BackgroundThe grading of recommendation, assessment, development and evaluation (GRADE) approach is widely implemented in health technology assessment and guideline development organisations throughout the world. GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention, but is complex and therefore challenging to apply in a consistent manner.MethodsWe developed a checklist to guide the researcher to extract the data required to make a GRADE assessment. We applied the checklist to 29 meta-analyses of randomised controlled trials on the effectiveness of health care interventions. Two reviewers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome.ResultsFor most (70%) checklist items, there was good agreement between reviewers. The main problems were for items relating to indirectness where considerable judgement is required.ConclusionsThere was consistent agreement between reviewers on most items in the checklist. The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessments, particularly for inexperienced users or in rapid reviews without the resources to conduct assessments by two researchers independently.

Trauma from various past experiences may be implicated in an increased risk of high dental anxiety.

Purpose -There is growing evidence that health behaviour change interventions are associated with mental health and wellbeing improvements. This paper aims to examine the effect of healthy lifestyle interventions on mental wellbeing. Design/methodology/approach -Six databases (Medline, Evidence Based Medicine Cochrane Registered Controlled Trials, Evidence Based Medicine Full Text Reviews, British Nursing Index, Embase, PsycINFO) were searched from database commencement up to April 2013. A broad focus on lifestyle interventions and mental health and wellbeing outcomes was chosen. Papers were systematically extracted by title then abstract according to predefined inclusion and exclusion criteria. Inclusion criteria: any individual population (non-couple/family); any health behaviour change interventions; mental health and wellbeing outcomes; and a one-two level of evidence. Interventions aimed at workers were excluded, as were articles assessing cognitive functioning rather than mental health or wellbeing, or those using medications in interventions. Findings -Two authors reviewed 95 full papers. In total, 29 papers met inclusion criteria, representing a range of interventions spanning physical activity, diet, alcohol intake, drug use and smoking. A range of measures were used. The majority (n ¼ 25) of studies demonstrated improvements on at least one indicator of mental health and wellbeing. Limitations include the broad range of outcome measures used, varied follow-up times and the lack of detail in reporting interventions. Originality/value -Health behaviour change interventions targeting physical outcomes appear to have benefits to mental health and wellbeing spanning healthy populations and those with physical or mental health problems. Evidence is strongest for interventions targeting exercise and diet, particularly in combination and the actual lifestyle changes made and adherence appear to be important. However, it is not clear from this review which specific components are necessary or essential for improvements in mental health and wellbeing.

BackgroundModifiable lifestyle risk behaviours such as smoking, unhealthy diet, physical inactivity and alcohol misuse are the leading causes of major, non-communicable diseases worldwide. It is increasingly being recognised that interventions which target more than one risk behaviour may be an effective and efficient way of improving people’s lifestyles. To date, there has been no attempt to summarise the global evidence base for interventions targeting multiple risk behaviours.ObjectiveTo identify and map the characteristics of studies evaluating multiple risk behaviour change interventions targeted at adult populations in any country.MethodsSeven bibliographic databases were searched between January, 1990, and January/ May, 2013. Authors of protocols, conference abstracts, and other relevant articles were contacted. Study characteristics were extracted and inputted into Eppi-Reviewer 4.ResultsIn total, 220 studies were included in the scoping review. Most were randomised controlled trials (62%) conducted in the United States (49%), and targeted diet and physical activity (56%) in people from general populations (14%) or subgroups of general populations (45%). Very few studies had been conducted in the Middle East (2%), Africa (0.5%), or South America (0.5%). There was also a scarcity of studies conducted among young adults (1%), or racial and minority ethnic populations (4%) worldwide.ConclusionsResearch is required to investigate the interrelationships of lifestyle risk behaviours in varying cultural contexts around the world. Cross-cultural development and evaluation of multiple risk behaviour change interventions is also needed, particularly in populations of young adults and racial and minority ethnic populations.

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