Integrating perceived physical environments and the theory of planned behaviors when explaining adherence to 24-hour movement guidelines in Chinese adolescents.

PURPOSES: Most adolescents worldwide do not meet 24-h movement guidelines, which recommend specific level of physical activity, sedentary behavior, and sleep for optimal health. Nevertheless, there remains a lack of understanding regarding how social cognitive and physical environmental factors influence adolescents' compliance with these guidelines. This prospective study aimed to examine the associations between perceived physical environments, constructs of the theory of planned behavior (TPB), habit strength, and adherence to 24-h movement guidelines in Chinese adolescents over a three-month period. METHODS: A total of 629 Chinese adolescents (Mage = 14.59 years, SD = 0.64) completed a set of questionnaires comprising perceived physical environmental characteristics, constructs of the TPB, habit strength, and 24-h movement behaviors at baseline and 3 months later. Data analysis was conducted using variance-based structural equation modeling. RESULTS: Attitude, subjective norm, and perceived behavioral control had a direct effect on intention and intention had a direct effect on number of the guidelines being met. Habit strength was a significant predictor of adherence to the guidelines, although its moderating effect on the intention-behavior relationship was not significant. Perceived neighborhood facility accessibility, school facility availability, and home physical activity equipment had significant indirect effects on intention through attitude, subjective norm, and perceived behavioral control. However, constructs of the TPB did not serve as mediators in the relationship between perceived physical environments and the number of guidelines being met. CONCLUSION: This study offers preliminary evidence supporting the integration of perceived physical environments and the TPB in predicting adolescents' adherence to 24-h movement guidelines. Future research should consider using experimental study designs with rigorous measures of 24-h movement behaviors to establish causal relationships.

Development and Validation of a Two-component Perceived Control Measure.

BACKGROUND: Research indicates that perceived behavioral control (PBC) is an important determinant of behavior and that it is composed of perceived capability and opportunity. However, typical measurement of these constructs may be confounded with motivation and outcome expectations. Vignettes presented before questionnaire items may clarify construct meaning leading to precise measurement. PURPOSE: The purpose of this study was to develop and validate measures of perceived capability and opportunity that parse these constructs from the influence of motivation and outcome expectations using vignettes. METHODS: Study 1 collected feedback from experts (N = 9) about the initial measure. Study 2a explored internal consistency reliability and construct and discriminant validity of the revised measure using two independent samples (N = 683 and N = 727). Finally, using a prospective design, Study 2b (N = 1,410) investigated test-retest reliability, construct and discriminant validity at Time 2, and nomological validity. RESULTS: After Study 1, the revised measure was tested in Studies 2a and 2b. Overall, the evidence suggests that the measure is optimal with four items for perceived capability and three for the perceived opportunity. The measure demonstrated strong internal consistency ( > 0.90) and test-retest reliability (intraclass correlation coefficients [ICCs] > .78). The measure also showed construct and discriminant validity by differentiating itself from behavioral intentions (i.e., motivation) and affective attitude (based on expected outcomes) (SRMR = 0.03; RMSEA = 0.06). It also demonstrated evidence of nomological validity as behavior 2 weeks later was predicted. CONCLUSIONS: We recommend researchers use this tool in future correlational and intervention studies to parse motivation and outcome expectations from perceived capability and opportunity measurement.

Fibroblast growth factor 13 is involved in the pathogenesis of temporal lobe epilepsy.

BACKGROUND: Temporal lobe epilepsy (TLE) is the most common drug-resistant epilepsy in adults, with pathological mechanisms remaining to be fully elucidated. Fibroblast Growth Factor 13 (FGF13) encodes an intracellular protein involved in microtubule stabilization and regulation of voltage-gated sodium channels (VGSCs) function. FGF13 mutation has been identified in patients with inherent seizure, suggesting a potential association between FGF13 and the etiology of TLE. Here, we set to explore the pathological role of FGF13 in the etiology of TLE. RESULTS: We found that the expression of FGF13 was increased in the cortical lesions and CA1 region of sclerotic hippocampus and correlated with the seizure frequency in TLE patients. Also, Fgf13 expression was increased in the hippocampus of chronic TLE mice generated by kainic acid (KA) injection. Furthermore, Fgf13 knockdown or overexpression was respectively found to attenuate or potentiate the effects of KA on axonal length, somatic area and the VGSCs-mediated current in the hippocampal neurons. CONCLUSIONS: Taken together, these findings suggest that FGF13 is involved in the pathogenesis of TLE by modulating microtubule activity and neuronal excitability.

The effects of walking on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia: a study protocol of randomized control trial by comparing supervised group-based intervention and non-supervised individual-based intervention.

BACKGROUND: Kingdom of Saudi Arabia (KSA) demographics are also changing with the increase in life expectancy in the country and the rise in the number of older Saudi Arabians. Saudi Arabia has a higher rate of physically inactive people, and most of them are between the ages of 55-64. Walking is one of the most prevalent forms of physical activity in Saudi Arabia and the study showed that most people prefer walking for recreational and health benefits. Therefore, the purpose of the proposed study is to compare the effects of supervised group-based walking and non-supervised individual-based walking interventions on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia. METHOD: This study will apply a three-group (2 intervention groups and 1 control group), double-blinded, randomized controlled trial (RCT) to examine the effect of different forms of walking interventions on Saudi Arabia older adults' frailty, cognitive function and quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions. DISCUSSION: This study aims to determine whether supervised group walking and non-supervised individual walking lead to different effects. Given the limited evidence in the literature regarding Saudi Arabia older adults' physical fitness and health, it is worthwhile to explore the effect of walking, as well as the forms of walking on improving the overall physical fitness and psychological status of older adults in Saudi Arabia. The findings of the current study could also create awareness of the government and the general public in Saudi Arabia of the ageing problems and the effective ways of achieving better intervention results. TRIAL REGISTRATION: The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05151575; Date of first posted: 12/07/2021).

Prospective associations between adherence to 24-hour movement guidelines and mental well-being in Chinese adolescents.

Most evidence regarding the relationships between adherence to 24-hour movement guidelines and adolescent mental health have been derived from cross-sectional studies or have ignored positive mental health indicators. The current prospective study examined the associations between adherence to 24-hour movement guidelines and changes in mental well-being among Chinese adolescents over three months. 816 Chinese adolescents (Mage = 14.76 years; SD = 0.81) completed baseline and follow-up scales of 24-hour movement behaviours, mental well-being, and covariates. Linear mixed-effects models were used for data analyses, with adjustments for covariates and mental well-being at baseline. There was a significant improvement in mental well-being across the three months, and the improvement in mental well-being was positively associated with meeting any single guidelines and both physical activity and sleep guidelines but not adherence to all three guidelines. Meeting both physical activity and sleep recommendations appears to exert more significant benefits on mental well-being than meeting one or two other recommendations. An integrative approach to mental health promotion by focusing on 24-hour movement behaviours (at least physical activity and sleep) may be more effective than focusing on a single behaviour alone.

Impaired State-Dependent Potentiation of GABAergic Synaptic Currents Triggers Seizures in a Genetic Generalized Epilepsy Model.

Epileptic activity in genetic generalized epilepsy (GGE) patients preferentially appears during sleep and its mechanism remains unknown. Here, we found that sleep-like slow-wave oscillations (0.5 Hz SWOs) potentiated excitatory and inhibitory synaptic currents in layer V cortical pyramidal neurons from wild-type (wt) mouse brain slices. In contrast, SWOs potentiated excitatory, but not inhibitory, currents in cortical neurons from a heterozygous (het) knock-in (KI) Gabrg2+Q/390X model of Dravet epilepsy syndrome. This created an imbalance between evoked excitatory and inhibitory currents to effectively prompt neuronal action potential firings. Similarly, physiologically similar up-/down-state induction (present during slow-wave sleep) in cortical neurons also potentiated excitatory synaptic currents within brain slices from wt and het KI mice. Moreover, this state-dependent potentiation of excitatory synaptic currents entailed some signaling pathways of homeostatic synaptic plasticity. Consequently, in het KI mice, in vivo SWO induction (using optogenetic methods) triggered generalized epileptic spike-wave discharges (SWDs), being accompanied by sudden immobility, facial myoclonus, and vibrissa twitching. In contrast, in wt littermates, SWO induction did not cause epileptic SWDs and motor behaviors. To our knowledge, this is the first mechanism to explain why epileptic SWDs preferentially happen during non rapid eye-movement sleep and quiet-wakefulness in human GGE patients.

The pathways linking objectively-measured greenspace exposure and mental health: A systematic review of observational studies.

BACKGROUND: With an increasing volume of research exploring the pathways linking greenspace exposure to mental health, there is a need to synthesise the strength of evidence on the mediation mechanisms. Synthesising the strength of evidence on the pathways can help us better understand how greenspace exposure affects mental health and guide future green space interventions to improve mental health. PURPOSE: The purpose of this study was to synthesise current evidence on the pathways linking objectively-measured greenspace exposure and mental health using a systematic review approach. METHODS: Literature searches were conducted in March 2020 from five common databases (i.e., MEDLINE, Embase, PsycINFO, SPORTDiscus, and Web of Science) using search terms of green spaces and mental health. English language and human population were imposed as search limits. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guideline was followed to synthesise and report results. RESULTS: The initial systematic searches yielded 16,415 records, of which 26 studies met the inclusion criteria. Mixed or non-significant evidence was revealed for the mediating effects of air quality, physical activity, perceived stress, perceived restorativeness, residential noise, social cohesion, and social support on the pathways from greenspace exposure to mental illness. The effect of greenspace exposure on mental well-being was mediated by air quality, perceived stress, and physical activity. In addition, mixed evidence was revealed for the mediating role of social cohesion on the path from greenspace exposure to mental well-being. CONCLUSIONS: This systematic review highlighted the key pathways linking green spaces to mental well-being via harmful mitigation, psychological restoration, and encouragement of health-related behaviours. Evidence for the pathway between greenspace exposure and mental illness is equivocal at present. Future research is recommended to adopt well-designed longitudinal and experimental studies to establish causal inferences on mental health benefits of greenspace exposure.

Park environment and moderate-to-vigorous physical activity in parks among adolescents in a high-density city: the moderating role of neighbourhood income.

BACKGROUND: Urban parks are critical environmental resources in which adolescents engage in physical activity (PA). Evidence on the associations between park environmental characteristics and park-based PA in adolescents is mixed, particularly for high-density cities. Evidence is also lacking concerning the moderating role of neighbourhood socioeconomic status on the park-PA relationships. The current study aimed to examine the associations between park environmental characteristics and moderate-to-vigorous physical activity (MVPA) in parks among adolescents in Hong Kong and the moderating effect of neighbourhood income on these associations. METHODS: A cross-sectional study involving direct observations of adolescents was conducted in 32 randomly selected urban parks in Hong Kong. Park environmental characteristics were measured using the Community Park Audit Tool. Park-based MVPA among adolescents was measured using the System for Observation Play and Recreation in Communities. Neighbourhood income was extracted from the 2011 Hong Kong Population Census data on median household income. RESULTS: There was a significant positive association between the quality of amenities and park-based MVPA (metabolic equivalents per observation) in adolescents. However, the associations between the diversity of active facilities, greenness and adolescents' park-based MVPA were not significant. Neighbourhood income moderated the association between adolescents' park-based MVPA and park safety, where the relationship between park safety and park-based MVPA was significantly positive in low-income neighbourhoods but not significant in high-income neighbourhoods. An income-by-environment interaction was also observed concerning park aesthetics, with a negative relationship between park aesthetics and park-based MVPA in high-income neighbourhoods but not in low-income neighbourhoods. CONCLUSION: Our findings provide evidence regarding how park environment and neighbourhood income impact adolescents' park-based MVPA in Hong Kong. These findings can inform urban planning and policymakers who seek to improve urban park development in high-density cities.

Effectiveness of resistance training on resilience in Hong Kong Chinese older adults: study protocol for a randomized controlled trial.

BACKGROUND: There is on one hand sufficient evidence showing strong association between resilience and self-rated successful aging. On the other hand, strength training could contribute the cultivation of resilience among older adults. Therefore, the current study aims to examine the effectiveness of resistance training on resilience among Chinese older adults in Hong Kong. METHODS: This study will apply a three-group, double blinded (outcome assessors and data analysts), randomized controlled trial (RCT) to examine the effectiveness of the interventions on resilience, functional fitness, and health related quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions. DISCUSSION: It is expected that resistance training is promising or even superior to aerobic training in the improvement of resilience. Given the limited evidence on the literature, it is urgently needed to explore the effects of resistance training on the improvement of resilience in older adults. Findings of the current study can contribute to the development of effective resistant training programs for the promotion of resilience among older adults. TRIAL REGISTRATION: The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT04690465 ; Date of First Posted: 30/12/2020).

Social Psychological Predictors of Sleep Hygiene Behaviors in Australian and Hong Kong University Students.

BACKGROUND: Sleep hygiene behaviors in undergraduate students are associated with night-time sleep duration and quality, daytime sleepiness, and psychological distress. This study aimed to identify the social psychological factors that impact on university students' sleep hygiene behaviors in samples from two countries. METHOD: Participants were undergraduate students from Australia (N = 201, MAge = 22.82, SDAge = 8.89; 165 female) and Hong Kong (N = 161, MAge = 20.47, SDAge = 7.80; 84 female). The study used a correlational-prospective design. Individuals self-reported their intention, attitude, subjective norms, perceived behavioral control, and past behavior with respect to sleep hygiene behaviors. Four weeks later, the students self-reported their action plans and participation in sleep hygiene behaviors. RESULTS: Analysis indicated acceptable model fit to data for both the Australian and Hong Kong samples. Results showed significant direct effects of attitude, subjective norms, perceived behavioral control, and past behavior on intention, and significant direct effects of action planning and past behavior on prospectively measured sleep hygiene behavior. There were also significant indirect effects of attitude, subjective norms (Hong Kong sample only), and perceived behavioral control on behavior mediated by intention and action planning. Overall, the model predicted a large portion of the variance in sleep hygiene behavior for both the Australian (R2 = .524) and Hong Kong (R2 = .483) samples. Schenker and Gentleman t tests found no parameters significantly differed between samples. CONCLUSION: Results indicate that university students' sleep hygiene behaviors are a function of both motivational and volitional processes. This formative data can inform future interventions to improve the sleep hygiene practices of university students.

A novel de novo TSC2 nonsense mutation detected in a pediatric patient with tuberous sclerosis complex.

PURPOSE: Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem disorder characterized by hamartomas in multiple organ systems. The TSC1 and TSC2 genes have been identified as the genetic basis of TSC. Two gene tests were used for definitive genetic diagnosis. METHODS: In our study, the case of a Chinese pediatric patient with seizures, hypomelanotic macules, hyperpigmented patches, multiple parenchymal lesions in the ventricle, and developmental retardation is detailed. Whole-genome sequencing (WGS) and multiplex ligation-dependent probe amplification (MLPA) were employed to detect genetic variations and copy number variations of TSC1 and TSC2. RESULTS: A novel heterozygous nonsense mutation in the TSC2 gene (c.3751A>T, p.Lys1251Ter) was identified in a Chinese pediatric patient suffering from TSC, whose unaffected parents did not carry this mutation. The mutation was classified as "pathogenic" according to the American College of Medical Genetics (ACMG) guidelines. CONCLUSION: WGS was carried out to definitively diagnose and detect variations in the exon and noncoding region of the gene and copy number variations in the whole genome simultaneously. For diseases with complex genetic mechanisms, WGS as the first-line test can be efficient and cost-effective for clinical diagnosis.

Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding.

BACKGROUND: Studies about treatment of patients with chronic portal vein thrombosis (CPVT) are still limited, especially in different types of CPVT. This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt (TIPS) in all types of CPVT with variceal bleeding. METHODS: Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis. All patients had a history of variceal bleeding. The characteristics and clinical parameters were collected and recorded. Data on procedure success rate, variation in portal vein pressure, rebleeding, hepatic encephalopathy (HE), stent stenosis, and overall mortality were analyzed. RESULTS: A total of 189 patients were included in this study (39 in type 1, 84 in type 2, 48 in type 3, 18 in type 4). The TIPS procedure success rate was 86.2%. The success rate was significantly different among the four types (89.7% vs. 88.1% vs. 83.3% vs. 77.8%, P = 0.001). In the TIPS success group, portal vein pressure was significantly reduced from 27.15 ± 6.59 to 19.74 ± 6.73 mmHg after the procedure (P < 0.001) and the rebleeding rate was significantly lower than that of the fail group (14.7% vs. 30.8%, P = 0.017). In addition, there were no significant differences in HE rate (30.7% vs. 26.9%, P = 0.912) or overall mortality (12.9% vs. 19.2%, P = 0.403) between the TIPS success group and the fail group. In the TIPS success group, we found that the occurrence of HE was significantly different (P = 0.020) among the four types, while there were no significant differences in rebleeding rate (P = 0.669), stent stenosis rate (P = 0.056), or overall mortality (P = 0.690). CONCLUSIONS: TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.

Personality and perceived stress during COVID-19 pandemic: Testing the mediating role of perceived threat and efficacy.

Prolonged stress is associated with poor physical and mental health outcomes. Understanding the mediators between personality and stress is critical for developing effective stress management interventions during a pandemic. Our study explored whether perceptions of threat from COVID-19 and efficacy to follow government recommendations for preventing COVID-19 would mediate the relationships between personality traits (e.g., neuroticism, conscientiousness-goal-striving, extroversion-activity and sociability) and perceived stress. In an online survey of a representative sample of Canadian adults (n = 1055), we found that higher neuroticism and extroversion were associated with higher levels of stress during the pandemic and a greater increase in stress levels compared to levels before the pandemic. Perceived threat and efficacy significantly mediated the relationship between neuroticism and stress, which suggested that individuals with higher neuroticism experienced higher levels of stress due to higher levels of perceived threat and lower levels of efficacy. Perceived threat did not mediate the relationship between extroverts and stress, which suggested that the source of stress may stem from elsewhere (e.g., inability to socialize). Our findings highlighted that personality traits could be an important factor in identifying stress-prone individuals during a pandemic and that stress management interventions need to be personality specific.

Direct and Indirect Relationships Between the Built Environment and Individual-Level Perceptions of Physical Activity: A Systematic Review.

BACKGROUND: Socioecological models highlight the potential direct and indirect effects of multiple levels of influence in explaining physical activity (PA). Social cognitive theories, however, position individual cognitions as the mediator of external factors such as the built environment when explaining PA. PURPOSE: To appraise the evidence for direct and indirect associations between the built environment and social cognition to predict PA. METHODS: Literature searches were concluded in February 2019 using five common databases. Eligible studies were in the English language that included any direct and indirect tests of individual perceptions and the built environment with PA. RESULTS: The initial search yielded 18,521 hits, which was reduced to 46 independent studies of primarily medium quality after screening for eligibility criteria. Findings were grouped by type of PA then grouped by the type of individual and built environment constructs within the model, and subdivided by adult and youth samples. There was evidence that self-efficacy/perceived control accounted for the covariance between environmental accessibility/convenience and total PA, while habit accounted for the covariance in this relationship for transport PA, particularly in adult samples. There was no evidence that the built environment had a direct association with PA after controlling for individual-level factors. CONCLUSIONS: The results provide initial support for the mediation tenet in social cognition models for the relationship between individual, built environment, and PA. In practice, these findings highlight the need for coordinated interventions of individual and environmental change.

Subtemporal selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy: Systematic review of seizure and neuropsychological outcomes.

In addition to standard anterior temporal lobectomy (ATL), subtemporal selective amygdalohippocampectomy (sSAH) is also a common technique for the treatment of medically intractable mesial temporal lobe epilepsy (MTLE). We conducted a systematic literature review to determine the seizure and neuropsychological outcomes in patients with MTLE who underwent sSAH. We searched PubMed and Embase using Medical Subject Headings and keywords related to sSAH, seizure outcome, and neuropsychological outcome. Titles, abstracts, and full-texts were screened in light of inclusion and exclusion criteria that were established a priori. Potential papers were reviewed by 3 reviewers, who reached a consensus on the final papers to be included. Literature review identified 208 abstracts from which a total of 29 full-text articles were reviewed. Six studies containing data from 4 countries (3 continents) met our inclusion criteria. The seizure-free rates at 12 months after sSAH ranged from 59.1% to 61.5% in 4 studies. Four studies showed that seizure-free rates ranged from 56% to 82.6% at 24 months after surgery. Six studies evaluated the neuropsychological changes of patients with MTLE after sSAH, including intelligence, verbal memory, nonverbal memory, language function, and so on. In terms of neuropsychological outcomes, there are some differences among the 6 studies. Taken together, sSAH can provide a considerable rate of seizure freedom. In addition, the neuropsychological outcomes of patients who underwent sSAH were slightly different among 6 studies. Therefore, large-scale case series or randomized controlled trials (RCTs) are needed to clarify the advantages and disadvantages of the sSAH.

Molecular basis for and chemogenetic modulation of comorbidities in GABRG2-deficient epilepsies.

OBJECTIVE: γ-Aminobutyric acid type A (GABAA ) receptor subunit gene mutations are significant causes of epilepsy, which are often accompanied by various neuropsychiatric comorbidities, but the underlying mechanisms are unclear. It has been suggested that the comorbidities are caused by seizures, as the comorbidities often present in severe epilepsy syndromes. However, findings from both humans and animal models argue against this conclusion. Mutations in the GABAA receptor γ2 subunit gene GABRG2 have been associated with anxiety alone or with severe epilepsy syndromes and comorbid anxiety, suggesting that a core molecular defect gives rise to the phenotypic spectrum. Here, we determined the pathophysiology of comorbid anxiety in GABRG2 loss-of-function epilepsy syndromes, identified the central nucleus of the amygdala (CeA) as a primary site for epilepsy comorbid anxiety, and demonstrated a potential rescue of comorbid anxiety via neuromodulation of CeA neurons. METHODS: We used brain slice recordings, subcellular fractionation with Western blot, immunohistochemistry, confocal microscopy, and a battery of behavior tests in combination with a chemogenetic approach to characterize anxiety and its underlying mechanisms in a Gabrg2+/Q390X knockin mouse and a Gabrg2+/- knockout mouse, each associated with a different epilepsy syndrome. RESULTS: We found that impaired GABAergic neurotransmission in CeA underlies anxiety in epilepsy, which is due to reduced GABAA receptor subunit expression resulting from the mutations. Impaired GABAA receptor expression reduced GABAergic neurotransmission in CeA, but not in basolateral amygdala. Activation or inactivation of inhibitory neurons using a chemogenetic approach in CeA alone modulated anxietylike behaviors. Similarly, pharmacological enhancement of GABAergic signaling via γ2 subunit-containing receptors relieved the anxiety. SIGNIFICANCE: Together, these data demonstrate the molecular basis for a comorbidity of epilepsy, anxiety, and suggest that impaired GABAA receptor function in CeA due to a loss-of-function mutation could at least contribute to anxiety. Modulation of CeA neurons could cause or suppress anxiety, suggesting a potential use of CeA neurons as therapeutic targets for treatment of anxiety in addition to traditional pharmacological approaches.

Adolescent sugar-sweetened beverage consumption: An extended Health Action Process Approach.

OBJECTIVE: Consumption of excess added sugar in the form of sugar-sweetened beverages (SSBs) contributes to a wide range of health concerns in adolescents. Identification of modifiable determinants of SSB consumption based on behavioral theory may inform development of interventions aimed at reducing SSB consumption. The aim of the current study was to test the efficacy of an extended version of the Health Action Process Approach to predict adolescent SSB consumption. METHODS: Using a prospective design, adolescent students (N = 450) self-reported their outcome expectancies, perceived behavioral control, intentions, habit, action, maintenance, and recovery self-efficacy, action and coping planning, perceived affordability, and past behavior with respect to SSB consumption. One month later, participants self-reported their SSB consumption. RESULTS: A structural equation model revealed significant direct effects of action self-efficacy, outcome expectancies, and perceived behavioral control on intentions to reduce SSB consumption. Significant direct effects of action self-efficacy on maintenance self-efficacy, and maintenance self-efficacy on recovery self-efficacy, were also identified. There were significant direct effects of intentions and maintenance self-efficacy on action and coping planning. Only intentions and perceived affordability had significant direct effects on SSB consumption. There were also indirect effects of outcome expectancy and perceived behavioral control on SSB consumption mediated by intentions. Inclusion of past behavior attenuated model effects, with past behavior the only remaining predictor of SSB consumption. CONCLUSIONS: Findings indicate that adolescent SSB consumption is predicted by intentions and perceived affordability, but effects were extinguished by the inclusion of past behavior. The pervasive effects of past behavior point to the importance of identifying potential mediators of past behavior in future research, and that interventions targeting non-conscious rather than intentional processes may be most effective in reducing SSB consumption.

Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis.

OBJECT: The aim of this study was to determine the predictors of seizure recurrence in surgery for focal cortical dysplasia (FCD) by conducting a meta-analysis. METHODS: Publications that met the pre-stated inclusion criteria were selected from PubMed and CNKI databases. Two authors extracted data independently about prognostic factors, surgical outcome, and clinical characteristics of participants. A fixed-effects model was used to calculate the summary of odds ratio (OR) with 95% confidence interval (CI). RESULTS: Forty-eight studies were included in our meta-analysis. Three predictors of seizure recurrence (Engel class III/IV)-histological FCD type I, incomplete resection, and extratemporal location were determined; combined OR with 95% CI were 1.94 (95%CI 1.53-2.46), 12.06 (95%CI 7.32-19.88), and 1.91 (95%CI 1.06-3.44), respectively. Trial sequential analysis revealed that the outcomes had a sufficient sample size to reach firm conclusions. Furthermore, seizure location was not substantially modified by geographic region, while histological FCD type I and incomplete resection showed a significant association with seizure recurrence in different continents except Asia for incomplete resection. Sensitivity analyses restricted to studies for each variable yielded robust results. Little evidence of publication bias was observed. Meanwhile, the difference in the standard for outcome failed to influence the results for prognosis. Network meta-analysis including 13 trials comparing subtypes of FCD found the FCD IIb had the lowest seizure recurrence rate. CONCLUSIONS: This meta-analysis suggests that histological FCD type I, incomplete resection, and extratemporal location are recurrence factors in patients with epilepsy surgery for FCD. In addition, FCD IIb is associated with the highest rates of postoperative seizure control among the subtypes of FCD, type I and type II.

Promoting influenza prevention for elderly people in Hong Kong using health action process approach: study protocol.

BACKGROUND: People 65 years or older are at greater risk of serious complications from the seasonal influenza compared with young. To promote elderly people's behavioral compliance toward influenza prevention, the aim of the current project is to develop, implement, and evaluate a theory-based low-administration-cost intervention building on a leading psychological theory, the Health Action Process Approach (HAPA). METHODS: The target group is Hong Kong Chinese elderly people aged 65 or older who rarely or never adopt any preventive actions. This project will be conducted in three phases over 24 months. In phase 1, intervention program will be developed building on the HAPA theoretical framework which comprises both the initiation and maintenance of influenza prevention behaviors. In phase 2, intervention will be implemented and evaluated using a randomized controlled trial, including: (a) behavior initiation only, (b) behavior initiation + behavior maintenance, and (c) control group. Both the initiation and maintenance components will comprise weekly-delivered telephone-based individual intervention sessions in 3 months. In phase 3, outcome evaluation of behavioral and psychological variables and process evaluation will be conducted. The effectiveness of the intervention will be analyzed using a series of linear mixed models on each behavioral and psychological outcome variable. Structural equation modelling will be used to test the hypothesized theoretical sequence in the HAPA model. DISCUSSION: The proposed project is expected to design theory-based intervention materials to promote the influenza prevention behaviors in Hong Kong elderly people and provide information on its effectiveness and the potential changing mechanism of behavior initiation and maintenance. TRIAL REGISTRATION: This randomized controlled trial was funded by the Health and Medical Research Fund (HMRF), Food and Health Bureau of the Government of the Hong Kong Special Administrative Region (Ref: 16151222) and was registered on 13/10/2017 at CCRB Clinical Trials Registry of the Chinese University of Hong Kong, a Partner Registry of a WHO Primary Registry (Ref: CUHK_CCRB00567 ).

Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein.

BACKGROUND: Treatment options for patients with cavernous transformation of portal vein (CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. METHODS: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. RESULTS: TIPS procedure was successfully performed in 56 out of 67 (83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone (n = 15), a combined transjugular/transhepatic approach (n = 33) and a combined transjugular/transsplenic approach (n = 8). Mean portosystemic pressure gradient (PSG) decreased from 28.09 ±â€¯7.28 mmHg to 17.53 ±â€¯6.12 mmHg after TIPS (P < 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. CONCLUSIONS: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement.