Negative Effects In Relation Research Articles

“Let’s not talk about it”: examining the interpersonal context of pornography use by investigating patterns of communicative avoidance

ABSTRACT We investigated the extent to which individuals deliberately avoid the topic of pornography use with their partner and how such avoidance influences the association between pornography use and sexual satisfaction. We reasoned that such communicative avoidance may account for some of the negative relational effects associated with pornography use. A sample of 191 participants in mixed-sex relationships completed online measures of pornography use, sexual satisfaction, and domain-specific and overall measures of communicative avoidance. Men tended to avoid the topic of pornography use more than other topics that have the potential to cause relationship conflict. Women did not avoid the topic of pornography use more or less than other relationship topics. Controlling for pornography use, men and women who were more likely to avoid the topic of pornography use were less likely to be sexually satisfied; this association remained significant for men (but not women) after controlling their overall communicative avoidance. Lastly, men who were high pornography users and reported high levels of overall communication avoidance were most likely to report lower sexual satisfaction. Our findings underscore the need to pay careful attention to relational processes and dynamics when investigating the influence of pornography use on intimate relationships.

NPK Fertilizer Requirements for Jatropha Zeyheri Indigenous Tea under Microplot Conditions

Effects of NPK fertilizer could have positive or negative effects in relation to growth of crops under certain environments, with minimum findings on how crops react to fertilizers under microplot conditions. Therefore, the objective of this study was to assess the effects of increasing NPK fertilizer rate on Jatropha zeyheri tea growth under microplot conditions. At two-leaf phase, J. zeyheri seedlings were transplanted into 25 cm diameter plastic pots. Each pot was filled with heated pasteurized sandy soil and Hygromix at 3:1 (v/v) ratio and placed in a spacing of 0.30 m × 0.30 m inter-and intra-row spacing. Six treatments constituting NPK fertilizer rates (0, 2, 4, 8, 16 and 32 g) were arranged in a randomized complete block design, with five replications. Treatments were initiated a week after transplanting, and 130 days after that, treatments had highly significant effects on leaf width, contributing 66% in TTV, whereas significant effects were reported on vine length, stem diameter, leaf length and dry root mass contributing 61, 67, 68 and 49% in TTV, respectively. NPK fertilizer rates did not affect chlorophyll content, NDVI, dry shoot mass, number of leaves and leaf area index. Jatropha zeyheri yield variables when exposed to increasing fertilizer rates displayed positive quadratic relations. Use of fertilizers had setbacks when applied inappropriately leading to inconsistent results. However, determining optimum fertilizer requirement for J. zeyheri was a strategical solution for inappropriate application. Jatropha zeyheri fertilizer requirements were optimized at 3.30 g fertilizer/plant, which shows that J. zeyheri requires a minimum amount of NPK fertilizer to stimulate growth.

Study of the effects of increasing the boom of the coastal application pump of herbicide in ergonomics

The forestry sector has been perfecting and developing techniques to improve its process. This is due to the great competitiveness of the market and the lack of labor. The objective of the work was to evaluate the effect of varying the length of the agrochemical application lance on ergonomics using the Rapid Upper Limb Assessment (RULA) methodology. This assessment relates the effect of the tool on different parts of the employee's body, and in this way it is possible to obtain a diagnosis through the postural assessment of the equipment during the activity. From this study it was possible to demonstrate that increasing the boom from 53 to 75 cm does not expose employees to negative effects in relation to posture. On the other hand, it was possible to highlight positive points arising from the change, such as productivity gains, less physical exhaustion and employee fatigue.

Resilience Communication Mitigates the Negative Relational Effects of Topic Avoidance: Evidence from Parental Caregiving and COVID-19 Pandemic Contexts.

Communicating about hardships with close others can be challenging, leading to avoidance of hardship-related topics. Although typically considered relationally damaging, topic avoidance could serve as a beneficial or neutral strategy when paired with relationally affirming communication. The current research investigates if the resilience communication processes outlined in the communication theory of resilience mitigate the negative relational effects of topic avoidance. Hypotheses are tested in two different contexts: sibling communication during parental caregiving (N=207) and spousal communication in the first months of the COVID-19 pandemic (N=598). The processes of crafting normalcy, communication networks, and productive action were beneficial across contexts. When participants reported higher engagement in these processes, topic avoidance was not significantly related to relationship satisfaction. At lower engagement levels, topic avoidance was negatively related to relationship satisfaction. Nuance between contexts existed. For example, humor moderated the effect of sibling caregiving topic avoidance but not spousal COVID-19 topic avoidance.

#6373 EFFECT ON BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS IN PEDIATRIC PATIENTS DURING COVID-19 PANDEMIC CONFINEMENT (COBECOR STUDY)

Abstract Background and Aims Patients monitored in the cardiovascular risk (CVR) consultation usually present overweight/obesity, metabolic syndrome, tendency to hypertension (HT), poor eating habits and sedentary lifestyle, with great resistance to change, great influence of the environment and, frequently, psychosocial limitations. We asked whether home confinement for COVID-19 (March-May 2020) could have negative effects in relation to CVR in these patients. The main objective of this work is to assess this hypothesis with respect to HTN and the use of antihypertensive drugs in these patients. As a secondary objective, we assessed changes in other parameters: body mass index (BMI), level of physical activity and diet. Method Retrospective cohort study with review of 738 ambulatory blood pressure monitoring (ABPM) between 2019-2022 obtaining, after applying the exclusion criteria (no overweight/obesity, poor therapeutic compliance, underlying renal pathology or failure to perform two ABPM in the study period), a final cohort of 46 patients divided into two groups (23 each): one group exposed to home confinement (G1) with one ABPM before and after home confinement and another group not exposed to confinement (G2) with two ABPM in different periods between 2021-2022. Blood pressure (BP) percentile values, dipper pattern, variability and blood pressure load, as well as the rest of the CVR parameters were compared in both periods. Results The mean age was 13 years (13.8 G1/13.2 G2) with a mean time between the 1st and 2nd ABPM of 11 months (11.08 G1/10.95 G2) and a greater reduction in BMI in G2 than in G1 (1.05 G1/1.21 G2). Despite this, the results were not statistically significant. Nor were the results significant in terms of differences in AT or worsening of the dipper pattern (30.4% in G1 and 21.7% in G2). We did observe differences (p<0.022) in the use of antihypertensive drugs, although contrary to our initial hypothesis, with greater use of drugs in G2. Conclusion Although the low sample size, the biases inherent in the design and the lack of previous studies make the interpretability and statistical significance of some results difficult, they reinforce that the measures during confinement did not contemplate all spheres of health and the need to implement specific CVR consultations. Obesity and its associated pathologies are an important public health problem that pediatricians have the responsibility to address.

Investigating potential effects of mobility and accessibility services using the avoid-shift-improve framework

Mobility services and accessibility services could contribute to reduced car-dependency and a more sustainable transport system. However, uncertainty remains regarding what the effects will be and further research is needed.In this paper we examine potential effects on passenger car-travel in an urban context. To do so, we actuate the Avoid-Shift-Improve (ASI) framework using a System Dynamics approach and develop thematic Causal Loop Diagrams. We draw on the findings from a literature study and workshops engaging actors involved in creating visions and planning for the future of mobility and accessibility services in Stockholm, Sweden. The effects discovered are categorized as direct, enabling and structural/systemic, using a retrofitted version of the Three-Levels Model.Contributions include the mapping of mechanisms through which the services can have positive and negative effects in relation to ASI, demonstrating a high degree of interconnectedness. This includes potential synergetic and competitive relations between the services. In addition, the approach gives insight to potential cumulative impact of the services, relatable to Mobility as a Service, including ‘user near’ effects regarding, e.g., commuting and leisure travel, as well as systemic and structural level effects. A discussion is conducted on the implications for actors and policy-makers.

Impacts of the invasive hornet Vespa velutina on native wasp species: a first effort to understand population-level effects in an invaded area of Europe

Invasive alien species could generate a multitude of impacts towards native species. The introduction and spread of Vespa velutina in Europe is raising concern for the conservation of insect’s biodiversity, including wasps due to predation, competition or a combination of these two mechanisms. Nevertheless, most evidence for negative effects on other wasps are based on laboratory experiments, direct observations, and on considerations about the biology and ecology of Vespidae. No field study in Europe explored how the abundance of V. velutina could affect the population of native Vespidae, as expected in case of competition and predation. We analysed how the abundance of V. velutina influenced that of Vespa crabro, 4 years after the arrival and establishment of V. velutina in our study area, in Italy. Moreover, we compared the abundances of three native Vespidae (V. crabro, Vespula vulgaris, Vespula germanica), between our study area and an adjacent uninvaded area with similar environmental conditions. Bayesian Generalized Linear Models revealed that the abundance of V. velutina and V. crabro was positively associated, where V. velutina was scarce. Covariation disappeared only at those trapping sites where V. velutina was extremely abundant. Moreover, abundances of native wasps were similar between the invaded and the uninvaded areas.Implications for insect conservationThe wide-scale monitoring activity performed to investigate the effects of V. velutina on native wasps has not detected any negative effects in relation to the presence of the invasive species. More effort is however requested for understanding if V. velutina could really affect native Vespidae at the population-level.

Self and Relative Effects of Competitive State Anxiety on Perceived Performance in Middle and High School Taekwondo Athletes: An Actor and Partner Interdependence Model Analysis.

Background:The present study aimed to provide an empirical theoretical basis for the psychological phenomena that occur among competing athletes. To this end, we utilized the actor and partner interdependence model (APIM) to analyze the self- and relative effects of competitive state anxiety on perceived performance in middle and high school Taekwondo athletes.Methods:Data were analyzed for 372 middle and high school athletes (red group=186, blue group=186) who participated in the first round of the 2020 Korea Taekwondo Association National Taekwondo Competition. Analysis based on the APIM was applied to the collected data, and a path analysis was conducted to verify the self- and relative effects of competitive state anxiety on perceived performance.Results:Cognitive (red: P<0.01, blue: P<0.001) and physical state anxiety (red: P<0.01, blue: P<0.01) exerted a significant negative self-effect on perceived performance in both groups. In contrast, state confidence (red: P<0.001, blue: P<0.001) exerted a significant positive self-effect on perceived performance. Furthermore, cognitive (red: P<0.001, blue: P<0.01) and physical state anxiety (red: P<0.001, blue: P<0.001) exerted a significant positive relative effect on the opponent’s perceived performance in both groups, while state confidence (red: P<0.01, blue: P<0.001) exerted a significant negative relative effect on the opponent’s perceived performance.Conclusion:Sports psychologists should focus on developing a psychological training program that provides practical psychological support as well as self-regulatory and relative strategies for improving athletic performance in competitive scenarios.

A expansão da jurisdição da Corte Interamericana de Direitos Humanos através de opiniões consultivas

Ao interpretar a Convenção Americana sobre Direitos Humanos através de opiniões consultivas, a Corte Interamericana de Direitos Humanos (CtIDH) em diversas ocasiões impactou também sua função contenciosa. Em algumas opiniões recentes, sustenta-se que a Corte Interamericana expandiu o âmbito de sua jurisdição contenciosa. Nesse artigo, são analisadas as técnicas interpretativas empregadas pela CtIDH para, através da via consultiva, aumentar o alcance de sua jurisdição contenciosa. Será realizada uma análise tanto das decisões da Corte bem como da literatura especializada e do posicionamento de alguns Estados em relação à Corte. Num contexto de resistência e contestação de cortes internacionais, sustenta-se que a atividade de expansão da jurisdição da Corte pode possuir efeitos positivos e negativos em relação à sua autoridade e legitimidade, mas que uma maior cautela em relação à expansão de sua jurisdição e ao uso do artigo 26 para circunscrever o consentimento dos Estados evitaria quaisquer efeitos negativos.

The dynamics of conspecific tree and seedling neighbors on seedling survival in a subtropical forest

Negative intraspecific interactions could provide opportunities for heterospecific regeneration, thereby maintaining species coexistence in forest communities. Increasing conspecific tree and seedling neighbor densities often have negative correlations with seedling survival. If and how the strength of interactions change with seedling age remains a knowledge gap. In this study, we followed 2184 newly germinated seedlings belonging to 26 species for five years in a subtropical evergreen broad-leaved forest in eastern China. We tested the density distribution pattern of different aged live seedlings and used generalized linear mixed models to assess the dynamic influence of conspecific tree and seedling neighbors on seedlings survival across years. Our results showed that the density distribution of newly germinated seedlings was more clustered than the other aged live seedlings. Over five years, the clustered density distribution of live seedlings gradually weakened. Particularly, the density distribution of five years old seedlings was statistically random. Meanwhile, the degree of positive correlation between the density of live seedlings and the density of conspecific tree neighbors decreased with seedling age. Correspondingly, the conspecific seedling neighbors had a significant negative correlation with newly germinated seedlings survival in the first year and had a greater effect than conspecific tree neighbor density. As seedlings age, the conspecific tree neighbors had a greater negative relative effect on seedlings survival than the conspecific seedling neighbors. Our findings demonstrate that intraspecific negative interactions are an important mechanism on seedling survival and the magnitude of those interactions change with seedling age. In younger seedlings, intraspecific negative interactions were mainly from conspecific seedling neighbors and weakened as the seedlings aged. In later seedling ages, the interactions from conspecific tree neighbors dominated. Ultimately, these effects reduce species clumping dynamically and provide space for establishment of heterospecifics which would maintain diversity in the forest.

The Transition to Renewable Energy Technologies—Impact on Economic Performance of North Rhine-Westphalia

The economic impacts of the German Renewable Energy Act (EEG) are of considerable importance for the discussion of the energy transition in Germany (Energiewende). The Energiewende implies structural changes of the energy system by deploying Renewable Energy (and energy efficiency) Technologies (RET), but it also may induce structural changes for the overall economy, with uneven effects on a sub-national level. North-Rhine Westphalia (NRW) is an ideal case to study such regional disparities, since this federal state has scarce per-capita renewable energy sources, whereas it stands out for its energy intensive industry and fossil-fuel based power plants. In order to support renewable energy policies, mostly gross impact assessments of RET deployment have been carried out both on national and regional levels. By definition, such analyses result in positive assessments, since only expansionary effects resulting from additional demand for RET are accounted for. This paper, in contrast, presents a net impact assessment of the EEG on the NRW economy of both expansionary and contractionary effects. The latter consist of negative income effects, increased production costs and, the crowding-out of conventional energy due to the renewable energy financing mechanism (i.e., electricity surcharge), as well as its preferential status for feed-in. Our findings show how North-Rhine Westphalia, with regard to the operation of RET, suffers disproportionally from negative effects in relation to the value addition of its economy in comparison to the rest the country, whereas it benefits marginally from the production of such facilities.

Increasing soil age drives shifts in plant-plant interactions from positive to negative and affects primary succession dynamics in a subalpine glacier forefield

The stress gradient hypothesis predicts that plant-plant interactions switch between facilitation (positive) and competition (negative) along environmental gradients, with facilitation being more common under high abiotic stress conditions relative to more moderate abiotic stress conditions. Our aim was to reveal, whether the interactions between Populus purdomii Rehder and Salix rehderiana Schneider switch from positive to negative during the early stages of primary succession in the Gongga Mountain glacier retreat region. We also investigated, whether soil age is a major driving factor for the transformation of interactions between neighboring plants. We analyzed differences between intraspecific interactions and interspecific interactions of Populus and Salix under 20- and 40-year-old soil conditions, including plant biomass accumulation and allocation, nutrient absorption and utilization, relative competition intensity, non-structural carbohydrates, foliar carbon and nitrogen isotope composition, mesophyll cell ultrastructure, soil microbial biomass and community structure, extracellular enzyme activities, and soil organic carbon (SOC), soil total nitrogen (TN), soil ammonium (NH4+-N), and soil nitrate (NO3−-N) contents. We found that P. purdomii and S. rehderiana growing under interspecific interactions had greater contents of aboveground dry matter, belowground dry matter and total dry matter compared to intraspecific interactions in 20-year-old soil. Furthermore, in 40-year-old soil conditions, the phospholipid fatty acid (PLFA) analysis showed that Populus and Salix exposed to interspecific interactions exhibited lower amounts of gram-positive bacteria, fungi (18,1 ω9c) and actinomycetes, and lower levels of total PLFAs than those growing under intraspecific interactions. The redundancy analysis (RDA) results demonstrated that soil N was the most important parameter contributing to the composition of microbial communities. In addition, the 15N stable isotope labeling method showed that Populus and Salix growing under interspecific interactions had higher foliage δ15N derived from NO3− (δ15N-NO3−) than those growing under intraspecific interactions in 20-year-old soil. In summary, our results demonstrated that Populus-Salix interactions exhibited positive effects on survival in 20-year-old soil. Conversely, under 40-year-old soil conditions, Populus-Salix interactions presented negative effects in relation to nutrients and elimination by neighboring plants. Moreover, soil age is a major driving factor for plant-plant interactions that shift from positive to negative with an increasing soil age in the Gongga Mountain glacier forefield. In all, our results support the stress gradient hypothesis. Our findings improve understanding of plant-plant interactions and plant-soil feedbacks during the early stages of soil development, and of the construction of vegetation communities.

Associations of Taking Conflict Personally with Mental and Physical Health: An Allostatic Load Perspective

ABSTRACTBuilding from an allostatic load perspective, this study tested mental and physical health outcomes associated with taking conflict personally. Four hundred and thirty-seven students completed measures assessing direct personalization, persecution feelings, stress reactions, positive relational effects, negative relational effects, and like/dislike valence; mental health; and physical health. Persecution feelings and like/dislike valence were negatively associated with mental health; negative relational effects were positively associated with mental health; direct personalization and persecution feelings were negatively associated with physical health; and like/dislike valence was positively associated with physical health. Results indicated partial support for a model in which mental health mediated associations between taking conflict personally and physical health.

Who responds best to text-delivered cannabis use disorder treatment? A randomized clinical trial with young adults.

Young adults ages 18 to 25 have the highest percentage (5%) of cannabis use disorder (CUD) among all age groups, and are the least likely to receive treatment compared with other age groups. Because this population is in need of creative approaches for treatment engagement, we tested Peer Network Counseling-txt (PNC-txt), a 4-week, automated text-delivered cannabis treatment that focuses on close peer relations with 96 treatment seeking young adults. Participants meeting CUD criteria were randomized to PNC-txt, or assessment only control condition and followed for 3-months. At 3-months, the PNC-txt group reduced number of heavy cannabis-use days and relationship problems due to cannabis use compared with controls. Subgroup analyses were conducted with cases having more and fewer CUD symptoms than the full sample. For cases with fewer symptoms, but not for those with more, PNC-txt reduced past 30-day use, urges to use, memory problems, and relationship problems due to cannabis use compared with controls. Treatment satisfaction data from the full sample indicated that participants thought the intervention texts helped them reduce or manage their cannabis use and increased their understanding of the negative relational effects associated with ongoing cannabis use. Findings provide evidence of the efficacy of PNC-txt in treating CUD in young adults, support clinically targeting peer relations, and suggest that PNC-txt may be most helpful for those with mild to moderate CUD severity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Role of Family Verbal Aggression and Taking Conflict Personally in Romantic Relationship Complaint Avoidance

This study examined complaint avoidance in adult romantic relationships as a function of both exposure to family verbal aggression in childhood and taking conflict personally. Four hundred thirty-seven college students completed measures assessing their histories of family verbal aggression, complaint avoidance behaviors, and tendencies to take conflict personally. Results indicated that a history of family verbal aggression and three components of taking conflict personally, namely positive relational effects, negative relational effects, and like/dislike valence, were negatively associated with complaint avoidance. In addition, a history of family verbal aggression was positively associated with positive relational effects, negative relational effects, and like/dislike valence. The relationship between a history of family verbal aggression and complaint avoidance, however, was not mediated by taking conflict personally.

"My wife's mistrust. That's the saddest part of being a diabetic": A qualitative study of sexual well-being in men with Type 2 diabetes in sub-Saharan Africa

IntroductionSexual dysfunction is a common complication for men with diabetes, yet little is known about the lived experiences of sexual difficulties within the context of diabetes, particularly in low-and-middle-income countries. This study explores how men with type 2 diabetes in three sub-Saharan African settings (Cape Town and Johannesburg, South Africa; Lilongwe, Malawi) perceive and experience sexual functioning and sexual well-being, and the biopsychosocial contexts in which these occur and are shaped.MethodsWe used a qualitative research design, including individual interviews (n = 15) and focus group discussions (n = 4). Forty-seven men were included in the study. We used an inductive thematic analysis approach to develop our findings. A biopsychosocial conceptual model on the relationship between chronic illness and sexuality informed the interpretation of findings.ResultsMen across the study settings identified sexual difficulties as a central concern of living with diabetes. These difficulties went beyond biomedical issues of erectile dysfunction, comprising complex psychological and relational effects. Low self-esteem, related to a sense of loss of masculinity and reduced sexual and emotional intimacy in partner relationships were common experiences. Specific negative relational effects included suspicion of infidelity, mutual mistrust, general unhappiness, and fear of losing support from partners. These effects may impact on men’s ability to cope with their diabetes. Further stressors were a lack of information about the reasons for their sexual difficulties, perceived lack of support from healthcare providers and an inability to communicate with partners about sexual difficulties.ConclusionMore in-depth research is needed to better understand sexual functioning and well-being within the context of diabetes, and its potential impact on diabetes self-management. Holistic and patient-centered care should include raising awareness of sexual problems as a potential complication of diabetes amongst patients, their partners and care providers, and incorporating sexual well-being as part of routine clinical care.

Effects of Short-Term Calcium Supplementation in Children and Adolescents with Phenylketonuria

Reduction of bone mineral density and the risk of osteopenia have been reported to occur in phenylketonuria (PKU) patients. This study aimed to evaluate the short-term effects of calcium supplementation in phenylketonuric children and adolescents. The study included 18 patients with PKU aged 5–18 yr (61% male) under clinical and nutritional treatment. Evaluation of food intake, anthropometry, and biochemical and phalangeal quantitative ultrasound were performed before (phase 1) and after (phase 2) calcium supplementation (1000 mg/d) for 34 d. Statistical analysis was performed using t test for paired samples, Wilcoxon's test, and McNemar's test (p < 0.05). There was an inadequate intake of phosphorus and vitamin D, the same occurring with serum concentrations of these nutrients. About 50% of the patients had an accumulation of adipose tissue measures, with a negative correlation between Z-score, body mass index, and phalangeal quantitative ultrasound (amplitude-dependent speed of sound [AD-SoS]). There was a significant difference in urinary phosphorus excretion with higher values before supplementation. Comparison of the two phases revealed significantly higher AD-SoS values after the supplementation (p = 0.017). The reduction in phosphorus excretion associated with increased AD-SoS between the two phases suggested increased bone formation, and showed no negative effects in relation to short-term calcium supplementation in children and in adolescents with PKU.

Religious tourism and possible negative effects in relation to the monasteries

Religious tourism occupies an important place at the global level. How much do tourism deals with religious tourism in Serbia and of any significance is this branch of tourism for the further development of tourism in our country. Does the besides positive effects can have adverse effects, and to what extent. Would you like the placing emphasis on religious tourism in Serbia noticeable affected the reducing the number of unemployed? It is undisputed that tourist visits to monasteries, not the believers, to disrupt the work and lifestyle of a priest. The ultimate effect of the visit to religious property, in addition to the positive effect for culture and cultural heritage of, can result in the transformation of the monastery in museum and so SPC loses its significance.

Communication that builds teams: assessing a nursing conflict intervention.

Quality communication is essential for building strong nursing teams. Structurational divergence (SD) theory explains how institutional factors can result in poor communication and conflict cycles; the theory has been developed in nursing context, although it is applicable to all organizational settings. We describe the design, implementation, and evaluation of an intervention to reduce SD and improve nurses' work life and team-member relationships. An intensive 9-hour course provided training in conflict/SD analysis and dialogic conflict/SD management to 36 working nurses from a variety of settings. Quantitative pre- and posttests were administered, with a comparison sample. The course reduced measures of negative conflict attitudes and behaviors: direct personalization, persecution feelings, negative relational effects, ambiguity intolerance, and triangulation (gossiping and complaining to uninvolved third parties). The course also increased important attitudes necessary for productive dialogue and conflict management: perceptions of positive relational effects, conflict liking, and positive beliefs about arguing. As compared with nonparticipants, participant posttests showed lower conflict persecution; higher recognition of positive relational effects; lower perceptions of negative relational effects; higher conflict liking; lower ambiguity intolerance; and lower tendency to triangulate. Qualitatively, participants perceived better understanding of, and felt more empowered to manage, workplace conflicts and to sustain healthier workplace relationships. This intervention can help nurses develop tools to improve system-level function and build productive team relationships.

Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia.

Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific interventional approaches designed to address difficulties with memory and other aspects of cognitive functioning. The present review is an update of previous versions of this review. The main aim of the current review was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation for people with mild Alzheimer's disease or vascular dementia in relation to important cognitive and non-cognitive outcomes for the person with dementia and the primary caregiver in the short, medium and long term. The CDCIG Specialized Register, ALOIS, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS and many other clinical trial databases and grey literature sources, was most recently searched on 2 November 2012. Randomised controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting relevant outcomes for the person with dementia and/or the family caregiver, were considered for inclusion. Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for 11 of the primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. The unit of analysis in the meta-analysis was the change from baseline score. Overall estimates of treatment effect were calculated using a fixed-effect model, and statistical heterogeneity was measured using a standard Chi(2) statistic. One RCT of cognitive rehabilitation was identified, allowing examination of effect sizes, but no meta-analysis could be conducted. Cognitive training was not associated with positive or negative effects in relation to any reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to a number of participant and caregiver outcomes, and was generally of high quality. Available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve. However, there is still no indication of any significant benefit derived from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardised outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to obtain more definitive evidence. Researchers should describe and classify their interventions appropriately using available terminology.