Effect of Polyphenol Supplementation on Memory Functioning in Overweight and Obese Adults: A Systematic Review and Meta-Analysis.

Negative health consequences of obesity include impaired neuronal functioning and cell death, thus bringing the risk of impaired cognitive functioning. Antioxidant properties of polyphenols offer a possible intervention for overweight people, but evidence for their effectiveness in supporting cognitive functioning is mixed. This review examined evidence from randomized controlled trials concerning the effect of polyphenols on tasks requiring either immediate or delayed retrieval of learned information, respectively, thus controlling for differences in cognitive processes and related neural substrates supporting respective task demands. Searches of the PubMed/Medline, PsycInfo, and Scopus databases identified 24 relevant primary studies with N = 2336 participants having a BMI ≥ 25.0 kg/m2. The participants' mean age for the 24 studies exceeded 60 years. Respective meta-analyses produced a significant summary effect for immediate retrieval but not for delayed retrieval. The present findings support a potential positive effect of chronic supplementation with polyphenols, most notably flavonoids, on immediate retrieval in participants aged over 60 years with obesity being a risk factor for cognitive impairment. We recommend further investigation of this potential positive effect in participants with such risk factors. Future research on all populations should report the phenolic content of the supplementation administered and be specific regarding the cognitive processes tested.

Polyphenol supplementation and executive functioning in overweight and obese adults at risk of cognitive impairment: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Increasing evidence indicates a link between obesity and cognitive impairment. Furthermore, there is limited literature regarding the effect of polyphenols, a plant derived compounds, on executive functioning in an overweight/obese population at-risk of cognitive impairment. The aim of the present systematic review and meta-analysis of randomized controlled trials is to examine the effect of polyphenol supplementation on executive functions in overweight and/or obese populations at risk of cognitive impairment. METHODS: A comprehensive literature search was conducted from inception to March 2023 using four electronic databases: PubMed/Medline, PsycInfo, Scopus and Cochrane trials library. Published primary research studies in English that compared the effect of polyphenols with placebo on executive function in overweight/obese adults were considered eligible for the meta-analysis. Jadad scale was used for the methodological quality rating of the included studies. Hedges g with 95% confidence intervals (CI) for endpoints were calculated using random effect model where applicable. Rosenthal's Fail-safe N, funnel plots, the Begg and Mazumdar's rank correlation test (Kendall's S statistic P-Q), Egger's linear regression test, and Duval and Tweedie's trim-and-fill test were identified for potential use as appropriate, to examine publication bias. Sensitivity analysis was conducted to examine the robustness of the results. RESULTS AND CONCLUSION: A total of 23 RCT studies involving N = 1,976 participants were included in the review. The results of the meta-analysis revealed a non-significant effect for polyphenol supplementation on executive function (g = 0.076, CI = -0.018 to 0.170). Observations from primary studies within the meta-analysis showed a potential positive effect of polyphenol supplementation in a younger population at-risk of cognitive impairment and it is recommended to investigate this further in future studies. Moreover, the variability of the tasks used to examine executive functions as well as the adequate reporting of supplement's phenolic composition is a limitation that future work should also consider.

Virtual clinics versus face-to-face review: Is the benefit the same for new orthopaedic patients?

BACKGROUND: COVID-19 shocked global healthcare systems, particularly the surgical services, resulting in a significant backlog of patients with waiting times not expected to return to pre-pandemic levels until 2025. The Royal College of Surgeons has recommended a wider use of virtual clinics to meet the increased demand. The efficacy of virtual follow up is well documented in the literature; however, there is very little evidence of the role of virtual clinics in the assessment of new elective patients. METHODS: Observational study comparing clinical outcomes of new patients electively referred to orthopaedic virtual clinics between January and February 2021 with face-to-face clinics in January and February 2020. RESULTS: Over the equivalent time frame, more patients were reviewed in virtual clinics compared to traditional face-to-face (821 vs 499). However, virtual clinics lead to significantly more patients being brought back for follow up (78.3% vs 37.3%) and fewer patients received outcomes that progressed their journey towards a definitive intervention or discharge. CONCLUSION: The overall benefit of virtual clinic appointments in the context of reviewing new patients remains to be proven. Despite increasing use of virtual clinics in the National Health Service, we have shown a potential delay to patients' clinical progression, ultimately delaying healthcare delivery. Potential methods to improve the benefit of virtual clinics are proposed.

Methadone-Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness.

BACKGROUND AND OBJECTIVES: Treatment guidelines emphasize patients' readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. METHODS: Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone-assisted withdrawal in all settings. Time 2 (T2) was a 6-month follow-up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. RESULTS: At T1, inpatients had higher self-efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self-efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. DISCUSSION AND CONCLUSIONS: Self-efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. SCIENTIFIC SIGNIFICANCE: These findings advance existing literature and knowledge by highlighting the importance of self-efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry). (Am J Addict 2021;30:11-20).

High drug related mortality rates following prison release: Assessing the acceptance likelihood of a naltrexone injection and related concerns.

BACKGROUND AND AIMS: High drug related mortality amongst former prisoners in the 4 weeks following release is an internationally recognised problem. Naltrexone injections at release could diminish this by blockading opioid receptors, but naltrexone is not licensed for injection for treating opiate misuse in the United Kingdom and some other countries. This study examined the likelihood of accepting a naltrexone injection at release, and the relationship of this likelihood to other relevant variables. METHOD: Sixty-one male prisoners with a history of heroin use, who were approaching release from two prisons in the north-west of England, provided likelihood ratings for accepting a naltrexone injection if it were to have been available. Additional data was gathered regarding demographic and drug use histories, and also from psychometric instruments relevant to drug misuse and treatment preparedness. RESULTS: Maximum likelihood ratings for accepting a naltrexone injection were recorded by 55.7% of the sample with only 9.8% indicating no likelihood of accepting an injection. Likelihood ratings were positively related to serving a current sentence for an acquisitive offence compared to drug related or violence offences, and negatively related to peak methadone dosages during the current sentence. CONCLUSIONS: Although naltrexone injections were not available to participants in this study, the findings suggest that the potential uptake for this intervention is sufficient to warrant a clinical trial with this population of British prisoners, with a view to potential changes to its current licencing status. However, the importance of individual patient readiness for such an abstinence orientated intervention is emphasised by the negative correlation between the likelihood ratings and recent methadone doses.

Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study.

INTRODUCTION: Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection. METHODS: 60 heels with intractable plantar fasciitis who had failed conservative treatment were randomised to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared. RESULTS: Pre-injection, the two groups were well matched with no statistically significant difference. At 3 months, all three outcome scores had significantly improved from their pretreatment level in both groups. The scores in the Steroid arm were marginally better than in the PRP arm, but this difference was not statistically significant. At 6 months, there was no statistically significant difference between the two groups, though there was a trend for the PRP scores to become better than the Steroid scores. At 12 months, the RM, VAS and AOFAS scores in the PRP arm (1.9, 3.3 and 88.5) were significantly better than the Steroid arm (2.6, 5.3 and 75) with P values of .013, .028 and .033, respectively. CONCLUSIONS: PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection.

An investigation into the use of multi-source feedback (MSF) as a work-based assessment tool.

INTRODUCTION: This study compared Specialist Trainees' (STs) hand-selected multi-source feedback (MSF) scores with those made by their clinical supervisors and explored perceptions of both those being assessed and those assessing. METHODS: Participating STs were asked to hand a mini-PAT questionnaire to a clinical colleague of their choice and also to their Clinical Supervisor. Statistical analysis was carried out on submitted paired assessments to determine any differences in responses between clinical supervisors and hand-chosen assessors. Semi-structured interviews were held with seven nurses, seven Consultants and six postgraduate doctors. RESULTS: Forty pairs of mini-PAT questionnaires were analysed. Hand-chosen assessors' ratings were significantly higher than those for clinical supervisors with respect to: "good clinical care" (p < 0.01), "good medical practice" (p < 0.05), "teaching and training" (p < 0.01), "relationship with patients" (p < 0.05) as well as for overall impression of the trainee (p < 0.05). Five themes were identified from interviews: validity of selecting assessors; anonymity of assessors; usefulness of feedback; the value of multi-professional assessors; and grading. DISCUSSIONS: There is a systematic difference in the assessment scores for trainees in MSF between clinical supervisors and hand-chosen assessors, the former scoring trainees more harshly. Grading was open to interpretation. This raised questions, especially from nurse interviewees regarding appropriate benchmarking.

Determining eye-hand coordination using the sport vision trainer: an evaluation of test-retest reliability.

The purpose of this investigation was to assess the number of test-retest trials required to familiarize participants in order to provide acceptable reliability for the measurement of an eye-hand coordination task using the Sport Vision Trainer (SVT). Two schedules were conducted (S1 and S2). For S1, 64 participants (male n = 51, age 20.8 ± 4.9 years; female n = 13, age 20.1 ± 2.1 years) attended four sessions each 1 week apart, and undertook four trials using the SVT. For S2, 60 participants (male n = 46, age 20.8 ± 4.9 years; female n = 14, age 20.1 ± 2.1 years) attended one 20-minute schedule consisting of four consecutive trials using the SVT. Limits of agreement (LoA) analyses showed that absolute reliability was increased in both studies. The LoA for S2 indicate that error decreased between trial 1-2, 2-3, and 3-4; ± 0.95 (CI, -1.16, +2.56sec), ± 0.97 (CI, -1.66, +2.14sec), ± 0.69 (CI, -1.08, +1.62sec). It was concluded that reliable measurements of eye-hand coordination can be obtained using the SVT in one session.

Are albumin and total lymphocyte count significant and reliable predictors of mortality in fractured neck of femur patients?

Hip fractures are a significant cause of mortality and morbidity in the elderly. It is important to identify factors that predict an increased mortality following hip fracture. The aim of this study was to identify significant predictors of mortality at 6 and 12 months following hip fractures. Three hundred patients above the age of 65 were identified who were admitted in to the hospital with fracture neck of femur. Two hundred and seventy-four patients were operated and were included into the study. Variables collected were age, gender, significant comorbidities, admission albumin level and admission total lymphocyte count (TLC). Admission time and subsequent time to surgery were also analysed. Our study showed that albumin and TLC were found to be the only clearly significant mortality predictors at 12 months and a delay of up to 4 days to surgery does not significantly increase the mortality at 12 months.

The treatment of intractable plantar fasciitis with platelet-rich plasma injection.

BACKGROUND: Whilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems. OBJECTIVE: Evaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis. PATIENTS AND METHODS: Patients with plantar fasciitis not responded to a minimum of 1 year standard conservative management were offered PRP therapy. Injections were performed in theatre as a day case. Roles-Maudsley (RM) scores, Visual Analogue Scores (VAS), AOFAS scores and 'would have injection again' were collated pre-operatively, three and six months. RESULTS: Prospective data was collected of 50 heels (44 patients). At six month review, RM score improved from mean 4 to 2 (p<0.001), VAS improved from 7.7 to 4.2 (p<0.001) and AOFAS improved from 60.6 to 81.9 (p<0.001). 28 patients (64%) were very satisfied and would have the injection again. No complications were reported. CONCLUSION: In these chronic cases, PRP produce an efficacy rate, approaching 2 out of every 3. The procedure was safe with no reported complications. The authors feel PRP may have some role in treatment, and merits further study with a prospective randomised trial.

The effects of 'ecstasy' (MDMA) on visuospatial memory performance: findings from a systematic review with meta-analyses.

To review, with meta-analyses where appropriate, performance differences between ecstasy (3,4-methylenedioxymethamphetamine) users and non-users on a wider range of visuospatial tasks than previously reviewed. Such tasks have been shown to draw upon working memory executive resources. Abstract databases were searched using the United Kingdom National Health Service Evidence Health Information Resource. Inclusion criteria were publication in English language peer-reviewed journals and the reporting of new findings regarding human ecstasy-users' performance on visuospatial tasks. Data extracted included specific task requirements to provide a basis for meta-analyses for categories of tasks with similar requirements. Fifty-two studies were identified for review, although not all were suitable for meta-analysis. Significant weighted mean effect sizes indicating poorer performance by ecstasy users compared with matched controls were found for tasks requiring recall of spatial stimulus elements, recognition of figures and production/reproduction of figures. There was no evidence of a linear relationship between estimated ecstasy consumption and effect sizes. Given the networked nature of processing for spatial and non-spatial visual information, future scanning and imaging studies should focus on brain activation differences between ecstasy users and non-users in the context of specific tasks to facilitate identification of loci of potentially compromised activity in users.

The effects of heavy social drinking on executive function: a systematic review and meta-analytic study of existing literature and new empirical findings.

BACKGROUND: Previous investigations of executive function in alcohol dependent and in social drinkers have not always produced consistent results and have not utilised key indicators of recent theoretical models of Executive Function (EF). The present paper reports the results of two studies that seek to address these limitations. METHOD: Study 1 took the form of a systematic review and meta-analysis of studies examining EF in social drinkers. In Study 2, 41 participants completed an alcohol use inventory and were assigned to either light or heavy alcohol use via median split of average weekly dose. Participants completed measures of the fractionated executive processes of updating, shifting, inhibition and access to semantic memory. RESULTS: Study 1 only identified seven studies of EF in social drinkers, and the mean effect size was non-significant. In study 2, the heavy alcohol use group performed worse on all measures of executive functioning except memory updating. CONCLUSIONS: To our knowledge, this is the first systematic investigation of executive functioning in social drinkers. Given that the participants were non-treatment seeking social drinking students, the EF deficit in the heavy user group is particularly worrying and could increase the likelihood of developing an alcohol use disorder.

Social services homecare for people with motor neurone disease/amyotrophic lateral sclerosis: why are such services used or refused?

Many patients with the terminal condition motor neurone disease/amyotrophic lateral sclerosis (MND/ALS) do not access social service homecare, which may have implications for the location of end-of-life care. We aimed to identify factors related to uptake of such care in MND/ALS. A case note review of patients at a UK MND/ALS clinic (N = 97) provided data concerning disease onset and severity, demographic variables and care received. Narrative interviews with people with MND/ALS (N = 24) and family carers (N = 18) explored their perspectives on social services homecare. Quantitative analyses highlighted the role of increasing disease severity and age for social services homecare uptake. However, qualitative findings revealed a number of barriers delaying the uptake of such care. 'Internal' issues focused on retaining control and normality within the home. 'External' issues arose from limited understanding of the disease amongst service providers and lack of awareness of service entitlement amongst patients and carers. Multiple factors are implicated in the uptake of social services homecare. Uncertainties surrounding service entitlement must be addressed, including the simplification of bureaucratic procedures and clarification of the roles of health and social care professionals. Service providers need a greater awareness of the nature of the disease and their role in its management.

The relationships of 'ecstasy' (MDMA) and cannabis use to impaired executive inhibition and access to semantic long-term memory.

This study aimed to examine the relationship between the consumption of ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) and cannabis, and performance on the random letter generation task which generates dependent variables drawing upon executive inhibition and access to semantic long-term memory (LTM). The participant group was a between-participant independent variable with users of both ecstasy and cannabis (E/C group, n = 15), users of cannabis but not ecstasy (CA group, n = 13) and controls with no exposure to these drugs (CO group, n = 12). Dependent variables measured violations of randomness: number of repeat sequences, number of alphabetical sequences (both drawing upon inhibition) and redundancy (drawing upon access to semantic LTM). E/C participants showed significantly higher redundancy than CO participants but did not differ from CA participants. There were no significant effects for the other dependent variables. A regression model comprising intelligence measures and estimates of ecstasy and cannabis consumption predicted redundancy scores, but only cannabis consumption contributed significantly to this prediction. Impaired access to semantic LTM may be related to cannabis consumption, although the involvement of ecstasy and other stimulant drugs cannot be excluded here. Executive inhibitory functioning, as measured by the random letter generation task, is unrelated to ecstasy and cannabis consumption.

Modelling the adverse effects associated with ecstasy use.

AIMS: Ecstasy, the street name for 3,4-meththylenedioxymethamphetamine, has been associated with a range of psychiatric symptoms and impaired psychological health in both problem and recreational users. The purpose of the present paper is to determine how these impairments are related to the history of polydrug use, and the conditions under which individuals ingest ecstasy. DESIGN: Associations between the variables of interest were investigated utilizing negative binomial regression. SETTING: Liverpool and Preston in the North West of England. PARTICIPANTS: A convenience sample of 159 recreational ecstasy/polydrug users (80 males, 79 females). The sample was composed primarily of undergraduates. MEASUREMENTS: The dependent variable was the number of reported ecstasy-related adverse effects. Independent variables included quantitative aspects of ecstasy and other drug use, and the various beliefs and behaviours associated with ecstasy use. FINDINGS: The number of adverse effects was associated positively with life-time exposure to ecstasy and negatively with period of abstinence from the drug. Adverse effects were more common among those who consumed ecstasy and alcohol concurrently, but were unrelated to other aspects of polydrug use. They were unaffected by whether the user took precautions when using the drug, and only weakly related to prior beliefs concerning the effects of ecstasy. CONCLUSIONS: Greater life-time exposure to ecstasy and consuming the drug concurrently with alcohol increase the likelihood of experiencing adverse effects, including paranoia, poor general health, irritability, confusion and moodiness. Adverse effects decrease with the period of abstinence from the drug.

Executive working memory deficits in abstinent ecstasy/MDMA users: a critical review.

AIMS: This review examined studies of executive functioning in abstinent ecstasy (3,4-methylenedioxymethamphetamine, MDMA) users on tasks which had been empirically mapped onto updating, shifting, inhibition and accessing long-term memory executive processes. Studies of some aspects of visuospatial memory performance were also included because of the investment of executive resources in such tasks. METHODS: Thirty-three studies were identified for the review following searches of the Psychinfo and Medline databases. Inclusion criteria were the reporting of new empirical findings from participants drug free at the time of testing, in peer-reviewed journals in the English language. RESULTS: Evidence for ecstasy-related performance deficits was strongest for the updating of verbal material, and for visuospatial memory tasks requiring additional processing beyond storage and retrieval. Such processing suggested that the overall level of executive demand was an important consideration. Executive shifting showed little evidence of ecstasy-related impairment, whilst examination of inhibition and long-term memory access presented an unclear picture. CONCLUSIONS: All but one of the studies had a cross-sectional design. Although this is a potential weakness with regard to confounds, the necessity of such designs was acknowledged. Studies were generally aware of the need to control for potential confounds, especially the effects of other drugs, through a mixture of group designs and statistical techniques. It was recommended that future studies of executive functioning in ecstasy users should detail the relationship of the tasks and dependent variables reported to specific executive processes and consider the level of executive demand imposed by such tasks.

The association between the negative effects attributed to ecstasy use and measures of cognition and mood among users.

In self reports, abstinent ecstasy/polydrug users claim that they experience certain ongoing affective and psychological changes including elevated anxiety, arousal, and depression. In addition, various aspects of cognition (e.g., everyday memory, reasoning, executive functioning) appear to be affected. The present paper investigated the link between these two psychological sequelae. Ninety-five ecstasy/polydrug users completed tests of reasoning, intelligence, information processing speed, executive functioning, and everyday memory. Affect was measured via a mood adjective checklist. Adverse effects attributed to ecstasy were measured via responses to adjectives reflecting changes in users since they started using the drug. In addition, indicators of sleep quality and daytime sleepiness were obtained. Users attributed a number of adverse effects to ecstasy, namely heightened irritability, depression, paranoia, and deteriorating health. Adverse effects were significantly and negatively correlated with aspects of intelligence, everyday memory, and sleep quality. Length of use of ecstasy use was positively correlated with adverse effects. While many users attribute a number of adverse affects to their use of ecstasy, it remains unclear whether these self-perceptions are a corollary of the psychopharmacological effects of the drug or reflect factors which in fact predate its use.

Information processing speed in ecstasy (MDMA) users.

Previous research draws parallels between ecstasy-related and age-related deficits in cognitive functioning. Age-related impairments in working memory have been attributed to a slow down in information processing speed. The present study compared 29 current ecstasy users, 10 previous users and 46 non-users on two tests measuring information processing speed and a computation span task measuring working memory. Results showed that ecstasy users performed worse than non-ecstasy users in the letter comparison task although the overall difference was not significant (p=0.089). Results from the pattern recognition task showed that current ecstasy users produced significantly more errors than the other two groups (p<0.01). When results were combined for both the letter and pattern tasks, once again current ecstasy users produced significantly more errors than non-ecstasy users (p<0.01). Working memory deficits obtained were statistically significant with both ecstasy using groups performing significantly worse than non-users on the computation span measure (p<0.01). Moreover, ANCOVA with measures of processing speed as covariates failed to eliminate the group difference in computation span (p<0.01). Therefore, it is likely the mechanism responsible for impairments in the computation span measure is not the same as that in elderly adults where processing speed generally removes most of the age-related variance. Also of relevance is the fact that the ecstasy users reported here had used a range of other drugs making it difficult to unambiguously attribute the results obtained to ecstasy use.