Reference intervals of aortic pulse wave velocity assessed with an oscillometric device in healthy children and adolescents from Argentina

Age-related reference intervals (RIs) of aortic pulse wave velocity (Ao-PWV) obtained from a large healthy population are lacking in South America. The aims of this study were to determine Ao-PWV RIs in a cohort of healthy children and adolescents from Argentina and to generate year-to-year percentile curves.

Ao-PWV was measured in 1000 healthy subjects non-exposed to traditional cardiovascular risk factors (Age: 10–22 y. o., 56% males). First, we evaluated if RIs for males and females were necessaries (correlation and covariate analysis). Second, mean (M) and standard deviation (SD) age-related equations were obtained for cf-PWV, using parametric regression methods based on fractional polynomials. Third, age-specific (year to year) percentiles curves (for all, males and females children and adolescents) were generated using the standard normal distribution. They were, age-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentile curves and values.

After covariate analysis (i.e., adjusting by age, jugulum-symphysis distance, body weight and height), specific RIs for males and females of children and adolescents were evidenced as necessaries. The equations were

For all subjects:

Ao-PWV_Mean = 4.98 + 12.86x10^?5 Age³.

Ao-PWV_SD = 0.47 + 21.00x10^?6Age³.

For girls:

Ao-PWV_Mean = 5.07 + 10.23x10^?5Age³.

Ao-PWV_SD = 0.50 + 10.00x10^?6Age³.

For boys:

Ao-PWV_Mean = 4.87 + 15.81x10^?5Age³.

Ao-PWV_SD = 0.46 + 22.34x10^?6Age³.

Our study provides the largest database to-date concerning Ao-PWV in healthy children and adolescents in Argentina. Age-related equations (M and SD values) for Ao-PWV are reported by the first time. Specific RIs and percentiles of Ao-PWV are now available according to age and sex for an Argentinian population.     

Cognitive Self-Efficacy and Mental Health Ratings after a Memory Skills Group for Older Veterans with PTSD

Objectives: Mental health factors, such as PTSD, can exacerbate typical age-related cognitive changes and lead individuals to have subjective concerns for which few interventions presently exist. This study evaluates self-reported mental health outcomes following a psychoeducational memory skills program designed for veterans over 50 with subjective memory concerns in the context of PTSD. It was hypothesized that outcomes would improve following program participation and that baseline cognitive self-efficacy would moderate improvements in self-reported depression and life satisfaction.

Methods: Veterans (n = 101, age ≥ 51) participated in an 8-week memory skills program and completed baseline and post-program assessment data as part of a quality improvement project.

Results: Life satisfaction and cognitive self-efficacy demonstrated significant improvement following participation in the memory skills program. Cognitive self-efficacy was found to significantly modify change in depressive symptoms.

Conclusions: We found improvement in mental health outcomes following participation in a psychoeducational memory skills program, with differential impact on depressive symptoms for those with low baseline cognitive self-efficacy.

Clinical Implications: Participation in this intervention led to improved life satisfaction and cognitive self-efficacy. Cognitive self-efficacy, in turn, appeared to have implications for improving depressive symptomology and may be a useful target of memory skills education.     

Harms from a partner’s drinking: an international study on adverse effects and reduced quality of life for women

Background: Partners of heavy drinking individuals can be detrimentally affected as a result of their partner’s drinking.

Objectives: The aim of this study was to identify the proportion of heterosexual intimate partner relationships with a heavy drinking male that resulted in reported alcohol-related harm and to investigate the impact of this on well-being in 9 countries.

Methods: This study used survey data from the Gender and Alcohol’s Harm to Others (GENAHTO) Project on Alcohol’s Harm to Others in 9 countries (10,613 female respondents, 7,091 with intimate live-in partners). Respondents were asked if their partners drinking had negatively affected them as well as questions on depression, anxiety, and satisfaction with life.

Results: The proportion of partnered respondents that reported having a harmful heavy drinking partner varied across countries, from 4% in Nigeria and the US to 33% in Vietnam. The most consistent correlate of experiencing harm was being oneself a heavy episodic drinker, most likely as a proxy measure for the acceptability of alcohol consumption in social circles. Women with a harmful heavy drinking partner reported significantly lower mean satisfaction with life than those with a partner that did not drink heavily.

Conclusions: Harms to women from heavy drinking intimate partners appear across a range of subgroups and impact on a wide range of women, at least demographically speaking. Women living with a heavy drinking spouse experience higher levels of anxiety and depression symptoms and lower satisfaction with life.     

Advance Care Planning Program and the Knowledge and Attitude Concerning Palliative Care

Objectives: The study aimed to evaluate the effects of an advance care planning (ACP) program on knowledge and attitudes concerning palliative care, and decisions regarding DNR orders in the older residents in a long-term care institution.

Methods: A quasi-experimental design was used. Participants were cognitively unimpaired older residents in a long-term care institution in Taiwan. The experimental group (n = 29) received the intervention including an individual interview using an ACP handbook and a group patient education; whereas the control group (n = 28) received the group patient education only.

Results: There were significant positive effects of the ACP program on understanding of DNR and palliative care, willingness to sign a DNR order, and knowledge of and attitude towards palliative care; however, there was no significant effect on willingness to receive palliative care. Six participants signed the DNR order after the intervention compared to none in the control group.

Conclusions: The ACP program can improve knowledge and attitudes towards palliative care in older residents in long-term care institutions.

Clinical Implications: The ACP program could incorporate multiple components, including individual interview using ACP handbook and group patient education, and address knowledge and attitudes towards palliative care.     

Modelling the role of microbial p-cresol in colorectal genotoxicity

Background: A greater understanding of mechanisms explaining the interactions between diet and the gut microbiota in colorectal cancer is desirable. Genotoxic microbial metabolites present in the colon may be implicated in carcinogenesis and potentially influenced by diet.

Aims: We hypothesised that microbial p-cresol is a colonic genotoxin and set out to model potential exposures in the colon and the effects of these exposures on colonic cells.

Methods: Batch culture fermentations with human faecal inoculate were used to determine the synthesis of p-cresol and other metabolites in response to various substrates. The fermentation supernatants were evaluated for genotoxicity and the independent effects of p-cresol on colonic cells were studied in vitro.

Results: In batch culture fermentation, supplementary protein increased the synthesis of phenols, indoles and p-cresol, whereas supplementary fructoligosaccharide (FOS) increased the synthesis of short chain fatty acids. The p-cresol was the greatest predictor of genotoxicity against colonocytes in the fermentation supernatants. Spiking fermentation supernatants with exogenous p-cresol further increased DNA damage, and independently p-cresol induced DNA damage in a dose-dependent manner against HT29 and Caco-2 cells and influenced cell cycle kinetics.

Conclusions: In the colon p-cresol may reach physiologically significant concentrations which contribute to genotoxic exposures in the intestinal lumen, p-cresol production may be attenuated by substrate, and therefore diet, making it a potential modifiable biomarker of genotoxicity in the colon.     

Positive Aging: The Impact of a Community Wellbeing and Resilience Program

Objectives: To test the effect of a community wellbeing intervention, delivered by community partners, on the wellbeing, resilience, optimism, and social connection of older adults in the general population (Study 1) and older adult carers (Study 2), a population at risk for low wellbeing.

Methods: Participants self-selected to take part in an 8-week multi-component wellbeing and resilience program consisting of weekly training sessions, and optional mentoring/peer support. Program participants and a natural control group were compared, post-intervention, on all outcomes of interest.

Results: Intervention participants (Study 1) reported significantly lower scores of social isolation, but no significant difference in wellbeing, optimism, or resilience. Intervention participants (Study 2) showed significantly higher scores on all measured outcomes except social isolation.

Conclusion: These studies point towards the potential benefits of wellbeing interventions for older adult from the general population and older adult carers, when delivered by community partners.

Clinical implications: Early interventions promoting mental health may contribute to reducing the burden of mental health conditions on individuals and the health care system. Studies with more rigorous designs and extended follow-up measurements are required to consolidate these positive initial findings.     

Facilitating Family Life Review during a Relocation to Assisted Living: Exploring Contextual Impact on Family Adjustment

Objectives: The purpose of this study was to explore how contextual aspects of participants’ lives before and throughout relocation to assisted living (ALF) informed family experience of family life review (FLR).

Method: Fourteen families participated in a single FLR session within 6 months of the older adults’ relocation. Semi-structured interviews, conducted one-month following the FLR session, were analyzed using the constant comparative method. Demographic and relational variables provided context for assessing how individual and family dynamics influenced the family relocation process.

Results: Techniques were used during the three phases of FLR (introduction, validation, consolidation) to encourage openness and mutual dialogue between family members. Health-related limitations challenged older adults’ understanding and openness during the FLR. Mental health concerns linked to older adults’ outlook on life, comfort in conversation during the FLR, and reflection of lifelong social ties. Family involvement and dynamics influenced how families communicated about their mutual narrative and the relocation transition.

Conclusion: FLR is an adaptable intervention to assist older adults and their family during a transition to ALF. Although contextual challenges impacted how families experienced the FLR, they enjoyed FLR as a unifying event that promoted mutual understanding.

Clinical Implications: The use of FLR facilitates enhanced understanding and communication during relocation. Older adults’ health status as well as family dynamics need to be assessed prior to organizing a FLR to accommodate each families’ unique needs.     

Dual biological therapy with anti-TNF,vedolizumab or ustekinumab in inflammatory bowel disease: a systematic review with pool analysis

Background: Inflammatory bowel diseases patients eligible for biological therapy represent a group with considerable disease burden and biologics only achieve 40% clinical remission rates in responders after 1 year of therapy.

Aims: To collect all the published data about patients treated with dual biological therapy with an Anti-TNF, vedolizumab or ustekinumab, for a period of at least 3 months and to pool the data about the effectiveness and safety.

Methods: A MEDLINE, and Web of Science search of all studies published in English until 1 January 2019 was conducted.

Results: We included 7 studies with a total of 18 patients. Fifteen patients were treated with a combination of an anti-TNF and vedolizumab, 3 patients were treated with vedolizumab and ustekinumab. Fifty-six percent of patients were affected by Crohn’s disease and 50% of patients were treated with an immunosuppressant drug or steroid too. A clinical improvement was obtained in 100% of patients, and an endoscopic improvement in 93% of patients. No serious adverse events were reported.

Conclusions: The use of dual biological therapy is an attractive therapeutic option and may be an opportunity to better tailor and personalize the therapies for patients. Further studies, as randomized control trials, to provide comparative efficacy and safety endpoints of combination therapies, and to clarify potential advantages of combined biological therapies, are needed.     

The Use of Tablet Technology by Older Adults in Health Care Settings—Is It Effective and Satisfying? A Systematic Review and Meta Analysis

Objectives: This systematic review/meta-analysis examines the potential for older people to accept and use tablet technology in clinical settings by assessing satisfaction and effectiveness.

Methods: A comprehensive literature search was conducted of PubMed, SCOPUS, and CINAHL through March 2017. Inclusion criteria included studies with any clinical use of a tablet technology with a median patient age above 65 years.

Results: We included a total of 12 studies (4 randomized controlled trials, 4 cross-sectional studies, and 4 pre/post studies). Interventions included the use of tablet technology for medication self-management, post-surgery education, memory retention, cognitive rehabilitation, and exercise promotion. The use of tablet technology by older people in clinical settings was associated with high satisfaction with a pooled prevalence of satisfaction of 78%; 95% CI 27–100. We did not find evidence for effectiveness in improving clinical or behavioral outcomes.

Conclusions: Older people can use and are satisfied with table technology in clinical settings. More studies are needed to evaluate the effectiveness of tablet technology at promoting health outcomes.

Clinical Implications: Clinicians should be encouraged to utilize tablet technology in the care of older patients.     

Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy with Older Adults: A Qualitative Review of Randomized Controlled Outcome Research

Objective: Many older adults cope with various chronic physical health conditions, and in some cases, with mental health and/or cognitive difficulties. Mindfulness-based interventions offer an evidence-based, mind-body complementary treatment approach for a wide range of comorbidities, yet most investigations were conducted with young or middle-aged adults. The purpose of this review was to identify randomized controlled trials (RCTs) of two leading mindfulness-based interventions conducted with older adults.

Methods: Our search of five databases identified seven RCT investigations of either Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) conducted exclusively with older adults.

Results: Results generally supported the use of MBSR for chronic low back pain, chronic insomnia, improved sleep quality, enhanced positive affect, reduced symptoms of anxiety and depression, and improved memory and executive functioning. In a sample of older adults exhibiting elevated anxiety in the absence of elevated depression, MBCT effectively reduced symptoms of anxiety.

Conclusions: This review highlights the feasibility and possible benefits of MBSR and MBCT for older adults. Additional large scale RCTs conducted with older adults coping with the range of physical, behavioral, and cognitive challenges older adults commonly face still are needed.

Clinical Implications: MBSR may be a promising intervention for older adults experiencing a variety of health concerns and possibly even cognitive decline. MBCT may reduce geriatric anxiety, although its effects on geriatric depression were not measured.     

Using a Reminiscence-based Approach to Investigate the Cognitive Reserve of a Healthy Aging Population

Objectives: The concept of Cognitive Reserve (CR) has been used to account for brain plasticity in older adults that may underlie the resilience against the effects of aging or pathology on cognitive abilities. This study aims at exploring the proxies of CR in a sample of healthy older adults by analyzing their spontaneous reminiscence through a discourse analysis approach.

Method: Fifteen community-dwelling older adults were asked to participate in a video-recorded, spontaneous reminiscence interview. Interviews were transcribed according to Conversation Analysis, and two judges classified the interview content identifying five main markers of CR: enriched environment, cognitively stimulating activities, education, physical activity, and social interaction.

Results: Reminiscence allowed to identify markers of CR. Sharing stories that are linked to CR markers promote positive emotion, coherent sense of self, and cognitive evaluation of the importance of the social network.

Conclusions: Reminisce looks like a possible approach not only to indirect evaluate the CR, but also to promote it.

Clinical Implications: The reminisce approach can be used as a clinical tool to assess and increase the CR, help the clinical population to experience more positive emotions, maintain a more defined sense of self, and value more the social resources available.     

Lighten UP! A Community-Based Group Intervention to Promote Eudaimonic Well-Being in Older Adults: A Multi-Site Replication with 6 Month Follow-Up

Objectives: Eudaimonic well-being (EWB), increasingly recognized as a critical component of health, typically declines in later life, and there are no existing programs to sustain or increase EWB in older adults. Lighten UP! is an 8-week program to promote EWB through facilitated group sessions in community settings and at-home practice. Building on earlier pilot research, the current study assessed the effect of the Lighten UP! Program using a longitudinal, multi-site design.

Methods: Men and women (N = 169) aged 60 and over were recruited from three Wisconsin communities. EWB, life satisfaction, depression, and diverse aspects of health were assessed before and after the program and at 6-month follow up.

Results: Participants reported significantly increased EWB; these changes were maintained 6 months later. The specific EWB domains of self-acceptance, positive relations, and personal growth showed the most robust gains. Participants also showed significant and sustained declines in depressive symptoms, anxiety, and hostility.

Conclusions: Lighten UP! Program confirmed its positive effects for enhancing EWB in older adults living in multiple community settings.

Clinical Implications: Programs that sustain or enhance EWB in older adults can be expected to yield improvements in diverse aspects of mental and physical health.     

Assessment of Cognitive Training & Social Interaction in People with Mild to Moderate Dementia: A Pilot Study

Objectives: To evaluate the cognitive, neuropsychiatric, and quality of life outcomes of computer-based cognitive training and social interaction on people with mild to moderate dementia.

Methods: Ten individuals with dementia were recruited to complete a cognitive training regimen. They were randomly assigned to a high social interaction (HSI) group (n = 5) and low social interaction (LSI) group (n = 5). Eight of the original 10 participants completed the cognitive training and were evaluated on cognitive abilities, neuropsychiatric symptoms (NPS), and quality of life (QoL).

Results: Mean scores for the HSI group increased on cognitive assessments, where mean scores for the LSI group saw decline, or stability. There was an overall reduction in the frequency and severity of NPS presentation in both the HSI and LSI group. Mixed results were found for mean changes in QoL.

Discussion: These results support the idea of social interaction influencing cognitive outcomes, cognitive training influencing NPS, and both social interaction and cognitive training influencing QoL. The findings illustrate the feasibility and importance of incorporating social activity to computerized cognitive training for people with dementia.

Clinical Implications: Cognitive training that incorporates social interaction may be a promising intervention for individuals with dementia experiencing NPS.     

Self-Compassion,Coping Strategies,and Caregiver Burden in Caregivers of People with Dementia

Objective: Caring for someone with dementia can have negative consequences for caregivers, a phenomenon known as caregiver burden. Coping strategies influence the impact of caregiving-related stress. Specifically, using emotion-focused strategies has been associated with lower levels of burden, whereas dysfunctional strategies have been related to increased burden. The concept of self-compassion has been linked to both positive outcomes and the coping strategies that are most advantageous to caregivers. However, as yet, no research has studied self-compassion in caregivers. Therefore, the aim of this study was to explore the relationship between self-compassion, coping strategies and caregiver burden in dementia caregivers.

Method: Cross-sectional survey data was collected from 73 informal caregivers of people with dementia recruited from post-diagnostic support services and caregiver support groups.

Results: Self-compassion was found to be negatively related to caregiver burden and dysfunctional coping strategies and positively related to emotion-focused coping strategies. Dysfunctional strategies mediated the relationship between self-compassion and caregiver burden, whereas emotion-focused strategies did not.

Conclusion: Caregivers with higher levels of self-compassion report lower levels of burden and this is at least partly due to the use of less dysfunctional coping strategies.

Clinical Implications: Interventions that develop self-compassion could represent a useful intervention for struggling caregivers.     

Telephone-Delivered Cognitive Behavioural Therapy for Treating Symptoms of Anxiety and Depression in Parkinson’s Disease: A Pilot Trial

Objectives: To determine the feasibility, acceptability and initial efficacy of telephone-delivered cognitive behavioral therapy (CBT) for the treatment of anxiety and depressive symptoms in people with Parkinson’s disease.

Methods: A small randomized controlled trial compared telephone-based CBT to waitlist control. Eleven participants aged >50 years with Parkinson’s disease and anxiety and/or depressive symptoms above recommended clinical cut-offs, were randomized to one of two conditions. Participants completed self-report measures of symptom severity and quality of life. Their carers were invited to participate and completed self-reported measures of symptoms and carer burden. At the end of the 10-week intervention period, participants and carers were reassessed on baseline measures, and again one month later.

Results: The CBT program was associated with significantly reduced depressive symptoms (Cohen’s d = .90) at post-treatment with gains maintained at one-month follow-up. Anxiety symptom decreases (Cohen’s d = 0.36) were not statistically different. Waitlist was associated with significantly worsened anxiety. Carer symptoms also reduced with CBT. No changes on quality of life were found. Good acceptability and feedback was received.

Conclusions: Telephone-based CBT reduced symptoms of depression in participants with Parkinson’s disease but not anxiety.

Clinical Implications: Telephone-based CBT is a promising treatment option.     

Urban–rural environmental exposure during childhood and subsequent risk of inflammatory bowel disease: a meta-analysis

Background: The relationship between living conditions in urban and rural areas during childhood and subsequent inflammatory bowel disease (IBD) remains controversial.

Aim: To explore the association between environmental exposures early in life and the subsequent risk of IBD.

Methods: Literature searches were conducted in the following databases: PubMed, EMBASE, and Conference Proceedings Citation Index. Studies were analyzed separately using rate ratios (RRs) or odds ratios (ORs) with 95% confidence intervals.

Results: The search strategy identified 15 studies. Of these, 9 studies explored the association between urban exposure during childhood and ulcerative colitis (UC), and 12 and 4 studies explored this relationship with Crohn’s disease (CD) and IBD, respectively. A meta-analysis showed that the pooled ORs estimated for the case–control studies of UC, CD, and IBD were 1.16 (0.83, 1.61), 1.45 (1.45, 1.85), and 1.34 (1.11, 1.62), respectively. The pooled RR estimated for the cohort studies of CD and IBD was 1.48 (1.17, 1.87). The stratified analysis and meta-regression showed significant relationships between CD and living conditions in case–control studies published during 2010–2017 and in non-European countries (P < 0.05).

Conclusions: Living conditions during childhood are positively associated with the subsequent development of IBD. Urban living environment is more common among those with CD than UC.     

Depression and risky alcohol use: an examination of the role of difficulties regulating positive emotions in trauma-exposed individuals

Background: The co-occurrence of depression and risky alcohol use is clinically relevant given their high rates of comorbidity and reciprocal negative impact on outcomes. Emotion dysregulation is one factor that has been shown to underlie this association. However, literature in this area has been limited in its exclusive focus on emotion dysregulation stemming from negative emotions.

Objectives: The goal of the current study was to extend research by exploring the role of difficulties regulating positive emotions in depression symptom severity, risky alcohol use, and their association.

Methods: Participants were 395 trauma-exposed adults recruited from Amazon’s Mechanical Turk (MTurk) platform (56.20% female, M_age = 35.55) who completed self-report questionnaires.

Results: Zero-order correlations among depression symptom severity, the three subscales of difficulties regulating positive emotions, and risky alcohol use were positive. Two subscales of difficulties regulating positive emotions—nonacceptance of positive emotions and difficulties controlling impulsive behavior when experiencing positive emotions—accounted for the relationship between depression symptom severity and risky alcohol use.

Conclusion: Results suggest the importance of incorporating techniques focused on improving positive emotion regulation skills in interventions for risky alcohol use among individuals with depression.