Multicomponent Approach Research Articles

Impact of multicomponent exercise and nutritional supplement interventions for improving physical frailty in community-dwelling older adults: a systematic review and meta-analysis

Abstract Objective To investigate the efficacy of both multicomponent exercise and nutritional interventions on frailty by conducting a systematic review and meta-analysis to examine changes in frailty incidence. Design A systematic review and meta-analysis. Eligible criteria The included studies were limited to original controlled trials focused on frailty interventions in older adults aged 65 years and over. The studies involved only participants with specific diseases, and those recovering from surgery or being hospitalized were excluded. Information sources A systematic search was performed on three databases: PUBMED, EMBASE, and Cumulative Index to Nursing and Allied Health, with the latest search in October 2024. Three authors independently extracted the data using a standardized data collection form. Relative risks were used as a summary measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis. Results After searching three databases, 5327 records were identified. After removing duplicates and screening the titles and abstracts, 19 multicomponent exercise studies and 7 nutritional intervention studies were eligible. In a pooled analysis of 18 multicomponent exercise RCTs, including a total of 3457 older adults, the multicomponent exercises showed a clinically significant reduction in frailty risk by relative change 55% times (95% CI 45% to 67%, p value < 0.001). The subgroup analysis of combinations of macronutrients and micronutrients also demonstrated statistically significant decrease in frailty risk by relative change 28% times (95% CI 11% to 72%, p value = 0.008). Conclusion Multicomponent exercises can effectively improve physical frailty, regardless of the duration and types of the activities, whereas the efficacy of nutritional supplements remains unclear. Personalized multicomponent approaches that incorporate both exercises and nutritional supplements have promised to enhance effectiveness in reducing frailty, thus warranting further investigation. Trial registration The study was registered on 12 September 2022, under PROSPERO registration number CRD42022357357.

Physical Activity Component of the Greek Interventional Geriatric Study to Prevent Cognitive Impairment and Disability (GINGER): Protocol Development and Feasibility Study

Background/Objectives: Individuals with subjective cognitive decline (SCD) have an increased risk of developing dementia, while non-pharmacological multicomponent lifestyle interventions are recommended for prevention/management. The Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) is such a multicomponent approach, encompassing simultaneous interventions (cognitive training, depression and sleep management, etc.). Exercise/Physical activity (PA) is suggested as one such intervention. This study (i) presents the exercise protocol developed for GINGER and (ii) explores its feasibility (acceptability, applicability, adherence, users’ satisfaction and reliability). Methods: Exercise/PA protocol development, targeting SCD individuals aged > 55 years, utilized relevant guidelines/literature followed by focus group involving exercise specialists. Data were synthesized through consensus to design optimal exercise interventions prescribed on participant’s physical capacity (heart rate, exertion, etc.), comprising 6-month combined aerobic, strengthening, balance and dual-task exercises, delivered 3 times/weekly in two group-based supervised sessions (in-person and online) and one home-based session. Physical outcomes include balance, aerobic capacity [2-Minute Walk Test (2 MWT), IPAQ-7], strength [Hand Grip Strength (HGS), Sit-to-Stand], fear of falling. Eligibility for entering intervention is low IPAQ-7, 2 MWT or HGS scoring. Feasibility was explored with adherence (exercise diaries and Exercise Adherence Rating Scale) and satisfaction (Patient Satisfaction Questionnaire) Results: Intervention was easily delivered with good reliability across testers’ assessments on 13 SCD participants (ICCs = 0.62–0.99), and improved physical outcomes, whereas users’ adherence and satisfaction scored highly. Conclusions: The exercise protocol for SCD was feasible, acceptable, applicable, reliable, demonstrating adherence and satisfaction, while improving physical parameters. It is thus integrated in the GINGER study, where multiple simultaneous interventions will take place to prevent/enhance cognitive function.

Interventions employed to address vaccine hesitancy among Black populations outside of African and Caribbean countries: a scoping review.

Black people are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. This scoping review explored interventions that have been employed to address vaccine hesitancy among Black population outside of African and Caribbean countries. This review provides several strategies for addressing this deep-rooted public health problem. The scoping review followed the five-step framework outlined by Arksey and O'Malley. It complies with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Research studies that examined interventions utilized to promote vaccine confidence within Black populations living outside of African and Caribbean countries were reviewed. A total of 20 articles met the inclusion criteria for this study: 17 were quantitative studies and three were mixed-method studies. This scoping review highlighted six themes: educational advancement, messaging, multi-component approaches, outreach efforts, enhancing healthcare access, and healthcare provider leadership. The review identified effective interventions for addressing vaccine hesitancy among Black populations outside Africa and the Caribbean, emphasizing education, multidimensional approaches, and healthcare provider recommendations. It calls for more qualitative research and interventions in countries like Canada and the UK to enhance vaccine confidence and reduce mistrust.

Case report: Multicomponent intervention for severe food selectivity in autism spectrum disorder: a single case study

Food selectivity is common in children with Autism Spectrum Disorder (ASD). The treatment used can be invasive and difficult to implement, necessitating the exploration of multicomponent approaches. This study presents the case of a 9-year-old autistic girl with severe food selectivity, who ate exclusively liquid and semi-solid foods. A multicomponent intervention protocol was developed, including stimulus fading and positive reinforcement techniques, to increase acceptance of new textures and foods. Treatment sessions showed significant improvement in acceptance of semi-solid and novel foods, with a reduction in problem behaviors associated with mealtime. This study suggests that a multicomponent intervention can significantly improve food acceptance and reduce mealtime distress, proving to be a practical and effective treatment strategy in an autistic child. The intervention led to an increase in food acceptance and a reduction in mealtime-related distress, potentially improving the child and family’s quality of life.

Multicomponent Cyanation of 2‐Amino‐3‐cyano‐4H‐chromenes in Aqueous Media

AbstractChromenes represent a pivotal molecular structure found in a diverse range of biologically active compounds. Specifically, derivatives of 2‐amino‐3‐cyano‐4H‐chromene have demonstrated pharmacological applications, displaying potential antioxidant and anticancer activities. This has heightened interest in the exploration of new and more efficient methods for their synthesis. In recent years, few examples have emerged, focusing on the organocatalytic and enantioselective synthesis of 2‐amino‐3‐cyano‐4H‐chromene derivatives, although the overall number of works to date is limited. In this study, we present the results of the synthesis of 2‐amino‐4H‐chromen‐3,4‐dicarbonitriles through a Michael addition of cyanide to 2‐iminochromenes. To achieve this, we utilized a mild source of cyanide (acetone cyanohydrin), green solvents and catalytic conditions at room temperature, via a multicomponent approach. Furthermore, we initiated the enantioselective study of this process using chiral organocatalysts obtaining promising preliminary results.

Local Electronic Correlation in Multicomponent Møller-Plesset Perturbation Theory.

We present in this contribution the first application of local correlation in the context of multicomponent methods. Multicomponent approaches allow for the targeted simulation of electrons together with other Fermions (most commonly protons) as quantum particles. These methods have become increasingly popular over the last years, particularly for the description of nuclear quantum effects (in strong hydrogen bonds, proton tunneling, and many more). However, most implementations are still based on canonical formulations of wave function theory, which we know for decades to be computationally inefficient for capturing dynamical correlation effects. Local correlation approaches, particularly with the use of pair natural orbitals (PNOs), enable asymptotically linear scaling of computational costs with very little impact on the overall accuracy. In this context, the efficient use of density fitting approximations in the integral calculation proves essential. We start by discussing our implementation of density-fitted NEO-MP2 and NEO-PNO-LMP2, upgrading the electronic correlation treatment up to PNO local coupled cluster level of theory. Several challenging examples are provided to benchmark the method in terms of accuracy as well as computational cost scaling. Following appropriate protocols, anharmonic corrections to localized X-H stretches can be applied routinely with little computational overhead.

Water extract of incense stick ash: an efficient, greener approach for the synthesis of 2-pyridones via multi-component reaction approach

Water extract of incense stick ash: an efficient, greener approach for the synthesis of 2-pyridones via multi-component reaction approach

Progress in dysphagia management in older patients.

The review summarizes current knowledge, recent findings and knowledge gaps about the pathophysiology and therapy of oropharyngeal dysphagia in older persons. Oropharyngeal dysphagia is a major yet underrecognized health problem in older persons. Due to its high prevalence, its multifactorial etiology and multimodal treatment it has been classified as a geriatric syndrome. Although the knowledge of its pathophysiology and the effective diagnostic approach increased substantially during the last years, there is still minor evidence on how to effectively manage and treat dysphagia. However, treatment should be a multicomponent approach, combining swallowing training, nutritional therapy and oral hygiene. Emerging new fields are neurostimulation and chemical sensory stimulation which may be added in selected patients and indications. The individual components to be chosen should be based on the individual dysphagia pattern and severity as well as the capabilities of the patient. Frequently, the competing risks of inadequate nutrition and unsafe swallowing represent a challenge in determining the individual relevance of each component. The understanding of the pathophysiology of oropharyngeal dysphagia increased substantially during recent years. However, due the multifaceted appearance of dysphagia, which requires an individualized treatment, the evidence for therapeutic approaches increases rather slowly.

Assessing [DMAP-DABCO]AcO as an effective dual basic ionic liquid for the synthesis of Chromeno[2,3-d]pyrimidine derivatives and Exploring their Anti-Cancer activity through computational analysis

Here, we report the synthesis of a new dual basic ionic liquid viz. 1-[3-(dimethylamino)propyl]-1,4-diazabicyclo[2.2.2]octan-1-ium acetate [DMAP-DABCO]AcO, and its use as a catalyst for the synthesis of chromeno[2,3-d]pyrimidine derivatives through multi-component reaction approach involving salicylaldehyde derivatives, secondary amines and malononitrile. The ionic liquid and the chromeno[2,3-d]pyrimidine derivatives were characterized using IR, NMR, and mass spectrometry techniques. The synthesized derivatives were evaluated for their in vitro anti-cancer activity against the MCF7 cell line. The compound 4a showed the highest anti-cancer activity with an IC50 value of 65.25 µg/mL compared with the standard drug 5-FU. The anti-cancer activity of synthesized derivatives was additionally validated through computational studies, including molecular docking, density functional study (DFT), and absorption, distribution, metabolism, excretion, and (toxicity) ADME(T) analysis.

Protocol for a pilot study: Feasibility of a web-based platform to improve nutrition, mindfulness, and physical function in people living with Post COVID-19 condition (BLEND)

Individuals with Post COVID-19 condition (PCC), or long COVID, experience symptoms such as fatigue, muscle weakness, and psychological distress, including anxiety, depression, or sleep disorders that persist after recovery from COVID-19. These ongoing symptoms significantly compromise quality of life and diminish functional capacity and independence. Multimodal digital interventions targeting behavioural factors such as nutrition and mindfulness have shown promise in improving health outcomes of people with chronic health conditions and may be beneficial for those with PCC. The BLEND study (weB-based pLatform to improve nutrition, mindfulnEss, and physical function, in patients with loNg COVID) study is an 8-week pilot randomized controlled trial evaluating the feasibility of a digital wellness platform compared to usual care among individuals with PCC. The web-based wellness platform employed in this study, My Viva Plan (MVP)®, integrates a holistic, multicomponent approach to promote wellness. The intervention group receives access to the digital health platform for 8 weeks with encouragement for frequent interactions to improve dietary intake and mindfulness. The control group receives general content focusing on improvements in dietary intake and mindfulness. Assessments are conducted at baseline and week 8. The primary outcome is the feasibility of platform use. Secondary and exploratory outcomes include a between-group comparison of changes in body composition, nutritional status, quality of life, mindfulness, physical activity, and physical performance after 8 weeks. Findings of this study will inform the development of effective web-based wellness programs tailored for individuals with PCC to promote sustainable behavioural changes and improved health outcomes.

COMPREHENSIVE INJURY PREVENTION STRATEGIES FOR FOOTBALL PLAYERS

Injury prevention in football is a critical issue for athletes, coaches, and health professionals, given the sport's dynamic movements that elevate the risk of muscle and joint injuries. Effective strategies should incorporate specialized physical training and physiotherapeutic interventions to optimize player protection and performance. Preventive training programs, emphasizing muscle strengthening and proprioception, are essential for reducing injury risks. Specific exercises targeting the hamstrings, quadriceps, calves, and core enhance joint stability and mitigate overload injuries. Neuromuscular training, which includes balance exercises and plyometrics, improves proprioception and helps prevent falls and twists. Flexibility through regular stretching and dynamic warm-ups, such as the FIFA 11+, is crucial for preparing players physically and lowering injury incidence. Additionally, physiotherapists play a vital role in injury prevention through functional assessments to identify muscle imbalances and develop corrective exercise programs. Manual therapy techniques, joint stabilization exercises, and preventive rehabilitation further contribute to maintaining soft tissue quality and preventing muscle strains. Monitoring training load is another fundamental aspect of injury prevention, as abrupt changes in training intensity can lead to injuries. Using tracking technologies allows for better control of players' physical efforts. Studies indicate that implementing structured injury prevention programs significantly reduces injury rates and enhances athletic performance. Research highlights the importance of a multicomponent approach, individualized training, and load management to lower hamstring injuries. Collaboration among athletes, coaches, and health professionals is crucial to create a safe training environment. As football evolves, prioritizing injury prevention is essential for players' health, success, and career longevity.

Addressing the complexities of evaluating comprehensive sexuality education: an Italian case study

Abstract Background Existing evaluation methods for assessing sexuality education programs may not be suitable for Comprehensive Sexuality Education (CSE) interventions, which are globally indicated as the most effective approach for promoting sexual health and preventing STIs. This holds particular significance in countries, such as Italy, where CSE is not integrated into school curricula. In a pilot project funded by the Italian Ministry of Health since 2019 (EduForIST), we aimed to develop a composite evaluation framework to test the CSE intervention we implemented in lower and upper secondary schools over the past 4 years. Methods Based on the latest available evidence, evaluating a CSE intervention requires addressing various dimensions. These include assessing the quality of programs and their implementation, as well as measuring outcomes and impact. Through iterative consultations with experts and providers, methods, criteria, and metrics were chosen and tested for each dimension. Results Program quality was evaluated by an expert advisory board. Instruments for implementation quality assessment included: satisfaction survey among students; reflective journals and SWOT analysis drawn up by educators delivering intervention, exploring their perceptions, practices, and attitudes; surveys among teachers and parents, measuring knowledge, attitude, and practice on CSE, and observed changes among adolescents. A four-arm, Solomon, cluster design study was designed to evaluate outcomes in terms of changes in students’ knowledge. Clinical and behavioral indicators in the short, medium and long term were selected as measures of the impact of the intervention. Conclusions In the field of CSE implementation research, a multi-component approach to evaluation is needed to provide a solid basis for informing policymakers. The involvement of providers, recipients and contextual adults is essential in evaluating CSE interventions. However, assessing long-term impact requires long time frame. Key messages • Assessing CSE interventions requires a multi-component evaluation approach, considering the impact on the personal and emotional development of individuals in order to sustain behavior changes. • The proposed evaluation framework may inform scientific community, professionals, and decision-makers on effectiveness of interventions in settings where CSE is not yet included in school curricula.

Nonpharmacological Prevention and Management of Delirium: Past, Present, and Future.

Delirium has been recognized, documented, and examined for centuries. In 500 BC Hippocrates described hyper- and hypoactive forms of delirium. As medicine, surgery, and critical care have accelerated over the last century, so too has our understanding of delirium and its profound risks to patients, families, and health care teams. It has also been increasingly understood that it is the accumulation of risk factors that ultimately precipitates delirium and nonpharmacological interventions to reduce these risks remain the cornerstone of delirium prevention and management. However, over the last three decades, these nonpharmacological strategies have moved from a single-component approach to a multicomponent approach, targeting multiple risk factors. Additionally, our understanding of what constitutes a risk factor for delirium has evolved, and in particular, it has been recognized that delirium can sometimes be a byproduct of our interventions and health care systems. In the surgical setting, for example, optimization of risk factors prior to surgery, when possible, is now seen as a key way to prevent postoperative delirium. Similarly, critical care medicine now operates with the appreciation of the profound risk to patients of prolonged mechanical ventilation, sedation, and immobilization and seeks to minimize each to reduce the risk of delirium, among other negative effects. The future of delirium prevention and management lies in both better implementation of best practices that have been defined over the last three decades as well as taking more of a whole patient view. This includes harnessing the electronic medical record, artificial intelligence, and so on to risk assess and individualize care for each patient; restructuring care to reduce deliriogenic practices and care environments; redefining what usual care looks like (e.g., utilizing music and involving loved ones, etc.); policy changes to change systematic priorities. In this paper, we will explore the past, present, and future of nonpharmacological prevention and management of delirium across care settings.

A Review on Recent One Pot Multi-Component Synthesis and Biological Properties of a Class of New Class of Chromenes, Coumarines, Chromeno-Pyrimidines, Pyrido-Pyrimidine and Quinazoline Heterocycles

The chromenes, coumarines, pyrido-pyrimidine and quinazoline cores possesses a vast number of biological activities such as anticancer, anti-malarial, anti-microbial, anti-fungal, anti-tubercular activities and the conventional classical synthetic methods have harsh conditions having multistep process. Currently, researchers are in search of new methodology to eliminate the use of chemicals, solvents and catalysts, which are hazardous to human health as well as to environment. This review provides a concise overview of new dimensions of one pot multi-component synthetic approaches in designing chromenes, coumarines, pyrido-pyrimidine and quinazoline scaffolds. This review will give more scientific ideas to synthesis a variety of heterocyclic moieties in a new synthetic way following the one-pot multi-component method.

The cardiovascular risks of sedentary behavior and the progress of physical activity interventions

Since the 1960s, sedentary behavior has been on the rise globally. Modern culture is characterized by sedentary behavior (SB), which has become a distinct risk factor for non-communicable illnesses. Cardiovascular diseases (CVD) are rapidly spreading around the world. A growing body of research has established the significance of SB as a risk factor for the onset of CVD. Additionally, blood lipoprotein (BL), blood pressure (BP), blood glucose (BG), and endothelial function (EF) are among the CVD risk variables that SB may significantly affect. Chinese scholars have not paid enough attention to the harm of SB to CVD, which needs urgent attention. Physical activity (PA) can improve the health of sedentary people. Increased PA may be able to counteract sedentary-induced CVD events, as analyzed by the study. In particular, a multi-component approach to exercise can significantly enhance cardio-metabolic health. Therefore, people may choose PA control as a means of reducing the incidence of CVD.

Study protocol for a single-arm pilot trial investigating the feasibility of a multimodal digital technology for managing metabolic syndrome in patients with chronic obstructive pulmonary disease

Individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are exposed to an increased risk of metabolic syndrome (MetS), which negatively affects their health outcomes and quality of life. Lifestyle interventions have shown promise in managing MetS. This study outlines the protocol for a web-based multimodal self-care program, Digital Metabolic Rehabilitation, for managing MetS in patients with COPD. The Digital Metabolic Rehabilitation is a single-arm pilot trial that integrates the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) Program and a web-based wellness platform. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which integrates a holistic, multicomponent approach to promote wellness. The intervention will primarily focus on lifestyle changes for patients with COPD. Over 6 months, participants will use the web-based wellness platform and engage in weekly online support group sessions. Fifty patients diagnosed with stage I-II COPD and MetS will participate. Blood tests, anthropometrics, body composition, physical function, muscle strength, physical activity, energy metabolism, quality of life and mental health will be assessed at baseline, 3, and 6 months. The Digital Metabolic Rehabilitation program aims to explore whether a multimodal integrative intervention delivered through a web-based wellness platform can be implemented by patients with COPD with MetS. By combining the expertise of the CHANGE Program with the digital delivery format, the intervention seeks to enhance self-monitoring and foster better self-management practices. The protocol outlines a novel and potentially impactful intervention for managing MetS in patients with COPD.

Microwave‐Assisted, Multicomponent Synthesis of Pyrazolo [3, 4‐b] Pyridines Under Green Conditions

AbstractDeveloping novel and environmentally friendly green methodologies are critical in synthetic organic chemistry. Here, we investigated the one‐pot, efficient green synthesis of pyrazolo[3,4‐b]pyridine derivatives via a multicomponent approach. The reactions were operated in an aqueous medium by using microwave irradiation and conventional protocols. The green protocol offered high yields of desired product in swift reaction time, and good tolerance under reaction conditions.

A time-series analysis examining implementation strategies to increase use of an early-supported discharge hospital at home model.

Early-supported discharge (ESD) hospital-at-home (HaH) programs facilitate hospitalized patients to receive ongoing acute-level care at home, thereby promoting patient-centeredness while improving hospital throughput. The current study aimed to test multiple implementation strategies to increase and sustain HaH ESD utilization. We conducted interrupted time series analyses to evaluate the effectiveness of implementation strategies on weekly HaH ESD referrals and capacity utilization at five hospitals. Intervention 1 included provider-focused education and HaH nurse navigator support (July 2021 to May 2022). Intervention 2 added provider-level referral performance feedback and daily electronic health record-based eligibility reports (May 2022 to December 2022). During postintervention (January 2023 to June 2023), implementation strategies were no longer supported by the study team. Clinical outcomes were assessed over time and between patient subgroups. There were 5951 HaH ESD patients overall. After Intervention 2, we observed immediate increases in weekly HaH ESD referrals (level change mean difference [MD, 95% confidence interval]: 14.8, 5.9-23.6) and capacity utilization (level change MD: 13.9%, 6.2%-21.5%) and additional week-to-week increases in capacity utilization (slope change MD: 0.6%, 0.2%-0.9%), compared to Intervention 1 trends. HaH ESD referrals and capacity utilization were sustained postintervention. The proportion of provider-initiated referrals increased over time (Intervention 1: 79.4%, Intervention 2: 90.9%, postintervention: 95.2%). As HaH ESD utilization increased, we observed shorter inpatient length of stay and fewer HaH ESD encounters per visit (p < 0.01). There were small, statistically significant differences in 30-day mortality and readmission for residents of rural and socioeconomically disadvantaged areas. Applying referral-focused provider feedback and daily eligibility reports were effective within a multicomponent approach to increase and sustain HaH ESD utilization.

Partnerships Between Faith Communities and the Mental Health Sector: A Scoping Review.

Faith communities are increasingly providing services to address the mental health needs of their congregations and communities. However, many feel limited in their capacity to address serious illness and experience challenges to collaborating with the mental health sector. To inform the development of faith community-mental health sector partnerships, the authors conducted a scoping review to assess the characteristics and evidence base of partnership approaches to addressing mental health needs. A search of four databases identified peer-reviewed articles published between 2010 and 2023 on faith community-mental health sector partnerships in the United States. In total, 37 articles representing 32 unique partnerships were reviewed. Most partnerships (N=19) used multicomponent approaches, particularly involving training the faith community (N=18), mental health education for the broader community (N=14), and direct counseling (N=11). Many partnerships (N=14) focused on African American communities. Partnerships that included an evaluation component (N=20) showed promising findings for improving mental health symptoms, mental health literacy, stigma, and referrals, among other outcomes. Several articles reported facilitators (e.g., support from faith leaders and reciprocal relationships and equal power) and barriers (e.g., limited time and funding and differing interests and attitudes) to developing partnerships. The findings highlight how faith communities can be a critical partner in providing services across the continuum of mental health care and reveal the need for more rigorous evaluations of the effectiveness, feasibility, and sustainability of these partnerships. The results also identify strategies that may facilitate the development and strengthening of future faith community-mental health partnerships.

To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study

BackgroundRacism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children’s mental health and sleep problems if interpersonal racial discrimination was eliminated. MethodsWe drew on cross-sectional data from the Speak Out Against Racism (SOAR; N=2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N=8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10-15 years; LSAC: 4-5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10-15 years; LSAC: 12-13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10-15 years; LSAC: 14-15 years). An interventional effects causal mediation approach was used. FindingsAboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40·1% versus 13·5%; LSAC: 25·3% versus 7·6%) and sleep problems (SOAR: 28·5% versus 18·4%; LSAC: 14·0% versus 9·9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children’s experiences of interpersonal racial discrimination could reduce 42·4% and 48·5% of mental health and sleep inequities in SOAR (equivalent to 11·2% and 4·7% absolute reductions) and 25·6% and 1·6% of mental health and sleep inequities in LSAC (equivalent to 5·5% and 0·1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes. InterpretationTargeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.Funding: National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia