A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial

Mental health and psychosocial interventions to limit the adverse psychological effects of disasters and emergencies in China: a scoping review

Exposure to disasters and public health emergencies negatively affects mental health. Research documenting the psychosocial responses to these calamities in China increased dramatically after the 2008 Wenchuan earthquake. However, there is no comprehensive assessment of the available literature on China's mental health and psychosocial support (MHPSS) responses to these events. This scoping review systematically maps existing published research and grey literature sources regarding MHPSS to disasters and emergencies in China. We examined relevant literature in English and Chinese from six databases and official websites from Jan 1, 2000, to Aug 13, 2021, and included 77 full-text records in this review. The main types of interventions reported included a) stepped care intervention models, b) individual structured psychotherapy and pharmacotherapy, c) mental health education, d) psychological counselling, and e) government-based policy interventions. Most interventions were evaluated using quantitative methods that assessed the treatment of common mental disorders. The review found that rapid national mobilization, emphasis on resilience-strengthening interventions, and the widespread use of step-care models were essential components of reducing the adverse psychosocial effects of disasters. The review also identified remaining gaps, including a) a lack of integration of disaster-related services with the pre-existing health care system, b) inadequate supervision of MHPSS providers, and c) limited monitoring and evaluation of the services provided. These results show where additional research is needed in China to improve mental health services. It also provides a framework that other countries can adapt when developing and evaluating MHPSS policies and plans in response to disasters.

The effects of physical activity on pediatric eyes: A systematic review and meta-analysis

INTRODUCTION

Examining the retina represents a non-invasive method to evaluate abnormalities pertaining to the nervous and cardiovascular systems. Evidence indicates that physical activity is a non-pharmacological intervention to enhance the nervous and cardiovascular systems. However, little is unknown about its effects on ocular characteristics in children and adolescents. The purpose of this study was to examine the effects of physical activity interventions on ocular characteristics in children and adolescents.

METHOD

The electronic bases Web of Science, Embase, Cochrane Library, PubMed, SPORTDiscus, CINAHL, and ERIC were searched from inception to May 2023. Incorporated were randomized controlled trials or quasi-experimental designs that had implemented acute or chronic physical activity interventions among children and adolescents to evaluate various eye-related attributes via clinical examinations or surveys. Two authors independently performed the data extraction and risk of bias assessment, utilizing the Physiotherapy Evidence Database checklist.

RESULTS

A total of 474 articles were identified, of which eight articles underwent a systematic review, and six were chosen for meta-analysis. Chronic physical activity interventions positively impacted central retinal artery equivalent (CRAE) with a small to moderate effect (SMD = 0.21; 95% CI 0.04 to 0.39, p = 0.034, I2 = 0%) and central retinal venular equivalent (CRVE) with a small effect (SMD = 0.098; 95% CI 0.08 to 0.11; p = 0.008, I2 = 0%). Intraocular pressure, kinetic visual acuity, and eye strain also improved significantly after physical activity interventions.

DISCUSSION

Participating in chronic physical activity programs appear to impact children and adolescents' eye-related attributes positively.

Pivoting school health and nutrition programmes during COVID-19 in low- and middle-income countries: A scoping review

Background

Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions.

Methods

We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible.

Results

We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition.

Conclusions

We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.

Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries

BACKGROUND

There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma.

OBJECTIVES

To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021.

SELECTION CRITERIA

Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs.

DATA COLLECTION AND ANALYSIS

Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2.

MAIN RESULTS

Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants).

AUTHORS' CONCLUSIONS

The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.

The impact of exercise on mental health during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

Amidst the COVID-19 pandemic, there has been a global surge in mental health challenges. This study (PROSPERO CRD42023443860) aimed to investigate the impact of exercise on individuals' mental health through systematic evaluation and meta-analysis to develop a scientific exercise program.

Methods

We systematically searched the literature up to August 2023 using PubMed, Web of Science, and SCOPUS. The Cochrane Risk Assessment Tool gaged the methodological quality of the included literature.

Results

Among the initially identified 10,343 search records, 12 studies were deemed to meet the criteria for systematic review and meta-analysis. Exercise significantly improved anxiety (SMD -0.81, 95% CI -1.10 to -0.52, p  < 0.00001), depression (-1.02, 95% CI -1.42 to -0.62, p  = 0.0001), stress (-1.05, 95% CI -1.33 to -0.78, p  < 0.00001), and quality of life (1.11, 95% CI 0.81 to 1.41, p  < 0.00001). Subgroup analyzes indicated that a single exercise session lasting 30-40 min had the most pronounced effect on reducing anxiety (-1.29, 95% CI -1.12 to -0.86, p  < 0.00001) and depression (-1.76, 95% CI -2.24 to -1.28, p  < 0.00001). Similarly, an exercise frequency of 3-5 times per week yielded the greatest benefits for anxiety (-1.31, 95% CI -2.15 to -0.46, p  < 0.00001) and depression (-1.27, 95% CI -2.11 to -0.41, p  = 0.0003). Notably, exercise exhibited its most significant impact on depression improvement in the 40-64 age group (-1.32, 95% CI -1.78 to -0.86, p  < 0.00001). Moreover, exercise notably enhanced anxiety levels among individuals in middle and upper-income brackets (-0.99, 95% CI -1.11 to -0.87, p  < 0.00001).

Conclusion

Exercise alleviated anxiety disorders, depression, stress levels, and quality of life during the COVID-19 pandemic. The most significant impact on anxiety and depression improvement is achieved by engaging in 30-40 min of exercise sessions, 3-5 times per week.

Effects of digital psychotherapy for depression and anxiety: A systematic review and bayesian network meta-analysis

OBJECTIVE

To evaluate the effectiveness of digital psychotherapies for depression and anxiety. We conducted a systematic review and network meta-analyses (NMA) to make comparisons of digital psychotherapies.

METHODS

A bayesian NMA was conducted in this study. The databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and CINAL were searched for all eligible randomized controlled trials (RCTs) published from Jan 1, 2012 to Oct 1, 2022. We used the Cochrane Collaboration's Risk of bias tool for quality assessment. The primary outcomes were set as a standardized mean difference model in efficacy to describe continuous outcomes. We used STATA and WinBUGS to conduct a bayesian network meta-analysis of all interventions based on a random-effects model. This study was registered with PROSPERO, number CRD42022374558.

RESULTS

From the retrieved 16,750 publications, we included 72 RCTs (13,096 participants) with the overall medium quality and above. In terms of depression scale, cognitive behavioral therapy (CBT) was more effective than TAU (SMDs 0.53) and NT (SMDs 0.98). In terms of anxiety scale, CBT (SMDs 0.68; SMDs 0.72) and exercise therapy (ERT) (SMDs 1.01; SMDs 1.05) were more effective than TAU and NT.

LIMITATIONS

Uneven quality of literature, simple network, and subjective judgment.

CONCLUSION

Based on NMA results, we suggest that CBT, which is the most commonly used digital technology, should be preferred among digital psychotherapy for relieving depression and anxiety symptoms. Digital exercise therapy is an effective strategy to relieve some anxiety problems in the context of COVID-19.

Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries

Background

Mental disorders affect about one in seven children and adolescents worldwide. Investment in effective child and adolescent mental health prevention, promotion and care is essential. To date, however, the evidence from this field is yet to be comprehensively collected and mapped.

Objectives

The objective of this evidence and gap map (EGM) is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in lower-middle-income countries (LMICs).

Search Methods

We searched for studies from a wide range of bibliographic databases, libraries and websites. All searches were conducted in December 2021 and covered the period between 2010 and 2021.

Selection Criteria

We included evidence on the effectiveness of any Mental Health and Psychosocial Support (MHPSS) interventions targeting children and adolescents from 0 to 19 years of age in LMICs. The map includes systematic reviews and effectiveness studies in the form of randomised control trials and quasi-experimental studies, and mixed-methods studies with a focus on intervention effectiveness.

Data Collection and Analysis

A total of 63,947 records were identified after the search. A total of 19,578 records were removed using machine learning. A total of 7545 records were screened independently and simultaneously by four reviewers based on title and abstract and 2721 full texts were assessed for eligibility. The EGM includes 697 studies and reviews that covered 78 LMICs.

Main Results

School-based interventions make up 61% of intervention research on child and adolescent mental health and psychosocial support. Most interventions (59%) focusing on treating mental health conditions rather than preventing them or promoting mental health. Depression (40%, N = 282) was the most frequently researched outcome sub-domain analysed by studies and reviews, followed by anxiety disorders (32%, N = 225), well-being (21%, N = 143), and post-traumatic stress disorder (18%, N = 125). Most included studies and reviews investigated the effectiveness of mental health and psychosocial support interventions in early (75%, N = 525) and late adolescence (64%, N = 448).

Conclusions

The body of evidence in this area is complex and it is expanding progressively. However, research on child and adolescent MHPSS interventions is more reactive than proactive, with most evidence focusing on addressing mental health conditions that have already arisen rather than preventing them or promoting mental health. Future research should investigate the effectiveness of digital mental health interventions for children and adolescents as well as interventions to address the mental health and psychosocial needs of children in humanitarian settings. Research on early childhood MHPSS interventions is urgently needed. MHPSS research for children and adolescents lacks diversity. Research is also needed to address geographical inequalities at the regional and national level. Important questions also remain on the quality of the available research-is child and adolescent MHPSS intervention research locally relevant, reliable, well-designed and conducted, accessible and innovative? Planning research collaborations with decision-makers and involving experts by experience in research is essential.

Interventions to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents: a systematic review and meta-analysis

The psychosocial health of children and adolescents has been particularly affected by the COVID-19 pandemic. Containment measures have restricted social development, education and recreational activities, may have increased family conflicts and, in many cases, led to feelings of loneliness, sleep disturbances, symptoms of anxiety and depression. We conducted a systematic review to identify interventions that seek to ameliorate these detrimental effects of the COVID-19 pandemic and to build resilience in children and adolescents. Literature searches were conducted in the databases MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO COVID-19 Global literature on coronavirus disease and Cochrane COVID-19 Study Register (up to 30 June 2022). The searches retrieved 9557 records of which we included 13 randomized-controlled trials (RCTs) for evidence synthesis. Included studies predominantly implemented online group sessions for school-aged children with either a psychological component, a physical activity component, or a combination of both. A meta-analysis of seven studies on anxiety and five on depressive symptoms provided evidence for a positive effect of interventions by reducing anxiety (Standardized Mean Difference (SMD) (95% CI): - 0.33 (- 0.59; - 0.06)) and depressive symptoms (SMD (95% CI): - 0.26 (- 0.36; - 0.16)) compared to the control interventions. Studies also showed improvements in positive mental health outcomes, such as resilience (n = 2) and mental and psychological wellbeing (n = 2). Exploratory subgroup analyses suggested a greater effectiveness of interventions that (i) are of higher frequency and duration, (ii) enable personal interaction (face-to-face or virtually), and (iii) include a physical activity component. Almost all studies were judged to be at high risk of bias and showed considerable heterogeneity. Further research may focus on the contribution of different intervention components or distinct subgroups and settings, and should examine children and adolescents over longer follow-up periods.

Physical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis

BACKGROUND

The coronavirus disease (COVID-19) and universal mitigation strategies have fundamentally affected peoples' lives worldwide, particularly during the first two years of the pandemic. Reductions in physical activity (PA) and increased mental health (MH) problems among children and youth have been observed. This systematic review and meta-analysis investigated the relationship between physical activity (PA) and mental health (MH) among children and youth during the COVID-19 pandemic.

METHODS

Four electronic databases (EMBASE, PsycINFO, PubMed, and Web of Science) were systematically searched to identify studies that (1) examined the relationship between PA and MH among children and youth (aged 2-24 years old) and (2) were published in peer-reviewed journals in English between January 2020 and December 2021. Relationships between PA and two MH aspects (i.e., negative and positive psychological responses) among children and youth at different age ranges and those with disabilities or chronic conditions (DCC) were synthesized. Meta-analyses were also performed for eligible studies to determine the pooled effect size.

RESULTS

A total of 58 studies were eventually included for variable categorization, with 32 eligible for meta-analyses. Our synthesis results showed that greater PA participation was strongly related to lower negative psychological responses (i.e., anxiety, depression, stress, insomnia, fatigue, and mental health problems) and higher positive psychological responses (i.e., general well-being and vigor) in children and youth during COVID-19. The pattern and strength of relations between PA and MH outcomes varied across age ranges and health conditions, with preschoolers and those with DCC receiving less attention in the existing research. Meta-analysis results showed that the magnitude of associations of PA with negative (Fisher's z = - 0.198, p < 0.001) and positive (Fisher's z = 0.170, p < 0.001) psychological responses among children and youth was weak. These results were linked to age of participants, study quality, and reporting of PA-related information.

CONCLUSIONS

PA participation and MH among children and youth deteriorated during the COVID-19 pandemic and were closely associated with each other. For the post-COVID-19 era, additional research on age- and health condition-specific relationships between PA and MH outcomes from a comprehensive perspective is warranted. (Word count: 344 words).

Understanding Mobile Health and Youth Mental Health: Scoping Review

BACKGROUND

A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy.

OBJECTIVE

The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes.

METHODS

Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis.

RESULTS

The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results.

CONCLUSIONS

This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.

Interventions to improve well-being among children and youth aged 6-17 years during the COVID-19 pandemic: a systematic review

BACKGROUND

The COVID-19 pandemic is an example of a global infectious disease outbreak that poses a threat to the well-being of children and youth (e.g., physical infection, psychological impacts). The consequences of challenges faced during COVID-19 may be longstanding and newly developed interventions are being deployed. We present a narrative synthesis of available evidence from the first 2 years of the COVID-19 pandemic on the feasibility, accessibility, and effects of interventions to improve well-being among children and youth to inform the development and refinement of interventions relevant to post-pandemic recovery.

METHODS

Six databases were searched from inception to August 2022. A total of 5484 records were screened, 39 were reviewed in full text, and 19 studies were included. The definition of well-being and the five domains of well-being as defined by the Partnership for Maternal, Newborn & Child Health and the World Health Organization in collaboration with the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being were used.

RESULTS

Nineteen studies (74% randomized controlled trials) from 10 countries were identified, involving a total of 7492 children and youth (age range: 8.2-17.2 years; 27.8-75.2% males) and 954 parents that occurred during the COVID-19 pandemic (March 2020 to March 2021). Nearly all interventions (n = 18, 95%) targeted health and nutrition, followed by connectedness (n = 6, 32%), while fewer studies targeted agency and resilience (n = 5, 23%), learning and competence (n = 2, 11%), or safety and support (n = 1, 3%). Five interventions (26%) were self-guided while 13 interventions (68%) were guided synchronous by a trained professional, all of which targeted physical and mental health subdomains within health and nutrition; one intervention (5%) was unclear.

CONCLUSIONS

Studies deploying synchronous interventions most often reported improved well-being among children and youth largely in the domain of health and nutrition, specifically physical and mental health. Targeted approaches will be crucial to reach sub-groups of children and youth who are most at risk of negative well-being outcomes. Further research is needed to determine how interventions that best supported children and youth early in the pandemic are different from interventions that are required now as we enter into the post-pandemic phase.

TFOS Lifestyle: Impact of the digital environment on the ocular surface

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis

BACKGROUND

Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care.

OBJECTIVE

We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance.

RESULTS

Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I²=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high.

CONCLUSIONS

Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal.

TRIAL REGISTRATION

PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.

A Creative and Movement-Based Blended Intervention for Children in Outpatient Residential Care: A Mixed-Method, Multi-Center, Single-Arm Feasibility Trial

The COVID-19 pandemic led to psychological distress among children and adolescents. Due to multiple psychosocial burdens, the youth in residential care were especially exposed to an increased risk of mental health problems during the pandemic. In a multi-center, single-arm feasibility trial, N = 45 children and adolescents aged 7-14 years were allocated to a 6-week blended care intervention, conducted in six outpatient residential child welfare facilities. The intervention covered a once weekly face-to-face group session for guided creative (art therapy, drama therapy) and movement-oriented (children's yoga, nature therapy) activities. This was accompanied by a resilience-oriented mental-health app. Feasibility and acceptance analyses covered app usage data and qualitative data. Effectiveness was determined by pre-post comparisons in quantitative data on psychological symptoms and resources. Further, subgroups for poorer treatment outcome were explored. The intervention and app were considered to be feasible and were accepted by residential staff and the children. No significant pre-post changes were found across quantitative outcomes. However, being female, being in current psychosocial crisis, a migration background, or a mentally ill parent were correlated with change in score of outcomes from baseline. These preliminary findings pave the way for future research on blended care interventions among at-risk children and adolescents.

Effects of Greenness on Myopia Risk and School-Level Myopia Prevalence Among High School-Aged Adolescents: Cross-sectional Study

BACKGROUND

Myopia is a serious public health issue. High school-aged adolescents in Beijing have an alarming prevalence of myopia. Therefore, determining myopia protective factors is essential. Green space has a certain association with myopia protective factors that can protect against myopia.

OBJECTIVE

This study aims to examine the effects of green space around schools on individual myopia risk in high school-aged adolescents and the school-level myopia prevalence.

METHODS

Green space was measured using the normalized difference vegetation index (NDVI). A total of 13,380 samples of 51 high schools were selected from a 2021 Beijing Municipal Health Commission survey. Adolescent myopia was defined as a spherical equivalent of ≤-1.00 diopters in the worse eye. Generalized linear mixed models with a binomial error structure were used to analyze the effects of the NDVI on personal myopia risk and adjust them by other factors, such as demographics, exposure time, and outdoor exercise. The effects of the NDVI on school-level myopia prevalence with adjusted demographics and the relative position factors of trees were analyzed through quasibinomial regression.

RESULTS

The overall prevalence of myopia was 80.61% (10,785/13,380, 95% CI 79.93%-81.27%). Although with a 0.1 increase in the 500 and 1000 m buffer NDVIs adjusted by demographic and other factors, the high school-aged personal myopia risk significantly dropped by 16% (odds ratio [OR] 0.84, 95% CI 0.73-0.97) and 12% (OR 0.88, 95% CI 0.79-0.99), respectively. However, only the adjusted 500 m buffer NDVI (by demographics and the position of trees) with a 0.1 increase significantly reduced the school-level myopia prevalence by 15% (OR 0.85, 95% CI 0.74-0.98). Subgroup analysis showed that the adjusted effects of the 500 m buffer NDVI are significant in schoolgirls (OR 0.82, 95% CI 0.72-0.93), juniors (OR 0.82, 95% CI 0.72-0.94), the Han nationality (OR 0.84, 95% CI 0.72-0.97), 1-year exposure (OR 0.84, 95% CI 0.71-0.99) and 3-year exposure (OR 0.78, 95% CI 0.65-0.94).

CONCLUSIONS

The greenness of a 500 m buffer around schools is associated with a lower personal myopia risk among adolescents and a lower prevalence of myopia in schools. With regard to prevention and control activities, green space within a 500 m buffer around schools is suggested as an independent protective factor for adolescent myopia.

Characteristics and Potential Challenges of Digital-Based Interventions for Children and Young People: Scoping Review (Preprint)

BACKGROUND

Digital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them.

OBJECTIVE

This study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people.

METHODS

This scoping review was conducted using the framework of Arksey and O'Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022.

RESULTS

The initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described.

CONCLUSIONS

We identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.

THE EFFECT OF DISTANCE LEARNING IN COLLEGES AND UNIVERSITIES ON PHYSICAL HEALTH PROMOTION IN COLLEGE STUDENTS

ABSTRACT Introduction Influenced by the traditional teaching methods of physical education, the teaching activities of athletics are exclusive to the outdoor environment, which is very common in China, resulting in many disadvantages in teaching these sports by distance, restricting career development and requiring adaptations due to current circumstances. Objective Provide a theoretical basis to further improve the level of physical health of university students and substantiate the necessary adaptations to the teaching of athletics in colleges and universities. Methods This paper reviews the physical health status of university students, raises the reasons for their decline, and analyzes the role of teaching athletics activities in promoting the physical health of university students. Results The performance of physical activities related to athletics promotes the physical health of university students. Conclusion Athletic sports play an important role in the health promotion of university students, not receiving proper care currently, lacking more attention in its promotion by responsible agents. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Interventions with Digital Tools for Mental Health Promotion among 11-18 Year Olds: A Systematic Review and Meta-Analysis

The availability of digital tools aiming to promote adolescent mental health is rapidly increasing. However, the field lacks an up-to-date and focused review of current evidence. This study thus looked into the characteristics and efficacy of digital, evidence-based mental health programs for youth (11-18 years). The selection procedure followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and resulted in 27 eligible studies. The high heterogeneity of the results calls for careful interpretation. Nevertheless, small, but promising, effects of digital tools were found with respect to promoting well-being, relieving anxiety, and enhancing protective factors. Some important factors influencing overall efficacy include the given setting, the level of guidance and support, and the adherence to the intervention.

The insufficiency of the Malaysian contact tracing app from the perspective of Chinese tourists: preparing for international tourism in the post-COVID-19 world

Understanding tourists' feedback on using Mysejahtera is critical for tourism recovery in these destinations, and even more so for countries like Malaysia and China, where national Contact Tracing Applications (CTA) are mandatory. However, Previous surveys on CTA use have mainly focused on voluntary CTA users, using qualitative research methods. In this research, Chinese overseas students in Malaysia are included as the reference group, and Chinese tourists with experiences traveling overseas are put into the experimental group. A total of 890 questionnaires were collected and taken as the original data to carry out the Chi-squared and Mann-Whitney U tests. Meanwhile, the experiment implemented a multiple linear regression mechanism to explore the variables that may improve the app Mysejahtera, with further analysis being conducted. According to the results, language issues are the most significant barrier to Chinese visitors using MySejahtera; the inability to register with a Chinese mobile phone number and the need to register a permanent address in Malaysia have a significant negative impact on the use of MySejahtera; and visitors' trust in science positively related to MySejahtera use.

Being Physically Active Leads to Better Recovery Prognosis for People Diagnosed with COVID-19: A Cross-Sectional Study

The regular practice of physical activity helps in the prevention and control of several non-communicable diseases. However, evidence on the role of physical activity in mitigating worsening clinical outcomes in people with COVID-19 is still unclear. The aim of this study was to verify whether different levels of physical activity provide protection for clinical outcomes caused by SARS-CoV-2 infection. A cross-sectional study was conducted with 509 adults (43.8 ± 15.71 years; 61.1% female) with a positive diagnosis of COVID-19 residing in Ribeirão Preto, São Paulo, Brazil. Participants were interviewed by telephone to determine the severity of the infection and the physical activity performed. Binary logistic regression was used to indicate the odds ratio (OR) of active people reporting less harmful clinical outcomes from COVID-19. Active people had a lower chance of hospitalization, fewer hospitalization days, less respiratory difficulty and needed less oxygen support. The results suggest that active people, compared to sedentary people, have a lower frequency of hospitalization, length of stay, breathing difficulty and need for oxygen support. These results corroborate the importance of public policies to promote the practice of physical activity, in order to mitigate the severity of the clinical outcomes of COVID-19.

Prevalence of Frailty and Its Association with Depressive Symptoms among European Older Adults from 17 Countries: A 5-Year Longitudinal Study

BACKGROUND

This study aimed to examine the association between frailty and depressive symptoms.

METHODS

Cross-sectional and five-year longitudinal study. Data were from the population-based Survey of Health, Aging, and Retirement in Europe (SHARE) waves six (2015) and eight (2020). Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported, and grip strength was measured using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depressive symptoms.

RESULTS

The sample comprised 25,771 older adults (56.2% female) with a mean age of 66.5 (95% CI 66.4, 66.6) years. The prevalence of frailty was 4.2% (95% CI 3.9, 4.4) in 2015 and 6.7% (95% CI 13.5, 14.3) in 2020. Among frail participants, 72.5% and 69.6% had depression in 2015 and 2020, respectively. Frailty was associated with depression over the 5 years. Those with pre-frailty and those with frailty in 2015 had 1.86 (95% CI 1.71, 2.01) and 2.46 (95% CI 2.14, 2.83) greater odds of having depressive symptoms in 2020.

CONCLUSIONS

Frailty is a predictor of depression in older adults, and frail participants had greater odds of presenting depressive symptoms.

Digital Eye Strain- A Comprehensive Review

Digital eye strain (DES) is an entity encompassing visual and ocular symptoms arising due to the prolonged use of digital electronic devices. It is characterized by dry eyes, itching, foreign body sensation, watering, blurring of vision, and headache. Non-ocular symptoms associated with eye strain include stiff neck, general fatigue, headache, and backache. A variable prevalence ranging from 5 to 65% has been reported in the pre-COVID-19 era. With lockdown restrictions during the pandemic, outdoor activities were restricted for all age groups, and digital learning became the norm for almost 2 years. While the DES prevalence amongst children alone rose to 50-60%, the symptoms expanded to include recent onset esotropia and vergence abnormalities as part of the DES spectrum. New-onset myopia and increased progression of existing myopia became one of the most significant ocular health complications. Management options for DES include following correct ergonomics like reducing average daily screen time, frequent blinking, improving lighting, minimizing glare, taking regular breaks from the screen, changing focus to distance object intermittently, and following the 20-20-20 rule to reduce eye strain. Innovations in this field include high-resolution screens, inbuilt antireflective coating, matte-finished glass, edge-to-edge displays, and image smoothening graphic effects. Further explorations should focus on recommendations for digital screen optimization, novel spectacle lens technologies, and inbuilt filters to optimize visual comfort. A paradigm shift is required in our understanding of looking at DES from an etiological perspective, so that customized solutions can be explored accordingly. The aim of this review article is to understand the pathophysiology of varied manifestations, predisposing risk factors, varied management options, along with changing patterns of DES prevalence post COVID-19.

Prevalence and Risk Factors of Parents Perceived Digital Eye Strain Syndrome among Saudi Students 1 Year after Online Studies: A Web-Based Survey

PURPOSE

The purpose is to present the prevalence and risk factors of parents' perceptions of digital eye strain (DES) syndrome 1 year after virtual learning among Saudi students.

METHODS

This web-based survey was conducted in December 2021 in Qassim, Saudi Arabia. Sixteen symptoms of DES were inquired. Parents responded to the frequency and severity of DES symptoms in their wards. The DES score assessed by the parents/guardian was associated with different determinants.

RESULTS

The survey included 704 students. The prevalence of DES was 59.4% (95% confidence interval 55.0; 63.8). Severe (scoring 18+) and moderate (score 12-18) grades of DES were found in 24% and 14% of students, respectively. Headache (20.9%), deterioration of vision (14.5%), difficulty focusing (12.5%), watering/tearing of eyes (10.1%), and blurred vision (10.8%) were noted as main DES symptoms. Girls, intermediate school students, students with spectacles, those with more than 4 h daily screen time or who position devices 25 cm or less from their eyes, and those attending virtual class for more than 4 h a day were found to have significantly severe DES grades. Females (P = 0.16), having outdoor activities of 1+ h (P = 0.02), 2+ h of daily screen time (P = 0.24), and attending virtual class for 4+ h (P = 0.001) were significant predictors of moderate and severe DES. Poor eye health and lower scholastic status were associated with severe DES.

CONCLUSION

DES in students after 1 year of virtual studying was high. Risk factors need to be addressed to avoid DES and its impact on students.

Physical Activity Behavior During and After COVID-19 Stay-at-Home Orders-A Longitudinal Study in the Austrian, German, and Italian Alps

Background

In Alpine regions, which are very similar due to their topographical location and their wide-ranging sports offerings, the restrictions on sports activities during the COVID-19 pandemic differed in type and level: while in some regions (Tyrol, South Tyrol, Trentino), all sports activities were forbidden except for walking near the home, in other regions (Upper Bavaria, Vorarlberg), people were allowed to go hiking and running during the first lockdown.

Objective

The aim of this study was to investigate the change in physical activity (PA) behavior in different Alpine regions (Upper Bavaria, Vorarlberg, Tyrol, South Tyrol, Trentino) over four periods in 2020, to examine the effects of COVID-19 measures of varying severity on PA behavior and to identify factors associated with a change in PA over time.

Methods

A retrospective online survey was conducted (N = 2975) from December 2020, to January 2021. Using the questionnaire of the Eurobarometer 472 study, PA behavior was measured over four periods: before COVID-19 (March), during the first lockdown (March and April), during the relaxed period (May-October) and during the second lockdown (November and December) in 2020.

Results

During the first (M = 5.0h, SD = 4.5) and the second lockdowns (M = 4.9h, SD = 4.3), the participants (age: 42 years, overly active in sports) engaged less in sports than before (M = 5.9h, SD = 4.8) and during the relaxed period in summer (M = 6.4h, SD = 5.0) (average number of hours per week being physically active). A larger percentage of participants from Alpine regions with severe restrictions (Tyrol, South Tyrol, Trentino) decreased their PA during the first lockdown as compared to participants from Upper Bavaria and Vorarlberg with a less strict first lockdown. Those with psychological distress, male participants, and individuals with decreased physical health and less free time during COVID-19 were more likely to reduce their PA.

Conclusions

Despite a short-term negative effect of COVID-19 restrictions on exercise participation during lockdowns, the majority of respondents returned to their original levels of PA during the relaxed COVID-19 phases. As a comparison of Alpine regions shows, particularly severe COVID-19 measures seem to have reduced PA with potential negative health effects. For the future, policy makers and sports organizations should collaborate to support the population in their PA behavior during pandemics to outweigh restrictions.

Application of Telemedicine in COVID-19: A Bibliometric Analysis

Background

Telemedicine as a tool that can reduce potential disease spread and fill a gap in healthcare has been increasingly applied during the COVID-19 pandemic. Many studies have summarized telemedicine's technologies or the diseases' applications. However, these studies were reviewed separately. There is a lack of a comprehensive overview of the telemedicine technologies, application areas, and medical service types.

Objective

We aimed to investigate the research direction of telemedicine at COVID-19 and to clarify what kind of telemedicine technology is used in what diseases, and what medical services are provided by telemedicine.

Methods

Publications addressing telemedicine in COVID-19 were retrieved from the PubMed database. To extract bibliographic information and do a bi-clustering analysis, we used Bicomb and gCLUTO. The co-occurrence networks of diseases, technology, and healthcare services were then constructed and shown using R-studio and the Gephi tool.

Results

We retrieved 5,224 research papers on telemedicine at COVID-19 distributed among 1460 journals. Most articles were published in the Journal of Medical Internet Research (166/5,224, 3.18%). The United States published the most articles on telemedicine. The research clusters comprised 6 clusters, which refer to mental health, mhealth, cross-infection control, and self-management of diseases. The network analysis revealed a triple relation with diseases, technologies, and health care services with 303 nodes and 5,664 edges. The entity “delivery of health care” was the node with the highest betweenness centrality at 6,787.79, followed by “remote consultation” (4,395.76) and “infection control” (3,700.50).

Conclusions

The results of this study highlight widely use of telemedicine during COVID-19. Most studies relate to the delivery of health care and mental health services. Technologies were primarily via mobile devices to deliver health care, remote consultation, control infection, and contact tracing. The study assists researchers in comprehending the knowledge structure in this sector, enabling them to discover critical topics and choose the best match for their survey work.

Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial

Background

Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries.

Objective

We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda.

Methods

The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression.

Results

Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%).

Conclusions

Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries.

Trial Registration

ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146

The Online Strength-Informed Acceptance and Commitment Therapy Among COVID-19-Affected Adolescents

Purpose: This study develops and investigates the changes in anxiety symptoms and quality of life (QoL) among participants of the online Strength-informed Acceptance and Commitment Therapy (SACT) across three tests.

METHODS

A small-scale, quasi-experiment with no control group was conducted. Repeated-measures analysis was employed to assess the changes of the three tests, which were the pre-experimental, post-test, and 3-month follow-up test. A total of 47 adolescents (ages 10-12) completed the 45-min intervention that lasted 10 weeks.

RESULTS

Compared with the pre-experimental, the post-test indicated significant anxiety symptoms reduction but not a statistically significant increase in QoL. The 3-month follow-up test indicated reduced anxiety symptoms and improved QoL compared with the pre-experimental. The with-in subject changes were substantial.

CONCLUSIONS

The online SACT is a promising model to reduce anxiety symptoms and promote QoL among adolescents during the current COVID-19 pandemic, which show both short- and long-term benefit to the participants.

Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy for youth with emotional problems related to the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has led to increased stress, anxiety, and depression in children. A six-session, parent-led, transdiagnostic, cognitive-behavioral teletherapy program was adapted from an established protocol to help youth aged between 5 and 13 years manage emotional problems during the pandemic.

METHODS

One-hundred twenty-nine parents of youth struggling with emotional problems during the COVID-19 pandemic participated in the program. Parents reported on their children's psychosocial functioning before and after treatment using validated assessments. They also reported on treatment satisfaction. Clinician-rated global improvement was assessed at each session to determine clinically significant treatment response.

RESULTS

Significant improvements in parent proxy-reported anxiety (d = 0.56), depression (d = 0.69), stress (d = 0.61), anger (d = 0.69), family relationships (d = 0.32), and COVID-19-related distress (d = 1.08) were found, with 62% of participants who completed the program being classified as treatment responders. Parents reported high levels of satisfaction with the program.

LIMITATIONS

This study was limited by use of primarily parent-report assessments and a lack of a control group.

CONCLUSIONS

Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy appeared to be an effective way to help youth cope with the pandemic and may be a scalable framework in response to large-scale mental health crises.

#KidsAnxiety and the Digital World

This article discusses child onset anxiety disorders in conjunction with the risks and benefits of the rapidly changing digital world including screen time, social media, and potential treatment platforms. A section includes the impact of pandemic stressors including social distancing, quarantining, the association of the pandemic and youth mental health, and prolonged screen time.

The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review

BACKGROUND

Mass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions. Although several forms of psychological interventions may be advocated or used, some may lack strong evidence of efficacy and some may not have been evaluated in mass infectious disease outbreaks. This paper reports a systematic review of published studies (PROSPERO CRD:42020182094. Registered: 24.04.2020) examining the types and effectiveness of psychological support interventions for the general population and healthcare workers exposed to mass infectious disease outbreaks.

METHODS

A systematic review was conducted. Randomised Controlled Trials (RCT) were identified through searches of electronic databases: Medline (Ovid), Embase (Ovid), PsycINFO (EBSCO) and the Cochrane Library Database from inception to 06.05.2021 using an agreed search strategy. Studies were included if they assessed the effectiveness of interventions providing psychological support to the general population and / or healthcare workers exposed to mass infectious disease outbreaks. Studies were excluded if they focused on man-made or natural disasters or if they included armed forces, police, fire-fighters or coastguards.

RESULTS

Twenty-two RCTs were included after screening. Various psychological interventions have been used: therapist-guided therapy (n = 1); online counselling (n = 1); 'Emotional Freedom Techniques' (n = 1); mobile phone apps (n = 2); brief crisis intervention (n = 1); psychological-behavioural intervention (n = 1); Cognitive Behavioural Therapy (n = 3); progressive muscle relaxation (n = 2); emotional-based directed drawing (n = 1); psycho-educational debriefing (n = 1); guided imagery (n = 1); Eye Movement Desensitization and Reprocessing (EMDR) (n = 1); expressive writing (n = 2); tailored intervention for patients with a chronic medical conditions (n = 1); community health workers (n = 1); self-guided psychological intervention (n = 1), and a digital behaviour change intervention (n = 1). Meta-analyses showed that psychological interventions had a statistically significant benefit in managing depression (Standardised Mean Difference [SMD]: -0.40; 95% Confidence Interval [CI]: - 0.76 to - 0.03), and anxiety (SMD: -0.72; 95% CI: - 1.03 to - 0.40). The effect on stress was equivocal (SMD: 0.16; 95% CI: - 0.19 to 0.51). The heterogeneity of studies, studies' high risk of bias, and the lack of available evidence means uncertainty remains.

CONCLUSIONS

Further RCTs and intervention studies involving representative study populations are needed to inform the development of targeted and tailored psychological interventions for those exposed to mass infectious disease outbreaks.

New Technologies for Promoting Physical Activity in Healthy Children and in Children with Chronic Respiratory Diseases: A Narrative Review

Physical activity (PA) is proven to benefit children and adolescents in several ways. New technologies may provide children with stimulating modalities for organizing their leisure time, accessing fitness programs, and obtaining daily goal reminders and peer support. Due to the current COVID-19 pandemic, following WHO recommendations for PA is difficult for many children, especially for those living in urban areas. Therefore, the use of digital tools to support and maintain PA could be useful in healthy children, as well as in those with chronic respiratory diseases (CRDs). This narrative review aims to summarize the most recent evidence about the role of new technologies in promoting PA in healthy children and in those with CRDs, in supporting PA during the COVID-19 pandemic, and in enhancing psychological wellbeing in this age group. The use of technological devices for promoting PA, such as web/mobile apps and games, has been proven to be effective both in healthy children and in those with CRDs. In conclusion, new technologies are very promising in terms of feasibility, acceptability, and efficacy in promoting PA. Further studies are required to evaluate the long-term health benefits of using these technologies.