Spotlight on community engagement: NICE resources in the context of COVID-19-NICE public health guidance update.

This article focuses on how the National Institute for Health and Care Excellence (NICE) quality standard on 'Community engagement: improving health and wellbeing' (QS148) may be used to support local areas with pandemic recovery planning. This article sets the standard in the context of the coronavirus pandemic, explores some of its content and highlights additional NICE resources to support its use across the health and care system.

Molecular spectrum of the SPAST, ATL1 and REEP1 gene mutations associated with the most common hereditary spastic paraplegias in a group of Polish patients.

Hereditary spastic paraplegias (HSPs) consist of a heterogeneous group of genetically determined neurodegenerative disorders. Progressive lower extremity weakness and spasticity are the prominent features of HSPs resulting from retrograde axonal degeneration of the corticospinal tracts. Three genetic types, SPG3 (ATL1), SPG4 (SPAST) and SPG31 (REEP1), appear predominantly and may account for up to 50% of autosomal dominant hereditary spastic paraplegias (AD-HSPs). Here, we present the results of genetic testing of the three mentioned SPG genetic types in a group of 216 unrelated Polish patients affected with spastic paraplegia. Molecular evaluation was performed by multiplex ligation-dependent probe amplification (MLPA) and DNA sequencing. Nineteen novel mutations: 13 in SPAST, 4 in ATL1 and 2 in REEP1, were identified among overall 50 different mutations detected in 57 families. Genetic analysis resulted in the identification of molecular defects in 54% of familial and 8.4% of isolated cases. Our research expanded the causative mutations spectrum of the three most common genetic forms of HSPs found in a large cohort of probands originating from the Central Europe.

Food provision for older people receiving home care from the perspectives of home-care workers.

Malnutrition is a significant cause of morbidity and mortality, particularly among older people. Attention has focused on the inadequacies of food provision in institutions, yet the majority suffering from malnutrition live in the community. The aim of this study was to explore barriers and facilitators to food provision for older people receiving home care. It was a qualitative exploratory study using semi-structured interviews with nine home-care workers in June 2013 employed by independent agencies in a large city in northern England. Data were analysed thematically, based on the principles of grounded theory. Findings showed that significant time pressures limited home-care workers in their ability to socially engage with service users at mealtimes, or provide them with anything other than ready meals. Enabling choice was considered more important than providing a healthy diet, but choice was limited by food availability and reliance on families for shopping. Despite their knowledge of service users and their central role in providing food, home-care workers received little nutritional training and were not involved by healthcare professionals in the management of malnutrition. Despite the rhetoric of individual choice and importance of social engagement and nutrition for health and well-being, nutritional care has been significantly compromised by cuts to social care budgets. The potential role for home-care workers in promoting good nutrition in older people is undervalued and undermined by the lack of recognition, training and time dedicated to food-related care. This has led to a situation whereby good quality food and enjoyable mealtimes are denied to many older people on the basis that they are unaffordable luxuries rather than an integral component of fundamental care.

Tremor in neuropathies of different origin.

BACKGROUND AND PURPOSE: Tremor accompanies some poly-neuropathies, but its prevalence and its clinical and electrophysiological manifestations are not well known. The aim of the study was to assess the occurrence and characteristics of hand tremor in patients with polyneuropathy of different origins, as well as relations between the occurrence of tremors and clinical and neurographic findings of polyneuropathy. MATERIAL AND METHODS: Eighty-nine patients diagnosed with polyneuropathy of known aetiology, and 50 age- and sex-matched healthy volunteers were included in the study. All subjects were interviewed regarding the occurrence of tremor. Tremor was assessed clinically and objectively using a triaxial accelerometer and electromyographic (EMG) recordings. A load test with a weight of 500 γ was performed in order to differentiate between enhanced physiological tremor (EPT) and essential tremor-like (ET-L) tremor. RESULTS: Tremor was found in 59.5% of patients in clinical assessment and in 74% of patients in objective evaluation, significantly more often than in controls (12%). Tremor was detected in all types of polyneuropathy apart from paraproteinaemic IgM polyneuropathy. Tremor was postural (70%), but resting (51%) or kinetic (32%) tremor was also present. In the majority of cases, the severity of the tremor was mild. Essential tremor-like tremor prevailed in the study group. The occurrence of hand tremor was not related to the axonal or demyelinating type of polyneuropathy, nor to the conduction velocity or other electrophysiological findings of the investigated upper limb nerves. CONCLUSION: Tremor accompanies 60-70% of patients with polyneuropathy; it is mostly postural, ET-L type with mild severity, and unrelated to other typical clinical and electrophysiological findings of neuropathy.

Exploring the mealtime experience in residential care settings for older people: an observational study.

Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research.