bluuebunny/crossref_metadata_2025 huggingface dataset:
Sports tourism and niche markets: Identification and analysis of the growing lesbian and gay sports tourism industry
Authors: Pitts Brenda G.
Published: June 2007

The purpose of this study was to determine if there is a lesbian and gay sports tourism industry. Results revealed evidence of an extensive and growing industry estimated to be worth $180m within the larger lesbian and gay sports industry that is estimated to be worth $15bn. Moreover, the market is gaining increased recognition by mainstream corporate America as an affluent and viable market. Some of the results include: there is a large lesbian and gay sports industry; there is a viable lesbian and gay sports travel industry; the demand for lesbian and gay sports products has led to the creation of companies that specialise in lesbian and gay sports travel products; lesbian and gay media give increasing attention to sports events and travel; there is proliferation of sports spectatorial products; and the Gay Games have had a significant impact on sports participant and spectatorial travel.
Hotel guest history as the foundation for database marketing: Embracing a pilot survey of UK hotels
Authors: Callan Roger J. , Teasdale Andrea
Published: June 2007

The recent emphasis on retention marketing and its impact on more traditional market segmentation methods is considered. In this context, the value of hotel guest history systems as a basis for database marketing is explained and a number of examples of applications in several industries, including hospitality, are cited. The methodology of a pilot study of UK hotels is presented together with a descriptive discussion of the results. The paper concludes that database marketing applications are increasing and will continue to grow, although hotels often fail to make full use of valuable data retained in their guest history files.
Branding a state from features to positioning: Making it simple?
Authors: Nickerson Norma P. , Moisey R. Neil
Published: June 2007

This paper provides an argument for going back to the simplification of branding and positioning based on features expressed by visitors as the attraction to a destination. Research indicates that as a result of visiting a destination, images tend to be more realistic, complex and differentiated. Therefore, an understanding of what attracted visitors can furnish the basis for image development and market positioning. Vacationers were cluster analysed and compared for significant differences based on the attraction features. The ‘attraction package’ portrayed five visitor group types. Within each visitor group a destination-specific icon was identified for market positioning.
Training practice nurses to assess and manage anxiety disorders: A pilot study
Authors: Morriss Richard , Gask Linda , Smith Craig , Battersby Lynn
Published: June 2007

There is a shortage of health staff available in primary care who can assess and manage anxiety disorders using effective evidence-based psychological methods. Previous training packages have largely failed to evaluate skill acquisition. We devised a brief training package for practice nurses to learn how to treat anxiety disorders. Fourteen practice nurses acted as their own controls in a before and one month after training design to determine retention of assessment and management skills. Both were rated 'blind' in videotaped role-played interviews with an actor. With training, there were significant improvements in specific history-taking, explaining anxiety disorders, all aspects of anxiety management (breathing exercise, distraction, exposure), follow-up of patients and overall performance. Overall, 11 practice nurses (79%) were judged to be clinically effective after training compared to none before. After training, all nurses reported that they had used the training package in clinical practice. The findings are discussed in the light of the published literature, and possible future directions for research are suggested.
Clinical governance: The route to (modern, dependable) nursing research?
Authors: Boden Louise , Kelly Daniel
Published: June 2007

The opportunities offered by clinical governance are explored by a chief nurse and director of quality and a senior nurse (R&D) working in an inner-city NHS trust at a time of considerable change and uncertainty. The paper offers an insight into each of our perspectives on clinical governance-the latest concept behind recent health reforms in the UK-and contributes to the debate on the subject by suggesting the adoption of a strategic approach to encourage nursing research that is more related to practice. First, clinical governance is defined, following which its component elements-clinical effectiveness, education and training, quality monitoring and cost control in healthcare-are explored in relation to the general concept of clinical governance. Examples of key initiatives, based on our recent experience at this NHS trust, are provided to examine how the various strands of the clinical governance framework (such as risk management) have the potential to benefit patients by their focus on improving the standard of healthcare being provided. Questions are then raised about the place of nursing research within the wider NHS R&D agenda.

We suggest that the adoption of clinical governance will offer a unique opportunity for nursing leaders, researchers and practice developers to work together to help shape the future culture of healthcare, particularly at the point of clinical delivery. If such an opportunity is to be maximised, a number of fundamental issues must be addressed with urgency. These include ensuring that successful initiatives are identified and implemented to demonstrate the contribution that nursing research can make to tangible healthcare improvements.
Women's symptoms at the menopause and their expectations of hormone replacement therapy
Authors: Rubin Rona , Quine Lyn
Published: June 2007

How do women feel about the menopause, and what factors do they consider when deciding whether to take hormone replacement therapy (HRT)? A random sample of 1,200 women aged between 38 and 58 was generated from Family Health Services Authority (FHSA) records. A postal questionnaire, based partly on Ajzen's Theory of Planned Behaviour (Ajzen, 1988) about symptoms, attitudes to and knowledge of the menopause and HRT, and their sources of information, was sent to the women. Respondents were asked about perceived physical and psychological problems in the previous six months and about whether they had consulted a doctor. Results indicate little difference in psychogenic symptoms between those who are taking HRT and those of a similar age who are not. The case for physical symptoms is more complicated, with HRT alleviating hot flushes and night sweats in particular. The most useful source of information was reported as being the media, although satisfaction with information varied between groups. Implications for practice nurses are discussed.
A national initiative to set priorities for R&D in nursing, midwifery and health visiting: Investigating the method
Authors: Scott Elizabeth , McMahon Ann , Kitson Alison , Rafferty Anne Marie
Published: June 2007

The aim of this paper is to provide a report of the progress made in the first phase of the national initiative established to identify priorities for R&D for the nursing professions, which was reported earlier in this journal (Kitson et al., 1997). Here we describe how the methods were used, discuss the primary and secondary results achieved in the first phase of the initiative and present an outline of how it is proposed to take these results forward in a second and more strategic phase. The aim of the first phase was to explore the feasibility of establishing a national systematic process for identifying priorities for R&D in the nursing professions*. It is now proposed to establish a strategic alliance for research in nursing, midwifery and health visiting and these proposals are summarised at the end of the paper.
Does nursing need `the dismal science'? The case for economic evaluations in nursing
Authors: Jenkins-Clarke Susan
Published: June 2007

This paper assesses the role of economic evaluation in the nursing context and reviews the problems involved in applying standard frameworks used elsewhere in health economics.

The UK literature on studies of cost-effectiveness and nursing is reviewed and, as a consequence of the gaps on the topic that were revealed, ways of approaching the issue are suggested. The question is asked whether economic evaluation in the nursing context needs to be addressed at all, following which a framework for analysis is suggested. The paucity of economic appraisals in nursing has been noted by previous authors. In the UK, the majority of these focus on specific areas of care, such as leg ulcer treatments, with more general areas, such as evaluations of case management, home versus hospital deliveries and new nursing roles, being confined to the USA literature.

Ways of approaching economic evaluation are outlined by means of a suggested framework for analysis, with a brief discussion on the complexities of measuring costs and outcomes. The final section of the paper introduces the concept of measurement of quality of nursing care into the framework and the difficult questions raised by its inclusion.

The paper concludes by suggesting that, in this time of scarce resources and the need to allocate such resources prudently, nurses could work with their colleagues in other disciplines to produce sound evidence in order to inform debate in this area.
Association between quality of ward nursing care and students' assessment of the ward as a learning environment
Authors: Saarikoski Mikko , Leino-Kilpi Helena
Published: June 2007

The aim of this study was to explore the association between the characteristics of a ward and its evaluation as a learning environment by students. The data were collected using a structured questionnaire in one college of nursing in southern Finland. Respondents were 162 second- and third-year students enrolled on a three-and-a-half year nursing programme. The quality of nursing care correlated strongly with the quality of the nursing environment. The method and implementation of the supervisory relationship was also a signifant factor in students' assessment of the ward as a learning environment. The role of staff nurses as mentors was very important. Clinical supervision is not only important in nurse education; it is also closely interwoven with nursing care in clinical wards in general.
Disco ‘Super-Culture’: Consuming Foreign Sex in the Chinese Disco
Authors: Farrer James
Published: June 2007

Based on ethnographic observations in Chinese discos, this article describes how urban Chinese youth participate in the cosmopolitan sexual culture of the discotheque, using the hybrid cultural space of the discotheque for their own forms of sexual display and interaction. The discotheque is perceived by youth as a cosmopolitan space allowing for appropriation and consumption of ‘foreign’ sexual styles. Especially for young women, the disco provides a space for sexual expression which would be unacceptable in other social spaces, and offers Chinese youth of both sexes a space for participation in a global consumer culture. Sub-cultural theories of youth culture are found to be inadequate to describe participation in this shifting and anonymous marketplace of sexual images and self-display. Chinese participation in the discotheque is less a ‘localization’ or subversion of global practices than an active consumption of and participation in a kind of sexual cosmopolitanism, more of a construction of a ‘super-culture’ rather than of a ‘sub-culture’. Rather than creating local group solidarities, participation in this ‘super-culture’ emphasizes, above all, sexual display and the exposure of the commodified sexual self to the gaze of anonymous and ‘foreign’ others.
Indoor Mould Exposure Reduces Th 1 Reactivity in Early Childhood
Authors: Lehmann Irina , Müller Andrea , Diez Ulrike , Richter Matthias , Wallach Swantje , Sierig Gabriele , Seiffart Annett , Wetzig Heide , Borte Michael , Herbarth Olf
Published: June 2007

A birth cohort study (LARS - Leipzig Allergy Risk Children Study) was used to investigate the influence of indoor mould exposure on T cell function in early childhood. T cell cytokines (IFN-γ, IL-4) were analysed in a sub-group of the LARS cohort (birth: n = 39, 6 months: n = 11, 12 months: n = 50, 36 months: n = 33). Mould burden was assessed by analysis of questionnaires completed at the birth of the child and measurement of indoor mould spores was carried out when the children were 3 years old. Children whose parents reported mould burden or dampness in their dwellings at the time of birth showed lower amounts of IFN-γ producing Th1 cells during the first year of life (significant at 12 months) in comparison to unexposed children. The capacity to produce IL-4 was not altered, however. When the children were 3 years old, an association between measured indoor mould and suppressed Th1 reactivity was observed. The data suggest that indoor mould exposure is associated with reduced Th1 reactivity in early childhood.
Labour market outcomes among retrenched workers in Australia: a review
Authors: Webber Michael , Campbell Iain
Published: June 2007

In any one year perhaps 5% of the Australian workforce experiences retrenchment. Retrenchment causes people shock and loss of income; they become socially isolated and their psychological health deteriorates. Many studies have examined the subsequent labour force experience of retrenched workers, in terms of conditions in the labour market, retrenchment and hiring practices, state policies and the personal characteristics of the workers. This paper reviews evidence about the factors that influence the prospects of retrenched workers, identifies some flaws in the design of studies in which that evidence has been collected, and points to ways in which more comprehensive evidence can be collected. An informed interpretation of evidence requires appropriate methods for identifying cause and effect, should rest on a clear identification of the forms of employment that exist, and needs to be sensitive to the manner in which personal characteristics are used by employers as hiring markers.
Natural disasters and national identity: time, space and mythology
Authors: West Brad , Smith Philip
Published: June 2007

This research note builds upon our recent publication in this journal entitled 'Drought, Discourse and Durkheim' (West and Smith 1996). Drawing upon Robert Merton's methodological recommendation that functionalist research should explore possible functional alternatives, we examine discourses surrounding Australian natural disasters other than drought: floods, earthquakes, cyclones and bushfires. The paper identifies three variables that constrain the risk and ritual orientations of natural disaster discourses—time, space and mythology. These variables explain why drought has a unique place among Australian natural disasters as the generator of a national solidaristic narrative.
Implicit and explicit identity constructions in the life story of one of Hitler's elite soldiers
Authors: van de Mieroop Dorien , Bruyninckx Kris , Leysen Kathy , Vanwesenbeeck Wendy
Published: June 2007

We study the life story of a former SS Leibstandarte soldier and we focus on the way the narrator deals with face threats by negotiating his identity constructions. The interviewee positions himself as a sportsman and an ignorant soldier, thus constructing denial of knowledge of and agreement with Hitler's ideology. These identities can be considered to be complementary, but they are built in quite different ways: the narrator explicitly presents himself as a sportsman, but mitigates his implicit construction of ignorance. Given the social and historical context, this contrast in degree of explicitness is expected since the ignorance claim has been the subject of many previous discourses and debates of this subject.
Negotiating International Framework Agreements in the Global Textile, Garment and Footwear Sector
Authors: Miller Doug
Published: June 2007

This article outlines the policy and practice of the International Textile, Garment and Leather Workers’ Federation (ITGLWF) with respect to multinationals in the sector. It concludes that while the multinational policy of the ITGLWF is in line with other global union federations, the negotiation of International Framework Agreements is proving to be a much harder objective to realize. This can, in part, be explained by an anti-union stance on the part of some multinationals, a plethora of existing voluntary initiatives, and possible collective employer resistance to such a development.
Decoration by design: Magneto Motivity
Authors: Young Lori
Published: June 2007

Magneto Motivity is a hybrid of the additive and subtractive fonts. This additive plus subtractive approach allowed me to play around with the decoration process without knowing ror certain what the outcome would be. The visual form of Magneto Motivity-which I suggest embodies aspects of our contemporary culture-turned out to be surprisingly Neo-Rococo.
Living Systemic Thinking
Authors: Marshall Judi
Published: June 2007

In this article I explore how ideas of systemic thinking, drawn from the work of Gregory Bateson and others, influence my practice of first-person action research. I track a story of inquiry through several phases, including gaining feedback from others about my behaviour. I identify quality issues in first-person action research, also called self reflective inquiry, as I proceed.
What really matters to patients living with chronic obstructive pulmonary disease? An exploratory study
Authors: Williams V. , Bruton A. , Ellis-Hill C. , McPherson K.
Published: June 2007

There is limited published research into what really matters to people living with chronic obstructive pulmonary disease (COPD). Most previous research in this area focuses on the impact of the symptoms of COPD, rather than on the issues defined as important by patients themselves. This paper describes an exploratory study investigating what is most important to people living with COPD.

A qualitative approach employing in-depth interviews with COPD patients was chosen. Thematic analysis was used to code and categorize data.

Six patients with `moderate' to `very severe' COPD were recruited. They considered engagement in specific activities to be very important (walking, household maintenance and driving), even though these activities were mainly centred around the home environment, or within confined spaces, due to their physical limitations. This restriction led to feelings of social isolation that these patients tried to overcome through social participation (holidays, social interaction).

People with COPD often experience physical restrictions, which can lead to reduced community mobility and social isolation. In this study, despite their physical limitations, these patients had a strong desire to participate and be engaged in various activities. The importance of enabling patients to `participate' rather than just `do' should be considered when planning and delivering patient-centred interventions across the whole spectrum of severity of COPD. Chronic Respiratory Disease 2007; 4: 77—85
Making Cultural Policy
Authors: O'Regan Tom , Goldsmith Ben
Published: June 2007

Policy makers face a number of difficulties meeting the traditional cultural and social objectives of broadcasting and film policy development in a rapidly changing digital environment. This new environment requires broadcasting policy and film policy alike to substantially adjust their settings to “speak to” new governmental, industry, and political priorities. Broadcasting and film policy-making frameworks now need to adjust to policy and industry settings stressing the knowledge economy and information society. This both creates a new centrality for audiovisual production as a “content creation” industry and raises new problems for the various local film and television production ecologies (including the cultural policy that has sustained them) that have developed. This article will use Australian developments to suggest ways broadcasting and film policy is both making and not making this adjustment.
Interstate Professional Associations and the Diffusion of Policy Innovations
Authors: Balla Steven J.
Published: June 2007

Although scholars have found that policy innovations diffuse across states in a systematic manner, they generally have not examined the role that individuals and institutions play in promoting diffusion. I posit that interstate professional associations provide institutional foundations for the development and dissemination of innovations by state officials with jurisdiction over particular policy areas. I test this hypothesis by examining the determinants of state adoption of the Health Maintenance Organization (HMO) Model Act, a comprehensive set of regulations developed by the National Association of Insurance Commissioners (NAIC). My central finding is that states whose insurance commissioner participated in the NAIC’s Accident and Health Insurance Committee, which has jurisdiction over HMO regulation, were more likely than other states to adopt the Model Act. This result provides evidence that associations can affect policy diffusion. It also sharpens the conventional wisdom by highlighting a specific institutional arrangement—a committee system—through which participation in associations can facilitate the adoption of innovations.
Use of Montessori-based activities for clients with dementia in adult day care: Effects on engagement
Authors: Judge Katherine S. , Camp Cameron J. , Orsulic-Jeras Silvia
Published: June 2007

Clients with dementia in an adult day care center were observed taking part in regular activities programming or Montessori-based activities developed for persons with dementia. During the nine-month study, clients in Montessori-based activities exhibited greater amounts of constructive engagement, defined as motor or verbal behavior exhibited in response to the activity in which the client was taking part, than clients in regular programming. Montessori-based activities also elicited less passive engagement, defined as listening and/or looking behavior exhibited in response to the activity the clients were participating in, than regular programming. Implications of these results and ways to implement Montessori-based programming in settings serving persons with dementia are discussed.
Caregiver burden in Alzheimer's disease: Case studies
Authors: Martin-Cook Kristin , Trimmer Carolyn , Svetlik Doris , Weiner Myron F.
Published: June 2007

A series of individual caregivers were studied in a program for reducing caregiver burden. Using a modified caregiver burden inventory for assessment, an educational program and a needs-based intervention algorithm to guide intervention of caregivers, attempts were made to mitigate caregiver burden. A study of individual cases suggested that primary burden for caregivers included time spent in caring for loved ones and missing out on phase-of-life-appropriate activities. It was our impression that caregiver burden did not represent an appropriate outcome measure in this situation, and that the most desired outcome was the openness of individuals to assistance when and where they were able to accept it.
Two new intergenerational interventions for Alzheimer's disease patients and families
Authors: Cohen Gene D.
Published: June 2007

Two new intergenerational interventions for Alzheimer's disease (AD) patients (with moderately severe to severe cognitive impairment) and families are being evaluated, with work to date described. Both interventions share the common goals of:

• Introducing a novel long-term care intervention for Alzheimer patients and their families in order to increase the quality of life for both;

• Increasing the incentive of family members, significant others, and volunteers to visit and spend time with AD patients;

• Increasing staff knowledge of the patient as person;

• Effecting a new intergenerational environment at sites providing care for AD patients; and

• Providing a new paradigm for innovative budget neutral programs, requiring no new public monies, building upon and leveraging existing resources to enhance the quality of life of older adults coping with dementing disorders.

The first intervention uses video biographies; the second involves the first game specifically designed for AD patients and their families. In pilot studies both interventions have been shown to increase patient engagement during visits approximately three-fold. Family and staff interest in both projects has been high.
Changes in emotional and behavioral symptoms of Alzheimer's disease
Authors: Lee Michelle M. , Strauss Milton E. , Dawson Deborah V.
Published: June 2007

Emotional distress and disruptive behaviors were assessed for 26 persons with Alzheimer's disease (AD) at admission to a research registry and again three years later. Average prevalence of disruptive behaviors increased, as did the variability among patients in these characteristics. Individual differences in disruptive symptoms at initial assessment were unrelated to symptom status three years later. Emotional symptoms decreased on average and the patient group became more homogeneous in this symptom dimension. Nonetheless, individual differences in prevalence showed significant stability over three years. These differences in pattern of average change and predictability of changes suggest the importance of studying behavioral change in Alzheimer's disease in terms of individual differences as well as group trends within specific symptom clusters.
Compensatory strategies in picture description across severity levels in Alzheimer's disease: A longitudinal study
Authors: Ripich Danielle N. , Fritsch Thomas , Ziol Elaine , Durand Ellen
Published: June 2007

Communication changes over time were studied in 55-persons with Alzheimer's disease (AD) who completed a picture description task at entry, six, and 12-months. Differences at three levels of AD severity (early, middle, late) were investigated using six discourse measures (total utterances, length of utterance, words, abandoned utterances, information units, and conciseness), and six pragmatic measures (questions, turns, unsure statements, judgments, egocentric comments, and giving names). Across all three groups, subjects were less concise over time, made shorter utterances, asked more questions, and provided fewer information units. Increasing percentages of subjects made unsure statements with time. However, performance varied by severity group, with increasing unsureness occurring only at early AD, and all other observed changes occurring at late AD. Persons with AD appear to strive for communication competence as language declines by increasing certain compensatory pragmatic aspects (questions and unsure statements) at different severity levels of the disorder. This suggests that compensatory pragmatic devices are used with flexibility, and that the desire to communicate is maintained throughout the course of AD.
Donepezil (Aricept®) treatment of multi infarct dementia: The caregivers and clinical impression
Authors: Shua-Haim J. R. , Shua-Haim Vered , Comsti Eric , Ross J. S.
Published: June 2007

The purpose of this study was to investigate the clinical and caregivers impression of Aricept ® treatment in patients suffering from Multi-Infarct Dementia (MID).

In a prospective study 73 MID patients1 were treated with Donepezil (Aricept®) for 16-to 20-weeks. Donepezil was administered as a 5mg tablet once daily at bedtime. After four weeks, patients tolerant of the 5-mg dose were increased to 10 mg daily. All patients satisfied the DSM-III-R criteria for Multi-Infarct Dementia. 2 After 16-to 20-weeks of treatment, the patient's caregiver completed a questionnaire concerning the effectiveness of the drug. Subjective cognitive improvement, MMSE, 3 ADL4 and IADL5 outcomes were all assessed before and after treatment (referred to as Clinical Impression). Behavioral outcomes evaluated included depression, agitation, violence, anxiety, and paranoid thoughts. Functional and overall family satisfaction were also evaluated. Side effects as well as reasons for discontinuation from the study were also reported.

Seventy-three patients participated in the study. Twelve patients (16 percent) terminated participation due to side effects. Total adverse events were reported in 34 (46.5 percent) of patients. Cognitive improvement was reported in 31 (42.4 percent) patients. Verbal skills and attention were the most commonly reported cognitive improvement. Average MMSE declined by 2.6 points after 16-weeks of treatment. No behavioral improvement was reported. Behavioral deterioration was reported in 16 (21.9 percent) of patients. Functional improvement was reported in 32 (42.8 percent) patients. Overall positive family satisfaction was reported in 54 (73.9 percent) patients.

Although Donepezil treatment was approved by the FDA for the treatment of Alzheimer's Disease (AD), such treatment for MID patients appears to be a reasonably safe and effective treatment from the caregiver and family's point of view.
The behavioral assessment of depression for people with dementia
Authors: Allen Brad , Esser Wayne , Tyriver Christine , Striepling Angie
Published: June 2007

The underdiagnosis of depression is considered to be very common in primary care with only one-third to onehalf of those people with a major depressive disorder being identified. 1 In addition to major depression, 50 percent of the approximately 1.5 million people in the United States residing in nursing facilities have less severe symptoms of depression which are also undiagnosed and untreated. 2 The under diagnosis of depression is even more apparent when a person has a cognitive impairment since the symptoms of depression are often mistakenly attributed to dementia. 3The following study compared the symptoms or behaviors of two groups of people, those with dementia and those with dementia and depression, using symptoms/behaviors taken from the Cornell Scale for Depression in Dementia. Of the 19 symptoms on the CSDD, none significantly discriminated the depressed group from the nondepressed group. This finding suggests that diagnosis based upon current observational approaches is insufficient when assessing for depression with concomitant moderate to severe dementia. Further considerations for assessing depression in dementia were discussed.
Empowering individuals with early dementia and their carers: An exploratory study in the Chinese context
Authors: Chung Jenny C.C.
Published: June 2007

This article discusses an early dementia program developed for sufferers and family carers in a Chinese context. Instead of replicating formats of similar programs developed in Western countries, this program considered cultural issues and caring values that are unique to Chinese people. Its main objective was to empower sufferers and carers through educational activities and support programs. Observations and interviews were used for program evaluation. The program creates a “win-win” situation in which both parties experienced pleasurable feelings and developed a close relationship. It also highlights the values of “meaningful occupation” in dementia care. Furthermore, the program broadens our understanding of needs and concerns of sufferers and carers at early stages, which are deemed important to develop continuous dementia programs along the disease course.
Legal guardianship and other alternatives in the care of elders with Alzheimer's disease
Authors: Kane Michael N.
Published: June 2007

This paper discusses planned instructional and proxy interventions for incapacity, legal guardianship, and supplements to care for people with Alzheimer's disease (AD). Service providers are encouraged to identify and initiate care decisions that are consistent with the client's care preferences. Case examples are discussed. Practitioners are encouraged to educate clients, particularly those in the early stages of Alzheimer's disease, to create evidence for care preferences through planning. Service providers' concerns for liability are briefly discussed.
Inherited Alzheimer's disease PS-1 olfactory function: A 10-year follow-up study
Authors: Nee Linda E. , Lippa Carol F.
Published: June 2007

This study was undertaken to evaluate smell tests as a clinical marker for identifying mutation carrier status and determining the clinical diagnosis of presenilin-1 Alzheimer's disease (AD) in family members of those afflicted with the disease. Ten years ago, we gave the self-administered, 40-question scratch and sniff University of Pennsylvania Smell Identification Test to 18 atrisk family members, individuals with dominantlyinherited Alzheimer's disease.

Testing results were normal 10 years ago except in the case of one individual who had smoked three packs of cigarettes a day for more than 23 years. Four subjects tested in 1990 are now afflicted with Alzheimer's disease, including the smoker. The smell test in 1990 did not demonstrate predictive capabilities before clinical conversion to dementia. At follow-up, two subjects were too impaired to take the test. Two “converted” from normal smell function toabnormal function with a wide range in score. Study findings indicate that the smell test is too variable a measure to be used as a reliable test for predicting or verifying a diagnosis of presenilin-1 Alzheimer's disease.
Psychological features in persons at risk for familial Alzheimer's disease
Authors: Swearer Joan M. , O'Donnell Brian F. , Parker Michael , Kane Kevin J. , Drachman David A.
Published: June 2007

Persons at risk for inherited neurodegenerative diseases may experience symptoms of anxiety and depression because of concern over the possibility of developing the disease in the future. The purpose of this study was to assess psychological and emotional symptoms in persons at the age of risk for developing early-onset familial Alzheimer's disease (FAD). Their responses on a psychiatric rating scale (SCL-90-R) were compared with four groups: patients with mild FAD; head injury patients; patients with clinically diagnosed depression; and healthy control subjects. Mean scores of the at-risk FAD group were not statistically different than those of the controls. In contrast, the head injury and depressed groups had significantly elevated scores across the clinical scales. These results suggest that depression and anxiety are not prominent features in persons at genetic risk for early-onset familial Alzheimer's disease. Similar results have been found in studies of persons at risk for developing Huntington's disease, another autosomal dominant neurodegenerative disease.
The employee victim of violence: Recognizing the impect of untreated psychological trauma
Authors: Flannery Raymond B.
Published: June 2007

The impact of psychological trauma in the workplace often goes unaddressed. The untreated aftermath of these critical incidents may manifest itself in various states of anxiety, depression, substance use disorders, and even subsequent violence by the victims. This paper reviews common presentations of untreated traumatic events and provides suggestions for outreach to untreated employee victims as well as basic prevention strategies to reduce the risk of additional episodes of violence and enhance safety in health care facilities, including long-term care (LTC) and special-care units (SCU) for dementia patients.
An overview of AIDS dementia complex
Authors: Meehan Rebecca A. , Brush Jennifer A.
Published: June 2007

The major neurological complications associated with HIV infection include cognitive, behavioral, and motor disturbances, which may range in severity from subtle, mild cognitive deficits to the clinical syndrome referred to as HIV-associated dementia or AIDS dementia complex (ADC). As with Alzheimer's type dementia, caregivers for people with HIV/AIDS have the overwhelming and burdensome task of caring for someone with deteriorating cognitive abilities, increasing physical debilitation, and changes in personality. This article describes ADC as well as some of the similarities and differences from Alzheimer's type dementia, and offers some special considerations for older adults and HIV.
Using external memory aids to increase room finding by older adults with dementia
Authors: Nolan Beth A. D. , Mathews R. Mark , Harrison Melanie
Published: June 2007

When nursing home residents with dementia are unable to locate their own rooms, it often creates problems for staff and other residents. The impact of placing two external memory aids outside participants' bedrooms was evaluated by using a multiple-baseline design experiment. Three female special care unit (SCU) residents with severe Alzheimer's disease (MMSE = 5.7) participated in the study. Results showed that a combination of a portrait-type photograph of the participant as a young adult and a sign stating the resident's name increased room finding by over 50 percent with all three participants. Room finding stabilized at 100 percent accuracy for all participants within a few days of implementing the environmental intervention.
Placement challenges: Implications for Long-term care of dementia sufferers
Authors: Marks Louise , Flannery Raymond B. , Spillane Michael
Published: June 2007

Caregivers and long-term care staff seek appropriate placements for dementia sufferers, but there is little empirical research to guide such decision-making. However, recent national trends in mental health care have emphasized the placement of persons with serious mental illness in privatized, community-based residences. This body of empirical research has indicated that persons with psychosis, substance use disorder, assaultive behavior, and medication noncompliance have shorter tenure in these residential settings. These findings are also important for other, more traditional health care settings, as the patients discharged from community residences may require assistance on occasion from such other settings. This study continues the inquiry into the characteristics of patients with serious mental illness, who have shorter tenure in community residences. Dangerous behaviors, treatmentresistant psychosis, medical illnesses, and social-interpersonal skill deficiencies were common causes for discharge in this study. Since there remains a paucity of published empirical studies on the issue for patients with Alzheimer's disease and other dementias, we present the implications of, and guidelines for, addressing these issues in dementia sufferers in long-term care settings.
Keeping the beat: Use of rhythmic music during exercise activities for the elderly with dementia
Authors: Mathews R. Mark , Clair Alicia A. , Kosloski Karl
Published: June 2007

Involving people with dementia in group exercise activities often presents a challenge. The effects of a recorded instrumental musical accompaniment was evaluated on participation in a series of 14 exercise activities with a group of nursing home residents with dementia. All exercise sessions, specifically designed by physical therapists for older adults, were lead by an activity aide and consisted of a series of seated exercises. Direct observations of resident behavior were conducted over a 25-week period in a reversal experimental design. Results showed increased levels of participation during the experimental condition observations where rhythmic music accompanied the exercise activities. The music intervention was most successful on those generally most willing to participate in social activities.
Apolipoprotein epsilon-4 allele and the two-year progression of cognitive function in Chinese subjects with late-onset Alzheimer's disease
Authors: Lam Linda CW , Tang Nelson LS , Ma Sl , Lui Victor WC , Chan Agnes SY , Leung P Y , Chiu Helen FK
Published: June 2007

Background: Although the significance of apolipoprotein E4 (Apo E4) in Alzheimer's disease (AD) has been well established in Caucasian populations, its role in determining the rate of cognitive decline in other ethnic groups has yet to be determined This study examined the two-year progression of cognitive decline and its association with Apo E4 allelic status in a group of Chinese elderly subjects with AD.

Method: One hundred andfour Chinese subjects with mild and moderate AD as assessed by the Clinical Dementia Rating (CDR 1 and 2) were followed up at a mean (SD) duration of 22.53 (5.21) months. The rate of cognitive decline and its association with Apo E4 allelic status was evaluated.

Results: At follow-up, 74 (73 percent) subjects were reassessed. Forty-nine remained stable at the same CDR and 25 had deteriorated The mean (SD) deterioration in the Mini-Mental State Examination (MMSE) was 2.52 (4.38) and in the Mattis Dementia Rating Scale (DRS) was 9.03 (14.98) (paired t-test, p < 0. 001). There was no significant difference in the baseline MMSE and DRS scores between the “stable,” “deteriorated,” or “deceased” groups. Mildly demented subjects with the Apo E4 allele were more likely to have deteriorated to a more severe CDR than subjects without the Apo E4 allele (Pearson χ2 = 5.72, df 1, p = 0.017, Odds ratio = 6.3, CI 1.3 to 30.53).

Conclusion: The presence of the Apo E4 allele may influence the rate ofcognitive deterioration, particularly in subjects with mildAD.
Management of aggression, agitation, and psychosis in dementia: Focus on atypical antipsychotics
Authors: Aupperle Peter
Published: June 2007

The behavioral and psychological symptoms of dementia (BPSD), such as psychosis, agitation, or aggression have a considerable negative impact on the quality of life of both patients and their caregivers. Multiple studies have demonstrated that atypical antipsychotics are efficacious in the treatment of the aggressive and psychotic symptom clusters, and here we review their use in this indication. Because of the safety concerns associated with the use of atypical antipsychotics in this population, these drugs must be usedjudiciously. For patients with severe BPSD such as psychosis, agitation, or aggression, for whom there are few options, atypical antipsychotics, particularly risperidone and olanzapine, should be considered.
Herbal medicine in the treatment of Alzheimer's disease
Authors: Akhondzadeh Shahin , Abbasi Seyed Hesameddin
Published: June 2007

Alzheimer s disease (AD) is characterized by profound memory loss sufficient to interfere with social and occupationalfunctioning. It is the most common form of dementia, affecting more than 20 million people worldwide. AD is characterized by an insidious loss of memory, associated functional decline, and behavioral disturbances. Patients may live for more than a decade after they are diagnosed with AD, making it the leading cause of disability in the elderly. The incidence of AD rangesfrom I to 4 percent of the population per year, rising from its lowest level at ages 65 to 70 years to rates that may approach 6 percent for those over the age of 85 years. The first neurotransmitter defect discovered in AD involved acetylcholine (A Ch). As cholinergic function is requiredfor short-term memory, the cholinergic deficit in AD was also believed to be responsible for much of the short-term memory deficit. Clinical drug trials in patients with AD have focused on drugs that augment levels of A Ch in the brain to compensate for the loss of cholinergic function. These drugs have included ACh precursors, muscarinic agonists, nicotinic agonists, and acetylcholinesterase inhibitors. The most highly developed and successful approaches to date have employed acetylcholinestrase inhibition. Although some Food and Drug Administration-approved drugs are available for the treatment ofAlzheimer's disease, the outcomes are often unsatisfactory, and there is a place for alternative medicine, in particular, herbal medicine. This paper reviews the clinical effects of a number of commonly used types of herbal medicines for the treatment ofAD.
Recognition and treatment of Alzheimer's disease: A case-based review
Authors: Marseille Dana M. , Silverman Daniel H.S.
Published: June 2007

Early recognition and treatment initiation are pivotal in managing Alzheimer k disease (AD). Once a diagnosis of AD is made, a treatment plan is developed and should include treatment initiation with cholinesterase inhibitors (ChEfs) to improve cognition, management of comorbid conditions, and treat behavioral symptoms. Caregiver compliance is integral to AD treatment success. The purpose of this report is to present two real case studies of “suspected” AD or related dementia and stress the significance of early and accurate diagnosis in disease management. In case 1, a caregiver reports gradual but progressive loss of memory, and the patient himself complains of memory impairment. Neuroimaging analysis confirms “typical” AD. In case 2, initiation of ChEI therapy is followed by substantial clinical improvement in the face of a complex medical picture, and neuroimaging revealing more neurodegenerative changes than could be accountedfor by “pure” AD.
Antioxidant protection and neurodegenerative disease: The role of amyloid-β and tau
Authors: Castellani Rudy J. , Lee Hyoung-gon , Perry George , Smith Mark A.
Published: June 2007

In Alzheimer s disease (AD), the major components of senile plaques and neurofibrillary tangles, amyloid-β and tau, respectively, are thought by many to play a key role in disease initiation and progression. However, herein we propose that rather than being initiators of disease pathogenesis, the lesions that characterize AD, senile plaques and neurofibrillary pathology, occur consequent to oxidative stress and, importantly, function as a primary line of antioxidant defense. Importantly, this paradigm shift in thinking about the role of lesions in disease also provides an explanation for the appearance of both amyloid-β and tau in control individuals given the increased levels of oxidative stress associated with the aged brain. In AD, oxidative stress is not only high but chronic and is superimposed upon an age-related vulnerable environment. Therefore, one would predict, successfully, an increased lesion load in patients with AD above and beyond that seen in normal aging. The notion that amyloid-β and tau accumulations indicate adaptation and, likely, physiological processes sheds light on the pathological expression of disease and calls into question the rationale of current therapeutic efforts targeted toward lesion removal.
The Accusers in Dementia
Authors: Nagaratnam Nages , Keen Ross , Gayagay George
Published: June 2007

The purpose of this retrospective study of 116 dementia patients with and without accusatory behavior was to determine its frequency and evaluate its relationship to individual characteristics, behavioral and psychological symptoms, and certain dementia-related domains, namely, cognitive impairment, stage of disease, language difficulties, and functional disability. Little more than one third (38%) of the patients studied had accusatory behavior. The average age of the patients with accusatory behavior was 74 years, and the male to female ratio was 2.6:1. Accusatory behavior was more prevalent in the higher stages of dementia by 2- to 3-fold and was positively associated with hallucinations. Three patients with accusatory behavior had delusions of infidelity. There were no significant associations between accusatory behavior and other categories studied. This study raises a caveat of issues and, more important, whether the different themes relating to accusatory behaviors are true delusions, persecutory ideation, misidentification, nondelusional suspiciousness, or other. It is suggested that it would be more useful to relate them as symptoms.