The Impact of Physical Distancing Policies During the COVID-19 Pandemic on Health and Well-Being Among Australian Adolescents.

PURPOSE: Physical distancing policies in the state of New South Wales (Australia) were implemented on March 23, 2020, because of the COVID-19 pandemic. This study investigated changes in physical activity, dietary behaviors, and well-being during the early period of this policy. METHODS: A cohort of young people aged 13-19 years from Sydney (N = 582) were prospectively followed for 22 weeks (November 18, 2019, to April 19, 2020). Daily, weekly, and monthly trajectories of diet, physical activity, sedentary behavior, well-being, and psychological distress were collected via smartphone, using a series of ecological momentary assessments and smartphone sensors. Differences in health and well-being outcomes were compared pre- and post-implementation of physical distancing guidelines. RESULTS: After the implementation of physical distancing measures in NSW, there were significant decreases in physical activity (odds ratio [OR] = .53, 95% confidence interval [CI] = .34-.83), increases in social media and Internet use (OR = 1.86, 95% CI = 1.15-3.00), and increased screen time based on participants' smartphone screen state. Physical distancing measures were also associated with being alone in the previous hour (OR = 2.09, 95% CI: 1.33-3.28), decreases in happiness (OR = .38, 95% CI = .18-.82), and fast food consumption (OR = .46, 95% CI = .29-.73). CONCLUSIONS: Physical distancing and social restrictions had a contemporaneous impact on health and well-being outcomes associated with chronic disease among young people. As the pandemic evolves, it will be important to consider how to mitigate against any longer term health impacts of physical distancing restrictions.

The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials.

Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD -0.24; 95% CI -0.35, -0.14; I2 = 76%) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21; I2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15; I2 = 51%), self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44; I2 = 83%), and hospital admissions (OR 0.83; 95% CI 0.70, 0.98; I2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26; I2 = 82%). The quality of individual studies ranged from "fair" to "good" by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.