"Dementia Doesn't Mean That Life Doesn't Have More Wonderful Things Ahead": A Qualitative Study Evaluating a Canadian Dementia Support Services Program.

Background: Community support programs can improve quality of life for people living with dementia and their care partners. Important to the successful implementation of such programs is close engagement with end-users to gain a better understanding of their needs. This study describes the perspectives of people living with dementia, care partners, and health-care providers on the First Link® dementia support program provided by the Alzheimer Society of British Columbia (ASBC). Methods: Following a large-scale survey (N=1,164), semi-structured interviews were conducted with participants to explore in greater detail the different needs and themes that emerged from the first phase of the study. The interviews explored: 1) experiences with the program; 2) future planning; 3) meaning of independence; and 4) impact of the program on emotional and physical well-being. Results: A total of 48 participants were interviewed in this study. Knowledge and education were key factors that helped participants manage the impact of dementia. Learning about dementia, the experiences of others, strategies on how to manage symptoms, what to plan for in the future, and how to access different services in the community, was tied to increased feelings of confidence and comfort, and decreased stress. Participants also provided suggestions for improvement of the First Link® dementia program such as further embedding the program into the patient journey, providing more services in remote areas, providing education for health-care providers, and increasing awareness of the program. Conclusion: By emphasizing the lived experiences and needs of those living with dementia and their caregivers, this work will inform future research-based program evaluations globally and, in turn, improve the existing services to support people living with-and impacted by-dementia.

The Return of Biomarker Results in Research: Balancing Complexity, Precision, and Ethical Responsibility.

Recent research aimed at the discovery, integration, and communication of health outcome measures (or "biomarkers") in Alzheimer's disease has raised challenging questions related to whether, how and when results from these investigations should be disclosed to research participants. Reflecting the apparent heterogeneity of many neurodegenerative diseases, biomarker or other risk factor results are often probabilistic, interactive, multi-modal, and selective. Such characteristics make it very complex to summarize and communicate to clinicians, researchers, and research participants. Whereas the format and content of academic literature is well-managed by the peer-review process, reporting individualized results to participants involves complex, sensitive, and ethical considerations. This paper describes three key factors to consider in decisions about the return of results to research participants: complexity, precision, and responsibility. The paper also presents six practical recommendations for implementing meaningful and ethical communication with research participants.

Technology in Dementia Education: An Ethical Imperative in a Digitized World.

Technology can support the delivery of care and improve the lives of people living with dementia. However, despite a substantial body of evidence demonstrating the benefits and opportunities afforded by technology, gaps remain in how technology and technology ethics are addressed in dementia care education. Here we discuss disparities in current educational programming and highlight the ethical challenges arising from underdeveloped knowledge exchange about dementia care technology. We put forward that for technology to be ethically deployed and maximized to improve outcomes, it must be embedded into dementia education programs and made widely accessible to the caregiver community.

Suicide patterns on the London Underground railway system, 2000-2010.

Aims and Method Suicidal acts on underground railway networks are an area of public health concern. Our aim was to review recent epidemiological patterns of suicidal acts on the London Underground to inform future preventive interventions. Data from 2000 to 2010 were obtained from the British Transport Police via a Freedom of Information request. Results The mean annual rate of suicidal acts from 2000 to 2010 was 5.8 per 100 million passenger journey stages. Of those who died by suicide, 77.3% were of White Northern European ethnicity. A fifth had a history of mental illness. Clinical implications The widening gap between the number of recorded suicide attempts and completed suicides is encouraging. Further research is required regarding the role of drug and alcohol use, psychiatric history and area of residence. Installation of platform screen doors should be considered in future railway network expansion.

How Might People Near National Roads Be Affected by Traffic Noise as Electric Vehicles Increase in Number? A Laboratory Study of Subjective Evaluations of Environmental Noise.

We face a likely shift to electric vehicles (EVs) but the environmental and human consequences of this are not yet well understood. Simulated auditory traffic scenes were synthesized from recordings of real conventional and EVs. These sounded similar to what might be heard by a person near a major national road. Versions of the simulation had 0%, 20%, 40%, 60%, 80% and 100% EVs. Participants heard the auditory scenes in random order, rating each on five perceptual dimensions such as pleasant-unpleasant and relaxing-stressful. Ratings of traffic noise were, overall, towards the negative end of these scales, but improved significantly when there were high proportions of EVs in the traffic mix, particularly when there were 80% or 100% EVs. This suggests a shift towards a high proportion of EVs is likely to improve the subjective experiences of people exposed to traffic noise from major roads. The effects were not a simple result of EVs being quieter: ratings of bandpass-filtered versions of the recordings suggested that people's perceptions of traffic noise were specifically influenced by energy in the 500-2000 Hz band. Engineering countermeasures to reduce noise in this band might be effective for improving the subjective experience of people living or working near major roads, even for conventional vehicles; energy in the 0-100 Hz band was particularly associated with people identifying sound as 'quiet' and, again, this might feed into engineering to reduce the impact of traffic noise on people.

Relationship between trajectories of trunk fat mass development in adolescence and cardiometabolic risk in young adulthood.

To examine developmental trajectories of trunk fat mass (FM) growth of individuals categorized as either low or high for cardiometabolic risk at 26 years, a total of 55 males and 76 females from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2007) were assessed from adolescence (11.5 ± 1.8 years) to young adulthood (26.2 ± 2.2 years) (median of 11 visits per individual) and had a measure of cardiometabolic risk in young adulthood. Participants were categorized as low or high for blood pressure and cardiometabolic risk as adults using a sex-specific median split of continuous standardized risk scores. Individual trunk FM trajectories of participants in each risk group were analyzed using multilevel random effects models. Males and females in the high blood pressure group had significantly steeper (accelerated) trajectories of trunk FM development (0.61 ± 0.14 and 0.52 ± 0.10 log g, respectively) than those in the low blood pressure group for females in the high cardiometabolic risk group trajectory of trunk FM was significantly steeper (0.52 ± 0.10 log g) than those females in the low cardiometabolic risk group. Dietary fat was positively related (0.01 ± 0.003 g/1,000 kcal) and physical activity negatively related (-0.16 ± 0.05 physical activity score) to trunk FM development in males. Young adults with high cardiometabolic risk, compared to low, have greater trunk FM as early as 8 years of age, which supports the need for early intervention.

Treating children with phonological problems: does an eclectic approach to therapy work?

BACKGROUND: A survey of clinicians made by Joffe and Pring in 2008 revealed that different approaches exist between researchers and clinicians in the treatment of children with phonological problems. Researchers have examined specific approaches to treatment often giving substantial amounts of therapy and have obtained encouraging results; clinicians, with less time available, often use an eclectic approach mixing different treatment methods. The reasons for this difference are discussed. AIMS: We examined the effectiveness of an eclectic approach giving amounts of therapy more consistent with clinical practice and involving parents in treating their children. METHODS & PROCEDURES: We report two small experiments conducted within Speech and Language Therapy clinics. In the first, a group of treated children are compared with a group of children whose treatment is delayed. Parents attended therapy sessions and were given homework tasks to do with their children. The second compared children treated as in the first experiment with children treated at home by their parents who had attended training sessions and with untreated children. OUTCOMES & RESULTS: In the first experiment, a general trend towards improvement was seen in all children. Change during treatment periods was statistically significant. In the second experiment, children treated by therapists showed strongly significant gains. Lesser but significant gains were made by children treated by their parents; no change was found in untreated children. CONCLUSIONS & IMPLICATIONS: The findings offer encouragement to clinicians who use an eclectic approach and who are only able to offer limited amounts of therapy. They also suggest that parental involvement is helpful. However, we find the current incompatibility of research and clinical work worrying and a hindrance to our efforts to understand and treat these children.