Comprehensive Prevention Approach Research Articles

Atrial Fibrosis and Inflammation inPostoperative Atrial Fibrillation: Comparative Effects of Amiodarone, Colchicine, or Exosomes.

Extracellular vesicles (EVs) isolated from human heart-derived cells have shown promise in suppressing inflammation and fibroblast proliferation. However, their precise benefits in atrial fibrillation (AF) prevention and the role of their antifibrotic/anti-inflammatory properties remain unclear. The purpose of this study was to conduct a head-to-head comparison of antiarrhythmic strategies to prevent postoperative AF using a rat model of sterile pericarditis. Specifically, we aimed to assess the efficacy of amiodarone (a classic antiarrhythmic drug), colchicine (an anti-inflammatory agent), and EVs derived from human heart-derived cells, which possess anti-inflammatory and antifibrotic properties, on AF induction, inflammation, and fibrosis progression. Heart-derived cells were cultured from human atrial appendages under serum-free xenogen-free conditions. Middle-aged Sprague Dawley rats were randomized into different groups, including sham operation, sterile pericarditis with amiodarone treatment, sterile pericarditis with colchicine treatment (2 dose levels), and sterile pericarditis with intra-atrial injection of EVs or vehicle. Invasive electrophysiological testing was performed 3days after surgery before sacrifice. Sterile pericarditis increased the likelihood of inducing AF. Colchicine and EVs exhibited anti-inflammatory effects, but only EV treatment significantly reduced AF probability, whereas colchicine showed a positive trend without statistical significance. EVs and high-dose colchicine reduced atrial fibrosis by 46 ± 2% and 26 ± 2%, respectively. Amiodarone prevented AF induction but had no effect on inflammation or fibrosis. In this study, both amiodarone and EVs prevented AF, whereas treatment with colchicine was ineffective. The additional anti-inflammatory and antifibrotic effects of EVs suggest their potential as a comprehensive therapeutic approach for AF prevention, surpassing the effects of amiodarone or colchicine.

Primary results of the brazilian registry of atherothrombotic disease (NEAT)

There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (± 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease.ClinicalTrials.gov NCT04677725

The role of quick pain management treatments in clinical physiotherapy practice in India: Advantages, disadvantages, and recommendations

Quick pain management treatments in physiotherapy play a vital role in addressing immediate musculoskeletal or movement-related issues, providing short-term relief to patients. This article explores the reasons why patients seek quick treatments, outlines their advantages and disadvantages, and provides recommendations for a more comprehensive physiotherapy approach. The content is based on a synthesis of current literature, including scholarly articles, clinical guidelines, and textbooks in physiotherapy, pain management, and rehabilitation. Patients often seek quick treatments for reasons such as immediate relief from pain and discomfort, convenience, shorter duration, cost considerations, a preference for rapid solutions, and concerns about more invasive procedures. However, relying solely on quick treatments may mask symptoms, delay overall recovery, and increase the risk of recurrent problems. The article emphasizes the importance of education, setting realistic expectations, developing comprehensive treatment plans, empowering patients, continuous monitoring and adjustment, evidence-based practice, addressing patient concerns, and promoting long-term health goals. Physiotherapists and patients should collaborate to strike a balance between quick treatments for short-term relief and a more comprehensive approach for long-term recovery and prevention. The recommendations provided aim to enhance patient understanding, engagement, and satisfaction, ultimately contributing to improved overall outcomes in physiotherapy.

Polygenic scores for tobacco use provide insights into systemic health risks in a diverse EHR-linked biobank in Los Angeles

Tobacco use is a major risk factor for many diseases and is heavily influenced by environmental factors with significant underlying genetic contributions. Here, we evaluated the predictive performance, risk stratification, and potential systemic health effects of tobacco use disorder (TUD) predisposing germline variants using a European- ancestry-derived polygenic score (PGS) in 24,202 participants from the multi-ancestry, hospital-based UCLA ATLAS biobank. Among genetically inferred ancestry groups (GIAs), TUD-PGS was significantly associated with TUD in European American (EA) (OR: 1.20, CI: [1.16, 1.24]), Hispanic/Latin American (HL) (OR:1.19, CI: [1.11, 1.28]), and East Asian American (EAA) (OR: 1.18, CI: [1.06, 1.31]) GIAs but not in African American (AA) GIA (OR: 1.04, CI: [0.93, 1.17]). Similarly, TUD-PGS offered strong risk stratification across PGS quantiles in EA and HL GIAs and inconsistently in EAA and AA GIAs. In a cross-ancestry phenome-wide association meta-analysis, TUD-PGS was associated with cardiometabolic, respiratory, and psychiatric phecodes (17 phecodes at P < 2.7E-05). In individuals with no history of smoking, the top TUD-PGS associations with obesity and alcohol-related disorders (P = 3.54E-07, 1.61E-06) persist. Mendelian Randomization (MR) analysis provides evidence of a causal association between adiposity measures and tobacco use. Inconsistent predictive performance of the TUD-PGS across GIAs motivates the inclusion of multiple ancestry populations at all levels of genetic research of tobacco use for equitable clinical translation of TUD-PGS. Phenome associations suggest that TUD-predisposed individuals may require comprehensive tobacco use prevention and management approaches to address underlying addictive tendencies.

The Emerging Role of Wearable Health Technologies in Proactive Disease Prevention

The study gives a complete plan for lowering disease through the use of ICT in personal healthcare. The Health Pattern Recognition (HPR), Dynamic Risk Assessment (DRA), and Personalized Intervention Strategy (PIS) formulas are all parts of this method. They are used to collect, prepare, and use data. This research focuses on cybersecurity using health pattern recognition (HPR), dynamic risk assessment (DRA), and personalized intervention strategies (PIS). PIS offers a comprehensive disease prevention approach in personal healthcare that takes advantage of technological advancements. Because they integrate secure data processing with privacy-preserving machine learning, these aspects assure the safety and validity of health data collected from wearable devices. This option allows for the assessment of medical records. It may be helpful to analyze the technique's accuracy and adherence to established security standards in order to evaluate its application for disease prediction and preventive health management. The HPR program looks at each person's health information to find trends in diseases and other results using machine learning. This helps with early evaluation and healthcare management that avoids problems. DRA keeps a person's risk rating up to date so that it takes into account any changes in their health. After that, people are given choices based on the results and risks that PIS has predicted. Some of the tests that were used to compare the suggested method to industry standards were accuracy, sensitivity, specificity, precision, and the Matthews Correlation Coefficient. The suggested way seems to work because it has better predicting power, fewer fake positives, and more users who are involved in preventive health management.

Examining predictors of suicide by firearm in young, middle, and late adulthood.

Suicide remains a leading cause of death in the U.S., and firearms are one of the most lethal methods of suicide. This study examines personal and contextual factors that predict suicide with a firearm compared to other methods across stages of adulthood. Data on adult suicide decedents from 2009 to 2019 were obtained from Colorado's National Violent Death Reporting System (NVDRS) data (N = 11,512). The dataset includes incident and person characteristics collected by law enforcement and coroners. Zip code level data were integrated from the American Community Survey. Age, sex, race, marital status, military service, substance use, suicide attempt history, mental health, and location characteristics (population density, as well as age, education, veteran status, and household status of population) predicted suicide by firearm. Risk was particularly high for males in older adulthood. We further explored age-specific models (young, middle-aged, and older adults) to determine salient risk factors for each group. This study highlights the need for comprehensive suicide prevention approaches that consider both individual and contextual risk factors, as well as unique risks in each stage of adulthood.

The Burden of Childhood Iron Deficiency Anemia in a Developed Country: A Croatian Tertiary Care Center Experience.

Given the high prevalence of unrecognized iron deficiency anemia (IDA) in Croatia and its negative impact on children's somatic and neurological outcomes, a comprehensive preventive and treatment approach is a necessity. Methods: This was an observational, cross-sectional study of pediatric patients referred to the Children's Hospital Zagreb, Croatia, from 2017 to 2021, for IDA. Epidemiological and clinical data were extracted. Laboratory workup and therapeutic actions in the primary and tertiary care settings were recorded. The need for transfusion, parenteral iron therapy, and hospital admission was noted. A total of 299 patients (52.2% female, median five years) were seen by the hematologistin the five-year study period. Almost half (45.1%) were referred by the primary care pediatrician. Only half of the patients (56.6%) received oral iron therapy prior to referral. The preferred preparation was Dextriferron (67.7%) during the mean period of 5.8 months, but more than one-third of the patients (36.5%) were non-compliant. Every 10th child seen by the hematologist for IDA was admitted to the hospital; 6.4% required transfusion therapy, and in only one patient, parenteral iron was administered. Conclusions: The results of this survey established that IDA still represents an excessive burden in a tertiary care setting of a high-income country. Therefore, consistent implementation of national guidelines and additional education of primary healthcare providers is crucial to ameliorate this significant public health concern.

A Comprehensive Approach to Posttraumatic Lymphedema Surgical Treatment.

Background Posttraumatic lymphedema (PTL) is sparsely described in the literature. The aim of this study is to propose a comprehensive approach for prevention and treatment of PTL using lymphovenous anastomosis (LVA) and lymphatic vessels free flap, reporting our experience in the management of early-stage lymphedema. Methods A retrospective observational study was performed between October 2017 and July 2022. Functional assessment with magnetic resonance lymphangiography and indocyanine green lymphography was performed. Patients with lymphedema and functional lymphatic channels were included. Cases with limited soft tissue damage were proposed for LVA, and those with acute or prior soft tissue damage needing skin reconstruction were proposed for superficial circumflex iliac artery perforator lymphatic vessels free flap (SCIP-LV) to treat or prevent lymphedema. Primary and secondary outcomes were limb volume reduction and quality of life (QoL) improvement, respectively. Follow-up was at least 1 year. Results Twenty-eight patients were operated using this approach during the study period. LVA were performed in 12 patients; mean reduction of excess volume (REV) was 58.82% and the improvement in QoL was 49.25%. SCIP-LV was performed in seven patients with no flap failure; mean REV was 58.77% and the improvement QoL was 50.9%. Nine patients with acute injury in lymphatic critical areas were reconstructed with SCIP-LV as a preventive approach and no lymphedema was detected. Conclusion Our comprehensive approach provides an organized way to treat patients with PTL, or at risk of developing it, to have satisfactory results and improve their QoL.

Analysis of the Ability of Different Allografts to Act as Carrier Grafts for Local Drug Delivery

Bone defects and infections pose significant challenges for treatment, requiring a comprehensive approach for prevention and treatment. Thus, this study sought to evaluate the efficacy of various bone allografts in the absorption and release of antibiotics. A specially designed high-absorbency, high-surface-area carrier graft composed of human demineralized cortical fibers and granulated cancellous bone (fibrous graft) was compared to different human bone allograft types. The groups tested here were three fibrous grafts with rehydration rates of 2.7, 4, and 8 mL/g (F(2.7), F(4), and F(8)); demineralized bone matrix (DBM); cortical granules; mineralized cancellous bone; and demineralized cancellous bone. The absorption capacity of the bone grafts was assessed after rehydration, the duration of absorption varied from 5 to 30 min, and the elution kinetics of gentamicin were determined over 21 days. Furthermore, antimicrobial activity was assessed using a zone of inhibition (ZOI) test with S. aureus. The fibrous grafts exhibited the greatest tissue matrix absorption capacity, while the mineralized cancellous bone revealed the lowest matrix-bound absorption capacity. For F(2.7) and F(4), a greater elution of gentamicin was observed from 4 h and continuously over the first 3 days when compared to the other grafts. Release kinetics were only marginally affected by the varied incubation times. The enhanced absorption capacity of the fibrous grafts resulted in a prolonged antibiotic release and activity. Therefore, fibrous grafts can serve as suitable carrier grafts, as they are able to retain fluids such as antibiotics at their intended destinations, are easy to handle, and allow for a prolonged antibiotic release. Application of these fibrous grafts can enable surgeons to provide longer courses of antibiotic administration for septic orthopedic indications, thus minimizing infections.

Preventing sexual violence among high school students through norms correction and bystander intervention: A school-based cluster trial of Your Voice Your View.

Risk for sexual violence begins early in the lifespan; thus, interventions are needed to decrease the risk for sexual violence among high school youth. The current study evaluates the Your Voice Your View (YVYV) sexual violence prevention program using a school-based cluster trial among 26 high schools in the Northeastern United States. YVYV, includes: 1) a series of four classroom workshops designed to engage students as allies in violence prevention through bystander intervention skills training, address risks for sexual aggression, and reduce risk for victimization; 2) a Lunch and Learn teacher training workshop; and 3) a 4-week social norms poster campaign based on normative data from the school. Schools were matched based on size and demographics and randomly assigned to the intervention group or a wait-list control group. A sample of 2685 10th grade students enrolled in the research and completed assessments at baseline, 2-month and 6-month follow-up periods. The magnitude of the difference in sexual aggression did not vary by condition at either follow-up period. The magnitude of 6-month differences in experiencing unwanted sexual intercourse varied significantly by condition (IRR = 0.33 [0.14-0.76]), demonstrating a small protective effect favoring intervention schools (Cohen's f2 = 0.012). These findings highlight the promise of multicomponent interventions grounded in bystander intervention skills training, risk reduction, and social norms theory as a promising, comprehensive approach for sexual violence prevention among youth.

A biopsychosocial approach assessing pain indicators among Black men.

The lack of empirical evidence documenting the pain experience of Black men may be the result of social messaging that men are to project strength and avoid any expression of emotion or vulnerability. This avoidant behavior however, often comes too late when illnesses/symptoms are more aggressive and/or diagnosed at a later stage. This highlights two key issues - the willingness to acknowledge pain and wanting to seek medical attention when experiencing pain. To better understand the pain experience in diverse raced and gendered groups, this secondary data analysis aimed to determine the influence identified physical, psychosocial, and behavioral health indicators have in reporting pain among Black men. Data were taken from a baseline sample of 321 Black men, >40 years old, who participated in the randomized, controlled Active & Healthy Brotherhood (AHB) project. Statistical models were calculated to determine which indicators (somatization, depression, anxiety, demographics, medical illnesses) were associated with pain reports. Results showed that 22% of the men reported pain for more than 30 days, with more than half of the sample being married (54%), employed (53%), and earning an income above the federal poverty level (76%). Multivariate analyses showed that those reporting pain were more likely to be unemployed, earn less income, and reported more medical conditions and somatization tendencies (OR=3.28, 95% CI (1.33, 8.06) compared to those who did not report pain. Findings from this study indicate that efforts are needed to identify the unique pain experiences of Black men, while recognizing its impact on their identities as a man, a person of color, and someone living with pain. This allows for more comprehensive assessments, treatment plans, and prevention approaches that may have beneficial impacts throughout the life course.

Workplace alcohol and other drug policy and support services in the United States, 2015-2019.

Despite their growing popularity, the extent and nature of workplace alcohol and other drug (AOD) policy and support services in the United States remain unclear. The present study examined the availability of AOD policies and support services in workplaces. Also, the associations between a combination of these workplace measures and the current AOD consumption (focusing on binge drinking, use of marijuana and other illicit drugs, and nonmedical use of prescription drugs) were assessed. Pooled Data from the 2015-2019 National Survey on Drug Use and Health (NSDUH) were utilized to examine a nationally representative sample of 131,751 employed adults. First, the rates of those who reported having a written AOD policy at their workplaces among the total sample and subpopulations across socioeconomic status, and those who reported an employee assistance program or other counseling services for substance use problems were estimated. Then the associations between a combination of the two workplace measures and individuals' current AOD consumption were tested using multinomial logistic regression analyses. Although 77.2% of employed individuals reported having a written AOD policy at their workplaces, only 50% of the sample had access to support services for substance use problems. The limited access to support services was most notable among traditionally disadvantaged groups (e.g., females, Hispanics, and individuals with limited English proficiency). The models suggest that having both a workplace AOD policy and support services was associated with significantly lower rates of marijuana and other illicit drug use compared to having neither of the two measures or only support services. Regardless of workplace AOD policies, the limited availability of support services, especially for disadvantaged workers, raises concerns. While further investigation is needed to understand the effectiveness of the comprehensive prevention approaches at workplaces, it is also important to advocate for the potential benefits of having employee assistance or other services available along with AOD policies.

Circumstances Contributing to Suicide Among U.S. Adolescents Aged 10–19 Years With and Without a Known Mental Health Condition: National Violent Death Reporting System, 2013–2018

PurposeSuicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death. MethodsLogistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021). ResultsDecedents with a known mental health condition were 1.2–1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death. DiscussionA comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.

Adolescent sexual risk behaviors and participation in structured leisure activities (SLA): Role of socio-demographic characteristics and school-related behaviors

Adolescence is the transitional period between childhood and adulthood during which many physical, cognitive, social and emotional changes take place, characterized by an increasing interest in romantic and sexual relationships. During adolescence, young people enter into their first sexual partnerships. This may involve behaviors referred to as sexual risk behaviors. The aim of this study was to gain insight into the prevalence of sexual risk behaviors and to determine whether socio-demographic characteristics and school-related behaviors contribute to sexual risk behaviors among adolescents, independent of participation in SLA. The study was conducted from April to June 2021 in Croatia. The sample consisted only of students who reported having had sexual intercourse (N=702; 28.6%). Participants were between 14 and 21 years (46.3% female). Logistic analyses were conducted. The results of this study showed that socio-demographic characteristics make only a limited contribution to the sexual risk behaviors studied. However, it is evident that school-related behaviors are associated with sexual risk behaviors among adolescents, with slight differences depending on their participation in SLA. That is, better grades are a protective factor for sexual risk behavior for both those who do not participate in SLA and those who do, while intentionally skipping school is a risk factor for sexual risk behavior only for those who do participate in SLA. Even though the results show that some school-related behaviors are predictors of sexual risk behavior, it is not enough to implement preventive interventions only in school or leisure settings. It is important to intervene in all areas that influence adolescent development, because a comprehensive preventive approach that addresses all areas can have a greater impact on adolescent development. Therefore, it is necessary to plan comprehensive, evidence-based interventions targeting individuals and their environments, including SLA, to prevent sexual risk behaviors among adolescents.

Abstract 13816: The Hypertension Care Cascade in 2019-21: A Nationally Representative Study of 1.9 Million Adults in India

Introduction: Previous studies from India reported management of hypertension (diagnosed: 45%, treated: 13%) among adults 15-49 years, a fraction of those suffering from disease. This study aimed to provide nationally-representative estimates of (i) the proportion of all adults (18+ years) with prehypertension and hypertension (HTN), and (ii) the heterogeneity in their cascade of care by natal sex, age, and urbanicity. Methods: Using data from non-pregnant women (n = 959,468) and men (n = 935,829) in the National Family Health Survey-V (2019-21), we estimated the sex-specific prevalence of prehypertension and HTN (see footnotes of Figure ), and among adults with HTN, the self-reported care cascade (ever screened, diagnosed, taking medication, under control defined by normotension). All estimates incorporated the complex survey design and were stratified by urban versus rural or by age group (18-39, 40-64, 65+). Results: Nationally, the prevalence of prehypertension and HTN were 19.1% (95%CI: 18.9,19.2) and 27.7% (95%CI: 27.5, 27.8) respectively. The prevalence of prehypertension was similar in urban areas (vs rural) among men (%; 23.2 vs 21.7) and women (%; 16.7 vs 16.1). Prevalence of HTN was higher in urban areas (vs rural) among men (%; 30.9 vs 27.2) and women (28.8 vs 26.2). Both prehypertension and HTN were higher with increasing age. Prevalence of screening in the total population was 56%, and was higher in urban areas, among women and higher with age. Among those with HTN, only 40%, 23%, and 10% being diagnosed, taking medication, and under control, respectively. Diagnosis, treatment and control were higher in urban areas, women, and older age groups ( Figure ). Conclusions: Despite the high prevalence of hypertension, there is a high unmet need at each step of care cascade nationally, especially in rural adults. Moreover, the prevalence of prehypertension is high in rural areas, and those under 40 years, requiring a comprehensive approach for prevention and management.

Abstract 13817: Diabetes Prevalence, Screening, Diagnosis, Treatment and Control in India: A Cross-Sectional Study of Individuals Aged 18 Years and Older

Previous studies from India reported management of diabetes (diagnosed: 53%, treated: 41%) among adults 15-49 years, a fraction of those suffering from disease. This study aimed to provide nationally-representative estimates of (i) the proportion of all adults (18+ years) with prediabetes and diabetes mellitus (DM), and (ii) the heterogeneity in their cascade of care by natal sex, age, and urbanicity. Methods: Using data from non-pregnant women (n = 959,468) and men (n = 935,829) in the National Family Health Survey-V (2019-21), we estimated the sex-specific prevalence of prediabetes and DM (see footnotes of Figure ), and among adults with diabetes, the self-reported care cascade (ever screened, diagnosed, taking medication, under control defined by normoglycemia). All estimates incorporated the complex survey design and were stratified by urban versus rural or by age group (18-39, 40-64, 65+). Results: Nationally, the prevalence of prediabetes and DM were 11.3% (95%CI: 11.1,11.4) and 6.5% (95%CI: 6.4, 6.6) respectively. Prediabetes was similar in urban areas (vs rural areas) among men (%; 12.9 vs 12.0) and women (%; 11.1 vs 10.1). DM was higher in urban areas (vs rural areas) among men (%; 8.8 vs 5.6) and women (9.0 vs 5.3). Both prediabetes and DM were higher with increasing age. Screening in the total population was 30%, and was higher in urban areas, among women and higher with age. Among those with DM, only 72%, 51%, and 29% reported being diagnosed, taking medication, and under control, respectively. Diagnosis, treatment and control were also higher in urban areas, women, and older age groups ( Figure ). Conclusions: Despite the high prevalence of diabetes, there is a high unmet need in screening, diagnosis, treatment and control of disease nationally, and this is pronounced in rural adults. Moreover, the prevalence of prediabetes is high in rural areas, and those under 40 years, requiring a comprehensive approach for prevention and management.

Caregivers' experiences and perceptions of suicidality among their children and youth with fetal alcohol spectrum disorder.

Individuals with Fetal Alcohol Spectrum Disorder (FASD) experience a range of biopsychosocial vulnerabilities that can increase the possibility of adverse life outcomes, including a heightened risk of suicidality. In this study, we explored the lived experiences of caregivers of children and youth with FASD and suicidality, including their perceptions of their child and youth's suicidal experiences. Between March and June 2021, six comprehensive, semi-structured interviews were conducted with five caregivers of children and youth with FASD (Mage = 14.5 years, range 11–22) who were currently experiencing suicidality or had a history of suicidality. Data were analyzed using interpretative phenomenological analysis and then developed into a composite vignette informed and organized by the social-ecological suicide prevention model (SESPM). The composite vignette revealed the narratives of families living with and caring for children and youth with FASD who experience suicidality in relation to the complex and intersectional individual, relational, community, and societal level contextual and protective factors. Findings from this study highlight the critical need for comprehensive FASD-informed suicide prevention and intervention approaches to promote the mental health and wellbeing of children and youth with FASD and their caregivers.

Diabetes care and prevention services provided by pharmacists: Progress made during the COVID-19 pandemic and the need for additional efforts in the post-pandemic era

Diabetes is a challenging metabolic disease that significantly impacts people's health worldwide. It requires a comprehensive approach for better prevention and control, especially during challenging times such as the recent pandemic. The COVID-19 pandemic has altered how health care professionals, including pharmacists, provide health care. With the widespread use of virtual and online platforms for service delivery, pharmacist-led diabetes care has been transformed to meet the needs of patients during the pandemic. This article aims to discuss examples of pharmacist-led diabetes care services during the pandemic and highlight areas where additional pharmacist efforts are needed in the post-pandemic era.

Formative evaluation of Zero Suicide in the emergency department: Identifying strategies to overcome implementation barriers

BackgroundZero Suicide has been widely promoted as a comprehensive suicide prevention approach in healthcare systems, yet less is known about the barriers to implementing this approach in the emergency department. ObjectivesThis developmental evaluation aimed to assess emergency department providers’ perceived knowledge and self-efficacy regarding suicide prevention practices, as well as apply the Consolidated Framework for Implementation Research to explore potential facilitators and barriers to implementing Zero Suicide and identify strategies to overcome barriers. MethodsA sequential mixed methods approach was used, including a survey assessing emergency department providers’ perceived knowledge and attitudes and semi-structured interviews exploring potential determinants of implementation. ResultsSurvey respondents (n = 43) perceived that they have the knowledge and self-efficacy to implement clinical elements of Zero Suicide; however, interview participants (n = 18) revealed that some clinical elements are not implemented consistently and perceive implementation barriers across multiple levels, including limited training on suicide risk assessment and limited resources needed to engage and re-engage at-risk patients in their suicide care management plan and provide follow-up supportive contacts during patients’ transitions in care. ConclusionTo overcome identified barriers in this setting, targeted implementation strategies are needed, including integration in electronic health record systems, leadership advocacy, and ongoing staff training.

Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial.

BackgroundMedical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches.ObjectiveThis study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated.MethodsIn this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants’ identified PF training needs at each log-in or nonindividualized.ResultsBurnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group.ConclusionsThe findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions.Trial RegistrationAustralian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspxInternational Registered Report Identifier (IRRID)PRR1-10.2196/32992