Intervention Studies Research Articles

A nutrition intervention study’s effect to hematology profiles on elderly group in social retirement home

The increase in the elderly brings consequences, including a higher risk of disease. Inappropriate nutritional intake is also known as one of the risk factors related to the elderly's non-communicable diseases, and nutritional intervention is essential to improve the elderly nutritional status and quality of life. It was an interventional study with a before-after one-group approach. The study was conducted for three months (October-December 2021) in three social retirement homes. The intervention given was supplementation with additional protein sources and snacks each day. The biochemistry profiles were taken 2 times: before and after three months of intervention, comprised of HbA1c, lipid, transferrin, creatinine, and blood pressure level. The data will be analyzed for its normality before being processed with paired t-test or Wilcoxon signed rank based on the normality results. The analysis results show that there are significantly lower transferrin levels (p=0.040), an increase in cholesterol level (p=0.000), and low-density lipoprotein (LDL) level increased from 114.05±32.03 to 125.94±31.41 (p=0.000). There is also a remarkable decrease in hemoglobin (p=0.005) and high-density lipoprotein (HDL) levels. Conversely, there are an increase in HbA1C (p=0.007) and triglyceride level (p=0.005). There is no significant difference in creatinine level. We conclude that nutrition interventions have a significant effect on elderly blood profiles. However, to achieve an improvement, the study should consider physical activity and other variables that might be altering the results.

Single organ metastatic sites in non-small cell lung cancer: Patient characteristics, treatment patterns and outcomes from a large retrospective Canadian cohort

BackgroundThere is a paucity of information about the characteristics, treatment patterns, and outcomes of non-small cell lung cancer (NSCLC) patients with single organ metastasis (SOM). MethodsThis retrospective cohort study includes all patients with a diagnosis of stage IV NSCLC diagnosed from 2014 to 2016 and treated at Princess Margaret Cancer Centre. We compared baseline characteristics and patterns of metastatic sites between patients with SOM versus multiple (M)OM. Additionally, we identified treatment modalities and outcomes for patients with SOM. Cox multivariable models (MVA) were utilized to evaluate differences in overall survival (OS) between the SOM and MOM cohorts. ResultsOf 893 pts analyzed, 457 (51 %) had SOM, while 436 (49 %) had MOM at initial diagnosis. Demographics were comparable between the two groups. Brain was the most common site of metastasis for SOM patients. When compared to the MOM group, the SOM group had lower percentages of liver and adrenal metastases. Amongst SOM patients, 54 % received single modality treatment, and 20 % did not receive any treatment for their SOM. In MVA, patients with liver (HR 2.4), bone (HR 1.8), and pleural (HR 1.7) metastasis as their SOM site had the worst outcomes, with median OS of 6.8 months, 12.1 months, and 13.0 months respectively. Patients with SOM had a significantly improved median OS compared to those with MOM (15.9 months vs. 10.6 months; HR 0.56, 95 % CI 0.47–0.66, p < 0.001). ConclusionIn NSCLC patients who presented with SOM, survival correlated with the initial organ involved and was better overall compared to patients with MOM. SOM NSCLC may benefit from specific management strategies and SOM patients could be considered as a specific subgroup for survival analyses in observational and non-randomized interventional studies. In clinical trials, SOM can be considered as a stratification factor in the future.

Foveal Changes after Uneventful Phacoemulsification Surgery for Senile Nuclear Cataract

Objective: To describe foveal thickness and foveal anatomical changes after uneventful phacoemulsification surgery. Design: Interventional case control study. Participants: Both eyes of healthy phakic patients presenting to the American University of Beirut Medical Center Eye clinic for phaco-emulsification surgery in one eye (the study eye). The fellow eye served as control. Methods: OCT images of the macula were taken pre-operatively, then on a weekly basis for 12 weeks post-operatively. Outcomes: post op foveal thickness and morphological changes. Results: From the originally recruited 66 patients, 52 patients (104 eyes) completed the study. A transient increase in foveal thickness was observed in 36/52 (69%) eyes mostly between weeks 4 and7 post operatively. Twenty-seven eyes developed anatomic changes including: microcysts in 15 eyes (55%), regular cysts in 6 eyes (22%), and epiretinal membranes in 6 eyes (11.5%). Changes appeared as early as 1 week post operatively, and lasted on the average 4 weeks. Conclusion: Uncomplicated cataract surgery can lead to transient thickening of the macula as well as morphological changes.

Intraocular Pressure Before and After Corneal Refractive Surgery: A Prospective Comparison of Corvis ST and Ocular Response Analyzer.

The study showed that Corvis ST's bIOP and ORA's IOPcc do not agree well, before or after PRK, and may not be used interchangeably. bIOP remained unchanged after PRK. To evaluate the agreement between the biomechanically-corrected intraocular pressure (bIOP) measured by the Corvis-ST and the cornea-compensated IOP (IOPcc) measured by the Ocular Response Analyzer (ORA) before and after photorefractive keratectomy (PRK). In this prospective interventional study, a total of 53 patients (53 eyes) were included. Measurements were acquired using both the Corvis-ST and ORA devices before and 3 months post- PRK. The agreement between the two devices was evaluated using limits of agreement (LoA) and Bland-Altman plots. The participants had a mean age of 29.6±5.21 years (range: 21 to 40), with 41 (77.4%) of them being female. Following the surgery, the average change in IOP was 0.3±1.7mmHg for bIOP and -1.6±4.0mmHg for IOPcc. The corresponding 95% LoA were -3.5 to 4.2mmHg and -9.5 to 6.3mmHg, respectively. The 95% LoA between bIOP and IOPcc after PRK was -2.3 to 8.5mmHg. Notably, the bIOP values were higher for IOPs <20mmHg and lower for IOPs >20mmHg compared to IOPcc. The findings indicate a weak agreement between the Corvis ST-bIOP and the ORA- IOPcc both before and after PRK. These devices may not be used interchangeably for IOP measurement. bIOP exhibited less variation compared to the IOPcc, suggesting that the bIOP is a superior option for IOP reading following PRK.

Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes - A prospective interventional study.

To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes. A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 (n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 (n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT). Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period (P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively. FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS.

Histopathological findings of anterior lens capsule in pediatric cataract.

To investigate the histopathological findings of the anterior lens capsule in pediatric patients who had surgery for cataracts. This study is a prospective interventional study. Anterior capsule tissue samples that were obtained by the anterior capsulotomy method during phacoemulsification surgery were fixed and examined under a transmission electron microscope. Twenty-two eyes of 19 patients who were diagnosed with congenital and juvenile cataracts were included in this study. Five patients had associated systemic diseases, including hydrocephalus, cerebral palsy, prematurity, juvenile myelomonocytic leukemia, and Down's syndrome. Electron microscopic evaluation demonstrated single-layered epithelium under the capsule, degenerated organelles with round-oval and prismatic-oval nuclei, and degenerated mitochondria and heterochromatin-rich nuclei. In the case with cerebral palsy, collagen fibrils of the connective tissue and fibroblast-like cells were observed replacing the epithelium that should be underneath the capsule in both eyes, and there was a disorganized distribution of collagen fibrils and vacuole structures in the cytoplasm of fibroblast-like cells. Similar histopathological findings were found in pediatric cataracts with or without systemic disease except in one cerebral palsy case. The absence of lens epithelium may have been a result of degeneration in this patient, and this can be attributed to the presence of systemic inflammation and gliosis in cerebral palsy. The absence of lens epithelium can play a role in the development of dense subcapsular fibrosis and cataract formation.

Combined topography-guided photorefractive keratectomy and corneal collagen crosslinking.

This study aimed to report the long-term results of combined topography-guided photorefractive keratectomy (PRK) and accelerated corneal collagen cross-linking (CXL) for keratoconus using the Zeiss refractive coordinated system. A prospective interventional study was conducted in a tertiary eye care hospital in South India. Patients with mild-to-moderate progressive keratoconus and corneal pachymetry greater than 450 μm were included. They underwent customized topography-guided PRK followed by CXL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings and complications were evaluated at 1, 3, 6, 12, and 24 months postoperatively. Thirty patients (30 eyes) were included in the study. All study parameters showed a statistically significant improvement postoperatively over baseline values. At 24 months, the mean UDVA improved from 0.8 ± 0.180 logarithm of the minimum angle of resolution (logMAR) to 0.38 ± 0.118 logMAR (P-value <0.001) and CDVA improved from 0.467 ± 0.142 logMAR to 0.227 ± 0.078 logMAR (P-value <0.001). The mean flat, steep, and maximum keratometry values were significantly reduced by 2.133, 3, and 4.54 diopters, respectively, at the last follow-up examination (P-value <0.001). The combined topography-guided PRK and accelerated CXL procedure seem to be a promising treatment alternative for early keratoconus. This is the first such study on the Zeiss refractive coordinated system. However, further studies with a larger study population and longer follow-up periods are required to draw final conclusions about the benefits of this procedure in keratoconus.

Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs.

The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. PROSPERO registration no. CRD42022303255.

Social activities in multidomain dementia prevention interventions: insights from practice and a blueprint for the future

IntroductionSocial activities are important for health and act as a driver of cognitive reserve during aging. In this perspective paper, we describe challenges and outline future (research) endeavors to establish better operationalization of social activities in multidomain interventions to prevent dementia.BodyWe first address the lack of conceptual clarity, which makes it difficult to measure engagement in social activities. Second, drawing from our experience with the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we discuss social activities in multidomain dementia prevention interventions. Using qualitative data from the Multimodal Preventive Trial for Alzheimer’s Disease (MIND-ADmini), we reflect on participant experiences with social activities. Third, we address the potential and challenges of digital solutions in promoting social activities in interventions for dementia prevention. Finally, we share insights from a workshop on digital technology, where we consulted with individuals with and without cognitive impairment who have been involved in three European projects (i.e., EU-FINGERS, Multi-MeMo, and LETHE).DiscussionBased on these insights, we advocate for research that strengthens and accelerates the integration of social activities into multidomain interventions for dementia prevention. We propose several ways to achieve this: (a) by conducting mixed methods research to formulate a broadly accepted definition and instructions to measure social activities; (b) by focusing on promoting engagement in social activities beyond the intervention setting; and (c) by exploring the needs and preferences of older adults towards digitally-supported interventions and co-design of new technologies that enrich in-person social activities.

Mindfulness-based strengths practice: a conceptual framework and empirical review of the literature

This review set out to provide empirical literature on mindfulness-based strengths practice (MBSP), a new approach in positive psychology that integrates mindfulness with character strengths, two positive predictors of well-being. First, the conceptualization of integrating character strengths and mindfulness into MBSP is discussed. The literature on the interrelatedness of character strengths and mindfulness is then described, along with ways that the intervention of MBSP encourages positive outcomes at various levels. The literature search returned 7 (10 samples, N = 3,851) studies supporting a positive association between character strengths and mindfulness (r = 0.3–0.4) and the mediating role of character strengths/virtues in mindfulness and mindfulness’s role in enhancing character strengths toward psychological well-being. The nine MBSP intervention studies (9 samples, N = 354) conducted in diverse contexts provide evidence of a significant improvement in well-being, engagement, life satisfaction, mindfulness, positive affect, character strengths, work-related outcomes, heightened birthing parents’ well-being during pregnancy and childbirth, increased academic performance, and enhanced mental health among students. The intervention studies also reported the fostering of mindful positive parenting and contributions to a significant reduction in negative psychological states, such as stress, depression, anxiety, and negative affect. This comprehensive review provides empirical support for the MBSP framework and its positive impact on well-being across various domains, including organizations, education, healthcare, and family. However, it underscores the need for more extensive research, as the current literature on MBSP is limited. The review encourages future studies to explore MBSP applications in diverse domains, thereby paving the way for a deeper understanding of its potential benefits.

Effect of artificial natural light on the development of myopia among primary school-age children in China: a three-year longitudinal study.

To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children. This is a prospective, randomized control, intervention study. A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study. The whole randomization method was adopted to include classes as a group according to 1:1 randomized control. Classrooms in the control group were illuminated by usual light, and classrooms in the intervention group were illuminated by artificial natural light. All students received uncorrected visual acuity and best-corrected visual acuity measurement, non-cycloplegic autorefraction, ocular biometric examination, slit lamp and strabismus examination. Three-year follow-up, the students underwent same procedures. Myopia was defined as spherical equivalent refraction ≤ -0.50 D and uncorrected visual acuity <20/20. There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y. The three-year cumulative incidence rate of myopia was 26.4% (207 incident cases among 784 eligible participants at baseline) in the control group and 21.2% (164 incident cases among 774 eligible participants at baseline) in the intervention group [difference of 5.2% (95%CI, 3.7% to 10.1%); P=0.035]. There was also a significant difference in the three-year change in spherical equivalent refraction for the control group (-0.81 D) compared with the intervention group [-0.63 D; difference of 0.18 D (95%CI, 0.08 to 0.28 D); P<0.001]. Elongation of axial length was significantly different between in the control group (0.77 mm) and the intervention group [0.72 mm; difference of 0.05 mm (95%CI, 0.01 to 0.09 mm); P=0.003]. Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

The Impact of Red Beetroot Products on Glycemic Profiles: A Systematic Review of Human Evidence.

Low-glycemic diets are crucial, particularly for individuals with diet-related diseases such as obesity and diabetes. Therefore, observing the impact of multiple forms of red beetroot-based products on the glycemic profiles of humans under various health conditions has arguably become significant due to beetroot's high fiber content, antioxidants, inorganic nitrates, etc., which this review aims to summarize. The relevant articles published between 2000 and 2022 were obtained from PubMed, Scopus, and ScienceDirect by following the PRISMA-P 2020 statement. This systematic review included 18 randomized controlled trials (RCTs), one non-randomized clinical trial (non-RCT), and one quasi-experimental (QE) study, and they covered different health conditions, e.g., type-2 diabetes mellitus (T2DM), obesity, hypertension, etc. The studies produced conflicting results, likely due to differences in the study design, dosage, duration, and population. The risk of bias in most of the RCTs and QE studies included in the review was assessed as low or moderate, and only one non-RCT was assessed as having a high risk of bias. Red beetroot may help maintain the blood sugar levels of humans under different health conditions. However, the existing results on beetroot's potential for glycemic management are unclear due to varied outcomes across studies. Further intervention studies with standardized protocols and diverse participant groups are necessary to assess the role of beetroot products in regulating blood sugar levels before making a definitive judgment.

Implementation of lung ultrasonography by general practitioners for lower respiratory tract infections: a feasibility study

Objective To evaluate the feasibility of lung ultrasonography (LUS) performed by novice users’ general practitioners (GPs) in diagnosing lower respiratory tract infections (LRTIs) in primary health care settings. Design A prospective interventional multicenter study (December 2019–March 2020). Settings and subjects Patients aged >3 months, suspected of having LRTI consulting in three different general practices (GPs) (rural, semirural and urban) in France. Main outcome measures Feasibility of LUS by GPs was assessed by (1) the proportion of patients where LUS was not performed, (2) technical breakdowns, (3) interpretability of images by GPs, (4) examination duration and (5) patient perception and acceptability. Results A total of 151 patients were recruited, and GPs performed LUS for 111 (73.5%) patients (LUS group). In 99.1% (n = 110) of cases, GPs indicated that they were able to interpret images. The median [IQR] exam duration was 4 [3–5] minutes. LRTI was diagnosed in 70.3% and 60% of patients in the LUS and no-LUS groups, respectively (p = .43). After LUS, GPs changed their diagnosis from ‘other’ to ‘LRTI’ in six cases (+5.4%, p < .001), prescribed antibiotics for five patients (+4.5%, p = .164) and complementary chest imaging for 10 patients (+9%, p < .001). Patient stress was reported in 1.8% of cases, 81.7% of patients declared that they better understood the diagnosis, and 82% of patients thought that the GP diagnosis was more reliable after LUS. Conclusions LUS by GPs using handheld devices is a feasible diagnostic tool in primary health care for LRTI symptoms, demonstrating both effectiveness and positive patient reception. Trial Registration Number Clinicaltrial.gov: NCT04602234, 20/10/2020.

The effect of niacin on inflammatory markers and adipokines: a systematic review and meta-analysis of interventional studies.

Niacin (nicotinic acid), known for its lipid-modifying effects, has been explored for its potential anti-inflammatory properties and potential to affect adipokines secretion from adipose tissue. The aim of this systematic review and meta-analysis was to assess the effects of niacin on inflammatory markers and adipokines. A comprehensive search was conducted across five databases: PubMed, Scopus, Cochrane Library, Embase, and ISI Web of Science. Randomized controlled trials exploring the effects of niacin on inflammatory markers (CRP, IL-6, TNF-α) and adipokines (Adiponectin, Leptin) were included. Pooled effect sizes were analysed using a random-effects model, and additional procedures including subgroup analyses, sensitivity analysis and dose-response analysis were also performed. From an initial 1279 articles, fifteen randomized controlled trials (RCTs) were included. Niacin administration demonstrated a notable reduction in CRP levels (SMD: -0.88, 95% CI: -1.46 to -0.30, p = 0.003). Subgroup analyses confirmed CRP reductions in trials with intervention durations ≤ 24 weeks, doses ≤ 1000mg/day, and elevated baseline CRP levels (> 3mg/l). The meta-analysis of IL-6 and TNF-α revealed significant TNF-α reductions, while IL-6 reduction did not reach statistical significance. Niacin administration also substantially elevated Adiponectin (SMD: 3.52, 95% CI: 0.95 to 6.1, p = 0.007) and Leptin (SMD: 1.90, 95% CI: 0.03 to 3.77, p = 0.04) levels. Niacin treatment is associated with significant reductions in CRP and TNF-α levels, suggesting potential anti-inflammatory effects. Additionally, niacin positively influences adipokines, increasing Adiponectin and Leptin levels. These findings provide insights for future research and clinical applications targeting inflammation and metabolic dysregulation.

Parents, Grandparents and Siblings: A Pilot Psychological Intervention Study in Pediatric Palliative Care

Parents, Grandparents and Siblings: A Pilot Psychological Intervention Study in Pediatric Palliative Care

Circulating total and H-specific GDF15 levels are elevated in subjects with MASLD but not in hyperlipidemic but otherwise metabolically healthy subjects with obesity

BackgroundGrowth differentiation factor 15 (GDF15) is a mitokine, the role of which, total or H-specific, in modulating energy metabolism and homeostasis in obesity-related diseases, such as metabolic dysfunction associated steatotic liver disease (MASLD), has not been fully elucidated in adult humans. We aimed to investigate the fasting and stimulated levels of GDF15, total and H-specific, glucose-dependent insulinotropic polypeptide (GIP) and C-peptide, in two physiology interventional studies: one focusing on obesity, and the other on MASLD.MethodsStudy 1 investigated individuals with normal weight or with obesity, undergoing a 3-h mixed meal test (MMT); and study 2, examined adults with MASLD and controls undergoing a 120-min oral glucose tolerance test (OGTT). Exploratory correlations of total and H-specific GDF15 with clinical, hormonal and metabolomic/lipidomic parameters were also performed.ResultsIn study 1, 15 individuals were included per weight group. Fasting and postprandial total and H-specific GDF15 were similar between groups, whereas GIP was markedly higher in leaner individuals and was upregulated following a MMT. Baseline and postprandial C-peptide were markedly elevated in people with obesity compared with lean subjects. GIP was higher in leaner individuals and was upregulated after a MMT, while C-peptide and its overall AUC after a MMT was markedly elevated in people with obesity compared with lean subjects. In study 2, 27 individuals were evaluated. Fasting total GDF15 was similar, but postprandial total GDF15 levels were significantly higher in MASLD patients compared to controls. GIP and C-peptide remained unaffected. The postprandial course of GDF15 was clustered among those of triglycerides and molecules of the alanine cycle, was robustly elevated under MASLD, and constituted the most notable differentiating molecule between healthy and MASLD status. We also present robust positive correlations of the incremental area under the curve of total and H-specific GDF15 with a plethora of lipid subspecies, which remained significant after adjusting for confounders.ConclusionSerum GDF15 levels do not differ in relation to weight status in hyperlipidemic but otherwise metabolically healthy individuals. In contrast, GDF15 levels are significantly increased in MASLD patients at baseline and they remain significantly higher compared to healthy participants during OGTT, pointing to a role for GDF15 as a mitokine with important roles in the pathophysiology and possibly therapeutics of MASLD.Trial registration ClinicalTrials.gov NCT03986684, NCT04430946.

“That was one of my most difficult and biggest challenges”: experiences, preconditions and preventive measures of health-oriented leadership in virtual teams – A qualitative study with virtual leaders

BackgroundHealth-oriented leadership (HoL) has a positive impact on health- and work-related outcomes of employees in face-to-face settings. Increased digitization during the COVID-19 pandemic has led to many changes and increased job demands. According to current state of research, HoL in virtual teamwork is insufficiently researched. The aim of the study is to examine the experiences of virtual leaders during the COVID-19 pandemic and to identify preconditions and preventive measures for promoting HoL.MethodUsing a qualitative study design, semi-structured, guide-based telephone interviews were conducted with 16 German virtual leaders between May and July 2021. The collected data were inductively analyzed and interpreted using qualitative content analysis according to Mayring. Explorative analyses of differences between leaders with and without pre-pandemic experiences with virtual leadership were made.ResultsResults indicated that leaders, regardless of pre-pandemic experiences with virtual leadership, faced diverse challenges in implementing HoL in virtual teamwork during the COVID-19 pandemic. Virtual leaders perceived personal preconditions (e.g., leaders’ characteristics or behaviors), organizational preconditions (support by management or open-minded corporate culture), social preconditions (e.g., social support by team) and technical preconditions (e.g., sufficient technical equipment) as conducive to implementation of HoL. Almost all leaders with pre-pandemic experience identified a need for structural preventive measures, whereas almost all leaders without pre-pandemic experience reported a need for behavioral preventive measures in order to promote HoL in virtual teams.ConclusionsThis study suggests that implementing HoL in virtual teamwork is challenging, complex and requires adjustments in leadership behavior. Thereby, the study provides initial empirical findings for a holistic approach to HoL implementation in virtual teams, considering beneficial multilevel preconditions. Due to a limited generalization of present results, longitudinal and interventional studies will be necessary for the analysis of causal relationships in future research. In particular, a holistic research perspective in order to understand the complex, contextual interdependencies of leadership is recommended. In practice, based on a differentiated needs analysis, structural preventive measures for a holistic organizational development as well as behavioral preventive measures for ongoing personnel development are recommended.

Active recess: School break time as a setting for physical activity promotion in European primary schools

Objective: This study investigated active recess as an innovative approach to improving physical activity levels in European primary schools, addressing the need to counteract sedentary behaviour and enhance health in students. Method and Design: Using rapid reviewing, the article summarises empirical evidence from a variety of sources, including cross-sectional and intervention studies. Different approaches are investigated to determine their impact on physical activity during recess. Results: Different playground settings have distinct effects on physical activity, with grassland and designated zones in particular promoting moderate-to-vigorous physical activity. Gender inequalities in physical activity patterns suggest the need for gender-sensitive interventions. Playground marking and scheduled activities temporarily increase physical activity, whereas recess of more than 60 minutes dramatically enhances physically active participation. Conclusions: This study demonstrates the impact of active recess in facilitating children to engage in higher levels of physical activity. The findings have implications for school health policy decisions.

Effects of exercise interventions on negative emotions, cognitive performance and drug craving in methamphetamine addiction

IntroductionMethamphetamine is currently one of the most commonly used addictive substances with strong addiction and a high relapse rate. This systematic review aims to examine the effectiveness of physical activity in improving negative emotions, cognitive impairment, and drug craving in people with methamphetamine use disorder (MUD).MethodsA total of 17 studies out of 133 found from Embase and PubMed were identified, reporting results from 1836 participants from MUD populations. Original research using clearly described physical activity as interventions and reporting quantifiable outcomes of negative mood, cognitive function and drug craving level in people with MUD were eligible for inclusion. We included prospective studies, randomized controlled trials, or intervention studies, focusing on the neurological effects of physical activity on MUD.ResultsTaken together, the available clinical evidence showed that physical activity-based interventions may be effective in managing MUD-related withdrawal symptoms.DiscussionPhysical exercise may improve drug rehabilitation efficiency by improving negative emotions, cognitive behaviors, and drug cravings.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024530359.

Effectiveness of implementation strategies for increasing clinicians' use of five validated imaging decision rules for musculoskeletal injuries: a systematic review.

Strategies to enhance clinicians' adherence to validated imaging decision rules and increase the appropriateness of imaging remain unclear. To evaluate the effectiveness of various implementation strategies for increasing clinicians' use of five validated imaging decision rules (Ottawa Ankle Rules, Ottawa Knee Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study and Canadian Computed Tomography Head Rule). Systematic review. The inclusion criteria were experimental, quasi-experimental study designs comprising randomised controlled trials (RCTs), non-randomised controlled trials, and single-arm trials (i.e. prospective observational studies) of implementation interventions in any care setting. The search encompassed electronic databases up to March 11, 2024, including MEDLINE (via Ovid), CINAHL (via EBSCO), EMBASE (via Ovid), Cochrane CENTRAL, Web of Science, and Scopus. Two reviewers assessed the risk of bias of studies independently using the Cochrane Effective Practice and Organization of Care Group (EPOC) risk of bias tool. The primary outcome was clinicians' use of decision rules. Secondary outcomes included imaging use (indicated, non-indicated and overall) and knowledge of the rules. We included 22 studies (5-RCTs, 1-non-RCT and 16-single-arm trials), conducted in emergency care settings in six countries (USA, Canada, UK, Australia, Ireland and France). One RCT suggested that reminders may be effective at increasing clinicians' use of Ottawa Ankle Rules but may also increase the use of ankle radiography. Two RCTs that combined multiple intervention strategies showed mixed results for ankle imaging and head CT use. One combining educational meetings and materials on Ottawa Ankle Rules reduced ankle injury imaging among ED physicians, while another, with similar efforts plus clinical practice guidelines and reminders for the Canadian CT Head Rule, increased CT imaging for head injuries. For knowledge, one RCT suggested that distributing guidelines had a limited short-term impact but improved clinicians' long-term knowledge of the Ottawa Ankle Rules. Interventions such as pop-up reminders, educational meetings, and posters may improve adherence to the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian CT Head Rule. Reminders may reduce non-indicated imaging for knee and ankle injuries. The uncertain quality of evidence indicates the need for well-conducted RCTs to establish effectiveness of implementation strategies.