ObjectiveTo describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services.DesignSystematic review and meta-ethnography.Data sourcesMedline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015).Eligibility criteriaPrimary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services.Data synthesisA set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria.Results51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke.LimitationsPotential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems.ConclusionsStroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services.Systematic review registration numberPROSPERO 2015:CRD42015026602

Objective To assess whether preadolescents’ objectively measured moderate-to-vigorous physical activity (MVPA) is associated with cognitive control and academic achievement, independent of aerobic fitness. Study design A sample of 74 children (Mage = 8.64 years, SD = .58, 46 % girls) were included in the analyses. Daily MVPA (min/day) was measured over 7 days using ActiGraph wGT3X+ accelerometer. Aerobic fitness was measured using a maximal graded exercise test and expressed as maximal oxygen uptake (mL*kg−1*min−1). Inhibitory control was measured with a modified Eriksen flanker task (reaction time and accuracy), and working memory with an Operation Span Task (accuracy scores). Academic achievement (in reading, mathematics and spelling) was expressed as standardized scores on the Kaufman Test of Educational Achievement. The relationships were assessed using hierarchical regression models adjusting for aerobic fitness and other covariates. Results No significant associations were found between MVPA and inhibition, working memory, or academic achievement. Aerobic fitness was positively associated with inhibitory control (p = .02) and spelling (p = .04) but not with other cognitive or academic variables (all p > .05). Conclusions Aerobic fitness, rather than daily MVPA, is positively associated with childhood ability to manage perceptual interference and spelling. Further research into the associations between objectively measured MVPA and cognitive and academic outcomes in children while controlling for important covariates is needed.

Transient epileptic amnesia is a form of temporal lobe epilepsy in which sufferers often complain of irretrievable loss of remote memories. We used a broad range of memory tests to clarify the extent and nature of the remote memory deficits in patients with transient epileptic amnesia. Performance on standard tests of anterograde memory was normal. In contrast, there was a severe impairment of memory for autobiographical events extending across the entire lifespan, providing evidence for the occurrence of 'focal retrograde amnesia' in transient epileptic amnesia. There was a milder impairment of personal semantic memory, most pronounced for midlife years. There were limited deficits of public semantic memory for recent decades. These results may reflect subtle structural pathology in the medial temporal lobes or the effects of the propagation of epileptiform activity through the network of brain regions responsible for long-term memory, or a combination of these two mechanisms.

A model for adolescent involvement in physical activity (PA) that incorporates individual differences in biological maturation is presented. The Biocultural Model of Maturity-Associated Variance in Physical Activity recognizes PA as a complex and multifaceted behavior that exists in multiple contexts (e.g., transport, vocation, sport, exercise & others) and can be viewed from multiple perspectives (e.g., energy expenditure, movement counts, performance outcomes & fitness). The model holds that biological maturation can exert both direct and indirect effects on PA during adolescence. Direct effects imply a direct and unmediated effect of individual differences in maturation on PA. Indirect effects imply influences of individual differences in maturation on PA that are mediated by psychological constructs (e.g., self-perceptions, beliefs) and/or are moderated by exogenous factors (e.g., social interaction, culture) associated with pubertal maturation.