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Preparedness levels have been shown to improve the outcomes for people who find themselves in an emergency. However, uptake of preparedness behaviors by the public prior to a major disaster is limited. This 2-part study examined perceived preparedness in the UK during the first months of the COVID-19 pandemic (Study 1), and 2 years later (Study 2).
Methods
Both studies investigated the effect of individual demographics (gender, age, perceived socioeconomic and health status) on perceived preparedness. Next, the studies examined the extent to which perceived preparedness was associated with mental health outcomes (anxiety, depression, and stress symptoms). Participants (Study 1, N = 409) completed an online survey in May to June 2020 during a national lockdown, with another sample (Study 2, N = 87) completing the same survey from March to July 2022.
Results
Across both studies, participants completed 2 to 3 different preparedness activities. Greater subjective perceptions of socioeconomic status were associated with perceived preparedness. Preparedness levels were related with better mental health, and unrelated to age and gender.
Conclusions
Encouraging the public to engage with preparedness behaviors may not only have practical benefits but also help to protect mental well-being during a disaster.
Currently, post-diagnostic dementia care and support in England and Wales is highly variable, and often insufficient in meeting the needs of people living with dementia and their families.
Objective:
To develop and deliver a new primary care based intervention to enable people living with dementia and their carers to live as well as possible from the point of diagnosis to end of life.
Method:
We conducted a survey and interviews with managers and commissioners of dementia services, and in-depth qualitative studies of six different existing service models to understand current post-diagnostic support in England and Wales. We also reviewed relevant literature on the management of long-term conditions and models of post-diagnostic support. Using the findings, a new intervention has been produced through a co-development process involving stakeholder task groups, our patient and public involvement group (the Dementia Care Community), and the multidisciplinary programme management board.
Results:
Our findings highlighted key priorities from the perspective of people living with dementia, their carers, and professionals which focus on the need for personalised, proactive and holistic care. We also identified a number of challenges in the provision of good quality post-diagnostic support, and examples of how these could be overcome to deliver best practice. Importantly, we found that no one service model delivered all aspects of post-diagnostic dementia support well.
The new intervention will focus on three main areas: developing systems for delivering evidence-based support; delivering tailored care and support; and building capacity and capability. A clinical dementia expert, a specialist nurse or similar professional with dementia expertise, will be based in primary care to lead and facilitate change across these three interlinked areas to develop systems and services that meet the needs of all older people living with dementia.
Conclusion:
Our new intervention will now be tested in practice in a feasibility and implementation study.
Continental Antarctica is a polar desert containing sparse pockets of vegetation within ice-free areas. Despite the recognized association between lichens, mosses and epiphytic diatoms, the environmental factors controlling diatom community structure are poorly understood. We investigated the association between diatom communities and host vegetation characteristics by experimentally adding nutrients and/or water to two bryophyte (healthy and moribund) and two lichen (crustose and Usnea) vegetation types in the Windmill Islands. Diatom communities were morphologically characterized, diversity indices calculated and differences between treatments, vegetation type and vegetation characteristics tested. We identified 49 diatom taxa, 8 of which occurred with > 1% relative abundance. Bryophyte and lichen vegetation harboured significantly different diatom communities, both in composition and diversity indices. Specifically, Luticola muticopsis was more prevalent in moribund bryophytes and crustose lichens, and Usnea lichens showed lower species richness than other types. While nutrient and water additions did not significantly alter diatom communities, diversity indices and some species showed relationships with vegetation physiological characteristics, notably %N and δ13C, suggesting the importance of ambient gradients in water and nutrient availability. Collectively, this work suggests that future conditions favouring the dominance of a particular vegetation type may have a homogenizing effect on the terrestrial diatom communities of East Antarctica.
Chordoma is a rare bone cancer for which there are no approved drugs. Surgery is the principle treatment but complete resection can be challenging due to the location of the tumours in the spine and therefore finding an effective drug treatment is a pressing unmet clinical need. A major recent study identified the transcription factor Brachyury as the primary vulnerability and drug target in chordoma. Previously, all-trans retinoic acid (ATRA) has been shown to negatively influence expression of the Brachyury gene, TBXT. Here we extend this finding and demonstrate that ATRA lowers Brachyury protein levels in chordoma cells and reduces proliferation of the chordoma cell line U-CH1 as well as causing loss of distinctive chordoma cell morphology. ATRA is available as a generic drug and is the first line treatment for acute promyelocytic leukaemia (APL). This study implies ATRA could have therapeutic value if repurposed for chordoma.
Personal disaster and emergency support networks of rural older adults are described before and after participation in a disaster preparedness intervention, PrepWise.
Methods
At baseline, a total of 194 disaster support network members were identified by 27 older adults in a rural Midwest community. After the intervention, these participants identified 232 support network members. Multilevel logistic regression models were constructed to identify characteristics of the network members and social interactions associated with support providers at baseline as well as newly added support sources after the PrepWise intervention.
Results
Member and interaction characteristics associated with being identified as emergency support sources at baseline were as follows: family, lived in close proximity, weekly or more frequent contact, and being someone whom participants shared concerns with, trusted, and exchanged emotional support with. After receiving PrepWise, participants on average identified 3 new sources of emergency support within their networks. Support sources added at follow-up tended to be nonfamily members and those participants trusted.
Conclusions
Enhancements in personal emergency support networks occurred after the intervention. Understanding characteristics of the network members and social interactions may assist in identifying additional emergency support sources. Larger studies investigating the impacts of enhanced support networks on disaster-related behaviors and outcomes will be beneficial. (Disaster Med Public Health Preparedness. 2017;11:110–119)
The active management of the experience of living with dementia appears to improve quality of life despite the lack of disease modification. However, research to date has been largely of modest scale and explanatory factors for improvements have been under-conceptualised. Thus, although promulgated through national strategies, the evidence base is relatively weak. This paper reports on a nation-wide study of the influence of the National Dementia Strategy for England in relation to Dementia Adviser and Peer Support Network services in 40 demonstration sites. The research aimed to identify ways in which the services contribute to the wellbeing and resilience of people with dementia and care partners. A mixed-methods research design collected data through: activity and outcome monitoring; organisational surveys; in-depth case studies, including qualitative interviews with people with dementia (N = 47) and care partners (N = 54), wellbeing and quality of life measures, and interviews with staff and other stakeholders (N = 82). Three themes are explored: addressing individual and community needs; promoting independence, control and choice; and getting a life back. Services promoted independence, control and choice, and consequently enabled people to re-narrate their lives as purposeful within their communities. Ways in which these are achieved resemble the public health model of lay health advisor and this research adds to the imperative to approach dementia as a key public health concern.
In the United States of America (USA), older adults in rural areas are at increased risk for adverse outcomes of disasters, partly due to medical needs, limited or long geographic distances from community resources, and less knowledge and motivation about preparedness steps. Older residents and ageing service providers in a rural community in the USA were interviewed regarding their perceptions about disasters and preparedness, and their reactions to the preparedness training programme using the concepts of the Extended Parallel Process Model. Participants generally indicated low motivation to engage in preparedness behaviours despite perceptions of personal risk and beliefs that preparedness behaviours were easy and could improve disaster outcomes. A theme of social relationships emerged from the data, with participants identifying social relationships as resources, barriers and motivators. People surrounding older adults can support or deter their preparedness behaviours, and sometimes elicit a desire to protect the wellbeing of others. Findings suggest two potential strategies to facilitate preparedness behaviours by moving beyond personal benefits: highlighting older adults' increased ability to protect the wellbeing of younger generations and their community by being prepared themselves, and engaging family, friends and neighbours in preparedness programmes to enhance the resilience of their social groups. Older adults in many cultures have a desire to contribute to their society. Novel and effective approaches to increase preparedness could target their social groups.
There is growing interest in brief contact interventions for self-harm and suicide attempt.
Aims
To synthesise the evidence regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide.
Method
A systematic review and random-effects meta-analyses were conducted of randomised controlled trials using brief contact interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts). Several sensitivity analyses were conducted to examine study quality and subgroup effects.
Results
We found 14 eligible studies overall, of which 12 were amenable to meta-analyses. For any subsequent episode of self-harm or suicide attempt, there was a non-significant reduction in the overall pooled odds ratio (OR) of 0.87 (95% CI 0.74–1.04, P = 0119) for intervention compared with control. The number of repetitions per person was significantly reduced in intervention v. control (incidence rate ratio IRR = 066, 95% CI 0.54–0.80, P<0001). There was no significant reduction in the odds of suicide in intervention compared with control (OR = 0.58, 95% CI 0.24–1.38).
Conclusions
A non-significant positive effect on repeated self-harm, suicide attempt and suicide and a significant effect on the number of episodes of repeated self-harm or suicide attempts per person (based on only three studies) means that brief contact interventions cannot yet be recommended for widespread clinical implementation. We recommend further assessment of possible benefits in well-designed trials in clinical populations.
Problem-solving and coping skills deficits have been shown in adolescents who experience suicide-related behaviours, including suicidal ideation. Little evidence exists about effective interventions for this population. We undertook a pilot study of an Internet-based CBT programme that included problem-solving skills training to investigate its impact on skills deficits. The study employed a pre-test/post-test design. Outcomes of interest were negative problem orientation, emotion- and task-focused coping, and adolescents’ perception of helpfulness of the intervention. Participants, recruited via the school wellbeing team, were assessed at baseline, at weekly intervention sessions and immediately post-intervention. Twenty-one adolescents completed the intervention. Over the course of the intervention, negative problem-solving orientation improved and students relied less on emotion-focused coping strategies. Because there was no control group, we cannot be certain that the changes seen between baseline and post-intervention can be attributed to the intervention. Adolescents rated the problem-solving and cognitive restructuring modules as particularly helpful. Interventions that include enhancement of problem-solving skills, as well as cognitive restructuring to address adolescents’ appraisal of problems and their ability to solve them appear promising for adolescents with suicidal ideation. Further investigation is warranted.
The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:
1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.
2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
Adults from South Auckland, New Zealand who required acute admission to hospital were followed from admission to discharge. After adjusting for demographic factors, diagnosis, chronicity, severity, consultant psychiatrist and involuntary admission, the length of stay for those from more deprived areas was significantly longer by 7 days than for those from less deprived areas. Information on socio-economic deprivation should be used in discharge planning and in optimising access to community care. Research is needed on group-level factors that may affect recovery from mental disorders.
Macroscopic Fabric Analysis, the systematic study and description of ceramic fabrics with the aid of a handlens and other simple equipment, has grown in importance along with systematic archaeological survey. Microscopic Fabric Analysis, or ceramic petrology, is better known, but more expensive and time-consuming. Using examples drawn from Sphakia Survey material, the authors show that Macroscopic Fabric Analysis of large pottery collections with a high proportion of coarse ware sherds, when combined with targeted microscopic analysis, provides detailed, reliable information on crucial topics such as chronology, in this case from FN/EM I–Turkish; function (cooking, transport, storage, and beehives); and regional interaction. The authors also discuss issues connected with publication, including the use of electronic publications such as the Sphakia Survey website, and the rigorous comparison of individual fabrics, and they make a case for adopting standard ceramic terminology.