PROGRAM CHARACTERISTICS ASSOCIATED WITH REDUCED FEAR OF FALLING: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RCTS

Fear of falling (FOF) is common among older people and can result in activity avoidance and decreased physical functioning. Different types of interventions have demonstrated significant small reductions in FOF. To optimize effect sizes, we sought to identify characteristics of interventions that were associated with a change in FOF. Five scientific databases were searched for articles using randomized controlled trial designs in community-dwelling older people without medical conditions. Data extraction included intervention type, setting, group format, type of supervision, provider, delivery format, duration, number of sessions, contact time, and risk of bias (assessed with the Cochrane Collaboration’s Risk of Bias Tool). After screening of titles, abstracts, and full texts, 55 unique studies – reporting on 68 interventions – were systematically reviewed. The majority of interventions focused on exercise (n=50). Interventions were performed at home (n=21) or in a community setting (n=23), were delivered in a group (n=26) or individual (n=30) format, and were often supervised (n=60) and delivered face-to-face (n=56). Duration ranged from 1 to 52 weeks and total contact time with the provider from 2 to 56 hours. Results of 42 interventions were suitable for meta-analysis. Univariate meta-regressions to evaluate associations between intervention characteristics and intervention effects directly after the intervention yielded no significant results. Due to self-reported outcomes and difficulties with blinding, risk of bias was high in all studies. To conclude, intervention characteristics were not associated with changes in FOF in this study. Possible reasons for an absence of associations and future research directions will be discussed

Sleep duration and incidence of obesity in infants, children and adolescents : a systematic review and meta-analysis of prospective studies

Study Objective: To assess the prospective relationship between sleep and obesity in a paediatric population. Methods: We performed a systematic search using PubMed, Embase, Web of Science and Cochrane (up to 25th September 2017). Included studies were prospective, had follow-up >1 year, had duration of sleep at baseline, and measures of incidence of overweight or obesity and/or changes in body mass index (BMI) z-score and BMI during follow-up. We extracted relative risks or changes in BMI z-score or BMI and 95% confidence intervals (CI) and pooled them using a random effect model. Results: Forty-two studies were included but, as there was significant heterogeneity, results are presented by age strata. Short sleep was associated with a greater risk of developing overweight or obesity in infancy (7 Studies, 14 738 participants, RR: 1.40; 95% CI 1.19 to 1.65; p<0.001), early childhood (8 Studies, 31 104 participants, RR: 1.57; 1.40 to 1.76; p<0.001), middle childhood (3 studies, 3 005 participants, RR: 2.23; 2.18 to 2.27; p<0.001) and adolescence (3 studies, 26 652 participants, RR: 1.30; 1.11 to 1.53; p<0.002). Sleep duration was also associated with a significant change in BMI z-score (14 studies, 18 cohorts, 31 665 participants) (mean difference -0.03; -0.04 to -0.01 per h sleep; P=0.001) and in BMI (16 studies, 24 cohorts, 24 894 participants) (mean difference -0.03 kg/m2; -0.04 to -0.01 for every h of increase in sleep; P=0.001). Conclusions: Short sleep duration is a risk factor or marker of the development of obesity in infants, children and adolescents

Towards enhanced management of fear of falling in older people: unravelling interventions and measuring related avoidance of activity

Many older adults have fear of falling or are concerned to fall. However, little is known about factors that contribute to effective interventions for this problem. The first part of this thesis identified several characteristics of interventions and intervention participants that potentially influence the effects of interventions. These can be used as inspiration for the optimization of interventions for fear of falling. The second part of this thesis evaluated a measurement instrument for avoidance behavior due to concerns about falling. The Falls Efficacy Scale – International Avoidance Behavior (FES-IAB) was a good instrument to assess avoidance behavior due to concerns about falling in the population under study. Overall, the findings in this thesis contribute towards improved management of fear of falling in older adults

Towards enhanced management of fear of falling in older people:unravelling interventions and measuring related avoidance of activity

Many older adults have fear of falling or are concerned to fall. However, little is known about factors that contribute to effective interventions for this problem. The first part of this thesis identified several characteristics of interventions and intervention participants that potentially influence the effects of interventions. These can be used as inspiration for the optimization of interventions for fear of falling. The second part of this thesis evaluated a measurement instrument for avoidance behavior due to concerns about falling. The Falls Efficacy Scale – International Avoidance Behavior (FES-IAB) was a good instrument to assess avoidance behavior due to concerns about falling in the population under study. Overall, the findings in this thesis contribute towards improved management of fear of falling in older adults

Association of sleep duration and quality with blood lipids: a systematic review and meta-analysis of prospective studies

Objectives: To assess the longitudinal evidence of the relationships between sleep disturbances (of quantity and quality) and dyslipidaemia in the general population and to quantify such relationships. Setting: Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methods: We performed a systematic search of PubMed and Embase (up to 9 September 2017), complemented with manual searches, of prospective population studies describing the association between sleep duration and quality and the incidence of dyslipidaemias. Relative risks (95% CIs) were extracted and pooled using a random effects model. Subgroup analyses by lipid type were performed. Heterogeneity and publication bias were also assessed. Quality was assessed with Downs and Black score. Participants: Studies were included if they were prospective, had measured sleep quantity and/or quality at baseline and either incident cases of dyslipidaemia or changes in blood lipid fractions assessed prospectively. Primary outcome measures: Incidence of dyslipidaemia and changes in lipid fractions. Dyslipidaemia was defined as a high total cholesterol, triglycerides, low-density lipoprotein cholesterol or low high-density lipoprotein cholesterol compared with the reference group. Results: Thirteen studies were identified (eight using sleep duration, four sleep quality and one both). There was heterogeneity in the sleep quality aspects and types of lipids assessed. Classification of sleep duration (per hour/groups) also varied widely. In the pooled analysis of sleep duration (6 studies, 16 cohort samples; 30 033 participants; follow-up 2.6–10 years), short sleep was associated with a risk of 1.01 (95% CI 0.93 to 1.10) of developing dyslipidaemia, with moderate heterogeneity (I2=56%, P=0.003) and publication bias (P=0.035). Long sleep was associated with a risk of 0.98 (95% CI 0.87 to 1.10) for dyslipidaemia, with heterogeneity (I2=63%, P<0.001) and no significant publication bias (P=0.248). Conclusion: The present analysis was unable to find supportive evidence of a significant relationship between sleep duration and the development of dyslipidaemia. However, heterogeneity and small number of studies limit the interpretation