Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial

Background: Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods: In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results: At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions: The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs

Older people's preferences regarding programme formats for managing concerns about falls

Objective: to explore the preferences of community-dwelling older persons regarding different programme formats for managing concerns about falls

Pharmacological Treatment of Visuospatial Neglect : A Systematic Review

Objectives: The aims of the current review were (1) to give an overview of human studies investigating pharmacotherapy to ameliorate visuospatial neglect and (2) to evaluate the quality of those studies. Methods: A systematic literature search using PubMed, Scopus, and ResearchGate was conducted in regard to studies that evaluated pharmacological interventions aiming to ameliorate poststroke visuospatial neglect. The search was limited in the following features: species (human), adults (≥18 years of age), language (English), and type of neglect (visuospatial). Two independent authors extracted data on study content and effectiveness and evaluated the quality of studies and methods. Results: A total of 11 studies were identified. Three studies were considered to be of moderate quality, the others of low quality. Seven studies represented dopaminergic treatment; 3 studies represented cholinergic treatment; and 1 study represented noradrenergic treatment. Three dopaminergic studies showed primarily positive effects of dopaminergic stimulation on visuospatial neglect, whereas three others showed adverse effects. All 3 cholinergic studies found positive effects in some outcome measures concerning visuospatial neglect. Noradrenergic stimulation improved maintenance of attention when exploring space. Conclusions: Currently, cholinergic therapy might be the best option for future research. However, we must emphasize the explorative nature and the limited quality of the reviewed studies

SCORE2 risk prediction algorithms : new models to estimate 10-year risk of cardiovascular disease in Europe

Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. Methods and results We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low- risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe

SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

176sinoneAims: The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. Methods and results: We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion: SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.noneHageman, Steven; Pennells, Lisa; Ojeda, Francisco; Kaptoge, Stephen; Kuulasmaa, Kari; de Vries, Tamar; Xu, Zhe; Kee, Frank; Chung, Ryan; Wood, Angela; McEvoy, John William; Veronesi, Giovanni; Bolton, Thomas; Achenbach, Stephan; Aleksandrova, Krasimira; Amiano, Pilar; Sebastian, Donostia-San; Amouyel, Philippe; Andersson, Jonas; Bakker, Stephan J L; Da Providencia Costa, Rui Bebiano; Beulens, Joline W J; Blaha, Michael; Bobak, Martin; Boer, Jolanda M A; Bonet, Catalina; Bonnet, Fabrice; Boutron-Ruault, Marie-Christine; Braaten, Tonje; Brenner, Hermann; Brunner, Fabian; Brunner, Eric J; Brunström, Mattias; Buring, Julie; Butterworth, Adam S; Capkova, Nadezda; Cesana, Giancarlo; Chrysohoou, Christina; Colorado-Yohar, Sandra; Cook, Nancy R; Cooper, Cyrus; Dahm, Christina C; Davidson, Karina; Dennison, Elaine; Di Castelnuovo, Augusto; Donfrancesco, Chiara; Dörr, Marcus; Doryńska, Agnieszka; Eliasson, Mats; Engström, Gunnar; Ferrari, Pietro; Ferrario, Marco; Ford, Ian; Fu, Michael; Gansevoort, Ron T; Giampaoli, Simona; Gillum, Richard F; Gómez de la Cámara, Agustin; Grassi, Guido; Hansson, Per-Olof; Huculeci, Radu; Hveem, Kristian; Iacoviello, Licia; Ikram, M Kamran; Jørgensen, Torben; Joseph, Bijoy; Jousilahti, Pekka; Wouter Jukema, J; Kaaks, Rudolf; Katzke, Verena; Kavousi, Maryam; Kiechl, Stefan; Klotsche, Jens; König, Wolfgang; Kronmal, Richard A; Kubinova, Ruzena; Kucharska-Newton, Anna; Läll, Kristi; Lehmann, Nils; Leistner, David; Linneberg, Allan; Pablos, David Lora; Lorenz, Thiess; Lu, Wentian; Luksiene, Dalia; Lyngbakken, Magnus; Magnussen, Christina; Malyutina, Sofia; Ibañez, Alejandro Marín; Masala, Giovanna; Mathiesen, Ellisiv B; Matsushita, Kuni; Meade, Tom W; Melander, Olle; Meyer, Haakon E; Moons, Karel G M; Moreno-Iribas, Conchi; Muller, David; Münzel, Thomas; Nikitin, Yury; Nordestgaard, Børge G; Omland, Torbjørn; Onland, Charlotte; Overvad, Kim; Packard, Chris; Pająk, Andrzej; Palmieri, Luigi; Panagiotakos, Demosthenes; Panico, Salvatore; Perez-Cornago, Aurora; Peters, Annette; Pietilä, Arto; Pikhart, , Hynek; Psaty, Bruce M; Quarti-Trevano, Fosca; Garcia, J Ramón Quirós; Riboli, Elio; Ridker, Paul M; Rodriguez, Beatriz; Rodriguez-Barranco, Miguel; Rosengren, Annika; Roussel, Ronan; Sacerdote, Carlotta; Sans, Susana; Sattar, Naveed; Schiborn, Catarina; Schmidt, Börge; Schöttker, Ben; Schulze, Matthias; Schwartz, Joseph E; Selmer, Randi Marie; Shea, Steven; Shipley, Martin J; Sieri, Sabina; Söderberg, Stefan; Sofat, Reecha; Tamosiunas, Abdonas; Thorand, Barbara; Tillmann, Taavi; Tjønneland, Anne; Tong, Tammy Y N; Trichopoulou, Antonia; Tumino, Rosario; Tunstall-Pedoe, Hugh; Tybjaerg-Hansen, Anne; Tzoulaki, Joanna; van der Heijden, Amber; van der Schouw, Yvonne T; Verschuren, W M Monique; Völzke, Henry; Waldeyer, Christoph; Wareham, Nicholas J; Weiderpass, Elisabete; Weidinger, Franz; Wild, Philipp; Willeit, Johann; Willeit, Peter; Wilsgaard, Tom; Woodward, Mark; Zeller, Tanja; Zhang, Dudan; Zhou, Bin; Dendale, Paul; Ference, Brian A; Halle, Martin; Timmis, Adam; Vardas, Panos; Danesh, John; Graham, Ian; Salomaa, Veikko; Visseren, Frank; De Bacquer, Dirk; Blankenberg, Stefan; Dorresteijn, Jannick; Di Angelantonio, EmanueleHageman, Steven; Pennells, Lisa; Ojeda, Francisco; Kaptoge, Stephen; Kuulasmaa, Kari; de Vries, Tamar; Xu, Zhe; Kee, Frank; Chung, Ryan; Wood, Angela; Mcevoy, John William; Veronesi, Giovanni; Bolton, Thomas; Achenbach, Stephan; Aleksandrova, Krasimira; Amiano, Pilar; Sebastian, Donostia-San; Amouyel, Philippe; Andersson, Jonas; Bakker, Stephan J L; Da Providencia Costa, Rui Bebiano; Beulens, Joline W J; Blaha, Michael; Bobak, Martin; Boer, Jolanda M A; Bonet, Catalina; Bonnet, Fabrice; Boutron-Ruault, Marie-Christine; Braaten, Tonje; Brenner, Hermann; Brunner, Fabian; Brunner, Eric J; Brunström, Mattias; Buring, Julie; Butterworth, Adam S; Capkova, Nadezda; Cesana, Giancarlo; Chrysohoou, Christina; Colorado-Yohar, Sandra; Cook, Nancy R; Cooper, Cyrus; Dahm, Christina C; Davidson, Karina; Dennison, Elaine; Di Castelnuovo, Augusto; Donfrancesco, Chiara; Dörr, Marcus; Doryńska, Agnieszka; Eliasson, Mats; Engström, Gunnar; Ferrari, Pietro; Ferrario, Marco; Ford, Ian; Fu, Michael; Gansevoort, Ron T; Giampaoli, Simona; Gillum, Richard F; Gómez de la Cámara, Agustin; Grassi, Guido; Hansson, Per-Olof; Huculeci, Radu; Hveem, Kristian; Iacoviello, Licia; Ikram, M Kamran; Jørgensen, Torben; Joseph, Bijoy; Jousilahti, Pekka; Wouter Jukema, J; Kaaks, Rudolf; Katzke, Verena; Kavousi, Maryam; Kiechl, Stefan; Klotsche, Jens; König, Wolfgang; Kronmal, Richard A; Kubinova, Ruzena; Kucharska-Newton, Anna; Läll, Kristi; Lehmann, Nils; Leistner, David; Linneberg, Allan; Pablos, David Lora; Lorenz, Thiess; Lu, Wentian; Luksiene, Dalia; Lyngbakken, Magnus; Magnussen, Christina; Malyutina, Sofia; Ibañez, Alejandro Marín; Masala, Giovanna; Mathiesen, Ellisiv B; Matsushita, Kuni; Meade, Tom W; Melander, Olle; Meyer, Haakon E; Moons, Karel G M; Moreno-Iribas, Conchi; Muller, David; Münzel, Thomas; Nikitin, Yury; Nordestgaard, Børge G; Omland, Torbjørn; Onland, Charlotte; Overvad, Kim; Packard, Chris; Pająk, Andrzej; Palmieri, Luigi; Panagiotakos, Demosthenes; Panico, Salvatore; Perez-Cornago, Aurora; Peters, Annette; Pietilä, Arto; Pikhart, ; Hynek, ; Psaty, Bruce M; Quarti-Trevano, Fosca; Garcia, J Ramón Quirós; Riboli, Elio; Ridker, Paul M; Rodriguez, Beatriz; Rodriguez-Barranco, Miguel; Rosengren, Annika; Roussel, Ronan; Sacerdote, Carlotta; Sans, Susana; Sattar, Naveed; Schiborn, Catarina; Schmidt, Börge; Schöttker, Ben; Schulze, Matthias; Schwartz, Joseph E; Selmer, Randi Marie; Shea, Steven; Shipley, Martin J; Sieri, Sabina; Söderberg, Stefan; Sofat, Reecha; Tamosiunas, Abdonas; Thorand, Barbara; Tillmann, Taavi; Tjønneland, Anne; Tong, Tammy Y N; Trichopoulou, Antonia; Tumino, Rosario; Tunstall-Pedoe, Hugh; Tybjaerg-Hansen, Anne; Tzoulaki, Joanna; van der Heijden, Amber; van der Schouw, Yvonne T; Verschuren, W M Monique; Völzke, Henry; Waldeyer, Christoph; Wareham, Nicholas J; Weiderpass, Elisabete; Weidinger, Franz; Wild, Philipp; Willeit, Johann; Willeit, Peter; Wilsgaard, Tom; Woodward, Mark; Zeller, Tanja; Zhang, Dudan; Zhou, Bin; Dendale, Paul; Ference, Brian A; Halle, Martin; Timmis, Adam; Vardas, Panos; Danesh, John; Graham, Ian; Salomaa, Veikko; Visseren, Frank; De Bacquer, Dirk; Blankenberg, Stefan; Dorresteijn, Jannick; Di Angelantonio, Emanuel

SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. Methods and results We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low- risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe