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Background Delay discounting is the depreciation in a reward's perceived value as a function of the time until receipt. Monetary incentive programs that provide rewards contingent on meeting daily physical activity (PA) goals may change participants' delay discounting preferences. Purpose Determine if monetary incentives provided in close temporal proximity to meeting PA goals changed delay discounting, and if such changes mediated intervention effects. Methods Inactive adults (n = 512) wore accelerometers during a 12-month intervention where they received proximal monetary incentives for meeting daily moderate-to-vigorous PA (MVPA) goals or delayed incentives for study participation. Delay discount rate and average MVPA were assessed at baseline, end of intervention, and a 24-month follow-up. Using structural equation modeling, we tested effects of proximal versus delayed rewards on delay discounting and whether any changes mediated intervention effects on MVPA. PA self-efficacy was also evaluated as a potential mediator, and both self-efficacy and delay discounting were assessed as potential moderators of intervention effects. Results Proximal rewards significantly increased participants' delay discounting (β = 0.238, confidence interval [CI]: −0.078, 0.380), indicating greater sensitivity to reinforcement timing. This change did not mediate incentive-associated increases in MVPA at the end of the 12-month intervention (β = −0.016, CI: −0.053, 0.019) or at a 24-month follow-up (β = −0.020, CI: −0.059, 0.018). Moderation effects were not found. Conclusions Incentive-induced increases in delay discounting did not deleteriously impact MVPA. This finding may help assuage concerns about using monetary incentives for PA promotion, but further research regarding the consequences of changes in delay discounting is warranted. [ABSTRACT FROM AUTHOR]

Objectives Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects. Method Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest. Results There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p >.05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = −.011, p <.001), memory training (b = −.011, p <.001), and reasoning training (b = −.012, p <.001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = −.001, p <.001). Discussion This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years. [ABSTRACT FROM AUTHOR]

There are few studies on interment preferences and practices for people in remote and rural regions of developed countries. This mixed methods study in rural Australia collated data on funeral and interment practices with an ethnographic exploration of the post-death preferences of terminally-ill rural residents. In the region, between February 2015 and May 2016, 44% of decedents were cremated. Burial preferences reflected family traditions, generational connections to historic cemeteries, and the wish to instantiate belonging to people and place. Cremation provided the opportunity for ashes to be scattered at personally-significant places. Funeral planning was important for patients and family caregivers, and funerals are valued rural community rituals. [ABSTRACT FROM AUTHOR]

Financial incentives can increase physical activity (PA), but differences in the immediacy of reward delivery and individual differences in delay discount rates (i.e., higher discount values associated with less tolerance for delayed rewards) may explain differential responding. The current study tested whether delay discount rate moderated the relative effectiveness of immediate financial rewards on increasing daily PA. Inactive, overweight adults (ages 18–60, N = 96) were randomized to receive either smaller, immediate goal-contingent rewards or larger, delayed rewards for participation. Delay discount rates were derived for those who completed the Monetary Choice Questionnaire (N = 85). Linear mixed models tested interactions between discount rate and intervention arm on changes in mean daily Fitbit-measured steps from baseline to intervention phases, and rates of change during the intervention phase. Across all groups, participants increased by 2258 steps/day on average from baseline to intervention and declined by 9 steps/day across the 4-month intervention phase. The mean increase in daily steps was greater for immediate reward-arm participants across all discount rates. Descriptive exploration of reward effects by delay discount rate suggested that the magnitude of reward effects decreased at higher discount rates. During the 4-month intervention phase, rates of decline in daily steps were similar in both reward arms, but declines became more pronounced at higher discount rates. Overall, intervention efficacy decreased with less tolerance for delays. The importance of financial reward immediacy for increasing PA appears to increase with greater delay discount rates. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined age-related differences in relationship magnitude between physical function and cognition in healthy older adults. Topics covered include how the time-varying effects modeling (TVEM) was used in the study, the role of increased age in the associations between grip strength and all cognitive domains, and inconsistencies found with regards to the relationships between physical and cognitive performance.

Objective: Nervoza is a commonly-used illness category among Macedonian Australians. Although nervoza belongs broadly to the category of 'nerve illnesses' little is known of its meaning among Macedonian immigrants, and whether there is intergenerational attrition in its meaning and use. We aimed to explore how nervoza and its treatment are perceived by members of the Macedonian community in Australia. Design: In-depth interviews in Macedonian with 18 participants from the Macedonian community in Melbourne, Australia. Results: Nervoza is a layered concept relating shame, emotional experience and nerves, used as an idiom of distress and sadness in the presence of acute and chronic stressors. Nervoza develops in both the social world (through poverty, grief or the loss of war), and in the psyche of distressed and isolated people. It is viewed as dangerous on many levels: to physical health, as a 'gateway condition' to long-term psychological illnesses such as depression and schizophrenia, and to the person's social well-being. The normalised treatment for nervoza in Macedonia - benzodiazepines - is the subject of significant medical control in Australia. Conclusion: For sufferers of nervoza, the social self is both medicalized and stigmatised. Health services in Australia are often considered marginal in the management of nervoza. Second generation Macedonians viewed the concept as unhelpful, and possibly increasing the stigmatisation of mental illnesses. The lack of knowledge about, and underutilisation of, mental health services and support groups in the Macedonian Australian community should be the focus of community-based inter-generational health literacy initiatives. [ABSTRACT FROM AUTHOR]

Background: In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the ‘good death’. Aim: To explore the concept of the ‘good death’ articulated by rural patients with life-limiting illnesses, and their family caregivers. Design: Ethnography, utilising open-ended interviews, observations and field-notes. Participants: In total, 12 rural (town and farm) patients with life-limiting illnesses, 18 family caregivers and 6 clinicians, in the Snowy Monaro region of New South Wales, Australia, participated in this study over the course of the deaths of the patients. Interviews were transcribed and analysed with observational data using an emergent thematic process. Results: A ‘safe death’ was central to a ‘good death’ and was described as a death in which one could maintain (1) a connection with one’s previous identity; (2) autonomy and control over decisions regarding management of end-of-life care and (3) not being overwhelmed by the physical management of the dying process. For all participants, the preferred place of death was the ‘safe place’, regardless of its physical location. Conclusion: Safety, in this study, is related to a familiar place for death. A home death is not essential for and does not ensure a ‘good death’. We all have a responsibility to ensure all places for dying can deliver the ‘safe death’. Future research could explore the inter-relationships between safety and preference for home or home-like places of death. [ABSTRACT FROM AUTHOR]

Abstract: Residential aged care (RAC) is a significant provider of end‐of‐life care for people aged 65 years and older. Rural residents perceive themselves as different to their urban counterparts. Most studies describing place of death (PoD) in RAC are quantitative and reflect an urban voice. Using a mixed‐methods design, this paper examines the PoD of 80 RAC residents (15 short‐stay residents who died in RAC during respite or during an attempted step‐down transition from hospital to home, and 65 permanent residents), within the rural Snowy Monaro region, Australia, who died between 1 February 2015 and 31 May 2016. Death data were collected from local funeral directors, RAC facilities, one multi‐purpose heath service and obituary notices in the local media. The outcome variable was PoD: RAC, local hospital or out‐of‐region tertiary hospital. For the permanent RAC residents, the outcome of interest was dying in RAC or dying in hospital. Cross tabulations by PoD and key demographic data were performed. Pearson Chi squared tests and exact p‐values were used to determine if any of the independent variables were associated with PoD. Using an ethnographic approach, data were collected from 12 face‐to‐face, open‐ended interviews with four RAC residents, with a life expectancy of ≤6 months, and six family caregivers. Interviews were audio‐recorded, transcribed and analysed thematically. Fifty‐one (78.5%) of the permanent residents died in RAC; 21.5% died in hospital. Home was the initial preferred POD for most interviewed participants; most eventually accepted the transfer to RAC. Long‐term residents considered RAC to be their “home”—a familiar place, and an important part of their rural community. The participants did not consider a transfer to hospital to be necessary for end‐of‐life care. Further work is required to explore further the perspectives of rural RAC residents and their families, and if transfers to hospital are avoidable. [ABSTRACT FROM AUTHOR]

Background: An online version of the Microscale Audit of Pedestrian Streetscapes (Abbreviated) tool was adapted to virtually audit built environment features supportive of physical activity. The current study assessed inter-rater reliability of MAPS Online between in-person raters and online raters unfamiliar with the regions. Methods: In-person and online audits were conducted for a total of 120 quarter-mile routes (60 per site) in Phoenix, AZ and San Diego, CA. Routes in each city included 40 residential origins stratified by walkability and SES, and 20 commercial centers. In-person audits were conducted by raters residing in their region. Online audits were conducted by raters in the alternate location using Google Maps (Aerial and Street View) images. The MAPS Abbreviated Online tool consisted of four sections: overall route, street segments, crossings and cul-de-sacs. Items within each section were grouped into subscales, and inter-rater reliability (ICCs) was assessed for subscales at multiple levels of aggregation. Results: Online and in-person audits showed excellent agreement for overall positive microscale (ICC = 0.86, 95% CI [0.80, 0.90]) and grand scores (ICC = 0.93, 95% CI [0.89, 0.95]). Substantial to near-perfect agreement was found for 21 of 30 (70%) subscales, valence, and subsection scores, with ICCs ranging from 0.62, 95% CI [0.50, 0.72] to 0.95, 95% CI [0.93, 0.97]. Lowest agreement was found for the aesthetics and social characteristics scores, with ICCs ranging from 0.07, 95% CI [-0.12, 0.24] to 0.27, 95% CI [0.10, 0.43]. Conclusions: Results support use of the MAPS Abbreviated Online tool to reliably assess microscale neighborhood features that support physical activity and may be used by raters residing in different geographic regions and unfamiliar with the audit areas. [ABSTRACT FROM AUTHOR]

Background: Ecological models suggest that interventions targeting specific behaviors are most effective when supported by the environment. This study prospectively examined the interactions between neighborhood walkability and an mHealth intervention in a large-scale, adequately powered trial to increase moderate-to-vigorous physical activity (MVPA). Methods: Healthy, insufficiently active adults (N = 512) were recruited purposefully from census block groups ranked on walkability (high/low) and socioeconomic status (SES, high/low). Participants were block-randomized in groups of four to WalkIT Arizona, a 12-month, 2 × 2 factorial trial evaluating adaptive versus static goal setting and immediate versus delayed financial reinforcement delivered via text messages. Participants wore ActiGraph GT9X accelerometers daily for one year. After recruitment, a walkability index was calculated uniquely for every participant using a 500-m street network buffer. Generalized linear mixed-effects hurdle models tested for interactions between walkability, intervention components, and phase (baseline vs. intervention) on: (1) likelihood of any (versus no) MVPA and (2) daily MVPA minutes, after adjusting for accelerometer wear time, neighborhood SES, and calendar month. Neighborhood walkability was probed at 5th, 25th, 50th, 75th, and 95th percentiles to explore the full range of effects. Results: Adaptive goal setting was more effective in increasing the likelihood of any MVPA and daily MVPA minutes, especially in lower walkable neighborhoods, while the magnitude of intervention effect declined as walkability increased. Immediate reinforcement showed a greater increase in any and daily MVPA compared to delayed reinforcement, especially relatively greater in higher walkable neighborhoods. Conclusions: Results partially supported the synergy hypotheses between neighborhood walkability and PA interventions and suggest the potential of tailoring interventions to individuals' neighborhood characteristics. Trial Registration: Preregistered at clinicaltrials.gov (NCT02717663). [ABSTRACT FROM AUTHOR]

Background: Many patients with chronic physical illnesses have co-morbid psychological illnesses, which may respond to interprofessional collaborative care. Continuing education programs frequently focus on skills and knowledge relevant for individual illnesses, and unidisciplinary care. This study evaluates the impact of "Mind the Gap", an Australian interprofessional continuing education program about management of dual illnesses, on practitioners' knowledge, use of psychological strategies and collaborative practice.Methods: A 6-h module addressing knowledge and skills needed for patients with physical and psychological co-morbid illnesses was delivered to 837 practitioners from mixed health professional backgrounds, through locally-facilitated workshops at 45 Australian sites. We conducted a mixed-methods evaluation, incorporating observation, surveys and network analysis using data collected, before, immediately after, and three months after training.Results: Six hundred forty-five participants enrolled in the evaluation (58 % GPs, 17 % nurses, 15 % mental health professionals, response rate 76 %). Participants' knowledge and confidence to manage patients with psychological and physical illnesses improved immediately. Among the subset surveyed at three months (response rate 24 %), referral networks had increased across seven disciplines, improvements in confidence and knowledge were sustained, and doctors, but no other disciplines, reported an increase in use of motivational interviewing (85.9 % to 96.8 %) and mindfulness (58.6 % to 74 %).Conclusions: Interprofessional workshops had an immediate impact on the stated knowledge and confidence of participants to manage patients with physical and psychological comorbidities, which appears to have been sustained. For some attendees, there was a sustained improvement in the size of their referral networks and their use of some psychological strategies. [ABSTRACT FROM AUTHOR]

Background: The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA—Qualitative Rapid Appraisal, Rigorous Analysis—to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Methods: Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. Results: We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. Conclusions: The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector. [ABSTRACT FROM AUTHOR]

Background. One in thirty-five Australians has poor proficiency in English, and may need language support in health consultations. Australia has the world's most extensive system of fee-free provision of interpreters for doctors, but the degree of uptake relative to need is unknown. Objective. To assess the current unmet and projected future needs for interpreters in Australia in Medicare-funded medical consultations. Method. Secondary analysis of Australian Census, Medicare and Translating and Interpreting Service (TIS) datasets. Age-specific rates of non-Indigenous populations who had self-reported poor proficiency in English were applied to age-specific attendances to general practitioners (GPs) and private specialists to estimate the need for language-assisted consultations in 2006-07. The proportion of services where language assistance was used when needed was estimated through aggregate data from the Medicare and TIS datasets. Results. We estimate that interpreters from the national fee-free service were used for patients with poor proficiency in English is less than 1 in 100 (0.97%) Medicare-funded consultations. The need for interpreters will escalate in future, particularly among those over 85 years. Discussion. Doctors currently underuse interpreters. Increasing the use of interpreters requires education and incentives, but also sustained investment in systems, infrastructure and interpreters to meet the escalation in demand as the population ages. INSET: What is known about this topic?. [ABSTRACT FROM AUTHOR]

Context The hidden curriculum – the norms, values and practices that are transmitted to students through modelling by preceptors and teachers, and decisions about curricular exclusions and inclusions – can be profoundly important in the socialising of trainee doctors. However, tracking the hidden curriculum as it evolves can be challenging for medical schools. Objectives This study aimed to explore the content of student e-portfolios on gender issues, a key perspective often taught through a hidden curriculum. Methods Online posts for a gender and medicine e-portfolio task completed by two cohorts of students in Year 3 of a 4-year medical course (n = 167, 66% female) were analysed using a grounded theory approach. Results A process of gendered ‘othering’ was applied to both men and women in the medical school using different pedagogical strategies. Curricular emphases on women’s health and lack of support for male students to acquire gynaecological examination skills were seen as explicit ways of excluding males. For female medical students, exclusion tended to be implicit, operating through modelling and aphoristic comments about so-called ‘female-friendly’ career choices and the negative impact of motherhood on career. Discussion E-portfolios can be a useful way of tracking the hidden curriculum as it evolves. Responses to gendered exclusion may be developed more readily for the explicit processes impacting on male students than for the implicit processes impacting on female students, which often reflect structural issues related to training and employment. [ABSTRACT FROM AUTHOR]

Background: The International Health Regulations (2005) and the emergence and global spread of infectious diseases have triggered a re-assessment of how rich countries should support capacity development for communicable disease control in low and medium income countries (LMIC). In LMIC, three types of public health training have been tried: the university-based model; streamed training for specialised workers; and field-based programs. The first has low rates of production and teaching may not always be based on the needs and priorities of the host country. The second model is efficient, but does not accord the workers sufficient status to enable them to impact on policy. The third has the most potential as a capacity development measure for LMIC, but in practice faces challenges which may limit its ability to promote capacity development. Discussion: We describe Australia's first Master of Applied Epidemiology (MAE) model (established in 1991), which uses field-based training to strengthen the control of communicable diseases. A central attribute of this model is the way it partners and complements health department initiatives to enhance workforce skills, health system performance and the evidence-base for policies, programs and practice. Summary: The MAE experience throws light on ways Australia could collaborate in regional capacity development initiatives. Key needs are a shared vision for a regional approach to integrate training with initiatives that strengthen service and research, and the pooling of human, financial and technical resources. We focus on communicable diseases, but our findings and recommendations are generalisable to other areas of public health. [ABSTRACT FROM AUTHOR]

Background: Although primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada. Methodology/Principal Findings: We adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publiclyavailable jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macroenvironment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about noninfluenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently. Conclusions: This is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research. [ABSTRACT FROM AUTHOR]

In June, 2019, delegates from more than 65 countries attended the first international Global Health Security conference in Sydney to debate how to strengthen global health security and contain epidemics at source.[1] The Sydney Statement[1] on global health security, announced as a "product of this conference", was presented in its final form on the first day of the conference with seven guiding principles, including reference to the values of "integrity of international norms, respect for human rights, and social justice...[and] transparent decision making". Global health security is an energising way of framing risk, of mobilising resources, increasing provision of development assistance for health,[2] and clarifying the international obligations of nation states. [Extracted from the article]

The article focuses on the role of teachers as medical counsellors in handling Attention Deficit Hyperactivity Disorder(ADHD) in children. The article critcizes the role of pharmaceutical companies in educating the educators to tackle autism and dyslexia for the reason that these education programs are profit motivated. The article also presents that teachers must be accurate interpreters of information for parents and healthworkers, rather than for pharmacetical companies.

The article discusses research conducted by David Heymann and colleagues on the Ebola epidemic and how it omitted the political and economic barriers to health security encountered by poor countries.

Background: Anxiety disorders are highly prevalent mental health conditions managed predominantly by general practitioners (GPs). This study aimed to examine the management of anxiety by Australian GPs since the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative in 2006. Methods: We conducted secondary analysis of Bettering the Evaluation and Care of Health data on GP encounters for anxiety from 2006 to 2016 (N = 28,784). We calculated point estimates and used multivariate logistic regression to explore the effect of GP and patient characteristics on rates and types of management. Results: The management rate of anxiety increased from 2.3% of GP encounters in 2006 to 3.2% in 2016. Over the 10-year period, increases were seen in referrals to psychologists (AOR = 1.09, 95%CI = 1.07–1.11, p <.0001) and selective serotonin / serotonin-noradrenalin reuptake inhibitors (AOR = 1.05, 95%CI = 1.03–1.06, p <.0001), and benzodiazepines decreased (AOR = 0.94, 95%CI = 0.92–0.95, p <.0001). Systematic differences in management were found for patient and GP characteristics, including high rates of benzodiazepines in certain groups. Conclusions: Anxiety is accounting for more of the GP workload, year on year. GP management of anxiety has become more closely aligned with practice guidelines since 2006. However, high rates of benzodiazepine prescribing in certain groups remains a concern. Further research is needed into GP treatment decision making for anxiety. [ABSTRACT FROM AUTHOR]

Little change over the decades has been seen in adults meeting moderate-to-vigorous physical activity (MVPA) guidelines. Numerous individual-level interventions to increase MVPA have been designed, mostly static interventions without consideration for neighborhood context. Recent technologies make adaptive interventions for MVPA feasible. Unlike static interventions, adaptive intervention components (e.g., goal setting) adjust frequently to an individual's performance. Such technologies also allow for more precise delivery of "smaller, sooner incentives" that may result in greater MVPA than "larger, later incentives". Combined, these factors could enhance MVPA adoption. Additionally, a central tenet of ecological models is that MVPA is sensitive to neighborhood environment design; lower-walkable neighborhoods constrain MVPA adoption and maintenance, limiting the effects of individual-level interventions. Higher-walkable neighborhoods are hypothesized to enhance MVPA interventions. Few prospective studies have addressed this premise. This report describes the rationale, design, intervention components, and baseline sample of a study testing individual-level adaptive goal-setting and incentive interventions for MVPA adoption and maintenance over 2 years among adults from neighborhoods known to vary in neighborhood walkability. We scaled these evidenced-based interventions and tested them against static-goal-setting and delayed-incentive comparisons in a 2 × 2 factorial randomized trial to increase MVPA among 512 healthy insufficiently-active adults. Participants (64.3% female, M age = 45.5 ± 9.1 years, M BMI = 33.9 ± 7.3 kg/m2, 18.8% Hispanic, 84.0% White) were recruited from May 2016 to May 2018 from block groups ranked on GIS-measured neighborhood walkability and socioeconomic status (SES) and classified into four neighborhood types: "high walkable/high SES," "high walkable/low SES," "low walkable/high SES," and "low walkable/low SES." Results from this ongoing study will provide evidence for some of the central research questions of ecological models. [ABSTRACT FROM AUTHOR]

Objective: Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years. Method: Older adults randomized to a processing speed (n = 702), reasoning (n = 694), or memory (n = 703) training intervention were compared with those randomized to a no-contact control condition (n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted. Results: There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength. Discussion: This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects. [ABSTRACT FROM AUTHOR]

To address the rising prevalence of Alzheimer's disease and related dementias, effective interventions that can be widely disseminated are warranted. The Preventing Alzheimer's with Cognitive Training study (PACT) investigates a commercially available computerized cognitive training program targeting improved Useful Field of View Training (UFOVT) performance. The primary goal is to test the effectiveness of UFOVT to reduce incidence of clinically defined mild cognitive impairment (MCI) or dementia with a secondary objective to examine if effects are moderated by plasma β-amyloid level or apolipoprotein E e4 (APOE e4) allele status. This multisite study utilizes a randomized, controlled experimental design with blinded assessors and investigators. Individuals who are 65 years of age and older are recruited from the community. Eligible participants who demonstrate intact cognitive status (Montreal Cognitive Assessment score > 25) are randomized and asked to complete 45 sessions of either a commercially available computerized-cognitive training program (UFOVT) or computerized games across 2.5 years. After three years, participants are screened for cognitive decline. For those demonstrating decline or who are part of a random subsample, a comprehensive neuropsychological assessment is completed. Those who perform below a pre-specified level are asked to complete a clinical evaluation, including an MRI, to ascertain clinical diagnosis of normal cognition, MCI, or dementia. Participants are asked to provide blood samples for analyses of Alzheimer's disease related biomarkers. The PACT study addresses the rapidly increasing prevalence of dementia. Computerized cognitive training may provide a non-pharmaceutical option for reducing incidence of MCI or dementia to improve public health. Registration: The PACT study is registered at http://Clinicaltrials.gov NCT03848312 [ABSTRACT FROM AUTHOR]

Introduction: Potent lifestyle interventions to increase moderate-to-vigorous physical activity are urgently needed for population-level chronic disease prevention. This trial tested the independent and joint effects of a mobile health system automating adaptive goal setting and immediate financial reinforcement for increasing daily walking among insufficiently active adults.Study Design: Participants were randomized into a 2 (adaptive versus static goal setting) X 2 (immediate versus delayed financial incentive timing) condition factorial trial to increase walking.Settings/participants: Participants (N=512 adults) were recruited between 2016 and 2018 and were 64.5% female, aged 18-60 years, 18.8% Hispanic, 6.1% African American, and 83% White.Intervention: Principles of reinforcement and behavioral economics directed intervention design.Main Outcome Measures: Participants wore accelerometers daily (133,876 day-level observations) that remotely measured moderate-to-vigorous physical activity bout minutes of ≥3 minutes/day for 1 year. Primary outcomes were between-condition differences in (1) engaging ≥1 bout of moderate-to-vigorous physical activity on each day and (2) on days with ≥1 bout, daily total moderate-to-vigorous physical activity minutes.Results: Mixed-effects hurdle models tested treatment group X phase (time) interactions using an intent-to-treat approach in 2021. Engaging in any ambulatory moderate-to-vigorous physical activity was greater for Adaptive than for Static Goal groups (OR=2.34, 95% CI=2.10, 2.60 vs OR=1.66, 95% CI=1.50, 1.84; p<0.001) and for Immediate than for Static Reinforcement groups (OR=2.16 95% CI=1.94, 2.40 vs OR=1.77, 95% CI=1.59, 1.97; p<0.01). The Immediate Reinforcement group increased by 16.54 moderate-to-vigorous physical activity minutes/day, whereas the Delayed Reinforcement group increased by 9.91 minutes/day (p<0.001). The combined Adaptive Goals + Immediate Reinforcement group increased by 16.52 moderate-to-vigorous physical activity minutes/day, significantly more than that of either Delayed Reinforcement group.Conclusions: This study offers automated and scalable-behavior change strategies for increasing walking among adults most at-risk for chronic diseases attributed to sedentary lifestyles.Trial Registration: This study is registered at www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02717663). [ABSTRACT FROM AUTHOR]

Abstract: Background: Almost all general practitioners in Australia now use a computer for some part of the consultation, and mostly use one of eight clinical software applications. There has been little research into the impact of clinical software on the clinical consultation. Clinical software broadly functions in two ways: it replaces the paper record of the patient''s history of health and clinical contacts within the general practice, and it communicates directly to the doctor in various ways about outstanding clinical actions. Aim: This paper draws on Goffman''s notion of “face” to explore the way in which the actions, visual presentation, and interactions between general practitioners, patients and the computer can imbue the software with its own “face” in the consultation. Methods: Analysis of 141 consultations by 20 doctors (13 men, 7 women), who used one of four medical software applications commonly used in Australian general practice. Consultations were videotaped, tagged, analysed using a hermeneutic framework. Results: All four software packages replicated constitutive elements of the paper health record, such as medical history, current medications, and the patient''s social history, but also introduced other content not present in a paper system. They differed in their use of communicative strategies. This necessitated differing interactions between the software and the doctor. The differences in communicative work of each software package led to their different “faces”, along a gradient from a relatively passive mode that provided context dependent information in an unobtrusive way, to a relatively active mode that interrupted to provide information and to demand responses. We conclude that the more active the mode of presence of the computer in the consultation, the more patients and doctors may have to adapt their communicative styles in response. [Copyright &y& Elsevier]

• Change point models (CPMs) are useful for event-based time conceptualization. • CPMs can evaluate compression of cognitive morbidity in intervention studies. • More basic and applied research should use CPMs for cognitive aging research. Chronological age is a commonly-used time metric, but there may be more relevant time measures in older adulthood. This paper reviews change point modeling, a type of analysis increasingly common in cognitive aging research but with limited application in applied research. Here, we propose a new application of such models for cognitive training studies. Change point models have the potential to assess intervention outcomes such as compression of morbidity or reduced decline after an event (e.g., reduced cognitive decline after a dementia diagnosis) as well as changes in outcome trajectories across different intervention dosages (e.g., initial vs. booster training). Through change point modeling, we can better understand how interventions impact cognitive aging trajectories. [ABSTRACT FROM AUTHOR]

• Common behavioral interventions in adults 65+ are cognitive or exercise training. • Cognitive training improves the trained domains and transfers to everyday function. • Aerobic activity generally improves executive function. • RCTs of leisure interventions are new, and effects on cognition are not known. • Studies should describe protocols and control arms, and include everyday function. Behavioral interventions to improve cognitive function in older adults are widespread and can vary from theater classes to cognitive training programs. However, the effectiveness in maintaining different cognitive domains varies greatly both across and within intervention types. To date, no systematic reviews have synthesized findings across more than a few types of interventions (e.g., cognitive vs. exercise). This systematic review examined 11 types of behavioral interventions and the respective transfer to 19 cognitive domains, as well as transfer to everyday function. Study inclusion criteria were: peer-reviewed articles in English, samples of healthy adults aged 65 and older, and randomized controlled trials of behavioral interventions with reported cognitive outcomes. The 2017 search yielded 75 eligible articles comprising cognitive training, exercise training, combination interventions, cognitively-stimulating activities, and action video games. In general, process- (n = 26) and strategy-based (n = 16) cognitive training improved the trained domains but had weak transfer to non-trained domains. Aerobic training (n = 13) most consistently improved executive function, and strength/resistance (n = 8) and aerobic/resistance combination training (n = 6) most consistently improved cognitive inhibition and visual working memory. Combination interventions (n = 15 nonfactorial, n = 3 factorial) showed promise in improving verbal delayed recall and executive function. Few studies examined cognitively-stimulating activities or action video games, leaving inconclusive results about their effect on cognitive function. Few studies examined everyday function (n = 9), however, process- and strategy-based training demonstrated notable long-term transfer. Recommendations for future research and practice are highlighted. [ABSTRACT FROM AUTHOR]

Abstract: The ‘good death’ is one objective of palliative care, with many ‘good death’ viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the ‘good’ rural death through the perspectives of rural residents, including rural patients with a life‐limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand‐searched. Twenty articles (for 17 studies and one systematic review) were identified after a two‐phase screening process by two reviewers, using pre‐determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life‐limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a ‘good death’ is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a ‘good death’, there is a need for further studies to elicit rural patient and family caregiver perspectives. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the place of death of residents in a rural region of New South Wales. Design: Cross‐sectional quantitative study using death data collected from local funeral directors (in person and websites), residential aged‐care facilities, one multipurpose heath service and obituary notices in the local media (newspapers/radio). Setting: Snowy Monaro region (New South Wales Australia). Participants: Residents, with advanced frailty or one of 10 conditions amenable to palliative care, who died between 1 February 2015 and 31 May 2016. Main outcome measure: Place of death. Results: Of 224 deaths in this period, 138 were considered amenable to palliative care. Twelve per cent of these deaths occurred in a private residence, 38% in the usual place of residence and 91% within the region. Conclusion: Most rural residents with conditions amenable to palliative care died in the region. Most did not die in their usual place of residence. Further qualitative work is needed to determine palliative care patients’ and family caregivers’ preferences for, and the importance placed on, place of death. While there may be a need to support an increase in home deaths, local rural hospitals and residential aged‐care facilities must not be overlooked as a substitute for inpatient hospices. [ABSTRACT FROM AUTHOR]

Background: End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. Aims: To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. Design: A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources: Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. Results: A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and ‘country’. Conclusion: Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers’ experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Driving is important for older adults' health and well-being, yet little research has examined interventions to maintain driving mobility. As fluid cognitive abilities are strongly linked to driving, targeted cognitive training interventions may impact driving mobility longitudinally. This study assessed the effects of three different cognitive training programs (reasoning, speed of processing, and memory) on driving cessation in older adults across 10 years (n = 2,390). Design and Methods: Cox regression analyses evaluated the impact of each program relative to a no-contact control group with intent-to-treat (ITT) analyses. The effects of randomization to additional booster sessions were also examined. Subsample analyses repeated these models in participants who were at-risk for driving mobility declines. Results: There were no training (n = 2,390) or booster training (n = 1,540) effects on driving cessation with ITT analyses. Individuals at-risk for future mobility declines were 49% (Hazard Ratio (HR) = 0.51, 95% confidence interval [CI]: 0.28, 0.94; n = 336) less likely to cease driving after speed of processing training and 55% (HR = 0.45, 95% CI: 0.24, 0.86; n = 324) less likely to quit driving subsequent to reasoning training. Additional booster sessions for speed of processing training resulted in a 70% reduction of driving cessation (HR = 0.30, 95% CI: 0.11, 0.82; n = 252) in the subsample analyses. There were no significant effects of memory training. Implications: Some cognitive interventions transfer to maintained driving among those at-risk for mobility declines due to cognitive impairment. Future research should identify moderators and mediators of training and transfer effects. [ABSTRACT FROM AUTHOR]