Reducing the incidence and impact of peer-to-peer online trolling: a protocol for a scoping review.

INTRODUCTION: Governments worldwide are committed to reducing the prevalence of peer-to-peer online trolling. The practice of peer-to-peer online trolling, which is broadly defined as where a user intends to cause disruption or conflict online for their own amusement or advantage, is a widespread pervasive and damaging behavior, affecting over one-third of all social media users. There remains, however, a substantial barrier to addressing this behaviour due to a lack of understanding of peer-to-peer online trolling and its unique psychopathology that distinguishes it from other forms of peer-to-peer online abuse such as cyberbullying and flaming, as well as the primary information technology approach used to investigate trolling. Providing a synthesis of peer-to-peer online trolling research will assist organisations, governments and educators in addressing this deviant behaviour online. METHODS AND ANALYSIS: This protocol follows the six-stage scoping review process proposed by Arksey and O'Malley. Identifying the scoping review research question (stage 1) is followed by discussion on how studies will be selected (stage 2). We then discuss how we will determine which studies will be included in the scoping review (stage 3), as well as chart the data involved for each study included (stage 4). In stage 5, the scoping review protocol gathers, synthesises and reports the results, and consults with stakeholders about the initial protocol specifications (stage 6). ETHICS AND DISSEMINATION: As the scoping review methodology focuses on incorporating information from available publications, ethical approval is not required. An article summarising the scoping review results will be submitted for publication to a journal, presented at appropriate conferences and disseminated as part of future workshops with professionals and educators involved in reducing online trolling.

Coconut sugar derived from coconut inflorescence sap lowers systolic blood pressure and arterial stiffness in middle-aged and older adults: a pilot study.

Nutraceutical-based interventions hold promise to reduce blood pressure (BP) and arterial stiffness, which are two cardiovascular disease (CVD) risk factors. However, the effects of coconut sap powder (CSP), an Asian sweetener and novel nutraceutical, on BP and arterial stiffness in middle-aged and older adults (MA/O, ≥45 yr) has yet to be established. We hypothesized CSP will decrease BP and arterial stiffness in MA/O adults. In a double-blind, randomized, placebo-controlled study design, 19 (age 55.3 ± 2.1 yr) MA/O adults completed measures of brachial and carotid BP, and arterial stiffness [carotid-femoral pulse wave velocity (cfPWV), common carotid artery (CCA) ß-stiffness, compliance, distensibility, and Young's and Peterson's Elastic moduli] before and after 8 wk of CSP (1.5 g/day) or placebo (1.5 g/day). A two-way repeated-measures analysis of variance was used to compare group mean differences. Compared with placebo, CSP lowered brachial systolic BP (SBP) (CSP pre: 117.4 ± 2.9 vs. post: 109.0 ± 2.4 mmHg, P < 0.05), but not carotid SBP (P = 0.12). CSP also lowered Young's (CSP pre: 5,514.4 ± 1,115.4 vs. post: 3,690.6 ± 430.9 kPa) and Peterson's elastic moduli (CSP pre: 22.2 ± 4.4 vs. post: 19.2 ± 4.5 kPa) (P < 0.05, both). A trend for CSP to lower CCA ß-stiffness (P = 0.06) and increase CCA compliance (P = 0.07) was also observed. Arterial stiffness assessed by cfPWV did not change (P > 0.05). No inflammatory or antioxidant biomarkers were affected by CSP. In summary, 8 wk of CSP lowers brachial SBP and CCA mechanical stiffness indicating a potential cardioprotective effect in MA/O adults.NEW & NOTEWORTHY Blood pressure (BP) and arterial stiffness are important predictors of cardiovascular health with aging. Nutraceuticals are an easy-to-implement lifestyle strategy demonstrating promise to effectively lower BP and arterial stiffness with aging and ultimately cardiovascular disease risk. We demonstrate that coconut sap powder (CSP), a traditional Asian sweetener, lowers brachial systolic BP and carotid artery mechanical stiffness in middle-aged and older (MA/O) adults. These findings provide initial evidence for the CSP-related cardioprotective effects in MA/O adults.

The impact of gender and age on bullying role, self-harm and suicide: Evidence from a cohort study of Australian children.

There has been limited longitudinal investigation to date into the association between bullying, self-harm, and suicidality in Australia and the impact of specific demographic differences on this relationship. This is despite the continued rise in the incidence of bullying, self-harm, and suicide. As such, the current study draws on data from the Longitudinal Survey of Australian children (LSAC) to examine the association between bullying, self-harm, and suicidality and explore the impact of demographic differences across three bullying related behaviors (being bullied, bullying others and being both bullied and bullying others). The evidence indicates that bully-victims exhibit the highest risk of self-harm and suicidality in Australia. When considering demographic differences, it was identified that females and adolescents aged 16-17-years-of-age had the highest risk of self-harm and suicidality. Further, a direct curvilinear relationship between age and the categories of self-harm was identified with an inflection point around 16-17 years. The study supports the need for further investigation into the association between bullying, self-harm, and suicidality longitudinally with a particular focus on other moderators.

Unilateral Handgrip Holds to Failure Result in Sex-Dependent Contralateral Facilitation.

This study examined changes in maximal voluntary isometric contraction (MVIC) force following dominant (Dm) and nondominant (NDm) unilateral, handgrip isometric holds to failure (HTF) for the exercised ipsilateral (IPS) and non-exercised contralateral (CON) limbs and determined if there are sex- and hand- (Dm vs NDm) dependent responses in the HTF time, performance fatigability (PF) for the exercised IPS limb, and changes in MVIC force for the CON limb after unilateral fatigue. Ten men and 10 women (Age = 22.2 years) completed an isometric HTF at 50% MVIC for the Dm and NDm hand on separate days. Prior to, and immediately after the HTF, an MVIC was performed on the IPS and CON limbs, in a randomized order. The Dm (130.3 ± 36.8 s) HTF (collapsed across sex) was significantly longer (p = 0.002) than the NDm (112.1 ± 34.3 s). The men (collapsed across hand) demonstrated IPS (%Δ = 22.9 ± 10.8%) PF and CON facilitation (%Δ = -6.1 ± 6.9%) following the HTF, while the women demonstrated differences in PF between the Dm and NDm hands for the IPS (%Δ Dm = 28.0 ± 9.4%; NDm = 32.3% ± 10.1%; p = 0.027), but not the CON limb (%Δ Dm = -1.6 ± 5.7%; NDm = 1.7 ± 5.9%). The cross-over facilitation of the CON limb for men, but not women, following a unilateral, isometric handgrip HTF may be related to post-activation potentiation.

Associations between potential inflammatory properties of the diet and frequency, duration, and severity of migraine headaches: a cross-sectional study.

Despite a large body of literature on the association between the dietary inflammatory index (DII) and various chronic diseases, limited knowledge is available regarding the association between DII and migraine. Therefore, we assessed the relationship between the DII and migraine characteristics, including duration, frequency, and severity of migraine headaches, Headache Impact Test-6 (HIT-6), and serum levels of nitric oxide (NO). This population-based cross-sectional study was conducted from August 2019 to June 2020 among 262 patients (38 men and 224 women; 20-50 years). A 168-item semiquantitative food frequency questionnaire (FFQ) was gathered to evaluate dietary intake, and subsequently, an energy-adjusted DII score was calculated. After controlling for potential confounders, an increase of 3.48 in headache frequency was observed when the DII score increased from - 4.04 to - 1.83 (ß = 3.48; 95% CI 1.43, 5.54). In the crude model, headache duration tended to be inversely associated with DII in the subjects with the pro-inflammatory diet compared to those with the anti-inflammatory diet (ß = - 0.22; 95% CI - 0.46, 0.02). After adjustment for confounders, those with the highest DII values were at a higher risk of severe headaches than those with the lowest values (OR = 2.25; 95% CI 1.17, 4.32). No other significant results were found in terms of the association between DII and HIT-6 or serum NO levels. We found evidence suggesting that higher adherence to a diet with anti-inflammatory properties was significantly and inversely related to headache frequency. Furthermore, our results suggest that the DII score is substantially related to migraine severity.

Cognitive control training for children with anxiety and depression: A systematic review.

Cognitive control training has gained traction as an intervention for reducing anxiety and depression vulnerability in adults. There are, however, a limited number of studies investigating such training interventions for reducing symptomology of anxiety and depression in children and adolescents. Thus, we aimed to provide a robust review and qualitative synthesis of the available research in young people. Twelve articles met the inclusion criteria, and all were randomised control trials. Evidence of the efficacy of cognitive control training for relief of symptoms are reported separately for anxiety, depression, and other related psychological factors, and on the basis of type of cognitive control training paradigm. A lack of standardisation in relation to type of intervention, duration and context, outcome measures and population was observed. Results are discussed in terms of these variations and recommendations for future research are provided.

Changes in physical activity during the initial stages of the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic response limited access to many traditional forms of physical activity (PA). Purpose:To assess changes in objectively measured PAofUniversity staff during the initial stageofthe COVID-19 pandemic. METHODS: We implemented a repeated measures natural experiment design. PA data (walking distance, steps∙d#x2D;1, and Moderate#x2D;to#x2D;Vigorous PA (MVPA) time) from commercial grade triaxial accelerometers were collected from employees (N#x3D;625) of a large, public university in the southeast United States during the months of Jan#x2D;May in calendar years 2019 and 2020. RESULTS: Walking distance (6#x2D;9#x25;, p#x3C;0.001) and steps∙d#x2D;1(7#x2D;11#x25;, p#x3C;0.001) were lower during April and May 2020 compared to 2019. However, MVPA time was not significantly different among calendar years for the months of March#x2D;May. Steps∙d#x2D;1significantly decreased after WHO's worldwide pandemic declaration (10,348#xB1;171 v. 9551#xB1;156 steps∙d#x2D;1, p#x3C;0.001) and campus closure (10,100#xB1;160 v. 9,186#xB1;167 steps∙d#x2D;1, p#x3C;0.001). Conversely, steps∙d#x2D;1significantly increased after implementation of the state's "Healthy at Home" order (9,693#xB1;177 vs. 10,156#xB1;185 steps∙d#x2D;1, p#x3C;0.001). CONCLUSION: A decrease in daily steps, but not MVPA, suggests increased sedentary behavior, not reduced participation in exercise, during the early stages of the COVID#x2D;19 pandemic. Specific pandemic response policies may positively or negatively affect PA and sedentary behavior.

Australian Early Childhood Teachers' Understanding of Bullying.

School bullying is a global phenomenon with teachers often at the forefront of responding to this behavior. It is, therefore, important that teachers are able both to understand and articulate what bullying is and to recognize bullying behavior. Ninety-five Australian early childhood teachers participated in an online survey to define bullying, fighting and identify the differences between the two behaviors. They were also asked to identify from 20 scenarios whether the behaviors depicted traditional bullying behaviors, cyberbullying behaviors, non-bullying face-to-face behaviors or non-cyberbullying behaviors. Results found that teachers described some of the three characteristics of bullying, that is, the intention to harm, power difference, and repetition; however, many teachers had difficulty clearly explaining the distinguishing differences between bullying and fighting. The majority of teachers identified the bullying behaviors in the scenarios; however, some teachers misinterpreted some non-bullying behaviors as bullying. The need to increase teacher's knowledge of bullying to support the prevention and intervention of bullying are discussed.

Effects of grape products on inflammation and oxidative stress: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to determine the effects of grapes and grape products on inflammation and oxidative stress among adults. PubMed, Scopus, ISI Web of Science, and Cochrane Library databases were searched up to July 2020 to identify RCTs investigating the effects of grape and grape products on inflammatory and oxidative stress markers. Weighted mean differences (WMD) were pooled using a random-effects model. Of the 8,962 identified studies, 24 RCTs (27 arms) were included in the statistical analysis. Grape products significantly reduced serum C-reactive protein (CRP) levels (WMD: -0.35 mg/L; 95% CI: -0.62, -0.09, p = .008), but they had no significant effect on serum tumor necrosis factor-alpha (TNF-α) (WMD = -1.08 pg/ml; 95% CI: -2.29, 0.11, p = .07), interleukin-6 (IL-6) (WMD = 0.13 pg/ml; 95% CI: -0.35, 0.60, p = .60), total antioxidant capacity (TAC) (WMD = 0.15; 95% CI: -0.35, 0.65, p = .54), or malondialdehyde (MDA) (WMD = 0.14; 95% CI: -0.64, 0.92, p = .72). The analysis indicated possible decreasing effects of grapes and grape products on CRP, but they might not be able to change IL-6, TNF-α, TAC, and MDA concentrations. Nonetheless, further studies are warranted before definitive conclusions may be reached.

Effects of artichoke on blood pressure: A systematic review and meta-analysis.

PURPOSE: Clinical trials considering the effects of artichoke supplementation on blood pressure have yielded different and contradictory outcomes. Thus, a systematic review and meta-analysis were performed to assess effects of artichoke administration on blood pressure. METHODS: Related studies were detected by searching the Cochrane Library, PubMed, Embase and Scopus databases up to 15 March 2020. Weighted Mean Differences (WMD) were pooled using a random-effects model. Heterogeneity, sensitivity analyses, and publication bias were evaluated using standard methods. RESULTS: Pooled analysis of eight randomized controlled trials revealed that artichoke supplementation did not have an effect on systolic blood pressure (SBP), (WMD: -0.77 mmHg, 95 % CI: -2.76 to 1.22) or diastolic blood pressure (DBP) (WMD: -0.11 mmHg, 95 % CI: -1.72 to 1.50) when compared to the placebo group. However, subgroup analyses based on health status suggested that artichoke administration among hypertensive patients may significantly reduce SBP (WMD: -3.19 mmHg, 95 % CI: -3.32 to -3.06) and DBP (WMD: -2.33 mmHg, 95 % CI: -2.23 to -2.43), but no such reduction was found in NAFLD patients. Furthermore, our results indicated that artichoke supplementation for 12 weeks led to a significantly decreased DBP (WMD: -2.33 mmHg, 95 % CI: -2.43 to -2.23), but 8 weeks of intervention did not (WMD: 0.80 mmHg, 95 % CI: -1.06 to 2.66). CONCLUSION: Artichoke supplementation may potentially lead to SBP and DBP reduction in hypertensive patients. In addition, artichoke supplementation for 12 weeks may significantly improve DBP.

Dietary fat and alcohol in the prediction of indices of vascular health among young adults.

OBJECTIVES: Arterial stiffness, particularly of the aorta, is an independent predictor of future cardiovascular disease, all-cause mortality, and hypertension. Arterial stiffening may be caused or exacerbated by the composition of the diet. Current research has indicated that habitual dietary patterns may influence arteriosclerosis, or the thickening and hardening of the artery walls, but has yet to identify a specific food group as the culprit. In young, college-aged adults, dietary fat intake and alcohol consumption tend to be higher compared to other periods throughout the life cycle. Therefore, the purpose of this study was to determine the influence of dietary fat and alcohol consumption on the vascular health of apparently healthy young adults. METHODS: The data collected were assessed to determine if dietary fat and alcohol in young (18-30 y), college-aged adults (n = 50) were independent predictors of an increase in arterial stiffening. Vascular health was determined by the carotid-femoral pulse-wave velocity and the augmentation index corrected for a heart rate of 75 beats/min; dietary patterns were assessed using the Dietary Health Questionnaire II. RESULTS: The gold standard marker of aortic stiffness, carotid femoral pulse-wave velocity, was positively correlated with cheese consumption (R2 = 0.092, P = 0.033), alcohol consumption (R2 = 0.102, P = 0.024), and total energy/calories (%) from alcohol (R2 = 0.118, P = 0.015) in univariate analysis. In forward-selection multiple regression analysis, energy from alcohol and cheese consumption accounted for 23.7% of the variance in carotid-femoral pulse-wave velocity (P = 0.009). The augmentation index wave reflection marker was positively correlated with total dietary fat (R2 = 0.110, P = 0.019), trans fatty acids (R2 = 0.092, P = 0.032), saturated fatty acids (R2 = 0.124, P = 0.012), monounsaturated fatty acids (R2 = 0.012, P = 0.015), red-meat consumption (R2 = 0.094, P = 0.030), and discretionary fat from solids in univariate analysis (R2 = 0.137, P = 0.008). Discretionary fat from solids accounted for 13.7% of the variation in augmentation index in forward-selection multiple regression analysis (P = 0.008). CONCLUSIONS: These results indicate the potential roles of dietary fat and alcohol consumption in early vascular aging by stiffening the arteries of young, college-aged adults, which may in turn contribute to future adverse cardiovascular disease outcomes.

Influence of curcumin on performance and post-exercise recovery.

Intense exercise, especially involving eccentric contractions, causes muscle damage concomitant with increased reactive oxygen species (ROS), which can lead to increased fatigue and decrements in physical performance. Additionally, inflammatory cytokines and advanced glycation end-products (AGEs) are produced as a result of eccentric exercise and may further lead to decreased exercise performance. Nutritional interventions may provide an avenue to respond to and reduce the symptoms associated with muscle damage. Of recent interest, curcumin, the main constituent in the spice turmeric, has been the focus of various studies considering post-exercise recovery. Curcumin has potent anti-oxidant and anti-inflammatory properties and can reduce the accumulation of AGEs. This review considers the current evidence for curcumin to impact muscle recovery following exercise to improve performance and the potential mechanisms of action. To date, clinical studies have considered the potential role of curcumin to reduce muscular damage following treadmill running (downhill and flat), conventional walking/running, cycling (acute and chronic), single-leg jumping (downhill), and eccentric muscular fitness exercises of the upper and lower body (single- and double-leg). Studies have been conducted in sedentary to highly active men and women, both young and old, with supplementation duration lasting from a single, acute dose to daily dosages for three months. Various curcumin-based interventions have improved self-perceived measures of pain and tenderness, reduced evidence of muscle damage, ameliorated inflammatory markers, increased markers of antioxidant capacity, diminished markers of oxidative stress, reduced markers of AGEs, and attenuated loss in mean power of single-leg sprints. However, these findings have not been consistently reported.

The Association Between Dietary Zinc Intake and Health Status, Including Mental Health and Sleep Quality, Among Iranian Female Students.

Epidemiological studies have suggested that there is an association between diet and mental health. The aim of the current study was to explore the association between dietary zinc intake and risk of depression, anxiety, and sleep quality distortion among female students of the Semnan University of Medical Sciences in a cross-sectional study. From January through October 2019, 142 female students were randomly selected from the Department of Nutrition and Food Science at the Semnan University of Medical Sciences by simple random sampling. Food frequency questionnaires (FFQs) were used to assess participants' dietary intake over the past 12 months. Depression, anxiety, and sleep quality were examined by the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI), respectively. In the analysis, the crude model was adjusted for total energy intake (kcal), while the model was adjusted for energy intake (kcal), age, economic status, physical activity level, serum vitamin D level, and body mass index. Dietary zinc intake is significantly associated with depression (odds ratio (OR) (95% confidence interval (CI)): 2.34 (0.38-4.30)) and anxiety (OR (95% CI): 3.43 (2.36-4.50)), sleep disorders (OR (95% CI): 3.65 (2.16-5.13)), sleep duration (OR (95% CI): 2.62 (0.39-4.86)), and daytime dysfunction (OR (95% CI): 5.31 (2.84-7.78)) in the model, as well as sleep delay (OR (95% CI): 1.80 (1.05-2.55)) and mental quality of sleep (OR (95% CI): 1.63 (1.10-2.15)) in the crude analysis. This cross-sectional study supports the inverse association between dietary zinc intake and mood disorders, including depression and anxiety, and some indices of sleep disturbance in the Iranian female students. Further cohort or intervention studies are required to draw a firm link between dietary zinc intake and mental health.

Effects of pistachios on anthropometric indices, inflammatory markers, endothelial function and blood pressure in adults: a systematic review and meta-analysis of randomised controlled trials.

Evidence suggests that eating nuts may reduce the risk of CVD. This study was intended to pool the data of all randomised controlled trials (RCT) available to determine if pistachios confer a beneficial effect on anthropometric indices, inflammatory markers, endothelial dysfunction and blood pressure. Without language restriction, PubMed, Scopus, Cochrane Library and Web of Science were searched for articles published from the earliest records to June 2019 investigating the effect of pistachio consumption on inflammation, endothelial dysfunction and hypertension. Mean difference (MD) was pooled using a random effects model. The Cochrane risk of bias tool was used to evaluate the quality of the studies. The meta-analysis of thirteen RCT with 563 participants indicated that pistachio consumption significantly decreased systolic blood pressure (SBP) (MD: -2·12 mmHg, 95 % CI -3·65, -0·59, P = 0·007), whereas changes in flow-mediated dilation (MD: 0·94 %, 95 % CI -0·99, 2·86, P = 0·813), diastolic blood pressure (MD: 0·32 mmHg, 95 % CI -1·37, 2·02, P = 0·707), C-reactive protein (MD: 0·00 mg/l, 95 % CI -0·21, 0·23, P = 0·942), TNF-α (MD: -0·09 pg/ml, 95 % CI -0·38, 0·20, P = 0·541), body weight (MD: 0·09 kg, 95 % CI -0·38, 0·69, P = 0·697), BMI (MD: 0·07 kg/m2, 95 % CI -0·16, 0·31, P = 0·553) and waist circumference (MD: 0·77 cm, 95 % CI -0·09, 1·64, P = 0·140) were not statistically significant. This systematic review and meta-analysis suggested the efficacy of pistachio consumption to reduce SBP levels. However, further large-scale studies are needed to confirm these results.

Effects of Curcumin and Fenugreek Soluble Fiber on the Physical Working Capacity at the Fatigue Threshold, Peak Oxygen Consumption, and Time to Exhaustion.

Herrick, LP, Goh, J, Menke, W, Campbell, MS, Fleenor, BS, Abel, MG, and Bergstrom, HC. Effects of curcumin and fenugreek soluble fiber on the physical working capacity at the fatigue threshold, peak oxygen consumption, and time to exhaustion. J Strength Cond Res 34(12): 3346-3355, 2020-The purpose of this study was to examine the effects of curcumin in combination with fenugreek soluble fiber (CUR + FEN) or fenugreek soluble fiber alone (FEN) on the neuromuscular fatigue threshold (PWCFT), peak oxygen consumption (V˙o2peak), and time to exhaustion (Tlim) on a graded exercise test (GXT), in untrained subjects. The PWCFT estimates the highest power output that can be maintained without evidence of neuromuscular fatigue. Forty-seven untrained, college-aged subjects were randomly assigned to one of 3 supplementation groups; placebo (PLA, n = 15), CUR + FEN (500 mg·d, n = 18), or FEN (300 mg·d, n = 14). The subjects completed a maximal GXT on a cycle ergometer to determine the PWCFT, V˙o2peak, and Tlim before (PRE) and after (POST) 28 days of daily supplementation. Surface electromyographic signals were recorded from a bipolar electrode arrangement on the vastus lateralis of the right leg during each test. Separate one-way analysis of covariances were used to determine if there were between-group differences for adjusted POST-PWCFT, POST-V˙o2peak, and POST-Tlim values, covaried for the respective PRE-test scores. The adjusted POST-PWCFT for the CUR + FEN group (mean ± SD: 196 ± 58 W) was greater (p = 0.016) than the PLA group (168 ± 49 W) but the FEN group (185 ± 32 W) was not different from the CUR + FEN or PLA groups (p > 0.05). There were no differences for adjusted POST-V˙o2peak (p = 0.612) or POST-Tlim (p = 0.508) among the groups. These findings suggested curcumin combined with fenugreek soluble fiber might delay neuromuscular fatigue.

Canadian Guidelines on Alcohol Use Disorder Among Older Adults.

BACKGROUND: Alcohol use disorder (AUD) is an increasingly common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the Canadian population ages. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of AUD in older adults. METHODS: A systematic review of English language literature from 2008-2018 regarding AUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method by drawing on current literature. Recommendations were created and assessed using the GRADE method. RESULTS: Twenty-two recommendations were created. Prevention recommendations: Best advice for older adults who choose to drink is to limit intake to well below the national Low-Risk Alcohol Drinking Guidelines. Screening recommendations: Alcohol consumption should be reviewed and discussed on an annual basis by primary care providers. This type of discussion needs to be normalized and approached in a simple, neutral, straight-forward manner. Assessment recommendations: Positive screens for AUD should be followed by a comprehensive assessment. Once more details are obtained an individualized treatment plan can be recommended, negotiated, and implemented. Treatment recommendations: AUD falls on a spectrum of mild, moderate, and severe. It can also be complicated by concurrent mental health, physical, or social issues, especially in older adults. Naltrexone and Acamprosate pharmacotherapies can be used for the treatment of AUD in older adults, as individually indicated. Psychosocial treatment and support should be offered as part of a comprehensive treatment plan. CONCLUSION: These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of AUD in older adults within the Canadian context.

Sleep and frailty risk: a systematic review and meta-analysis.

PURPOSE: Studies on the association between sleep and frailty risk have yielded contradictory outcomes. Therefore, a systematic review and meta-analysis were designed to examine the relationship between sleep and frailty risk. METHODS: Relevant studies were identified by searching PubMed, Embase, and Scopus databases until 30 November 2019. Data were available from ten studies. Selected articles were published between 2009 and 2019. The odds ratios of 41,233 individuals were used for the meta-analysis. RESULTS: Pooled analysis demonstrated that when compared to the reference category of 6 to 8 hours nightly sleep duration, both the highest category (more than 8 hours, OR 1.21; 95% CI 1.10-1.32) and lowest category of sleep (under 6 hours, OR 1.13; 95% CI 1.08-1.18), were significantly correlated with increased risk of frailty. Furthermore, daytime drowsiness (OR 1.25; 95% CI 1.02-1.52), sleep disordered breathing (OR 1.28; 95% CI 1.03-1.58), and prolonged sleep latency (OR 1.18; 95% CI 1.06-1.31) enhanced the risk of frailty. Subgroup analyses by frailty status suggest that a shorter sleep duration was associated with risk of frailty but not pre-frailty. However, prolonged sleep time was significantly related with enhanced risk of pre-frailty and frailty. In addition, subgroup analyses via sex revealed that longer and shorter sleep durations increased risk of frailty in both men and women. CONCLUSION: The present study revealed that longer and shorter sleep durations are associated with increased risk of frailty.

The effect of cinnamon supplementation on blood pressure in adults: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND & AIMS: Several clinical trials have shown that cinnamon can reduce blood pressure, but the results are controversial. Therefore, we conducted a systematic review and meta-analysis to provide a more precise estimate of the overall effects of cinnamon supplementation on blood pressure in adults. METHODS: We searched PubMed, Scopus, Cochrane Library, ISI Web of Science, and Google Scholar databases through September 2019 to identify randomized clinical trials (RCTs) investigating the effect of cinnamon supplementation on blood pressure. Data were pooled by using the random-effects model, and weighted mean difference (WMD) was considered as the summary effect size. Sensitivity analysis was conducted using the leave-one-out method. RESULTS: Meta-analysis of 9 RCTs with 641 participants showed significant reductions in both systolic (WMD: -5.17 mmHg, 95% CI: -9.35 to -0.99, P = 0.01) and diastolic blood pressure (WMD: -3.36 mmHg, 95% CI: -5.67 to -1.04, P ≤ 0.001) after cinnamon supplementation. Subgroup analyses indicated that these results were significant only when cinnamon was administered at the dosages of ≤2 g/day, for a period longer than 8 weeks, and in participants with a baseline BMI of ≥30 kg/m2. CONCLUSION: The present meta-analysis suggests that cinnamon supplementation can improve blood pressure by a modest degree. However, due to limited availability of studies with hypertensive cases and relatively small sample sizes of available studies, well designed trials with adequate sample sizes aimed at hypertensive populations are recommended.

Effect of fenugreek supplementation on blood lipids and body weight: A systematic review and meta-analysis of randomized controlled trials.

ETHNOPHARMACOLOGICAL RELEVANCE: Fenugreek is a traditional herbal medicine that has been used for centuries to treat hyperglycemia, muscle spasms, gastritis, constipation, edema, and other metabolic disorders. Recently, lipid-lowering effects of fenugreek have been identified. AIM OF THE STUDY: The aim of this systematic review and meta-analysis was to determine and clarify the impact of fenugreek supplementation on anthropometric indices and serum lipid levels. MATERIALS AND METHODS: We searched PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar from inception to June 2019 using relevant keywords. All randomized controlled trials (RCTs) investigating the effects of fenugreek on anthropometric indices and plasma lipids in adults were included. A random-effects model was used for quantitative data synthesis. A sensitivity analysis was conducted using the leave-one-out method. RESULTS: A meta-analysis of 12 RCTs (14 arms) with 560 participants suggested a significant decrease in plasma concentrations of total cholesterol (WMD = -9.371 mg/dL; 95% CI: -15.419, -3.323, p = 0.002), triglycerides (WMD = -13.776 mg/dL; 95% CI: -26.636, -0.916, p = 0.036), and low density lipoprotein cholesterol (WMD = -6.590 mg/Dl; 95% CI: -13.042, -0.137, p = 0.045), as well as an increase in plasma high density lipoprotein cholesterol (WMD = 3.501 mg/dL; 95% CI: 1.309, 5.692, p = 0.002), while body weight (WMD = 0.223 kg; 95% CI: -0.509, 0.955, p = 0.551) and body mass index (WMD = 0.091 kg/m2; 95% CI: -0.244, 0.426, p = 0.596) were not altered. CONCLUSION: Fenugreek supplementation improved lipid parameters in adults. However, to confirm these results, more studies, particularly among hyperlipidemic patients, are needed.