Findings from a pragmatic cluster randomised controlled feasibility trial of a music and dance programme for community dwelling older adults

INTRODUCTION

Functional decline, chronic illness, reduced quality of life and increased healthcare utilisation are common in older adults. Evidence suggests music and dance can support healthy ageing in older adults. This study explored the feasibility, potential for effect and cost effectiveness of the Music and Movement for Health (MMH) programme among community-dwelling older adults using a pragmatic cluster-randomised, controlled feasibility trial design.

METHODS

Community-dwelling adults aged 65 years or older were recruited to seven clusters in the Mid-West region of Ireland. Clusters were block randomised to either the MMH intervention or control. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, and safety. Secondary outcomes measured physical activity, physical and cognitive performance, and psychosocial well-being, along with healthcare utilisation were assessed at baseline and after 12 weeks.

RESULTS

The study successfully met feasibility targets, with recruitment (n = 100), retention (91 %), adherence (71 %), data completeness (92 %) and intervention fidelity (21 out of 24) all meeting predetermined criteria. Both groups exhibited an increase in self-reported physical activity and improved physical function. Participants in the intervention group scored consistently better in psychosocial measures compared to the control group at follow-up. The health economic analysis confirmed the feasibility of the methodology employed and points to the potential cost-effectiveness of the MMH relative to the control or no organised programme.

DISCUSSION AND IMPLICATIONS

The MMH intervention and study design were found to be feasible and acceptable with important findings to inform future evaluation of the clinical and cost-effectiveness of a definitive randomised controlled trial.

The relationship between the World Index for Sustainability and Health (WISH) score and mental health in women: A cross-sectional study

Diet quality has been associated with mental health, and recently, there has been growing interest in the association between sustainability of diets and human health. The objective of this cross-sectional study was to explore the relationship between a newly developed dietary index for health and sustainability, and psychological disorders among Iranian women. Participants in this cross-sectional study included 479 women living in Tehran with no history of chronic disease. A validated 168-item food frequency questionnaire was used to assess dietary intake. The World Index for Sustainability and Health (WISH) was calculated, consisting of four sub-scores: less healthy, healthy, low environmental impact, and high environmental impact. Participants psychological status was assessed using the Depression Anxiety Stress Scale-21. Logistic regression models were used to examine the association between WISH and psychological disorders. Participant ages ranged from 20-50 years, with a mean age of 31.86 (SD:7.68) years. After adjusting for potential confounders (age, energy, BMI, marital status, education, family history of chronic disease, body satisfaction, socio-economic status, physical activity, smoking), women in the highest tertile of the healthy sub-score had significantly lower odds of experiencing depression (OR: 0.40; 95% CI: 0.24-0.67), anxiety (OR: 0.45; 95% CI: 0.23-0.87) and psychological distress (OR: 0.46; 95% CI: 0.28-0.77) compared to the reference group. Similarly, the less healthy sub-score was significantly associated with depression (OR: 0.51; 95% CI: 0.32-0.89), anxiety (OR: 0.44; 95% CI: 0.25-0.78), and psychological distress (OR: 0.57; 95% CI: 0.36-0.90). An inverse association was observed between the low environmental impact sub-score and depression (OR: 0.32; 95% CI: 0.19-0.54), anxiety (OR: 0.38; 95% CI: 0.18-0.76), and psychological distress (OR: 0.30; 95% CI: 0.17-0.51). However, no further significant associations were found with the high environmental impact sub-score, except with depression (OR: 0.57; 95% CI: 0.33-0.96). The healthy and low environmental impact sub-scores of the WISH were found to be inversely associated with depression, anxiety, and psychological distress. However, due to the cross-sectional study design, causality cannot be inferred. Further prospective studies are required to validate and expand upon these findings and explore potential mechanisms and alternative explanations, such as reverse causation. While this study suggests that choosing a diet that is both healthy for individuals and sustainable for the environment may be associated with lower risk of mental health issues among women, more research is needed.

Plant and animal protein intake and its association with depression, anxiety, and stress among Iranian women

BACKGROUND

Mental disorders are conditions that affect the usual function of the brain, causing a huge burden on societies. The causes are often unclear, but previous research has pointed out, as is the case with many other diseases, that nutrition could have a major role in it. Amino acids, the building blocks of proteins, are the main precursor of neurotransmitters (the chemical messengers in the brain) malfunction of which is heavily associated with a wide range of brain disorders.

METHODS

We assumed different sources of dietary protein could have different impacts on mental well-being. Hence, we decided to collect the nutritional data (with a validated and reliable semi-quantitative food-frequency questionnaire) from a sample of 489 Iranian women and investigate the association between animal and plant protein sources and the risk of depression, anxiety, and stress. Symptoms of these mental disorders were assessed using a validated Depression, Anxiety, and Stress Scales (DASS) questionnaire with 21 items.

RESULTS

After multivariable adjustment, it was shown that women in the highest tertile of animal protein intake were more likely to show symptoms of depression (OR: 2.63; 95% CI: 1.45, 4.71; P = 0.001), anxiety (OR: 1.83; 95% CI: 1.04, 3.22; P = 0.03), and stress (OR: 3.66; 95% CI: 2.06, 6.50; p < 0.001). While no significant association was seen between plant protein and any of the studied mental disorders.

CONCLUSION

Overall, our findings suggest that a diet high in animal protein could predispose individuals to mental illnesses.

Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial

BACKGROUND

Optimising blood pressure (BP) control is one of the most important modifiable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. This study evaluated the feasibility and potential effectiveness of blood pressure self-monitoring with planned medication titration, to inform a definitive trial of the intervention, in patients with a previous stroke or transient ischaemic attack (TIA).

METHODS

Patients with a history of stroke/TIA and sub-optimal BP control were invited to take part in a mixed methods feasibility study for a randomised controlled trial. Those meeting the inclusion criteria with systolic BP >130 mmHg were randomised to a self-monitoring intervention group or usual care group. The intervention involved self-monitoring BP twice a day for 3 days within a 7-day period, every month, following text message reminders. Treatment escalation, based on a pre-agreed plan by the general practitioner (GP) and patient, was initiated according to the results of these readings. Semi-structured interviews were carried out with patients and clinicians and analysed thematically.

RESULTS

Of those identified, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study and there were no adverse events. Systolic BP was lower in the intervention group at 3 months. Participants found the intervention acceptable and easy to use. GPs found it easy to incorporate into their practice activity without increasing workload.

CONCLUSIONS

TASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke/TIA, is feasible and safe to deliver in primary care. A pre-agreed three-step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse effects. This feasibility study provides important information to inform a definitive trial to determine the potential effectiveness of the intervention in patients post-stroke or TIA.

TRIAL REGISTRATION

ISRCTN57946500 . Registered on 12/08/2019.

Towards an Integrated Blood Pressure Self-Monitoring SolutIoN for Stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial

BACKGROUND

Optimising Blood Pressure (BP) control is one of the most important modifiable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. The aim of this study was to evaluate the feasibility and effects of BP self-monitoring in patients with a previous stroke or TIA in Ireland.

METHODS

Patients with a history of stroke or TIA and sub-optimal BP control were identified from practice electronic medical records and invited to take part in the pilot study. Those with systolic BP >130 mmHg were randomised to a self-monitoring or usual care group. Self-monitoring involved monitoring BP twice a day for 3 days within a 7-day period every month, following text message reminders. Patients sent their BP readings by free-text to a digital platform. The monthly average BP was sent to the patient (traffic light system) and to the patient's GP after each monitoring period. Treatment escalation was subsequently agreed by the patient and GP.

RESULTS

Of those identified, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study with no adverse events. Systolic BP was lower in the intervention group at 12 weeks.

CONCLUSIONS

TASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke or TIA, is feasible and safe to deliver in primary care. A pre-agreed three step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse effects.

Preliminary findings from the early phases of the Music and Movement for Health study: the feasibility of an arts-based health programme for older adults

Introduction (including aim): There is a lack of community-based programmes for older adults in Ireland. Such activities are vital to enable older people to (re)connect after COVID-19 measures, which had a detrimental effect on physical function, mental health and socialisation. The aims of the preliminary phases of the Music and Movement for Health study were to refine stakeholder informed eligibility criteria, recruitment pathways and obtain preliminary measures for feasibility of the study design and programme, which incorporates research evidence, practice expertise and participant involvement.

METHODS

Two Transparent Expert Consultations (TECs) (EHSREC No: 2021_09_12_EHS), and Patient and Public Involvement (PPI) meetings were conducted to refine eligibility criteria and recruitment pathways. Participants from three geographical regions in the mid-west of Ireland will be recruited and randomised by cluster to participate in either a 12-week Music and Movement for Health programme or control. We will assess the feasibility and success of these recruitment strategies by reporting recruitment rates, retention rates and participation in the programme.

RESULTS

Both the TECs and PPIs provided stakeholder-informed specification on inclusion/ exclusion criteria and recruitment pathways. This feedback was vital in strengthening our community-based approach as well as effecting change at the local level. The success of these strategies from phase 1 (March-June) are pending.

DISCUSSION

Through engaging with relevant stakeholders, this research aims to strengthen community systems by embedding feasible, enjoyable, sustainable and cost-effective programmes for older adults to support community connection and enhance health and wellbeing. This will, in turn, reduce demands on the healthcare system.Note: We would like to thank and acknowledge those who participated in the PPIs for their time and invaluable feedback.

Self-monitoring for improving control of blood pressure in patients with hypertension: a Cochrane intervention review

BACKGROUND

Hypertension is a major risk factor for cardiovascular events with only a minority of people treated to satisfactory levels. There is an increasing body of literature pertaining to the beneficial effect of self-blood pressure monitoring (SBPM) on blood pressure control in hypertensive patients. It is cost-effective, well tolerated, and has been shown to be a better predictor of end organ damage than traditional office blood pressure monitoring (OBPM). The aim of this Cochrane review is to provide an up-to-date assessment on the effectiveness of self-monitoring in the management of hypertension.Is SBPM more efficacious in reducing blood pressure, compared with OBPM or usual care?Is SBPM with additional supports more efficacious in reducing blood pressure, compared with no additional support?Are there any adverse events associated with SBPM, compared with OBPM or usual care?

METHODS

All randomised controlled trials of adult patients with a diagnosis of primary hypertension where the intervention of interest is SBPM will be included. Data extraction, analysis and risk of bias assessment will be carried out by two independent authors. Analysis will be based on intention-to-treat (ITT) data from individual trials.

RESULTS

Primary outcome measures include change in mean office systolic and/or diastolic BP, change in mean ambulatory blood pressure, the proportion of patients reaching target BP, and adverse events including mortality or cardiovascular morbidity or related to treatment with antihypertensive agents.

DISCUSSION

This review will help to determine if self-monitoring of blood pressure, with or without co-interventions, is effective in lowering blood pressure. Results will be available for conference.

Parent and child perceptions of physical activity with type 1 diabetes

INTRODUCTION

Type 1 diabetes (T1D) is a lifelong illness that affects over 2500 children in Ireland. Management involves complex daily regimens including frequent blood glucose monitoring, pharmacotherapy, dietary management, and physical activity (PA). PA is an important modifiable lifestyle factor. Unfortunately, children with T1D remain physically inactive. Children with T1D face disease-specific barriers and facilitators to PA engagement. All aspects of T1D management for children are supported or supervised by parents. Thus, the purpose of this study was to examine parents' and children's perceptions of barriers and facilitators to PA engagement.

RESEARCH DESIGN AND METHODS

43 parent and child dyads participated. Parents completed a self-report survey. Children completed a modified version of the Physical Activity Questionnaire for Children (PAQ-C) that explored habitual PA patterns, perceived facilitators and barriers to PA engagement.

RESULTS

21 females, 22 males and their parents (36 mothers, 7 fathers) participated. 69% of males and 90% of females reported that having diabetes did affect their PA participation. 54% of males and 48% of females were insufficiently active based on their total PAQ-C score (<2.9 and <2.7). 53% of parents reported that their children participated in school physical education. 21% of parents reported that their child did not participate in PA outside of the school setting. 23% of parents reported that they did not feel comfortable with their child participating in strenuous PA. A further 30% of parents reported that they only felt comfortable with their child participating in strenuous PA if supervised. 66% of parents reported their child should be more physically active. 83% of parents reported that having T1D did impact their child's PA level.

CONCLUSIONS

This study demonstrates the potential influence of parents' perceptions on PA engagement in children with T1D. Additional education is needed to support the promotion of PA for children with T1D.

309 A FRAILTY CENSUS OF INPATIENTS AGED 65 AND OVER ADMITTED TO A MODEL 4 HOSPITAL

Background

Frailty is a risk factor for in-hospital mortality, long hospital stay and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty.

Methods

All patients aged ≥65 years and admitted to a medical or surgical inpatient setting, were screened over a 12-hour period (08:00-20:00) using validated frailty and co-morbidity scales. Age and Gender Demographics, Clinical Frailty Scale (CFS), Charlson Co-morbidity Index (CHI) and admitting specialty (Medical/Surgical) were collected. The data was fully anonymised and ethical approval was granted. Descriptive statistics were used to profile the cohort and Chi-squared tests applied for comparisons.

Results

Within a sample of 413 patients, 291(70%) were ≥65yrs. Of this cohort, 202(70%) were ≥75yrs. 207(71%) utilised in-patient medical services and 121(41%) surgical services while 37(12%) used both. The mean CFS was 6 indicating moderate frailty levels and the mean CCI score was 4 denoting moderate co-morbidity. Overall: 195(67%) had moderate-severe frailty (CSF ≥6) while 218 (75%) had moderate-severe co-morbidity (CCI Mod 3-4, Severe ≥5). Associations with age &gt;75 and frailty (p=0.001) and medical service usage and frailty (p=0.004) were established. No significant differences were observed across genders for CFS (p=0.110) and CCI (p=0.465).

Conclusion

There is a high prevalence of frailty and co-morbidity within the admitted patient cohort ≥65yrs. Overcrowding across the hospital system and higher levels of frailty and comorbidity will contribute to increased lengths of stay and the need for specialist intervention, particularly for those ≥75yrs who represented 70% of patients screened. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services and staff training in frailty care across the hospital and community setting.

Comprehensive geriatric assessment in the emergency department: A protocol for a prospective cohort study

Background: Comprehensive geriatric assessment (CGA) has been shown to improve outcomes in hospitalised older adults; however, there is currently no compelling evidence to support CGA interventions within the Emergency Department (ED). The aim of this study is  to explore the clinical and process outcomes of older adults who receive ED-CGA over a period of six months after their initial ED attendance.

Design: Prospective cohort study.

Methods: The STrengthening the Reporting of the OBservational studies in Epidemiology (STROBE) standardised reporting guidelines will be adhered to. Older adults aged ≥65 years who score ≥2 on the Identification of Seniors at Risk (ISAR) tool and present to the ED with a medical complaint during the operational hours of the dedicated interdisciplinary team, will be considered eligible for recruitment. Demographic and health assessment information will be obtained at the ED index attendance followed by completion of an interdisciplinary CGA. A dedicated research nurse will complete follow-up telephone interviews with participants at 30 days and six months. The primary outcome will be incidence of hospital admission from the ED index attendance. Secondary outcomes will include functional decline, patient satisfaction with the ED index attendance, unscheduled ED reattendance(s), unscheduled hospital (re)admission(s), nursing home admission(s), healthcare utilisation, and death. Descriptive statistics will be used to profile the characteristics of the study participants and multivariate logistic and linear regression analysis will be used to analyse risk of adverse outcomes.

Ethics and dissemination: Ethical approval was granted by the University of Limerick Hospital Group Research Ethics Committee (107/2021). The authors will disseminate study findings through publication in a peer-reviewed journal and presentation at national and international conferences. Patient and public involvement will be sought from a panel of older adults at the Ageing Research Centre in the University of Limerick.

Clinicaltrials.gov Identifier: NCT05252182.

Comprehensive geriatric assessment in the emergency department: A protocol for a prospective cohort study

Background: Comprehensive geriatric assessment (CGA) has been shown to improve outcomes in hospitalised older adults; however, there is currently no compelling evidence to support CGA interventions within the Emergency Department (ED). The aim of this study is  to explore the clinical and process outcomes of older adults who receive ED-CGA over a period of six months after their initial ED attendance. Design: Prospective cohort study. Methods: The STrengthening the Reporting of the OBservational studies in Epidemiology (STROBE) standardised reporting guidelines will be adhered to. Older adults aged ≥65 years who score ≥2 on the Identification of Seniors at Risk (ISAR) tool and present to the ED with a medical complaint during the operational hours of the dedicated interdisciplinary team, will be considered eligible for recruitment. Demographic and health assessment information will be obtained at the ED index attendance followed by completion of an interdisciplinary CGA. A dedicated research nurse will complete follow-up telephone interviews with participants at 30 days and six months. The primary outcome will be incidence of hospital admission from the ED index attendance. Secondary outcomes will include functional decline, patient satisfaction with the ED index attendance, unscheduled ED reattendance(s), unscheduled hospital (re)admission(s), nursing home admission(s), healthcare utilisation, and death. Descriptive statistics will be used to profile the characteristics of the study participants and multivariate logistic and linear regression analysis will be used to analyse risk of adverse outcomes. Ethics and dissemination: Ethical approval was granted by the University of Limerick Hospital Group Research Ethics Committee (107/2021). The authors will disseminate study findings through publication in a peer-reviewed journal and presentation at national and international conferences. Patient and public involvement will be sought from a panel of older adults at the Ageing Research Centre in the University of Limerick. Clinicaltrials.gov Identifier: NCT05252182.

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).

Physical Activity and Sedentary Behavior in Adults With Cystic Fibrosis: Association With Aerobic Capacity, Lung Function, Sleep, Well-Being, and Quality of Life

BACKGROUND

Physical activity (PA) and sedentary behavior (SB) have marked impact on key prognostic indicators such as aerobic capacity and lung function in people with cystic fibrosis (CF) and may have associations with sleep, well-being, and health-related quality of life (HRQOL).

METHODS

This observational study assessed PA, SB, aerobic capacity, spirometry, sleep, well-being, and HRQOL in adults with CF at University Hospital Limerick. PA and SB were assessed using an accelerometer that was worn for 7 days. A cardiopulmonary exercise test assessed aerobic capacity. Spirometry was performed according to American Thoracic Society guidelines. Well-being was measured by the AWESCORE, sleep quality by the Pittsburgh Sleep Quality Index (PSQI), and HRQOL using the CF Questionnaire-Revised.

RESULTS

Thirty-three participants (13 males/20 females) were recruited. Mean age was 26.2 y (± 7.1 SD), with mean FEV₁ 72.9% of predicted (± 26.2 SD). Mean step count was 7,788 (± 3,583 SD). Over 75% of participants did not reach recommended PA targets (> 10,000 steps), with females being 25.5% less active than males. The PSQI indicated 48.5% of participants scored > 5, indicating poor sleep quality. Number of steps and SB demonstrated a moderate significant correlation with FEV₁ (r = 0.45, P = .030; r = -0.37, P = .043, respectively) and sleep quality (r = -0.85, P < .001; r = 0.77, P < .001, respectively). [Formula: see text] peak expressed relative to body weight, and as a percentage of predicted, was significantly positively correlated with step count (r = 0.48, P = .007; r = 0.42, P = .02, respectively) but did not correlate with SB (P = .96). [Formula: see text] peak (L/min) strongly correlated with FEV₁ (r = 0.75, P < .001).

CONCLUSIONS

Most participants did not meet PA targets. PA levels correlated to aerobic capacity, FEV₁, and self-reported sleep quality, and this should be considered in longitudinal studies and in PA interventions.

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).

Accuracy of the ActivPAL and Fitbit Charge 2 in measuring step count in Cystic Fibrosis

BACKGROUND

Physical activity (PA) is important in Cystic Fibrosis (CF) management. Fitness wearables are becoming increasingly popular as measurement tools of PA; however, the accuracy of these devices should first be evaluated.

OBJECTIVE

The purpose of this study was to assess the accuracy of the ActivPAL and Fitbit Charge 2 as a measure of step count in Cystic Fibrosis.

METHODS

Twenty-one participants were recruited from an adult CF Center in Ireland for a single session of testing. Participants walked for 5 min at five pre-determined speeds in a controlled testing environment (2, 2.5, 3, 3.5 and 4 miles per hour on a treadmill) and at three self-selected speeds in a corridor (slow, medium, and fast). They concurrently wore an accelerometer (ActivPAL) and fitness wearable (Fitbit Charge 2), and both were compared to visual observations. Step count is the outcome being assessed.

RESULTS

The ActivPAL under-estimated step count by 0.63% across treadmill speeds and 1.1% across self-selected walking speeds. The Fitbit Charge 2 underestimated the step count by 2.97% across treadmill speeds and by 6.3% across self-selected walking speeds. Very strong correlations were found between the ActivPAL and visual observations (r: 0.93 to 0.99), while the Fitbit Charge 2 ranged from weak to very strong correlations when compared to visual observations (r: 0.34 to 0.84).

CONCLUSION

The ActivPAL and Fitbit Charge 2 demonstrated acceptable validity for step count measurement in CF. These devices can be used for tracking PA during interventions in people with CF.

Associations between Dietary Acid Load and Migraine Headache Severity and Duration among Women: A Cross-Sectional Study

Background: Migraine is considered the most common cause of long-term disability in under-50s, which can lead to unbearable pain and neurological dysfunction. Many factors, especially dietary factors, are suggested to trigger migraine headaches. The present study aimed to examine the association between diet-dependent acid load and severity and duration of headaches among migraine patients. Methods: In this cross-sectional study, a sample of 266 women (18-45 years) with history of migraine headaches was enrolled. Dietary data was collected by using a validated Food Frequency Questionnaire (FFQ). Then, diet-dependent acid load indices including Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) were calculated for the participants. For all cases, anthropometric measurements and headache duration were assessed. Headache severity was determined by Visual Analog Scale (VAS) and Migraine Disability Assessment (MIDAS) questionnaires. Results: In this study, individuals with higher PRAL (OR=1.87, 95% CI=1.19-2.96, p=0.007) and NEAP (OR=1.58, 95% CI=1.02-2.44, p=0.03) scores were 87 and 58%, respectively, more likely to have severe headaches. Moreover, our results showed a significant direct correlation between PRAL (β=0.14, 95% CI=0.56-2.94, p=0.04) and NEAP (β=0.18, 95% CI=0.45-3.34, p=0.01) scores and headache duration of participants. Conclusion: The present study showed that higher diet-dependent acid load scores may be associated with higher headache severity and duration in migraine patients.

From nowhere to nowhere. Homelessness and incarceration: a systematic review and meta-analysis

PURPOSE

This study aims to review international literature systematically to estimate the prevalence of homelessness among incarcerated persons at the time of imprisonment and the time of discharge.

DESIGN/METHODOLOGY/APPROACH

A systematic review methodology was used to identify quantitative observational studies that looked at the prevalence of homelessness at the time of imprisonment, or up to 30 days prior to that point (initial homelessness), and at the time of discharge from prisons. Studies reported in English from inception to 11 September 2019 were searched for using eight databases (PsycInfo, Medline, Embase, CINAHL, PsycArticles, Scopus, Web of Science and the Campbell Collaboration), in addition to grey literature. Studies were screened independently by three researchers. Results of studies meeting inclusion criteria were meta-analysed using a random effects model to generate pooled prevalence data.

FINDINGS

A total of 18 out of 2,131 studies met the inclusion criteria. All studies originated from the USA, Canada, UK, Ireland or Australia. The estimated prevalence of initial homelessness was 23.41% and at time of discharge was 29.94%. Substantial heterogeneity was observed among studies.

ORIGINALITY/VALUE

People in prisons are over twenty times more likely to be homeless than those in the general population. This is likely attributable to a range of health and social factors. Studies in this analysis suggest higher rates of homelessness in minority populations and among those with mental illnesses and neurodevelopmental disorders. While there was significant heterogeneity among studies, the results highlight the global burden of this issue and a clear necessity for targeted interventions to address homelessness in this population.

The Effects of Supplementation with Probiotic on Biomarkers of Oxidative Stress in Adult Subjects: a Systematic Review and Meta-analysis of Randomized Trials

Previous studies have supposed that probiotic supplementation led to a positive effect on different health outcomes. Furthermore, several studies indicated that probiotics supplementation improved antioxidant status, while some studies did not indicate these effects. Hence, current systematic review and meta-analysis study was conducted to determine the effect of probiotic supplementation on some oxidative stress biomarkers among adult subjects. We searched four electronic databases PubMed, SCOPUS, ISI Web of Science, and the Cochrane Library till November 2017. Clinical trials that compared the effects of probiotic supplementation with the control group were included. A random-effect model was used to pool weighted mean difference (WMD). Finding of 11 included studies (n = 577) indicated that probiotic supplementation increased total antioxidant capacity (TAC) (WMD 77.30 mmol/L; 95% confidence interval [CI] 2.60, 152.01; I² = 88.3%) and reduced malondialdehyde (MDA) (WMD - 0.31 μmol/L; 95% CI - 0.54, - 0.08; I² = 71.5%) significantly compared to the control group. However, its effects on glutathione (GSH) was not significant (WMD = 19.32 μmol/L; 95% CI - 18.70, 57.33; I² = 64.9%). The current meta-analysis revealed that probiotic supplementation may result in increasing TAC and lowering MDA, which improve antioxidant status. However, due to high heterogeneity, findings should be interpreted with caution. Further investigations are required to elucidate the effect of supplementation with probiotics on biomarkers of antioxidants.

The stability of 'add-on' coagulation assays in refrigerated citrated plasma stored on a packed cellular fraction

INTRODUCTION

Haematology laboratories are increasingly faced with requests for add-on coagulation testing. This study explores extending the specimen storage proposals by examining coagulation parameters on refrigerated citrated plasma retained on a cellular fraction over a 24-hour period.

METHODS

Sodium citrate (Sarstedt^® S-Monovette 3.2%) specimens from 206 patients in University Hospital Limerick, Ireland were refrigerated immediately post-analysis and re-analysed in the centrifuged primary container at 4, 8 and 24-hour intervals using the Diagnostica Stago coagulometer and reagent combination. Coagulation assays examined for statistically and clinically significant differences included PT, APTT, D-Dimer, fibrinogen and Protein C.

RESULTS

PT, APTT and Protein C values displayed statistical significance from 4 hours. Fibrinogen differences were statistically significant from 8 hours. D-Dimer differences were not statistically significant at any interval over the 24-hour period. The refrigerated storage limit for PT and APTT results was determined to be 4 hours. D-Dimer was the only test parameter to report a mean percentage variance >10%. However, result changes at the threshold region of 0.5 µg/mL FEU were found to be within assay precision limits and desirable bias up to 8 hours. Maximum mean differences for Protein C (-1.3%) and fibrinogen (2.3%) were within assay precision limits and desirable biases up to 24 hours.

CONCLUSION

PT and APTT results are stable in refrigerated citrated plasma maintained on a cellular fraction up to 4 hours post-phlebotomy. D-Dimers results are reliable up to 8 hours, while fibrinogen and Protein C results are stable for at least 24 hours.

Association of Plant-Based Dietary Patterns with Migraine Headache Severity and Duration among Women

Background: Migraine is a recurrent disorder which can cause socio-economic and public health burdens. Many factors, especially dietary factors are suggested to induce migraine headaches. The aim of this study was to examine the association between plant-based dietary patterns and headache severity and duration among migraine patients. Methods: A sample of two hundred and sixty-six women with migraine (18-50 years) took part in the present cross-sectional study. Dietary intake data was collected using a validated and reliable food-frequency questionnaire. Three dietary indices were evaluated including an overall plant-based diet (PDI), healthful Plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). Anthropometric measurements, headache duration, Migraine Disability Assessment (MIDAS), and Visual Analog Scale (VAS) were assessed for all cases. Multinomial logistic regression and linear regression models were used to show the association between headaches and plant-based dietary patterns. Results: An inverse association between higher adherence to hPDI and severity of headaches was found based on VAS (OR=0.40; 95% CI: 0.21, 0.74; p=0.003), and severe disability based on MIDAS (OR=0.50; 95% CI: 0.26, 0.95; p=0.03). Conversely, uPDI scores were positively associated with severe headaches (OR=3.00; 95% CI: 1.72, 5.23; p<0.001), and disability (OR=2.50; 95% CI: 1.39, 4.51; p=0.001). Moreover, headaches duration showed an inverse significant association with hPDI scores (β=-0.21, 95% CI=-4.69, -1.08, p=0.002). Conclusion: Plant-based diet, particularly healthful plant foods, was inversely associated with lower severity, disability and duration of headaches. In addition, unhealthy plant foods were associated with higher risk of migraine headaches.

Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology, goal setting and text message feedback

Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology,  smartphone use and remote monitoring, all of which may have potential to impact on PA in adults  with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep.

Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention.

Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA  in adults with CF. 

Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)

Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology

Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology,  smartphone use and remote monitoring, all of which may have potential to impact on PA in adults  with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA  in adults with CF.  Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)

The association of red meat consumption and mental health in women: A cross-sectional study

OBJECTIVES

Previous studies have shown that red meat consumption has beneficial effects on health. The purpose of this study was to determine the relationship between red meat consumption and depression, anxiety and psychological distress in Tehrani women.

METHODS

In this cross-sectional study, 482 women aged 20-50 years old referred to the health centers of Tehran University of Medical Sciences in 2018 were selected by multistage cluster sampling. The usual dietary intake was evaluated using a semi-quantitative food frequency questionnaire containing 168 items that its validity and reliability were approved previously. The red meat category was defined as the sum of red meats (beef, lamb), and organ meats (beef liver, kidney, and heart, ruminant meat). Psychological disorders were assessed using a validated Depression, Anxiety, Stress Scales (DASS) questionnaires with 21-items. In the logistic regression analysis, the results were adjusted to the confounding factors.

RESULTS

The mean age of the study participants was 31.87 ± 7.6 years. The prevalence of depressive symptoms, anxiety and psychological distress among participants was 34%, 40% and 42%, respectively. After controlling for potential confounders, women in the highest quartile of red meat had a highest prevalence of depressive symptoms (OR: 2.51; 95% CI: 1.32-4.76; p = 0.002), anxiety (OR: 1.82; 95% CI: 1.00-3.29; p = 0.034) and stress (OR: 3.47; 95% CI: 1.88-6.42; p < 0.001) compared with those in the lowest quartile.

CONCLUSIONS

We found a significant association between red meat intake and mental health in women. Prospective studies are needed to confirm these findings.

Direct-write 3D printing and characterization of a GelMA-based biomaterial for intracorporeal tissue

We develop and characterize a biomaterial formulation and robotic methods tailored for intracorporeal tissue engineering (TE) via direct-write (DW) 3D printing. Intracorporeal TE is defined as the biofabrication of 3D TE scaffolds inside of a living patient, in a minimally invasive manner. A biomaterial for intracorporeal TE requires to be 3D printable and crosslinkable via mechanisms that are safe to native tissues and feasible at physiological temperature (37 °C). The cell-laden biomaterial (bioink) preparation and bioprinting methods must support cell viability. Additionally, the biomaterial and bioprinting method must enable the spatially accurate intracorporeal 3D delivery of the biomaterial, and the biomaterial must adhere to or integrate into the native tissue. Current biomaterial formulations do not meet all the presumed intracorporeal DW TE requirements. We demonstrate that a specific formulation of gelatin methacryloyl (GelMA)/Laponite^®/methylcellulose (GLM) biomaterial system can be 3D printed at physiological temperature and crosslinked using visible light to construct 3D TE scaffolds with clinically relevant dimensions and consistent structures. Cell viability of 71%-77% and consistent mechanical properties over 21 d are reported. Rheological modifiers, Laponite^® and methylcellulose, extend the degradation time of the scaffolds. The DW modality enables the piercing of the soft tissue and over-extrusion of the biomaterial into the tissue, creating a novel interlocking mechanism with soft, hydrated native tissue mimics and animal muscle with a 3.5-4 fold increase in the biomaterial/tissue adhesion strength compared to printing on top of the tissue. The developed GLM biomaterial and robotic interlocking mechanism pave the way towards intracorporeal TE.

Associations between adherence to MIND diet and severity, duration and frequency of migraine headaches among migraine patients

OBJECTIVES

Migraine is a neurological disorder causing unbearable pain. Dietary approach is proposed as a preventive way of reducing the severity of migraine headaches. The present study aimed to examine the association between MIND diet and migraine headaches.

RESULTS

We found that participants with higher score of MIND diet compared to those with lower score, were less likely to have severe headaches (OR = 0.64; 95% CI 0.45, 0.91; P = 0.01). Moreover, our results showed an inversed correlation between mind diet score and duration (β = - 0.14, 95% CI - 1.42, - 0.14, P = 0.04) and frequency of headaches (β = - 0.13, 95% CI - 0.99, - 0.07, P = 0.03).

Steps Ahead: optimising physical activity and health in people with cystic fibrosis: Study Protocol for a pilot randomised trial

Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; fitness tracking, smartphone use and remote monitoring, all of which may have potential to impact on positive health outcomes in people with CF. The objective of this pilot randomised trial is to explore the potential efficacy of a fitness tracker, which is remotely monitored, combined with personalised text message feedback and goal setting, on lung function, aerobic capacity and PA in adults with CF. Secondary endpoints include quality of life, body composition and wellbeing. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of a fitness tracker (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) for data collection purposes that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set short- and long-term goals with participants and will send one-way text message feedback on Fitbit data and weekly progress. This message will consist of positive reinforcement and re-assess participant goals. The active comparator group will receive a fitness tracker which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on health outcomes in people with CF.  Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)

Effect of Bariatric Surgery on the Circulating Level of Adiponectin, Chemerin, Plasminogen Activator Inhibitor-1, Leptin, Resistin, and Visfatin: A Systematic Review and Meta-Analysis

Different adipokines secreted from adipose tissue, exert a range of physiological effects. The aim of present systematic review and meta-analysis was to critically investigate the consequence of bariatric surgery on circulating adipokines, that is, adiponectin, leptin, visfatin, resistin, plasminogen activator inhibitor, and chemerin. After systematically checking the following electronic databases: ISI web of Science, Scopus and PubMed without limitation in time and language up to February 2019, a pool based on a random effect model was established. Eighty-five eligible studies were entered for quantitative analysis. Our meta-analysis revealed that circulating adiponectin increased significantly after bariatric surgery [Standardized mean difference (SMD)=1.401, 95% CI: 1.101, 1.701, p<0.001]; whilst leptin (SMD=-2.178, 95% CI: -2.433, -1.923, p<0.001), PAI-1 (-14.928 ng/ml 95% CI: -21.794, -8.063, p<0.001), and chemerin (-50.238 ng/ml 95% CI: -85.708, -14.768, p<0.001) decreased. However, serum visfatin (2.05 ng/ml, 95% CI: -5.07, 9.17, p=0.573) and resistin (-2.080 ng/ml, 95% CI: -5.352, 1.192, p=0.21) were unchanged. In conclusion, bariatric surgery is associated with a reduction in specific adipokines including leptin, chemerin, and PAI-1, whereas adiponectin is raised, adaptations that could be indicative of improved fat mass and function.

Efficacy of l-carnitine supplementation for management of blood lipids: A systematic review and dose-response meta-analysis of randomized controlled trials

BACKGROUND AND AIM

l-carnitine has an important role in fatty acid metabolism and could therefore act as an adjuvant agent in the improvement of dyslipidemia. The purpose of present systematic review and meta-analysis was to critically assess the efficacy of l-carnitine supplementation on lipid profiles.

METHODS AND RESULTS

We performed a systematic search of all available randomized controlled trials (RCTs) in the following databases: Scopus, PubMed, ISI Web of Science, The Cochrane Library. Mean difference (MD) of any effect was calculated using a random-effects model. In total, there were 55 eligible RCTs included with 58 arms, and meta-analysis revealed that l-carnitine supplementation significantly reduced total cholesterol (TC) (56 arms-MD: -8.53 mg/dl, 95% CI: -13.46, -3.6, I²: 93%), low-density lipoprotein-cholesterol (LDL-C) (47 arms-MD: -5.48 mg/dl, 95% CI: -8.49, -2.47, I²: 94.5) and triglyceride (TG) (56 arms-MD: -9.44 mg/dl, 95% CI: -16.02, -2.87, I²: 91.8). It also increased high density lipoprotein-cholesterol (HDL-C) (51 arms-MD:1.64 mg/dl, 95% CI:0.54, 2.75, I²: 92.2). l-carnitine supplementation reduced TC in non-linear fashion based on dosage (r = 21.11). Meta-regression analysis indicated a linear relationship between dose of l-carnitine and absolute change in TC (p = 0.029) and LDL-C (p = 0.013). Subgroup analyses showed that l-carnitine supplementation did not change TC, LDL-C and TG in patients under hemodialysis treatment. Intravenous l-carnitine and lower doses (>2 g/day) had no effect on TC, LDL-C and triglycerides.

CONCLUSION

l-carnitine supplementation at doses above 2 g/d has favorable effects on patients' lipid profiles, but is modulated on participant health and route of administration.

The effects of supplementation with L-carnitine on apolipoproteins: A systematic review and meta-analysis of randomized trials

Randomized controlled trials (RCTs) have reported that L-carnitin may change serum apolipoproteins. However, the results of RCTs are contradictory. Our objective was to conduct a systematic review and meta-analysis to summarize earlier RCTs on the effects of L-carnitine supplementation on apolipoproteins B100 and AI. ISI web of science, Ovid, PubMed/Medline, Scopus, and Google Scholar were searched from inception to January 2019 using relevant keywords. Treatment effects were considered as weighted mean difference (MD) and the corresponding 95% confidence interval in concentrations of serum apolipoproteins. Random-effects model (Dersimonian-Liard) was used to estimate the overall summary effect. This meta-analysis was performed on fourteen trials. Our results indicated that L-carnitine supplementation has a non-significant effect on Apo B100 (mean difference (MD): 1.820 mg/dl; 95% CI: -3.367 to 7.006, p = 0.492) and Apo AI (MD: -0.119 mg/dl; 95% CI: -4.425 to 4.186, p = 0.957). We also found body mass index, L-carnitine dosage; health condition and intervention duration could change the results. We conclude that L-carnitine does not change Apo B100 and Apo AI concentration. Further trials with sufficient sample size are needed to confirm these findings.

Burnout in the emergency department: Randomized controlled trial of an attention-based training program

BACKGROUND

Burnout (encompassing emotional exhaustion, depersonalization and personal accomplishment) in healthcare professionals is a major issue worldwide. Emergency medicine physicians are particularly affected, potentially impacting on quality of care and attrition from the specialty.

OBJECTIVE

The aim of this study was to apply an attention-based training (ABT) program to reduce burnout among emergency multidisciplinary team (MDT) members from a large urban hospital.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

Emergency MDT members were randomized to either a no-treatment control or an intervention group. Intervention group participants engaged in a four session (4 h/session) ABT program over 7 weeks with a practice target of 20 min twice-daily. Practice adherence was measured using a smart phone application together with a wearable Charge 2 device.

MAIN OUTCOME MEASURES

The primary outcome was a change in burnout, comprising emotional exhaustion, depersonalization and personal achievement. The secondary outcomes were changes in other psychological and biometric parameters.

RESULTS

The ABT program resulted in a significant reduction (P < 0.05; T1 [one week before intervention] vs T3 [follow-up at two months after intervention]) in burnout, specifically, emotional exhaustion, with an effect size (probability of superiority) of 59%. Similar reductions were observed for stress (P < 0.05) and anxiety (P < 0.05). Furthermore, ABT group participants demonstrated significant improvements in heart rate variability, resting heart rate, sleep as well as an increase in pro-inflammatory cytokine expression.

CONCLUSION

This study describes a positive impact of ABT on emergency department staff burnout compared to a no-treatment control group.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02887300.

The effects of psyllium supplementation on body weight, body mass index and waist circumference in adults: A systematic review and dose-response meta-analysis of randomized controlled trials

Background: Previous studies reported inconsistent findings regarding the effects of psyllium supplementation on obesity measures. This systematic review and meta-analysis was performed to summarize data from available randomized clinical trials (RCTs) on the effect of psyllium supplementation on body weight, body mass index (BMI), and waist circumference (WC) in adults.Methods: PubMed, SCOPUS, Cochrane Library, and Google Scholar were searched to identify relevant articles up to August 2018. The effect sizes were presented as weighted mean difference (WMD) and 95% confidence intervals (CI) by using random effects model. To detect dose-response relationships, we used fractional polynomial modeling.Results: A total of 22 RCTs were included. Meta-analysis did not find any significant effect of psyllium supplementation on body weight (MD: -0.28 kg, 95% CI: -0.78, 0.21, p = 0.268), BMI (MD: -0.19 kg/m², 95% CI: -0.55, 0.15, p = 0.27) and WC (MD: -1.2 cm, 95% CI: -2.6, 0.2, p = 0.09). Subgroup analysis showed that psyllium dosage, kind of psyllium administration, duration of trial, study design, sample size, and gender were potential sources of heterogeneity. Moreover, there was nonlinear association between duration of psyllium consumption, BMI and WC.Conclusion: Psyllium supplementation does not reduce body weight, BMI, and WC significantly.

Resveratrol supplementation significantly influences obesity measures: a systematic review and dose-response meta-analysis of randomized controlled trials

This study aimed to summarize earlier randomized controlled trials on the effects of resveratrol supplementation on body weight (BW), body mass index (BMI), waist circumference (WC) and fat mass (FM). We searched PubMed, SCOPUS, Cochrane Library and Google Scholar from inception to April 2018 using relevant keywords. All clinical trials investigating the effects of resveratrol supplementation on BW, BMI, WC and FM in adults were included. Overall, 28 trials were included. Pooled effect sizes suggested a significant effect of resveratrol administration on weight (weighted mean differences [WMD]: -0.51 kg, 95% confidence interval [CI]: -0.94 to -0.09; I²  = 50.3%, P = 0.02), BMI (WMD: -0.17 kg m^-2 , 95% CI: -0.32, -0.03; I²  = 49.6%, P = 0.02) and WC (WMD: -0.79 cm, 95% CI: -1.39, -0.2; I²  = 13.4%, P = 0.009), respectively. However, no significant effect of resveratrol supplementation on FM was found (WMD: -0.36%, 95% CI: -0.88, 0.15; I²  = 0.0%, P = 0.16). Findings from subgroup analysis revealed a significant reduction in BW and BMI in trials using resveratrol at the dosage of <500 mg d^-1 , those with long-term interventions (≥3 month), and performed on people with obesity. Taken together, the data suggest that resveratrol supplementation has beneficial effects to reduce BW, BMI and WC, but not FM.

Cinnamon supplementation positively affects obesity: A systematic review and dose-response meta-analysis of randomized controlled trials

BACKGROUND & AIMS

Data about the effects of cinnamon supplementation on obesity measures are conflicting. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effects of cinnamon intake on body weight (BW), Body Mass Index (BMI), Waist Circumference (WC), and fat mass (FM) in adults.

METHODS

Online electronic search engines including PubMed, SCOPUS, Cochrane Library, and Google Scholar were searched to find pertinent articles until September 2018. Data were pooled using the random-effects method and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). The non-linear association was assessed using fractional polynomial modeling.

RESULTS

Out of 679 records, 12 trials that enrolled 786 subjects were included. The pooled results showed that cinnamon administration significantly decreased BW (WMD: -1.02 kg, 95% CI: -1.66 to -0.38, P = 0.002), BMI (WMD: -0.51 kg/m², 95% CI: -0.74, -0.28, P < 0.001), WC (WMD: -2.40 cm, 95% CI: -4.48, -0.33, P = 0.02), and FM (WMD: -1.02%, 95% CI: -1.80, -0.24, P = 0.01). Greater effects on BW were observed in subjects aged <50 years old and those with a baseline BMI of ≥30 kg/m². The cinnamon administrations significantly reduced FM at the dosages of ≥2 g/d, when administered for ≥12 weeks. Cinnamon administration resulted in BW and WC reduction in non-linear fashion (P = 0.04).

CONCLUSIONS

Cinnamon supplementation significantly affects obesity measures. It could be recommended as a weight-reducing supplement in obesity management.

Potato consumption and risk of all cause, cancer and cardiovascular mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

A systematic review and meta-analysis of prospective cohort studies was conducted to examine the association of potato consumption and risk of all-cause, cancer and cardiovascular mortality in adults. We searched PubMed, Scopus databases up to September 2018 for all relevant published papers. All analyses were performed on HRs or RRs and 95% CIs. In twenty prospective studies, 25,208 cases were reported for all-cause mortality, 4877 for cancer mortality and 2366 for CVD mortality. No significant association was found between potato consumption and risk of all-cause (0.90; 95% CI: 0.8, 1.02, p = 0.096) and cancer (1.09; 95% CI: 0.96, 1.24, P = 0.204) mortality. In addition, no significant linear association was found between each 100 g/d increments in potato consumption and risk of all-cause (P = 0.7) and cancer (P = 0.09) mortality. Moreover, nonlinear association between potato consumption and risk of cancer mortality was non-significant (P-nonlinearity = 0.99). In addition, two of three studies which examined the association of potato consumption with CVD mortality did not find any significant relationship. There was no evidence for publication bias in this study. We failed to find significant association between potato consumption and risk of mortality. Further studies are required to confirm this issue.

Effects of strawberry supplementation on cardiovascular risk factors: a comprehensive systematic review and meta-analysis of randomized controlled trials

Based on our findings, strawberry supplements that contained 10–454 g day⁻¹ freeze-dried/fresh strawberries and taken for 3–12 weeks can improve DBP, CRP, MDA and LDL.

Nilvadipine in mild to moderate Alzheimer disease: A randomised controlled trial

BACKGROUND

This study reports the findings of the first large-scale Phase III investigator-driven clinical trial to slow the rate of cognitive decline in Alzheimer disease with a dihydropyridine (DHP) calcium channel blocker, nilvadipine. Nilvadipine, licensed to treat hypertension, reduces amyloid production, increases regional cerebral blood flow, and has demonstrated anti-inflammatory and anti-tau activity in preclinical studies, properties that could have disease-modifying effects for Alzheimer disease. We aimed to determine if nilvadipine was effective in slowing cognitive decline in subjects with mild to moderate Alzheimer disease.

METHODS AND FINDINGS

NILVAD was an 18-month, randomised, placebo-controlled, double-blind trial that randomised participants between 15 May 2013 and 13 April 2015. The study was conducted at 23 academic centres in nine European countries. Of 577 participants screened, 511 were eligible and were randomised (258 to placebo, 253 to nilvadipine). Participants took a trial treatment capsule once a day after breakfast for 78 weeks. Participants were aged >50 years, meeting National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's disease Criteria (NINCDS-ADRDA) for diagnosis of probable Alzheimer disease, with a Standardised Mini-Mental State Examination (SMMSE) score of ≥12 and <27. Participants were randomly assigned to 8 mg sustained-release nilvadipine or matched placebo. The a priori defined primary outcome was progression on the Alzheimer's Disease Assessment Scale Cognitive Subscale-12 (ADAS-Cog 12) in the modified intention-to-treat (mITT) population (n = 498), with the Clinical Dementia Rating Scale sum of boxes (CDR-sb) as a gated co-primary outcome, eligible to be promoted to primary end point conditional on a significant effect on the ADAS-Cog 12. The analysis set had a mean age of 73 years and was 62% female. Baseline demographic and Alzheimer disease-specific characteristics were similar between treatment groups, with reported mean of 1.7 years since diagnosis and mean SMMSE of 20.4. The prespecified primary analyses failed to show any treatment benefit for nilvadipine on the co-primary outcome (p = 0.465). Decline from baseline in ADAS-Cog 12 on placebo was 0.79 (95% CI, -0.07-1.64) at 13 weeks, 6.41 (5.33-7.49) at 52 weeks, and 9.63 (8.33-10.93) at 78 weeks and on nilvadipine was 0.88 (0.02-1.74) at 13 weeks, 5.75 (4.66-6.85) at 52 weeks, and 9.41 (8.09-10.73) at 78 weeks. Exploratory analyses of the planned secondary outcomes showed no substantial effects, including on the CDR-sb or the Disability Assessment for Dementia. Nilvadipine appeared to be safe and well tolerated. Mortality was similar between groups (3 on nilvadipine, 4 on placebo); higher counts of adverse events (AEs) on nilvadipine (1,129 versus 1,030), and serious adverse events (SAEs; 146 versus 101), were observed. There were 14 withdrawals because of AEs. Major limitations of this study were that subjects had established dementia and the likelihood that non-Alzheimer subjects were included because of the lack of biomarker confirmation of the presence of brain amyloid.

CONCLUSIONS

The results do not suggest benefit of nilvadipine as a treatment in a population spanning mild to moderate Alzheimer disease.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02017340, EudraCT number 2012-002764-27.

Effect of Nigella sativa supplementation on obesity indices: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND & OBJECTIVE(S)

No meta-analysis is available on the effect of Nigella sativa (NS) on obesity indices. This systematic review and meta-analysis was conducted to systematically review the available Randomized Clinical Trials (RCTs) that examined the effects of NS on Body Weight (BW), Body Mass index (BMI), and Waist Circumference (WC) in adults.

METHODS

Relevant articles published up to January 2018 were searched through PubMed/Medline, SCOPUS, Cochrane Library, and Google Scholar databases, using relevant keywords. All RCTs that examined the effect of NS supplementation on BW, BMI, or WC were included.

RESULTS

Overall, thirteen RCTs, including 875 subjects (64% males) were included in this study. Combining effect sizes from ten studies, NS supplementation significantly reduced BW (Weighted Mean Differences (WMD): -1.76 kg, 95% CI: -3.34 to -0.17, I² = 87.4%), as compared to placebo. Subgroup analysis by the intervention type (I² = 0.0%), participants' gender (I² = 0.0%), and age (I² = 5.5%) removed between-study heterogeneity. A significant reduction was seen in BMI (WMD: -0.85 kg/m², 95% CI: -1.23, -0.46, I² = 70.6%) after NS supplementation than placebo among eleven trials. Subgroup analysis based on study duration (I² = 0.0%), participants' gender (females: I² = 0.0% & both genders: I² = 20.9%), an age (I² = 35.9%) disappeared the heterogeneity. However, no significant reduction was found in WC comparing NS supplementation to placebo (WMD: -4.04 cm, 95% CI: 11.37, 3.27, I² = 97.8%) in five studies.

CONCLUSIONS

We find a significant effect of NS supplementation on BW and BMI in adults. However, the effect of NS supplementation on WC was not significant in this meta-analysis.

Squishy nanotraps: hybrid cellulose nanocrystal-zirconium metallogels for controlled trapping of biomacromolecules

A brick-and-mortar-like ultrasoft nanocomposite metallogel is formed by crosslinking cellulose nanocrystals (CNC) with ammonium zirconium carbonate (AZC) to trap and reconfigure dextran, a model biomacromolecule.