The Effects of Outdoor versus Indoor Exercise on Psychological Health, Physical Health, and Physical Activity Behaviour: A Systematic Review of Longitudinal Trials.

A growing body of research is exploring the potential added health benefits of exercise when performed outdoors in nature versus indoors. This systematic review aimed to compare the effects of exercise in outdoor environments versus indoor environments on psychological health, physical health, and physical activity behaviour. We searched nine databases from inception to March 2021 for English language, peer-reviewed articles: MEDLINE, Embase, PubMed, Scopus, Web of Science, CINAHL, SportsDiscus, GreenFile, and CENTRAL. We included randomized and non-randomized trials that compared multiple bouts of exercise in outdoor versus indoor environments, and that assessed at least one outcome related to physical health, psychological health, or physical activity behaviour. Due to minimal outcome overlap and a paucity of studies, we performed a narrative synthesis. We identified 10 eligible trials, including 7 randomized controlled trials, and a total of 343 participants. Participant demographics, exercise protocols, and outcomes varied widely. In the 10 eligible studies, a total of 99 comparisons were made between outdoor and indoor exercise; all 25 statistically significant comparisons favoured outdoor exercise. Interpretation of findings was hindered by an overall high risk of bias, unclear reporting, and high outcome heterogeneity. There is limited evidence for added health or behaviour benefits of outdoor exercise versus indoor exercise. Rigorous randomized controlled trials are needed with larger samples and clear reporting.

Impact of Medication on Performance of Household Chores by Children with ADHD.

OBJECTIVE: To investigate associations between ADHD medication and household chore performance by children with ADHD. METHODS: A parent questionnaire collected information about the adequacy and quality of their child's performance of two self-care and six family-care chores. Parent perceptions of ADHD medication effect duration were used to identify children with after-school medication benefits (ASMB). Mann-Whitney U tests compared children with and without ASMB across measures of chore performance. RESULTS: A total of 565 parents of children with ADHD that regularly take medication completed the questionnaire. Children with ASMB were more likely to meet parental expectations for five of eight household chores and were more likely to be able to independently complete both self-care and family-care chores than those without ASMB. No differences were noted regarding their need for reminders or assistance with chores. CONCLUSION: Improvement in chore performance may be an additional consideration with respect to medication selection for children with ADHD.

The cannabidiol conundrum: potential benefits and risks of cannabidiol products for children.

PURPOSE OF REVIEW: Since the federal ban on hemp products was lifted in December 2018, cannabidiol (CBD), a nonpsychoactive cannabinoid derived from hemp, has become increasingly popular and accessible. CBD is sold in the form of oils, tablets, and foods in locations including gas stations, cafés, and drug stores. Despite a lack of reliable evidence, many parents praise its purported therapeutic effects on a variety of childhood ailments. RECENT FINDINGS: Epidiolex was the first CBD-based medication to be approved by the US Food and Drug Administration in 2018 for the treatment of two rare and severe forms of epilepsy, known as Lennox-Gastaut and Dravet syndrome, in patients of at least 2 years of age. Its efficacy was assessed through three randomized, double blind, and placebo-controlled trials in a sample of 516 patients with either Lennox-Gastaut syndrome or Dravet syndrome. Despite this development, there are few or no large-scale, rigorous studies concerning the effects of CBD on any other pediatric conditions that parents have tried to alleviate with CBD. The purpose of this review is to explore recent literature regarding the efficacy and safety of CBD in treating various health conditions in children; the risks of consuming CBD products, and the role of pediatricians in helping parents navigate often-confusing information about CBD. SUMMARY: Although CBD use has dramatically increased in recent years, both its potential to treat conditions and its risks have not yet been subjected to rigorous study. Pediatricians should be aware of the risks posed by poor-quality standards and labeling practices for cannabinoid products. Due to the confusing nature of the numerous sources of information about CBD, pediatricians are in a position to provide and clarify information about CBD to parents and understand the risks it poses to children.

Strategic donor investments for strengthening condom markets: The case of Zimbabwe.

BACKGROUND: Zimbabwe faces an uncertain future for condom funding and potential condom insecurity as international donors prioritize creating more self-sustaining markets and the government identifies how to best ensure access and uptake. We tested the impact of an intensive intervention on demand and supply after a price increase to the social marketed condom, Protector Plus. The study occurred during a deteriorating economy and pressure to reach sustainability quickly. We highlight where strategic donor investments can impact condom programming and markets. METHODS: We randomized ten purposively selected districts in Zimbabwe and assigned them to two study groups to test the impact of an intensive social marketing intervention. To the best of our knowledge, this is the first experimental study conducted within a larger market strengthening context. We tracked sales of Protector Plus and distribution of the public sector condom monthly. We conducted baseline and follow-up surveys among consumers and traders, and used the difference-in-difference method to test the intervention's impact on condom preferences and brand equity. RESULTS: Protector Plus sales rebounded to previous levels after the price increase. We detected no significant difference in sales between the experimental and control districts. Among traders, there were no significant differences in brand preference for Protector Plus attributed to the intervention. Among consumers, there was a significant increase in emotional attachment and beliefs about condom efficacy in the experimental districts. DISCUSSION: Study findings demonstrate where international donor and government investments can impact condom programming and condom markets. Broader findings from the intervention highlight where investments can improve condom coverage, cost recovery, and collaboration between the public, social marketing, and commercial sectors. Strategic investments for strengthening condom markets include: consumer research to segment markets, willingness to pay studies to set price points, distribution system improvements to increase efficiency, intensive demand generation to increase demand and use, market facilitation across sectors, and market intelligence to inform decision making. When a disciplined social marketing approach is used, the market benefits: subsidies can be better targeted, branded products can appeal to the right audiences, and room can be made for the commercial sector to enter the market.

HIV index testing to improve HIV positivity rate and linkage to care and treatment of sexual partners, adolescents and children of PLHIV in Lesotho.

Despite years of HIV testing and other interventions, Lesotho continues to experience an incredibly high HIV burden. Prevalence of HIV among children ages 0-14 years is at 2.1% and 25.6% among adults ages 15-59 years. Among adults living with HIV, 77.2% know their status, 90.2% of those with known HIV positive status are currently receiving ART and 88.3% are virally suppressed. In order to identify adults, adolescents and children at high risk of HIV infection, Population Services International (PSI)/Lesotho with support from the Centers for Disease Control and Prevention (CDC) introduced the HIV Index testing model in 2015. PLHIV recruited for index testing, were accessed through health facilities and community testing at PSI New Start channels in five districts. Consenting index clients received home visits for HIV testing of their biological children and sexual partners with unknown status. Routine monitoring of data gathered between May 2015 and November 2017 was analyzed to assess feasibility of this approach. For HIV index testing, 49.2% of children below 15 years and 37.3% of adolescents ages 15-19 were first time testers while 18.8% of all adults aged 20 years and above tested were testing for the first time. Higher HIV positivity rates among clients tested through the HIV index testing model across all age groups in comparison to other HIV testing models were statistically significant. Among children ages 2-14 years, the HIV positivity rate was 1.4%, adolescents ages 15-19 years had a positivity rate of 2.4% and adults ages 20 years and above had a positivity rate of 17.6%. Linkage rates of 92%, 73% and 72% for children, adolescents and adults, respectively, achieved with the HIV index testing model were higher than linkage rates observed with other HIV testing models. Results indicate that testing of biological children and sexual partners utilizing the HIV index testing model can be viable to identify and link children, adolescents and adults into care and treatment.