Health Education Group Research Articles

The effects of low-impact moderate-intensity stepping exercise on fatigue and other functional outcomes in older adults with multimorbidity: A randomized controlled trial

ObjectivesFatigue is highly prevalent among older adults with multimorbidity. As the World Health Organization advocates for strategies that improve the functional status of this aged cohort, this study examined the effects of a low-impact moderate-intensity exercise program on their fatigue levels and related functional health outcomes. Methods and MaterialsA multi-site clinical trial randomized 124 community-dwelling older adults with multimorbidity [mean age: 78.1 years (SD: 7.0); female: 83.8%] to a low-impact exercise program (intervention) group or a health education (control) group. The exercise program was designed to address fatigue-associated low energy levels, and consisted of thrice-weekly low-impact stepping exercises that were progressively increased from low intensity to moderate intensity over a 12-week period, using group-based practice to encourage engagement. The Multidimensional Fatigue Inventory, FRAIL Scale, International Physical Activity Questionnaire, the two-minute walking test, and Profile of Mood States (short-from) were administered at baseline, post-intervention, and 12 weeks thereafter. ResultsGeneralized estimating equation showed that the intervention group reported greater decreases in fatigue and frailty, and greater improvements in physical activity level, exercise tolerance, and mood status than the control group. The positive effects of the intervention on most of these outcomes were sustained over the two post-test endpoints. Discussion and implicationsThe low-impact stepping-based moderate-intensity exercise program is effective to improve fatigue and functional outcomes in older adults with multimorbidity. As it can be challenging to engage the fatigued older adults in exercise training, this study adds insights to inform community-based care approach for multimorbidity management.

WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality.

BackgroundDespite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain.ObjectiveThis study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups.MethodsA pilot focus group was conducted with Spanish-speaking women near the US–Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy.ResultsEvidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days.ConclusionsThe findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods.

Randomized controlled trial of stress reduction with meditation and health education in black men and women with high normal and normal blood pressure

BackgroundBlack men and women suffer from disparities in morbidity and mortality from hypertension, cardiovascular disease, and currently, COVID-19. These conditions are associated with social determinants of health and psychosocial stress. While previous trials demonstrated that stress reduction with meditation lowered BP in the grade I range in Black adults, there is a paucity of evidence for high normal and normal BP. ObjectiveThis randomized controlled trial was conducted to evaluate the effect of stress reduction with the Transcendental Meditation (TM) technique in Black adults with high normal BP and normal BP using international classifications. MethodsA total of 304 Black men and women with high normal (130–139/85–89 mm Hg) and normal BP (120–129/80–84 mm Hg) were randomized to either TM or health education (HE) groups. BP was recorded at 3, 6, 9, 12, 24, 30 and 36 months after baseline. Linear mixed model analysis was conducted to compare the BP change between TM and HE participants in the high-normal BP and normal-BP groups. Survival analysis for hypertensive events was conducted. ResultsAfter an average of 19.9 ± 11.1 months follow-up, TM participants in the high-normal BP group showed significantly lower posttest SBP (-3.33 mm Hg, p = 0.045). There was no difference in DBP (-0.785 mm Hg, p = 0.367) compared to HE participants. In the normal BP group, the SBP and DBP were not different between the TM and HE participants. The hazard ratio for hypertensive events was 0.52 (p = 0.15) in the high normal BP group (7 TM vs 13 HE) with no difference in the normal BP group ConclusionThis RCT found that meditation lowered systolic BP in Black men and women with high normal BP but not in normal BP participants. These results may be relevant to reducing health disparities in CVD and related co-morbidities.

Community-Based Health Education Improve Knowledge and Attitudes of COVID-19 Prevention

Background: Corona Virus Disease-19 is becoming a pandemic. The easy-to-spread nature of the virus which requires good knowledge and good attitude in determining preventive measures to break Covid-19 transmission.Purpose: This study aimed to determine the effect of community-based health education on knowledge and attitudes of Covid-19 prevention.Methods: This is quantitative research with design of quasi-experimental. The sampling technique used was simple random sampling, the samples were 62 people divided into two groups. The intervention group that received the intervention of community-based health education and control group that received a Covid-19 leaflet.Results: The research result found that Mann Whitney U test score of knowledge between intervention and control group after the given intervention was p=0.004. Independent T test score of attitudes between intervention and control group after intervention was p=0.003. The Mann Whitney U test score of knowledge differences (?) between intervention group and the control group after intervention was p=0.002. Mann Whitney U test of attitudes differences (?) between intervention group and the control group after intervention was p=0.000.Conclusion: The research showed that respondents in the intervention group have better knowledge and better attitudes. The community-based health education method can be an alternative option to promote and prevent the spread of Covid-19 infection

The effect of health education on the quality of life of postoperative patients with gastric cancer: a systematic review and meta-analysis.

Gastric cancer is one of the most common malignant tumors of the digestive tract worldwide. This study aims to evaluate the effect of health education on gastric cancer patients' quality of life after surgery. China National Knowledge Infrastructure (CNKI) and Wanfang Data (WFD) were searched to obtain relevant studies. Key words: postoperative gastric cancer/health education/quality of life. A total of 88 subject-related literatures were retrieved, and 7 literatures that met the requirements were screened out and included in the meta-analysis research. Cochrane software Revman 5.0 was used to perform heterogeneity test, sensitivity analysis and pool analysis of the included literature. A total of 7 relevant studies meeting the requirements were included, involving 772 postoperative gastric cancer patients. According to the heterogeneity test results, the fixed effects model and the random effects model were adopted in this study. The results showed that the quality of life score of the health education group was higher than that of the control group (P<0.001), with an OR (95% CI) value of 9.78 (8.59-10.99). The scores of physical function, role function, emotional function, cognitive function, and social function in the experimental group were higher than those in the control group (P<0.001), with OR (95% CI) values of 8.13 (6.65-9.60), 8.99 (7.84-10.14), 9.84 (8.64-11.50), 6.55 (5.59-7.71), and 9.79 (8.59-10.99), respectively. Health education can improve the overall health score of patients with gastric cancer after surgery. It can also improve the scores of physical function, role function, emotional function, cognitive function, and social function, and can significantly improve patients' quality of life.

Effect of Patient Empowerment Model on Smoking Cessation: Randomized Controlled Trial.

BackgroundSmoking is a preventable cause of chronic morbidity. Patient empowerment is a process through which people establish greater control over their health-related decisions and actions. To assess the effect of patient empowerment versus health education on the nicotine dependence score and progress of patients under different stages of smoking cessation. MethodsThis was a single-blinded randomized controlled clinical trial that included 76 smokers attending family medicine clinics. Participants were divided into two groups: empowerment and health education groups. Their nicotine-dependence score and smoking cessation stage were identified. All study participants were subjected to five health education sessions with a 3-month follow-up period. ResultsThe mean nicotine-dependence score decreased significantly in both groups after the intervention. This decrease was slightly higher in the empowerment group; however, the difference was not statistically significant. After the intervention, 16.7% of the health education and 30.0% of the empowerment group transitioned from stage 1 to stages 2–4 of smoking cessation, with the change being statistically significant only in the empowerment group. There was no statistically significant difference in the number of study participants who stopped smoking between the health education and empowerment groups. ConclusionBoth the empowerment model and traditional health education have similar positive effects on decreasing the nicotine-dependence level. There was a significant improvement in the stage of change for patients under the empowerment model, although there was no statistically significant difference between the groups regarding the number of participants who stopped smoking.

The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya

BackgroundExisting social relationships are a potential source of “social capital” that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based ‘microclinic’ intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness.MethodsIn nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits (‘time-in-care’). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma.ResultsOf 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61–1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08–0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2–0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17).ConclusionsThe data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care.Trial registrationClinical trial number: NCT02474992.

Computerised cognitive remediation to enhance mobility in older adults: a single-blind, single-centre, randomised trial

SummaryBackgroundDecline in executive functions and related cognitive processes is associated with mobility decline, and these functions might be amenable to cognitive remediation. This study aimed to examine whether a computerised cognitive remediation programme would improve walking in adults aged 70 years and older.MethodsThis single-blind, randomised trial at one academic centre in the USA evaluated the efficacy of an 8-week computerised programme (also known as brain games) of progressive intensity and complexity to improve walking in older adults at high-risk for mobility disability. Inclusion criteria included being 70 years or older; ambulatory; and at high-risk for mobility disability, defined using a cutscore of nine or less (frail range) on the Short Physical Performance Battery and a walking speed of 100 cm/s or less. Individuals with dementia, acute or terminal medical illnesses, recent or planned surgery affecting mobility, mobility limitations solely due to musculoskeletal limitation or pain that prevented them from completing mobility tests, and those who were nursing home residents were excluded. Participants were block randomised (1:1; block size 12 and no stratification) to the intervention group or the control group (low complexity computer games and health education classes). Primary outcomes were change in walking speed at normal pace and walking while talking conditions assessed from baseline to 8 weeks post-intervention by investigators who were masked to group assignment. Groups were compared using the intention-to-treat principle with linear mixed models adjusted for confounders. This trial was registered with ClinicalTrails.gov, NCT02567227.FindingsBetween March 1, 2016, and March 12, 2020, 383 patients were enrolled and randomly assigned to the intervention or control group. After randomisation, 11 (3%) patients were diagnosed with dementia. 372 (97%; 271 [73%] women) were included in the intention-to-treat analysis. The mean age of participants was 77·0 years [SD 5·6]). 183 (49·2%) participants were Black and 62 (16·7%) were Hispanic. 314 (93%) of the target 338 completers had finished the intervention when the trial was terminated due to the COVID-19 pandemic. Although there were significant within-group improvements in both groups after the 8-week intervention, there was no significant difference in normal walking speed (−1·03 cm/s [SD 1·30]; 95% CI −3·60 to 1·54) and walking while talking conditions (0·59 cm/s [SD 1·61]; 95% CI −2·59 to 3·76) between the intervention and control groups. Similarly, within-group, but no between-group, differences were seen on executive function tests and physical function. There were no severe adverse events related to interventions.InterpretationComputerised cognitive remediation improved walking in adults aged 70 years and older at high-risk for mobility disability, but improvements were not significantly greater compared with an active control. Although our findings corroborate the within-group improvements on cognition and mobility reported in previous pilot clinical trials, future studies are required to determine the optimal dose, frequency, intensity, and content of computerised cognitive remediation programmes.FundingNational Institute on Aging.

Editorial introductions

Editorial introductions

Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial.

This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12–36-month-old) diet and activity behaviors. Parent–toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA; accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children’s health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p < 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.

Education and screening for obesity, hypertension, and diabetes (including gestational diabetes) “at the doorstep” of women from nine underprivileged urban areas in Delhi National Capital Region

Background and aimsWomen in underprivileged urban areas have poor access to health and education, making them vulnerable to non-communicable diseases (NCDs), specifically diabetes. The current project has sought to focus on this group, to educate and screen this population to prevent and manage obesity and diabetes. MethodsThe project was conducted in 9 underprivileged areas of Delhi NCR using a mobile van unit. Women from these areas were invited for health education (this included talks, lectures and distribution of Information, Education & Communication material), screening {anthropometric, blood glucose and blood pressure (BP) measurements} diet counselling sessions and referral of subjects with uncontrolled blood glucose. ResultsBaseline survey on knowledge of diabetes and nutrition showed low awareness. Health education sessions (n, 46) included face-to-face discussion and problem solving and distribution of simple pictorial leaflets (n, 3000). The health education sessions were well accepted. In total, 4% women (n,3175/91000- total population, 3056 non-pregnant, 119 pregnant) participated in the research trial. Among non-pregnant women, an average weight gain of 11.8 kg between the ages of 20–40 years was observed. The average BMI and waist circumference (WC) was 26.8 ± 5.3 kg/m2 and 91.1 ± 13.2 cm, respectively in non-pregnant women. Further, 75.3.0% (2207/2928) and 96.7% (2875/2971) of the non-pregnant women had overweight/obesity and abdominal obesity, respectively. In the non-pregnant women, 21.7% had known diabetes. Further, 7.4% non-pregnant women and 2.5% pregnant women were identified as having hyperglycaemic state. Hypertension was observed in 11.9% pregnant women and 49.9% of non-pregnant women. ConclusionExtremely high prevalence of obesity, along with diabetes and hypertension in underprivileged urban women requires intensive individualised and group health education, screening, and counselling “at the doorsteps”, as has been shown in our model.

Pengaruh Terapi Kelompok Terapeutik dan Pendidikan Kesehatan Terhadap Kecemasan Menghadapi Menarche pada Siswi Di Kelurahan Delima Kecamatan Tampan Pekanbaru

Puberty is influenced by heredity, nation, environment, race or ethnicity, climatic factors, way of life, exposure to adult mass media and the environment. Children who have entered puberty will experience menarche. Menarche is an early sign of changes in the body such as breast growth, pubic and axillary hair growth, and fat distribution in the hip area. The symptom that often accompanies menarche is discomfort caused by the reduced volume of water in the body during menstruation. Other symptoms that are felt are headaches, aches in the legs and waist for several hours, stomach cramps and abdominal pain. Physical changes at puberty occur in tandem with emotional upheaval and adolescent psychological growth. Adolescent girls who will experience puberty show early signs of menarche showing feelings of confusion, anxiety, and other uncomfortable feelings such as fear and anxiety. The purpose of this study was to determine the effect of the application of Therapeutic Group Therapy and health education on the level of anxiety facing menarche in female students in RW 008, Delima Village, Tampan District, Pekanbaru. This type of Pre Experiment research with the One Group Pre Test Post Test design was carried out on 20 respondents, using the HARS scale questionnaire. This research will be carried out on students in RW 008, Delima Village, Tampan Pekanbaru District within an observation period of 4 months starting from September to December 2020. In sampling, this study uses the Non Probability Sampling technique with the type of Total Sampling where the sample selection method used is carried out based on certain goals or objectives determined by the researcher.

Prenatal stress self-help mindfulness intervention via social media: a randomized controlled trial

Background Prenatal stress is a pressing issue. However, there is a lack of robust evidence for psychosocial interventions to manage this problem. Aims This study aimed to examine the effectiveness of a mindfulness-based intervention on reducing prenatal stress compared to participation in health education groups. Methods A randomized controlled trial was conducted in a prenatal clinic of comprehensive tertiary care from April to October 2017. A total of 108 pregnant women were randomly assigned to an intervention or a control group. Participants completed self-report measures of depression, anxiety, perceived stress, fatigue, positive and negative affect, and mindfulness before, immediately after, and 15 weeks after the 4-week intervention period. Generalized estimating equations were used to analyze the intervention outcomes. Results The results supported greater improvement in terms of perceived stress (Wald χ 2=26.94, p<0.001), fatigue (Wald χ 2=17.61, p<0.001), positive affect (Wald χ 2=9.03, p = 0.011), negative affect (Wald χ 2=11.37, p = 0.003), and mindfulness (Wald χ 2=24.97, p<0.001) in the intervention group than in the control group. Conclusions The self-help mindfulness intervention decreased prenatal stress and negative affect and improved positive affect and mindfulness.

Effectiveness of a patient educational program on rheumatoid arthritis disease activity

Objectives To validate Arabic version of rheumatoid arthritis disease-specific patient's knowledge and attitude questionnaire (PKAQ-RA) and to assess the effect of health education on RA disease activity. Background RA is a disease requiring a change in patient's behavior, and hence preventing disability. Patients and methods A quasi-experimental pretest and posttest interventional study was conducted on 403 patients with RA. An equal number of matched controls were recruited. Patient's knowledge questionnaire on RA and authors' designed attitude questionnaire (PKAQ-RA) were delivered. All patients were assessed regarding disease duration and disease activity score 28. Laboratory investigations including fibrinogen, albumin, rheumatoid factor titer, and anti-cyclic citrullinated peptide antibodies in addition to gray-scale ultrasonography were conducted. Results Patients with RA (n = 403) had significantly higher laboratory investigation values than healthy controls (n = 403). Cronbach's alpha of the Arabic version of PKAQ-RA was 0.75 and 0.82, respectively. The total knowledge and attitude scores were significantly higher in posthealth than prehealth education implementation period (13.11 ± 1.93, R: 9–19 and 5.79 ± 1.44 vs. 15.18 ± 1.91 and 7.78 ± 1.50, respectively) (P < 0.001). Unsatisfactory knowledge was associated with male patients [odds ratio (OR)=2.02, 95% confidence interval (CI): 1.19–3.43], being of low education (OR = 2.03, 95% CI: 1.29–3.19), and having increased medications (OR = 2.03, 95% CI: 1.29–3.19). Negative attitude was associated with low education (OR = 3.15, 95% CI: 1.97–5.02) and increased number of medications (OR = 0.18, 95% CI: 0.10–0.34). Patients showed some improvement but still significantly different from controls. Biomarkers like albumin/fibrinogen ratio were significantly increased, whereas grayscale ultrasonography was significantly decreased after health education in active and inactive groups (P < 0.001). Conclusion The Arabic version of the PKAQ-RA was created and proved to be a reliable and valid tool. Patients' knowledge of RA was poor. RA disease activity got improved when upgrading patients' knowledge and modifying their attitude. Integration of patient-directed education programs in the treatment of RA to raise the patients' awareness, increase compliance, and improve the disease condition is required.

Risk factors and Molecular genotyping of Brucella melitensis strains recovered from humans and their owned cattle in Upper Egypt

Brucellosis is a zoonosis that has a devastating impact on the economy and public health, particularly in the Middle East, including Egypt. This study aimed to define risk factors associated with brucellosis in humans and in their cattle in Fayoum governorate - Upper Egypt. Also, molecular genotyping of recovered Brucella isolates from human cases and their cattle to assess the potential cross-species transmission in the study region. Data were obtained via double matched case–control studies for brucellosis in humans (106 cases and 160 controls) and in their cattle (78 cattle cases and 105 cattle controls). The results of multivariate regression analysis revealed that predictors of human brucellosis were animal-related occupations (OR 2.1, P 0.02), previous infection in other household members (OR 3.2, P 0.007), eating home-made soft cheese (OR 2.3, P 0.03), and exposure to cattle abortions (OR 6.9, P < 0.001). For cattle, predictors of brucellosis were maturity ≥2 years of age (OR 2.9, P 0.01), ≥2 animals reared by the same household (OR 3.7–6.9, P ≤ 0.001), and recent abortion (OR 15.2, P 0.01). Twelve Brucella isolates were recovered from eight human cases (7.5%, 8/106) and four cattle cases (6.2%, 4/65). All isolates were B. melitensis biovar 3. Analysis of the IS711 gene sequence revealed complete homology (100%) between isolates. Six virulence genes were utilized for virutyping: virB (100%), omp25 (100%), amiC (100%), ure (91.7%), wbkA (91.7%), and bvfA (75%). Virutyping revealed four virutypes: V1 (lack bvfA, 16.7%), V2 (harbored all genes, 66.7%), V3 (lack wbkA, 8.3%), and V4 (lack wbkA and ure, 8.3%). Repetitive extragenic palindromic PCR (REP-PCR) typing revealed two REP types. Combined REP-PCR/virulence genotyping revealed five different genotypes (G1–G5) for the detected isolates and a unique genotype for the reference strain (G6, B. melitensis bv3 Ether). Human and cattle isolates from the same household had matched genotypes. In conclusion, there were widespread risk factors among the cases studied. Health education for high-risk groups is essential for disease prevention, and combined REP-PCR/virulence genotyping is a quick tool for traceability, particularly in developing countries endemic with brucellosis as Egypt.

Effects of mobile health education on sexual and reproductive health information among female school-going adolescents of rural Thailand

Background: Adolescent pregnancy is one of the major public health issues globally, as well as in Thailand. Sexual health literacy (SHL) has been a proved effective intervention for preventing teenage pregnancy. The objective of this study was to evaluate the effects of mobile messages to improve sexual and reproductive health literacy among secondary school female students. Methods: A comparative cross-sectional study with pre–post design was conducted in two secondary schools of rural Thailand. 128 respondents were selected through a simple random sampling method; equal number of female secondary school students were selected from each school. Health education through mobile messages on sexual and reproductive health literacy were delivered in one group while the other group was observed through routine care for 24 weeks. Baseline (pre) and endline (post) measurement was taken to compare the effects of mobile messages. Study was ethically approved by the institutional review board of Chulalongkorn University, Thailand. Results: Both groups were same at baseline and found statistically non-significant (p>0.05). After the 24-week health education program, the mean scores of health education groups was found statistically significant (p<0.05), while the mean score in observed group did not show any statistical change (p>0.05) . Level of sexual health literacy scores among female students in the health education group was found statistically significant (p<0.05) in all four domains. While, the observation group was remained same at both measurements pre and post (p=0.521). Conclusion: The study concluded that the mobile messages have proved an effective information method for sexual and reproductive health information among female secondary students of rural Thailand.

Oral health for all-how can the development of dental public health in Germany be sustainably enhanced?

Public health promotes health through organised efforts of society. Oral and maxillofacial diseases and conditions are important public health problems due to the large burden of disease and oral health inequity caused by social determinants. Caries, periodontitis, traumatic dental injuries or carcinomas of the mouth and throat can be reduced by increased public health efforts. One example for ahighly effective public health measure like the health-promoting modification of the product range is the addition of fluoride to toothpastes, which is largely responsible for the impressive caries decline.However, the full potential of dental public health is not yet unlocked. It therefore appears necessary to create structures such as an "oral health institution" at the federal level and through statutory mandate. Its assignment should be "oral health for all" through changes in the social and economic environments to make them conducive to oral health. By this, the already established individual and group prophylaxis would be complemented with apopulation-based approach. The institution's tasks on the federal and on the federal states level should be to influence policies relevant to oral health, communication, collaboration, advanced training and research. Subdivisions of the proposed institution could provide oral health education for groups not yet reached. This would be an essential contribution to effectively addressing existing oral health problems across the population as well as for deprived and vulnerable groups.

Effects of mobile health education on sexual and reproductive health information among female school-going adolescents of rural Thailand.

Background: Adolescent pregnancy is one of the major public health issues globally, as well as in Thailand. Sexual health literacy (SHL) has been a proved effective intervention for preventing teenage pregnancy. The objective of this study was to evaluate the effects of mobile messages to improve sexual and reproductive health literacy among secondary school female students. Methods: A comparative cross-sectional study with pre-post design was conducted in two secondary schools of rural Thailand. 128 respondents were selected through a simple random sampling method; equal number of female secondary school students were selected from each school. Health education through mobile messages on sexual and reproductive health literacy were delivered in one group while the other group was observed through routine care for 24 weeks. Baseline (pre) and endline (post) measurement was taken to compare the effects of mobile messages. Study was ethically approved by the institutional review board of Chulalongkorn University, Thailand. Results: Both groups were same at baseline and found statistically non-significant (p>0.05). After the 24-week health education program, the mean scores of health education groups was found statistically significant (p<0.05), while the mean score in observed group did not show any statistical change (p>0.05) . Level of sexual health literacy scores among female students in the health education group was found statistically significant (p<0.05) in all four domains. While, the observation group was remained same at both measurements pre and post (p=0.521). Conclusion: The study concluded that the mobile messages have proved an effective information method for sexual and reproductive health information among female secondary students of rural Thailand.

Study protocol for a cluster randomised controlled trial of The Illicit Project, a digital, neuroscience-based substance use intervention for secondary school students

Older adolescence (16–19 years) is characterised by an increase in alcohol and illicit substance use, however limited age-appropriate prevention programs exist to target this critical group. Schools are increasingly opting for web-based programs to deliver health education due to their effectiveness, accessibility and scalability. This study outlines the web-based adaptation of a neuroscience-based harm reduction program targeting older adolescents known as, The Illicit Project, and the study protocol to evaluate its effectiveness. A cluster randomised controlled trial will be conducted with Year 10, 11 and/or 12 students (aged 16–19 years) from 8 secondary schools across New South Wales, Australia. Participating schools will be randomised into the control group (health education as usual) or the intervention group (The Illicit Project program; a three-lesson, web-based program delivered fortnightly over 6 weeks) and will complete four web-based assessments at baseline, 6-, 12- and 24-months post baseline. Primary outcomes are the quantity and frequency of substance use, alcohol-related harms and drug literacy levels, with the 12-month follow-up, the primary end point. Secondary outcomes include intentions to use alcohol and other drugs in the future and risk perceptions. This trial has been registered with Australia and New Zealand Clinical Trials Registry (ACTRN12620000805976). Intervention effects will be estimated using multilevel mixed effects models with an intention-to-treat sample. This is the first evaluation of a web-based, age-appropriate neuroscience-based prevention program for substance use targeting older adolescents.

Improving physical health for psychiatric patients detained in a low secure forensic psychiatric unit in the United Kingdom

AimsThis project aimed to improve physical health and to tackle obesity in patients detained in a low secure forensic psychiatric unit.BackgroundPeople suffering from severe and enduring mental health problems have a life expectancy of 15-20 years less than the general population. The main cause of death is cardiovascular disease due to lifestyle factors, such as smoking, substance misuse and obesity.Physical health problems such as metabolic syndrome, diabetes and heart disease have a knock on effect on motivation, self-esteem and concordance with treatment.Over 60% of the general population and up to 80% of patients detained in forensic psychiatric units in the UK are classed as overweight or obese, with serious consequences to physical health.Southfield Low Secure Unit is a 28 bed unit. Most patients suffer from treatment resistant schizophrenia and are prescribed high doses of antipsychotic medication, some up to 250% of the maximum recommended dose.MethodBaseline data were collected using Body Mass Index (BMI) and Simple Physical Activity Questionnaire (SPAQ). Following the initial data collection, patients were involved in focus groups, community meetings and a monthly physical health action group. There was input from the care team including psychology, occupational therapy, nursing, catering and security. New activities have been made available such as “physical health and mental health education group”, “rambling group”, “gym sessions”, “patient focus groups” and “walking group”.ResultThis project has been running for 9 months and is ongoing.There has been a modest change in the BMI – initial results ranging from BMI 23.6–42.8kg/m2. Of the initial cohort (n = 14), there has been weight loss (n = 3), weight gain (n = 3) and no change (n = 8).The initial SPAQ results showed that on average patients spend 19.8 hours per day either in bed or doing sedentary activities and only 1.68 hours per day walking or doing physical activities. This pattern is being reassessed.The qualitative data from patient focus groups shows increased interest in activities, motivation and desire to contribute to the project.ConclusionThe preliminary results show an increase in patient motivation and engagement with available activities. There have also been patient-led challenges which were well received. Patients feel positive about the programme and valued for their input. Further support is required to maintain progress.