The (cost-) effectiveness of exergaming in people living with dementia and their informal caregivers: protocol for a randomized controlled trial.

BACKGROUND: Physical activity is linked to benefits such as increased physical fitness, cognition, emotional and social functioning, general health and well-being in older people. Some evidence suggests that this also applies to people living with dementia. However, it can be harder for them to perform physical activities, due to several barriers, such as issues with orientation and balance problems. A relatively new type of physical activity called exergaming may help them overcome these barriers. Exergaming is "physical exercise interactively combined with cognitive stimulation in a gaming environment". The aim of our study is to evaluate the effectiveness and cost-effectiveness of exergaming compared to regular activities in people living with dementia, who attend day-care centres. Additionally, we want to investigate whether the exergaming activity for the person living with dementia, also (indirectly) affects the informal caregiver, as well as which facilitators and barriers to implementation of exergames for this target group exist. METHODS: A cluster Randomized Controlled Trial (RCT), with economic and process evaluations alongside will be carried out. In the Netherlands, 24 day-care centres are randomized in the experimental or control group. The study group will consist of 224 dyads (community-dwelling participants with dementia and their informal caregivers), who are interviewed at baseline, and at 3 and 6 months of follow-up. The participant with dementia has to visit the day-care centre for at least two days per week, have a diagnosis of mild to moderate dementia and have an informal caregiver present, who is willing to participate. Societal cost data will be collected during interviews, using healthcare utilization diaries, and from day-care centres. The process evaluation will only involve the experimental group, and will include an online survey, qualitative interviews and focus groups. DISCUSSION: This study will contribute to the evidence base that more effective exercise among people with dementia will result in positive effects on their wellbeing and quality of life. This will motivate people with dementia to be physically active. We also envision that there might be a positive effect on the burden of care experienced by their informal caregivers. TRIAL REGISTRATION: This trial was registered at the Netherlands Trial Register (NTR) on December 10, 2015 (number: NTR5537 ), this publication is based on protocol amendment number 01, issue date 28 December 2018. This includes all items from the World Health Organization Trial Registration Data Set [see Additional file 1].

Family relationships and the psychosocial adjustment of school-aged children in intact families.

The authors investigated whether the quality of three family relationships (i.e., marital, parent-child, sibling) in intact families are associated with each other and with children's psychosocial adjustment. Data were collected by means of maternal and child reports (N = 88) using standardized instruments (i.e., Marital Satisfaction Scale, Strengths and Difficulties Questionnaire). The findings confirm associations between the marital and the parent-child relationship, and between the parent-child and the sibling relationship, Further, both father-child relationships and sibling relationships predict children's adjustment. Father-child conflicts contribute to children's problem behavior, while father-child acceptance and sibling affection contribute significantly to children's general self-esteem. However, contrary to previous studies no support was found for the association between marital relationship and sibling relationship, or for that between marital relationship quality and children's adjustment.

Same-sex attraction, social relationships, psychosocial functioning, and school performance in early adolescence.

The authors examined whether 13- to 15-year-old adolescents who experience feelings of same-sex attraction (SSA) differ from those without such feelings in the quality of relationships with parents, peers, and class mentors and in psychosocial functioning (health status and school performance). The authors also assessed whether differences in psychosocial functioning resulted from differences in the quality of social relationships. Data were collected from 866 Dutch high school students (mean age 13.61 years) by means of a computer-based questionnaire. Of the participants, 74 (8.5%) reported having feelings of SSA. The participants with SSA rated the quality of their relationships with their fathers and their peers lower than did those without SSA. Participants with SSA also had poorer mental health (higher levels of depression and lower levels of self-esteem) and lower school performance. A mediation analysis revealed that differences in psychosocial functioning resulted from differences in the quality of the same-sex attracted youths' social relationships, especially with fathers and peers.

Child adjustment and parenting in planned lesbian families with known and as-yet unknown donors.

The present study examined child adjustment, experience of parenthood, and child-rearing between two types of planned lesbian families (i.e., two-mother families in which the child had been born to the lesbian relationship), viz. those with a known donor (n = 42) and those with an as-yet unknown donor (n = 58) (both with children between 4 - 8 years old). Data were collected by means of parental reports and standardized instruments were used in the questionnaires (e.g., Child Behaviour Checklist; CBCL). No differences were found on internalizing, externalizing and total problem behaviour scales of the CBCL between children with a known and a currently unknown donor, nor were differences found on parental stress and child rearing. However, social problems were more frequently reported for the children with known donors, and boys with a known donor showed more attention problems. Furthermore, annoying questions from people in their social environment as well as gossip and feelings of being excluded, were more frequently reported by mothers with a (currently) unknown donor.