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Statistical considerations
PCOS
This study is conducted to compare two treatment groups with each other in respect to PCOS parameters. In the double-blind part, comparisons between the probiotic and the placebo arms will be performed to show that probiotics are superior to placebos. The comparison of the open-label metformin arm with the probiotic ar...
PMC10106320
Sample size calculation
®, PCOS
Prior to this RCT, we conducted a short pilot trial with 30 women with PCOS (EC number 30–205 ex 17/18), randomly assigning 10 women into three probiotic intervention arms respectively, both to test our methodology as well as to assess the feasibility of improving PCOS symptoms with probiotics (Borzan V., Sommer F., Ri...
PMC10106320
Statistical analysis of outcomes
SECONDARY
The analysis of the collected data in the study will be performed with SAS v9.4. The primary analysis will be performed on the intention-to-treat population. Details regarding the defined populations and the statistical analysis will be provided in the statistical analysis plan (SAP). The SAP will be prepared before un...
PMC10106320
Adherence to study procedures
CRF
CRF
Due to stringent exclusion criteria and the long duration of the intervention period, we expect many participants to not be able to fully adhere to study procedures as outlined in the study protocol due to for example requiring antibiotic treatment or an unscheduled pregnancy. The study was planned and submitted prior ...
PMC10106320
Responsibilities
PD
This is an investigator-initiated trial, with Barbara Obermayer-Pietsch, Prof. MD acting as the principal investigator as well as the sponsor in the name of the Medical University of Graz, thereby having all rights and responsibilities of both roles. Additional investigators are Valentin Borzan, MD, Stefan Pilz, MD, Ph...
PMC10106320
Data collection and handling
MEDOCS, CRF
ADVERSE EVENTS, CRF
For data collection, the newest version of SPSS (currently Version 26) will be used.The results from the medical history and the physical examination are entered in the CRF. In addition, we will document the visit progress and whether every test and procedure was completed according to the protocol. This includes the l...
PMC10106320
Storage and data protection
ADVERSE EVENTS, RECRUITMENT
This study adheres to legal regulations for the storage, registration, transfer and evaluation of data according to the Austrian Act on Pharmaceutical Products and data protection law (AMG). By signing the consent form, potential participants are informed and agree to the following:Data obtained during the course of th...
PMC10106320
Acknowledgements
PD
Roswitha Gumpold, study nurse, as well as Natascha Schweighofer, PhD contributed to the study protocol as well as other study materials such as writing instructions for the use of the isoflavone and gut permeability test utensils, while study coordinator Cornelia Missbrenner gave valuable input regarding the outcome as...
PMC10106320
Author Contribution
The protocol as well as the manuscript were written by Valentin Borzan, MD and planned, edited and proofread by the principal investigator (and guarantor of this study) Barbara Obermayer-Pietsch, Prof. MD, with the exception of the statistical contributions, which were edited by Regina Riedl, PhD. All authors approved ...
PMC10106320
Funding
DISORDERS
This RCT is part of CBmed project 3.22: “Diagnostic and predictive biomarkers in disorders of fertility and metabolism”. Work done in “CBmed” was funded by the Austrian Federal Government within the COMET K1 Centre Program, Land Steiermark and Land Wien. Institut AllergoSan as well as Winclove Probiotics are company pa...
PMC10106320
Data Availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
PMC10106320
Declarations
PMC10106320
Ethics approval and consent to participate
CRF
CRF
This study including the protocol, consent forms, CRF and all study-related procedures has been approved by the Ethics committee at the Medical university of Graz (approval number: EK 32–230 ex 19/20). The Austrian authority for the conduct and safety of clinical trials (Bundesamt für Sicherheit im Gesundheitswesen, BA...
PMC10106320
Consent for publication
Not applicable.
PMC10106320
Competing interests
The authors and contributors declare no conflicts of interest regarding work related to this study and its published materials.
PMC10106320
References
PMC10106320
Background
TB
Several appliances have been used for correction of developing skeletal Class II, including different myofunctional appliances as Twin block (TB)as well as the new pre-fabricated Myobrace (MB) appliance. However, the effects of these devices on the pharyngeal airways have not been compared in the literature. Thus, the ...
PMC10720117
Methods
mandibular deficiency, TB, Skeletal Class II malocclusion
SECONDARY
This is a two parallel arms randomized comparative clinical trial. Twenty-six children of 9–12 years with Skeletal Class II malocclusion due to mandibular deficiency and normal maxillary growth as confirmed by lateral cephalometric X-ray readings (ANB angle > 4° and SNB angle < 78) and Cervical vertebral maturational i...
PMC10720117
Results
TB
By Comparing changes in airway measurements within each group, it was found that NPAA, OPAA, and LPAA increased significantly after treatment within each group of MB and TB. TB group showed significantly higher mean difference (T2-T1) in both NPAA and OPAA than MB group with 28.39 (± 56.75) and 40.46 (± 52.16) respecti...
PMC10720117
Conclusions
TB, airway problems
POSTURING
TB was more effective than MB in improving the upper (NPAA) and middle (OPAA) airways, while no difference was found regarding the lower airway (LPAA). Both TB and MB reduced the severity of developing skeletal class II due to mandibular retrognathism by forward posturing of the mandible. Thus, patients with airway pro...
PMC10720117
Keywords
Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).
PMC10720117
Introduction
TB, malocclusion, palate, dentofacial anomalies, Class II malocclusion, malocclusions
Skeletal Class II malocclusion is considered one of the most common dentofacial anomalies affecting almost one-third of the population [As a result of mandibular retrognathism, the space between the cervical column and the mandibular corpus is diminished, the tongue and soft palate are posteriorly postured; consequentl...
PMC10720117
Materials and methods
PMC10720117
Study Design
This is a two parallel arms randomized comparative clinical trial, involving two groups, each evaluating one of the tested Myofunctional appliances. This study followed the CONSORT guidelines of reporting of randomized controlled trials [
PMC10720117
Participants
Children were selected from the outpatient clinic of the Orthodontic Department, Faculty of Dentistry, Alexandria University.
PMC10720117
Inclusion criteria
mandibular deficiency
Healthy children age ranged from 9 to 12 years.Skeletal Class II malocclusion with mandibular deficiency and normal maxillary growth depending on clinical diagnosis and confirmed with the lateral cephalometric X-ray readings (ANB angle > 4° and SNB angle < 78).Cervical vertebral maturational index (CVMI) 3 assessed by...
PMC10720117
Exclusion criteria
ANTERIOR
Previous orthodontic/orthopedic treatment.Previous extractions.Mandibular shifts.Severe crowding.Anterior open bite.Any peri-oral habits.
PMC10720117
Sample size calculation
malocclusion
The sample size was planned based on 95% confidence level to detect differences in SNB angle between Twin block and Myobrace appliances in class II malocclusion patients. Johnson et al. [
PMC10720117
Ethical approval
This study was approved by the Institutional Review Board at the Faculty of Dentistry, Alexandria University, Alexandria, Egypt (IRB:00010556–IORG:0008839) Manuscript Ethics Committee number (0418-03/2022). The trial was registered on ClinicalTrials.gov, with the name of the registry being “CEPHALOMETRIC CHANGES IN PHA...
PMC10720117
Randomization and allocation concealment
Twenty-six children were randomly assigned in a 1:1 ratio using a computer-generated list of random numbers [ Research design flow chart
PMC10720117
Blinding
BLIND
Due to the nature of the intervention, it was not possible to blind the patients or the orthodontist. The researcher and the statistician who evaluated the data were blinded.
PMC10720117
Methods
PMC10720117
Appliance fabrication
PMC10720117
Group I: Twin block group
incisors, malocclusion
Wax bite registration included advancing the mandible of each patient until the upper and lower central incisors were in an edge-to-edge relation and a gap of 2–3 mm beyond the freeway space. Depending on the degree of the malocclusion, the procedure included one or two stages of advancement. The appliance should be wo...
PMC10720117
Group II: Myobrace group
crowding, upper incisors
The appropriate size of Myobrace is chosen by using a special ruler to measure the distance between the distal portion of the lateral upper right incisor and the left, regardless of any crowding or diastema. The measure is based on the mesial-distal dimensions of the upper incisors, and not on their position. In cases ...
PMC10720117
Lateral cephalograms analysis
Lateral cephalograms were taken for all patients in both groups before treatment (T1) and after treatment (6 months later) (T2). Lateral cephalograms were taken using a standardized technique with the same machine; patients stood in the natural head position (NHP) [Digital tracing of the Lateral cephalograms was done u...
PMC10720117
Intra-examiner and inter-examiner reliability
After a wash-out period of 2 weeks, the same and another calibrated independent investigator remeasured the whole parameters of 14 randomly selected x-rays to test intra and inter-examiner reliability using Intraclass Correlation Coefficient (ICC) [ Intra- examiner and inter-examiner reliabilityICC: Intraclass Correlat...
PMC10720117
Statistical analysis
Normality was checked for all variables using descriptive statistics, plots (Q-Q plots and histogram), and normality tests. All variables showed normal distribution, so means and standard deviation (SD) were calculated, and parametric tests were used. Comparisons between the two study groups were done using independent...
PMC10720117
Results
TB
Over the course of the study, there were no subject dropouts in the pre-intervention period, nor throughout the rest of the study. All the twenty-six initially recruited subjects completed the entire study period (13 subjects per group). The patient flow throughout the trial is presented through a CONSORT Flow Diagram ...
PMC10720117
Discussion
malocclusion, retrognathic mandible
According to literature, there is a reduction in pharyngeal airway dimensions in patients with skeletal Class II malocclusion and retrognathic mandible [Thus, in the current study Skeletal class II patients with ANB angle greater than 4° and SNB angle less than 78° were given functional appliances in an attempt to impr...
PMC10720117
Twin block group
TB
The present study showed a statistically significant increase in the three airways (NPAA, OPAA, LPAA) between T1 and T2 after the use of TB appliance. This was in agreement with the results of previous researches [From the present results, it was evident that the sagittal jaw relationship was significantly improved fol...
PMC10720117
Myobrace group
Unfortunately, there is a lack of evidence regarding the effect of MB on the airway dimensions. Therefore, this study was conducted regarding the use of MB for Class II patients to widen their airway passages. The current results agreed with AHN et al. [In this work, MB appliance postured the mandibular position forwar...
PMC10720117
Twin block versus myobrace
TB
There were no statistically significant differences between both groups regarding the sagittal skeletal relations with similar results obtained previously [Twin block was superior to MB because of the increased reciprocal force pushing backwards on the maxilla upon the practically full-time wear in combination with the...
PMC10720117
Limitations of the study
Due to ethical concerns, this research did not include a control group that was not given any therapy in order to determine the skeletal treatment effects and airway modifications of both appliances compared to natural development. In addition, two-dimensional measurements on the lateral cephalometric radiographs canno...
PMC10720117
Conclusion
TB, airway problems
POSTURING
TB was more effective than MB in improving the upper (NPAA) and middle (OPAA) airways, while no difference was found regarding the lower airway (LPAA). Both TB and MB reduced the severity of developing skeletal class II due to mandibular retrognathism by forward posturing of the mandible. Thus, patients with airway pro...
PMC10720117
Acknowledgements
Not applicable.
PMC10720117
Authors’ contributions
A.M: Conceptualization, data curation, Performing the study measurements, analysis of the study results, drawing out the final study conclusions, writing and preparing the original manuscript, reviewing and editing. D.E: Conceptualization, data curation, Performing the study measurements, analysis of the study results,...
PMC10720117
Funding
There was no funding source for this study.Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).
PMC10720117
Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
PMC10720117
Declarations
PMC10720117
Ethics approval and consent to participate
This study was approved by the Institutional Review Board at the Faculty of Dentistry, Alexandria University, Alexandria, Egypt (IRB:00010556–IORG:0008839) Manuscript Ethics Committee number (0418-03/2022). The trial was registered on ClinicalTrials.gov, with the name of the registry being “CEPHALOMETRIC CHANGES IN PHA...
PMC10720117
Consent for publication
Not applicable.
PMC10720117
Competing interests
The authors declare no competing interests.
PMC10720117
References
PMC10720117
Background
Physical activity participation among preschoolers in childcare settings are low, and interventions to increase physical activity levels have produced mixed results. The Physical Literacy in the Early Years (PLEY) project implemented a six-month childcare-based outdoor loose parts play intervention in childcare centres...
PMC10262461
Methods
Preschoolers (3–5 years) were recruited from 19 childcare centres in Nova Scotia and centres were randomized (parallel design) to the outdoor loose parts play intervention group (
PMC10262461
Results
Two hundred and nine preschoolers participated in the study (intervention group:
PMC10262461
Conclusions
Participation in the PLEY project was associated with increased development of various domains of physical literacy and perceived physical literacy among preschoolers, and outdoor loose parts play may be encouraged as an effective strategy to increase physical literacy in early learning settings.
PMC10262461
Trial registration
Biomed Central (ISRCTN14058106), 20/10/2017.
PMC10262461
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-023-16030-x.
PMC10262461
Keywords
PMC10262461
Introduction
Participation in regular physical activity in the early years (0–4 years) is associated with numerous physical, mental and social health benefits such as favourable motor skill and cognitive development, cardiometabolic health, fitness and psychosocial health [The majority of Canadian toddlers and preschoolers are in s...
PMC10262461
Methods
PMC10262461
Study design
This mixed-methods study used a convergent parallel design [Flow diagram of participants (preschoolers) through the study
PMC10262461
Recruitment
The study and associated protocols were approved by the Dalhousie University Research Ethics Board (REB #2016–3924) and registered as a randomized controlled trial with Biomed Central (ISRCTN14058106; 20/10/2017). Informed consent forms were received from parents/ legal guardians of participating children, and from all...
PMC10262461
Intervention
The PLEY project used a socio-ecological approach to address preschoolers’ physical activity, physical literacy, and outdoor play at multiple levels of influence, including intrapersonal, interpersonal, organizational, community, and physical environment [
PMC10262461
Assessment of physical literacy
At the time of data collection for the PLEY project, assessment tools to specifically measure preschoolers’ physical literacy were not available. As a result, the PLEY project conceptualized the assessment of physical literacy based on the term’s definition [
PMC10262461
Accelerometry (physical activity domain)
Physical activity data collection and analysis methods have been described previously [
PMC10262461
Test of Gross-Motor Development-3 (physical competence domain)
FMS
Data collection for FMS data has been described previously [
PMC10262461
Educator focus groups (all physical literacy domains)
Fifteen focus groups took place (9 at 3-months and 6 at 6-months), with 3–5 participants in each group. The focus groups included educators from multiple sites and took place in public locations. Educators from all intervention sites were represented in the focus groups. The focus groups included a series of questions ...
PMC10262461
Data analysis
PMC10262461
Quantitative
TGMD-3, balance assessment and accelerometry data were analysed and described in detail previously [
PMC10262461
Qualitative
Analysis of focus group data has been described previously [Theoretical model for the assessment of physical literacy in the Physical Literacy in the Early Years project (physical literacy domains adapted from Canadian Physical Literacy Consensus Statement, 2015)
PMC10262461
Physical activity domain
PMC10262461
Quantitative
Valid accelerometry data were available for 130 preschoolers at baseline (67% adherence), 71 at 3 months, and 62 at 6 months. MVPA and TPA had curvilinear relationships over time, with MVPA and TPA increasing from baseline to 3 months and decreasing from 3 to 6 months (Table
PMC10262461
Qualitative
PMC10262461
Theme 1: OLPP contributed to increased physical activity
In focus groups, educators reported that they observed that OLPP contributed to increased physical activity levels during outdoor play sessions; for example, one educator commented “
PMC10262461
Physical competence domain
PMC10262461
Quantitative
FMS
As we previously reported, there was no intervention effect on any of the FMS variables. All FMS variables increased across the three time points in children attending intervention or control sites [
PMC10262461
Qualitative
PMC10262461
Theme 2: OLPP contributed to increased physical competence
SAID
Several educators commented in the interviews how they observed that children’s physical competence was developing and improving over the course of the intervention; for example, they said: “The increased physical competence that educators observed was primarily developed through multiple attempts or trial-and-error. A...
PMC10262461
Confidence and motivation domain
PMC10262461
Qualitative
PMC10262461
Theme 4: OLPP increased confidence in physical abilities and desire to try new or challenging activities
In the focus groups, educators repeatedly shared how the loose parts helped increase children’s confidence in their physical abilities. For example, one educator shared: “Coupled with the increased confidence in physical abilities, educators shared that children had increased confidence and motivation to try something ...
PMC10262461
Theme 5: OLPP increased enjoyment of physical activity
The second theme related to confidence and motivation highlighted the children’s enjoyment to engage in OLPP over the course of the intervention. One educator shared how they also enjoyed the loose parts,
PMC10262461
Knowledge and understanding domain
PMC10262461
Qualitative
PMC10262461
Theme 6: OLPP increased knowledge/learning about physical activity
Educators perceived that much of the children’s learning with OLPP happened through mimicry, modelling, and peer leadership, as children observed other children do something and would then proceed to try it themselves, or with guidance from their peers. This quote displays that educators perceived children were learnin...
PMC10262461
Theme 7: OLPP contributed to cognitive and social development
cognitive and social development
In addition to increased knowledge and learning about PA through OLPP, educators observed that the OLPP helped with children’s cognitive and social development, including teamwork, collaboration, problem solving skills, and independence. One of the educators shared what they believed children developed through OLPP: “
PMC10262461
Discussion
’ increased cognitive and social development
FMS
This study described the role of the PLEY project’s OLPP intervention on domains of physical literacy in preschoolers attending childcare centres in Nova Scotia. Previous results from this study suggested that the OLPP intervention had a positive impact on some measures of physical activity and no impact on physical co...
PMC10262461
Conclusion
’ FMS
We observed that participation in the PLEY project was positively associated with the development of domains of physical literacy (physical activity, physical competence, confidence and motivation, knowledge and understanding) among a sample of preschoolers. Using a mixed-methods design, we reported that OLPP contribut...
PMC10262461
Acknowledgements
The authors would like to thank all childcare centres, parents and children who participated in the PLEY project. The authors also acknowledge the support provided by the Healthy Populations Institute at Dalhousie University and thank all research assistants and volunteers who supported the project.
PMC10262461
Authors’ contributions
MS and SFLK conceived the study and submitted the successful funding application for the PLEY Study. MS, NJ, KB, and JC contributed to data collection. HH and DS led the quantitative statistical analyses; HATC, RAS, NJ and KB completed the qualitative analyses, and all authors assisted with the interpretation of result...
PMC10262461
Funding
This research was generously supported by the Lawson Foundation’s Outdoor Play Strategy (GRT 2015–67).
PMC10262461
Availability of data and materials
The datasets analysed during the current study are available from the corresponding author on reasonable request.
PMC10262461
Declarations
PMC10262461
Ethics approval and consent to participate
The study was approved by the Dalhousie University Research Ethics Board (REB #2016–3924). Informed consent forms were received from parents/ guardians of participating children, and from all participating educators. All methods were carried out with relevant guidelines and regulation, with REB approved protocols.
PMC10262461
Consent for publication
Not applicable.
PMC10262461
Competing interests
The authors declare that they have no competing interests.
PMC10262461
References
PMC10262461