Quantitative systematic review of the effects of non‐pharmacological interventions on reducing apathy in persons with dementia

AimTo review the quantitative evidence concerning the effects of non‐pharmacological interventions on reducing apathy in persons with dementia.BackgroundApathy, a prevalent behavioural symptom among persons with Alzheimer Disease, is defined as a disorder of motivation with deficits in behavioural, emotional and cognitive domains and is associated with serious social and physical obstacles. Non‐pharmacological interventions show promise as symptom control modalities among persons with dementia.DesignQuantitative systematic review.Data sourcesCINAHL, PubMed, PSYCHinfo and Cochrane Trials databases were searched for published English language research inclusive through December 2014, with no early year limiters set.Review methodsComprehensive searches yielded 16 international randomized controlled trials or quasi‐experimental studies based on inclusion criteria and a rigorous quality appraisal process.ResultsA narrative summary analysis revealed that non‐pharmacological interventions for apathy varied substantially and lacked specificity, conceptual clarity and were methodologically heterogeneous. Select interventions demonstrated effectiveness, but lacked systematic long‐term follow‐up. Limitations include publication bias and lack of a meta‐analytic approach due to the methodological heterogeneity of included studies.ConclusionStudy results demonstrate promise for the use of non‐pharmacological interventions, particularly music‐based interventions, in reducing apathy levels in individuals with dementia. Intervening to reduce apathy may have a positive clinical impact and healthcare providers should be encouraged to incorporate positive sources of interest and intellectual stimulation into care. However, future research is needed to examine the aetiologic mechanism and predictors of apathy, to improve evidence‐based interventions and specificity and to optimize dosage and timing of non‐pharmacological interventions across the disease trajectory.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134246/1/jan13026_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134246/2/jan13026.pd

Nonalcoholic Fatty Liver Disease and The PNPLA3 Gene

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic and environmental factors that may have implications for health (Romeo et al., 2008; Romeo et al., 2009; Valenti et al., 2010). A description of NAFLD is provided in this article, with information about the genetic basis of NAFLD and potential implications of genetic health information related to NAFLD. Nurses’ critical role in health promotion, disease prevention, and management of chronic disease in persons with NAFLD also will be discussed

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Community Leader Perceptions of the Health Needs of Older Adults

The purpose of this needs assessment was to determine community leader perceptions of health-related needs and resources available to rural-dwelling older adults as part of a community–academic partnership in the rural Midwest. A community advisory board, in accordance with community-based participatory research principles, was influential in study design and implementation. Key informant interviews (N = 30) were conducted with community leaders including professionals from schools, businesses, churches, and health care as well as government officials. Thematic analysis revealed “Family Is Central,” “Heritage,” “Strength,” and “Longevity” as important themes related to older adults and their health care needs within the community. “Close-knit” and “Church Is Central” were also identified as important aspects of elder care. Community leaders perceived the “Rural Economy,” “Distance to Resources,” and “Seasonal Resources” as significant barriers for older adults. This work contributes important insights into community leaders’ perceptions of health needs and challenges faced by older adults in rural settings

Pedigree Structure and Kinship Measurements of a Mid-Michigan Community: A New North American Population Isolate Identified

Previous studies identified a cluster of individuals with an autosomal recessive form of deafness that reside in a small region of mid-Michigan. We hypothesized that affected members from this community descend from a defined founder population. Using public records and personal interviews, we constructed a genealogical database that includes the affected individuals and their extended families as descendants of 461 settlers who emigrated from the Eifel region of Germany between 1836 and 1875. The genealogical database represents a 13-generation pedigree that includes 27,747 descendants of these settlers. Among these descendants, 13,784 are presumed living. Many of the extant descendants reside in a 90-square-mile area, and 52% were born to parents who share at least one common ancestor. Among those born to related parents, the median kinship coefficient is 3.7 × 10–3. While the pedigree contains 2,510 founders, 344 of the 461 settlers accounted for 67% of the genome in the extant population. These data suggest that we identified a new population isolate in North America and that, as demonstrated for congenital hearing loss, this rural mid-Michigan community is a new resource to discover heritable factors that contribute to common health-related conditions

The Implications of Genomics on the Nursing Care of Adults with Neuropsychiatric Conditions

Purpose: Neuropsychiatric disorders contribute substantially to disease burden and quality of life across the lifespan and the globe. The purpose of this article is to review the state of the science regarding genomic contributions to selected common neuropsychiatric conditions and to examine the consequent immediate and future implications for nursing practice and research. Organizing Construct: Our work is guided by an ecological model that recognizes that common diseases are complex or multifactorial, meaning that multiple genomic and environmental factors contribute to their etiology. Methods: A review of the literature was conducted to determine the state of the science in relationship to the genomic contributions to selected neuropsychiatric disorders. Findings: Neuropsychiatric conditions are genomically heterogeneous, both within a single disorder and across groups of disorders. While recent genomic research yields clinically validated and useful information for a small subset of persons (e.g., predictive genetic testing for Huntington disease and early-onset Alzheimer disease), broad clinical application of genetic information is not yet available. In addition, the implications of genomics for the development and targeting of nonpharmacologic treatment strategies is largely unexplored. Conclusions: Further research is needed to expand knowledge beyond genomic risk for the presence of disease to knowledge about the genomic risk for symptoms, symptom burden, and tailored symptom management interventions. Clinical Relevance: Knowledge about the genomic influences on neuropsychiatric conditions suggests important implications for practicing nurses in the identification of persons at risk, provision of follow-up support, and in the administration of medications

Symptoms Experience in Persons with Obesity-Related Nonalcoholic Fatty Liver Disease

Aims. Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition strongly associated with obesity that can result in premature death. Little is known about a symptoms experience in this progressive disease, preventing health care providers from intervening in the early stages. The purpose of this study is to explicate symptoms in persons with NAFLD hypothesized to be at higher risk of disease progression based on the presence of one or two copies of the PNPLA3 gene, (rs738409)-G allele. Methods. A cross-sectional descriptive design, guided by the Symptoms Experience Model, was used to recruit 42 persons \u3e21 years of age with diagnosed NAFLD from gastroenterology and bariatric surgery offices in Western Michigan. Genotyping for the presence of the PNPLA3 gene, (rs738409)-G allele was used to stratify the population. The Memorial Symptom Assessment Scale (MSAS) and the Charlson Comorbidity Index were used to measure symptoms and comorbid conditions. Multiple linear regression and Fisher exact tests were used to analyze the data using PASW 17 software. Results. Participants (97%) experienced 1 or more symptoms (mean 12.02, SD 8.817). There was no statistically significant relationship between symptoms and the PNPLA3 (rs738409) variants. Significant predictors of mean frequency, severity and distress of symptoms [TMSAS] (F=2.609; df1=15, df2=25; p=.016) were identified. Conclusion. Persons with NAFLD experienced a mean of 12 symptoms. The MSAS would be beneficial in screening persons with NAFLD for changes in health before and after interventions and may be beneficial in preliminary screening of obese patients for the presence of NAFLD