Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

Objective: Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management. Methods: One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained. Results: Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%]) and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%]) were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01). Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%]) (P < 0.01). Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation wards 14 [47%]) (P < 0.01). Loose stools were the most prevalent factor present at baseline in 13 of the 19 (68%) subjects whose fecal incontinence had resolved at 3 months. Conclusion: The distribution of the factors contributing to fecal incontinence in older people living at home differs from those cared for in nursing home and hospital wards settings. These differences need to be borne in mind when assessing people in different settings. Management appears to result in a cure for those who are not significantly disabled with loose stools as a cause for their fecal incontinence, but this would need to be confirmed by further research.

Memory suppression can help people “unlearn” behavioral responses—but only for nonemotional memories

When encountering reminders of memories that we prefer not to think about, we often try to exclude those memories from awareness. Past studies have revealed that such suppression attempts can reduce the subsequent recollection of unwanted memories. In the present study, we examined whether the inhibitory effects extend even to associated behavioral responses. Participants learned cue–target pairs for emotional and nonemotional targets and were additionally trained in behavioral responses for each cue. Afterward, they were shown the cues and instructed either to think or to avoid thinking about the targets without performing any behaviors. In a final test phase, behavioral performance was tested for all of the cues. When the targets were neutral, participants’ attempts to avoid retrieval reduced accuracy and increased reaction times in generating behavioral responses associated with cues. By contrast, behavioral performance was not affected by suppression attempts when the targets were emotional. These results indicate that controlling unwanted recollection is powerful enough to inhibit associated behavioral responses—but only for nonemotional memories.

Leader characteristics and styles in the SMEs of the People's Republic of China during the global financial crisis

This empirical study explores successful views and characteristics of leaders and employees in the SMEs of the People's Republic of China during the global financial crisis.

It is always on your mind: experiences and perceptions of falling of older people and their carers and the potential of a mobile falls detection device

Background. Falls and fear of falling present a major risk to older people as both can affect their quality of life and independence. Mobile assistive technologies (AT) fall detection devices may maximise the potential for older people to live independently for as long as possible within their own homes by facilitating early detection of falls. Aims. To explore the experiences and perceptions of older people and their carers as to the potential of a mobile falls detection AT device. Methods. Nine focus groups with 47 participants including both older people with a range of health conditions and their carers. Interviews were audio recorded, transcribed verbatim, and thematically analysed. Results. Four key themes were identified relating to participants’ experiences and perceptions of falling and the potential impact of a mobile falls detector: cause of falling, falling as everyday vulnerability, the environmental context of falling, and regaining confidence and independence by having a mobile falls detector. Conclusion. The perceived benefits of a mobile falls detector may differ between older people and their carers. The experience of falling has to be taken into account when designing mobile assistive technology devices as these may influence perceptions of such devices and how older people utilise them.

Transitional justice in Nepal: the Commission on Investigation of Disappeared Persons, Truth and Reconciliation Act 2014

The Commission on Investigation of Disappeared Persons, Truth and Reconciliation Act 2014 is Nepal’s latest attempt to establish a transitional programme to respond to conflict era abuses. In part, the Act remedies the inadequacies of the 2013 Ordinance. It creates two commissions, on truth and reconciliation and enforced disappearances, makes provision for the establishment of a Special Court to try past abuses and incorporates systems to enable vulnerable witnesses to participate in truth seeking. Yet in a number of respects it continues to fall short of international legal standards, not least in the possibility of amnesty for international crimes and gross violations of human rights. In addition, the relationship between the three mechanisms – truth seeking, amnesty and prosecution – remains unclear and safeguards for individual rights are lacking. This paper explores these recent developments, highlighting issues that must be remedied if transitional justice objectives are to be achieved in Nepal.

The interaction between the physical environments and people

Buildings affect people in various ways. They can help us to work more effectively; they also present a wide range of stimuli for our senses to react to. Intelligent buildings are designed to be aesthetic in sensory terms not just visually appealing but ones in which occupants experience delight, freshness, airiness, daylight, views out and social ambience. All these factors contribute to a general aesthetic which gives pleasure and affects one’s mood. If there is to be a common vision, it is essential for architects, engineers and clients to work closely together throughout the planning, design, construction and operational stages which represent the conception, birth and life of the building. There has to be an understanding of how patterns of work are best suited to a particular building form served by appropriate environmental systems. A host of technologies are emerging that help these processes, but in the end it is how we think about achieving responsive buildings that matters. Intelligent buildings should cope with social and technological changes and also be adaptable to short-term and long-term human needs. We live through our senses. They rely on stimulation from the tasks we are focused on; people around us but also the physical environment. We breathe air and its quality affects the olfactory system; temperature is felt by thermoreceptors in the skin; sound enters our ears; the visual scene is beheld by our eyes. All these stimuli are transmitted along the sensory nervous system to the brain for processing from which physiological and psychological reactions and judgments are formed depending on perception, expectancies and past experiences. It is clear that the environmental setting plays a role in this sensory process. This is the essence of sensory design. Space plays its part as well. The flow of communication is partly electronic but also largely by people meeting face to face. Our sense of space wants different things at different times. Sometimes privacy but other times social needs have to be satisfied besides the organizational requirement to have effective human communications throughout the building. In general if the senses are satisfied people feel better and work better.

The housing pathways of young people in the UK

The authors examine the housing pathways of young people in the UK in the years 1999 to 2008, and consider the changing nature of these pathways in the run up to 2020. They employ a highly innovative methodology, which begins with the identification and description of key drivers likely to affect young people’s housing circumstances in the future. The empirical identification and analysis of housing pathways is then achieved using multiple-sequence analysis and cluster analysis of the British Household Panel Survey, contextualised by qualitative interviews with a large sample of young people. The authors describe how the interactions between the meanings, perceptions, and aspirations of young people, and the opportunities and constraints imposed by the drivers, are having a major impact on young people’s housing pathways, resulting in considerable housing policy challenges, particularly in relation to the private rented sector

People on the move in Roman Britain

Levels of mobility in the Roman Empire have long been assumed to be relatively high, as attested by epigraphy, demography, material culture and, most recently, isotope analysis and the skeletons themselves. Building on recent data from a range of Romano-British sites (Poundbury in Dorset, York, Winchester, Gloucester, Catterick and Scorton), this article explores the significance of the presence of migrants at these sites and the impact they may have had on their host societies. The authors explore the usefulness of diaspora theory, and in particular the concept of imperial and colonial diasporas, to illustrate the complexities of identities in later Roman Britain.

The Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP): development and psychometric properties

Background: There is increased interest in developing training in cognitive behaviour therapy (CBT) with children and young people. However, the assessment of clinical competence has relied upon the use of measures such as the Cognitive Therapy Scale-Revised (CTSR: Blackburn et al., 2001) which has been validated to assess competence with adults. The appropriateness of this measure to assess competence when working with children and young people has been questioned. Aim: This paper describes the development and initial evaluation of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTSCYP) developed specifically to assess competence in CBT with children and young people. Method: A cross section of child CBT practitioners (n = 61) were consulted to establish face validity. Internal reliability, convergent validity and discriminative ability were assessed in two studies. In the first, 12 assessors independently rated a single video using both the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) and Cognitive Therapy Scale-Revised (CTS-Revised: Blackburn et al., 2001). In the second, 48 different recordings of CBT undertaken with children and young people were rated on both the CBTS-CYP and CTS-R. Results: Face validity and internal reliability of the CBTS-CYP were high, and convergent validity with the CTS-R was good. The CBTS-CYP compared well with the CTSR in discriminative ability. Conclusion: The CBTS-CYP provides an appropriate way of assessing competence in using CBT with children and young people. Further work is required to assess robustness with younger children and the impact of group training in reducing interrater variations.