Physiological effects of physical activity on neurocognitive function in people living with HIV : a systematic review of intervention and observational studies

The inadequacy of antiretroviral therapy in the treatment of HIV-associated neurocognitive disorders paves a way for regular physical activity as a lifestyle modification alternative. However, uncertainty exists among scholars regarding the use of physical activity as a means of managing cognitive disorders among HIV-seropositive individuals. The objective of the review was to examine the potential therapeutic value of physical activity intervention in the rehabilitation of people living with HIV (PLWHIV) experiencing cognitive disorders. Undertaken in this study was a systematic literature review by narrative and quantitative synthesis examining studies from 2000 to 2019. Data sources for the review included the following electronic databases: Medline, PubMed, Cochrane Library, CINAHL (The Cumulative Index to Nursing and Allied Health Literature), Academic Search Complete, PsycINFO and relevant reference lists. The eligibility criteria for the selected studies included in the review were interventional and observational studies, which investigated the interaction of physical activity and cognitive function in adult PLWHIV. Fourteen studies met the inclusion criteria. The study outcomes were cognitive function, aerobic fitness and sociodemographic characteristics. Meta-analyses were executed using RevMan 5.3 and MedCalc, with alpha set at 0.05. A total of 2516 PLWHIV with a mean age of 54±8 years and education, 13±2 years participated in the studies reviewed. Men constituted a greater percentage (60%) of the study participants. Physical activity was not superior to control over cognitive function (Z=0.86; p=0.39; Tau2=61.79 and I2=94%). However, there was a significant correlation between physical activity and neurocognitive function (r=0.26; p<0.05). It was concluded that physical activity was not superior to control over cognitive function in PLWHIV with no reported cognitive deficit.https://www.ajol.info/index.php/ajpherdam2022Physiotherap

Impact of HIV‑associated cognitive impairment on functional independence, frailty and quality of life in the modern era: a meta‑analysis

HIV-associated neurocognitive disorder (HAND) is an important sequela of HIV infection. Combined antiretroviral therapy (cART) has improved the health outcomes of many people living with HIV but has given rise to a less severe but limiting form of HAND. The study aimed to evaluate the impact of HAND on medication adherence, activities of daily living (ADL), quality of life and frailty. This systematic review adheres to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched MEDLINE, PubMed, CINAHL, Academic Search Complete, and PsycINFO online databases. Studies were included if they examined the relationship between HAND and medication adherence, ADL, quality of life and frailty, and were conducted between 1997 and 2021. We used a random-efects meta-analysis model to assess the impact of HAND on outcome variables. Forty papers, totaling 11,540 participants, were included in the narrative and quantitative syntheses. Cognitive impairment was associated with poorer medication adherence (r= 0.601, CI 0.338 to 0.776, p = 0.001, I 2 = 94.66). Cognitive impairment did not infuence ADL (r = 0.167, CI-0.215 to 0.505, p = 0.393) and quality of life (r = 0.244, CI 0.117 to 0.548, p = 0.182). In the cART era, HAND appears to be associated with adherence to medication, which may infuence future health outcomes. In PLWHIV who are adherent to cART, cognitive impairment does not appear to interfere with ADL and quality of life.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.https://www.nature.com/srepPhysiotherap

Normative scores for select neuropsychological battery tests for the detection of HIV‑associated neurocognitive disorder amongst Nigerians

BACKGROUND : The study aimed to derive socio‑demographic–corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross‑sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla. AIMS AND OBJECTIVES : To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. METHODS : Eligibility criteria were being HIV negative, aged 18–64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS‑MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. RESULTS : All the participants were Nigerians aged 18–64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)‑forwards, while education affected all expect IHDS‑MS and DST‑backwards. The cut‑off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS‑MS and DST. CONCLUSIONS : With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV‑associated dementia to a minimum. The lack of variability in the IHDS‑MS and DST is unfavourable.http://www.npmj.orgam2023Physiotherap

Aerobic exercise in HIV-associated neurocognitive disorders : protocol for a randomized controlled trial

BACKGROUND : Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. OBJECTIVE : This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. METHODS : At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. RESULTS : This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. CONCLUSIONS : This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria.SUPPLEMENTARY MATERIALS : APPENDIX 1. Beck Depression Inventory.APPENDIX 2. Alcohol Use Disorder Identification Test (AUDIT).APPENDIX 3. Drug Abuse Screening Test.APPENDIX 4. International HIV Dementia Scale.APPENDIX 5. Controlled Oral Word Association Test (COWAT) (Verbal Fluency Test).APPENDIX 6. Hopkin Verbal Learning Test-Revised.APPENDIX 7. Trail Making Test A & B.APPENDIX 8. Digit span test.APPENDIX 9. Lawton Instrumental Activities of Daily Living (IADL) scale.APPENDIX 10. The World Health Organization Quality of Life (WHOQoL) Bref.APPENDIX 11. Oxford Participation and Activities Questionnaire (Ox-PAQ).APPENDIX 12. Physical Activity Readiness Questionnaire.APPENDIX 13. Adverse events form.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.http://www.researchprotocols.orgPhysiotherap

Meta-analysis of factors affecting prevalence estimates of HIV-associated neurocognitive disorder in sub-Saharan Africa

Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in subSaharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources. Significance: • The high prevalence of HAND in sub-Saharan Africa as estimated in this review calls for further research on the impact of HAND on activities of daily living and putative therapeutic modalities. • We highlight which study characteristics should be critically checked when using prevalence estimates for the purpose of health policy and distribution of scarce resources in sub-Saharan Africa. • By favouring certain factors, this review will guide HIV health researchers in which techniques should be used to estimate the burden of HAND. These factors may also apply to estimating the burden of other diseases in sub-Saharan Africa.University of Pretoria.https://sajs.co.zaPhysiotherap

Effects of an exercise programme on non-insulin dependant diabetes mellitus

Introduction: The best approach in minimising or delaying thecomplications associated with type 2 diabetes mellitus (NIDDM) in South African physiotherapy rehabilitation services has not been established. Physiotherapists continue to rehabilitate amputees as a result of diabetes mellitus. As hospital costs continue to rise every year, it becomes very costly to keep the patients for longerperiods. A study was undertaken at the Bethlehem Regional Hospital in the Free State to determine the effects of supervised and unsupervised exercise programmes in patients with non insulin dependant (type 2) diabetes mellitus. Aim: The purpose of this study was to evaluate the effects of the two different exercise programmes i.e. hospital based and home based exercise programmes on patients with type 2 diabetes mellitus. Methodology: The hospital based programme consisted of supervised walking and cycling whilst the home based programme consisted of walking only. Changes in measures of obesity, exercise capacity, glycaemic control and  plasma lipids were monitored before the exercise programme and 3 months after graded exercise programmes. Results: The exercise programmes significantly improved exercise capacity, anthropometric measurements and blood glucose levels but had no effect on lipid profiles. There was similar improvements in all the groups but no difference was found when comparing the results between the groups. Conclusion: Although there was no significant difference between the groups, it is concluded that, any form of low endurance exercise programme, whether supervised or unsupervised is beneficial for patients with type 2 diabetes mellitus

Checklists for interpreting chest radiographs : a scoping review

INTRODUCTION : Checklists reduce time to comprehensive radiographic reports, improve quality and consistency of abnormality detection on chest radiographs. AIM : The aim of this review was to examine and survey the scope of published research on checklists for the interpretation of chest radiographs. METHOD : We conducted a search of CINAHL, Scopus, Medline Ovid, Web of Science, ProQuest, and gray literature using search terms: chest radiographs, checklist, and image interpretation. Data were extracted from 16 articles. Data was analyzed numerically and thematically. RESULTS : The selected studies were conducted in the United States (37.5%), the United Kingdom (25%), Australia (12%), South Africa (12%), Turkey (6%), and Israel (6%). The codes were grouped into five categories related to the use of checklists, in chest interpretation. CONCLUSION : In the selected studies, reports showed that there was no checklist for chest interpretation in South Africa and no evidence supporting checklists as an interprofessional communication tool for chest interpretation. The authors of this study recommended a chest interpretation checklist should be developed for use by health care professionals practicing in resource-limited settings where radiologists are not on site.http://www.sciencedirect.com/journal/journal-of-radiology-nursing2024-08-26hj2023PhysiotherapyRadiographySchool of Health Systems and Public Health (SHSPH