Fracture risk is under-recognised and under-treated in memory clinic attendees.

UK national guidelines recommend that older people at risk of falling should have their fracture risk assessed and acted upon. People with cognitive impairment are more likely to sustain a fracture than their cognitively intact peers. We assessed the fracture risk of 79 memory clinic attendees and compared their actual management with guidelines. Despite reporting 57 falls in the last year, only 36% of those who would be recommended antiresportive treatment were prescribed it and a dual-energy X-ray absorptiometry (DEXA)scan was performed in only 13% where it would be recommended. These findings highlight an important deficit in fracture risk assessment which should inform future interventions.

Psychomotor Dance Therapy Intervention (DANCIN) for people with dementia in care homes: a multiple-baseline single-case study.

BACKGROUND: A Psychomotor DANCe Therapy INtervention (DANCIN) using Latin Ballroom (Danzón) in care homes has previously been shown to enhance well-being for both residents with dementia and staff. The aim of this study was to understand the effect of this approach on the mood and behavior of individual people living with mild to moderate dementia. METHOD: A multiple-baseline single-case study across two care homes and one nursing home with 3-6 weeks baseline, 12-weeks DANCIN (30 minutes/twice-weekly sessions), and 12-weeks follow-up was conducted. Seventeen items from the Dementia Mood Assessment Scale (DMAS) outcome measure were adapted with input from senior staff to match participants' behavior and mood symptoms. Daily monitoring diaries were collected from trained staff on reporting individualized items for ten residents. Data were analyzed, using a non-parametric statistical method known as Percentage of All Non-Overlapping Data (PAND) which provides Phi effect size (ES). Medication use, falls, and life events were registered. RESULTS: Seven residents participated throughout DANCIN whilst three became observers owing to health deterioration. One participant showed adverse effects in three DMAS items. Nine participants, dancers and observers, showed a small to medium magnitude of change (PAND) in 21 DMAS items, indicating a decrease in the frequency of behavior and mood indices which were regarded as problematic; eight items showed no change. CONCLUSION: Despite methodological challenges, the DANCIN model has the potential to facilitate and sustain behavior change and improve mood (e.g. decrease irritability, increase self-esteem) of the residents living with dementia. The study was conducted in two care homes and one nursing home, strengthening the interventions' validity. Findings suggest DANCIN is appropriate for a larger controlled feasibility study.

Leachate characteristics as influenced by application of anaerobic baffled reactor effluent to three soils: a soil column study.

A soil column study was undertaken in the laboratory with three contrasting soil types namely a sandy soil (Longlands (Typic Plinthaquult), E horizon), an organic soil (Inanda (Rhodic Hapludox), A horizon) and a clayey soil (Sepane (Aquic Haplustalf), A horizon). Anaerobic baffled reactor (ABR) effluent was leached through the soil and distilled water was concurrently used as a control. The effluent was slightly basic (pH 7.4-7.6), had heavy metal concentrations below permissible limits for irrigation purposes and contained plant nutrients such as P, S, Ca, Mg, and K. Results indicated that after application of 16 pore volumes, the concentrations of Ca(2+) and Mg(2+) were lower in the leachates than in the original effluent indicating adsorption by the soils and Mg(2+) was preferentially adsorbed to Ca(2+). Phosphorus was strongly adsorbed in all soils. While its adsorption in the Inanda could be attributed to organic matter and the presence of iron oxides and oxyhydroxides, the clay type and amount in the Sepane was likely responsible for P adsorption. The NO3(-)-N, which was initially low in the effluent, increased as leaching progressed while the NH4-N decreased. A chemical balance to ascertain loss or gain of major elements from the effluent application indicated P to be strongly immobilised from the effluent representing 41, 6 and 10 fold the fertilizer needs for maize in the Inanda, Longlands and Sepane, respectively. Results obtained indicated that the chemical composition of ABR effluent is significantly altered when leached through soils with distinct properties.

Dancing as a psychosocial intervention in care homes: a systematic review of the literature.

BACKGROUND: There is a need to find meaningful and engaging interventions to improve mood and behaviour for residents of care homes. The demand on care staff might diminish opportunities for them to encourage these activities. Staff anecdotal information attests that dancing as an activity improves mood in residents and staff. Hence, the importance of investigating what dancing brings to the care home social environment. AIMS: To provide a systematic review of the evidence from studies related to dancing interventions for older people with dementia living in care homes. METHOD: Electronic databases were searched. Previous reviews were also included, and recognised experts were consulted up to January 2012. Inclusion criteria considered study methodology and evidence that the impact of the dance intervention had been measured. RESULTS: Ten studies were identified that satisfied the inclusion criteria: seven qualitative and three quantitative. Studies used different approaches such as therapeutic dance, dance movement therapy, dance therapy, social dancing and psychomotor dance-based exercise. There was evidence that problematic behaviours decreased; social interaction and enjoyment in both residents and care staff improved. A few adverse effects were also acknowledged. CONCLUSION: The evidence on the efficacy of dancing in care homes is limited in part owing to the methodological challenges facing such research. This review aims to raise awareness of the possibility of implementing dance work as an engaging activity in care homes. We shall also consider options for future dance work research as a means to encourage relationships and sensory stimulation for both residents and staff.

Cord blood telomere length, telomerase activity and inflammatory markers in pregnancies in women with diabetes or gestational diabetes.

AIMS: We tested the hypothesis that diabetes during pregnancy leads to chromosomal DNA damage and telomere attrition in the feto placental unit and cord blood, and provides evidence for intrauterine programming towards a senescent phenotype in the offspring. METHODS: We obtained cord blood from pregnant women with pregestational Type 1 diabetes (n=26), Type 2 diabetes (n=20) or gestational diabetes (n=71), and control subjects without diabetes (n=45, n=76 and n=81, respectively) matched for maternal and gestational age. We measured cord blood mononuclear cell telomere length, telomerase activity (a reverse transcriptase that limits telomere attrition), and concentrations of insulin, high-sensitivity C-reactive protein (hs-CRP) and soluble intercellular adhesion molecule-1 (sICAM-1). RESULTS: We found no significant differences between groups in cord blood telomere length in any nucleated cell type, or in hs-CRP or sICAM-1 concentrations, but telomerase activity was higher in cord blood from Type 1 (P<0.05) and gestational diabetes pregnancies (P<0.05), but not in Type 2 diabetes pregnancies. There were no significant relationships between glycaemic control, cord blood telomere length, telomerase activity or inflammatory markers in any group. CONCLUSIONS: We found no difference in cord blood telomere length in pregnancies of women with diabetes compared with control subjects, but higher cord blood telomerase activity in Type 1 and gestational diabetes. This may reflect upregulated telomere reverse transcriptase in response to in utero oxidative DNA and telomere damage. These observations are relevant to the hypothesis that diabetes during pregnancy leads to in utero preprogramming towards senescence in the offspring.

The impact of group leaders' behaviour on parents acquisition of key parenting skills during parent training.

BACKGROUND: Parent training (PT) is identified as the most effective intervention for the treatment of conduct disorder (CD). Intervention observational outcomes are often reported as summarised composite scores, providing an overview of overall construct change. METHODS AND AIMS: Parents of children aged 3-5 years identified 'at risk' of developing CD were randomly allocated to either PT intervention or waiting list control group. Parent and child behaviours were assessed before and after the intervention period. The current paper aims to establish which individual observed parenting categories change as a result of PT, and which specific observed leader categories predict these changes. RESULTS: Controlling for baseline scores, ANCOVA demonstrated changes in parent praise and reflective behaviours as significant post-intervention. One-way ANOVAs demonstrated higher levels of leader praise and reflective behaviours resulted in greater change in parental praise and reflective behaviours respectively. Regression analyses indicated these leader behaviours predict positive change in parental praise and reflective behaviours for intervention families. CONCLUSIONS: Composite observational scores provide an account of behaviour constructs, whereas individual behaviour categories provide an insight into the core components of these constructs. The results suggest praise and reflection as key leader behaviours that influence the mechanisms of change in parenting behaviours as a result of PT.

Treatment fidelity as a predictor of behaviour change in parents attending group-based parent training.

BACKGROUND: Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome. AIMS: To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme. RESULTS: Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome. CONCLUSIONS: Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment.

Absence of telomere shortening and oxidative DNA damage in the young adult offspring of women with pre-gestational type 1 diabetes.

AIMS/HYPOTHESIS: The offspring of mothers with pre-gestational type 1 diabetes (PGDM) may be at increased risk of glucose intolerance and cardiovascular disease in childhood. The underlying causes of these observations, and whether they persist into adulthood, are unknown. The aim of the present study was to test the hypothesis that fetal chromosomal telomere oxidative DNA damage resulting from maternal PGDM programmes the offspring towards a senescent phenotype that is detectable in young adulthood. METHODS: We studied 21 young adult offspring (age 16-23 years) with a maternal history of PGDM and 23 age- and weight-matched controls with no maternal history of diabetes. All participants underwent anthropometric assessments, a standard 75 g OGTT, measurement of peripheral blood mononuclear cell and skin fibroblast telomere length, fibroblast senescence, cell DNA damage (by determination of 8-oxoguanine levels using flow cytometry), plasma lipoprotein profiles (determined by nuclear magnetic resonance) and plasma levels of soluble adhesion molecules and inflammatory markers. RESULTS: The groups did not differ significantly with respect to anthropometric measures, glucose tolerance, fasting and 2 h plasma insulin levels during OGTT, estimated peripheral insulin resistance, peripheral blood mononuclear cell or fibroblast telomere length, DNA damage or senescence in vitro, plasma NMR lipoprotein profiles or levels of high-sensitivity C-reactive protein. Plasma concentrations of soluble intercellular adhesion molecule 1 (sICAM-1; p < 0.05) and IL-6 (p = 0.08) were higher in the PGDM offspring. CONCLUSIONS/INTERPRETATION: Young adult offspring of mothers with PGDM do not differ in terms of glucose tolerance, DNA damage or telomere length from controls of the same weight and BMI. This does not preclude such abnormalities at an earlier age, but there is no evidence of telomere damage as a pre-programming mechanism in the young adults enrolled in this study.

The Leader Observation Tool: a process skills treatment fidelity measure for the Incredible Years parenting programme.

BACKGROUND: Despite recognition of the need to deliver evidence-based programmes in the field of mental health, there is little emphasis on implementing such programmes with fidelity. Attempts by programme developers to ensure adherence to their programmes include the development of training, manuals and content scales, but these alone may be insufficient to ensure fidelity in replication. Observational measures lend themselves as a potentially useful assessment of intervention outcomes, providing accurate and objective accounts of the intervention process. AIM: To develop a reliable and valid observational treatment fidelity tool of process skills required to deliver the Incredible Years (IY) BASIC parenting programme effectively. METHODS: An objective observational fidelity measure was developed to assess adherence to the IY BASIC parenting programme protocol. Observations were conducted on 12 IY BASIC parenting programme groups, attended by parents of pre-school children displaying signs of early onset conduct disorder. RESULTS: The Leader Observation Tool (LOT) achieved high internal reliability and good code-recode and inter-rater reliability. Evidence of concurrent validity was also obtained. CONCLUSIONS: Having demonstrated that the LOT is a reliable and valid measure of implementation fidelity, further research is necessary to examine the relationship between LOT scores and intervention outcome.

The disposal of a lime water treatment residue on soil and spoil material from a coalmine: a glasshouse investigation.

Eragrostis tef (Zucc.), Cenchrus ciliaris L., and Digitaria eriantha Steud. were grown in a soil (Psammentic Haplustalf) and spoil material from a coalmine both treated with a lime water treatment residue (WTR) at rates of 0, 50, 100, 200, and 400 g kg(-1). The yield of the grasses, from the sum of the three harvests, and concentrations of B, Ca, Cu, K, Fe, Mg, Mn, N, Na, P, and Zn in foliage from the second harvest were determined. The yield of grasses grown in the soil decreased exponentially as WTR application increased. The yields of C. ciliaris, D. eriantha, and E. tef (in the 400 g kg(-1) WTR treated soil) decreased by 74.4, 78.7, and 59.8%, respectively, when compared with the control treatments. In the spoil, the yield of E. tef and D. eriantha decreased by 13.6% and and D. eriantha by 23.9%, while an increase was observed for C. ciliaris (45.4%), at the highest WTR application rate. No relationship existed between yield of E. tef and WTR application rate when grown in the spoil, while a weak negative linear relationship (p < 0.05) was found for D. eriantha and a positive linear relationship existed for C. ciliaris. Magnesium concentrations of the grasses were positively correlated to WTR application rate. Grasses grown in the soil had higher Na concentrations, while those grown in the spoil typically had higher B, N, and Zn concentrations. The decreases in yield were attributed to nutrient deficiencies (notably Zn), induced by high WTR application rates that led to high substrate pH. Disposal of high rates of WTR on the mine materials was not recommended.

The effects of water treatment residues on soil respiration and microbial community structure.

Land disposal of water treatment residue (WTR), a by-product of potable water production, is increasingly being considered a viable alternative to land filling. It is crucial, inter alia, that soil quality is not affected adversely. Six different WTRs obtained from South African water treatment facilities were added to Hutton and Westleigh topsoils at rates of 0, 5, 15 and 25% (m/m) to determine their impacts on soil basal respiration. In general, respiration increased with rate of addition of WTR. The Umgeni, Rand, Midvaal and Faure2 WTRs had the greatest effect on respiration. Increases in respiration became less marked with time. The Hutton topsoil was mixed with the WTRs (at 15% m/m) and, following incubation, the bacterial community structure was examined by denaturing gradient gel electrophoresis. Changes in community structure were detected after 5 d and were attributed to physico-chemical changes arising from WTR amendment. However, dominant bands associated with the Hutton soil were retained and microbial diversity was not adversely affected. The findings of this investigation suggest that WTRs can be applied to the Hutton soil at a rate of at least 15% (300 Mg ha(-1)) without having a detrimental effect on microbial indicators of soil quality.

The effects of a polyacrylamide-derived water treatment residue on the hydraulic conductivity, water retention and evaporation of four contrasting South African soils and implications for land disposal.

Water treatment residue (WTR), a by-product from the production of potable water, was traditionally disposed of to landfill but there is growing interest in applying this waste to land as an alternative disposal option. Because WTR consists mainly of flocculated fine silt and clay, there is concern that should the residue decompose back to its original constituents, there is an adverse risk for soil water storage and transmission properties of soil. In a laboratory study, four different soil types were amended with a polyacrylamide WTR at rates ranging from 0 to 1280 Mg ha(-1). The treatments were evaluated for changes in water retention, hydraulic conductivity and evaporation. The results showed that WTR decreased bulk density and evaporation and actually increased hydraulic conductivity and water retention, mainly because of the sustained performance of the polymer in binding the silt and clay into gravel-sized aggregates. Such changes were, however, only significant at the 1280 Mg ha(-1) application rate. Therefore, very large amounts of WTR would have to be applied in order to markedly change these inherent physical properties of the soils. In view of this finding, the land treatment of WTR appears possible.

Hookworm (Necator americanus) transmission in inland areas of sandy soils in KwaZulu-Natal, South Africa.

This study extended the association between hookworm transmission in KwaZulu-Natal and the sandy coastal plain by investigating the parasite's occurrence in isolated areas of sandy soils further inland. A school-based prevalence survey was carried out in selected inland sandy areas and in surrounding areas dominated by clay soils within a narrow altitudinal range of between 500 and 700 m to reduce the effect of altitude on climate-related factors (rainfall and temperature). Sandy areas situated on the coastal plain were included in the analysis for comparative purposes. Soil samples (0-50 mm depth) were collected from each locality to assess their nematode loadings and to analyse selected physical and chemical properties. Significant differences were found between the moderate prevalence of hookworm infection among children living in inland areas with sandy soils (17.3%) and the low prevalence in surrounding non-sandy areas (5.3%, P < 0.001), and between infection among children living in all inland areas (9.3%) and the high prevalence on the coastal plain (62.5%, P < 0.001). Amounts of fine and medium sand were highest in both the coastal plain soils and in inland sandy areas and these fractions showed a significant positive correlation with hookworm prevalence and nematode loadings. Clay, coarse sand and organic matter contents were highest in surrounding non-sandy soils and showed a significant negative correlation with the nematode variables. No statistically significant correlations were found with soil pH at study localities. We conclude that properties of inland sandy soils, particularly particle size distribution, correlate well with hookworm prevalence and nematode loadings and therefore provide a more suitable habitat for nematodes than surrounding non-sandy areas. These results suggest that particle size distribution of sand fractions, organic matter and clay content in the soil influence the survival of hookworm larvae and hence the parasite's transmission.

The effect of soil type and climate on hookworm (Necator americanus) distribution in KwaZulu-Natal, South Africa.

We investigated environmental factors influencing the distribution of hookworm infection in KwaZulu-Natal, South Africa. Prevalence data were sourced from previous studies and additional surveys carried out to supplement the database. When geo-referenced the data revealed that higher prevalences are limited to areas below 150 m above sea level, and low prevalences to areas above this altitude. Using univariate analysis we investigated the differences in environmental factors in the two areas. The relationship between hookworm prevalence, altitude and climate-derived variables was assessed using Pearson correlation coefficient, and that of soil type using the t-test. Multivariate analysis was used to determine environmental factors that combine best to provide favourable conditions for hookworm distribution. The results revealed that areas 150 m above sea level, i.e. inland, supported low mean hookworm prevalences (x = 6, n = 21), and were characterized by soils with a clay content of more than 45%, variable temperatures and moderate rainfall. Hookworm prevalence also decreased southwards as temperatures became slightly cooler, rainfall remained more-or-less constant and the coastal plain narrowed. In the multivariate model prevalence was most significantly correlated with the mean daily minimum temperature for January followed by the mean number of rainy days for January. This indicates the importance of summer conditions in the transmission of hookworm infection in KwaZulu-Natal and suggests that transmission may be seasonal.

Views of the person with dementia.

In this paper I consider, in connection with dementia, two views of the person. One view of the person is derived from Locke and Parfit. This tends to regard the person solely in terms of psychological states and his/her connections. The second view of the person is derived from a variety of thinkers. I have called it the situated-embodied-agent view of the person. This view, I suggest, more readily squares with the reality of clinical experience. It regards the person as embedded in a history and culture. The human person is also an embodied agent. I contend that this view encourages a more appropriate approach towards the ethical issues that arise in dementia and towards people with dementia.

A new gas jet method for the assessment of sensory block after spinal anaesthesia.

We evaluated a new method of assessing sensory block after spinal anaesthesia using a fine gas jet and compared it with other established methods. The gas jet method was used to test the block before and after surgery and was found to compare favourably with pin-prick (median difference 0 and 0 dermatomes) and ethyl chloride (median difference 0.5 and 1.0 dermatomes) but less well with cotton wool (median difference -2.0 and -2.0 dermatomes).

The efficacy of disulfiram: a review of outcome studies.

Twenty-four studies of outcome following oral disulfiram and 14 following implanted disulfiram were identified for review from MEDLINE and PsycINFO databases and by manual searching for the period 1967-95. The methodological rigour of these studies was generally poor, albeit not as poor as that of earlier studies (not reviewed here). An overall assessment of the results of research in this field is hampered by the diversity of both the methods used and the subject populations studied. However, it is clear that support for the general use of oral disulfiram is equivocal, mostly being found in the form of reduced quantity of alcohol consumed and a reduced number of drinking days. Evidence for an effect in increasing the proportion of patients who achieve abstinence is surprisingly lacking. Where it is prescribed, disulfiram use should be supervised and it should be employed as one part of a comprehensive treatment programme. There is no good evidence in favour of implanting disulfiram tablets, but the possibility of a depot injection is intriguing.