Effective Interventions Research Articles

Outcomes of Non-Penetrating versus Penetrating Deep Sclerectomy in Open-Angle Glaucoma.

In this retrospective study, Non-Penetrating-Deep-Sclerectomy and Penetrating-Deep-Sclerectomy interventions showed similar >90% complete success rates at one-year post-surgery. However, Non-Penetrating-Deep-Sclerectomy achieved a superior safety profile in terms of best-corrected visual acuity recovery and rates of post-surgical complications. Comparing the surgical outcomes of two surgical techniques: non-penetrating deep sclerectomy (NPDS) and penetrating deep sclerectomy (PDS). This was a retrospective, longitudinal, comparative study including 66 eyes from 57 patients aged 69±9 years who underwent either NPDS or PDS for medically uncontrolled open-angle glaucoma. Outcome measurements included intraocular pressure (IOP), best-corrected visual acuity (BCVA), rates of complications, post-operative corrective interventions and glaucoma medications at baseline and at all post-operative appointments up to 1 year. An exploratory mixed-effects model was used to assess the intergroup differences for IOP and BCVA. One-year post-surgery, similar significant IOP reduction from baseline were observed in NPDS (from 19,9±1.3 to 11.5±0.9mmHg, P<0.001) and PDS (from 19,5±1,1 to 10.7±0.6mmHg, P<0.001). A conservative complete success rate (defined as medicated IOP ≤16mmHg and ≥20% reduction in IOP) was of 87% for NPDS and 97% for PDS. No BCVA changes were observed between baseline and 1-year post-surgery in both groups, and glaucoma medications showed a similar 10-fold reduction in both groups (P<0.001 vs. baseline). However, a significant difference in the speed of post-operative BVCA recovery was observed between NPDS and PDS (P<0.01), NPDS showing a faster recovery. Moreover, lower numbers of post-surgical complication and post-operative interventions were observed following NPDS compared to PDS (NPDS n=30 and 34 vs. PDS n=80 and 48 (P<0.05), respectively). The present study confirmed that both NPDS and PDS are highly effective surgical interventions for the management of primary open angle glaucoma. However, NPDS had a superior safety profile, in terms of BCVA recovery, complication rates and post-operative interventions.

A Qualitative evaluation in community settings in England exploring the experiences of coaches delivering the NHS Low Calorie Diet programme pilot to ethnically diverse participants

BackgroundThe management of type 2 diabetes (T2D) within diverse ethnic populations requires a culturally tailored approach. However, little is known about the experiences of coaches delivering interventions for T2D, such...

The impact of social media intervention based on functional motivation on repeat blood donation behavior: A prospective randomized controlled trial study.

Blood plays an irreplaceable role in medical care. Low retention rate among blood donors is the major issue in China. Various functional motivations can encourage blood donors to participate in blood donation. Therefore, it is necessary to conduct research studies on re-donate behavior based on functional motivations. This study aimed to evaluate the impact of social media intervention based on functional motivation, to discover effective intervention methods to improve re-donate rate among nonregular blood donors. In 2022-2023, 726 adults aged 18-55 years were randomized into the intervention or control group. Over 6 months, the intervention group received science popularization via social media. After the follow-up period, re-donate rate and functional motivation were assessed. Statistical analyses included t-test, chi-square test, logistic regression analysis, and analysis of variance. Five hundred and sixty-eight participants completed the intervention survey. Overall, the repeat blood donation rate in the intervention group (18.1%) was significantly higher than the control group (4.2%) (p < .001). After the intervention, understanding, protection, sensation, and values motivation increased (p < .001). The changes in functional motivations vary across different age groups. In the 18-30 age group, understanding motivation increased (p < .001), while in the 31-45 and 46-55 age groups, protection motivation increased (p < .001). In the groups donating blood 3 time and 4 time, protection motivation increased (p < .05), and in the group donating blood 4 times, the values motivation increased (p < .05). Social media intervention based on functional motivation can effectively increase the re-donate rate. Understanding, protection, sensation, and values motivations can directly influence the re-donate behavior.

Social Work Services – An Effective Intervention in Dealing with Problems of Families having Children with Autism

Social Work Services – An Effective Intervention in Dealing with Problems of Families having Children with Autism

The assessment of pathways towards suicide in adolescent patients: A PDM-2-oriented approach.

Increasing evidence has supported the mutual relationship between suicidal motivations and personality pathology, especially in adolescence. Distinctive aspects of personality functioning can explain the tendency to resort to suicidal ideation and behaviours, which, in turn, may play a specific role in exacerbating severe impairments in self-regulation mechanisms that underlie personality pathology. This study illustrates, through two clinical cases, the clinical utility of using the Psychodynamic Diagnostic Manual - Second Edition (PDM-2) to better understand distinct pathways of suicidal processes. Two adolescents, named Luis and Gael, who attempted suicide multiple times were assessed using the Psychodiagnostic Chart Adolescent (PDC-A) of the PDM-2 to evaluate their mental functioning, emerging personality styles or syndromes, and symptom patterns. They were interviewed using the Motivational Interview for Suicidality in Adolescence (MIS-A) to identify the motivations underpinning their suicidal behaviour. The results showed that Luis presented a narcissistic personality characterized by the need to deny his vulnerabilities through suicidal fantasies as a form of escape, while Gael presented a borderline personality characterized by the use of suicide attempts to express her inner and unspeakable pain. The study seems to support the reciprocal interconnections between personality functioning and suicidal motivations that should be better identified to plan tailored and more effective interventions.

Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study.

The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating.

Text Messages With Financial Incentives for Men With Obesity: A Randomized Clinical Trial.

Effective weight loss interventions are needed for men with obesity. To determine whether an intervention that combined text messaging with financial incentives attained significant weight loss at the 12-month follow-up compared with the control group and whether an intervention of text messaging alone attained significant weight loss at the 12-month follow-up compared with the control group. An assessor-blinded randomized clinical trial conducted in Belfast, Bristol, and Glasgow areas in the UK. A total of 585 men with body mass index (BMI) of 30 or more were enrolled between July 2021 and May 2022. Final follow-up occurred June 2023. Participants were randomly assigned to 12 months of behavioral focused text messages combined with financial incentives (n = 196), 12 months of behavioral focused text messages alone (n= 194), or a waiting list (control group; n= 195). The financial incentive consisted of a monetary reward that was lost if weight loss targets were not met. All participants received weight management information and a pedometer at baseline. The 2 primary comparisons were the 12-month comparison of within-participant weight change between the text messaging with financial incentive group and the control group and the comparison between the text messaging alone group and the control group (minimum clinically important difference, 3%). The P value defined for statistical significance was P < .025 for each comparison. Of the 585 men (mean [SD] age, 50.7 [13.3] years; mean weight, 118.5 [19.9] kg; mean BMI, 37.7 [5.7]; 525 [90%] White), 227 (39%) lived in postal code areas with lower socioeconomic status, and 426 (73%) completed the 12-month follow-up. At the 12-month follow-up, compared with the control group, the mean percent weight change was significantly greater in the text messaging with financial incentive group (mean difference, -3.2%; 97.5% CI, -4.6% to -1.9%; P < .001) but was not significantly greater in the text messaging alone group (mean difference, -1.4%; 97.5% CI, -2.9% to 0.0, P = .05). The mean (SD) weight changes were -5.7 (7.4) kg for the text messaging with financial incentives group, -3.0 (7.5) kg for the text messaging alone group, and -1.5 (6.6) kg for the control group. The 12-month mean (SD) percentage weight changes from baseline were -4.8% (6.1%) for the text messaging with financial incentives group, -2.7% (6.3%) for text messaging alone group, and -1.3% (5.5%) for the control group. Of 366 adverse events reported, the most common were infections (83 [23%]). Of the 23 serious adverse events (6.3%), 12 (52%) occurred in the text messaging with financial incentives group, 5 (22%) in the texts messaging alone group, and 6 (26%) in the control group. None were considered related to participating in a trial group. Among men with obesity, an intervention with text messaging with financial incentive significantly improved weight loss compared with a control group, whereas text messaging alone was not significantly better than the control condition. These findings support text messaging combined with financial incentives to attain weight loss in men with obesity. isrctn.org Identifier: ISRCTN91974895.

Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson's disease: a randomized controlled trial.

The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking. To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD. A single-center randomized, single-blind controlled study. University laboratory; outpatient. Individuals with idiopathic PD. Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I). The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group. Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training. The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.

Risk factors for delayed colorectal postpolypectomy bleeding: a meta-analysis

BackgroundTo systematically analyze risk factors for delayed postpolypectomy bleeding (DPPB) in colorectum.MethodsWe searched seven large databases from inception to July 2022 to identify studies that investigated risk factors for DPPB. The effect sizes were expressed by relative risk (RR) and 95% confidence interval (95% CI). The heterogeneity was analyzed by calculating I2 values and performing sensitivity analyses.ResultsA total of 15 articles involving 24,074 subjects were included in the study. The incidence of DPPB was found to be 0.02% (95% CI, 0.01–0.03), with an I2 value of 98%. Our analysis revealed that male sex (RR = 1.64), history of hypertension (RR = 1.54), anticoagulation (RR = 4.04), polyp size (RR = 1.19), polyp size ≥ 10 mm (RR = 2.43), polyp size > 10 mm (RR = 3.83), polyps located in the right semicolon (RR = 2.48) and endoscopic mucosal resection (RR = 2.99) were risk factors for DPPB.ConclusionsMale sex, hypertension, anticoagulation, polyp size, polyp size ≥ 10 mm, polyps located in the right semicolon, and endoscopic mucosal resection were the risk factors for DPPB. Based on our findings, we recommend that endoscopists should fully consider and implement effective intervention measures to minimize the risk of DPPB.

Assessing Mental Health and Psychological Wellbeing in Medical Students: A Systematic Review

Medical students' psychological wellbeing is a growing concern. However, the methods used and outcomes measured in studies evaluating psychological wellbeing lack consistency given their wide and diverse array. This systematic review aims to characterise and comprehensively evaluate the outcomes measured and methods used in studies assessing psychological wellbeing among medical students. A consensus on the constructs and methods used in indexing psychological wellbeing can lead to more effective assessments and consequently more effective interventions aimed at promoting wellbeing in medical students. Methods: Multiple databases were searched, including Medline, PsycINFO, Cochrane Library, and Web of Science. Grey literature was searched through Google Scholar, and reference lists of the included studies were further searched. Results: Forty-five studies were included, and findings were integrated into a narrative synthesis. The results showed that various methods were used and various outcomes were measured to index medical students’ mental wellbeing; outcomes tapped on stress, depression, anxiety, burnout, and minor psychiatric disorders as wellbeing indicators while commonly used measures were the General Health Questionnaire, Oldenburg Burnout Inventory, Perceived Stress Scale and Depression Anxiety Stress Scale. Self-reported measures and quantitative designs predominated, focusing on negative indicators of wellbeing. The findings of this systematic review highlighted the vast heterogeneity in outcomes measured and methods used in studies assessing psychological wellbeing in medical students. Conclusions: Homogeneity in the measures and outcomes used to assess wellbeing is necessary to improve the comparability and reliability of findings among studies. Future research should also use validated measures that capture both positive and negative aspects of psychological wellbeing to gain a more comprehensive understanding of the factors that can promote positive psychological wellbeing; and consequently, to inform the development of more effective interventions tailored to the mental health needs of medical students.

The effect of education on safe use of pesticides based on the health belief model

ObjectiveIn agricultural activities, pesticide use is critical, but poisoning issues are one of the most important occupational hazards for farmers. Training can help protect farmers’ health from pesticide hazards. This study aimed to investigate the effect of education on farmers’ behavior in the safe use of pesticides using the health belief model.MethodsA quasi-experimental (pretest-post-test) study conducted on 84 farmers who were selected using the convenience sampling method. The data collection tool was a two-part questionnaire including demographic information and a questionnaire designed based on the constructs of the health belief model in using personal protective equipment while working with the pesticides. The instrument was completed before and two weeks after an educational intervention. Data analysis was performed using SPSS software version 26.ResultsThe mean age of the participants was 48.94 ± 9.14 years and 69% were male. The study showed that with increasing age, the mean score of health belief model constructs in the safe use of pesticides decreased. Female and higher-educated farmers had higher scores. After the intervention, the mean scores of health belief model constructs in the safe use of pesticides increased significantly, except perceived barriers construct which decreased significantly. Also, the frequency of protective equipment uses while working with pesticides increased significantly after the intervention and safe behaviors increased, while unsafe behaviors decreased.ConclusionThe education as an effective intervention, improves farmers’ safety attitudes and behaviors in pesticide use and it is recommended that educational programs be designed according to the characteristics of the audience.

Impact of Socioeconomic Factors and Health Insurance Coverage on Out-of-Pocket Health Expenditure among Ghanaian Women: Implications for Health Financing Policy

Background. The cost of health financing is an age-long social challenge in resource-constrained settings. Out-of-pocket (OOP) health spending adversely affects maternal healthcare provisions and use, making health insurance one of the most effective social interventions. Objective. The purpose of this research was to study the effect of OOP health expenditure on socioeconomic factors and health insurance coverage among Ghanaian women. Materials and Methods. Secondary statistical data pulled out from Ghana Demographic and Health Survey (GDHS)—2014 was investigated. A sample of 9,396 women whose ages ranged from 15 to 49 years was studied. We used marginal predictive model to examine the interaction effect between socioeconomic factors and health insurance coverage on OOP health expenditure. The significance level was determined at 5%. Results. Overall, about 41.9% (95% CI: 39.4%−44.4%) of Ghanaian women reported OOP health expenditure for drugs and services. Amongst those covered by health insurance, this was 37.9% (95% CI: 35.3%−44.4%). The marginal interaction effects of OOP health expenditure were higher for women in the lowest neighborhood socioeconomic disadvantage group (42.6%) than those in the highest neighborhood socioeconomic disadvantage group (26.0%) who were covered by health insurance. In addition, the marginal interaction effects of OOP health expenditure were found to be greater among women who had higher education (43.8%) compared with those who had no formal education (34.0%) who were covered by health insurance. Furthermore, the marginal interaction effects of OOP health expenditure were higher for rural (39.0%), than their urban counterpart (36.6.0%) who were under the covering of health insurance. Conclusion. There is a gap in health insurance coverage, which leads to increased OOP health expenditure. The OOP health expenditure effect was more concentrated among high socioeconomic women with health insurance. The healthcare system’s stakeholders should implement policies aimed at eliminating OOP health expenditure for maternal health services.

The association between energy‐adjusted dietary inflammatory index and 10‐year cardiovascular risk: Fasa adult cohort study

AbstractA healthy diet is dominant in cardiovascular disease (CVD) prevention. Inflammation is pivotal for CVD development. This study aimed to evaluate the association between the pro‐inflammatory diet and the CVD risk. This cross‐sectional study involved 10,138 Fasa adult cohort study participants. After excluding participants with missing data, the Energy‐Adjusted Dietary Inflammatory Index (E‐DII) was calculated to assess the inflammatory potential of diet using the recorded Food Frequency Questionnaire. Framingham risk score (FRS) was used to predict the 10‐year risk of CVD. The association between E‐DII and high risk for CVD was investigated using multinominal regression. After exclusion, the mean age of studied individuals (n = 10,030) was 48.6 ± 9.6 years, including 4522 men. Most participants were low risk (FRS &lt;10%) for CVD (87.6%), while 2.7% of them were high risk (FRS ≥20%). The median FRS was 2.80 (1.70, 6.30). The E‐DII ranged from −4.22 to 4.49 (mean E‐DII = 0.880 ± 1.127). E‐DII was significantly associated with FRS. This result persisted after adjusting for confounding factors and in both genders. This study revealed that the pro‐inflammatory diet significantly increases the CVD risk. Consequently, reducing the inflammatory potential of diet should be considered an effective dietary intervention in CVD prevention.

404-error "Disease not found": Unleashing the translational potential of -omics approaches beyond traditional disease classification in heart failure research.

The emergence of personalized medicine, facilitated by the progress in -omics technologies, has initiated a new era in medical diagnostics and treatment. This review examines the potential of -omics approaches in heart failure, a condition that has not yet fully capitalized on personalized strategies compared to other medical fields like cancer therapy. Here, we argue that integrating multi-omics technology with systems medicine approaches could fundamentally transform heart failure management, moving away from the traditional paradigm of 'one size fits all'. Our review examines how omics can enhance understanding of heart failure's molecular foundations and contribute to a more comprehensive disease classification. We draw attention to the current state of medical practice that only relies on clinical evidence and a number of standard laboratory tests. At the same time, we propose a shift towards a universal approach that uses quantitative data from multi-omics to unravel complex molecular interactions. The discussion centres around the potential of the transition as a means to enhance individual risk assessment and emphasizes management within clinical settings. While the use of omics in cardiovascular research is not recent, many past studies have focused only on a single omics approach. In order to achieve a better understanding of disease mechanisms, we explore more holistic approaches using genomics, transcriptomics, epigenomics, and proteomics. This review concludes with a call to action to adopt multi-omics in clinical trials and practice to pave the way for more personalized disease management and more effective heart failure interventions.

Top predator status and trends: ecological implications, monitoring and mitigation strategies to promote ecosystem-based management

The conservation and management of marine ecosystems hinge on a comprehensive understanding of the status and trends of top predators. This review delves into the ecological significance of marine top predators, examining their roles in maintaining ecosystem stability and functioning through an integrated analysis of current scientific literature. We first assess the efficacy of various monitoring methods, ranging from traditional field observations to cutting-edge technologies like satellite tracking and environmental DNA (eDNA) analysis and evaluating their strengths and limitations in terms of accuracy, spatial coverage, and cost-effectiveness, providing resource managers with essential insights for informed decision-making. Then, by synthesizing data from diverse marine ecosystems, this study offers a comprehensive overview of the trends affecting top predator populations worldwide. We explore the multifaceted impacts of human activities, climate change, and habitat degradation on the abundance and distribution of these key species. In doing so, we shed light on the broader implications of declining top predator populations, such as trophic cascades and altered community structures. Following a thorough assessment of successful strategies for reversing the decline of top predators, a compilation of recommendations is presented, encompassing effective governance interventions. A crucial aspect of effective ecosystem-based management is the implementation of robust monitoring strategies. Mitigation measures are imperative to reverse the adverse impacts on marine top predators. We present a comprehensive array of mitigation options based on successful case studies. These include the establishment of marine protected areas, the enforcement of fisheries regulations, and the promotion of sustainable fishing practices. We deepen the synergies between these strategies and their potential to mitigate human-induced stressors on top predator populations to safeguard their pivotal role in maintaining marine ecosystem structure and function. By examining marine top predators’ ecological significance, analyzing population trends, discussing monitoring techniques, and outlining effective mitigation strategies, we provide a comprehensive resource for researchers, policymakers, and stakeholders engaged in fostering ecosystem-based management approaches. We conclude that integrating these insights into current management frameworks will be essential to safeguard both top predators and the broader marine environment for future generations.

Potential Stem Cell Treatment for Common Hip Conditions: Osteoarthritis, Osteonecrosis and Gluteal Tendinopathy

Hip pathology, encompassing common conditions such as Osteoarthritis (OA), Osteonecrosis (ONFH) and gluteal tendinopathy, presents significant challenges in clinical management which often necessitate innovative treatment modalities. Stem cell therapy has emerged as a promising approach for addressing these complex hip conditions by promoting tissue regeneration and modifying disease progression. This paper aims to review the current literature on stem cell therapy for hip pathology, focusing on its application in OA, ONFH and gluteal tendinopathy. A comprehensive review of relevant studies and clinical trials was conducted by examining the safety, efficacy and potential mechanisms of action of stem cell therapy in hip conditions. Studies investigating the use of Bone Marrow-Derived Mesenchymal Stem Cells (BMMSCs), Adipose-Derived Mesenchymal Stem Cells (ADMSCs) and Tendon-Derived Stem Cells (TDSCs) were included in the analysis. The reviewed studies demonstrate promising outcomes of stem cell therapy in improving pain, functionality and halting disease progression in patients with hip OA. Intra-articular injections of MSCs have shown sustained benefits and arrested the progression of osteoarthritis. Stem cell therapy has also shown effectiveness in delaying the progression of ONFH, reducing femoral head collapse and decreasing the need for total hip replacement. Furthermore, in cases of gluteal tendinopathy, stem cell therapy has exhibited significant improvements in pain and functionality in a limited number of studies on the topic and also offers sustained relief in patients unresponsive to conventional treatments. Stem cell therapy holds immense potential as a safe and effective intervention for hip pathology and offers disease-modifying effects and sustained clinical benefits in these prevalent conditions. Further research is warranted to optimize treatment protocols, clarify mechanisms of action and validate long-term efficacy in larger cohorts.

Study protocol for a randomized controlled trial of supportive parents – coping kids (SPARCK)—a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems

BackgroundTo meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents – coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent–child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group).MethodsWe describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up.DiscussionThe current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology.Trial registrationClinicalTrials.gov ID: NTCT05800522

"I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements.

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.

Effects of Dexmedetomidine Added to Ropivacaine in Ultrasound-Guided Continuous Pericapsular Nerve Group Block Among Elderly Patients Undergoing Total Hip Arthroplasty.

Total hip arthroplasty (THA) is a highly effective intervention for addressing hip joint issues, yet managing perioperative pain remains a significant challenge. In this study, we aimed to investigate the impact of supplementing ropivacaine with dexmedetomidine in ultrasound-guided continuous pericapsular nerve group block (PENGB) among elderly patients undergoing THA. We conducted a retrospective analysis involving 112 elderly patients who underwent THA. These patients were divided into two groups: the Control group, receiving ropivacaine alone, and the DEX group, receiving ropivacaine combined with dexmedetomidine. We evaluated various parameters including hemodynamic data, postoperative pain levels assessed using the Visual Analog Scale, cognitive status measured with the Montreal Cognitive Assessment, and serum markers (S100β and GFAP). Our findings revealed that the DEX group exhibited improved stability in blood pressure and oxygen saturation following surgery. Moreover, patients in the DEX group reported significantly lower levels of pain at 6 and 12 hours postsurgery, with a prolonged duration of pain relief. Furthermore, dexmedetomidine administration was associated with preserved cognitive function during the early postoperative period. Analysis of serum markers suggested potential cognitive protection conferred by the addition of dexmedetomidine. Overall, our study underscores the multifaceted benefits of incorporating dexmedetomidine into ropivacaine-based PENGB for elderly THA patients.

The Effectiveness of Modular Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual for Youths Displaying School Attendance Problems: A Randomized Controlled Trial.

School attendance problems (SAPs) are associated with negative short- and long-term outcomes. Despite high prevalence of SAPs, there is a shortage of evidence-based interventions. Existing approaches often target either school refusal or truancy, leaving a gap in effective interventions addressing both types of SAPs. This randomized controlled trial (RCT) assessed the effectiveness of Back2School (B2S), a modular transdiagnostic cognitive behavioral therapy (CBT) for SAPs, compared to treatment as usual (TAU). Outcomes included youths' school attendance and mental health. A group (B2S, TAU) × time (Pre, Post, 3-Month Follow-Up) design involving 152 youths (B2S; n = 74, TAU; n = 78) with SAPs (i.e., ≥ 10% absence in the past three months), aged 6-16 years (M = 12.2, SD = 2.2, males = 60%) were used. B2S comprised three months of CBT with youths, parents, and school involvement, while TAU comprised public and/or private intervention services. On average, youths in B2S received 15.0, (SD = 3.9) hours of intervention, while those in TAU received 13.4, (SD = 21.6). Intervention effects were investigated using mixed linear models. Both B2S and TAU exhibited significant within-group improvements in school attendance, with no significant differences between them. However, the B2S group significantly outperformed TAU in reducing youths' emotional problems, conduct problems, problems with peers, the overall impact of problems, and increasing youths self-efficacy for attending school and parent self-efficacy for dealing with a SAP. This RCT represents the first evaluation of a modular transdiagnostic CBT for youths displaying SAPs, showing significant mental health and self-efficacy benefits. (Clinical trial registration: ClinicalTrials.gov: NCT03459677).