StandUPTV: Preparation and optimization phases of a mHealth intervention to reduce sedentary screen time in adults.

Recreational sedentary screen time (rSST) is the most prevalent sedentary behavior for adults outside of work, school, and sleep, and is strongly linked to poor health. StandUPTV is a mHealth trial that uses the Multiphase Optimization Strategy (MOST) framework to develop and evaluate the efficacy of three theory-based strategies for reducing rSST among adults. This paper describes the preparation and optimization phases of StandUPTV within the MOST framework. We identified three candidate components based on previous literature: (a) rSST electronic lockout (LOCKOUT), which restricts rSST through electronic means; (b) adaptive prompts (TEXT), which provides adaptive prompts based on rSST behaviors; and (c) earning rSST through increased moderate-vigorous physical activity (MVPA) participation (EARN). We also describe the mHealth iterative design process and the selection of an optimization objective. Finally, we describe the protocol of the optimization randomized controlled trial using a 23 factorial experimental design. We will enroll 240 individuals aged 23-64 y who engage in >3 h/day of rSST. All participants will receive a target to reduce rSST by 50% and be randomized to one of 8 combinations representing all components and component levels: LOCKOUT (yes vs. no), TEXT (yes vs. no), and EARN (yes vs. no). Results will support the selection of the components for the intervention package that meet the optimization objective and are acceptable to participants. The optimized intervention will be tested in a future evaluation randomized trial to examine reductions in rSST on health outcomes among adults.

The relationship between urban greenspace perception and use within the adolescent population: A focused ethnography.

INTRODUCTION: Greenspace is beneficial for improving adolescent mental health, yet healthcare professionals still do not understand the connection between the built environment and subjective mental well-being. We also need to understand how this population uses greenspace and how they feel when in it. AIM: The aim of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace and to explore how they feel when they are in greenspace. DESIGN: Focused ethnography. METHODS: Data were collected between June 2022 and August 2022 using participant observation, photo elicitation and semi-structured interviews. Braun and Clarke's (2006) six phases of thematic analysis were used to guide data collection and analysis. RESULTS: A total of 11 adolescents between ages 12 and 18 who resided in and around Newark, NJ, were recruited. Three themes were identified from the data: (1) A tranquil space in an unsafe place; (2) Park means family connection with burgeoning independence; and (3) My park: Sense of ownership and responsibility. CONCLUSIONS: This study deepens the understanding between subjective mental well-being and urban greenspace exposure. Adolescents accepted responsibility for maintaining "my park", which strengthens community cohesion, detailing the importance of youth input during urban planning. IMPLICATIONS FOR PRACTICE: Implications from this study suggest that environmental interventions may help ameliorate an ongoing mental health care crisis among adolescents. Healthcare providers should consider the built environment as another approach to promoting mental health. PATIENT OR PUBLIC CONTRIBUTION: None other than research participants.

An ecological momentary assessment study of affectively-charged motivational states and physical activity.

The physical activity (PA) intention-behavior gap has prompted researchers to explore other explanatory factors such as affective mechanisms which might better explain PA engagement. Affectively-charged motivations (e.g., desire, dread) are thought to influence the pursuit or avoidance of future behavior. This study examined whether affectively-charged motivations for PA changed across the day and were differentially associated with PA intensity. Participants (N = 60) wore ActiGraph GT3X accelerometers and answered EMA (M = 134.7 prompts/person) about affectively-charged motivations for upcoming PA using a 0-to-100-point scale (dread-excitement) in the morning, pre-activity, at-random, and evening for 14 days. Affectively-charged motivations for PA were lower in the morning and at-random compared to pre-activity (p = .004) and evening (p < .001). On average, individuals who rated morning affectively-charged motivations for PA 10-points higher engaged in 28 additional min/week of moderate-to-vigorous PA (p = .048). These findings suggest that affectively-charged motivations occurring in the morning may have greater salience for PA.

Effects of Increased Standing and Light-Intensity Physical Activity to Improve Postprandial Glucose in Sedentary Office Workers: Protocol for a Randomized Crossover Trial.

BACKGROUND: Prolonged bouts of sedentary time, independent from the time spent in engaging in physical activity, significantly increases cardiometabolic risk. Nonetheless, the modern workforce spends large, uninterrupted portions of the day seated at a desk. Previous research suggests-via improved cardiometabolic biomarkers-that this risk might be attenuated by simply disrupting sedentary time with brief breaks of standing or moving. However, this evidence is derived from acute, highly controlled laboratory experiments and thus has low external validity. OBJECTIVE: This study aims to investigate if similar or prolonged cardiometabolic changes are observed after a prolonged (2-week) practice of increased brief standing and moving behaviors in real-world office settings. METHODS: This randomized crossover trial, called the WorkWell Study, will compare the efficacy of two 2-week pilot intervention conditions designed to interrupt sitting time in sedentary office workers (N=15) to a control condition. The intervention conditions use a novel smartphone app to deliver real-time prompts to increase standing (STAND) or moving (MOVE) by an additional 6 minutes each hour during work. Our primary aim is to assess intervention-associated improvements to daily postprandial glucose using continuous glucose monitors. Our secondary aim is to determine whether the interventions successfully evoke substantive positional changes and light-intensity physical activity (LPA). Other outcomes include the feasibility and acceptability of the intervention conditions, fasting blood glucose concentration, femoral artery flow-mediated dilation (f-FMD), and systolic and diastolic blood pressure. RESULTS: The trial is ongoing at the time of submission. CONCLUSIONS: This study is a novel, randomized crossover trial designed to extend a laboratory-based controlled study design into the free-living environment. By using digital health technologies to monitor and prompt participants in real time, we will be able to rigorously test the effects of breaking up sedentary behavior over a longer period of time than is seen in traditional laboratory-based studies. Our innovative approach will leverage the strengths of highly controlled laboratory and free-living experiments to achieve maximal internal and external validity. The research team's multidisciplinary expertise allows for a broad range of biological measures to be sampled, providing robust results that will extend knowledge of both the acute and chronic real-life effects of increased standing and LPA in sedentary office workers. The WorkWell Study uses a rigorous transdisciplinary protocol that will contribute to a more comprehensive picture of the beneficial effects of breaking up sitting behavior. TRIAL REGISTRATION: ClinicalTrials.gov NCT04269070; https://clinicaltrials.gov/study/NCT04269070. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45133.

Affective Response During Real-World Physical Activity as an Intervention Mediator.

Some people experience pleasure during physical activity, whereas it can be unpleasant for others. Modifying affective responses during physical activity in real-world situations may be an intervention strategy for increasing physical activity. This article follows an experimental medicine framework to summarize evidence identifying, assessing, and influencing affective response during real-world physical activity to inform interventions targeting this mediating mechanism.

Assessing basic and higher-level psychological needs satisfied through physical activity.

Background: There has been increasing interest in the extent to which the fulfillment of psychological needs is associated with physical activity engagement. However, a vast majority of studies consider only basic psychological needs such as relatedness, competence, and autonomy-with higher-level psychological needs such as challenge, creativity, and spirituality rarely being addressed. The aim of this study was to examine the preliminary reliability (i.e., internal consistency) and validity (i.e., discriminant, construct, and predictive) of a multi-dimensional scale to assess a range of basic and higher-level psychological needs satisfied through physical activity. Methods: A sample of 75 adults (ages 19-65 years, 59% female, 46% White) completed a baseline questionnaire measuring 13 psychological needs subscales (i.e., physical comfort, safety, social connection, esteem from others, individual esteem, learning, challenge, entertainment, novelty, creativity, mindfulness, aesthetic appreciation, and morality), exercise enjoyment, and exercise vitality. Participants then completed 14 days of accelerometer monitoring of physical activity and ecological momentary assessment of affective responses during physical activity sessions in daily life. Results: Internal consistency reliability was acceptable (>0.70) for all subscales except for mindfulness, aesthetic appreciation, and morality. Ten of the 13 subscales exhibited discriminant validity by differentiating between engagement (vs. no engagement) in at least one physical activity type (e.g., brisk walking and yoga/Pilates). All the subscales, except physical comfort and esteem from others, were associated with at least one of the construct validation criteria (e.g., exercise enjoyment, affective response during exercise). Five of the subscales were associated with at least one of the predictive validation criteria (i.e., light, moderate, vigorous intensity activity measured by accelerometer). Conclusion: Having the capacity to assess whether one's current physical activity is failing to fulfill various psychological needs-combined with recommendations about which types of activities may satisfy those needs-may address an important gap in physical activity promotion.

A snapshot of parenting practices useful for preventing adolescent vaping.

INTRODUCTION: Smoking research demonstrates that parents can influence their adolescent's tobacco smoking perceptions and behaviors, but little is known about the protective effects of different parenting practices on adolescent vaping. In this study we investigate how adolescent perceptions of parents' knowledge of their activities and parental media mediation are associated with adolescents' perceptions of vaping and adolescent vaping behaviors. METHOD: Six hundred thirty-nine youth (65.7% female, average age: 14.71 years old) recruited through 4-H clubs in nine states participated in a study evaluating a substance use intervention program. Because the evaluation design could influence participants, we used only baseline data. An online self-reported survey was administrated. Most youth self-identified as White (87.3%) and only handful youth indicated Asian (3.4%), African American (3.4%), American Indian (1.1%), and other or unreported (4.8%). Approximately 60% of youth lived in small town or rural areas in US. RESULTS: Analyses revealed that parental knowledge was positively related with adolescent perceived harm of vaping and perceived prevalence of vaping, but was negatively related with perceived acceptability of vaping and social expectancy of vaping. In addition, youth who reported greater parental media mediation were more likely to perceive the harm of vaping and less likely to vape compared with youth with lower parental media mediation. CONCLUSION: These findings suggest that parental education about vaping, including those promoting conversations regarding vaping and vaping ads, may be important to the prevention of adolescent vaping.

Urban greenspace use among adolescents and young adults: An integrative review.

PURPOSE: The purpose of this integrative review was to explore how adolescents and young adults used the social determinant of the built environment, specifically greenspace, as a potential point of intervention to address overall well-being, specifically mental health symptoms. METHOD: The approach used strategies described by Whittemore and Knafl. Peer-reviewed, published research articles in English were identified using electronic databases CINAHL, PubMed, and EMBASE. Seventeen research reports using qualitative or quantitative methods with adolescents and young adults. Each article was evaluated for quality using a critical appraisal tool by Hawker et al. Data were analyzed and then synthesized using the Matrix Method. FINDINGS: Three themes related to the purpose and aims were extracted: elements of greenspace, activity variation, and amenities. All themes shared a common element of quality, which influenced the perception of safety and greenspace use. DISCUSSION: The science of urban greenspace and adolescent-young adult well-being is still relatively new. Public health nurses can incorporate social determinants of health, such as the built environment in research, to understand how greenspace is to be used as an alternative health strategy to possibly reduce mental health symptoms and improve well-being.

More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study.

INTRODUCTION: Onychomycosis is a common, difficult-to-treat fungal nail infection. Clinical signs include nail discoloration and thickening, which patients often find embarrassing, causing a negative impact on their quality of life (QOL). METHODS: In this post hoc study, we analyze the effect of efinaconazole 10% solution on a patient's QOL using patient-reported scores from the OnyCOE-t™ questionnaire (appearance, stigma, physical problems, symptom frequency, symptom bothersomeness, treatment satisfaction, and overall problem). Higher scores corresponded to better functioning, thus higher QOL. RESULTS: Efinaconazole 10% treatment and clinical efficacy were positively correlated with improved QOL in all domains for all groups, except with symptom bothersomeness (how much the onychomycosis symptoms worried or concerned the patient) for female patients <40 years. While still showing improvement in most domains during efficacious treatment, female and younger patients reported lower QOL scores than their male and older counterparts, despite having better clinical outcomes at follow-ups. DISCUSSION: Female and younger patients appear to be more emotionally bothered by their symptoms, regardless of treatment success or improvement of their nail's appearance, suggesting that onychomycosis is more than nail deep and has a greater psychological effect on these patients. Therefore, younger female patients may require more assurance and mental support.

Primary vaccination in foals: a comparison of the serological response to equine influenza and equine herpesvirus vaccines administered concurrently or 2 weeks apart.

This study compared concurrent and separate primary vaccination against equid alphaherpesviruses 1 and 4, genus Varicellovirus, subfamily Alphaherpesvirinae, family Herpesviridae, and equine influenza A virus, genus Alphainfluenzavirus, family Orthomyxoviridae. Their vernacular names are equine herpesvirus 1 and 4 (EHV1/4) and equine influenza virus (EIV). Infection with these respiratory pathogens is associated with loss of performance, interruption of training schedules, and on occasion, cancellation of equestrian events. Vaccination is highly recommended, and for some activities it is a mandatory requirement of the relevant authority. As there is a dearth of information relating to the impact of concurrent vaccination on the antibody response to EHV and EIV vaccines, they are usually administered separately, often 2 weeks apart. In a previous study of booster vaccination in Thoroughbred racehorses, concurrent vaccination with whole-virus inactivated carbopol-adjuvanted EHV and EIV vaccines did not impact negatively on the antibody response. In this study, investigations were extended to concurrent versus separate primary vaccination of warmblood foals. A field study was conducted to compare the immune response to a carbopol-adjuvanted EHV vaccine and an immune stimulating complex (ISCOM)-adjuvanted EI vaccine administered concurrently and 2 weeks apart. No adverse clinical reactions were observed, the pattern of EI and EHV antibody response was similar for both groups, and there was no evidence that concurrent primary vaccination compromised the humoral response. The results are of relevance to horse owners who wish to decrease veterinary costs, limit handling of young animals, and simplify record keeping by vaccinating concurrently.

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization.

BACKGROUND: The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H). METHODS: 639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms. RESULTS: Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms. CONCLUSIONS: We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Annual booster vaccination and the risk of equine influenza to Thoroughbred racehorses.

BACKGROUND: Equine influenza (EI) outbreaks occurred among horses on four racing yards (two National Hunt, one Flat, one mixed National Hunt racing/breeding yard) in Ireland within a 4-week period. OBJECTIVES: To carry out a detailed analysis of racing yards affected in order to identify the source of infection and monitor virus spread among a vaccinated population. STUDY DESIGN: Observational field study. METHODS: Epidemiological and vaccination data along with repeat clinical samples were collected from 118 horses on four premises. RESULTS: Failure to implement appropriate biosecurity measures following the introduction of new arrivals and the return of horses from equestrian events contributed to disease spread as did the movement of horses within premises. Mixing of racing and non-racing populations with inadequate vaccination histories also facilitated virus transmission. The index case(s) on all premises was vaccinated in accordance with the Turf Club rules. Vaccine breakdown was observed across all products in 27/80 horses (33.8%) with an up-to-date vaccination record. Eighteen of the 27 (66.7%) horses had not received a booster vaccination within the previous 6 months and 10 (37%) horses were due annual booster vaccination at the time of developing clinical signs. MAIN LIMITATIONS: The interpretation of laboratory results followed a delay in veterinary intervention. CONCLUSIONS: Annual booster vaccination should not be relied on as the sole preventative measure against EI. The findings of this study suggest that increasing the frequency of booster vaccinations may be beneficial particularly in young horses and that synchronised scheduling of vaccination regimes across racing yards may contribute to high-risk periods for EI virus (EIV) transmission.

Molecular Characterisation of Equine Herpesvirus 1 Isolates from Cases of Abortion, Respiratory and Neurological Disease in Ireland between 1990 and 2017.

Multiple locus typing based on sequencing heterologous regions in 26 open reading frames (ORFs) of equine herpesvirus 1 (EHV-1) strains Ab4 and V592 was used to characterise 272 EHV-1 isolates from 238 outbreaks of abortion, respiratory or neurological disease over a 28-year period. The analysis grouped the 272 viruses into at least 10 of the 13 unique long region (UL) clades previously recognised. Viruses from the same outbreak had identical multi-locus profiles. Sequencing of the ORF68 region of EHV-1 isolates from 222 outbreaks established a divergence into seven groups and network analysis demonstrated that Irish genotypes were not geographically restricted but clustered with viruses from all over the world. Multi-locus analysis proved a more comprehensive method of strain typing than ORF68 sequencing. It was demonstrated that when interpreted in combination with epidemiological data, this type of analysis has a potential role in tracking virus between premises and therefore in the implementation of targeted control measures. Viruses from 31 of 238 outbreaks analysed had the proposed ORF30 G2254/D752 neuropathogenic marker. There was a statistically significant association between viruses of the G2254/D752 genotype and both neurological disease and hypervirulence as defined by outbreaks involving multiple abortion or neurological cases. The association of neurological disease in those with the G2254/D752 genotype was estimated as 27 times greater than in those with the A2254/N752 genotype.

Multifocal Equine Influenza Outbreak with Vaccination Breakdown in Thoroughbred Racehorses.

Equine influenza (EI) outbreaks occurred on 19 premises in Ireland during 2014. Disease affected thoroughbred (TB) and non-TB horses/ponies on a variety of premises including four racing yards. Initial clinical signs presented on 16 premises within a two-month period. Extensive field investigations were undertaken, and the diagnostic effectiveness of a TaqMan RT-PCR assay was demonstrated in regularly-vaccinated and sub-clinically-affected horses. Epidemiological data and repeat clinical samples were collected from 305 horses, of which 40% were reported as clinically affected, 39% were identified as confirmed cases and 11% were sub-clinically affected. Multivariable analysis demonstrated a significant association between clinical signs and age, vaccination status and number of vaccine doses received. Vaccine breakdown was identified in 31% of horses with up to date vaccination records. This included 27 horses in four different racing yards. Genetic and antigenic analysis identified causal viruses as belonging to Clade 2 of the Florida sublineage (FCL2). At the time of this study, no commercially available EI vaccine in Ireland had been updated in line with World Organisation for Animal Health (OIE) recommendations to include a FCL2 virus. The findings of this study highlight the potential ease with which EI can spread among partially immune equine populations.

Change to healthcare is history repeating itself.

In my last Board's Eye View, I wrote about the US presidential candidates and uncertainty about healthcare reform. Six months later, the story is continuing.

A tale of two proposals.

This autumn, the United states will choose a new president and, with this, a change in health care. Democratic candidate Hillary Clinton proposes the least change, offering a public-option insurance plan and allowing Americans to enrol in Medicare at 55.

Board's eye view - Changing roles.

AS HEALTHCARE providers, we rely on the latest technology. It helps us to understand and treat complex health conditions, and to model clinical trials.

Board's eye view - Safe practices.

THE THEME for this year's annual conference of the Emergency Nurses Association, in Indianapolis, was 'safe practice, safe care'.

Is this case an EMTALA violation?

The advanced practice registered nurse (APRN) working in the emergency department (ED) is asked to see a patient with an "eye infection." The patient has a severe retrobulbar orbital abscess requiring complex multidisciplinary specialty management and is ultimately transferred to a tertiary care center. The patient had first presented to a community ED per the recommendation of her ear, nose, and throat (ENT) specialist. The patient was advised to leave the first ED during triage and to go to a second community ED. Although the referring physician was made aware of the recommendation to have the patient drive to another facility, the APRN questions whether this is a case of an Emergency Medical Treatment and Active Labor Act (EMTALA) violation. This article defines EMTALA and evaluates the case.