Interdisciplinary Intervention Research Articles

Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the aim to reduce the incidence of caries in children at the age of 18 months, an interdisciplinary primary prevention intervention is designed for families with children following the pediatric health program “Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica” (PAPPS). Methodology: non-randomized clinical trial, carried out in two primary care centers in Catalonia from January 2019 to June 2022. In one of the centers, an educational intervention for primary prevention of caries was designed and implemented with advice and skills to the families. In the other center, the usual protocol of recommendations was maintained. The incidence of caries was evaluated and compared in both groups at the age of 18 months with a logistic regression model estimated with the R program. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI 1.8-20.2), despite the fact that the caries risk assessment based on the called “Caries Management by Risk Assessment” (CAMBRA) indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention incorporated into child health programs reduces the incidence of caries in the first years of life.

An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study

BackgroundChildren and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents.MethodsIn all, 47 children and adolescents aged 6–16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent’s condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences.ResultsAlmost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18–30 (47–77%) rated relational empathy in the intervention as “Very good” or “Excellent”. Of the parents, 35–39 (92–100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001).ConclusionsThe present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention.Trial registrationThe study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.

Reduction in Feeding Problems and Impact on Family Following a 12-Week Interdisciplinary Group Feeding Intervention for Children With Feeding Problems and Their Caregivers

Caregivers and their children with clinical levels of feeding problems participated in Picnic Group, an outpatient interdisciplinary family group treatment program for children with feeding disorders and their caregivers at a large regional pediatric hospital. The manualized treatment is based on an interdisciplinary systematic approach that draws from sensory integration, communication, and cognitive behavioral strategies (e.g., classical conditioning, systematic desensitization, communication of automatic thoughts) to increase pleasurable interactions with food over a 12-week period and includes caregiver and child intervention components. Escape extinction techniques such as nonremoval of the spoon were not used in treatment. Caregivers completed measures focused on their children’s feeding behaviors and family strain at baseline and at the end of the 12-week intervention. Wilcoxon signed-rank tests compared measures between baseline and the end of treatment. Results indicated that at the 12th week, caregivers generally reported one less feeding problem, fewer specific types of eating and mealtime problematic behaviors, and decreased impact of feeding problems on the family. Children were able to work up a hierarchy of food interactions with more foods per group session than at the first session. Caregivers of children with a developmental diagnosis showed the most decrease in caregiver strain. Outpatient interdisciplinary group treatment can decrease feeding problems and caregiver strain in families with children with feeding disorders.

Cognitive recovery in psychiatric disorders: transdiagnostic interdisciplinary intervention in a high intensity partial psychiatric in-patient unit

Aim: The present study aims to analyze the impact on cognitive recovery of an interdisciplinary treatment for acute and severe psychiatric patients. Methods: The present research is a naturalistic observational study of 130 adults (mean age of 47.68 years, 68% women). Clinical severity was assessed using Brief Psychiatry Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Hamilton Anxiety Rating Scale (HARS). Functional performance was evaluated using the Functioning Assessment Short Test (FAST), and cognitive impairment by applying the Montreal Cognitive Assessment (MoCA). Patients were clustered into four diagnostic groups (non-affective psychosis, bipolar, depressive, and personality disorders) and had individualized psychopharmacological treatment. They receive a transdiagnostic group program including several interventions that have shown evidence of beneficial effects over the different cognitive domains impaired in mental illness (attention, speed of processing, memory, working memory, reasoning, and problem-solving), as well as social cognition domains (emotion processing and social skills), in combination with psychoeducation and some strategies oriented to achieve healthy lifestyle routines (balanced diet, physical exercise, sleep hygiene, and smoking and alcohol cessation). Results: All clinical scales scores were improved after the end of treatment compared with those achieved at admission (BPRS, MADRS, and HARS scores below the cut-off point for establishing a case diagnosis). MoCA scores improved after the end of treatment concerning admission, both in the total score and in the differentiated cognitive domains, excluding orientation, which remained unchanged in the whole of the sample studied. No statistical significance was found in any comparisons between different diagnostic groups. No correlation between MoCA scores and BPRS, MADRS, or HARS scores at admission or discharge was found. Conclusions: These results show that the interdisciplinary therapeutic intervention can be effective for recovering cognitive impairment associated with mental disorders, irrespective of the diagnosis.

Heavy Metal Pollution in the Aquatic System and Their Toxicological Effects on Clarias Batrachus

Heavy metal pollution has emerged as a prominent environmental concern, particularly in aquatic ecosystems. This study delves deep into the impact of such pollutants on Clarias batrachus, a species intrinsic to the health and balance of freshwater habitats. By assessing variations in behaviour, physiology, and survival rates, the research underscores the peril these pollutants pose to C. batrachus. Furthermore, the study elucidates various mitigation strategies, emphasizing their significance in not just salvaging the populations of this species but also in reinstating the holistic well-being of our aquatic ecosystems. The findings underscore the urgent need for interdisciplinary interventions to combat the looming threat of heavy metal pollution.

Moving forward on the road to recovery after concussion: participant experiences of interdisciplinary intervention for persisting post-concussion symptoms

Purpose Many factors contribute to persisting post-concussion symptoms (PPCSs), necessitating multi-modal treatment. Quantitative investigations have shown the potential of interdisciplinary intervention to reduce the burden of PPCSs and facilitate return to activities. There are often varied responses to intervention, warranting further investigation of potential factors underlying treatment response. This study aimed to explore participant experiences of i-RECOveR, an interdisciplinary intervention for PPCSs and its impact on symptoms, daily function, and concussion beliefs. Materials and Method Semi-structured interviews were conducted 1-month post-treatment via videoconferencing with 13 individuals (61% female) with mild traumatic brain injury (M age =39.77 years, SD = 16.27) who participated in i-RECOveR. Interview transcripts were analysed thematically. Results Three themes reflected participants’ treatment journeys from concussion to life after treatment: (1) Dissatisfaction with Previous Consultations, reflected personal experiences prior to commencing treatment; (2) Perceived Active Ingredients of Intervention, reflected participant experiences of i-RECOveR; and (3) Impact of Interdisciplinary Intervention, reflected a range of positive changes after completing i-RECOveR. Conclusions Findings highlight current gaps in the acute management of concussion and provide end-user insights into the facilitators and barriers of treatment engagement and response. Responses also highlight the potential positive impact of interdisciplinary treatments. Clinician perspectives should be explored in future research.

FRI417 An Interdisciplinary Program Promoting The Adoption Of A Healthy Lifestyle Increases Insulin Sensitivity In Women With Obesity And Infertility

Abstract Disclosure: A. Forget-Renaud: None. M. Belan: None. F. Jean-Denis: None. M. Pesant: None. J. Baillargeon: Grant Recipient; Self; Ferring Pharmaceuticals, JPB received an unrestricted investigator-initiated grant from Ferring Canada, which was not for the reported study. Introduction Obesity increases the risk of ovulatory and anovulatory infertility in women, mainly through the development of polycystic ovary syndrome (PCOS). Insulin resistance contributes to the pathogenesis of PCOS and may play a role in the infertility of PCOS and non-PCOS women with overweight or obesity. Lifestyle modifications are recommended as a first-line therapy in women with PCOS or those with obesity and infertility, as it was associated with improvement in menstrual pattern and fertility outcomes. We therefore hypothesized that a lifestyle intervention may increase insulin sensitivity in women with obesity and infertility. Methods Women with obesity and infertility were randomly allocated to usual fertility care (control group, CG) or to an interdisciplinary intervention promoting the adoption of a healthy lifestyle (LSG) alone for 6 months and then combined with usual care. Insulin resistance was estimated during fasting (HOMA-IR) and a 75-g oral glucose test (Matsuda Insulin Sensitivity Index, ISI(M)), and β-cell function was estimated using the Insulin Secretion-Sensitivity Index (ISSI-2) in women not taking medication affecting insulin sensitivity (except metformin). Data were collected at baseline, 6, 12 and 18 months, and as soon as possible when the participant knew she was pregnant. We estimated the integrated change in insulin sensitivity during follow-up using the incremental area-under-the-curve of ISI(M) divided by time (iAUC-ISI(M)/time). Results Among 130 randomized participants, 105 had available data (LSG=51, CG=54). PCOS was diagnosed using the Rotterdam criteria in 63.2% of participants, equally distributed between the groups. As compared to CG, women in the LSG improved significantly more their ISI(M) after 6 months (+0.24 [IQR: -0.48 - +0.94] vs 0.16 [-1.32 - +0.53], p=0.039, n=90), as well as their iAUC-ISI(M)/time during follow-up (+0.18±0.84 vs -0.21±0,93, p=0.035, n=104). All these results remained statistically significant after correction for baseline BMI, age and use of folic acid. Increases in iAUC-ISI(M)/time in the intervention vs control groups were significantly more important (p for interaction=0.045) in participants with baseline ISI(M) above the median (LSG: +0.10±1.13, n=24, vs CG: -0.62±1.13, n=27, p=0.028) than in those below the median (LSG: +0.26±0.48, n=27, vs CG: +0.21±0.35, n=26, p=0.71). Interactions with PCOS status and other subgroups were not statistically significant. There was no impact on HOMA-IR or ISSI-2. Conclusion An interdisciplinary program promoting the adoption of a healthy lifestyle significantly increases whole-body insulin sensitivity in women with infertility and obesity, mainly in those with higher baseline insulin sensitivity. It may be explained in part by the weight loss associated with the intervention and may have a role in improving fertility in this population. Presentation: Friday, June 16, 2023

Interdisciplinary rehabilitation for persisting post-concussion symptoms after mTBI: N=15 single case experimental design

BackgroundDespite clinical guidelines recommending an interdisciplinary approach to persisting post-concussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant. ObjectivesThis pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs. MethodA single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility outcomes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-centred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1- and 3-month follow-ups. Other secondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau-U. Clinically significant changes in secondary outcomes were explored descriptively. Results16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1- and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1- and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clinically significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved. ConclusionsThis pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that progressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisciplinary treatments.

A Novel Tangible Interaction Authoring Tool for Creating Educational Activities: Analysis of Its Acceptance by Educators

The creation of applications based on tangible interaction (TI applications), particularly on tabletops, is a developing area that requires the collaboration of professionals with expert knowledge in specific domains. Having an authoring tool that facilitates interdisciplinary intervention in the design and implementation of such applications is a current challenge to bring TI to different contexts. This article presents an authoring tool (named EDIT) and analyzes its acceptance by educators for creating educational activities. The novelty of the tool lies in the possibility of creating projects with a schedule of educational activities, sequenced as required for a group of students. In addition, it has specific characteristics for the educational scenario, such as the personalization of feedback and the meta-annotation of projects. Sessions were held with educators (n = 38) to analyze variables related to the Technology Acceptance Model (such as perceived usefulness and perceived ease of use) when creating TI educational activities on tabletops using the EDIT tool. The sessions were observed and recorded on video, and a Focus Group was held afterwards. During the sessions, educators gave a positive assessment in relation to using this type of tool. It was observed that, in general, they find tangible interaction valuable mostly for working with children. Finally, the results show a high acceptance obtained from the TAM and the novel features of EDIT were found to be useful.

Enhancing deficit schizophrenia treatment in college students through the integration of paliperidone and reformed civic education in higher education

BackgroundCollege students face challenges in communication, employment, learning, and emotional interaction, contributing to a range of psychological issues. Deficit schizophrenia, though uncommon among college students, can exhibit symptoms of delayed thinking and cognitive impairment. Prolonged use of traditional medications can lead to tolerance. This study investigates the synergy of reformed ideological and political education in higher education with Paliperidone to offer comprehensive intervention for college students with deficit schizophrenia.Subjects and MethodsA study was conducted on 85 college students with defective schizophrenia at a certain university. They were divided into Group C and Group D. Group C received a single treatment with Paliperidone, while Group B received combined treatment with reformed ideological and political education and teaching in universities. The treatment lasted for 3 months, and after treatment, SPSS 20.0 was used for data analysis, and the Mental Classification Cognitive Test Scale was used to quantify the mental status of college students.ResultsPost-treatment, positive symptoms in Group D reduced to 15.46 ± 1.53 points, negative symptoms dropped to 15.61 ± 3.51 points, and general psychiatric symptoms decreased to 15.12 ± 1.21 points. These values were lower than pre-treatment levels and Group C scores. The effective treatment rate for Group D reached 96.67%, surpassing Group C.ConclusionsThe intervention involving the combined use of reformed ideological and political education in universities with Paliperidone exhibited efficacy in addressing deficit schizophrenia in college students. This approach showcases the potential of interdisciplinary interventions in higher education for improving psychological well-being.

Protocol for an economic evaluation of a tele-neurologic intervention alongside a stepped wedge randomised controlled trial (NeTKoH)

BackgroundA significant and growing portion of the global burden of diseases is caused by neurological disorders. Tele-neurology has the potential to improve access to health care services and the quality of care, particularly in rural and underserved areas. The economic evaluation of the stepped wedge randomised controlled trial NeTKoH aims to ascertain the cost-effectiveness and cost-utility regarding the effects of a tele-neurologic intervention in primary care in a rural area in Germany.MethodsThis protocol outlines the methods used when conducting the trial-based economic evaluation of NeTKoH. The outcomes used in our economic analysis are all prespecified endpoints of the NeTKoH trial. Outcomes considered for the cost-utility and cost-effectiveness analyses will be quality-adjusted life years (QALYs) derived from the EQ-5D-5L, proportion of neurologic problems being solved at the GP’s office (primary outcome), hospital length-of-stay and number of hospital stays. Costs will be prospectively collected during the trial by the participating statutory health insurances, and will be analysed from a statutory health insurance perspective within the German health care system. This economic evaluation will be reported complying with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.DiscussionThis within-trial economic evaluation relaying the costs and outcomes of an interdisciplinary tele-consulting intervention will provide high-quality evidence for cost-effectiveness and policy implications of a tele-neurological programme, including the potential for application in other rural areas in Germany or other jurisdictions with a comparable health system.Trial registrationGerman Clinical Trials Register (DRKS00024492), date registered: September 28, 2021.

An interdisciplinary intervention for children with complex health complaints; a feasibility study of selection criteria.

There is a need for re-designing the health service for children suffering from complex and compound health complaints. Based on a previous register study, we have developed criteria to select patients with complex health complaints eligible for an Intervention with an interdisciplinary professional team. The team consists of a pediatrician, a psychologist and a physiotherapist. To identify children with complex health complaints who would benefit from this intervention, we have selected a group of patients by using a set of criteria consisting of the following criteria: multi-referred young school age children referred to both mental health service and pediatric service. This study focuses on the feasibility of these criteria by measuring participation and compliance and by gathering feedback from the team members in the interdisciplinary team. Among 677 children aged 6-12 years referred to a regional hospital, we found 32 (5%) children eligible for the interdisciplinary Intervention according to the applied criteria. Only 6% of the invited parents declined to participate in the intervention. According to the interdisciplinary team, the intervention was found suitable for 88% of the children. The suggested criteria seemed feasible, in terms of identifying eligible patients for this interdisciplinary Intervention for children with complex health complaints. Retrospectively registered on www.clinicaltrials.gov, ID NCT04652154, on the 3rd of December 2020.

246 Feasibility of a delirium intervention pathway by a frailty at the front door team

Abstract Background Consistent success in reducing delirium incidence and related falls, cognitive and functional decline, length of stay, use of one-to-one supervision, institutionalisation, readmissions, and health-care costs (hospital and 1-year) has been demonstrated in delirium, with and without dementia. Intervention strategies reduce delirium and its adverse outcomes by 30–40%. Frailty at the Front Door (FFD) emergency department teams perform 4AT as a routine component of comprehensive geriatric assessment. The aim of this study was to benchmark delirium with and without dementia in patients assessed by a FFD team in an urban tertiary referral centre and assess feasibility of an FFD delivered inter-disciplinary delirium intervention pathway. Methods Age, gender, Clinical Frailty Score (CFS), 4AT, AD8 and dementia diagnosis recorded in 500 consecutive patients in a clinical excel database were analysed using descriptive statistics. An inter-disciplinary delirium pathway, consisting of blood tests, anti-cholinergic cessation, neuro-imaging, individualised patient, carer, staff education was embedded into practice and use of the pathway recorded over a subsequent 2 month period. Results Mean (SD) age was 83 (6.9) years. Female to male ratio was 1.5:1. Mean(SD) CFS was 5 (1.2), with CFS unrecorded in 10%. 91% (n = 456) had 4AT recorded. 50% (n = 230) had a 4AT of zero. 38% (n = 177) had a 4AT of 1–3. 25% (n = 114) had a 4AT of &amp;gt;/=4. Of those where dementia diagnosis was recorded, n = 74, 40% (n = 29) had a 4AT of &amp;gt;/= 4. Where AD8 was measured, 50%(n = 12) had a 4AT of &amp;gt;/=4. The delirium intervention pathway was applied to 16% (n = 70) of the total population over a 2 month study period. Conclusion 4AT&amp;gt;/4 was retrospectively benchmarked at 25% in this population. Recording of dementia diagnosis and AD8 was low. Targeting existing resources to prevent delirium resulted in two-thirds of the expected population benefitting from standardised delirium prevention. Dedicated delirium resources in acute hospitals will further improve outcomes.

An interdisciplinary intervention program to prevent early childhood caries in the Dominican Republic.

The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists. After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria. At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460). The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.

Cognitive-behavioral Interventions in Occupational Therapy for Chronic Upper Limb Pain - A Qualitative Study

Aim: Within the framework of the Perezoso research group at the Carinthian University of Applied Sciences, which deals with the interdisciplinary treatment of patients with osteoarthritis, it was necessary to focus on the topic of pain. Therefore, the present research work was conducted. But beyond that, it's also essential for the increasing knowledge and awareness in the field of (chronic) pain especially in occupational therapy but also in other health professions. Background: In the treatment of chronic pain, occupational therapists use cognitive-behavioral therapy interventions (CBT) among other methods. The aim is to learn new behaviors and to question and change negative interpretations and constructions. Possible effects of CBT in chronic pain can be a reduction of pain, anxiety, disease activity, psychological effects and disability on the one hand and an increase in self-efficacy, pain control and quality of life on the other hand. Methods: To find out how occupational therapists apply CBT when treating clients with chronic upper limb pain, a systematic literature search was conducted in various databases. Within the framework of a qualitative research approach, five experts were interviewed using semi-structured guided interviews. The transcription was done according to Dresing and Pehl, supplemented by Rädiker and Kuckartz and was analyzed using the deductive-inductive approach by means of qualitative content analysis according to Elo and Kyngäs. Results: The approach is highly individualized, but aims to incorporate both the biological, social and psychological aspects of chronic pain. Everything from individual or group sessions, inpatient or outpatient stays and different emphases are involved. Pain education, awareness and coping measures are applied. Through the orientation to everyday life, a distinction is made between occupational therapy and other professions. The involvement of relatives is sometimes considered useful, but the final decision should be made by the clients. Discussion and Conclusion: Different pain patterns as well as hardly any current studies, especially in which occupational therapists explicitly apply CBT, only lead to a limited comparability. There is a need for more psychological and interdisciplinary interventions in order to be able to optimally treat clients with persistent pain. An advanced knowledge of pain, conversation management or CBT is considered essential.

O.5.2-1 Return to running after childbirth: barriers and facilitators

Abstract Purpose To investigate barriers to and facilitators of returning to running after childbirth, to inform the design of a return to running intervention. Methods The study adopted a mixed-methods design, using an e-survey for data collection with 503 postpartum runners (age: 34.8 ± 3.8 years) within 24 months after childbirth. The e-survey comprised closed- (quantitative) and open-ended (qualitative) questions. The closed-ended questions related to demographics, birth details, physical activity and running behaviour. The open-ended questions focussed on respondents’ experiences and opinions on the barriers and facilitators that ‘helped’, ‘hindered’ or ‘would have helped’ them to return to running. Quantitative data were presented as medians with interquartile ranges (IQR) and proportions. Free text responses to the open-ended questions were analysed using thematic analysis. Results On completion of the e-survey, participants were a median time of 10 months post-birth (IQR: 5-16). Of the cohort, 81% had returned to running (n = 405), with a median time of 12 weeks (IQR: 8-16) to first post-birth run. However, only just over a third of those who had returned to running had returned to at least their pre-pregnancy level (n = 146). Prominent themes for what ‘helped’, ‘hindered’ and ‘would have helped’ mothers return to running included psychological factors, physical factors that affected recovery, presence or absence of advice, degrees of childcare, time and access to running, as well as availability of training programmes and social support. Conclusions The key barriers to and facilitators of returning to running after childbirth were psychological, physical, and social in nature, with a number of possible interactions between them. The findings suggest the need for the development of an interdisciplinary intervention to address these factors holistically to support postpartum women in returning to running. Future research, utilising more in-depth methods such as interviews or focus groups, should be undertaken to increase understanding of some of these barriers and facilitators further. In particular, exploration of the possible interactions between these factors would allow for the design of an intervention that is appropriate to these relationships. Support/Funding Source Funded PhD studentiship from the Economic and Social Research Council.

Motor development in premature infants: Study protocol for an interdisciplinary hospital-home intervention.

Deviations occur in the neuropsychomotor development of premature infants; early interventions minimize delay motor. This study aimed to determine the effect of an interdisciplinary hospital-home intervention addressing motor development adaptation in premature infants in Colombia in comparison with traditional interventions. This study was based on a parallel design, with two groups, namely, experimental and control. The experimental group, hospital-home intervention (HHI) performed in two settings (i.e., hospital neonatal care units and homes), and the control group, traditional intervention, (TI) performed in institutions for premature infants. The sample will be composed of 130 randomly-allocated infants, 65 in the experimental group (HHI) and 65 in the control group (TI) of moderate to late preterm infants (gestational age between 34 and 37 weeks), weighing more than or equal to 1.800 g, who are hemodynamically stable and reside in the cities of Tunja and Bogotá-Colombia recruited between 2021 and 2022. For the pre- and post-intervention assessments, the TIMPSI and the CapDMP are the instruments used to assess motor development and the degree of parents' or caregivers' knowledge about motor development. The HHI is composed of 10 intervention strategies based on stimulation of motor development, performed twice a day for 10 min for two months, in combination with calls to a mobile device, using software (Baby Motor Skills) and an instant messaging system (WhatsApp). This hospital-home intervention program proposes an approach focused on the motor development of premature infants, based on sensory and motor stimulation strategies, in addition to follow-up performed at home with the use of a mobile application that improves the motor development of premature infants. Register Clinical Trial: NCT04563364. The HHI provides the opportunity to determine whether the individualized four-week from admission to follow up at home with parent training will improve the motor skills of premature infants.

Cyberbullying in Sport

Despite over 30 years of scholarly attention devoted to bullying and cyberbullying behaviors in school settings, research related to these experiences in the sport context remains limited. Yet, numerous anecdotal examples and preliminary evidence suggests cyberbullying exists in the sport domain and must be addressed given the potential adverse psychosocial outcomes for athletes. This commentary reviews research related to bullying and cyberbullying in the sport literature. To advance our understanding of cyberbullying in sport, recommendations are made to clarify conceptual issues around the central defining features (i.e., power, repetition, intent) commonly used to operationalize these experiences. Further, methodological issues to be addressed are discussed, including, the use of more diverse methods; adoption of an intersectional lens to all research; and the development, implementation, and evaluation of interdisciplinary evidence-based prevention and intervention strategies. Only through a research base that addresses these conceptual and methodological challenges, will empirically-informed prevention and intervention strategies be developed to advance safe, healthy, and inclusive sport environments.

Oral Squamous Cell Carcinoma Metastasis to Anterolateral Thigh Flap Donor Site: A Case Report.

In the realm of oncologic reconstructive surgery, local or distant autologous tissue is frequently used to improve function and appearance. Due to advances in microsurgery and intensive care, reconstructive free flap surgery has become the standard treatment for head and neck cancer. However, the complexity of interdisciplinary intervention and prolonged surgical time inevitably increase the risk of cross-contamination, potentially leading to donor site metastasis. According to the literature, tumor transmission to the donor site of free flaps is extremely rare. We present the case of a 54-year-old man with left tongue squamous cell carcinoma. Three months after tumor ablation and reconstruction with a free anterolateral thigh flap, the patient presented with a mass on the donor site of the left thigh, which was proven to be a metastasis. A systemic workup revealed multiple metastases. Six months after reconstruction, the patient died of COVID-19 pneumonia. The incidence and risk factors of donor site metastasis are not well known. The primary causes are direct implantation or hematogenous spread. Cross-contamination is primarily prevented by the surgeon's awareness and avoidance. The development of new-onset lesions at the donor site warrants additional testing to detect systemic disease progression during follow-up.

Post COVID-19 condition, work ability and occupational changes in a population-based cohort.

Evidence on the impact of post COVID-19 condition (PCC) on work ability is limited but critical due to its high prevalence among working-age individuals. This study aimed to evaluate the association between PCC, work ability, and occupational changes in a population-based cohort. We used data from working-age adults included in a prospective, longitudinal cohort of a random sample of all individuals infected with SARS-CoV-2 between August 2020 and January 2021 in the Canton of Zurich, Switzerland. We evaluated current work ability, work ability related to physical and mental demands, and estimated future work ability in 2 years (assessed using Work Ability Index), and PCC-related occupational changes one year after infection. Of 672 individuals included in this study, 120 (17.9%) were categorised as having PCC (defined as presence of self-reported COVID-19 related symptoms) at 12 months. There was very strong evidence that current work ability scores were mean 0.62 (95% CI 0.30-0.95) points lower among those with PCC compared to those without in adjusted regression analyses. Similarly, there was very strong evidence for lower odds of reporting higher work ability with respect to physical (adjusted odds ratio (aOR) 0.30, 95% CI 0.20-0.46) and mental (aOR 0.40, 0.27-0.62) demands in individuals with PCC. Higher age and history of psychiatric diagnosis were associated with more substantial reductions in current work ability. 5.8% of those with PCC reported direct effects of PCC on their occupational situation, with 1.6% of those with PCC completely dropping out of the workforce. These findings highlight the need for providing support and interdisciplinary interventions to individuals affected by PCC to help them maintain or regain their work ability and productivity. Federal Office of Public Health, Department of Health of the Canton of Zurich, University of Zurich Foundation, Switzerland; Horizon Europe.