Can physical activity be used to maintain cognitive function in nursing home residents with dementia? A literature review

Background: Dementia is a noncommunicable disease with no effective prevention, treatment or cure. Evidence is emerging for the use of exercise to decelerate cognitive decline; however, few studies exist among nursing home residents and an optimum exercise protocol is yet to be determined. Objectives: To determine the effectiveness of physical activity in maintaining cognitive function in nursing home residents with dementia. Methods: Databases searched included CINAHL, MEDLINE complete, SPORTDiscus and ScienceDirect. Six relevant studies were identified and critically appraised using the Effective Public Health Practice Project Quality Assessment Tool. Results: All trials included different exercise programmes with various activity types and duration; all control interventions were social activities. Three studies demonstrated improved cognition in the intervention group, whilst one study observed a slower decline. Four studies found statistically significant cognitive decline in the control groups. Two studies observed no significant changes in either the intervention or control groups. Overall, there is moderate-to-moderate evidencestrong evidence that physical activity can effectively maintain cognitive function in nursing home residents with dementia. Conclusions: All interventions had a favourable effect on cognition. Results suggest that aerobic exercise of longer duration may be most effective for those with mild-to-moderate cognitive impairment; whilst multimodal programmes may be most effective for moderate-to-severe dementia. Combining an exercise programme with standard daily activities appears no more effective than exercise alone. Future research should aim to determine an optimum exercise protocol and whether the positive effects on cognition can be maintained long term with continued exercise

Systematic review: Effective Home Support in Dementia Care, components and impacts – Stage 2, effectiveness of home support interventions.

Aim: To explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research. Background: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored. Design: Systematic review with narrative summary. Data sources: Electronic searches of published studies in English using PubMed, Cochrane Central Register of Controlled Trials, PsychINFO, CINAHL, Applied Social Science Index and CSA Social Services Abstracts. Databases and sources were searched from inception to April 2014 with no date restrictions to locate studies. Review methods: The PRISMA statement was followed and established systematic review methods used. Using 14 components of care for people with dementia and their carers, identified previously, data across studies were synthesized. Interventions were grouped and described and effectiveness ratings applied. Qualitative studies were synthesized using key themes. Results: Seventy studies (four qualitative) were included. Most were directed to carers and of high quality. Seven interventions for carers and two for people with dementia were identified, covering 81% of studies. Those relating to daily living, cognitive training and physical activity for people with dementia were absent. Measures of effectiveness were influenced mainly by the intensity (duration and frequency) of interventions. Those containing education, social support and behaviour management appeared most effective. Conclusion: These interventions reflect emergent patterns of home support. Research is required to identify effective interventions linked to the stage of dementia, which can be applied as part of routine clinical care

Are Computer-Based Treatment Programs Effective at Reducing Symptoms of Substance Misuse and Mental Health Difficulties Within Adults? A Systematic Review

Objective: Comorbid substance misuse and mental health difficulties are recognized as a leading contributor to disease burden worldwide. Amid cuts to health care services, computer-based interventions may provide support for patients experiencing these difficulties. The aims of this systematic review were to identify and investigate the efficacy of these computer-based interventions at improving substance misuse and mental health outcomes. Methods: A systematic search was conducted of CINAHL Plus, PsycARTICLES, PsycINFO, Medline, Web of Science, and the Cochrane Library. Gray literature was also searched for relevant papers. Data were extracted from 33 papers, which met eligibility criteria by reporting a computer-based intervention designed to treat substance misuse and mental health in adults. Quality assessments were conducted on these papers. Results: Computer-based interventions generally led to an improvement of substance misuse and mental health outcomes within groups and when compared against waitlist control and psychoeducation. Computer-based interventions were effective at improving dual diagnosis outcomes, and improvements to mental health outcomes specifically were maintained for up to nine months. However, the combined effect of computer-based interventions and therapist support was found to be more effective than the effects of computer-based interventions alone. Conclusions: Many papers were limited by high attrition rates commonly attributed to “digital” interventions. Future research should consider systematically recruiting a range of participants, including those potentially affected by the digital divide, and incorporating methods within research to maintain engagement. This review was also limited by the heterogeneity of the papers reported, many of which differed between targeting dual diagnosis and targeting either substance misuse or mental health respectively, with outcomes investigating other difficulties out of curiosity

How can we meet the support needs of LGBT cancer patients in oncology? A systematic review

Objectives Approximately 3.6 million people in the UK identify as lesbian, gay, bisexual and transgender (LGBT). Fear of discrimination and lack of sexual orientation and gender identity recording suggests LGBT people are invisible to health services. A systematic review was conducted to critically analyse primary research investigating psychosocial support needs for LGBT cancer patients during and after treatment. Key findings Twenty studies were included in the review; of which ten were qualitative, seven quantitative and three mixed methods. The main themes highlighted include health care professional knowledge and education, negative impact on mental health, lack of inclusive support groups, prevalence of discrimination within healthcare services and the disclosure or non-disclosure of sexual orientation and gender identity. Conclusion The review highlights how healthcare providers are failing LGBT cancer patients in psychosocial support resulting in unmet needs. Recommendations have been made to ensure an LGBT inclusive environment within cancer services, as well as the need to develop support services for LGBT cancer patients. Implications for practice Training should be provided for HCP staff in LGBT health and awareness. Sexual orientation and gender identity recording and monitoring is important to ensure LGBT people are not ‘invisible’ in oncology, radiotherapy and in future research. LGBT cancer support groups and resources should be created, as the review evidence suggests LGBT patients are actively looking for these resources

Systematic review of risk factors for eating psychopathology in athletes: A critique of an etiological model

Objective: The theoretical model by Petrie and Greenleaf (2007, 2012) is an admirable attempt to collate the causal factors of disordered eating in athletes. The aims of this systematic review are (a) to provide an overview of the findings from the relevant literature, (b) to assess whether the model is supported by the existing research, (c) to evaluate the different designs, methods, and measures used to test the mediators in the model, and (d) to highlight areas for improvements and future research. Method: A systematic review of four major online databases identified 37 relevant papers on risk factors of disordered eating in athletes, which were reviewed and critically compared with the theoretical model. Results: There is a lack of longitudinal research with the relevant mediators in athlete populations, which makes it difficult to determine whether the potential mediators described by Petrie and Greenleaf are causal risk factors rather than simply correlates of disordered eating for athletes. Findings for all the potential mediators are inconsistent, and the range of measures used makes it problematic to draw conclusions. Conclusions: Future research needs to use gold standard measures and longitudinal designs in order to fully test and possibly update the model