The person, interactions and environment programme to improve care of people with dementia in hospital: a multisite study

Background: Improving care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal for service improvement. Objectives: PIE (Person: Interaction; Environment) comprises an observation tool and systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to: evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards; and develop insight into what person-centred care might look like in practice in this setting. Methods: We performed a longitudinal comparative case study design in ten purposively selected wards in five Trusts in three English regions; alongside an embedded process evaluation. Data was collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records), patient and ward aggregate data. Data was synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. Cross case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data was analysed using simple descriptive statistics. Qualitative data analysis employed grounded theory methods. Results: The study furthered understanding of dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’); or were ‘partial implementers’. The interaction between micro-level contextual factors (aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals) and miso and macro level organisational factors, were the main barriers to PIE adoption. Where implemented, evidence suggests that the programme directly affected improvement in ward practice with positive impact on the experience of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations: Although PIE has potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes was not systematically collected; and PIE was not adopted on most study wards. Research implications: Further research is required to identify more precisely the skill-mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires more in-depth understanding of contextual factors that impact the capacity of organisations to absorb and embed new practices

Inundaciones y cambio climático

Las inundaciones de los ríos han sucedido de forma tradicional en numerosos ríos de la Península Ibérica, aportando grandes beneficios en la agricultura y en la disponibilidad de recursos hídricos, pero en la historia más reciente han originado graves daños en personas y bienes haciendo que hoy día predomine una percepción de las inundaciones como “catástrofes”. En el origen del incremento de la frecuencia de las inundaciones hay que mencionar la intensificación del uso del territorio, sellando y compactando los suelos haciendo que aumenten las escorrentías rápidas, y la alteración hidromorfológica de los ríos, concentrando las aguas y favoreciendo la ocurrencia de avenidas y desbordamientos. En el incremento exponencial de las pérdidas que las inundaciones han originado en los últimos años hay que referirse a la intensa ocupación de las riberas de los ríos y sus llanuras de inundación por personas y actividades económicas, con un desarrollo en dichas zonas no compatible con la dinámica fluvial. El cambio climático es considerado un factor de riesgo adicional muy variable según las regiones, y la estimación de sus efectos sobre las inundaciones presenta todavía numerosas incertidumbres. Atendiendo a ello se revisan algunos estudios e informes relacionados con el fenómeno de las inundaciones y su posible relación con el cambio climático, y se propone la restauración de los sistemas fluviales y la restricción de usos en las zonas inundables como estrategias más acertadas para hacer frente a la mencionada problemática de las inundaciones y a la incertidumbre creada con el cambio climático. El análisis de los sucesivos paradigmas históricos planteados por el hombre frente a las inundaciones de los ríos pone en evidencia el interés de cambiar unas estrategias de “defensa” en contra de ellas, tratando de evitar que ocurran, por otras de “convivencia” con las mismas gestionando de la forma más apropiada el riesgo de los daños que pueden generar, atendiendo al espíritu de las Directivas europeas Marco del Agua y de evaluación y gestión del riesgo de la inundación

A Spanish Adaptation of the Computer and Mobile Device Proficiency Questionnaires (CPQ and MDPQ) for Older Adults

Technology can help support the goal of many older adults to live independently, though cognitive, attitudinal, and other barriers often result in a “digital divide” in which older adults use and adopt new technology at a lower rate compared to younger adults. Due to the many potential benefits of technology it is not surprising that interest in tools that assess technology proficiency among older adults has increased. These tools can help support older adult technology research and training. However, to understand these issues more broadly, especially cross-cultural determinants of technology proficiency, translated, validated, and standardized measures of proficiency are necessary. For example, according to the last Eurobarometer (European Commission, 2015), Spain has experienced the largest increase in technology adoption among European Union nations in the past few years, indicating potential cultural mediation of technology adoption and use. To benefit the investigation of cross-cultural differences and their causes, we adapted the Mobile Device Proficiency Questionnaire (MDPQ) and Computer Proficiency Questionnaire (CPQ) for older adults in Spain, including the full and brief forms of each measure. Consistent with English versions of the questionnaires, the scales and their subscales were found to be reliable and valid measures of mobile device and computer proficiency in Spanish older adults. However, in contrast to earlier studies, the factor structure for both questionnaires simplified into two factors for the population under study. We conclude that the Spanish versions of the MDPQ and CPQ can be employed as useful tools for measuring mobile device and computer proficiency in the Spanish older adult population for research and training purposes

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Background: Improving the care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal of service improvement. Objectives: The Person, Interactions and Environment (PIE) Programme comprises an observation tool and a systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards, and develop insight into what person-centred care might look like in practice in this setting. Methods: We performed a longitudinal comparative case study design in 10 purposively selected wards in five trusts in three English regions, alongside an embedded process evaluation. Data were collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records); and patient and ward aggregate data. Data were synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. A cross-case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data were analysed using simple descriptive statistics. A qualitative data analysis employed grounded theory methods. Results: The study furthered the understanding of the dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’) or were ‘partial implementers’. The interaction between micro-level contextual factors [aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals] and meso- and macro-level organisational factors were the main barriers to PIE adoption. Evidence suggests that the programme, where implemented, directly affected improvements in ward practice, with a positive impact on the experiences of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations: Although PIE has the potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes were not systematically collected, and PIE was not adopted on most study wards. Research implications: Further research is required to identify more precisely the skill mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires a more in-depth understanding of the contextual factors that have an impact on the capacity of organisations to absorb and embed new practices

Distribution and genetic variation of hymenolepidid cestodes in murid rodents on the Canary Islands (Spain)

<p>Abstract</p> <p>Background</p> <p>In the Canary Islands there are no previous data about tapeworms (Cestoda) of rodents. In order to identify the hymenolepidid species present in these hosts, a survey of 1,017 murine (349 <it>Rattus rattus</it>, 13 <it>Rattus norvegicus </it>and 655 <it>Mus musculus domesticus</it>) was carried out in the whole Archipelago. Molecular studies based on nuclear <it>ITS1 </it>and mitochondrial <it>COI </it>loci were performed to confirm the identifications and to analyse the levels of genetic variation and differentiation.</p> <p>Results</p> <p>Three species of hymenolepidids were identified: <it>Hymenolepis diminuta</it>, <it>Rodentolepis microstoma </it>and <it>Rodentolepis fraterna</it>. <it>Hymenolepis diminuta </it>(in rats) and <it>R. microstoma </it>(in mice) showed a widespread distribution in the Archipelago, and <it>R. fraterna </it>was the least spread species, appearing only on five of the islands. The hymenolepidids found on Fuerteventura, Lanzarote and La Graciosa were restricted to one area. The <it>COI </it>network of <it>H. diminuta </it>showed that the haplotypes from Lanzarote and Fuerteventura are the most distant with respect to the other islands, but clearly related among them.</p> <p>Conclusions</p> <p>Founder effects and biotic and abiotic factors could have played important role in the presence/absence of the hymenolepidid species in determined locations. The haplotypes from the eastern islands (Fuerteventura and Lanzarote) seem to have shared an ancestral haplotype very distant from the most frequent one that was found in the rest of the islands. Two colonization events or a single event with subsequent isolation and reduced gene flow between western-central and eastern islands, have taken place in the Archipelago. The three tapeworms detected are zoonotic species, and their presence among rodents from this Archipelago suggests a potential health risk to human via environmental contamination in high risk areas. However, the relatively low prevalence of infestations detected and the focal distribution of some of these species on certain islands reduce the general transmission risk to human.</p

The contribution of cannabis use to the increased psychosis risk among minority ethnic groups in Europe

Background: We examined whether cannabis use contributes to the increased risk of psychotic disorder for non-western minorities in Europe. Methods: We used data from the EU-GEI study (collected at sites in Spain, Italy, France, the United Kingdom, and the Netherlands) on 825 first-episode patients and 1026 controls. We estimated the odds ratio (OR) of psychotic disorder for several groups of migrants compared with the local reference population, without and with adjustment for measures of cannabis use. Results: The OR of psychotic disorder for non-western minorities, adjusted for age, sex, and recruitment area, was 1.80 (95% CI 1.39-2.33). Further adjustment of this OR for frequency of cannabis use had a minimal effect: OR = 1.81 (95% CI 1.38-2.37). The same applied to adjustment for frequency of use of high-potency cannabis. Likewise, adjustments of ORs for most sub-groups of non-western countries had a minimal effect. There were two exceptions. For the Black Caribbean group in London, after adjustment for frequency of use of high-potency cannabis the OR decreased from 2.45 (95% CI 1.25-4.79) to 1.61 (95% CI 0.74-3.51). Similarly, the OR for Surinamese and Dutch Antillean individuals in Amsterdam decreased after adjustment for daily use: from 2.57 (95% CI 1.07-6.15) to 1.67 (95% CI 0.62-4.53). Conclusions: The contribution of cannabis use to the excess risk of psychotic disorder for non-western minorities was small. However, some evidence of an effect was found for people of Black Caribbean heritage in London and for those of Surinamese and Dutch Antillean heritage in Amsterdam

The relationship of symptom dimensions with premorbid adjustment and cognitive characteristics at first episode psychosis: Findings from the EU-GEI study

Premorbid functioning and cognitive measures may reflect gradients of developmental impairment across diagnostic categories in psychosis. In this study, we sought to examine the associations of current cognition and premorbid adjustment with symptom dimensions in a large first episode psychosis (FEP) sample. We used data from the international EU-GEI study. Bifactor modelling of the Operational Criteria in Studies of Psychotic Illness (OPCRIT) ratings provided general and specific symptom dimension scores. Premorbid Adjustment Scale estimated premorbid social (PSF) and academic adjustment (PAF), and WAIS-brief version measured IQ. A MANCOVA model examined the relationship between symptom dimensions and PSF, PAF, and IQ, having age, sex, country, self-ascribed ethnicity and frequency of cannabis use as confounders. In 785 patients, better PSF was associated with fewer negative (B = −0.12, 95% C.I. −0.18, −0.06, p &lt; 0.001) and depressive (B = −0.09, 95% C.I. −0.15, −0.03, p = 0.032), and more manic (B = 0.07, 95% C.I. 0.01, 0.14, p = 0.023) symptoms. Patients with a lower IQ presented with slightly more negative and positive, and fewer manic, symptoms. Secondary analysis on IQ subdomains revealed associations between better perceptual reasoning and fewer negative (B = −0.09, 95% C.I. −0.17, −0.01, p = 0.023) and more manic (B = 0.10, 95% C.I. 0.02, 0.18, p = 0.014) symptoms. Fewer positive symptoms were associated with better processing speed (B = −0.12, 95% C.I. −0.02, −0.004, p = 0.003) and working memory (B = −0.10, 95% C.I. −0.18, −0.01, p = 0.024). These findings suggest that the negative and manic symptom dimensions may serve as clinical proxies of different neurodevelopmental predisposition in psychosis

Synergistic effects of childhood adversity and polygenic risk in first-episode psychosis: The EU-GEI study

BACKGROUND: A history of childhood adversity is associated with psychotic disorder, with an increase in risk according to the number of exposures. However, it is not known why only some exposed individuals go on to develop psychosis. One possibility is pre-existing polygenic vulnerability. Here, we investigated, in the largest sample of first-episode psychosis (FEP) cases to date, whether childhood adversity and high polygenic risk scores for schizophrenia (SZ-PRS) combine synergistically to increase the risk of psychosis, over and above the effect of each alone. METHODS: We assigned a schizophrenia-polygenic risk score (SZ-PRS), calculated from the Psychiatric Genomics Consortium (PGC2), to all participants in a sample of 384 FEP patients and 690 controls from the case–control component of the EU-GEI study. Only participants of European ancestry were included in the study. A history of childhood adversity was collected using the Childhood Trauma Questionnaire (CTQ). Synergistic effects were estimated using the interaction contrast ratio (ICR) [odds ratio (OR)exposure and PRS − ORexposure − ORPRS + 1] with adjustment for potential confounders. RESULTS: There was some evidence that the combined effect of childhood adversities and polygenic risk was greater than the sum of each alone, as indicated by an ICR greater than zero [i.e. ICR 1.28, 95% confidence interval (CI) −1.29 to 3.85]. Examining subtypes of childhood adversities, the strongest synergetic effect was observed for physical abuse (ICR 6.25, 95% CI −6.25 to 20.88). CONCLUSIONS: Our findings suggest possible synergistic effects of genetic liability and childhood adversity experiences in the onset of FEP, but larger samples are needed to increase precision of estimates

The Independent Effects of Psychosocial Stressors on Subclinical Psychosis: Findings From the Multinational EU-GEI Study

The influence of psychosocial stressors on psychosis risk has usually been studied in isolation and after the onset of the disorder, potentially ignoring important confounding relationships or the fact that some stressors that may be the consequence of the disorder rather than preexisting. The study of subclinical psychosis could help to address some of these issues. In this study, we investigated whether there was (i) an association between dimensions of subclinical psychosis and several psychosocial stressors including: childhood trauma, self-reported discrimination experiences, low social capital, and stressful life experiences, and (ii) any evidence of environment-environment (ExE) interactions between these factors. Data were drawn from the EUGEI study, in which healthy controls (N = 1497) and siblings of subjects with a psychotic disorder (N = 265) were included in six countries. The association between psychosocial stressors and subclinical psychosis dimensions (positive, negative and depressive dimension as measured by the Community Assessment of Psychic Experiences (CAPE) scale) and possible ExE interactions were assessed using linear regression models. After adjusting for sex, age, ethnicity, country, and control/sibling status, childhood trauma (β for positive dimension: 0.13, negative: 0.49, depressive: 0.26) and stressful life events (positive: 0.08, negative: 0.16, depressive: 0.17) were associated with the three dimensions. Lower social capital was associated with the negative and depression dimensions (negative: 0.26, depressive: 0.13), and self-reported discrimination experiences with the positive dimension (0.06). Our findings are in favor of independent, cumulative and non-specific influences of social adversities in subclinical psychosis in non-clinical populations, without arguments for E × E interactions