Combined Intervention Research Articles

Effect of diet combined with exercise intervention on tumor necrosis factor α in overweight or obese groups: Based on the exercise dose-response relationship

Background: Chronic low-grade systemic inflammation, often linked to obesity or being overweight, is associated with various complications and an increased risk of disease development. Tumor necrosis factor α (TNF-α) is a key inflammatory factor that significantly impacts various body functions. Objective: 1) To assess whether combined interventions are more effective than single interventions in combining diet and exercise. 2) To assess the effectiveness of exercise dose in different interventions on tumor necrosis factor (TNF-α) levels in obese or overweight patients. Methods: A thorough search was conducted across four electronic databases of randomized controlled trials that focus on exercise or dietary interventions for patients with obesity or overweight. This comprehensive review encompasses data collected up to August 2024. Two independent researchers conducted a thorough evaluation of the literature's quality. Network and dose-response analyses were performed using random effects models to examine the impact of diverse interventions on TNF-α. Results: A total of 19 randomized controlled trials with 1479 patients with obesity or overweight were included. The meta-analysis showed that the hypocaloric diet combined with aerobic training (HDAT) possessed the highest ranking (SMD= -1.00,95%CI -1.51 to -0.49), followed by the hypocaloric diet (HD) (SMD= -0.40,95%CI -0.89 to 0.09), hypocaloric diet combined with resistance training (HDRT) (SMD= -0.48,95%CI- 1.43 to 0.48), and aerobic training combined with resistance training (ART) (SMD= -0.18,95%CI -0.92 to 0.57). Additionally, a notable improvement in TNF-α levels was observed in individuals adhering to a hypocaloric diet in conjunction with exercise when the cumulative exercise volume reached 150 metabolic equivalent of task minutes per week. Conclusion: Based on the GRADE rating guidelines, moderate-quality research evidence indicates that a hypocaloric diet combined with aerobic training (HDAT) is the most effective intervention for enhancing tumor TNF-α levels in individuals with obesity or overweight. Additionally, the dose-response relationship was observed between the total exercise dose and TNF-α levels. Future research should investigate the specific effects of various aerobic exercise modalities on TNF-α levels in obese or overweight patients to develop a more personalized approach to exercise prescription.

(Cost-)effectiveness and implementation of a combined lifestyle intervention for outpatients with severe mental illness (GOAL!): a hybrid quasi-experimental study protocol.

People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!. In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group's needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one's daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3). This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI. ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

A Multidimensional Investigation of Diastasis Recti Abdominis Treatment and Assessment in Postpartum Women: A Systematic Review and Meta-Analysis

Introduction: Diastasis recti abdominis (DRA) is prevalent among postpartum women, with various physiotherapy treatments utilized. Despite the effectiveness of diverse DRA treatment methods and the importance of evaluating its levels and methods, limited attention has been given to this aspect. This study comprehensively investigates DRA, examining evaluation levels and methods, and assessing the efficacy of diverse physiotherapy interventions. Materials and Methods: Online search was conducted in Cochrane, ProQuest, PubMed, Embase, Scopus, Web of Science, Google Scholar, and Magiran databases until the end of 2022, employing the population, intervention, comparison, and outcome framework (population = DRA, intervention = physiotherapy, comparison = control, and outcome = inter- rectus-distance [IRD]). The JBI checklist and Cochrane Collaboration RoB 2.0 tool evaluated critical appraisal and bias risk. Meta-analysis was performed using the RevMan software. Results: The study included 16 articles with 650 postpartum women. The findings revealed no significant differences in various measurement methods (P=0.25) and levels (P=0.10). Combination therapy demonstrated greater effectiveness than exercise alone in reducing IRD (P=0.04), with tape being particularly impactful (P=0.009). Conclusion: Although sonography evaluation of IRD above the umbilicus is recommended, the study highlights the limitation of diverse measurement methods and levels in determining the optimal physiotherapy intervention. Despite the preference for combined interventions, especially tape alongside exercise for women with DRA, further research is essential due to limited evidence, aiming to provide greater insights into this issue.

“Investigating the combined effects of scapular-focused training and Mulligan mobilization on shoulder impingement syndrome” a three-arm pilot randomized controlled trial

ObjectivesTo assess whether the combination of scapular-focused training and mulligan mobilization (SFTMM) improves pain and proprioception compared to scapular-focused training (SFT) and a control group in female rock climbers with shoulder impingement syndrome (SIS).DesignThree-arm randomized controlled trial (RCT).SettingOutpatient setting.SubjectsIndividuals were randomly assigned to SFTMM, SFT alone, and control group.Interventions8 weeks of SFTMM and SFT.Main measuresOutcome measures were pain and proprioception.ResultsThe results revealed significant differences in pain scores and proprioception among female rock climbers with SIS who participated in SFTMM, SFT, and a control group (F(2, 32) = 81.01, p = 0.001, η2 = 0.83 for pain scores; F(2, 32) = 178.2, p = 0.001, η2 = 0.91 for proprioception scores). Post-hoc tests via the Bonferroni test indicated that both SFTMM and SFT significantly reduced pain levels (p = 0.001) and improved proprioception levels (p = 0.001) compared with the control group. There was no significant difference in pain scores and proprioception between the SFTMM group and the SFT group (p > 0.05).ConclusionsIn conclusion, the study indicates that SFTMM significantly reduces pain and improves proprioception in female rock climbers with SIS, as shown by notable changes compared to the control group. However, no statistically significant difference was found between the SFTMM (combined intervention) and SFT alone. Therefore, while the incorporation of SFT and MM shows promise; further research is needed to fully understand its long-term benefits and clinical implications.Ethical Code RegistrationThe study was approved at Ethics.research.ac.ir, code: IR.SSRC.REC.1402.170 on 2023-10-22.

Colonoscopy Assisted Laparoscopic Wedge Resection for Colonic Lesions: Impact on Quality of LifE: Results from the LIMERIC Study.

The LIMERIC study has proven that colonoscopy-assisted laparoscopic wedge resection effectively and safely removes benign colonic lesions unsuitable for endoscopic removal, thereby avoiding the need for major surgery. To evaluate the impact of colonoscopy-assisted laparoscopic wedge on health-related quality of life of patients who participated in the LIMERIC study. Prospective multicenter study. The LIMERIC study was performed between 2016 and 2020 in 13 Dutch hospitals. EQ-5D-5L questionnaires were administered at baseline and 3 months after the procedure. Patients with incomplete pre- or postoperative questionnaires or those undergoing combined interventions were excluded from the intention-to-treat analysis. Those for whom CAL-WR was not feasible or who underwent completion surgery were excluded from the per-protocol analysis. Colonoscopy-assisted laparoscopic wedge for either (1) colon polyp unsuitable for endoscopic resection; (2) non-lifting residual or recurrent polyp within scar tissue following previous polypectomy; or (3) Rx/R1 endoscopic removal of a low-risk pT1 colon carcinoma. Three-month health-related quality of life. Colonoscopy-assisted laparoscopic wedge did not affect health-related quality of life in the per-protocol analysis (n = 56), or in the intention-to-treat analysis (n = 67). The majority of patients reported no change in health status (57%). No significant differences were observed in the distribution of responses across all 5 dimensions before and after colonoscopy-assisted laparoscopic wedge. Patients' self-rated EQ-VAS was also unaffected by colonoscopy-assisted laparoscopic wedge, with a median VAS score of 82.5 at baseline and 80 after surgery in the per-protocol analysis (p = 0.63). Solely a patient-reported outcome measure evaluating global health-related quality of life was used, rather than one specifically assessing disease-related quality of life, such as the QLQ-CR29. Colonoscopy-assisted laparoscopic wedge has no significant impact on the health-related quality of life in patients with benign colonic lesions and should therefore be considered before major surgery is performed. See Video Abstract.

The intervention effect of psychological care combined with ondansetron, dexamethasone, and promethazine hydrochloride on chemotherapy in breast cancer surgical patients.

Breast cancer (BC) is one of the most common malignancies in women and imposes a significant health burden globally. According to data from the World Health Organization, the incidence of BC has been increasing steadily over the years. It has become one of the leading causes of cancer-related death among women worldwide. This work was to evaluate the combined intervention effect of psychological care along with the use of ondansetron, dexamethasone, and promethazine hydrochloride in breast cancer (BC) patients undergoing chemotherapy, including their impact on nausea and vomiting control, quality of life (QoL), and psychological status. 64 BC patients undergoing chemotherapy were collected and randomly rolled into a control group (Group C) and an intervention group (Group I). Group C received ondansetron combined with routine psychological support and counseling therapy, while Group I received a combination of ondansetron, dexamethasone, promethazine hydrochloride, and psychological care therapy. Self-assessment scores for anxiety, QoL ratings, white blood cell counts, and incidence of adverse reactions were assessed and compared between the two groups. Group I showed better control of nausea and vomiting versus Group C (P< 0.05). Marked improvements were also observed in the self-rating anxiety scale (SAS) scores, white blood cell counts, and nursing satisfaction in Group I versus Group C (P< 0.05). Nevertheless, the two groups had no significant difference regarding QoL scores (P> 0.05). the combination of psychological care with ondansetron, dexamethasone, and promethazine hydrochloride effectively controls nausea and vomiting symptoms in BC patients undergoing chemotherapy and provides higher levels of clinical nursing satisfaction.

Impact of exercise intervention with or without curcumin supplementation on body fat composition, glucose, and lipid metabolism in obese adults: A meta-analysis.

This study was carried out to systematically review and evaluate the influence of exercise with and without curcumin on body fat composition, glucose, and lipid metabolism in obese adults. Search for eligible studies through four databases, and then proceed with screening. The inclusion criteria are as follows: (1) obese adults; (2) randomized controlled trial (RCT); (3) classified the exercise intervention with curcumin supplementation as the exercise with curcumin (CU) group and without curcumin supplementation as the exercise without curcumin (EX) group; (4) Conducted pre- and post-training assessments, which include body fat composition, glucose and lipid metabolism parameters. Use the Cochrane bias risk assessment tool to evaluate the quality of the selected study. Select standardized mean difference (SMD) as the appropriate effect scale index, and use Revman 5.4 software to analyze the mean difference of the selected article data with a 95% confidence interval (CI). A total of seven studies fulfilled the inclusion criteria and were selected for the meta-analysis. The included studies involved 72 males and 111 females, where 94 belonged to the EX group and 89 from the CU group. The CU group benefited more from the reduced Fat% (SMD, 2.18 [0.12, 4.24], p < 0.05, I2 = 0%, p for heterogeneity = 0.98) than the EX group. The study demonstrated that the combined exercise intervention with curcumin supplementation significantly reduced Fat% in obese adults compared with exercise without supplementing curcumin.

The Effect of Interventions on Quality of Life, Depression, and the Burden of Care of Stroke Patients and Their Caregivers: A Systematic Review.

BACKGROUND: The impact of stroke is a global concern for health policymakers. A large proportion of survivors require long-term support from family members who are typically unprepared for their caregiving duties. This study determined the effect of different interventions on quality of life (QoL), depression, and the burden of care of stroke patients and their caregivers. METHODS: A systematic review was conducted from 2000 up to May 2023. Study inclusion criteria were as follows: individuals serving as informal caregivers for stroke survivors 18 years and older, devoting a significant portion of their time to the care of such survivors; involvement in psychoeducational, informational, supportive, psychosocial, or combined interventions; exposure to standard or conventional care practices; evaluation of outcomes relating to the QoL for stroke caregivers, depression, caregiver burden, and levels of stroke survivors; and consideration of randomized controlled trials and quasi-experimental studies. RESULTS: Thirty-seven studies met the inclusion criteria and were synthesized in this systematic review. Details of intervention were divided into 3 groups: educational and psychoeducational programs, multidisciplinary approaches, and support and caregiver skill-building programs; 12 studies focused on different interventions affecting the QoL, 23 studies focused on the burden of stroke caregivers, and 20 studies focused on depression of stroke patients and their caregivers. CONCLUSION: The desired effectiveness of particular interventions was evident in the results, although conflicting findings have emerged. The study emphasizes the need for well-structured preliminary studies for each intervention type. More studies on interventions and outcomes might lead secondary researchers to conduct analyses to ensure the certainty of results.

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.