Combined Intervention Research Articles

Evaluating the Effectiveness of Lifestyle Interventions in Preventing Chronic Diseases: A Systematic Review

This systematic review evaluates the effectiveness of lifestyle interventions, including dietary changes, physical activity, smoking cessation, and alcohol reduction, in preventing chronic diseases such as cardiovascular disease, diabetes, and obesity. Chronic diseases pose a significant burden globally, and lifestyle interventions are increasingly recommended to reduce risk factors. A comprehensive search was conducted in databases like PubMed, Cochrane Library, and Embase, focusing on studies published in the past decade. Included studies assessed adult populations at risk of chronic diseases, using interventions targeting lifestyle modifications with measurable health outcomes. Findings indicate that dietary changes and increased physical activity significantly reduce chronic disease risk, while smoking cessation and alcohol reduction further contribute to improved health outcomes. Combination interventions generally showed the most substantial impact on preventing chronic disease. Although the evidence strongly supports lifestyle changes for disease prevention, variations in intervention type, duration, and adherence remain a limitation. Future research should explore long-term effects and implementation strategies in diverse populations. This review underscores the need for integrating effective lifestyle interventions into healthcare policies to improve public health.

Amelioration of fructose-induced hepatic lipid accumulation by vitamin D3 supplementation and high-intensity interval training in male Sprague‒Dawley rats

BackgroundIntrahepatic lipid accumulation (IHL), a hallmark of metabolic disorders, is closely associated with de novo lipogenesis (DNL). Notably, fructose feeding increased the DNL. Lifestyle modifications resulting from dietary changes and increased physical activity/exercise can decrease the IHL content. We examined the effects of vitamin D3 supplementation (VDS), high-intensity interval training (HIIT), and their combination on the transcription factors and enzymes of the DNL pathway in male Sprague‒Dawley rats fed a high-fructose diet (HFrD).MethodsForty male rats were assigned to 5 groups (n = 8): CS (the control group had a standard diet); CF (the control group had HFrD (10% (w/v) fructose solution in tap water)); and FT (HFrD + HIIT: 10 bouts of 4 min of high-intensity running, corresponding to 85–90% of the maximal speed with 2 min active rest periods of 50% maximal speed, 5 days per week); FD (HFrD + intervention of intraperitoneal injection of 10000 IU/kg/week VDS); FTD (HFrD + HIIT + VDS) that were maintained for 12 weeks. ELISA, the GOD-POD assay, folch, western blotting, and oil red O staining were used to determine insulin, fasting blood glucose (FBG), hepatic triglyceride (TG) and cholesterol levels; SREBP1c, ChREBP-β, ACC1, FASN, p-ACC1, AMPK, p-AMPK, and PKA protein expression; and IHL content, respectively.ResultsBoth HIIT and VDS led to significant increases in the levels of PKA, AMPK, p-AMPK, and p-ACC1, as well as significant decreases in the levels of SREBP1c, ChREBP-β, ACC1, FASN, insulin, FBG, liver TG, liver cholesterol, and IHL. HIIT exhibited superior efficacy over VDS in reducing ChREBP-β, ACC1, insulin, FBG, liver TG and cholesterol, as well as increasing p-ACC1 and PKA. Notably, the combined intervention of HIIT and VDS yielded the most substantial improvements across all the parameters.ConclusionsHFrD causes IHL accumulation and the onset of diabetes, whereas VDS and HIIT, along with their combined effects, prevent the consequences of HFrD.

Inoculation and accuracy prompting increase accuracy discernment in combination but not alone.

Misinformation is a major focus of intervention efforts. Psychological inoculation-an intervention intended to help people identify manipulation techniques-is being adopted at scale around the globe. Yet the efficacy of this approach for increasing belief accuracy remains unclear, as prior work uses synthetic materials that do not contain claims of truth. To address this issue, we conducted five studies with 7,286 online participants using a set of news headlines based on real-world true/false content in which we systematically varied the presence or absence of emotional manipulation. Although an emotional manipulation inoculation did help participants identify emotional manipulation, there was no improvement in participants' ability to tell truth from falsehood. However, when the inoculation was paired with an intervention that draws people's attention to accuracy, the combined intervention did successfully improve truth discernment (by increasing belief in true content). These results provide evidence for synergy between popular misinformation interventions.

Effects of home-based exercise alone or combined with cognitive training on cognition in community-dwelling older adults: A randomized clinical trial

BackgroundStructured and supervised physical exercise and cognitive training are two efficient ways to enhance cognition in older adults. Performing both within a combined intervention could maximize their effect on cognition due to their potential synergy on brain functions. During the COVID-19 pandemic, these interventions were particularly relevant due to the collateral impact of social restrictions regarding physical activity and the level of cognitive stimulation. However, the benefits of remotely monitored intervention combining physical exercise and cognitive training for older adult cognition remain to be demonstrated. Methods127 older adults (age: 65.20 ± 7.95) were randomized in two arms, encouraging self-engagement in six months of home-based physical exercise alone or combined with cognitive training, monitored by phone once a week. Neuropsychological assessment was performed under videoconference supervision at baseline and after three and six months. Composite Z-scores were calculated for processing speed, executive functioning, working, and episodic memory to assess changes after three and six months of training. The weekly metabolic expenditure of self-reported activities was estimated using the compendium of physical activity to distinguish participants performing higher and lower doses of exercise (median split). Results106 participants (83.46 %) completed the 6-month training. Results showed a greater Z-score change in executive functioning for participants in the combined arm than those who only exercised (F = 4.127, p = 0.046, ηp2 = 0.050). Group x Exercise dose interaction was observed for episodic memory Z-score change (F = 6.736, p = 0.011, ηp2 = 0.070), with a greater improvement for participants performing higher doses of exercise compared to those who performed a lower dose, only in exercise alone arm. Performing a higher dose of exercise increased the working memory Z-score change in both intervention arms compared to a lower dose (F = 7.391, p = 0.008, η p2 = 0.076). ConclusionRemote combined training may lead to larger improvement in executive functioning than exercise alone. Physical exercise showed a dose-related improvement in working and episodic memory performances. The combination of cognitive interventions mitigated the effects of exercise on episodic memory. These results suggest that home-based exercise and cognitive training may help improve older adults' cognition. Trial registrationCOVEPIC was retrospectively registered on December 03, 2020. Clinical trials Identifier: NCT04635462 - https://clinicaltrials.gov/ct2/show/record/NCT04635462?term=NCT04635462&draw=2&rank=1

Long-term effects of non-pharmacological interventions in adolescents and young adults with type 1 diabetes: A systematic review and meta-analysis.

Consistent diabetes control is crucial for patients with type 1 diabetes (T1D) to prevent diabetic complications. Analyzing the long-term effects of non-pharmacological interventions can improve diabetes management. To examine the long-term effects of non-pharmacological interventions in adolescents and young adults with T1D through a systematic review and meta-analysis of randomized controlled trials (RCTs). The searches, without any year limitations, were conducted in seven databases. Two reviewers independently performed data extraction and risk of bias assessments. The meta-analysis was conducted using the RevMan 5.4 program and R Studio. The study was registered with PROSPERO (CRD42024503185). A total of 40 studies were included in the systematic review, of which 28 were included in the meta-analysis. Notably, non-pharmacological interventions were effective in improving glycated hemoglobin (HbA1c) at 6 months and self-care at >12 months of follow-up. Subgroup analyses revealed that combined interventions encompassing self-care behavior management, education, and psychological interventions could enhance self-care. Additionally, a combination of face-to-face and telephonic communication was effective in improving HbA1c. Non-pharmacological interventions are effective in improving HbA1c levels and self-care in adolescents and young adults undergoing long-term treatment. However, few studies have analyzed their effects on cardiovascular disease risk factors. Future studies should investigate the long-term effects of non-pharmacological interventions.

Comparison of the Effects of Sanyinjiao Point (SP6) Acupressure with Combined SP6 and LI4 Acupressure on Labor Pain Intensity in Primiparous Women: A Randomized Controlled Trial

Background: Childbirth is an important event and special experience in women's lives. Labor pain is the most severe pain that women undergo in their lives. Pain management during labor is crucial for the well-being of the mother and fetus. Objective: This study aimed to compare the effect of combined LI4 and SP6 acupressure with SP6 acupressure on reducing labor pain. Methods: A total of 108 primiparous women who participated in the study were randomized into three groups, combining LI4 and SP6 acupressure, SP6 acupressure, and a control group. Pain intensity was evaluated before, immediately, 1 and 2 hours after the intervention and the second stage of labor by visual analogue scale (VAS). Results: Although the pain intensity immediately after the intervention was lower in the combined SP6 and LI4 acupressure group than in the other groups, the differences were not significant between the three groups (p = 0.147). The pain intensity 1 hour after the intervention and in the second stage of labor had a statistically significant difference between the three groups (p =0.006, p =0.001). The pain intensity 2 hours after the intervention was lower in the combined SP6 and LI4 acupressure group than the other groups, but it was not statistically significantly different (p= 0.05). The pain intensity 1 hour after the intervention was not statistically different between the SP6 group and the control group (p= 0.095). The pain intensity 2 hours after the intervention was lower in the combined SP6 and LI4 acupressure group compared to the control group, but it was not significant (p=0.06). The pain intensity in the second stage of labor was lower in the combined SP6 and LI4 acupressure group and SP6 acupressure group compared to the control group (p =0.001, p = 0.017), but there was no significant difference between the SP6 acupressure group and combined SP6 and LI4 acupressure group (p=1.000). Conclusion: The obtained results revealed that combination intervention is a safe, effective, noninvasive and economical method in alleviating labor pain intensity. Healthcare providers are expected to master the acupressure technique as an alternative, complementary therapy, which can be used as an alternative or additional therapy.

Understanding the features and effectiveness of randomized controlled trials in reducing COVID-19 misinformation: a systematic review.

This systematic review aimed to assess the features and effectiveness of individual-level randomized controlled trials targeting COVID-19 misinformation. The selection process included rigorous criteria, resulting in the inclusion of 24 individual studies from 21 papers. The majority of studies were conducted in high-income countries, with the accuracy/credibility of information as the primary outcome. Debunking and boosting interventions were the most common interventions while nudging and content labeling interventions were examined in a few studies. This study highlights that further research is needed to enhance the effectiveness of boosting strategies and to explore the impact of combined interventions. Addressing bias concerns and standardizing intervention assessment measures will contribute to the development of evidence-based approaches in this critical area.

Strategies to Limit Benzodiazepine Use in Anesthesia for Older Adults

Despite guidelines recommending avoidance of benzodiazepine administration to older patients, many of them now receive benzodiazepines as a part of anesthesia care. The effectiveness of clinician- and patient-facing interventions to discourage such use remains insufficiently characterized. To evaluate the effect of clinician peer comparison, patient informational mail, or a combination of these interventions compared with usual care on the rate of perioperative benzodiazepine administration to older patients. This 2 × 2 factorial, stepped-wedge, cluster randomized clinical trial of a corporate quality improvement initiative was conducted between August 8, 2022, and May 28, 2023, across 415 hospitals, surgery centers, and physician offices in 8 US states served by anesthesia clinicians from a national anesthesia practice. Participants were adults aged 65 years or older who underwent an elective surgical or endoscopic procedure with general anesthesia. Data analyses followed the intention-to-treat principle. Patients were randomly assigned to 1 of 4 groups-clinician peer comparison (wherein clinicians received feedback regarding their performance compared with other clinicians in the practice), patient informational mail (wherein patients received an informational letter encouraging them to have a discussion regarding medication selection with their clinician on the day of surgery), both interventions, or usual care (no intervention). Rate of benzodiazepine administration during anesthesia care and patient satisfaction with anesthesia care (measured by the Anesthesia Patient Satisfaction Questionnaire, version 2). Among the 509 269 enrolled participants (255 871 females [50.2%]; mean [SD] age, 74 [7] years), 81 363 (16.0%) were assigned to clinician peer comparison, 98 520 (19.3%) to patient informational mail, 169 712 (33.3%) to both interventions, and 159 674 (31.4%) to usual care. Among patients who received benzodiazepine during anesthesia care, 24.5% were in the usual care group compared with 19.7% in the clinician peer comparison group, 20.0% in the patient informational mail group, and 19.7% in the combination group. After adjustment for time, none of the study interventions were associated with lower odds of benzodiazepine administration compared with usual care (odds ratio [OR], 1.02 [95% CI, 0.98-1.07]; P = .35 for clinician peer comparison; OR, 1.01 [95% CI, 0.96-1.05]; P = .81 for patient informational mail; and OR, 1.11 [95% CI, 1.05-1.16]; P < .001 for combined interventions). Satisfaction scores were high in all groups and did not vary by treatment assignment. This randomized clinical trial found that clinician peer comparison, patient informational mail, or a combination of both interventions did not reduce benzodiazepine administration to older patients compared with usual care; patient satisfaction remained high throughout the study. Overall, the findings suggest a need to explore other patient-targeted interventions to improve anesthesia care. Clinicaltrials.gov Identifier: NCT05436392.

Limb-girdle muscular dystrophies: A scoping review and overview of currently available rehabilitation strategies.

Limb-girdle muscular dystrophies (LGMDs) constitute a diverse group of inherited disorders primarily affecting skeletal muscle. Despite the absence of cures, rehabilitative treatments offer potential for preventing and mitigating loss of muscle strength. However, the role of exercise training in LGMD patients remains contentious. This review aims to provide an overview of the currently available motor rehabilitation strategies for the most common subtypes of LGMD. To identify relevant articles, we performed a systematic search in PubMed, Embase, Cochrane Library, and Web of Science, focusing on muscular and respiratory interventions. The search resulted in 560 potentially relevant articles, of which 16 were included in the review. Eight studies concentrated on neuromuscular functional rehabilitation therapy programs, seven combined both neuromuscular rehabilitation and interventions to maintain or enhance respiratory functionality and one focused on respiratory intervention only. Altogether, the papers examined offered a comprehensive view on the rehabilitative strategies available and provided an indication of the most valuable practices to deal with patients' health and needs. Upon analysis, we conclude that, when tailored to individual needs, muscle training can enhance strength and functional abilities, positively impacting psychological well-being. However, generic protocols may lead to limited benefits, fatigue, pain, and compliance issues. Moreover, early management of respiratory symptoms and personalized respiratory physiotherapy can enhance patients' well-being and their capability to participate in muscle training exercises. Future studies should not only refine rehabilitation approaches but also assess their impact on patients' quality of life, including psychological factors like depression and self-esteem.

Comparing the effectiveness of peer-led healthy aging interventions on depression and quality of life in community-dwelling older adults: A systematic review and network meta-analysis.

Healthy aging has become increasingly important owing to the rapidly growing population of older adults globally, and results from the complex interplay of multiple characteristics such as depression and quality of life. Several countries have included peer-led interventions in their health policies to promote healthy aging. Given the growing evidence for these interventions, determining their comparative effectiveness is vital and warranted. The aim of this study was to examine the relative effectiveness of peer-led interventions on the depression and quality of life of community-dwelling older adults. A systematic review and network meta-analyses were performed. The meta-analysis was performed using random-effects models. Additionally, subgroup, meta-regression, and frequentist network meta-analyses were conducted. The protocol was registered with PROSPERO (CRD 42023492659). Twelve studies with depression outcomes and 11 studies with quality-of-life outcomes were included. The effect sizes for depression and quality of life were moderate and small, respectively. For depression, face-to-face interactions and intervention duration were moderating factors. For quality of life, intervention provider was a moderating factor. The combined peer-nurse intervention was shown to have a large effect on quality of life, whereas interventions provided by professionals other than nurses or provided only by peers had a small effect. A ranking analysis found that the most effective intervention for increasing quality of life was the simultaneous involvement of both healthcare professionals and peers. The provision of education and exercise interventions showed a higher ranking than goal setting in the leading group. The peer-led interventions were sufficient for depression. The effectiveness for improving quality of life may increase when involving both peers and healthcare professionals, particularly nurses. Nursing and health policymakers could establish distinct strategies depending on whether the goal of peer-led interventions is to improve quality of life or alleviate depression for older adults.

Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults.

Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination. We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained. Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses. In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings.

Reducing the climate impact of food choices with comparable nutritional quality: a randomised trial

Abstract Background Diets largely contribute to the global disease burden, and a third of global warming emissions. We assessed the climate footprint reduction effect of framing the climate impact of diets as a collective action problem (social dilemma), compared or in combination with a reflective intervention (information) and a choice architecture intervention (nudge). Interactions with lifestyle factors were examined. Methods A randomised 2X2X2 between-subjects online experiment was conducted among university students ≥18 years, enrolled at a Swiss university, and not following a medically prescribed diet. The outcome was the mean climate footprint of food choices (in kg CO2-eq), based on a Life Cycle Assessment. Meals varied in climate footprints while adhering to the Swiss dietary guidelines. Results This analysis focused on the subset of meat eaters (n = 1691). Median age was 24 years, and 59.85% (n = 1012) were female. Seven intervention groups resulted in significantly lower climate footprints compared to the control. The social dilemma plus a nudge menu was the most effective behavioural intervention leading to 20.20% footprint reduction (b = -1.20 kg CO2-eq) compared to the control group (Mcontrol=5.94, SDcontrol=2.76; Mdilemma+nudge=4.74, SDdilemma+nudge=2.09 t(436) = -5.10, p &amp;lt; 0.001). Lifestyle factors linked to a higher climate footprint of food choices included adhering to a low-calorie diet (b = 1.21 kg CO2-eq, p &amp;lt; 0.05), or a muscle gain diet (b = 2.12 kg CO2-eq p &amp;lt; 0.05) and practising physical activities (PA) while adhering to a muscle-gain diet (Aerobic/Cardio: 3.82 kg CO2-eq, p &amp;lt; 0.05; Muscle-strengthening: 2.24 kg CO2-eq, p &amp;lt; 0.05). Conclusions The combination of reflective collective action communication and menu nudges is an effective strategy to mitigate the climate footprint of food choices in education institutions. Adherence to a muscle-gain diet was identified as a critical but manageable lifestyle factor linked to a higher climate footprint. Key messages • The dilemma plus a nudge was the most effective to reduce the climate footprint of food choices. • This combined intervention can manage the high climate footprints linked to lifestyle factors.

A transnational movement to support the sustainable transition towards a healthy and Eco-friendly Agri-Food System through the promotion of MEDIET and its lifestyle in modern society: MEDIET4ALL

Abstract The Mediterranean diet is considered the world’s most evidence-based low processed eating pattern for promoting health and longevity while saving water/energy and conserving land. Unfortunately, due to the modern societal trends, adherence to the Mediterranean diet model is decreasing, while the consumption of takeout and ultra-processed foods and drinks (UPFDs) is exponentially growing, with alarming levels in many European-Mediterranean (EUR-MED) regions. The overall objective of “MEDIET4ALL” is to support the transition from UPFs culture to modern and sustainable Mediterranean diet through the creation of transnational movement aiming at implementing best practices and innovative solutions to enhance the convenience, modernity, competitivity, and shelf life of Mediterranean diet. To achieve this overall objective, different multidisciplinary tailored approaches are proposed. Specifically, multicenter databases of ingredients/food and their providers will be created to promote the accessibility. Additionally, a variety of highly nutritional and antioxidant-rich “Quick &amp; Easy” recipes that respond to modern trends while following the Mediterranean diet and considering sustainability aspects will be developed. To preserve the eco-friendly and food safety characteristics and extend the shelf life of the Mediterranean diet products, active bio-packaging will also be designed. A strategic “MEDIET4ALL” platform and m-app integrating the abovementioned MEDIET4ALL products and combined Mediterranean lifestyle interventions tailored to each user profile will be developed. Traditional and technology-based awareness and motivational campaigns with extensive marketing and advertising actions to promote MEDIET4ALL movement are also programmed. Working under the concept of a multidisciplinary approach consortium, multiple impacts, particularly supporting the transition towards a healthy and sustainable MED diet and lifestyle, are expected.

The effectiveness of exercise interventions on psychological distress in patients with lung cancer: a systematic review and meta-analysis.

To assess the effectiveness of exercise interventions on psychological distress in lung cancer patients and how this effectiveness varies by cancer stage, treatment, intervention type (exercise/with other interventions), exercise mode, duration, and sustained effects over time. Randomized controlled trials (RCTs) investigating exercise effects on psychological distress were included. Exclusion criteria were studies with less than 50% lung cancer patients, those on pharmacotherapy/psychotherapy, and studies focused solely on breathing exercises. Data sources included PubMed, Embase, MEDLINE, CINAHL, and Scopus. Reporting followed PRISMA 2020 guidelines, with analysis via Review Manager 5.4, and quality assessed using Cochrane RoB 2. Twenty-two studies with 1524 participants were selected from 611 articles. All intervention groups were compared to usual care. Meta-analysis, including 11 studies, showed significant reductions in anxiety (SMD = - 0.52, 95% CI = - 0.94 to - 0.09, p = .02) and depression (SMD = - 0.55, 95% CI = - 0.89 to - 0.21, p = .001). The subgroup revealed that early-stage patients, surgery alone, engaging in aerobic exercise (with other exercise modes) or combined interventions showed greater effectiveness in reducing anxiety and depression. Regarding sustained effects, exercise interventions showed a significant medium-term effect on reducing anxiety. Exercise interventions show promise in reducing psychological distress among lung cancer patients. However, further research is needed to optimize these interventions and explore their long-term effects. The effectiveness of exercise interventions on psychological distress in lung cancer patients varies by cancer stage, treatment, and intervention type, supporting the use of tailored programs.

Effectiveness of combined physical exercise and cognitive training in older adults with cognitive impairment: A systematic review and meta-analysis

Falls among cognitively impaired older adults are a global concern. The aim of this study was to assess the efficacy of combining physical exercise and cognitive training to improve balance among older adults. A systematic search of databases, including Embase, Medline-OVID, CINAHL-EBSCOhost, and Central-Cochrane Library, was conducted from March 9 to April 6, 2023. The search used keywords based on the PICO question, where the population was older adults with cognitive impairment. Compared to a single therapy, the intervention involved a combination of muscle strengthening and cognitive therapy, with the outcome of falls or balance. Inclusion criteria were randomized controlled trials (RCTs) in any setting. Studies with participants under 60 years old and lacking baseline clinical assessments were excluded. EndNote 20 was used as a reference manager tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram was used to map out the number of identified records. Two investigators worked independently, and the Jadad scale was used for critical appraisal. The PROSPERO registration number is CRD42023454876. A fixed-effects meta-analysis was performed using an inverse-variance method. Four articles met the inclusion criteria, three of which were included in the meta-analysis. Studies were from Europe, New Zealand, and the Philippines, with a total sample of 255 participants and mean ages of 65.9–87.5 years. The studies used combined physical and cognitive training in one group. Results showed a significant moderate effect size (effect size (ES): 2.29; standardized mean difference (SMD): 0.41; p&lt;0.05; heterogeneity (I2): 0%) indicating no heterogeneity. In conclusion, the combined intervention displayed the potential to improve balance for cognitively impaired older adults.

Clinical study on the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence

To explore the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence. Ninety stroke patients during convalescence were collected and randomized into scalp point group, robot training group and combined intervention group, with 30 cases each. In the scalp point group, the cluster needling was delivered at scalp points with the needles retained. In the robot training group, the patients were trained with the upper-limb intelligent rehabilitation robot. In the combined intervention group, the patients received both the cluster needling and the training of the upper-limb intelligent rehabilitation robot. In each group, the treatment was given once daily, 5 treatments a week with 2 days rest, for consecutive 4 weeks. Separately, before and after treatment, the score of Fugl-Meyer assessment upper extremity scale (FMA-UE) and the score of activity of daily living (ADL) were evaluated. Using the in-built assessment system of the upper-limb intelligent rehabilitation robot, the range of motion (ROM) of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint were evaluated. With surface electromyogram (sEMG), the sEMG value of the deltoid muscle and the pectoralis major on the affected side were detected. Compared with the values before treatment, ADL score and FMA-UA score increased in patients of the three groups (P<0.05), and ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint was larger (P<0.05), the sEMG value of the fasciculi pectoralis major anterior of patients in the combined intervention group was reduced (P<0.05), and the sEMG of anterior deltoid tract was elevated in the three groups (P<0.05). When compared with the scalp point group and the robot group, in the combined intervention group, after treatment, ADL score and FMA-UA score were higher (P<0.05), ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint elevated (P<0.05) and sEMG value of the fasciculi pectoralis major anterior reduced (P<0.05), while which of the anterior deltoid tract was elevated (P<0.05). The cluster needling at scalp points with needle retaining, combined with the training of the upper-limb intelligent rehabilitation robot, improves the upper limb motor function and the range of motion of the shoulder joint in stroke patients during convalescence.

Efficacy of a combined exercise and nutrition intervention study for outpatients with possible sarcopenia in community-based primary care clinics (ENdSarC): study protocol for a multicenter single-blinded randomized controlled trial

BackgroundSarcopenia is a geriatric disease characterized by loss of muscle mass and strength. Although combined exercise and nutrition intervention are known to be effective for sarcopenia, clinical trials involving outpatients with sarcopenia in primary care are scarce. We describe a protocol for a trial to examine the effects of a 12-week combined exercise and nutrition intervention in Korean older adults with possible sarcopenia in community-based primary care.MethodsThis multicenter, randomized, controlled trial will include 94 community-dwelling older outpatients aged 65–85 years with possible sarcopenia (47 participants in the intervention and control groups each). Resistance exercises, which incorporate concentric and eccentric exercises, will consist of an introductory phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; contraction exercises), an expanded phase (3 weeks: twice-weekly supervised exercise sessions and once-weekly home exercises; eccentric exercises), and a maintenance phase (6 weeks: once-weekly supervised exercise sessions and twice-weekly home exercises; power/eccentric exercises). Nutritional supplementation will be provided according to the nutritional status of the participants using a Mini-Nutritional Assessment. Participants will be assessed at baseline, 12 and 24 weeks, and the primary outcome will be the 5-times chair stand test results.DiscussionTo the best of our knowledge, this will be the first clinical trial to evaluate the efficacy of a combined exercise and nutritional supplementation intervention in older outpatients with possible sarcopenia in community-based primary care clinics. These findings will provide new insights to clinicians regarding the long-term usability for doctors and outpatients with possible sarcopenia in community-based primary care.Trial registrationThis trial was prospectively registered at ClinicalTrials.gov on September 16, 2023 (registration number: NCT06049914).

Combined exercise Intervention protocol validation in sedentary workers health risk with Nonspecific Chronic low back pain People

Background: Most chronic low back pain is nonspecific as the cause of the pain is unknown. Hence exercise protocol focussing on one area of fitness is not appropriate. A general exercise programme that combines muscular strength, flexibility and aerobic fitness would benefit the rehabilitation of Nonspecific Chronic Low Back Pain and its health risk. The present study aimed to validate the content of the combined exercise intervention protocol. Methods: The development and expert judgement stages are part of the content validation process. The development of the exercise protocol was based on a comprehensive literature review. The protocol was created in a step-by-step progressive manner. Exercises for flexibility (20 minutes), stabilisation and strengthening (20 minutes), and aerobic (20 minutes) make up the three main parts of the exercise protocol. 12 independent professionals with a minimum of 10 years of experience were invited. Ten of the twelve specialists consented to take part in the study. In India, all of the professionals were engaged in orthopaedic and musculoskeletal physical therapy. There are two professors, three associate professors, and five senior physiotherapists among the experts. Responses were gathered by mail. During the validation phase, The Exercise protocol was graded by the experts on relevance and ease of performance using a 5-point scale. After collecting the responses content validity index and kappa values were calculated. Results: 37 out of 39 items in the combined exercise intervention protocol showed good agreement. Treadmill walking with 60-75% and 80% and above target heart rate showed a kappa value of 0.66 for relevance and 0.50 for ease of performance. Conclusions: The designed exercise protocol exhibited good content validity.

Synergistic amelioration of obesity in high‐fat diet–fed mice by Bifidobacterium longum and green banana powder through targeting multiple pathways

AbstractLong‐term consumption of high‐fat diet (HFD) is a major significant risk factor for various diseases, including hyperlipidemia, diabetes, cardiovascular disease, and certain cancers. Recently, there has been a focus on effective dietary methods to improve lipid absorption and accumulation in the body. Simultaneously, exploring non‐pharmacological interventions to counteract the adverse consequences of obesity is crucial. Probiotics and prebiotics emerge as promising alternatives in this context, with their combined utilization yielding substantial effects surpassing those achieved by individual application alone. The aim of this study was to investigate the combined effects of Bifidobacterium longum (BL) SYP‐B4138 and green banana powder (GBP) on HFD‐induced obesity while exploring their underlying mechanisms. The findings demonstrated that the combined intervention exhibited significantly greater efficacy than BL or GBP alone, including in mitigating weight gain and organ weight among obese mice, while also improving lipid profile, glucose tolerance, and inflammation levels. Furthermore, it effectively reduced liver fat accumulation. The mechanism study revealed that the combined intervention increased the expression of gene‐related lipid metabolism, such as Pparα, Cpt1a, Fxr, Cyp7a1, and Bsep, while decreasing expression of the regulatory genes involved in fat synthesis, Acc1, Srebpf1, and Pparγ. The correlation analysis of gut microbes and metabolites suggests that the combined effect of BL and GBP can reverse the intestinal microecological imbalance, leading to changes in bile acids, glycerophospholipids, and other related metabolites. Overall, this study demonstrates that BL combined with GBP can effectively alleviate dietary obesity, highlighting its potential as a non‐pharmacological intervention for weight reduction.

Effectiveness of Educational Interventions to Develop Patient Safety Competencies in Undergraduate Nursing Students: A Systematic Review.

Nursing professionals are key to providing safe care that improves patient outcomes. Hence, it is essential to focus on developing nurses' patient safety competencies and principles. This review examined the effectiveness of educational interventions in developing patient safety knowledge, skills, behaviors, and attitudes in undergraduate nursing students. The search strategy aimed to identify published and unpublished studies in databases and grey literature. Studies were assessed using the Joanna Briggs Institute critical appraisal tools. A total of 36 studies met the inclusion criteria. The teaching methods employed single or combined interventions and the educational interventions suggested either improvements in outcomes or no impact. The effectiveness of educational interventions to develop patient safety competencies in undergraduate nursing students, either as a single or combined strategy, was mixed. Further research is needed to provide more robust evidence on which teaching method for patient safety is most effective.