Sci Rep. 2025 Jan 11;15(1):1713. doi: 10.1038/s41598-025-85397-1.
ABSTRACT
Participation in outdoor play is beneficial for the health, well-being, and development of children. Early childhood education centers (ECECs) can provide equitable access to outdoor play. The PROmoting Early Childhood Outside (PRO-ECO) study is a pilot randomized trial that evaluates the PRO-ECO intervention on children's outdoor play participation. The PRO-ECO intervention included four components: ECEC outdoor play policy; educator training; ECEC outdoor space modification; and parent engagement. This study included eight ECECs delivering licensed care to children (n = 217) aged 2.5 to 6 years in Greater Vancouver, British Columbia, Canada. Using a wait-list control cluster randomized trial design, ECECs were randomly allocated to either the intervention arm (n = 4) or the wait-list control arm (n = 4). Change in the proportion and diversity of observed outdoor play behaviour during scheduled outdoor time was measured. Outcome data were collected at baseline, 6-month follow-up, and 12-month follow-up. The intervention effect on children's outdoor play participation was examined using logistic regression mixed effect models. Controlling for gender, weather and temperature, there were no changes in children's outdoor play participation following implementation of the PRO-ECO intervention in the between-group analysis. Within-group comparisons also revealed no change in play participation following the PRO-ECO intervention, however, the intervention group showed a positive effect (OR = 1.28, 95% CI = 0.97, 1.70) in play participation 6 months after implementation of the intervention. The findings indicate that further analyses on child- and ECEC-level outcomes collected as part of the PRO-ECO study, including the diversity of children's play, is required to effectively assess the impact of this intervention.
PMID:39799248 | PMC:PMC11724985 | DOI:10.1038/s41598-025-85397-1
Wounds. 2024 Dec;36(12):410-418. doi: 10.25270/wnds/24186.
ABSTRACT
BACKGROUND: The Wound Care Collaborative Community (WCCC) assesses shortcomings and unmet needs in wound care by partnering with key stakeholders, such as the National Institutes of Health, the US Food and Drug Administration (FDA), industry leaders, and expert health care providers and researchers, to advance the study of wound healing. Through this work, the WCCC has identified a few key barriers to innovation in wound care. The WCCC aims to accelerate the development of science-based, patient-centered solutions and address public policy challenges related to ensuring patients receive early access to innovative treatment options.
OBJECTIVE: To develop consensus recommendations that would address current deficiencies in wound care and promote improved innovation and patient access with an expert panel discussion based on both the work conducted within the WCCC and the existing evidence. These recommendations include the voices of the at-large, US-based wound care community.
METHODS: In May 2024, a multi-panel summit with 65 leading voices in clinical practice, academia, industry, and the FDA convened in person in Orlando, Florida. Thirty-two participants with backgrounds in clinical practice, surgery, industry, academia, and research took part in panel discussions. Following the panel meeting, the group corresponded via email and a formal survey process to create consensus recommendations, with the ultimate goal of identifying and overcoming barriers to innovation in wound care.
RESULTS: A total of 32 experts convened during the 1-day summit, each representing key stakeholders. Five panel discussions took place to discuss the obstacles to innovation, including alternative primary and co-primary endpoints, generating and reporting evidence, real-world evidence in policy decision-making, and the appropriate standard of care in wound management. From these discussions, 12 consensus statements were generated. The statements, their proportion of agreement or disagreement, and summary comments are presented in the order they appeared at the presentation. Overall, greater than or equal to 85% agreement was received on all statements.
CONCLUSION: The consensus recommendations promote and encourage a standardized path forward to established, consistent metrics that facilitate innovation and quality assessment, improving patient access to advancements in healing.
PMID:39787512 | DOI:10.25270/wnds/24186
J Rural Health. 2025 Jan;41(1):e12909. doi: 10.1111/jrh.12909.
ABSTRACT
INTRODUCTION: The objective of this scoping review is to identify interventions to promote well-being that have been tried or proven effective to prevent or address burnout in rural health care professionals and trainees (HCPTs). Secondarily, we aimed to identify potentially applicable and feasible well-being interventions that could help rural HCPTs.
METHODS AND ANALYSIS: We used PRISMA guidelines to conduct a scoping review of peer-reviewed English language studies, from all countries, published in core health sciences databases. We focused on intervention studies for burnout and well-being in rural HCPTs published from July 2013 to January 2024. Searches identified 571 studies; 18 additional studies were identified from hand searches of websites, reviews, and bibliographies identified in the original search strategy. Two authors screened and extracted all data using Covidence.
FINDINGS: After deduplication, 507 studies were screened for inclusion, and 50 full-text studies were assessed for eligibility. After discussion and consensus, 30 studies were selected for inclusion. We included selected "applicable" studies, for example, online interventions. We excluded potentially applicable studies that would not be feasible in rural settings, that is, health system interventions requiring substantial personnel and infrastructure. Interventions included individual interventions (eg, mindfulness), increased support for professionals (eg, remote pharmacist assistance), and interventions to improve quality or teamwork.
CONCLUSIONS: Few interventional studies have been done to support well-being and prevent burnout in vulnerable rural HCPTs. While individual interventions, such as mindfulness, are most effective to date, studies replicating or extending these interventions, and to identify supports that address workload and systems issues are needed.
PMID:39757437 | PMC:PMC11701247 | DOI:10.1111/jrh.12909
NEJM Evid. 2025 Jan;4(1):EVIDoa2400200. doi: 10.1056/EVIDoa2400200. Epub 2024 Dec 23.
ABSTRACT
BACKGROUND: Older adults with type 1 diabetes are at risk for serious hypoglycemia. Automated insulin delivery can reduce risk but has not been sufficiently evaluated in this population.
METHODS: We conducted a multicenter, randomized crossover trial in adults older than or equal to 65 years of age with type 1 diabetes. Participants completed three 12-week periods of using hybrid closed loop, predictive low-glucose suspend, and sensor-augmented pump insulin delivery in a randomized order. The primary outcome was the percentage of time with continuous glucose monitoring glucose values less than 70 mg/dl.
RESULTS: Eighty-two participants between 65 and 86 years of age were randomly assigned: 45% were female; the baseline mean (±SD) glycated hemoglobin level was 7.2±0.9%; and the baseline percentage of time with glucose values less than 70 mg/dl was 2.49±1.78%. In the sensor-augmented pump, hybrid closed-loop, and predictive low-glucose suspend periods, percentages of time with glucose less than 70 mg/dl were 2.57±1.54%, 1.58±0.95%, and 1.67±0.96%, respectively. Compared with the sensor-augmented pump results, the mean difference with the hybrid closed-loop system was -1.05 percentage points (95% confidence interval [CI], -1.48 to -0.73 percentage points; P<0.001) and with the predictive low-glucose suspend system it was -0.93 percentage points (95% CI, -1.27 to -0.66 percentage points; P<0.001). Comparing a hybrid closed-loop system with a sensor-augmented pump, time in the range 70 to 180 mg/dl changed by 8.9 percentage points (95% CI, 7.4 to 10.4 percentage points) and the glycated hemoglobin level changed by 0.2 percentage points (95% CI, -0.3 to -0.1 percentage points). Serious adverse events were uncommon. Severe hypoglycemia occurred in 4% or less of participants; there were two hospitalizations for diabetic ketoacidosis.
CONCLUSIONS: In older adults with type 1 diabetes, automated insulin delivery decreased hypoglycemia compared with sensor-augmented pump delivery. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number: NCT04016662.).
PMID:39714936 | DOI:10.1056/EVIDoa2400200
J Neurol Sci. 2025 Jan 15;468:123340. doi: 10.1016/j.jns.2024.123340. Epub 2024 Dec 9.
ABSTRACT
While rising global rates of neurodegenerative disease encourage early diagnosis and therapeutic intervention to block clinical expression (secondary prevention), a more powerful approach is to identify and remove environmental factors that trigger long-latencybrain disease (primary prevention) by acting on a susceptible genotype or acting alone. The latter is illustrated by the post-World War II decline and disappearance of Amyotrophic Lateral Sclerosis and Parkinsonism-Dementia Complex (ALS/PDC), a prototypical often-familial neurodegenerative disease formerly present in very high incidence on the island of Guam. Lessons learned from 75 years of investigation on the etiology of ALS/PDC include: the importance of focusing field research on the disease epicenter and patients with early-onset disease; soliciting exposure history from patients, family, and community to guide multidisciplinary biomedical investigation; recognition that disease phenotype may vary with exposure history, and that familial brain disease may have a primarily environmental origin. Furthermore, removal from exposure to the environmental trigger effects primary disease prevention.
PMID:39667295 | DOI:10.1016/j.jns.2024.123340