ABSTRACT
BACKGROUND: Healthy diet and exercise are associated with reduced risk of dementia in older adults. The impact of diet and exercise interventions on brain health is less consistent, especially with dietary interventions which rely on varying approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counseling approach to improve hippocampal volume among older adults at-risk for dementia. METHODS: Participants with vascular risk factors and subjective cognitive decline or early mild cognitive impairment were cluster randomized in groups of 3-4 to the diet intervention (DIET) or control education (ED) group. All participants engaged in 1 h of supervised exercise per week and additional exercise at home. DIET involved 1 h per week of group-based dietary counseling comprising education, goal setting, and strategy training. ED involved 1 h per week of group-based brain health education classes. Our primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included changes in cognitive function, blood biomarkers, diet, and fitness. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. RESULTS: Of 190 older adults contacted, 14 (7%) were eligible and enrolled, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and DIET/ED sessions on average. All 6-month assessments prior to COVID-19 were completed but disruptions to in-person testing resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the study. Preliminary findings did not identify any significant changes in hippocampal volume; however, substantial improvements in diet and HbA1c were observed with DIET compared to ED (d = 1.75 and 1.07, respectively). CONCLUSIONS: High adherence and retention rates were observed among participants and preliminary findings illustrate improvements in diet quality and HbA1c. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03056508 .
ABSTRACT
BACKGROUND: Persons living with dementia (PLWD) and family care partners (CPs) want to improve their health, maintain independence, and enhance well-being. Multi-domain interventions towards this goal are needed, but few are available and fewer were co-created with PLWD, CPs, and program providers. The objective of the DELIGHT project is to use a participatory approach to co-design a feasible, effective multi-domain intervention (the DELIGHT program) that meets the health and well-being goals of PLWD and CPs. METHOD: Using a participatory approach, the DELIGHT project is guided by a core team of researchers, PLWD, CPs, and an Alzheimer Society representative. The co-design team included the core team and additional PLWD/CPs, exercise professionals, dietitians, health care professionals, and community service providers (n=29). Due to COVID-19, research team meetings have been virtual since May 2020. The co-design was planned for four in-person, half-day sessions but was transitioned to six online, 1.5-hour sessions, using small breakout rooms for discussion. The co-design meetings focused on identifying target population, key outcomes of the program and developing program components and structure. During co-design meetings, two or three guiding questions were set to focus discussion on a specific topic (e.g., exercise). The final co-design session focused on the overall structure of the DELIGHT program. The core team then reflected on co-design discussions and decisions and made final decisions on program structure. Program resources were iteratively designed with the core team, co-design team, and other external stakeholders (including an illustrator). RESULT: The DELIGHT program is designed to promote well-being among PLWD and CP. Engagement soon after diagnosis is a goal. The program will meet twice per week for one hour of exercise and thirty minutes of facilitated discussion/education with a healthy snack and social engagement. Education will focus on healthy eating, sleeping well, mental well-being, social connection, and physical activity. Program resources and manual are in development. CONCLUSION: The DELIGHT program was co-created by PLWD, CPs, researchers, and community stakeholders to meet the health and well-being goals of PLWD and CPs. The on-line and in-person program options will be piloted and evaluated in fall 2021. © 2021 the Alzheimer's Association.
ABSTRACT
BACKGROUND: Engaged research involves stakeholders as active partners in the research process, not just as research participants. Engaged dementia research can improve the relevance and quality of research, empower persons living dementia (PLWD) and family care partners, and acknowledge their expertise gained through lived experience. Conducting engaged research is challenging during COVID-19 when in-person interactions are difficult or impossible. The Dementia Lifestyle Intervention for Getting Health Together (DELIGHT) project used an online, engaged research approach to co-design the DELIGHT program, a 12-week program to support the health and well-being goals of PLWD and care partners. Here, we used mixed-methods to evaluate the DELIGHT co-design process, its alignment with an Authentic Partnership approach, and experiences, satisfaction, and suggestions for future online co-design processes. METHOD: The DELIGHT project engaged 29 people in the co-design process during Summer 2020, including PLWD, care partners, service/program providers, healthcare providers, and researchers. The co-design team met over six, 1.5-hour online meetings (via Zoom) to develop the program. Although the co-design process is on-going, evaluation focused on this first phase of the co-design process. A 17-item survey assessed alignment with an Authentic Partnerships approach. Focus groups and interviews used a semi-structured guide to assess experiences, satisfaction, and suggestions for future on-line co-design. RESULT: Surveys were completed by 11 co-design members, and 11 co-design members participated in interviews or focus groups (not all completed both). Initial analysis of survey results indicates co-design members felt respected and safe in the co-design process, felt their perspectives and opinions were valued, and valued the contributions of other members (100% agreed or strongly agreed). All survey respondents felt they gained knowledge and strategies for living well with dementia during the co-design process. All survey respondents also strongly agreed that the DELIGHT program, when implemented, will have a positive impact on PLWD and care partners. Analysis of interviews/focus groups is ongoing and will be available in Spring 2021. CONCLUSION: Co-design members expressed high satisfaction with the process and felt their experiences were valued and heard. All members expressed a strong belief that the program developed will benefit PLWD and care partners. © 2021 the Alzheimer's Association.
ABSTRACT
The COVID-19 study (clinicaltrials.gov:NCT04354519) is a prospective observational cohort launched on 17 March 2020 as part of the UKMSR. As of 24 April, out of 3910 participants, 237 (6.1% (95% CI 5.3% to 6.8%)) reported self-diagnosed COVID-19 among whom 54 (22.8% (17.5% to 28.2%)) also had a diagnosis by a healthcare professional based on symptoms and 37 (15.6% (11.2% to 20.6%)) a confirmed diagnosis by testing. Three participants reported hospitalisation due to COVID-19. No deaths were reported. Among 1283 siblings without MS, 79 (6.2%) had a reported diagnosis of COVID-19. Adjusting for age and gender, the likelihood of contracting COVID-19 in pwMS was similar to siblings (OR 1.180 (0.888 to 1.569)). Seven hundred and fifty-nine of 3812 participants reported that they were self-isolating and that they had been self-isolating for at least 2 weeks before symptom onset if they had COVID-19. Of these, 2 (0.3% (0% to 0.7%)) had self-diagnosed COVID-19 whereas 137 of 3053 participants not self-isolating (4.5% (3.8% to 5.2%)) had the disease. Participants on DMTs were less likely to have self-diagnosed COVID-19 (OR 0.640 (CI 0.428 to 0.957)), which remained significant after removing self-isolating participants (OR 0.633 (0.402 to 0.998)). High-efficacy DMTs reduced the likelihood of self-diagnosed COVID-19 compared with no DMTs (OR 0.540 (0.311 to 0.938)) but not compared with moderate-efficacy DMTs. Including webEDSS (n=2808) and physical MSIS-29v2 (n=3192) as additional predictors in the analysis showed no significant association with the likelihood of contracting COVID-19. The gender distribution was similar between participants with and without COVID-19. More participants with self-diagnosed COVID-19 reported themselves as having any ethnicity other than white compared with those without the disease (6.9% (3.9% to 10.1%) vs 3.8% (3.2% to 4.4%), p=0.019). Gender and ethnicity did not affect the likelihood of having COVID-19.
ABSTRACT
The COVID-19 pandemic is a systemic shock that affects all areas of the global food system. A growing range of impacts on aquatic food producers, value chain actors and consumers is evident. In response, the report provides the impacts of COVID-19 on aquatic food value chains in Bangladesh, Egypt, India, Myanmar and Nigeria. Results show that: (1) COVID-19 and associated containment measures severely disrupted aquatic food value chains, but effects on supply were relatively short-lived;(2)Demand for aquatic foods has yet to recover to pre-pandemic levels;(3) prices of aquatic foods have downward trend while prices of manufactured feeds have risen;and (4) COVID-19 has exacerbated pre-existing inequalities. As COVID-19 pandemic reversed years of progress on key human development indicators, it is important to revitalize aquatic food value chains to protect livelihoods and human nutrition. The paper also provides policy recommendations for both supply and demand sides.