There were insufficient data to establish whether oral EPA was better than placebo. Comparisons of EPA combined with a protein energy supplementation versus a protein energy supplementation (without EPA) in the presence of an appetite stimulant (Megestrol Acetate) provided no evidence that EPA improves symptoms associated with the cachexia syndrome often seen in patients with advanced cancer.

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Background Despite a growing elderly South Asian population, little is known about the experience of diagnosis and care for those living with dementia. There have been a number of individual qualitative studies exploring the experiences of South Asian people living with dementia and their carers across different contexts. There has also been a growing interest in synthesizing qualitative research to systematically integrate qualitative evidence from multiple studies to tell us more about a topic at a more abstract level than single studies alone. The aim of this qualitative synthesis was to clearly identify the gaps in the literature and produce new insights regarding the knowledge and understanding of the attitudes, perceptions, and beliefs of the South Asian community about dementia. Methods Following a systematic search of the literature, included qualitative studies were assessed by two independent reviewers for methodological quality. Data were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Findings were synthesized using the Joanna Briggs Institute approach to qualitative synthesis by meta-aggregation. Results Seventeen papers were critically appraised, with 13 meeting the inclusion criteria. Participants were mostly of South Asians of Indian background; followed by Pakistani with a few Sri Lankans. Missing South Asian countries from the current evidence base included those from Bangladesh, Bhutan, Maldives, and Nepal. Three meta-synthesis themes emerged from the analysis: (1) a poor awareness and understanding of dementia, (2) the experience of caregiving, and (3) the attitudes toward dementia care provision. Conclusions A consistent message from this qualitative synthesis was the limited knowledge and understanding of dementia amongst the South Asians. Whilst symptoms of dementia such as ‘memory loss’ were believed to be a part of a normal ageing process, some South Asian carers viewed dementia as demons or God’s punishments. Most studies reported that many South Asians were explicit in associating stigmas with dementia.

Background: Commercially produced infant food has a different taste profile and nutritional content to homemade baby food and its consumption is now very widespread. This change in early food experience may lead to a reduced dietary variety and a decreased microbial load exposure.Objective: The purpose of this study was to gain insight into parental perceptions of complementary feeding, specifically opinions of commercially produced baby food, using qualitative research methods. Methods:Four focus group discussions took place (n = 24), with mothers of infants aged 4-7 months. Half of participants were first time mothers and a third had experience weaning infants with symptoms of cows' milk allergy. Participants were prompted with questions about complementary feeding and shown several different products to stimulate discussion.Results: Thematic analysis of focus groups indicated that three distinctive groups of mothers exist; "relaxed", "concerned" and "balanced", which may be influenced by parity, socioeconomic status and previous experience of weaning. The majority of mothers commenced the weaning process using homemade foods, but transitioned to include commercial baby foods after 3-6 weeks. Commercial baby food was perceived as more convenient to homemade baby food by the majority and as superior and "safer" by some mothers. Although there were concerns raised about the identity of ingredients, few concerns were expressed regarding nutritional quality or allergen content, even by mothers with experience of weaning an infant with food allergic symptoms. Conclusion:Overall complementary feeding was viewed as a natural process with the goal of enjoyment of food and development of a broad palate. Opinions on readymade baby food were influenced by parity, education level and previous experience of weaning.

The aim of this study was to explore and compare the experiences of tilt-in-space wheelchair use and conventional wheelchair use in severely disabled clients with multiple sclerosis and significant spasticity. The research design was a descriptive qualitative approach, using in-depth audio-taped interviews in clients' homes carried out over a 9-month period. A total of 23 clients (7 tilt-in-space wheelchair users and 16 conventional wheelchair users) were recruited from three adjacent district wheelchair services in South-East England. The criteria for recruitment were that the clients were severely disabled with multiple sclerosis, had significant spasticity and were full-time wheelchair users, usually requiring hoisting. Their carers were also interviewed. The majority of tilt-in-space wheelchair users (6 out of 7) reported that their chairs were comfortable compared with only half of those in conventional wheelchairs (8 out of 16). The positive aspects of tilt-in-space wheelchair provision included comfort, improved postural support, enhanced seating stability, relief of pressure and being able to rest sitting out of bed for prolonged periods, often for more than 6 hours a day. One person reported improved catheter drainage and another reported reduced spasms. The negative aspects of tilt-in-space wheelchairs included their bulky size and lack of manoeuvrability compared with conventional wheelchairs. All the wheelchair users had experienced difficulty with transport and many had relied on family and friends to help with the purchase of expensive adapted vehicles. In conclusion, the majority of the tilt-in-space users were satisfied with their wheelchair, particularly in terms of comfort.

Background & objectives:The age at which menopause naturally occurs may reflect nutritional and environmental circumstances as well as genetic factors. In this study we examined natural menopause as a marker of women's health at the population level in India and in some major States.Methods:Data from the Indian District Level Household Survey (DLHS) carried out during 2007-2008 covering 643,944 ever-married women aged 15-49 yr were used; women of older ages were not included in this survey. Since not all women in this age group had achieved natural menopause at the time of survey, Cox proportional hazard regression models were employed to obtain the median age of women reporting a natural menopause, excluding those who underwent hysterectomy. Hazard ratios (HRs) were estimated for key socio-economic and reproductive variables that could potentially affect the age at natural menopause <40 yr.Results:Overall, menopause prior to age 40 was reported by approximately 1.5 per cent of women. In the national data set, significant associations with age at natural menopause were identified with marriage breakdown or widowhood, poverty, Muslim religious affiliation, ‘scheduled caste’ status, not having received schooling, rural residence, having never used contraceptive pills, not been sterilized or had an abortion, low parity and residence in the western region. Within data from five selected States examined separately, the strength of these associations varied.Interpretation & conclusions:Associations of natural menopause with sociocultural, family planning and demographic variables were noted. Most importantly, there was an association with poverty that would require further investigation as to causality. The proportion of women experiencing early menopause may represent a useful overall indicator of women's health. The data are reassuring with regard to possible late effects of sterilization on ovarian function.

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Evidence based practice (EBP) is a process that involves making conscientious decisions that take into account the best available information, clinical expertise, and values and experiences of the patient. EBP helps empower health care professionals to establish service provisions that are clinically excellent, cost-effective, and culturally sensitive to the wishes of their patients. With a need for rapid integration of new evidence into EBP, systematic reviews and meta-analyses have become important tools for health care professionals. Systematic reviews and meta-analyses are conducted in a conscientious manner, following an established set of rules where individuals identify studies that address a particular question based on clearly defined inclusion and exclusion criteria along with a predetermined method of analysis. Conducting systematic reviews and meta-analyses isn't easy nor quick and requires knowledge in a particular subject area, research methods, and statistics. Teaching health care professionals, including undergraduate and graduate students, the processes and skills necessary to carry out systematic reviews and meta-analyses is essential, yet few teaching resources exist for academic staff to facilitate this endeavor. The purpose of this article is to present two strategies taken by academic staff in the Faculty of Science at the University of Portsmouth, UK to teach evidence synthesis and processes to enhance EBP. One case involves a pedagogical approach used with exercise science masters students while the other details the work of an on-line postgraduate certificate program that has been developed in collaboration with Cochrane UK.