Center Program Research Articles

PRDM1 is a key regulator of the natural killer T-cell central memory program and effector function.

Natural killer T cells (NKTs) are a promising platform for cancer immunotherapy, but few genes involved in regulation of NKT therapeutic activity have been identified. To find regulators of NKT functional fitness, we developed a CRISPR/Cas9-based mutagenesis screen that employs a guide RNA (gRNA) library targeting 1,118 immune-related genes. Unmodified NKTs and NKTs expressing a GD2-specific chimeric antigen receptor (GD2.CAR) were transduced with the gRNA library and exposed to CD1d+ leukemia or CD1d-GD2+ neuroblastoma cells, respectively, over six challenge cycles in vitro. Quantification of gRNA abundance revealed enrichment of PRDM1-specific gRNAs in both NKTs and GD2.CAR NKTs, a result that was validated through targeted PRDM1 knockout. Transcriptional, phenotypic, and functional analyses demonstrated that CAR NKTs with PRDM1 knockout underwent central memory-like differentiation and resisted exhaustion. However, these cells downregulated the cytotoxic mediator granzyme B and showed reduced in vitro cytotoxicity and only moderate in vivo antitumor activity in a xenogeneic neuroblastoma model. In contrast, shRNA-mediated PRDM1 knockdown preserved effector function while promoting central memory differentiation, resulting in GD2.CAR NKTs with potent in vivo antitumor activity. Thus, we have identified PRDM1 as a regulator of NKT memory differentiation and effector function that can be exploited to improve the efficacy of NKT-based cancer immunotherapies.

Writing worlds: Exploring mentorship approaches supporting adolescents' authentic writing across a Canadian youth centre's programmes

AbstractIn its diverse forms, authentic writing carries the potential to connect literacy practice to an author's ‘real world’. While contemporary approaches to authentic writing instruction—advocating writer‐centred, intertextual and culturally relevant productions—are most often explored in formal learning contexts like classrooms, this paper seeks to amplify the mentorship strategies employed within an informal youth centre learning space in Montreal, Canada. The following research questions have guided this work: (1) How do adult mentors leverage authentic writing principles to support adolescents' participation within two writing‐based programmes developed in a youth centre context? (2) How do the interests, perspectives and backgrounds of adult mentors shape the mentorship strategies they choose to employ? Data collected and analysed through participant‐focused ethnographic approaches assist the author in revealing how adult writing mentors draw from their own cultural, linguistic and embodied experiences to foster interest‐driven, culturally sustaining and community‐based writing opportunities for adolescents. The four key mentorship themes emerging through this research—centring the essential role of writing journeys, identities and communities while acknowledging several barriers to authentic writing—advocate drawing from the rich literacy practices thriving within informal contexts to inform contemporary writing curricula.

Case Study on Public Service Responsibility Implementation in Surabaya via the Broadband Learning Centre Programme

This study explores the Broadband Learning Centre (BLC) Programme in Surabaya, Indonesia, a municipal initiative to promote digital inclusion and technology access. Through a case study approach, it examines BLC’s strategies to bridge the digital divide, enhance digital literacy, and serve underserved groups, aligning with public service objectives. The research assesses BLC’s effectiveness, explores the challenges in managing and sustaining such initiatives, and addresses a gap in literature on targeted digital inclusion efforts in urban governance. The findings aim to provide insights into the operational model, challenges, and social impact of the BLC Programme, offering implications for similar initiatives seeking to integrate public service responsibilities and advance digital equity in other urban settings.

Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients.

Can antinuclear antibodies (ANA) affect the subsequent live birth rate (LBR) in patients with unexplained recurrent pregnancy loss (RPL) in the absence of antiphospholipid antibodies (aPL)? Women with unexplained RPL have a high probability of live birth following a positive pregnancy test (>70%), being similar between those with positive and negative ANA testing, regardless of the cut-off value. The RPL guidelines of the ESHRE state that 'ANA testing can be considered for explanatory purposes'. However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear. A retrospective cohort study was conducted at Nagoya City University Hospital between 2006 and 2019. The study included 1021 women with RPL without known cause. Hysterosalpingography or 3D-ultrasound, chromosome analysis for both partners, blood tests for aPL, ANA, hypothyroidism, and diabetes mellitus were performed before a subsequent pregnancy. ANAs were measured by indirect immunofluorescence on Hep-2 cell slides. The cutoff dilution used was 1:40. In addition, patients were classified according to the ANA pattern on immunofluorescence staining: homogeneous, speckled, nucleolar, centromeric, peripheral, cytoplasmic, and others. LBRs were compared between ANA-positive and ANA-negative patients after excluding patients with antiphospholipid antibody syndrome, an abnormal chromosome in either partner and a uterine anomaly. Considering the cut-off value = 1:40 dilution, the subsequent LBRs were 72.5% (256/353) for the ANA-positive group and 73.2% (489/668) for the ANA-negative group; odds ratio (OR) = 0.97, 95% CI = 0.72-1.29. After excluding the miscarriages occurring from embryonic aneuploidy, the biochemical pregnancy losses, and the ectopic pregnancies, LBRs were 92.8% (256/276) for the ANA-positive group and 93.0% (489/526) for the ANA-negative group: OR = 0.97 (95% CI = 0.55-1.70). Considering the cut-off value = 1:80 dilution, the subsequent LBRs were 75.0% (87/116) for the ANA-positive group and 72.7% (658/905) for the ANA-negative group; OR = 1.13 (95% CI = 0.72-1.76). After excluding the miscarriages occurring from embryonic aneuploidy, the biochemical pregnancy losses, and the ectopic pregnancies, LBRs were 89.7% (87/97) for the ANA-positive group and 93.3% (658/705) for the ANA-negative group: OR = 0.62 (95% CI = 0.30-1.27). Considering the cut-off value = 1:160 dilution, the subsequent LBRs were 82.4% (28/34) for the ANA-positive group and 72.6% (717/987) for the ANA-negative group; OR = 1.76 (95% CI = 0.72-4.29). After excluding the miscarriages occurring from embryonic aneuploidy, the biochemical pregnancy losses, and the ectopic pregnancies, LBR were 93.3% (28/30) for the ANA-positive group and 92.9% (717/772) for the ANA-negative group: OR = 1.07 (95% CI = 0.25-4.63). There was no difference in LBR between the 2 groups before or after adjustment for age and BMI, but ANA-positive patients were significantly older than ANA-negative patients when using the 1:40 dilution, and ANA-positive patients had significantly lower BMIs than ANA-negative patients when using the 1:80 dilution. A healthy control group was not established, making it impossible to compare ANA positivity rates between healthy controls and RPL patients. There were significant differences in age (1:40 dilution) and BMI (1:160 dilution) between the ANA-positive and ANA-negative groups. Our results suggest that ANA testing is not useful to predict future pregnancy loss in women with RPL without known cause. This study was supported by MEXT Promotion of Distinctive Joint Research Center Program, Grant Number JPMXP0621467963 and used for English proofreading costs. There are no competing interests for all authors. N/A.

The adoption and compliance to central line-associated bloodstream infection insertion and maintenance bundle programs in intensive care unit settings across Canada.

Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.

Recommendations for Transitioning Young People with Primary Immunodeficiency Disorders and Autoinflammatory Diseases to Adult Care

PurposeSignificant improvements in the prognosis for young patients with Primary Immunodeficiency Diseases (PID) and Autoinflammatory Disorders (AID), which together make up the majority of Inborn Errors of Immunity (IEI), have resulted in the need for optimisation of transition and transfer of care to adult services. Effective transition is crucial to improve health outcomes and treatment compliance among patients. Evaluations of existing transition programmes in European health centres identified the absence of disease-specific transition guidelines for PID and AID, as a challenge to the transition process. This research aimed to establish expert consensus statements for the transition of young patients with PID and AID to adult services.MethodsThis project used the Delphi method to establish mutual agreement for the proposed recommendations. A draft set of statements was developed following a literature review of existing transition programmes. Then the ERN RITA Transition Working Group convened to review the drafted recommendations and develop them into a survey. This survey was circulated among healthcare professionals to determine consensus using a five-point Likert scale, with the level of agreement set to 80% or greater. Statements that did not reach consensus were revised by the Working Group and recirculated among respondents.ResultsThe initial survey received 93 responses from 68 centres across 23 countries, while the following survey outlining revised recommendations received 66 responses. The respondents agreed upon recommendations detailing the structure and administration of transition programmes, collaborative working with social systems, and contraindications to transfer of care.ConclusionThis paper sets out a comprehensive set of recommendations to optimise transitional care for PID and AID.

The Influence of Biological Literacy and Adolescents' Attitudes Regarding Reproductive Health on Healthy Reproductive Behavior in the 2024 PIK-KRR Program

Adolescent reproductive health includes physical, mental and social aspects. Apart from being related to physical conditions such as diseases or disorders of the reproductive organs, reproductive health also involves psychological and social well-being which has an impact on the quality of life of teenagers. Factors that influence adolescent reproductive health include individual knowledge and attitudes as internal factors, as well as the family environment, the role of teachers, peers, and access to information as external factors. This research aims to analyze the influence of biological literacy and attitudes of adolescents regarding reproductive health in the PIK-KRR (Adolescent Reproductive Health Information and Counseling Center) program on healthy reproductive behavior in adolescents. This research uses an analytical observational design with a case-control method. The sample was taken proportionally with a 1:1 ratio, consisting of 250 teenagers with non-risky reproductive behavior and 250 teenagers with risky reproductive behavior. Data analysis was carried out using the Chi-square test. The results showed that biological literacy (p=0.000) and attitudes (p=0.000) had a significant effect on healthy reproductive behavior in adolescents. These findings emphasize the importance of knowledge and attitudes obtained from the PIK-KRR program in shaping healthy reproductive behavior.

How Well Are Surgical Quality Improvement Projects Planned? Review of 242 Surgical Improvement Efforts Across Five American College of Surgeons Quality Programs.

Structured preparation is necessary to conduct quality improvement (QI) strategies that are relevant to the problem, feasible, appropriately resourced, and potentially effective. Recent work suggests improvement efforts are sub-optimally conducted. Our goal was to determine how well preparation for surgical QI is undertaken, including detailing the problem, setting project goals, and planning an intervention. This retrospective cross-sectional study included QI efforts submitted in 2019 to the American College of Surgeons (ACS) during review for accreditation across five ACS Quality Programs: Children's Surgery Verification (CSV), the Commission on Cancer (CoC), the Metabolic and Bariatric Surgical Accreditation and Quality Improvement Program (MBSAQIP), the National Accreditation Program for Breast Centers (NAPBC), and the Trauma Verification Program. Projects were scored for alignment with three components of the pre-conduct phase of the ACS Quality Framework: problem detailing, goal specification, and strategic planning. 242 projects satisfied inclusion criteria and were scored. Most projects in the final cohort were from MBSAQIP (36%), CoC (31%), or NAPBC (29%) programs. The average overall pre-conduct score was 52% (Standard Deviation (SD)=17). On average, projects performed best in the 'Goal Specification' component (65% SD=27), followed by 'Problem Detailing' (52% SD=16), and 'Strategic Planning' (44% SD=25). Within these components, identification of possible limitations (5%) and consideration of contextual issues (12%) were among the least frequently reported items. Thorough planning is a critical component of effective QI, and our study reflects significant opportunity for its improvement. The ACS Quality Framework may serve as a guide to improve QI planning, thereby promoting efficiency and effectiveness of these efforts.

A Multimethod International Mapping Exercise of Arts Interventions in Renal Units: The PAINT Project

Introduction: Due to the chronic nature of kidney disease, the challenges of symptom burden, and reduced mortality and comorbidity, individuals living with the condition experience substantial anxiety and depression. Incorporating the arts into clinical practice is encouraged to promote and support mental health and well-being. The aim of the PAINT project was to undertake an international mapping exercise to identify the current provision of arts programmes in kidney centres for people living with kidney disease. Methods: A multimethod approach was employed, involving a cross-sectional online survey and semi-structured qualitative interviews, which employed qualitative description research design. Healthcare staff working in kidney centres or organisations providing arts activities to individuals living with kidney disease were recruited into the study. Results: One hundred and nineteen participants from 29 countries responded to the survey, with 39 of the respondents reporting arts activities in their renal unit. There was a wide range of respondents in terms of role, and the types of arts activities included visual arts activities, music, literature/creative writing, film, movement/dance, and craft. Individuals with chronic kidney disease who had taken part in arts activities were mostly adults (64%), and most were undergoing haemodialysis (82%). Sixteen respondents participated in the semi-structured interviews and encouraged the adoption of arts activities for people living with kidney disease. Three themes were identified: enhanced well-being and positive outcomes for individuals living with kidney disease; staff engagement and enthusiasm; and barriers to participation. Conclusions: This overview of arts activities being offered globally to people living with kidney disease and experiences of renal healthcare staff who provide activities in their units are encouraging in terms of arts in healthcare. These practitioners have observed the benefits of this person-centred arts approach in action, predominantly in terms of the positive impact on the well-being of individuals with kidney disease and improved relationships with staff in dialysis units. Further attention and funding should be focused on arts activities within renal centres.

The Okanagan Charter to improve wellbeing in higher education: shifting the paradigm

There is a growing trend among US universities and colleges to become Health Promoting Universities (HPUs) and adopt the Okanagan Charter. This trend is based on the aspirations of these universities and colleges to infuse health into everyday operations and improve the wellbeing of people, places and the planet. As university and colleges adopt the Okanagan Charter there is little guidance on how to think about wellbeing and address the social and planet determinants of health on a university campus. In addition, there is a need to understand the strategies of HPUs and how they differ compared to current activities of schools or programs of public health and medical centers already focused on improving health and wellness. HPUs will be a driving force for campus public health and improvements in wellbeing as additional higher education institutions move in this direction.

Comparison of the Effects of Brief Intervention (BI) on Relapse Prevention and Withdrawal Permanency in Opioid Addicts and Stimulant Users: A Quasi-Experimental Study

Background: Addiction to narcotics and stimulants is a major social and health challenge worldwide. Objectives: Considering the importance of non-medical treatments in addiction rehabilitation and the necessity of psychotherapy programs in substance abuse rehabilitation centers, the present study aimed to compare the effects of Brief Intervention (BI) on relapse prevention and sustained abstinence in opioid addicts and stimulant abusers seeking help from drop-in-centers (DICs) dedicated to harm reduction in Ahvaz, a city in southwestern Iran. Methods: This applied, quasi-experimental study employed a pre-test, post-test, and follow-up design. The statistical population included 120 male substance abusers and opioid addicts aged 18 to 59, systematically selected from 467 individuals with active files in Iran’s Drug and Alcohol Treatment Information System (IDATIS) under the Ministry of Health in 2023. Participants were selected based on inclusion and exclusion criteria and randomized into four groups: Two experimental groups and two control groups, each with 30 participants. Brief Intervention was provided only to the two experimental groups in four 60-minute sessions, while no intervention was offered to the control groups. Testing tools included specific kits for screening morphine and amphetamines in the urine of participants. Data were analyzed using analysis of variance (ANOVA) with repeated measures and descriptive statistical methods, utilizing SPSS version 24. Results: The study demonstrated that BI was significantly effective in relapse prevention and promoting sustained abstinence in opioid addicts attending harm reduction centers in Ahvaz (P < 0.001). However, BI was not effective in preventing relapse or promoting abstinence in stimulant abusers (P = 0.235). Conclusions: The findings suggest that BI is an effective intervention for preventing relapse and promoting abstinence in opioid abusers. It is recommended that executive managers of addiction harm reduction centers guide their experienced social workers to implement this method as a selective psychotherapy approach complementary to medical treatment for opioid addicts.

Time From Screening to Treatment at Accredited Breast Centers in the United States.

The National Accreditation Program for Breast Centers (NAPBC) launched the Patient-Reported Observations for Medical Procedure Timeliness quality collaborative to assess time intervals between screening and treatment for patients with breast cancer. Sites submitted monthly timeliness data in calendar days from 2019 to 2021 along with their perceptions of timeliness at their centers and facility characteristics. All patients were included in the interval from screening to diagnosis, whereas only patients with cancer were included in the biopsy to treatment intervals. Institutions were compared and assessed for differences and associations with center characteristics via the Kruskal-Wallis test. Three hundred seventy-three (64.5%) NAPBC-accredited breast centers enrolled, and 311 (83.3%) provided complete timeliness metrics. Two hundred nine (56%) sites did not have trainees, 154 (41.3%) sites were within 10 miles of a major city, and the median number of annual breast cancer cases was 280 (IQR, 189-366). From 2019 to 2021, the time between diagnosis and treatment was as follows: 11-12 days between screening mammogram (MGM) and diagnostic MGM, 8-9 days between diagnostic MGM and biopsy, 32-34 days between biopsy and neoadjuvant therapy, and 39-42 days between biopsy and surgery. The enrolled centers believe that these intervals should be 7, 7, 21, and 28 days, respectively. Higher annual case volume and a larger number of surgeons exclusively devoted to breast disease were significantly associated with longer time intervals. Time from biopsy to first treatment is longer than that centers expected compared with time from screening to diagnosis. There is significant variability across NAPBC in time from screening mammogram to treatment, and some institutions will face more challenges with timely quality measures than others. Further investigation into whether these differences confer outcome differences should be pursued.

Gendered narratives and cultural shifts: A qualitative study on decadal changes in community alcohol consumption.

Alcohol consumption has been a central practice in Sabah, Malaysia. However, this region has witnessed a nuanced shift in drinking habits over the last decade, raising concerns about the health, economic, and social implications of alcohol use within the community in Sabah. This study explores the impact of gender narratives and cultural transformations on alcohol consumption within Sabah over the last decade. The objectives of this research include 1) assessing the shifts in alcohol consumption patterns over the last 10 years, 2) understand the role of gender differences in shaping these patterns, and 3) identify the economic consequences resulting from the changes. Employing a qualitative approach, we conducted focus group interviews with members of the native community, each group consisting of up to 7 participants. Thematic analysis was used to identify key themes pertaining to gender roles, cultural practices, and socioeconomic influences of alcohol consumption. The data were then contextualized using Bronfenbrenner's social-ecological model and social role theory. The study reveals a significant shift in drinking habits. Historically, alcohol was mostly consumed by men, but now more women are drinking, changing long-standing gender roles related to alcohol use. Children often copy their parents' drinking behaviors, and with alcohol being more easily available, more people are drinking than before. Our findings also expose the complex consequences of alcohol use, which extend to health concerns, familial tension, and economic hardship. Despite the entrenched cultural status of alcohol, these negative outcomes are exacerbated by a lack of supportive healthcare services. In light of these insights, the study suggests the need for intervention plans that respect the cultural background of Sabah and account for gender dynamics while tackling the current issues of alcohol misuse. The research adds to the wider conversation about managing alcohol in different cultural settings and also recommended strategies based on the findings, such as cultural and gender sensitive community programs, youth centered programs, community-based healthcare services, employment support and training and development of laws and policies.

Implementation of the Child-Friendly City Policy through the Family Learning Center (Puspaga) Program in the City of Surabaya

Children are often vulnerable to violence due to their limited knowledge and physical strength. The family, the environment, and the state must be responsible for the fulfillment of children's rights and child protection. The purpose of this study is to determine the suitability between the Family Learning Center (PUSPAGA) program and beneficiaries, the suitability between the PUSPAGA program and the implementing organization, and the suitability between beneficiaries and implementing organizations in an effort to implement the Child-Friendly City policy in the city of Surabaya through the PUSPAGA program. Through a descriptive qualitative method, this study provides an overview of the implementation of a program. This analysis is based on the indicators of the program implementation suitability model introduced by David C. Korten. The results of this study show that the PUSPAGA program has supported the implementation of the Child-Friendly City policy relatively well, but there are obstacles experienced due to the limitations of professional psychologists at PUSPAGA Balai RW (Rukun Warga) and the participation of the beneficiary community.

Improving Oral Nutrition Intake Through One-on-One Meal Support for Patients With Eating Disorders.

INTRODUCTION: Treatment for eating disorders (EDs) after hospitalization requires structured environments such as residential care programs where treatment options such as meal support therapy can help manage the physical and psychological effects of their illness. The residential center for this project follows a multidisciplinary approach that uses cognitive behavior therapy (CBT) as a treatment modality for ED. Structured meal support is an essential part of implementing the center's CBT program. AIM(S): The project aimed to determine if one-on-one mealtime support training for staff can help increase oral nutrition intake in adolescents with ED. METHODS: Meal consumption data for five residents of the ED center was used for this project. First, 2 weeks of meal consumption data were collected (210 meals). Then residential center staff were trained on using meal support strategies adapted from the Auckland Eating Disorder Manual. After training the staff and having them implement the strategies with ED clients for a week, another 2 weeks of meal consumption data were collected (210 meals). The preimplementation and postimplementation data were compared to determine if the intervention had an impact on the overall meal intake by residents of the ED center. RESULTS: Before implementing the project, patients completed 122 meals in 2 weeks, representing 58.1% of their meals and after the intervention, patients completed 141 meals representing 67.14% of their meals. CONCLUSION: Project findings show that the use of mealtime support strategies while providing one-on-one support for patients with EDs led to an increase in the overall oral intake.

The impact of the green direction in central banking on the general public's trust: Evidence from Hungary

Climate considerations are rising on the agenda of central banks worldwide. Given the importance of the general public's trust for the success of central bank policy, the objective of our study is to examine how this trust may change in response to green central bank measures. We rely on an independently conducted survey of 1000 Hungarian adults and apply multinomial and ordered logistic regressions. Our results indicate that even in an environment of high inflation, there is potential for some increase and limited risk of decrease in trust. We find that green variables are more important in explaining variance than those associated with the economy or institutions. A higher level of climate worry, seeing environmental protection as important, being a woman and being a student are associated with an expectation that trust would increase following the central bank's pro-environmental measures. Our findings provide support for the central bank's green programme and do not point to a need to modify the green programme, public relation efforts or the conducting of monetary policy on account of negative trust implications. Findings may be useful for other jurisdictions due to similarities in the trust-building process, climate change concerns and the monetary policy framework.

Etiology, Risk Factors, and Outcomes of Bacteremia in Patients With Hematologic Malignancies and Febrile Neutropenia in Uganda.

We determined the etiology, risk factors, and outcomes associated with bacteremia in patients with hematologic malignancies and febrile neutropenia (FN) at the Uganda Cancer Institute (UCI). UCI adult and pediatric inpatients with hematologic malignancies and FN were prospectively enrolled and followed up to determine 30-day mortality. Blood drawn from participants with FN was cultured in the BACTEC 9120 blood culture system. Antimicrobial susceptibility testing was performed with the disk diffusion method on identified bacteria. Logistic regression and Cox proportional hazards regression were applied to estimate associations between participant characteristics and FN, bacteremia, and mortality. Of 495 participants, the majority (n = 306 [62%]) were male. Median age was 23 years (interquartile range, 11-42 years). Of the 132 participants who experienced FN, 43 (33%) had bacteremia. Participants with younger age (odds ratio [OR], 0.98; P = .05), severe neutropenia (OR, 2.9; P = .01), hypotension (OR, 2.46; P = .04), mucositis (OR, 2.77; P = .01), and receipt of chemotherapy (OR, 2.25; P = .03) were more likely to have bacteremia. Fifty (78%) bacteria isolated were gram negative. Escherichia coli (n = 25 [50%]) was predominant. Thirty-seven of 43 (86%) episodes were caused by multidrug-resistant (MDR) bacteria. Thirty-day overall survival for participants with bacteremia was significantly lower than that for participants with no bacteremia (P = .05). MDR bacteremia (hazard ratio, 1.84; P = .05) was associated with increased risk of death. Bacteremia was frequent in patients with hematologic cancer and FN and was associated with poor survival. MDR bacteria were the main cause of bacteremia and mortality. There is a need for robust infection control and antimicrobial stewardship programs in cancer centers in sub-Saharan Africa.

A new normal in primary care: the rapid normalization of a major eHealth program in public health centers

BackgroundThis study aimed to contribute to a better understanding of the context, mechanisms and outcomes in the implementation process of an eHealth video consultation program in primary care. The study focused on how the program is normalized in the primary care setting. The primary research question for this study is “in what ways is the implementation of video consultation normalized in primary care?”.MethodsThe qualitative design and content analysis of primary data from the transcripts were based on in-depth interviews, complemented with free-text answers to open-ended survey questions and various documents. The study focuses on the large-scale implementation of the public eHealth program Närhälsan Online, which represents more than 100 health centers in Sweden’s largest region of Västra Götaland. Multiagent perspectives on how the program is normalized were drawn from expressed perceptions by professions directly linked to both strategic and functional implementation, as well as administration and clinical operation.ResultsThis study both confirms and enhances the field with a theoretical contribution in six ways to the reviewed previous research, as well as showing practical implications. It also provides multi-agent perspectives on the rapid normalization of the implementation program studied.ConclusionsIn relation to the rapid progression of different initiatives in eHealth, this study contributes to perspectives on specific challenges as expressed by professions directly linked to both strategic and functional implementation as well as administration and clinical operation.

Nutritional guidance needs and influence factors for gastric cancer survivors in primary healthcare setting: a cross-sectional survey.

This study aimed to build a comprehensive understanding of the nutritional guidance needs of gastric cancer survivors in the primary healthcare setting that could be fulfilled by community health service centers as part of their primary healthcare services. Gastric cancer survivors were invited to participate in a questionnaire-based survey by convenience sampling method from the community health center. Relationships between nutritional demand and potential influence factors were examined by a multivariable logistic regression model. A total of 200 gastric cancer survivors were recruited from the community health service center in Shanghai, China, from whom we obtained 194 valid questionnaires, resulting in a 97.0% response rate. Of these gastric survivor participants, 48 individuals (24.7%) expressed a need for nutritional guidance administered by community health service centers, whereas 146 participants (75.3%) held the perspective that such guidance was unnecessary. Preferences for nutritional guidance included having a dietitian as the provider (68.8%), home-based engagement (72.9%), face-to-face consultation (68.8%), individual counseling (87.5%), and beginning immediately post-discharge (89.6%). A notable reluctance (66.7%) towards financial contribution was also observed. After adjusting for confounders, participants with higher income level (odds ratio (OR) = 4.45, 95% confidence interval (CI) = 1.39-15.50), history of food intake reduction (OR = 14.96, 95% CI = 3.49-82.28), and gastrointestinal symptoms (OR = 4.40, 95% CI = 1.35-14.33) were more likely to seek nutritional guidance. Gastric cancer survivors have a certain need for nutritional guidance administered by primary health service centers. Personal guidance by the primary health service center should be provided to gastric cancer survivors to support their dietary and nutritional intake needs. There is a need to develop and implement nutritional guidance programs in community health service centers as part of their primary healthcare services for gastric cancer survivors.

Interdisciplinary research center programs positively impact graduate and postdoctoral training

Interdisciplinary research center programs positively impact graduate and postdoctoral training