Critical Need For Interventions Research Articles

Nudging (dis)trust in science: Exploring the interplay of social norms and scientific trust during public health crises

AbstractIn times of public health crisis, such as the COVID‐19 pandemic, there is a critical need for interventions that emphasize group unification. Such interventions may motivate individuals to adhere personally and collectively to health advice, enhance national solidarity, and reduce conspiratorial beliefs among members—particularly among those who may express skepticism or distrust towards science. Across three experimental studies (Ntotal = 1604) conducted online (Experiments 1 & 3) and in a real‐world setting (Experiment 2) in Ireland and Kosovo, we assessed participants' trust in science (i.e., the extent to which they trust in science and scientists) and exposed them to one of three conditions regarding COVID‐19 health advice: compliance (i.e., the majority of ingroup members comply with the health advice), non‐compliance (i.e., the majority of ingroup members do not comply with the health advice), or no advice (i.e., control condition with no health advice information). Overall, the results showed that participants with low (vs. high) trust in science, intending to adhere to health advice and expecting ingroup members to do the same, experienced greater national solidarity and reduced their conspiracy beliefs in the compliance condition compared to noncompliance or control conditions. Participants' feelings of national solidarity explained the observed effects. In sum, this set of experimental studies shows that compliance with health advice during a health crisis not only enhances national solidarity but also promotes adherence to health behaviors and reduces conspiracy beliefs, especially among those initially skeptical of science.

Nudging (dis)trust in science: Exploring the interplay of social norms and scientific trust during public health crises

AbstractIn times of public health crisis, such as the COVID‐19 pandemic, there is a critical need for interventions that emphasize group unification. Such interventions may motivate individuals to adhere personally and collectively to health advice, enhance national solidarity, and reduce conspiratorial beliefs among members—particularly among those who may express skepticism or distrust towards science. Across three experimental studies (Ntotal = 1604) conducted online (Experiments 1 & 3) and in a real‐world setting (Experiment 2) in Ireland and Kosovo, we assessed participants' trust in science (i.e., the extent to which they trust in science and scientists) and exposed them to one of three conditions regarding COVID‐19 health advice: compliance (i.e., the majority of ingroup members comply with the health advice), non‐compliance (i.e., the majority of ingroup members do not comply with the health advice), or no advice (i.e., control condition with no health advice information). Overall, the results showed that participants with low (vs. high) trust in science, intending to adhere to health advice and expecting ingroup members to do the same, experienced greater national solidarity and reduced their conspiracy beliefs in the compliance condition compared to noncompliance or control conditions. Participants' feelings of national solidarity explained the observed effects. In sum, this set of experimental studies shows that compliance with health advice during a health crisis not only enhances national solidarity but also promotes adherence to health behaviors and reduces conspiracy beliefs, especially among those initially skeptical of science.

Work-related musculoskeletal disorders, fatigue and stress among gas station workers in China: a cross-sectional study

IntroductionWork-related musculoskeletal disorders (WMSDs) are disorders of the musculoskeletal system that have the highest prevalence among workers worldwide. Workers in gas stations usually work in poor ergonomic working conditions, including...

Mental Health, Suicidality, Health, and Social Indicators Among College Students Across Nine States in India

Background: The prevalence of mental health issues among youth is significantly high globally. This article presents findings from a survey that examined psychological distress, suicidal thoughts and behaviors, and health and social indicators among college students in India. Methods: The study recruited 8,542 students from 30 universities spanning nine Indian states, utilizing a questionnaire that included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to measure depression and anxiety symptoms. It also examined the prevalence of suicidal thoughts, attempts, non-suicidal self-injury, and other health and social factors. Results: Findings indicate that 18.8% and 12.4% of students had considered suicide over their lifetime and in the past year, respectively, with 6.7% having attempted it at some point in their lives. Among those with lifetime suicidal thoughts, more than one-third (38.1%) reported having previously disclosed these thoughts to someone, with friends being the most common confidants. Furthermore, one-third (33.6%) of participants reported moderate to severe symptoms of depression, and one-quarter (23.2%) reported moderate to severe symptoms of anxiety. Conclusions: The study revealed a significant prevalence of depressive and anxiety symptoms, as well as suicidal thoughts and attempts among college students in India. The study underscores the critical need for interventions aimed at improving mental health and supporting this demographic.

IJCM_20A: Understanding determinants of increased home deliveries in accessing antenatal care in the two blocks of the Chamba, Himachal Pradesh

Background: Maternal mortality has been declining over the years in India. Despite India achieving a maternal mortality ratio below 100 per 100,000 live births by 2020, Chamba, an aspirational district of Himachal Pradesh, still faces challenges. In Chamba, access to antenatal care (ANC) and postnatal care (PNC) remains suboptimal. Objective: To understand the perspectives of key stakeholders on barriers and facilitators for accessing ANC/PNC and institutional delivery services in the Chamba district. Methodology: The qualitative study was conducted in May and June 2023 in two blocks of the Chamba district. Around 5-6 villages were purposively selected in each block. The study encompassed 19 in-depth interviews and 7 focus group discussions involving lactating and pregnant women, family members, medical officers, and frontline healthcare workers. Additionally, the assessment of 2 labour rooms at the health facility was conducted using DAKSHATA standards. Results: The study revealed multifaceted barriers in Chamba, including challenging road conditions worsened by weather impeding timely health facility access. Women’s heavy workloads and limited awareness resulted in delayed ANC, PNC, and registration. Cultural preferences and myths hindered institutional deliveries. Transportation challenges, ambulance limitations, hospital overload, and health facility constraints amplified the difficulties. The DAKSHATA assessment indicated a mean score of 22 out of 30, stressing the need for improvements to enhance ANC, PNC, and institutional delivery access. Conclusion: The findings emphasize the critical need for interventions that enhance awareness among women, counteract cultural preferences for home deliveries and dispel prevalent myths and misconceptions. Furthermore, addressing transportation limitations, ambulance constraints, and hospital overload is crucial.

Abstract 4791: Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review

Abstract Background: Lung cancer is the leading cause of cancer-related deaths in the United States, and yet, lung cancer screening rates remain persistently low. Many interventions are being developed to address the low rates of lung cancer screening (LCS), including interventions that address the additional barriers faced by historically marginalized racial and ethnic populations as well as low-income and rural populations. However, the impact of Medicaid expansion on the types of interventions developed in non-expansion states and the efficacy of those interventions is not well understood. Methods: A research librarian conducted searches in MEDLINE via PubMed, Web of Science, and Embase. Results were screened and evaluated for eligibility by three reviewers in Covidence. Data was extracted from included studies after full-text review and analyzed using both a thematic analysis and a descriptive numerical summary of studies. The chosen framework was based on scoping review guidelines by Levac et al. and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Results: Of 4696 studies found through the initial search, 53 met inclusion criteria. This includes 34 studies in Medicaid expansion states (M) and 17 studies in non-Medicaid expansion states (NM). Two additional studies compared interventions implemented in a Medicaid expansion state to a similar intervention implemented in a non-expansion state. Studies in both groups were primarily focused on addressing disparities by race and ethnicity (M=74%; NM=65%), with fewer studies focusing on rurality (M=9%; NM=12%), income (M=9%; NM=0%), or multiple disparities (M=9%; NM=24%). In non-expansion states, the most common interventions were patient navigation (29%) and community outreach (24%). While in Medicaid expansion states, the most common interventions were EHR algorithms (24%) and decision aids (21%). The intervention setting for both Medicaid expansion and non-expansion states were most commonly in a hospital/health system (M=53%; NM=47%) or community setting (M=24%; NM=47%). Interventions in both groups typically showed some improvement in uptake of LCS, though the degree of impact was variable between studies. Conclusion: Due to continued barriers to access posed by inadequate insurance coverage, there is a critical need for interventions to reduce disparities in lung cancer mortality in states that have not expanded Medicaid. Interventions focused on patient navigation and community outreach have been effective in multiple settings in these states and could fill that gap. Citation Format: Miranda J. Reid, Caretia Washington, Meghann Wheeler, Lauren Adkins, Dejana Braithwaite, Ramzi Salloum. Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4791.

Prevalence of Elder Abuse and Its Related Factors in Isfahan, Iran

Background: Elder abuse presents a significant public health concern with implications for overall well-being. As Iran undergoes demographic aging, there is a lack of data regarding the prevalence of elder abuse. Objectives: This study aimed to provide insight into the prevalence of elder abuse in Isfahan, Iran. Methods: A cross-sectional study was conducted in Isfahan in 2021, recruiting 424 individuals aged 60 and above from the "Comprehensive Health Services Centers" through simple random sampling. Demographic information and responses to the Elderly Abuse questionnaire were collected via interviews. Descriptive statistics, including mean and confidence intervals, were utilized, while analytical methods such as independent t-tests, chi-square tests, Spearman and Pearson correlation coefficients, and logistic regression were employed for data analysis. Results: The study revealed a 36% prevalence of elder abuse across at least one category, with authority deprivation (19.6%) and emotional neglect (19.3%) being the most prevalent forms. This prevalence was higher among individuals aged 60 - 69 years (adjusted odds ratio (OR) = 2, CI (1.19 - 3.45), P = 0.01), females (adjusted OR = 2.61, CI (1.30 - 5.25), P = 0.007), retirees (adjusted OR = 4.15, CI (1.59 - 10.92), P = 0.004), and those with a history of chronic illness (adjusted OR = 2.11, CI (1.26 - 3.53), P = 0.004). Conclusions: Elder abuse emerges as a significant public health issue in Isfahan. Given the ongoing aging process nationwide, there is a critical need for interventions aimed at preventing and mitigating this public health concern.

“Provided a window on the world and lessened my feeling of isolation”: older adults’ perceived COVID-19 impact and technology use in Australia during recurrent lockdowns

BackgroundAn informed understanding of older adults’ perceptions of the impact (positive or negative) of recurrent COVID-19 long lockdowns is important for the development of targeted interventions and resources for future restrictions. This study aimed to understand self-reported impacts of COVID-19 recurrent restrictions on older adults and how technology has been used to mitigate these.MethodsA cross-sectional national study of 257 community-dwelling older Australians based in Victoria (mean age = 67.6 years [SD = 7.2]; 20.6% male) completed an online or postal survey as part of a larger study examining the physical and mental health impacts of a second extended COVID-19 lockdown period. This secondary analysis reports on the findings from free-text responses to two open-ended questions included in that survey that asked participants to comment on the greatest impacts of the COVID-19 lockdowns (positive or negative) and the role of technology in supporting their wellbeing during this time. Responses were collected between July and September 2020. Data were analysed using content (COVID-19 impacts) and thematic (role of technology) analysis.ResultsRespondents gave more negative responses (75.5%) than mixed (15.2%) and positive responses (6.2%) in reporting on the biggest impact of COVID-19 lockdowns. Inductive content analysis revealed two first-order main categories (Positive impacts and Negative impacts). Axial coding of main categories showed five second-order categories (Environmental, Physical Health, Social, Mental Health, and Personal) for both negative and positive main categories (totalling 10 second-order categories). Overall, respondents highlighted social loss as the key negative experience (70%), with acute feelings of social isolation contributing to negative impacts on mental wellbeing. The most commonly reported positive impact reported (11%) was having more time for relationships, relaxation, and new hobbies. Technology was primarily used to sustain socialisation and provide access to essential resources, services, and goods, which respondents perceived to contribute to maintaining their wellbeing.ConclusionsFindings suggest a critical need for interventions that address the social loss experienced by older adults during COVID-19 recurrent lockdowns, particularly to alleviate the associated negative impact on mental wellbeing. Recognising the positive aspect of increased time for relationships and leisure activities indicates potential areas for resilience-building strategies. The pivotal role of technology in mitigating adverse effects highlights its significance in building social connections and supporting overall wellbeing during challenging times. These implications can guide future efforts to enhance older adults’ resilience, mental health, and holistic wellbeing in future public health crises.

Health service factors affecting the COVID-19 vaccination campaign in a Ghanaian metropolis: A qualitative exploratory study

ObjectiveThe study sought to explore the perspectives of vaccinators on the health system factors that impacted the COVID-19 vaccination campaign.DesignThe study employed an exploratory-descriptive qualitative design. Key-informants’ interviews were conducted...

An epidemic behind the bars: AIDS in American prisons

Recommendation:By analyzing current research, the article provides useful strategies to prevent, detect, and treat HIV infection among the incarcerated population in the United States, emphasizing the critical need for interventions to mitigate the impact of the HIV epidemic among prisoners.Objective:The aim of this text is to present the challenges associated with the spread of the virus in the population incarcerated in correctional facilities and to emphasize the difficulties that the prison system faces in this context.Materials and Methods: Review of available literature using PubMed and Google Scholar platforms. Results and Conclusions: The article presents complex relationships between HIV infection and the prison system, emphasizing specific challenges and risk factors for infection. The history and evolution of the virus, its impact on the lives and health of prisoners, and issues related to treatment within the prison environment are discussed. The epidemiology of HIV in prisons is analyzed, pointing out positive trends, but further action is necessary. Ongoing intervention, improvement of access to healthcare, and collaboration are essential to effectively manage the issue of HIV infection among incarcerated individuals.Implications: The article implies that effective management of the HIV problem in the prison system requires a comprehensive approach, encompassing preventive strategies, equal access to healthcare, integration of care before and after release, elimination of racial and social disparities, as well as interinstitutional cooperation.

Survival Disparities By Frontline Clinical Trial Enrollment Status for Treatment of Pediatric Acute Myeloid Leukemia

Introduction: Studies have suggested superior outcomes for patients enrolled on clinical trials for their cancer treatment. While sociodemographic disparities in trial enrollment are well established in adults, the literature in children is mixed and limited. A deeper understanding of disparities in pediatric clinical trial enrollment and potential survival differences is critical to ensure the generalizability of trial results and equitable outcomes. In a cohort of children with AML, we sought to examine (1) differences in sociodemographic and clinical characteristics by trial enrollment status, (2) the impact of trial enrollment on survival, and (3) the potential drivers of survival differences. Methods: A retrospective cohort including all pediatric (age <19 years) patients with AML treated at 10 institutions in the United States from 2011-2018 was established and is being actively expanded to include diagnoses through 2023. Chart abstraction by trained study personnel collected detailed demographic and clinical information. Resource utilization data from the Pediatric Health Information System was merged to ascertain patient acuity. Higher acuity was defined as requiring ICU-level resources for 2 or more organ systems within 72 hours of diagnosis. Only patients who had a frontline therapeutic trial option available at their treating institution were included. This was operationalized as a center-level restriction to patients initiating therapy while any frontline trial was enrolling at the center. We additionally included only patients with complete data for all covariates in this analysis. Statistical Analysis: Demographic and clinical characteristics by trial enrollment status were compared using t-test or Fisher's exact test as appropriate. Cox proportional hazards regression estimated hazard ratios (HR) with a doubly robust estimator (adjusted models only) of 4-year OS and EFS by trial enrollment status. A stepwise propensity score (PS) approach assessed the impact of potential drivers of the associations between trial enrollment and overall survival (OS) and event-free survival (EFS). PS were computed by logistic regression and generated stabilized inverse probability weights used for adjustment. First, a Base PS model including a predefined set of potential confounders (age, sex, weight category, preferred language, risk classification, mean annual hospital AML volume) was created. Additional variables of interest were then sequentially added to the PS. The change in adjusted HR relative to the unadjusted comparison was used to quantify the proportion of the association explained at each step. Results: 342 pediatric patients diagnosed with AML with representation from three distinct frontline clinical trials (AAML1031, AML08, and AML16) were included. Patients who were Black (11% vs. 24%), Hispanic (24% vs. 28%), publicly insured (44% vs. 55%), higher acuity (3% vs. 8%), and high-risk classification (29% vs. 34%) were underrepresented in the trial enrollment group compared to non-trial enrolled (Table 1). In unadjusted analyses, trial enrollment was significantly associated with superior OS (HR=0.69, 95% CI 0.47-0.99, p=0.04); there was no significant difference in EFS (HR=0.95, 95% CI 0.69-1.31, p=0.75). Adjustment for the Base PS accounted for 23% of the observed association between trial enrollment and OS (Figure 1). Acuity explained an additional 7% of the association. Inclusion of race/ethnicity and insurance did not result in further adjustment. In fully adjusted analysis, the association was substantially attenuated (HR=0.93, 95% CI 0.59-1.46, p=0.76). Conclusions: Significant sociodemographic and clinical differences exist in frontline trial enrollment for pediatric AML, which may contribute to worse overall survival outcomes for patients not enrolled on trials. Acuity at diagnosis may be a potential modifiable driver of survival differences. These findings support the need to evaluate enrollment patterns across pediatric clinical trials, including how enrollment disparities impact generalizability of clinical trial results, as well as a critical need for interventions designed to improve equity in healthcare access.

College Students' Day-to-Day Maladaptive Drinking Responses to Stress Severity and Stressor-Related Guilt and Anger.

Stress is a common part of college students' daily lives that may influence their physical activity (PA) and alcohol use. Understanding features of daily stress processes that predict health behaviors could help identify targets for just-in-time interventions. This study used intensive longitudinal data to examine whether prior day stress processes predict current day PA or alcohol use. Participants (N=58, Mage=20.5, 59% women, 70% White) were 18-to-25-year-old students who engaged in binge drinking at least twice monthly and used cannabis or tobacco in the past year. They wore activity (activPAL4) and alcohol (Secure Continuous Remote Alcohol Monitor) monitors for 11 days to assess daily PA (e.g., step counts) and alcohol use (e.g., drinking day), and completed daily surveys about yesterday's stress, including number of stressors (i.e., frequency), stressor intensity (i.e., severity), and frequency of affective states (e.g., guilt). Multilevel models examined prior day stress predicting current day PA or alcohol use. Participants had higher odds of current day drinking (odds ratio=1.21) and greater area under the curve (B=0.08) when they experienced greater than usual stress severity the prior day. Participants had higher current day peak transdermal alcohol concentration (B=0.12) and area under the curve (B=0.11) when they more frequently experienced guilt due to stressors the prior day. College students' unhealthy response of increasing alcohol use due to stress could adversely impact health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

Promoting transportation safety in adolescence: the drivingly randomized controlled trial

BackgroundThe impact of young drivers’ motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens’ risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases.MethodsEligible participants are aged 16-17.33 years of age, have a learner’s permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children’s Hospital of Philadelphia’s Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation’s online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation.DiscussionMost evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence.Trial RegistrationClinicalTrials.gov # NCT03639753.

Child Sexual Abuse in Schools in India: A Critical Analysis

Purpose: The purpose of this study is to investigate the types and prevalence of Child Sexual Abuse (CSA) in India, with a focus on its widespread presence throughout the educational system. It also aims to identify and address societal, cultural, and familial risk factors for CSA. The report argues for increased awareness of minors' safety and rights, particularly those of girls, throughout their schooling years. Theoretical reference: This study employs a multidisciplinary approach, including findings from psychology, sociology, and education. It combines trauma theory, child development, and gender studies to examine the impact of CSA on minors in the educational context. Method: The study adopts a mixed-method approach, integrating qualitative interviews with survivors, instructors, and parents with a quantitative survey to examine CSA beliefs and knowledge levels. To obtain relevant insights, data is evaluated using thematic coding and statistical approaches. Result and conclusion: The study demonstrates a worrying incidence of CSA inside the Indian education system, emphasizing the critical need for intervention. It addresses significant risk factors, emphasizing the importance of education in protecting children. The findings highlight the need of effective reporting procedures and due process in protecting children's rights and safety. Implications of Research: This study emphasizes the need of educational institutions prioritizing minors' safety and well-being. It promotes the adoption of clear, accessible reporting systems as well as strong preventive initiatives. Furthermore, it emphasizes the importance of knowing and addressing teachers' and parents' views and knowledge levels in order to create a safe workplace. Originality: This study adds to the current body of knowledge by providing a thorough assessment of CSA inside the Indian school system. It gives deep insights into the special issues faced by minors, particularly girls, as well as effective preventative and intervention solutions. This research also emphasizes the critical role of educators and parents in fostering a safer learning environment.

PP08 Evaluation Of Nutritional Status In Diabetic And Non-Diabetic Chronic Kidney Disease Patients Using A Web Tool

IntroductionPoor nutritional status, a complex consequence of numerous interrelated factors, is poorly characterized in patients with chronic kidney disease (CKD) before they commence dialysis. This study aimed to characterize the risk factors and prevalence of malnutrition among patients with CKD, with or without diabetes mellitus, before they underwent dialysis at a tertiary care public teaching hospital.MethodsThis longitudinal observational study utilized a Pt-Global web tool© to assess the nutritional status of patients based on their Subjective Global Assessment score as follows: a score of two to three indicates that patient and family education is required; scores of four to eight mean that intervention is required as indicated by symptoms; and a score of nine or more indicates a critical need for intervention. Glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration equation was used as the measure of kidney function. Multinomial regression analyses were used to ascertain the predictors of poor nutritional status.ResultsA total of 450 patients (265 men and 185 women) who had CKD, with or without diabetes, and were not on dialysis were recruited during the period of study. The average age of the patients was 53.9 years (standard deviation 14.2). ‘Severe’ malnutrition was present in 152 (33.8%) patients, while 140 (31.1%) were ‘mildly or moderately’ malnourished, and 158 (35.1%) were ‘well-nourished’. Patients with CKD and diabetes were more severely malnourished: 68 were rated as mild or moderate (15.1%) and 91 were rated as severe (20.2%). The prevalence of malnutrition increased with the decline of residual renal function. Fatigue, loss of appetite, pain anywhere in the body, constipation, dry mouth, feeling full quickly, and physical and functional inactivity were the most common risk factors for poor nutritional status.ConclusionsThis study presents real-world evidence of poor nutritional status in patients with CKD and confirms that it is more common in individuals who are diabetic and have poor kidney function and hypoalbuminemia. Emphasis on nutrition in patients with CKD is important for improving their health.

Predicting medical events and ICU requirements using a multimodal multiobjective transformer network.

Effective utilization of premium hospital resources such as intensive care unit (ICU), operating theater (OT), mechanical ventilator, endotracheal tube, and so on plays a significant role in providing high-quality care to critically ill patients within reasonable costs. Non-availability of specialized resources can lead to dire consequences for such patients, and in the worst case, may even turn out to be fatal. However, these resources cannot be kept idle, as they are expensive to maintain. Therefore, one of the core functions of hospital management is targeted at planning and managing these critical resources in order to provide efficient and effective health-care services to the end-users. Predictive technologies play a big role in this. In this article, we present methods for predicting the length of stay in ICU as well as the need for critical interventions for a patient based on the vital signs, laboratory measurements, and the nursing notes of the patient prepared within the first 24 h of ICU stay. The model has been built and cross-validated on the publicly available Medical Information Mart for Intensive Care (MIMIC-III v1.4) data set. We show that the proposed model performs way better than most of the earlier models in the prediction of ICU stay, which had used patient vitals primarily. Experimental results also demonstrate the advantage of using a multiobjective model over independent models for the prediction of ICU stay and critical interventions. The proposed model uses Local Interpretable Model-agnostic Explanations (LIME) that help in identifying the features responsible for predictive decisions. This is very useful in building trust and confidence in the prediction model among clinical practitioners.

Feasibility of a peer-led, after-school physical activity intervention for disadvantaged adolescent females during the COVID-19 pandemic: results from the Girls Active Project (GAP)

IntroductionThere is a critical need for interventions that can be feasibly implemented and are effective in successfully engaging adolescent females in physical activity (PA). A theory-based, peer-led, after-school PA intervention, the Girls Active Project (GAP), was codesigned with adolescent females. This study aimed to assess the feasibility of implementing and evaluating the GAP programme.SettingOne single-sex, female-only, designated disadvantaged postprimary school (students aged 12–18) in Dublin, Ireland.MethodsMixed methods were applied with multiple stakeholders over a 12-week trial (March to May 2021). A single-arm study design was used to examine intervention: reach, dose, fidelity, acceptability, compatibility and context. Feasibility of using proposed self-reported outcome measures (moderate-to-vigorous PA levels, self-rated health, life satisfaction, PA self-efficacy and PA enjoyment) was also explored. Due to school closure resulting from the COVID-19 pandemic, the intervention was delivered both online and in person in the school setting.ResultsEight exercise classes were peer delivered by project leaders (n = 6, students aged 15–17) to intervention recipients (students aged 13-14). Recruitment was low (n = 8, 10% of eligible students, mean age: 13.3 SD: 0.46), yet retention was high (n = 7/8, 88%). Attendance rates were satisfactory (68%), and the intervention was implemented with high fidelity (87%). Data completion rates suggested proposed self-reported outcome measures were deemed appropriate (≥ 95%), except for weight (50%) and height data (80%). Despite COVID-19 hindering intervention implementation, both quantitative and qualitative data suggested that stakeholders were satisfied and perceived the in-person delivered intervention to be compatible with the school setting. Recommended refinements included extending class duration, introducing different rewards, and boosting programme awareness.ConclusionsFurther thought must be given on how to increase recruitment. Overall, the in-person delivered after-school PA programme was well-received by stakeholders and shows promise as an intervention that can be feasibly implemented and evaluated. Suggested improvements to the GAP intervention programme are recommended, before continuing to a more robust evaluation.Trial registration10.17605/OSF.IO/75HWJ (prospectively registered, date of registration: 9th December 2020)

Impact of Transition to Studying on Online Mode on the Mental Health of MBA Students in Mumbai

Coronavirus set off a global chain reaction of socioeconomic calamity and mental distress. Throughout the COVID-19 epidemic, a variety of psychological issues and serious mental health consequences emerged gradually. MBAstudents have been identified as a vulnerable group, with rates of anxiety, depression, drug misuse, and disordered eating that are greater than the overall population. As a result of the COVID-19 epidemic, the nature of their educational experience transformed radically from an offline to an online one. Measures such as social distancing, quarantine, the closure of educational institutions, and self-isolation have a negative impact on people's psychology because they increase loneliness, distrust, and reduce social interaction. Aweakened immune system or having close relatives who are susceptible to diseases increases stress, anxiety, and frustration in the population to a life-threatening level. This research is being conducted to learn more about the psychological effects of the covid19 pandemic on MBAstudents in Mumbai, such as social isolation, insomnia, frustration, and over thinking, as well as the effects of the same pandemic's shift from offline to online learning. In both primary and secondary research, the impact of psychological discomfort caused by social isolation/distancing, as well as dissatisfaction and sadness caused by overthinking about the future, is being investigated. Our findings underscore the critical need for intervention to address college students' mental health, as well as how the pandemic impacted more than simply traditional teaching and learning.

Financial burden in adults with chronic liver disease: A scoping review.

The economic burden of chronic liver disease is rising; however, the financial impact of chronic liver disease on patients and families has been underexplored. We performed a scoping review to identify studies examining financial burden (patient/family health care expenditures), financial distress (material, behavioral, and psychological consequences of financial burden), and financial toxicity (adverse health outcomes of financial distress) experienced by patients with chronic liver disease and their families. We searched MEDLINE, Embase, Cochrane Library, and the Web of Science online databases for articles published since the introduction of the Model for End-Stage Liver Disease score for liver transplantation allocation in February 2002 until July 2021. Final searches were conducted between June and July 2021. Studies were included if they examined the prevalence or impact of financial burden or distress among patients with chronic liver disease and/or their caregivers. A total of 19 observational studies met inclusion criteria involving 24,549 patients and 276 caregivers across 5 countries. High rates of financial burden and distress were reported within the study populations, particularly among patients with hepatic encephalopathy, hepatocellular carcinoma, and liver transplantation recipients. Financial burden and distress were associated with increased pre- and posttransplantation health care utilization and poor health-related quality of life as well as caregiver burden, depression, and anxiety. None of the included studies evaluated interventions to alleviate financial burden and distress. Observational evidence supports the finding that financial burden and distress are underrecognized but highly prevalent among patients with chronic liver disease and their caregivers and are associated with poor health outcomes. There is a critical need for interventions to mitigate financial burden and distress and reduce financial toxicity in chronic liver disease care.

COVID-19 and stress: An evaluation using Beck's depression and anxiety inventory among college students and faculty members of Jouf University.

Individuals might suffer emotional, psychological, and even bodily challenges as a result of any pandemic. The impact of the COVID-19 outbreak on Saudi Arabian University students and faculty members has received little attention. To assess stress during the COVID-19 pandemic among university college students and faculty members of Jouf University, KSA and evaluate the impact of socio- demographic factors on anxiety and depression levels. Two hundred and seventeen participants from Jouf University completed an anonymous web-based survey that includes questionnaires about anxiety and depression symptoms. Beck's anxiety inventory (BAI) was used to assess the anxiety levels, and Beck's depression inventory (BDI) was used to determine the depression levels due to COVID 19 pandemic. The research was carried out between April 1, 2020, and June 30, 2020. An ordinal logistic regression analysis was performed to explain the odds of observing anxiety and depression. For "moderate anxiety" (22-35), the most frequently observed category of age, nationality, gender, duration spent in lockdown and profession was 20-30 years (n = 15, 65%), Saudis (n = 14, 61%), female (n = 15, 65%),>3 months (n = 17, 74%), and students (n = 15, 65%) respectively. For "moderate depression" (21-30), the most frequently observed category of age, nationality, gender, duration spent in lockdown and profession was 20-30 years (n = 10, 50%), Saudi (n = 15, 65%), female (n = 26, 65%).>3 months (n = 13, 65%), and both students and faculty members, each with an observed frequency of 10 (50%) respectively. Ordinal logistic regression analysis suggested that the observed effects of nationality, gender, and duration spent in lockdown period influenced the anxiety levels among participants. The impact of the lockdown duration was more significant in students than in faculty members and females than in males. Authors recommend the critical need for intervention and prevention strategies to address college students' mental health.