Transforming the future of ageing

Anxiety disorders are amongst the most common psychological concerns of childhood and adolescence (Cartwright-Hatton et al., 2004). Whilst cognitive-behavioural therapy has been established as an efficacious treatment, only a small proportion of children with anxiety disorders receive help from mental health professionals (Essau et al., 2000). In recent years, there has been growing interest in using the Internet as a mechanism for delivering psychological services. Although initial investigations of online treatment for child anxiety disorders have produced similar results to that of clinic-based treatment, there remains a proportion of children who do show recovery following treatment. By identifying predictors of child response to treatment, it is possible that treatment could be tailored to suit the needs of children who may be a risk for poor treatment outcomes. A large body of research exists regarding the role of family factors in the development and maintenance of child anxiety disorders (see McLeod et al., 2007; Wood et al., 2003). If left unchanged following treatment, it is likely that family factors involved in the maintenance of child anxiety will have an adverse effect on child outcome following treatment. Additionally, the absence of direct contact with a therapist in online treatment presents a greater requirement for self-direction on the part of the client. In the case of children, this is likely to signal the need for greater encouragement and involvement from parents, which may be problematic when dysfunctional dynamics exist within the family. As such, compliance with the online treatment may also be an important predictor of child outcome, when treatment is completed in an online format. The aim of the current study was to examine the role of family factors, compliance with treatment, and child characteristics (specifically, age and gender), as predictors of treatment outcome for children receiving online CBT for anxiety disorders. Participants were 156 children, ranging from 7 to 18 years of age (M = 11.92, SD = 2.47), and at least one of their parents. Children were required to present with a primary anxiety diagnosis of either separation anxiety disorder, social phobia, generalised anxiety disorder, or specific phobia, based on a clinical interview, administered by a trained clinician. Children and parents also completed a battery of questionnaires to assess child anxiety symptoms, parent psychopathology, family functioning, parenting behaviours, and parent relationship quality. Eligible families were assigned to a one of the BRAVE – ONLINE programs based on the child‟s age; children aged 7 to 12 years completed BRAVE for Children – ONLINE and children aged 13 to 18 years completed BRAVE for Teenagers – ONLINE. Results indicated that anxiety severity decreased significantly over time, and 66% of children were free of their primary diagnosis at 6-month follow-up. Child treatment compliance (both session compliance and homework compliance) was found to predict child treatment outcome at 6-month follow-up for older children (aged 13 years or older), but not for younger children (12 years or younger). For older children, low treatment compliance was associated with less favourable child outcomes at 6-month follow-up. Parent compliance with the online treatment was unrelated to child treatment outcome, irrespective of child age. A number of significant relationships were also identified between family factors and child outcome following online treatment for anxiety disorders. Higher levels of parent depression or parent stress, and low parent relationship quality, were associated with less favourable child treatment outcomes at 6-month follow-up (on at least one indicator of child outcome), irrespective of child age. Additionally, high levels of parental anxiety were found to be detrimental to treatment outcome for younger children, though not for older children. Furthermore, the effect of family adaptability on child treatment outcome was conditional on child age, such that high family adaptability (i.e. highly flexible in structure) predicted more favourable treatment outcomes for younger children, though was associated with poor treatment response for older children. Finally, the relationship between parent depression and child global functioning at 6-month follow-up, was shown to be mediated by child homework compliance, for children receiving online CBT for anxiety disorders. Specifically, high levels of parental depression were associated with lower child homework compliance, which in turn was predictive of lower child global functioning at 6-month follow-up. These findings can be seen to have important clinical implications for the treatment of child anxiety disorders, particularly in regards to the relationship between family factors and child treatment outcome. It is possible that the inclusion of additional treatment modules aimed at improving problematic family dynamics (e.g. parent anxiety management), may also improve the chances of children achieving successful outcomes following treatment. Given the paucity of evidence in this area, further investigation is needed to allow for greater conclusions to be drawn. A discussion is provided in relation to future research directions, with the aim of expanding upon the findings of the current study.

Purpose: This study is to identify the sport tourism participating-motivation, attraction, satisfaction, and loyalty discrepancy among tourists from different backgrounds in 2012 International Massive Swimming Cross Sun Moon Lake Activity. Moreover, it analyzed whether participating-motivation, attraction, and satisfaction can be used to make predictions on the loyalty and examined the materiality level of the International Massive Swimming Cross Sun Moon Activity to the local. Method: Tourists participating in 2012 International Massive Swimming Cross Sun Moon Lake Activity were chosen to be the subject of this study. There were 420 valid questionnaires with an effective response rate of 93.3%. Result: (1) From the gender aspect, males had a significantly higher extent of sport tourism participating satisfaction and loyalty than females. There were no obvious distinctions appeared in different education status. Aged 51 and above subjects showed the highest degree of satisfaction, followed by aged 20 and below, aged 21-30, aged 31-40, and lastly aged 41-50; aged 31-40 group had a significantly higher loyalty than the aged 21-30 group; aged 51 and above group had a remarkably higher sport tourism participating attraction degree than aged 21-30. Subjects living in Southern parts had much more sport tourism motivation than those living in the central parts; those from the northern parts had a significantly higher degree of sport tourism loyalty than those living in the central parts. Participants with tour packages showed conspicuously higher sport tourism motivation and loyalty than those without packages. (2) Sport tourism motivation, attraction, and satisfaction can all be taken into account to predict loyalty. (3) Participants who rated 2012 International Massive Swimming Cross Sun Moon Lake Activity to be ＂very important＂ took up the largest portion, followed by ＂extremely important＂, ＂unimportant＂, and then ＂extremely unimportant＂. Conclusion: This study gave the results that holding such activity brought positive influences to the local. This conclusion can be a reference for the sponsor and related future studies.

As a consequence of the obligations of the Directive Seveso III, there is a need of methods and tools that support industrial managers and the auditors, respectively, to manage and to verify the ageing status of critical equipment. Risk-Based Inspection methods (RBI) are usually used, as well as some other recommended practices (ASME, API or RIMAP). Criticalities are associated with RBI methods as these were born to optimise inspections’ costs by comparing them with safety levels, thus an effort is always necessary to adapt the method in order to manage ageing. This work describes an under-development system that supports industrial managers and auditors in controlling and managing ageing. It can be considered as a virtual sensor, made up by hardware and software. It collects information about process variables (recorded by control systems), external variables, inspection information and other data, then it processes collected information and predicts the numeric value of a performance indicator based on the approach for the ageing assessment, which was developed by an Italian working group on ageing. Based on such an indicator the prediction of the ageing state of the equipment is possible as well as its management based on the levels of industrial risk acceptance. The software is a dynamic model indicating factors that accelerate and those that slow down the degradation processes. The model is expected to build a “digital twin” of a complex plant by using a huge amount of data, which is valuable to understand how the plant will age in the next future.

The biology and ecology of carcharhiniform sharks in the Gulf of Papua prawn trawl fishery

Australian population aged over 65 years is 14% (3.3 million) and this expected to increase to 21% by 2053 (8.3 million), of which 1.9% to 4.2% is attributed to Australians over 85 years. With increase in ageing, there is high prevalence in long-term health conditions and more likely multiple visits to the doctors or the hospitals, particularly when one's functional condition declines. This adds burden to the already stretched health system such as the overcrowding of emergency departments in hospitals. This is partly due to many ageing patients with high care needs occupying significant number of hospital beds because they are waiting for entry to the limited placements in residential care. To address this increase in ageing population and its impact in the society, the Australian government has funded aged care reforms for initiatives for older community stay at home longer. Recently, this was implemented through consumer directed age care reform. Advances in information and communication technologies, particularly in the advancement of lifestyle technologies and its increased use, show promise in the uptake of telehealth approach to support older people to live longer in their homes. In 2011, CSIRO took the initiative to a develop consumer designed innovative platform that would assist and support the older community in their functional ability and health for day to day living in their home environment. This platform was called the Smarter Safer Homes technology. The Smarter Safer Homes platform infers the Activities of Daily Living information from a passive sensor-enabled environment and correlates the information with home-based health monitoring measurements. The use of sensors enables the information to be captured in an unobtrusive manner. This information is then provided to the individual in the household through an iPad application while information can also be shared with formal and informal carers. The platform has undergone a few pilot studies to explore an objective and individualised approach to Activities of daily living based on an individual's profile and its applicability in multi-resident home setting in individual's in regional Queensland. Furthermore, the platform is being validated in a clinical study for its application in the aged care service in various geographical settings such as in urban and remote communities. This paper describes the platform, outcomes of pilot studies, and its future application.

The studies presented in this thesis sought to investigate a number of developmental factors that influence the efficacy of preventive intervention for child anxiety disorders. Preventive intervention has emerged as a vital step forward in clinical research following data indicating anxiety disorders are among the most common forms of psychopathology in youngsters (Kashani & Orvaschel, 1990; Mattison, 1992). Several risk and protective factors associated with childhood anxiety disorders have been identified, along with effective treatment protocols (Kendall, 1994; Howard & Kendall, 1996; Barrett, 1998, 1999; Silverman et al., 1999a, 1999b), as prerequisites to the development of preventive programs for child anxiety problems (Spence, 2001). The first objective of this research was to add to the literature on risk and protective factors by investigating the role of peer interaction in the development of child anxiety problems. Study one examined developmental differences in the influence of peer interaction on children's anxiety-related cognition and behaviour. One hundred and sixty two children enrolled in grade 6 (n = 96) aged between 9 and 10 years, and grade 9 (n = 66) aged between 14 and 16 years participated in the study. Participants were stratified into either an at risk group or to a healthy group, based on their anxiety scores on the Spence Child Anxiety Scale (SCAS; Spence, 1997), and further allocated to a peer group comprising of 3 'healthy' (non-anxious) and 3 'at risk' (high anxious) children. Prior to and following a peer discussion, participants completed a standardised self-report measure of threat interpretation and response plans to two ambiguous vignettes (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996). Results showed all participants evidenced changes in threat interpretation and response plans following the discussion with peers (p < .001). Overall, findings highlight the potential importance of peer interaction in the development of anxiety-related cognition and behaviour. The findings of study one have important implications for the future development of school-based intervention programs; specifically those conducted in the classroom. Study two sought to advance the current research on preventive intervention for child anxiety by establishing the age at which youngsters benefit the most from the FRIENDS program as a classroom-based universal intervention. Study two presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years, Participants were allocated to either a school-based cognitive behavioural intervention or to a monitoring group. Participants completed standardised measures of anxiety, depression and coping style. Participants identified as 'at risk' of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Results indicated the universal intervention effective in significantly reducing anxiety (p < .001), depression (p < .001) and behaviour avoidance in children at post- intervention and 12-month follow-up intervals. Grade 6 children reported significantly higher anxiety at pre-intervention and greater reductions in anxiety at post intervention compared with the grade 9 (p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow up. Overall, findings suggest universal intervention potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.

We live in a technological world with a rapidly ageing population. With age, increases are seen in cognitive impairment, motor/movement impairment, and hearing and visual impairment, leading to an increased likelihood of hospitalization for older adults. Considering the rapid growth both of North America's ageing population and of technology, it makes good sense to develop and apply smart technology to help older adults maintain or improve their heath and quality of life. William Mann's Smart Technology for Aging, Disability, and Independence: The State of the Science is a timely and informative book for researchers, clinicians, and students in rehabilitation, medicine, or engineering, as well as for people who have elderly family members and friends. The first chapter provides detailed information about older adults, disability, and technology as well as clear definitions of key terms used throughout the book. Relevant socio-demographic data and trends of ageing, disability, and technology are presented in a very accessible format for readers. What this book does especially well is to introduce and explain smart technology to help older adults with disabilities in a practical way, making it easy for readers to apply the information to their own particular field or need. The technology discussed in the book ranges from the very basic—such as walking aids, canes, and hearing aids—to the very advanced, including robots and smart houses. Some readers may find the more advanced technology a bit difficult to understand, and this information may be less relevant for older adults with limited financial means. In Chapter 4, the health conditions most common among older adults are categorized (e.g., vision, cognition, and mobility/movement problems). Assistive devices applicable to each category are listed and described, including (1) electronic reading devices for older adults with visual impairment; (2) different types of hearing aids for elderly persons with hearing impairment; and (3) wheelchairs and other self-care devices for older individuals with mobility/movement impairment. Information about the use of each device is provided, as well as pictures, descriptions, costs, and technical details. Some chapters introduce the technology or device information in an easy to read and compare tabular format, enabling readers without previous technical training to read and enjoy the book. Chapter 10 presents common causes of older adults’ injury and death (e.g., falls, fire, or medication errors). Both low- and high-technology devices that can prevent older adults from injury or death are then described. Detailed information as to how smart technology can help older adults maintain their health and quality of life is provided throughout the book. Overall, this book introduces technology for older adults with disabilities in a user-friendly way and leaves readers feeling comfortable with these new developments. Technology will likely be an important part of our future, one that can make older adults’ daily lives easier, safer, and more comfortable. This is a wonderful book, especially for clinicians, researchers, and students in rehabilitation, medicine, or engineering, to update current knowledge or acquire new information about smart technology applicable to older adults with disabilities. I am certain that it will inspire these types of readers and provide them with great ideas for their research or clinical programs for older adults.

This article aims at contributing to a little explored theme in the academy: the third age, ageing and capoeira. Through a bibliographical review and supported by the experience of life of the author as a capoeira master, it contributes with information and initial reflections on the subject. This study shows the importance of playful aspects in the practice of capoeira at this age. With the increase of third age practitioners and masters in a near future, there is a need for further investigations in the area and for a greater deepening in the application of concepts and knowledge by the professionals that act specifically in the sector.

A person's right to self-determination in health care is now a fundamental principle of health care provision. As a consequence Advance Care Planning (ACP) is a critical issue in health care including palliative care as it is seen as a way of ensuring a person's right to participate not only in future health care choices but in end of life decision making. To date there have been few reports of successful ACP programs. In 2004 and 2005 a program of advance care planning, known as Respecting Patient Choices was introduced in 17 residential aged care facilities in metropolitan Melbourne, Australia. This program consisted of a system-wide approach that included education for aged care staff; information for residents and families as well as changes to organisational processes to ensure that residents have opportunity for self-determination in their future health care. This paper will report on the lessons learnt from this implementation and identify strategies which foster sustainability of ACP.

The working population is aging fast in most European countries and in the USA. The health and well-being of an elderly shift worker depends on the interaction of several individual, medical, psychosocial and job-related factors. These factors are related to the biological ageing process, but also to changes in one's individual life situation and the needs of the ageing shift worker. The evidence of good age-specific solutions in working hours is limited, but the few published intervention studies support the use of individual flexibility, rapid forward rotating shift systems, and earlier shift start-end times in three-shift work. In addition to the development of shift schedules, the counter-measures to improve the health and well-being of ageing shift workers should be focused on the improvement of occupational health care and the promotion of appropriate coping mechanisms for the aging.

Objective To estimate the oral health behaviors of local residents aged 35-44 and to recommend some policies for oral health care in Shenzhen. Methods A multi-stage random sampling was applied to obtain a representative sample consisted of 1230 people aged 35-44. The questionnaire was designed according to 'The guideline for the 3rd National Oral Health Survey’, regarding oral health practice, oral health services and knowledge about oral health, and 1224 effective questionaires were finally collected. Results In the tested people, 91.7% of people held brushing their teeth per day; 55.6% of people brushed their teeth twice or more per day; 72.1% used fluoride toothpaste; dental floss was rarely used. Only 15.9% people went to department of stomatology of hospital last year, and 90% patient were due to acute and chronic toothache or other discomforts. People with periodic oral examination was rarely, and television/broadcast were still the primary sources of the oral health knowledge. Conclusion The key points of oral preventive care were to improve the people′s preventive oral health consciousness, change oral behaviors and intensify oral health education contents in Shenzhen in future. Key words: People aged 35-44; Oral health; Questionnaire; Health behavior; Health service

Background: Chlamydia is the most common Sexually Transmitted Infection (STI) in England (Public Health England, 2016) and the impact of the infection has serious health and financial implications (World Health Organisation (WHO), 2003). The stigmatisation of STIs is linked to self-conscious emotions (Earl, Nisson & Abarracin, 2015) which could have a negative impact for treatment as physician communication which promotes shame has been found to influence adherence to treatment for health problems (Harris & Darby, 2009). Aim: The aim of this study was to further understand the effect of practitioner-patient communication, particularly the effect of guilt-promoting, shame-promoting or neutral communication on likelihood of following medical advice for chlamydia. Method: 140 females aged 18-25 took part in an online experiment. Participants were randomly allocated to one of three practitioner communication conditions: 1) designed to induce shame (internal focus on self) 2) designed to induce guilt (external focus on behaviour) 3) designed to be neutral. Participants then answered questions about their likelihood of adhering to medical advice (take medication, use condoms in future, make and attend follow-up appointments (NHS choices, 2015)). Participants also completed measures of shame and guilt proneness. Results: Counter to expectation, both the shame and guilt promoting communication had a significantly positive effect on some aspects of likely adherence to medical advice. There was no evidence that shame and guilt proneness correlated with likeliness to adhere to medical advice for those who received corresponding shame or guilt provoking communication. However, there was a relationship between guilt proneness and intention to perform safe sex in the future and take prescribed antibiotics. Conclusion: Findings might not be as predicted because likelihood of adherence to medical advice may not be suggestive of actual adherence to medical advice. Furthermore, as STIs are so greatly stigmatised by society, it may be that all participants were influenced by the effect of self-conscious emotions. The study also suggests that guilt-proneness may predict intention to follow medical advice of taking antibiotics and practicing safe sex in the future. The study could also be interpreted as suggesting that those who are guilt-prone or receive shame provoking communication are more likely to engage in behaviours that would ensure they would not have to attend a sexual health screening appointment in the future, which is counter to current medical advice of yearly screening for under 25 year olds.

This paper explores the ways in which young people aged 12 to 18 who were born in Central and Eastern European EU countries but now live in the United Kingdom construct their future imaginaries in the context of Brexit. It reports on findings from a large-scale survey, focus groups and family case studies to bring an original perspective on young migrants’ plans for the future, including mobility and citizenship plans, and concerns over how Britain’s decision to leave the European Union might impact them. While most of the young people planned to stay in Britain for the immediate future, it was clear that Brexit had triggered changes to their long-term plans. These concerns were linked to uncertainties over access to education and the labour market for EU nationals post-Brexit, the precarity of their legal status and their overall concerns over an increase in racism and xenophobia. While our young research participants expressed a strong sense of European identity, their imaginaries rarely featured ‘going back’ to their country of birth and instead included narratives of moving on to more attractive, often unfamiliar, destinations. The reasons and dynamics behind these plans are discussed by drawing on theories of transnational belonging.

With the population ageing, increasing health needs and demands, changing family structure and the transformation of general hospital service model, home care as an important part of primary care, has been brought more and more attention. Home healthcare would relieve the pressure caused by increasing needs of elderly care and transformation of hospital functions, so it should have greater development in the future. This article reviews the present situation and the future development direction of home healthcare in China. Key words: Home nursing; Home-based care for the aged

Background: With an estimated 10.4 million incident tuberculosis (TB) cases in 2015, and the current trajectory of 1.5%/year incidence rate decline, new TB vaccines are urgently needed to help meet the WHO goal of tuberculosis elimination by 2050. However, insufficient epidemiological evidence exists to inform TB vaccine development strategies and to assist clinical trial site selection and design. Research to meet these data needs is critical to accelerate TB vaccine development. To maximise the future impact of new TB vaccines, estimates of the population-level impact of vaccine characteristics and implementation strategies are needed to inform design of TB vaccine target product profiles. To accelerate and de-risk clinical trials, appropriate epidemiological data are required to inform trial site selection, sample size calculations and recruitment strategy. However, data availability at trial sites is limited, and prospective studies are resource-intensive, so new methods are needed to collect appropriate data to inform TB vaccine trial design.&#13;\nTo inform data-driven development strategies for new TB vaccines, the aims of this thesis were to 1) estimate the epidemiological impact of new TB vaccine characteristics and implementation in China to inform design of target product profiles; and 2) to develop a novel epidemiological spatial mapping tool capable of informing clinical trial design for new TB vaccines in low-income, high-burden settings.&#13;\nMethods: A deterministic, age-structured, Mycobacterium tuberculosis transmission model was developed and calibrated to age-stratified epidemiological and demographic data from China. This was employed to estimate the population-level epidemiological impact of new TB vaccines over the 2025-2050 time horizon, through an exploration of potential vaccine characteristics and implementation strategies. &#13;\nA new methodology for empirical data collection to determine spatial distribution of TB notifications was developed. The electronic PArticipant Locator application (ePAL app) combined 3,243 community-identified points of interest with high resolution satellite maps, within an electronic tablet-based case report form. The app was integrated in to the National Tuberculosis Programme in Blantyre, Malawi, for collection of demographics, health status and coordinates of place of residence for patients ≥18 years initiating TB treatment. Accuracy of ePAL-recorded co-ordinates was evaluated against GPS coordinates obtained at the participant’s place of residence. &#13;\nResults: Mathematical modelling predicted a shift towards a reactivation-driven, ageing TB epidemic in China by 2050. Vaccines protective against disease, effective post-infection and providing at least 5 years protection were essential for achieving higher levels of impact. Vaccination of older adults provided greater population-level impact than vaccinating adolescents for all equivalent vaccines explored, even if much lower coverage were achieved in older adult vaccination. Recommendations for post-infection vaccines were robust to substantial reductions in efficacy and duration of protection in older adults, whereas for pre-infection vaccines in some of these scenarios adolescent vaccination may be equivalent or preferred. Vaccinating older adults with post-infection vaccines provided substantially higher impact than pre-infection vaccines.&#13;\n1,899 TB patients were registered using ePAL in the 12-month study period, with high patient acceptance (98.7%, 1,899/1,924). ePAL achieved clinic-based collection of patient location of residence accurate to a median of 84 metres (IQR: 35-317 metres) in a high population density urban setting without a municipal address system. Advantages of the ePAL system included real-time availability of high-resolution spatial data, low set up costs, and ease of use by health staff as part of routine TB registration. Data were used to identify areas with high TB burden, potentially suitable for TB vaccine trials.&#13;\nConclusions: The research presented in this thesis informs the development of appropriate TB vaccines and target populations to maximise future population-level impact. A prevention of disease vaccine efficacious post-infection and delivered to older adults would contribute towards maximising population-level impact in China. Adolescent-targeted tuberculosis vaccines are likely to have low impact in ageing, reactivation-driven epidemics like China, which suggests a modification of the current strategic focus on adolescents among certain funders. Clinical trials should assess disease endpoints, include M.tb-infected and older adult populations, and extend beyond the usual 2-3 years follow up. To support design of disease endpoint trials, ePAL may provide an accurate, easily implementable, low-cost tool for identification of areas of high TB burden in settings without addresses.