Maximum (prior) brain size, not atrophy, correlates with cognition in community-dwelling older people: a cross-sectional neuroimaging study

<p>Abstract</p> <p>Background</p> <p>Brain size is associated with cognitive ability in adulthood (correlation ~ .3), but few studies have investigated the relationship in normal ageing, particularly beyond age 75 years. With age both brain size and fluid-type intelligence decline, and regional atrophy is often suggested as causing decline in specific cognitive abilities. However, an association between brain size and intelligence may be due to the persistence of this relationship from earlier life.</p> <p>Methods</p> <p>We recruited 107 community-dwelling volunteers (29% male) aged 75–81 years for cognitive testing and neuroimaging. We used principal components analysis to derived a 'general cognitive factor' (g) from tests of fluid-type ability. Using semi-automated analysis, we measured whole brain volume, intracranial area (ICA) (an estimate of maximal brain volume), and volume of frontal and temporal lobes, amygdalo-hippocampal complex, and ventricles. Brain atrophy was estimated by correcting WBV for ICA.</p> <p>Results</p> <p>Whole brain volume (WBV) correlated with general cognitive ability (g) (r = .21, P < .05). Statistically significant associations between brain areas and specific cognitive abilities became non-significant when corrected for maximal brain volume (estimated using ICA), i.e. there were no statistically significant associations between atrophy and cognitive ability. The association between WBV and g was largely attenuated (from .21 to .03: i.e. attenuating the variance by 98%) by correcting for ICA. ICA accounted for 6.2% of the variance in g in old age, whereas atrophy accounted for < 1%.</p> <p>Conclusion</p> <p>The association between brain regions and specific cognitive abilities in community dwelling people of older age is due to the life-long association between whole brain size and general cognitive ability, rather than atrophy of specific regions. Researchers and clinicians should therefore be cautious of interpreting global or regional brain atrophy on neuroimaging as contributing to cognitive status in older age without taking into account prior mental ability and brain size.</p

Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study

<p>Abstract</p> <p>Background</p> <p><it>Zuo yuezi </it>is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of <it>zuo yuezi </it>from social, cultural and western medical perspectives.</p> <p>Methods</p> <p>We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional beliefs and their behaviour postpartum. We used a framework approach to identify main themes. We categorised reported behaviour against their probable effects on health, drawing on Western standards.</p> <p>Results</p> <p>Respondents reported that <it>zuo yuezi </it>was commonly practiced in urban and rural families to help the mother regain her strength and protect her future health. <it>Zuo yuezi </it>included: dietary precautions, such as eating more food and avoiding cold food; behavioural precautions, such as staying inside the home, avoiding housework and limiting visitors; hygiene precautions, such as restricting bathing and dental hygiene; and practices associated with infant feeding, including supplementary feeding and giving honeysuckle herb to the infant. Respondents reported that the main reasons for adhering to these practices were respect for tradition, and following the advice of elders. Categorised against Western medical standards, several <it>zuo yuezi </it>practices are beneficial, including eating more, eating protein rich food, avoiding housework, and daily vulval and perineal hygiene. A few are potentially harmful, including giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants supplementary feeds, although <it>zuo yuezi </it>emphasises breast feeding.</p> <p>Conclusion</p> <p><it>Zuo yuezi </it>is an important ritual in Fujian. In medical terms, most practices are beneficial, and could be used by health staff to promote health in this period. Further research on reported potentially harmful practices, such as supplements to breast feeding, is needed.</p

Utilization of antenatal ultrasound scan and implications for caesarean section: a cross-sectional study in rural Eastern China

<p>Abstract</p> <p>Background</p> <p>Antenatal ultrasound scan is a widely accepted component of antenatal care. Studies have looked at the relationship between ultrasound scanning and caesarean section (CS) in certain groups of women in China. However, there are limited data on the utilization of antenatal ultrasound scanning in the general population, including its association with CS. The purpose of this study is to describe the utilization of antenatal ultrasound screening in rural Eastern China and to explore the association between antenatal ultrasound scan and uptake of CS.</p> <p>Methods</p> <p>Based on a cluster randomized sample, a total of 2326 women with childbirth participated in the study. A household survey was conducted to collect socio-economic information, obstetric history and utilization of maternal health services.</p> <p>Results</p> <p>Coverage of antenatal care was 96.8% (2251/2326). During antenatal care, 96.1% (2164/2251) women received ultrasound screening and the reported average number was 2.55. 46.8% women received at least 3 ultrasound scans and the maximum number reached 11. The CS rate was found to be 54.8% (1275/2326). After adjusting for socio-demographic and clinical variables, it showed a statistically significant association between antenatal ultrasound scans and uptake of CS by multivariate logistic regression model. High husband education level, high maternal age, having previous adverse pregnant outcome and pregnancy complications during the index pregnancy were also found to be risk factors of choosing a CS.</p> <p>Conclusions</p> <p>A high use of antenatal ultrasound scan in rural Eastern China is found and is influenced by socio-demographic and clinical factors. Evidence-based guidelines for antenatal ultrasound scans need to be developed and disseminated to clinicians including physicians, nurses and sonographers. Guidance about the appropriate use of ultrasound scans should also be shared with women in order to discourage unreasonable expectations and demands. It is important to monitor the use of antenatal ultrasound scan as well as the indications for caesarean section in rural China.</p

Ocean Acidification at High Latitudes: Potential Effects on Functioning of the Antarctic Bivalve Laternula elliptica

Ocean acidification is a well recognised threat to marine ecosystems. High latitude regions are predicted to be particularly affected due to cold waters and naturally low carbonate saturation levels. This is of concern for organisms utilising calcium carbonate (CaCO3) to generate shells or skeletons. Studies of potential effects of future levels of pCO2 on high latitude calcifiers are at present limited, and there is little understanding of their potential to acclimate to these changes. We describe a laboratory experiment to compare physiological and metabolic responses of a key benthic bivalve, Laternula elliptica, at pCO2 levels of their natural environment (430 µatm, pH 7.99; based on field measurements) with those predicted for 2100 (735 µatm, pH 7.78) and glacial levels (187 µatm, pH 8.32). Adult L. elliptica basal metabolism (oxygen consumption rates) and heat shock protein HSP70 gene expression levels increased in response both to lowering and elevation of pH. Expression of chitin synthase (CHS), a key enzyme involved in synthesis of bivalve shells, was significantly up-regulated in individuals at pH 7.78, indicating L. elliptica were working harder to calcify in seawater undersaturated in aragonite (ΩAr = 0.71), the CaCO3 polymorph of which their shells are comprised. The different response variables were influenced by pH in differing ways, highlighting the importance of assessing a variety of factors to determine the likely impact of pH change. In combination, the results indicate a negative effect of ocean acidification on whole-organism functioning of L. elliptica over relatively short terms (weeks-months) that may be energetically difficult to maintain over longer time periods. Importantly, however, the observed changes in L. elliptica CHS gene expression provides evidence for biological control over the shell formation process, which may enable some degree of adaptation or acclimation to future ocean acidification scenarios

Community perceptions of voluntary health insurance in rural Vietnam

OBJECTIVES To explore community perceptions of voluntary health insurance (VHI) as factors influencing low enrolment in VHI. METHODS A qualitative study was conducted using focus group discussions with men and women who are members of VHI schemes and who are not members in four districts in rural Vietnam. Data was analysed using grounded theory. RESULTS Many perceived that illness and the costs of illness cannot be predicted. Knowledge and understanding about HI (health insurance) schemes was limited. There is a common perception that HI can help with the costs of health care, and this is linked to buying HI when ill. Information about HI schemes is not well disseminated: information is often insufficiently detailed and inconsistent, whilst methods do not reach many. There were several complaints about HI schemes: the premium is too high for individuals and families; delay in receiving HI cards and frequent mistakes on cards prevents people using HI; and the drug list is too narrow, so people need to buy additional drugs. Many people with insurance perceived that they received lower quality care than those who paid fees for healthcare. They reported receiving fewer and cheaper drugs and less sophisticated investigations and treatments. They also felt they had to wait longer to be seen by healthcare workers. These experiences limited willingness to enrol and use of HI cards at outpatient facilities. CONCLUSION Low enrolment in VHI is affected by low perceptions of ability to control health risks, lack of understanding of HI in general and specific schemes and perceived problems with scheme administration, benefits and quality of health services. The potential problem of adverse selection may influence the sustainability of the scheme. Recommendations to increase enrolment and benefit from the scheme include improving communication with the rural population on HI, reducing the premium level (consider additional government subsidy), adjusting the benefit package, reducing administrative problems in the schemes and addressing provider payment issues

Enrolment in health insurance in rural Vietnam

OBJECTIVES To improve enrolment in voluntary health insurance in rural Vietnam by increasing community understanding and knowledge of the schemes and ease of participation through a multi-faceted intervention including information, education and communication activities and efforts to improve the administration of health insurance. METHODS The study took place in four rural districts in Vietnam. In two of these districts a multi-faceted intervention was carried out which included strengthening the awareness and understanding of local people of Health Insurance schemes, through the development and distribution of information education and communication (IEC) messages and materials and training for Health Insurance partners and collaborators on IEC and efforts to improve the administration of the scheme. Pre- and post-intervention household surveys were conducted to investigate enrolment in and knowledge of health insurance, health seeking behaviour, and costs of seeking healthcare. Pre- and postintervention qualitative studies were undertaken to investigate population, policy makers’ and service providers’ perceptions and experiences of health insurance, the interventions and attribution of any changes over the intervention period. RESULTS Following the intervention, enrolment in health insuranceincreased by 6.9% and 7.4% in the two intervention districts. Community awareness of health insurance has improved in the intervention districts. Following the intervention, there were 42% and 38% increases in awareness of voluntary health insurance schemes in the two districts. Similarly, community awareness of health insurance for the poor has also increased with 25% and 22% increases in the two districts. From the qualitative study factors affecting changes in enrolment and awareness emerged. Health insurance collaborators provided information on health insurance to community members in their homes. There was better involvement of social organisations, such as the Red Cross, in promoting and administering health insurance. Enrolment procedures have improved resulting in fewer mistakes on health insurance cards and less delay in receiving cards. Procedures for admission to hospitals for people with health insurance have improved in the two intervention districts. CONCLUSION Enrolment has increased in the study areas. Changes in awareness of HI and HI for the poor are likely to have contributed to the increases in enrolment. Interventions aiming to increase awareness of HI in the intervention districts appear to have contributed to this effect. Improvements in the administration of the schemes were also perceived to have contributed to increases in enrolment

Spatiotemporal complexity patterns of resting‐state bioelectrical activity explain fluid intelligence: Sex matters

Neural complexity is thought to be associated with efficient information processing but the exact nature of this relation remains unclear. Here, the relationship of fluid intelligence (gf) with the resting‐state EEG (rsEEG) complexity over different timescales and different electrodes was investigated. A 6‐min rsEEG blocks of eyes open were analyzed. The results of 119 subjects (57 men, mean age = 22.85 ± 2.84 years) were examined using multivariate multiscale sample entropy (mMSE) that quantifies changes in information richness of rsEEG in multiple data channels at fine and coarse timescales. gf factor was extracted from six intelligence tests. Partial least square regression analysis revealed that mainly predictors of the rsEEG complexity at coarse timescales in the frontoparietal network (FPN) and the temporo‐parietal complexities at fine timescales were relevant to higher gf. Sex differently affected the relationship between fluid intelligence and EEG complexity at rest. In men, gf was mainly positively related to the complexity at coarse timescales in the FPN. Furthermore, at fine and coarse timescales positive relations in the parietal region were revealed. In women, positive relations with gf were mostly observed for the overall and the coarse complexity in the FPN, whereas negative associations with gf were found for the complexity at fine timescales in the parietal and centro‐temporal region. These outcomes indicate that two separate time pathways (corresponding to fine and coarse timescales) used to characterize rsEEG complexity (expressed by mMSE features) are beneficial for effective information processing