Building Evidence for Dementia Prevention

As was the case in 2010 when the National Institutes of Health issued a consensus statement on the prevention of Alzheimer’s and other dementias, there remains a lack of firm evidence for dementia prevention. Because of the difficulties in studying this phenomenon, no modifiable risk factors for dementia have been definitively established, and no pharmaceutical or nutritional supplements been proven to prevent Alzheimer’s disease or cognitive decline. However, longitudinal observational studies have identified several factors associated with dementia. A recent review article summarizes the current epidemiological evidence about Alzheimer’s and other dementias, and presents three ongoing large scale randomized control trials (RCTs) that focus on preventing dementia. The review argues that there is substantial evidence for many factors that, in combination, might reduce the risk of, or delay the onset of, dementia. Although no specific cure for dementia exists, and no specific pathway between risk factor and disease onset has been identified, several cardiovascular, stress, toxicity, and psychosocial variables have been repeatedly associated with dementia. Protective factors, such as high education, physical exercise, and not smoking cigarettes, have been identified as well. Intervention studies that account for these multiple factors may well identify strategies for preventing or delaying dementia. However, the protective effects and risk factors suggested by observational data have yet to be assessed in RCT research. The role of such factors in reducing or increasing the risk for dementia needs to be more specifically defined. Three ongoing RCT studies in Europe show promise in this area, as they target multiple risk and protective factors by promoting healthy lifestyle changes and medical treatment of vascular diseases. These are: FINGER, a Finnish trial involving 1,200 older adults at risk for dementia. This intervention features nutritional guidance, physical activity, cognitive and social engagement, and medical management of risk factors. Participants were involved in previous, intensive observational studies of vascular health and health behavior, so FINGER will provide a level of relevant information about its research subjects that is normally impossible for clinical RCTs to attain;MAPT, a multicenter study of 1,680 frail older adults in France. This study will compare the efficacy of omega-3 dietary supplementation with a multidomain training intervention that involves physical and cognitive training. The study will include follow-up assessments after five years;PreDIVA, a Dutch study of 3,534 community dwelling participants between 70 and 78 years old, recruited from primary care clinics. This study will compare standard medical care with a multicomponent vascular health intervention. The study will last for six years and measure both dementia and disability outcomes. These studies are an important step in dementia research, using earlier observational studies as the basis for rigorously assessed interventions. Although a cure for dementia has not been identified, this new research may identify preventive strategies against dementia. �� Source: Mangialasche F, Kivipelto M, et al. (2012). Dementia prevention: current epidemiological evidence and future perspective. Alzheimer’s Research and Therapy 4:6.

Candida colonization in intensive care unit patients' urine

The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU) patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100%) and indwelling urinary catheter (92.6%). The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.

Attracting, Developing and Training Effective Teachers - OECD Country Background Report for Ireland

This Country Background Report (CBR) on the teaching career in Ireland forms part of the major OECD study “Attracting, Developing and Retaining Effective Teachers.” Similar reports are being submitted from twenty six other countries. Nine of these countries are also engaged on ‘thematic’ studies of the teaching career, involving site visits by external reviewers appointed by the OECD. The format of the CBRs follows a common pattern, set out by the OECD in its Design and Implementation Plan. This is to facilitate comparative analysis of sub-themes of the reports. Thus, each CBR involves six chapters. The first two – “the national context” and “school system and the teaching force”– are intended to provide succinct overviews of these themes in line with queries posed in the OECD documentation. Each of the other four chapters is designed on a common format – identification of policy concerns; data, trends and factors; policy initiatives and their impact. Specific questions are posed regarding data, trends and factors. The same questions may be posed in relation to more than one sub-theme which gives rise to some repetition in the report, but is important for the comparative analysis.

Explanatory Note on the General Scheme of the Further Education and Training Authority (SOLAS) Bill 2012

1. Interpretation. The purpose of this provision is set out some commonly used terms to be used in the Bill. 2. Establishment day. The purpose of this provision is to require the Minister to specify a day as the establishment day for the purposes of the Bill. This will be the day on which the new authority, to be known as SOLAS, will come into existence. 3. Establishment of SOLAS. The purpose of this head is to provide for the formal establishment of SOLAS and to define its status as a corporate body with the usual consequent powers. 4. Functions of SOLAS. The purpose of this head is to set down the statutory functions of the new further education and training authority. SOLAS is to have overall strategic responsibility for the provision of further education and training in the country. It will be responsible for deciding what further education and training programmes are provided. A core part of its role will be to ensure the referral of jobseekers to appropriate courses which may be delivered by VECs or by other, including private, providers. It will provide the funding stream to VECS and those other bodies for the provision of this training.

Further Education and Training Strategy 2014-2019

he first ever strategy for the Further Education and Training (FET) sector is being launched by the Minister for Education and Skills, Ruair�_ Quinn T.D., and Minister of State for Training and Skills Ciarn Cannon T.D. The overall aim of the Strategy is to develop a world-class integrated system of further education and training in Ireland, which will promote economic development and meet the needs of all citizens. The new strategy was developed by SOLAS with assistance from the ESRI which was commissioned to carry out evidence based research and assist in the development of the Strategy. Five high level strategic goals have been identified: -Skills for the Economy: to address the current and future needs of learners, jobseekers, employers and employees and to contribute to national economic development -Active Inclusion: to support the active inclusion of people of all abilities in society with special reference to literacy and numeracy -Quality Provision: to provide high quality education and training programmes and to meet the appropriate national and international quality standards -Integrated Planning and Funding: FET provision will be planned and funded on the basis of objective analysis of needs and evidence of social and economic impact -Standing of FET: to ensure a valued learning path leading to agreed employment, career, developmental, personal and social options. The Strategy follows a radical overhaul of the structure of the sector by the Government which includes the streamlining of 33 existing VECs into 16 Education and Training Boards (ETBs), the abolition of F́S and creation of SOLAS, the Further Education and Training Authority. Speaking at the launch in the Chester Beatty li

General Scheme of a Further Education and Training Authority (SOLAS) Bill 2012

General Scheme of a Further Education and Training Authority (SOLAS) Bill 2012. Provided by the Department of Education and Skills, Ireland.

Medical Education in Ireland A New Direction - Report of the Working Group on Undergraduate Medical Education and Training

Ireland can be justly proud of the history and quality of its medical education. Graduates of Irish medical schools are accepted globally as being of international standard and many of the most eminent of Irish medical professionals have returned to Ireland after periods of distinguished service in other countries. This high international standing is reflected in the large number of North American, African and Asian students attending medical school in Ireland. Indeed, the ability of Irish medical schools to successfully compete at an international level in terms of attracting students to Ireland, and to establish a range of strategic relationships with Universities and Governments in other countries is to be commended.

Review of Apprenticeship Training in Ireland

On 19 May 2013, Ruairi Quinn T.D, Minister for Education and Skills, announced a review of apprenticeship training in Ireland. The terms of reference of the review were “to determine whether the current model of apprenticeship should be retained, adapted or replaced by an alternative model of vocational education and training for apprentices –taking into account the needs of learners, the needs of employers, the needs of the economy and the need for cost effectiveness into the future.” The Review Group was asked to complete its work before the end of 2013. A Technical Group was also established to provide background evaluative data for the review. To provide a context for the review, a Background Issues Paper 1 was prepared by the Department of Education and Skills and published at www.education.ie in May 2013 .

Medical students' skills and needs for training in breaking bad news.

This study assessed medical students' perception of individual vs. group training in breaking bad news (BBN) and explored training needs in BBN. Master-level students (N = 124) were randomised to group training (GT)-where only one or two students per group conducted a simulated patient (SP) interview, which was discussed collectively with the faculty-or individual training (IT)-where each student conducted an SP interview, which was discussed during individual supervision. Training evaluation was based on questionnaires, and the videotaped interviews were rated using the Roter Interaction Analysis System. Students were globally satisfied with the training. Still, there were noticeable differences between students performing an interview (GT/IT) and students observing interviews (GT). The analysis of the interviews showed significant differences according to scenarios and to gender. Active involvement through SP interviews seems required for students to feel able to reach training objectives. The evaluation of communication skills, revealing a baseline heterogeneity, supports individualised training.

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

Background Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument. Objectives To determine frequency of discrepancies between subjective and objective delirium monitoring. Methods An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit. Results Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium. Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.

Cochrane Training, Short Courses Guidance Notes 2011

Guidance Notes for Training Courses on Conducting Systematic Reviews, 2011.

Cochrane Short Courses Training Application Form 2011

Application Form for Training Courses on Conducting Systematic Reviews, 2011.

Northern Ireland regional breastfeeding peer support training

This resource�has been produced for breastfeeding coordinators and breastfeeding peer support trainers who provide training for peer support volunteers. �� The resource has been distributed by PHA directly to those involved in breastfeeding peer support programmes in Northern Ireland. Further copies can be requested as applicable from Lesley Blackstock at: Lesley.blackstock@hscni.net The CD supports delivery of eight peer support teaching sessions (two hours each), which meet Open College Network NI requirements for certification at Level 2, credit value 3. The resource contains background information, support materials, lesson plans, Powerpoint presentations, DVD clips and worksheets for peer supporters. � Please note this resource is only suitable for individuals involved in delivering breastfeeding peer support in Northern Ireland.�

Mental Health First Aid Training Programme

The Mental Health First Aid (MHFA) Training Programme for Northern Ireland has been adapted from the original MHFA programme established in Australia by Betty Kitchener and Anthony Jorm. MHFA is the help provided to a person who is developing a mental health problem or who is currently in a mental health crisis. The first aid is given until professional help is available or until the crisis resolves. More than 4,500 people have attended MHFA training in Northern Ireland since it began in 2009 following a successful pilot in 2005. The aims of MHFA are to: preserve life where a person may be a danger to themselves or others; provide help to prevent the mental health problem becoming more serious; promote the recovery of good mental health; provide comfort to a person experiencing a mental health problem. MHFA teaches participants: how to recognise the symptoms of mental health problems; how to provide initial help; how to go about guiding a person towards appropriate professional help. The training programme is available to people from all backgrounds and has proved successful with different professional groups. MHFA training involves teaching participants how to recognise the symptoms of mental health problems such as depression, anxiety and psychosis. Each course is delivered by two MHFA instructors, usually over two consecutive days and four sessions to a maximum of 20 delegates. The course can also be delivered one day a week for two weeks or in four three-hour sessions. To apply for the training programme, people should contact their local Health and Social care Trust. Each Trust runs MHFA training several times a year. Topics covered include: What is meant by mental health/mental ill health? Dealing with crisis situations such as suicidal behaviour, self-harm, panic attacks and acute psychotic behaviour. Recognising the signs and symptoms of common mental health problems including depression, anxiety disorders, psychosis and substance use disorders. Where and how to get help. Self help strategies.

Multimedia materials for education, training, and advocacy in international health: experiences with the Schistosomiasis Control Initiative CD-ROM

We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.