Me, myself, and nature: living with dementia and connecting with the natural world – more than a breath of fresh air? A literature review

Objective: Depsite the growing awareness of the importance of engagement with the natural world for people living with dementia, little is known about the impact specifically for people living independently in their own home. This review identifies, analyses and synthesises existing research, incorporating first-person narrative accounts of the benefits and potential challenges experienced inforging meaningful connections with the natural world.Methods: Six databases were searched from February 2000 to February 2021. Relevant organisations and authors were contacted, and a hand search of included study reference lists was conducted. The findings of included studies were synthesised using a thematic analysis approach.Findings: Sixteen studies were included: 13 qualitative and three mixed methods. Eight themes and three sub-themes were identified, revealing how contact with the natural world held a significancefor people living with dementia, associated with a sense of pleasure, comfort, stimulation, freedom and meaning. Support and the use of adaptive strategies afforded opportunities for continued engagement with meaningful outdoor activities and the promotion of identity, independence, social interaction, enhanced wellbeing and quality of life for people living independently with dementia.Conclusion: Meaningful connections with the natural world offer far more than a ‘breath of freshair’. When support mechanisms are in place, engaging with the natural world can be a valuable arenafor enablement and continuity, providing a sense of connectedness to self, place and others

Mitochondrial DNA damage and atherosclerosis

This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Elsevier.Mitochondria are the cellular powerhouses, fuelling metabolic processes through their generation of ATP. However we now recognise that these organelles also have pivotal roles in the generation of reactive oxygen species (ROS) and the regulation of cell death, inflammation and metabolism. Mitochondrial dysfunction therefore leads to oxidative stress, cell death, inflammation and altered metabolism, which are all key processes in atherosclerosis. Recent evidence indicates that mitochondrial DNA (mtDNA) damage is present and promotes atherosclerosis through mitochondrial dysfunction. In this review we discuss the role and mechanisms linking mtDNA damage and atherosclerosis, and identify areas of mitochondrial biology that may yield potential therapeutic targets.This work was supported by British Heart Foundation grants PG/14/69/31032 and RG/13/14/30314, the National Institute for Health Research Cambridge Biomedical Research Centre, and the Academy of Medical Sciences

Use of mutants to dissect the role of ethylene signalling in organ senescence and the regulation of yield in Arabidopsis thaliana

The role of ethylene in regulating organ senescence in Arabidopsis has been investigated by studying the development of mutants that have an attenu- ated capacity to perceive the gas. The onset of leaf senescence and floral organ abscission was delayed in the ethylene-insensitive mutant etr1. The photosynthetic life span of rosette leaves was similarly extended in the gain- of-function mutant ers2, and this mutant also exhibited a delay in the timing of pod dehiscence primarily as a con- sequence of an extension in the final stages of senescence. A detailed analysis of yield revealed that whilst thousand grain weight was increased, by as much as 20 %, in etr1, ein4, and the loss-of-function mutant etr2, only the latter showed a significant increase in total weight of seeds produced per plant. The other studied mutants exhibited a reduction in total seed yield of almost 40 %. These observations are discussed in the context of the possible role of ethylene in regulating organ senescence and their significance in the breeding of crop plants with enhanced phenotypic characteristics

When you ask the fish: Child wellbeing through the eyes of Samoan children

Child wellbeing is the subject of substantial academic and policy interest globally and in New Zealand. Notably however, the voices of children are largely missing in much of the extended literature. In addition, and largely due to an assumption that wellbeing is a universally held construct, the influence of cultural values and beliefs on the perceptions and experiences of wellbeing of children, such as the Samoan children in this study, have not warranted in-depth attention. This study explores the influence of culture on how 8-year old Samoan children living in Wellington, NZ, conceptualise their wellbeing (Dunlop-Bennett, 2019). Part I of this article details the research approach developed for this study. Guided by Talanoa ile i’a (Faleolo, 2009) or ‘Talking to the Fish’, this study positioned children as experts on their wellbeing and through the use of talanoa and photos successfully created the reflective discussion space for 11 Samoan children to share their knowledge. The findings, outlined in Part II, show that when given the opportunity, these Samoan children offered critical and realistic insights into their experiences and aspirations. One model of wellbeing shared by these children used the analogy of a seesaw, where wellbeing was achieved when the “good bits and the bad bits” are balanced. The influence of context of wellbeing was a second key finding. These Samoan children’s experiences of wellbeing indicated a subtle interplay and balancing of their fa’asamoa (the Samoan way) and New Zealand life experiences. While this ethnic-specific study does not purport to represent the diversity of the Samoan diaspora, it presents a model that can be adapted by the Samoan diaspora living in other parts of New Zealand as well as other Pasifika and minority groups, as appropriate

Through their eyes: A Samoan perspective on child wellbeing

Child wellbeing is the subject of a considerable body of research and policy making globally, and in New Zealand today. Despite its extensive use, the concept of child wellbeing is used differently across disciplines and across diverse social and cultural contexts. Little of the extant literature recognises the influence of ‘other’ worldviews, cultural beliefs, values, and ways of knowing. Further, the voices of children are largely missing in the child wellbeing debates, despite the fact that children are able to offer authoritative knowledge of their world and of their experiences. A review of the literature on Pasifika, children and childhoods, and wellbeing, highlights that there is currently no literature in New Zealand that connects these three areas together. This is the gap where this research contributes new knowledge to understanding - from the standpoint of Samoan children and their parents living in Wellington - how they conceptualise child wellbeing. The Samoan diaspora is the focus of this research given the diversity that exists within Pasifika. Guided by the Talanoa ile i’a (Faleolo, 2009), this exploratory research positions children as ‘experts’ on their wellbeing and creates the space for them to share their knowledge. The Samoan children do so through combining Samoan (talanoaga) and Western (photovoice) research methods. The Samoan children took 10 photos of what made them feel ‘happy, safe, and loved’, which they used to guide their talanoa. The views of their parents were elicited through talanoaga. From the talanoaga, the Samoan children defined their wellbeing as “a bunch of stuff that has good bits and bad bits”. This definition picks up the relational aspect of wellbeing as well as resilience. Four factors are important to their wellbeing, which are: social connections, not having to worry, feeling valued and included, and being a good person. Connecting with people, particularly their family, stands out as being of overwhelming importance to their wellbeing. The Samoan children bring these ideas together conceptually as a seesaw in a playground. Parents conceptualise the wellbeing of their children as ola manaia or the beautiful life. They see their main role as laying the foundations on which their children could have a beautiful life. For many parents, they are drawing on the fa’asamoa and the way in which they have been raised, but ‘tweaking’ this to account for shifts in the broader context. Of note, parents view wellbeing in terms of their children being happy and emotionally stable, being good people, having values, and that they do something meaningful with their lives that they were passionate about. The talanoa from the parents are woven together as the Ola Manaia model that captures the importance of resilience and the relational aspect of wellbeing. This research has significance in terms of adding to the community, national and global body of knowledge on child wellbeing. This is the first New Zealand study of the wellbeing of Samoan children that gives priority to the voices of children. In doing so, it adds the child’s voice as well as the ‘other’ to the child wellbeing literature, and does this in a holistic way that takes account of the multi-dimensional aspect of child wellbeing. Further, this research reinforces that, when given the opportunity, children are able to make an incredible contribution to issues that affect them

External validation of the Vulnerable Elder\u27s Survey for predicting mortality and emergency admission in older community-dwelling people: a prospective cohort study.

BACKGROUND: Prospective external validation of the Vulnerable Elder\u27s Survey (VES-13) in primary care remains limited. The aim of this study is to externally validate the VES-13 in predicting mortality and emergency admission in older community-dwelling adults. METHODS: Design: Prospective cohort study with 2 years follow-up (2010-2012). SETTING: 15 General Practices (GPs) in the Republic of Ireland. PARTICIPANTS: n = 862, aged ≥70 years, community-dwellers Exposure: VES-13 calculated at baseline, where a score of ≥3 denoted high risk. OUTCOMES: i) Mortality; ii) ≥1 Emergency admission and ≥1 ambulatory care sensitive (ACS) admission over 2 years. STATISTICAL ANALYSIS: Descriptive statistics, model discrimination (c-statistic) and sensitivity/specificity. RESULTS: Of 862 study participants, a total of 246 (38%) were classified as vulnerable at baseline. Fifty-three (6%) died during follow-up and 246 (29%) had an emergency admission. At the VES-13 cut-point of ≥3 denoting high-risk model discrimination was poor for mortality (c-statistic: 0.61 (95% CI 0.54, 0.67), ≥1 emergency admission (c-statistic: 0.59 (95% CI 0.56, 0.63) and ≥1 ACS emergency admission (c-statistic: 0.63 (95% CI 0.60, 0.67). CONCLUSIONS: In this study the VES-13 demonstrated relatively limited predictive accuracy in predicting mortality and emergency admission. External validation studies examining the tool in different health settings and healthier populations are needed and represent an interesting area for future research

Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study.

BACKGROUND: Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident \u26 emergency visits. METHODS: Study design: Two-year (2010-2012) prospective cohort study (n = 904, ≥70 years, community-dwelling) with linked pharmacy dispensing data. EXPOSURE: Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. STUDY OUTCOMES: ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident \u26 emergency visits (general practice medical record review). STATISTICAL ANALYSIS: Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI]], linear regression models [regression coefficient [95% CI]], and logistic [odds ratio [OR] [95% CI]). RESULTS: Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 40% and 445 (74%) patients reported ≥1 ADE at follow-up. In multivariable analysis, ≥2 STOPP PIP was associated with ADEs (adjusted incidence rate ratio: 1.29 [95% CI 1.03, 1.85; p = .03]; poorer health related quality of life [adjusted regression coefficient: -0.11 [95% CI -0.16, -0.06; p \u3c .001]]; and, ≥1 accident \u26 emergency visit [adjusted OR: 1.85 [95% CI 1.06, 3.24; p = .03]]). Baseline Beers 2012 prevalence was 26% and there was no association with adverse health outcomes in multivariable analysis. CONCLUSIONS: Older community-dwelling people, prescribed ≥2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident \u26 emergency department over 2-year follow-up