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As part of the Pathology, Alzheimer’s and Related Dementias Study, we conducted uniform structured interviews with knowledgeable informants (72% children) of 1,493 older (age > 65) Brazilian decedents.
The interview included measures of social isolation (number of family and friends in at least monthly contact with decedent), emotional isolation (short form of UCLA Loneliness Scale), and major depression plus the informant portion of the Clinical Dementia Rating Scale to diagnose dementia and its precursor, mild cognitive impairment (MCI).
Decedents had a median social network size of 8.0 (interquartile range = 9.0) and a median loneliness score of 0.0 (interquartile range = 1.0). On the Clinical Dementia Rating Scale, 947 persons had no cognitive impairment, 122 had MCI, and 424 had dementia. In a logistic regression model adjusted for age, education, sex, and race, both smaller network size (odds ratio [OR] = 0.975; 95% confidence interval [CI]: 0.962, 0.989) and higher loneliness (OR = 1.145; 95% CI: 1.060, 1.237) were associated with higher likelihood of dementia. These associations persisted after controlling for depression (present in 10.4%) and did not vary by race. After controlling for depression, neither network size nor loneliness was related to MCI.
Social and emotional isolation are associated with higher likelihood of dementia in older black and white Brazilians.
Despite the substantial investment by Australian health authorities to improve the health of rural and remote communities, rural residents continue to experience health care access challenges and poorer health outcomes. Health literacy and community engagement are both considered critical in addressing these health inequities. However, the current focus on health literacy can place undue burdens of responsibility for healthcare on individuals from disadvantaged communities whilst not taking due account of broader community needs and healthcare expectations. This can also marginalize the influence of community solidarity and mobilization in effecting healthcare improvements.
The objective is to present a conceptual framework that describes community literacy, its alignment with health literacy, and its relationship to concepts of community engaged healthcare.
Community literacy aims to integrate community knowledge, skills and resources into the design, delivery and adaptation of healthcare policies, and services at regional and local levels, with the provision of primary, secondary, and tertiary healthcare that aligns to individual community contexts. A set of principles is proposed to support the development of community literacy. Three levels of community literacy education for health personnel have been described that align with those applied to health literacy for consumers. It is proposed that community literacy education can facilitate transformational community engagement. Skills acquired by health personnel from senior executives to frontline clinical staff, can also lead to enhanced opportunities to promote health literacy for individuals.
The integration of health and community literacy provides a holistic framework that has the potential to effectively respond to the diversity of rural and remote Australian communities and their healthcare needs and expectations. Further research is required to develop, validate, and evaluate the three levels of community literacy education and alignment to health policy, prior to promoting its uptake more widely.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
To develop evidence-based materials which provide information and support for parents who are concerned about their baby’s excessive crying. As well as meeting these parents’ needs, the aim was to develop a package of materials suitable for use by the UK National Health Service (NHS).
Parents report that around 20% of infants in Western countries cry excessively without an apparent reason during the first four months of age. Traditionally, research has focused on the crying and its causes. However, evidence is growing that how parents evaluate and respond to the crying needs to receive equal attention. This focus encompasses parental resources, vulnerabilities, well-being and mental health. At present, the UK NHS lacks a set of routine provisions to support parents who are concerned about their baby’s excessive crying. The rationales, methods and findings from a study developing materials for this purpose are reported.
Following a literature review, 20 parents whose babies previously cried excessively took part in focus groups or interviews. They provided reports on their experiences and the supports they would have liked when their baby was crying excessively. In addition, they identified their preferred delivery methods and devices for accessing information and rated four example support packages identified by the literature review.
During the period their baby cried excessively, most parents visited a health service professional and most considered these direct contacts to have provided helpful information and support. Websites were similarly popular. Telephones and tablets were the preferred means of accessing online information. Groups to meet other parents were considered an important additional resource by all the parents. Three package elements – a Surviving Crying website, a printed version of the website and a programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner, were developed for further evaluation.
While the use of formal trauma teams is widely promoted, the literature is not clear that this structure provides improved outcomes over emergency physician delivered trauma care. The goal of this investigation was to examine if a trauma team model with a formalized, specialty-based trauma team, with specific activation criteria and staff composition, performs differently than an emergency physician delivered model. Our primary outcome was survival to discharge or 30 days.
An observational registry-based study using aggregate data from both the New Brunswick and Nova Scotia trauma registries was performed with data from April 1, 2011 to March 31, 2013. Inclusion criteria included patients 16 years-old and older who had an Injury Severity Score greater than 12, who suffered a kinetic injury and arrived with signs of life to a level-1 trauma centre.
266 patients from the trauma team model and 111 from the emergency physician model were compared. No difference was found in the primary outcome of proportion of survival to discharge or 30 days between the two systems (0.88, n=266 vs. 0.89, n=111; p=0.8608).
We were unable to detect any difference in survival between a trauma team and an emergency physician delivered model.
The objective of the present study was to investigate associations between sugar intake and overweight using dietary biomarkers in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).
Prospective cohort study.
EPIC-Norfolk in the UK, recruitment between 1993 and 1997.
Men and women (n 1734) aged 39–77 years. Sucrose intake was assessed using 7 d diet diaries. Baseline spot urine samples were analysed for sucrose by GC-MS. Sucrose concentration adjusted by specific gravity was used as a biomarker for intake. Regression analyses were used to investigate associations between sucrose intake and risk of BMI>25·0 kg/m2 after three years of follow-up.
After three years of follow-up, mean BMI was 26·8 kg/m2. Self-reported sucrose intake was significantly positively associated with the biomarker. Associations between the biomarker and BMI were positive (β=0·25; 95 % CI 0·08, 0·43), while they were inverse when using self-reported dietary data (β=−1·40; 95 % CI −1·81, −0·99). The age- and sex-adjusted OR for BMI>25·0 kg/m2 in participants in the fifth v. first quintile was 1·54 (95 % CI 1·12, 2·12; Ptrend=0·003) when using biomarker and 0·56 (95 % CI 0·40, 0·77; Ptrend<0·001) with self-reported dietary data.
Our results suggest that sucrose measured by objective biomarker but not self-reported sucrose intake is positively associated with BMI. Future studies should consider the use of objective biomarkers of sucrose intake.
This book explores the changing context of public services, and more specifically higher education, arguing that collaboration is the critical issue for the ongoing transformation and success of libraries, learning environments and learning services. This chapter explores these new demands on the people who work, and who potentially will work, in such services. Its central argument is that leadership development for collaboration, rather than leadership in general, is the single biggest issue and the single greatest lever for success in the future. Leadership and leaders at all levels are required when working across boundaries and when working in an increasingly diverse environment. This chapter explores this challenging issue in a global context, a context that demands increased flexibility when collaborating with diverse professional groups and where the boundaries of territory and service delivery become increasingly permeable. It will explore and provide models to help us consider these skills, attributes and behaviours indicating that certain approaches are transferable, transformational and sustainable across many kinds of libraries and learning environments. It will also discuss the significance of diversity and difference for leadership and suggest ways in which we can develop as individuals and as organizations in order to ensure effective collaboration and boundary crossing.
The leadership context: general observations
Several authors (including several of the contributors to this volume) have proposed that leadership is fundamental to the present and future development of library and information services – across all sectors – and to the future of public services in general. Yet this obsession with leadership, which pervades all aspects of our lives, conveys a disillusionment both with leaders in the current and recent global context and with models of leadership (Sinclair, 2007). There has been a cynicism and scepticism towards political and business leaders as we ask ‘Has leadership failed? Or worse, is it simply absent?’ (Walsh, 1994, 24); this has been exacerbated during the global financial crisis of the 21st century. The literature illustrates how much people and organizations expect from their leaders (see Kouzes and Posner, 2003), yet how often those expectations are not met.
This book grew out of our sense that the World Trade Organization (WTO) regime on government procurement – currently consisting principally of the plurilateral Agreement on Government Procurement (GPA) – is undergoing a far-reaching transition from constituting an important but relatively obscure element of the WTO to becoming a cornerstone of the international trading system. This change is occurring first and foremost as a result of the pending accession to the Agreement of important developing and transition economies such as China, Jordan and Armenia but also as a result of the ongoing effort to modernize the Agreement which is nearing completion and of increased interest in government procurement as a dimension of world trade in light of the recent economic crisis. There is, in our view, a critical need for informed discussion and reflection on these developments in the international community and among international legal scholars, practitioners and students. There is, of course, already a significant body of literature on the GPA as it emerged from the Uruguay Round and on other aspects of the WTO's procurement work, in particular on transparency, and we do not seek to replicate this here. Rather, the aim of the present volume is to explain, and to explore, the most recent developments concerning the WTO regime for government procurement, and to stimulate debate on the challenges that they pose.
Originally an important but relatively obscure plurilateral instrument, the WTO Agreement on Government Procurement (GPA) is now becoming a pillar of the WTO system as a result of important developments since the Uruguay Round. This collection examines the issues and challenges that this raises for the GPA, as well as future prospects for addressing government procurement at a multilateral level. Coverage includes issues relating to pending accessions to the GPA, particularly those of developing countries with a large state sector such as China; the revised (provisionally agreed) GPA text of 2006, including provisions on electronic procurement and Special and Differential Treatment for Developing Countries; and procurement provisions in regional trade agreements and their significance for the multilateral system. Attention is also given to emerging issues, especially those concerning environmental, social and SME policy; competition law; and the implications of the recent economic crisis.