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Background Dementia prevalence is increasing as populations live longer, with no cure and the costs of caring exceeding many other conditions. There is increasing evidence for modifiable risk factors which, if addressed in mid-life, can reduce the risk of developing dementia in later life. These include physical inactivity, low cognitive activity, mid-life obesity, high blood pressure, and high cholesterol. This study aims to assess the acceptability and feasibility and impact of giving those in mid-life, aged between 40 and 60 years, an individualised dementia risk modification score and profile and access to personalised on-line health information and goal setting in order to support the behaviour change required to reduce such dementia risk. A secondary aim is to understand participants’ and practitioners’ views of dementia prevention and explore the acceptability and integration of the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) intervention into daily life and routine practice. Methods/design In-MINDD is a multi-centre, primary care-based, single-blinded randomised controlled feasibility trial currently being conducted in four European countries (France, Ireland, the Netherlands and the UK). Participants are being recruited from participating general practices. Inclusion criteria will include age between 40 and 60 years; at least one modifiable risk factor for dementia risk (including diabetes, hypertension, obesity, renal dysfunction, current smoker, raised cholesterol, coronary heart disease, current or previous history of depression, self-reported sedentary lifestyle, and self-reported low cognitive activity) access to the Internet. Primary outcome measure will be a change in dementia risk modification score over the timescale of the trial (6 months). A qualitative process evaluation will interview a sample of participants and practitioners about their views on the acceptability and feasibility of the trial and the links between modifiable risk factors and dementia prevention. This work will be underpinned by Normalisation Process Theory. Discussion This study will explore the feasibility and acceptability of a risk profiler and on-line support environment to help individuals in mid-life assess their risk of developing dementia in later life and to take steps to alleviate that risk by tackling health-related behaviour change. Testing the intervention in a robust and theoretically informed manner will inform the development of a future, full-scale randomised controlled trial. Trial registration ISRCTN Registry: ISRCTN 98553005 (DOI: 10.1186/ISRCTN98553005). Electronic supplementary material The online version of this article (doi:10.1186/s40814-015-0035-x) contains supplementary material, which is available to authorized users.

Background Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This study aimed to describe that role, identify how professionally supported they felt and their career intentions. An additional aim was to explore whether they felt isolated and identify contributory factors.\ud \ud Methods A cross-sectional questionnaire survey in one large urban Scottish Health Board, targeted all practice nurses (n=329). Domains included demographics, workload, training and professional support. Following univariate descriptive statistics, associations between categorical variables were tested using the chi-square test or chi-square test for trend; associations between dichotomous variables were tested using Fisher's Exact test. Variables significantly associated with isolation were entered into a binary logistic regression model using backwards elimination.\ud \ud Results There were 200 responses (61.0% response rate). Most respondents were aged 40 or over and were practice nurses for a median of 10 years. Commonest clinical activities were coronary heart disease management, cervical cytology, diabetes and management of chronic obstructive pulmonary disease. Although most had a Personal Development Plan and a recent appraisal, 103 (52.3%) felt isolated at least sometimes; 30 (15.5%) intended leaving practice nursing within 5 years. Isolated nurses worked in practices with smaller list sizes (p=0.024) and nursing teams (p=0.003); were less likely to have someone they could discuss a clinical/professional (p=0.002) or personal (p\ud \ud Conclusions A significant proportion of practice nurses reported feeling isolated, at least some of the time. They were more likely to be in small practices and more likely to be considering leaving practice nursing. Factors contributing to their isolation were generally located within the practice environment. Providing support to these nurses within their practice setting may help alleviate the feelings of isolation, and could reduce the number considering leaving practice nursing.

The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of\ud user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health\ud improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw\ud from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and longterm relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome.