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390 patients living at home with mild to moderate dementia and their family caregivers were recruited by 129 general practitioners (GPs) for a three-arm cluster-randomized longitudinal study. The IDA-Study (Initiative for dementia care in general practice, www.projekt-ida.de) was performed between 2005 and 2010 in Germany. Data were recorded by the GPs and the caregivers at baseline and after 12 and 24 months. 357 caregivers could be interviewed at baseline. The predictors for institutionalization were determined by means of binary logistic regression analysis.
The mean age of the dementia patients was 80.3 years (SD = 6.8). 65% suffered mild dementia, 35% had moderate dementia at baseline. 68% of the patients were women. The mean age of the family caregivers was 59.4 years (SD = 13.4); 73% were women.
Of the 250 evaluable cases who did not die at home during the first two years after baseline, 60 (24%) were institutionalized during this period. Neither the gender of the dementia patients (p = 0.78) nor that of the caregivers (p = 0.12) was a significant predictor for institutionalization in the regression analysis. Admission to a nursing home was significantly more frequent when the caregiver was older, in a city, when more use had been made of relief offers at baseline, and when the caregivers felt more burdened.
Institutionalization of a dementia patient does not depend on the gender of the dementia patient or on the gender of the caregiver. Factors of the care situation are decisive, especially whether relief offers are used or not.
Post-traumatic stress disorder (PTSD) is associated with elevated risk for metabolic syndrome (MetS). However, the direction of this association is not yet established, as most prior studies employed cross-sectional designs. The primary goal of this study was to evaluate bidirectional associations between PTSD and MetS using a longitudinal design.
A total of 1355 male and female veterans of the conflicts in Iraq and Afghanistan underwent PTSD diagnostic assessments and their biometric profiles pertaining to MetS were extracted from the electronic medical record at two time points (spanning ~2.5 years, n = 971 at time 2).
The prevalence of MetS among veterans with PTSD was just under 40% at both time points and was significantly greater than that for veterans without PTSD; the prevalence of MetS among those with PTSD was also elevated relative to age-matched population estimates. Cross-lagged panel models revealed that PTSD severity predicted subsequent increases in MetS severity (β = 0.08, p = 0.002), after controlling for initial MetS severity, but MetS did not predict later PTSD symptoms. Logistic regression results suggested that for every 10 PTSD symptoms endorsed at time 1, the odds of a subsequent MetS diagnosis increased by 56%.
Results highlight the substantial cardiometabolic concerns of young veterans with PTSD and raise the possibility that PTSD may predispose individuals to accelerated aging, in part, manifested clinically as MetS. This demonstrates the need to identify those with PTSD at greatest risk for MetS and to develop interventions that improve both conditions.
The histories of chronicles composed in England during the fourteenth and fifteenth centuries and onwards, with a focus on texts belonging to or engaging with the Prose Brut tradition, are thefocus of this volume. The contributors examine the composition, dissemination and reception of historical texts written in Anglo-Norman, Latin and English, including the Prose Brut chronicle (c. 1300 and later), Castleford's Chronicle (c. 1327), and Nicholas Trevet's Les Cronicles (c. 1334), looking at questions of the processes of writing, rewriting, printing and editing history. They cross traditional boundaries of subject and period, taking multi-disciplinary approaches to their studies in order to underscore the (shifting) historical, social and political contexts inwhich medieval English chronicles were used and read from the fourteenth century through to the present day. As such, the volume honours the pioneering work of the late Professor Lister M. Matheson, whose research in this area demonstrated that a full understanding of medieval historical literature demands attention to both the content of the works in question and to the material circumstances of producing those works.
Jaclyn Rajsic is a Lecturer in Medieval Literature in the School of English and Drama at Queen Mary University of London; Erik Kooper taught Old and Middle English at Utrecht University; until his retirement in 2007; Dominique Hoche is an Associate Professor at West Liberty University in West Virginia.
Contributors: Elizabeth J. Bryan, Caroline D. Eckhardt, A.S.G. Edwards, Dan Embree, Alexander L. Kaufman, Edward Donald Kennedy, Erik Kooper, Julia Marvin, William Marx, Krista A. Murchison, Heather Pagan, Jaclyn Rajsic, Christine M. Rose, NeilWeijer
The number of confirmed, high-redshift galaxy clusters is very low compared to the number of well-studied clusters nearby. Bent, double-lobed radio sources are frequently found in galaxy clusters, and thus can be used as tracers for efficiently locating high-redshift clusters. Using our Spitzer Snapshot Survey, we have identified approximately 300 potential new clusters with redshifts 0.7 < z < 3. These objects make up the high-redshift portion of the Cluster Occupied by Bent Radio AGN (COBRA) survey. We have created color-magnitude diagrams using infrared and optical data. Using the colors of the radio source host and the red sequence we can estimate redshifts for our clusters, as well as examine the evolution of the cluster galaxies over a large range of cosmic time.
Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps.
We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980–December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties.
Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties.
A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.
In the European Rosetta project three separate, previously developed, ICT systems were improved and integrated to create one modular system that helps community-dwelling people with mild cognitive impairment and dementia in different stages of the disease. The system aims to support them in daily functioning, monitor (deviations from) patterns in daily behaviour and to automatically detect emergency situations. The study aimed to inventory the end users’ needs and wishes regarding the development and design of the new integrated Rosetta system, and to describe the to be developed Rosetta system.
Qualitative user-participatory design with in total 50 persons: 14 people with dementia, 13 informal carers, 6 professional carers, 9 dementia experts, 7 care partners within the project, and 1 volunteer. In the Netherlands user focus group sessions were performed and in Germany individual interviews. Dementia experts were consulted by means of a questionnaire, an expert meeting session, and interviews.
Persons with dementia and informal carers appreciated the following functionalities most: help in cases of emergencies, navigation support and the calendar function. Dementia experts rated various behaviours relevant to monitor in order to detect timely changes in functioning, e.g. eating, drinking, going to the toilet, taking medicine adequately, performance of activities and sleep patterns. No ethical issues regarding the use of sensors and cameras were mentioned.
The user participatory design resulted in valuable input from persons with dementia, informal carers and professional carers/dementia experts, based on which a first prototype Rosetta system was built.