Cancer Cachexia: Its Mechanism and Clinical Significance

The term "cachexia" is derived from the Greek words kakos (bad) and hexis (habit). Cachexia is a malnutrition associated with chronic diseases such as cancer, chronic heart failure, chronic renal failure, and autoimmune diseases, and is characterized by decreased skeletal muscle mass. Cancer cachexia is quite common in patients with advanced cancer. Weight loss is also a characteristic symptom of cancer cachexia, along with decreased skeletal muscle mass. As nutritional supplementation alone cannot improve cachexia, cytokines and tumor-derived substances have been attracting attention as its relevant factors. Cancer cachexia can be also associated with reduced chemotherapeutic effects, increased side effects and treatment interruptions, and even poorer survival. In 2011, a consensus definition of cachexia has been proposed, and the number of relevant research reports has increased significantly. However, the pathogenesis of cachexia is not fully understood, and there are currently few regulatory-approved standard treatments for cachexia. The main reason for this is that multiple etiologies are involved in the development of cachexia. In this review, we will outline the current status of cachexia, the mechanisms of which have been elucidated in recent years, especially from the perspective of advanced cancer.

Effects of the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) on biomedical outcomes, observed cardiovascular events and cardiovascular risks in primary care: a longitudinal comparative study

BACKGROUND

To assess whether the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) led to improvements in biomedical outcomes, observed cardiovascular events and predicted cardiovascular risks after 12-month intervention in the primary care setting.

METHODS

A random sample of 1,248 people with diabetes enrolled to RAMP-DM for at least 12 months was selected and 1,248 people with diabetes under the usual primary care were matched by age, sex, and HbA1c level at baseline as the usual care group. Biomedical and cardiovascular outcomes were measured at baseline and at 12-month after the enrollment. Difference-in-differences approach was employed to measure the effect of RAMP-DM on the changes in biomedical outcomes, proportion of subjects reaching treatment targets, observed and predicted cardiovascular risks.

RESULTS

Compared to the usual care group, RAMP-DM group had lower cardiovascular events incidence (1.21% vs 2.89%, P = 0.003), and net decrease in HbA1c (-0.20%, P < 0.01), SBP (-3.62 mmHg, P < 0.01) and 10-year cardiovascular disease (CVD) risks (total CVD risk, -2.06%, P < 0.01; coronary heart disease (CHD) risk, -1.43%, P < 0.01; stroke risk, -0.71%, P < 0.01). The RAMP-DM subjects witnessed significant rises in the proportion of reaching treatment targets of HbA1c, and SBP/DBP. After adjusting for confounding variables, the significance remained for HbA1c, predicted CHD and stroke risks.

CONCLUSIONS

The RAMP-DM resulted in greater improvements in HbA1c and reduction in observed and predicted cardiovascular risks at 12 months follow-up, which indicated a risk-stratification multidisciplinary intervention was an effective strategy for managing Chinese people with diabetes in the primary care setting.

TRIAL REGISTRY

ClinicalTrials.gov, NCT02034695.

Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting

BACKGROUND

Heart failure (HF) patients living in rural areas have a lack of HF knowledge and poor self-care because of limited medical care access. Multidisciplinary education to improve self-care behavior is indispensable for such patients. The present study evaluated whether intensive inpatient education improved outcomes of hospitalized HF patients in a Japanese rural setting.

METHODS

An inpatient HF management program based on multidisciplinary team intervention was applied to hospitalized HF patients in a Japanese rural area. We defined patients treated within the program from May 2009 to April 2011 as the intervention group (n = 144), and those treated with the usual care from May 2006 to April 2009 as the usual care group (n = 133). The composite endpoints of HF hospitalization and all-cause mortality were compared between the two groups.

RESULTS

Compared with patients in the usual care group, those in the intervention group more often received the optimal interventions such as discharge use of β-blockers, cardiac rehabilitation, pre-discharge diagnostic tests, and multidisciplinary intensive education including nurse-led patient education, pharmacist's medication teaching, and dietitian's nutritional guidance (all P < 0.05). The incidence of the composite endpoints significantly decreased after introducing the program (P < 0.001). Among a number of interventions, multidisciplinary intensive education was the most effective intervention to improve the primary outcome (P < 0.001).

CONCLUSIONS

Multidisciplinary intensive education is a key strategy for helping improve the outcome for Japanese HF patients in a rural setting. Our data may give a positive impact on the improvement of healthcare system in Japan.

Effect of HIIT versus MICT on body composition and energy intake in dietary restrained and unrestrained adolescents with obesity

High-intensity interval training (HIIT) has been suggested as an effective alternative to traditional moderate-intensity continuous training (MICT) that can yield improvements in a variety of health outcomes. Yet, despite the urgent need to find effective strategies for the treatment of pediatric obesity, only a few studies have addressed the impact of HIIT on eating behaviors and body composition in this population. This study aimed to compare the effect of HIIT versus MICT on eating behaviors in adolescents with obesity and to assess if the participants' baseline dietary status is associated with the success of the intervention. Forty-three adolescents with obesity were randomly assigned to a 16-week MICT or HIIT intervention. Body composition and 24-h ad libitum energy intake were assessed at baseline and at the end of the program. Restrained eating, emotional eating, and external eating were assessed using the Dutch Eating Behavior Questionnaire at baseline. Both interventions led to significant weight, body mass index (BMI), and fat mass percentage (FM%) reductions, with better improvements in FM% in the HIIT group; whereas 24-h ad libitum energy intake increased to a similar extent in both groups. HIIT provides better body composition improvements over MICT, despite a similar increase in energy intake. Restrained eaters experienced less weight loss and smaller BMI reduction compared with unrestrained eaters; higher baseline cognitively restrained adolescents showed a greater increase of their ad libitum energy intake. Novelty HIIT favors better body composition improvements compared with MICT. Both MICT and HIIT increased ad libitum energy intake in adolescents with obesity. Weight loss achievement is better among unrestrained eaters.

Employment status five years after a randomised controlled trial comparing multidisciplinary and brief intervention in employees on sick leave due to low back pain

AIMS

To evaluate differences in employment status, during a five-year follow-up period in patients on sick leave due to low back pain who had participated in a trial comparing a brief and a multidisciplinary intervention.

METHODS

From 2004 to 2008, 535 patients were referred to the Spine Centre at the Regional Hospital in Silkeborg if they had been on sick leave for 3-16 weeks due to low back pain. All patients underwent a clinical examination by a rehabilitation physician and a physiotherapist, and were randomised to either the brief intervention or the multidisciplinary intervention. The outcome was employment status from randomisation to five years of follow-up and was measured by the mean number of weeks in four different groups of employment status (sequence analysis) and a fraction of the number of weeks working (work participation score) that were accumulated over the years.

RESULTS

A total of 231 patients were randomised to the brief intervention and 233 patients to the multidisciplinary intervention. No statistically significant differences in the mean weeks spent within the different employment statuses were found between the two intervention groups. After five years of follow-up, participants in the multidisciplinary intervention had a 19% higher risk of not having a work participation score above 75% compared to participants in the brief intervention.

CONCLUSIONS

After five years of follow-up no differences in employment status were found between participants in the brief and the multidisciplinary intervention.

Cost-effectiveness of Multidisciplinary Interventions for Chronic Low Back Pain: A Narrative Review

OBJECTIVE

Chronic musculoskeletal pain in adults is a global health and economic problem. The aim of this paper was to systematically review and determine what proportion of multidisciplinary approaches to managing chronic musculoskeletal pain are cost-effective.

MATERIALS AND METHODS

The EconLit, Embase, and PubMed electronic databases were searched for randomized and nonrandomized economic evaluation studies of nonpharmaceutical multidisciplinary chronic pain management interventions published from inception through to August 2019.

RESULTS

Seven studies comprising 2095 patients were included. All studies involved diverse multidisciplinary teams in one or more of the study arms. All studies involved chronic (both chronic and subacute) low back pain and were economic evaluations from either a societal or health care perspective. Two of the 3 studies that reported on a multidisciplinary pain intervention compared with nonmultidisciplinary intervention concluded favorable cost-effectiveness based on cost per quality adjusted life years gained, 1 study was not found to be cost-effective. Cost-effectiveness of the multidisciplinary intervention of interest was also not established by another 3-arm study. Two studies compared 2 multidisciplinary interventions; neither of these could definitively declare cost-effectiveness. The remaining study indicated the intervention by a multidisciplinary team was more effective but at a higher cost. None of the included studies used decision models to estimate long-term health outcomes and cost-effectiveness of multidisciplinary programs.

DISCUSSION

There are few studies on the cost-effectiveness of multidisciplinary chronic pain management interventions. This study encourages additional rigorous economic evaluations of multidisciplinary models for chronic pain management. Economic evaluations that enable extrapolating costs and effects of multidisciplinary programs beyond the time horizon of clinical trials may be more informative for clinicians and health administrators.

A multidisciplinary intervention to prevent subsequent falls and health service use following fall-related paramedic care: a randomised controlled trial

Background

approximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes.

Objective

to evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use.

Design, setting, participants

Randomised controlled trial involving 221 non-transported older fallers from Sydney, Australia.

Intervention

the intervention targeted identified risk factors and used existing services to implement physiotherapy, occupational therapy, geriatric assessment, optometry and medication management interventions as appropriate. The control group received individualised written fall prevention advice.

Measurements

primary outcome measures were rates of falls and injurious falls. Secondary outcome measures were ambulance re-attendance, ED presentation, hospitalisation and quality of life over 12 months. Analysis was by intention-to-treat and per-protocol according to self-reported adherence using negative binominal regression and multivariate analysis.

Results

ITT analysis showed no significant difference between groups in subsequent falls, injurious falls and health service use. The per-protocol analyses revealed that the intervention participants who adhered to the recommended interventions had significantly lower rates of falls compared to non-adherers (IRR: 0.53 (95% CI : 0.32-0.87)).

Conclusion

a multidisciplinary intervention did not prevent falls in older people who received paramedic care but were not transported to ED. However the intervention was effective in those who adhered to the recommendations.

Trial registration

the trial is registered at the Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921, 13/05/2011.

Evaluation of a psychoeducational intervention compared with education in people with Parkinson's disease and their informal caregivers: a quasi-experimental study

AIM

To evaluate the effects of a psychoeducational intervention compared with an education programme to strengthen quality of life, psychosocial adjustment, and coping in people with Parkinson's disease and their informal caregivers.

DESIGN

A quasi-experimental study was performed with repeated measures at baseline, after the intervention and 6 months post-intervention.

METHODS

The study was carried out at seven primary care centres from 2015-2017. A total of 140 people with Parkinson's and 127 informal caregivers were allocated to the experimental and the control groups. The experimental group received a 9-week psychoeducational intervention, whereas the control group received a 5-week education programme. Repeated measures ANOVA were used to test differences in quality of life, psychosocial adjustment, and coping between the experimental and control groups and over time.

RESULTS

Patients and informal caregivers in both the experimental and control groups showed significantly better psychosocial adjustment at the post-intervention measurement compared with baseline data. We also found significantly greater quality of life in patients and coping skills in caregivers after the end of the interventions in the experimental and control groups. Nevertheless, no significant differences were identified on the outcomes at the 6-month post-intervention measurement.

CONCLUSION

The effect of the psychoeducational intervention was not different from the effect of the education programme. The strategies applied in both interventions followed a group approach led by a multidisciplinary team covering information about PD, healthy lifestyles, and social resources. They might be easily sustained in Primary Care to improve care for people with Parkinson's and informal caregivers.

Clinical pain management by a multidisciplinary palliative care team: Experience from a tertiary cancer center in China

To investigate the effect of multidisciplinary interventions on pain management in cancer inpatients.Four hundred thirty eight patients with cancer pain, who performed the multidisciplinary intervention were recruited. Before and after intervention, the Brief Pain Inventory (BPI) and the MD Anderson Symptom Inventory (MDASI) score as the primary endpoints and QOL scores as the secondary endpoint were all evaluated. To investigate the factors that led to different responses to multidisciplinary interventions, patients were classified as non-responders or responders.Finally, 92 patients (63 male and 29 female) scheduled for cancer pain management by inter-professional team were studied. After individualized multidisciplinary therapy, both pain and symptom severity was improved, as demonstrated by lowered BPI worst and average pain scores, as well as symptom severity score measured by MDASI (P = .017, P = .003, and P = .011, respectively). The proportion of patients with mild pain increased regarding the BPI worst and average pain at baseline and after treatment (P < .05). The QOL analyses showed multidisciplinary interventions could significantly improve the function and symptom scores (P < .001). More patients in responder group received chemotherapy (58, 70.7%, P = .003), while fewer received mini-invasive therapy (6, 7.32%, P = .011).Multidisciplinary interventions had certain beneficial effect on cancer pain management, especially in patients with moderate or severe pain.

The Effects of a "Health at Every Size(®)"-Based Approach in Obese Women: A Pilot-Trial of the "Health and Wellness in Obesity" Study

This study explored the effects of Health at Every Size(®)-based intervention on obese women by qualitatively evaluating participants' perception toward the program and quantitatively evaluating changes related to psychological, behavioral, and body composition assessments. A prospective 1-year quasi-experimental mixed-method trial was conducted. The mixed-method design was characterized by a spiral method, and quantitative and qualitative findings were combined during the interpretation phase. The qualitative data involved three focus groups; and quantitative data comprised physiological, psychological, and behavioral assessments. Initially, 30 participants were recruited; 14 concluded the intervention. From the focus groups, the following interpretative axes were constructed: the intervention as a period of discoveries; shifting parameters: psychological, physical, and behavioral changes; eating changes, and; redefining success. Body weight, body mass index, total body fat mass, and body fat percentage were significantly decreased after the intervention (-3.6, -3.2, -13.0, and -11.1%, respectively; p ≤ 0.05, within-time effect). Participants reported to be more physically active and perceiving better their bodies. Eating-wise, participants reported that the hunger and satiety cues and the consumption of more frequent meals facilitated their eating changes. Finally, participants reported that they could identify feelings with eating choices and refrain from the restrained behavior. These qualitative improvements were accompanied by modest but significant improvements in quantitative assessments. Clinicaltrials.gov registration: NCT02102061.

Impact of a structured multidisciplinary intervention on quality of life of older adults with advanced cancer

BACKGROUND

Patients experience reductions in quality of life (QOL) while receiving cancer treatment and several approaches have been proposed to address QOL issues. In this project, the QOL differences between older adult (age 65+) and younger adult (age 18-64) advanced cancer patients in response to a multidisciplinary intervention designed to improve QOL were examined.

METHODS

This study was registered on ClinicalTrials.gov, NCT01360814. Newly diagnosed advanced cancer patients undergoing radiation therapy were randomized to active QOL intervention or control groups. Those in the intervention group received six multidisciplinary 90-minute sessions designed to address the five major domains of QOL. Outcomes measured at baseline and weeks 4, 27, and 52 included QOL (Linear Analogue Self-Assessment (LASA), Functional Assessment of Cancer Therapy-General (FACT-G)) and mood (Profile of Mood States (POMS)). Kruskall-Wallis methodology was used to compare scores between older and younger adult patients randomized to the intervention.

RESULTS

Of 131 patients in the larger randomized controlled study, we report data on 54 evaluable patients (16 older adults and 38 younger adults) randomized to the intervention. Older adult patients reported better overall QOL (LASA 74.4 vs. 62.9, p = 0.040), higher social well-being (FACT-G 91.1 vs. 83.3, p = 0.045), and fewer problems with anger (POMS anger-hostility 95.0 vs. 86.4, p = 0.028). Long-term benefits for older patients were seen in the anger-hostility scale at week 27 (92.2 vs. 84.2, p = 0.027) and week 52 (96.3 vs. 85.9, p = 0.005).

CONCLUSIONS

Older adult patients who received a multidisciplinary intervention to improve QOL while undergoing advanced cancer treatments benefited differently in some QOL domains, compared to younger adult patients. Future studies can provide further insight on how to tailor QOL interventions for these age groups.

Delaying cognitive and physical decline through multidomain interventions for residents with mild-to-moderate dementia in dementia care units in Taiwan: A prospective cohort study

AIM

To develop experimental multi-domain interventions for older people with mild-to-moderate dementia, and to evaluate the effect of delaying cognitive and physical decline, and improvement or prevention of geriatric syndromes during 1-year follow up.

METHODS

Participants aged 65 years and older with mild-to-moderate dementia (clinical dementia rating [CDR] 1 or 2) were grouped as intervention in Jia-Li Veterans Home and usual care model in the community (Memory clinic). All residents in Jia-Li Veterans Home received comprehensive intervention, including Multi-disciplinary team consultation and intervention, Multi-component non-pharmacological management, geriatric syndromes survey and intervention by CGA, and a dementia friendly medical Green channel Approach (2MCGA). The decline of cognitive and physical function are determined by the change of Mini-Mental State Examination score, CDR and the sum of CDR box, as well as activities of daily living based on the Barthel Index. We also screened geriatric syndromes at baseline and 1 year later.

RESULTS

Participants in the intervention group were older and had a lower educational level, lower body mass index, poor baseline activities of daily living function, lower visual impairment, and higher rates of hearing impairment, polypharmacy and risk of malnutrition. The residents receiving 2MCGA had lower baseline Mini-Mental State Examination scores, and higher CDR. For residents in Jia-Li Veterans Home, all cognitive measurements except Mini-Mental State Examination were significantly associated with delaying the decline of cognition after analyzing by multiple linear regression, and multivariate logistic regression also showed that patients living in the community was independently associated with a higher odds ratio for activities of daily living decline (3.180, 95% CI 1.384-7.308, P = 0.006). There are also more improvement in their baseline geriatric syndromes and suffered less from new geriatric syndromes, including falls, urinary incontinence, and risk of malnutrition.

CONCLUSIONS

The 2MCGA intervention shows strong delays in the decline of cognition and physical function for older residents with mild-to-moderate dementia. Furthermore, this strategy can also improve or prevent the onset of new geriatric syndromes, especially fall episodes, urinary incontinence and risk of malnutrition. Geriatr Gerontol Int 2017; 17 (Suppl. 1): 36-43.

Demonstrating the impact and model of care of a Statewide psychiatric intensive care service

OBJECTIVE

To characterise patients and their outcomes following referral to a Statewide psychiatric intensive care service.

METHOD

This study conducted a medical audit for patients referred to the Statewide service during the first four years of operation (2007-2011). Demographics and the presence of alcohol and other drug and forensic comorbidities were documented along with the treatment received prior to and during admission.

RESULTS

In the first four years of operation, 58 referrals were received, 41 resulting in admission and seven in secondary consultation delivered to the referring inpatient psychiatry service. Admitted patients were most commonly experiencing a psychotic illness, had high levels of substance comorbidities and antisocial personality traits, required lengthy admissions (mean days = 41.5), and were in most cases successfully discharged back to the referring inpatient psychiatry service or the community. Significant reductions in clinician-rated difficulties measured via the Health of the Nations Outcome Scale were found at discharge, and despite the significant presenting aggression risk, few attempted or actual assaults occurred.

CONCLUSION

Improved outcomes were achieved with patients deemed unsafe for psychiatric care in high dependency units in other Victorian acute mental health services through management by an acute service that has developed special expertise in this area.

"Now I Can Do Better": A Study of Obese Women's Experiences Following a Nonprescriptive Nutritional Intervention

The present study analyzed obese women’s experiences following a nonprescriptive nutritional intervention, implemented through a 1-year program based on the Health at Every Size^® philosophy. We employed an action research method and conducted three focus groups during the intervention. We identified five interpretative axes across the focus groups, as follows: conflicts and perceptions; gaining motivation, perspective, and positioning; becoming autonomous eaters; acquiring tools; and the meetings between the nutritional therapist and participant. Our findings revealed varying levels of readiness among participants in adapting to the intervention and varying valuations of achievements related to eating and health, independent of body-weight changes. Participants reported benefiting from and expressed approval of the intervention. Participants reported positive behavioral and attitudinal changes to their diet and improvements to diet quality, diet structure, and consumption. Finally, participants seemed to show increased autonomy concerning diet and indicated increased confidence, comfort, flexibility, and positivity of attitude regarding eating.

Age and menarcheal status do not influence metabolic response to aerobic training in overweight girls

BACKGROUND

Multidisciplinary intervention is an alternative for the treatment of children and adolescent obese. However, the influence of age and menarcheal status in the pattern of metabolic response of obese girls has not been investigated. The following study examined the effects of a 12-week multidisciplinary intervention on metabolic health in overweight girls and the contribution of age and menarcheal status on the resulting changes.

METHODS

Eighty-eight overweight girls (10 - 16 years) were considered initially for this study and randomly assigned (intervention group: n = 58; control group: n = 30). Forty-six girls completed the intervention program and 16 girls completed the follow-up for the control group. The 12-week intervention included aerobic exercises (three times per week) and nutritional intervention. Anthropometrical measures (body mass, body mass index and waist circumference), menarcheal status and metabolic profiles including glucose, insulin, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were assessed in the beginning and after of intervention. Additionally, were calculated homeostatic model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI).

RESULTS

After 12-week, girls decreased significantly the body mass (76.6 ± 14.7 to 75.7 ± 14.6 kg) body mass index (30.1 ± 4.0 to 29.4 ± 4.0 kg/m2) and waist circumference (98.9 ± 10.9 to 96.5 ± 11.4 cm). There were differences in HDL-C (43.1 ± 8.2 to 50.3 ± 9.4 mg/dl), TG (120.9 ± 64.3 to 93.3 ± 47.9 mg/dl) and insulin (16.9 ± 7.6 to 15.6 ± 9.8 mg/dl). Relative contribution of age was significant only for within-subject variability in waist circumference.

CONCLUSIONS

The multidisciplinary based on aerobic training intervention used in this study produced substantial benefits on metabolic health indicators in overweight girls. The changes observed were not related to inter-individual variability in age and maturity status.

Safety and Efficacy of Pulmonary Rehabilitation for Long COVID Patients Experiencing Long-Lasting Symptoms

Due to the high prevalence and persistence of long COVID, it is important to evaluate the safety and efficacy of pulmonary rehabilitation (PR) for patients who experience long-lasting symptoms more than six months after initial COVID-19 onset. Enrolled patients were admitted for a four-week in-patient-PR due to long COVID symptoms (n = 47). The safety of PR was confirmed by the absence of adverse events. Symptom-related outcomes were evaluated pre- and post-PR with significant score changes for: 6 min walking distance (61 [28 to 103] m), quality of life (mental Short Form-12: 10 [6 to 13], and physical: 9 [6 to 12]), Montreal Cognitive Assessment (1 [0 to 3]), fatigue (MFI-20: -19 [-28 to -8]), dyspnea (DYSPNEA-12: -7 [-9 to -2] and mMRC; -1 [-1 to 0]), Nijmegen questionnaire (-8 [-11 to -5]), anxiety and depression (HADS:-4 [-5 to -2] and -2 [-4 to -1], respectively) and posttraumatic stress disorder checklist scale (-8 [-12 to -4]). At the individual level, the percentage of symptomatic patients for each outcome decreased, with a high response rate, and the number of persistent symptoms per patient was reduced from six at PR initiation to three at the end of the program. Our results show that in-PR is safe and efficient at decreasing long-lasting symptoms experienced by long COVID patients at more than six months after initial disease onset.

Transition to Employment Program (SUPER) for Youth at Risk: A Conceptual and Practical Model

This article describes the development, implementation, and evaluation of the transdisciplinary “Successful Pathways to Employment for youth at Risk” (SUPER) program to raise the transition readiness of youth at risk (YAR) from school into participation in adults’ responsibilities and employment. More than 10% of adolescents are at risk of dropping out of school following poor academic attainments. Schools appraise academic merit but do not develop relevant educational programs to prepare youth to transition into adult working life. The SUPER program addresses a range of knowledge and skills required for this transition. Sixty YAR from three high schools participated in the 18-week SUPER program. Comparing the pre- and postintervention results revealed that the students’ engagement with responsibilities, objective knowledge about the work world, and self-rated self-advocacy skills improved as did their supervisor-rated work performance capacity. This study confirms the contribution of the SUPER model. Its concepts, tools, principles, and community labor-market involvement through workplace internships were effective and could apply in other contexts. The SUPER model provides evidence-based knowledge translation that can bring conceptual and practical changes towards successful transition and participation of YAR in adult working roles.

Thyroid axis hormones and anthropometric recovery of children/adolescents with overweight/obesity: A scoping review

Introduction

Thyroid hormones exert multiple physiological effects essential to the maintenance of basal metabolic rate (BMR), adaptive thermogenesis, fat metabolism, growth, and appetite. The links between obesity and the hormones of the thyroid axis, i.e., triiodothyronine (T3), thyroxine (T4), and thyrotropin (TSH), are still controversial, especially when considering children and adolescents. This population has high rates of overweight and obesity and several treatment approaches, including nutritional, psychological, and physical exercise interventions have been used. Understanding the importance of the hormones of the thyroid axis in the recovery from overweight and obesity may help directing measures to the maintenance of a healthy body composition. The present scoping review was carried out to analyze studies evaluating these hormonal levels throughout interventions directed at treating overweight and obesity in children and adolescents. The main purpose was to ascertain whether the hormones levels vary during weight loss.

Methods

We selected for analysis 19 studies published between 1999 and 2022.

Results

Most of the studies showed that changes in different anthropometric indicators, in response to the multidisciplinary interventions, correlated positively with free T3 (fT3), total T3 (TT3), and TSH. With respect to free T4 (fT4) and total T4 (TT4).

Discussion

The most common finding was of unchanged levels and, hence, no significant association with weight loss. Moreover, thyroxine supplementation has failed to affect the response to the interventions. Further studies are necessary to elucidate the relevance of the variations in hormone levels to the establishment of overweight/obesity and to the recovery from these conditions in children/adolescents.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42020203359.

Effectiveness of multidisciplinary intervention for gestational diabetes mellitus

OBJECTIVE

To explore the effectiveness of multidisciplinary intervention for patients with gestational diabetes mellitus (GDM).

METHODS

A total of 126 patients diagnosed with GDM from January 2020 to December 2021 in our hospital were enrolled in this retrospective study. Patients were divided into the control group (conventional treatment) and the study group (adding multidisciplinary intervention). Glucose index, self-management ability, psychological status, and delivery outcomes were evaluated.

RESULTS

Fasting plasma glucose (4.32 ± 0.81 mmol/L), glycosylated hemoglobin (5.47 ± 1.09%), and postprandial blood glucose (6.02 ± 1.47 mmol/L) after intervention in study group were significantly lower than those in control group (p < 0.05), as well as those before intervention (p < 0.05). The score of GDM knowledge (38.03 ± 2.76), self-management (38.93 ± 2.32), social support (17.84 ± 1.23), and belief (17.93 ± 1.09) were all significantly higher than those of control group (p < 0.05), as well as those before intervention (p < 0.05). Besides, anxiety (7.83 ± 1.59) and depression (10.29 ± 1.82) evaluation scores showed that emotional relief were significantly achieved after intervention in study group compared with control group (p < 0.05). Moreover, the incidence of postpartum hemorrhage, cesarean delivery, premature delivery, macrosomia, and neonatal hypoglycemia was also significantly improved after intervention in study group compared with control group (p < 0.05).

CONCLUSIONS

Multidisciplinary intervention can effectively control blood glucose levels, adjust self-management behavior, relieve psychological disorder, reduce complications, and improve delivery outcomes of GDM patients.

The effectiveness of multidisciplinary, activity-based chronic pain interventions for adults of ethnoculturally diverse backgrounds: a systematic review with meta-analysis

PURPOSE

The aim of this review was to assess the effectiveness of multidisciplinary, activity-based interventions on adults with chronic musculoskeletal or widespread pain who identify as ethnoculturally diverse (ECD) compared to adults belonging to the predominant culture of the host country.

METHODS

Online databases Medline, CINAHL, AMED, Psych Info and PubMed were searched from the earliest date available until April 2023. The quality of the included studies were assessed against the Risk of Bias in Non Randomized Studies of Interventions (ROBINS-I). Postintervention data were analyzed using meta-analyses and the certainty of evidence determined using the Grading of Recommendation, Assessment, Development and Evaluation approach (GRADE).

RESULTS

Nine cohort studies with 3467 participants living in America and north-western European countries were included. ECD adults had higher pain intensity (SMD 1.36, 95%CI 0.29 to 2.35, p = 0.03), higher levels of depression (SMD 0.96, 95%CI 0.40 to 1.52, p < 0.01) and a nonsignificant difference in pain-related disability (SMD -1.45, 95%CI -3.28 to 0.39, p = 0.12) following multidisciplinary pain intervention compared to adults of the predominant culture.

CONCLUSION

Adults from ECD backgrounds in Western nations have poorer outcomes after multidisciplinary, activity-based chronic pain interventions compared to adults from predominant cultural groups in these countries suggesting program adaptations may be required.

Tackling Childhood Overweight: Parental Perceptions of Stakeholders' Roles in a Community-Based Intervention

Introduction. Collaborative efforts among communities, schools, parents, and health professionals are needed to prevent childhood obesity, which touches one third of Canadian youth. The purpose of this case study was to obtain parents’ experience and perceptions about stakeholder roles in a multidisciplinary community-based intervention aiming to tackle childhood overweight. Methods. Data were collected from semistructured interviews with 10 parents following their participation in a community-based program designed to help families with overweight children adopt a healthier lifestyle. Results and Discussion. All parents preferred a multidisciplinary health team to monitor their children’s health. They expect that a physician or a pediatrician could diagnose overweight, explain results to parents, and refer families to resources. The team could also include professionals from health and education such as nutritionists/dietitians, nurses, physical education teachers, psychologists, kinesiologists, and social workers. Parents’ own perceived role would consist of instructing and reinforcing their children about healthy behaviors, role modeling for a healthy lifestyle, and seeking for professional help when needed. Conclusion. Parents involved in a support group with overweight child consider their own role as crucial to help changing their family lifestyle. They also prefer a multidisciplinary team that can address different aspects of overweight/obesity. However, the physician was perceived as having the central role in mobilizing a group of stakeholders around youth with overweight/obese, including the parents. A further step would be to understand barriers and facilitators to collaboration among health professionals in childhood overweight prevention and treatment.

The comparative effects of brief or multidisciplinary intervention on return to work at 1 year in employees on sick leave due to low back pain: A randomized controlled trial

OBJECTIVE

To compare return to work (RTW) rates among patients with low back pain (LBP) and different job relations randomized to brief or multidisciplinary intervention.

DESIGN

A randomized controlled trial with 1-year follow-up.

SETTING

Silkeborg Regional Hospital, Denmark.

SUBJECTS

Four hundred seventy-six participants were divided into two groups concerning job relations: strong (influence on job and no fear of losing it) or weak (no influence on job and/or fear of losing it), and afterwards randomized to brief or multidisciplinary intervention.

INTERVENTIONS

Brief intervention included examination and advice by a rheumatologist and a physiotherapist. Multidisciplinary intervention included brief intervention plus coaching by a case manager making a plan for RTW with the patient.

MAIN MEASURES

Primary outcome was 1-year RTW rate. Secondary outcomes included pain intensity (LBP rating scale), disability (Roland Morris disability scale), and psychological measures (Common Mental Disorder Questionnaire, Major Depression Inventory, and EQ-5D-3L).

RESULTS

Mean (SD) age was 43.1 (9.8) years. Among 272 participants with strong job relations, RTW was achieved for 104/137 (76%) receiving brief intervention compared to 89/135 (66%) receiving multidisciplinary intervention, hazard ratio 0.73 (CI: 0.55-0.96). Corresponding results for 204 participants with weak job relations were 69/102 (68%) in both interventions, hazard ratio 1.07 (CI: 0.77-1.49). For patients with strong job relations, depressive symptoms and quality of life were more improved after brief intervention.

CONCLUSION

Brief intervention resulted in higher RTW rates than multidisciplinary intervention for employees with strong job relations. There were no differences in RTW rates between interventions for employees with weak job relations.

Multidisciplinary interventions increase weekly working hours and quality of life in persons with post-concussion syndrome

OBJECTIVES

To improve labor market attachment, general health and quality of life in persons suffering from post-concussion syndrome. Labor market attachment often changes after mTBI, and especially in persons suffering from post-concussion syndrome, and constitutes a huge societal burden.

METHODS

Eighty-two adults with persistent post-concussion syndrome participated in this single-center and uncontrolled interventional efficacy open-label investigation. The primary endpoint was to increase weekly working hours. Outcome measures ranged from self-reported cognitive symptoms to objective performance testing. Multidisciplinary interventions were used to reduce symptoms of fatigue, stress, pain, oculomotor malfunction, and sensitivity to both sound and light.

RESULTS

Workhours improved from median 0 to 6 hours (p = 0.00002). Several significant improvements were observed in quality of life measured by the SF-36. General fatigue measured by the MFI-20 was reduced (p < 0.0001), and symptoms of depression were reduced (p < 0.0001). The COPM results were improved for task completion satisfaction and for ability to perform a task (p < 0.0001). Reading speed, and performances in the Groffman Visual Tracing Test and the King-Devick Test, all improved (p < 0.01). The intervention did not reduce perception of pain intensity (p = 0.11).

CONCLUSION

After the intervention, participants increased weekly workhours and improved in many aspects of life - including quality of life, performance in everyday activities, fatigue and depression. Perception of pain intensity was not improved.

Stressor-Oriented MUlticomponent Intervention and the WeLl-Being of Patients with Alzheimer's Disease: A Randomized Controlled Trial (SOUL-P)

BACKGROUND

Patients with Alzheimer's disease (AD) experience various stressors that negatively impact well-being. Most studies have, however, small effect size and are limited by the experiences of severe patients. Therefore, we conducted a single-blind, randomized controlled trial, which has included patients at different stages.

OBJECTIVE

The stressor-oriented multicomponent program was designed as an intervention for AD patients to enhance well-being.

METHODS

Patients were randomly assigned to control or SOUL-P conditions according to disease severity. The SOUL-P group received 15 intensive sessions over 6 months and 6 maintenance sessions over a 6-month follow-up by a multidisciplinary team comprising psychologists, occupational therapists, and community nurses. The control group received a similar number of sessions by community nurses. Stress-related outcomes (primary stressors and well-being outcomes) were obtained from in-person baseline and follow-up interviews conducted at 6- and 12-months post-baseline. A treatment compliance survey was conducted at the intervention endpoint for patients.

RESULTS

Of the 863 patients screened, 218 (25.3%) were eligible. At 6 months, compared to controls, SOUL-P patients had improved quality of life (QoL) (p < 0.001; Cohen d = 0.56), depression (p = 0.020; Cohen d = -0.33), neurobehavioral symptoms (p = 0.034; Cohen d = -0.30), perceived stress (p = 0.030; Cohen d = -0.31), and family conflict (p = 0.026; Cohen d = -0.32). QoL, depression, perceived stress, and family conflict were still significantly different at 12 months. Most patients were satisfied with SOUL-P, while caregivers in the SOUL-P group reported overloading tasks.

CONCLUSION

SOUL-P may reduce perceived stress and improve psychological outcomes in AD patients. Stressor-based interventions, patient-oriented goals, and a multidisciplinary team are essential features for a successful SOUL-P.

The Relevance of Insomnia Among Healthcare Workers: A Post-Pandemic COVID-19 Analysis

Background: Insomnia significantly impairs healthcare worker (HCW) well-being, particularly amid COVID-19 sequelae and shift work demands. We aimed to assess the prevalence of insomnia among HCWs, identify those needing clinical intervention, analyze shift work as a potential risk factor, and explore associations with COVID-19 sequelae and psychiatric comorbidities. Methods: A cross-sectional online survey was administered at the University of Salamanca University Care Complex (CAUSA) from March 2023 to January 2024. Validated scales (Insomnia Severity Index, Patient Health Questionnaire-4, Generalized Anxiety Disorder Scale-2) were used to measure insomnia, depression, and anxiety. Participants scoring ISI ≥ 7 were invited for Occupational Medicine follow-up. Descriptive and inferential analyses were performed. Results: Overall, 1121 HCWs participated (mean age 44.59 ± 11.78, 78.3% women). The mean ISI score was 10.5 ± 5.8 (subclinical insomnia), with 22.7% reporting moderate and 3% reporting severe insomnia. Depression and anxiety affected 28.4% and 33% of respondents, respectively. Shift workers had poorer sleep (mean ISI 11.3 ± 0.9 vs. 8.8 ± 0.3, p < 0.001). Individuals reporting COVID-19 sequelae were 3.1 times more likely to have insomnia than those who did not (mean ISI 13.89 ± 5.9 vs. 10.33 ± 5.7, p < 0.001). Over one-quarter reported at least the monthly use of sleep or psychiatric medications. Conclusions: Insomnia remains prevalent among HCWs, influenced by shift work, COVID-19 sequelae, and mental health factors. Targeted, multidisciplinary interventions, e.g., workplace policy changes, mental health programs, and shift schedule adjustments) are urgently needed to safeguard well-being, reduce burnout, and maintain quality patient care. Ensuring adequate sleep is central to minimizing errors and preserving professional performance. Future studies should investigate the impact of coordinated workplace strategies to effectively address insomnia.