Intervention System Research Articles

Secular trends in sleep and circadian problems among adolescents in Hong Kong: From 2011-2012 to 2017-2019

ObjectiveThe study aimed to investigate secular trends in sleep and circadian problems in Hong Kong Chinese adolescents. MethodsThis study analyzed cross-sectional data from two large-scale school-based sleep surveys conducted in 2011-2012 and 2017-2019. Sleep and circadian problems, including sleep-wake pattern, insomnia, chronotype, social jetlag, daytime sleepiness, and other sleep-related factors, were compared between two survey years. ResultsA total of 8082 adolescents (5639 students in 2011-2012 [Mean age: 14.4 years, 50.9% boys] and 2443 students in 2017-2019 [Mean age: 14.7 years, 54.0% boys]) were included in this 7-year study. The average time in bed of Hong Kong adolescents decreased from 8.38 hours to 8.08 hours from 2011-2012 to 2017-2019. There was a 0.28-hour delay in weekday bedtime, 0.54-hour advance in weekend wake-up time, and a 0.36-hour decline in average time in bed, resulting in increased trends of sleep loss (Time in bed <8h: OR = 2.06, 95%CI: 1.44–2.93, p < 0.01; Time in bed <7h: OR = 2.73, 95%CI: 1.92–3.89, p < 0.01), daytime sleepiness (OR = 1.70, 95%CI: 1.34–2.16, p < 0.01), and evening chronotype (OR = 1.26, 95%CI: 1.08–1.48, p < 0.01). The increased trend in insomnia disorder, however, was insignificant when covariates were adjusted. ConclusionA secular trend of reduced time in bed, delay in weekday bedtime, advance in weekend wake-up time, increase in evening chronotype and daytime sleepiness from 2011-2012 to 2017-2019 were observed. There is a timely need for systematic intervention to promote sleep health in adolescents.

Fortune favors the invariant: Enhancing GNNs’ generalizability with Invariant Graph Learning

Generalizable and transferrable graph representation learning endows graph neural networks (GNN) with the ability to extrapolate potential test distributions. Nonetheless, current endeavors recklessly ascribe the demoralizing performance on a single entity (feature or edge) distribution shift and resort to uncontrollable augmentation. By inheriting the philosophy of Invariant graph learning (IGL), which characterizes a full graph as an invariant core subgraph (rationale) and a complementary trivial part (environment), we propose a universal operator termed InMvie to release GNN’s out-of-distribution generation potential. The advantages of our proposal can be attributed to two main factors: the comprehensive and customized insight on each local subgraph, and the systematical encapsulation of environmental interventions. Concretely, a rationale miner is designed to find a small subset of the input graph — rationale, which injects the model with feature invariance while filtering out the spurious patterns, i.e., environment. Then, we utilize systematic environment intervention to ensure the out-of-distribution awareness of the model. Our InMvie has been validated through experiments on both synthetic and real-world datasets, proving its superiority in terms of interpretability and generalization ability for node classification over the leading baselines.

Hyperuricemia research progress in model construction and traditional Chinese medicine interventions.

Hyperuricemia (HUA), a severe metabolic disease derived from purine metabolism disorder, will lead to abnormally increased serum uric acid (SUA) levels in the body. Studies have shown that HUA is highly related to gout, hypertension, diabetes, coronary heart disease, chronic kidney diseases, and so on. Traditional Chinese medicine (TCM) shows excellent results in treating HUA because of its unique advantages of multi-metabolites and multi-targets. This article reports on the use of TCM components for uric acid (UA)-lowering activity with excellent efficacy and low side effects based on established HUA models. This work summarizes the advantages and limitations of various HUA disease models for efficacy evaluation. Applications of TCM in HUA treatment have also been discussed in detail. This paper reveals recent research progress on HUA in constructing evaluation models and systematic TCM interventions. It will provide a scientific reference for establishing the HUA model and suggest future TCM-related HUA studies.

The Gap Between What Parents Need and How Pediatric Primary Care Providers Can Help Families of Children With Special Education Needs.

We describe the gap between parents' special education needs and pediatric primary care providers' (PCPs) ability to address those needs from a mixed-methods study at a safety-net hospital. We conducted qualitative interviews with English- and Spanish-speaking parents (n = 25) and PCPs (n = 11) about special education knowledge and experience and interactions with a primary care-embedded special education clinic. PCPs also answered survey questions on these topics. Parents reported four challenges: (1) knowing where to start and how to advocate for their youth, (2) being heard or having a say, (3) using the "right" language, and (4) gathering information on special education resources. Primary care providers disclosed three barriers: (1) training, (2) knowledge to assess the appropriateness of supports, and (3) time to address concerns. The gap between PCPs and parents was bridged by the special education clinic. Systematic interventions can ensure that PCPs help parents address the special education needs of their patients.

Unraveling psychological dilemma among miners in the context of low-carbon transformation: an ISM-MICMAC approach

Purpose With the rapid low-carbon transformation in China, the industrial approach and labor structure of mining enterprises are undergoing constant changes, leading to an increasing psychological dilemma faced by coal miners. This study aims to reveal the relationship and mechanism of factors influencing the psychological dilemma of miners, and to provide optimal intervention strategies for the safety and sustainable development of employees and enterprises. Design/methodology/approach To effectively address the complex issue of the psychological dilemma faced by miners, this study identifies and constructs five-dimensional elements, comprising 20 indicators, that influence psychological dilemmas. The relational mechanism of action of factors influencing psychological dilemma was then elucidated using an integration of interpretive structural modeling and cross-impact matrix multiplication. Findings Industry dilemma perception is a “direct” factor with dependent attributes. The perceptions of management response and relationship dilemmas are “root” factors with driving attributes. Change adaptation dilemma perception is a “susceptibility” factor with linkage attributes. Work dilemma perception is a “blunt” factor with both dependent and autonomous attributes. Originality/value The aforementioned findings offer a critical theoretical and practical foundation for developing systematic and cascading intervention strategies to address the psychological dilemma mining enterprises face, which contributes to advancing a high-quality coal industry and efficient energy development.

Learning Analytics in Serious Games as Predictors of Linguistic Competence in Students at Risk

The planned systematized design of the use of serious games in the classroom is presented as a strategy to optimize learning. In this framework, Learning Analytics represents stealth assessment and follow-up method, and a way to personalize such games by simplifying their application for teachers. The aim of this research was to analyze the impact of the use of serious games on improving linguistic competence in socio-educationally disadvantaged students, with a proposal for a planned systematized intervention. We use two specific games to improve linguistic competence and its learning analytics to achieve the proposed goal. This study carried out was pre-experimental, with pretest and posttest, and the sample consisted of 75 students at 4 primary education centers in Spain (36 boys, 39 girls) aged 9–12 (M = 10.6; SD = 0.7) at risk due to socioeconomic conditions in Primary Education. The results show that (a) the serious games integrated into the curriculum and adjusted to the learning objectives can facilitate the development and acquisition of linguistic competence in students with socio-educational disadvantages; (b) these students can match their peers in performance and competencies with appropriate systematic intervention; (c) the level acquired in a key competence can be evaluated and specific needs identified in students with academic difficulties using learning analytics; (d) learning analytics can contribute to predicting student performance in academic subjects through the scores collected in the analysis of learning integrated into serious games. These findings contribute to filling research gaps in these four aspects.

Relationship between self-efficacy and adherence to antiretroviral therapy in HIV/AIDS patients: An analytical cross-sectional study in southern Iran.

The human immunodeficiency virus (HIV) infection, also known as acquired immunodeficiency syndrome (AIDS), is spreading rapidly in the world, especially in developing countries, and is considered a serious health threat. This study aimed to assess the relationship of adherence antiretroviral therapy (ART) and self-efficacy among people living with HIV. This cross-sectional study was conducted in March-July 2022 at the Center for Behavioral Diseases in Bandar Abbas. A total number of 208 HIV patients treated with ART entered the study after voluntarily signing an informed letter of consent. The data collection instrument was the adherence to ART questionnaire with the six subscales and the General Self-Efficacy Scale-17(GSE-17) general self-efficacy questionnaire. Multivariate regression analysis was used to test the relationship among the variables. The participants' mean age was 41.7 ± 8.2 years. Self-efficacy was positively correlated with adherence ART. With every one score of increased self-efficacy, MA increased for 0.85 score (p < 0.001) and medical challenges have the strongest correlation (r = 0.27) with self-efficacy. The multivariable regression analysis showed that moderate and high socioeconomic status (SES) each improved MA for 18 and 22 units, respectively, compared to poor SES. Alcohol consumption reduced MA for 11 units. This study proved the positive relationship of self-efficacy in adherence to ART in HIV patients. The insights offered by this research can help develop a systematic and effective intervention to promote MA in HIV patients. SES and alcohol consumption significantly affect MA.

Effect of systematic oral nursing interventions on dental plaque control and oral health care behavior in patients with periodontal disease

Effect of systematic oral nursing interventions on dental plaque control and oral health care behavior in patients with periodontal disease

Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review

IntroductionPreventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings.MethodsFive databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool.ResultsOne-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included ‘exercise’ (61%, n = 65), ‘multifactorial’ (two or more intervention types delivered together) (26%, n = 28), and ‘vitamin D’ (18%, n = 19). In RAC and community settings, ‘exercise’ interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. ‘Multifactorial’ interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. ‘Vitamin D’ interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively).Conclusion‘Exercise’ interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting ‘exercise’ interventions to become ‘multifactorial’ interventions may also improve the incidence of falls in both settings.

Relationship between Anemia and Readmission among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study.

Readmission rates among older adults are a growing concern, and the association of readmission with anemia and the potential benefits of a systematic assessment and intervention remain unclear. This study investigated the association between anemia and readmission within 28 and 90 days in an older population. Data from 1280 patients admitted to the Department of General Medicine of Unnan City Hospital between April 2020 and December 2021 were retrospectively analyzed. Variables such as anemia status, Charlson comorbidity index (CCI) score, Functional Independence Measure (FIM) score, and dependent status were evaluated. Multivariate logistic regression was used to determine the associations between 28-day and 90-day readmissions. The average age was 84.9 years, and the prevalence of anemia was 36.4%. The readmission rates within 28 and 90 days were 10.4% and 19.1%, respectively. Anemia was significantly associated with readmission in both periods (28-day adjusted odds ratio, 2.28; 90-day adjusted odds ratio, 1.65). CCI score, FIM score, and dependent status were also identified as significant factors. Anemia is significantly associated with short- and medium-term readmissions in older patients. Addressing anemia, along with other identified factors, may help reduce readmission rates.

Emerging tools for uncovering genetic and transcriptomic heterogeneities in bacteria.

Bacterial communities display an astonishing degree of heterogeneities among their constituent cells across both the genomic and transcriptomic levels, giving rise to diverse social interactions and stress-adaptation strategies indispensable for proliferating in the natural environment (Ackermann in Nat Rev Microbiol 13:497-508, 2015). Our knowledge about bacterial heterogeneities and their physiological ramifications critically depends on our ability to unambiguously resolve the genetic and phenotypic states of the individual cells that make up the population. In this short review, I highlight several recently developed methods for studying bacterial heterogeneities, primarily focusing on single-cell techniques based on advanced sequencing and microscopy technologies. I will discuss the working principle of each technique as well as the types of problems each technique is best positioned to address. With significant improvements in resolution and throughput, these emerging tools together offer unprecedented and complementary views of various types of heterogeneities found within bacterial populations, paving the way for mechanistic dissections and systematic interventions in laboratory and clinical settings.

Innovations in Bulgaria: Problems and challenges for sustainable development

The main goal of the research is to study the limitations, deficits, advantages, and potential for innovation in Bulgaria with focus on sustainable development and green models. The study goes through different dimensions of factors such as: availability of favourable infrastructure, the development of innovation activities at the company level, and the achieved results of the innovation activity. By carrying out a comparative analysis, we aim to identify directions for improving the innovation ecosystem. The main result is establishing the key problem areas in the research of innovations in Bulgaria after the country’s acceptance into the European Union especially green and bio innovations and their key role for development. We found that the major implication was the need for targeted and systematic interventions at a high level, including strategic documents that support the creation and implementation of innovations. The research pointed permanent deficits and outlined some positive processes.

Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction.

Due to limited real-world evidence on the association between time to presentation (T2P) and outcomes following acute myocardial infarction and diabetes (AMI-DM), we investigated the characteristics of patients with AMI-DM and their outcomes based on their T2P. 4,455 patients with AMI-DM from a Korean nationwide observational cohort (2011-2015) were divided into early and late presenters according to symptom-to-door time. The effects of T2P on three-year all-cause mortality were estimated using inverse probability of treatment weighting (IPTW) and survival analysis. The incidence of all-cause mortality was consistently higher in late presenters than in early presenters (11.4 vs. 17.2%; p < 0.001). In the IPTW-adjusted dataset, the incidence of all-cause mortality was numerically higher in late presenters than in early presenters (9.1 vs. 12.4%; p = 0.072). In the survival analysis, the cumulative incidence of all-cause mortality was significantly higher in late presenters than in early presenters before and after IPTW. In the subgroup with ST-elevation myocardial infarction, late presenters had a higher incidence of cardiac death than early presenters before (4.8 vs. 10.5%; p < 0.001) and after IPTW (4.2 vs. 9.7%; p = 0.034). In the initial glycated hemoglobin (HbA1c)-stratified analysis, these effects were attenuated in patients with HbA1c ≥ 9.0% before (adjusted hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 0.80-2.64) and after IPTW (adjusted HR: 0.82, 95% CI: 0.40-1.67). Late presentation was associated with higher mortality in patients with AMI-DM; therefore, multifaceted and systematic interventions are needed to decrease pre-hospital delays.

Essential thrombocythemia: nutritional management in weight loss and malnutrition.

Essential thrombocythemia is the category of myeloproliferative syndromes, generally characterized by a group of clonal stem cell diseases that present a disturbance in the growth of one or more sets of hematopoietic cells. All long clinical treatment, patients may experience gastrointestinal disorders and other metabolic processes that can lead to weight loss and malnutrition. Cytokine is involved in the control of appetite, digestive, and metabolic processes in the body, it can be assumed that increased stimulation could impair the control of these processes leading to loss of body mass. Effective and systematic nutritional intervention is required to ensure patient compliance with treatment and improved nutritional status.

Nomogram for Predicting the Risk Factors for Falls in Older People: A Secondary Data Analysis Based on the 2021 Community Health Survey.

This study aimed to identify the risk factors for falls among older individuals living at home in a community and develop a nomogram to predict falls. This study included 74 492 people aged 65 years or older who participated in the 2021 Community Health Survey conducted in Korea. The data analysis methods used included the Rao-Scott χ2 test, a complex sample t-test, and complex binary logistic regression using SPSS 26.0. Using logistic regression analysis, a fall-risk prediction nomogram was created based on regression coefficients, and the reliability of the nomogram was calculated using a receiver operating characteristic (ROC) curve and values of the area under the curve (AUC). The fall incidence rate among older adults was 16.4%. Factors affecting the subject's fall experience included being more than 85 years old (OR = 1.40); living alone (OR = 1.13); receiving basic welfare (OR = 1.18); subjective health status (OR = 1.72); number of days spent walking (OR = 0.98); obesity (OR = 1.08); severe depression (OR = 2.84); sleep duration time (OR = 1.11); experiencing cognitive decline (OR = 1.34); and diabetes (OR = 1.12). In the nomogram, the depression score exhibited the greatest discriminatory power, followed by subjective health status, gender, experience of cognitive decline, age, basic livelihood security, adequacy of sleep, living alone, diabetes, and number of days of walking. The AUC value was 0.66. An intervention plan that comprehensively considers physical, psychological, and social factors is required to prevent falls in older adults. The nomogram developed in this study will help local health institutions assess all these risk factors for falling and create and implement systematic education and intervention programs to prevent falls and fall-related injuries among older individuals.

Self-reported MeasUrement of Physical and PsychosOcial Symptoms Response Tool (SUPPORT-dialysis): systematic symptom assessment and management in patients on in-centre haemodialysis – a parallel arm, non-randomised feasibility pilot study protocol

IntroductionPatients with kidney failure experience symptoms that are often under-recognised and undermanaged. These symptoms negatively impact health-related quality of life and are associated with adverse clinical outcomes. Regular symptom assessment,...

초등영어 리터러시 격차 및 보정체계 연구

This study diagnosed the basic literacy skills and analyzed the competency gaps of 91 second graders across four classes of a public elementary school in Metropolitan City B in South Korea. Second graders were selected because they have not begun formally studying EFL (English as a foreign language) in school. Based on Acadience Reading K-6, the test used in this study consisted of 30 multiple-choice questions specifically developed for Korean students encompassing eight diagnostic areas (Alphabetics, Letter Naming, Fluency, First Sound Fluency, Phoneme Segment Fluency, Non-Sense Word Fluency, Word Decoding, and Maze). The study found a wide gap among the participants in basic literacy skills, and a key variable was the starting age of English study. Multi-level analysis showed that the participants’ abilities grew systematically and disproportionately. Explicit instruction for the deficit areas was found to be required, and systematic phonics education was deemed essential. The study attempted to derive the implications of systematic intervention in the future, based on the revealed areas of deficit in the detailed literacy capabilities.

Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis

Background: Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain’s arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. Methods: We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. Results: The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20–2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87–2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20–1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48–3.17). Conclusion: Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.

School Absence Seen from a School Perspective and a Parent Perspective

Inspired by social practice theory (Lave &amp; Wenger, 1991; Nielsen, 2016), this article adopts a contextual perspective to address school absence, specifically focusing on the relationship between parents and schools in addressing excessive school absence. The central questions of the article are: How do parents of children with excessive school absence perceive the support they receive from the school? Secondly, why do schools struggle to support parents dealing with children with excessive school absence? By exploring the experiences of parents and school staff in their interactions regarding excessive school absence, the article highlights how the organization of everyday practices influences the dynamics between schools and parents. The study is based on 41 interviews, including 24 interviews with parents, four with school leaders, four with pedagogical leaders, and 11 with teachers. The article reveals that parents of children with excessive absence describe feeling left in a communicative vacuum due to schools not taking sufficient action regarding their children’s absences. On the other hand, school staff reported challenges related to internal coordination, negotiation of responsibilities, and limited resources in implementing long-term systematic interventions for parents dealing with children with excessive school absence. The article argues that in order to understand and address school absence effectively, it is essential to consider its contextual and relational nature.

Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors.

Evidence attests a link between junior doctors' working conditions and psychological distress. Despite increasing concerns around suicidality among junior doctors, little is known about its relationship to their working conditions. To (a) establish the prevalence of suicidal ideation among junior doctors in the National Health Service; (b) examine the relationships between perceived working conditions and suicidal ideation; and (c) explore whether psychological distress (e.g. symptoms of depression and anxiety) mediates these relationships. Junior doctors were recruited between March 2020 and January 2021, for a cross-sectional online survey. We used the Health and Safety Executive's Management Standards Tool; Depression, Anxiety and Stress Scale 21; and Paykel Suicidality Scale to assess working conditions, psychological distress and suicidality, respectively. Of the 424 participants, 50.2% reported suicidal ideation, including 6.1% who had made an attempt on their own life. Participants who identified as LGBTQ+ (odds ratio 2.18, 95% CI 1.15-4.12) or reported depression symptoms (odds ratio 1.10, 95% CI 1.07-1.14) were more likely to report suicidal ideation. No direct relationships were reported between working conditions (i.e. control, support, role clarity, strained relationships, demand and change) and suicidal ideation. However, depression symptoms mediated all six relationships. This sample of junior doctors reported alarming levels of suicidal ideation. There may be an indirect relationship between working conditions and suicidal ideation via depressive symptoms. Clearer research exploring the experience of suicidality in junior doctors is needed, including those who identify as LGBTQ+. Systematic interventions addressing working environment are needed to support junior doctors' mental health.