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Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.
We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.
Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.
Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
The purpose of this Editorial is to summarise the key recommendations of the Lancet Commission on Dementia Prevention, Intervention, and Care, reporting on the best available evidence to date on what we can do to prevent and intervene for dementia. We briefly describe the new life-course model of dementia prevention incorporating nine modifiable risk factors and their potential effect in reducing individuals’ risk of dementia. We also summarise the recommendations of the report about which pharmacological, psychological, and social interventions are effective, and improve outcomes for people with dementia and their families. Recent developments highlight that there is good potential for the prevention of dementia. Progress in evidence-based approaches indicate the potential for dementia care to be of high-quality and widely accessible. Acting upon this knowledge now will reduce the global burden of dementia and improve the lives of people living with dementia and their families.
Serious mental illness (SMI) is profoundly stigmatised, such that there is even an impact on relatives of people with SMI.
To develop and validate a scale to comprehensively measure self-stigma among first-degree relatives of individuals with SMI.
We conducted group interviews focusing on self-stigma with first-degree relatives (n = 20) of people with SMI, from which 74 representative quotations were reframed as Likert-type items. Cognitive interviews with relatives (n = 11) identified 30 items for the Self-Stigma in Relatives of people with Mental Illness (SSRMI) scale. Relatives (n = 195) completed the scale twice, a month apart, together with four external correlate scales.
The 30-item SSRMI was reliable, with scores stable over time. Its single-factor structure allowed generation of a 10-item version. Construct validity of 30- and 10-item versions was supported by expected relationships with external correlates.
Both versions of the SSRMI scale are valid and reliable instruments appropriate for use in clinical and research contexts.
A variety of observations have been made of solar features (sunspots, faculae, the limb) using both array and single element scanning techniques. The telescope was the 1.6 m McMath-Pierce on Kitt Peak. Array data were acquired with a 58×62 pixel Si:Ga detector at 4.8, 7.8, 12.4, and 18 μm, while a CCD camera recorded the same image position at 0.5 μm. In a separate experiment, a nutating mirror device was used to generate a raster scan of solar disk areas, the output being fed to a Si PIN diode (0.5 μm filter) and a As:Si diode (12.4 μm filter). The scanner data yield simultaneous images at the two wavelengths and was essentially a repeat of the 1970 Turon-Léna experiment with updated equipment. Examples of images at the various wavelengths are given in the poster. Analysis of the data is incomplete at this time. We can report that the effects of seeing were encountered at all wavelengths, including 18μm, even though conditions were deemed good at times (for example, penumbral filaments were resolved in sunspots). We have thus been unable to verify, as yet, the conditions reported by Bester et al, in which exceptional seeing is realized in the infrared.
The technology leading to very large aperture telescopes and their optics has progressed well in the period since 1984 and plans for many new large aperture telescopes have been made. Focal plane instrumentation continues to become more sophisticated or more efficient: multi-object capabilities, automatic instrument control and operation, and increasing use of CCDs are examples of areas to which this applies. The proportion of time devoted to observations using two-dimensional photoelectronic detectors has grown substantially at many observatories, particularly with telescopes of moderate aperture; and the use of high quantum efficiency array detectors is now being extended into the infrared spectral region. Important advances have also been made in instrumentation and techniques for ground-based high angular resolution interferometry.
Surveying and declaring disease freedom in wildlife is difficult because information on population size and spatial distribution is often inadequate. We describe and demonstrate a novel spatial model of wildlife disease-surveillance data for predicting the probability of freedom of bovine tuberculosis (caused by Mycobacterium bovis) in New Zealand, in which the introduced brushtail possum (Trichosurus vulpecula) is the primary wildlife reservoir. Using parameters governing home-range size, probability of capture, probability of infection and spatial relative risks of infection we employed survey data on reservoir hosts and spillover sentinels to make inference on the probability of eradication. Our analysis revealed high sensitivity of model predictions to parameter values, which demonstrated important differences in the information contained in survey data of host-reservoir and spillover-sentinel species. The modelling can increase cost efficiency by reducing the likelihood of prematurely declaring success due to insufficient control, and avoiding unnecessary costs due to excessive control and monitoring.
Larger portion sizes (PS) may be inciting over-eating and contributing to obesity rates. Currently, there is a paucity of data on the effectiveness of serving size (SS) guidance. The aims of the present review are to evaluate SS guidance; the understanding, usability and acceptability of such guidance, its impact on consumers and potential barriers to its uptake. A sample of worldwide SS guidance schemes (n 87) were identified using targeted and untargeted searches, overall these were found to communicate various inconsistent and often conflicting messages about PS selection. The available data suggest that consumers have difficulty in understanding terms such as ‘portion size’ and ‘serving size’, as these tend to be used interchangeably. In addition, discrepancies between recommended SS and those present on food labels add to the confusion. Consumers generally understand and visualise SS best when expressed in terms of household measures rather than actual weights. Only a limited number of studies have examined the direct impact of SS guidance on consumer behaviour with equivocal results. Although consumers recognise that guidance on selecting SS would be helpful, they are often unwilling to act on such guidance. The challenge of achieving consumer adherence to SS guidance is formidable due to several barriers including chronic exposure to larger PS, distorted consumption norms and perceptions, the habit of ‘cleaning one's plate’ and language barriers for ethnic minorities. In conclusion, the impact of SS guidance on consumers merits further investigation to ensure that future guidance resonates with consumers by being more understandable, usable and acceptable.
Visual hallucinations and visuoperceptual deficits are common in dementia
with Lewy bodies, suggesting that cortical visual function may be
To investigate: (1) cortical visual function using functional magnetic
resonance imaging (fMRI); and (2) the nature and severity of perfusion
deficits in visual areas using arterial spin labelling (ASL)-MRI.
In total, 17 participants with dementia with Lewy bodies (DLB group) and
19 similarly aged controls were presented with simple visual stimuli
(checkerboard, moving dots, and objects) during fMRI and subsequently
underwent ASL-MRI (DLB group n = 15, control group
n = 19).
Functional activations were evident in visual areas in both the DLB and
control groups in response to checkerboard and objects stimuli but
reduced visual area V5/MT (middle temporal) activation occurred in the
DLB group in response to motion stimuli. Posterior cortical perfusion
deficits occurred in the DLB group, particularly in higher visual
Higher visual areas, particularly occipito-parietal, appear abnormal in
dementia with Lewy bodies, while there is a preservation of function in
lower visual areas (V1 and V2/3).
Background: People with dementia report lower quality of life, but we know little about what interventions might improve it.
Methods: We systematically reviewed 20 randomized controlled trials reporting the effectiveness of non-pharmacological interventions in improving quality of life or well-being of people with dementia meeting predetermined criteria. We rated study validity with a checklist. We contacted authors for additional data. We calculated standardized mean differences (SMD) and, for studies reporting similar interventions, pooled standardized effect sizes (SES).
Results: Pooled analyses found that family carer coping strategy-based interventions (four studies, which did not individually achieve significance; n = 420; SES 0.24 (range 0.03–0.45)) and combined patient activity and family carer coping interventions (two studies, not individually significant; n = 191; SES 0.84 (range 0.54–1.14)) might improve quality of life. In one high-quality study, a care management system improved quality of life of people with dementia living at home. Group Cognitive Stimulation Therapy (GCST) improved quality of life of people with dementia in care homes.
Conclusion: Preliminary evidence indicated that coping strategy-based family carer therapy with or without a patient activity intervention improved quality of life of people with dementia living at home. GCST was the only effective intervention in a higher quality trial for those in care homes, but we did not find such evidence in the community. Few studies explored whether effects continued after the intervention stopped. Future research should explore the longer-term impact of interventions on, and devise strategies to increase, life quality of people with dementia living in care homes or at home without a family carer.
The aetiology of visual hallucinations is poorly understood in dementia with Lewy bodies. Pathological alterations in visual cortical excitability may be one contributory mechanism.
To determine visual cortical excitability in people with dementia with Lewy bodies compared with aged-matched controls and also the relationship between visual cortical excitability and visual hallucinations in dementia with Lewy bodies.
Visual cortical excitability was determined by using transcranial magnetic stimulation (TMS) applied to the occiput to elicit phosphenes (transient subjective visual responses) in 21 patients with dementia with Lewy bodies and 19 age-matched controls.
Phosphene parameters were similar between both groups. However, in the patients with dementia with Lewy bodies, TMS measures of visual cortical excitability correlated strongly with the severity of visual hallucinations (P = 0.005). Six patients with dementia with Lewy bodies experienced visual hallucination-like phosphenes (for example, seeing people or figures on stimulation) compared with none of the controls (P = 0.02).
Increased visual cortical excitability in dementia with Lewy bodies does not appear to explain visual hallucinations but it may be a marker for their severity.
The a.c. magnetic properties measured at 60 Hz are found to be strongly affected by ribbon thickness and annealing temperature. These magnetic results are further characterized by observations on magnetic domain structure, crystallization, stress relaxation, and ribbon surface finish.