Informal (unpaid) care-givers of older people with dementia experience stress and isolation, causing physical and psychiatric morbidity. Comprehensive geriatric assessment clinics represent an important geriatrician-led model of dementia care. Our qualitative study examined the educational and support needs of care-givers of people diagnosed with dementia at a geriatric assessment clinic, resources used to address those needs and challenges experienced in doing so. We conducted structured thematic analysis of interviews with 18 informal care-givers. Participants’ narratives reflected four themes. First, care-givers sought information from varied sources, including the Alzheimer Society, the internet and clinic staff. Responsive behaviours, the expected progression of dementia and system navigation were topics of particular interest. Second, care-givers obtained assistance from public, for-profit and voluntary sources. Third, care-givers received little assistance. Two-thirds received fewer than four hours of help weekly from all sources combined, and none more than 15. Several received no assistance whatsoever. Publicly funded support workers’ tasks, and their timing, were often unhelpful. Finally, while numerous care-givers felt physical and emotional strain, and worried about how poor health impaired their care-giving, many hesitated to seek help. The needs of this unique population of informal care-givers can be met by improved home-care service flexibility, and access to trustworthy information about the expected progression of dementia and skills for managing behavioural and psychological symptoms.

Objective.Previous studies combining biologic disease-modifying antirheumatic drugs (bDMARD) to treat rheumatoid arthritis (RA) have shown an increased risk of infection. However, the risk of infection with concurrent use of denosumab, a biologic agent for the treatment of osteoporosis, and a bDMARD remains unclear. Here, we evaluated the incidence of serious and opportunistic infections in patients treated concurrently with denosumab and a bDMARD and patients treated with a bDMARD alone.Methods.A chart review of patients with RA from 2 Canadian rheumatology practices between July 1, 2010, and July 31, 2014, identified 2 groups of patients: those taking denosumab and a bDMARD concurrently (concurrent group) and those taking only a bDMARD (biologic-alone group). Patients were followed from the time of initiation of denosumab, or a matched index date for the biologic-alone group, to the end of the study or loss to followup. Instances of serious or opportunistic infections were recorded.Results.A total of 308 patients (n = 102 for the concurrent group and n = 206 for the biologic-alone group) were evaluated. Within the concurrent group, 3 serious infection events occurred. Within the biologic-alone group, 4 serious infection events and 1 opportunistic infection event occurred. In both groups, all patients with serious or opportunistic infection recovered, and there were no instances of death during the study period.Conclusion.This study demonstrated a low occurrence of serious and opportunistic infections in patients with RA taking bDMARD, including patients with concurrent denosumab use.

Proton pump inhibitors (PPIs) are a commonly prescribed class of medications. Their use has been associated with an increased rate of fractures, most notably hip fractures. However, there does not seem to be a clear association between PPI use and bone mineral density measurements, assessed by dual X-ray absorptiometry. The mechanism by which PPI use increases the risk of fractures remains unclear. This review will summarize the current evidence on this topic.

Physical activity has many health benefits, one of which is the health of the heart and blood vessels. People with cerebral palsy are at risk of developing unhealthy heart and blood vessels due to limitations in mobility reducing the amount of physical activity they can perform. We studied the differences in blood vessel health between people with cerebral palsy who walk without limitations compared with those who walk with limitations. The group who walk without limitations had better measures of vessel health, such as lower blood pressure, and engaged in more physical activity than those who walk with limitations. We recommend that healthcare providers measure blood pressure and discuss physical activity with people with cerebral palsy in order to help them maintain heart and blood vessel health. Objective: To compare cardiovascular health vari ables and physical activity levels of adolescents and adults with cerebral palsy who are Gross Motor Func tion Classification System (GMFCS) levels I and II. Methods: Eleven adolescents (mean age 13.1 (stan dard deviation (SD) 2.1) years) and 14 adults (mean age 31.7 (SD 10.4) years)) with cerebral palsy were included, grouped by their GMFCS level (level I (n = 12); level II (n = 13)). Assessments of cardio vascular health, body composition and physical acti vity levels were performed. Cardiovascular variables included resting blood pressure and carotid artery intima media thickness. Body composition included height, weight, body mass index, and waist circum ference. Physical activity was measured using acce lerometry. Results: Adjusting for age between GMFCS levels (GMFCS I mean 17.3 (SD 5.2); GMFCS II mean 29.3 (SD 14.1) years, p = 0.011), significant differences were evident for moderate-to-vigorous physical activity per day (GMFCS I median 45.8 (interquar tile range (IQR) 32.4-75.1); GMFCS II median 16.4 (IQR 13.0, 25.0) min/day, p = 0.011), height (GM FCS I mean 1.63 (SD 0.14); GMFCS II mean 1.56 (SD 0.12) m, p = 0.010), mean arterial pressure (GMFCS I mean 84.6 (SD 7.8); GMFCS II mean 89.4 (SD 8.5) mmHg, p = 0.030), and carotid artery intima media thickness (GMFCS I mean 0.431 (SD 0.06); GMFCS II mean 0.489 (SD 0.04), p = 0.026). Conclusion: Individuals with cerebral palsy who were GMFCS level I had lower mean arterial pres sure, thinner carotid artery intima media thickness, and engaged in a greater amount of moderate-tovigorous physical activity per day than those who were GMFCS level II. Clinicians should acknowled ge that ambulatory individuals with cerebral palsy could have differing cardiovascular health profiles and should monitor these cardiovascular variables and discuss physical activity during healthcare vi sits, regardless of age.