As emerging contaminants microplastic particles have become of particular relevance as they are widely present in the environment and of potential concern to human health. Humans are exposed through different routes, with oral intake and inhalation being the most significant. Dietary intake substantially contributes to oral exposure, although data is still lacking. This first-of-its-kind pilot study investigates the influence of different plastic use and food consumption scenarios (normal, low, high) on microplastic content in stool reflecting oral intake by performing an intervention study with fifteen volunteers. Stool samples were analyzed for ten different plastic types in three size fractions including 5-50 μm (qualitative), 50-500 μm and 500-5000 μm (quantitative). In all samples, microplastic particles were detected with median concentrations up to 3.5 particles/g stool in the size fraction 50-500 μm. Polyethylene was the most frequently detected polymer type. The different scenarios did not result in a consistent pattern of microplastics, however, the use of plastics for food packaging and preparation, and the consumption of highly processed food were statistically significantly associated with microplastics content in stool. These results provide initial findings that contribute to filling current knowledge gaps and pave the way for further research.

BACKGROUND: A food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees\' eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior.
METHODS: Using a pre-post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis.
RESULTS: A total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing \"balanced meals\" to lower Na/K and salads to increase potassium excretion were second.
CONCLUSIONS: Food environment intervention using nudge tactics can improve staff\'s food intake and lower Na/K.
BACKGROUND: Registration number: UMIN000049444 (UMIN-CTR). Date of registration: November. 7. 2022.

BACKGROUND: Social networks have emerged as powerful tools in education, offering new opportunities for interactive learning. TikTok has gained popularity among young people and has potential for use as a teaching tool in health disciplines.
OBJECTIVE: To evaluate the effectiveness of an educational program based on a multimodal intervention using the TikTok platform to improve theoretical-practical knowledge about diabetic debut and vaccination schedules and satisfaction in nursing students.
METHODS: A quasi-experimental study design.
METHODS: Faculty of Nursing, University of Cadiz, Spain.
METHODS: 74 third-year undergraduate university nursing students.
METHODS: According to Kolb\'s experiential learning model, a multimodal educational intervention was carried out during the academic year 2022/2023, with 12 h of training. In these sessions, theoretical content on the vaccination calendar and diabetic debut was developed with written case studies. In the last session, 19 working groups were formed and each group was given a practical case study to solve through role-playing and creating a video in TikTok. A questionnaire to measure individual knowledge and a rubric questionnaire were used to evaluate the simulations in TikTok platform.
RESULTS: A significant improvement (z = 6.843, p < 0.001) was observed in the mean scores (9.93 ± 1.65) of the posttest of the knowledge questionnaire, used to evaluate abstract conceptualisation abilities. Additionally, a mean score of 10.42 (SD = 1.42) of the items on the rubric questionnaire, designed to assess active experimentation and reflective observation abilities, were correctly performed. It stands out that 97.1 % of the students positively valued the elements of teaching innovation implemented, while 82.9 % showed a high level of satisfaction with their activity.
CONCLUSIONS: A multimodal educational intervention using TikTok platform proved to be effective in improving the acquisition of theoretical-practical knowledge in the university students included in the study. Therefore, this type of experiential training is recommended for the training of future health professionals.

UNASSIGNED: With a growing aging population, the focus on the health and well-being of older adults, especially in preventing falls, becomes crucial. This 3 month study, initiated in July 2022, aimed to assess the impact of a nutrition and exercise program in senior daycare centers in Chuncheon, South Korea.
UNASSIGNED: A 3 month study, beginning in July 2022, included 204 older adults from 10 senior daycare centers in Chuncheon, South Korea. Randomly assigned to intervention or control groups, the intervention involved nutrition, daily toe exercises, or both. Control centers received interventions post-measurements. Pre- and post-intervention analyses used paired t-tests and multiple linear regression, assessing metrics like toe grip strength for significance. While 204 were initially enrolled, the analysis included 151 participants due to dropouts.
UNASSIGNED: Participants, with a mean age of 83.3 years (43.1% aged ≥ 85 years), exhibited mild to moderate cognitive impairment and multiple chronic illnesses. Health data indicated that 37.3% were obese, and the average BMI was 24.0 kg/m2. Both the intervention and control groups showed significant improvements in toe grip strength post-intervention. Specifically, the exercise-only and combined exercise-nutrition groups demonstrated significant differences in hallux strength compared to the control group after adjusting for age and gender.
UNASSIGNED: The study showed that a basic nutrition and exercise program increased toe strength in older adults with chronic diseases, including mild cognitive impairments. This intervention holds potential to prevent muscle strength decline and reduce fall risks in older individuals. As the first of its kind in Korean senior daycare centers, it emphasizes the need for future research and standardized programs for senior daycare users.

Evidence mapping was performed to systematically search and review the clinical studies about the treatment of insomnia with Chinese patent medicines. The evidence distribution in this field was analyzed and the problems of the studies were summarized. Chinese-and English-language articles of the studies involving the Chinese patent medicines specified in three national drug catalogs for the treatment of insomnia were searched against the databases with the time interval from inception to August 2023. Figures and tables were established to present the results. Finally, 23 Chinese patent medicines were screened out, which were mentioned in 299 articles involving 236 randomized controlled trials(RCTs), 35 non-randomized controlled trials(non-RCTs), 7 retrospective studies, 17 systematic reviews/Meta-analysis, and 4 guidelines/expert recommendations or consensus. Bailemian Capsules, Wuling Capsules, and Yangxue Qingnao Granules were mentioned in a large proportion of articles. The outcome indicators included sleep rating scale, clinical response rate, safety indicators, and anxiety and depression scores. The results showed that the studies about the treatment of insomnia with Chinese patent medicines were growing. However, there was a scarcity of research evidence, and the available studies were single-center with small sample sizes and short periods. These studies spanned broad clinical scopes with inadequately emphasized advantages of TCM and insufficient outcome indicators about quality of life, follow-up, and recurrence rate. RCT exhibited a high risk of bias, and the systematic reviews/Meta-analysis demonstrated low overall quality. The retrospective studies received suboptimal scores, and the non-RCT failed to mention follow-up time, loss rate to follow-up, and sample size estimations, which compromised result reliability. It is recommended that the research protocol for Chinese patent medicines in treating insomnia should adhere to the clinical research standards of TCM. The TCM syndrome score can serves as a crucial outcome measure, and emphasis should be placed on patients\' quality of life, follow-up, and recurrence prevention. Measures should be taken to enhance the accessibility and affordability of Chinese patent medicines and strengthen the connection between medical insurance policies and the policies pertaining to Chinese patent medicines. Furthermore, it is advisable to reasonably increase the inclusion of Chinese patent medicines with well-established efficacy and safety evidence in the category A list of medical insurance.

BACKGROUND: Engaging in physical activity (PA) during adolescence is beneficial for health and positive development. However, most adolescent girls have low PA levels, and there is a need for interventions outside of school hours. This pilot randomised controlled trial aimed to explore the preliminary effectiveness of three different remote PA interventions in increasing adolescent girls\' moderate-to- vigorous PA (MVPA), fitness and psychosocial outcomes.
METHODS: Girls living in the UK or Ireland, aged between 13 and 16 years old, who wished to increase their activity levels, were eligible for the study. Using a random number generator, participants (n = 153; 14.8y ± 1.4) were randomised into one of three 12-week intervention groups (i) PA programme, (ii) Behaviour change support, or (iii) Combined PA programme and Behaviour change support, or (iv) a Comparison group. Outcome measures included accelerometer and self-reported PA, physical fitness (cardiorespiratory fitness; 20 m shuttle run, muscular endurance; push up, muscular strength; long jump), and psychosocial assessments (perceived competence; body appreciation; self-esteem; behavioural regulation). Linear mixed models were used to analyse differences between each intervention arm and the comparison group immediately postintervention (12 weeks) and at follow up (3-months post-intervention), while adjusting for potential confounders.
RESULTS: Participation in the PA programme group was associated with higher perceived competence (0.6, 95% CI 0.1 to 1.2), identified regulation (0.7, 95% CI 0.2 to 1.1) and intrinsic motivation (0.9, 95% CI 0.2 to 1.6) at post-intervention. Participation in the Behaviour change group was associated with higher perceived competence at post-intervention (0.6, 95% CI 0.1 to 1.2), and higher push-up scores at the 3-month follow-up (4.0, 95% CI 0.0 to 7.0). Participation in the Combined group was also associated with higher perceived competence at post-intervention (0.8, 95% CI 0.2 to 1.4), and higher push-up scores at the 3-month follow-up (5.0, 95% CI 1.0 to 8.0). No other significant differences were found between the intervention arms and the comparison group.
CONCLUSIONS: Results suggest perceived competence increased across all intervention arms, while the PA programme group enhanced autonomous motivation in the short term. Intervention arms with behaviour change support appear most promising in improving muscular endurance. However, a larger scale trial is needed for a better understanding of between-group differences and the impact of intervention arms on MVPA and fitness, given the small sample size and short-term follow-up.

BACKGROUND: Radiation-induced dysphagia and restricted mouth opening are common problems among patients with head and neck cancer. The aim of the present randomized controlled trial was to determine if an exercise protocol could prevent swallowing and mouth opening impairment.
METHODS: Eighty-nine participants were randomly assigned to either an active group performing preventive swallowing and mouth opening exercises (n = 45) or to a control group (n = 44). Outcome measures were collected at baseline before radiotherapy and approximately 1-month post-treatment. Primary endpoints were changes in swallowing function according to the Penetration Aspiration Scale and mouth opening ability measured in millimeters. Intention-to-treat analysis was used.
RESULTS: Swallowing function and mouth opening deteriorated in both groups, with no statistically significant positive effect of the protocol detected at follow-up. Among patients who completed >75% of exercises, there was a trend toward better outcomes.
CONCLUSIONS: Preventive exercises did not improve short-term swallowing function and mouth opening after radiotherapy.

UNASSIGNED: This research evaluated the effect of a nurse-facilitated intervention on elderly or medically frail community members\' level of household emergency preparedness as measured in knowledge, actions taken, and supplies gathered. These community members had access and functional needs that must be accommodated during disasters to mitigate their increased risk of injury, illness, and death because of the disaster. With adequate preparedness, it is plausible these community members may survive the aftermath of a disaster without needing assistance from disaster responders.
UNASSIGNED: This was a non-randomized, single group, before-after feasibility study (N = 31) conducted in a one-on-one session with a nurse interventionist in an urban community setting in the United States of America. We used the Household Emergency Preparedness Instrument to measure intervention effectiveness and a Participant Experience Survey to evaluate participant satisfaction with the intervention. The intervention included an educational booklet that provided instruction to participants on how to create a disaster-related evacuation and communication plan and identify community resources. Upon completion of the booklet, participants received a complimentary disaster supply kit.
UNASSIGNED: Mean general preparedness scores increased from 5.5 (SD = 4.1) pre-intervention to 20.2 (SD = 3.1) post-intervention (p < .001). Preparedness in all sub-scales also increased significantly (all ps < .001).
UNASSIGNED: Study findings provide support for the feasibility of the intervention to increase all measured aspects of emergency preparedness (knowledge, behaviors, and supplies) among elderly and medically frail adults with access and functional needs during disasters.

OBJECTIVE: This study explored the potential role of stage-related variables in intervention outcomes in bipolar disorder (BD). Specifically, we aimed to identify which subgroups of individuals were most likely to experience improved quality of life following digitally delivered psychosocial interventions for BD.
METHODS: The study involved a secondary analysis of combined data from two randomised control trials (RCTs). Each trial assessed the effectiveness of digitally delivered interventions for improving quality of life, in late-stage (ORBIT RCT) or early-stage (BETTER RCT) BD. Three iterations of cluster analyses were performed, identifying subgroups of individuals based on (i) current phenomenology, (ii) course of illness and (iii) medication response. The resultant subgroups were compared with regard to changes in quality of life pre-post intervention, via repeated measures ANOVAs.
RESULTS: In each cluster analysis, two clusters were found. The current phenomenology clusters reflected two impairment levels, \'moderate impairment\' and \'low impairment\'. The course of illness clusters reflected \'more chronicity\' and \'less chronicity\' and the medication response clusters reflected \'good medication response\' and \'poor medication response\'. Differences in changes in quality of life over time were observed between the two current phenomenology clusters and between the medication response clusters, while the course of illness subgroups did not respond differently.
CONCLUSIONS: There are at least two distinct groups of treatment-seeking individuals with established BD, based on illness features with previously established links to different illness stages. Clusters within the current phenomenology and medication response domains demonstrated significantly different trajectories of QoL change over time in the context of our interventions, highlighting potential implications for treatment selection aligned with precision psychiatry.

UNASSIGNED: Anemia is associated with fatigue, low physical activity, and poor quality of life. The purpose of this study was to determine the effects of a field trial on 6-month change in anemia and physical activity among nonpregnant women living in rural India.
UNASSIGNED: The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized controlled trial of a social norms-based intervention to reduce anemia among women (15-49 years). Participants (n = 292) performed a modified Queen\'s College Step Test (QCST) and wore an ActivPAL accelerometer for 3 days. Hemoglobin concentrations (g/dL) were determined using a HemoCue 301 photometer. Linear regression tested the effects of the intervention on 6-month change in hemoglobin and physical activity, while adjusting for age, body mass index, education, parity, and predicted VO2max.
UNASSIGNED: We observed no differences in hemoglobin (11.8 ± 1.2 vs.11.6 ± 1.4 g/dL) or overall physical activity (36.6 ± 2.1 vs. 35.3 ± 5.8 metabolic equivalent of task-hours/day) at 6 months between the treatment and control groups, respectively. In contrast, steps/day was significantly higher in the treatment, compared with the control group (β = 1353.83; 95% confidence interval: 372.46, 2335.31), independent of other covariables.
UNASSIGNED: The potential to modify walking and other health-seeking behaviors using a social norms approach is worthy of further investigation among women living in rural India.Clinical Trial Registry - India: CTRI/2018/10/016186.