Impact of the Sonas Programme on Communication over a Period of 24 Weeks in People with Moderate-to-Severe Dementia

Objectives: The primary aim was to examine how communication abilities changed over time among nursing home residents with moderate-to-severe dementia who were attending the Sonas programme and to explore whether changes in communication abilities were related to cognitive ability. Method: A longitudinal secondary descriptive study method was employed, where 56 people with moderate-to-severe dementia attended a 45-min Sonas group session twice a week for 24 weeks. The Threadgold Communication Tool (TCT) was completed every 4 weeks. Results: The impact of the Sonas programme on communication showed a significant non-linear trend in the TCT, with an increase in communication abilities during the first 16 weeks, regardless of the level of the residents’ cognitive abilities. Thereafter it levelled out. No interaction was found between time and the frequency of attendances at Sonas sessions. Both verbal and non-verbal communication increased from the baseline, with non-verbal communication increasing quickly and verbal communication increasing marginally. Conclusion: Communication abilities increased with the time of the intervention, but the peak was achieved after 16 weeks, after which the effect levelled out. This suggest that the Sonas programme should be used for a period of at least 16 weeks before evaluating its effect

The Importance of Personal Recovery and Perceived Recovery Support Among Service Users With Psychosis

OBJECTIVE: More knowledge is needed about whether personal recovery, as defined by the CHIME framework (connectedness, hope, identity, meaning and purpose, and empowerment), is considered important by service users with psychosis. This study examined the importance of personal recovery for a large, heterogeneous group of service users with psychosis and their perceived support from clinicians for personal recovery. METHODS: This cross-sectional study used baseline data from 321 service users with psychosis from 39 clinical units across Norway. The INSPIRE Measure of Staff Support for Personal Recovery (based on CHIME) was used to examine personal recovery and perceived support provided for recovery. Twenty support-for-recovery items were each rated on importance (yes or no) and on the extent of support received (5-point scale). Bivariate and multiple linear regression models assessed variables associated with rated importance and support. Results: Most service users rated personal recovery items as important, regardless of their symptomatology and functioning. Previous experience with Illness Management and Recovery, knowledge about coping with stress and illness, and having a plan for early detection and prevention of relapse were significantly associated with higher perceived support. Higher self-reported depressive symptoms, lower score on the Global Assessment of Functioning symptom subscale, and male sex were significantly associated with less perceived support. CONCLUSIONS: Most service users with psychosis found personal recovery important, regardless of symptomatology and functioning, which has implications for clinical practice and provides empirical evidence that recovery-oriented treatments are relevant for most service users with psychosis in various mental health services

Body mass index in nursing home residents during the first year after admission

La desnutrición, que comprende tanto la desnutrición como el sobrepeso, debe ser abordada en el seguimiento médico de los adultos mayores debido a las consecuencias negativas para el estado funcional y la salud general. Aún así, se sabe poco sobre el estado nutricional de los residentes de hogares de ancianos (NH), especialmente con respecto al aumento o la pérdida de peso después de la admisión a NH. Por lo tanto, este estudio tiene como objetivo evaluar los cambios en el índice de masa corporal (IMC) durante el primer año posterior al ingreso a NH y explorar las características demográficas y clínicas relacionadas con los cambios en el IMC. Métodos Se combinaron los datos de dos estudios prospectivos que reclutaron participantes al ingreso a NH. Las características demográficas y clínicas, incluido el IMC, se evaluaron al inicio y después de un año. Se estimó un modelo de regresión lineal para explorar el impacto de las características demográficas y clínicas en el cambio del IMC. Resultados La cohorte del estudio constaba de 1044 participantes con una edad media de 84,3 años (DE 7,6) al inicio del estudio; El 64,2% eran mujeres. Al inicio del estudio, el 33% de los residentes de NH tenían desnutrición severa a moderada, mientras que el 10% eran obesos. Durante el primer año de su estadía en NH, los residentes con desnutrición severa a moderada tuvieron un aumento promedio en el IMC de 1,3 kg/m2 (DE 2,2; p < 0,001), mientras que los cambios de peso fueron muy pequeños o no significativos en los otros grupos de IMC . Las características relacionadas con el aumento de peso fueron una edad más joven y menos agitación. Conclusión La desnutrición es un desafío de salud común al momento de la admisión a NH, con un tercio de los residentes de NH con un peso bajo moderado a severo y un 10% con obesidad. Sin embargo, durante el primer año de estancia en NH, hubo una evolución favorable para los residentes de NH con bajo peso, ya que aumentaron su IMC, y el 43,6% cambió a una clasificación de mayor peso, mientras que no observamos cambios en el IMC en los residentes con obesidad. Dado que los residentes de NH se encuentran en la última fase de sus vidas, las intervenciones para prevenir la desnutrición o el sobrepeso deben iniciarse mientras aún viven en el hogar y luego continuar en los hogares de ancianos.Q2Q2Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. Methods Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. Results The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. Conclusion Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes.https://orcid.org/0000-0001-5832-0603https://scholar.google.com/citations?user=MrICwaMAAAAJ&hl=enhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659Revista Internacional - IndexadaS

Data splitting as a countermeasure against hypothesis fishing: with a case study of predictors for low back pain

There is growing concern in the scientific community that many published scientific findings may represent spurious patterns that are not reproducible in independent data sets. A reason for this is that significance levels or confidence intervals are often applied to secondary variables or sub-samples within the trial, in addition to the primary hypotheses (multiple hypotheses). This problem is likely to be extensive for population-based surveys, in which epidemiological hypotheses are derived after seeing the data set (hypothesis fishing). We recommend a data-splitting procedure to counteract this methodological problem, in which one part of the data set is used for identifying hypotheses, and the other is used for hypothesis testing. The procedure is similar to two-stage analysis of microarray data. We illustrate the process using a real data set related to predictors of low back pain at 14-year follow-up in a population initially free of low back pain. “Widespreadness” of pain (pain reported in several other places than the low back) was a statistically significant predictor, while smoking was not, despite its strong association with low back pain in the first half of the data set. We argue that the application of data splitting, in which an independent party handles the data set, will achieve for epidemiological surveys what pre-registration has done for clinical studies

Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The increasing attention on functional assessments in medical and vocational rehabilitation requires a focus change for the general practitioners (GP) into paying attention to patient resources, possibilities and coping instead of symptoms, problems and limitations. The GPs report difficulties in performing the requested explicit functional assessments. The purpose of this study was to implement a structured method in general practice for assessing functional ability in persons with long-term sick leave. The study aim was to evaluate intervention effects on important GP parameters; knowledge, attitudes, self-efficacy towards functional assessments and knowledge about patient work factors.</p> <p>Methods</p> <p>Fifty-seven GPs were randomly assigned to an intervention or a control group. The intervention group GPs attended an introductory one-day work-shop and implemented structured functional assessments during an eight months intervention period. GP knowledge, GP attitudes, and GP self-efficacy towards functional assessments, as well as GP knowledge of patient work factors, were collected before, after and six months after the intervention period started. Evaluation score-sheets were filled in by both the intervention GPs and their patients immediately after the consultation to evaluate the GPs' knowledge of patient work factors.</p> <p>Results</p> <p>The intervention GPs reported increased knowledge (B: 0.56, 95% CI (0.19, 0.91)) and self-efficacy (B: 0.90, 95% CI (0.53, 1.26)) towards functional assessments, and increased knowledge about their patients' workplace (B: 0.75, 95% CI (0.35, 1.15)) and perceived stressors (B: 0.55, 95% CI (0.23, 0.88)) with lasting effects at the second follow-up. No intervention effect was seen in relation to GP attitudes. Both before and after the intervention, the GPs were most informed about physical stressors, and less about mental and work organisational stressors (Guttman's reproducibility coefficient: 0.95 and 1.00). After the consultation, both the intervention GPs and their patients reported that the GPs' knowledge about patient work factors had increased (GP B: 0.60 (95% CI: 0.42, 0.78); patient B: 0.50 (95% CI: 0.34, 0.66)).</p> <p>Conclusion</p> <p>Introducing and implementing structured functional assessments in general practice made the GPs capable to assess functional ability of their patients in a structured manner. Intervention effects of increased GP knowledge and GP self-efficacy sustained at the second follow-up.</p

Spatial--temporal model for wind speed in Lithuania

In this paper, we propose a spatial--temporal model for the wind speed (WS). We first estimate the model at the single spatial meteorological station independently on spatial correlations. The temporal model contains seasonality, a higher-order autoregressive component and a variance describing the remaining heteroskedesticity in residuals. We then model spatial dependencies by a Gaussian random field. The model is estimated on daily WS records from 18 meteorological stations in Lithuania. The validation procedure based on out-of-sample observations shows that the proposed model is reliable and can be used for various practical applications.

Weather Derivatives and Stochastic Modelling of Temperature

We propose a continuous-time autoregressive model for the temperature dynamics with volatility being the product of a seasonal function and a stochastic process. We use the Barndorff-Nielsen and Shephard model for the stochastic volatility. The proposed temperature dynamics is flexible enough to model temperature data accurately, and at the same time being analytically tractable. Futures prices for commonly traded contracts at the Chicago Mercantile Exchange on indices like cooling- and heating-degree days and cumulative average temperatures are computed, as well as option prices on them