Health Improvement Program Research Articles

Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms

BackgroundUp to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM).MethodsThe MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement.DiscussionThe overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination.Trial registrationClinicalTrials.gov NCT06036147. Registered on September 13, 2023.

Anal Sexual Roles and Impacts on HIV Infection and Psychological Distress Among Men Who Have Sex With Men in China: A 14-Year Longitudinal Study.

Previous studies have shown that men who have sex with men (MSM) with different anal sexual roles, namely bottom, versatile, and top, are at different risk of HIV infection and psychological distress. However, the evidence was primarily derived from cross-sectional designs from Western countries, and it remains unclear how anal sexual roles change over a long time and their health impacts among MSM from Eastern countries. We aimed to describe the changes in anal sexual roles among a Chinese sample of MSM over 14years and explore their effects on HIV infection, depression, anxiety, and suicidal ideation. Between 2009 and 2023, a longitudinal study was conducted on 373 MSM in Changsha, China, to assess their anal sexual roles, HIV infection, and psychological distress, including depression, anxiety, and suicidal ideation. Generalized linear models with a binomial probability was used to analyze the predictive effect of anal sexual roles on HIV infection and psychological distress. At baseline, 30.3% of MSM self-identified as bottom, 32.2% as versatile, and 37.5% as top, and these numbers changed slightly to 35.9%, 33.0%, and 31.1%, respectively, at follow-up (p = 0.131). From baseline to follow-up, 48 (12.9%) new HIV cases were identified. The prevalence of depression increased from 23.1 to 38.1% (p < 0.001), anxiety increased from 25.5% to 35.4% (p = 0.003), and suicidal ideation increased from 30.8 to 38.9% (p = 0.021). MSM with bottom and versatile roles were more likely to have HIV infection, depression, anxiety, and suicidal ideation than those with top roles. MSM's risk of HIV infection and psychological distress varies according to their anal sexual roles, suggesting that future HIV prevention and mental health improvement programs for MSM may benefit from providing targeted and individualized support based on their anal sexual roles, with a particular focus on those with bottom and versatile roles.

Determinants of quality antenatal care use in Kenya: Insights from the 2022 Kenya Demographic and Health Survey

Provision of quality antenatal care (ANC) is important to reduce maternal and newborn fatalities worldwide. However, the use of quality ANC by women of reproductive age and associated factors remain unclear in many developing countries. Therefore, this study aimed to determine factors associated with receiving quality ANC in Kenya among women of reproductive age. We analyzed secondary data from the 2022 Kenya Demographic Health Survey, which included 11,863 women. Participants were selected using two-stage stratified sampling. Univariate and multivariable logistic regression analyses were used to analyze the data. Of the 11,863 participating women, 61.2% (95% confidence interval (CI): 59.7%–62.6%) received quality ANC. Participants aged 20–34 years had a 1.82 (95%CI: 1.15–2.87) times higher likelihood of receiving quality ANC compared with those aged 15–19 years. Those who had attended four or more ANC visits were 1.42 (95%CI: 1.14–1.79) times more likely to receive quality ANC than those who attended three or fewer visits. Participants with media access were 1.47 (95%CI: 1.06–2.03) times more likely to receive quality ANC than those without media access. Compared with participants in the “poorest” quintile, the likelihood of receiving quality ANC was 1.93 (95%CI: 1.21–3.08) and 1.44 (95%CI: 1.01–2.06) times higher for participants in the “richest” and “richer” quintiles, respectively. Furthermore, compared with participants from the Coastal region, the odds of receiving quality ANC were 0.25 (95%CI: 0.15–0.31) to 0.64 (95%CI: 0.44–0.92) times lower for those from all other Kenyan regions. Participants whose partners made their healthcare decisions were 0.74 (95%CI: 0.58–0.95) times less likely to receive quality ANC than those who made decisions independently. We found that just over 60% of participating mothers had received quality ANC. Factors associated with receiving quality ANC were: age, region, maternal education, healthcare-seeking decision-making, access to media, time to the health facility, ANC visits, and ANC provider type (doctor, nurse/midwife/clinical officer). Maternal health improvement programs should prioritize promoting access to education for girls. Furthermore, interventions should focus on promoting shared decision-making and autonomy in healthcare-seeking behaviors among pregnant women and their partners, increasing access to care provided by skilled healthcare workers, and addressing regional disparities in healthcare delivery.

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. This trial is registered as ISRCTN12139369. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

Sleep and health improvement programme (SHIP) for patients with prostate cancer and caregivers

AbstractObjectiveThe objective of this study is to determine whether a sleep and health improvement programme (SHIP) to promote healthy sleep, eating and physical activity would be feasible, acceptable and have a positive impact on lifestyle behaviours for prostate cancer survivors and caregivers.MethodsWe recruited 50 participants for a single group 3‐month pre‐post pilot study. The SHIP intervention included (1) website about sleep, nutrition and physical activity (≥1 view/week), (2) two email newsletters with goal‐setting exercises and resources and (3) midpoint health coach call. The primary outcome was changes in validated sleep scales; secondary outcomes included changes in diet, physical activity and concentration from baseline to 3 months.ResultsOf 50 participants enrolled, median age was 65, 30% were Black and 8% were Hispanic. Thirty‐four patients and 7 family caregivers completed the pilot study (82%). Following the intervention, we observed a statistically significant improvement in the Sleep Hygiene Index (pre: 15, post: 13, p &lt; 0.01), and a trend toward lower Insomnia Severity Index (pre: 12, post: 9, p = 0.07). There were no statistically significant improvements in sleep quality or physical activity, but there were improvements in healthy eating (e.g., increase in cruciferous vegetables and reduction in dairy) and in fatigue‐related problems and concentration. Exit interview feedback was positive.ConclusionsA web‐based sleep and healthy lifestyle programme for patients with prostate cancer and their caregivers is feasible and acceptable. A randomized controlled trial is planned to test whether a refined SHIP improves sleep and lifestyle in patients with prostate cancer and caregivers.

Collaborative Governance in Public Health Policy Implementation: A Literature Review in the Southeast Asia Region Including Indonesia

In the context of Indonesia, public health issues necessitate a comprehensive and coordinated strategy involving various stakeholders. Collaborative Governance serves as a means to materialize this approach. The purpose of this study is to identify instances of Collaborative Governance that have been implemented or are currently underway in public health improvement programs. research used a qualitative methodology, with data acquired through an exhaustive literature review. Data reduction, presentation, and conclusion form the three stages of data analysis. Findings from this literature review indicate that Collaborative Governance has been implemented in several public health programs in Indonesia. These programs involve stakeholders from both the government and non-governmental sectors, including communities, non-profit organizations, and industry associations. Collaborative Governance is achieved through regular meetings, coordination committees, and the use of digital platforms to facilitate information exchange and monitor program implementation. Successful examples of Collaborative Governance in public health programs in Indonesia include initiatives for infectious disease control, where the government collaborates with international organizations, pharmaceutical companies, and local communities to enhance health awareness.

A Descriptive Study of Pulmonary Function Comparison Between Spot Welding and Assembly Line Workers in a Large Automotive Factory in Iran.

This study seeks to define the pulmonary function of a considerably large group in one of the largest automotive companies in Iran. The aim of this study was to compare the two groups of spot-welding (exposed) and assembly line (unexposed) workers in terms of pulmonary function and conclude the probable impacts of metal fumes on pulmonary function in the two groups. A total of 1,798 spot-welding personnel and 2,160 assembly line personnel were compared in terms of pulmonary function. Moreover, 120 breathing zone samples were collected from the welders' metal fumes and were analyzed. The parameters of age, anthropometric indices, smoking, and pulmonary symptoms were also compared with across the two groups. Results revealed the FEV1 mean of the total population to be 3.9 ± 0.5 liters and FVC to have been 4.9 ± 0.7 liters. Besides, predicted FEV1 and FVC percentages across the whole population were close to 100%, suggesting the better condition of the studied population compared with normal individuals in the society. All the parameters of age, weight, height, and smoking status were similar in the two groups, and no statistically significant difference was observed between the two groups in terms of pulmonary functions. Implementation of professional health and health improvement programs, running screening programs, and hiring personnel with no history of mild pulmonary disorders, and healthy workers effect at the recruitment stage could be the reasons behind the lack of significant difference between the two exposed and unexposed groups to metal fumes in the automotive industry in terms of pulmonary function.

Hubungan Penerapan Perilaku Hidup Bersih dan Sehat (PHBS) Keluarga terhadap Kejadian Infeksi Saluran Pernapasan Akut (ISPA) pada Balita di Puskesmas Mandai Kabupaten Maros

This study aims to explore the relationship between the implementation of clean and healthy living behaviors (PHBS) in the family with the incidence of Acute Respiratory Infections (ARI) in toddlers at Puskesmas Mandai, Maros Regency. Using a quantitative approach with a correlation analytic method, this study involved 58 toddlers aged 0-5 years who were diagnosed with ARI. The results showed that 58.6% of respondents were male, with the largest age group 0-12 months (25.9%). 74.1% of the toddlers were not exclusively breastfed, and 80.9% were underweight. In addition, 75.7% of respondents did not have the habit of washing hands with soap, and 94.8% lived in an environment with active smokers. Bivariate analysis showed a significant association between the PHBS variables and the incidence of ARI, with P values less than 0.05 for all variables. These results suggest that the implementation of exclusive breastfeeding, routine weighing of toddlers, hand washing with soap, and not smoking in the house play an important role in reducing the incidence of ARI. Therefore, health centers are advised to increase the socialization of PHBS and education about the dangers of smoking, as well as encourage the community to apply clean living behavior in everyday life. This study is expected to be the basis for improving health programs at Puskesmas Mandai and increasing public awareness about the importance of PHBS in preventing ARI.

Epidemiological Trends in the Incidence of Gastritis and Duodenitis among Children in Moscow

Introduction. The article analyzes the incidence of gastritis and duodenitis among children based on the data provided by medical organizations subordinate to the Moscow Healthcare Department. The disease incidence is presented by age groups. Materials and methods. The data was obtained from the Federal Statistical Observation Form No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, Form of Federal Statistical Monitoring No. 30 “Information about a medical organization” for the period from 2019 to 2023, as well as data on child population in Moscow published on the official website of the Federal State Statistics Service. Results and conclusions. The analysis of the incidence of gastritis and duodenitis in the observed period showed that the most vulnerable age groups are children aged 10-14 years and adolescents (39.9% and 37.0% out of the total number over the past five years, respectively). Among all age groups, there is a negative dynamic in the overall and primary incidence of gastroduodenitis. Based on the results obtained, it can be concluded that there is a moderate incidence of gastritis and duodenitis among the child population in Moscow. Special attention should be paid to preventive measures and health-improving programs in order to reduce the incidence rate and ensure the health of the rising generation.

Develop a bone mineral density T-score distribution nomograms based on osteoporosis risk factors for middle-aged and older adults

PurposeThis study aimed to understand how age, health status, and lifestyle impact bone mineral density (BMD) in middle-aged and older adults, focusing on predicting osteoporosis risk. MethodsThis study included 2836 participants aged 50–88 from the Health Improvement Program of Bone (HOPE) conducted from 2021 to 2023. We used logistic regression to make a prediction tool. Then checked its accuracy and reliability using receiver operating characteristic (ROC) and calibration curves. ResultsFactors like age, body weight, prior fractures, and smoking were independently found to affect BMD T-score distribution in men. In women, age and body weight were identified as independent factors influencing BMD T-score distribution. A nomogram was created to visually illustrate these predictive relationships. ConclusionsThe nomogram proved highly accurate in identifying men aged 50 and above and postmenopausal women based on their BMD T-score distribution, improving clinical decision-making and patient care in osteoporosis evaluation and treatment.

IDEA tool: Establishing a prioritisation matrix for oral health improvement interventions.

Initial impetus for action: Oral health is not equitably distributed. More deprived areas experience appreciably worse oral health outcomes. Oral health improvement programmes in Local Authorities (LA) seek to reduce these inequalities but have diminished in recent years following the COVID-19 pandemic. LAs have also endured funding cuts to public health budgets, placing a greater emphasis on the need for establishing a clear prioritisation matrix for oral health improvement interventions. Solution: A prioritisation matrix that considered both the importance and do-ability of oral health improvement interventions was developed. Both are composite measures. The importance comprised evidence of benefit, impact on inequalities, alignment with national/local priorities and cost-effectiveness of the intervention. The do-ability considered the available support from stakeholders, building/equipment requirements, workforce issues and investment funding. A working group was necessary to inform the do-ability aspect of the prioritisation matrix. Scores were assigned to each criterion, the sum of the scores informed whether the intervention was eliminated, aspirational or implemented based on predetermined thresholds. Outcome: The prioritisation matrix ensured a transparent and systematic approach for intervention selection, which reflected local resources and priorities. Moreover, this tool should help ensure the most effective, equitable, practical and sustainable interventions are chosen having the greatest impact on improving oral health outcomes.

Use of indices to assess women’s health in wellness fitness

Background and Study Aim. With increasing focus on women's health and well-being, there's a pressing need for efficient tools to accurately reflect their physical condition and health status. This study aims to substantiate the use of indices as effective instruments for assessing women's health and wellness fitness. Material and Methods. This study involved 40 women, aged 43.33 ± 0.93 years, who participated in a wellness fitness program for 8 months. Sessions were held three times a week, each lasting 1 hour. A comprehensive health improvement program was utilized, incorporating dance aerobics, strength fitness, and stretching exercises. Anthropometric measurements were taken, and the Stange test was administered to calculate 12 health-related indices. The significance of differences was evaluated using the sign criterion (z) and Rosenbaum's Q index. Assessments were conducted both before the initiation and upon completion of the wellness program. Results. Significant changes were observed in several indices, including the Body Mass Index (z=2), Erisman Index (z=0), Vital Index (z=0), Skibinsky Index (z=1), Kerdo Autonomic Index (z=2), Robinson Index (z=3), Waist-to-Hip Ratio (z=11), Systolic Blood Pressure Index (z=5), Diastolic Blood Pressure Index (z=4), and Livy Index (z=0). Additionally, a reliable improvement in the left arm strength index was confirmed using Rosenbaum's Index (Q=7). Conclusions. The results validate the use of specific indices to evaluate the efficacy of wellness fitness programs. Notable improvements were observed in the Body Mass Index, Erisman Index, and Livy Index, indicative of enhanced physical condition and normalization of body mass, particularly significant among overweight and obese participants. An increase in the strength index reflects augmented hand muscle strength, while enhancements in the vital index signal boosted respiratory system functionality. Furthermore, changes in the Skibinsky Index, Robinson Index, and Kerdo Autonomic Index highlight an elevated adaptation capacity of the cardiorespiratory system. The comprehensive set of indices employed offers insights into the cardiovascular, respiratory, and musculoskeletal systems' state. Their applicability at both individual and group levels, combined with the simplicity of calculations, clarity, and informativeness, markedly improves the monitoring effectiveness of health and fitness status.

Physical activity and sedentary behavior among school-going adolescents in low- and middle-income countries: insights from the global school-based health survey.

The Global School Student Health Survey (GSHS) is being carried out by students in various countries across the globe to advance improved health programs for youth. However, in comparison to high-income countries, adolescents in low- and middle-income countries (LMICs) are generally at an early stage of understanding regarding physical activity (PA) and sedentary behavior (SB), often exhibiting low levels of PA and high levels of SB. Furthermore, there is limited evidence connecting PA and SB in school-going adolescents from LMICs. The objective of this review was to synthesize the available evidence regarding PA and sedentary behavior among school-going adolescents in LMICs using data from the GSHS. On March 18, 2023, a systematic literature search was performed across four electronic databases, namely Web of Science, PubMed, ScienceDirect, and EBSCO with n odaterestrictions. Studies were eligible if they: (1) utilization of data sourced from the Global Student-based Health Survey; (2) exploration of physical activity; (3) specific focus on adolescents; (4) conducted in low- and middle-income countries; (5) study design encompassing observational; (6) published as English journal articles. Among the 29 studies included in the analysis, the majority revealed elevated levels of sedentary behavior and diminished levels of PA in low- and middle-income countries. Furthermore, notable disparities in physical engagement and sedentary behavior were noted between male and female adolescents (p < 0.001). Augmented PA among teenagers was observed to correlate with higher consumption of vegetables and fruits (AOR = 1.30; 95% CI [1.13-1.50]; p < 0.001), decreased alcohol consumption, and a reduced prevalence of loneliness and depression (aOR 1.37, 95% CI [1.18-1.59]). The results of this review affirm that in contrast to high-income countries, adolescents in low- and middle-income countries (LMICs) are in the early stages of comprehending physical activity, marked by low levels of PA. Physical activity and sedentary behavior in school-going adolescents from LMICs appear to be influenced by factors such as policies, cultural norms, socioeconomic conditions, as well as gender, and age.

Regulatory and legal regulation of the healtcare sector in Ukraine and Hungary: general and special

This article conducts a comparative analysis of the current state of legal regulation in the healthcare sector in Ukraine and Hungary. The significance of healthcare issues has elevated them to the level of one of the most important state tasks and an internal function of the modern state. This necessitates not only the execution of effective state governance but also the formation and implementation of state policy in this sphere. The article is dedicated to the formation and implementation of state policy concerning the legal regulation of the healthcare sector in Ukraine and Hungary, which underscores its relevance.&#x0D; During the writing process, the author researched the system of legal relations and state bodies responsible for performing relevant functions and tasks in the formation and implementation of healthcare policy. It analyzes the legislative system regulating these areas and the practice of its application in both countries. The article identifies the roles and places of the Verkhovna Rada (Supreme Council) of Ukraine and the Hungarian National Assembly, as well as the Cabinets of Ministers and the executive branch systems in both countries in the realization of healthcare policy.&#x0D; Like most contemporary scientific developments in this field, the article covers problems of three scientific disciplines – medicine, management, and law. In preparing this article, the author reviewed a considerable amount of medical literature, particularly in social medicine and healthcare organization, thoroughly exploring their scientific issues in both Ukraine and Hungary. However, it aims to illuminate the issues and problems arising in this context, specifically from the legal standpoint, particularly administrative law. Therefore, the focus of this work is primarily on legal categories and concepts – the legal mechanisms for implementing state medical and health improvement programs, ensuring the constitutionally guaranteed right of individuals in Ukraine and the Fundamental Law of Hungary to medical care, healthcare, and medical insurance, particularly the guaranteed level of free qualified medical aid.

Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review

BackgroundPublic–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.MethodsWe searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.ResultsWe identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change.ConclusionsMany of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.

Exploring the engagement behaviours of Smile4life practitioners: lessons from an evaluation of the national oral health improvement programme for people experiencing homelessness in Scotland.

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness, aimed at reducing oral health inequalities experienced by this population. This study forms part of an evaluation of how the Smile4life intervention was being implemented within Scottish NHS Boards. The aim was to investigate the influence of the Smile4life intervention upon the engagement behaviours of Smile4life practitioners. Focus groups were conducted with Smile4life practitioners, to provide an insight into how the Smile4life intervention affected their skills, attitudes and experiences while interacting with people experiencing homelessness and their services providers. A purposive sample of oral health practitioners, including dental health support workers, oral health promoters/educators, and oral health improvement coordinators working in three NHS Boards were invited to take part. One focus group was conducted in each of the three NHS Boards. The focus groups were audio-recorded and transcribed. The COM-B model of behaviour was used as a framework for analysis. Eleven Smile4life practitioners took part in the focus groups. All had first-hand experience of working with the Smile4life intervention. The average focus group length was 67 min. Working on the Smile4life intervention provided the Smile4life practitioners with: (i) the capability (physical and psychological), (ii) the opportunity (to establish methods of communication and relationships with service providers and service users) and (iii) the motivation to engage with Third Sector homelessness services and service users, by reflecting upon their positive and negative experiences delivering the intervention. Enablers and barriers to this engagement were identified according to each of the COM-B categories. Enablers included: practitioners' sense of responsibility, reflecting on positive past experiences and success stories with service users. Barriers included: lack of resources, negative past experiences and poor relationships between Smile4life practitioners and Third Sector staff. The Smile4life programme promoted capability, provided opportunities and increased motivation in those practitioners who cross disciplinary boundaries to implement the Smile4life intervention, which can be conceptualised as "boundary spanning". Practitioners who were found to be boundary spanners often had a positive mindset and proactive attitude towards the creation of strategies to overcome the challenges of implementation by bridging the gaps between the NHS and the Third Sector, and between oral health and homelessness, operating across differing fields to achieve their aims.

Evaluation of willingness to obtain of Covid 19 vaccine in patients with multiple sclerosis.

Assessing vaccine willingness and understanding sources of vaccine hesitancy in individuals with multiple sclerosis (MS) helps healthcare providers approach patients more effectively while respecting their autonomy to encourage coronavirus disease 2019 (COVID-19) vaccination. A descriptive-analytical cross-sectional study using a researcher-made checklist was conducted on MS patients referred to Neshat Clinic of Hamadan during the years 2020-2021. The checklist contained questions about demographic information, MS phenotype, duration of illness, expanded disability status scale (EDSS) score, and COVID-19 vaccination status. The expanded disability status scale (EDSS) is the most commonly used instrument for measuring disability in patients with multiple sclerosis (MS). The EDSS scale ranges from 0 to 10 in increments of 0.5 units, denoting advanced points of disability. Based on the results, 20 individuals (10%) were in the vaccine non-acceptance group, while 181 individuals (90%) were in the vaccine acceptance group. A significant number of relapsing and remitting (RR) type MS patients (90.7%) and all primary progressive (PP) type MS patients (100%) accepted the vaccine. In comparison, vaccine non-acceptance in the secondary progressive (SP) group was relatively higher (20.7%) compared to other types of MS, and this difference was significant (P < 0.05). Additionally, there was a statistically significant relationship between the history of COVID-19 and vaccine acceptance (P < 0.05). The study results demonstrated a high rate of COVID-19 vaccine acceptance among MS patients. MS phenotype, previous infection experiences, and other influences allow for COVID-19 vaccine acceptance among MS patients. This information can improve health programs and communication strategies for COVID-19 and future possible infectious disease vaccination in individuals with MS.

Fluoridated food on preventing dental caries in Latin American and Caribbean children and adolescents: a systematic review

Dental caries is a significant global public health challenge, particularly among children and adolescents. It affects individuals' quality of life and can lead to various adverse outcomes, including pain, infection, and impaired school performance. Fluoride has been widely recognized as a key component in oral health improvement programs due to its ability to prevent tooth demineralization and promote remineralization. This systematic review aimed to evaluate the existing literature on the effectiveness of fluoridated food interventions in preventing dental caries in Latin American and Caribbean children and adolescents. The study focuses on this specific region, which faces unique challenges such as limited access to dental care services, socioeconomic inequalities, and cultural practices that may influence oral hygiene and dietary habits. The review follows the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A comprehensive search was conducted in multiple databases, including EMBASE, MEDLINE, Scielo, and Web of Science. The search strategy utilized relevant MeSH terms and Boolean phrases related to fluoridated food interventions and dental caries in children aged 12 years and younger. After screening the articles based on predetermined inclusion criteria, no study met the eligibility criteria for inclusion in the systematic review. Overall, the systematic review highlights the absence of high-quality available evidence specifically focused on the effectiveness of fluoridated food interventions on children and adolescents of the Latin American and the Caribbean, underscoring the importance of conducting further studies to inform evidence-based decisions regarding public health policies, resource allocation, and oral health promotion strategies in this population.

Modified realist evaluation of a complex, multi-centred, multi-intervention programme.

Well North was a complex, multi-intervention health improvement programme spanning 10 sites across the North of England. The aim was to address inequalities by improving the health of the poorest fastest, increasing resilience and reducing levels of worklessness. The intention of the programme was for all sites to have freedom and flexibility to conduct different interventions reflecting local priorities. Evaluation ran concurrently with the programme, and an iterative approach was required to ensure constant feedback, allowing the programme to be adapted and improved as necessary. Realist methodology was chosen for evaluation, as it provides insight into what works, for whom and in what circumstances. Due to the complex nature of the programme and diverse approaches, it was necessary to adapt the methodology to meet the needs of the evaluation. The Evaluation Team utilized a range of qualitative and quantitative techniques within the context of a Rapid Cycle Evaluation framework. For each project, Contexts, Mechanisms and Outcomes (CMOs) were identified at three stages and were incorporated into the CMO configuration, leading to the development of a middle range theory. Validation and testing of theory took place at every stage. Realist methodology was the most appropriate existing method. However, it still necessitated modification.

Priority directions of occupational medicine development in Perm Krai: challenges and realities

Objective. To analyze the priority directions of the development of occupational medicine in Perm Region.&#x0D; Materials and methods. Statistical data on morbidity and mortality from cardiovascular diseases in Russia, obtained from the Central Statistical Database of the Federal State Statistics Service, were analyzed. A literature review was performed.&#x0D; Results. Priority areas of occupational medicine in Perm Region are the following: preservation of workers' health, improvement of occupational medicine based on corporate health improvement programs. An important aspect is the assessment of specific working conditions, the identification of risk groups for the development of production-related and occupational diseases.&#x0D; Conclusions. It is necessary to take into account early signs of comorbidity of age-associated diseases, introduction of health-saving technologies and development of corporate programs.