DEVELOPMENT OF A HOLISTIC APPROACH TO ASSISTING FAMILIES WITH AN ALZHEIMER ' S SUFFERER

Alzheimer's is an irreversible degenerative disease in which brain cells die and are not replaced . It re sults in progressive impairment of memory, declining cognitive abilities, emotional distress and eventually, death. From an eco-systemic perspective the patient in an illness such as Alzheimer's Disease (AD) is the family rather than the sufferer alone. An intense period of suffering is experienced by all in the caring network as a sufferer progressively loses mental faculties,. emotional balance and motor abilities. This demands a more holistic response than simply medical management of the patient. Doctors, however, are often the first professionals to become aware of a patient's declining capacities, and possibly as much through reports by family members as from direct assessment of the patient. Within the evolution of a comprehensive response to AD, then, medical practitioners occupy a gatekeeper role. In tracking the evolution of support services for AD sufferers over a period of time in the Nelson Mandela Metropole, this article gives particular attention to a survey of general practitioners and physicians as well as psychiatrists and neurologists who explored, inter alia, their knowledge and use of support groups as part of treatment plans and their attitude to a holistic treatment approach

Relationship between antihypertensive medications and cognitive impairment: Part I. review of human studies and clinical trials

Purpose of review: There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer’s disease; however, associations between antihypertensive medications (AHMs) and dementia risk are less consistent. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews are comprehensive. Our extensive review includes 15 observational and randomized controlled trials (RCTs) published over the last 5 years, assessing the relationship between AHM and cognitive impairment. Recent findings: All classes of AHM showed similar result patterns in human studies with the majority of study results reporting point estimates below one and only a small number of studies (N = 15) reporting statistically significant results in favor of a specific class. Summary: Only a small number of studies reported statistically significant results in favor of a specific class of AHM. Methodological limitations of the studies prevent definitive conclusions. Further work is now needed to evaluate the class of AHM and cognitive outcomes in future RCTs, with a particular focus on the drugs with the promising results in both animals and human observational studies

Elevated plasma phenylalanine in severe malaria and implications for pathophysiology of neurological complications.

Journal ArticleCerebral malaria is associated with decreased production of nitric oxide and decreased levels of its precursor, l-arginine. Abnormal amino acid metabolism may thus be an important factor in malaria pathogenesis. We sought to determine if other amino acid abnormalities are associated with disease severity in falciparum malaria. Subjects were enrolled in Dar es Salaam, Tanzania (children) (n = 126), and Papua, Indonesia (adults) (n = 156), in two separate studies. Plasma samples were collected from subjects with WHO-defined cerebral malaria (children), all forms of severe malaria (adults), and uncomplicated malaria (children and adults). Healthy children and adults without fever or illness served as controls. Plasma amino acids were measured using reverse-phase high-performance liquid chromatography with fluorescence detection. Several plasma amino acids were significantly lower in the clinical malaria groups than in healthy controls. Despite the differences, phenylalanine was the only amino acid with mean levels outside the normal range (40 to 84 microM) and was markedly elevated in children with cerebral malaria (median [95% confidence interval], 163 [134 to 193] microM; P < 0.0001) and adults with all forms of severe malaria (median [95% confidence interval], 129 [111 to 155] microM; P < 0.0001). In adults who survived severe malaria, phenylalanine levels returned to normal, with clinical improvement (P = 0.0002). Maintenance of plasma phenylalanine homeostasis is disrupted in severe malaria, leading to significant hyperphenylalaninemia. This is likely a result of an acquired abnormality in the function of the liver enzyme phenylalanine hydroxylase. Determination of the mechanism of this abnormality may contribute to the understanding of neurological complications in malaria

The Effect of Diabetes Medication on Cognitive Function: Evidence from the PATH Through Life Study

Objective. To examine the effect of diabetes treatment on change of measures of specific cognitive domains over 4 years. Research Design and Methods. The sample was drawn from a population-based cohort study in Australia (the PATH Through Life Study) and comprised 1814 individuals aged 65-69 years at first measurement, of whom 211 were diagnosed with diabetes. Cognitive function was measured using 10 neuropsychological tests. The effect of type of diabetes treatment (diet, oral hypoglycemic agents, and insulin) on measures of specific cognitive domains was assessed using Generalized Linear Models adjusted for age, sex, education, smoking, physical activity level, BMI, and hypertension. Results. Comparison of cognitive function between diabetes treatment groups showed no significant effect of type of pharmacological treatment on cognitive function compared to diet only group or no diabetes group. Of those on oral hypoglycaemic treatment only, participants who used metformin alone had better cognitive function at baseline for the domains of verbal learning, working memory, and executive function compared to participants on other forms of diabetic treatment. Conclusion. This study did not observe significant effect from type of pharmacological treatment for diabetes on cognitive function except that participants who only used metformin showed significant protective effect from metformin on domain of verbal learning, working memory, and executive function.The PATH Through Life Study was funded by National Health and Medical Research Council (NHMRC) Grants (973302, 179805, and 350833). Kaarin J. Anstey and Nicolas Cherbuin were supported by NHMRC Fellowships (002560 and 1063907, resp.). Pushpani M. Herath was supported by Australian National University International Student Scholarship and Australian Research Council Centre for Excellence in Population Ageing Research (CEPAR)

High Morbidity during Treatment and Residual Pulmonary Disability in Pulmonary Tuberculosis: Under-Recognised Phenomena

BACKGROUND In pulmonary tuberculosis (PTB), morbidity during treatment and residual pulmonary disability can be under-estimated. METHODS Among adults with smear-positive PTB at an outpatient clinic in Papua, Indonesia, we assessed morbidity at baseline and during treatment, and 6-month residual disability, by measuring functional capacity (six-minute walk test [6MWT] and pulmonary function), quality of life (St George's Respiratory Questionnaire [SGRQ]) and Adverse Events ([AE]: new symptoms not present at outset). Results were compared with findings in locally-recruited volunteers. RESULTS 200 PTB patients and 40 volunteers were enrolled. 6WMT was 497m (interquartile range 460-529) in controls versus 408m (IQR 346-450) in PTB patients at baseline (p<0.0001) and 470m (IQR 418-515) in PTB patients after 6 months (p=0.02 versus controls). SGRQ total score was 0 units (IQR 0-2.9) in controls, versus 36.9 (27.4-52.8) in PTB patients at baseline (p<0.0001) and 4.3 (1.7-8.8) by 6 months (p<0.0001). Mean percentage of predicted FEV1 was 92% (standard deviation 19.9) in controls, versus 63% (19.4) in PTB patients at baseline (p<0.0001) and 71% (17.5) by 6 months (p<0.0001). After 6 months, 27% of TB patients still had at least moderate-severe pulmonary function impairment, and 57% still had respiratory symptoms, despite most achieving 'successful' treatment outcomes, and reporting good quality of life. More-advanced disease at baseline (longer illness duration, worse baseline X-ray) and HIV positivity predicted residual disability. AE at any time during treatment were common: itch 59%, arthralgia 58%, headache 40%, nausea 33%, vomiting 16%. CONCLUSION We found high 6-month residual pulmonary disability and high AE rates. Although PTB treatment is highly successful, the extent of morbidity during treatment and residual impairment could be overlooked if not specifically sought. Calculations of PTB-related burden of disease should acknowledge that TB-related morbidity does not stop at 6 months. Early case detection and treatment are key in minimising residual impairment.The study received funding from the Australian Respiratory Council, Royal Australasian College of Physicians (Covance Award to APR), National Health and Medical Research Council (NHMRC) of Australia (Grants 605806 and 496600, a scholarship to APR, and fellowships to APR, TWY, PMK, NMA). Graeme Maguire is supported by an NHMRC Practitioner Fellowship and the Margaret Ross Chair in Indigenous Health. Views expressed in this publication are those of the authors and do not reflect the views of NHMRC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

The effects of sense of coherence on work stressors and outcomes in blue collar workers

Bibliography: pages 105-116.The present study investigated the relationships between work stressors, three moderator variables, and a variety of affective, behavioural and health outcomes. More specifically, it was hypothesized that the work stressors would be significantly associated with adverse affective, behavioural and health outcomes. Furthermore, it was hypothesized that personal and situational variables, in the form of the Sense of Coherence (Antonovsky, 1979, 1987), Job Decision Latitude (Karasek, 1979), and Participation in Decision Making, would moderate the relationships between work stressors and a variety of outcomes. The data were obtained from a sample of 111 male, white, blue collar workers at a large chemicals manufacturing organization from a questionnaire compiled for this study, and organizational records. The data were subjected to correlational analysis, supplemented by a form of moderated multiple regression analysis. It was found that the relationships between work stressors and outcome variables were insignificant which led to the conclusions that firstly, a priori specification of stressors may ignore the specificity of persons' appraisals of and responses to stressors, and secondly, consideration must be given to the affective meaning ascribed by subjects to job demands. The moderating effects of the Sense of Coherence, Job Decision Latitude and Participation in Decision Making were inconsistently related to outcome variables, frequently operating in the unexpected direction. It was, however, demonstrated that the main effects of the moderating variables which operated in the expected direction, outweighed the unanticipated negative interaction effects. It was observed that the inclusion of personality variables and situational variables in future studies of occupational stress are necessary, a conclusion which is consistent with more recent findings

Towards More Data-Aware Application Integration (extended version)

Although most business application data is stored in relational databases, programming languages and wire formats in integration middleware systems are not table-centric. Due to costly format conversions, data-shipments and faster computation, the trend is to "push-down" the integration operations closer to the storage representation. We address the alternative case of defining declarative, table-centric integration semantics within standard integration systems. For that, we replace the current operator implementations for the well-known Enterprise Integration Patterns by equivalent "in-memory" table processing, and show a practical realization in a conventional integration system for a non-reliable, "data-intensive" messaging example. The results of the runtime analysis show that table-centric processing is promising already in standard, "single-record" message routing and transformations, and can potentially excel the message throughput for "multi-record" table messages.Comment: 18 Pages, extended version of the contribution to British International Conference on Databases (BICOD), 2015, Edinburgh, Scotlan

A self-report risk index to predict occurrence of dementia in three independent cohorts of older adults: The ANU-ADRI

Background and Aims: The Australian National University AD Risk Index (ANU-ADRI, http://anuadri.anu.edu.au) is a self-report risk index developed using an evidence-based medicine approach to measure risk of Alzheimer's disease (AD). We aimed to evaluate the extent to which the ANU-ADRI can predict the risk of AD in older adults and to compare the ANU-ADRI to the dementia risk index developed from the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study for middle-aged cohorts. Methods: This study included three validation cohorts, i.e., the Rush Memory and Aging Study (MAP) (n = 903, age ≥53 years), the Kungsholmen Project (KP) (n = 905, age ≥75 years), and the Cardiovascular Health Cognition Study (CVHS) (n = 2496, age ≥65 years) that were each followed for dementia. Baseline data were collected on exposure to the 15 risk factors included in the ANU-ADRI of which MAP had 10, KP had 8 and CVHS had 9. Risk scores and C-statistics were computed for individual participants for the ANU-ADRI and the CAIDE index. Results: For the ANU-ADRI using available data, the MAP study c-statistic was 0.637 (95% CI 0.596-0.678), for the KP study it was 0.740 (0.712-0.768) and for the CVHS it was 0.733 (0.691-0.776) for predicting AD. When a common set of risk and protective factors were used c-statistics were 0.689 (95% CI 0.650-0.727), 0.666 (0.628-0.704) and 0.734 (0.707-0.761) for MAP, KP and CVHS respectively. Results for CAIDE ranged from c-statistics of 0.488 (0.427-0.554) to 0.595 (0.565-0.625). Conclusion: A composite risk score derived from the ANU-ADRI weights including 8-10 risk or protective factors is a valid, self-report tool to identify those at risk of AD and dementia. The accuracy can be further improved in studies including more risk factors and younger cohorts with long-term follow-up. © 2014 Anstey et al

The influence of smoking, sedentary lifestyle and obesity on cognitive impairment-free life expectancy

BACKGROUND Smoking, sedentary lifestyle and obesity are risk factors for mortality and dementia. However, their impact on cognitive impairment-free life expectancy (CIFLE)has not previously been estimated. METHODS Data were drawn from the DYNOPTA dataset which was derived by harmonizing and pooling common measures from five longitudinal ageing studies. Participants for whom the Mini-Mental State Examination was available were included (N¼8111,48.6% men). Data on education, sex, body mass index, smoking and sedentary lifestyle were collected and mortality data were obtained from Government Records via data linkage.Total life expectancy (LE), CIFLE and years spent with cognitive impairment (CILE)were estimated for each risk factor and total burden of risk factors. RESULTS CILE was approximately 2 years for men and 3 years for women, regardless of age. For men and women respectively, reduced LE associated with smoking was 3.82and 5.88 years, associated with obesity was 0.62 and 1.72 years and associated with being sedentary was 2.50 and 2.89 years. Absence of each risk factor was associated with longer LE and CIFLE, but also longer CILE for smoking in women and being sedentary in both sexes. Compared with participants with no risk factors, those with 2þ had shorter CIFLE of up to 3.5 years depending on gender and education level. CONCLUSIONS Population level reductions in smoking, sedentary lifestyle and obesity increase longevity and number of years lived without cognitive impairment. Years lived with cognitive impairment may also increase.This work was supported by a National Health and Medical Research Council grant # 410215 and by the Australian Research Council Centre of Excellence in Population Ageing Research (CE110001029). K.J.A is funded by NHMRC Fellowship #1002560. C.J. is funded by the AXA Research Fund

An innovation in curriculum content and delivery of cancer education within undergraduate nurse training in the UK. What impact does this have on the knowledge, attitudes and confidence in delivering cancer care?

Purpose: This was an evaluation of an innovation in curriculum content and delivery within undergraduate nursing education in the UK. Its purpose was to investigate the effect on knowledge, attitudes and confidence in delivering cancer care. Methods: The study design was a pre-test post-test survey design with a comparison group. Participants were two cohorts of undergraduate nursing students (nintervention ¼ 84, ncomparison ¼ 91). The intervention cohort were exposed to a new 3.5 day programme of cancer education, coproduced with patients, carers and health professionals, which focused on cancer as a life changing long-term condition. The comparison cohort had been exposed to a 2 day programme produced by a lecturer. Results: Following exposure to the new model for the delivery of undergraduate nurse cancer education, the intervention cohort demonstrated good overall knowledge of the impact of cancer, more positive attitudes towards cancer treatment and more confidence in their ability to deliver cancer care. Attitudes were more positive and confidence in ability to support cancer patients at all stages of the cancer journey were greater than in the comparison group. Insights gained into the cancer patient and carer perspectives were highly valued. Conclusions: This study has found that a new model for the delivery of cancer education focusing on survivorship and delivered in partnership with patients, carers and clinicians, may improve knowledge, attitudes and confidence in the delivery of cancer care. Further work is now needed, using a more robust experimental design, to investigate the generalisability of the results to other education programs