Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for children in treatment for anxiety and depression is unknown as the evidence base is scarce.

This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM. However, further research is needed to confirm this and investigate alternative educational models.

BackgroundPrevious studies have shown that Norwegian public health physicians do not systematically and explicitly use scientific evidence in their practice. They work in an environment that does not encourage the integration of this information in decision-making. In this study we investigate whether a theoretically grounded tailored intervention to diffuse evidence-based public health practice increases the physicians' use of research information.Methods148 self-selected public health physicians were randomised to an intervention group (n = 73) and a control group (n = 75). The intervention group received a multifaceted intervention while the control group received a letter declaring that they had access to library services. Baseline assessments before the intervention and post-testing immediately at the end of a 1.5-year intervention period were conducted. The intervention was theoretically based and consisted of a workshop in evidence-based public health, a newsletter, access to a specially designed information service, to relevant databases, and to an electronic discussion list. The main outcome measure was behaviour as measured by the use of research in different documents.ResultsThe intervention did not demonstrate any evidence of effects on the objective behaviour outcomes. We found, however, a statistical significant difference between the two groups for both knowledge scores: Mean difference of 0.4 (95% CI: 0.2–0.6) in the score for knowledge about EBM-resources and mean difference of 0.2 (95% CI: 0.0–0.3) in the score for conceptual knowledge of importance for critical appraisal. There were no statistical significant differences in attitude-, self-efficacy-, decision-to-adopt- or job-satisfaction scales. There were no significant differences in Cochrane library searching after controlling for baseline values and characteristics.ConclusionThough demonstrating effect on knowledge the study failed to provide support for the hypothesis that a theory-based multifaceted intervention targeted at identified barriers will change professional behaviour.

This Campbell systematic review examines the impact of exercise interventions on the self‐esteem of children and young people. The review summarise findings from 23 studies conducted in the USA, Canada, Australia and Nigeria. Participants were children and adolescents between the ages of 3–20 years and a total of 1,821 participants were included in the studies. Exercise interventions have positive effects on self‐esteem, at least in the short‐term. The finding is the same for interventions which comprise exercise alone, and those including exercise as part of a more comprehensive programme. There was no significant difference in effects according to the type of exercise intervention or intervention duration. No follow‐up results were given so long‐run effects are not known. However, there are several methodological weaknesses including risk of moderate to high bias in the studies and insufficient data, which reduces the strength of the current evidence. As such, further research that provides stronger evidence of the effectiveness of exercise programmes on self‐esteem is needed. Furthermore, there is a need for follow‐up data to demonstrate the extent to which the effects of programmes are maintained over time. Synopsis Some evidence that exercise has positive short‐term effects on self‐esteem in children and young people Improving self‐esteem may help to prevent the development of psychological and behavioural problems which are common in children and adolescents. Strong evidence exists for the benefits of exercise on physical health, but evidence for the effects of exercise on mental health is scarce. This review of trials suggests that exercise has positive short‐term effects on self‐esteem in children and young people, and concludes that exercise may be an important measure in improving children's self‐esteem. However, the reviewers note that the trials included in the review were small‐scale, and recognise the need for further well‐designed research in this area. Abstract BackgroundPsychological and behavioural problems in children and adolescents are common, and improving self‐esteem may help to prevent the development of such problems. There is strong evidence for the positive physical health outcomes of exercise, but the evidence of exercise on mental health is scarce. ObjectivesTo determine if exercise alone or exercise as part of a comprehensive intervention can improve self‐esteem among children and young people. Search strategyComputerised searches in MEDLINE, EMBASE, The Cochrane Controlled Trials Register (CENTRAL), CINAHL, PsycINFO and ERIC were undertaken and reference lists from relevant articles were scanned. Relevant studies were also traced by contacting authors. Dates of most recent searches: May 2003 in (CENTRAL), all others: January 2002. Selection criteriaRandomised controlled trials where the study population consisted of children and young people aged from 3 to 20 years, in which one intervention arm was gross motor activity for more than four weeks and the outcome measure was self‐estee...

Background and ObjectiveAdolescents are frequent media users who access health claims from various sources. The plethora of conflicting, pseudo-scientific, and often misleading health claims in popular media makes critical appraisal of health claims an essential ability. Schools play an important role in educating youth to critically appraise health claims. The objective of this systematic review was to evaluate the effects of school-based educational interventions for enhancing adolescents’ abilities in critically appraising health claims.MethodsWe searched MEDLINE, Embase, PsycINFO, AMED, Cinahl, Teachers Reference Centre, LISTA, ERIC, Sociological Abstracts, Social Services Abstracts, The Cochrane Library, Science Citation Index Expanded, Social Sciences Citation Index, and sources of grey literature. Studies that evaluated school-based educational interventions to improve adolescents’ critical appraisal ability for health claims through advancing the students’ knowledge about science were included. Eligible study designs were randomised and non-randomised controlled trials, and interrupted time series. Two authors independently selected studies, extracted data, and assessed risk of bias in included studies. Due to heterogeneity in interventions and inadequate reporting of results, we performed a descriptive synthesis of studies. We used GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) to assess the certainty of the evidence.ResultsEight studies were included: two compared different teaching modalities, while the others compared educational interventions to instruction as usual. Studies mostly reported positive short-term effects on critical appraisal-related knowledge and skills in favour of the educational interventions. However, the certainty of the evidence for all comparisons and outcomes was very low.ConclusionEducational interventions in schools may have beneficial short-term effects on knowledge and skills relevant to the critical appraisal of health claims. The small number of studies, their heterogeneity, and the predominantly high risk of bias inhibit any firm conclusions about their effects. None of the studies evaluated any long-term effects of interventions. Future intervention studies should adhere to high methodological standards, target a wider variety of school-based settings, and include a process evaluation.Systematic Review RegistrationPROSPERO no. CRD42015017936.

The results indicate that exercise has positive short-term effects on self-esteem in children and young people. Since there are no known negative effects of exercise and many positive effects on physical health, exercise may be an important measure in improving children's self-esteem. These conclusions are based on several small low-quality trials.

This qualitative study aims to interpret the results of a randomized controlled trial comparing two educational programs (directed learning and self-directed learning) in evidence-based medicine (EBM) for medical students at the University of Oslo from 2002 to 2003. There is currently very little comparative educational research in this field. In the trial, no statistically significant differences between the study groups were shown for any outcomes considered (EBM knowledge, skills, and attitudes). Further analysis suggests that main reason for the negative trial results was that the majority of students learned equally effectively, whichever program they received, although implementation of the educational programs was not complete because of varying attendance. This study illustrates a stepwise evaluation model that might be useful in evaluating other socially complex interventions.

BackgroundLeg ulcers and diabetes-related foot ulcers are frequent and costly complications of their underlying diseases and thus represent a critical issue for public health. Since the population is aging, the prevalence of these conditions will probably increase considerably and require more resources. Treatment of leg and foot ulcers often demands frequent contact with the health care system, may pose great burden on the patient, and involves follow-up in both primary and specialist care. Telemedicine provides potential for more effective care management of leg and foot ulcers. The objective of this systematic review of the literature was to assess the effect of telemedicine follow-up care on clinical, behavioral or organizational outcomes among patients with leg and foot ulcers.MethodsWe searched Ovid MEDLINE (1980–), Ovid EMBASE (1980–), Clinical Trials in the Cochrane Library (via Wiley), Ebsco CINAHL with Fulltext (1981–) and SveMed + (1977–) up to May 2014 for relevant articles. We considered randomized controlled trials, non-randomized trials, controlled before-after studies and prospective cohort studies for inclusion and selected studies according to predefined criteria. Three reviewers independently assessed the included studies using the Cochrane Collaboration risk-of-bias tool. We performed a narrative synthesis of results and assessed the strength of evidence for each outcome using GRADE (grading of recommendations, assessment, development and evaluation).ResultsOnly one non-randomized study was included. The study (n = 140) measured the effect of real-time interactive video consultation compared with face-to-face follow-up on healing time, adjusted healing ratio and the number of ulcers at 12 weeks among patients with neuropathic forefoot ulcerations. There were no statistically significant differences in results of the different outcomes between patients receiving telemedicine and traditional follow-up. We assessed the study to have a high risk of bias.ConclusionsThere is insufficient evidence available to unambiguously determine whether telemedicine consultation of leg and foot ulcers is as effective as traditional follow-up.