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Background: Physical activity is important for healthy ageing, however most older adults are inactive. Numerous reviews with a range of inclusion criteria have been conducted on digital interventions to promote physical activity in older adults, and a synthesis of these is needed. Therefore, the objective of this study is to conduct an umbrella review and meta-meta-analysis on the effectiveness of digital interventions to promote physical activity in older adults. Methods: Nine databases were searched from January 2010 to December 2023. Systematic reviews and meta-analyses of primary studies using digital physical activity interventions to target healthy older adults or clinical populations of older adults with a self-reported or device measured physical activity outcome were eligible for inclusion. Results: In total, 22 systematic reviews and meta-analyses covering 185 primary research papers were eligible for inclusion. The total number of participants across all primary studies was 28,198. Most (21, 95%) reviews and meta-analyses were rated as having a low or critically low AMSTAR-2 confidence rating. Of the 22 included systematic reviews, 13 (59%) conducted a meta-analysis and 10 (45%) conducted a narrative synthesis. Most systematic reviews with a narrative synthesis found strong evidence for a positive effect or moderate evidence for a positive effect for physical activity outcomes (7/9, 78%) and steps (3/3, 100%). The meta-meta-analysis of primary papers included in meta-analyses demonstrated a significant moderate effect for steps and a significant small effect for total PA and MVPA. The strength of effect did not vary by intervention components (activity tracker, app-based, SMS/phone, web-based, and face-to-face), population (primary or secondary prevention), control group (none, other digital intervention, or non-digital intervention), or outcome measurement (self-reported or device measured). Only 3 (14%) reviews included longer term follow up outcomes after the end of the intervention, with mixed results. Conclusions: Evidence from 22 reviews and meta-analyses suggests that digital physical activity interventions are effective at increasing physical activity in older adults. Further primary research is needed in adults 65 years and over exclusively, and with longer-term follow up of physical activity outcomes. Future reviews should include a published protocol and interpret results according to risk-of-bias. [ABSTRACT FROM AUTHOR]

Background: Stress influences examination performance among Sri Lankan students. Validated tests are required to evaluate stress levels among elementary students in Sri Lanka. Therefore, the Perceived Stress Questionnaire 8–11 (PSQ8-11) was translated into a Sinhala version. The aim of this study was to examine the psychometric properties of the translated and adapted scale among elementary level school children in Sri Lanka and examine invariance across male and female children. Methods: The participants were 1021 students from seven schools. After removing missing values, responses from 693 students (mean age = 9.65 ± 0.478 years, 51.8% male) were analysed for participant characteristics. Cronbach's alpha, Spearman's correlation, and confirmatory factor analysis with measurement invariance models were conducted after adding one item to the original PSQ8-11 version. Results: The Cronbach's alpha value for the 20-item modified PSQ8-11 Sinhala version was.788. The two subscales, psychological stress (Cronbach's alpha = 0.615) and physiological stress (Cronbach's alpha = 0.711), indicated a satisfactory level of internal consistency. Furthermore, a statistically significant correlation (p < 0.01; 2-tailed) was reported among each of the subscales. Confirmatory factor analyses demonstrated a satisfactory goodness-of-fit across the two models by confirming the theoretical constructs of the PSQ8-11 translated version with its two subscales. The two-factor model has better model fit indices compared to the unidimensional model (χ2/df = 1.447, CFI = 0.947, TLI = 0.938, WRMR = 0.028, RMSEA = 0.026, SRMSR = 0.0341, and PCLOSE = 1 of the two-factor model). Measurement variance across gender was supported by the establishment of configural and metric invariances. Conclusion: Acceptable psychometric properties for the PSQ8-11 Sinhala version were observed in elementary schoolers in Sri Lanka. [ABSTRACT FROM AUTHOR]

Background: Classroom-based physical activity interventions have demonstrated positive effects in reducing sedentary behaviour among school children. However, this is an understudied area, especially in low- and middle-income countries such as Sri Lanka. This study aims to explore teachers' opportunity, capability and motivation relating to the implementation of an in-classroom physical activity breaks programme. Methods: Twenty-seven teachers were recruited through snowball sampling and participated in semi-structured telephone interviews from early-January to the mid-June 2022. The Capability, Opportunity, and Motivation Behaviour (COM-B) model was used to guide and deductively thematic analyse the interviews. Results: 21 out of the recruited teachers responded to the full study. The mean age of respondents was 39.24 years old ranging from 27 years to 53 years. Teaching experience of the respondents ranged from three to 37 years, and 57% were female. Three teachers had a degree with a teacher training diploma, while others were having General Certificate of Education in Advanced Level with a teacher training diploma as the highest education qualification. Capability factors such as age, dress code, mask wearing, knowledge, skills and workload of the teachers were identified as important factors in implementing a physical activity breaks intervention in a Sri Lankan classroom setting. Classroom space, facilities, student backgrounds and safety were identified as opportunity factors. Obtaining policy level decisions to implement the activity breaks and managing the time of the activities to reduce time lost in education time were identified as motivational factors. Conclusion: During the intervention development phase, implementation facilitators and barriers must be considered carefully. Behaviour change techniques can be utilised to address the identified COM-B factors to ensure a good implementation of the intervention. [ABSTRACT FROM AUTHOR]

Introduction: Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk. In this project, we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice. Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Islander and non-indigenous adults, recruited through primary care, at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care. Methods and analysis: Randomised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk. The trial will be augmented by formal economic and process evaluations to assess acceptability, equity and cost-effectiveness of the intervention. The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management. The programme is electronically integrated with the primary care provider's software and will include interactive smart phone and Internet platforms. The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline-recommended blood pressure (BP) and cholesterol targets. Secondary outcomes include change in mean BP and fasting cholesterol levels, proportion meeting BP and cholesterol targets separately, self-efficacy, health literacy, self-reported point prevalence abstinence in smoking, body mass index and waist circumference, self-reported physical activity and self-reported medication adherence. Ethics and dissemination: Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences Clinical Trials registration number: ACTRN12613000715774. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) can be caused by a number of reasons. Previous works have identified the genetic causes, such as alterations in the DNA sequence, for many of these diseases. We hypothesize that some patients may show genomic imbalances and changes in the gene copy number leading to genetic instability. To clarify this, we analysed DNA samples from SCD victims using comparative genomic hybridization (CGH), a molecular cytogenetic technique that permits the genome-wide screening of chromosomal imbalances, and telomere length measurement. DNA derived from peripheral blood and heart tissue of 14 SCD cases and six apparently healthy control individuals were subjected to CGH analysis. Telomere length measurements were done by the Southern blotting method. Eight out of 14 SCD cases exhibited changes in DNA/gene copy number. CGH analysis showed variation in the gene copy number of some of the genes associated with potassium (KCNAB1, KCNH2, and KCNA4) and calcium (RyR2, ATP2A2) ions which are involved in maintaining the ionic balance of the heart. Alterations in TERC and TERT genes were also detected in SCD victims. In nine SCD victims shorter telomeres were detected. This might have resulted from excessive cellular proliferation and/or oxidative stress in these individuals. Copy number changes observed and telomere shortening detected in SCD cases would possibly explain at least some of the causes of SCD at early ages in humans. Identification of biomarkers of SCD is of great importance and thus the present study will facilitate the identification of some of the biomarkers. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Rhabdomyolysis results from acute damage of the skeletal muscle brought on by various conditions of which hypokalemia is a recognized, but less common condition. Although primary aldosteronism may cause severe hypokalemia leading to rhabdomyolysis, the patients may have potassium levels within the normal range on routine biochemistry. In addition, hypokalemia may be triggered by initiation of diuretic therapy for control of hypertension. Here, we describe a patient with an aldosterone secreting adrenal adenoma, who presented with acute rhabdomyolysis secondary to severe hypokalemia triggered by initiation of diuretic therapy. [ABSTRACT FROM AUTHOR]

Background: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes.Methods: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines.Discussion: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes. [ABSTRACT FROM AUTHOR]

Background: The Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP) Study aims to examine whether a polypill-based strategy (using a single capsule containing aspirin, a statin and two blood pressure-lowering agents) amongst Indigenous and non-Indigenous people at high risk of experiencing a cardiovascular event will improve adherence to guideline-indicated therapies, and lower blood pressure and cholesterol levels.Methods/design: The study is an open, randomised, controlled, multi-centre trial involving 1000 participants at high risk of cardiovascular events recruited from mainstream general practices and Aboriginal Medical Services, followed for an average of 18 months. The participants will be randomised to one of two versions of the polypill, the version chosen by the treating health professional according to clinical features of the patient, or to usual care. The primary study outcomes will be changes, from baseline measures, in serum cholesterol and systolic blood pressure and self-reported current use of aspirin, a statin and at least two blood pressure lowering agents. Secondary study outcomes include cardiovascular events, renal outcomes, self-reported barriers to indicated therapy, prescription of indicated therapy, occurrence of serious adverse events and changes in quality-of-life. The trial will be supplemented by formal economic and process evaluations.Discussion: The Kanyini-GAP trial will provide new evidence as to whether or not a polypill-based strategy improves adherence to effective cardiovascular medications amongst individuals in whom these treatments are indicated.Trial Registration: This trial is registered with the Australian New Zealand Clinical Trial Registry ACTRN126080005833347. [ABSTRACT FROM AUTHOR]

Boluses were crystalloid (Normal Saline) or colloid (Dextran40), 10ml/kg/hour over one hour (full bolus-FB) or 5ml/kg over 30minutes (half bolus-HB). B Background: b Dengue, a devastating public health problem has clinical entities dengue fever (DF) and dengue haemorrhagic fever (DHF) differentiated by plasma leaking in latter. [Extracted from the article]

Most clinical guidelines, identify DHF/Severe dengue by rising haematocrit >= 20% [World Health Organization (WHO) Guideline on dengue 1997] and "warning signs" (WHO/TDR guideline of 2009). The dengue illness has two main clinical entities; Dengue fever (DF) and Dengue haemorrhagic fever (DHF). The Centre for Clinical Management of Dengue and Dengue haemorrhagic fever (CCMDDHF) routinely used limited Ultrasound Scan (USS), of chest and abdomen, as the most reliable way to identify DHF early. [Extracted from the article]