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Sample records for national dementia strategy

  1. Personhood, dementia policy and the Irish National Dementia Strategy.

    PubMed

    Hennelly, Niamh; O'Shea, Eamon

    2017-01-01

    Personhood and its realisation in person-centred care is part of the narrative, if not always the reality, of care for people with dementia. This paper examines how personhood is conceptualised and actualised in Ireland through a content analysis of organisational and individual submissions from stakeholders in the development of the Irish National Dementia Strategy, followed by an examination of the Strategy itself. The organisational submissions are further categorised into dementia care models. A structural analysis of the Strategy examines its principles, actions and outcomes in relation to personhood. Of the 72 organisational and individual submissions received in the formulation of the Strategy, 61% contained references to personhood and its synonyms. Of the 35 organisational submissions, 40% fit a biomedical model, 31% a social model and 29% a biopsychosocial model. The Strategy contains one direct reference to personhood and 33 to personhood synonyms. Half of these references were contained within its key principles and objectives; none were associated with priority actions or outcomes. While stakeholders value personhood and the Strategy identifies personhood as an overarching principle, clearer direction on how personhood and person-centred care can be supported in practice and through regulation is necessary in Ireland. The challenge, therefore, is to provide the information, knowledge, incentives and resources for personhood to take hold in dementia care in Ireland.

  2. Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems?

    PubMed

    Nakanishi, Miharu; Nakashima, Taeko

    2014-07-01

    The Ministry of Health, Labour, and Welfare of the Japanese national government announced a "Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)" in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies. An international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy. The study consisted of a bibliographical survey, a field survey, and an online case vignette survey in several countries. The Japanese health- and social-care system had multiple access points in the dementia care pathway, as did Australia, France, South Korea, and the Netherlands. Contrary to Japan, a simplified access point was observed in Denmark, England, and Sweden. The Orange Plan aimed to establish specific health-care services, social-care services, and the coordination of agencies for persons with dementia. However, fragmentation remains in the dementia care pathway. The national government should examine fundamental revisions in health, social-care services, and advocacy in joint initiatives with Alzheimer's Association Japan to improve the national dementia strategy. Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  3. National Dementia Strategy: well intentioned — but how well founded and how well directed?

    PubMed Central

    Greaves, Ian; Jolley, David

    2010-01-01

    The National Dementia Strategy was published in February 2009. It was eagerly anticipated and has generated a good deal of sustained media interest, widened awareness, and heightened expectation of better help for people with dementia. The three ambitions of the strategy — to raise awareness, facilitate assessment, and improve services — are unquestionably correct; but the assumptions, emphases, and economic predictions are questionable. Encouraging reliance on referral to secondary care centres, and exaggerated claims for the effectiveness of interventions to achieve clinical improvement and cost savings, may lead to disappointment and frustration. The infrastructure of care and treatment of people throughout the course of dementia will be better informed and delivered by a collaborative model which respects the knowledge and commitment contained within families and primary care. Better services will require substantial redirection of resources. PMID:20202364

  4. Developing a national strategy to prevent dementia: Leon Thal Symposium 2009

    PubMed Central

    Khachaturian, Zaven S.; Barnes, Deborah; Einstein, Richard; Johnson, Sterling; Lee, Virginia; Roses, Allen; Sager, Mark A.; Shankle, William R.; Snyder, Peter J.; Petersen, Ronald C.; Schellenberg, Gerard; Trojanowski, John; Aisen, Paul; Albert, Marilyn S.; Breitner, John C. S.; Buckholtz, Neil; Carrillo, Maria; Ferris, Steven; Greenberg, Barry D.; Grundman, Michael; Khachaturian, Ara S.; Kuller, Lewis H.; Lopez, Oscar L.; Maruff, Paul; Mohs, Richard C.; Morrison-Bogorad, Marcelle; Phelps, Creighton; Reiman, Eric; Sabbagh, Marwan; Sano, Mary; Schneider, Lon S.; Siemers, Eric; Tariot, Pierre; Touchon, Jacques; Vellas, Bruno; Bain, Lisa J.

    2015-01-01

    Among the major impediments to the design of clinical trials for the prevention of Alzheimer's disease (AD), the most critical is the lack of validated biomarkers, assessment tools, and algorithms that would facilitate identification of asymptomatic individuals with elevated risk who might be recruited as study volunteers. Thus, the Leon Thal Symposium 2009 (LTS'09), on October 27–28, 2009 in Las Vegas, Nevada, was convened to explore strategies to surmount the barriers in designing a multisite, comparative study to evaluate and validate various approaches for detecting and selecting asymptomatic people at risk for cognitive disorders/dementia. The deliberations of LTS'09 included presentations and reviews of different approaches (algorithms, biomarkers, or measures) for identifying asymptomatic individuals at elevated risk for AD who would be candidates for longitudinal or prevention studies. The key nested recommendations of LTS'09 included: (1) establishment of a National Database for Longitudinal Studies as a shared research core resource; (2) launch of a large collaborative study that will compare multiple screening approaches and biomarkers to determine the best method for identifying asymptomatic people at risk for AD; (3) initiation of a Global Database that extends the concept of the National Database for Longitudinal Studies for longitudinal studies beyond the United States; and (4) development of an educational campaign that will address public misconceptions about AD and promote healthy brain aging. PMID:20298968

  5. Developing a national strategy to prevent dementia: Leon Thal Symposium 2009.

    PubMed

    Khachaturian, Zaven S; Barnes, Deborah; Einstein, Richard; Johnson, Sterling; Lee, Virginia; Roses, Allen; Sager, Mark A; Shankle, William R; Snyder, Peter J; Petersen, Ronald C; Schellenberg, Gerard; Trojanowski, John; Aisen, Paul; Albert, Marilyn S; Breitner, John C S; Buckholtz, Neil; Carrillo, Maria; Ferris, Steven; Greenberg, Barry D; Grundman, Michael; Khachaturian, Ara S; Kuller, Lewis H; Lopez, Oscar L; Maruff, Paul; Mohs, Richard C; Morrison-Bogorad, Marcelle; Phelps, Creighton; Reiman, Eric; Sabbagh, Marwan; Sano, Mary; Schneider, Lon S; Siemers, Eric; Tariot, Pierre; Touchon, Jacques; Vellas, Bruno; Bain, Lisa J

    2010-03-01

    Among the major impediments to the design of clinical trials for the prevention of Alzheimer's disease (AD), the most critical is the lack of validated biomarkers, assessment tools, and algorithms that would facilitate identification of asymptomatic individuals with elevated risk who might be recruited as study volunteers. Thus, the Leon Thal Symposium 2009 (LTS'09), on October 27-28, 2009 in Las Vegas, Nevada, was convened to explore strategies to surmount the barriers in designing a multisite, comparative study to evaluate and validate various approaches for detecting and selecting asymptomatic people at risk for cognitive disorders/dementia. The deliberations of LTS'09 included presentations and reviews of different approaches (algorithms, biomarkers, or measures) for identifying asymptomatic individuals at elevated risk for AD who would be candidates for longitudinal or prevention studies. The key nested recommendations of LTS'09 included: (1) establishment of a National Database for Longitudinal Studies as a shared research core resource; (2) launch of a large collaborative study that will compare multiple screening approaches and biomarkers to determine the best method for identifying asymptomatic people at risk for AD; (3) initiation of a Global Database that extends the concept of the National Database for Longitudinal Studies for longitudinal studies beyond the United States; and (4) development of an educational campaign that will address public misconceptions about AD and promote healthy brain aging. 2010. Published by Elsevier Inc.

  6. Organisational space for partnership and sustainability: lessons from the implementation of the National Dementia Strategy for England.

    PubMed

    Clarke, Charlotte Laura; Keyes, Sarah Elizabeth; Wilkinson, Heather; Alexjuk, Joanna; Wilcockson, Jane; Robinson, Louise; Corner, Lynne; Cattan, Mima

    2014-11-01

    National policy initiatives are faced with challenges in their partnership development and sustainability. The National Dementia Strategy for England recommended Dementia Adviser (DA) and Peer Support Network (PSN) services and 40 demonstration sites were established. In this paper, we report on the national evaluation of these demonstration sites, with specific reference to aspects of organisational development. The research used a mixed-methods design with three main strands: (i) activity and outcome monitoring; (ii) organisational surveys and collaborative discussion; (iii) in-depth case studies in eight of the 40 sites. This paper focuses primarily on three rounds of organisational surveys distributed to all 40 demonstration sites over a period of 21 months and interviews in the case studies. Data identify the significance of infrastructure within immediate services as well as the position of services within the external infrastructure of the wider health and social care landscape. Partnership - both internally and externally - was key to establishing and sustaining services that flourished. When working well, DAs and PSNs acted as a link between services and people with dementia at the same time as filling gaps in existing support, providing information, advice and interpersonal support that was tailored to individual needs and circumstances. In conclusion, to achieve the full potential and sustainability of services requires them to be in an organisational space that allows them to work in partnership and collaboration with other services, and that values their distinct knowledge of their communities. © 2014 John Wiley & Sons Ltd.

  7. The Italian Dementia National Plan. Commentary.

    PubMed

    Di Fiandra, Teresa; Canevelli, Marco; Di Pucchio, Alessandra; Vanacore, Nicola

    2015-01-01

    The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

  8. [Preventive strategies for dementia].

    PubMed

    Müller, Patrick; Schmicker, Marlen; Müller, Notger G

    2017-05-01

    In the context of the demographically induced increase in the prevalence of dementia and the simultaneous lack of causal pharmacological therapies, preventive approaches are gaining in importance. By reducing risk factors and with measures which induce neuroplasticity successful aging can be supported. This article summarizes the current developments in preventing dementia by modification of life style factors. The main focus lies on the impact of cognitive and physical activity on neuroprotection. A promising approach combines both activities within a dance training program. Further studies that meet the demanding criteria of a randomized clinical trial are urgently needed.

  9. Barriers and enablers of health promotion, prevention and early intervention in primary care: evidence to inform the Australian national dementia strategy.

    PubMed

    Travers, Catherine; Martin-Khan, Melinda; Lie, David

    2009-06-01

    A comprehensive literature review was undertaken to: (i) identify and summarise the research evidence regarding barriers and enablers of health promotion, prevention and early intervention (PPEI) in primary care to reduce the risk of chronic disease in the older population; and (ii) use this evidence to make recommendations to inform the Australian national dementia prevention strategy around the translation of evidence-based care into practice. PPEI activities in primary care have the potential to not only reduce the prevalence and impact of a number of chronic diseases, but may also prevent or slow the onset of dementia given the apparent overlap in risk factors. While sizeable gaps exist regarding the most effective ways to promote the adoption of these activities, limited evidence suggests that, to be effective, PPEI activities should be quick and easy to administer, have a sound rationale and be readily incorporated into existing work processes.

  10. Communication Strategies to Assist Comprehension in Dementia

    PubMed Central

    2010-01-01

    Communication with individuals with dementia requires use of conversational strategies from health care providers. Strategies are provided for issues pertaining to poor comprehension. The strategies promote more successful comprehension and compliance, offset mood disorder, and create ease in the way that health information may be accepted by the patient. PMID:20397508

  11. Promising strategies for the prevention of dementia.

    PubMed

    Middleton, Laura E; Yaffe, Kristine

    2009-10-01

    The incidence and prevalence of dementia are expected to increase several-fold in the coming decades. Given that the current pharmaceutical treatment of dementia can only modestly improve symptoms, risk factor modification remains the cornerstone for dementia prevention. Some of the most promising strategies for the prevention of dementia include vascular risk factor control, cognitive activity, physical activity, social engagement, diet, and recognition of depression. In observational studies, vascular risk factors-including diabetes, hypertension, dyslipidemia, and obesity-are fairly consistently associated with increased risk of dementia. In addition, people with depression are at high risk for cognitive impairment. Population studies have reported that intake of antioxidants or polyunsaturated fatty acids may be associated with a reduced incidence of dementia, and it has been reported that people who are cognitively, socially, and physically active have a reduced risk of cognitive impairment. However, results from randomized trials of risk factor modification have been mixed. Most promising, interventions of cognitive and physical activity improve cognitive performance and slow cognitive decline. Future studies should continue to examine the implication of risk factor modification in controlled trials, with particular focus on whether several simultaneous interventions may have additive or multiplicative effects.

  12. Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period.

    PubMed

    Szczepura, Ala; Wild, Deidre; Khan, Amir J; Owen, David W; Palmer, Thomas; Muhammad, Tariq; Clark, Michael D; Bowman, Clive

    2016-09-20

    To assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. Retrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated. No statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices). The NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear standards specifying recommended agents, dosages and length of treatment, together with routine

  13. Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period

    PubMed Central

    Szczepura, Ala; Owen, David W; Palmer, Thomas; Muhammad, Tariq; Clark, Michael D

    2016-01-01

    Objectives To assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. Setting and participants Retrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. Primary and secondary outcome measures Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated. Results No statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices). Conclusions The NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear

  14. Articulating the strategies for maximising the inclusion of people with dementia in qualitative research studies.

    PubMed

    Murphy, Kathy; Jordan, Fionnuala; Hunter, Andrew; Cooney, Adeline; Casey, Dympna

    2015-11-01

    It is essential to understand the experience of living with dementia from the perspective of the person with dementia so that services can be appropriately constructed. This review paper, drawing on prior work, identifies key strategies for the meaningful inclusion of persons with dementia within qualitative research studies, it examines the articulation of these strategies and shares how these strategies were operationalised within one national research study in Ireland. Strategies within the literature were categorised and then synthesized into a guide consisting of four main areas; gaining COnsent, maximizing Responses, Telling the story, and Ending on a high (CORTE). The CORTE guideline was used to as a tool for analysing relevant research reports. CORTE is a synthesized account of grouped strategies that could be used to maximize the meaningful involvement of persons with dementia and can also provide a guide for reporting the strategies used so that researchers can learn from each other.

  15. Diagnostic rates and treatment of dementia before and after launch of a national dementia policy: an observational study using English national databases.

    PubMed

    Mukadam, Naaheed; Livingston, Gill; Rantell, Khadija; Rickman, Sam

    2014-01-09

    To assess the 2009 National Dementia Strategy's (NDS) impact on dementia diagnosis and treatment. Primary care data for England before and after launch of the NDS. We used nationally available data to estimate the trends over time in rates of dementia diagnoses recorded on the Quality Outcomes Framework (QOF) in Primary Care Trusts (PCT) and antidementia medication prescriptions from 2006/2007 (the first available figures) and the associated increase in cost relative to all other prescriptions. To establish PCT general practitioner (GP) QOF dementia recording validity, we correlated it with medication prescription using the NIC (net ingredient cost). Regression analysis showed that dementia diagnosis rate was lower prior to launch of the NDS and increased significantly after it was launched. The number of antidementia prescriptions and the cost of antidementia drugs relative to total PCT prescribing costs increased significantly after 2009. GP recording of dementia diagnosis correlated highly with prescription of cholinesterase inhibitors and memantine in the same area (p<0.001 each year). The launch of the NDS was associated with a significant increase in dementia diagnosis rates and prescriptions of antidementia drugs. We cannot establish the causality but this was a change from the prelaunch pattern. Further assessment of any intervention to increase the diagnoses should include an assessment of harm as well as potential benefit.

  16. Strategies for feeding patients with dementia.

    PubMed

    Chang, Chia-Chi; Roberts, Beverly L

    2011-04-01

    Despite the high prevalence of dementia among elderly patients in hospitals and nursing homes and the strong association between dementia and feeding difficulty, few sources adequately address effective feeding interventions. Basing their discussion on the conceptual model that grew out of a previously published systematic literature review, the authors address a wide range of assessment and intervention practices specific to various observed behaviors that may aid in feeding patients with dementia.

  17. Between practice, policy and politics: Music therapy and the Dementia Strategy, 2009.

    PubMed

    Spiro, Neta; Farrant, Camilla L; Pavlicevic, Mercédès

    2017-04-01

    Does current music therapy practice address the goals encapsulated in the UK Department of Health document, Living well with dementia: a national dementia strategy (the Dementia Strategy) published in 2009? A survey elicited the views of clients, family members, music therapists, care home staff and care home managers, about this question by focusing on the relationship between music therapy and the 17 objectives outlined in the Dementia Strategy. The results showed that the objectives that are related to direct activity of the music therapists (such as care and understanding of the condition) were seen as most fulfilled by music therapy, while those regarding practicalities (such as living within the community) were seen as least fulfilled. Although the responses from the four groups of participants were similar, differences for some questions suggest that people's direct experience of music therapy influences their views. This study suggests that many aspects of the Dementia Strategy are already seen as being achieved. The findings suggest that developments of both music therapy practices and government strategies on dementia care may benefit from being mutually informed.

  18. International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans.

    PubMed

    Watchman, Karen; Janicki, Matthew P; Splaine, Michael; Larsen, Frode K; Gomiero, Tiziano; Lucchino, Ronald

    2017-06-01

    The World Health Organization (WHO) has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down's syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia, held in Scotland, reviewed the inclusion of ID in national plans and recommended that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes, and greater advocacy is required from national organizations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia.

  19. Strategies for molecular imaging dementia and neurodegenerative diseases

    PubMed Central

    Schaller, Bernhard J

    2008-01-01

    Dementia represents a heterogeneous term that has evolved to describe the behavioral syndromes associated with a variety of clinical and neuropathological changes during continuing degenerative disease of the brain. As such, there lacks a clear consensus regarding the neuropsychological and other constituent characteristics associated with various cerebrovascular changes in this disease process. But increasing this knowledge has given more insights into memory deterioration in patients suffering from Alzheimer’s disease and other subtypes of dementia. The author reviews current knowledge of the physiological coupling between cerebral blood flow and metabolism in the light of state-of-the-art-imaging methods and its changes in dementia with special reference to Alzheimer’s disease. Different imaging techniques are discussed with respect to their visualizing effect of biochemical, cellular, and/or structural changes in dementia. The pathophysiology of dementia in advanced age is becoming increasingly understood by revealing the underlying basis of neuropsychological changes with current imaging techniques, genetic and pathological features, which suggests that alterations of (neuro) vascular regulatory mechanisms may lead to brain dysfunction and disease. The current view is that cerebrovascular deregulation is seen as a contributor to cerebrovascular pathologies, such as stroke, but also to neurodegenerative conditions, such as Alzheimer’s disease. The better understanding of these (patho) physiological mechanisms may open an approach to new interventional strategies in dementia to enhance neurovascular repair and to protect neurovascular coupling. PMID:18830391

  20. Problem-Solving Strategies in Dementia Patient-Caregiver Dyads.

    ERIC Educational Resources Information Center

    Cavanaugh, John C.; And Others

    1989-01-01

    Examined applicability of scaffolding and zone of proximal development to the study of dementia. Compared caregiver-patient dyads (n=29) to normal elderly dyads (n=16) in terms of strategies used in completing the Block Design subtest of the Wechsler Adult Intelligence Scale-Revised. Results indicated that caregiver-patient dyads can be observed…

  1. Management strategies for problem behaviors in the patient with dementia.

    PubMed

    Lehninger, F W; Ravindran, V L; Stewart, J T

    1998-04-01

    Psychiatric and behavioral problems are present in most patients with dementia and are usually the clinician's main focus of management. Differential diagnosis of these problems can be challenging, but the effort is essential for planning appropriate therapy. Pharmacologic interventions are available for treatment of depression, agitation, aggression, psychotic symptoms, wandering, and sleep disorders. Given the less than favorable risk-benefit ratio of most psychotropic drugs in the population of older patients with dementia, the importance of nonpharmacologic strategies and limiting treatment goals should not be overlooked.

  2. National Port Strategy Assessment

    EPA Pesticide Factsheets

    The assessment finds that air pollution at the Nation's ports can be significantly reduced by implementing currently available strategies and technologies to reduce emissions of harmful pollutants from diesel vehicles and engines.

  3. Public knowledge and beliefs about dementia risk reduction: a national survey of Australians

    PubMed Central

    2014-01-01

    Background With the dramatically increasing contribution of Alzheimer’s Disease and other forms of dementia to the global burden of disease, countries are being urged to address this as a public health priority. This study investigated whether Australian adults recognise this as an important health issue, and hold beliefs and knowledge that are consistent with recommendations concerning dementia risk reduction. This research was undertaken to guide national brain health awareness and education strategies. Methods A cross-sectional telephone survey was undertaken of 1,003 Australians aged 20–75 years. This measured the importance placed on dementia, beliefs and confidence related to risk reduction, knowledge of risk reduction methods, and the perceived age-relevance of these. In analysis the data were stratified by sex, age, educational attainment, household income, language preference and previous exposure to dementia. Multivariable logistic regression was undertaken to identify variables independently associated with beliefs and knowledge. Results People aged 60 years and over identified dementia as very important (17.2%) more often than those aged 40–59 years (5.1%) or 20–39 years (2.1%). While 41.5% of respondents believed the risk of dementia could be reduced, 26.9% were very confident that they could achieve this. Mental activity (57.1%) was identified as beneficial much more often than physical activity (31.3%), healthy eating (23.3%) and other cardiovascular health behaviours. Women, people of English-speaking origin, and those having contact with a person with dementia, showed better knowledge of several health behaviours. Conclusions Growing attention is being given to population risk reduction to combat the dramatic increase in the burden of disease due to dementia. In Australia many people do not yet hold beliefs and knowledge that support this, which highlights the need for concerted awareness raising that dementia is not an inevitable aspect

  4. Comprehensive national energy strategy

    SciTech Connect

    1998-04-01

    This Comprehensive National Energy Strategy sets forth a set of five common sense goals for national energy policy: (1) improve the efficiency of the energy system, (2) ensure against energy disruptions, (3) promote energy production and use in ways that respect health and environmental values, (4) expand future energy choices, and (5) cooperate internationally on global issues. These goals are further elaborated by a series of objectives and strategies to illustrate how the goals will be achieved. Taken together, the goals, objectives, and strategies form a blueprint for the specific programs, projects, initiatives, investments, and other actions that will be developed and undertaken by the Federal Government, with significant emphasis on the importance of the scientific and technological advancements that will allow implementation of this Comprehensive National Energy Strategy. Moreover, the statutory requirement of regular submissions of national energy policy plans ensures that this framework can be modified to reflect evolving conditions, such as better knowledge of our surroundings, changes in energy markets, and advances in technology. This Strategy, then, should be thought of as a living document. Finally, this plan benefited from the comments and suggestions of numerous individuals and organizations, both inside and outside of government. The Summary of Public Comments, located at the end of this document, describes the public participation process and summarizes the comments that were received. 8 figs.

  5. Dementia

    MedlinePlus

    ... skills) Dementia usually first appears as forgetfulness. Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems ...

  6. Strategies for dementia prevention: latest evidence and implications

    PubMed Central

    Rakesh, Gopalkumar; Szabo, Steven T.; Alexopoulos, George S.; Zannas, Anthony S.

    2017-01-01

    Dementia is a common and debilitating syndrome with enormous impact on individuals and societies. Preventing disease onset or progression would translate to public health and societal benefits. In this review, we discuss the latest evidence on interventions that may show promise for the prevention of cognitive decline. We appraise existing evidence primarily drawn from randomized controlled trials, systematic reviews, and meta-analyses, but also highlight observational studies in humans and relevant work in model organisms. Overall, there is currently limited evidence to support a cause–effect relationship between any preventive strategy and the development or progression of dementia. However, studies to date suggest that a multifactorial intervention comprising regular exercise and healthy diet, along with the amelioration of vascular risk factors, psychosocial stress, and major depressive episodes may be most promising for the prevention of cognitive decline. We discuss the challenges, future directions, and implications of this line of research. PMID:28815009

  7. Strategies for dementia prevention: latest evidence and implications.

    PubMed

    Rakesh, Gopalkumar; Szabo, Steven T; Alexopoulos, George S; Zannas, Anthony S

    2017-08-01

    Dementia is a common and debilitating syndrome with enormous impact on individuals and societies. Preventing disease onset or progression would translate to public health and societal benefits. In this review, we discuss the latest evidence on interventions that may show promise for the prevention of cognitive decline. We appraise existing evidence primarily drawn from randomized controlled trials, systematic reviews, and meta-analyses, but also highlight observational studies in humans and relevant work in model organisms. Overall, there is currently limited evidence to support a cause-effect relationship between any preventive strategy and the development or progression of dementia. However, studies to date suggest that a multifactorial intervention comprising regular exercise and healthy diet, along with the amelioration of vascular risk factors, psychosocial stress, and major depressive episodes may be most promising for the prevention of cognitive decline. We discuss the challenges, future directions, and implications of this line of research.

  8. Dementia

    MedlinePlus

    ... dementia have serious problems with two or more brain functions, such as memory and language. Although dementia is common in very elderly people, it is not part of normal aging. Many different diseases ... dementia or repair brain damage, they may improve symptoms or slow down ...

  9. National Youth Development Strategy.

    ERIC Educational Resources Information Center

    Ministerial Council on Education, Employment, Training and Youth Affairs, Carlton South (Australia).

    In April 1999, the Australian Ministerial Council on Education, Employment, Training, and Youth Affairs established a subgroup to develop a national youth development strategy. Youth development is about helping young people make the transition to happy, productive, and successful adulthood through the guided provision of opportunities to try new…

  10. Dementia Management Strategies and Adjustment of Family Members of Older Patients.

    ERIC Educational Resources Information Center

    Hinrichsen, Gregory A.; Niederehe, George

    1994-01-01

    Examined how strategies to manage dementia problems in 152 older people were associated with adjustment of family members while providing assistance to relative. Identified three dementia management strategies (criticism, encouragement, and active management) that were associated with three indices of family members' emotional adjustment (burden,…

  11. Dementia-friendly communities: challenges and strategies for achieving stakeholder involvement.

    PubMed

    Heward, Michelle; Innes, Anthea; Cutler, Clare; Hambidge, Sarah

    2017-05-01

    Dementia-friendly communities (DFCs) are a UK policy initiative that aims to enable people with dementia to feel supported and included within their local community. Current approaches to DFC creation rely on stakeholder involvement, often requiring volunteer assistance. There is though a lack of evidence that examines the reality of achieving this. This paper critically assesses the challenges and strategies for achieving stakeholder involvement in DFCs. The evidence base is drawn from an inter-agency project funded by the National Health Service in the South of England where seven DFCs were developed by steering group partners and four part-time project workers (PWs). Data from the independent evaluation undertaken in the first year (2013-2014) of the project were analysed: 14 semi-structured interviews and a focus group examined PWs' experiences; while progress and key milestones are determined from monthly progress forms, good news stories, locality steering group minutes and press releases. Analysis was undertaken using a directed content analysis method, whereby data content for each locality was matched to the analytical framework that was drawn from Alzheimer's Society guidance. Challenges to achieving stakeholder involvement were identified as: establishing networks and including people representative of the local community; involving people affected by dementia; and gaining commitment from organisations. Strategies for achieving stakeholder involvement were recognised as: a sustainable approach; spreading the word; and sharing of ideas. By highlighting these challenges and the approaches that have been used within communities to overcome them, these findings form the foundation for the creation of DFC initiatives that will become embedded within communities. Stakeholder involvement is unpredictable and changeable; therefore, reliance on this approach questions the long-term sustainability of DFCs, and must be considered in future policies designed to

  12. Younger adults with dementia: a strategy to promote awareness and transform perceptions.

    PubMed

    Chaston, Denise

    2010-01-01

    Within modern society, dementia is considered to be an older person's disease yet people younger than 65 years are also diagnosed with this condition. This article describes dementia in the younger person highlighting their experiences and those of their families, along with nurses' attitudes towards and perceptions of this client group. A strategy is proposed to positively influence and enhance the attitudes of health professionals ultimately enhancing the quality of life for younger people with dementia.

  13. Death of Dementia Patients in Psychiatric Hospitals and Regional Supply of Psychiatric Services: Study of the National Data from 1996 to 2014 in Japan.

    PubMed

    Nakanishi, Miharu; Niimura, Junko; Yamasaki, Syudo; Nishida, Atsushi

    2017-01-01

    Japan designates psychiatric inpatient care for behavior management of individuals with dementia and for helping dementia patients discharge to home. However, there has been no examination of the effectiveness of this strategy. The present study investigated the association between dementia and the discharge destination of patients in psychiatric hospitals. Data from the National Patient Survey, which is a nationally representative cross-sectional survey of inpatient care, were used. The 96,420 patients with dementia or other mental illness who were discharged from psychiatric hospitals in September of every 3 years from 1996 to 2014 were included in analyses. Of the 96,420 discharged patients, 13,823 had dementia as the primary disease. Of the 13,823 dementia patients, 3,865 (28.0%) were discharged to home, 3,870 (28.0%) were admitted to a facility or other care settings, 3,574 (25.9%) were admitted to another hospital, and 2,514 (18.2%) died. Patients were more likely to die in psychiatric hospital if their primary disease was dementia, and they had resided in a region that provided fewer home visits for psychiatric nursing care or had available a larger number of psychiatric hospital beds per capita. Psychiatric inpatient care may be ineffective as a treatment for the challenging behaviors of dementia. A community mental health system for behavior management should be constructed in parallel with a reduction in the number of hospital beds allotted for psychiatric care.

  14. Prevalence of Dementia and Associated Factors among Older Adults in Iran: National Elderly Health Survey (NEHS).

    PubMed

    Sharifi, Farshad; Fakhrzadeh, Hossein; Varmaghani, Mehdi; Arzaghi, Seyed Masoud; Alizadeh Khoei, Mahtab; Farzadfar, Farshad; Taheri Tanjani, Parisa

    2016-12-01

    The prevalence of cognitive impairment and dementia is increasing in Iran and the world. There is no study available on the prevalence of dementia at the national level in Iran. This study aimed to report the rate of dementia at the national level in Iran. The National Elderly Health Survey (NEHS) was a cross-sectional study with multistage cluster random sampling on people aged ≥ 60 years in Iran. Dementia was diagnosed by trained general practitioners using Brief Cognitive Assessment Tool (BCAT). In this study, the dementia diagnosis rate was considered as the ratio of individuals previously diagnosed with dementia to individuals considered as dementia. Analyses were carried out using survey analysis method. The provincial rates were standardized based on the Iranian population in 2011 and the national rate was standardized based on WHO standard populations. Association between risk factors and dementia was assessed using a multivariable logistic regression model. The overall crude prevalence of dementia among people aged ≥ 60 years was 7.9% (8.7% in women and 6.9% in men) and age standardized dementia prevalence rate in Iran based on WHO standard population was 8.1% (9.6% in women and 6.5% in men). The prevalence of dementia was observed as 3.7% among people aged 60-64 years, 6.2% in the age-group 65-69 years, 10.4% in the age-group 70-74 years, 14.4% in the age-group 75-79 years, and 13.0% in the age-group ≥ 80 years. West Azerbaijan had the lowest and North Khorasan had the highest age-sex adjusted prevalence rate of dementia. Our results indicated that only 21.2% of subjects with dementia were diagnosed. We observed that diabetes mellitus, depressed mood, illiteracy, and increased age were associated with dementia. It seems that dementia is more common in Iran than many other countries. However, the rate of dementia diagnosis is much lower than that in developed countries.

  15. The effectiveness of control strategies for dementia-driven wandering, preventing escape attempts: a case report.

    PubMed

    Padilla, Daniel Valle; González, María Teresa Daza; Agis, Inmaculada Fernández; Strizzi, Jenna; Rodríguez, Raquel Alarcón

    2013-03-01

    One of the most complicated aspects of caring for patients with dementia is dementia-driven wandering due to its adverse ramifications. We report a case of an 80-year-old man who had been previously diagnosed with dementia (with a score of 6 on the Reisberg Global Deterioration Scale - GDS). The patient went to an Adult Day Care Center on a daily basis where he demonstrated wandering behavior with a high rate of escape attempts (the number of times the Center's glass exit door was approached). The objective of this study is to present effective non-pharmacological intervention strategies for dementia-driven wandering; assessed strategies included: environmental (subjective barriers), cognitive/behavioral (cognitive training with differential reinforcement), and combined (subjective barriers + cognitive/behavioral). The results showed that all of these three strategies significantly decreased the number of escape attempts.

  16. National Drug Control Strategy.

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, Washington, DC.

    This report presents a comprehensive blueprint for new direction and effort in the national fight against illegal drug use. It is the result of an intensive review of federal anti-drug efforts to date and incorporates advice and recommendations from hundreds of interested and involved anti-drug leaders outside the federal government. The…

  17. National Strategy for Aviation Security

    DTIC Science & Technology

    2007-03-26

    for Aviation Security (hereafter referred to as the Strategy") to protect the Nation and its interests from threats in the Air Domain. The Secretary of... Aviation security is best achieved by integrating public and private aviation security global activities into a coordinated effort to detect, deter...might occur. The Strategy aligns Federal government aviation security programs and initiatives into a comprehensive and cohesive national effort

  18. Dementia

    MedlinePlus

    ... Hospitalization and Palliative Care Friends & Family Dating and Marriage Family Planning Mixed-Status Couples Discrimination Legal Issues ... National HIV/AIDS and Aging Awareness Day National Gay Men's HIV/AIDS Awareness Day National Latinx AIDS ...

  19. National Drug Control Strategy. Update

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, 2005

    2005-01-01

    The first National Drug Control Strategy set ambitious two and five-year performance based goals: (1) to lower the rate of drug use by 10 percent over 2 years among both youth and adults; and (2) to lower the rate by 25 percent over 5 years. The chapters in this updated version are keyed to the strategies three priorities: (1) Stopping Use Before…

  20. National Drug Control Strategy, 2011

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, 2011

    2011-01-01

    In May of 2010, President Obama released the Administration's inaugural "National Drug Control Strategy". Based on the premise that drug use and its consequences pose a threat not just to public safety, but also to public health, the 2010 "Strategy" represented the first comprehensive rebalancing of Federal drug control policy in the nearly 40…

  1. Technological Strategies and National Purpose

    ERIC Educational Resources Information Center

    Gilpin, Robert

    1970-01-01

    Discusses the international and domestic implications of technological growth. Defines three basic national strategies: a broad front approach, scientific and technological specialization and importation. Analyzes the strategies followed by form countries - France, the United States, Sweden, and Japan- to illustrate the alternatives and the…

  2. Technological Strategies and National Purpose

    ERIC Educational Resources Information Center

    Gilpin, Robert

    1970-01-01

    Discusses the international and domestic implications of technological growth. Defines three basic national strategies: a broad front approach, scientific and technological specialization and importation. Analyzes the strategies followed by form countries - France, the United States, Sweden, and Japan- to illustrate the alternatives and the…

  3. National Drug Control Strategy. Update.

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, Washington, DC.

    President Bush's new National Drug Control Strategy for 2003 focuses on three core priorities: stopping drug use before it starts; healing America's drug users; and disrupting the market. The 2003 strategy reports progress toward meeting the President's goals of reducing drug use by 10 percent over 2 years, and 25 percent over 5 years. With regard…

  4. Pure National Security Strategy

    DTIC Science & Technology

    2011-06-01

    the United States and the Soviet Union during end of the 1940’s up to the 1960’s. It stabilized in the later 1960’s and was present in its most acute...filled a gap in the United States and substituted demonstrated resolve, which deterrence previously depended on. Thus, with game theory, strategy...communication technologies empower other types of actors. 11 Her estimation and the fact that states are the main developers and consumers of grand

  5. Hypertensive disorders in pregnancy and later dementia: a Swedish National Register Study.

    PubMed

    Andolf, Ellika G; Sydsjö, Gunilla C M; Bladh, Marie K; Berg, Goran; Sharma, Surendra

    2017-04-01

    Our aim was to investigate the rate of vascular dementia and dementia in women with previous hypertensive disorders in pregnancy, since white matter lesions of the brain and cardiovascular disease are linked both to dementia and hypertensive disorders in pregnancy. Prospective population-based registry study on all women giving birth in Sweden between 1973 and 1975 (284 598). Women with and without hypertensive disorders in pregnancy were identified by means of the Swedish Medical Birth Register and linked to the National Patient Register, where data on somatic disease later in life were obtained. International classification of disease was used. The Cox proportional hazard model was used to calculate hazard ratios for both groups and adjusted for possible confounders. Main outcome measures were in-hospital diagnosis of cardiovascular disease, vascular dementia and dementia. No increased risks were seen for vascular dementia or dementia after any hypertensive disorders in pregnancy. If broken down in specific diagnoses for hypertensive disease in pregnancy, adjusted risks for vascular dementia after hypertension and proteinuria during pregnancy the hazard ratio was 6.27 (95% CI 1.65-27.44). Higher risks for cardiovascular disease were confirmed. Because of the very low absolute risk, the wide confidence interval and risk of misclassification, our results on vascular dementia could be questioned. Considering the pathophysiology of preeclampsia, the findings of brain lesions and the increased risk for cardiovascular disease, the possibly increased risk for all kinds of dementia must be investigated in larger and more well-defined cohorts. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Strategies for sustaining self used by family caregivers for older adults with dementia.

    PubMed

    Bull, Margaret J

    2014-06-01

    The negative health consequences of caring for an older adult family member with dementia are well documented. However, not all family caregivers experience these negative health consequences. The purposes of this study were to describe strategies family caregivers use to help them continue to provide care for an older family member with dementia despite challenges and describe these family caregivers' resilience and psychological distress. A mixed methods design was used with a narrative approach dominant and standardized scales for resilience and psychological distress used to enhance the description of the sample. Data were collected through telephone interviews with 18 family caregivers residing in an urban area. The findings indicate that family caregivers used four strategies to sustain the self: drawing on past life experiences, nourishing the self, relying on spirituality, and seeking information about dementia. Understanding strategies used by family caregivers to sustain themselves is essential for providing holistic nursing care and developing effective interventions.

  7. Testing the psychometric properties of a Chinese version of Dementia Management Strategies Scale

    PubMed Central

    Chien, Wai Tong

    2015-01-01

    Caregiving stress and burden are universal phenomena among family caregivers of people with dementia. Family caregivers who adopted adaptive management strategies in dementia care could alleviate their own distress and the progression of neuropsychiatric symptoms in people with dementia. An understanding about the management strategies used by these caregivers in caring for their relatives with dementia would be crucial to family services in dementia care. This study aimed to validate a Chinese version of Dementia Management Strategies Scale (DMSS) in family caregivers of Hong Kong Chinese people with dementia. Face and content validity, semantic equivalence, and test–retest reliability of the translated Chinese version of 34-item DMSS were examined. A random sample of 211 family caregivers and their relatives with dementia were then recruited to identify the factor structure of the Chinese version by exploratory factor analysis followed by varimax rotation and assess its internal consistency. Reproductibility and responsiveness of the scale to changes in neuropsychiatric symptoms were also examined over a 6-month interval. Results indicated that the Chinese version of DMSS indicated very satisfactory content validity, semantic equivalence with the original English version, and test–retest reliability. Factor analysis showed that 32 items of the Chinese version had substantial loadings on one of the three identified factors (“Criticism toward older relative”, “Showing encouragement”, and “Active management strategies”), explaining 72.4% of the total variance. The three-factor Chinese version also indicated good internal consistency of its three subscales (Cronbach’s α=0.86–0.90) and satisfactory reproducibility over 6 months (intraclass correlation coefficients =0.85–0.89). Furthermore, the Chinese version demonstrated moderate effect sizes for detecting changes in symptom severity of dementia (Cohen’s d=0.50–0.60). This study provides

  8. Enabling resources in people with dementia: a qualitative study about nurses' strategies that may support a sense of coherence in people with dementia.

    PubMed

    Lillekroken, Daniela; Hauge, Solveig; Slettebø, Åshild

    2015-11-01

    To explore nurses' strategies that may support the sense of coherence in people with dementia. People with dementia are often described as people with no resources, people who need support from family or from healthcare personnel to function in everyday life. Despite the disease, some people still have the resources needed to cope well with parts of their lives and experience coherence. To date, no research has explored any nurses' strategies that may support the sense of coherence in people with dementia. The design of the study is qualitative and exploratory. Data were collected by participant observation and focus group interviews. Sixteen registered nurses from two different Norwegian nursing homes were recruited and participated in the study. Qualitative content analysis was used to analyse the data. The empirical material consisted of field notes from participant observation and transcripts from focus group interviews. Three generic categories were identified as strategies that may support sense of coherence in people with dementia: 'Finding and nurturing the individual's resources', 'Customising meaningful activities' and 'Finding creative solutions'. These categories were identified as strategies that may support and possibly enhance the sense of coherence in people with dementia. The findings provide an empirical base for assuming that with support and help from nurses, people with dementia may experience and strengthen their sense of coherence, therefore, the nurses need to be aware of the activities that may support and possibly enhance the sense of coherence in people with dementia. Despite the contextual limitations, this study highlights the need to identify and nurture resources in people with dementia, thus supporting their sense of coherence. The findings may contribute in enhancing the quality of care for people with dementia. © 2015 John Wiley & Sons Ltd.

  9. Acute hospital dementia care: results from a national audit.

    PubMed

    Timmons, Suzanne; O'Shea, Emma; O'Neill, Desmond; Gallagher, Paul; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean

    2016-05-31

    Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Dementia care relating to assessment, access to certain specialist services

  10. Age-related hearing loss and dementia: a 10-year national population-based study.

    PubMed

    Su, Peijen; Hsu, Chih-Chao; Lin, Hung-Ching; Huang, Wei-Shin; Yang, Tsung-Lin; Hsu, Wei-Ting; Lin, Cheng-Li; Hsu, Chung-Yi; Chang, Kuang-Hsi; Hsu, Yi-Chao

    2017-05-01

    Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate the relationship between ARHL and the prevalence, and 10-year incidence of dementia in the Taiwan National Health Insurance Research Database (NHIRD). We selected patients diagnosed with ARHL from the NHIRD. A comparison cohort comprising of patients without ARHL was frequency-matched by age, sex, and co-morbidities, and the occurrence of dementia was evaluated in both cohorts. The ARHL cohort consisted of 4108 patients with ARHL and the control cohort consisted of 4013 frequency-matched patients without ARHL. The incidence of dementia [hazard ratio (HR), 1.30; 95% confidence interval (CI 1.14-1.49); P = 0.002] was higher among ARHL patients. Cox models showed that being female (HR, 1.34; 95% CI 1.07-1.68), as well as having co-morbidities, including chronic liver disease and cirrhosis, rheumatoid arthritis, hypertension, diabetes mellitus, stroke, head injury, chronic kidney disease, coronary artery disease, alcohol abuse/dependence, and tobacco abuse/dependence (HR, 1.27; 95% CI 1.11-1.45), were independent risk factors for dementia in ARHL patients. We found ARHL may be one of the early characteristics of dementia, and patients with hearing loss were at a higher risk of subsequent dementia. Clinicians should be more sensitive to dementia symptoms within the first 2 years following ARHL diagnosis. Further clinical studies of the relationship between dementia and ARHL may be necessary.

  11. National Drug Control Strategy, 2006

    ERIC Educational Resources Information Center

    The White House, 2006

    2006-01-01

    This report presents a summary of the Fiscal Year 2007 Budget for the National Drug Control Strategy within the three key priority areas; education and community action, treatment and intervention, and disruption in the illegal drug market. The first chapter, "Stopping Drug Use Before It Starts," outlines the Administration's work to prevent the…

  12. Preserving personhood: The strategies of men negotiating the experience of dementia.

    PubMed

    Tolhurst, Edward; Weicht, Bernhard

    2017-01-01

    An understanding of dementia requires sensitivity to the complex breadth of factors that comprise the person's experiential and social context. This is necessary to ensure that academic and public perspectives on dementia are not subsumed under homogenising discourses that prioritise the neurodegenerative basis of the condition. Gender is one such factor of this 'social location' that must be acknowledged. Cultural standards of masculinity have particular impacts upon men with the condition, thus generating distinctive challenges. This article draws upon qualitative research that included joint interviews with 14 men with dementia and their carers. The analytical focus is on the perspectives of the men with dementia and the strategies with which they respond to the condition. These perspectives are organised via four themes: remaining unmoved, fighting back, emphasising social contributions, and redefining services. This enables exploration of how men adopt particular strategies to preserve their own personhood, which include equable resilience, but also more agential measures to counter the influence of the condition. It is concluded that an approach to dementia research that is more sensitive to masculine-gendered experience is required so that the experience of men with the condition can be conveyed more cogently.

  13. Coping strategies and caregiving outcomes among rural dementia caregivers.

    PubMed

    Sun, Fei; Kosberg, Jordan I; Kaufman, Allan V; Leeper, James D

    2010-08-01

    We studied the coping styles by which family caregivers living in rural areas of Alabama deal with the demands of caring for an older relative with dementia. Data were obtained from a sample of 141 caregivers through the random-digit dialing telephone survey. Two coping styles were identified: deliberate coping and avoidance coping. Deliberate coping was related to higher life satisfaction scores and, avoidance coping was related to lower life satisfaction scores and higher caregiver burden scores. Avoidance coping appeared to moderate the effects of caregiver health on caregiver burden. Social workers should pay greater attention to caregivers with dysfunctional coping styles.

  14. Adapting to conversation with semantic dementia: using enactment as a compensatory strategy in everyday social interaction

    PubMed Central

    Kindell, Jacqueline; Sage, Karen; Keady, John; Wilkinson, Ray

    2014-01-01

    Background Studies to date in semantic dementia have examined communication in clinical or experimental settings. There is a paucity of research describing the everyday interactional skills and difficulties seen in this condition. Aims To examine the everyday conversation, at home, of an individual with semantic dementia. Methods & Procedures A 71-year-old man with semantic dementia and his wife were given a video camera and asked to record natural conversation in the home situation with no researcher present. Recordings were also made in the home environment, with the individual with semantic dementia in conversation with a member of the research team. Conversation analysis was used to transcribe and analyse the data. Recurring features were noted to identify conversational patterns. Outcomes & Results Analysis demonstrated a repeated practice by the speaker with semantic dementia of acting out a diversity of scenes (enactment). As such, the speaker regularly used direct reported speech along with paralinguistic features (such as pitch and loudness) and non-vocal communication (such as body posture, pointing and facial expression) as an adaptive strategy to communicate with others in conversation. Conclusions & Implications This case shows that while severe difficulties may be present on neuropsychological assessment, relatively effective communicative strategies may be evident in conversation. A repeated practice of enactment in conversation allowed this individual to act out, or perform what he wanted to say, allowing him to generate a greater level of meaningful communication than his limited vocabulary alone could achieve through describing the events concerned. Such spontaneously acquired adaptive strategies require further attention in both research and clinical settings in semantic dementia and analysis of interaction in this condition, using conversation analysis, may be helpful. PMID:24033649

  15. The Lay Public's Understanding and Perception of Dementia in a Developed Asian Nation

    PubMed Central

    Tan, Wai Jia; Hong, Song-Iee; Luo, Nan; Lo, Tong Jen; Yap, Philip

    2012-01-01

    Background Early detection of dementia aims to improve treatment outcomes. However, poor perception and understanding of dementia are significant barriers. We aim to investigate the public's perception of dementia and identify variables associated with the different profiles of public perception. Methods A custom-designed questionnaire was used to assess laypersons’ knowledge and perception of dementia during a health fair at a public hospital in Singapore, a developed Asian nation. Out of a sample of 370 subjects, 32 declined to participate (response rate = 91.4%). Latent class analysis (LCA) was used to identify meaningful subgroups of subjects from significant associations with multiple indicators of dementia awareness. Multinomial logistic regression was performed exploring variables associated with each of the subgroups derived from LCA. Results The majority of the study participants were female (66.9%), 65 years or older (71.1%), and ethnic Chinese (88.1%). LCA classified the study participants into 3 subgroups: Class 1 (good knowledge, good attitude), Class 2 (good knowledge, poor attitude), and Class 3 (poor knowledge, poor attitude), in proportions of 14.28, 63.83, and 21.88%, respectively. Compared to other classes, participants with good knowledge and good attitude towards dementia (Class 1) were more likely to know someone with dementia and understand the effects of the disease, be married, live in private housing, receive higher monthly income, and not profess belief in Buddhism, Taoism, or Hinduism. Conclusion Our results show that the public in Singapore may not be ready for screening initiatives and early dementia diagnosis. Education efforts should be targeted at lower socioeconomic groups, singles, and those of certain oriental religions. PMID:23139688

  16. 2007 National Money Laundering Strategy

    DTIC Science & Technology

    2007-03-16

    National Money Laundering Strategy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER...based inter- agency cooperation. More than a dozen Federal agen- cies, bureaus, and offices participated in these projects , each with a unique...of bulk cash smuggling along the Northern border. The project will seek to identify the areas in this region where bulk cash smuggling is taking

  17. National Strategy to Secure Cyberspace

    DTIC Science & Technology

    2006-08-01

    2002, pg. 3 BGP - encourage the use of MD5 encryption on BGP4 TCP links. NSTAC Internet Service Provider Working Groups, May 1, 2002, pg. 3 BGP - the...communications security (including SCADA system encryption and authentication), high-assurance systems, and se- cure system composition. • (The National... encryption and authentication), high-assurance systems, and secure system composition. Since the release of the Strategy, the Department of Homeland

  18. Transitions in Care among Older Adults with Dementia in a Nationally Representative Sample of Older Americans

    PubMed Central

    Callahan, Christopher M.; Tu, Wanzhu; Unroe, Kathleen T.; LaMantia, Michael A.; Stump, Timothy E.; Clark, Daniel O.

    2016-01-01

    Background Older adults with dementia experience frequent transitions in care Objectives To describe transitions in care among older adults with dementia identified from a nationally representative cohort and to describe transition rates among subjects with more severe levels of cognitive and functional impairment Design Longitudinal cohort study Setting Health and Retirement Study (HRS) Participants 16,186 HRS respondents aged 65 years or over whose survey data were linked with Medicare claims from 1999-2008 Measurements Transitions in care between home, home with formal services, hospital, and nursing facility care, as well as cognitive function, activities of daily living, and mortality. Results The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Among subjects transitioning from a hospital stay, 52.2% returned home without home care services while 33.8% transitioned to a nursing facility. Among subjects transitioning from a nursing facility, 59.2% transitioned to the hospital while 25.3% returned home without services. There were 2,139 transitions to death and 58.7% of HRS subjects with dementia died at home. Even among persons with moderate to severe dementia, we documented multiple transitions in care, including transitions from the hospital to home and back to the hospital. Conclusion In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Those persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in both function and cognition. PMID:26200764

  19. Strategies to support engagement and continuity of activity during mealtimes for families living with dementia; a qualitative study.

    PubMed

    Keller, Heather H; Martin, Lori Schindel; Dupuis, Sherry; Reimer, Holly; Genoe, Rebecca

    2015-10-09

    Mealtimes are an essential part of living and quality of life for everyone, including persons living with dementia. A longitudinal qualitative study provided understanding of the meaning of mealtimes for persons with dementia and their family care partners. Strategies were specifically described by families to support meaningful mealtimes. The purpose of this manuscript is to describe the strategies devised and used by these families living with dementia. A longitudinal qualitative study was undertaken to explore the meaning and experience of mealtimes for families living with dementia over a three-year period. 27 families [older person with dementia and at least one family care partner] were originally recruited from the community of South-Western Ontario. Individual and dyad interviews were conducted each year. Digitally recorded transcripts were analyzed using grounded theory methodology. Strategies were identified and categorized. Strategies to support quality mealtimes were devised by families as they adapted to their evolving lives. General strategies such as living in the moment, as well as strategies specific to maintaining social engagement and continuity of mealtime activities were reported. In addition to nutritional benefit, family mealtimes provide important opportunities for persons with dementia and their family care partners to socially engage and continue meaningful roles. Strategies identified by participants provide a basis for further education and support to families living with dementia.

  20. Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

    ERIC Educational Resources Information Center

    Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

    2010-01-01

    Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

  1. Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

    ERIC Educational Resources Information Center

    Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

    2010-01-01

    Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

  2. Knowledge management in dementia care networks: a qualitative analysis of successful information and support strategies for people with dementia living at home and their family caregivers.

    PubMed

    Heinrich, S; Laporte Uribe, F; Roes, M; Hoffmann, W; Thyrian, J R; Wolf-Ostermann, K; Holle, B

    2016-02-01

    Stakeholders involved in community dementia support services often work on their own and without coordination with other services. These circumstances can result in a lack of information and support for people with dementia and their family caregivers at home. To increase the coordination between existing support services, so-called 'Dementia Care Networks' (DCNs) have been established. Most of the tasks that are performed in DCNs are based on communication strategies. Therefore, knowledge management (KM) is a key process in these networks. However, few studies have focused on this topic. This study attempted to evaluate KM strategies in DCNs across Germany as part of the DemNet-D study. A qualitative interview study design was used. Qualitative data were collected during single and group interviews with key persons associated with thirteen DCNs. Interviews were audiotaped and transcribed, and a structured content analysis was conducted. The framework for the analysis was derived from a KM model. Information dissemination strategies for people with dementia and their informal caregivers based on actively established contacts appear to be more successful than passive strategies. General practitioners often play a key role as external gatekeepers in initiating contact between a network and a person affected by dementia. In this context, case managers can help integrate external stakeholders, such as general practitioners or pharmacists, into DCNs using different KM strategies. The systematic development of common objectives under an agency-neutral leadership seems to be an important aspect of successful KM within DCNs. The findings reported here can help DCNs optimize their KM strategies for generating tailored information and support services for people with dementia living at home and their family caregivers. In particular, the identified potential knowledge distribution barriers and facilitators will be of practical use to DCN stakeholders. Copyright © 2015 The

  3. Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving

    PubMed Central

    Moon, Heehyul; Dilworth-Anderson, Peggye

    2015-01-01

    Background: previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia. Objective: the purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes. Design: we selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia). Methods: the Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs' down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs' outcomes. Results: high blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs' outcomes. Conclusion: the current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health. PMID:25359299

  4. Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving.

    PubMed

    Moon, Heehyul; Dilworth-Anderson, Peggye

    2015-03-01

    Previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia. The purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes. We selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia). The Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs' down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs' outcomes. High blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs' outcomes. The current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Quality of life of patients with Parkinson's disease and neurodegenerative dementia: A nationally representative study.

    PubMed

    Chekani, Farid; Bali, Vishal; Aparasu, Rajender R

    2016-01-01

    The disability inherent to Parkinson's disease and dementia would suggest poor health-related quality of life for patients with these neurodegenerative conditions; however, the extent of disability from a nationally representative data has not been previously available. This study examined factors associated with the health-related quality of life in patients with Parkinson's disease and dementia using nationally representative samples. The study used data from 2002 to 2011 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of households in the United States. The quality of life of patients was captured based on Physical Component Summary (PCS), Mental Component Summary (MCS), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Multivariate regression models were used to compare PCS, MCS, ADL and IADL across the two neurodegenerative conditions after controlling for various sociodemographic and clinical characteristics. The weighted study population included 0.80 million (95% Confidence Interval, CI: 0.75-0.85) patients; those with Parkinson's disease accounted for 40.23% and remaining 59.77% were diagnosed with dementia. Mean age of the study population was 74.32 years (Standard Deviation, SD = 11.36). Most of the Parkinson's patients were male (57.70%), whereas most of the dementia patients were females (58.10%). The unadjusted mean PCS was 33.66 and 35.31 in Parkinson's and dementia patients, respectively (P < 0.01). Patients with Parkinson's disease were less likely to seek help for IADL than neurodegenerative dementia (Odds Ratio, OR = 0.68, P = 0.02). Various other individual, biological and environmental factors were also associated with quality of life in patients with Parkinson's disease and neurodegenerative dementia. This study found that patients with Parkinson's disease had lower PCS and were less likely to seek help for IADL when compared to the patients with neurodegenerative dementia

  6. Reach the Person behind the Dementia - Physical Therapists' Reflections and Strategies when Composing Physical Training

    PubMed Central

    Nordin, Ellinor; Skelton, Dawn A.; Lundin-Olsson, Lillemor

    2016-01-01

    Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists’ (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category “Discover and act in the moment—learn over time” reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high

  7. The use of memory recall strategies in the management of behaviours associated with dementia.

    PubMed

    Stern, Cindy; Gibb, Heather

    2011-01-01

    Background Many people who develop dementia are placed in long-term care facilities, as they often require high-level care that can no longer be provided by family and friends. As yet no cure for dementia exists and management of dementia-associated behaviours can be complex. Mental recall is one type of behaviour therapy whereby a representation of past experience is elicited. To date there has not been a systematic review conducted that focuses specifically on recall techniques for managing behaviours associated with dementia.Aim To determine the effects of using recall strategies in managing behaviours associated with dementia. Types of studies Any quantitative and qualitative study designs were considered.Types of participants People aged over 60 years who had a clinical diagnosis of dementia and displayed behaviours associated with dementia.Types of intervention Any behaviour therapy modality that used recall was considered for this review. For the purpose of this review memory or mental recall related to the ability to recall previously encountered items from memory.Types of outcome measures The outcome of interest was a positive change in the behaviour associated with dementia.Search strategy Using a collection of keywords and MeSH terms, a selection of electronic bibliographic databases were searched for both published and unpublished studies between the years 1990 and 2009. A three-step search strategy was utilised: firstly an initial limited search of MEDLINE and CINAHL was undertaken, followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then performed across all included databases. Thirdly, the reference list of all identified reports and articles were searched for additional studies.Critical appraisal Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to

  8. Language-based communication strategies that support person-centered communication with persons with dementia.

    PubMed

    Savundranayagam, Marie Y; Moore-Nielsen, Kelsey

    2015-10-01

    There are many recommended language-based strategies for effective communication with persons with dementia. What is unknown is whether effective language-based strategies are also person centered. Accordingly, the objective of this study was to examine whether language-based strategies for effective communication with persons with dementia overlapped with the following indicators of person-centered communication: recognition, negotiation, facilitation, and validation. Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded twice, using language-based and person-centered categories. There were 21 language-based categories and 4 person-centered categories. There were 5,800 utterances transcribed: 2,409 without indicators, 1,699 coded as language or person centered, and 1,692 overlapping utterances. For recognition, 26% of utterances were greetings, 21% were affirmations, 13% were questions (yes/no and open-ended), and 15% involved rephrasing. Questions (yes/no, choice, and open-ended) comprised 74% of utterances that were coded as negotiation. A similar pattern was observed for utterances coded as facilitation where 51% of utterances coded as facilitation were yes/no questions, open-ended questions, and choice questions. However, 21% of facilitative utterances were affirmations and 13% involved rephrasing. Finally, 89% of utterances coded as validation were affirmations. The findings identify specific language-based strategies that support person-centered communication. However, between 1 and 4, out of a possible 21 language-based strategies, overlapped with at least 10% of utterances coded as each person-centered indicator. This finding suggests that staff need training to use more diverse language strategies that support personhood of residents with dementia.

  9. The dementia social care workforce in England: secondary analysis of a national workforce dataset.

    PubMed

    Hussein, Shereen; Manthorpe, Jill

    2012-01-01

    Little is known about the social care workforce supporting people with dementia in England. This article seeks to compare the characteristics of people employed in the social care sector supporting people with dementia with other members of the social care workforce. This article reports on the secondary analysis of a new national workforce dataset from England covering social care employees. Secondary analysis of this dataset was undertaken using 457,031 unique workers' records. There are some important differences between the dementia care workforce and other parts of the social care workforce in respect of the dementia care workforce being more likely to be female, to work part-time, to be employed by agencies and to be less qualified. Many work for medium-sized care businesses and in people's own homes. The findings are set in the context of efforts to increase training and skills. Knowledge of the social care workforce is relevant to care quality and should be borne in mind when planning interventions and commissioning services.

  10. Adherence to medication in patients with dementia: predictors and strategies for improvement.

    PubMed

    Arlt, Sönke; Lindner, Reinhard; Rösler, Alexander; von Renteln-Kruse, Wolfgang

    2008-01-01

    Measures to facilitate patient medication adherence should be considered an integral part of the comprehensive care of older patients with multiple diseases. However, impairment of cognitive functions and dementia, in particular, may substantially compromise adherence behaviour. Therefore, a literature review was performed to identify factors associated with adherence to medication in patients with cognitive impairment or dementia, and to discuss strategies for improvement of non-adherence. Evidence-based information on how to deal with adherence to medication in patients with dementia is scarce because of a lack of specific studies. However, there is increasing knowledge about factors influencing medication adherence behaviour in older age, and emerging insight into the relationships between adherence behaviour and cognitive capacity, memory and executive function, in particular. Nevertheless, understanding elderly persons' strategies for maintaining regular use of even complex drug regimens is still limited. Progress of research in this field is needed. It is notable that measures to improve adherence consist of combinations of educational interventions and cognitive support but assessment of study participants' cognitive function is rare. In clinical practice, awareness of non-adherence as a result of cognitive impairment is relatively low. The most important step is early detection of cognitive impairment when this is impacting negatively on medication management. A practical geriatric screening test is recommended to identify memory problems and further functional impairments associated with cognitive impairment. Performance-based assessments might be useful for screening medication management capacity, in addition to a careful drug history, inspection of all medicines used (including over-the-counter drugs) and proxy information. However, no feasible screening methods have as yet found their way into clinical practice. Patients with impaired executive

  11. Hospitalization, Depression and Dementia in Community-Dwelling Older Americans: Findings from the National Health and Aging Trends Study

    PubMed Central

    Davydow, Dimitry S.; Zivin, Kara; Langa, Kenneth M.

    2014-01-01

    Objective To estimate the prevalence of both dementia and depression among community-dwelling older Americans, and to determine if hospitalization is independently associated with dementia or depression in this population. Method This cross-sectional study utilized data from a nationally representative, population-based sample of 7,197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2. Results An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls, and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval[95%CI]: 1.16, 1.73) and substantial depressive symptoms (OR: 1.60, 95%CI: 1.29, 1.99). Conclusions Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bi-directional relationship between hospitalizations, dementia, and depression, along with targeted interventions to reduce hospitalizations, are needed. PMID:24388630

  12. Improving the National Strategy Process

    DTIC Science & Technology

    2013-03-01

    nation. Sunil Desai stated, “For any nation, coordinating the diverse elements of national power--diplomatic, economic, intelligence, military, and...Strategy”, Studies In Conflict and Terrorism, 34, no. 2, (2011), 139. 12 Sunil B. Desai, “Solving the Interagency Puzzle,” Policy Review 129

  13. National Drug Control Strategy. 2008 Annual Report

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, 2008

    2008-01-01

    This report presents the 2008 National Drug Control Strategy of the White House Office of National Drug Control Policy. The overarching goal of the President's Strategy is to reduce drug use in America through a balanced approach that focuses on stopping use before it starts, healing America's drug users, and disrupting the market for illegal…

  14. 2011 National Drug Control Strategy. Executive Summary

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, 2011

    2011-01-01

    In May of 2010, President Obama released the Administration's inaugural "National Drug Control Strategy", a comprehensive approach to combat the public health and safety consequences posed by drug use. Now, a year later, the Administration is releasing its update building upon that initial "Strategy". The "Strategy" establishes ambitious goals to…

  15. Improving Nutritional Status of Older Persons with Dementia Using a National Preventive Care Program.

    PubMed

    Johansson, L; Wijk, H; Christensson, L

    2017-01-01

    The aim of the study was to investigate the outcome of change in body weight associated with use of a structured preventive care process among persons with dementia assessed as at risk of malnutrition or malnourished. The preventive care process is a pedagogical model used in the Senior Alert (SA) quality register, where nutrition is one of the prioritized areas and includes four steps: assessment, analysis of underlying causes, actions performed and outcome. An analysis of data from SA with a pre-post design was performed. The participants were living in ordinary housing or special housing in Sweden. 1912 persons, 65 years and older, registered in both SA and the dementia quality register Svedem were included. A national preventive care program including individualized actions. The Mini Nutritional Assessment-Short Form was used to assess nutritional status at baseline. Body weight was measured during baseline and follow-up (7-106 days after baseline). 74.3% persons were malnourished or at risk of malnutrition. Those at risk of malnutrition or malnourished who were registered in all four steps of the preventive care process, increased in body weight from baseline (Md 60.0 kg) to follow-up (Md 62.0 kg) (p=0.013). In those with incomplete registration no increase in body weight was found. Using all steps in the structured preventive care process seems to improve nutritional status of persons with dementia assessed as at risk of malnutrition or malnourished. This study contributes to the development of evidence-based practice regarding malnutrition and persons with dementia.

  16. The Clinton National Security Strategy

    DTIC Science & Technology

    1998-01-01

    second, promoting prosperity, outlrnes enhancing competltlveness through deficit reduction, gaining access to foreign markets , fostering free trade...murky Does domestic investment outweigh free trade? Will North American prosper@ count more than Asian advances? Are any markets more important than...Integration of emerging nations into free market systems to reslstrng genital mutilation find a home as national Interests Again, the order of

  17. START (STrAtegies for RelaTives) coping strategy for family carers of adults with dementia: qualitative study of participants’ views about the intervention

    PubMed Central

    Sommerlad, Andrew; Manela, Monica; Cooper, Claudia; Rapaport, Penny; Livingston, Gill

    2014-01-01

    Objectives To analyse the experience of individual family carers of people with dementia who received a manual-based coping strategy programme (STrAtegies for RelaTives, START), demonstrated in a randomised-controlled trial to reduce affective symptoms. Design A qualitative study using self-completed questionnaires exploring the experience of the START intervention. Two researchers transcribed, coded and analysed completed questionnaires thematically. Setting Three mental health and one neurology dementia clinic in South East England. Participants Participants were primary family carers of a patient diagnosed with dementia who provided support at least weekly to their relative. We invited those in the treatment group remaining in the START study at 2 years postrandomisation (n=132) to participate. 75 people, comprising a maximum variation sample, responded. Primary and secondary outcome measures (1) Important aspects of the therapy. (2) Continued use of the intervention after the end of the therapy. (3) Unhelpful aspects of the therapy and suggestions for improvement. (4) Appropriate time for intervention delivery. Results Carers identified several different components as important: relaxation techniques, education about dementia, strategies to help manage the behaviour of the person with dementia, contact with the therapist and changing unhelpful thoughts. Two-thirds of the participants reported that they continue to use the intervention's techniques at 2-year follow up. Few participants suggested changes to the intervention content, but some wanted more sessions and others wanted the involvement of more family members. Most were happy with receiving the intervention shortly after diagnosis, although some relatives of people with moderate dementia thought it should have been delivered at an earlier stage. Conclusions Participants’ varied responses about which aspects of START were helpful suggest that a multicomponent intervention is suited to the differing

  18. Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia.

    PubMed

    Chen, Hui-Mei; Huang, Mei-Feng; Yeh, Yi-Chun; Huang, Wen-Hui; Chen, Cheng-Sheng

    2015-03-01

    Coping strategies are a potential way to improve interventions designed to manage the caregiver burden of dementia. The purpose of this study was to develop an intervention targeted towards improving coping strategies and to examine its effectiveness on reducing caregiver burden. A controlled study design was used. Fifty-seven caregivers of dementia patients were enrolled. Coping strategies were assessed with the Revised Ways of Coping Checklist (WCCL-R) and caregiver burden was assessed with the Chinese version of the Caregiver Burden Inventory. The participants were randomly divided into two groups. The intervention group was offered a series of five interventions in which problem-solving skills, knowledge of dementia, social resources, and emotional support were taught every 2 weeks, and the control group was telephoned every 2 weeks for the usual clinical management. Two weeks after the end of the intervention, we again administered the WCCL-R and the Caregiver Burden Inventory. Two-way repeated-measure anova was used to evaluate the changes in coping strategies and caregiver burden. Forty-six participants completed the study. No statistically significant differences were noted in the demographic data between the two groups. On the problem-focused coping subscale on the WCCL-R, the intervention group's mean score increased by 3.8 points, and the control group's decreased by 5.1 points (F = 7.988, P = 0.007). On the seeking social support coping subscale on the WCCL-R, the intervention group's mean score increased by 3.8 points, and the control group's decreased by 3.1 points (F = 4.462, P = 0.04). On the Caregiver Burden Inventory, the intervention group's mean score decreased by 7.2 points, and the control group's increased by 2.2 points (F = 6.155, P = 0.017). Psychosocial intervention can help caregivers to adopt more problem-focused and social support coping strategies, which are beneficial in terms of reducing the caregiver

  19. Linking Acquisition Decisionmaking With National Military Strategy

    DTIC Science & Technology

    1990-10-01

    ICopy .17 of 146 copie; !1 AD-A235 445 I IDA REPORT R-366 LINKING ACQUISITION DECISIONMAKING I WITH NATIONAL MILITARY STRATEGY David R. Graham...National Military Strategy C-MDA-903 89 C0003 TA-T-G6-678 6. AUTHOR(S) David R. Graham, Herschel E. Kanter, Martin J. Ralley, Barbara A. Blcksler...executing acquisition programs that are consistent with national military strategy and projected budgets. Next it reviews the long-standing concerns with

  20. [A new strategy for preventive and functional therapeutic methods for dementia--approach using natural products].

    PubMed

    Ohizumi, Yasushi

    2015-01-01

    Alzheimer's disease (AD) has become a serious social problem in Japan. However, effective preventive and fundamental therapeutic methods for AD have not yet been developed. Using a new strategy in the course of our survey of numerous natural resouces having neurotrophic activity, we isolated a variety of active constituents and proved their pharmacological properties. As a result, we successfully found nobiletin, a compound with anti-dementia activity that comes from citrus peels. Also, we have demonstrated that nobiletin ameliorates cognitive impairment in several dementia model animals such as chronically amyloid β(Aβ) infused rats, amyloid precursor protein transgenic (APPTg) mice, olfactory-bulbectomized (OBX) mice, N-methyl-D-aspartate (NMDA) receptor antagonist (MK-801)-treated mice, senescence-accelated mice and bilaterial common carotid arteries occlusion mice. In a APPTg mouse of AD, nobiletin greatly improved memory impairment, and this was accompanied by a marked decrease in Aβ deposition. Also, in OBX mice memory impairment was markedly recoverd by nobiletin, accompanied by improvement of a decrease indensity of cholinergic neurons. Interestingly, nobiletin improves age-related congnitive impairment and decreased hyperphosphorylation of tau as well as oxidative stress in senescence-accelerated mice. In cultured cells, nobiletin reversed the Aβ-induced inhibition of glutamate-induced increases in cAMP response element binding protein (CREB) phosphorylation and modulated gen expression of thioredoxin-interacting protein and NMDA resceptor subunits. These results suggest that nobiletin prevents memory impairment and exhibits a protecting action against neurodgeneration in AD model animals. Nobiletin and citrus peels thus have potential as functional foods for prevention of dementia.

  1. Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998–2008: a systematic literature review

    PubMed Central

    Kverno, Karan S.; Black, Betty S.; Nolan, Marie T.; Rabins, Peter V.

    2011-01-01

    Background Advanced dementia is characterized by severe cognitive and functional impairments that lead to almost total dependency in self-care. Neuropsychiatric symptoms (NPS) are common in advanced dementia, diminishing quality of life and increasing the care burden. The challenge for health care providers is to find safe and effective treatments. Non-pharmacological interventions offer the potential for safer alternatives to pharmacotherapy, but little is known about their efficacy. This review evaluates the published literature on non-pharmacological interventions for treating NPS in advanced dementia. Methods A literature search was undertaken to find non-pharmacological intervention studies published between 1998 and 2008 that measured NPS outcomes in individuals diagnosed with advanced dementia. Strict inclusion criteria initially required that all study participants have severe or very severe dementia, but this range was later broadened to include moderately severe to very severe stages. Results Out of 215 intervention studies, 21 (9.8%) specifically focused on treatments for individuals with moderately severe to very severe dementia. The studies provide limited moderate to high quality evidence for the use of sensory-focused strategies, including aroma, preferred or live music, and multi-sensory stimulation. Emotion-oriented approaches, such as simulated presence may be more effective for individuals with preserved verbal interactive capacity. Conclusions Most studies of interventions for dementia-related NPS have focused on individuals with mild to moderate cognitive impairment. Individuals with severe cognitive impairment do not necessarily respond to NPS treatments in the same manner. Future studies should be specifically designed to further explore the stage-specific efficacy of non-pharmacological therapies for patients with advanced dementia. Areas of particular need for further research include movement-based therapies, hands-on (touch) therapies

  2. Effect of fever-management strategy on the progression of dementia of the Alzheimer type.

    PubMed

    Hurley, A C; Volicer, B J; Volicer, L

    1996-01-01

    This study was undertaken to determine if the progression of dementia of the Alzheimer type (DAT) is accelerated by an intercurrent infection and if management strategy (aggressive or palliative care) would modify this effect. A prospective cohort study compared the progression of DAT in patients in three 25-bed dementia special care units that provide a hospice option for care. There were three groups of patients, as follows: (a) developed a fever and received aggressive care (FAC, n = 30), (b) developed a fever and received palliative care (FPC, n = 19), and (c) did not develop a fever (NF, n = 46). The presence of a fever episode did not have an effect of its own on DAT progression. Over a 3-month period, DAT severity increased in most patients, but more so in FAC patients. Thus aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT. Providing palliative care is recommended because it prevents patients from undergoing invasive diagnostic workups and treatments, does not accelerate the progression of DAT, and conserves scarce health care resources.

  3. The 2012 national drug control strategy.

    PubMed

    2013-03-01

    This report is adapted from the Executive Summary and Introduction to the federal national drug control strategy report, which was posted online by the White House in December 2012. Section headings from the full report and brief descriptions of what appears in each section are provided. The full report is posted on the World Wide Web at: http://www.whitehouse.gov/ondcp/2012-national-drug-control-strategy .

  4. National Strategy, Future Threats and Defense Spending

    DTIC Science & Technology

    1992-06-05

    AD-A256 884 NATIONAL STRATEGY, FUTURE THREATS AND DEFENSE SPENDING A thesis presented to the Faculty of the U.S. Army Command and General Staff...Jun 92 4. TITLE AND SUBTITLE S. FUNDING NUMBERS National Strategy, Future Threats and Defense Spending 6. AUTHOR(S) MAJ Daniel M. Gerstein, USA 7...Future Threats, Defense Spending , 192 Regional Threats 16. PRICE COOE 17. SECURITY CLASSIFICATION 118. SECURITY CLASSIFICATION 19. SECURITY

  5. A Systematic Review of Strategies to Foster Activity Engagement in Persons with Dementia

    ERIC Educational Resources Information Center

    Trahan, Maranda A.; Kuo, Julie; Carlson, Michelle C.; Gitlin, Laura N.

    2014-01-01

    Dementia is a growing public health issue. Activity, a positive therapeutic modality, has potential to enhance quality of life and reduce behavioral symptoms in persons with dementia--outcomes eluding pharmacological treatments. However, it is unclear how to effectively engage persons with dementia in activities for them to derive desired…

  6. A Systematic Review of Strategies to Foster Activity Engagement in Persons with Dementia

    ERIC Educational Resources Information Center

    Trahan, Maranda A.; Kuo, Julie; Carlson, Michelle C.; Gitlin, Laura N.

    2014-01-01

    Dementia is a growing public health issue. Activity, a positive therapeutic modality, has potential to enhance quality of life and reduce behavioral symptoms in persons with dementia--outcomes eluding pharmacological treatments. However, it is unclear how to effectively engage persons with dementia in activities for them to derive desired…

  7. A National Strategy for Lifelong Learning.

    ERIC Educational Resources Information Center

    Coffield, Frank, Ed.

    The first paper of this set of 12 conference papers, "Nine Learning Fallacies and Their Replacement by a National Strategy for Lifelong Learning," by Frank Coffield, synthesizes the opinions of other participants, and goes beyond them to set forth an outline of a strategy for lifelong learning in the United Kingdom. Following this…

  8. Applying Knowledge Translation Concepts and Strategies in Dementia Care Education for Health Professionals: Recommendations From a Narrative Literature Review.

    PubMed

    Phillipson, Lyn; Goodenough, Belinda; Reis, Samantha; Fleming, Richard

    2016-01-01

    Dementia education programs are being developed for health professionals, but with limited guidance about "what works" in design and content to promote best practice in dementia care. Knowledge translation (KT) is a conceptual framework for putting evidence to work in health care. This narrative literature review examined the question: What does the field KT offer, conceptually and practically, for education of health professionals in dementia care? It seeks to identify the types of strategies currently used within education to facilitate effective KT for the wide range of health professionals who may be involved in the care of people with dementia, plus explore enablers and barriers to KT in this context. From 76 articles identified in academic databases and manual bibliographic searching, 22 met review criteria. The literature synthesis indicated four hallmarks of successful KT-oriented dementia education for health professionals: (1) multimodal delivery, (2) tailored approaches, (3) relationship building, and (4) organizational support for change in the work setting. Participatory action frameworks were also favored, based on interactive knowledge exchange (eg, blended learning) rather than passive unidirectional approaches alone (eg, lectures). The following six principles are proposed for educating health professionals in dementia care: (1) Match the education strategy to the KT goal and learner preferences; (2) Use integrated multimodal learning strategies and provide opportunities for multiple learning exposures plus feedback; (3) Build relationships to bridge the research-practice gap; (4) Use a simple compelling message with formats and technologies relevant to the audience; (5) Provide incentives to achieve KT goals; and (6) Plan to change the workplace, not just the individual health professional.

  9. Cholinergic deficiency involved in vascular dementia: possible mechanism and strategy of treatment

    PubMed Central

    Wang, Juan; Zhang, Hai-yan; Tang, Xi-can

    2009-01-01

    Vascular dementia (VaD) is a progressive neurodegenerative disease with a high prevalence. Several studies have recently reported that VaD patients present cholinergic deficits in the brain and cerebrospinal fluid (CSF) that may be closely related to the pathophysiology of cognitive impairment. Moreover, cholinergic therapies have shown promising effects on cognitive improvement in VaD patients. The precise mechanisms of these cholinergic agents are currently not fully understood; however, accumulating evidence indicates that these drugs may act through the cholinergic anti-inflammatory pathway, in which the efferent vagus nerve signals suppress pro-inflammatory cytokine release and inhibit inflammation, although regulation of oxidative stress and energy metabolism, alleviation of apoptosis may also be involved. In this paper, we provide a brief overview of the cholinergic treatment strategy for VaD and its relevant mechanisms of anti-inflammation. PMID:19574993

  10. Effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease based on a national administrative database.

    PubMed

    Murata, Atsuhiko; Mayumi, Toshihiko; Muramatsu, Keiji; Ohtani, Makoto; Matsuda, Shinya

    2015-10-01

    Little information is available on the effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease at the population level. This study aimed to investigate the effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer based on a national administrative database. A total of 14,569 elderly patients (≥80 years) who were treated by endoscopic hemostasis for hemorrhagic peptic ulcer were referred to 1073 hospitals between 2010 and 2012 in Japan. We collected patients' data from the administrative database to compare clinical and medical economic outcomes of elderly patients with hemorrhagic peptic ulcers. Patients were divided into two groups according to the presence of dementia: patients with dementia (n = 695) and those without dementia (n = 13,874). There were no significant differences in in-hospital mortality within 30 days and overall mortality between the groups (odds ratio; OR 1.00, 95 % confidence interval; CI 0.68-1.46, p = 0.986 and OR 1.02, 95 % CI 0.74-1.41, p = 0.877). However, the length of stay (LOS) and medical costs during hospitalization were significantly higher in patients with dementia compared with those without dementia. The unstandardized coefficient for LOS was 3.12 days (95 % CI 1.58-4.67 days, p < 0.001), whereas that for medical costs was 1171.7 US dollars (95 % CI 533.8-1809.5 US dollars, p < 0.001). Length of stay and medical costs during hospitalization are significantly increased in elderly patients with dementia undergoing endoscopic hemostasis for hemorrhagic peptic ulcer disease.

  11. Handling the Dilemma of Self-Determination and Dementia: A Study of Case Managers' Discursive Strategies in Assessment Meetings.

    PubMed

    Österholm, Johannes H; Taghizadeh Larsson, Annika; Olaison, Anna

    2015-01-01

    In assessment meetings concerning care services for people with dementia, Swedish case managers face a dilemma. On the one hand, according to the law, the right to self-determination of every adult citizen must be respected, but on the other hand cognitive disabilities make it difficult to fulfill obligations of being a full-fledged citizen. In this article, we examine 15 assessment meetings to identify discursive strategies used by case managers to handle this dilemma. We also examine how these affect the participation of persons with dementia, and indicate implications of our study for social work practice and research.

  12. Weight Loss Associated with Cholinesterase Inhibitors In Patients With Dementia in a National Healthcare System

    PubMed Central

    Sheffrin, Meera; Miao, Yinghui; Boscardin, W. John; Steinman, Michael A.

    2016-01-01

    Background/Objectives Inconsistent data from randomized trials suggest cholinesterase inhibitors may cause weight loss. We sought to determine if the initiation of cholinesterase inhibitors is associated with significant weight loss in a real-word clinical setting. Design Retrospective cohort study from 2007-2010, comparing weight loss in patients with dementia newly prescribed cholinesterase inhibitors and patients newly prescribed other chronic medications Setting National Veterans Affairs (VA) data Participants Patients 65 years or older with a diagnosis of dementia who received a new prescription for a cholinesterase inhibitor or other new other chronic medication. Measurements The primary outcome was time to 10 pound weight loss over 12 months. We used propensity score matching patients to control for the likelihood of receiving a cholinesterase inhibitor based on baseline characteristics. Data were analyzed in a priori defined subgroups by age, comorbid burden, and initial weight. Results Of 6,504 patients that met study criteria, 1188 patients started on cholinesterase inhibitors were matched to 2189 patients started on other medications. The propensity-matched cohorts were well balanced on baseline covariates. Patients initiated on cholinesterase inhibitors had a higher risk of weight loss compared to matched controls at 12 months, HR 1.23 (95% CI 1.07 - 1.41). At twelve months, 29.3% of patients on cholinesterase inhibitors had experienced weight loss compared to 22.8% of non-users, corresponding to a number needed to harm of 21.2 (95% CI 12.5 – 71.4) over one year. There were no significant differences across subgroups. Conclusion Patients with dementia started on cholinesterase inhibitors had a higher risk of clinically significant weight loss over a 12-month period compared to matched controls. These results are consistent with the available data from randomized controlled trials. Clinicians should consider the risk of weight loss when prescribing

  13. National Manufacturing Strategy: Is a National Manufacturing Strategy Essential to National Security?

    DTIC Science & Technology

    2011-05-01

    Education of the Middle States Association of Colleges and Schools, 3624 Market Street, Philadelphia, PA 19104, (215) 662-5606. The Commission on...required by U.S. Code, the Department of Defense states it will “rely on market forces to create, shape and sustain the industrial, manufacturing, and...requires decisive intervention through a coordinated national manufacturing strategy. Over the last several decades, U.S. markets saw

  14. Being Dementia Smart (BDS): A Dementia Nurse Education Journey in Scotland.

    PubMed

    Macaden, Leah

    2016-06-24

    There is a global demographic transition secondary to population ageing. The number of older people living with multimorbidities including dementia has been significantly rising both in developed and developing countries. It is estimated that there would be 74.7 million people living with dementia by 2030 that would escalate to 135.46 million by 2050. 62 % of people with dementia currently live in low and middle income countries that are very poorly resourced to cope with this epidemic. Dementia is now duly recognised as a national priority within the UK and a global priority at the 2013 G8 Summit. Management and care of an individual with dementia requires a multidisciplinary approach with expertise and a competent skill base. Nurses are central to the delivery of dementia care delivery in hospitals, community and residential care settings. It is against this background that this pre-registration integrated dementia curriculum was developed to build capacity and capability with dementia expertise among the future nursing workforce in Scotland in line with the National Dementia Strategy.

  15. National Strategy to Combat Terrorist Travel

    DTIC Science & Technology

    2006-05-02

    Terrorist Travel Visa Waiver Program The Visa Waiver Program (VWP) generally enables citizens of 27 countries to travel to the United States for tourism or...NATIONAL STRATEGY TO COMBAT TERRORIST TRAVEL May 2, 2006 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the...Strategy to Combat Terorist Travel 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER

  16. Public Diplomacy: Enabling National Security Strategy

    DTIC Science & Technology

    2007-03-12

    2002, arguably a period when international public opinion was overwhelmingly supportive of the United States, highlight the depth and breadth of the...it 9 resources and implements this strategy and then sustains the effort over an extended period of time. Implications of Ineffective Public...of Cambrian Studies, Boulder, CO. 52 Secretary Donald R. Rumsfeld, The National Defense Strategy of the United States of America (Washington, D.C

  17. Pain in Community-Dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study

    PubMed Central

    Hunt, Lauren J.; Covinsky, Kenneth E.; Yaffe, Kristine; Stephens, Caroline E.; Miao, Yinghui; Boscardin, W. John; Smith, Alex K.

    2016-01-01

    OBJECTIVES To report prevalence, correlates, and medication management of pain in community-dwelling older adults with dementia. DESIGN Cross-sectional. SETTING In-person interviews with self- or proxy respondents living in private residences or non-nursing home residential care settings. PARTICIPANTS Nationally representative sample of community-dwelling Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study 2011 wave. MEASUREMENTS Dementia status was determined using a modified previously validated algorithm. Participants were asked whether they had had bothersome and activity-limiting pain over the past month. A multivariable Poisson regression model was used to determine the relationship between bothersome pain and sociodemographic and clinical characteristics. RESULTS Of the 7,609 participants with complete data on cognitive function, 802 had dementia (67.2% aged ≥80, 65.0% female, 67.9% white, 49.7% proxy response, 32.0% lived alone, 18.8% lived in residential care); 670 (63.5%) participants with dementia experienced bothersome pain, and 347 (43.3%) had pain that limited activities. These rates were significantly higher than in a propensity score–matched cohort without dementia (54.5% bothersome pain, P < .001, 27.2% pain that limited activity, P < .001). Proxies reported slightly higher rates of pain than self-respondents, but differences were statistically significant only for activity-limiting pain (46.6% proxy vs 40.1% self, P = .03). Correlates of bothersome pain included arthritis, heart and lung disease, less than high school education, activity of daily living disability, depressive and anxiety symptoms, and low energy. Of those reporting pain, 30.3% stated that they rarely or never took any medications for pain. CONCLUSION Community-living older adults with dementia are at high risk of having pain. Creative interventions and programs are needed to manage pain adequately in this vulnerable population. PMID

  18. Teaching about National Conservation Strategy for Australia.

    ERIC Educational Resources Information Center

    Greenall, Annette

    1986-01-01

    This article describes the development and content of the National Conservation Strategy for Australia (NCSA). The Australian Department of Arts, Heritage, and Environment has produced a teacher's guide designed to help teachers bring the content of the NCSA to their classroom. A description of the guide and ordering information are provided. (JDH)

  19. Adapting to Conversation with Semantic Dementia: Using Enactment as a Compensatory Strategy in Everyday Social Interaction

    ERIC Educational Resources Information Center

    Kindell, Jacqueline; Sage, Karen; Keady, John; Wilkinson, Ray

    2013-01-01

    Background: Studies to date in semantic dementia have examined communication in clinical or experimental settings. There is a paucity of research describing the everyday interactional skills and difficulties seen in this condition. Aims: To examine the everyday conversation, at home, of an individual with semantic dementia. Methods &…

  20. Adapting to Conversation with Semantic Dementia: Using Enactment as a Compensatory Strategy in Everyday Social Interaction

    ERIC Educational Resources Information Center

    Kindell, Jacqueline; Sage, Karen; Keady, John; Wilkinson, Ray

    2013-01-01

    Background: Studies to date in semantic dementia have examined communication in clinical or experimental settings. There is a paucity of research describing the everyday interactional skills and difficulties seen in this condition. Aims: To examine the everyday conversation, at home, of an individual with semantic dementia. Methods &…

  1. National policies and strategies for noncommunicable diseases.

    PubMed

    Mendis, Shanthi; Fuster, Valentin

    2009-11-01

    Good public policies are vital for protecting the health of populations. For the prevention and control of noncommunicable diseases (NCD), a single national policy is essential. Such a policy ensures clarity of vision and purpose, sets the platform for joint action to address risk factors and determinants that are shared by major NCDs, and provides coherence with other health and social policies. A national NCD policy also provides an overarching framework that enables governments to combine and balance synergistic public health strategies that target the whole population and those that target high-risk groups. Given that the adopted strategies are evidence-based and cost-effective, national NCD policy development can provide a strong basis for appropriate legislation and regulation in relation to tobacco control and promotion of healthy diet and physical activity. A national policy also serves as a vehicle to facilitate efficient and effective use of available public finances for NCD-related health care, while safeguarding equity. For the reasons alluded to above, a single national NCD policy is more appropriate than separate national polices for each individual NCD, particularly in low-income and middle-income countries that have a critical shortage of human and financial resources, including those necessary for policy development and implementation.

  2. Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System.

    PubMed

    Sheffrin, Meera; Miao, Yinghui; Boscardin, W John; Steinman, Michael A

    2015-08-01

    To determine whether initiation of cholinesterase inhibitors is associated with significant weight loss in a real-word clinical setting. Retrospective cohort study from 2007 to 2010 comparing weight loss in individuals with dementia newly prescribed cholinesterase inhibitors and those newly prescribed other chronic medications. National Veterans Affairs data. Individuals aged 65 and older with a diagnosis of dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication. The primary outcome was time to 10-pound weight loss over 12 months. Propensity score matching was used to control for the likelihood of receiving a cholinesterase inhibitor based on baseline characteristics. Data were analyzed in a priori defined subgroups according to age, comorbid burden, and initial weight. Of 6,504 individuals that met study criteria, 1,188 started on cholinesterase inhibitors were matched to 2,189 started on other medications. The propensity-matched cohorts were well balanced on baseline covariates. Participants initiated on cholinesterase inhibitors had a higher risk of weight loss than matched controls at 12 months (hazard ratio = 1.23, 95% confidence interval (CI) = 1.07-1.41). At 12 months, 29.3% of participants taking cholinesterase inhibitors had experienced weight loss, compared with 22.8% of nonusers, corresponding to a number needed to harm of 21.2 (95% CI = 12.5-71.4) over 1 year. There were no significant differences in the risk of weight loss within subgroups. These results are consistent with the available data from randomized controlled trials. Clinicians should consider the risk of weight loss when prescribing cholinesterase inhibitors. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  3. A National Strategy for Advancing Climate Modeling

    SciTech Connect

    Dunlea, Edward; Elfring, Chris

    2012-12-04

    Climate models are the foundation for understanding and projecting climate and climate-related changes and are thus critical tools for supporting climate-related decision making. This study developed a holistic strategy for improving the nation's capability to accurately simulate climate and related Earth system changes on decadal to centennial timescales. The committee's report is a high level analysis, providing a strategic framework to guide progress in the nation's climate modeling enterprise over the next 10-20 years. This study was supported by DOE, NSF, NASA, NOAA, and the intelligence community.

  4. Evaluating the MESSAGE Communication Strategies in Dementia training for use with community-based aged care staff working with people with dementia: a controlled pretest-post-test study.

    PubMed

    Conway, Erin R; Chenery, Helen J

    2016-04-01

    The study aims to evaluate the effects of a communication skills training programme on community aged care staff's knowledge of communication support in dementia and on staff's care experience. Dementia can lead to impairments in communication. Therefore, quality community-based dementia care requires that staff be skilled communicators, equipped to facilitate interactions with people with dementia. The current investigation evaluated the effectiveness of the MESSAGE Communication Strategies in Dementia for Care Staff training programme with respect to knowledge of communication support and the staff/caregiver experience. A multi-centre controlled pretest/post-test design with randomised cohort allocation was used. Outcome measures were completed at baseline, immediately after training (training group only), and at three-month follow-up. Thirty-eight care staff working in community aged care participated and completed all outcome measures (training = 22; control = 16).Training and control groups completed the following outcome measures: knowledge of communication support strategies, self-efficacy, preparedness to provide care, strain in nursing care and attitude to dementia care. Staff in the training group provided written feedback on the training. A significant improvement in knowledge scores from baseline was found for the training group both immediately after training and at three-month follow-up. There was also a significant training effect for self-efficacy and preparedness to provide care. No significant difference was found for the control group for any measure. No significant training effects were found for measures of strain or attitudes to dementia care. Feedback from staff suggests that the training was well received. The MESSAGE training was positively received by staff and had a significant effect on care staff knowledge, and confidence to provide care for people with dementia. The easily accessible multimedia training programme is well received by

  5. Teaching and learning about dementia in UK medical schools: a national survey

    PubMed Central

    2013-01-01

    Background Dementia is an increasingly common condition and all doctors, in both primary and secondary care environments, must be prepared to competently manage patients with this condition. It is unclear whether medical education about dementia is currently fit for purpose. This project surveys and evaluates the nature of teaching and learning about dementia for medical students in the UK. Methods Electronic questionnaire sent to UK medical schools. Results 23/31 medical schools responded. All provided some dementia-specific teaching but this focussed more on knowledge and skills than behaviours and attitudes. Only 80% of schools described formal assessment of dementia-specific learning outcomes. There was a widespread failure to adequately engage the multidisciplinary team, patients and carers in teaching, presenting students with a narrow view of the condition. However, some innovative approaches were also highlighted. Conclusions Although all schools taught about dementia, the deficiencies identified represent a failure to sufficiently equip medical students to care for patients with dementia which, given the prevalence of the condition, does not adequately prepare them for work as doctors. Recommendations for improving undergraduate medical education about dementia are outlined. PMID:23537386

  6. Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia.

    PubMed

    Desai, Anand; Wharton, Tracy; Struble, Laura; Blazek, Mary

    2017-02-01

    With an increase in the number of individuals affected by dementia, it is imperative for health care providers to be well versed in the most effective ways to manage neuropsychiatric symptoms, such as aggression. Aggression can be particularly hard to manage because it creates risk of harm for formal and informal caregivers, and options for medical intervention are complex and situation dependent. Although multiple guidelines for management of aggression in dementia are available in the literature, their scope is widespread and suggested treatments often vary, making decision making difficult to navigate for busy clinicians. Using a composite case as a model, the current article provides guidelines that take outpatient providers through the steps needed to provide effective treatment for aggression in individuals with dementia. Shifting the current focal point of health care for aggressive dementia patients toward a more person-centered approach will have a positive impact on patient care. [Journal of Gerontological Nursing, 43(2), 9-17.].

  7. Crafting citizen(ship) for people with dementia: How policy narratives at national level in Sweden informed politics of time from 1975 to 2013.

    PubMed

    Nedlund, Ann-Charlotte; Nordh, Jonas

    2015-08-01

    This article explores how policy narratives in national policy documents in Sweden inform associated politics on people with dementia. This is disentangled in terms of how people with dementia have been defined, what the problems and their imminent solutions have been, and if and how these have differed over time. Based on a textual analysis of policy documents at national level in Sweden, covering nearly 40 years the study shows how divergent policy narratives shape the construction of citizens with dementia as policy target groups. This study shows the temporal character of people with dementia as a political problem, the implications of policy narratives on people with dementia as a citizen group, and policy narratives as something being crafted rather than shaped by fixed pre-existing "facts". Dementia, and further citizens living with dementia, does not have a once and for all stabilised meaning. Instead, the meanings behind the categories continue to evolve and to be crafted, which affects the construction of citizens living with dementia, the space in which to exercise their citizenship and further belonging to the society.

  8. Personality of the caregiver influences the use of strategies to deal with the behavior of persons with dementia.

    PubMed

    Melo, Graça; Maroco, João; Lima-Basto, Marta; de Mendonça, Alexandre

    Personality of family caregiver is an important factor influencing the caregiver's burden, depression and distress. We now hypothesized that the personality is associated with specific strategies used by family caregivers to deal with the behavioral and psychological symptoms of demented relatives (BPSD). Participants were 98 consecutive persons with dementia and their family caregivers. Assessments included: Personality (NEO-FFI), Burden (ZBI), Depression (CES-D), Cognitive Function (MMSE), BPSD (NPI), Distress (NPI-D), and an open question to identify the strategies used by caregivers when faced with BPSD. Caregivers used different strategies to cope with their relatives' behavior: avoiding conflict; confronting; reassuring; orienting; responding coercively; distracting; colluding; medicating and restricting the movements. Extraversion was the only dimension of caregiver's personality that determined the use of caregiver strategies to deal with BPSD. Extroverted caregivers used the "confronting" strategy less often. Caregiver's personality should be taken into account when designing adapted intervention programs. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Toward a national semiconductor strategy, volume 1

    NASA Astrophysics Data System (ADS)

    1991-02-01

    Updated here are key market data showing trends in the U.S. semiconductor industry's world market position. New information is given on three emerging semiconductor-based technologies: broadband communications, advanced display systems, and intelligent vehicles and highways. These are examples of important, high-volume markets that will consume significant numbers of semiconductor components and that must be addressed in a national semiconductor strategy. New recommendations and a summary of all Committee recommendations to date are given as well as a summary of comments received at a public forum held in Silicon Valley in may 1990.

  10. Home-based music strategies with individuals who have dementia and their family caregivers.

    PubMed

    Hanser, Suzanne B; Butterfield-Whitcomb, Joan; Kawata, Mayu; Collins, Brett E

    2011-01-01

    The purpose of this exploratory study was to test a caregiver-administered music program with family members who have dementia. The music protocol was designed to reduce distress and enhance satisfaction with caregiving, while offering the person with dementia the potential to improve mood and psychological state. Fourteen elders with dementia and their family caregivers were recruited, and 8 completed the protocol. Both caregivers and care recipients improved self-reported relaxation, comfort, and happiness, when mean scores were compared between baseline and music conditions. Caregivers showed the most benefit. While drop-out was high (6 families dropped), and caregiving satisfaction failed to improve over time, caregivers expressed enjoyment in reminiscing and participating in musical activities with their loved ones. More direct intervention by a music therapist is recommended to improve impact.

  11. Diabetes mellitus and dementia.

    PubMed

    Ninomiya, Toshiharu

    2014-01-01

    Growing epidemiologic evidence has suggested that people with diabetes mellitus are at an increased risk for the development of dementia. However, the results for the subtypes of dementia are inconsistent. This review examines the risk of dementia in people with diabetes mellitus, and discusses the possible mechanism underpinning this association. Diabetes mellitus is associated with a 1.5- to 2.5-fold greater risk of dementia among community-dwelling elderly people. Notably, diabetes mellitus is a significant risk factor for not only vascular dementia, but also Alzheimer's disease. The mechanisms underpinning the association are unclear, but it may be multifactorial in nature, involving factors such as cardiovascular risk factors, glucose toxicity, changes in insulin metabolism and inflammation. The optimal management of these risk factors in early life may be important to prevent late-life dementia. Furthermore, novel therapeutic strategies will be needed to prevent or reduce the development of dementia in people with diabetes mellitus.

  12. Greater Sage-Grouse National Research Strategy

    USGS Publications Warehouse

    Hanser, Steven E.; Manier, Daniel J.

    2013-01-01

    The condition of the sagebrush ecosystem has been declining in the Western United States, and greater sage-grouse (Centrocercus urophasianus), a sagebrush-obligate species, has experienced concurrent decreases in distribution and population numbers. This has prompted substantial research and management over the past two decades to improve the understanding of sage-grouse and its habitats and to address the observed decreases in distribution and population numbers. The amount of research and management has increased as the year 2015 approaches, which is when the U.S. Fish and Wildlife Service (FWS) is expected to make a final decision about whether or not to protect the species under the Endangered Species Act. In 2012, the Sage-Grouse Executive Oversight Committee (EOC) of the Western Association of Fish and Wildlife Agencies (WAFWA) requested that the U.S. Geological Survey (USGS) lead the development of a Greater Sage-Grouse National Research Strategy (hereafter Research Strategy). This request was motivated by a practical need to systematically connect existing research and conservation plans with persisting or emerging information needs. Managers and researchers also wanted to reduce redundancy and help focus limited funds on the highest priority research and management issues. The USGS undertook the development of this Research Strategy, which addresses information and science relating to the greater sage-grouse and its habitat across portions of 11 Western States. This Research Strategy provides an outline of important research topics to ensure that science information gaps are identified and documented in a comprehensive manner. Further, by identifying priority topics and critical information needed for planning, research, and resource management, it provides a structure to help coordinate members of an expansive research and management community in their efforts to conduct priority research.

  13. An Example of National Literacy Strategy Medium-Term Planning. The National Literacy Strategy.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    These medium-term plans have been produced to support, but not prescribe, teachers' planning. They exemplify ways in which England's National Literacy Strategy (NLS) Framework objectives (and the Early Learning Goals) can be clustered. The Key Stage 1 and Key Stage 2 medium term plans cluster the NLS text, sentence and word level objectives into…

  14. Improving Dementia Long-Term Care: A Policy Blueprint.

    PubMed

    Shih, Regina A; Concannon, Thomas W; Liu, Jodi L; Friedman, Esther M

    2014-01-01

    In 2010, 15 percent of Americans older than age 70 had dementia, and the number of new dementia cases among those 65 and older is expected to double by the year 2050. As the baby boomer generation ages, many older adults will require dementia-related long-term services and supports (LTSS). This blueprint is the only national document to date that engages local, state, and national stakeholders to specifically focus on policy options at the intersection of dementia and LTSS. The authors undertook five major tasks that resulted in a prioritized list of policy options and research directions to help decisionmakers improve the dementia LTSS delivery system, workforce, and financing. These were to (1) identify weaknesses in the LTSS system that may be particularly severe for persons with dementia; (2) review national and state strategies addressing dementia or LTSS policy; (3) identify policy options from the perspective of a diverse group of stakeholders; (4) evaluate the policy options; and (5) prioritize policy options by impact and feasibility. Stakeholders identified 38 policy options. RAND researchers independently evaluated these options against prespecified criteria, settling on 25 priority options. These policy options can be summarized into five objectives for the dementia LTSS system: (1) increase public awareness of dementia to reduce stigma and promote earlier detection; (2) improve access to and use of LTSS; (3) promote high-quality, person- and caregiver-centered care; (4) provide better support for family caregivers of people with dementia; and (5) reduce the burden of dementia LTSS costs on individuals and families. This policy blueprint provides a foundation upon which to build consensus among a larger set of stakeholders to set priorities and the sequencing of policy recommendations.

  15. National launch strategy vehicle data management system

    NASA Technical Reports Server (NTRS)

    Cordes, David

    1990-01-01

    The national launch strategy vehicle data management system (NLS/VDMS) was developed as part of the 1990 NASA Summer Faculty Fellowship Program. The system was developed under the guidance of the Engineering Systems Branch of the Information Systems Office, and is intended for use within the Program Development Branch PD34. The NLS/VDMS is an on-line database system that permits the tracking of various launch vehicle configurations within the program development office. The system is designed to permit the definition of new launch vehicles, as well as the ability to display and edit existing launch vehicles. Vehicles can be grouped in logical architectures within the system. Reports generated from this package include vehicle data sheets, architecture data sheets, and vehicle flight rate reports. The topics covered include: (1) system overview; (2) initial system development; (3) supercard hypermedia authoring system; (4) the ORACLE database; and (5) system evaluation.

  16. EEI adopts a national marketing strategy

    SciTech Connect

    Gorzelnik, E.F.

    1982-06-01

    For about a decade, the electric utility industry has deemphasized the role of marketing and stressed instead management of natural resources and conservation. This has caused a lack of two-way commnication between customers and utilities, and has encouraged growing customer dissatisfaction, resentment, and disillusionment. Although these problems have been recognized for several years, it's only during the past 1 1/2 to 2 years that they have been looked into in depth. Now, under the auspices of the Edison Electric Institute, a two-pronged national marketing strategy for investor-owned utilities has been developed and adopted--one that will accommodate company situations that may be significantly dissimilar in character and regulatory climate.

  17. Trends in use of antipsychotics in elderly patients with dementia: impact of national safety warnings

    PubMed Central

    Gallini, Adeline; Andrieu, Sandrine; Donohue, Julie M; Oumouhou, Naïma; Lapeyre-Mestre, Maryse; Gardette, Virginie

    2014-01-01

    Based on evidence of an increased risk of death, drug agencies issued safety warnings about the use of second generation antipsychotics (SGAs) in the elderly with dementia in 2004. This warning was extended to all antipsychotics in 2008. Little is known about the impact of these warnings on use. We conducted a quasi-experimental study (interrupted time-series) in France, for 2003–2011, including subjects aged ≥65 with dementia and subjects aged ≥65 without dementia in the EGB database (1/97th representative random sample of claims from the main Health Insurance scheme). Outcomes were monthly rates of use of antipsychotics (by class and agent) and of 5 comparison drug classes (antidepressants, benzodiazepines, dermatologicals, antidiabetics, antiasthmatics). Trends were analyzed by joinpoint regression, impact of warnings by linear segmented regression. In patients with dementia (n=7169), there was a 40% reduction in antipsychotic use from 14.2% in 2003 to 10.2% in 2011. The reduction began before 2004 and was unaffected by the warnings. Use of first generation antipsychotics declined over the period, while use of SGAs increased and leveled off from 2007. Use of the 5 comparison drug classes increased on the period. In subjects without dementia (n=91942), rates of overall antipsychotic use decreased from 2.3% in 2003 to 1.8% in 2011 with no effect of the warnings. Meanwhile, use of SGAs continuously increased from 0.37% to 0.64%. Antipsychotic use decreased in the elderly between 2003 and 2011, especially in dementia. The timing of the decrease, however, did not coincide with safety warnings. PMID:24126116

  18. Trends in use of antipsychotics in elderly patients with dementia: Impact of national safety warnings.

    PubMed

    Gallini, Adeline; Andrieu, Sandrine; Donohue, Julie M; Oumouhou, Naïma; Lapeyre-Mestre, Maryse; Gardette, Virginie

    2014-01-01

    Based on evidence of an increased risk of death, drug agencies issued safety warnings about the use of second generation antipsychotics (SGAs) in the elderly with dementia. The French agency issued a warning in 2004. which was extended to all antipsychotics in 2008. Little is known about the impact of these warnings on use. We conducted a quasi-experimental study (interrupted time-series) in France, for 2003-2011, including subjects aged ≥65 with dementia and subjects aged ≥65 without dementia in the EGB database (1/97th representative random sample of claims from the main Health Insurance scheme). Outcomes were monthly rates of use of antipsychotics (by class and agent) and of five comparison drug classes (antidepressants, benzodiazepines, dermatologicals, antidiabetics, antiasthmatics). Trends were analyzed by joinpoint regression, impact of warnings by linear segmented regression. In patients with dementia (n=7169), there was a 40% reduction in antipsychotic use from 14.2% in 2003 to 10.2% in 2011. The reduction began before 2004 and was unaffected by the warnings. Use of first generation antipsychotics declined over the period, while use of SGAs increased and leveled off from 2007. Use of the five comparison drug classes increased on the period. In subjects without dementia (n=91,942), rates of overall antipsychotic use decreased from 2.3% in 2003 to 1.8% in 2011 with no effect of the warnings. Meanwhile, use of SGAs continuously increased from 0.37% to 0.64%. Antipsychotic use decreased in the elderly between 2003 and 2011, especially in dementia. The timing of the decrease, however, did not coincide with safety warnings. © 2013 Published by Elsevier B.V. and ECNP.

  19. US national energy strategy: Progress and viewpoint

    SciTech Connect

    1992-01-01

    Interest in energy policy is not new. President Eisenhower grappled with oil policy. President Nixon pushed {open_quotes}energy independence.{close_quotes} President Carter attempted the formulation of a comprehensive policy. All failed in one way or another. Efforts to define comprehensive national policy continue. Two years ago President Bush directed the DOE to prepare a {open_quotes}National Energy Strategy.{close_quotes} An energy package was sent to Congress in 1991, but despite compromises among competing interests, the end result was that not enough votes could be garnered to pass the legislation. Another attempt is expected in 1992. A major problem with the previous bill was that in attempting to be {open_quotes}comprehensive,{close_quotes} too many controversial issues were wrapped into a single package. The next attempt is likely to be divided into several bills; some may pass, others may not. Topics that received the most attention in the 1991 session are expected to get equal scrutiny in 1992. These topics include: (1) Mandated automobile gasoline mileage standards-raised required corporate average fuel economy (CAFE) from 24 to 40 miles per gallon. (2) Oil exploration in Alaska`s Arctic National Wildlife Refuge. (3) Simplified licensing of nuclear power plants. (4) Increased competition in electrical power production. (5) Increase of conservation and renewables development funding beyond the Administration`s proposed level. Concern about the environment, adequate supply of electrical power, and production and conservation of petroleum is the driving force behind consideration of these topics and the major underlying influence shaping debate over energy policy.

  20. The role of higher education in transforming the quality of dementia care: dementia studies at the University of Bradford.

    PubMed

    Downs, M; Capstick, A; Baldwin, P C; Surr, C; Bruce, E

    2009-04-01

    There is now widespread concern about the inadequate care and support provided to people with dementia from diagnosis to death. It is acknowledged that while there is a range of effective ways to care for and support people with dementia and their families from diagnosis to death, these have yet to become integral to practice. In England, for example, the National Dementia Strategy seeks to transform the quality of dementia care. One of the key components to transforming the quality of care is to ensure we have an informed and effective workforce. We argue here that in order to transform the quality of care we need to distinguish between the aims of training and education. Whilst there is a place for skills-based workplace training, Higher Education in dementia studies has a key role to play in the provision of specialist knowledge and skills in dementia care emphasizing as it does the development of critical thinking, reflection and action. In this paper we describe dementia studies at Bradford University available at both undergraduate and postgraduate levels. We outline their aims and learning outcomes, curricula, approach to teaching, learning and assessment. We describe the nature of students who study with us, noting their fit with the Higher Education Funding Council in England's agenda for widening participation in higher education. Higher Education in dementia studies has a unique role to play in equipping practitioners and professionals with the information, skills and attitudes to realize the potential for quality of life for people with dementia and their families.

  1. Antipsychotic Use In a Diverse Population with Dementia: A Retrospective Review of the National Alzheimer’s Coordinating Center (NACC) database

    PubMed Central

    Xiong, Glen L.; Filshtein, Teresa; Beckett, Laurel A.; Hinton, Ladson

    2015-01-01

    A cross-sectional analysis examined medication records to Alzheimer’s Disease Centers from 2008 to 2014, in the community dwelling patients with dementia in the National Alzheimer’s Coordinating Center Database. Hispanic participants had a 1.62-fold greater use of antipsychotic medications (95% CI 1.32–1.98), largely accounted for by a higher prevalence of neuropsychiatric symptoms and more severe dementia, compared to non-Hispanic Whites. Our results are consistent with reports of later transition to nursing home care among Hispanic participants. Further studies are needed to clarify ethnic differences on how families and physicians address dementia progression and neuropsychiatric symptoms in community dwelling patients with dementia. PMID:26488486

  2. A Systematic Review of Strategies to Foster Activity Engagement in Persons With Dementia

    PubMed Central

    Trahan, Maranda A.; Kuo, Julie; Carlson, Michelle C.; Gitlin, Laura N.

    2015-01-01

    Dementia is a growing public health issue. Activity, a positive therapeutic modality, has potential to enhance quality of life and reduce behavioral symptoms in persons with dementia—outcomes eluding pharmacological treatments. However, it is unclear how to effectively engage persons with dementia in activities for them to derive desired benefits. We present a systematic review of 28 studies involving 50 tests of different ways of modifying activities to enhance engagement and reduce behavioral and psychological symptoms for this group. Of 50 tests, 22 (44%) evaluated changes to objects and properties (e.g., introducing activities with intrinsic interest), 6 (12%) evaluated changes to space demands (e.g., lighting, noise levels), 8 (16%) evaluated changes to social demands (e.g., prompts, praise), and 14 (28%) combined two or more activity modifications. No modifications were made to the sequence and timing of activities. Although modifications to objects and properties were the most common, outcomes for engagement and behaviors were mixed. Modifications to space and social demands were less frequently tested, but consistently yielded positive outcomes. No modifications resulted in negative behavioral outcomes or decreased engagement. Methodological strengths of studies included direct observation of outcomes and fidelity assessments. Few studies however involved persons with dementia at home. Our review revealed a growing evidentiary base for different modifications to foster engagement in activities and reduce behavioral and psychological symptoms. Future studies should evaluate how contextual factors (e.g., physical environment, activity type) and caregiver ability to employ activity modifications affect engagement. PMID:25274714

  3. “The Right Way at the Right Time”: Insights on the Uptake of Falls Prevention Strategies from People with Dementia and Their Caregivers

    PubMed Central

    Meyer, Claudia; Dow, Briony; Hill, Keith D.; Tinney, Jean; Hill, Sophie

    2016-01-01

    Strong evidence exists for effective falls prevention strategies for community-dwelling older people. Understanding the translation of these strategies into practice for people with dementia has had limited research focus. People with dementia desire to have their voice heard, to engage meaningfully in the health-care decision-making process, making it a priority for researchers and practitioners to better understand how to engage them in this process. This paper reports on the qualitative aspects of a series of studies, which aimed to identify the views of people with dementia and their caregivers regarding perceptions of falls prevention and the successes and challenges of adopting falls prevention strategies. Twenty five people with dementia and their caregivers were interviewed in their homes at baseline, and 24 caregivers and 16 people with dementia were interviewed at completion of a 6-month individualized falls prevention intervention. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Five themes were identified at baseline: perceptions of falls; caregivers navigating the new and the unpredictable; recognition of decline; health services – the need for an appropriate message; and negotiating respectful relationships. At 6 months, caregivers and people with dementia decided on “what we need to know” with firm views that the information regarding falls risk reduction needed to be in “the right way … at the right time.” Rather than caregivers and people with dementia being only recipients of knowledge, they felt they were “more than just empty vessels to be filled” drawing on a “variety of resources” within their circle of influence to be able to positively “adapt to change.” The voices of people with dementia and their caregivers add an important dimension to understanding the translation of falls prevention knowledge for this population. Insights from this study will enable community care health

  4. The United States National Security Strategy: Grand Strategy or Propaganda

    DTIC Science & Technology

    2007-06-15

    Hegel was right when he said that we learn from history that man can never learn anything from history.” George Bernard Shaw 58 July 26th, 2007...nation more challenging.124 As Taylor and Snider explain, “With the global diffusion of power, national policy also becomes less fungible, less...124 William J. Taylor and Don M Snider, “U.S. National Security Agenda and U.S. National Security Policy: Realities and Dilemmas,” The

  5. Healthcare providers' knowledge of disordered sleep, sleep assessment tools, and nonpharmacological sleep interventions for persons living with dementia: a national survey.

    PubMed

    Brown, Cary A; Wielandt, Patricia; Wilson, Donna; Jones, Allyson; Crick, Katelyn

    2014-01-01

    A large proportion of persons with dementia will also experience disordered sleep. Disordered sleep in dementia is a common reason for institutionalization and affects cognition, fall risk, agitation, self-care ability, and overall health and quality of life. This report presents findings of a survey of healthcare providers' awareness of sleep issues, assessment practices, and nonpharmacological sleep interventions for persons with dementia. There were 1846 participants, with the majority being from nursing and rehabilitation. One-third worked in long-term care settings and one-third in acute care. Few reported working in the community. Findings revealed that participants understated the incidence of sleep deficiencies in persons with dementia and generally lacked awareness of the relationship between disordered sleep and dementia. Their knowledge of sleep assessment tools was limited to caregiver reports, self-reports, and sleep diaries, with few using standardized tools or other assessment methods. The relationship between disordered sleep and comorbid conditions was not well understood. The three most common nonpharmacological sleep interventions participants identified using were a regular bedtime routine, increased daytime activity, and restricted caffeine. Awareness of other evidence-based interventions was low. These findings will guide evidence-informed research to develop and test more targeted and contextualized sleep and dementia knowledge translation strategies.

  6. Healthcare Providers' Knowledge of Disordered Sleep, Sleep Assessment Tools, and Nonpharmacological Sleep Interventions for Persons Living with Dementia: A National Survey

    PubMed Central

    Brown, Cary A.; Jones, Allyson; Crick, Katelyn

    2014-01-01

    A large proportion of persons with dementia will also experience disordered sleep. Disordered sleep in dementia is a common reason for institutionalization and affects cognition, fall risk, agitation, self-care ability, and overall health and quality of life. This report presents findings of a survey of healthcare providers' awareness of sleep issues, assessment practices, and nonpharmacological sleep interventions for persons with dementia. There were 1846 participants, with the majority being from nursing and rehabilitation. One-third worked in long-term care settings and one-third in acute care. Few reported working in the community. Findings revealed that participants understated the incidence of sleep deficiencies in persons with dementia and generally lacked awareness of the relationship between disordered sleep and dementia. Their knowledge of sleep assessment tools was limited to caregiver reports, self-reports, and sleep diaries, with few using standardized tools or other assessment methods. The relationship between disordered sleep and comorbid conditions was not well understood. The three most common nonpharmacological sleep interventions participants identified using were a regular bedtime routine, increased daytime activity, and restricted caffeine. Awareness of other evidence-based interventions was low. These findings will guide evidence-informed research to develop and test more targeted and contextualized sleep and dementia knowledge translation strategies. PMID:24851185

  7. Mixed Dementia

    MedlinePlus

    ... community Use our Virtual Library Treatment and outcomes back to top Because most people with mixed dementia are diagnosed with a single type of dementia, physicians often base their prescribing decisions on the type of dementia ...

  8. Social policy for people with dementia in England: promoting human rights?

    PubMed

    Boyle, Geraldine

    2010-09-01

    This paper discusses whether current UK social policy promotes the human rights of people with dementia living in England. The author focuses on the role of recent legal reforms and key developments in social care policy--notably the Mental Capacity Act 2005 and the 2009 National Dementia Strategy--in facilitating their human rights to liberty and self-determination, particularly a right to choose to live at home. The extent to which the National Dementia Strategy provides access to services and support which provide an alternative to institutional care is critiqued. Whilst recent legislative change has endorsed the rights of people with dementia to liberty and self-determination, it is suggested there is a lack of commitment in government policy more generally to providing access to social care to enable people with dementia to exercise these human rights.

  9. Dementia Friendly, Dementia Capable, and Dementia Positive: Concepts to Prepare for the Future

    PubMed Central

    Lin, Shih-Yin; Lewis, Frances Marcus

    2015-01-01

    With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer’s Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and promoting dementia research. In the U.S., President Obama signed the National Alzheimer’s Project Act, which led to the formation of the Advisory Council on Alzheimer’s Research, Care, and Services and the launch of the first National Plan to Address Alzheimer’s Disease. The term “dementia capable” was introduced in the 2012 Recommendations of the Public Members of the Advisory Council and has since been adopted in both the recommendations and annual updates of the national plan. This paper will first compare and contrast government usage of the concepts dementia friendly and dementia capable, along with another valuable concept, dementia positive, that was added after reviewing the literature. Finally, a new vision statement for the U.S.’ national plan will be proposed and recommendations incorporating these 3 concepts in policy, research, and practice will be made. PMID:26035599

  10. Dementia friendly, dementia capable, and dementia positive: concepts to prepare for the future.

    PubMed

    Lin, Shih-Yin; Lewis, Frances Marcus

    2015-04-01

    With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer's Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and promoting dementia research. In the U.S., President Obama signed the National Alzheimer's Project Act, which led to the formation of the Advisory Council on Alzheimer's Research, Care, and Services and the launch of the first National Plan to Address Alzheimer's Disease. The term "dementia capable" was introduced in the 2012 Recommendations of the Public Members of the Advisory Council and has since been adopted in both the recommendations and annual updates of the national plan. This paper will first compare and contrast government usage of the concepts dementia friendly and dementia capable, along with another valuable concept, dementia positive, that was added after reviewing the literature. Finally, a new vision statement for the U.S.' national plan will be proposed and recommendations incorporating these 3 concepts in policy, research, and practice will be made. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. National Indigenous English Literacy and Numeracy Strategy, 2000-2004.

    ERIC Educational Resources Information Center

    Australian Dept. of Employment, Education, Training and Youth Affairs, Canberra.

    Australia's National Indigenous Literacy and Numeracy Strategy acknowledges that extra effort and resources will be required for Indigenous Australian children to achieve the recently enacted national educational goals. The principal objective of the strategy is to achieve English literacy and numeracy for Indigenous students at levels comparable…

  12. National Drug Control Strategy. FY 2009 Budget Summary

    ERIC Educational Resources Information Center

    The White House, 2008

    2008-01-01

    The National Drug Control Budget Summary identifies resources and performance indicators for programs within the Executive Branch that are integral to the President's National Drug Control Strategy. The Strategy, which is the Administration's plan for reducing drug use and availability, is based on three pillars: (1) Stopping Use Before It Starts,…

  13. National Indigenous English Literacy and Numeracy Strategy, 2000-2004.

    ERIC Educational Resources Information Center

    Australian Dept. of Employment, Education, Training and Youth Affairs, Canberra.

    Australia's National Indigenous Literacy and Numeracy Strategy acknowledges that extra effort and resources will be required for Indigenous Australian children to achieve the recently enacted national educational goals. The principal objective of the strategy is to achieve English literacy and numeracy for Indigenous students at levels comparable…

  14. A Bayesian Approach to Identifying New Risk Factors for Dementia

    PubMed Central

    Wen, Yen-Hsia; Wu, Shihn-Sheng; Lin, Chun-Hung Richard; Tsai, Jui-Hsiu; Yang, Pinchen; Chang, Yang-Pei; Tseng, Kuan-Hua

    2016-01-01

    Abstract Dementia is one of the most disabling and burdensome health conditions worldwide. In this study, we identified new potential risk factors for dementia from nationwide longitudinal population-based data by using Bayesian statistics. We first tested the consistency of the results obtained using Bayesian statistics with those obtained using classical frequentist probability for 4 recognized risk factors for dementia, namely severe head injury, depression, diabetes mellitus, and vascular diseases. Then, we used Bayesian statistics to verify 2 new potential risk factors for dementia, namely hearing loss and senile cataract, determined from the Taiwan's National Health Insurance Research Database. We included a total of 6546 (6.0%) patients diagnosed with dementia. We observed older age, female sex, and lower income as independent risk factors for dementia. Moreover, we verified the 4 recognized risk factors for dementia in the older Taiwanese population; their odds ratios (ORs) ranged from 3.469 to 1.207. Furthermore, we observed that hearing loss (OR = 1.577) and senile cataract (OR = 1.549) were associated with an increased risk of dementia. We found that the results obtained using Bayesian statistics for assessing risk factors for dementia, such as head injury, depression, DM, and vascular diseases, were consistent with those obtained using classical frequentist probability. Moreover, hearing loss and senile cataract were found to be potential risk factors for dementia in the older Taiwanese population. Bayesian statistics could help clinicians explore other potential risk factors for dementia and for developing appropriate treatment strategies for these patients. PMID:27227925

  15. Economic Sanctions Targeting Yugoslavia - An Effective National Security Strategy Component

    DTIC Science & Technology

    2006-05-31

    USAWC STRATEGY RESEARCH PROJECT Economic Sanctions Targeting Yugoslavia – An Effective National Security Strategy Component by COL Charles J. Kacsur...Jr. U.S. Army Dr. Clayton K. S. Chun Project Advisor The views expressed in this academic research paper are those of the author and do not...National Security Strategy Component 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Charles Kacsur; 5d. PROJECT

  16. People with dementia and carers' experiences of dementia care and services: Outcomes of a focus group study.

    PubMed

    Sutcliffe, Caroline L; Roe, Brenda; Jasper, Rowan; Jolley, David; Challis, David J

    2015-11-01

    An ageing population and an associated increase in the prevalence of dementia are of increasing concern in the United Kingdom and worldwide. Recently, the United Kingdom and other European countries implemented national dementia strategies to address this. This paper reports on the outcomes of a focus group study involving people with dementia and carers on their experiences of dementia care and support services in relation to government and third sector agencies' objectives and recommendations. Three focus groups comprising carers and people with dementia (n = 27) were undertaken covering topics related to experiences, service receipt, information sharing and service development. Some participants experienced difficulties or delays in receiving a dementia diagnosis and in accessing appropriate care. The provision of training, timeliness of information, access to appropriate advice, and consistent and flexible services were deemed important. The findings suggest that some issues raised by participants were highlighted in earlier policy objectives and recommendations but remain of central concern. The projected growth in the number of people with dementia coupled with reduced availability of informal care and increased demand for services emphasises the need to transform dementia care in the United Kingdom.

  17. Response to the National Career Development Strategy Green Paper

    ERIC Educational Resources Information Center

    Australian Journal of Career Development, 2012

    2012-01-01

    The National Career Development Strategy Green Paper paper proposes a strategy that is committed to these principles: (1) quality through Career Industry Council of Australia (CICA) benchmarking, quality frameworks and processes and as a risk management strategy; (2) lifetime access to career development services; (3) development of career…

  18. Response to the National Career Development Strategy Green Paper

    ERIC Educational Resources Information Center

    Australian Journal of Career Development, 2012

    2012-01-01

    The National Career Development Strategy Green Paper paper proposes a strategy that is committed to these principles: (1) quality through Career Industry Council of Australia (CICA) benchmarking, quality frameworks and processes and as a risk management strategy; (2) lifetime access to career development services; (3) development of career…

  19. Strategy, National Interests, and Means to an End

    DTIC Science & Technology

    2007-10-01

    STRATEGY, NATIONAL INTERESTS, AND MEANS TO AN END Stephen D. Sklenka October 2007 This publication is a work of the U.S. Government as defined in...REPORT DATE OCT 2007 2. REPORT TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE Strategy, National Interests, and Means to...Non- Resident Program. v ABSTRACT This paper focuses on the interrelationship among national interests, stated ends, means to achieve those ends, and

  20. National Will: Achilles Heel in United States National Strategy

    DTIC Science & Technology

    1990-05-01

    turn off our Christmas tree lights. A nation’s psyche is like a child’s: without any successes it loses confidence to act forcefully. The United States...successes. In turn, this could reduce the endemic national self-criticism, which is so damaging to our national psyche . Finally, this might allow the people...ANALYTICAL STUDY SUBMITTED TO THE FACULTY IN FULFILLMENT OF TRE CURRICULUM REQUIREMENT Advisor: Lieutenant Colonel James S. O’Rourke, IV MAXWELL AIR FORCE BASE

  1. Geo-Strategic Context: South Asia, A National Security Strategy

    DTIC Science & Technology

    1998-02-27

    ARCHIVE COPY NATIONAL DEFENSE UNIVERSITY NATIONAL WAR COLLEGE GEO-STRATEGIC CONTEXT SOUTH ASIA, A NATIONAL SECURITY STRATEGY MS Youngeun ... Anderson and Captain D Craig Wellmg/Class of 1998 Course 5604 Seminar I FACULTY SEMINAR LEADER CAPT J Kelso 27 February 1998 78-E-54 c-. I Report

  2. Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia.

    PubMed

    Luxford, Karen; Axam, Anne; Hasnip, Fiona; Dobrohotoff, John; Strudwick, Maureen; Reeve, Rebecca; Hou, Changhao; Viney, Rosalie

    2015-06-01

    To examine the impact of implementing a clinician-carer communication tool for hospitalized patients with dementia. Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-psychotics and one-to-one nursing. Twenty-one hospitals in Australia. Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation. Implementation of a communication tool over 12 months. The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs. Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = -6.85, P < 0.05). Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents 'good practice' with a low risk of harm for patients. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  3. Risk of dementia in patients hospitalised with type 1 and type 2 diabetes in England, 1998-2011: a retrospective national record linkage cohort study.

    PubMed

    Smolina, Kate; Wotton, Clare J; Goldacre, Michael J

    2015-05-01

    Type 2 diabetes increases the risk of subsequent dementia. Our objective was to determine whether a similar risk of subsequent dementia is associated with type 1 diabetes in a large defined population. This retrospective cohort study examined national administrative record-linked statistical data on hospital care and mortality in England, 1998-2011. Cohorts of people admitted to hospital when aged 30 or over were constructed: 343,062 people with type 1 diabetes; 1,855,141 people with type 2 diabetes; and a reference cohort. Results were expressed as rate ratios (RR) comparing each diabetes cohort with the control cohort. The overall RR for dementia in people admitted to hospital with type 1 diabetes was 1.65 (95% CI 1.61, 1.68), and for people admitted to hospital with type 2 diabetes was 1.37 (1.35, 1.38). Young age at admission for diabetes appeared to confer a greater rate of subsequent dementia; the RR for dementia in people admitted to hospital with type 1 diabetes aged 30-39 years was 7.10 (4.65, 10.6), which reduced to 4.40 (3.55, 5.40) in those aged 40-49 at admission, and further reduced with increasing age to 1.16 (1.11, 1.20) in those aged 80 or over at admission. A similar pattern was seen with type 2 diabetes. Type 1 diabetes, as well as type 2 diabetes, may be associated with an elevated risk of subsequent dementia. The risk of dementia varies with age at admission to hospital with diabetes, and appears to be much greater in the young.

  4. National Security Strategy: What About the Environment

    DTIC Science & Technology

    2006-02-27

    and South Korea, to seabed mining and drilling rights in countries surrounding the Caspian Sea. According to Ambassador Jan Kubis , Secretary General of...national economy, distribute wealth, and provide basic goods and services. Kubis notes, “Such environmental pressures 8 could make social polarization...the U.S. interest (Washington, D.C.: Jewish Institute for National Security Affairs, 2001), x. 21 7 Ibid. 8 Jan Kubis , “Initiative For Change,” Our

  5. [Behavioural and psychological signs in dementia. Clinical features. Pharmacological and non-pharmacological treatment strategies].

    PubMed

    Gabay, Pablo M; Herrera Mingorace, Julio; Kremer, Janus; Taragano, Fernando; Reich, Edgardo G; Ure, Jorge

    2008-01-01

    In first term, we define the current concepts in regard to psychosis (delirium and hallucinations) and abnormal behaviours (aggression, depression and mood changes such as mania, apathy, anxiety, agitation and desinhibition) in dementia. We also review the most used drugs in order to control these symptoms (typical and atypical antipsychotics, anti-epileptic drugs, benzodiazepines, SSRI, memantine and AcheI). As well, we take in consideration pharmacokinetic and pharmacodynamic characteristics, relationship to aging and interactions of these medications. Finally, we briefly describe the management of non-pharmacological of the most common behavioural symptoms: disruptive conducts such as exaggerated responses to minimal stimuli, catastrophic reaction, violence, anger and hostility, wandering and sundowning. As well, we discuss how to manage sleep disturbances, sexual aggression, incontinence and dressing apraxia. Management of these conditions involves, in first term, a comprehensive understanding of the whole situation and identification of underlying possible causes will make possible to evaluate results. This approach will lead to a more rationale proposal of psychotherapeutic and behavioural techniques, and milieu modifications. Finaly, we consider safety patient's in the community as well as the risk of abuse originated in a non-healthy patient-caregiver relationship.

  6. Assistive technology for people with dementia: an overview and bibliometric study.

    PubMed

    Asghar, Ikram; Cang, Shuang; Yu, Hongnian

    2017-03-01

    This study presents an overview of recent research activities in assistive technology (AT) for people with dementia. Bibliometric studies are used to explore breadth and depth of different research areas, yet this method has not yet been fully utilised in AT research for people with dementia. The bibliometric method was used for collecting studies related to AT. Based on inclusion/exclusion criteria, the AT studies with a focus on people with dementia are considered. The study is based on factors such as number of publications, citations per paper, collaborative research output, P-Index, major research and application areas and national dementia strategies. Data were collected from 2000 to 2014 in AT research. The top 10 countries are selected based on their research outputs. USA emerged as the leading contributor with 503 publications and an annual growth rate of 16%, followed by UK with 399 publications and growth rate of 22%. Germany with 101 publications is on the 6th place, but it has a higher citation rate 16.43% as compared to USA (13.34%). Although all 10 countries show good collaborative research output, Italy, Spain and the Netherlands emerge as top collaborative research contributors with high percentages (84%, 84% and 79%). All the top 10 countries, except Canada, Germany and Spain, have national dementia strategies in place. The overall analysis shows that USA and UK are working extensively in AT research for people with dementia. Both these countries also have well established national dementia strategies. © 2017 Health Libraries Group.

  7. The National Drug Control Strategy, 1997.

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, Washington, DC.

    This federal document offers a comprehensive approach to reduce demand for illegal drugs and decrease their availability. Supported by statistical tables and graphs, the summary is divided into six sections. "The Purpose and Nature of the Strategy" outlines a 10-year plan for drug interdiction and reduction and identifies the elements of…

  8. News Note: National Strategy for Multi-wavelength Astronomy

    NASA Astrophysics Data System (ADS)

    2016-06-01

    The Department of Science and Technology (DST) has released the National Strategy for Multiwavelength Astronomy, which is intended to allow South Africa to take full advantage of its geographical advantages, and to maximise the return on investment made in astronomy.

  9. National Strategy for Modernizing the Regulatory System for Biotechnology Products

    EPA Pesticide Factsheets

    This National Strategy for Modernizing the Regulatory System for Biotechnology Products sets forth a vision for ensuring that the federal regulatory system is prepared to efficiently assess the risks, if any, of the future products of biotechnology.

  10. Forging a National Strategy for Success

    ERIC Educational Resources Information Center

    Reed, Jack

    2009-01-01

    At the National Staff Development Council's (NSDC's) 40th Annual Conference in December 2008, former NSDC Board President Karen Dyer and Executive Director Stephanie Hirsh presented the first Policy Maker of the Year Award to Senator Jack Reed (D-RI) in recognition of his dedicated work on behalf of legislation that promotes effective professional…

  11. National Interest: From Abstraction to Strategy

    DTIC Science & Technology

    1994-05-20

    the national values are Christianity, Communism, Islam, or vegetarianism . Only one question matters: Is the statesman acting to preserve the state...enter the capitalistic world market economy . Funny how things work out. As noted above, the real problem is when reputedly I intelligent, well

  12. From National to Theater: Developing Strategy

    DTIC Science & Technology

    2013-01-01

    important to set priorities. Hans Morgenthau differentiated between vital national interests and secondary interests, which are more dif- ficult to...Hegemony on the Cheap,” World Policy Journal 20, no. 4 (Winter 2003/2004). 12 Hans J. Morgenthau , The Impasse of Ameri- can Foreign Policy (Chicago

  13. Forging a National Strategy for Success

    ERIC Educational Resources Information Center

    Reed, Jack

    2009-01-01

    At the National Staff Development Council's (NSDC's) 40th Annual Conference in December 2008, former NSDC Board President Karen Dyer and Executive Director Stephanie Hirsh presented the first Policy Maker of the Year Award to Senator Jack Reed (D-RI) in recognition of his dedicated work on behalf of legislation that promotes effective professional…

  14. A national cohesive wildland fire management strategy

    Treesearch

    Forest Service U.S. Department of Agriculture; Office of Wildland Fire Coordination. Department of the Interior

    2011-01-01

    Addressing wildfire is not simply a fire management, fire operations, or wildland-urban interface problem - it is a larger, more complex land management and societal issue. The vision for the next century is to: Safely and effectively extinguish fire, when needed; use fire where allowable; manage our natural resources; and as a Nation, live with wildland fire. Three...

  15. How Nation-States Craft National Security Strategy Documents

    DTIC Science & Technology

    2012-10-01

    These were derived by utilizing the Balanced Score- card Performance Measurement System developed by Drs. Robert Kaplan and David Norton for the...accomplished with the em- ployment of a system developed in the United States ( Balanced Scorecard Performance Measurement Sys- tem) and applied to...effectiveness for a na- tional strategy. The Balanced Scorecard Performance 122 Measurement System was applied to supporting ob- jectives contained in

  16. National Military Strategy: Determinant, Resultant, or Figment.

    DTIC Science & Technology

    1981-01-01

    A IWII _A 969",l with strategy issues for fear of the attendant impact on force structure and roles and miss ions of the Services. While the study...Secretary of Defense. Thus, any study which impacts on the concepts for force employmenc or on the proposed force structure which emrges from the PPBS...President. Four executive branch studies mrit mntion because of their comprehensive nature and Significant impact . 17 In 1950, President Truman instructed

  17. Creativity and dementia: a review.

    PubMed

    Palmiero, Massimiliano; Di Giacomo, Dina; Passafiume, Domenico

    2012-08-01

    In these last years, creativity was found to play an important role for dementia patients in terms of diagnosis and rehabilitation strategies. This led us to explore the relationships between dementia and creativity. At the aim, artistic creativity and divergent thinking are considered both in non-artists and artists affected by different types of dementia. In general, artistic creativity can be expressed in exceptional cases both in Alzheimer's disease and Frontotemporal dementia, whereas divergent thinking decreases in dementia. The creation of paintings or music is anyway important for expressing emotions and well-being. Yet, creativity seems to emerge when the right prefrontal cortex, posterior temporal, and parietal areas are relatively intact, whereas it declines when these areas are damaged. However, enhanced creativity in dementia is not confirmed by controlled studies conducted in non-artists, and whether artists with dementia can show creativity has to be fully addressed. Future research directions are suggested.

  18. Lack of strategy holding: a new pattern of learning deficit in cortical dementias.

    PubMed

    Benedet, María J; Lauro-Grotto, Rosapia; Giotti, Chiara

    2009-09-01

    The aim of this study was to demonstrate, by means of systematic research and qualitative data analysis, the presence, among a group of patients with fronto-temporal lobar degeneration of a subgroup that, at variance with the standard pattern, is able to devise and implement learning strategies, but appear impaired at carrying them on from a trial to the next. In order to provide evidence of the existence of a group of patients showing this type of learning disability, that we refer to as lack of strategy holding, we performed a stepwise hierarchical cluster analysis of a set of variables whose scores were selected from the subject's performance at the Test de Aprendizaje Verbal España-Complutense. Results substantiate the segregation of three groups of subjects characterized by the following patterns of performance: normal elderly individuals, who show a quite preserved ability to discover a semantic strategy along the learning trials and to carry it from a trial to the next, patients presenting with a deficit in implementing semantic learning strategies and possibly use of serial and/or phonological strategies to perform the task, and to patients who, although able to generate and implement appropriate learning strategies, appear unable to carry them over the learning trials. The presence of this new pattern raises a few questions that seem worth trying to address.

  19. 3 CFR - Implementation of the National HIV/AIDS Strategy

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Implementation of the National HIV/AIDS Strategy... HIV/AIDS Strategy Memorandum for the Heads of Executive Departments and Agencies As we approach 30 years from the onset of the HIV/AIDS epidemic in the United States, new actions are needed to...

  20. National Military Strategy: Army Reserve Readiness

    DTIC Science & Technology

    2013-03-01

    like a Chevrolet dealership that only has sedans and mini- van while the Regular Army and National Guard are General Motors dealerships. 31F32 The...pick-ups trucks, and 21 SUVs. 32F33 In this scenario, the General Motors dealerships would be moving more units than the Army Reserve. In order...vehicles they have in stock today, but also start talking to General Motors about getting some other franchises and allocations for sportier model

  1. The National Literacy Strategy: A Critical Review of Empirical Evidence

    ERIC Educational Resources Information Center

    Wyse, Dominic

    2003-01-01

    This article examines three areas that are of central importance to the pedagogy of the National Literacy Strategy Framework for Teaching (FFT) at primary level: inspection evidence; school effectiveness (SE) research; and child development evidence. Analysis of national inspection reports on the teaching of English illustrates that these cannot…

  2. Developing and Implementing an Effective National Security Strategy for Croatia

    DTIC Science & Technology

    2013-03-01

    unfortunately unrealized dream.” This position was deemed unacceptable by the Minister of Foreign Affairs of the Republic of Croatia, Vesna Pusic.26 The...Parliament, Croatian National Security Strategy (Zagreb: The National Papers, number 32/02, March 2002), 2. 26 Minister of Foreign Affairs Vesna

  3. The National Security Strategy of the United States of America

    DTIC Science & Technology

    2006-03-01

    freedom to all the people in the region, including those suffering under the repressive regime in Burma. In ...National Security Strategy It is the policy of the United States to seek and support democratic movements and institutions in every nation and...culture, with the ultimate goal of ending tyranny in our world. In the world today, the fundamental character of regimes matters

  4. Toward a digital library strategy for a National Information Infrastructure

    NASA Technical Reports Server (NTRS)

    Coyne, Robert A.; Hulen, Harry

    1993-01-01

    Bills currently before the House and Senate would give support to the development of a National Information Infrastructure, in which digital libraries and storage systems would be an important part. A simple model is offered to show the relationship of storage systems, software, and standards to the overall information infrastructure. Some elements of a national strategy for digital libraries are proposed, based on the mission of the nonprofit National Storage System Foundation.

  5. Drug-induced, dementia-associated and non-dementia, non-drug delirium hospitalizations in the United States, 1998-2005: an analysis of the national inpatient sample.

    PubMed

    Lin, Robert Y; Heacock, Laura C; Fogel, Joyce F

    2010-01-01

    The incidence and pattern of delirium recorded in a broad spectrum of American hospitalizations has not been well described. The National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project is an administrative database of hospitalizations in the US that affords an opportunity to examine for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes relating to delirium. To examine the prevalence of delirium diagnoses and associated clinical factors, including adverse drug effects, in a broad spectrum of hospitalizations in the US. Delirium was grouped into three categories: drug-induced delirium, dementia-associated delirium, and non-dementia, non-drug (NDND). Hospitalizations during the years 1998-2005 in the NIS databases were examined. These databases represent samples of hospitalizations that allow for national prevalence estimates. ICD-9 codes for drug-induced, dementia-associated and NDND delirium were identified in the hospitalizations for each year. Delirium tremens was not considered in this classification, and paediatric and psychiatric admissions were excluded. Yearly prevalence for drug-induced, dementia-associated and NDND delirium were tabulated, and time trends were analysed with negative binomial regression. A hospitalization subset cohort with urinary tract/kidney infection, pneumonia, heart failure and lower extremity orthopaedic surgery diagnosis-related group categories was also analysed for clinical associations with the presence of the three categories of delirium using multinomial logistic regression. ICD-9 E codes (external causes of injury) constituting adverse drug effects were identified and considered as clinical predictors. Delirium was recorded in 1 269 185 (0.54%) non-psychiatric adult hospitalizations during the study years. Whereas the overall prevalence of dementia-associated delirium and NDND delirium decreased over time, drug-induced delirium prevalence increased (p < 0

  6. Medical management of frontotemporal dementias: the importance of the caregiver in symptom assessment and guidance of treatment strategies.

    PubMed

    Jicha, Gregory A

    2011-11-01

    There are no currently Food and Drug Administration-approved or proven off-label treatments for the frontotemporal dementias (FTD). Clinicians, caregivers, and patients struggle regularly to find therapeutic regimens that can alleviate the problematic behavioral and cognitive symptoms associated with these devastating conditions. Success is "hit or miss" and the lessons learned are largely anecdotal to date. Drug discovery in this area has been largely hampered by the heterogeneous clinical presentations and pathological phenotypes of disease that represent significant obstacles to progress in this area. Biologically, plausible treatment strategies include the use of antidepressants (selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor and monoamine oxidase inhibitors), acetylcholinesterase inhibitors, N-methyl-D-aspartic acid antagonists, mood stabilizers, antipsychotics, stimulants, antihypertensives, and agents that may ameliorate the symptoms of parkinsonism, pseudobulbar affect, and motor neuron disease that can often coexist with FTD. These medications all carry potential risks as well as possible benefits for the person suffering from FTD, and a clear understanding of these factors is critical in selecting an appropriate therapeutic regimen to maximize cognition and daily functions, reduce behavioral symptoms, and alleviate caregiver burden in an individual patient. The role of the caregiver in tracking and reporting of symptoms and the effects of individual therapeutic interventions is pivotal in this process. This manuscript highlights the importance of establishing an effective therapeutic partnership between the physician and caregiver in the medical management of the person suffering from FTD.

  7. The WHO-ITU national eHealth strategy toolkit as an effective approach to national strategy development and implementation.

    PubMed

    Hamilton, Clayton

    2013-01-01

    With few exceptions, national eHealth strategies are the pivotal tools upon which the launch or refocusing of national eHealth programmes is hinged. The process of their development obviates cross-sector ministerial commitment led by the Ministry of Health. Yet countries often grapple with the task of strategy development and best efforts frequently fail to address strategic components of eHealth key to ensure successful implementation and stakeholder engagement. This can result in strategies that are narrowly focused, with an overemphasis placed on achieving technical outcomes. Without a clear link to a broader vision of health system development and a firm commitment from partners, the ability of a strategy to shape development of a national eHealth framework will be undermined and crucial momentum for implementation will be lost. WHO and ITU have sought to address this issue through the development of the National eHealth Strategy Toolkit that provides a basis for the components and processes to be considered in a strategy development or refocusing exercise. We look at this toolkit and highlight those areas which the countries should consider in formulating their national eHealth strategy.

  8. 78 FR 79071 - National Maritime Strategy Symposium: Cargo Opportunities and Sealift Capacity

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... Maritime Administration National Maritime Strategy Symposium: Cargo Opportunities and Sealift Capacity... intended to develop a robust national maritime strategy. Stakeholders were asked to provide their ideas for... listen-only information January 10, 2014. distributed to registrants. National Maritime Strategy...

  9. Vascular Dementia

    MedlinePlus

    ... dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused ... dementia. Whether a stroke affects your thinking and reasoning depends on your stroke's severity and location. Vascular ...

  10. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease

    PubMed Central

    McKhann, Guy M.; Knopman, David S.; Chertkow, Howard; Hyman, Bradley T.; Jack, Clifford R.; Kawas, Claudia H.; Klunk, William E.; Koroshetz, Walter J.; Manly, Jennifer J.; Mayeux, Richard; Mohs, Richard C.; Morris, John C.; Rossor, Martin N.; Scheltens, Philip; Carrillo, Maria C.; Thies, Bill; Weintraub, Sandra; Phelps, Creighton H.

    2012-01-01

    The National Institute on Aging and the Alzheimer’s Association charged a workgroup with the task of revising the 1984 criteria for Alzheimer’s disease (AD) dementia. The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. We present criteria for all-cause dementia and for AD dementia. We retained the general framework of probable AD dementia from the 1984 criteria. On the basis of the past 27 years of experience, we made several changes in the clinical criteria for the diagnosis. We also retained the term possible AD dementia, but redefined it in a manner more focused than before. Bio-marker evidence was also integrated into the diagnostic formulations for probable and possible AD dementia for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. Much work lies ahead for validating the biomarker diagnosis of AD dementia. PMID:21514250

  11. An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes.

    PubMed

    Saini, Geena; Sampson, Elizabeth L; Davis, Sarah; Kupeli, Nuriye; Harrington, Jane; Leavey, Gerard; Nazareth, Irwin; Jones, Louise; Moore, Kirsten J

    2016-07-07

    Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between families and nursing home staff are uncommon, despite a range of potential benefits. In this study we aimed to examine practices relating to end-of-life discussions with family members of people with advanced dementia residing in nursing homes and to explore strategies for improving practice. An ethnographic study in two nursing homes where the Compassion Intervention was delivered. The Compassion Intervention provides a model of end-of-life care engaging an Interdisciplinary Care Leader to promote integrated care, educate staff, support holistic assessments and discuss end of life with families. We used a framework approach, undertaking a thematic analysis of fieldwork notes and observations recorded in a reflective diary kept by the Interdisciplinary Care Leader, and data from in-depth interviews with 23 informants: family members, GPs, nursing home staff, and external healthcare professionals. Four major themes described strategies for improving practice: (i) educating families and staff about dementia progression and end-of-life care; (ii) appreciating the greater value of in-depth end-of-life discussions compared with simple documentation of care preferences; (iii) providing time and space for sensitive discussions; and (iv) having an independent healthcare professional or team with responsibility for end-of-life discussions. The Interdisciplinary Care Leader role offers a promising method for supporting and improving end-of-life care discussions between families of people with advanced dementia and nursing home staff. These strategies warrant further evaluation in nursing home settings.

  12. [Development of oncogeriatry: national and international strategies].

    PubMed

    Droz, Jean-Pierre; Rodde-Dunet, Marie-Hélène; Vitoux, Anne

    2008-05-28

    Incidence of cancer increases with the recent increase of the life expectancy. Aging is characterized by health status heterogeneity. It is therefore difficult to exactly predict tolerance to treatment and to make decision. One of the major question is to classify the problems on the base of their impact on health status and outcome. It is only possible if oncologists and geriatricians work together. The objectives at the national and international levels are the same: to develop formation (teaching programs), information (for professionals and the public), clinical research. It is more difficult to develop case management, because it depends on health organisation status. A strong global program has been developed in France with the emergence of Pilot Units for the coordination of Oncogeriatrics. It begins to produce results.

  13. Multisensory Stimulation as an Intervention Strategy for Elderly Patients With Severe Dementia: A Pilot Randomized Controlled Trial.

    PubMed

    Sánchez, Alba; Marante-Moar, M Pilar; Sarabia, Carmen; de Labra, Carmen; Lorenzo, Trinidad; Maseda, Ana; Millán-Calenti, José Carlos

    2016-06-01

    The objective of this study was to compare the effect of multisensory stimulation environment (MSSE) and one-to-one activity sessions in the symptomatology of elderly individuals with severe dementia. Thirty-two participants were randomly assigned to the following 3 groups: MSSE, activity, and control group. The MSSE and activity groups participated in two 30-minute weekly sessions over 16 weeks. Pre-, mid-, and posttrial; 8-week follow-up behavior; mood; cognitive status; and dementia severity were registered. Patients in the MSSE group demonstrated a significant improvement in the Neuropsychiatric Inventory and Bedford Alzheimer Nursing Severity Scale scores compared with the activity group. Both MSSE and activity groups showed an improvement during the intervention in the Cohen-Mansfield Agitation Inventory aggressive behavior factor and total score, with no significant differences between groups. The MSSE may have better effects on neuropsychiatric symptoms and dementia severity in comparison with one-to-one activity sessions in patients with severe dementia.

  14. National Institute on Drug Abuse symposium report: drugs of abuse, dopamine, and HIV-associated neurocognitive disorders/HIV-associated dementia.

    PubMed

    Purohit, Vishnudutt; Rapaka, Rao; Frankenheim, Jerry; Avila, Albert; Sorensen, Roger; Rutter, Joni

    2013-04-01

    The National Institute on Drug Abuse organized a symposium on drugs of abuse, dopamine, and HIV-associated neurocognitive disorders (HAND)/HIV-associated dementia (HAD) in Rockville, Maryland, October 4, 2011. The purpose of this symposium was to evaluate the potential role of dopamine in the potentiation of HAND/HAD by drugs of abuse. A summary of the symposium has been presented in this report.

  15. Comparison of Recruitment Strategy Outcomes in the National Children's Study.

    PubMed

    Park, Christina H; Winglee, Marianne; Kwan, Jennifer; Andrews, Linda; Hudak, Mark L

    2017-07-19

    In 2000, the US Congress authorized the National Institutes of Health to conduct a prospective national longitudinal study of environmental influences on children's health and development from birth through 21 years. Several recruitment methodologies were piloted to determine the optimal strategy for a main National Children's Study. After an initial pilot recruitment that used a household enumeration strategy performed poorly, the National Children's Study Vanguard Study developed and evaluated the feasibility, acceptability, and cost of 4 alternate strategies to recruit a large prospective national probability sample of pregnant women and their newborn children. We compare household-based recruitment, provider-based recruitment, direct outreach, and provider-based sampling (PBS) strategies with respect to overall recruitment success, efficiency, cost, and fulfillment of scientific requirements. Although all 5 strategies achieved similar enrollment rates (63%-81%) among eligible women, PBS achieved the highest recruitment success as measured by the ratio of observed-to-expected newborn enrollees per year of 0.99, exceeding those of the other strategies (range: 0.35-0.48). Because PBS could reach the enrollment target through sampling of high volume obstetric provider offices and birth hospitals, it achieved the lowest ratio of women screened to women enrolled and was also the least costly strategy. With the exception of direct outreach, all strategies enrolled a cohort of women whose demographics were similar to county natality data. PBS demonstrated the optimal combination of recruitment success, efficiency, cost, and population representativeness and serves as a model for the assembly of future prospective probability-based birth cohorts. Copyright © 2017 by the American Academy of Pediatrics.

  16. Young-Onset Dementia

    PubMed Central

    Kuruppu, Dulanji K; Matthews, Brandy R

    2014-01-01

    Young-onset dementia (YOD) is an neurological syndrome that affects behavior and cognition of patients younger than 65 years of age. Although frequently misdiagnosed, a systematic approach, reliant upon attainment of detailed medical history, collateral history from an informant, neuropsychological testing, laboratory studies, and neuroimaging, may facilitate earlier and more accurate diagnosis with subsequent intervention. The differential diagnosis of YOD is extensive and includes early-onset forms of adult neurodegenerative conditions including Alzheimer's disease, vascular dementia, frontotemporal dementia, Lewy body dementias, Huntington's disease, and prion disease. Late-onset forms of childhood neurodegenerative conditions may also present as YOD and include mitochondrial disorders, lysosomal storage disorders, and leukodystrophies. Potentially reversible etiologies including inflammatory disorders, infectious diseases, toxic/metabolic abnormalities, transient epileptic amnesia, obstructive sleep apnea, and normal pressure hydrocephalus also represent important differential diagnostic considerations in YOD. This review will present etiologies, diagnostic strategies, and options for management of YOD with comprehensive summary tables for clinical reference. PMID:24234358

  17. A Model for the Development of US National Security Strategy.

    DTIC Science & Technology

    1983-05-01

    national security Is not just a matter of military strength but of an understandable and isplementable strategy. Understandable to Americans , Allies, and and...strategy process calculating risks, costs, impacts and results a little better than how we do it today. b.3 Together with American Allies and friendly...jeans and pays royalities to an American Firm (Levi). Two years ago, the largest selling movie in Yugoslavia was Star Wars. We loose morale because we

  18. The National Military Strategy of 1864, Who was the Author

    DTIC Science & Technology

    1994-04-22

    Reduction Project (0704-01M). Washington. DC 20S03. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED I 22 April 1994...This relationship not only le~ d to a successful strategy but also masterful execution that doomed the Confederacy. ii The National Military Strategy...profile. He was an extrovert who relied on sensing, thinking and judgment over intuition, feeling and perceptions. This personality type is good at

  19. The 2015 National Security Strategy: Authorities, Changes, Issues for Congress

    DTIC Science & Technology

    2016-02-26

    climate change ;  ensure access to shared spaces (expanding cyberspace and including outer space and air and maritime security); and  increase global...hand, one could conclude that these, along with confronting climate change , convey both a wider range of national security challenges in terms of...The 2015 National Security Strategy: Authorities, Changes , Issues for Congress Nathan J. Lucas, Coordinator Section Research Manager Kathleen

  20. Medical treatment and management of patients with dementia.

    PubMed

    Dening, Tom; Babu Sandilyan, Malarvizhi

    2015-07-08

    This article, the fifth in a series on dementia, discusses the principles of management and treatment of people with dementia. It describes how to proceed after a diagnosis of dementia has been made in the early stages of the condition, and general measures to maintain physical and mental health. Drug therapy for cognitive dysfunction is explained in the context of the National Institute for Health and Care Excellence guidance, and strategies for managing depression and psychotic symptoms are outlined. Non-pharmacological approaches are often effective. For behavioural problems such as agitation and aggression, it is important to try to understand any underlying factors. In general, the most important strategy is to avoid excessive prescribing.

  1. Dementia: getting the environment right.

    PubMed

    Yates-Bolton, Natalie; Codinhoto, Ricardo

    2013-03-01

    An IHEEM-supported conference staged recently at Salford University by the University's Dementia Design Group (HEJ - November 2012), examined the impact that different hospital environments have on people with dementia. Ricardo Codinhoto of the International Dementia Design Network, a qualified architect with practical, teaching, and research experience, and his co-chair on the Network, Natalie Yates-Bolton, a lecturer in Nursing at the University, explain the thinking behind the Group's approach to well-designed mental healthcare environments, and report on some of the key topics discussed at this first ever National Dementia Design Conference.

  2. National quality improvement policies and strategies in European healthcare systems.

    PubMed

    Spencer, E; Walshe, K

    2009-02-01

    This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer.

  3. National quality improvement policies and strategies in European healthcare systems

    PubMed Central

    Spencer, E; Walshe, K

    2009-01-01

    Objective: This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. Study design: A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. Participants: The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. Principal findings: There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. Conclusions: Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer. PMID:19188457

  4. Climate Change: Implications for National Security and Strategy

    DTIC Science & Technology

    2011-11-02

    The  National  Security  Implications  of   Climate   Change       November  2,  2011   Climate Change : Implications for National Security and...00-00-2011 4. TITLE AND SUBTITLE Climate Change : Implications for National Security and Strategy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c... Change       November  2,  2011   Climate Change : Part of the Strategic Landscape Enduring  trends  and  operational  challenges  will  shape

  5. Response to the National Career Development Strategy Green Paper

    ERIC Educational Resources Information Center

    Australian Journal of Career Development, 2012

    2012-01-01

    The Career Development Association of Australia (CDAA) congratulates the Commonwealth Government on the development of the National Career Development Strategy Green Paper. This is a timely and important document that provides a framework to demonstrate the central contribution that career development services play in supporting individuals,…

  6. Year 5 Booster Units. The National Literacy Strategy.

    ERIC Educational Resources Information Center

    Department for Education and Employment, London (England).

    The eight units of work in this document are designed to complement existing literacy booster units. Each unit is based on teaching objectives from the National Literacy Strategy Framework. They have been produced with the help of Year 5 teachers and have been trialled with pupils in a range of schools. The units support teachers' work with Year 5…

  7. Cybersecurity Strategy in Developing Nations: A Jamaica Case Study

    ERIC Educational Resources Information Center

    Newmeyer, Kevin Patrick

    2014-01-01

    Developing nations have been slow to develop and implement cybersecurity strategies despite a growing threat to governance and public security arising from an increased dependency on Internet-connected systems in the developing world and rising cybercrime. Using a neorealist theoretical framework that draws from Gilpin and Waltz, this qualitative…

  8. Cybersecurity Strategy in Developing Nations: A Jamaica Case Study

    ERIC Educational Resources Information Center

    Newmeyer, Kevin Patrick

    2014-01-01

    Developing nations have been slow to develop and implement cybersecurity strategies despite a growing threat to governance and public security arising from an increased dependency on Internet-connected systems in the developing world and rising cybercrime. Using a neorealist theoretical framework that draws from Gilpin and Waltz, this qualitative…

  9. Easter School Guidance. The National Literacy and Numeracy Strategies.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    This booklet explains the goals of Easter Schools, part of England's National Literacy and Numeracy Strategies. Easter Schools should be planned to cover four half-days and include four literacy and four mathematics lessons each covering the equivalent of at least an hour. The booklet addresses the following issues: why funding has been made…

  10. Teacher Stress and Coping Strategies: A National Snapshot

    ERIC Educational Resources Information Center

    Richards, Jan

    2012-01-01

    This national survey of 1,201 kindergarten through Grade-12-U.S. teachers focused on three related areas: (1) sources of teacher stress, (2) manifestations of stress, and (3) suggested coping strategies. The survey instrument was adapted from the Teacher Stress Inventory and the Coping Scale for Adults. Results indicated that teachers nationwide…

  11. Teacher Stress and Coping Strategies: A National Snapshot

    ERIC Educational Resources Information Center

    Richards, Jan

    2012-01-01

    This national survey of 1,201 kindergarten through Grade-12-U.S. teachers focused on three related areas: (1) sources of teacher stress, (2) manifestations of stress, and (3) suggested coping strategies. The survey instrument was adapted from the Teacher Stress Inventory and the Coping Scale for Adults. Results indicated that teachers nationwide…

  12. The National Security Strategy of the United States of America

    DTIC Science & Technology

    2006-03-01

    freedom to all the people in the region, including those suffering under the repressive regime in Burma. In promoting...Security Strategy It is the policy of the United States to seek and support democratic movements and institutions in every nation and culture...with the ultimate goal of ending tyranny in our world. In the world today, the fundamental character of regimes matters

  13. Response to the National Career Development Strategy Green Paper

    ERIC Educational Resources Information Center

    Australian Journal of Career Development, 2012

    2012-01-01

    The Career Development Association of Australia (CDAA) congratulates the Commonwealth Government on the development of the National Career Development Strategy Green Paper. This is a timely and important document that provides a framework to demonstrate the central contribution that career development services play in supporting individuals,…

  14. Strategies for job creation through national forest management

    Treesearch

    Susan Charnley

    2014-01-01

    This chapter explores the ways in which national forest managers may contribute to community well-being by designing projects that accomplish forest management in ways that not only meet their ecological goals, but also create economic opportunities for nearby communities. The chapter summarizes a number of strategies for enhancing the economic benefits to communities...

  15. National Health Insurance and Health Education: Strategies for Change.

    ERIC Educational Resources Information Center

    Dwore, Richard B.

    1980-01-01

    The concept of National Health Insurance (NHI) as one of several strategies for resolving health problems in the U.S. is discussed. NHI goals include comprehensive health care, quality health care, efficient delivery systems, phased-in benefits, and consumer representation. (JD)

  16. Year 8 English Banks. Key Stage 3: National Strategy.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    Part of England's Key Stage 3 National Strategy, this key objectives bank for Year 8 provides information and guidance to help teachers to: translate numerical targets into curricular objectives; focus teaching on those things that will help pupils' progress; and inform assessment tasks. Word level objectives concern complex and unfamiliar words;…

  17. Year 6 Planning Exemplification 3. National Literacy Strategy.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    Third in a series of booklets designed to assist Year 6 teachers with planning instruction to meet objectives of the National Literacy Strategy, this booklet contains Summer Term planning exemplification for three "revision" units (Narrative, Poetry and Non-fiction) prior to the Key Stage 2 tests and one unit after the tests (Extended…

  18. Strategies and Students: Beginning Teachers' Early Encounters with National Policy

    ERIC Educational Resources Information Center

    Rosowsky, Andrey

    2006-01-01

    The 1-year Postgraduate Certificate in Education Secondary English method course at the University of Sheffield's School of Education has, since 2001, asked its students to write an essay of around 4000 words on their initial understanding and experience of the National Strategies promoted by the United Kingdom's Department for Education and…

  19. Spatial strategies for managing visitor impacts in National Parks

    USGS Publications Warehouse

    Leung, Y.-F.; Marion, J.L.

    1999-01-01

    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  20. Effect of educational and supportive strategies on the ability of caregivers of people with dementia to maintain participation in that role.

    PubMed

    Thinnes, Andrea; Padilla, René

    2011-01-01

    A systematic review of evidence of the effectiveness of educational and supportive strategies for enabling caregivers of people with Alzheimer's disease (AD) or related dementias to maintain participation in that role was conducted as part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. Forty-three articles met inclusion criteria. Results suggest that interventions that jointly engage people with AD and their caregivers in education and training in the home setting are more successful than strategies that focus solely on people with AD. Greater carryover is noted when education and training are implemented at the time that the caregiver identifies concerns. Interventions should provide caregivers with problem solving, technical skills, support, simple home modification strategies, and referral to community resources. Interventions mediated by technology have a positive effect on the caregiver and are especially important for those who live in rural areas.

  1. Dementia as a Disability and Human Rights Issue.

    PubMed

    Rushford, Nancy; Harvey, David

    In their article "Toward a Community-Based Dementia Care Strategy: How Do We Get There from Here?" Morton-Chang et al. draw attention to the urgent need for a community-based dementia care strategy in Canada. Drawing from national and international experience, including an illustrative case study of policy in Ontario, they identify three key strategic pillars to guide strategic action: 1. Engage persons living with dementia (PLWD) to any extent possible in decisions around their own care. 2. Acknowledge and support informal caregivers in their pivotal roles supporting PLWD and consequently the formal care. 3. Enable "ground-up" change through policies and funding mechanisms designed to ensure early intervention across a continuum of care. In this paper, we aim to broaden the lens for dementia and strategic action by framing dementia in terms of disability and human rights. We contend that a human rights approach is critical to addressing the vulnerability of people with dementia and caregivers and achieving the principal goals of dementia care, as they are largely represented in the strategic pillars proposed. These pillars direct action towards key areas of change within the existing health system but may not in and of themselves create the transformative change needed across systems and levels. Through the lens of disability and human rights, we reflect upon the complexity of dementia and move from the individual to the social sphere - shifting the focus from "care" that is oriented to "maintenance" in the community, towards "enablement," "empowerment" and social change, as it involves the reconceptualization of dementia that has begun to take shape at local, national and international levels. This brings us to the central argument of this paper, that dementia is as much a human rights issue and a social problem as it is a health issue, necessitating widespread social/systems change and strategic action that "challenges and changes the defining beliefs of a

  2. [Perspectives of Spanish psychiatrists on the management of dementias: the PsicoDem survey].

    PubMed

    Martín-Carrasco, Manuel; Arranz, Francisco Javier

    2015-01-01

    Mental health services are not systematically involved in the care of dementias in Spain. Nevertheless, many patients with dementia attend these services. The perspective of psychiatrist as regards this situation has not been evaluated at the national level to date, and it may be of interest to determine their actual involvement and the strategies to foster it. A survey was conducted on 2,000 psychiatrists on a range of mental health care services. Respondents provided socio-demographic data and information about clinical aspects, together with their opinions regarding the management of dementia. Responses were described by their raw frequencies and measures of association for cross-tabulations resulting from selected pairs of questions. Inferences were made by calculating their 95% confidence intervals. Psychiatrist involvement in the management of dementias was limited, aside from those involved in psycho-geriatric units or nursing homes facilities. However, there were wide, regional differences. Nearly all respondents (81%) were ready to augment their knowledge and skills in the area of dementia. In particular, the insufficient medical education, together with other organizational factors, such as the difficulties in ordering diagnostic tests (i.e. neuroimaging), or prescribing anti-dementia drugs in some regions, were common barriers psychiatrists faced when approaching patients with dementia. Increasing psychiatrist involvement and boosting coordinated efforts with other specialists in a form of integrated care may advance the care of dementias in Spain to a more valuable level. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

  3. A new ball game: the United Nations Convention on the Rights of Persons with Disabilities and assumptions in care for people with dementia.

    PubMed

    Smith, Anita; Sullivan, Danny

    2012-09-01

    The United Nations Convention on the Rights of Persons with Disabilities is a powerful international instrument which imposes significant responsibilities on signatories. This column discusses changes in the definition of legal capacity which will have significant impacts on decision-making related to people with dementia. Various restrictions and limitations on personal freedoms are discussed in light of the Convention. The main focus is on challenges to existing paradigms of substitute decision-making, which are in wide use through a guardianship model. Under Art 12 of the Convention, moves to supported decision-making will result in significant changes in ensuring the rights of people with dementia. There are challenges ahead in implementing supported decision-making schemes, not only due to tension with existing practices and legislation, but also the difficulty of developing and resourcing workable schemes. This is particularly so with advanced dementia, which is acknowledged as a pressing issue for Australia due to effective health care, an ageing population and changing expectations.

  4. Impact on the PACOM regional command strategy of the evolving national security strategy. Final report

    SciTech Connect

    Riddle, M.H.

    1994-02-08

    This paper deals with the conclusions and recommendations of the impact the evolving United States national security strategy may have on the PACOM regional command strategy. The conclusions and recommendations are based on a survey of the January 1993 National Security Strategy of the United States presented by the outgoing Administration and the impact that the evolving strategy of the Clinton Administration is having. These conclusions and recommendations are also influenced by current events surrounding the activities and policy debate centered on the Peoples Democratic Republic of Korea. The conclusions drawn are that the objectives of national security are timeless and consistent from Administration to Administration, even when the party changes. The divergence occurs in emphasis and priority. Several impacts on the PACOM regional command strategy are identified as a result. To break the reliance on the strategy of deterrence requires refocusing of the priority from the global-international level to the regional level. The recommendation is made that the Administration should de-link the military considerations on the Korean peninsula from the international debate over the DPRK nuclear program.

  5. Cost of dementia in Switzerland.

    PubMed

    Kraft, Eliane; Marti, Michael; Werner, Sarah; Sommer, Heini

    2010-09-10

    The aim of this study was (a) to estimate the cost of dementia in Switzerland, (b) to compare the average annual cost for people with dementia who live at home and those living in an institution and (c) to analyse how the average cost per person with dementia who lives at home increases with the severity of dementia. This prevalence-based cost-of-illness study from a societal perspective combined top-down and bottom-up approaches and included both direct and indirect costs of dementia. Cost estimations were based on Swiss national statistics and surveys, as well as international reviews and expert interviews. The total annual cost of dementia amounted up to CHF 6.3 billion for the year 2007. Together, institutional and informal care accounted for over 90% of the cost. The average annual cost was estimated at CHF 55'300 per person with dementia who lives at home and at CHF 68'900 per person who lives in an institution. The cost per person living at home with severe dementia was nearly five times the cost per person with mild dementia. The present study indicates that dementia imposes a considerable economic burden on Swiss society. The cost of dementia is dominated by the costs of care. Diagnosis and treatment related costs are minor. These findings are consistent with contemporary international studies on the subject. The contribution of informal caregivers is substantial since they account for 44% of the total cost of dementia (based on market cost valuation). Given demographic developments in Switzerland, healthcare decision making should have an interest in securing this potential for the future.

  6. Reversible dementias

    PubMed Central

    Tripathi, Manjari; Vibha, Deepti

    2009-01-01

    In recent years, more attention has been given to the early diagnostic evaluation of patients with dementia which is essential to identify patients with cognitive symptoms who may have treatable conditions. Guidelines suggest that all patients presenting with dementia or cognitive symptoms should be evaluated with a range of laboratory tests, and with structural brain imaging with computed tomography (CT) or magnetic resonance imaging (MRI). While many of the disorders reported as ‘reversible dementias’ are conditions that may well be associated with cognitive or behavioral symptoms, these symptoms are not always sufficiently severe to fulfill the clinical criteria for dementia. Thus, while the etiology of a condition may be treatable it should not be assumed that the associated dementia is fully reversible. Potentially reversible dementias should be identified and treatment considered, even if the symptoms are not sufficiently severe to meet the clinical criteria for dementia, and even if partial or full reversal of the cognitive symptoms cannot be guaranteed. In the literature, the most frequently observed potentially reversible conditions identified in patients with cognitive impairment or dementia are depression, adverse effects of drugs, drug or alcohol abuse, space-occupying lesions, normal pressure hydrocephalus, and metabolic conditions land endocrinal conditions like hypothyroidism and nutritional conditions like vitamin B-12 deficiency. Depression is by far the most common of the potentially reversible conditions. The review, hence addresses the common causes of reversible dementia and the studies published so far. PMID:21416018

  7. Malnutrition and dementia.

    PubMed

    Wilhelm, Karen

    2016-07-13

    What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? The CPD article outlined the effects dementia may have on a person's ability to eat and drink safely. It discussed assessment tools to identify patients at risk of malnutrition and management strategies to help maintain nutritional intake.

  8. Validity of the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination for detecting the incidence of dementia in older Japanese adults.

    PubMed

    Shimada, Hiroyuki; Makizako, Hyuma; Park, Hyuntae; Doi, Takehiko; Lee, Sangyoon

    2017-06-16

    Numerous neuropsychological tests are implemented in the clinical setting. However, a readily available cognitive test is required to detect the risk of dementia in the community setting. A total of 4151 persons aged ≥65 years participated in the present prospective cohort study. We assessed cognitive performance using the Mini-Mental State Examination and the National Center for Geriatrics and Gerontology-Functional Assessment Tool. The National Center for Geriatrics and Gerontology-Functional Assessment Tool includes tests of story and word list memory, attention and executive function, processing speed, and visuospatial skill to screen for cognitive impairment. All measurements were transformed to Z-scores to compare among the cognitive tests. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. After an average of 43 months, 180 (4.3%) participants were diagnosed with dementia. Survival analyses showed that the probability of dementia was significantly associated with all cognitive tests, except for visuospatial skill. The processing speed test showed the highest hazard ratios for the incidence of dementia (Z-score: hazard ratio 0.61, 95% confidence interval 0.50-0.75, P < 0.01). In subgroup analysis, there were no significant relationships between cognitive tests and the incidence of dementia in participants without global cognitive impairment. We conclude that the National Center for Geriatrics and Gerontology-Functional Assessment Tool, as well as the Mini-Mental State Examination, play an important role in detecting the risk of dementia in the community setting. Further analysis is required to identify the risk of dementia in older people without global cognitive impairment. Geriatr Gerontol Int 2017; ••: ••-••. © 2017 Japan Geriatrics Society.

  9. Bridge to a sustainable future: National environmental technology strategy

    SciTech Connect

    1995-04-01

    For the past two years the Administration has sought the views of Congress, the states, communities, industry, academia, nongovernmental organizations, and interested citizens on ways to spur the development and use of a new generation of environmental technologies. This document represents the views of thousands of individuals who participated in events around the country to help craft a national environmental technology strategy that will put us on the path to sustainable development.

  10. Private Military and Security Companies - Counterinsurgency and Nation Building Strategy

    DTIC Science & Technology

    2013-04-25

    activities of PMSCs so far has been inconsistent. However, the international community and the industry have worked to develop principles of employment and...building strategy. Once the international legal framework is in place, PMSCs, the private sector, and nation states will benefit from a better...Security Contractors, PMSC, International Code of Conduct, ICoC, Montreux document 16.  SECURITY  CLASSIFICATION  OF:   17.  LIMITATION  OF

  11. America Promises to Come Back: A New National Strategy

    DTIC Science & Technology

    1991-08-05

    revised version will appear in issue #2 of Security Studies (Winter 1991/1992). An analysis of President Bush’s new national security strategy first...a transition period, arms control, and new requirements for military operations research and analysis . Concludes that there are four major critical...Operations Research and Analysis ..... o.......o111 Critical Success Factors ................o....................115 Impact on the Navy and Marine Corps

  12. America Promises to Come Back: Our New National Security Strategy

    DTIC Science & Technology

    1991-10-23

    August 2, 1990, involving a mix of active, reserve, and reconstitutable forces, and General Colin Powell’s Base Force. If implemented, the new strategy...and force structure would return significant U.S. ground and air forces to the continental U.S. where most would be demobilized. In the event of a ...major crisis, the U.S. would rely on active and reserve forces for a contingency response, much as was done for Operation DESERT SHIELD. The new national

  13. The National Economic Strategy: Security and Prosperity Today and Tomorrow

    DTIC Science & Technology

    2007-11-02

    Reagan and Beyond. New York: Simon and Schuster, 1984. Sunstein , Cass R. “Economic Security: A Human Right,” The American Prospect, October 2004, A24...president’s NSS provides the vision to spread economic prosperity through democracy , globalization, and free trade while improving the lives of all...but will create conditions that allow democracy , freedom, security, and prosperity to spread around the globe. 2. The National Economic Strategy in

  14. The National Space Weather Strategy: Policy on Observations

    NASA Astrophysics Data System (ADS)

    Murtagh, W. J.

    2016-12-01

    Ensuring that the United States is prepared to respond to and recover from severe space weather storms is a priority to the President and to this Administration. We cannot ignore the potential impact space weather may have on key infrastructures and technologies including aviation and satellite operations, the electric power grid, and GPS applications. These technologies form the very backbone of the critical technology infrastructure we rely on for so much of what we do today. In October 2015, OSTP Director John Holdren announced the release of the National Space Weather Strategy and the National Space Weather Action Plan. The Strategy identifies goals and establishes the principles that will guide efforts to develop national space-weather preparedness in both the near and long term, while the Action Plan identifies specific activities, outcomes, and timelines that the Federal government must pursue to be prepared for and resilient to future space-weather events. The Strategy recognizes that observations are the backbone of forecast and warning capabilities. The Strategy also recognized that to achieve a robust operational program for space-weather observations, the United States must: (1) establish and sustain a foundational set of observations; (2) when feasible and cost effective, use data from multiple sources, including international, Federal, State, and local governments, as well as from the academic and industry sectors; (3) ensure the continuity of critical data sources; (4) continue to support sensors for solar and space physics research; (5) ensure data-assimilation techniques are in place; and (6) maintain archives for ground- and space-based data, which are essential for model development and benchmarking. In this talk we explore elements in the Space Weather Action Plan that will ensure our Nation has the information we need to enhance resilience to the risk of space weather.

  15. Medical Diplomacy: A Tool for Enabling National Security Strategy Objectives

    DTIC Science & Technology

    2012-04-06

    REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 The public reporting burden for this collection of Information Is estimated to...information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. 1. REPORT DATE (DD-MM...SUBJECT TERMS Medical Diplomacy, National Security Strategy, Health Service Support ( HSS ), HSS Doctrine, HSS Engagement Programs, Global Health

  16. 75 FR 43528 - Seeking Public Comment on Draft National Health Security Strategy Biennial Implementation Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-26

    ... HUMAN SERVICES Office of the Secretary Seeking Public Comment on Draft National Health Security Strategy... achieve national health security and to implement the first quadrennial National Health Security Strategy... the National Health Security Strategy of the United States of America (2009) the U.S. Government has...

  17. Afghanistan's national strategy for improving quality in health care

    PubMed Central

    Rahimzai, Mirwais; Amiri, Mirwais; Burhani, Nadera Hayat; Leatherman, Sheila; Hiltebeitel, Simon; Rahmanzai, Ahmed Javed

    2013-01-01

    Quality problem or issue When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. Initial assessment A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. Plan of action In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. Implementation The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. Lessons Learned Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented. PMID:23485422

  18. Afghanistan's national strategy for improving quality in health care.

    PubMed

    Rahimzai, Mirwais; Amiri, Mirwais; Burhani, Nadera Hayat; Leatherman, Sheila; Hiltebeitel, Simon; Rahmanzai, Ahmed Javed

    2013-07-01

    When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented.

  19. Canadian national high blood pressure prevention and control strategy.

    PubMed

    Chockalingam, A; Campbell, N; Ruddy, T; Taylor, G; Stewart, P

    2000-09-01

    Despite major efforts to prevent and control high blood pressure, it is one of the most common and important health problems facing Canadians. To address this issue, Health Canada, in collaboration with the Canadian Coalition for High Blood Pressure Prevention and Control, established an Expert Working Group to prepare a national strategy. The present report outlines a strategy to prevent and control high blood pressure. It is directed at policy makers at the local, provincial, and/or territorial and national levels in both the health and nonhealth sectors. The strategy is based on current research and expertise. A multifaceted, comprehensive approach is proposed because there is no one intervention that will accomplish the goal of improving the health of Canadians through high blood pressure prevention and control. The present report focuses on the general population. It does not address the unique needs of children, pregnant women or aboriginal peoples. Each of these groups needs to be studied in its own right, and, in particular, with the involvement of aboriginal people themselves. An implementation committee has been established to realize this strategy, and the Canadian Hypertension Society is a key stakeholder in this effort. Several initiatives are underway. Strong advocates are necessary to increase public awareness and to support the system changes required for a successful public health approach to reduce the prevalence of hypertension and its complications.

  20. Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey.

    PubMed

    Cooper, C; Rapaport, P; Robertson, S; Marston, L; Barber, J; Manela, M; Livingston, G

    2017-10-03

    As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014-2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. Seventy-one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen-Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia-friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes. © 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

  1. The National Security Strategy of the Republic of Albania

    DTIC Science & Technology

    2004-01-01

    5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6 . AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...5. The national interests…………………………………………………………… 13 PART THREE THE ELEMENTS OF NATIONAL POWER 6 . Diplomacy……………………………………………………………………… 14...cooperating with who”. 6 .The strategy of priority selection for the use of resources. Our country actually has limited national resources and

  2. 76 FR 30193 - National Fish, Wildlife, and Plants Climate Adaptation Strategy; Notice of Intent: Request for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-24

    ... Fish and Wildlife Service National Fish, Wildlife, and Plants Climate Adaptation Strategy; Notice of... National Fish, Wildlife, and Plants Climate Adaptation Strategy (Strategy). The Strategy will provide a... ensure that we are able to consider your comments and information as we develop our draft strategy...

  3. The apolipoprotein E genotype predicts longitudinal transitions to mild cognitive impairment but not to Alzheimer's dementia: findings from a nationally representative study.

    PubMed

    Brainerd, C J; Reyna, V F; Petersen, R C; Smith, G E; Kenney, A E; Gross, C J; Taub, E S; Plassman, B L; Fisher, G G

    2013-01-01

    The ε4 allele of the apolipoprotein E (APOE) genotype is the most widely accepted genetic risk factor for Alzheimer's dementia (AD), but findings on whether it is a risk factor for the AD prodrome, mild cognitive impairment (MCI), have been inconsistent. In a prospective longitudinal design, we investigated (a) whether transitions to MCI and other forms of neurocognitive impairment without dementia (CIND) are more frequent among normal ε4 carriers than among noncarriers and (b) whether subsequent transitions to AD from MCI and from other forms of CIND are more frequent among ε4 carriers than among noncarriers. The frequency of the ε4 allele was studied in older adults (mean age > 70), who had participated in two or more waves of neuropsychological testing and diagnosis in the Aging, Demographics, and Memory Study (ADAMS) of the United States Department of Health and Human Services, National Institutes of Health, National Institute on Aging's Health and Retirement Study, conducted by the University of Michigan. The association between ε4 and longitudinal transitions to specific types of CIND and dementia can be determined with this data set. Epsilon 4 increased the rate of progression from normal functioning to MCI (58% of new diagnoses were carriers) but not to other forms of CIND. The rate of progression to AD from MCI or from other forms of CIND was not increased by ε4. The results support the hypothesis that ε4 is a risk factor for transitions from normal functioning to MCI but not for subsequent transitions to AD. In the ADAMS sample, the reason ε4 is elevated in AD individuals is because it is already elevated in MCI individuals, who are the primary source of new AD diagnoses.

  4. Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED).

    PubMed

    Iliffe, Steve; Wilcock, Jane; Griffin, Mark; Jain, Priya; Thuné-Boyle, Ingela; Koch, Tamar; Lefford, Frances

    2010-02-10

    The National Dementia Strategy seeks to enhance general practitioners' diagnostic and management skills in dementia. Early diagnosis in dementia within primary care is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice. An earlier unblinded, cluster randomised controlled study tested the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. In this original trial, a computer decision support system and practice-based educational workshops were effective in improving rates of detecting dementia although not in changing clinical management. The challenge therefore is to find methods of changing clinical management. Our aim in this new trial is to test a customised educational intervention developed for general practice, promoting both earlier diagnosis and concordance with management guidelines. The customised educational intervention combines practice-based workshops and electronic support material. Its effectiveness will be tested in an unblinded cluster randomised controlled trial with a pre-post intervention design, with two arms; normal care versus the educational intervention. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. We will examine whether the intervention is effective, pragmatic and feasible within the primary care setting. Our primary outcome measure is an increase in the proportion of patients with dementia who receive at least two dementia-specific management reviews per year. We will also examine important secondary outcomes such as practice concordance with management guidelines and benefits to patients and carers in terms of quality of life and carer strain. The EVIDEM-ED trial builds on the earlier study but the intervention is different in

  5. Climate Change Education Roundtable: A Coherent National Strategy

    NASA Astrophysics Data System (ADS)

    Storksdieck, M.; Feder, M.; Climate Change Education Roundtable

    2010-12-01

    The Climate Change Education (CCE) Roundtable fosters ongoing discussion of the challenges to and strategies for improving public understanding of climate science and climate change among federal agencies, the business community, non-profit, and academic sectors. The CCE Roundtable is provides a critical mechanism for developing a coherent, national strategy to advance climate change education guided by the best available research evidence. Through its meetings and workshops, the roundtable brings together 30 federal and state policymakers, educators, communications and media experts, and members from the business and scientific community. The roundtable includes a number of ex officio members from federal agencies with dedicated interests in climate change education, including officials from the National Science Foundation’s EHR Directorate and its collaborating partner divisions, the National Oceanic and Atmospheric Administration (NOAA), the National Aeronautics and Space Administration (NASA), the Department of Interior, the Department of Energy, and the Department of Education. The issues that are addressed by the roundtable include: - ways to incorporate knowledge about learning and understanding in developing informative programs and materials for decision-makers who must cope with climate change - the design of educational programs for professionals such as local planners, water managers, and the like, to enable them to better understand the implications of climate change for their decisions - development of training programs for scientists to help them become better communicators to decision-makers about implications of, and solutions to climate change - coordinated and collaborative efforts at the national level between federal agencies and other stakeholders This presenation will describe how the roundtable is fostering a coherent direction for climate change education.

  6. [Indonesia draws up plans for a national strategy].

    PubMed

    1991-01-01

    Dr. Sumedha Khanna, the World Health Organization representative in Indonesia, has reported that Indonesia is about to undertake a national level evaluation of maternal health care and training of midwives with the help of a UN subsidy. The results will be presented at a high level seminar planned for July 1992. The main elements of the national strategy and plan of action will also be developed at the meeting and integrated into the National Health Plan. The goal is to reduce maternal mortality to half its current level of 4500/100,000 live births by the year 2000. Part of the strategy will be to remedy the shortage of qualified midwives and of emergency services. Priority will be given to providing each village or health center with a qualified nurse-midwife. The Indonesian government expects to train 33,000 nurse-midwives within 5 years. The World Bank has agreed to subsidize training of 15,000. Physicians in district hospitals will be trained in essential obstetrical functions with the collaboration of the Indonesian Society of Obstetricians and Gynecologists. UNICEF is reportedly prepared to help. The Indonesian Association of Midwives has supported the initiative by using surveys of maternal mortality in different parts of the country to analyze the need to improve the health of Indonesian women.

  7. Vascular dementia

    MedlinePlus

    ... to dementia. Risk factors for VaD include: Diabetes Hardening of the arteries ( atherosclerosis ) High blood pressure ( hypertension ) ... Control conditions that increase the risk of hardening of the ... saturated fats and salt in the diet Treating related disorders

  8. The National Shipbuilding Research Program. Build Strategy Development

    DTIC Science & Technology

    1994-02-01

    A301 A 3 0 2 A302 A302 A303 A303 A305 A401-A416 A401 A403 A403 A406 A411 -A411 A411 A416 A501-A504 A501 A501 A501 A501 A502 APPENDIX A - CONTENTS...to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE FEB...1994 2. REPORT TYPE N/ A 3. DATES COVERED - 4. TITLE AND SUBTITLE The National Shipbuilding Research Program, Build Strategy Development

  9. Doing dementia better: anthropological insights.

    PubMed

    Castillo, Elizabeth Herskovits

    2011-05-01

    Dementia, or neurodegenerative disease, is a disease category, and yet it is widely described in popular and professional media as a horror story. Patients with dementia and their families frequently report that they are less than pleased with their clinical encounters. This article reveals the deleterious impact that cultural assumptions about dementia have on the care provided, and, through an exploration of anthropological theories of personhood, suggests strategies for seeking improved quality of life through personhood-centered care. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. [Normative-legal support for implementation of national strategy of glaucoma control in Ukraine].

    PubMed

    Vitovs'ka, O P; Tymchenko, O I

    2009-01-01

    The review of normative legal database for implementation of national strategy of glaucoma control has demonstrated that there are all terms and conditions for implementation of national strategy on the national level. There is no necessity to change present normative legal database in the field of public health for the purpose of strategy implementation.

  11. Dementia skills for all: a core competency framework for the workforce in the United Kingdom.

    PubMed

    Tsaroucha, Anna; Benbow, Susan Mary; Kingston, Paul; Le Mesurier, Nick

    2013-01-01

    One of the biggest challenges facing health and social care in the United Kingdom is the projected increase in the number of older people who require dementia care. The National Dementia Strategy (Department of Health, 2009) emphasizes the critical need for a skilled workforce in all aspects of dementia care. In the West Midlands, the Strategic Health Authority commissioned a project to develop a set of generic core competencies that would guide a competency based curriculum to meet the demands for improved dementia training and education. A systematic literature search was conducted to identify relevant frameworks to assist with this work. The core competency framework produced and the methods used for the development of the framework are presented and discussed.

  12. Los Alamos National Laboratory accelerated tru waste workoff strategies

    SciTech Connect

    Kosiewicz, S.T.; Triay, I.R.; Rogers, P.Z.; Christensen, D.V.

    1997-03-01

    During 1996, the Los Alamos National Laboratory (LANL) developed two transuranic (TRU) waste workoff strategies that were estimated to save $270 - 340M through accelerated waste workoff and the elimination of a facility. The planning effort included a strategy to assure that LANL would have a significant quantity (3000+ drums) of TRU waste certified for shipment to the Waste Isolation Pilot Plant (WIPP) beginning in April of 1998, when WIPP was projected to open. One of the accelerated strategies can be completed in less than ten years through a Total Optimization of Parameters Scenario ({open_quotes}TOPS{close_quotes}). {open_quotes}TOPS{close_quotes} fully utilizes existing LANL facilities and capabilities. For this scenario, funding was estimated to be unconstrained at $23M annually to certify and ship the legacy inventory of TRU waste at LANL. With {open_quotes}TOPS{close_quotes} the inventory is worked off in about 8.5 years while shipping 5,000 drums per year at a total cost of $196M. This workoff includes retrieval from earthen cover and interim storage costs. The other scenario envisioned funding at the current level with some increase for TRUPACT II loading costs, which total $16M annually. At this funding level, LANL estimates it will require about 17 years to work off the LANL TRU legacy waste while shipping 2,500 drums per year to WIPP. The total cost will be $277M. This latter scenario decreases the time for workoff by about 19 years from previous estimates and saves an estimated $190M. In addition, the planning showed that a $70M facility for TRU waste characterization was not needed. After the first draft of the LANL strategies was written, Congress amended the WIPP Land Withdrawal Act (LWA) to accelerate the opening of WIPP to November 1997. Further, the No Migration Variance requirement for the WIPP was removed. This paper discusses the LANL strategies as they were originally developed. 1 ref., 3 figs., 2 tabs.

  13. Periodontitis as a Modifiable Risk Factor for Dementia: A Nationwide Population-Based Cohort Study.

    PubMed

    Lee, Yao-Tung; Lee, Hsin-Chien; Hu, Chaur-Jongh; Huang, Li-Kai; Chao, Shu-Ping; Lin, Chia-Pei; Su, Emily Chia-Yu; Lee, Yi-Chen; Chen, Chu-Chieh

    2017-02-01

    To determine whether periodontitis is a modifiable risk factor for dementia. Prospective cohort study. National Health Insurance Research Database in Taiwan. Individuals aged 65 and older with periodontitis (n = 3,028) and an age- and sex-matched control group (n = 3,028). Individuals with periodontitis were compared age- and sex-matched controls with for incidence density and hazard ratio (HR) of new-onset dementia. Periodontitis was defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 diagnosed by dentists. To ensure diagnostic validity, only those who had concurrently received antibiotic therapies, periodontal treatment other than scaling, or scaling more than twice per year performed by certified dentists were included. Dementia was defined according to ICD-9-CM codes 290.0-290.4, 294.1, 331.0-331.2. After adjustment for confounding factors, the risk of developing dementia was calculated to be higher for participants with periodontitis (HR = 1.16, 95% confidence interval = 1.01-1.32, P = .03) than for those without. Periodontitis is associated with greater risk of developing dementia. Periodontal infection is treatable, so it might be a modifiable risk factor for dementia. Clinicians must devote greater attention to this potential association in an effort to develop new preventive and therapeutic strategies for dementia. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  14. Local Solutions for National Challenges? Exploring Local Solutions through the Case of a National Succession Planning Strategy

    ERIC Educational Resources Information Center

    Collins, Mike

    2013-01-01

    The notion of localism and decentralization in national policy has come increasingly to the fore in recent years. The national succession planning strategy for headteachers in England introduced by the National College for School Leadership promoted "local solutions for a national challenge". This article deals with some aspects of the…

  15. Local Solutions for National Challenges? Exploring Local Solutions through the Case of a National Succession Planning Strategy

    ERIC Educational Resources Information Center

    Collins, Mike

    2013-01-01

    The notion of localism and decentralization in national policy has come increasingly to the fore in recent years. The national succession planning strategy for headteachers in England introduced by the National College for School Leadership promoted "local solutions for a national challenge". This article deals with some aspects of the…

  16. Healthy cognitive aging and dementia prevention.

    PubMed

    Smith, Glenn E

    2016-01-01

    Behavioral prevention strategies can help maintain high levels of cognition and functional integrity, and can reduce the social, medical, and economic burden associated with cognitive aging and age-associated neurodegenerative diseases. Interventions involving physical exercise and cognitive training have consistently shown positive effects on cognition in older adults. "Brain fitness" interventions have now been shown to have sustained effects lasting 10 years or more. A meta-analysis suggests these physical exercise and brain fitness exercises produce nearly identical impact on formal measures of cognitive function. Behavioral interventions developed and deployed by psychologists are key in supporting healthy cognitive aging. The National Institutes of Health should expand research on cognitive health and behavioral and social science to promote healthy aging and to develop and refine ways to prevent and treat dementia. Funding for adequately powered, large-scale trials is needed. Congress must maintain support for crucial dementia-related initiatives like the Centers for Disease Control and Prevention Healthy Brain Initiative and fund training programs to insure there is a work force with skills to provide high quality care for older adults. Insurers must provide better coverage for behavioral interventions. Better coverage is needed so there can be increased access to evidence-based disease prevention and health promotion services with the potential for reducing dementia risk. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  17. Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial

    PubMed Central

    Barber, Julie; Rapaport, Penny; Knapp, Martin; Griffin, Mark; King, Derek; Mummery, Cath; Walker, Zuzana; Hoe, Juanita; Sampson, Elizabeth L; Cooper, Claudia

    2013-01-01

    Objective To assess whether a manual based coping strategy compared with treatment as usual reduces depression and anxiety symptoms in carers of family members with dementia. Design Randomised, parallel group, superiority trial. Setting Three mental health community services and one neurological outpatient dementia service in London and Essex, UK. Participants 260 carers of family members with dementia. Intervention A manual based coping intervention comprising eight sessions and delivered by supervised psychology graduates to carers of family members with dementia. The programme consisted of psychoeducation about dementia, carers’ stress, and where to get emotional support; understanding behaviours of the family member being cared for, and behavioural management techniques; changing unhelpful thoughts; promoting acceptance; assertive communication; relaxation; planning for the future; increasing pleasant activities; and maintaining skills learnt. Carers practised these techniques at home, using the manual and relaxation CDs. Main outcome measures Affective symptoms (hospital anxiety and depression total score) at four and eight months. Secondary outcomes were depression and anxiety caseness on the hospital anxiety and depression scale; quality of life of both the carer (health status questionnaire, mental health) and the recipient of care (quality of life-Alzheimer’s disease); and potentially abusive behaviour by the carer towards the recipient of care (modified conflict tactics scale). Results 260 carers were recruited; 173 were randomised to the intervention and 87 to treatment as usual. Mean total scores on the hospital anxiety and depression scale were lower in the intervention group than in the treatment as usual group over the eight month evaluation period: adjusted difference in means −1.80 points (95% confidence interval −3.29 to −0.31; P=0.02) and absolute difference in means −2.0 points. Carers in the intervention group were less likely to

  18. Developing a national salt reduction strategy for Mongolia.

    PubMed

    Enkhtungalag, Batsaikhan; Batjargal, Jamayan; Chimedsuren, Ochir; Tsogzolmaa, Bayandorj; Anderson, Craig S; Webster, Jacqui

    2015-06-01

    The increase in prevalence of risk factors such as hypertension has contributed to an incremental rise in non-communicable diseases (NCDs) in Mongolia over recent decades, such that they now account for 80% of all deaths in the country. Salt reduction is one of the most cost-effective interventions to reduce the burden of NCDs. In 2011, the Ministry of Health (MOH) instigated the development of a national salt reduction strategy for Mongolia. As part of a 2-week national consultation and training program on salt reduction, it established an inter-sectoral working party and organized a series of bilateral meetings and visits to factories. Actions arising included a baseline survey of population salt consumption patterns and the implementation of a series of pilot salt reduction initiatives. The results of the baseline assessment revealed that average daily intake of salt, based on 24 hour urine samples from a representative national sample (n=1,027), was 11.06±5.99 g in 2011, more than double the World Health Organization (WHO) five grams recommendation. Moreover, while most participants knew that salt was bad for health, few were taking efforts to reduce intake, and many were consuming highly salty meals and tea; salt in tea alone was estimated to contribute 30% of daily salt intake. A pilot Pinch Salt intervention to reduce salt consumption of factory workers was undertaken in Ulaanbaatar (UB) city between 2012 and 2013, and was associated with a reduction of 2.8 g of salt intake. Ongoing food industry initiatives have led to significant reductions in salt levels in bread, and companies producing processed meat have indicated a willingness to reduce salt. Relevant stakeholders have also supported the campaign by participating in annual World Salt Awareness Week events. The activities to date have demonstrated the potential for action and there is now a need scale these up to a national level to ensure that Mongolia is in a strong position to achieve a 30

  19. Developing a national salt reduction strategy for Mongolia

    PubMed Central

    Enkhtungalag, Batsaikhan; Batjargal, Jamayan; Chimedsuren, Ochir; Tsogzolmaa, Bayandorj; Anderson, Craig S.

    2015-01-01

    Background The increase in prevalence of risk factors such as hypertension has contributed to an incremental rise in non-communicable diseases (NCDs) in Mongolia over recent decades, such that they now account for 80% of all deaths in the country. Salt reduction is one of the most cost-effective interventions to reduce the burden of NCDs. Methods In 2011, the Ministry of Health (MOH) instigated the development of a national salt reduction strategy for Mongolia. As part of a 2-week national consultation and training program on salt reduction, it established an inter-sectoral working party and organized a series of bilateral meetings and visits to factories. Actions arising included a baseline survey of population salt consumption patterns and the implementation of a series of pilot salt reduction initiatives. Results The results of the baseline assessment revealed that average daily intake of salt, based on 24 hour urine samples from a representative national sample (n=1,027), was 11.06±5.99 g in 2011, more than double the World Health Organization (WHO) five grams recommendation. Moreover, while most participants knew that salt was bad for health, few were taking efforts to reduce intake, and many were consuming highly salty meals and tea; salt in tea alone was estimated to contribute 30% of daily salt intake. A pilot Pinch Salt intervention to reduce salt consumption of factory workers was undertaken in Ulaanbaatar (UB) city between 2012 and 2013, and was associated with a reduction of 2.8 g of salt intake. Ongoing food industry initiatives have led to significant reductions in salt levels in bread, and companies producing processed meat have indicated a willingness to reduce salt. Relevant stakeholders have also supported the campaign by participating in annual World Salt Awareness Week events. The activities to date have demonstrated the potential for action and there is now a need scale these up to a national level to ensure that Mongolia is in a strong

  20. Understanding dementia: effective information access from the Deaf community's perspective.

    PubMed

    Young, Alys; Ferguson-Coleman, Emma; Keady, John

    2016-01-01

    This study concerns older Deaf sign language users in the UK. Its aim was to explore how to enable effective information access and promote awareness and understanding of dementia from a culturally Deaf perspective. A purposive sample of 26 Deaf people without dementia participated in one of three focus groups facilitated directly in British Sign Language (BSL) without an intermediate interpreter. The sample was differentiated by age, role in the Deaf community, and diversity of educational attainment and professional experience. A phenomenological approach underpinned the thematic analysis of data. The findings demonstrate: (i) translation into (BSL) is a necessary but not sufficient condition to support understanding. Attention to culturally preferred means of engagement with information is vital; (ii) the content of information is best presented utilising structures and formats which cohere with Deaf people's visual cognitive strengths; and (iii) the importance of cultural values and cultural practices in raising awareness and building understanding of dementia. These include collective rather than individual responsibility for knowledge transfer and the pan-national nature of knowledge transfer among Deaf people(s). The discussion demonstrates how these specific features of effective information access and awareness building have universal implications relevant to public engagement and the promotion of general knowledge consistent with the National Dementia Strategy (England). © 2014 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

  1. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial.

    PubMed

    Knapp, Martin; King, Derek; Romeo, Renee; Schehl, Barbara; Barber, Julie; Griffin, Mark; Rapaport, Penny; Livingston, Debbie; Mummery, Cath; Walker, Zuzana; Hoe, Juanita; Sampson, Elizabeth L; Cooper, Claudia; Livingston, Gill

    2013-10-25

    To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone. Cost effectiveness analysis nested within a pragmatic randomised controlled trial. Three mental health and one neurological outpatient dementia service in London and Essex, UK. Family carers of people with dementia. Eight session, manual based, coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment, compared with usual treatment alone. Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline. Of the 260 participants recruited to the study, 173 were randomised to the START intervention, and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference -1.79 (95% CI -3.32 to -0.33)), indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (-0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (-28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30,000 per QALY gained, and a high probability of cost effectiveness on the HADS-T measure. The manual based coping intervention START, when added to treatment as usual, was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers, and carer based QALYs). ISCTRN 70017938.

  2. Development of a Nationally Coordinated Evaluation Plan for the Ghana National Strategy for Key Populations

    PubMed Central

    Reynolds, Heidi W; Atuahene, Kyeremeh; Sutherland, Elizabeth; Amenyah, Richard; Kwao, Isaiah Doe; Larbi, Emmanuel Tettey

    2015-01-01

    Objective Just as HIV prevention programs need to be tailored to the local epidemic, so should evaluations be country-owned and country-led to ensure use of those results in decision making and policy. The objective of this paper is to describe the process undertaken in Ghana to develop a national evaluation plan for the Ghana national strategy for key populations. Methods This was a participatory process that involved meetings between the Ghana AIDS Commission (GAC), other partners in Ghana working to prevent HIV among key populations, and MEASURE Evaluation. The process included three two-day, highly structured yet participatory meetings over the course of 12 months during which participants shared information about on-going and planned data and identified research questions and methods. Results An evaluation plan was prepared to inform stakeholders about which data collection activities need to be prioritized for funding, who would implement the study, the timing of data collection, the research question the data will help answer, and the analysis methods. The plan discusses various methods that can be used including the recommendation for the study design using multiple data sources. It has an evaluation conceptual model, proposed analyses, proposed definition of independent variables, estimated costs for filling data gaps, roles and responsibilities of stakeholders to carry out the plan, and considerations for ethics, data sharing and authorship. Conclusion The experience demonstrates that it is possible to design an evaluation responsive to national strategies and priorities with country leadership, regardless of stakeholders' experiences with evaluations. This process may be replicable elsewhere, where stakeholders want to plan and implement an evaluation of a large-scale program at the national or subnational level that is responsive to national priorities and part of a comprehensive monitoring and evaluation system. PMID:26120495

  3. National Space Weather Program Releases Strategy for the New Decade

    NASA Astrophysics Data System (ADS)

    Williamson, Samuel P.; Babcock, Michael R.; Bonadonna, Michael F.

    2010-12-01

    The National Space Weather Program (NSWP; http://www.nswp.gov) is a U.S. federal government interagency program established by the Office of the Federal Coordinator for Meteorology (OFCM) in 1995 to coordinate, collaborate, and leverage capabilities across stakeholder agencies, including space weather researchers, service providers, users, policy makers, and funding agencies, to improve the performance of the space weather enterprise for the United States and its international partners. Two important documents released in recent months have established a framework and the vision, goals, and strategy to move the enterprise forward in the next decade. The U.S. federal agency members of the NSWP include the departments of Commerce, Defense, Energy, Interior, State, and Transportation, plus NASA, the National Science Foundation, and observers from the White House Office of Science and Technology Policy (OSTP) and the Office of Management and Budget (OMB). The OFCM is also working with the Department of Homeland Security's Federal Emergency Management Agency to formally join the program.

  4. Antipsychotic Prescribing to Patients Diagnosed with Dementia Without a Diagnosis of Psychosis in the Context of National Guidance and Drug Safety Warnings: Longitudinal Study in UK General Practice.

    PubMed

    Stocks, S Jill; Kontopantelis, Evangelos; Webb, Roger T; Avery, Anthony J; Burns, Alistair; Ashcroft, Darren M

    2017-08-01

    Policy interventions to address inappropriate prescribing of antipsychotic drugs to older people diagnosed with dementia are commonplace. In the UK, warnings were issued by the Medicines Healthcare products Regulatory Agency in 2004, 2009 and 2012 and the National Institute for Health and Care Excellence guidance was published in 2006. It is important to evaluate the impact of such interventions. We analysed routinely collected primary-care data from 111,346 patients attending one of 689 general practices contributing to the Clinical Practice Research Datalink to describe the temporal changes in the prescribing of antipsychotic drugs to patients aged 65 years or over diagnosed with dementia without a concomitant psychosis diagnosis from 2001 to 2014 using an interrupted time series and a before-and-after design. Logistic regression methods were used to quantify the impact of patient and practice level variables on prescribing prevalence. Prescribing of first-generation antipsychotic drugs reduced from 8.9% in 2001 to 1.4% in 2014 (prevalence ratio 2014/2001 adjusted for age, sex and clustering within practices (0.14, 95% confidence interval 0.12-0.16), whereas there was little change for second-generation antipsychotic drugs (1.01, confidence interval 0.94-1.17). Between 2004 and 2012, several policy interventions coincided with a pattern of ups and downs, whereas the 2006 National Institute for Health and Care Excellence guidance was followed by a gradual longer term reduction. Since 2013, the decreasing trend in second-generation antipsychotic drug prescribing has plateaued largely driven by the increasing prescribing of risperidone. Increased surveillance and evaluation of drug safety warnings and guidance are needed to improve the impact of future interventions.

  5. Headaches and Risk of Dementia.

    PubMed

    Tzeng, Nian-Sheng; Chung, Chi-Hsiang; Lin, Fu-Huang; Yeh, Chin-Bin; Huang, San-Yuan; Lu, Ru-Band; Chang, Hsin-An; Kao, Yu-Chen; Chiang, Wei-Shan; Chou, Yu-Ching; Tsao, Chang-Huei; Wu, Yung-Fu; Chien, Wu-Chien

    2017-03-01

    Primary headaches include migraines, tension-type headaches and other primary headache syndromes. Migraines and tension-type headaches are associated with patient discomfort and other diseases. This study aimed to investigate the association between primary headaches and the risk of developing dementia, and to clarify the association between different types of headaches and dementia. We conducted a nationwide matched cohort population-based study. A total of 3,620 patients with newly diagnosed primary headaches, including migraines and tension-type headaches, between January 1 and December 31, 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 10,860 controls matched for sex and age. After adjusting for confounding factors, Fine and Gray׳s competing risk analysis was used to compare the risk of developing dementia during 10 years of follow-up. Of the study subjects, 170 (4.70 %) developed dementia compared with 433 (3.99%) of the controls. Fine and Gray׳s competing risk analysis revealed that the study subjects were more likely to develop dementia (hazard ratio = 2.057; 95% CI: 1.718-2.462; P < 0.001). After adjusting for sex, age, monthly income, urbanization level, geographic region of residence and comorbidities, the hazard ratio for dementia was 2.048 (95% CI: 1.705-2.461, P < 0.001). Migraines and tension-type headaches were associated with nonvascular dementia but not vascular dementia. The patients with headaches had a 105% increased risk of dementia. Further studies are needed to elucidate the underlying mechanisms. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  6. 77 FR 76034 - National Water Program 2012 Strategy: Response to Climate Change

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... AGENCY National Water Program 2012 Strategy: Response to Climate Change AGENCY: Environmental Protection... publishing the final ``National Water Program 2012 Strategy: Response to Climate Change'' (2012 Strategy... light of climate change and charts key strategic actions to be taken to achieve the goals in 2012 and...

  7. Vascular dementia

    PubMed Central

    Korczyn, Amos D; Vakhapova, Veronika; Grinberg, Lea T

    2012-01-01

    The epidemic grow of dementia causes great concern for the society. It is customary to consider Alzheimer’s disease (AD) as the most common cause of dementia, followed by vascular dementia (VaD). This dichotomous view of a neurodegenerative disease as opposed to brain damage caused by extrinsic factors led to separate lines of research in these two entities. Indeed, accumulated data suggest that the two disorders have additive effects and probably interact; however it is still unknown to what degree. Furthermore, epidemiological studies have shown “vascular” risk factors to be associated with AD. Therefore, a clear distinction between AD and VaD cannot be made in most cases, and is furthermore unhelpful. In the absence of efficacious treatment for the neurodegenerative process, special attention must be given to vascular component, even in patients with presumed mixed pathology. Symptomatic treatment of VaD and AD are similar, although the former is less effective. For prevention of dementia it is important to treat aggressively all factors, even in stroke survivors who do not show evidence of cognitive decline,. In this review, we will give a clinical and pathological picture of the processes leading to VaD and discuss it interaction with AD. PMID:22575403

  8. 75 FR 31818 - National Science Board; Committee on Strategy and Budget; Sunshine Act Meetings; Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-04

    ... From the Federal Register Online via the Government Publishing Office NATIONAL SCIENCE FOUNDATION National Science Board; Committee on Strategy and Budget; Sunshine Act Meetings; Notice The National Science Board's Committee on Strategy and Budget, pursuant to NSF regulations (45 CFR part 614), the...

  9. Apraxias in Neurodegenerative Dementias

    PubMed Central

    Chandra, Sadanandavalli Retnaswami; Issac, Thomas Gregor; Abbas, Mirza Masoom

    2015-01-01

    Background: Apraxia is a state of inability to carry out a learned motor act in the absence of motor, sensory or cerebellar defect on command processed through the Praxis circuit. Breakdown in default networking is one of the early dysfunction in cortical dementias and result in perplexity, awkwardness, omission, substitution errors, toying behavior and unrecognizable gestures in response to command with voluntary reflex dissociation where, when unobserved patient will carry out reflex movements normally. Awareness into the organicity of these phenomenas will help in early diagnosis, which will help in initiating appropriate treatment and slowing down the progression of the disease. Aims and Objectives: The aim was to look for the various kinds of apraxias in patients with dementia using appropriate simple tests. Patients and Methods: Three hundred patients satisfying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for dementia were evaluated in detail with mandatory investigations for dementia followed by testing for ideational, ideomotor, limb-kinetic, buccopharyngeal, dressing apraxia, constructional apraxia and gait apraxias in addition to recording of rare apraxias when present. Results: Alzheimer's disease showed maximum association with apraxias in all the phases of the disease ideational, ideomotor, dressing and constructional apraxias early and buccopharyngeal and gait apraxia late. Frontotemporal lobe dementia showed buccopharyngeal and gait apraxias late into the disease. Cortical basal ganglionic degeneration showed limb apraxias and diffuse Lewy body disease showed more agnosias and less apraxias common apraxias seen was Ideational and Ideomotor. Conclusion: Recognition of the apraxias help in establishing organicity, categorization, caregiver education, early strategies for treatment, avoiding anti-psychotics and introducing disease modifying pharmacotherapeutic agents and also prognosticating. PMID:25722511

  10. Expanding Expectations for Narrative Styles in the Context of Dementia

    ERIC Educational Resources Information Center

    Guendouzi, Jackie; Davis, Boyd H.; Maclagan, Margaret

    2015-01-01

    This article uses discourse analyses to examine the narrative styles produced by 2 women with a diagnosis of dementia. Because of constrained cognitive resources, people with dementia (PWD) often use alternative strategies to weave their stories into conversations. People with dementia have difficulty in initiating and maintaining a canonical…

  11. Expanding Expectations for Narrative Styles in the Context of Dementia

    ERIC Educational Resources Information Center

    Guendouzi, Jackie; Davis, Boyd H.; Maclagan, Margaret

    2015-01-01

    This article uses discourse analyses to examine the narrative styles produced by 2 women with a diagnosis of dementia. Because of constrained cognitive resources, people with dementia (PWD) often use alternative strategies to weave their stories into conversations. People with dementia have difficulty in initiating and maintaining a canonical…

  12. Intracranial stenosis in cognitive impairment and dementia.

    PubMed

    Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

    2017-06-01

    Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

  13. Cost-effectiveness of nationwide opportunistic screening program for dementia in South Korea.

    PubMed

    Yu, Su-Yeon; Lee, Tae-Jin; Jang, Su-Hyun; Han, Ji Won; Kim, Tae Hui; Kim, Ki Woong

    2015-01-01

    Although more demand for screening for dementia is envisaged, the cost-effectiveness of opportunistic population screening for dementia at a nationwide level has never been directly investigated. Since 2010, Korea has implemented "the National Dementia Early Detection Program" (NDEDP) for the aged. This study aims to investigate the cost-effectiveness of the NDEDP of Korea and to explore the requirements for enhancing its cost-effectiveness. A Markov model was developed to simulate the disease progression of dementia patients. Data sources for the model parameters included the NDEDP database for cohort characteristics and other national representative data. The model's estimates of the expected costs and Quality Adjusted Life Years (QALYs) for each strategy were used to calculate the incremental cost-effectiveness ratio of screening compared to no screening, and sensitivity analysis was performed to assess the effect of key variables on the cost-effectiveness. Screening showed that the cost per QALY gained ranged from $24,150 to $35,661 depending on the age group. The probability of screening being cost-effective was highest in the group over 75 years old in a wide range of willingness to pay (WTP). The implementation of an opportunistic screening program for dementia can be cost-effective depending on disease severity, treatment effect, costs by disease stage, ages of the participants, and the societal WTP. Above all things, improving access to more effective therapies in slowing the course of the disease is essential since the main benefit of earlier diagnosis for dementia is starting early treatment and subsequent savings. Although it is too early to conclude the cost-effectiveness of opportunistic population screening for dementia, this current study may be a meaningful step toward generating practical evidence for implementing an effective and efficient dementia screening program.

  14. Serum phosphorus levels and risk of incident dementia

    PubMed Central

    Li, Tingting; Xie, Yan; Bowe, Benjamin; Xian, Hong

    2017-01-01

    Higher serum phosphorous is associated with cerebral small vessel disease, an important driver of cognitive decline and dementia. Whether serum phosphorous, a potentially modifiable parameter, associates with risk of incident dementia is not known. We aimed to examine the association between serum phosphorous and risk of incident dementia and to determine if the association is modified by age. We used the United States Department of Veterans Affairs national databases to build a longitudinal observational cohort of US veterans without prior history of dementia and with at least one outpatient serum phosphorus between October 2008 and September 2010 and followed them until September 2014. Serum phosphorus was categorized into quintiles: ≤2.9, >2.9 to ≤3.2, >3.2 to ≤3.5, >3.5 to ≤3.9, >3.9 mg/dL. There were 744,235 participants in the overall cohort. Over a median follow-up of 5.07 years (Interquartile range [IQR]: 4.28, 5.63), adjusted Cox models show that compared to quintile 2, the risk of incident dementia was increased in quintile 4 (Hazard Ratio [HR] = 1.05; CI = 1.01–1.10) and quintile 5 (HR = 1.14; CI = 1.09–1.20). In cohort participants ≤60 years old, the risk of incident dementia was increased in quintile 4 (HR = 1.29; CI = 1.12–1.49) and 5 (HR = 1.45; CI = 1.26–1.68). In participants > 60 years old, the risk was not significant in quintile 4, and was attenuated in quintile 5 (HR = 1.10; CI = 1.05–1.16). Formal interaction analyses showed that the association between phosphorous and dementia was more pronounced in those younger than 60, and attenuated in those older than 60 (P for interaction was 0.004 and <0.0001 in quintiles 4 and 5; respectively). We conclude that higher serum phosphorous is associated with increased risk of incident dementia. This association is stronger in younger cohort participants. The identification of serum phosphorous as a risk factor for incident dementia has public health relevance and might inform the

  15. The neuropathology and cerebrovascular mechanisms of dementia

    PubMed Central

    Knoefel, Janice; Bhaskar, Kiran

    2016-01-01

    The prevalence of dementia is increasing in our aging population at an alarming rate. Because of the heterogeneity of clinical presentation and complexity of disease neuropathology, dementia classifications remain controversial. Recently, the National Plan to address Alzheimer’s Disease prioritized Alzheimer’s disease-related dementias to include: Alzheimer’s disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia, and mixed dementias. While each of these dementing conditions has their unique pathologic signature, one common etiology shared among all these conditions is cerebrovascular dysfunction at some point during the disease process. The goal of this comprehensive review is to summarize the current findings in the field and address the important contributions of cerebrovascular, physiologic, and cellular alterations to cognitive impairment in these human dementias. Specifically, evidence will be presented in support of small-vessel disease as an underlying neuropathologic hallmark of various dementias, while controversial findings will also be highlighted. Finally, the molecular mechanisms shared among all dementia types including hypoxia, oxidative stress, mitochondrial bioenergetics, neuroinflammation, neurodegeneration, and blood–brain barrier permeability responsible for disease etiology and progression will be discussed. PMID:26174330

  16. Insulin, cognition, and dementia

    PubMed Central

    Cholerton, Brenna; Baker, Laura D.; Craft, Suzanne

    2015-01-01

    Cognitive disorders of aging represent a serious threat to the social and economic welfare of current society. It is now widely recognized that pathology related to such conditions, particularly Alzheimer’s disease, likely begins years or decades prior to the onset of clinical dementia symptoms. This revelation has led researchers to consider candidate mechanisms precipitating the cascade of neuropathological events that eventually lead to clinical Alzheimer’s disease. Insulin, a hormone with potent effects in the brain, has recently received a great deal of attention for its potential beneficial and protective role in cognitive function. Insulin resistance, which refers to the reduced sensitivity of target tissues to the favorable effects of insulin, is related to multiple chronic conditions known to impact cognition and increase dementia risk. With insulin resistance-associated conditions reaching epidemic proportions, the prevalence of Alzheimer’s disease and other cognitive disorders will continue to rise exponentially. Fortunately, these chronic insulin-related conditions are amenable to pharmacological intervention. As a result, novel therapeutic strategies that focus on increasing insulin sensitivity in the brain may be an important target for protecting or treating cognitive decline. The following review will highlight our current understanding of the role of insulin in brain, potential mechanisms underlying the link between insulin resistance and dementia, and current experimental therapeutic strategies aimed at improving cognitive function via modifying the brain’s insulin sensitivity. PMID:24070815

  17. 78 FR 19514 - National Fish, Wildlife, and Plants Climate Adaptation Strategy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-01

    ... Fish and Wildlife Service National Fish, Wildlife, and Plants Climate Adaptation Strategy AGENCY: Fish..., Wildlife, and Plants Climate Adaptation Strategy (NFWPCAS or Strategy). The purpose of the Strategy is to... natural systems provide, in a changing climate. Input from public comments and workshops has been...

  18. Hypnotics and the Occurrence of Bone Fractures in Hospitalized Dementia Patients: A Matched Case-Control Study Using a National Inpatient Database

    PubMed Central

    Tamiya, Hiroyuki; Yasunaga, Hideo; Matusi, Hiroki; Fushimi, Kiyohide; Ogawa, Sumito; Akishita, Masahiro

    2015-01-01

    Background Preventing falls and bone fractures in hospital care is an important issue in geriatric medicine. Use of hypnotics is a potential risk factor for falls and bone fractures in older patients. However, data are lacking on the association between use of hypnotics and the occurrence of bone fracture. Methods We used a national inpatient database including 1,057 hospitals in Japan and included dementia patients aged 50 years or older who were hospitalized during a period of 12 months between April 2012 and March 2013. The primary outcome was the occurrence of bone fracture during hospitalization. Use of hypnotics was compared between patients with and without bone fracture in this matched case-control study. Results Of 140,494 patients, 830 patients suffered from in-hospital fracture. A 1:4 matching with age, sex and hospital created 817 cases with fracture and 3,158 matched patients without fracture. With adjustment for the Charlson comorbidity index, emergent admission, activities of daily living, and scores for level walking, a higher occurrence of fractures were seen with short-acting benzodiazepine hypnotics (odds ratio, 1.43; 95% confidence interval, 1.19–1.73; P<0.001), ultrashort-acting non-benzodiazepine hypnotics (1.66; 1.37–2.01; P<0.001), hydroxyzine (1.45; 1.15–1.82, P=0.001), risperidone and perospirone (1.37; 1.08–1.73; P=0.010). Other drug groups were not significantly associated with the occurrence of in-hospital fracture. Conclusions Short-acting benzodiazepine hypnotics and ultrashort-acting non-benzodiazepine hypnotics may increase risk of bone fracture in hospitalized dementia patients. PMID:26061231

  19. Hypnotics and the Occurrence of Bone Fractures in Hospitalized Dementia Patients: A Matched Case-Control Study Using a National Inpatient Database.

    PubMed

    Tamiya, Hiroyuki; Yasunaga, Hideo; Matusi, Hiroki; Fushimi, Kiyohide; Ogawa, Sumito; Akishita, Masahiro

    2015-01-01

    Preventing falls and bone fractures in hospital care is an important issue in geriatric medicine. Use of hypnotics is a potential risk factor for falls and bone fractures in older patients. However, data are lacking on the association between use of hypnotics and the occurrence of bone fracture. We used a national inpatient database including 1,057 hospitals in Japan and included dementia patients aged 50 years or older who were hospitalized during a period of 12 months between April 2012 and March 2013. The primary outcome was the occurrence of bone fracture during hospitalization. Use of hypnotics was compared between patients with and without bone fracture in this matched case-control study. Of 140,494 patients, 830 patients suffered from in-hospital fracture. A 1:4 matching with age, sex and hospital created 817 cases with fracture and 3,158 matched patients without fracture. With adjustment for the Charlson comorbidity index, emergent admission, activities of daily living, and scores for level walking, a higher occurrence of fractures were seen with short-acting benzodiazepine hypnotics (odds ratio, 1.43; 95% confidence interval, 1.19-1.73; P<0.001), ultrashort-acting non-benzodiazepine hypnotics (1.66; 1.37-2.01; P<0.001), hydroxyzine (1.45; 1.15-1.82, P=0.001), risperidone and perospirone (1.37; 1.08-1.73; P=0.010). Other drug groups were not significantly associated with the occurrence of in-hospital fracture. Short-acting benzodiazepine hypnotics and ultrashort-acting non-benzodiazepine hypnotics may increase risk of bone fracture in hospitalized dementia patients.

  20. Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience.

    PubMed

    Edvardsson, David; Sandman, P O; Borell, Lena

    2014-07-01

    Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear - targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.

  1. Environmental Education and National Parks: The World Conservation Strategy, Values and Naturalist Interpretive Activities.

    ERIC Educational Resources Information Center

    Henning, Daniel H.

    1990-01-01

    This paper deals with environmental education aspects of national parks in terms of the World Conservation Strategy, values, and naturalist interpretive activities. Definitions of terms and details of interpretive activities and national park values are provided. (CW)

  2. What to Ask: Dementia

    MedlinePlus

    ... What to Ask: Dementia Tools and Tips The memory loss and other changes seen in dementia can ... can ask your healthcare proffesional about dementia. Is memory loss a normal part of aging? If so, ...

  3. A national strategy for the export of US geothermal technology

    SciTech Connect

    Not Available

    1989-03-01

    This document presents a proposal for an explicit US strategy to focus this still diffuse interest into a coordinated effort by the public and private sectors to increase exports of US geothermal goods and services over the next five to ten years. This document summarizes the background and need for an explicit US strategy, the factors influencing the development of this strategy, strategy options, and a recommended strategy.

  4. National Energy Strategy: A compilation of public comments; Interim Report

    SciTech Connect

    Not Available

    1990-04-01

    This Report presents a compilation of what the American people themselves had to say about problems, prospects, and preferences in energy. The Report draws on the National Energy Strategy public hearing record and accompanying documents. In all, 379 witnesses appeared at the hearings to exchange views with the Secretary, Deputy Secretary, and Deputy Under Secretary of Energy, and Cabinet officers of other Federal agencies. Written submissions came from more than 1,000 individuals and organizations. Transcripts of the oral testimony and question-and-answer (Q-and-A) sessions, as well as prepared statements submitted for the record and all other written submissions, form the basis for this compilation. Citations of these sources in this document use a system of identifying symbols explained below and in the accompanying box. The Report is organized into four general subject areas concerning: (1) efficiency in energy use, (2) the various forms of energy supply, (3) energy and the environment, and (4) the underlying foundations of science, education, and technology transfer. Each of these, in turn, is subdivided into sections addressing specific topics --- such as (in the case of energy efficiency) energy use in the transportation, residential, commercial, and industrial sectors, respectively. 416 refs., 44 figs., 5 tabs.

  5. Strategies for Overcoming Key Barriers to Development of a National Security Workforce

    SciTech Connect

    2008-06-30

    This report documents the strategies for overcoming identified key barriers to development of an adequate national security workforce as part of the National Security Preparedness Project (NSPP) being performed under a Department of Energy (DOE) National Nuclear Security Administration (NNSA) grant. Many barriers currently exist that prevent the development of an adequate number of properly trained national security personnel. The identified strategies to address the barriers will focus on both short-term and long-term efforts, as well as strategies to capture legacy knowledge of retiring national security workforce personnel.

  6. Practice patterns, beliefs, and perceived barriers to care regarding dementia: a report from the American Academy of Family Physicians (AAFP) national research network.

    PubMed

    Stewart, Thomas V; Loskutova, Natalia; Galliher, James M; Warshaw, Gregg A; Coombs, Letoynia J; Staton, Elizabeth W; Huff, Jessica M; Pace, Wilson D

    2014-01-01

    Given the increasing age of the US population, understanding how primary care is delivered surrounding dementia and physicians' perceived barriers and needs associated with this care is essential. A 29-item questionnaire was developed by project investigators and family physician consultants and mailed to a random sample of 1500 US members of the American Academy of Family Physicians in 2008; 2 follow-up mailings were sent to nonrespondents. Physicians were queried about sociodemographic characteristics, practice patterns, and beliefs (including challenges, barriers, and needs) about care processes focusing on dementia among older patients. The response rate was 60%, with respondents statistically comparable (P > .05) to the American Academy of Family Physicians physician population. Among physicians, 93% screen and/or conduct diagnostic evaluations for dementia in older patients, whereas 91% provide ongoing primary care for patients with dementia whether or not they screen for or diagnose dementia. Forty percent of physicians refer some patients with suspected dementia to other providers (primarily neurologists) to verify diagnosis, for comanagement, or both. Factors affecting the diagnosis of dementia and the delivery of dementia care included patient behavior challenges (aggressiveness, restlessness, paranoia, wandering); comorbidities (falls, delirium, adverse medication reactions, urinary incontinence); caregiver challenges (fatigue, planning for patient's institutional placement, anger); and structural barriers (clinician time, time required for screening, limited treatment options). Tools needed to provide enhanced dementia care included better assessment tools, community resources, and diagnostic and screening tools. Family physicians are highly involved in the assessment and routine care of patients with suspected dementia or diagnosed with dementia, although a relative few are not. This is despite the recognized challenges physicians encounter in the

  7. The National Radon Action Plan - A Strategy for Saving Lives

    EPA Pesticide Factsheets

    NRAP Guide-A Strategy for Saving Lives sets out strategies to drive the changes needed to reduce exposure to radon, a naturally occurring, invisible and odorless gas. Partnership headed by ALA with feds and NGOs.

  8. Building a UNESCO National Education Support Strategy (UNESS) Document: 2008-2013. Guidance Note. Education Policies and Strategies 11

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific and Cultural Organization (UNESCO), 2006

    2006-01-01

    This is a Guidance Note for designing a UNESCO National Education Support Strategy (UNESS) document. This guide is meant to be indicative, evolving and inclusive. It presents a number of useful questions one may ask when analysing national development policies and priorities, mapping donors' interventions in-country and accordingly, defining…

  9. Dementia and legal competency.

    PubMed

    Filaković, Pavo; Erić, Anamarija Petek; Mihanović, Mate; Glavina, Trpimir; Molnar, Sven

    2011-06-01

    execution, language difficulties, loosing perception of time and space, changes in mood and behaviour, personality alterations, loss of interests and initiative). Towards more accurate determination of legal competency the psychometric tests are being used. The appliance of these tests must be guided with basic question during evaluation: "For what is or is not he/she capable?" In prediction of possible dementia development, the modern diagnostic procedures are used as help for potentially demented individuals in order to plan own affairs and by oneself determine future guardian. This ensures the maximal respect and protection of rights among persons with dementia in order to independently manage life one step ahead of progressive illness. Finally, it is to be distinguished medical concept of legal capacity which is universal and judicial concept which is restricted by rules of national legal system differing from country to country.

  10. Compliance strategy in national thermal power corporation, India

    SciTech Connect

    Basu, B.; Rao, M.H.

    1998-07-01

    Established in the mid-seventies the National Thermal Power Corporation (NTPC) is now the largest power producing company in India with an installed capacity of more than 16,000 MW. The environmental impacts associated with thermal power generation are inviting greater attention in the country. Power generation, a vital input for industrial development has to grow but at the same time emphasis on mitigation of environmental impact associated with thermal power generation can not be undermined. The Regulatory Agencies in the country are also enacting several environmental laws progressively to ensure that the industrial development is sustainable. The growing concern of Regulatory Agencies is evident from the Environmental Clearance accorded by them for power plants. As against simple conditions stipulated in clearances for projects in the late seventies the current regulatory clearances address specific protective actions in almost all areas of environment like air, water, noise, ecology etc. Compliance by utilities to environmental laws and requirements of the Regulatory Agencies is a major step toward sustainable development. At the NTPC Stations apart from compliance there is emphasis on data generation through scientific studies on different aspects of ecosystem where information are scanty or ground truth is to be established, adoption of eco-friendly measures like re-use and recycling where feasible for optimization of requirement of plant, schemes for treatments of effluents etc. to ensure enhanced performance and adoption of comprehensive environmental management program with a view to identify critical parameters and take timely corrective action. The paper underscores the concern of NTPC toward environmental protection. Compliance strategies vis a vis the environmental laws and requirements of Regulatory Agencies have been discussed.

  11. Role of geriatric hospitals for dementia care in the community.

    PubMed

    Hattori, Hideyuki

    2012-06-01

    In dementia care, behavioural and psychological symptoms of dementia and physical illness in patients with dementia impose a marked care burden and require medical intervention. Therefore, it is important for patients and their families to select appropriate medical institutions and facilities with nursing units specializing in the care of behavioural and psychological symptoms of dementia, such as geriatric hospitals, which are required to deal with various aspects of dementia. Geriatric hospitals should offer two treatment approaches: a care unit for patients with behavioural and psychological symptoms of dementia or dementia with physical illness, and a multidisciplinary team approach involving physicians, nurses, psychologists, and social workers who provide coping strategies for dementia patients. © 2012 The Author. Psychogeriatrics © 2012 Japanese Psychogeriatric Society.

  12. Developing a National STEM Workforce Strategy: A Workshop Summary

    ERIC Educational Resources Information Center

    Alper, Joe

    2016-01-01

    The future competitiveness of the United States in an increasingly interconnected global economy depends on the nation fostering a workforce with strong capabilities and skills in science, technology, engineering, and mathematics (STEM). STEM knowledge and skills enable both individual opportunity and national competitiveness, and the nation needs…

  13. Developing a National STEM Workforce Strategy: A Workshop Summary

    ERIC Educational Resources Information Center

    Alper, Joe

    2016-01-01

    The future competitiveness of the United States in an increasingly interconnected global economy depends on the nation fostering a workforce with strong capabilities and skills in science, technology, engineering, and mathematics (STEM). STEM knowledge and skills enable both individual opportunity and national competitiveness, and the nation needs…

  14. 75 FR 75707 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-06

    ... TECHNOLOGY POLICY Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY: White House Office of Science and... draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology-Related Environmental, Health...

  15. 76 FR 2428 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-13

    ... TECHNOLOGY POLICY Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY: White House Office of Science and... draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology-Related Environmental, Health...

  16. Reviving the Dead Butler? Towards a Review of Aspects of National Literacy Strategy Grammar Advice

    ERIC Educational Resources Information Center

    Wales, Lynn

    2009-01-01

    In his 2004 article "How was a dead butler killed: The way English national strategies maim grammatical parts" published in "Language and Education" 18, no. 1, Wasyl Cajkler calls for a review of grammar advice to teachers in the UK National Literacy Strategy (NLS) materials. His evidence demonstrates clearly that NLS grammar…

  17. Changing Classroom Practice at Key Stage 2: The Impact of New Labour's National Strategies

    ERIC Educational Resources Information Center

    Webb, Rosemary; Vulliamy, Graham

    2007-01-01

    The article examines the impact of New Labour policies--particularly the National Literacy and Numeracy Strategies and the subsequent Primary National Strategy--on classroom practice at Key Stage 2 in England. Evidence is drawn from fieldwork conducted in 2003-2005 from a sample of 50 schools, replicating a study conducted a decade previously in…

  18. Methodology and emission scenarios employed in the development of the National Energy Strategy

    SciTech Connect

    Fisher, R.E.

    1992-09-01

    This paper describes the steps taken to model the National Energy Strategy (NES). It provides an overview of the NES process including the models used for the project. The National Energy Strategy Environmental Analysis Model (NESEAM), which was used in analyzing environmental impacts, is discussed. The structure of NESEAM, as well as results and analyses are presented.

  19. Methodology and emission scenarios employed in the development of the National Energy Strategy

    SciTech Connect

    Fisher, R.E.

    1992-01-01

    This paper describes the steps taken to model the National Energy Strategy (NES). It provides an overview of the NES process including the models used for the project. The National Energy Strategy Environmental Analysis Model (NESEAM), which was used in analyzing environmental impacts, is discussed. The structure of NESEAM, as well as results and analyses are presented.

  20. Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia

    PubMed Central

    Lemke, Nele; Werner, Christian; Hauer, Klaus

    2016-01-01

    cognitive tests and simple (rs=−.22 to .68, P ≤.001-.03), moderate (rs=−.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=−.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test–retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. Conclusions Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game. PMID:27432746

  1. Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia.

    PubMed

    Wiloth, Stefanie; Lemke, Nele; Werner, Christian; Hauer, Klaus

    2016-07-18

    .001-.03), moderate (rs=-.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=-.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test-retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game.

  2. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial

    PubMed Central

    King, Derek; Romeo, Renee; Schehl, Barbara; Barber, Julie; Griffin, Mark; Rapaport, Penny; Livingston, Debbie; Mummery, Cath; Walker, Zuzana; Hoe, Juanita; Sampson, Elizabeth L; Cooper, Claudia; Livingston, Gill

    2013-01-01

    Objective To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone. Design Cost effectiveness analysis nested within a pragmatic randomised controlled trial. Setting Three mental health and one neurological outpatient dementia service in London and Essex, UK. Participants Family carers of people with dementia. Intervention Eight session, manual based, coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment, compared with usual treatment alone. Primary outcome measures Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline. Results Of the 260 participants recruited to the study, 173 were randomised to the START intervention, and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference −1.79 (95% CI −3.32 to −0.33)), indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (−0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (−28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30 000 per QALY gained, and a high probability of cost effectiveness on the HADS-T measure. Conclusions The manual based coping intervention START, when added to treatment as usual, was cost effective compared with treatment as usual alone by reference to both outcome measures

  3. Clinical features and multidisciplinary approaches to dementia care

    PubMed Central

    Grand, Jacob HG; Caspar, Sienna; MacDonald, Stuart WS

    2011-01-01

    Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1) Alzheimer’s disease; 2) vascular dementias; 3) frontotemporal dementias; and 4) dementia with Lewy bodies/Parkinson’s disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of pathological burden. Future research goals are outlined, with a call to action for social policy initiatives that promote preventive lifestyle behaviors, and healthcare programs that will support the growing number of individuals affected by

  4. Maritime Commerce Security Plan for The National Strategy for Maritime Security

    DTIC Science & Technology

    2005-10-01

    MARITIME COMMERCE SECURITY PLAN FOR THE NATIONAL STRATEGY FOR MARITIME SECURITY OCTOBER 2005 Report Documentation Page Form...COVERED 00-00-2005 to 00-00-2005 4. TITLE AND SUBTITLE Maritime Commerce Security Plan for The National Strategy for Maritime Security 5a... Commerce Security Plan i FOREWORD By signing National Security Presidential Directive 41/Homeland Security Presidential Directive 13 (NSPD-41/HSPD

  5. Nationalism and Rights in the New Europe. Teaching Strategy.

    ERIC Educational Resources Information Center

    Chan, Adrian

    1992-01-01

    Presents a lesson plan designed to teach upper grade level secondary students about nationalism and civil rights in post-Cold War Europe. Examines the rise of nationalism and discrimination against ethnic minorities in eastern Europe since the end of Communist rule. Includes a map of Europe, suggested teaching procedures, and follow-up activities.…

  6. Flavonoids and dementia: an update.

    PubMed

    Orhan, I E; Daglia, M; Nabavi, S F; Loizzo, M R; Sobarzo-Sánchez, E; Nabavi, S M

    2015-01-01

    Dementia is a strongly age-related syndrome due to cognitive decline that can be considered a typical example of the combination of physiological and pathological aging-associated changes occurring in old people; it ranges from intact cognition to mild cognitive impairment, which is an intermediate stage of cognitive deterioration, and dementia. The spread of this syndrome has induced to study and try to reduce dementia modifiable risk factors. They include insulin resistance and hyperinsulinaemia, high blood pressure, obesity, smoking, depression, cognitive inactivity or low educational attainment as well as physical inactivity and incorrect diet, which can be considered one of the most important factors. One emerging strategy to decrease the prevalence of mild cognitive impairment and dementia may be the use of nutritional interventions. In the last decade, prospective data have suggested that high fruit and vegetable intakes are related to improved cognitive functions and reduced risks of developing a neurodegenerative process. The protective effects against neurodegeneration could be in part due to the intake of flavonoids that have been associated with several health benefits such as antioxidant and anti-inflammatory activities, increased neuronal signaling, and improved metabolic functions. The present article is aimed at reviewing scientific studies that show the protective effects of flavonoid intake against mild cognitive impairment and dementia.

  7. Effectiveness of a multifaceted implementation strategy on physicians' referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial.

    PubMed

    Döpp, Carola M E; Graff, Maud J L; Teerenstra, Steven; Nijhuis-van der Sanden, Maria W G; Olde Rikkert, Marcel G M; Vernooij-Dassen, Myrra J F J

    2013-05-30

    To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therapists received a postgraduate course. In the experimental group physicians and managers had access to a website, received newsletters, and were approached by telephone. In addition, physicians were offered one outreach visit. In the experimental group occupational therapists received the postgraduate course, training days, outreach visits, regional meetings, and access to a reporting system. Main outcome measure was the number of COTiD referrals received by each cluster which was assessed at 6 and 12 months after the start of the intervention. Referrals were included from both participating physicians (enrolled in the study and received either the control or experimental intervention) and non-participating physicians (not enrolled but of whom referrals were received by participating occupational therapists). Mixed model analyses were used to analyze the data. All analyses were based on the principle of intention-to-treat. At 12 months experimental clusters received significantly more referrals with an average of 5,24 referrals (SD 5,75) to the COTiD program compared to 2,07 referrals in the control group (SD 5,14). The effect size at 12 months was 0.58. Although no difference in referral rate was found for the physicians participating in the study, the number of referrals from non-participating physicians (t -2,55 / 43 / 0,02) differed significantly at 12 months. Passive dissemination strategies are less likely to result in changes in professional behavior. The amount of physicians exposed to

  8. Does America Need a National Human Resource Development Strategy?

    ERIC Educational Resources Information Center

    Craig, Robert L.; And Others

    1984-01-01

    Essays by Robert L. Craig, Mervyn M. Dymally, Nolen M. Ellison, Sheila M. Korhammer, Rich Redeker, Markley Roberts, and Richard F. Schubert present various perspectives on U.S. human resource development needs and strategies. (DMM)

  9. Strategies for Preventing Behavioral Incidents in the Nation's Secondary Schools.

    ERIC Educational Resources Information Center

    Purvis, Johnny; Leonard, Rex

    1985-01-01

    Discusses strategies that can be used to prevent the five most common behavioral problems in secondary schools: (1) failure to complete assigned work, (2) tardiness, (3) inattentiveness, (4) littering, and (5) failure to bring materials to class. (FL)

  10. Strategies for Preventing Behavioral Incidents in the Nation's Secondary Schools.

    ERIC Educational Resources Information Center

    Purvis, Johnny; Leonard, Rex

    1985-01-01

    Discusses strategies that can be used to prevent the five most common behavioral problems in secondary schools: (1) failure to complete assigned work, (2) tardiness, (3) inattentiveness, (4) littering, and (5) failure to bring materials to class. (FL)

  11. Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma.

    PubMed

    Asher, I; Haahtela, T; Selroos, O; Ellwood, P; Ellwood, E

    Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013-2014. One of the questions was: "Has a national asthma strategy been developed in your country for the next five years? For children? For adults?". Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p<0.001). In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. Copyright © 2017 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

  12. Dietary patterns, cognitive decline, and dementia: a systematic review.

    PubMed

    van de Rest, Ondine; Berendsen, Agnes Am; Haveman-Nies, Annemien; de Groot, Lisette Cpgm

    2015-03-01

    Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until now mainly focused on the role of individual nutrients and bioactive components. However, the evidence for combined effects, such as multinutrient approaches, or a healthy dietary pattern, such as the Mediterranean diet, is growing. These approaches incorporate the complexity of the diet and possible interaction and synergy between nutrients. Over the past few years, dietary patterns have increasingly been investigated to better understand the link between diet, cognitive decline, and dementia. In this systematic review we provide an overview of the literature on human studies up to May 2014 that examined the role of dietary patterns (derived both a priori as well as a posteriori) in relation to cognitive decline or dementia. The results suggest that better adherence to a Mediterranean diet is associated with less cognitive decline, dementia, or Alzheimer disease, as shown by 4 of 6 cross-sectional studies, 6 of 12 longitudinal studies, 1 trial, and 3 meta-analyses. Other healthy dietary patterns, derived both a priori (e.g., Healthy Diet Indicator, Healthy Eating Index, and Program National Nutrition Santé guideline score) and a posteriori (e.g., factor analysis, cluster analysis, and reduced rank regression), were shown to be associated with reduced cognitive decline and/or a reduced risk of dementia as shown by all 6 cross-sectional studies and 6 of 8 longitudinal studies. More conclusive evidence is needed to reach more targeted and detailed guidelines to prevent or postpone cognitive decline.

  13. Dietary Patterns, Cognitive Decline, and Dementia: A Systematic Review12

    PubMed Central

    van de Rest, Ondine; Berendsen, Agnes AM; Haveman-Nies, Annemien; de Groot, Lisette CPGM

    2015-01-01

    Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until now mainly focused on the role of individual nutrients and bioactive components. However, the evidence for combined effects, such as multinutrient approaches, or a healthy dietary pattern, such as the Mediterranean diet, is growing. These approaches incorporate the complexity of the diet and possible interaction and synergy between nutrients. Over the past few years, dietary patterns have increasingly been investigated to better understand the link between diet, cognitive decline, and dementia. In this systematic review we provide an overview of the literature on human studies up to May 2014 that examined the role of dietary patterns (derived both a priori as well as a posteriori) in relation to cognitive decline or dementia. The results suggest that better adherence to a Mediterranean diet is associated with less cognitive decline, dementia, or Alzheimer disease, as shown by 4 of 6 cross-sectional studies, 6 of 12 longitudinal studies, 1 trial, and 3 meta-analyses. Other healthy dietary patterns, derived both a priori (e.g., Healthy Diet Indicator, Healthy Eating Index, and Program National Nutrition Santé guideline score) and a posteriori (e.g., factor analysis, cluster analysis, and reduced rank regression), were shown to be associated with reduced cognitive decline and/or a reduced risk of dementia as shown by all 6 cross-sectional studies and 6 of 8 longitudinal studies. More conclusive evidence is needed to reach more targeted and detailed guidelines to prevent or postpone cognitive decline. PMID:25770254

  14. Canadian STI national goals and phase specific strategies.

    PubMed

    Wong, T; Sutherland, D

    2002-04-01

    National goals should be "SMART"-specific, measurable, achievable, resource sensitive, and timed. To be meaningful, these goals must be sustainable and realistic within the time frame and fiscal limitations. Multisector partnerships are essential for the goals to become operational.

  15. The National Intelligence Strategy of the United States of America

    DTIC Science & Technology

    2014-01-01

    security issues , and ultimately, to make our nation more secure. We face significant changes in the domestic and global environment and must be...to the changing environment, and promotes best practices across the IC; • Provide a workplace free of discrimination, harassment , and the fear of...components, described as follows: (1) the Strategic Environment section portrays the global national security milieu; (2) the Mission Objective section

  16. U.S. National Security and Strategy: A Selected Bibliography

    DTIC Science & Technology

    2007-10-01

    National Security and the Threat of Climate Change . Alexandria: CNA Corpora- tion, 2007. 68pp. (UA23. N171 2007) http://securityandclimate.cna.org/report...2005) Schwartz, Peter, and Doug Randall. An Abrupt Climate Change Scenario and Its Implications for United States National Security. New York: Time...CSIS Press, 2004. 73pp. (DS79.76 .C567 2004) Cordesman, Anthony H., and Ionut C. Popescu. The Changing Challenges of U.S. Defense Spend- ing

  17. Gastritis May Boost Odds of Dementia.

    PubMed

    Momtaz, Yadollah Abolfathi; Hamid, Tengku Aizan; Ibrahim, Rahimah

    2014-08-01

    Given the high prevalence of dementia and its devastating consequences, identifying risk factors for dementia is a public health priority. The present study aims to assess whether gastritis increases the odds of dementia. The data for this study, consisting of 2926 community-dwelling older adults, were obtained from the National survey entitled "Mental Health and Quality of Life of Older Malaysians." Dementia was diagnosed using the Geriatric Mental State-Automated Geriatric Examination for Computer-Assisted Taxonomy. Prevalence of dementia was considerably higher among older adults with gastritis (29.5%) compared to those without gastritis (13.2%). After adjusting for age, gender, marital status, educational attainment, hypertension, stroke, and diabetes, gastritis was significantly associated with more than twice odds of dementia (adjusted odds ratio = 2.42, P < .001, 95% confidence interval = 1.68-3.49). The findings from this population-based observational study showing evidence that gastritis may increase the risk of dementia provide avenue for further inquiries into dementia. © The Author(s) 2014.

  18. Epidemiology of dementias and Alzheimer's disease.

    PubMed

    Sosa-Ortiz, Ana Luisa; Acosta-Castillo, Isaac; Prince, Martin J

    2012-11-01

    Global population aging has been one of the defining processes of the twentieth century, with profound economic, political and social consequences. It is driving the current epidemic of dementia, both in terms of its extent and global distribution. The aim of the study was to summarize recent findings relevant to the epidemiological knowledge of dementia and Alzheimer's disease (AD). A narrative mini-review of the literature relevant to the epidemiology of dementia and AD is presented, summarizing important findings and analyzing their implications. It was estimated that in 2010 there were 36.5 million people living with dementia, with 7.7 million new cases yearly and a new case of dementia every 4 sec. The number of persons living with dementia will nearly double every 20 years. Most of these persons will be living in low- and middle-income countries (LMIC). There are a substantial number of people with dementia worldwide and these numbers will continue to increase mainly in LMIC, producing a wide range of impacts. It is important to make dementia a national public health and social care priority worldwide. Recent reviews and meta-analyses have failed to clearly identify a singular causal or preventive pathway for AD that seems to be a multicausal, heterogeneous and age-related condition. Copyright © 2012 IMSS. Published by Elsevier Inc. All rights reserved.

  19. Apolipoproteins and HDL cholesterol do not associate with the risk of future dementia and Alzheimer's disease: the National Finnish population study (FINRISK).

    PubMed

    Tynkkynen, Juho; Hernesniemi, Jussi A; Laatikainen, Tiina; Havulinna, Aki S; Sundvall, Jouko; Leiviskä, Jaana; Salo, Perttu; Salomaa, Veikko

    2016-12-01

    Data on associations of apolipoproteins A-I and B (apo A-I, apo B) and HDL cholesterol (HDL-C) with dementia and Alzheimer's disease (AD) are conflicting. Our aim was to examine, whether apo B, apoA-I, their ratio, or HDL-C are significant, independent predictors of incident dementia and AD in the general population free of dementia at baseline. We analyzed the results from two Finnish prospective population-based cohort studies in a total of 13,275 subjects aged 25 to 74 years with mainly Caucasian ethnicity. The follow-up time for both cohorts was 10 years. We used Cox proportional hazards regression to evaluate hazard ratios (HR) for incident dementia (including AD) (n = 220) and for AD (n = 154). Cumulative incidence function (CIF) analysis was also performed to adjust the results for competing risks of death. Adjusted for multiple dementia and AD risk factors, log-transformed apo A-I, log HDL-C, log apo B, and log apo B/A-I ratio were not associated with incident dementia or AD. HDL-C was inversely associated with AD risk when adjusted for competing risks but no other statistically significant associations were observed in the CIF analyses. Apo A-I, HDL-C, apo B, or apo B/A-I ratio were not associated with future dementia or AD. HDL-C was inversely associated with incident AD risk when adjusted for competing risks of death, but the finding is unlikely to be of clinical relevance. Our study does not support the use of these risk markers to predict incident dementia or AD.

  20. Collaborative transdisciplinary team approach for dementia care.

    PubMed

    Galvin, James E; Valois, Licet; Zweig, Yael

    2014-01-01

    Alzheimer's disease (AD) has high economic impact and places significant burden on patients, caregivers, providers and healthcare delivery systems, fostering the need for an evaluation of alternative approaches to healthcare delivery for dementia. Collaborative care models are team-based, multicomponent interventions that provide a pragmatic strategy to deliver integrated healthcare to patients and families across a wide range of populations and clinical settings. Healthcare reform and national plans for AD goals to integrate quality care, health promotion and preventive services, and reduce the impact of disease on patients and families reinforcing the need for a system-level evaluation of how to best meet the needs of patients and families. We review collaborative care models for AD and offer evidence for improved patient- and family-centered outcomes, quality indicators of care and potential cost savings.

  1. The Industrial Base and National Security: A New Strategy

    DTIC Science & Technology

    1993-04-01

    There is a direct and clear link between industrial base capability and U.S. national security. The weapon systems of the 21st century will require...means to produce the weapons required for our national security. In the face of a declining defense industrial base and budget reductions, there is...Industrial Modernization Program (IMIP) and focuses on the areas of education, research and development and capital investment to address the productivity issues facing the defense industrial base in the 21st century.

  2. Diabetes, Dementia and Hypoglycemia.

    PubMed

    Meneilly, Graydon S; Tessier, Daniel M

    2016-02-01

    We are experiencing an epidemic of both diabetes and dementia among older adults in this country. The risk for dementia appears to be increased in patients with diabetes, and patients with dementia and diabetes appear to be at greater risk for severe hypoglycemia. In addition, there may be an increased risk for developing dementia by older patients with diabetes who have had episodes of severe hypoglycemia, although this issue is controversial. In this article, we review the factors that contribute to the increased risk for dementia in older adults with diabetes and outline the complex relationships between hypoglycemia and dementia. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  3. The Folkeskole Year 2000: A National Strategy for Enhanced Learning.

    ERIC Educational Resources Information Center

    Skovsgaard, Joern

    This paper describes the Danish program, Folkeskole year 2000, an educational change strategy that involves an agreement between the teachers' union, the Association of Municipalities, and the Ministry of Education to improve education. The Folkeskole stipulates that the municipal council has the overall responsibility for the municipal school…

  4. The National Drug Control Strategy: A Reality Check.

    DTIC Science & Technology

    1997-01-01

    and continue to gain support at the highest levels in the military and government. President Alberto Fujimori of Peru recently suspended all commercial...through terrorism and murder. All of this is especially frustrating to the United States whose supply side strategy requires honest, trustworthy

  5. National Aeronautics and Space Administration Exploration Systems Interim Strategy

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Contents include the following: 1. The Exploration Systems Mission Directorate within NASA. Enabling the Vision for Space Exploration. The Role of the Directorate. 2. Strategic Context and Approach. Corporate Focus. Focused, Prioritized Requirements. Spiral Transformation. Management Rigor. 3. Achieving Directorate Objectives. Strategy to Task Process. Capability Development. Research and Technology Development. 4. Beyond the Horizon. Appendices.

  6. Conference takes first step toward positive national health strategy.

    PubMed

    Longe, M E

    1978-01-01

    Although scientific advancements have improved and extended our lives, we must still go one step farther--in the direction of disease prevention and health education. With that in mind, Sen. Edward Kennedy and the American Medical Association sponsored a conference to plot out a strategy for developing a healthier American life-style. Highlights of that conference are presented here.

  7. Suicide Prevention in the Army National Guard: Modeling Effective Strategies

    DTIC Science & Technology

    2013-04-01

    large-scale domestic emergencies of hurricanes, wildfires , southwest border operations and even national inaugural events. The breadth, scope, and... frequency of these obligations combined with a recovering economy have exacted an extraordinary commitment from citizen Soldiers. Significantly... impact of multiple deployments causing the traditional Soldier to leave the workplace, deploy to a combat zone, and return home to resume civilian

  8. [The national strategy of tuberculosis control in the Russian Federation].

    PubMed

    Mikhaĭlova, Iu V; Matinian, N S; Shestakov, M G

    2009-01-01

    The decrease of social and economic burden of tuberculosis is possible under conditions of acceptance of common national program targeted to the enhancement of prevention and medical care system, to the development of effective scientifically-grounded technologies of tuberculosis control and adequate measures of medical social post-treatment rehabilitation.

  9. Retooling the Nation-Building Strategy in Afghanistan

    DTIC Science & Technology

    2006-02-28

    reconstruction. 3 Bob Woodward, Bush at War (New York: Simon & Schuster, 2002), 339. 4 Kurt Amend, the Director for Afghanistan on the National Security...Al Qaeda remnants). 27 Perito, 3. 28 Dylan Hendrickson, Michael Bhatia, Mark Knight, and Annabel Taylor, A Review of DFID Involvement in Provincial

  10. A Communications Strategy for the National Children's Study

    ERIC Educational Resources Information Center

    National Institutes of Health, 2005

    2005-01-01

    The National Children's Study is the largest long term study of children's health and development ever to be conducted in the United States, involving 100,000 children from before birth to age 21. The Study aims to better understand the link between the environments in which children are raised and their physical and mental health and development.…

  11. Drama Objectives Bank. Key Stage 3: National Strategy.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    In England, drama is part of young people's core entitlement in the National Curriculum Orders and in the "Framework for Teaching English: Years 7, 8 and 9." It exists as an academic subject in its own right as GCSE (General Certificate of Secondary Education) and beyond. This guide is intended for teachers of drama within English, as…

  12. Limber pine conservation strategy: Recommendations for Rocky Mountain National Park

    Treesearch

    Christy M. Cleaver; Anna W. Schoettle; Kelly S. Burns; J. Jeff Connor

    2015-01-01

    Limber pine (Pinus flexilis), designated by Rocky Mountain National Park (RMNP) as a Species of Management Concern, is a keystone species that maintains ecosystem structure, function, and biodiversity in the park. In RMNP, limber pine is declining due to the interacting effects of recent severe droughts and the climate-exacerbated mountain pine beetle (...

  13. Neuropsychiatric management of young-onset dementias.

    PubMed

    Shinagawa, Shunichiro

    2015-06-01

    A combination of pharmacologic and nonpharmacologic approaches is necessary for the appropriate neuropsychiatric management of patients with young-onset dementia. Nonpharmacologic interventions, including psychological management, environmental strategies, and caregiver's support, should be the first choice for neuropsychiatric management. Pharmacologic interventions differ according to the underlying causes of dementia; thus, differential diagnoses are very important. Antipsychotics should be prescribed carefully; they should be used for the shortest time possible, at the lowest possible dose. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. [What is dementia? 2. A fuzzy construct].

    PubMed

    Derouesné, Christian

    2003-03-01

    Since the publication of the third edition of the classification of mental disorders by the American Psychiatric Association, APA (DSM-III) in 1980, a large international consensus has been reached to define dementia as a multiple cognitive deficit centered by memory disturbances, interfering with the daily life activities and related to organic brain lesions. The DSM-III defined a diagnostic strategy in two steps. First to make the diagnosis of dementia according to the clinical criteria and then to specify its etiology. The more recent editions of the APA classification did not significantly modify these recommendations. The use of the DSM criteria has allowed important advances in epidemiological, clinical and therapeutic research. However, several criticisms should be addressed to the clinical diagnostic criteria as well as to the current concept of dementia. First, from a theoretical point of view, dementia is not a disease, not even a disorder. It only corresponds to a conventional collection of symptoms. Actually, clinical symptoms of dementia basically depend of the localization of brain lesions. Therefore, there could not be one single dementia syndrome. Similarly, the basis of the search for one "antidementia drug" should be questioned. From a clinical point of view, the DSM-IV criteria present some inaccuracies regarding the description of deficits in memory and executive functions as well as in the assessment of the interference of the cognitive decline with the activities of daily living. The definition of dementia as a purely cognitive deficit results in neglecting its psychological and relational manifestations which play a large part in the detection of dementia and its acceptance by the family. A major criticism concerns the definition of dementia as a sincle clinical entity with memory deficits as the core symptom. This definition is well adapted to Alzheimer's disease but results in delayed diagnosis or misclassification of dementias such as

  15. America Promises to Come Back: A New National Strategy

    DTIC Science & Technology

    1991-05-13

    an annex. In mid-March, "Scooter" Libby , the Principal Deputy Tynder- secretary of Defense (Strategy and Resources)2 9 and Admiral Jeremiah 3 0...Annual Report to the President and the Congress, January 1991, 134 pp. (29) "Statement of I. Lewis Libby , Principal Deputy Undersecre- tary of... Willard Avenue Chevy Chase, MD 20815-4625 15 138 Vivian Ravdin SECDEF Speechwriter Pnt Room 3D853 Office of the Secretary of Defense Washington, D.C

  16. A national research & development strategy for biomass crop feedstocks

    SciTech Connect

    Wright, L.L.; Cushman, J.H.

    1997-07-01

    Planning was initiated in 1996 with the objective of reevaluating current biomass feedstock research and development strategies to: (1) assure that by 2005, one or more commercial lignocellulosic to ethanol projects will be able to acquire a dependable supply of biomass crop feedstocks; (2) assure that recently initiated demonstrations of crops to electricity will be successful and; (3) assure that the research base needed to support future biomass industry expansion is being developed. Multiple trends and analyses indicate that biomass energy research and development strategies must take into account the fact that competition for land will define the upper limits of available biomass energy crop supplies and will largely dictate the price of those supplies. Only crop production and utilization strategies which contribute profit to the farmer or landowner and to energy producers will be used commercially for biomass energy production. Strategies for developing biomass {open_quotes}energy{close_quotes} crop supplies must take into consideration all of the methods by which biomass crops will enter biomass energy markets. The lignocellulosic materials derived from crops can be available as primary residues or crop by-products; secondary residues or processing by-products; co-products (at both the crop production and processing stages); or, as dedicated energy crops. Basic research and development (R&D) leading to yield improvement continues to be recommended as a major long-term focus for dedicated energy crops. Many additional near term topics need attention, some of which are also applicable to by-products and co-products. Switchgrass R&D should be expanded and developed with greater collaboration of USDA and state extension groups. Woody crop research should continue with significant cost-share from industries developing the crops for other commercial products. Co-product options need more investigation.

  17. The Path to a Culturally Relevant National Security Strategy

    DTIC Science & Technology

    2008-05-22

    Theory This section discusses the key theory linking self and society. Henri Tajfel , the father of social identity theory, developed this theory as...32 John C. Turner, “An Introduction,” in Social Groups and Identities – Developing the Legacy of Henri Tajfel , ed...in Social Groups and Identities – Developing the Legacy of Henri Tajfel , 17. 13 strategies for achieving or maintaining intergroup comparisons that

  18. Longitudinal Association of Dementia and Depression

    PubMed Central

    Snowden, Mark B.; Atkins, David C.; Steinman, Lesley E.; Bell, Janice F.; Bryant, Lucinda L.; Copeland, Catherine; Fitzpatrick, Annette L.

    2015-01-01

    Objectives Depression is an important precursor to dementia, but less is known about the role dementia plays in altering the course of depression. We examined whether depression prevalence, incidence, and severity are higher in those with dementia versus those with mild cognitive impairment (MCI), or normal cognition. Design Prospective cohort study using the longitudinal Uniform Data Set of the National Alzheimer's Coordinating Center (2005–2013). Setting 34 Alzheimer Disease research centers. Participants 27,776 subjects with dementia, MCI, or normal cognition. Measurements Depression status was determined by a clinical diagnosis of depression within the prior 2 years and by a Geriatric Depression Scale-Short Form score >5. Results Rates of depression were significantly higher in subjects with MCI and dementia compared with those with normal cognition at index visit. Controlling for demographics and common chronic conditions, logistic regression analysis revealed elevated depression in those with MCI (OR: 2.40 [95% CI: 2.25, 2.56]) or dementia (OR: 2.64 [95% CI: 2.43, 2.86]) relative to those with normal cognition. In the subjects without depression at the index visit (N = 18,842), those with MCI and dementia had higher probabilities of depression diagnosis 2 years post index visit than those with normal cognition: MCI = 21.7%, dementia 24.7%, normal cognition = 10.5%. Conclusion MCI and dementia were associated with significantly higher rates of depression in concurrent as well as prospective analyses. These findings suggest that efforts to effectively engage and treat older adults with dementia will need also to address co-occurring depression. PMID:25441056

  19. Longitudinal Association of Dementia and Depression.

    PubMed

    Snowden, Mark B; Atkins, David C; Steinman, Lesley E; Bell, Janice F; Bryant, Lucinda L; Copeland, Catherine; Fitzpatrick, Annette L

    2015-09-01

    Depression is an important precursor to dementia, but less is known about the role dementia plays in altering the course of depression. We examined whether depression prevalence, incidence, and severity are higher in those with dementia versus those with mild cognitive impairment (MCI), or normal cognition. Prospective cohort study using the longitudinal Uniform Data Set of the National Alzheimer's Coordinating Center (2005-2013). 34 Alzheimer Disease research centers. 27,776 subjects with dementia, MCI, or normal cognition. Depression status was determined by a clinical diagnosis of depression within the prior 2 years and by a Geriatric Depression Scale-Short Form score >5. Rates of depression were significantly higher in subjects with MCI and dementia compared with those with normal cognition at index visit. Controlling for demographics and common chronic conditions, logistic regression analysis revealed elevated depression in those with MCI (OR: 2.40 [95% CI: 2.25, 2.56]) or dementia (OR: 2.64 [95% CI: 2.43, 2.86]) relative to those with normal cognition. In the subjects without depression at the index visit (N = 18,842), those with MCI and dementia had higher probabilities of depression diagnosis 2 years post index visit than those with normal cognition: MCI = 21.7%, dementia = 24.7%, normal cognition = 10.5%. MCI and dementia were associated with significantly higher rates of depression in concurrent as well as prospective analyses. These findings suggest that efforts to effectively engage and treat older adults with dementia will need also to address co-occurring depression. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  20. Antipsychotic prescription amongst hospitalized patients with dementia.

    PubMed

    Gallagher, P; Curtin, D; de Siún, A; O'Shea, E; Kennelly, S; O'Neill, D; Timmons, S

    2016-09-01

    Antipsychotic drugs are used to treat behavioural and psychological symptoms of dementia, despite significant safety concerns regarding increased risk of stroke and mortality. The numbers of patients with dementia and related behavioural symptoms being treated in acute hospitals is increasing. (i) to determine pre-admission and in-hospital prevalence of antipsychotic use in a national sample of patients with dementia and acute illness; (ii) identify reasons for antipsychotic use; (iii) assess features of the ward environment which impact on patients with dementia; (iv) determine availability of dementia-specific policies, training, appraisal and mentorship programs which influence service delivery. Four-part standardized audit in 35 public acute hospitals comprising (i) retrospective healthcare record review (n = 660); (ii) prospective assessment of ward environment (n = 77); (iii) ward organization interview with clinical managers (n = 77); (iv) hospital organisation interview with senior managers (n = 35). Antipsychotic drugs were prescribed to 29% of patients with dementia before hospitalization and to 41% during hospitalization; one quarter received new or additional prescriptions. Assessments for delirium (45%), dementia symptoms (39%), mood (26%), mental state (64%) and distress-provoking factors (3%) were suboptimal. Drug indications were documented in 78%. Non-pharmacological interventions were not documented. Most wards lacked environmental cues to promote orientation. Dementia-specific care pathways existed in 2 of 35 hospitals. Staff support and training programmes were suboptimal. 12% of patients were discharged with new antipsychotic prescriptions. Antipsychotic medications are commonly prescribed for hospitalized patients with dementia in Ireland. Ward environments and dementia-related governance structures are suboptimal. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights

  1. A Career Practitioner's Response to the National Career Development Strategy Green Paper

    ERIC Educational Resources Information Center

    Athanasou, James A.

    2012-01-01

    The National Career Development Strategy Green Paper is a discussion paper issued by the Department of Employment, Education and Workplace Relations. It is aimed at the formulation of a coherent and structured career development strategy throughout Australia. The Green Paper seeks to lay the foundation for policy change through establishing the…

  2. A Career Practitioner's Response to the National Career Development Strategy Green Paper

    ERIC Educational Resources Information Center

    Athanasou, James A.

    2012-01-01

    The National Career Development Strategy Green Paper is a discussion paper issued by the Department of Employment, Education and Workplace Relations. It is aimed at the formulation of a coherent and structured career development strategy throughout Australia. The Green Paper seeks to lay the foundation for policy change through establishing the…

  3. 75 FR 41685 - Implementation of the National HIV/AIDS Strategy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-16

    ... Memorandum of July 13, 2010--Implementation of the National HIV/AIDS Strategy #0; #0; #0; Presidential... HIV/AIDS Strategy Memorandum for the Heads of Executive Departments and Agencies As we approach 30 years from the onset of the HIV/AIDS epidemic in the United States, new actions are needed to...

  4. Changing Practice: The National Literacy Strategy and the Politics of Literacy Policy

    ERIC Educational Resources Information Center

    Moss, Gemma

    2004-01-01

    Drawing on a recent ESRC-funded research project, this paper will explore some of the contradictory structural features of the National Literacy Strategy (NLS), which have helped shape its evolution over time, and reflect on some of the tension points which have arisen at different levels of implementation as the Strategy unfolds. In the process,…

  5. The National Drug Control Strategy: The First-Line Approach to Decreasing Violence in Our Communities.

    ERIC Educational Resources Information Center

    Garcia, Fred

    1995-01-01

    Describes the National Drug Control Strategy's nine-pronged approach in addressing drug abuse, which includes the formation of partnerships between federal, state, and local governments and the private and public sectors. The strategy includes prevention initiatives, individualized treatment programs for high-risk groups, education aimed at…

  6. Breaking the Cycle of Drug Abuse. 1993 Interim National Drug Control Strategy.

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, Washington, DC.

    This Interim Drug Strategy is intended to give a new sense of direction and to reinvigorate the nation's efforts against drug trafficking and abuse. The preface to the report lists eight new strategies that the Administration will implement: (1) make drug policy a cornerstone of domestic and social policy; (2) target pregnant women, children, and…

  7. Interactive Whole Class Teaching in the National Literacy and Numeracy Strategies

    ERIC Educational Resources Information Center

    Smith, Fay; Hardman, Frank; Wall, Kate; Mroz, Maria

    2004-01-01

    The study set out to investigate the impact of the official endorsement of 'interactive whole class teaching' on the interaction and discourse styles of primary teachers while teaching the National Literacy and Numeracy Strategies. In both strategies, interactive whole class teaching is seen as an 'active teaching' model promoting high quality…

  8. A Strategy for Designing Instruction for Educational Television in Developing Nations.

    ERIC Educational Resources Information Center

    Awotua-Efebo, Ebi Bio

    1987-01-01

    Explains a strategy for the design and development of instructional programs for educational television in developing nations using a modified version of the Shannon-Weaver Communication Model. Highlights include design strategy, manner of presentation, and stages of program development. The importance of making materials realistic and culturally…

  9. Strategy to Combat Transnational Organized Crime: Addressing Converging Threats to National Security

    DTIC Science & Technology

    2011-07-01

    Initiative, the Law Enforcement Strategy to Combat International Organized Crime, the National Strategy for Maritime Security, Countering Piracy Off the...territory and piracy ransoms generate significant sums of illicit revenue and promote the spread of government instability. Threats to the Economy, U.S...property, including through intrusions into corporate and proprietary computer networks. Theft of intellectual property ranges from movies , music, and

  10. National Strategy for Violence Prevention in the Austrian Public School System: Development and Implementation

    ERIC Educational Resources Information Center

    Spiel, Christiane; Strohmeier, Dagmar

    2011-01-01

    As a result of a quick succession of several spectacular events in schools, and the ensuing public discussion on the high rates of bullying in Austria, a national strategy for violence prevention in schools and preschools has been developed. In formulating the strategy, a systematic procedure involving international experts and a number of local…

  11. Changing Practice: The National Literacy Strategy and the Politics of Literacy Policy

    ERIC Educational Resources Information Center

    Moss, Gemma

    2004-01-01

    Drawing on a recent ESRC-funded research project, this paper will explore some of the contradictory structural features of the National Literacy Strategy (NLS), which have helped shape its evolution over time, and reflect on some of the tension points which have arisen at different levels of implementation as the Strategy unfolds. In the process,…

  12. National Strategy for Violence Prevention in the Austrian Public School System: Development and Implementation

    ERIC Educational Resources Information Center

    Spiel, Christiane; Strohmeier, Dagmar

    2011-01-01

    As a result of a quick succession of several spectacular events in schools, and the ensuing public discussion on the high rates of bullying in Austria, a national strategy for violence prevention in schools and preschools has been developed. In formulating the strategy, a systematic procedure involving international experts and a number of local…

  13. National Strategy of Defense: Peace and Security for Brazil

    DTIC Science & Technology

    2008-12-19

    to control the maritime access to Brazil: the strip that goes from Santos to Vitória, and the area around the mouth of the Amazon River. National...reestablish the tradition of the Tiros de Guerra [military training school for reserves]. In principle, all of the country’s town halls should be able...to take part in the renovation of the Tiros de Guerra , when the legal restrictions that still limit the list of qualified townships are eliminated

  14. The 2015 National Security Strategy: Authorities, Changes, Issues for Congress

    DTIC Science & Technology

    2016-04-05

    persistent threat of terrorism ;  build capacity to prevent conflict;  prevent the spread and use of weapons of mass destruction;  confront climate...on Safeguarding Americans’ Civil Liberties,” “Strengthening the Sharing of Terrorism Information to Protect Americans,” “National Counterterrorism...Reform and Terrorism Prevention Act of 2004, December 17, 2004 (P.L. 108-458). These changes were informed in part by the recommendations provided

  15. Strategies for dealing with the national coding shortage.

    PubMed

    Schwieters, Jill

    2010-04-01

    Steps providers should consider to deal with a national coding shortage and implementation of ICD-10 include the following: Concentrate on employee retention (consider retention bonuses; upgrade pay scales; and offer flex-time and flexible work schedules). Begin a training program for ICD-10. Target other healthcare professionals and current employees to transition into coding positions. Collaborate with colleges, high schools, and middle schools to draw prospective students to this career path and your organization.

  16. Political Objective Denial: Enhancing Deterrence in the National Strategy.

    DTIC Science & Technology

    2014-09-26

    many that the Soviets would not attack Western Europe suggests a subconscious understanding of the I nature of any Soviet political decision that...the minds of * the decisionmaking elites. It is possible, however, to develop plans for dealing with political 2 objectives without knowing exact...political in nature, such as -a nation being compelled to adopt a certain ideology, form of government or alliance. Clausewitz had in mind those

  17. A monitoring strategy for the national wilderness preservation system

    Treesearch

    Peter B. Landres; David N. Cole; Alan E Watson

    1994-01-01

    In 1964, the Wilderness Act (P.L. 88-577) established the National Wilderness Preservation System (NWPS), currently composed of nearly 39 million hectares in 564 separate units, ranging in size from 2.4 he&ares to 3.5 million hectares. The purpose of the NWPS is “. . . to secure for the American people of present and future generations the benefits of an enduring...

  18. National Strategy for the Southwest Border: Having the Desired Effect?

    DTIC Science & Technology

    2011-03-18

    government victories against the DTOs include the December 2009 killing of Arturo Beltrán Leyva and January 2010 capture of Teodoro Garcia Simental, the...http://www.fbi.gov/news/stories/2010/august/southwest- border3/border-violence (accessed February 12, 2011). 6 Bob Killebrew and Jennifer Bernal , Crime...2011), 1. 9 Killebrew and Bernal , Crime Wars: Gangs, Cartels and U.S. National Security, 16. 10 June S. Beittel, Mexico’s Drug-Related Violence

  19. Changing Classroom Practice through the English National Literacy Strategy: A Micro-Interactional Perspective

    ERIC Educational Resources Information Center

    Lefstein, Adam

    2008-01-01

    How and why is national policy translated into interactions between teachers and pupils? This article examines the enactment of the English National Literacy Strategy (NLS) in a case study of two literacy lessons, which are drawn from a yearlong ethnographic study of the NLS in one school. Although the teacher taught directly from and adhered…

  20. Why Are the Mathematics National Examination Items Difficult and What Is Teachers' Strategy to Overcome It?

    ERIC Educational Resources Information Center

    Retnawati, Heri; Kartowagiran, Badrun; Arlinwibowo, Janu; Sulistyaningsih, Eny

    2017-01-01

    The quality of national examination items plays an enormous role in identifying students' competencies mastery and their difficulties. This study aims to identify the difficult items in the Junior High School Mathematics National Examination, to find the factors that cause students' difficulty and to reveal the strategies that the teachers and the…

  1. Education for National Identity: Arab Schools Principals and Teachers Dilemmas and Coping Strategies

    ERIC Educational Resources Information Center

    Arar, Khalid; Ibrahim, Fadia

    2016-01-01

    This article discusses strategies used by Arab principals and teachers in Israel to cope with dilemmas involved in education for national identity stemming from conflict between two national narratives. While the Israeli Ministry of Education expects the Arab education system to educate students according to the Jewish State's values, Palestinian…

  2. Education for National Identity: Arab Schools Principals and Teachers Dilemmas and Coping Strategies

    ERIC Educational Resources Information Center

    Arar, Khalid; Ibrahim, Fadia

    2016-01-01

    This article discusses strategies used by Arab principals and teachers in Israel to cope with dilemmas involved in education for national identity stemming from conflict between two national narratives. While the Israeli Ministry of Education expects the Arab education system to educate students according to the Jewish State's values, Palestinian…

  3. Argumentative Form and Negotiating Strategy in Three United Nations Security Council Debates.

    ERIC Educational Resources Information Center

    Renz, Mary Ann

    1987-01-01

    Examines arguments used in three United Nations Security Council debates which contradict the conclusion that different nations use different argumentative forms and think differently. Finds that the nature of data and the relative emphasis on principle as a negotiating strategy were more characteristic factors. (MS)

  4. English Learning Strategies of Various Nations: A Study in Military Context

    ERIC Educational Resources Information Center

    Solak, Ekrem

    2014-01-01

    How successful learners learn English has been one of the primary interest of scientists and researchers in recent years. Therefore, this study aimed to determine what language learning strategies the military personnel from different nations used while learning English. 56 subjects from 14 different nations deployed in three different military…

  5. Types of Dementia

    MedlinePlus

    ... Normal pressure hydrocephalus Huntington's disease Wernicke-Korsakoff Syndrome Alzheimer's disease Most common type of dementia; accounts for an ... and death in the brain. Learn more about Alzheimer's disease . Vascular dementia back to top Previously known as ...

  6. Lewy Body Dementia

    MedlinePlus

    ... People with Lewy body dementia may experience visual hallucinations, and changes in alertness and attention. Other effects ... body dementia signs and symptoms may include: Visual hallucinations. Hallucinations may be one of the first symptoms, ...

  7. Psychiatric Aspects of Dementia.

    PubMed

    Onyike, Chiadi U

    2016-04-01

    The psychiatric aspects of dementia are increasingly recognized as significant contributors to distress, disability, and care burden, and, thus, are of increasing interest to practicing neurologists. This article examines how psychiatric disorders are entwined with dementia and describes the predictive, diagnostic, and therapeutic implications of the psychiatric symptoms of dementia. Psychiatric disorders, particularly depression and schizophrenia, are associated with higher risk for late-life dementia. Psychiatric phenomena also define phenotypes such as frontotemporal dementia and dementia with Lewy bodies, cause distress, and amplify dementia-related disabilities. Management requires a multidisciplinary team, a problem-solving stance, programs of care, and pharmacologic management. Recent innovations include model programs that provide structured problem-solving interventions and tailored in-home care. There is new appreciation of the complexity of the relationship between psychiatric disorders and dementia as well as the significance of this relationship for treatment, community services, and research.

  8. Psychiatric Aspects of Dementia

    PubMed Central

    Onyike, Chiadi U.

    2016-01-01

    Purpose of Review: The psychiatric aspects of dementia are increasingly recognized as significant contributors to distress, disability, and care burden, and, thus, are of increasing interest to practicing neurologists. This article examines how psychiatric disorders are entwined with dementia and describes the predictive, diagnostic, and therapeutic implications of the psychiatric symptoms of dementia. Recent Findings: Psychiatric disorders, particularly depression and schizophrenia, are associated with higher risk for late-life dementia. Psychiatric phenomena also define phenotypes such as frontotemporal dementia and dementia with Lewy bodies, cause distress, and amplify dementia-related disabilities. Management requires a multidisciplinary team, a problem-solving stance, programs of care, and pharmacologic management. Recent innovations include model programs that provide structured problem-solving interventions and tailored in-home care. Summary: There is new appreciation of the complexity of the relationship between psychiatric disorders and dementia as well as the significance of this relationship for treatment, community services, and research. PMID:27042910

  9. Dementia: Diagnosis and Tests

    MedlinePlus

    ... our e-newsletter! Aging & Health A to Z Dementia Diagnosis & Tests If you or someone you care ... To determine whether an older adult might have dementia, a healthcare professional will: Ask about the person’s ...

  10. Lewy Body Dementias: Dementia With Lewy Bodies and Parkinson Disease Dementia.

    PubMed

    Gomperts, Stephen N

    2016-04-01

    This article provides an overview of the clinical features, neuropathologic findings, diagnostic criteria, and management of dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD), together known as the Lewy body dementias. DLB and PDD are common, clinically similar syndromes that share characteristic neuropathologic changes, including deposition of α-synuclein in Lewy bodies and neurites and loss of tegmental dopamine cell populations and basal forebrain cholinergic populations, often with a variable degree of coexisting Alzheimer pathology. The clinical constellations of DLB and PDD include progressive cognitive impairment associated with parkinsonism, visual hallucinations, and fluctuations of attention and wakefulness. Current clinical diagnostic criteria emphasize these features and also weigh evidence for dopamine cell loss measured with single-photon emission computed tomography (SPECT) imaging and for rapid eye movement (REM) sleep behavior disorder, a risk factor for the synucleinopathies. The timing of dementia relative to parkinsonism is the major clinical distinction between DLB and PDD, with dementia arising in the setting of well-established idiopathic Parkinson disease (after at least 1 year of motor symptoms) denoting PDD, while earlier cognitive impairment relative to parkinsonism denotes DLB. The distinction between these syndromes continues to be an active research question. Treatment for these illnesses remains symptomatic and relies on both pharmacologic and nonpharmacologic strategies. DLB and PDD are important and common dementia syndromes that overlap in their clinical features, neuropathology, and management. They are believed to exist on a spectrum of Lewy body disease, and some controversy persists in their differentiation. Given the need to optimize cognition, extrapyramidal function, and psychiatric health, management can be complex and should be systematic.

  11. Task Force on Defense Strategies for Ensuring the Resilience of National Space Capabilities. Executive Summary

    DTIC Science & Technology

    2017-03-21

    March 2017 Task Force on Defense Strategies for Ensuring the Resilience of National Space Capabilities OFFICE OF THE UNDER SECRETARY OF...the Department of Defense. The DSB Task Force on Defense Strategies for Ensuring the Resilience of National Space Capabilities completed its formal...public release. D E P A R T M E N T O F D E F E N S E | D E F E N S E S C I E N C E B O A R D DSB Task Force on Defense Strategies for

  12. Imaging amyloid in Parkinson's disease dementia and dementia with Lewy bodies with positron emission tomography.

    PubMed

    Brooks, David J

    2009-01-01

    Although Parkinson's disease with later dementia (PDD) and dementia with Lewy bodies (DLB) are pathologically characterized by the presence of intraneuronal Lewy inclusion bodies, amyloid deposition is also associated to varying degrees with both these disorders. Fibrillar amyloid load can now be quantitated in vivo with positron emission tomography (PET) using imaging biomarkers. Here the reported findings of 11C-PIB PET studies concerning the amyloid load associated with PD and its influence on dementia are reviewed. It is concluded that the presence of amyloid acts to accelerate the dementia process in Lewy body disorders, though has little influence on its nature. Anti-amyloid strategies could be a relevant approach for slowing dementia in a number of DLB and PDD cases.

  13. After Iraq: The Search for a Sustainable National Security Strategy

    DTIC Science & Technology

    2009-01-01

    of some current regional powers to a yet greater category, China and India specifically. When we add in current uncertainty about the future course...manifest in the behavior and norms of the United Nations Security Council. It is not. Rising states such as China and India are on a collision...trends hostile to U.S. hegemony, the well-announced “rise of “ China and India , and one day, just possibly, the EU/Europe, and even a long-delayed

  14. Recommendations of the Alzheimer's disease-related dementias conference.

    PubMed

    Montine, Thomas J; Koroshetz, Walter J; Babcock, Debra; Dickson, Dennis W; Galpern, Wendy R; Glymour, M Maria; Greenberg, Steven M; Hutton, Michael L; Knopman, David S; Kuzmichev, Andrey N; Manly, Jennifer J; Marder, Karen S; Miller, Bruce L; Phelps, Creighton H; Seeley, William W; Sieber, Beth-Anne; Silverberg, Nina B; Sutherland, Margaret; Torborg, Christine L; Waddy, Salina P; Zlokovic, Berislav V; Corriveau, Roderick A

    2014-08-26

    The National Alzheimer's Project Act, signed into law in 2011, mandates a National Plan to Address Alzheimer's Disease that is updated annually. In the Plan, the term Alzheimer disease includes not only Alzheimer disease (AD) proper, but also several specified related dementias, namely, frontotemporal, Lewy body, vascular, and mixed dementia. In response to a specific action item in the 2012 National Plan, the National Institute of Neurological Disorders and Stroke, in collaboration with the National Institute on Aging, convened panels of experts and conducted a 2-day public conference to develop research priorities and timelines for addressing Alzheimer disease-related dementias (ADRD) in 5 topic areas: multiple etiology dementias, health disparities, Lewy body dementias including dementia with Lewy bodies and Parkinson disease dementia, frontotemporal dementia and related tauopathies, and vascular contributions to ADRD. By design, the product was up to 8 prioritized research recommendations in each topic area including estimated timelines from when work on a recommendation is started to completion or to full implementation of an ongoing activity, and recognition of shared research themes across recommendations. These included increased education and training of both researchers and health care professionals, addressing health disparities, fundamental neurobiology research, advanced diagnostics, collaborative biosample repositories, and a focus on developing effective interventions to prevent or treat ADRD by the year 2025 as targeted by the National Plan.

  15. Composite risk scores for predicting dementia.

    PubMed

    Stephan, Blossom C M; Tang, Eugene; Muniz-Terrera, Graciela

    2016-03-01

    A key priority in dementia research is the development of tools to identify individuals at high risk of dementia. This is important to prevent or delay dementia onset and as we move towards personalized medicine. Numerous models (n > 50) for predicting dementia have been developed. These vary in the number (0 to 20+) and type (e.g. demographics, health, neuropsychological, and genetic) of predictor variables used for risk calculation, follow-up length (1-20 years) and age at screening (mid vs laterlife). Evaluation of the models shows that most have moderate-to-poor predictive accuracy. Few have been externally validated, raising questions about their generalizability outside the cohorts from which they were developed. The results highlight that if additional models are proposed the field will be overwhelmed with many competing risk models, making it difficult to reach consensus on which is best. Numerous models for predicting dementia have been proposed but are limited by a lack of external validation and evaluation of economic impact. Innovative methods and data designs may be needed to improve derivation of dementia risk scores. Having a method for predicting dementia risk could transform medical research and allow for earlier testing of intervention strategies.

  16. Evolving National Strategy Driving Nursing Informatics in New Zealand.

    PubMed

    Honey, Michelle; Westbrooke, Lucy

    2016-01-01

    An update to the New Zealand Health Strategy identifying direction and priorities for health services is underway. Three specific areas have implications for nursing informatics and link to education and practice: best use of technology and information, fostering and spreading innovation and quality improvements, and building leaders and capability for the future. An emphasis on prevention and wellness means nursing needs to focus on health promotion and the role of consumers is changing with access to their on-line information a major focus. As the modes of delivery for services such as telehealth and telenursing changes, nurses are increasingly working independently and utilizing information and communication technologies to collaborate with the health team. New Zealand, and other countries, need strong nursing leadership to sustain the nursing voice in policy and planning and ensure nurses develop the required informatics skills.

  17. The DEVELOP National Program's Strategy for Communicating Applied Science Outcomes

    NASA Astrophysics Data System (ADS)

    Childs-Gleason, L. M.; Ross, K. W.; Crepps, G.; Favors, J.; Kelley, C.; Miller, T. N.; Allsbrook, K. N.; Rogers, L.; Ruiz, M. L.

    2016-12-01

    NASA's DEVELOP National Program conducts rapid feasibility projects that enable the future workforce and current decision makers to collaborate and build capacity to use Earth science data to enhance environmental management and policy. The program communicates its results and applications to a broad spectrum of audiences through a variety of methods: "virtual poster sessions" that engage the general public through short project videos and interactive dialogue periods, a "Campus Ambassador Corps" that communicates about the program and its projects to academia, scientific and policy conference presentations, community engagement activities and end-of-project presentations, project "hand-offs" providing results and tools to project partners, traditional publications (both gray literature and peer-reviewed), an interactive website project gallery, targeted brochures, and through multiple social media venues and campaigns. This presentation will describe the various methods employed by DEVELOP to communicate the program's scientific outputs, target audiences, general statistics, community response and best practices.

  18. Los Alamos National Laboratory Develops ''Quick to WIPP'' Strategy

    SciTech Connect

    Jones, R.; Allen, G.; Kosiewicz, S.; Martin, B,; LANL; Nunz, J.; Biedscheid, J.; Sellmer, T.; Willis, J.; Orban, J.; Liekhus, K.; Djordjevic, S.

    2003-02-25

    The Cerro Grande forest fire in May of 2000 and the terrorist events of September 11, 2001 precipitated concerns of the vulnerability of legacy contact-handled (CH), high-wattage transuranic (TRU) waste stored at Los Alamos National Laboratory (LANL). An analysis of the 9,100 cubic meters of stored CH-TRU waste revealed that 400 cubic meters or 4.5% of the inventory represented 61% of the risk. The analysis further showed that this 400 cubic meters was contained in only 2,000 drums. These facts and the question ''How can the disposition of this waste to the Waste Isolation Pilot Plant (WIPP) be accelerated?'' formed the genesis of LANL's Quick to WIPP initiative.

  19. National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders.

    PubMed

    Martin-Gill, Christian; Gaither, Joshua B; Bigham, Blair L; Myers, J Brent; Kupas, Douglas F; Spaite, Daniel W

    2016-01-01

    Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy

  20. Implementation of Strategies to Leverage Public and Private Resources for National Security Workforce Development

    SciTech Connect

    2009-04-01

    This report documents implementation strategies to leverage public and private resources for the development of an adequate national security workforce as part of the National Security Preparedness Project (NSPP), being performed under a U.S. Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. There are numerous efforts across the United States to develop a properly skilled and trained national security workforce. Some of these efforts are the result of the leveraging of public and private dollars. As budget dollars decrease and the demand for a properly skilled and trained national security workforce increases, it will become even more important to leverage every education and training dollar. This report details some of the efforts that have been implemented to leverage public and private resources, as well as implementation strategies to further leverage public and private resources.

  1. Developing an information resources management strategy for regulatory veterinary medicine: a national imperative.

    PubMed

    Miller, L E; Honeycutt, T L; Cowen, P; Morrow, W E; Hueston, W D

    1994-10-15

    Lack of a standardized information technology management strategy has resulted in state and federal information systems evolving separately, rather than in tandem. Absence of an information management strategy will eventually affect regulatory program management, epidemiologic research, and domestic and international livestock trade. Producers will ultimately pay the price for the lack of regulatory coordination of US animal health and disease information. The longer the development of state and federal information technology management strategies is postponed, the more cost-, labor-, and time-intensive correcting the deficiency will be. Development of a national information resources management environment is the first step in constructing state and federal information technology strategies.

  2. Prevalence and Incidence Rates of Dementia and Cognitive Impairment No Dementia in the Mexican Population

    PubMed Central

    Mejia-Arango, Silvia; Gutierrez, Luis Miguel

    2012-01-01

    Objective To estimate the prevalence and incidence of dementia and cognitive impairment without dementia (CIND) in the Mexican population. Methods The MHAS study is a prospective panel study of health and aging in Mexico with 7,000 elders that represent 8 million subjects nationally. Using measurements of cognition and activities of daily living of dementia cases and CIND were identified at baseline and follow up. Overall incidence rates and specific rates for sex, age and education were calculated. Results Prevalence was 6.1% and 28.7% for dementia and CIND, respectively. Incidence rates were 27.3 per 1,000 person-years for dementia and 223 per 1,000 persons-year for CIND. Rates of dementia and CIND increased with advancing age and decreased with higher educational level; sex had a differential effect depending on the age strata. Hypertension, diabetes and depression were risk factors for dementia but not for CIND. Discussion These data provide estimates of prevalence and incidence of dementia and cognitive impairment in the Mexican population for projection of future burden. PMID:21948770

  3. Forecasting the Incidence of Dementia and Dementia-Related Outpatient Visits With Google Trends: Evidence From Taiwan.

    PubMed

    Wang, Ho-Wei; Chen, Duan-Rung; Yu, Hsiao-Wei; Chen, Ya-Mei

    2015-11-19

    Google Trends has demonstrated the capability to both monitor and predict epidemic outbreaks. The connection between Internet searches for dementia information and dementia incidence and dementia-related outpatient visits remains unknown. This study aimed to determine whether Google Trends could provide insight into trends in dementia incidence and related outpatient visits in Taiwan. We investigated and validated the local search terms that would be the best predictors of new dementia cases and outpatient visits. We further evaluated the nowcasting (ie, forecasting the present) and forecasting effects of Google Trends search trends for new dementia cases and outpatient visits. The long-term goal is to develop a surveillance system to help early detection and interventions for dementia in Taiwan. This study collected (1) dementia data from Taiwan's National Health Insurance Research Database and (2) local Internet search data from Google Trends, both from January 2009 to December 2011. We investigated and validated search terms that would be the best predictors of new dementia cases and outpatient visits. We then evaluated both the nowcasting and the forecasting effects of Google Trends search trends through cross-correlation analysis of the dementia incidence and outpatient visit data with the Google Trends data. The search term "dementia + Alzheimer's disease" demonstrated a 3-month lead effect for new dementia cases and a 6-month lead effect for outpatient visits (r=.503, P=.002; r=.431, P=.009, respectively). When gender was included in the analysis, the search term "dementia" showed 6-month predictive power for new female dementia cases (r=.520, P=.001), but only a nowcasting effect for male cases (r=.430, P=.009). The search term "neurology" demonstrated a 3-month leading effect for new dementia cases (r=.433, P=.008), for new male dementia cases (r=.434, P=.008), and for outpatient visits (r=.613, P<.001). Google Trends established a plausible relationship

  4. Dementia with Lewy bodies: current concepts.

    PubMed

    Buracchio, Teresa; Arvanitakis, Zoe; Gorbien, Martin

    2005-01-01

    As life expectancy continues to increase over time, dementia is becoming an increasingly more common problem and a major cause of disability in older persons. It is now more important than ever to identify and manage common causes of dementia given variations in disease course, treatments and the possibility for modification of risk factors. Dementia with Lewy bodies (DLB) is a dementia syndrome characterized by progressive cognitive decline, with fluctuating cognition, recurrent detailed and well-formed hallucinations, and parkinsonism. This article aims to provide an overview of current concepts of DLB, including a description of the key clinical features and neuropathology, neurochemistry, and genetics of DLB, then a discussion of the relationship of DLB with Alzheimer's disease and Parkinson's disease, and, finally, a summary of current management strategies available for this disorder.

  5. Dementia beyond 2025: Knowledge and uncertainties.

    PubMed

    Kenigsberg, Paul-Ariel; Aquino, Jean-Pierre; Bérard, Alain; Gzil, Fabrice; Andrieu, Sandrine; Banerjee, Sube; Brémond, François; Buée, Luc; Cohen-Mansfield, Jiska; Mangialasche, Francesca; Platel, Hervé; Salmon, Eric; Robert, Philippe

    2016-01-01

    Given that there may well be no significant advances in drug development before 2025, prevention of dementia-Alzheimer's disease through the management of vascular and lifestyle-related risk factors may be a more realistic goal than treatment. Level of education and cognitive reserve assessment in neuropsychological testing deserve attention, as well as cultural, social, and economic aspects of caregiving. Assistive technologies for dementia care remain complex. Serious games are emerging as virtual educational and pleasurable tools, designed for individual and cooperative skill building. Public policies are likely to pursue improving awareness and understanding of dementia; providing good quality early diagnosis and intervention for all; improving quality of care from diagnosis to the end of life, using clinical and economic end points; delivering dementia strategies quicker, with an impact on more people. Dementia should remain presented as a stand-alone concept, distinct from frailty or loss of autonomy. The basic science of sensory impairment and social engagement in people with dementia needs to be developed. E-learning and serious games programs may enhance public and professional education. Faced with funding shortage, new professional dynamics and economic models may emerge through coordinated, flexible research networks. Psychosocial research could be viewed as an investment in quality of care, rather than an academic achievement in a few centers of excellence. This would help provide a competitive advantage to the best operators. Stemming from care needs, a logical, systems approach to dementia care environment through organizational, architectural, and psychosocial interventions may be developed, to help reduce symptoms in people with dementia and enhance quality of life. Dementia-friendly environments, culture, and domesticity are key factors for such interventions. © The Author(s) 2015.

  6. A national strategy to develop pragmatic clinical trials infrastructure.

    PubMed

    Concannon, Thomas W; Guise, Jeanne-Marie; Dolor, Rowena J; Meissner, Paul; Tunis, Sean; Krishnan, Jerry A; Pace, Wilson D; Saltz, Joel; Hersh, William R; Michener, Lloyd; Carey, Timothy S

    2014-04-01

    An important challenge in comparative effectiveness research is the lack of infrastructure to support pragmatic clinical trials, which compare interventions in usual practice settings and subjects. These trials present challenges that differ from those of classical efficacy trials, which are conducted under ideal circumstances, in patients selected for their suitability, and with highly controlled protocols. In 2012, we launched a 1-year learning network to identify high-priority pragmatic clinical trials and to deploy research infrastructure through the NIH Clinical and Translational Science Awards Consortium that could be used to launch and sustain them. The network and infrastructure were initiated as a learning ground and shared resource for investigators and communities interested in developing pragmatic clinical trials. We followed a three-stage process of developing the network, prioritizing proposed trials, and implementing learning exercises that culminated in a 1-day network meeting at the end of the year. The year-long project resulted in five recommendations related to developing the network, enhancing community engagement, addressing regulatory challenges, advancing information technology, and developing research methods. The recommendations can be implemented within 24 months and are designed to lead toward a sustained national infrastructure for pragmatic trials.

  7. A National Strategy to Develop Pragmatic Clinical Trials Infrastructure

    PubMed Central

    Guise, Jeanne‐Marie; Dolor, Rowena J.; Meissner, Paul; Tunis, Sean; Krishnan, Jerry A.; Pace, Wilson D.; Saltz, Joel; Hersh, William R.; Michener, Lloyd; Carey, Timothy S.

    2014-01-01

    Abstract An important challenge in comparative effectiveness research is the lack of infrastructure to support pragmatic clinical trials, which compare interventions in usual practice settings and subjects. These trials present challenges that differ from those of classical efficacy trials, which are conducted under ideal circumstances, in patients selected for their suitability, and with highly controlled protocols. In 2012, we launched a 1‐year learning network to identify high‐priority pragmatic clinical trials and to deploy research infrastructure through the NIH Clinical and Translational Science Awards Consortium that could be used to launch and sustain them. The network and infrastructure were initiated as a learning ground and shared resource for investigators and communities interested in developing pragmatic clinical trials. We followed a three‐stage process of developing the network, prioritizing proposed trials, and implementing learning exercises that culminated in a 1‐day network meeting at the end of the year. The year‐long project resulted in five recommendations related to developing the network, enhancing community engagement, addressing regulatory challenges, advancing information technology, and developing research methods. The recommendations can be implemented within 24 months and are designed to lead toward a sustained national infrastructure for pragmatic trials. PMID:24472114

  8. The LANDFIRE Refresh strategy: updating the national dataset

    USGS Publications Warehouse

    Nelson, Kurtis J.; Connot, Joel A.; Peterson, Birgit E.; Martin, Charley

    2013-01-01

    The LANDFIRE Program provides comprehensive vegetation and fuel datasets for the entire United States. As with many large-scale ecological datasets, vegetation and landscape conditions must be updated periodically to account for disturbances, growth, and natural succession. The LANDFIRE Refresh effort was the first attempt to consistently update these products nationwide. It incorporated a combination of specific systematic improvements to the original LANDFIRE National data, remote sensing based disturbance detection methods, field collected disturbance information, vegetation growth and succession modeling, and vegetation transition processes. This resulted in the creation of two complete datasets for all 50 states: LANDFIRE Refresh 2001, which includes the systematic improvements, and LANDFIRE Refresh 2008, which includes the disturbance and succession updates to the vegetation and fuel data. The new datasets are comparable for studying landscape changes in vegetation type and structure over a decadal period, and provide the most recent characterization of fuel conditions across the country. The applicability of the new layers is discussed and the effects of using the new fuel datasets are demonstrated through a fire behavior modeling exercise using the 2011 Wallow Fire in eastern Arizona as an example.

  9. [Patient safety: the need for a national strategy].

    PubMed

    Sousa, Paulo

    2006-01-01

    Patient safety has become a core issue for many modern healthcare systems. All healthcare systems around the world occasionally and unintentionally harm patients whom they are seeking to help. In recognition of this, patient safety has become a fundamental part of the drive to improve quality in many countries. The effects of harming a patient are widespread. There can be devastating emotional and physical consequence for patients and their families. For the staff involved too, incidents can be distressing, while members of their clinical teams can become demoralised and disaffected. Safety incidents also incur costs through litigation and extra treatment. Patient safety is nowadays a serious problem of public health, with several implications in different clinical areas and level of care. It is crucial to establish priorities, hierarchy's interventions and engaged all stakeholders who are involved around this big issue. In other word, it is important to define a strategy that could reflect a global framework, which allow us to integrate, articulate and be actors action-oriented, with the final aim of reducing the possibilities to harm patients. Consequently, these could contribute for a health care delivery of excellence and based on the best evidence. In the last few years, several studies have estimated that around 4% to 17% of patients have experienced an adverse event, and that up to half of these incidents could have been prevented. Many of them have also showed that, the best way of reducing error rates, is to target the underlying systems failures, rather than take actions against individual members of staff. We should recognise that healthcare will always involve risk, but that these risks can be reduced by analysing and tackling the root causes of patient safety incidents. It is important to promote an open and fair culture, and to encourage staff to report when things have gone wrong.

  10. Engagement and disarmament: A US National Security Strategy for biological weapons of mass destruction. Strategy research project

    SciTech Connect

    Moilanen, J.H.; McIntyre, A.J.; Johnson, D.V.

    1995-04-18

    The specter of biological weapons -- one of the three weapons of mass destruction (WMD) -- is an unusual and extraordinary threat to the national security of the United States. Since the U.S. unilaterally renounced biological warfare in 1969, biotechnology advances, aggressive nation-states, and terrorism have complicated a precarious balance of world and regional stability. U.S. shortfalls in biological warfare preparedness during the Persian Gulf War may convince potential adversaries that the U.S. is incapable of protecting its vital interests from biological assault. This paper examines the menace of biological weapons and global challenges to nonproliferation and counterproliferation. Analysis concludes that the United States can dissuade, deter, and defend against biological warfare and terrorism with an integrated national security strategy for Biological Weapons Engagement and Disarmament.

  11. Human gut microbiota: the links with dementia development.

    PubMed

    Alkasir, Rashad; Li, Jing; Li, Xudong; Jin, Miao; Zhu, Baoli

    2017-02-01

    Dementia is a comprehensive category of brain diseases that is great enough to affect a person's daily functioning. The most common type of dementia is Alzheimer's disease, which makes most of cases. New researches indicate that gastrointestinal tract microbiota are directly linked to dementia pathogenesis through triggering metabolic diseases and low-grade inflammation progress. A novel strategy is proposed for the management of these disorders and as an adjuvant for psychiatric treatment of dementia and other related diseases through modulation of the microbiota (e.g. with the use of probiotics).

  12. Diagnosis and management of dementia in family practice.

    PubMed

    Wilcock, Jane; Jain, Priya; Griffin, Mark; Thuné-Boyle, Ingela; Lefford, Frances; Rapp, David; Iliffe, Steve

    2016-01-01

    Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management. Evaluating family physicians' concordance with guidelines on diagnosis and management of people with dementia, from first documentation of symptoms to formal diagnosis. Analysis of medical records of 136 people with dementia recruited by 19 family practices in NW London and surrounding counties. Practices invited 763 people with dementia to participate, 167 (22%) agreed. Complete records were available for 136 (18%). The majority of records included reference to recommended blood tests, informant history and caregiver concerns. Presence or absence of symptoms of depression, psychosis, other behavioural and psychological symptoms of dementia, and cognitive function tests were documented in 30%-40% of records. Documentation of discussions about signs and symptoms of dementia, treatment options, care, support, financial, legal and advocacy advice were uncommon. Comparison of these findings from a similar study in 2000-2002 suggests improvements in concordance with blood tests, recording informant history, presence or absence of depression or psychosis symptoms. There was no difference in documenting cognitive function tests. Immediate referral to specialists was more common in the recent study. Five years after UK dementia guidelines and immediately after the launch of the dementia strategy, family physicians appeared concordant with clinical guidelines for dementia diagnosis (other than cognitive function tests), and referred most patients immediately. However, records did not suggest systematic dementia management.

  13. International Outreach and Coordination Strategy for the National Strategy for Maritime Security

    DTIC Science & Technology

    2005-11-01

    main Theater Strategy elements in the Caribbean , Central and South America - building regional cooperative security; developing roles and missions for...emergencies. Two major changes that Enduring Friendship seeks to enact are a reduced pressure on U.S. assets in the Caribbean Basin and expanding...objectives behind the establishment of the Association are to coordinate and standardize African port operations, equipment and services of ports, with a

  14. Forecasting the Incidence of Dementia and Dementia-Related Outpatient Visits With Google Trends: Evidence From Taiwan

    PubMed Central

    2015-01-01

    Background Google Trends has demonstrated the capability to both monitor and predict epidemic outbreaks. The connection between Internet searches for dementia information and dementia incidence and dementia-related outpatient visits remains unknown. Objective This study aimed to determine whether Google Trends could provide insight into trends in dementia incidence and related outpatient visits in Taiwan. We investigated and validated the local search terms that would be the best predictors of new dementia cases and outpatient visits. We further evaluated the nowcasting (ie, forecasting the present) and forecasting effects of Google Trends search trends for new dementia cases and outpatient visits. The long-term goal is to develop a surveillance system to help early detection and interventions for dementia in Taiwan. Methods This study collected (1) dementia data from Taiwan’s National Health Insurance Research Database and (2) local Internet search data from Google Trends, both from January 2009 to December 2011. We investigated and validated search terms that would be the best predictors of new dementia cases and outpatient visits. We then evaluated both the nowcasting and the forecasting effects of Google Trends search trends through cross-correlation analysis of the dementia incidence and outpatient visit data with the Google Trends data. Results The search term “dementia + Alzheimer’s disease” demonstrated a 3-month lead effect for new dementia cases and a 6-month lead effect for outpatient visits (r=.503, P=.002; r=.431, P=.009, respectively). When gender was included in the analysis, the search term “dementia” showed 6-month predictive power for new female dementia cases (r=.520, P=.001), but only a nowcasting effect for male cases (r=.430, P=.009). The search term “neurology” demonstrated a 3-month leading effect for new dementia cases (r=.433, P=.008), for new male dementia cases (r=.434, P=.008), and for outpatient visits (r=.613, P<.001

  15. The design, results and future development of the National Energy Strategy Environmental Analysis Model (NESEAM)

    SciTech Connect

    Fisher, R.E.; Boyd, G.A. ); Breed, W.S. . Office of Environmental Analysis)

    1991-01-01

    The National Energy Strategy Environmental Model (NESEAM) has been developed to project emissions for the National Energy Strategy (NES). Two scenarios were evaluated for the NES, a Current Policy Base Case and a NES Action Case. The results from the NES Actions Case project much lower emissions than the Current Policy Base Case. Future enhancements to NESEAM will focus on fuel cycle analysis, including future technologies and additional pollutants to model. NESEAM's flexibility will allow it to model other future legislative issues. 7 refs., 4 figs., 2 tabs.

  16. Music and dementia.

    PubMed

    Baird, Amee; Samson, Séverine

    2015-01-01

    There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an "island of preservation" in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia.

  17. Laughter, communication problems and dementia.

    PubMed

    Lindholm, Camilla

    2008-01-01

    This article investigates how the elderly with dementia and their professional caregivers use laughter as a device to deal with problems related to language production and comprehension. The data consist of two game-playing situations, used to engage the elderly people in memory work. The article shows how the elderly patients recurrently laugh to acknowledge communication difficulties and to show awareness of their potential non-competency. The professional caregivers are shown to use slightly different strategies for responding to laughter segments initiated by the patients, either making the shortcomings part of the conversation or avoiding referring to the lapse explicitly. The laughter strategies used by the patients are compared to those reported in the CA-literature on laughter. It is well known that laughter is used in sequences of trouble and delicacy in both ordinary and institutional contexts, but my study shows that speakers with dementia laugh when they encounter problems related to language production and comprehension. This functional expansion in relation to premorbid occurrence is evidence that laughter fits the definition of compensatory behaviour utilized to overcome communication barriers. Certain conversational skills are preserved in individuals with dementia, but due to their cognitive impairment these resources are utilized in a slightly different way than by healthy speakers.

  18. Toward a national fuels mapping strategy: Lessons from selected mapping programs

    USGS Publications Warehouse

    Loveland, T.R.

    2001-01-01

    The establishment of a robust national fuels mapping program must be based on pertinent lessons from relevant national mapping programs. Many large-area mapping programs are under way in numerous Federal agencies. Each of these programs follows unique strategies to achieve mapping goals and objectives. Implementation approaches range from highly centralized programs that use tightly integrated standards and dedicated staff, to dispersed programs that permit considerable flexibility. One model facilitates national consistency, while the other allows accommodation of locally relevant conditions and issues. An examination of the programmatic strategies of four national vegetation and land cover mapping initiatives can identify the unique approaches, accomplishments, and lessons of each that should be considered in the design of a national fuel mapping program. The first three programs are the U.S. Geological Survey Gap Analysis Program, the U.S. Geological Survey National Land Cover Characterization Program, and the U.S. Fish and Wildlife Survey National Wetlands Inventory. A fourth program, the interagency Multiresolution Land Characterization Program, offers insights in the use of partnerships to accomplish mapping goals. Collectively, the programs provide lessons, guiding principles, and other basic concepts that can be used to design a successful national fuels mapping initiative. Keywords: vegetation, land cover, fuels, mapping, United States, remote sensing.

  19. Sociodemographic risk factors and correlates of dementia in older Malaysians.

    PubMed

    Hamid, Tengku Aizan; Krishnaswamy, Saroja; Abdullah, Siti Suhailah; Momtaz, Yadollah Abolfathi

    2010-01-01

    The rapid expansion of the aged population in Malaysia is expected to greatly increase the number of persons with dementia in the country. However, data on dementia prevalence at the national level is lacking, and little is known about the sociodemographic risk factors and correlates of dementia. This paper describes a nationwide study of dementia prevalence and its sociodemographic risk factors and health correlates among older Malaysians. In the nationwide study, the Mental Health and Quality of Life of Older Malaysians, AGECAT-GMS was used to diagnose dementia in a nationally representative sample of 2,980 persons aged 60 and above. The prevalence rate of dementia was 14.3%. Higher dementia prevalences were found in oldest age (26.3%), women (19.7%), no formal education (24.1%), Bumiputeras (32.2%), unmarried (19.4%), unemployed (31.3%) and very poor on self-rated health (33.3%). Multivariate logistic regression analyses showed that older age, female gender, no formal education, ethnicity and very poor self-rated health were independent risk factors and correlates of dementia. Relatively higher prevalence rates of dementia in older Malaysians were accounted for by greater proportions without education, Malay and Bumiputera ethnicity, and other unknown factors which should be further investigated. Copyright © 2011 S. Karger AG, Basel.

  20. Projecting Burden of Dementia in Spain, 2010-2050: Impact of Modifying Risk Factors.

    PubMed

    Soto-Gordoa, Myriam; Arrospide, Arantzazu; Moreno-Izco, Fermín; Martínez-Lage, Pablo; Castilla, Iván; Mar, Javier

    2015-01-01

    Risk and protective factors such as obesity, hypercholesterolemia, physical activity, and hypertension can play a role in the development of dementia. Our objective was to measure the effect of modification of risk and protective factors on the prevalence and economic burden of dementia in the aging Spanish population during 2010-2050. A discrete event simulation model including risk and protective factors according to CAIDE (Cardiovascular Risk Factors, Aging and Incidence of Dementia) Risk Score was built to represent the natural history of dementia. Prevalence of dementia was calculated from 2010 to 2050 according to different scenarios of risk factor prevalence to assess the annual social and health care costs of dementia. The model also supplied hazard ratios for dementia. Aging will increase between 49% and 16% each decade in the number of subjects with dementia. The number of working-age individuals per person with dementia will decrease to a quarter by 2050. An intervention leading to a 20% change in risk and protective factors would reduce dementia by 9% , prevent over 100,000 cases, and save nearly 4,900 million euros in 2050. Switching individuals from a group with a specific risk factor to one without it nearly halved the risk of the development of dementia. Dementia prevalence will grow unmanageable if effective prevention strategies are not developed. Interventions aiming to reduce modifiable risk factor prevalence represent valid and effective alternatives to reduce dementia burden. However, further research is needed to identify causal relationships between dementia and risk factors.

  1. Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers.

    PubMed

    Tomlinson, Emily; Spector, Aimee; Nurock, Shirley; Stott, Joshua

    2015-09-01

    Despite media and academic interest on assisted dying in dementia, little is known of the views of those directly affected. This study explored the views of former carers on assisted dying in dementia. This was a qualitative study using thematic analysis. A total of 16 former carers of people with dementia were recruited through national dementia charities and participated in semi-structured interviews. While many supported the individual's right to die, the complexity of assisted dying in dementia was emphasized. Existential, physical, psychological and psychosocial aspects of suffering were identified as potential reasons to desire an assisted death. Most believed it would help to talk with a trained health professional if contemplating an assisted death. Health workers should be mindful of the holistic experience of dementia at the end of life. The psychological and existential aspects of suffering should be addressed, as well as relief of physical pain. Further research is required. © The Author(s) 2015.

  2. Dance for Individuals With Dementia.

    PubMed

    Lapum, Jennifer L; Bar, Rachel J

    2016-03-01

    The movement and music associated with dance plays an important role in many individuals' lives and can become imprinted upon the body and mind. Dance is thus closely associated with memory because of these deep connections. Without conscious thought, dance has the potential to be initiated as individuals age. In the current article, the authors share narrative reflections about their experiences with, and the potential of, dance as an intervention for aging populations diagnosed with dementia-related diseases. They draw upon their experiences in working with the aging population and a dance program currently being developed by Canada's National Ballet School and Baycrest Health Sciences for individuals with dementia-related diseases in long-term care. The current article is structured as dialogue between the authors because it mimics dance as a dialogical encounter between movement and music, and/or between individuals.

  3. Folie à deux and dementia.

    PubMed

    Draper, B; Cole, A

    1990-06-01

    Folie à deux has been infrequently reported in dementia patients. A case is described in which both partners with folie à deux suffered from an Alzheimer type dementia. The development and management of folie à deux in dementia is discussed.

  4. Depression and dementias among military veterans.

    PubMed

    Byers, Amy L; Yaffe, Kristine

    2014-06-01

    Depression is very common throughout the course of veterans' lives, and dementia is common in late life. Previous studies suggest an association between depression and dementia in military veterans. The most likely biologic mechanisms that may link depression and dementia among military veterans include vascular disease, changes in glucocorticoid steroids and hippocampal atrophy, deposition of β-amyloid plaques, inflammatory changes, and alterations of nerve growth factors. In addition, military veterans often have depression comorbid with posttraumatic stress disorder or traumatic brain injury. Therefore, in military veterans, these hypothesized biologic pathways going from depression to dementia are more than likely influenced by trauma-related processes. Treatment strategies for depression, posttraumatic stress disorder, or traumatic brain injury could alter these pathways and as a result decrease the risk for dementia. Given the projected increase of dementia, as well as the projected increase in the older segment of the veteran population, in the future, it is critically important that we understand whether treatment for depression alone or combined with other regimens improves cognition. In this review, we summarize the principal mechanisms of this relationship and discuss treatment implications in military veterans.

  5. Vascular aspects of cognitive impairment and dementia

    PubMed Central

    Wiesmann, Maximilian; Kiliaan, Amanda J; Claassen, Jurgen AHR

    2013-01-01

    Hypertension and stroke are highly prevalent risk factors for cognitive impairment and dementia. Alzheimer's disease (AD) and vascular dementia (VaD) are the most common forms of dementia, and both conditions are preceded by a stage of cognitive impairment. Stroke is a major risk factor for the development of vascular cognitive impairment (VCI) and VaD; however, stroke may also predispose to AD. Hypertension is a major risk factor for stroke, thus linking hypertension to VCI and VaD, but hypertension is also an important risk factor for AD. Reducing these two major, but modifiable, risk factors—hypertension and stroke—could be a successful strategy for reducing the public health burden of cognitive impairment and dementia. Intake of long-chain omega-3 polyunsaturated fatty acids (LC-n3-FA) and the manipulation of factors involved in the renin–angiotensin system (e.g. angiotensin II or angiotensin-converting enzyme) have been shown to reduce the risk of developing hypertension and stroke, thereby reducing dementia risk. This paper will review the research conducted on the relationship between hypertension, stroke, and dementia and also on the impact of LC-n3-FA or antihypertensive treatments on risk factors for VCI, VaD, and AD. PMID:24022624

  6. Nation Assistance: Does an Exercise in Guatemala by Reserve Components Support United States National Security Strategy?

    DTIC Science & Technology

    2007-11-02

    exercises called Fuertes Caminos in 1993, 1994, and 1995. The author was the aviation commander of Fuertes Caminos 95-North. This paper follows a...sequence describing the background of Guatemala and Fuertes Caminos exercises, defining nation assistance policy, then flowing through the United...called Fuertes Caminos. Two key guestions result from this analysis. Is it in the United States’ best interest to perform another Fuertes Caminos

  7. The National Security Strategy Under the United Nations and International Law

    DTIC Science & Technology

    2004-03-19

    a result of that war." This was addressed in 1951 by Hans Kelsen in a legal analysis of fundamental problems with the UN Charter. He concluded that...www.zmag.org/content/print_article.cfm>; Internet; accessed 31 January 2004. 36 Charter of the United Nations, Article 107. 37 Kearly, 27–28. 38 Hans Kelsen ...the framers introduced ambiguity reveals exactly what the framers intended. Kearly cites Hans Kelsen’s authoritative research of the charter of the

  8. The validation of the Italian version of the GPCOG (GPCOG-It): a contribution to cross-national implementation of a screening test for dementia in general practice.

    PubMed

    Pirani, Alessandro; Brodaty, Henry; Martini, Emilio; Zaccherini, Davide; Neviani, Francesca; Neri, Mirco

    2010-02-01

    The General Practitioner Cognitive Assessment of Cognition (GPCOG), a brief, efficient dementia-screening instrument for use by general practitioners (GPs), consists of cognitive test items and historical questions asked of an informant. The validity of instruments across different cultures and languages requires confirmation and so the aim of this study was to validate the Italian version of GPCOG (GPCOG-It). The validity of the GPCOG-It was assessed against standard criteria for diagnosis of dementia (Diagnostic and Statistical Manual of Mental Disorders - 4th edition) as well as the Clinical Dementia Rating scale. The participants comprised 200 community-dwelling patients aged at least 55 years with (patient group) or without memory complaints (control group). Seven general practitioners were involved. Measurements used were the Cambridge Cognitive Assessment, Mini-mental State Examination with standard (24/25) and Italian cut-off (26/27), Alzheimer's Disease Assessment Scale-Cognitive scale and Geriatric Depression Scale. The GPCOG-It, total score and two-stage method, were at least equivalent in detecting dementia to the MMSE using the standard 24/25 or the Italian 26/27 cut-offs. The two-stage method of administering the GPCOG-It (cognitive testing followed by informant questions if necessary) had a sensitivity of 82%, a specificity of 92%, a misclassification rate of 17.4% and positive predictive value of 95%. Patient interviews took less than 4 minutes to administer and informant interviews less than 2 minutes, half the time needed for MMSE administration. GPCOG-It maintains the same psychometric features and time efficiency as the original English version. Despite methodological limitations (i.e. use of defined samples), the GPCOG-It performed well in detecting clear cut and borderline cognitively impaired patients and can be introduced in the daily practice of Italian GPs.

  9. Dementia Resulting From Traumatic Brain Injury

    PubMed Central

    Shively, Sharon; Scher, Ann I.; Perl, Daniel P.; Diaz-Arrastia, Ramon

    2013-01-01

    Traumatic brain injury (TBI) is among the earliest illnesses described in human history and remains a major source of morbidity and mortality in the modern era. It is estimated that 2% of the US population lives with long-term disabilities due to a prior TBI, and incidence and prevalence rates are even higher in developing countries. One of the most feared long-term consequences of TBIs is dementia, as multiple epidemiologic studies show that experiencing a TBI in early or midlife is associated with an increased risk of dementia in late life. The best data indicate that moderate and severe TBIs increase risk of dementia between 2-and 4-fold. It is less clear whether mild TBIs such as brief concussions result in increased dementia risk, in part because mild head injuries are often not well documented and retrospective studies have recall bias. However, it has been observed for many years that multiple mild TBIs as experienced by professional boxers are associated with a high risk of chronic traumatic encephalopathy (CTE), a type of dementia with distinctive clinical and pathologic features. The recent recognition that CTE is common in retired professional football and hockey players has rekindled interest in this condition, as has the recognition that military personnel also experience high rates of mild TBIs and may have a similar syndrome. It is presently unknown whether dementia in TBI survivors is pathophysiologically similar to Alzheimer disease, CTE, or some other entity. Such information is critical for developing preventive and treatment strategies for a common cause of acquired dementia. Herein, we will review the epidemiologic data linking TBI and dementia, existing clinical and pathologic data, and will identify areas where future research is needed. PMID:22776913

  10. Exemplar Units of Work for English. Key Stage 3: National Strategy.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    These exemplar units of work for National Strategy Key Stage 3 English show how medium and short-term planning can be based on the Key Stage 3 Framework objectives and support the implementation of Curriculum 2000. The Key Stage 3 English strand introduces pupils to more specialist study of language and literature and supports the study of…

  11. A Methodology for the Transition from National Strategy to Adaptive Force Packaging

    DTIC Science & Technology

    1994-06-03

    military, economic , political/diplomatic, informational and humanitarian. Examination of the environment of military operations, traditionally termed... economic , political/diplomatic, informational and humanitarian. Examination of the environment of military operations, traditionally termed "battle...development of national strategy requires an appropriate blend of all instruments of power- economic , diplomatic, informational, military and

  12. National Offshore Wind Strategy: Facilitating the Development of the Offshore Wind Industry in the United States

    SciTech Connect

    Patrick Gilman; Maurer, Ben; Feinberg, Luke; Duerr, Alana; Peterson, Lauren; Musial, Walt; Beiter, Phillipp; Golladay, Jennifer; Stromberg, Jessica; Johnson, Isis; Boren, Doug; Moore, Annette

    2016-09-01

    The U.S. Department of Energy, through its Wind Energy Technologies Office, and U.S. Department of the Interior, through its Bureau of Ocean Energy Management, have jointly produced this updated national strategy to facilitate the responsible development of offshore wind energy in the United States.

  13. National study on faculty-to-faculty incivility: strategies to foster collegiality and civility.

    PubMed

    Clark, Cynthia M

    2013-01-01

    Faculty incivility can have lasting and devastating effects on individuals and organizations, including low morale, high turnover, increased absenteeism, isolation and alienation, diminished quality of work, and increased illness and health issues. To assess the nature and impact of faculty-to-faculty incivility, the author discusses a national study, its outcomes, and several evidence-based strategies to affectively address the problem.

  14. Transfer Skills across a National Curriculum: The Role of Cognitive Strategies for Children with Learning Difficulties.

    ERIC Educational Resources Information Center

    Sugden, David A.

    1989-01-01

    Under the National Curriculum in the United Kingdom, children with learning difficulties will need to use transfer skills for various cross-curricular themes. To promote transfer, the use of cognitive strategies is recommended, including perceived similarity, analysis of the learning context, expert scaffolding, and detailed planning of practice…

  15. Building a National Strategy for Digital Preservation: Issues in Digital Media Archiving.

    ERIC Educational Resources Information Center

    Council on Library and Information Resources, Washington, DC.

    The United States Congress in December 2000 appropriated funds to the Library of Congress (LC) to spearhead an effort to develop a national strategy for the preservation of digital information. LC staff scheduled a series of conversations with representatives from the technology, business, entertainment, academic, legal, archival, and library…

  16. Strategic Leadership for Large-Scale Reform: The Case of England's National Literacy and Numeracy Strategy

    ERIC Educational Resources Information Center

    Leithwood, Kenneth; Jantzi, Doris; Earl, Lorna; Watson, Nancy; Levin, Benjamin; Fullan, Michael

    2004-01-01

    Both 'strategic' and 'distributed' forms of leadership are considered promising responses to the demands placed on school systems by large-scale reform initiatives. Using observation, interview and survey data collected as part of a larger evaluation of England's National Literacy and Numeracy Strategies, this study inquired about sources of…

  17. Roots and Research. Key Stage 3 English. Key Stage 3: National Strategy.

    ERIC Educational Resources Information Center

    Harrison, Colin

    In 1998, Roger Beard of the University of Leeds wrote an account of the research underpinning the emerging National Literacy Strategy (NLS). Since Beard published his review, there have been developments both in terms of age groups covered and within the field of literacy research. This document attempts a fresh review of the relationship between…

  18. The National Literacy Strategy and Setting: An Investigation in One School

    ERIC Educational Resources Information Center

    Wall, Kate

    2004-01-01

    This article investigates the policy of setting that is commonly being seen as an organizational tool for effective delivery of the National Literacy Strategy (NLS). It is suggested that teachers are finding the increased amount of whole-class teaching to a diverse range of abilities, as prescribed by the NLS, problematic. This case-study…

  19. Investigating Learning English Strategies and English Needs of Undergraduate Students at the National University of Laos

    ERIC Educational Resources Information Center

    Souriyavongsa, Thongma; Abidin, Mohamad Jafre Zainol; Sam, Rany; Mei, Leong Lai; Aloysius, Ithayaraj Britto

    2013-01-01

    This paper aims to investigate learning English strategies and the requirement of English needs of the undergraduate students at the National University of Laos (NUOL). The study employed a survey design which involved in administering questionnaires of rating scales, and adapting the items from (Barakat, 2010; Chengbin, 2008; Kathleen A, 2010;…

  20. 77 FR 19661 - Draft National Water Program 2012 Strategy: Response to Climate Change

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-02

    ... AGENCY Draft National Water Program 2012 Strategy: Response to Climate Change AGENCY: Environmental... will address climate change challenges to its mission of protecting human health and the environment. Climate change alters the hydrological background in which EPA's programs function. Depending upon the...

  1. Factor Analysis of the HEW National Strategy for Youth Development Model's Community Program Impact Scales.

    ERIC Educational Resources Information Center

    Truckenmiller, James L.

    The former HEW (Health, Education, and Welfare) National Strategy for Youth Development Model proposed a community-based program to promote positive youth development and to prevent delinquency through a sequence of youth needs assessments, needs-targeted programs, and program impact evaluation. HEW Community Program Impact Scales data obtained…

  2. Adult Learning in the Queer Nation: A Foucauldian Analysis of Educational Strategies for Social Change

    ERIC Educational Resources Information Center

    Walker, Wayland

    2009-01-01

    Adult education for social change can occur within social movements, and the fight for Lesbian, Gay, Bisexual, Transgendered and Queer (LGBTQ) rights has included educational strategies designed to challenge heterosexist and homophobic systems of power. This article explores how the Queer Nation movement of the early 1990s deployed a Foucauldian…

  3. A Critical Review of the National Skills Development Strategy in South Africa

    ERIC Educational Resources Information Center

    Kraak, Andre

    2008-01-01

    This article provides an update on the Special Edition of the "Journal of Vocational Education and Training" 57, no. 3, 2005, which focused on the launch of the National Skills Development Strategy (NSDS) in South Africa. The analysis here evaluates the impact of the first phase of the NSDS, which ran between 1 April 2001 and 31 March…

  4. The Key Role of Educational Research in the Development and Evaluation of the National Numeracy Strategy

    ERIC Educational Resources Information Center

    Brown, Margaret; Askew, Mike; Millett, Alison; Rhodes, Valerie

    2003-01-01

    The authors contest a politician's claim that the National Numeracy Strategy (NNS) in English primary schools has been an undisputed success with no contribution from educational researchers. First, the key role of researchers and research in the development of the NNS is outlined. Then there is a description of the Leverhulme Numeracy Research…

  5. Not the Whole Story of the National Literacy Strategy: A Response to Dominic Wyse

    ERIC Educational Resources Information Center

    Beard, Roger

    2003-01-01

    There is evidence that the National Literacy Strategy (NLS) has led to a sustained increase in literacy attainment, especially in reading, although recent international comparisons also suggest some additional issues regarding pupil performance in England. The relative success of the NLS may at least partly lie in the policy application of several…

  6. Sexual disinhibition and dementia.

    PubMed

    Cipriani, Gabriele; Ulivi, Martina; Danti, Sabrina; Lucetti, Claudio; Nuti, Angelo

    2016-03-01

    To describe inappropriate sexual behaviour (ISB) observed in patients with dementia, we conducted searches using the Cochrane Library, PubMed, and Web of Science to find relevant articles, chapters, and books published from 1950 to 2014. Search terms used included 'hypersexuality', 'inappropriate sexual behaviors', and 'dementia'. Publications found through this indexed search were reviewed for further relevant references. Sexuality is a human's need to express intimacy, but persons with dementia may not know how to appropriately meet their needs for closeness and intimacy due to their decline in cognition. Generally, the interaction among brain, physical, psychological, and environmental factors can create what we call ISB. The most likely change in the sexual behaviour of a person with dementia is indifference. However, ISB in dementia appear to be of two types--intimacy-seeking and disinhibited--that differ in their association with dementia type, dementia severity and, possibly, other concurrent behavioural disorder. Tensions develop from uncertainties regarding which, or when, behaviours are to be considered 'inappropriate' (i.e. improper) or abnormal. While most ISB occur in the moderate to severe stages of Alzheimer's dementia, they may also be seen in early stages of frontotemporal dementia because of the lack of insight and disinhibition. ISB are often better managed by non-pharmacological means, as patients may be less responsive to psychoactive therapies, but non-pharmacological interventions do not always stop the behaviour. © 2015 The Authors. Psychogeriatrics © 2015 Japanese Psychogeriatric Society.

  7. Potentially Unsafe Activities and Living Conditions in Older Adults with Dementia

    PubMed Central

    Amjad, Halima; Roth, David L.; Samus, Quincy M.; Yasar, Sevil; Wolff, Jennifer L.

    2016-01-01

    Objectives To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. Design Observational cohort study. Setting Community. Participants 7,609 Medicare beneficiaries age ≥ 65 enrolled in the National Health and Aging Trends Study. Measurements Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: 1) probable dementia with reported dementia diagnosis (n=457), 2) probable dementia without reported dementia diagnosis (n=581), 3) possible dementia (n=996), or 4) no dementia (n=5,575). We examined potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) by dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. Results The prevalence of driving (22.9%), preparing hot meals (31%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia. However, among persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than for those with reported diagnosis (all odds ratios ≥ 2.00, p's < 0.01). Conclusion Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with

  8. Potentially Unsafe Activities and Living Conditions of Older Adults with Dementia.

    PubMed

    Amjad, Halima; Roth, David L; Samus, Quincy M; Yasar, Sevil; Wolff, Jennifer L

    2016-06-01

    To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. Observational cohort study. Community. Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study (N = 7,609). Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n = 457), probable dementia without reported dementia diagnosis (n = 581), possible dementia (n = 996), or no dementia (n = 5,575). Potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) were examined according to dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. The prevalence of driving (22.9%), preparing hot meals (31.0%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia; however, but in persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than in those with reported diagnosis (all odds ratios ≥2.00, all P < .01). Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia.

  9. The impact of a national strategy to increase physical activity among older adults on national organizations.

    PubMed

    Park, Chae-Hee; Chodzko-Zajko, Wojtek; Ory, Marcia G; Gleason-Senior, Jane; Bazzarre, Terry L; Mockenhaupt, Robin

    2010-10-01

    This study was designed to evaluate the impact of the National Blueprint (NB) on the policies, programs, and organizational culture of selected national organizations. The theoretical model selected to assess the impact of the NB on organizational behavior was Burke's system theory of organizational change. Three organizations, AARP, the American College of Sports Medicine (ACSM), and the Administration on Aging (AoA), were selected for the study. Two individuals in each of these organizations were selected for interview. Semistructured interviews and document reviews were used in the data-collection process. Findings showed that the publication and establishment of the NB resulted in changes in the operating procedures of AARP, ACSM, and AoA. The results were broadly consistent with Burke's system theory of organizational change. The publication of the NB was shown to affect the behavior of organizational leaders, organizational culture, policies, programs, and individual and organizational performance. The new information generated has increased our understanding of the impact of health campaigns on organizational behavior.

  10. Dementia severity and the longitudinal costs of informal care in the Cache County Population

    PubMed Central

    Rattinger, Gail B.; Schwartz, Sarah; Mullins, C. Daniel; Corcoran, Chris; Zuckerman, Ilene H.; Sanders, Chelsea; Norton, Maria C.; Fauth, Elizabeth B.; Leoutsakos, Jeannie-Marie S.; Lyketsos, Constantine G.; Tschanz, JoAnn T.

    2015-01-01

    Background Dementia costs are critical for influencing healthcare policy, but limited longitudinal information exists. We examined longitudinal informal care costs of dementia in a population-based sample. Methods Data from the Cache County Study included dementia onset, duration and severity assessed by the Mini Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR) and Neuropsychiatric Inventory (NPI). Informal cost of daily care (COC) was estimated based on median Utah wages. Mixed models estimated the relationship between severity and longitudinal COC in separate models for MMSE and CDR. Results 287 subjects [53% female, mean (sd) age was 82.3(5.9) years] participated. Overall COC increased by 18%/year. COC was 6% lower per MMSE-point increase and compared with very mild dementia, COC increased over 2-fold for mild, 5-fold for moderate and 6-fold for severe dementia on the CDR. Conclusions Greater dementia severity predicted higher costs. Disease management strategies addressing dementia progression may curb costs. PMID:25614127

  11. What can imaging tell us about cognitive impairment and dementia?

    PubMed Central

    Narayanan, Leela; Murray, Alison Dorothy

    2016-01-01

    Dementia is a contemporary global health issue with far reaching consequences, not only for affected individuals and their families, but for national and global socio-economic conditions. The hallmark feature of dementia is that of irreversible cognitive decline, usually affecting memory, and impaired activities of daily living. Advances in healthcare worldwide have facilitated longer life spans, increasing the risks of developing cognitive decline and dementia in late life. Dementia remains a clinical diagnosis. The role of structural and molecular neuroimaging in patients with dementia is primarily supportive role rather than diagnostic, American and European guidelines recommending imaging to exclude treatable causes of dementia, such as tumor, hydrocephalus or intracranial haemorrhage, but also to distinguish between different dementia subtypes, the commonest of which is Alzheimer’s disease. However, this depends on the availability of these imaging techniques at individual centres. Advanced magnetic resonance imaging (MRI) techniques, such as functional connectivity MRI, diffusion tensor imaging and magnetic resonance spectroscopy, and molecular imaging techniques, such as 18F fluoro-deoxy glucose positron emission tomography (PET), amyloid PET, tau PET, are currently within the realm of dementia research but are available for clinical use. Increasingly the research focus is on earlier identification of at risk preclinical individuals, for example due to family history. Intervention at the preclinical stages before irreversible brain damage occurs is currently the best hope of reducing the impact of dementia. PMID:27029053

  12. Possible role of vascular risk factors in Alzheimer's disease and vascular dementia.

    PubMed

    Hasnain, Mehrul; Vieweg, W Victor R

    2014-01-01

    The contribution of vascular risk factors to Alzheimer-vascular spectrum dementias is increasingly being recognized. We provide an overview of recent literature on this subject. Overweight and obesity as well as underweight during midlife predict cognitive decline and dementia later in life. Hypertension during midlife is also associated with dementia later in life and the association is stronger for untreated hypertension. Calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin-1 receptor-blockers may be particularly beneficial in diminishing the risk of dementia associated with hypertension. Studies have fairly consistently shown that type 2 diabetes is a risk factor for dementia. Episodes of hypoglycemia add to this risk. Regular physical exercise during any point in the lifespan protects against cognitive decline and dementia. Most benefit is realized with physical exercise during early and midlife. Dyslipidemia also increases the risk of dementia but the findings are less consistent. Findings on the possible benefit of lipid-lowering agents (statins) are conflicting. Earlier studies identified smoking as protective of dementia but recent better designed studies have consistently shown that smoking increases the risk of dementia. The association of vascular risk factors with dementia is more robust for vascular dementia than Alzheimer's disease. Heterogeneity of studies and lack of trials specifically designed to assess cognition as an endpoint make firm conclusions difficult. But considering the expected global burden of dementia and projected attributable risk of vascular risk factors to it, there is sufficient evidence to promote vascular risk factor reduction strategies as dementia prevention interventions.

  13. National climate policies across Europe and their impacts on cities strategies.

    PubMed

    Heidrich, O; Reckien, D; Olazabal, M; Foley, A; Salvia, M; de Gregorio Hurtado, S; Orru, H; Flacke, J; Geneletti, D; Pietrapertosa, F; Hamann, J J-P; Tiwary, A; Feliu, E; Dawson, R J

    2016-03-01

    Globally, efforts are underway to reduce anthropogenic greenhouse gas emissions and to adapt to climate change impacts at the local level. However, there is a poor understanding of the relationship between city strategies on climate change mitigation and adaptation and the relevant policies at national and European level. This paper describes a comparative study and evaluation of cross-national policy. It reports the findings of studying the climate change strategies or plans from 200 European cities from Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Italy, Netherlands, Spain and the United Kingdom. The study highlights the shared responsibility of global, European, national, regional and city policies. An interpretation and illustration of the influences from international and national networks and policy makers in stimulating the development of local strategies and actions is proposed. It was found that there is no archetypical way of planning for climate change, and multiple interests and motivations are inevitable. Our research warrants the need for a multi-scale approach to climate policy in the future, mainly ensuring sufficient capacity and resource to enable local authorities to plan and respond to their specific climate change agenda for maximising the management potentials for translating environmental challenges into opportunities.

  14. [Hypertension and dementia].

    PubMed

    Hanon, O

    2014-06-01

    Prevention and treatment of dementia has turned into a major public health challenge. Several epidemiological studies have indicated a significant association between the presence of hypertension and the onset of dementia (vascular or Alzheimer's type) several years later. Cognitive disorder may be related to focal cerebral lesions of vascular origin (infarctus, lacunae) and/or chronic ischemia of the white matter (white matter lesions) related to arteriosclerosis and/or lipohyalinosis of small perforating arteries high blood pressure in mid-life to later cognitive decline and dementia. Moreover, disorders of cerebral microcirculation and endothelial dysfunction may be associated to blood brain barrier dysfunction and amyloid plaques formation leading to Alzheimer's process. Few randomized clinical trials have included a cognitive assessment and dementia as outcome in their design. They all raise some major criticisms: cognitive assessment was never the main outcome, too short follow-up to study dementia; incomplete assessment of cognition, lost of follow-up and a small proportion of subjects at risk for dementia at inclusion. However, the results of therapeutic trials (SYST-EUR, PROGRESS) open the way to the prevention of dementia (vascular or Alzheimer's type) or cognitive decline by antihypertensive treatments. A meta-analysis including randomized controlled studies, suggests a significant decrease in the risk of dementia with antihypertensive treatment compared to placebo.

  15. Creating the laboratory`s future; A strategy for Lawrence Livermore National Laboratory

    SciTech Connect

    1997-09-01

    ``Creating The Laboratory`s Future`` describes Livermore`s roles and responsibilities as a Department of Energy (DOE) national laboratory and sets the foundation for decisions about the Laboratory`s programs and operations. It summarizes Livermore`s near-term strategy, which builds on recent Lab achievements and world events affecting their future. It also discusses their programmatic and operational emphases and highlights program areas that the authors believe can grow through application of Lab science and technology. Creating the Laboratory`s Future reflects their very strong focus on national security, important changes in the character of their national security work, major efforts are under way to overhaul their administrative and operational systems, and the continuing challenge of achieving national consensus on the role of the government in energy, environment, and the biosciences.

  16. Identification of Strategies to Leverage Public and Private Resources for National Security Workforce Development

    SciTech Connect

    2009-02-01

    This report documents the identification of strategies to leverage public and private resources for the development of an adequate national security workforce as part of the National Security Preparedness Project (NSPP).There are numerous efforts across the United States to develop a properly skilled and trained national security workforce. Some of these efforts are the result of the leveraging of public and private dollars. As budget dollars decrease and the demand for a properly skilled and trained national security workforce increases, it will become even more important to leverage every education and training dollar. The leveraging of dollars serves many purposes. These include increasing the amount of training that can be delivered and therefore increasing the number of people reached, increasing the number and quality of public/private partnerships, and increasing the number of businesses that are involved in the training of their future workforce.

  17. Prevalence of Cognitive Impairment without Dementia in the United States

    PubMed Central

    Plassman, Brenda L.; Langa, Kenneth M.; Fisher, Gwenith G.; Heeringa, Steven G.; Weir, David R.; Ofstedal, Mary Beth; Burke, James R.; Hurd, Michael D.; Potter, Guy G.; Rodgers, Willard L.; Steffens, David C.; McArdle, John J.; Willis, Robert J.; Wallace, Robert B.

    2009-01-01

    Background Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States. Objective To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes. Design Longitudinal study from July 2001 to March 2005. Setting In-home assessment for cognitive impairment. Participants Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment. Measurements Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample. Results In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions. Limitations Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to

  18. Chicago partners in the American dream: A local effort within the national homeownership strategy

    SciTech Connect

    Wallace, E.; Cavallo, J.; Peterson, N.; Nelson, M.

    1997-03-01

    President Clinton and the U.S. Department of Housing and Urban Development (HUD) have set a goal of increasing homeownership in America. Currently the rate of homeownership is approximately 64 percent of the population. The goal is to raise that rate to 67.5 percent by the year 2000, a higher rate than ever recorded in U.S. history. Achieving the goal will require about 8 million families to acquire homes of their own. HUD has developed a plan for reaching the national homeownership goal. The plan is known as the National Homeownership Strategy. It was formulated with input from more than 50 public- and private-sector groups and consists of 100 objectives designed to make homeownership easier and affordable for American families. Among the objectives are expanded use of energy conservation and new construction technologies. The groups participating in the formulation of the National Homeownership Strategy formed a collaboration that was named the National Partners in Homeownership. Chicago Partners in the American Dream is a collaboration of Chicago organizations implementing the National Homeownership Strategy on a local level. It has made achieving the objectives of the Strategy the foundation for its local partnership. The Chicago Partners in the American Dream is a grassroots collaboration, combining the experience, resources, and expertise of a variety of local organizations. The fundamental goal of the Chicago Partners in the American Dream is to create 5,000 homeownership opportunities in nine to twelve focused areas within Empowerment Zone/Enterprise Communities in the Chicagoland market by the end of the year 2000.

  19. Dementia in intellectual disability.

    PubMed

    Sheehan, Rory; Ali, Afia; Hassiotis, Angela

    2014-03-01

    Dementia is emerging as a significant condition in the population with intellectual disability. This review is aimed at clinicians working in the field. We revisit what is known on the subject and expand on this with results from recent research. The emphasis of this review is on the clinical research rather than laboratory or molecular research. Research has encompassed all aspects of dementia in intellectual disability, from epidemiology, assessment and diagnosis, through to management. There remains a lack of evidence concerning both pharmacological and nonpharmacological treatment of dementia in people with intellectual disability. Recent research has tended to focus on dementia in Down syndrome. More research is necessary in order to translate improvements in the understanding of the neuropathology of intellectual disability and dementia into effective treatments. There is also a need to investigate the optimum environment in which to provide holistic care for individuals affected.

  20. Dementia and Hip Fractures

    PubMed Central

    Friedman, Susan M.; Menzies, Isaura B.; Bukata, Susan V.; Mendelson, Daniel A.; Kates, Stephen L.

    2010-01-01

    Dementia and hip fractures are 2 conditions that are seen primarily in older adults, and both are associated with substantial morbidity and mortality. An individual with dementia is up to 3 times more likely than a cognitively intact older adult to sustain a hip fracture. This may occur via several mechanisms, including (1) risk factors that are common to both outcomes; (2) the presence of dementia increasing hip fracture incidence via intermediate risk factors, such as falls, osteoporosis, and vitamin D; and (3) treatment of dementia causing side effects that increase hip fracture risk. We describe a model that applies these 3 mechanisms to explain the relationship between dementia and hip fractures. Comprehensive understanding of these pathways and their relative influence on the outcome of hip fracture will guide the development of effective interventions and potentially improve prevention efforts. PMID:23569663

  1. Hearing and dementia.

    PubMed

    Hardy, Chris J D; Marshall, Charles R; Golden, Hannah L; Clark, Camilla N; Mummery, Catherine J; Griffiths, Timothy D; Bamiou, Doris-Eva; Warren, Jason D

    2016-11-01

    Hearing deficits associated with cognitive impairment have attracted much recent interest, motivated by emerging evidence that impaired hearing is a risk factor for cognitive decline. However, dementia and hearing impairment present immense challenges in their own right, and their intersection in the auditory brain remains poorly understood and difficult to assess. Here, we outline a clinically oriented, symptom-based approach to the assessment of hearing in dementias, informed by recent progress in the clinical auditory neuroscience of these diseases. We consider the significance and interpretation of hearing loss and symptoms that point to a disorder of auditory cognition in patients with dementia. We identify key auditory characteristics of some important dementias and conclude with a bedside approach to assessing and managing auditory dysfunction in dementia.

  2. Dementia for hospital physicians.

    PubMed

    Harwood, Rowan H

    2012-02-01

    Many people with dementia are admitted to general hospitals, yet doctors feel ill-prepared to manage them. Problems are often multiple and complex. In many cases, dementia is complicated by delirium. Medical assessment must be meticulous and requires collateral history taking, mental state examination and cognitive function testing. Hospital environments can be provocative, and the way staff interact with people with dementia can increase distress. Difficult behaviours usually represent unmet needs. The right approach by (all) staff can reduce this, including special efforts to establish reassuring, comforting relationships with patients. Try to see situations from the perspective of the person with dementia. Skilled communication is vital and family carers should be kept informed and involved. People with dementia are prone to side effects of prescribed drugs. Antipsychotic drugs are rarely the answer to difficult behaviours, but may be used in cases of psychosis or severe distress.

  3. Personality traits and risk of cognitive impairment and dementia.

    PubMed

    Terracciano, Antonio; Stephan, Yannick; Luchetti, Martina; Albanese, Emiliano; Sutin, Angelina R

    2017-06-01

    We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Comparison of dementia recorded in routinely collected hospital admission data in England with dementia recorded in primary care.

    PubMed

    Brown, Anna; Kirichek, Oksana; Balkwill, Angela; Reeves, Gillian; Beral, Valerie; Sudlow, Cathie; Gallacher, John; Green, Jane

    2016-01-01

    Electronic linkage of UK cohorts to routinely collected National Health Service (NHS) records provides virtually complete follow-up for cause-specific hospital admissions and deaths. The reliability of dementia diagnoses recorded in NHS hospital data is not well documented. For a sample of Million Women Study participants in England we compared dementia recorded in routinely collected NHS hospital data (Hospital Episode Statistics: HES) with dementia recorded in two separate sources of primary care information: a primary care database [Clinical Practice Research Datalink (CPRD), n = 340] and a survey of study participants' General Practitioners (GPs, n = 244). Dementia recorded in HES fully agreed both with CPRD and with GP survey data for 85% of women; it did not agree for 1 and 4%, respectively. Agreement was uncertain for the remaining 14 and 11%, respectively; and among those classified as having uncertain agreement in CPRD, non-specific terms compatible with dementia, such as 'memory loss', were recorded in the CPRD database for 79% of the women. Agreement was significantly better (p < 0.05 for all comparisons) for women with HES diagnoses for Alzheimer's disease (95 and 94% agreement with any dementia for CPRD and GP survey, respectively) and for vascular dementia (88 and 88%, respectively) than for women with a record only of dementia not otherwise specified (70 and 72%, respectively). Dementia in the same woman was first mentioned an average 1.6 (SD 2.6) years earlier in primary care (CPRD) than in hospital (HES) data. Age-specific rates for dementia based on the hospital admission data were lower than the rates based on the primary care data, but were similar if the delay in recording in HES was taken into account. Dementia recorded in routinely collected NHS hospital admission data for women in England agrees well with primary care records of dementia assessed separately from two different sources, and is sufficiently reliable for epidemiological

  5. Proposed national strategies for the prevention of leading work-related diseases and injuries. Part 1

    SciTech Connect

    Not Available

    1986-01-01

    Preliminary strategies developed at the National Symposium on the Prevention of Leading Work Related Diseases and Injuries, held in Atlanta, Georgia on May 1 to 3, 1985 were revised, elaborated, and further developed. Strategies were developed for the prevention of occupational lung diseases, musculoskeletal injuries, occupational cancers, severe occupational traumatic injuries, and occupational cardiovascular diseases. Lung diseases considered included silicosis, asbestosis, lung cancer mesothelioma, coal workers' pneumoconiosis, byssinosis, occupational asthma, hypersensitivity pneumonitis, asphyxiation, irritation, pulmonary edema, brucellosis, psitticosis, anthrax, mycobacterioses, histoplasmosis, aspergillosis, and coccidioidomycosis. Occupational cancers were discussed as they occur in the lung, pleura, peritoneum, bladder, kidneys, blood, nasal cavity, skin, nasal sinuses, and liver.

  6. Towards National eHealth Implementation--a comparative study on WHO/ITU National eHealth Strategy Toolkit in Iran.

    PubMed

    Riazi, Hossein; Jafarpour, Maryam; Bitaraf, Ehsan

    2014-01-01

    Experiences has shown that utilization of ICT in health sector requires national commitment and planned efforts to make the best use of existing capacity. Establishing the main directions as well as planning the detailed steps needed are key to achieving longer-term goals such as health sector efficiency, reform or more fundamental transformation. Collaboration between the health and ICT sectors, both public and private, is central to this effort. As the major United Nations agencies for health and telecommunications respectively, the World Health Organization (WHO) and the International Telecommunication Union (ITU) have recognized the importance of collaboration for eHealth in their global resolutions, which encourage countries to develop national eHealth strategies; the National eHealth Strategy Toolkit is the proof of these recommendations. In this study a mapping of eHealth components in WHO/ITU National eHealth Strategy Toolkit and our national eHealth vision is presented.

  7. Understanding challenging behaviour in patients with dementia.

    PubMed

    Cunningham, C

    The fifth and final article in the series on patients with dementia in acute care examines challenging behaviour. Hospital admission, combined with unfamiliar surroundings and memory problems, can be frightening and disorientating for those with dementia. This can lead to behaviour which is perceived as 'disruptive' or 'difficult'. Aspects of the hospital environment or care practice can contribute to problems that may be misinterpreted and lead to challenging behaviour. Staff should seek to understand the cause of challenging behaviour, assess the possible causes and use strategies to reinforce familiarity and minimise distress for these patients.

  8. Stress-coping strategies among medical residents in Saudi Arabia: A cross-sectional national study.

    PubMed

    Alosaimi, Fahad D; Almufleh, Auroabah; Kazim, Sana; Aladwani, Bandar

    2015-01-01

    Maladaptive stress-coping strategies have been linked to reduced quality of life, psychiatric disorders, and reduced work performance among residents or physicians. This study aimed to examine stress-coping strategies among medical residents in Saudi Arabia and their association with stress levels and important personal characteristics. This cross-sectional study was conducted between May and October 2012. Residents of different specialties were recruited from a national database. Stress-coping strategies were assessed using the 28-item brief coping scale (BCS), while stress was assessed using the perceived stress scale (PSS). Nine hundred seventeen residents completed both BCS and PSS assessments. Almost 55% of participants were males, 88% were Saudi, 58% were married, and 15% had positive history of psychiatric disorders. The adaptive stress-coping strategy with the highest score was religion, followed by planning, acceptance, and active coping. The maladaptive stress-coping strategy with the highest score was self-blame, followed by self-distraction, and venting. Maladaptive stress-coping strategies were associated with high stress level, female gender, and history of psychiatric disorders. Stress-coping strategies were not correlated/associated with age, presence of major medical illnesses, or stress management education/training. Adaptive stress-coping strategies were more frequently used among a sample of residents in Saudi Arabia than maladaptive stress-coping strategies, with higher use of religion in coping than previously reported. To avoid potential negative impact on resident well-being, future studies among residents should aim to identify the type of stress management program that most positively impacts stress-coping skills.

  9. UK quality statements on end of life care in dementia: a systematic review of research evidence.

    PubMed

    Candy, Bridget; Elliott, Margaret; Moore, Kirsten; Vickerstaff, Victoria; Sampson, Elizabeth; Jones, Louise

    2015-10-19

    Globally, the number of people who die with dementia is increasing. The importance of a palliative approach in the care of people with dementia is recognised and there are national polices to enhance current care. In the UK implementation of these polices is promoted by the National Institute for Health and Care Excellence (NICE) Dementia Quality Standards (QS). Since publication of the QS new care interventions have been developed. To explore critically the current international research evidence on effect available to inform NICE Dementia QS relevant to end of life (EOL) care. We used systematic review methods to seek the research evidence for three statements within the Dementia QS. These are those that recommend: (1) a case management approach, (2) discussing and consideration of making a statement about future care (SFC) and (3) a palliative care assessment (PCA). We included evaluative studies of relevant interventions that used a comparative design, such as trials and cohort studies, and measured EOL care outcomes for persons dying with moderate to severe dementia. Our primary outcome of interest was whether the intervention led to a measurable impact on wellbeing for the person with dementia and their family. We assessed included studies for quality using a scale by Higginson and colleagues (2002) for assessment of quality of studies in palliative care, and two authors undertook key review processes. Data sources included Cinahl, Embase, and PsychINFO from 2001 to August 2014. Our search strategy included free text and medical subject headings relevant to population and recommended care. We found seven studies evaluating a care intervention; four assessed SFC, three PCA. None assessed case management. Studies were of weak design; all used retrospective data and relied on others for precise record keeping and for accurate recall of events. There was limited overlap in outcome measurements. Overall reported benefits were mixed. Quality statements relevant to

  10. Strategies for International Cooperation in Support of Energy Development in Pacific Island Nations

    SciTech Connect

    Miller, M.; Voss, P.; Warren, A.; Baring-Gould, I.; Conrad, M.

    2012-05-01

    The U.S. Department of Energy's National Renewable Energy Laboratory (NREL) has been partnering with island communities around the world to address the technical, policy, social, and economic hurdles to deploying energy efficiency and renewable energy technologies (RETs) on small, islanded systems. The lessons learned from these partnerships are briefly summarized in this document with the goal of supporting the International Renewable Energy Agency (IRENA) in the development of specific near-term and longer-term strategies for island RET deployment.

  11. Would the U.S. Benefit from a Unified National Strategy to Combat Violent Salafi Jihadism

    DTIC Science & Technology

    2015-12-01

    generic term “ terrorism ” has resulted in a vast array of counterterrorism “experts,” many of whom have little or no understanding of VSJ. An unintended...countering violent extremism(CVE), radicalization, Islam, Muslim, antiterrorism, terrorism 15. NUMBER OF PAGES 121 16. PRICE CODE 17. SECURITY...this threat for the past 14 years, a unified national strategy is warranted. The use of the generic term “ terrorism ” has resulted in a vast array

  12. American Primacy and Major Power Concert: A Critique of the 2002 National Security Strategy

    DTIC Science & Technology

    2002-12-01

    thinking. It seemed wise to be patient in issuing a report, with the hope that time would bring a settling of major power relations and also clearer...international political landscape after the Cold War. They also described an America fixated on military means and tone deaf about politics. In the... dumbed down to the lowest common denominator, and we can’t afford 71 National Security Strategy, p

  13. Applying change management metaphors to a national e-Health strategy.

    PubMed

    Saunders, Chad; Scott, Richard E

    2014-01-01

    Recent attempts at a collective understanding of how to develop an e-Health strategy have addressed the individual organisation, collection of organisations, and national levels. At the national level the World Health Organisation's National eHealth Strategy Toolkit serves as an exemplar that consolidates knowledge in this area, guides practical implementations, and identifies areas for future research. A key implication of this toolkit is the considerable number of organisational changes required to successfully apply their ideas in practice. This study looks critically at the confluence of change management and e-Health strategy using metaphors that underpin established models of change management. Several of Morgan's organisational metaphors are presented (highlighting varied beliefs and assumptions regarding how change is enacted, who is responsible for the change, and guiding principles for that change), and used to provide a framework. Attention is then directed to several prominent models of change management that exemplify one or more of these metaphors, and these theoretical insights are applied to evaluate the World Health Organisation's National eHealth Strategy Toolkit. The paper presents areas for consideration when using the WHO/ITU toolkit, and suggestions on how to improve its use in practice. The goal is to seek insight regarding the optimal sequence of steps needed to ensure successful implementation and integration of e-health into health systems using change management models. No single model, toolkit, or guideline will offer all the needed answers, but clarity around the underlying metaphors informing the change management models being used provides valuable insight so potentially challenging areas can be avoided or mitigated.

  14. Brazil’s National Defense Strategy -- A Deepening of Civilian Control

    DTIC Science & Technology

    2009-05-15

    Identity Crisis.” Journal of Interamerican Studies and World Affairs 42, no.3 (Autumn 2000): 149 in JSTOR (Accessed September 17, 2008). 26 Ibid. 161 27...34 Ibid. 35 Stockholm International Peace Research Institute, “Military Expenditure Database – Brazil,” http://milexdata.sipri.org/result.php4...International Peace Research Institute, “Military Expenditure Database – Brazil,” 59 Jobim and Unger, National Defense Strategy. 60 Senior SOUTHCOM

  15. The Interagency Breakdown: Why We Need Legislative Reform to Coordinate Execution of the National Security Strategy

    DTIC Science & Technology

    2008-04-01

    core areas that the reform needs to address require analysis . The analysis starts with the fact that the National Security Strategy is the centerpiece... tinder 5om!1iI𔃻 .t>:l A:s1stanl seu.Ia’~ CltIP. /JirFtlrce Marine Corps Major Commands & Agencies Cl:iH or N>\\𔃻J1 Opemlions Navy Major Commands &A

  16. Metal homeostasis in dementia.

    PubMed

    Sensi, Stefano

    2014-10-01

    The molecular determinants of dementia of Alzheimer's tipe (DAT) are still not completely known; however, in the past two decades, a large body of evidence has indicated that an important contributing factor is represented by the unbalanced homeostasis of two cations: calcium (Ca(2) ) and zinc (Zn(2)). The two ions serve a critical role in the physiological signalling of the central nervous system. However, Alzheimer's disease-related neurodegeneration, deregulation of brain levels of Ca(2) and Zn(2) is instrumental in promoting amyloid-β (Aβ) dysmetabolism and tau phosphorylation as well as interference with additional pathogenic factors like energy production failure, hyperexcitabilty, excitotoxicity, and oxidative stress. Hyperexcitabilty and excitotoxicity are key mechanisms in the disease development and progression as an altered glutamatergic activation can further promote both Ca(2) and Zn(2) dyshomeostasis. The two cations can operate synergistically to promote the generation of free radicals that further increase intracellular Ca(2) and Zn(2) rises and set the stage for a self-perpetuating injurious loop. In the talk, we will review mechanisms of AD-related Ca(2) and Zn(2) dyshomeostasis in a preclinical model of DAT and discuss opportunity for disease-modifying strategies based on interventions aimed at restoring brain metal homeostasis.

  17. Nutrition and Physical Activity Strategies for Cancer Prevention in Current National Comprehensive Cancer Control Program Plans.

    PubMed

    Puckett, Mary; Neri, Antonio; Underwood, J Michael; Stewart, Sherri L

    2016-10-01

    Obesity, diet and physical inactivity are risk factors for some cancers. Grantees of the National Comprehensive Cancer Control Program (NCCCP) in US states, tribes, and territories develop plans to coordinate funding and activities for cancer prevention and control. Including information and goals related to nutrition and physical activity (NPA) is a key opportunity for primary cancer prevention, but it is currently unclear to what extent NCCCP plans address these issues. We reviewed 69 NCCCP plans and searched for terms related to NPA. Plans were coded as (1) knowledge of NPA and cancer link; (2) goals to improve NPA behaviors; and (3) strategies to increase healthy NPA activities, environments, or systems changes. NPA content was consistently included in all cancer plans examined across all years. Only 4 (6 %) outlined only the relationship between NPA and cancer without goals or strategies. Fifty-nine plans (89 %) contained goals or strategies related to NPA, with 53 (82 %) including both. However, numbers of goals, strategies, and detail provided varied widely. All programs recognized the importance of NPA in cancer prevention. Most plans included NPA goals and strategies. Increasing the presence of NPA strategies that can be modified or adapted appropriately locally could help with more widespread implementation and measurement of NPA interventions.

  18. [Disruptive sexual behaviour among patients with dementia].

    PubMed

    Kämpf, C; Abderhalden, C

    2012-10-01

    In addition to diagnostically decisive cognitive problems, behavioural and psychological symptoms (BPSD) are frequent among people with dementia, including sexually related behavioural problems. This paper provides an overview on the state of knowledge about these problems. Research on this topic is hampered by the absence of unanimous definitions, aetiological classifications, and diagnostic instruments. The wide range of prevalence rates reported (1.8 - 18 %) originate from the heterogenity of study samples as well as in the variety of definitions and instruments employed. Regarding aetiology, dysfunctions in various cortical regions are being discussed. Sexually related behavioural problems are more prevalent in men and among patients with vascular, frontotemporal and Parkinson-associated forms of dementia, as compared with dementias of the Alzheimer type. The pharmacological and non-pharmacological treatment strategies published to date have not been sufficiently studied.

  19. [Diabetes mellitus and dementia].

    PubMed

    Kopf, D

    2015-05-01

    Diabetes mellitus, particularly type 2 diabetes, is a risk factor for dementia and this holds true for incident vascular dementia and Alzheimer's disease. Cerebrovascular complications of diabetes and chronic mild inflammation in insulin resistant states partly account for this increased risk. In addition, cellular resistance to the trophic effects of insulin on neurons and glial cells favor the accumulation of toxic metabolic products, such as amyloid and hyperphosphorylated tau protein (pTau). Weight loss frequently precedes overt cognitive symptoms of Alzheimer's disease. This results in an increased risk of hypoglycemic episodes in stable diabetic patients who are on suitably adjusted doses of oral insulin or insulinotropic antidiabetic drugs. In turn, hypoglycemic episodes may induce further damage in the vulnerable brains of type 2 diabetes patients. Patients with unexplained weight loss, hypoglycemic episodes and subjective memory complaints must be screened for dementia. Once dementia has been diagnosed the goals of diabetes management must be reevaluated as prevention of hypoglycemia becomes more important than tight metabolic control. As weight loss accelerates the rate of cognitive decline, nutritional goals must aim at stabilizing body weight. There is no available evidence on whether drug treatment of diabetes in middle-aged persons can help to prevent dementia; however, physical exercise, mental activity and higher education have preventive effects on the risk of dementia in later life. In addition, nutritional recommendations that are effective in preventing cardiovascular events have also been shown to reduce the risk of dementia.

  20. Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries.

    PubMed

    Broda, Anja; Bieber, Anja; Meyer, Gabriele; Hopper, Louise; Joyce, Rachael; Irving, Kate; Zanetti, Orazio; Portolani, Elisa; Kerpershoek, Liselot; Verhey, Frans; Vugt, Marjolein de; Wolfs, Claire; Eriksen, Siren; Røsvik, Janne; Marques, Maria J; Gonçalves-Pereira, Manuel; Sjölund, Britt-Marie; Woods, Bob; Jelley, Hannah; Orrell, Martin; Stephan, Astrid

    2017-08-03

    As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

  1. Use of health economics in the development of a national radon control strategy in Ireland.

    PubMed

    Pollard, D; Fenton, D

    2014-07-01

    A health economics evaluation of different radon intervention strategies was undertaken including the incorporation of prevention into new buildings, the incorporation of potential remedial measures into new buildings and remediation of existing buildings. The analysis shows that (1) the incorporation of prevention into new houses at the time of construction is generally more cost effective than remediation of existing houses and (2) that the cost effectiveness of programmes aimed at encouraging householders to test and remediate their houses may be poor if they are not undertaken within the context of coherent radon reduction strategy. The results of this evaluation were used to identify the most cost-effective radon interventions in an Irish context in support of the development of a National Radon Control Strategy. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Treatment of Frontotemporal Dementia

    PubMed Central

    Boxer, Adam L.

    2016-01-01

    Opinion statement Frontotemporal dementia (FTD) encompasses a spectrum of neurodegenerative diseases with heterogeneous clinical presentations and two predominant types of underlying neuropathology. FTD typically comprises three distinct clinical syndromes: behavioral variant frontotemporal dementia (bvFTD), semantic variant primary progressive aphasia (svPPA), and nonfluent variant primary progressive aphasia (nfvPPA). FTD also frequently overlaps both clinically and neuropathologically with three other neurodegenerative syndromes: corticobasal syndrome (CBS), progressive supranuclear palsy (PSP), and amyotrophic lateral sclerosis (ALS). Each syndrome can be associated with one or more underlying neuropathological diagnoses and are referred to as frontotemporal lobar degeneration (FTLD). Although the various FTD syndromes can substantially differ in terms of clinical symptoms and underlying pathology, the symptoms can be broadly categorized into behavioral, cognitive and motor domains. Currently there are no Food and Drug Administration (FDA) approved therapies for the above syndromes except riluzole for ALS. FTD treatment strategies generally rely on off-label use of medications for symptomatic management, and most therapies lack quality evidence from randomized, placebo-controlled clinical trials. For behavioral symptoms, selective serotonin reuptake inhibitors may be effective, while case reports hint at possible efficacy with antipsychotics or antiepileptics, but use of these latter agents is limited due to concerns regarding side effects. There are no effective therapies for cognitive complaints in FTD, which frequently involve executive function, memory, and language. Motor difficulties associated with FTD may present with parkinsonian symptoms or motor neuron disease, for which riluzole is indicated as therapy. Compared to idiopathic Parkinson’s disease, FTD-related atypical parkinsonism is generally not responsive to dopamine replacement therapies, but a

  3. [Dementia: management and prevention].

    PubMed

    Daher, Oscar; Nguyen, Sylvain; Smith, Cindi; Büla, Christophe; Démonet, Jean-François

    2016-04-20

    Dementia represents a great challenge for health care providers. Detection of cognitive impairment is critical for early diagnosis of dementia. Early diagnosis allows to initiate individualized management that focuses on maintaining patient's autonomy and supporting their caregivers. Proposed multimodal interventions include physical activity, cognitive training, mediterranean diet, and management of cardiovascular risk factors. Before the initiation of pro-cognitive therapy, medication review is essential to evaluate current treament and determine specific therapeutic objectives, based on patient's overall health and preferences. Overall risk reduction for dementia revolves around similar measures that target physical activity, cognition, diet and management of cardiovascular risk factors.

  4. Delirium Superimposed on Dementia

    PubMed Central

    Steis, Melinda R.; Fick, Donna M.

    2012-01-01

    Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. Nurses did not document that they recognized delirium. Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavior, delusions, and restlessness. Delirium is a medical emergency. Nurses are in need of education coupled with clinical and decisional support to facilitate recognition and treatment of underlying causes of delirium in individuals with dementia. PMID:21761816

  5. Frailty and incident dementia.

    PubMed

    Gray, Shelly L; Anderson, Melissa L; Hubbard, Rebecca A; LaCroix, Andrea; Crane, Paul K; McCormick, Wayne; Bowen, James D; McCurry, Susan M; Larson, Eric B

    2013-09-01

    We sought to examine whether frailty is associated with dementia, Alzheimer's disease (AD), and non-AD dementia risk. This is a prospective population-based cohort derived from an integrated health maintenance organization. The sample consisted of 2,619 participants aged 65 and older without dementia at baseline followed from 1994 to 2010. Frailty was defined as having at least 3 of the following criteria: weakness (grip strength), slowness (walking speed), weight loss, low physical activity, and self-reported exhaustion. Follow-up occurred every 2 years to identify incident dementia, possible or probable AD, and non-AD dementia using standard research criteria. Covariates came from self-report and study measures. We used adjusted Cox proportional hazards models to examine the association between frailty and each outcome. Over a mean follow-up of 6.5 years, 521 participants developed dementia (of which 448 developed AD). In the model adjusted for age, sex, education, and race, the hazard ratio for frailty was 1.78 (95% confidence interval [CI] 1.32-2.40). In the fully adjusted models, the hazard ratio for frailty was 1.20 for all-cause dementia (95% CI 0.85-1.69), 1.08 for AD (95% CI 0.74-1.57), and 2.57 for non-AD dementia (95% CI 1.08-6.11). For all-cause dementia, we found an interaction between baseline cognitive score and frailty (p = .02); hazard ratio for frailty was 1.78 for those with higher global cognition (95% CI 1.14-2.78) and 0.79 for those with lower global cognition (95% CI 0.50-1.26). Frailty was associated with dementia when adjusting only for demographic variables but not in the fully adjusted model. Frailty was associated with higher risk of developing non-AD dementia but not AD. Although frailty was not associated with all-cause dementia in the entire sample, an association did exist in participants with higher cognitive scores. Mechanisms underlying these associations remain to be elucidated.

  6. The Swedish strategy and method for development of a national healthcare information architecture.

    PubMed

    Rosenälv, Jessica; Lundell, Karl-Henrik

    2012-01-01

    "We need a precise framework of regulations in order to maintain appropriate and structured health care documentation that ensures that the information maintains a sufficient level of quality to be used in treatment, in research and by the actual patient. The users shall be aided by clearly and uniformly defined terms and concepts, and there should be an information structure that clarifies what to document and how to make the information more useful. Most of all, we need to standardize the information, not just the technical systems." (eHälsa - nytta och näring, Riksdag report 2011/12:RFR5, p. 37). In 2010, the Swedish Government adopted the National e-Health - the national strategy for accessible and secure information in healthcare. The strategy is a revision and extension of the previous strategy from 2006, which was used as input for the most recent efforts to develop a national information structure utilizing business-oriented generic models. A national decision on healthcare informatics standards was made by the Swedish County Councils, which decided to follow and use EN/ISO 13606 as a standard for the development of a universally applicable information structure, including archetypes and templates. The overall aim of the Swedish strategy for development of National Healthcare Information Architecture is to achieve high level semantic interoperability for clinical content and clinical contexts. High level semantic interoperability requires consistently structured clinical data and other types of data with coherent traceability to be mapped to reference clinical models. Archetypes that are formal definitions of the clinical and demographic concepts and some administrative data were developed. Each archetype describes the information structure and content of overarching core clinical concepts. Information that is defined in archetypes should be used for different purposes. Generic clinical process model was made concrete and analyzed. For each decision

  7. Setting strategy for system change: using concept mapping to prioritise national action for chronic disease prevention.

    PubMed

    Wutzke, Sonia; Roberts, Nick; Willis, Cameron; Best, Allan; Wilson, Andrew; Trochim, William

    2017-08-08

    Chronic diseases are a serious and urgent problem, requiring at-scale, multi-component, multi-stakeholder action and cooperation. Despite numerous national frameworks and agenda-setting documents to coordinate prevention efforts, Australia, like many countries internationally, is yet to substantively impact the burden from chronic disease. Improved evidence on effective strategies for the prevention of chronic disease is required. This research sought to articulate a priority set of important and feasible action domains to inform future discussion and debate regarding priority areas for chronic disease prevention policy and strategy. Using concept mapping, a mixed-methods approach to making use of the best available tacit knowledge of recognised, diverse and well-experienced actors, and national actions to improve the prevention of chronic disease in Australia were identified and then mapped. Participants (ranging from 58 to 78 in the various stages of the research) included a national sample of academics, policymakers and practitioners. Data collection involved the generation and sorting of statements by participants. A series of visual representations of the data were then developed. A total of 95 statements were distilled into 12 clusters for action, namely Inter-Sectoral Partnerships; Systems Perspective/Action; Governance; Roles and Responsibilities; Evidence, Feedback and Learning; Funding and Incentive; Creating Demand; Primary Prevention; Social Determinants and Equity; Healthy Environments; Food and Nutrition; and Regulation and Policy. Specific areas for more immediate national action included refocusing the health system to prevention over cure, raising the profile of public health with health decision-makers, funding policy- and practice-relevant research, improving communication about prevention, learning from both global best-practice and domestic successes and failures, increasing the focus on primary prevention, and developing a long-term prevention

  8. Considering the senses in the diagnosis and management of dementia.

    PubMed

    Behrman, Sophie; Chouliaras, Leonidas; Ebmeier, Klaus P

    2014-04-01

    Associations between dementia and impairments in hearing, vision, olfaction and (to a lesser degree) taste have been identified. Hearing impairment has been shown to precede cognitive decline, but it is not clear if the hearing loss is an early marker of dementia or a modifiable risk factor. Olfactory impairment is seen in many neurodegenerative conditions, but it has been shown that those with dementia have particular difficulties with the recognition and identification of odours rather than the detection, suggesting a link to impairment of higher cognitive function. Olfactory impairment has been shown to be predictive of conversion from mild cognitive impairment to Alzheimer's disease with 85.2% sensitivity. As cognitive function deteriorates, the world is experienced at a sensory level, with reduced ability to integrate the sensory experiences to understand the context. Thus, people with dementia are very sensitive to sensory experiences and their environment needs to be managed carefully to make it understandable, comfortable, and (if possible) therapeutic. Light can be used to stabilise the circadian rhythm, which may be disturbed in dementia. Music therapy, aromatherapy, massage and multisensory stimulation are recommended by NICE for the management of behavioural and psychological symptoms of dementia (BPSD), although the mechanisms behind such interventions are poorly understood and evidence is limited. Sensory considerations are likely to play a greater role in dementia care in the future, with the development of purpose-built dementia care facilities and the focus on non-pharmacological management strategies for BPSD.

  9. Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review

    PubMed Central

    Handley, Melanie; Bunn, Frances; Goodman, Claire

    2017-01-01

    Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia. Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory. Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature. Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded. Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress. Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or

  10. Higher education provision for professionals working with people with dementia: a scoping exercise.

    PubMed

    Pulsford, David; Hope, Kevin; Thompson, Rachel

    2007-01-01

    This paper reports on the first national UK survey of higher education provision related to dementia care. A questionnaire was distributed to lecturers in Higher Education Institutions (HEIs) in England and Wales seeking information about the amount of coverage of dementia within their pre-registration and pre-qualifying courses for health and social care professionals, and continuing professional development (CPD) courses on dementia care. Information was sought regarding the content of courses, and their relation to a published "dementia curriculum" [Pulsford et al., The contribution of higher education to dementia care, Journal of Dementia Care 11(4) (2003) 27-29]. Results show that coverage of dementia within the mental health branch of pre-registration nursing programmes is very variable, and may be related to the presence of an experienced and committed lecturer within the HEI. Coverage of dementia on adult branch programmes is limited, and sometimes non-existent, despite reported deficits in the ability of general nurses to work effectively with people with dementia. Occupational Therapists and Social Workers receive similar input to adult branch nurses. CPD courses are provided by around 70% of HEIs overall, but there is a shortage of specialised diploma and degree level courses on dementia care. Most areas of the dementia curriculum are covered in both pre-registration and CPD courses, but culture and diversity, young onset dementia, and physical health care may be less well addressed. Recommendations are made for developing higher education provision for professionals working with this group of people.

  11. Parkinson's Disease Dementia

    MedlinePlus

    ... newsletter Stay up-to-date on the latest advances in Alzheimer's and dementia treatments, care and research. Subscribe now ... up-to-date on the latest news and advances in Alzheimer's treatments, care and research. Get tips for living ...

  12. Dementia and driving

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000028.htm Dementia and driving To use the sharing features on this page, ... their independence is being taken away. Signs That Driving May No Longer be Safe People with signs ...

  13. Burnout and Coping Strategies in Male Staff from National Police in Valparaíso, Chile

    PubMed Central

    BRIONES MELLA, Daniel; KINKEAD BOUTIN, Ana P.

    2013-01-01

    Abstract Background This cross-sectional study aimed to examine the relationship between several dimensions of the burnout syndrome with certain stress-coping strategies, seniority level and marital status in male staff from National Police in Vaparaíso, Chile. Methods The sample collected in 2010 was composed of 338 male officers coming from various special units of a National Police in Valparaíso. Burnout and Coping Strategies were assessed and classified according Maslach Burnout Inventory (MBI) and COPE Inventory, respectively. Data was analyzed using Pearson product-moment correlation, t-test for independent measures and Multiple Linear Regression to generate a predictive model. Results The prevalence of the burnout syndrome disaggregated by grouping criteria, the dimensions concentrated in middle levels for emotional exhaustion with a 52.1%, a 51.8% for depersonalization and finally, personal achievement with a 48.8%. Only 28% of participants showed more exacerbated dimensions of the burnout syndrome. There was a weak and direct yet statistically significant relationship between personal achievement and active coping. Mental disconnection had a weak direct relationship between both coping strategies and emotional exhaustion also existed. Certain correlations between burnout dimensions and coping strategies focused on emotion as predictor variables over the criterion variable corresponding to emotional exhaustion were mental disconnection in first place, secondly, focusing on emotions, and emotional social support. Conclusions Burnout dimensions scored medium values ​​focusing mainly on emotional exhaustion and reduced personal accomplishment. Coping strategies are used in parallel and in general are not mutually exclusive. Finally, there were not any relationship between variables seniority level and marital status. PMID:26060656

  14. Quantifying the benefits of peer support for people with dementia: A Social Return on Investment (SROI) study.

    PubMed

    Willis, Elizabeth; Semple, Amy C; de Waal, Hugo

    2016-03-24

    Peer support for people with dementia and carers is routinely advocated in national strategies and policy as a post-diagnostic intervention. However there is limited evidence to demonstrate the value these groups offer. This study looked at three dementia peer support groups in South London to evaluate what outcomes they produce and how much social value they create in relation to the cost of investment. A Social Return on Investment (SROI) analysis was undertaken, which involves collecting data on the inputs, outputs and outcomes of an intervention, which are put into a formula, the end result being a SROI ratio showing how much social value is created per £1 of investment. Findings showed the three groups created social value ranging from £1.17 to £5.18 for every pound (£) of investment, dependent on the design and structure of the group. Key outcomes for people with dementia were mental stimulation and a reduction in loneliness and isolation. Carers reported a reduction in stress and burden of care. Volunteers cited an increased knowledge of dementia. This study has shown that peer groups for people with dementia produce a social value greater than the cost of investment which provides encouraging evidence for those looking to commission, invest, set up or evaluate peer support groups for people with dementia and carers. Beyond the SROI ratio, this study has shown these groups create beneficial outcomes not only for the group members but also more widely for their carers and the group volunteers. © The Author(s) 2016.

  15. Young onset dementia

    PubMed Central

    Sampson, E; Warren, J; Rossor, M

    2004-01-01

    Young onset dementia is a challenging clinical problem with potentially devastating medical and social consequences. The differential diagnosis is wide, and includes a number of rare sporadic and hereditary diseases. However, accurate diagnosis is often possible, and all patients should be thoroughly investigated to identify treatable processes. This review presents an approach to the diagnosis, investigation, and management of patients with young onset dementia, with particular reference to common and treatable causes. PMID:15016933

  16. Neuroimaging and dementia

    SciTech Connect

    Benson, D.F.

    1986-05-01

    The tremendous increase in dementia has created a need for improved diagnostic techniques, and each of the newly established brain imaging techniques has been applied to this problem. Several, particularly computerized tomography (CT), magnetic resonance imaging (MRI), and isotope emission tomography, have proved valuable. Each procedure has strengths--specific disorders that can be diagnosed--and weaknesses--types of dementia that cannot be demonstrated.

  17. A national environmental monitoring system to support the Moroccan sustainable development strategy

    NASA Astrophysics Data System (ADS)

    Mourhir, A.; Rachidi, T.

    2010-12-01

    Morocco is a mountainous country, subject to both marine and Saharan influences. The increase in population has led to an increase of the gross domestic product (GDP), which accentuated by inadequate resource management, has been accompanied by the degradation of the environment. The annual cost of environmental damage has been estimated at nearly eight percent of Morocco’s GDP. Morocco is a country that has scarce natural resources, especially arable land and water. In recent years, intensive agricultural production, large-scale irrigation schemes, industrialization, and urbanization have been creating serious problems. The country has faced severe air, water and soil pollution, environmental health problems, deforestation and soil erosion. The country is very vulnerable to impacts of global climate change. Morocco’s approach to sustainable development (SD) is mainly environmental. The two main documents for Morocco’s SD strategy are the National Strategy for the Protection of the Environment and Sustainable Development (SNPEDD), 1995, and the National Plan of Action for the Environment (PANE), 1998. SNPEDD’s main objective is the integration and strengthening of environmental concerns in economic development activities. The activities for the formulation and implementation of the strategy include: a) studies on the state of the Moroccan environment; b) formulation of the PANE; c) preparation of a sensitization program on environmental issues and the implementation of a database and information system on the environment; (d) preparation of regional and local environmental monographies. The aim of the current work is to create an information system as an approach to complex sustainability analyses at the national level using GIS technologies. This information system includes the following: 1.Development of a database of SD indicators and historical data. Morocco has been involved in the working framework of the Mediterranean Commission for Sustainable

  18. Hypercholesterolaemia and vascular dementia.

    PubMed

    Appleton, Jason P; Scutt, Polly; Sprigg, Nikola; Bath, Philip M

    2017-07-15

    Vascular dementia (VaD) is the second commonest cause of dementia. Stroke is the leading cause of disability in adults in developed countries, the second major cause of dementia and the third commonest cause of death. Traditional vascular risk factors-diabetes, hypercholesterolaemia, hypertension and smoking-are implicated as risk factors for VaD. The associations between cholesterol and small vessel disease (SVD), stroke, cognitive impairment and subsequent dementia are complex and as yet not fully understood. Similarly, the effects of lipids and lipid-lowering therapy on preventing or treating dementia remain unclear; the few trials that have assessed lipid-lowering therapy for preventing (two trials) or treating (four trials) dementia found no evidence to support the use of lipid-lowering therapy for these indications. It is appropriate to treat those patients with vascular risk factors that meet criteria for lipid-lowering therapy for the primary and secondary prevention of cardiovascular and cerebrovascular events, and in line with current guidelines. Managing the individual patient in a holistic manner according to his or her own vascular risk profile is recommended. Although the paucity of randomized controlled evidence makes for challenging clinical decision making, it provides multiple opportunities for on-going and future research, as discussed here. © 2017 The Author(s).

  19. Dementia and dysphagia.

    PubMed

    Easterling, Caryn S; Robbins, Elizabeth

    2008-01-01

    In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.

  20. Early Dementia Screening

    PubMed Central

    Panegyres, Peter K.; Berry, Renee; Burchell, Jennifer

    2016-01-01

    As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying Aβ1–42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history—hence the need for cost-effective screening measures for early dementia. PMID:26838803

  1. Early Dementia Screening.

    PubMed

    Panegyres, Peter K; Berry, Renee; Burchell, Jennifer

    2016-01-21

    As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET), cerebrospinal fluid (CSF) examination assaying Aβ1-42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history-hence the need for cost-effective screening measures for early dementia.

  2. [Pain assessment in dementia].

    PubMed

    Husebø, Bettina Sandgathe

    2009-10-08

    Patients with dementia are often unable to describe their pain because of memory deficiency and speech problems. This may lead to under-diagnosing and suboptimal pain treatment. The article summarises a thesis on development and testing of a new instrument for pain assessment: Mobilisation-Observation-Behavior-Intensity-Dementia (MOBID-2) pain scale. 284 nursing home patients (with and without pain), who had been diagnosed with dementia of different types in various stages, were included in the study. Behaviour and intensity of pain was assessed during video-uptakes of clinical examinations and during regular morning care. Psychometric property testing included assessments of reliability, validity and clinical usefulness for the nursing home staff. Observation of pain behaviour during standardised and guided movements, by using the MOBID-2 Pain Scale, provides reliable and valid estimation of intensity of pain associated with the musculoskeletal-system. Pain that is not associated with the musculoskeletal-system is frequently observed, but more challenging to assess. Patients who have severe dementia and/or a combination of Alzheimer's disease and vascular dementia, have a higher risk of suffering from severe and untreated pain than patients without dementia. The MOBID-2 pain scale may help to ensure competent pain treatment, and should be available in all Norwegian nursing homes. A multidisciplinary approach is needed for its implementation and use. Physicians in nursing homes should reconsider the staff's observations, perform additional investigations and find the balance between effects and side effects of pain treatment.

  3. Anxiety in dementia

    PubMed Central

    Seignourel, Paul J.; Kunik, Mark E.; Snow, Lynn; Wilson, Nancy; Stanley, Melinda

    2008-01-01

    Until recently, little attention has been paid to anxiety symptoms in dementia. However, anxiety is common in this population, and associated with poor outcome and quality of life. The current review examines the existing literature around three major themes: the definition of anxiety in dementia, the properties of available instruments for assessment, and the clinical characteristics of anxiety in this population. Defining anxiety in individuals with dementia is complicated by the overlap between symptoms of anxiety, depression and dementia, and by the influence of the source of information. Several instruments are available to assess anxiety in this population, including general neuropsychiatric instruments and two scales designed specifically for this purpose. The reliability of these instruments is acceptable, but their validity has not been sufficiently examined, and they may discriminate poorly between anxiety and depression. Anxiety may be higher in vascular dementia than in Alzheimer’s Disease, and it decreases in the severe stages of dementia. It is associated with poor quality of life and behavioral disturbances, even after controlling for depression. Little is known, however, about its social and environmental correlates. Limitations of the existing literature and key directions for future research are discussed. PMID:18555569

  4. Benefits of a health impact assessment in relation to fuel poverty: assessing Luton's Affordable Warmth Strategy and the need for a national mandatory strategy.

    PubMed

    Stewart, Jill; Habgood, Veronica

    2008-05-01

    The links between fuel poverty and poor health are well documented, yet there is no statutory requirement on local authorities to develop fuel poverty strategies, which tend to be patchy nationally and differ substantially in quality. Fuel poverty starts from the perspective of income, even though interventions can improve health. The current public health agenda calls for more partnership-based, cost-effective strategies based on sound evidence. Fuel poverty represents a key area where there is currently little local evidence quantifying and qualifying health gain arising from strategic interventions. As a result, this initial study sought to apply the principles of a health impact assessment to Luton's Affordable Warmth Strategy, exploring the potential to identify health impact arising--as a baseline for future research--in the context of the public health agenda. A national strategy would help ensure the promotion of targeted fuel poverty strategies.

  5. Great Apes and Biodiversity Offset Projects in Africa: The Case for National Offset Strategies

    PubMed Central

    Kormos, Rebecca; Kormos, Cyril F.; Humle, Tatyana; Lanjouw, Annette; Rainer, Helga; Victurine, Ray; Mittermeier, Russell A.; Diallo, Mamadou S.; Rylands, Anthony B.; Williamson, Elizabeth A.

    2014-01-01

    The development and private sectors are increasingly considering “biodiversity offsets” as a strategy to compensate for their negative impacts on biodiversity, including impacts on great apes and their habitats in Africa. In the absence of national offset policies in sub-Saharan Africa, offset design and implementation are guided by company internal standards, lending bank standards or international best practice principles. We examine four projects in Africa that are seeking to compensate for their negative impacts on great ape populations. Our assessment of these projects reveals that not all apply or implement best practices, and that there is little standardization in the methods used to measure losses and gains in species numbers. Even if they were to follow currently accepted best-practice principles, we find that these actions may still fail to contribute to conservation objectives over the long term. We advocate for an alternative approach in which biodiversity offset and compensation projects are designed and implemented as part of a National Offset Strategy that (1) takes into account the cumulative impacts of development in individual countries, (2) identifies priority offset sites, (3) promotes aggregated offsets, and (4) integrates biodiversity offset and compensation projects with national biodiversity conservation objectives. We also propose supplementary principles necessary for biodiversity offsets to contribute to great ape conservation in Africa. Caution should still be exercised, however, with regard to offsets until further field-based evidence of their effectiveness is available. PMID:25372894

  6. Great apes and biodiversity offset projects in Africa: the case for national offset strategies.

    PubMed

    Kormos, Rebecca; Kormos, Cyril F; Humle, Tatyana; Lanjouw, Annette; Rainer, Helga; Victurine, Ray; Mittermeier, Russell A; Diallo, Mamadou S; Rylands, Anthony B; Williamson, Elizabeth A

    2014-01-01

    The development and private sectors are increasingly considering "biodiversity offsets" as a strategy to compensate for their negative impacts on biodiversity, including impacts on great apes and their habitats in Africa. In the absence of national offset policies in sub-Saharan Africa, offset design and implementation are guided by company internal standards, lending bank standards or international best practice principles. We examine four projects in Africa that are seeking to compensate for their negative impacts on great ape populations. Our assessment of these projects reveals that not all apply or implement best practices, and that there is little standardization in the methods used to measure losses and gains in species numbers. Even if they were to follow currently accepted best-practice principles, we find that these actions may still fail to contribute to conservation objectives over the long term. We advocate for an alternative approach in which biodiversity offset and compensation projects are designed and implemented as part of a National Offset Strategy that (1) takes into account the cumulative impacts of development in individual countries, (2) identifies priority offset sites, (3) promotes aggregated offsets, and (4) integrates biodiversity offset and compensation projects with national biodiversity conservation objectives. We also propose supplementary principles necessary for biodiversity offsets to contribute to great ape conservation in Africa. Caution should still be exercised, however, with regard to offsets until further field-based evidence of their effectiveness is available.

  7. Priorities in national space strategies and governance of the member states of the European Space Agency

    NASA Astrophysics Data System (ADS)

    Adriaensen, Maarten; Giannopapa, Christina; Sagath, Daniel; Papastefanou, Anastasia

    2015-12-01

    The European Space Agency (ESA) has twenty Member States with a variety of strategic priorities and governance structures regarding their space activities. A number of countries engage in space activities exclusively though ESA, while others have also their own national space programme. Some consider ESA as their prime space agency and others have additionally their own national agency with respective programmes. The main objective of this paper is to provide an up-to date overview and a holistic assessment of strategic priorities and the national space governance structures in 20 ESA Member States. This analysis and assessment has been conducted by analysing the Member States public documents, information provided at ESA workshop on this topic and though unstructured interviews. The paper is structured to include two main elements: priorities and trends in national space strategies and space governance in ESA Member States. The first part of this paper focuses on the content and analysis of the national space strategies and indicates the main priorities and trends in Member States. The priorities are categorised with regards to technology domains, the role of space in the areas of sustainability and the motivators that boost engagement in space. These vary from one Member State to another and include with different levels of engagement in technology domains amongst others: science and exploration, navigation, Earth observation, human space flight, launchers, telecommunications, and integrated applications. Member States allocate a different role of space as enabling tool adding to the advancement of sustainability areas including: security, resources, environment and climate change, transport and communication, energy, and knowledge and education. The motivators motivating reasoning which enhances or hinders space engagement also differs. The motivators identified are industrial competitiveness, job creation, technology development and transfer, social benefits

  8. Responding to safety issues in frontotemporal dementias.

    PubMed

    Talerico, K A; Evans, L K

    2001-06-01

    As frontotemporal dementia progresses in individuals, safety issues related to behaviors and injury become a paramount concern. In addition to self-care deficits, frontotemporal dementias are often characterized by behavioral manifestations that include aggression and disinhibition. These behaviors may place the patient and caregivers at risk of injury, stress, and social embarrassment, and frequently lead to institutionalization. Additionally, motor disturbances associated with frontotemporal dementias may contribute to risk of injury from falls. The authors present an integrated biopsychosocial model to guide assessment of needs that may be expressed through behavior. Environmental, behavioral, and psychosocial strategies to assist caregivers in preventing and responding to behaviors and risks are discussed, with the goal of promoting maximum function and quality of life and minimizing caregiver strain. The authors discuss the dangers of physical restraints, which are commonly suggested as a response to fall risk and behavioral symptoms without an awareness of research-based data regarding their lack of efficacy. Benefits and risks of a variety of need-based interventions are presented in a practical, clinically relevant manner. The discussion of diverse safety-enhancing interventions is intended to enable clinicians and caregivers to identify individualized care strategies for patients with frontotemporal dementia.

  9. Molecular Imaging and Precision Medicine in Dementia and Movement Disorders.

    PubMed

    Mallik, Atul K; Drzezga, Alexander; Minoshima, Satoshi

    2017-01-01

    Precision medicine (PM) has been defined as "prevention and treatment strategies that take individual variability into account." Molecular imaging (MI) is an ideally suited tool for PM approaches to neurodegenerative dementia and movement disorders (MD). Here we review PM approaches and discuss how they may be applied to other associated neurodegenerative dementia and MD. With ongoing major therapeutic research initiatives that include the use of molecular imaging, we look forward to established interventions targeted to specific molecular pathophysiology and expect the potential benefit of MI PM approaches in neurodegenerative dementia and MD will only increase. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Risk of suicide in patients with dementia: a case study.

    PubMed

    Nicholson, Linda

    Evidence indicates that the risk of attempted suicide is a significant issue among people with dementia, however there is a lack of information to guide professional practice. This article uses a case study to reflect on the risk management strategies and ethics of suicide and assisted suicide in relation to a specific patient with dementia. It analyses recommendations aimed at improving the lived experience of people with dementia and those involved in their care, including providing patients with a formal diagnosis as early as possible.

  11. Clinical Phenotype of Dementia after Traumatic Brain Injury

    PubMed Central

    Sayed, Nasreen; Culver, Carlee; Dams-O'Connor, Kristen; Hammond, Flora

    2013-01-01

    Abstract Traumatic brain injury (TBI) in early to mid-life is associated with an increased risk of dementia in late life. It is unclear whether TBI results in acceleration of Alzheimer's disease (AD)-like pathology or has features of another dementing condition, such as chronic traumatic encephalopathy, which is associated with more-prominent mood, behavior, and motor disturbances than AD. Data from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set was obtained over a 5-year period. Categorical data were analyzed using Fisher's exact test. Continuous parametric data were analyzed using the Student's t-test. Nonparametric data were analyzed using Mann-Whitney's test. Overall, 877 individuals with dementia who had sustained TBI were identified in the NACC database. Only TBI with chronic deficit or dysfunction was associated with increased risk of dementia. Patients with dementia after TBI (n=62) were significantly more likely to experience depression, anxiety, irritability, and motor disorders than patients with probable AD. Autopsy data were available for 20 of the 62 TBI patients. Of the patients with TBI, 62% met National Institute of Aging-Reagan Institute “high likelihood” criteria for AD. We conclude that TBI with chronic deficit or dysfunction is associated with an increased odds ratio for dementia. Clinically, patients with dementia associated with TBI were more likely to have symptoms of depression, agitation, irritability, and motor dysfunction than patients with probable AD. These findings suggest that dementia in individuals with a history of TBI may be distinct from AD. PMID:23374007

  12. Professional carers' experiences of caring for individuals with intellectual disability and dementia.

    PubMed

    Cleary, Josephine; Doody, Owen

    2017-03-01

    The number of people with intellectual disability living into old age and developing dementia continues to increase. Dementia presents a wide range of challenges for staff due to progressive deterioration. This article presents the findings from a narrative literature review of professional caregivers' experiences of caring for individuals with intellectual disability and dementia. Seven electronic databases were searched using Boolean operators and truncation to identify relevant literature. Search results were combined and narrowed to articles relevant to staff working with individuals with intellectual disability and dementia, and 14 articles met the criteria for review. Themes outlined in the review include staff knowledge of dementia, staff training in dementia, caregiving, challenging behaviour, pain management, mealtime support and coping strategies. Overall carers must review and adjust their care delivery and support to people with intellectual disability and dementia, not only in terms of identifying and responding to their health needs but also through collaborative team working within and across services.

  13. Family physicians and dementia in Canada

    PubMed Central

    Pimlott, Nicholas J.G.; Persaud, Malini; Drummond, Neil; Cohen, Carole A.; Silvius, James L.; Seigel, Karen; Hollingworth, Gary R.; Dalziel, William B.

    2009-01-01

    ABSTRACT OBJECTIVE To assess Canadian family physicians’ awareness of, attitudes toward, and use of the 1999 Canadian Consensus Conference on Dementia (CCCD) clinical practice guidelines (CPGs); to explore the barriers and enablers to implementing dementia CPGs in clinical practice; and to identify more effective strategies for future dementia guideline development and dissemination. DESIGN Qualitative study using focus groups. SETTING Academic family practice clinics in Calgary, Alta, Ottawa, Ont, and Toronto, Ont. PARTICIPANTS Eighteen family physicians. METHODS Using a semistructured interview guide, we conducted 4 qualitative focus groups of 4 to 6 family physicians whose practices we had audited in a previous study. Transcripts were coded using an inductive data analytic strategy, and categories and themes were identified and described using the principles of thematic analysis. MAIN FINDINGS Four major themes emerged from the focus group discussions. Family physicians 1) were minimally aware of the existence and the detailed contents of the CCCD guidelines; 2) had strong views about the purposes of guidelines in general; 3) expressed strong concerns about the role of the pharmaceutical industry in the development of such guidelines; and 4) had many ideas to improve future dementia guidelines and CPGs in general. CONCLUSION Family physicians were minimally aware of the 1999 CCCD CPGs. They acknowledged, however, the potential of future CPGs to assist them in patient care and offered many strategies to improve the development and dissemination of future dementia guidelines. Future guidelines should more accurately reflect the day-to-day practice experiences and challenges of family physicians, and guideline developers should also be cognizant of family physicians’ perceptions that pharmaceutical companies’ funding of CPGs undermines the objectivity and credibility of those guidelines. PMID:19439707

  14. Management of inappropriate sexual behaviors in dementia: a literature review.

    PubMed

    Tucker, Inese

    2010-08-01

    This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia. A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed. No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior. Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.

  15. How people with dementia and carers understand and react to social functioning changes in mild dementia: a UK-based qualitative study.

    PubMed

    Singleton, David; Mukadam, Naaheed; Livingston, Gill; Sommerlad, Andrew

    2017-07-12

    To analyse people with dementia and their family carers' attribution of social changes in dementia and the consequences of these attributions. Qualitative study, using a semi-structured interview guide. Individual interviews continued to theoretical saturation. Two researchers independently analysed interview transcripts. People with mild dementia and family carers purposively selected from London-based memory services for diverse demographic characteristics to encompass a range of experiences. Attribution of social changes experienced by the person with dementia and the consequences of these attributions. We interviewed nine people with dementia and nine carers, encompassing a range of age, ethnicity and educational backgrounds.Both groups reported that the person with dementia had changed socially. People with dementia tended to give one or two explanations for social change, but carers usually suggested several. People with dementia were often socially embarrassed or less interested in going out, and they or their relatives' physical illness or fear of falls led to reduced social activity. Carers often attributed not going out to a choice or premorbid personality. Carers found that their relative needed more support to go out than they could give and carers needed time to themselves because of carer stress or other problems from which they shielded the person with dementia. Additionally, there was decreased opportunity to socialise, as people were bereaved of friends and family. Participants acknowledged the direct impact of dementia symptoms on their ability to socially engage but sometimes decided to give up socialising when they knew they had dementia. There were negative consequences from social changes being attributed to factors such as choice, rather than dementia. Clinicians should ask about social changes in people with dementia. Explaining that these may be due to dementia and considering strategies to overcome them may be beneficial. © Article author

  16. Strategies for Meaningful Engagement between Community-Based Health Researchers and First Nations Participants

    PubMed Central

    Cidro, Jaime; Maar, Marion; Peressini, Sabrina; Schroth, Robert J.; Broughton, John; Jamieson, Lisa; Lawrence, Herenia P.

    2017-01-01

    The Baby Teeth Talk Study (BTT) is a partnership-based research project looking at interventions to prevent early childhood caries (ECC) in First Nations populations in Canada. Community-based researchers (CBRs) conducted preventive and behavioral interventions that targeted expectant mothers and their newborns, over a 3-year period. The work of the CBRs requires a great deal of training and skills to administer the interventions. It also requires a broad set of strategies to meaningfully engage participants to make health-promoting changes in their behavior to prevent ECC in their children. After implementing the intervention, BTT CBRs participated in interviews to explore the strategies they employed to engage participants in the prevention of ECC. CBRs perceived two key strategies as essential for meaningful engagement with BTT participants. First, CBRs indicated that their shared experiences through motherhood, First Nations identity, age, and childhood experience provided a positive foundation for dialog with participants that lead to build trust and rapport. Second, supportive interpersonal and culturally based communication skills of the CBR provided further foundation to engage with participants from a strength-based approach. For example, the CBRs knew how to effectively communicate in ways such as being gentle, non-intrusive, and avoiding any perception of judgment when discussing oral health behavior. In First Nations health research, CBRs can provide an essential link in engaging participants and the community for improvements in health. Researchers should carefully consider characteristics such as shared experience and ability to understand cultural communication styles when hiring CBRs in order to build a solid foundation of trust with research participants. PMID:28713800

  17. Announced Strategy Types in Multiagent RL for Conflict-Avoidance in the National Airspace

    NASA Technical Reports Server (NTRS)

    Rebhuhn, Carrie; Knudson, Matthew D.; Tumer, Kagan

    2014-01-01

    The use of unmanned aerial systems (UAS) in the national airspace is of growing interest to the research community. Safety and scalability of control algorithms are key to the successful integration of autonomous system into a human-populated airspace. In order to ensure safety while still maintaining efficient paths of travel, these algorithms must also accommodate heterogeneity of path strategies of its neighbors. We show that, using multiagent RL, we can improve the speed with which conflicts are resolved in cases with up to 80 aircraft within a section of the airspace. In addition, we show that the introduction of abstract agent strategy types to partition the state space is helpful in resolving conflicts, particularly in high congestion.

  18. Analysis of sheltering and evacuation strategies for a national capital region nuclear detonation scenario.

    SciTech Connect

    Yoshimura, Ann S.; Brandt, Larry D.

    2011-12-01

    Development of an effective strategy for shelter and evacuation is among the most important planning tasks in preparation for response to a low yield, nuclear detonation in an urban area. Extensive studies have been performed and guidance published that highlight the key principles for saving lives following such an event. However, region-specific data are important in the planning process as well. This study examines some of the unique regional factors that impact planning for a 10 kT detonation in the National Capital Region. The work utilizes a single scenario to examine regional impacts as well as the shelter-evacuate decision alternatives at one exemplary point. For most Washington, DC neighborhoods, the excellent assessed shelter quality available make shelter-in-place or selective transit to a nearby shelter a compelling post-detonation strategy.

  19. Update of the management strategy for Oak Ridge National Laboratory Liquid Low-Level Waste

    SciTech Connect

    Robinson, S.M.; Abraham, T.J.; DePaoli, S.M.; Walker, A.B.

    1995-04-01

    The strategy for management of the Oak Ridge National Laboratory`s (ORNL) radioactively contaminated liquid waste was reviewed in 1991. The latest information available through the end of 1990 on waste characterization, regulations, US Department of Energy (DOE) budget guidance, and research and development programs was evaluated to determine how the strategy should be revised. Few changes are needed to update the strategy to reflect new waste characterization, research, and regulatory information. However, recent budget guidance from DOE indicates that minimum funding will not be sufficient to accomplish original objectives to upgrade the liquid low-level waste (LLLW) system to comply with the Federal Facilities Agreement, provide long-term LLLW treatment capability, and minimize environmental, safety, and health risks. Options are presented that might allow the ORNL LLLW system to continue operations temporarily, but they would significantly reduce its capabilities to handle emergency situations, provide treatment for new waste streams, and accommodate waste from the Environmental Restoration Program and from decontamination and decommissioning of surplus facilities. These options are also likely to increase worker radiation exposure, risk of environmental insult, and generation of solid waste for on-site and off-site disposal/storage beyond existing facility capacities. The strategy will be fully developed after receipt of additional guidance. The proposed budget limitations are too severe to allow ORNL to meet regulatory requirements or continue operations long term.

  20. Strategies to Address Identified Education Gaps in the Preparation of a National Security Workforce

    SciTech Connect

    2008-06-30

    This report will discuss strategies available to address identified gaps and weaknesses in education efforts aimed at the preparation of a skilled and properly trained national security workforce.The need to adequately train and educate a national security workforce is at a critical juncture. Even though there are an increasing number of college graduates in the appropriate fields, many of these graduates choose to work in the private sector because of more desirable salary and benefit packages. This is contributing to an inability to fill vacant positions at NNSA resulting from high personnel turnover from the large number of retirements. Further, many of the retirees are practically irreplaceable because they are Cold War scientists that have experience and expertise with nuclear weapons.

  1. Development of year 2020 goals for the National HIV/AIDS Strategy for the United States.

    PubMed

    Holtgrave, David R

    2014-04-01

    In July, 2010, President Barack Obama released the National HIV/AIDS Strategy (NHAS). The NHAS set forth ambitious goals for the year 2015. These goals were potentially achievable had the appropriate level of resources been invested; however, investment at the necessary scale has not been made and the 2015 goals now may well be out of reach. Therefore, we propose that an updated NHAS be developed with goals for the year 2020 clearly articulated. For the purposes of fostering discussion on this important topic, we propose bold yet achievable quantitative 2020 goals based on previously published economic and mathematical modeling analyses.

  2. Basic science and energy research sector profile: Background for the National Energy Strategy

    SciTech Connect

    March, F.; Ashton, W.B.; Kinzey, B.R.; McDonald, S.C.; Lee, V.E.

    1990-11-01

    This Profile report provides a general perspective on the role of basic science in the spectrum of research and development in the United States, and basic research's contributions to the goals of the National Energy Strategy (NES). It includes selected facts, figures, and analysis of strategic issues affecting the future of science in the United States. It is provided as background for people from government, the private sector, academia, and the public, who will be reviewing the NES in the coming months; and it is intended to serve as the basis for discussion of basic science issues within the context of the developing NES.

  3. [National planning of health policy in Brazil: strategies and instruments in the 2000s].

    PubMed

    Machado, Cristiani Vieira; Baptista, Tatiana Wargas de Faria; de Lima, Luciana Dias

    2010-08-01

    This paper discusses the national planning of health policy between 2003 and 2010, in the light of the development of state planning in Brazil and Lula's administration. Firstly an historical overview is presented of the key moments for national planning, regarding its effects on health care. The governmental context is then described with a review of the strategies and instruments in health planning over recent years. The methodology involved a bibliographic and documental review - including the Multi-year Plans, the National Health Plan, the Health Pact and the More Health program - considering their intention, contents and development processes. The results indicate that national health planning has been condensed in order to enable better direction of the policy. Two key moments in federal health planning were identified: between 2003 and 2006 a managerial and participative line was followed; between 2007 and 2010, the managerial line was kept allied to an effort to tie health policy to the development model. Despite the advances, health planning has displayed limitations, such as: restrictions in health financing, which has compromised the execution of the plans; failure to tackle structural problems in the health care system; and the fragile territorial organization.

  4. The Iranian National Geodata Revision Strategy and Realization Based on Geodatabase

    NASA Astrophysics Data System (ADS)

    Haeri, M.; Fasihi, A.; Ayazi, S. M.

    2012-07-01

    In recent years, using of spatial database for storing and managing spatial data has become a hot topic in the field of GIS. Accordingly National Cartographic Center of Iran (NCC) produces - from time to time - some spatial data which is usually included in some databases. One of the NCC major projects was designing National Topographic Database (NTDB). NCC decided to create National Topographic Database of the entire country-based on 1:25000 coverage maps. The standard of NTDB was published in 1994 and its database was created at the same time. In NTDB geometric data was stored in MicroStation design format (DGN) which each feature has a link to its attribute data (stored in Microsoft Access file). Also NTDB file was produced in a sheet-wise mode and then stored in a file-based style. Besides map compilation, revision of existing maps has already been started. Key problems of NCC are revision strategy, NTDB file-based style storage and operator challenges (NCC operators are almost preferred to edit and revise geometry data in CAD environments). A GeoDatabase solution for national Geodata, based on NTDB map files and operators' revision preferences, is introduced and released herein. The proposed solution extends the traditional methods to have a seamless spatial database which it can be revised in CAD and GIS environment, simultaneously. The proposed system is the common data framework to create a central data repository for spatial data storage and management.

  5. Competitive Strategy for Successful National University Hospital Management in the Republic of Korea.

    PubMed

    Lee, Munjae

    2016-06-01

    This study provides information to aid decision making for managers and the staff of national university hospitals through analyzing their financial statements. In order to analyze the finances of national university hospitals, this study used the report of final accounts announced by each hospital from 2009 to 2012 as baseline data. The research participants were 10 national university hospitals. According to the results of the analysis, most hospitals (except for a few) had medical expenses exceeding their medical revenues, resulting in a net deficit; however, there were significant differences amongst the hospitals. The result of adjustments based on a standard size of 100 beds showed that most hospitals had medical revenue deficits, and there were significant differences between hospitals in terms of medical revenues and medical costs. It is not clear whether an expansion of national university hospitals is always beneficial for increasing net revenues, and it is necessary to establish a differentiation strategy to increase profitability by securing financial soundness instead of externally-oriented growth.

  6. Assisting Professional Militaries in Latin America. National Security Strategy Development Workshop, La Paz, Bolivia 28 July - 1 August 2003

    DTIC Science & Technology

    2003-10-01

    National Security Strategy Development Workshop, La Paz , Bolivia 28 July – 1 August 2003 The Challenge of Professionalization Professionalization of...2003 to 00-00-2003 4. TITLE AND SUBTITLE Assisting Professional Militaries in Latin America. National Security Strategy Development Workshop, La Paz ...Commander, U.S. Southern Command, and in collaboration with the Bolivian Escuela de Altos Estudios Nacionales (E.A.E.N.), a USAWC-CSL team conducted a

  7. Plasma and cerebrospinal fluid amyloid beta for the diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI).

    PubMed

    Ritchie, Craig; Smailagic, Nadja; Noel-Storr, Anna H; Takwoingi, Yemisi; Flicker, Leon; Mason, Sam E; McShane, Rupert

    2014-06-10

    According to the latest revised National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (now known as the Alzheimer's Association) (NINCDS-ADRDA) diagnostic criteria for Alzheimer's disease dementia of the National Institute on Aging and Alzheimer Association, the confidence in diagnosing mild cognitive impairment (MCI) due to Alzheimer's disease dementia is raised with the application of biomarkers based on measures in the cerebrospinal fluid (CSF) or imaging. These tests, added to core clinical criteria, might increase the sensitivity or specificity of a testing strategy. However, the accuracy of biomarkers in the diagnosis of Alzheimer's disease dementia and other dementias has not yet been systematically evaluated. A formal systematic evaluation of sensitivity, specificity, and other properties of plasma and CSF amyloid beta (Aß) biomarkers was performed. To determine the accuracy of plasma and CSF Aß levels for detecting those patients with MCI who would convert to Alzheimer's disease dementia or other forms of dementia over time. The most recent search for this review was performed on 3 December 2012. We searched MEDLINE (OvidSP), EMBASE (OvidSP), BIOSIS Previews (ISI Web of Knowledge), Web of Science and Conference Proceedings (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We also requested a search of the Cochrane Register of Diagnostic Test Accuracy Studies (managed by the Cochrane Renal Group).No language or date restrictions were applied to the electronic searches and methodological filters were not used so as to maximise sensitivity. We selected those studies that had prospectively well defined cohorts with any accepted definition of cognitive decline, but no dementia, with baseline CSF or plasma Aß levels, or both, documented at or around the time the above diagnoses were made. We also included studies which looked at data from those cohorts

  8. [Sleep disorders and dementia].

    PubMed

    Hess, C W

    1997-08-27

    A clinically relevant sleep-wake disturbance is found in up to half the patients with dementia, and the sundowning agitation is a common cause of institutionalisation of demented geriatric patients. The circadian rhythm of demented patients is levelled off with increased daytime sleep and disrupted night sleep. Particularly in vascular dementia, Korsakow syndrome, Parkinson's disease, and depression the alteration of sleep architecture may be pronounced, whereas in Alzheimer's disease prominent hypersomnolence or insomnia is typically only found in later stages of the diseases. Greatly increased daytime sleepiness or striking insomnia at the very beginning of suspected dementia should thus prompt the search for other, possibly treatable causes of dementia. Neuropathological and neurophysiological studies support the hypothesis of a deteriorated hypothalamic suprachiasmatic nucleus (harbouring the biological clock) as a cause for the deranged circadian sleep-wake system in dementia. Management of sundowning behaviour includes restriction of daytime sleep, exposure to bright lights, and social interaction schedules during the day. The benzodiazepines and analogues usually not being sufficiently effectual, low doses of mild neuroleptics are often needed. Whether recent reports on efficacy of melatonin in elderly insomniacs also apply to demented patients is yet uncertain. The careful search and treatment of possible extracerebral physiologic factors causing reversible hypersomnia or insomnia is an important requisite. Polysomnographic studies are needed to recognise treatable sleep disturbance which could deteriorate or mimic dementia and sundowning. Particularly, a sleep-apnea-hypopnea syndrome must be searched for at the beginning of a suspected dementia, when successful treatment is still possible. Sleep studies should also identify periodic leg movements of sleep with restless legs and/or increased daytime sleepiness, and hyperkinetic parasomnias such as REM sleep

  9. Making sense of dementia: Exploring the use of the Markers of Assimilation of Problematic Experiences in Dementia scale to understand how couples process a diagnosis of dementia.

    PubMed

    Snow, Katie; Cheston, Richard; Smart, Cordet

    2016-11-01

    This qualitative study aimed to see whether the Markers of Assimilation of Problematic Experiences in Dementia (MAPED) scale could be applied to couples. It aimed to explore the interactions between couples and how this affected the levels of assimilation. Semi-structured interviews were conducted with four heterosexual couples. The results suggested that MAPED can be usefully applied to couples. It highlighted the oscillating process which couples undergo as they process a dementia diagnosis. This supports the notion that making sense of a dementia diagnosis is not static, but a fluctuating and ever changing process. The strategies couples employed either facilitated or prevented the expression and integration of the Problematic Voice. The study highlights the importance of supporting couples together during a dementia diagnosis.

  10. Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies.

    PubMed

    Deckers, Kay; van Boxtel, Martin P J; Schiepers, Olga J G; de Vugt, Marjolein; Muñoz Sánchez, Juan Luis; Anstey, Kaarin J; Brayne, Carol; Dartigues, Jean-Francois; Engedal, Knut; Kivipelto, Miia; Ritchie, Karen; Starr, John M; Yaffe, Kristine; Irving, Kate; Verhey, Frans R J; Köhler, Sebastian

    2015-03-01

    Dementia has a multifactorial etiology, but the importance of individual health and lifestyle related risk factors is often uncertain or based on few studies. The goal of this paper is to identify the major modifiable risk factors for dementia as a first step in developing an effective preventive strategy and promoting healthy late life cognitive functioning. A mixed-method approach combined findings from a systematic literature review and a Delphi consensus study. The literature search was conducted in PubMed and updated an earlier review by the United States National Institutes of Health from 2010. We reviewed the available evidence from observational epidemiological studies. The online Delphi study asked eight international experts to rank and weigh each risk factor for its importance for dementia prevention. Out of 3127 abstracts, 291 were included in the review. There was good agreement between modifiable risk factors identified in the literature review and risk factors named spontaneously by experts. After triangulation of both methods and re-weighting by experts, strongest support was found for depression, (midlife) hypertension, physical inactivity, diabetes, (midlife) obesity, hyperlipidemia, and smoking, while more research is needed for coronary heart disease, renal dysfunction, diet, and cognitive activity. Findings provide good support for several somatic and lifestyle factors and will be used to inform the design of a new multicenter trial into dementia prevention. Copyright © 2014 John Wiley & Sons, Ltd.

  11. Multiplex analyte assays to characterize different dementias: brain inflammatory cytokines in poststroke and other dementias.

    PubMed

    Chen, Aiqing; Oakley, Arthur E; Monteiro, Maria; Tuomela, Katri; Allan, Louise M; Mukaetova-Ladinska, Elizabeta B; O'Brien, John T; Kalaria, Raj N

    2016-02-01

    possible specific involvement of immunosenescence in dementia pathogenesis. In contrast, CRP was not altered between dementia and nondementia subjects or between PSD and PSND. Our study provides evidence not only for the feasibility of tracking cytokines in postmortem brain tissue but also suggests differentially impaired inflammatory mechanisms underlying dementia including AD. There was a diminished inflammatory response, possibly reflecting immunosenescence and cerebral atrophy, in all dementias. Strategies to enhance anti-inflammatory cytokines and boost the immune system of the brain may be beneficial for preventing cognitive dysfunction, especially after stroke.

  12. Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics

    PubMed Central

    Innes, Anthea; Mountain, Gail; Robinson, Louise; van der Roest, Henriëtte; García-Casal, J Antonio; Gove, Dianne; Thyrian, Jochen René; Evans, Shirley; Dröes, Rose-Marie; Kelly, Fiona; Kurz, Alexander; Casey, Dympna; Szcześniak, Dorota; Dening, Tom; Craven, Michael P; Span, Marijke; Felzmann, Heike; Tsolaki, Magda; Franco-Martin, Manuel

    2017-01-01

    issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them. PMID:28582262

  13. Association of traditional Chinese medicine therapy and the risk of dementia in patients with hypertension: a nationwide population-based cohort study.

    PubMed

    Chen, Kuen-Hau; Yeh, Ming-Hsien; Livneh, Hanoch; Chen, Bor-Chyuan; Lin, I-Hsin; Lu, Ming-Chi; Tsai, Tzung-Yi; Yeh, Chia-Chou

    2017-03-29

    Patients with hypertension (HTN) reportedly have a higher risk of developing dementia. However, it remains unclear if use of Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of dementia for these patients. So the aim of the study was to investigate the effects of TCM on dementia risk among patients with hypertension. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database (NHIRD) to identify 143,382 newly diagnosed hypertension patients aged 20-90 years who received treatment between 1998 and 2007. Among them, 52,365 (36.52%) had received TCM after the onset of hypertension (TCM users), and the remaining 91,017 patients (63.48%) were designated as a control group (non-TCM users). All enrollees were followed until the end of 2012 to record the incidence of dementia. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of dementia in patients who received TCM. During the 15-year follow-up, 3933 TCM users and 10,316 non-TCM users developed dementia, representing an incidence rate of 8.41 and 11.55%, respectively, per 1000 person-years. TCM users had a significantly reduced risk of dementia compared to non-TCM users (adjusted HR = 0.76; 95% confidence interval [CI] = 0.74-0.81). The predominant effect was observed among those treated with TCM longer than 180 days (adjusted HR = 0.65; 95% CI = 0.62-0.69). Among the commonly used TCM products, Tian-Ma-Gou-Teng-Yin, Dan-Shen (Radix Salviae Miltiorrhizae), Chuan-Niu-Xi (Radix Cyathulae), Ge-Gen (Radix Puerariae), Jia-Wei-Xiao-Yao-San, and Jue-Ming-Zi (Semen Cassiae) were significantly associated with a lower risk of dementia. Results from this population-based study support the effects of TCM on reducing dementia risk, which may provide a reference for dementia prevention strategies.

  14. Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics.

    PubMed

    Meiland, Franka; Innes, Anthea; Mountain, Gail; Robinson, Louise; van der Roest, Henriëtte; García-Casal, J Antonio; Gove, Dianne; Thyrian, Jochen René; Evans, Shirley; Dröes, Rose-Marie; Kelly, Fiona; Kurz, Alexander; Casey, Dympna; Szcześniak, Dorota; Dening, Tom; Craven, Michael P; Span, Marijke; Felzmann, Heike; Tsolaki, Magda; Franco-Martin, Manuel

    2017-01-16

    for researchers to include in their evaluation of assistive technologies. Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

  15. Experience of Dementia-related Anxiety in Middle-aged Female Caregivers for Family Members with Dementia: A Phenomenological Study.

    PubMed

    Kim, Jeong Sun; Kim, Eun Ha; An, Minjeong

    2016-06-01

    In Korea, most elderly with dementia receive care from family members, yet little research is available on the experience of dementia-related anxiety in middle-aged female caregivers for a family member with dementia. The purpose of this study was to describe the lived experience of dementia-related anxiety in middle-aged female caregivers for family members with dementia. A descriptive phenomenological study was conducted. A purposive sampling strategy was used to recruit participants. Twelve middle-aged women (40-59 years, mean age = 51.90 years) who were family caregivers were interviewed from February 2014 to August 2014. Data were collected through semistructured interviews and analyzed using Giorgi's method. The essential structure of the phenomenon was a fear of losing self-identity. The main essence was represented by six components: keenly feeling the effects of aging because of memory deficit, continuous comparison of the family member's behavior with that of the participant's, Finding it painful to see a family member with dementia as he/she does not know how this will end, not knowing the conclusion of the disease process, reducing the risk of dementia, and trying to change one's lifestyle from what it used to be in the past. The study provides the essential structure of the experience on dementia-related anxiety that caregivers of a family member with dementia have. The findings could help healthcare providers and researchers have better understanding of dementia-related anxiety and give more attention to the caregivers to relieve their anxiety. Copyright © 2016. Published by Elsevier B.V.

  16. Symptoms of Lewy Body Dementia

    MedlinePlus

    ... usually memory problems, changes in their way of speaking, such as forgetting words, and personality problems. Cognitive symptoms of dementia include poor problem solving, difficulty with learning new skills and impaired decision making. Other causes of dementia ...

  17. Dementia screening using computerized tests.

    PubMed

    Gualtieri, C Thomas

    2004-01-01

    The preclinical phase of dementia usually precedes the clinical diagnosis by many years. Early detection of dementing conditions during this preclinical phase may provide opportunities for treatments that may slow or mitigate progression. Conventional assessment tools usually can only detect dementia when the symptoms are overt and the disease is well-established. Computerized neurocognitive screening tools hold promise for diagnosing dementia in its early phase. The use, performance and development of several computerized screening tools to diagnose and monitor patients with pre-dementias and dementia are reviewed. The ability to accurately assess the presence of dementia clearly has direct relevance to insurance risk assessment and risk management. As new treatments appear, their role in clinical management of dementia patients will increase as well. In a future issue, the differential diagnosis of dementias related to the findings on these screening tools will be reviewed.

  18. Brain function, disease and dementia.

    PubMed

    Sandilyan, Malarvizhi Babu; Dening, Tom

    2015-05-27

    Dementia is a consequence of brain disease. This article, the second in this series on dementia, discusses normal brain function and how certain functions are localised to different areas of the brain. This is important in determining the symptoms of dementia, depending on which parts of the brain are most directly involved. The most common types of dementia - Alzheimer's disease, vascular dementia, dementia with Lewy bodies and frontotemporal dementia - affect the brain in different ways and cause different changes at the microscopic level. Dementia is affected by genetics, and recent advances in molecular techniques have improved our understanding of some of the mechanisms involved, which in turns suggests possibilities for new treatments in the future.

  19. Investigating the ways that older people cope with dementia: a qualitative study.

    PubMed

    Preston, Laura; Marshall, Ann; Bucks, Romola S

    2007-03-01

    Understanding the way that older people cope with dementia has important implications for the enhancement of the psychological well-being and quality of life of this group of people. This qualitative study explored how older people cope with dementia, by engaging 12 people with early-stage dementia in semi-structured interviews. Interpretative phenomenological analysis (IPA) was used to identify the shared themes in participants' accounts. Three major themes emerged: "managing identity in relation to dementia", "making sense of dementia", and "coping strategies and mechanisms" (the latter theme divided into "everyday, individual strategies", "coping in relation to others", and "personal attitude/approach"). There were also two additional themes in relation to process issues: issues of "conflict and control" which were evident across all other themes, as was individuality and the importance of "context" in coping with dementia. These findings are discussed in the relation to previous research in this field, and suggestions for further research and clinical practice are outlined.

  20. Treating sleep problems in dementia caregivers based on parent-child interventions.

    PubMed

    Gallagher, Katherine Steiger; Odenheimer, Germaine; Kunik, Mark E

    2011-08-01

    Interventions developed for improving sleep in parents of young children or in developmentally delayed children might also prove effective for persons with dementia and their caregivers. We selectively reviewed the literature for interventions effective in improving sleep in parents of young children or in developmentally delayed children. Graduated extinction and adult fading have been minimally explored in dementia populations. They are fairly brief and could be administered during primary care or dementia clinic visits. Combination strategies such as extinction and sleep-enhancing medication are very effective and may be applicable for persons with dementia and their caregivers. Physical capabilities and degree of cognitive decline of patients with dementia must be considered, and medical staff and caregivers should adjust behavioral strategies to maximize the use of patients' intact cognitive abilities. Interventions for divergent populations prone to similar problems as those of patients with dementia might be effective and advance existing research.