Facilitating LGBT medical, health and social care content in higher education teaching

ncreasingly, Lesbian, Gay, Bisexual, and Transgender (LGBT) health care is becoming an important quality assurance feature of primary, secondary and tertiary healthcare in Britain. While acknowledging these very positive developments, teaching LGBT curricula content is contingent upon having educators understand the complexity of LGBT lives. The study adopted a qualitative mixed method approach. The study investigated how and in what ways barriers and facilitators of providing LGBT medical, health and social care curricula content figure in the accreditation policies and within undergraduate and postgraduate medical and healthcare teaching. This paper illustrates opposing views about curricula inclusion. The evidence presented suggests that LGBT content teaching is often challenged at various points in its delivery. In this respect, we will focus on a number of resistances that sometimes prevents teachers from engaging with and providing the complexities of LGBT curricula content. These include the lack of collegiate, colleague and student cooperation. By investing some time on these often neglected areas of resistance, the difficulties and good practice met by educators will be explored. This focus will make visible how to support medical, health and social care students become aware and confident in tackling contemporaneous health issues for LGBT patients

Chronic cerebral hypoperfusion:a key mechanism leading to vascular cognitive impairment and dementia. Closing the translational gap between rodent models and human vascular cognitive impairment and dementia

Increasing evidence suggests that vascular risk factors contribute to neurodegeneration, cognitive impairment and dementia. While there is considerable overlap between features of vascular cognitive impairment and dementia (VCID) and Alzheimer’s disease (AD), it appears that cerebral hypoperfusion is the common underlying pathophysiological mechanism which is a major contributor to cognitive decline and degenerative processes leading to dementia. Sustained cerebral hypoperfusion is suggested to be the cause of white matter attenuation, a key feature common to both AD and dementia associated with cerebral small vessel disease (SVD). White matter changes increase the risk for stroke, dementia and disability. A major gap has been the lack of mechanistic insights into the evolution and progress of VCID. However, this gap is closing with the recent refinement of rodent models which replicate chronic cerebral hypoperfusion. In this review, we discuss the relevance and advantages of these models in elucidating the pathogenesis of VCID and explore the interplay between hypoperfusion and the deposition of amyloid β (Aβ) protein, as it relates to AD. We use examples of our recent investigations to illustrate the utility of the model in preclinical testing of candidate drugs and lifestyle factors. We propose that the use of such models is necessary for tackling the urgently needed translational gap from preclinical models to clinical treatments.</jats:p

Impaired Glymphatic Function and Pulsation Alterations in a Mouse Model of Vascular Cognitive Impairment

ACKNOWLEDGMENTS Schematic diagrams in Figures 2, 8 are created withBiorender.com. FUNDING We gratefully acknowledge the grant support from the Alzheimer’s Society (152 (PG-157); 290 (AS-PG-15b-018); 228 (AS-DTC-2014-017), 314 (AS –PhD-16-006), and Alzheimer’s Research United Kingdom (ART-PG2010-3; ARUK-PG2013- 22; ARUK-PG2016B-6), and The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (G0700704/84698). ML and JB are funded by an Alzheimer’s Society Scotland Doctoral Training Programme and RS Macdonald Trust. ML was also funded by a China Scholarship Council (CSC)/University of Edinburgh scholarship.Peer reviewedPublisher PD

INHIBITING CSF1R ALLEVIATES CEREBROVASCULAR WHITE MATTER DISEASE AND COGNITIVE IMPAIRMENT

White matter abnormalities, related to poor cerebral perfusion, are a core feature of small vessel cerebrovascular disease, and critical determinants of vascular cognitive impairment and dementia. Despite this importance there is a lack of treatment options. Proliferation of microglia producing an expanded, reactive population and associated neuroinflammatory alterations have been implicated in the onset and progression of cerebrovascular white matter disease, in patients and in animal models, suggesting that targeting microglial proliferation may exert protection. Colony-stimulating factor-1 receptor (CSF1R) is a key regulator of microglial proliferation. We found that the expression of CSF1R/Csf1r and other markers indicative of increased microglial abundance are significantly elevated in damaged white matter in human cerebrovascular disease and in a clinically relevant mouse model of chronic cerebral hypoperfusion and vascular cognitive impairment. Using the mouse model, we investigated long-term pharmacological CSF1R inhibition, via GW2580, and demonstrated that the expansion of microglial numbers in chronic hypoperfused white matter is prevented. Transcriptomic analysis of hypoperfused white matter tissue showed enrichment of microglial and inflammatory gene sets, including phagocytic genes that were the predominant expression modules modified by CSF1R inhibition. Further, CSF1R inhibition attenuated hypoperfusion-induced white matter pathology and rescued spatial learning impairments and to a lesser extent cognitive flexibility. Overall, this work suggests that inhibition of CSF1R and microglial proliferation mediates protection against chronic cerebrovascular white matter pathology and cognitive deficits. Our study nominates CSF1R as a target for the treatment of vascular cognitive disorders with broader implications for treatment of other chronic white matter diseases.<br/

Facilitando Atención Sanitaria, de Salud y Social del Colectivo LGTB en Enseñanza Universitaria

Increasingly, Lesbian, Gay, Bisexual, and Transgender (LGBT) health care is becoming an important quality assurance feature of primary, secondary and tertiary healthcare in Britain. While acknowledging these very positive developments, teaching LGBT curricula content is contingent upon having educators understand the complexity of LGBT lives. The study adopted a qualitative mixed method approach. The study investigated how and in what ways barriers and facilitators of providing LGBT medical, health and social care curricula content figure in the accreditation policies and within undergraduate and postgraduate medical and healthcare teaching. This paper illustrates opposing views about curricula inclusion. The evidence presented suggests that LGBT content teaching is often challenged at various points in its delivery. In this respect, we will focus on a number of resistances that sometimes prevents teachers from engaging with and providing the complexities of LGBT curricula content. These include the lack of collegiate, colleague and student cooperation. By investing some time on these often neglected areas of resistance, the difficulties and good practice met by educators will be explored. This focus will make visible how to support medical, health and social care students become aware and confident in tackling contemporaneous health issues for LGBT patients.Cada vez más, la atención sanitaria a Lesbianas, Gays, Bisexuales y Transexuales (LGBT) se está convirtiendo en una característica importante de garantía de calidad de la asistencia sanitaria primaria, secundaria y terciaria en Gran Bretaña. Si bien reconocemos estos avances muy positivos, la enseñanza de contenidos curriculares de LGBT está supeditada a tener educadores que comprendan la complejidad de la vida de LGBT. El estudio adoptó un enfoque de método mixto cualitativo. Investigó en los planes de estudio cómo y de qué manera las barreras y facilitadores de la prestación médica, atención sanitaria y social de LGBT figuran como contenido en las políticas de acreditación y dentro de la enseñanza médica y la atención sanitaria de pregrado y postgrado. Este documento ilustra puntos de vista opuestos sobre la inclusión curricular. La evidencia presentada sugiere que la enseñanza del contenido de LGBT es a menudo cuestionada en varios puntos de su entrega. En este sentido, nos centraremos en una serie de resistencias que a veces impiden que los profesores participen y proporcionan las complejidades de los contenidos curriculares de LGBT. Estos incluyen la falta de colegiado, compañerismo y la cooperación de los estudiantes. Al invertir algo de tiempo en estas áreas con frecuencia descuidadas de la resistencia, se explorarán las dificultades y las buenas prácticas a cumplir por los educadores. Este enfoque hará visible la forma de apoyar a los estudiantes de medicina, atención sanitaria y social para que tomen conciencia y confianza en la lucha contra los problemas de salud contemporáneos para los pacientes LGBT

Reliability of the Australian Therapy Outcome Measures for quantifying disability and health

Unsworth, CA ORCiD: 0000-0001-6430-2823The Australian Therapy Outcome Measures (AusTOMs) quantify dient outcomes for physiotherapy, speech pathology and occupational therapy across four domains: impairment (of body structure and function); limitation in functionai activity; restriction of participation in societal roles; and distress/wellbeing (level of concern). Data reporting the preiiminary reliabiiity of the AusTOMs toois are presented. Participants were 150 clinicians from hospital and rehabilitation centres in Melbourne, Australia. Written case vignettes were used to obtain percentage agreement scores between raters for each of the four domains of the AusTOMs. Test-retest reiiability was also determined. Satisfactory preliminary inter-rater scores were obtained, with most scales in each profession showing high levels of agreement, although some scales had at least one domain with iess than 80% agreement. Across all three professions, test-retest reliability was satisfactory Overall, specific domains showed less agreement than others, and the impiications of these findings and indications for further research are discusse

Nox2 underpins microvascular inflammation and vascular contributions to cognitive decline

Chronic microvascular inflammation and oxidative stress are inter-related mechanisms underpinning white matter disease and vascular cognitive impairment (VCI). A proposed mediator is nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (Nox2), a major source of reactive oxygen species (ROS) in the brain. To assess the role of Nox2 in VCI, we studied a tractable model with white matter pathology and cognitive impairment induced by bilateral carotid artery stenosis (BCAS). Mice with genetic deletion of Nox2 (Nox2 KO) were compared to wild-type (WT) following BCAS. Sustained BCAS over 12 weeks in WT mice induced Nox2 expression, indices of microvascular inflammation and oxidative damage, along with white matter pathology culminating in a marked cognitive impairment, which were all protected by Nox2 genetic deletion. Neurovascular coupling was impaired in WT mice post-BCAS and restored in Nox2 KO mice. Increased vascular expression of chemoattractant mediators, cell-adhesion molecules and endothelial activation factors in WT mice post-BCAS were ameliorated by Nox2 deficiency. The clinical relevance was confirmed by increased vascular Nox2 and indices of microvascular inflammation in human post-mortem subjects with cerebral vascular disease. Our results support Nox2 activity as a critical determinant of VCI, whose targeting may be of therapeutic benefit in cerebral vascular disease