General Practitioners' Views And Experiences Of Loneliness In Their Older Adult Patients

Background: Loneliness is associated with numerous detrimental effects on physical health, mental health, cognition, and lifestyle. Older adults are one of the groups at highest risk of loneliness, and indeed about 46% of older adults in England are lonely. Those experiencing loneliness visit their General Practitioner (GP) more frequently than those who are not, which has the capacity to put a strain on GPs and primary care waiting lists and costs. There is some literature on GPs’ experiences of other social problems, but it is yet unknown how GPs in the UK perceive and work with loneliness in older adult patients. Aims: To explore GPs’ views and experiences of loneliness within their older adult patients. Method: A qualitative approach was taken for this research and followed a social constructivist perspective. 19 GPs were recruited using researcher contacts, snowballing, and purposive sampling. Individual semi-structured interviews were conducted either in person or over the telephone. Data were transcribed and analysed using thematic analysis Findings: Five over-arching themes and 14 corresponding sub-themes were presented. GPs’ definitions of loneliness and its prevalence in our society is discussed. GPs held a medicalised and individualistic view regarding loneliness. They discussed their barriers to raising the topic, as well as the social stigma surrounding loneliness for both GP and patient. GPs felt powerless in their ability to fix the problem, and tended to use self-protection strategies. Further need for GP support and system improvements were discussed. Conclusions: Study findings are discussed in the context of relevant theories and literature. Implications include greater emphasis on social problems like loneliness in GP training, more practical and emotional support for qualified GPs, and a clearer more streamlined approach to managing loneliness presentations in primary care. Strengths and limitations of the study are discussed, and avenues for future research suggested

Engaging ‘hard to reach’ groups in health promotion: the views of older people and professionals from a qualitative study in England

Background Older people living in deprived areas, from black and minority ethnic groups (BME) or aged over 85 years (oldest old) are recognised as ‘hard to reach’. Engaging these groups in health promotion is of particular importance when seeking to target those who may benefit the most and to reduce health inequalities. This study aimed to explore what influences them practicing health promotion and elicit the views of cross-sector professionals with experiences of working with ‘hard to reach’ older people, to help inform best practice on engagement. Methods ‘Hard to reach’ older people were recruited through primary care by approaching those not attending for preventative healthcare, and via day centres. Nineteen participated in an interview (n = 15) or focus group (n = 4); including some overlaps: 17 were from a deprived area, 12 from BME groups, and five were oldest old. Cross-sector health promotion professionals across England with experience of health promotion with older people were identified through online searches and snowball sampling. A total of 31 of these 44 professionals completed an online survey including open questions on barriers and facilitators to uptake in these groups. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team. Results Older people’s motivation to stay healthy and independent reflected their everyday behaviour including practicing activities to feel or stay well, level of social engagement, and enthusiasm for and belief in health promotion. All of the oldest old reported trying to live healthily, often facilitated by others, yet sometimes being restricted due to poor health. Most older people from BME groups reported a strong wish to remain independent which was often positively influenced by their social network. Older people living in deprived areas reported reluctance to undertake health promotion activities, conveyed apathy and reported little social interaction. Cross-sector health professionals consistently reported similar themes as the older people, reinforcing the views of the older people through examples. Conclusions The study shows some shared themes across the three ‘hard-to-reach’ groups but also some distinct differences, suggesting that a carefully outlined strategy should be considered to reach successfully the group targeted.Peer reviewedFinal Published versio

Static Wettability of Differently Mechanically Treated and Amphiphobic-Coated Aluminium Surfaces

Wettability, roughness and surface treatment methods are essential for the majority of practical applications, where liquid–solid surface interactions take place. The present study experimentally investigated the influence of different mechanical surface treatment methods on the static wettability of uncoated and amphiphobic-coated aluminium alloy (AlMg3) samples, specially focusing on the interaction between surface finishing and coating. Five different surfaces were prepared: as-received substrate, polished, sandpapered, fleece-abraded and sandblasted. After characterisation, the samples were spray-coated using an amphiphobic coating. The characterisation of the uncoated and coated samples involved measurements of the roughness parameters and the apparent contact angles of demineralized water and rapeseed oil. The coating was initially characterised regarding its adhesion to the sample and elevated temperature stability. The applied surface treatments resulted in the scattered sample roughness in the range of Sa = 0.3–15.8 µm, water contact angles of θap,w = 78°–106° and extremely low oil contact angles. Coating the samples more than doubled the surface roughness to Sa = 13.3–29 µm, whereas the initial surface treatment properties (structure, anisotropy, etc.) were entirely repressed by the coating properties. Coating led the water contact angles to increase to θap,w_coated = 162°–173° and even more pronounced oil contact angles to increase to θap,o_coated = 139°–150°, classifying the surfaces as superhydrophobic and oleophobic

Strategies to improve engagement of 'hard to reach' older people in research on health promotion: : a systematic review

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: This review aimed to identify facilitators, barriers and strategies for engaging 'hard to reach' older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas. Methods: Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people. Results: Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions. Conclusions: This review identified facilitators, barriers and strategies for engaging 'hard to reach' older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.Peer reviewedFinal Published versio

Influence of Non-Thermal Plasma Treatment on Structural Network Attributes of Wheat Flour and Respective Dough

Due to its “generally recognized as safe status” (GRAS) and moderate treatment temperatures, non-thermal plasma (NTP) has lately been considered a suitable replacement for chemicals in the modification of food properties and for preserving food quality. One of the promising areas for the application of NTP is the treatment of wheat flour, leading to improved flour properties and product quality and consequently to higher customer satisfaction. In the present research, the German wheat flour type 550, equivalent to all-purpose flour, was treated using NTP in a rotational reactor to determine the influence of short treatment times (≤5 min) on the properties of flour (moisture and fat content, protein, starch, color, microbial activity, and enzymes), dough (visco-elastic properties, starch, wet and dry gluten, and water absorption), and baking products (color, freshness, baked volume, crumb structure, softness, and elasticity). Based on the properties of NTP, it was expected that even very short treatment times would have a significant effect on the flour particles, which could positively affect the quality of the final baking product. Overall, the experimental analysis showed a positive effect of NTP treatment of wheat flour, e.g., decreased water activity value (8% after 5 min. treatment); dough extensibility increased (ca. 30% after 3 min treatment); etc. Regarding the baking product, further positive effects were detected, e.g., enhanced product volume (>9%), improved crumb whiteness/decreased crumb yellowness, softening of breadcrumb without a change in elasticity, and limited microorganism and enzymatic activity. Furthermore, no negative effects on the product quality were observed, even though further food quality tests are required. The presented experimental research confirms the overall positive influence of NTP treatment, even for very low treatment times, on wheat flour and its products. The presented findings are significant for the potential implementation of this technique on an industrial level

Degradation of Low Concentrated Perfluorinated Compounds (PFCs) from Water Samples Using Non-Thermal Atmospheric Plasma (NTAP)

Perfluorinated compounds (PFCs) are manmade chemicals, containing the covalent C-F bond, which is among the strongest chemical bonds known to organic chemistry. Abundant use of these chemicals contaminates air, water, and soil around the world. Despite recent initiatives and legal regulations set to reduce their omnipresence, conventional water purification processes are either inefficient or very expensive, especially for low PFC contamination levels. This research is focused on the non-thermal atmospheric plasma (NTAP) decomposition of very low concentrations (<1 µg/L) of PFCs (especially perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS)), present in the wastewater produced during the process of PFCs removal from contaminated soil. The efficiency of the decomposition process was investigated for air, oxygen, and nitrogen plasma, with exposure times of 1–10 min and different plasma nozzle- and reactor sizes. Experiments demonstrated that the NTAP treatment is an efficient alternative method for degradation of more than 50% of the initial PFC concentration in the water samples, in less than 200 s. The final concentration of PFC showed strong dependency on the tested parameters. The treatment effect showed to be strongly non-linear with time, followed by the reduction of the pH-value of the treated sample, which might present a limiting factor for further PFC decomposition

The novel Parkinson's disease linked mutation G51D attenuates in vitro aggregation and membrane binding of alpha-synuclein, and enhances its secretion and nuclear localization in cells

A novel mutation in the alpha-Synuclein (alpha-Syn) gene "G51D" was recently identified in two familial cases exhibiting features of Parkinson's disease (PD) and multiple system atrophy (MSA). In this study, we explored the impact of this novel mutation on the aggregation, cellular and biophysical properties of alpha-Syn, in an attempt to unravel how this mutant contributes to PD/MSA. Our results show that the G51D mutation significantly attenuates alpha-Syn aggregation in vitro. Moreover, it disrupts local helix formation in the presence of SDS, decreases binding to lipid vesicles C-terminal to the site of mutation and severely inhibits helical folding in the presence of acidic vesicles. When expressed in yeast, alpha-Syn(G51D) behaves similarly to alpha-Syn(A30P), as both exhibit impaired membrane association, form few inclusions and are non-toxic. In contrast, enhanced secreted and nuclear levels of the G51D mutant were observed in mammalian cells, as well as in primary neurons, where alpha-Syn(G51D) was enriched in the nuclear compartment, was hyper-phosphorylated at S129 and exacerbated alpha-Syn-induced mitochondrial fragmentation. Finally, post-mortem human brain tissues of alpha-Syn(G51D) cases were examined, and revealed only partial colocalization with nuclear membrane markers, probably due to post-mortem tissue delay and fixation. These findings suggest that the PD-linked mutations may cause neurodegeneration via different mechanisms, some of which may be independent of alpha-Syn aggregation

The novel Parkinson's disease linked mutation G51D attenuates in vitro aggregation and membrane binding of alpha-synuclein, and enhances its secretion and nuclear localization in cells

A novel mutation in the alpha-Synuclein (alpha-Syn) gene "G51D" was recently identified in two familial cases exhibiting features of Parkinson's disease (PD) and multiple system atrophy (MSA). In this study, we explored the impact of this novel mutation on the aggregation, cellular and biophysical properties of alpha-Syn, in an attempt to unravel how this mutant contributes to PD/MSA. Our results show that the G51D mutation significantly attenuates alpha-Syn aggregation in vitro. Moreover, it disrupts local helix formation in the presence of SDS, decreases binding to lipid vesicles C-terminal to the site of mutation and severely inhibits helical folding in the presence of acidic vesicles. When expressed in yeast, alpha-Syn(G51D) behaves similarly to alpha-Syn(A30P), as both exhibit impaired membrane association, form few inclusions and are non-toxic. In contrast, enhanced secreted and nuclear levels of the G51D mutant were observed in mammalian cells, as well as in primary neurons, where alpha-Syn(G51D) was enriched in the nuclear compartment, was hyper-phosphorylated at S129 and exacerbated alpha-Syn-induced mitochondrial fragmentation. Finally, post-mortem human brain tissues of alpha-Syn(G51D) cases were examined, and revealed only partial colocalization with nuclear membrane markers, probably due to post-mortem tissue delay and fixation. These findings suggest that the PD-linked mutations may cause neurodegeneration via different mechanisms, some of which may be independent of alpha-Syn aggregation

Health promotion interventions for community-dwelling older people with mild or pre-frailty : a systematic review and meta-analysis

BACKGROUND: Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty. METHODS: We searched 20 bibliographic databases and 3 trials registers (January 1990 - May 2016) using mild/pre-frailty and associated terms. We included randomised controlled and crossover trials of health promotion interventions for community-dwelling older people (65+ years) with mild/pre-frailty and excluded studies focussing on populations in hospital, long term care facilities or with a specific condition. Risk of bias was assessed by two reviewers using the Cochrane Risk of Bias tool. We pooled study results using standardised mean differences (SMD) where possible and used narrative synthesis where insufficient outcome data were available. RESULTS: We included 10 articles reporting on seven trials (total n = 506 participants) and included five trials in a meta-analysis. Studies were predominantly small, of limited quality and six studies tested group exercise alone. One study additionally investigated a nutrition and exercise intervention and one evaluated telemonitoring. Interventions of exercise in groups showed mixed effects on functioning (no effects on self-reported functioning SMD 0.19 (95% CI -0.57 to 0.95) n = 3 studies; positive effects on performance-based functioning SMD 0.37 (95% CI 0.07 to 0.68) n = 3 studies). No studies assessed moves to long-term care or hospitalisations. CONCLUSIONS: Currently the evidence base is of insufficient size, quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty. High quality studies of rigorously developed interventions are needed

Freezing of gait and fall detection in Parkinson’s disease using wearable sensors:a systematic review

Despite the large number of studies that have investigated the use of wearable sensors to detect gait disturbances such as Freezing of gait (FOG) and falls, there is little consensus regarding appropriate methodologies for how to optimally apply such devices. Here, an overview of the use of wearable systems to assess FOG and falls in Parkinson’s disease (PD) and validation performance is presented. A systematic search in the PubMed and Web of Science databases was performed using a group of concept key words. The final search was performed in January 2017, and articles were selected based upon a set of eligibility criteria. In total, 27 articles were selected. Of those, 23 related to FOG and 4 to falls. FOG studies were performed in either laboratory or home settings, with sample sizes ranging from 1 PD up to 48 PD presenting Hoehn and Yahr stage from 2 to 4. The shin was the most common sensor location and accelerometer was the most frequently used sensor type. Validity measures ranged from 73–100% for sensitivity and 67–100% for specificity. Falls and fall risk studies were all home-based, including samples sizes of 1 PD up to 107 PD, mostly using one sensor containing accelerometers, worn at various body locations. Despite the promising validation initiatives reported in these studies, they were all performed in relatively small sample sizes, and there was a significant variability in outcomes measured and results reported. Given these limitations, the validation of sensor-derived assessments of PD features would benefit from more focused research efforts, increased collaboration among researchers, aligning data collection protocols, and sharing data sets