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Background: Hand hygiene (HH) is recognized as an important measure to avoid the transmission of harmful germs, and assists significantly in preventing healthcare-associated infections. HH compliance among health care workers (HCWs) is a result of their knowledge and perceptions., Aim: To investigate the knowledge and perceptions of WHO hand hygiene guidelines among HCWs, and the perceived barriers to compliance with hand hygiene in a major public hospital in Cyprus., Methods: A descriptive correlational study was conducted in September of 2019. The target population was all of the HCWs in Nicosia General Hospital (N = 1,386). The final sample consisted of 820 participants (119 physicians, 613 nurses, 27 physiotherapists, 59 ward assistants, 2 unidentified). This study used the HH knowledge and perception questionnaire that was developed by the WHO., Results: The results revealed that the average percentage score for knowledge among our sample was 61%, and statistically significant differences were observed among HCWs with regard to certain questions. It was found that HCWs, in most of their responses, presented high percentages of correct answers regarding their perceptions on hand hygiene guidelines but several perceived barriers to compliance on HH guidelines were identified as well., Conclusions: Knowledge and perceptions of HH guidelines among HCWs were moderate and good respectively. In addition, several perceived barriers to compliance on HH recommendations were identified. HH education is recognized as an important tool for removing these barriers but the recommended HH strategy should be multi-modal and consider local resources, administrative support and barriers to compliance with HH., (© 2024. The Author(s).)

Introduction: Cirrhosis is the main cause of morbidity and mortality globally, accounting for approximately 1.2 million deaths annually. Impaired aerobic capacity, muscle wasting and reduced muscle strength are significant complications in patients with cirrhosis. Preoperative exercise intervention "prehabilitation" has been recognised as a potential approach to optimise muscle strength, aerobic capacity and body composition as well as quality of life in patients awaiting abdominal surgery. However, there is little evidence on the effects of preoperative exercise on older adults with cirrhosis and awaiting liver transplant. Thus, the primary objective of this systematic review and meta-analysis will be to assess the effects of exercise interventions in improving aerobic capacity, muscle strength and body composition of older adults with cirrhosis and awaiting liver transplant., Methods and Analysis: This systematic review and metaanalysis protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review will include all peer-reviewed randomised controlled trials (RCTs), including cluster RCTs, controlled (non-controlled), complex clinical trials (CCTs) or cluster trials, cohort, observational studies published in English from inception until July 2024. The following electronic databases will be searched: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO) and Scopus (Elsevier) and supplemented by a secondary screening of the reference lists of all included articles. Searches will involve studies with both male and female participants aged ≥ 18 years with cirrhosis and awaiting liver transplant. Primary outcomes will include muscle strength, and aerobic capacity. The secondary outcomes include body composition (e.g. body mass index, and thigh circumference). The Cochrane Collaboration Risk of Bias Tool will be used to evaluate quality of the studies and Review Manager (RevMan) V.5.3 (Copenhagen, Denmark: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Effect sizes will be expressed as a standardised mean difference, and their 95% confidence intervals will be calculated and presented as a forest plot. The standard χ 2 and I 2 tests will be used to test heterogeneity., Conclusion: This systematic review and meta-analysis is anticipated to provide meaningful and contemporary evidence on the effects of preoperative exercise in older adults living with cirrhosis and awaiting liver transplant. In addition, the findings will help clinicians with developing safe and effective preoperative exercise regimens for these patients., (© 2024. The Author(s).)

Background: The acute and chronic adaptation of endurance athletes' hearts shows that increased volume of endurance exercise might cause an acute reduction in cardiac function, causing a physiological cascade that leads to the release of cardiac biomarkers specific to cardiomyocyte stress. Heart rate variability (HRV) is a valuable tool used as a physiological measurement to evaluate the autonomic nervous system (ANS). It is frequently used to assess cardiac autonomic regulation, determining a patient's risk for unfavorable events. This study set out to determine the changes in the ANS by participating in a 3-day mountain bike cycling race in amateur cyclists using HRV as an outcome measure., Methods: Sixteen healthy participants (male and female) participating in a 3-day mountain bike cycling race underwent five-minute resting electrocardiography recordings in a supine position 2 days before the race (baseline testing). In addition, HRV measurements were recorded after each race day and 24 h post-race (recovery)., Results: Time-domain and frequency-domain measures showed significant changes from baseline HRV parameters after each race day (p ≤ 0.05). In addition, our data revealed that the mean heart rate and R-R variability intervals did not return to baseline values after 24 h of recovery. Thus, autonomic nervous system (ANS) alterations may be due to changes in cardiac sympatho-vagal balance., Conclusions: The main strength of this study is using HRV as a measuring and screening tool to assess cardiac autonomic activity, whereby the state of the ANS before and after endurance races can be measured. Thus, physicians, athletes, and coaches can determine the stress of endurance races on the ANS and plan recovery strategies. The reasoning is that if the ANS is in a state of sub-optimal function, susceptible amateur athletes might be at risk for a cardiovascular event or maladaptation due to the endurance race., (© 2023. The Author(s).)

Background: Anti-retroviral therapy (ART) is associated with low bone mineral density (BMD) among people living with HIV (PLWHIV). Although physical activity is recommended for improving bone health in patients with reduced BMD, data on effects of strength exercises on low BMD among PLWHIV is scarce. This study therefore aimed to determine the effects of a 12 weeks maximal strength training (MST) on BMD among PLWHIV in Blantyre, Malawi., Methods: Twenty-six PLWHIV with reduced BMD were randomised into a training group (TG, n  = 15) and control group (CG, n  = 11). The TG underwent 12 weeks of MST consisting of 4 sets of 3 to 5 repetitions at 85-90% of one repetition maximum (1RM) 3 times per week. The CG was advised to maintain their usual lifestyle. Measurements of BMD using dual-energy X-ray absorptiometry, 1RM using a squat machine, heart rate using a heart rate monitor, weight, height and body mass index were obtained before and after the intervention in the TG and CG. Descriptive statistics and student's t - tests were used to analyse data., Results: The study was conducted for 12 weeks. Data of 24 participants [14 (TG) and 10 (CG)] were analysed. At base line, there were no significant differences in age ( p  = 0.34), height ( p  = 0.91), weight ( p  = 0.43) and body mass index ( p  = 0.34) between participants in the TG and the CG. After the intervention, there were significant improvements in lumbar BMD ( p  < 0.001) and resting heart rate ( p  = 0.03) in the TG compared to the CG. There were significant improvements in muscle strength (1 RM) in both the TG ( p  < 0.001) and the CG ( p  = 0.01)., Conclusions: MST improves lumbar BMD and strength in PLWHIV receiving ART in Blantyre, Malawi. MST with a shorter exercise duration of 12 weeks seem to have the potential in treating reduced BMD in PLWHIV., Trial Registration: PACTR201712002889203. Registered with the Pan African Clinical Trial Registry on 22nd December, 2017 at www. pactr.org., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: There is compelling evidence for the benefits of regular exercise during pregnancy, and medical practitioners (MPs) can play an important role in changing antenatal health behaviours. The purpose of this study was to assess the knowledge, attitudes and beliefs of South African MPs towards exercise during pregnancy., Methods: A convenience sample of ninety-six MPs working in the private health care sector, including General Practitioners (n = 58), Obstetricians/Gynaecologists (n = 33) and other Specialists (n = 5), participated in this cross sectional, descriptive survey study. A 33-item questionnaire was distributed manually at medical practices and via email to an on-line survey tool. Descriptive statistics and frequency tables were calculated for all questions. Chi-squared and Fisher's exact statistical tests were used to determine the differences in response by age, speciality and years of practice (p < 0.05)., Results: The majority of practitioners (98%) believe that exercise during pregnancy is beneficial, and were knowledgeable on most of the expected benefits. Seventy-eight percent believed that providing exercise advice is an important part of prenatal care, however only 19% provided informational pamphlets and few (24%) referred to exercise specialists. A large majority (83%) were unaware of the recommended exercise guidelines. Although age and years of practice played no role in this awareness, practitioners who focussed on obstetrics and gynaecology were more likely to be aware of the current guidelines, than those in general practice (p < 0.001)., Conclusion: Although the MPs were largely positive towards exercise during pregnancy, their advice did not always align with the current guidelines. Therefore, better dissemination of available research is warranted, to bridge the gap between clinical knowledge and current recommendations for physical activity promotion.