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Adults with Down's Syndrome are at risk of developing Alzheimer's disease in later life. This paper gives an overview of the current research in the area and discusses the implications it raises for individuals, carers and service providers. Information on the link between Down's Syndrome and Alzheimer's disease and prevalence rates are given. The clinical symptoms of Alzheimer's disease and a stage model documenting the progression of the disease are presented. Attention is drawn to the problems inherent in assessing and diagnosing Alzheimer's disease in a person with a pre‐existing learning disability. The importance of a thorough assessment procedure and guidelines for assessment methods are highlighted. The paper also discusses the management of Alzheimer's disease and focuses on care management practices and recommendations for service provision. Guidelines for supporting individuals include maintaining skills, adopting a person‐centred approach, implementing psychosocial interventions and multidisciplinary care management. Finally, high prevalence rates of Alzheimer's disease in adults with Down's Syndrome and increasing life spans are highlighted as a particular concern, and recommendations for the future include increasing education and awareness, implementing screening services, improving assessment methods and developing appropriate services.

The purpose of this paper is to discuss the development of a competency framework for staff working in a specialist service for people with dementia.

A qualitative and purposive methodology was used and included focus groups, questionnaires and interviews. Content analysis together with synthesis of literature was used to generate the competency framework.

A competency framework was developed with eight main clusters. These were: skills for working effectively with people with dementia and their families; advanced assessment skills; enhancing psychological well-being; understanding behaviours; enhancing physical well-being; clinical leadership; understanding ethical and legal issues; and demonstrating skills in personal and professional development.

Further research is needed to include service user perspectives.

The framework could be implemented in practice by managers, health care professionals and training providers as a tool to identify strengths and limitations in knowledge skills and attitudes and to identify areas for competency development through specific training.

The competency framework contributes to the development of a training curriculum for staff working within a specialist service.

Malnutrition is widespread and affects about one-third of humanity. Increasing production and consumption of vegetables is an obvious pathway to improve dietary diversity, nutrition and health. This chapter analyses how climate change is affecting vegetable production, with a special focus on the spread of insect pests and diseases. A thorough literature review was undertaken to assess current global vegetable production, the factors that affect the spread of diseases and insect pests, the implications caused by climate change, and how some of these constraints can be overcome. This study found that climate change combined with globalization, increased human mobility, and pathogen and vector evolution has increased the spread of invasive plant pathogens and other species with high fertility and dispersal. The ability to transfer genes from wild relatives into cultivated elite varieties accelerates the development of novel vegetable varieties. World Vegetable Center breeders have embarked on breeding for multiple disease resistance against a few important pathogens of global relevance and with large evolutionary potential, such as chili anthracnose and tomato bacterial wilt. The practical implications of this are that agronomic practices that enhance microbial diversity may suppress emerging plant pathogens through biological control. Grafting can effectively control soil-borne diseases and overcome abiotic stress. Biopesticides and natural enemies either alone or in combination can play a significant role in sustainable pathogen and insect pest management in vegetable production system. This chapter highlights the importance of integrated disease and pest management and the use of diverse production systems for enhanced resilience and sustainability of highly vulnerable, uniform cropping systems.

Poor mental health and well-being disproportionately affects vulnerable and disadvantaged children and young people. The paper aims to discuss this issue.

The focus of this paper is socioeconomic inequalities in perinatal, child and adolescent mental health.

Children and young people in the poorest British households are up to three times more likely to develop mental health problems than their more advantaged peers (Green et al., 2005). The pattern can also be observed in the opposite direction, with poor mental health known to contribute to socioeconomic and other health problems (McCulloch and Goldie, 2010, Parckar, 2008). At a larger scale, the higher the level of inequality within developed countries, the higher the rate of child and adolescent mental health problems (Pickett et al., 2006).

Mechanisms posited as underlying such inequalities include family investment and stress processes. These factors have been taken into account when developing the economic case for investing in perinatal, child and adolescent mental health.

Illustrative examples of progressive universal strategies and policies to help reduce socioeconomic inequalities in mental health, include: action to address the inequality gap in the UK; early intervention to improve mental health; investing in sustainable and evidence-based mental health services; ensuring parity of esteem, and; using appropriately designed social media and online sources to support children’s mental health.

The purpose of this paper is to establish that social determinants are vital contributing factors to mental health difficulties and that, similar to physical health, mental health follows a social gradient. Despite this acknowledgement, there is a rhetoric/reality gap found in social determinants of mental health (SDMH). It will be argued in this paper that this rhetoric/reality gap is located on a number of levels, including theoretical, methodological, practical, political and policy based, which are proposed here to be interrelated.

The approach is a conceptual analysis of the rhetoric/reality gap found in SDMH using a critical perspective. It draws on a wide variety of theories in order to provide an analysis of the issues outlined.

The paper's central finding is that there is a dissonance between the dominant ontological, epistemological and methodological, or axiomatic, focus in contemporary mental health theory and practice and SDMH. This dissonance has led to a form of “analysis paralysis” on all levels, and the initiatives required to tackle SDMH have been marginalised in favour of a narrow interpretation of evidence-based research and its accompanying ideology centring on the individual, which has established itself as a primary position on what constitutes valid knowledge to the detriment of other views.

The paper offers a critical perspective on an area of SDMH which is often alluded to but never explicitly explored, and questions the underlying assumptions inherent to mental health theory and practice. The paper's value is that it draws attention to this particular dilemma on a wider scale, including on a political and policy-based level, which is often neglected in mental health theory, and it makes some recommendations on how to move forward.

Through the lens afforded by two theories drawn from the discipline of social psychology, the purpose of this paper is to explain the evident continuing abuse of adults at risk living in care homes by the staff who should be looking after them.

By considering existing theories and research into the reasons why vulnerable adults are abused the paper proposes the relevance of other extant theories on the degradation of moral restraint and dehumanisation of victims, and on the social psychology of intergroup relations, to the perpetration of abuse.

The paper demonstrates how theories that explain the psychology of human behaviour in certain circumstances may be usefully applied to the inveterate social problem of the abuse of vulnerable adults living in care homes.

The paper offers the opportunity for the reader to consider how these theories of social psychology may be applied to explain and guide remedies to the persistent levels of abuse in English care homes, abuse that continues despite government oversight of care provided to adults who may be at risk by virtue of the activities of the statutory regulator and health and social care commissioners, and the interventions of safeguarding personnel.

This is a conceptual paper from which future research and theorising may arise to better understand the most fundamental causes of the abuse of older people in care homes in order to develop feasible and effective measures to overcome it.

The purpose of this paper is to introduce and explore stuckness as a felt phenomenon in psychiatric practice in order to stimulate clinicians in mental health settings to be on the lookout for stuckness and on the lookout for unexpected solutions to difficult clinical scenarios.

Signs of stuckness are looked at and then proposed causal factors of stuckness in clinical practice are reviewed. These are divided conceptually into four main groupings: patient factors, clinician factors, service factors and societal factors.

Although clinicians are encouraged to acknowledge when stuckness is present and to try to address possible causes with their patients, clinicians are also advised to work on understanding stuckness as a natural part of creative processes. It is suggested that services should draw on a psychoanalytic ethos to support staff to tolerate and respond to stuckness better.

Feeling stuck with patients’ partial recoveries or “revolving door” cycles is uncomfortable. In stretched psychiatric services in particular stuckness may go unnoticed, and instead the difficulty of the work with patients may inadvertently drive therapeutic mania or rejection of the patients, which can lead to harm. This paper offers a simple scheme to use when thinking about stuck patients in the psychiatric setting with the hope that this can stimulate clinicians to search for new creative solutions for patients.

The purpose of this study is to examine the effectiveness of the Thai nursing student competency enhancement program applied through project-based learning (PjBL) in caring for the elderly in the community.

This quasi-experimental one-group pre-post-test design was used to compare mean scores on gerontological nursing competency scales comprising four dimensions including holistic health promotion, empirical evidence, empowerment and quality care and ethical and moral competencies. A total of 95 participants were randomly selected from a list of registered attendees. A five-week PjBL approach for a community nursing practicum was designed and comprised of an introduction to the project, components of research methodology, group projects and group presentations. A gerontological nursing competencies questionnaire was used with participants, and data were analyzed using descriptive statistics. Two-way ANOVA and a paired t-test were used to compare pre-post mean scores of competencies.

A total of 95 students participated in the PjBL and the majority of participants were female (92.6%). The results revealed post–PjBL mean scores of gerontological nursing competencies were higher than the premean score (p value < 0.05) except the empirical evidence competencies which showed no statistical difference.

Since the results show the effectiveness of the student nursing competency enhancement program through PjBL when caring for the elderly in the community, it is important for health care instructors to apply PjBL, especially in community nursing. Improving empirical competency evidence among nursing students is still required and necessary.