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Fodor's essential Great Britain
Presents a travel guide to England, Scotland, and Wales, providing recommendations on hotels, restaurants, shopping, local transportation, sights of interest, and nightlife.
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Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review
ObjectiveIn March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called ‘lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown.Design, data sources and eligibility criteriaElectronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale.ResultsSixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.ConclusionGiven the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.
Journal Article
Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses
Background
Diabetic retinopathy is a complication of diabetes affecting the eyes and can lead to blindless if left untreated. Several significant risk factors have been reported for DR, of which several can be classified as some form of disease. Furthermore, several systematic reviews have reported associations between several types of mortality and DR. Numerous meta-analyses have pooled the data on these factors, however, a systematic evaluation of these meta-analytic relationships is lacking. In this study, therefore, we performed an umbrella review of systematic reviews of meta-analyses for mortality, diseases and DR, grading the credibility of evidence.
Methods
A comprehensive database search for observational meta-analyses was conducted from inception until 29/04/2022 against pre-published inclusion criteria. For each meta-analytic outcome, a random-effects meta-analysis was re-conducted, stratifying by study design (and type of DR where possible) of included studies. Several statistical variables, including publication bias, heterogeneity, excess significance bias, and prediction intervals were used to grade the credibility of significant evidence from I to IV, using the recommendations from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
Results
Of the 1,834 initial results, 11 systematic reviews with meta-analyses were included covering 16 independent outcomes (total participants = 299,655; median participants per outcome: 7,266; median individual studies per outcome = 5). Overall, 10/16 outcomes (62.5%) yielded significant results, most of which were graded as ‘highly suggestive’ (Grade II) evidence. DR was associated with all-cause and cardio-vascular mortality, obstructive sleep apnoea, depression eating disorders, and several forms of cognitive impairment.
Conclusions
Results show highly suggestive evidence for associations between health outcomes and/or conditions and DR. Public health professionals and practitioners should note these findings when developing and/or reviewing public health polices.
Journal Article
The prevalence of sensory changes in post-COVID syndrome: A systematic review and meta-analysis
Post-COVID syndrome can be defined as symptoms of COVID-19 that persist for longer than 12 weeks, with several studies reporting persistent symptoms relating to the sensory organs (eyes, ears, and nose). The aim of this systematic review was to examine the prevalence of persistent anosmia, hyposmia, ageusia, and hypogeusia, as well as eye/vision and ear/hearing related long-COVID symptoms. Authors searched the electronic databases from inception to November 2021. Search terms included words related to long-COVID, smell, taste, eyes/vision, and ears/hearing, with all observational study designs being included. A random effects meta-analysis was undertaken, calculating the prevalence proportions of anosmia, hyposmia, ageusia, and hypogeusia, respectively. From the initial pool, 21 studies met the inclusion criteria (total n 4,707; median n per study 125; median age = 49.8; median percentage female = 59.2%) and 14 were included in the meta-analysis The prevalence of anosmia was 12.2% (95% CI 7.7–16.6%), hyposmia 29.9% (95% CI 19.9–40%), ageusia 11.7% (95% CI 6.1–17.3%), and hypogeusia 31.2% (95% 16.4–46.1%). Several eye/vision and ear/hearing symptoms were also reported. Considering that changes in the sensory organs are associated with decreases in quality of life, future research should examine the etiology behind the persistent symptoms.
Journal Article
Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature
The aim was to investigate the effectiveness of glucocorticoid therapy in patients with COVID-19. A systematic search of the literature across nine databases was conducted from inception until 15th March 2020, following the PRISMA guidelines. Patients with a validated diagnosis of COVID-19 and using corticosteroids were included, considering all health outcomes. Four studies with 542 Chinese participants were included. Two studies reported negative findings regarding the use of corticosteroids in patients with COVID-19, i.e., corticosteroids had a detrimental impact on clinical outcomes. One study reported no significant association between the use of corticosteroids and clinical outcomes. However, one study, on 201 participants with different stages of pneumonia due to COVID-19, found that in more severe forms, the administration of methylprednisolone significantly reduced the risk of death by 62%. The literature to date does not fully support the routine use of corticosteroids in COVID-19, but some findings suggest that methylprednisolone could lower mortality rate in more severe forms of the condition.
Journal Article
The Risk of COVID-19 Related Hospitalsation, Intensive Care Unit Admission and Mortality in People With Underlying Asthma or COPD: A Systematic Review and Meta-Analysis
Background: Several underlying diseases have been associated with unfavorable COVID-19 related outcomes including asthma and Chronic Obstructive Pulmonary Disease (COPD), however few studies have reported risks that are adjusted for confounding variables. This study aimed to examine the adjusted risk of COVID-19 related hospitalsation, intensive care unit (ICU) admission, and mortality in patients with vs. without asthma or COPD. Methods: A systematic review of major databases was undertaken for studies published between 1/12/2019 and 19/4/2021. Studies reporting the adjusted (for one or more confounder) risks of either hospitalsation, ICU admission, or mortality in asthmatics or COPD patients (control group = no asthma or no COPD) were identified. Risk of bias was determined via the QUIPS tool. A random effect meta-analysis was undertaken. Findings: 37 studies were eligible for analysis, with a total of 1,678,992 participants. The pooled ORs of COVID-19 hospitalsation in subjects with asthma and COPD was 0.91 (95% CI 0.76–1.09) and 1.37 (95% CI 1.29–1.46), respectively. For ICU admission, OR in subjects with asthma and COPD was 0.89 (95% CI 0.74–1.07) and 1.22 (95% CI 1.04–1.42), respectively. For mortality, ORs were 0.88 (95% CI 0.77–1.01) and 1.25 (95% CI 1.08–1.34) for asthma and COPD, respectively. Further, the pooled risk of mortality as measured via Cox regression was 0.93 (95% CI 0.87–1.00) for asthma and 1.30 (95% CI 1.17–1.44) for COPD. All of these findings were of a moderate level of certainty. Interpretation: COPD was significantly associated with COVID-19 related hospital admission, ICU admission, and mortality. Asthma was not associated with negative COVID-19 related health outcomes. Individuals with COPD should take precautions to limit the risk of COVID-19 exposure to negate these potential outcomes. Limitations include differing population types and adjustment for differing cofounding variables. Practitioners should note these findings when dealing with patients with these comorbidities. Review Protocol Registration: https://www.crd.york.ac.uk/prospero/ .
Journal Article
Sedentary time elimination with periodic activity snacks (STEPS): protocol for a codesigned feasibility trial in people with severe mental illness
IntroductionPeople with severe mental illness (SMI) experience substantially reduced life expectancy, largely due to cardiovascular disease (CVD). Sedentary behaviour is a major risk factor for CVD, and people with SMI spend significantly more time sedentary and are less physically active than the general population. While interventions to increase physical activity have focused on structured exercise, these are not accessible or acceptable to many consumers. The sedentary time elimination with periodic activity snacks (STEPS) study aims to test and evaluate the feasibility of a codesigned novel intervention using ‘activity snacks’ to interrupt sedentary behaviour in people with SMI.Methods and analysisThe STEPS study is a single-arm feasibility trial. We will recruit 20 participants with SMI to complete a 6-week intervention. The intervention will include the use of the STEPS smartphone app to prompt short bouts of movement across the day, the type of which are personalised to the individual. Feasibility will be assessed through recruitment and retention rates, adherence to the intervention and acceptability measured via qualitative interviews. Secondary outcomes include changes in sedentary time, physical activity, mood and quality of life, with pre–post variables analysed via either a t-test or Mann’s Whitney U test, dependent on the normality of the data. Effect sizes for secondary outcomes will be calculated as Cohen’s d.Ethics and disseminationThis trial has received ethical clearance from the Metro South Human Research Ethics Committee (HREC/2025/QMS/117193) and was prospectively registered with the Australia New Zealand Clinical Trials Registry (ACTRN12625000265471p). Results from this trial will be published in a peer-reviewed journal.Trial registration numberAustralia New Zealand Clinical Trials Registry (ACTRN12625000265471p).
Journal Article
Interventions for Improving Long COVID-19 Symptomatology: A Systematic Review
Introduction: Although the understanding of several aspects of long COVID-19 syndrome is increasing, there is limited literature regarding the treatment of these signs and symptoms. The aim of our systematic review was to understand which therapies have proved effective against the symptoms of long COVID-19. Methods: A systematic search for randomized controlled or clinical trials in several databases was conducted through 15 May 2022. Specific inclusion criteria included: (1) intervention studies, either randomized controlled (RCTs) or clinical trials; (2) diagnosis of long COVID-19, according to the World Health Organization criteria; (3) presence of long COVID-19 for at least 12 weeks after SARS-CoV-2 infection. Results: We initially found 1638 articles to screen. After removing 1602 works based on their title/abstract, we considered 35 full texts, and among them, two intervention studies were finally included. The first RCT focused on the greater improvement of treatment combining olfactory rehabilitation with oral supplementation with Palmitoylethanolamide and Luteolin in patients with olfactory dysfunction after COVID-19. The second study evaluated the positive impact of aromatherapy vs. standard care in adult females affected by fatigue. Conclusion: Our systematic review found only two intervention studies focused on patients affected by long COVID-19. More intervention studies are needed to investigate potentially positive interventions for long COVID-19 symptoms.
Journal Article
Relationship between severe mental illness and physical multimorbidity: a meta-analysis and call for action
BackgroundPeople with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this study was to assess the strength of the association between SMI and physical multimorbidity.Study selection and analysisWe systematically searched PubMed/Medline, Scopus, Embase, Web of Science, PsycINFO and the behavioural sciences collection databases, from inception to 31 January 2023, for studies that investigated the association between SMI and physical multimorbidity. Humans of any age either clinically diagnosed and/or currently receiving treatment for SMI, specified as schizophrenia (and related psychotic disorders), bipolar disorder and psychotic depression, were eligible. Data from studies selected for inclusion were converted into ORs, with a subsequent meta-analysis conducted.FindingsWe included 19 studies with a total of 194 123 patients with SMI with different diagnoses and drawn from the general population. The pooled OR for physical multimorbidity in people with versus without SMI was 1.84 (95% CI 1.33 to 2.54), with the analysis indicating a high level of heterogeneity (98.38%). The other 15 studies included in the systematic review for which it was not possible to conduct a meta-analysis showed strong associations between SMI and physical multimorbidity.ConclusionsThe current evidence highlights the link between SMI and physical multimorbidity. A multidisciplinary approach is now urgent to develop the best models of services tailored to patients with SMI with physical multimorbidities to improve physical, mental and social outcomes. PROSPERO registration number CRD42023395165.
Journal Article
Could master protocols be adapted for effectiveness-implementation hybrid studies?
Background
Master protocols leverage a common trial infrastructure for launching multiple sub-studies. Translational research aims to progress scientific discoveries toward public health impact, which depends on establishing an intervention’s efficacy, effectiveness in real-world conditions, and successful strategies for implementation. While master protocols have been designed to improve the efficiency of clinical trials as sub-studies addressing a particular disease, their application with effectiveness-implementation hybrid studies is yet to be explored. The aim of this study was to develop recommendations for adapting mater protocol methods for effectiveness-implementation research.
Methods
A method of consultation with translational research networks was undertaken between January and December 2024. Consideration was given to the requirements for service providers to engage in translational research, and how master protocols could support effectiveness-implementation hybrid sub-studies. The underlying rationale for potential adaptations is provided with reference to implementation frameworks, discussion of advantages and disadvantages, and summary recommendations.
Results
Recommendations are proposed on establishing common trial infrastructure, aims and hypotheses, data collection, control groups, adaptive elements, and eligibility criteria. By leveraging cross-sectoral partnerships, co-producing research and dissemination, and incorporating adaptive elements, master protocols may offer a promising approach for accelerating progress along the translational research pipeline.
Conclusions
The adaptation of master protocols for hybrid sub-studies could enable evidence-based interventions to be more effectively implemented in routine care settings. The feasibility of master protocols for effectiveness-implementation research is yet to be tested, and further development in this area is needed to trial the proposed methodology.
Journal Article