Exergaming and older adult cognition: A cluster randomized clinical trial

Background: Dementia cases may reach 100 million by 2050. Interventions are sought to curb or prevent cognitive decline. Exercise yields cognitive benefits, but few older adults exercise. Virtual realityenhanced exercise or exergames may elicit greater participation. Purpose: To test the following hypotheses: (1) stationary cycling with virtual reality tours ( cybercycle ) will enhance executive function and clinical status more than traditional exercise; (2) exercise effort will explain improvement; and (3) brain-derived neurotrophic growth factor (BDNF) will increase. Design: Multi-site cluster randomized clinical trial (RCT) of the impact of 3 months of cybercycling versus traditional exercise, on cognitive function in older adults. Data were collected in 20082010; analyses were conducted in 20102011. Setting/participants: 102 older adults from eight retirement communities enrolled; 79 were randomized and 63 completed. Interventions: A recumbent stationary ergometer was utilized; virtual reality tours and competitors were enabled on the cybercycle. Main outcome measures: Executive function (Color Trails Difference, Stroop C, Digits Backward); clinical status (mild cognitive impairment; MCI); exercise effort/fitness; and plasma BDNF. Results: Intent-to-treat analyses, controlling for age, education, and cluster randomization, revealed a significant group X time interaction for composite executive function (p=0.002). Cybercycling yielded a medium effect over traditional exercise (d=0.50). Cybercyclists had a 23% relative risk reduction in clinical progression to MCI. Exercise effort and fitness were comparable, suggesting another underlying mechanism. A significant group X time interaction for BDNF (p=0.05) indicated enhanced neuroplasticity among cybercyclists. Conclusions: Cybercycling older adults achieved better cognitive function than traditional exercisers, for the same effort, suggesting that simultaneous cognitive and physical exercise has greater potential for preventing cognitive decline. Trial registration: This study is registered at Clinicaltrials.gov NCT01167400. © 2012 American Journal of Preventive Medicine

Co-occurring forms of child maltreatment and adult adjustment reported by Latina college students

Objectives: This study had two primary objectives: First, to examine the nature and co-occurrence of various forms of child maltreatment (sexual, physical. emotional, and witnessing violence) reported by Latina college students, and second, to explore coexisting maltreatment types and acculturation status as possible contributors to long-term adjustment difficulties. Method: Participants were 112 Latina undergraduate students categorized by the number of childhood maltreatment types experienced (0, 1, or 2 or more) and acculturation level (1 to 5). The possible effects of co-occurring forms of maltreatment, in conjunction with acculturation status, were investigated with respect to participants’ reported trauma symptomatology. Data were collected using self-report measures. Results: Nearly three out of 10 participants (29%) experienced more than one type of child maltreatment and, as expected, these individuals reported greater trauma symptomatology than those reporting either a single type of maltreatment or no maltreatment at all. Those who reported multiple types also endured more severe maltreatment than did respondents who experienced a single type. Acculturation level was neither directly related to trauma symptoms nor did it moderate the lasting correlates of maltreatment among victims. Interestingly, those who experienced a single form of maltreatment reported no more trauma symptoms than did participants who reported no maltreatment history at all. Conclusion: This investigation documents a large degree of overlap among various forms of self-reported childhood maltreatment within a Latina college population. The results underscore the need to consider multiple forms of maltreatment, as well as severity, when making inferences regarding potential effects on later functioning

Learning from mistakes: What do inconsistent choices over risk tell us?

Risk preferences, Inconsistent choices, Financial decisions, Experiments, C91, D81,

Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial

Background: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. Methods: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. Findings: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43–0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26–0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60–1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54–1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. Interpretation: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. Funding: National Institute for Health Research Research for Patient Benefit and Allergan