Previous studies have found childhood trauma to be associated with functional and structural abnormalities in corticostriatal-limbic brain regions, which may explain the associations between trauma and negative mental and physical health outcomes. However, functional neuroimaging of maltreatment-related trauma has been limited by largely using generic and predominantly aversive stimuli. Personalized stress, favorite-food, and neutral/relaxing cues during functional magnetic resonance imaging were used to probe the neural correlates of emotional/motivational states in adolescents with varying exposure to maltreatment-related trauma. Sixty-four adolescents were stratified into high-or low-trauma-exposed groups. Cue-related measures of subjective anxiety and craving were collected. Relative to the low-trauma-exposed group, high-trauma-exposed adolescents displayed an increased activation of insula, anterior cingulate, and prefrontal cortex in response to stress cues. Activation in subcortical structures, including the hippocampus, was inversely correlated with subjective anxiety in the high-but not the low-trauma-exposed group. The high-trauma-exposed group displayed hypoactivity of cerebellar regions in response to neutral/relaxing cues. No group differences were observed in response to favorite-food cues. The relationship between trauma exposure and altered cortico-limbic circuitry may in part explain the association between childhood trauma and heightened vulnerability to emotional disturbances and risky behaviour. This may be particularly pertinent during adolescence when such difficulties often emerge. Further work is needed to elucidate the mechanism linking trauma to obesity.

Perceived self-efficacy is proposed to impact on the psychological health of dementia care staff. The current study adopted a qualitative methodology to increase understanding of the experiences of self-efficacious care assistants. Purposive sampling identified eight care assistants with high levels of self-efficacy. Data from semi-structured interviews were analysed using interpretative phenomenological analysis. Four themes captured experiences of 'feeling torn' between competing demands when providing care; a sense of 'togetherness and connection', included sub-themes of support, closeness and the value of engaging; 'emotional attunement' to resident's needs, including reciprocity of emotion, personal perspective-taking and empathy as guides to care. The final theme, 'caring as a part of life', described interest, motivation and accepting attitudes as well as caring being part of carers' identity. The themes highlight how staff might manage the dilemmas they face and emphasize important areas for care staff training as well as further research.

Purpose The purpose of this paper is to report on a service evaluation of a competency-based dementia training programme for clinicians to establish its value in improving their knowledge and confidence of dementia care and to explore any resulting changes to practice. Design/methodology/approach Mixed method quantitative and qualitative data, using rating scales and focus group discussions (FGDs), were collected. Wilcoxon signed-rank test was used to analyse changes in the responses to the rating scales of knowledge and confidence and thematic analysis of FGDs was undertaken to identify staff perceptions of the impact of training on their practice. Findings In total, 162 qualified and clinical support staff undertook the training. A significant change in knowledge and confidence scores was found on all three scales. In general, feedback on the course was positive. Seven themes, demonstrating the relevance of the training to practice, emerged from the FGDs – experiential training awareness of diagnosis, approach, understanding, communication, risk, changed practice and going forward. Practical implications Providing competency-based dementia training for large numbers of staff can have a positive effect on the care delivered to patients with dementia. Originality/value Healthcare organisations have a responsibility to ensure their staff have the training to provide quality care for patients living with dementia. This paper suggests this can be achieved through a collaborative, multi-disciplinary approach involving co-production and best practice guidance.