The effects of L-carnitine supplementation on inflammation, oxidative stress, and clinical outcomes in critically Ill patients with sepsis: a randomized, double-blind, controlled trial.

BACKGROUND: Sepsis, a life-threatening organ dysfunction caused by a host's dysregulated response to infection with an inflammatory process, becomes a real challenge for the healthcare systems. L-carnitine (LC) has antioxidant and anti-inflammatory properties as in previous studies. Thus, we aimed to determine the effects of LC on inflammation, oxidative stress, and clinical parameters in critically ill septic patients. METHODS: A randomized double-blinded controlled trial was conducted. A total of 60 patients were randomized to receive LC (3 g/day, n = 30) or placebo (n = 30) for 7 days. Inflammatory and oxidative stress parameters (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), superoxide dismutase (SOD), malondialdehyde (MDA), total antioxidant capacity (TAC), 28-day mortality rate, and some monitoring variables were evaluated. RESULTS: There was no statistically significant difference between study arms in baseline characteristics and disease severity scores. CRP (p < 0.001) and ESR (p: 0.004) significantly reduced, and SOD (p < 0.001) and TAC (p < 0.001) significantly improved in the LC group after 7 days. Between-group analysis revealed a significant reduction in CRP (p: 0.001) and serum chloride (p: 0.032), an increase in serum albumin (p: 0.036) and platelet (p: 0.004) significantly, and an increase in SOD marginally (p: 0.073). The 28-day mortality rate was also lower in the LC group compared with placebo (7 persons vs. 15 persons) significantly (odds ratio: 0.233, p: 0.010). CONCLUSIONS: L-carnitine ameliorated inflammation, enhanced antioxidant defense, reduced mortality, and improved some clinical outcomes in critically ill patients with sepsis. TRIAL REGISTRATION: IRCT20201129049534N1; May 2021.

Coenzyme Q10 supplementation in burn patients: a double-blind placebo-controlled randomized clinical trial.

BACKGROUND: Burn injuries are important medical problems that, aside from skin damage, cause a systemic response including inflammation, oxidative stress, endocrine disorders, immune response, and hypermetabolic and catabolic responses which affect all the organs in the body. The aim of this study was to determine the effect of coenzyme Q10 (CoQ10) supplementation on inflammation, oxidative stress, and clinical outcomes in burn patients. METHODS: In a double-blind placebo-controlled randomized clinical trial, 60 burn patients were randomly assigned to receive 100 mg CoQ10 three times a day (total 300 mg/day) or a placebo for 10 days. Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), oxidative stress markers including total antioxidant capacity (TAC), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine, white blood cells (WBC), and body temperature were assessed as primary outcomes and albumin, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), other hematological parameters, blood pressure, O2 saturation, ICU duration, and 28-mortality rate were assessed as secondary outcomes. RESULTS: Fifty-two participants completed the trial. CRP and ESR levels were not significantly different between CoQ10 and placebo groups at the end of the study (P = 0.550 and P = 0.306, respectively). No significant differences between groups were observed for TAC (P = 0.865), MDA (P = 0.692), and SOD activity (P = 0.633) as well. Administration of CoQ10 resulted in a significant increase in albumin levels compared to placebo (P = 0.031). There was no statistically significant difference between the two groups in other measured outcomes (P > 0.05). CONCLUSION: Results showed that in patients with burn injury, CoQ10 administration had no effect on inflammatory markers and oxidative stress, although serum albumin levels were improved after supplementation. Further studies with albumin as the primary outcome are needed to confirm this finding.

Deep temporal networks for EEG-based motor imagery recognition.

The electroencephalogram (EEG) based motor imagery (MI) signal classification, also known as motion recognition, is a highly popular area of research due to its applications in robotics, gaming, and medical fields. However, the problem is ill-posed as these signals are non-stationary and noisy. Recently, a lot of efforts have been made to improve MI signal classification using a combination of signal decomposition and machine learning techniques but they fail to perform adequately on large multi-class datasets. Previously, researchers have implemented long short-term memory (LSTM), which is capable of learning the time-series information, on the MI-EEG dataset for motion recognition. However, it can not model very long-term dependencies present in the motion recognition data. With the advent of transformer networks in natural language processing (NLP), the long-term dependency issue has been widely addressed. Motivated by the success of transformer algorithms, in this article, we propose a transformer-based deep learning neural network architecture that performs motion recognition on the raw BCI competition III IVa and IV 2a datasets. The validation results show that the proposed method achieves superior performance than the existing state-of-the-art methods. The proposed method produces classification accuracy of 99.7% and 84% on the binary class and the multi-class datasets, respectively. Further, the performance of the proposed transformer-based model is also compared with LSTM.

An Integrated Yoga and Cognitive Behavioral Therapy Intervention for Managing Excessive Use of Internet among the Youth: A Case Series.

Background: Internet addiction is a behavioral problem that is managed by pharmacological and nonpharmacological methods. The nonpharmacological methods focus on enhancing skills for healthy use of technology and promoting mindfulness and mental relaxation. Yoga therapy is an effective tool to reduce psychological stress and promote self-regulation and mindfulness. Thus, present work focused on developing an integrated yoga and cognitive behavioral therapy intervention (Y-CBT) for the management of excessive use of technology amongst adolescents and young adult students. Methods: Feasibility of the Y-CBT program was tested by implementing 10 sessions of yoga and 6 sessions of CBT program for 2 weeks by certified Yoga therapist and psychologist, respectively. This was followed by online booster sessions once a week, and post assessments were conducted at 12 weeks. A total of 4 college-going students with the excessive use of technology were recruited from tertiary specialty service for promotion of healthy use of technology. Each participant was assessed using short-version of internet addiction test (s-IAT), Smartphone Addiction Scale-Short Version, Kessler's Psychological distress scale for baseline, and follow-up assessment after completion of the program. Results: The Y-CBT program was found feasible and useful in reducing internet use, smart phone use, and psychological distress. There were no reported side-effects. A trend was observed for increase compliance toward treatment at follow-up. Future studies should explore this further with robust methodology.

Exploring Yoga Behaviors among College Students Based on the Multi-Theory Model (MTM) of Health Behavior Change.

During college years, perceived stress is the top reported hindrance to well-being and academic success. Data on the acceptance and perceived benefits of yoga among college students are limited. A purposive sample of college students (n = 79) from a course centered on Vinyasa Yoga and Mindfulness Meditation were recruited. Comprehensive yoga journaling data were collected, and a directed content analysis along the constructs of the multi-theory model (MTM) of health behavior change was utilized. The advantages of yoga that emerged were improved physical performance, reduced perceived stress, acceptance of oneself, better well-being, and improved coping. The identified disadvantages were time commitment, lack of motivation, and other competing interests. Learning through small steps, modifications, and identifying multiple sources of confidence helped build behavioral confidence. Practicing at home or at a yoga studio was a common theme for support in the physical environment. Directing negative emotions into purposes was helpful in maintaining the yoga practice. Sustained commitment to the practice also helped maintain the regular performance of yoga. Finally, social support from family, friends, and instructors was vital for continued practice. The study has important ramifications for the development of survey tools for descriptive studies and designing behavior-change yoga interventions in this target population.

Experiential Avoidance as a Mediator of the Relationship between Dispositional Mindfulness and Problematic Smartphone Use.

Background: Experiential avoidance (EA) and mindfulness are the two important transdiagnostic process and outcome variables in psychological formulation and treatment. While smartphones have a large utility value, they also have the potential for adverse impacts on functioning. Studies have separately shown associations among EA, dispositional mindfulness (DM), and problematic smartphone use (PSU). However, there is a lack of study exploring the associations and mediation relationship among these variables together in an Indian context. The current study aims to explore the associations of PSU, DM, EA, and sociodemographic factors; including the mediating effect of EA between DM and PSU in the Indian adult context. Methods: Four hundred and thirty-four participants (M age = 25.4, standard deviation = 2.6, 58.8% females) were recruited for an online survey using a cross-sectional design. Data were collected using sociodemographic questionnaire, Smartphone Addiction Scale-Short Version, brief EA scale, and Mindfulness Attention Awareness Scale. Statistical analyses comprised multiple regression, mediation analysis, and significance in sociodemographic variables. Results: Both EA and DM significantly predicted PSU with a 37% variance; however, DM had an inverse relationship. EA as a mediator could account for a quarter of the effect, PM = 24.4%, ab = -0.14, 95% CIcs (-0.19, -0.09). Conclusion: The current study implicates the monitoring and treatment planning for PSU from a transdiagnostic perspective in the Indian context.

Introspective Meditation before Seeking Pleasurable Activities as a Stress Reduction Tool among College Students: A Multi-Theory Model-Based Pilot Study.

In the realm of behavioral interventions, a combined approach of yoga and a cognitive-behavioral strategy in the form of introspective meditation (manan-dhyana) may offer benefits as a stress management tool. This pilot study focuses on introspective meditation performed before seeking pleasurable activities, which is a self-reflection about whether to pursue a goal that will bring sensory pleasure in life. A non-probability sample of college students was recruited from a mid-sized Southern University of the United States using a 52-items web-based survey built in Qualtrics. Univariate, bivariate, and multivariate statistics were used to analyze data. Of total 65 students, only 21.5% students reported being engaged in the introspective meditation. The sample constituted predominantly females (75.4%), White (64.6%), and undergraduate students (87.7%). The proportions of anxiety, depression, and moderate/high stress were 50.8%, 40.0%, 86.1% respectively. In the hierarchical regression for initiation, the final model explained nearly 21.1% of variance in initiating introspective meditation among participants (n = 51) who had not been practicing it. With each unit increment in subscales of initiation (i.e., changes in physical environment), the conditional mean for initiating introspective meditation behavior increased by 0.373 units. In the hierarchical regression for sustenance, the final model explained nearly 50.5% of variance in sustaining introspective meditation behavior among participants (n = 51) who had not been practicing it. With each unit increment in subscales of sustenance (i.e., emotional transformation), the conditional mean for sustaining introspective meditation behavior increased by 0.330 units. This study can pave a way for designing interventions for college students to promote introspective meditation directed toward seeking pleasurable activities before engaging in them. This has implications for the reduction of stress as well as a preemptive measure for sexual risk-taking, indulgence in maladaptive behaviors such as smoking, vaping, alcohol, and substance use.

Effect of long-term aggressive nutrition therapy on survival in patients with alcohol-related cirrhosis: A randomized controlled trial.

BACKGROUND: The aim of this study was to assess the effect of long-term aggressive nutritional therapy on clinical outcomes and survival in patients with alcoholic liver cirrhosis (ALC). METHODS: Malnourished patients assessed by Royal Free Hospital-Subjective Global Assessment (RFH-SGA) were randomized to control group (CG) (35-40 kcal and 1.2 g protein/kg/day; diet alone) or intervention group (IG) (40-45 kcal and 1.5 g protein/kg/day; diet plus polymeric formula) for 3 months. Patients were followed up at 3 and 12 months. RESULTS: Malnourished patients (age 44.0 ± 9 years; M [100%]; Child A:B:C [%] = 11:39:50) were randomized to the CG (n = 50) or IG (n = 54); 21 patients in CG and 27 in IG completed 3 months of follow-up. The RFH-SGA improved in 7 (33.3%; p = 0.016) in IG vs. 3 (14.2%; p = 0.625) in CG. Over 3 months, increments (CG vs. IG) were seen in calories (1554 ± 972 to 1823 ± 398; p = 0.001 vs.1542 ± 603 to 2254 ± 372; p=0.001), protein (53.1 ± 18.4 to 72.5 ± 19.6; p = 0.001 vs. 53 ± 21 to 86.9 ± 18.8; p = 0.00), dry body weight (64 ± 10 to 66 ± 11; p = 0.04 vs. 60.8 ± 9.2 to 63.2 ± 10.7; p = 0.009), and mid-upper arm circumference (MUAC) (24.7 ± 3.3 to 25.5 ± 3.3; p = 0.116 vs. 23.5 ± 2.7 to 24.1 ± 2.9; p = 0.015), with better ascites resolution in IG (53.3%; p = 0.008) vs. CG (44.4%; p = 0.227). Median 12-month survival was comparable in both the groups (p = 0.864). Irrespective of the intervention group, energy intake > 25 kcal and protein > 0.8 g/kg/day significantly improved 12-month survival. CONCLUSION: Aggressive nutritional therapy improves nutritional status and resolves ascites, however fails to show long-term survival benefit, though higher calorie and protein intake has the potential to impact survival. TRIAL REGISTRATION: NCT02140294.

Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain Yoga Practice.

BACKGROUND: Diverse groups, including college students, are being encouraged to practice yoga. Research suggests that college students fail to attain the mental and physical benefits of yoga practice. OBJETIVE: The purpose of this study was to utilize the fourth-generation, multi-theory model (MTM) of health behavior change to explain change regarding yoga practice of asanas, shava asana, pranayama, dhyana, yama and niyama among college students. METHOD: This cross-sectional study relied on a quota sample of students 18 years and older attending Jackson State University, a historically black college in Jackson, Mississippi, United States. MEASURES: A 36-item face and content valid instrument was used to collect data. Stepwise multiple regression was used to analyze the survey data for identifying the best possible predictors of yoga practice. A statistical significance level of 0.05 was set a priori. RESULTS: A total of 70 participants, mean age 28.62 years (SD, 6.11), predominately female (84%) and black (87%) completed the survey. The initiation model constructs- changes in the physical environment (ß = 3.99, P = .002) and behavioral confidence (ß = 0.331, P = .008)-were significant, explaining 40% of the variability in the dependent variable. Practice change was statistically significant (F1,65 =7.569; P = .0001; adjusted R2 = 0.460) for the maintenance model, explaining 46% of the variability. CONCLUSION: The MTM model of health behavior change is effective for explaining the intent to initiate and maintain yoga behavior among college students.

Digital resilience mediates healthy use of technology.

Excessive use of online technology brings with it the risk of problematic digital behaviour like over-use of social media, online gambling, webinar fatigue, digital burnout, and in extreme cases doom surfing, and doom scrolling. In addition, digital failures can cause significant mental health distress to people, and unhealthy interactions on social media can also lead to deviant behaviour such as cyber bullying and cybercrime. This paper discusses the various vulnerabilities an individual is predisposed to on the internet, and highlights the importance of "Digital Resilience". Digital resilience is a new concept which refers to the learning, recovery, and bouncing back process after having negative or adverse experiences online. A comprehensive and holistic model to introduce Digital Resilience to everyone through a multitier approach that includes Individual, Societal, and Community intervention is formulated and elaborated. The importance of addressing these concerns from both a psychological and legal perspective is also discussed.

Can the Multi-Theory Model (MTM) of Health Behavior Change Explain the Intent for People to Practice Meditation?

Meditation is gaining popularity as adjuvant therapy for many chronic ailments, mental well-being, and spiritual growth. Behavioral theories have been underutilized in understanding meditation behavior. This study aimed to test if a fourth-generation multi-theory model (MTM) could explain the intent for starting and maintaining meditation behavior in a sample of US adults. A face and content valid 48-item instrument based on MTM was administered in a cross-sectional design through an online survey (n = 330). Internal consistency (Cronbach's alpha > 0.70) and construct validation using structural equation modeling of the subscales were all acceptable. Hierarchical multiple regression revealed that, after controlling for demographic covariates, the MTM constructs of participatory dialogue (ß = 0.153; P = .002) and behavioral confidence (ß = 0.479; P < .001) were statistically significant in predicting intent for starting meditation behavior and accounted for 32.9% of the variance. Furthermore, after controlling for demographic covariates, the MTM constructs of emotional transformation (ß = 0.390; P < .001) and changes in the social environment (ß = 0.395; P < .001) were statistically significant and accounted for 52.9% of the variance in the intent for maintaining meditation behavior. Based on this study, it can be concluded that MTM offers a pragmatic framework to design, implement, and evaluate evidence-based (theory-based) meditation behavior change interventions.

Testing Multi-Theory Model (MTM) in Explaining Sunscreen Use among Florida Residents: An Integrative Approach for Sun Protection.

Florida residents have the second highest incidence of skin cancer in the nation. Sunscreen usage was found to be the one of the most effective integrative health approaches for reducing risk of skin cancer. Given the limited information on the likelihood of adopting and continuing sunscreen usage behavior, this cross-sectional study aimed to examine the correlates of initiating and sustaining sunscreen usage behavior among Florida dwellers, using the fourth-generation, multi-theory model (MTM) of behavior change. A web-based survey containing 51 questions was emailed to Florida residents aged 18 years or above, who were randomly selected from the state voter file. Psychometric validity of the survey instrument was established using structural equation modeling, and Cronbach's alpha values were calculated for assessing the internal consistency. An independent-samples-t-test and hierarchical multiple regression tests were used to analyze the data. The results indicated that participants who engaged in sunscreen usage behavior, participatory dialogue (ß = 0.062, p < 0.05), behavioral confidence (ß = 0.636, p < 0.001), and changes in the physical environment (ß = 0.210, p < 0.001) were statistically significant and accounted for 73.6% of the variance in initiating sunscreen usage behavior. In addition, the constructs of emotional transformation (ß = 0.486, p < 0.001) and practice for change (ß = 0.211, p < 0.001), as well as changes in the social environment (ß = 0.148, p < 0.001) were significant predictors of maintaining sunscreen usage behavior and contributed to 59% of variance in sustenance. These findings offer a valuable insight regarding the applicability of MTM models to guiding public health interventions promoting sunscreen usage and preventing UV radiation risk and related skin cancer.

Development and validation of Yoga Module for Anger Management in adolescents.

BACKGROUND: Development of anger management programs and in particular, yoga module for anger management has not been well researched. Being a complex emotion, anger poses serious challenges in developing a comprehensive anger management program. While various theories of anger are dealt in modern psychology, several anger management techniques are set forth in Indian traditional texts. Yoga, which is considered as a holistic and integrated approach is explored in this study to develop and validate a school-based yoga program for anger management in adolescence. MATERIALS AND METHODS: Integrated Approach to Yoga Therapy (IAYT) principles and literary review formed the basis for deriving the concepts of anger management. The methodology includes construction of the yoga module, validation of the module by 22 experts followed by a pilot non-randomised control study (n-50) to assess feasibility and initial effectiveness. Content Validity Ratio (CVR) and paired t-test were employed to analyse the experts' rating and pilot-study data respectively. RESULTS: Emergence of IAYT based yoga program for anger management. Based on CVR ratio, 16 out of 18 yogic techniques qualified for the final module. The pilot study revealed viability of the module and its recognition as an anger management program. Significant reduction of anger scores in yoga group substantiates initial effectiveness of the module. CONCLUSION: The developed and validated yoga module for anger management is recognised as a well-accepted and effective yoga program for anger management in adolescents.

Efficacy of Meditation-Based Interventions on Post-Traumatic Stress Disorder (PTSD) Among Veterans: A Narrative Review.

BACKGROUND: Decades of research have documented post-traumatic stress disorder (PTSD) symptoms in war veterans. Current treatment options for PTSD are unappealing as they either require re-exposure to the traumatic event or medications that are greatly impacted by comorbidities. Meditation-based interventions are a promising alternative. However, there is a dearth of research examining their impact. PRIMARY OBJECTIVE: The purpose of this study was to examine meditation-based interventions tested for efficacy in treating PTSD among veterans and provide collective evidence. METHODS: Authors searched the MEDLINE and CINAHL databases for relevant studies using the following inclusion criteria: (1) published in peer-reviewed journals; (2) conducted between January 2014 and July 2020; (3) described the evaluation of interventions; and (4) incorporated quantitative or mixed methods. SETTING: United States. PARTICIPANTS: U.S. Veterans. RESULTS: A total of 15 studies (ten articles) met the inclusion criteria. Four tested Transcendental Meditation (n = 4), three tested Mantra Meditation (n = 3), two tested Mindful Meditation (n = 2), one tested Breathing-based Meditation (n = 1), one tested Mindfulness-based Exposure Therapy (n = 1), one tested Cognitively-based Compassion Training Meditation (n = 1), one tested Mantra Meditation and Mindfulness-based Treatment (n = 1), one tested Mindfulness-based PTSD Treatment (n = 1), and one tested Primary Care Brief Mindfulness Program (n = 1). The most common duration was 8 weeks (n = 8) and the most common evaluation design was the randomized controlled trial (n = 10). The most common outcome measure was the Clinician Administered PTSD Scale (CAPS) (n = 12). CONCLUSION: All interventions reported improvements in PTSD symptoms. Based on this review, meditation-based therapy is a promising approach for managing PTSD, particularly among veterans resistant to trauma-focused therapies. Randomized control trials with large sample sizes that apply CAPS as their primary outcome measure, and take into account effect size, attrition rates, and blinding are recommended for further research.

Applying the integrated marketing communication approach to recruit and retain African American women.

Background: Researchers use multiple approaches to engage and maintain underrepresented populations in research. They often overlook integrated marketing communication (IMC), a useful approach for commercial marketing, for more established health promotion and social marketing techniques. There is limited information on the application of the IMC approach for recruiting and retaining African American study participants. This article explores the IMC approach used to recruit and retain volunteers for a community-based intervention. Methods: This is a cross-sectional study relying on extracted data from the Multi-Theory Model (MTM) of Health Behavior Physical Activity intervention. A brief multiple-choice survey was administered to a sample of African American women (n=74) to assess the effectiveness of applying an IMC approach for recruiting and retaining volunteers for the multi-week program during January - June 2018. The measures were (1) source for study information, (2) preferred method of contact, (3) primary source for health information. Results: Sixty-nine women listed their doctor as the primary source of health information and five women in the age group 18-34 identified social media (n=3) and websites (n=2). Age is significantly related to the preference of communication tools used to recruit and retain the African American participants. A statistical significance (P =0.025) suggests for women ages 51-69, a combination of radio, church, and word of mouth was more effective for recruitment. The older women preferred telephone calls compared to the women ages 18-50 who relied on texting. Conclusion: IMC can synergize individual communication elements in a coordinated manner to address niche audiences and develop cost-effective health communications programs that can improve recruitment and retention efforts in minority populations.

Mindfulness-Based Interventions: Potentials for Management of Internet Gaming Disorder.

Mindfulness-based interventions have been found to be efficacious among cases with substance addiction. Its role in Internet gaming disorder (IGD) has not been extensively studied. Prisma model approach was used to search for relevant articles from January 2009 to March 2021, to synthesize the role of empirical findings with mindfulness-based interventions to address various psychological domains in IGD. Eighteen relevant papers were included to understand the role of mindfulness-based interventions in IGD. Studies revealed the role of mindfulness-based interventions in the promotion of emotional regulation, metacognitive awareness, adaptive coping/cognition, reducing impulsivity, and craving for playing games. Studies also reveal neuro-biological basis for the effect of these interventions among users with IGD. Mindfulness-based interventions are potentially useful in IGD. It implicates the need to understand the empirical linkages within the root factors for a comprehensive understanding of the phenomenon of mindfulness-based treatment in IGD.

Edible Tuber Amorphophallus paeoniifolius (Dennst.) Extract Induces Apoptosis and Suppresses Migration of Breast Cancer Cells.

Medicinal plants offer enormous possibilities in the quest of novel bioactive formulation for cancer therapy. Here, we studied the anticancer efficacy of the extract of edible tuber Amorphophallus paeoniifolius (Dennst.) (APTE) against estrogen positive MCF-7 and triple negative MDA-MB-231 breast cancer cell lines. APTE showed significant cytotoxic activity in both MCF-7 and MDA-MB-231 cells in a dose and time-dependent manner. The effect of APTE on metastatic parameters e.g., migration, adhesion, and invasion in MCF-7 and MDA-MB-231 cells were studied using wound healing, collagen adhesion, and transwell matrigel invasion assays, respectively. APTE significantly reduced migration in both the cell lines, however, its effect on the inhibition of adhesion and invasion was higher in MDA-MB-231 cells. Annexin V-Cy3 staining suggested that APTE induced apoptosis in these cells which was further validated by attenuation of antiapoptotic Bcl-2 and induction of pro-apoptotic Bax, Caspase-7 expression and cleavage of PARP. High resolution-liquid chromatography mass spectroscopy analysis with bioactive ethyl acetate and butanol fractions of APTE detected several compounds with anticancer activities. Overall, the study described the mechanism of anticancer activity of a common edible tuber A. paeoniifolius and contributes to growing list of naturally occurring chemo-preventive strategies.

Yoga as an Alternative Therapy for Weight Management in Child and Adolescent Obesity: A Systematic Review and Implications for Research.

BACKGROUND: Obesity remains among one of the greatest health care threats facing today's children and adolescents. Yoga has gained increased popularity in the United States and appears as a promising way to assist with weight loss and management in adults. However, research examining yoga programs targeting weight loss for children or adolescents are relatively scarce. OBJECTIVE: The current study provided a systematic review of yoga-based interventions targeting weight loss among overweight or obese children and adolescents. METHODOLOGY: The authors conducted a systematic review of articles obtained from Alt HealthWatch, CINAHL, SPORTDiscus, PubMed, and Web of Science databases. Inclusion criteria were studies employed yoga as a primary component, targeted overweight or obese children or adolescents, measured body weight or BMI as an outcome, utilized any type of study design, and published in peer-reviewed journals in English language. RESULTS: A total of nine studies met the inclusion criteria. Most studies were conducted in the United States (n = 5), and implemented in the school setting (n = 5). Among studies reviewed, three were randomized controlled trials, and two were with the attrition rates approaching 50%. A majority of the interventions were able to facilitate weight loss and relevant behaviors. CONCLUSION: The impact of yoga interventions on child and adolescent obesity was small but meaningful. Some of the limitations include small sample sizes, lack of follow-up assessment after posttest, lack of control groups, lack of utilization of behavioral theories, and lack of intervention targeting disadvantaged populations. Future interventions utilizing randomized controlled trials with large sample sizes are needed to assess the impact of yoga on child and adolescent obesity.

Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain Intentional Outdoor Nature Contact Behavior among College Students.

Nature contact is an emerging health behavior and is defined as the interaction between human beings and animals, plants, natural scenic views, or outdoor activities. Studies have shown that exposure to the outdoors (as a means of contact with nature) reduces perceived stress and promotes health and wellbeing among varying populations in many settings. To date, however, there are few studies exploring the impact of nature contact among college students, especially in the United States. In addition, the determinants of nature contact behavior have not adequately been explored using behavioral theories. The purpose of this study was to use the multi-theory model (MTM) of health behavior change, a contemporary fourth-generation behavioral theory in explaining intentional outdoor nature contact behavior among college students. Using a cross-sectional design, 401 students completed the validated survey based on MTM. Of these, 281 met the inclusion criteria. The mean score for perceived stress based on the Perceived Stress Scale (PSS-10) in the sample was 21.60 (7.08) units, with a possible minimum and maximum scores ranging from 0 to 40 units. Constructs of behavioral confidence (standardized coefficient = 0.591, p < 0.001) and changes in the physical environment (standardized coefficient = 0.271, p < 0.001) from MTM accounted for 57.5% of the variance in the initiation for intentional outdoor nature contact behavior. All the three constructs of MTM-namely, emotional transformation (standardized coefficient = 0.173, p = 0.021), practice for change (standardized coefficient = 0.317, p < 0.001), and changes in the social environment (standardized coefficient = 0.204, p = 0.002)-were statistically significant and contributed substantively toward the variance (31.0%) in sustenance. MTM provides a useful and pragmatic framework for designing interventions to promote intentional nature contact behavior among college students.