Marion Gray

Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review.

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

The emerging story of disability associated with lymphatic filariasis: a critical review.

Globally, 40 million people live with the chronic effects of lymphatic filariasis (LF), making it the second leading cause of disability in the world. Despite this, there is limited research into the experiences of people living with the disease. This review summarises the research on the experiences of people living with LF disability. The review highlights the widespread social stigma and oppressive psychological issues that face most people living with LF-related disability. Physical manifestations of LF make daily activities and participation in community life difficult. The findings confirm the need for the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support morbidity management activities that address the complex biopsychosocial issues that people living with LF-related disability face.

Analysis of iron, zinc, selenium and cadmium in paraffin-embedded prostate tissue specimens using inductively coupled plasma mass-spectrometry

Formalin-fixed paraffin-embedded (FFPE) tissue specimens represent a valuable and abundant resource of pathologic material for various biomedical studies. In the present study, we report the application of high-resolution inductively coupled mass-spectrometry (ICP-MS) for quantification of Fe, Zn, Se and Cd in FFPE prostate tissue. These elements have a possible role in the development of prostate diseases: while Zn and Se are needed for a healthy prostate, Cd shows multiple toxic and carcinogenic effects. Excessive accumulation of Fe induces the production of highly reactive hydroxyl radical species, which may play a role in cancer etiopathogenesis. To assess whether the levels of these metals in the FFPE prostate tissue represent their original content, we compared their levels with those in the fresh tissue (on dry weight basis) in samples obtained from 15 patients. We found that in FFPE tissue, the recoveries of Se, Fe, Cd and Zn were progressively decreased, 97+/-11% (r=0.88), 82+/-22% (r=0.86), 59+/-23% (r=0.69) and 24+/-11% (r=0.38), respectively. Thus, the use of correction factors, determined as k=0.16 for Se, k=0.20 for Fe, k=0.27 for Cd and k=0.67 for Zn, is required to estimate the retrospective levels of these elements in the parental non-processed fresh (wet) prostate tissue. The technique used in this study enables the analysis of archival FFPE prostate tissue for the concentrations of Fe, Zn, Se and Cd to study association between the levels of these metals and prostate disease.

Baby boomers' use and perception of recommended assistive technology: a systematic review.

Purpose. The objective of this article is to review published studies to describe issues and quality of evidence surrounding assistive technology (AT) use by the baby boomer generation. As the baby boomer generation are ageing, they represent a new era for aged health care. In terms of helping this generation maintain independence, it is expected that there will be an increased demand for AT. Method. A systematic literature search of Medline, CINAHL and Cochrane was undertaken. Selected studies were critically appraised using a previously validated tool. Inclusion criteria were: research related to AT use by a population which includes baby boomers; published in peer-reviewed journals and full-text English language articles. Studies were based in acute rehabilitation units in the USA and Australia. Frequency of use and patient satisfaction surveys were the main outcome measures. Results. A total of 11 eligible studies were reviewed. All were cross-sectional. Many studies indicated a significant rate of AT non-use; use rates ranged from 35% to 86.5%. Numerous factors influencing use were proposed. Study quality was upper-mid range. Conclusions. Baby boomers will place more demand on AT in the future. There is a need for high-quality research to verify current findings and highlight AT issues specific to this generation.

Extended roles for allied health professionals: an updated systematic review of the evidence

Background Internationally, health care services are under increasing pressure to provide high quality, accessible, timely interventions to an ever increasing aging population, with finite resources. Extended scope roles for allied health professionals is one strategy that could be undertaken by health care services to meet this demand. This review builds upon an earlier paper published in 2006 on the evidence relating to the impact extended scope roles have on health care services. Methods A systematic review of the literature focused on extended scope roles in three allied health professional groups, ie, physiotherapy, occupational therapy, and speech pathology, was conducted. The search strategy mirrored an earlier systematic review methodology and was designed to include articles from 2005 onwards. All peer-reviewed published papers with evidence relating to effects on patients, other professionals, or the health service were included. All papers were critically appraised prior to data extraction. Results A total of 1,000 articles were identified by the search strategy; 254 articles were screened for relevance and 21 progressed to data extraction for inclusion in the systematic review. Conclusion Literature supporting extended scope roles exists; however, despite the earlier review calling for more robust evaluations regarding the impact on patient outcomes, cost-effectiveness, training requirements, niche identification, or sustainability, there appears to be limited research reported on the topic in the last 7 years. The evidence available suggests that extended scope practice allied health practitioners could be a cost-effective and consumer-accepted investment that health services can make to improve patient outcomes.

Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer's disease: a randomised controlled trial

OBJECTIVE the aim of this study was to compare the effects of a functional tasks exercise programme to a cognitive training programme in older adults with mild cognitive impairment. DESIGN a single-blind randomised control trial with the intervention group compared with an active control group. SETTING out-patient clinic. PARTICIPANTS older adults with mild cognitive impairment (n = 83) aged 60 and older living in the community. METHODS participants were randomised to either a functional task exercise group (n = 43) or an active cognitive training group (n = 40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test. RESULTS the functional task exercise group showed significant between-group differences in general cognitive functions, memory, executive function, functional status and everyday problem solving ability. The improvements were sustained over time at 6-month follow-up. CONCLUSION a functional tasks exercise programme is feasible for improving cognitive functions and functional status of older adults with mild cognitive impairment. This may serve as a cost-effective adjunct to the existing interventions for populations with mild cognitive impairment. TRIAL REGISTRATION NUMBER ACTRN12610001025022.

Prostate cancer outcome and tissue levels of metal ions.

There are several studies examining prostate cancer and exposure to cadmium, iron, selenium, and zinc. Less data are available on the possible influence of these metal ions on prostate cancer outcome. This study measured levels of these ions in prostatectomy samples in order to examine possible associations between metal concentrations and disease outcome.

A critical review of the evidence on the use of videotapes or DVD to promote patient compliance with home programmes

Purpose. The purpose of this paper is to critically review published research in order to evaluate the evidence surrounding the provision of video or DVD technology to promote patient compliance with home exercise or health programmes. Method. A literature search of the MEDLINE, CINAHL and Cochrane databases was undertaken. Critical appraisal of selected studies was undertaken using a previously validated tool. Inclusion criteria were: research related to DVD or videotape technology to improve compliance; published in peer-reviewed journals and full-text English language articles. Compliance was the main outcome measure. Results. Eleven eligible studies were reviewed. All but one, which used a before–after design, were randomised controlled trials. Study quality tended medium to high in the critical appraisal scoring system, but an overall low quality on the Jadad score for randomisation; with only one study from 11 scoring well on both these measures. Research into the use of video or DVD showed mainly positive effects on compliance; however, methodological issues limit clinical applicability. Conclusions. Future well-designed randomised controlled trials with adequate sample sizes and reliable outcome measures will provide clearer evidence into the effectiveness of this technology in improving home exercise or health programme compliance, particularly for rural and remote populations.

A Systematic Review of Occupational Therapy Interventions With Homeless People

ABSTRACT A systematic review of the occupational therapy literature 1990–2008 was undertaken with the aim to assess the quality of evidence that supports the role of occupational therapy with homeless people. Forty articles were initially identified and critically appraised, including 16 research studies. Seven quantitative articles were included in this review and demonstrated the effectiveness of occupational therapy in providing interventions that increase employment and education prospects, money management, coping skills, and leisure activities. The literature suggests that occupational therapy has an appropriate role with people experiencing homelessness.

The functional impact of a traumatic hand injury on people who live in rural and remote locations

Purpose. This study aimed to gain an understanding of the functional impact of a traumatic hand injury on a rural and remote Australian population. Method. A retrospective, exploratory design was used. Patients who had experienced a traumatic hand injury were samples and were treated at the occupational therapy department at a major regional Australian hospital between January 2003 and February 2007 (n = 198). A mail-out survey was utilized, with 65 respondents included in the study. Questions focused on the impact on specific areas of occupational performance and on compliance to home exercises. The upper extremity functional index was also incorporated in the survey. Results. The results revealed that almost 90% of survey respondents had residual difficulties as a result of the traumatic hand injury. The overall impact these difficulties have on ‘day-to-day’ life was moderate to extreme for over half of the respondents. In the areas of occupational performance, the most affected were work and leisure with less impact reported in self-care and rest. Comments were at times contrary with closed question data, with many respondents expressing relative satisfaction with their outcome despite highlighting the functional difficulties. Conclusion. A significant impact on occupational performance has been highlighted, which reflects common issues within this rural and remote population. Confirmation of the extent of these identified issues within the larger rural and remote Australian population will contribute to the formulation of policy and consequent improvements in health for this traditionally underserved population.