32 results
FC13: A qualitative exploration of older people’s lived experiences of homelessness and memory problems – Stakeholder perspectives
- Penny Rapaport, Garrett Kidd, Martin Knapp, Jill Manthorpe, Caroline Shulman, Gill Livingston
-
- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 75-76
-
- Article
-
- You have access Access
- Export citation
-
Background:
The numbers of older people experiencing both homelessness and Alzheimer’s disease and related dementias are growing, yet their complex health, housing and care needs remain undelineated and unmet. Older people experiencing homelessness have high levels of memory and cognitive impairment relative to stably housed age equivalent populations. In this study we aim to address a critical gap in understanding what can improve the care, support and experiences of older people experiencing homelessness with memory and other cognitive impairments.
Objectives:To explore how stakeholders understand and experience memory problems among older people experiencing homelessness. We consider what they perceive to be meaningful outcomes for those living with memory problems and those supporting them and what gets in the way of achieving good care and support for these individuals.
Method:We conducted reflexive thematic analysis of qualitative interviews (n=49) with 17 older people (aged ≥50 years) experiencing memory and other cognitive problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners working in England.
Results:We identified four overarching themes. The population is not taken seriously; you ‘can’t see the wood for the trees’; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience of homelessness intensified the disorienting nature of memory and cognitive impairment. Older people experiencing homelessness and memory problems fall through gaps in service provision further fragmenting their lived experiences and intensified by cognitive difficulties. Those providing direct and indirect support required flexibility and persistence to advocate, provide care and safeguard individuals, with staff moving beyond traditionally commissioned roles to advocate, provide care and safeguard individuals.
Conclusions:Efforts to meet the needs of older people living with Alzheimer’s disease and related dementias and experiencing homelessness must reflect the complexity their lives and current service provision. These findings have been used to co-design a psychosocial care and support intervention for hostel staff to be tested in a feasibility trial.
Weight Change Following Diagnosis With Psychosis: A 25 Year Perspective in Greater Manchester, UK
- Adrian Heald, Lamiece Hassan, Joseph Firth, Mark Livingston, Martin Gibson, Christopher Daly
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S51-S52
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Weight gain in the months/years after diagnosis/treatment severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased cardiometabolic risk in people treated with antipsychotic agents. There is limited data on the longer term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a 25-year perspective on weight change post-SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on a history of psychosis vs bipolar affective disorder.
MethodsWe undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) also bipolar disorder = BPD). We analysed body mass index (BMI) change in the period before and after first prescription of anti-psychotic medication.
ResultsWe identified 9125 people with the diagnoses above. NAP (n = 5618; 37.5% female) mean age 49.3 years; BPD (n = 4131; 63.3% female) mean age 48.1 years. Follow-up period was up to 25 years. 27.0% of NAP were of non-white ethnicity vs 17.8% of BAP individuals.
A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for BPD. There were no significant differences in baseline BMI profile but mean HbA1c in those 2103 people where available was higher in NAP at baseline at 40.4mmol/mol vs 36.7mmol/mol for BPD.
At 5-year follow-up 53.6% of those NAP with a normal healthy BMI transitioned to obese / overweight BMI vs 55.6% with BPD. 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7 % with BPD. At 5-year FU for NAP, 83.1% of those with BMI ≥30kg/m2 stayed in this category vs 81.5% of BPD.
At 5-year follow-up there was similarity in the overall % NAP in the obese ≥30kg/m2 category (42.4%) vs BPD (44.1%).
ConclusionThe results of this 25-year real world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, highlighting the importance of regular physical health monitoring in all people with SMI.
Using longitudinal population data in this way has the potential to open up new avenues of research in psychiatry in terms of physical and mental health outcomes.
Cost-effectiveness of mirtazapine for agitated behaviors in dementia: findings from a randomized controlled trial
- Catherine Henderson, Martin Knapp, Susan Stirling, Lee Shepstone, Juliet High, Clive Ballard, Peter Bentham, Alistair Burns, Nicolas Farina, Chris Fox, Julia Fountain, Paul Francis, Robert Howard, Iracema Leroi, Gill Livingston, Ramin Nilforooshan, Shirley Nurock, John T. O’Brien, Annabel Price, Ann Marie Swart, Naji Tabet, Tanya Telling, Alan J. Thomas, Sube Banerjee
-
- Journal:
- International Psychogeriatrics / Volume 34 / Issue 10 / October 2022
- Published online by Cambridge University Press:
- 19 July 2022, pp. 905-917
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Objectives:
To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up.
Design:Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo.
Setting:Community settings and care homes in 26 UK centers.
Participants:People with probable or possible Alzheimer’s disease and agitation.
Measurements:Primary outcome included incremental cost of participants’ health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants’ and unpaid carers’ gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives.
Results:One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment.
Conclusions:On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Development of an international template to support patient submissions in Health Technology Assessments
- Nigel Cook, Heidi Livingstone, Jennifer Dickson, Louise Taylor, Kate Morgan, Martin Coombes, Sally Wortley, Elisabeth Oehrlein, María José Vicente-Edo, Franz Waibel, Barry Liden
-
- Journal:
- International Journal of Technology Assessment in Health Care / Volume 37 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 01 April 2021, e50
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Objectives
To develop an international template to support patient submissions in Health Technology Assessments (HTAs). This was to be based on the experience and feedback from the implementation and use of the Scottish Medicines Consortium's (SMC) Summary Information for Patient Groups (SIP).
MethodsTo gather feedback on the SMC experience, web-based surveys were conducted with pharmaceutical companies and patient groups familiar with the SMC SIP. Semistructured interviews with representatives from HTA bodies were undertaken, along with patient group discussions with those less familiar with the SIP, to explore issues around the approach. These qualitative data informed the development of an international SIP template.
ResultsSurvey data indicated that 82 percent (18 of 22 respondents) of pharmaceutical company representatives felt that the SIP was worthwhile; 88 percent (15/17) of patient group respondents found the SIP helpful. Both groups highlighted the need for additional support and guidance around plain language summaries. Further suggestions included provision of a glossary of terms and cost-effectiveness information. Patient group interviews supported the survey findings and led to the development of a new template. HTA bodies raised potential challenges around buy-in, timing, and bias connected to the SIP approach.
ConclusionsThe international SIP template is another approach to support deliberative processes in HTA. Although challenges remain around writing summaries for lay audiences, along with feasibility considerations for HTA bodies, the SIP approach should support more meaningful patient involvement in HTAs.
411 - Implementing the STrAtegies for RelaTives (START) intervention in Portugal – preliminary findings
- Fatima Urzal, Ana Quintão, Catarina Santos, Nuno Moura, Ana Banazol, Rui Martins, Penny Rapaport, Sarah Amador, Gill Livingston, Manuel Gonçalves-Pereira
-
- Journal:
- International Psychogeriatrics / Volume 32 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 04 November 2020, p. 127
-
- Article
-
- You have access Access
- Export citation
-
Introduction
As in other countries, Portuguese family caregivers have unmet needs regarding information and distress. START (STrAtegies for RelaTives) is a manual-based coping intervention for families of people with dementia, including coping strategies and stress-management components, by Livingston and colleagues (https://www.ucl.ac.uk/psychiatry/research/mental-health-older-people/projects/start). In the UK, START has been clinically effective, immediately and continuing even after 6-years, without increasing costs. Clinical training and supervision ensures treatment fidelity. In Portugal, these kind of interventions are less available and, when provided, are mostly supportive and fail to address coping strategies. Paradoxically, recruitment may also prove challenging.
ObjectivesWe describe the development of the Portuguese translation of START, incorporating guidance from the UK team, and a pilot study of delivery to family caregivers of people with dementia. We will also discuss the challenges of recruiting participants and delivering the intervention.
MethodWe translated the START intervention and recruited family caregivers from neurology and psychiatry outpatients, in a central hospital in Lisbon. Our baseline assessment included the Hospital Anxiety and Depression Scale and the Zarit Burden Interview. The pilot is still ongoing at time of submitting, so we focus on recruitment, baseline assessments and process issues.
ResultsDuring a three-month period, we recruited six caregivers. Five were primary caregivers (spouses or adult children) who had been caring for their relatives for 2 up to 10 years. Two caregivers met the international cutoff for clinically relevant affective disorder . The most frequent motivators for taking part were learning to communicate with their relatives and increasing knowledge to build community resources. Overall, the subjective impression of the therapist in charge is that the intervention seems acceptable and promising.
Discussion/ConclusionsThis pilot study will eventually lead to an improved version of the Portuguese version of the START manual. So far, the intervention seems appropriate for selected caregivers in Portugal. However, response to striking unmet needs, particularly basic home support, may need to precede interventions like START. We look forward to concluding the intervention study and analyzing the implementation challenges, as a basis to inform a wider-scale trial.
Effect of vitamin D supplementation on vitamin D status in pregnant women: findings from the MO-VITD study
- Raghad Alhomaid, Maria Mulhern, Laura Cassidy, Eamon Laird, Martin Healy, Sean Strain, Barbara Livingstone, Michael Parker, Mary McCann
-
- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E99
-
- Article
-
- You have access Access
- Export citation
-
Pregnant women who are overweight/obese are particularly vulnerable to vitamin D insufficiency owing to higher physiological requirements and lower status (25(OH)D concentrations) associated with obesity. Achieving adequate maternal vitamin D status with current recommendations (10μg/d) remains controversial.
This study examined supplementation effects (10μg-vs-20μg vitamin D3/d) throughout pregnancy (12 weeks gestation until delivery) on vitamin D status of normal weight, overweight and obese pregnant women and on cord blood, using a double-blind randomised vitamin D intervention study (MO-VITD). 240 pregnant women were recruited throughout the year at antenatal clinics in Northern Ireland (equal numbers of normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (> 30kg/m2)). Non-fasting maternal blood samples were collected at 12, 28 and 34–36 weeks gestation and from the umbilical cord after delivery and analysed for total serum 25(OH)D using LCMS.
A high prevalence of vitamin D insufficiency (25–50nmol/L) was found in the 1st trimester in both treatment groups (41.5% and 48.8%; 10μg vs. 20μg respectively). Maternal 25(OH)D concentrations increased from the 1st to 3rd trimester in both the 10μg/d and 20μg/d groups, with a higher increase in the 20μg group (17.1 ± 24.7 and 28.8 ± 33.3nmol/L, P = 0.002). There was no difference in cord blood 25(OH)D concentrations between treatment groups.
Women who started pregnancy with insufficient 25(OH)D concentrations remained insufficient throughout pregnancy in the 10μg/d group (49.9 ± 28.2nmol/L at trimester 3). In the 20μg/d group, women starting pregnancy as insufficient achieved levels of sufficiency in the 2nd (58.9 ± 30.6nmol/L) and 3rd (64.0 ± 35.9nmol/L) trimesters. Women who started pregnancy with sufficient vitamin D status (25(OH)D > 50nmol/L), maintained levels of sufficiency throughout pregnancy irrespective of treatment group (83.1 ± 24.4 and 96.7 ± 30.7 at trimester 3 in 10μg/d and 20 μg/d groups respectively); findings were similar across all BMI categories.
Obese women who started pregnancy with an insufficient status were found to have deficient cord blood (25(OH)D < 25 nmol/L) in both the 10μg/d and 20μg/d groups (19.4 ± 20.2 vs. 19.5 ± 9.4nmol/L respectively), whilst obese women who started pregnancy with sufficient status (> 50nmol/L) had cord blood concentrations considered insufficient (40.2 ± 18.4 vs. 44.2 ± 15.6nmol/L; 10μg vs. 20μg groups respectively).
Based on our findings of the high prevalence of vitamin D insufficiency in early pregnancy, maternal vitamin D supplementation of 20μg/d is advisable to maintain maternal vitamin D status in pregnant women in Northern Ireland.
The association between maternal body weight and vitamin D status in early pregnancy: findings from the MO-VITD study
- Raghad Alhomaid, Maria Mulhern, Laura Cassidy, Eamon Laird, Martin Healy, Sean Strain, Barbara Livingstone, Michael Parker, Mary McCann
-
- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E586
-
- Article
-
- You have access Access
- Export citation
-
Maternal BMI has been shown to be inversely correlated with vitamin D status (25-hydroxyvitamin D (25(OH)D) concentrations) during pregnancy. Pregnant women with obesity and with vitamin D deficiency are at risk of many adverse health outcomes in pregnancy.
The aim of this study was to examine differences in maternal vitamin D status across normal weight, overweight and obese pregnant women in early pregnancy.
Data collected at baseline from a double-blind randomised vitamin D intervention study (MO-VITD) were used. Pregnant women without pregnancy complications, aged > 18 years and having a singleton pregnancy were recruited between January 2016 and August 2017 at antenatal clinics in the Western Health and Social Care Trust, Northern Ireland. Non-fasting blood samples were collected at 12 weeks gestation and analysed for total serum 25(OH)D, using liquid chromatography tandem mass spectrometry. Data from 239 pregnant women (80 normal weight, 79 overweight, 80 obese) were included in the current analysis.
The mean ± SD 25(OH)D concentration of all pregnant women at 12 weeks gestation was 52.0 ± 21.6 nmol/L. Women classed as obese or overweight had significantly lower 25(OH)D concentrations compared to women of normal weight (48.8 ± 20.3 vs 49.8 ± 20.4 vs. 57.5 ± 23.1 nmol/L, P = 0.019; obese, overweight, normal weight respectively). A total of 45% of all pregnant women were found to be either vitamin D deficient (25(OH)D < 25nmol/L; 13%) or insufficient (25–50 nmol/L; 32%) in early pregnancy. BMI was significantly negatively correlated with 25(OH)D concentrations (r = -0.168; P = 0.009). Regression analyses showed that BMI (β = -0.165; P = 0.006), season (β = 0.220; P = < 0.0001), supplement use (β = -0.268; P < 0.0001) and a sun holiday within the previous 6 months (β = -0.180; P = 0.010) were significant predictors of 25(OH)D concentrations. In early pregnancy, 62% of pregnant women reported using a supplement containing vitamin D and 38% reported no supplement use. Supplement users had a significantly higher vitamin D status than non-supplement users in all BMI categories but overall, 37% of supplement users were still classified as vitamin D insufficient. Vitamin D status was significantly lower in winter months compared to summer months. In early pregnancy, especially during winter months, pregnant women with obesity, particularly non-supplement users, are at higher risk of low vitamin D status. Based on the lower vitamin D status observed in early pregnancy in obese women, the effect of BMI on vitamin D supplementation throughout pregnancy needs to be examined.
Changes in Resting Energy Expenditure following Gastric Bypass Surgery: Impact on Total Body Weight.
- Fathimath Naseer, Ruth Price, Adele McElroy, Carel Le Roux, Tamsyn Redpath, Melanie Martin, Barbara Livingstone
-
- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E497
-
- Article
-
- You have access Access
- Export citation
-
Bariatric surgery, including Gastric Bypass (GBP) Surgery, is the most efficient modality to manage severe obesity. Resting Energy Expenditure (REE) is an area of interest in the context of weight loss (WL) as it has been postulated to be an independent predictor of WL success following GBP. As such, the aim of this study is to investigate the impact of REE on WL following GBP. 31 GBP patients (77.4% females BMI 45.5 ± 7.0kg/m2 ; 47.3 ± 11.6y) and 32 weight-stable controls (46.9% females; BMI 27.0 ± 4.6kg/m2 ; 41.1 ± 13.5y) were assessed at one-month pre-surgery and at 3 and 12-months post-surgery. Fat mass (FM) and fat-free mass (FFM) were measured using dual energy X-ray absorptiometry (Lunar iDXA, GE Healthcare). REE was measured under standardised conditions using indirect calorimetry (ECAL, Metabolic Health Solutions). Statistical analyses were performed with SPSS v24.0, Armonk, NY. Multiple regression analysis showed that FM (P = 0.001), FFM (P < 0.0001) and gender (P = 0.012) significantly predicted the interindividual variability in REE. Total body weight (TBW) was removed from the model due to collinearity. Adjusted-REE values were then generated using the above predictor variables. Low-REE and high-REE groups were created using within-group adjusted-REE split. At both follow-ups (3- and 12-months post-surgery), patients had a greater reduction in TBW, FM, FFM, measured-REE and adjusted-REE values compared with controls (P < 0.0001). There was also no significant difference between measured and adjusted-REE values at all time-points (P > 0.05). Patients with high REEs at baseline lost more TBW than those in the low-REE group at 3-months post-surgery (-24.9 ± 6.5 kg vs. -16.6 ± 7.0 kg; P = 0.005) and 12-months post-surgery (-41.3 ± 12.5 kg vs. -25.8 ± 10.4.0 kg; P = 0.003). There was no significant difference in mean TBW changes for controls in the low-and high-REE groups at both follow-ups. Patients with high REEs at 3-months post-surgery did not lose more TBW than those in the low-REE group at 12-months post-surgery (-30.1 ± 12.8 kg vs. -38.6 ± 14.4 kg; P = 0.155). Similarly, there was no difference in mean TBW reduction between controls in the low- and high-REE groups (P = 0.115). Thus while patients with a high adjusted-REE value at baseline (> 9746.6kJ/day) lost more weight at 3- and 12-months post-GBP, it is plausible that from the third to the 12th month post-surgery, other key drivers of weight loss, particularly the reduction in energy intake are more important in predicting WL. Further research with a larger sample size is required to increase the chances of detecting a true effect.
Time to invest in prevention and better care of behaviors and psychological symptoms associated with dementia
- Claire V. Burley, Gill Livingston, Martin R. J. Knapp, Anders Wimo, Richard Norman, Henry Brodaty
-
- Journal:
- International Psychogeriatrics / Volume 32 / Issue 5 / May 2020
- Published online by Cambridge University Press:
- 31 March 2020, pp. 567-572
-
- Article
- Export citation
Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial
- Gill Livingston, Monica Manela, Aidan O'Keeffe, Penny Rapaport, Claudia Cooper, Martin Knapp, Derek King, Renee Romeo, Zuzana Walker, Juanita Hoe, Cath Mummery, Julie Barber
-
- Journal:
- The British Journal of Psychiatry / Volume 216 / Issue 1 / January 2020
- Published online by Cambridge University Press:
- 12 July 2019, pp. 35-42
- Print publication:
- January 2020
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.
AimsTo assess the clinical effectiveness over 6 years and the impact on costs and care home admission.
MethodWe conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.
ResultsIn total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference −2.00 points, 95% CI −3.38 to −0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58–1.35).
ConclusionsSTART is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.
Declarations of interestG.L., Z.W. and C.C. are supported by the UCLH National Institute for Health Research (NIHR) Biomedical Research Centre. G.L. and P.R. were in part supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Z.W. reports during the conduct of the study; personal fees from GE Healthcare, grants from GE Healthcare, grants from Lundbeck, other from GE Healthcare, outside the submitted work.
On the Age and Origin of Lake Ejagham, Cameroon, and Its Endemic Fishes
- Jay Curt Stager, Kenneth Alton, Christopher H. Martin, David T. King, Jr., Lucille W. Petruny, Brendan Wiltse, Daniel A. Livingstone
-
- Journal:
- Quaternary Research / Volume 89 / Issue 1 / January 2018
- Published online by Cambridge University Press:
- 20 July 2017, pp. 21-32
-
- Article
- Export citation
-
Lake Ejagham is a small, shallow lake in Cameroon, West Africa, which supports five endemic species of cichlid fishes in two distinct lineages. Genetic evidence suggests a relatively young age for the species flocks, but supporting geologic evidence has thus far been unavailable. Here we present diatom, geochemical, mineralogical, and radiocarbon data from two sediment cores that provide new insights into the age and origin of Lake Ejagham and its endemic fishes. Radiocarbon ages at the base of the longer core indicate that the lake formed approximately 9 ka ago, and the diatom record of the shorter core suggests that hydroclimate variability during the last 3 millennia was similar to that of other lakes in Cameroon and Ghana. These findings establish a maximum age of ca. 9 cal ka BP for the lake and its endemic species and suggest that repeated cichlid speciation in two distinct lineages occurred rapidly within the lake. Local geology and West African paleoclimate records argue against a volcanic, chemical, or climatic origin for Lake Ejagham. Although not conclusive, the morphometry of the lake and possible signs of impact-induced effects on quartz grains are instead more suggestive of a bolide impact.
Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial
- Renee Romeo, Martin Knapp, Jennifer Hellier, Michael Dewey, Clive Ballard, Robert Baldwin, Peter Bentham, Alistair Burns, Chris Fox, Clive Holmes, Cornelius Katona, Claire Lawton, James Lindesay, Gill Livingston, Niall McCrae, Esme Moniz-Cook, Joanna Murray, Shirley Nurock, John O'Brien, Michaela Poppe, Alan Thomas, Rebecca Walwyn, Kenneth Wilson, Sube Banerjee
-
- Journal:
- The British Journal of Psychiatry / Volume 202 / Issue 2 / February 2013
- Published online by Cambridge University Press:
- 02 January 2018, pp. 121-128
- Print publication:
- February 2013
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.
AimsTo evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.
MethodA pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.
ResultsThere were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.
ConclusionsIn terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.
A novel approach to assess the probability of disease eradication from a wild-animal reservoir host
- D. P. ANDERSON, D. S. L. RAMSEY, G. NUGENT, M. BOSSON, P. LIVINGSTONE, P. A. J. MARTIN, E. SERGEANT, A. M. GORMLEY, B. WARBURTON
-
- Journal:
- Epidemiology & Infection / Volume 141 / Issue 7 / July 2013
- Published online by Cambridge University Press:
- 23 January 2013, pp. 1509-1521
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Surveying and declaring disease freedom in wildlife is difficult because information on population size and spatial distribution is often inadequate. We describe and demonstrate a novel spatial model of wildlife disease-surveillance data for predicting the probability of freedom of bovine tuberculosis (caused by Mycobacterium bovis) in New Zealand, in which the introduced brushtail possum (Trichosurus vulpecula) is the primary wildlife reservoir. Using parameters governing home-range size, probability of capture, probability of infection and spatial relative risks of infection we employed survey data on reservoir hosts and spillover sentinels to make inference on the probability of eradication. Our analysis revealed high sensitivity of model predictions to parameter values, which demonstrated important differences in the information contained in survey data of host-reservoir and spillover-sentinel species. The modelling can increase cost efficiency by reducing the likelihood of prematurely declaring success due to insufficient control, and avoiding unnecessary costs due to excessive control and monitoring.
Antipsychotic Long-acting Injections Edited by Peter Haddad, Tim Lambert and John Lauriello Oxford University Press, 2010, £32.95, pb, 282 pp. ISBN: 9780199586042
- Martin Livingston
-
- Journal:
- The Psychiatrist / Volume 35 / Issue 11 / November 2011
- Published online by Cambridge University Press:
- 02 January 2018, pp. 438-439
- Print publication:
- November 2011
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
Authors' reply
- Simon Adelman, Martin Blanchard, Greta Rait, Gerard Leavey, Gill Livingston
-
- Journal:
- The British Journal of Psychiatry / Volume 199 / Issue 3 / September 2011
- Published online by Cambridge University Press:
- 02 January 2018, p. 250
- Print publication:
- September 2011
-
- Article
-
- You have access Access
- HTML
- Export citation
Prevalence of dementia in African–Caribbean compared with UK-born White older people: two-stage cross-sectional study
- Simon Adelman, Martin Blanchard, Greta Rait, Gerard Leavey, Gill Livingston
-
- Journal:
- The British Journal of Psychiatry / Volume 199 / Issue 2 / August 2011
- Published online by Cambridge University Press:
- 02 January 2018, pp. 119-125
- Print publication:
- August 2011
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
Preliminary studies in the UK, all using screening instruments of unknown cultural validity, indicate that there may be an increased prevalence of dementia in African–Caribbean people, possibly related to vascular risk factors and potentially amenable to preventative measures.
AimsTo determine the prevalence of dementia in older people of African–Caribbean country of birth compared with their White UK-born counterparts.
MethodA total of 218 people of African–Caribbean country of birth and 218 White UK-born people aged ⩾60 years were recruited from five general practices in North London. Those who screened positive for cognitive impairment using a culturally valid instrument were offered a standardised diagnostic interview. Two independent assessors diagnosed dementia according to standard operationalised criteria.
ResultsAfrican–Caribbean participants were 2 years younger, and those with dementia nearly 8 years younger than their White counterparts. The prevalence of dementia was significantly higher in the African–Caribbean (9.6%) than the White group (6.9%) after adjustment for the confounders age and socioeconomic status (odds ratio (OR) = 3.1, 95%CI 1.3–7.3, P = 0.012).
ConclusionsThere is an increased prevalence of dementia in older people of African–Caribbean country of birth in the UK and at younger ages than in the indigenous White population. These findings have implications for service provision and preventive interventions. Further research is needed to explore the role of vascular risk factors and social adversity in the excess of dementia in this population.
Contributors
-
- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
-
- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
-
- Chapter
- Export citation
Family carers' distress and abusive behaviour: longitudinal study
- Claudia Cooper, Martin Blanchard, Amber Selwood, Zuzana Walker, Gill Livingston
-
- Journal:
- The British Journal of Psychiatry / Volume 196 / Issue 6 / June 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 480-485
- Print publication:
- June 2010
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
A third of family carers of people with dementia report abusive behaviour towards the person for whom they are caring. This is the first longitudinal study to investigate such behaviour.
AimsTo test our hypotheses that carers' reports of abusive behaviour would increase over time, and that change in abuse scores would be predicted by change in anxiety and depression scores.
MethodIn total, 131 (71.6%) of the family/friend dementia carers consecutively recruited from new referrals to Essex and London community mental health teams who were interviewed at baseline, completed the revised Modified Conflict Tactics Scale to measure abuse 1 year later.
ResultsSixty-three (48.1%) of the carers reported any abusive behaviour at baseline compared with 81 (61.8%) a year later (χ2 = 6.9, P = 0.009). An increase in abuse scores was predicted by an increase in anxiety and depressive symptoms (respectively ß = 0.32, t = 3.9, P<0.001 and ß = 0.24, t = 2.9, P = 0.005), and by less domiciliary care at baseline (ß = –0.18, t =–2.2, P = 0.031).
ConclusionsMost abusive behaviour reported by carers at baseline persisted or worsened in the following year, despite contact with specialist services. We suggest that trials of psychological interventions shown to reduce anxiety and depression in the carers of people with dementia are needed to determine whether they also reduce elder abuse, and can be delivered cost-effectively within the National Health Service (NHS).
Service use and cost of mental disorder in older adults with intellectual disability
- Andre Strydom, Renee Romeo, Natalia Perez-Achiaga, Gill Livingston, Michael King, Martin Knapp, Angela Hassiotis
-
- Journal:
- The British Journal of Psychiatry / Volume 196 / Issue 2 / February 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 133-138
- Print publication:
- February 2010
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
The cost of caring for people with intellectual disability currently makes up a large proportion of healthcare spending in western Europe, and may rise in line with the increasing numbers of people with intellectual disability now living to old age.
AimsTo report service use and costs of older people with intellectual disability and explore the influence of sociodemographic and illness-related determinants.
MethodWe collected data on receipt and costs of accommodation, health and personal care, physical as well as mental illness, dementia, sensory impairment and disability in a representative sample of adults with intellectual disability aged 60 years and older (n = 212).
ResultsThe average weekly cost in GBP per older person was £790 (£41 080 per year). Accommodation accounted for 74%. Overall costs were highest for those living in congregate settings. Gender, intellectual disability severity, hearing impairment, physical disorder and mental illness had significant independent relationships with costs. Mental illness was associated with an additional weekly cost of £202.
ConclusionsOlder adults with intellectual disability comprise about 0.15–0.25% of the population of England but consume up to 5% of the total personal care budget. Interventions that meet needs and might prove to be cost-effective should be sought.
The sensitivity and specificity of the Modified Conflict Tactics Scale for detecting clinically significant elder abuse
- Claudia Cooper, Kate Maxmin, Amber Selwood, Martin Blanchard, Gill Livingston
-
- Journal:
- International Psychogeriatrics / Volume 21 / Issue 4 / August 2009
- Published online by Cambridge University Press:
- 01 August 2009, pp. 774-778
-
- Article
- Export citation
-
Background: A third of family carers of people with dementia describe acting abusively in research studies, but far fewer cases of abuse are currently detected in clinical situations. This discrepancy may be explained by inadequate detection by health professionals, or disagreement regarding what constitutes elder abuse. This study was undertaken to determine the sensitivity and specificity of the revised Modified Conflict Tactics Scale (MCTS) for detecting clinically significant abuse.
Methods: We interviewed 220 family carers of people consecutively referred to psychiatric services with dementia in Essex and London (U.K.), using the MCTS to measure abuse. We defined abuse cases using (1) the MCTS conventional scoring system; (2) the Pillemer criteria; and (3) clinical judgment of an expert panel.
Results: Our panel judged that 15 (6.8%) of carers reported potentially clinical concerning abusive behavior; but 47 (21%) were cases according to the Pillemer criteria and 74 (34%) using the MCTS conventional scoring system. We developed a weighted MCTS scoring system, with high sensitivity and specificity for detecting clinically concerning abuse.
Conclusions: The MCTS could be used routinely in clinical practice with carers of people with dementia to detect clinically concerning cases of abuse, many of which are currently being missed.