapy approaches with detailed analysis of current hurdles and resolutions, is discussed.

Despite the fact that insulin injection can protect diabetic patients from developing diabetes-related complications, recent meta-analyses indicate that rapid and long-acting insulin analogues only provide a limited benefit compared with conventional insulin regarding glycemic control. As insulin deficiency is the main sequel of type-1 diabetes (T1D), transfer of the insulin gene-by-gene therapy is becoming an attractive treatment modality even though T1D is not caused by a single genetic defect. In contrast to human insulin and insulin analogues, insulin gene therapy targets to supplement patients not only with insulin but also with C-peptide. So far, insulin gene therapy has had limited success because of delayed and/or transient gene expression. Sustained insulin gene expression is now feasible using current gene-therapy vectors providing patients with basal insulin coverage, but management of postprandial hyperglycaemia is still difficult to accomplish because of the inability to properly control insulin secretion. Enteroendocrine cells of the gastrointestinal track (K cells and L cells) may be ideal targets for insulin gene therapy, but cell-targeting difficulties have limited practical implementation of insulin gene therapy for diabetes treatment. Therefore, recent gene transfer technologies developed to generate authentic beta cells through transdifferentiation are also highlighted in this review.

A statically stable stratified water column that also contains horizontal property contrasts (either of passive tracer alone or of two dynamically active solutes) is generated and continuously maintained for a long period by releasing two turbulent buoyant plumes of equal buoyancy fluxes into opposite ends of a long channel of water. The bottom outflows from the plumes also continuously excite internal gravity waves that produce a series of counter-flowing quasi-horizontal shear layers which are quasi-stationary relative to the box but whose phase propagates downward through the upward-moving water column. We report that the flow further involves an oscillation associated with the internal waves that gives rise to a sequence of interleaving intrusions across the horizontal gradient region. The wave-driven intrusions are advected upward with the ‘filling-box’ circulation and have the appearance of a spatially growing instability. The intrusions are examined in cases having no horizontal property differences other than a passive tracer. In further experiments where one plume is salt solution and the other is sugar solution, there is vigorous double-diffusive convection on the interleaving intrusions, including salt fingering and diffusive density interfaces, but this convection has only a weak influence on the intrusion thicknesses and velocities. We conclude that under all conditions attained in these experiments, the interleaving is driven by internal waves and not by the property gradients, and we infer that the wave-generated intrusions enhance double-diffusive buoyancy fluxes.