Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. Systematic reviews showed insufficient evidence for clinical practice in 2004: what about in 2011? The next appeal for the evidence-based medicine age. A pragmatic randomised controlled trial of an implementation intervention to increase healthy eating and physical activity-promoting policies, and practices in centre-based childcare services: study protocol Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews Weight Management Interventions in Adult and Pediatric Asthma Populations: A Systematic Review. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Effects of school-based interventions on mental health stigmatization: a systematic review Ten years of evidence to guide physiotherapy interventions: Physiotherapy Evidence Database (PEDro) Changes in nurse practitioners' knowledge and behaviors following brief training on the healthy eating and activity together (HEAT) guidelines.
While the role of diet and nutrition in cognitive health and prevention of dementia  in older adults has attracted much attention , the efficacy of different dietary patterns remains uncertain . Previous review s have mainly focused on the Mediterranean diet , but either omitted other dietary patterns , lacked more recent studies , were based on cross-sectional studies , or combined older and younger population s. We followed PRISMA guidelines , and examined the efficacy of current research from r and omized controlled trials and cohort studies on the effects of different dietary patterns . We review ed the Mediterranean diet , Dietary Approach to Stop Hypertension ( DASH ) diet , the Mediterranean-DASH diet Intervention for Neurodegenerative Delay ( MIND ) diet , Anti-inflammatory diet , Healthy diet recommended by guidelines via dietary index , or Prudent healthy diets generated via statistical approaches , and their impact on cognitive health among older adults . Of 38 studies , the Mediterranean diet was the most investigated with evidence supporting protection against cognitive decline among older adults . Evidence from other dietary patterns such as the MIND , DASH , Anti-inflammatory , and Prudent healthy diets was more limited but showed promising results , especially for those at risk of cardiovascular disease . Overall , this review found positive effects of dietary patterns including the Mediterranean , DASH , MIND , and Anti-inflammatory diets on cognitive health outcomes in older adults . These dietary patterns are plant-based , rich in poly- and mono-unsaturated fatty acids with lower consumption of processed foods . Better underst and ing of the underlying mechanisms and effectiveness is needed to develop comprehensive and practical dietary recommendations against age-related cognitive decline among older adult RATIONALE AND AIM The aims of the Cochrane systematic review s are to make readily available and up-to- date information for clinical practice , offering consistent evidence and straightforward recommendations . In 2004 , we evaluated the conclusions from Cochrane systematic review s of r and omized controlled trials in terms of their recommendations for clinical practice and found that 47.83 % of them had insufficient evidence for use in clinical practice . We proposed to reanalyze the review s to evaluate whether this percentage had significantly decreased . METHODS A cross-sectional study of systematic review s published in the Cochrane Library ( Issue 7 , 2011 ) was conducted . We r and omly selected review s across all 52 Cochrane Collaborative Review Groups . RESULTS We analyzed 1128 completed systematic review s. Of these , 45.30 % concluded that the interventions studied were likely to be beneficial , of which only 2.04 % recommended no further research . In total , 45.04 % of the review s reported that the evidence did not support either benefit or harm , of which 0.8 % did not recommend further studies and 44.24 % recommended additional studies ; the latter has decreased from our previous study with a difference of 3.59 % . CONCLUSION Only a small number of the Cochrane collaboration 's systematic review s support clinical interventions with no need for additional research . A larger number of high- quality r and omized clinical trials are necessary to change the ' insufficient evidence ' scenario for clinical practice illustrated by the Cochrane data base . It is recommended that we should produce higher- quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of method ological advance in this context Background Promotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy . Centre-based childcare services represent a promising setting to provide children with opportunities to improve healthy eating and physical activity . Evidence to inform implementation of childcare obesity prevention guidelines into routine practice in childcare , however , is lacking . This study aims to assess the effectiveness of an intervention , delivered to childcare staff , aim ing to increasing service implementation of healthy eating and physical activity-promoting policies and practice s. Methods and analysis A pragmatic parallel group r and omised controlled trial will be undertaken with 165 childcare services in the Hunter New Engl and region of New South Wales , Australia . Services will be r and omised to receive either a 10-month evidence -based performance review intervention with other re sources to support practice change , or to a waitlist control group . The primary trial outcome is the proportion of services implementing all of the following recommended healthy eating and physical activity promoting practice s : written nutrition , physical activity and small screen recreation policies ; providing information to families regarding healthy eating ( including breastfeeding ) , physical activity and small screen time ; providing twice weekly healthy eating learning experiences to children ; providing water and only plain milk to children ; providing fundamental movement skills activities for children every day ; and limiting and using electronic screen time more for educational purpose s and learning experiences . Effectiveness will be assessed using a telephone interview of practice implementation with childcare staff at baseline and 12 months following baseline . Ethics and dissemination The study was approved by the Hunter New Engl and Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee . Study findings will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number Australian New Zeal and Clinical Trials Registry ACTRN12614000972628 Background The evidence that higher levels of physical activity and /or lower levels of physical inactivity are associated with beneficial health-related outcomes stems mainly from observational studies . Findings from these studies often differ from r and omised controlled trials and systematic review s currently demonstrate mixed results , due partly to heterogeneity in physical activity interventions , method ologies used and population s studied . As a result , translation into clinical practice has been difficult . It is therefore essential that an overview is carried out to compare and contrast systematic review s , and to identify those physical activity interventions that are the most effective in preventing and /or treating major chronic disease . This protocol has been registered on PROSPERO 2013 : CRD42013003523 . Methods We will carry out an overview of Cochrane systematic review s. We will search the Cochrane Data base of Systematic Review s for systematic review s of r and omised controlled trials that have a primary focus on disease-related outcomes . We will restrict review s to those in selected major chronic diseases . Two authors will independently screen search outputs , select studies , extract data and assess the quality of included review s using the assessment of multiple systematic review s tool ; all discrepancies will be resolved by discussing and reaching a consensus , or by arbitration with a third author . The data extraction form will summarise key information from each review , including details of the population ( s ) ( for example , disease condition ) , the context ( for example , prevention , treatment or management ) , the participants , the intervention(s ) , the comparison(s ) and the outcomes . The primary outcomes of interest are the prevention of chronic disease and /or improved outcomes , in the treatment or management of chronic disease . These outcomes will be summarised and presented for individual chronic diseases ( for example , any change in blood pressure in hypertension or glucose control in diabetes ) . Secondary outcomes of interest are to describe the structure and delivery of physical activity interventions  across chronic disease conditions and adverse events associated with physical activity . Discussion We anticipate that our results could inform research ers , guideline groups and policymakers of the most efficacious physical activity interventions in preventing and /or managing major chronic disease BACKGROUND Ample evidence suggests a dose-response relationship between increasing weight and level of asthma risk or reduced asthma control . To establish reversibility , several r and omized controlled trials ( RCTs ) have recently been published to investigate the impact of weight management on asthma . This systematic review synthesizes evidence from these RCTs on the effects of weight management ( weight loss , weight maintenance , maintenance of lost weight , or weight gain prevention ) interventions on  asthma outcomes in both adult and pediatric population s. METHODS We search ed Medline , CINAHL , PsychInfo , and Cochrane for studies published between 1950 and November 2014 . Two research ers independently rated the included studies using the quality assessment tool for RCTs as outlined in the 2013 Obesity Treatment Guideline . Discrepancies were resolved by consensus after discussion between the raters and , if needed , with the senior author . RESULTS Four RCTs in adults and 3 in children and adolescents were included . The adult studies seem to consistently support the benefit of substantial weight loss , but a threshold effect may exist such that only weight loss beyond a minimal amount will likely lead to clinical ly important improvement in asthma outcomes . Three of them suggest that the threshold may lie between 5 - 10 % of weight loss . RCTs in youth suggest that modest calorie reductions alone or combined with increased physical activity , or even a healthy normocaloric diet , may lead to improved asthma outcomes . However , most RCTs review ed were limited by small sample size , short intervention duration s , and short follow-up periods . CONCLUSION Trial evidence shows the promise of weight loss interventions for asthma control in adults and youth . More adequately-powered , long-term RCTs are needed to eluci date the role of weight loss and other weight management interventions in asthma control and prevention . Definitive data are needed to guide clinical and public health practice to effectively address the dual epidemic of obesity and asthma At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as Stigmatizing , or discriminatory , perspectives and behaviour , which target individuals on the basis of their mental health , are observed in even the youngest school children . We conducted a systematic review of the published and unpublished , scientific literature concerning the benefits and harms of school-based interventions , which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization . Forty relevant studies were identified , yet only a qualitative synthesis was deemed appropriate . Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions : poor reporting quality , a dearth of r and omized controlled trial evidence , poor methods quality for all research design s , considerable clinical heterogeneity , and inconsistent or null results . Nevertheless , certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development , implementation and evaluation of a curriculum , which fosters the development of empathy and , in turn , an orientation toward social inclusion and inclusiveness . These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct , structured contact with an infant , and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties . The possible value of using educational activities , material s and contents to enhance hypothesized benefits accruing to direct contact also requires investigation . Overall , the curriculum might serve as primary prevention for some students and as secondary prevention for others Clinicians are increasingly using evidence from high- quality clinical research to guide clinical decision making . Recent articles in this journal have examined research evidence to assist in clinical decisions as diverse as the prescription of running shoes,1 exercise therapy in the treatment of chronic disease2 and the use of protective equipment to prevent concussion.3 The most valid information about the effectiveness of healthcare interventions is provided by r and omised controlled trials and systematic review s of r and omised controlled trials.4 The Physiotherapy Evidence Data base ( PEDro ; http://www.pedro.org.au ) provides easy access to r and omised controlled trials and systematic review s of physiotherapy interventions . PEDro also includes links to evidence -based clinical practice guidelines . October 2009 marked the 10th anniversary of the launch of PEDro . PEDro is freely available on the internet . The data base indexes citation details , author abstract s and , where available , links to full text for r and omised controlled trials , systematic review s and practice guidelines in physiotherapy . Although the PEDro data base is design ed primarily for health professionals , a subsite , called Physiotherapy Choices ( http://www.physiotherapychoices.org.au ) , provides information in lay terms directly to consumers of physiotherapy services . As of August 2009 , more than 15 000 records ( 12 408 trials , 2060 review s and 603 guidelines ) have been indexed on PEDro . Each record is coded according to the subdiscipline(s ) of physiotherapy it addresses . PEDro now includes 615 r and omised controlled trials and 102 INTRODUCTION Primary care providers , particularly pediatric nurse practitioners , are an integral force involved in tackling the obesity epidemic among youth . The majority of nurse practitioners , however , report low proficiency regarding their ability to adequately prevent and treat pediatric overweight . In response , the National Association of Pediatric Nurse Practitioners ( NAPNAP ) developed the evidence -based Healthy Eating and Activity Together ( HEAT ) Clinical Practice Guideline ( CPG ) to improve provider behavior and efficacy . METHOD Thirty-five nurse practitioners attending the NAPNAP Annual Conference participated in an intensive 4-hour HEAT CPG training session . Pre-training and post-training data were collected on provider knowledge , practice behaviors , and barriers in relation to the prevention of overweight among youth . RESULTS Post-training results revealed significant improvements in ( a ) practitioner knowledge ( assessment of patient growth , family history , psychosocial functioning , nutrition , and physical activity ) ; ( b ) practitioners ' intent to improve behavior ( i.e. , increased intent to use behavior modification and counseling aim ed at patient and family behavior change ) ; and ( c ) practitioners ' report of increased confidence in ability to address barriers . DISCUSSION Study findings demonstrate preliminary support for the HEAT CPG as an effective tool aim ed at helping providers to improve their ability to maintain patients ' healthy weight . Future research is needed to verify the effects of HEAT CPG on long-term improvements in care
Results of the analysis indicated that increased consumption of unsaturated fats , fruits , vegetables and low-fat dietary products  , decreased consumption of dietary sodium and beverages containing caffeine , and breastfeeding were found to have preventive effects against high blood pressure in later years of life .
The effects of training given during youth to encourage a healthy lifestyle and behavior changes based on diet and physical activity were also noted
The aim of this systematic review was to analyze the results of observational and interventional research / studies on nutrition-based practice s in the prevention of hypertension among healthy youth .