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Objective:To study the clinical effect of lens cleaning paper patching on traumatic eardrum perforations.Methods:A total of 122 patients were divided into 2 groups, of which 56 patients were treated with lens cleaning paper patching and 66 acted as controls. The closure rate and healing time were compared between the two groups.Results:The healing rate of small perforations was 96.4 per cent (27 out of 28) in the patching group and 90 per cent (27 out of 30) in the control group. The difference was not statistically significant (p > 0.05). The healing rate of large perforations was 89.3 per cent (25 out of 28) and 80.6 per cent (29 out of 36) in the two groups, respectively. The difference was statistically significant (p < 0.05). The healing time of large perforations was shorter in the patching group than in the control group (p < 0.01).Conclusion:Patching with lens cleaning paper under an endoscope can accelerate the closure of large traumatic eardrum perforations. [ABSTRACT FROM AUTHOR]

Existing policy research has not comprehensively examined the processes by which young people experience social exclusion: that is, the relationships among different risk factors for exclusion, their actual experiences of exclusion, and outcomes that matter for their life chances. Drawing on data from a survey of Australian 13-14 year olds (N=3,535), this paper adapts the Bristol Social Exclusion Matrix to examine pathways from young people's personal and family resources, their experience of participation (school engagement; bullying victimization; teacher support), and their life satisfaction – a predictive indicator of wellbeing and mental health in adulthood. The effects of other characteristics or risk factors for young people's social exclusion (living with disability, being a young carer, identifying as Indigenous, and speaking a language other than English at home), are also examined. This paper shows that experience of exclusion mediates the relationship between young people's personal and family resources and life satisfaction. Controlling for characteristics or risk factors does not change this relationship, suggesting that processes of social exclusion, enacted in interpersonal encounters, are driven by overarching structural factors. These findings are relevant for policy in Australia, and in other countries with similar policy regimes. [ABSTRACT FROM AUTHOR]

Background: We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. Methods: We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression. Results: All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior. Conclusions: Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes. [ABSTRACT FROM AUTHOR]

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited. [ABSTRACT FROM AUTHOR]

Older people have increasingly been using the new information and communication technologies (ICTs), namely the internet. Seeking to contribute with substantive information on their digital inclusion, this paper focuses on the adoption and use of ICTs by older adults, highlighting their experiences and considering their plurality. Taking a qualitative approach, the core goal of the empirical research underlying this paper was to understand what mechanisms and modalities configure the relationship of older internet users with the new ICTs. With that objective in mind, interviews were conducted with 20 internet users over the age of 60. Those interviews, which included a biographical element, were subjected to multi-categorical analysis. Results suggest a typology of modes of relating to the new ICTs among older internet users that reflects different trajectories, practices, skills, significances and impacts. The analysis shows how life trajectories and differentiated uses are reflected in equally differentiated impacts for older adults, contributing to their quality of life in different ways and to different degrees. Digital skills play a fundamental role in enhancing or limiting those effects. The results of this research help break down the stereotypes associated with the older generations and may have relevant implications for the design of digital inclusion policies and initiatives. [ABSTRACT FROM AUTHOR]

Independent mobility is an important component of healthy ageing. Public transit may be an affordable way to achieve independent mobility, and yet little is known about older adults' transition to public transit. This paper addresses this research gap by providing an exploration of older adults' experiences transitioning to public transit use, and by comparing these experiences to those of older people who have always travelled using transit. Twenty-four older adults (65+) living in Hamilton, Canada, who use public transit completed semi-structured interviews during which they discussed their experiences when they first began to use transit. These experiences are framed herein with the concept self-efficacy, i.e. how one's belief in their ability to complete a task shapes their ability to complete said task. Results indicate that most older adults acquire skills to transition to public transit, such as trip planning, boarding, knowing where to sit and exiting the bus. These skills are developed through practice. As one gains experience, one becomes more confident in their ability to meet their daily travel needs using transit. Therefore, the transition to public transit as an older adult can be more challenging for those with little experience using public transit. This paper highlights the danger of assuming all older adults will effortlessly take up transit and stresses the importance of older adults gaining experience using public transit. [ABSTRACT FROM AUTHOR]

D-allulose, D-sorbose and D-tagatose are D-fructose isomers that are called rare sugars. These rare sugars have been studied intensively in terms of biological production and food application as well as physiological effects. There are limited papers with regard to the transporters mediating the intestinal absorption of these rare sugars. We examined whether these rare sugars are absorbed via sodium-dependent glucose cotransporter 1 (SGLT1) as well as via GLUT type 5 (GLUT5) using rats. High-fructose diet fed rats, which express more intestinal GLUT5, exhibited significantly higher peripheral concentrations, Cmax and AUC0–180 min when D-allulose, D-sorbose and D-tagatose were orally administrated. KGA-2727, a selective SGLT1 inhibitor, did not affect the peripheral and portal vein concentrations and pharmacokinetic parameters of these rare sugars. The results suggest that D-allulose, D-sorbose and D-tagatose are likely transported via GLUT5 but not SGLT1 in rat small intestine. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to identify the trajectory of conduct and emotional problems for young people within the general population at four time points (between 9 years 7 months and 16 years 6 months), investigate their relationship with hyperactive/inattentive traits and explore the moderating effect of autistic social traits (ASTs). Methods: Data from 9305 individuals involved in The Avon Longitudinal Study of Parents and Children (ALSPAC) study were included. Conduct and emotional problems and hyperactive/inattentive traits were measured by the Strengths and Difficulties Questionnaire. ASTs were assessed using the Social Communication Disorder Checklist. Individual trajectories for conduct and emotional problems were identified via growth curve modelling. Hyperactive/inattentive traits were included within the growth curve model as a time-varying covariate to determine their effect on these outcomes. Finally, participants were split into two groups (below and above clinical threshold ASTs Groups) and multi-group invariance testing was conducted on the data to identify the moderating effect of ASTs on the relationship between hyperactive/inattentive traits and outcomes (i.e. conduct and emotional problems). Results: Hyperactive/inattentive traits were associated with higher rates of conduct and emotional problems for both boys and girls. The presence of ASTs moderated these relationships for boys, but not for girls, by increasing the risk of boys with hyperactive/inattentive traits developing greater conduct and emotional problems. Conclusions: These findings underscore the importance of identifying hyperactive/inattentive traits and ASTs in young people and addressing the increased risk of conduct and emotional problems. Research and clinical implications are explored. [ABSTRACT FROM AUTHOR]

Background: Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. Methods: 360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. Results: Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year. Conclusions: Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study. [ABSTRACT FROM AUTHOR]

The financialization of everyday life has received considerable attention since the 2008 global financial crisis. Financialization is thought to have created active financial subjects through the ability to participate in mainstream financial services. While the lived experience of these mainstream financial subjects has been the subject of close scrutiny, the experiences of financial subjects at the financial fringe have been rarely considered. In the UK, for example, the introduction of High-Cost, Short-Term Credit [HCSTC] or payday loan regulation was designed to protect vulnerable people from accessing unaffordable credit. Exploring the impact of HCSTC regulation is important due to the dramatic decline of the high-cost credit market which helped meet essential needs in an era of austerity. As such, the paper examines the impact of the HCSTC regulation on sixty-four financially marginalized individuals in the UK that are unable to access payday loans. First, we identify the range of socioeconomic strategies that individuals employ to manage their finances to create a typology of financial subjectivity at the financial fringe. Second, we demonstrate how the temporal and precarious nature of financial inclusion at the financial fringe adds nuance to existing debates of the everyday lived experience of financialization. [ABSTRACT FROM AUTHOR]

FFQ are commonly used to examine the association between diet and disease. They are the most practical method for usual dietary data collection as they are relatively inexpensive and easy to administer. In Australia, the Cancer Council of Victoria FFQ (CCVFFQ) version 2 and the online Commonwealth Scientific and Industrial Research Organisation FFQ (CSIROFFQ) are used. The aim of our study was to establish the level of agreement between nutrient intakes captured using the online CSIROFFQ and the paper-based CCVFFQ. The CCVFFQ and the online CSIROFFQ were completed by 136 healthy participants. FFQ responses were analysed to give g per d intake of a range of nutrients. Agreement between twenty-six nutrient intakes common to both FFQ was measured by a variety of methods. Nutrient intake levels that were significantly correlated between the two FFQ were carbohydrates, total fat, Na and MUFA. When assessing ranking of nutrients into quintiles, on average, 56 % of the participants (for all nutrients) were classified into the same or adjacent quintiles in both FFQ, with the highest percentage agreement for sugar. On average, 21 % of participants were grossly misclassified by three or four quintiles, with the highest percentage misclassification for fibre and Fe. Quintile agreement was similar to that reported by other studies, and we concluded that both FFQ are suitable tools for dividing participants’ nutrient intake levels into high- and low-consumption groups. Use of either FFQ was not appropriate for obtaining accurate estimates of absolute nutrient intakes. [ABSTRACT FROM PUBLISHER]

Policy makers across the political spectrum have extolled the virtues of volunteering in achieving social policy aims. Yet little is known about the role that volunteering plays in addressing one of the significant challenges of an ageing population: the provision of care and support to people with dementia. We combine organisational survey data, secondary social survey data, and in-depth interviews with people with dementia, family carers and volunteers in order to better understand the context, role and challenges in which volunteers support people with dementia. Social policies connecting volunteering and dementia care in homes and communities often remain separate and disconnected and our paper draws on the concept of policy 'assemblages' to suggest that dementia care is a dynamic mixture of formal and informal volunteering activities that bridge and blur traditional policy boundaries. Linking home and community environments is a key motivation, benefit and outcome for volunteers, carers and those living with dementia. The paper calls to widen the definition and investigation of volunteering in social policy to include and support informal volunteering activity. [ABSTRACT FROM AUTHOR]

Recent years have seen a growth in research on retirement/lifestyle migration to Spain, however this has tended to focus on the reasons for moving, as well as the lifestyles adopted as part of a healthy and active retirement. However, ageing in Spain can bring challenges as a person's resources for independent living diminish. This paper draws on narrative interviews with vulnerable older British people in Spain, focusing on those who have encountered a severe decline in health, are frail and in need of care. It looks at the formal and informal networks and agencies that support these individuals, in particular the resources and strategies they employ to access care. Drawing on a framework of care provision developed by Glucksmann and Lyons, four broad modes of provision for old age care used by older British people in Spain are identified: state/public, family/community, voluntary/not-for-profit and market/for-profit. The paper argues that there are language, cultural, spatial and financial barriers when accessing care in Spain as an older British citizen. It is concluded that there are some frail, vulnerable people that may fall through a support gap, whereby they are no longer the responsibility of UK welfare services, yet not fully recognised in their new country of residence, and asks if more should be done to support this population. [ABSTRACT FROM PUBLISHER]

In recent years, various pro-natalist policies have been adopted in Singapore and other high-income Asian countries with low fertility, aiming at raising fertility rates. Previous studies were mainly focused on the impact or outcome of the policies. This paper, however, aims to identify the most influential groups in determining Singapore's total fertility rate (TFR) and evaluate the targeting of pro-natalist measures adopted by the government. We first reveal the changing age-parity-and-marital-status composition of women at childbearing age, and further conduct an elasticity analysis to assess the roles of different subgroups of women in changing the TFR. Our results show that compared to other groups, the 20–29-year-old single women and the married childless women aged 30–34 (‘married’ throughout this paper includes women who are or have been married) are more influential in determining the TFR and should be the potential pro-natalist target groups. However, Singapore's pro-natalist policies are more in favour of third and higher-order births. Such mismatch indicates that, if more efforts are devoted to facilitating marriage and first births in these potential groups, the TFR may be increased effectively. In order to achieve a long-term and significant fertility reversal, it calls for a long-term and integrated policy package. [ABSTRACT FROM PUBLISHER]

High sodium (Na) diet is one of the leading behavioural risks of disease identified in the Singapore Burden of Disease Study. We aim to estimate the cost attributable to a high Na diet in Singapore in 2019 from a societal perspective by employing a prevalence-based approach in cost-of-illness studies. We extracted national-level healthcare data and population attributable fractions by sex and age. Costs included direct and indirect costs from inpatient treatment and productivity losses. In 2019, the annual societal cost attributable to a high Na diet was conservatively estimated to be USA$262 million (95 % uncertainty interval (UI) 218, 359 million). At least USA$67·8 million (95 % UI 48·4, 120 million) and USA$194 million (95 % UI 153, 274 million) could be saved on healthcare and indirect costs, respectively, if the daily Na intake of Singaporeans was reduced to an average of 3 g. Overall, males had higher costs compared with females at USA$221 million (95 % UI 174, 312 million) and USA$41·1 million (95 % UI 33·5, 61·7 million), respectively. Productivity loss from foregone wages due to premature mortality had the largest cost at USA$191 million (95 % UI 150, 271 million). CVD had the largest healthcare expenditure at USA$61·4 million (95 % UI 41·6, 113 million), driven by ischaemic heart disease at USA$41·0 million (95 % UI 21·4, 88·9 million). Our study found that reducing Na intake could reduce future healthcare expenditures and productivity losses. This result is vital for policy evaluation in a rapidly ageing society like Singapore, where the burden of diseases associated with high Na diet is expected to increase. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic hydro-mastoidectomy, in which mastoidectomy is performed underwater, can be employed during transcanal endoscopic ear surgery for cholesteatoma removal. It was hypothesised that endoscopic hydro-mastoidectomy might take less time than endoscopic non-underwater mastoidectomy because the endoscope does not need to be removed for cleaning. Methods: This study compared the mastoidectomy and total operative durations between the endoscopic hydro-mastoidectomy (n = 25) and endoscopic non-underwater drilling (control, n = 8) groups. Moreover, it compared the size of resected areas of the external auditory canal between the two groups. Results: The mastoidectomy time of the endoscopic hydro-mastoidectomy group was significantly shorter than that of the control group (p < 0.01). The total operative time did not differ significantly between the endoscopic hydro-mastoidectomy and control groups (p = 0.17). The resected area was significantly larger in the endoscopic hydro-mastoidectomy group than in the control group (p < 0.05). Conclusion: Endoscopic hydro-mastoidectomy enables more extensive bone resection within a shorter period. [ABSTRACT FROM AUTHOR]

With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse.This paper provides empirical evidence about levels of uptake of PBs and safeguarding referrals in England based on in-depth analysis of national data at aggregate, local council level in England, covering 152 Councils. This is complemented by analysis of 2,209 individual referral records obtained from three purposively selected study sites. The aim is to explore whether available data could provide evidence of association between the uptake of PBs and safeguarding referrals. Analysis of the national dataset found no significant relationships between PB uptake and the level and type of alleged abuse. However, analysis of individual-level referral data, from the three selected sites did find some significant associations particularly with financial abuse; and found the main perpetrators of the alleged abuse to be home-care employees. The findings are discussed within the context of current policy and practice. [ABSTRACT FROM AUTHOR]

Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring 'practice languages' is important in understanding how policy is enacted. This paper contributes to the literature exploring the generative nature of metaphors in policy implementation, demonstrating their role in not just describing the world, but also framing it, determining what is seen/unseen, and what solutions seem possible. The metaphor 'care pathway' is ubiquitous and institutionalised in healthcare. We build upon existing work critiquing its use in care delivery, and explore its use in health care commissioning, using evidence from the recent reorganisation of the English NHS. We show that the pathways metaphor is ubiquitous, but not necessarily straightforward. Conceptualising health care planning as 'designing a pathway' may make the task more difficult, suggesting a limited range of approaches and solutions. We offer an alternative metaphor: the service map. We discuss how approaches to care design might be altered by using this different metaphor, and explore what it might offer. We argue not for a barren language devoid of metaphors, but for their more conscious use. [ABSTRACT FROM AUTHOR]

Concern about the increasing use of payday lending led the UK's Financial Conduct Authority to introduce landmark reforms in 2014/15. While these reforms have generally been welcomed as a way of curbing 'extortionate' and 'predatory' lending, this paper presents a more nuanced picture based on a theoretically-informed analysis of the growth and nature of payday lending combined with original and rigorous qualitative interviews with customers. We argue that payday lending has grown as a result of three major and inter-related trends: growing income insecurity for people both in and out of work; cuts in state welfare provision; and increasing financialisation. Recent reforms of payday lending do nothing to tackle these root causes. Our research also makes a major contribution to debates about the 'everyday life' of financialisation by focusing on the 'lived experience' of borrowers. We show that, contrary to the rather simplistic picture presented by the media and many campaigners, various aspects of payday lending are actually welcomed by customers, given the situations they are in. Tighter regulation may therefore have negative consequences for some. More generally, we argue that the regul(aris)ation of payday lending reinforces the shift in the role of the state from provider/redistributor to regulator/enabler. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice. [ABSTRACT FROM PUBLISHER]

Access to economic resources influences the material conditions of life for older people, as well as the freedoms and capacities of older people to achieve the kind of lives they value. Security is one aspect of later life valued by older people. Ontological security provides a sense of order and continuity and needs to be understood in terms of the situated life experiences and circumstances of older people. The study reported in this paper analysed 145 qualitative interviews with New Zealanders aged 63–93 in order to explore how participants understand ontological security. Varying levels of access to economic resources were associated with differing abilities of participants to manage the unpredictability of everyday life. Among the wealthy, security was strongly connected to the freedoms provided by ample financial resources. Contrary to what might be expected, those with the lowest levels of economic resources did not express higher levels of insecurity, but instead drew upon life experiences of managing and making do to construct a trajectory of security. Those with mid-range levels of economic resources expressed most insecurity, including anxiety over changing economic conditions and concerns over their ability to manage reductions in economic resources. In discussing the implications of this, the paper highlights the need to recognise ways in which access to economic resources intersect with life circumstances, past experiences and future social expectations to provide opportunities for all older people to pursue security as they strive to age well. [ABSTRACT FROM PUBLISHER]

In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process. [ABSTRACT FROM AUTHOR]

The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on ‘international data’, at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice. [ABSTRACT FROM PUBLISHER]

Background: More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap. Methods: FEP participants (n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year). Results: In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ2). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none. Conclusions: In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a key developmental period for the emergence of psychopathology. Reward-related brain activity increases across adolescence and has been identified as a potential neurobiological mechanism of risk for different forms of psychopathology. The reward positivity (RewP) is an event-related potential component that indexes reward system activation and has been associated with both concurrent and family history of psychopathology. However, it is unclear whether the RewP is also associated with higher-order psychopathology subfactors and whether this relationship is present across different types of reward. Methods: In a sample of 193 adolescent females and a biological parent, the present study examined the association between adolescent and parental psychopathology subfactors and adolescent RewP to monetary and social reward. Results: Results indicated that the adolescent and parental distress subfactors were negatively associated with the adolescent domain-general RewP. The adolescent and parental positive mood subfactors were negatively associated with the adolescent domain-general and domain-specific monetary RewP, respectively. Conversely, the adolescent and parental fear/obsessions subfactors were positively associated with the adolescent domain-general RewP. The associations between parental and adolescent psychopathology subfactors and the adolescent RewP were independent of each other. Conclusions: The RewP in adolescent females is associated with both concurrent and parental psychopathology symptoms, suggesting that it indexes both severity and risk for higher-order subfactors. [ABSTRACT FROM AUTHOR]

Background: Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis. Methods: We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models. Results: SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs. Conclusions: Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development. [ABSTRACT FROM AUTHOR]

Background: Extensive research has focused on the potential benefits of education on various mental and physical health outcomes. However, whether the associations reflect a causal effect is harder to establish. Methods: To examine associations between educational duration and specific aspects of well-being, anxiety and mood disorders, and cardiovascular health in a sample of European Ancestry UK Biobank participants born in England and Wales, we apply four different causal inference methods (a natural policy experiment leveraging the minimum school-leaving age, a sibling-control design, Mendelian randomization [MR], and within-family MR), and assess if the methods converge on the same conclusion. Results: A comparison of results across the four methods reveals that associations between educational duration and these outcomes appears predominantly to be the result of confounding or bias rather than a true causal effect of education on well-being and health outcomes. Although we do consistently find no associations between educational duration and happiness, family satisfaction, work satisfaction, meaning in life, anxiety, and bipolar disorder, we do not find consistent significant associations across all methods for the other phenotypes (health satisfaction, depression, financial satisfaction, friendship satisfaction, neuroticism, and cardiovascular outcomes). Conclusions: We discuss inconsistencies in results across methods considering their respective limitations and biases, and additionally discuss the generalizability of our findings in light of the sample and phenotype limitations. Overall, this study strengthens the idea that triangulation across different methods is necessary to enhance our understanding of the causal consequences of educational duration. [ABSTRACT FROM AUTHOR]

Two-parent families with dependent children are known to be at lower risk of poverty and significantly less reliant on state financial help than lone-parent households. It might therefore be expected that the factors influencing partnership transitions among low-income women would represent a key area of policy interest. However, driven by concerns about weak work incentives, policy focus and research has to date concentrated on understanding lone parents’ labour supply and encouraging the transition from benefits into employment. Surprisingly little is therefore known about demographic decision making among women reliant on UK means-tested welfare. As part of a wider qualitative study exploring family formation, partnership dissolution and repartnering decisions among low-income mothers, this paper examines whether and to what extent entitlement to welfare benefits or tax credits influenced the decision to live with or apart from a partner or child's father. The research found that the aspects of welfare that remove or reduce a mother's access to an independent income and require one partner in a couple to be financially dependent on the other had been strongly influential in partnering decisions and living arrangements. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

Long-range temporal choices are built into contemporary policy-making, with policy decisions having consequences that play out across generations. Decisions are made on behalf of the public who are assumed to give much greater weight to their welfare than to the welfare of future generations. The paper investigates this assumption. It briefly discusses evidence from sociological and economic studies before reporting the findings of a British survey of people's intergenerational time preferences based on a representative sample of nearly 10,000 respondents. Questions focused on two sets of policies: (i) health policies to save lives and (ii) environmental policies to protect against floods that would severely damage homes, businesses and other infrastructure. For both sets of policies, participants were offered a choice of three policy options, each bringing greater or lesser benefits to their, their children's and their grandchildren's generations. For both saving lives and protecting against floods, only a minority selected the policy that most benefited their generation; the majority selected policies bringing equal or greater benefits to future generations. Our study raises questions about a core assumption of standard economic evaluation, pointing instead to concern for future generations as a value that many people hold in common. [ABSTRACT FROM AUTHOR]

This paper assesses provision for older people affected by homelessness in England, giving regard to research findings, such as those developed through a pathways model, which show that the experiences of this group are qualitatively distinct when compared to younger households. Current conceptualisations of older age held by Local Authority Housing Option Service professionals are considered, alongside factors relating to government policy and resource issues. It was found that some practitioners adopted an age-blind approach when assessing older groups, despite this being contrary to policy guidance on assessing vulnerability in England. Further, services and housing options aimed at older groups were viewed as inadequate due to a mixture of lack of awareness, targeting and resources. It is concluded that assessment of vulnerability based on older age is complex, as whilst gerontological discourse may discourage viewing age as a number, homelessness scholars stress that rooflessness causes poor health conditions consistent with premature ageing. It is therefore asserted that policy makers must focus greater attention to developing suitable provision for older service users and look to incorporate a richer conceptualisation of how older age may impact upon the homelessness experience. [ABSTRACT FROM PUBLISHER]

This paper examines some demographic and medical factors associated with the likelihood of residing in a care home during the last month of life for persons aged 70 and over in France and, if so, of remaining in the care home throughout or being transferred to hospital. The data are from the Fin de vie en France (End of Life in France) survey undertaken in 2010. During the last month of life, very old people are more likely to be living in a care home but are not less likely to be transferred to hospital. Medical conditions and residential trajectories are closely related. People with dementia or mental disorders are more likely to live in a care home and, if so, to stay there until they die. Compared to care homes, a more technical and medication-based approach is taken in hospitals and care home residents who are transferred to hospital more often receive medication while those remaining in care homes more often receive support from a psychologist. In hospitals as in care homes, few older persons had recourse to advance directives and hospice programmes were not widespread. Promoting these two factors may help to increase the quality of end of life and facilitate an ethical approach to end-of-life care. [ABSTRACT FROM PUBLISHER]

Background: Very-late-onset schizophrenia-like psychosis (VLOSLP) is associated with significant burden. Its clinical importance is increasing as the global population of older adults rises, yet owing to limited research in this population, the neurobiological underpinnings of VLOSP remain insufficiently clarified. Here we address this knowledge gap using novel morphometry techniques to investigate grey matter volume (GMV) differences between VLOSLP and healthy older adults, and their correlations with neuropsychological scores. Methods: In this cross-sectional study, we investigated whole-brain GMV differences between 35 individuals with VLOSLP (mean age 76.7, 26 female) and 36 healthy controls (mean age 75.7, 27 female) using whole-brain voxel-based morphometry (VBM) and supplementary source-based morphometry (SBM) on high resolution 3D T1-weighted MRI images. Additionally, we investigated relationships between GMV differences and cognitive function assessed with an extensive neuropsychological battery. Results: VBM showed lower GMV in the thalamus, left inferior frontal gyrus and left insula in patients with VLOSLP compared to healthy controls. SBM revealed lower thalamo-temporal GMV in patients with VLOSLP. Processing speed, selective attention, mental flexibility, working memory, verbal memory, semantic fluency and confrontation naming were impaired in patients with VLOSLP. Correlations between thalamic volumes and memory function were significant within the group of individuals with VLOSLP, whereas no significant associations remained in the healthy controls. Conclusions: Lower GMV in the thalamus and fronto-temporal regions may be part of the underlying neurobiology of VLOSLP, with lower thalamic GMV contributing to memory impairment in the disorder. [ABSTRACT FROM AUTHOR]

Worldwide, populations are ageing and consequently so are the consumer profiles for most organisations. Understanding how best to ensure satisfaction in interactions with older customers, patients, members of organisations, and so on is therefore increasingly important. This paper examines two research questions: (a) How satisfied or dissatisfied are older people with their customer service experience, and what are the factors associated with dissatisfaction? and (b) What prompts older people to want to change service providers? The research questions are addressed using a mixed-methods approach – quantitative analysis of observation logs, supported by illustrative quotes from focus groups. We find that on the whole older people are generally satisfied with their interactions with organisations, although a substantial minority of interactions lead to dissatisfaction or lower-than-expected satisfaction. Dissatisfaction with interactions is mostly associated with impersonal communications, including interactions that are not conducted face to face, and those that are one-off interactions rather than repeated interactions. Media and communications firms prompted the greatest levels of dissatisfaction among older consumers. Dissatisfied older consumers from our sample are more than 12 times more likely to report an intention to switch providers than satisfied consumers. This highlights the potential costs to organisations of poor customer interactions with older people. [ABSTRACT FROM PUBLISHER]

The impact of disparities in socio-economic status on the health of older people is an important issue for policy makers in the context of population ageing. As older people live in different types of economic circumstances and because, as people age, their desires and needs are different to those of younger generations, measures of living standards need to be appropriate for older people. This paper reports on the validation of a measure of living standards for older people based on Sen's Capability Approach. Using this approach, living standards are conceptualised as varying from constraint to freedom rather than from hardship to comfort. Using the New Zealand Longitudinal Study of Ageing omnibus survey of 3,923 adults aged 50–87 years, the validity of the measure was assessed. The results indicate that this measure assesses what older people are able to achieve. In addition, this measure discriminates better at the higher end of the living standards spectrum than an existing measure that assesses living standards from hardship to comfort in terms of what people possess. From this, a short form of the measure has been developed which offers a conceptually based and valid measure useful for survey research with older people. This measure of living standards provides future avenues for improved understandings of socio-economic position in later life. [ABSTRACT FROM PUBLISHER]

Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the ‘right’ leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed. [ABSTRACT FROM PUBLISHER]

Improving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population. [ABSTRACT FROM PUBLISHER]

Epidemiological studies have demonstrated inconsistent associations between tea consumption and mortality of all cancers, CVD and all causes. To obtain quantitative overall estimates, we conducted a dose–response meta-analysis of prospective cohort studies. A literature search in PubMed and Embase up to April 2015 was conducted for all relevant papers published. Random-effects models were used to calculate pooled relative risks (RR) with 95 % CI. In eighteen prospective studies, there were 12 221, 11 306 and 55 528 deaths from all cancers, CVD and all causes, respectively. For all cancer mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 1·06 (95 % CI 0·98, 1·15) and 0·79 (95 % CI 0·65, 0·97), respectively. For CVD mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·67 (95 % CI 0·46, 0·96) and 0·88 (95 % CI 0·77, 1·01), respectively. For all-cause mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·80 (95 % CI 0·68, 0·93) and 0·90 (95 % CI 0·83, 0·98), respectively. The dose–response analysis indicated that one cup per d increment of green tea consumption was associated with 5 % lower risk of CVD mortality and with 4 % lower risk of all-cause mortality. Green tea consumption was significantly inversely associated with CVD and all-cause mortality, whereas black tea consumption was significantly inversely associated with all cancer and all-cause mortality. [ABSTRACT FROM PUBLISHER]

Data are lacking with regard to participants' perspectives on return of genetic research results to relatives, including after the participant's death. This paper reports descriptive results from 3,630 survey respondents: 464 participants in a pancreatic cancer biobank, 1,439 family registry participants, and 1,727 healthy individuals. Our findings indicate that most participants would feel obligated to share their results with blood relatives while alive and would want results to be shared with relatives after their death. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between self-reported loneliness and living arrangements. A structured questionnaire with some open-ended questions was administered face-to-face in English, Hindi or Punjabi to a sample of 161 elderly South Asian immigrants 60 or more years of age living in Edmonton, Alberta, Canada in 2003. The majority of respondents said that they never felt lonely. More than one in three (37.3%) respondents indicated that they felt lonely occasionally, frequently or all of the time. Those living alone were significantly more likely to report feeling lonely at least occasionally than were those living with others, especially those living with their spouse in an extended family. The fact that South Asian immigrant seniors typically lived with others, often in an extended family with or without their spouse, and rarely lived alone protected them to some extent from loneliness. However, our findings showed that among those living with others, it was the amount of waking time spent alone at home and the quality of family relationships rather than living arrangement per se that significantly predicted self-reported loneliness. Nevertheless, living in a larger household was associated with spending less time alone. We discuss plausible influences of culture on expectations regarding family and social relationships and on the meaning of being alone, as well as practical implications for addressing loneliness in a multi-cultural society. [ABSTRACT FROM PUBLISHER]

Since the World Health Organization introduced the concept of ‘age-friendly’ communities in 2006, there has been rapidly growing interest in making communities more age-friendly on the part of policy makers world-wide. There is a paucity of research to date, however, that has examined age-friendliness in diverse communities, particularly in rural communities. The main objective of the study reported in this paper was to examine whether age-friendliness varies across community characteristics, such as a population size. The study was based on surveys administered in 56 communities throughout Manitoba, a mid-Western Canadian province, in the context of a needs assessment process for communities that are part of the Age-Friendly Manitoba Initiative. A total of 1,373 individuals completed a survey developed to measure age-friendliness. Domains included the physical environment; housing options; the social environment; opportunities for participation; community supports and health-care services; transportation options; and communication and information. Community characteristics were derived from census data. Multi-level regression analysis indicated that the higher the percentage of residents aged 65 or older, the higher the ratings of age-friendliness overall and, specifically, ratings of the social environment, opportunities for participation, and communication and information. Moreover, small communities located within a census metropolitan area and remote communities in the far north of the province emerged as having the lowest age-friendliness ratings. These findings suggest that communities are generally responsive to the needs of their older residents. That different results were obtained for the various age-friendly domains underscores the importance of considering age-friendliness in a holistic way and measuring it in terms of a range of community features. Our study further highlights the importance of differentiating between degrees of rurality, as different patterns emerged for communities of different sizes and proximity to a larger urban centre. [ABSTRACT FROM PUBLISHER]

Population ageing occurs in all industrialised societies and is the demographic phenomenon that currently gets the highest attention from scientists, policy makers and the general public. The main aim of this paper is to broaden our understanding of its societal consequences, such as ageism and intergenerational solidarity. Our study is based on the 2008 investigation of attitudes towards population ageing and older people in seven European countries of Schoenmaeckers et al. We replicate their analysis in a specific human subpopulation in which the process of population ageing started earlier and is much more advanced than in the general societies: the members of Catholic orders. The study compares the attitudes of 148 nuns and monks from three Bavarian monasteries to those of the western German general population using descriptive and multivariate analyses in the context of the debate around population ageing in Germany. We discuss the specific characteristics of order members that might influence their attitudes and also take a brief look at their views on possible political strategies to solve the problems connected with the demographic changes. Our results confirm the findings of Schoenmaeckers et al. and reveal that worldly and monastic populations show an identical basic pattern of a positive attitude towards older people while at the same time considering population ageing a worrisome development. However, order members evaluate older people's abilities and their role in society more positively. This result gives rise to the optimistic perspective that in an aged population the younger and older generations can build a well-functioning society. [ABSTRACT FROM PUBLISHER]

Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017–2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach. [ABSTRACT FROM AUTHOR]

Informal caregiving for older family members is increasingly recognized and encouraged by public policies. This is even more the case in familialistic countries such as Austria. This article aims to examine the role of the family in the care culture of a familialistic care regime through the experiences of care dyads combining upwards intergenerational family care and formal care services. The analysis is based on framework analysis of 48 face-to-face interviews, almost all conducted separately, with 24 care dyads of older care users (average age 86 years old with moderate to high care needs) and their main informal carers in Austria combining formal and informal care. A quarter of caregivers and care receivers were male. We identified four different ideals (family care, preferences, involvement, gendered care) which were distributed across different groups of Socio-Economic Status (SES) and described by women and men. [ABSTRACT FROM AUTHOR]

Background: Parenting is a common and potent environmental factor influencing adolescent anxiety. Yet, the underlying neurobiological susceptibility signatures remain elusive. Here, we used a longitudinal twin neuroimaging study to investigate the brain network integration and its heritable relation to underpin the neural differential susceptibility of adolescent anxiety to parenting environments. Methods: 216 twins from the Beijing Twin Study completed the parenting and anxiety assessments and fMRI scanning. We first identified the brain network integration involved in the influences of parenting at age 12 on anxiety symptoms at age 15. We then estimated to what extent heritable sensitive factors are responsible for the susceptibility of brain network integration. Results: Consistent with the differential susceptibility theory, the results showed that hypo-connectivity within the central executive network amplified the impact of maternal hostility on anxiety symptoms. A high anti-correlation between the anterior salience and default mode networks played a similar modulatory role in the susceptibility of adolescent anxiety to paternal hostility. Genetic influences (21.18%) were observed for the connectivity pattern in the central executive network. Conclusions: Brain network integration served as a promising neurobiological signature of the differential susceptibility to adolescent anxiety. Our findings deepen the understanding of the neural sensitivity in the developing brain and can inform early identification and personalized interventions for adolescents at risk of anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation. Methods: Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months. Results: 10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation. Conclusion: Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning. [ABSTRACT FROM AUTHOR]

Anaemia is characterised by low hemoglobin (Hb) concentration. Despite being a public health concern in Ethiopia, the role of micronutrients and non-nutritional factors as a determinant of Hb concentrations has been inadequately explored. This study focused on the assessment of serum micronutrient and Hb concentrations and a range of non-nutritional factors, to evaluate their associations with the risk of anaemia among the Ethiopian population (n 2046). It also explored the mediation effect of Zn on the relation between se and Hb. Bivariate and multivariate regression analyses were performed to identify the relationship between serum micronutrients concentration, inflammation biomarkers, nutritional status, presence of parasitic infection and socio-demographic factors with Hb concentration (n 2046). Sobel–Goodman test was applied to investigate the mediation of Zn on relations between serum se and Hb. In total, 18·6 % of participants were anaemic, 5·8 % had iron deficiency (ID), 2·6 % had ID anaemia and 0·6 % had tissue ID. Younger age, household head illiteracy and low serum concentrations of ferritin, Co, Cu and folate were associated with anaemia. Serum se had an indirect effect that was mediated by Zn, with a significant effect of se on Zn (P < 0·001) and Zn on Hb (P < 0·001). The findings of this study suggest the need for designing a multi-sectorial intervention to address anaemia based on demographic group. [ABSTRACT FROM AUTHOR]

Background: Understanding the interplay between psychosocial factors and polygenic risk scores (PRS) may help elucidate the biopsychosocial etiology of high alcohol consumption (HAC). This study examined the psychosocial moderators of HAC, determined by polygenic risk in a 10-year longitudinal study of US military veterans. We hypothesized that positive psychosocial traits (e.g. social support, personality traits, optimism, gratitude) may buffer risk of HAC in veterans with greater polygenic liability for alcohol consumption (AC). Methods: Data were analyzed from 1323 European-American US veterans who participated in the National Health and Resilience in Veterans Study, a 10-year, nationally representative longitudinal study of US military veterans. PRS reflecting genome-wide risk for AC (AUDIT-C) was derived from a Million Veteran Program genome-wide association study (N = 200 680). Results: Among the total sample, 328 (weighted 24.8%) had persistent HAC, 131 (weighted 9.9%) had new-onset HAC, 44 (weighted 3.3%) had remitted HAC, and 820 (weighted 62.0%) had no/low AC over the 10-year study period. AUDIT-C PRS was positively associated with persistent HAC relative to no/low AC [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI) = 1.23–1.67] and remitted HAC (RRR = 1.63, 95% CI = 1.07–2.50). Among veterans with higher AUDIT-C PRS, greater baseline levels of agreeableness and greater dispositional gratitude were inversely associated with persistent HAC. Conclusions: AUDIT-C PRS was prospectively associated with persistent HAC over a 10-year period, and agreeableness and dispositional gratitude moderated this association. Clinical interventions designed to target these modifiable psychological traits may help mitigate risk of persistent HAC in veterans with greater polygenic liability for persistent HAC. [ABSTRACT FROM AUTHOR]

Background: Older brain age – as estimated from structural MRI data – is known to be associated with detrimental mental and physical health outcomes in older adults. Social isolation, which has similar detrimental effects on health, may be associated with accelerated brain aging though little is known about how different trajectories of social isolation across the life course moderate this association. We examined the associations between social isolation trajectories from age 5 to age 38 and brain age assessed at age 45. Methods: We previously created a typology of social isolation based on onset during the life course and persistence into adulthood, using group-based trajectory analysis of longitudinal data from a New Zealand birth cohort. The typology comprises four groups: 'never-isolated', 'adult-only', 'child-only', and persistent 'child-adult' isolation. A brain age gap estimate (brainAGE) – the difference between predicted age from structural MRI date and chronological age – was derived at age 45. We undertook analyses of brainAGE with trajectory group as the predictor, adjusting for sex, family socio-economic status, and a range of familial and child-behavioral factors. Results: Older brain age in mid-adulthood was associated with trajectories of social isolation after adjustment for family and child confounders, particularly for the 'adult-only' group compared to the 'never-isolated' group. Conclusions: Although our findings are associational, they indicate that preventing social isolation, particularly in mid-adulthood, may help to avert accelerated brain aging associated with negative health outcomes later in life. [ABSTRACT FROM AUTHOR]

The current study aims to confirm the positive effects of dietary nano-Se on nutrients deposition and muscle fibre formation in grass carp fed with high-fat diet (HFD) before overwintering and to reveal its possible molecular mechanism. The lipid deposition, protein synthesis and muscle fibre formation in grass carp fed with regular diet (RD), HFD or HFD supplemented with nano-Se (0·3 or 0·6 mg/kg) for 60 d were tested. Results show that nano-Se significantly reduced lipid content, dripping loss and fibre diameter (P < 0·05), but increased protein content, post-mortem pH24 h and muscle fibre density (P < 0·05) in muscle of grass carp fed with HFD. Notably, dietary nano-Se decreased lipid deposition in the muscle by regulating amp-activated protein kinase activity and increased protein synthesis and fibre formation in muscle by activating target of rapamycin and myogenic determining factors pathways. In summary, dietary nano-Se can regulate the nutrients deposition and muscle fibre formation in grass carp fed with HFD, which exhibit potential benefit for improving flesh quality of grass carp fed with HFD. [ABSTRACT FROM AUTHOR]

Background: Losing a parent or spouse in adulthood may result in prolonged grief disorder (PGD) symptoms. PGD levels in parents may affect PGD levels in their adult offspring and the other way around. However, research on transmission of PGD in parent–child dyads is lacking. Consequently, we aimed to examine temporal associations between PGD levels in parent and adult children. Methods: In doing so, we analyzed longitudinal self-report data on PGD levels (using the PG-13) assessed at 2, 11, 18, and 26 months after loss in 257 adult parent–child dyads from Denmark. Cross-lagged panel modeling was used for data-analyses. Results: Changes in PGD levels in parents significantly predicted PGD levels in adult children, but not vice versa. Small through moderate cross-lagged effects (β = 0.05 through 0.07) were found for PGD levels in parents predicting PGD levels in adult children at a subsequent time-point. These cross-lagged effects were found while taking into account the association between PGD levels in parents and adult children at the same time-point as well as the associations between the same construct over time and relevant covariates. Conclusions: Pending replication of these findings in clinical samples and younger families, our findings offer tentative support for expanding our focus in research and treatment of PGD from the individual to the family level. [ABSTRACT FROM AUTHOR]