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Frontiers in Aging Neuroscience 2024Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by diverse and prominent changes in behavior and personality. One of the...
Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by diverse and prominent changes in behavior and personality. One of the greatest challenges in bvFTD is to capture, measure and predict its disease progression, due to clinical, pathological and genetic heterogeneity. Availability of reliable outcome measures is pivotal for future clinical trials and disease monitoring. Detection of change should be objective, clinically meaningful and easily assessed, preferably associated with a biological process. The purpose of this scoping review is to examine the status of longitudinal studies in bvFTD, evaluate current assessment tools and propose potential progression markers. A systematic literature search (in PubMed and Embase.com) was performed. Literature on disease trajectories and longitudinal validity of frequently-used measures was organized in five domains: global functioning, behavior, (social) cognition, neuroimaging and fluid biomarkers. Evaluating current longitudinal data, we propose an adaptive battery, combining a set of sensitive clinical, neuroimaging and fluid markers, adjusted for genetic and sporadic variants, for adequate detection of disease progression in bvFTD.
PubMed: 38784446
DOI: 10.3389/fnagi.2024.1382593 -
JNCI Cancer Spectrum Apr 2024Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors.
METHODS
Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation.
RESULTS
Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment.
CONCLUSIONS
CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.
Topics: Adult; Humans; Anxiety; Cancer Survivors; Cognitive Behavioral Therapy; Depression; Exercise Therapy; Fatigue; Hypnotics and Sedatives; Melatonin; Mind-Body Therapies; Mindfulness; Neoplasms; Phototherapy; Sleep Aids, Pharmaceutical; Sleep Initiation and Maintenance Disorders
PubMed: 38781520
DOI: 10.1093/jncics/pkae041 -
Journal of the American Medical... Jun 2024Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing...
OBJECTIVES
Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED.
MATERIALS AND METHODS
We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs' timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes.
RESULTS
Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes.
DISCUSSION
Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation.
CONCLUSION
We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.
Topics: Emergency Service, Hospital; Humans; Heuristics; Decision Support Systems, Clinical; Hospital Information Systems; Clinical Decision-Making
PubMed: 38781289
DOI: 10.1093/jamia/ocae096 -
JMIR MHealth and UHealth May 2024Unaddressed early-stage mental health issues, including stress, anxiety, and mild depression, can become a burden for individuals in the long term. Digital phenotyping... (Review)
Review
BACKGROUND
Unaddressed early-stage mental health issues, including stress, anxiety, and mild depression, can become a burden for individuals in the long term. Digital phenotyping involves capturing continuous behavioral data via digital smartphone devices to monitor human behavior and can potentially identify milder symptoms before they become serious.
OBJECTIVE
This systematic literature review aimed to answer the following questions: (1) what is the evidence of the effectiveness of digital phenotyping using smartphones in identifying behavioral patterns related to stress, anxiety, and mild depression? and (2) in particular, which smartphone sensors are found to be effective, and what are the associated challenges?
METHODS
We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process to identify 36 papers (reporting on 40 studies) to assess the key smartphone sensors related to stress, anxiety, and mild depression. We excluded studies conducted with nonadult participants (eg, teenagers and children) and clinical populations, as well as personality measurement and phobia studies. As we focused on the effectiveness of digital phenotyping using smartphones, results related to wearable devices were excluded.
RESULTS
We categorized the studies into 3 major groups based on the recruited participants: studies with students enrolled in universities, studies with adults who were unaffiliated to any particular organization, and studies with employees employed in an organization. The study length varied from 10 days to 3 years. A range of passive sensors were used in the studies, including GPS, Bluetooth, accelerometer, microphone, illuminance, gyroscope, and Wi-Fi. These were used to assess locations visited; mobility; speech patterns; phone use, such as screen checking; time spent in bed; physical activity; sleep; and aspects of social interactions, such as the number of interactions and response time. Of the 40 included studies, 31 (78%) used machine learning models for prediction; most others (n=8, 20%) used descriptive statistics. Students and adults who experienced stress, anxiety, or depression visited fewer locations, were more sedentary, had irregular sleep, and accrued increased phone use. In contrast to students and adults, less mobility was seen as positive for employees because less mobility in workplaces was associated with higher performance. Overall, travel, physical activity, sleep, social interaction, and phone use were related to stress, anxiety, and mild depression.
CONCLUSIONS
This study focused on understanding whether smartphone sensors can be effectively used to detect behavioral patterns associated with stress, anxiety, and mild depression in nonclinical participants. The reviewed studies provided evidence that smartphone sensors are effective in identifying behavioral patterns associated with stress, anxiety, and mild depression.
Topics: Humans; Depression; Stress, Psychological; Anxiety; Phenotype; Smartphone
PubMed: 38780995
DOI: 10.2196/40689 -
F1000Research 2024Health security as a domain has gained tremendous importance in the recent past. Emerging and re-emerging diseases globally, coupled with the derailment of the... (Review)
Review
BACKGROUND
Health security as a domain has gained tremendous importance in the recent past. Emerging and re-emerging diseases globally, coupled with the derailment of the determinants of health mainly the socio-political environment, has made health security a cross-cutting entity in diverse fields including International Relations (IR). With the ongoing global polycrisis, the health-related issues which were previously sidelined as a concept of less strategic importance in the IR field, are now contributing to the shift of the world order. This has instilled an increased participation of IR scholars in the discussions and debates on health security concerns. The field of IR contains numerous theoretical lenses through which scholars analyze such situations, policies, and systems of the world.
METHODS
In this paper, we use a scoping review method to inspect how IR theories have been applied in analyzing health security concerns.
RESULTS
We observed that various diverging IR theories have been used to deliberate on states' actions in tackling the recent pandemic and have also been prescriptive about the changing notions of multilateralism and international governing organizations. Realism, liberalism, and securitization were among the most frequently applied IR theories in the context of health security discussions.
CONCLUSIONS
This work provides an impetus to enhance the interaction among interdisciplinary teams leading to evolving solutions that can address issues of global importance in the contemporary world.
Topics: Humans; Diplomacy; Global Health; Internationality; International Cooperation
PubMed: 38779318
DOI: 10.12688/f1000research.145568.1 -
BMC Public Health May 2024The unknownness and dread potential of a risk event shapes its perceived risk. A public health emergency of international concern (PHEIC) declaration by the World Health... (Review)
Review
The unknownness and dread potential of a risk event shapes its perceived risk. A public health emergency of international concern (PHEIC) declaration by the World Health Organisation (WHO) is a signal for such an event. Understanding perceived risk then shapes risk-avoiding behaviours, important for health prevention. The review aims to consolidate the determinants of risk perception during a PHEIC, underscoring the need for grounding in context and theory. Studies published from 2010 until end-2020, searching PubMed, PsycINFO, MedlinePlus, PubPsych, and CINAHL, were included. Studies with only biological conceptualisations of risk, or no association to risk perception, were excluded. A total of 65 studies were included. Quality of the cross-sectional studies was assessed using Newcastle Ottawa Scale (NOS), yielding an average of 5.4 stars (out of 10). Factors were classified into three broad categories - individual, contextual, and media. Individual risk factors include emotions; beliefs, trust, and perceptions; immutable physical traits (sex, age, ethnicity); mutable traits (education, income, etc.); and knowledge, with no definitive correlation to risk perception. Contextual traits include pandemic experience, time, and location, with only time negatively correlated to risk perception. Media traits include exposure, attention, and framing of media, with no clear association to risk perception. One limitation is excluding a portion of COVID-19 studies due to censoring. Still, this lack of consensus highlights the need to better conceptualise "risk perception". Specifying the context and timing is also important since jurisdictions experience different outbreaks depending on outbreak histories. Using theories to ground risk perception research assists with these tasks.
Topics: Humans; Public Health; Emergencies; Perception; Risk Assessment; COVID-19; Risk Factors; Health Knowledge, Attitudes, Practice; Internationality
PubMed: 38778355
DOI: 10.1186/s12889-024-18832-z -
Trials May 2024Informed consent for participation in an RCT is an important ethical and legal requirement. In placebo surgical trials, further issues are raised, and to date, this has... (Review)
Review
INTRODUCTION
Informed consent for participation in an RCT is an important ethical and legal requirement. In placebo surgical trials, further issues are raised, and to date, this has not been explored. Patient information leaflets (PILs) are a core component of the informed consent process. This study aimed to investigate the key content of PILs for recently completed placebo-controlled trials of invasive procedures, including surgery, to highlight areas of good practice, identify gaps in information provision for trials of this type and provide recommendations for practice.
METHODS
PILs were sought from trials included in a recent systematic review of placebo-controlled trials of invasive procedures, including surgery. Trial characteristics and data on surgical and placebo interventions under evaluation were extracted. Directed content analysis was applied, informed by published regulatory and good practice guidance on PIL content and existing research on placebo-controlled surgical trials. Results were analysed using descriptive statistics and presented as a narrative summary.
RESULTS
Of the 62 eligible RCTs, authors of 59 trials were contactable and 14 PILs were received for analysis. At least 50% of all PILs included content on general trial design. Explanations of how the placebo differs or is similar to the surgical intervention (i.e. fidelity) were reported in 6 (43%) of the included PILs. Over half (57%) of the PILs included information on the potential therapeutic benefits of the surgical intervention. One (7%) included information on potential indirect therapeutic benefits from invasive components of the placebo. Five (36%) presented the known risks of the placebo intervention, whilst 8 (57%) presented information on the known risks of the surgical intervention. A range of terms was used across the PILs to describe the placebo component, including 'control', 'mock' and 'sham'.
CONCLUSION
Developers of PILs for placebo-controlled surgical trials should carefully consider the use of language (e.g. sham, mock), be explicit about how the placebo differs (or is similar) to the surgical intervention and provide balanced presentations of potential benefits and risks of the surgical intervention separately from the placebo. Further research is required to determine optimal approaches to design and deliver this information for these trials.
Topics: Humans; Informed Consent; Pamphlets; Randomized Controlled Trials as Topic; Surgical Procedures, Operative; Patient Education as Topic; Placebo Effect; Research Design; Placebos; Comprehension
PubMed: 38778336
DOI: 10.1186/s13063-024-08166-x -
Global Mental Health (Cambridge,... 2024Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of...
Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences.
Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.
PubMed: 38774885
DOI: 10.1017/gmh.2024.56 -
The Cochrane Database of Systematic... May 2024Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.
OBJECTIVES
To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure).
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour.
MAIN RESULTS
We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.
AUTHORS' CONCLUSIONS
To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
Topics: Humans; Randomized Controlled Trials as Topic; Mental Health; Developing Countries; Quality of Life; Adult; Child; Psychosocial Intervention; Adaptation, Psychological; Altruism; Adolescent; Refugees; Bias; Health Promotion; Psychosocial Functioning; Female; Stress Disorders, Post-Traumatic; Mental Disorders
PubMed: 38770799
DOI: 10.1002/14651858.CD014300.pub2 -
The Cochrane Database of Systematic... May 2024Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review.
OBJECTIVES
To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was February 2023.
SELECTION CRITERIA
Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome.
MAIN RESULTS
This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect.
AUTHORS' CONCLUSIONS
The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.
Topics: Humans; Adolescent; Randomized Controlled Trials as Topic; Child; Pediatric Obesity; Exercise; Body Mass Index; Female; Energy Intake; Male; Sedentary Behavior; Bias; Diet, Healthy; Research Support as Topic; Sleep
PubMed: 38763518
DOI: 10.1002/14651858.CD015330.pub2