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"Behavioral Symptoms prevention "
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Dementia Family Caregivers’ Willingness to Pay for an In-home Program to Reduce Behavioral Symptoms and Caregiver Stress
Objectives
Our objective was to determine whether family caregivers of people with dementia (PwD) are willing to pay for an in-home intervention that provides strategies to manage behavioral symptoms and caregiver stress and to identify predictors of willingness-to-pay (WTP).
Methods
During baseline interviews of a randomized trial and before treatment assignment, caregivers were asked how much they were willing to pay per session for an eight-session program over 3 months. We stratified the sample into those who refused to provide a WTP, those willing to pay $US0, and those willing to pay > $US0. We used a two-part model, controlling for demographic characteristics, to predict adjusted mean WTP and to examine associations between WTP, clinical features (cognition, function, behavioral symptoms), and time spent assisting PwD with daily activities. First, we used logistic regression to model the probability a caregiver was willing to pay > $US0. Second, we used a generalized linear model (log link and Gamma distribution) to estimate the amount caregivers were willing to pay conditional on WTP > $US0.
Results
Of 250 dyads enrolled, 226 (90%) had complete data and were included in our analyses. Of 226 dyads, 26 (11%) refused to provide a WTP value, 72 (32%) were willing to pay $US0, and 128 (57%) were willing to pay > $US0. In the combined model, mean adjusted WTP was $US36.00 (95% confidence interval [CI] 26.72–45.27) per session. Clinical features were not significantly associated with WTP. One additional hour providing PwD assistance was associated with a $US1.64 (95% CI 0.23–3.04) increase in WTP per session.
Conclusion
As caregivers spend more time assisting with daily activities, they are willing to pay more for a supportive program.
Clinical Trial Registration Number
NCT01892579.
Journal Article
Psychomotor Dance Therapy Intervention (DANCIN) for people with dementia in care homes: a multiple-baseline single-case study
ABSTRACTBackgroundA Psychomotor DANCe Therapy INtervention (DANCIN) using Latin Ballroom (Danzón) in care homes has previously been shown to enhance well-being for both residents with dementia and staff. The aim of this study was to understand the effect of this approach on the mood and behavior of individual people living with mild to moderate dementia. MethodA multiple-baseline single-case study across two care homes and one nursing home with 3–6 weeks baseline, 12-weeks DANCIN (30 minutes/twice-weekly sessions), and 12-weeks follow-up was conducted. Seventeen items from the Dementia Mood Assessment Scale (DMAS) outcome measure were adapted with input from senior staff to match participants’ behavior and mood symptoms. Daily monitoring diaries were collected from trained staff on reporting individualized items for ten residents. Data were analyzed, using a non-parametric statistical method known as Percentage of All Non-Overlapping Data (PAND) which provides Phi effect size (ES). Medication use, falls, and life events were registered. ResultsSeven residents participated throughout DANCIN whilst three became observers owing to health deterioration. One participant showed adverse effects in three DMAS items. Nine participants, dancers and observers, showed a small to medium magnitude of change (PAND) in 21 DMAS items, indicating a decrease in the frequency of behavior and mood indices which were regarded as problematic; eight items showed no change. ConclusionDespite methodological challenges, the DANCIN model has the potential to facilitate and sustain behavior change and improve mood (e.g. decrease irritability, increase self-esteem) of the residents living with dementia. The study was conducted in two care homes and one nursing home, strengthening the interventions’ validity. Findings suggest DANCIN is appropriate for a larger controlled feasibility study.
Journal Article
A Strategic Plan for Strengthening America’s Families: A Brief from the Coalition of Behavioral Science Organizations
Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America’s children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.
Journal Article
Challenging behaviour and learning disabilities: summary of NICE guidance
General principles of care Working with people with a learning disability and behaviour that challenges, and with their families and carers When providing support and interventions: -Take into account the severity of people's learning disability and their developmental stage, any communication difficulties, and physical or mental health problems -Aim to provide support and interventions in the least restrictive setting (such as the person's home or in other places where the person regularly spends time) -Aim to prevent, reduce, or stop the development of future episodes of behaviour that challenges -Offer support and interventions respectfully and aim to improve quality of life -Ensure that the focus is on improving people's support and increasing their skills rather than changing people -Ensure that people know whom to contact if they are worried about care or interventions, including their right to a second opinion -Offer independent advocacy to the person and to family members or carers.
Journal Article
Euterpe oleracea fruit (Açai)-enriched diet suppresses the development of experimental cerebral malaria induced by Plasmodium berghei (ANKA) infection
Background
Cerebral malaria is one of the most severe complications attributed to protozoal infection by
Plasmodium falciparum
, gaining prominence in children mortality rates in endemic areas. This condition has a complex pathogenesis associated with behavioral, cognitive and motor sequels in humans and current antimalarial therapies have shown little effect in those aspects. Natural products with antioxidant and anti-inflammatory properties have become a valuable alternative therapeutic option in the treatment of distinct conditions. In this context, this study investigated the neuroprotective effect of
Euterpe oleracea
(açai) enriched diet during the development of experimental cerebral malaria induced by the inoculation of Swiss albino mice with
Plasmodium berghei
ANKA strain.
Methods
After
Plasmodium
infection, animals were maintained on a feeding with
Euterpe oleracea
enriched ration and parameters such as survival curve, parasitemia and body weight were routinely monitored. The present study has also evaluated the effect of açai-enriched diet on the blood-brain barrier leakage, histological alterations and neurocognitive impairments in mice developing cerebral malaria.
Results
Our results demonstrate that between 7th–19th day post infection the survival rate of the group treated with açai enriched ration was higher when compared with
Plasmodium-
infected mice in which 100% of mice died until the 11th days post-infection, demonstrating that açai diet has a protective effect on the survival of infected treated animals. The same was observed in the brain vascular extravasation, where Evans blue dye assays showed significantly less dye extravasation in the brains of
Plasmodium-
infected mice treated with açai enriched ration, demonstrating more preserved blood-brain barrier integrity. Açai-enriched diet also attenuate the histopathological alterations elicited by
Plasmodium berghei
infection. We also showed a decrease of the neurological impairments arising from the exposure of cerebral parenchyma in the group treated with açai diet, ameliorating motor and neuropsychiatric changes, analyzed through the SHIRPA protocol.
Conclusion
With these results, we conclude that the treatment with açai enriched ration decreased the mortality of infected animals, as well as protected the blood-brain barrier and the neurocognitive deficits in
Plasmodium
-infected animals.
Journal Article
Living at the farm, innovative nursing home care for people with dementia – study protocol of an observational longitudinal study
Background
In nursing home care, new care environments directed towards small-scale and homelike environments are developing. The green care farm, which provides 24-h nursing home care for people with dementia, is one such new care environment. Knowledge is needed on the relation between environmental features of green care farms such as nature, domesticity and offering care in small groups and the influence on the daily lives of residents. The aim of this study is to explore (1) the daily lives of residents, (2) the quality of care and (3) the experiences of caregivers on green care farms compared with other nursing home care environments.
Methods/design
An observational longitudinal study including a baseline and a six-month follow-up measurement is carried out. Four types of nursing home care environments are included: (1) large scale nursing home ward, (2) small scale living facility on the terrain of a larger nursing home (3) stand-alone small scale living facility and (4) green care farm. Quality of care is examined through structure, process and outcome indicators. The primary outcome measure is the daily life of residents, assessed by ecological momentary assessments. Aspects of daily life include (1) activity (activity performed by the resident, the engagement in this activity and the degree of physical effort); (2) physical environment (the location of the resident and the interaction with the physical environment); (3) social environment (the level and type of social interaction, and with whom this social interaction took place) and (4) psychological well-being (mood and agitation). In addition, social engagement, quality of life, behavioral symptoms and agitation are evaluated through questionnaires. Furthermore, demographics, cognitive impairment, functional dependence and the severity of dementia are assessed. Semi-structured interviews are performed with caregivers regarding their experiences with the different nursing home care environments.
Discussion
This is the first study investigating green care farms providing 24-h nursing home care for people with dementia. The study provides valuable insight into the daily lives of residents, the quality of care, and the experiences of caregivers at green care farms in comparison with other nursing home care environments including small-scale care environments and large scale nursing home wards.
Journal Article
The Effect of Early Poststressor Intervention with Sertraline on Behavioral Responses in an Animal Model of Post-Traumatic Stress Disorder
Whereas several well-controlled studies have established the selective serotonin reuptake inhibitors (SSRIs) as the recommended first-line pharmacotherapeutic agents for acute and chronic post-traumatic stress disorder (PTSD), drug interventions in the acute postexposure phase have not been studied to the same extent and tend to be largely speculative. This study employed an animal model which assesses prevalence of individual stress-response behavior patterns in order to assess the short-term effects of a brief treatment regimen with an SSRI (sertraline) administered immediately after stress-exposure, with those of an identical delayed regimen and of saline. Prevalence rates of rats displaying extreme anxiety-like behavioral responses to predator stress, compared to partial and minimal responses, were assessed in the elevated plus maze and startle response paradigms, with and without intraperitoneal administration of sertraline for 7 days immediately postexposure, or 7 days after exposure. Immediate postexposure administration of sertraline reduced anxiety-like and avoidant behavior, decreased hyperarousal responses and diminished the overall incidence of extreme (PTSD-like) behavioral responses, compared to the delayed treatment regimen and to saline controls. Brief immediate poststress exposure treatment with sertraline reduced prevalence rates of extreme behavioral disruption in the short-term. SSRI drugs are thus worthy of further investigation as agents of secondary prevention in the acute aftermath of stress-exposure.
Journal Article
Implementation of the 2013 Psychoactive Substances Act and mental health harms from synthetic cannabinoids
Evaluates the numbers and clinical characteristics of patients presenting with mental health harms associated with use of synthetic cannabinoids for three months before and after the 18 Jul 2013 implementation of the Psychoactive Substances Act (PSA). Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Journal Article