Memory support training and lifestyle modifications to promote healthy aging in persons at risk for Alzheimer's disease: a digital application supported intervention (Brain Boosters).

BACKGROUND: Evidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application. METHODS: The study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work. DISCUSSION: Successful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD. TRIAL REGISTRATION: ClinicalTrials.gov. (NCT05027789, posted 8/30/2021).

Intervention for Cognitive Reserve Enhancement in Delaying the Onset of Alzheimer's Symptomatic Expression (INCREASE) Study: Results from a Randomized Controlled Study of Medication Therapy Management Targeting a Delay in Prodromal Dementia Symptom Progression.

BACKGROUND: Cognitive reserve has been hypothesized as a mechanism to explain differences in individual risk for symptomatic expression of Alzheimer's Disease (AD). Inappropriate medications may diminish cognitive reserve, precipitating the transition from preclinical AD (pAD) to a symptomatic state. To date, there is limited data on the potential impact of medication optimization as a potential tool for slowing the symptomatic expression of AD. OBJECTIVES: (1) To test the efficacy of a medication therapy management intervention designed to bolster cognitive reserve in community-dwelling older adults without dementia. (2) To evaluate the efficacy of intervention by baseline pAD status. DESIGN: A 1-year randomized controlled trial was conducted in community-dwelling older adults without dementia. Randomization was stratified by amyloid ß positron emission tomography levels. SETTING: Community-based, Lexington, Kentucky. PARTICIPANTS: Adults 65 years or older with no evidence of dementia and reporting at least one potentially inappropriate medication as listed in the Beers 2015 criteria were recruited. The study aimed to enroll 90 participants based on the a priori sample size calculation. INTERVENTION: Medication therapy management versus standard of care. MEASUREMENTS: Primary outcomes were: (1) one-year changes in the Medication Appropriateness Index; (2) one-year changes in Trail Making Test B under scopolamine challenge. RESULTS: The medication therapy management intervention resulted in significant improvement in Medication Appropriateness Index scores. Overall, there was no beneficial effect of the medication therapy management on Trail Making Test B scores, however stratified analysis demonstrated improvement in Trail Making Test B challenged scores associated with the medication therapy management for those with elevated amyloid ß positron emission tomography levels consistent with pAD. CONCLUSIONS: Medication therapy management can reduce inappropriate medication use in older adults at risk for AD. Our study indicated beneficial cognitive effects in those with preclinical Alzheimer's Disease. No statistically significant effects were evident in the study group as a whole, or in those without preclinical cerebral amyloidosis. Further work designed to improve the effectiveness of the medication therapy management approach and defining other preclinical pathologic states that may benefit from medication optimization are readily achievable goals for promoting improved cognitive health and potentially delaying the onset of symptomatic AD.

Changes in Physical Activity and Television Viewing From Pre-pregnancy Through Postpartum Among a Socioeconomically Disadvantaged Perinatal Adolescent Population.

STUDY OBJECTIVE: Adolescent pregnancy contributes to accelerated trajectories of adiposity and cardiometabolic diseases. Two potentially low-cost prevention strategies include promoting physical activity (PA) and limiting television (TV) viewing. Few studies have explored these behavior patterns in perinatal adolescents. This study sought to characterize PA and TV viewing in a socioeconomically disadvantaged perinatal adolescent population. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: A cross-sectional, retrospective, 10-item survey was used to explore behavior patterns in 79 predominantly Black (86%) postpartum adolescents. MAIN OUTCOME MEASURES: Outcomes included self-reported changes in PA from pre-pregnancy through pregnancy, and 7-day recall of PA and TV viewing in postpartum. RESULTS: The majority of adolescents (66%) reported being active on ≥3 days/week in pre-pregnancy; however, many reported low PA (≤2 days/wk) in their first (59%), second (66%), and third (54%) trimesters. Adolescents who reported being active on ≥5 days/wk in pre-pregnancy (19%) experienced first trimester PA decline, which subsequently plateaued. This group remained the most active throughout pregnancy. In postpartum, over half (54%) of all adolescents reported low PA and irrespective of PA, spent considerable time watching TV (median = 1680.0 minutes, inerquartile range = 2940). CONCLUSION: Interventions promoting PA coupled with reducing TV viewing during pregnancy and in postpartum may benefit perinatal adolescents. The findings from this study suggest that PA history is a predictor of gestational PA, and low PA and high TV viewing in postpartum underscore the need for behavioral intervention. Conducting a brief assessment of PA history in early gestation may offer important insight.

Childhood obesity prevention cluster randomized trial for Hispanic families: outcomes of the healthy families study.

BACKGROUND: Obesity prevalence is disproportionately high among Hispanic children. OBJECTIVES: The Healthy Families Study assessed the efficacy of a culturally targeted, family-based weight gain prevention intervention for Hispanic immigrant families with children ages 5-7 years. METHODS: The study used a two-group, cluster randomized trial design, assigning 136 families (clusters) to the active intervention (weight gain prevention) and 136 families to attention control (oral health). The active intervention included a 4-month intensive phase (eight classes) and an 8-month reinforcement phase (monthly mail/telephone contact). Children's body mass index z-score (BMI-Z) was the primary outcome. RESULTS: The BMI-Z growth rate of the active intervention group did not differ from the attention control group at short-term follow-up (median 6 months; 168 families, 206 children) or long-term follow-up (median 16 months; 142 families, 169 children). Dose response analyses indicated a slower increase in BMI-Z at short term among overweight/obese children who attended more intervention classes. Moderate physical activity on weekends increased at short term. Weekend screen time decreased at short term among those attending at least one class session. CONCLUSION: Low class attendance likely impacted intention-to-treat results. Future interventions targeting this population should test innovative strategies to maximize intervention engagement to produce and sustain effects on weight gain prevention.

Attrition in paediatric weight management: a review of the literature and new directions.

Paediatric obesity continues to be one of the most important health issues facing children and families today, and there remains a need for effective treatment options. There are a few reports in the literature demonstrating high rates of attrition from paediatric weight management programmes, ranging from 27% to 73%. While some studies show that racial/ethnic minorities, the economically disadvantaged and those with higher levels of obesity are at risk, other studies do not. There is some consistency in reasons given by families for attrition from treatment, most often scheduling issues and programmes not meeting family needs or expectations. This review highlights identified contributors to attrition from paediatric weight management and provides a framework to study this problem, based on models of adherence to paediatric medical regimens.

Self-help CBT for depression: opportunities for primary care mental health nurses?

Mental health treatments that are effective and accessible to the general population are in high demand. Cognitive behavioural therapy (CBT) has been shown to be effective and is popular but such treatments are difficult to access especially within primary care, causing delay, frustration and suffering. One approach to meeting demand would be through the use of self-help CBT materials that aim to address common mental health problems such as depression. The aim of this review is to discover whether self-help CBT materials are effective in the treatment of depression and how mental health nurses within primary care can use their skills to provide access and low-level support. Studies critiqued within this literature review indicate that self-help CBT is effective for the treatment of depression. However, there is a lack of evidence that specifically considers self-help CBT for the treatment of depression in primary care. This review addresses the question of how much nurse client contact is needed to provide adequate support for the facilitation of self-help CBT in depression with primary care patients and recommends the use of a service delivery model. However, more research needs to be carried out on the application of self-help CBT for depression in primary care.

Zero tolerance of violence against healthcare staff.

A government campaign aimed at stopping violence against healthcare staff is a start in dealing with the problem of aggression in the workplace. Staff attitudes will also need to be addressed, particularly in those areas where violence has become an accepted part of the job, if zero tolerance is to be achieved.

Sign of the times or the shape of things to come? A 3-day unit of instruction on 'aggression and violence in health settings for all students during pre-registration nurse training'.

In the UK, figures based on a recent survey of NHS Trusts suggest that health-care workers are at greater risk (four times higher than normal) from work related violence than the general population. Studies also show that, of all health professions and grades, student nurses are at the greatest risk of being the victim. Yet, training in self-protection and pro-active management of aggression and violence remains predominantly a post-registration preserve. Despite English National Board (1993) recommendations recognizing that all pre-registration courses for nurses and midwives should contain material on aggression and violence delivered by appropriately qualified trainers and teachers, this input is still likely to be uncoordinated and disparate within curricula. This paper reports the design, and early experience of delivery, of an integrated, 3-day unit of instruction for pre-registration students within a Common Foundation Programme of a diploma-level course. The unit designer/leader is a University Lecturer and Royal College of Nursing (RCN) Institute Registered Trainer in the management of actual and potential aggression. Consequently, all aspects involving teaching physical skills (breakaway skills) adhere to the recently published RCN training standards. In addition, initial student feedback on the delivery and suitability of the unit will be presented, along with a discussion of related issues.

Ethics, home births and NHS trusts.

A long-time campaigner, for women to have a better and safer deal from the maternity services when giving birth, reviews the continuing difficulties many face when wanting to give birth at home.

The strengths and weaknesses of cognitive behavioural approaches to treating depression and their potential for wider utilization by mental health nurses.

Depression is widely acknowledged to be the major factor implicated with suicide, an enormous financial cost on the economies of western countries and a source of intense despair for millions of people around the world. A steady stream of articles are published both in popular, generic and specialist nursing journals that illustrate the potential of cognitive behavioural therapies in the treatment of depression. Should these therapies be restricted for use by registered therapists or do the techniques have a wider application? The marketing of these approaches for use by nurses prompted a review of the purported strengths and weaknesses of these approaches in comparison with other possible alternatives. Many mental health nurses in community settings already use cognitive behavioural approaches with clients. Here it will be argued that several of the recognized strengths of cognitive behavioural approaches lend themselves to incorporation in nurse-patient interactions in varied in-patient settings by nurses who spend protracted periods of time with depressed patients but lack formal therapist qualifications and do not consider themselves counsellors.

A pilot project to determine the demand for and utility of an out-of-hours psychiatric service run by on-call psychiatric nurses in an A&E department.

This paper presents the results of a 12-week pilot project that studied the demand for and utility of an out-of-hours on-call psychiatric service delivered by two experienced psychiatric nurses in an A&E department. It also considers some of the implications for a possible permanent, substantive service. An initiative to reduce the on-call hours worked by junior medical staff harked back to literature which has long suggested that health professionals, other than medical staff, can competently perform risk assessments and determine the immediate needs of patients who self-harm. The project's aims were to determine: (i) whether an on-call psychiatric nurse could satisfactorily reduce the pressures on on-call junior doctors; and (ii) the absolute demand for and nature of requested out-of-hours psychiatric assistance. Summarized details of referred patients include data on time and duration of contact, reasons for referral, outcome and other professionals involved. Of the 88 patients referred during the pilot period, 33 (37.5% of the total) were admitted to psychiatric wards and four to medical wards. Although a range of professionals was needed during the 12-week period, the nurses dealt with 42 (47.7%) of the referrals without any other professional involvement.

Knowledge, attitudes, and practices related to fruit and vegetable consumption of high school students.

PURPOSE: To assess the level of nutrition knowledge, attitudes and practices related to fruit and vegetable consumption of high school students attending participating parochial schools in the New Orleans area. METHODS: The baseline data reported in this study, "Gimme 5: A Fresh Nutrition Concept for Students," represents one of the nine National Cancer Institute-funded projects from the national "5-A-Day for Better Health Program" initiated in 1991. A survey containing 22 nutrition-related items about fruit and vegetables was used to assess knowledge in 2213 students. RESULTS: On average, adolescents reported 39% correct knowledge scores. A significant ethnic effect (p < .001) was noted, with White adolescents scoring higher than African American adolescents. Significant ethnic differences in the frequency of fruit and vegetable consumption were also observed, with African-American adolescents reporting a lower mean consumption (2.17 servings) than white adolescents (2.69 servings). Consumption by Hispanic youth (2.48 servings) was similar to those in the "other" ethnic category (2.55 servings). Girls reported being more confident in their ability to eat five servings of fruits and vegetables per day than did boys (p < .05). CONCLUSIONS: Although the knowledge and consumption levels of adolescents with regard to fruits and vegetables were low, their attitudes toward learning about healthier eating practices were favorable.

Sign of the times or the shape of things to come? A 3-day unit of instruction on 'aggression and violence in health settings for all students during pre-registration nurse training'.

In the UK, figures based on a recent survey of NHS Trusts suggest that health-care workers are at greater risk (four times higher than normal) from work related violence than the general population. Studies also show that, of all health professions and grades, student nurses are at the greatest risk of being the victim. Yet, training in self-protection and pro-active management of aggression and violence remains predominantly a post-registration preserve. Despite English National Board (1993) recommendations recognizing that all pre-registration courses for nurses and midwives should contain material on aggression and violence delivered by appropriately qualified trainers and teachers, this input is still likely to be uncoordinated and disparate within curricula. This paper reports the design, and early experience of delivery, of an integrated, 3-day unit of instruction for pre-registration students within a Common Foundation Programme of a diploma-level course. The unit designer/leader is a University Lecturer and Royal College of Nursing (RCN) Institute Registered Trainer in the management of actual and potential aggression. Consequently, all aspects involving teaching physical skills (breakaway skills) adhere to the recently published RCN training standards. In addition, initial student feedback on the delivery and suitability of the unit will be presented, along with a discussion of related issues.