Who benefits most from resilience-building groups for 'at-risk' older people? a pilot service-evaluation.

OBJECTIVES: Resilience-building interventions have not yet targeted older adults, despite the importance of well-being for maintaining independence and health. The 'My Generation' programme aims to build resilience through greater access to social networks, well-being activities, and psycho-educational support; this paper examines service evaluation data from its pilot implementation to identify factors leading to positive outcomes. METHOD: The 'My Generation' programme comprises eight weekly 2-hour group sessions; each session includes both psychoeducation and a well-being activity. Participants were invited to complete questionnaires at the start and end of the course, and 12 weeks later. These included measures of well-being, loneliness, social connections and self-efficacy. RESULTS: Baseline assessments were completed by 239 older people (average age 71, range 50-97), attending 38 courses in four centres. Most were female (80%), 40% were widowed, 25% divorced/separated and 64% lived alone. Demographics did not differ between those completing post-intervention assessments (N = 137) and those who did not. Compared with normative data, participants had significantly lower well-being and greater feelings of loneliness than age-peers. Significant improvements in well-being, self-efficacy, social connections and one measure of loneliness were evident at post-intervention and follow-up assessments. Improvement in well-being at post-intervention was greater in those who were divorced/separated and who were not carers, and at follow-up in females and those living alone. CONCLUSION: The 'My Generation' package appeared effective in improving well-being, self-efficacy, social connections and aspects of loneliness in at-risk older people. More research is needed to identify the intervention's key components and possible between-centre differences in outcomes.

An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study.

BACKGROUND: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ≥65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. OBJECTIVE: The objective of this study was to assess the impact of the e-learning module on participants' knowledge and behavior change. METHODS: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. RESULTS: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants' pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). CONCLUSIONS: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice.

Neonatal abdominal X-rays: indications, procedure and interpretation.

Abdominal X-rays (AXRs) are one of the most common imaging modalities used to investigate suspected abdominal conditions in neonates. They are frequently requested for a variety of suspected conditions including necrotising enterocolitis, congenital diaphragmatic hernia, duodenal atresia and Hirschsprung's disease. Nurses play an important role in preparing and supporting neonates who are undergoing an AXR, and in some centres advanced neonatal nurse practitioners may be involved in requesting and interpreting AXRs as part of their enhanced role in patient management. It is therefore important that nurses understand the indications, procedure and interpretation for this imaging modality, as well as its limitations and potential long-term risks.

Abdominal X-rays in children: indications, procedure and interpretation.

Abdominal X-rays (AXRs) are often used as an imaging modality in children who present with abdominal pain with a suspected serious underlying pathology. Nausea, vomiting and constipation that are unresponsive to treatment may also prompt a request for an AXR in a child. Nurses play an important role in ensuring that requests for AXRs in children are appropriate and that the procedure is performed safely. This is the second of two articles on the use of AXRs for diagnosing abdominal pathologies in childhood. The first article focused on AXRs in neonates. This one focuses on AXRs in children, discussing their indications, procedure and interpretation and describing abdominal conditions in children for which an AXR is likely to support diagnosis.

Model-based iterative reconstruction in low-dose CT colonography-feasibility study in 65 patients for symptomatic investigation.

RATIONALE AND OBJECTIVES: To compare image quality on computed tomographic colonography (CTC) acquired at standard dose (STD) and low dose (LD) using filtered-back projection, adaptive statistical iterative reconstruction, and model-based iterative reconstruction (MBIR) techniques. MATERIALS AND METHODS: A total of 65 symptomatic patients were prospectively enrolled for the study and underwent STD and LD CTC with filtered-back projection, adaptive statistical iterative reconstruction, and MBIR to allow direct per-patient comparison. Objective image noise, subjective image analyses, and polyp detection were assessed. RESULTS: Objective image noise analysis demonstrates significant noise reduction using MBIR technique (P < .05) despite being acquired at lower doses. Subjective image analyses were superior for LD MBIR in all parameters except visibility of extracolonic lesions (two-dimensional) and visibility of colonic wall (three-dimensional) where there were no significant differences. There was no significant difference in polyp detection rates (P > .05). Doses: LD (dose-length product, 257.7), STD (dose-length product, 483.6). CONCLUSIONS: LD MBIR CTC objectively shows improved image noise using parameters in our study. Subjectively, image quality is maintained. Polyp detection shows no significant difference but because of small numbers needs further validation. Average dose reduction of 47% can be achieved. This study confirms feasibility of using MBIR in this context of CTC in symptomatic population.

HIV-associated facial lipoatrophy.

BACKGROUND: HIV-infected individuals are living long, healthy lives. They are now concerned with less life-threatening problems, especially lipodystrophy. OBJECTIVE: To review the current state of our knowledge about lipodystrophy in HIV-infected individuals. METHODS: The literature was reviewed and analyzed for relevant information. In addition, our clinical experience of managing such individuals was utilized. RESULTS: Lipodystrophy and facial lipoatrophy and their relationship to HIV-infection are discussed. Their differences are noted. The spectrum of appearance in individuals with facial lipoatrophy is described and a severity scale suggested which should be of value in assessing the results of treatment. CONCLUSION: Lipodystrophy and lipoatrophy are intimately related to infection with HIV. In consequence, facial lipoatrophy is a major stigma for HIV-infected individuals and can have dramatic effects on their self-esteem and socialization. Effective treatment is essential.