A Two-Step Model for Encouraging the General Public to Exhibit Helping Behaviors Toward People Living With Dementia

This study was done to examine actor and partner effect of dementia knowledge, self-efficacy and depression on dementia preventive behavior in elderly couples. Participants were 115 couples aged 60 years or over who met eligibility criteria. All measures were self-administered. Data were analyzed using SPSS 18.0 and AMOS 18.0 program. Dementia knowledge in elderly couples showed actor and partner effect on dementia preventive behavior. Self-efficacy in the wife did not have direct effects on dementia preventive behavior, but showed indirect effects through dementia knowledge. Self-efficacy in the husband showed direct effects on dementia preventive behavior and indirect effects through dementia knowledge. Wife's depression had direct actor effect on dementia preventive behavior and indirect effect through self-efficacy and dementia knowledge. Husband's depression did not have direct actor effect on dementia preventive behavior, but indirect effect through self-efficacy and dementia knowledge. Effect size of wives' dementia knowledge, self-efficacy and depression on dementia preventive behavior was larger than that of husbands'. Dementia preventive behavior, dementia knowledge and depression had a mutual effect. Results indicate that to promote dementia preventive activity in elderly couples, programs should be conducted for both of the couple, but focused differently for wife and husband.

IntroductionPerceived vulnerability to disease/PVD may influence psychological reactions to COVID-19 pandemic.ObjectivesTo analyse the role of PVD in psychological distress/PD during the COVID-19 pandemic, testing whether it is mediated by perceived risk of COVID-19, fear of COVID-19 and repetitive negative thinking/RNT.MethodsParticipants (N=413 adults; 69.2% women) were recruited from September until December 2020, via social networks. They completed the following self-report validated questionnaires: Perceived Vulnerability to Disease Questionnaire/PVDQ; Perceived Risk of COVID-19 Scale, Fear of COVID-19 Scale; Perseverative Thinking Questionnaire and Depression Anxiety and Stress Scale. As women had significantly higher levels of PVD, COVID-19 perceived risk and fear, RNT, and psychological distress/PD, gender was controlled in mediation analysis (using PROCESS macro for SPSS; Hayes 2018).ResultsAll the variables significantly (p<.01), moderately (r>.20) and positively correlated. The serial mediation model 6 with the three sequential mediators resulted in significant total effect (c=.326, se=.0791, p<.001, CI:.1702-.4814), non-significant direct effect (c’=.111, se=.065, p=.087, CI:-.0162 to .2380), significant total indirect effect (.2149, se=.065, CI:.1079-.3278); most indirect effects were significant, including the indirect 7 (.0144, se=.0077, CI=.0017-.0320), that goes through all mediators (PVD->COVID19 perceived risk->COVID19 fear->RNT->PD), meaning full mediation.ConclusionsThe effect of PVD on psychological distress operates by increasing the perception of risk and the fear of COVID-19, which intensify related worries and ruminations in times of pandemic. People with high perceived threat, aversion and discomfort in situations associated with increased risk of infection should be helped to decrease dysfunctional cognitive contents and processes in times of pandemic.DisclosureNo significant relationships.

BackgroundHealth care students are instrumental in shaping the future of dementia care. Cultivating a positive attitude and understanding toward people living with dementia is crucial for diminishing the stigma associated with the condition, providing effective and person-centered care, and enhancing the quality of life for people living with dementia. Educational programs about dementia are increasingly recognizing the potential of gaming tools.ObjectiveThis study aimed to evaluate the effectiveness of gaming-based dementia educational programs in improving attitudes toward people living with dementia among health care students.MethodsThis single-arm pre-post study will be conducted among health care students in Indonesian universities. This educational program based on gaming tools will consist of a lecture on dementia, the use of N-impro (gaming tool), and the enactment of short dramas depicting desirable and undesirable communication with people living with dementia behaviors. We will assess attitudes toward people living with dementia, intention to help people living with dementia, knowledge of dementia, and the stigma associated with people living with dementia. The gaming-based dementia education program will be integrated into the curriculum of the health care students. The program will be implemented once with a duration of 90 minutes.ResultsData collection will occur from August 2023 to March 2024. Analysis of the data will be finalized by May 2024, and the outcome will be determined by July 2024. The impact of the gaming-based dementia educational program on improving attitudes toward people living with dementia will be reported. The study findings will be published in a peer-reviewed journal.ConclusionsThe gaming education program demonstrates significant potential in enhancing attitudes toward people living with dementia across various countries, introducing an innovative method for the community-based support of people living with dementia.Trial RegistrationClinicalTrials.gov NCT06122623; https://clinicaltrials.gov/study/NCT06122623International Registered Report Identifier (IRRID)DERR1-10.2196/62654

There is a lack of information about the experiences of people living with dementia and their carers, especially in rural and regional areas. Understanding these experiences helps to identify gaps and unmet needs within the health system and improve quality of care and outcomes for people living with dementia. The aim of this study was to improve our knowledge of dementia support needs. This included access to health and social care services and supports for people living with dementia and those who provide informal or formal support to someone living with dementia. Interviews were conducted with 26 participants from the Gippsland region of Victoria, Australia with knowledge of dementia care. Purposive sampling engaged people with lived experience, carers/family members and health professionals delivering dementia care and social services. Discussions centred around participants' experiences of support services, the diagnosis process and what they thought was needed to improve the services and supports offered. Thematic analysis of the data was undertaken using the framework method. The interview data indicated that the needs of many people living with dementia and their carers were not currently being met. The themes were limited access to services and supports, including primary and specialist care, often impacted by lack of knowledge of care options, difficulty navigating the system and funding models as a barrier, leading to delays in getting a diagnosis and accessing specialist services; lack of holistic care to enable people living with dementia to 'live well'; and stigma impacted by a lack of knowledge of dementia among professionals and in the community. Relationship-centred care was described as a way to improve the lives of people living with dementia. Key areas for improvement include increasing community awareness of dementia and available local services, more support to obtain an early dementia diagnosis, increased help to navigate the system, especially immediately after diagnosis, and easier access to appropriate home support services when they are needed. Other recommendations include person-centred care across settings - supported by funding models, more education and communication skills training for health professionals and care staff - and greater support for and increased recognition of carers.

Feeding concerns are common in the first 2 years of life and typically reflect maternal perceptions occurring within the larger context of the parent-child relationship. We aimed to determine whether (1) maternal depressive systems predicted perceived picky eating, mediated by maternal negative perceptions; (2) receipt of the Video Interaction Project (VIP) parenting intervention impacted perceived picky eating through this pathway; and (3) perceived picky eating was associated with child growth or subsequent dietary patterns. We performed a partial longitudinal analysis of 187 low-income, predominantly Hispanic mother-child dyads enrolled in a randomized controlled trial of the VIP. Mother-infant dyads were enrolled postpartum in an urban public hospital. Participants randomized to the VIP met with an interventionist on days of well-child visits; sessions were designed to facilitate interactions in play and shared reading through provision of learning materials and review of videotaped parent-child interaction; the curriculum did not contain feeding-specific elements. We used structural equation modeling to determine direct, indirect, and total effects of maternal depressive symptoms, maternal negative perceptions, and the VIP on perceived picky eating. We then tested associations between perceived picky eating and (1) child growth, using multivariable linear regression and multilevel modeling; and (2) subsequent child dietary consumption, using multivariable multinomial logistic regression. Maternal depressive symptoms had significant total effects on negative maternal perceptions (β = 0.32, p < 0.001) and perceived picky eating (β = 0.21, p < 0.01) after controlling for potential confounders. This effect was partially mediated by maternal negative perceptions (indirect effect: β = 0.06, p = 0.04). When used in the model as the predictor, the VIP had a significant total effect on perceived picky eating (β = -0.16, p = 0.02), which was partially mediated by maternal depressive symptoms and negative perceptions (indirect effect: β = -0.05, p = 0.02). Perceived picky eating was not associated with child diet at age 2 years or adiposity from 6 months to 3 years. Maternal concerns about picky eating may reflect deeper depressive symptoms and negative perceptions of her child's behavior. Interventions designed to facilitate positive parenting in general may lessen feeding-specific concerns, such as picky eating. Although reassurance about growth and nutritional outcomes for children perceived as picky eaters is appropriate, clinicians should also consider probing for underlying symptoms of depression that could lead to eating concerns.

BackgroundAgainst the backdrop of population aging and the accelerated development of dementia-friendly communities, public stigmatizing attitudes toward dementia have emerged as a critical barrier to the social integration of affected individuals. To date, limited empirical research in China has examined the mechanisms linking dementia knowledge, contact, and stigmatizing attitudes (perceived stigma) across different age groups within indigenous community settings. This study, conducted as part of a pilot dementia-friendly community initiative in Shanghai, seeks to investigate intergenerational differences in dementia knowledge, contact experiences, and stigmatizing attitudes, and to examine the mediating role of contact in the relationship between knowledge and stigma, thereby contributing locally grounded empirical evidence to the field.MethodsA cross-sectional survey design was employed. A total of 397 community-dwelling residents aged 18 years and older in Shanghai participated in the study. Data were collected on sociodemographic characteristics, dementia knowledge, contact experiences with individuals living with dementia, and stigmatizing attitudes. Descriptive statistics and between-group analyses were used to compare age-group differences, and a mediation model was constructed to test the associations among dementia knowledge, contact, and stigma.ResultsSignificant intergenerational differences were observed in dementia knowledge, contact experiences, and stigmatizing attitudes. Middle-aged adults demonstrated higher levels of knowledge and more positive contact intentions; older adults reported the highest frequency of contact and the lowest levels of stigma; and younger adults exhibited the most pronounced stigmatizing attitudes. Mediation analysis further revealed that contact experience partially mediated the relationship between dementia knowledge and stigmatizing attitudes, suggesting that higher levels of dementia knowledge may be associated with reduced stigma through the facilitation of positive contact.ConclusionEnhancing public knowledge of dementia and promoting positive contact with affected individuals may contribute to reducing social stigma and supporting the social inclusion of people living with dementia. This study further elucidates the pathway linking dementia knowledge and stigmatizing attitudes, identifying contact behavior as a significant mediator. The findings lend support to intervention strategies that integrate cognitive enhancement with structured contact initiatives, and provide preliminary evidence for age-specific community-based anti-stigma practices. It should be noted that the mediation pathway identified in this study is correlational rather than causal; moreover, as the sample was drawn from pilot dementia-friendly communities in Shanghai, the generalizability of the findings to other communities or regions may be constrained by variations in local support systems, public awareness, and aging profiles. Future research should adopt longitudinal or interventional designs to validate these findings across broader populations.

Commentary: Mediation Analyses in the Real World.

BackgroundIndividuals with psychiatric diagnoses who are unemployed or underemployed are likely to disproportionately experience financial hardship and, in turn, lower life satisfaction (LS). Understanding the mechanisms though which financial hardship affects LS is essential to inform effective economic empowerment interventions for this population.AimTo examine if subjective financial hardship (SFH) mediates the relationship between objective financial hardship (OFH) and LS, and whether hope, and its agency and pathways components, further mediate the effect of SFH on LS among individuals with psychiatric diagnoses seeking employment.MethodsWe conducted structured interviews with participants (N = 215) of two peer-run employment programs using indicators of OFH and SFH and standardized scales for hope (overall hope, hope agency, and hope pathways) and LS. Three structural equation models were employed to test measurement models for OFH and SFH, and mediational relationships. Covariates included gender, age, psychiatric diagnosis, race/ethnicity, education, income, employment status, SSI/SSDI receipt, and site.ResultsConfirmatory factor analysis (CFA) for items measuring OFH and SFH supported two separate hypothesized factors. OFH had a strong and significant total effect on SFH [standardized beta (B) = 0.68] and LS (B = 0.49), and a weak-to-moderate effect on hope (B = –0.31). SFH alone mediated up to 94% of the effect of OFH on LS (indirect effect B = –0.46, p < 0.01). The effect of SFH on LS through hope was small (indirect effect B = –0.09, p < 0.05), primarily through hope agency (indirect effect B = –0.13, p < 0.01) and not hope pathways. Black and Hispanic ethno-racial identification seemed to buffer the effect of financial hardship on hope and LS. Individuals identifying as Black reported significantly higher overall hope (B = 0.41–0.47) and higher LS (B = 0.29–0.46), net of the effect of OFH and SFH.ConclusionSFH is a strong mediator of the relationship between OFH and LS in our study of unemployed and underemployed individuals with psychiatric diagnoses. Hope, and particularly its agency component, further mediate a modest but significant proportion of the association between SFH and LS. Economic empowerment interventions for this population should address objective and subjective financial stressors, foster a sense of agency, and consider the diverse effects of financial hardship across ethno-racial groups.

BackgroundRecent studies have reported an association between toothbrushing frequency and systemic health. Plaque control, achieved through frequent brushing, is known to prevent dental caries and periodontal disease, potentially reducing the risk of systemic diseases. However, individuals with good oral health behaviours may also exhibit healthier lifestyle habits which could impact systemic health. In examining the relationship between oral health behaviours and systemic health, it is important to consider the influence of factors that mediate the relationship between them. This study conducted mediation analyses to evaluate the extent to which lifestyle habits and periodontal status mediate the relationship between oral health behaviours and systemic health.MethodsHealth examinations, including dental assessments, were performed on 15,579 individuals at the Aichi Health Promotion Foundation. Of these, 12,540 participants aged 40–74 years were included in the analysis. Mediation analyses were conducted using the number of metabolic syndrome (MS) components as the outcome variable, oral health behaviours (regular dental visits, use of interdental brushes or dental floss, and toothbrushing frequency) as exposure variables, lifestyle habits (smoking, drinking, exercise, and eating habits) and periodontal status as mediators, and age and sex as covariates.ResultsRegular dental visits showed significant total and indirect effects on MS, although no significant direct effect was observed. The use of interdental brushes or dental floss and toothbrushing frequency demonstrated significant total, direct and indirect effects on MS. Exercise habits, eating habits and periodontal status were significant mediators in the relationship between regular dental visits and MS. These mediators also significantly influenced the associations between both the use of interdental brushes or dental floss and toothbrushing frequency with MS.ConclusionThe relationship between oral health behaviours and MS is mediated by lifestyle habits and periodontal status. Among the mediating variables tested in this study, the indirect effects of diet and exercise habits tended to be stronger than the indirect effect of periodontal disease. Oral health behaviours may influence systemic health through their impact on lifestyle habits.

Purpose This paper aims to understand the relationship between the trust of executives in their board, board effectiveness (board performance and strategic decision quality) and organizational performance (financial and operational performance). Design/methodology/approach Data were collected from 184 board members in the Nordic region, using cross-sectional research design. Confirmatory factor analysis was used to test the validity of the used scales, whereas correlational analysis and mediation analysis via PROCESS macro in SPSS were used for testing of the hypotheses. Findings Trust between board members is positively correlated with both dimensions of board effectiveness and both tested dimensions of organizational performance. Besides, trust between the board members positively affects both financial and operational performance (significant total effects in mediation analysis). However, trust had a direct effect only on financial performance, whereas it shows an indirect effect on operational performance through both mediators, board performance and strategic decision quality. Research limitations/implications Future research should investigate trust into the board using a longitudinal design, and expand the sample cross-culturally, and control for the influence of other interpersonal variables in board members. Practical implications The development of trust in work relationships serves as the foundation for the establishment of significant team and organizational benefits. Business leaders should take into consideration trust issues in business teams and cultivate a trust culture in their organizations. Social implications The findings advance theoretical, social and empirical understanding of trust of executives in their board and its effect on board performance, strategic decision quality and perceived performance. The development of trust in work relationships enhances team performance, networks with strategic partners, community and government, and serves as the foundation for the establishment of trust in the society. Originality/value This is one of the scarce studies that examines direct and indirect effects of trust in board and organizational outcomes.

PurposeThis study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson’s disease (PD).MethodsDemographical data, PD-specific data (MDS-Unified Parkinson’s Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck’s depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates.ResultsOverall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck’s Depression Inventory but not by Montreal Cognitive Assessment.ConclusionsPatients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.

Background and objective At the height of the coronavirus disease 2019 (COVID-19) pandemic, numerous strategies were introduced by the authorities to contain the spread of the virus, which significantly affected people's lives andimpeded their mobility. As the general public was unable to leave their dwellings, many digitalized pharmacist-led services were initiated to meet the public's needs for pharmaceutical care. The aim of this study was to ascertain the knowledge, perception, and willingness to utilize telepharmacy services and the determinants associated with these services among the general public in the Kingdom of Saudi Arabia (KSA). Methodology A cross-sectional survey involving participants recruited from the Saudi general public was conducted by using a validated questionnaire. We collected information regarding participants' demographics, as well as knowledge, perception, and willingness toward telepharmacy. The results were analyzed via descriptive statistics. The Mann-Whitney U Test was applied to assess the associations between knowledge, perception, willingness, and demographic variablesregarding the utilization of telepharmacy services. Results A total of 273 Saudi citizens participated in the study; 71% (n=193) of them were aware of telepharmacy services. Many respondents showed a positive perception towards telepharmacy services and 83% (n=227) of the total participants showed their willingness to use telepharmacy services in the future. A significant association was identified between education, gender, and the knowledge of the participants regarding telepharmacy services. The demographic characteristics such as age, gender, and education, were not associated with the participants' perception regarding telepharmacy services. However, gender was significantly associated with the willingness to use telepharmacy services in the future. Conclusions Many participants had a fair knowledge and positive perception of telepharmacy services. More than two-thirds of the participants showed their willingness to utilize telepharmacy services in the future. However, further measures should be implemented involving strategies to increase the knowledge about telepharmacy by targeting the less educated among the Saudi populationand those with limited access to technology.

Deep Vein Thrombosis and Pulmonary Embolism: Awareness and Knowledge Gaps In the General Public and at-Risk Oncology Patients

This study examines the prevalence of, and factors mediated to, unmet healthcare need of urban refugees and asylum seekers (URAS) in Thailand. In 2019, a cross-sectional survey of 181 URAS was merged with Thai data (total n=3,122). Self-reporting questionnaire was applied. Unmet healthcare need, defined as a status where a person needed health examination or treatment within the past 12 months, but he or she did not receive it, were analysed using multivariable logistic regression within a concept of mediation analysis. URAS were younger and had lower household economic status than Thais, and almost all URAS were uninsured. Most URAS suffered from a high prevalence of unmet healthcare need, 54.1% (range 31.4–100.0%) for outpatient (OP) care and 28.0% (range 0–83.3%) for inpatient (IP) care, while unmet healthcare need prevalence amongst Thais was 2.1% for both OP and IP care. For OP care, the direct effect of URAS status (predictor) on unmet healthcare need (outcome) showed a significant adjusted odds ratio (AOR) of 8.8 (95% CI 1.3–58.6), and a total effect (combining direct effect and indirect effect where insurance status served as a mediator) had AOR as large as 42.3 (95% CI 26.4–67.8). A significant total effect was also observed for IP care (AOR 13.1, 95% CI 7.8–22.0). Since most URAS substantially suffer from a lack of insurance coverage and this markedly influenced healthcare inaccessibility, policymakers should prioritise expanding insurance coverage towards URAS to promote health equity for all.

Background/Objectives: The conventional strategy for addressing age-related hearing loss is hearing aid (HA) use, yet many individuals underutilize their devices. Despite the positive effects of HA use, adherence remains low, highlighting the importance of studying associated variables. We hypothesize that better unaided speech perception in noise (SPiN) would be associated with greater perceived benefit from HAs, which, in turn, would be linked to increased HA use. Methods: A cross-sectional study design was used, including 114 older adults (≥65 years) who were HA users. HA use and perceived benefit were assessed using questions 1 and 2 of the International Outcome Inventory for Hearing Aids (IOI-HAs), while unaided SPiN performance was measured monaurally with a speech-in-noise test. In the mediation analysis, SPiN performance was the predictor, perceived benefit the mediator, and HA use the outcome. Direct and indirect effects were evaluated using generalized structural equation modeling. Results: No significant total effect was found for the right ear. For the left ear, there was a significant indirect effect of SPiN performance on HA use through perceived benefit (OR = 1.26, 95% CI 1.06-1.57, p = 0.019) but no direct effect (p = 0.563). In addition, a significant total effect of left ear SPiN performance on HA use was observed (p = 0.041). Conclusions: The findings suggest that unaided SPiN performance-particularly in the left ear-may be indirectly associated with HA use through its effect on perceived benefit. These results underscore the potential value of including SPiN assessments in the HA fitting process and counseling strategies for older adults.