Session Duration Research Articles

An interactive dashboard for analyzing user interaction patterns in the i2b2 clinical data warehouse

Abstract Background Clinical data warehouses provide harmonized access to healthcare data for medical researchers. Informatics for Integrating Biology and the Bedside (i2b2) is a well-established open-source solution with the major benefit that data representations can be tailored to support specific use cases. These data representations can be defined and improved via an iterative approach together with domain experts and the medical researchers using the platform. To facilitate these discussions, it is important to understand how users interact with the system. Objective The objective of this work was to develop metrics for describing user interactions with clinical data warehouses in general and i2b2 in particular. Moreover, we aimed to develop a dashboard featuring interactive visualizations that inform data engineers and data stewards about potential improvements. Methods We first identified metrics for different data usage dimensions and extracted the relevant metadata about previous user queries from the i2b2 database schema for further analysis. We then implemented associated visualizations in Python and integrated the results into an interactive dashboard using Dash. Results The identified categories of metrics include frequency of use, session duration, and use of functionality and features. We created a dashboard that extends our local i2b2 data warehouse platform, focusing on the latter category, further broken down into the number of queries, frequently queried concepts, and query complexity. The implementation is available as open-source software. Conclusion A range of metrics can be derived from metadata logged in the i2b2 database schema to provide data engineers and data stewards with a comprehensive understanding of how users interact with the platform. This can help to identify the strengths and limitations of specific instances of the platform for specific use cases and aid their iterative improvement.

Do Beliefs About Intelligence Drive Engagement in Online Learning?

This study investigates the relationship between students’ beliefs about intelligence (fixed vs. growth mindset) and their engagement and behaviour in an online learning platform. The data was collected from 28 students enrolled in COMP90082 – Software Project subject at The University of Melbourne. Students’ beliefs about intelligence were measured through a survey administered during the first week, while their online learning behaviours were captured through clickstream data from the learning management system. The study adopted a two-fold approach: first, students’ learning strategies were identified through cluster analysis of their online session duration. By examining over 41,000 learning actions —such as accessing course materials, participating in discussions, and completing assignments— three distinct learning strategies emerged: “light”, “light-intensive”, and “intensive.” Subsequently, the relationship between these learning strategies and students’ beliefs about intelligence was examined using data visualisation techniques, chi-square tests, and logistic regression models. The findings revealed that students with a growth mindset were more likely to adopt intensive and engaged learning approaches within the online platform. Conversely, those with a fixed mindset tended to exhibit lower engagement levels and less intensive learning strategies. The study may contribute to the growing literature on the psychology of online learning and highlight the potential for tailoring instructional interventions and platform design to foster a growth mindset, thereby enhancing student engagement and academic success in digital learning environments.

The Effect of Effort During a Resistance Exercise Session on Glycemic Control in Individuals Living With Prediabetes or Type 2 Diabetes: Protocol for a Crossover Randomized Controlled Trial.

Type 2 diabetes (T2D) is preceded by prediabetes, and these conditions place a great burden on patients and society. These conditions are significantly associated with poor glycemic control, which is improved by resistance exercise. It has been suggested that resistance exercise should be performed with a high degree of effort to improve glucose metabolism, but this is associated with negative psychological responses that might lead to lower long-term adherence. This study aimed to investigate the effect of the degree of effort during a resistance exercise session on glycemic control and psychological responses in individuals living with prediabetes or T2D. This study will be a crossover, 3-arm, randomized controlled trial. A total of 15 participants living with prediabetes or T2D will be thoroughly familiarized with 7 resistance exercises; afterward, they will perform 3 randomized experimental sessions, each lasting approximately 48 hours each, separated by at least 4 washout days. In 2 of these sessions, supervised resistance exercise will be performed, but the sessions will differ in the degree of effort in each set (high vs low) and will be equalized in terms of total weight lifted and session duration. For this, proximity to failure will be manipulated by changing the number of sets per exercise, the number of repetitions per set, and the resting interval between sets and exercises. Participants will also complete a sedentary (control) session, where they will not perform any exercise. In response to each session, psychological responses will be assessed (exertion, affect, enjoyment, self-efficacy, and discomfort). Glycemic control will be assessed by a continuous glucose monitoring device every 5 minutes, throughout the approximately 48 hours of each experimental session. Food and drink will be individually prescribed by a registered dietitian nutritionist and provided to participants, in order to control for the confounding effect of energy intake and diet composition. Physical activity levels will be assessed by accelerometry. Randomization will be done using the opaque, sequentially numbered envelopes technique. Participants and researchers will be blinded for continuous glucose monitoring and accelerometry data, and data will be analyzed by a blinded statistician. This study has been funded, and data collection is expected to take place between June 2024 and May 2025. Final manuscript submission should happen by August 2025. The results of this project might encourage individuals living with prediabetes and T2D to engage in resistance exercise while better informing exercise specialists on how to best incorporate resistance exercise in their client's or patient's routine. ClinicalTrials.gov NCT06208189; https://clinicaltrials.gov/study/NCT06208189. PRR1-10.2196/63598.

Artificial gravity: an effective countermeasure for microgravity-induced headward fluid shift?

Long-duration spaceflight is associated with pathophysiological changes in the intracranial compartment hypothetically linked to microgravity-induced headward fluid shift. This study aimed to determine whether daily artificial gravity (AG) sessions can mitigate these effects, supporting its application as a countermeasure to spaceflight. Twenty-four healthy adult volunteers (16 men) were exposed to 60 days of 6° head-down tilt bed rest (HDTBR) as a ground-based analog of chronic headward fluid shift. Subjects were divided equally into three groups: no AG (control), daily 30-min intermittent AG (iAG), and daily 30-min continuous (cAG). Internal carotid artery (ICA) stroke volume (ICASV), ICA resistive index (ICARI), ICA flow rate (ICAFR), aqueductal cerebral spinal fluid flow velocity (CSFV), and intracranial volumetrics were quantified at 3 T. MRI was performed at baseline, 14 and 52 days into HDTBR, and 3 days after HDTBR (recovery). A mixed model approach was used with intervention and time as the fixed effect factors and the subject as the random effect factor. Compared with baseline, HDTBR was characterized by expansion of lateral ventricular, white matter, gray matter, and brain + total intracranial cerebral spinal fluid volumes, increased CSFv, decreased ICASV, and decreased ICAFR by 52 days into HBTBR (All Ps < 0.05). ICARI was only increased 14 days into HDTBR (P < 0.05). Neither iAG nor cAG significantly affected measurements compared with HDTBR alone, indicating that 30 min of daily exposure was insufficient to mitigate the intracranial effects of headward fluid shift. Greater AG session exposure time, gravitational force, or both are suggested for future countermeasure research.NEW & NOTEWORTHY Brief exposure to continuous or intermittent artificial gravity via short-arm centrifugation was insufficient in mitigating the intracranial pathophysiological effects of the headward fluid shift simulated during head-down tilt bed rest (HDTBR). Our results suggest that greater centrifugation session duration, gravitational force, or both may be required to prevent the development of spaceflight-associated neuro-ocular syndrome and should be considered in future ground-based countermeasure studies.

Relation between wearable heart rate monitor derived training load and cardiac adaption in endurance athletes

Abstract Background No studies have effectively measured training load (TL) from wearable heart rate (HR) monitors and determined its relation to exercise induced left and right ventricular (LV, RV) remodeling. A better insight into drivers of exercise induced cardiac remodeling is of clinical relevance to guide training advice in athletes at risk of adverse remodeling. Purpose We determined the TL, based on HR monitoring by commercial wearables[1]. The number and duration of training sessions was quantified during a period of 3 months. Training-intensity was calculated as Edwards TRIMP (eTRIMP) based on the product of training duration in one of 5 HR zones (1=light, 5=very vigorous) and the coefficient related to the respective HR zone. Methods Training data was collected in 2 prospective multicenter studies. Master@Heart comprises endurance trained middle-aged men aged 45 to 70years[2]. Pro@Heart consists of elite athletes aged 16 to 23years[3]. For this analysis, all male athletes with complete training data recorded using a chest-worn HR monitor for 3 months were included. Using an in-house developed pipeline, maximal HR and TL were calculated from raw training data. Cardiac magnetic resonance imaging was performed to measure indexed LV/RV end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume (LVESVi, RVESVi), ejection fraction (LVEF, RVEF) and LV mass (LVMi). Results Pro@Heart athletes (n=69; age 21.9 ± 4.2 years) trained more than Master@Heart athletes (n=82; age 55.2 ± 6.5 years) and their total 3-month TL (eTRIMP) was also higher (9718 ± 3190 vs. 5499 ± 3775min; P&amp;lt;0.05 and 22339 ± 7350 vs. 13438 ± 8880 AU; P&amp;lt; 0.05; Table 1). Considering all athletes, there was a strong correlation between both training duration and eTRIMP and LVEDVi, LVESVi, LVMi, RVEDVi and RVESVi. Training duration in zone 1&amp;2 correlated well with LVEDVi, LVESVi, LVSV, LVMi, RVEDVi and RVESVi (Table 2). We found small significant negative correlations between duration and eTRIMP compared to LVEF and RVEF (Table 2). To filter out individual training factors influencing cardiac remodeling we used a partial least squares method which included time and percentage of time spent in training zones and age. Accordingly, training duration in zone 1&amp;2 and age were the main predictors of cardiac volumes and LVMi. For LVEF, age and time in zone 3 was most predictive, whereas for RVEF zone 3 and to a lesser degree zone 1&amp;2 were the main predictors, irrespective of age. Interestingly, time spent in high intensity zones 4 and 5 was not predictive. Conclusion We prospectively quantified TL in comparison to CMR-derived measures of cardiac remodeling and demonstrated that training duration in low intensity training zones is most predictive for cardiac volumes and mass, whereas LVEF and RVEF are more closely associated to time in zone 3. Very vigorous intensity exercise was not predictive, likely due to limited time training in zone 4 and 5.

Surfing a culturally-relevant physical activity: a new wave for health promotion

Abstract Background Surfing originated with Native Hawaiians prior to Western contact. It has since gained worldwide popularity, with an estimated 50 million surfers globally, and recently became an official Olympic sport. Associations have been reported between surfing and mental and physical health outcomes, greater community cohesion, and stronger intra-family relationships. Despite this evidence, surfing is deeply understudied in the context of health promotion. Purpose Surfing was analyzed from a mixed methods perspective to explore factors associated with lifetime participation and current engagement, including gender, race/ethnicity, chronic disease, social context, meaning, and average time of participation. Methods Hawai’i adult residents (n = 1066) completed an online or phone questionnaire. Modified Poisson regression models were fit for lifetime engagement and having a self-reported chronic disease, adjusting for primary race/ethnicity, age, gender, and education. Results Over their lifetime, 42% of respondents (50% men and 37% women) had participated in surfing. Engagement was highest during youth and young adulthood, and decreased with age, yet trends varied notably by race/ethnicity, gender, and generation. Lifetime surfing engagement was significantly related to lower likelihood of diabetes (aPR:0.72; 95%CI:0.56-0.92;p=0.009). Individuals who regularly participated in surfing typically did so with friends (78%) or family (61%); average surfing session duration was 209 minutes. Qualitative results revealed the relevance of surfing across levels of influence for health and wellbeing from physical fitness to community, culture, history and spirituality. Conclusions This work provides insights on the health promotion opportunities of surfing across the life-course and populations, including disease prevention and management. This study has implications for planning and policy locally and globally to achieve optimal community and planetary health. Key messages • Surfing is not only a sport for elite athletes, but also an activity that can support community and individual health and wellbeing in many populations over the lifespan. • Promotion of surfing and public ocean access can support multidimensional influences for wellbeing and should be a focus of cross sector collaborations for optimal community and planetary health.

Assessment of digital literacy and user experience in patients with cochlear implants

Abstract Introduction The cochlear implant (CI) is the treatment of choice for people affected by deafness or profound hearing loss. Patients with cochlear implants (PwCIs) can enhance their hearing outcomes using digital hearing training programs (dHTPs). Current technological trends leans towards personalized, AI-driven dHTPs, aiming to optimize user experience (UX) and adherence. This study aims to investigate the digital literacy skills and UX of PwCI before and after testing a prototype of a dHTP with an AI-driven design (TraiCI). Methods Two research-specific questionnaires developed by the Hearing Center Düsseldorf (QDL and QUX) were used to assess digital literacy skills and user experience in TraiCI. Additionally, the User Experience Questionnaire (UEQ) was employed to evaluate general user experience. The UEQ assesses software quality across dimensions such as transparency and stimulation using paired opposites. Results 22 outpatient PwCIs the Hearing Center Düsseldorf with unilateral or bilateral CI (mean age 54 years; SD = 15) were included. In QDL, PmCI demonstrated high levels of digital literacy skills. The majority of PmCI (80.6%) reported prior experience with dHTP. Usage of these programs occurred daily to multiple times per week within the first six months after CI treatment, with session durations predominantly ranging from 10 to 30 minutes. QUX data indicated a smooth initiation process (70.8%) and seamless login experience (95.5%). The UEQ addressed various aspects of user experience, with ‘transparency’ receiving the highest scores (MW = 1.9; SD = 0.6), while ‘stimulation’ received the least positive ratings (MW = 0.0; SD = 2.1). Conclusions The results show a high degree of digital literacy among PwCIs. They encountered minimal challenges in operating hardware and software components. Further refinement is necessary to align with PwCI’s expectations and maximize benefits. Early and iterative involvement of PwCIs in future projects could optimize outcomes. Key messages • The study highlights the proficient digital literacy skills of cochlear implant patients (PwCIs). • Further refinement of dHTPs is needed to better align with PwCIs’ expectations and maximize benefits, emphasizing the importance of iterative involvement for optimized outcomes.

Relationship Between Training Frequency and Training Session Duration on Vitality in Recreational Runners: A Cross-Sectional Study

Background: Running can improve health status from a biopsychosocial perspective. However, isolation strategies, like the COVID-19 pandemic-induced lockdown, produce deleterious effects on both health status and sport performance. The aim of our study was to investigate recreational runners’ sporting habits, subjective vitality (SV), and well-being after the COVID-19 pandemic-induced lockdown. Methods: After data filtration, 5542 recreational runners (74.5% men and 25.5% women, &gt;18 years) were selected for further analyses. The participants answered preliminary questions regarding sporting habits and completed the validated Spanish version of the Subjective Vitality as a Dynamic Reflection of Well-Being questionnaire for assessing their SV after lockdown. Results: Subjective vitality scores did not differ between men and women, nor between age groups (p = 0.41 and p = 0.11, respectively). Subjective vitality was greater with weekly training frequency up to 5 days/week, where this enhancement plateaued, while average training session duration was positively related to SV, stabilizing at 91–120 min/session (p &lt; 0.001 for both). Conclusions: There is a dose–response relationship between both weekly training frequency and training session duration, and mental health benefits in recreational runners. Further longitudinal studies are needed in order to determine the optimal dose–response relationship for simultaneously enhancing mental health outcomes and running performance in recreational runners, especially regarding weekly training frequency, training session duration, and exercise intensity.

Assessing the Efficacy of Lokomat Training in Pediatric Physiotherapy for Cerebral Palsy: A Progress Evaluation

Background: Gait disturbances in children with cerebral palsy can increase the hindrance caused by loss of independence and social engagement. The Lokomat, developed by Hocoma, shows promise as a supplementary tool for gait rehabilitation. This study investigates the impact of Lokomat training on gait parameters and trends observed during training. Methods: A total of 26 children (13 male individuals) with a diagnosis of cerebral palsy (CP), aged 4 to 23 years, were enrolled in the study. Patients participated in a standard comprehensive rehabilitation program with additional Lokomat training sessions. Gait function was assessed using the Timed Up and Go Test (TUG) and the 10 m walking test (10mWT) at the beginning and end of the rehabilitation period. Changes in Lokomat parameters (step number, session duration, speed, body weight support, and guidance force) were also analysed. Results: The median duration of the 10mWT and TUG significantly decreased across the groups after the treatment program. The highest increases were observed for the number of steps taken. Across the entire cohort, the linear trend curves for distance and number of steps exhibited near-perpendicular alignment with the horizontal axis, suggesting significant improvement in these parameters. A consistent trend was noted for speed, with the trend line aligned parallel with the horizontal axis. Decreasing trends were observed for body weight support and guidance force. Conclusions: Therapy with the Lokomat functioning as the active gait orthosis can be used as a form of support to the standard rehabilitation protocol for patients with CP.

Hyperbaric Oxygen Therapy (HBOT) in Moderate Traumatic Brain Injury (TBI): A Randomized Controlled Trial

Abstract Introduction Hyperbaric oxygen therapy (HBOT) is a novel technique recently under investigation with intention to improve outcomes in traumatic brain injury (TBI). It increases the partial pressure of oxygen in the blood and tissues by inhaling pure oxygen in an environment pressurized to at least 1.4 times normal atmospheric pressure (ATM) at sea level. The rationale behind the use of HBOT in TBI is its potential to mitigate the secondary brain injury cascade initiated by the primary mechanical trauma. Tissue damage and neuroinflammation secondary to intricate and complex cellular biochemical processes are expected to be counteracted by increased oxygen availability during HBOT, which reduces oxidative stress and improves neuroplasticity. Materials and Methods All patients, except whose legal guardians denied informed consent, with moderate TBI presenting to the neurotrauma center, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, were included within the study period of June 2022 to July 2023. Patient allocation was randomized into two arms: namely, treatment and control arm. Simple randomization was done using randomization mobile app, RRApp. Each patient received standard of care per the Brain Trauma Foundation guidelines. Patients randomized under the treatment arm additionally received adjuvant HBOT sessions. One session daily for 10 consecutive days. Session duration was for 60 minutes each at 1.4 ATM. The primary objective of the study was to compare the Glasgow Coma Score (GCS) at discharge and 3-month post-TBI Glasgow Outcome Scale-Extended (GOS-E) among patients in the treatment arm (those who received adjuvant HBOT) with those in the control arm (those who received only standard of care). Results The mean GCS (±standard deviation [SD]) at discharge in the treatment arm was 14.37 (±00.51) with a median of 14 and a range of 14 to 15. Comparatively, the mean GCS (±SD) at discharge in the control arm was 13.40 (±00.84) with a median of 13 and a range of 12 to 15. The difference between the two arms was statistically significant (p &lt; 0.001). GOS-E at 3 months postinjury for the treatment arm was 7.62 ± 00.51 (mean ± SD) with a median of 8 (range: 7–8). For the control arm, GOS-E at 3 months postinjury was 6.40 ± 1.50 (mean ± SD) with a median of 7 (range: 4–8). The difference between the two arms was statistically significant (p &lt; 0.001). Conclusion The current study concludes that early adjuvant HBOT using 1.4 ATM with one session of one-hour daily for 10 days among adults sustaining moderate TBI significantly improves GCS at 10 days. Early adjuvant HBOT is also associated with significantly improved GOS-E at 3 months postinjury compared to standard of care alone.

Social Support and Quality of Life in Hemodialysis Patients: A Comparative Study with Healthy Controls

Background and Objectives: Hemodialysis patients face significant physical and psychological challenges, including diminished quality of life and reduced social support. This study aimed to assess the levels of social support and quality of life in hemodialysis patients and identify the sociodemographic and dialysis-related factors influencing these outcomes. Materials and Methods: This study included 115 hemodialysis patients and 107 healthy controls. Social support was measured using the Modified Social Support Survey (MSSS) and its abbreviated version (MSSS-5). Quality of life was assessed using the WHOQOL-BREF questionnaire. Demographic variables (age, sex, education, marital status) and dialysis-related factors (session duration, Kt/V, vascular access type, and urea reduction ratio) were analyzed to determine their effects on social support and quality of life. Results: Hemodialysis patients reported significantly lower scores in the Physical Health and Psychological Health domains of the WHOQOL-BREF compared to healthy controls. Males on hemodialysis scored lower than the controls in the Physical Health, Psychological Health, and Environment domains of the WHOQOL-BREF and the Affectionate Support and Positive Social Interaction subscales of MSSS. Conversely, hemodialysis females reported higher scores for Tangible Support, Emotional/Informational Support, and Affectionate Support. Longer dialysis sessions negatively impacted the Social Relationships domain. Married hemodialysis patients had higher Emotional/Informational Support and Affectionate Support scores. Conclusions: Hemodialysis patients experience diminished physical and psychological quality of life, particularly males. Social support, especially emotional and informational support, is crucial for hemodialysis patients, with marital status playing a key role. Addressing these psychosocial factors may improve outcomes for hemodialysis patients.

Harnessing Physical Training Resolve through the Modernization of Large-Scale Sports Venues in Selected Colleges in Henan Province, China

The results of this study highlight the relationship between the modernization of large-scale sports venues and the physical training resolve of students in selected universities in Henan Province, China. The findings indicate that while the modernization of sports facilities generally improved public accessibility and provided students with better infrastructure, it did not significantly influence all aspects of physical training resolve. There were significant correlations between public accessibility and students' motivation to participate in diverse sports activities, as well as between government-market dynamics and the duration of physical training sessions. However, areas such as social influence, peer support, and psychological constructs did not show strong associations with the modernization efforts. The study also found that the physical training resolve of students varied based on their course of study, with certain disciplines showing higher engagement in specific types of sports and psychological benefits. Overall, the results suggest that while modernization enhances some aspects of physical training, a more comprehensive approach is needed to fully support students’ physical engagement across all dimensions.

The effectiveness of reminiscence therapy on anxiety, depression, and quality of life in adult cancer patients: a systematic review and meta-analysis.

To investigate the effectiveness of reminiscence therapy on anxiety, depression, and quality of life in adult cancer patients. This study is a systematic review and meta-analysis, including 16 randomized controlled trials (RCTs) and controlled clinical trials (CCTs), encompassing a total of 1948 participants. The sample sizes of the included studies ranged from 32 to 210, with results from 1852 participants being evaluated. Potential studies up to July 31, 2023, were searched across seven electronic literature databases, reference lists of similar reviews, gray literature, and the Clinical Trials Registry. Studies were required to meet the PICOS inclusion criteria. Two independent investigators assessed the risk of bias in the included studies using the Cochrane Collaboration Tool. Meta-analysis was conducted using RevMan 5.4 when data were available. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024524176 (28/03/2024). This meta-analysis included 16 articles; nine studies found that reminiscence therapy significantly reduced the anxiety scores with a standardized mean difference (SMD) of 0.80 (95% CI - 1.15, - 0.44) and depression scores with an SMD of 0.67 (95% CI - 0.94, - 0.4) (p < 0.001). In four studies, reminiscence therapy significantly improved quality of life with an SMD of 0.37 (95% CI 0.18, 0.56) (p < 0.001). Reminiscence therapy can be used by nurses as a nonpharmacological intervention to reduce anxiety and depression and improve quality of life in cancer patients during treatment, rehabilitation, and end-of-life periods. Further studies are needed as there is no standard for the duration and frequency of sessions.

Screening for Systemic Diseases Associated with Dental Self-Care in Japanese Adolescents

Background: Toothbrushing is important for maintaining oral health and preventing periodontal disease. However, the association between toothbrushing and systemic diseases remains unclear in adolescence. In this study, the association between dental self-care (frequency and duration of toothbrushing) and systemic diseases/disorders in adolescents was examined. Methods: We conducted a retrospective review of mandatory medical questionnaires administered during legally mandated freshman medical checkups between 2017 and 2019 at the University of Tokyo, Japan. Out of 9376 total responses, 9098 cases involving individuals under the age of 20 were included in the analysis. Respondents were classified into three groups based on their daily toothbrushing frequency: “1 time or less”, “twice”, and “3 times or more”. For the duration of each toothbrushing session, they were classified into three groups: “1 min or less”, “2–3 min”, and “4 min or more”. A statistical analysis was performed by Pearson’s χ2 test and multinomial logistic regression analysis. Results: Regarding frequency of daily toothbrushing: The χ2 test showed no significant relationship between frequency of toothbrushing and 17 systemic diseases/disorders. A multivariate analysis found that gingival bleeding and sex were independent factors. The risk of gingival bleeding decreased dramatically with increased frequency of toothbrushing (odds ratio (OR): 0.428; 95% confidence interval (CI), 0.366–0.501; p &lt; 0.001). Regarding the amount of time spent on toothbrushing: The χ2 test showed atopic dermatitis and arrhythmia were significantly associated with the duration of toothbrushing (p = 0.032 and p = 0.016, respectively). In the multivariate analysis, atopic dermatitis, gingival bleeding, and sex were independent factors regarding the duration of toothbrushing; longer brushing time was associated with a lower risk of atopic dermatitis (OR: 0.731, 95% CI: 0.578–0.924, p = 0.009) and a lower risk of gingival bleeding (OR: 0.643, 95% CI: 0.567–0.729, p &lt; 0.001). Conclusions: Dental self-care was most strongly associated with gingival bleeding, while the risk of atopic dermatitis was found to increase with shorter toothbrushing times. The results suggest that dental self-care during adolescence is important not only for oral health but also for general health.

Dietary Habits and Nutritional Knowledge of Pregnant Women: The Importance of Nutrition Education.

A good diet during pregnancy is associated with improvements to maternal and fetal health. Nevertheless, excessive weight gain during pregnancy has been reported in several studies. The aim of this review is to determine the dietary habits of pregnant women (measured according to their degree of adherence to the Mediterranean diet, a reference in dietary quality), their knowledge of food and nutrition, and their perceptions of the nutritional education received during their pregnancy, in order to detect intervention needs within that group. The bibliographic search was conducted on three databases (Medline, PubMed central, and Web of Science), using the keywords "pregnancy", "Mediterranean diet", "nutrition knowledge", "nutritional education", and some synonyms. The final selection included 68 original articles. The available evidence indicated that, although pregnant women were aware of the importance of nutrition during pregnancy, their habits showed some room for improvement in terms of diet and physical exercise. Lack of adequate advice was the main barrier to the practice of healthy habits that pregnant women encountered; they considered that the information they received during pregnancy follow-up visits was inadequate. However, the success of interventions within different countries is a source of hope for well-structured nutrition education throughout pregnancy. The lack of nutrition-related knowledge among pregnant women could be originally related to poorly planned nutrition education from healthcare providers. Research focused on the consultations with these healthcare providers could be of help when proposing strategies to improve the content, the depth, and the duration of nutrition education sessions. It should, in any case, be noted that the available evidence in this field is limited to certain geographical origins. Therefore, research that uncovers evidence in different countries will be useful for learning about the factors that condition the habits of pregnant women and, in that way, guide strategies for the improvement of the health of expectant mothers during that stage in their lives.

Evaluating the effectiveness of a multi-component lifestyle therapy program versus psychological therapy for managing mood disorders (HARMON-E): protocol of a randomised non-inferiority trial

BackgroundMood disorders, including unipolar and bipolar depression, contribute significantly to the global burden of disease. Psychological therapy is considered a gold standard non-pharmacological treatment for managing these conditions; however, a growing body of evidence also supports the use of lifestyle therapies for these conditions. Despite some clinical guidelines endorsing the application of lifestyle therapies as a first-line treatment for individuals with mood disorders, there is limited evidence that this recommendation has been widely adopted into routine practice. A key obstacle is the insufficient evidence on whether lifestyle therapies match the clinical and cost effectiveness of psychological therapy, particularly for treating those with moderate to severe symptoms. The HARMON-E Trial seeks to address this gap by conducting a non-inferiority trial evaluating whether a multi-component lifestyle therapy program is non-inferior to psychological therapy on clinical and cost-effectiveness outcomes over 8-weeks for adults with major depressive disorder and bipolar affective disorder.MethodsThis trial uses an individually randomised group treatment design with computer generated block randomisation (1:1). Three hundred and seventy-eight adults with clinical depression or bipolar affective disorder, a recent major depressive episode, and moderate-to-severe depressive symptoms are randomised to receive either lifestyle therapy or psychological therapy (adjunctive to any existing treatments, including pharmacotherapies). Both therapy programs are delivered remotely, via a secure online video conferencing platform. The programs comprise an individual session and six subsequent group-based sessions over 8-weeks. All program aspects (e.g. session duration, time of day, and communications between participants and facilitators) are matched except for the content and program facilitators. Lifestyle therapy is provided by a dietitian and exercise physiologist focusing on four pillars of lifestyle (diet, physical activity, sleep, and substance use), and the psychological therapy program is provided by two psychologists using a cognitive behavioural therapy approach. Data collection occurs at baseline, 8-weeks, 16-weeks, and 6 months with research assistants blinded to allocation. The primary outcome is depressive symptoms at 8 weeks, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) (minimal clinically important difference = 1.6). A pre-specified within-trial economic evaluation will also be conducted.DiscussionShould lifestyle therapy be found to be as clinically and cost effective as psychological therapy for managing mood disorders, this approach has potential to be considered as an adjunctive treatment for those with moderate to severe depressive symptoms.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12622001026718, registered 22nd July 2022.Protocol version: 4.14, 26/06/2024

The Evolvement of Session Design From Junior Age to Senior Peak Performance in World-Class Cross-Country Skiers.

To compare designs of training sessions applied by world-class cross-countryskiers during their most successful junior and senior season. Retrospective analysis of self-reported training characteristics (ie,training form, intensity, and exercise mode) among 8 male and 7 female world-class cross-country skiers was conducted. Total number of sessions (441 [71] vs 519 [34], P < .001, large effect) and mean duration (1.5 [0.1]h vs 1.7 [0.1]h, P < .001, moderate effect) increased from junior to senior age. More double-session days were performed at senior age (124 [50] vs 197 [29]d, P < .001, large). The number (310 [64] vs 393 [64], P < .001, large effect) and duration (1.3 [0.1]h vs 1.5 [0.1]h, P < .001, moderate effect) of low-intensity training sessions increased from junior to senior age. Regarding intensive training, most emphasis was put on high-intensity training sessions lasting 20 to 39minutes with <5-minute intervals at junior age, while 40 to 59minutes ofmoderate-intensity training with 5- to 9-minute intervals was predominant at senior age. More MIXED (combined moderate- and high-intensity) sessions (9 [7] vs 14 [7], P = .023, moderate effect) and longer races (0.5 [0.1]h vs 0.6 [0.1]h, P = 0.29, moderate effect) compensated for fewer high-intensity training sessions at senior age (36 [17] vs 25 [10], P = .027, moderate effect). Duration of strength-training sessions increased significantly (0.6 [0.1] vs 0.8 [0.2]h, P = 0.30, moderate effect), while other training forms remained unchanged. World-class cross-country skiers increased their training volume from junior to senior age primarily by more and longer low-intensity training sessions and more often training twice per day. Concurrently, the most frequent intensive sessions were modified from high- to moderate-intensity training, lasted longer, and contained longer intervals.

The Magnitude Of Exercise-induced Hypervolemia Following High-intensity Interval Exercise Depends On Session Duration

The Magnitude Of Exercise-induced Hypervolemia Following High-intensity Interval Exercise Depends On Session Duration

Evaluating ExpandED: Evaluating the effectiveness of a serious game expansion pack in teaching health professional students about interprofessional care.

The emergency department (ED) is a challenging fast-paced environment with high-acuity, undifferentiated patients who often require extensive interdisciplinary care. This paper introduces ExpandED, an expansion pack to the serious board game GridlockED, designed to enhance players' understanding of interprofessional collaboration in the ED and the diverse scope of practice of different ED professionals including physicians, residents, registered nurses, registered practical nurses, social workers, occupational therapists, and physiotherapists. This investigation evaluates the effectiveness of ExpandED as a teaching tool for medical and allied health professions students about interprofessional collaboration in the ED. A program evaluation harnessing a playtest framework was employed. Participants completed pre- and postgame surveys including quantitative measures (e.g., Likert scales) and qualitative free-text feedback that focused on participant familiarity with ED functioning, valuation of interprofessional collaboration before and after playing, and feedback on game usability and effectiveness. Recruitment was open to students in all health care and allied health professional programs at the institution. Forty-five participants were recruited from medical doctor, nursing, physiotherapy, and speech language pathology programs. ExpandED enhances participants' understanding of ED workflow (p < 0.001) and provides an enjoyable playing experience. However, participants' valuation of interdisciplinary teamwork did not change significantly before and after game play (p = 0.17). Participants expressed satisfaction with the game's accuracy in simulating the ED environment and appreciated the opportunity to collaborate with peers from different disciplines. Challenges reported included some tension among players, potential biases, and limitations of fidelity to a real-life ED. While this study has limitations regarding participant sampling and duration of gameplay sessions, it highlights the potential of ExpandED for teaching interprofessional collaboration in the ED. These findings will guide further development to optimize the expansion pack's effectiveness and its implementation into health care curricula.

Developing the optimal gross movement interventions to improve the physical fitness of 3-10 year-old children: a systematic review and meta-analysis.

To identify the optimal parameters of gross movement interventions to yield the strongest effects on physical fitness among children aged 3-10 years and to provide a reference for the development of gross movement interventions to improve the physical fitness of children. There has been a global decline in children's physical fitness. Previous studies have shown that gross movement interventions can improve children's physical fitness, but the optimal intervention parameters for achieving the strongest effects have yet to be determined. Therefore, we conducted this meta-analysis to determine the optimal intervention parameters for yielding the strongest effects on children's physical fitness. We searched the Web of Science, PubMed, China Biology Medicine, China National Knowledge Infrastructure, Wanfang Data, and China Science and Technology Journal databases to identify randomized controlled trials on the effects of gross movement interventions (walking, running, jumping, throwing, batting, rolling, spinning, catching, and leg lifting) on children's physical fitness (upper-body strength, lower-body strength, explosive power, speed, flexibility, and balance). We included studies published up to September 2023. The inclusion and exclusion criteria were developed based on the PICOS framework, and the quality of the included studies was evaluated. Subgroup analysis was performed using Review Manager 5.3, and the data were pooled using a random effects model to obtain the SMD (or WMD) and 95% confidence intervals (CIs). A total of 23 studies involving 2007 healthy children aged 3-10 years met the inclusion criteria. Gross movement interventions significantly improved the explosive power of children aged 3-10 years [WMD, 6.2]. The most effective intervention duration was 16-18 weeks [WMD, 0.45]. The most effective intervention frequency was one session per week [WMD, 1.06]. The optimal duration of single sessions was 60 min [WMD, 0.47]. Children aged 7-10 years [WMD, 1.41] showed the most significant improvements in physical fitness after gross movement interventions. Gross movement interventions had a positive effect on the physical fitness of children aged 3-10 years. The optimal intervention parameters include 60-min sessions once a week across a total duration of 16-18 weeks.