scholarly journals A critical review of exercise as a treatment for clinically depressed adults: time to get pragmatic

2016 ◽  
Vol 29 (2) ◽  
pp. 65-71 ◽  
Author(s):  
Felipe Barreto Schuch ◽  
Ioannis Dimitrios Morres ◽  
Panteleimon Ekkekakis ◽  
Simon Rosenbaum ◽  
Brendon Stubbs
Keyword(s):  
Antidepressant Treatment ◽  
Current Evidence ◽  
Future Research ◽  
Routine Practice ◽  
Pragmatic Trials ◽  
Exercise Interventions ◽  
Current Evidence Base ◽  
Clinically Depressed ◽  
Comparison Groups ◽  
The Impact

ObjectiveAlthough considerable evidence supports the efficacy of exercise as an antidepressant treatment, critical reviews informing routine practice and future research directions are scarce.MethodsWe critically reviewed exercise studies for clinically depressed adults, focussing on the PICOS criteria referred to participants, interventions, comparisons, outcomes, and study designs.ResultsMost studies have not screened their samples for symptom heterogeneity. Also, they have employed heterogeneous exercise interventions and control groups that may lead to an underestimation of the benefits of exercise. In addition, pragmatic trials allowing scalable replication and implementation in routine practice are scarce. Future studies, can consider the research domain criteria as a diagnostic framework, and conduct moderator analyses to identify depressed subgroups with symptomatology and biopsychosocial characteristics associated with differential responses to exercise interventions. The search for biomarkers of the antidepressant responses to exercise should be prioritised. Further, non-physically active comparison groups should be used to minimise treatment cross-overs and thus the underestimation of the effects of exercise interventions. Finally, the use of outcome measures that maintain their validity at low and moderate levels of symptom severity and the development of trials with a pragmatic design are essential.ConclusionThe current evidence base is fraught with methodological considerations that need to be taken into account in order to increase further our understanding on the impact of exercise as medicine in depression. Future research should include moderator analyses, incorporate biomarker assays, use appropriate control and comparison groups, assess outcomes with psychometrically sensitive measures, and prioritise pragmatic trials towards transition to routine practice.

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals High-Deductible Health Plans and Prevention

2019 ◽  
Vol 40 (1) ◽  
pp. 411-421 ◽  
Author(s):  
Olena Mazurenko ◽  
Melinda J.B. Buntin ◽  
Nir Menachemi
Keyword(s):  
Preventive Services ◽  
Current Evidence ◽  
Future Research ◽  
Health Plans ◽  
Public Health Decision ◽  
Traditional Health ◽  
Research Designs ◽  
Health Decision ◽  
The Impact ◽  
Care Costs

High-deductible health plans (HDHPs) are becoming more popular owing to their potential to curb rising health care costs. Relative to traditional health insurance plans, HDHPs involve higher out-of-pocket costs for consumers, which have been associated with lower utilization of health services. We focus specifically on the impact that HDHPs have on the use of preventive services. We critique the current evidence by discussing the benefits and drawbacks of the research designs used to examine this relationship. We also summarize the findings from the most methodologically sophisticated studies. We conclude that the balance of the evidence shows that HDHPs are reducing the use of some preventive service, especially screenings. However, it is not clear if HDHPs affect all preventive services. Additional research is needed to determine why variability in conclusions exists among studies. We describe an agenda for future research that can further inform public health decision makers on the impact of HDHPs on prevention.

scholarly journals SSRI use in pregnancy: Evaluating the risks and benefits

2015 ◽  
Vol 21 (2) ◽  
pp. 6
Author(s):  
Elsa Du Toit ◽  
Eileen Thomas ◽  
Liezl Koen ◽  
Bavi Vythilingum ◽  
Stoffel Grobler ◽  
...  
Keyword(s):  
Antidepressant Treatment ◽  
Severe Depression ◽  
Evidence Base ◽  
Current Evidence ◽  
Benefit Analysis ◽  
Medication Effects ◽  
Current Evidence Base ◽  
Pregnancy And Lactation ◽  
Potential Risks ◽  
Risk Benefit Analysis

<p>Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy.<span><em> </em></span>Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with concern around potential harmful medication effects on the pregnancy, fetus and infant. Information on potential risks remains extremely varied and inconsistent across sources. This lack of clarity regarding drug safety brings significant uncertainty not only for treating physicians, but also for women seeking information about depression during pregnancy. This review aims to summarise and evaluate the current evidence base and to aid clinicians in performing a risk/benefit analysis for SSRI use during pregnancy and lactation.</p><div> </div>

scholarly journals Encouraging the implementation of clinical standards into practice

2000 ◽  
Vol 24 (3) ◽  
pp. 90-93 ◽  
Author(s):  
Claire Palmer ◽  
Paul Lelliott
Keyword(s):  
Mental Health ◽  
Evidence Base ◽  
Current Evidence ◽  
Routine Practice ◽  
Clinical Standards ◽  
Current Evidence Base

The articles by Geddes & Wessely (2000, this issue) and Lelliott (2000, this issue) describe the current evidence base and guidelines from which clinical standards can be developed in mental health. They highlight some of the issues and complexity surrounding the development of standards. It could be argued, however, that an even greater challenge lies in getting clinical standards used in routine practice.

scholarly journals The Theoretical Framework of the Clinical Pilates Exercise Method in Managing Non-Specific Chronic Low Back Pain: A Narrative Review

Biology ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1096
Author(s):  
Boon Chong Kwok ◽  
Justin Xuan Li Lim ◽  
Pui Wah Kong
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Chronic Low Back Pain ◽  
Early Stage ◽  
Current Evidence ◽  
Future Research ◽  
Low Back ◽  
Exercise Interventions ◽  
Directional Preference

Exercise plays an important role in rehabilitating people with chronic low back pain. Aerobic exercise and resistance training are general exercise strategies to manage chronic low back pain, but these strategies require longer intervention period to achieve clinical outcomes in pain reduction and functional improvements. Directional preference is recognised as an important exercise strategy in managing low back pain. The Clinical Pilates exercise method leverages on the directional preference of an individual to achieve clinical outcomes faster. Clinical Pilates is a hybrid of two of the best exercise interventions for low back pain, which are general Pilates and the McKenzie method. Due to the scarcity of Clinical Pilates literature, a review of its theory and studies was undertaken to provide a structured guide to the technique in managing people with chronic low back pain. Hypothetical algorithms are developed to support translation into clinical practice and future research studies. These algorithms are useful in the management of complex cases involving multiple directional trauma. Although limited, current evidence suggests that the Clinical Pilates exercise method is safe and provides faster functional recovery in the early stage of rehabilitation and similar longer term outcomes as general exercises.

Dementia friendly initiatives: A state of the science review

Dementia ◽  
2017 ◽  
Vol 18 (5) ◽  
pp. 1858-1895 ◽  
Author(s):  
Catherine A Hebert ◽  
Kezia Scales
Keyword(s):  
Interdisciplinary Collaboration ◽  
Well Being ◽  
Evidence Base ◽  
Research Literature ◽  
Current Evidence ◽  
Future Research ◽  
Current Evidence Base ◽  
Centered Care ◽  
State Of The Science

Background Dementia friendly initiatives share similarities with the age-friendly movement in a focus on active engagement and creating a good quality of life for older adults. Dementia friendly initiatives offer a welcoming optimistic narrative in dementia studies by embracing dignity, empowerment, and autonomy to enable well-being throughout the dementia trajectory. Purpose The purpose of this review is to explore the current science of dementia friendly initiatives, identify gaps, and inform future research. Method Quantitative, qualitative, and conceptual/theoretical peer-reviewed dementia friendly research literature were evaluated for their current evidence base and theoretical underpinnings. Results The dementia friendly initiatives research base is primarily qualitative and descriptive focused on environmental design, dementia awareness and education, and the development of dementia friendly communities. Person-centered care principles appear in dementia friendly initiatives centered in care settings. Strong interdisciplinary collaboration is present. Research is needed to determine the effect of dementia friendly initiatives on stakeholder-driven and community-based outcomes. Due to the contextual nature of dementia, the perspective of persons with dementia should be included as dementia friendly initiatives are implemented. Theory-based studies are needed to confirm dementia friendly initiative components and support rigorous evaluation. Dementia friendly initiatives broaden the lens from which dementia is viewed.

What is the impact of physicians in prehospital treatment for patients in need of acute critical care? – An overview of reviews

2019 ◽  
Vol 35 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Gitte Valentin ◽  
Lotte Groth Jensen
Keyword(s):  
Cardiac Arrest ◽  
Systematic Reviews ◽  
Critical Conditions ◽  
Current Evidence ◽  
Cochrane Library ◽  
Future Research ◽  
Success Rates ◽  
Prehospital Treatment ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractObjectivesThe aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement.MethodsThe Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non–physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response.ResultsTen reviews published from 2009 to 2017 were included. Physician treatment was associated with increased survival in patients with out-of-hospital cardiac arrest and patients with severe trauma; in the latter group, the result was based on more limited evidence. The success rate of prehospital endotracheal intubation (ETI) has improved over the years, but ETI by physicians is still associated with higher success rates than intubation by paramedics. In patients with severe traumatic brain injury, intubation by paramedics who were not well skilled to do so markedly increased mortality.ConclusionsCurrent evidence is hinting at a benefit of physicians in selected aspects of prehospital emergency services, including treatment of patients with out-of-hospital cardiac arrest and critically ill or injured patients in need of prehospital intubation. Evidence is, however, limited by confounding and bias, and comparison is hampered by differences in case mix and the organization of emergency medical services. Future research should strive to design studies that enable appropriate control of baseline confounding and obtain follow-up data for the proportion of patients who die in the prehospital setting.

Preventing late-life depression: a clinical update

2010 ◽  
Vol 22 (8) ◽  
pp. 1216-1224 ◽  
Author(s):  
Robert C. Baldwin
Keyword(s):  
Risk Factors ◽  
Primary Prevention ◽  
Depressive Disorder ◽  
Functional Limitation ◽  
Late Life ◽  
Current Evidence ◽  
Secondary Outcome ◽  
Late Life Depression ◽  
Current Evidence Base ◽  
The Impact

ABSTRACTBackground: Achieving remission in late-life depressive disorder is difficult; it is far better to prevent depression. In the last ten years there have been a number of clinical studies of the feasibility of prevention.Methods: A limited literature review was undertaken of studies from 2000 specifically concerning the primary prevention of late-life depressive disorder or where primary prevention is a relevant secondary outcome.Results: Selective primary prevention (targeting individuals at risk but not expressing depression) has been shown to be effective for stroke and macular degeneration but not hip fracture. It may also prove effective for the depression associated with caregiving in dementia. Emerging evidence finds effectiveness for indicated prevention (in those identified with subthreshold depression often with other risk factors such as functional limitation). Despite a number of promising risk factors (for example, diet, exercise, vascular risk factors, homocysteine and insomnia), universal prevention of late-life depression (acting to reduce the impact of risk factors at the population level) has no current evidence base, although a population approach might mitigate suicide.Conclusion: Interventions which work in preventing late-life depression include antidepressant medication in standard doses and Problem-Solving Treatment. When integrated into a care model, such as collaborative care, prevention is feasible but more economic studies are needed.

scholarly journals Marketing to Youth in the Digital Age: The Promotion of Unhealthy Products and Health Promoting Behaviours on Social Media

2016 ◽  
Vol 4 (3) ◽  
pp. 35-49 ◽  
Author(s):  
Sally Dunlop ◽  
Becky Freeman ◽  
Sandra C. Jones
Keyword(s):  
Social Media ◽  
Health Behaviours ◽  
Negative Influence ◽  
Lessons Learned ◽  
Current Evidence ◽  
Future Research ◽  
Policy And Practice ◽  
Media Campaigns ◽  
Health Promoting ◽  
The Impact

The near-ubiquitous use of social media among adolescents and young adults creates opportunities for both corporate brands and health promotion agencies to target and engage with young audiences in unprecedented ways. Traditional media is known to have both a positive and negative influence on youth health behaviours, but the impact of social media is less well understood. This paper first summarises current evidence around adolescents’ exposure to the promotion and marketing of unhealthy products such as energy dense and nutrient poor food and beverages, alcohol, and tobacco on social media sites such as Facebook, Twitter, Instagram and YouTube. We explore emerging evidence about the extent of exposure to marketing of these harmful products through social media platforms and potential impacts of exposure on adolescent health. Secondly, we present examples of health-promoting social media campaigns aimed at youth, with the purpose of describing innovative campaigns and highlighting lessons learned for creating effective social media interventions. Finally, we suggest implications for policy and practice, and identify knowledge gaps and opportunities for future research.

scholarly journals Nitrate levels in drinking water and their impact on the risk of developing gynecological diseases and adverse pregnancy outcomes

2020 ◽  
Vol 19 (1) ◽  
pp. 27-34
Author(s):  
Vasilios Pergialiotis ◽  
Dimitrios Loutradis
Keyword(s):  
Drinking Water ◽  
World Health ◽  
Current Evidence ◽  
Future Research ◽  
Gynecological Diseases ◽  
Fetal Malformations ◽  
Adverse Pregnancy ◽  
Health Organization ◽  
Nitrate And Nitrite ◽  
The Impact

Nitrate is a nitrogen oxoanion formed by loss of a proton from nitric acid. It is an important source of nitrogen which is essential for protein formation. Regular levels of nitrate in the environment do not exceed 2-5 mg/L. Fertilizers, herbicides and pesticides increase, however, the amount of nitrate in drinking water. In 2011 the World Health Organization (WHO) has issued a revised document on nitrate and nitrite levels in drinking water to help establish a common guideline that will help countries. To date, the majority of guidelines on drinking water quality that is directly related to nitrate levels are based in its toxic effect in infants and neonates (primarily the occurrence of methemoglobinemia) and suggest as an arbitrary cut-off the existence of less than 10 mg/L as a measure of safety. Exposure to nitrate levels has been linked to adverse neurodevelopmental effects, fetal malformations and several forms of cancer. However, the associations remain scarce in several fields as the majority of available data is retrieved from articles that investigate the impact of nitrosatable drugs, rather than environmental exposure. In Greece, seven vulnerable regions have been recently identified, following the country`s referral to the Court of Justice by Commission. The aim of the present article is to summarize current evidence and provide recommendations for clinical practice and future research in the field.

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