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As the population ages, the proportion of older people requiring functional support will increase significantly, as will the ‘dependency ratio’ (the number of dependent people divided by the working-age population). These demographic changes will place significant strain on society and systems of long-term care (LTC). Growing expectations of standards of care will, in the future, amplify tensions between quality and affordability. Although there is significant international variation, the LTC system in many countries has become increasingly sophisticated, with services provided in both the home and residential LTC provision. The roles of informal carers and family are also being acknowledged as part of a complex system of care .
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
Driving anxiety can range from driving reluctance to driving phobia, and 20% of young older adults experience mild driving anxiety, whereas 6% report moderate to severe driving anxiety. However, we do not know what impact driving anxiety has on health and well-being, especially among older drivers. This is problematic because there is a growing proportion of older adult drivers and a potential for driving anxiety to result in premature driving cessation that can impact on health and mortality. The purpose of the current study was to examine the impact of driving anxiety on young older adults’ health and well-being.
Data were taken from a longitudinal study of health and aging that included 2,473 young older adults aged 55–70 years. The outcome measures were mental and physical health (SF-12) and quality of life (WHOQOL-8).
Hierarchical multiple regression analyses demonstrated that driving anxiety was associated with poorer mental health, physical health, and quality of life, over and above the effect of socio-demographic variables. Sex moderated the effect of driving anxiety on mental health and quality of life in that, as driving anxiety increased, men and women were more likely to have lower mental health and quality of life, but women were more likely to have higher scores compared to men.
Further research is needed to investigate whether driving anxiety contributes to premature driving cessation. If so, self-regulation of driving and treating driving anxiety could be important in preventing or reducing the declines in health and quality of life associated with driving cessation for older adults affected by driving anxiety.
To investigate whether socioeconomic status influenced rates of depot medication prescribing, polypharmacy (more than two psychotropic medications), newer (second-generation) antipsychotic prescribing and clozapine therapy. Postcodes, Scottish Index of Multiple Deprivation (SIMD) categories and current medication status were ascertained. Patients in the most deprived SIMD groups (8–10 combined) were compared with those in the most affluent SIMD groups (1–3 combined).
Overall, 3200 patients with ICD-10 schizophrenia were identified. No clear relationship between socioeconomic status and any of the four prescribing areas was identified, although rates of depot medication use in deprived areas were slightly higher.
Contrary to our hypothesis, there was no evidence that patients with schizophrenia within NHS Greater Glasgow and Clyde who live in more deprived communities had different prescribing experiences from patients living in more affluent areas.
Prior studies have found no adverse effects of pediatric epilepsy
surgery on IQ. However, empirical techniques such as regression models,
designed to account for confounding factors such as practice effects
and test–retest reliability and able to provide a standardized
method for evaluating outcome, have not been used in studying change
after pediatric epilepsy. The goal of this study was to demonstrate the
regression technique while empirically measuring the effect of epilepsy
surgery on IQ in a group of pediatric patients. Predictors of retest IQ
(e.g., baseline IQ, retest interval, demographics, epilepsy severity)
were evaluated in a control group with intractable seizures (N
= 23) assessed twice with the WISC–III. The resulting equation
was used to evaluate IQ changes in a second group of children who
underwent epilepsy surgery (N = 22). In controls, baseline IQ
was a strong predictor of retest IQ. Number of AEDs was inversely
related to retest IQ. Based on the control regression, four children
(18%) in the surgical sample obtained significantly higher than
expected postsurgical IQ scores and one child (5%) obtained a lower
than expected IQ score. This study demonstrates that regression-based
techniques yield informative estimates on outcome and may be an
improvement over prior methods of measuring change after pediatric
epilepsy surgery. (JINS, 2003, 9, 879–886.)
Chronic obstructive pulmonary disease is a major cause of morbidity, disability and mortality in old age. The disease is characterized by shortness of breath, impaired ventilatory function and easy fatiguability. These are the most distressing and disabling symptoms of COPD, limiting exercise tolerance, interfering with basic activities of daily living and often, in turn, impairing quality of
The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.
A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).
The DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.
The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.
The ability of a target-controlled propofol infusion system to provide sedation for patients undergoing assessment of the upper airway during snoring is presented. This technique provides the desired sedation level for induction of snoring and is short acting and readily controllable. We advocate its use in sedation nasal endoscopy.