Does the presence of chronic pain affect scores on cognitive screening tests/brief cognitive measures for dementia? A systematic review and meta-analysis.

OBJECTIVE: Cognitive screening tests can identify potential dementia by indicating a concerning level of cognitive impairment. The older populations for whom this is most relevant are more likely to experience chronic pain, which also impairs cognitive function, but pain's impact on cognitive screening tests specifically remains unknown. METHOD: We conducted a systematic review and meta-analysis (SR/MA) following PRISMA guidelines evaluating cognitive screening scores in studies involving participants with chronic pain compared with a pain-free control group. Our question was whether the presence of chronic pain (self-reported or based on diagnosis) was associated with poorer performance on these screens, and to identify the heterogeneity across groups and screens. RESULTS: The 51 studies identified yielded 62 effect size estimates. The pooled g was 0.76 (95% confidence interval 0.57 to 0.95). Heterogeneity was high for the full model (= 93.16%) with some reductions in sub-analyses. Around half of the studies were identified as being at a low risk of bias. There was no evidence of publication bias. CONCLUSIONS: As a whole, this analysis suggests medium to large effect sizes on cognitive screen performance when people are living with chronic pain. We suggest that clinicians should consider the effect of chronic pain when cognitive screens are employed to investigate dementia. Further research could clarify the effect pain has on different screen sub-domains to aid their effective use with these populations.

Connecting, learning, supporting: Caregivers' experiences of a stress and distress biopsychosocial group intervention.

BACKGROUND: Family caregivers are fundamental in supporting people living with dementia to remain at home, however, psychological distress can occur as a result of their caring role. Research into interventions for caregivers of people living with young-onset dementia, including their experience of and the mediating processes of such interventions, remains limited. METHODS: An Interpretative Phenomenological Analysis explored caregiver experiences and influence on caregiving of participating in a "Responding to Distress in Dementia" group. Five family caregivers were interviewed with discussions covering the period from first noticing symptoms to the interview session. RESULTS: Within the group experience, four superordinate themes were identified: 'connecting to other caregivers', 'learning about caregiving', 'group factors' and 'reduced caregiver distress'. During the post-group period, three superordinate themes were recognised: 'maintaining support', 'applying learning', and 'normalising caregiving'. CONCLUSIONS: The study highlighted several interrelated themes involving creating connections amongst caregivers with similar experiences, social learning, and supportive learning through group structure and facilitation. Many of the processes reflected those found in existing dementia caregiver intervention research. Recommendations included facilitating peer support groups and exploring whole-family approaches.

Situational variables and institutional violence: a systematic review of the literature.

The impact of violence on institutions is not hard to discern: staff and patients are physically injured and may become psychologically disturbed, property is destroyed, and regimes and programs are disrupted and thereby impoverished. Furthermore, violent individuals are not only incarcerated for longer but are held in more expensive and more restrictive conditions. In order to manage institutional violence, risk factors need to be identified. Research directed at understanding institutional violence has tended to focus on person-centered explanations. However, human behavior does not occur in a vacuum of internal drives and motivations; situational factors are also relevant. A focus on situational risk factors may provide an additional means for managing institutional violence. The primary aim of this systematic review was to examine research that measured the impact of situational factors on institutional violence. The relationships among physical, verbal and/or sexual face-to-face violence and situational factors in prisons and closed psychiatric settings were reviewed. A descriptive and in-depth analysis of previous research findings was carried out. Findings indicated that a range of situational factors may impact on institutional violence. Methodological issues that influence the confidence that can be placed on these findings are considered. The implications of the findings are outlined.

Negative alcohol consumption outcome associations in young and mature adult social drinkers: a route to drinking restraint?

Alcohol 'cognitions' were explored using an implicit methodology [Stacy, Leigh and Weingardt, 1994]. In Study 1, an Associations Questionnaire was developed with young adult undergraduates (median=20 years) comprising culturally available (i.e., high-frequency occurrence) and idiosyncratic (i.e., low-frequency occurrence) positive and negative alcohol consumption outcomes and positive and negative outcomes of behaviors-other-than-alcohol consumption. In Study 2, the relationship was explored between the alcohol consumption of young adult undergraduates (median age = 19 years) and implicit alcohol-related associations made through the Associations Questionnaire. A significant positive relationship was found between consumption and positive and negative culturally available (experimental) outcomes but not for the other two types of (control) outcome. In Study 3, the relationship between alcohol consumption and alcohol-related associations was explored in mature adults (median = 45 years) with many more years' drinking experience. The results of Study 1 were replicated except that a significant positive relationship between consumption and some control outcomes was now found--e.g., negative outcomes of what where hitherto behaviors-other-than-alcohol consumption. In Study 4, however, using the same techniques that were used to develop the Associations Questionnaire in Study 1, an extended set of negative alcohol consumption outcomes was found in mature adults (median = 44 years) that included a proportion of the negative outcomes of behaviors-other-than-alcohol consumption that had served as controls in Studies 2 and 3. A reanalysis of the data from Study 3, with such items removed from the controls and designated 'new' negative alcohol consumption outcomes, showed a positive relationship between consumption and implicit alcohol-related associations made through these 'new' items of the Associations Questionnaire. The changing profile of associations with negative outcomes of consumption is discussed and related to negative expectancy research and drinking restraint.