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BackgroundThere is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. ObjectiveThis study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. MethodsA pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician–led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). ResultsBaseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means −3.86, 95% CI −6.81 to −0.90, P=.01; week 18: difference in means −4.05, 95% CI −6.81 to −1.28, P

Most massive open online courses (MOOCs) are offered in English, including those offered by non-English speaking universities. The study investigated an identified English language dementia MOOC's accessibility and effectiveness in improving the dementia knowledge of non-native English speaker participants. A total of 6,389 enrolees (age range 18--82 years; 88.4% female) from 67 countries was included in analyses. Dementia knowledge was measured by the Dementia Knowledge Assessment Scale (DKAS) before and after the MOOC completion. Rates of completion were also compared. Native English speakers (n = 5,320) were older, more likely to be female, less likely to be employed, and had lower educational attainment than non-native English speakers (n = 1025). Native English speakers were also more likely to care for or have cared for a family member or friend living with dementia than were non-native English speakers. Native English speakers had a significantly higher DKAS score both pre- (M = 33.0, SD = 9.3) and post-MOOC (M = 44.2, SD = 5.5) than did non-native English speakers (M = 31.7, SD = 9.1; and M = 40.7, SD = 7.7 for pre- and post-MOOC, respectively). Non-native English speakers with low pre-MOOC dementia knowledge scores gained significantly less dementia knowledge following course completion than did native English speakers (p <.001, adjusted for age and education). There was no significant difference between the two groups in their likelihood of completing the MOOC. Our findings suggest that non-native English speakers are motivated and able to complete the MOOC at similar rates to native English speakers, but the MOOC is a more effective educational intervention for native English speakers with low dementia knowledge.

Utilizing Critical Race Theory (CRT), this study conducted a systemic review of scholarship on the schooling experiences of racial/ethnic minority students called multicultural students in South Korea. For the current analysis, CRT helped illuminate racism and other intersecting forms of structural issues that shape multicultural students' experiences, which tend to be obfuscated in the dominant multicultural education discourse in Korea. In doing so, this study helped acknowledge the structural embeddedness of multicultural students' experiences with discrimination and stigma and race/ethnicity as a marginalizing factor in the Korean education system. In addition to providing local implications, the current study seeks to expand the transnational application of CRT in education by examining racial injustice in Korean society that has received little attention in the CRT scholarship.

Background: Clinical guidelines have concluded that there are insufficient data to provide recommendations for the hemoglobin threshold for the use of red cell transfusion in patients with acute myocardial infarction (MI) and anemia. After the recent publication of the Myocardial Infarction and Transfusion (MINT) trial, we performed an individual patient-level data meta-analysis to evaluate the effect of restrictive versus liberal blood transfusion strategies. Methods: We conducted searches in major databases. Eligible trials randomly assigned patients with MI and anemia to either a restrictive (i.e., transfusion threshold of 7-8 g/dl) or liberal (i.e., transfusion threshold of 10 g/dl) red cell transfusion strategy. We used individual patient data from each trial. The primary outcome was a composite of 30-day mortality or MI. Results: We included 4311 patients from four trials. The primary outcome occurred in 334 patients (15.4%) in the restrictive strategy and 296 patients (13.8%) in the liberal strategy (relative risk [RR] 1.13, 95% confidence interval [CI], 0.97 to 1.30). Death at 30 days occurred in 9.3% of patients in the restrictive strategy and in 8.1% of patients in the liberal strategy (RR 1.15, 95% CI, 0.95 to 1.39). Cardiac death at 30 days occurred in 5.5% of patients in the restrictive strategy and in 3.7% of patients in the liberal strategy (RR 1.47, 95% CI, 1.11 to 1.94). Heart failure (RR 0.89, 95% CI, 0.70 to 1.13) was similar in the transfusion strategies. All-cause mortality at 6 months occurred in 20.5% of patients in the restrictive strategy compared with 19.1% of patients in the liberal strategy (hazard ratio 1.08, 95% CI, 1.05 to 1.11). Conclusions: Pooling individual patient data from four trials did not find a definitive difference in our primary composite outcome of MI or death at 30 days. At 6 months, a restrictive transfusion strategy was associated with increased all-cause mortality. (Partially funded by a grant from the U.S. National Heart, Lung, and Blood Institute [R01HL171977].) [ABSTRACT FROM AUTHOR]

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors. [ABSTRACT FROM AUTHOR]

The article discusses the oversight of international students' experiences with race and racism in U.S. higher education, advocating for institutional support to develop their racial consciousness and agency. It explores empowering international students with language and tools to navigate racial systems, their role in shaping racial dynamics on college campuses, and the need for a paradigm shift in discourse surrounding internationalization.