Dietary protein in older adults: adequate daily intake but potential for improved distribution

Daily distribution of dietary protein may be important in protecting against sarcopenia, specifically in terms of per meal amounts relative to a proposed threshold for maximal response. The aims of this study were to determine total and per meal protein intake in older adults, as well as identifying associations with physical activity and sedentary behavior. Three-day food diaries recorded protein intake in 38 participants. Protein distribution, coefficient of variation (CV), and per meal amounts were calculated. Accelerometry was used to collect physical activity data as well as volume and patterns of sedentary time. Average intake was 1.14 g·kg−1·day−1. Distribution was uneven (CV = 0.67), and 79% of participants reported <0.4 g·kg−1 protein content in at least 2/3 daily meals. Protein intake was significantly correlated with step count (r = 0.439, p = 0.007) and negatively correlated with sedentary time (r = −0.456, p = 0.005) and Gini index G, which describes the pattern of accumulation of sedentary time (r = −0.421, p = 0.011). Total daily protein intake was sufficient; however, distribution did not align with the current literature; increasing protein intake may help to facilitate optimization of distribution. Associations between protein and other risk factors for sarcopenia may also inform protective strategies

A novel computerized test for detecting and monitoring visual attentional deficits and delirium in the ICU

Objectives: Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box–ICU). Design: A pilot study was conducted, followed by a prospective case-control study. Setting: Royal Infirmary of Edinburgh General ICU. Patients: A pilot study was conducted in an opportunistic sample of 20 patients. This was followed by a validation study in 30 selected patients with and without delirium (median age, 63 yr; range, 23–84) who were assessed with the Edinburgh Delirium Test Box–ICU on up to 5 separate days. Presence of delirium was assessed using the Confusion Assessment Method for the ICU. Measurements and Main Results: The Edinburgh Delirium Test Box–ICU involves a behavioral assessment and a computerized test of attention, requiring patients to count slowly presented lights. Thirty patients were assessed a total of 79 times (n = 31, 23, 15, 8, and 2 for subsequent assessments; 38% delirious). Edinburgh Delirium Test Box–ICU scores (range, 0–11) were lower for patients with delirium than those without at the first (median, 0 vs 9.5), second (median, 3.5 vs 9), and third (median, 0 vs 10.5) assessments (all p < 0.001). An Edinburgh Delirium Test Box–ICU score less than or equal to 5 was 100% sensitive and 92% specific to delirium across assessments. Longitudinally, participants’ Edinburgh Delirium Test Box–ICU performance was associated with delirium status. Conclusions: These findings suggest that the Edinburgh Delirium Test Box–ICU has diagnostic utility in detecting ICU delirium in patients with Richmond Agitation and Sedation Scale Score greater than –3. The Edinburgh Delirium Test Box–ICU has potential additional value in longitudinally tracking attentional deficits because it provides a range of scores and is sensitive to change

Investigating speech and language impairments in delirium: a preliminary case-control study

<div><p>Introduction</p><p>Language impairment is recognized as as part of the delirium syndrome, yet there is little neuropsychological research on the nature of this dysfunction. Here we hypothesized that patients with delirium show impairments in language formation, coherence and comprehension.</p><p>Methods</p><p>This was a case-control study in 45 hospitalized patients (aged 65–97 years) with delirium, dementia without delirium, or no cognitive impairment (N = 15 per group). DSM-5 criteria were used for delirium. Speech was elicited during (1) structured conversational questioning, and (2) the "Cookie Theft" picture description task. Language comprehension was assessed through standardized verbal and written commands. Interviews were audio-recorded and transcribed.</p><p>Results</p><p>Delirium and dementia groups scored lower on the conversational assessment than the control group (p<0.01, moderate effect sizes (r) of 0.48 and 0.51, resp.). In the Cookie Theft task, the average length of utterances (i.e. unit of speech), indicating language productivity and fluency, distinguished patients with delirium from those with dementia (p<0.01, r = 0.50) and no cognitive impairment (p<0.01, r = 0.55). Patients with delirium performed worse on written comprehension tests compared to cognitively unimpaired patients (p<0.01, r = 0.63), but not compared to the dementia group.</p><p>Conclusions</p><p>Production of spontaneous speech, word quantity, speech content and verbal and written language comprehension are impaired in delirious patients compared to cognitively unimpaired patients. Additionally, patients with delirium produced significantly less fluent speech than those with dementia. These findings have implications for how speech and language are evaluated in delirium assessments, and also for communication with patients with delirium. A study limitation was that the delirium group included patients with co-morbid dementia, which precludes drawing conclusions about the specific language profile of delirium.</p></div

Does living near blue space modify the effect of socioeconomic deprivation on mental health in urban areas: a population-based retrospective study

Background: The incidence of mental health disorders in urban areas is increasing and there is a growing interest in using urban blue spaces as nature-based therapy to prevent and manage mental health. However, there is a dearth of longitudinal evidence of the mechanisms and effect of blue spaces on clinical markers of mental health to support and inform such interventions. Restoration of the north Glasgow branch of the Forth and Clyde canal began in 2000 as part of Glasgow's Smart Canal project, which is the largest programme of canal regeneration in the UK. The canal was completely closed and left to dereliction for more than 40 years and the first canal lock reopened as a space for recreation in 2006. Situated within the most deprived neighbourhoods in Europe and characterised by a clustering of environmental and socioeconomic deprivation, physical and mental health challenges, substantial health disparities, and climate change vulnerabilities, this is a unique natural experiment that was primarily developed to increase the communities' resilience to climate change. Methods: To investigate the mental health cobenefits deriving from the canal regeneration project, we conducted a population-based retrospective cohort study and explored whether living near blue space modified the negative effect of socioeconomic deprivation on the mental health of the population of north Glasgow, Scotland, using routinely collected NHS data, over a 10-year period (2009-18). We developed two Cox proportional hazards models; a base model estimating the effect of socioeconomic deprivation on mental health and a second identical model with an additional variable of distance to blue space. We then investigated the modifying effect of living near blue space by comparing the effects between the two models. Findings: Our findings indicate that living near blue space modified the risk of mental health disorders deriving from socioeconomic deprivation by 6% (hazard ratio [HR] 2·48, 95% CI 2·39-2·57) for those living in the most deprived tertile, and 4% (1·66, 1·60-1·72) for those in the medium-deprivation tertile. Interpretation: The findings of this study support the notion that living near blue space could play an important role in reducing the burden of mental health inequalities in urban populations. Funding: The Data Lab (to SC)

Mechanisms of impact of blue spaces on human health: a systematic literature review and meta-analysis

Blue spaces have been found to have significant salutogenic effects. However, little is known about the mechanisms and pathways that link blue spaces and health. The purpose of this systematic review and meta-analysis is to summarise the evidence and quantify the effect of blue spaces on four hypothesised mediating pathways: physical activity, restoration, social interaction and environmental factors. Following the PRISMA guidelines, a literature search was conducted using six databases (PubMed, Scopus, PsycInfo, Web of Science, Cochrane Library, EBSCOHOST/CINAHL). Fifty studies were included in our systematic review. The overall quality of the included articles, evaluated with the Qualsyst tool, was judged to be very good, as no mediating pathway had an average article quality lower than 70%. Random-effects meta-analyses were conducted for physical activity, restoration and social interaction. Living closer to blue space was associated with statistically significantly higher physical activity levels (Cohen's d = 0.122, 95% CI: 0.065, 0.179). Shorter distance to blue space was not associated with restoration (Cohen's d = 0.123, 95% CI: -0.037, 0.284) or social interaction (Cohen's d = -0.214, 95% CI: -0.55, 0.122). Larger amounts of blue space within a geographical area were significantly associated with higher physical activity levels (Cohen's d = 0.144, 95% CI: 0.024, 0.264) and higher levels of restoration (Cohen's d = 0.339, 95% CI: 0.072, 0.606). Being in more contact with blue space was significantly associated with higher levels of restoration (Cohen's d = 0.191, 95% CI: 0.084, 0.298). There is also evidence that blue spaces improve environmental factors, but more studies are necessary for meta-analyses to be conducted. Evidence is conflicting on the mediating effects of social interaction and further research is required on this hypothesised pathway. Blue spaces may offer part of a solution to public health concerns faced by growing global urban populations

Urban blue spaces as therapeutic landscapes: “a slice of nature in the city”

Urban blue spaces are defined as all natural and manmade surface water in urban environments. This paper draws on how the concepts of experienced, symbolic, social, and activity space combine to position urban blue spaces as therapeutic landscapes. We conducted 203 intercept interviews between 12 October 2019 and 10 November 2019. Although safety concerns had health-limiting impacts, interacting with the Glasgow Canal and surrounding landscape was predominantly perceived as health-enhancing. Our findings build on current evidence, which has suggested that urban blue spaces, particularly canals, may foster therapeutic properties, contributing to healthier city environments. Further research is required to understand better the interconnectedness of urban blue spaces and health and how such spaces can be best developed and managed to improve the health outcomes of local populations