Explore the vast range of titles available.

Previous reviews on active learning in dental education have not comprehensibly summarized the research activity on this topic as they have largely focused on specific active learning strategies. This scoping review aimed to map the breadth and depth of the research activity on active learning strategies in undergraduate classroom dental education. The review was guided by Arksey & O'Malley's multi-step framework and followed the PRISMA Extension Scoping Reviews guidelines. MEDLINE, ERIC, EMBASE, and Scopus databases were searched from January 2005 to October 2022. Peer-reviewed, primary research articles published in English were selected. Reference lists of relevant studies were verified to improve the search. Two trained researchers independently screened titles, abstracts, and full-texts articles for eligibility and extracted the relevant data. In total, 93 studies were included in the review. All studies performed outcome evaluations, including reaction evaluation alone (n = 32; 34.4%), learning evaluation alone (n = 19; 20.4%), and reaction and learning evaluations combined (n = 42; 45.1%). Most studies used quantitative approaches (n = 85; 91.3%), performed post-intervention evaluations (n = 70; 75.3%), and measured student satisfaction (n = 73; 78.5%) and knowledge acquisition (n = 61; 65.6%) using direct and indirect (self-report) measures. Only 4 studies (4.3%) reported faculty data in addition to student data. Flipped learning, group discussion, problem-based learning, and team-based learning were the active learning strategies most frequently evaluated (≥6 studies). Overall, most studies found that active learning improved satisfaction and knowledge acquisition and was superior to traditional lectures based on direct and indirect outcome measures. Active learning has the potential to enhance student learning in undergraduate classroom dental education; however, robust process and outcome evaluation designs are needed to demonstrate its effectiveness in this educational context. Further research is warranted to evaluate the impact of active learning strategies on skill development and behavioral change in order to support the competency-based approach in dental education.

Background International dietary guidelines aim to reduce risks of all-cause mortality, cardiovascular disease (CVD), and fatal CVD often associated with poor dietary habits. However, most studies have examined associations with individual nutrients, foods, or dietary patterns, as opposed to quantifying the pooled health effects of adherence to international dietary recommendations. We investigated associations between total adherence to the World Health Organization (WHO) dietary recommendations for saturated fats, free sugars, fibre, and fruits and vegetables and all-cause mortality and fatal and non-fatal CVD. Methods We included participants from the UK Biobank cohort recruited in 2006–2010, which provided at least two valid 24-h dietary assessments. We defined adherence to dietary recommendations as ≤ 10% saturated fats, ≤ 10% free sugars, ≥ 25 g/day fibre, and ≥ 5 servings of fruits and vegetables/day. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. In cross-sectional analyses, multivariable linear regression was used to examine associations with cardiometabolic risk factors. Results Among 115,051 participants (39–72 years), only 29.7%, 38.5%, 22.3%, and 9.5% met 0, 1, 2, or 3–4 recommendations, respectively. There was a lower risk of all-cause mortality among participants meeting more dietary recommendations ( P trend < 0.001), with a significantly lower risk among participants meeting 2: HR 0.91 (95% confidence interval [CI] 0.85–0.97) and 3–4: HR 0.79 (95% CI 0.71–0.88) recommendations. There was no trend with CVD risk, but a significantly lower risk of fatal CVD with 3–4 recommendations: HR 0.78 (95% CI 0.61–0.98). Meeting more recommendations resulted in significant cross-sectional trends ( P trend < 0.001) towards lower body fat, waist circumference, LDL cholesterol, apolipoprotein B, triglycerides, alkaline phosphatase, gamma glutammyltransferase, and hs-CRP, but higher glucose and aspartate aminotransferase. Conclusions Meeting dietary recommendations is associated with additive reductions in premature mortality. Motivating and supporting people to adhere to dietary guidelines may help extend years of healthy life expectancy.

All too often, what's important to patients differs from what health researchers want to study. A recent review in the field of kidney dialysis, for example, showed that only one in five clinical studies addressed an issue that was on a top-10 list prioritized by patients, their caregivers and clinicians. Researchers were mostly focused on hemodialysis, whereas patients were more concerned with troubling symptoms, such as itching, cramping and restless legs. Patient-oriented research, in which patients play an integral role in the research team, is based on an understanding that people with lived experience of an illness usually have a good idea of what their health care needs are or how they would like to improve their quality of life. It also empowers patients with knowledge and influence while offering researchers greater insight into their area of study.

This cross-sectional study evaluated the nutritional composition and labelling of commercial foods in Canada targeted to infants up to 18 months of age. Front-of-package labelling requirements were assessed based on daily values identified by Health Canada for saturated fatty acids, sugars, and sodium for children aged one year and older. Infant commercial food products were identified from online and in-person records of retailers across Canada. A total of 1,010 products were identified. Products aimed at older infants (12–18 months) contained significantly more calories, macronutrients, sugars, saturated fat, and trans fat compared to those targeted at younger infants (<12 months). In addition, 40% of products for children aged 12–18 months required a ‘high in sugar’ front-of-package label, while less required a ‘high in saturated fats’ (13%) and ‘high in sodium’ (5%) label. Organic products had higher added sugar and fibre, while they were lower in calories, total fat, saturated fat, and protein. Plant-based products, including vegetarian/vegan products, contained fewer calories, fat, saturated fat, trans fat, and protein, but more fibre. Gluten-containing products had more calories, macronutrients, sugar, fibre, and saturated fat. Non-GMO labelled products had more calories, carbohydrates, and sugar, but less saturated fat. Significant differences were observed for vitamins and minerals across food categories (p < 0.05). Our findings offer valuable guidance for parents, caregivers, and healthcare professionals on infant nutrition, highlighting the importance of selecting foods that align with infants’ specific dietary needs.

Natural disasters can lead to more adverse pregnancy outcomes (APO). It is unclear if the extended COVID-19 pandemic has impacted APOs and pre-existing conditions among perinatal populations with increased risk of severe maternal morbidity and mortality. A retrospective chart review was conducted of hospital records and birth certificates in the largest birth hospital in Louisiana from 2017 to 2022. Amongst 27,877 births (50.9% White, 38.3% Black, 28.9 ± 5.6 years), gestational diabetes (GDM) was lowest in pre-pandemic conceptions (11.0%, June 2017-May 2019) and rose to 16.4% early pandemic (October 2019-February 2020) but leveled off at 12.2% in peak (March 2020-February 2021) and late pandemic (March 2021-September 2021). Individuals who conceived in early and peak pandemic were 47% (95% CI 33, 63) and 11% (95% CI 2, 20) more likely to develop GDM respectively, compared to pre-pandemic conceptions. Individuals who delivered during early (aRR: 1.54, 95% CI 1.33–1.78), peak (aRR: 1.48, 95% CI 1.32–1.65), and late (aRR: 1.62, 95% CI 1.41, 1.85) pandemic were more likely to develop preeclampsia and HELLP syndrome compared to pre-pandemic conceptions. Individuals were also 17% (95% CI 5, 32) more likely to enter pregnancy with chronic hypertension in peak pandemic compared to pre-pandemic. In paired analysis ( n  = 3390), individuals with a pandemic conception that occurred early pandemic had a higher risk of developing GDM compared to their pre-pandemic pregnancy (aOR 3.26, 95% CI 1.52, 6.97). Supporting birthing individuals amongst significant stressful events, especially in early gestation, is critical for preventing APOs and severe maternal morbidity and mortality.

Dietary self-monitoring is a behaviour change technique used to help elicit and sustain dietary changes over time. Current dietary self-monitoring tools focus primarily on itemizing foods and counting calories, which can be complex, time-intensive, and dependent on health literacy. Further, there are no dietary self-monitoring tools that conform to the plate-based approach of the 2019 Canada Food Guide (CFG), wherein the recommended proportions of three food groups are visually represented on a plate without specifying daily servings or portion sizes. This paper explored the perceptions of end-users (i.e., general public) and Registered Dietitians of iCANPlate TM —a dietary self-monitoring mobile application resembling the CFG. Qualitative data were collected through virtual focus groups. Focus group questions were based on the Capability, Opportunity, Motivation-Behaviour (COM-B) theoretical framework to explore perceptions of using the CFG and currently available dietary self-monitoring tools. The prototype iCANPlate TM (version 0.1) was presented to gain feedback on perceived barriers and facilitators of its use. Focus group discussions were audio recorded and verbatim transcribed. Trained researchers used thematic analysis to code and analyze the transcripts independently. Seven focus groups were conducted with Registered Dietitians (n = 44) and nine focus groups with members from the general public (n = 52). During the focus groups, participants mainly discussed the capabilities and opportunities required to use the current iteration of iCANPlate TM . Participants liked the simplicity of the application and its capacity to foster self-awareness of dietary behaviours rather than weight control or calorie counting. However, concerns were raised regarding iCANPlate TM ’s potential to improve adherence to dietary self-monitoring due to specific characteristics (i.e., insufficient classifications, difficulty in conceptualizing proportions, and lack of inclusivity). Overall, participants liked the simplicity of iCANPlate TM and its ability to promote self-awareness of dietary intakes, primarily through visual representation of foods on a plate as opposed to reliance on numerical values or serving sizes, were benefits of using the app. Findings from this study will be used to further develop the app with the goal of increasing adherence to plate-based dietary approaches.

Underserved pregnant women have a greater risk of excessive or inadequate gestational weight gain (GWG) and adverse perinatal outcomes. In the United States, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental nutrition and is uniquely positioned to deliver equitable interventions that support recommended GWG. Yet to date, no randomized controlled trials have evaluated behavioral strategies for managing GWG in this setting. The primary objective was to examine the effects of a statewide randomized multicomponent mobile eHealth lifestyle intervention trial on change in physical activity and sedentary time across pregnancy. The secondary objective was to explore associations between changes in physical activity, sedentary time, and GWG. A total of 351 pregnant women were recruited from the Louisiana WIC clinics and were randomly assigned to a multicomponent mobile eHealth intervention for GWG management (N=179) or usual care (N=172; standard in-person WIC care) prior to 16 weeks of gestation. The multicomponent mobile intervention included daily weighing, step tracking, counseling, exercise videos, health coach interactions, and social support. For the first objective, physical activity, including movement duration and movement context, and sedentary time were assessed at baseline (early pregnancy) and at the end of the intervention (late pregnancy) using accelerometry and the Pregnancy Physical Activity Questionnaire. For the second objective, GWG was determined based on weight collected at study visits in early and late pregnancy. Linear mixed models assessed intervention effects on physical activity and GWG. Both the Intervention Group and the Usual Care Group significantly increased sedentary time from early to late pregnancy (adjusted effect estimate [95% CI] 62 minutes per day (42-83), P<.001 and 52 minutes per day (31-72), P<.001, respectively). Both the Intervention Group and the Usual Care Group significantly decreased moderate activity (-13 minutes per day (-20 to -6), P<.001 and -10 minutes per day (-17 to -3), P=.01, respectively) and total moderate to vigorous physical activity (-14 minutes per day (-21 to -7), P<.001 and -10 minutes per day (-18 to -3), P=.01, respectively) from early to late pregnancy. For the Pregnancy Physical Activity Questionnaire, the Intervention Group reported an increase in sports participation across pregnancy compared with the Usual Care Group (+4 metabolic equivalent task (MET)-hours per week (2-7); P=.002). There were no associations between physical activity (-7 g (-32 to 18), P=.57) or sedentary time measures (4 g (-4 to 12), P=.31) and GWG. The first of its kind mobile eHealth multicomponent behavioral lifestyle intervention that included guidance to increase physical activity toward national guidelines did not meaningfully impact physical activity outcomes in pregnant women who were enrolled in Louisiana WIC. ClinicalTrials.gov NCT04028843; https://www.clinicaltrials.gov/study/NCT04028843. RR2-10.2196/18211.

Background Stressful large-scale events, such as the COVID-19 pandemic and natural disasters, impact birthing individuals’ postpartum experiences and their mental health. Resultant changes in government assistance, housing, and employment may further exacerbate these impacts, with differences experienced by varying income levels and races. This study aimed to examine maternal depression and anxiety in postpartum individuals by income and race during a stressful large-scale event, and the mediating role of government assistance, housing, and employment. Methods An explanatory sequential mixed methods study was conducted (QUANT + QUAL). For aim 1 (quantitative), birthing individuals who delivered during peak pandemic (June 2020 - September 2021) completed questionnaires related to their perinatal experiences and mental health. Macrosystem factors (government assistance, housing, and employment changes) were assessed using the Psychosocial Recommended Measures. The Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 (GAD7) assessed depression and anxiety, respectively. Serial linear regression models assessed the relationship between race and income with mental health and macrosystem factors. For aim 2 (qualitative), 40 individuals from the quantitative study balanced by income (low vs. high income) and race (Black vs. White) completed one-on-one semi-structured interviews which were analyzed using thematic analysis. Results Amongst 1582 birthing individuals, Black individuals had a significantly higher EPDS score compared to White counterparts. Not receiving government assistance, unstable housing, and experiencing various employment changes were all related to worse mental health during stressful large-scale events. In semi-structured interviews, low-income individuals discussed that government assistance helped alleviate a financial and mental burden. Low- and high-income individuals reported varying job changes that impacted their mental health (low-income: job loss, high-income: increased hours). Conclusions This research spotlights the negative impact of large-scale events most affected both Black and low-income individuals’ postpartum mental health, and the role of government assistance, stable housing, and secure employment in helping to alleviate these disparities between income levels.

Many adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management. To explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for pediatric weight management. In this multi-centre, qualitative description study, we used purposeful sampling to recruit 13-17 year olds (body mass index ≥85th percentile) enrolled in one of two pediatric weight management clinics in Edmonton and Ottawa, Canada. Adolescents participated in one-on-one, in-person, semi-structured interviews in English or French. Interviews lasted 30-60 minutes, were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive, semantic thematic analysis. In total, 19 adolescents (12 Anglophone and 7 Francophone; 15.1±1.7 years old; 3.5±0.6 BMI z-score; n = 11 female; n = 13 Caucasian) participated. Adolescents reported diverse barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits, which we organized into the following themes: physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. Across these themes and lifestyle areas, we identified three shared barriers and/or enablers, including the degree of controllability, the impact of mental health, and social pressures related to weight management. This research provides evidence that can be used to tailor interventions and health services delivery, including a focus on psychosocial well-being, to support adolescents with obesity in making and maintaining healthy lifestyle behavior changes.

IntroductionIn pregnancy, people with obesity or excess adiposity are prone to excess gestational weight gain (GWG) and have the highest risks for multiple maternal morbidities. Epidemiological studies suggest that the lowest incidence of adverse maternal and infant outcomes occurs with GWG lower than current recommendations (<5 kg) and with gestational weight maintenance, resulting in fat mass loss, in those with obesity. Data from randomised clinical trials are needed to evaluate the efficacy of a fat mass loss intervention on pregnancy outcomes. The objective of this proof-of-principle randomised controlled trial is to test the effect of a gestational fat mass loss intervention in pregnant individuals with obesity on changes in weight, fat mass and cardiometabolic disease risk factors.Methods and analysisIn this two-site randomised parallel group, 100 women (30% black; 30% Hispanic) with pre-existing obesity (31.0≤body mass index≤55.0 kg/m2) are randomised to usual care (Provider Directed Group) or usual care plus a fat mass loss intervention with food provision (Weight Maintenance Group). The primary outcomes of the trial (Healthy Mamas/Mamis Saludables) are weight, fat mass (via three-compartment model) and cardiometabolic disease risk factors (ie, blood pressure, lipids, glucose, insulin) from baseline (~13 weeks gestation) to ~35 weeks gestation and at 2 weeks postpartum. Secondary aims evaluate the safety of the fat mass loss intervention during pregnancy and test the hypotheses that compared with usual care, the intervention will have no significant adverse effect on fetal growth, neonatal size, infant body composition and other adverse events. Mediators (eg, eating, activity) and moderators (eg, parity, obesity grade, race/ethnicity) of intervention effects are also examined. Finally, the study will explore the effect of prenatal fat mass loss on reducing the incidence of adverse obstetrical outcomes, including non-elective caesarean delivery, gestational diabetes, hypertension and pre-eclampsia.Ethics and disseminationThe trial has been approved by the Pennington Biomedical Research Center Institutional Review Board, is monitored by an independent data and safety monitoring board and will be conducted in agreement with the Declaration of Helsinki. All results, positive, negative and inconclusive, will be disseminated at national and/or international scientific meetings and in peer-reviewed scientific journals.Trial registration number NCT04731688.