Angela Clifford

Effects of maternal cigarette smoking during pregnancy on cognitive parameters of children and young adults: a literature review.

The long term effects of maternal smoking during pregnancy on the cognitive development of the child are not well understood due to conflicting findings in past research. The aim of this paper was to provide an up to date, critical review of the literature to determine whether there is evidence of a relationship between tobacco smoke exposure in utero and cognitive functioning. We systematically reviewed observational studies (dated 2000-2011) that examined associations between tobacco smoke exposure in utero due to maternal smoking and performance on cognitive, intelligence, neurodevelopmental and academic tests. Eligible studies were identified through searches of Web of Knowledge, Medline, Science Direct, Google Scholar, CINAHL, EMBASE, Zetoc and Clinicaltrials.gov databases. The review found evidence of a relationship between tobacco smoke exposure in utero and reduced academic achievement and cognitive abilities independent of other variables. Maternal smoking during pregnancy may therefore be a modifiable risk factor for reduced cognitive abilities later in the life of the child. Giving up smoking during pregnancy should be initiated as early as possible to reduce the impact on the childs cognitive development.

Exposure to air pollution and cognitive functioning across the life course--A systematic literature review.

OBJECTIVES Air pollution is associated with increased risk of respiratory, cardiovascular and cerebrovascular disease, but its association with cognitive functioning and impairment is unclear. The aim of this systematic review was to examine whether a relationship exists between these variables across the life course. METHODS We searched Web of Knowledge, Pubmed, SciVerse Scopus, CINAHL, PsychInfo and Science Direct up to October 2015 to identify studies that investigated the association between air pollution and performance on neurocognitive tests. RESULTS Variations in exposure assessment and outcome measures make meta-analysis impossible. Thirty one studies published between 2006 and 2015, from the Americas (n=15), Asia (n=5) and Europe (n=11), met the criteria for inclusion. Many showed weak but quantified relationships between various air pollutants and cognitive function. Pollution exposure in utero has been associated with increased risk of neuro-developmental delay. Exposure in childhood has been inversely associated with neuro-developmental outcomes in younger children and with academic achievement and neurocognitive performance in older children. In older adults, air pollution has been associated with accelerated cognitive decline. CONCLUSIONS The evidence to date is coherent in that exposure to a range of largely traffic-related pollutants has been associated with quantifiable impairment of brain development in the young and cognitive decline in the elderly. There is insufficient evidence at present to comment on consistency, in view of the different indices of pollution and end-points measured, the limited number of studies, and the probability at this stage of publication bias. However, plausible toxicological mechanisms have been demonstrated and the evidence as a whole suggests that vehicular pollution, at least, contributes to cognitive impairment, adding to pressure on governments and individuals to continue to reduce air pollution.

Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis

Objectives Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates. Methods/setting/participants A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation. Primary and secondary outcome measures The outcome measures of interest were the prevalence and determinants of undetected dementia. Results 23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria. Conclusions The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.

Doing, seeing, or both: Effects of learning condition on subsequent action perception

It has been proposed that common codes for vision and action emerge from associations between an individuals production and simultaneous observation of actions. This typically first-person view of ones own action subsequently transfers to the third-person view when observing another individual. We tested vision–action associations and the transfer from first-person to third-person perspective by comparing novel hand-action sequences that were learned under three conditions: first, by being performed and simultaneously viewed from a first-person perspective; second, by being performed but not seen; and third, by being seen from a first-person view without being executed. We then used functional magnetic resonance imaging (fMRI) to compare the response to these three types of learned action sequences when they were presented from a third-person perspective. Visuomotor areas responded most strongly to sequences that were learned by simultaneously producing and observing the action sequences. We also note an important asymmetry between vision and action: Action sequences learned by performance alone, in the absence of vision, facilitated the emergence of visuomotor responses, whereas action sequences learned by viewing alone had comparably little effect. This dominance of action over vision supports the notion of forward/predictive models of visuomotor systems.

Demographic and socio-economic influences on community-based care and caregivers of people with dementia in China.

Background Dementia is a major public health challenge and China has the largest population with dementia in the world. However, dementia care and caregivers for Chinese are less investigated. Objectives and design To evaluate demographic and socio-economic influences on dementia care, management patterns and caregiver burden in a household community-dwelling-based survey, using participants’ care receipts and Zarit scale. Setting and participants Rural and urban communities across six provinces of China comprising 4837 residents aged ≥60 years, in whom 398 had dementia and 1312 non-dementia diseases. Results People with dementia were less likely to receive care if they were living in rural compared to urban areas (Odd ratio (OR) = 0.20; 95%CI: 0.10–0.41), having education level below compared to above secondary school (OR = 0.24; 95%CI: 0.08–0.70), manual labourer compared to non-manual workers (OR = 0.27; 95%CI: 0.13–0.55), having personal annual income below RMB 10,000 yuan (£1000) compared to above (OR = 0.37; 95%CI: 0.13–0.74) or having four or more than compared to less four children (OR = 0.52; 95%CI: 0.27–1.00). Caregivers for dementia compared with those for non-dementia diseases were younger and more likely to be patients’ children or children in-law, had lower education and spent more caring time. Caregiver burden increased with low education, cutback on work and caring for patients who were younger or living in rural areas, and this caregiver burden was three-fold greater than that for non-dementia diseases. Conclusions There are a number of inequalities in dementia care and caregiver burden in China. Reducing the socio-economic gap and increasing education may improve community care for people with dementia and preserve caregivers’ well-being.

Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis

OBJECTIVE To assess the association of fish consumption with risk of dementia and its dose-response relationship, and investigate variations in the association among low-, middle- and high-income countries. DESIGN A new community-based cross-sectional study and a systematic literature review.SettingsUrban and rural communities in China; population-based studies systematically searched from worldwide literature. SUBJECTS Chinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis. RESULTS In the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose-response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose-response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimers disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively. CONCLUSIONS Greater consumption of fish is associated with a lower risk of dementia. Increasing fish consumption may help prevent dementia worldwide regardless of income level.

A cross-sectional study of physical activity and health-related quality of life in an elderly Indonesian cohort

Introduction: Improving health-related quality of life (QoL) may have far-reaching clinical implications, and previous studies have shown associations between participation in physical activity and higher QoL. However, it is unclear which types of physical activity are particularly beneficial and how much of this relationship is explained by instrumental activities of daily living (IADL) following physical activity. Method: This observational study measured frequency of participation in several different physical activities and IADL scores in a large elderly, community-dwelling sample. Hierarchical regression analyses were used to assess relationships between these variables and self-rated QoL using the Medical Outcome Survey SF-36 questionnaire. Findings: Participation in walking was found to be associated with higher QoL ratings in older men and women. IADL scores were correlated with QoL ratings but only partially mediated the association between walking and QoL. Participation in other types of physical activity was not significantly associated with QoL ratings. Conclusion: Walking may be recommended alongside treatment for illness or disability due to its potential benefits to QoL and treatment outcomes. Further research should investigate the role of physical fitness in this relationship, to determine whether these findings can be replicated in different populations.

What disability? I am a leader! Understanding leadership in HE from a disability perspective:

This article is based on the findings of an externally funded, mixed-methods research project conducted at one English university. This small-scale project aimed to examine leadership, barriers to becoming a leader and the support needed to overcome them, from the perspectives of disabled staff. An online questionnaire was sent to all 66 members of staff who had disclosed their disabled status to the university and 22 responses were received. Twelve participants were then interviewed as two focus groups to discuss their views on leadership and its relation to their role. Six more respondents opted for individual face-to-face/telephone interviews. The findings indicated that over half of the respondents were already engaged in ‘formal’ leadership and even more exercised ‘informal’ leadership. This key finding seems to contradict the under-representation of disabled academics in leadership reported in the literature. Despite their engagement in leadership, disabled staff faced several institutional and personal barriers. The findings suggest that having an impairment per se might not necessarily deter disabled staff from exercising leadership. A number of support strategies are recommended to facilitate their participation in (formal) leadership.

Success of a sports-club led-community X-PERT Diabetes Education Programme

Abstract This study examined the effectiveness of a sports-club-led X-PERT Diabetes Programme, measuring changes to participants’ physical condition, knowledge of diabetes, psychological well-being, activity level, diabetes self-management and participants’ rating of the programme. In this mixed-method, repeated measures evaluative study, data were gathered at baseline (T0), six weeks (T1) and 6 months (T2) using the Diabetes Health Profile, General Practice Physical Activity Questionnaire, Diabetes Empowerment Scale – Short Form, Participant Evaluation Questionnaire and focus groups. Over three years, 260 individuals with type 2 diabetes provided data for the evaluation. The sports-club-led X-PERT Diabetes Education Programme was successful in achieving its targets with improvement in clinical outcomes including significant reductions in BMI, waist circumference, total cholesterol, LDL cholesterol, triglycerides and glycated haemoglobin by T2. Positive changes were also evident in relation to participants’ health profile, self-management and empowerment. This study illustrates the important role that European sports stadia can play in community health through delivering targeted programmes beyond general health promotion activities.

Personal sacrifice and corporate cultures: career progression for disabled staff in higher education

Abstract Disabled people are under-represented in higher education (HE), especially in senior posts. This article reports research on the perspectives of career progression into leadership held by disabled staff in one post-1992 university. Findings indicated that some participants were already engaged in leadership or aspired to such roles, and reported positive experiences. However, participants also experienced barriers to progression, including a lack of awareness of equality and diversity among managers and colleagues, inadequate professional development opportunities and the competitive organisational culture of management that could impact on their health and work–life balance. We conclude that disabled staff in HE do not yet have equal opportunities for progression into leadership roles compared with their non-disabled peers. There is a need for realignment of the culture of leadership and management to make it more compatible with the full inclusion of disabled staff in HE such that their unique contributions are valued.