University of Greenwich

About: University of Greenwich is a education organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Poison control. The organization has 3749 authors who have published 9958 publications receiving 234340 citations.

Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis

Abstract: Objective: To investigate whether people with subjective memory complaints (SMC) but no objective deficits are at increased risk of developing mild cognitive impairment (MCI) and dementia. Method: Major electronic databases were searched till 03/2014, and a meta-analysis was conducted using inception cohort studies. Results: Across 28 studies, there were 29 723 unique individuals (14 714 with SMC and 15 009 without SMC) (mean 71.6 years) followed on average for 4.8 years through to dementia. The annual conversion rate (ACR) of SMC to dementia was 2.33% (95% CI = 1.93%–2.78%) a relative risk (RR) of 2.07 (95% CI = 1.76–2.44) compared with those without SMC (n = 15 009). From 11 studies the ACR of developing MCI was 6.67% (95% CI = 4.70–8.95%). In long-term studies over 4 years, 14.1% (9.67–19.1%) of people with SMC developed dementia and 26.6% (95% CI = 5.3–39.7) went on to develop MCI. The ACR from SMC to dementia and MCI were comparable in community and non-community settings. Conclusion: Older people with SMC but no objective complaints are twice as likely to develop dementia as individuals without SMC. Approximately 2.3% and 6.6% of older people with SMC will progress to dementia and MCI per year.

Community level adaptation to climate change: The potential role of participatory community risk assessment

Abstract: This paper explores the value of using community risk assessments (CRAs) for climate change adaptation. CRA refers to participatory methods to assess hazards, vulnerabilities and capacities in support of community-based disaster risk reduction, used by many NGOs, community-based organizations, and the Red Cross/Red Crescent. We review the evolution of climate change adaptation and community-based disaster risk reduction, and highlight the challenges of integrating global climate change into a bottom-up and place-based approach. Our analysis of CRAs carried out by various national Red Cross societies shows that CRAs can help address those challenges by fostering community engagement in climate risk reduction, particularly given that many strategies to deal with current climate risks also help to reduce vulnerability to climate change. Climate change can also be explicitly incorporated in CRAs by making better use of CRA tools to assess trends, and by addressing the notion of changing risks. However, a key challenge is to keep CRAs simple enough for wide application. This demands special attention in the modification of CRA tools; in the background materials and trainings for CRA facilitators; and in the guidance for interpretation of CRA outcomes. A second challenge is the application of a limited set of CRA results to guide risk reduction in other communities and to inform national and international adaptation policy. This requires specific attention for sampling and care in scaling up qualitative findings. Finally, stronger linkages are needed between organizations facilitating CRAs and suppliers of climate information, particularly addressing the translation of climate information to the community level.

Guidance on the management of pain in older people.

Abstract: This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided, for the shortest duration. For older adults, an NSAID or cyclooxygenase-2 (COX-2) selective inhibitor should be co-prescribed with a proton pump inhibitor (PPI), and the one with the lowest acquisition cost should be chosen. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered. Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and adverse effects limit their use in an older population. Intra-articular corticosteroid injections in osteoarthritis of the knee are effective in relieving pain in the short term, with little risk of complications and/or joint damage. Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients who are intolerant to systemic therapy. Intra-articular hyaluronic acid appears to have a slower onset of action than intra-articular steroids, but the effects seem to last longer. The current evidence for the use of epidural steroid injections in the management of sciatica is conflicting and, until further larger studies become available, no firm recommendations can be made. There is, however, a limited body of evidence to support the use of epidural injections in spinal stenosis. The literature review suggests that assistive devices are widely used and that the ownership of devices increases with age. Such devices enable older people with chronic pain to live in the community. However, they do not necessarily reduce pain and can increase pain if used incorrectly. Increasing activity by way of exercise should be considered. This should involve strengthening, flexibility, endurance and balance, along with a programme of education. Patient preference should be given serious consideration. A number of complementary therapies have been found to have some efficacy among the older population, including acupuncture, transcutaneous electrical nerve stimulation (TENS) and massage. Such approaches can affect pain and anxiety and are worth further investigation. Some psychological approaches have been found to be useful for the older population, including guided imagery, biofeedback training and relaxation. There is also some evidence supporting the use of cognitive behavioural therapy (CBT) among nursing home populations, but of course these approaches require training and time. There are many areas that require further research, including pharmacological management where approaches are often tested in younger populations and then translated across. Prevalence studies need consistency in terms of age, diagnosis and terminology, and further work needs to be done on evaluating non-pharmacological approaches.

Postharvest losses and waste in developed and less developed countries: opportunities to improve resource use

Abstract: This review compares and contrasts postharvest food losses (PHLs) and waste in developed countries (especially the USA and the UK) with those in less developed countries (LDCs), especially the case of cereals in sub-Saharan Africa. Reducing food losses offers an important way of increasing food availability without requiring additional production resources, and in LDCs it can contribute to rural development and poverty reduction by improving agribusiness livelihoods. The critical factors governing PHLs and food waste are mostly after the farm gate in developed countries but before the farm gate in LDCs. In the foreseeable future (e.g. up to 2030), the main drivers for reducing PHLs differ: in the developed world, they include consumer education campaigns, carefully targeted taxation and private and public sector partnerships sharing the responsibility for loss reduction. The LDCs’ drivers include more widespread education of farmers in the causes of PHLs; better infrastructure to connect smallholders to markets; more effective value chains that provide sufficient financial incentives at the producer level; opportunities to adopt collective marketing and better technologies supported by access to microcredit; and the public and private sectors sharing the investment costs and risks in market-orientated interventions.