Active Intervention Research Articles

Improving access to psychological intervention in low-middle income settings: Results from a waitlist-controlled, proof-of-concept trial of the MemFlex intervention for trauma-exposed Afghan youth.

Low-intensity interventions targeting a range of mental health issues offer a scalable approach for young trauma survivors in low-middle income countries. Here, we present results from a proof-of-concept, randomized, waitlist-controlled trial evaluating MemFlex, an autobiographical memory-based intervention, for trauma-exposed Afghan youth residing in Iran. MemFlex seeks to reduce the negative and overgeneral memory biases which maintain and predict poor mental health. Young people aged 12-18 years (N = 40) with parents who had experienced forced migration from Afghanistan were recruited from high schools in Karaj City in Iran. All had experienced a traumatic event in the last year. Participants were randomized to receive four weeks of a group-based delivery of MemFlex or Waitlist. Our primary cognitive outcome was autobiographical memory flexibility, that is, the ability to deliberately retrieve any memory type on demand. Primary clinical outcome was emotional distress, measured on the Farsi version of the Hopkins Symptom Checklist. Results indicated that MemFlex participants demonstrated large effect sizes for pre-to-post improvement in memory flexibility (d = 2.04) and emotional distress (d = 1.23). These improvements were significantly larger than Waitlist (ds < .49), and were maintained at three-month follow-up. Positive benefits were observed for completion of MemFlex, and future comparison against an active intervention appears warranted. Further evaluation of MemFlex in this context may offer a low-cost, and low-resource intervention to improve access to psychological intervention for young migrants in low-middle income countries.

BACK-to-MOVE: Machine learning and computer vision model automating clinical classification of non-specific low back pain for personalised management.

Low back pain (LBP) is a major global disability contributor with profound health and socio-economic implications. The predominant form is non-specific LBP (NSLBP), lacking treatable pathology. Active physical interventions tailored to individual needs and capabilities are crucial for its management. However, the intricate nature of NSLBP and complexity of clinical classification systems necessitating extensive clinical training, hinder customised treatment access. Recent advancements in machine learning and computer vision demonstrate promise in characterising NSLBP altered movement patters through wearable sensors and optical motion capture. This study aimed to develop and evaluate a machine learning model (i.e., 'BACK-to-MOVE') for NSLBP classification trained with expert clinical classification, spinal motion data from a standard video alongside patient-reported outcome measures (PROMs). Synchronised video and three-dimensional (3D) motion data was collected during forward spinal flexion from 83 NSLBP patients. Two physiotherapists independently classified them as motor control impairment (MCI) or movement impairment (MI), with conflicts resolved by a third expert. The Convolutional Neural Networks (CNNs) architecture, HigherHRNet, was chosen for effective pose estimation from video data. The model was validated against 3D motion data (subset of 62) and trained on the freely available MS-COCO dataset for feature extraction. The Back-to-Move classifier underwent fine-tuning through feed-forward neural networks using labelled examples from the training dataset. Evaluation utilised 5-fold cross-validation to assess accuracy, specificity, sensitivity, and F1 measure. Pose estimation's Mean Square Error of 0.35 degrees against 3D motion data demonstrated strong criterion validity. Back-to-Move proficiently differentiated MI and MCI classes, yielding 93.98% accuracy, 96.49% sensitivity (MI detection), 88.46% specificity (MCI detection), and an F1 measure of .957. Incorporating PROMs curtailed classifier performance (accuracy: 68.67%, sensitivity: 91.23%, specificity: 18.52%, F1: .800). This study is the first to demonstrate automated clinical classification of NSLBP using computer vision and machine learning with standard video data, achieving accuracy comparable to expert consensus. Automated classification of NSLBP based on altered movement patters video-recorded during routine clinical examination could expedite personalised NSLBP rehabilitation management, circumventing existing healthcare constraints. This advancement holds significant promise for patients and healthcare services alike.

Recruitment strategies for reaching adults aged 50 years and older with low socioeconomic status for participation in online physical activity interventions

BackgroundGenerally, the health condition of those with higher socioeconomic status (SES) is better compared to those with lower SES. The application of appropriate strategies to reach low SES populations with electronic health (eHealth) interventions is thus of major importance to reduce health inequalities. eHealth-studies providing detailed information on recruitment strategies are scarce, despite the fact that this information is crucial for comparable research and implementation.ObjectiveTo provide insight into the reach, sample characteristics and costs of three pre-planned strategies for recruiting adults aged 50 years and older with low SES for participation in an online physical activity intervention, as part of a field study.MethodsRecruitment took place via (1) invitation letters via a municipality, (2) gyms and (3) social media advertisements, aiming to include 400 participants. Additional procedures were followed to reach specifically the low SES group. Response rates, sociodemographic characteristics and costs per strategy were assessed.ResultsThe highest response was shown for the municipality approach (N = 281), followed by social media (N = 71) and gyms (N = 45). Ten participants were recruited via family/friends. The most low-educated participants were reached via the municipality (N = 128) followed by social media (N = 9), gyms (N = 8) and family/friends (N = 5). Recruitment costs were with €2,142.37 the highest for the municipality compared to €96.81 for social media and no costs for gyms.ConclusionsRecruitment via invitation letters through a municipality has the highest potential for reaching low SES participants of the three applied strategies, although the higher recruitment costs need to be taken into account.

Cystic fibrosis management in pediatric population—from clinical features to personalized therapy

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). In 1949, it's been identified as a monogenic disease and was thought to primarily affect individuals of Northern European descent. It was the most prevalent autosomal recessive disease that shortens life. With the availability of multiple testing methodologies nowadays, there is a chance to create novel and enhanced treatment options. Even in the absence of a high sweat chloride test (SCT) result, the discovery of two causal mutations is diagnostic for cystic fibrosis (CF). For a CF diagnosis, however, at least two positive E sweat chloride tests are still required. In order to achieve early and active intervention to manage cystic fibrosis (CF) and its comorbidities, treatment regimens for pediatric patients should be evaluated, improved, and closely monitored. New developments in the treatment of cystic fibrosis (CF) have led to the development of medications derived from molecules that target the pathogenetic pathway of the illness. These options are very efficient and allow pediatric patients to receive individualized care. However, in order to better direct patient care and enhance patient outcomes, it is crucial to research uncommon CF mutations, which can provide crucial information about the prognosis of the disease and the relationships between genotype and phenotype. To ensure the success of creating novel, safer, and more efficient treatment approaches, a deeper understanding of the pathogeny of the illness is required. In the age of customized medicine, genetic research will be essential to improving patient care and quality of life for those with uncommon mutations.

The effects of co-designed physical activity interventions in older adults: A systematic review and meta-analysis.

Physical activity (PA) declines with age despite the knowledge that physical inactivity is a leading cause of disease, death, and disability worldwide. To better tailor PA interventions to older adults, researchers are turning to the collaborative principles of co-design. The purpose of this systematic review was to compare the effectiveness of co-designed PA interventions and standard care for increasing PA and other health outcomes (i.e., physical function, quality of life, mental health, functional independence, attendance and attrition rates) in older adults. A search was conducted in MEDLINE, AgeLine, CINAHL, Embase, and SPORTDiscus. Records were screened by independent pairs of reviewers. Primary research studies conducted among community-dwelling older adults (age 60+) comparing co-designed PA interventions to standard care were considered for inclusion. Controls included wait-list control, usual care, sham interventions, PA interventions without the use of co-design, and no intervention. A random effects meta-analysis was conducted, and the standardized mean difference (SMD) was used to report effect estimates. Quality of evidence was rated using GRADE. Of 16,191 studies screened, eight (N = 16,733) were included in this review. Most studies reported results favouring the effect of co-design on physical activity; however, only two studies (N = 433) could be pooled for meta-analysis resulting in a SMD of 0.28, (95% CI = -0.13 to 0.69; p = 0.19; I2 = 56%) immediately post-intervention. The GRADE quality of evidence was very low. The quantitative analysis of three studies reported improved physical function. This review did not demonstrate that co-designed PA interventions are more effective than standard care for increasing PA in older adults; however, evidence was limited and of very low quality. Further well-designed trials are warranted to better understand the impacts of co-designed PA interventions and how to best implement them into practice. PROSPERO registration number: CRD42022314217.

Baseline trait mindfulness moderates the efficacy of mindfulness interventions and active controls: A meta‐analysis of 177 randomised controlled trials

AbstractPrevious evidence suggests that benefits of mindfulness‐based interventions (MBIs) may depend on individuals' baseline trait mindfulness (BTM) levels. This meta‐analysis investigated moderating effects of BTM on changes in mental health outcomes and trait mindfulness in randomised controlled trials (RCTs) of MBIs. A total of 177 primary studies (total N = 13,486), comparing the treatment effects of MBIs against active, treatment‐as‐usual (TAU) and waitlist control groups, were synthesised via three‐level meta‐analysis. Lower BTM was associated with larger changes in mental health outcomes (B = −0.14, 95% CI [−0.21, −0.06], p &lt; .001) and trait mindfulness (B = −0.09 [−0.16, −0.02], p = .009) in MBIs and active controls combined. These associations were significantly larger than from those in TAU and waitlist controls. Moderating effects were less tangible for changes in trait mindfulness in MBIs and active controls individually and less tangible in various sensitivity analyses which, however, were confounded by client type across the RCTs. Individuals low in BTM may, by a small effect size, benefit more from MBIs and active control interventions. BTM may thus affect the evaluation of treatment efficacy. MBIs and active interventions could be offered specifically to persons low in BTM.

Walk With Ease made easier: A community feasibility pilot study of implementing an arthritis activity intervention.

Walk With Ease made easier: A community feasibility pilot study of implementing an arthritis activity intervention.

Optimizing the physical activity intervention for older adults with mild cognitive impairment: a factorial randomized trial

BackgroundPhysical activity (PA) intervention is one of the most effective interventions to promote cognitive function of older adults with mild cognitive impairment (MCI). However, the level of PA remains low. Based on the two core interventions (X-CircuiT and health education), this study aimed to examine the effect of three implementation strategies (viz., role modeling, goal-setting, and reminding) on the PA level among older adults with MCI using the multiphase optimization strategy (MOST).MethodsParticipants were randomized into one of eight conditions in a factorial design involving three factors with two levels: (i) role modeling (on vs. off); (ii) goal-setting (on vs. off); and (iii) reminding (on vs. off). The primary outcome was PA level at 12 weeks. The secondary outcomes were cognitive function, self-efficacy, and cost-effectiveness at 12 weeks. The intention-to-treat (ITT) analysis was performed as the main analysis and the per-protocol (PP) analysis as the sensitivity analysis.ResultsA total of 107 participants were included and randomly assigned into three groups, each receiving different implementation strategies. The results of the multivariate regression analysis showed that the three implementation strategies, namely, reminding (B = 0.31, p &amp;lt; 0.01), role modeling (B = 0.21, p &amp;lt; 0.01), and goal-setting (B = 0.19, p &amp;lt; 0.01), could significantly improve PA level. Specifically, it was found that role modeling (B = 0.68, p = 0.03) could significantly improve cognitive function. There were no significant interactions among the three implementation strategies. Role modeling was the most cost-effective strategy, costing 93.41 RMB for one unit of PA.ConclusionsRole modeling was likely to be the best implementation strategy. The value-based and cost-effective PA intervention package could include the core intervention (X-CircuiT and health education) and implementation strategy (role modeling).Clinical Trial Registrationhttps://www.chictr.org.cn, The study was retrospectively registered on 30 June 2022 (ChiCTR2200061693).

Does a person's body size and the application type influence healthcare students' perceptions of technologies to promote physical activity? Findings from a cross-sectional study

BackgroundRecent evidence suggests that weight bias may be pervasive, even among health professionals specialized in obesity, including healthcare students. Technology-based physical activity interventions are promising for people with obesity, specifically when they are theory-driven (e.g., autonomy-supportive as described by self-determination theory). However, perceptions of these technologies have been understudied among healthcare students and professionals. ObjectiveThe purpose of this study was to examine the influence of a person's body size based on body mass index and technology type on healthcare students' perceptions. DesignThis is a cross-sectional, experimental study. Participants and methodsFive hundred and two healthcare students (360 females, 142 males; mean age = 23.3, SD = 5.0) were randomly exposed to one of four scenarios that manipulated a hypothetical person's body mass index (22 kg/m2 vs. 42 kg/m2) and a technology-based physical activity type based on self-determination theory (autonomy-supportive app vs. controlling app). They then completed measures of their perceptions of the person's app acceptability and self-efficacy and of their intention to recommend the app. Multivariate and univariate analyses of covariance were performed. ResultsStudents exposed to the larger-bodied people (42 kg/m2) versus the smaller-bodied people (22 kg/m2) perceived a lower level of person's app acceptability (i.e., higher social influence and less enjoyment in using the app), as well as a lower level of self-efficacy to use the technology. Students exposed to the controlling app were more likely to recommend it compared to those exposed to the autonomy-supportive app. ConclusionsThese results suggest that healthcare students' attitudes may be negatively influenced by explicit weight bias. Also, in contrast to self-determination theory precepts, a controlling app may be more frequently recommended. Further study of healthcare students' implicit attitudes toward technology is needed.

Supplementation with selenium and coenzyme Q10 in an elderly Swedish population low in selenium — positive effects on thyroid hormones, cardiovascular mortality, and quality of life

BackgroundSelenium-dependent deiodinases play a central role in thyroid hormone regulation and metabolism. In many European countries, insufficient selenium intake may consequently lead to adverse effects on thyroid function. In this randomised placebo-controlled double-blind study, we examined the effect of supplementation with selenium and coenzyme Q10 on thyroid hormonal status, cardiovascular (CV) mortality and health-related quality of life (Hr-QoL).MethodsFree T3, free T4, reverse T3, and TSH were determined in 414 individuals at baseline, and the effect of selenium yeast (200 µg/day) and coenzyme Q10 (200 mg/day) supplementation on hormone concentrations, CV mortality and Hr-QoL was evaluated after 48 months using Short Form 36 (SF-36). Pre-intervention plasma selenium was low, mean 67 µg/L, corresponding to an estimated intake of 35 µg/day. Changes in concentrations of thyroid hormones following the intervention were assessed using T-tests, repeated measures of variance, and ANCOVA analyses.ResultsIn the total population, the group with the lowest selenium concentration at baseline presented with significantly higher levels of TSH and lower levels of fT3 as compared to subjects with the highest selenium concentration. Supplementation with selenium and coenzyme Q10 for 4 years significantly increased fT3 and rT3, decreased fT4, and diminished the increase in TSH levels compared with placebo treatment (p = 0.03, all). In the placebo group, TSH and fT4 values above the median were associated with an increase in 10-year CV mortality, as compared with the mortality rate among those with TSH and fT4 below the median (p < 0.04, both), with no difference in mortality rate according to TSH and fT4 levels in the active intervention group. Similarly, TSH > median and fT3 < median were associated with a decline in mental Hr-QoL measures vs. TSH < and fT3 > median in the placebo group during 4 years of follow-up, but this was wiped out in the active group.ConclusionsSupplementation with selenium and coenzyme Q10 had a beneficial effect on thyroid hormones with respect to CV mortality and Hr-QoL outcomes. The initial deficient selenium status was associated with an impaired thyroid function and the changes in thyroid hormone levels can be explained by increased activity of deiodinases. We conclude that a substantial part of the elderly study population might suffer from suboptimal thyroidal function with adverse clinical implications due to selenium deficiency.Trial registrationThis study was registered at ClinicalTrials.gov and has the identifier NCT01443780. Since it was not mandatory to register at the time the study began, the study has been registered retrospectively.

The Role of Physical Activity in Adjunctive Nursing Management of Neuro-Degenerative Diseases among Older Adults: A Systematic Review of Interventional Studies

Neurodegenerative diseases such as dementia and Parkinson’s disease pose significant challenges to older adults globally. While pharmacological treatments remain primary, increasing evidence supports the role of non-pharmacological strategies like physical activity in managing these conditions. This systematic review critically evaluates the effectiveness of Nursing based physical activity interventions in improving cognitive function, physical functioning, mobility, and overall quality of life among older adults with neurodegenerative diseases. We conducted a comprehensive search across PubMed, EMBASE, Web of Science, CENTRAL, and other relevant databases, focusing on randomized controlled trials and observational studies that examined the impact of structured physical activity. Our findings from nineteen studies involving 1673 participants indicate that interventions ranging from aerobic exercises, resistance training, to mind-body exercises like Tai Chi and yoga have beneficial effects. Specifically, physical activity was consistently found to enhance cognitive performance, increase mobility, and improve balance and daily living activities, contributing to a better quality of life. However, these benefits vary depending on the type, intensity, and duration of the activity performed. Despite promising results, limitations such as small sample sizes, study heterogeneity, and short-term follow-up periods call for more robust, long-term studies to solidify these findings. This review underscores the potential of tailored physical activity programs as adjunctive therapy in the comprehensive management of neurodegenerative diseases among the elderly population.

Feasibility of blinding spinal manual therapy interventions among participants and outcome assessors: protocol for a blinding feasibility trial

IntroductionBlinding is a methodologically important aspect in randomised controlled trials yet frequently overlooked in trials of spinal manual therapy interventions for back pain. To help inform the blinding methods of a future, double-placebo-controlled trial comparing spinal manual therapy and nerve root injection for lumbosacral radicular pain, we set four objectives: (1) to assess the feasibility of blinding participants, randomly allocated to an active or placebo-control spinal manual therapy intervention protocol, (2) to assess the feasibility of blinding outcome assessors within the trial, (3) to explore the influence of spinal manual therapy experience and low back pain on blinding, and (4) to explore factors contributing to perceptions about intervention assignment among participants and outcome assessors.Methods and analysisTwo-parallel-group, single-centre, placebo-controlled, methodological blinding feasibility randomised trial. We will recruit between 60 and 100 adults with or without back pain and with or without experience of spinal manual therapy from Zurich, Switzerland. Participants will be randomised to either an active spinal manual therapy or a placebo-control spinal manual therapy protocol—both interventions delivered over two study visits, up to two weeks apart. The primary outcome is participant blinding using the Bang blinding index within each intervention arm immediately after each of the two study visits. Secondary outcomes are participant blinding using the James blinding index, outcome assessor blinding (Bang and James blinding indices), self-reported factors influencing perceived intervention assignment among participants and outcome assessors, and participant-reported credibility and expectancy of study interventions. Other outcomes—included to blind the study objective from participants—are lumbar spine range of motion, self-rated general health, satisfaction with care, pain intensity, and function. Intervention provider outcomes include intervention component fidelity and quality of intervention delivery.Ethics and disseminationThe independent ethics commission of Canton Zurich granted ethical approval for this study (KEK 2023–00381). Written informed consent will be obtained from all participants. Findings will be disseminated in scientific conferences and a peer-reviewed publication and inform the blinding methods of a future double-placebo controlled trial comparing spinal manual therapy and nerve root injection for lumbosacral radicular pain—the SALuBRITY trial.Trial registrationNCT05778396.

Association between physical health and neurocognition in first-episode schizophrenia

IntroductionImpaired cognition is a core feature of schizophrenia that is evident early in the first episode and is frequently accompanied by compromised physical health. Although physical health confers benefits to cognition, it remains unclear whether physical activity, body mass index (BMI) and cardiorespiratory fitness are associated with neurocognition in first episode schizophrenia patients. The purpose of this study was to examine differences in stimulus categorization and motor response selection processes between first-episode schizophrenia patients compared to age-matched controls and explore associations between physical health and these stages of information processing.MethodsFourteen young adult patients receiving care following a first episode of psychosis and a matched sample of nonpsychiatric controls completed a visual oddball task from which the P3 and LRP (lateralized readiness potential) event-related potential (ERP) components were extracted to assess stimulus categorization and response selection processes, respectively. Physical activity, aerobic fitness, and BMI were correlated with ERP measures.ResultsCompared with controls, patients had lower physical activity levels and longer P3 and LRP latencies. Regardless of stimulus probability, patients had reduced accuracy and slower reaction times relative to controls. In patients, marginal associations were found between physical activity and P3 difference waveform amplitude, and BMI was negatively associated with parent P3 waveform amplitude.DiscussionThe present findings suggest that cognitive impairment in first-episode schizophrenia spans both stimulus- and response-related stages of information processing, and may be targeted through physical activity interventions.

Journey of a drug: teaching pharmacokinetics and pharmacodynamics

BackgroundPharmacology is a challenging course for nursing students, especially when considering the pharmacologic principles of pharmacokinetics and pharmacodynamics (PK/PD). Active learning strategies including the use of manipulatives aimed at increasing knowledge and engagement may improve learning outcomes in a pharmacology course. AimThe aim of this study was to determine if an interactive ‘Journey of a Drug’ (JoaD) activity using manipulatives to represent key components of PK and PD processes was more effective than textbook readings and asynchronous video lecture for teaching PK/PD. MethodsThe efficacy of this activity was evaluated using a pretest-posttest design to compare students’ scores on a PK/PD knowledge test, as well as student self-reported engagement and perceptions of the JoaD activity compared to asynchronous PK/PD video lecture. ResultsThere were significant improvements in PK/PD knowledge, student engagement, and students’ perceptions of the JoaD activity compared to asynchronous video lecture. ConclusionsThese results suggest that the JoaD activity is an effective active learning intervention that improves knowledge of PK/PD principles and enhances student engagement.

Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol.

The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling. Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling. This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling. CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence. PROSPERO CRD42023455617.

Muva physical activity intervention improves social functioning in people with a severe mental illness: a pragmatic stepped wedge cluster controlled trial

Muva physical activity intervention improves social functioning in people with a severe mental illness: a pragmatic stepped wedge cluster controlled trial

IMPROVING MENTAL HEALTH, PAIN AND QUALITY OF LIFE IN PERSONS LIVING WITH OSTEOPOROSIS AND DEPRESSION OR ANXIETY: A SYSTEMATIC REVIEW

Osteoporosis (OP) is a progressive, age-related condition impacting approximately 3.8% of Australians. OP is associated with increased psychological distress, increased pain and decreased quality of life. Correlations exist between OP and psychological distress, with people living with OP three times more likely to experience very high levels of psychological distress compared to those without. Emerging evidence suggests a connection between bone loss and depressive symptoms. For people living with OP, depression and/or anxiety, increasing physical activity is recommended to improve overall health outcomes. Currently, no guidelines for exercise recommendations exist for people living with these co-occurring conditions. The aim of this systematic review is to identify the most effective physical activity intervention to improve mental and physical health, quality of life and pain in people with co-occurring OP and symptoms of depression and/or anxiety. The research question, eligibility criteria and search strategy were developed, and peer reviewed by the research team, and the search was registered through PROSPERO (CRD42023440020). A systematic search of the following databases was conducted using the Cochrane Highly Sensitive Search Strategy for identifying randomized trials and Polyglot search translator: PubMed, CINAHL, Embase, PsycInfo, Scopus &amp; Web of Science. From 7,405 results, 2,372 were excluded as duplicates leaving 5,033. Covidence was used to screen by title and abstract, with a further 5,009 excluded based on study design, population and outcome measures. Full-text screening by two researchers (CF &amp; KM) led to 19 studies included for data extraction, with 5 excluded based on population (OP diagnosis), questionnaire validity and availability of data. Data extraction and analysis is currently underway with results to be presented at the conference. Findings will be used to design and implement a tailored lifestyle intervention program for people living with OP and symptoms of anxiety and/or depression. This research has been generously funded by the Estate of the Late Faye Patricia Williams.

Mortality impact of further delays in active targeted antibiotic therapy in bacteraemic patients that did not receive initial active empiric treatment: results from the prospective, multicentre cohort PROBAC

ObjectivesThe early initiation of the empirical antibiotic treatment and its impact on mortality in patients with bacteraemia has been extensively studied. However, information on the impact of precocity of the targeted antibiotic treatment is scarce. We aimed to study the impact of further delay in active antibiotic therapy on 30-day mortality among patients with bloodstream infection (BSI) who had not received appropriate empirical therapy. DesignWe worked with PROBAC cohort (prospective and compound by patients from 26 different Spanish hospitals). We selected a total of 1703 patients, who survived to day 2 without having received any active antibiotic therapy against the causative pathogen. ResultsThe 30-day mortality was 14% (238 patients). The adjusted odds of mortality increased for every day of delay, from 1.53 (95% CI 1.13-2.08) for day 3 or after to 11.38 (95% CI 7.95-16.38) for day 6 or after. ConclusionsWe concluded that among patients who had not received active treatment within the first two days of blood culture collection, additional delays in active targeted therapy were associated with increased mortality. These results emphasize the importance of active interventions in the management of patients with bloodstream infections.

POSITIVE: experiences of an intervention aiming for reversing and preventing frailty using a home monitoring and communication platform within primary health care.

Frailty is increasing worldwide as the population ages. Physical activity is one component that has been shown to hinder and even reverse the process. The POSITIVE system (i.e., maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a prevention program that consists of home-monitoring equipment and a communication platform to support the initial treatment of frailty symptoms in primary health care. The participants, older aged (+ 70) frail persons and those at risk for frailty, took part in the program that promoted physical activity at home for six months. The aim was to explore and describe older persons' experiences of participating in a new prevention program using the POSITIVE system including technological tools intended to prevent the development of frailty. Nine interviews were conducted about experiences of participating in an intervention including use of technological tools to support physical activity. Qualitative content analysis was applied. Two themes revealed: (1) Perceptions of being old are seldom positive, and (2) A rewarding and fruitful participation in the project with suggestions for improvement. Becoming older was related to physical pain and tiredness reducing the performance of former meaningful activities as well as an increase in mental stress. There was also a tendency to postpone the start of everyday activities, and in general, fewer activities were planned for one day than at younger ages. Participating in a physical activity intervention, including the use of technical tools, was considered meaningful and added motivation for engaging in other physical activities, this despite some difficulties with technical tools provided by the program. The contact with health care and the research team was appreciated. In addition, contact with other participants was requested and reported to be highly valued if added to the intervention, which could have been an expression of loneliness. Participation in a prevention program motivated activities and social interaction. Adding opportunities for participants to meet each other is suggested for improving the intervention in terms of increasing the social dimensions. Our findings conclude that despite difficulties with handling the technical tools for the home-monitoring and communication platform, participation in the POSITIVE intervention was in general a positive experience.

Effect of Therapeutic Gardening Program in Urban Gardens on the Mental Health of Children and Their Caregivers with Atopic Dermatitis.

This study was conducted to identify the physical and psychological difficulties of children with atopic dermatitis and their caregivers, and to investigate the effects of participation in a novel therapeutic gardening program based on psychological intervention on their physical and mental health. The program, consisting of 15 sessions, was conducted for approximately 4 months in urban gardens in Seoul and involved 30 children with atopic dermatitis and their caregivers. Additionally, a control group of 30 non-participating caregivers was recruited for comparative analysis. The psychological and emotional changes in caregivers were assessed using six self-report scales (depression, anxiety, stress, vitality, life satisfaction, parenting efficacy) before and after participation in the program. Additionally, the depression index (CDI) and atopic dermatitis index (SCORAD, TEWL) were measured for the children with atopic dermatitis. The research results indicate that the therapeutic gardening program utilizing psychological intervention had a positive impact on the physiological and psychological health of participants. These results are significant as they demonstrate the clinical application of the professionally developed therapeutic gardening program through active intervention and operation. This study suggests that this program can serve as an effective intervention in improving the mental health of both children with atopic dermatitis and their caregivers.