Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: After diagnosis of a dementing illness patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine in an objective-oriented group intervention the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of care-givers. METHODS: During the years 2011-12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in for usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (10 participants/group) once a week for 8 weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources, patients' depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. DISCUSSION: This is a "proof -of-concept" study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention.     

Variation of basal EROD activities in ten passerine bird species--relationships with diet and migration status

Inter-specific differences in animal defence mechanisms against toxic substances are currently poorly understood. The ethoxyresorufin-O-deethylase (EROD) enzyme plays an important role in defence against toxic chemicals in a wide variety of animals, and it is an important biomarker for environmental contamination. We compared basal hepatic EROD activity levels among ten passerine species to see if there is inter-specific variation in enzyme activity, especially in relation to their diet and migration status. Migratory insectivores showed higher EROD activity compared to granivores. We hypothesize that the variable invertebrate diet of migratory insectivores contains a wider range of natural toxins than the narrower diet of granivores. This may have affected the evolution of mixed function oxidases (MFO) system and enzyme activities. We further tested whether metabolic rates or relative liver size were associated with the variation in detoxification capacity. We found no association between EROD activity and relative (per mass unit) basal metabolic rate (BMR). Instead, EROD activity and relative liver mass (% of body mass) correlated positively, suggesting that a proportionally large liver also functions efficiently. Our results suggest that granivores and non-migratory birds may be more vulnerable to environmental contaminants than insectivores and migratory birds. The diet and migration status, however, are phylogenetically strongly connected to each other, and their roles cannot be fully separated in our analysis with only ten passerine species.     

Antioxidant status in relation to age,condition, reproductive performance and pollution in three passerine species

Oxidative stress has been suggested as a mediator in life‐history trade‐off. By spending more resources on for example reproduction an organism might sacrifice its antioxidant defence. So far, most conclusions on trade‐offs between life‐history traits and oxidative stress have been drawn from laboratory studies using a few model species and there is a need for studies conducted in natural settings. We investigated associations between markers for antioxidant status (antioxidant enzyme activities and antioxidant levels), body condition, age and reproduction in three species of wild‐living passerines. The impact from an anthropogenic stressor (metal pollution) was also assessed. The three bird species showed interspecific variation in their SOD and CAT activities, indicating different pathways to eliminate radicals. The age of females affected both antioxidant status and the breeding performance, indicating the importance of age as a factor in life‐history studies. Old birds had lower levels of antioxidants/antioxidant enzyme activities and they produced larger broods/more successful broods, though the latter might be confounded by surviving females having increased fitness. Metal exposure had a negative impact on breeding, and improved breeding outcome was also associated with increased antioxidant defence, but metal exposure was not directly related to the oxidative status of birds, emphasizing that additional stressors might independently affect the same traits. Our results highlight that caution has to be taken when generalizing and extrapolating results to even closely related species. The results support the idea that there is a cost of reproduction, in terms of increased resources spent on antioxidant defence, though this should be confirmed with experimental studies.     

Diversity and Community Structure of Primary Wood-Inhabiting Bacteria in Boreal Forest

DNA-based pyrosequencing analysis of the V1- V3 16S rRNA gene region was used to identify bacteria community and shift during early stages of wood colonization in boreal forest soils. The dataset comprised 142,447 sequences and was affiliated to 11 bacteria phyla, 25 classes and 233 genera. The dominant groups across all samples were Proteobacteria, followed by Bacteroidetes, Acidobacteria, Actinobacteria, Amatimonadetes, Planctomycetes and TM7 group. The community structure of the primary wood-inhabiting bacteria differed between types of forest soils and the composition of bacteria remained stable over prolonged incubation time. The results suggest that variations in soil bacterial community composition have an influence on the wood-inhabiting bacterial structure.     

Rewetting of Cutaway Peatlands: Are We Re‐Creating Hot Spots of Methane Emissions?

Hot spots of CH₄ emissions are a typical feature of pristine peatlands at the microsite and landscape scale. To determine whether rewetting and lake construction in a cutaway peatland would result in the re‐creation of hot spots, we first measured CH₄ fluxes over a 2‐year period with static chambers and estimated annual emissions. Second, to assess whether rewetting and lake creation would produce hot spots at the landscape level, we hypothesized a number of alternative land use scenarios for the peatland following the cessation of peat extraction. Using the results from this study and other studies from literature, we calculated the global warming potential (GWP) of each scenario and the respective contribution of CH₄. The results showed that hot spots of CH₄ fluxes were observed as a consequence of microsite‐specific differences in water table (WT) position and plant productivity. CH₄ fluxes were closely related to peat temperature at 10 cm depth and WT position. Annual emissions ranged from 4.3 to 38.8 g CH₄ m^?2 yr^?1 in 2002 and 3.2 to 28.8 g CH₄ m^?2 yr^?1 in 2003. The scenario results suggest that lake creation is likely to result in the re‐creation of a hot spot at the landscape level. However, the transition from cutaway to wetland ecosystem may lead to a reduction in the GWP of the peatland.     

Quantification of point mutations associated with Leber hereditary optic neuroretinopathy by solid-phase minisequencing

About two-thirds of patients with Leber hereditary optic neuroretinopathy (LHON) harbor mutations in mitochondrial DNA at positions 11778 (ND4) or 3460 (ND1). Thus, the clinical diagnosis of LHON can often be confirmed with mutation analysis. Detection of pathogenic mutations and quantification of heteroplasmy has mainly relied on PCR and restriction site analysis and densitometric scanning. We applied the recently developed solid-phase minisequencing method, based on primerguided nucleotide incorporation, to the simultaneous detection and quantitation of the ND4/11778 and ND1/3460 mutations. The method was highly sensitive, heteroplasmy as low as 1.5% being easily detected. Rapid, reproducible, and accurate results prove solid-phase minisequencing to be the method of choice for quantitative analysis of LHON mutations.     

Endomitosis: A reappraisal

Summary The concept and role of endomitosis is reevaluated in the light of observations on three organisms. Endomitosis which morphologically agrees with Geitler's (1939) classical definition is compared in tapetal cells of the liliaceous plant Eremurus, in the septal cells of the testicular follicles of the grasshopper Melanoplus, and in human cells from normal and molar trophoblasts and cervical cancer. These observations, together with those of Kidnadze and Istomina (1980), show that functionally at least two fundamentally different types of endomitosis exist, although morphologically the stages resemble each other in the three organisms. In the first type, exemplified by Eremurus, each endomitosis leads to a chromosome constitution which represents one level higher ploidy, a course that has been assumed to be characteristic of endomitosis in general. The second type, observed in its most characteristic form in the grasshopper, seems to be stationary: no DNA synthesis occurs, but an intensive RNA synthesis takes place. Presumably such cells have reached a final state in their development and are specialized in manufacturing one or more gene products. Endomitosis in normal placenta comes near this type, although DNA synthesis takes place in occasional cells. However, similar endomitotic nuclei in the hydatiform moles are in the process of DNA synthesis. When endomitosis is analyzed in different organisms and tissues, the observation that this process is not one entity should be kept in mind.     

Microscopic examination of bacteria in Fe(III)-oxide deposited from ground water

Ochreous sludge deposited in the course of aeration of ground water contained an assortment of bacterial forms and structures which were investigated by light microscopy, scanning electron microscopy, and transmission electron microscopy. Bacterial structures were often covered by iron deposition which could be removed by acidification of the samples. Sulfuric acid treatment was consistently better than hydrochloric acid to dissolve iron without a considerable damage to the bacterial cells. Partial dissolution of amorphous ferric iron was achieved by acidifying the samples with oxalic acid or citric acid prior to the preparation for electron microscopy.