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The safety of chemicals, drugs, novel foods and genetically modified crops is often tested using repeat-dose sub-acute toxicity tests in rats or mice. It is important to avoid misinterpretations of the results as these tests are used to help determine safe exposure levels in humans. Treated and control groups are compared for a range of haematological, biochemical and other biomarkers which may indicate tissue damage or other adverse effects. However, the statistical analysis and presentation of such data poses problems due to the large number of statistical tests which are involved. Often, it is not clear whether a “statistically significant” effect is real or a false positive (type I error) due to sampling variation. The author's conclusions appear to be reached somewhat subjectively by the pattern of statistical significances, discounting those which they judge to be type I errors and ignoring any biomarker where the p-value is greater than p = 0.05. However, by using standardised effect sizes (SESs) a range of graphical methods and an over-all assessment of the mean absolute response can be made. The approach is an extension, not a replacement of existing methods. It is intended to assist toxicologists and regulators in the interpretation of the results. Here, the SES analysis has been applied to data from nine published sub-acute toxicity tests in order to compare the findings with those of the author's. Line plots, box plots and bar plots show the pattern of response. Dose-response relationships are easily seen. A “bootstrap” test compares the mean absolute differences across dose groups. In four out of seven papers where the no observed adverse effect level (NOAEL) was estimated by the authors, it was set too high according to the bootstrap test, suggesting that possible toxicity is under-estimated. [ABSTRACT FROM AUTHOR]

Background: Voxel-based morphometry (VBM) studies have demonstrated that grey matter abnormalities are involved in the pathophysiology of late-life depression (LLD), but the findings are inconsistent and have not been quantitatively reviewed. The aim of the present study was to conduct a meta-analysis that integrated the reported VBM studies, to determine consistent grey matter alterations in individuals with LLD. Methods: A systematic search was conducted to identify VBM studies that compared patients with LLD and healthy controls. We performed a meta-analysis using the effect size signed differential mapping method to quantitatively estimate regional grey matter abnormalities in patients with LLD. Results: We included 9 studies with 11 data sets comprising 292 patients with LLD and 278 healthy controls in our meta-analysis. The pooled and subgroup meta-analyses showed robust grey matter reductions in the right lentiform nucleus extending into the parahippocampus, the hippocampus and the amygdala, the bilateral medial frontal gyrus and the right subcallosal gyrus as well as a grey matter increase in the right lingual gyrus. Meta-regression analyses showed that mean age and the percentage of female patients with LLD were not significantly related to grey matter changes. Limitations: The analysis techniques, patient characteristics and clinical variables of the studies included were heterogeneous, and most participants were medicated. Conclusion: The present meta-analysis is, to our knowledge, the first to overcome previous inconsistencies in the VBM studies of LLD and provide robust evidence for grey matter alterations within fronto–striatal-limbic networks, thereby implicating them in the pathophysiology of LLD. The mean age and the percentage of female patients with LLD did not appear to have a measurable impact on grey matter changes, although we cannot rule out the contributory effects of medication. [ABSTRACT FROM AUTHOR]

E-mental health (EMH) interventions gain increasing importance in the treatment of mental health disorders. Their outpatient efficacy is well-established. However, research on EMH in inpatient settings remains sparse and lacks a meta-analytic synthesis. This paper presents a meta-analysis on the efficacy of EMH in inpatient settings. Searching multiple databases (PubMed, ScienceGov, PsycInfo, CENTRAL, references), 26 randomized controlled trial (RCT) EMH inpatient studies (n = 6112) with low or medium assessed risk of bias were included. A small significant total effect of EMH treatment was found (g = 0.3). The effect was significant both for blended interventions (g = 0.42) and post-treatment EMH-based aftercare (g = 0.29). EMH treatment yielded significant effects across different patient groups and types of therapy, and the effects remained stable post-treatment. The results show the efficacy of EMH treatment in inpatient settings. The meta-analysis is limited by the small number of included studies. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) are a significant contributor to morbidity and mortality in East Africa. Lower extremity (LE) injuries are especially debilitating, negatively impacting quality of life and employment prospects. This systematic review characterizes the proportion of LE injuries due to RTAs in four members of the East African Community: Kenya, Rwanda, Tanzania, and Uganda. Methods: Embase, Medline, Web of Science, and PubMed were queried for studies from 2010 to 2022 providing information on lower extremity injuries caused by RTAs in the countries of interest. Proportions of RTA-related LE injuries were extracted from eligible papers. Study quality and bias were assessed using the framework for systematic reviews established by Zaza et al.1 Results: Seven studies met the eligibility criteria--four for Kenya, two for Uganda, and one for Tanzania; however, no eligible studies were found for Rwanda. The proportion of RTA-related injuries affecting the lower extremities ranged from 0.39 to 0.49. In patients presenting with LE injuries, RTAs were the most frequent cause, representing more than 70% of cases in the examined studies. Motorcycle accidents were not more likely to cause LE injuries, but they were the most significant contributor to the overall LE injury burden due to their prevalence. Conclusions: With urbanization and the increased adoption of low-cost motorcycles, RTAs will continue to pose a public health challenge. Investments in traffic enforcement and physical infrastructure will alleviate the risks to both motorists and pedestrians. In addition to primary prevention, there is a significant need for improvements in emergency care and surgical capacity. [ABSTRACT FROM AUTHOR]

This paper presents a stochastic analysis of the size effect on the nominal strength of quasibrittle structures with a large preexisting notch. This type of scaling behavior has been extensively studied within a deterministic framework. Little attention is paid to stochastic analysis, which is essential for reliability-based analysis and design of engineering structures. Stochastic finite element simulations are performed to study the failure of geometrically similar beams of different sizes. The numerical analysis uses a continuum damage model, in which the tensile strength and fracture energy are modeled by homogeneous random fields. Different correlation lengths are considered as a parametric study. The analysis yields the size effects on the mean and coefficient of variation (CoV) of the nominal structural strength. It is shown that the size effect on the mean strength agrees well with the Bazant size effect model. The simulation predicts a strong size effect on the CoV of the nominal strength. Small-, intermediate-, and large-size asymptotes are derived analytically for the scaling behavior of the strength CoV. Based on these asymptotes, an approximate scaling equation is proposed for the CoV of nominal strength. The effect of the correlation length on the simulated failure behavior is discussed. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR). Methods: The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression. Results: Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction. Discussion: Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people. [ABSTRACT FROM AUTHOR]

At present, it is still controversial whether patients in intensive care unit (ICU) use tracheal intubation with or without cuff. This paper evaluates the effect of tracheal intubation with and without cuff on overall complication rate of patients with intubation in ICU. The database of PubMed, Embase, Conchrane Library and Web of Science was searched by computer, and the clinical research on intubation with and without cuff in ICU was collected. The time range was from the database establishment to November 2023. Literature was independently screened, information was extracted, and quality was assessed by two researchers. Finally, there were nine studies included, with 11 068 patients (7391 in cuff group and 3677 in non‐cuff group). The results showed that the overall complication rate of cuff group was significantly lower than that of non‐cuff group, and that of cuff group (RR = 0.53, p < 0.01). In addition, compared with the non‐cuff group, the cuff group had a lower number of tracheal intubation changes [RR = 0.05, p < 0.01] and a lower incidence of aspiration pneumonia (RR = 0.45, p = 0.01). Compared with the non‐cuff group, the cuff group had a higher incidence of oral mucosal ulcers and pharyngitis (RR = 1.99, p = 0.04), while the cuff group had a lower incidence of laryngeal edema (RR = 0.39, p < 0.01). In ICU intubation patients, the use of cuffs reduces overall complication rate in comparison to patients without cuffs. Therefore, patients with intubation in ICU can recommend tracheal intubation with cuff. [ABSTRACT FROM AUTHOR]

(1) Background: The increasing older population and demographic shifts highlight the need to understand the digital profiles of older adults, a pivotal factor in developing innovative technologies like the e-VITA virtual coach. This personalized coach provides recommendations for sustainable well-being in a smart home environment. (2) Methods: This study focuses on analyzing the characteristics of older individuals categorized as Internet users (onliners) and non-users (offliners). European Social Survey data from 2021 were utilized for European analysis, determining Internet usage based on frequency. Offliners are defined as users who never use the Internet, and onliners as those who use it, albeit with different frequencies. In Japan, data from the 9th International Comparative Survey on the Lives and Attitudes of the Elderly were employed, based on the responses of 1367 subjects, which defined onliners as individuals using communication devices and offliners as those not utilizing fax machines, cell phones, or the Internet. (3) Results: This paper presents a primary analysis of older end-user context and perspectives, outlining effective strategies for the diffusion of an active and healthy aging coaching system in the market and society. (4) Conclusions: the study emphasizes the importance of analyzing digital behavior in any user-centered design approach to ensure the system's acceptance after deployment. [ABSTRACT FROM AUTHOR]

Background: Interrupted time series (ITS) analysis is a time series regression model that aims to evaluate the effect of an intervention on an outcome of interest. ITS analysis is a quasi-experimental study design instrumental in situations where natural experiments occur, gaining popularity, particularly due to the Covid-19 pandemic. However, challenges, including the lack of a control group, have impeded the quantification of the effect size in ITS. The current paper proposes a method and develops a user-friendly R package to quantify the effect size of an ITS regression model for continuous and count outcomes, with or without seasonal adjustment. Results: The effect size presented in this work, together with its corresponding 95% confidence interval (CI) and P-value, is based on the ITS model-based fitted values and the predicted counterfactual (the exposed period had the intervention not occurred) values. A user-friendly R package to fit an ITS and estimate the effect size was developed and accompanies this paper. To illustrate, we implemented a nation population-based ITS study from January 2001 to May 2021 covering the all-cause mortality of Israel (n = 9,350 thousand) to quantify the effect size of Covid-19 exposure on mortality rates. In the period unexposed to the Covid-19 pandemic, the mortality rate decreased over time and was expected to continue decreasing had Covid-19 not occurred. In contrast, the period exposed to the Covid-19 pandemic was associated with an increased all-cause mortality rate (relative risk = 1.11, 95% CI = 1.04, 1.18, P < 0.001). Conclusion: For the first time, the effect size in ITS: was quantified, can be estimated by end-users with an R package we developed, and was demonstrated with data showing an increase in mortality following the Covid-19 pandemic. ITS effect size reporting can assist public health policy makers in assessing the magnitude of the entire intervention effect using a single, readily understood measure. [ABSTRACT FROM AUTHOR]

There are many studies on variables related to burnout among preschool teachers, but the results of these studies are inconsistent. This study explored the variables most associated with preschool teachers' burnout through meta-analysis. The researchers conducted an extensive search of the China Knowledge Network (CNKI), Vip journal, and Wanfang databases. A total of 59 papers were included through strict inclusion criteria, and a total of 14 variables were analyzed. The results indicate that the variables that have large effect sizes with burnout are turnover intention (r = 0.7124), job stress (r = 0.4744), teacher efficacy (r = −0.4331), and job satisfaction (r = −0.4229). This study provides a data reference for the prevention and improvement of burnout among preschool teachers in China, and will also provide directions for further research to follow. [ABSTRACT FROM AUTHOR]

Background: Interventions aimed at promoting physical activity (PA) behavior through habit formation pathways are gaining popularity, as they differ from conventional interventions that rely on intention pathways. Past research has established a positive correlation between PA habits and behavior. However, the efficacy of current interventions designed to form PA habits and improve PA automaticity is not yet fully ascertained. Additionally, the intervention components that significantly impact the effectiveness of these interventions are yet to be determined. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a search of three databases (PubMed, Embase, and Cochrane Library) from January 2000 to December 2022, with a focus on interventions for developing PA habits. Two independent authors conducted paper selection, quality assessment, data extraction, and coding of behavior change techniques (BCTs). The effect size of interventions was calculated using standardized mean difference. Subgroup analyses were carried out based on follow-up duration, delivery method, sample characteristics, and theory. Furthermore, we employed meta-regression to investigate the association between BCTs and PA habits. Results: Ten eligible studies with relatively high quality were included in the final data set. Characteristics of studies varied in intervention sample and delivery way. The habit formation interventions significantly increased PA habit (SMD = 0.31, 95% CI 0.14—0.48, P <.001) compared to the control groups. Subgroup analysis demonstrated that the duration of follow-up ≤ 12 weeks have a higher effect size on PA habit than the duration > 12 weeks. Meta-regression revealed that problem solving has a significant positive association with effectiveness improvement (β = 0.36, 95% CI 0.17–0.55), while social reward is linked with a reduction in effectiveness (β = -0.40, 95% CI -0.74–0.06). Conclusions: Our findings reveal that habit formation interventions are effective in fostering PA habit. Future studies could leverage the insights form this study to optimize the intervention design and achieve better effectiveness. [ABSTRACT FROM AUTHOR]

Background: Trunk rotator strength plays an important role in sports performance and health. A reliable method to assess these muscles with functional electromechanical dynamometer has not been described. Therefore, the objectives of this paper were (I) to explore the reliability of different strength variables collected in isokinetic and isometric conditions during two trunk rotator exercises, and (II) to determine the relationship of isometric and dynamic strength variables collected in the same exercise. Methods: A repeated measures design was performed to evaluate the reliability of the horizontal cable woodchop (HCW) and low cable woodchop (LCW) exercises. Reliability was assessed using t-tests of paired samples for the effect size, the standard error of measurement, the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). The Pearson's (r) correlation coefficient was used to explore the association between isometric and isokinetic tests. Results: HCW exercise is more reliable than LCW exercise in assessing trunk rotator muscles. The strength manifestation that should be used is the average strength, and the most reliable evaluation was the HCW at 0.40 m·s−1 concentric (ICC = 0.89; CV = 10.21%) and eccentric (ICC = 0.85; CV = 9.33%) contraction and the dynamic condition that most correlated with the isometric was LWC at 0.50 m·s−1 (r = 0.83; p < 0.01). Conclusion: HCW is a reliable exercise to measure trunk rotator muscles. [ABSTRACT FROM AUTHOR]

Background Chronic disease is a significant burden on the global population. The Helping Everyone Achieve Long Term Health (HEALTH) Passport is a paper-based approach previously utilized to help adults modify clinical risk factors through lifestyle, which may be effective in improving the long-term health of school-age children. This study investigates the feasibility of in-school use by engaging trainee teachers in primary and secondary education. Methods Two hundred and fifty six unique responses were collated to evaluate current teaching of the main health risk factors and HEALTH Passports specifically adapted for schools. Trainees attended workshops with pre- and post-questionnaires used to measure training efficacy and evaluate the Passports' suitability for in-school use. Narrative analysis of feedback was performed. Results Feedback received for both Passports was positive overall. Trainees highlighted the need for the Passports to be further age differentiated. Significantly increased confidence (P  < 0.01) in knowledge of exercise, type 2 diabetes, weight and blood pressure was shown. Confidence in smoking, drugs and alcohol knowledge was reduced highlighting the requirement for further teacher training. Conclusions The HEALTH Passport has potential as an intervention to improve health literacy in school-age children. Age adaptation is needed with references to weight measures removed. Emotional well-being should be focused on, and data management stringently assessed for child protection. [ABSTRACT FROM AUTHOR]

Aims A mediator is a variable that explains the underlying mechanism between an independent variable and a dependent variable. The indirect effect indicates the effect from the predictor to the outcome variable via the mediator. In contrast, the direct effect represents the predictor's effort on the outcome variable after controlling for the mediator. Methods A single study rarely provides enough evidence to answer research questions in a particular domain. Replications are generally recommended as the gold standard to conduct scientific research. When a sufficient number of studies have been conducted addressing similar research questions, a meta-analysis can be used to synthesize those studies' findings. Results The main objective of this paper is to introduce two frameworks to integrating studies using mediation analysis. The first framework involves calculating standardized indirect effects and direct effects and conducting a multivariate meta-analysis on those effect sizes. The second one uses meta-analytic structural equation modeling to synthesize correlation matrices and fit mediation models on the average correlation matrix. We illustrate these procedures on a real dataset using the R statistical platform. Conclusion This paper closes with some further directions for future studies. [ABSTRACT FROM AUTHOR]

Background: Plyometric training can be performed through many types of exercises involving the stretch-shortening cycle in lower limbs. In the last decades, a high number of studies have investigated the effects of plyometric training on several outcomes in different populations. Objectives: To systematically review, summarize the findings, and access the quality of published meta-analyses investigating the effects of plyometric training on physical performance. Design: Systematic umbrella review of meta-analyses. Data Sources: Meta-analyses were identified using a systematic literature search in the databases PubMed/MEDLINE, Scopus, SPORTDiscus, Web of Science, Cochrane Library and Scielo. Eligibility Criteria for Selecting Meta-analyses: Meta-analyses that examined the effects of plyometric training on physical fitness in different populations, age groups, and sex. Results: Twenty-nine meta-analyses with moderate-to-high methodological quality were included in this umbrella review. We identified a relevant weakness in the current literature, in which five meta-analyses included control group comparisons, while 24 included pre-to-post-effect sizes. Trivial-to-large effects were found considering the effects of plyometric training on physical performance for healthy individuals, medium-trivial effects for the sports athletes' groups and medium effects for different sports athletes' groups, age groups, and physical performance. Conclusion: The available evidence indicates that plyometric training improves most related physical fitness parameters and sports performance. However, it is important to outline that most meta-analyses included papers lacking a control condition. As such, the results should be interpreted with caution. PROSPERO number: CRD42020217918. [ABSTRACT FROM AUTHOR]

Based on the theory of change, we gather, organize, and synthesize the evidence on the impact of three language of instruction (LOI) choices (teaching in mother tongue [MT] with later transition, teaching in a non‐MT language, or teaching in two or more languages at one time) on literacy and biliteracy outcomes. We focus on quantitative and qualitative studies of LOI interventions in low‐ and middle‐income countries (LMICs) and consider languages that are commonly spoken in the developing world. As such, we include studies that examine transfers from local languages to English, but not those evaluating transfers from local languages to languages that are less spoken in LMICs (e.g., Swedish). [ABSTRACT FROM AUTHOR]

Objective Several tools have been developed to evaluate the extent to which the findings from a network meta-analysis would be valid; however, applying these tools is a time-consuming task and often requires specific expertise. Clinicians have little time for critical appraisal, and they need to understand the key elements that help them select network meta-analyses that deserve further attention, optimising time and resources. This paper is aimed at providing a practical framework to assess the methodological robustness and reliability of results from network meta-analysis. Methods As a working example, we selected a network meta-analysis about drug treatments for generalised anxiety disorder, which was published in 2011 in the British Medical Journal. The same network meta-analysis was previously used to illustrate the potential of this methodology in a methodological paper published in JAMA. Results We reanalysed the 27 studies included in this network following the methods reported in the original article and compared our findings with the published results. We showed how different methodological approaches and the presentation of results can affect conclusions from network metaanalysis. We divided our results into three sections, according to the specific issues that should always be addressed in network meta-analysis: (1) understanding the evidence base, (2) checking the statistical analysis and (3) checking the reporting of findings. Conclusions The validity of the results from network meta-analysis depends on the plausibility of the transitivity assumption. The risk of bias introduced by limitations of individual studies must be considered first and judgement should be used to infer about the plausibility of transitivity. Inconsistency exists when treatment effects from direct and indirect evidence are in disagreement. Unlike transitivity, inconsistency can be always evaluated statistically, and it should be specifically investigated and reported in the published paper. Network meta-analysis allows researchers to list treatments in preferential order; however, in this paper we demonstrated that rankings could be misleading if based on the probability of being the best. Clinicians should always be interested in the effect sizes rather than the naive rankings. [ABSTRACT FROM AUTHOR]

Background: Presbyopia is a progressive condition that reduces the eye's ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed. Results: To explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach's coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes. Conclusions: This research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability. Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1. [ABSTRACT FROM AUTHOR]

Background: Impaired glucose regulation represents an opportunity to prevent Type 2 diabetes mellitus. It is important to have a clear understanding of the prevalence of this condition in order to be able to plan interventions and health care provision. This paper presents a meta-analysis of literature assessing the prevalence of impaired glucose regulation in the general population of developed countries in Europe. Methods: Five electronic databases were systematically searched in March 2014 to identify English language articles with general population samples aged 18 and over from developed countries in Europe. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out. Results: A total of 5594 abstracts were screened, with 46 studies included in the review. Overall prevalence of impaired glucose regulation was 22.3%. Mean prevalence of impaired glucose tolerance was 11.4% (10.1-12.8) and did not differ by gender. Sample age, diagnostic criteria and country were found to have a significant univariate effect on prevalence of impaired glucose tolerance but only diagnostic criteria remained significant in multivariate analysis. Mean prevalence of impaired fasting glucose was significantly higher in men at 10.1% (7.9-12.7) compared with 5.9% in women (4-8.7). The only moderator variable with a significant effect on impaired fasting glucose prevalence was country. Conclusions: This meta-analysis shows a moderate prevalence of impaired glucose regulation in developed Europe with over one in five people meeting the criteria for either impaired glucose tolerance, impaired fasting glucose or both. [ABSTRACT FROM AUTHOR]

Background: Effects of Tai Chi on people with peripheral neuropathy (PN) are not yet apparent. This systematic review was conducted to evaluate the effects of Tai Chi on postural control in people with PN. Methods: Literature was screened in seven databases for relevant randomized controlled trials. The reports and methodological quality were evaluated. A meta-analysis was performed using RevMan5.4 software. Results: Ten reports were included, involving a total of 344 subjects. The meta-analysis found that Tai Chi therapy for people with PN resulted in a smaller sway area, in the double-leg stance with eyes closed test (SMD = −2.43, I2 = 0%), than that observed in the control group, greater distance covered in the six-minute walking test (SMD = −0.46, I2 = 49%) and faster performance in the timed-up-and-go test (SMD = 0.68, I2 = 50%), than the baseline. Conclusions: Tai chi effectively enhanced dynamic postural control in people with PN. However, no better effects on postural control from Tai Chi than from other rehabilitation approaches were observed in this study. Further high-quality trials are needed to better understand Tai Chi's effects on individuals with PN. [ABSTRACT FROM AUTHOR]

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The article discusses a study on the overall mean impact of adherence interventions on blood pressure outcomes among subjects with hypertension. Study highlights include ancestry searches on eligible studies and review papers, summary measure and method of analyses, and a table that outlines characteristics of primary studies included in blood pressure meta-analyses.

Objective: To describe confidence intervals (CIs) and effect sizes and provide practical examples to assist clinicians in assessing clinical meaningfulness. Background: As discussed in our first article in 2015, which addressed the difference between statistical significance and clinical meaningfulness, evaluating the clinical meaningfulness of a research study remains a challenge to many readers. In this paper, we will build on this topic by examining CIs and effect sizes. Description: A CI is a range estimated from sample data (the data we collect) that is likely to include the population parameter (value) of interest. Conceptually, this constitutes the lower and upper limits of the sample data, which would likely include, for example, the mean from the unknown population. An effect size is the magnitude of difference between 2 means. When a statistically significant difference exists between 2 means, effect size is used to describe how large or small that difference actually is. Confidence intervals and effect sizes enhance the practical interpretation of research results. Recommendations: Along with statistical significance, the CI and effect size can assist practitioners in better understanding the clinical meaningfulness of a research study. [ABSTRACT FROM AUTHOR]

In this paper, we evaluate 11 measures of inequality, d (p 1, p 2), between 2 proportions p 1 and p 2, some of which are new to the health disparities literature. These measures are selected because they are continuous, nonnegative, equal to 0 if and only if | p 1 − p 2| = 0, and maximal when | p 1 − p 2| = 1. They are also symmetrical [ d (p 1, p 2) =  d (p 2, p 1)] and complement-invariant [ d (p 1, p 2) =  d (1 − p 2, 1 − p 1)]. To study intermeasure agreement, 5 of the 11 measures, including the absolute difference, are retained, because they remain finite and are maximal if and only if | p 1 − p 2| = 1. Even when the 2 proportions are assumed to be drawn at random from a shared distribution—interpreted as the absence of an avoidable difference—the expected value of d (p 1, p 2) depends on the shape of the distribution (and the choice of d) and can be quite large. To allow for direct comparisons among measures, we propose a standard measurement unit akin to a z score. For skewed underlying beta distributions, 4 of the 5 retained measures, once standardized, offer more conservative assessments of the magnitude of inequality than the absolute difference. We conclude that, even for measures that share the highlighted mathematical properties, magnitude comparisons are most usefully assessed relative to an elicited or estimated underlying distribution for the 2 proportions. [ABSTRACT FROM AUTHOR]

Background Attention is essential to daily life and cognitive functioning, and attention deficits can affect daily functional and social behaviour, such as falls, risky driving, and accidental injuries. However, attention function is important yet easily overlooked in older adults with mild cognitive impairment, and evidence is limited. We aimed to explore the pooled effect of cognitive training on domains of attention in older adults with mild cognitive impairment and mild dementia using a meta-analysis of randomised controlled trials. Methods We searched PubMed, Embase, Scopus, Web of Science, CINAHL, PsycINFO, and Cochrane Library for randomised controlled trials (RCTs) up to 3 November 2022. We included participants aged ≥50 years diagnosed with cognitive impairment, with various cognitive training interventions as the intervention measures. The primary outcome was overall attention and the secondary outcomes were attention in different domains and global cognitive function. We calculated the Hedges' g and confidence intervals (CIs) using a random-effects model to evaluate the effect size of the outcome measures and evaluated heterogeneity using the χ2 test and I2 value. Results We included 17 RCTs and found that cognitive training interventions improve overall attention (Hedges' g = 0.41; 95% CI = 0.13, 0.70), selective attention (Hedges' g = 0.37; 95% CI = 0.19, 0.55), divided attention (Hedges' g = 0.38; 95% CI = 0.03, 0.72), and global cognitive function (Hedges' g = 0.30; 95% CI = 0.02, 0.58) in older adults with mild cognitive impairment, but with relatively low effectiveness. Conclusions Cognitive training intervention can improve some attention functions in older adults with mild cognitive impairment. Attention function training should also be incorporated into routine activities and long-term sustainability planning to delay the deterioration of attention function in older adults. Besides reducing their risk of abnormal events in daily life (such as falls), it can also improve their quality of life and help reduce the progression of cognitive impairment, achieving early detection of secondary prevention. [ABSTRACT FROM AUTHOR]

Background Multiple studies and meta-analyses have claimed that breastfeeding is inversely correlated with maternal and childhood cancers. These results could either be causal or confounded by shared risk factors. By conducting an umbrella review, we aimed to consolidate the relationship between breastfeeding and maternal and childhood cancers. Methods We searched PubMed, Embase, Web of Science, Elsevier ScienceDirect, and Cochrane Library databases from inception to December 2022. Two reviewers independently extracted the data and assessed the quality of the studies using standardised forms. We considered two types of breastfeeding comparisons ("ever" vs "never" breastfeeding; and "longest" vs "shortest" duration). We estimated the pooled risk and 95% confidence interval (CI) for each meta-analysis. Results We included seventeen meta-analyses with 55 comparisons. There was an inverse correlation between breastfeeding and childhood leukaemia (pooled risk = 0.90, 95% CI = 0.81-0.99), neuroblastoma (pooled risk = 0.81, 95% CI = 0.71-0.93), maternal ovarian cancer (pooled risk = 0.76, CI = 0.71-0.81), breast cancer (pooled risk = 0.85, 95% CI = 0.82-0.88), and oesophageal cancer (pooled risk = 0.67, 95% CI = 0.54-0.81) for "ever" vs "never" breastfeeding; and with childhood leukaemia (pooled risk = 0.94, 95% CI = 0.89-0.98), and maternal ovarian cancer (pooled risk = 0.84, 95% CI = 0.78-0.90) and breast cancer (pooled risk = 0.92, 95% CI = 0.89-0.96) for "longest" vs "shortest" breastfeeding duration. Conclusions We found evidence that breastfeeding may reduce the risk of maternal breast cancer, ovarian cancers, and childhood leukaemia, suggesting positive implications for influencing women's decision in breastfeeding. [ABSTRACT FROM AUTHOR]

Most management theories include hypotheses about interaction effects (i.e., the relation between two variables depends on values of another), but it is common for articles to present results that make it difficult to evaluate the nature, strength, and importance of the effect. We offer recommendations for improving the reporting of interaction effects by focusing on (a) visualizations, (b) effect size estimates, and (c) assessments of the nature, meaning, and importance of interactions for theory and practice. [ABSTRACT FROM AUTHOR]

Background Estimating sample size is an integral requirement in the planning stages of quantitative studies. However, although abundant literature is available that describes techniques for calculating sample size, many are in-depth and have varying degrees of complexity. Aim To provide an overview of four basic parameters that underpin the determination of sample size and to explain sample-size estimation for three study designs common in nursing research. Discussion Researchers can estimate basic sample size if they have a comprehension of four parameters, such as significance level, power, effect size, and standard deviation (for continuous data) or event rate (for dichotomous data). In this paper, these parameters are applied to determine sample size for the following well-established study designs: a comparison of two independent means, the paired mean study design and a comparison of two proportions. Conclusion An informed choice of parameter values to input into estimates of sample size enables the researcher to derive the minimum sample size required with sufficient power to detect a meaningful effect. An understanding of the parameters provides the foundation from which to generalise to more complex size estimates. It also enables more informed entry of required parameters into sample size software. Implications for practice Underpinning the concept of evidence-based practice in nursing and midwifery is the application of findings that are statistically sound. Researchers with a good understanding of parameters, such as significance level, power, effect size, standard deviation and event rate, are enabled to calculate an informed sample size estimation and to report more clearly the rationale for applying any particular parameter value in sample size determination. [ABSTRACT FROM AUTHOR]

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Depression is one of the most prevalent mental disorders worldwide. This study examined the effect of a spiritual connectivity intervention on individuals with depression in a randomized waitlist-controlled trial. Fifty-seven participants with mild or moderate depressive symptoms were randomly assigned to either the intervention group (n = 28) or the waitlist control group (n = 29). The intervention comprised eight weekly sessions focusing on divine connection, forgiveness and freedom, suffering and transcendence, hope, gratitude, and relapse prevention. The outcome measures included depressive symptoms, anxiety, hope, meaning in life, self-esteem, and social support. Participants completed self-administered questionnaires at baseline (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Repeated-measures ANOVA and one-way ANCOVA were used to compare the within-group and between-group differences in the changes in outcome variables. Participants in the intervention group showed significant improvements in depression, anxiety, spiritual experience, hope, self-esteem, and perceived social support after the intervention. Effect size statistics showed small to large differences (Cohen's d, 0.308 to −1.452). Moreover, 85.71% of participants in the intervention group also experienced clinically significant reductions in PHQ-9 scores from baseline to immediate post-intervention. This study highlights the effectiveness of a low-cost, accessible intervention suitable for community implementation by clergy and faith-based organizations. [ABSTRACT FROM AUTHOR]

In this article, we assess the 31 articles published in Basic and Applied Social Psychology (BASP) in 2016, which is one full year after the BASP editors banned the use of inferential statistics. We discuss how the authors collected their data, how they reported and summarized their data, and how they used their data to reach conclusions. We found multiple instances of authors overstating conclusions beyond what the data would support if statistical significance had been considered. Readers would be largely unable to recognize this because the necessary information to do so was not readily available. [ABSTRACT FROM AUTHOR]

Background: Healthy eating by primary school-aged children is important for good health and development. Schools can play an important role in the education and promotion of healthy eating among children. The aim of this review was to: 1) perform a systematic review of randomised controlled, quasi-experimental and cluster controlled trials examining the school-based teaching interventions that improve the eating habits of primary school children; and 2) perform a meta-analysis to determine the effect of those interventions. Methods: The systematic review was limited to four healthy eating outcomes: reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; reduced sugar consumption or preference (not from whole fruit); increased nutritional knowledge. In March 2014, we searched seven electronic databases using predefined keywords for intervention studies that were conducted in primary schools which focused on the four healthy eating outcomes. Targeted internet searching using Google Scholar was also used. In excess of 200,000 possible citations were identified. Abstracts and full text of articles of potentially relevant papers were screened to determine eligibility. Data pertaining to teaching strategies that reported on healthy eating outcomes for primary school children was extracted from the 49 eligible papers. Results: Experiential learning strategies were associated with the largest effects across the reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; and increased nutritional knowledge outcomes. Reducing sugar consumption and preference was most influenced by cross-curricular approaches embedded in the interventions. Conclusions: As with most educational interventions, most of the teaching strategies extracted from the intervention studies led to positive changes in primary school children's healthy eating behaviours. However, given the finite resources, increased overcrowding of school curriculum and capacity of teachers in primary schools, a meta-analysis of this scope is able to provide stakeholders with the best evidence of where these resources should be focused. [ABSTRACT FROM AUTHOR]

Background A growing body of research has found that participating in choir singing can increase positive emotions, reduce anxiety and enhance social bonding. Consequently, group singing has been proposed as a social intervention for people diagnosed with mental health problems. However, it is unclear if group singing is a suitable and effective adjunct to mental health treatment. The current paper systematically reviews the burgeoning empirical research on the efficacy of group singing as a mental health intervention. Methods The literature searched uncovered 709 articles that were screened. Thirteen articles representing data from 667 participants were identified which measured mental health and/or wellbeing outcomes of group singing for people living with a mental health condition in a community setting. Results The findings of seven longitudinal studies, showed that while people with mental health conditions participated in choir singing, their mental health and wellbeing significantly improved with moderate to large effect sizes. Moreover, six qualitative studies had converging themes, indicating that group singing can provide enjoyment, improve emotional states, develop a sense of belonging and enhance self-confidence in participants. Conclusion The current results indicate that group singing could be a promising social intervention for people with mental health conditions. However, these studies had moderate to high risk of bias. Therefore, these findings remain inconclusive and more rigorous research is needed. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smokers are more likely to be at risk of developing severe COVID-19. This study aimed to develop and evaluate the effect of a communication intervention for enhancing perceived threat of coronavirus 19 (COVID-19) infection associated with smoking and examine intentions to quit smoking among smokers during the COVID-19 pandemic in Thailand. METHODS This study was of experimental design. The sample was 427 eligible smokers who were living in Kosumphi Nakhon district. They were either assigned to the intervention group (233) or control group (194). The intervention group received the communication intervention, developed based on the Health Belief Model (HBM), including education online, motivation via social networks, and communication through local mass media. The difference in mean scores between the two groups was examined using an independent t-test. Regression models were fitted to explore the factors associated with the improvement score of intention to quit smoking. RESULTS The participants in the intervention group who received the communication intervention had a significantly higher mean score of perceived threats of smokinginduced COVID-19 (effect size=0.518, p<0.001) and had a significantly higher mean score of intentions to quit smoking (effect size=0.717, p<0.001) than in the control group. However, the number of e-cigarettes smoked per day betweengroups was not significantly different (p=0.532). In the regression analysis, factors that significantly associated with the improvement score of intentions to quit smoking, included female gender (p=0.002), addicted to nicotine score (p<0.001), intervention group (p=0.010), and the improvement score of perceived threats (p=0.026). CONCLUSIONS This community-based communication intervention could enhance the perceived threats of smoking-induced COVID-19 and increased the intentions to quit smoking among the smokers. However, further research to track the success rate of smoking cessation is still needed. [ABSTRACT FROM AUTHOR]

Perinatal mental health problems, experienced by 15-20% of women, are a significant public health issue associated with adverse effects among childbearing women; yet only 20-25% receive adequate treatment. There has been a recent proliferation of intensive perinatal day treatment programs in the United States. To meet this need in the greater Philadelphia area, we introduce Mother Baby Connections (MBC), an innovative interdisciplinary, attachment-focused, intensive, outpatient perinatal mental health program recently launched at Drexel University. The purpose of this paper is to (1) present an overview of MBC, its theoretical framework for services, and its evidence-based components, highlighting the unique factors that differentiate this program from traditional outpatient treatment, and (2) present clinical outcome data utilizing scores from reliable and valid scales, including enrollment to discharge outcomes from 20 months of MBC operation. In sum, outcomes for 20 predominantly minority women with complete measures showed significant improvements in maternal depression symptom severity, maternal functioning, birth trauma symptoms, perceived stress, parenting stress, and emotional regulation. Effect sizes were medium to large (i.e., 0.42-2.00). We conclude that MBC is a viable model for tailored intensive outpatient treatment to foster maternal mental health and functioning during the perinatal period. [ABSTRACT FROM AUTHOR]

Background: Recently, cases of medical disputes and even acts of violence toward physicians by patients in China have been escalating. It remains unknown whether competition improves the patient-physician relationship. Methods: This paper analyzes the relationship between hospital competition and the probability of medical disputes occurrence according to the theory of social control. Data from all hospitals in the Sichuan province of China from 2011 to 2014 were included in the study. The fixed radius approach with GIS information was employed to define hospital market, and the differences in competition over time and across regions were utilized. Our analysis is based on the fixed effect estimation, which accounts for the time-invariant unobserved heterogeneity among hospitals. Results: We found an inversed U-shaped relationship between HHI and the likelihood of medical disputes. As beneath either situation of monopoly or full competition, the burst of physician-patient dispute was downward into a valley, but it rises and then falls again with the increase of HHI, it reached the peak at the typical semi-market hospital competition structure. Conclusions: Our results highlight the probability of change in disputes occurrence with the transition of hospital competition and its psychological explanation, providing implications for China's future health reform. [ABSTRACT FROM AUTHOR]

Background and Aims: Several methods have been used in plastic and reconstructive surgery to reduce post-surgical complications, such as partial or complete flap loss due to ischemia and necrosis. Nitroglycerine application has been introduced as a viable alternative to papaverine to act as a local vasodilator to improve perfusion and reduce vasospasm. However, the literature has not thoroughly studied its efficacy and administration dose. This systematic review and meta-analysis study has been designed to assess the efficacy of topical nitroglycerine applications in reducing post-surgical flap necrosis and complications. Methods and Materials: A systematic literature search was performed on PubMed, Scopus, and Web of Science from inception to January 2023 with relevant keywords and terms. Case reports, review articles, letters, articles in any language other than English, and animal studies were excluded. The Newcastle-Ottawa and Jadad scales were used to assess the quality of the included studies. The pooled effect sizes were calculated using the random effect model with the Mantel-Haenszel method. Results: Overall, 2031 studies were obtained, among which 454 articles were duplicated and removed. Of the remaining 1577 articles, based on the eligibility and exclusion criteria, 20 articles were retrieved for full-text review. Finally, eight articles were included in our study. Three thousand nine hundred six patients had undergone reconstructive microsurgery and received topical nitroglycerin for the prevention of possible complications. The pooled rate of flap complication was 15% (95% CI: 8% to 25%, I2 = 96%, p-value < 0.01), and the pooled odds ratio of flap complication was 0.35 (95% CI: 0.15 to 0.83, I2 = 91%, p-value = 0.02). The heterogeneity of the included studies was significantly high. The dose and regimen of application significantly differed between each study. Conclusion: Topical administration of nitroglycerin compounds post reconstructive microsurgery can reduce the risk of flap necrosis. However, the precise dosage, duration of application, and possible underlying factors affecting drug efficacy are yet to be discovered. [ABSTRACT FROM AUTHOR]

Background: High rates of youth re‐offending indicate that young custody‐leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre‐, during, and post‐release and generally provide multiple forms of support services to address youths' transitional needs. Objectives: The present review examines (1) the impact of youth aftercare/resettlement programs on crime‐related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost. Search Methods: A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well‐known researchers in the field. The search was completed in January 2023. Selection Criteria: For objectives 1–3, studies were included if they utilized a randomized controlled design or quasi‐experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual‐measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1–4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered. Data Collection and Analysis: Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross‐checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS‐I (Sterne et al., 2016), ROB‐2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1–3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta‐regression. Thematic and narrative analysis was conducted to address objectives 4–6. Results: The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = −1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis. Authors' Conclusions: Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime‐related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects. [ABSTRACT FROM AUTHOR]

Objectives: The development of effective connections between nurses and parents depends heavily on nurses' empathy. Parenting strategies and attitudes have an impact on the emotional connection between parents and children in a variety of scenarios. Accordingly, this descriptive correlation study evaluates the level of empathy and investigates the relationship between parenting styles and the empathy of nurses. Methods: A purposive (non-probability) sample of 180 nurses was recruited in the current study and selected from four teaching hospitals in Kerbala City, Iraq, according to specific criteria. A pilot study was used to assess the questionnaire's reliability, and a panel of (17) experts was used to determine the questionnaire's content validity. The data were collected through interviews using two scales, namely the parental authority questionnaire, and the Jefferson scale of empathy physician/health professions. The data were investigated and interpreted using the SPSS software, version 22. Numbers and percentages were used to illustrate the quantitative qualities. The Spearmen coefficient was applied to evaluate the relationships between the study variables. The significance level was considered a P=0.05. Results: Nurses have a low level of empathy. There are significant correlations between the father's and mother's parenting styles (authoritative, permissive, and authoritarian dimensions) and empathy. In addition, there is a substantial association between nurses' empathy and job desire. Discussion: Nurse empathy is vital for building strong connections with parents. Parenting styles affect the parent-child emotional bond in various situations. The study on parental rearing patterns and empathy among nurses at teaching hospitals revealed that nurses who have low empathy levels and parenting styles significantly relate to empathy. Nurses' empathy also impacts their job satisfaction. The study recommends adopting the authoritative parenting style to enhance empathy. Awareness programs through various media should educate parents about positive and negative parenting styles and their effects on children's futures. By promoting empathy and supportive parenting, parents can nurture empathetic and well-adjusted individuals. The parenting style of both fathers and mothers is associated with empathy among nurses, and job desire may be an important factor that is related to nurses' empathy. [ABSTRACT FROM AUTHOR]

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7–13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child's unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy. [ABSTRACT FROM AUTHOR]

The high levels of musculoskeletal pain, in conjunction with the low levels of functional capacity, may negatively affect workers' health, efficiency, and productivity. This randomized controlled study investigated the efficacy of a 6-month comprehensive workplace exercise program on musculoskeletal pain and functional capacity in office workers. Seventy male and female office workers with musculoskeletal pain in any body area were randomly assigned to either an intervention (IG; n = 35) or a control group (CG; n = 35). The IG participated every working day (during working hours) in a 6-month supervised combined (flexibility, strength, and balance) exercise program (120 training sessions; five times/week) for the total body. The CG did not participate in any intervention. Musculoskeletal pains in nine body areas and functional capacity (flexibility, balance, and strength) of the lower and upper body were measured before and following the intervention. The IG significantly reduced duration and intensity of pain (43.1–70%; p = 0.000) as well as days of work absenteeism (84.6%; p = 0.000), while improving work capacity (87.1%; p = 0.000). Furthermore, the IG significantly increased cervical, handgrip, back, and leg maximal strength (10.3–27.1%; p = 0.000) and flexibility and balance (12.3–73.7%; p = 0.000). In CG, all musculoskeletal pain and functional capacity indices remained unchanged. In conclusion, this program may be effectively used to reduce musculoskeletal pain and improve functional capacity. [ABSTRACT FROM AUTHOR]

Millions of children in low-income and middle-income countries falter in linear growth and neurobehavioral development early in life. This faltering may be caused by risk factors that are associated with both growth and development, such as insufficient dietary intake and infection in infancy. Alternatively, these risk factors may be indicative of an environment that constrains both linear growth and development through different mechanisms. In a cluster-randomized trial in Burkina Faso, we previously found that provision of lipid-based nutrient supplements plus malaria and diarrhoea treatment from age 9 to 18 months resulted in positive effects of ~0.3 standard deviation on length-for-age z-score (LAZ) and of ~0.3 standard deviation on motor, language and personal-social development scores at age 18 months. In this paper, we examined whether the effect of the intervention on developmental scores was mediated by the effect on LAZ, or, alternatively, whether the intervention had independent effects on growth and development. For motor, language, and personal-social z-scores, the effect of the intervention decreased from 0.32 to 0.21, from 0.33 to 0.27 and from 0.35 to 0.29, respectively, when controlling for change in LAZ from 9 to 18 months. All effects remained significant. These results indicate that the intervention had independent positive effects on linear growth and development, suggesting that these effects occurred through different mechanisms. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Background: Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c and body weight. Methods: We performed a systematic review of papers published between 1975-2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA1c and body weight were meta-analysed and examined in relation to use of BCTs. Results: Thirteen RCTs were identified. Meta-analyses revealed reductions in HbA1c at 3, 6, 12 and 24 months of -1. 11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall reduction of -0.53 % (6 mmol/mol [95 % CI -0.74 to -0.32, < 0.00001]) in intervention groups compared to control P groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, = 0.002). P Four of 46 BCTs identified were associated with >0.3 % reduction in HbA1c: 'instruction on how to perform a behaviour', 'behavioural practice/rehearsal', 'demonstration of the behaviour' and 'action planning', as were intervention features 'supervised physical activity', 'group sessions', 'contact with an exercise physiologist', 'contact with an exercise physiologist and a dietitian', 'baseline HbA1c >8 %' and interventions of greater frequency and intensity. Conclusions: Diet and physical activity interventions achieved clinically significant reductions in HbA1c at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes. [ABSTRACT FROM AUTHOR]

Neuropsychiatric symptoms are common in Parkinson's disease (PD) and have a disproportionate impact on quality of life and carer burden. Pharmacological treatment is the main approach in dealing with these symptoms, but it is limited by variable efficacy and risk of drug interactions. Non-pharmacological approaches using the cognitive-behavioural therapy (CBT) model are viable alternatives and in this review paper we summarise the evidence of CBT for three of the most common psychiatric manifestations of PD: depression and anxiety, impulse-control disorders and insomnia. Most studies modified the usual CBT format to include modules accounting for problems specific to PD: activity scheduling around motoric function, motor symptoms as triggers of anxiety, fear of falling and preparation for disease progression as well as accommodation of materials for suspected executive dysfunction. We found a growing evidence base that CBT (modified to account for PD-specific problems) is effective in the treatment of PD psychiatric symptoms. Where controlled study design was used, moderate effect sizes are reported for the efficacy of CBT for depression, including with distance administration of CBT The effects were sustained during follow-up which was between 1 and 6 months. In addition, there are some initial data on the effects of CBT on impulse-control disorders and insomnia. The studies were limited by their small and potentially unrepresentative samples and the quality of sample reporting (eg, concomitant antidepressant and dopaminergic therapy use). Additional well-designed and adequately powered studies are required to determine the utility of CBT in PD. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the leading cause of death globally. However, many individuals are unaware of their CVD risk factors. The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of CVD risk factors screening. Methods: A systematic search was conducted through Pubmed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials. Additional articles were located through cross-checking of the references list and bibliography citations of the included studies and previous review papers. We included intervention studies with controlled or baseline comparison groups that were conducted in primary care practices or the community, targeted at adult populations (randomized controlled trials, non-randomized trials with controlled groups and pre- and post-intervention studies). The interventions were targeted either at individuals, communities, health care professionals or the health-care system. The main outcome of interest was the relative risk (RR) of screening uptake rates due to the intervention. Results: We included 21 studies in the meta-analysis. The risk of bias for randomization was low to medium in the randomized controlled trials, except for one, and high in the non-randomized trials. Two analyses were performed; optimistic (using the highest effect sizes) and pessimistic (using the lowest effect sizes). Overall, interventions were shown to increase the uptake of screening for CVD risk factors (RR 1.443; 95% CI 1.264 to 1.648 for pessimistic analysis and RR 1.680; 95% CI 1.420 to 1.988 for optimistic analysis). Effective interventions that increased screening participation included: use of physician reminders (RR ranged between 1.392; 95% CI 1.192 to 1.625, and 1.471; 95% CI 1.304 to 1. 660), use of dedicated personnel (RR ranged between 1.510; 95% CI 1.014 to 2.247, and 2.536; 95% CI 1.297 to 4.960) and provision of financial incentives for screening (RR 1.462; 95% CI 1.068 to 2.000). Meta-regression analysis showed that the effect of CVD risk factors screening uptake was not associated with study design, types of population nor types of interventions. Conclusions: Interventions using physician reminders, using dedicated personnel to deliver screening, and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake. [ABSTRACT FROM AUTHOR]

Background: Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes.Hypothesis: In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated.Study Design: Cross-sectional study.Level Of Evidence: Level 3.Methods: Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations.Results: The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) "dings" in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of "small" effect size ( r < 0.10). The remaining (49.2%) correlations were between "small" and "medium" effect sizes (0.1 < r < 0.3). However, all correlations were statistically nonsignificant.Conclusion: There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees.Clinical Relevance: Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study. [ABSTRACT FROM AUTHOR]

Background: Identifying clusters of co-occurring diseases may help characterise distinct phenotypes of Multiple Long-Term Conditions (MLTC). Understanding the associations of disease clusters with health-related outcomes requires a strategy to assign clusters to people, but it is unclear how the performance of strategies compare. Aims: First, to compare the performance of methods of assigning disease clusters to people at explaining mortality, emergency department attendances and hospital admissions over one year. Second, to identify the extent of variation in the associations with each outcome between and within clusters. Methods: We conducted a cohort study of primary care electronic health records in England, including adults with MLTC. Seven strategies were tested to assign patients to fifteen disease clusters representing 212 LTCs, identified from our previous work. We tested the performance of each strategy at explaining associations with the three outcomes over 1 year using logistic regression and compared to a strategy using the individual LTCs. Results: 6,286,233 patients with MLTC were included. Of the seven strategies tested, a strategy assigning the count of conditions within each cluster performed best at explaining all three outcomes but was inferior to using information on the individual LTCs. There was a larger range of effect sizes for the individual LTCs within the same cluster than there was between the clusters. Conclusion: Strategies of assigning clusters of co-occurring diseases to people were less effective at explaining health-related outcomes than a person's individual diseases. Furthermore, clusters did not represent consistent relationships of the LTCs within them, which might limit their application in clinical research. [ABSTRACT FROM AUTHOR]

Two neurodevelopmental conditions, autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), have been associated with executive function (EF) impairments but the specificity of their impairments is still controversial. The present meta-analysis aimed to identify the differences in EF profiles of ASD, ADHD, and ASD+ADHD in relation to a control group of individuals with typical development (TD) and to understand whether the EF performance could change depending upon the type of measure used to assess EF (performance tests vs. questionnaires). Results from 36 eligible studies revealed that ADHD and ASD showed more difficulties than the TD group in tests and, particularly, in questionnaires. No significant differences in the EF profile emerged between ASD and ADHD when assessed through neuropsychological tests (d = 0.02), while significant differences emerged when assessed through questionnaires, with ADHD having higher ratings than ASD (d = −0.34). EF questionnaires and neuropsychological tests may catch two different constructs of EF, with the former being more predictive of everyday life EF impairments. The comparison between the double diagnosis group (ADHD+ASD) and the clinical groups pointed out that the former has a more similar EF profile to the ADHD-alone one and that it shows more difficulties than ASD-alone. [ABSTRACT FROM AUTHOR]

In order to investigate the influence of separation of grade distributions and ratio of common items on the precision of vertical scaling, this simulation study chooses common item design and first grade as base grade. There are four grades with 1,000 students each to take part in a test which has 100 items. Monte Carlo simulation method is used to simulate the response matrices by self-made program in R 3.0. As the items are scored by 0/1, we select two-parameter logistic model of Item Response Theory and use BILOG-MG for concurrent calibration with EAP method. The Bias and RMSE are calculated as precision indicators. The results show that: (1) Estimation precision of item and ability parameters differs in different grades. For discrimination and difficulty parameters, estimation precision is higher as closer to the base grade and is lower with the increase of effect size. For the ability parameters, the estimation precision is high generally except for fourth grade which is much lower. The precision is best at 0.5 of effect size in general. (2) There is an interaction between the ratio of common items to total test and effect size. When the effect size is 0.5 and 1.0, estimation precision of each grade is most accurate at 30% of common-item ratio. When the effect size is 1.5, the estimation precision of difficulty parameters is best for first, second, and third grade at 30% of common-item ratio while grade 4 at 15% of common-item ratio. The ability parameters of all grades are all best estimated at 15% of common item ratio. There must be a trade-off between the estimation precision of ability parameters and item parameter if the common item ratio is at the range of 15% to 30%. (3) The choice of base grade affects the accuracy of vertical scaling. When the lower grade is selected as the base grade, if the number of consecutive cumulative conversions from the upper grade test score to the lower grade exceeds 2, there will be a large deviation. Therefore if the senior grade changes to the junior grade, it is suggested that the gap of grades should not exceed 2 grades. As a whole, the proportion of anchor items for vertical scaling is set at 30%, but it is better to set the proportion of anchor items as "variable" value (15%-30%) when considering the separation of grade distributions. [ABSTRACT FROM AUTHOR]