Living with Systemic Sclerosis: A Patient and Physician Perspective

The fears associated with being diagnosed with a disease unfamiliar to many, systemic sclerosis, is described by a patient living with systemic sclerosis. The patient, a coauthor, also describes the challenges of being a young person diagnosed with a chronic and, at times, debilitating disease. Despite initially being told that she had 6 months to live, she has embraced life and has become a fierce advocate for others living with systemic sclerosis. The physician perspective is provided by two rheumatologists who specialize in systemic sclerosis and work at a scleroderma center of excellence. This section details the current challenges in diagnosing systemic sclerosis early and the dangers of a delayed diagnosis. It also reviews the importance of multi-disciplinary specialty centers in the care of patients with systemic sclerosis as well as empowering patients through education.

Are the impacts of food systems on climate change being reported by the media? An Australian media analysis

OBJECTIVE

Food systems are a major contributor to climate change, producing one-third of global greenhouse gas emissions. However, public knowledge of food systems' contributions to climate change is low. One reason for low public awareness may be limited media coverage of the issue. To investigate this, we conducted a media analysis examining coverage of food systems and their contribution to climate change in Australian newspapers.

DESIGN

We analysed climate change articles from twelve Australian newspapers between 2011 and 2021, sourced from Factiva. We explored the volume and frequency of climate change articles that mentioned food systems and their contributions to climate change, as well as the level of focus on food systems.

SETTING

Australia.

PARTICIPANTS

N/A.

RESULTS

Of the 2892 articles included, only 5 % mentioned the contributions of food systems to climate change, with the majority highlighting food production as the main contributor, followed by food consumption. Conversely, 8 % mentioned the impact of climate change on food systems.

CONCLUSIONS

Though newspaper coverage of food systems' effects on climate change is increasing, coverage of the issue remains limited. As newspapers play a key role in increasing public and political awareness of matters, the findings provide valuable insights for advocates wishing to increase engagement on the issue. Increased media coverage may raise public awareness and encourage action by policymakers. Collaboration between public health and environmental stakeholders to increase public knowledge of the relationship between food systems and climate change is recommended.

Predictors of patient self-advocacy among patients with chronic heart failure

The purpose of this study was to examine predictors of self-advocacy among patients with chronic heart failure (HF) as they were unknown. A convenience sample of 80 participants recruited from one Midwestern HF clinic completed surveys related to relationship-based predictors of patient self-advocacy including trust in nurses and social support. Self-advocacy is operationalized using the three dimensions of HF knowledge, assertiveness, and intentional non-adherence. Hierarchical multiple regression was used showing that trust in nurses predicted HF knowledge (ΔR² = 0.070, F = 5.91, p < .05), social support predicted advocacy assertiveness (ΔR² = 0.068, F = 5.67, p < .05), and ethnicity predicted overall self-advocacy (ΔR² = 0.059, F = 4.89, p < .05). These findings suggest that support from family and friends can give the patient the needed encouragement to advocate for what they need. A trusting relationship with nurses impacts patient education so that patients not only understand their illness and its trajectory but also use that understanding to speak up for themselves. African American patients, who are less likely to self-advocate than their White counterparts, could benefit from nurses recognizing the impact of implicit bias so that these patients do not feel silenced in their care.

Climate Change and Child Health Equity

The climate crisis is a major public health threat for children, disproportionately affecting the most vulnerable populations. Climate change causes a myriad of health issues for children, including respiratory illness, heat stress, infectious disease, the effects of weather-related disasters, and psychological sequelae. Pediatric clinicians must identify and address these issues in the clinical setting. Strong advocacy from pediatric clinicians is needed to help prevent the worst effects of the climate crisis and to support the elimination of use of fossil fuels and enactment of climate-friendly policies.

The invisible hands in policy making: A qualitative study of the role of advocacy in priority setting for maternal and child health in Nigeria

Background

Maternal and child health is a priority for most governments, especially those in low and middle-income countries (LMICs), due to high mortality rates. The combination of individual and social actions designed to gain political commitment, policy support and social acceptance for health goals are influenced by the interplay between the advocates and the strategies they deploy in planning and advocating for maternal and child health issue. This study aims to deepen our understanding of how advocacy has influenced maternal and child health priority setting in Nigeria.

Methods

This is a mixed method study that involved 24 key informant interviews, document review, policy tracking and mapping of advocacy events that contributed to the repositioning of maternal and child health on the political agenda was done. Respondents were deliberately selected according to their roles and positions. Analysis was based on Shiffman and Smith's policy analysis framework of agenda setting.

Results

Our findings suggest that use of various strategies for advocacy such as influencers, media, generated different outcomes and the use of a combination of strategies was found to be more effective. The role of advocacy in issue emergence was prominent and the presence of powerful actors, favorable policy window helped achieve desired outcomes. The power of the advocates and the strength of the individuals involved played a key role.

Conclusion

This study finds it possible to understand the role of advocacy in policy agenda setting through the application of agenda setting framework. To achieve the health SDG goals, advocacy barriers need to be addressed at multiple levels.

Van der Wees P, Bocchino JM, Rosseau GL. Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects

BACKGROUND

Neural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities.

AIM

This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide.

METHODS

A comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy.

RESULTS

We identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively.

CONCLUSIONS

Several determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification.

Spina bifida management in low- and middle-income countries - a comprehensive policy approach

INTRODUCTION

Globally, spina bifida (SB) occurs more often in low- and middle-income countries, where the healthcare demands are often quite challenging. Several social/societal issues and/or lack of government support makes for incomplete SB management in many areas. Clearly, neurosurgeons should be knowledgeable about initial closure techniques and the basics of SB management, but must also advocate for the patients outside our immediate scope of care.

METHODS

Recently, the Comprehensive Policy Recommendations for the Management of Spina Bifida and Hydrocephalus in Low- and Middle-Income Countries (CHYSPR) and the Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders (IGAP) publications emphasized the need for a more unified approach to SB care. Although both documents discuss other neurological conditions, they support SB as a congenital malformation needing attention.

RESULTS

We identified several similarities for comprehensive SB care in these approaches - including education, governance, advocacy, and the need for continuum of care. Prevention was recognized as the most important aspect for SB going forward. A significant return of investment was noted, and both documents recommend more active neurosurgical involvement (i.e., folic acid fortification).

CONCLUSION

A new call for holistic and comprehensive care for SB management is recognized. Neurosurgeons are called upon to use solid science to educate governments and actively participate to advocate for better care and most importantly, prevention. Folic acid fortification schemes are mandatory and neurosurgeons should advocate for global strategies.

Awareness, attitudes and practices relating to Article 5.3 of the WHO Framework Convention on Tobacco Control among members of tobacco control committees in a southern Indian state

BACKGROUND AND OBJECTIVES

The tobacco industry (TI) has undermined tobacco control policy for decades. The WHO Framework Convention on Tobacco Control Article 5.3 implementation guidelines provide guidance for preventing TI interference. Government officials responsible for policy implementation must understand these guidelines to manage TI tactics. This study assessed awareness, attitudes and practices of Article 5.3 guidelines among members of District Level Coordination Committees (DLCC) in Karnataka mandated with overseeing tobacco control activity.

METHOD

A semistructured questionnaire survey of awareness, attitudes and adherence to Article 5.3 guidelines among 102 DLCC members carried out between January and July 2019.

RESULT

Responses were received from 82 members, comprising 51 (62%) from health and 31 (38%) from non-health departments. Our study demonstrates a lack of understanding of Article 5.3 and its guidelines, even among those actively involved in tobacco control at the district level. Nearly 80% of respondents were aware that corporate social responsibility (CSR) by tobacco companies is an indirect form of promoting tobacco. However, 44% of members felt that CSR funding from the TI should be used to combat tobacco-related harm. A higher proportion (12%) of health respondents agreed that subsidies should be provided to tobacco agriculture compared with non-health (3%).

CONCLUSION

Awareness of international guidance designed to prevent the TI influence on health policy among policymakers in this Indian state is low. Respondents from non-health departments were less aware of TI CSR. Those in health departments were more receptive towards taking a TI role in the future .

Advocacy counterstrategies to tobacco industry interference in policymaking: a scoping review of peer-reviewed literature

BACKGROUND

There has been remarkable tobacco control progress in many places around the globe. Tobacco industry interference (TII) has been identified as the most significant barrier to further implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Civil society has been recognised as a key actor in countering TII. While TII has been extensively studied for several decades now, there is little research that focuses on counteractions to limit it and their effectiveness to do so. This scoping review seeks to map the peer-reviewed literature on civil society's activities of countering TII in policymaking to identify common counterstrategies and assess their effectiveness.

METHODS

Data sources: We searched Embase, IBSS, JSTOR, PubMed, Science Direct, Scopus and Web of Science using the following terms: ("Tobacco industry" OR "Tobacco compan*") AND. ("corporate political activity" OR "CPA" OR "lobbying" OR "interference") AND ("advoca*" OR "counter*" OR "activi*"), without time or language restrictions.

STUDY SELECTION

Our selection criteria included peer-reviewed studies that were written in English, German, or Spanish that drew on primary data and/or legal and policy documents and reported at least one specific example of civil society members or organisations countering tobacco industry action-based strategies.

DATA EXTRACTION

Advocates' counterstrategies were analysed inductively and countered industry strategies were analysed using the Policy Dystopia Model (PDM). Perceptions of effectiveness of countering attempts were analysed descriptively.

RESULTS

We found five common counterstrategies among 30 included papers covering five WHO regions; 1. Exposing industry conduct and false claims; 2. Accessing decision-makers; 3. Generating and using evidence; 4. Filing a complaint or taking legal action; 5. Mobilising coalition and potential supporters. These counterstrategies were used to work against a wide range of industry strategies, which are captured by five action-based strategies described in the PDM (Coalition Management, Information Management, Direct Access and Influence, Litigation, Reputation Management). While some studies reported the outcome of the countering activities, their impact remained largely underexplored.

CONCLUSION

The review shows that peer-reviewed literature documenting how civil society actors counter TII is scarce. It suggests that advocates employ a range of strategies to counter TII in its different forms and use them flexibly. More work is needed to better understand the effects of their actions. This could stimulate discussions about, and facilitate learning from, past experiences and help to further enhance advocates' capacity.

Needs, Roles and Challenges of Young Asian Neurosurgeons

BACKGROUND

Asia has a marked shortage of neurosurgical care, with approximately 2.5 million critical cases left untreated. The Young Neurosurgeons Forum (YNF) of the World Federation of Neurosurgical Societies (WFNS) surveyed Asian neurosurgeons to identify the of research, education, and practice.

METHODS

A cross-sectional study using a pilot-tested e-survey was circulated to the Asian neurosurgical community from April to November 2018. Descriptive statistics were used to summarize variables pertaining to demographics and neurosurgical practices. Chi square test was utilized to explore the relation between World Bank income level and variables on neurosurgical practices.

RESULTS

A total of 242 responses were analyzed. Respondents were mostly from the low- and middle-income countries (70%). Most represented institutions were teaching hospitals (53%). >50% of the hospitals had between 25-50 neurosurgical beds. Access to an operating microscope (p=0.038) or image guidance system (p=0.001) appeared to increase in correlation to a higher World Bank income level. Limited opportunities for conducting research (56%) and hands-on operating opportunities (45%) were leading challenges in daily academic practice. The leading challenges were limited numbers of intensive care unit beds (51%), inadequate or absent insurance coverage (45%), and lack of organized peri-hospital care (43%). Inadequate insurance coverage decreased with increasing World Bank income levels (p<0.001). Organized peri-hospital care (p=0.001), regular MRI access (p=0.032), and equipment necessary for microsurgery (p=0.007) increased with higher World Bank income levels.

CONCLUSION

Improving neurosurgical care hinges on regional and international collaboration and national policies to ensure universal access to essential neurosurgical care.

Community engagement group model in basic and biomedical research: lessons learned from the BEAT-HIV Delaney Collaboratory towards an HIV-1 cure

INTRODUCTION

Achieving effective community engagement has been an objective of U.S. National Institutes of Health-funded HIV research efforts, including participation of persons with HIV. Community Advisory Boards (CABs) have remained the predominant model for community engagement since their creation in 1989. As HIV cure-directed research efforts have grown into larger academic-industry partnerships directing resources toward both basic and clinical research under the Martin Delaney Collaboratories (MDC), community input models have also evolved. The BEAT-HIV MDC Collaboratory, based at The Wistar Institute in Philadelphia, United States, implemented a three-part model for community engagement that has shown success in providing greater impact for community engagement across basic, biomedical, and social sciences research efforts.

DISCUSSION

In this paper, we review the case study of the formation of the BEAT-HIV Community Engagement Group (CEG) model, starting with the historical partnership between The Wistar Institute as a basic research center and Philadelphia FIGHT as a not-for-profit community-based organization (CBO), and culminating with the growth of community engagement under the BEAT-HIV MDC. Second, we present the impact of a cooperative structure including a Community Advisory Board (CAB), CBO, and researchers through the BEAT-HIV CEG model, and highlight collaborative projects that demonstrate the potential strengths, challenges, and opportunities of this model. We also describe challenges and future opportunities for the use of the CEG model.

CONCLUSIONS

Our CEG model integrating a CBO, CAB and scientists could help move us towards the goal of effective, equitable and ethical engagement in HIV cure-directed research. In sharing our lessons learned, challenges and growing pains, we contribute to the science of community engagement into biomedical research efforts with an emphasis on HIV cure-directed research. Our documented experience with implementing the CEG supports greater discussion and independent implementation efforts for this model to engage communities into working teams in a way we find a meaningful, ethical, and sustainable model in support of basic, clinical/biomedical, social sciences and ethics research.

Advocacy for patients with headache disorders

Primary headache disorders are worldwide highly prevalent and burdensome and should be therefore considered as a global public health priority. However, too many patients with primary headache disorders still do not receive satisfying care. The most likely identified reasons for such a scenario - lack of public awareness, stigma, lack of trained professionals with inadequate healthcare systems and policies - are remediable. Despite the progresses that were made in headache advocacy, these efforts have not yielded substantial improvements in research funding or access to specialty care and even standards of care. The situation is more complex in Low and Middle Income Countries (LMICs) where headache advocacy is urgently needed given the magnitude of the difficulties that patients with primary headache disorders face in accessing care. The growing emergence of coordinated, collaborative, patient-centered advocacy efforts with improved patient-clinician partnership is an opportunity to enhance progress in advocacy for a satisfying life and optimal and equitable care for people with primary headache disorders. LMICs can benefit greatly from coordinating these efforts on a global scale. The recent organization of a training program on headache diagnosis and management for healthcare professionals in Africa is a concrete example.

Disability Justice and Anti-ableism for the Pediatric Clinician

The impact of ableism on health care, and specifically the health of people with disabilities, is not only underrecognized, but misunderstood at a foundational level due to socially acceptable denial of anti-disability bias. For the pediatrician that seeks to learn about the value of anti-ableist approaches to health care and how it can promote child health, this article reviews the relationship between medical jargon and anti-disability bias, and provides a primer on disability justice, the medical versus social models of disability, and other scholarly concepts related to anti-ableism. The authors provide narrative examples of disability bias in clinical scenarios, and the article concludes with actionable recommendations on anti-ableist language etiquette and clinical best practices. Although ableism is a societal issue, pediatricians have a responsibility to recognize and address ableism as a threat to child health.

Survey of colleges and schools of pharmacy to determine restrictions for teaching, research, and advocacy related to contraception

INTRODUCTION

The pharmacist's role in reproductive health is evolving. Since 46 states allow providers to refuse to provide reproductive health services, it is important to consider whether learning is impacted by institution restrictions on contraception teaching, advocacy, and research.

METHODS

An electronic survey was emailed to deans of all pharmacy schools on the American Association of Colleges of Pharmacy Institutional Membership list with a request to share with faculty teaching women's health content within their curriculum. The survey collected information about contraception teaching, research, and advocacy.

RESULTS

Of 145 schools contacted, 39 (27%) provided complete responses. Of these, 22 (56%) were public, not religiously-affiliated, seven (18%) were private, not religiously-affiliated, six (15%) were private, currently religiously-affiliated, and four were (10%) private, historically religiously-affiliated. All respondents taught hormonal contraception in the required curriculum and 15 (39%) taught miscarriage management/abortifacients. None reported restrictions on contraception teaching or research. One respondent cited an advocacy restriction for contraception methods due to violation of the school's beliefs, and another cited an advocacy restriction for miscarriage management/abortifacients. Respondents noted students expressed ethical questions/concerns about refusing to dispense contraception (59%), dispensing certain contraceptives (54%), dispensing to minors (46%), and dispensing all contraceptives (21%). Additionally, respondents reported pharmacists/faculty expressed ethical questions/concerns about refusing to dispense contraception (31%), dispensing to minors (21%), dispensing certain contraceptives (15%), and all contraceptives (13%).

CONCLUSIONS

Overall, respondents reported no restrictions in contraception teaching and scholarship and minimal advocacy restrictions. Faculty should consider ethical questions/concerns from students, faculty, and pharmacists when teaching this material.

Pediatric Rehabilitation Medicine Physicians: Your Essential Medical Home Neighbors for Children with Disabilities

Pediatric rehabilitation medicine (PRM) physicians are subspecialists in the field of physical medicine and rehabilitation trained to promote the health and function of children with disabilities (CWD) across their lifespans. Management strategies employed include prescribing medications, therapy, and adaptive equipment (braces and mobility devices) to optimize function and allow participation. PRM physicians collaborate with other providers to mitigate the negative consequences of health conditions and injuries. Their work is interdisciplinary because CWD with either temporary or permanent impairments needs treatments, services, and support that extend beyond the clinical environment. Owing to this, PRM physicians are essential members of the health neighborhood for CWD.

International variability in the diagnosis and management of disorders of consciousness

This manuscript explores the international variability in the diagnosis and management of disorders of consciousness (DoC). The identification, evaluation, intervention, exploration, prognostication and limitation of therapy for patients with DoC is reviewed through an international lens. The myriad factors that impact the diagnosis and management of DoC including 1) financial, 2) legal and regulatory, 3) cultural, 4) religious and 5) psychosocial considerations are discussed. As data comparing patients with DoC internationally are limited, findings from the general critical care or neurocritical care literature are described when information specific to patients with DoC is unavailable. There is a need for improvements in clinical care, education, advocacy and research related to patients with DoC worldwide. It is imperative to standardize methodology to evaluate consciousness and prognosticate outcome. Further, education is needed to 1) generate awareness of the impact of the aforementioned considerations on patients with DoC and 2) develop techniques to optimize communication about DoC with families. It is necessary to promote equity in access to expertise and resources for patients with DoC to enhance the care of patients with DoC worldwide. Improving understanding and management of patients with DoC requires harmonization of existing datasets, development of registries where none exist and establishment of international clinical trial networks that include patients in all phases along the spectrum of care. The work of international organizations like the Curing Coma Campaign can hopefully minimize international variability in the diagnosis and management of DoC and optimize care.

Speaking up for the lost voices: representation and inclusion of people with communication impairment in brain tumour research

Brain tumours and their associated treatments can lead to progressive impairments of communication, adversely affecting quality-of-life. This commentary explores our concerns that people with speech, language, and communication needs face barriers to representation and inclusion in brain tumour research; we then offer possible solutions to support their participation. Our main concerns are that there is currently poor recognition of the nature of communication difficulties following brain tumours, limited focus on the psychosocial impact, and lack of transparency on why people with speech, language, and communication needs were excluded from research or how they were supported to take part. We propose solutions focusing on working towards more accurate reporting of symptoms and the impact of impairment, using innovative qualitative methods to collect data on the lived experiences of speech, language, and communication needs, and empowering speech and language therapists to become part of research teams as experts and advocates for this population. These solutions would support the accurate representation and inclusion of people with communication needs after brain tumour in research, allowing healthcare professionals to learn more about their priorities and needs.

Everyday advocacy

When considering advocacy, many people think of the political fundraising form, and assume it is difficult to carry out, or that it requires a big investment of time, energy, or money. However, advocacy comes in many different forms, and can be implemented every day. A more mindful approach and a few small, but critical, steps can take our advocacy to a new, more intentional level; one that we can practice every day. There are many opportunities to use our advocacy skills every day to stand up for something that matters and to make advocacy a habit. It will take all of us working together to rise to the challenge and make a difference in our specialty, for our patients, in our society and in our world.

Implementing an exclusive human milk diet for preterm infants: real-world experience in diverse NICUs

BACKGROUND

Human milk-based human milk fortifier (HMB-HMF) makes it possible to provide an exclusive human milk diet (EHMD) to very low birth weight (VLBW) infants in neonatal intensive care units (NICUs). Before the introduction of HMB-HMF in 2006, NICUs relied on bovine milk-based human milk fortifiers (BMB-HMFs) when mother's own milk (MOM) or pasteurized donor human milk (PDHM) could not provide adequate nutrition. Despite evidence supporting the clinical benefits of an EHMD (such as reducing the frequency of morbidities), barriers prevent its widespread adoption, including limited health economics and outcomes data, cost concerns, and lack of standardized feeding guidelines.

METHODS

Nine experts from seven institutions gathered for a virtual roundtable discussion in October 2020 to discuss the benefits and challenges to implementing an EHMD program in the NICU environment. Each center provided a review of the process of starting their program and also presented data on various neonatal and financial metrics associated with the program. Data gathered were either from their own Vermont Oxford Network outcomes or an institutional clinical database. As each center utilizes their EHMD program in slightly different populations and over different time periods, data presented was center-specific. After all presentations, the experts discussed issues within the field of neonatology that need to be addressed with regards to the utilization of an EHMD in the NICU population.

RESULTS

Implementation of an EHMD program faces many barriers, no matter the NICU size, patient population or geographic location. Successful implementation requires a team approach (including finance and IT support) with a NICU champion. Having pre-specified target populations as well as data tracking is also helpful. Real-world experiences of NICUs with established EHMD programs show reductions in comorbidities, regardless of the institution's size or level of care. EHMD programs also proved to be cost effective. For the NICUs that had necrotizing enterocolitis (NEC) data available, EHMD programs resulted in either a decrease or change in total (medical + surgical) NEC rate and reductions in surgical NEC. Institutions that provided cost and complications data all reported a substantial cost avoidance after EHMD implementation, ranging between $515,113 and $3,369,515 annually per institution.

CONCLUSIONS

The data provided support the initiation of EHMD programs in NICUs for very preterm infants, but there are still methodologic issues to be addressed so that guidelines can be created and all NICUs, regardless of size, can provide standardized care that benefits VLBW infants.

Campus interpersonal violence survivor advocacy services

Objective: Although there has been increased attention to campus interpersonal violence, there is limited information on survivor advocacy services. Participants: We recruited participants from 155 U.S. institutions of higher education responsible for advocacy services on their campus. Methods: We used a community participatory action approach in partnership with the Campus Advocacy and Prevention Professionals Association to develop and disseminate a survey regarding campus advocacy services. Results: Participants shared critical insights about (a) advocacy staffing/caseload, (b) program structure, (c) advocacy practices, and (d) connection to services for people who had caused harm. We found that advocacy programs are often providing best practice services for survivors of violence but operating with few staff and unclear privacy protections. Conclusions: This study provided crucial preliminary information about how campuses provide advocacy services, but more researcher-practitioner engagement is needed to build on this study and establish clear practice guidelines.

Mediators and moderators of the effect of the game changers for cervical cancer prevention intervention on cervical cancer screening among previously unscreened social network members in Uganda

INTRODUCTION

Cervical cancer (CC) rates are high in Uganda, yet CC screening rates are very low. Our peer advocacy group intervention, Game Changers for Cervical Cancer Prevention (GC-CCP), was shown to increase CC screening uptake among social network members. In this secondary analysis, we examined mediators and moderators of this effect to better understand how and for whom the intervention was most successful in promoting CC screening.

METHODS

We conducted a pilot randomized controlled trial of GC-CCP in Namayingo district, Eastern Uganda between September 2021 and April 2022. Forty adult women who had screened for CC in the past year (index participants) enrolled at baseline: 20 were randomized to receive the 7-session intervention to empower women to engage in CC prevention advocacy, and 20 were assigned to the waitlist control; from these index participants, 103 unscreened social network members (alters) also enrolled. All participants were assessed at baseline and month 6 follow-up. Change in cognitive and behavioral CC-related constructs from baseline to month 6 were examined as mediators, using multivariate linear regression analysis. Index and alter demographics and index CC treatment status were examined as moderators.

RESULTS

Increased alter engagement in CC prevention advocacy fully mediated the intervention effect on alter uptake of CC screening, and was associated with an increased likelihood of alter CC screening. CC treatment status of the index participant was the sole moderator of the intervention effect, as those in the intervention group who had screened positive and received treatment for pre-cancerous lesions were more likely to have alters who got screened for CC by month 6.

CONCLUSION

The effect of GC-CCP on alter CC screening is greater when the alter reports increased engagement in her own advocacy for CC prevention with others. The intervention effects on increased engagement in CC prevention advocacy among both index and alter participants suggest a diffusion of advocacy, which bodes well for dissemination of knowledge and screening activation throughout a network and the larger community.

Effects of student-led drama on nursing students' attitudes to interprofessional working and nursing advocacy: A pre-test post-test educational intervention study

BACKGROUND

Nursing educators need to equip students to work in interprofessional teams and advocate for patients in increasingly integrated health and social care settings. Drama-based education has been used in nursing to help students understand complex concepts and practices, including communication, empathy, and patient safety. However, few studies have evaluated drama-based education to promote understanding of interprofessional care and advocacy, and none have involved student-led drama where students create dramatic performances to support learning.

OBJECTIVES

To examine the effects of student-led drama on student nurses' attitudes to interprofessional working and advocacy.

DESIGN

Pre-test post-test educational intervention study.

SETTINGS

Public university in Scotland.

PARTICIPANTS

400 undergraduate student nurses enrolled on a 15-week module focussed on health and social care integration and interprofessional working.

METHODS

Students completed paper questionnaires at the start (n = 274, response rate: 80.1 %) and end (n = 175, 63.9 %) of the module. Outcome measures were the validated Attitudes Towards Healthcare Teams Scale (ATHCTS) and Protective Nursing Advocacy Scale (PNAS). Change in mean ATHCTS and PNAS scores were assessed using paired samples t-tests, with Cohen's d to estimate effect size.

RESULTS

ATHCTS scores significantly increased from 3.87 to 4.19 (p < 0.001, d = 0.52). PNAS scores increased from 3.58 to 3.81 (p < 0.001, d = 0.79), with significant improvements in the 'acting as an advocate' (4.18 to 4.51, p < 0.001, d = 0.81) and 'environmental and educational influences' subscales (3.79 to 4.13, p < 0.001, d = 0.75). Statements focussed on promoting holistic, dignified care and enabling health professionals to be responsive to emotional and financial needs of patients, showed greatest change.

CONCLUSIONS

Education based on plays created and performed by student nurses led to significant improvements in student nurses' attitudes towards interprofessional working and nursing advocacy. Student-led drama should be embedded in nursing curricula to enable students to understand the realities and complexities of health and social care integration and interprofessional working.

Epidemiology, Management, and Treatment Access of Hereditary Angioedema in the Asia Pacific Region: Outcomes From an International Survey

BACKGROUND

Hereditary angioedema (HAE) is a rare genetic disease with significant morbidity and mortality for which early diagnosis and effective therapy are critical. Many Asia Pacific (AP) countries still lack access to diagnostic tests and evidence-based therapies. Epidemiologic data from the AP is needed to formulate regional guidelines to improve standards of care for HAE.

OBJECTIVE

To investigate the estimated minimal prevalence, needs, and potential interventions for the diagnosis and management of HAE in the AP.

METHODS

A structured questionnaire was distributed to representative experts from member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Patient profiles and the presence of diagnostic facilities or tests, regional and national HAE guidelines, and patient support groups were reported and compared.

RESULTS

Completed questionnaires were received from 14 representatives of 12 member countries and territories, representing 46% of the world population. Overall minimal prevalence of HAE in the AP region was 0.02/100,000 population, with significant heterogeneity across different centers. Only one-half and one-third had registered on-demand and prophylactic medications, respectively. Few had patient support groups (58%) or regional guidelines (33%), and their existence was associated with the availability of HAE-specific medications. Availability of C1-inhibitor level testing was associated with a lower age at HAE diagnosis (P = .017).

CONCLUSIONS

Hereditary angioedema in the AP differs from that in Western countries. Hereditary angioedema-specific medications were registered in only a minority of countries and territories, but those with patient support groups or regional guidelines were more likely to have better access. Asia Pacific-specific consensus and guidelines are lacking and urgently needed.

Current status of African pediatric oncology education efforts aligned with the Global Initiative for Childhood Cancer

Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn't exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for. LEARNING POINTSThe African continent has various resources to increase the capacity of childhood cancer care stakeholders to increase their knowledge.African pediatric oncology teams rely on a multitude of international sources for training while developing their own.There is a greater need for formal, standardized cancer training especially for pediatric surgeons, radio-oncologists and nurses.Greater inclusion of pathologists, pediatric oncology pharmacists and dieticians into multidisciplinary care and childhood cancer training should be facilitated and resourced.Successful advocacy programs and tool kits exist in parts of Africa, but the training in advocacy is still underdeveloped.