Effects of weight loss through dietary intervention on pain characteristics, functional mobility, and inflammation in adults with elevated adiposity.

Background: The relationship between adiposity and pain is complex. Excess weight increases the risk for chronic musculoskeletal pain (CMP), driven by increased biomechanical load and low-grade systemic inflammation. Pain limits physical function, impacting energy balance contributing to weight gain. The primary aims of this study were to profile pain characteristics in participants with overweight or obesity and determine if weight loss through dietary-induced energy restriction, and presence of CMP, or magnitude of weight loss, was associated with changes in adiposity, pain, functional mobility, and inflammation. Methods: This was a secondary analysis of data from adults (25-65 years) with overweight or obesity (BMI 27.5-34.9 kg/m2) enrolled in a 3-month, 30% energy-restricted dietary intervention to induce weight loss (January 2019-March 2021). Anthropometric measures (weight, waist circumference and fat mass), pain prevalence, pain severity (McGill Pain Questionnaire, MPQ), pain intensity (Visual Analog Scale, VAS), functional mobility (timed up and go, TUG) and inflammation (high sensitivity C-Reactive Protein, hsCRP) were assessed at baseline and 3-months. Results: One hundred and ten participants completed the intervention and had weight and pain assessed at both baseline and 3-months. Participants lost 7.0 ± 0.3 kg, representing 7.9% ± 3.7% of body mass. At 3-months, functional mobility improved (TUG -0.2 ± 0.1 s, 95% CI -0.3, -0.1), but there was no change in hsCRP. Compared to baseline, fewer participants reported CMP at 3-months (n = 56, 51% to n = 27, 25%, p < 0.001) and presence of multisite pain decreased from 22.7% to 10.9% (p < 0.001). Improvements in anthropometric measures and functional mobility did not differ between those presenting with or without CMP at baseline. Improvements in pain were not related to the magnitude of weight loss. Conclusion: Weight loss was effective in reducing pain prevalence and improving functional mobility, emphasizing the importance of considering weight-loss as a key component of pain management. Clinical trial registration: identifier, ACTRN12618001861246.

Weight training and risk of all-cause, cardiovascular disease and cancer mortality among older adults.

BACKGROUND: While previous studies indicate muscle-strengthening exercises may reduce mortality risk, further research is needed to increase certainty of the evidence. We investigated overall and dose-response associations between weight training and the risks of all-cause, cardiovascular disease (CVD) and cancer mortality in a large cohort of older adults with long follow-up time and a large number of deaths. We also investigated the joint associations of weight training and aerobic exercise with mortality risk. METHODS: Weight training was assessed via self-report in 2004-05 in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study (USA; n = 216 339), with follow-up to 2019. Cox regression estimated the hazard ratios (HR) and 95% confidence intervals (CI) for the associations between weight training and mortality, after adjusting for confounders including aerobic exercise. RESULTS: Around 25% of participants [mean age = 69.9 years (standard deviation = 5.4), 58% men] reported engaging in weight training over the past year, and there were 79 107 (37%) deaths. Engaging in any weight training (vs none) was associated with lower risks of all-cause (HR = 0.94; 95% CI = 0.93-0.96), CVD (HR = 0.92; 95% CI = 0.90-0.95) and cancer mortality (HR = 0.95; 95% CI = 0.92-0.98). More time spent in weight training was associated with only marginally greater risk reductions. Larger risk reductions were observed among women than men. Performing both aerobic exercise and weight training conferred the greatest mortality risk reduction; weight training was not associated with mortality risk among participants who did no aerobic exercise. CONCLUSION: Performing any amount of weight training lowered mortality risk.

Characterising concurrent pain experience and dietary patterns in people with chronic musculoskeletal pain: a feasibility study protocol.

INTRODUCTION: Nutrition-related factors linked to pain chronicity and disability include weight status and dietary behaviours. Dietary patterns associated with concurrent pain episodes, however, remain poorly characterised. This paper outlines the protocol for a feasibility study that aims to characterise pain-related dietary and lifestyle behaviours in people experiencing chronic musculoskeletal pain. METHODS: The study will recruit participants who experience musculoskeletal pain on 5 or more days of the week for at least 3 months. Participants will attend two in-person clinic visits where physical measurements and a series of pain and lifestyle questionnaires will be completed. Visits will be conducted pre and post a 2-week self-monitoring period where participants will self-report concurrent diet, sleep, mood, and pain on four days and will wear a wrist-worn activity monitor (GENEActiv). Key feasibility metrics will evaluate participant recruitment, enrolment and retention rates, and compliance with the study data collection protocol. DISCUSSION: There remains a lack of evidence behind dietary advice as an adjunct pain management tool. Upon completion of the protocol, feasibility outcomes will identify challenges to guide the design and delivery of a dietary intervention for chronic musculoskeletal pain.

Experiences of research-policy engagement in policy-making processes.

Objectives and importance of study: For public policy to respond effectively to social, economic, and health challenges, there is an urgent need for research-policy collaboration to advance evidence-informed policy. Many organisations seek to promote these engagement activities, but little is known about how this is experienced by researchers and policy actors. This study aimed to understand how policy actors and researchers in Australia experience collaboration and the impediments and enablers they encounter. Study type and methods: An online survey was developed, and using convenience sampling, self-identified Australian policy actors and researchers were invited to participate. Results: In total, 170 responses were analysed, comprising 58% policy actors and 42% researchers. Respondents reported the primary purpose for collaboration was evidence-informed policy making. Policy actors reported that the most common barrier to collaboration with academics was 'budget constraints' while academics reported 'budget, 'political risk' and 'structural barriers'. Reported enablers were 'leadership' and 'connections'. Conclusions: Our findings build upon existing evidence that highlights the importance of collaboration for facilitating evidence-informed policy. Structural deficits in both policy agencies and research funding systems and environments continue to present challenges to policy-research partnerships. Future initiatives could use these findings to implement preferred collaboration methods, alongside rigorous evaluation, to explore 'what works' in promoting engagement for evidence-informed policy.

Urbanisation generates multiple trait syndromes for terrestrial animal taxa worldwide.

Cities can host significant biological diversity. Yet, urbanisation leads to the loss of habitats, species, and functional groups. Understanding how multiple taxa respond to urbanisation globally is essential to promote and conserve biodiversity in cities. Using a dataset encompassing six terrestrial faunal taxa (amphibians, bats, bees, birds, carabid beetles and reptiles) across 379 cities on 6 continents, we show that urbanisation produces taxon-specific changes in trait composition, with traits related to reproductive strategy showing the strongest response. Our findings suggest that urbanisation results in four trait syndromes (mobile generalists, site specialists, central place foragers, and mobile specialists), with resources associated with reproduction and diet likely driving patterns in traits associated with mobility and body size. Functional diversity measures showed varied responses, leading to shifts in trait space likely driven by critical resource distribution and abundance, and taxon-specific trait syndromes. Maximising opportunities to support taxa with different urban trait syndromes should be pivotal in conservation and management programmes within and among cities. This will reduce the likelihood of biotic homogenisation and helps ensure that urban environments have the capacity to respond to future challenges. These actions are critical to reframe the role of cities in global biodiversity loss.

Parent and early childhood educator perspectives of unstructured nature play for young children: A qualitative descriptive study.

Nature play is growing in popularity, with many early childhood settings transforming their outdoor play environments to incorporate more natural elements. Current research highlights the benefits of engaging in unstructured nature play for children's health and development; yet little is known about the experiences of key nature play end-users such as parents and early childhood educators, even though they directly impact the application of nature play within early childhood settings. This study aimed to address this knowledge gap by exploring parent and early childhood educator (ECE) perspectives to gain an understanding about their experiences with nature play. Using a qualitative descriptive approach, semi-structured in-person and telephone interviews were conducted with 18 ECE and 13 parents across four early childhood centres (from various socio-economic regions) across metropolitan Adelaide, South Australia during 2019-2020. Interviews were audio-recorded and transcribed verbatim. Thematic analysis identified five main themes; positive affirmations of nature play, factors influencing nature play engagement, defining nature play, outdoor play space design and risky play. Children's connection to the natural world, learning about sustainability, emotional regulation, and children discovering their own capabilities were perceived advantages of engaging in nature play. Despite the benefits, ECE's described institutional barriers such as resourcing, adhering to policies and scheduling conflicts, whereas, parents described time, getting dirty and proximity to nature play spaces as barriers to nature play engagement. Parents and ECEs alike described adults as gatekeepers for play, especially when other daily tasks compete for their time, or when faced with weather-imposed barriers (cold, rain, extreme heat in summer). The findings suggest that parents and ECEs may need additional resources and guidance on how to engage with nature play and how to overcome barriers within early childhood settings and the home environment.

Exploring what matters to residents of Australian aged care facilities with the Happy Life Index: comparison of qualitative responses between pre- and mid-Covid-19 pandemic time points.

PURPOSE: This study analysed data from a national survey of people living in Australian Residential Aged Care Facilities (RACFs) reporting on what is the best thing about where they live and suggestions for improvement. Data from prior to the Covid-19 pandemic were compared with data during the Covid-19 pandemic. METHODS: Qualitative data from the Happy Life Index Survey were analysed using summative content analysis to code the responses in the data sets and then organise them into categories. Once categorised, the pre-Covid-19 and mid-Covid-19 data sets were compared using descriptive statistics. RESULTS: A total of 4745 residents, from over 100 RACFs, provided 8512 open-text responses to at least one of the two survey questions. Pre-Covid-19 responses were compared with mid-Covid-19 responses and those trending towards relevance (5-10% change) were identified. There were both positive and negative relevant percent changes for staff number, food (general comments), and friendliness. A trending positive percentage change was observed for staff quality and the internal environment. There was a trending negative relevant percentage change for lifestyle activities, staff generally, level of contentedness, the general environment, general choice, and general views about the service. CONCLUSION: People living in RACFs notice the changes in staffing levels and visitors during restrictions imposed during infectious outbreaks. During these times, they appreciate the quality of the staff attending to their needs and the quality of their food. Further exploration is needed of the value of lifestyle activities and strategies to promote feelings of contentedness and general wellbeing during times of restriction.

Are We Teaching Nurses to Be Racist towards Aboriginal and Torres Strait Islander Peoples? A Critical Race Document Analysis of Discrete Aboriginal and Torres Strait Islander Health Courses.

BACKGROUND: Racism is responsible for health inequity and the harm perpetrated upon Aboriginal and Torres Strait Islander peoples by white institutions, building on attitudes and beliefs dominated by assumptions of white superiority. The National Aboriginal and Torres Strait Islander Health Curriculum Framework 'Curriculum Framework', released in 2014, was introduced to provide a framework for nursing programs and included the introduction of discrete Aboriginal and Torres Strait Islander health courses to draw attention to the relationship between racism health outcomes of Aboriginal and Torres Strait Islander peoples within health care settings. METHODS: Using an Indigenist research paradigm with Colonial Critical Race Theory as the methodology and framework, this study presents a document analysis of discrete Aboriginal and Torres Strait Islander health courses taught in undergraduate nursing programs at 31 Australian Universities. RESULTS: This work draws on the collective activism of Aboriginal and Torres Strait Islander nurses in challenging the systemic racism embedded in the Australian nursing curriculum. We demonstrate the utility of the Racial Segregation Audit Tool (RSAT), as an innovative approach to identify and respond to racism embedded in course learning outcomes. CONCLUSIONS: This study explores and uncovers how the learning outcomes assert the social construction of race as a tool of oppressive segregation.

Are Australian Universities Perpetuating the Teaching of Racism in Their Undergraduate Nurses in Discrete Aboriginal and Torres Strait Islander Courses? A Critical Race Document Analysis Protocol.

Systemic racism has a profound negative impact on the health outcomes of Australia's First Nations peoples, hereafter referred to as Aboriginal and Torres Strait Islander peoples, where racism and white privilege have largely become normalised and socially facilitated. A national framework is being mobilised within the tertiary-level nursing curriculum to equip future health professionals with cultural capabilities to ensure culturally safe, equitable health care for Aboriginal and Torres Strait Islander peoples. In 2019, nurses comprised more than half of all registered health professionals in Australia, and current national standards for nursing state that Australian universities should be graduating registered nurses capable of delivering care that is received as culturally safe. It is therefore critical to evaluate where learning objectives within nursing curricula may lead to the reinforcement and teaching of racist ideologies to nursing students. This protocol outlines a framework and methodology that will inform a critical race document analysis to evaluate how learning objectives assert the social construction of "race" as a tool of oppressive segregation. The document analysis will include each discrete Aboriginal and Torres Strait Islander health course within all undergraduate nursing programs at Australian universities. The approach outlined within this protocol is developed according to an Indigenous research paradigm and Colonial Critical Race Theory as both the framework and methodology. The purpose of the framework is a means for improving health professional curriculum by reducing racism as highlighted in nation-wide strategies for curriculum reform.

Prevalence and characteristics of advocacy curricula in Australian public health degrees.

BACKGROUND: Public health advocacy is a fundamental part of health promotion practice. Advocacy efforts can lead to healthier public policies and positive impacts on society. Public health educators are responsible for equipping graduates with cross-cutting advocacy competencies to address current and future public health challenges. PROBLEM: Knowledge of the extent to which students are taught public health advocacy is limited. To determine whether advocacy teaching within public health degrees matches industry needs, knowledge of pedagogical approaches to advocacy curricula is required. This study sought to understand the extent to which advocacy is taught and assessed within Australian public health degrees. METHODOLOGY: Australian public health Bachelor's and Master's degrees were identified using the CRICOS database. Open-source online unit guides were reviewed to determine where and how advocacy was included within core and elective units (in title, unit description or learning outcomes). Degree directors and convenors of identified units were surveyed to further garner information about advocacy in the curriculum. RESULTS: Of 65 identified degrees, 17 of 26 (65%) undergraduate degrees and 24 of 39 (62%) postgraduate degrees included advocacy within the core curriculum, while 6 of 26 (23%) undergraduate and 8 of 39 (21%) postgraduate offered no advocacy curriculum. IMPLICATIONS: Australian and international public health competency frameworks indicate advocacy curriculum should be included in all degrees. This research suggests advocacy competencies are not ubiquitous within Australian public health curricula. The findings support the need to advance public health advocacy teaching efforts further.

Epidemiology of Helicobacter pylori in Australia: a scoping review.

Background: Helicobacter pylori (H. pylori), a bacterium implicated in the development of peptic ulcer and gastric cancer, is estimated to infect around half the world's population. Its prevalence in Australia is unclear. This scoping review aimed to evaluate all Australian literature providing estimates of the prevalence of H. pylori. Methods: Australian studies examining H. pylori prevalence from 1982 onwards were eligible for inclusion. Medline, Embase and Scopus databases, and grey literature sources, were searched. Two independent reviewers undertook a two-stage screening process. Data were extracted by two independent reviewers using a pre-specified template. Results: Of 444 identified studies, 75 were included in the review. H. pylori prevalence in Australian population-based studies (n = 8) ranged from 38.0% in 1991 to 15.1% in 2002; however, estimated prevalence across all non-clinical population studies in diverse sub-groups (n = 29) has varied dramatically. Decreased prevalence has been more marked in populations with gastrointestinal symptoms and conditions compared to non-clinical populations. Data on H. pyloriprevalence in vulnerable populations are lacking. Conclusions: This is the first scoping review of Australian studies reporting H. pylori prevalence. A wide range of study designs, population groups, geographic regions, and diagnostic methods was included, involving data collected over a 50-year period (1969 to 2018). The summary of H. pylori prevalence estimates over time in this review points to a decrease in prevalence in Australia, particularly among populations with gastrointestinal symptoms and illnesses; however, it is unknown whether there is inequity in prevalence trends across vulnerable sub-groups of the Australian population. Future research and interventions supporting the health and wellbeing of vulnerable populations is required to ensure equitable health gains are made for all.

Citizen Science Mosquito Surveillance by Ad Hoc Observation Using the iNaturalist Platform.

Citizen science mosquito surveillance has been growing in recent years due to both increasing concern about mosquito-borne disease and the increasing popularity of citizen science projects globally. Health authorities are recognising the potential importance of citizen science to expanding or enhancing traditional surveillance programs. Different programs have shown success in engaging communities to monitor species of medical importance through low-cost methods. The Mozzie Monitors project was established on iNaturalist-an open citizen science platform that allows participants to upload photos (i.e., observers) and assist identification (i.e., identifiers). This article describes the likelihood of citizen scientists submitting photos of mosquitoes, assesses user submission behaviour, and evaluates public health utility from these citizen science-derived data. From October 2018 to July 2021, the Mozzie Monitors project on iNaturalist received 2118 observations of 57 different species of mosquitoes across Australia. The number of observers in the system increased over time with more than 500 observers and 180 identifiers being active in the project since its establishment. Data showed species bias with large-bodied and colourful mosquitoes being over-represented. Analyses also indicate regional differentiation of mosquito fauna per state, seasonality of activity, and ecological information about mosquitoes. The iNaturalist citizen science platform also allows connectedness, facilitated communication and collaboration between overall users and expert entomologists, of value to medical entomology and mosquito management.

Resistance Training and Mortality Risk: A Systematic Review and Meta-Analysis.

INTRODUCTION: This study aimed to systematically review and meta-analyze the relationship between resistance training and all-cause, cardiovascular disease, and cancer mortality. METHODS: Systematic review and meta-analysis following PRISMA guidelines (International Prospective Register of Systematic Reviews Registration Number CRD42019136654) was conducted. MEDLINE (OVID), Embase, Emcare, SPORTDiscus, The Cochrane Library, and SCOPUS were searched from inception to June 6, 2021. Included studies reported resistance training as the exposure and all-cause mortality, cardiovascular disease‒specific mortality, and/or cancer-specific mortality as outcome/s. Only studies conducted among nonclinical adult populations (aged ≥18 years) and written in English were included. RESULTS: A total of 10 studies were included in the meta-analyses. Compared with undertaking no resistance training, undertaking any amount of resistance training reduced the risk of all-cause mortality by 15% (RR of 6 studies=0.85; 95% CI=0.77, 0.93), cardiovascular disease mortality by 19% (RR of 4 studies=0.81; 95% CI=0.66, 1.00), and cancer mortality by 14% (RR of 5 studies=0.86; 95% CI=0.78, 0.95). A dose-response meta-analysis of 4 studies suggested a nonlinear relationship between resistance training and the risk of all-cause mortality. A maximum risk reduction of 27% was observed at around 60 minutes per week of resistance training (RR=0.74; 95% CI=0.64, 0.86). Mortality risk reductions diminished at higher volumes. DISCUSSION: This systematic review and meta-analysis provides the strongest evidence to date that resistance training is associated with reduced risk of all-cause, cardiovascular disease, and cancer-specific mortality. More research is needed to determine whether any potential mortality benefits gained from resistance training diminish at higher volumes.

Primary School Educators' Perspectives and Experiences of Nature-Based Play and Learning and Its Benefits, Barriers, and Enablers: A Qualitative Descriptive Study.

Nature-based play and learning is of increasing interest to primary schools and research suggests that it has many potential benefits for children's health and development. However, little is known about educators' perspectives and experiences of nature-based play and learning, particularly the barriers, benefits and enablers, despite their direct relevance to the uptake of nature-based play and learning in schools. A qualitative descriptive methodology was employed to uncover these. Individual, semi-structured interviews were conducted with 12 principals and educators from South Australian public primary schools, recruited via a participant contact list from a previous study. The participants were two principals, eight educators and two individuals with dual principal and educator positions. Metropolitan and rural schools were equally represented. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. Analysis identified four overarching themes: the practice, perceived benefits, barriers and enablers of nature-based play and learning. Children's learning, enjoyment, creativity, and a relaxed and flexible environment were clear benefits. Meanwhile educator knowledge and confidence and the crowded curriculum were barriers. Enablers were nature-based play and learning champions and support from school leadership. The findings suggest that schools can help engage students with nature-based play and learning activities by mitigating these barriers and promoting these enablers.

Chronic Stress and Arthritis: A Scoping Review.

OBJECTIVE: Emerging research supports the role of chronic stress in chronic disease development. The objective was to perform a scoping review mapping the field of research exploring relationships between chronic stress and the development of arthritis in adult populations. METHODS: Five electronic databases were systematically searched without publication limits based on 3 key concepts: stress, arthritis, and adults. Eligible qualitative studies investigated individuals' perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by 2 independent reviewers, and data were narratively synthesized. RESULTS: Of 1,819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods, and 45 used quantitative methods. The frequency of studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorized as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self-reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development. CONCLUSION: Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease etiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiologic framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions.

Interventions in outside-school hours childcare settings for promoting physical activity amongst schoolchildren aged 4 to 12 years.

BACKGROUND: Insufficient physical activity is one of four primary risk factors for non-communicable diseases such as stroke, heart disease, type 2 diabetes, cancer and chronic lung disease. As few as one in five children aged 5 to 17 years have the physical activity recommended for health benefits. The outside-school hours period contributes around 30% of children's daily physical activity and presents a key opportunity for children to increase their physical activity. Testing the effects of interventions in outside-school hours childcare settings is required to assess the potential to increase physical activity and reduce disease burden. OBJECTIVES: To assess the effectiveness, cost-effectiveness and associated adverse events of interventions designed to increase physical activity in children aged 4 to 12 years in outside-school hours childcare settings. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ERIC and SportsDISCUS to identify eligible trials on 18 August 2020. We searched two databases, three trial registries, reference lists of included trials and handsearched two physical activity journals in August 2020. We contacted first and senior authors on articles identified for inclusion for ongoing or unpublished potentially relevant trials in August 2020. SELECTION CRITERIA: We included randomised controlled trials, including cluster-randomised controlled trials, of any intervention primarily aimed at increasing physical activity in children aged 4 to 12 years in outside-school hours childcare settings compared to usual care. To be eligible, the interventions must have been delivered in the context of an existing outside-school hours childcare setting (i.e. childcare that was available consistently throughout the school week/year), and not set up in the after-school period for the purpose of research. Two review authors independently screened titles and abstracts of identified papers with discrepancies resolved via a consensus discussion. A third review author was not required to resolve disagreements. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of included trials with discrepancies resolved via a consensus discussion; a third review author was not required to resolve disagreements. For continuous measures of physical activity, we reported the mean difference (MD) with 95% confidence intervals (CIs) in random-effects models using the generic inverse variance method for each outcome. For continuous measures, when studies used different scales to measure the same outcome, we used standardised mean differences (SMDs). We conducted assessments of risk of bias of all outcomes and evaluated the certainty of evidence (GRADE approach) using standard Cochrane procedures. MAIN RESULTS: We included nine trials with 4458 participants. Five trials examined the effectiveness of staff-based interventions to change practice in the outside-school hours childcare setting (e.g. change in programming, activities offered by staff, staff facilitation/training). Two trials examined the effectiveness of staff- and parent-based interventions (e.g. parent newsletters/telephone calls/messages or parent tool-kits in addition to staff-based interventions), one trial assessed staff- and child-based intervention (e.g. children had home activities to emphasise physical activity education learnt during outside-school hours childcare sessions in addition to staff-based interventions) and one trial assessed child-only based intervention (i.e. only children were targeted).  We judged two trials as free from high risk of bias across all domains. Of those studies at high risk of bias, it was across domains of randomisation process, missing outcome data and measurement of the outcome. There was low-certainty evidence that physical activity interventions may have little to no effect on total daily moderate-to-vigorous physical activity compared to no intervention (MD 1.7 minutes, 95% CI -0.42 to 3.82; P = 0.12; 6 trials; 3042 children). We were unable to pool data on proportion of the OSHC session spent in moderate-to-vigorous physical activity in a meta-analysis. Both trials showed an increase in proportion of session spent in moderate-to-vigorous physical activity (moderate-certainty evidence) from 4% to 7.3% of session time; however, only one trial was statistically significant. There was low-certainty evidence that physical activity interventions may lead to little to no reduction in body mass index (BMI) as a measure of cardiovascular health, compared to no intervention (SMD -0.17, 95% CI -0.44 to 0.10; P = 0.22; 4 trials, 1684 children). Physical activity interventions that were delivered online were more cost-effective than in person. Combined results suggest that staff-and-parent and staff-and-child-based interventions may lead to a small increase in overall daily physical activity and a small reduction or no difference in BMI. Process evaluation was assessed differently by four of the included studies, with two studies reporting improvements in physical activity practices, one reporting high programme satisfaction and one high programme fidelity. The certainty of the evidence for these outcomes was low to moderate. Finally, there was very low-certainty evidence that physical activity interventions in outside-school hours childcare settings may increase cardiovascular fitness. No trials reported on quality of life or adverse outcomes. Trials reported funding from local government health grants or charitable funds; no trials reported industry funding. AUTHORS' CONCLUSIONS: Although the review included nine trials, the evidence for how to increase children's physical activity in outside-school hours care settings remains limited, both in terms of certainty of evidence and magnitude of the effect. Of the types of interventions identified, when assessed using GRADE there was low-certainty evidence that multi-component interventions, with a specific physical activity goal may have a small increase in daily moderate-to-vigorous physical activity and a slight reduction in BMI. There was very low-certainty evidence that interventions increase cardiovascular fitness. By contrast there was moderate-certainty evidence that interventions were effective for increasing proportion of time spent in moderate-to-vigorous physical activity, and online training is cost-effective.

Evaluating changes in student health, wellbeing and social circumstances before and during COVID-19 pandemic restrictions in Australia.

The impacts of COVID-19 have been felt on a global scale, with associated physical distancing restrictions and economic downturn having flow-on effects for mental health and wellbeing across the community, and for university students in particular. First-year pharmaceutical and medical science students completing a common introductory population health course at an Australian university are routinely surveyed at the beginning of the semester as part of the course. Survey data inform teaching approaches based on understanding the 'real life' commitments and health profiles of students, and deidentified data form part of the teaching material. The 2020 student cohort was invited to complete a second follow-up survey during COVID-19 physical distancing restrictions. A total of n = 126 students completed both the initial and follow-up surveys (50.6% response rate), and n = 99 (39.8% of the total cohort) consented for their data to be included in research. There was a non-significant decrease in student employment; however, 22% of all students reported loss of work due to COVID-19. There was a statistically significant decrease in the proportion of students undertaking sufficient levels of physical activity, and a statistically significant increase in reported family stressors associated with loss of employment or an inability to gain employment between March and May 2020. Two-thirds of respondents reported increased stress as an impact of the transition to online learning. Implementation of holistic strategies, incorporating attention to additional factors influencing students' capacity to engage in study, and which may have long-term impacts across the life of the degree program, should be considered.

Large herbivores transform plant-pollinator networks in an African savanna.

Pollination by animals is a key ecosystem service1,2 and interactions between plants and their pollinators are a model system for studying ecological networks,3,4 yet plant-pollinator networks are typically studied in isolation from the broader ecosystems in which they are embedded. The plants visited by pollinators also interact with other consumer guilds that eat stems, leaves, fruits, or seeds. One such guild, large mammalian herbivores, are well-known ecosystem engineers5-7 and may have substantial impacts on plant-pollinator networks. Although moderate herbivory can sometimes promote plant diversity,8 potentially benefiting pollinators, large herbivores might alternatively reduce resource availability for pollinators by consuming flowers,9 reducing plant density,10 and promoting somatic regrowth over reproduction.11 The direction and magnitude of such effects may hinge on abiotic context-in particular, rainfall, which modulates the effects of ungulates on vegetation.12 Using a long-term, large-scale experiment replicated across a rainfall gradient in central Kenya, we show that a diverse assemblage of native large herbivores, ranging from 5-kg antelopes to 4,000-kg African elephants, limited resource availability for pollinators by reducing flower abundance and diversity; this in turn resulted in fewer pollinator visits and lower pollinator diversity. Exclusion of large herbivores increased floral-resource abundance and pollinator-assemblage diversity, rendering plant-pollinator networks larger, more functionally redundant, and less vulnerable to pollinator extinction. Our results show that species extrinsic to plant-pollinator interactions can indirectly and strongly alter network structure. Forecasting the effects of environmental change on pollination services and interaction webs more broadly will require accounting for the effects of extrinsic keystone species.

Nature-Based Citizen Science as a Mechanism to Improve Human Health in Urban Areas.

The world is becoming increasingly urbanised, impacting human interactions with natural environments (NEs). NEs take a number of forms, ranging from pristine, modified, to built NEs, which are common in many urban areas. NEs may include nature-based solutions, such as introducing nature elements and biological processes into cities that are used to solve problems created by urbanisation. Whilst urbanisation has negative impacts on human health, impacting mental and physical wellbeing through a number of mechanisms, exposure to NEs may improve human health and wellbeing. Here, we review the mechanisms by which health can be improved by exposure to NEs, as explained by Stress Reduction Theory, Attention Restoration Theory, and the 'Old Friends'/biodiversity hypothesis. Such exposures may have physiological and immunological benefits, mediated through endocrine pathways and altered microbiota. Citizen Science, which often causes exposure to NEs and social activity, is being increasingly used to not only collect scientific data but also to engage individuals and communities. Despite being a named component of scientific and environmental strategies of governments, to our knowledge, the intrinsic health benefits of Citizen Science in NEs do not form part of public health policy. We contend that Citizen Science programs that facilitate exposure to NEs in urban areas may represent an important public health policy advance.