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Exercise referral schemes (ERS) reduce depression but the additional effect on mental health from web-based behavioural support is unknown. The e-coachER trial reported no effect of augmenting usual ERS with theory-driven web-based behavioural support on moderate to vigorous physical activity (MVPA) at 12 months for patients with chronic physical and mental health conditions. The present study reports the effects of the e-coachER intervention on depression, anxiety and MVPA only among participants with elevated depressive symptoms and investigates whether these were mediated by changes in MVPA and hypothesised cognitive and behavioural processes. Of the original 450 adults recruited into the e-coachER trial, 205 had at least mild depression, based on the Hospital Anxiety and Depression Scale (HADS), and were included in the present analysis. Data collected included the HADS, accelerometer measured and self-reported MVPA and survey process measures on physical activity action planning, self-monitoring and goal reviewing, and perceived importance, confidence, competence, autonomy and support. Linear mixed models were used to compare groups for change in depression and anxiety at 4 and 12 months using intention-to-treat complete case analysis, controlling for baseline. We also examined whether changes in physical activity and process variables at 4 months mediated changes in depression and anxiety at 12 months. Of the 205 participants, 138 (67%) provided follow-up data at four months and 126 (61%) at 12 months. For those that provided follow-up data, those randomised to e-coachER reported improved levels of depression (−1.36, 95% CI: −2.55 to −0.18) but not anxiety, or MVPA, compared with controls at four months. No differences were observed at 12 months for depression, anxiety or MVPA. Intervention effects on accelerometer-measured or self-reported MVPA did not mediate improvements in depression or anxiety. However, intervention effects on confidence, competence and self-monitoring at four months significantly mediated the reduction in depression scores at four months. Intervention effects on competence and self-monitoring at four months also significantly mediated improvements in anxiety scores at four months. Adding web-based support to usual ERS leads to reductions in depression but not anxiety at four months. Changes in depression and anxiety were influenced by changing people's motivational regulations toward physical activity. The benefit of adding web-based support to usual ERS on mental health appears to be from increasing a sense of confidence, competence and self-monitoring rather than from increasing physical activity in people with elevated depression. ERS should focus more on strengthening motivational regulations than just doing more exercise. ISRCTN15644451. • We report the effects of augmenting exercise referral schemes with web-based support for people with elevated depressive symptoms. • We investigated whether changes in outcomes were mediated by changes in physical activity and psychological processes. • Those randomised to e-coachER reported improved symptoms of depression compared with controls at four months. • Intervention effects on confidence, competence and self-monitoring at four months mediated reduction in depression scores. • Intervention effects on competence and self-monitoring at four months mediated improvements in anxiety scores at four months. [ABSTRACT FROM AUTHOR]

Background: Foods prepared outside the home (e.g., fast-food chains, restaurants) represent increasing proportions of diets worldwide, and have been associated with higher energy intakes and BMIs. To improve the healthiness of population diets, it is important to understand patterns of consumption of these foods, and whether related policy measures are effective.Objectives: This study aimed to identify the frequency and sources of consumption of foods prepared outside the home in Australia, and to understand the impact of nutrition information in restaurants on related food choices.Methods: Data were from a web-based survey (the International Food Policy Study) completed in 2018 by Australian adults aged ≥18 years (n = 4103). The number of meals prepared outside the home, their purchase locations, and the extent to which nutrition information was noticed and influenced purchasing decisions were each analyzed by sociodemographic characteristics and BMI, with linear models also adjusted for sex, age group, education, ethnicity, and BMI.Results: An average of 2.73 (95% CI, 2.61-2.86) meals per week were prepared outside the home, with higher frequencies among men, younger ages, and more highly educated participants. A wide variety of sources for these foods was observed, with fast-food outlets being most common. Around one-quarter of all foods prepared outside the home were delivered. A small percentage (14.9%; 95% CI, 13.3%-16.7%) of participants reported noticing nutrition information, but among those who did, around half reported that it influenced their behavior.Conclusions: Foods prepared outside the home are commonly purchased in Australia, particularly by young adults, from a variety of outlet types. While current menu energy labeling regulations may provide some population health benefit, a broader policy focus on foods prepared outside the home is needed as part of efforts to improve population diets. [ABSTRACT FROM AUTHOR]

Abstract: Background: Blepharophimosis-ptosis-epicanthus inversus syndrome is an autosomal dominant condition because of mutations or deletions of the FOXL2 gene. Microcephaly is not associated with FOXL2 mutations but has been reported in individuals with chromosome 3q deletions, which include the FOXL2 gene and other contiguous genes. The ATR gene has been reported as a candidate gene for microcephaly in individuals with contiguous deletion of chromosome 3q involving the FOXL2 gene. Patient: We describe a girl with blepharophimosis-ptosis-epicanthus inversus syndrome along with acquired microcephaly and intellectual disability. Results: Our patient had a deletion of chromosome 3q22.2q23, which does not include the ATR gene but does include the PIK3CB gene as a candidate gene for microcephaly. Conclusion: We propose that the PIK3CB gene included in our patient's chromosome 3q deletion may be the gene responsible for microcephaly and other patients with blepharophimosis-ptosis-epicanthus inversus syndrome because of a chromosome 3q deletion. [Copyright &y& Elsevier]

Objective: Patient-centered goal setting, while central to contemporary rehabilitation, has been associated with growing uncertainty regarding its application in clinical practice. We aimed to examine the application of goal setting in inpatient stroke rehabilitation. Methods: Data collected from 44 participants (nine patients, seven family members, 28 health professionals), using multiple data sources (interviews, recorded clinical sessions, team meetings, participant-observation, and clinical documentation), were analyzed using constant comparative methods. Results: Certain goals (characterized by short timeframes, conservative estimation of outcomes, and physical function) were privileged over others. Involvement of patients and family in goal setting resulted in interactional dilemmas when their objectives, skills and perceived capacity did not align with privileged goals. When alignment did occur, greater patient involvement still did not appear to influence clinical reasoning. Conclusion: This study raises questions about how 'patient-centered' current goal setting practices are and whether a 'patient-centered' approach is even possible in inpatient stroke rehabilitation when considering predominant funding and health system models. Practice Implications: For 'patient-centered' goal setting to be more than rhetorical, clinicians need to examine the values they attribute to certain types of goals, the influence of organizational drivers on goal selection, and how goals are actually used to influence clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Study design: : Retrospective non-experimental study. Objective: To investigate variables associated with active spondylolysis. Design: A retrospective study audited clinical data over a two year period from patients with suspected spondylolysis that were referred for a SPECT bone scan. Six exploratory variables were identified and analysed using uni- and multi-variate regression from 82 patient records to determine the association between symptomatic, physical and demographic characteristics, and the presence of an active spondylolysis. Setting: Tertiary level multidisciplinary private practice sports medicine clinic. Participants: All patients with low back pain that required a SPECT bone scan to confirm suspected spondylolysis. 82 subjects were included in the final sample group. Main outcome measurements: The six exploratory variables included Age, Gender, Injury duration, Injury onset, Sports participation and the result of the Single Leg Hyperextension Test. The dependent outcome variable was the result of the SPECT bone scan (scan-positive or scan-negative). Results: Adolescent males had a higher incidence of spondylolysis detected by SPECT bone scan compared to other patients and a statistically significant association was demonstrated for both age (p =0.01) and gender (p =0.01). Subjects with an active spondylolysis were nearly five times more likely to be male and aged less than 20 years. Furthermore, the likelihood ratio indicated that adolescent males with suspected spondylolysis were three and a half times more likely to have a positive bone scan result. The Single Leg Hyperextension Test did not demonstrate a statistically significant association with spondylolysis (p =0.47). Conclusions: Clinicians assessing for a predisposition to the development of spondylolysis should consider the gender and age of the patient and not rely on the predictive ability of the Single Leg Hyperextension Test. [Copyright &y& Elsevier]

Summary: Objectives: Does the Orthosense Posture Monitor (OPM), a small biofeedback device, have utility for back care training? Background: Performing moving and handling tasks inappropriately could contribute to low back pain (LBP). If the OPM is acceptable to wear during such tasks and influences technique, exposure to LBP risk factors might be reduced. Method: Twenty-five healthy volunteers (amateur golfers, aged 30–65 years) removed their golf bag from their car boot whilst wearing the OPM. Results: The OPM was acceptable to wear. Receiving biofeedback significantly altered the number of times and duration of time postures exceeded 20° lumbar flexion. Conclusions: The OPM may be a useful device for back care moving and handling training for healthy individuals in a real-world environment. Further research is required to assess reliability and validity and to test OPM biofeedback in a randomized controlled trial. [Copyright &y& Elsevier]

Many women experience urinary incontinence (UI) during and after pregnancy. Pelvic floor muscle exercises (PFME) can prevent and reduce the symptoms of UI. The objective of the study was to explore challenges, opportunities and concerns for women and health care professionals (HCPs), related to the implementation of PFME training for women in current antenatal care. An ethnographic study design was used. Researchers also formed and collaborated with a public advisory group, consisting of seven women with recent experiences of pregnancy, throughout the study. Seventeen midwife-woman interactions were observed in antenatal clinics. In addition, 23 midwives and 15 pregnant women were interviewed. Repeat interviews were carried out with 12 of the women postnatally. Interviews were also carried out with other HCPs; four physiotherapists, a linkworker/translator and two consultant obstetricians. Additional data sources included field notes, photographs, leaflets, policy and other relevant documents. Data were collected in three geographical areas of the UK spanning rural, urban and suburban areas. Data collection took place in antenatal clinics, in primary and secondary care settings, and the majority of women were interviewed in their homes. Three broad and inter-related themes of "ideological commitment", "confidence" and "assumptions, stigma and normalisation" were identified. The challenges, opportunities and concerns regarding PFME implementation were explored within these themes. Although HCPs and some women knew that PFME were important, they were not prioritised and the significant benefits of doing PFME may not have been communicated by midwives or recognised by women. There was a lack of confidence amongst midwives to teach PFME and manage UI within the antenatal care pathway and amongst women to ask about PFME or UI. A perceived lack of consistent guidelines and policy at local and national levels may have impeded clear communication and prioritisation of PFME. Furthermore, assumptions made by both women and midwives, for example, women regarding UI as a normal outcome of pregnancy, or midwives' perception that certain women were more likely to do PFME, may have exacerbated this situation. Training for midwives to help women in the antenatal period to engage in PFME could address challenges and concerns and to help prevent opportunities for women to learn about PFME from being missed. [ABSTRACT FROM AUTHOR]

• Neuroticism mediates the relationship between amygdala connectivity and alcohol use. • Amygdala-temporal parietal junction connectivity is negatively related to neuroticism. • Amygdala-temporal fusiform gyrus connectivity is positively related to alcohol use. The purpose of this study was to investigate the effect neuroticism has on the relationship between alcohol use severity and amygdala connectivity. Previous studies have indicated that amygdala connectivity and negative affect play a role in the cycle of addiction, and that neuroticism, which shares similar qualities with negative affect, is also related to amygdala connectivity, but the role neuroticism plays in mediating the relationship between AUD and amygdala connectivity has not been examined. To complete this study, 158 participants (58 female) enrolled in studies through NIAAA (National Institutes of Alcohol Abuse and Alcoholism) underwent resting state functional MRI (rs-fMRI) scans. The Alcohol Use Disorders Identification Test (AUDIT) was used to quantify alcohol use severity and the Revised NEO Personality Assessment (NEO PI-R) was used to quantify levels of neuroticism. A whole brain analysis was conducted to investigate the relationship of rs-fMRI amygdala connectivity with AUDIT and NEO neuroticism scores. A latent variable model (LVM) was used to measure the mediation effect of neuroticism on alcohol use severity and rs-fMRI amygdala connectivity. The whole brain analysis showed a positive relationship between right amygdala-right temporal fusiform gyrus connectivity and AUDIT scores and a negative relationship between left amygdala-left temporal parietal junction (TPJ) connectivity and NEO neuroticism scores. The indirect effect of neuroticism was significant for the LVMs of left amygdala connectivity with the nucleus accumbens (NAcc), posterior insula, and dorsal anterior cingulate cortex (dACC). These results suggest that personality plays an important role in the cycle of addiction. [ABSTRACT FROM AUTHOR]

Objective To analyze attitudes and beliefs about movement and physical activity in people with low back pain (LBP) and compare these beliefs between people with acute and chronic LBP. Design Qualitative inductive analysis of data collected via face-to-face semistructured interviews. Interviews were audio-recorded and transcribed verbatim. Setting Participants were purposively recruited from 1 region of New Zealand. Participants Persons with LBP (N=23), consisting of individuals with acute LBP (<6wk; n=12) and chronic LBP (>3mo; n=11). Interventions Not applicable. Main Outcome Measure Themes that emerged from participant interview transcripts using analysis based on Interpretative Description. Results Participants with acute and chronic LBP made judgments about physical activity and rest using the same conceptual model. Concerns about creating more pain, tissue damage, or impairment influenced the physical activity judgments of most participants with acute and chronic LBP. These perceived risks were balanced against the perceived benefits, the most important of which were psychological or social rather than physical. Judgments made by those with acute and chronic LBP were context dependent and influenced by the nature and duration of pain, the type of physical activity, the importance of the activity, and the participant's previous experience. Participants with acute pain who had not experienced back pain previously often expressed more uncertainty, whereas those with chronic LBP appeared to have developed cognitive rules that determined physical activity decisions. Conclusions Exploring the perceived risks, benefits, and contextual factors that influence decisions about physical activity and rest may help clinicians to understand the behavior of patients with acute and chronic LBP. Clinicians may best support their patients to engage in physical activity by providing an informed assessment of risks and an explanation about the range of potential benefits. [ABSTRACT FROM AUTHOR]

Aims To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs. Methods Randomised controlled trials were initially identified from previous systematic reviews of CR. We undertook updated literature searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Library to December 2015. A total of 19 trials with median follow up of 3 months were included — 17 comparisons of home-based CR to usual care (995 patients) and four comparing home and centre-based CR (295 patients). Results Compared to usual care, home-based CR improved VO 2max (mean difference: 1.6 ml/kg/min, 0.8 to 2.4) and total Minnesota Living with Quality of Life score (− 3.3, − 7.5 to 1.0), with no difference in mortality, hospitalisation or study drop out. Outcomes and costs were similar between home-based and centre-based CR with the exception of higher levels of trial completion in the home-based group (relative risk: 1.2, 1.0 to 1.3). Conclusions Home-based CR results in short-term improvements in exercise capacity and health-related quality of life of heart failure patients compared to usual care. The magnitude of outcome improvement is similar to centre-based CR. Home-based CR appears to be safe with no evidence of increased risk of hospitalisation or death. These findings support the provision of home-based CR for heart failure as an evidence-based alternative to the traditional centre-based model of provision. [ABSTRACT FROM AUTHOR]

Abstract: There is strong evidence for the protective effects of physical activity on chronic health problems. Activity monitors can objectively measure free living occupational and leisure time physical activity. Utility is an important consideration when determining the most appropriate monitor for specific populations and environments. Hours of activity data collected, the reasons for activity hours not being recorded, and how these two factors might change over time when using an activity monitor in free living are rarely reported. This study investigated user perceptions, adherence to minimal wear time and loss of data when using the RT3 activity monitor in 21 healthy adults, in a variety of occupations, over three (7 day) repeated weeks of measurement in free living. An activity diary verified each day of monitoring and a utility questionnaire explored participant perceptions on the usability of the RT3. The RT3 was worn for an average of 14h daily with 90% of participants having complete data sets. In total 6535.8 and 6092.5h of activity data were collected from the activity diary and the RT3 respectively. An estimated 443.3h (6.7%) of activity data were not recorded by the RT3. Data loss was primarily due to battery malfunction (45.2%). Non-adherence to wear time accounted for 169.5h (38.2%) of data loss, of which 14h were due to occupational factors. The RT3 demonstrates good utility for free living activity measurement, however, technical issues and strategies to manage participant adherence require consideration with longitudinal and repeated measures studies. [Copyright &y& Elsevier]