There’s no apprenticeship for Alzheimer’s: The caring relationship when an older person experiencing dementia falls

© Cambridge University Press 2011Older people experiencing dementia are twice as likely to fall with consequences of serious injury, reduction in everyday activity, admission to long-term care and mortality. Carers of people with dementia are themselves at greater risk of physical and mental ill health, which increases as the dementia progresses. Unsurprisingly, carer burden also increases when a care-recipient falls. The aim of this study was to explore the experiences of falling of community-living older people with dementia and their carers. A qualitative approach was taken using interpretative phenomenological analysis. Nine older people with predominantly Alzheimer's disease and their ten carers were recruited from a large mental health National Health Service trust and participated in one-to-one and joint in-depth interviews. Three dyads participated in repeat interviews. Three focus groups were also carried out, with nine older people experiencing memory problems and 12 carers from a local Alzheimer's Society branch. The antecedents, falls events and consequences of falls were discussed. This paper reports specifically on the impact of falls on the caring relationship. Three themes emerged: ‘learning as you go’, ‘we're always together’, ‘nobody was interested’. The findings demonstrate how falling accentuates the impact of dementia on the dyad. Spouse-carers' discussion of their own falls emphasise the need for joint assessment of health and wellbeing to reduce carer burden and preserve the couplehood of the dyad.The South West London NHS Mental Health Care Trust which part-funded this researc

Studies on the inhibition of plant pathogenic fungi by cyclohexylamine and spermidine analogues

The potential inhibitory activity of several compounds against plant pathogenic fungal growth was studied. Prevention of growth was hypothesised to occur by the inhibition of polyamine biosynthesis and/or an effect on cellular functions associated with spermidine, the predominant polyamine in fungi. The spermidine synthase inhibitor, cyclohexylamine (CHA), and the spermidine analogue, norspermidine, demonstrated protective, eradicant and systemic activity against a range of plant pathogenic infections of host plants: broad bean rust and chocolate spot, barley and apple powdery mildew, and potato late blight. For example, both 2.0 mM CHA and 2.0 mM norspennidine, applied pre inoculation, reduced powdery mildew infection of barley by 88 %. CHA and norspermidine were equally effective although apple powdery mildew and potato late blight infections were slightly more responsive towards norspermidine than CHA treatment. Against bean rust and barley powdery mildew, little increased efficacy was afforded by increasing inhibitor concentrations from 0.5 mM to 2.0 mM. Higher concentrations were, however, more effective against the other pathogenic infections examined. Pre inoculation treatments tended to be more effective than post inoculation applications of the inhibitors, although the reason for this is unclear as microscopic examination of bean rust spores and developing germlings on bean leaves found little difference between the treated leaves and the untreated control, suggesting the compounds acted on later stages of fungal development. CHA and norspermidine were also effective against powdery mildew infection of spring barley in the field. The compounds were as effective as a commercially available fungicide in reducing disease. Neither the commercial fungicide nor the inhibitors caused any increase in yield over the untreated control, although this may have been the result of additional environmental pressures. The study therefore showed that CHA and spermidine analogues possessed both antifungal and fungicidal activity against a range of plant pathogens. Although differences in in vivo and in vitro studies exist, perturbation of polyamine biosynthesis was unlikely to account for such activity of the compounds. The compounds were most likely exerting their effects via some other cellular function related to polyamines. (Abstract shortened by ProQuest.)

Physiology and biology of non-legume root-nodule plants

(1) Investigations were carried out into several aspects of diurnal variation in nitrogen fixation, the 15N method being mainly employed. Most of the experiments involved second year plants of Casuarina cunninghamiana, but in several cases first year plants of Hippophae rhamnoides and Myrica cerifera were used as well. Fluctuations in nitrogen fixation and the carbohydrate content of the nodules during the day were studied under greenhouse conditions. The effects of temperature and plant darkening on the fixation process were also investigated. (2) A well marked diurnal rhythm in fixation, with maximal rates during the early afternoon and minimal rates in the early morning and late evening, was found in second year Casuarina plants held under greenhouse conditions. Temperature was found to have a marked effect on the fixation rate, and it was concluded that this was mainly responsible for the fluctuations in fixation during the day. The effect of light intensity was less immediate, since darkening of the plants had no effect on fixation until after three days. It was concluded that changes in light intensity during a particular day would have little effect on the rate of fixation on that day. (3) Fluctuations in the level of nodular carbohydrates did not parallel fluctuations in the nitrogen fixation rate during the day. (4) The effect of darkening on the fixation of first year plants was more immediate and it was considered that in these light intensity on a particular day might well have some control over fixation on that day

Tobacco marketing awareness on youth smoking susceptibility and perceived prevalence before and after an advertising ban

Background: The Tobacco Advertising and Promotion Act (TAPA) was implemented in the UK in 2003, although its impact on young people has not been assessed. This study assessed smoking susceptibility (intention to smoke among never smokers) and perceived prevalence across three British cross-sectional samples (aged 11 to 16) before and after the introduction of the ban. Methods: Three in-home surveys (n = 1078, 1121 and 1121) were conducted before (1999 and 2002) and after (2004) the implementation of the TAPA. Results: Significant declines in awareness of tobacco marketing and perceived prevalence occurred across the three waves. Higher levels of awareness and perceived prevalence were associated with increased susceptibility, but direct measures of susceptibility remained stable. Conclusions: The TAPA is successfully protecting young people in the UK from tobacco marketing and reducing perceived prevalence, both of which are linked to susceptibility. The stability of susceptibility across the three waves is probably best explained by both the partial implementation of TAPA at the final survey point and the time such effects take to emerge. The evidence from this and previous studies is, however, that, ultimately, they will appear

How adolescents perceive cigarette packaging and possible benefits of plain packaging

Surveys in secondary schools in Scotland show 3% of 13 year olds to be regular smokers, i.e. smoke one or more cigarettes a week, with this number rising to 13% for 15 year olds (Black et al., 2011). While smoking prevalence is in long-term decline in Scotland, and indeed most of Europe, these figures are concerning given that trying a single cigarette increases the risk that an adolescent will become a later smoker, even after a gap of not smoking for up to three years (Fidler et al., 2006). Furthermore, the earlier that adolescents start smoking regularly, the greater the risk of developing tobaccorelated cancers and other diseases (International Agency for Research on Cancer, 2004; Muller, 2007). For smoking prevention to be effective a coordinated approach is required. This may include policy measures such as increasing taxation on tobacco products to keep prices high, and non-policy measures such as providing health advice to parents and carers, as well as promoting smoke-free domestic environments and encouraging smoking cessation (Muller, 2007). School-based interventions can also play a key role in helping prevention efforts (NICE, 2010)

Young women smokers' response to using plain cigarette packaging: Qualitative findings from a naturalistic study

Background: The aim of this study was to explore in-depth the response of young women smokers (18-35 years) to using dark brown ‘plain' cigarette packs in naturalistic settings. Methods: Participants were recruited in six towns and cities in Scotland to take part in a naturalistic study, where they used plain cigarette packs for a week. Participants completed a number of questionnaires during the study period (reported elsewhere), and a sub-sample participated in post-study telephone interviews to explore their experiences of using the plain packs. Of the 187 participants who completed the study, 23 were randomly selected to participate in the post-study interviews. Within the interviews a semi-structured topic guide was used to assess perceptions of the plain pack, feelings created by the pack, feelings about smoking, and avoidant and smoking behaviour. Results: The brown (plain) packs were perceived negatively due to the colour, the  undesirable image the pack conveyed, and the reaction from others. The plain packs were  also associated with negative feelings, such as embarrassment, discomfort and guilt. Some participants also commented that they felt differently about the product, considered to be less enjoyable or more harmful, when using the plain packs, and were less interested in, or felt more negatively about, smoking. A number of participants said that they had engaged in avoidant behavior with the plain packs, such as hiding it, due to their negative thoughts about the packs and the reaction of others. Some participants also mentioned cessation-related behaviours when using the plain packs, such as forgoing cigarettes, stubbing cigarettes out early and thinking about quitting, largely due to the decreased enjoyment of smoking. Conclusions: The experience of using cigarettes in plain packs prompted a range of negative responses from young women smokers, who are a crucial target group for tobacco control interventions

Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study

Objectives: To explore perceptions of superslims packaging, including compact ‘lipstick’ packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks.  Design: Qualitative focus group study. SettingInformal community venues in Scotland, UK.  Participants: 75 female non-smokers and occasional smokers (age range 12–24).  Results: Compact ‘lipstick’-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, ‘lipstick’ packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning.  Conclusions: As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban ‘lipstick’-style cigarette packs in the EU and has implications for policy elsewhere

Attitudes towards bystander cardiopulmonary resuscitation:Results from a cross-sectional general population survey

Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR

Introduction of standardized tobacco packaging during a 12-month transition period: Findings from small retailers in the United Kingdom

Introduction: Factory-made cigarettes (FMC) and roll-your-own (RYO) tobacco have had to be produced in standardised packaging since 20th May 2016 in the United Kingdom, with a minimum pack size of 20 sticks for FMC and 30 grams for RYO. Manufacturers and retailers were given a 12-month transition period.  Methods: An observational study was conducted using monthly Electronic Point of Sale data from 500 small retailers in England, Scotland, and Wales, between May 2016 and May 2017. The 20 top selling tobacco products (15 FMC, 5 RYO) were monitored to observe when standardised packs were first introduced, the proportion of retailers selling each fully branded and standardised product, and the average number of monitored fully branded and standardised products sold by each retailer. The number of unique tobacco-related product codes sold by each retailer was also recorded each month.  Results: Eighteen of the fully branded products continued to be sold throughout the transition period and no standardised variants were sold in the first five months. It was not until month eleven that the average number of standardised products sold by retailers exceeded the fully branded products. The average number of unique tobacco-related product codes sold by each retailer decreased by a third over the transition period.  Conclusions: Tobacco companies used the transition period to delay the removal of fully branded products and gradually introduce standardised variants. This staggered introduction may have mitigated some of the immediate intended effects of the legislation by desensitising consumers to new pack designs

Improving uptake of seasonal influenza vaccination by healthcare workers: Implementation differences between higher and lower uptake NHS trusts in England

Background Uptake of influenza vaccination by healthcare workers (HCWs) may be related to how influenza campaigns are implemented. This study explores differences in annual influenza campaign implementation between NHS trusts (healthcare organisations) with higher and lower vaccine uptake. Methods A cross-sectional survey with influenza campaign staff in 2016/2017 in 87 NHS trusts in England. The survey measured vaccination policy and uptake target, staff involvement, accessibility, use of peer vaccinators, communication strategies, strategies to address HCW concerns, use of incentives, and management support. The analysis considered implementation differences between higher (n Z 50) and lower (n Z 37) uptake trusts. Results and Conclusions Higher uptake trusts were more likely to set higher uptake targets, involve a broader range of staff groups in the campaign, and make the vaccine easy to access by core or hard-toreach HCWs. Higher uptake trusts were also more likely to use a greater range of communication strategies, provide real-time feedback on uptake, provide a greater range of incentives to be vaccinated, and have vaccine uptake considered important by managers. Successful influenza vaccination programmes are multifaceted and involve implementation factors at a strategic, organisational, logistical, and personnel level. Lower uptake trusts could improve uptake by identifying and implementing examples of best practice from higher uptake trusts