Intervention Centre Research Articles

Competency mapping among Rashtriya Bal Swasthya Karyakram nurses in Kerala

Background: In India, birth defects, nutritional deficiencies, disabilities, and developmental delays among children cause significant public health challenges. The Ministry of Health and Family Welfare, aims to address these issues through the Rashtriya Bal Swasthya Karyakram (RBSK) program. RBSK nurses are the crucial part of this program. They screen the children between zero to eighteen years as a part of early intervention. This study mainly aimed to map the competencies among RBSK nurses from randomly selected districts of Kerala. Methods: This qualitative study employed key informant interviews with the state nodal officer, district early intervention centre managers, and district coordinators; and in-depth interviews (IDIs) with RBSK nurses, as well as report and document review. Inductive coding was applied to two selected interview transcripts from each district, followed by deductive coding with the rest of the transcribed data to derive themes. Results: The findings are presented using the ‘core competencies of public health professionals’ as revised and adopted by the council on linkages between academia and public health practice in 2021. RBSK nurses in Kerala exhibited proficiency in multiple domains, including knowledge of child health issues, clinical skills, communication, patient education, care for vulnerable population, organizing activities, electronic health record usage, multitasking, teamwork, and problem-solving skills. Conclusions: This dedication and proficiency demonstrated by RBSK nurses in Kerala, serve as a global model for emphasising the importance of early intervention and comprehensive care for children.

Lipid lowering therapy and the unmet targets in Indian patients with angiographically proven coronary artery disease: results from the OLS registry

Abstract Introduction The Lipid Association of India (LAI) 2020 guidelines classify patients with established atherosclerotic cardiovascular disease in either very high-risk or extreme-risk groups and recommend that intensive lipid-lowering therapy (LLT) should be administered to such patients to achieve a target low-density lipoprotein cholesterol (LDL-C) level below 50 mg/dl at least (preferably < 30 mg/dl in extreme risk groups). Purpose This study aimed to assess the achievement of the LAI-recommended LDL-C goals in patients with angiographically proven coronary artery disease (CAD). Methods The Optimization of LDL-C in the Stable CAD (OLS) registry started in August 2023 in 10 interventional cardiology centers across Northern India. Interventional cardiologists (ICs) were treating all enrolled patients with angiographically proven stable CAD, and data were collected at a single visit, including the most recent LDL-C and the LLT in the preceding three months of that LDL-C reading. The primary outcome was achieving the LAI-recommended LDL-C goal of <50 mg/dl. The achievement of the American College of Cardiology (ACC) recommended goal of <70 mg/dl was also assessed. Results A total of 1860 patients with angiographically proven CAD were enrolled in this ongoing registry over four months (August 2023- November 2023). The mean age of the study population was 60.2 + 9.2 years, and 79% were males. 30.3% of patients had Diabetes mellitus (DM), 36.1% had hypertension (HTN), 42.3% were obese (body mass index > 25kg/m2), and 17.8% of patients were current smokers. 74.2% of patients had a history of myocardial infarction, while 76.7% had undergone prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Rosuvastatin was the statin prescribed in 59.4% of patients, while atorvastatin was prescribed in 37.2%. 1270 (68.3%) of patients were taking high-intensity statin (HIS) therapy (either 20-40 mg rosuvastatin or 40-80 mg atorvastatin). Only 22 (1.2%) patients took other lipid-lowering agents, including ezetimibe, bempedoic acid, and fibrates. None of the patients were using PCSK9 Inhibitors. Only 482(25.9%) patients achieved their LAI recommended goal of LDL-C <50 mg/dl, 113(6.1%) achieved LDL-C < 30 mg/dl, while 863(46.4%) achieved ACC goal of <70 mg/dl. Notably, only 62(3.3%) patients were not taking any lipid-lowering treatment. Conclusion Results of the OLS study demonstrate the high-risk status of CAD in Indian patients with a high prevalence of DM, HTN, and obesity. Most patients were post-PCI/CABG, mainly because ICs did enrolments. More than two-thirds of patients were taking HIS and very few were not taking any treatment. Despite this, only one-fourth of patients achieved the target LDL-C goals. Greater and early utilization of combination LLT, including HIS and non-statin LLT, is likely needed to reduce these gaps for patients at the highest risk.

“Assessment Of Cardiac Autonomic Dysfunction In Children With Cerebral Palsy Using Heart Rate Variability”

Background: Cardiac autonomic imbalance in children with CP might be due to primary brain insult, vary with different levels of Gross Motor Functional Classification System or may alter with multimodal therapies in various types of cerebral palsy (1,2) . It is important to understand and to create awareness that autonomic impairment in children with CP is in part due to sedentary lifestyle (3).HRV(Heart Rate Variability) in cerebral palsy is recognized as an important tool for monitoring cardiovascular health, in which autonomic imbalance is characterized by reduced HRV (i.e. regarded as increased cardiac sympathetic activity and decreased vagal modulation) (4,5) . Of the research that does exist, each study discusses only very few parameters of the autonomic nervous system, thus providing opportunities for further research and hence the need for the study. Materials and Methods: This is a cross-sectional case control study of 51 children with Cerebral Palsy (CP) and 51 normal children, conducted at District Early Intervention Centre (DEIC) in the Department of Paediatrics, Vani Vilas hospital. These 51 cases were assessed and classified based on their demographic features, etiology, type of CP, GMFCS scale and with the objectives of assessing the heart rate variability (HRV) in children with cerebral palsy and compare it with controls in both supine position and after a stress test, and also to correlate the obtained parameters with GMFCS level, type of CP using a systematically designed proforma. Results: Results of the study showed that of the children with CP studied, 62% were male children, and majority of were between 6-8 years of age (58%), and it was found that the most common etiology for CP in our study was due to perinatal asphyxia (43%), and 80% of the children had history of NICU admission. Of the 51 cerebral palsy children studied 72% were in GMFCS levels 3 and 4, regarding the topographical classification majority had spastic quadriplegia (58.8%) followed by spastic diplegia (15.7%). Study revealed that cerebral palsy children had significantly lower HRV, higher sympathetic activity, autonomic response deficit to stress test, and higher autonomic dysfunction when compared to normal children. Among cases, HRV was lowest with spastic quadriplegia and triplegic CP, in functional classification HRV was lowest among GMFCS 4 and 3. Conclusion: Cerebral palsy children had significantly higher sympathetic activity and less cardiac vagal modulation compared to normal children in supine position and there was existence of autonomic response deficit in cerebral palsy children after stress test, higher the motor impairment, higher was the sympathetic activity

Community-Wide Active Case Finding for Tuberculosis: Time to Use the Evidence We Have.

Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world's deadliest infectious diseases. Despite being the world's oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective of whether they have common vulnerabilities to the disease warranting the current WHO recommendations for community-wide tuberculosis active case finding in these settings. Despite good evidence of effectiveness in reducing tuberculosis transmission, uptake of this strategy has been lacking in the communities that would derive greatest benefit. We consider the various complexities in eliminating tuberculosis from the first principles of the disease, including diagnostic and other challenges that must be navigated under an elimination agenda. We make the case that community-wide tuberculosis active case finding is the best strategy currently available to drive elimination forward in high-incidence settings and that no time should be lost in its implementation. Recognizing that high-incidence communities vary in their epidemiology and spatiosocial characteristics, tuberculosis research and funding must now shift towards radically supporting local implementation and operational research in communities. This "preparing of the ground" for scaling up to community-wide intervention centers the local knowledge and local experience of community epidemiology to optimize implementation practices and accelerate reductions in community-level tuberculosis transmission.

The dawn of a sexual assault relief center: A 12-year fact-finding survey of victims of sexual assault conducted since2010 by SACHICO, Japan's first rape crisis center.

In Japan, amidst insufficient legal provisions and governmental support, in 2010, the first rape crisis center, the Sexual Assault Crisis Healing Intervention Center Osaka (SACHICO) was established. We compared SACHICO visitor data from 2010 to 2021 with National Police Agency statistics to clarify the current situation of sexual assault victims in Japan and considered future issues for Japan to address. This study was a cross-sectional study that analyzed the data described below. All visitations to SACHICO between April 2010 and December 2021 were considered targets for data totaling. Data on crime statistics were gathered from the official governmental statistics portal site. A total of 12 036 visitations occurred, of which 3189 were first-time consultations; 3100 initial medical examinations were conducted, and no medical examination was conducted in the remaining 89 cases (2.7%). The number of initial medical examinations increased 3.7 times from 2010 to 2021. Victims under the age of 19 comprised 60% of the total number of initial medical examinations (1863/3100). The reporting rate for all 3100 initial medical examinations was only 31.3% (969/3100) of the cases. The proportion of forcible sexual intercourse versus forcible indecency were the converse of those observed among acknowledged cases nationwide and in Osaka Prefecture. For several years, the number of initial medical consultations at SACHICO has exceeded that of acknowledged cases in Osaka Prefecture. Support for victims of sexual assault in Japan is still insufficient. It is necessary to strengthen the system of rape crisis centers system to realize an unbroken chain of support for victims.

The offload study: A prospective observational study of the time to offload a patient from an ambulance or helicopter into an emergency department or percutaneous coronary intervention centre

Introduction Providing an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance. Methods A prospective observational study was conducted at The Air Ambulance Service (TAAS) from August 2022 to February 2023. Consecutive emergency patients who were pre-alerted to hospital and arrived at an ED or Percutaneous Coronary Intervention (PCI) centre with an escorting air ambulance crew member were included. The offload time (time between hospital arrival and handover of the patient) was measured using a stopwatch. Results Data was available for 228 patients arriving at 18 hospitals and 6 helipads. The median offload time by road ambulance was 2 min 34 s. The range of helicopter offload times was from 4 min 20 s to 21 min 37 s, which mainly depended on the location of the helipad. Conclusion An additional 2–3 min should be added to the ETA by road ambulance. There is large variation in helicopter offload times depending on the helipad location (secondary/offsite helipad taking longer than a primary rooftop helipad or primary same-level helipads). HEMS services should review their own offload times at local sites to be able to provide a more accurate ETA.

‘Where Liberty is Not, There is My Country’: Nineteenth-Century American Abolitionist Writings on India and its Legacies

ABSTRACT This article examines nineteenth century American abolitionist writings on India. My sources include abolitionist newspapers, primarily focusing on William Lloyd Garrison’s newspaper the Liberator, but also incorporating other abolitionist newspapers. These include the Friend of Man and publications of individual abolitionists like Lydia Maria Child’s The History of the Condition of Women, in Various Ages and Nations. By looking at their writings on Christian missionary activities in India, Indian women, and British rule in India, this article argues that although many abolitionists Orientalized India, they at the same time found many parallels between Indian society and the US. Although they did not develop a full criticism towards colonialism in the antebellum period, their criticism towards Empire matured by the early twentieth century. My scholarly intervention centres on acknowledging the hitherto unknown role of abolitionist writings on India in the intellectual history of American abolitionism and US-India transnational history. By not fully engaging with India, the scholarship on US-India relations and abolitionism misses a critical dimension of the abolitionist movement’s intimate relationship with related causes of feminism, anti-clericalism, and anti-imperialism. Most importantly, this article demonstrates that abolitionist writings on India far exceeded Orientalism as the only frame of understanding.

From Adolescence to Adulthood: Understanding Care Trajectories in an Early Detection and Intervention Centre in France.

Psychiatric disorders often emerge during adolescence or young adulthood, leading to significant disability among youth. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is critical for individuals experiencing emerging psychopathology, with delayed access to care negatively impacting long-term outcomes. Accessing mental health services for adolescents and young adults is often complex and delayed due to challenges in service visibility, accessibility and appropriateness. This study examines the care trajectories of individuals consecutively accessing the early detection and intervention (EDI) centre C'JAAD (Evaluation Centre for Young Adults and Adolescents) in Paris (France) over the year 2021. The main goal was to clarify the role of this EDI centre in the continuity of care and transition to AMHS. Data about their history of care, hospitalisations and referral sources were collected retrospectively. The sample comprised 194 individuals, with 57.2% males and a median age of 20 years. Most patients (67.5%) were ≥18 years old upon arrival, with 31% in a situation of not being in education, employment, or training (NEET). Over one-third (35.2%) had prior psychiatric hospitalisations. Patients were mainly referred to our EDI centre from other hospital departments (42.3%). Regarding care in CAMHS, 50.3% of the total sample had medical follow-up during childhood, of whom 41.9% had discontinued care upon arrival at the EDI centre. The median onset age of care in CAMHS was 14, with a median duration of 12 months. Adult patients experienced an approximately 3-year gap between the end of CAMHS care and assessment at the EDI centre. The sample's characteristics resemble those of other EDI centres, but concerns persist regarding referral timing and the NEET status of many youths. Lack of prior medical follow-up and challenges in transitioning to AMHS underscore the need to enhance care continuity and address difficulties in accessing care during the transition to adulthood.

Unlocking Potential: The Transformative Impact of Early Intervention Centers on the Well-being of the Naval Community

Unlocking Potential: The Transformative Impact of Early Intervention Centers on the Well-being of the Naval Community

Constrains for attending District Early Intervention Centre (DEIC) of Purba Bardhaman district, West Bengal: Perspectives of both service providers and caregivers of the beneficiaries, a Mixed-Method Study.

This study was conducted to assess the clinicosocial profile characteristics of the beneficiaries attending DEIC and to explore the challenges faced by both the caregivers and service providers. A facility-based, mixed-method study with phenomenological approach was conducted in Burdwan Medical College of Purba Bardhaman district, West Bengal, from January 2023 to April 2023. For quantitative part, record analysis was conducted involving all children enrolled at DEIC from January 2022 to December 2022, and for qualitative part, caregivers and service providers were selected purposively and interviewed using the in-depth-interview (IDI) guide. Inductive thematic analysis was conducted simultaneously till data saturation was achieved. The principles of descriptive statistics were applied to organize and present the quantitative data in tables and diagrams. Qualitative data were transcribed into verbatim and analyzed thematically with inductive approach. Out of 3332 children enrolled, 58.4% were males, and 44.2% were aged between 0 and 1 month. 59.3% of them had developmental delays, 7.9% had defects, 42.9% had diseases, and 21.3% had some deficiencies. Major hindering factors in service provision among service providers were resource deficiency, inadequate capacity building, administrative bottlenecks, limited supportive supervision, inadequate advocacy, and awareness deficit. No major constraints were found from caregivers' perspective in accessing healthcare. DEIC is running with shortage of proper infrastructure and adequate supervision. Periodic training, appropriate awareness building, and continuous flow of logistics are needed to ensure a better quality of life among beneficiaries.

Same-day discharge coronary interventions: How to succeed?

Percutaneous coronary interventions(PCI) are the cornerstone of treatment in patients with coronary artery disease, generating substantial costs for the healthcare system. Considerable improvement in PCI technique, stent technology and antiplatelet therapy led to a complication rate of <5%, a success rate of >95% and lack of routine cardiothoracic surgical support. Thereby, the concept of same-day discharge following PCI has been proposed due to comparable efficacy, safety, and socioeconomic benefits to inpatient PCI. Although single-vessel disease was the primary indication for outpatient (OP) PCI, more complex scenarios such as multivessel disease, left main disease and chronic total occlusions were shown to be feasible and safe in OP setting as well. Currently available data shows that OP PCI leads to cost optimization, increased PCI center capacity, decrease in nosocomial infections rate and increased patient satisfaction, along with good clinical outcomes. Although OP PCI seems promising in a subset of well-prepared and compliant patients without severe comorbidities, there are some challenges to overcome before its routine implementation. To prevent unnecessary hospitalizations and unsafe same-day discharges, interventional cardiology teams should be trained to perform reliable risk-benefit assessments. Standardized forms should be created to obtain informed consent and instruct OP PCI patients and their relatives about postprocedural management. Here, we summarize the available data on OP and inpatient PCI outcomes, discuss the opportunities and challenges of OP PCI and propose a periprocedural patient management checklist, with the goal of facilitating OP PCI implementation in interventional cardiology centers.

Novel Machine Learning HIV Intervention for Sexual and Gender Minority Young People Who Have Sex With Men (uTECH): Protocol for a Randomized Comparison Trial.

Sexual and gender minority (SGM) young people are disproportionately affected by HIV in the United States, and substance use is a major driver of new infections. People who use web-based venues to meet sex partners are more likely to report substance use, sexual risk behaviors, and sexually transmitted infections. To our knowledge, no machine learning (ML) interventions have been developed that use web-based and digital technologies to inform and personalize HIV and substance use prevention efforts for SGM young people. This study aims to test the acceptability, appropriateness, and feasibility of the uTECH intervention, a SMS text messaging intervention using an ML algorithm to promote HIV prevention and substance use harm reduction among SGM people aged 18 to 29 years who have sex with men. This intervention will be compared to the Young Men's Health Project (YMHP) alone, an existing Centers for Disease Control and Prevention best evidence intervention for young SGM people, which consists of 4 motivational interviewing-based counseling sessions. The YMHP condition will receive YMHP sessions and will be compared to the uTECH+YMHP condition, which includes YMHP sessions as well as uTECH SMS text messages. In a study funded by the National Institutes of Health, we will recruit and enroll SGM participants (aged 18-29 years) in the United States (N=330) to participate in a 12-month, 2-arm randomized comparison trial. All participants will receive 4 counseling sessions conducted over Zoom (Zoom Video Communications, Inc) with a master's-level social worker. Participants in the uTECH+YMHP condition will receive curated SMS text messages informed by an ML algorithm that seek to promote HIV and substance use risk reduction strategies as well as undergoing YMHP counseling. We hypothesize that the uTECH+YMHP intervention will be considered acceptable, appropriate, and feasible to most participants. We also hypothesize that participants in the combined condition will experience enhanced and more durable reductions in substance use and sexual risk behaviors compared to participants receiving YMHP alone. Appropriate statistical methods, models, and procedures will be selected to evaluate primary hypotheses and behavioral health outcomes in both intervention conditions using an α<.05 significance level, including comparison tests, tests of fixed effects, and growth curve modeling. This study was funded in August 2019. As of June 2024, all participants have been enrolled. Data analysis has commenced, and expected results will be published in the fall of 2025. This study aims to develop and test the acceptability, appropriateness, and feasibility of uTECH, a novel approach to reduce HIV risk and substance use among SGM young adults. ClinicalTrials.gov NCT04710901; https://clinicaltrials.gov/study/NCT04710901. DERR1-10.2196/58448.

Evaluating the diagnostic and triage performance of digital and online symptom checkers for the presentation of myocardial infarction; A retrospective cross-sectional study.

Online symptom checkers are increasingly popular health technologies that enable patients to input their symptoms to produce diagnoses and triage advice. However, there is concern regarding the performance and safety of symptom checkers in diagnosing and triaging patients with life-threatening conditions. This retrospective cross-sectional study aimed to evaluate and compare commercially available symptom checkers for performance in diagnosing and triaging myocardial infarctions (MI). Symptoms and biodata of MI patients were inputted into 8 symptom checkers identified through a systematic search. Anonymised clinical data of 100 consecutive MI patients were collected from a tertiary coronary intervention centre between 1st January 2020 to 31st December 2020. Outcomes included (1) diagnostic sensitivity as defined by symptom checkers outputting MI as the primary diagnosis (D1), or one of the top three (D3), or top five diagnoses (D5); and (2) triage sensitivity as defined by symptom checkers outputting urgent treatment recommendations. Overall D1 sensitivity was 48±31% and varied between symptom checkers (range: 6-85%). Overall D3 and D5 sensitivity were 73±20% (34-92%) and 79±14% (63-94%), respectively. Overall triage sensitivity was 83±13% (55-91%). 24±16% of atypical cases had a correct D1 though for female atypical cases D1 sensitivity was only 10%. Atypical MI D3 and D5 sensitivity were 44±21% and 48±24% respectively and were significantly lower than typical MI cases (p<0.01). Atypical MI triage sensitivity was significantly lower than typical cases (53±20% versus 84±15%, p<0.01). Female atypical cases had significantly lower diagnostic and triage sensitivity than typical female MI cases (p<0.01).Given the severity of the pathology, the diagnostic performance of symptom checkers for correctly diagnosing an MI is concerningly low. Moreover, there is considerable inter-symptom checker performance variation. Patients presenting with atypical symptoms were under-diagnosed and under-triaged, especially if female. This study highlights the need for improved clinical performance, equity and transparency associated with these technologies.

Type and morphology affect the success rate of bronchoscopy for postintubation tracheal stenosis.

With advancements in respiratory interventional techniques, bronchoscopic intervention technology has emerged as a viable approach for managing postintubation tracheal stenosis (PITS). However, there was a paucity of research investigating the potential impact of stenosis characteristics and morphology (such as stenosis degree, length, type, and morphology) on bronchoscopic intervention treatment prognosis for PITS patients. This study was to assess the impact of various preoperative stenosis characteristic factors on the bronchoscopic cure rate among patients. This is a retrospective study analyzing the medical records of patients with PITS who received bronchoscopic intervention at the tertiary interventional pulmonology center. Among the cases, 115 individuals achieved a in a success rate of 79.86% for bronchoscopic intervention therapy and were assigned to Group S. On the other hand, 29 cases required surgical intervention, accounting for a surgical treatment rate of 20.14% and were assigned to Group F. The stenosis in the Group F predominantly exhibited irregular shapes with scar granulation accompanied by tracheal chondromalacia collapse. Patients in group S experienced fewer total procedures, rigid bronchoscopy treatment, intraoperative hypoxemia, needed emergency re-bronchoscopy in 24 h and transferred to ICU postoperatively. Patients with pure scar and granuloma, the rate of bronchoscopic success cure was higher than patients with scar granulation accompanied by tracheal chondromalacia (odds ratio: 8.208; 95% confidence interval: 2.755-24.459), and regular stenosis morphology was associated with a higher bronchoscopic success cure rate (odds ratio: 9.463; 95% confidence interval: 3.128-28.623). Irregular airway stenosis, chondromalacia or airway collapse are key factors affecting the success rate of bronchoscopic treatment for post-intubation tracheal stenosis. Level of evidence: 4 (historically controlled studies).

Impact of the Physical Activity Environment on Change in Body Mass Index Percentile in Child Care Centers Serving Children with Disabilities.

Childcare centers (CCCs) can provide opportunities to implement physical activity (PA) via health promotion interventions to prevent obesity and associated chronic disease risk factors in young children. This study evaluated the impact of the Healthy Caregivers-Healthy Children (HC2) intervention on body mass index percentile (PBMI) and the PA environment in CCCs serving children with disabilities (CWD) over one school year. Ten CCCs were cluster-randomized to either (1) an intervention arm that received the HC2 curriculum adapted for CWD or (2) an attention control arm. Mixed-effect linear regression models analyzed the relationship between change in child PBMI and CCC childcare center PA environment by experimental condition and child disability status over one school year. Findings showed a significant decrease in PBMI among children in the HC2 centers (-6.74, p = 0.007) versus those in control centers (-1.35, p = 0.74) over one school year. Increased PA staff behaviors (mean change 3.66, p < 0.001) and PA policies (mean change 6.12, p < 0.001) were shown in intervention centers during the same period. Conversely, there was a significant increase in sedentary opportunities (mean change 4.45, p < 0.001) and a decrease in the portable play environment (mean change -3.16, p = 0.03) and fixed play environment (mean change -2.59, p = 0.04) in control centers. No significant differences were found in PBMI changes between CWD and children without disabilities (beta = 1.62, 95% CI [-7.52, 10.76], p = 0.73), suggesting the intervention's efficacy does not differ by disability status. These results underscore the importance of (1) including young CWD and (2) PA and the supporting environment in CCC health promotion and obesity prevention interventions.

Unraveling Sociocultural Influences on Leptospirosis Incidence and Prevalence: A Qualitative Study in Sri Lanka.

This study aimed to explore sociocultural determinants that might contribute to the increased prevalence and incidence of leptospirosis, and how those determinants can also hinder health promotion interventions, particularly in rural areas of Sri Lanka. Even though several epidemiological studies have been conducted on leptospirosis in the Asia-Pacific region, the sociocultural background of this disease has not received sufficient attention. Therefore, through a qualitative study involving nine public health officials and 25 infected patients in five selected health administrative divisions, we demonstrate that a set of certain sociocultural determinants influence leptospirosis incidence and its prevalence. The thematic analysis generated six themes: a lack of knowledge of the causes and consequences of leptospirosis, false illness interpretations, a lack of readiness for the disease, poor economic conditions, social capital failure, and issues within the health system at the community level. Overall, results suggest that awareness programs aimed at demystifying false interpretations of leptospirosis lie at the center of any health promotion interventions at the community level.

A Chatbot-Based Version of the World Health Organization-Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing.

Advancements in technology offer new opportunities to support vulnerable populations, such as pregnant women and women diagnosed with breast cancer, during physiologically and psychologically stressful periods. This study aims to adapt and co-design the World Health Organization's Self-Help Plus intervention into a mobile health intervention for these target groups. On the basis of the Obesity-Related Behavioral Intervention Trials and Center for eHealth Research and Disease Management models, low-fidelity and high-fidelity prototypes were developed. Prototypes were evaluated by 13 domain experts from diverse sectors and 15 participants from the target groups to assess usability, attractiveness, and functionality through semantic differential scales, the User Version of the Mobile Application Rating Scale questionnaire, and semistructured interviews. Feedback from participants indicated positive perceptions of the mobile health intervention, highlighting its ease of use, appropriate language, and attractive multimedia content. Areas identified for improvement included enhancing user engagement through reminders, monitoring features, and increased personalization. The quality of the content and adherence to initial protocols were positively evaluated. This research provides valuable insights for future studies aiming to enhance the usability, efficacy, and effectiveness of the app, suggesting the potential role of a chatbot-delivered Self-Help Plus intervention as a supportive tool for pregnant women and women with a breast cancer diagnosis.

Approaches in Training for Non-Option Special Education Teacher at Private Early Intervention Center: The Nominal Group Technique Approach

In the past, studies only focused on approaches to training for teachers in the special education field. Hence, this study develops approaches for training non-option Special Education Teachers (SETs) in private early intervention centers, addressing their lack of specialized qualifications. Seven panel experts participated in this study using the Nominal Group Technique (NGT). The findings using this approach indicate that observation, reflection, and co-teaching are essential for SET at private early intervention centers. This study aims to enhance professional development and improve educational outcomes for children with special needs by tackling the unique challenges these educators face.

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.

To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Cross-sectional survey. International. Clinicians involved in the management of MCDA twin pregnancies with sFGR. A structured, self-administered survey. Clinical practices and attitudes to diagnostic criteria and management strategies. Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management.

Balloon-expandable cobalt chromium stent versus self-expandable nitinol stent for the Atherosclerotic Iliac Arterial Disease (SENS-ILIAC Trial) Trial: a randomized controlled trial.

Iliac artery angioplasty with stenting is an effective alternative treatment modality for aortoiliac occlusive diseases. Few randomized controlled trials have compared the efficacy and safety between self-expandable stent (SES) and balloon-expandable stent (BES) in atherosclerotic iliac artery disease. In this randomized, multicenter study, patients with common or external iliac artery occlusive disease were randomly assigned in a 1:1 ratio to either BES or SES. The primary end point was the 1-year clinical patency, defined as freedom from any surgical or percutaneous intervention due to restenosis of the target lesion after the index procedure. The secondary end point was a composite event from major adverse clinical events at 1year. A total of 201 patients were enrolled from 17 major cardiovascular intervention centers in South Korea. The mean age of the enrolled patients was 66.8 ± 8.5years and 86.2% of the participants were male. The frequency of critical limb ischemia was 15.4%, and the most common target lesion was in the common iliac artery (75.1%). As the primary end point, the 1-year clinical patency as primary end point was 99% in the BES group and 99% in the SES group (p > 0.99). The rate of repeat revascularization at 1year was 7.8% in the BES group and 7.0% in the SES group (p = 0.985; confidence interval, 1.011 [0.341-2.995]). In our randomized study, the treatment of iliac artery occlusive disease with self-expandable versus balloon-expandable stent was comparable in 12-month clinical outcomes without differences in the procedural success or geographic miss rate regardless of the deployment method in the distal aortoiliac occlusive lesion (ClinicalTrials.gov, NCT01834495).