Intervention Practices Research Articles

Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis

Abstract Background Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework. Methods First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis. Results From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability. Conclusions EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions. Key messages • PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. • EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.

Virtual Lifelines: Filipino Psychologists' Experiences with Tele-Counseling for Suicide Prevention

The COVID-19 pandemic forced a rapid shift to tele-counseling, presenting unique challenges for psychologists, especially those working with high-risk clients. This exploratory multiple-case study investigated the experiences of three Filipino psychologists providing tele-counseling for suicide prevention. The study revealed initial struggles with technology, ethical concerns, and perceived clinical effectiveness. However, the psychologists demonstrated resilience through a two-phase continuous professional development process: orientation and recalibration. Key outcomes included increased clinician enthusiasm, new professional opportunities, and improved ethical responses to crises. Tele-counseling emerged as a client-responsive tool that expands access to mental health services. Despite challenges, tele-counseling can be effective for suicide prevention with proper adaptation and training. These findings underscore the importance of integrating tele-counseling competencies into professional training curricula and developing evidence-based practices for remote crisis intervention.

Overcoming non-usage of e-mental health: A qualitative study in a Dutch general practice

Abstract Background Worldwide percentages of people with mental health problems are substantial and increased during the COVID pandemic (to about 25 % in the general population). E-mental health has potential to help with waiting lists, rising health care costs and work pressure. To reach the desired effects, participants need to use the technology as intended. Non-usage though is a common problem. Research question is: what elements obstruct the intention to use e-mental Health interventions, plus what are barriers to bridging the intention-behaviour gap? Methods In a qualitative study, semi-structured interviews were conducted (interview guide). We recruited patients who were invited for an e-mental health intervention in a Dutch general practice but did not start the intervention. Data saturation occurred with 11 patients. Open, axial and selective coding was done on the transcribed interviews using the software ATLAS.ti. Results Five main themes were associated with non-use: 1) ‘Expectations about the eHealth in general’ were neutral to positive. 2) ‘thresholds to start e-mental health’ were: negative expectations about the content, lacking mental capacity due to mental problems, missing personal contact, the therapy with the mental health professional in general did not fit their needs or aversion towards more screen time. 3) ‘lack of planning’. 4) lacking encouragement from mental health professional 5) ‘Expectations from therapy in general’. (a.o. face-to-face contact and tailoring) Conclusions Embedding the e-mental health more into regular therapy has potential to overcome non-usage. The mental health care professional has social influence to increase usage, by a clear and convincing introduction plus joint review of the exercises during consultations. This study needs to be repeated in other clinical settings. Future research should also include age (computer use) and disease prognosis to define when e-mental health is a suitable solution for patients. Key messages • E-mental health interventions have potential to help with waiting lists, rising health care costs and workload, but non usage is a problem. • Embedding the e-mental health more into regular therapy has potential to overcome non-usage.

Watery traces and absences: sensations and speculative histories of an ancient well and a carse landscape

This paper explores how mighty earth processes, aquatic agencies and human practical, political, religious, technological, commercial and environmental interventions have shaped and reshaped a now obscure Scottish holy well and the carse landscape to which it belongs. More specifically, I detail the historic pagan rituals, vigilant religious policing, romantic redesign and extensive terraforming that have informed the changing uses and symbolic associations of these watery realms, demonstrating how they testify to ceaselessly changing human-water relations. I explore how an awareness of particular historical events garnered from diverse texts can be supplemented with affective and sensory engagements with the non-human agencies, vestiges and absences of place. Together, they foster intimations and speculative imaginaries that conjure up speculative watery histories and conjectural futures.

Prediction of Suicidal Thoughts and Suicide Attempts in People Who Gamble Based on Biological-Psychological-Social Variables: A Machine Learning Study.

Recent research has shown that people who gamble are more likely to have suicidal thoughts and attempts compared to the general population. Despite the advancements made, no study to date has predicted suicide risk factors in people who gamble using machine learning algorithms. Therefore, current study aimed to identify the most critical predictors of suicidal ideation and suicidal attempts among people who gamble using a machine learning approach. An online survey conducted a cross-sectional analysis of 741 people who gamble (mean age: 25.9 ± 5.56). To predict the risk of suicide attempts and ideation, we employed a comprehensive set of 40 biological, psychological, social, and socio-demographic variables. The predictive models were developed using Logistic Regression, Random Forest (RF), robust eXtreme Gradient Boosting (XGBoost), and ensemble machine learning algorithms. Data analysis was performed using R-Studio software. Random Forest emerged as the top-performing algorithm for predicting suicidal ideation, with an impressive AUC of 0.934, sensitivity of 0.7514, specificity of 0.9885, PPV of 0.9473, and NPV of 0.9347. Across all models, dissociation, depression, and anxiety symptoms consistently emerged as crucial predictors of suicidal ideation. However, for suicide attempt prediction, all models exhibited weaker performance. XGBoost showed the best performance in this regard, with an AUC of 0.663, sensitivity of 0.78, specificity of 0.8990, PPV of 0.34, NPV of 0.984, and accuracy of 0.8918. Depressive symptoms and rumination severity were highlighted as the most important predictors of suicide attempts according to this model. These findings have important implications for clinical practice and public health interventions. Machine learning could help detect individuals prone to suicidal ideation and suicide attempts among people who gamble, assisting in creating tailored prevention programs to address future suicide risks more effectively.

Turkish validity and reliability of the universal mental health literacy scale for adolescents (10-14 years): A methodological study.

Mental health literacy enables adolescents to acquire information that will accompany them in their future lives and to define their attitudes and behaviors. This study evaluated the Turkish validity and reliability of the Universal Mental Health Literacy Scale for Adolescents (10-14 years). This is a methodological, correlational, cross-sectional, and descriptive study. The study was conducted with 223 adolescents. Data were collected by 'Information Form' and 'Universal Mental Health Literacy Scale for Adolescents.' Exploratory Factor Analysis, Confirmatory Factor Analysis, and Pearson Correlation analysis were used to assess the validity and reliability of the UMHL-A. Item Content Validity Index (I-CVI) scores ranged from 0.94 to 0.96, while the Scale Content Validity Index (S-CVI) was 0.95. For 'Help-seeking and Stigma dimensions' χ2/df = 3.347, NFI = 0.804, IFI = 0.854, TLI = 0.778, CFI = 0.849, RMSEA = 0.103. For 'Knowledge of Mental Health and Knowledge of Mental Illnesses dimensions' χ2/df = 1.959, NFI = 0.731, IFI = 0.847, TLI = 0.774, CFI = 0.837, RMSEA = 0.066. The internal consistency and time stability were affirmed by a Hotelling T-square value of 15.241 and an F-test result of 27.793. This study reveals that the Turkish validity and reliability of the Universal Mental Health Literacy Scale for Adolescents is a valid and reliable tool for assessing mental health literacy among adolescents. The UMHL-A scale is a valid tool to evaluate critical aspects of mental health literacy in adolescent populations and can be used in both research and clinical practice in mental health education and intervention. It is recommended that the Turkish version of the Universal Mental Health Literacy Scale should be used to determine resilience in adolescents.

Current research trends in child poverty and psychological resilience research: A bibliometric analysis approach

AbstractThe first of the sustainable development goals is to end poverty by 2030. Although many individual, social, and psychological resources have been proposed to reduce poverty, little is known about psychological resilience factors and related variables in reducing it. While the literature on childhood poverty and psychological resilience indicates that there was a relationship between these variables, it also draws attention to the fact that a growing interest in the need to consider psychological factors in reducing child poverty. Contextually, this study is bibliometric research that aims to reveal the current research trends about child poverty and psychological resilience. The researcher reviewed the Web of Science to highlight current trends in child poverty and resilience research and found 1065 relevant documents that met the inclusion criteria. The research used co‐occurrence, citation, and bibliographic coupling techniques from the bibliometric analysis type. Research results showed that poverty, resilience, children, protective factors, youth, parenting, COVID‐19, stress, and mental health were the nine significant clusters where the poverty and resilience keywords were gathered (items = 120, links = 988, total link strength = 1646). The United States had the most publications and was the most collaborative country. The most associated SDG target was good health and well‐being. Research trends underline that the five most studied keywords were resilience, poverty, children, health, and risk. Thematic map results indicated that socioeconomic status, childhood, and adjustment topics were important, well‐developed, and structuring themes, while resilience, poverty, and children topics were essential themes but still needed to be well‐developed. The research findings highlight the importance of resiliency factors that can potentially reduce child poverty. The results also give researchers essential insights into socioeconomic, mental, psychological, and environmental factors that they can use in their intervention practices holistically in reducing child poverty.

Voluntary Neonatal Medication Incident Reporting—A Single Centre Retrospective Analysis

Background: Medication errors in neonatal intensive care units (NICUs) are prevalent, with dosage and prescription errors being the most common. Aims: To identify the common medication errors reported over twelve years using a voluntary, nonanonymous incident reporting system (RiskMan clinical incident reporting information system) at an Australian tertiary NICU. Methods: This was a single-centre cohort study conducted at a tertiary NICU. All medication-related incidents (errors) reported prospectively through the RiskMan online voluntary reporting database from January 2010 to December 2021 were included. The medication incidents were grouped into administration, prescription, pharmacy-related, and others, which included the remaining uncommon incidents. Results: Over the study period, 583 medication errors were reported, including administration-related (41.3%), prescription-related (24.5%), pharmacy-related (10.1%), and other errors (24%). Most incidents were reported by nursing and midwifery staff (77%) and pharmacists (17.5%). Most outcomes were minor or insignificant (98%), with only a few resulting in major or significant harm. There was one extreme incident that may have contributed to the death of a neonate and nine moderate incidents. Conclusions: Our results demonstrate that medication errors are common and highlight the need to support improvement initiatives and implement existing evidence-based interventions in routine practice to minimise medication errors in the NICU.

Incidence rates of hepatocellular carcinoma based on risk stratification in steatotic liver disease for precision medicine: A real-world longitudinal nationwide study.

Detailed subgroup incidence rates for steatotic liver disease (SLD)-related hepatocellular carcinoma (HCC) are critical to inform practice and public health interventions but remain sparse. We aimed to fill in this gap. In a retrospective cohort study of adults with SLD from the United States (US) Merative Marketscan Research Databases (1/2007 to 12/2021), we estimated HCC incidence stratified by sex, age, cirrhosis, diabetes mellitus (DM), and a combination of all these 4 factors. We excluded patients with significant alcohol use and chronic viral hepatitis. We analyzed data from 741,816 patients with SLD (mean age 51.5 ± 12.8 years, 46% male, 14.7% cirrhosis). During a 2,410,166 person-years (PY) follow-up, 1,740 patients developed HCC. The overall HCC incidence yielded 0.72 per 1,000 PY (95% confidence interval [CI, 0.68, 0.75]). The incidence was higher in males (0.95, 95% CI [0.89, 1.01]) compared to females (0.52, 95% CI [0.48, 0.56]) (p < 0.001). For those with cirrhosis, the incidence was significantly higher at 4.29 (95% CI [4.06, 4.51]) compared to those without cirrhosis (0.14, 95% CI [0.13, 0.16]) (p < 0.001). Additionally, the incidence was higher in patients with DM (1.19, 95% CI [1.12, 1.26]) compared to those without DM (0.41, 95% CI [0.38, 0.44]) (p < 0.001). Chronic kidney disease (CKD) was also associated with a higher HCC incidence of 2.20 (95% CI [2.00, 2.41]) compared to those without CKD (0.58, 95% CI [0.55, 0.62]) (p < 0.001). Similarly, individuals with cardiovascular disease (CVD) had a higher HCC incidence of 1.89 (95% CI [1.75, 2.03]) compared to those without CVD (0.51, 95% CI [0.48, 0.54]) (p < 0.001). Finally, the incidence of HCC was significantly higher in patients with non-liver cancer (3.90, 95% CI [3.67, 4.12]) compared to those without other cancers (0.29, 95% CI [0.26, 0.31]) (p < 0.001). On further stratification, HCC incidence incrementally rose by 10-year age intervals, male sex, cirrhosis, and DM, reaching 19.06 (95% CI [16.10, 22.01]) and 8.44 (95% CI [6.78, 10.10]) in males and females, respectively, but only 0.04 for non-diabetic, noncirrhotic aged <40 years patients in both sexes. The main limitation of this methodology is the potential misclassification of the International Classification of Diseases (ICD) codes inherent in claims database studies. This nationwide study provided robust granular estimates for SLD-related HCC incidence stratified by several key risk factors. In addition to cirrhosis, future surveillance strategies, prevention, public health initiatives, and future research models should also take into account the impact of sex, age, and DM.

Current Practice, Safety and Efficacy of Interventions for Recurrent Respiratory Papillomatosis: Evidence From a UK Registry.

To determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS. Prospective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub-group data-linked to Hospital Episode Statistics for additional follow-up (until 31st July 2022). UK NHS hospitals treating RRP patients. Children and adults diagnosed with RRP and managed in an NHS hospital. Disease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death). Three hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow-up period. This is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time. NCT03465280, ISRCTN36100560.

Advancing Community Care and Access to Follow-Up after Acute Kidney Injury Hospitalization: A Randomized Clinical Trial.

Key Points A risk-guided intervention improved adherence to processes of care for AKI survivors.Further supports are necessary to improve uptake of processes of care for AKI survivors in primary care. Background AKI is associated with development and progression of CKD. Gaps in recommended care for CKD are common after AKI. Methods In this randomized controlled trial conducted in Alberta, Canada, we allocated adults hospitalized with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI to a risk-guided, transition of care intervention versus usual practices at the time of hospital discharge. For people in the intervention group, we used a validated risk index to predict risk of severe CKD after AKI. People at low risk (&lt;1%) received patient education alone. People at medium risk received additional clinical guidance, provided to their primary care physician. People at high risk (&gt;10%) were referred to nephrology. The primary outcome was the proportion of patients who received treatment with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB), statin, and nephrology specialist follow-up within 90 days of discharge. Results One hundred fifty-five patients were recruited; the mean (SD) age was 60 (15) years, 91 (60%) were male, and 96 (62%) had eGFR &lt;60 ml/min per 1.73 m2 or urine albumin-creatinine ratio &gt;30 mg/g at discharge. The proportion of participants who received ACE-I/ARB, statin treatment, and nephrologist follow-up was 28% in the intervention group versus 3% in the usual care group (absolute risk difference [RD], 25%; 95% confidence interval [CI], 15% to 36%). The use of ACE-I or ARB in participants with urine albumin-creatinine ratio &gt;300 mg/g or diabetes was greater in the high-risk group with the intervention versus usual care (RD, 37%; 95% CI, 6% to 67%), as was statin use among those with CKD (RD, 30%; 95% CI, 5% to 56%) and nephrologist follow-up for those with sustained eGFR &lt;30 ml/min per 1.73 m2 at discharge (RD, 78%; 95% CI, 56% to 100%). Hyperkalemia was more frequent in the intervention group (RD, 10%; 95% CI, 9% to 19%). Conclusions A risk-guided intervention for patients hospitalized with AKI increased recommended processes of care for CKD for high-risk patients after hospital discharge. Clinical Trial registry name and registration number: Improving Post Discharge Care after Acute Kidney Injury (AFTER AKI), NCT02915575.

Transitioning practices of vegetable small-scale actors in Vietnam: an interplay of food safety, labor demand, and soil environment

AbstractFood safety is a critical and persistent issue that challenges the sustainability of agri-food systems in Vietnam. The government has launched multiple food safety initiatives, but there is limited understanding of their contribution to changing the practices of small-scale producers and distributors. This study explores these changing practices by applying Social Practice Theory (SPT) to analyze the transitions in everyday routines of small-scale vegetable producers while being embedded in socio-institutional contexts of agri-food system transitions. We conducted semi-structured interviews and survey with small-scale food producers and distributors in Hanoi, Vietnam to examine the transitions in production and post-production practices over the last 20 years and the intersection between smallholding practices and cross-level dynamics. The study revealed, contrary to some common perceptions, that smallholder producers are transitioning towards food safety, with the use of more bio-pesticides and eco-friendly pest control methods. The smallholders also reproduce a variety of (sustainable) intensification practices, including crop rotation, organic fertilization, and soil cultivation, to sustain soil fertility and save labor. However, there are no clear patterns of change for post-production practices, although they have been diversifying under the impacts of urbanization. The findings highlight the interplay of food safety, labor, and soil environment in shaping the transitions of smallholder practices. We suggest that success in improving safety in production practices is feasible, but that this requires more thorough interventions in distribution and consumption practices to transform the food systems at large.

Nutritional Psychology: Review the Interplay Between Nutrition and Mental Health.

Nutritional psychology is a burgeoning field that examines the intricate relationship between nutrition and mental health. This concept, its historical development, and its current significance in understanding the complex interplay between diet and psychological well-being are explored in this article. The influence of various nutrients on mental health, the role of dietary patterns, and the impact of nutrition on specific mental disorders are examined. Highlighted are the potential mechanisms underlying the nutrition-mental health connection, and the implications for clinical practice and public health interventions are discussed. The discussion in this article underscores the importance of considering nutrition as essential in mental health promotion and treatment.

Exploring methodological approaches used in network meta-analysis of psychological interventions: A scoping review.

Psychological interventions are complex in nature and have been shown to benefit various clinical outcomes. Gaining insight into current practices would help identify specific aspects that need improvement to enhance the quality of network meta-analysis (NMA) in this field. This scoping review aimed to explore methodological approaches in the NMA of psychological interventions. We searched PubMed, EMBASE, and Cochrane CENTRAL in September 2023. We included NMAs of psychological interventions of randomized controlled trials that reported clinical outcomes. Three independent researchers assessed the eligibility and extracted relevant data. The findings were presented using descriptive statistics. Of the 1827 articles identified, 187 studies were included. Prior protocol registration was reported in 130 studies (69.5%). Forty-six studies (24.6%) attempted to search for gray literature. Ninety-four studies (50.3%) explicitly assessed transitivity. Nearly three-quarters (143 studies, 76.5%) classified treatment nodes by the type of psychological intervention, while 13 studies (7.0%) did so by lumping different intervention types into more broader intervention classes. Seven studies (3.7%) examined active components of the intervention using component NMA. Only three studies (1.6%) classified interventions based on factors affecting intervention practices, specifically intensity, provider, and delivery platform. Meanwhile, 29 studies (15.5%) explored the influential effects of these factors using meta-regression, subgroup analysis, or sensitivity analysis. The certainty of evidence was assessed in 80 studies (42.8%). The methodological approach in NMAs of psychological interventions should be improved, specifically in classifying psychological interventions into treatment nodes, exploring the effects of intervention-related factors, and assessing the certainty of evidence.

Little disease but lots of bites: social, urbanistic, and entomological risk factors of human exposure to Aedes aegypti in South Texas, U.S.

Aedes aegypti presence, human-vector contact rates, and Aedes-borne virus transmission are highly variable through time and space. The Lower Rio Grande Valley (LRGV), Texas, is one of the few regions in the U.S. where local transmission of Aedes-borne viruses occurs, presenting an opportunity to evaluate social, urbanistic, entomological, and mobility-based factors that modulate human exposure to Ae. aegypti. Mosquitoes were collected using BG-Sentinel 2 traps during November 2021 as part of an intervention trial, with knowledge, attitudes, and practices (KAP) and housing quality surveys to gather environmental and demographic data. Human blood samples were taken from individuals and a Bitemark Assay (ELISA) was conducted to quantify human antibodies to the Ae. aegypti Nterm-34kDa salivary peptide as a measure of human exposure to bites. In total, 64 houses were surveyed with 142 blood samples collected. More than 80% of participants had knowledge of mosquito-borne diseases and believed mosquitoes to be a health risk in their community. Our best fit generalized linear mixed effects model found four fixed effects contributed significantly to explaining the variation in exposure to Ae. aegypti bites: higher annual household income, younger age, larger lot area, and higher female Ae. aegypti abundance per trap night averaged over 5 weeks prior to human blood sampling. Most surveyed residents recognized mosquitoes and the threat they pose to individual and public health. Urbanistic (i.e., lot size), social (i.e., income within a low-income community and age), and entomological (i.e., adult female Ae. aegypti abundance) factors modulate the risk of human exposure to Ae. aegypti bites. The use of serological biomarker assays, such as the Bitemark Assay, are valuable tools for surveillance and risk assessment of mosquito-borne disease, especially in areas like the LRGV where the transmission of target pathogens is low or intermittent.

A child-centred intercultural approach to the socio-educational inclusion of migrant and refugee children

The increasing trend of child migration, whether forced or voluntary, poses a challenge to policies aimed at ensuring social cohesion and protecting children's rights. Inclusive educational environments play a crucial role in the integration of migrant and refugee children by promoting intercultural dialogue and participation. This study aims to explore the potential of a child-centred approach to the socio-educational inclusion of migrant and refugee children in Europe, proposing a framework of inclusive interculturalism to address the specific challenges these children face in educational settings. A narrative review was conducted, examining a wide range of peer-reviewed sources to synthesise current knowledge on child-centred education and its applicability to migrant and refugee children. The review identifies key challenges in adopting a child-centred approach, including socio-cultural, linguistic and psychological barriers that hinder migrant and refugee children's full participation in education. It highlights the importance of promoting agency, cultural competence and emotional well-being through inclusive and intercultural educational practices. Implementing a child-centred, inclusive intercultural approach can promote social cohesion and reduce inequalities by ensuring that all children, regardless of their background, have access to quality education and opportunities for personal development. However, more empirical research is needed to translate these theoretical frameworks into practical interventions.

Game-Based eHealth Interventions for the Reduction of Fatigue in People With Chronic Diseases: Systematic Review and Meta-Analysis.

Fatigue is a common and debilitating side effect of chronic diseases, significantly impacting patients' quality of life. While physical exercise and psychological treatments have been shown to reduce fatigue, patients often struggle with adherence to these interventions in clinical practice. Game-based eHealth interventions are believed to address adherence issues by making the intervention more accessible and engaging. This study aims to compile empirical evidence on game-based eHealth interventions for fatigue in individuals with chronic diseases and to evaluate their effectiveness in alleviating fatigue. A comprehensive literature search was performed across Embase, MEDLINE ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in August 2021. Study characteristics and outcomes from the included studies were extracted, and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity. Of 1742 studies identified, 17 were included in the meta-analysis. These studies covered 5 different chronic diseases: multiple sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1), and Parkinson disease (n=1). All but 1 study used exergaming interventions. The meta-analysis revealed a significant moderate effect size in reducing fatigue favoring the experimental interventions (standardized mean difference [SMD] -0.65, 95% CI -1.09 to -0.21, P=.003) compared with control conditions consisting of conventional care and no care. However, heterogeneity was high (I2=85.87%). Subgroup analyses were conducted for the 2 most prevalent diseases. The effect size for the multiple sclerosis subgroup showed a trend in favor of eHealth interventions (SMD -0.47, 95% CI -0.95 to 0.01, P=.05, I2=63.10%), but was not significant for the cancer group (SMD 0.61, 95% CI -0.36 to 1.58, P=.22). Balance exercises appeared particularly effective in reducing fatigue (SMD -1.19, 95% CI -1.95 to -0.42, P=.002). Game-based eHealth interventions appear effective in reducing fatigue in individuals with chronic diseases. Further research is needed to reinforce these findings and explore their impact on specific diseases. Additionally, there is a lack of investigation into interventions beyond exergaming within the field of game-based learning.

Participation experiences of young people with limb difference in sports and recreation in Australia: a qualitative study

Purpose The primary objective was to investigate the experiences of young people with limb difference participating in sports and recreation. Materials and methods A qualitative study using an interpretive description approach was undertaken with nine family dyads (n = 9 young people; n = 9 parents) recruited across Australia via convenience sampling. Data were collected via 18 semi-structured interviews and analysed in line with the interpretive description approach. Young people were aged between 9-16 years (mean 14 y 1 m), with unilateral (n = 7) or bilateral (n = 2) limb differences. All participating parents were mothers. Findings Three themes were interpreted from the data: (1) “Just treat me like everyone else”: equitable participation in sports and recreation, (2) “Provide them opportunities and let them take the lead”: genuine choice within activities, and (3) “I wish they were easier to get”: the impact of sports-specific prostheses on participation. Facilitators and barriers to participation were mapped to illustrate the socio-ecological levels at which these influences operate, and a conceptual model was developed to guide application in practice. Conclusions This study provides guidance for practitioners, coaches, and families on how to support participation for young people with limb difference, and future research may operationalise this conceptual model into policy or practice interventions.

Diagnostic value of nocturnal trend changes in a dynamic electrocardiogram for coronary heart disease

ObjectiveTo explore the diagnostic value of intermittent changes in the nocturnal ST segment trend graph in a dynamic electrocardiogram (ECG) for coronary heart disease (CHD).MethodsA total of 205 patients who underwent coronary angiography were included in this retrospective study. The study sample was determined through a power analysis aimed at achieving power of 80% with a significance level of 0.05. The participants were divided into the CHD (n = 101) and the non-CHD (n = 104) group, based on the degree of coronary artery diameter stenosis. The morphological changes in the ST segment trend graph were observed and divided into two categories: ‘wall-shaped’ and ‘peak-shaped’ changes.ResultsAmong the 205 patients, 94 had nocturnal ST segment dynamic changes and 111 did not. The detection rate of CHD without nocturnal ST segment dynamic changes was 21.59%, significantly lower than the detection rate of 93.18% in those with nocturnal ST segment changes, reflecting a statistically significant difference (P < 0.05). The positive rate of ST segment in patients with single-vessel disease (71.88%) was lower than in patients with multi-vessel disease (78.57%), and both differences were statistically significant (P < 0.05). The duration of ST segment trend graph changes in 94 cases in the CHD group with intermittent changes in the nocturnal ST segment trend graph was higher than in the non-CHD group, but no significant difference was observed (P > 0.05). The detection rate of CHD in the peak-shaped dynamic change group of the nocturnal ST segment trend graph was significantly higher (76/82) than in the wall-shaped (6/82) dynamic change group (P < 0.05).ConclusionPeak-shaped changes in the nocturnal ST segment trend graph indicate coronary artery lesions. Nocturnal ST segment changes observed through dynamic ECG monitoring can serve as a valuable non-invasive predictor for CHD, providing a feasible method for early diagnosis and intervention in clinical practice.

Investigating the influence of Bowen technique with retro-walking on hamstring flexibility and dynamic balance in young college-going students

Abstract: BACKGROUND: Hamstring tightness is a common issue affecting individuals, leading to discomfort, pain, and increased risk of injury. The Bowen technique, a gentle myofascial release technique, and retro-walking have been suggested as potential interventions to improve hamstring flexibility and dynamic balance. This study aimed to assess the impact of combining the Bowen technique with retro-walking on hamstring flexibility and dynamic balance in college students. METHODOLOGY: A pre–post-experimental study was conducted among 50 college students aged 17–25 years. Participants were randomly allocated to either the experimental group (n = 25) receiving Bowen technique and retro-walking intervention or the control group (n = 25). Hamstring flexibility was assessed using the active knee extension test, and dynamic balance was evaluated using the Y-Balance test. The data were analyzed using paired and unpaired t-tests. RESULTS: Intragroup analysis revealed significant improvements in hamstring flexibility and dynamic balance posttreatment in the experimental group (P &lt; 0.05), with no significant changes observed in the control group (P &gt; 0.05). Intergroup analysis demonstrated statistically significant improvements in hamstring flexibility (P &lt; 0.05) and dynamic balance (P &lt; 0.05) between the experimental and control groups postintervention. DISCUSSION: The results indicate that the combination of the Bowen technique and retro-walking effectively improves hamstring flexibility and dynamic balance in college students. The Bowen technique likely enhances muscle extensibility and tissue repair, while retro-walking optimizes muscle length utilization and proprioception. These findings underscore the potential utility of these interventions in clinical practice for managing hamstring tightness and improving overall musculoskeletal health. CONCLUSION: The integration of the Bowen technique with retro-walking holds promise as a noninvasive and effective approach to enhance hamstring flexibility and dynamic balance in college students.