Objective: To evaluate the effectiveness and safety of pharmacological interventions for the treatment of psychological distress in people with asthma.Data sources: Electronic searches were performed in Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase, PsycInfo, Health Technology Assessment Database and Web of Science (inception to April 2019).Study selections: Included studies were randomized controlled trials (RCT) or controlled clinical trials investigating the effect of pharmacological interventions for psychological distress in people with asthma. Records were screened and data extracted by two independent authors into standardized pilot-tested extraction templates. Data was analyzed according to standard Cochrane methodology and entered into Review Manager Software version 5.3.Results: From 5,689 studies, six RCTs (n = 215) met inclusion criteria and were included in the systematic review, of which four studies were included in the meta-analysis. A meta-analysis of four studies (n = 158) indicated no evidence of an effect for selective serotonin reuptake inhibitors (Citalopram or Escitalopram) on reduction of psychological distress in adult patients with asthma. Similarly, antiepileptic medication (Levetiracetam) was no better than placebo in the treatment of psychological distress in people with asthma. Adverse events were poorly reported across all studies but were slightly increased among intervention participants compared to control participants.Conclusions: There was great heterogeneity between studies and overall poor methodological quality providing insufficient evidence to make recommendations for or against the use of pharmacotherapy in asthma patients with psychological distress. Further confirmatory trials are warranted to make recommendations for clinical practice.
Interventions that encompass behavioural modifications of dietary intake and physical activity are essential for the management of obesity in children. This study assessed the effectiveness of a stage-based lifestyle modification intervention for obese children.
Despite a marked reduction in Aboriginal and Torres Strait Islander infant deaths from 1998 to 2012 (AIHW 2015) Aboriginal and Torres Strait Islander infants remain over-represented in sudden and unexpected infant death rates.
Introduction Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive ‘nudge’ interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. Methods and analyses Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. Ethics and dissemination The protocol and study documents have been reviewed and approved by the Women’s and Children’s Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. Trial registration number NCT05613751 .
Families of overweight and obese children require support to make sustainable lifestyle changes to improve their child's diet and activity behaviours and in turn weight status. The aim of this pre-post intervention pilot study was to evaluate the feasibility of an individualised home-based intervention for treatment seeking overweight/obese 4–12 year olds and their caregivers. Baseline measures were used to develop a family-specific intervention to improve the quality of the home environment. The intervention was delivered as individualised written recommendations and resources plus phone call and home visit support. Baseline measures were repeated approximately 6 months later. Complete data for 24 children was available. Parents reported that 43 % of intervention recommendations were implemented 'very much'. Some descriptive changes were observed in the home environment, most commonly including fruit and vegetables in their child's lunchbox, not providing food treats, and restricting children's access to chips/savoury snack biscuits. At the group level, minimal change was detected in children's diet and activity behaviours or weight status (all p > 0.05). The study findings did not support intervention feasibility in its current form. Future interventions should target the family food and activity environment, but also utilise an approach to address the complex social circumstances which limit parent's ability to prioritise healthy family lifestyle behaviours. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 3/12/2014. http://www.ANZCTR.org.au . ACTRN12614001264673
SARS-CoV-2 is a novel coronavirus and causative pathogen to the pandemic illness COVID-19. Although RNA has been detected in various clinical samples, no reports to date have documented SARS-CoV-2 in human milk. This case report describes an actively breastfeeding patient with COVID-19 infection with detectable viral RNA in human milk.
Non-pharmaceutical interventions including physical distancing and restriction on public gatherings were the cornerstone in controlling the COVID-19 pandemic, in the absence of effective vaccines and available treatment options. Many sport mega-events and sport leagues were canceled or indefinitely postponed, leaving stadiums globally empty or converted to be used as part of the COVID-19 response. There were calls for exit strategies to be developed. With the early containment of COVID-19 in South Australia, various restrictions were lifted in a staged and controlled manner, including the reopening of the Adelaide Oval for recommencement of sport leagues with spectator attendance. This involved the collaboration between public health authorities, other governmental agencies, Adelaide Oval Stadium Management Authority, various sporting leagues etc. Recommencement of sport leagues with staged increase in number of attending spectators allowed various measures to be introduced, revisited, and implemented accordingly, demonstrating that a case-by-case risk assessment can be conducted for mega-events during COVID-19, accounting for the epidemiological context at the time. Economic impacts and non-economic benefits of this recommencement were documented. This globally unprecedented, staged and controlled approach in returning spectators to sporting events during the COVID-19 pandemic could inform the reopening strategy of stadiums, recommencement of sport leagues and mega-events all over the world before herd immunity is achieved or in the event of future outbreaks.
Abstract Background Influenza and COVID-19 infections during pregnancy may have serious adverse consequences for women as well as their infants. However, uptake of influenza and COVID-19 vaccines during pregnancy remains suboptimal. This study aims to assess the effectiveness of a multi-component nudge intervention to improve influenza and COVID-19 vaccine uptake among pregnant women. Methods Pregnant women who receive antenatal care at five tertiary hospitals in South Australia, Western Australia and Victoria will be recruited to two separate randomised controlled trials (RCTs). Women will be eligible for the COVID-19 RCT is they have received two or less doses of a COVID-19 vaccine. Women will be eligible for the influenza RCT if they have not received the 2023 seasonal influenza vaccine. Vaccination status at all stages of the trial will be confirmed by the Australian Immunisation Register (AIR). Participants will be randomised (1:1) to standard care or intervention group ( n = 1038 for each RCT). The nudge intervention in each RCT will comprise three SMS text message reminders with links to short educational videos from obstetricians, pregnant women and midwives and vaccine safety information. The primary outcome is at least one dose of a COVID-19 or influenza vaccine during pregnancy, as applicable. Logistic regression will compare the proportion vaccinated between groups. The effect of treatment will be described using odds ratio with a 95% CI. Discussion Behavioural nudges that facilitate individual choices within a complex context have been successfully used in other disciplines to stir preferred behaviour towards better health choices. If our text-based nudges prove to be successful in improving influenza and COVID-19 vaccine uptake among pregnant women, they can easily be implemented at a national level. Trial registration ClinicalTrials.gov Identifier NCT05613751. Registered on November 14, 2022.
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