Evaluating the Efficacy of an Attachment-Informed Psychotherapeutic Parenting Program for Incarcerated Parents

An attachment-based, psychotherapeutic parent education course was created for incarcerated mothers and fathers to improve their ability to provide positive parenting and a more stable home environment for their children. The current study assessed the effects of this parenting curriculum on parents’ tendencies to be abusive, their sense of efficacy and satisfaction as a parent, their psychological distress, and their knowledge of child development and positive child guidance strategies. Results of pre-post assessments showed a significant improvement in parents’ sense of efficacy and satisfaction in the parenting role; their knowledge, skills, and behavior as a parent; their understanding of child development; their knowledge of alternatives to using corporal punishment; establishing appropriate parent-child boundaries; and they were less likely to view their child’s independence as a threat. Females showed a significant decrease in distress symptoms. Results are discussed in terms of the critical need for effective, high-quality parent education to break the intergenerational cycle of poor parenting for this at-risk population

Changes in Cognition and Mortality in Relation to Exercise in Late Life: A Population Based Study

BACKGROUND: On average, cognition declines with age but this average hides considerable variability, including the chance of improvement. Here, we investigate how exercise is associated with cognitive change and mortality in older people and, particularly, whether exercise might paradoxically increase the risk of dementia by allowing people to live longer. METHODS AND PRINCIPAL FINDINGS: In the Canadian Study of Health and Aging (CSHA), of 8403 people who had baseline cognition measured and exercise reported at CSHA-1, 2219 had died and 5376 were re-examined at CSHA-2. We used a parametric Markov chain model to estimate the probabilities of cognitive improvement, decline, and death, adjusted for age and education, from any cognitive state as measured by the Modified Mini-Mental State Examination. High exercisers (at least three times per week, at least as intense as walking, n = 3264) had more frequent stable or improved cognition (42.3%, 95% confidence interval: 40.6-44.0) over 5 years than did low/no exercisers (all other exercisers and non exercisers, n = 4331) (27.8% (95% CI 26.4-29.2)). The difference widened as baseline cognition worsened. The proportion whose cognition declined was higher amongst the high exercisers but was more similar between exercise groups (39.4% (95% CI 37.7-41.1) for high exercisers versus 34.8% (95% CI 33.4-36.2) otherwise). People who did not exercise were also more likely to die (37.5% (95% CI 36.0-39.0) versus 18.3% (95% CI 16.9-19.7)). Even so, exercise conferred its greatest mortality benefit to people with the highest baseline cognition. CONCLUSIONS: Exercise is strongly associated with improving cognition. As the majority of mortality benefit of exercise is at the highest level of cognition, and declines as cognition declines, the net effect of exercise should be to improve cognition at the population level, even with more people living longer

The inclusion of cognition in vascular risk factor clinical practice guidelines

Kenneth Rockwood1, Laura E Middleton2, Paige K Moorhouse1, Ingmar Skoog3, Sandra E Black41Department of Medicine, Dalhousie University, Halifax, NS, Canada; 2Department of Psychiatry, University of California, San Francisco, CA, USA; 3Institute of Neuropsychiatry, Sahlgrenska Academy of Göteborg University, Göteborg, Västra Götaland, Sweden; 4Department of Medicine, University of Toronto, Toronto, ON, CanadaBackground: People with vascular risk factors are at increased risk for cognitive impairment as well as vascular disease. The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance.Methods: Articles from PubMed, EMBASE, and the Cochrane Library were assessed by at least two reviewers and were included if: (1) Either hypertension, high cholesterol, diabetes, or atrial fibrillation was targeted; (2) The guideline was directed at physicians; (3) Adult patients (aged 19 years or older) were targeted; and (4) The guideline was published in English. Of 91 guidelines, most were excluded because they were duplicates, older versions, or focused on single outcomes.Results: Of the 20 clinical practice guidelines that met inclusion criteria, five mentioned cognition. Of these five, four described potential treatment benefits but only two mentioned that cognition may affect compliance. No guidelines adequately described how to screen for cognitive impairment.Conclusion: Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment. Keywords: clinical practice guidelines, evidence-based medicine, vascular risk, cognition, target organ damag

The inclusion of cognition in vascular risk factor clinical practice guidelines

This find is registered at Portable Antiquities of the Netherlands with number PAN-0003302