Trauma outcomes at higher-level trauma centres compared with lower-level trauma centres: a systematic review and meta-analysis

The introduction of trauma systems has helped reduce mortality in severely injured patients. This fall in mortality, however, appears to be concentrated in higher-level trauma centres (TCs) in comparison to lower-level TCs, but the evidence is inconsistent. Therefore, we undertook a systematic review with the aim of comparing outcomes in lower-level TCs (i.e. level III and IV trauma centres) with higher-level TCs (i.e. level I and II centres). This systematic review was performed in accordance with the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). The review was registered on PROSPERO (CRD42019111933). Mortality data were combined using the Mantel-Haenszel random-effects method for meta-analysis, using Review Manager (RevMan v5.3.5). We found 28 eligible articles from an initial total of 10,816 identified abstracts. Our meta-analysis revealed no evidence of a difference in mortality risk in severely injured patients between lower-level and higher-level TCs (RR 1.55; 95% CI 0.97 to 2.50; p=0.07), but there was considerable heterogeneity (I2=92%) in the dataset. The risk of death in lower-level TCs in patients with neurological trauma, however, was statistically lower than in higher-level TCs (RR 0.80; 95% CI 0.73 to 0.86; I2=78%; p<00001). There was a higher risk of death in patients with neurological trauma managed at higher-level TCs and this is likely to be due to the higher severity of injury (intracranial and extracranial) sustained by patients at higher-level TCs. However, the high level of heterogeneity in the risk estimates of evaluated studies reduces the certainty of our interpretations

The effects of a home-based physical activity intervention on cardiorespiratory fitness in breast cancer survivors; a randomised controlled trial

The aim of this current randomised controlled trial was to evaluate the effects of a home-based physical activity (PA) intervention on cardiorespiratory fitness in breast cancer survivors. Thirty-two post-adjuvant therapy breast cancer survivors (age = 52 ± 10 years; BMI = 27.2 ± 4.4 kg∙m2) were randomised to a six-month home-based PA intervention with face-to-face and telephone PA counselling or usual care. Cardiorespiratory fitness and self-reported PA were assessed at baseline and at six-months. Participants had a mean relative V̇O2max of 25.3 ± 4.7 ml∙kg−1∙min−1, which is categorised as “poor” according to age and gender matched normative values. Magnitude-based inference analyses revealed likely at least small beneficial effects (effect sizes ≥.20) on absolute and relative V̇O2 max (d = .44 and .40, respectively), and total and moderate PA (d = .73 and .59, respectively) in the intervention compared to the usual care group. We found no likely beneficial improvements in any other outcome. Our home-based PA intervention led to likely beneficial, albeit modest, increases in cardiorespiratory fitness and self-reported PA in breast cancer survivors. This intervention has the potential for widespread implementation and adoption, which could considerably impact on post-treatment recovery in this population

Exercise, or exercise and diet for the management of polycystic ovary syndrome:a systematic review and meta-analysis

Background: Typically, management of PCOS focuses on lifestyle changes (exercise and diet), aiming to alleviate symptoms, and lower the associated risk of type 2 diabetes and cardiovascular disease. Our objective was to analyse evidence on the effectiveness of exercise in the management of PCOS, when compared to (i) usual care, (ii) diet alone, and (iii) exercise combined with diet, and also exercise combined with diet, compared to (i) control or usual care and (ii) diet alone. Methods: Relevant databases were searched (June 2017) with no time limit for trial inclusion. Eligible trials employed a randomised or quasi-randomised design to measure the chronic effects of exercise, or exercise and diet in women with PCOS. Results: Searches returned 2390 articles; of those, 27 papers from 18 trials were included. Results are presented as mean difference (MD) and 95% confidence intervals (95% CI). Compared with control, exercise had a statistical effect on change from baseline fasting insulin (MD - 2.44 μIU/mL, 95% CIs - 4.24 to - 0.64; very low-quality evidence), HOMA-IR (- 0.57, - 0.99 to - 0.14; very low-quality evidence), total cholesterol (- 5.88 mg/dL, - 9.92 to - 1.83; low-quality evidence), LDL cholesterol (- 7.39 mg/dL, - 9.83 to - 4.95; low-quality evidence), and triglycerides (- 4.78 mg/dL, - 7.52 to - 2.05; low-quality evidence). Exercise also improved VO 2 max (3.84 ml/kg/min, 2.87 to 4.81), waist circumference (- 2.62 cm, - 4.13 to - 1.11), and body fat percentage (- 1.39%, - 2.61 to - 0.18) when compared with usual care. No effect was found for change value systolic/diastolic blood pressure, fasting glucose, HDL cholesterol (all low-quality evidence), or waist-to-hip ratio. Many favourable change score findings were supported by post-intervention value analyses: fasting insulin (- 2.11 μIU/mL, - 3.49 to - 0.73), total cholesterol (- 6.66 mg/dL, - 11.14 to - 2.17), LDL cholesterol (- 6.91 mg/dL, - 12.02 to - 1.80), and VO 2 max (5.01 ml/kg/min, 3.48 to 6.54). Statistically lower BMI (- 1.02 kg/m 2 , - 1.81 to - 0.23) and resting heart rate (- 3.26 beats/min - 4.93 to - 1.59) were also revealed in post-intervention analysis. Subgroup analyses revealed the greatest improvements in overweight/obese participants, and more outcomes improved when interventions were supervised, aerobic in nature, or of a shorter duration. Based on limited data, we found no differences for any outcome between the effects of exercise and diet combined, and diet alone. It was not possible to compare exercise vs diet or exercise and diet combined vs diet. Conclusion: Statistically beneficial effects of exercise were found for a range of metabolic, anthropometric, and cardiorespiratory fitness-related outcomes. However, caution should be adopted when interpreting these findings since many outcomes present modest effects and wide CIs, and statistical effects in many analyses are sensitive to the addition/removal of individual trials. Future work should focus on rigorously designed, well-reported trials that make comparisons involving both exercise and diet

The Effects of Different Passive Static Stretching Intensities on Recovery from Unaccustomed Eccentric Exercise - A Randomized Controlled Trial

Effects of passive static stretching intensity on recovery from unaccustomed eccentric exercise of right knee extensors was investigated in 30 recreationally active males randomly allocated into three groups: high-intensity (70-80% maximum perceived stretch), low-intensity (30-40% maximum perceived stretch), and control. Both stretching groups performed 3 sets of passive static stretching exercises of 60s each for hamstrings, hip flexors, and quadriceps, over 3 consecutive days, post-unaccustomed eccentric exercise. Muscle function (eccentric and isometric peak torque) and blood biomarkers (CK and CRP) were measured before (baseline) and after (24, 48, and 72h) unaccustomed eccentric exercise. Perceived muscle soreness scores were collected immediately (time 0), and after 24, 48, and 72h post-exercise. Statistical time x condition interactions observed only for eccentric peak torque (p=.008). Magnitude-based inference analyses revealed low-intensity stretching had most likely, very likely, or likely beneficial effects on perceived muscle soreness (48-72h and 0-72h) and eccentric peak torque (baseline-24h and baseline-72h), compared with high-intensity stretching. Compared with control, low-intensity stretching had very likely or likely beneficial effects on perceived muscle soreness (0-24h and 0-72h), eccentric peak torque (baseline-48h and baseline-72h), and isometric peak torque (baseline-72h). High-intensity stretching had likely beneficial effects on eccentric peak torque (baseline-48h), but likely harmful effects eccentric peak torque (baseline-24h) and CK (baseline-48h and baseline-72h), compared with control. Therefore, low-intensity stretching is likely to result in small-to-moderate beneficial effects on perceived muscle soreness and recovery of muscle function post-unaccustomed eccentric exercise, but not markers of muscle damage and inflammation, compared with high-intensity or no stretching.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

S06-1 Putting young people at the heart of physical activity research design: The Walking In ScHools (WISH) Study

BACKGROUND: Young people have the right to be informed and consulted about decisions affecting their lives. Youth Patient and Public Involvement (PPI) should be encouraged to ensure research is carried out ‘with' or ‘by' young people rather than ‘to', ‘about' or ‘for' them. PPI can ensure research is relevant, results are accessible and recruitment rates are improved. Young people have had limited involvement in the design, implementation and dissemination of public health research and there have been calls for a greater focus on youth PPI in research. METHODS: Following the WISH feasibility study that consulted young people pre and post-intervention, a Youth Advisory Group (YAG) was set up within the main trial. The WISH study is a clustered randomised controlled trial in which a peer-led, school-based, brisk walking intervention is compared to usual physical activity in adolescent females. The YAG was introduced to inform intervention delivery and provide researchers with an understanding of what would encourage/discourage participation. Schools were asked to invite pupils aged 12-14 years (participants) and 15-18 years (walk leaders). Participative methods were used to develop and review study documentation. The YAG completed a short questionnaire and recruitment rates were monitored. RESULTS: Fourteen pupils from 3 schools attended the 2019 YAG meeting. The YAG agreed the meeting was a good way of getting young people involved in research (93%) and attendees enjoyed the meeting (100%). As a result, changes were made to study documentation, incentives were purchased and recruitment materials developed. Participant recruitment was higher in schools who participated in the YAG (54%) compared to those who did not (47%). In 2021 the second YAG occurred and 1 teacher, 12 participants and 10 walk leaders from 2 schools provided feedback on the trials COVID-19 contingency plan. The girls felt their feedback was valued (100%) and it was important young people had the chance to contribute to research studies (100%). CONCLUSIONS: The views of young people have been central to the development of the WISH Study and although youth PPI is not without challenges, there are many benefits for researchers, the study and the young people involved

Key findings from The Walking In ScHools (WISH) Study, a peer-led walking intervention for adolescent girls

Project Description: The effects of walking interventions on adult health are known, however the potential of walking to promote physical activity (PA) in adolescents is less known. This study evaluated the effectiveness of a novel, school-based walking intervention at increasing PA levels of adolescent girls. Female pupils aged 12-14 years, were recruited from eighteen (mixed or single-sex) schools across the Border Region of Ireland/Northern Ireland. Schools were randomised to control (usual physical activity; n9) or intervention (n9). In intervention schools, female pupils (15-18 years) were trained as walk leaders and led the younger pupils in 10-15min walks before school, at break and lunchtime. Walks were in school grounds and pupils were encouraged to join as many walks as possible. Excluding holidays, the intervention was delivered for a full school year (18-21 weeks). Accelerometers measured PA and the primary outcome was total PA (cpm). Impact: In total, 589 pupils were recruited (intervention: n286; control n303). Baseline moderate-vigorous PA (MVPA) for the intervention group was (median [IQR]) 36.1 (23.0) mins per day and 35.3 (19.8) mins per day in the control group. At baseline, only 15% (n37) of intervention and 10% (n29) of control participants met PA guidelines (60 mins MVPA per day). Post-intervention total PA (cpm) did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline PA (mean difference, -33.5, 95% CI= -21.2 to 88.1; p=0.213). Learning: ‘Scaling-up’ PA interventions is challenging. Despite a promising feasibility study, the results of this fully powered trial indicate that in this context, the walking programme did not increase PA. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low. There is a need to better understand the implementation of interventions such as WISH within schools