START-online: acceptability and feasibility of an online intervention for carers of people living with dementia

BACKGROUND: With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). METHOD: A mixed-methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia. RESULTS: Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these, 16 (80%) completed all 8 sessions, 2 completed only 3 sessions, and 2 withdrew. Carers' qualitative feedback indicated that the therapist interaction was valued, content and online delivery of the program was acceptable. Feedback was mixed on the appropriate stage of caring. CONCLUSION: START-online was feasible and acceptable for carers, including those living outside of metropolitan areas who might otherwise be unable to access face-to-face programs. With the recent COVID-19 pandemic necessitating social distancing to avoid infection, interventions such as this one have increasing relevance in the provision of flexible services

Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial

BACKGROUND: Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. METHODS: This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision. DISCUSSION: Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. TRIAL REGISTRATION: anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019

Common and distinct brain activation to viewing dynamic sequences of face and hand movements

The superior temporal sulcus (STS) and surrounding lateral temporal and inferior parietal cortices are an important part of a network involved in the processing of biological movement. It is unclear whether the STS responds to the movement of different body parts uniformly, or if the response depends on the body part that is moving. Here we examined brain activity to recognizing sequences of face and hand movements as well as radial grating motion, controlling for differences in movement dynamics between stimuli. A region of the right posterior STS (pSTS) showed common activation to both face and hand motion, relative to radial grating motion, with no significant difference between responses to face and hand motion in this region. Distinct responses to face motion relative to hand motion were observed in the right mid-STS, while the right posterior inferior temporal sulcus (pITS) and inferior parietal lobule (IPL) showed greater responses to hand motion relative to face motion. These findings indicate that while there may be distinct processing of different body part motion in lateral temporal and inferior parietal cortices, the response of the pSTS is not body part specific. This region may provide input to other parts of a network involved with processing human actions with a high-level visual description of biological motion

Is increased carer knowledge of the health care system associated with decreased preventable hospitalizations for people in the community diagnosed with dementia? A systematic review protocol

Abstract Background People living with dementia (PLWD) are admitted to hospital twice as often as those without dementia, for ambulatory care sensitive conditions (ACSC) that could have been managed in ambulatory and primary care settings. PLWD are at greater risk of poor outcomes during and following hospital admission. Compared to those without dementia, they are almost twice as likely to die in hospital and two to three times more likely to experience an adverse event. Although some hospitalizations are clinically necessary, there may be a proportion related to ACSC that could be potentially avoided with additional support and education for PLWD and their carers. This study aims to assess the effectiveness of interventions focused on reducing avoidable hospitalization for PLWD by supporting carers to manage the health care needs of the PLWD, via improved awareness and understanding of health and the healthcare system. Method Scientific and gray literature will be searched using a combination of keywords pertaining to dementia, caregivers, education, and support. Included studies will involve community-dwelling PLWD and caregivers, with interventions aimed at improving carer’s understanding of the healthcare system and ability to manage the caregiving role. The primary outcome will be hospitalization related to the PLWD and secondary outcomes will be carer burden, stress, wellbeing, and quality of life. All study designs will be considered. Data from included studies will be analyzed using descriptive statistics and content analysis. If the data permits, we will perform a meta-analysis and subgroup analyses, related to the intervention and participant characteristics. Discussion This review will provide a comprehensive picture of the knowledge available on the subject and identify knowledge gaps in existing literature. The findings may highlight the lack of existing interventions for PLWD and their carers who live in the community and will help stakeholders to identify needs and develop programs targeted to carers and care recipients that prevent avoidable hospitalization for PLWD. Systematic review registration PROSPERO number: 49655

Gender segregation in the labour market : root causes, implications and policy responses in the EU

The aim of this report is to analyse employment segregation for women and men in the European labour market at both the sectoral and occupational levels. It provides a comparative analysis of trends in segregation across the 27 EU Member States, Norway, Iceland and Liechtenstein, and examines the root causes of the phenomenon, the consequences, and current and desirable policy responses. Gender-based employment segregation is so pervasive that distinctions have multiplied in order to facilitate analysis: occupational versus sectoral segregation, overall or horizontal versus vertical segregation, vertical versus hierarchical segregation. Horizontal segregation is understood as under- (over-) representation of a given group in occupations or sectors, not ordered by any criterion, and is often referred to as segregation tout court. Vertical segregation denotes the under- (over-) representation of the group in occupations or sectors at the top of an ordering based on ‘desirable’ attributes — income, prestige, job stability, etc. Finally, hierarchical segregation stands for under- (over-) representation of the group at the top of occupation-specific ladders. All forms of gender-based segregation are considered in this report, although overall and vertical segregation in occupations receive closest attention. The first part of the report examines levels and change in overall segregation in European countries (Chapter 1). It goes on to review the most important factors that impinge on segregation (Chapter 2) and to assess three main implications, namely undervaluation of women’s work, confinement in ‘low quality’ jobs, and skill shortages (Chapter 3). Policies are reviewed and assessed in Chapter 4. The second part of the report summarises the highlights from case-study research conducted at national level on 10 occupational groups, the evidence from this research being used as a reference throughout the report.peer-reviewe