Intervention Research Articles

The Effect of Post-Exercise Warm Water Immersion on Anaerobic Power Performance in College Students

Background/Objectives: The purpose of this study was to investigate the effect of a short-term passive post-exercise heat acclimation (HA) protocol on anaerobic performance in college students. Methods: In total, 28 participants (age 22.3 ± 2.1 years, height 168 ± 9.1 cm, mass 71.5 ± 16.6 kg) volunteered and were randomly divided into either an intervention (INT) or control (CON) group. Both groups followed a consecutive two-day protocol, consisting of a 25 min submaximal cycle @ 50–60% heart rate reserve (HRR), followed by a 25 min hot water immersion (INT) or nothing (CON). All participants performed a 30 s Wingate Anaerobic Test (WAnT) on four separate occasions—familiarization, pre-intervention, acutely post-intervention, and 24 h post intervention. The WAnT measured their peak power (W), relative peak power (W/kg), mean power (W), fatigue index (%), and total work (kJ). Results: From the results of the Factorial ANOVA, it was found that there were no significant differences, with no main effect for group (INT vs. CON) or time (Trials 1–4) and no significant interaction across all measured variables (p > 0.05). Conclusions: A two-day post-exercise passive HA protocol utilizing hot water immersion had no significant effect on the measurement of anaerobic performance in college students.

A new injury prevention program ‘FUNBALL’ improves cognitive performance of young football (soccer) players: A cluster randomized controlled trial

The youth football injury prevention program ‘FUNBALL’ contains exercises requiring high cognitive demands, which are performed concurrently to the training of the respective motor task. This study evaluates whether the program increases cognitive performances of young football players.1253 football players (aged 13–19 years old) were randomly assigned to either a control (CON) or an intervention (INT) group. The INT group performed the ‘FUNBALL’ program at least twice per week in their training sessions for one season (9 months). The CON group continued their training routine. From the total sample, the cognitive performance of 304 players (n = 135 CON; n = 169 INT) was assessed at the beginning and the end of the season using the Cogstate® Brief Battery, with the following subtests: One Back test (accuracy), Two Back test (accuracy), One Card Learning test (accuracy), Chase Test (correct moves per second), Set Shifting (accuracy), Identification test (speed), Detection test (speed), Groton Maze Learning Test (accuracy), and Groton Maze Learning Test Delayed Recall (accuracy).A multivariate analysis of variance (MANOVA) on the cognitive performance improvements from pre-to posttest showed that the INT group improved their performances more strongly than the CON group for all cognitive tests, namely for working memory, visual learning, visual motor control, attention, psychomotor function, memory, and executive function.The present study indicates that the exercise-based injury prevention program ‘FUNBALL’ may improve the cognitive performance of young football players. Future research should include an active control group, and should investigate whether the improvement in cognition also has beneficial effects on in-game performance. Trial registration numberAsPredicted (https://aspredicted.org/2kb3b.pdf).

A Study on the Attributes and Interv ention Measures of Child Abuse Case Management Subjects

A Study on the Attributes and Interv ention Measures of Child Abuse Case Management Subjects

Polarized running training adapted to versus contrary to the menstrual cycle phases has similar effects on endurance performance and cardiovascular parameters

PurposeThis study compared the effects of polarized running training adapted to the menstrual cycle (MC) phases versus polarized training adapted contrary to the MC on endurance performance and cardiovascular parameters.MethodsThirty-three naturally menstruating, moderately trained females (age: 26 ± 4 years; BMI: 22.3 ± 3.2 kg/m2; V˙\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\dot{V}$$\\end{document}O2max/rel: 40.35 ± 4.61 ml/min/kg) were randomly assigned to a control (CON) and intervention (INT) group. Both groups participated in a load-matched eight-week running training intervention. In the INT, high-intensity sessions were aligned with the mid and late follicular phase, low-intensity sessions with the early and mid-luteal phase, and recovery with the late luteal and early follicular phase. In the CON, high-intensity sessions were matched to the late luteal and early follicular phase, and recovery to the mid and late follicular phase. Endurance performance and cardiovascular parameters were assessed at baseline and after the intervention.ResultsTwenty-six females completed the intervention. A repeated measures ANOVA determined no time × group interaction effect for any parameter. A significant time effect was found for maximal oxygen uptake (F(1,12) = 18.753, p = 0.005, ηp2 = 0.630), the velocity at the ventilatory threshold one (F(1,12) = 10.704, p = 0.007, ηp2 = 0.493) and two (F(1,12) = 7.746, p = .018, ηp2 = .413).ConclusionThe training intervention improved endurance performance in both groups, with no further benefit observed from the MC-adapted polarized training in a group-based analysis. Replications with an extended intervention period, a larger sample size, and a more reliable MC determination are warranted.

The cost-utility of an intervention for children and adolescents with a parent having a mental illness in the framework of the German health and social care system: a health economic evaluation of a randomized controlled trial

BackgroundChildren of families with a parent with a mental illness have an increased risk of developing social and mental health problems resulting in decreased quality of life. Therefore, children and adolescents living in families with a parent with mental illness are regarded as a target group for preventive interventions. To date, only a few economic evaluation studies for interventions directed at preventing the intergenerational transmission of mental health problems exist. In this investigation we estimated the cost utility of an intervention for the support of children and adolescents with a parent having a mental illness from the perspective of the German health and social care system.MethodsWe randomly assigned a total of 214 families with 337 children and adolescents to the intervention (INT) group (108/170) or the control (TAU) group (106/167). Families in the intervention group received on average eight intervention sessions (50–90 min) over 6 months. We estimated total cost of illness by means of the Children and Adolescent Mental Health Service Receipt Inventory (CAMHSRI) over 24 months. For the estimation of Quality-Adjusted Live Years (QALYs) we applied the KIDSCREEN-10. For estimating the incremental cost-utility of the intervention compared to treatment as usual we used the net-benefit approach.ResultsWe estimated the annual cost of illness amounting to € 3784.59 (SD € 8581.11) in the TAU group and € 3264.44 (SD € 9431.89) in the INT group. The annual cost difference between INT and TAU was € − 516.14 (SE 1124.95) which was not significant (p ≤ 0.05). We estimated the average QALY to be 0.759 (SD 0.073) in the TAU group and 0.763 (SD 0.072). The QALY difference between INT and TAU was 0.0037 (SE 0.0092) which was not significant (p ≤ 0.05). The incremental cost utility ratio (ICUR) indicated that the gain of one additional year in full health by means of the intervention was associated with the saving of € 139.49. However, the stochastic insecurity of the ICUR did not allow a unique decision about the cost-utility of the intervention.ConclusionsMore information on the economic value of the intervention for families with a parent with mental illness in comparison to treatment as usual in Germany is needed.Trial registration: ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

Abstract 12585: The Impact of Remote Patient Monitoring and Digital Therapeutics on Major Clinical Events and Costs in Heart Failure Patients: Early Experience in the Quebec Public Healthcare System

Introduction: There is increasing use of digital health solutions in heart failure (HF), but few studies have demonstrated its impact on public healthcare systems in North America. The Continuum project developed a mobile app for remote patient monitoring (RPM) and a digital therapeutics (DTx) solution aimed at assisting clinicians in medication optimization and preventing hospitalizations among HF outpatients. Research Question: Are RPM and DTx cost-effective for care of outpatients with HF? Methods: A 3-month randomized controlled trial for HF outpatients at risk of hospitalisation evaluated the Continuum program versus standard of care alone. This 12-week program included: 1. A self-care app via smartphone or tablet where patients entered vital signs, weight, and HF symptoms; 2. Remote monitoring of these data by clinical nurses; 3. DTx automated medication suggestions sent to the treating medical team; and 4. HF educational modules for patients. Results: A total of 171 patients were included. Preliminary results are available for the first 63 patients that completed the study, 32 intervention (INT) and 31 control (CTRL). Patients were similar in age (70±12 vs 69±13y), NYHA class (II 81 vs 87%), patients with ejection fraction <40% (56 vs 48%) and comorbidities such as diabetes (38 vs 45%; INT vs CTRL). The number of emergency room (ER) visits and/or hospitalisations (all cause) per patient was 0.19±0.47 for the INT group and 0.55±0.89 for the CTRL one (P=0.05). Survival analysis (Figure) showed a trend in favor of the INT group (95 days (CI95% 87-104) vs 78 days (CI95% 68-89); P=0.08). The total cost of healthcare consumption (hospitalizations + ER visits) in the INT group was 134,088 Canadian dollars vs 174,924 in the CTRL group (+30%). Conclusions: Our preliminary results show potential benefits of a mobile app incorporating self-care, remote monitoring, and digital therapeutics in preventing major events in HF outpatients at a reduced cost for the healthcare system.

Residual effects of 12 weeks of power-oriented resistance training plus high-intensity interval training on muscle dysfunction, systemic oxidative damage, and antioxidant capacity after 10 months of training cessation in older people with COPD.

This study aimed to assess the residual effects of a 12-week concurrent training program (power training + high-intensity interval training) in older adults with chronic obstructive pulmonary disease (COPD). A total of 21 older adults with COPD [intervention (INT), n = 8; control (CON), n = 13; 76.9 ± 6.8 years] were assessed at baseline and 10 months after the completion of the intervention by the short physical performance battery (SPPB), health-related quality of life (EQ-5D-5L), vastus lateralis muscle thickness (MT), peak pulmonary oxygen uptake (peak VO2 ) and peak work rate (Wpeak ), early and late isometric rate of force development (RFD), leg and chest press maximum muscle power (LPmax and CPmax ), and systemic oxidative damage and antioxidant capacity. Compared to baseline, after 10 months of detraining, the INT group presented increased SPPB (∆ = 1.0 point), health-related quality of life (∆ = 0.07 points), early RFD (∆ = 834 N∙s-1 ), LPmax (∆ = 62.2 W), and CPmax (∆ = 16.0 W) (all p < 0.05). In addition, a positive effect was noted in INT compared to CON regarding MT and Wpeak (both p < 0.05). No between-group differences were reported in peak VO2 , late RFD, systemic oxidative damage, and antioxidant capacity from baseline to 10 months after the completion of the intervention (all p > 0.05). Twelve weeks of concurrent training were enough to ensure improved physical function, health-related quality of life, early RFD and maximum muscle power and to preserve MT and Wpeak but not peak VO2 , late RFD, systemic oxidative damage and antioxidant capacity in the subsequent 10 months of detraining in older adults with COPD.

Effect of Immunonutrition on the Liver Function Status of End-Stage Liver Disease Patients Waiting/Referred for Liver Transplant: A Randomized Controlled Trial.

Background Malnutrition and liver dysfunction are commonly observed in patients with chronic liver disease. With the current surge in liver diseases, prompt nutritional planning will ensure the well-being of patients during the waiting period and will improve the clinical outcomes following liver transplantation (LT). We conducted this study to monitor the effect of immunonutrition on liver function parameters among end-stage liver disease (ESLD) patients referred for LT. Methodology In this randomized controlled trial, 144 ESLD patients who met the inclusion criteria were randomly enrolled into control (CON) and intervention (INT) groups after obtaining informed consent. Three patients were lost to follow-up due to the COVID-19 lockdown. The INT group(n = 69) was provided with 100 g of immunonutrient and the CON group (n = 72)was provided with supervised diet advice. Liver function test (LFT) parameters such as total protein, albumin, total bilirubin, direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and prothrombin time/international normalized ratio before and after therapy at one month were checked in both groups. Results The majority of patients with the disease were males (83.3% in the CON group vs 76.8% in the INT group), having alcoholism as the etiology in both groups with 45.8% in the CON group and 56.5% in the INT group. Thecomparison of LFT parameters among ESLD patients during pre and post-therapy between the control and immunonutrition groups did not show any statistically significant difference in the LFT parameters between the INT and CON groups both at baseline and at one month. Conclusions The impact of immunonutrition on ESLD patients awaiting LT compared to supervised diet advice did not significantly improve liver function. The liver disease itself profoundly affects the level of nutrition; hence, nutritional assessment and early nutritional interventions can be instituted to improve clinical outcomes.

Changing perspectives among pre-health undergraduates through a brief weight bias pedagogical intervention

Background: Weight stigma and bias are present in education, employment, and health care institutions, and have increased in recent years. College students in pre-health majors have been documented to hold weight biases, and interventions to mitigate these beliefs have had varying results. Objectives: This study’s purpose was to assess the impact of a pedagogical intervention regarding weight stigma outcomes among first-year students. Method: Three instructors of lower-division health and social science courses implemented a 3-module lecture series on weight stigma, the environmental sources of weight variability, and body appreciation. Participants ( N = 81; 48 from intervention (INT) classrooms, 33 from comparison [COM] classrooms) completed an end-of-semester survey regarding their anti-fat biases, fat phobia, and body appreciation, and a subset ( n = 13) participated in a semi-structured interview about their experiences. Results: Results revealed no outcome differences between the treatment versus comparison groups, although self-reported body mass index (BMI) was a significant covariate ( p = .008). A significant correlation emerged between BMI and fear of fat scores for COM ( r = .52, p &lt; .01) but not for INT students ( r = .28, p &gt; .05), suggesting the intervention may have impacted how students form their anti-fat biases in relation to their BMI. Qualitative findings yielded five themes – connected course material with personal experiences; learned about weight stigma; shifted perspective on weight stigma; recognised application of weight stigma; material to future career; and valued learning about weight stigma – that provided insight into how the intervention positively affected students. Conclusion: Informed by the findings from this study, future interventions should take a more immersive pedagogical approach.

Integrated mental healthcare and vocational rehabilitation for people on sick leave with stress-related disorders: 24-month follow-up of the randomized IBBIS trial

Integrating vocational rehabilitation and mental healthcare has shown effects on vocational outcomes during sick leave with common mental disorders. In a previous paper, we showed that a Danish integrated healthcare and vocational rehabilitation intervention (INT) had a surprisingly negative impact on vocational outcomes compared to service as usual (SAU) at 6- and 12-month follow-up. That was also the case with a mental healthcare intervention (MHC) tested in the same study. This article reports the 24-month follow-up results of that same study. A randomized, parallel-group, three-arm, multi-centre superiority trial was conducted to test the effectiveness of INT and MHC compared to SAU. In total, 631 persons were randomized. Contrary to our hypothesis, SAU showed faster return to work than both INT [hazard rate (HR) 1.39, P=0.0027] and MHC (HR 1.30, P=0.013) at 24-month follow-up. Overall, no differences were observed regarding mental health and functional level. Compared to SAU, we observed some health benefits of MHC, but not INT, at 6-month follow-up but not thereafter, and lower rates of employment at all follow-ups. Since implementation problems might explain the results of INT, we cannot conclude that INT is no better that SAU. The MHC intervention was implemented with good fidelity and did not improve return to work. This trial does not support the hypothesis that INT lead to faster return to work. However, implementation failure may explain the negative results.

Steps Ahead: Optimising physical activity in adults with cystic fibrosis: A pilot randomised trial using wearable technology, goal setting and text message feedback

BackgroundRegular participation in physical activity (PA) is encouraged for people with Cystic Fibrosis (CF). This study aimed to assess the effectiveness of an intervention using wearable technology, goal setting and text message feedback on PA and health outcomes in people with CF. MethodsThis was a pilot randomised trial conducted at University Hospital Limerick. Participants were randomly assigned to the intervention (INT) or active comparator (AC). The 12-week intervention consisted of wearable technology (Fitbit Charge 2) which was remotely monitored, and participants set step count goals. Participants were sent a one-way text message once a week over 12 weeks to positively reinforce and encourage PA participation. The AC group received the wearable technology alone. Follow up was assessed at 24 weeks. Outcomes assessed were PA, aerobic capacity, lung function, sleep, quality of life and wellbeing. ResultsStep count increased significantly for the INT group over 12 weeks when compared to the AC group (p=0.019). The INT group had a 28% week-to-week percentage change (Weeks 1-12), while the AC group reduced by 1%, p=0.023. Within group changes demonstrated that VO2 peak (ml/kg/min) significantly increased for the INT group at 12 weeks (24.4 ±7.65 to 26.13 ±7.79, p=0.003) but not at 24 weeks (24.45 ±7.05, p=0.776). There were no significant differences observed for VO2 peak (ml/kg/min) for the AC group. There was no significant effect on lung function, sleep, well-being, or quality of life for either group. ConclusionsA personalised PA intervention using wearable technology, goal setting and text message feedback increased PA and aerobic capacity in people with CF. Integration of this intervention into usual care may encourage regular PA participation for people with CF.

Effects of a Diabetes Prevention Program on Type 2 Diabetes Risk Factors and Quality of Life Among Latino Youths With Prediabetes

Latino youths are disproportionately impacted by prediabetes and type 2 diabetes (T2D). Lifestyle intervention is the first-line approach for preventing or delaying T2D among adults with prediabetes. To assess the efficacy of a diabetes prevention program among Latino youths aged 12 to 16 years with prediabetes. This 2-group parallel randomized clinical trial with 2:1 randomization assessed a lifestyle intervention against usual care among Latino youths with prediabetes and obesity with 6- and 12-month follow-up. The study was conducted at YMCA facilities in Phoenix, Arizona from May 2016 to March 2020. Participants were randomized to lifestyle intervention (INT) or usual care control (UCC). The 6-month INT included 1 d/wk of nutrition and health education and 3 d/wk of physical activity. UCC included 2 visits with a pediatric endocrinologist and a bilingual, bicultural registered dietitian to discuss diabetes risks and healthy lifestyle changes. Insulin sensitivity, glucose tolerance, and weight-specific quality of life (YQOL-W) at 6- and 12-month follow-up. A total of 117 Latino youths (mean [SD] age, 14 [1] years; 47 [40.1%] girls) were included in the analysis. Overall, 79 were randomized to INT and 38 to UCC. At 6 months, the INT led to significant decreases in mean (SE) 2-hour glucose (baseline: 144 [3] mg/dL; 6 months: 132 [3] mg/dL; P = .002) and increases in mean (SE) insulin sensitivity (baseline: 1.9 [0.2]; 6 months: 2.6 [0.3]; P = .001) and YQOL-W (baseline: 75 [2]; 6 months: 80 [2]; P = .006), but these changes were not significantly different from UCC (2-hour glucose: mean difference, -7.2 mg/dL; 95% CI, -19.7 to 5.3 mg/dL; P for interaction = .26; insulin sensitivity: mean difference, 0.1; 95% CI, -0.7 to 0.9; P for interaction = .79; YQOL-W: mean difference, 6.3; 95% CI, -1.1 to 13.7; P for interaction = .10, respectively). Both INT (mean [SE], -15 mg/dL [4.9]; P = .002) and UCC (mean [SE], -15 mg/dL [5.4]; P = .005) had significant 12-month reductions in 2-hour glucose that did not differ significantly from each other (mean difference, -0.3; 95% CI, -14.5 to 14.1 mg/dL; P for interaction = .97). At 12 months, changes in mean (SE) insulin sensitivity in INT (baseline: 1.9 [0.2]; 12 months: 2.3 [0.2]; P = .06) and UCC (baseline: 1.9 [0.3]; 12 months: 2.0 [0.2]; P = .70) were not significantly different (mean difference, 0.3; 95% CI, -0.4 to 1.0; P for interaction = .37). At 12 months, YQOL-W was significantly increased in INT (basline: 75 [2]; 12 months: 82 [2]; P < .001) vs UCC (mean difference, 8.5; 95% CI, 0.8 to 16.2; P for interaction = .03). In this randomized clinical trial, both INT and UCC led to similar changes in T2D risk factors among Latino youths with diabetes; however, YQOL-W was improved in INT compared with UCC. Diabetes prevention interventions that are effective in adults also appeared to be effective in high risk youths. ClinicalTrials.gov Identifier: NCT02615353.

The sequence of intervention determines the risk of early postoperative acute kidney injury in infants with bilateral ureteropelvic junction obstruction

The management of bilateral ureteropelvic junction obstruction (UPJO) is greatly debated. We aim to identify the risk of early postoperative acute kidney injury (AKI) in relation to the sequence of intervention in children with bilateral UPJO managed in a sequential manner. A single center database was retrospectively reviewed for children ≤2 years who underwent bilateral pyeloplasty. According to the differential renal function on the preoperative renograms, patients were categorized into group A: pyeloplasty on the poorer functioning kidney first and group B: pyeloplasty on the better functioning side first. Serum creatinine and eGFR, using the modified Schwartz formula, were evaluated at four time points (I): before the first intervention (II): within 48h of the first intervention (III): before the second intervention and (IV): within 48h of the second intervention. Preoperative and postoperative values were compared. The incidence of early postoperative AKI in both groups was defined according to the Acute Kidney Injury Network (AKIN) criteria. The study comprised 46 children treated by staged pyeloplasty, 28 of them underwent pyeloplasty on the poorer functioning side first. Baseline serum creatinine and eGFR were not significantly different between both groups. Patients who underwent pyeloplasty on the poorer functioning side first, had a significant decline of eGFR after the first intervention (p=0.006). Conversely, no significant eGFR changes were observed after the first or second interventions in the other group (figure). Overall, 64.3% and 33.3% of patients developed some degrees of AKI when intervention was started on the poorer and better functioning renal units, respectively (p=0.04). Bilaterality is seen in approximately ¼ of patients with UPJO. Oftentimes, both renal units are asymmetrically affected with little data to guide surgeons on the optimal sequence of intervention. Following pyeloplasty, 52.2% of the evaluated children with bilateral UPJO had early postoperative AKI, mostly of low stage. Our data suggest that intervening first on the better functioning side allows for better recovery of the renal functional reserve and lowers the risk of postoperative AKI. In children with bilateral UPJO, starting intervention on the poorer functioning kidney is associated with increased risk of postoperative AKI. Long-term prospective studies are needed to confirm our findings.

Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02.

One fourth of early-stage breast cancer cases become metastatic during the follow-up period. Limited metastasis is a metastatic disease condition in which the number of metastatic sites and the extent of the disease both are limited, and the disease is amenable to metastatic intervention. This prospective study aimed to evaluate intervention for limited metastases in the lung, liver, or both. The study enrolled luminal A/B and/or human epidermal growth factor receptor 2 (HER2)-neu+ patients with operable lung and/or liver metastases in the follow-up assessment after completion of primary breast cancer treatment and patients with a diagnosis of metastasis after 2014. Demographic, clinical, tumor-specific, and metastasis detection-free interval (MDFI) data were collected. Bone metastasis in addition to lung and liver metastases also was included in the analysis. The patients were divided into two groups according to the method of treatment for metastases: systemic therapy alone (ST) group or intervention (IT) group. Until June 2020, 200 patients were enrolled in the study. The demographic data were similar between the two groups. The median follow-up time was 77months (range 55-107months) in the IT group (n = 119; 59.5%) and 57months (range 39-84) in the ST-only group (n = 81; 40.5%). The median MDFI was 40months (range 23-70months) in the IT group, and 35months (range 13-61months) in the ST-only group (p = 0.47). The groups had similar surgeries for the primary tumor and axilla. Most of the patients had liver metastases (49.5%, n = 99), and 42% (n = 84) of the patients had lung metastases. Both lung and liver metastases were found in 8.5% (n = 17) of the patients. The primary tumor was estrogen receptor/progesterone receptor-positive in 75% (n = 150) of the patients, and 32% (n = 64) of the patients had HER2-neu+ tumors. Metastatic-site resection was performed for 32% (n = 64) of the patients, and 27.5% (n = 55) of the patients underwent metastatic ablative interventions. In the Kaplan-Meier survival analysis, the hazard of death (HoD) was 56% lower in the IT group than in the ST-only group (hazard ratio [HR], 0.44; 95% confidence interval [CI] 0.26-0.72; p = 0.001). The HoD was lower in the IT group than in the ST-only group for the patients younger than 55years (HR, 0.32; 95% CI 0.17-0.62; p = 0.0007). In the multivariable Cox regression model, HoD was significantly lower for the patients who underwent intervention for metastases and had an MDFI longer than 24months, but their liver metastases doubled the risk of death compared with lung metastases. Metastasis-directed interventions have reduced the risk of death for patients with limited lung/liver metastases who are amenable to interventions after completion of primary cancer treatment. For a select group of patients, such as those with luminal A/B or HER2-neu+ breast cancer who are younger than 55years with limited metastases to the lung and liver or an MDFI longer than 24months, surgical or ablative therapy for metastases should be considered and discussed on tumor boards.

P-572 Hormonal Monitoring and Progesterone Adjustment in Frozen Embryo Transfer Cycles

Abstract Study question We investigated the effect of monitoring and follow-up of serum progesterone, estradiol &amp; luteinizing hormone levels and progesterone supplement adjustments on pregnancy outcomes for FET in programmed HRT cycles. Summary answer Monitoring and follow-up of different hormones in patient’s serum in programmed frozen embryo transfer cycles didn’t have an impact on overall pregnancy rate. What is known already Frozen Embryo transfer treatment rapidly expanded in recent years. FET can effectively prevent IVF associated complications, such as ovarian hyperstimulation syndrome and multiple pregnancy. In addition, FET serves as a safe &amp; cost-effective way to increase cumulative pregnancy rate. Though progesterone levels on the day of transfer have not yet been studied extensively in humans, tailoring the time of transferring a frozen embryo based on serial P4 values rather than cycle day number alone results in higher pregnancy rates.The value of measuring the serum E2 levels on the day of embryo transfer as an indicator for clinical pregnancy is still doubtful. Study design, size, duration Six Hundred FETs were performed in a randomized prospective manner in an infertility center in Alexandria starting from 2019 till 2021.These were further subdivided based on computer randomization into Group I (Non-intervention) including300 patients with only ultrasound monitoring &amp; Group II (intervention) including 300 patients with monitoring of serum level of progesterone, estrogen &amp; luteinizing hormone as well as progesterone supplement adjustments. Participants/materials, setting, methods Group I (Non-intervention) including300 patients with only ultrasound monitoring &amp; Group II (intervention) including 300 patients with monitoring of serum level of progesterone, estrogen &amp; luteinizing hormone as well as progesterone supplement adjustments which are further subdivided into three groups depending on progesterone level in patient’s serum early in the morning prior to embryo transfer. Group II A: P4 levels &amp;lt; 5ng/dl, Group II B: P4 levels 5-10ng/dl, Group II C: P4 levels &amp;gt;10ng Main results and the role of chance Live birth and overall pregnancy rate showed no significant difference among group monitored with ultrasound only compared to the hormonal monitored group. However, on the day of embryo transfer, serum P4 &amp;gt; 11.83 ng/ml represented a cut-off value above which there is marked increase in OPR/LBR and a sensitivity of 53.7% &amp; specificity of 51.2% in predicting pregnancy. Also, serum E2 value more than 292 pg/ml at day 18 demonstrated an increase in OPR/LBR.In our study, the cut off value of LH level less than of 10.8 IU/L at day13 had a sensitivity of 58.3% &amp; specificity of 50.4% in predicting pregnancy. Regarding pregnancy outcome, monitoring of LH levels didn’t generate useful data with no added prognostic value.Conclusion: Monitoring and follow-up of different hormones in patient’s serum in programmed frozen embryo transfer cycles didn’t have an impact on live birth, overall pregnancy &amp; abortion rate when compared to ultrasound only in non-intervention group. Limitations, reasons for caution Patients in non-intervention group didn’t have a hormonal pre-transfer assessment so it’s not possible to determine if the progesterone levels are suboptimal or not when compared to intervention group. Also, we didn’t have a post transfer hormonal assessment in case group to determine whether the progesterone dose reached desired levels. Wider implications of the findings Kofinas et al. proposed in his study that in order to optimize pregnancy and rate, P4 levels in FET cycles should be sustained between 10 and 20 ng/ml. This was in accordance to our study where the cut off value of P4 on day of 11.83 ng/ml optimized pregnancy rates. Trial registration number NCT05189145

347-OR: Effects of a Diabetes Prevention Program among Latino Youth with Prediabetes

Introduction: Latino youth are disproportionately impacted by prediabetes and type 2 diabetes (T2D) . Lifestyle intervention is the first line approach for preventing or delaying T2D among adults with prediabetes. We assessed the efficacy of a diabetes prevention program among Latino youth with prediabetes. Methods: A total of 117 Latino youth (mean±SD, age 13.5±1.4) with prediabetes and obesity were randomized to lifestyle intervention (INT) or usual care (UC) . The 6-month INT (n=79) included 1 d/wk of nutrition education and training and 3 d/wk of physical activity. UC (n=38) included 2 visits with a pediatric endocrinologist and registered dietitian to discuss diabetes risks and healthy lifestyle changes. A 75-g oral glucose tolerance test was used to assess glucose tolerance (2-h glucose) , insulin sensitivity (Matsuda Index) , and β-cell function (oral disposition index, oDI) at baseline, 6 months, and 12 months. Changes in outcomes were analyzed using latent difference scores models. Results: The INT led to significant decreases in 2-h glucose (mean±SE, from 144.5±3.4 to 132.2±3.4 mg/dL, p=0.002) and increases in insulin sensitivity (from 1.9±0.2 to 2.6±0.3, p=0.001) and oDI (from 4.5±0.3 to 5.5±0.4, p=0.035) at 6 months, but these changes were not significantly different from UC (interaction, p=0.260, p=0.79, and p=0.78, respectively) . Both INT (-15.4 mg/dL, p=0.002) and UC (-15.1 mg/dL, p=0.005) had significant 12-month reductions in 2-h glucose that did not differ significantly from each other (interaction, p=0.97) . INT led to significant increases in oDI (from 4.5±0.3 to 6.2±0.6, p=0.035) and non-significant increases in insulin sensitivity (from 1.9±0.2 to 2.3±0.2, p=0.060) at 12 months that did not differ from UC (interaction, p=0.66 and p=0.37, respectively) . Conclusion: Both INT and UC led to similar changes in T2D risk factors among high risk Latino youth. Diabetes prevention interventions that are effective in adults also appear to be effective in high risk youth. Disclosure A. Pena: None. M. Olson: None. S. Ayers: None. D.L. Patrick: Consultant; Allakos, Bristol-Myers Squibb Company, Grail, Philip Morris. F.G. Castro: None. E. Lish: None. W.C. Knowler: None. G.Q. Shaibi: None. Funding R01DK107579F31DK125037

Reducing Ageism in an Undergraduate Nutrition Class Using an Online Educational Intervention

ObjectivesAgeism is prevalent in healthcare and can lead to negative health outcomes. The aim of our study is to determine the effectiveness of an online educational intervention to reduce ageism among students in an undergraduate nutrition class. MethodsVolunteers in an entry-level nutrition course were randomized into an intervention (INT) (n = 30) and a control (CON) (n = 29) group. Participants were asked to watch 6 videos (∼20 minutes total) and describe what they learned. The INT group learned about ageism and myths on aging, while the CON group learned about cultural competency. Ageism was measured at pre (T1), immediate-post (T2), and 2-weeks post-intervention (T3) using the Fraboni Scale of Ageism (FSA), the Ambivalent Ageism Scale (AAS) which provides a total score, benevolent (AAS-Ben) and hostile (AAS-hostile) ageism sub scores, and the age Implicit Association Test (IAT) (D-score). Participants were categorized based on D score as higher (≤.15) or lower preference for older adults (>.15). Also, perceived old age cutoff was asked. Mixed model analysis with repeated measures and binomial logistic regression analysis were performed. Results93% and 63% were female and non-Hispanic white, respectively. Group-by-time interactions for ageism indicators were not statistically significant (p > .05). Significant changes in estimated mean and standard error with simple effect analyses in the INT group includes decrease of FSA from 55.5 (1.4) at T1 to 49.9 (1.9) and 50.0 (2.0) at T2 and T3 respectively; decrease of total AAS from 41.2 (1.6) at T1 to 35.5 (1.8) and 35.7 (1.8) at T2 and T3, respectively; and decrease of AAS Hostile from 12.2 (0.6) at T1 to 9.5 (0.7) and 9.0 (0.7) at T2 and T3, respectively. Perceived old age cutoff increased from 59 (2) to 71 (2) and 72 (2) years by T2 and T3, respectively. Thus, ageism was significantly reduced up to 2 weeks only in the INT group after the educational intervention (p < .05). No significant changes in IAT. Qualitative data analysis of written answers provided by INT group also supported these findings. ConclusionsFindings from our study suggest that an online educational intervention may be useful in reducing ageism among undergraduate nutrition and dietetic students. Funding SourcesUniversity of Mississippi Startup funds; School of Applied Sciences - Dean’s office funds.

Screening, Brief Intervention, and Referral to Treatment to Prevent Post-Traumatic Stress Disorder After Gunshot Wounds.

Screening, brief intervention, and referral to treatment (SBIRT) is an intervention originally developed to prevent and deter substance abuse. Adaptation of the SBIRT model to prevent post-traumatic stress disorder (PTSD) may potentially reduce acute stress symptoms after traumatic injury. We conducted a prospective randomized control study of adult patients admitted for gunshot wounds. Patients were randomized to intervention (INT) vs. treatment as usual (TAU) groups. INT received the newly developed SBIRT Intervention for Trauma Patients (SITP)-a 15-minute session with elements of cognitive behavioral therapy techniques. SITP took place during the index hospitalization; both groups had followup at 30 and 90 days at which time a validated PTSD screening tool, PCL-5, was administered. Most of the 46 participants were young (mean age = 30.5y), male (91.3%), and black (86.9%). At three-month follow-up, SBIRT and TAU patients had similar physical healing scores but the SBIRT arm showed reductions in PTSD symptoms.

The cost-effectiveness of a resilience-based psychosocial intervention for HIV prevention among MSM in India.

MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India. We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS). We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM. Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ . A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India.

Prevalence of Positive Effects on Body Fat Percentage, Cardiovascular Parameters, and Cardiorespiratory Fitness after 10-Week High-Intensity Interval Training in Adolescents.

Simple SummaryIn this study, we aimed to analyze the prevalence of positive effects of high-intensity interval training (HIIT) on body composition, cardiovascular parameters, and cardiorespiratory fitness among adolescents. We investigated 52 boys and 89 girls from a secondary school, separated into an experimental group (EG) with HIIT intervention and a control group (CG). The measured parameters were body fat % (BFP), resting systolic blood pressure (SBP), diastolic blood pressure (DBP), and fitness index (FI). The results indicate that positive HIIT-induced changes in SBP, DBP, and FI were most common among boys, especially those with low body mass index. Our study also revealed relationships between changes in FI and BFP and BP parameters. The effectiveness of HIIT was confirmed concerning the prevalence of the positive changes in measured parameters. We suggest that HIIT should be implemented in PE lessons, although there is a need to look for a more efficient method for girls.Analysis of the interventions on cardiovascular disease risk factors focuses on quantitative changes, omitting assessment of positive effect frequency in individuals. The aim of this study was to assess the prevalence of positive effects of high-intensity interval training (HIIT) on body composition, cardiovascular parameters, and cardiorespiratory fitness among adolescents. A total of 52 boys and 89 girls from a secondary school were separated into an experimental group (EG) with HIIT and a control group (CG). Body fat % (BFP), resting systolic blood pressure (SBP), diastolic blood pressure (DBP), and fitness index (FI) changes were calculated. We assessed the influence and interaction of three factors: intervention (INT), sex (SEX), and body mass index (BMIstatus) on the ratio of individuals with and without positive changes. We used log-linear models for interactions and multivariate correspondence analysis (MCA). The results indicate that HIIT affects the prevalence of positive changes in SBP, DBP, and FI. Interactions between factors suggest boys with low BMI get more benefit from the intervention than girls. The MCA indicates a relationship between FI and BFP and between BP parameters. The effectiveness of HIIT was confirmed concerning the prevalence of the positive changes in measured parameters. We suggest that HIIT should be implemented in PE lessons, although there is a need to look for a more efficient method for girls.