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Implementation of the World Health Organization's QualityRights initiative in Ghana: an overview
- Akwasi O. Osei, Caroline Amissah, Samuel Cudjoe Hanu, Priscilla E. Tawiah, Kwaku A. Brobbey, Yaw Amankwah Arthur, Joana Ansong, Sally-Ann Ohene, Leveana Gyimah, Humphrey Kofie, Daniel Taylor, Peter Badimak Yaro, Michelle Funk, Natalie Drew, Maria Francesca Moro, Mauro Giovanni Carta, Florence Kamayonza Baingana, Victus Kwaku Kpesese, Martin Orrell, Celline Cole, WHO QualityRights Ghana Team
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- Journal:
- BJPsych Open / Volume 10 / Issue 3 / May 2024
- Published online by Cambridge University Press:
- 13 May 2024, e111
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Background
Globally, human rights violations experienced by persons with psychosocial, intellectual or cognitive disabilities continue to be a concern. The World Health Organization's (WHO) QualityRights initiative presents practical remedies to address these abuses. This paper presents an overview of the implementation of the initiative in Ghana.
AimsThe main objective of the QualityRights initiative in Ghana was to train and change attitudes among a wide range of stakeholders to promote recovery and respect for human rights for people with psychosocial, intellectual and cognitive disabilities.
MethodReports of in-person and online training, minutes of meetings and correspondence among stakeholders of the QualityRights initiative in Ghana, including activities of international collaborators, were analysed to shed light on the implementation of the project in Ghana.
ResultsIn-person and online e-training on mental health were conducted. At the time of writing, 40 443 people had registered for the training, 25 416 had started the training and 20 865 people had completed the training and obtained a certificate. The team conducted 27 in-person training sessions with 910 people. The successful implementation of the project is underpinned by a committed partnership among stakeholders, strong leadership from the coordinating agency, the acceptance of the initiative and the outcome. A few challenges, both in implementation and acceptance, are discussed.
ConclusionsThe exposure of the WHO QualityRights initiative to a substantial number of key stakeholders involved in mental healthcare in Ghana is critical to reducing human rights abuses for people with psychosocial, intellectual and cognitive disabilities.
Salmonella Saintpaul outbreak associated with cantaloupe consumption, the United Kingdom and Portugal, September to November 2023
- Luke J. McGeoch, Ann Hoban, Clare Sawyer, Hussein Rabie, Incident Team, Anaïs Painset, Lynda Browning, Derek Brown, Caitlin McCarthy, Andrew Nelson, Ana Firme, Ângela Pista, Joana Moreno, João Vieira Martins, Leonor Silveira, Jorge Machado, Paula Vasconcelos, Oluwakemi Olufon, Carmellie Inzoungou-Massanga, Amy Douglas, Jacquelyn McCormick, Lesley Larkin, Sooria Balasegaram
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- Journal:
- Epidemiology & Infection / Volume 152 / 2024
- Published online by Cambridge University Press:
- 06 May 2024, e78
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In September 2023, the UK Health Security Agency identified cases of Salmonella Saintpaul distributed across England, Scotland, and Wales, all with very low genetic diversity. Additional cases were identified in Portugal following an alert raised by the United Kingdom. Ninety-eight cases with a similar genetic sequence were identified, 93 in the United Kingdom and 5 in Portugal, of which 46% were aged under 10 years. Cases formed a phylogenetic cluster with a maximum distance of six single nucleotide polymorphisms (SNPs) and average of less than one SNP between isolates. An outbreak investigation was undertaken, including a case–control study. Among the 25 UK cases included in this study, 13 reported blood in stool and 5 were hospitalized. One hundred controls were recruited via a market research panel using frequency matching for age. Multivariable logistic regression analysis of food exposures in cases and controls identified a strong association with cantaloupe consumption (adjusted odds ratio: 14.22; 95% confidence interval: 2.83–71.43; p-value: 0.001). This outbreak, together with other recent national and international incidents, points to an increase in identifications of large outbreaks of Salmonella linked to melon consumption. We recommend detailed questioning and triangulation of information sources to delineate consumption of specific fruit varieties during Salmonella outbreaks.
P93: Characteristics of complex, non-pharmacological cognitive stimulation interventions for people with dementia in nursing homes: systematic review
- Julie Guicheteau, Ümran Sema Seven, Jana Boes, Ina Monsef, Sascha Köpke, Ann-Kristin Folkerts, Justina Doffiné, Elke Kalbe, Martin N. Dichter
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 124
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Objective:
Several guidelines propose the use of cognitive stimulation (CS) in people with dementia. Multi-component CS interventions seem most effective in improving cognitive function, quality of life, and behavioral and psychological symptoms of dementia. For successful implementation, it is important to analyze CS interventions in detail in order to identify frequently used and potentially effective components. The aim of this systematic review is to identify, describe and summarise multicomponent CS interventions conducted in nursing homes aiming to improve cognitive function, quality of life, mood, and behavior of people with dementia in nursing homes.
Methods:This review is based on established methodological frameworks for systematic evidence syntheses. We conducted a database search in February 2021, using PubMed, CENTRAL, PsycINFO, ALOIS and CINAHL. Two independent reviewers assessed all search results for eligible studies and assessed studies’ methodological quality using the Cochrane Risk of Bias tool for RCTs and the Joanna Briggs Institute checklist for quasi-experimental studies. Evaluation and intervention development studies of any design examining multicomponent interventions CS were included. Components of included intervention programs were analyzed using the TIDieR and CReDECI 2 criteria following a narrative analysis.
Results:We identified 19,992 references and included 45 publications. We observed large heterogeneity regarding intervention components, delivery, materials, mode of delivery, intervention provider, and intervention duration. Intervention components included for example reminiscence therapy, activities of daily living, cognitive exercises or reality orientation. Risk of bias was generally low. Reporting of complex interventions was frequently insufficient. No study reported patient and public involvement (PPI) at any stage of the research process.
Conclusion:This systematic review is the first to describe complex CS interventions conducted in nursing homes in detail. Results indicate the need for more detailed intervention description for future studies based on TIDieR and CReDECI2 guidelines to allow reliable replication of these interventions. Despite enormous research activities, many questions regarding the implementation and efficacy are still unanswered as process evaluations are lacking. In addition, reproducibility of interventions is hardly possible due to limited reporting. Future studies should use established frameworks for the development, evaluation and implementation of complex interventions and apply PPI concepts.
Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)
- Konstantinos N. Fountoulakis, Grigorios N. Karakatsoulis, Seri Abraham, Kristina Adorjan, Helal Uddin Ahmed, Renato D. Alarcón, Kiyomi Arai, Sani Salihu Auwal, Michael Berk, Sarah Bjedov, Julio Bobes, Teresa Bobes-Bascaran, Julie Bourgin-Duchesnay, Cristina Ana Bredicean, Laurynas Bukelskis, Akaki Burkadze, Indira Indiana Cabrera Abud, Ruby Castilla-Puentes, Marcelo Cetkovich, Hector Colon-Rivera, Ricardo Corral, Carla Cortez-Vergara, Piirika Crepin, Domenico De Berardis, Sergio Zamora Delgado, David De Lucena, Avinash De Sousa, Ramona Di Stefano, Seetal Dodd, Livia Priyanka Elek, Anna Elissa, Berta Erdelyi-Hamza, Gamze Erzin, Martin J. Etchevers, Peter Falkai, Adriana Farcas, Ilya Fedotov, Viktoriia Filatova, Nikolaos K. Fountoulakis, Iryna Frankova, Francesco Franza, Pedro Frias, Tatiana Galako, Cristian J. Garay, Leticia Garcia-Álvarez, Maria Paz García-Portilla, Xenia Gonda, Tomasz M. Gondek, Daniela Morera González, Hilary Gould, Paolo Grandinetti, Arturo Grau, Violeta Groudeva, Michal Hagin, Takayuki Harada, Tasdik M. Hasan, Nurul Azreen Hashim, Jan Hilbig, Sahadat Hossain, Rossitza Iakimova, Mona Ibrahim, Felicia Iftene, Yulia Ignatenko, Matias Irarrazaval, Zaliha Ismail, Jamila Ismayilova, Asaf Jakobs, Miro Jakovljević, Nenad Jakšić, Afzal Javed, Helin Yilmaz Kafali, Sagar Karia, Olga Kazakova, Doaa Khalifa, Olena Khaustova, Steve Koh, Svetlana Kopishinskaia, Korneliia Kosenko, Sotirios A. Koupidis, Illes Kovacs, Barbara Kulig, Alisha Lalljee, Justine Liewig, Abdul Majid, Evgeniia Malashonkova, Khamelia Malik, Najma Iqbal Malik, Gulay Mammadzada, Bilvesh Mandalia, Donatella Marazziti, Darko Marčinko, Stephanie Martinez, Eimantas Matiekus, Gabriela Mejia, Roha Saeed Memon, Xarah Elenne Meza Martínez, Dalia Mickevičiūtė, Roumen Milev, Muftau Mohammed, Alejandro Molina-López, Petr Morozov, Nuru Suleiman Muhammad, Filip Mustač, Mika S. Naor, Amira Nassieb, Alvydas Navickas, Tarek Okasha, Milena Pandova, Anca-Livia Panfil, Liliya Panteleeva, Ion Papava, Mikaella E. Patsali, Alexey Pavlichenko, Bojana Pejuskovic, Mariana Pinto Da Costa, Mikhail Popkov, Dina Popovic, Nor Jannah Nasution Raduan, Francisca Vargas Ramírez, Elmars Rancans, Salmi Razali, Federico Rebok, Anna Rewekant, Elena Ninoska Reyes Flores, María Teresa Rivera-Encinas, Pilar Saiz, Manuel Sánchez de Carmona, David Saucedo Martínez, Jo Anne Saw, Görkem Saygili, Patricia Schneidereit, Bhumika Shah, Tomohiro Shirasaka, Ketevan Silagadze, Satti Sitanggang, Oleg Skugarevsky, Anna Spikina, Sridevi Sira Mahalingappa, Maria Stoyanova, Anna Szczegielniak, Simona Claudia Tamasan, Giuseppe Tavormina, Maurilio Giuseppe Maria Tavormina, Pavlos N. Theodorakis, Mauricio Tohen, Eva Maria Tsapakis, Dina Tukhvatullina, Irfan Ullah, Ratnaraj Vaidya, Johann M. Vega-Dienstmaier, Jelena Vrublevska, Olivera Vukovic, Olga Vysotska, Natalia Widiasih, Anna Yashikhina, Panagiotis E. Prezerakos, Daria Smirnova
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- Journal:
- CNS Spectrums / Volume 29 / Issue 2 / April 2024
- Published online by Cambridge University Press:
- 25 January 2024, pp. 126-149
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Background
The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
MethodsThe sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
ResultsAbout 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
ConclusionsThe finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
4 Evaluating Plasma GFAP for the Detection of Alzheimer’s Disease Dementia
- Madeline Ally, Henrik Zetterberg, Kaj Blennow, Nicholas J. Ashton, Thomas K. Karikari, Hugo Aparicio, Michael A. Sugarman, Brandon Frank, Yorghos Tripodis, Ann C. McKee, Thor D. Stein, Brett Martin, Joseph N. Palmisano, Eric G. Steinberg, Irene Simkina, Lindsay Farrer, Gyungah Jun, Katherine W. Turk, Andrew E. Budson, Maureen K. O’Connor, Rhoda Au, Wei Qiao Qiu, Lee E. Goldstein, Ronald Killiany, Neil W. Kowall, Robert A. Stern, Jesse Mez, Michael L. Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 408-409
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Objective:
Blood-based biomarkers represent a scalable and accessible approach for the detection and monitoring of Alzheimer’s disease (AD). Plasma phosphorylated tau (p-tau) and neurofilament light (NfL) are validated biomarkers for the detection of tau and neurodegenerative brain changes in AD, respectively. There is now emphasis to expand beyond these markers to detect and provide insight into the pathophysiological processes of AD. To this end, a reactive astrocytic marker, namely plasma glial fibrillary acidic protein (GFAP), has been of interest. Yet, little is known about the relationship between plasma GFAP and AD. Here, we examined the association between plasma GFAP, diagnostic status, and neuropsychological test performance. Diagnostic accuracy of plasma GFAP was compared with plasma measures of p-tau181 and NfL.
Participants and Methods:This sample included 567 participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC) Longitudinal Clinical Core Registry, including individuals with normal cognition (n=234), mild cognitive impairment (MCI) (n=180), and AD dementia (n=153). The sample included all participants who had a blood draw. Participants completed a comprehensive neuropsychological battery (sample sizes across tests varied due to missingness). Diagnoses were adjudicated during multidisciplinary diagnostic consensus conferences. Plasma samples were analyzed using the Simoa platform. Binary logistic regression analyses tested the association between GFAP levels and diagnostic status (i.e., cognitively impaired due to AD versus unimpaired), controlling for age, sex, race, education, and APOE e4 status. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate diagnostic groups compared with plasma p-tau181 and NfL. Linear regression models tested the association between plasma GFAP and neuropsychological test performance, accounting for the above covariates.
Results:The mean (SD) age of the sample was 74.34 (7.54), 319 (56.3%) were female, 75 (13.2%) were Black, and 223 (39.3%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having cognitive impairment (GFAP z-score transformed: OR=2.233, 95% CI [1.609, 3.099], p<0.001; non-z-transformed: OR=1.004, 95% CI [1.002, 1.006], p<0.001). ROC analyses, comprising of GFAP and the above covariates, showed plasma GFAP discriminated the cognitively impaired from unimpaired (AUC=0.75) and was similar, but slightly superior, to plasma p-tau181 (AUC=0.74) and plasma NfL (AUC=0.74). A joint panel of the plasma markers had greatest discrimination accuracy (AUC=0.76). Linear regression analyses showed that higher GFAP levels were associated with worse performance on neuropsychological tests assessing global cognition, attention, executive functioning, episodic memory, and language abilities (ps<0.001) as well as higher CDR Sum of Boxes (p<0.001).
Conclusions:Higher plasma GFAP levels differentiated participants with cognitive impairment from those with normal cognition and were associated with worse performance on all neuropsychological tests assessed. GFAP had similar accuracy in detecting those with cognitive impairment compared with p-tau181 and NfL, however, a panel of all three biomarkers was optimal. These results support the utility of plasma GFAP in AD detection and suggest the pathological processes it represents might play an integral role in the pathogenesis of AD.
6 Association Between American Football Play and Parkinson's Disease: Analysis of the Fox Insight Data Set
- Hannah Bruce, Yorghos Tripodis, Michael McClean, Monica Korell, Caroline M Tanner, Brittany Contreras, Joshua Gottesman, Leslie Kirsch, Yasir Karim, Brett Martin, Joseph Palmisano, Thor D Stein, Jesse Mez, Robert A Stern, Charles H Adler, Chris Nowinski, Ann C McKee, Michael L Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 415-416
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Objective:
Parkinsonism and Parkinson's disease (PD) have been described as consequences of repetitive head impacts (RHI) from boxing, since 1928. Autopsy studies have shown that RHI from other contact sports can also increase risk for neurodegenerative diseases, including chronic traumatic encephalopathy (CTE) and Lewy bodies. In vivo research on the relationship between American football play and PD is scarce, with small samples, and equivocal findings. This study leveraged the Fox Insight study to evaluate the association between American football and parkinsonism and/or PD Diagnosis and related clinical outcomes.
Participants and Methods:Fox Insight is an online study of people with and without PD who are 18+ years (>50,000 enrolled). Participants complete online questionnaires on motor function, cognitive function, and general health behaviors. Participants self-reported whether they "currently have a diagnosis of Parkinson's disease, or parkinsonism, by a physician or other health care professional." In November 2020, the Boston University Head Impact Exposure Assessment was launched in Fox Insight for large-scale data collection on exposure to RHI from contact sports and other sources. Data used in this abstract were obtained from the Fox Insight database https://foxinsight-info.michaeljfox.org/insight/explore/insight.jsp on 01/06/2022. The sample includes 2018 men who endorsed playing an organized sport. Because only 1.6% of football players were women, analyses are limited to men. Responses to questions regarding history of participation in organized football were examined. Other contact and/or non-contact sports served as the referent group. Outcomes included PD status (absence/presence of parkinsonism or PD) and Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15) for assessment of cognitive symptoms. Binary logistic regression tested associations between history and years of football play with PD status, controlling for age, education, current heart disease or diabetes, and family history of PD. Linear regressions, controlling for these variables, were used for the PDAQ-15.
Results:Of the 2018 men (mean age=67.67, SD=9.84; 10, 0.5% Black), 788 (39%) played football (mean years of play=4.29, SD=2.88), including 122 (16.3%) who played youth football, 494 (66.0%) played high school, 128 (17.1%) played college football, and 5 (0.7%) played at the semi-professional or professional level. 1738 (86.1%) reported being diagnosed with parkinsonism/PD, and 707 of these were football players (40.7%). History of playing any level of football was associated with increased odds of having a reported parkinsonism or PD diagnosis (OR=1.52, 95% CI=1.14-2.03, p=0.004). The OR remained similar among those age <69 (sample median age) (OR=1.45, 95% CI=0.97-2.17, p=0.07) and 69+ (OR=1.45, 95% CI=0.95-2.22, p=0.09). Among the football players, there was not a significant association between years of play and PD status (OR=1.09, 95% CI=1.00-1.20, p=0.063). History of football play was not associated with PDAQ-15 scores (n=1980) (beta=-0.78, 95% CI=-1.59-0.03, p=0.059) among the entire sample.
Conclusions:Among 2018 men from a data set enriched for PD, playing organized football was associated with increased odds of having a reported parkinsonism/PD diagnosis. Next steps include examination of the contribution of traumatic brain injury and other sources of RHI (e.g., soccer, military service).
5 Antemortem Plasma GFAP Predicts Alzheimer’s Disease Neuropathological Changes
- Madeline Ally, Henrik Zetterberg, Kaj Blennow, Nicholas J. Ashton, Thomas K. Karikari, Hugo Aparicio, Michael A. Sugarman, Brandon Frank, Yorghos Tripodis, Brett Martin, Joseph N. Palmisano, Eric G. Steinberg, Irene Simkina, Lindsay Farrer, Gyungah Jun, Katherine W. Turk, Andrew E. Budson, Maureen K. O’Connor, Rhoda Au, Wei Qiao Qiu, Lee E. Goldstein, Ronald Killiany, Neil W. Kowall, Robert A. Stern, Jesse Mez, Bertran R. Huber, Ann C. McKee, Thor D. Stein, Michael L. Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 409-410
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Objective:
Blood-based biomarkers offer a more feasible alternative to Alzheimer’s disease (AD) detection, management, and study of disease mechanisms than current in vivo measures. Given their novelty, these plasma biomarkers must be assessed against postmortem neuropathological outcomes for validation. Research has shown utility in plasma markers of the proposed AT(N) framework, however recent studies have stressed the importance of expanding this framework to include other pathways. There is promising data supporting the usefulness of plasma glial fibrillary acidic protein (GFAP) in AD, but GFAP-to-autopsy studies are limited. Here, we tested the association between plasma GFAP and AD-related neuropathological outcomes in participants from the Boston University (BU) Alzheimer’s Disease Research Center (ADRC).
Participants and Methods:This sample included 45 participants from the BU ADRC who had a plasma sample within 5 years of death and donated their brain for neuropathological examination. Most recent plasma samples were analyzed using the Simoa platform. Neuropathological examinations followed the National Alzheimer’s Coordinating Center procedures and diagnostic criteria. The NIA-Reagan Institute criteria were used for the neuropathological diagnosis of AD. Measures of GFAP were log-transformed. Binary logistic regression analyses tested the association between GFAP and autopsy-confirmed AD status, as well as with semi-quantitative ratings of regional atrophy (none/mild versus moderate/severe) using binary logistic regression. Ordinal logistic regression analyses tested the association between plasma GFAP and Braak stage and CERAD neuritic plaque score. Area under the curve (AUC) statistics from receiver operating characteristics (ROC) using predicted probabilities from binary logistic regression examined the ability of plasma GFAP to discriminate autopsy-confirmed AD status. All analyses controlled for sex, age at death, years between last blood draw and death, and APOE e4 status.
Results:Of the 45 brain donors, 29 (64.4%) had autopsy-confirmed AD. The mean (SD) age of the sample at the time of blood draw was 80.76 (8.58) and there were 2.80 (1.16) years between the last blood draw and death. The sample included 20 (44.4%) females, 41 (91.1%) were White, and 20 (44.4%) were APOE e4 carriers. Higher GFAP concentrations were associated with increased odds for having autopsy-confirmed AD (OR=14.12, 95% CI [2.00, 99.88], p=0.008). ROC analysis showed plasma GFAP accurately discriminated those with and without autopsy-confirmed AD on its own (AUC=0.75) and strengthened as the above covariates were added to the model (AUC=0.81). Increases in GFAP levels corresponded to increases in Braak stage (OR=2.39, 95% CI [0.71-4.07], p=0.005), but not CERAD ratings (OR=1.24, 95% CI [0.004, 2.49], p=0.051). Higher GFAP levels were associated with greater temporal lobe atrophy (OR=10.27, 95% CI [1.53,69.15], p=0.017), but this was not observed with any other regions.
Conclusions:The current results show that antemortem plasma GFAP is associated with non-specific AD neuropathological changes at autopsy. Plasma GFAP could be a useful and practical biomarker for assisting in the detection of AD-related changes, as well as for study of disease mechanisms.
59 Objectively-Measured Performance on Tests of Episodic Memory and Executive Function in Autopsy-Confirmed Chronic Traumatic Encephalopathy
- Madeline Uretsky, Evan Nair, Nicole Saltiel, Bobak Abdolmohammadi, Sydney Mosaheb, Julia Culhane, Brett Martin, Joseph Palmisano, Yorghos Tripodis, Robert Stern, Victor Alvarez, Bertrand Russell Huber, Thor Stein, Ann McKee, Jesse Mez, Michael Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 264-265
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Objective:
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that can only be diagnosed at post-mortem. Revised criteria for the clinical syndrome of CTE, known as traumatic encephalopathy syndrome (TES), include impairments in episodic memory and/or executive function as core clinical features. These criteria were informed by retrospective interviews with next-of-kin and the presence and rates of objective impairments in memory and executive functions in CTE are unknown. Here, we characterized antemortem neuropsychological test performance in episodic memory and executive functions among deceased contact sport athletes neuropathologically diagnosed with CTE.
Participants and Methods:The sample included 80 deceased male contact sport athletes from the UNITE brain bank who had autopsy-confirmed CTE (and no other neurodegenerative diseases). Published criteria were used for the autopsy diagnosis of CTE. Neuropsychological test reports (raw scores) were acquired through medical record requests. Raw scores were converted to z-scores using the same age, sex, and education-adjusted normative data. Tests of memory included long delay trials from the Rey Complex Figure, CVLT-II, HVLT-R, RBANS, and BVMT-R. Tests of executive functions included Trail Making Test-B (TMT-B), Controlled Oral Word Association Test, WAIS-III Picture Arrangement, and various WAIS-IV subtests. Not all brain donors had the same tests, and the sample sizes vary across tests, with 33 donors having tests from both domains. Twenty-eight had 1 test in memory and 3 had 2+. Eight had 1 test of executive function and 46 had 2+. A z-score of 1.5 standard deviations below the normative mean was impaired. Interpretation of test performance followed the American Academy of Clinical Neuropsychology guidelines (Guilmette et al., 2020). Bivariate correlations assessed cumulative p-tau burden (summary semiquantitative ratings of p-tau severity across 11 brain regions) and TMT-B (n=34) and CVLT-II (n=14), the most common tests available.
Results:Of the 80 (mean age= 59.9, SD=18.0 years; 13, 16.3% were Black), 72 played football, 4 played ice hockey, and 4 played other contact sports. Most played at the professional level (57, 71.3%). Mean time between neuropsychological testing and death was 3.9 (SD= 4.5) years. The most common reason for testing was dementia-related (43, 53.8%). Mean z-scores fell in the average psychometric range(mean z= -0.52, SD=1.5, range= -6.0 to 3.0) for executive function and the low average range for memory (mean z= -1.3, SD=1.1, range= -4.0 to 2.0). Eleven (20.4%) had impairment on 1 test and 3 (5.6%) on 2+ tests of executive functions. The most common impairment was on TMT-B (mean z= -1.77, 13 [38.2%] impaired). For memory, 13 (41.9%) had impairment on 1 test. Of the 14 who had CVLT-II, 7 were impaired (mean z= -1.33). Greater p-tau burden was associated with worse performance on CVLT-II (r= -.653, p= .02), but not TMT-B (r= .187, p>.05).
Conclusions:This study provides the first evidence for objectively-measured impairments in executive functions and memory in a sample with known, autopsy-confirmed CTE. Furthermore, p-tau burden corresponded to worse memory test performance. Examination of neuropsychological tests from medical records has limitations but can overcome shortcomings of retrospective informant reports to provide insight into the cognitive profiles associated with CTE.
Psychological risk factors for Long COVID and their modification: study protocol of a three-arm, randomised controlled trial (SOMA.COV)
- Petra Engelmann, Christian Büchel, Jördis Frommhold, Hans F. E. Klose, Ansgar W. Lohse, Kerstin Maehder, Yvonne Nestoriuc, Martin Scherer, Anna Suling, Anne Toussaint, Angelika Weigel, Antonia Zapf, Bernd Löwe
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- Journal:
- BJPsych Open / Volume 9 / Issue 6 / November 2023
- Published online by Cambridge University Press:
- 03 November 2023, e207
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Background
Growing evidence suggests that in addition to pathophysiological, there are psychological risk factors involved in the development of Long COVID. Illness-related anxiety and dysfunctional symptom expectations seem to contribute to symptom persistence.
AimsWith regard to the development of effective therapies, our primary aim is to investigate whether symptoms of Long COVID can be improved by a targeted modification of illness-related anxiety and dysfunctional symptom expectations. Second, we aim to identify additional psychosocial risk factors that contribute to the persistence of Long COVID, and compare them with risk factors for symptom persistence in other clinical conditions.
MethodWe will conduct an observer-blinded, three-arm, randomised controlled trial. A total of 258 patients with Long COVID will be randomised into three groups of equal size: targeted expectation management in addition to treatment as usual (TAU), non-specific supportive treatment plus TAU, or TAU only. Both active intervention groups will comprise three individual online video consultation sessions and a booster session after 3 months. The primary outcome is baseline to post-interventional change in overall somatic symptom severity.
ConclusionsThe study will shed light onto the action mechanisms of a targeted expectation management intervention for Long COVID, which, if proven effective, can be used stand-alone or in the context of broader therapeutic approaches. Further, the study will enable a better understanding of symptom persistence in Long COVID by identifying additional psychological risk factors.
Chapter Four - Education in the Time of the School Board
- Anne Allsopp
- Edited by Martin G. Deacon
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- The Education and Employment of Girls in Luton, 1874-1924
- Published by:
- Boydell & Brewer
- Published online:
- 03 August 2023, pp 62-92
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Summary
Before 1870, elementary education in Luton was provided by the National and British Societies and in dame or private adventure (small independent) schools. A few respectable establishments offered higher levels of education, but the market for these was small. However, the passing of the 1870 Forster Education Act forced the town to confront the situation. This Act required local authorities to assess the number of elementary school places available and, if there was a shortfall, to ‘fill up the gaps’.
The possibility of an elected body having a say in what local children were taught angered members of Luton churches who firmly believed that education was their responsibility. Dony explains how bad feelings on this subject date back to 1834 when the government offered grants towards the building of new schools. The National and British Societies both wanted a school in Luton, but the number of children to be taught allowed for only one grant and that went to the National Society. ‘The die was cast for a dispute that was to disturb the peace of Luton for seventy years.’
Dony, referring to the Forster Act, says that ‘it would have been impossible to have drafted any Act of Parliament to give more trouble to [mainly Nonconformist] Luton’. A vestry meeting was called, possibly ‘the most disgraceful meeting ever held in the town’. The Church promised to build new schools and to provide a sufficient number of places, thereby warding off government interference. Their opponents, led by the treasurer of the British School, wanted a poll which, it was hoped, would support the establishment of a School Board. Some of the points made against the Board system were that it was a ‘leap in the dark’, that once you have a Board you cannot get rid of it and that there was already a burden of taxation. There was also a fear that educating children with public money would lead to feeding and clothing them as well.
Arguments for a Board were that it would provide and secure the education of the ‘entire population … calculated to promote the moral and material well-being of the Working Classes – to fit them for higher spheres of usefulness, to give them a “fair start in life”, and to enable them the better to make their way in the world’. The education which it would provide would be ‘free from all denominational teaching’.
Chapter Three - Sunday Schools
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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Growth of the Sunday School Movement
Sunday schools played a significant part in the schooling of children in Luton. Before compulsory education, which came into force in Luton in 1874, Sunday schools were often the only places where children could learn to read and write. Later they became the focus of much of the social life of the town. The schools were so important that they have been considered here, even though some of the material relates to the years that preceded the main focus of this book. Reference has also been made to some other Sunday schools in Bedfordshire in order to present a fuller picture.
Dr Kay Shuttleworth, the first Secretary of the Committee of the Privy Council (precursor of the Ministry of Education), which was set up in 1839 ‘for the consideration of all matters affecting the education of the people’, believed that Sunday schools were the ‘root from which sprang our system of day schools’. This belief was shared by Wesleyans in Luton who claimed that their first school was ‘the harbinger not only of the fine schools that now are our pride in Chapel Street, Waller Street, and elsewhere but also a great stimulus to the educational movement in general’. It was also said that ‘the Sunday School Movement may claim some credit for the splendid Elementary and Secondary Schools of the town’. In order to support this, names are given of men who were active both in Sunday and elementary schools: Mr Henry Blundell, Mr Gustavus Jordan and Mr George Warren, JP, CA.
Robert Raikes of Gloucester, a publisher, has generally been credited with the introduction of Sunday schools although there are in fact records of other schools which existed before 1780, which is when Raikes began to popularize the idea. Raikes, having observed the lawlessness of children running wild on Sundays, believed that by educating the children he might find a way to turn them from crime. ‘He saw that in many cases their misdemeanours were the result of ignorance alone, and that if instruction and enlightenment were not provided, many more people would be in the same pitiful state’.
Conclusion
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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This book has looked at the changes in education and employment prospects for girls in Luton and has tried to demonstrate how these two aspects of their lives were inter-related.
Increased opportunities
The date chosen for the commencement of this study (1874) was an important one for girls in Luton because it marked both the establishment of the School Board and the introduction of compulsory education. Whereas girls’ time had once been dominated by the demands of the hat industry and their educational prospects had been at the mercy of parents’ ability to pay fees and forgo their children's income, regular attendance at school was now obligatory.
Women in Luton had traditionally received education in less formal organizations and this kind of initiative was still alive, for example private commercial courses were available. Organizations such as the Sunday and adult schools no longer needed to teach basic literacy but continued to receive loyal support in classes which extended interests and stimulated discussions. Lectures given under the auspices of groups such as the Workers’ Education Association (WEA) were also supported by Luton women. Middle-class families who were conscious of their status and who wished to have their daughters educated as young ladies, supported private establishments throughout the years covered in this book.
However, the fee-paying day secondary school which had been set up by Bedfordshire County Council (BCC) was open to all and became increasingly popular. Children whose parents were unable to pay could earn a free place, but there were other financial constraints such as purchasing uniforms and supporting charities. It was therefore inevitable that this school was seen to be for the privileged few. It also seems likely that some kind of selection existed within the girls’ school itself when the emphasis became decidedly academic. However, by 1924 there was, for a small minority, the very real possibility of a university education.
There were also increased opportunities for girls in the employment market. Changes in the hat industry had required local businessmen to welcome other industries into the town, with the result that women had wider choices. Census figures show that, while the hat industry dominated the scene, many women were taking advantage of opportunities to work in local factories and offices. By the 1920s, a Juvenile Advisory Committee had been set up to offer advice to boys and girls who were leaving school. This would hardly have been necessary when one industry dominated women's lives, but times were changing.
Bibliography
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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Index
- Anne Allsopp
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Chapter Seven - Elementary Education 1903–1924
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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This chapter looks at the effect which the 1902 Education Act had on the schools and on the lives of girls in Luton. Some of the curriculum changes offered a genuinely wider concept of education, an attempt to shift the emphasis ‘from mere instruction to education’1 and a desire to stimulate children as individuals whose physical and mental needs must be met. Others, however, were based on an ideology which thought of girls primarily as potential wives and mothers and presented a challenge to a town where women had, for many years, been an accepted part of economic life.
External influences were significant: the Boer War activated a concern for the health of the nation, the responsibilities of Empire influenced an ethos of duty and service and the First World War affected the lives of children, particularly with regard to their level of attendance. Another major influence on the working lives of children was the setting up of agencies which gave them advice on their choice of employment. Diana St John, having assessed the experiences of girls educated during this period under the London County Council, identified different approaches to the education of girls. The first of these is that schools came a poor second to the influence of the home. The second approach held that girls’ education should be directed towards their future domestic roles. A third, very negative, attitude tended to ignore girls almost completely. The fourth was more positive, however, and saw girls as ‘pupils in their own right’:
They were seen not as uneducable drudges, not simply as wives and mothers, not as adjuncts to an educational process designed for boys, but as pupils in their own right with qualities, interests and needs sometimes coinciding with those of boys, at other times quite distinct, but in no way inferior or of less account.
Luton schooling is assessed with these factors in mind.
The 1902 Act
County councils were to be responsible for education, but in Bedfordshire both Bedford and Luton were large enough to be Part III authorities and could therefore control elementary education within their boroughs. As far as Luton was concerned the changes meant that the Luton Education Committee (LEC) supervised the town's elementary schools while the Bedfordshire Education Committee (BEC) controlled secondary education and also assumed responsibility for the schools in the hamlets.
Introduction
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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This book complements two others which have already been published in this series. Volume 78, Strawopolis (1999), looked at the transformation of Luton in the middle of the nineteenth century ‘from a market town, where hats were made, to principally a manufacturing centre’. Volume 82, Vauxhall Motors and the Luton Economy, 1900–2002 (2003), explored the life of the town in the twentieth century when the dominant hat industry was replaced by an equally dominant motor industry. This study (Volume 84) has concentrated on the changing role of women against these backgrounds.
The year 1874 was significant as it was the one in which the first Luton School Board was elected. In the same year education became compulsory for the town's children. New schools were built and by 1924 elementary schools were offering a wider and more stimulating style of curriculum. Of particular importance was the opening of a secondary school for girls under the leadership of a dedicated headmistress who brought new vision to the furtherance of higher education for girls. By 1924 the school had established a tradition of excellence and had laid foundations for the future. This book has therefore concentrated on the years between 1874 and 1924.
The focus of this study was originally intended to be the provision of schooling, but it soon became clear that the demands of the traditional hat industry and those of the School Board were closely intertwined. The theme therefore ceased to be education alone but the fascinating relationship between education and the changing patterns of employment for women.
Luton itself is worthy of serious study because its character is in some respects unique. In 1874 political power in the town lay with businessmen, mostly self-made, who ruled over every aspect of urban life and saw that prosperity could be achieved within the hat trade and without academic qualifications. Consequently, before 1874, education, particularly for girls, had not been given high priority. This is reflected in illiteracy rates in Luton, which, in 1856, were 44% opposed to the national average of 35%.
One reason for this was the existence of a domestic industry which dominated children's lives. Women, too, could spend the whole of their working lives in the hat industry and they were undoubtedly central to the prosperity of the town.
Chapter Two - Further Perspectives Concerning Employment Patterns for Women
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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This chapter will look at specific information regarding the employment of women. The 1911 and 1921 censuses give detailed figures and these have been compared with national figures and statistics for Bedford. Less exact, but of interest from a social point of view, are details taken from the Kelly's Directories for 1890 and 1920. Advertisements in the Luton News between 1901 and 1924 indicate general trends and are of value in the assessment of attitudes and expectations. Year Books have also provided useful information and it has been possible to make some comparisons concerning wages and salaries.
Observations based on the 1911 and 1921 censuses
The 1911 and 1921 censuses show just how employment for women had diversified since the height of the hat industry and the arrival of the new industries. The number of unemployed females in 1921 also indicates that some women preferred to remain at home after the First World War. Figures for Bedford have been noted because they offer a contrast to the types of employment available for women in Luton.
While the female population of Luton had increased between 1911 and 1921, the number and proportion of women employed fell. In some respects this supports Carol Dyhouse's view that ‘the first world war only temporarily increased women's participation in industry, and was followed by a period of intensified social opposition to the employment of married women in industry and professional life’. However, the involvement of women in the new industries seems to have risen, as indicated by the proportion involved with metal, food and chemical production. Significantly, the number of women involved with the hat industry fell from 6,972 (63.5%) in 1911 to 5,992 (59%) in 1921. As women had always worked in the straw industry, there would appear to be no ideological explanation. It is more likely that market forces and the First World War, which had affected export markets, rather than ideology accounted for this drop.
Interesting comparisons can be made between Luton and Bedford. A larger proportion of Bedford's female population was involved in the service industries indicating that the town enjoyed a different social structure, with many families able to employ domestic help. Fewer Bedford ladies worked, although there were significant numbers involved in commercial and public life. By 1921, more Bedford women were working in the food and drink industry, for example at Meltis.
Appendix
- Anne Allsopp
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- The Education and Employment of Girls in Luton, 1874-1924
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Dedication
- Anne Allsopp
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The Education and Employment of Girls in Luton, 1874-1924
- Widening Opportunities and Lost Freedoms
- Anne Allsopp
- Edited by Martin G. Deacon
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- Boydell & Brewer
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- 03 August 2023
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This book, based on the author's PhD thesis, examines the education of Luton girls and the relationship with employment opportunities. The acknowledged independence of spirit to be found in Luton was especially noticeable among its female population who enjoyed considerable economic power within the traditional hat-making industry.
In spite of this, there is evidence to show that girls' education was biased towards their roles as wives and mothers. However, by the early twentieth century, the effects of compulsory education and the introduction of new industries into the town meant that their status and expectations had changed.
Sunday schooling was important to children from the labouring classes and the contribution of these schools has been assessed. Specific themes include half-time schooling and the granting of labour certificates which allowed children to leave school before the statutory age.
The contribution of the home and independent organisations, the training of teachers, the character of rural schools and the introduction of technical and secondary education have also been considered. While emphasis is on the education of girls from the lower social classes, the middle classes have not been ignored.