Group Meetings Research Articles

Consensus statement addressing controversies and guidelines on pediatric urolithiasis.

We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15years, and 4 with 6-10years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.

Meaningful climate change communication: an analysis of women dry season farmers in Kuliyaa community of Ghana

ABSTRACT Access to climate change information can play a critical role in helping rural women adapt to climate change. Our research investigates the communication channels used for climate education among female dry-season farmers in the Kuliyaa community of northern Ghana. Particularly, we address access to climate change information among smallholder female farmers. We adopted a community-based participatory approach to guide the study. To achieve our research objectives of investigating climate change communication channels among smallholder female farmers, specific methods of in-depth interviews and focus group discussions were used to gather knowledge from smallholder female farmers. The research findings provide a well-rounded exploration of the unique climate change communication challenges female farmers face and the innovative approaches they have adopted to share climate change information. Specifically, the findings show that women have adopted innovative oral communication channels to disseminate and transfer climate knowledge among themselves. We also found that there is limited access to radio in the Kuliyaa community making them resort to group meetings to share knowledge and ideas empowering them economically in other livelihoods. The study discovered the community utilises gender inclusivity in decision-making. We recommend that the government and other relevant organisations to develop and implement a strategic policy on climate information dissemination with a focus on supporting farmers in rural communities of Ghana to mitigate climate change effects. Technologies can also be developed to aid in disseminating relevant information to farmers in rural areas as the available oral communication is less effective in disseminating useful information on climate change.

Enhancing resilience in ageing: The role of age-friendly community and individual health in reducing seismic risk

Age-friendly cities/communities (AFC) propose promising strategies for incorporating disaster resilience-building with urban planning and design interventions. However, little attention has been paid to exploring the effects of AFC concept on the resilience and health of older people from a behavioural perspective and through empirical-based approaches. This article aims to expand on the attributes of AFC by incorporating social capital, community support, and individual health factors. We further explore their roles in enhancing earthquake resilience among older adults. We develop a novel interdisciplinary analytical framework, called the Framework of Age-friendly and Resilience Behaviour for Seismic Risk Reduction (FARBSR). This framework combined with focus group meetings and cluster, regression, and factor analyses to compare the determinants of pre-disaster preparedness, coping responses, post-disaster recovery behaviour and resilience among older adults. Based on an empirical survey conducted in Taipei, Taiwan, we randomly selected 427 older adults for face-to-face questionnaire interviews. Results show that high-quality age-friendly physical environments significantly increase older adults’ adoption of adaptation behaviour and resilience. Social environments, social capital, and community support play a relatively weak but critical supporting role. Resilience and adaptation to earthquakes also result from interactions between individuals and their environment. However, the effect of individual health and cognitive factors on this dynamic is mixed. Our research opens avenues for fresh perspectives, bridging the AFC framework with the health and cognitive attributes of older adults, and highlighting implications for policy in land use planning and built environment design.

Navigating Cross-Cultural Challenges: A Phenomenological Study on Strategies for International Faculty in Higher Education to Support Local Students

Dealing with local challenges and providing effective support for students as an international faculty member can be both challenging and rewarding. This phenomenological study delved into the intricate dynamics of cross-cultural encounters within higher education settings, focusing on the experiences of international faculty in supporting local students. Using semi-structured focus group meetings, the researchers explored how their lived experiences as full‐time international faculty working in institutions of higher learning in the United States could be applied in providing support for students. This process required intricate navigation to acquire some level of cultural understanding of the local culture and traditions and build relationships with native faculty, staff, and students. The study was based on firsthand experiences of how the authors, international scholars from various parts of the world, navigated through these hurdles to become effective educators. The researchers constructed generalizations, noting that the institutions whose policies include embracing cultural diversity, fostering inclusivity, and providing targeted support are better positioned to enable their international faculty members to address local challenges and empower students to succeed effectively.

Exploring Learners' Experiences with Neonatal Resuscitation Training Using the Multimedia Method: A Qualitative Study

Background: Resuscitation training should be based on facts, skills, and attitudes, using appropriate teaching methods and aids. Training through multimedia is one of the student-oriented methods. This method encourages learners to actively engage in training and take responsibility for their own learning. Objectives: The present research aimed to assess the learning experiences of medical interns regarding neonatal resuscitation training using the multimedia method. Methods: This study was a qualitative conventional content analysis conducted on 17 interns in the last semester of general medicine at the Department of Pediatrics, Alborz University of Medical Sciences. The multimedia method in this study involved a camera connected to a television, recording the interns' activities during resuscitation procedure education. After completing each procedure, the TV showed the recorded activity films to the participants using the on-and-off method. Data were collected through focus group meetings, where students discussed their experiences of participating in this intervention. Their words were converted to written meaning codes and categorized based on similarities and differences. Results: A total of 17 general medicine interns from the last semester, admitted in 2015, participated in this study. Two themes and five subthemes were extracted from the results of conventional content analysis. The results were categorized into two themes: Strengths, which included the subthemes of educational pedagogy and feedback, and weaknesses, which included the subthemes of time, stakeholders, and facilities. Overall, this multimedia method is considered useful for learning. It had some advantages, such as providing detailed feedback, but also had weaknesses, such as the expense of use. Conclusions: It seems that the multimedia method is influential in enhancing interns' learning by providing feedback after conducting neonatal resuscitation. Encompassing different learning aspects and various strengths, this combined method encourages learners' participation in training. Additionally, it can help reduce medical errors and maintain patient safety by developing the necessary skills among interns.

Operational Mechanisms of Peer Support Groups and Support for Caregivers of People Living with Serious Mental Illness.

The challenges faced by caregivers of people living with serious mental illness in Canada are well documented in the literature including emotional distress, financial strain, social isolation, and concerns about their physical health following the impact of caregiving. Peer support programs (including peer support groups) emerged as a promising method to attempt to address these challenges. While there is evidence on the positive impacts of peer support groups in providing support for caregivers, the mechanisms by which peer support groups operate and influence support for caregivers of people living with serious mental illness are less understood. This qualitative study took on a co-designed participatory research approach. Fifteen adult caregivers of people living with serious mental illness across Canada were engaged through key informant interviews that lasted for 45-60min each. A thematic analysis was carried out to help understand the operational mechanisms of peer support groups in influencing support for caregivers. The key informant interviews allowed for the identification and description of the following operational mechanisms that influenced the support caregivers received from peer support groups: (1) Group dynamics; (2) Messaging/content; (3) Equity and inclusion, (4) Group philosophy; and (5) Privacy concerns. Findings from this study showed that caregivers identified a number of operational mechanisms of peer support groups that explained how they felt supported when they participated in peer support groups. Among other operational mechanisms, group dynamics in terms of the gathering of caregivers of different age brackets and varying caregiving experience negatively influenced the peer support experience of caregivers. This pointed to the need for group dynamics that consider close age ranges and similar caregiving experience during group meetings to enhance support for caregivers. Caregivers also identified a gap in equity and inclusion in peer support groups that could have otherwise enriched their experience and enhanced the support they looked to receive from the group. Practical examples to enhance equity and inclusion include promoting active listening, using inclusive language, encouraging diverse representation and asking for feedback from peer support group members. While peer support groups in Canada exist independently of one another, it may help to consolidate evidence-based recommendations in the operational mechanisms of these groups, for the benefit of caregivers who turn to these groups for support, having been left on their own by an otherwise fractured mental health system.

What Does 'Preconception Health' Mean to People? A Public Consultation on Awareness and Use of Language.

There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. A public consultation was undertaken with people of any gender aged 18-50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. Fifty-fourpeople joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18-30 years, 30% 31-40 years, 15% 41-50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well-being during the childbearing years', 'health and well-being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals. This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co-authors of the paper.

A support framework to facilitate social learning and integration skills of first-year undergraduate medical students

Background. Limited research exists on medical students’ coping and adjustment skills, especially in the South African context. Stakeholders planning medical curricula need to be aware of emotional and communication skills that allow students to cope and adjust to stress associated with transitioning to medical studies. Objective. To design a support framework to facilitate first-year undergraduate medical students’ social learning and integration skills. Methods. This descriptive qualitative case study used multiple data collection methods, nominal group meetings and Delphi questionnaires to explore and understand undergraduate medical students’ challenges with social learning and integration factors. These insights were then used to develop the support framework. Results. The support framework articulates levels of engagement and actions required to address social learning and integrated factors, namely under- preparedness, peer support, confidence, self-management, alienation and academic advice. Conclusion. Implementing the proposed support framework on social learning and integration could facilitate the successful transition of first-year undergraduate medical students from high school to university. This framework aids students in dealing with social learning and integrated factors, such as under-preparedness, peer support, confidence, self-management and alienation as well as academic advice using contextualised and appropriate skills and tools.

Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data

BackgroundOver the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.MethodsData for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.ResultsThe coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.ConclusionsThere was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

Educating the Adult Learners: Development of Digital Marketing Strategies for Local Community Products of Pasakngam Village, Chiang Mai, Thailand

This study aimed to educate adult learners by addressing marketing challenges faced by Pasakngam Village, Chiang Mai. The objectives were 1) examine current marketing management procedures and the needs for community products 2) analyze and develop a digital marketing strategy model, and 3) educate the adult villagers on digital marketing strategies. This research employed a participatory phenomenological method to collect both quantitative and qualitative data including public hearings, in-depth interviews with village and product group leaders, focus group meetings with 34 village members and surveys with 215 tourists. Analytical tools included statistical analysis with SPSS software for quantitative data and content analysis for qualitative data. The research findings disclosed a lack of structured marketing management and digital, as well as insufficient public relations plans. The community attempts to promote products via a Facebook page were lacked proper supervision. The research introduced practical workshops based on the Reach, Act, Convert, Engage (RACE) to teach digital marketing to the community members. The villagers learned to operate digital marketing strategies by creating and sharing promotional videos on digital platforms such as YouTube and Facebook, aiming to increase tourist visits and product visibility. The digital marketing strategies improved community engagement and product promotion, highlighting the need for ongoing training and strategy refinement. The research underscores the importance of equipping local communities with digital marketing skills to enhance economic resilience and sustainable development. The study's comprehensive approach provides a replicable model for similar communities seeking to leverage digital marketing for local product promotion.

Validity of Cardiopulmonary Exercise Testing for Assessing Aerobic Capacity in Neuromuscular Diseases

ObjectivesTo determine the content validity of cardiopulmonary exercise testing (CPET) for assessing peak oxygen uptake (VO2peak) in neuromuscular diseases (NMD). DesignBaseline assessment of a randomized controlled trial. SettingAcademic hospital. ParticipantsEighty-six adults (age: 58.0±13.9 y) with Charcot-Marie-Tooth disease (n=35), postpolio syndrome (n=26), or other NMD (n=25). InterventionNot applicable. Main Outcome MeasuresWorkload, gas exchange variables, heart rate, and ratings of perceived exertion were measured during CPET on a cycle ergometer, supervised by an experienced trained assessor. Muscle strength of the knee extensors was assessed isometrically with a fixed dynamometer. Criteria for confirming maximal cardiorespiratory effort during CPET were established during 3 consensus meetings of an expert group. The percentage of participants meeting these criteria was assessed to quantify content validity. ResultsThe following criteria were established for maximal cardiorespiratory effort: a plateau in oxygen uptake (VO2plateau) as the primary criterion, or 2 of 3 secondary criteria: (1) peak respiratory exchange ratio (RERpeak) ≥1.10 (2), peak heart rate ≥85% of predicted maximal heart rate; and (3) peak rating of perceived exertion (RPEpeak) ≥17 on the 6-20 Borg scale. These criteria were attained by 71 participants (83%). VO2plateau, RERpeak ≥1.10, peak heart rate ≥85%, and RPEpeak ≥17 were attained by 31%, 73%, 69%, and 72% of the participants, respectively. Peak workload, VO2peak, and knee extension muscle strength were significantly higher, and body mass index was lower (all P<.05), in participants with maximal cardiorespiratory effort than other participants. ConclusionsMost people with NMD achieved maximal cardiorespiratory effort during CPET. This study provides high quality evidence of sufficient content validity of VO2peak as a maximal aerobic capacity measure. Content validity may be lower in more severely affected people with lower physical fitness.

Sickle cell anaemia control mission: Implementation of a comprehensive care model in Anuppur, Madhya Pradesh.

Background & objectives Sickle cell disease (SCD) is a common genetic disorder, predominantly found in the tribal population of India. The examples of models providing comprehensive care and management to individuals with SCD in public health facilities are sparse. The Sickle Cell Anaemia Control Mission is one such model implemented by Jan Swasthya Sahyog, a non-profit organization in collaboration with the National Health Mission in the Anuppur district of Madhya Pradesh. This article aimed to identify the key learnings from this programme that can guide the public health system strengthening with respect to SCD. Methods The Sickle Cell Anemia Control Mission Programme included door to door screening for anaemia, SCD and blood group. SCD cases were included in the programme and other individuals with Anemia were referred for further care. Care for individuals with SCD included counselling, provision of hydroxyurea, regular follow up of clinical parameters and management of complications. Care for individuals with SCD was provided through monthly patient support group (PSG) meetings and regular outpatient /in-patient care at public health facilities. Quantitative data on programme design, screening and patient management collected during programme implementation were used for analysis. Results A total of 39421 persons were screened in 18 months (August 2018-March 2020). Of these 81.9 per cent persons were anaemic, 16.9 per cent had sickle cell trait and 779 (1.98%) had SCD. Eighty-six already diagnosed individuals joined the programme for care. People from all caste categories were diagnosed with SCD. Out of 865 individuals with SCD, 157 underwent regular 9-11 months follow up and showed improvement in clinical symptoms and drug compliance. Interpretation & conclusions Central India has a significant burden of anaemia and SCD. This study found that SCD is present in non-tribals as well. PSGs are an efficient way to deliver non-emergency care for chronic diseases such as SCD.

The Eternal Present: A Photovoice Study of the Experience of Geriatrics Residents During the COVID-19 Pandemic.

During the COVID-19 pandemic, medical residents had the task of being the frontline of the response, being exposed to high risk of infection, increased clinical duty, and long and irregular working hours in highly restricted environments, increasing their levels of stress. We sought to expose the experiences of a group of geriatrics residents during this period of change in their professional and personal lives through the photovoice methodology. Thirteen participants were recruited and had 2weeks to take photographs. The photographs were discussed in group meetings; the content of the conversations was transcribed and analyzed using interpretive description. Sixteen themes were identified. They were divided into personal life (11 themes) and life as a resident (5 themes). Adaptation was the main theme that came into discussion. The photographs and themes show how life changed for the participants, having a feeling of isolation, especially from their families, and highlighting their experiences as a team and community. While the pandemic, particularly at its beginning, was a period of uncertainty and a heavy load of work, it also provided learning and experience to this group of young physicians, which should not hide the fact that mental health concerns and burnout were a common situation. An online gallery was created which is publicly accessible.

Assessment of the Effects of the COVID-19 Pandemic on Orthopaedic Surgery Training Among Orthopaedic Residents in Southern Nigeria.

Surgical training is hands-on, with residents requiring optimal exposure to patients for optimal training and adequate experience. Thus, despite the increased usage of virtual, non-physical resources for medical education during the pandemic, orthopaedic surgical training still suffered adversely. To explore the overall impact of the COVID-19 pandemic on Orthopaedic surgery training, teaching and practice amongst residents in southern Nigeria. This was a cross-sectional prospective study involving 54 senior orthopaedic surgery residents in southern Nigeria. Data were collected using a semi-structured online-based questionnaire created on the Google Forms and sent via online platforms (e.g., WhatsApp and Telegram). Descriptive and inferential analysis was done using Statistical Package for Social Sciences (SPSS). Consent was also obtained from all respondents. A total of 54 orthopaedic surgery residents responded to our questionnaire. About 71.7% of the residents surveyed reported reduced exposure to surgical cases in general, and 70.3% reported reduced operative teaching exposure. About 68.5% of the respondents reported reduced opportunities for surgical skills acquisition training. More than half of respondents (63%) reported no changes in morbidity/mortality of orthopaedic cases witnessed and performed. The majority of the respondents agreed to a slight decrease in the availability of implants and courses (40.7%) whereas 44.4% affirmed an increase in the cost of training. Overall, 70.4% believed that the impact of COVID-19 on orthopaedic surgical training has been slightly negative. The average rating for experience on alternative learning methods - virtual video conferences, pre-recorded lectures, in-person small group meetings and surgical simulation activities was 2.26 on a scale of 1-4 (decreasing order of satisfaction). The COVID-19 pandemic caused significant changes in orthopaedic surgery training, with low cases exposure and reduction in operative teaching being the most significant changes and the resultant increase in alternative forms of training and skill acquisition.

How can networks address barriers to nature-based solutions? The case of agriculture and construction in the Netherlands

Nature-based solutions (NBS) can play a critical role in sustainability transitions in both urban and rural areas, but their uptake is hindered by a wide variety of barriers. While networks have been identified as a support structure for mainstreaming NBS, it is unclear what specific roles networks play in addressing the multiple barriers that NBS mainstreaming faces. Through qualitative research using focus group meetings and semi-structured interviews within two sectors in the Netherlands where attempts towards a nature-based transition are observed – i.e., agriculture and construction – we identify seven different functions through which networks address six specific barrier categories. We find broad network functions (e.g., knowledge sharing) that address multiple types of barriers simultaneously and targeted network functions (e.g., lobbying towards policy makers) aimed at alleviating one specific type of barrier. We also document that networks leave certain barriers unaddressed, such as technological and political barriers in the construction sector and social barriers in both sectors. Our results contribute to a more in-depth understanding of network function – barrier combinations for nature-based sustainability transitions, both in an urban and a rural context, which can help networks to further strategize and allocate their resources.

Study of Antidiabetic Properties of Berberis asiatica and Withania somnifera in Streptozotocin-Nicotinamide-Induced Type II Diabetes Mellitus in Wistar Rats.

Background and aim Diabetes is a chronic metabolic disorder characterized by elevated blood glucose levels. Although current antidiabetic drugs are highly effective, they are associated with various adverse drug reactions, including life-threatening hypoglycemia, skin rashes, and gastrointestinal intolerance, in addition to being costly. This animal-based experimental study aims to develop a herbal alternative or adjuvant to current antidiabetic drugs usingBerberis asiatica(BA)andWithania somnifera(WS), which could potentially have fewer adverse drug reactions and reduce the required dose of existing antidiabetic medications. Material and methods Seventy-eight adult albino Wistar rats weighing between 150 and 250 gwere used for the study. Diabetes mellitus (DM) was induced by intraperitoneal (i.p) injections of streptozotocin (STZ) (65 mg/kg) 15 minutes after nicotinamide (NIC) (110 mg/kg) administration. As the diabetes was confirmed (blood glucose level > 250 mg/dL), rats were divided into 13 different groups mentioned. The standard antidiabetic drugs (metformin [MET] and glimepiride [GLI]) and polyherbal combinations (PHC) (BA + WS) were administered orally, individually (WS and BA), and in combination (BA + WS). Blood samples were collected for biochemical analysis using the tail vein prick method. The study is based on a total of 13 groups, six rats in each group.Groups 1 and 2 (normal control [NC] and diabetic control [DC]) received distilled water at a dose of 10 mL/kg orally for 28 days. Groups 3-5(BA250, 500, and1000) received dried ethanolic root extract of BA at a dose of 250, 500, and 1000 mg/kg orally, respectively, for 28 days. Groups 6-8(WS250,500, and 1000) received dried ethanolic root extract of WS at a dose of 250, 500, and 1000 mg/kg orally, respectively, for 28 days. Groups 9-11 (PHC250, 500, and 1000) received dried ethanolic root extract ofBA + WSat a dose of 250, 500, and 1000 mg/kg orally, respectively, for 28 days. Groups 12 and 13 (MET and GLI) received standard drugs MET and GLI at a dose of 250 and 10 mg/kg orally, respectively, for 28 days. Results The dried ethanolic root extract of medicinal herbal plantsBAandWSand their combination exhibited significant antidiabetic efficacy. PHChas been shown to have a superior antidiabetic effect than individuals. PHC 500 and 1000 showed blood glucose levels similar to those of the GLI group (P < 0.05). Additionally, PHC 1000 showed blood glucose levels similar to those of the MET group (P < 0.05). Conclusion Our results indicate that bothBAandWSpossess hypoglycemic activity, and their combination also has a synergistic antidiabetic effect compared to the individual extract. These findings are promising in developing new safe and cost-effective herbal combinations as alternatives or additives to currently used synthetic antidiabetic drugs.

Reconceptualising the role of direct support staff for adults with intellectual disabilities by introducing the holistic support model

ABSTRACT Background: This study aims to introduce direct support staff (DSS) working with adults with intellectual disabilities to the Holistic Support Model (HSM) and assess its influence on their perceptions of their professional role. The HSM, grounded in humanistic principles, guides the support process, prioritising autonomy and meaningful living. Method: Using participatory action research, this study used survey data, qualitative analysis of group meetings, and interviews, to assess changes in DSSs' role perceptions after undergoing in-service training on the HSM. Results: DSS exhibited a shift towards a humanistic perspective, gaining clarity on their roles, which reduced frustration. Doubts persist among DSS regarding the applicability of the HSM to all adults with intellectual disabilities. Conclusions: The studies underscore the positive impact of the HSM on DSS, highlighting its potential to enhance DSS practice. It recommends researching the experiences of adults with intellectual disabilities with the HSM.

Integrating the Sufficiency Economy Royal Philosophy and Participatory Action Research Approach to Promote Self-Care for Stroke Prevention in Selected Communities of Southern Thailand.

(1) Introduction: Effective control of stroke risk factors can reduce stroke incidence. Motivation for participatory action of community dwellers to practice self-care to modify stroke risk after providing them with knowledge of stroke risk factors is considered useful under a situation of limited healthcare resources. This study aimed to evaluate the outcomes of integrating the sufficiency economy philosophy (SEP), a royal economic philosophy in Thailand, and the participatory action research (PAR) approach on stroke risk factors control among selected communities. (2) Methods: Villagers who had medium to high stroke risk from two provinces with leading stroke incidences in southern Thailand were invited to participate in an eight-month SEP-PAR program conducted in 2019. Group meetings among the study participants, local healthcare providers, the researchers, and relevant stakeholders in the communities were held to co-design a health behaviors program targeting lower waist circumference (WC), body weight (BW), blood pressure (BP), fasting blood sugar, blood lipids, and smoking and alcohol consumption rates. Follow-up physical measurements and blood tests were compared with the baseline results for significant differences by descriptive statistics (p < 0.05) using the R program. (3) Results: Of 126 participants, 75.4% were female. Moderate and high stroke risk levels were found in 58.2% and 19.8%, respectively. Elevated baseline WC, BW, BP, and blood test results were found in 50-80% of the participants. The co-designed health behaviors in this study were dietary control, regular exercise, relieving psychological stress, and stopping smoking and alcohol consumption. Overall, the participants had significant adherence to the co-designed health behaviors. At the end of the program, the follow-up tests showed significant reductions in BW, BP, fasting blood sugar, and lipids, but not in WC. (4) Conclusions: A combined SEP and PAR approach was effective for stroke risk factors control among the community dwellers. Motivation for self-care is a significant strategic outcome expected of this approach. Longer follow-up studies in larger populations are needed.

Implementation Mapping of the Collaborative University of California Teleophthalmology Initiative (CUTI): A Qualitative Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework.

Background This study aimed to investigate the rationale, barriers, and facilitators of teleretinal camera implementation in primary care and endocrinology clinics for diabetic retinopathy (DR) screening across University of California (UC) health systems utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Methodology Institutional representatives from UC Los Angeles, San Diego, San Francisco, and Davis participated in a series of focus group meetings to elicit implementation facilitators and barriers for teleophthalmology programs within their campuses. Site representatives also completed a survey regarding their program's performance over the calendar year 2022 in the following areas: DR screening camera sites, payment sources and coding, screening workflows including clinical, information technology (IT), reading, results, pathologic findings, and follow-up, including patient outreach for abnormal results. Focus group and survey results were mapped to the EPIS framework to gain insights into the implementation process of these programs and identify areas for optimization. Results Four UC campuses with 20 active camera sites screened 7,450 patients in the calendar year 2022. The average DR screening rate across the four campuses was 55%. Variations between sources of payment, turn-around time, image-grading structure, image-report characteristics, IT infrastructure, and patient outreach strategies were identified between sites. Closing gaps in IT integration between data systems, ensuring the financial sustainability of the program, and optimizing patient outreach remain primary challenges across sites and serve as good opportunities for cross-institutional learning. Conclusions Despite the potential for long-term cost savings and improving access to care, numerous obstacles continue to hinder the widespread implementation of teleretinal DR screening. Implementation science approaches can identify strategies for addressing these challenges and optimizing implementation.

Thrombotic thrombocytopenic purpura: 100 years of research on Moschcowitz syndrome

AbstractIn the 100 years since Eli Moschcowitz reported the first case of thrombotic thrombocytopenic purpura (TTP), there has been remarkable awareness and progress in the diagnosis and management of this rare blood disorder. This progress initially was the result of careful clinical observations followed by well thought-out therapeutic interventions, with dual goals of both improving outcomes and discerning the pathophysiology of TTP. The discovery of the ADAMTS13 protease set in motion the efforts to more accurately define the specific etiologies of thrombotic microangiopathies (TMAs) based on objective, scientific data rather than clinical characterizations alone. This accurate differentiation led to better and more revealing clinical trials and advancements in the treatment of TTP and other TMAs. Further advances followed and included improvements in immune-suppressive therapy and targeted therapies of immune-mediated TTP (iTTP; caplacizumab) and congenital TTP (cTTP; recombinant ADAMTS13). The longitudinal study of patients with TTP revealed the unexpected risk for long-term complications in both patients with iTTP and those with cTTP in remission. Ongoing studies aim to further understand the prevalence, mechanisms, and appropriate screening for these mood disorders, neurocognitive deficits, and cardiovascular complications that develop at remarkably high rates and are associated with a decreased life expectancy. These discoveries are a result of the collaborative efforts of investigators worldwide that have been fostered by the frequent interactions of investigators via the International TTP Working Group meetings and TMA workshops held regularly at international meetings. These efforts will support the rapid pace of discovery and improved understanding of this rare disease.