This study compared the level of education and tests from multiple cognitive domains as proxies for cognitive reserve.

The participants were educationally, ethnically, and cognitively diverse older adults enrolled in a longitudinal aging study. We examined independent and interactive effects of education, baseline cognitive scores, and MRI measures of cortical gray matter change on longitudinal cognitive change.

Baseline episodic memory was related to cognitive decline independent of brain and demographic variables and moderated (weakened) the impact of gray matter change. Education moderated (strengthened) the gray matter change effect. Non-memory cognitive measures did not incrementally explain cognitive decline or moderate gray matter change effects.

Episodic memory showed strong construct validity as a measure of cognitive reserve. Education effects on cognitive decline were dependent upon the rate of atrophy, indicating education effectively measures cognitive reserve only when atrophy rate is low. Results indicate that episodic memory has clinical utility as a predictor of future cognitive decline and better represents the neural basis of cognitive reserve than other cognitive abilities or static proxies like education.

To investigate whether gender balance in academic psychiatry in the UK has improved since a 2005 initiative to encourage career progression for female academics in UK universities. We surveyed the gender of academic psychiatrists across the UK and compared our findings with our previous 2003 London-wide survey and with the Royal College of Psychiatrists’ 2001 workforce census.

The percentage of women in academic psychiatry posts in the UK more than doubled, from 20% in 2001 to 40% in 2019, with increases at senior lecturer (from 25 to 50%), reader/associate professor (from 29 to 48%) and professor level (from 11 to 21%). Outside London, men occupy 72% of all posts and 89% of professorial posts. Within London, men occupy 45% of all posts and 74% of professorial posts.

The representation of women in academic psychiatry has improved but men continue to dominate at professorial level. Gender equality appears worse outside London. The situation is exacerbated by the diminishing availability of posts across the UK.

Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness.

A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation.

We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics.

Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92–21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01–7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice.

Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.

Hispanics with lower acculturation may be at higher risk for neural tube defects compared with those with higher acculturation due to lower total folic acid intake or other undetermined factors. Modelling has indicated that fortification of corn masa flour with folic acid could selectively target Mexican Americans more than other race/ethnicities. We assessed whether fortification of corn masa flour with folic acid could selectively increase folic acid intake among Mexican-American women with lower acculturation, as indicated by specific factors (language preference, country of origin, time living in the USA).

We used dietary intake and dietary supplement data from the National Health and Nutrition Examination Survey 2001–2008, to estimate the amount of additional total folic acid that could be consumed if products considered to contain corn masa flour were fortified at 140 μg of folic acid per 100 g of corn masa flour.

USA.

Non-pregnant women aged 15–44 years (n 5369).

Mexican-American women who reported speaking Spanish had a relative percentage change in usual daily total folic acid intake of 30·5 (95 % CI 27·8, 33·4) %, compared with 8·3 (95 % CI 7·3, 9·4) % for Mexican-American women who reported speaking English. We observed similar results for other acculturation factors. An increase of 6·0 percentage points in the number of Mexican-American women who would achieve the recommended intake of ≥400 μg folic acid/d occurred with fortification of corn masa flour; compared with increases of 1·1 percentage points for non-Hispanic whites and 1·3 percentage points for non-Hispanic blacks. An even greater percentage point increase was observed among Mexican-American women who reported speaking Spanish (8·2).

Fortification of corn masa flour could selectively increase total folic acid intake among Mexican-American women, especially targeting Mexican-American women with lower acculturation, and result in a decrease in the number of pregnancies affected by neural tube defects.

This paper explores the variable provision of English health visiting services, despite government emphasis on the need to reduce health inequalities through early interventions and provide support to families with pre-school children.

There is increasing evidence of the importance to later health of early child development; that is from prenatal to eight years of age. In this population group, the strongest evidence for health improvement emphasizes support for families (especially mothers) until the infant is at least two to three years of age. In the last four to five years, English government policy has focused strongly on this important life stage, particularly noting its relevance in reducing health inequalities. Simultaneously, the health visiting workforce, arguably the occupational group most closely associated with this form of work, has reduced by 10%; and there is evidence of extreme variability in the way services are provided across the country.

Three sources of data were analysed to discover whether the variation in health visiting services relates to need, levels of deprivation or whether other factors are influential in planning provision. The ratio of health visitors to pre-school children was mapped to indices of multiple deprivations across 144 Primary Care Trusts. Survey data were examined for evidence of links, or not, to levels of deprivation and, finally, 30 Children and Young People’s Plans (CYPPs) were analysed to explore strategic planning about the distribution and type of services.

Health visiting service provision appears unrelated to areas of deprivation; although, the survey data offered some evidence that individual practitioners focused efforts on the most deprived clients on their caseloads, regardless of location. At a strategic level, the CYPPs made little mention of pre-school children or their needs and offered only limited descriptions of preventive health services. Policy recommendations are made about strengthening service provision in this field.