Search

Why you should read this article: • To understand the challenges of providing inpatient care for people with dementia • To familiarise yourself with the differences between organic inpatient wards and mixed inpatient wards • To learn about the optimal inpatient environment for people with dementia Dementia presents a major public health challenge to healthcare providers globally. When older people with dementia need inpatient mental healthcare, they can be cared for in one of two different types of older adult ward. These patients can either be admitted to an organic inpatient ward for people with dementia or the subtypes of dementia, or they can be admitted to a mixed inpatient ward for older people who have either functional or organic conditions. Using a quality assurance pilot study, the authors aimed to investigate whether the quality of care for patients with dementia differed between mixed and organic inpatient wards in units exclusively serving older people. The quality of care on both types of ward was compared by analysing observed interactions between patients and staff, patient well-being and patient environment and mealtimes. The quality of care was measured with a specially developed instrument and against evidence-based standards of care. The ratings of both types of ward showed high levels of quality interactions between patients and staff. There were minimal differences in the quality of patient and staff interactions, patient well-being, and patient environment and mealtimes between the two types of ward. Further work on outcomes and carer experiences needs to be undertaken to establish the optimal care environment for people with dementia. [ABSTRACT FROM AUTHOR]

The article focuses on the preferred modality of teaching for General Practice specialty trainees, and how the COVID-19 pandemic has affected the format of their formal teaching. Topics include shift in teaching sessions structure with increased mixed teaching, the preference of some trainees for online teaching; and the trainers feel that trainees may miss out on peer-to-peer learning, pastoral support, and informal curriculum development that face-to-face teaching provides.

Purpose: This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. Methods: We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). Results: Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. Conclusion: Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Whereas genetic variants influencing total amygdala volume have been identified, the genetic architecture of its distinct nuclei has yet to be explored. We aimed to investigate whether increased phenotypic specificity through nuclei segmentation aids genetic discoverability and elucidates the extent of shared genetic architecture and biological pathways with related disorders. T1-weighted brain magnetic resonance imaging scans (N = 36,352, 52% female) from the UK Biobank were segmented into 9 amygdala nuclei with FreeSurfer (version 6.1). Genome-wide association analyses were performed on the entire sample, a European-only subset (n = 31,690), and a generalization (transancestry) subset (n = 4662). We estimated single nucleotide polymorphism–based heritability; derived polygenicity, discoverability, and power estimates; and investigated genetic correlations and shared loci with psychiatric disorders. The heritability of the nuclei ranged from 0.17 to 0.33. Across the whole amygdala and the nuclei volumes, we identified 28 novel genome-wide significant (p adj < 5 × 10−9) loci in the European analysis, with significant en masse replication for the whole amygdala and central nucleus volumes in the generalization analysis, and we identified 10 additional candidate loci in the combined analysis. The central nucleus had the highest statistical power for discovery. The significantly associated genes and pathways showed unique and shared effects across the nuclei, including immune-related pathways. Shared variants were identified between specific nuclei and autism spectrum disorder, Alzheimer's disease, Parkinson's disease, bipolar disorder, and schizophrenia. Through investigation of amygdala nuclei volumes, we have identified novel candidate loci in the neurobiology of amygdala volume. These nuclei volumes have unique associations with biological pathways and genetic overlap with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs). A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms. GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program. Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods. [ABSTRACT FROM AUTHOR]