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Background Slow gait speed and Timed Up-and Go (TUG) are often independent predictors of falls in regression analysis, although their ability to discriminate between fallers and non-fallers is questionable. Random forest plots can model complex interactions between predictor variables and have high classification accuracy. We compare the predictive and discriminative ability of UGS and TUG in predicting recurrent falls over 4 years using poisson regression and random forest plots. Methods Data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), a population-based study of community-dwelling adults aged ≥50 years were used. Baseline physical, neuro-cognitive, sensory and behavioural health were assessed. The outcome was recurrent (≥2) falls at Wave 2 or Wave 3. Poisson regression analysis was used to examine associations between UGS, TUG and falls adjusting for covariates. Random forest models were used. Predictive accuracy was calculated using 5 fold cross-validation and as there was class imbalance, the algorithm was trained using under-sampling of the larger class. Classification rate, area under the receiver operating characteristic curve (AUC) and area under the precision recall curve (PRROC) were obtained to assess predictive accuracy. Results In poisson regression analysis (n=4918), TUG predicted recurrent falls independent of covariates including UGS (IRR=1.06, 95% CI: 1.01, 1.12, p<0.05). The random forest model predicted 60.82% of participants correctly (61.85% of non-fallers; 55.37% of fallers). AUC was 0.63 and PRROC was 0.28. Conclusion Impaired mobility i.e. slower TUG performance, is an independent predictor of future recurrent falls, however it does not discriminate well between fallers and non-fallers. This is highlighted by the PRROC which provides a more conservative estimate of predictive accuracy than AUC as it accounts for the ability to identify both fallers and non-fallers. The analysis highlights the multifactorial nature and complexity of falls, and supports the need for comprehensive falls assessment. [ABSTRACT FROM AUTHOR]

Background The patient profile in a 160-bed rehabilitation hospital is evolving with increasing numbers of older adults admitted with falls and frailty. In 2018 a snapshot audit revealed over 60% of patients obtained scores indicative of cognitive impairment. Traditional falls prevention education delivered in a group format relies on attendees having an adequate level of sensory registration and cognitive abilities to comprehend and recall information given. The Occupational Therapists (OTs) proposed greater benefits from caregiver inclusion in such education to enhance understanding for both patients and caregivers on falls prevention and home environment modifications to facilitate safer home discharges. Methods A mixed-methods design was used. Quantitative data was gathered using a pre and post education 10-point Likert scale to assess attendees' perceived knowledge in four domains: (1) Falls risk factors (2) Modifiable environmental factors (3) Managing falls (4) Accessing support/information to reduce risk of falls Qualitative data was gathered through written feedback. Referrals were generated by OTs. Evening sessions facilitated increased caregiver attendance. OTs delivered a 45 minute PowerPoint presentation, demonstrated adaptive equipment and engaged in discussion with attendees. Information packs were provided to caregivers including a Home Safety Assessment Tool to aid with home environment modification. Results Data from April 2018-2019 was analysed using Microsoft Excel. 21 groups were facilitated with 385 attendees overall. Average percentage increase in knowledge in each of the four domains was 30%. Overall knowledge increased by 32%. Conclusion Increased knowledge of modifiable falls risk factors and supporting persons at risk of falls in the home was demonstrated. OTs reported reduced caregiver concerns regarding home environment modification. Home assessments completed after group attendance found caregivers had implemented recommendations made in the presentation. Further data could be collected to measure the degree of environmental modification completed prior to OT home assessments. Additional qualitative data is required to fully assess benefits to both patients and caregivers. [ABSTRACT FROM AUTHOR]

Background: Abstracts and plain language summaries (PLS) are often the first, and sometimes the only, point of contact between readers and systematic reviews. It is important to identify how these summaries are used and to know the impact of different elements, including the authors' conclusions. The trial aims to assess whether (a) the abstract or the PLS of a Cochrane Review is a better aid for midwifery students in assessing the evidence, (b) inclusion of authors' conclusions helps them and (c) there is an interaction between the type of summary and the presence or absence of the conclusions., Methods: Eight hundred thirteen midwifery students from nine universities in the UK and Ireland were recruited to this 2 × 2 factorial trial (abstract versus PLS, conclusions versus no conclusions). They were randomly allocated to one of four groups and asked to recall knowledge after reading one of four summary formats of two Cochrane Reviews, one with clear findings and one with uncertain findings. The primary outcome was the proportion of students who identified the appropriate statement to describe the main findings of the two reviews as assessed by an expert panel., Results: There was no statistically significant difference in correct response between the abstract and PLS groups in the clear finding example (abstract, 59.6 %; PLS, 64.2 %; risk difference 4.6 %; CI -0.2 to 11.3) or the uncertain finding example (42.7 %, 39.3 %, -3.4 %, -10.1 to 3.4). There was no significant difference between the conclusion and no conclusion groups in the example with clear findings (conclusions, 63.3 %; no conclusions, 60.5 %; 2.8 %; -3.9 to 9.5), but there was a significant difference in the example with uncertain findings (44.7 %; 37.3 %; 7.3 %; 0.6 to 14.1, p = 0.03). PLS without conclusions in the uncertain finding review had the lowest proportion of correct responses (32.5 %). Prior knowledge and belief predicted student response to the clear finding review, while years of midwifery education predicted response to the uncertain finding review., Conclusions: Abstracts with and without conclusions generated similar student responses. PLS with conclusions gave similar results to abstracts with and without conclusions. Removing the conclusions from a PLS with uncertain findings led to more problems with interpretation.

Background: There is increasing recognition of the potential use of reminiscence in maintaining or improving the quality of life of people with dementia. Despite being used widely in dementia care, evidence on the effectiveness of reminiscence remains uncertain., Aims: This study aims to evaluate the effectiveness of a structured education-based reminiscence programme-the Dementia Education Programme Incorporating Reminiscence for Staff-for people with dementia residing in long-stay care settings in Ireland., Methods: Dementia Education Programme Incorporating Reminiscence for Staff is a two-group, single-blind, cluster randomised trial conducted in long-stay residential care settings in Ireland. The primary outcome was the self-rated quality of life of residents as measured by the Quality of Life-Alzheimer's Disease instrument., Results: Using an intention-to-treat analysis, we found that the estimated effect of the intervention on the quality of life of residents was a non-significant 3.54 (p = 0.1; 95% confidence interval -0.83, 7.90), expressed as the difference in mean improvement between the intervention and control groups. However, the per-protocol analysis yielded a significant effect for the intervention on the quality of life of residents of 5.22 (p = 0.04; 95% confidence interval 0.11, 10.34)., Conclusions: Reminiscence may, in certain circumstances, be an effective care option for people with dementia in long-stay settings with potential to impact positively on the quality of life of residents., (Copyright © 2014 John Wiley & Sons, Ltd.)

Background: Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units., Methods/design: The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation., Discussion: Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in relation to scale and scope. This trial is powered to deliver more credible and durable results. The trial may also convey process utility to a long-stay system in Ireland that has not been geared for education and training, especially in relation to dementia. The results of this trial are applicable to long-stay residential units in Ireland and internationally., Trial Registration: Current Controlled Trials ISRCTN99651465.

Recall data from a representative sample of 3080 adults in Ireland in 2003 is used to investigate transitions into and out of regular participation in sports and exercise--an important contributor to overall physical activity. The method produces a continuous picture of participation across the life-course, allowing key transition periods in the life-course to be identified and the determinants of transitions to be analysed with multivariate models. Late adolescence emerges as an important period, when many people drop out from team sports, especially females. Participation in adulthood mostly involves taking up individual sports and exercise activities. The likelihood of making this transition is strongly associated with socio-economic status. Transitions in activity during adulthood do not display significant sex differences, suggesting that the gender gap for involvement in sports and exercise has its roots in childhood. The method also allows age and cohort effects to be distinguished, revealing higher participation among more recent cohorts. The findings must be interpreted carefully, since they are reliant on the accuracy of personal recall. Yet they have implications for how physical activity policy applies over the life-course, suggesting possible returns to targeting lower socio-economic groups in early adulthood, to offering a broader range of activities to young females, and to researching and promoting those activities most likely to be of interest to current young adults as they age., (2009 Elsevier Ltd. All rights reserved.)

Background: population studies suggest that cardiovascular risk factors may be associated with cognitive impairment. Epidemiological studies evaluating individual markers of vascular disease as risk factors for cognitive dysfunction have yielded inconsistent results. Homocysteine has emerged as a marker consistently associated with poorer outcomes. Existing studies have largely examined individual vascular risks in isolation and have tended to ignore patient psychological status., Objective: to investigate the association between markers of vascular disease and cognition in a community-dwelling non-demented elderly population while adjusting for vascular and non-vascular confounds., Design: cross-sectional community based assessment., Participants: 466 subjects with mean age 75.45 (s.d., 6.06) years. 208 (44.6%) were male., Results: higher levels of homocysteine were consistently associated with poorer performance in tests assessing visual memory and verbal recall. No other vascular biomarker was found to be associated with cognitive performance. Factors such as alcohol use, tea intake, life satisfaction, hypertension and smoking were positively correlated with global cognitive performance. Negative correlations existed between cognitive performance and depression, past history of stroke, intake of fruit and use of psychotropic medication., Conclusions: homocysteine was the only vascular biomarker associated with poorer function in a number of domains on neuropsychological testing, independent of vascular and non-vascular confounds. Other psychosocial factors may need to be taken into account as potential confounds in future studies investigating cognition.

Introduction: Females care for individuals with chronic illness more commonly than males and have different attitudes to illness. Additionally, they experience greater burden and reduced quality of life, when compared to their male counterparts. Since knowledge has been shown to be related to burden, we sought to determine whether there were gender differences in knowledge acquisition during a six-week caregiver psychoeducation programme (CPP)., Methods: Caregivers of people with schizophrenia completed a 23-item adapted version of the self-report Family Questionnaire (FQ) before and after the six-week CPP. Using a Generalized Linear Mixed Model, we studied the differences in proportions of correct answers before and after the programme by gender., Results: Over a 46-month study period, 115 caregivers (58% female) participated in the programme. There was an overall improvement in knowledge with an effect size of 1.12. The improvement was statistically significant (P<0.001) within each of six specific areas of knowledge. However, female caregivers gained more knowledge overall and specifically regarding signs and symptoms, recovery and especially caregiver support. Knowledge gains regarding medication were roughly equal, while male caregivers gained more knowledge about risk factors., Discussion: Our findings indicate that there are gender differences in the amount and type of knowledge gained during a CPP, with female caregivers showing greater knowledge acquisition than their male counterparts in most areas. Interventions designed to assist caregivers may be improved by targeting areas of knowledge specific to each gender. Such an approach might further reduce burden and improve the outcome for their relatives affected by schizophrenia.

Objective: To assess tracking of energy and nutrient intakes between adolescence and young adulthood., Design: Longitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (kappa)., Setting: Northern Ireland population survey., Subjects: Adolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n=245 males, n=231 females)., Results: Despite overall increases in height and weight (both P<0.001), increases in body mass index in males (P<0.001) and body fatness in females (P<0.001), median reported intakes of energy (kJ kg(-1) day(-1)), carbohydrate (g day(-1)) and fat (g day(-1)) decreased (all P<0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (all P<0.001), vitamin C (P<0.01) and vitamin D (P<0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P<0.05) and vitamin A (P<0.001), iron and riboflavin densities increased in the females' diet (P<0.001). Tracking of energy (MJ day(-1)) and nutrient intakes (expressed per MJ day(-1)) at the individual level was only poor to fair (all kappa<0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age., Conclusions: These data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.

It has been suggested that consultants should consider writing directly to patients with a summary of their outpatient consultation. In a controlled trial involving consecutive new referrals to a haematology outpatient clinic, we randomised patients to receive either a personal letter from their consultant summarising their consultation (n = 77) or a brief note thanking them for attending the clinic (n = 73). Patients were assessed for recall of and satisfaction with the consultation by a single independent observer, using standardised methods. At the second visit to outpatients, the patients' median percentage recall of items discussed during the consultation was 67% (IQ range 50-80%) in the intervention group, versus 57% (IQ range 43-76%) in the control group (p = 0.3). Strongly positive views on the personal letter were expressed by patients and referring clinicians. The findings suggest that although personal letters do not substantially improve recall of the clinical encounter, they are feasible, highly valued by patients and acceptable to referring clinicians.

Background: The Millennium Cohort Study of UK babies born this century obtained maternal report of birth weight and data on the family's characteristics, including parental ethnicity, education, and social circumstances. Parental permission to link babies to their birth registration data provided the opportunity to investigate factors affecting accuracy of maternal recall of birth weight and to determine possible causes of error., Methods: Logistic regression was used to investigate the relationship between maternal factors and recall of birth weight. Numerical and graphical methods were used to identify potential causes for birth weight discrepancies., Results: Data were obtained from the birth registry and Millennium Cohort Study for 11 890 of the 14 294 cohort children born in England and Wales. Weight was reported in imperial units by 84% of mothers and this was more common in younger mothers. Accuracy within 100 g was 92% overall, varying from 94% among British/Irish white mothers to 69-89% for other ethnic groups and was lower among the long-term unemployed and those living in disadvantaged or ethnic wards. Explanations (mostly rounding and transcription errors) were identified for 27% of the discrepancies of 100 g or more. Conclusion Mothers' reports of their infants' birth weight showed high level of agreement with registration data, the mean discrepancy being consistently close to zero. However, the variance of the discrepancy differed according to ethnic group, ward type, and socioeconomic status. These sources of differential variability should be taken into account in analyses using birth weight, and possibly other reported data, from socially mixed populations.