The Importance of Creating Habits and Routine

Adherence Rates and Barriers to Second-Generation Antipsychotic Medication Use in Youth with Bipolar Spectrum Disorders Who Have Overweight/Obesity

Objective: Youth with bipolar spectrum disorders (BSD) are frequently prescribed second-generation antipsychotics (SGAs). Nonadherence to treatment often results in increased mood symptoms and diminished quality of life. We examined SGA adherence rates and adherence barriers among youth who have overweight/obesity and are diagnosed with BSD enrolled in a multisite pragmatic clinical trial. Methods: SGA adherence and adherence barriers at baseline via patient- and caregiver report was assessed. Adherence was defined as taking ≥70% of prescribed SGA doses in the past week. The weighted Kappa statistic was used to measure child-caregiver agreement about adherence rates, barriers, and caregiver assistance. Regression analyses were used to examine associations of caregiver assistance, age, sex, race, insurance status, dosing frequency, and number of concomitant medications with adherence. Barriers to adherence were analyzed separately for youth and their caregivers, using logistic regression to assess associations between informant-reported barriers and informant-reported adherence. Results: Participants included 1485 patients and/or caregivers. At baseline, 88.6% of patients self-reported as adherent; 92.0% of caregivers reported their child was adherent. Concordance between patients and caregivers was moderate (k = 0.42). Approximately, 50% of the sample reported no adherence barriers. Frequently endorsed barriers included forgetting, side effects, being embarrassed to take medications, and preferring to do something else. Concordance between informants regarding adherence barriers was weak (k = 0.05-0.36). Patients and caregivers who did not endorse adherence barriers reported higher adherence than those who endorsed barriers. Male sex and having once daily dosing of medications were associated with lower adherence. Discussion: One-week patient- and caregiver-reported adherence was high in this sample. Half of the sample reported adherence barriers. Most commonly endorsed barriers were forgetting, side effects, being embarrassed, and preferring to do something else. Caregivers and patients have unique perspectives regarding adherence barriers. Understanding and addressing treatment barriers in clinical practice may facilitate adherence.

How Perceptions of Aging Influence Physical Activity and Exercise in Older Age: Exploring the Behavior of People Aged 70+ Years Engaged in Fall Prevention Activities

For older people, physical inactivity increases fall risk as well as other preventable health conditions. Despite the well-documented benefits of physical activity, uptake and adherence continue to challenge efforts aimed at increasing physical activity and reducing falls. Nested within a randomized controlled trial, this study reports on the factors influencing the physical activity behavior of people, aged between 70 and 90 years, engaged in StandingTall, a home-based balance exercise program proven to reduce falls in the community. The perception of aging, physical activity in older age, and the delivery of exercise were identified as major themes, with the perception of aging an overarching theme influencing both preferences for physical activity in older age and exercise delivery. Findings demonstrate the importance of considering the role of aging, the influence aging has on physical activity and exercise behavior, and how aging influences the delivery and design of exercise programs including falls prevention activities for older people.

Medication Management Strategies to Support Medication Adherence: Interview Study With Older Adults

BACKGROUND

Home medication management has been insufficiently studied, including the factors that impact the development and effectiveness of adherence strategies under both routine and anomalous circumstances. Older adults are a particularly important population to study due to the greater likelihood of taking medication in combination with the desire to "age in place."

OBJECTIVE

This interview study aims to understand how older adults develop medication management strategies, identify when and why such strategies succeed or fail, learn more about how older adults think about their medication, and explore interventions that increase medication adherence.

METHODS

This study used a qualitative, semistructured interview design to elicit older adults' experiences with home medication management. Overall, 22 participants aged ≥50 years taking 1 to 3 prescription medications were recruited and interviewed. Interview responses were recorded, and thematic, qualitative analysis was performed by reviewing recordings and identifying recurring patterns and themes. Responses were systematically coded, which not only facilitated the identification of these themes but also allowed us to quantify the prevalence of behaviors and perceptions, providing a robust understanding of medication management and medication adherence.

RESULTS

Participants reported developing home medication management strategies on their own, with none of the participants receiving guidance from health care providers and 59% (13/22) of the participants using trial and error. The strategies developed by study participants were all unique and generally encompassed prescription medication and vitamins or supplements, with no demarcation between what was prescribed or recommended by a physician and what they selected independently. Participants thought about their medications by their chemical name (10/22, 45%), by the appearance of the pill (8/22, 36%), by the medication's purpose (2/22, 9%), or by the medication's generic name (2/22, 9%). Pill cases (17/22, 77%) were more popular than prescription bottles (5/22, 23%) for storage of daily medication. Most participants (19/22, 86%) stored their pill cases or prescription bottles in visible locations in the home, and those using pill cases varied in their refill routines. Participants used ≥2 routines or objects as triggers to take their medication. Nonadherence was associated with a disruption to their routine. Finally, only 14% (3/22) of the participants used a time-based reminder or alarm, and none of the participants used a medication adherence device or app.

CONCLUSIONS

Participants in our study varied considerably in their home medication management strategies and developed unique routines to remember to take their medication as well as to refill their pill cases. To reduce trial and error in establishing a strategy, there are opportunities for physicians and pharmacists to provide adherence guidance to older adults. To minimize the impact of disruptions on adherence, there are opportunities to develop more durable strategies and to design aids to medication adherence that leverage established daily routines.

Is the frequency of breakfast consumption associated with life satisfaction in children and adolescents? A cross-sectional study with 154,151 participants from 42 countries

BACKGROUND

The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the relationship between breakfast frequency and life satisfaction in large and representative samples of school-going children and adolescents aged 10-17 years from 42 different countries.

METHODS

This study used information from the 2017/2018 Health Behavior in School-aged Children study, comprising nationally representative samples of children and adolescents aged 10-17 years who were attending school. The total number of participants from the 42 countries included in the study was 155,451 (51.3% girls). The evaluation of breakfast consumption in this study involved a specific question: "How often do you typically have breakfast (more than a glass of milk or fruit juice)?". To measure life satisfaction, a subjective assessment scale was used in the form of a ladder, visually spanning from 0 to 10. On this scale, the topmost point (10) denotes the highest conceivable quality of life, whereas the bottom point (0) represents the worst imaginable quality of life.

RESULTS

After adjusting for several covariates, the lowest estimated marginal mean of life satisfaction was identified in those participants who skipped breakfast (mean [M] = 5.6, 95% confidence interval [CI] 5.5 to 5.8). Conversely, the highest estimated marginal mean of life satisfaction was observed in those who had breakfast every day (M = 6.5, 95% CI 6.3 to 6.6). Overall, a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents was identified (p-for-trend < 0.001). In addition, the highest estimated marginal mean of life satisfaction score was identified in those participants from Portugal who had breakfast every day (M = 7.7; 95% CI 6.9 to 8.5 points). Conversely, the lowest estimated marginal mean of life satisfaction was observed in those participants from Romania who no breakfast (M = 3.5; 95% CI 2.6 to 4.4 points).

CONCLUSIONS

There is a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents. Considering the potential health advantages associated with breakfast during this critical age phase, these findings imply the necessity for additional global efforts to promote increased breakfast consumption among children and adolescents.

Understanding the experiences of ketogenic metabolic therapy for people living with varying levels of depressive symptoms: a thematic analysis

Background

Evidence suggests that a ketogenic diet (KD) may help to alleviate psychiatric symptoms, including depression and anxiety. Positive changes have been reported such as improvements in cognition, concentration, and sleep, a reduction in hunger, and an increase in well-being, energy, confidence, and resilience. This research aims to understand the impact of a non-calorie-restricted KD on depression and aspects of psychological well-being in those with varying degrees of depressive symptoms. Though there are a few studies directly exploring the experiences of those following a KD, this will be the first study to explore the narrative from a mental health and psychological well-being viewpoint.

Method

A sample of nine participants who had followed a non-calorie restricted KD intervention of 50 g of carbohydrates or less per day for at least 12 weeks were recruited. Participants were split into 'healthy adults' group who had no to low depressive symptoms and 'depressive symptoms' group who had mild to moderate depressive symptoms. A reflexive thematic analysis was considered suitable for this study.

Findings

Five core themes and 24 subthemes were created. These were, (1) Poor health prior to program; (2) Hunger and cravings-the food and mood connection; (3) Psychological well-being improvements; (4) It becomes a lifestyle; and (5) Implementation difficulties. Participants experienced mental health improvements such as increased self-esteem, confidence, motivation, and achievement. Some experienced more control in life and a greater sense of reward. Those with depressive symptoms who initially reported low self-worth and hopelessness later reported increased self-esteem and renewed meaning and purpose in life. The findings from this study reflect the previous reports that the diet implementation can be difficult initially, but soon becomes easy to follow and turns into a lifestyle.

Conclusion

In the literature, there are very few qualitative studies that explore the accounts and lived experiences of those following a KD. From the participants' accounts in this study, it appears that the benefits and positive outcomes of this diet outweigh any negative side-effects experienced. This is encouraging for those who are looking for adjunctive therapies to address and improve their depressive symptoms and overall mental health.

A controlled weight loss intervention study among women of Somali background in Norway

Background

Women of Somali background in Norway have a high prevalence of overweight and obesity, compared with women in the general Norwegian population. For lifestyle interventions to be applicable for immigrants to Norway, it is important to culturally tailor interventions in collaboration with relevant communities. The primary outcome was a difference in weight change between the intervention and control groups.

Methods

In this interventional study, Somali women living in one borough of Oslo Municipality in Norway with body mass index (BMI) ≥27.0 kg.m-2 received a co-created, culturally tailored 12-month weight loss intervention consisting of 24 interactive sessions during the first three months, and monthly sessions for the next nine months, compared to a control group. Both groups were measured at baseline and 12 months.

Results

A total of 169 participants were recruited, and 101 participants completed the follow-up. After multiple imputation, the mean difference in weight change adjusted for baseline weight, age, education, employment, marital status, number of children in the household and length of Norwegian residency was -1.6 kg (95 % CI -3.57, 0.43, p = 0.12) in the intervention compared to the control group.

Conclusion

This culturally tailored intervention study demonstrated a modest non-significant effect on weight change after 12 months, possibly due to the short intervention duration and COVID-19. Further studies of a longer duration and considering the provision of childcare are needed to understand whether this approach can be transferred to other immigrant groups and genders.Trial registration: The study was registered at clinicaltrials.gov NCT04578067, 2020-09-29.

Lifestyle modification for mental health and well-being

Background

Unhealthy life-style leads to mental ill-health and poor quality of life and is the major determinant of a wide range of lifestyle disorders. The aim was to 1) review the work relating to life style modification for promoting mental health and 2) Present recommendations on life-style modification for mental health and wellbeing.

Material and Methods

The work on life style changes for promotion of mental health was retrieved from the scientific literature and critically reviewed.

Conclusions

Recommendations on 'Life-style modification for mental health and wellbeing' are presented. 20 specific components of healthy life style included are: Routine, time management, prayer, basic activities, reading newspaper, study/work, exercise, recreation/ relaxation/ talent promotion, education, cognitive activities, social networking, guidelines for behavior, peer group, social group, marriage/family, life skills, physical health, health education, mobile use, and digital media. The lifestyle modification package is comprehensive and geared to promote mental health and well-being.

Exploring the link between perceived physical literacy and academic performance outcomes: insights from the EHDLA study

Objective

The aim of this study was to verify the relationship between perceived physical literacy (PPL) and academic performance outcomes among Spanish adolescents aged 12-17 years.

Methods

This cross-sectional study is a secondary examination utilizing data derived from the Eating Healthy and Daily Life Activities (EHDLA) project. The Spanish Perceived Physical Literacy Instrument for Adolescents (S-PPLI) was used to evaluate the PPL of the participants. To determine academic performance, the numerical grades for each subject were added together and then divided by the total number of subjects.

Results

Overall, a positive trend in the association between S-PPLI scores and academic performance was observed. We identified two significant ranges within the S-PPLI scores. First, there was a significant range between 9 and 33 points on the S-PPLI, indicating an inverse association with academic performance. Second, another significant range was observed at scores of 34 points or higher on the S-PPLI, suggesting a positive association with academic performance. Participants with low PPL had the lowest academic performance (mean = 6.4; bias-corrected and accelerated (BCa) bootstrapped 95% confidence interval (CI): 6.2-6.6). Conversely, those adolescents with high PPL had the highest academic performance (mean = 6.9; BCa bootstrapped 95% CI: 6.6-7.1). Significant differences were found between low PPL and medium PPL (p-adjusted = 0.031) and between low PPL and high PPL (p-adjusted = 0.031).

Conclusions

Increased physical literacy could be a relevant factor for achieving greater academic performance in adolescents. This study has potential implications for physical education instructors, school leaders, and healthcare practitioners.

Application of a cognitive program with a comprehensive strategy feedback for Korean older adults

This study assesses the effect of a cognitive program with a comprehensive strategy feedback on the cognitive function and memory self-efficacy of community-dwelling older adults and explores its applicability in Korea. The study employed a group pre-posttest design on 10 cognitively normal older participants. The four-week cognitive program involved daily completion of cognitive tasks at home using CoTras-Pro 2 and remotely provided individual non-face-to-face feedback. Additionally, biweekly face-to-face group feedback sessions were conducted with five participants. The Korean version of the Montreal Cognitive Assessment, the Korean-Color Word Stroop Test, and the Memory Self-Efficacy Questionnaire were used. Post-interviews were conducted to collect feedback. The program exerted a notable positive impact on cognitive function and memory self-efficacy. A study designed as a large-scale program conducted in collaboration with community-based public and private organizations holds the potential to be modeled for similar intervention programs involving a large number of participants.

Sleep quality and sleep routines as mediators of stressors and life satisfaction in Czech university students: a structural equation model

Introduction

Sleep is especially important to overall well-being. Some aspects of sleep have been well documented, for example sleep quantity and its effect on well-being, but the value of a consistent sleep routine remains poorly studied. University students are a population group especially susceptible to stress, mental health problems and poor sleep quality and experience changing daily schedules. Investigating the protective power of sleep in this population group is therefore an important avenue of research.

Methods

Applying a structural equation model, the current study surveyed a large sample of Czech university students during the COVID-19 pandemic in late spring, 2021, and observed the mediation effects of sleep on this group.

Results and Discussion

The study found that working, maintaining social contact and attending lectures in person had a strong effect on satisfaction with life. Increased personal study time indirectly supported consistent sleep routines and mediated perceptions of life satisfaction. As expected, the results indicated the importance of high-quality sleep. The results also verified partial mediation, directly and indirectly, through sleep quality, highlighting the significance of a consistent sleep routine in students on their self-reported satisfaction with life.

Development of a digital biomarker and intervention for subclinical depression: study protocol for a longitudinal waitlist control study

BACKGROUND

Depression remains a global health problem, with its prevalence rising worldwide. Digital biomarkers are increasingly investigated to initiate and tailor scalable interventions targeting depression. Due to the steady influx of new cases, focusing on treatment alone will not suffice; academics and practitioners need to focus on the prevention of depression (i.e., addressing subclinical depression).

AIM

With our study, we aim to (i) develop digital biomarkers for subclinical symptoms of depression, (ii) develop digital biomarkers for severity of subclinical depression, and (iii) investigate the efficacy of a digital intervention in reducing symptoms and severity of subclinical depression.

METHOD

Participants will interact with the digital intervention BEDDA consisting of a scripted conversational agent, the slow-paced breathing training Breeze, and actionable advice for different symptoms. The intervention comprises 30 daily interactions to be completed in less than 45 days. We will collect self-reports regarding mood, agitation, anhedonia (proximal outcomes; first objective), self-reports regarding depression severity (primary distal outcome; second and third objective), anxiety severity (secondary distal outcome; second and third objective), stress (secondary distal outcome; second and third objective), voice, and breathing. A subsample of 25% of the participants will use smartwatches to record physiological data (e.g., heart-rate, heart-rate variability), which will be used in the analyses for all three objectives.

DISCUSSION

Digital voice- and breathing-based biomarkers may improve diagnosis, prevention, and care by enabling an unobtrusive and either complementary or alternative assessment to self-reports. Furthermore, our results may advance our understanding of underlying psychophysiological changes in subclinical depression. Our study also provides further evidence regarding the efficacy of standalone digital health interventions to prevent depression. Trial registration Ethics approval was provided by the Ethics Commission of ETH Zurich (EK-2022-N-31) and the study was registered in the ISRCTN registry (Reference number: ISRCTN38841716, Submission date: 20/08/2022).

The Health and Functional Benefits of Eccentric versus Concentric Exercise Training: A Systematic Review and Meta-Analysis

This review compared the effects of eccentric versus concentric exercise training in healthy people and people with metabolic disease. A systematic search on Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, SPORTDiscus, Web of Science, SCOPUS and PubMed was conducted in February 2022. Randomised controlled trials conducted on sedentary healthy adults or those with an existing metabolic disease that compared eccentric versus concentric exercise training interventions of four weeks or longer that involved multiple joints and large muscle groups (e.g., walking, whole-body resistance training) were included in the review. The primary outcome was glucose handling, measured as HbA1c, HOMA, fasting glucose or insulin. Measures of cardiovascular health, muscle strength, and functional physical fitness were secondary outcomes. Nineteen trials involving 618 people were included. Results of meta-analyses showed that eccentric exercise had no benefit to glucose handling (HbA1c level; SMD - 0.99; 95% CI, -2.96 to 0.98; n = 74; P = 0.32) but resulted in significant increases in overall muscle strength (SMD 0.70; 95% CI 0.25 to 1.15; n = 224; P = 0.003) and decreases in blood pressure (Systolic Blood Pressure; MD -6.84; 95% CI, -9.84 to -3.84; n = 47, P = 0.00001, and Diastolic Blood Pressure; MD -6.39; 95% CI -9.62 to -3.15; n = 47, P = 0.0001). Eccentric exercise is effective for improving strength and some markers of cardiovascular health compared to traditional exercise modalities. Additional high-quality studies are necessary to validate these results. (PROSPERO registration: CRD42021232167).

Development of "LvL UP 1.0": a smartphone-based, conversational agent-delivered holistic lifestyle intervention for the prevention of non-communicable diseases and common mental disorders

Background

Non-communicable diseases (NCDs) and common mental disorders (CMDs) are the leading causes of death and disability worldwide. Lifestyle interventions via mobile apps and conversational agents present themselves as low-cost, scalable solutions to prevent these conditions. This paper describes the rationale for, and development of, "LvL UP 1.0″, a smartphone-based lifestyle intervention aimed at preventing NCDs and CMDs.

Materials and Methods

A multidisciplinary team led the intervention design process of LvL UP 1.0, involving four phases: (i) preliminary research (stakeholder consultations, systematic market reviews), (ii) selecting intervention components and developing the conceptual model, (iii) whiteboarding and prototype design, and (iv) testing and refinement. The Multiphase Optimization Strategy and the UK Medical Research Council framework for developing and evaluating complex interventions were used to guide the intervention development.

Results

Preliminary research highlighted the importance of targeting holistic wellbeing (i.e., both physical and mental health). Accordingly, the first version of LvL UP features a scalable, smartphone-based, and conversational agent-delivered holistic lifestyle intervention built around three pillars: Move More (physical activity), Eat Well (nutrition and healthy eating), and Stress Less (emotional regulation and wellbeing). Intervention components include health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), breathing exercises, and journaling. In addition to the intervention components, formative research also stressed the need to introduce engagement-specific components to maximise uptake and long-term use. LvL UP includes a motivational interviewing and storytelling approach to deliver the coaching sessions, as well as progress feedback and gamification. Offline materials are also offered to allow users access to essential intervention content without needing a mobile device.

Conclusions

The development process of LvL UP 1.0 led to an evidence-based and user-informed smartphone-based intervention aimed at preventing NCDs and CMDs. LvL UP is designed to be a scalable, engaging, prevention-oriented, holistic intervention for adults at risk of NCDs and CMDs. A feasibility study, and subsequent optimisation and randomised-controlled trials are planned to further refine the intervention and establish effectiveness. The development process described here may prove helpful to other intervention developers.

Supporting early childhood routines to promote cardiovascular health across the life course

Optimal cardiovascular health is an essential component of human health and well-being across the life course. Heart healthy practices around diet, physical activity, and sleep early in childhood have the potential to greatly improve lifespan and quality (Mehta et al., 2020). Early childhood routines, defined as functional practices that are predictable and repeatable, predict positive growth and development across the lifecourse (Fiese et al., 2002; Ferretti and Bub, 2017; Spagnola and Fiese, 2007). The American Heart Association has identified key heart healthy routines, such as daily regular activities including diet, physical activity, and sleep that promote cardiovascular health (Lloyd-Jones et al., 2022). Integrating the strength-based relational aspects of routines with the acquisition of cardiovascular health development capabilities allows children to establish their own optimal cardiovascular health trajectory early on. A systematic life course approach to supporting heart healthy routines in early childhood would inform clinical, research, and policy strategies to promote long-term cardiovascular health, and contribute to reducing inequalities in cardiovascular outcomes.

Centre-based childcare in early childhood and growth in later childhood: a prospective cohort study

BACKGROUND

Attending government-regulated centre-based childcare may influence important health behaviours including dietary quality, physical activity and routines related to child growth. However, the relationship between centre-based childcare and childhood obesity remains unclear.

OBJECTIVES

The primary objective was to evaluate the association between centre-based childcare attendance in early childhood and body mass index z-score (zBMI) in later childhood. Secondary objectives included exploring whether family income, child sex, or non-centre-based setting modified these relationships.

METHODS

A prospective cohort study of children aged 1 to 10 years who participated in the TARGet Kids! cohort was conducted. Linear mixed-effect modelling was used to evaluate the relationship between centre-based childcare attendance (in hours/week) compared to non-centre-based childcare between 1-4 years of age and zBMI between 4 and 10 years of age. Generalised estimating equation modelling was used to explore weight status categories. Models were adjusted for confounders and effect modification was explored.

RESULTS

A total of 3503 children were included. Children who attended centre-based childcare full-time (40 h/week) had 0.11 (95% CI: -0.19, -0.03; p = 0.01) lower zBMI at 4 and 7 years of age and lower odds of overweight and obesity at 4 years (OR 0.78; 95% CI: 0.62, 0.97; p = 0.03), but no evidence of an association was found at 10 years of age. Children from families with income < $50,000CDN who attended centre-based childcare full-time had 0.32 (95% CI: -0.50, -0.14; p = 0.001) lower zBMI and lower odds of overweight and obesity (OR 0.52; 95% CI: 0.28, 0.99; p = 0.05) at 10 years of age.

CONCLUSIONS

Attending centre-based childcare in early childhood was associated with a lower zBMI and odds of overweight and obesity in later childhood. These associations were stronger for children from lower income families. Centre-based childcare may be an early intervention for the prevention of childhood obesity.

CLINICAL TRIAL

Clinical Trial Registry Number: NCT01869530 (clinicaltrials.gov).

Comparative analysis of acoustic therapies for tinnitus treatment based on auditory event-related potentials

Introduction

So far, Auditory Event-Related Potential (AERP) features have been used to characterize neural activity of patients with tinnitus. However, these EEG patterns could be used to evaluate tinnitus evolution as well. The aim of the present study is to propose a methodology based on AERPs to evaluate the effectiveness of four acoustic therapies for tinnitus treatment.

Methods

The acoustic therapies were: (1) Tinnitus Retraining Therapy (TRT), (2) Auditory Discrimination Therapy (ADT), (3) Therapy for Enriched Acoustic Environment (TEAE), and (4) Binaural Beats Therapy (BBT). In addition, relaxing music was included as a placebo for both: tinnitus sufferers and healthy individuals. To meet this aim, 103 participants were recruited, 53% were females and 47% were males. All the participants were treated for 8 weeks with one of these five sounds, which were moreover tuned in accordance with the acoustic features of their tinnitus (if applied) and hearing loss. They were electroencephalographically monitored before and after their acoustic therapy, and wherefrom AERPs were estimated. The sound effect of acoustic therapies was evaluated by examining the area under the curve of those AERPs. Two parameters were obtained: (1) amplitude and (2) topographical distribution.

Results

The findings of the investigation showed that after an 8-week treatment, TRT and ADT, respectively achieved significant neurophysiological changes over somatosensory and occipital regions. On one hand, TRT increased the tinnitus perception. On the other hand, ADT redirected the tinnitus attention, what in turn diminished the tinnitus perception. Tinnitus handicapped inventory outcomes verified these neurophysiological findings, revealing that 31% of patients in each group reported that TRT increased tinnitus perception, but ADT diminished it.

Discussion

Tinnitus has been identified as a multifactorial condition highly associated with hearing loss, age, sex, marital status, education, and even, employment. However, no conclusive evidence has been found yet. In this study, a significant (but low) correlation was found between tinnitus intensity and right ear hearing loss, left ear hearing loss, heart rate, area under the curve of AERPs, and acoustic therapy. This study raises the possibility to assign acoustic therapies by neurophysiological response of patient.

Life in lockdown: a qualitative study exploring the experience of living through the initial COVID-19 lockdown in the UK and its impact on diet, physical activity and mental health

BACKGROUND

In response to the COVID-19 pandemic, the UK imposed a national lockdown prompting change to daily routines. Among behaviours impacted by the lockdown, diet and physical activity may be particularly important due to their association with mental health and physical health. The aim of this study was to explore people's experiences of how lockdown impacted their physical activity, dietary behaviours and mental health, with a view to informing public health promotion.

METHODS

This phenomenological qualitative study used semi-structured telephone interviews. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted, guided by the Framework Approach.

RESULTS

Forty participants (28 female) completed an interview (mean duration: 36 min) between May and July 2020. The overarching themes identified were (i) Disruption (loss of routines, social interaction and cues to physical activity) and (ii) Adaptation (structuring the day, accessing the outdoor environment, finding new ways for social support). The disruption to daily routines altered people's cues for physical activity and eating; some participants spoke of comfort eating and increased alcohol intake in the early days of lockdown, and how they consciously tried to change these when restrictions lasted longer than first anticipated. Others spoke of adapting to the restrictions using food preparation and meals to provide both routine and social time for families. Disruptions from the closure of workplaces resulted in flexible working times for some, allowing for physical activity to be built into the day. In later stages of restrictions, physical activity became an opportunity for social interaction and several participants reported intending to continue to replace sedentary means of socialising (e.g., meeting in cafes) with more active, outdoor activities (e.g., walking) once restrictions were lifted. Staying active and building activity into the day was seen as important to support physical and mental health during the challenging times of the pandemic.

CONCLUSIONS

Whilst many participants found the UK lockdown challenging, adaptations to cope with the restrictions presented some positive changes related to physical activity and diet behaviours. Helping people sustain their new healthier activities since restrictions have lifted is a challenge but presents an opportunity for public health promotion.

The Negative Impact of Routine, Dietary Pattern, and Physical Activity on Obesity and Dysglycemia During the COVID-19 Pandemic

The global coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, has disrupted routines in education, work, exercise, and dining habits. To prevent viral spread, communal spaces including offices, schools, restaurants, and gyms have closed or drastically limited their capacity. Additionally, government-mandated lockdown orders have forced people to spend more time at home. Studies have shown that these COVID-19 restrictions have led to unhealthier eating patterns, increased sedentary behaviors, and decreased physical activity, leading to weight gain, dysglycemia, and increased metabolic risk. While strict social distancing measures have been necessary to curb the spread of the SARS-CoV-2 virus, people have been forced to adapt by altering their daily routines. Based on existing literature, a model is proposed for intentionally creating daily routines to ensure healthy habits, minimize weight gain, and prevent worsening dysglycemia.

Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review

The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics' and healthcare professionals' knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.

Beyond physiology: Acute effects of side-alternating whole-body vibration on well-being, flexibility, balance, and cognition using a light and portable platform A randomized controlled trial

A good body-balance helps to prevent slips, trips and falls. New body-balance interventions must be explored, because effective methods to implement daily training are sparse. The purpose of the current study was to investigate acute effects of side-alternating whole-body vibration (SS-WBV) training on musculoskeletal well-being, flexibility, body balance, and cognition. In this randomized controlled trial, participants were randomly allocated into a verum (8.5 Hz, SS-WBV, N = 28) or sham (6 Hz, SS-WBV, N = 27) condition. The training consisted of three SS-WBV series that lasted one-minute each with two one-minute breaks in between. During the SS-WBV series, participants stood in the middle of the platform with slightly bent knees. During the breaks in between, participants could loosen up. Flexibility (modified fingertip-to-floor method), balance (modified Star Excursion Balance Test), and cognitive interference (Stroop Color Word Test) were tested before and after the exercise. Also, musculoskeletal well-being, muscle relaxation, sense of flexibility, sense of balance, and surefootedness were assessed in a questionnaire before and after the exercise. Musculoskeletal well-being was significantly increased only after verum. Also, muscle relaxation was significantly higher only after verum. The Flexibility-Test showed significant improvement after both conditions. Accordingly, sense of flexibility was significantly increased after both conditions. The Balance-Test showed significant improvement after verum, and after sham. Accordingly, increased sense of balance was significant after both conditions. However, surefootedness was significantly higher only after verum. The Stroop-Test showed significant improvement only after verum. The current study shows that one SS-WBV training session increases musculoskeletal well-being, flexibility, body balance and cognition. The abundance of improvements on a light and portable platform has great influence on the practicability of training in daily life, aiming to prevent slip trips and falls at work.

Role of Psychologists in Pediatric Sleep Medicine

Sleep disorders commonly afflict infants, children, and adolescents and have a significant adverse impact on them and their families, sometimes to a severe degree. They can cause immediate stress and suffering and long-term loss of opportunities and potential. Many of these disorders can be well managed by the psychologist and often one is required, either as the sole provider or as an integral part of a team. Sleep disorders have a bidirectional interplay with mental health disorders. The patient may therefore present initially to the psychologist, primary care provider, or the sleep medicine specialist.

Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom

BACKGROUND

COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants.

METHODS

An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected.

RESULTS

The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format.

CONCLUSIONS

Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.

Seven Ways to Inspire Innovation in the Health Technology Industry

This article explores ways in which technological innovation can be bolstered in organizations that operate in the health technology industry. We present seven interventions at the team level (employee empowerment, servant leadership, hiring innovators, and scheduling time for innovation) and organizational level (intrapreneurship, flat management, and allowing for failure) that organizations can use to encourage and inspire innovation among employees. Given the increasingly dynamic nature of work within the health technology fields, in terms of both manufacturing processes and clinical developments, creating a culture of innovation and creativity and emboldening employees to regularly engage in such behaviors within these workplaces are critical.

Impact of Routines and Rituals on Burden of Treatment, Patient Training, Cognitive Load, and Anxiety in Self-Injected Biologic Therapy

BACKGROUND

Self-injection of biologics is a mainstay of chronic disease treatment, yet the process of self-injection often causes persistent apprehension and anxiety, distinct from needle phobia. While literature alludes to the role that routines and rituals play in self-injection, there is no comprehensive study on the routines and rituals self-injectors employ, nor of the process by which they are discovered and ingrained.

METHODS

We conducted a mixed-method, observational pilot ethnography study of 27 patients with plaque psoriasis, psoriatic arthritis, or ankylosing spondylitis with and without prior biologic self-injection experience. Patients submitted self-made videos, photos, and projective exercises of an actual biologic self-injection and completed validated instruments to assess burden of treatment. Videos and photos containing routine and ritual elements were thematically categorized based on functional and emotional benefit, and analyzed for differences based on current biologic, dosing frequency, time on current biologic, and burden of treatment measures.

RESULTS

During patients' initial at-home injections, training gaps became apparent, leading to a process of experimentation aimed at reducing pain/anxiety, increasing confidence, and building a consistent injection process. Routines were present in 27/27 (100%) patients and anchored the time, place, and process for injection, and incorporated approved use steps for the injection device. Ritual elements served as emotional coping strategies for patients and were present in 21/27 (77.8%) of patients.

CONCLUSION

Our findings suggest that providing patients device training using adult learning principles, teaching routines and rituals concurrently, and providing at-home opportunities for practice with a device trainer may be useful strategies to reduce anxiety, avoid unnecessary experimentation, and improve adherence to injection therapy. While further studies are needed to generalize our findings, we posit that routine and ritual elements can be incorporated into existing patient-clinician interactions or novel digital interventions through mobile medical applications, smart training devices, and connected injection ecosystems.

"People Will Continue to Suffer If the Virus Is Around": A Qualitative Analysis of Sub-Saharan African Children's Experiences during the COVID-19 Pandemic

Children are particularly impressionable and at risk during a global public health crisis, making it essential to examine their unique perspectives. To hear and understand sub-Saharan African children's experiences with the COVID-19 pandemic, we conducted an exploratory qualitative analysis based on interviews with 51 children, ages 9 to 13, from Nigeria, Tanzania, and Sierra Leone. Applying the organization of Bronfenbrenner's ecological systems theory, we reveal how COVID-19 affected children's daily lives and domestic challenges, schooling and neighborhood issues, media use (and its relationship to knowledge and fear of the disease), perceptions of the country, and government response, and thoughts of religion and hope. Children's responses dif-fered greatly, but patterns emerged across sex, age, household size, religion, and country. This study offers guidance and recommendations for meeting the needs of children, especially in times of crisis.

"People Will Continue to Suffer If the Virus Is Around": A Qualitative Analysis of Sub-Saharan African Children's Experiences during the COVID-19 Pandemic

Children are particularly impressionable and at risk during a global public health crisis, making it important to examine their unique perspectives. To hear and understand sub-Saharan African children's experiences with the COVID-19 pandemic, we conducted an exploratory qualitative analysis based on interviews with 51 children, ages 9 to 13, from Nigeria, Tanzania, and Sierra Leone. Applying the organization of Bronfenbrenner's ecological systems theory, we reveal how COVID-19 affected children's daily lives and domestic challenges, schooling and neighborhood issues, media use (and its relationship to knowledge and fear of the disease), perceptions of the country and government response, and thoughts of religion and hope. Children's responses differed greatly, but patterns emerged across sex, age, household size, religion, and country. This study offers guidance and recommendations for meeting the needs of children, especially in times of crisis.

Patterns and Facilitators for the Promotion of Glaucoma Medication Adherence-A Qualitative Study

Primary open-angle glaucoma (POAG) is a chronic optic neuropathy causing irreversible nerve fiber damage. Initially asymptomatic, it progresses slowly without any notable sign of vision loss, thus early detection and treatment is essential. The standard treatment being non-invasive topical administration of eye drops harbors the problem of patients not being adherent. This study aimed to explore the experiences and thoughts of glaucoma patients about their medication management to improve our knowledge on how adherence works for the individual patient. Narrative interviews were conducted with 21 glaucoma patients. Data were analyzed using inductive content analysis and the documentary method. Different patterns of adherence were identified which depended on personal biographies, living conditions, or the patient's knowledge about the disease. Interpreting eye drop medication as a ritual, a task, or routine was helpful for some patients, whereas other patients, who were aware of the consequences of not taking the drops, were motivated by intrinsic or extrinsic factors. The patterns identified here represent strategies for managing and adhering to daily glaucoma medication at an individual level. Linking daily drop application or medication intake to these patterns may help to promote correct medication management of patients with chronic diseases who lack a regular medication regimen.

The experience of social distancing for families with children and adolescents during the coronavirus (COVID-19) pandemic in Uruguay: Difficulties and opportunities

The social distancing measures implemented to contain the coronavirus (COVID-19) pandemic worldwide have created a series of emotional and economic challenges. The aim of the present work was to explore the experiences of families with children and adolescents during the coronavirus (COVID-19) pandemic in Uruguay. An online study was conducted in March 2020 with 1725 parents with children under 18 years old. A series of closed and open-ended questions about their family life since the implementation of social distancing measures were asked, addressing the following topics: how they had felt, changes they had experienced in their daily life, children's daily routine, changes implemented in relation to child-care, changes they had perceived in children's eating patterns, changes in their relationship with their children, changes in their children's mood and behavior, and their reaction to those changes. Results showed that the coronavirus pandemic elicited negative feelings in the majority of participants, mainly related to worry, fear, anxiety and uncertainty. Social distancing measures caused a major disruption in daily habits, which were mostly attributed to changes in work-related activities and the closure of educational institutions. Changes in children's mood and behavior were perceived by the majority of the participants, who mainly referred to boredom, agitation and restlessness. Although some participants reported difficulties to cope with children's behavior during social distancing, others valued the opportunity of spending more time with their children. In terms of children's eating patterns, changes related to both an increase and a decrease in the consumption of healthy foods were observed. Results from the present work have relevant implications for public health policy and practice by highlighting the importance of providing emotional and psychological support to people during social distancing measures and providing insights for the design of communication campaigns and interventions.