A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia

OBJECTIVE: Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD. METHODS: A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020).

A Systematic Review of Nonpharmacological Interventions for Moderate to Severe Dementia: A Study Protocol for a Systematic Review and Meta-Analysis

The study is designed as a systematic review on nonpharmacological interventions for patients with moderate to severe dementia. This review will be conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The following databases will be searched: Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, KoreaMED, KMbase, and KISS. The primary outcome will include the effect of the interventions on activities of daily living and behavioral and psychological symptoms of dementia. The literature search will be conducted based on search strategies designed for each database. The reviewers will independently assess the identified studies and extract the data. The risk of bias will be assessed and a meta-analysis will be conducted in accordance with the methodology for meta-analysis described in the Cochrane handbook. This systematic review will provide clinicians and policy makers with reliable evidence for developing and implementing nonpharmacological interventions for moderate to severe patients with dementia.

Cognitive Stimulation as a Therapeutic Modality for Dementia: A Meta-Analysis

OBJECTIVE: Although cognitive stimulation (CS) is one of the most popular non-pharmacological interventions for people with dementia, its efficacy is still debatable. We performed a meta-analysis of randomized controlled trials (RCTs) on the efficacy of CS in people with dementia. METHODS: Data sources were identified by searching PubMed, MEDLINE, Embase, psychINFO, and Cochrane Reviews Library. A total of 7,354 articles were identified, and of these, 30 RCTs were selected based on the selection criteria. Of these 30 RCTs, 14 were finally included in our meta-analysis [731 participants with dementia; 412 received CS (CS group) and 319 received usual care (control group)]. RESULTS: We found that the people with dementia had a moderate benefit from CS. The mean difference between the CS and control groups was 2.21 [95% CI (0.93, 3.49), Z=3.38, p=0.00007] in the Alzheimer's Disease Assessment Scale-Cognition and 1.41 [95% CI (0.98, 1.84), Z=6.39, p<0.00001] in the Mini-Mental State Examination. CS also improved quality of life in people with dementia [95% CI (0.72, 3.38), Z=3.02, p=0.003]. CONCLUSION: CS is effective for improving cognition and quality of life in people with dementia; however, its effects were small to moderate.

A Study on the Propensity of Koreans in Choosing Dementia Care Settings

OBJECTIVE: This study was to investigate the factors that influence the propensity of Koreans in choosing care settings of dementia patients. METHODS: This study analyzed the data from the '2014 Nationwide Survey on Dementia Awareness of Koreans' that was conducted by the National Institute of Dementia. Korean's perception of care burden for dementia was measured with grading on its types. Also its influences on preference for care between facilities and homes were evaluated using multivariate analysis with socio-demographic characteristics. RESULTS: In terms of preferred care settings, respondents preferred facilities over homes in case of themselves and their family, respectively 77.5% and 68.2%. The preference for facilities was significantly influenced by the respondents' age for both themselves and their family. Additionally, the perception of relatively higher emotional and physical burden compared to economic burden significantly influenced preference for facilities for their family. CONCLUSION: Improving public awareness and setting-up a practical social supporting system are needed to reduce emotional and physical burden as well as economic burden of dementia. Furthermore, building up an appropriate and safer communities for dementia patients and their caregivers is much demanded for reducing their burdens.

Prevalence and Trends of Dementia in Korea: A Systematic Review and Meta-Analysis

Through a systematic review and meta-analysis of epidemiological studies on dementia, we assessed the prevalence of dementia and its subtypes-Alzheimer' disease (AD) and vascular dementia (VaD)-in Korea. We searched for epidemiological studies on dementia published in 1990-2013 using PubMed, Scopus, EMBASE, KoreaMed, KISS, and RiCH. Dementia prevalence in elderly patients (aged> or =65 yr) was 9.2% (95% confidence interval [CI], 8.2%-10.4%) from 11 studies, which was higher than those from Western and other Asian countries. AD was the most prevalent dementia type, with a prevalence of 5.7% (95% CI, 5.0%-6.4%) from 10 studies compared with 2.1% (95% CI, 1.6%-2.7%) for VaD from 9 studies. The age-specific prevalence of dementia approximately doubled with each 5.8-yr increase of age. Although a significant increasing trend of dementia prevalence was not observed, it increased slightly from 7.3% to 8.7% after 2005; AD prevalence increased after 1995 and VaD prevalence decreased after the early 2000s. The AD/VaD ratio increased from 1.96 in the early 1990s to 4.13 in the 2010s, similar to the worldwide ratio. Owing to this high prevalence in the aging population, dementia will impose significant economic burdens to Korean society.

Association between measures of obesity and colorectal adenoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few studies have used body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC) at the same time to investigate the association between obesity and colorectal adenoma. This study examined the strength of association between colorectal adenoma and obesity using not only BMI, but also WHR and WC.</p><p><b>METHODS</b>Subjects of this study included 1322 asymptomatic patients who underwent colonoscopy for cancer screening from January 2006 to June 2008. Anthropometric measurements, blood test results, and a self-administered questionnaire from each subject were analyzed.</p><p><b>RESULTS</b>Four hundred and fourteen adenoma cases were identified in 1322 subjects. Using univariate analysis, the prevalence of adenoma was associated with BMI and WHR and was higher among the abdominal obesity group using WC guidelines of the Korean Society for the Study of Obesity, but not using WC guidelines of the International Diabetes Federation. In multiple Logistic regression analysis, general obesity (BMI ≥ 25 kg/m(2)) increased the risk of colorectal adenoma (odds ratio (OR), 1.43; 95% confidence interval (CI), 1.05 - 1.94). Also, abdominal obesity by the WC cutoffs and the highest WHR percentile group (WHR ≥ 0.95) were significantly associated with adenoma. Among three measures of obesity, however, only BMI had a persistent association with adenoma after adjusting reciprocally for BMI, WC, and WHR (OR, 1.30; 95%CI, 1.02 - 1.80; and 1.49; 1.06 - 2.10, adjusted for WC and WHR, respectively).</p><p><b>CONCLUSION</b>The data suggest that general obesity is associated with an increased risk of colorectal adenoma.</p>

Clinical Features and Prognostic Factors in Ischemic Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Ischemic colitis mainly occurs in elderly patients and encompasses a wide clinical spectrum from mild, transient to severe and gangrenous forms. Since life expectancy is now increasing, more often physicians will encounter patients with this disease entity. Our aim was to review the clinical features of ischemic colitis and to analyze the effect of clinical factors on the duration of hospital stay and evaluate predictive factors of poor prognosis. METHODS: We retrospectively analyzed the medical records of 294 patients diagnosed with ischemic colitis during 10 years from March 1997 to February 2007. RESULTS: The mean hospital stay was 12.4+/-6.6 days. According to the use of multiple regression analysis, age, sex, clinical symptoms, hypertension, constipation, use of laxatives or antibiotics did not affect hospital stay. Factors that significantly increased hospital stay were diabetes mellitus (p=0.007), colonic involvement of more than three segments (p=0.009) and the presence of an ulcer on a colonoscopic finding (p=0.008). CONCLUSIONS: Diabetes mellitus, colonic involvement of more than three segments and the presence of an ulcer on a colonoscopic finding are important predictive factors of poor prognosis in patients with ischemic colitis. In cases with one of these factors, more intensive treatment options should be adapted.

Conventional EGD versus Small-caliber EGD : The Thinner, the Better? / 대한소화기내시경학회지

BACKGROUND/AIMS: Small-caliber esophagogastroduodenoscopy (scEGD) was developed to facilitate unsedated EGD, and has many advantages over sedated EGD in terms of costs and complications. This study compared the feasibility and tolerance of scEGD with unsedated conventional EGD (cEGD), and examined the effect of the endoscopic diameter on the patients' tolerance. METHODS: A total of 114 patients who were referred for a diagnostic EGD was randomly allocated to undergo either scEGD (GIF XP260, Olympus, diameter 6.5 mm; n=57) or cEGD (GIF XQ240, Olympus, diameter 9.0 mm; n=57). After EGD, the patients and endoscopists completed questionnaires on the level of discomfort, satisfaction and acceptance of the examination. RESULTS: Patients in the scEGD group reported significantly less discomfort (choking, pain and nausea) and more overall satisfaction than those in the cEGD group. Patients in the scEGD group were more willing to choose the same procedure again if medically indicated. According to multivariate analysis, the ultrathin endoscopic diameter itself was positively associated with the increased patients' satisfaction (odds ratio 3.07, p=0.003). CONCLUSIONS: scEGD has comparable feasibility and accuracy but is more tolerable than cEGD. scEGD may have a role in clinical practice by minimizing the level of discomfort during unsedated EGD.

The Prevalence of Defecation Difficulty and Bowel Habits in University Students / 간호학회지

To determine bowel patterns and the prevalence of defecation difficulty in young university students, we administered a self-reported questionnaire to 1,617 college students about their bowel habits and eating patterns and obtained the following: 83.7% showed defecation frequency between 2 times per day and 3 times per week, and 33.4% reported difficulty in defecation. Among the subjects with defecation difficulty, 69% complained of constipation and 31% of diarrhea. It was also shown that the prevalence of self-reported defecation difficulty varied by sex. Women were more likely to have defecation difficulty than men (OR=2.5; 95% CI: 2.005-3.149). There were also differences between men and women in respect to the bowel habits (frequency, regularity, thickness, volume, form and time required) and food preferences. Men reported a higher frequency of defecation than women (p<.001). The dietary fiber intake volume of the subjects with defecation difficulty was smaller than subjects without the problem (OR=0.83, CI; 0.706-0.978). Moreover, those whose favorite food was meat were more likely to have defecation difficulty than those preferred vegetables (OR=1.39; 95% CI: 1.058-1.820). Irregular defecation was reported in 44.5% of the students, especially non-residents of Cheolla province (OR=1.2; 95% CI: 1.007-1.480). Non-residents ate dietary fiber significantly less than residents and there were some differences in diet habits and also in bowel habits.

Infectious Features In Patients with Acute Leukemia / 감염

PURPOSE: Despite the advancement in chemotherapy and supportive care, a persisting problem in patients with leukemia is infectious complications, which are the leading cause of death. We evaluated infectious complications in acute leukemic patients to understand the current features and also evaluated risk factors for death in acute leukemia. METHODS: The medical records of 186 cases of acute leukemia who underwent chemotherapy in St. Mary's Hospital between January 1995 and December 1997 were reviewed. And we compared these data to our previous data published in 1994. RESULTS: One hundred (95%) cases among 126 leu- kemic patients who received induction chemotherapy and 42 (70%) of 60 cases who received consolidation chemotherapy experienced at least one febrile episodes during treatment. Microbiologically defined infection (MDI), clinically defined infection (CDI), and unexplained fever (UF) were evenly distributed. In MDI, the isolation rate of gram positive organism was markedly increased but that of fungus was decreased. The common clinical manifestations were bacteremia, pneumonia, neutropenic enterocolitis, and catheter infection, in the order of decreasing frequency. The overall mortality rates reduced from 50% (early of the 1980s) to 12.9%, but the infection-related mortality increased up to 80% in spite of improvement in supportive care, antimicrobials and administration of hematopoietic growth factors. Refractory or relapsed acute myelogenous leukemia (AML) had 5 times higher risk of death than primarily diagnosed AML and MDI had 10.9 times higher risk of death than UF. And one more febrile day increased the risk of death by 1.4 times. CONCLUSION: Infection is still the most important cause of morbidity and mortality in acute leukemia patients. Dominant infecting organisms are changing from gram-negative bacilli to gram-positive cocci. New preventive, diagnostic, and treatment strategies should be developed and prophylactic use of antimicrobials should be restricted as much as possible to prevent emergence of resistant microorganisms.