No Intervention Research Articles

Toddler Screen Use Before Bed and Its Effect on Sleep and Attention

Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance. To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers' sleep and attention. This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study. Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual. Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures. A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = -0.96; 95% CI, -1.32 to -0.60; vs BB only: Cohen d = -0.65; 95% CI, -1.03 to -0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, -0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = -0.28; 95% CI, -0.67 to 0.12; vs BB only: Cohen d = -0.31; 95% CI, -0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = -0.30; 95% CI, -0.74 to 0.13) but no difference compared with BB only. There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = -0.40; 95% CI, -0.75 to -0.05) and inhibitory control (Cohen d = -0.48; 95% CI, -0.77 to -0.19), due to an increase in BB-only scores. Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI's adoption by parents and pediatricians. ISRCTN.org Identifier: ISRCTN58249751.

Virtual reality-based therapy for chronic low back and neck pain: a systematic review with meta-analysis.

To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP). Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author. Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy. VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.

The effect of distance reiki on patient reported quality of life, correlated with changes in immune repertoires among patients with multiple myeloma: A pilot study.

e23199 Background: Psychological distress and diminished health related quality of life (HRQOL) is associated with multiple myeloma (MM). Complementary and alternative medicine (CAM) is an adjunct to traditional medicine. T-cells are essential to the adaptive immune system. The complementarity determining region (CDR3) of the T cell receptor formed by combination of the V,D,J regions is highly variable and critical for antigen specificity. PCR is used to analyze the TCR-CDR3 to monitor T-cell clonotypes as a measure of antigen specific T cell responses and thereby cancer immunity. Reiki is a Japanese energy healing technique involving noninvasive light touch to modulate energy fields. The primary aim was feasibility and acceptability of Reiki within a structured medical paradigm. Secondary aims were changes in HRQOL and T-cell receptor repertoires with Reiki. Methods: Adult MM patients (pts) on a stable regimen were eligible. Pts randomized in a 1:1:1 to weekly True Reiki (Treiki), Simulated Reiki (Sreiki) or no intervention (NI). The PROMIS-29® assessed HRQOL. A “Was it Worth it” (WIWI) questionnaire was administered post intervention to assess the experience. TCR-CDR3 sequencing was performed on PBMCs at enrollment and end of therapy to determine immune repertoire changes. Samples underwent library preparation and next generation sequencing for TCR repertoire analysis by iRepertoire® Results: Thirty pts were randomized into 3 arms between 12/2020 to 4/2022. Median age 62.5 (range 27-76), 18/30 (60%) female, median time to diagnosis was 48 mo (Range 7-221), 50% had high risk FISH,(90%) had prior ASCT and received median 2 (range 1-13) lines of therapy prior to enrollment. No pts relapsed or progressed during study period. Using WIWI 100% of pts in Treiki and 75% in Sreiki arms found the therapy useful and would do it again; 100% Treiki pts and 87.5% in the Sreiki arm would recommend the study to others. No statistical difference between groups in any HRQOL domains. Among TCR repertoires, no statistically significant difference was observed between groups with respect to Richness, Shannon entropy, Clonality, Diversity 50 (D50) and Inverse Simpson indexes. Each pt showed substantial variability in certain TCR-CDR3 clones and clonal diversity. Conclusions: We successfully demonstrated acceptability and feasibility of Reiki among MM pts, although no impact on HRQOL was shown. Reiki intervention is an easy non-invasive additional option for pts’ to their conventional therapies. The TCR-CDR3 repertoires showed no difference with the reiki intervention but had significant variability. Further research comparing TCR repertoires between MM and age/sex matched healthy controls is ongoing. T-cell directed therapies are evolving in MM, we plan to analyze if changing diversity of TCR-CDR3 repertoires could define how best to sequence these treatments. Clinical trial information: NCT04783038 .

Effect of coffee staining and simulated oral hygiene methods on the color and translucency of a nanoceramic resin.

Evaluate the color and translucency of a nanoceramic resin subjected to hygiene practices and immersion in coffee over time. Specimens (n = 80, HT and LT, 0.5-mm thick) of a nanoceramic resin were obtained and were divided in groups according to the simulated oral hygiene: no intervention (NT), brushing with an electric brush and water (BN), brushing with an electric brush and toothpaste for 10 s (BT), and immersion in mouthwash for 30 s (MW). Oral hygiene practices were repeated after staining in coffee solution for 15, 48, 336, 1440, 8640, and 35,040 min. Spectral wavelengths were recorded with a spectrophotometer at each time. ∆E00, ∆L', ∆C', ∆H', and TP00 were calculated by CIEDE2000 and were evaluated by 2-way ANOVA, repeated measures ANOVA, and Tukey's HSD test (α = 0.05). ANOVA showed significance among factors for ΔE00 (p < 0.05), with higher ΔE00 for NT-HT (11.7) and NT-LT (11.2). After T6 (2-year simulation), the lowest values were found for BT-HT (5.3) and BT-LT (4.9). All groups showed a reduction in lightness and translucency and increased chroma and hue. However, the smallest variations were found in the BT groups (p < 0.05). Brushing with toothpaste effectively minimized the color change of NCRs caused by coffee staining. Oral hygiene practices, such as brushing with toothpaste, might be important to minimize staining of nanoceramic resin restorations, especially in patients who frequently consume coffee.

Взаимодействие с близким взрослым в замещающих семьях у детей с опытом институционализации в зависимости от типа окружения в доме ребенка и длительности проживания в семье

&lt;p&gt;&lt;strong&gt;Background. &lt;/strong&gt;To date there is a lack of information in the scientific literature on the influence of children's early institutionalization experience on their interaction with caregivers after their placement in foster care. In order to develop effective early support programs for children and parents in substitute families, it is important to understand the specifics of their interaction, including in connection with children's early experience of interaction with caregivers in baby home and the duration of their living in the substitute family. &lt;strong&gt;Objective. &lt;/strong&gt;The study was aimed to investigate the characteristics of interaction of post&amp;ndash;institutional parents and children with the experience of living in the baby home (BH) after implementation of changes in the socio&amp;ndash;emotional caregiving environment (T+SC) and in a baby home with no intervention (NoI) and care as usual. &lt;strong&gt;Participants. &lt;/strong&gt;A total of 18 couples of adults with children from NoI (mean age of children M = 40.7; SD = 20.3 months; 9 boys; mean age of caregivers M=43; SD=7,6) and 42 couples with children from T+SC (mean age M = 38,6; SD = 20 months; 21 boys; mean age of caregivers M=43,9; SD=8,8). &lt;strong&gt;Study design. &lt;/strong&gt;Interaction was assessed at 3 stages (in BH before transition to family; &amp;lt;24 months in a post&amp;ndash;institutional family (PI family); 25&amp;ndash;48 months in the PI family). &lt;strong&gt;Measurements. &lt;/strong&gt;Video recordings of free play of dyads were analyzed using the PCERA method (The Parent &amp;ndash; Child Early Relational Assessment, R. Clark) to assess caregiver&amp;ndash;child interaction. &lt;strong&gt;Results. &lt;/strong&gt;The results indicate higher interaction quality in dyads with children who have experience of living in T+SC baby home, compared with children brought up in NoI baby home. In the first 24 months after the transfer of children to post&amp;ndash;institutional families (PI) from the T+SC baby home, the quality of interaction between children and parents in the PI families is lower than at the assessment of children and caregivers in the T+SC baby home. An indicator of interaction on the part of children and the indicator of interaction in dyads are higher in the T+SC group then in NoI group after two years of children living in the PI families. &lt;strong&gt;Conclusions. &lt;/strong&gt;These results confirm that stable and sensitive socio&amp;ndash;emotional early environment (in T+SC) is crucial for establishing relationships and interacting with close adults in a new family. Low quality of caregiver-child interaction &amp;ndash; such as low level of sensitivity, involvement and predictability on the part of substitute parents, the lack of reciprocity and regulation of interaction in dyads during the first two years of living in the PI family, as well as low emotional stability and unwillingness to cooperate in children from NoI BH after two years of living in the PI family &amp;ndash; is discussed in the terms of need for evidence&amp;ndash;based psychological follow&amp;ndash;up programs for the PI families with focus on the caregiver&amp;ndash;child interaction.&lt;/p&gt;

An intervention based on Well-Being Therapy to prevent alcohol use and other unhealthy lifestyle behaviors among students: a three-arm cluster randomized controlled trial

ABSTRACT Unhealthy lifestyle, such as alcohol use, and negative health outcomes have been associated with impairments in psychological well-being. The primary objective of the study was to test the efficacy of an intervention based on Well-Being Therapy to prevent or stem alcohol use, binge drinking and other unhealthy lifestyle among Italian adolescents in school settings. A three-arm cluster randomized controlled trial including three test periods (baseline, post-test, six-month follow-up) was implemented. Seven classes (144 students) were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI), or no intervention (NI). Primary outcomes were alcohol use (AUDIT-C), binge drinking and other unhealthy lifestyle behaviors (i.e. unhealthy diet, physical inactivity, tobacco and cannabis smoking, poor sleep and Internet addiction). Linear mixed models and mixed-effects logistic regression were used to test the efficacy of WBI in comparison with LI and NI. At six-month follow-up, AUDIT-C total score increased more in NI in comparison with WBI (p = 0.044) and LI (p = 0.016), whereas the odds of being classified as at-risk drinker were lower in WBI (p = 0.038) and LI (p = 0.002), than NI. Only WBI showed a protective effect for cannabis use at post-test in comparison with NI (p = 0.003) and LI (p = 0.014). Sleep hours at night decreased more in NI than in LI (p = 0.027) at six months. Internet addiction decreased more in WBI (p = 0.002) and LI (p = 0.005) at post-test in comparison with NI. Although both interventions showed a positive impact on adolescent lifestyle, the positive effect of WBI on cannabis use underlines how this approach might be promising to stem adolescents’ substance use.

Abstract P4-07-42: Intervention to Distant Metastatic Lesions in Patients with Breast Cancer

Abstract INTRODUCTION Approximately one-fourth of patients presenting with early-stage breast cancer develop distant metastatic disease, a prominent cause of mortality. The role of metastasis-directed intervention is still uncertain in this cohort. The aim of this study is to evaluate whether intervention to metastatic lesions impacts overall survival (OS) and post-distant recurrence survival (PDRS), defined as survival after first occurrence of metastatic disease. METHODS Our prospectively maintained international multi-center database of patients diagnosed with distant recurrence was retrospectively reviewed. Patients initially presenting with stage I-III breast cancer and diagnosed with metastatic disease to the bone, liver or lung from 2014-2020 were divided into cohorts receiving intervention to their metastases (IM, n=180) versus no interventions to their metastases (NI, n=120). The characteristics of the patients were compared with X2 test. OS curves were calculated by Kaplan-Meier method and multivariable analysis by Cox regression. Statistical significance was set at p&amp;lt; 0.05. RESULTS No significant differences in OS and PDRS were noted between the two groups when comparing age at diagnosis, menopausal status, tumor histopathology, pathological stage, axillary lymph node involvement, and hormone receptor and HER2 status. However, median OS and PDRS were significantly longer for patients who received IM compared to those who did not. The hazard of death was 59% lower with IM than with NI for both OS (HR 0.59: 95% CI 0.42 – 0.83; p=0.002) and for PDRS (HR 0.59: 95% CI 0.42 – 0.84). On multivariable analysis, OS was improved among patients with IM, and among those with lung metastases, compared to liver and bone metastases. CONCLUSIONS Metastatic site intervention had both an OS and PDRS benefit in this cohort. In order to explore the potential for interventions to their metastases, patients who develop limited metastatic disease following initial breast surgery should be discussed at a multidisciplinary tumor board. Post-Distant Recurrence Survival in Patients with Breast Cancer Receiving Intervention to Metastatic Lesions (IM) Versus No Intervention (NI) Citation Format: Hira Abidi, Serdar Ozbas, Beyza Ozcinar, Lutfi Dogan, Arda Isik, Emilia Diego, Priscilla F. McAuliffe, Ronald Johnson, Jennifer Steiman, Efe Sezgin, Atilla Soran. Intervention to Distant Metastatic Lesions in Patients with Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-42.

Antibiotic prophylaxis for percutaneous endoscopic gastrostomy in pediatric patients: a meta-analysis.

To investigate if Antibiotic Prophylaxis (AP) can prevent wound and/or systemic infection in pediatric patients who underwent Percutaneous Endoscopic Gastrostomy (PEG). PubMed, Embase, and Cochrane databases were searched for Randomized Controlled Trials (RCT) and Observational Studies that compared AP vs. no Intervention (NI) in children submitted to PEG. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with random-effect models. Quality assessment and risk of bias were performed as outlined by Cochrane recommendations. Four studies, including one RCT, with a total of 568 patients were included, in which 230 (40.5%) individuals received AP. The use of AP during PEG reduced the incidence of systemic infection (OR 0.46; 95% CI 0.24-0.90; p = 0.02; I2 = 0). However, no statistical difference was found for wound infection (OR 0.85; 95% CI 0.43-1.69; p = 0.64; I2 = 12%) and for the composite outcome of any kind of infection (OR 0.74; 95% CI 0.13-4.06; p = 0.73; I2 = 67%). In this pooled analysis of 568 infants who underwent PEG, the use of AP reduced the incidence of systemic infection. Our results were compatible with findings obtained in the adult population. No differences were found regarding wound infection or the composite outcome of any kind of infection.

Characteristics, Components, and Efficacy of Telerehabilitation Approaches for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Chronic obstructive pulmonary disease (COPD) is at the top of the list of non-communicable diseases with related rehabilitation needs. Digital medicine may provide continuative integrated intervention, overcoming accessibility and cost barriers. We systematically searched for randomized controlled trials on telerehabilitation (TR) in people with COPD to profile the adopted TR strategies, focusing on TR models and the main rehabilitation actions: monitoring and assessment, decision, and feedback. Additionally, a meta-analysis was run to test the TR effect on functional capacity, dyspnea, and quality of life compared to no intervention (NI) and conventional intervention (CI). Out of the 6041 studies identified, 22 were eligible for the systematic review, and 14 were included in the meta-analyses. Results showed a heterogeneous scenario in terms of the TR features. Furthermore, only a small group of trials presented a comprehensive technological kit. The meta-analysis highlighted a significant effect of TR, especially with the asynchronous model, on all outcomes compared to NI. Moreover, a non-inferiority effect of TR on functional capacity and quality of life, and a superiority effect on dyspnea compared to CI were observed. Finally, the studies suggested a high rate of TR adherence and high safety level. TR is an effective strategy to increase and maintain functional capacity, breath, and quality of life in people with COPD. However, a consensus on the essential elements and features of this approach needs to be defined, and the effect of long-term maintenance merits further investigation.

Design and Evaluation of a School-based Sustained Attention Training Program with Parental Involvement for Preschoolers in Rural China

ABSTRACT Research Findings: Sustained attention is a fundamental cognitive function for young children’s development. We investigated the effects of school-based audiovisual game training with parental involvement on sustained attention (SA) in 5–6-year-old Chinese children. Totally 75 children and their parents participated and were assigned into three groups. The School Practice Intervention (SPI) group and the Parental Involvement Intervention (PII) group underwent an eight-week audiovisual game training, while the No Intervention (NI) group participated in regular activities and received no intervention. We tested participants’ visual and auditory sustained attention at four time points, i.e., pretest, middle test, posttest, and follow-up test. Results indicated that (1) children in PII and SPI groups had significantly greater visual and auditory sustained attention than the NI group in posttest and follow-up test; (2) the PII group showed better SA than the SPI group in posttest and follow-up test; (3) visual SA of experimental groups improved significantly since the middle test, while the improvement of auditory SA emerged since posttest. Practice or Policy: The play-based audiovisual training in a school setting effectively enhances SA for 5–6-year-olds, and parental involvement benefits the intervention. More efforts should be made to improve auditory sustained attention. The educational implications of these findings were discussed.

A Cost-Effectiveness Analysis of Comprehensive Smoking-Cessation Interventions Based on the Community and Hospital Collaboration.

BackgroundThe prevalence of cigarette smoking in China is high and the utilization of smoking cessation clinics is very low. Multicomponent smoking cessation interventions involving community and hospital collaboration have the potential to increase the smoking cessation rate. However, the cost-effectiveness of this intervention model is unknown.MethodsWe conducted a smoking cessation intervention trial in 19 community health service centers in Beijing, China. A cost-effectiveness analysis was performed from a societal perspective to compare three strategies of smoking cessation: no intervention (NI), pharmacological intervention (PI), and comprehensive intervention (CI) (PI plus online health promotion). A Markov model, with a time horizon of 20 years, was used to simulate the natural progression of estimated 10,000 male smokers. A cross-sectional survey was conducted to obtain data on costs and quality-adjusted life years (QALYs) by using the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire. Probabilistic sensitivity analysis was performed to explore parameters of uncertainty in the model.ResultsA total of 680 participants were included in this study, including 283 in the PI group and 397 in the CI group. After 6 months of follow-up, the smoking cessation rate reached 30.0% in the CI group and 21.2% in the PI group. Using the Markov model, compared with the NI group, the intervention strategies of the PI group and the CI group were found to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of $535.62/QALY and $366.19/QALY, respectively. The probabilistic sensitivity analysis indicated that the CI strategy was always the most cost-effective intervention.ConclusionCI for smoking cessation, based in hospital and community in China, is more cost-effective than PI alone. Therefore, this smoking cessation model should be considered to be implemented in healthcare settings.

C-11 | Clinical Outcomes of Cancer Patients Hospitalized with Acute Pulmonary Embolism

There is paucity of data about the optimal treatment of acute pulmonary embolism (PE) in patients with malignancy. The objective of this study was to compare outcomes of catheter-directed thrombolysis (CDT), Systemic thrombolysis (ST), and no intervention (NI) in patients with cancer and hospitalized with acute PE.

Water Wins, Communication Matters: School-Based Intervention to Reduce Intake of Sugar-Sweetened Beverages and Increase Intake of Water.

We compared three interventions designed for reducing the consumption of sugar-sweetened beverages (SSBs) aimed at decreasing the risk of overweight and obesity among children. We included three experimental (n = 508) and one control school (n = 164) in Slovenia (672 children; 10–16 years) to evaluate interventions that influence behaviour change via environmental (E), communication (C), or combined (i.e., double) environmental and communication approaches (EC) compared to no intervention (NOI). Data of children from the ‘intervention’ and ‘non-intervention’ schools were compared before and after the interventions. The quantity of water consumed (average, mL/day) by children increased in the C and EC schools, while it decreased in the E and NOI schools. Children in the C and EC schools consumed less beverages with sugar (SSBs + fruit juices), and sweet beverages (beverages with: sugar, low-calorie and/or noncaloric sweeteners) but consumed more juices. The awareness about the health risks of SSB consumption improved among children of the ‘combined intervention’ EC school and was significantly different from the awareness among children of other schools (p = 0.03). A communication intervention in the school environment has more potential to reduce the intake of SSBs than a sole environmental intervention, but optimum results can be obtained when combined with environmental changes.

Early vegetation recovery of a burned Mediterranean forest in relation to post-fire management strategies

Abstract The risk of wildfires in the Mediterranean region is expected to increase with climate change. Fire is one of the main drivers of plant diversity and composition, triggering succession processes that vary according to the fire regime and species’ regeneration traits. Human management can modulate these processes to promote the recovery of the burned soil-vegetation system, through the application of practices such as salvage logging. Effects of these managements have been studied mostly for coniferous forests, with contrasting results, while little is known about the responses of evergreen broadleaved woodlands. Here, we analysed the 34-month recovery processes of a Quercus ilex forest and an adjacent Pinus pinaster stand in central Italy with respect to their diversity, composition and plant fire-related traits, in relation to three different management strategies applied after fire. These were: (1) no intervention (NT), (2) salvage logging and mulching (SM and SMP for the pine stand), (3) salvage logging, mulching and erosion control measures (e.g. fascines for hill slope stabilization; EC). Overall, the increase of post-fire vegetation cover was negatively affected by SM and EC treatments, while their effects on ɣ- and α-diversity were positive. Species diversity was significantly lower in pine than in broadleaved plots and compositional differences associated with forest type were significant. Abundance of woody species was higher in the unsalvaged sites, except for a few species (e.g. Q. ilex), while herbaceous plants were not affected. Species composition in managed plots was different from control plots after 10 and 22 months, while differences decreased after 34 months. Effects of management strategies on the frequency of resprouters as well as on the proportion of species with persistent vs transient soil seed bank were minor; these traits were mainly driven by forest type. Our findings suggest that non-treatment is the best post-fire management strategy for a fast recovery of woody species in typical Mediterranean broadleaved forests. However, the EC strategy promoted a high diversity level, while not apparently altering species composition compared with the natural post-fire succession process.

The effect of mobile health focused on diet and lifestyle on blood pressure: a systematic review and meta-analysis.

To determine the effect of mobile health (mHealth) focused on diet and lifestyle on blood pressure (BP). We performed a systematic review with meta-analysis using the mean difference (MD) of change from baseline as an effect measure. MEDLINE via PubMed, Cochrane Central, and EMBASE were reviewed until 6 May 2020. We included randomized controlled trials of adults who participated in mHealth focused on diet and lifestyle. Interventions were grouped according to the presence of health professional intervention (PI) (PI + mHealth or mHealth only). Eligible controls did not participate in mHealth and were classified as active comparator (PI) or no intervention (NI). Subgroup analyses were performed according to the presence of prior cardiovascular disease and hypertension status. We included 44 trials involving 24 692 participants. Mobile health interventions were superior to NI in reducing SBP in both situations: alone [MD = -1.8 mmHg; 95% confidence interval (CI): -3.6; 0.0] or with PI (MD = -5.3 mmHg; 95% CI: -7.5; -3.1), with a greater effect size in the latter group (P = 0.016). This benefit was not observed when the control was PI. DBP and SBP had consistent results. There was a marked effect of PI + mHealth vs. NI on the BP reduction among hypertensive participants. Current evidence shows that mHealth focused on diet and lifestyle can reduce BP, especially when implemented in hypertensive participants, and PI may provide additional benefit. PROSPERO ID CRD42019141475.

Effects of internet-delivered eating disorder prevention on reward-based eating drive: A randomized controlled trial

ObjectiveThis study is a secondary analysis testing the effects of an internet eating disorder prevention program on reward-based eating drive in a high-risk sample of college-aged women. MethodWe analyzed data from 278 women who were randomized to internet dissonance-based intervention (DBI-I), internet cognitive-behavioral treatment (CBTI), or no intervention (NI). Both active conditions consisted of self-guided activities completed over the course of four weeks. Linear mixed effects modeling was used to test the effect of internet intervention on reward-based eating drive. ResultsDBI-I was associated with greater reductions in reward-based eating over time than NI. No other Condition × Time effects were found. DiscussionThe results provide preliminary support for DBI-I as a strategy for reducing reward-based eating drive in a high-risk population relative to no intervention.

Cost effectiveness of antihypertensive drugs and treatment guidelines.

Arterial hypertension (AH) is associated with a high economic burden for the individual patient and for society in general. The study evaluates antihypertensives and their cost-effectiveness, comparing diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A) and calcium channel blockers (C) with no intervention (NI). The study included five health states in a Markov model. Cost values included average cost of the drugs used, treatment in hospital and treatment in general practice (collected from Croatian Health Insurance Fund). The study was conducted separately for 65-year old men and women, with an initial probability of cardiovascular death risk of 2% and heart failure risk of 1%. The results were presented in terms of increase in QALYs and associated financial savings or costs in euros (€). Results for men (compared with NI): treatment with D resulted in a QALY increase of 0.76 and €886 in savings, treatment with C in an increase of 0.74 QALYs and €767 in savings, treatment with A in an increase of 0.69 QALYs and €834 in savings, treatment with B resulted in an increase of 0.40 QALYs, but with an additional cost of €41. Results for women (compared with NI): treatment with D resulted in an increase of 0.93 QALYs and €987 in savings, treatment with C in an increase of 0.89 QALYs and savings of €855, treatment with A in an increase of 0.86 QALYs and savings of €991, treatment with B in an increase of 0.48 QALYs, but with an additional cost of €148. Treatment of AH with D, C and A is cost effective compared with the no-intervention scenario. Diuretics are the most cost-effective first-line treatment. The scenario with beta-blockers resulted in additional QALY when compared with no intervention, but also additional costs; therefore, based on our results, this therapy would not be recommended as first-line treatment.

Syndrome of Ventricular Septal Defect and Aortic Regurgitation - A 22-Year Review of its Management.

IntroductionThe presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge.MethodsThis is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR).ResultsA total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse.ConclusionWe can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

Effects of Hydration Educational Intervention in High School Football Players.

Atkins, WC, McDermott, BP, Kanemura, K, Adams, JD, and Kavouras, S. Effects of Hydration Educational Intervention in High School Football Players. J Strength Cond Res XX(X): 000-000, 2020-The purpose of this study was to assess the effects of a one-time educational intervention (EI) on hydration behaviors, status, and knowledge. In a pre-test, post-test quasi-experimental design, 41 in-season American high school football players (16 ± 1 years) voluntarily participated. Teams were assigned to EI or no intervention (NI) groups. Educational intervention included a 5-minute presentation on hydration importance, self-assessment, urine-color charts, water bottles, and hydration status feedback. Baseline data included 24-hour fluid intake logs, urinalysis, and questionnaires. Data collection was repeated 3 and 24-days post-EI. Subjects provided urine samples and recorded fluid intake. Twenty-four hour mean fluid consumed (FC) and water consumed (WC) were calculated. Questionnaires quantified hydration knowledge. Significance was set a priori at p ≤ 0.05. Urine specific gravity was not significantly different at baseline (EI: 1.026 ± 0.006; NI: 1.023 ± 0.009; p = 0.118, confidence interval [CI] 95% [-0.001 to 008]), improved 3-days post-EI (EI: 1.017 ± 0.010; NI: 1.026 ± 0.007; p = 0.004, CI 95% [-0.015 to -0.003]), and was not different 24-days post-EI (EI: 1.021 ± 0.009; NI: 1.025 ± 0.007; p = 0.213, CI 95% [-0.008 to 002]) between groups. Three days post-EI, 24-hour WC increased significantly in the EI (EI: 888 ± 713 ml; t(19) = -5.685, p < 0.001, CI 95%: [-1,208.9 to -560.0]) but not NI (119 ± 583 ml; t(20) = -0.915, CI 95%: [-392.0 to 153.5]) and EI increased FC by 19%, whereas NI showed a 6% FC decrease. There were no significant group (F(1,19) = 0.025, p = 0.876, = 0.001) or interaction effects for hydration knowledge (F(2,38) = 0.677, p = 0.514, = 0.034). Educational intervention improved hydration status and behaviors despite no change in knowledge. Hydration education should be implemented and reinforced by team personnel as benefits to an EI are reduced at 24-days post-intervention.

Auricular stimulation vs. expressive writing for exam anxiety in medical students - A randomized crossover investigation.

ObjectiveAuricular stimulation (AS) is a promising method in the treatment of situational anxiety. Expressive writing (EW) is an established psychological method, which reduces test anxiety and improves exam results. The aim of this crossover trial was to compare AS with EW, and with the no intervention (NI) condition, for treatment of exam anxiety.MethodsHealthy medical students underwent 3 comparable anatomy exams with an interval of one month, either performing EW, receiving AS or NI prior to the exam; the order of interventions was randomized. AS was applied using indwelling fixed needles bilaterally at the areas innervated mostly by the auricular branch of the vagal nerve on the day before the exam. Anxiety level, measured using State-Trait-Anxiety Inventory (STAI) before and after the interventions and immediately before exam, was the primary outcome. Quality of night sleep, blood pressure, heart rate and activity of salivary alpha-amylase (sAA) were analyzed across 3 conditions.ResultsAll 37 included participants completed the study. Anxiety level (STAI) decreased immediately after AS in comparison with baseline (P = 0.02) and remained lower in comparison with that after EW and NI (P<0.01) on the day of exam. After EW and NI anxiety increased on the day of exam in comparison with baseline (P<0.01). Quality of sleep improved after AS in comparison with both control conditions (P<0.01). The activity of sAA decreased after EW and after AS (P<0.05) but not after NI condition.ConclusionAuricular stimulation, but not expressive writing, reduced exam anxiety and improved quality of sleep in medical students. These changes might be due to reduced activity of the sympathetic nervous system.