Publications by authors named "Brendon Stubbs"

605 Publications

Efficacy of non-invasive brain stimulation interventions in reducing smoking frequency in patients with nicotine dependence: a systematic review and network meta-analysis of randomized controlled trials.

Addiction 2021 Aug 4. Epub 2021 Aug 4.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

Background And Aims: Nicotine is a highly addictive substance in tobacco products that dysregulates several neurotransmitters in the brain and impairs executive function. Non-invasive brain stimulation (NIBS) methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising treatments for nicotine dependence. We investigated the efficacy and acceptability of NIBS in managing smoking cessation through a systematic review and network meta-analysis (NMA).

Methods: We conducted a systematic review to identify randomized controlled trials (RCTs) that investigated the efficacy of NIBS for smoking cessation. All pairwise meta-analyses and NMA procedures were conducted using random-effects and frequentist models. The co-primary outcomes were (1) the change in number of cigarettes smoked per day (change in frequency of smoking) in patients with nicotine dependence after NIBS and (2) acceptability (the dropout rate). The effect sizes for co-primary outcomes of change in frequency of smoking and acceptability were assessed according to standardized mean difference (SMD) and odds ratio, respectively.

Results: Twelve RCTs with 710 participants (mean age: 44.2 years, 31.2% female) were included. Compared with the sham control, 10-Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) was associated with the largest changes in smoking frequency [SMD = -1.22, 95% confidence interval (95% CI) = -1.77 to -0.66]. The 2-mA bifrontal tDCS (SMD = -0.97, 95% CI = -1.32 to -0.62) and 10-Hz deep rTMS over the bilateral DLPFC with cue provocation (SMD = -0.77, 95% CI = -1.20 to -0.34) were associated with a significantly larger decrease in smoking frequency versus the sham. None of the investigated NIBSs was associated with dropout rates significantly different from those of the sham control groups.

Conclusion: Prefrontal non-invasive brain stimulation interventions appear to reduce the number of cigarettes smoked with good acceptability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/add.15624DOI Listing
August 2021

Risk of hospitalised falls and hip fractures in working age adults receiving mental health care.

Gen Hosp Psychiatry 2021 Jul 20;72:81-87. Epub 2021 Jul 20.

Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom.

Objective: This retrospective cohort study investigates risks of hospitalised fall or hip fractures in working age adults receiving mental health care in South London.

Methods: Patients aged 18 to 64, who received a first mental illness diagnosis between 2008 and 2016 were included. Primary outcome was hospitalised falls, secondary outcome was hip fractures. Age- and gender-standardised incidence rates and incidence rate ratios (IRRs) compared to local general population were calculated. Multivariate Cox proportionate hazard models were used to investigate which mental health diagnoses were most at risk.

Results: In 50,885 patients incidence rates were 8.3 and 0.8 per 1,000 person-years for falls and hip fractures respectively. Comparing mental health patients to the general population, age-and-gender-adjusted IRR for falls was 3.6 (95% CI: 3.3-4.0) and for hip fractures 7.5 (95% CI: 5.2-10.4). The falls IRR was highest for borderline personality and bipolar disorder and lowest for schizophreniform and anxiety disorder. After adjusting for multiple confounders in the sample of mental health service users, borderline personality disorder yielded a higher and anxiety disorder a lower falls risk.

Conclusion: Working age adults using mental health services have almost four times the incidence of hospitalised falls compared to general population. Targeted interventions are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.genhosppsych.2021.07.006DOI Listing
July 2021

Reply to Yi M et al.

Adv Nutr 2021 Jul;12(4):1595-1596

Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/advances/nmab043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321832PMC
July 2021

Association of mentally-active and mentally-passive sedentary behaviour with depressive symptoms among adolescents.

J Affect Disord 2021 Jul 13;294:143-150. Epub 2021 Jul 13.

MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK.

Background: The evidence on the association between sedentary behaviour and depression in adolescence is mixed. We aimed to investigate the association between mentally-active and mentally-passive sedentary behaviours at 11 years (11y) and depressive symptoms at 14y, and to examine potential mediators.

Methods: UK Millennium Cohort Study data were used (n=7,124; 49% boys). At 11y, participants self-reported frequency of mentally-passive (listening to music, internet use) and mentally-active sedentary behaviours (reading, playing electronic games). Additional parental-reported behaviours (mentally-passive: TV viewing; mentally-active: homework) were summed with self-reported behaviours to represent continuous indicators of mentally-active and mentally-passive sedentary behaviour. Depressive symptoms were assessed (at 11y and 14y) using the short-version of Mood and Feelings Questionnaire. Body mass index (BMI), mentally-passive sedentary behaviour and cognition at 14y were examined as potential mediators. Linear regression models were adjusted for confounders and stratified by sex. Subsequent mediation analyses reporting e-values were used to assess unmeasured confounding.

Results: Among girls, mentally-passive sedentary behaviour at 11y was associated with later depressive symptoms (14y) [β:0.089 (95%CI:0.055-0.122), e-value:1.32]. This association was mediated by BMI [5.6% (95%CI:4.1%-8.6%)] and mentally-passive sedentary behaviour [105.6% (95%CI:79.6%-156.7%)]. No associations were observed in boys or between mentally-active sedentary behaviour and later depressive symptoms.

Limitations: The parental report of behaviours and the assessment of mediators and outcome in the same wave are the main limitations.

Conclusion: Future interventions aiming to improve mental health among girls could aim to reduce mentally-passive sedentary behaviour in early teens and could target potential mediators including BMI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.07.004DOI Listing
July 2021

Disparities in Screening and Treatment of Cardiovascular Diseases in Patients With Mental Disorders Across the World: Systematic Review and Meta-Analysis of 47 Observational Studies.

Am J Psychiatry 2021 Jul 14:appiajp202121010031. Epub 2021 Jul 14.

Neurosciences Department (Solmi, Miola), Padua Neuroscience Center (Solmi), Department of General Psychology (Poddighe), and Department of Philosophy, Sociology, Education, and Applied Psychology (Delogu), University of Padua, Italy; Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Solmi, Fusar-Poli); Psychiatry Department, University of Ottawa, Ottawa (Fiedorowicz); Department of Clinical Medicine, Faculty of Health Sciences, UiT-Arctic University of Norway, Tromsø (Høye); Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø (Høye); Center for Clinical Documentation and Evaluation (SKDE), Tromsø (Høye, Heiberg); Physiotherapy Department, South London and Maudsley NHS Foundation Trust, and Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Stubbs); Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, U.K. (Smith); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, and School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark, and Department of Clinical Sciences, Lund University, Lund, Sweden (Attar); Department of Psychiatry, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (Nielsen); Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, and NHS Trust, Southampton, U.K. (Cortese); Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York (Cortese); Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, U.K. (Cortese); Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (Shin); National Institute for Health Research, Maudsley Biomedical Research Centre, and OASIS Service, South London and Maudsley NHS Foundation Trust, London (Fusar-Poli); Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy (Fusar-Poli); Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K. (Firth); NICM Health Research Institute, Western Sydney University, Westmead, Australia (Firth); Department of Psychiatry, University of British Columbia, Vancouver (Yatham); Department of Psychiatry, University of Toronto, and Centre for Addiction and Mental Health, Toronto (Castle, Seeman); IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia (Carvalho); Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Charité University Medicine Berlin, Berlin (Correll); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y. (Correll); and Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (Correll).

Objective: This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality.

Methods: The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed.

Results: Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results.

Conclusions: People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1176/appi.ajp.2021.21010031DOI Listing
July 2021

Treatment Efficacy and Acceptabilityof Pharmacotherapies for Dementia with Lewy Bodies: A Systematic Review and Network Meta-Analysis.

Arch Gerontol Geriatr 2021 Sep-Oct;96:104474. Epub 2021 Jul 2.

Institute of Psychiatry, King's College London, UK; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan. Electronic address:

Introduction: We investigated the efficacy and acceptability of pharmacotherapy for dementia with Lewy bodies (DLB) while simultaneously considering the neuropsychiatric symptoms (NPS), cognitive function, motor symptoms, and acceptability.

Methods: Electronic databases were searched from inception through June 5, 2019, for randomized controlled trials (RCTs) and open-label trials (OLTs) in patients with DLB. We performed a pairwise conventional meta-analysis (PWMA) and network meta-analysis (NMA) within a frequentist framework. The main outcomes were mean change scores in NPS, general cognition, motor symptoms and acceptability. The effect sizes and odds ratios with 95% confidence intervals (CIs) were calculated. This study was registered with PROSPERO (CRD42018096996).

Results: In total, we included 29 studies (9 RCTs and 20 OLTs). In the NMA with 9 RCTs, both high- (mean difference [MD] 2.00, 95% CIs, 0.69 to 3.31) and low-dose (1.86, 0.58 to 3.15) donepezil were associated with a greater cognitive improvement than placebo. High-dose zonisamide was associated with greater motor symptom improvement ( -4.10, -7.03 to -1.17]). No medications reached statistical significance regarding improving neuropsychiatric symptoms or developing intolerable adverse effects as compared to placebo. In the second NMA, with 29 studies as an exploratory analysis, aripiprazole and yokukansan may be effective for neuropsychiatric symptoms, while levodopa may be associated with cognitive impairment.

Conclusions: We report the most comprehensive evidence for the selection of pharmacotherapy for treating different clusters of DLB-related symptoms. Due to the limited availability of RCTs on DLB, more well-conducted RCTs are needed for MMA to warrant clinical efficacy in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.archger.2021.104474DOI Listing
July 2021

Effects of aerobic exercise on gut microbiota in adolescents with subthreshold mood syndromes and healthy adolescents: A 12-week, randomized controlled trial.

J Affect Disord 2021 Jun 20;293:363-372. Epub 2021 Jun 20.

School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing. Electronic address:

Background: Animal and human studies have revealed reciprocal association between exercise and gut-brain axis. However, the clinical evidence from randomized controlled trials (RCT) are still limited to directly assess the effects of aerobic exercise on gut microbiota. To fill this gap, we conducted this 12-week RCT in both groups of adolescents with and without sub-threshold mood symptoms.

Methods: A total of 224 adolescents were randomized to the aerobic exercise intervention or psychoeducation-controlled arm. 49 adolescents with subthreshold symptoms and 142 clinically-well adolescents provided the sample for microbiota assessed by metagenomic sequencing. Aerobic exercise of running at the moderate-intensity for 30 min per day, 5 days a week, were conducted for 12 weeks.

Results: Adolescents with subthreshold symptoms had significantly lower beta diversity than clinically-well adolescents in both the exercise intervention and psychoeducation-controlled arms (p<0.05). After intervention, no difference in gut microbiota diversity, phylum, genus, species level abundancies or gut microbial functions were found in both of the symptomatic or non-symptomatic groups. Metagenome-wide association study analysis showed no significant difference in metagenomic linkage groups.

Limitations: The sample size is relatively small. The exercise intensity we employed may be insufficient to result in observable effects on intestinal microbiota.

Conclusion: We conclude that a 12-week moderate-intensity aerobic exercise intervention showed no significant beneficial effect on the gut microbiota in clinically-well adolescents as well as in adolescents with subthreshold symptoms. The beta diversity of gut microbiota in adolescents with subthreshold mood syndromes may be impaired when compared with clinically-well adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.06.025DOI Listing
June 2021

The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence.

Psychiatry Res 2021 Aug 11;302:114046. Epub 2021 Jun 11.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium.

Exercise as a treatment option for people with mental disorders is a field of growing interest. The increased number of published randomized controlled trials (RCTs) evaluating the effects of exercise in the treatment of anxiety and related disorders in recent years calls for an update of the available meta-analytic evidence. Electronic databases (PubMed, CINAHL, PSYCArticles, and Embase) were searched up to 17.2.2021, for RCTs evaluating the effects of exercise on anxiety and stress symptoms in adults with anxiety and related disorders. A random effects meta-analysis was conducted. A total of 13 RCTs comprising 731 adult participants (exercise n=376; control n=355) were included. Exercise had a small, bordering medium, but statistically significant effect on decreasing anxiety symptoms compared to control condition (standardized mean difference=-0.425, 95%CI -0.67 to -0.17; I = 47.9%) in people with anxiety and related disorders. Our meta-analysis updates the existing evidence supporting exercise as an efficacious intervention for anxiety and related disorders. Although the updated meta-analytic evidence is less heterogenous than previously reported, future research is still needed to explore the factors moderating the effects of exercise on outcome such as frequency, intensity, duration of the sessions, and type of exercise and qualification of the provider in more detail.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2021.114046DOI Listing
August 2021

Cross-sectional associations of leisure and transport related physical activity with depression and anxiety.

J Psychiatr Res 2021 08 4;140:228-234. Epub 2021 Jun 4.

Departmento de Clínica Médica, Faculdade de Medicina da USP & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil.

Background: Previous evidence supports the notion that the physical activity (PA) domain (leisure-time or transport), and the amount of time spent in PA, influence the association of PA with depressive and anxiety symptoms. However, no study evaluated the associations of different volumes of leisure-time PA (LTPA) and transport PA (TPA) with prevalent depression, anxiety, and co-occurring depression and anxiety (D&A) disorders.

Aim: To investigate the associations between different volumes of LTPA and TPA with prevalent depression, anxiety, and D&A.

Methods: Cross-sectional study using baseline data of the ELSA-Brasil cohort. The International Physical Activity Questionnaire (IPAQ) long-form was used to assess PA levels in each domain. The Clinical Interview Scheduled Revised (CIS-R) was used to diagnose prevalent depressive, anxiety, and D&A disorders. Logistic regressions, adjusting for confounding factors, were employed. Results are expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results: A total of 14,381 adults (54.5% female, 67.5% aged 45-64 years) were assessed. T60-89min/week >300min/week p < 0.001). High volumes of LTPA were associated with a lower prevalence 270-299min/week; >300 minutes60-89min/week volumes of TPA were associated with lower prevalence of depression.

Limitations: Cross-sectional design and self-reported PA. Lack of assessment of sedentary behaviour or occupational PA.

Conclusions: The present study highlights the importance of contextual factors in the association between PA and mental health, particularly at higher levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2021.05.053DOI Listing
August 2021

Prospective associations of different contexts of physical activity with psychological distress and well-being among middle-aged adults: An analysis of the 1970 British Cohort Study.

J Psychiatr Res 2021 08 23;140:15-21. Epub 2021 May 23.

Department of Physical Education, Federal University of Sergipe - UFS, São Cristóvão, Brazil.

Background: Our aim was to investigate whether different types and social contexts of physical activity (PA) participation are prospectively associated with psychological distress and well-being among middle-aged adults.

Methods: Data from the 1970 British Cohort Study was used (N = 5144-2733 women). At age 42y, participants reported their type of leisure-time PA, which was classified as individual PA or group PA (exposure). At age 46y, participants reported co-primary outcomes: psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale). Highest academic achievement, employment status, country of interview, baseline values of psychological distress and well-being, smoking, alcohol use, TV-viewing and total physical activity at 42y were used as covariates. Main analyses included linear regression stratifying by sex.

Results: Jogging, cross-country, road-running (both sexes) as well as team sports (men) were associated with higher well-being. Health, fitness, gym or conditioning activities and jogging, cross-country (women), road-running (women) and team sports (men) were associated with lower psychological distress. Participation in both individual and group PA were associated with lower psychological distress and higher well-being for both sexes in crude models. However, adjusted models revealed that only group PA was associated with lower psychological distress (B: -0.106; 95%CI: -0.188 to -0.025) and higher well-being (0.835; 0.050 to 1.619) among men but not women. In the sensitivity analysis, group PA was associated with higher well-being (0.855; 0.094 to 1.616) when compared with individual PA among men. Group PA was not associated with psychological distress among both sexes and well-being among women when compared with individual PA.

Conclusion: Group PA was prospectively associated with lower psychological distress and higher well-being among men but not females. Future PA interventions could focus on group activities for males. Further research to understand the relationship between individual/group PA and mental health is required in females.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2021.05.049DOI Listing
August 2021

Eight-week high-intensity interval training is associated with improved sleep quality and cardiorespiratory fitness in patients with depressive disorders.

Sleep Breath 2021 May 27. Epub 2021 May 27.

Psychiatry & Behavioral Sciences, Gerontology & Geriatric Medicine, and Biobehavioral Nursing, University of Washington, Seattle, WA, 98195-6560, USA.

Purpose: This study aimed to examine the effect of high-intensity interval training (HIIT) on both sleep and cardiorespiratory fitness in patients with depression.

Methods: Using a single pre- and post-test study design with no control group, 82 patients diagnosed with depressive disorders underwent HIIT comprising a total of 24 15-min sessions, three times per week for 8 weeks. Depressive symptoms, sleep quality, and cardiorespiratory fitness were evaluated using the Beck depression inventory-II, the Pittsburgh sleep quality index (PSQI), and cardiopulmonary exercise testing (CPET) in the form of maximum oxygen uptake (VO max), respectively.

Results: All 82 patients completed the intervention. HIIT training was associated with significant improvements in BDI-II score (diff =  - 1.57 [95% CI - 2.40 to - 0.73], P = 0.001), PSQI score (diff =  - 1.20 [95% CI - 2.10 to - 0.32], P = 0.008), and CPET VO max (diff = 0.95 [95% CI 0.62-1.28], P = 0.001). Effect size calculations revealed that the greatest improvement occurred in CPET VO max (Cohen's d = 0.64) and that improvements in the BDI-II and PSQI scores were somewhat smaller in magnitude (Cohen's d =  - 0.41 and - 0.30, respectively). Sleep quality improvements were observed in sleep latency, habitual sleep efficiency, and the use of sleep-promoting medications (Cohen's d = 0.18, 0.19, and 0.25, respectively). Change in cardiorespiratory fitness successfully predicted change in sleep quality but not in depressive symptoms. Adverse effects were limited to minor injuries which did not interfere with completion of training.

Conclusions: HIIT training delivered over 8 weeks was associated with improvements in depression symptoms, sleep quality, and cardiorespiratory fitness in patients with depressive disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-021-02388-yDOI Listing
May 2021

Resistance training reduces depressive and anxiety symptoms in older women: a pilot study.

Aging Ment Health 2021 May 18:1-7. Epub 2021 May 18.

Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil.

Objectives: The purposes of this study were to analyze the effect of resistance training (RT) on depressive and anxiety symptomsand examine the possible consequences of age, cognitive alterations, and muscular strength on such symptoms. Forty-one older women (68 ± 8 years) composed a training group (TG) or a control group (CG). The TG was submitted to a supervised, progressive RT program over 12 weeks, involving eight whole-body exercises performed with three sets of 8-12 repetitions, three days per week, whereas CG remains with no intervention for the same period. Muscular strength (one-repetition maximum tests), cognitive function (Montreal Cognitive Assessment - MoCA; Verbal Fluency Tests), depression (15-item eriatric Depression Scale - GDS-15), and anxiety (Beck Anxiety Inventory - BAI) were assessed before and after the intervention period.

Results: There were observed significant (P < 0.001) RT-induced improvements on total muscular strength (TG: pre = 122.4 ± 24.1/post = 134.3 ± 36.7; CG: pre = 105.4 ± 15.4/post = 99.2 ± 17.1) and MoCA (TG: pre =21.7 ± 4.5/post = 22.5 ± 4.7; CG: pre = 20.3 ± 3.7/post = 19.3 ± 4.1). Depressive and anxiety symptoms (even when adjusted by chronological age and changes in muscular strength or cognitive function) were reduced with RT according to GDS-15 (TG: pre = 2.26 ± 1.53/post = 1.92 ± 1.68; CG: pre =2.68 ± 1.13/post = 2.25 ± 1.18) and BAI (TG: pre = 4.07 ± 5.68/post = 2.33 ± 3.71; CG: pre = 5.18 ± 7.70/post = 9.81 ± 7.10). The time x group interactions were significant for depressive and anxiety symptoms.

Conclusions: Our results suggest that a 12-week RT program reduces depressive and anxiety symptoms, regardless of age, muscular strength, and cognition function in older women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13607863.2021.1922603DOI Listing
May 2021

Efficacy of serotonergic antidepressant treatment for the neuropsychiatric symptoms and agitation in dementia: A systematic review and meta-analysis.

Ageing Res Rev 2021 08 14;69:101362. Epub 2021 May 14.

Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Objective: Serotonergic dysfunction may be involved in the etiology of overall neuropsychiatric symptoms (NPS) and agitation in patients with dementia; therefore, we aim to perform a systematic review and meta-analysis to investigate the efficacy of serotonergic antidepressants in such populations.

Methods: We systematically searched PubMed, Medline, Embase, and Cochrane Library to obtain randomized controlled trials (RCTs) from the date of their inception until December 11, 2020 to examine the effect of serotonergic antidepressants on the outcomes of interest in patients with dementia. Data were pooled using a random-effects model. Co-primary outcomes were mean changes in overall NPS and agitation as a specific symptom of NPS. Secondary outcomes were mean changes in depressive symptoms, cognition, and care burden.

Results: Fourteen randomized controlled trials were eligible (n = 1,374; mean age = 76.8 years; mean proportion of female = 61.9 %). Serotonergic antidepressants significantly reduced the overall NPS (k = 12, n = 1276, Hedges' g = -0.49, 95 % confidence intervals [CIs] = -0.74 to -0.24, p < 0.001) and agitation severity (k = 9, n = 749, Hedges' g = -0.28, 95 % CIs = -0.43 to -0.14, p < 0.001), both with small effect size in patients with dementia. For secondary outcome, serotonergic antidepressants also significantly improved depressive symptoms, cognition, and care burden with small to very small effect sizes (depressive symptoms, k = 8, n = 938, Hedges' g = -0.32, 95 % CIs = -0.49 to -0.15, p < 0.001;cognition, k = 6, n = 983, Hedges' g = 0.15, 95 % CIs = 0.002 to 0.29, p = 0.046; care burden, k = 7, n = 961, Hedges' g = -0.24, 95 % CIs = -0.41 to -0.07, p = 0.005). Subgroup analysis showed that both selective serotonin reuptake inhibitors (SSRIs) and non-SSRIs significant reduced agitation and depressive symptoms (For agitation, SSRIs, k = 6, n = 605, Hedges' g = -0.25, 95 % CIs = -0.41 to -0.09, p=0.002; non-SSRIs, k = 3, n = 144, Hedges' g = -0.41, 95 % CIs = -0.74 to -0.08, p = 0.016; For depression, SSRIs, k = 6, n = 736, Hedges' g = -0.29, 95 % CIs = -0.48 to -0.09, p=0.004; non-SSRIs, k = 343, n = 144, Hedges' g = -0.43, 95 % CIs = -0.78 to -0.09, p = 0.016), whereas only SSRIs reduced overall NPS (k = 9, n = 1109, Hedges' g = -0.49, 95 % CIs = -0.78 to -0.20, p = 0.001) and care burden (k = 5, n = 740, Hedges' g = -0.29, 95 % CIs = -0.50 to -0.08, p=0.007).

Conclusion: The present meta-analysis indicates that serotonergic antidepressants effectively alleviate overall NPS, agitation, depressive symptoms, and care burden, and improve cognitive function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arr.2021.101362DOI Listing
August 2021

Association between psychosocial factors and mental health symptoms to cervical spine pain with or without radiculopathy on health outcomes: systematic review protocol.

Pain Rep 2021 2;6(1):e870. Epub 2021 Feb 2.

School of Health and Social Care, Division of Allied Health Sciences, London South Bank University, London, United Kingdom.

Introduction: Cervical spine pain with or without radiculopathy (CSp ± R) has significant negative impacts to a person's quality of life. Psychosocial factors and/or mental health symptoms are associated with spinal pain with or without radiculopathy and negatively impact health outcomes. This area of research is not yet established for CSp ± R. Our objective is to conduct a systematic review assessing the association between psychosocial factors and/or mental health symptoms and health outcomes in adults with CSp ± R.

Methods: A systematic electronic search of 3 online databases will retrieve studies in which adults (older than 18 years) with CSp ± R, assessing how psychosocial factors or mental health symptoms impact outcomes related to disability, pain, and/or healthcare utilisation. Data extracted will include study design, CSp ± R definition, psychosocial and/or mental health symptoms, and health outcomes. Reporting study quality through the Newcastle-Ottawa Quality Scale Assessment and certainty through Grading of Recommendations, Assessment, Development and Evaluations will be completed. Studies will be assessed from a clinical perspective, methodology design, and statistical testing to determine whether studies can be pooled for meta-analysis. If there is significant clinical heterogeneity, narrative description will be undertaken.

Perspective: This will be a comprehensive synthesis review to enhance understanding of the association of psychosocial factors and/or mental health symptoms and CSp ± R on health outcomes. The findings will support the formulation of prognosis, collaborative management decisions, and guide healthcare resources to improve outcomes for this patient group. The review will identify gaps in research, thereby informing future experimental and observational study design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PR9.0000000000000870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108582PMC
February 2021

Efficacy and acceptability of noninvasive brain stimulation interventions for weight reduction in obesity: a pilot network meta-analysis.

Int J Obes (Lond) 2021 Aug 10;45(8):1705-1716. Epub 2021 May 10.

Division of Community & Rehabilitation Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

Background/objectives: Obesity has recently been recognized as a neurocognitive disorder involving circuits associated with the reward system and the dorsolateral prefrontal cortex (DLPFC). Noninvasive brain stimulation (NIBS) has been proposed as a strategy for the management of obesity. However, the results have been inconclusive. The aim of the current network meta-analysis (NMA) was to evaluate the efficacy and acceptability of different NIBS modalities for weight reduction in participants with obesity.

Methods: Randomized controlled trials (RCTs) examining NIBS interventions in patients with obesity were analyzed using the frequentist model of NMA. The coprimary outcome was change in body mass index (BMI) and acceptability, which was calculated using the dropout rate.

Results: Overall, the current NMA, consisting of eight RCTs, revealed that the high-frequency repetitive transcranial magnetic stimulation (TMS) over the left DLPFC was ranked to be associated with the second-largest decrease in BMI and the largest decrease in total energy intake and craving severity, whereas the high-frequency deep TMS over bilateral DLPFC and the insula was ranked to be associated with the largest decrease in BMI.

Conclusion: This pilot study provided a "signal" for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on weight reduction in participants with obesity by different NIBS interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41366-021-00833-2DOI Listing
August 2021

Efficacy and acceptability of different anti-fungal interventions in oropharyngeal or esophageal candidiasis in HIV co-infected adults: a pilot network meta-analysis.

Expert Rev Anti Infect Ther 2021 May 16:1-11. Epub 2021 May 16.

Program in Translational Medicine, National Chung Hsing University, Taichung City, Taiwan.

: Oropharyngeal/esophageal candidiasis are the most common opportunistic infections observed in patients with human immunodeficiency virus (HIV). While the commonly recommended treatment is fluconazole, relapse of oropharyngeal or esophageal candidiasis has been gradually increasing in recent decades.: The current network meta-analysis (NMA) included randomized controlled trials (RCTs) investigating the efficacy and acceptability (i.e. drop-out rate) of different anti-fungal interventions against oropharyngeal or esophageal candidiasis in adults with HIV. All NMA procedures were conducted using the frequentist model.: Twenty-seven RCTs and 6277 participants were included. For oropharyngeal candidiasis, photosensitizer-based antimicrobial photodynamic therapy (aPDT) with laser irradiation plus methylene blue was associated with the highest cure rate and the lowest relapse rate among the investigated interventions [odds ratio (OR) = 6.82, 95% confidence intervals (95%CIs) = 0.19 to 244.42, p = 0.293, and OR = 0.03, 95%CIs = 0.00 to 0.77, p = 0.034, compared to fluconazole]. None of the investigated anti-fungal interventions were superior to fluconazole for esophageal candidiasis in respect of cure rates/relapse rates. All investigated anti-fungal interventions were well-accepted.: aPDT could be the preferred strategy to manage oropharyngeal candidiasis; however the evidence for esophageal candidiasis still remained inconclusive.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14787210.2021.1922078DOI Listing
May 2021

Associations between loneliness and acute hospitalisation outcomes among patients receiving mental healthcare in South London: a retrospective cohort study.

Soc Psychiatry Psychiatr Epidemiol 2021 Apr 20. Epub 2021 Apr 20.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK.

Purpose: It is well known that loneliness can worsen physical and mental health outcomes, but there is a dearth of research on the impact of loneliness in populations receiving mental healthcare. This study aimed to investigate cross-sectional correlates of loneliness among such patients and longitudinal risk for acute general hospitalisations.

Method: A retrospective observational study was conducted on the data from patients aged 18 + receiving assessment/care at a large mental healthcare provider in South London. Recorded loneliness status was ascertained among active patients on the index date, 30th Jun 2012. Acute general hospitalisation (emergency/elective) outcomes were obtained until 31st Mar 2018. Length of stay was modelled using Poisson regression models and time-to hospitalisation and time-to mortality were modelled using Cox proportional hazards regression models.

Results: The data from 26,745 patients were analysed. The prevalence of patients with recorded loneliness was 16.4% at the index date. In the fully adjusted model, patients with recorded loneliness had higher hazards of emergency (HR 1.15, 95% CI 1.09-1.22) and elective (1.05, 1.01-1.12) hospitalisation than patients who were not recorded as lonely, and a longer duration of both emergency (IRR 1.06, 95% CI 1.05-1.07) and elective (1.02, 1.01-1.03) general hospitalisations. There was no association between loneliness and mortality. Correlates of loneliness included having an eating disorder (OR 1.67, 95% CI 1.29-2.25) and serious mental illnesses (OR 1.44, 1.29-1.62).

Conclusion: Loneliness in patients receiving mental healthcare is associated with higher use of general hospital services. Increased attention to the physical healthcare of this patient group is therefore warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00127-021-02079-9DOI Listing
April 2021

A systematic review of the latent structure of the Center for Epidemiologic Studies Depression Scale (CES-D) amongst adolescents.

BMC Psychiatry 2021 04 19;21(1):197. Epub 2021 Apr 19.

Oxford Institute of Population Ageing, University of Oxford, Oxford, UK.

Background: The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents.

Methods: We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data.

Results: Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia.

Limitations: Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure.

Conclusions: A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-021-03206-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054366PMC
April 2021

Physical activity correlates in children and adolescents, adults, and older adults with an intellectual disability: a systematic review.

Disabil Rehabil 2021 Apr 16:1-12. Epub 2021 Apr 16.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Purpose: Understanding enablers of and barriers for physical activity (PA) participation in people with intellectual disability (ID) is an essential first step to develop effective interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental and policy level) in people with ID across the lifespan.

Material And Methods: Major electronic databases were searched from inception until 15 February 2021. Keywords included "physical activity" or "exercise" and "intellectual disability" or "mental retardation." A summary coding was used to analyze the data for adolescents (<18 years), adults (18 < 50 years), and older adults (50≤ years).

Results: Out of 83 PA correlates, retrieved from 39 studies ( = 26,456), only three consistent (i.e., reported in four or more studies) correlates were identified. In adults, older age (7/11, 64%), more severe ID (9/9, 100%) and the presence of physical mobility problems (3/4, 75%) were associated with decreased PA. From 38 correlates identified, no consistent correlates were identified for children and adolescents and older people.

Conclusions: Despite the abundance of evidence of the PA benefits for people with ID, we only found consistent evidence for three correlates reliably being related to PA in adults with ID. More research, particularly among young and older people is urgently needed.IMPLICATIONS FOR REHABILITATIONMore severe intellectual disability is an important barrier for being active in adults with intellectual disability.Presence of physical health problems is an important barrier for being active in adults with intellectual disability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638288.2021.1909665DOI Listing
April 2021

What are the most common restraint techniques taught by expert practitioners?

J Psychiatr Ment Health Nurs 2021 Apr 13. Epub 2021 Apr 13.

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.

WHAT IS KNOWN ON THE SUBJECT?: Physical restraint is used across the NHS in Mental Health, Learning disability and other specialist settings. Physical restraint should be used as a last resort, with least amount of force for the minimum amount of time. There is no national set of skills from which trainers or practitioners choose what might be appropriate for them and the population they care for. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A national online survey gathered insights from representatives of public and private training services in relation to 20 selected techniques and their perceived risks. The most frequently taught techniques are identified and evident trends were seen among respondents according to their perceived suitability for different population groups. The need to be able to compare and contrast techniques is discussed, and the utility of developing an evaluative framework is outlined. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In England the restraint training is now being regulated. This survey reveals the variation in the techniques used across groups or settings. The ability to compare techniques and make informed decisions around which techniques to commission, specify or use, could support the aims of the RRN Training Standards (RRN, 2020a) and Towards Safer Services (RRN, 2020b) and in so doing support the goals of safer, less restrictive person-centred practice. Individuals are encouraged to reflect on their practice and think critically about what is a good restraint technique. ABSTRACT: Introduction Despite widespread use of restraint techniques, it is unclear what techniques are taught. Aim To identify the types of techniques commonly taught. Method A national online survey was developed through iteration and stakeholder involvement. Ethical approval was obtained and it was disseminated through the Positive and Safe network, and the Restraint Reduction Network Community of Practice where expert practitioners answered questions relating to 20 randomly selected used physical 'Holds'. Results One hundred seventy-two people completed the survey. The most commonly taught techniques were a Guiding Posture (71%), a Guiding Hold (44%), a Two-Handed Forearm Hold (36%), a Finger, Thumb & Wrist Hold (27%) and a Cupped/Capped Fist Hold (26%). The Guiding Posture (71%), and Guiding Hold were used most commonly across populations. Despite the potential to induce pain, the Finger, Thumb and Wrist Hold was deemed suitable for Adult populations, but not Older Adults, Young Persons and Children. Wrap-Type Holds were seen as unsuitable for all populations. Discussion There is currently high variation in which techniques are taught across different settings. An evaluation framework could be beneficial. IMPLICATIONS FOR PRACTICE: An evaluation framework could aid training commissioners, providers and practitioner reflect on what constitutes a good restraint technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpm.12761DOI Listing
April 2021

Employment and relationship outcomes in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies.

Schizophr Res 2021 05 8;231:122-133. Epub 2021 Apr 8.

Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland.

As employment and relationship status are important long-term outcomes in individuals with a diagnosis of first episode psychosis (FEP) disorders, there is a need to elucidate more accurately the extent of these social deficits in people with FEP. This in turn can aid treatment planning and policy development ultimately ensuring more complete and sustainable recoveries. We carried out a systematic review and meta-analysis of longitudinal studies in FEP reporting on employment and relationship status during the illness course. Random effects meta-analyses and meta-regression analyses were employed. Seventy-four studies were included with a sample totalling 15,272 (range = 20-1724) FEP cases with an average follow-up duration of 8.3 years (SD = 7.2). 32.5% (95%CI = 28.5-36.9) of people with a diagnosis of FEP disorders were employed and 21.3% (95%CI = 16.5-27.1) were in a relationship at the end of follow-up. Studies from high-income countries and Europe had a higher proportion of people in employment at the end of follow-up compared to middle-income nations and non-European countries. The inverse was found for relationship status. The proportion of people with a diagnosis of FEP in employment decreased significantly with longer follow-up. Living with family, being in a relationship at first contact and Black and White ethnicities were identified as significant moderators of these outcomes. These findings highlight marked functional recovery deficits for people with FEP, although cultural factors need to be considered. They support the need for interventions to improve employment opportunities, and social functioning, both in early psychosis and during the longitudinal illness course.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.schres.2021.03.013DOI Listing
May 2021

Pharmacologic and hormonal treatments for menopausal sleep disturbances: A network meta-analysis of 43 randomized controlled trials and 32,271 menopausal women.

Sleep Med Rev 2021 Jun 11;57:101469. Epub 2021 Mar 11.

Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address:

This network meta-analysis aimed at investigating efficacy/tolerability of pharmacologic/hormonal interventions for menopausal sleep disturbances. Major databases were searched for randomized controlled trials (RCTs) examining pharmacologic or hormonal interventions with either placebo or active controlled designs. Primary outcomes were improvements in sleep disturbance severity/tolerability (i.e., overall dropout rates), whereas secondary outcome was adverse event-related discontinuation rates. Analysis of 43 RCTs with 25 treatment arms involving 32,271 women during/after menopausal transition (age: 61.24 ± 4.23, duration: 90.83 ± 66.29 wks) showed therapeutic effect of melatonin-fluoxetine [SMD = -2.47 (95% CI:-4.19-0.74)] against sleep disturbances compared to placebo. Subgroup analysis of 15 RCTs on vasomotor symptoms demonstrated superior benefits of gabapentin [SMD = -1.04 (95% CI:-1.90-0.18)], oral combined hormone therapy [SMD = -0.62 (95% CI:-1.06-0.18)], and bazedoxifene-conjugated estrogens [SMD = -0.50 (95% CI:-0.96-0.04)] to placebo/control. Despite benefits of raloxifene-only [SMD = -1.86 (95% CI:-3.09-0.63)] and raloxifene-oral estrogen [SMD = -2.64 (95% CI:-4.64-0.63)], patient selection may be a confounder. Dropout rates were comparable between interventions and placebo/control. Eszopiclone [RR = 3.84 (95% CI: 1.14-12.87)] and oral combined hormone therapy [RR = 2.51 (95% CI: 1.04-6.07)] were associated with higher rates of adverse event-related discontinuation. The results support combined estrogen-progesterone therapy for menopausal sleep disturbances associated with vasomotor symptoms but showed no significant effects of hypnotics in this clinical setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.smrv.2021.101469DOI Listing
June 2021

Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries.

Int J Environ Res Public Health 2021 03 2;18(5). Epub 2021 Mar 2.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain.

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38-4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14-3.22), 4.71 (95%CI = 3.67-6.11), 6.96 (95%CI = 4.95-9.87), 10.59 (95%CI = 7.10-15.80), and 19.89 (95%CI = 11.13-35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18052439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967573PMC
March 2021

Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital.

Ther Adv Psychopharmacol 2021 19;11:20451253211000610. Epub 2021 Mar 19.

University Psychiatric Center KU Leuven, Kortenberg, Belgium.

Aims: This cross-sectional pharmacoepidemiologic study examined the prevalence of polypharmacy and psychotropic polypharmacy among inpatients in a tertiary psychiatric hospital in Belgium.

Methods: Current prescriptions of all inpatients suffering from mental disorders were extracted from the hospital Computerized Physician Order Entry. Two methods were used to examine definitive polypharmacy (defined as the concomitant use of at least five medicines): number of medicines per active component and per prescription. Psychotropic polypharmacy was defined as the concomitant use of at least two psychotropic medicines, based on the first counting, i.e., per active component.

Results: In 292 included patients, the prevalence of definitive polypharmacy was 65.8%, with a mean number of 6.8 ± 4.2 medicines per patient. The most prevalent medicines were related to the central nervous system (55.7%), followed by medicines related to the gastro-intestinal (17.6%) and cardiovascular (9.4%) systems. A prevalence of psychotropic polypharmacy of 78.1% was observed, with a mean of 3.0 ± 1.7 psychotropic medicines per patient. Psychotropic polypharmacy was classified in same-class (71.5%), multi-class (82.5%), augmentation (20.6%), and adjuvant (35.5%) polypharmacy.

Conclusion: These findings are consistent with previous reports of highly prevalent polypharmacy in patients with mental disorders. Although, in some cases, polypharmacy can be an important part of good clinical practice, the high prevalence of both polypharmacy and psychotropic polypharmacy emphasizes that attention must be paid to the potentially associated risks. Consensus on the definition and method of determination of polypharmacy is needed to support further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/20451253211000610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985946PMC
March 2021

Physical multimorbidity and social participation in adults aged ≥65 years from six low- and middle-income countries.

J Gerontol B Psychol Sci Soc Sci 2021 Mar 31. Epub 2021 Mar 31.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.

Objectives: Multimorbidity is common among older adults from low- and middle-income countries (LMICs). Social participation has a role in protecting against negative health consequences, yet its association with multimorbidity is unclear, particularly in LMICs. Thus, this study investigated the relationship between physical multimorbidity and social participation among older adults across six LMICs.

Methods: Cross-sectional, community-based data including adults aged ≥65 years from six LMICs were analyzed from the WHO Study on Global AGEing and adult health (SAGE) survey. The association between 11 individual chronic conditions or the number of chronic conditions (independent variable) and social participation (range 0-10 with higher scores indicating greater social participation) (dependent variable) was assessed by multivariable linear regression analysis.

Results: 14,585 individuals [mean age 72.6 (SD 11.5) years; 54.9% females] were included. Among individual conditions, hearing problems, visual impairment, and stroke were significantly associated with lower levels of social participation. Overall, an increasing number of chronic conditions was dose-dependently associated with lower levels of social participation [e.g., ≥4 vs. 0 conditions ß=-0.26 (95%CI=-0.39, -0.13)]. The association was more pronounced among males than females.

Discussion: Older people with multimorbidity had lower levels of social participation in LMICs. Future longitudinal studies are warranted to further investigate temporal associations, and whether addressing social participation can lead to better health outcomes among older people with multimorbidity in LMICs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/geronb/gbab056DOI Listing
March 2021

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial.

Alzheimers Res Ther 2021 03 30;13(1):70. Epub 2021 Mar 30.

KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

Background: It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities.

Methods: Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (ηp) effect sizes were calculated.

Results: Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η = 0.41), total SPPB (p < 0.001, η = 0.64), SRTT (p<0.001, η = 0.51), MoCA (p<0.001, η = 0.38), and reductions in CSDD (p<0.001, η = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η = 0.05), DQoL (p = 0.012, η = 0.16), and ADL (p = 0.008, η = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team.

Conclusions: The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities.

Trial Registration: ClinicalTrials.gov, NCT04436302.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13195-021-00806-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008333PMC
March 2021

Metformin and health outcomes: An umbrella review of systematic reviews with meta-analyses.

Eur J Clin Invest 2021 Jul 16;51(7):e13536. Epub 2021 Mar 16.

Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.

Background: The objective was to capture the breadth of outcomes that have been associated with metformin use and to systematically assess the quality, strength and credibility of these associations using the umbrella review methodology.

Methods: Four major databases were searched until 31 May 2020. Meta-analyses of observational studies and meta-analyses of randomized controlled trials (RCTs) (including active and placebo control arms) were included.

Results: From 175 eligible publications, we identified 427 different meta-analyses, including 167 meta-analyses of observational studies, 147 meta-analyses of RCTs for metformin vs placebo/no treatment and 113 meta-analyses of RCTs for metformin vs active medications. There was no association classified as convincing or highly suggestive from meta-analyses of observational studies, but some suggestive/weak associations of metformin use with a lower mortality risk of CVD and cancer. In meta-analyses of RCTs, metformin was associated with a lower incidence of diabetes in people with prediabetes or no diabetes at baseline; lower ovarian hyperstimulation syndrome incidence (in women in controlled ovarian stimulation); higher success for clinical pregnancy rate in poly-cystic ovary syndrome (PCOS); and significant reduction in body mass index in people with type 1 diabetes mellitus, in women who have obesity/overweight with PCOS and in obese/overweight women. Of 175 publications, 166 scored as low or critically low quality per AMSTAR 2 criteria.

Conclusions: Observational evidence on metformin seems largely unreliable. Randomized evidence shows benefits for preventing diabetes and in some gynaecological and obstetrical settings. However, almost all meta-analyses are of low or critically low quality according to AMSTAR 2 criteria.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/eci.13536DOI Listing
July 2021

Exercise addiction in athletes: Comparing two assessment instruments and willingness to stop exercise after medical advice.

Psychol Assess 2021 Apr 22;33(4):326-337. Epub 2021 Feb 22.

Department of Neuroscience, University of Padua.

Exercise is overwhelmingly beneficial for physical and mental health, but for some people exercise addiction (EA) can develop and negatively impact an individual. This study sought to (a) compare the latent structure of two instruments assessing EA and (b) examine differences in attitudes toward stopping exercise, if required to on medical grounds, among exercise-addicted and non-addicted athletes. In a cross-sectional study, 1,011 athletes competing at different levels completed an anonymous on-line survey. The survey contained Exercise Dependence Scale-Revised (EDS-R), Exercise Addiction Inventory (EAI), and questions on adherence to medical prescriptions to stop exercise. We tested the latent structure of EDS-R and EAI with multigroup confirmatory factor analyses (CFA), across gender and competition level. Finally, we measured the difference of athletes' attitudes toward stopping exercise, if prescribed by a physician. Both instruments showed good fit indexes, even across gender. CFAs on EAI scores showed some violations of measurement invariance across competition level (ΔCFI = .03; ΔRMSEA = .02). On the contrary, CFAs on EDS-R scores did not show invariance violations across competition level (ΔCFI = <.01; ΔRMSEA = <.01). Finally, athletes who reached thresholds for exercise addiction, by means of EDS-R, were more prone to not follow medical prescriptions to cease exercise, independently of the competition level. These results suggest that athletes' answers on the EDS-R seem to be less affected by competition level, compared to EAI. Moreover, EDS-R outcomes could be used to identify individuals who may be unlikely to cease exercise for medical reasons, independently of their competition level. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/pas0000987DOI Listing
April 2021

Dropout from exercise randomized controlled trials among people with anxiety and stress-related disorders: A meta-analysis and meta-regression.

J Affect Disord 2021 03 6;282:996-1004. Epub 2021 Jan 6.

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.

Objective: . Exercise has established efficacy in people with anxiety and stress-related disorders. Dropouts from randomized controlled trials (RCT's) pose a threat to the validity of the evidence, with dropout rates varying across studies. We conducted a meta-analysis to investigate the prevalence and predictors of dropout rates among adults with anxiety and stress-related disorders participating in exercise RCT's.

Methods: . Two authors searched major electronic databases up to 07/2020. We included RCT's of exercise interventions in people with anxiety and stress-related disorders that reported dropout rates. A random effects meta-analysis and meta-regression were conducted.

Results: . Fourteen RCT's involving 16 exercise interventions (n=369, mean age 20.7 to 67.7years; 38.4% male) were included. The trim-and-fill-adjusted prevalence of dropout across all studies was 22.4% (95%CI = 15.0% to 32.0%). Applying controlled motivation strategies (P<0.001) predicted higher dropout. Supervision during all sessions and by an expert in exercise prescription and applying autonomous motivation strategies predicted lower dropout (all P<0.001). Dropout was similar in exercise versus control conditions (OR = 0.84, 95%CI = 0.54 to 1.29, p = 0.42, I = 0%; N=16).

Limitations: . Potentially important moderators of dropout, such as the severity of mental health symptoms and illness duration were insufficiently available.

Conclusions: . Exercise is well tolerated by people with anxiety and stress-related disorders and drop out in RCT's is comparable to control conditions. Thus, exercise is a feasible treatment, in particular when autonomous motivation strategies are included and when the intervention is delivered by healthcare professionals with expertise in exercise prescription.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.01.003DOI Listing
March 2021

Efficacy and acceptability of different interventions for acrophobia: A network meta-analysis of randomised controlled trials.

J Affect Disord 2021 03 30;282:786-794. Epub 2020 Dec 30.

Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan. Electronic address:

Background: Currently, different psychological interventions have shown significant efficacy in the treatment of acrophobia. However, the superiority of these individual treatments remains unclear. This network meta-analysis (NMA) aimed to investigate the efficacy, acceptability, and superiority of different existing interventions for acrophobia.

Methods: We conducted a NMA of randomised controlled trials (RCTs) and compared the efficacy, acceptability, and superiority of different existing interventions for acrophobia.

Results: In total, 17 RCTs (946 participants) were included in this study. The NMA demonstrated that virtual reality (VR) coach-delivered psychotherapy (standardised mean difference [SMD]=-2.08, 95% confidence interval [CI]: -3.22 to -0.93), in vivo exposure augmented with oppositional action (SMD=-1.66, 95% CI: -2.81 to -0.51), VR exposure therapy with 20 mg cortisol administration (SMD=-1.61, 95% CI: -3.14 to -0.09), VR based cognitive behavioural therapy (VRbasedCBT; SMD=-1.14, 95% CI: -2.22 to -0.05), and in vivo exposure (SMD=-1.02, 95% CI: -1.81 to -0.23) were significantly superior than the placebo/control interventions in improving the symptoms of patients with acrophobia. The NMA further indicated that VR coach-delivered psychotherapy was associated with the best improvement among all the 19 treatments for acrophobia. Furthermore, only VRbasedCBT (odds ratio=2.55, 95% CI: 1.09 to 5.96) was associated with higher dropout rate than the control/placebo.

Limitations: Sample heterogeneity, non-standardised assessment tools, and limited RCTs in some of the treatment arms.

Conclusions: VR coach-delivered psychotherapy could be considered as a first-line intervention for treating acrophobia. However, because of the study limitations, the overall evidence was not sufficiently strong, which warrants future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2020.12.172DOI Listing
March 2021
-->