The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis.

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

Definitions of positive health: a systematic scoping review.

An agreed definition, model, and indicators of positive health would contribute to a better understanding and wider use of the term, thus favoring the development of the positive health approach in public health. However, there is no consensus even on the definition of positive health. In this study, we systematically reviewed its definitions. We conducted a scoping review as per PRISMA guidelines. We queried the MEDLINE, Embase, PsychINFO, and Web of Science databases. The PubMed search equation was: 'positive health' [Title/Abstract] AND ('health' [MeSH] OR 'health status' [MeSH] OR 'health status indicators' [MeSH]). Definitions of positive health referring to a 'one-dimensional' conceptualization of health are: (i) positive health as a state 'far beyond a mere absence of disease'; (ii) positive health as wellbeing; and those referring to a 'two-dimensional' conceptualization are (iii) positive health as resilience and (iv) positive health as (a reserve in) capacities. This work contributes to the refining of the salutogenic vocabulary. At this stage of the ongoing discussion on health promotion vocabulary, we propose the 'reserve in capacities' as the candidate for the definition of positive health.

Social class and the risk of dementia: A systematic review and meta-analysis of the prospective longitudinal studies.

BACKGROUND: The association between belonging to a disadvantaged socio-economic status or social class and health outcomes has been consistently documented during recent decades. However, a meta-analysis quantifying the association between belonging to a lower social class and the risk of dementia has yet to be performed. In the present work, we sought to summarise the results of prospective, longitudinal studies on this topic. METHODS: We conducted a systematic review and meta-analysis of prospective, longitudinal studies measuring the association between indicators of social class and the risk of all-cause/Alzheimer's dementia. The search was conducted in four databases (Medline, Embase, Web of Science and PsychInfo). Inclusion criteria for this systematic review and meta-analysis were: (a) longitudinal prospective study, (b) aged ⩾60 years at baseline, (c) issued from the general population, (d) no dementia at baseline and (e) mention of social class as exposure. Exclusion criteria were: (a) study of rare dementia types (e.g. frontotemporal dementia), (b) abstract-only papers and (c) articles without full text available. The Newcastle-Ottawa scale was used to assess the risk of bias in individual studies. We calculated the overall pooled relative risk of dementia for different social class indicators, both crude and adjusted for sex, age and the year of the cohort start. RESULTS: Out of 4548 screened abstracts, 15 were included in the final analysis (76,561 participants, mean follow-up 6.7 years (2.4-25 years), mean age at baseline 75.1 years (70.6-82.1 years), mean percentage of women 58%). Social class was operationalised as levels of education, occupational class, income level, neighbourhood disadvantage and wealth. Education (relative risk (RR)=2.48; confidence interval (CI) 1.71-3.59) and occupational class (RR=2.09; CI 1.18-3.69) but not income (RR=1.28; CI 0.81-2.04) were significantly associated with the risk of dementia in the adjusted model. Some of the limitations of this study are the inclusion of studies predominantly conducted in high-income countries and the exclusion of social mobility in our analysis. CONCLUSIONS: We conclude that there is a significant association between belonging to a social class and the risk of dementia, with education and occupation being the most relevant indicators of social class regarding this risk. Studying the relationship between belonging to a disadvantaged social class and dementia risk might be a fruitful path to diminishing the incidence of dementia over time. However, a narrow operationalisation of social class that only includes education, occupation and income may reduce the potential for such studies to inform social policies.

Community Partnership in Response to Hoarding Disorder in Montreal.

Clinical management of hoarding disorder is challenging because of the weak insight of people with hoarding disorder, the lack of available tools for disease management in the health care system, and the absence of communication between health care and primary responders. To tackle this communication gap and, hence, improve clinical management of hoarding disorder, a community partnership initiated by people with hoarding disorder took place in Montreal. This initiative could profitably offer guidelines for other communities facing hoarding disorder challenges.

Group cognitive-behavioural therapy for hoarding disorder: Systematic review and meta-analysis.

Previous meta-analysis has reported the rate of reliable and clinically significant changes in hoarding disorder (HD) after cognitive-behavioural therapy (CBT) based on the classical CBT model of HD, as between 42% and 25%. However, in this analysis, different types of therapy (group vs individual, G-CBT and I-CBT, respectively), different providers (psychologist vs nonpsychologist), and different diagnosis (HD vs hoarding behaviour) were analysed together. Hence, it remains unclear if reported rate of changes was due to limits of the CBT model of HD or due to the fact that different applications of the model were analysed together. The aim of this meta-analysis is to highlight shortcomings in the description of existing approaches in G-CBT in HD and provide an up-to-date review of the current state of efficacy. We searched references for treatment trials of G-CBT for HD in adults with object hoarding, where treatment was conducted by a professional in PubMed, PsychINFO and Web of Science databases, and ResearchGate (for grey literature). Data on participants, treatment modalities, and outcomes were extracted; treatment effect-size was meta-analysed. Five hundred and forty-three references were found; after title and abstract screening, eight articles (178 participants) were retained of which seven were included in the meta-analysis. G-CBT showed improvement of HD severity at posttreatment (Hedge's g = 0.96). The rate of clinically reliable changes across groups of treatment was 21%-68% (M = 36.7%; SD = 12.1%). The meta-analyses showed a statistically but not clinically significant impact of age on effect-size. No publication bias was found. There is strong evidence supporting the efficacy of G-CBT including modified or extended versions of classical G-CBT protocols. However, controlled trials with follow-up assessment are needed to evaluate long-term G-CBT efficacy for HD. As well, the rate of clinically significant changes is low; further research on the HD model could improve the efficacy of G-CBT.

Group cognitive-behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: An open trial.

BACKGROUND: Group cognitive-behavioural therapy (G-CBT) for hoarding disorder (HD) may be an intervention of choice, considering its efficacy, low costs, and impact on comorbid anxiety and depression. But although G-CBT and modifications of G-CBT have been applied, none has assessed G-CBT efficacy at follow-up. In the current open-label pilot study, we tested the efficacy of G-CBT at posttreatment and 6-month follow-up and whether the inclusion of targeted reasoning and self-identity components added to G-CBT efficacy. METHODS: Participants (n = 16) with the HD according to the DSM-5 criteria without major comorbid conditions and not requiring immediate medical intervention were retained. The intervention included a 20-week G-CBT with the inclusion of modules on reasoning and self-identity. RESULTS: Very large/large effect sizes, depending on the outcome measure, were observed at posttreatment. Also, HD severity decreased from posttreatment to 6-month follow-up. All participants showed reliable change from pretreatment to follow-up. CONCLUSIONS: The results emphasize the efficacy of G-CBT with additional targeted reasoning and self-components.

Factors Affecting the Referral Rate of the Hoarding Disorder at Primary Mental Health Care in Quebec.

Hoarding disorder (HD) places an important burden on people with HD, on their family members and society. In this paper we evaluate help-seeking in HD at primary mental health, measured in referral rate, together with its individual, environmental and structural correlates. We conducted an aggregate study by combining existing official data with our own survey data at the catchment area level. We found a mean annual referral rate of 1.58 (SD = 1.79) cases of HD in primary mental health facilities per 10,000 of adult population. The referrals rate correlated with socio-demographic characteristics of the catchment area, the availability of tools for clinical management of HD, and affiliation to a University Medical school. We also found that: (1) family members, neighbours, municipal workers and health professionals are the primary source of complaints for HD; (2) 72% of primary mental health facilities worked with HD in crisis situations, 52% expressed difficulties in obtaining the consent of people with HD for an intervention (3) health/social services professionals lack HD clinical management tools, training and formal collaboration with municipal (housing, building security, fire prevention) specialists. Improvement of the readiness of the health-system to deal with HD will improve help-seeking for formal medical counselling on the part of people with HD. We can improve this readiness by providing primary mental-health facilities with training, clinical management tools and by helping them to establish formal collaboration with municipalities and community organisations. University medical schools can take a leadership role and become centers catalysing the change in HD clinical management.