Methodological Weaknesses Research Articles

UV Radiation, not European Ancestry, Explains States’ Cognitive Performance in Brazil and USA

A debate in Mankind Quarterly positing racial categorization of populations vis-à-vis biological effects of UV radiation was based on data from a single country, used absolute latitude instead of UV radiation, and limited the analysis to path analysis. To overcome limitations of the studies, we utilized measurements of UV radiation for 26 Brazilian and 48 USA states instead of absolute latitude and performed seemingly unrelated regressions in addition to path analysis. NAEP scores and infectious disease rate were collected in USA and PISA scores and infant mortality in Brazil. Significant cognitive effects of European ancestry were replicated, but showed spuriousness, disappearing when the effects of UV radiation were controlled. Our evidence strongly suggests that UV radiation is a consistent antecedent of cognitive ability directly and through income in the USA and Brazil and through infant mortality in Brazil, whereas European ancestry only influences cognitive ability positively by reducing infectious diseases in the USA or infant mortality in Brazil. The between-country consistency of our findings compensates for methodological weaknesses that took place especially in the Brazil study. Psychologists and economists should be aware of these findings to avoid making erroneous inferences based on genetic or cultural variables.

The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis.

BackgroundAnxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses.ObjectiveThis study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review.MethodsWe conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies.ResultsOf the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03).ConclusionsThis review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

Energy intensity and foreign direct investment nexus: Advanced panel data analysis

This paper analyzes the impact of foreign direct investment (FDI) on energy intensity. The survey was conducted on a large panel sample of 81 (43) countries for the period 1990–2014 (1991–2014) using advanced econometric methods that eliminate the methodological and conceptual weaknesses of the existing papers. The obtained results reveal energy-saving effect of foreign direct investment that is realized directly and indirectly. Every new net inflow of foreign direct investment reduces energy intensity. The strength of this negative impact depends on the level of countries’ technological development and the degree of their inventive activity. The higher the level of technological development, the more pronounced the energy-saving effect of foreign direct investment. When taking into account the average level of technological development for the entire sample, it can be concluded that each additional foreign direct investment net inflow of one billion dollars results in a decrease in energy intensity by 0.23%. The findings of this study confirm the hypothesis that more technologically developed countries have higher absorption capacity and can easily accept and exploit potential foreign direct investment technological spillover. Since the results of the analysis indisputably show that foreign direct investment reduces energy intensity, some useful guidelines for attracting quality foreign direct investment have been proposed.

Multivariable prediction models for difficult direct laryngoscopy: Systematic review and literature metasynthesis.

The difficult airway is an important scenario in anaesthesia due to the impact of its potential complications, and the difficulty in predicting its presence in current clinical practice. Systematic review of articles in English and Spanish retrieved from MEDLINE (Ovid), LILACS and EMBASE up to March 2018. The search strategy was defined by the authors. The reviewers uploaded the studies to specially designed tables in order to qualitatively analyse the results of each paper. A total of 3602 studies were identified. Thirty-four of these were included in the qualitative review. The most commonly used definition of difficulty was the Cormack-Lehane 3 or 4 classification, with a weighted mean incidence of 7.23%. The most relevant finding was the methodological weaknesses in obtaining these scales. Available prediction models show limited discrimination, and weaknesses were detected in the methodology used to develop these prediction rules.

Sind Psychedelika schnell wirksame Antidepressiva?

Psychedelics, such as psilocybin represent one of the most promising current therapeutic approaches in psychiatry. Psychedelics seem to have not only potent antidepressant effects. Do they also work particularly quickly, i.e. within one day? The available literature on clinical studies of psychedelics in depressive syndromes is presented both from the period up to the prohibition of these substances in the late 1960s as well as after the resumption of research in the 2000s. One focus is the speed of onset of antidepressant action. Only the clinical studies published since 2016 that meet modern methodological standards have also systematically examined the speed of the antidepressant onset of action. The published studies, which were almost exclusively carried out with psilocybin, so far show small sample sizes (the total number of patients with depression treated in published clinical studies is < 200) and some of them have methodological weaknesses; however, they suggest apronounced and very rapid onset of action within one day for depression, treatment-resistant depression and depression in the context of life-threatening cancer. The available studies indicate apotent, rapid onset and in many cases long-lasting antidepressant effect over several months. The currently conducted studies with three-digit patient numbers will provide final information about the potential of psilocybin for depression.

Effects of Mindfulness Exercise Guided by a Smartphone App on Negative Emotions and Stress in Non-Clinical Populations: A Systematic Review and Meta-Analysis.

BackgroundStudies have acknowledged that mindfulness exercise guided by a smartphone app has a positive impact on mental health and physical health. However, mindfulness guided by a smartphone app on mental health is still in its infancy stage. Therefore, we conducted a meta-analysis evaluating the effect of mindfulness intervention guided by a smartphone app on negative emotions and stress in a non-clinical population with emotional symptoms.MethodsWe searched major databases, namely, Web of Science, PubMed, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang, to identify all of the relevant studies published in English or Chinese from their inception until November 9, 2021. The methodological quality of the included studies was assessed with Cochrane risk-of-bias bias assessment tool. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation.ResultA total of eight studies were included in the study, with 574 subjects (experimental group: 348; control group: 226). A random effects model was selected to combine effect sizes. The results of the meta-analysis showed that mindfulness exercise guided by a smartphone app reduced negative emotions [standardized mean difference (SMD) = −0.232, 95% CI: −0.398 to −0.066, p = 0.006], depressive symptoms (SMD = −0.367, 95% CI: −0.596 to −0.137, p = 0.002), and anxiety symptoms (SMD = −0.490, 95% CI: −0.908 to −0.071, p = 0.022).ConclusionsThe findings indicate the potentially beneficial effect of mindfulness exercise guided by a smartphone app on symptoms of depression and anxiety among individuals in a non-clinical population with emotional symptoms. Considering the small number and overall methodological weakness of the included studies and lack of randomized controlled trials (RCTs), the results should be interpreted with caution, and future rigorously designed RCTs are warranted to provide more reliable evidence.

Weaknesses of research methodologies on musculoskeletal disorders associated with mobile touch-screen devices.

The objective of the currently study is to point out the weaknesses of some recent researches, which were done about the effects or symptoms of using Touch Screen Mobile Devices on the human musculoskeletal system. In this article, we reviewed the research processes performed in recent 26 randomly selected papers about musculoskeletal disorder to clarify the common weaknesses of these published articles. The electronic database search and reference search were conducted in four different databases: Medline, PubMed, Web of Science, and Scopus. We noticed that none of the reviewed papers had performed the experimental design phase of a scientific research. Additionally they had not validated the assumptions of the statistical methods used in their researches. Therefore, their findings are doubtful. In this article, we proposed practical outlines for a reliable experimental research.

An evolving safety culture journey: Cross-border methodologies and findings in safety and security culture between Switzerland and Austria

For many safety operators, the measurement of safety culture is not just a requirement, but a valuable tool for the health check of systems, future safety investment planning, and insight into day-to-day human performance. But the collection of data, especially qualitative is often costly, time consuming and requires considerable effort in processing. In 2021, Austro Control and Skyguide created a cross-border methodology utilizing both existing surveying methodologies and the introduction of asset-based qualitative workshops via MS Teams to collect safety culture data. Additional questions pertaining to security culture and Covid-19 responses at both companies were also collected. A total of 998 employees between both companies responded. The results of both organizations were collected independently and are compared and analysed within this paper. An overview of the strengths and weaknesses of the joint methodology are shared and discussed. It is concluded that for smaller Air Navigation Service Providers - especially for those with similarities in culture - this approach is beneficial and cost-effective. Moreover, the use of asset-based qualitative workshops has shown to be beneficial not only for quality of subjective data but for encouraging individuals to take immediate actions generating stronger bottom-up initiatives. The quantitative results showed that despite two years of the Covid-19 pandemic, the safety culture at both organizations for operators has remained high and robust with future work needing to focus on rebuilding trust in the industry as well as maintaining high level of safety in times of transformation and adaptation to changing industry demands.

Evaluation of Wind Turbine Failure Modes Using the Developed SWARA-CoCoSo Methods Based on the Spherical Fuzzy Environment

Accurately recognizing potential failures in the early stages of providing products or services can prevent the loss of investment and time and reduce the risk of safety hazards. Failure mode and effects analysis (FMEA) is a conventional approach for detecting and prioritizing the probable failures of a product&#x2019;s design or production process. Nevertheless, the traditional risk priority number (RPN) method has come under criticism for its deficiencies. This paper proposes a modified FMEA method based on fuzzy Multi-Criteria Decision Making (MCDM) techniques to cope with the weaknesses of the previous methodologies and improve the primary method. The concept of spherical fuzzy sets (SFS) is utilized to address the vagueness and impreciseness of the information that allows the experts to have more freedom in making decisions by including membership, non-membership, and hesitation of fuzzy sets. Initially, the procedure of assigning weights to the RPN criteria is implemented with SFS step-wise weight assessment ratio analysis (SWARA). Then, the failure modes are ranked by the SFS combined compromise solution (CoCoSo) method. The effectiveness and practicality of the suggested approach are illustrated through a case study on the Manjil wind farm in Iran. Results show that the suggested model is more reliable and realistic to be utilized in the prioritization of failures than the common FMEA method or other integrated MCDM approaches.

RNAscope in situ hybridization and RT-PCR for detection of SARS-CoV-2in chilblain-like lesions: A clinical, laboratory and histopathological study.

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of chilblain-like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS-CoV-2 infection has not been unequivocally established. In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1June 2020. The mean age was 14.2years, and 21 patients (78%) experienced mild systemic symptoms a median of 28days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients - 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT-PCR for SARS-CoV-2showing only 1 positive. Histopathological examinations of 7skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS-CoV-2 RNA in skin biopsies, both with real-time polymerase chain reaction (RT-PCR) and RNAscope in situ hybridization (ISH). Limited number of cases, unavailability of laboratory confirmation of COVID-19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN-I or complement-mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.

Acupuncture for the Adjunctive Therapy of Post-stoke Fatigue: A Systematic Review and Meta-analysis

The aim of this research is to assess the effectiveness and safety of acupuncture combined with rehabilitation therapy for post-stroke fatigue. The methods used in this research are as follows: systematically retrieving China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biological Medicine Database, Cochrane Library, Medline and Embase were electronically searched from inception to Dec 2020. The dataset included randomized controlled trials (RCTs) with Chinese and English only that compared acupuncture as an adjunct to rehabilitation in stroke patients with fatigue. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool. Statistical analyses were performed by RevMan V.5.4.A total of 6 RCTs were included in this study, including 426 cases (213 cases in the treatment group and 213 cases in the control group). The results of meta-analysis showed that compared with conventional treatment, acupuncture as an adjuvant therapy can significantly reduce the incidence of post-stroke fatigue [MD = -5.45, 95% CI = (-6.75, -4.14), Z = 8.19 (P &lt; 0.001)]. In terms of energy, acupuncture also has an obvious effect [MD = 1.69, 95% CI = (0.27, 3.12), Z = 2.33 (P &lt; 0.02)]. Our systematic review and meta-analysis suggests that acupuncture combined with conventional rehabilitation therapy is an effective therapy for patients suffering from post-stroke fatigue, which is suitable for clinical promotion and use. However, due to methodological weakness and limited number of RCTs, the results should be interpreted cautiously. Further clinical trials with large sample sizes and a rigorous design are needed.

Links Between Arts and Health, Examples From Quantitative Intervention Evaluations.

The author presents eight of his own group’s studies. They have been published from early 1980s until 2016. Each study will be placed in its scientific context and discussed in relation to possible progress in arts and health research. In these examples, statistical methods with longitudinal designs and mostly control groups have been used. Some of them are randomized controlled trials. Physiological and endocrinological variables have been assessed in some of these studies in efforts to increase our understanding of how music experiences and other kinds of arts experiences interact with bodily reactions of relevance for health development. Although some of the studies have suffered from low statistical power and other methodological weaknesses, they show that it is possible to do statistical evaluations of arts interventions aiming at improved health.

Spatial Causality: A Systematic Review on Spatial Causal Inference

The growing interest in causal inference in recent years has led to new causal inference methodologies and their applications across disciplines and research domains. Yet, studies on spatial causal inference are still rare. Causal inference on spatial processes is faced with additional challenges, such as spatial dependency, spatial heterogeneity, and spatial effects. These challenges can lead to spurious results and subsequently, incorrect interpretations of the outcomes of causal analyses. Recognizing the growing importance of causal inference in the spatial domain, we conduct a systematic literature review on spatial causal inference based on a formal concept mapping. To identify how to assess and control for the adverse effects of spatial influences, we assess publications relevant to spatial causal inference based on criteria relating to application discipline, methods used, and techniques applied for managing issues related to spatial processes. We thus present a snapshot of state of the art in spatial causal inference and identify methodological gaps, weaknesses and challenges of current spatial inference studies, along with opportunities for future research.

Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review.

There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

Combatting digital addiction: Current approaches and future directions

In recent years, the notion of digital addiction has become popular. Calls for solutions to combat it, especially in adolescents, are on the rise. Whilst there remains debate on the status of this phenomenon as a diagnosable mental health condition; there is a need for prevention and intervention approaches that encourage individuals to have more control over their digital usage. This narrative review examines digital addiction countermeasures proposed in the last ten years. By countermeasures, we mean strategies and techniques for prevention, harm reduction, and intervention towards addictive digital behaviours. We include studies published in peer-reviewed journals between 2010 and 2021 and based on empirical evidence. In total, 87 studies were included in the review. The findings show that the main countermeasures could be grouped under four categories: psycho-social, software mediated, pharmacological, and combined. Overall, it has been shown that the proposed countermeasures were effective in reducing addictive digital use. However, a general statement on the efficacy of proposed countermeasures cannot be made due to inconsistent conceptualisation of digital addiction and methodological weaknesses. Accordingly, this review highlights issues that need to be addressed in future studies.

Acupuncture for oligospermia and asthenozoospermia: A systematic review and meta-analysis.

Background:Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture in treating oligospermia and asthenozoospermia.Methods:An electronic search for randomized controlled trials evaluating acupuncture treatment in patients with oligospermia and asthenozoospermia published from database inception to October 2018 was conducted in PubMed, EMBASE, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database (VIP Database), the Wan-Fang Database, the China National Knowledge Infrastructure and the Cochrane Library. We established search terms related to 3 areas (oligospermia, asthenozoospermia, and acupuncture). Two authors independently screened all identified citations and extracted the data. The methodological quality of the included trials was assessed using the Cochrane criteria.Results:Seven studies with a total of 527 subjects were screened according to inclusion and exclusion standards, and most of the studies had significant methodological weaknesses. Seven randomized controlled trials tested the effects of acupuncture compared with placebo acupuncture and conventional medications in patients with oligospermia and asthenozoospermia. The results of this study suggest that acupuncture alone has no clear superiority in improving sperm motility (standard mean difference [SMD] = 1.13, 95% confidence interval [CI]: −0.64 to 2.89), the sperm concentration (SMD = 0.32, 95% CI: 0.27–0.92) or semen volume compared with placebo acupuncture. No significant difference was found between acupuncture alone and conventional medications in improving sperm motility (SMD = −0.53, 95% CI: −2.54 to 1.48), the sperm concentration (SMD = −1.10, 95% CI: −1.48 to −0.72) or semen volume. However, adjuvant acupuncture may enhance the effect of medications on improving sperm motility (SMD = 4.10, 95% CI: 1.09–7.12) and the sperm concentration (SMD = 1.07, 95% CI: 0.739–1.40), but the study heterogeneity was too high to establish robust conclusions.Conclusion:These results suggest that the current evidence does not support acupuncture as an effective treatment for oligospermia and asthenozoospermia; therefore, acupuncture is not currently recommended as a treatment for these conditions. However, owing to the high risk of bias among the included studies, the evidence is limited, and more large-scale, high-quality clinical trials are needed in the future.Trial registration number:PROSPERO CRD42018083885

Efficacy of Web-Based Supportive Interventions in Quality of Life in COPD Patients, a Systematic Review and Meta-Analysis.

Background: Adults living with Chronic Obstructive Pulmonary Disease (COPD) often have difficulties when trying to access health care services. Interactive communication technologies are a valuable tool to enable patients to access supportive interventions to cope with their disease. The aim of this revision and meta-analysis is to analyze the content and efficacy of web-based supportive interventions in quality of life in COPD. Methods: Medline (via PubMed), Web of Science, and Scopus were the databases used to select the studies for this systematic review. A screening, analysis, and assessment of the methodological quality was carried out by two independent researchers. A meta-analysis of the extracted data was performed. Results: A total of 9 of the 3089 studies reviewed met the inclusion criteria. Most repeated web content elements were educational and involved communication with healthcare professional content. Finally, seven of the nine studies were included in a quantitative analysis. Web-based supportive interventions significantly improved quality of life when added to usual care (SMD = −1.26, 95% CI = −1.65, −0.86; p < 0.001) but no significant differences were found when compared with an autonomous pedometer walking intervention (p = 0.64) or a face-to-face treatment (p = 0.82). Conclusion: This systematic review and meta-analysis suggests that web-based supportive interventions may complement or accompany treatments in COPD patients due to the advantages of online interventions. The results obtained should be treated with caution due to the limited number of studies in this area and methodological weaknesses.

Acute and Chronic Temporomandibular Disorder Pain: A critical review of differentiating factors and predictors of acute to chronic pain transition.

The aims of this critical review were to: (i) assess the factors that differentiate acute from chronic temporomandibular disorders (TMD) pain; (ii) assess the risk factors associated with the transition from acute to chronic TMD pain; and (iii) summarize and appraise the studies. The databases used were MEDLINE, Embase, and Cochrane Database of Systematic Reviews. Eligible studies included articles comparing acute to chronic TMD pain, and cohort studies assessing the risk factors implicated in the transition from acute to chronic TMD pain. Seven articles were selected: one case-control study, three cross-sectional studies, and three cohort studies. These studies found that psychological factors were more common in chronic than acute TMD pain patients; however, these factors did not increase the transition risk in the multivariable model. Myofascial and baseline pain intensity were associated with the transition from acute to chronic TMD pain at a 6-month follow-up. Due to methodological weaknesses in the available literature, more research is required to establish the risk factors implicated in the transition from acute to chronic TMD pain. This review found some evidence that myofascial pain is associated with the transition risk from acute to chronic TMD pain at a 6-month follow-up and that pain intensity at baseline is associated with more intense TMD pain 6months later. There is insufficient evidence to draw conclusions about the role of demographics and psychological disorders as independent risk factors.

The association between diet in mid‐life and dementia incidence over a 20‐year period

AbstractBackgroundModifiable risk factors account for 40% of worldwide dementias. A potential modifiable risk factor for dementia and cognitive impairment is diet. However, there are conflicting results and methodological weaknesses in previous studies. The aim of this study was to investigate whether midlife diet quality is associated with subsequent risk of developing all‐cause dementia, Alzheimer’s disease (AD) or vascular dementia (VaD). In addition, the association between diet quality and future accumulation of β‐amyloid (Aβ) in cerebrospinal fluid (CSF) was examined.MethodBaseline examination within the Swedish population‐based Malmö Diet and Cancer Study (MDCS) took place between 1991‐1996 on 30,447 middle‐aged individuals. Participants from the MDCS with complete baseline dietary examination were included in this study (n=28,027) and the follow‐up for incident dementia took place until December 31, 2014. Diagnoses were collected from the Swedish National Patient Register and validated by Memory Clinic physicians. CSF Aβ42 was available in a sub‐population (n=777). Information on dietary habits was gathered through a 7‐day food diary, a detailed food frequency questionnaire and a one‐hour interview. A diet quality index was calculated from adherence to nutrition recommendations of intake of dietary fibre, added sugar, fish and shellfish, fruit and vegetables and red and processed meat (0‐5 points, poor to good). Cox proportional hazard models were used to examine associations between diet and risk of developing dementia adjusted for age, sex, education, total caloric intake and season.ResultDuring a median of 19.8 years of follow‐up, 1,943 (6.9%) participants were diagnosed with dementia. Individuals adhering to diet recommendations did not lower the risk of developing all cause dementia (HR 0.98, 95% CI 0.95‐1.02), AD (HR 0.99, 95% CI 0.95‐1.04) or VaD (HR 0.98, 95% CI 0.91‐1.06). No significant association was found between diet score and abnormal Aβ accumulation measured with CSF Aβ42 (OR 1.10, 95% CI 0.66‐1.84),Conclusion: In this long‐term prospective cohort study, adherence to dietary recommendations for fibre, sugar, fish, fruit and vegetables and red and processed meat was not significantly associated with subsequent reduced risk for developing all‐cause dementia, AD or VaD.

Systematic review of the current psychosocial interventions for people with moderate to severe dementia

AbstractBackgroundDementia, a global epidemic, currently affects 40 to 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life to evaluate what treatments are working and whether improvements are possible.MethodA systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or quality of life in randomized controlled trials (RCTs), published between 2000 and 2020.ResultThe search identified 4193 studies, and 74 articles were assessed for full‐text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality.ConclusionAromatherapy and reminiscence therapy showed the strongest evidence in improving quality of life. There was some evidence that aerobic exercise enhanced cognition, and a multi‐component study improved quality of life. However, a quality assessment, using pre‐specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and quality of life for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.