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The Cumberland Ankle Instability Tool is a common patient reported outcome used to assess those with Chronic Ankle Instability. However, paper versions of the Cumberland Ankle Instability Tool have only been assessed for reliability purposes. The purpose of this study was to assess the agreement and reliability of a digital version of the Cumberland Ankle Instability Tool-Digital. Sixty-eight participants with a history of ankle sprain(s) were recruited to participate in this study. Participants completed a paper version of the Cumberland Ankle Instability Tool and a digital version then returned one week later and completed them again. Intraclass correlation coefficients (ICC) and Kappa coefficients were used to determine the agreement between the paper and digital versions as well as test-retest reliability between the two time periods. The digital version showed excellent reliability (ICC = 0.93, 95% CI: 0.89–0.96) with the paper version. The test-retest reliability between testing sessions was considered good (ICC = 0.86, 95% CI: 0.77–0.92). A majority of individual items on the digital version demonstrated substantial agreement (κ = 0.60–0.81) with the paper version. A digital version of the Cumberland Ankle Instability Tool demonstrated good to excellent psychometric properties. Clinicians who utilize a digital version as part of an electronic medical record system can utilize them confidently to accurately assess patients with Chronic Ankle Instability. Future studies may want to consider assessing a digital version with expanded clinical and research populations. The digital version of the Cumberland Ankle Instability Tool demonstrated adequate psychometric properties. The digital version of the Cumberland Ankle Instability Tool can be considered a reliable instrument for the assessment of Chronic Ankle Instability. A digital version of the Cumberland Ankle Instability Tool can provide automated scoring and quick administration for clinicians in a rehabilitation setting. [ABSTRACT FROM AUTHOR]

Given the politicization of abortion, professionals working in U.S. health departments (HDs) may not be receptive to communications about abortion, despite often regulating abortion facilities. This paper reports results of a randomized, prospective, observational study to test the effects of e-mail language when disseminating evidence on abortion to HD professionals. Our sample was 302 HD employees who oversee healthcare facilities inspection/regulation in all 50 U.S. state HDs, clustered by HD and randomized into two study groups. In November–December 2019, we sent biweekly e-mails containing links to a website summarizing evidence on abortion facility regulation. E-mails/headers sent to one group emphasized public health values and did not include the word abortion; e-mails/headers to the other group used the word abortion. Primary outcome measures were e-mail open rates and click-through rates. Among 221 participants to whom e-mails were deliverable, the overall open rate was 36%. Open rate was 25% for PH values and 46% for abortion groups (p <.05). Effects were moderated by state abortion policy environment: in both supportive and restrictive environments, participants in the abortion messaging group were statistically more likely to open e-mails than those in the PH values group. There was no difference between groups in states with middle-ground abortion policy environments. Among participants opening at least one e-mail, 19% clicked through to the website, with no significant difference by group. This study demonstrates that repeated targeted e-mail campaigns can reach HD professionals with research summaries. Concerns that communications to HDs should avoid the word abortion are unsupported. [ABSTRACT FROM AUTHOR]

While video games can be helpful in personal development, participating in certain gaming activities may lead to negative effects such as video game addiction. The overuse of computer games, which can lead to reduced quality of life and affect a person's practical skills. Around 3% of adolescents suffer from Internet Gaming Disorder (IGD), there is currently no universally accepted psychometric method. The AICA-S scale was applied to results from 3,901 respondents aged between 11 and 19. During the 2017/2018 school year, a battery of questionnaires in "pen and paper" form was administered to students at primary schools and secondary schools. The respondents were selected from all the regions of the Czech Republic through a random stratified selection to ensure that the respondents were an accurate representation of students across the Czech Republic. The results were obtained using statistical methods such as ANOVA, chi-square tests and t-tests. These results affirm the psychometric quality of AICA-S and note the prevalence of IGD among Czech adolescents. Based on our results, 0.8% of our respondents fulfilled the criteria for an IGD. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact. Design: Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level. Setting: PCCs in Region Västra Götaland, Sweden, with care manager organisation. Participants: Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (n = 142 intervention, n = 116 control PCCs). Intervention: Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs. Main outcome measures: 12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months. Results: There were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 − 138.8); control, mean = 99.1 days (95% CI 73.9 − 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%. Conclusion: Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation. Trial registration: ClinicalTrials.gov Identifier: NCT03250026 CO-WORK-CARE First Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017 [ABSTRACT FROM AUTHOR]

The phenomenon of regularization – learners imposing systematicity on inconsistent variation in language input – is complex. Studies show that children are more likely to regularize than adults, but adults will also regularize under certain circumstances. Exactly why we see the pattern of behaviour that we do is not well understood, however. This paper reports on an experiment investigating whether it is possible to induce regularization in adults by varying the conditions of learning and/or testing in ways that made retrieval more difficult, something predicted by previous studies of regularization. The data show that interfering with learning does not lead to regularization, but that interfering with retrieval at test does, although only to a small degree. [ABSTRACT FROM AUTHOR]

Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics' resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4–6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments. [ABSTRACT FROM AUTHOR]

Background: The correlates of alcohol misuse among female Veterans are not well understood. The present study explored associations among alcohol misuse, demographic/military-related characteristics, interpersonal violence exposure, and posttraumatic stress disorder (PTSD) and depression symptom severity. Method: Participants were 369 female Veteran patients of the VA New England Healthcare System. Participants completed a paper-and-pencil mail survey that included validated assessments of alcohol misuse, interpersonal violence, and psychological distress. Results: Younger age, adulthood physical abuse, military sexual trauma, past-year psychological aggression by an intimate partner, and PTSD and depression symptom severity showed significant univariate associations with alcohol misuse (as indicated by unsafe drinking levels, presence or incipience of an alcohol use disorder, intrapersonal alcohol-related concerns, and/or interpersonal alcohol-related concerns). A couple of these associations remained significant when examined in logistic regression models. Conclusions: Findings suggest that female Veterans who are at risk for alcohol use disorders and/or are experiencing alcohol-related problems may benefit from screening and intervention efforts that take into account interpersonal violence exposures and mental health symptoms on a case-by-case basis. Results also suggest the importance of future research examining correlates and risk factors for substance misuse among female Veterans. [ABSTRACT FROM AUTHOR]

The co-occurrence of severe mental illness (SMI) and substance use disorder (SUD) in dual diagnosis patients is common and associated with negative treatment outcomes. Therefore, integrated treatments, combining proven effective mental health and substance abuse interventions, have emerged. However, evidence about the effectiveness of integrated outpatient versus inpatient treatment for dual diagnosis patients from randomised controlled trials is lacking. The aim of the paper is to determine whether integrated outpatient treatment for patients with SMI and SUD is more effective than integrated inpatient treatment. Three months of post-treatment hospitalisation, problem drug use and psychiatric status were assessed in 82 patients with SMI and SUD in a randomised controlled trial (RCT) comparing five months of integrated inpatient treatment (n = 40) with five-months integrated outpatient treatment (n = 42) following a shared one-month inpatient stabilisation phase. No significant differences in outcomes were found between the two treatment conditions using intention-to-treat analyses. However, considerable crossover of patients between treatment conditions occurred. This crossover occurred significantly more in the outpatient treatment group, where patients remained in inpatient treatment longer than the intended one month stabilisation phase. As a consequence, actual time in inpatient treatment did not differ between the study groups. Post hoc analyses showed that baseline patient characteristics did not predict actual time in inpatient treatment. Due to considerable crossover of study participants, we were unable to answer our study question regarding the comparative effectiveness of inpatient versus outpatient treatment. This raises serious questions regarding the feasibility of RCTs investigating inpatient versus outpatient integrated treatment in patients with SMI and co-occurring SUD. [ABSTRACT FROM AUTHOR]

We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits. The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on the acceptability of the adapted CTI. Using a multimethod approach, the CTI implementation was assessed quantitatively for site- and coach-level differences. Qualitatively, barriers to implementation and participant satisfaction with the CTI were thematically analyzed. Of the 863 patient participants, 726 (84.1%) completed their home visits. Cancellations were usually patient-generated (94.9%). Most planned follow-up visits were successfully completed (94.6%). Content on the planning for red flags and post-discharge goal setting was discussed with high rates of fidelity overall (95% and greater), while content on outpatient follow-up was lower overall (75%). Differences in service delivery between the two sites existed for the in-person visit and the first phone follow-up, but the differences narrowed as the study progressed. Participants showed a 24.6% increase in patient activation (i.e., behavioral adoption) over the 30-day study period (p < 0.001). Overall, participants reported that the program was beneficial for managing their health, the quality of coaching was high, and that the program should continue. Not all participants felt that they needed the program. Community paramedic coaches reported barriers to CTI delivery due to patient medical problems and difficulties with phone visit coordination. Coaches also noted refusal to communicate or engage with the intervention as an implementation barrier. Community paramedic coaches delivered the adapted CTI with high fidelity across geographically distant sites and successfully facilitated participant engagement, highlighting community paramedics as an effective resource for implementing such patient-centered interventions. [ABSTRACT FROM AUTHOR]

The BetterBack model of care (MoC) for low back pain (LBP) was recently developed in Swedish physiotherapy (PT) primary care. To evaluate if PTs' adherence to LBP clinical practice guidelines (CPGs) improves after implementation of the BetterBack MoC (intervention). This was a stepped, single-blinded cluster randomized controlled trial. Patients nested in the three clusters were allocated to routine care (n = 222) or intervention (n = 278). The primary outcome was referral to specialist consultation. This was among five best practice recommendations divided into an assessment quality index (no referral to specialist consultation and no medical imaging) and a treatment quality index (use of educational interventions; use of exercise interventions; no use of non-evidence-based physiotherapy). For overall adherence, patients had to be treated with all five recommendations fulfilled. Logistic regression was used for between-group comparisons. The proportion of patients receiving referral to specialist consultation during the PT treatment period was low in both groups with no between-group differences. However, patients in the intervention group showed significantly higher assessment quality index, treatment quality index and overall adherence compared to routine care. Adherence to the separate recommendations showed improved stratified number of visits, use of exercise was maintained high, patient educational intervention increased and use of non-evidence-based physiotherapy decreased. A reduction of medical imaging during the physiotherapy treatment period was also observed. The adoption of CPGs could be substantially improved by introducing a MoC through PT training and supportive materials. [ABSTRACT FROM AUTHOR]

Although ongoing exercise is known to reduce disability in people with multiple sclerosis (MS), participation in lower-extremity exercise programs can be limited by their existing mobility impairments. Lower-extremity exoskeletons could address this problem by facilitating home and community locomotion and enhancing exercise capability but little data is available on the potential of this technology for reducing disability of people with MS. We evaluated the Keeogo™ exoskeleton for people with MS using an open-label randomised cross-over design. The trial design allowed us to quantify rehabilitation effects (tested without device) and training effects (tested with device) using functional outcomes: 6-minute walk test (6MWT), timed stair test (TST), and timed up-and-go (TUG). Baseline and post-study self-report instruments included Medical Outcomes Survey Short Form-36 (SF36), MS Walking Scale (MSWS), and others. Amount of home use was documented by daily activity log. Partial correlation analysis was used to explore the relationships between changes in functional outcomes and self-report disability, controlling for amount of home use of the device. Twenty-nine participants with MS completed the trial. Change scores for MSWS, SF36 physical function and SF36 emotional well-being correlated positively with changes in 6MWT which was explained by amount of home use. The benefits in physical functioning and emotional well-being from using the exoskeleton at home were linked to amount of device usage. Low-profile robotic exoskeletons could be used to deliver facilitated exercise while assisting with locomotor activities of daily living, such as walking and stair climbing in the home and community environment. Exoskeletons for home use may have the potential to benefit people with MS in terms of physical functioning and emotional well-being. The benefits in physical functioning and emotional well-being appeared to be linked to amount of usage. Exoskeletons might be useful for delivering facilitated exercise while assisting with walking and stair climbing in the home. [ABSTRACT FROM AUTHOR]

To investigate the effects of providing rigid wrist-hand orthoses plus usual multidisciplinary care, on reducing hand impairments in children with cerebral palsy. A pragmatic, multicentre, assessor-blinded randomised controlled trial aimed to enrol 194 children aged 5–15 years, with wrist flexor Modified Ashworth Scale score ≥1. Randomisation with concealed allocation was stratified by study site and passive wrist range. The treatment group received a rigid wrist-hand orthosis, to wear ≥6 h per night for 3 years. Analysis included repeated measures mixed-effects linear regression models, using intention-to-treat principles. The trial stopped early due to insufficient recruitment: 74 children, across all Manual Ability Classification System levels, were randomised (n = 38 orthosis group; n = 36 control). Mean age was 10.2 (SD 3.1) years (orthosis group) and 9.1 (SD 2.8) years (control). Data showed some evidence that rigid wrist-hand orthosis impacted passive wrist extension with fingers extended in the first year [mean difference between-groups at 6 months: 13.15° (95%CI: 0.81–25.48°, p = 0.04); 12 months: 20.94° (95%CI: 8.20–33.69°, p = 0.001)]. Beyond 18 months, participant numbers were insufficient for conclusive findings. The study provided detailed data about short- and long-term effects of the wrist-hand orthosis and highlighted challenges in conducting large randomised controlled trials with this population. Trial Registration: Australia and New Zealand Clinical Trials Registry: U1111-1164-0572 There may be incremental benefit, for children with cerebral palsy, at 6 and 12 months on passive wrist range from wearing a rigid wrist-hand orthosis designed according to this protocol. The rigid-wrist-hand orthosis evaluated in this study, which allowed for some tailoring for individual children's presentations, differed in design from past recommendations for "resting hand" positioning. Longitudinal follow up of children with cerebral palsy prescribed a rigid wrist-hand orthosis is essential to monitor any benefit. Minor adverse events were commonly experienced when wearing the orthosis and should be discussed prior to prescription of a rigid wrist-hand orthosis. [ABSTRACT FROM AUTHOR]

Many adolescents and young adults hold erroneous beliefs that cigarillos and waterpipe tobacco (WT) are safer than cigarettes, contributing to use. Communication campaigns can correct misperceptions and increase risk beliefs. We tested point-of-sale (POS) communication campaigns focused on chemical exposure for cigarillos and WT. We conducted two cluster randomized trials at 20 gas stations with convenience stores (10 stores for cigarillos, 10 for WT) in North Carolina between June and November 2017. Within each trial, stores were randomly assigned to either the intervention (campaign messages displayed) or a no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 adolescents and young adults (ages 16–25) per store, at baseline and follow-up. There were 978 participants (mean age = 20.9 years) in the cigarillo trial, and 998 participants (mean age = 21.0 years) in the WT trial. Rates of campaign exposure were low (26% for cigarillos; 24.3% for WT). The cigarillo campaign increased knowledge that ammonia is in cigarillo smoke (p <.01). There were also significant increases in knowledge about ammonia and cyanide in cigarillo smoke and arsenic in WT smoke (p <.05) in the sub-sample who reported exposure to the campaign. No differences were found in outcome expectancies, product attitudes, worry about chemical exposure, or behavioral intentions in either campaign. Garnering attention for communication campaigns in saturated POS environments, often dominated by tobacco advertising, is challenging. Our study demonstrates the feasibility of anti-tobacco campaigns at the POS and points to several lessons learned for future POS campaigns. [ABSTRACT FROM AUTHOR]

To assess the benefits of the Ida Institute's Why improve my hearing? Telecare Tool used before the initial hearing assessment appointment. A prospective, single-blind randomised clinical trial with two arms: (i) Why improve my hearing? Telecare Tool intervention, and (ii) standard care control. Adults with hearing loss were recruited from two Audiology Services within the United Kingdom's publicly-funded National Health Service. Of 461 individuals assessed for eligibility, 57 were eligible to participate. Measure of Audiologic Rehabilitation Self-efficacy for Hearing Aids (primary outcome) scores did not differ between groups from baseline to post-assessment (Mean change [Δ]= −2.28; 95% confidence interval [CI]= −6.70, 2.15, p=.307) and 10-weeks follow-up (Mean Δ= −2.69; 95% CI= −9.52, 4.15, p =.434). However, Short Form Patient Activation Measure scores significantly improved in the intervention group compared to the control group from baseline to post-assessment (Mean Δ= −6.06, 95% CI= −11.31, −0.82, p =.024, ES=.61) and 10-weeks follow-up (Mean Δ= −9.87, 95% CI= −15.34, −4.40, p =.001, ES= −.97). This study demonstrates that while a patient-centred telecare intervention completed before management decisions may not improve an individual's self-efficacy to manage their hearing loss, it can lead to improvements in readiness. [ABSTRACT FROM AUTHOR]

Purpose We studied the effectiveness of a new cardiac rehabilitation (CR) program developed for patients with obesity compared with standard CR on HRQOL and psychosocial well-being. Materials and methods OPTICARE XL was a multicentre RCT in patients with cardiac disease and obesity (Netherlands Trial Register: NL5589). Patients were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). The one-year OPTICARE XL CR group program included endurance and resistance exercises, behavioural coaching, and after-care. Standard CR consisted of a 6- to 12-week endurance exercise group program, and cardiovascular lifestyle education. Primary endpoint was HRQOL (MacNew) at six months post CR. Second, we assessed anxiety and depression (both HADS), fatigue (FSS), and participation in society (USER-P). Results In both groups, improvements in HRQOL were observed six months post CR. Mean HRQOL improved from 4.92 to 5.40 in standard CR [mean change (95% CI): 0.48 (0.28, 0.67)] and from 4.96 to 5.45 in OPTICARE XL CR (mean change (95% CI): 0.49 (0.29, 0.70), without between-group differences. Psychosocial well-being improvements within both groups were obtained at six months post CR, regardless of allocated program. Conclusions OPTICARE XL CR did not have added value in improving HRQOL and psychosocial well-being in patients with obesity. More than a third of cardiac patients suffers from obesity, and standard cardiac rehabilitation (CR) programs are suboptimal in this increasing patient population. The OPTICARE XL CR program is a state-of-the art, one-year CR program designed for patients with obesity including aerobic and strength exercises, behavioural coaching towards a healthy diet and an active lifestyle, and after-care. Improvements in HRQOL and psychosocial well-being were comparable between patients with obesity allocated to standard CR and OPTICARE XL CR. Therefore, there was no additional benefit of OPTICARE XL CR. [ABSTRACT FROM AUTHOR]

To compare the effectiveness of 12 weeks of community-based, in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health and wellbeing in older adults with hypertension and in promoting psychological resilience during COVID-19. A 12-week randomized controlled trial (RCT) in San Diego County, USA. Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, resilience, mental and physical health were assessed in-person pre- and post-intervention, and by long-term follow-up surveys during COVID-19. Linear mixed-effects models were used to assess study arm differences over time and logistic regression to identify predictors of positive intervention response. Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 completed the intervention. Modest improvements in health and wellbeing occurred post-intervention in both arms (Cohen's d: TC = 0.38, 95% CI: 0.25–0.51; HAP-E = 0.24, 0.11–0.37), though positive intervention responses were more than twice as likely in TC (OR = 2.29, 1.07–4.57). Younger age, higher anxiety, and poorer mental health at baseline predicted greater odds of response. Small declines in health and wellbeing were reported at the first COVID-19 follow-up, with smaller declines in the TC arm (Cohen's d: TC = −0.15, −0.31–0.00; HAP-E = −0.34, −0.49 to −0.19). Health and wellbeing stabilized at the second COVID-19 follow-up. Most participants (>70%) reported that the interventions benefitted their health and wellbeing during COVID-19. TC and HAP-E improved health and wellbeing, though TC conferred greater odds of an improved mental health response. Declines in health and wellbeing were observed at pandemic follow-up, with smaller declines in the TC arm, suggesting increased resilience. [ABSTRACT FROM AUTHOR]

Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand. [ABSTRACT FROM AUTHOR]

It is believed that clinical management of osteoarthritis should address muscle weakness to improve physical function and prevent disability and frailty This sub-study investigated the effects of supervised progressive resistance training (RT), supervised Nordic Walking (NW), and unsupervised home-based exercise (HBE) on muscle and functional performance; and associations between these exercise-induced changes in persons with hip osteoarthritis. Forty-two patients with hip osteoarthritis were recruited from a larger RCT (NCT01387867). All the groups (RT, n = 15; NW, n = 12; HBE, n = 15) exercised 1 h 3 times/week for 4 months. Quadriceps cross-sectional area (QCSA, MRI-determined); quadriceps strength (QMVC); leg extensor power (LEP); functional performance (chair stands (30sCS); stair climbs (TSC); and 6-minute walk (6MWT)) were assessed at baseline and 4 months. Per protocol analyses (one-way ANOVA and Bonferroni test) showed significant between-group differences for improvements in QCSA in the most symptomatic leg favoring RT versus NW (2.3 cm2, 95% CI [0.6, 3.9]) and HBE (2.3 cm2 [0.8, 3.9]); and 30sCS (1.8 repetitions [0.2–3.3]), and 6MWT (35.1 m [3.5–66.7]) favoring NW versus HBE. Associations existed between exercise-induced changes in QCSA and QMVC (r = 0.366, p =.019) for the most symptomatic leg and between changes in 6MWT and QMVC (r = 0.320, p =.04) and LEP (r = 0.381, p =.01), respectively, for the least symptomatic leg. Resistance training appeared effective for improving muscle mass, but less effective for improving muscle strength, power, and functional performance. Only exercise-induced changes in muscle strength and power of the least symptomatic leg, not the most symptomatic leg, were related to changes in functional performance. [ABSTRACT FROM AUTHOR]

Little is known about the economic impact of military mental health screening. To investigate (a) whether post-deployment screening of military personnel affects use and cost of services and (b) the impact of psychiatric morbidity on costs. Participants were recruited from UK Royal Marine and Army platoons and randomised to an intervention group (which received tailored advice predicated upon mental health status) or a control group (which received general advice following assessment of mental health status). The intervention costs were calculated while service use and associated costs were assessed at 12-month follow-up. Data were available for 6323 participants. Mean screening cost was £34. Service costs were slightly higher in the control group compared to the intervention group (£1197 vs. £1147) which was not statistically significant (bootstrapped 95%CI, −£363 to £434. In both groups, screening and control, costs were significantly higher for those who screened positive for mental health problems. Costs were not affected by screening. In countries that have already implemented post-deployment screening, the political cost of disinvestment needs careful consideration. Those who develop psychiatric morbidity have substantially higher care costs than those who do not. [ABSTRACT FROM AUTHOR]

This study confirms the effectiveness of aerobic exercise on waist circumference, Vo2 max, blood glucose, insulin, serum lipid in middle-aged women. The Ovid-Medline, Embase, the Cochrane Library, and CINAHL were searched. The risk of bias 2 revised in 2019 was used to assess the risk of bias in randomized controlled trials (RCTs). Selected studies were meta-analyzed with Review Manager 5.3. Data were compiled from 15 RCTs comprising 1,110 participants. Overall, aerobic exercise reduced waist circumference and blood glucose, and increased VO2 max significantly. We recommend the application of aerobic exercise to prevent metabolic disease in middle-aged women. [ABSTRACT FROM AUTHOR]

Temporal information is an essential component of human movements. However, it is still unclear how the temporal information is extracted from complex whole-body movements through observation and how it is encoded and retained in working memory. In the current study, we investigated how the sequence length and maintenance delay influence working memory for movement rhythms (i.e., temporal structures of movement sequences) after considering the task-relevance of the corresponding spatial information and the sensitivity difference between spatial and temporal processing in visual perception. We found that the sequence length – in the sense of information load more than temporal duration – may act as the first bottleneck in the processing of movement rhythms, deciding whether temporal information can be encoded as individual units in high precision or it might be encoded as an ensemble "whole" in relatively low precision. In addition, the maintenance delay may act as the second bottleneck, determining to what extent the encoded information can be retained in memory. [ABSTRACT FROM AUTHOR]

Self-affirmation theory has inspired numerous studies that have tried to understand the effects of self-affirmation on defensive processing of threatening health messages and subsequent behavior. Despite the overall positive effects of self-affirmation, psychological processes through which self-affirmation exerts such impact remain unclear. We examined Consideration of Future Consequences (CFC) as a potential moderator of the effects of self-affirmation on responses to graphic cigarette warning warnings, in an attempt to shed light on the psychological processes. We conducted an experimental study in which 925 African American smokers were instructed to self-affirm (or not) prior to viewing graphic cigarette warning labels. We found that smokers with stronger present time orientation (PTO) experienced higher defensive responses as measured by anger, perceived message manipulation, and message derogation, after viewing graphic cigarette warning labels; whereas smokers with stronger future time orientation (FTO) reported less message derogation. PTO interacted with self-affirmation in predicting defensive processing measures, such that self-affirmation reduced message derogation at lower levels of PTO and increased message derogation and perceived message manipulation at higher levels of PTO. Self-affirmation also had a conditional indirect effect on smoking intentions and intention to quit smoking through measures of defensive processing. We discuss implications of our study. [ABSTRACT FROM AUTHOR]

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Objective: This study examines whether parents involved in the child welfare system, due to substance abuse, who receive solution-focused brief therapy (SFBT) counseling experience more hope and positive emotions than those receiving treatment-as-usual counseling services. Methods: Randomized controlled trial design was used to evaluate the effectiveness of SFBT in primary substance use treatment services for parents (n = 123). Difference-in-Difference (DiD) estimation was used to assess the effect of SFBT intervention on hope, positive emotions, and negative emotions. Results: DiD analyses showed SFBT parents had slightly worse scores on hope and emotion subscales at baseline and demonstrated slightly greater positive changes on all scales at posttest, though these findings were not statistically different from control group. Positive associations between SFBT and hope subscales were found; however, effects were not statistically significant. Conclusion: SFBT may help increase positive emotions and hope in parents through a solution-building approach, but more research is needed. [ABSTRACT FROM AUTHOR]

This study compared self-report logbooks of exercise performance to objective measures of performance to determine the accuracy of and patterns of misreporting in self-report logbooks in people with Parkinson's disease. Fifteen participants from the intervention arm of a randomized control trial were prescribed a minimally supervised, 12-week, home-based upper limb exergame program (ACTRN 12614001048673). The exergame system provided an objective electronic measure of adherence for comparison with self-report logbooks. Logbooks showed excellent to good accuracy of overall reported adherence to prescribed sessions (Intraclass correlation (ICC) = 0.83) and games (ICC 0.71). Logbooks were also a good to fair representation of weekly adherence across participants for both sessions (ICC 0.66) and games (ICC 0.56). Individual participant ICCs ranged from minimal to perfect agreement between logbooks and electronic records (ICC sessions range: −0.02 to 1; games range: −0.24 to 0.99). The pattern of logbook reporting suggested some participants were biasing entries to match prescribed exercise. Self-report logbooks may provide an accurate measure of overall adherence. However, the accuracy of individual logbooks was highly variable indicating caution is needed in using self-report measures to assess individual adherence in intervention studies and for clinical decision making. Clinical Trial Registration: Registered in Australia and New Zealand Clinical Trials Registry (): Registration number: ACTRN12614001048673. Adherence to prescribed unsupervised exercise is usually self-reported. Self-reported logbooks gave a good to excellent indication of exercise adherence overall when compared to electronically captured records for a group of participants with mild to moderate Parkinson's disease. There were high levels of variability in the accuracy of individual logbooks with a tendency to record prescribed rather than actual exercise. Logbooks may be accurate to monitor group adherence, but caution is required when using them to assess an individual's adherence to an exercise prescription. [ABSTRACT FROM AUTHOR]

Background: The use of methamphetamine has had arising trend among Iranian women in recent years. The present study was conducted to assess the effect of self-compassion training on craving and self-efficacy in female patients with methamphetamine users and the rate of relapse over a one-year follow-up in 2017–2018 in the city of Kermanshah, Iran. Methods: This study was a randomized, controlled, clinical trial. A total of 40 female patients diagnosed with methamphetamine dependency were randomly assigned either to self-compassion training and control groups. Both groups were assessed before and one month after the educational intervention using craving and self-efficacy questionnaires. The groups were followed-up in terms of methamphetamine use relapse one year after the intervention. Results: After the intervention, the mean craving score decreased (51.82) while the mean self-efficacy score increased (28.82) in the trial group. In the one-year follow-up, ten participants (27.7%) from the trial group and 28 (75.7%) from the control group relapsed into methamphetamine users. Conclusions: Given the present findings regarding the effect of self-compassion training on reduced craving and increased self-efficacy in female patients with methamphetamine dependence, the researchers recommend that self-compassion skills training be applied in drug rehabilitation centers and hospital wards to complement conventional therapies. [ABSTRACT FROM AUTHOR]

To determine the feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents with Down syndrome. Assessor-blinded, parallel-group randomised pilot study. Thirty-three children and adolescents with Down syndrome were randomly allocated to a custom-fitted footwear group (Clarks® footwear) or a wait-list control group. Six feasibility domains were evaluated at baseline, 6 and 12 weeks; demand (recruitment), implementation (co-interventions and adherence), acceptability, practicality (adverse events), limited efficacy testing (physical activity, disability associated with foot and ankle problems, and gait parameters), and adaptation (shoe-fit). Three participants were recruited per month. The use of co-interventions was common with six control group participants purchasing new footwear during the study. Mean adherence was 35 h/week in the custom-fitted footwear group, and there were few minor adverse events. There were trends for differences in physical activity favouring the custom-fitted footwear, but no trends for differences in disability associated with foot and ankle problems or gait parameters. The fit of the custom-fitted footwear was no better than participants' regular footwear. A definitive randomised trial is feasible. However, recruitment, use of co-interventions and footwear fit need further consideration. Conducting a definitive randomised trial to determine the efficacy of custom-fitted footwear in increasing physical activity in children and adolescents with Down syndrome is feasible. Custom-fitted footwear may improve physical activity in children and adolescents with Down syndrome. Commercially available footwear may not be suitable for children and adolescents with Down syndrome due to their unique foot shape. [ABSTRACT FROM AUTHOR]

Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults. Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support). Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71–77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely. Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care. Older adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores. Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support. Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained. [ABSTRACT FROM AUTHOR]

This trial examined the effectiveness of an 8-week home meal service on protein and other nutrient intake, physical performance (PP) and health related quality of life (HRQoL) among older people living at home (≥65 years; home care clients, caregivers and care recipients). Participants were randomized into three groups; (1) protein-rich meal, snack, and bread (INT1), (2) regular meal (INT2) and (3) control group. Nutrient intake was assessed with 3-day food diaries, PP with Short Physical Performance Battery (SBBP) and HRQoL with 15 dimensional Health-related quality of life instrument. Total of 67 (59.7% women, mean age 78.2 years) participants (n = 22 INT1, n = 24 INT2, n = 21 CG) completed the trial. At baseline, mean protein intake was 0.92 (SD 0.32) g/kg adjusted body weight (aBW)/d. At 8 weeks, protein-rich home meal service in INT1 increased protein intake (+ 0.11 (95%CI −0.01 to 0.21) g/kg aBW/d, 9.4 (95%CI 1.0 to 17.8) g/d) compared to other groups. It also increased calcium intake (+169.9 (95%CI 26 to 314) mg/d) and improved results in Sit-to-Stand Test (-4.8 (95%CI −6.8 to −2.7) sec) in INT1 compared to CG. Both home meal services increased saturated fat intake (INT1; 4.6 (95%CI 1.0–8.2) g/d, INT2;7.8 (95%CI 1.9 to 13.7)g/d) and decreased salt intake (INT1;-2330.9 (95%CI −2998 to -1664) mg/d, INT2; −2371.9 (95%CI −3399 to -1345) mg/d) compared to CG. There was no effect on overall HRQoL. [ABSTRACT FROM AUTHOR]

In Ghana, people with mental disorders commonly experience negative attitudes and discrimination because of deep-rooted public stigma. The aim of the study was to assess the effectiveness of a mental health literacy programme in improving community leaders' attitudes toward people with mental disorders. A cluster randomised controlled trial, comprising an intervention and control group, participated in a 3-hour problem-solving, Story-bridge mental health literacy programme. Data were collected at baseline and 12-week follow-up. The intervention group performed better in most outcome measures at follow-up compared to the control group. There were statistically significant differences between the two groups, in perceived stigma, community mental health ideology (CMHI), and benevolence outcome measures over the two time-points. Overall, the findings suggest that the programme was somewhat effective in improving community leaders' attitudes and who might, subsequently, foster supportive, non-judgemental and empathetic attitudes toward individuals with mental disorders in their communities. There is scope for community psychiatric nurses and other primary health care workers to work with community leaders to increase public awareness of, and favourable attitudes toward, people with mental health problems in the community. [ABSTRACT FROM AUTHOR]

Purpose: To compare family and functional outcome in infants at very high risk of cerebral palsy, after receiving the family centred programme "Coping with and Caring for infants with special needs (COPCA)" or typical infant physiotherapy. Materials and methods: Forty-three infants at very high risk were included before 9 months corrected age and randomly assigned to one year COPCA (n = 23) or typical infant physiotherapy (n = 20). Family and infant outcome were assessed before and during the intervention. Physiotherapy intervention sessions were analysed quantitatively for process analysis. Outcome was evaluated with non-parametric tests and linear mixed-effect models. Results: Between-group comparisons revealed no differences in family and infant outcomes. Within-group analysis showed that family's quality of life improved over time in the COPCA-group. Family empowerment was positively associated with intervention elements, including "caregiver coaching." Conclusions: One year of COPCA or typical infant physiotherapy resulted in similar family and functional outcomes. Yet, specific intervention elements, e.g., coaching, may increase empowerment of families of very high risk infants and may influence quality of life, which emphasizes the importance of family centred services. One year of the family centred programme "Coping with and a Caring for infants with special needs" compared with typical infant physiotherapy resulted in similar family outcome and similar functional outcome for the infants at very high risk for cerebral palsy. Specific contents of intervention, such as caregiver coaching, are associated with more family empowerment and increased quality of life. Emphasis on family needs is important in early intervention for infants at very high risk for cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: Therapeutic horse riding aims to improve the health of children and young people experiencing disability; however, its benefits across a range of health domains, particularly the impact on participation outcomes, are not well known. This research evaluated to what extent there was a change in riders balance, functional performance, social responsiveness, quality of life and participation outcomes as a result of therapeutic horse riding. Methods: A multiple-baseline across participants (n = 12) single-case experimental design, with randomly allocated baseline phase lengths, quantitatively evaluated how riders responded to a 20-week intervention. Results: Social participation outcomes measured using the Canadian Occupational Performance Measure demonstrated the most consistent positive between-phase differences (performance ES = 1.20, 95% CI [0.82, 1.63]; satisfaction ES = 1.11, 95% CI [0.73, 1.55]). A causal relationship was seen in three riders, but improvements only reached clinical significance for two riders when accounting for phase data trends. No significant outcome patterns were found comparing riders with principally physical impairments to those with principally psychosocial impairments. Conclusions: Being involved in therapeutic horse riding may improve rider's social participation in home, school and community settings. We postulate that rider self-concept development may be a mechanism of treatment effect leading to participation-level changes. Social participation was the health outcome demonstrating the most consistent change following therapeutic horse riding, regardless of rider impairment. Therapeutic horse riding can improve social participation in settings beyond the riding arena. Greater intervention tailoring based on rider responses may enhance therapeutic horse riding intervention effects. [ABSTRACT FROM AUTHOR]

Objectives: Examining mediators of intervention efficacy in an m-health intervention targeting physical activity and sleep in 160 Australian adults. Design: Nationwide randomised controlled trial. Main outcome measures: Moderate- and vigorous-intensity physical activity (MVPA), assessed using the Active Australia Questionnaire; sleep quality (Pittsburgh Sleep Quality Index); and sleep hygiene practices (Sleep Hygiene Index). Hypothesised psychosocial (e.g. self-efficacy) and behavioural (i.e. MVPA, sleep quality, sleep hygiene) mediators were tested on primary endpoint data at 3 months using bias-corrected bootstrapping (PROCESS 2 for SPSS). All outcomes and mediators were assessed using self-report. Results: At three months, the intervention had significantly improved sleep quality (d = 0.48, 95% CI: −2.26, −0.33, p = 0.009) and sleep hygiene (d = 0.40, 95% CI: −3.10, −0.19, p = 0.027). Differences in MVPA were not significant (d = 0.24, 95% CI: −35.53, 254.67, p = 0.139). Changes in MVPA were mediated by self-efficacy, perceived capability, environment, social support, intentions and planning, some of which showed inconsistent mediation (suppression). None of the hypothesised psychosocial factors mediated sleep outcomes. Changes in sleep hygiene mediated changes in sleep quality. Conclusions: Several psychosocial factors mediated changes in physical activity but not in sleep outcomes. Mediation effects of sleep hygiene on sleep quality highlight the importance of providing evidence-based strategies to improve sleep quality. [ABSTRACT FROM AUTHOR]

The concept of digital game-based learning (DGBL) evolves rapidly together with technological enhancements of virtual reality (VR) and smart phones. However, the mental workload (MWL) that VR-training applications demand and motivational qualities originating from user experience (UX) should be identified in order to create effective and enjoyable training/learning challenges that fit with individual users' capabilities. This study examined the effects of reality-based interaction (RBI) and VR on measures of student motivation and MWL, in a mental arithmetic game for secondary school pupils. In a randomised controlled trial with sixty school children, a mental arithmetic game was tested with three different interaction and two different presentation methods – VR RBI, VR head-mounted-display tapping and tablet flick-gesture. Results found a significant effect of RBI on MWL but no differences in enjoyment of training were found between VR-experience and tablet training-experience. In fact, adding the gaming-context to the mental arithmetic task created an enjoyable, motivating experience regardless of presentation or interaction-style. [ABSTRACT FROM AUTHOR]

Purpose: To compare children's speech, language and early literacy outcomes, and caregivers' empowerment and satisfaction following provision of 12 sessions of direct intervention (therapy), or face-to-face advice or a purpose-built website (device) while waiting for therapy. Method: A four-stage randomised controlled trial was undertaken involving three- to six-year-old children referred to speech-language pathology waiting lists at two Australian community health centres over eight months (n = 222). Stage 1 (screening): 149 were eligible to participate. Stage 2 (pre-assessment): 117 were assessed. Stage 3 (intervention): 110 were randomised to advice (33), device (39) or therapy (38). Stage 4 (post-assessment): 101 were re-assessed by a speech-language pathologist blinded to the intervention condition. Result: After controlling for baseline levels, children's speech (percentage of consonants correct) was significantly higher in the therapy group compared to the advice and device conditions. Caregivers' satisfaction was also significantly higher in the therapy condition compared to the device condition. There were no significant differences between the three conditions for children's intelligibility, language and early literacy or caregivers' empowerment. Conclusion: Therapy resulted in significantly higher speech outcomes than the advice and device conditions and was associated with significantly greater caregiver satisfaction. Provision of a website containing evidence-based material or a single session of advice may be a viable alternative while children wait for therapy targeting intelligibility, language and early literacy, and to empower caregivers. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the effects of interdisciplinary pain rehabilitation programmes with different dosages; care as usual versus short form. Methods: A single blinded, two armed, randomised controlled trial, with non-inferiority design was performed. All patients with chronic musculoskeletal pain referred to an outpatient multidisciplinary pain rehabilitation programme were eligible for this study. Only dosage differed, content was similar. The difference on Pain Disability Index was the primary outcome measure. Four points difference on Pain Disability Index was applied as a non-inferiority margin. Treatment effects within groups were expressed in standardised mean difference and effect sizes were calculated between the groups. Results: Because care as usual was frequently extended, the difference in dosage between groups was limited. The study was stopped prematurely because of an a-priori stopping rule. Interim analyses are presented. Both groups (care as usual n = 58, short form n = 54) improved significantly (mean Pain Disability Index change care as usual: −10.8; short form: −8.3). Mean difference between groups was 2.5 points (95% confidence interval was −2.2 to 7.3). Effect size between groups was 0.2. Conclusions: The 95% confidence interval for the difference in mean pain disability reduction exceeded the upper limit of the non-inferiority margin. The results of the primary analyses of this trial are, therefore, inconclusive. Ancillary analyses revealed that programme dosage was not associated with differences in the disability outcomes. Optimum dosage of interdisciplinary pain rehabilitation programs is unknown and scarcely studied. This study is the first to analyse dosage as primary aim. Although results are inconclusive, they also suggest that differences in dosage may not automatically lead to differences in effects. Further research is needed to analyse what dosage works for whom; to detect optimum effective and cost-effective dosage of pain rehabilitation programmes. [ABSTRACT FROM AUTHOR]

This ex-post facto study reanalyzed data from Romski et al. to examine whether intervention focus moderated the relationship between pre-intervention standardized measures of receptive language and post-intervention standardized measures of receptive and expressive language age and observations of expressive target vocabulary size. In all, 62 toddlers with developmental delay were randomly assigned to augmented communication-input (AC-I), augmented communication-output (AC-O), or spoken communication (SC) interventions. AC-I provided augmented language input via spoken language and a speech-generating device (SGD); AC-O encouraged the production of augmented output via an SGD; and SC provided spoken input and encouraged spoken output without using an SGD. Intervention focus moderated the impact of initial receptive language on expressive language age and expressive target vocabulary size. Participants in AC-I, when compared to those in the other two interventions, had a significantly stronger relationship between initial receptive language and post-intervention expressive language age. For expressive target vocabulary size, participants in AC-O showed a strong relationship and those in AC-I a slightly weaker relationship between initial receptive language and expressive target vocabulary size; no significant relationship was found in the SC group. Results emphasize that different interventions may have distinct outcomes for children with higher or lower initial receptive language. [ABSTRACT FROM AUTHOR]

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients' adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants' satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants' clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence. [ABSTRACT FROM AUTHOR]

Objective: Older adults account for 38–48% of emergency medical service (EMS) calls, have more chronic diseases, and those with low income have lower quality of life. Mobile integrated health and community paramedicine may help address these health inequalities and reduce EMS calls. This study examines the effectiveness of the Community Paramedicine at Clinic (CP@clinic) program in decreasing EMS calls and improving health outcomes in low-income older adults. Methods: This was an open-label, pragmatic, cluster-randomized controlled trial conducted within subsidized public housing buildings for older adults in 5 paramedic services across Ontario, Canada. A total of 30 apartment buildings were eligible (>50 units, >60% of units occupied by older adults, unique postal code, available match for pairing). Paired buildings were randomly allocated to intervention (CP@clinic for one year) or control (usual care) via computer-generated randomization. The CP@clinic intervention is a community-based, paramedic-led, health promotion and disease prevention program held weekly in building common rooms. CP@clinic includes risk assessment with validated tools, decision support, health promotion, referrals to resources, and reports back to family doctors. All residents could participate, but only older adults (55 years and older) were included in analyses. The primary outcome was building-level EMS calls from paramedic service databases. Secondary outcomes were individual-level changes in chronic disease risk factors and quality-adjusted-life-years (QALYs). Data were analyzed using Generalized Estimating Equations to account for clustering by sites. Results: Intention-to-treat analysis showed no significant difference in EMS calls (mean difference = −0.37/100 apartment units/month, 95%CI: −0.98 to 0.24). Sensitivity analysis excluding data from 2 building pairs with eligibility changes after intervention initiation revealed a significant difference in EMS calls in favor of the intervention buildings (mean difference = −0.90/100 apartment units/month, 95%CI: −1.54 to −0.26). At the individual level, there was a significant QALY increase (mean difference = 0.06, 95%CI: 0.02 to 0.10) and blood pressure decrease (systolic mean change = 3.65 mmHg, 95%CI: 2.37 to 4.94; diastolic mean change = 2.03 mmHg, 95%CI: 1.00 to 3.06). Conclusions: CP@clinic showed a significant decrease in EMS calls, decrease in BP, and improvement in QALYs among older adults in subsidizing public housing, suggesting this simple program should be replicated in other communities with public housing. Trial Registration: Clinicaltrials.gov, Registration no. NCT02152891. [ABSTRACT FROM AUTHOR]

Two cluster-randomised trials were carried out in 2013-2014, investigating the impact of In:tuition (a school-based life skills and alcohol education intervention). One involved 10-11 year olds in primary schools and the other 12-13 year olds in secondary schools. In primary schools, the outcomes measured were: resistance skills; knowledge of alcohol; decision-making skills; and understanding of social norms relating to alcohol. The secondary school trial also measured age of first alcoholic drink and frequency of drinking (among drinkers). Schools were randomly allocated to receive In:tuition or to a 'business-as-usual' control. A self-report student survey was administered before and after the intervention. In total, 79 primary schools and 55 secondary schools were included. 'Intention-to-treat' analysis was undertaken, including all students regardless of the extent of In:tuition delivery. 'On-treatment' analysis was also carried out, to account for differences in programme delivery. A process evaluation, involving interviews with staff and pupils in nine schools and a teacher survey, was carried out to investigate programme implementation. The primary intervention group had slightly better knowledge of alcohol than those in the control, although the results were not significant at p = 0.07. There was no evidence of impact on resistance skills, decisionmaking or understanding of social norms. There was no evidence of any significant impact in secondary schools. Although teachers saw some value in the individual elements of the programme, they did not always deliver it in its entirety. It was recommended that for the programme to have a positive impact in its entirety it needed fundamental revision. [ABSTRACT FROM AUTHOR]

This study examined the separate and combined effects of heat acclimation and hand cooling on post-exercise cooling rates following bouts of exercise in the heat. Seventeen non-heat acclimated (NHA) males (mean ± SE; age, 23 ± 1 y; mass, 75.30 ± 2.27 kg; maximal oxygen consumption [VO2max], 54.1 ± 1.3 ml·kg−1·min−1) completed 2 heat stress tests (HST) when NHA, then 10 days of heat acclimation, then 2 HST once heat acclimated (HA) in an environmental chamber (40°C; 40%RH). HSTs were 2 60-min bouts of treadmill exercise (45% VO2max; 2% grade) each followed by 10 min of hand cooling (C) or no cooling (NC). Heat acclimation sessions were 90–240 min of treadmill or stationary bike exercise (60–80% VO2max). Repeated measures ANOVA with Fishers LSDpost hoc(α < 0.05) identified differences. When NHA, C (0.020 ± 0.003°C·min−1) had a greater cooling rate than NC (0.013 ± 0.003°C·min−1) (mean difference [95%CI]; 0.007°C [0.001,0.013],P = 0.035). Once HA, C (0.021 ± 0.002°C·min−1) was similar to NC (0.025 ± 0.002°C·min−1) (0.004°C [−0.003,0.011],P = 0.216). Hand cooling when HA (0.021 ± 0.002°C·min−1) was similar to when NHA (0.020 ± 0.003°C·min−1) (P = 0.77). In conclusion, when NHA, C provided greater cooling rates than NC. Once HA, C and NC provided similar cooling rates. [ABSTRACT FROM PUBLISHER]

Aim: To examine the reproducibility in measurement of physical activity performance using the ActiGraph®GT3X+ accelerometer in children aged 8–16 years with Acquired Brain Injury (ABI). Methods: Reproducibility of standardized tasks: Thirty-two children with ABI (12 years 1 month, SD = 2 years 4 months; 20 males; Gross Motor Function Classification System I = 17, II = 15) performed the following activities on 2 consecutive days while wearing an accelerometer and a heart rate monitor: quiet sitting, slow walking (SW), moderate walking (MW), fast walking (FW) and rapid stepping on/off a block (STEP). Intra-class correlation coefficients (ICC) were calculated. Performance variability: Fifty-one participants (12 years 1 month, SD = 2 years 5 months; 27 males; GMFCS I = 26, II = 25) wore an accelerometer for 4 days in the community and reliability coefficients were calculated using standardized 12-hour time spent in moderate-to-vigorous physical activity (MVPA). Results: Test–re-test reproducibility was excellent for all activities (SW, ICC = 0.90; MW, ICC = 0.83; FW, ICC = 0.91; STEP, ICC = 0.89). Three days of monitoring produced excellent variability estimates of MVPA (R= 0.78). Conclusion: Therapists can confidently use accelerometry as a reproducible measure of physical activity under standardized walking and stepping conditions, as well as in the community for children with ABI. [ABSTRACT FROM PUBLISHER]

This 9-month randomised controlled workplace physical activity trial investigated the effects of soccer and Zumba exercise, respectively, on muscle strength, maximal jump height, sit-and-reach flexibility and postural sway among female workers. A total of 107 female hospital employees aged 25–63 were cluster-randomised to a soccer group, a Zumba group or a control group. Training was conducted outside working hours as two to three 1-h weekly sessions the first 3 months and once a week the last 6 months. Tests were conducted at baseline, after 3 and 9 months. The soccer group improved maximal neck extension strength both after 3 (1.2 kg;P < 0.05) and 9 months (1.7 kg;P < 0.01) compared to the control group. The Zumba group improved maximal trunk extension strength (3.1 kg;P = 0.04) after 3 months, with improvements in postural sway velocity moment (−9.2 mm2/s;P < 0.05) and lower limb lean mass (0.4 kg;P < 0.05) after 9 months. No significant intervention effects were revealed in vertical jump height or sit-and-reach flexibility. The present study indicates that workplace-initiated soccer and Zumba exercise may be beneficial for improvement of the neck and trunk strength, which may have preventive effects with regard to future perceived muscle pain in the respective body regions. Furthermore, the Zumba group revealed positive effects on lower limb lean mass and postural sway compared to the control group. [ABSTRACT FROM PUBLISHER]

Despite growing awareness of the benefits of interprofessional education and interprofessional collaboration (IPC), understanding how teams successfully transition to IPC is limited. Student exposure to interprofessional teams fosters the learners’ integration and application of classroom-based interprofessional theory to practice. A further benefit might be reinforcing the value of IPC to members of the mentoring team and strengthening their IPC. The research question for this study was: Does training in IPC and clinical team facilitation and mentorship of pre-licensure learners during interprofessional clinical placements improve the mentoring teams’ collaborative working relationships compared to control teams? Statistical analyses included repeated time analysis multivariate analysis of variance (MANOVA). Teams on four clinical units participated in the project. Impact on intervention teams pre- versus post-interprofessional clinical placement was modest with only the Cost of Team score of the Attitudes Towards Healthcare Team Scale improving relative to controls (p = 0.059) although reflective evaluations by intervention team members noted many perceived benefits of interprofessional clinical placements. The significantly higher group scores for control teams (geriatric and palliative care) on three of four subscales of the Assessment of Interprofessional Team Collaboration Scale underscore our need to better understand the unique features within geriatric and palliative care settings that foster superior IPC and to recognise that the transition to IPC likely requires a more diverse intervention than the interprofessional clinical placement experience implemented in this study. More recently, it is encouraging to see the development of innovative tools that use an evidence-based, multi-dimensional approach to support teams in their transition to IPC. [ABSTRACT FROM PUBLISHER]

Conclusions:The potential effects of KOS are still uncertain regarding the most effective air pressure to be used as well as the physiological effects on the nasal mucosa. The results of the study do not support a convincing treatment effect by KOS on IR.Objectives:Idiopathic rhinitis (IR) is a common disorder, affecting ∼10–20% of the population. A new method for treating IR, Kinetic Oscillation Stimulation (KOS), has been reported to have beneficial effects on total vasomotor symptom scores (TVRSS). The primary objective with this study was to evaluate if a mean pressure of 65 mbar, pressure amplitude of 100 mbar, and 68 Hz treatment with KOS had a positive effect on total vasomotor symptom scores (TVRSS), as compared with a mean pressure of 65 mbar, pressure amplitude of 4 mbar, and 68 Hz treatment in patients with idiopathic rhinitis.Methods:Two hundred and seven patients were randomized (Full Analysis Set, FAS) in the study, including five visits and lasting for ∼25 weeks. All patients had two treatment episodes, and all patients had at least one treatment, meant as active, with high amplitude pressure for 10 min in each nostril. Group 1 had two such treatments, and Group 2 had one treatment with low amplitude pressure, initially meant as placebo, on one occasion. Because of numerical improvements in these two groups, a new control group, Group 3, was introduced. They had one new control treatment where the balloon was inserted into the nose, without any air inflation and without oscillations.Results:KOS treatment with high amplitude pressure did not have significant beneficial effects as compared to low amplitude pressure on TVRSS. Numerical improvements in TVRSS and SNOT 22 were found when comparing high and low amplitude pressure treatments with uninflated balloon treatment. However, this part of the study was initially single-blinded, and these results were secondary objectives. [ABSTRACT FROM PUBLISHER]

Objective:This study explores whether a web-based physical activity (PA) intervention grounded in self-determination theory (SDT) and motivational interviewing (MI) is more effective and better appreciated than a traditional web-based PA intervention. Design:A randomized controlled trial was conducted, comparing (1) I Move; a web-based PA intervention based on SDT and MI, (2) Active Plus; a traditional web-based PA intervention and (3) a waiting list control condition. Main outcome measures:Weekly minutes of moderate to vigorous PA and weekly days with ≥30 min PA were measured through self-report at baseline and at 3 and 6 months from baseline. Results:I Move achieved a small, but significant increase in weekly minutes of moderate to vigorous PA, while Active Plus did not have a significant impact on this outcome. Both interventions were effective in increasing weekly days with ≥30 min PA, whereas Active Plus yielded a greater effect on this outcome. Conclusion:Overall, the web-based PA intervention grounded in SDT and MI did not outperform the traditional web-based PA intervention. Further research should reveal whether this type of intervention is profitable for long-term maintenance of PA levels. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate an intervention aimed at increasing human papillomavirus (HPV) vaccine completion of the 3-dose series and knowledge.Participants: Two hundred sixty-four male and female US college students 18–26 years old who were receiving HPV vaccine dose 1.Methods: Students were randomly assigned to the intervention or control group. Intervention participants received the electronic intervention (text/e-mail appointment reminders and education messages) and controls received standard-of-care. Baseline/follow-up survey data were collected. Main outcome measures included vaccine completion and knowledge.Results: HPV vaccine completion across groups were not significantly different for HPV dose 2 (53% vs 52%) and dose 3 (34% vs 32%). Mean knowledge score at follow-up for intervention group was significantly higher (p= .01) than at baseline. No significant differences in knowledge were found for the control group. The biggest predictor of HPV vaccine completion was female gender.Conclusions: The intervention increased knowledge but not vaccine completion. More research with catch-up age populations is needed. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to examine the mediating effect of resistance training skill competency on percentage of body fat, muscular fitness and physical activity among a sample of adolescent boys participating in a school-based obesity prevention intervention. Participants were 361 adolescent boys taking part in the Active Teen Leaders Avoiding Screen-time (ATLAS) cluster randomised controlled trial: a school-based program targeting the health behaviours of economically disadvantaged adolescent males considered “at-risk” of obesity. Body fat percentage (bioelectrical impedance), muscular fitness (hand grip dynamometry and push-ups), physical activity (accelerometry) and resistance training skill competency were assessed at baseline and post-intervention (i.e., 8 months). Three separate multi-level mediation models were analysed to investigate the potential mediating effects of resistance training skill competency on each of the study outcomes using a product-of-coefficients test. Analyses followed the intention-to-treat principle. The intervention had a significant impact on the resistance training skill competency of the boys, and improvements in skill competency significantly mediated the effect of the intervention on percentage of body fat and the combined muscular fitness score. No significant mediated effects were found for physical activity. Improving resistance training skill competency may be an effective strategy for achieving improvements in body composition and muscular fitness in adolescent boys. [ABSTRACT FROM PUBLISHER]

Educational achievement has important implications for the health and well-being of young women in sub-Saharan Africa. The authors assessed the effects of providing school support on educational outcomes of orphan girls in rural Zimbabwe. Data were from a randomized controlled trial offering the intervention group comprehensive schooling support and controls no treatment initially and then fees only. Results indicated comprehensive support reduced school dropout and absence but did not improve test scores. Providing support to orphan girls is promising for addressing World Health Organization Millennium Development Goals, but further research is needed about contextual factors affecting girls’ school participation and learning. [ABSTRACT FROM AUTHOR]

The double-blind phase of the randomized ANRS IPERGAY trial, evaluating sexual activity-based oral HIV pre-exposure prophylaxis (PrEP), was conducted among high-risk men who have sex with men (MSM). Results showed an 86% (95% CI: 40–98) relative reduction in HIV incidence among participants with tenofovir disoproxil fumarate–emtricitabine vs. placebo. The present pooled analysis aimed to analyze (i) participants’ adherence to the prescribed treatment and/or condom use during sexual intercourse and (ii) sexual behavior during the double-blind phase of the study. Four hundred MSM were enrolled in the trial. Every 2 months they completed online questionnaires collecting sexual behavior and PrEP adherence data regarding their most recent sexual intercourse. A total of 2232 questionnaires (M0–M24) were analyzed. Changes over time were evaluated using a mixed model accounting for multiple measures. Irrespective of sexual partner and practice type, on average, 42.6% (min: 32.1–max: 45.8%) reported PrEP use only during their most recent episode of sexual intercourse; 29% (22.9–35.6%) reported both PrEP and condom use; 11.7% (7.2–18.9%) reported condom-use only, and 16.7% (10.8–29.6%) reported no PrEP or condom use with no significant change during the study. Scheduled (i.e., correct) PrEP use was reported on average by 59.0% (47.2–68.5%) of those reporting PrEP use during their most recent sexual intercourse. Overall, 70.3% (65.3–79.4%) and 69.3% (58.3–75.4%) of participants reported, respectively, condomless anal and condomless receptive anal intercourse during their most recent sexual encounter without significant change during follow-up. Overall, on average 83.3% (min: 70.4–max: 89.2%) of participants protected themselves by PrEP intake or condom use or both during the trial, and no increase in at-risk sexual practices was observed. None of these indicators showed significant trend during the follow-up, although we found a tendency toward decrease (p = .19) of the median number of sexual partners strengthening the absence of behavioral disinhibition. On-demand PrEP within a comprehensive HIV prevention package could improve prevention in MSM. [ABSTRACT FROM PUBLISHER]