Free range users and one hit wonders: community users of an Internet-based cognitive behaviour therapy program

OBJECTIVE: Little is known about the predictors of symptom change or the methods that might increase user 'compliance' on websites designed to improve mental health outcomes. The present paper: (i) examines predictors of expected final depression and anxiety scores on the MoodGYM website as a function of user characteristics; and (ii) compares the compliance rates of the original site with the new public version of the site (MoodGYM Mark II). The latter site requires compulsory completion of 'core' online assessments and may increase completion of site questionnaires. METHOD: MoodGYM Mark I participants were 19,607 visitors (public registrants) between April 2001 and September 2003 plus 182 participants who had been randomly assigned to MoodGYM in an earlier trial (The BlueMood Trial). MoodGYM Mark II participants were 38,791 public registrants of the MoodGYM Mark II site collected between September 2003 and October 2004. Symptom assessments are repeated within the website intervention to allow the examination of change in symptoms. Outcome variables were gender, initial depression severity scores, number of assessments completed and final anxiety and depression scores. RESULTS: Men are predicted to be 0.19 units (SE=0.095) higher than women on depression, controlling for the initial depression level and number of modules completed. For initial depression scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. For initial anxiety scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. Mark II registrants were more likely than to Mark I registrants to complete onsite assessments. CONCLUSIONS: Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.     

Risk management dilemmas in dementia care: an organizational survey in three UK countries

Aims and objectives.  The overall project aimed to understand the variability of the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. This paper focuses on the objective of identifying the understandings of risk by practitioners.
Background.  Risk management can result in a 'safety first' approach to care practices, but this may be disempowering for people with dementia.
Design.  This paper describes the results of the first stage of the study: a survey to service managers or equivalent in health, social and voluntary sector care organizations in three countries of the UK.
Methods.  Data from this stage was collection by postal questionnaire ( n  = 46).
Results.  Risk was portrayed as a multidimensional concept and clustered around three themes: (1) Risk and Independence, (2) Risk and Resource, and (3) Organizational Risk Management.
Conclusions.  Very wide understandings of risk are identifiable, ranging from avoidance of physical harm through to managed risk taking to improve quality of life, and to an appreciation of the impact of organizational and professional patterns of behaviour resulting in harm to the person with dementia.
Relevance to clinical practice.  Obtaining information about the perspectives of others may help to illuminate some of the dilemmas experienced by staff in this study, and the development of risk assessment frameworks may assist staff to resolve some of these.     

Factors Associated with Successful Ageing

Book reviews in this article: Objective : To assess the prevalence of successful ageing and the factors associated with it. Method : An epidemiological survey was carried out with 1,045 persons aged 70+ living in Canberra or Queanbeyan. Successful ageing was defined as living in the community without disability, with excellent or good self-rated health and a high score on a cognitive screening test. Results : The prevalence of successful ageing declined steeply from age 70–74 to age 80+. Men had a higher prevalence than women. In both men and women, successful ageing was associated with higher verbal intelligence. For women there were, in addition, associations with lower neuroticism, not smoking and lower frequency of strenuous activity earlier in life. Conclusions : While the ageing of the population may lead to a higher prevalence of age-related disease, increasing intelligence test scores in future cohorts of the elderly may lead to countervailing positive effects on successful ageing.     

‘You have got to stick to your times’: Care workers and managers’ experiences of working in extra care housing

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016–2017. This paper reports findings from semi‐structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care.     

Associations of birth weight and length, childhood size, and smoking with bone fractures during growth: evidence from a birth cohort study

Little information exists on risk factors associated with bone fractures during childhood and adolescence. This 1972/1973-1990/1991 New Zealand study examined the influence of birth size, height and weight throughout growth, smoking, breastfeeding, and sports participation on the risk of fracture in participants of the Dunedin Multidisciplinary Health and Development Study. Information on height, weight, fracture status, and lifestyle was collected at birth and at ages 3, 5, 7, 9, 11, 13, 15, and 18 years from parents and/or participants. Study members sustained 229 (girls) and 393 (boys) fractures between birth and age 18 years. Fracture risk was elevated (per standard deviation unit increase) in relation to birth length (prepubertal fractures only) (risk ratio (RR) = 1.28, 95% confidence interval (CI): 1.04, 1.58), weight at age 3 years (RR = 1.14, 95% CI: 1.03, 1.27), weight from ages 5 to 18 years (RR = 1.15, 95% CI: 1.03, 1.28), height at age 3 years (RR = 1.13, 95% CI: 1.01, 1.26), and height from ages 5 to 18 years (RR = 1.13, 95% CI: 1.02, 1.24). Birth weight, maternal smoking, breastfeeding, and sports participation had no significant effect on fracture risk. However, for teenagers, personal daily smoking increased the risk of fracture (RR = 1.43, 95% CI: 1.05, 1.95). The authors concluded that tall and heavy children had an increased risk of fracture, as did adolescents who smoked regularly.