The results from cross-sectional studies showed that a prudent/healthy pattern is associated with a lower prevalence of MetS, whereas a Western/unhealthy is associated with an increased risk for MetS. Additional prospective studies are needed to confirm the association between dietary patterns and MetS.

Epidemiological studies show that diet is linked to the risk of developing CVD. The objective of this meta-analysis was to estimate the association between empirically derived dietary patterns and CVD. PubMed was searched for observational studies of data-driven dietary patterns that reported outcomes of cardiovascular events. The association between dietary patterns and CVD was estimated using a randomeffects meta-analysis with 95 % CI. Totally, twenty-two observational studies met the inclusion criteria. The pooled relative risk (RR) for CVD, CHD and stroke in a comparison of the highest to the lowest category of prudent/healthy dietary patterns in cohort studies was 0·69 (95 % CI 0·60, 0·78; I 2 = 0 %), 0·83 (95 % CI 0·75, 0·92; I 2 = 44·6 %) and 0·86 (95 % CI 0·74, 1·01; I 2 = 59·5 %), respectively. The pooled RR of CHD in a case-control comparison of the highest to the lowest category of prudent/healthy dietary patterns was 0·71 (95 % CI 0·63, 0·80; I 2 = 0 %). The pooled RR for CVD, CHD and stroke in a comparison of the highest to the lowest category of western dietary patterns in cohort studies was 1·14 (95 % CI 0·92, 1·42; I 2 = 56·9 %), 1·03 (95 % CI 0·90, 1·17; I 2 = 59·4 %) and 1·05 (95 % CI 0·91, 1·22; I 2 = 27·6 %), respectively; in case-control studies, there was evidence of increased CHD risk. Our results support the evidence of the prudent/healthy pattern as a protective factor for CVD.Key words: Dietary patterns: CVD: Systematic reviews: Meta-analyses CVD is the world's leading cause of morbidity and mortality, affecting millions of people in developed and developing countries (1,2) . In Europe, a decline in CVD deaths has been observed, particularly in affluent countries (3) . Analysis from the WHO MONICA (Multinational MONitoring of trends and determinants in CArdiovascular disease) project attributed this lower CVD incidence and more than two-thirds of the decline in CHD deaths to a reduced exposure to risk factors, such as smoking or high blood cholesterol levels (4) . Nevertheless, CVD remains the major cause of overall death and premature deaths in Europe, especially in people younger than 75 years, accounting for 42 and 38 % of all deaths in women and men, respectively. In addition to 4·3 million deaths every year, there is an enormous individual and societal burden of cardiovascular ill-health (5) . Similarly, some studies have found that a large proportion of the decline in mortality -from approximately 44 % in the USA, Italy, England and Spain, for example, to as much as 72 % in Finland -can be attributed to reduced exposure to risk factors (6)(7)(8)(9) . The interrelationship between many chronic conditions and their risk factors also means that targeting key CVD risk factors may help prevent cancer and diabetes (10) .Multiple risk factors for CVD, such as family history, obesity, diabetes, hypertension and hypercholesterolaemia, are well established (11) . Furthermore, the evolution of the disease depends on how many factors can be modified throughout life. The existing resea...

BackgroundThe prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses’ current experiences of screening and caring for long-term care residents who have dementia and sensory impairment.MethodsAs part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis.ResultsFollowing a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed.ConclusionsNurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0917-x) contains supplementary material, which is available to authorized users.

Aim To examine the association between stress secondary to residents' responsive behaviours and job satisfaction of nurses and nursing assistants working in nursing homes. To test whether supervisory support, work effectiveness and work empowerment confound this relationship. Background Understanding how the stress secondary to residents' responsive behaviours influences job satisfaction for staff and determining the factors influencing this relationship are important for retention of staff in nursing homes. The term ‘responsive behaviours’ refers to the subset of behavioural and psychological symptoms of dementia. Methods Survey responses from 191 nursing assistants and 81 nurses in five nursing homes in Ontario were analysed. Results Staff's stress attributed to residents' responsive behaviours was negatively associated with job satisfaction. This direct effect was weakened by more than a third through the confounding net effects of supervisory support, work effectiveness and work empowerment. Conclusion The work environment created by leaders in nursing homes can lessen the influence of stress secondary to residents' responsive behaviours on staffs' job satisfaction. Implications for Nursing Management Supervisors need training and education to support and mentor their staff effectively, and to guide their use of evidence‐based practices that integrate the patient‐centred care approach in order to effectively respond and minimize responsive behaviours.

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