Longitudinal Intervention Study Research Articles

Approaches towards menstrual cycle disorder therapy in reproductive-aged women with long COVID

Background. The mirror of a female’s reproductive health is the menstrual cycle. The SARS-CoV-2 pandemic itself acts as a significant stressor. This leads to women’s overall health and life quality disturbance. Moreover, patients struggle with long COVID effects, which is a prolongation of symptoms after recovery. Due to the expression of angiotensin-converting enzyme type 2 receptors in the intestinal mucosa and inflammation, the gastrointestinal (GI) tract is also triggered by the virus.Objectives. To assess the efficacy of the chosen treatment approach in women with changes in premenstrual syndrome and cyclicity due to long COVID with or without GI symptoms.Material and methods. A single-centre longitudinal interventional study was organized. Were studied data from the conducted tests (progesterone level, ultrasound follicle scan, etc.) and surveys. Then the effectiveness of the suggested treatment with the use of oral and vaginal forms of progesterone was evaluated. The study was held in the Kyiv City Center of Reproductive and Perinatal Medicine (Ukraine) from January to June 2021.Results. On average 78% patients without GI symptoms experienced relief after 3 months and 89% patients after 6 months of suggested treatment. 71% patients with GI symptoms experienced improvement after 3 and 87% of them after 6 months. The vaginal progesterone had better results compared to oral form. Averagely 6–8% experienced side effects (nausea, hypotension, less compliance) due to progesterone intake. The vaginal micronised progesterone also presented better results than oral with fewer side effects compared to the total number of participants.Conclusions. The proposed approach has shown particular correction of the menstrual cycle disturbances in women with long COVID. Vaginal micronized progesterone offers more promising outcomes in patients with GI symptoms and disrupted absorption, compared to the oral form.Further investigation is required for a more reasonable conclusion.

The effect of vitamin D on neurocognitive functions in older vitamin D deficient adults: a pilot longitudinal interventional study.

The relationship between vitamin D and cognitive status remains controversial. We aimed to evaluate the effect of vitamin D replacement on cognitive functions in healthy and cognitively intact vitamin D deficient older females. This study was designed as a prospective interventional study. A total of 30 female adults aged ≥60 with a serum 25 (OH) vitamin D level of <10 ng/ml were included. Participants were administered 50 000 IU vitamin D3 weekly for 8 weeks followed by a maintenance therapy of 1000 U/day. Detailed neuropsychological assessment was performed prior to vitamin D replacement and repeated at 6 months by the same psychologist. Mean age was 63 ± 6.7 years and baseline vitamin D level was 7.8 ± 2.0 (range: 3.5-10.3) ng/ml. At 6 months, vitamin D level was 32.5 ± 3.4 (32.2-55) ng/ml. The Judgement of Line Orientation Test (P = 0.04), inaccurate word memorizing of the Verbal Memory Processes Test (P = 0.02), perseveration scores of the Verbal Memory Processes Test (P = 0.005), topographical accuracy of the Warrington Recognition Memory Test (P = 0.002), and the spontaneous self-correction of an error in the Boston Naming Test (P = 0.003) scores increased significantly, while the delayed recall score in the Verbal Memory Processes Test (P = 0.03), incorrect naming of words in the Boston Naming Test (P = 0.04), interference time of the Stroop Test (P = 0.05), and spontaneous corrections of the Stroop Test (P = 0.02) scores decreased significantly from baseline. Vitamin D replacement has a positive effect on cognitive domains related to visuospatial, executive, and memory processing functions.

A longitudinal intervention study of the effects of increasing amount of meaningful writing across grades 1 and 2

The current study examined the effectiveness of a writing is caught approach with young developing writers in Norway. This method is based on the premise that writing competence is acquired naturally through real use in meaningful contexts. Our longitudinal randomized control trial study tested this proposition by examining if increasing first grade students’ opportunities to write in various genres for different purposes and for a range of audiences over a two-year time period improved the quality of their writing, handwriting fluency, and attitude towards writing. The study included data from 942 students (50.1% girls) in 26 schools randomly assigned to the experimental treatment, and 743 students (50.6% girls) in 25 schools randomly assigned to the business-as-usual (BAU) control condition. Across Grades 1 and 2, experimental teachers were asked to supplement their typical writing instruction by implementing 40 writing activities designed to increase students’ purposeful writing. Increasing experimental students’ writing over the two-year period did not result in statistically detectable differences in the writing quality, handwriting fluency, and attitude towards writing of students in the experimental and BAU control conditions. These findings did not provide support for the effectiveness of the writing is caught approach. Implications for theory, research, and practiced are discussed.

Gut Microbiota Signatures Are Associated With Psychopathological Profiles in Patients With Ulcerative Colitis: Results From an Italian Tertiary IBD Center.

Several patients with ulcerative colitis (UC) suffer from psychiatric disorders, such as major depressive disorder, anxiety, or bipolar disorder, and show specific personality traits. Despite this, there are few data about personality profiles' characterization in UC patients and about correlation of their psychopathological profile with their intestinal microbiota.The aim of our study is to analyze the psychopathological and personality profile of UC patients and correlate it with specific signatures of their gut microbiota. This is a prospective interventional longitudinal cohort study. We enrolled consecutive patients affected by UC attending to the IBD Unit of Center for Digestive Disease of "A. Gemelli" IRCCS Hospital in Rome and a group of healthy subjects, matched for specific characteristics. Each patient was evaluated by a gastroenterologist and a psychiatrist. Moreover, all participants underwent psychological tests and a collection of stool samples. We recruited 39 UC patients and 37 healthy subjects. Most patients showed high level of alexithymia, anxiety symptoms, depressive symptoms, as well as neuroticism and hypochondria, with obsessive-compulsive features at the behavioral level, which significantly impaired their quality of life and abilities at work. Gut microbiota analysis in UC patients demonstrated an increase in actinobacteria, Proteobacteria and Saccharibacteria (TM7), with a reduction in verrucomicrobia, euryarchaeota and tenericutes. Our study confirmed the presence of high levels of psycho-emotional distress in UC patients, alongside alterations of the intestinal microbiota, and highlighted some families and genera of bacteria (Enterobacteriaceae, Streptococcus, Veillonella, Klebsiella, and Clostridiaceae) as potential markers of an altered gut-brain axis in these patients.

Metamemory in older adults, preliminary results of a multifactorial training program

AbstractBackgroundCognitive intervention is a broad field that uses different means to increase or maintain these capacities. One of the aspects worked in memory training interventions refers to beliefs about performance, control and aging beliefs regarding this function in old age. More favorable beliefs towards memory in old age, performance capacity and greater self‐perceived control are related to successful aging and feelings of well‐being. The aim of the present study is to evaluate memory and aging beliefs in older adults who took part in a memory training program and a control group of subjects belonging to the same age group.MethodDesign: Comparative, pre‐post, longitudinal intervention study. Community dwelling older adults over 60 years. Memory training program participants (n = 58) (M = 70,04 years old; ds = 8.07 years) and controls (n = 72) (M = 69.92 years old; ds = 7.31 years) were assed at the begging and the end of the program. Instruments: Questionnaire of Social Demographic Data (built ad hoc), Brief Neuropsychological assessment for memory and attention. Metacognition: Memory Control Capacity Inventory (MCI) and ‐Metamemory Questionnaire. Procedure: All the participants of the Intervention group took part in the Memory training program. The program has a duration of 8 sessions of 90 minutes each, where theoretical and practical tools are provided to improve cognitive performance in everyday life Program participants and controls were assed twice, with eight weeks of difference between the first and second evaluation.ResultResults reveal that when comparing the groups, statistically significant differences can be observed in favor of memory program participants in the following aspects: Metamemory beliefs: satisfaction(z = ‐3,376 p = .001), Metamemory capacity z = (‐2.32‐ p = .050) Metamemory Strategy (z = ‐4.556‐ p = .000), total metamemory beliefs (z = 4.620‐ p = .000) and in aging beliefs, in the aspect :aging independence concerns (z = ‐2.526 p = .000).ConclusionIt is of great significance the incorporation of the assessment, training and observation of meta‐memory beliefs together with cognitive assessment and cognitive training in memory programs for older adults. The inclusion of cognitive training is an approach that can help cognitively vulnerable older adults and promote healthy cognitive aging.

Analysis of factors associated with sterile inflammation in women with pe receiving different antihypertensive treatment strategies

Systemic inflammation alongside endothelial dysfunction is considered to play a crucial role in PE pathogenesis. Endothelial dysfunction can be assessed by endothelial glycocalyx (eGC) damage. eGC is a superficial layer of cells associated with endothelial membrane that provides all endothelial cells functions. Its damage can be evaluated by the levels of its circulating components in blood. Patients with PE generally receive methyldopa (Dopegyt) solely or in combination with nifedipine (Cordaflex), and there is no understanding of their effect on proinflammatory state of blood vessels. Our study aimed to assess levels of IL-6, IL-18, TNFα, galektin-3 and homocysteine as well as levels of syndecan-1, eCG structural component, representing system inflammatory response and endothelial dysfunction development in blood of women with early- and late-onset PE receiving different antihypertensive treatment strategies. Eighty-two patients were enrolled into this interventional longitudinal pilot study. The comparison group included 15 patients before 34 gestational weeks and 15 patients after 34 weeks. Study subgroup 1 included 12 patients with early- onset PE receiving Dopegyt solely and 16 patients with early-onset PE receiving Dopegyt together with Cordaflex. Study subgroup 2 included 12 patients with late-onset PE receiving Dopegyt solely and 12 patients with late-onset PE receiving combined therapy. As for early-onset PE, only IL-6 demonstrated statistically significant differences in patients receiving both treatment strategies compared to control. Proinflammatory state was more profound in late-onset PE. IL-6 levels were significantly increased in late-onset PE treated with Dopegyt. IL-6 and TNFa levels were significantly higher in late-onset PE patients treated with Dopegyt + Cordaflex compared to control. Syndecan-1 levels were statistically significantly higher in patients with early-onset PE treated with Dopegyt solely. There were no statistically significant differences between the groups despite elevated mean values of syndecan-1 in late-onset PE. Galectin-3 and homocysteine levels did not differ significantly between the groups, representing lack of pronounced inflammatory response and endothelial dysfunction.

Effect of voxelotor on cardiopulmonary testing in youths with sickle cell anemia in a pilot study.

Individuals with sickle cell anemia (SCA) exhibit decreased exercise capacity. Anemia limits oxygen-carrying capacity and affects cardiopulmonary fitness. The drug voxelotor raises hemoglobin in SCA. We hypothesized that voxelotor improves exercise capacity in youths with SCA. In a single-center, open-label, single-arm, longitudinal interventional pilot study (NCT04581356), SCA patients aged 12 and older, stably maintained on hydroxyurea, were treated with 1500mg voxelotor daily, and performed cardiopulmonary exercise testing before (CPET#1) and after voxelotor (CPET#2). A modified Bruce Protocol was performed on a motorized treadmill, and breath-by-breath gas exchange data were collected. Peak oxygen consumption (peak VO2 ), anaerobic threshold, O2 pulse, VE/VCO2 slope, and time exercised were compared for each participant. The primary endpoint was change in peak VO2 . Hematologic parameters were measured before each CPET. Patient Global Impression of Change (PGIC) and Clinician Global Impression of Change (CGIC) surveys were collected. Ten hemoglobin SS patients aged 12-24 completed the study. All demonstrated expected hemoglobin rise, with average +1.6g/dL (p=.003) and P50 left shift of average -11mmHg (p<.0001) with decreased oxygen off-loading at low pO2 . The change in % predicted peak VO2 from CPET#1 to CPET#2 ranged from -12.8% to +11.3%, with significant improvement of more than 5% in one subject, more than 5% decrease in five subjects, and insignificant change of less than 5% in four subjects. All 10 CGIC and seven of 10 PGIC responses were positive. In a plot study of 10 youths with SCA, voxelotor treatment did not improve peak VO2 in 9 out of 10 patients.

Divulging the Impetus of Yoga on Cardiorespiratory Fitness and Its Persona in Alleviating Anxiety Experienced by Youth: A Cohort Interventional Study.

Globalization endangers youngsters worldwide with new standards and possibilities. Hereat of being exposed to greater demands and expectations, when it comes to performance review, their life may become more distressed. Yoga with revolutionary methods may assistyoungsters in bettering their physical health regardingtheir maximal oxygen uptake, and also help manage their anxiety. This study ascertains the effect of yoga on youth's anxiety levels and cardio-respiratory fitness. It was a longitudinal interventional study recruiting 99 medical students wherein VO2max (maximal oxygen uptake) on thetreadmill/ergometer exercise and anxiety scores throughSpielberger's anxiety scale was assessed at baseline and evaluated after 6 months of a regular yogic regime.The VO2max wasrecorded by the metabolic module of Labchart software (Bella Vista,New South Wales, Australia). The VO2max evaluated by incremental exercise to volitional fatigue was found to be 2.64 ± 0.49 L/min in males and 1.51 ± 0.44 L/min in females pre-yoga and 2.81 ± 0.52 L/min in males and 1.69 ± 0.47 L/min in females post yoga. The difference in the endline and baseline VO2max values of yoga-performing males (t=6.595, p<0.001) and females (t = 2.478, p = 0.017) was found to be significantly higher than non-yoga performers. The METS value obtained in males was 11.96 and in females was 7.68 before yoga. Post-yoga values were 13.44 and 8.37, respectively. The difference in total anxiety scores post-intervention was 34.6 which was statistically significant (t= 4.959, p <0.001). From the viewpoint of a physiologist, higher VO2max in young adults links to better physical fitness which is the potential outcome of regular yogic practice. As a result ofregular yogic practice, initial soaring anxiety levels of subjects culminated in a drastic observable reduction in anxiety, which helped inculcate a judicious acumen in youngsters.

Effect of Tai Chi on stress, anxiety, and self-perception of happiness: a longitudinal intervention study

This intervention follow-up study evaluated anxiety and stress levels and self-perceived happiness of individuals linked to the health field who did not practice Tai Chi and compared these variables before and after practicing this art. One hundred twenty-three participants were subdivided into two groups: G1) Older health professionals (n=41) and G2) Younger pre-university students interested in the health field (n=82). Participants received a 60-minute Tai Chi class. The Perceived Stress Scale (PSS-14) was applied before the practice, and the State-Trait Anxiety Inventory (STAI) and Andrews Face Scale were used before and after the class. Generalized linear models and the Bowker symmetry test were applied for data analysis. 46.3% and 30.5% of participants in G1 and G2 had mild stress levels, and 43.9% and 46.3% had moderate stress levels, respectively. After practicing Tai Chi, both groups presented significantly lower mean anxiety scores. In G1, 31.7% of participants went from moderate to mild anxiety levels after practice, 19.5% from severe to moderate, and 7.3% from severe to mild. In G2, 28.2% of participants went from moderate to mild anxiety levels after practice, 18.3% from severe to moderate, and 6.1% from severe to mild. Furthermore, 100.0% of individuals in G1 and 96.3% in G2 were happy after the class. Tai Chi was effective in reducing anxiety levels and improving self-perceived happiness.

Effect of psychosocial stress and coping strategies on non-surgical periodontal therapy in patients with generalized stage III/IV periodontitis: a longitudinal intervention study

ObjectivesThe aim of this longitudinal intervention study was to assess the impact of psychosocial stress and coping response strategies on the clinical outcomes in periodontitis patients treated with non-surgical periodontal therapy (NSPT).Materials and methodsAfter the administration of psychological questionnaires, patients diagnosed with generalized stage III–IV periodontitis were categorized into different groups depending on their stress levels (10-item perceived stress level (PSS-10)) and coping response strategies (coping responses inventory (CRI)). Clinical data were collected 1 week before and 3 months after the completion of NSPT.ResultsOf the 90 patients included at baseline, 27 presented major and 63 minor stress levels, while 40 had avoidance and 50 approach coping behavior. All clinical parameters were similar at the baseline across different categories. At re-evaluation, full-mouth bleeding score (FMBS), mean probing pocket depth (PPD), and number of residual pathological pockets were significantly superior in groups with higher stress levels (p <0.001, p =0.001, and p =0.020, respectively), while higher full-mouth plaque scores (FMPS) and FMBS were found in patients with avoidance coping strategies (p =0.009 and p <0.001, respectively). When jointly evaluated, an added detrimental effect of coping styles on allostatic load was observed. Multivariate analysis confirmed a significant effect of stress levels and coping strategies on final FMBS, but not of coping on mean PPD.ConclusionPsychosocial stress and avoidance coping strategy seem to negatively influence the clinical outcomes of NSPT at short term (NCT04739475; 9/1/2017).Practical implicationsBased on these findings, patients reflecting these psychological profiles should be considered at greater risk for poor NSPT response and may benefit from complementary stress management strategies.

Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study

IntroductionOur aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living...

Enhancing medical students` confidence and performance in integrated structured clinical examinations (ISCE) through a novel near-peer, mixed model approach during the COVID-19 pandemic

BackgroundNear-peer medical education serves as an important method of delivering education to junior students by senior students. Due to the reduced clinical exposure because of the COVID-19 pandemic, we developed a mentorship scheme to help medical students with their Integrated Structured Clinical Examinations (ISCEs) by providing a combination of near-peer mentorship together with lecture-based teaching on a weekly basis for a 12-week period. Students attended a specialty-focused lecture every Tuesday followed by a small group teaching session organised by their tutor.MethodsA longitudinal evaluative interventional study was undertaken by the international student led medical education organisation, OSCEazy. The teaching programme was organised and conducted by third year medical students to a recruited cohort of second year medical students. Students’ perceptions of ISCEs (confidence, anxiety, and overall performance) were evaluated using 5-point Likert scales while their knowledge of the specialty was assessed using 10 single best answer questions which were distributed via Google® forms at the start and end of each week. In addition, we assessed tutor perceptions of their teaching and learning experience.ResultsSeventy-two tutees were enrolled in the programme (mean age: 24.4, female: 77.8%). 88.9% of the participants had not attended any online ISCE teaching prior to this. They preferred in-person ISCE teaching as compared to virtual sessions [median 4.5 (IQR 4–5) vs 3 (IQR 3–4), p < 0.0001), respectively]. There was a significant overall increase in knowledge when comparing pre-session and post-session performance [mean 53.7% vs 70.7%, p < 0.0001)]. There was a significant increase in student confidence [Confidence: median 3 (IQR:3–4) vs 4 (IQR 3–4), p < 0.0001] while no change was seen in the anxiety and perception of their overall performance in an ISCE. [Anxiety: median 3 (IQR 2–4) vs 3 (IQR 3–4), p = 0.37, Performance: median 3 (IQR 3–4) vs median 3 (IQR 3–4), p < 0.0001]. The tutors reported an increase in their confidence in teaching ISCEs online [median 3 (IQR 2–3.25) vs median 4 (IQR 4–5), p < 0.0001)].ConclusionOnline near-peer teaching increases the confidence of both tutees and tutors involved while enhancing the tutees’ knowledge of the specialty. Thus, medical schools should incorporate near-peer teaching in their curriculum to enhance the student learning experience.

Impact of keratoprosthesis implantation on retinal and visual pathway function assessed by electrophysiological testing.

To investigate the impact of Boston Type I Keratoprosthesis (BI-Kpro) implantation on retinal and visual pathway function, respectively, assessed by full-field electroretinography (ERG) and visually evoked potentials (VEPs). This is a prospective interventional longitudinal study, and patients with BI-Kpro implantation were assessed preoperatively and at 3 and 12months after surgery. ERG, flash, and pattern-reversal VEPs (15' and 60' checks) along with visual acuity (VA) were performed. A total of 13 patients (24 to 88years of age) were included. Mean baseline VA (logMAR) improved from 2.30 to 1.04 at 3months and to 1.00 at 12months. Flash VEPs were normal in 6 (46%) patients and in 10 (77%) patients at the 12-month follow-up. PVEP was non-detectable in all patients preoperatively for both check sizes. For 15' check size, 6 (46%) patients showed responses after 3 and 12months except for 1 patient with normal responses at 12months with the remaining non-detectable. For 60' checks, 11 (85%) patients had responses 3months after surgery with only 9 (70%) showing responses at 12months. Abnormal full-field ERGs were found in all patients preoperatively. Amplitude improvement was found in 10 (77%) patients from baseline to 3months and in 8 (62%) patients from the 3- to the 12-month follow-up. In this small cohort of patients with BI-Kpro implantation, a remarkable improvement on visual function quantitatively assessed by electrophysiological testing was found in the majority of cases. Visual electrophysiological testing can contribute to objectively assess functional outcomes in this population.

Functional and Radiological Outcome of Conservatively Managed Fracture of Radius and Ulna Forearm Bone in Paediatric PopulationA Longitudinal Interventional Study

Introduction: Fractures of the shaft of both bones of forearm are one of the most common fractures in the paediatric age group. There is often a difference of opinion regarding the management of these fractures. Though, there has been an increasing inclination towards surgical correction of these injuries, conservative management is still very popular because of the advantage of good bone remodelling potential in children. Loss of reduction is a known complication of conservative method of treatment. Assessment of the cast index can serve as a tool for the prediction of failure of the conservative management. Aim: To analyse the functional and radiological outcomes of both radius and ulna forearm bones shaft fractures. Materials and Methods: This longitudinal interventional study was conducted in the Department of Orthopaedic Surgery, at King George’s Medical University, Lucknow, Uttar Pradesh, India. The duration of the study was one year 11 months, from June 2017 to May 2019. A total of 196 (156 males and 40 females) patients were included in the study, who presented with closed diaphyseal fractures of the radius and ulna, and were managed conservatively. The patients with acceptable reductions were followed-up at three weeks, six weeks, three months and six months. The functional and radiological parameters were assessed, analysed and the cast index was estimated at each follow-up visit. Chi-square test was performed on the numerical/frequency displays of the dichotomous variables. Student’s t-test with a 95% confidence interval was performed to compare the means of the two groups. Results: The changes in angulation for Anteroposterior (AP), as well as, lateral view of both radius and ulna were significant at each follow-up (p&lt;0.001), but the fracture reduction was found acceptable as per protocol. The loss of reduction was seen equally in male and female patients, only on the left-side and only in the middle third of both bone forearm fracture, but no significant association was found between sex, laterality, site and loss of reduction. The final Range Of Motion (ROM) obtained at elbow, forearm and wrist were all in the functional range at six months follow-up. There were two cases of failure, both above 10 years of age having high cast index and greater angulation in ulna in the prereduction phase. Conclusion: Conservative treatment remains the gold standard for management of paediatric bones forearm fractures with very good functional outcome. A high cast index can be used to predict failure of the conservative management.

Interprofessional education in problem-based learning: A frontier form of PBL in medical education.

Interprofessional education (IPE) aims to educate healthcare students to improve collaboration and the quality of care. The delivery of IPE through a problem-based learning (PBL) setting appears to hold good validity. However, there are few studies that show the value of combining these two teaching modes. The research was a longitudinal intervention study. A total of 360 students were randomly divided into three interprofessional PBL (IPBL) groups that mixed nursing, pharmacy, and clinical medical students and three uniprofessional PBL (UPBL) groups that consisted of a single profession. An improved Attitude and Learning Ability Questionnaire (ALAQ) was used to measure the improvement in attitudes toward interprofessional cooperation and learning outcomes. The tutorial session and final examination grades were compared between IPBL and UPBL by Chi-square tests and Cochran-Mantel-Haenszel tests. Cronbach's α analysis was calculated to assess the validity and reliability. Cronbach's alpha coefficient of the questionnaire was 0.887, demonstrating high levels of reliability (95% confidence interval [CI]: 0.842 0.916). According to Chi-square tests and Cochran-Mantel-Haenszel tests, we observed the student's positive attitudes toward interprofessional collaboration and the student's role awareness in the IPBL students was increased compared with UPBL students. In addition, a great majority of IPBL students felt that they had improved their self-learning ability and maintained a high enthusiasm for learning during the course. Our study found that the IPBL teaching model was more effective than the UPBL teaching model in healthcare student's positive attitudes toward interprofessional collaboration and learning outcomes.

Impact of Diabetes Nutrition Education on Nutrition Knowledge and Physical Activity Duration among Type 2 Diabetic Patients: A Longitudinal Cohort Intervention Study

Impact of Diabetes Nutrition Education on Nutrition Knowledge and Physical Activity Duration among Type 2 Diabetic Patients: A Longitudinal Cohort Intervention Study

The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study.

Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.

Computer-Assisted Learning versus Conventional Methods for Pathology Tutorials: A Longitudinal Interventional Study

Introduction: One of the important objectives of undergraduate pathology teaching is to enable the student to correlate the normal and altered morphology of different organ systems in common diseases. The conventional chalk and board method of tutorials for imparting this training is not free of disadvantages. ComputerAssisted Learning (CAL) is the trend of the day worldwide. Aim: The present study aimed to compare the effectiveness of CAL with the conventional method for pathology tutorials, with special emphasis on the retention of knowledge in students. Materials and Methods: The present study was a longitudinal interventional study involving 110 students of the second Professional MBBS batch of the Department of Pathology at North Bengal Medical College, Darjeeling, a rural area Medical College, for a period of six months from December 2017 to June 2018. The students were divided into an intervention group taught by the CAL method and a control group taught by the chalk and board method. On the day of teaching and one month after that, assessment was done by histopathology slide spotting. Focus Group Discussion (FGD) and a pre-tested and validated questionnaire completion were also undertaken. Paired t-test was used for comparison in both groups. Results: Those instructed by the CAL Method scored significantly higher than the control group students in both Spotting-1 and Spotting-2. In Spotting-1, the average score of group A (interventional group) and group B (control group) students was 71.11±27.67 (SD) and 38.89±24.75, respectively (p-value 0.01). In Spotting-2, the average score of group A and group B students was 67.78±28.52 (SD) and 29.44±28.85 (SD), respectively (p-value-0.01). Conclusion: The present study concluded that the CAL method is acceptable to both students and facilitators. It resulted in a significantly improved performance of students in the diagnosis of histopathology slides assessed immediately after teaching and one month after teaching. Hence, CAL also assists in the retention and recall of information.

Effects of yogic interventions on cardiopulmonary and endothelial health at high altitude: A prospective longitudinal interventional study

High-altitude sojourn may lead to risk factors for high-altitude disorders and subsequent altitude sickness. This study was aimed to analyse the effects of sea-level yoga practices on individuals when they ascend to high altitudes (HAs). Healthy male subjects were randomly divided into two groups i) yoga group (n = 43) and ii) control group (n = 44). One month of yoga training was given to the yoga group for 30 min daily. The control group was provided daily routine for one month. Blood samples were collected when subjects were in fasting condition at sea level and at high altitude. The pulmonary function, blood pressure, cardiovascular and resting metabolic parameters and estimated markers of endothelial homeostasis were monitored at sea level and then at high altitude. The study revealed that yoga group had enhanced pulmonary functions (p < 0.001), maintained blood pressure, and increased endothelial homeostasis markers such as corin and ACE; and showed decrease in VO2resting and hypoxia-induced endothelial leak parameters such as Angptl4, sKDR. In control group, the blood pressure, VO2, VCO2, and Angptl4 increased, while ACE, corin, and sKDR decreased. Sea-level yogic intervention before ascending to high altitude was found helpful for individuals.

The impact of yogic practices on perception of stress and sleep among medical students amid COVID-19 pandemic

Background: Medical undergraduates struggled to cope up with undue stress resulting in disturbed sleep during COVID-19 pandemic. Stress had affected not only the mental or psychological health but also affected the whole body systems including the sleep rhythm and quality. This study was undertaken focusing on the fact that yogic practices induce changes in stress level and sleep. Aims and Objectives: The aim of the study was to measure and compare the perceived stress and sleep quality among the medical undergraduate who discontinued and those who continued yogic practices in follow-up. Materials and Methods: This online longitudinal interventional study was conducted from November 2020 to May 2021. The study was conducted in three stages: Baseline (before intervention). after 6 weeks of yogic intervention, and after 3 months (for follow-up). All medical students of 18–30 years were enrolled (Total 600 students). Fifty-one undergraduate with prolonged illness, spine issues, any physiological issue, trained athletes, and trained yoga persons were excluded from the study. Total 549 medical students were falling in our inclusion criteria. Results: Significant level of stress response is a high predictor of poor sleep because of HPA mediated hormonal and sympathetic system activation. High level of stress is a significant predictor of poor quality of sleep. This causes persistent production of cortisol and epinephrine. Intervention of yogic practice helps in balancing the mind and body, thus improving the quality of life. Conclusion: The authors findings suggest that the undergraduates are in favor of practicing yoga as it helps them to cope up with the academic stress. It had also improved the quality of sleep among them.