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The Interdisciplinary Home-bAsed Reablement Program (I-HARP) integrates evidence-based rehabilitation strategies into a dementia-specific person-centred, time-limited, home-based, interdisciplinary rehabilitation package. I-HARP was a 4-month model of care, incorporated into community aged care services and hospital-based community geriatric services. I-HARP involved: 8-10 individually tailored home visits by occupational therapist and registered nurse; 2-4 optional other allied health sessions; up to A$1,000 minor home modifications and/or assistive devices; and three individual carer support sessions. The aim of the study was to determine the effectiveness of I-HARP on the health and wellbeing of people living with dementia and their family carers.
A multi-centre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and family carers in Sydney, Australia (2018-22). Assessments of the client’s daily activities, mobility and health-related quality of life, caregiver burden and quality of life were conducted at baseline, 4- and 12-month follow-up. Changes from baseline were compared between groups.
Of 260 recruited, 232 (116 dyads of clients and their carers, 58 dyads per group) completed the trial to 4-month follow-up (89% retention). Clients were: aged 60-97 years, 63% female, 57% with mild dementia and 43% with moderate dementia. The I-HARP group had somewhat better mean results for most outcome measures than usual care at both 4 and 12 months, but the only statistically significant difference was a reduction in home environment hazards at 4 months (reduction: 2.29 on Home Safety Self-Assessment Tool, 95% CI: 0.52, 4.08; p=.01, effect size [ES] 0.53). Post-hoc sub-group analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group: 11.2 on Disability Assessment for Dementia (95% CI: 3.4, 19.1; p=.005; ES 0.69) at 4 months and 13.7 (95% CI: 3.7, 23.7; p=.007; ES 0.69) at 12 months.
The I-HARP model enhanced functional independence of people with mild dementia only but not significantly in people with moderate dementia, so did not result in better outcomes in the group overall. A different type of rehabilitation model or strategies may be required as dementia becomes more severe.
A simple FFQ which ranks young children's dietary habits is necessary for population-based monitoring and intervention programmes. The aim of the present study was to determine the reliability and validity of a short FFQ to assess the dietary habits of young children aged 2–5 years.
Parents completed a seventeen-item FFQ for their children by telephone on two occasions, two weeks apart. Sixty-four parents also completed 3 d food records for their children. The FFQ included daily servings of fruit and vegetables, frequency of eating lean meat, processed meats, take-away food, snack foods (biscuits, cakes, doughnuts, muesli bars), potato crisps and confectionery, and cups of soft drinks/cordials, juice, milk and water. Weighted kappa and intra-class correlation coefficients were used to assess FFQ reliability and the Bland–Altman method was used to assess validity of the FFQ compared with the 3 d food record.
Seven pre-school centres in metropolitan Sydney, Australia.
Seventy-seven children aged 2–5 years.
The majority of questions had moderate to good reliability: κw ranged from 0·37 (lean meat) to 0·85 (take-away food consumption). Validity analysis showed a significant increase in mean values from the food record with increasing ordered categories from the FFQ for servings of vegetables and fruit and cups of drinks (all trend P ≤ 0·01). Spearman rank correlation coefficient was >0·5 for vegetables, fruit, diet soft drinks and fruit juice.
The FFQ provides reliable and moderately valid information about the dietary intakes and habits of children aged 2–5 years, in particular for fruit, vegetables and beverages.
The effect on individual rankings and total intakes of nutrients of correcting total fruit and vegetable frequencies from a long food frequency questionnaire (FFQ) using the responses to two summary questions was examined in a group of women.
The performance of a self-administered FFQ in ranking individual levels of intake and estimating absolute levels of nutrient and energy intake was compared with the performance of the questionnaire when it was corrected for fruit and vegetable intake reported using the Block summary questions.
The study population included 123 women, aged between 18 and 54 years, who were recruited from the Family Planning Association Colposcopy Clinic in Sydney.
Substantial and significant differences (P<0.001) were found in fruit and vegetable intakes between the FFQ and the summary questions. Intake frequency by the FFQ was more than double that by the summary questions. When the FFQ was corrected for fruit and vegetable intakes using the summary questions, the intakes of beta-carotene, vitamins A and C, and dietary fibre were more than 20% lower (P<0.001) than the uncorrected results. However, this had little effect on ranking individuals. This study also examined seasonal differences in vegetable intakes and differences in nutrient intakes when either summer or winter vegetable consumption was substituted for seasonal vegetable intake in the FFQ. Although there were seasonal differences for some foods, the substitution had little effect on intake of nutrients.
These results indicate that important differences in intakes are observed when two methods, which appear to yield the same results, are used. Further work is needed to determine which, if either, of the two methods yields intakes that can be compared quantitatively with national references for assessing the adequacy of population intakes.
For families with multiple cases of bipolar disorder this study explored: attitudes towards childbearing; causal attributions for bipolar disorder, in particular the degree to which a genetic model is endorsed and its impact on the perceived stigma of bipolar disorder; and predictors of psychological distress.
Two hundred individuals (95 unaffected and 105 affected with either bipolar disorder, schizo-affective disorder – manic type, or recurrent major disorder) were surveyed, using mailed, self-administered questionnaires.
Thirty-five (35%) participants reported being ‘not at all willing to have children’ or ‘less willing to have children’ as a result of having a strong family history of bipolar disorder. Being not at all or less willing to have children was associated with perceived stigma of bipolar disorder [odds ratio (OR) 2·42, p=0·002], endorsement of a genetic model (OR 1·76, p=0·046), and being affected (OR 2·16, p=0·01). Among unaffected participants only, endorsement of a genetic model was strongly correlated with perceived stigma (rs=0·30, p=0·004). Perceiving the family environment as an important factor in causing bipolar disorder was significantly associated with psychological distress (OR 1·58, p=0·043) among unaffected participants. Among affected participants, perceived stigma was significantly correlated with psychological distress (OR 2·44, p=0·02), controlling for severity of symptoms (p<0·001).
Having a genetic explanation for bipolar disorder may exacerbate associative stigma among unaffected members from families with multiple cases of bipolar disorder, while it does not impact on perceived stigma among affected family members. Affected family members may benefit from interventions to ameliorate the adverse effects of perceived stigma.
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