Systematic Review and Meta-Analysis of Psychosocial Risk Factors for Stroke

Background Several studies have assessed the link between psychosocial risk factors and stroke; however, the results are inconsistent. We have conducted a systemic review and meta-analysis of cohort or case-control studies to ascertain the association between psychosocial risk factors (psychological, vocational, behavioral, interpersonal and neuropsychological) and the risk of stroke. Methods Systematic searches were undertaken in MEDLINE, EMBASE, CINAHL, PsycInfo and the Cochrane Database of Systematic Reviews between 2000 and January 2017. Two reviewers independently screened titles, abstracts and full texts. One reviewer assessed quality and extracted data, which was checked by a second reviewer. For studies that reported risk estimates, a meta-analysis was performed. Results We identified 41 cohort studies and five case-control studies. No neuropsychological papers were found. Overall pooled adjusted estimates showed that all other psychosocial risk factors were independent risk factors for stroke. Psychological factors increased the risk of stroke by 39% (HR 1.39 95% CI:1.27;1.51), vocational by 35% (HR 1.35 95% CI: 1.20;1.51), and interpersonal by 16% (HR 1.16 95% CI:1.03;1.31). and the effects of behavioral factors were equivocal (HR 0.94 95% CI: 0.20;4.31). The meta-analyses were affected by heterogeneity. Conclusions Psychosocial risk factors are associated with an increased risk of strok

Do home modifications reduce care home admissions for older people? A matched control evaluation of the Care & Repair Cymru service in Wales

Background: home advice and modification interventions aim to promote independent living for those living in the community, but quantitative evidence of their effectiveness is limited. Aim: assess the risk of care home admissions for people with different frailty levels receiving home advice and modification interventions against a control group who do not. Study design and setting: matched control evaluation using linked longitudinal data from the Secure Anonymised Information Linkage (SAIL) Databank, comprising people aged 60–95, registered with a SAIL contributing general practice. The intervention group received the Care & Repair Cymru (C & RC) service, a home advice and modification service available to residents in Wales. Methods: frailty, age and gender were used in propensity score matching to assess the Hazard Ratio (HR) of care home admissions within a 1-, 3- and 5-year period for the intervention group (N = 93,863) compared to a matched control group (N = 93,863). Kaplan–Meier curves were used to investigate time to a care home admission. Results: the intervention group had an increased risk of a care home admission at 1-, 3- and 5-years [HR (95%CI)] for those classified as fit [1-year: 2.02 (1.73, 2.36), 3-years: 1.87 (1.72, 2.04), 5-years: 1.99 (1.86, 2.13)] and mildly frail [1-year: 1.25 (1.09, 1.42), 3-years: 1.25 (1.17, 1.34), 5-years: 1.30 (1.23, 1.38)], but a reduced risk of care home admission for moderately [1-year: 0.66 (0.58, 0.75), 3-years: 0.75 (0.70, 0.80), 5-years: 0.83 (0.78, 0.88)] and severely frail individuals [1-year: 0.44 (0.37, 0.54), 3-years: 0.54 (0.49, 0.60), 5-years: 0.60(0.55, 0.66)]. Conclusions: HRs indicated that the C & RC service helped to prevent care home admissions for moderately and severely frail individuals. The HRs generally increased with follow-up duration

Do home adaptation interventions help to reduce emergency fall admissions? A national longitudinal data-linkage study of 657,536 older adults living in Wales (UK) between 2010 and 2017

Backgroundfalls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited.Aimdetermine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls.Study Designretrospective longitudinal controlled non-randomised intervention cohort study.Settingour cohort consisted of 657,536 individuals aged 60+ living in Wales (UK) between 1 January 2010 and 31 December 2017. About 123,729 individuals received a home adaptation service.Methodswe created a dataset with up to 41 quarterly observations per person. For each quarter, we observed if a fall occurred at home that resulted in either an emergency department or an emergency hospital admission. We analysed the data using multilevel logistic regression.Resultscompared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%).ConclusionsC&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling post-intervention. Service provisioning should meet the needs of an individual and need varies by personal and regional circumstance

Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review protocol

Introduction: Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies, focusing on psychological factors that may underpin overweight and obesity. Psychological therapy interventions are gaining recognition for their effectiveness in addressing underlying emotional factors and promoting weight loss. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction and sustained weight reduction in adults with overweight or obesity. Methods and analysis: The review will combine the methodology outlined by Arksey and O’Malley with the PRISMA-ScR guidelines. A total of six databases will be searched using a comprehensive search strategy. Intervention studies will be included if participants are 18 years and over, classified as overweight or obese (≥BMI 25kg/m2), and have received a psychological therapy intervention. The review will exclude studies that are not available in English, not full text, none peer reviewed or combine a lifestyle and/or pharmacological intervention with a psychological intervention. Data will be synthesised using a narrative synthesis approach. Ethics and dissemination: Ethical approval is not required to conduct this scoping review. The findings will be disseminated through journal publication(s), social media, and a lay summary for key stakeholders

Identifying and Characterizing Impact Melt Outcrops in the Nectaris Basin

The Nectaris Basin is an 820-km diameter, multi-ring impact basin located on the near side of the Moon. Nectaris is a defining stratigraphic horizon based on relationships between ejecta units, giving its name to the Nectarian epoch of lunar history. Lunar basin chronology based on higher resolution LRO imagery and topography, while assigning some important basins like Serenitatis to pre-Nectarian time, were generally consistent with those previously derived. Based on this stratigraphy, at least 11 large basins formed in the time between Nectaris and Imbrium. The absolute age of Nectaris, therefore, is a crucial marker in the lunar time-stratigraphic sequence for understanding the impact flux on the Moon, and by extension, the entire inner solar system. For several decades, workers have attempted to constrain the age of the Nectaris basin through radiometric dating of lunar samples. However, there is little agreement on which samples in our collection represent Nectaris, if any, and what the correct radiometric age of such samples is. The importance of the age of Nectaris goes far beyond assigning a stratigraphic marker to lunar chronology. Several dynamical models use Nectaris as their pin date, so that this date becomes crucial in understanding the time-correlated effects in the rest of the solar system. The importance of the Nectaris basin age, coupled with its nearside, mid-latitude location, make remnants of the impact-melt sheet an attractive target for a future mission, either for in-situ dating or for sample return. We have started exploring this possibility. We have begun a consortium data-analysis effort bringing multiple datasets and analysis methods to bear on these putative impact-melt deposits to characterize their extent, elemental composition and mineralogy, maturity and geologic setting, and to identify potential landing sites that meet both operational safety and science requirements

The living and the dead; an investigation into the status of erasure within the floor of Bath Abbey

The floor of Bath Abbey offers a singular test of authenticity. Nineteenth century repairs and additions caused horizontal grave markers, which comprise the majority of the Abbey’s floor, to become separated from the burial sites they were intended to memorialize. A century and a half of further occupation has had the effect of removing many inscriptions as surfaces are worn smooth. The result is a patchwork of unintended edits and accidental poetry. This paper explores the notions of authenticity, essence, memorial and erasure as they pertain to the Abbey floor, in particular with regard to the role the body plays in inhabiting/eroding the floor—from both above and below. The author argues that the stones which are most out of place or worn to a state of erasure are no less authentic than their intact equivalents, but that they can be considered to have moved to another state of authenticity rich in resonance and meaning. This paper, in short, is a defense of erasure and that erosion through occupation may be considered a form of social memory; indeed, the marks of walking become the inscription. In other words, the undesigned (erasure, the cutting and repositioning of ledger stones, the missing inscriptions) becomes considered not as a form of dirt but as the positive traces of on-going and meaningful occupation

External validation of the electronic Frailty Index using the population of Wales within the Secure Anonymised Information Linkage Databank

Background: frailty has major implications for health and social care services internationally. The development, validation and national implementation of the electronic Frailty Index (eFI) using routine primary care data has enabled change in the care of older people living with frailty in England. Aims: to externally validate the eFI in Wales and assess new frailty-related outcomes. Study design and setting: retrospective cohort study using the Secure Anonymised Information Linkage (SAIL) Databank, comprising 469,000 people aged 65–95, registered with a SAIL contributing general practice on 1 January 2010. Methods: four categories (fit; mild; moderate and severe) of frailty were constructed using recognised cut points from the eFI. We calculated adjusted hazard ratios (HRs) from Cox regression models for validation of existing outcomes: 1-, 3- and 5-year mortality, hospitalisation, and care home admission for validation. We also analysed, as novel outcomes, 1-year mortality following hospitalisation and frailty transition times. Results: HR trends for the validation outcomes in SAIL followed the original results from ResearchOne and THIN databases. Relative to the fit category, adjusted HRs in SAIL (95% CI) for 1-year mortality following hospitalisation were 1.05 (95% CI 1.03-1.08) for mild frailty, 1.24 (95% CI 1.21-1.28) for moderate frailty and 1.51 (95% CI 1.45-1.57) for severe frailty. The median time (lower and upper quartile) between frailty categories was 2,165 days (lower and upper quartiles: 1,510 and 2,831) from fit to mild, 1,155 days (lower and upper quartiles: 756 and 1,610) from mild to moderate and 898 days (lower and upper quartiles: 584 and 1,275) from moderate to severe. Conclusions: further validation of the eFI showed robust predictive validity and utility for new outcomes

Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: A systematic review protocol

Introduction Prehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as well as a risk for cardiovascular disease, heart attack and stroke. In the UK, non-pharmacological interventions are recommended for prehypertension management, but no reviews have focused on the effectiveness of these types of interventions solely in people with prehypertension. Therefore, the proposed systematic review will assess the clinical- and cost–effectiveness of non-pharmacological interventions in reducing or maintaining blood pressure in pre-hypertensive people. Methods and analysis This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases/ trial registries that will be searched to identify relevant randomised controlled trials (RCTs) and economic evaluations include Medline, EMBASE, CINAHL, PsycINFO, CENTRAL, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, Cochrane Library, Scopus, and the International HTA Database. Search terms have been identified by the team including an information specialist. Three reviewers will be involved in the study selection process. Risk of bias will be evaluated using the Cochrane risk-of-bias tool for RCTs, and the Consensus Health Economic Criteria list for economic evaluations. Findings from the included studies will be tabulated and synthesised narratively. Heterogeneity will be assessed through visual inspection of forest plots and the calculation of the Chi2 and I2 statistics, and causes of heterogeneity will be assessed where sufficient data are available. If possible, we plan to investigate differential effects on specific sub-groups and from different types of interventions using meta-regression. Where relevant, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) will be used to assess the certainty of the evidence found. Ethics and dissemination Ethical approval is not needed. Results will be published in a peer-reviewed journal, disseminated via the wider study website and shared with the study sites and participants. Registration details: The review is registered with Prospero (CRD420232433047

Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

Introduction: This study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and fall prevention. Methods and analysis: All individuals living in Wales, UK, aged 60 years and over, will be included in the study using anonymised linked data from the Secure Anonymised Information Linkage Databank. We will use a national database of home modifications implemented by the charity organisation Care & Repair Cymru (C&R) from 2009 to 2017 to define an intervention cohort. We will use the electronic Frailty Index to assign individual levels of frailty (fit, mild, moderate or severe) and use these to create a comparator group (non-C&R) of people who have not received a C&R intervention. Coprimary outcomes will be quarterly numbers of emergency hospital admissions attributed to falls at home, and the associated length of stay. Secondary outcomes include the time in moving to a care home following a fall, and the indicative financial costs of care for individuals who had a fall. We will use appropriate multilevel generalised linear models to analyse the number of hospital admissions related to falls. We will use Cox proportional hazard models to compare the length of stay for fall-related hospital admissions and the time in moving to a care home between the C&R and non-C&R cohorts. We will assess the impact per frailty group, correct for population migration and adjust for confounding variables. Indicative costs will be calculated using financial codes for individual-level hospital stays. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and prevention. Ethics and dissemination: Information governance requirements for the use of record-linked data have been approved and only anonymised data will be used in our analysis. Our results will be submitted for publication in peer-reviewed journals. We will also work with lay members and the knowledge transfer team at Swansea University to create communication and dissemination materials on key findings