Evidence-based Prevention Interventions Research Articles

Quality improvement approach for surgical-site infection prevention in a Philippine provincial hospital

Background: Globally, the 30-day cumulative incidence of surgical-site infections (SSI) was 11% (95% CI, 10%–13%) based on the systematic review and meta-analysis derived from 57 studies. SSIs are poorly studied in the Philippines. Americares and its hospital partner, Camarines Norte Provincial Hospital, Philippines, sought to reduce SSIs through (1) establishing SSI surveillance in the hospitals’ surgical departments, (2) implementing quality improvement processes, and (3) developing and implementing an SSI prevention care bundle. Methods: A quality improvement methodology was used to introduce SSI surveillance and care-bundle checklist in partnership with Americares. Using paired t tests, pre- and posttest scores of the SSI care bundle training were analyzed. SSI surveillance was established based on the adapted CDC criteria. All clean surgeries were monitored except orthopedic surgeries. The number of surgeries performed, monitored, and SSIs identified were documented using the surveillance forms and plotted using Microsoft Excel software. A care bundle based on WHO evidence-based interventions for SSI prevention was designed and implemented. Compliance with the SSI care bundle was documented using Microsoft Excel. The relationship between the use of a care bundle and SSIs was analyzed using the Pearson correlation coefficient. Results: An online SSI care bundle training session was conducted. Overall, 150 participants had a mean pretraining test score of +6.46. After the training was conducted, the same participants had a mean posttraining test score of + 1.76). a statistically significant increase of 5.29 (95% CI). Thereby, the mean score difference after training showed that knowledge increased overall. These findings show an average of 90.43% compliance with the SSI care-bundle checklist over the 18-month window from May 2021 to November 2022. From a baseline of 0%, compliance increased from 80% upon its introduction in May 2021. Lastly, the SSI incidence rate from May 2021to November 2022 averaged 1.89%. The days between reported SSIs averaged 16.85. No baseline was available for comparison prior to the introduction of the surveillance and care bundle. A Pearson r data analysis (n = 1,850) was used to determine the relationship between the use of the care bundle and SSIs. The data illustrated a moderate negative correlation (r = −.31). Therefore, higher care-bundle compliance yielded fewer SSI cases. Conclusions: The use of an evidence-based care bundle paired with a local quality improvement process significantly improved SSI prevention and surveillance. Future studies are needed that include clean-contaminated, contaminated, and dirty surgical cases to test the degree of SSI reduction possible.Disclosures: None

Te Kaahui Ora Māori Health Team Offering Whanau Ora and Secondary Prevention in Te Whatu Ora – Counties Manukau

Cardiac rehabilitation (CR) is an important evidence-based secondary prevention intervention following acute coronary syndrome (ACS). In this catchment, Māori uptake of CR is persistently low. A partnership with the Māori health team was introduced during the COVID pandemic to deliver a Te Kaahui Ora model of care. Using the ACS and CR database, 100 consecutive Māori patients—50 preintervention and 50 postintervention—were retrospectively audited. All patients were discharged alive after ACS with similar characteristics: 78% vs 72%, revascularised, 93% vs 94% discharged on standard ACS medications. Risk factors: smoking 53% vs 56%, mean SBP 145.4 vs 146.3, LDL >2, 86.3% vs 74%, BMI >30 67% vs 63%, and diabetes 34% vs 34%. The majority were male 64% vs 68% and mean age was 54 vs 58.6 years. Cardiac rehabilitation attendance declined 44% vs 28%; however, 96% in the intervention cohort received 20% home visits and 100% telephone support with often multiple contacts. The introduction of a wide-ranging intervention in Māori post-ACS patients resulted in a decrease in traditional CR attendance but also a significant increase in phase 1 and 2 contacts, and addressed a wide range of issues unlikely to be addressed in standard CR interventions.

Peer-Written Caring Letters for Veterans after a Suicidal Crisis

Objective In the evidence-based suicide prevention intervention, Caring Letters, healthcare providers send brief, caring messages to patients following psychiatric inpatient care, a time of elevated suicide risk. However, recent studies with military populations have found mixed results. An adaptation of Caring Letters employed a peer framework in which veterans from the community wrote brief caring messages to veterans discharging from psychiatric inpatient treatment after a suicidal crisis. Methods The present study utilized content analysis to assess 90 caring messages generated by 15 peer veterans recruited from veteran service organizations (e.g., American Legion). Results Three themes emerged: (1) Shared Military Service, (2) Care, and (3) Overcoming Adversity. Peer-generated content varied in how the coded themes were expressed in the messages. Conclusion These veteran-to-veteran caring messages may bolster belongingness, social support, and destigmatize mental health struggles, and have the potential to augment existing Caring Letters effects and interventions. HIGHLIGHTS Veterans commonly wrote about shared military services, care, and adversities. Supportive messages from peers may be tied to social support. Our analyses support possible benefits for veterans receiving caring messages.

From Prevention Science to Services: Identifying Paths to Sustainable Evidence-Based Preventive Interventions.

Back to table of contents Previous article Next article ViewpointNo AccessFrom Prevention Science to Services: Identifying Paths to Sustainable Evidence-Based Preventive InterventionsAmy B. Goldstein, Ph.D., Barbara A. Oudekerk, Ph.D., Carlos Blanco, M.D., Ph.D.Amy B. GoldsteinSearch for more papers by this author, Ph.D., Barbara A. OudekerkSearch for more papers by this author, Ph.D., Carlos BlancoSearch for more papers by this author, M.D., Ph.D.Published Online:12 Apr 2023https://doi.org/10.1176/appi.ps.20220641AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article"From Prevention Science to Services: Identifying Paths to Sustainable Evidence-Based Preventive Interventions." Psychiatric Services, , pp. – Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Metrics KeywordsPreventionDrug abuseDrug abuseEvidence-based preventionPDF download History Received 29 December 2022 Revised 23 February 2023 Accepted 9 March 2023 Published online 12 April 2023

They Live in an Isolation Chamber: Medicare Fails the Depressed Homebound Elderly

There is significant literature on the existence and adverse effects of social isolation and depression among the elderly, exacerbated by the recent COVID-19 pandemic. A literature review indicates no studies of how the Medicare home health benefit addresses social isolation and depression, including no studies of home care social workers’ perceptions of the nature and consequences of Medicare coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021 and May 31, 2022. Six themes emerged from the study. Social workers believe: (1) extensive social isolation and depression exist among Medicare home health beneficiaries; (2) Medicare home health policy provides no systematic measure to detect or monitor social isolation and a limited measure for depression among the homebound elderly; (3) Medicare home health policy provides no coverage to treat either depression or social isolation; (4) effective interventions are available to prevent and treat depression and social isolation. Social workers also believe that: (5) the lack of social isolation and depression coverage results in additional mental and physical health conditions; (6) lack of social isolation and depression coverage exacerbates existing mental and physical health conditions. Policymakers are urged to modify the Medicare home health benefit to improve detection and monitoring of social isolation and depression as well as coverage of appropriate evidence-based preventative and treatment interventions.

Experiences of violence among female and male grade eight learners: baseline findings from the Girls Achieve Power (GAP Year) trial across three South African townships

Background: South African adolescents experience disproportionally high rates of violence, with lifelong health, social and economic impacts. Few papers present risk factors associated with experiences of adolescent violence. Methods: A baseline cross-sectional survey was done (April 2017 – Sept 2018) with 3432 grade 8 learners in the Girls Achieve Power (GAP Year) trial from 26 high schools in three townships (Soweto and Tembisa, Gauteng and Khayelitsha, Western Cape). Collected data on lifetime experiences of different types of violence, perpetrators, and place of violence. Descriptive statistics and logistic regression were used to enumerate experiences of, and factors associated with violence. Results: A total of 2383 respondents are included. Most (63.1%) were girls, 81.5% aged 12-14. In total 25.9% had ever experienced violence, higher among boys (p=<0.001). Physical violence was most common (35.7%), then psychological (21.8%), sexual (13.1%), neglect (10.6%), cyberbullying (7.6%), corporal punishment (6.5%) and economic abuse (4.8%). Boys experienced more physical violence (36.0%); girls experienced more psychological violence (22.2%). Gauteng had double the reports of sexual violence (18.4% vs 7.6%, p<0.001). Violence happened most at school (27.4%), followed by the park (19.8%) or their friends’ home (12.9%). Multivariate analysis showed that boys (aOR 1.68; 95% CV 1.32-2.14; p<0.001), those aged 15-17 years (aOR 1.41; 95% CV 1.04-1.89; p=0.025), those who ever used substances (aOR 1.90; 95% CI 1.9-2.28; p<0.001), and those who sometimes feel worthless (aOR 1.33; 95% CI 1.09-1.63, p=0.005) were at higher odds of ever experiencing violence. Those who had ever had sex were more likely to have ever experienced violence (aOR 1.42; 95% CI 1.10-1.83; p=0.008). Conclusion: Urgently need wider adoption, scaling, and sustaining of evidence-based primary violence prevention and structural interventions are required to reduce the high burden of adolescent violence. Stakeholders across the ecological model are needed to tackle harmful cultural norms that perpetuate violence.

399 The development of a digital game to prevent suicide in youth who misuse substances

OBJECTIVES/GOALS: Suicide is the second leading cause of death in teens. Substance misuse, including opioids, is a risk factor for suicidal thoughts and behaviors among teens. School-based approaches are promising, yet they lack evidence on their effectiveness. To fill this gap, we created supportED, a digital game to prevent suicide in youth who misuse substances. METHODS/STUDY POPULATION: We conducted focus groups and interviews to inform the development of the digital game and discuss approaches to enhance user experiences, acceptability, and feasibility of the intervention. A semi-structured focus group/interview guide was developed, pilot tested, and used in focus groups/interviews. The guides aligned with constructs from a safety planning intervention, a well-recognized, evidence-based suicide prevention intervention, to identify potential warning signs of emotional distress, coping strategies, and resources for seeking help to prevent suicidal thoughts and behaviors. Focus groups/interviews were led by a facilitator, who is also a certified school counselor and licensed professional counselor, and a co-facilitator who took field notes and provided debrief summaries. RESULTS/ANTICIPATED RESULTS: A total of 35 participants, including 10 high-school-aged teens [aged 16-19], 10 college-aged youth [aged 18-22], 10 school-based providers, and five interviews with adults who had experience with opioids in their youth informed the development stage. Of the focus group participants, 25.7% identify as female (n=23), 71.4% identify as male (n=6), and 2.9% do not identify as male or female (n=1); 60% identify as White (n=18), 20% identify as multi-racial (n=6), 10% identify as Black (n=3), 3.3% identify as Asian (n=1), and 6.7% identify as race unknown (n=2); and, 37.1% (n=13) identify as Hispanic/Latinx. Salient themes that emerged focused on opioids, substance misuse, mental health, bullying, grief, family, identity, and stigma to create six distinct narratives in the digital game. DISCUSSION/SIGNIFICANCE: Findings informed the development of a digital game to prevent suicide among adolescents who misuse substances. The digital game is currently being evaluated in a pilot RCT to assess the preliminary efficacy of the intervention, user experience, usability, and feasibility of delivering the intervention and protocols among 60 youth.

More Than Just a Game: Teachers’ Experiences of the PAX Good Behavior Game

<p style="text-align:justify">The PAX Good Behavior Game (PAX-GBG) is an evidence-based universal preventive intervention program for classroom use. Our aim was to explore teachers’ perceptions of PAX-GBG and their work with it, and whether this changed during the implementation of the intervention. In addition, we explored teachers’ perceptions, and changes in perceptions, regarding how they perceived their workload when learning and using PAX, how it influenced relationships in the classroom and students with special needs. Semi-structured telephone interviews were conducted with six female teachers at three time-points during a school year. Based on thematic analysis, four themes illustrating teachers’ experiences and the perceived effects of PAX-GBG on classroom relationships were identified: (1) Working with PAX-GBG, (2) The Game, (3) Focus on Behaviour, and (4) Relationships. A notable finding was that most teachers, at the outset, had concerns regarding the PAX Game and that these concerns mostly disappeared after they had experienced working with it. Based on improved student behaviours and overall enhanced relationships in the classroom, our results show that PAX-GBG is a suitable intervention for all students. Students with special needs may especially benefit due to a focus on clear expectations, positive reinforcement, and a more inclusive classroom climate. Some remaining concerns regarding the universal suitability of the game need to be explored further in future studies. Based on the results in this study, PAX-GBG seems to have high social validity in a Swedish context.</p>

Abstract P377: The Restore Health Equity Research Network: An American Heart Association-Funded Initiative to Prevent Hypertension in Black Communities

Introduction: The RESTORE Network is an American Heart Association-funded health equity research network that is testing the implementation of evidence-based interventions for hypertension prevention in community settings. The goals are to: (1) Work with Black communities to mitigate the negative impact of social determinants of health on blood pressure (BP) in Black adults; (2) Develop and test strategies for implementing evidence-based lifestyle interventions in Black communities; (3) Disseminate findings to policy makers, payors and stakeholders to promote adoption of effective hypertension prevention strategies in Black communities; and (4) Train early-career scientists in health equity and hypertension research. Methods: RESTORE Network investigators across eight institutions are conducting five hybrid implementation-effectiveness trials to test scalable, sustainable, and potentially cost-effective implementation strategies to mitigate adverse social determinants of health that contribute to the high prevalence of hypertension in Black communities. The implementation strategies include the use of: 1) trained community health workers (Alabama, Baltimore, Detroit); 2) community-based organizations as portals of food access and patient navigation (New York City, Alabama, Boston, Detroit); 3) patient activation via home BP monitoring (Baltimore); and 4) digital technologies (Baltimore, Detroit). The social determinants of health targeted are: poor access to care, low health literacy, food insecurity, barriers to physical activity, neighborhood deprivation, under-insurance, and inadequate linkage to medical and social services. The five projects are based on the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework, and evaluation of each implementation strategy is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) implementation research framework. The projects are supported by five highly-integrated cores (BP Measurement, Statistical, Intervention, Community Engagement, Training). RESTORE will advance the career of early stage investigators in hypertension, health equity, implementation science and community-engaged research; trainees will work on network projects, develop their own projects, complete rotations across network sites, and attend lectures and workshops. Synergy across projects will facilitate economic and scale-up analyses to inform policy makers on the strategies being tested. Discussion: The RESTORE Network will advance health equity in the U.S. by identifying community-driven, sustainable and effective implementation strategies to deliver lifestyle interventions that prevent hypertension in Black adults. The strong infrastructure of the network will support new collaborations and ancillary studies that are aligned with our mission.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 5. Mortality assessment

BackgroundThe Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality.MethodsThe Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST).FindingsThe leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively.ConclusionThe baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond.

Sexting coercion within romantic context: a test of Akers’ social learning theory

ABSTRACT Prior research has mainly focused on why individuals are engaging in sexting. However, little is known about sexting in intimate relationships, particularly sexting coercion. This study examined sexting coercion using social learning theory in a sample of young adults who had experience with a romantic relationship (N = 315, aged 14–28 years, 67.94% female). Individuals completed the sexting coercion scale and the social learning scale online. The results showed that over 33% of the respondents reported being victims of sexting coercion in an intimate relationship, while about 28% of them had perpetrated sexting coercion. The results suggest that sexting coercion in an intimate relationship is significantly predicted by differential association, differential reinforcement, and imitation. The findings of this study highlight the importance of exposing youth to evidence-based preventive educational interventions on sexting from the earliest age, based on the constructs of social learning theory. Practice Impact Statement The findings of this study of sexting coercion among young adults are relevant to educational programmes given recent evidence of the prevalence of sexting coercion victimisation and sexting coercion perpetration among youth in romantic relationships. The findings suggest that those who engage in sexting coercion use a social learning mechanism that should be considered when developing educational interventions to prevent sexting coercion.

Harmonizing Social, Emotional, and Behavioral Constructs in Prevention Science: Digging into the Weeds of Aligning Disparate Measures.

While integrative data analysis (IDA) presents great opportunity, it also necessitates a myriad of methodological decisions related to harmonizing disparate measures collected across multiple studies. There is a lack of step-by-step methodological guidance for harmonizing disparate measures of latent constructs differently conceptualized or operationalized across studies, such as social, emotional, and behavioral constructs often utilized in prevention science. The current paper addressed this gap by providing methodological guidance and a case illustration focused on harmonizing measures of disparately conceptualized and operationalized constructs. We do so by outlining a five-phased harmonization approach paired with an illustrative example of the approach as applied to harmonization of broadband latent emotional and behavioral health constructs assessed with different measures across studies. This approach builds on and expands upon procedures currently recommended in the IDA literature with parallels to best practices in test development procedures. The illustrative example of our phased approach is drawn from an IDA study of 11 randomized controlled trials of Coping Power (Lochman & Wells, 2004), an evidence-based preventive intervention. We demonstrate the harmonization of two constructs, internalizing and externalizing problems, as harmonized across the teacher-reported scales of the Achenbach System of Empirically Based Assessment (Achenbach, 1991a) and the Behavior Assessment System for Children (Reynolds & Kamphaus, 2004). Finally, we consider the potential strengths and limitations of this phased approach, underscoring areas for future methodological research and conclude with some recommendations.

“It gives you a road map of what to do to solve your problems”: acceptability of a combination HIV prevention intervention among adolescent girls in Uganda

BackgroundThe HIV burden remains a critical public health concern and adolescent girls are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high HIV prevalence among adolescent girls and young women. Yet, both evidence-based HIV prevention interventions and their acceptability among adolescent girls have not been widely studied. In this study, we examined the acceptability of the Suubi4Her intervention, an evidence-based combination intervention aimed at reducing HIV risk among adolescent girls in Uganda.MethodsWe conducted semi-structured in-depth interviews with 25 adolescent girls upon intervention completion to explore their experiences with the Suubi4Her intervention that was tested in a clinical trial in Uganda (2017–2023). Specifically, we explored their decision-making process for participating in the intervention, experiences with program attendance, and their feedback on specific intervention characteristics. Informed by the Theoretical Framework of Acceptability, the data were analyzed using thematic analysis.ResultsThe main motivation for participation was access to health-related information, including information on STIs, HIV, and pregnancy as well as information on banking, saving, and income-generating activities. Though many participants did not have any initial concerns, mistrust of programs, initial paperwork, caregiver’s ability to commit time, concerns about ability to save, and HIV/STI and pregnancy testing were raised by some participants. Facilitators to session attendance included motivation to learn information, caregiver commitment, reminder calls, and incentives received for participation. The main challenges included household responsibilities and obligations, difficulty raising transport money, and weather challenges. Adolescent girls appreciated the group format and found the location and times of the sessions convenient. They also found the content relevant to their needs and noted positive changes in their families.ConclusionsThe results showed high intervention acceptability among adolescent girls. These findings have important programmatic and policy implications in Uganda, especially given the higher HIV prevalence among adolescent girls in the country.Trial registrationNCT03307226 (Registered: 10/11/17).

SG-APSIC1040: Implementing a quality-improvement approach to surgical-site infection prevention in the Philippines

Objectives: We aimed to reduce surgical site infections in Camarines Norte Provincial Hospital, Philippines, (1) by establishing SSI surveillance in the surgical departments, (2) by implementing quality improvement processes, and (3) by developing and implementing an SSI prevention care bundle. Methods: In partnership with Americares, SSI surveillance based on CDC criteria was instituted for all surgeries, excluding orthopedic surgeries. Staff were trained in applying quality-improvement methodology, infection prevention and control, and SSI prevention. A care bundle based on the WHO evidence-based interventions for SSI prevention was designed. Interventions included preoperative bathing, surgical hand preparation, intraoperative surgical-site preparation using 2% chlorhexidine isopropanol solution, and postoperative wound management. The model for improvement methodology was used to implement these changes for 12 months from May 2020 to May 2021. Results: In total, 718 surgeries were followed for SSI surveillance, with an average of 58 surgical patients per month in 2020, which increased to 90 patients per month in 2021. In 2020, the SSI incidence rate was 1.76%, and this rate increased 38.64% to 2.44% in 2021. A statistically significant increase in knowledge of 5.29 points (95% CI, 4.91–5.67) among 150 participants undergoing SSI training between pretest (+6.46) and posttest (+ 11.76) was achieved. SSI care-bundle checklists were used for 80% of eligible surgical patients by 2021. Compliance with the SSI care-bundle checklist increased from 0 to 87.69% (n = 718) by October 2021, subsequently decreasing by 2.75% by December 2021. Conclusions: A quality-improvement process embedded in routine surgical care can be a building block for reducing SSIs. However, we did not achieve an overall decrease in SSIs, likely due to increased reporting of SSIs through improved SSI surveillance. However, important gains were achieved in improved healthcare worker knowledge and practice through the implementation of an SSI care bundle. Fluctuations in checklist compliance reflected COVID-19 surges.

Abstract WP55: Development Of Comprehensive Post-Acute Stroke Program Standards

Introduction: Evidence-based rehabilitation and secondary prevention interventions improve post-stroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where post-acute care (PAC) is delivered. Purpose: The American Heart Association (AHA) developed quality standards based on the AHA 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. Methods: An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. AHA staff and PAC sites in Montana (MT) convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in MT, and quantitative results from the nationwide survey and MT sites were analyzed and used to refine the standards further. Results: The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding MT findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure performance improvement initiatives are followed. However, with adequate support and resources, most MT sites stated they would be able to meet the proposed standards. Conclusions: The Stroke PAC Program Standards are applicable in diverse PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.

Why are western diet and western lifestyle pro-inflammatory risk factors of celiac disease?

The prevalence of celiac disease increased in recent years. In addition to the genetic and immunological factors, it appears that environmental determinants are also involved in the pathophysiology of celiac disease. Gastrointestinal infections impact the development of celiac disease. Current research does not directly confirm the protective effect of natural childbirth and breastfeeding on celiac disease. However, it seems that in genetically predisposed children, the amount of gluten introduced into the diet may have an impact on celiac disease development. Also western lifestyle, including western dietary patterns high in fat, sugar, and gliadin, potentially may increase the risk of celiac disease due to changes in intestinal microbiota, intestinal permeability, or mucosal inflammation. Further research is needed to expand the knowledge of the relationship between environmental factors and the development of celiac disease to define evidence-based preventive interventions against the development of celiac disease. The manuscript summarizes current knowledge on factors predisposing to the development of celiac disease including factors associated with the western lifestyle.

Preventing the onset of depressive disorders in low-and middle-income countries: An overview.

Depressive disorders constitute an important and costly public health problem and worldwide most of the disease burden is suffered in low-and middle-income countries (LMICs). Treatments only have limited possibilities to reduce the disease burden of depressive disorders. Prevention may be one of the alternative ways to further reduce the disease burden of depressive disorders. In this paper, the results of a subgroup analysis of a previous meta-analysis on the effect of preventive interventions on the incidence of depressive disorders was undertaken. Only 6% of all trials examining the possibility to prevent the onset of major depression have been conducted in LMICs, and these studies find significantly smaller effects than those in high-income settings. It is too early, therefore, to consider implementing and disseminating preventive interventions in LMICS. However, in optimal conditions and assuming that evidence-based preventive interventions will be developed, investments should be made into treatment, universal, selective and indicated prevention, as well as in social institutions focusing on larger risk factors for mental health problems.

Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial

BackgroundObesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour).MethodsA total of 2,025 parents and their preschool-aged children (20–60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO—the Family Nutrition and Physical Activity (FNPA) risk assessment—from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child’s electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures.DiscussionStudy findings will inform health care systems’ choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors.Trial registrationClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.

Prevalence and Characteristics of Burnout among Pharmacists in Primary Care Centers in the Kingdom of Bahrain- A Cross-Sectional Study

INTRODUCTION: Burnout syndrome is defined as the state of physical, emotional, and mental exhaustion that results from exposure to stressors. It is prevalent among healthcare workers including pharmacists and is associated with significant detrimental effects on the patients, healthcare workers, and healthcare systems. Nonetheless, few studies have assessed the prevalence and characteristics of burnout among pharmacists. This study aimed to assess the prevalence and characteristics of burnout among pharmacists in governmental primary health care centers in Bahrain.
 
 METHODS: A cross-sectional study was conducted in the period between January 2022 and February 2022 and involved all the pharmacists in the primary health care centers in the kingdom of Bahrain. Burnout syndrome was assessed using the Maslach Burnout Inventory, a validated tool designed to assess the emotional exhaustion, depersonalization, and personal accomplishment aspects of burnout.
 
 RESULTS: A total of 148 pharmacists completed the online questionnaire and were included in the analysis (response rate = 80.4%). The majority of participants were females (n = 130, 87.8%), married (n = 117, 79.1%), and aged between 25 and 35 years (n = 99, 66.9%). Almost 60% (n = 86, 58%) of the pharmacists had high levels of emotional exhaustion, 62 (41.9%) participants reported high levels of depersonalization, and 60.1% (n = 89) of them reported low accomplishment levels. No statistical differences were found between the baseline characteristics of the pharmacists and the aspects of burnout.
 
 CONCLUSION: In conclusion, this study revealed an alarmingly high prevalence of burnout syndrome among pharmacists in primary care centers in Bahrain. Evidence-based preventive strategies and interventions to reduce burnout levels among pharmacists are urgently needed.

Community priorities for obesity prevention among low-income adults in Kuala Lumpur: a discrete choice experiment.

Non-communicable diseases and associated risk factors, such as obesity, are prevalent and increasing in Malaysia. To address this burden and the heightened vulnerability of low-income communities to these risk factors, the Better Health Programme Malaysia conducted a partial-profile discrete choice experiment (DCE) to inform the design of a community-based obesity-prevention programme. The DCE survey was conducted with community members (n = 1453) from three publicly supported low-cost, high-rise flat complexes in urban Kuala Lumpur. In the survey, community members were asked to choose between different sets of potential evidence-based interventions for obesity prevention. Their responses to these choice tasks were analysed to quantify preferences for these different health interventions using a random utility maximization model. Based on these results, we determined participants' relative prioritization of the different options. The most preferred interventions were those that reduced the price of fruit and vegetables; altered cooking practices at restaurants and food vendors to reduce salt, sugar and oil; and offered reward incentives for completing online educational activities. Community members did not prioritize several evidence-based interventions, including changes to product placement or product labelling, suggesting that these effective approaches may be less familiar or simply not preferred by respondents. The DCE enabled the clear articulation of these community priorities for evidence-based interventions that focus on the supply and promotion of affordable healthy foods within the local food environment, as well as community demand for healthier food options.