Journeying through Dementia, a community-based self-management intervention for people aged 65 years and over : a feasibility study to inform a future trial

Background: A study to determine the feasibility of conducting a future population-based trial into a self-management intervention for community-living adults with early stage dementia included evaluation of intervention content and modes of delivery, staffing requirements, recruitment methods and the utility and usability of patient reported outcomes. Methods: Participants identified through memory clinics in one city took part in an intervention called ‘Journeying through Dementia’. The 12-week programme incorporating four individual sessions with one of the facilitators encourages participants to engage in discussion and activities related to health and well-being positioning them as the expert enabling long-term behavioural change. Participants (n = 10) and their nominated carers (n = 7) were all asked to complete selected outcomes at baseline, 8 weeks (participants only) and post intervention and invited to comment on their usability. All participants and carers were qualitatively interviewed before intervention delivery about their expectations and participants; nominated carers and facilitators were all interviewed after cessation about their experiences. Results: The manualised intervention and modes of delivery proved acceptable to participants and carers. Reported benefits included increased confidence and self-efficacy, engagement in new or lapsed activities and re-engagement in fun and friendships. People with dementia and carers were able to self-complete all outcome measures, but time required to complete the measures is a key factor. Strategies for recruitment need to include direct contact within 24–48 h post invitation to the study. Analysis of data on the primary outcome did not reveal any trends. Facilitators found the training and support to be appropriate and helpful. Conclusions: The tailored intervention reportedly met the needs of all participants. The study confirmed the need for careful identification and application of patient-reported outcome measures. Outcomes to measure some dimensions of reported benefit are not available

Effets des stages en soirée sur l'apprentissage d'étudiantes en soins infirmiers et recommandations pédagogiques

La présente recherche a été subventionnée par le ministère de l'Éducation et de l'Enseignement supérieur dans le cadre du Programme d'aide à la recherche sur l'enseignement et l'apprentissage (PAREA).Comprend des références bibliographiques

Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011–2019

Introduction: Low-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking. Methods: Using data from CDC's annual Behavioral Risk Factor Surveillance System 2011-2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18-64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL). Results: Regression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08). Conclusions: Expanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees

Improving Intersections for Pedestrians and Bicyclists Informational Guide

DTFH61-16-D-00005Intersections are critical points of access to local and regional destinations for all roadway users. When designed with pedestrians and bicyclists explicitly in mind, all types of intersections can facilitate safe, accessible, convenient, and comfortable walking and bicycling. The purpose of this guide is to inform the state of the practice concerning intersection planning and design to implement solutions that help achieve the goal for zero fatalities and serious injuries while improving mobility for bicyclists and pedestrians. The primary intersection types discussed in this guide include traditional signalized intersections, roundabouts, Median U-Turn (MUT) intersections, Reduced Crossing U-Turn (RCUT) intersections, Quadrant Roadway (QR) intersections, Displaced Left Turn (DLT) intersections, and Diverging Diamond Interchanges (DDI). This guide also includes discussion about stop-controlled and uncontrolled intersection crossings for bicyclists and pedestrians. This guide illustrates integration of bikeways and pedestrian pathways at and across traditional and alternative intersections, describes countermeasures applicable to pedestrian and bicyclist crossings at intersections, and summarizes the application of intersection analysis methods for the safety and mobility of pedestrians and bicyclists. This guide serves as a supplement to the Federal Highway Administration\u2019s (FHWA\u2019s) series of intersection informational guides and makes direct connections to other FHWA bikeway and pedestrian facility selection guides. Part I presents three foundational principles for planning and designing intersections for pedestrians and bicyclists. Part 2 presents design concepts for each of the intersection types discussed in this guide and illustrates options and design flexibility for incorporating a variety of pedestrian and bicycling facility types. This guide is intended to supplement, but not replace, design guidance, traffic control standards, and countermeasure selection criteria

Effets des stages en soirée sur l'apprentissage d'étudiantes en soins infirmiers et recommandations pédagogiques

La présente recherche a été subventionnée par le ministère de l'Éducation et de l'Enseignement supérieur dans le cadre du Programme d'aide à la recherche sur l'enseignement et l'apprentissage (PAREA).Comprend des références bibliographiques

Defective removal of ribonucleotides from DNA promotes systemic autoimmunity

Genome integrity is continuously challenged by the DNA damage that arises during normal cell metabolism. Biallelic mutations in the genes encoding the genome surveillance enzyme ribonuclease H2 (RNase H2) cause Aicardi-Goutières syndrome (AGS), a pediatric disorder that shares features with the autoimmune disease systemic lupus erythematosus (SLE). Here we determined that heterozygous parents of AGS patients exhibit an intermediate autoimmune phenotype and demonstrated a genetic association between rare RNASEH2 sequence variants and SLE. Evaluation of patient cells revealed that SLE- and AGS-associated mutations impair RNase H2 function and result in accumulation of ribonucleotides in genomic DNA. The ensuing chronic low level of DNA damage triggered a DNA damage response characterized by constitutive p53 phosphorylation and senescence. Patient fibroblasts exhibited constitutive upregulation of IFN-stimulated genes and an enhanced type I IFN response to the immunostimulatory nucleic acid polyinosinic:polycytidylic acid and UV light irradiation, linking RNase H2 deficiency to potentiation of innate immune signaling. Moreover, UV-induced cyclobutane pyrimidine dimer formation was markedly enhanced in ribonucleotide-containing DNA, providing a mechanism for photosensitivity in RNase H2–associated SLE. Collectively, our findings implicate RNase H2 in the pathogenesis of SLE and suggest a role of DNA damage–associated pathways in the initiation of autoimmunity