Usual Routines Research Articles

Six Weeks to Wellness: The Role of Breathing Exercises Based on Motor Development Pattern in Improving Fitness and Quality of Life in Overweight Elderly Women.

Background: Being overweight is a major global health epidemic of the 20th and 21st centuries, which can affect the movement system function of older adult women. This study evaluated the effects of a breathing exercise based on motor development patterns on functional fitness and quality of life in overweight older adult women. Methods: A randomized controlled trial was conducted with 40 community-dwelling women aged 65-75. Participants were randomly assigned to an intervention group, which completed a 6-week breathing exercise program (three supervised and three home-based sessions per week), or a control group, which maintained usual routines. Outcome measures included cardiovascular fitness, upper and lower body flexibility, muscle strength, dynamic balance, and quality of life, assessed at baseline and post-intervention. Results: The intervention group showed significant improvements in cardiovascular fitness (p < .001, ES = 0.652), upper body flexibility (p < .001, ES = 0.652), lower body flexibility (p < .001, ES = 0.538), upper body strength (p < .001, ES = 0.538), lower body strength (p < .001, ES = 0.538), and dynamic balance (p < .001, ES = 0.475) compared to the control group. Quality of life also significantly improved in the intervention group (p < .001, ES = 0.475). Conclusion: Breathing exercises based on motor development patterns significantly enhance functional fitness and quality of life in overweight older adult women. Incorporating these exercises into regular physical activity routines may promote health and independence in older adults. Further research should explore long-term benefits and optimal exercise parameters for older adults.

The Effect of Super Brain Yoga on Concentration, Memory, and Academic Progress in Nursing Students: A Quasi-Experimental Study.

During university life, students often face significant changes in relationships and academic pressures. Given the stressors faced by nursing students and the importance of their academic success, the study aimed to assess the impact of Super Brain Yoga on nursing students' concentration, memory, and academic progress. This quasi-experimental study was conducted on 59 nursing students at Near East University in Cyprus from February to June 2023. The intervention group (N=29) performed Super Brain Yoga three times a week for two months, while the control group (N=30) continued the usual routines. Data were collected using the demographic questionnaire, Wechsler's memory test, Concentration test, and the semester grade point average. Data analysis was performed using independent and paired t-test, chi-square, and ANCOVA using SPSS software version 26, with a significance level of P˂0.05. The study revealed a significant difference in total memory scores (P<0.001) and its subscales including personal and public information (P<0.001), orientation (P<0.001), mental control (P<0.001), logical memory (P=0.002), repeating numbers (P<0.001), visual memory (P<0.001), and learning associations (P=0.003) between the experimental and control groups after the intervention. Findings revealed a significant difference between the two groups in the reaction time (P=0.003) and the error of the reverse counting (P=0.021) following the intervention. After the intervention, based on ANCOVA test with adjusting the baseline values, there was no statistically significant difference in the semester mean of Grade Point Average between the two groups (95% confidence interval, P=0.657). Super Brain Yoga is a non-invasive intervention that can improve memory, concentration, and cognitive abilities in nursing students.

Implementing Montessori approaches after training: A mixed methods study to examine staff understanding and movement toward action.

Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams (N = 906), post-training evaluations (N = 761), and optional validated surveys on perceptions of Montessori training (N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training (N = 22). Findings: The majority of staff (83%-90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training (p = .002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners.

The Effect of Physical Education with a Humanistic Approach on the Physical Activity Level and Physical Fitness in Shy Children

Background: Shy children often avoid interacting with their peers, which can restrict their participation in physical activities and impact their physical fitness. Therefore, it is essential to offer specific support and strategies to assist these children in increasing their involvement and enhancing their physical fitness. Objectives: This study aimed to investigate how physical education, utilizing a humanistic approach, impacts the physical fitness and daily physical activity behavior of shy children. Methods: In order to achieve this, a quasi-experimental field study was planned with pre- and post-tests including a control group. Participants were 9 to 10-year-old elementary school girls from Tehran, selected based on the Chick-Briggs Shyness Scale Physical fitness was measured using tests for cardiorespiratory endurance, agility, muscular endurance, muscular strength, and flexibility. The physical Activity Questionnaire for Children (PAQ-C) was utilized in assessing children's attitude towards physical activity. The experimental group (n = 15) received a physical education course with a humanistic approach using the teaching physical and social responsibility (TPSR) model, while the control group (n = 15) maintained their usual daily routines. Results: The experimental group showed significant improvements in physical activity levels, muscular endurance, and flexibility compared to the control group. A humanistic, game-based educational approach using the TPSR model can effectively improve certain components of physical fitness and promote a positive attitude towards physical activity in shy children. Conclusions: This approach can help teachers and coaches better understand and assist this group of children in overcoming the negative relationship between shyness, sports participation, and physical fitness.

Effects of a 12-week training program in outdoor gym equipment in morphological and functional parameters, quality of life, and physical activity levels in older adults.

This study aimed to investigate the effectiveness of a supervised physical training program with controlled cadence on functional fitness parameters, quality of life perception, and physical activity level in older adults. Sixty physically independent older adults were randomly divided into three groups: Supervised Training (ST, n = 20), Unsupervised Training (UT, n = 20), and a Control Group (C, n = 20). The ST and UT groups participated in a 12-week program, performing exercises three times a week for 30 min. The ST group had structured weekly sessions consisting of a 5-minute warm-up (walking at 60% of max heart rate), 20 sets of 30 s at a moderate pace controlled by a metronome with 30 s of passive recovery, and a 5-minute cool-down on non-consecutive days. The UT group trained spontaneously using senior gym equipment, including elliptical machines, rowing machines, air skiers, and leg press machines. The control group maintained their usual daily routines throughout the study. Parameters evaluated included body mass, body mass index (BMI), muscle thickness (biceps brachii, triceps brachii, and vastus lateralis), and functional capacity tests (walking 10 m [W10 m], rising from a sitting position [RSP], rising from the prone position [RVDP], sitting and rising from a chair and moving around the house [SRCW]). Quality of life was assessed across physical, psychological, environmental, and social domains, and physical activity levels were also measured. No significant changes (p > 0.05) in body mass, BMI, or muscle thickness were observed between groups before and after the intervention. However, significant time effects in functional fitness tests were found only in the ST group for W10 m (p = 0.0469), RVDP (p < 0.0004), RSP (p < 0.0001), and SRCW (p < 0.0001). Quality of life improved significantly over time in the ST and UT groups across all domains (p < 0.0001). Both ST and UT groups also showed significant increases in weekly physical activity time (p > 0.0001). 12 weeks of training improved quality of life perception and physical activity levels in older adults.

Impact of parent-delivered traditional Thai massage on children with autism spectrum disorder and parenting stress: a randomized controlled trial

Objectives To evaluate the effects of parent-delivered traditional Thai massage (TTM) on children with autism and its potential influence on parenting stress. Methods Forty-eight children with autism (aged 10.32 ± 1.35 years) were enrolled from Haikou Special Education School (Haikou Province, China) and randomly assigned to either the TTM group or control group in a 1:1 ratio. Alongside their regular school routines, the TTM group underwent 16 sessions of 50-min TTM, twice weekly for 8 weeks. The control group continued their usual daily school routines. Intervention effects and parenting stress were measured using the Autism Treatment Evaluation Checklist and Parenting Stress Index, Fourth Edition Short Form. Results The TTM intervention had a significant positive impact on sociability (p = 0.001, partial ŋ2=0.168) and total scores (p = 0.009, partial ŋ2=0.103). Additionally, the TTM group had significantly reduced parental distress (p = 0.016, partial ŋ2=0.179), parent − child dysfunctional interaction scores (p = 0.008, partial ŋ2=0.206), and total scores (p = 0.001, partial ŋ2=0.179) post-intervention, with a significant rebound observed during the follow-up period. Conclusions Our findings indicate that parent-delivered TTM can effectively improve certain autism symptoms and reduce parenting stress in the short-term. Incorporating parent-delivered massage into family-based interventions offers a convenient, effective, and personalized treatment option for families with limited access to alternative treatment resources. Trial registration Clinical Trials Registry Identifier: ChiCTR2100051355, 2021-09-21

Supporting siblings during the critical illness hospitalization of a child: learning from experience.

Childhood critical illness impacts the entire family of the critically ill patient. Disruptions to usual family rhythms and routines, established relationships, physical relocations or shifts in caregivers, and the uncertainty about the patient's well-being can have significant impacts on siblings and other connected children in the family. Promoting and facilitating family interactions and engaging younger family members in the hospital experience have been shown to reduce patient and family anxiety, enhance family adaptation, and improve child and family outcomes. The critical care team can implement evidence-informed approaches to address and mitigate challenges for families and provide developmentally aligned support to impacted siblings. This conceptual paper describes the potential impacts of a critical illness hospitalization on siblings, approaches to supporting siblings, and practical interventions drawn from a synthesis of the current literature and the author's practice experience caring for critically ill children and their families. A traditional review and narrative analysis moderated by the authors and supported by lived experience. There is a range of impacts of a critical illness hospitalization on siblings and young family members of the patient. Providing consistent, transparent, and supportive child, sibling, and whole family-centered care can improve the experience and outcomes for the child and family.

The population of Veneto faced with technological consumption of music during the pandemic.

This work is the result of one of the lines of research opened in the LabinTic group (UCLM) and a stay in the city of Padua, in the Italian Veneto area, in 2022. After observing the side effects in Italy as a result of COVID-19 and the Great Lockdown, we wanted to know in more depth some aspects related to how the people of Veneto used IT as an important weapon to fight against forced isolation and, if possible, compare this with other similar studies performed in Castilla-La Mancha. To achieve this objective, an ad hoc questionnaire was designed and validated through expert judgment. This questionnaire was administered to a random probabilistic sample by disseminating it through social media and email using the "snowball" method. A total of 338 people who comprised the population sample of the study (n = 338) were obtained. After analyzing the data through SPSS 28, using a mixed methodology considering qualitative and quantitative aspects, the great influence that IT had among the Italian population during the lockdown common aspects of their everyday lives and incorporating some acquired habits (listening to music, for example) into their usual life routines after the return to normality was determined among other features and assessments. In summary, the text highlights how the pandemic influenced music consumption, the popularity of different music genres, the role of social media, and the enduring importance of the music itself in people's lives. It suggests that music remains a source of comfort and entertainment in challenging times.

Impact on postoperative complications of combined prehabilitation targeting co-existing smoking, malnutrition, obesity, alcohol drinking, and physical inactivity: a systematic review and meta-analysis of randomised trials

Background This study aimed to compare the effect on postoperative complications of prehabilitation targeting predefined co-existing risky lifestyle factors with usual preoperative routines in surgical patients. Methods This systematic review followed the PRISMA 2020 guideline and the protocol (CRD42022282611). Five databases were searched from inception to November 7, 2022 for randomised controlled trials on prehabilitation targeting ≥2 predefined risky lifestyles compared with usual preoperative routines. Risky lifestyles included Smoking, Nutrition (malnutrition and/or BMI&gt;25), risky Alcohol intake, and Physical inactivity (SNAP). Primary outcome was postoperative complications ≤30 days. Cochrane’s risk-of-bias tool 2 was used and meta-analyses were conducted. GRADE was used to assess certainty of evidence. Results The search resulted in 20,862 records. At full-text screening, only two (120 participants) of 24 identified trials on combined SNAP intervention had ≥2 predefined risk factors and were included. One (n=110) on intensive physical and brief nutritional intervention to frail patients with colorectal cancer resection reported complication rates of 45% in both groups (relative risk (RR) 1.00, 95% CI 0.66 to 1.51). The other study (n=10, subgroup) on intensive alcohol and smoking intervention in patients with bladder cancer undergoing radical cystectomy, reported complications in 3/7 vs 3/3 participants (RR 0.50, 95% CI 0.21 to 1.19). The meta-analysis estimated a RR of 0.79 (95% CI 0.41 to 1.51, I2 51%). Conclusion Two small of the 24 trials on prehabilitation targeted co-existing and predefined risky SNAP factors and the effect on postoperative complications is very uncertain. Future prehabilitation research involving patient needs is warranted.

Healthcare professionals' competencies and confidence in managing hospitalized patients with type 2 diabetes.

In hospitals, 15%-20% of patients have diabetes. Therefore, all healthcare professionals (HCPs) must have a basic knowledge of in-hospital diabetes management. This survey assessed the knowledge of diabetes among HCPs in Denmark. A 27-item questionnaire was developed and reviewed independently before the survey was distributed. The questionnaire contained seven baseline questions on the HCPs' current workplace, educational level, usual shift routines and years of experience, 18 multiple-choice questions and 2 cases. A total of 252 completed questionnaires were returned by 133 (52.8%) physicians, 101 (40.1%) nurses and 18 (7.1%) healthcare assistants. HCPs answered 50% of the questions correctly. Having experience from endocrinological departments increased the correct response score (0%-100%) by 6.2% points (95% CI 0.3-12.1) (p = 0.039) and 3.1% points (95% CI 1.5-4.7) for every increase in confidence level on a scale from 1 to 10 (p < 0.001). HCPs scored 8 out of 10 on a confidence level scale on average. In a fictive case, 50% of HCPs administered the correct bolus insulin dose. Hyperglycaemia (>10.0 mmol/L) and hypoglycaemia (<3.9 mmol/L) were correctly identified by around 40% of HCPs. Hypoglycaemia was rated more important than hyperglycaemia by most HCPs. Significant gaps in identifying hypo- and hyperglycaemia and correct administration of bolus insulin have been identified, which could be targeted in future education for HCPs. HCPs answered 50% of questions related to in-hospital diabetes management correctly. Experience from endocrinological departments and self-rated confidence levels are associated with HCPs' in-hospital diabetes competencies.

The impact of real-time carbon dioxide awareness on occupant behavior and ventilation rates in student dwellings

Although existing standards typically prescribe fixed ventilation rates, a large portion of the building stock lacks mechanical ventilation systems. Such buildings obtain outdoor air through unintentional infiltration, open windows, and the operation of exhaust fans, which are mainly dependent on user awareness and behavior. This study investigates whether the presence of a simple CO2 meter display can alter user behavior and improve indoor air quality (IAQ) in dwellings. We conducted a two-week monitoring of CO2 concentration, air temperature, and relative humidity in 60 student dwellings (bedrooms and living rooms) in Denmark and Switzerland. During the first week, the CO2 display was concealed, and occupants adhered to their usual routines. In the second week, occupants used the display's visual feedback to enhance IAQ when necessary. Results revealed that over 95% of dwellings witnessed a reduction in median CO2 levels during the second week, both overall and in individual rooms. Furthermore, a descriptive analysis of CO2 concentration step changes exceeding the thresholds of “normal variation” showed an increase in the number of negative step changes, indicating a shift in user behavior. These findings underscore the efficacy ofa display interface providing information on the indoor environment in triggering behavior changes and improving IAQ in dwellings.

Changes in rural caregivers' health behaviors while supporting someone with cancer: A qualitative study.

Caring for someone with cancer has a significant impact on usual routines, including caregivers' ability to maintain their own health and wellbeing. Caregivers living in rural areas face additional challenges in supporting someone with cancer, and little is known about the impact of caregiving on the health behaviors of rural caregivers. Therefore, this study explored how caring for someone with cancer affected rural caregivers' health behaviors. Through semi-structured interviews, 20 rural caregivers described changes in their health behaviors while caring for someone with cancer and the factors underlying these changes. Specific prompts were provided for diet, physical activity, alcohol, smoking, sleep, social connection and leisure, and accessing health care when needed. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to identify changes in health behaviors and the factors underlying these changes. The factors identified were mapped to the socioecological framework, identifying areas for intervention across multiple levels (individual, interpersonal, organizational, community, and policy). Rural caregivers reported both positive and negative changes to their diet, physical activity, alcohol, and smoking. Sleep, social connection and leisure, and accessing health care were negatively impacted since becoming a caregiver. Designing interventions to address rural caregivers' coping strategies, reduce carer burden and fatigue, improve access to cooking and exercise facilities and social support while away from home, reduce the need to travel for treatment, and increase the financial support available could yield widespread benefits for supporting the health and wellbeing of rural caregivers.

Communication in disasters to support families with children with medical complexity and special healthcare needs: a rapid scoping review.

Disasters can disrupt normal healthcare processes, with serious effects on children who depend upon regular access to the health care system. Children with medical complexity (CMC) are especially at risk. These children have chronic medical conditions, and may depend on medical technology, like feeding tubes. Without clear, evidence-based processes to connect with healthcare teams, families may struggle to access the services and supports they need during disasters. There is limited research about this topic, which has been pushed forward in importance as a result of the COVID-19 pandemic. The authors therefore conducted a rapid scoping review on this topic, with the intention to inform policy processes. Both the peer-reviewed and gray literatures on disaster, CMC, and communication were searched in summer 2020 and spring 2021. Twenty six relevant articles were identified, from which four main themes were extracted: 1. Cooperative and collaborative planning. 2. Proactive outreach, engagement, and response. 3. Use of existing social networks to connect with families. 4. Return to usual routines. Based on this review, good practices appear to involve including families, professionals, other stakeholders, and children themselves in pre-disaster planning; service providers using proactive outreach at the outset of a crisis event; working with existing peer and neighborhood networks for support; employing multiple and two-way communication channels, including social media, to connect with families; re-establishing care processes as soon as possible, which may include virtual connections; addressing mental health issues as well as physical functioning; and prioritizing the resumption of daily routines. Above all, a well-established and ongoing relationship among children, their caregivers, and healthcare teams could reduce disruptions when disaster strikes.

Breaking Away From Hectic Daily Media Production: Unleashing Explorative Innovation Through Inter-Firm Collaborations

Beyond the widespread disruption narrative around media innovation, journalism scholarship has put forward valuable remedies to counteract a techno-deterministic perspective by embracing socio-constructivist and socio-technical approaches. Nevertheless, thus far, scholarly attention has primarily been directed towards the newsroom despite the journalism field having undergone significant structural transformations. In this article, we adopt an organisational perspective to journalism innovation and apply it to the emerging locus of inter-firm collaborations in journalism. In fact, while the newsroom has traditionally been considered the dominant location for implementing innovations, an increasing amount of media work currently occurs in decentralised settings. Our study draws upon 20 qualitative interviews with media practitioners and media managers who have been involved as project leaders in inter-firm collaborative projects. These projects have received institutional funding specifically aimed at fostering media innovation. We strive to understand how practitioners conceive of innovation in their overall activity, what obstacles they encounter in their usual routines, and how collaborative practices support them in their innovation trajectory. Our findings indicate that innovation is predominantly perceived as a demanding and complex ongoing practice characterised by adaptation to an evolving environment and hindered by a lack of resources and time. We also find that collaborations offer media practitioners a temporary framework for balancing their efforts to keep up with the demand for daily media production and their aspiration to carry out explorative activities. Lastly, our research reveals that these collaborations provide occasions for knowledge exchange and self-reflection that are frequently absent in non-collaborative settings.

Effectiveness of high-intensity interval training and moderate-intensity continuous training on cardiometabolic health in university labourers

Abstract Background: The prevalence of obesity continues to drive the growth of chronic, non-communicable diseases in sub-Saharan African countries. Little evidence is available to prevent the spread of chronic diseases in vulnerable African communities and amongst workers living in these settings. This study aimed to compare and evaluate the effectiveness of a 12-week high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on cardiometabolic health in a cohort of African workers. Methods: Forty-three Black South African university professional workers employed at the University of the Witwatersrand were randomized into 3 groups: HIIT (n = 17), a MICT (n = 15) and a control group (n = 11). The HIIT performed progressive supervised exercise on a cycle ergometer, the MICT performed continuous aerobic activity and the control group maintained their usual routines. Changes in body composition, blood glucose, blood pressure and VO2max outcomes were measured at baseline and at 3-month follow-up. Results: Compared to controls both HIIT and MICT significantly reduced waist circumference (−5.3 and −4.0 cm), BMI (−2.4 and −1.9), and blood pressure (systolic &amp; diastolic - moderate to large effects) (p ♯αμπ;λτ; 0.05). Similarly, blood glucose levels dropped in both intervention groups (−1.9 and −2.0 mmol/L−1) (p ♯αμπ;λτ; 0.05). Notably, both interventions significantly improved VO2max (+7.5 and +7.0 mL.kg−1.min−1) (p ♯αμπ;λτ; 0.05). Conclusions: These findings suggest both HIIT and MICT effectively improve key health markers. In the context of a growing chronic diseases crisis, our study provides important formative data for developing feasible workplace interventions to improve health outcomes.

High-intensity interval training in patients with an implantable cardioverter defibrillator: a randomized controlled study

Abstract Background Exercise is an effective treatment in a broad spectrum of cardiovascular diseases. High-intensity interval training (HIIT) has shown superior effect on cardiorespiratory fitness and equal or superior effect on morbidity and quality of life (QoL) compared to moderate continuous exercise training. However, evidence of the efficacy and risks of HIIT in patients with increased risk of ventricular arrhythmia remains limited. Purpose To evaluate the effects of HIIT on exercise capacity, QoL and burden of ventricular arrhythmias in patients with an implantable cardioverter defibrillator (ICD) with or without cardiac resynchronization therapy. Methods Patients with ischemic or dilated cardiomyopathy and ICD were randomized to a supervised 12-week HIIT program or to a control group continuing their usual exercise routines. HIIT consisted of four 4-minute intervals aiming at 85-95% of maximum heart rate (HRmax), and 3-minute active recovery aiming at 60-70 % of HRmax in between intervals, 3 times a week for 12 weeks. Primary outcomes were exercise capacity measured as peak oxygen uptake (VO2 peak) and QoL assessed with the Short Form 36 (SF-36) questionnaire. Main secondary outcome was the burden of ventricular arrhythmias analysed from remote patient monitoring data. Results Fifty-six patients were included (table 1). Three patients in the HIIT group did not complete the intervention. Two withdrew due to a knee injury and due to fear of SARS-CoV-2 exposure, respectively. One experienced an appropriate shock during exercise and was excluded from further training after clinical consideration. Fifty-three patients completed all follow-up examinations. HIIT significantly increased VO2 peak with 7.0 %, with no changes in the control group (p=0.001) (figure 1A). There was a significant increase in the SF-36 subscale scores on physical functioning (p&amp;lt;0.05), general health (p&amp;lt;0.05) and health change (p=0.001) in the HIIT group compared to the control group (figure 1B). There were no significant differences between groups in number of non-sustained or sustained ventricular tachycardias, anti-tachycardia pacing therapy or ICD shocks. Conclusions In patients with ICD due to ischemic or dilated cardiomyopathy, a supervised 12-week HIIT-program significantly increased VO2 peak and QoL without increasing the burden of ventricular arrhythmias.Table 1:Patient characteristicsFigure 1:Peak oxygen uptake and QoL

Pre-sleep routines in adult typical sleepers

ABSTRACT Sleep is the most important restorative occupation in which humans engage and pre-sleep routines, which occur prior to it, have not been explored. The main question this project sought to answer was: “What are the pre-sleep routines of typical adult sleepers?” Sixteen adults identified as good sleepers based on scores from the Pittsburgh Sleep Quality Index, between 23 and 60 years-old, drew pictures of their pre-sleep routines, followed by interviews about their depictions. Data analysis began after the first interview and continued through theoretical saturation, producing a descriptive theory of pre-sleep routines. During the pre-sleep period, participants performed an average of eight occupations in three to four spaces, using an average of five objects, and primarily in solitude. Routines had a clear beginning and end, and were both obligatory and optional. Occupations within the pre-sleep routine included body care, care for home, pets, or plants, engagement with technology, quiet leisure, and communicating with others. The intent of the pre-sleep routines was to ensure that sleep was not disturbed and to prepare for the next day. The construct of routines is important to the understanding of daily patterns of human occupation and is used as an intervention in occupational therapy, the primary profession applying the products of occupational science. This research describes usual routines before sleep, thus contributing to a fuller grasp of daily occupational patterns with potential for supporting sleep in adults with and without sleep issues. Drawings were found to be a useful method to collect information on routines.

Social Connectedness and Perceived Stress Among Caregivers During the COVID-19 Pandemic: a Mixed-Methods Study.

The COVID-19 pandemic has created unprecedented stressors for caregivers due to social distancing requirements that simultaneously increased their responsibilities and reduced opportunities for social connection and support. This concurrent embedded mixed-methods study examined differences between caregivers and non-caregivers regarding the effects of social connectedness on perceived stress and explored challenges caregivers experienced related to social connectedness and perceived stress. A national online survey containing forced-choice and free-response questions was administered between April and June 2020. The survey was distributed via social media advertisements and a crowdsourcing platform to eligible adult residents in the United States (US) fluent in either English or Spanish. Multivariable regression and thematic analysis were used to analyze the quantitative and qualitative data. Mixed-methods integration occurred during the data analysis, interpretation, and reporting phases. The study sample comprised 1540 US adults (1275 non-caregivers, 265 caregivers; 65% women; 36% racial/ethnic minorities). Relative to non-caregivers, caregivers had lower levels of social connectedness and higher levels of perceived stress. Social connectedness was also inversely related to perceived stress for non-caregivers (p < 0.001) and slightly but not significantly positively related to perceived stress for caregivers. Qualitative findings showed caregivers experienced a variety of stressors including fear of COVID-19 exposure to their care recipients, disruption to usual care routines, and difficulty accessing healthcare services that may have contributed to decrements in social connectedness and higher levels of perceived stress. Findings suggest social connectedness may be beneficial for reducing perceived stress, but its impact can vary depending on individual circumstances. Overall, findings support the idea that caregivers are a particularly vulnerable sub-group of the population and may benefit from more targeted support and interventions.

Collaborative implementation of an evidence-based package of integrated primary mental healthcare using quality improvement within a learning health systems approach: Lessons from the Mental health INTegration programme in South Africa.

The treatment gap for mental health disorders persists in low- and middle-income countries despite overwhelming evidence of the efficacy of task-sharing mental health interventions. Key barriers in the uptake of these innovations include the absence of policy to support implementation and diverting of staff from usual routines in health systems that are already overstretched. South Africa enjoys a conducive policy environment; however, strategies for operationalizing the policy ideals are lacking. This paper describes the Mental health INTegration Programme (MhINT), which adopted a health system strengthening approach to embed an evidence-based task-sharing care package for depression to integrate mental health care into chronic care at primary health care (PHC). The MhINT care package consisting of psycho-education talks, nurse-led mental health assessment, and a structured psychosocial counselling intervention provided by lay counsellors was implemented in Amajuba district in KwaZulu-Natal over a 2-year period. A learning health systems approach was adopted, using continuous quality improvement (CQI) strategies to facilitate embedding of the intervention.MhINT was implemented along five phases: the project phase wherein teams to drive implementation were formed; the diagnostic phase where routinely collected data were used to identify system barriers to integrated mental health care; the intervention phase consisting of capacity building and using Plan-Do-Study-Act cycles to address implementation barriers and the impact and sustaining improvement phases entailed assessing the impact of the program and initiation of system-level interventions to sustain and institutionalize successful change ideas. Integrated planning and monitoring were enabled by including key mental health service indicators in weekly meetings designed to track the performance of noncommunicable diseases and human immunovirus clinical programmes. Lack of standardization in mental health screening prompted the validation of a mental health screening tool and testing feasibility of its use in centralized screening stations. A culture of collaborative problem-solving was promoted through CQI data-driven learning sessions. The province-level screening rate increased by 10%, whilst the district screening rate increased by 7% and new patients initiated to mental health treatment increased by 16%. The CQI approach holds promise in facilitating the attainment of integrated mental health care in resource-scarce contexts. A collaborative relationship between researchers and health system stakeholders is an important strategy for facilitating the uptake of evidence-based innovations. However, the lack of interventions to address healthcare workers' own mental health poses a threat to integrated mental health care at PHC.

A 20-week exercise program improved total body and legs bone mineral density in children with overweight or obesity: The ActiveBrains randomized controlled trial

ObjectivesThe aim of this study was to investigate the effect of a 20-week exercise program on bone mineral parameters in children with overweight or obesity. DesignRandomized controlled trial. MethodsThis study took part from November 21, 2014, to June 30, 2016, in Granada, Spain. A secondary analysis of this parallel-group randomized controlled trial was performed with 77 children with overweight or obesity (9.9 ± 1.2, 65 % boys) who were randomly allocated to exercise or control group. All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions/week of aerobic plus resistance training for 20 weeks. A whole-body scan by dual-energy X-ray absorptiometry was carried out to obtain body composition at total body less head, arms, lumbar spine, pelvis, and legs. ResultsParticipants in the exercise group acquired significantly higher total body aBMD (mean z-score [95 % confidence intervals, CI], 0.607 [0.522–0.692]) compared with the participants in the control group (mean z-score, 0.472 [0.388–0.556]); difference between groups, 0.135 standard deviations [95 % CI 0.015–0.255], and legs aBMD (mean z-score, 0.629 [0.550–0.708]); control group (mean z-score, 0.518 [0.440–0.596]); difference between groups, 0.111 [0.001–0.222]; all p < 0.05. There were no significant differences between exercise group and control group at the remaining evaluated regions (p > 0.05). ConclusionsA 20-week non-specifically bone-targeted exercise program induced a small, yet significant, improvement on total body and legs aBMD in children with overweight or obesity. Future studies should investigate the interaction of weight status in the bone response to exercise programs. Trial registrationProspectively registered in ClinicalTrials.gov Identifier: NCT02295072.