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Journal of the American Medical... Jul 2024Home-based primary care (HBPC) provides interdisciplinary, longitudinal, comprehensive care at home to homebound older adults. The prevalence of dementia among HBPC... (Review)
Review
OBJECTIVES
Home-based primary care (HBPC) provides interdisciplinary, longitudinal, comprehensive care at home to homebound older adults. The prevalence of dementia among HBPC recipients is approximately 50%. To date, little research has been performed to determine whether dementia-specific interventions have been conducted in HBPC or their efficacy. We performed a scoping review to assess the landscape of dementia interventions in HBPC.
DESIGN
Systematic scoping review.
SETTING AND PARTICIPANTS
Care delivery programs for patients or caregivers of patients with dementia for the purpose of improving the management of dementia in the setting of HBPC.
METHODS
The PRISMA-ScR protocol was followed. Literature searches were performed using PubMed, Embase, and Scopus for articles on dementia-focused interventions implemented in HBPC. Articles were excluded if they consisted of abstracts only, were not in English, or were not dementia interventions in HBPC.
RESULTS
A total of 1657 unique titles and abstracts were screened. Overall, 1584 titles and abstracts were excluded, resulting in 73 full-text studies to assess for eligibility. Of these 73 full-text studies, 1 study met criteria for inclusion, an observational study assessing the implementation of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in Veterans Affairs HBPC. That study found the intervention to be effective in reducing caregiver burden, with a decrease of 2 hours on duty per day, trending toward significance. Among the excluded 72 full-text studies, some studies included potentially relevant interventions that could be translated into HBPC care, including dementia interventions that targeted long-term services and supports, office-based primary care and other nonhome settings such as nursing homes, and home-based palliative care.
CONCLUSIONS AND IMPLICATIONS
Despite high prevalence of dementia among homebound older adults receiving HBPC, there are a dearth of studies on HBPC-specific dementia interventions. Future studies should consider adapting and testing interventions found to be effective in other settings to HBPC.
Topics: Humans; Dementia; Home Care Services; Primary Health Care; Aged; Caregivers; Female; Male
PubMed: 38663452
DOI: 10.1016/j.jamda.2024.03.112 -
Frontiers in Public Health 2024This systematic review examines the impacts of suicide bereavement on men's psychosocial outcomes relating to suicidality, mental health, substance use, grief, and...
INTRODUCTION
This systematic review examines the impacts of suicide bereavement on men's psychosocial outcomes relating to suicidality, mental health, substance use, grief, and social functioning. Given the high global incidence of suicide and the substantial number of individuals affected by each suicide, understanding the specific experiences and outcomes for men is crucial, particularly in the context of observed gender differences in suicide rates, grief coping styles and mental health outcomes.
METHODS
Adhering to PRISMA guidelines, this review included peer-reviewed, English-language studies that involved men bereaved by suicide using quantitative, qualitative and mixed-methods designs. Searches were conducted in MEDLINE, Embase, Emcare, PsycINFO, and Scopus. Analysis used narrative synthesis methods due to the heterogeneity of findings. These were categorised based on comparison groups: non-bereaved men, or women bereaved by suicide. Prospero registration: CRD42023437034.
RESULTS
The review included 35 studies (25 quantitative, 8 qualitative, 2 mixed-methods) published between 1995 and 2023. Compared to non-bereaved men, suicide-bereaved men are more likely to experience adverse psychosocial outcomes included increased suicide mortality, heightened susceptibility to mental health problems such as depression and posttraumatic stress disorder, and challenges in interpersonal relationships and social functioning. The review also identified gender differences in grief responses and coping strategies, with men often exhibiting more pronounced grief reactions and facing unique challenges due to societal expectations and norms regarding masculinity.
DISCUSSION
The findings of this review underscore the elevated risk of adverse suicide- and mental-health related outcomes for suicide-bereaved men and the need for tailored postvention supports for this cohort. Gender-specific factors, including cultural norms and coping strategies, significantly influence men's experiences of suicide bereavement. Further qualitative and longitudinal quantitative exploration is needed to enhance understanding and effective support for men bereaved by suicide.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437034.
Topics: Humans; Male; Bereavement; Suicide; Adaptation, Psychological; Mental Health
PubMed: 38655522
DOI: 10.3389/fpubh.2024.1372974 -
Frontiers in Physiology 2024In recent years, an increasing trend has been observed in the consumption of specific polyphenols, such as flavonoids and phenolic acids, derived from green tea,...
In recent years, an increasing trend has been observed in the consumption of specific polyphenols, such as flavonoids and phenolic acids, derived from green tea, berries, and other similar sources. These compounds are believed to alleviate oxidative stress and inflammation resulting from exercise, potentially enhancing athletic performance. This systematic review critically examines the role of polyphenol supplementation in improving aerobic endurance among athletes and individuals with regular exercise habits. The review involved a thorough search of major literature databases, including PubMed, Web of Science, SCOPUS, SPORTDiscus, and Embase, covering re-search up to the year 2023. Out of 491 initially identified articles, 11 met the strict inclusion criteria for this review. These studies specifically focused on the incorporation of polyphenols or polyphenol-containing complexes in their experimental design, assessing their impact on aerobic endurance. The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the risk of bias was evaluated using the Cochrane bias risk assessment tool. While this review suggests that polyphenol supplementation might enhance certain aspects of aerobic endurance and promote fat oxidation, it is important to interpret these findings with caution, considering the limited number of studies available. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023453321.
PubMed: 38651044
DOI: 10.3389/fphys.2024.1369174 -
Pain Management Nursing : Official... Jun 2024The psychosocial aspects of chronic pain among youth with sickle cell are poorly described and may be better understood within a biopsychosocial model of chronic pain as...
OBJECTIVES
The psychosocial aspects of chronic pain among youth with sickle cell are poorly described and may be better understood within a biopsychosocial model of chronic pain as applied to youth living with sickle cell disease.
DESIGN
A systematic literature review was performed to synthesize the psychosocial factors contributing to chronic pain in this population. Criteria for study inclusion were primary quantitative research studies focused on psychosocial aspects of chronic pain among youth with sickle cell disease.
DATA SOURCES
PubMed, CINAHL, PsychINFO, and Scopus were searched for relevant articles.
REVIEW/ANALYSIS METHODS
Articles selected for full-text review were appraised for quality using the Joanna Briggs Institute Quality Appraisal Tools. Thirteen articles were included.
RESULTS
Depression, anxiety, pain catastrophizing, pain coping, executive functioning, and functional impairment were prevalent in youth living with sickle cell disease and chronic pain. Research gaps included the influence of stigma, injustice, peer interactions, and school and work on chronic pain.
CONCLUSIONS
The biopsychosocial model of chronic sickle cell disease-related pain for youth was developed and modified based on the results of this systematic review to remind clinicians of the various factors to consider in clinical practice and spur additional research in this field.
Topics: Adolescent; Child; Female; Humans; Male; Adaptation, Psychological; Anemia, Sickle Cell; Anxiety; Chronic Pain; Depression
PubMed: 38643039
DOI: 10.1016/j.pmn.2024.03.009 -
BMJ Open Apr 2024The mental health of veterinary and other animal health professionals is significantly impacted by the psychological stressors they encounter, such as euthanasia,...
OBJECTIVES
The mental health of veterinary and other animal health professionals is significantly impacted by the psychological stressors they encounter, such as euthanasia, witnessing animal suffering and moral distress. Moral distress, initially identified in nursing, arises when individuals are aware of the right action but are hindered by institutional constraints. We aimed to review existing research on moral distress scales among animal care workers by focusing on the identification and psychometric validity of its measurement.
DESIGN
Two-step systematic review. First, we identified all moral distress scales used in animal care research in the eligible original studies. Second, we evaluated their psychometric validity, emphasising content validity, which is a critical aspect of patient-reported outcome measures (PROMs). This evaluation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
DATA SOURCES
PubMed, EMBASE and PsycINFO to search for eligible studies published between January 1984 and April 2023.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included original (primary) studies that (1) were conducted in animal care workers; (2) describing either the development of a moral distress scale, or validation of a moral distress scale in its original or modified version, to assess at least one of the psychometric properties mentioned in COSMIN guidelines.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers used standardised methods to search, screen and code included studies. We considered the following information relevant for extraction: study reference, name and reference of the moral distress scale used, psychometric properties assessed and methods and results of their assessments. The collected information was then summarised in a narrative synthesis.
RESULTS
The review identified only one PROM specifically adapted for veterinary contexts: the Measure of Moral Distress for Animal Professionals (MMD-AP), derived from the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Both MMD-HP and MMD-AP were evaluated for the quality of development and content validity. The development quality of both measures was deemed doubtful. According to COSMIN, MMD-HP's content validity was rated as sufficient, whereas MMD-AP's was inconsistent. However, the evidence quality for both PROMs was rated low.
CONCLUSION
This is the first systematic review focused on moral distress measurement in animal care workers. It shows that moral distress is rarely measured using standardised and evidence-based methods and that such methods should be developed and validated in the context of animal care.
PROSPERO REGISTRATION NUMBER
CRD42023422259.
Topics: Humans; Animals; Health Personnel; Mental Health; Consensus; Stress, Psychological; Morals; Psychometrics; Reproducibility of Results; Patient Reported Outcome Measures
PubMed: 38643012
DOI: 10.1136/bmjopen-2023-082235 -
Preventive Medicine Jun 2024The impact of various exercise modalities on the improvement of sleep quality in adults remains controversial. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The impact of various exercise modalities on the improvement of sleep quality in adults remains controversial.
OBJECTIVE
This study aimed to perform a network meta-analysis to analyze the effects of different exercise interventions on sleep quality in adults.
METHODS
The PubMed, Cochrane, Embase, Web of Science, and EBSCO databases were searched for studies published from March 18, 1993, to March 18, 2023. The Cochrane risk of bias tool was used to assess the quality of the included studies. Then, a random-effects network meta-analysis was conducted within a frequentist framework.
RESULTS
A total of 2142 participants from 27 randomized controlled trials were included in the analysis. Exercise modalities such as Pilates, yoga, and traditional Chinese exercises were found to significantly improve sleep quality when compared to a no-exercise control group, with Pilates exhibiting the most potent effect at a 95.3% improvement level.
CONCLUSION
This study demonstrates that exercise interventions are effective in enhancing sleep quality in adults. Adapting exercise to individual preferences and needs may maximize the sleep-related benefits of the activity.
REGISTRATION
The review was registered with PROSPERO, registration number CRD42023434565.
Topics: Humans; Network Meta-Analysis; Sleep Quality; Exercise; Randomized Controlled Trials as Topic; Adult; Exercise Therapy; Yoga
PubMed: 38641082
DOI: 10.1016/j.ypmed.2024.107955 -
Guideline Recommendations on Behavioral and Psychological Symptoms of Dementia: A Systematic Review.Journal of the American Medical... May 2024To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia... (Review)
Review
OBJECTIVE
To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management.
METHODS
We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4.
RESULTS
Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations.
CONCLUSIONS AND IMPLICATIONS
There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.
Topics: Humans; Dementia; Practice Guidelines as Topic; Canada; Behavioral Symptoms; Aged; Female; Male
PubMed: 38640961
DOI: 10.1016/j.jamda.2024.03.007 -
Frontiers in Public Health 2024Although older adults are particularly vulnerable to the effects of climate change, they seem to be overall less concerned about it, and less inclined to support climate...
INTRODUCTION
Although older adults are particularly vulnerable to the effects of climate change, they seem to be overall less concerned about it, and less inclined to support climate policies. The study aims to identify the communication strategies that have been evaluated in promoting awareness and/or climate friendly behaviors in older adults.
METHODS
We searched multiple electronic databases for studies that evaluated the effects of any interventions aimed at communicating climate change to older persons (over 65 years) and assessed the results as awareness and /or behavioral changes. We selected quantitative, qualitative and mixed methods studies, and we also included systematic reviews for cross-referencing. Risk of bias of included studies was evaluated using different tools according to the study design.
RESULTS
From a total of 5,486 articles, only 3 studies were included. One mixed-method study engaged older adults to assess the community vulnerability to climate change and to develop adaptation recommendations based on their perspectives; one qualitative study conducted focus groups to identify the more effective language, values and themes based on participants' responses to narratives; one quantitative study utilized a 360-degree audio-visual platform allowing users to engage with immersive visualizations of sea-level rise scenarios.
DISCUSSION
Despite the paucity of literature, this review demonstrates the potential for different strategies to increase the awareness of older persons about climate change. The involvement of older adults in the communication process, the identification of their priorities, and the integration of technology in their daily lives are promising approaches but more research, including both quantitative and qualitative studies is recommended on this topic.
SYSTEMATIC REVIEW REGISTERATION
For further details about the protocol, this systematic review has been registered on PROSPERO on July 1, 2023 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023438256).
Topics: Aged; Aged, 80 and over; Humans; Climate Change; Communication; Focus Groups; Language; Qualitative Research
PubMed: 38638477
DOI: 10.3389/fpubh.2024.1347935 -
Health and Social Care Delivery Research Apr 2024Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered...
BACKGROUND
Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence.
OBJECTIVE(S)
To explore variations in the care home nursing and support workforce; how resident and relatives' needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents' needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers.
DESIGN
Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 - two evidence syntheses (one realist); WP2 - cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 - analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 - secondary analysis of care home regulator reports; WP5 - social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model.
SETTING
English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings.
PARTICIPANTS
Managers, residents, families and care home staff.
FINDINGS
Staffing's contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop 'familial' relationships between staff and residents, and staff-staff reciprocity, 'knowing' residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged.
LIMITATIONS
Many of our findings stem from self-reported and routine data with known biases - such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes.
CONCLUSIONS
Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible - rather than available - inputs and outcomes.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062.
FUNDING
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in ; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.
Topics: Humans; Aged; Nursing Homes; Cross-Sectional Studies; Quality of Life; Quality of Health Care; Outcome Assessment, Health Care
PubMed: 38634535
DOI: 10.3310/GWTT8143 -
MedRxiv : the Preprint Server For... Apr 2024Environmental health services (e.g., water, sanitation, hygiene, cleaning, waste management) in healthcare facilities are important to improve health outcomes and...
INTRODUCTION
Environmental health services (e.g., water, sanitation, hygiene, cleaning, waste management) in healthcare facilities are important to improve health outcomes and strengthen health systems, but coverage gaps remain. The World Health Organization and United Nations Children's Fund developed WASH FIT, a quality improvement tool, to help assess and improve environmental health services. Fifty-three countries have adopted it. However, there is little evidence of its effectiveness. This systematic review evaluates whether WASH FIT improves environmental health services or associated health outcomes and impacts.
METHODS
We conducted database searches to identify relevant studies and extracted data on study design, healthcare facility characteristics, and inputs, activities, outputs, outcomes, and impacts associated with WASH FIT. We summarized the findings using a logic model framework and narrative synthesis.
RESULTS
We included 31 studies in the review. Most inputs and activities were described qualitatively. Twenty-three studies reported quantitative outputs, primary WASH FIT indicator scores, and personnel trained on WASH FIT. Nine studies reported longitudinal data demonstrating changes in these outputs throughout WASH FIT implementation. Six studies reported quantitative outcomes measurements; the remainder described outcomes qualitatively or not at all. Common outcomes included allocated funding for environmental health services, community engagement, and government collaboration, changes in knowledge, attitudes, or practices among healthcare staff, patients, or community members, and policy changes. No studies directly measured impacts or evaluated WASH FIT against a rigorous control group.
CONCLUSIONS
Available evidence is insufficient to evaluate WASH FIT's effects on outputs, outcomes, and impacts. Further effort is needed to comprehensively identify the inputs and activities required to implement WASH FIT and to draw specific links between changes in outputs, outcomes, and impacts. Short-term opportunities exist to improve evidence by more comprehensive reporting of WASH FIT assessments and exploiting data on health impacts within health management information systems. In the long term, we recommend experimental studies. This evidence is important to ensure that funding invested for WASH FIT implementation is used cost-effectively and that opportunities to adapt and refine WASH FIT are fully realized as it continues to grow in use and influence.
PubMed: 38633794
DOI: 10.1101/2024.04.05.24305396