The present research was aimed to investigate the effectiveness of mindfulness training and dietary regime on weight loss in obese people. The research was quasi-experimental with posttest-pretest that used control group. The population consisted of all the individuals who attended two clinics of nutrition advice and diet therapy in Karaj. 60 individuals, whose BMI was more than 30, were selected by using the random sampling method. Moreover, they were evaluated by using the SCL-90 test in order to neglect them in case there existed any other significant disorder. Next, they were selected based on age, sex, and education. After explaining the individuals the ongoing research and collecting the informed consent written by them, the samples were placed in four groups (15 in each group). The groups that received mindfulness training attended the nutrition center for eight to 120-minute sessions. In addition, since all the participants referred to the center were motivated to lose weight, individuals who were placed in the control group and those who received mindfulness training were asked not to follow any specific diet for two months. Moreover, the in depth relaxation CD was prepared for those who asked, in order to train themselves at home. Descriptive statistical methods were employed in order to analyze the data and ANACOVA and variance analysis with frequent measurement were used. The research findings indicated that mindfulness training was accompanied by diet, which resulted in weight loss in obese patients. In addition, the findings of the two-month follow-up indicated lasting results. Fat metabolism disorder often shows itself as a chronic disease named obesity. Obesity is the most important public health challenge in the present era and the health sector in most countries involves in the rising incidence of obesity and its complications [2]. According to a report published by the World Health Organization (WHO) in 2008, more than 1.4 billion people in the world deal with overweight, 200 million of them are male and 300 million are female. It was predicted that 1.3 billion of people in the world will be overweight and 53 billion will be obese in 2020. Obesity is not caused only by physiological factors but it is also influenced by the interplay of psychological and physiological factors, and has been classified as a disease by the medical and health centers [3]. Undoubtedly, a high percentage of different age groups deal with obesity in Iran [4]. It is not clear if obesity is an independent risk factor for public health or it can endanger people’s health by preparing the ground for the development of some diseases and cancers. Related researches indicated that obesity is accompanied by psychical effects such as polycystic ovary syndrome, type 2 diabetes, blood pressure, lipid disorders, cardiovascular diseases, asthma, cancer, arthritis, gout, skin disorders, liver disease, and shortness of breath in sleep. In addition, it has psychological effects such as depression, reduction in self-confidence, increase in anxiety and aggression [5]. Some of the studies were also conducted with the aim of investigating the relationship between obesity and the psychological well-being [6]. Moreover, the indirect expenses of obesity such as the reduction in capability, increase in illness period, premature exhaustion, insomnia caused by depression and osteoarthritis pains in the joints that bear the weight and social consequences such as injustice. Although the psychological factors are of fundamental importance in the development of obesity, obviously, it is not clear to what extent these factors result in death [3]. There was a positive correlation between obesity and depression in many researches [7]. Lamertz believed that obesity leads to the creation of a negative attitude, psychological stress, and increase in psychological disorders [8]. There is a variety of methods to reduce obesity, among which diet could be named in the meantime. There are many evidences that prove failure of dietary regimes including commercial aspects, body’s ability to adapt to difficult situations and a wide range of neurotransmitters in the phenomenon of weight control. In addition, relevant studies demonstrated that one-third to two thirds of the individuals who use only dietary regimes to reduce their weight, could not continue the procedure successfully [9]. The imperfect cycle of dietary regimes is repeated due to the failure in weight loss and leads to depression, severe mood swings, insomnia, sadness, tears, and other symptoms [5]. Accordingly, the strength of cognitive infrastructures in the etiology of obesity could be mentioned [10]. However, according to Johnson, the cognitive approach is not developed in explaining obesity, especially our understanding of specific processes which are involved in the emergence and maintenance of cognitive symptoms that are effective in eating is limited [10]. Since it is associated with a complex causal network, obesity is associated with a complex causal network, interventions to improve it are also complex and the demand for a combination of several approaches, thereby combined methods are more effective in the reduction of obesity. Recent developments in the treatment of psychological disorders and the reduction of obesity led to the development of novel and new methods by the clinical psychologists [11]. In this regard, interventions based on mindfulness, which is deemed as a third generation behavioral-cognitive therapy and considered as a form of meditation, originating in the Eastern religious teachings and rituals, are employed [12]. Recently, therapists have deduced that mindfulness has a great impact on the elaboration of orderly and restrained eating patterns [13]. Kabat-Zinn defined mindfulness as paying attention to purposeful, specific, and without judgment and prejudice methods [14]. Marshal [37] emphasized the necessity and importance of the inclusion of mindfulness as one of the major components of psychological treatments. Hence, there have been many interventions and treatments based on mindfulness [15]. The preliminary empirical evidences indicated that mindfulness could be involved in obesity. For instance, Dalen et al. (2010) indicated in a research entitled “mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity” that conscious eating has an impact on weight changes and dietary habits of obese people. Kristeller and Hallet (1999) referred to the effects of the cognitive therapy method based on mindfulness on eating disorder. It seems that “paying attention” is the main mechanism of mindfulness, because the frequent concentration and focus on a neutral stimulus such as breathing creates a proper attention atmosphere [16]. When a person is informed about his current status, he/ she does not pay attention to future [17-19]. Therefore, conscious eating helps people be informed of their physical and emotional desires thoroughly and changes their mental moods in any interaction with food and eating. It can be said that using mindfulness practices associated with dietary regimes prepared for the person particularly is a novel work that is expected to lead to weight loss. Therefore, the present research aimed to present a comprehensive training package based on Mindfulness-based Cognitive Therapy (MBCT) together with a proper and practical dietary regime.In the recent years, changes in lifestyle led the people to face with a new dimension of nutrition disorder, meaning overweight and obesity, so that this has become a new problem in public health [20]. The first experimental group was a group that received only a dietary regime and the second one only received mindfulness training based on cognitive therapy. The third experimental group received a mindfulness training based on cognitive therapy together with a dietary regime. The control group received no treatment. It should be mentioned that individuals were weighed by a portable digital scale. Descriptive statistical methods were employed in order to analyze the data and ANACOVA and variance analysis with frequent measurement were used. The research instruments for the collection of data were the following: demographic characteristics questionnaires and revised list of psychiatric symptoms of SCL-90-r. The research was quasi-experimental with posttest-pretest that used control group. The population consisted of all the individuals who attended two clinics of nutrition advice and diet therapy in Karaj. Next, 60 individuals whose BMI was of more than 30 were selected by using the random sampling method. Moreover, they were evaluated by using SCL-90 test in order to neglect them in case there existed any other significant disorder. Afterwards, they were selected based on age, sex, and education. After explaining the individuals the ongoing research and collecting the informed consent written by them, the samples were placed in four groups (15 in each group). It should be mentioned that the minimum sample population in the experimental studies is 15 individuals . Douketis et al. (1976) reviewed the mentioned questionnaire and prepared the final edition with the revised list of psychiatric symptoms entitled SCL90-r which consisted of 90 5-point questions . Moreover, it had nine subscales including somatization, obsession, interpersonal sensitivity, depression, anxiety, aggression, phobia, paranoid thoughts, and psychosis. Deragotis, Rickels and Rock (1676) calculated the concurrent criterion validity coefficients of nine dimensions of the test to be between 36% and 73%, of which all were significant at 1% level [22]. The domestic version of the reliability and validity of the questionnaire was investigated by Mirzaie R (1980) [35] and it was in line with the American version . Furthermore, Mar'ashi (1996) found the reliability coefficients of the test to be between 80% and 94% by using Cronbach’s alpha method . In addition, after the implementation of the questionnaire in the present research, the reliability coefficients related to its dimensions were calculated to be 67% to 87% by using Cronbach’s alpha method.A revised list of psychiatric symptoms of SCL-90-r was developed by Lipman and Covi in 1973 in order to show the psychological aspect of mental and physical patients . This intervention consisted of 8 training sessions which lasted for 2 hours once a week. In order to carry out the trainings, the relaxation in depth CD and book were used . It should be said that as the authors mentioned in the beginning of their books, theories are basically based on cognitive sciences with references to the history of Buddhism.The instruction of the sessions was based on the handbook of “Mindfulness-based Cognitive Therapy” written by Rebecca .After the referees were screened in terms of having the research criteria and explaining individuals the ongoing research and collecting the informed consent written by them, the samples were placed in four groups (15 in each group). The groups that received mindfulness training attended the nutrition center for eight to 120-minutes sessions. In addition, since all the participants referred to the center motivated to lose weight, individuals who were placed in the control group and those who received mindfulness training were asked not to pursue any specific diet for two months. Moreover, an in depth relaxation CD was prepared for those who asked in order to train themselves at home .According to the findings of the research, it was specified that dietary regime alone had an impact on obesity of people and their weight presented a considerable reduction. Moreover, the average value of weight of the individuals in the experiment group was reduced after the implementation of the dietary regime compared to the average weight in the control group. The significance level was equal to 0.000, which was less than 0.05. In addition, the impact of the dietary regime was 43% (43% of the variance was explained by the test implementation). Since obesity is one of the most threatening issues and of the most significant non-communicable diseases , the necessity to correct the pattern of food consumption seems to be required. This is applicable through nutrition advice and proper and continuous education and training. The effectiveness of the weight loss regime demands frequent references and sufficient incentives of the referees. An appropriate regime needs to be given according to the weight and BMI of referees and changes in BMI and weight should be measured in the next sessions in order to perform the necessary changes in addition to calculate its success and they must be told to the person. The results of the present research indicated that the low-calorie diet had an impact on weight loss of individuals with obesity, which was in line with the findings of relevant studies such as the ones of Navidian A, Abedi MR, Baghban I, Fatehizadeh M, Poursharifi H, Hashemi Dehkordi M (2010), Mazloom Z, Kazemy F, Tabatabaie SH, Ansar H (2009), West DS, Gorin AA, Subak LL, Foster G, Bragg C, Hecht J et al (2011), Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C et al (2010) [Second hypothesis: mindfulness training leads to weight loss in obese individuals.28]. Cognitive-behavioral approaches in the treatment have been considered as the center of gravity of medical researches on obesity in 1990’s [29]. Emotional eating was mentioned in explaining obesity in terms of psychology. In addition, it was said that overeating was a type of reaction to stress and anxiety that a person used in order to avoid other obese individuals or individuals with overweight when he was influenced by stress or emotional states. Generally, the mindfulness method had a great impact on obese individuals because mindfulness training led to cognitive changes in the way of thinking and actions of patients and took advantage of the conditional strengthening principals. Therefore, the patient made an effort to reach the next step and see himself above and this tendency to continuous improvement led to better conditions gradually. The finding was in line with the results obtained by Mousavian N, Moradi A, Mirzaie J, Sheidfar F, Mahmoudi B, Taheri F (2010), Dalen J et al (2010), Singh NN, Lancioni GE, Singh AN et al (2008), Kristeller JL, Hallet CB (1999), Tapper K, Shaw C, Ilsley J, Hill AJ, Bond FW, Moore L (2008) . According to the findings of the present investigation, it was specified that mindfulness training had a considerable impact on weight loss among individuals with obesity since the average weight of the participants in the experiment group was reduced after they received mindfulness training based on cognitive therapy compared to those who received the training in the control group. The significance level was equal to 0.000, which was less than 0.05. In addition, the impact of mindfulness training based on cognitive therapy was 95% (95% of variance was explained by the test implementation). Due to the undesirable impacts of different methods on weight reduction , the psychological treatment was the most common and convenience method for obesity treatment .The research findings indicated that the dietary regime alone during 2 months after the end of dietary cannot guarantee weight loss of individuals and durability. Here, this question arose that what happens after the end of the dietary regime? If we asked the question, the answer would be: I cannot have a proper dietary regime, it is observed a few days, and I forget it after a while. One of the reasons could be the fact that these persons are someone who think they have no control on their life events including on how to feed themselves and someone else must control them from outside. In this case, the external locus of control is a nutritionist. They observe their regime until they are under supervision of a nutritionist, but they return to previous bad nutritional habits as soon as they complete the course. Therefore, these individuals significantly believe that they cannot control their behaviors. The clinical challenge is not convincing these people regarding the fact that they need permanent training and education but the important challenge is to motivate these people based on the fact that the successful management of their weight demands a continuous control of emotions and thoughts, especially for individuals who might show an established pattern of overeating in reaction to environmental motivations. The findings were in line with the ones of Mousavian N, Moradi A, Mirzaie J, Sheidfar F, Mahmoudi B, Taheri F (2010), Kristeller JL, Hallet CB (1999) [Sixth hypothesis: effectiveness of mindfulness and dietary regime on weight loss of individuals has durability after 2 months34]. The concept of mindfulness is one of the features of consciousness that is in relation to well-being and there have been many discussions in this regard. Mindfulness refers to one’s clear awareness of what is within and in interaction with the external environment [34]. In total, it could be expressed that since mindfulness training is one of the interventions based on behavioral-cognitive therapies and performing a dietary regime is of its solutions, one could be ready for to eat less than before. When these two (dietary regime and mindfulness training) are combined with each other and individuals are under control both physically and psychologically in order to reduce weight, better results are obtained. The results of the present research confirmed what was mentioned above.According to the present research, individuals who received both mindfulness training and appropriate dietary regime had no weight gain after two months. Therefore, this combined training program had a great impact and it was even more durable than mindfulness training. Previous researches also approved the finding because individuals who received both mindfulness training and dietary regime were ready to reduce weight in terms of mental and physical and this mutual readiness led to more durability. The research findings indicated that performing a dietary regime and also mindfulness training based on cognitive therapy, each of them individually, and a combination of both of them (mindfulness training and dietary regime) all had an impact on the weight reduction of obese individuals. In the field of mindfulness, concentration was mostly on the individuals’ mind and these trainings motivated them to reduce their weight psychologically. These trainings mostly emphasized the hazards of obesity and how to treat them. It should be mentioned in the scope of mindfulness that most of psychological, religious, and philosophical points of view emphasized the importance of consciousness in maintaining and enhancing the well-being [


This paper describes a systematic review (1980–2014) of evidence on effects of transport noise interventions on human health. The sources are road traffic, railways, and air traffic. Health outcomes include sleep disturbance, annoyance, cognitive impairment of children and cardiovascular diseases. A conceptual framework to classify noise interventions and health effects was developed. Evidence was thinly spread across source types, outcomes, and intervention types. Further, diverse intervention study designs, methods of analyses, exposure levels, and changes in exposure do not allow a meta-analysis of the association between changes in noise level and health outcomes, and risk of bias in most studies was high. However, 43 individual transport noise intervention studies were examined  as to whether the intervention was associated with a change in health outcome. Results showed that many of the interventions were associated with changes in health outcomes irrespective of the source type, the outcome or intervention type . For road traffic sources and the annoyance outcome, the expected effect-size can be estimated from an appropriate exposure–response function, though the change in annoyance in most studies was larger than could be expected based on noise level change. This paper systematically reviews the literature from 1980 to 2014 on evidence of the effects of transport noise interventions on human health. A wide range of noise interventions, noise management, or noise control, actions are included, and the source types considered in this review were road traffic, railways, and air traffic. The intent of both exposure-related, and non-exposure-related, interventions is to change  the adverse health outcomes from noise, and the health outcomes reported here include sleep disturbance, annoyance, cognitive impairment of children, and cardiovascular diseases. Exposure-related actions aim to change the level of noise exposure of people, usually as measured at the external façade of their dwellings. Non-exposure related actions such as communication or education are directed at changing health outcomes but do not include changing people’s exposure. The different noise sources, and the different types of interventions possible for each noise source, introduce considerable complexity to this review, and a structure that provides a conceptual framework for considering interventions and health effects is presented in the next section.air pollution accountability research [A conceptual model by which to consider noise interventions and their health effects was first reported by Brown and van Kamp . The modresearch ,3,4,5. TAnother difference is that air pollution accountability research has tended to focus on regulatory interventions directed at reducing emissions; examining whether this type of intervention consequently reduces ambient concentrations over time. While regulatory intervention is also used in managing environmental noise, for example by control of aircraft or road vehicle source levels, this is only one of a range of possible environmental noise interventions  (Chaptersource interventions and path interventions). The third category of intervention is termed new/closed infrastructure. The fourth category is termed other physical interventions, and the fifth category referred to as education/communication interventions. The categories and sub-categories of these intervention types are largely self-explanatory, but they are also illustrated by the examples included in Based on the available intervention literature, and the experience of many decades of noise management, five broad categories of transport noise intervention were identified and are listed in The framework for considering noise interventions and related health effects is in Noise interventions are presumed to result in changes in various outcomes along the system pathway between noise sources and human health responses.Evidence of the effect of any noise intervention on human health can best be examined in studies in which the effect of the intervention has been reported directly in terms of a change in health outcomes. The availability of a measured change in health outcomes in an intervention study was the primary basis for inclusion of a study in this review.intermediate outcome of change in exposure of a population of interest is also appropriate as change in exposure can be presumed to result in changes in health outcome. Thus, individual studies that reported a change in the exposures of the population of interest were also included.However, on the assumption that there is a well-established link between exposure and particular health outcomes, it is not necessary to evaluate interventions only by means of change in measured health outcome. Evaluation by the In addition, certain interventions for environmental noise, directed at changing knowledge or perceptions, may result in change in exposure of a group. They also may result directly in changes in health outcomes—as where a group may report lower annoyance scores from a transport source if authorities have undertaken a program of communication and explanation regarding the noise. Thus, studies where the intervention was designed to educate or change behaviour or perceptions were also considered.health outcomes, the intermediate change in exposure outcomes, and the change in knowledge/attitude outcomes could potentially be measured.measurable change in levels at locations near sources. Studies of this sort that report only change in levels near sources, rather than changes in people’s exposure, cannot be utilised to elucidate the relationship between interventions and their health consequences.We note, however, that there are many examples in the literature of noise management or noise control where the effect of a noise intervention is reported solely as change in the level of noise at or near the source. For example, the effects of motor vehicle source limit regulations, or of limits on aircraft noise emission resulting from certification requirements, may be reported as changes in noise levels emitted by these sources. Equally, the effect of a path intervention through construction of a noise barrier near a roadway may be reported as the change in level immediately behind the barrier—not as a change in exposure levels for some affected population. Similarly, after an intervention involving modification to airport flight paths, the effect may be reported as changes in noise levels at particular points on the ground—again not as a change in exposure levels of an affected population. These types of outcomes are indicated on Five prior narrative reviews on environmental noise interventions were located. These are listed in SBASScopusME66MEDLINENLMEM74EMBASE2014 Elsevier B.V.PI67PsycINFOAM. PSYCH. ASSN. 2010IN73Social SciSearchThomson ReutersIS74SciSearchThomson ReutersBA70BIOSIS PreviewsThomson ReutersTo identify individual studies, we performed search runs on the following data sets:The search string was refined and adapted for the different data bases and is available . The searail, road, aircraftIt dealt with noise sources as defined in the Study Protocol … It reported the nature of an intervention of any Type A through EIt specified (for intervention Types A–C), the change in exposure, usually as levels before and after the interventionThe intervention (for intervention Types A–C) was not temporary or laboratory-basedbefore and after health outcomes ORbefore and after exposures of a target population ORfor interventions Type E, before and after knowledge/attitudes/behaviour ORa comparison of two exposure conditions with variation in some other relevant factor .It reported:Papers were read independently by the two authors, applying the following inclusion criteria. A study was retained for further analysis if the following conditions were met:A list of the papers that were excluded, with brief explanation of the reasons for exclusion, is available .It will be shown below that, overall, there is a relatively small number of studies available on the health effect of interventions. Further, when individual studies are grouped according to noise source categories, health outcome categories, and intervention categories, the number of studies within most of the categories is very small. Further, even in categories with more than two or three studies, these studies tend to be very different from each other.den, Ldn, LAeq,24 h, LDay, L10,18 h, L10,12 h, L10,3 h) and outcome response scales . As Köhler et al. [Although the studies can be evaluated as being of good methodological quality, comparison between them is hard to make, due to difference in research groups, the way confounders are dealt with, sample size, study design…and the fact that information concerning particular characteristics is not always given…’. Risk of bias in most individual studies was judged as high  groups of respondents. This allows for relating the observed outcomes only to some averaged change in exposure rather than to actual individual changes in exposure); the exposure levels before the intervention; the study design; and the approach to data analysis. Differences in the latter include reporting response scores for groups/subgroups as measures of central tendency (mean or median)—which cannot then be converted to, say, percentages highly annoyed as is commonly used in other studies. Some studies analyzed and reported outcome responses as logistic regressions of individual responses on exposures, with no reporting of effects at group or subgroup levels. Studies also utilised various noise exposure scales  of response, the other differences between individual studies within each group would remain. Overall, the consequence is that we have had to seek other ways to summarise the available evidence.Did the study demonstrate that the intervention led to a change in health outcome?For source, path and infrastructure change interventions, if there was a change in health outcome, was the observed change in outcome of a magnitude at least equivalent to that which would be predicted from a relevant exposure–response function (ERF), based on the observed change in exposure?We sought instead to use the evidence presented within each of the individual studies to qualitatively answer two questions with respect to the effect of environmental noise interventions. These questions were as follows:In examining the first question, we do not assess the magnitude of the change for each individual study (but report it if available), but look instead to any evidence that health outcomes did change in association with the intervention. We include a column in the tables below to record this observation. While this question is a minimal test of the consequence of an intervention, it contributes to an important policy issue: do environmental noise interventions change health outcomes?an ERF based on the responses to the before (steady-state) exposure conditions in that particular study , or sometime separate ERFs for both before and after states (5 studies used an ERF of this nature).an ERF reported from similar situations to those in the particular individual study, as determined by the study authors (4 studies used an ERF of this nature).a previous synthesis of ERFs. The particular ERF chosen depended on the date of the study,: namely, Schultz’s 1978 synthesis   of each individual study specified the ERF they believed was relevant to the context of their study: either an ERF derived from before-study responses from the study area, or one that had been reported from elsewhere but was considered appropriate. Given that synthesised ERFs are, by definition, the amalgamation of a wide range of study-specific ERFs, we suggest that the approach we adopt is no less appropriate than comparing each individual study results to some normative, synthesised ERF. Further, where the comparison is with an ERF derived from the before-data of the same study, it has the advantage of controlling for many confounders in that study area. The relevant ERF used in each individual study is reported in the summary tables below. In the individual studies, the relevant ERFs  were as follows:We compared the magnitude of the observed change in health outcome to the magnitude of the change that would be ‘predicted’ from the same change in exposure on the relevant ERF. If the observed health outcome changed similarly to the ERF-predicted change, the conclusion was that the ERF could have estimated the magnitude of the response to the intervention given the magnitude of the change in exposure. If the observed change was greater, then the study has reported an excess response to the change . We inclDifferent source types are each considered separately in The resulting 545 titles, keywords and abstracts were examined by each of the authors independently to identify papers that were to be read in full, based on the inclusion criteria described in From this selection process we arrived at a small, but relevant, set of studies for each transport related noise source that linked transport noise interventions to health outcomes. The distribution of the papers, grouped across sources, outcomes, and type of intervention, is shown in Some 37 papers  describing road traffic noise interventions met the inclusion criteria—with papers counted twice if they reported results on two different outcomes. This is considerably more than the number of intervention papers reporting on each of air and rail traffic interventions (seven and three papers respectively).25 papers examined the effects of an intervention on the annoyance of adults in their dwellings6 examined the effects of an intervention on sleep on adults in dwellings 4 examined cardiovascular effects2 modelled the extent of exposures to different levels of road traffic noise or the prevalence of annoyance arising from hypothetical interventions  of the road traffic noise studies were source interventions; a smaller number path interventions; new or closed infrastructure; or other physical interventions.The publication dates of the studies were approximately equally divided over three periods: 2010 to present; 2000–2009; the two decades 1980–1999. This indicates an increasing frequency of reporting of road traffic noise intervention studies, though the total number of such studies is small.The tables below group together studies of the same health outcome from the same intervention type, summarising each of the individual studies in that group. The tables report the nature of the intervention; the study design, size and method; and the exposure levels before and after the intervention, and what is reported about the distribution of the magnitude of the changes in exposure across the study sample. The tables also show how the outcome measures of annoyance or sleep disturbance/quality changed as a consequence of the intervention, and whether the magnitude of that change was statistically significant. There is also an observation on the relationship of the observed change in response to that estimated from the same change on a relevant ERF.Most were where traffic flow rates on the roadway changed . Most were a decrease in traffic flow as a consequence of provision of relief roads, but at several sites there was an increase in traffic flow. Less than half of the studies were single-site studies; the others included results from multiple roadway sites.1 was where there was improved roadway resurfacing.1 was a truck restriction strategy.1 was a complex set of control measures including barriers, road surfaces and other measures.Of the source intervention studies:All studies as presented in eq,24 of 70 dB), but several were where levels were considerably lower (by 10 to 15 dB) than this. In one study, there was very limited change in exposure resulting from reduced traffic flow and no observed change in annoyance outcomes. This study is not considered further below. In another, where there was a restriction in night-time truck traffic flow, there was zero change in energy-based noise indicators but a significant change in annoyance—postulated by the author as a response to the change in the number of noise events in the night-time traffic stream.Most of the changes experienced were reductions in noise levels, but in one study, and at a small number of sites in three multi-site studies, the change experienced were increases in level. The changes in level ranged from approximately −15 dB to +15.5 dB  but not uniformly across this range, with the majority of changes in the range from −5 to +5 dB. The source interventions were generally where before-conditions were high road traffic noise exposure ;3 were barrier construction (one of which was a multi-site study involving 12 sites);1 was a combination of barriers and dwelling insulation;1 was a full-scale building intervention, filling in gaps between existing buildings to create a barrier for dwellings further from the roadway.Of the seven path intervention studies that are in All studies were before and after designs, with only the dwelling insulation study having more than one after-survey round. Most before-studies were conducted 6 months to 1–2 years before the intervention. Apart from the dwelling insulation study where the after-study was conducted some six months after insulation was installed (12 months after the before-survey) the time gap between before and after studies was much larger than for the source interventions, presumably related to the required construction time of the barrier or building refurbishments. Apart from one barrier study where the gap was 2 years, the before-after gap varied between 5 and 10 years. Three of the studies included control groups. The number of participants in the studies varied between 75 and 852.The changes in level achieved by the interventions ranged from −3 to −13 dB . Apart from the dwelling insulation intervention where all participants experienced a uniform reduction in exposure of −7 dB, the variation in the change in levels experienced by respondents within any one study was wide, varying, for example, from −10 to −13 dB close to barriers, small to zero changes distant from the barriers.All six studies (excluding the repeat after-survey study) found that the path intervention resulted in change in annoyance outcomes; three of the studies demonstrated that the observed difference in outcomes was statistically significant, the other three studies reported no statistical tests on the changes in response, but differences were observed in the data, tables, or plots in the original papers.at least of the same magnitude as estimated by the ERF . Two of these also showed responses to the change were much steeper than the gradient of the ERF over the same exposure range, thus exhibiting an excess response (and another was unclear with respect to the presence of excess response). Only one study provided a statistical test of the presence of excess response.Four of these path intervention studies compared the change in response to that estimated by an ERF. All four showed that the response to the change was in the same direction and There was one study in this group in which the exposure–response function, or the test for a change effect, was adjusted for confounding . In most of the other studies, the influence of confounders and potential moderators was analysed in a univariate manner. Confounders (moderators) included in this way were as follows: distance to the road (2 studies); visual aspects (2); window opening behaviour (1); other interventions such as playgrounds; access to shopping centre; opinion of residents towards noise source; coping; acceptance; window type; newcomers between surveys; negative experience before the intervention; SES (each 1 study).both studies involved major changes (reductions) in road traffic flows;both studies combined the main intervention with other environmental improvements.Of the two infrastructural intervention studies included in Both studies were of new road tunnel infrastructure that resulted in very large reductions in traffic and levels of noise for residents near the previously heavily trafficked surface roadway. They are distinguished from Type A interventions by the magnitude of the change in flows .Both studies were before and after designs using repeated measures of annoyance outcomes. Both conducted before- and after-studies approximately one year before and after the tunnel opened. Both included a control. The number of participants experiencing the change was 758 and 50 in the two studies.Aeq,24 h) reduced an average of −12 dB in one study (the distribution of the magnitude of the change across the sample of participants was not reported); between −11 dB and −17 dB for just under half of the respondents with the other half experiencing −3 to −5 dB reductions. In the other study, participants experienced a mean −12 dB reduction, with no information of the distribution of the magnitude of change across the sample.Noise levels  with no change in the controls.Both studies also compared the change in outcomes to those estimated from an ERF. They reported that the after-scores in the studies matched those estimated by the ERF  and suggested on this basis that there was no evidence of excess response. However, both reported, but did not identify as excess response, very large changes in the before-to-after levels resulting from the interventions. This means that the response to change was not only in the same direction as estimated by the ERF, but much steeper .None of the studies in this group adjusted for confounders in their analyses.Confounders included otherwise were noise sensitivity (2 studies), location of bedroom (2), insulation, and window opening behaviour (each 1 study).The only studies that are available on other physical interventions  are not Aeq,24 h less than 48 dB in another.In these studies, the designs were such that participants could be similarly exposed at the most exposed façade of the dwelling but would differ on some other dimension (say the difference between the exposures on the most and least-exposed facades of the dwelling). The other physical dimensions considered in this group of studies, in addition to availability of a quiet side, included: whether bedroom or living room windows faced a quiet street (effectively a variation on the existence of a quiet side to the dwelling), the non-acoustic ‘quality’ of the space that constituted the quiet side of the dwelling (such as a courtyard); and the existence of nearby green areas. Quiet side was defined differently in the different studies: for example, 10 dB noise/quiet difference in one, LAll studies found the presence of the particular dimension being investigated had an effect, and all but one demonstrated that this was statistically significant . One study reported the Odds Ratio was 3.3 when adjusted for noise sensitivity (95% CI 1.35–8.01) and, when participants actually used a bedroom on the quiet side, the OR = 10.6 (CI 2.0–56). Another study showed that visual quality of the space that provided the quiet side was also relevant, with 9–13% of participants less annoyed, depending on noisy side exposure levels. The Odds Ratio for courtyard quality was 0.59 (95% CI: 0.36–0.96).In this group, several of the studies adjusted for a large number of different confounders in their analyses see  but otheIn the one study in The details of the two studies in The studies found that the path intervention resulted in change in sleep outcomes. The percentage of people with self-reported disturbed sleep (variously measured/defined) was lower . In one of the studies, a follow-up survey two years after the intervention found that the changes observed in the initial study remained the same.In one of the two studies in this category, the exposure response function was adjusted for confounding, including gender, age, education level, marital status, access to a bedroom on the quiet side of the building, and noise sensitivity.The summary details of the two studies reported in Both studies demonstrated statistically significant lower reporting of various sleep disturbance indicators (or improvement in sleep compared to conditions before the intervention), post-intervention.In one study, a remarkable finding was that the time spent in bed was significantly reduced after the intervention, suggesting increased sleep efficiency according to the authors. The group aged 48 years and over seemed to profit most from the intervention.way the risk of confounding was minimised. Other confounders included in the study were noise sensitivity (1 study), insulation (1), quiet side (2), and window opening behaviour (2).None of the studies adjusted for confounding in their analyses, but in one study the participants in the experimental and control groups were matched on relevant characteristics, and in this housing/roadway redesign intervention.The summary details of the one study in at least sometimes’ between homes with and without a quiet side was statistically significant. Absence of quiet façade results in increased reporting of this sleep parameter. The Odds Ratio for falling asleep was 5.5 (95% CI 0.7–44.1).Subjective assessment of difficulty in falling asleep was assessed before and after the intervention. The difference in the percentage of participants reporting difficulty falling asleep ‘den.Confounding was adjusted for in the analyses of the ERFs including noise sensitivity, window closing behaviour, and front-façade LThis group are, again, not intervention studies per se as they do not provide direct evidence of an intervention. However, they do provide evidence of the likely effect of a particular action (such as the provision of a quiet side to the dwelling), which could be undertaken as part of a significant housing/roadway redesign intervention. Three of the studies found changes (including in self-reported high blood pressure) with and without a quiet side—two of those were tested to be significant. One study found no change.Confounders included age, gender, education, body mass index, physical activity at leisure, alcohol intake, family history of hypertension, and occupants per room .The publication date of the aircraft studies were generally more recent that the road traffic noise interventions, with all published from 2002, with four of them in the last eight years.The tables below group together studies of the same health outcome from the same intervention type, summarising each of the individual studies in that group. The tables report the nature of the intervention; the study design, size and method; and the exposure levels before and after the intervention, and what is reported about the distribution of the magnitude of the changes in exposure across the study sample. The tables also show how the outcome measures of annoyance or sleep outcome changed as a consequence of the intervention, and whether the magnitude of that change was statistically significant. There is also a commentary on the relationship of the observed change in response to the slope of a relevant ERF.This path intervention study for aircraft noise was around five Spanish airports . A noiseThis study did not adjust for confounding, but reports in a descriptive manner on the influence of the aesthetics of the installed measures; and the performance of the construction company—explaining respectively 30% and 25% of the variance in satisfaction.All three studies in this group were associated with opening of new runways, closure of others, or flight path rearrangements . Two werden or similar). However, for the majority of participants the change was much smaller, perhaps 1 to 2 dB. Changes in two of the studies included increased exposures as well as decreased exposures. It would appear that attempts to carefully design a study associated with changed flights paths to ensure a good distribution of changed exposures is difficult because of differences in what is initially proposed (and used as the basis for intervention study design) and what is actually implemented in terms of flight paths and aircraft numbers. The changes at Zurich were particularly related to changes in number of flights in the shoulder hours: early morning and late evening.The changes in exposure over the areas studied were highly variable, with only relatively small numbers of participants experiencing the larger changes in noise level  of both level, and change in level, as exposure variables for participants, for modelling the effects of change. Evidence of excess response was tested statistically in the Amsterdam study and presented graphically in the other two studies.With respect to the strength of association between the change in exposure and the change in annoyance responses, all intervention studies demonstrated that the response was of a magnitude, he FICON  synthesiThe Amsterdam study provided evidence on the durability of the excess response – it still being present three years after the intervention—though with one unexplained temporary reduction from the fourth panel survey.In this group of studies, all three studies either adjusted for confounding, or ruled out confounding by design. Military aircraft noise was accounted for by exclusion. Variables included pertained to year of survey, age, sex, ethnicity, home ownership, degree of urbanisation, time of residence, living satisfaction, noise sensitivity, expectations about the airport and the neighbourhood, coping behaviour, dependency on the airport, fear for aircraft crashes, and a negative attitude towards the airport.See summary of these papers under In both studies , there wBoth studies adjusted for confounding including the same variables as described in As in the three aircraft noise studies in In this study, the risk of bias by residual confounding was minimized by study design. This included: ethnicity, parental education, number of family members, parental occupation, and attrition.Three studies  reportinIn two of the studies, the changes in the level of exposure as a result of the intervention were minimal, but in one of these there was, additionally, a communication intervention (Type E).In this one study, there was evidence that the approximately −10 dB changes in noise exposure as a consequence of the source level change resulted in change in annoyance outcomes; that this difference was statistically significant; and that it persisted more than 12 months after the intervention. However, this was a small study, with only one estimate of noise level change reported across all participants together with the means of their annoyance scores.This study did not adjust for confounding factors.While this was new rail infrastructure in Hong Kong, noise from road traffic overwhelmed the train noise for effectively all participants. This study is not reported on further.This study provides some evidence that information communicated to participants about a noise source  has the effect of reducing that community’s response to the noise.This study did not adjust for confounding but took age, gender, education and coping into account in a descriptive manner.Below we provide an overview, across source types, health outcomes, and intervention types, as to whether the intervention resulted in a change in the health outcome, and observations on the magnitude of that change. YES column). Excluding those studies for which no observation was appropriate  there was only one transport noise study reporting no change in health outcomes. The original authors had provided statistically significant tests of this change in 51% of the entries (red asterisks); in a further 37% of entries this observation was interpreted, by the original authors or as part of the process of this review, from the data, tables, or plots presented in the papers, but without statistical tests (black asterisks).Nearly all of the entries in excess response—a change effect in addition to the exposure effect predicted by an ERF. In other words, the reduction in outcome was greater than would be expected based merely on the reduction in noise levels. Brown and van Kamp [van Kamp  reportedIn general, interventions at the source, in the pathway and intervention in infrastructure (Types A to C) are effective in reducing annoyance, but the available evidence is too poorly conditioned across different group of studies to be able to test for any differences in change in health outcomes arising from different types of interventions.There is also no clear evidence with respect to thresholds regarding changes in health outcomes as a result of interventions. Intervention thresholds could have two dimensions: (1) the smallest change in exposure levels that result in a change in outcome, and (2) the minimum before-level. The only observation we can make is that several interventions that reduced noise exposures by −1 to −2 dB  did not result in any observed change in health outcomes.When interpreting the results, the quality of evidence for various combinations of source, intervention type, and outcome, needs to be considered. The overall quality of evidence within each of the source/intervention type/outcome groups varied, and was judged to range from high to very low across the different groups  were not intervention studies per se as they did not provide direct evidence of an intervention. Instead, they provide comparisons of health outcomes from groups with and without the particular physical dimension of interest. These ‘other physical interventions’ did, in the majority of studies, demonstrate the efficacy of potential interventions of this sort, but it must be noted that this is indirect evidence consisting of comparison of outcomes of different groups under different conditions, rather than before-after comparisons on the same group.Nearly all of the entries in However, a handful of studies continued to assess participant health outcomes longitudinally beyond the initial after-survey. Four road traffic studies, two aircraft studies and two railway studies resurveyed participants after various intervals: five surveys out to 20 months; six surveys out to three years; 12 months; two years, seven to nine years, etc. While the evidence is meagre and scattered, the consistent finding is that the latter after-surveys showed no difference in outcomes to those surveys immediately following the intervention—with no diminution in the magnitude of the effect, including excess response if present. The exception was that the survey seven to nine years after the intervention did show some attenuation in the excess response observed at the first after-survey.adaptation being defined [In summary, while there is little evidence regarding longer-term changes in health outcomes subsequent to the initial change following an intervention, none of it suggests adaptation . Repeated measurements should also be made of activity interference (Actx), potential confounders such as noise sensitivity (Sensx), coping strategies (Copx), and a range of other attitudinal, retrospective, and prospective assessments. In addition, that model incorporates steady-state controls into the study design. The protocol in A protocol is required for the conduct of future intervention studies that provides longitudinal assessment of both exposure and human response, and Brown  reportedIn reporting the evidence for excess response (in annoyance outcomes) above, we noted that an excess response occurs when the magnitude of the observed change in outcomes is greater than that ‘predicted’ by the ERF, irrespective of whether the observed before and after outcomes themselves lie on the ERF curve. We have noted a tendency, in many studies in which there is evidence of an excess response, for the observed before-outcomes to be much higher than would be indicated by synthesised ERFs. Authors of these individual studies did not explain these higher than anticipated before-responses. We also note the comment by Baughan and Huddart  that it We note that the noise exposure metrics reported in the individual studies reviewed did not include a metric that dealt specifically with noise events in transport noise time histories. One exception is the study  by BrownThe following are implications arising from this review for further research into the health effects of interventions:Spatial scales of interventions and effects will vary from highly local  to regional, national (emission limits for motor vehicles), or international .There may be lag times between interventions  and measurable effect. There may also be lag times between noise reduction and health consequences, e.g., decreased risk of cardiovascular disease.Some interventions are applied for short periods  vs. permanent interventions (studies of temporary interventions were excluded from the current review).Interventions may result in unintended displacement outcomes. For example, a traffic restriction intervention that forces traffic into surrounding areas, introduces higher exposures in other areas, even though at the point of application the exposure is reduced. Examples include congestion charging in London  and the A related consideration is that there may be subgroup differences in health outcomes from an area-wide intervention  and interventions that redistribute exposures across different areas need to be cognizant of differential socio-economic status of populations in these different areas.There may be effects on human health responses to noise generated by interventions in other fields .There is a range of systems-wide matters that additionally should be considered in future evaluations of the health outcomes of transport noise interventions. We note them here, largely without comment, except to indicate that few of these matters were raised within any of the papers examined in the systematic review. However, they are important as they provide, in contrast to existing evidence based on a specific intervention within specific space and time bounds, a systems-wide understanding of transport noise interventions. The latter are likely to be important in comprehensive evaluation of the human health effects of transport noise interventions:It is appropriate to note the possibility that publication bias may have influenced the findings of this review. We have no evidence of this, but it is reasonable to suggest that intervention studies that failed to find a change in human-response outcomes may tend to go unreported compared with those that did find a change.A potential impediment is that some government and private instrumentalities who initiate noise intervention programs may have little interest in undertaking an evaluation of that intervention once a decision to implement it has been taken—avoiding any possible reputational risk that could be associated with a costly intervention later being shown to have little effect on human health.An environmental noise intervention framework, showing different types of interventions along the causal path between noise sources and human outcomes, and measurement points along the pathway where changes relevant to human outcomes can be measured, has been used to structure this review. The framework also assists in focussing future studies of the effects of noise intervention strategies.This systematic review of the literature, 1980–2014, found, overall, that there has been a limited number of transport intervention studies published that report observed changes in health outcomes, or observed changes in peoples’ exposures, together with quantitative details on the association between change in exposure and change in human health effects.The majority of these were for road traffic noise sources; fewer for aircraft noise and rail traffic noise. The principal change in health outcomes assessed was annoyance, with fewer sleep disturbance, cardiovascular effects, and cognitive development in children.We note that there are many studies in the noise management/control literature of interventions, which report a change in noise emissions or in noise levels, but in the absence of reporting of change in health outcomes or of exposures, these do not elucidate the relationship between interventions and health.The consequence is that there is a restricted evidence base on the health effects of transport noise interventions, with studies spread across 16 different groupings . Only two of these groupings source interventions and path interventions for road traffic for the annoyance outcome have more than three studies.A major difficulty for this review was the diversity between studies, even within those categorised in the same group. This was in terms of study designs method of analyses, exposure levels, and changes in exposure experienced as a result of the interventions. In some studies, the changes in noise exposure were variable across participants (sometimes reported in aggregate) and were not always adequately linked to the corresponding change in outcomes.Because of the diversity, a meta-analysis across studies examining the association between changes in level and changes in outcome was not possible. However, the available evidence did show that transport noise interventions changed the health outcomes reported by those who experience the intervention. This is the case irrespective of the source, the outcome or the intervention type.minimum magnitude of the change in annoyance outcomes because of the interventions can be predicted using a relevant exposure–response function (ERF). Further, in the majority of these studies, the magnitude of the change in response to an intervention exhibited a change effect—an excess response in addition to the level effect predicted using an ERF. This evidence was available for studies of road traffic noise sources  and largely only for the annoyance outcome.The The available evidence did not allow testing for any differences in change in health outcomes arising from different types of interventions, or for different source types. We also could not make observations regarding thresholds for observable changes in health outcomes, other than that several interventions that reduced noise exposures by −1 to −2 dB did not result in any observed change in health outcomes.While there is little evidence available with respect to the longitudinal path of health outcomes changes following the initial change as a result of an intervention, there is no evidence to suggest the initial change in response is not sustained over at least several years—that is, there is no adaptation.Further studies directly linking transport noise interventions to health outcomes are required, particularly for aircraft and rail noise sources, and for human health outcomes other than annoyance. A protocol has been recommended for the design of future studies.While recognising the difficulty in doing so in many study designs, we suggest that future intervention studies should aim for precise specification of the change in exposure for individuals, or subgroups. There are advantages in following the approach ,46, of rchange effect associated with interventions, particularly as situations in which noise levels increase as a result of infrastructure changes are always likely to be contentious. To do otherwise would be to deny them important information regarding potential community response to these changes.Policy makers need to be informed of the existence of the The results of the studies available to us regarding other physical interventions were obtained primarily through indirect evidence . These have proved useful as a means of estimating the efficacy of such potential interventions, but they need to be supplemented by direct evidence.We note, without evidence, that publication bias may have influenced the findings of this review. We also suggest, again without evidence, that government and private instrumentalities that initiate noise intervention programmes may be inhibited in conducting follow-up evaluations of the intervention through a perception of reputational risk in doing so.The environmental noise intervention studies included in this review focussed on changes at the site of the interventions. We have indicated that there is a range of system-wide factors that also need to be considered in any comprehensive evaluation of the human health effects of any particular environmental noise intervention.


Introduction: Positive psychology (PP) constructs contribute significantly to a better quality of life for people with various diseases. There are still few studies that have evaluated the evolution of these aspects during the progression of dementia.Objective: To compare the scores for self-esteem, life satisfaction, affect, spirituality, hope, optimism and perceived support network between elderly people with mild cognitive impairment (MCI), mild dementia and moderate dementia and control group.Methods: Cross-sectional study. The sample consisted of 66 healthy controls, 15 elderly people with MCI, 25 with mild dementia and 22 with moderate dementia matched by age, gender, and schooling. The instruments used were: Spirituality Self Rating Scale (SSRS), Rosenberg Self-Esteem Scale, Medical Outcomes Study’s Social Support Scale, Life Satisfaction Scale (LSS), Positive and Negative Affect Schedule (PANAS), Revised Life Orientation Test (LOT-R), and Adult Dispositional Hope Scale (ADHS).Results: The scores for spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affect, and hope differed significantly between the groups (p < 0.05). The individuals with MCI and mild dementia had lower spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism and hope scores, and higher negative affect scores compared with the controls. The scores for PP constructs did not differ between the group of people with moderate dementia and the control group.Conclusion: Dementia was found to impact several PP constructs in the early stages of the disease. For individuals with greater cognitive impairment, anosognosia appears to suppress the disease’s impact on these constructs. The maintenance of the well-being of elderly people with cognitive impairment is relevant to promote the independence and autonomy of these individuals. One of the demands on health professionals is to prevent or even delay the brain degeneration process, thus contributing to productive aging through the promotion of social engagement and significant interpersonal relationships . ElderlyCurrent studies on emotions have pointed out that individuals with dementia exhibit a lack of recognition, assessment, and even the ability to feel negative emotions  and presPositive psychology is the study of the conditions and processes that contribute to the flourishing and optimal functioning of people, groups, and institutions . The folRegarding the PP construct approach in dementia, a systematic review that included 11 articles on religion and spirituality in patients with dementia concluded that intervening in these constructs appears to delay cognitive decline and helps them to cope with their disease . This fiSelf-esteem in subjects with dementia has also been related to a better quality of life. Higher self-esteem scores predicted a better quality of life in a sample of 95 individuals with dementia and this association was partially mediated by depression and anxiety . SimilarIn addition to self-esteem, other positive variables investigated in patients with dementia are life satisfaction and daily experienced affection. Life satisfaction predicted dementia in a sample of 1.751 elderly people without cognitive impairment at baseline who were followed for 5 years  consisted of 62 outpatients who were being treated at a dementia clinic located in a southern Brazilian capital city. Their ages ranged from 60 to 89 . Dementia diagnoses were made by dementia experts according to the NIA–AA , and BraThe control group consisted of 66 individuals aged 60–88  who were selected from a group of elderly people who engaged in physical activities in an active aging group in a capital city in southern Brazil. The controls were chosen after clinical group was selected so that their age, gender, schooling, and social class would be similar to those of the individuals in the clinical group, aiming to match the groups. Depression and cognitive impairment were exclusion criteria for this group. The 15-item Geriatric Depression Scale (GDS)  and the The researchers were trained beforehand to apply the PP scales. The following instruments were used to evaluate the PP constructs.– The Brazilian Portuguese Adaptation of the Spirituality Self Rating Scale (SSRS) . This is– The Brazilian Portuguese Adaptation of the Social Outcomes Study Scale (MOS) . This in– The Brazilian Version of the Rosenberg Self-Esteem Scale . This un– The Brazilian Portuguese Version of the Life Satisfaction Scale (LSS) . The LSS– The Brazilian Version of the Positive and Negative Affect Schedule (PANAS) . The Bra– The Revised Life Orientation Test (LOT-R) by – The Brazilian Version of the Adult Dispositional Hope Scale (ADHS) . The BraSocial class was established according to the Economic Classification of the Brazilian Economic Classification Criteria developed by All of the instruments were used in their validated versions for application in Brazil and have good validity and reliability indicators.Data were initially collected from the individuals in the clinical group. Based on their characteristics  they were paired with members of the control group when its participants were selected, aiming to match the groups. The elderly people who met the inclusion criteria were invited to participate in the study through an approach carried out in different places, according to the group to be studied. After the informed consent form was explained and signed in a silent and private room, the subjects were evaluated. The PP questionnaires were applied in random order to avoid response bias.This study was carried out in accordance with the ethical recommendations for clinical research laid out in Resolution 446/12, with written informed consent from all subjects. It was previously approved by the UFCSPA Research Ethics Committee . All subjects provided informed written consent in accordance with the Helsinki Declaration.t-test was used to compare age between the case and control groups; the Chi-square association test was used to compare the other demographic data between the groups. Since the normality and homogeneity tests did not present statistically significant values, parametric tests were applied. To compare the scales between the groups, we applied the one-way analysis of variance (ANOVA) complemented by Tukey’s test. The significance level was set at 5% (p < 0.05).The data were stored in an SPSS 22.0 database and analyzed using this statistical program. Variable distribution was assessed using the Shapiro–Wilk normality test and variance homogeneity was evaluated with the Levene test. The Student’s Table 1 shows the comparison of the demographic data, presence of cognitive complaints and antidepressant use between the healthy individuals (controls) and those with MCI, mild dementia and moderate dementia (cases). The demographic data  did not differ between the groups. The MCI and dementia groups presented cognitive complaints. Such complaints became increasingly frequent the higher the level of cognitive impairment and dementia severity. Although major depression was one of the exclusion criteria, some individuals reported that they currently used antidepressants for minor anxiety or depression symptoms. Such use was significantly higher in the control group.In total, 128 subjects aged 60–89  were included in the study. Table 2 presents a comparison of the scores on the spiritual well-being, social support, self-esteem, life satisfaction, positive affect, negative affect, optimism and hope scales among the healthy elderly people and those with MCI and mild and moderate dementia. There was a significant difference in all of the PP constructs between the groups.The multiple comparisons using Tukey’s test showed significantly lower scores for the majority of the PP constructs in individuals with MCI and mild dementia than in the healthy elderly individuals and those with moderate dementia. There was no difference in the total spiritual well-being score between the MCI and mild dementia groups, while individuals with MCI presented significantly lower scores for this construct than the healthy subjects and the individuals with moderate dementia. Multiple comparisons using Tukey’s test also showed that the total social support scores were similar between the MCI and mild dementia groups and that both groups presented lower scores for this construct than the moderate dementia group and the healthy control group. Individuals with MCI showed lower scores in all of this construct’s subgroups than those observed in the healthy group and the moderate dementia group, while the mild dementia group showed lower scores than the moderate dementia group only for the affective, information and positive social interaction sub-scales of social support. Scores for the self-esteem, life satisfaction, positive affect, and hope constructs did not differ between the MCI and mild dementia groups. These constructs were also similar between the moderate dementia group and the healthy individuals. On the other hand, the scores for these constructs were significantly lower in the MCI and mild dementia groups compared with the moderate dementia group and the healthy control group. The healthy controls showed the highest optimism scores among all the groups. The optimism scores did not differ between the mild dementia group and the MCI group and both presented lower levels of optimism than the healthy control group and the moderate dementia group. Negative affect scores were significantly higher in the MCI and mild dementia groups than in the healthy control group, while negative affect levels did not differ between these groups.The present study evaluated self-perception in several PP constructs in elderly individuals with MCI and different degrees of dementia compared with that in healthy individuals. The study showed two main results: (a) Groups with MCI and mild stages of dementia had worse scores for all constructs, and (b) The scores of patients with moderate-stage dementia did not differ from those of the control group. Therefore, our first hypothesis that better cognitive performance would be associated with higher scores in the PP constructs was refuted. The second hypothesis that cognitive impairment would be associated with better scores in all of the PP constructs was validated.It is worth discussing some points about the first result (worse scores in the early stages of dementia). It is known that the neuropsychological impacts of dementia include the deterioration of life quality, perception, mood, and behaviors that are associated with neurodegenerative diseases. These changes are mainly perceived at an early stage of the disease and are associated with a poor prognosis of progressive cognitive loss . This maThe reduction of the constructs studied in the earlier stages of dementia can also be understood as resulting from the impacts that the disease generates, posing itself as a threat to existence, the meaning of life and social context, since believing that the rest of one’s life may be unpleasant overwhelms the individual, threatening his/her identity and lowering his/her self-esteem . RegardiTo deal with these disabilities, the literature suggests that dementia interventions in the various positive psychology constructs studied may help the elderly to cope with their disease. Recent studies have investigated the benefits of interventions in positive psychology for individuals with dementia . These sOur investigation also found that the PP constructs did not differ between the patients with moderate dementia and the healthy controls–i.e., as their dementia severity worsened, the elderly patients’ responses became more positive. This finding is similar to that of a study by As the disease progresses, the perception of its initial impact may not be perceived as a threat, since the disease’s own effects can lead to an inability to judge and understand the losses it causes, as well as to better responses in many domains, such as emotions and empathy . A patieGreater impairment of an individual’s ability to perceive his/her own limitations with the progression of dementia determines his/her awareness of the pathology’s severity or even of being ill (known as anosognosia), which was mentioned earlier in this study . StudiesThe scarcity of research on PP and the associations between its constructs and dementia is still evident in current literature . ConsideOne of the present study’s strengths is that it investigates several PP domains at different stages of dementia, including the earliest stages, such as MCI. It is original in that it provides a view of the differences that exist in PP constructs in terms of the degrees of dementia impairment and performs a broad analysis of the findings, aiming to improve the psychosocial conditions of elderly people.An important limitation of the study is that there is limited literature available in the field of PP, mainly due to the novelty of studies on PP in dementia. Important gaps still exist . This prFor future studies, a longitudinal design is suggested with dementia patients in the assessment of the progression of losses in PP, since this may help in understanding the progression of the constructs studied. The impressions of caregivers would be an interesting topic for future studies. Potential causality, selection and measuring biases, and confounding effects are related to the study’s design.Mild cognitive impairment and mild dementia result in lower scores for the constructs of self-esteem, spirituality, social support, affect, life satisfaction, optimism, and hope. However, as dementia severity increases, the construct scores more closely resemble those of individuals in the control group, leading to the hypothesis that factors such as anosognosia, a reduction in the suppression of positive emotions and a reduction in emotional self-perception and understanding of the disease gain influence with the progression of dementia.SdS was the lead author in conceptualizing the study and writing the manuscript. GR, AdP, LF, and CR contributed to all stages of the research and then critically reviewed and revised the manuscript. CR was a doctoral advisor for this research. LF and AdP were co-advisors for this research. All authors were accountable for the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.