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Cognitive impairment, depressive symptoms, and demographic characteristics of care home residents living with dementia in six countries
Get PDF© 2025 NORCE Research AS. Published by
Informa UK Limited, trading as Taylor &
Francis Group. his is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unre stricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the
posting of the Accepted Manuscript in a repository by the author(s) or with their consent.OBJECTIVES: As the prevalence of dementia and depression continues to increase globally, understanding the interplay between these conditions becomes important for effective diagnosis, treatment, and tailoring of interventions. We investigate the relationship between depressive symptoms and cognitive impairment and the potential role of sociodemographic characteristics, among care home residents in Australia, Germany, the Netherlands, Norway, Türkiye, and the United Kingdom. METHOD: The study used baseline data from an international cluster-randomised controlled trial comprising 1021 residents with dementia and depressive symptoms in 86 care home units. The relationship between cognitive impairment and depressive symptoms was investigated using linear mixed effects models, with country, age, sex, marital status, and education level as possible predictors. RESULTS: Higher severity of cognitive impairment was related to more severe depressive symptoms in all countries. The association was especially strong in Türkiye. Marital status was a significant predictor for depressive symptoms and education level predicted cognitive ability. CONCLUSION: Findings confirm that lower cognitive ability is associated with more depressive symptoms across different contexts in a large international sample. As thresholds to long-term care are likely to be set even higher in the future, interventions to alleviate depressive symptoms among older adults with dementia become even more important.https://www.tandfonline.com/doi/full/10.1080/13607863.2025.2551788?src=exp-l
The Effects of Protein Nutrition on Muscle Function in Critical Illness: A Systematic Review and Meta-Analysis.
Get PDFBACKGROUND: owing to altered protein metabolism during crtical illness, skeletal muscles are utilised as a source of protein, with subsequent debilitating effects on both muscle structure and function. Protein nutrition has been shown to improve clinical outcomes in critically unwell patients; however, the impact on muscle function is less established. Therefore, the aim of this review was to systematically determine the effect of protein dose on skeletal muscle strength in critically ill patients. METHODS: we searched five databases (Ovid MEDLINE, Embase, Emcare, CINAHL, and PubMed) and clinical trial registers for randomised controlled trials (RCTs) of non-pregnant, adult patients admitted to an intensive care unit (ICU), which assessed the impact of different doses of protein nutrition on muscle strength. Studies investigating only muscle structure or with co-interventions were excluded. Six RCTs were eligible for inclusion, and five were suitable for meta-analysis. RESULTS: there was a significant difference in skeletal muscle strength with higher versus lower protein intakes, with a mean difference of 2.36 kg (95% CI: 0.37-4.35). The mean difference in protein dose was 0.46 g/kg/d (95% CI: 0.29-0.64). Inconsistency was evident across the included studies, with risk of bias ranging from moderate to high. CONCLUSION: muscle strength of ICU patients does appear to be affected by different protein doses. However, trials focusing on muscle function are limited by number and quality, highlighting a clear need for future work
Empagliflozin Treatment for Non-alcoholic Fatty Liver Disease in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Get PDFEmpagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, has emerged as a promising therapeutic option for patients with concurrent type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). This systematic review and meta-analysis evaluated the efficacy of empagliflozin on liver enzymes and metabolic parameters in this dual-pathology population. A comprehensive search was conducted across PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases from inception to July 2025. Randomized controlled trials (RCTs) comparing empagliflozin with placebo in adults with T2DM and NAFLD were included. Primary outcomes included changes in liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT)), while secondary outcomes comprised systolic blood pressure (SBP) and glycated hemoglobin (HbA1c) levels. Four studies met the inclusion criteria, encompassing 393 participants (206 empagliflozin, 187 control) with follow-up periods ranging from 20 to 24 weeks. Meta-analysis demonstrated significant reductions in ALT (mean difference (MD): -11.61; 95% confidence interval (CI): -19.18 to -4.04), AST (MD: -10.31; 95% CI: -15.41 to -5.21), and GGT levels (MD: -15.19; 95% CI: -18.13 to -12.25) with empagliflozin treatment compared to placebo. However, no statistically significant differences were observed for SBP (MD: -0.87; 95% CI: -7.93 to 6.20) or HbA1c (MD: -0.44; 95% CI: -1.10 to 0.22). Considerable heterogeneity was noted across studies for most outcomes. These findings suggest that empagliflozin offers hepatoprotective benefits in patients with concurrent T2DM and NAFLD, primarily through significant improvements in liver enzyme profiles. However, larger long-term studies with histological endpoints are needed to establish definitive clinical recommendations for this therapeutic approach
Supporting qualitative practitioner research in child and adolescent mental health
No full textThis editorial piece addresses the relationship between clinical practice and qualitative research in child and adolescent mental health. We outline some guiding assumptions informing the development of a practice orientated research 'lab' which focusses on child and adolescent mental health and child welfare research with ethnographic and psychosocial methodologies. We consider cascading effects of practitioner-initiated research, where skills and ambitions for a 'bottom up' research culture can help professionals embed research-minded practice in services. We also address the role of researcher and methodological reflexivity in research that is close to the social and emotional complexity of practice. We suggest 'labs' for such practice-near research generate opportunities for clinical ideas to be examined more effectively as they are resituated outside of the clinic for the purposes of research; furthermore such research can support critical awareness of the socially and historically contingent quality of methods and practices.https://www.cambridge.org/core/journals/irish-journal-of-psychological-medicine/article/supporting-qualitative-practitioner-research-in-child-and-adolescent-mental-health/9FED98E9447BA11EE334C3F998C487B
Lipodermatosclerosis: from pathophysiology to treatment
No full textLipodermatosclerosis (LDS), also known as sclerosing panniculitis, is a chronic inflammatory condition of the skin and subcutaneous tissue caused by longstanding venous insufficiency. Often misdiagnosed as cellulitis due to overlapping clinical features, it requires accurate diagnosis and a multifaceted management approach. This clinical review explores the epidemiology, pathophysiology, clinical presentation, diagnostic challenges and management strategies for LDS. Acute LDS manifests with erythema and induration similar to cellulitis, while chronic LDS is characterised by fibrosis and skin tightening. Key management strategies include compression therapy, lifestyle modifications and interventions targeting venous insufficiency. Challenges such as delayed diagnosis, poor adherence to therapy and limited evidence for systemic treatments may compromise the quality of patient care. Future directions emphasise novel therapeutic approaches, evaluation of current treatments and the integration of artificial intelligence to enhance diagnostic decisions. Increased clinician awareness and research into the epidemiology, pathogenesis and treatment of LDS remain essential to improve patient outcomes.https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2024.044
Cognitive and neuroimaging for neurodegenerative disorders : a cohort study design with initial findings [In Press]
No full textIntroduction: Dementia presents with significant heterogeneity across age groups, particularly in early-onset cognitive decline (EOCD), which poses diagnostic and management challenges. The Cognitive and Neuroimaging for Neurodegenerative Disorders (CogNID) study aims to characterise clinical, cognitive, neuroimaging, and biomarker features across a diverse cohort of individuals with cognitive impairment, with a focus on diagnostic complexity, biomarker utility, and mortality. Methods: Out of 680 study participants within this prospective cohort enrolled from the real-world clinics within the National Health Service, who consented to take part in the study, we analysed data from 429 individuals recruited between December 2018 and November 2024 from the Memory Clinics, including the young-onset dementia service and associated services. Participants underwent structured cognitive assessments, neuroimaging (MRI/CT), and Cerebrospinal fluid (CSF) biomarker evaluation, where available. Diagnoses were made by multidisciplinary consensus. Group comparisons were conducted between early-onset (EOCD, <65 years) and late-onset cognitive decline (LOCD, ≥65 years). Results: Of the 429 participants, 349 (81.4%) had EOCD and 80 (18.6%) had LOCD. The mean age was 60.05 years, with no significant difference in sex or ethnicity across groups. Depression and anxiety were common (29.6%), as were cardiovascular risk factors. Lumbar punctures were more frequently performed in EOCD (p = 0.03), with 36.4% of tested participants demonstrating biomarker profiles consistent with Alzheimer’s disease (A+T+). Functional cognitive disorder (FCD) was more common in EOCD (22.3% vs. 5.0%, p < 0.001). Subgroup analysis revealed significantly lower ACE-III scores and higher pathological CSF findings in Alzheimer’s disease versus FCD. Mortality was higher in the LOCD group (11.3% vs. 4.6%, p = 0.03). Conclusion: The CogNID study highlights the clinical and diagnostic heterogeneity of individuals with cognitive impairment, particularly in younger adults. Incorporating neuroimaging and CSF biomarkers into routine clinical pathways enhances diagnostic precision and reveals distinct phenotypic profiles between EOCD and LOCD. These findings underscore the need for harmonised diagnostic protocols, broader biomarker accessibility, and inclusive recruitment strategies in dementia research and clinical services.https://www.medrxiv.org/content/10.1101/2025.05.19.25327923v
Optimising access to vocational rehabilitation through multiple sclerosis charities : protocol for a feasibility randomised controlled trial
No full text© 2025 De Dios Pérez et al. This is
an open access article distributed under the
terms of the Creative Commons AttributionBackground People with multiple sclerosis (MS) often leave the workforce prematurely due to MS symptoms and difficulties managing workplace relationships and performance. Vocational rehabilitation (VR) can improve job retention outcomes for people with MS, but there is a lack of evidence on the effectiveness of these interventions. Methods A multicentre, feasibility, parallel-group randomised controlled trial (RCT) comparing a job retention VR intervention plus usual care (n = 30) with usual care alone (n = 30). This study includes an embedded mixed-methods process evaluation. People with MS, aged 18–65 years, in paid employment will be recruited from MS charities. Participants with MS will be able to include their employers in the intervention to receive information about MS and employment. The intervention involves an initial interview and up to 10 hours of employment support for people with MS and up to four hours of support for employers, over six months. Employees from MS charities will be recruited and trained to deliver the MSVR intervention. Participants will be followed up by postal/telephone/online questionnaires at 6-, 9-, and 12-months post-randomisation. The aim is to ascertain the feasibility and acceptability of delivering the intervention within MS charities, and to determine parameters for future trial and explore the acceptability of the study intervention and procedures. Discussion This novel study will provide insight into how existing services from MS charities can fill a service gap by providing employment support to people with MS. Findings will inform the design of a future fully powered RCT. Trial registration number ClinicalTrials.gov NCT06966115.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.032557
Barriers and facilitators to using standardised diagnostic assessments in child and adolescent mental health services : a qualitative process evaluation of the STADIA trial
Get PDF© The Author(s) 2025. This article is licensed under a Creative Commons Attri bution 4.0 International License, which permits use, sharing, adapta tion, distribution and reproduction in any medium or format, as long
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copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The STADIA trial aimed to assess the effectiveness of a standardised diagnostic assessment tool (Development and Wellbeing Assessment, DAWBA) in aiding clinician-made diagnosis decisions in Child and Adolescent Mental Health Services (CAMHS). This study reports the qualitative process evaluation of the STADIA trial, which aimed to identify barriers and facilitators to using the online-completed DAWBA in CAMHS. Qualitative data were collected through 109 semi-structured interviews with young people, parents/carers, healthcare professionals and service commissioners/funders in 8 CAMHS sites across England. Deductive thematic analysis was guided by the domains of the Consolidated Framework for Implementation Research. Young people and parents/carers showed high levels of engagement with the DAWBA. They perceived a validation of symptoms from the generated DAWBA report, which they actively used as 'evidence' when seeking help from other services. Clinicians involved in determining referral acceptance/rejection decisions were positive about its use and saw benefits in aiding decision-making. In contrast, however, barriers to clinicians engaging with the DAWBA report during the assessment stage arose from limited awareness and accessibility to the report, a context of high workload and pressure, and general concerns about the value of a diagnosis. The DAWBA was not widely used by clinicians in the expected way to aid diagnostic decision-making. However, it may offer children and young people much-needed engagement during long waiting times for initial assessment in CAMHS. The DAWBA may be more acceptable to clinical teams in triaging referrals to help with timely decisions about the most suitable services.Trial registration ISRCTN15748675 (29/05/2019).https://link.springer.com/article/10.1007/s00787-025-02678-
Sexual and reproductive health needs of women with severe mental illness in low- and middle-income countries: A scoping review
Get PDF© 2025 Sisodia et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.BACKGROUND: This scoping review aimed to understand the extent and type of evidence in relation to sexual and reproductive health needs of women with severe mental illness (SMI) in low- and middle-income countries (LMIC) and to summarise those needs. METHODS: Inclusion criteria were 1) focus on sexual and reproductive health needs 2) women or girls with SMI, professionals, caregivers of women with SMI and community members 3) study set in a LMIC 4) peer reviewed literature (no restriction on study date or design). Studies were identified from comprehensive searches of Medline, EMBASE, CINAHL and PsycINFO (to July 2023). RESULTS: The review included 100 papers. Most studies were cross-sectional and set in hospital outpatient departments. Only 20 of 140 LMIC countries were included in this review and only 15 studies were set-in low-income countries (LIC). Included studies often had multiple focus areas and were grouped by frequency of topic into categories of HIV (prevalence, risk behaviour and knowledge), other sexually transmitted infections (STIs), sexual function, contraception use and family planning, sexual violence, fertility, pregnancy and postpartum. Included studies indicated women with SMI have worse outcomes and worse sexual and reproductive health compared to both women without SMI and men with SMI. Women with SMI were shown to have higher rates of HIV and low levels of contraception knowledge and use, with little advice offered by professionals. CONCLUSIONS: This review highlights the need for a greater diversity of study methodology, robustness of ethical and consensual reporting when researching vulnerable populations and for further research on interventions and models of care aimed at addressing stigma, discrimination and improving the sexual and reproductive health of women with SMI. Future research should better represent the breadth of LMIC, investigate cultural adaptability of interventions and consider sexual health needs across the life course.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.031155
Audit of melatonin use across child and adolescent mental health services (CAMHS) in Lincolnshire
No full textAims: To establish baseline data on melatonin use. To compare the patterns of use with national guidelines. To make recommendations to the teams. Method(s): A retrospective audit of patient records under the CAMHS services in Lincolnshire was undertaken to identify patients on melatonin as of June 2024. Data was collected from medical records between June and July 2024. Patients under 19 years and prescribed melatonin were included. Patients previously on melatonin but discontinued by June 2024 were excluded. This audit was inspired by the POMH melatonin audit. Result(s): 54 patients were identified, 23 males and 31 females. About half of the patients had been on melatonin for over one year (n=25). Autism/autistic spectrum disorder was the most common diagnosis/comorbidity - 36 patients, 29 patients had an anxiety disorder, 21 patients had diagnosed/comorbid hyperkinetic disorders, 12 patients had mood disorders while 14 patients did not have a diagnosed neurodevelopmental disorder. In 84.6% of prescriptions, evidence-based non-pharmacological measures were tried first. The target symptom(s) for melatonin treatment was clear in 55.6% of cases. Sleep latency was the most common target, followed by reducing night-time awakening. Licensed melatonin preparation was used in 46.3% of prescriptions. The preparation was however not clearly documented in most of the cases. (Licensed use covers insomnia with autism spectrum disorder (Slenyto), insomnia with Smith-Magenis syndrome (Slenyto), insomnia associated with behavioural disorders in children and adolescents (Adaflex)). 86.7% of prescriptions were reviewed for efficacy within 3 months while tolerability (side effects) was reviewed in 46.7%. The need for continuing melatonin treatment was reviewed annually in 80.8% of cases while tolerability was reviewed in 30.8%. Conclusion(s): The audit revealed high rates of prescription in certain areas of the county, it also showed that documentation of indication and target symptoms was not always available, similarly review of tolerability (side effects) was not always available. The findings were presented to the CAMHS consultants. The high rates were thought to be related to shift in practice over time, perhaps due to consultants shortage. Documentation of efficacy was more often done than review of tolerability. One reason for this could be that melatonin was being monitored by the community paediatrics team or the GP. The need for clear documentation can therefore not be overemphasized. The audit did not consider those who were able to stop melatonin. This could be useful to support patients.https://www.cambridge.org/core/journals/bjpsych-open/article/audit-of-melatonin-use-across-child-and-adolescent-mental-health-services-camhs-in-lincolnshire/E03800DC5649893EFB725039D537B7D