765 EFFECTIVENESS OF AROMATHERAPY IN MANAGING BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: A MIXED METHODS: SYSTEMATIC REVIEW

Introduction

Over 90% older persons with dementia (PWD) exhibit behavioural and psychological symptoms of dementia (BPSD) during their illness, which is the most prominent and distressing manifestation for PWD and caregivers. Aromatherapy has demonstrated its effectiveness in BPSD management in previous studies. However, previous studies and systematic reviews have shown inconsistent findings, and no review has been done on qualitative studies. The aim of this review was to identify and review the evidence from quantitative and qualitative studies of the effectiveness of aromatherapy on BPSD management, for PWD and caregivers.

Methods

Joanna Briggs Institute (JBI) methodology for mixed method systematic review with convergent segregated approach was followed. 28 English and Chinese databases were searched for published and unpublished studies. The titles, abstracts, and full-texts were screened by two reviewers based on pre-specified criteria, and methodological quality was assessed with JBI critical appraisal tools. Quantitative synthesis including meta-analysis by Review Manager 5.4, qualitative synthesis including meta-aggregation, and integration of both evidence were performed.

Results

Total 8,264 articles were retrieved. After screening, 24 studies (12 randomised controlled trials, 10 quasi-experimental studies, 2 qualitative studies) were included. Most of the studies with moderate methodological quality. Some inconsistent findings regarding the effectiveness of aromatherapy in reducing the severity of BPSD, and insufficient adherence monitoring were reported in the included studies. Significant improvement in PWD’s QoL and caregivers’ distress and burden, positive experience from the caregivers, as well as very low adverse effects (and no adverse effect for aromatherapy inhalation) to PWD were reported in some of the studies.

Conclusion

Aromatherapy, especially in inhalation approach, might be regarded as a potentially safe and effective strategy for BPSD management with positive effects to PWD and caregivers. More structuralised and comparable studies with sufficient sample size and adherence monitoring are needed to obtain more conclusive findings.

Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey

OBJECTIVE

To examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years.

STUDY DESIGN

Cross-sectional population-based survey.

METHODS

A sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis.

RESULTS

In total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram.

CONCLUSIONS

This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies.

Associations of uric acid and gamma-glutamyltransferase (GGT) with obesity and components of metabolic syndrome in children and adolescents

BACKGROUND

The combined effect of uric acid, gamma-glutamyltransferase (GGT) and cardiovascular risk factors clustering in the youth remains under-explored.

OBJECTIVE

The objective of this study was to examine the association between uric acid, GGT, obesity and the individual components of metabolic syndrome in children and adolescents.

METHODS

We performed a cross-sectional observational study of 2067 children and adolescents (875 boys and 1192 girls) aged 6-20 years who were healthy volunteers and were recruited from primary and secondary schools in Hong Kong between 2007 and 2008. Subjects were divided into two strata (75th percentile as cut-off) for comparison between odds of cardiovascular risk factors.

RESULTS

After adjustment by multivariable logistic regression, subjects in upper stratum, i.e., >75th percentile, of either serum uric acid or GGT levels were associated with obesity, low high-density lipoprotein cholesterol (HDL-C) level and high blood pressure (adjusted odds ratios [AOR] ranged from 1.63 to 5.82, all P < 0.005) compared with those in the lower stratum. There were combined effect for upper stratum of both uric acid and GGT in the association with obesity, low HDL-C and high blood pressure (AOR ranged from 2.60 to 10.69, all P < 0.05) after adjustment for age, sex and body mass index z-score (except for obesity status) as well as body height (for high blood pressure).

CONCLUSION

Uric acid and GGT have combined effect in association with obesity and other cardiovascular risk factors in children and adolescents.

Quality-of-life among head and neck cancer survivors at one year after treatment--a systematic review

BACKGROUND

The importance of quality-of-life (QoL) research has been recognised over the past two decades in patients with head and neck (H&N) cancer. The aims of this systematic review are to evaluate the QoL status of H&N cancer survivors one year after treatment and to identify the determinants affecting their QoL.

METHODS

Pubmed, Medline, Scopus, Sciencedirect and CINAHL (2000-2011) were searched for relevant studies, and two of the present authors assessed their methodological quality. The characteristics and main findings of the studies were extracted and reported.

RESULTS

Thirty-seven studies met the inclusion criteria, and the methodological quality of the majority was moderate to high. While patients of the group in question recover their global QoL by 12 months after treatment, a number of outstanding issues persist - deterioration in physical functioning, fatigue, xerostomia and sticky saliva. Age, cancer site, stage of disease, social support, smoking, feeding tube placement and alcohol consumption are the significant determinants of QoL at 12 months, while gender has little or no influence.

CONCLUSIONS

Regular assessments should be carried out to monitor physical functioning, degree of fatigue, xerostomia and sticky saliva. Further research is required to develop appropriate and effective interventions to deal with these issues, and thus to promote the patients' QoL.

Fatigue patterns in Chinese patients receiving radiotherapy

Fatigue has been reported as the most frequently occurring symptom in cancer patients receiving chemoradiotherapy. The purpose of the current descriptive study was to explore the pattern, associated factors, and experience of fatigue in Chinese cancer patients receiving radiotherapy. Twenty-seven subjects from an out patient clinic of a university hospital in Hong Kong participated in the study. They were asked to complete three times daily (morning, afternoon and evening) a diary over a period of two weeks from the beginning of their therapy. The diary incorporated a 10-cm horizontal visual analogue scale (VAS) for measuring fatigue intensity. Further, the Chinese version of the fatigue subscale of the Profile of Mood States was completed before the radiotherapy, at the end of the first week post-treatment, and at the end of the second week. Most patients (44-80.8%) undergoing radiotherapy in this study experienced fatigue at some point during their treatment. The pattern of fatigue was that of repeated curves, with higher levels observed in the afternoons and evenings, and at the end of the first week or the end of the second week. Qualitative data indicated the universal sensations of fatigue and also some culturally specific descriptors. A variety of methods were used by the patients to cope with their fatigue but the effects of such methods were not always positive. It is important for clinical practice to assess the individual patterns and perceptions of fatigue, identify those patients at risk for developing fatigue and initiate interventions to combat fatigue.