Health Programs Research Articles

HTA model for laboratory medicine technologies: overview of approaches adopted in some international agencies.

The Health Technology Assessment (HTA) Working Group of the Emerging Technology Division of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) aims to develop a methodological approach for producing structured HTA information for laboratory medicine technologies. This approach seeks to support decision-making processes at the country, regional, and/or hospital levels regarding the introduction of specific technologies. The focus of this model will primarily be ondefining assessment elements within the domains of 'organizational aspects' and 'costs and economic evaluations', potentially differentiated by the type of diagnostic technology (e.g., genetic tests, molecular tests). To achieve this project's goal, a literature review and examination ofwebsites of international HTA agencies have been conducted. The research aims to identify multidisciplinary methodological approaches used to assess laboratory diagnostic technologies and to pinpoint the domains and assessment elements utilized. Wefound 7 methodological articles describing methodological approaches adopted toassess laboratory diagnostic technologies. Among the HTA organizations considered, 23 reports were found, of which 7 were produced by the European Network of HTA (EUnetHTA), 4 by the National Institute for Health and Care Excellence Diagnostic Assessment Program (NICE DAP), and 12 by other HTA agencies. The EUnetHTA reports wererapid collaborative assessments covering various domains, while the NICE DAP reports focused on diagnostic guidances, including descriptions of technologies, clinical need and practice, diagnostic tests, accuracy, effectiveness, and cost-effectiveness. Finally, a survey targeting laboratory professionals will be conducted to introduce assessment elements, differentiated by the type of diagnostic technology, primarily for organizational and economic domains.

Ohio Health care Professionals' Pandemic-Related Help-Seeking Knowledge, Behaviors, and Concerns.

Health care professionals (HCPs) historically exhibit high rates of stress, burnout, and low rates of service utilization from Employee Assistance Programs (EAPs) and Professional Health Programs (PHPs). New and magnified stressors that accompanied COVID-19 exacerbated HCPs' risk of burnout. During the pandemic, this study examined Ohio HCP's utilization of EAPs and PHPs, knowledge of available services, barriers to accessing services, and likelihood of future service utilization. Conditions needing to change to increase likelihood of future utilization were also explored. A one-time survey was administered in July and August of 2021 to HCPs from 13 licensing boards in Ohio. This study used a subset of data to examine the extent of convergence between quantitative results-analyzed using frequency calculations-and results from thematic analysis of corresponding open-ended survey items. Qualitative results supported and elaborated the quantitative findings. Fewer than 25% of respondents (N = 12,807) utilized EAPs or PHPs to address mental health concerns. Obstacles impeding service utilization included issues around awareness, time commitment, and confidentiality-a concern encompassing issues of stigma and fear of employment repercussions. Noting multiple obstacles to accessing EAPs and PHPs, HCPs in Ohio reported low rates of support service utilization and low likeliness to use services in the future despite their experiences of extreme stress and burnout. Addressing the time commitment and confidentiality concerns could increase the likelihood of accessing services. Employers of HCPs should explore additional support mechanisms such as comprehensive wellness programs and innovative, brief intervention strategies to combat burnout, especially during viral outbreaks and other high-stress events.

The Effectiveness of Hope Groups, a Mental Health, Parenting Support, and Violence Prevention Program for Families Affected by the War in Ukraine: Findings from a Pre-Post Study

BackgroundNearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called ‘Hope Groups’ on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design. MethodsParticipants (n=577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0-17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points – baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired t-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex. FindingsCompared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1,-57.9; -1.2 days/week), respectively. Outcomes stratified by displacement status remained significant across all groups, as did those according to facilitator type (lay versus professional). InterpretationThis study demonstrates preliminary evidence, using a brief survey and pre-post design as is appropriate for acute and early protracted emergency settings, of the feasibility and effectiveness of Hope Groups for war-affected Ukrainian caregivers, on improved mental health, positive parenting, and reduced violence against children.

Contextually Sensitive Polyvictimization Profiles and Physical and Mental Health Outcomes among South African Adolescents from Low-Resource Communities: An Extended Latent Class Analysis

AbstractAdolescents in South Africa may experience violence victimizations in many forms (abuse, bullying, assault) and across many contexts (home, school, community). Polyvictimization is a valuable framework to examine the diversity of violence in adolescents’ lives, particularly when employed alongside person-centered methods such as latent class analysis. This study builds on previous work examining contextually sensitive patterns of polyvictimization among South African adolescents and uses longitudinal Young Carers data (n = 3401) from highly-deprived, low-resource settings to investigate the associations between latent class polyvictimization profiles and physical and mental health outcomes using the Bolck–Croon–Hagenaars (BCH) method. Key results found that adolescents who experienced high polyvictimization alongside contextual factors (poverty, disability, etc.) had greater odds of suicidality and higher scores for depression and anxiety measures than their peers who experienced moderate or low polyvictimization. These outcomes were often worse within the high polyvictimization classes for those participants experiencing burdens of HIV/AIDS and disability. Results were mixed for the physical health outcomes (chronic health condition; recent poor health) and when distinguishing between the moderate and low polyvictimization classes, as some classes characterized by decreased polyvictimization had worse health outcomes. These findings highlight the need to consider polyvictimization as a relevant health risk and contextual factor when addressing the health and well-being needs of South African adolescents. Health programming and policy efforts should seek to screen for and address the causes of and distress from polyvictimization when targeting adolescents and provide a cohesive response to the adolescent violence and health burdens in low-resource communities.

The Genetic Information Nondiscrimination Act and workplace genetic testing: Knowledge and perceptions of employed adults in the United States.

Workplace wellness programs are an emerging avenue for health-related genetic testing, with some large employers now offering such testing to employees. Employees' knowledge and concerns regarding genetic discrimination may impact their decision-making about and uptake of workplace genetic testing (wGT). This study describes employed adults' objective knowledge of the Genetic Information Nondiscrimination Act (GINA) and evaluates how this knowledge correlates with attitudes and beliefs regarding wGT. Analyses utilized data from a large, national web-based survey of employed adults (N = 2000; mean age = 43 years; 51% female; 55.2% college educated). Overall, most respondents (57.3%) said they were unaware of any laws protecting against genetic discrimination. Specifically, 62.6% indicated they were not at all familiar with GINA. The primary study outcome was respondents' score on a 13-item measure assessing knowledge of basic facts about GINA. Participants had low overall GINA knowledge (M = 4.6/13 items correct (35%), SD = 2.9), with employees often presuming GINA offers greater legal protections than it does (e.g., 45.3% erroneously endorsed that GINA protected against discrimination in life insurance). Logistic regression analyses assessed associations between GINA knowledge and employees' demographic characteristics, prior experience with genetic testing, and attitudes regarding wGT. Variables significantly associated with GINA knowledge included higher interest in wGT (aOR = 1.45; 95% CI: 1.20, 1.77), self-reported familiarity with GINA (aOR = 2.02; 95% CI: 1.64, 2.50), and favorable attitudes toward wGT (aOR = 1.92; 95% CI: 1.52, 2.44). Results indicate public knowledge of GINA remains low over 15 years after its passage. These findings highlight the need for employee education on GINA before participating in wGT, as well as broader public education on GINA's legal protections and limitations. Genetic counselors lead GINA education efforts in clinical and public settings and can play a pivotal role in ongoing public education initiatives about GINA.

Equality of healthcare resource allocation between impoverished counties and non-impoverished counties in Northwest China: a longitudinal study

BackgroundThe Health and Medical Assistance Program for Poverty Alleviation is part of China’s targeted poverty elimination strategy, which aims to protect poor people’s right to health and prevent them from becoming trapped in or returning to poverty because of illness. Many tasks have been defined in this program, including raising the medical insurance level, providing a triage system, improving medical and health services, and enhancing people’s health. One pivotal aspect of this initiative involves equitable health resource allocation, a key measure aimed at bolstering medical and health services. This study aimed to analyze and compare health resource allocations in different counties in Northwest China after the implementation of the program.MethodsThe Gini coefficient quantifies the level of distributional equality, the Theil index assesses the sources of inequality, and the Health Resource Agglomeration Degree gauges the accessibility of health resources.Results1) The health resource allocation distributed based on population(Gini Coefficient < 0.45) was more equitable than that distributed based on area(Gini Coefficient > 0.35) among counties in Northwest China. 2) The contribution rate within non-impoverished counties is higher than that of impoverished counties, which means the inequality within non-impoverished counties. 3) The allocation of beds in medical institutions by area in non-impoverished counties was better than that in impoverished counties, and accessibility to health services for residents in non-impoverished counties was better than that in impoverished counties.ConclusionThe analysis of health resource allocation among the five provinces in Northwest China revealed significant differences in equality among the five provinces in Northwest China, and the differences were mainly derived from the non-impoverished counties. Although the equality is gradually improving, the number of health resources in impoverished counties remain lower than that in non-impoverished counties.Subsequently, it is essential to ensure equitable distribution of healthcare resources while also taking into account their utilization and quality.

Nurse-led digital health program for home blood pressure monitoring in stroke patients: protocol for a pooled analysis of randomized controlled trials

BackgroundHypertension is a major risk factor for stroke recurrence in stroke patients. Home blood pressure monitoring, facilitated by digital health technologies and led by nurses, may improve blood pressure control in this high-risk population. However, the evidence is not yet conclusive. This study protocol outlines a pooled analysis of the current literatures to evaluate the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients.Methods and analysisWe will conduct a comprehensive search of some major electronic databases (e.g., PubMed, EMBASE, Cochrane Library, and CINAHL) and trial registries for randomized controlled trials evaluating nurse-led digital health programs for home blood pressure monitoring in stroke patients. Two reviewers will independently screen titles and abstracts, review full-text articles, extract data, and assess risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The primary outcome measures will be changes in both systolic and diastolic blood pressure from baseline to the end of the intervention period. Secondary outcomes include adherence to the program, patient satisfaction, and stroke recurrence. Data will be pooled and analyzed using meta-analysis techniques, if appropriate.DiscussionThis study will provide comprehensive evidence on the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. The findings could have substantial implications for clinical practice and health policy, potentially informing the development of guidelines and policies related to hypertension management and stroke prevention.ConclusionBy pooling the results of randomized controlled trials, this study will offer a robust evidence base to inform clinical practice and health policy in the context of stroke patients. Despite potential limitations such as heterogeneity among studies and risk of publication bias, the rigorous methodology and comprehensive approach to data synthesis will ensure the reliability and validity of the findings. The results will be disseminated through a peer-reviewed publication and potentially at relevant conferences.Registration DOIhttps://doi.org/10.17605/OSF.IO/59XQA.

Multilevel perspectives on the implementation of the collaborative care model for depression and anxiety in primary care

BackgroundThe Collaborative Care Model (CoCM) is an evidence-based mental health treatment in primary care. A greater understanding of the determinants of successful CoCM implementation, particularly the characteristics of multi-level implementers, is needed.MethodsThis study was a process evaluation of the Collaborative Behavioral Health Program (CBHP) study (NCT04321876) in which CoCM was implemented in 11 primary care practices. CBHP implementation included screening for depression and anxiety, referral to CBHP, and treatment with behavioral care managers (BCMs). Interviews were conducted 4- and 15-months post-implementation with BCMs, practice managers, and practice champions (primary care clinicians). We used framework-guided rapid qualitative analysis with the Consolidated Framework for Implementation Research, Version 2.0, focused on the Individuals domain, to analyze response data. These data represented the roles of Mid-Level Leaders (practice managers), Implementation Team Members (clinicians, support staff), Innovation Deliverers (BCMs), and Innovation Recipients (primary care/CBHP patients) and their characteristics (i.e., Need, Capability, Opportunity, Motivation).ResultsMid-level leaders (practice managers) were enthusiastic about CBHP (Motivation), appreciated integrating mental health services into primary care (Need), and had time to assist clinicians (Opportunity). Although CBHP lessened the burden for implementation team members (clinicians, staff; Need), some were hesitant to reallocate patient care (Motivation). Innovation deliverers (BCMs) were eager to deliver CBHP (Motivation) and confident in assisting patients (Capability); their opportunity to deliver CBHP could be limited by clinician referrals (Opportunity). Although CBHP alleviated barriers for innovation recipients (patients; Need), it was difficult to secure services for those with severe conditions (Capability) and certain insurance types (Opportunity).ConclusionsOverall, respondents favored sustaining CoCM and highlighted the positive impacts on the practice, health care team, and patients. Participants emphasized the benefits of integrating mental health services into primary care and how CBHP lessened the burden on clinicians while providing patients with comprehensive care. Barriers to CBHP implementation included ensuring appropriate patient referrals, providing treatment for patients with higher-level needs, and incentivizing clinician engagement. Future CoCM implementation should include strategies focused on education and training, encouraging clinician buy-in, and preparing referral paths for patients with more severe conditions or diverse needs.Trial registrationClinicalTrials.gov(NCT04321876). Registered: March 25,2020. Retrospectively registered.

Assessing the Influence of the Flipped Classroom on Physical Education Students’ Engagement in Basketball Learning Activities

Background. The flipped classroom approach has been gaining increasing attention across various educational domains, including physical education. Recent research has underscored the necessity for innovative strategies to enhance student engagement in physical education, particularly in basketball instruction. Objectives. This study aimed to investigate the influence of the flipped classroom approach on student engagement in Basketball instruction within the Physical Education, Health, and Recreation program at the University level. Materials and methods. The research method involved an experimental design using the static group comparison approach, where 62 students enrolled in physical education were divided into experimental and control groups. The experimental group received instruction through the flipped classroom approach, while the control group underwent conventional instruction, with the intervention lasting for seven weeks. A comprehensive engagement scale questionnaire was used as the research instrument. Data analysis techniques included descriptive analysis and independent samples t-test. Results. The research findings revealed significantly higher levels of engagement in the agentic, behavioral, emotional, and cognitive dimensions among students in the flipped classroom group compared to those in the conventional classroom group. This indicates that the flipped classroom approach has a considerable effect on student engagement in basketball instruction. Conclusions. The study’s results have confirmed the effectiveness of the innovative pedagogical strategy of the flipped classroom in fostering meaningful learning experiences and motivating students within the context of physical education.

Exploring the impact of oral health on the quality of life in older patients: a cross-sectional study

ObjectiveTo investigate the significant impact of oral health on the quality of life of older individuals in Riyadh, Saudi Arabia, across various socioeconomic and demographic contexts.MethodsA cross- sectional study was conducted, involving the distribution of a translated online questionnaire based on the OHQoL-UK® tool to evaluate oral health-related quality of life OHRQoL. This included utilizing the Oral Health Quality of Life Scale to assess overall quality of life.ResultsA total of 586 participants were involved in the study, with the majority being over 60 years old (77.1%). The mean score of OHRQoL was 3.79. The Social Dental Scale SDS had a mean score of 0.71. The General Oral Health Assessment GOHS scored 3.51 on average. The mean score of Dental Impact Profile DIP was 3.12. The Subjective Oral Health Status Indicators SOHSIs had a mean score of 3.82. The mean score of Oral Health Benefit of Life Inventory OHBLI averaged at 4.04, and Dental Impact on Daily Living DIDL scored an average of 4.05. The mean scores of OHRQoL and Oral Impacts on Daily Performance OIDP were 3.90 and 3.89 respectively. Cronbach’s Alpha values ranged from 0.854 to 0.939, with an overall questionnaire reliability of 0.977, indicating a good reliability of the study’s tool.ConclusionOlder adults exhibited lower OHRQoL compared to younger adults, particularly influenced by factors such as health insurance coverage, monthly income, and educational level. It is essential to develop health programs specifically tailored for senior adults to safeguard their overall health and quality of life. Making health and medical insurance obligatory and accessible to all individuals is crucial for enhancing their QoL and reducing the diseases.

Pilot implementation of an evidence-based online cognitive behavioural therapy for perfectionism in university students: Lessons learnt.

Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID-19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence-based eight-module online self-guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6-weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs.

The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study

BackgroundWomen with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress.MethodsThis analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman’s correlation, t-test, analysis of variance, and multiple linear regression.ResultsThe mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress (P < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life.ConclusionGDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.

Determinants of Wellness Program Utilization Among Law Enforcement Personnel: A Focus on Psychological and Physical Health

Determinants of Wellness Program Utilization Among Law Enforcement Personnel: A Focus on Psychological and Physical Health

Reflections on the Kerala Public Health Act 2023: A response to Dr Karpagam’s commentary

In this response, we seek to analyse and rebut the observations of Karpagam S using an understanding of the Kerala Health system and the general purpose of the Kerala Public Health Act (KPHA). The KPHA was crafted with a greater focus on a one-health and preventive approach. It does not seek to interfere in an individual’s preferred choice of treatment, except in the case of public health emergencies. KPHA is not a standalone document, but a supporting tool to the existing Kerala Health Policy and various other health policies and programmes instrumental in improving the health and quality of life of the people of the State. The KPHA is intended to be an enforcement tool for legal provisions to ensure welfare maximisation of the society at large, and thus detailed discussions regarding actions to be taken beyond these legal provisions do not fall within the purview of the Act.

Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya

BackgroundComprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya.MethodsWe implemented a top–bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization’s expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020).ResultsIn 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60.ConclusionPrograms should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.

Determinants of Wellness Program Utilization Among Law Enforcement Personnel: A Focus on Psychological and Physical Health

Determinants of Wellness Program Utilization Among Law Enforcement Personnel: A Focus on Psychological and Physical Health

Educational Prerogative or Public Health Program: A Comparative Approach to Sex Education Policies in the United States and Spain

Educational Prerogative or Public Health Program: A Comparative Approach to Sex Education Policies in the United States and Spain

Highly sensitive wastewater surveillance of SARS-CoV-2 variants by targeted next-generation amplicon sequencing provides early warning of incursion in Victoria, Australia.

The future of the COVID pandemic and its public health and societal impact will be determined by the profile and spread of emerging variants and the timely identification and response to them. Wastewater surveillance of SARS-CoV-2 has been widely adopted in many countries across the globe and has played an important role in tracking infection levels and providing useful epidemiological information that cannot be adequately captured by clinical testing alone. However, novel variants can emerge rapidly, spread globally, and markedly alter the trajectory of the pandemic, as exemplified by the Delta and Omicron variants. Most mutations linked to the emergence of new SARS-CoV-2 variants are found within variable regions of the SARS-CoV-2 Spike protein. We have developed a duplex hemi-nested PCR method that, coupled with short amplicon sequencing, allows simultaneous typing of two of the most highly variable and informative regions of the Spike gene: the N-terminal domain and the receptor binding motif. Using this method in an operationalized public health program, we identified the first known incursion of Omicron BA.1 into Victoria, Australia and demonstrated how sensitive amplicon sequencing methods can be combined with wastewater surveillance as a relatively low-cost solution for early warning of variant incursion and spread.IMPORTANCEThis study offers a rapid, cost-effective, and sensitive approach for monitoring SARS-CoV-2 variants in wastewater. The method's flexibility permits timely modifications, enabling the integration of emerging variants and adaptations to evolving SARS-CoV-2 genetics. Of particular significance for low- and middle-income regions with limited surveillance capabilities, this technique can potentially be utilized to study a range of pathogens or viruses that possess diverse genetic sequences, similar to influenza.

Promoting healthy sleep in 0-2-year-old infants: a study protocol for the development and mixed method evaluation of a sleep health program tailored to Dutch youth healthcare regions

BackgroundSleep problems are common among infants and can have a serious impact on the health and wellbeing of both child and parents. To sustainably promote infant sleep on a population level, it is necessary to develop evidence-based programs that can be implemented on a large scale. The Youth Health Care setting, with its focus on prevention, child health promotion and services widely available for parents, can be a suitable setting to do so. Currently however, sleep health promotion in this setting seems to be suboptimal. To promote healthy infant sleep on a population level, programs need to be accessible and comprehensible for all parents, including parents with limited (health) literacy. Therefore, this study aims to develop, implement and evaluate a program called ‘Sleep on number 1’, that is tailored to Dutch Youth Health Care, to sustainably promote healthy sleep in 0-2-year-old infants.MethodsThe program was developed based on co-creation with parents and Youth Health Care professionals, evidence-based behaviour change theories and sleep health promotion methods. Program effectiveness is investigated with a quasi-experimental study design comparing the program group with the care as usual control group. Participants consist of parents of 0-2-year-old children. Primary outcome is infant sleep quality at the age of 10 weeks and 6, 9, 14 and 24 months, measured with a sleep diary. The primary data analysis focuses on night awakenings at 9 months. Secondary outcomes focus on parental behaviour regarding infant sleep, related behavioural determinants and parental satisfaction with Youth Health Care sleep advice. Program effectiveness is analysed using a linear mixed-model in case of data clustering, and an independent samples T-test or linear regression in case no substantial clustering effects are found. A mixed methods process evaluation is performed with parents and Youth Health Care professionals, assessing program reach, adoption, implementation, maintenance and working mechanisms.DiscussionThe ‘Sleep on number 1’ program is an evidence-based sleep health program for 0-2-year-old children, tailored to Dutch Youth Health Care. If effective, this program has the potential to improve infant sleep on a population level.Trial registrationISRCTN, ISRCTN27246394, registered on 10/03/2023. https://www.isrctn.com/ISRCTN27246394.

Norwegian Health Professionals’ Attitudes Toward Addressing Sexual Health with People with Intellectual Disabilities

Abstract Introduction Staff working with individuals with intellectual disabilities face challenges addressing sexual health. Professionals in this context have diverse backgrounds and education, and little is known about their attitudes and skills in providing support for a healthy sexual life and preventing abuse. Moreover, this topic has not been explored in the Norwegian context. The current study examined health professionals’ attitudes toward addressing sexual health with individuals with intellectual disabilities in Norwegian municipal health and care services. Methods A cross-sectional study was conducted using the Norwegian version of the professionals’ attitudes toward addressing sexual health among 72 health professionals working in municipal services for people with intellectual disabilities in Mid-Norway. The data was collected from November 2022 to January 2023. Results The professionals reported feeling partially comfortable and prepared to address sexual health issues with clients. They consistently expressed a need for more basic knowledge about sexual health and training in communicating about sexuality. Attitudes toward addressing sexual health varied based on the professionals’ education, gender, age, and work experience. Conclusions More targeted training on sexual health is needed within the educational programmes in health and social sciences. Sexual health should also be continuously addressed in the workplace and among colleagues. The differences in attitudes between professionals indicate that the composition of the staff benefits from diversity. Policy Implications Healthcare managers are responsible for ensuring greater openness and reflection on attitudes toward sexuality among individuals with intellectual disabilities in workplaces. Educational institutions must provide the necessary skill development and training in communication about sexual health for this client group.