The Effect of Food Odor Exposure on Appetite and Nutritional Intake of Older Adults with Dementia

Objectives Dementia can lead to decreased appetite and nutritional intake. Food odor exposure has been shown to increase appetite and nutritional intake in young healthy adults. This study investigates the effect of food odor exposure on appetite, nutritional intake and body weight of Dutch nursing home residents with dementia. Design This was a one-armed, non-randomized, non-blinded intervention study consisting of a four-week control period followed by a twelve-week intervention period. Setting Four nursing homes in the Netherlands. Participants Forty-five nursing home residents with dementia. Intervention During the intervention period, odors were dispersed prior to the main meals. Measurements General and specific appetite for sweet and savory foods was measured weekly. Nutritional intake was measured once during the control period and three times during the intervention period through a 3-day food record. Body weight was assessed at the start and end of the control period and at the start, end and halfway the intervention period. Data were analyzed with linear mixed models. Results Small changes in general and specific appetite were observed after odor exposure. Overall energy intake did not change during the first four intervention weeks, but increased during the second and third (+118kcal/d, p=0.003 and +122kcal/d, p=0.004). Protein intake and body weight did not significantly change during the study. Conclusion In this study, no clinically relevant changes in appetite, nutritional intake and body weight were observed after food odor exposure. Future studies should assess the effect of natural food odors and/or meal-tailored odors on nutritional intake of older adults with dementia.

Impact of Classical Counterconditioning (Quiet Kennel Exercise) on Barking in Kenneled Dogs—A Pilot Study

Excessive barking is a major source of noise pollution in dog kennels and negatively impacts welfare. Because resources are often limited, minimizing barking in the simplest and most easily implementable way is imperative. This pilot study implemented a Quiet Kennel Exercise (QKE) that utilized classical counterconditioning to change the dogs’ negative emotional state (which can lead to barking) to a more positive emotional state. Therefore, barking motivation is reduced, so barking should decrease. This study aims to show proof of concept that decreasing barking through classical counterconditioning is effective. It was conducted in one ward of day-time boarding kennels at North Carolina State University College of Veterinary Medicine. Data was collected three times per day and included decibel readings, number of dogs present, and number of dogs barking during a 5-day initial baseline and 10-day intervention period. During baseline, people passing through the ward acted as they normally would. During intervention, passersby were asked to simply toss each dog a treat regardless of the dogs’ behaviors in the kennel. Descriptive results show improvement in maximum level of barking after QKE, fewer dogs barking over time, dogs barking less each time, and the most improvement noted in the afternoon.

Effects of Computer-Based Cognitive Rehabilitation on Attention, Executive Functions, and Quality of Life in Patients with Parkinson’s Disease: A Randomized, Controlled, Single-Blinded Pilot Study

<b><i>Background:</i></b> Cognitive decline in Parkinson’s disease (PD) has become increasingly recognized in recent years, and there is a need to identify methods for cognitive rehabilitation in PD patients. <b><i>Objective:</i></b> The aim of this study was to explore the feasibility and effects of 2 different computer-based cognitive rehabilitation (CBCR) interventions on attention, executive functions, and quality of life (QoL) in PD patients. <b><i>Methods:</i></b> Thirty nondemented PD patients were randomly assigned to one of 3 groups: one passive control group and 2 intervention groups with 2 different CBCR programmes. The intervention period was 8 weeks with follow-up visits in clinic every second week. Before and after the intervention period, patients were tested with a neuropsychological battery of attention, executive functions, and QoL. <b><i>Results:</i></b> Twenty-four patients completed the study. Patients in one of the CBCR groups experienced a significant within-group increase on the primary measures of attention, executive functions, and QoL. However, this effect was not significant between groups. No significant differences were observed for the other CBCR group or the control group. <b><i>Conclusions:</i></b> CBCR is a feasible intervention for cognitive rehabilitation in nondemented PD patients. The effects of training were modest and should be further explored in larger clinical trials. Some CBCR programmes might be more effective than others for PD patients. The protocol for this study was published prospectively at ClinicalTrials.gov on September 18, 2017 with ID: NCT03285347.

Effect of Replacing Vendor QTc Alerts with a Custom QTc Risk Alert in Inpatients

Objective The aim of the study is to implement a customized QTc interval clinical decision support (CDS) alert strategy in our electronic health record for hospitalized patients and aimed at providers with the following objectives: minimize QTc prolongation, minimize exposure to QTc prolonging medications, and decrease overall QTc-related alerts. A strategy that was based on the validated QTc risk scoring tool and replacing medication knowledge vendor alerts with custom QTc prolongation alerts was implemented. Methods This is a retrospective quasi-experimental study with a pre-intervention period (August 2019 to October 2019) and post-intervention period (December 2019 to February 2020). The custom alert was implemented in November 2019. Results In the pre-implementation group, 361 (19.3%) patients developed QTc prolongation, and in the post-implementation group, 357 (19.6%) patients developed QTc prolongation (OR: 1.02, 95% CI: 0.87–1.20, p = 0.81). The odds ratio of an action taken post-implementation compared with pre-implementation was 18.90 (95% CI: 14.03–25.47, p <0. 001). There was also a decrease in total orders for QTc prolonging medications from 7,921 (5.5%) to 7,566 (5.3%) with an odds ratio of 0.96 (95% CI: 0.93–0.99, p = 0.01). Conclusion We were able to decrease patient exposure to QTc prolonging medications while not increasing the rate of QTc prolongation as well as improving alert action rate. Additionally, there was a decrease in QTc prolonging medication orders which illustrates the benefit of using a validated risk score with a customized CDS approach compared with a traditional vendor-based strategy. Further research is needed to confirm if an approach implemented at our organization can reduce QTc prolongation rates.

Assessment of Technological Interventions in Farm Women Empowerment

Women play an important role in agriculture. There is a need to empower these farm womento improve their overall wellbeing. An attempt was made to assess the impact oftechnological interventions in terms of participation of farm women in farming activities,change in drudgery involved, involvement in decision making and other attributes relatedto empowerment in North 24 Parganas district of West Bengal involving 110 farm families.The results reveal that there is significant increase in participation in all the selected farmingactivities in post intervention period. Majority of the farm women participated in decisionmaking always in activities like drying (95%), weeding (70%) and storing (70%) in thepost intervention period. The mean drudgery score had also decreased for all the activities,the higher decrease was observed in case of retting (1.525) followed by sowing (1.225).Among the personal attributes studied, the highest difference level in mean was attained incase of self-confidence (2.45) followed by decision making ability (2.15). The present studyclearly indicate that special emphasis on women friendly technologies can make a hugechange in their existing status in agriculture by improving their participation in farmingactivities, decision making ability and self-confidence.

ANXIETY AND DEPRESSION IN CHILDREN AND ADOLESCENTS WITH CONGENITAL HEART DISEASE BEFORE AND AFTER SURGICAL INTERVENTION PERIOD

Objective: To evaluate the level of anxiety and depression in children and adolescents with congenital heart disease in pre and post-surgical intervention period. Study Design: Quasi experimental study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: After written informed consent from parents and approval of hospital ethical committee 152 children and adolescents with congenital heart disease were included in the study. Demographic and clinical data was recorded on relevant proforma. In addition to clinical assessment the level of anxiety and depression were objectively measured with the help of Urdu version of Hospital Anxiety and Depression Scale by the mental health specialist a day before and 15 days after surgery. Results: The mean age of participants was 14.5 ± 3.3 years. Out of 152 participants, 80 (52.6%) were females, while 72 (47.4%) were males. Level of anxiety and depression was found higher in the preoperative period being 44 (28.9%) and 52 (34.2%) which dropped significantly in the postoperative period to 16 (10.5%) and 8 (5.3%) respectively. Majority of the patients had Tetralogy of Fallot i.e., 52 (34.2%) followed by Ventricular Septal Defect in 24 (15.7%) and Atrial Septal Defect in 18 (11.2%). Females were more likely to have depression than males (p-value=0.01). Conclusion: We found significant decrease in anxiety and depression in the postoperative period.

Can Public Health Interventions Change Immediate and Long-Term Dietary Behaviours? Encouraging Evidence from a Pilot Study of the U.K. Change4Life Sugar Swaps Campaign

The aim of this pilot study was to evaluate the effectiveness of the U.K. Change4Life Sugar Swaps campaign for improving nutritional intake in a small sample of families prior to the 2015 nationwide launch. A total of 49 participants from 14 families received information and materials during a two-week intervention period in November 2014 encouraging them to swap high sugar foods and drinks for low sugar alternatives. Daily dietary intake was reported with online food diaries over four stages, each two weeks in length: (i) baseline (no information provided), (ii) intervention when Sugar Swaps materials were accessible, (iii) immediate follow-up, and (iv) one year on from baseline. Data were analysed for sugar, glucose, fructose, sucrose, lactose, fat, saturated fat, carbohydrate, protein, salt, fibre, vitamin C, and energy. During the intervention, significant daily reductions of 32 g sugar, 11 g fat, and 236 kcal for each family member were observed, among others, and 61% of benefits achieved during the intervention period were maintained at immediate follow-up. Encouragingly, for children, reductions in sugar, sucrose, fat, saturated fat, carbohydrate, and energy were observed one year on. The Sugar Swaps Campaign is potentially an effective public health intervention for improving short- and long-term dietary behaviour for the whole family.

Treatment of Dysphagia with Biofeedback and Functional Electrical Stimulation in a Patient with Wallenberg Syndrome: A Prospective Case Report

Biofeedback games and automated functional electrical stimulation (FES) can be used in the treatment of dysphagia. This case study aims to evaluate the effect of the treatment on a 77-year-old man with chronic Wallenberg syndrome and his and the therapist’s experiences when using this therapy form. The participant received intensive treatment for nine days with Facial Oral Tract Therapy, biofeedback games and FES. The Penetration Aspiration Scale was scored using Functional Endoscopic Evaluation of Swallowing at baseline and the end of the intervention period. Swallowing-specific parameters were measured daily, and interviews were conducted with the patient and therapist during the intervention period. The patient and therapist both expressed a positive attitude to the ease of use and usefulness of this technology, despite there being no measurable change in the participant’s swallowing and eating function and only small improvements in swallowing parameters. The experience from this study was that biofeedback games and FES gave only small improvements in swallowing for this participant but were motivating and easy to use. Further research is needed to investigate the effect of this therapy on other participants with a more robust research design.

Healthy Mind Healthy You: An Online Study Comparing Standard Mindfulness-Based Cognitive Therapy with a Brief Mindfulness Program to Improve Well-Being (Preprint)

BACKGROUND Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. OBJECTIVE The purpose of this study was to compare standard with brief mindfulness training to improve overall well-being. METHODS Participants were recruited from 17 Patient-Powered Research Networks, online communities of stakeholders interested in a common area of research. Participants were randomized to either a standard 8-session mindfulness based cognitive therapy (MBCT) or a brief 3-session mindfulness training intervention accessed online. Participants were followed for 12 weeks. The primary outcome of the study was well-being as measured by the World Health Organization (WHO)-5 Index. We hypothesized that MBCT would be superior to brief mindfulness training. RESULTS We randomized 4,411 participants, 88% of whom were white and 80% female sex assigned at birth. Baseline WHO-5 score mean was 50.3 (SD = 20.7). Average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks) (model-based slope [95% CI] for MBCT group: 0.78 [0.63, 0.93]; brief mindfulness group: 0.76 [0.60, 0.91]) as well as the full study period (i.e., intervention plus follow-up; baseline to 20 weeks) (model-based slope [95% CI] for MBCT group: 0.41 [0.34, 0.48]; brief mindfulness group: 0.33 [0.26, 0.40]). Change in self-reported well-being was not statistically significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes [95% CI]: -0.02 [-0.24, 0.19], P = .80) or during the intervention period plus 12-week follow-up (-0.08 [-0.18, 0.02], P = .10). During the intervention period, younger participants (P = .05) and participants who completed a higher percentage of intervention sessions (P = .005) experienced greater improvements in well-being across both interventions, effects that were stronger for participants in the MBCT condition. CONCLUSIONS Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. Younger patients and those able to complete more training sessions improved the most. CLINICALTRIAL ClinicalTrials.gov, NCT03844321, https://clinicaltrials.gov/ct2/show/NCT03844321

Long-term effects of the use of a step count-specific smartphone application on physical activity and weight loss: a randomized clinical trial (Preprint)

BACKGROUND Some studies on weight loss promotion using smartphone applications (smartphone app) including mobile applications have shown a weight loss effect, but not an increase in physical activity, and they have not been rigorously examined for longer periods. OBJECTIVE To assess whether the use of a smartphone app will increase physical activity and reduce body weight. METHODS In this parallel randomized clinical trial, participants recruited between April 2018 and June 2019 were randomized in equal proportions to a smartphone app group (n=55) or control group (n=54). The intention-to-treat approach was used to analyze the data from December 2019 through November 2021. Before the intervention, an hour-long lecture on weight loss instruction and increasing physical activity was conducted once for both groups. Participants in both groups were instructed to weigh themselves immediately after waking up at least once daily from the start of the intervention. Monthly e-mails were sent advising the participants on how to lose weight and increase physical activity in order to maintain or increase motivation in both groups. Participants in the smartphone app group were instructed to launch the app at least once a day to check their step count and rank. The primary outcome was daily accelerometer-measured physical activity (step count) and secondary outcomes was body weight. RESULTS The 109 participants had a mean (standard deviation) age of 47 (8) years. At baseline, the mean (standard deviation) daily total steps were 7259 (3256) for the smartphone app and 8243 (2815) for control groups, respectively. After the 32-week intervention period, the step count per wear time was significantly higher in the smartphone app group than in the control group [average difference (95%CI): 65 (30 to 101) vs. -9 (-56 to 39), p=0.042]. The weight loss was -2.2 kg (-3.1%) in the smartphone app group and -2.2 kg (-3.1%) in the control group, with no significant difference between the groups. During the intervention period, the step count per wear time on Saturdays [615 (545 to 684) vs. 554 (483 to 624), p=0.006] and Sundays [623 (553 to 694) vs. 556 (485 to 627), p=0.004] was significantly higher in the smartphone app group than in the control group. CONCLUSIONS In this trial, the smartphone app group showed increased physical activity, especially on weekends. However, this increased physical activity did not lead to weight loss. CLINICALTRIAL UMIN000033397 https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000037956&type=summary&language=J