Augmented Reality Improves Pediatric Mask Induction: A Prospective, Matched Case-Control Study.

Introduction: Pediatric perioperative anxiety is a significant problem during mask induction for general anesthesia. Immersive technologies, such as extended reality headsets, are a promising strategy for alleviating anxiety. Our primary aim was to investigate mask acceptance during inhalational induction utilizing augmented reality (AR). Methods: This was a prospective, matched case-control study at a quaternary academic hospital. Fifty pediatric patients using AR for mask induction were matched to 150 standard-of-care (SOC) controls. The primary outcome was measured with the Mask Acceptance Scale (MAS). Secondary outcomes of cooperation and emergent delirium (ED) were assessed. Results: MAS scores ≥2 occurred at 4% (95% CI [0, 9.4%]) with AR versus 19.3%, (95% CI [13%, 25.7%]) with SOC (RR 0.21, 95% CI [0.05, 0.84], P = .027). Ninety-eight percent of AR patients were cooperative versus 91.3% with SOC (P = .457). Zero percent had ED with AR versus 0.7% with SOC (P = 1.000). Conclusions: AR during mask induction improved mask acceptance compared to SOC. No relationship was observed between AR and cooperation or ED. Future research will investigate the integration of AR into clinical practice as a nonpharmacologic intervention.

Time-Dependent Changes in Depressive Symptoms Among Control Participants in Digital-Based Psychological Intervention Studies: Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Digital-based psychological interventions (DPIs) have been shown to be efficacious in many randomized controlled trials (RCTs) in dealing with depression in adults. However, the effects of control comparators in these DPI studies have been largely overlooked, and they may vary in their effects on depression management. OBJECTIVE: This meta-analytical study aimed to provide a quantitative estimate of the within-subject effects of control groups across different time intervals and explore the moderating effects of control types and symptom severity at baseline. METHODS: A systematic literature search was conducted in late September 2021 on selected electronic databases: PubMed; ProQuest; Web of Science; and the Ovid system with MEDLINE, PsycINFO, and Embase. The control conditions in 107 RCTs with a total of 11,803 adults with depressive symptoms were included in the meta-analysis, and effect sizes (Hedges g) were calculated using the standardized mean difference approach. Study quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. RESULTS: The control conditions collectively yielded small to moderate effects in reducing depressive symptoms within 8 weeks since the baseline assessment (g=-0.358, 95% CI -0.434 to -0.281). The effects grew to moderate within 9 to 24 weeks (g=-0.549, 95% CI -0.638 to -0.460) and peaked at g=-0.810 (95% CI -0.950 to -0.670) between 25 and 48 weeks. The effects were maintained at moderate to large ranges (g=-0.769, 95% CI -1.041 to -0.498) beyond 48 weeks. The magnitude of the reduction differed across the types of control and severity of symptoms. Care as usual was the most powerful condition of all and produced a large effect (g=-0.950, 95% CI -1.161 to -0.739) in the medium term. The findings showed that waitlist controls also produced a significant symptomatic reduction in the short term (g=-0.291, 95% CI -0.478 to -0.104), refuting the previous suspicion of a nocebo effect. In addition, a large effect on depressive symptom reduction in the long term (g=-1.091, 95% CI -1.210 to -0.972) was noted among participants with severe levels of depressive symptoms at baseline. CONCLUSIONS: This study provided evidence that depressive symptoms generally reduced over time among control conditions in research trials of DPIs. Given that different control conditions produce variable and significant levels of symptomatic reduction, future intervention trials must adopt an RCT design and should consider the contents of control treatments when investigating the efficacy of DPIs. The results of waitlist controls confirmed previous findings of spontaneous recovery among people with mild to moderate depressive symptoms in face-to-face studies. Researchers may adopt watchful waiting as participants wait for the availability of digital-based psychological services.

Endothelial reactive oxygen-forming NADPH oxidase 5 is a possible player in diabetic aortic aneurysm but not atherosclerosis.

Atherosclerosis and its complications are major causes of cardiovascular morbidity and death. Apart from risk factors such as hypercholesterolemia and inflammation, the causal molecular mechanisms are unknown. One proposed causal mechanism involves elevated levels of reactive oxygen species (ROS). Indeed, early expression of the ROS forming NADPH oxidase type 5 (Nox5) in vascular endothelial cells correlates with atherosclerosis and aortic aneurysm. Here we test the pro-atherogenic Nox5 hypothesis using mouse models. Because Nox5 is missing from the mouse genome, a knock-in mouse model expressing human Nox5 in its physiological location of endothelial cells (eNOX5ki/ki) was tested as a possible new humanised mouse atherosclerosis model. However, whether just on a high cholesterol diet or by crossing in aortic atherosclerosis-prone ApoE-/- mice with and without induction of diabetes, Nox5 neither induced on its own nor aggravated aortic atherosclerosis. Surprisingly, however, diabetic ApoE-/- x eNOX5ki/ki mice developed aortic aneurysms more than twice as often correlating with lower vascular collagens, as assessed by trichrome staining, without changes in inflammatory gene expression, suggesting that endothelial Nox5 directly affects extracellular matrix remodelling associated with aneurysm formation in diabetes. Thus Nox5-derived reactive oxygen species are not a new independent mechanism of atherosclerosis but may enhance the frequency of abdominal aortic aneurysms in the context of diabetes. Together with similar clinical findings, our preclinical target validation opens up a first-in-class mechanism-based approach to treat or even prevent abdominal aortic aneurysms.

Effectiveness of a mindfulness intervention for older adults to improve emotional well-being and cognitive function in a Chinese population: A randomized waitlist-controlled trial.

BACKGROUND: To investigate the effect of a modified mindfulness-based stress reduction (mMBSR) program on mental well-being and cognitive function of older adults. METHOD: Two hundred and fourty-six participants were randomly assigned to mMBSR (n = 120) group or waitlist control group which received mMBSR at 2-month (n = 123). Data collected at baseline, 2 and 4 months after recruitment. PRIMARY OUTCOME: mental well-being: Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). SECONDARY OUTCOMES: Five Facet Mindfulness Questionnaire Short Form, Montreal Cognitive Assessment (MOCA), Verbal Fluency Test (VFT), international shopping list test, self-compassion scale, peace of mind scale, geriatric depression scale (GDS), and Pittsburgh sleep quality index (PSQI). In modified-intention-to-treat analysis, paired t-test for within group comparison, and ANCOVA to compare group differences at 2-months with adjustment of baseline values. RESULTS: Most participants were female (83.7%), living with others (67.0%), and married (50.7%). No significant difference of baseline characteristics except sleep quality. At 2 months, intervention group reported better mental well-being (0.9, 95%CI: 0.1-1.8, p = 0.025) and less depressive symptoms (-1.0; 95%CI: -1.7 to -0.3, p = 0.004). Within group at 2 months, intervention group had improvement in: mental well-being (SWEMWBS: 22.5-23.4, p = 0.011), cognitive function (MOCA: 24.6-25.8, p < 0.001; VFT: 38.7-42.1, p < 0.001), depressive symptoms (GDS: 4.1-3.1, p < 0.001), and sleep quality (PSQI: 8.3-6.7, p < 0.001). All these changes, except mental well-being, were sustained at 4 months. DISCUSSION: Attrition rate was 14% and mindfulness intervention was found to be feasible and acceptable in older adults. Major limitation of the study was the absence of an active control group to control for non-specific effect.

The impact of dementia daycare service cessation due to COVID-19 pandemic.

OBJECTIVES: This study aimed at revealing the caregiving challenges of the caregivers of people with dementia (PwD) during the COVID-19 pandemic when daycare service was stopped as an infection control measure, and discussed ways to help PwD and their family caregivers to maintain their well-being in the era of the pandemic. METHODS: Between April and May 2020, a cross-sectional survey was conducted in 152 family caregivers of PwD who were clients of daycare service prior to the pandemic. The survey examined caregivers' stress and challenges faced during daycare service cessation, their perceived needs for continuation of daycare service, and observed changes in functional status of PwD. Regression analyses were performed to explore the associated factors of caregiving stress and preference for continuation of daycare service. RESULTS: Family caregivers of PwD experienced greater caregiving stress after cessation of daycare service. Infection was their main challenge in caregiving, and their physical and emotional health was adversely affected by the longer time commitment with PwD under the stay-home policy. Older age of caregivers, greater emotional and communication problems of PwD, and more time spent with PwD were associated with greater caregiving stress. More than one-third of the participants preferred the continuation of daycare service during the pandemic. CONCLUSIONS: Policy makers should consider the well-being of PwD and their caregivers when planning infection control measures. Daycare service with enhanced infection controlled measures should remain available to PwD during the COVID-19 pandemic.

Capacity building for dementia care in community care services: a mixed methods approach.

BACKGROUND: The prevalence of dementia is surging that results in huge service demand in the community care services. Dementia care competence of staff working in these settings is fundamental of the care quality. This project aims to examine the effects of staff training on their competence for the anticipated challenges in dementia care and explore how the training influence their care practices. METHODS: This study adopted a mixed methods triangulation design, including a prospective multi-center study with pre-test post-test evaluations and a narrative analysis of the participants' reflective essays. Seventeen experienced health and social care professionals were trained as trainers at the Dementia Services Development Centre of the University of Stirling, UK. The trainers provided local facilitator training to staff members by using training materials that were culturally adapted to the local context. The facilitators were required to deliver 12 two-hour in-service training sessions for 6 months to their colleagues in a small group format in their respective workplace. Eventually a total of 1347 staff members from community care centers, day care centers, outreach teams and care homes of 70 non-government organizations in Hong Kong participated in the study between April 2017 and December 2018. Validated instruments were used to measure knowledge, attitude, sense of competence in dementia care and job satisfaction at the baseline and at 12-month follow-up. All participants were required to write a reflective essay to describe their experiences in dementia care by the end of the training. RESULTS: A total of 1264 participants, including 195 facilitators and 1069 learners, completed all assessment were included for analysis. Significant improvements were observed in all outcomes at the 12-month follow-up assessment (Ps ≤ .001). The magnitude of improvements in attitudes was the largest. The findings also showed that the effects of the training program significantly varied across different groups of learners in terms of age, occupation, work and training experience. CONCLUSIONS: This community-wide large-scale project provided evidence that the train-the-trainer model and reflective learning are effective means to facilitate situated learning that promote awareness and understanding of dementia, and consequently enhance sustainability of changes in care practices.

NADPH Oxidase Inhibition: Preclinical and Clinical Studies in Diabetic Complications.

Significance: Oxidative stress plays a critical role in the development and progression of serious micro- and macrovascular complications of diabetes. Nicotinamide adenine dinucleotide phosphate oxidase (NOX)-derived reactive oxygen species (ROS) significantly contribute to oxidative stress-associated inflammatory pathways that lead to tissue damage of different organs, including the kidneys, retina, brain, nerves, and the cardiovascular system. Recent Advances: Preclinical studies, including genetic-modified mouse models or cell culture models, have revealed the role of specific NOX isoforms in different diabetic complications, and suggested them as a promising target for the treatment of these diseases. Critical Issues: In this review, we provide an overview of the role of ROS and oxidative stress in macrovascular complications, such as stroke, myocardial infarction, coronary artery disease, and peripheral vascular disease that are all mainly driven by atherosclerosis, as well as microvascular complications, such as diabetic retinopathy, nephropathy, and neuropathy. We summarize conducted genetic deletion studies of different Nox isoforms as well as pharmacological intervention studies using NOX inhibitors in the context of preclinical as well as clinical research on diabetic complications. Future Directions: We outline the isoforms that are most promising for future clinical trials in the context of micro- and macrovascular complications of diabetes.

Effects of a Multicomponent Frailty Prevention Program in Prefrail Community-Dwelling Older Persons: A Randomized Controlled Trial.

OBJECTIVE: To examine the effects of a multicomponent frailty prevention program in community-dwelling older persons with prefrailty. DESIGN: A randomized controlled trial. SETTING: A community elderly center in Hong Kong. PARTICIPANTS: Persons aged ≥50 years who scored 1-2 on a simple frailty questionnaire (FRAIL) METHODS: Participants (n = 127) were randomly assigned to a 12-week multicomponent frailty prevention program (exercise, cognitive training, board game activities) or to a wait-list control group. The primary outcomes were FRAIL scores, frailty status, and a combined frailty measure including subjective (FRAIL total score) and objective (grip strength, muscle endurance, balance, gait speed) measures. The secondary outcomes were verbal fluency assessed by dual-task gait speed, attention and memory assessed by digit span task, executive function assessed by the Frontal Assessment Battery, self-rated health, and life satisfaction. Assessments were conducted at baseline and at week 12. RESULTS: The mean age of the participants was 62.2 years, and 88.2% were women. At week 12, the FRAIL score had decreased in the intervention group (-1.3, P < .001) but had increased in the control group (0.3, P < .01) (between-group differences P < .001). In addition, 83.3% and 1.6% of the intervention and control groups, respectively, had reversed from prefrailty to robust phenotype (between-group differences P < .001). Participants in the intervention group also had a greater reduction in the combined frailty score and greater improvements in muscle endurance, balance, verbal fluency, attention and memory, executive function, and self-rated health than those in the control group (all P < .05). There were no significant differences between the groups with respect to grip strength, gait speed, and life satisfaction. CONCLUSIONS AND IMPLICATIONS: The multicomponent frailty prevention program reduced frailty and improved physical and cognitive functions, and self-rated health in community-dwelling older persons with prefrailty. Findings can provide insights into the consideration of incorporating frailty prevention programs into the routine practice of community elderly services.

The effects of an expanded cognitive stimulation therapy model on the improvement of cognitive ability of elderly with mild stage Dementia living in a community - a randomized waitlist controlled trial.

OBJECTIVE: This research study aims to evaluate the effectiveness of an expanded cognitive stimulation therapy (CST) model that combines a CST group and tai chi on improving the cognitive ability of community-dwelling Chinese elderly with mild stage dementia (EwMD). METHOD: A randomized waitlist controlled trial design was adopted in this study. The treatment group participated in a structured CST group followed by tai chi twice a week, with a total of 14 sessions throughout the study period. The waitlist control group received treatment as usual at the initial stage and expanded CST model at a later stage. The Chinese Mattis Dementia Rating Scale (DRS) and the Chinese Mini Mental State Examination (MMSE) were used to assess the cognitive ability of EwMD in the pre- and post- treatment periods. RESULTS: At baseline, the treatment group (n = 51) and control group (n = 50) did not differ significantly in any demographic or clinical variables. Overall, the participants had a mean baseline MMSE score of 20.67 (SD = 2.30). The 2 × 2 repeated measures ANCOVA demonstrated that the treatment group was significantly more effective than the control group in improving the MMSE score (F = 12.31, p< .01) with a moderate effect size (partial eta square = .11) after controlling for group difference in age, gender, education, and having a diagnosis of dementia. CONCLUSION: The present study demonstrates the effectiveness of the expanded CST model on the improvement of cognitive ability of community-dwelling EwMD. More research is needed to further investigate this intervention model across cultures and societies.

A causal link between oxidative stress and inflammation in cardiovascular and renal complications of diabetes.

Chronic renal and vascular oxidative stress in association with an enhanced inflammatory burden are determinant processes in the development and progression of diabetic complications including cardiovascular disease (CVD), atherosclerosis and diabetic kidney disease (DKD). Persistent hyperglycaemia in diabetes mellitus increases the production of reactive oxygen species (ROS) and activates mediators of inflammation as well as suppresses antioxidant defence mechanisms ultimately contributing to oxidative stress which leads to vascular and renal injury in diabetes. Furthermore, there is increasing evidence that ROS, inflammation and fibrosis promote each other and are part of a vicious connection leading to development and progression of CVD and kidney disease in diabetes.

Assessing Grief of Family Caregivers of People with Dementia: Validation of the Chinese Version of the Marwit-Meuser Caregiver Grief Inventory.

Grief in dementia caregiving is underexplored in research studies in the Chinese context, yet social workers often work with caregivers of people with dementia (PWD) and who experience grief. Having a valid assessment tool can help social workers better identify the grief of caregivers and facilitate caregivers' articulation of grief. This article describes a study aimed to validate the Marwit-Meuser Caregiver Grief Inventory-Short Form (C-MM-CGI-SF) among Hong Kong Chinese caregivers of PWD. One hundred and twenty caregivers participated in this study. They were recruited from day care centers and a memory clinic. The short version of MM-CGI was translated into Chinese, and participants were asked to complete a questionnaire that included this scale and other scales validating it. Reliability and validity were examined. C-MM-CGI-SF was found to be a reliable and valid measure in the Hong Kong context. Its construct validity was demonstrated by the positive correlations with caregiving strain and depression, and negative correlations with presence of meaning and life satisfaction. The discriminant validity was supported by showing that spousal caregivers' grief level was significantly higher than that of nonspousal caregivers. Authors recommend social workers using the C-MM-CGI-SF to assess the grief of Chinese caregivers caring for people suffering from dementia.

Living With Dementia: An Exploratory Study of Caregiving in a Chinese Family Context.

This qualitative study explored themes that described families taking care of elderly relatives with dementia in Chinese society. Ten families were invited for two in-depth family interviews involving spousal caregivers, child caregivers, and care recipients. Five themes resulted: positive affection as coping strategies, power and control in the caregiving relationship, adult children's involvement in caregiving, sibling rivalry, and intergenerational conflicts. The ways these themes functioned and helped in dementia care, the research implications, and limitations are discussed.

Effectiveness of a life story work program on older adults with intellectual disabilities.

OBJECTIVE: This study examines the effectiveness of a life story work program (LSWp) in older adults with mild-to-moderate levels of intellectual disability (ID). METHODS: Using a quasiexperimental design, this study assigned 60 older adults who were between 50-90 years old with mild-to-moderate levels of ID to receive either the LSWp (intervention group, N=32) or usual activities (control group, N=28) during a period of 6 months. Evaluation was made based on the outcomes assessed by the Mood Interest and Pleasure Questionnaire, the Vineland Adaptive Behavior Scales, and the Personal Wellbeing Index - ID. RESULTS AND CONCLUSION: LSWp shows potential for improving the quality of life and preventing the loss of interest and pleasure in older adults with ID. It also shows promise in enhancing their socialization skills. Patients with better communication abilities seemed to benefit more from the LSWp.

Effectiveness of online cognitive behavioral therapy on family caregivers of people with dementia.

PURPOSE: Family caregivers of persons with dementia (PWD) may receive caregiver training because of logistical constraints and privacy concerns. This study evaluated the effectiveness of an online intervention for family caregivers of PWD in improving their self-efficacy in managing behavioral and psychological symptoms of dementia (BPSD), and their emotion well-being. SUBJECTS AND METHODS: A total of 36 family caregivers of people with dementia participated in a 9-week online intervention based on the cognitive behavioral therapy model. Outcomes of the intervention were measured by the Chinese version of the Neuropsychiatric Inventory Questionnaire and two domains of the Revised Scale for Caregiving Self-Efficacy. Wilcoxon signed rank tests were used to compare the change in outcome variables. RESULTS: The severity of BPSD of PWD and BPSD-related distress in family caregivers showed a statistically significant reduction after the intervention. Subgroup analysis showed self-efficacy in controlling upsetting thoughts significantly improved in caregivers of PWD at moderate to severe stages. CONCLUSION: Online cognitive behavioral therapy for family caregivers reduced BPSD of PWD and the related distress in their caregivers.

Macrophage CGI-58 deficiency activates ROS-inflammasome pathway to promote insulin resistance in mice.

Overnutrition activates a proinflammatory program in macrophages to induce insulin resistance (IR), but its molecular mechanisms remain incompletely understood. Here, we show that saturated fatty acid and lipopolysaccharide, two factors implicated in high-fat diet (HFD)-induced IR, suppress macrophage CGI-58 expression. Macrophage-specific CGI-58 knockout (MaKO) in mice aggravates HFD-induced glucose intolerance and IR, which is associated with augmented systemic/tissue inflammation and proinflammatory activation of adipose tissue macrophages. CGI-58-deficient macrophages exhibit mitochondrial dysfunction due to defective peroxisome proliferator-activated receptor (PPAR)γ signaling. Consequently, they overproduce reactive oxygen species (ROS) to potentiate secretion of proinflammatory cytokines by activating NLRP3 inflammasome. Anti-ROS treatment or NLRP3 silencing prevents CGI-58-deficient macrophages from oversecreting proinflammatory cytokines and from inducing proinflammatory signaling and IR in the cocultured fat slices. Anti-ROS treatment also prevents exacerbation of inflammation and IR in HFD-fed MaKO mice. Our data thus establish CGI-58 as a suppressor of overnutrition-induced NLRP3 inflammasome activation in macrophages.

Physical restraint use and older patients' length of hospital stay.

In both acute care and residential care settings, physical restraints are frequently used in the management of patients, older people in particular. Recently, the negative outcomes of physical restraint use have often been reported, but very limited research effort has been made to examine whether such nursing practice have any adverse effects on patients' length of stay (LOS) in hospitals. The aim of this study was to examine the association between physical restraint use on older patients during hospitalization and their LOS. Medical records of 910 older patients aged 60 years and above admitted to one of the Hong Kong public hospitals in 2007 were randomly selected and recorded during July to September 2011. The recorded items included patients' general health status, physical and cognitive function, the use of physical restraints, and patients' LOS. Hierarchical regression analysis was conducted to analyze the data. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. Independent of these factors, the physical restraint use was still significantly predictive of longer LOS, and these two blocks of variables together served as an effective model in predicting older patients' LOS in the hospital. Since physical restraint use has been found to be predictive of longer hospital stay, physical restraints should be used with more caution and the use of it should be reduced on older patients in the hospital caring setting. All relevant health care staff should be aware of the negative effects of physical restraint use and should reduce the use of it in hospital caring and nursing home settings.

Telephone-delivered psychoeducational intervention for Hong Kong Chinese dementia caregivers: a single-blinded randomized controlled trial.

PURPOSE: Many family caregivers of persons with dementia (PWD) are unable to participate in community center-based caregiver support services because of logistical constraints. This study evaluated the effectiveness of a telephone-delivered psychoeducational intervention for family caregivers of PWD in alleviating caregiver burden and enhancing caregiving self-efficacy. SUBJECTS AND METHODS: In a single-blinded randomized controlled trial, 38 family caregivers of PWD were randomly allocated into an intervention group or a control group. The intervention group received psychoeducation from a registered social worker over the phone for 12 sessions. Caregivers in the control group were given a DVD containing educational information about dementia caregiving. Outcomes of the intervention were measured by the Chinese versions of the Zarit Burden Interview and the Revised Scale for Caregiving Self-efficacy. Mann-Whitney U tests were used to compare the differences between the intervention and control groups. RESULTS: The level of burden of caregivers in the intervention group reduced significantly compared with caregivers in the control group. Caregivers in the intervention group also reported significantly more gain in self-efficacy in obtaining respite than the control group. CONCLUSION: A structured telephone intervention can benefit dementia caregivers in terms of self-efficacy and caregiving burden. The limitations of the research and recommendations for intervention are discussed.

The effectiveness of acupuncture on the sleep quality of elderly with dementia: a within-subjects trial.

PURPOSE: Elderly with dementia are often afflicted with sleep problems. Recent studies have suggested that acupuncture may be a feasible alternative to traditional sleep medicine for treating sleep disturbance. This study investigated the effectiveness of acupuncture on sleep quality of elderly with dementia. PATIENTS AND METHODS: Nineteen elders with dementia were followed through a control period and an acupuncture treatment period, each lasting 6 weeks. Outcome measures were subjects' sleep quality and cognitive function. Sleep parameters were recorded by wrist actigraphy. Cognitive function was assessed by the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog). Pretests and posttests were conducted immediately before and after the control and treatment periods. Changes in the outcome measures between control and treatment periods were compared. RESULTS: Wilcoxon signed rank tests revealed that the subjects gained significantly more resting time and total sleep time in the treatment period than in the control period (P < 0.05). A nonsignificant trend for improvement in sleep efficiency was observed. Improvement in cognitive function was not statistically significant. A total of 86% of the subjects completed the treatment regime. CONCLUSION: Results reveal that acupuncture was effective in improving some domains of sleep quality of elderly with dementia, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered.

Determinants of job satisfaction in foreign domestic helpers caring for people with dementia in Hong Kong.

The job satisfaction of live-in foreign domestic helpers (FDHs) may influence their caring motivation and the quality of care they provide, which may in turn affect the health status of care recipients. This study identifies the factors affecting job satisfaction of FDHs caring for people with dementia in Hong Kong, focusing especially on the role of FDHs' adaptation status, job self-efficacy and care recipients' situation. A total of 152 FDHs taking care of people with dementia were recruited from 6 day care centres for elderly people in Hong Kong when they attended with their care recipients. Data were collected from February to August 2011 and the response rate was 95%. Participants completed questionnaires which included measures of care recipients' dementia severity and disruptive behaviours, FDHs' demographic factors, personal adaptation status, caregiving self-efficacy and job satisfaction. Hierarchical regression analysis was conducted to analyse the data. The results showed that longer stay in Hong Kong, better fluency in Cantonese (local dialect), greater satisfaction in living conditions, higher caregiving self-efficacy and less disruptive behaviour of care recipients were independently associated with stronger job satisfaction in FDHs looking after people with dementia. On the basis of these findings, we would suggest that employers should consider helpers who have been in Hong Kong for a longer period of time and speak fluent Cantonese, and have previous experience of taking care of people with dementia. In addition, FDHs caring for people with dementia may benefit from carer training which improves their self-efficacy in dementia care.

Effectiveness of cognitive training for Chinese elderly in Hong Kong.

In Hong Kong, the evidence for cognitive-training programs in fighting against memory complaints is lacking. This study aimed to evaluate the effectiveness of the Active Mind cognitive-training program in improving the cognitive function and quality of life (QoL) for local community-dwelling Chinese older adults. A total of 200 subjects were recruited from 20 different district elderly community centers (DECCs). Centers were randomly assigned into either the intervention group or control group. The intervention group underwent eight 1-hour sessions of cognitive training, while the control group were included in the usual group activities provided by the DECCs. Standardized neuropsychological tests (the Chinese version of Mattis Dementia Rating Scale [CDRS] and the Cantonese version of the Mini-Mental State Examination) and the QoL questionnaire SF12 were used to assess participants' cognitive function and QoL before and after the trial. A total of 176 subjects completed the study. The intervention group showed greater improvement in the cognitive function measured by total CDRS score (treatment: 12.24 ± 11.57 vs control: 4.37 ± 7.99; P < 0.001) and QoL measured by total SF12 score (treatment: 7.82 ± 13.19 vs control: 3.18 ± 11.61; P = 0.014). Subjects with lower education level were associated with better cognitive response to the cognitive-training program. The current findings indicated that the Active Mind cognitive-training program was effective in improving the cognitive function and QoL for community-dwelling Chinese older adults in Hong Kong.