Robust Intervention Studies Research Articles

Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia

BackgroundMaximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents’ QoL. The goal of this study is to address this critical knowledge gap.MethodsWe will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident’s social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument – Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents’ QoL and its health and social determinants.DiscussionThis large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.

Factors influencing oral health behaviours, access and delivery of dental care for autistic children and adolescents: A mixed-methods systematic review.

BackgroundAutistic children and young people (CYP) experience oral health (OH) inequalities. They are at high risk of dental disease and show significant levels of unmet need in relation to OH and access to dental care.AimThis study aimed to gather evidence on the factors that influence OH behaviours, access to and delivery of dental care for autistic CYP.DesignThis was a mixed‐methods narrative systematic review.Data SourcesEmbase, Web of Science, Dentistry & Oral Sciences Source, MEDLINE, Psychinfo, Scopus, CINAHL, SocINDEX and grey literature were the data sources for this study.Review MethodsA systematic search was conducted for qualitative, quantitative and mixed‐methods research studies from countries with a High Development Index that related to OH behaviours, access to and delivery of dental care for autistic CYP. Results were analysed using narrative synthesis.ResultsFrom 59 eligible studies, 9 themes were generated: (1) affordability and accessibility; (2) autism‐related factors and cognitive or motor skill differences; (3) the dental environment; (4) managing CYP's behaviour; (5) responding and adapting to the needs of the autistic CYP and their parent/carer; (6) attitude of dental health professionals (DHPs) towards autistic CYP and their parents/carers; (7) knowledge of how to care for and support CYP's OH; (8) empowerment of parents/carers and collaboration with DHPs; and (9) communication and building rapport.ConclusionThe adoption of healthy OH behaviours and access to dental care by autistic CYP is impacted by a range of factors including those intrinsically related to a diagnosis of autism, for example, communication and those often associated with autism, for example, sensory sensitivities. Access to better OH and dental care can be facilitated by responding to the individual needs of autistic CYP through accommodation, education and adaptation. This necessitates greater awareness and knowledge of autism amongst DHPs and the provision of appropriate services. More methodologically robust intervention studies are needed to identify effective ways to support autistic CYP in achieving good OH and access to dental care.Patient and Public ContributionThe review protocol was developed with members of the project patient and public involvement group who provided the autistic voice, contributing to the interpretation of the review findings and writing of the manuscript.

Systematic Review of Psychological Aging Research in Nepal

Nepal faces unprecedented levels of aging similar to trends in many less well-resourced countries. It has limited capacity to address the medical, social and psychological needs of older persons. Difficult choices regarding allocation of resources will be needed. In this review, we hope to clarify what is already known in aging research in Nepal. The databases APA PsychINFO and PubMed were searched. The inclusion criteria were peer-reviewed articles on i) psychological constructs and mental illnesses, ii) use of original data, iii) inclusion of senior participants and iv) studies conducted in Nepal. Studies that included mixed age group and cross-country comparisons were excluded from this review. The initial search resulted in 76 articles from APA PsychINFO and 590 articles from PubMed. Articles were reviewed independently for inclusion and exclusion criteria. A total of 49 articles were included in the final list. Preliminary results showed that the largest share of articles focused on depression (32.1%), followed by quality of life/life satisfaction or loneliness(18.9%). A large number of studies also examined prevalence rates of psychiatric and neurocognitive disorders (22.6%). Common conditions, like dementia and delirium were studied only in 1.9% and 3.8% of published studies respectively. All of the studies were cohort-based and none focused on evaluations of psychosocial/medical interventions. Robust intervention studies are needed to help improve the lives of seniors in Nepal. To our knowledge this is the first comprehensive review of published articles on psychological construct in aging populations in Nepal.

Systematic Review of Psychological Aging Research in Nepal

Abstract Nepal faces unprecedented levels of aging similar to trends in many less well-resourced countries. It has limited capacity to address the medical, social and psychological needs of older persons. Difficult choices regarding allocation of resources will be needed. In this review, we hope to clarify what is already known in aging research in Nepal. The databases APA PsychINFO and PubMed were searched. The inclusion criteria were peer-reviewed articles on i) psychological constructs and mental illnesses, ii) use of original data, iii) inclusion of senior participants and iv) studies conducted in Nepal. Studies that included mixed age group and cross-country comparisons were excluded from this review. The initial search resulted in 76 articles from APA PsychINFO and 590 articles from PubMed. Articles were reviewed independently for inclusion and exclusion criteria. A total of 49 articles were included in the final list. Preliminary results showed that the largest share of articles focused on depression (32.1%), followed by quality of life/life satisfaction or loneliness(18.9%). A large number of studies also examined prevalence rates of psychiatric and neurocognitive disorders (22.6%). Common conditions, like dementia and delirium were studied only in 1.9% and 3.8% of published studies respectively. All of the studies were cohort-based and none focused on evaluations of psychosocial/medical interventions. Robust intervention studies are needed to help improve the lives of seniors in Nepal. To our knowledge this is the first comprehensive review of published articles on psychological construct in aging populations in Nepal.

Diet and Inflammatory Bowel Disease: What Quality Standards Should Be Applied in Clinical and Laboratory Studies?

Many patients suffering from inflammatory bowel disease (IBD) follow restrictive diets, as many respective recommendations circulate. Efforts are made to evaluate and summarize the published information, for example, in a recent consensus manuscript by the International Organization for the Study of IBD (IOIBD). However, the standards that should be applied to make claims about dietary effects are poorly defined. In this manuscript, the scientific basis of recommendations for nutritional interventions in IBD is analyzed. Epidemiological evidence on diet in IBD is always biased by numerous factors, and the number of robust dietary intervention studies is limited due to methodological difficulties. Therefore, animal models are used to test hypotheses with respect to dietary factors and intestinal inflammation. Naturally, animal models have limitations, and knowledge of key characteristics of colitis animal models is crucial to understand their advantages and disadvantages. In recent years the important role of the microbiota for IBD and dietary factors has been discovered. Microbiota data are added to many publications on IBD and nutrition. The quality of those data varies largely. Subsequently, quality standards for microbiota analyses also are discussed. Finally, quality requirements to be applied on recommendations for dietary changes in patients with IBD are suggested.

Community interventions in Low-And Middle-Income Countries to inform COVID-19 control implementation decisions in Kenya: A rapid systematic review.

Globally, public health measures like face masks, hand hygiene and maintaining social distancing have been implemented to delay and reduce local transmission of COVID-19. To date there is emerging evidence to provide effectiveness and compliance to intervention measures on COVID-19 due to rapid spread of the disease. We synthesized evidence of community interventions and innovative practices to mitigate COVID-19 as well as previous respiratory outbreak infections which may share some aspects of transmission dynamics with COVID-19. In the study, we systematically searched the literature on community interventions to mitigate COVID-19, SARS (severe acute respiratory syndrome), H1N1 Influenza and MERS (middle east respiratory syndrome) epidemics in PubMed, Google Scholar, World Health Organization (WHO), MEDRXIV and Google from their inception until May 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO (CRD42020183064). Of 41,138 papers found, 17 studies met the inclusion criteria in various settings in Low- and Middle-Income Countries (LMICs). One of the papers from LMICs originated from Africa (Madagascar) with the rest from Asia 9 (China 5, Bangladesh 2, Thailand 2); South America 5 (Mexico 3, Peru 2) and Europe 2 (Serbia and Romania). Following five studies on the use of face masks, the risk of contracting SARS and Influenza was reduced OR 0.78 and 95% CI = 0.36-1.67. Equally, six studies on hand hygiene practices reported a reduced risk of contracting SARS and Influenza OR 0.95 and 95% CI = 0.83-1.08. Further two studies that looked at combined use of face masks and hand hygiene interventions showed the effectiveness in controlling the transmission of influenza OR 0.94 and 95% CI = 0.58-1.54. Nine studies on social distancing intervention demonstrated the importance of physical distance through closure of learning institutions on the transmission dynamics of disease. The evidence confirms the use of face masks, good hand hygiene and social distancing as community interventions are effective to control the spread of SARS and influenza in LMICs. However, the effectiveness of community interventions in LMICs should be informed by adherence of the mitigation measures and contextual factors taking into account the best practices. The study has shown gaps in adherence/compliance of the interventions, hence a need for robust intervention studies to better inform the evidence on compliance of the interventions. Nevertheless, this rapid review of currently best available evidence might inform interim guidance on similar respiratory infectious diseases like Covid-19 in Kenya and similar LMIC context.

Sexuality and Sexual Health In Adults with Limb Loss: A Systematic Review

A systematic review was conducted to provide an overview of the current state of research regarding sexuality and sexual health in adults with limb loss. Five databases (Medline, CINAHL, Scopus, Web of Science and PsycINFO) were searched between January 1, 2000 and April 14, 2019. Two reviewers independently screened all titles and abstracts for primary inclusion and full texts for secondary inclusion. The inclusion criteria were peer-reviewed journal articles that were published in English, that addressed at least one aspect of sexuality or sexual health and included adults (18 years and older) who acquired a major limb amputation. A modified Sackett Scale was used to assign levels of evidence to each study. A total of 29 articles met the inclusion criteria. With regard to sexuality, the most common topics investigated were body image (n = 21), sexual desire (n = 6) and sexual activity (n = 4). The Amputee Body Image Scale was the most commonly used outcome measure to assess body image (n = 10). In terms of sexual health, the most frequently studied issues were sexual functioning (n = 5) and sexual counselling (n = 2). Sexuality and sexual health issues affect the health and wellbeing of adults with limb loss. The majority of studies were low in evidence; indicating that more robust intervention studies are needed to help people cope with limb loss as it relates to their sexual health and sexuality. In particular, more targeted efforts for women and individuals with upper limb loss are needed.

Effectiveness of Nutrition Interventions in Vending Machines to Encourage the Purchase and Consumption of Healthier Food and Drinks in the University Setting: A Systematic Review.

University food environments typically offer an abundance of unhealthy foods, including through vending machines. This review evaluated the effectiveness of nutrition interventions in vending machines in the university setting. Ten databases were searched for experimental studies published up to July 2019, evaluating nutrition interventions that aimed to encourage the purchase or consumption of healthier foods and drinks in vending machines in the university setting. In total, 401 articles were identified, and 13 studies were included. Studies were pre-post test (n = 7, 54%), randomized controlled trials (RCTs) (n = 5, 38%), and non-randomized controlled trial (n = 1, 8%). Most studies were from the USA (n = 10, 77%) and were published between 2014 and 2018 (n = 9, 69%). Eight interventions (62%) reported positive change in outcomes, including increased number/proportion of sales or revenue from healthier items (n = 6), improved adherence to guidelines for the ratio of healthy/unhealthy products available (n = 1), and improved consumer perception of items available (n = 1). Effective interventions involved the promotion, reduced pricing, increased availability, and/or optimized product placement of healthier items within vending machines. Strategies to improve the nutritional quality of food and drinks in vending machines are warranted. This may be achieved by making healthier options more available and promoting them; however, more robust intervention studies are needed to determine effectiveness.

A protocol for a nationwide multicentre, prospective surveillance cohort and nested-consented cohort to determine the incidence and clinical outcomes of slipped capital femoral epiphysis.

AimsSlipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge.MethodsThe study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes.DiscussionThis is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study.

A protocol for a nationwide multicentre, prospective surveillance cohort and nested-consented cohort to determine the incidence and clinical outcomes of slipped capital femoral epiphysis

Aims Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. Methods The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes. Discussion This is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study.

Nonpharmacologic Interventions to Prevent or Mitigate Adverse Long-Term Outcomes Among ICU Survivors: A Systematic Review and Meta-Analysis.

ICU survivors suffer from long-lasting physical, mental, and cognitive health impairments, also called "postintensive care syndrome". However, an overview of the effectiveness of interventions to prevent or mitigate these impairments is lacking. The aim of this study is to assess the effectiveness of nonpharmacologic interventions. PubMed, CINAHL, PsycINFO, Embase, and Cochrane Library were systematically searched from inception until July 19, 2018. (Non)randomized clinical trials, controlled before-after studies, and interrupted time series were included. Outcomes of interest included patients physical, mental and cognitive outcomes, quality of life, and outcomes such as social functioning and functional status, measured after hospital discharge. Two independent reviewers selected studies, extracted data, and assessed the risk of bias. Pooled mean differences and standardized mean differences were calculated using random-effect meta-analyses. After screening 17,008 articles, 36 studies, including 10 pilot studies, were included (n = 5,165 ICU patients). Interventions were subdivided into six categories: 1) exercise and physical rehabilitation programs; 2) follow-up services; 3) psychosocial programs; 4) diaries; 5) information and education; and 6) other interventions. Many outcomes favored the interventions, but significant differences were only found for diaries in reducing depression (two studies, n = 88; standardized mean difference, 0.68; 95% CI, 0.14-1.21) and anxiety (two studies, n = 88; standardized mean difference, 0.44; 95% CI, 0.01-0.87) and exercise programs in improving the Short Form Health Survey-36 Mental Component Score (seven studies, n = 664; mean difference, 2.62; 95% CI, 0.92-4.32). There is thin evidence that diaries and exercise programs have a positive effective on mental outcomes. Despite outcomes favoring the intervention group, other commonly used nonpharmacologic interventions in daily ICU practice are not supported by conclusive evidence from this meta-analysis. To improve recovery programs for ICU survivors, more evidence is needed from robust intervention studies using standardized outcomes.

The “Managing Fatigue” programme for people with multiple sclerosis – acceptance and feasibility with Swedish occupational therapists

Background: Fatigue is common among people with multiple sclerosis (MS), and significantly influences engagement in occupations. The Managing Fatigue (MF) programme is an evidence-based occupational therapy group-based intervention, utilising self-management science that provides people with tools to manage fatigue. Although the national MS-guidelines in Sweden cite this as best practice, a Swedish version is not available.Aim: To translate and investigate the feasibility of a Swedish MF programme delivered by occupational therapists working with MS clients in Sweden.Material and methods: We used a mixed-methods design. Eight recruited occupational therapists, participated in a workshop prior to delivering the MF programme. Following programme delivery, they completed a questionnaire and participated in focus group interviews.Results: Each therapist conducted one programme with 5–9 MS clients. Overall, therapists were satisfied with programme content, and delivery was followed. Minor improvements were suggested, specifically in relation to how cognitive fatigue can be managed. Therapists acknowledged challenges moving from “expert” to supporting self-management.Conclusion: The MF programme is feasible in Sweden, and its client-centred and occupation focus is consistent with therapists’ scope of practice. In the future, acceptability and satisfaction from the perspectives of MS participants should be examined. Larger, more robust intervention studies evaluating effectiveness are also warranted.

Coffee Consumption and Oxidative Stress: A Review of Human Intervention Studies.

Research on the potential protective effects of coffee and its bioactives (caffeine, chlorogenic acids and diterpenes) against oxidative stress and related chronic disease risk has been increasing in the last years. The present review summarizes the main findings on the effect of coffee consumption on protection against lipid, protein and DNA damage, as well as on the modulation of antioxidant capacity and antioxidant enzymes in human studies. Twenty-six dietary intervention studies (involving acute and chronic coffee intake) have been considered. Overall, the results suggest that coffee consumption can increase glutathione levels and improve protection against DNA damage, especially following regular/repeated intake. On the contrary, the effects of coffee on plasma antioxidant capacity and antioxidant enzymes, as well as on protein and lipid damage, are unclear following both acute and chronic exposure. The high heterogeneity in terms of type of coffee, doses and duration of the studies, the lack of information on coffee and/or brew bioactive composition, as well as the choice of biomarkers and the methods used for their evaluation, may partially explain the variability observed among findings. More robust and well-controlled intervention studies are necessary for a thorough understanding of the effect of coffee on oxidative stress markers in humans.

Periodontitis and atherosclerotic cardiovascular disease

Robust intervention studies are required to examine the impact of periodontal treatment on prevention of ACVD.

Evidence-based Interventions for Immigrant Students Experiencing Behavioral and Academic Problems: A Systematic Review of the Literature

The purpose of the present research review is to identify effective, high quality school-based interventions for immigrant students with disabilities or academic and behavioral problems. A systematic review of the literature was conducted to synthesize international research studies. Initial and criteria-based selection processes yielded six intervention studies published between 1975 and 2010. Two of the studies are academic interventions while four are behavioral interventions. Three studies were conducted in the United States while the remaining three in Israel, Canada, and Norway. The identified studies were evaluated against the quality indicators of special education research. Three experimental studies met the minimum criteria for acceptable methodological rigor. The results show an urgent need for methodologically robust intervention studies in the field of special education for immigrant students. Implications for research and practice are discussed.

Milk in the diet: good or bad for vascular disease?

CVD still represent the greatest cause of death and disease burden in Europe and there remains uncertainty whether or not diets rich in milk and/or dairy products affect CVD risk. This paper reviews current evidence on this from prospective studies and the role of serum lipids and blood pressure as markers of CVD risk with such diets. Also the potential of animal nutrition-based approaches aimed at reducing CVD risk from consumption of milk and dairy products is outlined. Briefly, the evidence from prospective studies indicates that increased consumption of milk does not result in increased CVD risk and may give some long-term benefits, although few studies relate specifically to cheese and butter and more information on the relationship between milk/dairy product consumption and dementia is needed. Recent data suggest that the SFA in dairy products may be less of a risk factor than previously thought; although this is based on serum cholesterol responses which taken in isolation may be misleading. Milk and some dairy products have counterbalancing effects by reducing blood pressure and possibly BMI control. Despite this, animal nutrition strategies to replace some SFA in milk with cis-MUFA or cis-PUFA are extensive and intuitively beneficial, although this remains largely unproven, especially for milk. There is an urgent need for robust intervention studies to evaluate such milk-fat modifications using holistic markers of CVD risk including central arterial stiffness.

C114 Use and understanding of prepositions by children of 3–6 with cochlear implant

Language disorder is a cardinal challenge for children with Down syndrome, and their learning capacity has been debated. The aim of the current study was to conduct a systematic review and meta-analysis of existing language interventions for children with Down syndrome to reveal knowledge about the effects of these interventions and identify any common characteristics specific to effective or ineffective interventions. A systematic search was conducted in databases relevant for education, speech and language therapy, and psychology. Based on a set of predefined inclusion criteria, the hits were screened and coded. Eight studies were synthesised in a systematic review and four in a meta-analysis. The overall effect of the interventions was large (g = 1.01), but significant transfer effects to untrained aspects of language were rarely found. Interventions showing significant effects varied with regards to numerous characteristics including the age of the target group, the intervention approach, the dosage, and the implementer. The common characteristic across the effective interventions was simply the aim of improving language skills in children with Down syndrome. Overall, there was a moderate to high risk of bias across all studies. To conclude, children with Down syndrome have the potential to respond to language intervention. However, more interventions that reach transfer effects are needed to maximise children’s language outcomes. Based on the limited number of studies and a moderate to high risk of bias across the studies, there is a great need for more robust intervention studies to ensure that future interventions are informed by high-quality research.

Chronic Rhinosinusitis: Therapeutic Efficacy of Anti-Inflammatory and Antibiotic Approaches

Despite the high prevalence of chronic rhinosinusitis (CRS) worldwide, the exact pathogenesis of the disease remains unknown. Even with therapeutic intervention, treatment response is often only partial and frequently ineffective. The inability to define exact disease phenotypes in relation to specific disease mechanisms has led to a broad based approach with both anti-inflammatory and anti-microbial intervention. The clinical efficacy of such current therapeutic strategies is highlighted and the urgent need for further robust therapeutic intervention studies in CRS is discussed in this article.