Cost-Effectiveness of an Online Intervention for Caregivers of People Living With Dementia

ObjectivesLittle evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment.DesignCost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation).Setting and ParticipantsUK-resident adult dementia caregivers with mild-to-moderate anxiety/depression.Cost-effectiveness analysisWe calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire–12 (GHQ-12) rating at 26-weeks, cost of prevented “caseness” on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form–6 Dimensions (SF-6D) over 26 weeks.ResultsData from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective.Conclusions and ImplicationsWe report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life.     

Summary-of-findings tables in Cochrane reviews improved understanding and rapid retrieval of key information

ObjectiveTo measure the effects of a summary-of-findings (SoF) table on user satisfaction, understanding, and time spent finding key results in a Cochrane review.Study Design and SettingWe randomized participants in an evidence-based practice workshop (randomized controlled trial [RCT] I) and a Cochrane Collaboration entities meeting (RCT II) to receive a Cochrane review with or without an SoF table. In RCT I, we measured user satisfaction. In RCT II, we measured correct comprehension and time spent finding key results.ResultsRCT I: Participants with the SoF table (n = 47) were more likely to “agree” or “strongly agree” that it was easy to find results for important outcomes than (n = 25) participants without the SoF table—68% vs. 40% (P = 0.021). RCT II: Participants with the SoF table (n = 18) were more likely to correctly answer two questions regarding results than (n = 15) those without the SoF table: 93% vs. 44% (P = 0.003) and 87% vs. 11% (P < 0.001). Participants with the SoF table spent an average of 90 seconds to find key information compared with 4 minutes for participants without the SoF table (P = 0.002).ConclusionIn two small trials, we found that inclusion of an SoF table in a review improved understanding and rapid retrieval of key findings compared with reviews with no SoF table.     

The Effect of COVID-19 Endemicity on the Mental Health of Health Workers

ObjectivesA major surge in COVID-19 cases despite Singapore's high vaccination has strained the health care system in October 2021. Our aim was to assess and compare Healthcare Worker (HCW) mental well-being in 2021 against a previously published cohort in 2020.DesignCross-sectional survey study.Setting and ParticipantsHCWs from 4 public hospitals and a primary health care system over a 4-week duration in 2021 coinciding with a major surge compared with a similar period in 2020.MethodsA survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) was distributed via email. Primary endpoints were the proportion meeting OLBI thresholds for both disengagement and exhaustion and being at risk for both Anxiety and Depression using HADS. Multivariate analysis identified significant predictors among demographic, workplace, and SAQ data. Subgroup analysis of overseas HCWs was performed.ResultsWe surveyed 1475 HCWs. Significantly more HCWs met primary outcomes using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in either subscale was significantly associated with meeting burnout thresholds (P < .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), preuniversity educational qualifications (P = .026), and longer shift workhours of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a year ago was significantly associated with worse OLBI disengagement scores and a greater proportion meeting HADS thresholds vs seeing them within a year or being local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001).Conclusions and ImplicationsHCW mental health has objectively worsened between 2020 and 2021 in the pandemic’s second year. Avoiding prolonged shifts, adopting preventive mental health strategies, improving patient safety, and attention to HCWs of minority ethnicity, from overseas, and with preuniversity education may help.     

Gender Differences in Service Utilization among OEF/OIF Veterans with Posttraumatic Stress Disorder after a Brief Cognitive–Behavioral Intervention to Increase Treatment Engagement: A Mixed Methods Study

PurposeWomen veterans who served in Iraq and Afghanistan (Operation Enduring Freedom and Operation Iraqi Freedom [OEF/OIF]) have a moderately higher risk of developing posttraumatic stress disorder (PTSD) than male veterans. However, gender disparities in treatment engagement may prevent women veterans from initiating the care they need. Understanding gender differences in predictors of and barriers to treatment is essential to improving engagement and mental health outcomes. The purpose of this study was to examine gender differences in treatment utilization after a brief, cognitive–behavioral therapy (CBT) intervention among male and female OEF/OIF veterans.MethodsParticipants were assigned randomly to either the intervention or control conditions. Intervention participants received the telephone-based CBT intervention. Participants were 35 female and 238 male OEF/OIF veterans who screened positive for PTSD and had never initiated PTSD treatment. Participants were asked about treatment utilization, beliefs about PTSD treatment, and symptoms at months 1, 3, and 6 months subsequent to the baseline telephone assessment. The PTSD Checklist—Military Version was used to assess PTSD and the Patient's Health Questionnaire was used to assess symptoms of depression.FindingsFemale veterans who received an intervention were significantly more likely to have attended treatment over the 6-month follow-up period than male veterans who received an intervention (χ² = 7.91; df = 3; odds ratio, 3.93; p = .04).ConclusionsThe CBT intervention may be a critical mechanism to engage female veterans in treatment. Further research is needed to understand how to engage male veterans with PTSD in treatment.     

Psychotherapy for the Treatment of Anxiety and Depression in Patients with Parkinson Disease: A Meta-Analysis of Randomized Controlled Trials

ObjectiveAnxiety and depression are major psychiatric nonmotor symptoms (NMSs) of Parkinson disease (PD). Although several studies have investigated the effects of psychotherapeutic interventions, particularly cognitive-behavioral therapy (CBT), for alleviating anxiety and depression in patients with PD, the findings have been inconclusive because of the small sample size and the lack of a unified protocol for such treatments. Thus, the present meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effect of psychotherapy on PD-related anxiety and depression.DesignSystematic review and meta-analysis.Setting and ParticipantsRelevant RCTs were extracted from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases. This study was registered in PROSPERO under the number CRD 42020165052.MeasuresThe primary and secondary outcomes were changes in the anxiety score and depressive symptoms, respectively.ResultsFourteen RCTs including 507 patients with PD were analyzed. The interventions were classified as CBT and non-CBT. CBT significantly reduced anxiety at the end of the study (standardized mean difference = −0.85, 95% confidence interval = −1.12 to −0.58, P < .001, I² = 0%), whereas non-CBT did not. Greater heterogeneity in the effects of non-CBT treatment was observed. CBT was significantly beneficial for depression (standardized mean difference = −0.83, 95% confidence interval = −1.26 to −0.40, P < .001, I² = 55%). Despite the greater heterogeneity in the effects, non-CBT interventions were also effective in alleviating depressive symptoms.Conclusion and ImplicationsCBT is effective for the management of anxiety and depression in patients with PD. Routine treatment for patients with this condition is strongly recommended.     

Función familiar y salud mental del cuidador de familiares con dependencia

ObjectiveTo analyse the influence of family function on the caregiver's perceived mental health.DesignCross-sectional study.SettingTwo primary care urban health centres.Participants153 caregivers of dependent people.MeasurementSociodemographic variables of caregiver and dependent relative and psychoactive drugs prescribed to caregiver. Caregiver questionnaires: mental health evaluated with General Health Questionnaire (GHQ-12), family function with adaptation, partnership, growth, affection and resolve (APGAR), and Duke University-University of North Carolina functional social support questionnaire. Care-recipient questionnaires: cognitive disorders with Pfeiffer and functional dependence level with Barthel.ResultsCaregiver's mean age was 63.8 years; 72.5% (n=111) were female; 57.5% have only primary school studies; and 37.1% take psychoactive drugs. More than 40% of the care-receivers have cognitive disorders and 49.7% have total functional impairment. According to the GHQ-12, 27% of the caregivers had mental health disorders; 31.3% of the families were dysfunctional and 32.7% had poor social support. The variables that significantly contributed to the explanation of caregiver's mental health have been: psychoactive drug intake, family function, social support and educational level.ConclusionFamily function is an important predictor of caregiver's mental health.     

Predictors of successful telephone follow-up in a multicenter study of infants with severe bronchiolitis

PurposeTo identify the characteristics that predict successful telephone follow-up with parents of infants with severe bronchiolitis.MethodsWe analyzed data from a 17-center, prospective cohort study of infants (age <1 year) hospitalized with bronchiolitis during three consecutive fall/winter seasons. Participant contact information and clinical data were collected during the index hospitalization. Parents were called at 6-month intervals (based on the child's age) after discharge to assess respiratory problems. The primary outcome was age 12-month telephone interview status. Participants were classified as unreachable after 28 days of unsuccessful attempts.Results798 of 916 children (87%) completed the age 12-month telephone interview. In unadjusted analyses, factors associated with successful follow-up included: private health insurance, annual household income $60,000 or more, and residing in the Northeast, Midwest, or West. Follow-up was less common among non-Hispanic blacks, Hispanics, and households with 3 or more children. In multivariable analyses, follow-up was more likely among parents of females, and, compared with the South, in the Northeast and Midwest (all P < .05). Compared with non-Hispanic whites, non-Hispanic blacks and Hispanics remained less likely to complete the interview as did households with 3 or more children (all P < .05).ConclusionSociodemographic and geographic factors predict successful telephone follow-up, even among parents of infants with severe illness.     

Physicians' attitudes towards smartphone-based emergency response communities for anaphylaxis: Survey

ObjectivesPatients at risk of anaphylaxis are required to always carry an adrenaline auto-injector (AAI), as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid.The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC).MethodsA convenience sample of 224 physicians were surveyed using an online questionnaire. Answers were analyzed using ANOVA, t-tests and ordinal regression.ResultsPositive attitudes towards an AERC found 88.4% (n = 198) see potential in the ERC and 62.9% (n = 141) think that ERC is excellent and should be implemented immediately. Fewer respondents (6.25%, n = 14) rejected the ERC completely.Respondents showed high willingness to provide patients with solicited or unsolicited advice to join an AERC (78%, n = 175 and 50%, n = 111 respectively).Physicians' opinion about the minimum age to join an AERC is an average of 15.45 years.Leading concerns are 'being left without AAI' (54.5%, n = 122), 'expired AAI' (44.2%, n = 99) and 'wrong AAI administration' (41.1%, n = 92).High support for mediated AERC (79%, n = 177) was found and mediation seems to reduce concerns among the majority (68.3%, n = 153) of respondents.ConclusionsPhysicians expressed high support for unmediated AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Findings support the AERC approach for patients at risk of anaphylaxis.Public interest summaryPatients at risk of anaphylaxis are required to always carry an adrenaline auto-injector, as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid. The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC).A convenience sample of 224 physicians were surveyed using an online questionnaire.Physicians expressed high support for unmediated AERC and high willingness to provide patients with solicited or unsolicited advice to join an AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Leading concerns are 'being left without AAI', 'expired AAI', and 'wrong AAI administration'.     

Physical activity and loneliness among adolescents with disabilities: Examining the quality of physical activity experiences as a possible moderator

BackgroundAdolescents with disabilities (AWD) often report higher loneliness levels than adolescents without disabilities, as they frequently encounter barriers to social participation. A negative relationship between physical activity (PA) and loneliness has been established outside of AWD populations, while few studies have examined this association among AWD. Research investigating the relationship between PA and loneliness has not systematically examined aspects of PA experiences that may influence this relationship.ObjectivesThe objectives of this study were to: a) examine the direct relationship between PA and loneliness among AWD, and b) examine the quality of PA experiences, as framed within a quality participation conceptualization, as a possible moderator of the relationship between PA and loneliness.MethodsThis study was a cross-sectional sub-analysis of data from The National Physical Activity Measurement Study. Participants included 40 Canadian adolescents, age 10-17, with any type of disability who completed a series of questionnaires either online or via telephone/video interview.ResultsPA and loneliness were not significantly related at the bivariate level (r = ?0.10, p = .54), but quality of PA participation significantly moderated the relationship between PA and loneliness (95% C.I. = 0.002–0.019, p = .02). These results suggest that greater PA rates were significantly and negatively associated with loneliness among AWD who reported experiencing high quality PA experiences.ConclusionsThis research can be used as evidence to inform mechanistic studies with causal data to provide more robust findings on the possible value of high-quality PA experiences to mitigate feelings of loneliness among AWD.     

Harvest for Health,a Randomized Controlled Trial Testing a Home-Based,Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

BackgroundAccelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity.ObjectiveThe aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported.DesignHarvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over.Participants/settingMedicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021.InterventionParticipants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens.Main outcome measuresAlthough the RCT’s primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19.Statistical analyses performedχ² and t tests (α < .05) were used to compare enrolled vs unenrolled populations.ResultsOlder cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022.ConclusionsThis RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors—one with capacity for sustainability and widespread dissemination.     

Unit Support Protects Against Sexual Harassment and Assault Among National Guard Soldiers

ObjectiveDespite concerns about increased sexual harassment and assault after the 2013 legislation repealing the ban on women in combat, little research has examined military factors that could prevent sexual harassment and assault during deployment. This study examined whether unit support, which reflects the quality of service members' relationships within their unit, protects against sexual harassment and assault during deployment.MethodsParticipants were 1,674 Ohio Army National Guard service members who reported at least one deployment during a telephone survey conducted in 2008 and 2009. Participants completed measures of sexual harassment/assault, unit support, and psychosocial support. Logistic regression was used to model odds of sexual harassment/assault.ResultsApproximately 13.2% of men (n = 198) and 43.5% of women (n = 74) reported sexual harassment, and 1.1% of men (n = 17) and 18.8% of women (n = 32) reported sexual assault during their most recent deployment. Greater unit support was associated with decreased odds of sexual harassment and assault.ConclusionsA substantial proportion of men and women reported sexual harassment/assault. Greater unit support was associated with diminished odds of sexual harassment/assault during deployment. Programming designed to improve unit cohesion has the potential to reduce sexual harassment and assault.     

Technology acceptance and trust: Overlooked considerations in young people's use of digital mental health interventions

ObjectivesDigital mental health interventions (DMHIs) have potential to provide support at scale for young people, yet uptake is low. The present study investigated whether attitudes towards technology solutions in relation to perceived usefulness, perceived ease of use, and trust of DMHIs influenced young people's intentions to use DMHIs.MethodsYoung people aged 17–25 (N = 248) were recruited online via advertising (e.g., Facebook, Twitter) to a survey assessing attitudes of technology acceptance and intentions to use DMHIs, previous use of DMHIs, demographics, and mental health need.ResultsParticipants reported relatively neutral attitudes towards DMHIs. Outcomes from linear regression indicated that greater perceived usefulness (β = .24) and trust of DMHIs (β = .28) have significant small to moderate positive associations with higher intentions to use DMHIs. Perceived ease of use (β = .07) was not associated with intentions to use DMHIs. Gender, age, previous use of DMHIs, and mental health need did not moderate unique associations between intentions to use DMHIs and perceived usefulness, perceived ease of use, and trust of DMHIs.ConclusionsModerate levels of technology acceptance for mental health, particularly in domains of perceived usefulness and trust of DMHIs, may represent a barrier to DMHI adoption among young people. Developers and service providers are recommended to provide information about the usefulness, effectiveness, and trustworthiness of DMHIs to improve uptake among young people.     

Physical activity counseling promotes physical and psychological resilience in older veterans with posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD.MethodsOlder (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months.ResultsPrimary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 min/week to 161 min/week among participants in the intervention arm (p = 0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p < 0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p < 0.05).ConclusionsGiven the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.     

Depressive symptoms during pregnancy: Exploring the role of sitting

Statement of problemStudies exploring relationships between sitting and mental health have been conducted in child and adult, but not pregnant populations. Depression during pregnancy is associated with deleterious outcomes for mothers and children, and shortcomings have been identified in current management strategies. Modifiable lifestyle behaviors may provide more acceptable alternatives to current management strategies if shown to be important. The aim of this study was to explore the relationship between sitting behavior and depressive symptoms in a population of pregnant Australian women.MethodsThis pilot cross-sectional study included 81 pregnant women in Brisbane, Australia. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Sitting behavior was measured using the Australian Women's Activity Survey (AWAS). Several potential covariates were also assessed. Linear regression analyses were used to explore the relationship between sitting and depressive symptoms, whilst controlling for known covariates.ResultsThe model investigating “total sitting time” showed no association with depressive symptoms (F = .77, p = 0.38). The model investigating “planned leisure sitting time” was statistically significant (F = 4.42, p = 0.04): significant contributors to the model variance were HADS anxiety score (p = 0.003) and number of existing children (p = 0.02). “Planned leisure sitting time” showed a statistical trend toward significance (p = 0.06).ConclusionsThis study suggests further investigation of the relationship between sitting, particularly planned leisure sitting, and depression during pregnancy is warranted. Future research should include a larger sample and an objective measure of leisure time sitting.     

The impact of the energy cost of walking on the quality of life of post-stroke individuals: A one-year longitudinal study

BackgroundThe increased energy cost of walking (Cw) for stroke patients affects the walking function and walking independence of stroke patients. However, its impact on quality of life (QoL) has never been studied.ObjectiveAssess the association between Cw and QoL for post-stroke individuals in the year following hospital discharge.MethodThirty-seven individuals with stroke were included. QoL was assessed by the EuroQol-5 Dimensions on the day after hospital discharge (T0), at six months (T1) and at one year after hospital discharge (T2). Concomitant an evaluation of Cw, mood disorders (HADS), fatigue, independence in activities of daily living and the presence of a family caregiver was performed. The association between QoL and the different covariates was analyzed using multiple regression analysis.ResultsAt T2, data from 29 individuals were analyzable. Multiple regression analyses showed Cw had a significant influence on the QoL at T1 (coeff ?0.42 (?0.71 to ?0.12), P = .008) and T2 (coeff ?0.49 (?0.71 to ?0.26), P < .001). HADS score was the only other variable to significantly impact variances of QoL at T0, T1 and T2. Moreover, we showed that Cw at T0 explained 29% of variances of QoL at T1 and 42% at T2.ConclusionCw appears to be an independent factor in the QoL of individuals with stroke at six months and one year after hospital discharge. In addition, the initial Cw and HADS are predictive of QoL at one year highlighting the importance of early interventions in these two dimensions to improve QoL over the long term.     

Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas

ObjectiveTo evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community.DesignRandomised clinical trial.SettingFamily health centre, primary care.ParticipantsIndependent elderly people living in the community.InterventionFor intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre.Main measurementsPerception of risk of falls, number of risk factors and number of falls in the study period.ResultsIn both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004).ConclusionsThe multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.     

Effect of Angiotensin System Inhibitors on Physical Performance in Older People – A Systematic Review and Meta-Analysis

ObjectivePreclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle. We aimed to summarize current evidence from randomised controlled trials in this area.DesignSystematic review and meta-analysis.Setting and ParticipantsRandomized controlled trials enrolling older people, comparing ACEi or ARB to placebo, usual care or another antihypertensive agent, with outcome data on measures of physical performance.MethodsWe searched multiple electronic databases without language restriction between inception and the end of February 2020. Trials were excluded if the mean age of participants was <65 years or treatment was targeting specific diseases known to affect muscle function (for example heart failure). Data were sought on measures of endurance and strength. Standardized mean difference (SMD) treatment effects were calculated using random-effects models with RevMan software.ResultsEight trials (952 participants) were included. Six trials tested ACEi, 2 trials tested ARBs. The mean age of participants ranged from 66 to 79 years, and the duration of treatment ranged from 2 months to 1 year. Trials recruited healthy older people and people with functional impairment; no trials specifically targeted older people with sarcopenia. Risk of bias for all trials was low to moderate. No significant effect was seen on endurance outcomes [6 trials, SMD 0.04 (95% CI –0.22 to 0.29); P = .77; I² = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I² = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I² = 0%]. No evidence of publication bias was evident on inspection of funnel plots.Conclusions and ImplicationsExisting evidence does not support the use of ACE inhibitors or angiotensin receptor blockers as a single intervention to improve physical performance in older people.     

Serum and macular responses to multiple xanthophyll supplements in patients with early age-related macular degeneration

ObjectiveThis randomized controlled trial examined serum and macular (in vivo measured macular pigment optical density [MPOD]) responses to supplemental lutein and zeaxanthin in Chinese subjects with early age-related macular degeneration.MethodsOne hundred and eight patients with early age-related macular degeneration older than 50 y were randomized to low lutein (LL; 10 mg/d), high lutein (HL; 20 mg/d), lutein plus zeaxanthin (LZ; each 10 mg/d), or placebo during a 48-wk intervention. Serum concentrations were quantified by C₃₀ high-performance liquid chromatography (at baseline and 4, 12, 24, and 48 wk), and MPOD was measured by analysis of autofluorescence images (at baseline and 24 and 48 wk).ResultsSerum lutein levels in the LL, LZ, and HL groups increased significantly in the first 4 wk and then increased 4.24-, 4.66-, and 6.23-fold during the trial, respectively (all P < 0.001). The serum lutein level in the HL group was significantly higher than that in the LL or LZ group at 48 wk (P < 0.05). Similarly, the serum zeaxanthin concentration in the LZ group increased 3.11-fold at 48 wk. MPOD increased smoothly in all treated groups, and the increase from baseline was greatest in the HL group at 24 and 48 wk (both P < 0.05). MPOD and serum lutein levels increased linearly with the dosage and their increasing rates were statistically correlated (all P < 0.05). No notable changes were detected in the placebo group for MPOD and serum concentrations.ConclusionXanthophyll supplementation significantly increased serum concentrations and MPOD in patients with early age-related macular degeneration, and a higher lutein supplementation (20 mg/d) might be more effective in increasing these two biochemical markers in Chinese patients without significant side effects.     

Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review

BackgroundSexually transmitted infections (STIs) are more common in young people and men who have sex with men (MSM) and effective in-service interventions are needed.MethodsA systematic review of randomized controlled trials (RCTs) of waiting-room-delivered, self-delivered and brief healthcare-provider-delivered interventions designed to reduce STIs, increase use of home-based STI testing, or reduce STI-risk behavior was conducted. Six databases were searched between January 2000 and October 2014.Results17,916 articles were screened. 23 RCTs of interventions for young people met our inclusion criteria. Significant STI reductions were found in four RCTs of interventions using brief one-to-one counselling (2 RCTs), video (1 RCT) and a STI home-testing kit (1 RCT). Increase in STI test uptake was found in five studies using video (1 RCT), one-to-one counselling (1 RCT), home test kit (2 RCTs) and a web-based intervention (1 RCT). Reduction in STI-risk behavior was found in seven RCTs of interventions using digital online (web-based) and offline (computer software) (3 RCTs), printed materials (1 RCT) and video (3 RCTs). Ten RCTs of interventions for MSM met our inclusion criteria. Three tested for STI reductions but none found significant differences between intervention and control groups. Increased STI test uptake was found in two studies using brief one-to-one counselling (1 RCT) and an online web-based intervention (1 RCT). Reduction in STI-risk behavior was found in six studies using digital online (web-based) interventions (4 RCTs) and brief one-to-one counselling (2 RCTs).ConclusionA small number of interventions which could be used, or adapted for use, in sexual health clinics were found to be effective in reducing STIs among young people and in promoting self-reported STI-risk behavior change in MSM.