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Abstract Background and Hypothesis People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. Study Design We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Study Results The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02–3.19). The methodological quality of studies evidence was relatively low. Conclusions The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects.

Background Public health and social measures (PHSM) intend to reduce the transmission of infectious diseases and to reduce the burden on health systems, economies and societies. During the COVID‐19 pandemic, PHSM have been selected, combined and implemented in a variable manner and inconsistently categorized in policy trackers. This paper presents an initial conceptual framework depicting how PHSM operate in a complex system, enabling a wide‐reaching description of these measures and their intended and unintended outcomes. Methods In a multi‐stage development process, we combined (i) a complexity perspective and systems thinking; (ii) literature on existing COVID‐19 PHSM frameworks, taxonomies and policy trackers; (iii) expert input and (iv) application to school and international travel measures. Results The initial framework reflects our current understanding of how PHSM are intended to achieve transmission‐related outcomes in a complex system, offering visualizations, definitions and worked examples. First, PHSM operate through two basic mechanisms, that is, reducing contacts and/or making contacts safer. Second, PHSM are defined not only by the measures themselves but by their stringency and application to specific populations and settings. Third, PHSM are critically influenced by contextual factors. The framework provides a tool for structured thinking and further development, rather than a ready‐to‐use tool for practice. Conclusions This conceptual framework seeks to facilitate coordinated, interdisciplinary research on PHSM effectiveness, impact and implementation; enable consistent, coherent PHSM monitoring and evaluation; and contribute to evidence‐informed decision‐making on PHSM implementation, adaptation and de‐implementation. We expect this framework to be modified and refined over time.

Background Subjective cognitive decline (SCD) is considered a risk factor for Alzheimer's disease (AD), highlighting the need for identifying and ranking effective interventions. This was addressed in a systematic review and network meta‐analysis (NMA) of pharmacological and non‐pharmacological interventions for SCD. Methods MEDLINE, Web of Science Core Collection, CENTRAL, and PsycINFO were searched for randomized controlled trials (RCTs) investigating effects on memory, global cognition, and quality of life. Random‐effect model NMAs were conducted. The Cochrane Risk‐of‐Bias‐2 tool assessed methodological quality. Prospero‐Registration: CRD42020180457. Results The systematic review included 56 RCTs. Education programs were most effective for improving memory, second most effective for improving global cognition. Quality of life and adverse events could not be included due to insufficient data. Overall methodological quality of studies was low. Conclusion Education programs were most effective for improving memory and cognition, warranting further research into effective elements of this intervention. There is urgent need to address identified methodological shortcomings in SCD intervention research.

INTRODUCTION Olfactory‐based cognitive training may be of benefit to individuals at risk of dementia given the strong association between olfactory impairment and cognitive decline. The Mind Your Nose (MYN) trial compared an olfactory‐based memory training protocol (OMT) to a visually‐based memory training protocol (VMT) among older adults with subjective cognitive decline. METHODS Participants (N = 53; 17 males; Mage = 72.77, standard deviation [SD] = 6.12) were randomly assigned in a 2:1 ratio to daily OMT (n = 36) or VMT (n = 17) intervention for 20 days. Outcomes were evaluated at baseline (T0), post‐intervention (T1), and 1‐month follow‐up (T2) and included standardized measures of global olfaction (Sniffin’ Sticks) and cognition (National Institutes of Health Toolbox), as well as performance on the olfactory memory (OM) and the visual memory (VM) tasks, and measures of mood and meta‐cognition. RESULTS A significant interaction was found between treatment allocation, time, and modality of memory task at T1(β = −37.50, p = 0.008) and T2(β = −28.75, p = 0.041). Post‐hoc comparisons revealed improvement in trained tasks; OMT led to improvement on the OM task (T1; g = 0.71, p = 0.036; T2; g = 0.72, p = 0.035), and VMT led to improvement on the VM task (T1; g = 1.22, p = 0.011; T2; g = 1.29, p = 0.006). Improvement on the untrained memory task only occurred in OMT (VM task, T1; g = 0.63, p = 0.071; T2; g = 0.74, p = 0.033). No interaction between treatment allocation and time was observed post intervention or at follow‐up for global olfactory ability (T1; β = 0.27, p = 0.871; T2; β = −1.27, p = 0.296). DISCUSSION Consistent with previous research, transfer gains from the OMT condition to an untrained VM task suggest that olfaction may contribute to a‐modal representations of memory. We argue that memory‐based olfactory training offers a new frontier for cognitive interventions among those at risk of dementia. Highlights Relatively few cognitive training programs engage the olfactory sense. Olfactory memory training offers a new frontier of cognitive training for older adults. Olfaction may contribute to improved performance on trained and untrained tasks. The functional impact of olfactory training should be further explored.

Background Changes to the wound dressing frequently cause pain. Some adverse side effects of pharmacologic pain management may cause problems or even impede wound healing. There is no systematic study of non‐pharmacologic therapies for pain during wound dressing changes, despite the gradual promotion of non‐pharmacologic pain reduction methods. Objectives To give clinical wound pain management a new direction, locating and assessing non‐pharmacological interventions regarding pain brought on by wound dressing changes are necessary. Method The researchers conducted a comprehensive literature review on non‐pharmacological interventions for pain during wound dressing changes across five databases: PubMed, Web of Science, Medline, Embase, and the Cochrane Library spanning the period from January 2010 to September 2022. The evaluation of literature and data extraction was carried out independently by two researchers, and in cases of disagreement, a third researcher participated in the deliberation. To assess the risk of bias in the literature, the researchers utilised the Cochrane Handbook for Reviews of Interventions, version 5.1.0. Results In total, 951 people were involved in 11 investigations covering seven non‐pharmacological therapies. For pain triggered by dressing changes, virtual reality (VR) distraction, auditory and visual distractions, foot reflexology, religious and spiritual care, and guided imaging demonstrated partially positive effects, with hypnosis therapy and jaw relaxation perhaps having a weak effect. Conclusion The key to managing wounds is pain management. According to our review, there is some indication that non‐pharmacologic interventions can help patients feel less discomfort when having their wound dressings changed. However, the evidence supporting this view is weak. It needs to be corroborated by future research studies with multicentre and large samples. To promote and use various non‐pharmacologic interventions in the future, it is also necessary to build standardised and homogenised paths for their implementation.

Background The impact of non‐pharmacological interventions (NPIs) on asthma prevention and management is insufficiently examined. We aim to comprehensively evaluate and synthesize existing evidence regarding the effectiveness of various NPIs throughout the life course. Methods We conducted a systematic search and screening of reviews that examined the effectiveness of various NPIs on asthma prevention and control in the Cochrane Library, PubMed, Embase, and Ovid databases. Data extraction was performed by considering the type of NPIs and the life course stages of the target population. Recommendations were provided by considering the quality of review assessed using the AMSTAR2 tool and the consistency of findings across reviews. Results We identified 145 reviews and mapped the evidence on the impact of 25 subtypes of NPIs on asthma prevention and control based on five stages of life course. Reviews indicated a shift of focus and various impacts of major NPIs on asthma prevention and control across life courses, while a few types of NPIs, such as physical exercise, appeared to be beneficial in children, adolescents and adults. Consistent and high‐level evidence was observed only for psychological intervention on asthma control and quality of life among adults and older adults. Potential benefit with high‐level evidence was reported on certain NPIs, such as vitamin D in reducing risk of developing asthma in offsprings in the prenatal stage, digital health interventions in improving asthma control from childhood to older adulthood, and breathing exercise in improving quality of life, asthma‐related symptoms and lung function in adulthood and older adulthood. Conclusion This study emphasizes the significance of delivering NPIs to improve asthma prevention and management and highlights the heterogeneity regarding the impact of NPIs across life courses. High‐quality research is urgently needed to further strengthen the evidence base of NPIs and tailored interventions should be considered in guideline development.

Aim To review and analyse the evidence on the efficacy and safety of non‐pharmacological interventions for preterm infants to relieve endotracheal suctioning (ES) pain. Design A systematic review per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Methods Six databases were searched with a retrieval strategy. Parallel and crossover randomized controlled trials reporting non‐pharmacological interventions for relieving ES pain in preterm infants were identified from inception to 1 September 2021. The protocol was published in PROSPERO (CRD42021276058). Results Ten studies were retrieved, including nine different non‐pharmacological interventions. Seven studies reported that non‐pharmacological interventions in relieving pain were more effective than conventional care during ES, and three trials reported its safety. Due to the heterogeneity of pain assessment tools, time of assessment and population, only Facilitated tucking had sufficient evidence that it is a safe and effective non‐pharmacological intervention.

Aim To explore the best non‐pharmaceutical interventions for improving the behavioural and psychological symptoms in elders with dementia. Design Bayesian network meta‐analysis. Methods A comprehensive electronic literature search was performed in five English databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to 31 October 2019. Results A total of 41 RCTs were included in this network meta‐analysis involving 5 different non‐pharmacological interventions: therapeutic recreation (TC), reminiscence therapy (RT), behaviour therapy (BT), massage therapy (MT) and individualized nursing (IN).The results of network meta‐analysis showed that individualized nursing was the best in improving depression, cognitive function, and activities of daily living of behavioural and psychological symptoms of dementia. Behaviour therapy was the best in improving anxiety symptoms. Reminiscence therapy was the best in improving neuropsychiatric symptoms.

In addition to the lack of disease modifying treatments in osteoarthritis (OA), there is also a need for safer and efficacious treatments for pain relief. Patients with hand osteoarthritis (HOA) experience pain that can be incapacitating, which is usually unresponsive to painkillers. Non-pharmacological alternatives are an interesting option for pain relief in HOA. to demonstrate that paraffin baths (PB) provide safe, significant, clinically meaningful pain relief in HOA patients. (CAAE:07360819930015045) 67 patients with HOA diagnosis according to ACR criteria were prospectively recruited from March 2020 to August 2022 (interruptions due to COVID pandemic) in private rheumatology services and randomized to receive either 20 min daily sessions of PB, 3 times/week for 4 weeks or a leaflet with information for protection of hand joints (control, C). Baseline demographic, clinical and radiographic (Kellgren-Lawrence, KL score) data were registered. The evaluator was blinded to group allocation. Primary endpoint was 15% reduction of pain on movement (0-10 VAS, visual analogue scale) in the most affected joint of the hand at baseline as compared to pain value at 4w; secondary endpoints were sustained pain reduction at 12w as compared to baseline, increase in grip and pinch strength (KgF) as well as improvement in Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores at 12w as compared to baseline. baseline characteristics of 34 paraffin and 33 control patients are shown in Table 1; three patients in each group did not return for follow up at 4 weeks; median disease duration was 58(range 3-360) months in both groups; Primary outcome was reached: baseline pain in PB (7.8±1.9) was reduced to 6.4±2.7 (p<0.017) whereas baseline pain in C (7.1±1.8) was not significantly reduced at 4w (6.9±1.9; p=0.7067); reduction of pain in PB was significantly sustained at 12w (6.3±2.9) (p=0.0196). Grip and pinch strength as well as CHFS, FIHOA, and SF-12 scores were similar both at baseline and at 12 weeks in both groups. There were no major adverse events. PB in a single-blinded prospective randomized trial provided early and sustained pain reduction in HOA. Although larger trials are needed, we believe that spreading of this cheap, easy-to-use method, should be encouraged. NIL. NIL. None Declared. Table 1Baseline characteristicsControlPBP valueAge60±959±10nsWomen31(94)32(94)nsBMI26.6±428±5nsMonth Family income <900 US$14(42)21(61)K-L>224(72)26(76)nsCRP (mg/dL)0.27±0.190.56±0.90.12367 patients were randomized to PB or control treatment; data are mean(%) or SD; ns, non-significant.

Purpose of Review We review non-pharmacological and pharmacological approaches to managing behavioral and psychological symptoms of dementia (BPSD). We examine methods for assessment and evidence for interventions, focusing on recent findings and innovations. Finally, we recommend an algorithm for management of BPSD. Recent Findings Training of formal caregivers is the most effective intervention for BPSD; other non-pharmacological interventions are also beneficial. Antidepressants and antipsychotics remain a mainstay of pharmacological treatment for BPSD. There is limited evidence supporting the use of stimulants, cognitive enhancers, dextromethorphan/quinidine, benzodiazepines, anticonvulsants, and pimavanserin. Summary The management of BPSD is highly individualized. Following thorough assessment, the initial step is addressing contributing medical problems. Non-pharmacological interventions should be tried prior to pharmacological interventions. Antipsychotics should be prescribed only when behaviors pose a significant safety risk or if the person with dementia is very distressed. New approaches will be needed to address an increasing population of people with dementia.