Interventions to Improve Knowledge, Attitudes, and Uptake of Recommended Vaccines during Pregnancy and Postpartum: A Scoping Review

Tetanus, pertussis, influenza, and COVID-19 vaccines are recommended for the prevention of related morbidity and mortality during pregnancy and postpartum. Despite the established benefits of vaccination for prenatal and postnatal women, maternal vaccination is not universally included in routine antenatal programs, especially in low- and middle-income countries. Furthermore, the uptake of recommended vaccines among pregnant and postpartum women remains below optimum globally. This review aimed to map the evidence on interventions to improve knowledge, attitudes, and uptake of recommended vaccines among pregnant and postpartum women. We conducted a comprehensive and systematic search for relevant literature in PubMed, Scopus, Web of Science, EBSCOhost, and Google Scholar. Overall, 29 studies published between 2010 and 2023 were included in this review. The majority (n = 27) of these studies were from high-income countries. A total of 14 studies focused on the influenza vaccine, 6 on the Tdap vaccine, 8 on both influenza and Tdap vaccines, and only one study on the COVID-19 vaccine. Patient-centered interventions predominated the evidence base (66%), followed by provider-focused (7%), health system-focused (10%), and multilevel interventions (17%). Overall, the effect of these interventions on knowledge, attitudes, and uptake of maternal vaccines was variable.

Management of hypertensive crisis in a patient with underlying kidney disease: A case report

RATIONALE

This case report elucidates the management of a hypertensive crisis in a patient with underlying kidney disease, shedding light on the intricate interplay between these conditions. This unique case contributes valuable insights to the scientific literature.

PATIENT CONCERNS

The patient exhibited severe headache, visual disturbances, and chest pain. Clinical evaluation revealed elevated blood pressure and impaired kidney function, emphasizing the importance of monitoring hypertension and renal health in such cases.

DIAGNOSES AND INTERVENTIONS

The primary diagnoses included malignant hypertension and underlying kidney disease. Immediate interventions comprised intravenous antihypertensive agents and rigorous hemodynamic monitoring, yielding favorable outcomes. Blood pressure gradually returned to acceptable levels, and renal function improved during treatment.

CONCLUSIONS

This case underscores the critical need for timely recognition and management of hypertensive crises in patients with preexisting kidney dysfunction. Simultaneously addressing both conditions is vital for successful outcomes. Healthcare practitioners must remain vigilant in assessing the intricate relationship between hypertension and kidney disease, employing tailored interventions for optimal results.

LESSON LEARNED

The primary lesson from this case is the necessity of a comprehensive approach to managing hypertensive crises in individuals with underlying kidney disease. Early intervention and a multidisciplinary strategy are essential to achieve positive clinical outcomes and prevent potential complications.

A Multi-Perspective Qualitative Study About Working With Autistic Individuals in Prison-Based Interventions to Address Sexual Offending

Research suggests that sexual offending is one of the more common forms of offending behaviour committed by autistic individuals. Despite this, very little research has investigated approaches to rehabilitation for autistic individuals who have sexually offended. The small body of literature that does exist suggests that interventions to address sexual offending may not be sufficiently adapted for this group. In this paper we present an exploratory qualitative study that (i) explores how prison-based interventions to address sexual offending are experienced by autistic individuals with sexual offense convictions and the staff who work with them, and (ii) identifies and explores the features of prison-based sexual offending interventions that may be challenging or beneficial for autistic individuals, from the perspective of those involved in treatment. Semi-structured interviews were conducted with 12 autistic men serving prison sentences for sexual convictions, and 13 members of prison staff. A multi-perspective phenomenologically-informed thematic (MPT) analysis identified three themes of 'Feeling overwhelmed', 'Out of the comfort zone', and '(Dis)connected to others'. These themes highlight some of the key issues relating to the format and delivery of interventions, as well as the impact of the broader prison context on rehabilitation.

Physiotherapy-Led Health Promotion Strategies for People with or at Risk of Cardiovascular Diseases: A Scoping Review

Cardiovascular diseases (CVD) are prevalent and lead to high morbidity and mortality globally. Physiotherapists regularly interact with patients with or at risk of CVDs (pwCVDs). This study aimed to assess the nature of existing evidence, interventional approaches used, and the population groups included in physiotherapy-led health promotion (PLHP) for pwCVDs. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until June 2023. Two reviewers independently screened the titles, abstracts, and full text and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 4992 records were identified, of which 20 full-text articles were included in the review. The studies had varied populations, including those with stroke, coronary artery diseases, peripheral artery diseases, hypertension, diabetes, and multiple CVD risk factors. The interventions ranged from exercise and physical activity programmes, dietary interventions, education, and counselling sessions with various supplementary approaches. Most interventions were short-term, with less than 12 months of follow-up. Interventions were personalised and patient-centred to promote adherence and health behaviour change. Among the included studies, 60% employed experimental designs, with the remainder using quasi-experimental designs. Although a wide range of PLHP strategies have been used for pwCVDs, exercise and physical activity were employed in 85% of the included studies. Other components of health promotion, such as sleep, smoking, and alcohol abuse, should be investigated within PLHP.

Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature

Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of effective medical treatments for dementia, informal caregivers play essential roles in allowing dementia patients to live with dignity. Our review focusing on caregiver burden showed that this burden has not been sufficiently addressed, despite having negative effects on caregivers' health, employment, and finances. It is important to consider non-pharmacological interventions that contribute to effective coping strategies for mitigating the caregiver burden. Online communication tools may be a viable intervention measure to educate caregivers on the importance of sharing resilient coping strategies to reduce their stress so that they can continue to provide care for their loved ones.

The Role of the Innate Immune Response in Oral Mucositis Pathogenesis

Oral mucositis (OM) is a significant complication of cancer therapy with limited management strategies. Whilst inflammation is a central feature of destructive and ultimately ulcerative pathology, to date, attempts to mitigate damage via this mechanism have proven limited. A relatively underexamined aspect of OM development is the contribution of elements of the innate immune system. In particular, the role played by barriers, pattern recognition systems, and microbial composition in early damage signaling requires further investigation. As such, this review highlights the innate immune response as a potential focus for research to better understand OM pathogenesis and development of interventions for patients treated with radiotherapy and chemotherapy. Future areas of evaluation include manipulation of microbial-mucosal interactions to alter cytotoxic sensitivity, use of germ-free models, and translation of innate immune-targeted agents interrogated for mucosal injury in other regions of the alimentary canal into OM-based clinical trials.

Mindfulness-Based Interventions for End-of-Life Professionals

In a recently published paper in this journal, Covington et al explored the potential advantages of mindfulness-based interventions (MBIs) for healthcare staff burnout and associated problems. In the demanding and emotionally charged field of end-of-life (EOL) care, healthcare professionals play a pivotal role in supporting patients and their families during their most vulnerable moments. However, as a recent systematic review reveals, the empirical research on MBIs in the context of EOL care is still in its nascent stages. This correspondence contributes to the research gap on mental health and self-care of EOL for professionals.

It's not a virus! Reconceptualizing and de-pathologizing music performance anxiety

Music Performance Anxiety (MPA) is one of the most widespread and debilitating challenges facing musicians, affecting significant numbers of performers in terms of both their personal and professional functioning. Although numerous interventions exist to target MPA, its prevalence remains unchanged since the first large-scale studies of the 1980s, indicating that available interventions are having limited impact. This review synthesizes and critiques existing literature in order to investigate possible reasons for the limited efficacy of current approaches to managing MPA. Key concepts discussed include conceptual and methodological challenges surrounding defining MPA, theoretical perspectives on MPA's etiology and manifestation, and the coping strategies and interventions used to manage MPA. MPA has predominantly been investigated pathologically and defined as a negative construct manifesting in unwanted symptoms. Based on this conceptualization, interventions largely seek to manage MPA through ameliorating symptoms. This review discusses possible reasons why this approach has broadly not proved successful, including the issue of relaxation being both unrealistic and counterproductive for peak performance, issues associated with intentionally changing one's state creating resistance thus exacerbating anxiety, and focusing on the presence of, rather than response to, symptoms. Despite 50 years of research, MPA remains an unsolved enigma and continues to adversely impact musicians both on and off the stage. Reconceptualizing MPA as a normal and adaptive response to the pressures of performance may offer a new perspective on it, in terms of its definition, assessment and management, with practical as well as theoretical implications.

The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review

BACKGROUND

Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs).

OBJECTIVE

This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs.

METHODS

Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions.

RESULTS

The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024.

CONCLUSIONS

Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings.

TRIAL REGISTRATION

PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=366354.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/48234.

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

Occupational Therapy Interventions in Patients with Frontotemporal Dementia: A Systematic Review

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by progressive impairments in behavior, executive function, and language, primarily affecting individuals under the age of 65. This disorder is associated with expressive and receptive anomia, word comprehension deficits, and behavioral symptoms such as apathy, loss of empathy, and disinhibition, all of which closely correlate with functional impairment in daily activities. Despite substantial efforts, research on occupational therapy (OT) interventions has yet to demonstrate clear benefits in managing the disease. The aim of this study is to investigate OT interventions and assess their efficacy, with a specific focus on individuals suffering from FTD. We systematically conducted searches on two databases, namely Medline and Science Direct, spanning a ten-year period from 2003 to 2023, in accordance with the PRISMA guidelines. Eleven studies met the inclusion criteria. OT interventions targeted both patients and caregivers and yielded significant positive improvements in their lives. A key focus of these interventions was to teach acceptable alternatives to the behaviors exhibited by FTD patients, as these behaviors are strongly influenced by the disease itself. OT contributes positively to enhancing the quality of life of FTD patients and alleviating the caregiving burden experienced by those providing long-term care to these patients.

Recovery from shift work

One fifth of today's workforce is engaged in shift work and exposed to various mental and physical health risks including shift work disorder. Efficiently recovering from shift work through physical and mental interventions allows us to mitigate negative effects on health, enables a better work-life balance and enhances our overall wellbeing. The aim of this review is to provide a state-of-the-art overview of the available literature. The role of sleep timing and naps, light therapy and psychotherapy, diet and exercise in recovery from shift work is presented here. We further review the impact of shift schedules and social support on post-shift unwinding.

Grappling with Issues of Motherhood for Women with Schizophrenia

Despite the fact that most persons with schizophrenia find steady employment difficult to sustain, many women with this diagnosis embrace and fulfill the most difficult task of all-motherhood. The aim of this paper is to specify the challenges of motherhood in this population and review the treatment strategies needed to keep mothers and children safe, protecting health and fostering growth. The review addresses concerns that had been brought to the author's earlier attention during her clinical involvement with an outpatient clinic for women with psychosis. It is, thus, a non-systematic, narrative review of topic areas subjectively assessed as essential to "good enough" mothering in the context of schizophrenia. Questions explored are the stigma against motherhood in this population, mothers' painful choices, issues of contraception, abortion, child custody, foster care and kin placement of children, the effects of antipsychotics, specific perinatal delusional syndromes, and, finally, the availability of parental support. This review is intended for clinicians. Recommendations are that care providers work collaboratively with mothers, take note of their strengths as well as their failings, offer a wide array of family services, monitor households closely for safety and for treatment adherence, appreciating the many challenges women with schizophrenia face daily.

Renally Inappropriate Medications in the Old Population: Prevalence, Risk Factors, Adverse Outcomes, and Potential Interventions

Like most organs, the renal system decreases in function as we age. In the elderly, chronic kidney disease is common. When patients with chronic kidney disease take nephrotoxic medications, they are more likely to suffer adverse drug reactions, be hospitalized, and spend an extended period in the hospital. Calculating the renal clearance of a drug dose based on its glomerular filtration rate, or creatinine clearance, is necessary. Multiple tools are available for identifying renally inappropriate medications (RIMs). RIM prescriptions can be influenced by various factors, which vary according to the study. A higher number of medications means a higher likelihood of using RIMs. Numerous studies have investigated RIMs. The most contraindicated drug in renal insufficiency patients was a non-steroidal anti-inflammatory medication. A variety of interventions have been used to reduce RIM prescriptions to varying degrees of success.

Review: Interventions addressing loneliness amongst university students: a systematic review

BACKGROUND

Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. However, little research has explored interventions to reduce loneliness among students. This review identifies the characteristics and effectiveness of interventions targeting university/college students.

METHODS

PsycINFO, Medline, ASSIA and Web of Science were searched from inception using keywords linked to 'loneliness', 'intervention' and 'students'. Relevant peer and nonpeer-reviewed English-language articles on studies implementing an intervention with loneliness as an outcome and investigating undergraduate or postgraduate students at a higher education institution were included for quality analysis and narrative synthesis. Risk of bias was assessed at both study level and at outcome level.

RESULTS

Twenty-eight articles were included, comprising 25 quantitative and three qualitative studies, covering 37 interventions, most implemented in the United States. Interventions were based on psychoeducation, social support groups, increasing social interaction or reflective exercises. The age of the participants (n = 2339) ranged from 17.62 to 25 (mean age 20.63) years. Evidence from the RCTs suggests that most interventions influenced loneliness outcomes, but the magnitude of the benefit is unclear. Across quantitative studies, 80% (16/20) of interventions based on either social support groups, increasing social interaction or reflective exercises, and 50% (7/14) of interventions based on psychoeducation were deemed effective in reducing loneliness. Most interventions measured quantitatively were delivered in a group setting, of which two thirds were considered effective in reducing loneliness scores, regardless of intervention.

CONCLUSIONS

Universities have a choice of interventions to help reduce loneliness among students either on campus or virtually. Ones promoting social connectedness appear to be more successful. More high-quality studies in a larger number of countries are needed, taking vulnerable student groups into consideration.

Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA

Aim: Preventing unnecessarily long durations of antibiotic therapy is a key opportunity to reduce antibiotic overuse in children 2 years of age and older with acute otitis media (AOM). Pragmatic interventions to reduce durations of therapy that can be effectively scaled and sustained are urgently needed. This study aims to fill this gap by evaluating the effectiveness and implementation outcomes of two low-cost interventions of differing intensities to increase guideline-concordant antibiotic durations in children with AOM. Methods: The higher intensity intervention will consist of clinician education regarding guideline-recommended short durations of antibiotic therapy; electronic health record (EHR) prescription field changes to promote prescribing of recommended short durations; and individualized clinician audit and feedback on adherence to recommended short durations of therapy in comparison to peers, while the lower intensity intervention will consist only of clinician education and EHR changes. We will explore the differences in implementation effectiveness by patient population served, clinician type, clinical setting and organization as well as intervention type. The fidelity, feasibility, acceptability and perceived appropriateness of the interventions among different clinician types, patient populations, clinical settings and intervention type will be compared. We will also conduct formative qualitative interviews with clinicians and administrators and focus groups with parents of patients to further inform the interventions and study. The formative evaluation will take place over 1.5 years, the interventions will be implemented over 2 years and evaluation of the interventions will take place over 1.5 years. Discussion: The results of this study will provide a framework for other healthcare systems to address the widespread problem of excessive durations of therapy for AOM and inform national antibiotic stewardship policy development. Clinical Trial Registration: NCT05608993 (ClinicalTrials.gov).

A Scoping Review of Interventions to Improve Occupational Safety and Health of Construction Workers

OBJECTIVE

This review comprehensively examines interventions which sought to improve the occupational safety and/or health of construction workers. Factors that explain the (in)effectiveness of interventions were also summarized.

DATA SOURCE

This review consisted of a search using two electronic databases, PubMed and Web of Science.

STUDY INCLUSION AND EXCLUSION CRITERIA

Targeted workers in the construction industry; had at least one primary outcome that aimed to improve occupational safety and/or health; were published between January 01, 1990 and December 01, 2019; and were written in English.

DATA EXTRACTION AND SYNTHESIS

Two researchers independently carried out the process of reviewing the titles, abstracts and full texts, and extracted all data. If there were differences, discussions were held until a consensus was reached.

RESULTS

A total of 1297 articles were retrieved and 24 were selected for final evaluation. Seventeen studies reported significant intervention effects, while 7 found their primary outcome not significantly improved.

CONCLUSION

Future research should place more effort on interventions aimed at improving both occupational safety and health outcomes in an integrated manner, with environmental interventions that accompany behavioral interventions at the individual level. Besides, additional effort is also needed to ensure the involvement of relevant stakeholders in designing the intervention, avoiding contamination effects (through cluster randomization), optimizing the "dosage" of intervention, and improving measurement of outcomes.

Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice

Cognitive-behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive--behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (e.g., scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Beyond the Asylum Walls: Tracing the Tapestry of Mental Health Interventions Across Eras and Cultures

This article offers an extensive review of the changing field of mental health therapies, charting a transformational path from traditional methods to modern breakthroughs and speculating on potential future developments. The story develops by investigating historical viewpoints while reflecting on the present and highlighting the lessons learned and their impact on contemporary practices. We have advanced from the stigmatized constraints of asylums to a paradigm that puts human rights, dignity, and individualized, culturally sensitive treatment first. Modern methods are much more varied and evidence-based, from cutting-edge technical advancements to evidence-based psychotherapies. The ethical considerations arising from the delicate balance of pharmacological therapies underline the responsibility of administering drugs that significantly affect mental health. Cultural factors become a pillar, highlighting how crucial cultural sensitivity is to promoting tolerance. By acknowledging how many facets of the human experience are interrelated, holistic methods help close the gap between the mind and body. Integrative medicine and alternative therapies represent a shift away from reductionist approaches and toward a holistic viewpoint. The delivery of mental health treatment is being reimagined by technological advancements, with virtual and digital environments opening up new access and support channels. These developments cut beyond regional boundaries, reinventing conventional therapy dynamics and paving the way for individualized therapies. Cultural concerns highlight the significance of cultural competency in navigating the complex mental health treatment system and adapting interventions to fit the particular requirements of various cultural contexts. With telepsychiatry, virtual reality, and artificial intelligence among the new technologies that promise to further revolutionize mental health therapies, the essay looks to the future. This review concludes by imagining a day when mental health is prioritized, therapies are available, and the diversity of human experience is valued. The path to a society that values, nurtures, and celebrates mental health continues.

Review of intervention products for use in the prevention and control of anemia

Anemia remains a major public health problem, especially in low- and middle-income countries. The World Health Organization recommends several interventions to prevent and manage anemia in vulnerable population groups, including young children, menstruating adolescent girls and women, and pregnant and postpartum women. Daily iron supplementation reduces the risk of anemia in infants, children, and pregnant women, and intermittent iron supplementation reduces anemia risk in menstruating girls and women. Micronutrient powders reduce the risk of anemia in children. Fortifying wheat flour with iron reduces the risk of anemia in the overall population, whereas the effect of fortifying maize flour and rice is still uncertain. Regarding non-nutrition-related interventions, malaria treatment and deworming have been reported to decrease anemia prevalence. Promising interventions to prevent anemia include vitamin A supplementation, multiple micronutrient supplementation for pregnant women, small-quantity lipid-based supplements, and fortification of salt with iodine and iron. Future research could address the efficacy and safety of different iron supplementation formulations, identify the most bioavailable form of iron for fortification, examine adherence to supplementation regimens and fortification standards, and investigate the effectiveness of integrating micronutrient, helminth, and malaria control programs.

Opportunities in Multiple Sclerosis Care Partner Research: An Interview

Guest editor Marcia Finlayson, PhD, OT Reg (Ont), OTR, is a professor in the School of Rehabilitation Therapy at Queen's University in Ontario, Canada. She began her career as a clinical occupational therapist and shifted to a research career focused on generating and sharing knowledge to help people affected by multiple sclerosis (MS) lead healthy, meaningful lives with control over their participation in daily activities, at home and in the community, particularly as they age. For this special issue on caregiving in MS, she chose to interview Kenneth Pakenham, PhD, emeritus professor of clinical and health psychology at the University of Queensland in Brisbane, Australia. For more than 4 decades, he has investigated the psychological well-being welle-eing of caregivers, including coping mechanisms and innovative interventions to improve their quality of life. His work is dedicated to applying positive health frameworks to chronic illnesses and to empowering caregivers and individuals with MS. Together, their expertise illuminates the multifaceted challenges and opportunities in MS caregiving research and understanding.

Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it

Economic evaluation is used to determine the optimal provision of services and programs under budget constraints and to inform public and private payer funding decisions. To maximize value-for-money in the design and delivery of programs and services for persons with autism spectrum disorder (ASD), it's essential to generate high-quality economic evidence to inform budget allocation. There is a paucity however, of economic evaluations of interventions for ASD. This is due in part to challenges in conducting economic evaluations in this population and the lack of guidance on suitable approaches. These challenges are related to the inherent heterogeneity of the autistic population; establishing short- and long-term effectiveness; measurement of costs and the availability of valid instruments for collecting economic data; the appropriateness of outcomes for use in economic evaluation; and achieving statistical power. This commentary addresses a lack of awareness and needed guidance on these issues by discussing the challenges and providing recommendations for how economic evaluations in ASD could be improved to generate high-quality evidence for program funding decision-making.

Applying machine-learning to rapidly analyze large qualitative text datasets to inform the COVID-19 pandemic response: comparing human and machine-assisted topic analysis techniques

Introduction

Machine-assisted topic analysis (MATA) uses artificial intelligence methods to help qualitative researchers analyze large datasets. This is useful for researchers to rapidly update healthcare interventions during changing healthcare contexts, such as a pandemic. We examined the potential to support healthcare interventions by comparing MATA with "human-only" thematic analysis techniques on the same dataset (1,472 user responses from a COVID-19 behavioral intervention).

Methods

In MATA, an unsupervised topic-modeling approach identified latent topics in the text, from which researchers identified broad themes. In human-only codebook analysis, researchers developed an initial codebook based on previous research that was applied to the dataset by the team, who met regularly to discuss and refine the codes. Formal triangulation using a "convergence coding matrix" compared findings between methods, categorizing them as "agreement", "complementary", "dissonant", or "silent".

Results

Human analysis took much longer than MATA (147.5 vs. 40 h). Both methods identified key themes about what users found helpful and unhelpful. Formal triangulation showed both sets of findings were highly similar. The formal triangulation showed high similarity between the findings. All MATA codes were classified as in agreement or complementary to the human themes. When findings differed slightly, this was due to human researcher interpretations or nuance from human-only analysis.

Discussion

Results produced by MATA were similar to human-only thematic analysis, with substantial time savings. For simple analyses that do not require an in-depth or subtle understanding of the data, MATA is a useful tool that can support qualitative researchers to interpret and analyze large datasets quickly. This approach can support intervention development and implementation, such as enabling rapid optimization during public health emergencies.

Prevalence, characteristics, and associated risk factors of drug consumption and chemsex use among individuals attending an STI clinic (EpITs STUDY)

Sex-related drug consumption and its health-related consequences have gained relevance in the assessment of patients with sexually transmitted infections (STIs), which pose a significant challenge to public health. We aim to assess the prevalence and characteristics of drug consumption and chemsex practices, describe the associated risk factors among general individuals attending an STI clinic, and evaluate the psychological impact associated with these behaviors. We conducted an online anonymous survey offered to patients with a diagnosis of STI in a tertiary hospital in Spain. Data included sociodemographic characteristics, sexual preferences and behavior, and assessment of drug use, chemsex, and psychological and mental health symptoms. Data from 145 subjects was collected, with a higher proportion of cis-gender men (71%), and a median age of 32 years. 64 participants (44%) reported drug use in the last year, with an observed 33.8% prevalence of chemsex consumption. Drug use and chemsex were more frequent among cis-gender men, Men who have Sex with Men (MSM), people living with HIV (PLHIV), and those reporting previous group sex. Poppers and cannabis were the most frequently reported drugs, with a prevalence close to 20% for cocaine, mephedrone, extasis, and GHB. Consequences related to drug use included unpleasant physical sensations, sexual dysfunction, and impaired sexual experience after reduction or drug discontinuation. The prevalence of drug use and chemsex practices are high among patients evaluated for STIs, especially between men, MSM, and subjects practicing group sex. The study highlights the urgent need for targeted interventions on prevention and reduction of their impact on health and social well-being.

Strengths and Weaknesses of Inviting Men to a Voluntary-Based Domestic Violence Intervention

This study examines the factors motivating domestic violence perpetrators to participate in a voluntary-based intervention program. The experiences and determining factors around men's positive and negative responses to this invitation were examined through semi-structured interviews with professionals, observations, and reflexive notes during the first meeting with 29 men. Two major themes emerged from the thematic analysis: the factors making men more likely to attend the first meeting or resisting the group intervention. These findings can help professionals recognize the challenges of inviting perpetrators to interventions, especially in countries with insufficient laws for mandated domestic violence perpetrator programs. The paper discusses the importance during the first meeting of building rapport and trust and recognizing complex family histories to encourage voluntary attendance and intervention engagement.

Childhood Trauma and Exposure to Violence Interventions: The Need for Effective and Feasible Evidence-Based Interventions

Several crimes in South Africa cause physical, economic, and mental problems. Xenophobic attacks, mob justice, and other violent conduct directly traumatise children. Service delivery riots and physical and sexual abuse are examples. This evaluation evaluates childhood trauma and exposure to violence interventions. The review describes the therapeutic methods for traumatised children exposed to violence, the healthcare professionals administering them, and the strategies used to tailor the interventions. The researcher systematically searched PsycINFO, Google Scholar, PubMed, Science Direct, and EBSCOhost. Literature from 2011 to 31 July 2023 was searched, and 19 papers were chosen for further review after the systematic search. The authors conducted an eligibility evaluation according to PRISMA guidelines. A thorough review of article texts identified 19 papers that met eligibility standards. Only nineteen studies have validated trauma and violence therapies for children. An effective multi-phased intervention that is feasible and adaptable to varied socioeconomic backgrounds is needed. Further studies on the mental health benefits of brief trauma intervention treatment are needed.

Effect of a school-linked life skills intervention on adolescents' sexual and reproductive health skills in Guji zone, Ethiopia (CRT)-A generalized linear model

Background

Although appropriate life skills are recognized as a fundamental right for adolescents and a critical component of health policy, they are often overlooked and rarely researched in pastoral communities. Life skills encompass the ability to adopt positive behaviors, which enable individuals to effectively deal with the demands and challenges of everyday life. This study aimed to evaluate the effectiveness of a school-linked life skills intervention program on adolescents' sexual and reproductive health skills in the pastoral community of Guji zone.

Methods

A two-arm cluster randomized control trial with a pretest-posttest experimental design was conducted, involving the intervention group (N = 375) and the control group (N = 384). This study assessed the effect of a school-linked adolescent-friendly life skills intervention in comparison to the usual RH curriculum, used as a control arm. Pretest-posttest and posttest-posttest scores of the control group and trial groups were compared, and the data were collected using 27 self-administered questions. The collected data were analyzed using paired-sample independent t-tests and a generalized linear model to examine the relationship between the dependent and independent variables.

Results

Data were collected from 759 adolescents in 15 intervention and 15 control clusters. The findings have shown that the proportion of mean life skills score was significantly higher in the intervention clusters than controls [(375) 70.49% vs. (384) 62.25%, P < 0.001 95% CI (0.06 and 0.1)]. Adolescents who were trained in school-linked life skills (β = 1.915, 95% CI: 1.411-2.418), were confident to make safe and informed decisions (β = 1.999, 95% CI: 1.562-2.436), and had life skills to deal with SRH issues (β = 1.66, 95% CI: 1.233-2.087) were significantly correlated with predicting the relevant life skills. The proportion of adolescents with SRH life skills increased from 384 (52%) at baseline to 375 (70%) at end line in the intervention group compared to 384 (60.31%) at baseline to 384 (62.31%) in control arms, respectively.

Conclusions

The implementation of a school-linked life skills intervention program proved to have a significant effect on SRH life skills development. Furthermore, individual-level and behavioral-level variables were significant in explaining variability in life skills development within the pastoral community. Therefore, we recommend scaling up this intervention in all high schools.

Trial registration

Trial registration PACTR202107905622610, registered on 16 July 2021.

Digital Health and Health Promotion: A Scoping Review of Systematic Reviews

INTRODUCTION AND METHODOLOGY

Health Promotion is moving into a new technological era, that of Digital Health Promotion (DHP). The aim was to collect systematic reviews of digital health promotion interventions.

RESULTS AND DISCUSSION

147 articles met the criteria and were included in the present study. A diverse range of digital health promotion topics was identified, with certain topics garnering significant attention. While this scoping review provides valuable insights into the field of digital health promotion interventions, a more detailed analysis of their alignment with health prevention stages will serve as a critical next step.

GABAergic signaling in alcohol use disorder and withdrawal: pathological involvement and therapeutic potential

Alcohol is one of the most widely used substances. Alcohol use accounts for 5.1% of the global disease burden, contributes substantially to societal and economic costs, and leads to approximately 3 million global deaths yearly. Alcohol use disorder (AUD) includes various drinking behavior patterns that lead to short-term or long-lasting effects on health. Ethanol, the main psychoactive molecule acting in alcoholic beverages, directly impacts the GABAergic system, contributing to GABAergic dysregulations that vary depending on the intensity and duration of alcohol consumption. A small number of interventions have been developed that target the GABAergic system, but there are promising future therapeutic avenues to explore. This review provides an overview of the impact of alcohol on the GABAergic system, the current interventions available for AUD that target the GABAergic system, and the novel interventions being explored that in the future could be included among first-line therapies for the treatment of AUD.

Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis

Zero-dose children, or children who have not received any routine vaccination, are a priority population for global health policy makers as these children are at high risk of mortality from vaccine-preventable illnesses. We conducted a narrative review to identify potential interventions, both within and outside of the health sector, to reach zero-dose children. We reviewed the peer-reviewed and grey literature and identified 27 relevant resources. Additionally, we interviewed six key informants to enhance the synthesis of our findings. Data were organized into three priority settings: (1) urban slums, (2) remote or rural communities, and (3) conflict settings. We found that zero-dose children in the three priority settings face differing barriers to vaccination and, therefore, require context-specific interventions, such as leveraging slum health committees for urban slums or integrating with existing humanitarian response services for conflict settings. Three predominant themes emerged for grouping the various interventions: (1) community engagement, (2) health systems' strengthening and integration, and (3) technological innovations. The barriers to reaching zero-dose children are multifaceted and nuanced to each setting, therefore, no one intervention is enough. Technological interventions especially must be coupled with community engagement and health systems' strengthening efforts. Evaluations of the suggested interventions are needed to guide scale-up, as the evidence base around these interventions is relatively small.

Exploring the factors that contribute to the successful implementation of antimicrobial resistance interventions: a comparison of high-income and low-middle-income countries

Introduction

Antimicrobial resistance (AMR) is a challenge to modern medicine. Interventions have been applied worldwide to tackle AMR, but these actions are often not reported to peers or published, leading to important knowledge gaps about what actions are being taken. Understanding factors that influence the implementation of AMR interventions and what factors are relevant in low-middle-income countries (LMICs) and high-income countries (HICs) were the key objectives of this exploratory study, with the aim to identifying which priorities these contexts need.

Methods

A questionnaire was used to explore context, characteristics, and success factors or obstacles to intervention success based on participant input. The context was analyzed using the AMR-Intervene framework, and success factors and obstacles to intervention success were identified using thematic analysis.

Results

Of the 77 interventions, 57 were implemented in HICs and 17 in LMICs. Interventions took place in the animal sector, followed by the human sector. Public organizations were mainly responsible for implementation and funding. Nine themes and 32 sub-themes emerged as important for intervention success. The themes most frequently reported were 'behavior', 'capacity and resources', 'planning', and 'information'. Five sub-themes were key in all contexts ('collaboration and coordination', 'implementation', 'assessment', 'governance', and 'awareness'), two were key in LMICs ('funding and finances' and 'surveillance, antimicrobial susceptibility testing and preventive screening'), and five were key in HICs ('mandatory', 'multiple profiles', 'personnel', 'management', and 'design').

Conclusion

LMIC sub-themes showed that funding and surveillance were still key issues for interventions, while important HIC sub-themes were more specific and detailed, including mandatory enforcement, multiple profiles, and personnel needed for good management and good design. While behavior is often underrated when implementing AMR interventions, capacity and resources are usually considered, and LMICs can benefit from sub-themes captured in HICs if tailored to their contexts. The factors identified can improve the design, planning, implementation, and evaluation of interventions.

New terminology of medication adherence enabling and supporting activities: ENABLE terminology

Introduction: Medication non-adherence negatively affects the effectiveness of evidence-based therapies and sustainability of healthcare systems. Lack of agreed terminology of medication adherence enabling and supporting activities leads to underuse of the available tools. The ENABLE COST Action was aimed at proposing a new terminology for these activities in order to help both scientific research and its clinical application. Methods: Initial discussions within the ENABLE Working Groups allowed for the conceptualization of four interlinked terms related to adherence, i.e., "medication adherence technology", "medication adherence enhancing intervention", "best practice" and "reimbursement". The iterative process of internal discussion was structured around two dedicated international workshops. Moreover, extensive stakeholder consultations have been organised, including an interactive online survey used to assess the level of agreement with, and the clarity of relevant terms and definitions proposed. Results: Detailed analysis of the results of this process allowed for fine-tuning of the items, and finally, for proposing the final set of definitions. Across all the three phases of this process, the definitions were substantially modified to better reflect the concepts, simplify the language, and assure completeness and cohesiveness of terminology. Feedback obtained from the stakeholders helped this process and confirmed that the final terms and definitions were well received by the experts active in the field of medication adherence. Discussion: Covering the gap in the existing terminology, this work proposes a cohesive set of terms and definitions applicable to medication adherence enabling and supporting activities. Promoting evidence-based approach to this field, this terminology may help research, clinical practice and policy.

Self-care interventions of community-dwelling older adults: a systematic review and meta-analysis

Introduction

The current notion of "care in old age" should be reconceptualized in the ageing societies of the 21st century. Currently, "being old" means that one is actively involved in their care and has the desire to retain control and independence.

Objective

Understand and analyze the efficacy of interventions in the physical and psychological self-care practices of healthy community-dwelling older people.

Methodology

Systematic review and meta-analysis. The guidelines of the PRISMA guide were followed. The methodological quality of the studies was checked using Cochrane Effective Practice and Organisation of Care criteria, and the search was performed between 2016 and 2021.

Results

Of the 1,866 evaluated, 8 studies met the criteria. The systematic review reveals that self-care interventions focus on physical health-related variables but not on psychological variables. The meta-analysis shows that interventions significantly improve physical health-related variables (care visits, hospital admission, medication, and gait speed).

Conclusion

Self-care training programs should include psychological variables to increase health and well-being in healthy older people.

Clinical and Histopathological Discoveries in Patients with Hepatic Injury and Cholangiopathy Who Have Died of COVID-19: Insights and Opportunities for Intervention

The COVID-19 pandemic has had a profound impact on global health, necessitating a comprehensive understanding of its diverse manifestations. Cholangiopathy, a condition characterized by biliary dysfunction, has emerged as a significant complication in COVID-19 patients. In this review, we report the epidemiology of COVID-19, describe the hepatotropism of SARS-CoV-2, and present the histopathology of acute liver injury (ALI) in COVID-19. Additionally, we explore the relationship between pre-existing chronic liver disease and COVID-19, shedding light on the increased susceptibility of these individuals to develop cholangiopathy. Through an in-depth analysis of cholangiopathy in COVID-19 patients, we elucidate its clinical manifestations, diagnostic criteria, and underlying pathogenesis involving inflammation, immune dysregulation, and vascular changes. Furthermore, we provide a summary of studies investigating post-COVID-19 cholangiopathy, highlighting the long-term effects and potential management strategies for this condition, and discussing opportunities for intervention, including therapeutic targets, diagnostic advancements, supportive care, and future research needs.

Why are some people susceptible to Super-Helper Syndrome and what can be done about it?

Chartered Psychologists Jess Baker and Rod Vincent coined the term Super-Helper Syndrome as a useful moniker for the net effects of compulsive helping and not meeting one's own needs-where helping others is to the detriment of one's own wellbeing. Together, they have written an award-winning book that includes excerpts from their qualitative research to offer insights into this common phenomenon that until now has gone unexplored. In this article, the authors provide an overview of Super-Helper Syndrome and why some people are more susceptible to it than others. They describe the range of practical interventions that have been most successful in ameliorating its harmful effects.

The physician gender pay gap in Maryland: current state and future directions

BACKGROUND

Over the last few decades, more attention has been paid to the physician gender pay gap and more interventions have been attempted. This paper discusses the physician gender pay gap between 2017 and 2021 in Maryland.

METHODS

An online cross-sectional survey was distributed to over 10,000 physicians in the Maryland Medical Society, featuring questions regarding employment characteristics, compensation, impact of the COVID-19 pandemic, and educational debt. Using descriptive and regression analyses, we explored cross-sectional associations between gender and employment characteristics.

RESULTS

Male physicians reported a significantly higher average 2020 pre-tax income ($333,732 per year) than female physicians ($225,473 per year, p < 0.001), amounting to a nearly 50% difference in raw income, consistent with a previously reported pay gap in 2016. Women physicians earned 31.5% less than their male colleagues in 2020 and were projected to earn 28.7% less in 2021. Female physicians were also more likely to have educational debt (33.6% vs.12.9%, p < 0.001) and also more likely to have a high burden of debt, with 36% owing over $200,000 in education loans, compared to 14.7% of men (p < 0.01).

CONCLUSION

The physician gender pay gap in Maryland has remained relatively stable over four years, including the period of the COVID-19 pandemic.

Reduction of Escherichia coli O157:H7 in Finishing Cattle Fed Corn Genetically Modified to Produce Increased Concentrations of Alpha Amylase in the Corn Kernel

Cattle are recognized as the principal reservoir for Escherichia coli O157:H7 and preharvest food safety efforts often focus on decreasing shedding of this pathogen in cattle feces. Enogen® corn (EC; Syngenta Seeds, LLC) is genetically modified to produce enhanced concentrations of α-amylase in the corn kernel endosperm. Research has demonstrated improvements in feed efficiency for cattle fed EC and research has not yet explored whether improved digestion impacts foodborne pathogen populations in cattle. Therefore, this study explored effects of finishing diets containing EC on Escherichia coli O157:H7 prevalence in cattle. A 2 × 2 factorial experiment was conducted with steers (n = 960) fed diets consisting of 2 types of silage (EC or Control) and grain (EC or Control), fed daily ad libitum. Steers were grouped into 12 blocks by incoming body weight, blocks were randomly assigned to one of four pens, and pens were randomly assigned to one diet. Cattle were sampled using rectoanal mucosal swabs in cohorts of 298-337 cattle per day, for a total of 3 sampling days (15-16 days apart). Escherichia coli O157:H7 prevalence rates ranged from not detected (0/75) to 10.0% (8/80) depending on sampling day. Tests for the silage × corn interaction, and the main effects of silage and corn, were not significant (p > 0.05); however, EC reduced the odds of Escherichia coli O157:H7 prevalence by 43% compared to the control corn diet (p = 0.07). Diets containing EC tended to decrease Escherichia coli O157:H7 prevalence in feedlot cattle; however, this reduction was not significant. Before a conclusion can be drawn about impact of EC on Escherichia coli O157:H7 in cattle, further research is necessary to (1) determine if this tendency is due to increased alpha amylase activity and (2) elucidate impact on Escherichia coli O157:H7 prevalence and concentration, as well as a possible mechanism of action.

Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis

OBJECTIVE

This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness.

DATA SOURCES

Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023.

STUDY ELIGIBILITY CRITERIA

Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included.

METHODS

The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates.

RESULTS

A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US-based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US-based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6-16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8-10.0), followed by educational interventions (1 US-based study and 2 non-US-based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9-6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7-6.7).

CONCLUSION

The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.

Effects of Prenatal Stress on Behavior, Cognition, and Psychopathology: A Comprehensive Review

Prenatal stress is increasingly recognized as a significant factor impacting an individual's life from the beginning. This comprehensive review explores the intricate relationship between prenatal stress and its effects on behaviour, cognition, and psychopathology. Key findings reveal that prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions. These effects' mechanisms involve epigenetic modifications, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, neurodevelopmental alterations, inflammatory processes, and changes in brain structure and function. Moreover, moderating factors such as maternal stress levels, maternal mental health, socioeconomic status, social support, and early-life adversity can significantly influence the impact of prenatal stress. The review also discusses intervention and prevention strategies, emphasizing the importance of prenatal stress reduction programs, maternal mental health support, nutritional interventions, and targeted early interventions for at-risk populations. These findings have substantial implications for public health and clinical practice, highlighting the need for a holistic approach to prenatal care that prioritizes maternal well-being and mitigates the lasting effects of prenatal stress. Addressing this critical issue promises healthier generations and stronger communities in the future.

Occupational Therapy Interventions for Persons with Cognitive Impairments Living in the Community

This study describes interventions provided by community occupational therapists for persons with cognitive impairments. Using an online questionnaire, a cross-sectional study was conducted, collecting data from 497 of the 1367 occupational therapists in Norwegian community-based services. The most common interventions provided were environmental modifications (87%), implementation of assistive devices (85%), and training of activities of daily life (ADL) (77%). Two main reasons to carry out these interventions were identified as the initial assessment of clients (89%) and expectations of others. The most preferred interventions were ADL training (77%), cognitive training (63%), and environmental modifications (56%). Chi-squared tests identified a significant difference (p < 0.001) between interventions provided and preferred interventions on all interventions except environmental modifications. The findings provide an insight into interventions provided for persons with cognitive impairments in community services.

Adolescents' interactive electronic device use, sleep and mental health: a systematic review of prospective studies

Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access to and use of interactive electronic devices (e.g., smartphones, tablets, portable gaming devices) and social media have become deep-rooted elements of adolescents' lives and are associated with poor sleep. Additionally, there is evidence of increases in poor mental health and well-being disorders in adolescents; further linked to poor sleep. This review aimed to summarise the longitudinal and experimental evidence of the impact of device use on adolescents' sleep and subsequent mental health. Nine electronic bibliographical databases were searched for this narrative systematic review in October 2022. Of 5779 identified unique records, 28 studies were selected for inclusion. A total of 26 studies examined the direct link between device use and sleep outcomes, and four reported the indirect link between device use and mental health, with sleep as a mediator. The methodological quality of the studies was generally poor. Results demonstrated that adverse implications of device use (i.e., overuse, problematic use, telepressure, and cyber-victimisation) impacted sleep quality and duration; however, relationships with other types of device use were unclear. A small but consistent body of evidence showed sleep mediates the relationship between device use and mental health and well-being in adolescents. Increasing our understanding of the complexities of device use, sleep, and mental health in adolescents are important contributions to the development of future interventions and guidelines to prevent or increase resilience to cyber-bullying and ensure adequate sleep.

General practitioners' assessment of interventions applied to optimize laboratory test utilization: a cross-sectional survey study

General practitioners (GPs) in the Region of Southern Denmark were randomly allocated to a range of interventions to optimize their use of Vitamin D tests over one year. The aim of the current survey study was to investigate GPs assessment of the interventions. Using REDCap web-platform, we invited 638 GPs to participate in a survey about their experiences of guidelines, feedback reports, non-interruptive alerts, and interruptive alerts. The questions were customized for the different interventions. We received responses from only 131 GPs (21%), but no differences in gender, age, or type of GP clinic were observed between responders and invited GPs. Approximately half of the GPs found that guidelines were helpful, and a similar proportion of GPs read the feedback reports 'often' or 'always'. The pop-up alerts were accepted when used for maximum three months for often-used tests. In contrast, alerts were accepted for long periods for rarely-used tests. The groups that were exposed to the interruptive alert found it 'problematic' that it appeared every time vitamin D was requested. Guidelines and feedback reports on tests numbers were accepted, but it was previously found, that they had little effect on improving the use of biochemical tests. Pop-up alerts in the requesting IT system can produce alert fatigue. Future research should focus on developing feedback reports that - when possible - also include relevant clinical information, and pop-up alerts should for often used tests be displayed only for weeks or a few months, but can be repeated.

Use of BeSmooth peripheral stent in paediatric cardiology

I read with interest the article by Haddad et al concerning the bench testing of BeSmooth peripheral tests, and I would like to share some thoughts and highlight few points.BeSmooth stent is behaving like any pre-mounted stent available on the market. None can achieve the Holy Grail of being dilatable to adult size without losing their integrity. Until dedicated stents are available, pre-mounted stents are preferred to unmounted stents because of their better profile and deliverability. Technically, proper post-dilatation should be performed in order to avoid and extensive foreshortening and the formation of a ring that would limit further expansion of the stent. BeSmooth stent like other pre-mounted stents can also be used without restriction in situations where overexpansion is not required.BeSmooth stent platform with the knowledge of its intrinsic properties is, in our opinion, a good add-on to the armamentarium of pre-mounted stents used in paediatric cardiology.

Early impacts of the 'National Suicide Prevention Trial' on trends in suicide and hospital admissions for self-harm in Australia

OBJECTIVES

The National Suicide Prevention Trial was announced by the Australian Government in 2016 and aimed to prevent suicidal behaviour in 12 trial sites (representing a population of ~8 million). This study investigated the early population-level impact of the National Suicide Prevention Trial activity on rates of suicide and hospital admissions for self-harm in comparison to control areas.

METHODS

Relative and absolute differences in monthly rates of suicide and hospital admissions for self-harm were compared in the period after the National Suicide Prevention Trial implementation (July 2017-November 2020) to the period prior to implementation (January 2010-June 2017) in (1) 'National Suicide Prevention Trial areas' and (2) 'Control areas', using a difference-in-difference method in a series of negative binomial models. Analyses also investigated whether associations for suicide and self-harm rates differed by key socio-demographic factors, namely sex, age group, area socio-economic status and urban-rural residence.

RESULTS

There were no substantial differences between 'National Suicide Prevention Trial areas' and 'Control areas' in rates of suicide (2% relative decrease, relative risk = 0.98, 95% confidence interval = [0.91, 1.06]) or self-harm (1% relative decrease, relative risk = 0.99, 95% confidence interval = [0.96, 1.02]), adjusting for sex, age group and socio-economic status. Stronger relative decreases in self-harm only were evident for those aged 50-64 years, high socio-economic status areas, metropolitan and remote geographic areas.

CONCLUSION

There was limited evidence that the National Suicide Prevention Trial resulted in reductions in suicide or hospital admissions for self-harm during the first 4 years of implementation. Continued monitoring of trends with timely data is imperative over the next 2-3 years to ascertain whether there are any subsequent impacts of National Suicide Prevention Trial activities.

What is the effect of a brief intervention to promote physical activity when delivered in a health care setting? A systematic review

ISSUE ADDRESSED

What are the effects of a brief intervention to promote physical activity (PA) delivered in a health care setting other than primary care?

METHODS

MEDLINE, EMBASE, CINAHL and PsycINFO were used to identify randomised controlled trials which evaluated the effect of brief interventions to increase PA, delivered in a health care setting. Review outcomes included subjectively or objectively measured PA, adherence to prescribed interventions, adverse events, health-related quality of life, self-efficacy and stage of change in relation to PA. Where possible, clinically homogenous studies were combined in a meta-analysis.

RESULTS

Twenty-five eligible papers were included. Brief counselling interventions were associated with increased PA compared to control, for both self-reported PA (mean difference 34 minutes/week, 95% confidence intervals [95% CI] 9-60 minutes), and pedometer (MD 1541 steps/day, 95% CI 433-2649) at medium term follow up.

CONCLUSION

Our findings suggest that some brief interventions to increase PA, delivered in the health care setting, are effective at increasing PA in the medium term. There is limited evidence for the long-term efficacy of such interventions. The wide variation in types of interventions makes it difficult to determine which intervention features optimize outcomes. SO WHAT?: Brief counselling interventions delivered in a health care setting may support improved PA. Clinicians working in health care settings should consider the implementation of brief interventions to increase PA in vulnerable patient groups, including older adults and those with chronic illness.

Exploring occupation-based practice among occupational therapists in hospitals and rehabilitation institutions

BACKGROUND

While occupational therapists value occupation-based practice, they appear to spend less time on this approach and more time on impairment-based practices. Several barriers are reported for the occupation-based approach.

AIM

To explore different aspects of occupation-based practice among occupational therapists working in hospitals and rehabilitation institutions, and to examine associations between sociodemographic factors, barriers, and occupation-based practice.

MATERIALS AND METHODS

A cross-sectional survey was conducted. Participants were occupational therapists working in hospitals and rehabilitation institutions in Norway. The data were analysed with descriptive statistics and logistic regression.

RESULTS

The therapists (n = 124) valued occupation-based practice and reported using it frequently and to a large extent. Relatively small proportions of their practice (26% assessments and 38% interventions) were classified as occupation-based. Lack of time, space and equipment were reported as large barriers. Lack of time and lack of equipment were associated with low self-reported level of occupation-based practice.

CONCLUSIONS

The participants valued occupation-based practice, while the reported assessment and intervention methods were mainly not occupation-based. Several barriers were reported, and some were associated with less use of occupation-based practice.

SIGNIFICANCE

The results can be used to raise awareness of occupational therapists' use of occupation-based practice and barriers to this approach.

Rabies in the SAARC region: An epidemiological study of disease burden and challenges

Our original study explored trends in rabies-related cases in the South Asian Association for Regional Cooperation region from 2017 to 2021. We analyzed population-level data from Global Health Observatory, World Animal Health Information Database and media reports using Microsoft Excel v.2016. Rabies prevalence varied with India experiencing the highest increase, while Bhutan reported a significant decrease. In contrast, Nepal and Pakistan observed fluctuations, emphasizing the need for ongoing intervention.

Affective Response During Real-World Physical Activity as an Intervention Mediator

Some people experience pleasure during physical activity, whereas it can be unpleasant for others. Modifying affective responses during physical activity in real-world situations may be an intervention strategy for increasing physical activity. This article follows an experimental medicine framework to summarize evidence identifying, assessing, and influencing affective response during real-world physical activity to inform interventions targeting this mediating mechanism.

Psychosocial interventions for personality and behavior changes in adults with a brain tumor: A scoping review

Background

The objective of this scoping review was to describe the intervention characteristics and effectiveness of psychosocial interventions aimed at managing personality and behavior changes in people with brain tumors. A secondary objective was to explore if these interventions had an impact on outcomes for carers. Personality and behavior changes considered included aggression, apathy, paranoia, disinhibition, and emotional lability.

Methods

This review was conducted following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Searches were conducted in PsycINFO, CINAHL, Medline (Ovid), and Scopus. We synthesized studies published from 1996 to 2022 that evaluated interventions to manage brain tumor related personality and behavioral changes in adults. A data extraction tool were used based on the Joanna Briggs Institute template. Results are presented in a summary table and a narrative synthesis was conducted.

Results

Three thousand and five hundred and ninety-four records were screened. Title and abstract screening resulted in 29 potentially eligible studies. Full screening excluded 24 articles and 5 interventions met the inclusion criteria. The interventions were diverse in duration, delivery modality, setting, and participation (eg, the patient individually or patient and carer). The interventions reported improvements in the targeted personality and behavior change symptoms for patients with primary brain tumors. Four studies included a measure of personality and behavior change symptoms and two studies included a measure of outcomes for carers and reported improvements in carer knowledge and a reduction in carer distress. All studies sampled fewer than 100 participants. Studies had limited follow-up data and different tools were used to assess the presence and nature of personality and behavior changes.

Conclusions

There is a dearth of psychosocial interventions to support patients and their carers to manage brain tumor related personality and behavior changes.