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Family caregivers of people with dementia can experience loss and grief before death. We hypothesized that modifiable factors indicating preparation for end of life are associated with lower pre-death grief in caregivers.
Caregivers of people with dementia living at home or in a care home.
In total, 150 caregivers, 77% female, mean age 63.0 (SD = 12.1). Participants cared for people with mild (25%), moderate (43%), or severe dementia (32%).
Primary outcome: Marwit-Meuser Caregiver Grief Inventory Short Form (MMCGI-SF). We included five factors reflecting preparation for end of life: (1) knowledge of dementia, (2) social support, (3) feeling supported by healthcare providers, (4) formalized end of life documents, and (5) end-of-life discussions with the person with dementia. We used multiple regression to assess associations between pre-death grief and preparation for end of life while controlling for confounders. We repeated this analysis with MMCGI-SF subscales (“personal sacrifice burden”; “heartfelt sadness”; “worry and felt isolation”).
Only one hypothesized factor (reduced social support) was strongly associated with higher grief intensity along with the confounders of female gender, spouse, or adult child relationship type and reduced relationship closeness. In exploratory analyses of MMCGI-SF subscales, one additional hypothesized factor was statistically significant; higher dementia knowledge was associated with lower “heartfelt sadness.”
We found limited support for our hypothesis. Future research may benefit from exploring strategies for enhancing caregivers’ social support and networks as well as the effectiveness of educational interventions about the progression of dementia (ClinicalTrials.gov ID: NCT03332979).
We clarify the theoretical foundations of partisan fairness standards for district-based democratic electoral systems, including essential assumptions and definitions not previously recognized, formalized, or in some cases even discussed. We also offer extensive empirical evidence for assumptions with observable implications. We cover partisan symmetry, the most commonly accepted fairness standard, and other perspectives. Throughout, we follow a fundamental principle of statistical inference too often ignored in this literature—defining the quantity of interest separately so its measures can be proven wrong, evaluated, and improved. This enables us to prove which of the many newly proposed fairness measures are statistically appropriate and which are biased, limited, or not measures of the theoretical quantity they seek to estimate at all. Because real-world redistricting and gerrymandering involve complicated politics with numerous participants and conflicting goals, measures biased for partisan fairness sometimes still provide useful descriptions of other aspects of electoral systems.
Pinterest (San Francisco, CA) and Instagram (Menlo Park, CA) are 2 popular photo-sharing social media platforms among young individuals. We assessed differences between Instagram and Pinterest in relaying photographic information regarding Zika virus. Specifically, we investigated whether the percentage of Zika-virus-related photos with Spanish or Portuguese texts embedded therein was higher for Instagram than for Pinterest and whether the contents of Zika-virus-related photos shared on Pinterest were different from those shared on Instagram.
We retrieved and manually coded 616 Pinterest (key words: “zika” AND “virus”) and 616 Instagram (hashtag: #zikavirus) photos.
Among the manually coded samples, 47% (290/616) of Pinterest photos and 23% (144/616) of Instagram photos were relevant to Zika virus. Words were embedded in 57% (164/290) of relevant Pinterest photos and all 144 relevant Instagram photos. Among the photos with embedded words, photos in Spanish or Portuguese were more prevalent on Instagram (77/144, 53%) than on Pinterest (14/164, 9%). There were more Zika-virus-related photos on Instagram than on Pinterest pertinent to Zika virus prevention (59/144, 41%, versus 41/290, 14%; P<0.0001), the effects of Zika virus on pregnancy (27/144, 19%, versus 32/290, 11%; P=0.04), and Zika-virus-associated deaths (4/144, 2%, versus 0/290, 0%; P=0.01).
Pinterest and Instagram are similar platforms for Zika virus prevention communication. (Disaster Med Public Health Preparedness. 2017;11:656–659)
Early in the history of schistosomiasis research, children under 5 years of age were known to be infected. Although this problem was recognized over 100 years ago, insufficient action has been taken to address this issue. Under current policy, such infected children only receive their first antiparasitic treatment (praziquantel – PZQ) upon entry into primary school as current mass drug administration programmes typically target school-aged children. For many infected children, they will wait up to 6 years before receiving their first medication and significant schistosomiasis-related morbidity may have already established. This inequity would not be accepted for other diseases. To unveil some of the reasons behind this neglect, it is paramount to understand the intricate historical relationship between schistosomiasis and British Imperial medicine, to underline its lasting influence on today's public health priorities. This review presents a perspective on the historical neglect of paediatric schistosomiasis, focusing on important gaps that persist from the early days after discovery of this parasite. Looking to end this inequity, we address several issues that need to be overcome to move forward towards the lasting success of schistosomiasis control and elimination efforts.
We evaluated the QX200 Droplet Digital PCR (ddPCR™, Bio-Rad) system and protocols for the detection of the tick-borne pathogens Borrelia burgdorferi and Borrelia miyamotoi in Ixodes scapularis nymphs and adults collected from North Truro, Massachusetts. Preliminary screening by nested PCR determined positive infection levels of 60% for B. burgdorferi in these ticks. To investigate the utility of ddPCR as a screening tool and to calculate the absolute number of bacterial genome copies in an infected tick, we adapted previously reported TaqMan®-based qPCR assays for ddPCR. ddPCR proved to be a reliable means for detection and absolute quantification of control bacterial DNA with precision as low as ten spirochetes in an individual sample. Application of this method revealed the average carriage level of B. burgdorferi in infected I. scapularis nymphs to be 2291 spirochetes per nymph (range: 230–5268 spirochetes) and 51 179 spirochetes on average in infected adults (range: 5647–115 797). No ticks naturally infected with B. miyamotoi were detected. The ddPCR protocols were at least as sensitive to conventional qPCR assays but required fewer overall reactions and are potentially less subject to inhibition. Moreover, the approach can provide insight on carriage levels of parasites within vectors.
Impulse control and future orientation increase across adolescence, but little is known about how contextual factors shape the development of these capacities. The present study investigates how stress exposure, operationalized as exposure to violence, alters the developmental pattern of impulse control and future orientation across adolescence and early adulthood. In a sample of 1,354 serious juvenile offenders, higher exposure to violence was associated with lower levels of future orientation at age 15 and suppressed development of future orientation from ages 15 to 25. Increases in witnessing violence or victimization were linked to declines in impulse control 1 year later, but only during adolescence. Thus, beyond previous experiences of exposure to violence, witnessing violence and victimization during adolescence conveys unique risk for suppressed development of self-regulation.
Consumer health organisations (CHOs), which operate outside the mainstream healthcare system with a specific focus on supporting people to self-manage their health conditions, have become widespread. Yet, there has been little systematic research into CHOs, including their perceived benefits and barriers, which encourage or deter their access by people with a variety of chronic health conditions.
This study explored the benefits of CHOs in self-management and also the barriers that inhibit their access, from the perspective of people with chronic conditions and their unpaid carers.
In-depth, semi-structured interviews were completed with 97 participants across four regions of Australia. The sample included a high representation of people from culturally and linguistically diverse backgrounds and Aboriginal and Torres Strait Islander people as well as non-indigenous Australians.
Three inter-related themes were identified that represented the benefits of involvement and participation in CHOs: knowledge and information, connection and support and experiential learning. However, limited access pathways emerged as a barrier that inhibited a person’s entry into CHOs. Furthermore, the person’s beliefs and experiences about their own health condition(s) also inhibited their continued participation in CHO programmes.
Although our findings confirm that CHOs are a valuable resource in alleviating the ‘work of being a patient’ for some people, there seems to be some barriers that prevent their full access and utilisation. Structured integration systems to increase the reliable delivery and accessibility of CHOs are needed to ensure that people who would benefit from accessing them can do so.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
A number of studies in a range of samples attest a link between childhood
sexual abuse and psychosis.
To use data from a large representative general population sample (Adult
Psychiatric Morbidity Survey 2007) to test hypotheses that childhood
sexual abuse is linked to psychosis, and that the relationship is
consistent with mediation by revictimisation experiences, heavy cannabis
use, anxiety and depression.
The prevalence of psychosis was established operationally in a
representative cross-sectional survey of the adult household population
of England (n = 7353). Using computer-assisted
self-interview, a history of various forms of sexual abuse was
established, along with the date of first abuse.
Sexual abuse before the age of 16 was strongly associated with psychosis,
particularly if it involved non-consensual sexual intercourse (odds ratio
(OR) = 10.14, 95% CI 4.8–21.3, population attributable risk fraction
14%). There was evidence of partial mediation by anxiety and depression,
but not by heavy cannabis use nor revictimisation in adulthood.
The association between childhood sexual abuse and psychosis was large,
and may be causal. These results have important implications for the
nature and aetiology of psychosis, for its treatment and for primary
Gender shapes one's role at home, in society, and in the economy. All cultures interpret and translate men's and women's biological differences into expectations about what behaviors and activities are appropriate for them and what rights, resources, and power they possess. Over the past three decades, these gender differences have increasingly gained prominence in the development agenda. More attention is being given to the plight of poor and disadvantaged women in developing countries, as well as to the unfinished gender agenda in more developed countries. Recognizing the importance of ensuring equal opportunities for females and males on grounds of both fairness and efficiency and as an instrument for achieving poverty reduction and economic growth, the international development community has included gender equality among the Millennium Development Goals (MDGs).
MDG3 reflects the strong belief by the development community that starkly unequal access to assets and opportunities between men and women produce further inequalities, harming not only women but also their families, and their communities. For example, disparities in education, employment, and wages hurt the women affected and also reduce the overall efficiency of the economy. Gender disparities that begin at a young age have significant long-term effects and are more costly to overcome later. Restricting the pool of educated people to boys reduces the overall talent pool.