A systematic review of stress in staff caring for people with dementia living in 24-hour care settings

Background: Family carers of people with dementia are at risk of psychological morbidity, and it is suggested that this may also be the case in paid carers as caring for people with dementia can be emotionally and physically demanding. Care homes have historically had difficulty recruiting and retaining staff, and job stress has previously been linked to high turnover amongst long-term care staff. We performed a systematic review of studies of the prevalence of psychological stress in staff caring for people with dementia in residential long-term care settings.Methods: We conducted a comprehensive literature search of MEDLINE, PsychINFO and Web of Science databases up to May 2009, supplemented by a search of the references of all relevant articles. Search terms encompassed nursing staff, residential care and psychological distress. Validity of studies was graded by two authors independently using a standardized checklist.Results: We identified 601 studies of which five met our inclusion criteria. Two studies reported on prevalence rates of staff distress and found 37% and 5% levels of being "at risk" from burnout, four studies reported mean stress scores and all were low.Conclusions: All studies were either small or used instruments with unsatisfactory psychometric properties and so our conclusions are limited by the lack of good quality evidence. The preliminary evidence suggests that most staff who remain working in homes do not have a high prevalence of psychological stress or level of symptoms

Enhancing communication between dementia care staff and their residents: an arts-inspired intervention

Objectives: The arts are increasingly recognised as important and beneficial activities for people living with dementia. However, there is little peer-reviewed published research exploring arts-based learning for dementia care staff. In response, this paper explores (a) how dementia care staff describe forms of communication in care settings, and (b) the impact on communication following four sessions of ‘Creative Conversations’, an arts-based intervention for skills development. Method: Fourteen care homes received the intervention, delivered as 4 × 2 hour sessions. The intervention uses a range of activities (e.g. poetry, film, music, art making). Twenty–eight care staff were opportunistically sampled (mean age = 42.29), and provided pre-post qualitative data, obtained through interviews. Transcripts were analysed thematically. Results: At baseline, the dominant ‘task-focussed’ nature of care work was described as a barrier to communication, challenging opportunities for developing meaningful relationships with residents. Post-intervention, three primary themes were identified regarding improving communication: (1) learning through the arts (secondary themes: simplicity and subtlety, innovation in communication, and strengthening the role of non-verbal communication), (2) Enhancing creative approaches to care (secondary themes: element of surprise, confidence to experiment and catalyst for communication) and (3) professional introspection (secondary themes: development of empathy, sharing knowledge and experiences and a new appreciation). Conclusions: The intervention validated staff skills and confidence, enabling meaningful interactions that could be creative, ‘in the moment’, spontaneous and improvised. This arts-based intervention, which departs from formal education and fact-based learning may be particularly useful for the development of the dementia care workforce

The impact of curriculum hierarchies on the development of professional self in teaching: student-teachers of drama negotiating issues of subject status at the interface between drama and English

At the level of policy the relative ‘value’ of subjects is determined by their official curriculum designation, creating a hierarchy of learning within which particular subjects are categorised as optional to the educational experience of young people. This situation is well-illustrated by the marginalised position of drama in the National Curriculum for England and Wales in which drama appears as an adjunct to the ‘core’ subject English. Yet at school level drama has survived as a discrete and reasonably embedded subject. Drawing on questionnaire and interview data, I investigate the effects of this mismatch on the emergence of pedagogical content knowledge, linked to notions of professional self, in drama student-teachers at one university in the UK. Findings indicate that the student-teachers, whilst not entirely eschewing a less-regulated relationship between the two subjects, view the curriculum for English and its accompanying assessment regime as an inadequate host for drama. In addition, they regard teacher autonomy over curriculum content and pedagogy as indicative of a high degree of professional expertise. This suggests that a case can be made for re-evaluating the nature of the relationship between drama and English and its representation in policy-constructed curricula

Bone histomorphometric measures of physical activity in children from Medieval England

Objectives: Histomorphometric studies show consistent links between physical activity patterns and the microstructure underlying the size and shape of bone. Here we adopt a combined bone approach to explore variation in microstructure of ribs and humeri related to physical activity and historical records of manual labor in skeletal samples of children (n=175) from medieval England. The humerus reflects greater biomechanically induced microstructural variation than the rib which is used here as a control. Variation in microstructure is sought between regions in England (Canterbury, York, Newcastle), and between high- and low-status children from Canterbury. Materials and Methods: Thin-sections were prepared from the humerus or rib and features of bone remodeling were recorded using high-resolution microscopy and image analysis software. Results: The density and size of secondary osteons in the humerus differed significantly in children from Canterbury when compared to those from York and Newcastle. Amongst the older children, secondary osteon circularity and diameter differed significantly between higher and lower status children. Discussion: By applying bone remodeling principles to the histomorphometric data we infer that medieval children in Canterbury engaged in less physically demanding activities than children from York or Newcastle. Within Canterbury, high-status and low-status children experienced similar biomechanical loading until around seven years of age. After this age low-status children performed activities that resulted in more habitual loading on their arm bones than the high-status children. This inferred change in physical activity is consistent with historical textual evidence that describes children entering the work force at this age

Cortical histomorphometry of the human humerus during ontogeny

Modeling and remodeling are two key determinants of human skeletal growth though little is known about the histomorphometry of cortical bone during ontogeny. In this study we examined the density and geometric properties of primary and secondary osteons (osteon area and diameter, vascular canal area and diameter) in sub-periosteal cortical bone from the human humerus (n=84) between birth and age 18 years. Sections were removed from the anterior midshaft aspect of humeri from skeletons. Age-at-death was reconstructed using standard osteological techniques. Analyses revealed significant correlation between the histomorphometric variables and age. Higher densities of primary osteons occurred between infancy and seven years of age but were almost completely replaced by secondary osteons after 14 years of age. The geometry of primary osteons was less clearly related to age. Secondary osteons were visible after two years of age, and reached their greatest densities in the oldest individuals. Osteon size was positively but weakly influenced by age. Our data implies that modeling and remodeling are age dependent processes that vary markedly from birth to adulthood in the human humerus

Polyphase Neoproterozoic orogenesis within the East Africa-Antarctica Orogenic Belt in central and northern Madagascar

Our recent geological survey of the basement of central and northern Madagascar allowed us to re-evaluate the evolution of this part of the East Africa–Antarctica Orogen (EAAO). Five crustal domains are recognized, characterized by distinctive lithologies and histories of sedimentation, magmatism, deformation and metamorphism, and separated by tectonic and/or unconformable contacts. Four consist largely of Archaean metamorphic rocks (Antongil, Masora and Antananarivo Cratons, Tsaratanana Complex). The fifth (Bemarivo Belt) comprises Proterozoic meta-igneous rocks. The older rocks were intruded by plutonic suites at c. 1000 Ma, 820– 760 Ma, 630–595 Ma and 560–520 Ma. The evolution of the four Archaean domains and their boundaries remains contentious, with two end-member interpretations evaluated: (1) all five crustal domains are separate tectonic elements, juxtaposed along Neoproterozoic sutures and (2) the four Archaean domains are segments of an older Archaean craton, which was sutured against the Bemarivo Belt in the Neoproterozoic. Rodinia fragmented during the early Neoproterozoic with intracratonic rifts that sometimes developed into oceanic basins. Subsequent Mid- Neoproterozoic collision of smaller cratonic blocks was followed by renewed extension and magmatism. The global ‘Terminal Pan-African’ event (560–490 Ma) finally stitched together the Mid-Neoproterozoic cratons to form Gondwana

Geochemical mapping using stream sediments in west-central Nigeria : implications for environmental studies and mineral exploration in West Africa

This paper provides an overview of regional geochemical mapping using stream sediments from central and south-western Nigeria. A total of 1569 stream sediment samples were collected and 54 major and trace elements determined by ICP-MS and Au, Pd and Pt by fire assay. Multivariate statistical techniques (e.g., correlation analysis and principal factor analysis) were used to explore the data, following appropriate data transformation, to understand the data structure, investigate underlying processes controlling spatial geochemical variability and identify element associations. Major geochemical variations are controlled by source geology and provenance, as well as chemical weathering and winnowing processes, more subtle variations are a result of land use and contamination from anthropogenic activity. This work has identified placer deposits of potential economic importance for Au, REE, Ta, Nb, U and Pt, as well as other primary metal deposits. Areas of higher As and Cr (>2 mg/kg and >70 mg/kg respectively) are associated with Mesozoic and younger coastal sediments in SW Nigeria. High stream sediment Zr concentrations (mean>0.2%), from proximal zircons derived from weathering of basement rocks, have important implications for sample preparation and subsequent analysis due to interferences. Associated heavy minerals enriched in high field strength elements, and notably rare earths’, may also have important implications for understanding magmatic processes within the basement terrain of West Africa. This study provides important new background/baseline geochemical values for common geological domains in Nigeria (which extend across other parts of West Africa) for assessment of contamination from urban/industrial land use changes and mining activities. Regional stream sediment mapping is also able to provide important new information with applications across a number of sectors including agriculture, health, land use and planning