A mixed method study exploring gender differences in dementia caregiving.

Few studies have investigated the experience of male carers of people with dementia and fewer specifically examined whether male and female carers of people with dementia differ in their approach to the caring role. As such, this research set-out to investigate whether male carers of people with dementia approach the caring role differently to female carers. Data from 167 survey participants (24 males and 143 females) were analysed using a mixed research methodology. Participants' demographics and scores on standardised burden and coping scales were analysed using linear regression. Participants' written responses to open-ended questions were analysed using thematic analysis anchored in theories of hegemonic masculinity. No significant gender differences were identified in carers' coping strategies or self-reported carer burden. However, qualitative analysis revealed strong thematic gender differences like: gendered barriers to help-seeking; gendered service preference; gendered considerations about residential care; gendered expression of burden; and themes of the absent son and exhausted daughter. This research identified that male carers of people with dementia approach help-seeking differently to female carers, typically focusing on addressing functional tasks and refraining from showing emotions, this despite reporting similar carer burden. Rapport building with male carers should start with conversations around functional issues rather than assessing the emotional impact of the caring role. The findings reinforce the need for more qualitative research into the unmet needs of male carers of people with dementia, to inform the design of male-friendly interventions which could facilitate timely access to services by male carers.

Changing attitudes towards annual influenza vaccination amongst staff in a Tertiary Care Irish University Hospital.

BACKGROUND: Healthcare workers are encouraged annually to get vaccinated against influenza. This year in view of COVID-19 pandemic, attitudes of HCWs towards vaccination are particularly important. A cross-sectional study was completed to understand how to best encourage and facilitate the vaccination of HCWs based on the previous years' findings. METHODS: An online survey was disseminated to all hospital staff via electronic channels. The clinical audit sphinx software was used for data collection and analysis. RESULTS: The total number of responses was n = 728, almost double the rate from 2018 (N = 393). A total of 78% (N = 551) of participants were vaccinated last year. A total of 94% (N = 677) of participants reported their intention to be vaccinated this year. The main barriers listed were being unable to find time (32%, N = 36), side effects (30%, N = 33) and thinking that it does not work (21%, N = 23). The most popular suggestions for how to increase uptake were more mobile immunisation clinics (72%, N = 517) and more information on the vaccine (50%, N = 360). A total of 82% of participants (N = 590) agreed that healthcare workers should be vaccinated, with 56% (N = 405) agreeing that it should be mandatory. Of the participants who were not vaccinated last year (N = 159), 40% (N = 63) agreed that COVID-19 had changed their opinion on influenza immunisation with a further 11% (N = 18) strongly agreeing. DISCUSSION: In light of the increasing number of survey participants, more staff were interested in flu vaccination this year than ever before. The COVID-19 pandemic has had some influence on staff's likelihood to be vaccinated. Feasibility of immunisation and education posed the largest barriers to HCW vaccination.

Discrepancies Between Community-Dwelling Individuals with Dementia and Their Proxies in Completing the Cornell Scale for Depression in Dementia: A Secondary Data Analysis.

BACKGROUND: Depressive symptoms are common in people with dementia. PURPOSE: This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia. PARTICIPANTS AND METHODS: This study is a cross-sectional secondary analysis. Twenty-five people living with dementia ("participants") and their family caregivers ("proxies") participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall's tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann-Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group. RESULTS: The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The "high functional impairment" group had larger discrepancy scores and a lower level of agreement than the "low functional impairment" group. CONCLUSION: The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.

Bridging the gap between clinical trials and community care: Translating a memory group for older people with mild cognitive impairment into a community-based organisation.

OBJECTIVES: Older people with mild cognitive impairment (MCI) are seeking interventions for maintaining independence. This study investigates the feasibility of translating a research-evaluated memory group (LaTCH) into a community-based organisation by evaluating the experiences of clients and trained staff. METHODS: Dementia Australia staff trained as facilitators of memory groups for 274 people with MCI and families. Clients and staff were interviewed regarding experiences from group participation. RESULTS: Clients and staff reported benefits of shared experience through group participation, leading to greater use of compensatory strategies. Staff observed client improvement in memory-related self-confidence, thereby reducing anxiety and increasing re-engagement in life activities. In their own professional roles, staff reported increased self-efficacy, leading to greater role satisfaction. Several challenges in running and sustaining the program were also identified. CONCLUSIONS: Memory group interventions can be feasibly delivered in a community setting and increase service access opportunities for older people with memory problems.

Increasing Psychiatric Rehabilitation Knowledge in a Supported Housing Setting: Pre- and Posttest Analysis.

The current study investigated the effectiveness of a state-wide Community Support Services training grounded in work-based learning to improve knowledge about psychiatric rehabilitation principles and skills. Supervisory staff and direct care staff in supported housing settings completed a 17-item, multiple choice, preand posttest after attending a 48-hour training series. Results indicated that participants gained psychiatric rehabilitation knowledge. These findings support the effectiveness of the training series grounded in work-based learning. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 39-44.].

Work-based learning: A training model for state wide system changes.

TOPIC: Despite the substantial amount of money invested in staff training each year, many people trained fail to transfer what they learn to the workplace. We document a training initiative that was implemented to develop and maintain a competent workforce. PURPOSE: A work-based learning (WBL) model was used as a guide to teach the knowledge and skills necessary to effectively deliver psychiatric rehabilitation services. SOURCES USED: This training framework afforded practitioners an opportunity to acquire the critical knowledge and skills to improve the quality of life for individuals living with serious mental illnesses. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Preliminary pre and posttest results show an overall increase in practitioner knowledge. Additionally, individualized technical assistance has the potential to increase positive learning outcomes. (PsycINFO Database Record

Lessons learned about primary weight maintenance and secondary weight maintenance: results from a qualitative study.

BACKGROUND: Obesity is now a worldwide problem and Ireland is no exception with approximately two thirds of the adult population now overweight or obese. A recent report has found that 53% of Irish adults aged 50 years and over are classified as centrally obese and at substantially increased risk of metabolic complications. While most studies investigating weight maintenance have been conducted on those who have managed to lose weight and/or achieved weight loss maintenance (secondary weight maintainers), few studies have been undertaken to understand the attitudes, behaviours, motivations and strategies of those who maintain their weight within normal weight ranges over their lifetime, so called primary weight maintainers. This study aims to explore this issue through qualitative exploration of primary weight maintainers in an Irish University. METHODS: Seven focus groups were conducted (including three single interviews) with 17 participants in total across three different groups, 1) primary weight maintainers, 2) secondary weight maintainers, and 3) those unable to sustain or achieve weight loss. The interviews were transcribed and thematic analysis was applied to interpret the findings. RESULTS: After analyzing the participant's interviews, planning and organization or lack of, emerged as themes across the three groups in varying degrees. Strategizing, perseverance and willpower were seen as integral to weight maintenance and weight loss in groups one and two, these were lacking in group three. Prioritizing exercise and perseverance in maintaining a high level of activity was evident in groups one and two and was lacking in group three. Motivational influences were equal across the groups however, group three found it difficult to turn this into action. Group one had behavioural control of calorie intake maintaining a balance between week and weekend eating. Group three found it difficult to control calorie intake and portion size. Self-image differed across the three groups with cognitive dissonance evident amongst those in group three. CONCLUSIONS: This study showed that there are many factors that influence primary weight maintenance. Considering that we live in a society that is predominantly sedentary, predominantly overweight and with poor food choice options facing us every day, fighting our way through to ensure healthy weight maintenance requires active, conscious efforts. The factors identified in this study which are important in healthy weight maintenance are all potentially modifiable with life-coach, nutrition, exercise and cognitive interventions particularly if peer support and a whole family approach are incorporated.

The relationship between hope and symptoms.

OBJECTIVE: Hope is a critical aspect of the recovery process for persons with serious mental illnesses. The goal of this pilot study was to assess the relationship between hope and symptoms for a cohort of individuals with mental illnesses receiving supported employment services. METHOD: A total of 74 participants enrolled in supported employment were assessed on their level of hopefulness, hopelessness and psychiatric symptoms. Correlations were performed to determine the relationship between hope and psychiatric symptoms, and hopelessness and psychiatric symptoms. RESULTS: The findings indicated a significant inverse relationship between hope and symptoms, and a significant positive relationship between hopelessness and symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Hope and symptoms were inversely related, highlighting the importance of developing a wellness strategy that addresses managing symptoms as part of one's recovery process. Additionally, this finding highlights the critical role of PsyR providers in supporting people in recovery with developing a wellness strategy that will both help ameliorate symptoms and increase hope.

Reductive activation of nitrate reductases.

Protein film voltammetry of Paracoccus pantotrophus respiratory nitrate reductase (NarGH) and Synechococcus elongatus assimilatory nitrate reductase (NarB) shows that reductive activation of these enzymes may be required before steady state catalysis is observed. For NarGH complementary spectroscopic studies suggest a structural context for the activation. Catalytic protein film voltammetry at a range of temperatures has allowed quantitation of the activation energies for nitrate reduction. For NarGH with an operating potential of ca. 0.05 V the activation energy of ca. 35 kJ mol-1 is over twice that measured for NarB whose operating potential is ca. -0.35 V.

Structural dynamics of the membrane translocation domain of colicin E9 and its interaction with TolB.

In order for the 61 kDa colicin E9 protein toxin to enter the cytoplasm of susceptible cells and kill them by hydrolysing their DNA, the colicin must interact with the outer membrane BtuB receptor and Tol translocation pathway of target cells. The translocation function is located in the N-terminal domain of the colicin molecule. (1)H, (1)H-(1)H-(15)N and (1)H-(13)C-(15)N NMR studies of intact colicin E9, its DNase domain, minimal receptor-binding domain and two N-terminal constructs containing the translocation domain showed that the region of the translocation domain that governs the interaction of colicin E9 with TolB is largely unstructured and highly flexible. Of the expected 80 backbone NH resonances of the first 83 residues of intact colicin E9, 61 were identified, with 43 of them being assigned specifically. The absence of secondary structure for these was shown through chemical shift analyses and the lack of long-range NOEs in (1)H-(1)H-(15)N NOESY spectra (tau(m)=200 ms). The enhanced flexibility of the region of the translocation domain containing the TolB box compared to the overall tumbling rate of the protein was identified from the relatively large values of backbone and tryptophan indole (15)N spin-spin relaxation times, and from the negative (1)H-(15)N NOEs of the backbone NH resonances. Variable flexibility of the N-terminal region was revealed by the (15)N T(1)/T(2) ratios, which showed that the C-terminal end of the TolB box and the region immediately following it was motionally constrained compared to other parts of the N terminus. This, together with the observation of inter-residue NOEs involving Ile54, indicated that there was some structural ordering, resulting most probably from the interactions of side-chains. Conformational heterogeneity of parts of the translocation domain was evident from a multiplicity of signals for some of the residues. Im9 binding to colicin E9 had no effect on the chemical shifts or other NMR characteristics of the region of colicin E9 containing the TolB recognition sequence, though the interaction of TolB with intact colicin E9 bound to Im9 did affect resonances from this region. The flexibility of the translocation domain of colicin E9 may be connected with its need to recognise protein partners that assist it in crossing the outer membrane and in the translocation event itself.