Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial

Prevalence of unintended pregnancy in the MENA region: a systematic review and meta-analysis

BACKGROUND

Unintended pregnancies pose significant public health challenges globally, particularly in the Middle East and North Africa (MENA) region, where cultural, religious and societal factors play the most substantial role. This systematic review and meta-analysis investigated the pooled prevalence and factors associated with unintended pregnancies in the MENA region.

METHODS

We conducted a systematic review to identify relevant studies in Medical Literature Analysis and Retriaval System (MEDLINE), Embase and Scopus published on unintended pregnancies until July 2024. We included studies that were conducted on unintended pregnancy prevalence within MENA countries and employed suitable measurement tools. We analysed data from 40 studies involving 34 837 participants across the region, including Egypt, Iran, Saudi Arabia and Qatar. We used a random-effects model to estimate the pooled prevalence of unintended pregnancy.

RESULTS

In this meta-analysis, we found that the overall prevalence of unintended pregnancy was 27.0% (95% CI 25.0% to 30.0%) in the MENA region, and the certainty of the evidence was moderate. Saudi Arabia had the highest prevalence of unintended pregnancy at 32.0% (95% CI 27.0% to 38.0%). A lower prevalence, 10.0% (95% CI 8.0% to 14.0%), was found in the studies that used validated tools compared with non-validated tools to measure unintended pregnancy. Between 2006 and 2010, the prevalence was 34.0% (95% CI 28.0% to 40.0%), the highest compared to other time periods . Age, rural areas, education, employment, economic status, parity, gravidity, history of miscarriage, previous pregnancies or abortion, non-use or failure of contraception methods, limited antenatal care, were associated with unintended pregnancies.

CONCLUSION

Our findings suggest that the MENA region faces a substantial burden of unintended pregnancies, with variations among countries and over time. The results emphasise the need for evidence-based interventions to address this issue, focusing on factors associated with unintended pregnancy.

Efficacy of lifting devices for wheelchair transfers: a systematic review and meta-analysis

A high prevalence of work-related musculoskeletal disorders (WMSDs) has been reported among nurses as a result of the injuries caused by patient transfer and handling. This review examines the impact of motorised and non-motorised lifting devices on reducing physical stress during wheelchair transfers among nurses. Systematic electronic database searches were performed, and the review was prepared according to the PRISMA guidelines. The results of 20 studies on biomechanical stresses related to WMSDs were synthesised qualitatively, and 13 were analysed quantitatively using meta-analysis. Motorised lifting devices significantly decreased biomechanical stress among nurses [SMD -0.68; 95% CI -1.02 to -0.34], whereas non-motorised counterparts showed no significant change [SMD - 0.23; 95% CI -0.59 to 0.13]. This study underscores the effectiveness of motorised lifting devices in mitigating WMSD risk during wheelchair transfers. The findings provide practical guidance for hospital administrators, policymakers, and experts seeking suitable devices to prevent WMSDs in nursing professionals.

Practitioner Summary: This study investigated the impact of motorised and non-motorised lifting devices on nurses during wheelchair transfers. Findings revealed that motorised devices significantly reduce biomechanical stress, while non-motorised devices showed limited effectiveness. The research emphasises the superior role of motorised devices in preventing WMSDs during wheelchair transfers among nurses.

Reporting and incorporation of social risks in low back pain and exercise studies: A scoping review

BACKGROUND

Exercise is a common intervention for low back pain, but its effect sizes are small to modest. Social risk factors significantly influence health outcomes, yet their consideration in randomized controlled trials on exercise for low back pain is often neglected. Determining their relationship to outcomes may provide better insight into exercise effectiveness.

OBJECTIVES

To assess the reporting of social risk factors (SRFs) in randomized controlled trials (RCTs) of exercise interventions for low back pain (LBP) in adults and explore associations between SRFs and outcomes.

DESIGN

Scoping Review.

METHODS

The databases MEDLINE, CINAHL and Cochrane were searched for studies published between January 2014 to March 2025. RCTs were included if exercise was the primary intervention for LBP treatment and had a minimum follow-up of 12 weeks. A planned analysis of SRF and outcome associations was not conducted due to insufficient data.

RESULTS

A total of 10,292 studies were identified and 157 studies included. Fewer than half (47.1 %) reported any SRFs at baseline. Socioeconomic position (42.7 %) was most frequently reported, followed by social relationships (17.8 %), race/ethnicity/cultural context (8.3 %), residential/community context (1.3 %), and gender (0.6 %). Four studies incorporated SRFs in their outcome analyses; one examined associations with outcomes and found no significant association.

CONCLUSION

SRFs are underreported in RCTs of exercise interventions for LBP and are rarely analyzed in relation to primary outcomes, limiting our understanding of their impact. Future trials should prioritize collecting and reporting SRFs at baseline and incorporating them in outcome analyses to assess their influence on outcomes.

Videoconference-Supervised Group Exercise Reduces Low Back Pain in Eldercare Workers: Results from the ReViEEW Randomised Controlled Trial

PURPOSE

To assess the effects of a group exercise intervention conducted by real-time videoconference on the low back pain of eldercare workers.

METHODS

We randomly assigned 130 eldercare workers to an experimental group (EG: n = 65) or control group (CG: n = 65). Participants from both groups took part in routine prevention programs carried out in their workplace, and participants from the EG received an additional 12-week resistance-exercise intervention supervised by real-time videoconference. Assessments were conducted before and after the intervention, and the primary outcome was average low back pain intensity during the last 7 days, measured by the 0-10 numerical rating scale. Secondary outcomes included additional measures of low back, neck, shoulder and hand/wrist pain, as well as psycho-affective parameters, medication consumption and muscle performance. Both intention-to-treat and per-protocol analyses were applied with a group-by-time ANCOVA including baseline measurements as covariates.

RESULTS

125 participants completed post-intervention assessments (EG: n = 63, CG: n = 62). The intention-to-treat analysis showed an effect favouring the EG on average low back pain intensity (p = 0.034). Improvements in additional low back and hand/wrist pain outcomes were also observed, as well as on upper limb muscle performance (p < 0.05). The per-protocol analysis demonstrated additional benefits in depression, quality of life, hypnotic/anxiolytic medication consumption and lower limb and trunk muscle performance in participants with ≥ 50% adherence (p < 0.05).

CONCLUSIONS

The intervention was effective for reducing the low back and hand/wrist pain of eldercare workers and increasing upper limb muscle performance. The per-protocol analysis showed additional benefits in psycho-affective parameters, medication consumption and muscle performance.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05050526. Registered 20 September 2021-Prospectively registered, https://www.

CLINICALTRIALS

gov/study/NCT05050526.

Inclusive sexual and reproductive health services for teenage mothers: a qualitative study in a Rwandan district

Background

Sexual and reproductive health (SRH) plays a crucial role in overall well-being, and there is a concerning rise in teenage pregnancies globally, particularly evident in Rwanda according to the Demographic and Health Survey. These pregnancies result in serious consequences, impacting the health of teenage mothers and various aspects of their lives. Lack of accessibility to inclusive SRH services among adolescents was documented in different studies and deters them from using SRH services. To date, no studies have explored how teenage mothers access inclusive SRH services in Rwanda.

Purpose

This study aimed at exploring the accessibility to inclusive SRH services among teenage mothers. The focus was on exploring the understanding of teenage mothers about SRH services; exploring their inclusiveness to SRH services and identifying their suggestions to improve their inclusiveness in SRH services.

Methods

A qualitative descriptive design was used. 50 teenage mothers from 5 health centres of a Rwandan district participated. They were recruited using purposive sampling and interviewed in five focus group discussions. Before participation, the participants provided their consent. For participants who were minors, consent was obtained from their legal guardians in addition to the participants' assent. The discussions were audio-recorded, transcribed and thematically analysed.

Results

Some participants had limited knowledge of certain aspects of SRH and reported difficulties accessing inclusive SRH services, while others mentioned receiving unfriendly SRH services. Participants suggested flexibility in policies related to providing SRH services to teenage mothers, as well as the assignment of specific healthcare providers to address their SRH needs.

Conclusions

This study revealed knowledge gaps among participants in SRH and limited accessibility to inclusive SRH services among teenage mothers, due to policy and negative attitudes of some healthcare providers. This highlights the need to educate these professionals in offering inclusive and quality SRH services to teenage mothers.

Effectiveness of an ergonomic training with exercise program for work-related musculoskeletal disorders among hemodialysis nurses: A pilot randomized control trial

INTRODUCTION

Hemodialysis nurses suffer a high prevalence of work-related musculoskeletal disorders due to the nursing job contents and high repetition. A practical ergonomic program was expected to improve their occupational health and musculoskeletal discomfort. This study developed an ergonomic training program with exercise and examined its effectiveness for musculoskeletal discomfort and muscle strength in hemodialysis nurses.

METHOD

A cluster pilot randomized control trial was conducted. Participant nurses were from two hemodialysis units at two medical centers in Taiwan in 2019 and 2020. A 12-week ergonomic program with exercise customized by the job analysis of hemodialysis nursing tasks applied to the intervention group (n = 14). A mobile messenger application was adopted to remind, monitor, and consult the implementation of exercises. The musculoskeletal discomfort degree and muscle strength were measured before and after training as well as the follow-up after another 12 weeks. The training effect between the intervention group and the control group (n = 20), was analyzed by the generalized estimating equations model.

RESULTS

The significant improvements in muscle strength of the wrist and pinch power of the dominant hand were identified after training. The sustaining effect showed significant decreases in musculoskeletal discomfort degrees in the elbows, wrists/hands, knees, and ankles/feet. Training participants achieved an 80% adherence rate to the exercise program, facilitated by a convenient mobile messenger application. They also responded with very high satisfaction with all the ergonomic education, exercise regimen, and use of resistance devices.

CONCLUSIONS

This trial approves the effectiveness of the developed program for hemodialysis nurses and its feasibility in clinical practice.

PRACTICAL APPLICATIONS

This ergonomic training with a customized exercise program for hemodialysis nurses can serve as a valuable educational resource for hemodialysis nurses to mitigate work-related musculoskeletal disorders and improve occupational strength. Integrating the support of remote technology can enhance program adherence in hectic work environments.

Economic effects of priority setting in healthcare: a scoping review of current evidence

OBJECTIVES

Study objective was to map the current literature on the economic effects of priority setting at the system level in healthcare.

DESIGN

The study was conducted as a scoping review.

DATA SOURCES

Scopus electronic database was searched in June 2023.

ELIGIBILITY CRITERIA

We included peer-reviewed articles published 1 January 2020-1 January 2023. All study designs that contained empirical evidence on the financial effects or opportunity costs of healthcare priority setting were included excluding disease, condition, treatment, or patient group-specific studies.

DATA EXTRACTION AND SYNTHESIS

Two independent researchers screened the articles, and two additional researchers reviewed the full texts and extracted data. We used Joanna Briggs Institute checklists to assess the quality of qualitative, quasi-experimental and economic evaluations and the mixed methods appraisal tool for the mixed method studies. Synthesis was done qualitatively and through descriptive statistics.

RESULTS

8869 articles were screened and 15 fulfilled the inclusion criteria. The most common study focus was health technology assessment (7/15). Other contexts were opportunity costs, effects of programme budgeting and marginal analysis, and disinvestment initiatives. Priority setting activities analysed in the studies did not achieve cost savings or cost containment (4/15) or have mixed findings at best (8/15). Only five studies found some indication of cost savings, cost containment or increased efficiency. Also, many of the studies consider costs only indirectly or qualitatively.

CONCLUSIONS

All in all, there is very little research addressing the pressing question of whether explicit priority setting and priority-setting methods can support cost containment on a health service system level (regional or national). There is limited evidence of the economic effects of priority setting.

An expert consensus on the most effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: protocol for an online modified Delphi study

INTRODUCTION

Behaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy (MI-CBT) interventions have become increasingly popular to promote behaviour change; however, there is a lack of agreement as to what constitutes necessary components of MI-CBT interventions for lifestyle behaviour change. The primary objective of this study is to use a consensus method to develop guidelines to design and deliver MI-CBT interventions for lifestyle behaviour change.

METHODS

A three-round modified Delphi study will be conducted with an expert, international panel of clinicians and researchers. An online survey will be developed from assessments of key MI-CBT literature and practice guides to identify commonly used components of individually delivered MI and CBT interventions. In each round, participants will rate the extent to which they agree with each component using a Likert scale. Responses from Rounds 1 and 2 will be presented to participants in subsequent rounds. Responses will be represented using bar graphs and include the median and IQR of participants' responses. To encourage consensus, participants will be asked to consider the group responses before finalising their opinion to the statements. If at least 80% of the experts agree to a statement in Rounds 2 or 3, it will be included in a final list of necessary statements.

DISCUSSION

This modified Delphi process will help transparency in the design and implementation of MI-CBT interventions. The consensus statement will also help reporting and comparability among effectiveness studies for MI-CBT intervention studies, and help inform research, policy and practice.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the La Trobe University Human Research Ethics Committee (approval number HEC24066). The results will be disseminated via peer-reviewed publications, conferences and international professional associations.

Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain)

PURPOSE

To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff.

METHODS

The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed.

RESULTS

Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group.

CONCLUSION

This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings.

STUDY REGISTRATION

ISRCTN15780649, retrospectively registered.

Cross-validation of the Canadian Assessment of Physical Literacy second edition (CAPL-2) for Spanish children

Background/objective

This study aimed to explore physical literacy (PL) using the Canadian Assessment of Physical Literacy, second edition (CAPL-2), adapt it to the Spanish context and provide evidence of its validity for use in Spanish children aged 8-12.

Methods

A total of 280 students (150 girls, mean age 10.5±0.9 years) from Extremadura (Spain) completed the CAPL-2. Means and SDs were used to present CAPL-2 scores according to age and sex, as well as frequencies to place participants at different PL levels. Confirmatory factor analysis (CFA) was conducted to establish the best model fit for the data.

Results

The median PL of Spanish children was progressing, and girls had a lower PL than boys for all ages except 12 years. The results supported a four-domain model for the CAPL-2 Spanish version and reported good fit indices after CFA (χ2 per df ratio=1.118; P (χ2)=0.256; root mean square error of approximation=0.021; comparative fit index=0.987; Tuker-Lewis index=0.991; normed fit index=0.895).

Conclusion

The CAPL-2 model is a valid and reliable instrument for Spanish children aged 8-12. It represents the first tool that assesses PL in Spanish children, covering the domains of motivation and confidence, physical competence, knowledge and understanding, and daily behaviour. It may be relevant for all professionals related to physical activity, education and the health field.

Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations

BACKGROUND

Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists.

METHODS

We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist.

RESULTS

We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons.

CONCLUSIONS

High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.

Evaluation of four interventions using behavioural economics insights to increase demand for voluntary medical male circumcision in South Africa through the MoyaApp: A quasi-experimental study

Background

While voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission by 60%, circumcision coverage falls short of the UNAIDS 90% target. We investigated whether behaviourally informed message framing increased demand for VMMC.

Setting

Adult users of the MoyaApp, a data free application in South Africa, who viewed a form designed to generate interest in VMMC during August-November 2022.

Methods

A quasi-experimental study was conducted to evaluate four MoyaApp VMMC intervention forms against the Standard of Care (SOC) form. All forms enabled users to provide contact details for follow-up engagement by a call centre. The primary outcome was the proportion of forms submitted. Secondary outcomes included successful contact with the user, VMMC bookings/referrals and confirmed circumcision. Multivariable ordinary least-squares regression was used for the analysis.

Results

MoyaApp VMMC form viewers totalled 118,337 of which 6% submitted a form. Foot-in-the-Door form viewers were more likely (+1.3 percentage points, p<0.01) to submit a form compared to the SOC group (6.3%). Active Choice (-1.1 percentage points, p<0.01) and Reserved for You (-0.05 percentage points, p<0.05) form viewers were less likely to submit a form compared to SOC. Users submitting on Foot-in-the-Door were less likely to be booked/referred compared to SOC (-5 percentage points, p<0.05). There were no differences between the intervention and SOC forms for successful contact and circumcisions.

Conclusions

Message framing using behavioural insights was able to nudge men to engage with VMMC services. However, more work is needed to understand how to convert initial interest into bookings and circumcisions.

Trial registration

South African Clinical Trials Registry DOH-27-062022-7811Pan-African Clinical Trials Registry PACTR202112699416418.

Home health care nurse routing and scheduling problem considering ergonomic risk factors

Home health care routing and scheduling is a complex problem that requires many aspects to be considered simultaneously. One of the important aspects is ergonomics. Home health care nurses are at higher risk of work-related health problems such as musculoskeletal disorders and burnout since they are frequently exposed to physical, mental, and environmental ergonomic risks in their jobs. Therefore, it is essential to integrate ergonomic considerations into the construction of daily schedules for home health care nurses to mitigate these health risks. The purpose of this study is to present a mathematical model that incorporate ergonomic risks. We introduce a set of constraints into our model to prevent nurses from encountering excessive workloads. To assess the workload, we propose a subjective assessment method and employ a fuzzy inference system to calculate nurses' perceived workload levels. We applied our model to a several numerical examples to investigate the impact of workload on the nurse daily schedules. We observed that, at a specified workload level, there may be alternative solutions where the number of patients visited is the same. Therefore, we defined an objective function to maximize patient visits while minimizing nurses' workload levels as much as possible. As a result, our model generates solutions that effectively reduce nurse workloads, leading to more balanced schedules. Thus, our study offers a comprehensive approach to home health care scheduling by incorporating ergonomic considerations, ultimately enhancing both patient care and nurse well-being.

Prevention of Work Absence Due to Back Pain: A Network Meta-Analysis

This paper reviewed the most effective strategies for preventing work absence due to back pain (BP) and BP episodes (the number of people reporting back pain). We searched randomized controlled trials (RCTs) of prevention strategies for BP from previous meta-analyses, PubMed, CENTRAL, and Embase and conducted a network meta-analysis. Thirteen RCTs (2033 participants) were included. Low- to high-quality evidence showed that exercise combined with ergonomics, education, back belts, and education combined with ergonomics did not prevent sickness absenteeism or BP episodes. There was moderate-quality evidence that exercise, especially resistance exercise, was the best prevention strategy to reduce the number of people reporting absenteeism due to BP (risk ratio [RR] = 0.10; 95% CI: 0.01 to 0.69). Moderate-quality evidence suggested that resistance and stretching exercises combined with education was the best prevention strategy to reduce pain (RR = 0.80; 95% CI: 0.67 to 0.96) and the number of absenteeism days for BP (standardized mean difference [SMD] = -0.39; 95% CI: -0.77 to -0.02). In conclusion, exercise, especially resistance and stretching exercises, and exercise combined with education were ranked as the best interventions to prevent sickness absenteeism and BP episodes.

Efficacy of Interventions in Reducing the Risks of Work-Related Musculoskeletal Disorders Among Healthcare Workers: A Systematic Review and Meta-Analysis

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are prevalent among healthcare professionals, including nurses, therapists, doctors, and paramedics, due to the potential injuries incurred during patient transfer and handling. This review aimed to assess the effectiveness of existing interventions in reducing the risks of WMSDs in this population.

METHODS

Four databases including PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect were searched to identify randomized and nonrandomized controlled trials, as well as studies with pre-post design. Two reviewers independently extracted data and assessed the quality of the included studies using the Effective Public Health Practice Project criteria. A meta-analysis was performed to obtain quantitative results.

RESULTS

A total of 40 studies were included in the review. Among the interventions, motorized assistive devices showed the most significant relative reduction in WMSD risks (p < .0000; standardized mean difference [SMD] = -3.32, 95% confidence interval [CI] = [-4.53, -2.12]), followed by combined interventions of cognitive and exercise (p < .0001; SMD = -0.62, 95% CI = [-0.91, -0.33]), combined intervention of cognitive and assistive device intervention (p = .02; SMD = -0.77, 95% CI = [-1.42, -0.12]), nonmotorized assistive device (p = .02; SMD = -0.63, 95% CI = [-1.15, -0.12]), cognitive intervention (p < .0001; SMD = -0.62, 95% CI = [-0.91, -0.33]), and physical exercise (p = .06; SMD = -0.16, 95% CI = [-0.32, 0.00]) intervention.

CONCLUSION

The overall evidence indicates that interventions have a significant effect in reducing the risk of WMSDs among healthcare workers, with motorized assistive devices showing the most promising results. The findings from this review can provide valuable guidance for hospital administrators, policymakers, and other experts in implementing effective strategies to prevent WMSDs among healthcare professionals.

The effect of a workplace wellness program on disability, function and pain in healthcare providers workers with low back pain-outcomes of 3040 academic health center employees

PURPOSE

(1) Identification of musculoskeletal risk factors for healthcare providers suffering low back pain (LBP) and the creation of risk profiles for those individuals and (2) analyze the impact of a workplace wellness program on healthcare providers who suffer from low back pain.

METHODS

A total of 3040 employees at an academic healthcare center underwent a computer-adaptive survey of health-related quality of life (HRQOL), biometric tests, and a disability and functional movement assessment as part of the workplace wellness program (WWP). Clinical interventions with a rehabilitation specialist were offered to employees identified as at risk for low back pain. Data collected were analyzed using descriptive methods and multivariable regressions to address the study objectives.

RESULTS

Of the 3040 healthcare providers enrolled in this study, 77% identified with non-specific LBP with greater weakness, numbness, reduced flexibility, and physical activity. The major predictive risk factors for LBP were Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference score, PROMIS fatigue, previous work injury, flexibility, numbness, PROMIS social function, level of education, and BMI. Healthcare providers with LBP who completed the WWP improved in most dimensions of HRQOL and disability and functional outcomes.

CONCLUSIONS

A high proportion of healthcare providers suffer from LBP as a result of the nature of their work. Disability and functional outcomes measurements and PROMIS results quantitatively assess healthcare providers with LBP. Organizations can develop injury mitigation programs to target employees at high risk of LBP using the risk factors we identify. Completion of the WWP was associated with improvements in disability, HRQOL and functional measures.

Global malaria predictors at a localized scale

Malaria is a life-threatening disease caused by Plasmodium parasites transmitted by Anopheles mosquitoes. In 2021, more than 247 million cases of malaria were reported worldwide, with an estimated 619,000 deaths. While malaria incidence has decreased globally in recent decades, some public health gains have plateaued, and many endemic hotspots still face high transmission rates. Understanding local drivers of malaria transmission is crucial but challenging due to the complex interactions between climate, entomological and human variables, and land use. This study focuses on highly climatically suitable and endemic areas in Côte d'Ivoire to assess the explanatory power of coarse climatic predictors of malaria transmission at a fine scale. Using data from 40 villages participating in a randomized controlled trial of a household malaria intervention, the study examines the effects of climate variation over time on malaria transmission. Through panel regressions and statistical modeling, the study investigates which variable (temperature, precipitation, or entomological inoculation rate) and its form (linear or unimodal) best explains seasonal malaria transmission and the factors predicting spatial variation in transmission. The results highlight the importance of temperature and rainfall, with quadratic temperature and all precipitation models performing well, but the causal influence of each driver remains unclear due to their strong correlation. Further, an independent, mechanistic temperature-dependent R 0 model based on laboratory data aligns well with observed malaria incidence rates, emphasizing the significance and predictability of temperature suitability across scales. By contrast, entomological variables, such as entomological inoculation rate, were not strong predictors of human incidence in this context. Finally, the study explores the predictors of spatial variation in malaria, considering land use, intervention, and entomological variables. The findings contribute to a better understanding of malaria transmission dynamics at local scales, aiding in the development of effective control strategies in endemic regions.

Neuromuscular exercise and counseling for treating recurrent low back pain in female healthcare workers-Findings from a 24-month follow-up study of a randomized controlled trial

BACKGROUND

Female healthcare workers have a high prevalence of low back pain (LBP)-related sickness absence. Here, we report findings of a 24-month follow-up of a previously published 6-month randomized controlled trial (RCT).

METHODS

By adopting an RCT with 6 months of intervention and follow-up at 6, 12, and 24 months, we assessed the maintenance of changes in the effectiveness (LBP and fear of pain) of the interventions (neuromuscular exercise [NME], back-care counseling, both combined) using a generalized linear mixed model adjusted for baseline covariates. The incremental cost-effectiveness ratio was calculated in terms of quality-adjusted life years (QALY). A bootstrap technique was used to estimate the uncertainty around a cost-effectiveness acceptability curve.

RESULTS

Of the 219 females, 71% had data at 24 months. Between 6 and 24 months, LBP intensity (primary outcome) remained low in all intervention arms (-20% to -48%) compared to the control (-10% to -16%). Pain interfering with work remained low in the combined and exercise arms for up to 24 months. At 24 months, the total costs were lowest in the combined arm (€484 vs. €613-948, p < 0.001), as were the number of back-related sickness absence days (0.16 vs. 1.14-3.26, p = 0.003). The analysis indicated a 95% probability of the combined arm to be cost-effective per QALY gained at €1120.

CONCLUSIONS

Six months of weekly NME combined with four counseling sessions was cost-effective for treating LBP and the effect was maintained over 24 months.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01465698, 7/11/2011, prospective.

Impact of built environment change on all-cause and cause-specific mortality: a novel longitudinal method and study

BACKGROUND

Public health research increasingly acknowledges the influence of built environments (BE) on health; however, it is uncertain how BE change is associated with better population health and whether BE change can help narrow health inequalities. This knowledge gap is partly due to a lack of suitable longitudinal BE data in most countries. We devised a method to quantify BE change longitudinally and explored associations with mortality. The method is replicable in any nation that captures BE vector map data.

METHODS

Ordnance Survey data were used to categorise small areas as having no change, loss or gain, in buildings, roads, and woodland between 2015 and 2019. We examined individual mortality records for 2012-2015 and 2016-2019, using negative binomial regression to explore associations between BE change and all-cause and cause-specific mortality, adjusting for income deprivation.

RESULTS

BE change varied significantly by deprivation and urbanicity. Change in the BE and change in mortality were not related, however, areas that went on to experience BE change had different baseline mortality rates compared with those that did not. For example, areas that gained infrastructure already had lower mortality rates.

CONCLUSION

We provide new methodology to quantify BE change over time across a nation. Findings provide insight into the health of areas that do/do not experience change, prompting critical perspectives on cross-sectional studies of associations between BE and health. Methods and findings applied internationally could explore the context of BE change and its potential to improve health in areas most in need beyond the UK.

Measurement of and training for NCD guideline implementation in LMICs: a scoping review protocol

INTRODUCTION

Globally, non-communicable diseases (NCDs) are the leading causes of morbidity and mortality with an estimated 41 million deaths (74% of all global deaths) annually. Despite the WHO's Global Action Plan for the Prevention and Control of NCDs since 2013, progress on implementation of the guidelines has been slow. Although research has shown success of some NCD prevention and treatment interventions, there is a dearth of research on NCD care delivery approaches, cost-effectiveness and larger implementation research, especially in low/middle-income countries (LMICs). The objective of this scoping review is to identify the existing variation in how, why and by whom implementation of NCD guidelines is measured as part of implementation research or non-research programme improvement.

METHODS AND ANALYSIS

Using the methods established by Arksey and O'Malley, the search strategy was developed in consultation with a research librarian together with stakeholder feedback from content experts. We will apply the search to multiple electronic databases and grey literature sources. Two reviewers will independently screen title and abstract for inclusion followed by a full-text screening and all included records will be abstracted using a standardised tool that will be piloted with a sample of articles before application to all records. We will conduct a narrative synthesis of abstracted data and simple quantitative descriptive statistics.

DISSEMINATION

The results will enable stakeholders in LMICs to leverage existing tools and resources for implementation and ongoing evaluation of NCD guidelines, to improve education and capacity building, and ultimately NCD care across the lifespan.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

Caregiver experiences of feeding children with developmental disabilities: a qualitative study using interpretative phenomenological analysis from India

OBJECTIVE

We aimed to explore caregiver experiences of feeding children with developmental disabilities, in the context of it being influenced by biological, personal and social factors.

DESIGN

This study applied a qualitative study design through focus group discussions (FGDs), using interpretative phenomenological analysis. Data were analysed using thematic content analysis.

SETTING

This study was conducted at the Child Psychiatry Unit of a tertiary care centre in South India, between March and November 2020.

PARTICIPANTS

Seventeen mothers of children with developmental disabilities, who provided written informed consent, participated in four FGDs.

RESULTS

Three over-arching themes were identified. Feeding experience: (a) a tedious, confusing task; (b) disproportionate onus on mothers; (c) influenced by sociocultural norms.

CONCLUSION

Feeding can be a stressful activity for both caregiver and child, influenced by family structure and sociocultural belief systems. Considering caregivers' emotional status, facilitatory and hindering environmental factors, and actively exploring strategies to promote the generalisation of strategies learnt into real-life outcomes are essential in tailoring deficit-specific feeding interventions.

Effects of a videoconference-based therapeutic exercise intervention on the musculoskeletal pain of eldercare workers: protocol for the ReViEEW randomized controlled trial

BACKGROUND

Prevalence of musculoskeletal pain is high among eldercare workers, and therapeutic exercise has shown to be effective for its management. Although telerehabilitation is an increasingly used alternative for delivering therapeutic exercise, no studies have assessed synchronous group telerehabilitation interventions for the management of musculoskeletal disorders. Thus, the aim of this article is to describe the protocol of a randomized controlled trial that will assess the effects of a videoconference-based group therapeutic exercise intervention on the musculoskeletal pain of eldercare workers.

METHODS

This multicenter trial will randomly assign 130 eldercare workers to either a control or experimental group. Participants in the control group will not receive any intervention, and participants in the experimental group will take part in a 12-week remote supervised videoconference-based intervention, consisting of 2 weekly 45-min group sessions. Each session will include 4 sets of 6 progressive resistance exercises for the lower limbs, upper limbs and trunk, performed with bodyweight and elastic bands at moderate-high intensity. Following the 12 weeks, participants in the experimental group will be provided with material for autonomously carry on the therapeutic exercises and advised to continue performing 2 weekly sessions on their own until a 48-week follow-up. Assessments will be performed at baseline, 12 and 48 weeks. Primary outcome will be average pain intensity in the low back during the last 7 days, measured by the 0-10 Numerical Rating Scale. Secondary outcomes will include additional measures of musculoskeletal pain, psycho-affective state, work-related variables, and physical fitness.

DISCUSSION

This will be the first trial, to our knowledge, assessing whether a remote delivery of a group therapeutic exercise intervention via videoconference is effective for reducing the musculoskeletal pain, improving the psycho-affective state and physical fitness, and enhancing the work-related parameters in eldercare workers. If successful, this study will provide innovative tools for implementing effective, scalable and affordable interventions to tackle musculoskeletal disorders in the workplace. It will also highlight the utility of telehealth, and address the importance of therapeutic exercise to manage musculoskeletal pain in a critical population for the future of the aging societies as it is the eldercare workers.

TRIAL REGISTRATION

The study protocol was prospectively registered at ClinicalTrials.gov (registration number: NCT05050526) on September 20, 2021.

Convergence of HIV and non-communicable disease epidemics: Geospatial mapping of the unmet health needs in a HIV Hyperendemic South African community

Background

As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterize the spatial structure of convergence of chronic health conditions in a HIV hyperendemic community in KwaZulu-Natal, South Africa.

Methods

We utilized data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes, and hypertension. We implemented a novel health needs scale to categorize participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and sub-optimally controlled (Score 2), diagnosed but not engaged in care (Score 3), or undiagnosed and uncontrolled (Score 4). Scores 2-4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods.

Findings

The analytical sample comprised of 18,041 individuals. We observed a similar spatial structure for HIV among those with a combined needs Score 2-3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern peri-urban area, which was relatively densely populated within the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area.

Interpretation

In a HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. The identification and prioritization of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs.

Funding

Research reported in this publication was supported by the Fogarty International Center (R21 TW011687; D43 TW010543), the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases (K24 HL166024; T32 AI007433) of the National Institutes of Health, and Heart Lung and Blood Institute (K24 HL166024, T32 AI007433). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funders.

Risk factors of multidrug resistant tuberculosis among patients with tuberculosis at selected multidrug resistance treatment initiative centres in southern Ethiopia: a case-control study

OBJECTIVE

To identify the risk factors for multidrug resistant tuberculosis (MDR-TB) among patients with TB at selected MDR-TB treatment initiative centres, southern Ethiopia, 2021.

DESIGN

An unmatched case-control study was employed.

SETTING

Multidrug resistance treatment initiative centres in southern Ethiopia (Nigist Elen Mohamed Memorial Comprehensive Specialized Hospital and Butajira General Hospital).

PARTICIPANTS

A total sample size of 392 (79 cases and 313 controls) were selected by the systematic sampling technique. Cases were all patients with TB with culture proven or line probe assay confirmed Mycobacterium tuberculosis resistant to at least both isoniazid and rifampicin and registered on second-line TB treatment. Controls were all patients with bacteriological (molecular) proven drug-susceptible TB strains and whose recent smear results were turned to negative and registered as cured. Both bivariate and multivariable logistic regression analysis was used to identify risk factors of MDR-TB infections.

MAIN OUTCOME MEASURE

Identifying the risk factors for MDR-TB.

RESULTS

A total of 392 participants (79 cases and 313 controls) were interviewed. Multivariable analysis showed that direct contact with known patients with TB (AOR =4.35; 95% CI: 1.45 to 9.81), history of previous TB treatment (AOR=2.51; 95% CI: 1.50 to 8.24), history of cigarette smoking (AOR=3.24; 95% CI :2.17 to 6.91) and living in rural area (AOR=4.71; 95% CI :3.13 to 9.58) were identified risk factors for MDR-TB infections.

CONCLUSIONS

The study findings revealed that direct contact with known patients with TB, previous history of TB treatment, history of cigarette smoking and rural residence were potential risk factors for the occurrence of MDR-TB. In order to reduce the burden of drug resistance, strategies of controlling MDR-TB in the study area should emphasise on enhancing public health education and reducing treatment interruptions of patients with TB and drug-resistant TB.

Developing and testing unconditional cash transfer strategies among young adults with first-episode psychosis in South Africa: a study protocol for a pilot randomised control trial (PRS-FEP trial)

INTRODUCTION

Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse.

METHODS AND ANALYSIS

This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively.

ETHICS AND DISSEMINATION

The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement.

TRIAL REGISTRATION NUMBER

DOH-27-092022-5894.

Balancing benefits and potential risks of vaccination: the precautionary principle and the law of unintended consequences

Vaccination is a life-saving endeavour, yet risk and uncertainty are unavoidable in science and medicine. Vaccination remains contentious in the public mind, and vaccine hesitancy is a serious public health issue. This has recently been reignited in the discussion over potential side effects of COVID-19 vaccines, and the decision by several countries to suspend measures such as the AstraZeneca vaccine. In these instances, the precautionary principle has often been invoked as a rationale, yet such heuristics do not adequately weigh potential harms against real benefits. How we analyse, communicate and react to potential harms is absolutely paramount to ensure the best decisions and outcomes for societal health, and maintaining public confidence. While balancing benefits and risks is an essential undertaking, it cannot be achieved without due consideration of several other pertinent factors, especially in the context of vaccination, where misguided or exaggerated fears have in the past imperilled public health. While well meaning, over reactions to potential hazards of vaccination and other health interventions can have unintended consequences, and cause lingering damage to public trust. In this analysis, we explore the challenges of assessing risk and benefit, and the limitations of the precautionary principle in these endeavours. When risk is unclear, cautious vigilance might be a more pragmatic and useful policy than reactionary suspensions.

Neighbourhood tobacco retail access and tobacco use susceptibility in young adolescents in urban India

BACKGROUND

Neighbourhood tobacco retail access may influence adolescent tobacco use. In India, we examined the association between neighbourhood tobacco retail access and cognitive risks for tobacco use during early adolescence.

METHODS

In 2019-2020, a population-based sample (n=1759) of adolescents aged 13-15 years was surveyed from 52 neighbourhoods in Mumbai and Kolkata. Neighbourhood tobacco retail access was measured as the frequency of visits to tobacco retailers, mapped tobacco retailer density and perceived tobacco retailer density. We estimated associations between neighbourhood tobacco retail access and cognitive risks for tobacco use (perceived ease of access to tobacco, perceived peer tobacco use and intention to use tobacco).

RESULTS

There was high neighbourhood tobacco retail access. Tobacco retailer density was higher in lower income neighbourhoods (p<0.001). Adolescent frequency of tobacco retailer visits was positively associated with cognitive tobacco use risks. Mapped tobacco retailer density was associated with perceived ease of access in Kolkata but not in Mumbai, and it was not associated with perceived peer tobacco use nor intention. Perceived tobacco retailer density was associated with perceived ease of access and perceived peer use, but not with intention. In Kolkata, higher perceived retailer density and frequency of tobacco retailer visits were negatively associated with perceived ease of access.

CONCLUSIONS

Efforts to reduce neighbourhood tobacco retail access in India may reduce cognitive tobacco use risk factors in young adolescents. The frequency of tobacco retailer visits and perceived tobacco retailer density increased cognitive risks, though there were some exceptions in Kolkata that further research may explain.

Cohort profile: CareConekta: a pilot study of a smartphone application to improve engagement in postpartum HIV care in South Africa

PURPOSE

Pregnant and postpartum women living with HIV in South Africa are at high risk of dropping out of care, particularly after delivery. Population mobility may contribute to disruptions in HIV care, and postpartum women are known to be especially mobile. To improve engagement in HIV care during the peripartum period, we developed CareConekta, a smartphone application (app) that uses GPS coordinates to characterise mobility and allow for real-time intervention. We conducted a randomised controlled pilot study to assess feasibility, acceptability and initial efficacy of the app intervention to improve engagement in HIV care. This cohort profile describes participant enrolment and follow-up, describes the data collected and provides participant characteristics.

PARTICIPANTS

We enrolled 200 pregnant women living with HIV attending routine antenatal care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Eligible women must have owned smartphones that met the app's technical requirements. Seven participants were withdrawn near enrolment, leaving 193 in the cohort.

FINDINGS TO DATE

Data were collected from detailed participant questionnaires at enrolment and follow-up (6 months after delivery), as well as GPS data from the app, and medical records. Follow-up is complete; initial analyses have explored smartphone ownership, preferences and patterns of use among women screened for eligibility and those enrolled in the study.

FUTURE PLANS

Additional planned analyses will characterise mobility in the population using the phone GPS data and participant self-reported data. We will assess the impact of mobility on engagement in care for the mother and infant. We also will describe the acceptability and feasibility of the study, including operational lessons learnt. By linking this cohort to the National Health Laboratory Service National HIV Cohort in South Africa, we will continue to assess engagement in care and mobility outcomes for years to come. Collaborations are welcome.

TRIAL REGISTRATION NUMBER

NCT03836625.

Asking youth and adults about child maltreatment: a review of government surveys

OBJECTIVES

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress.

DESIGN

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

RESULTS

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

CONCLUSIONS

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.

Patients' with asplenia and doctors' experiences in implementing preventative measures following a novel educational intervention: a qualitative analysis

OBJECTIVE

To explore patients' with asplenia and general practitioners' (GPs) (1) perceptions of a novel, Health Action Process Approach (HAPA)-based, educational intervention which targets to increase adherence to post-splenectomy sepsis (PSS) prevention measures and (2) their experience in implementing prevention measures following this intervention.

DESIGN

A process evaluation conducted on average 3.5 (for patients) and 3.8 (for GPs) months after the intervention between January 2020 and April 2021 individually by means of semi-structured guideline-based telephone interviews. Data was analysed using qualitative content analysis.

PARTICIPANTS

Volunteer subsample of N=25 patients with asplenia and N=8 GPs who received the intervention. Inclusion criteria were met by prior participation in the intervention (German-speaking, of full age and insured by the cooperating health insurance). Patient selection was done by purposeful selection aiming at maximum variability in terms of adherence to preventative measures prior to intervention participation. Participating GPs are a non-purposeful selected convenience sample. For reasons of data protection, no personal data was collected.

RESULTS

The intervention was positively evaluated and its personal relevancy for patients and for the GPs' professional work became apparent. The intervention promoted risk awareness, intention to action, action planning and subsequently, improved adherence to preventative measures. Helpful factors for implementation among the patients were social support by relatives and GPs. Barriers to adherence identified in both groups can be divided into patient-attributed (eg, comorbidities), doctor-related (eg, lack of knowledge or support) as well as contextual factors (eg, vaccine supply constraints).

CONCLUSIONS

Our findings indicate a patient and GP perceived benefit of the intervention, but still identify prevailing barriers to implementation. In a further step, a quantitative evaluation of the intervention will be conducted and recommendations for integrating the intervention in usual care will be made.

TRIAL REGISTRATION NUMBER

DRKS00015238.

CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022

This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient's circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

How do tobacco control policies work in low-income and middle-income countries? A realist synthesis

BACKGROUND

The burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in these settings. Given the complex nature of tobacco control policy implementation, diversity in outcomes of widely implemented policies and the defining role of the context, we conducted a realist synthesis to examine tobacco control policy implementation in LMICs.

METHODS

We conducted a systematic realist literature review to test an initial programme theory developed by the research team. We searched EBSCOHost and Web of Science, containing 19 databases. We included studies on implementation of government tobacco control policies in LMICs.

RESULTS

We included 47 studies that described several contextual factors, mechanisms and outcomes related to implementing tobacco control policies to varying depth. Our initial programme theory identified three overarching strategies: awareness, enforcement, and review systems involved in implementation. The refined programme theory identifies the plausible mechanisms through which these strategies could work. We found 30 mechanisms that could lead to varying implementation outcomes including normalisation of smoking in public places, stigmatisation of the smoker, citizen participation in the programme, fear of public opposition, feeling of kinship among violators and the rest of the community, empowerment of authorised officials, friction among different agencies, group identity among staff, shared learning, manipulation, intimidation and feeling left out in the policy-making process.

CONCLUSIONS

The synthesis provides an overview of the interplay of several contextual factors and mechanisms leading to varied implementation outcomes in LMICs. Decision-makers and other actors may benefit from examining the role of one or more of these mechanisms in their particular contexts to improve programme implementation. Further research into specific tobacco control policies and testing particular mechanisms will help deepen our understanding of tobacco control implementation in LMICs.

PROSPERO REGISTRATION NUMBER

CRD42020191541.

Adolescent birth rates and the urban social environment in 363 Latin American cities

INTRODUCTION

Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR.

METHODS

We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15-19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries).

RESULTS

The median subcity ABR was 58.5 per 1000 women 15-19 (IQR 43.0-75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively).

CONCLUSIONS

The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.

Investigating households' out-of-pocket healthcare expenditures based on number of chronic conditions in Riyadh, Saudi Arabia: a cross-sectional study using quantile regression approach

OBJECTIVES

This study investigated the level and associated factors, focusing on the number of individuals with chronic conditions, of out-of-pocket healthcare expenditures (OOPHE).

DESIGN

A cross-sectional study was conducted from January 2021 to June 2021.

SETTING

Riyadh Province, Saudi Arabia.

PARTICIPANTS

A total of 1176 households that used any healthcare services at least once in the past 3 months.

OUTCOME MEASURES

The OOPHE incurred in the previous 3-month period when a household member is receiving health services. The effects of predisposing, enabling and need factors on the level of OOPHE. The association between the number of individuals with chronic conditions in a household and OOPHE along with the OOPHE distribution.

RESULTS

The average household OOPHE among all the surveyed households (n=1176) was SAR1775.30. For households affected by one chronic condition, OOPHE was SAR1806, and for households affected by more than one chronic condition, OOPHE was SAR2704. If the head of the household was older, better educated and employed, they were more vulnerable to a higher OOPHE (p<0.0001). At the household level, the increased number of family members with chronic conditions, the presence of a member less than 14 years old, higher socioeconomic status, coverage from health insurance plans, residence in an urban area and the presence of a member with a disability in the household were correlated with a considerably greater level of OOPHE (p<0.0001). The result of quantile regression analysis indicates that an increase in the number of members with chronic conditions in a household was significantly associated with greater overall OOPHE at higher health expenditure quantiles.

CONCLUSIONS

The burden of OOPHE on households with chronic conditions remains heavy, and some disparities still exist. The number of individuals with chronic conditions in a household plays a substantial and prominent role in increasing the risk of incurring OOPHE.

Effectiveness of interventions to improve health behaviours of health professionals: a systematic review

OBJECTIVE

To evaluate the effectiveness of interventions designed to improve the health behaviours of health professionals.

DESIGN

Systematic review.

DATA SOURCES

Database searches: Medline, Cochrane library, Embase and CINAHL.

REVIEW METHODS

This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare randomised controlled trials of health professionals, published between 2010 and 2021, which aimed to improve at least one health behaviour such as physical activity, diet, smoking status, mental health and stress. Two independent reviewers screened articles, extracted data and assessed quality of studies and reporting. The quality of articles was assessed using the Effective Public Health Practice Project quality assessment tool and the completeness of intervention reporting was assessed.

OUTCOME MEASURES

The outcome assessed was change in behaviour between intervention and control groups from baseline to follow-up.

RESULTS

Nine studies met the eligibility criteria, totalling 1107 participants. Health behaviours targeted were mental health and stress, physical activity, and smoking cessation, physical activity and nutrition. Six interventions observed significant improvements in the health behaviour in the intervention compared with control groups. Seven of the studies selected in person workshops as the mode of intervention delivery. The quality of the included studies was high with 80% (7/9) graded as moderate or strong.

CONCLUSIONS

Although high heterogeneity was found between interventions and outcomes, promising progress has occurred across a variety of health behaviours. Improving reporting and use of theories and models may improve effectiveness and evaluation of interventions. Further investigation is needed to recommend effective strategies.

PROSPERO REGISTRATION NUMBER

CRD42021238684.

Trends in weight loss attempts among children in England

OBJECTIVES

To describe trends in reported weight loss attempts among school-aged children and to investigate its sociodemographic determinants.

DESIGN

We analysed data of children who participated in the Health Survey for England from 1997 to 2016 (n=34 235). This repeated cross-sectional survey reported weight loss attempts and sociodemographic characteristics. Body weight and height were measured by trained interviewers, and body mass index for age z-score was calculated. Multivariable logistic regression was used to investigate the sociodemographic determinants.

SETTING

England.

PARTICIPANTS

Children (8-17 years).

MAIN OUTCOME MEASURES

Weight loss attempts by year, age group, gender, BMI for age z-score, ethnicity and household income.

RESULTS

The prevalence of reported weight loss attempts increased significantly from 21.4% (1997-1998) to 26.5% (2015-2016). The increase was significant for boys, older children, Asian children, children from lower income households and in all categories of BMI for age z-score. Significant predictors of weight loss attempts included having overweight (8-12 years old, OR 4.01 (%CI 3.47 to 4.64); 13-17 years old, OR 1.96 (%CI 1.58 to 2.42)) or obesity (8-12 years old, OR 13.57 (%CI 11.94 to 15.43); 13-17 years old, OR 4.72 (%CI 3.94 to 5.66)) as well as being older, girls, from ethnic minority groups or low household income.

CONCLUSION

The prevalence of reported weight loss attempts among children is increasing at a faster rate than the rise in excess weight and includes an increasing proportion of children with a 'healthy' weight. The increase in the prevalence of reported weight loss attempts among children is greatest among subgroups with lower baseline prevalence.

Association between physical activity and musculoskeletal pain: an analysis of international data from the ASAP survey

OBJECTIVE

To explore the association of physical activity (PA) with musculoskeletal pain (MSK pain).

DESIGN

Cross-sectional study SETTING: 14 countries (Argentina, Australia, Austria, Brazil, Chile, France, Germany, Italy, the Netherlands, Singapore, South Africa, Spain, Switzerland and the USA).

PARTICIPANTS

Individuals aged 18 or older.

PRIMARY AND SECONDARY OUTCOME MEASURES

PA volumes were assessed with an adapted version of the Nordic Physical Activity Questionnaire-short. Prevalence of MSK pain was captured by means of a 20-item checklist of body locations. Based on the WHO recommendation on PA, participants were classified as non-compliers (0-150 min/week), compliers (150-300 min/week), double compliers (300-450 min/week), triple compliers (450-600 min/week), quadruple compliers (600-750 min/week), quintuple compliers (750-900 min/week) and top compliers (more than 900 min/week). Multivariate logistic regression was used to obtain adjusted ORs of the association between PA and MSK pain for each body location, correcting for age, sex, employment status and depression risk.

RESULTS

A total of 13 741 participants completed the survey. Compared with non-compliers, compliers had smaller odds of MSK pain in one location (thoracic pain, OR 0.77, 95% CI 0.64 to 0.93). Double compliance was associated with reduced pain occurrence in six locations (elbow, OR 0.70, 95% CI 0.50 to 0.98; forearm, OR 0.63, 95% CI 0.40 to 0.99; wrist, OR 0.74, 95% CI 0.57 to 0.98; hand, OR 0.57, 95% CI 0.40 to 0.79; fingers, OR 0.72, 95% CI 0.52 to 0.99; abdomen, OR 0.61, 95% CI 0.41 to 0.91). Triple to top compliance was also linked with lower odds of MSK pain (five locations in triple compliance, three in quadruple compliance, two in quintuple compliance, three in top compliance), but, at the same time, presented increased odds of MSK pain in some of the other locations.

CONCLUSION

A dose of 300-450 min WHO-equivalent PA/week was associated with lower odds of MSK pain in six body locations. On the other hand, excessive doses of PA were associated with higher odds of pain in certain body locations.

Geographical disparities and determinants of adherence to iron folate supplementation among pregnant women in Ethiopia: spatial and multilevel analysis of the Ethiopian Mini Demographic and Health Survey of 2019

OBJECTIVE

This study aimed to investigate geographic disparities and determinants of adherence to iron and folate supplementation among pregnant women in Ethiopia.

METHOD

A secondary data analysis was performed using data from the Ethiopian Mini Demographic and Health Survey 2019. A total of 2235 pregnant women aged 15-49 years were included in the analysis. ArcGIS V.10.8 and SaTScan V.9.6 were used for spatial analysis. Multilevel logistic regression analysis was used to determinants.

RESULT

Of the total number of participants, 80.3% of pregnant mothers took iron and folate supplements for less than the recommended days. Adherence to iron folate supplementation among pregnant women in Ethiopia was spatially clustered with Moran's global I=0.15868. The SaTScan analysis identified the most likely significant clusters found in the eastern Tigray, northeast Amhara and northwest Afar regions. Multivariable multilevel analysis showed that mothers who were living apart from their partner (adjusted OR (AOR)=10.05, 95% CI 1.84 to 55.04), had antenatal care (ANC) visits at least four times (AOR=0.53, 95% CI 0.41 to 0.69), a higher education level (AOR=0.39, 95% CI 0.25 to 0.63), big distance from health facilities (AOR=1.7, 95% CI 1.51 to 1.97) were significant factors of adherence to iron-folate supplementation. Mothers living in the Amhara and Addis Ababa regions were 0.35 (AOR=0.35, 95% CI 0.19 to 0.621), and 0.29 (AOR=0.29, 95% CI 0.15 to 0.7) times lower iron-folate supplementation intake than mother's in Tigray region.

CONCLUSION

In this study, 8 out of 10 pregnant women did not take iron and folate supplements during the recommended period. As a result, health education activities were necessary to raise awareness among women and the community about the importance of iron folate supplementation during pregnancy, and public health programmes should increase iron folate supplementation through women's education, ANC visits and mothers living in low-iron areas.

Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies.

METHODS

A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues.

RESULTS

Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles.

CONCLUSIONS

This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed.

PRACTICAL APPLICATION

Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs.

Self-rated health and perceived environmental quality in Brunei Darussalam: a cross-sectional study

OBJECTIVES

This paper examines the relationship between individuals' perceptions of environmental quality and self-rated health (SRH) after controlling for dimensions of socioeconomic, demographic and healthy lifestyle variables.

DESIGN

A cross-sectional survey.

SETTING

The survey was conducted in Belait, an oil-rich and gas-rich district in Brunei Darussalam, from 17 October to 11 November 2019 and focused on the most populated subdistricts (Kuala Belait, Seria and Liang), where 97% of the people reside.

PARTICIPANTS

A final sample of 1000 respondents aged 18 years and older were randomly selected from the population of the chosen subdistricts, with 95% CI and ±3 margin of error. Due to variable selection, only 673 respondents were available for analysis.

OUTCOME MEASURES

SRH was dichotomised into 1 for good health and 0 otherwise. Perceptions of environmental quality included perceptions of the natural environment (air quality, marine quality, water supply, noise and olfactory pollution) and the social environment (crime). χ² and logistic regression models were used to assess the relationship between individuals' perceived environmental quality and SRH.

RESULTS

Most respondents perceived themselves with good SRH (72%). The adjusted logistic regression shows that perceptions of air quality (OR=2.20, 95% CI 1.15 to 4.22, p=0.018) and marine resources (OR=1.84, 95% CI 1.24 to 2.74, p=0.002) in their surrounding areas were significantly associated with good SRH. However, other environmental variables were insignificantly associated with SRH. Among the control variables, healthy lifestyle and employment had positive associations with good SRH (OR=3.89, 95% CI 1.96 to 7.71, p=0.000, for exercising 3-5 times a week; OR=1.72, 95% CI 1.09 to 2.71, p=0.021, for being employed). In addition, frequent physical exercise compensated for the negative health impact of environmental pollution.

CONCLUSIONS

This study suggests that environmental quality has an important role in SRH. However, a healthy lifestyle measured with frequency of physical exercise seems to compensate for the adverse environmental effects on SRH.

Factors influencing adults who participate in a physical activity coaching intervention: a theoretically informed qualitative study

OBJECTIVE

Behaviour change interventions targeting changes in physical activity (PA) can benefit by examining the underlying mechanisms that promote change. This study explored the use of the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to code and contextualise the experiences of participants who completed a PA coaching intervention underpinned by motivational interviewing and cognitive-behavioural therapy.

DESIGN

Semistructured interviews were conducted with a purposive sample of participants.

SETTING

Interviews were conducted in a tertiary hospital in regional Victoria, Australia.

PARTICIPANTS

Eighteen participants who completed a PA coaching intervention were interviewed. The participants were recruited into the coaching intervention because they were insufficiently physically active at the time of recruitment.

RESULTS

Thirteen (72%) participants were women and the average age of participants was 54 (±5) years. Four participant themes mapped directly onto five components of the COM-B model, and ten of the TDF domains. Increases in PA were influenced by changes in motivation and psychological capability. The autonomy-supportive PA coaching intervention helped to evoke participants' own reasons (and motives) for change and influenced PA behaviours. Participants reflected on their own social and/or professional strengths, and used these skills to set appropriate PA goals and action plans. The structure of the PA coaching intervention provided clarity on session determinants and a framework from which to set an appropriate agenda. Relational components (eg, non-judgemental listening, collaboration) were continually highlighted as influential for change, and should be considered in future behaviour change intervention design.

CONCLUSIONS

We demonstrate the beneficial effect of using theory-informed behaviour change techniques, and delivering them in a style that promotes autonomy and relatedness. The views of participants should be a key consideration in the design and implementation of PA coaching interventions TRIAL REGISTRATION NUMBER: ACTRN12619000036112. Post-results analysis.

Impact of persistent pain symptoms on work absence, health status and employment 18 months following disabling work-related injury or illness

OBJECTIVES

While most individuals physically injured at work will make a complete medical recovery, a portion of workers will experience persistent pain following their injury. This study estimated persistent pain prevalence and its association with health and return-to-work outcomes 18 months following the incidence of a disabling work-related injury.

METHODS

We studied 1131 workers disabled by a work-related injury who were recruited from a sampling frame of disability benefit claimants in Ontario, Canada. Work injuries and claim benefits characteristics from administrative data were linked with measures of work status, pain symptoms, and physical and mental health obtained from telephone interviews completed 18 months postinjury. Associations of persistent pain symptoms with health and employment outcomes 18 months postinjury were estimated using multinomial and linear regression.

RESULTS

Roughly 30% of participants reported no pain symptoms in the previous 4 weeks, 45% reported mild pain symptoms and 25% reported severe pain symptoms accompanied by substantial functional impairment. Workers with severe pain symptoms were more likely to not be currently working at 18 months (33%) vs those without pain symptoms (16%), and had poorer self-reported physical and mental health. Workers with severe pain symptoms had higher probabilities of benefit durations of 12-18 months (OR=9.35), higher lost-earnings costs (~47.7% higher) and higher healthcare expenditure costs at 18 months (~125.9% higher) compared with those with no pain symptoms.

CONCLUSIONS

Persistent pain symptom prevalence 18 months postinjury is high among workers disabled by a work-related injury and associated with substantial functional impairment and longer wage replacement benefit duration.

Gender differences in the price elasticity of demand for waterpipe and cigarette smoking in Lebanon, Jordan and Palestine: a volumetric choice experiment

OBJECTIVES

This study assessed the extent to which the elasticity of cigarette and waterpipe tobacco products differs between men and women. We also explored the levels of substitution and complementarity in tobacco products among men and women.

SETTING

The study examines tobacco elasticities in three Arab countries: Lebanon, Jordan and the West Bank of Palestine.

PARTICIPANTS

We used data from nationally representative surveys of adults aged ≥18 years in Lebanon (n=1680), Jordan (n=1925) and Palestine (n=1679). The proportion of women was 50.0% of the sample in Lebanon and Palestine, and 44.6% in Jordan.

PRIMARY AND SECONDARY OUTCOME MEASURES

A zero-inflated Poisson regression model estimated own-price and cross-price elasticities for two variations of cigarettes and five variations of waterpipe tobacco products. Elasticities were measured based on eight scenarios of prices.

RESULTS

Demand for waterpipe tobacco products was elastic for both men and women. The cross-price elasticities in the three countries indicate the existence of substitution between cigarettes and waterpipe products and by different varieties within each of the two tobacco products. Gender differences varied across the three countries whereby higher cross-price elasticities were observed for women in Jordan and Palestine. For example, the price elasticity for discount waterpipe was -1.4 and -0.6 for women and men in Jordan, respectively.

CONCLUSIONS

Results on the elasticity of demand for tobacco products and the existence of substitution between tobacco products reveal the higher responsiveness of men and women to changes in tobacco prices. This should be taken into consideration in tobacco control strategies particularly when reducing tobacco consumption via taxation policies.

Treatment outcomes and associated factors among patients with multidrug-resistant tuberculosis in Ashanti Region, Ghana: a retrospective, cross-sectional study

OBJECTIVE

Although several studies have assessed treatment outcomes of drug-susceptible tuberculosis (TB) in Ghana, very little has been done in the area of multidrug-resistant TB (MDR-TB). The aim of this study was to determine treatment outcomes and associated factors among patients treated for MDR-TB in the Ashanti Region, Ghana.

DESIGN

A retrospective, cross-sectional analysis.

SETTING

The study was conducted in the Ashanti Region, the second most populous region in Ghana. The regional MDR-TB register, which contains information on all patients with MDR-TB being treated at the various TB centres in the region, was analysed between February and May 2021.

PARTICIPANTS

The participants consisted of all registered patients with MDR-TB who were placed on treatment between 1 January 2015 and 31 December 2020. Patients were included in the analysis if their treatment outcome had been assigned. Patients with no record of treatment outcome were excluded from the study.

OUTCOME MEASURES

The main outcome variable for the study was MDR-TB treatment outcome, standardised as 'cured', 'treatment completed', 'treatment failure', 'died' and 'lost to follow-up'. A logistic regression model was fitted for factors associated with the outcome measure.

RESULTS

Out of 159 patients included in the analysis, 86 (54.1%) were declared cured, 28 (17.6%) completed their treatment successfully, 6 (3.8%) were declared treatment failure, 12 (7.5%) were lost to follow-up and 27 (17.0%) died. The overall treatment success rate was 71.7%. Patients who were female (adjusted OR (AOR)=1.27, 95% CI: 1.18 to 1.39, p=0.023), younger (AOR=0.53, 95% CI: 0.19 to 2.11, p=0.012), had a higher level of education (AOR=1.12, 95% CI: 0.65 to 1.90, p=0.034), had a baseline body mass index of 18.5 kg/m² or above (AOR=1.57, 95% CI: 1.23 to 2.47, p=0.011) and those who did not have a history of TB (AOR=0.47, 95% CI: 0.10 to 0.75, p=0.028) were more likely to have successful MDR-TB treatment outcomes.

CONCLUSIONS

Favourable treatment outcomes for patients with MDR-TB can be achieved in a resource-limited country. Although the recommended WHO target of ≥75% was not met, the current result (71.7% treatment success rate) is still commendable considering all the challenges associated with TB treatment in Ghana.

Exploring the key anthropological drivers of and barriers to zoonotic malaria preventative behaviour in a community exposed to Plasmodium knowlesi infection in Malaysia: protocol for a qualitative study with a participatory research design

INTRODUCTION

Plasmodium knowlesi malaria is a zoonotic mosquito-borne disease with complex epidemiology. According to the WHO, the prevention and control of vector-borne diseases require community participation to increase coherence between malaria interventions and sustainable public health programmes. We describe a participatory research (PR) design for a study aimed at exploring the key anthropological drivers of and barriers to zoonotic malaria preventive behaviour among communities exposed to P. knowlesi infection in Malaysia. Participatory approaches can facilitate policymakers in designing future zoonotic malaria control programmes by investigating community perspectives and concerns about zoonotic malaria in a local context.

METHODS AND ANALYSIS

The PR will be conducted over a period of 12 months, from March 2022 to March 2023, among adults (>18 years old) who are permanent residents in a rural village exposed to P. knowlesi malaria in Sabah, Malaysia. We will select patients who were diagnosed with P. knowlesi infection from January to December 2021 for focus group discussions (FGDs), as they can provide perspectives on the disease from the point of view of those previously diagnosed with infection. In-depth interviews (IDIs) with people of importance in the community, such as village heads, will also be conducted. Both FGDs and IDIs will be conducted from March 2022 until June 2022. Concurrently, a photovoice with adults over 18 years old who reside in the community will be conducted. The target sample sizes for FGDs, IDIs and photovoice are 6-8, 12 and 10-15 participants, respectively. We will use a study framework as a theoretical lens to guide the exploration of the beliefs, social contexts, barriers and drivers surrounding zoonotic malaria preventive behaviour.

ETHICS AND DISSEMINATION

This study has been approved by the Medical Research and Ethics Committee Ministry of Health Malaysia (NMRR ID-21-01980-JEH) and the Research and Innovation Secretariat, Faculty of Medicine, Universiti Kebangsaan Malaysia (FF-2021-462). All participants will provide consent prior to participation. The results will be reported in international peer-reviewed journals and presented at conferences and on other platforms.

School-based screening for childhood anxiety problems and intervention delivery: a codesign approach

OBJECTIVES

A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems.

DESIGN

Codesign.

SETTING

UK primary schools.

PARTICIPANTS

Data were collected from year 4 children (aged 8-9 years), parents, school staff and mental health practitioners.

RESULTS

We report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback.

CONCLUSIONS

We reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.

Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study

OBJECTIVES

To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia.

DESIGN

A nationwide cross-sectional study.

SETTING

The Gambia.

PARTICIPANTS

The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis.

DATA ANALYSIS

We analysed data from the Gambia Demographic and Health Survey (DHS), 2019-2020. DHS collected nationally stratified data from local government areas and rural-urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking.

RESULTS

The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019-2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40-49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40-49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia.

CONCLUSIONS

Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.

Perinatal mortality and its predictors in Kersa Health and Demographic Surveillance System, Eastern Ethiopia: population-based prospective study from 2015 to 2020

OBJECTIVE

Perinatal mortality is an important outcome indicator for newborn care and directly mirrors the quality of prenatal, intra partum and newborn care. Therefore, this study was aimed at estimating perinatal mortality and its predictors in Eastern Ethiopia using data from Kersa Health and Demographic Surveillance System (KHDSS).

DESIGN, SETTINGS AND PARTICIPANTS

An open dynamic cohort design was employed among pregnant women from 2015 to 2020 at KHDSS. A total of 19 687 women were observed over the period of 6 years, and 29 719 birth outcomes were registered.

OUTCOME MEASURES

Perinatal mortality rate was estimated for each year of cohort and the cumulative of 6 years. Predictors of perinatal mortality are identified.

RESULTS

From a total of 29 306 births 783 (26.72 deaths per 1000 births; 95% CI 24.88 to 28.66) deaths were occurred during perinatal period. Rural residence (adjusted OR (AOR)=3.43; 95% CI 2.04 to 5.76), birth weight (low birth weight, AOR=3.98; 95% CI 3.04 to 5.20; big birth weight, AOR=2.51; 95% CI 1.76 to 3.57), not having antenatal care (ANC) (AOR=1.67; 95% CI 1.29 to 2.17) were associated with higher odds of perinatal mortality whereas the parity (multipara, AOR=0.46; 95% CI 0.34 to 0.62; grand multipara, AOR=0.31; 95% CI 0.21 to 0.47) was associated with lower odds of perinatal mortality.

CONCLUSIONS

The study revealed relatively high perinatal mortality rate. Place of residence, ANC, parity and birth weight were identified as predictors of perinatal mortality. Devising strategies that enhance access to and utilisations of ANC services with due emphasis for rural residents, primipara mothers and newborn with low and big birth weights may be crucial for reducing perinatal mortality.

Prevalence of alcohol and other drug use in patients presenting to hospital for fall-related injuries: a systematic review

BACKGROUND

Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries.

METHODS

This systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses.

RESULTS

A total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies.

CONCLUSIONS

AOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies .

PROSPERO REGISTRATION NUMBER

CRD42020188746.