High Acceptance Research Articles

Automating COVID-19 epidemiological situation reports based on multiple data sources, the Netherlands, 2020 to 2023

BackgroundDuring the COVID-19 pandemic, the National Institute for Public Health and the Environment in the Netherlands developed a pipeline of scripts to automate and streamline the production of epidemiological situation reports (epi‑sitrep). The pipeline was developed for the Automation of Data Import, Summarization, and Communication (hereafter called the A-DISC pipeline). ObjectiveThis paper describes the A-DISC pipeline and provides a customizable scripts template that may be useful for other countries wanting to automate their infectious disease surveillance processes. MethodsThe A-DISC pipeline was developed using the open-source statistical software R. It is organized in four modules: Prepare, Process data, Produce report, and Communicate. The Prepare scripts set the working environment (e.g., load packages). The (data-specific) Process data scripts import, validate, verify, transform, save, analyze, and summarize data as tables and figures and store these data summaries. The Produce report scripts gather summaries from multiple data sources and integrate them into a RMarkdown document – the epi‑sitrep. The Communicate scripts send e-mails to stakeholders with the epi‑sitrep. ResultsAs of March 2023, up to ten data sources were automatically summarized into tables and figures by A-DISC. These data summaries were featured in routine extensive COVID-19 epi‑sitreps, shared as open data, plotted on RIVM's website, sent to stakeholders and submitted to European Centre for Disease Prevention and Control via the European Surveillance System -TESSy [38]. DiscussionIn the face of an unprecedented high number of cases being reported during the COVID-19 pandemic, the A-DISC pipeline was essential to produce frequent and comprehensive epi‑sitreps. A-DISC's modular and intuitive structure allowed for the integration of data sources of varying complexities, encouraged collaboration among people with various R-scripting capabilities, and improved data lineage. The A-DISC pipeline remains under active development and is currently being used in modified form for the automatization and professionalization of various other disease surveillance processes at the RIVM, with high acceptance from the participant epidemiologists. ConclusionThe A-DISC pipeline is an open-source, robust, and customizable tool for automating epi‑sitreps based on multiple data sources.

Sustained therapeutic effects of self-assembled hyaluronic acid nanoparticles loaded with α-Ketoglutarate in various osteoarthritis stages

Osteoarthritis (OA) is a prevalent degenerative disease characterized by irreversible destruction of articular cartilage, for which no current drugs are known to modify its progression. While intra-articular (IA) injections of hyaluronic acid (HA) offer temporary relief, their effectiveness and long-term benefits are debated. Alpha-ketoglutarate (αKG) has potential chondroprotective properties, but its use is limited by a short half-life and poor cartilage-targeting efficiency. Here, we developed self-assembled HA-αKG nanoparticles (NPs) to combine the benefits of both HA and αKG, showing stability, bioavailability, and sustained pH-responsive release in the knee joint. In both early and advanced OA stages in mice, HA, αKG, and HA-αKG NPs could relieve pain, enhance mobility, and reduce cartilage damage, with HA-αKG NPs demonstrating the best efficacy. Mechanistically, αKG not only promotes cartilage matrix synthesis but also inhibits degradation by activating the PERK-ATF4 signaling pathway to reduce endoplasmic reticulum stress (ERS) in chondrocytes. This study highlights the therapeutic potential of HA-αKG NPs for treating various OA stages, with efficient and sustained effects, suggesting rapid clinical adoption and high acceptability among clinicians and patients.

“Being a Parent in Finland” - psycho-educative intervention: development and acceptability of a group programme aimed at increasing trust among migrant parents

ABSTRACT The existing literature highlights distrust among migrant parents in Nordic countries towards child welfare and other services. However, interventions to enhance parental trust are few in number, and descriptions of their development and feasibility testing in a Nordic context are lacking. This paper describes the development of ‘Being a Parent in Finland’, a psycho-educative group intervention designed for migrant parents to foster institutional trust. The intervention’s content and structure are outlined using the Six Steps for Quality Intervention Development framework (6SQuID). Additionally, the paper presents findings from a small-scale pilot study involving thematic interviews with 16 parents and a pre-post survey with 14 parents to assess programme acceptability. The pilot study indicated high acceptability and perceived benefits among parents, although no changes in institutional trust emerged in the quantitative survey. Implications for future development, practice, and research are discussed.

Influence of variety and harvest on the sensory characteristics of chocolate made from cocoa fermented with different pulp contents

Despite the long-standing recognition of pulp's impact on cocoa fermentation, studies correlating pulp removal with cocoa variety remain scarce. This study investigates the influence of two cocoa varieties (Parazinho and PS1319) harvested in three different periods and various pulp contents (0–100%) on chocolate's physicochemical and sensory properties. Fermentation was conducted with varying pulp contents, followed by natural drying. The beans were roasted, ground to produce liquor, and mixed with other ingredients, undergoing conching, tempering, and storage to produce chocolate. Sensory evaluations included acceptance tests, CATA (Check-All-That-Apply), and JAR tests. Physicochemical analysis showed no correlation with harvest or variety but differed between samples. Sensory evaluation revealed no significant differences in “aroma” among samples. However, “overall liking” and “flavor” had higher acceptance with partial pulp removal for the PS1319 variety, whereas the Parazinho variety showed no impact. CATA and ideal scale analyses indicated that attributes like “chocolate flavor,” “sweet taste,” “pleasant flavor,” and “pleasant aroma” varied with harvest, variety, and pulp content. In conclusion, partial pulp removal positively impacts certain attributes, enhancing chocolate quality and adding value to pulp, benefiting the cocoa supply chain.

National Addiction Workshop: A Virtual Adaptation to Support Competency Development in Opioid Use Disorder Management.

Accessible, manualized, skill-based training ready for wide dissemination is needed to prepare healthcare staff to meet the needs of people impacted by the opioid epidemic. A 2-day workshop and simulation training was designed by an interprofessional substance use disorder (SUD) specialty care team, adapted to a virtual platform, manualized, and offered to healthcare staff and trainees from a large healthcare system. The workshop was offered 6 times over the course of 10 months with a total of 177 participants from across the United States enrolled in the training. Interactive experiential learning strategies including games designed to test knowledge, small-group case discussions, video demonstrations of skills, patient panels, and 3 simulations of a patient with chronic pain who developed opioid use disorder in the context of long-term opioid therapy were utilized in efforts to build skills and confidence managing SUDs in primary care and general mental health settings. Of those who completed the post-workshop survey, most found both content and training structure useful, particularly content related to medication management, stigma, and collaborative care. In addition, overall confidence scores in assessing, diagnosing, and treating SUD increased. Skill building exercises, such as interprofessional team simulations, were highlighted as most beneficial. The workshop received national attention leading to a partnership with the healthcare system's simulation center for wider dissemination. Expanding access to SUD treatment requires training healthcare staff to effectively change attitudes, increase knowledge, and improve key skills. This 2-day interprofessional workshop was well-received by participants who reported high acceptability and satisfaction scores and demonstrated improved confidence in the management of SUDs. This type of manualized, collaborative, skill-based learning experience can foster staff preparedness and willingness to conceptualize SUD as a chronic condition amenable to treatment in different healthcare settings.

Coping patterns associations with cognitive function in older adults.

Cognitive function may contribute to variability in older adults' ability to cope with chronic stress; however, limited research has evaluated this relationship. This study investigated the relationship between theoretically derived coping domains and cognitive function in 165 middle-to-older adults during the Omicron stage of COVID-19. Participants completed a clinical interview and self-report measures of health. The National Alzheimer's Coordinating Center Uniform Data Set neuropsychological battery was used to evaluate memory, language, executive function/speed, and working memory. Structural equation modeling evaluated the underlying factor structure of the Brief COPE adapted for COVID-19. The data supported the proposed second-order Approach factor comprised of Problem-Solving and Emotion Regulation (ER) strategies and a first-order Avoidance factor. Higher Avoidance was associated with greater depression symptoms, lower income and worse memory, executive function, working memory, and verbal fluency performance. Higher Problem-Solving was associated with better verbal fluency performance. ER strategies were not significantly associated with cognitive function. The use of Problem-Solving was not associated with less Avoidance. Greater use of Problem-Solving, ER, and Avoidance were all associated with higher levels of stress. Post-hoc analyses found that higher Acceptance was the only coping strategy associated with less stress. These findings demonstrate that older adults with worse cognitive function were more likely to use Avoidance during the pandemic, which could result in prolonged stress and adverse health consequences. Future research is warranted to investigate whether acceptance-based interventions reduce the avoidance and impact of stress on health in vulnerable older adults.

Feasibility of a Dutch post-discharge parenting intervention (TOP program) for moderate preterm born infants

Background and aimModerate preterm (MP) birth is associated with an increased risk of developmental problems. However, post-discharge support for this group is scarce. The aim of this study was to evaluate the feasibility of a post-discharge parenting program (TOP program) for MP infants. Three feasibility dimensions were evaluated (1) recruitment capability and compliance, (2) intervention acceptability, and (3) limited efficacy testing. MethodsA group of MP infants with a gestational age (GA) between 320/7‐346/7 weeks and their parents received six home visits by a TOP interventionist until 6 months corrected age (CA). A pre-posttest intervention design with quantitative and qualitative measures was used.Recruitment capability and compliance, acceptability, and satisfaction with the intervention were evaluated using a questionnaire, checklists, interviews, and a focus group. Infant socio-emotional development, parental distress, self-efficacy, and reflective functioning were measured with questionnaires. Observation measurements were used for infant motor development and parental sensitivity. ResultsThirty-two families completed the six home visits. The satisfaction rate (scale 0–10) was remarkably high (Mean 9.4, range: 8–10). Parents reported that the program was suitable, enhanced their understanding of their infants' developmental needs, and increased their self-efficacy. The infants showed age-appropriate motor and socio-emotional development post-intervention. Parental self-efficacy, reflective functioning, and sensitivity improved from pre to post intervention, with small to large effect sizes. ConclusionThe study demonstrated high compliance, acceptability, and satisfaction with the TOP program for MP infants with promising infant and parent outcomes. This study contributes to the preparatory work prior to a larger scale evaluation and dissemination.

Innovative Development of Instant Kombucha Drink and Kombucha Ice Cream Using Spray Drying Techniques

This research focuses on the development of instant kombucha drink and kombucha ice cream using spray drying techniques. Kombucha, a fermented tea known for its health benefits, is processed to halt alcohol production and enhance its usability in various forms. The study utilized three treatment methods to ferment kombucha: Cold shock at ≤ 4°C for 5 days, pasteurization at 72°C for 20 mins and yeast removal using a coffee filter, alongside a standard fermentation control. The spray drying process was applied to kombucha from these treatments to produce instant kombucha powder. The physicochemical properties, nutritional quality and microbial safety of the resulting powder were evaluated. The best results were obtained from pasteurization, yielding a powder with low alcohol content (0.13 % w/w), desirable physicochemical properties (4.70 total dissolved solids, 3.10 pH, 0.2177 titratable acidity) and microbial safety (< 1 CFU/ml). Subsequently, instant kombucha powder was utilized to develop two new products: Instant kombucha drink and kombucha ice cream. The instant drink reconstituted well with water, maintaining the original kombucha's flavour profile and health benefits. The kombucha ice cream was formulated to preserve the bioactive compounds and probiotics, offering a novel health-promoting dessert option. Sensory evaluations indicated high consumer acceptance for both products, with the instant drink and ice cream scoring well on taste, texture and overall satisfaction. The innovative use of spray drying to produce instant kombucha powder and its application in diverse products highlights the potential for expanding kombucha’s market presence while retaining its health benefits.

Feasibility and acceptability of a parent-child intervention to improve step count in childhood cancer survivors exposed to cardiotoxic therapy: The STEP UP for FAMILIES Study.

Late morbidity after childhood cancer may be mitigated by healthy lifestyle behaviors. We piloted a game-based, parent-child digital intervention to increase activity in sedentary survivors. Survivors aged 10-16 treated with cardiotoxic therapy and not meeting US physical activity guidelines were enrolled in a single-arm study with a parent. Following a 14-day run-in, participants chose a prespecified step goal and wore an accelerometer daily for 24weeks (12-week game-based intervention; 12-week follow-up). Participants completed the Acceptability of Intervention Measure (AIM) at 24weeks; a subset of dyads completed qualitative interviews. Among 129 eligible survivors, 27 enrolled (20.9% participation rate) with a parent. Four dyads were removed during the 14-day run-in period due to noncompliance. Among the 23 dyads who continued to the study, the tracker was worn for 95% of days during the 12-week intervention (95% confidence interval [CI]: 94-96) and 81% during the 12-week follow-up (95% CI: 79-82). Overall, the prespecified step goal was met for 64% (95% CI: 63-66) of days during the intervention and 37% (95% CI: 35-38) during the follow-up. At the end of study, 17/23 dyads responded to AIM; 82% of survivors and 94% of parents reported the intervention as acceptable. During qualitative interviews (n=5), dyads noted that they liked the accountability of the "buddy system," but would have liked more personalized goal-setting. Despite high ratings of acceptability among participants, difficulties with sustained adherence and retention were encountered in this parent-child gamification intervention. Alternate, tailored designs should be considered in the future.

Single elemental planar light concentrator using skewed V-groove optics

Light concentrators are widely used to address the challenges of solar radiation's limited energy density. However, traditional light concentrators suffer from bulkiness, higher focal length, low solar acceptance, and cost factor due to the usage of large imaging optics elements. Waveguide-based planar light concentrators (PLC) have been engineered as a solution to these challenges. They work by collecting light at the incident face and channeling it to the lateral face of the waveguides. However, the existing PLC designs mostly consist of multiple optics elements, resulting in the need for precise positioning and point-to-point solar tracking. Addressing these complexities, a new design for waveguide-based PLC is presented. It features a simplified array of skewed V-grooves within an optical slab, essentially creating a single elemental optics. This novel skewed V-groove-based PLC (SV-PLC) introduces a low-concentration (i.e., <10X geometric concentration (GC)) solution that offers high angular acceptance along one axis. The current study aims to establish the novel design concept, validate, optimize, and assess the design through the Ray-tracing simulation. Further, based on the simulation results, a functional prototype was successfully fabricated in PMMA using laser machining. The results of the optical characterization of the SV-PLC showed that the Optical Efficiency (OE) was approximately around half the theoretical OE. Angular-dependent ray trace results showed a lower OE drop (<10 %) for incident angles less than 15°, and a maximum drop of 30 % (for a 10X GC design) for an incident angle of 23.5° (i.e., half the angle shift of the sun through seasons).

Democratic discrepancies in urban sustainable development

AbstractCities are critical for achieving the United Nations Sustainable Development Goals. Their urban sustainable development (USD) plans and policies cover a wide range of issues, such as biodiversity protection, transportation or poverty reduction. Yet, such policy-making may lack democratic legitimacy if these policies are out of step with the demands and concerns of residents. Considering this, the present study compares residents’ preferences about USD policy issues with the priorities set out in existing USD policy plans. We scrutinized the preferences of 5,800 residents across eight European cities through the application of survey experiments and simultaneously examined 166 existing USD policy plans from these cities and compared them with the survey results. Our findings indicate an on average high acceptance of USD (72.61%) but with substantial democratic discrepancies: while USD policy plans predominantly prioritize issues, such as biodiversity, education and transportation, residents expressed preferences for issues linked to their essential and everyday needs, such as cost of living, public health and poverty. These democratic discrepancies between residents’ priorities and the content of USD policy plans highlight the necessity of securing basic human needs as integral aspects of USD to foster a more profound and democratically supported urban socio-ecological sustainability transformation.

Modeling of Applying Road Pricing to Airport Highway Using VISUM Software in Jordan

Road congestion in Amman City has been increasing yearly, due to the increase in private car ownership and traffic volumes. This study aims to (a) evaluate the toll road’s effects on society and the economy in Amman, Jordan, through a survey questionnaire using statistical software (SPSS), (b) assess the impact of the toll road on reducing congestion and delays using micro-simulation (VISUM), (c) identify the optimal toll price for a selected road using VISUM and (d) validate the simulated models with the optimal revenue. Traffic, geometric, and cost data about the toll technique of two sections on the Airport Highway (from the Ministry of Foreign Affairs to the Madaba Interchange; and from the Madaba Interchange to the Queen Alia International Airport (QAIA) Interchange) were used for simulation purposes. The toll road (across seven different scenarios at different prices) was evaluated for optimal revenue. The survey questionnaire was made based on all scenarios, including the AM peak hour. The operation cost for the toll road was determined based on the Greater Amman Municipality (GAM). The best scenario was determined based on the value of revenue (JOD). The results indicate that higher acceptance is achieved when applying road pricing during the AM peak hour and that users prefer the charging method based on travelled distance (54.02%). Additionally, the total cost of the manual toll collection (MTC) method is 126,935 JOD. Road pricing can reduce traffic delay (or speed up traffic flow) by 4.61 min in the southbound direction and by 9.52 min in the northbound direction. The optimal toll value is 0.25 JOD (34.08%), with revenues of 1089.6 JOD for 2024 and 1122.6 JOD for 2025. Eventually, applying road pricing on the airport road is shown to be effective and economically feasible only when using the manual method.

Evaluating the feasibility and utility of telephonic motivational interviewing in older adults

Older adults face unique barriers and challenges related to physical activity (PA) participation. Motivational interviewing (MI) is a commonly used health coaching strategy to support behavior change that holds potential for older adults. Previous research on MI strategies has focused primarily on face-to-face delivery, limiting insights regarding virtual programs. ObjectivesThe purpose of this study was to determine if MI could be delivered telephonically with high fidelity and high acceptability in older adult participants. The study is designed to inform future trials evaluating its effectiveness in supporting virtual PA programs. MethodsThis study evaluated the feasibility and acceptability of telephonic MI among older adults that enrolled in an online version of the Walk with Ease program. ResultsOf 39 participants referred, 29 enrolled and 27 provided feedback. Participants were highly accepting and adherent, with 74 % of patients attending at least five of six sessions, and 96 % of participants indicating satisfaction with the MI provided. Coaches improved program enjoyment by helping set effective goals and providing ongoing accountability. ConclusionsEvaluations documented adequate fidelity and high acceptability of telephonic delivery, and motivation results revealed large, significant increases in autonomous regulation (quality of motivation). InnovationTelephonic MI using non-healthcare professional coaches is feasibly delivered with high fidelity, and is acceptable to older adult participants. The innovative delivery format offers novel opportunities supporting virtual and telehealth interventions to reduce chronic disease risk among older adults.

Improved Bayesian model updating of geomaterial parameters for slope reliability assessment considering spatial variability

In engineering practice, Bayesian model updating using field data is often conducted to reduce the substantial inherent epistemic uncertainties in geomaterial properties resulting from complex geological processes. The Bayesian Updating with Subset simulation (BUS) method is commonly employed for this purpose. However, the wealth of field data available for engineers to interpret can lead to challenges associated with the “curse of dimensionality”. Specifically, the value of the likelihood function in the BUS method can become extremely small as the volume of field data increases, potentially falling below the accuracy threshold of computer floating-point operations. This undermines both the computational efficiency and accuracy of Bayesian model updating. To effectively address this technical challenge, this paper proposes an improved BUS method developed based on parallel system reliability analysis. Leveraging the Cholesky decomposition-based midpoint method, the total failure domain in the original BUS method, which involves a low acceptance rate, is subdivided into several sub-failure domains with a high acceptance rate. Facilitated with an improved Metropolis-Hastings algorithm, the improved BUS method enables the consideration of a large volume of field data and spatial variability of geomaterial properties in the probabilistic back analysis. The results of an illustrative soil slope, involving spatially variable undrained shear strength, demonstrate that the improved BUS method is effective in simultaneously incorporating a substantial volume of field measurements and observations in the model updating process. Through a comparison with the original BUS method, the improved BUS method is shown to be useful for Bayesian model updating of high-dimensional spatially variable geomaterial properties and slope reliability assessment.

Engineered PLGA Core-Lipid Shell Hybrid Nanocarriers Improve the Efficacy and Safety of Irinotecan to Combat Colon Cancer.

Poly(lactide-co-glycolide) (PLGA) is a biocompatible and biodegradable copolymer that has gained high acceptance in biomedical applications. In the present study, PLGA (Mw = 13,900) was synthesized by ring-opening polymerization in the presence of a biocompatible zinc-proline initiator through a green route. Irinotecan (Ir) loaded with efficient PLGA core-lipid shell hybrid nanocarriers (lipomers, LPs) were formulated with 1,2-distearoyl-sn-glycero-3-phosphoethanolamine and 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[amino (polyethylene glycol)-2000] (DSPE-PEG-2000), using soya lecithin, by a nanoprecipitation method, and the fabricated LPs were designated as P-DSPE-Ir and P-DSPE-PEG-Ir, respectively. The formulated LPs were further validated for their physicochemical properties and biological potential for colon cancer application. The potential delivery of a poorly water-soluble chemotherapeutic drug (Ir) was studied for the treatment of colon cancer. LPs were successfully prepared, providing controlled size (80-120 nm) and surface charge (∼ -35 mV), and the sustained release properties and cytotoxicity against CT-26 colon cancer cells were studied. The in vivo biodistribution and tumor site retention in CT-26 xenograft tumor-bearing Balb/C mice showed promising results for tumor uptake and retention for a prolonged time period. Unlike P-DSPE-Ir, the P-DSPE-PEG-Ir LP exhibited significant tumor growth delay as compared to untreated and blank formulation-treated groups in CT-26 (subcutaneous tumor model) after 4 treatments of 10 mg irinotecan/kg dose. The biocompatibility and safety of the LPs were confirmed by an acute toxicity study of the optimized formulation. Overall, this proof-of-concept study demonstrates that the PLGA-based LPs improve the efficacy and bioavailability and decrease neutropenia of Ir to combat colon cancer.

Development of cybersecurity framework for FinTech innovations: Bahrain as a case study

FinTech is the term used to refer to financial and technology convergence space solutions. It usually refers to new innovations that conduct or connect with financial services via the internet, smart devices, software applications, or cloud services and encompasses anything from mobile banking to cryptocurrency applications. Despite the advantages of FinTech, cybercriminals seized the opportunity to exploit vulnerabilities in FinTech systems. Phishing attacks, ransomware, and data breaches have become more prevalent, targeting individuals and FinTech institutions. Bahrain, which is not different from the rest of the world, was impacted by such cyber threats. Thus, FinTech companies have had to strengthen their cybersecurity countermeasures and protocols to combat these threats.Existing countermeasures in the literature primarily focus on general cybersecurity practices and frameworks, with limited attention given to the specific needs of the FinTech industry. Hence, there is a notable gap in the literature regarding a focused cybersecurity framework that caters to the unique requirements of FinTech innovations, especially in Bahrain. To bridge this gap, this research addresses the problem by conducting an extensive review of existing cybersecurity challenges, common practices, and cybersecurity standards and through in-depth research interviews with executives, experts, and other FinTech business stakeholders. Leveraging this knowledge, this research proposed an adaptable framework that addresses the risks and vulnerabilities faced by FinTech innovations in Bahrain.Through panel discussions and Delphi sessions, industry experts evaluated the framework’s practical feasibility, ability to address specific risks, and compatibility with the existing FinTech regulatory landscape. The results demonstrate a high acceptance of the developed framework and highlight the framework’s potential to enhance cybersecurity resilience significantly. Moreover, the experts acknowledge the proposed framework as a fundamental baseline in securing the FinTech ecosystem in Bahrain. The importance of this research lies in its potential to enhance the cybersecurity posture of the FinTech industry in Bahrain, mitigating risks and vulnerabilities associated with cyber threats in this vital sector.

ProVIA-Kids - outcomes of an uncontrolled study on smartphone-based behaviour analysis for challenging behaviour in children with intellectual and developmental disabilities or autism spectrum disorder.

Challenging behaviour (CB) is a common issue among children with autism spectrum disorder or intellectual and developmental disability. Mental health applications are low-threshold cost-effective tools to address the lack of resources for caregivers. This pre-post study evaluated the feasibility and preliminary effectiveness of the smartphone app ProVIA-Kids using algorithm-based behaviour analysis to identify causes of CB and provide individualized practical guidance to manage and prevent CB. A total of 18 caregivers (M = 38.9 ± 5.0) of children with a diagnosis of autism spectrum disorder (44%), intellectual and developmental disabilities (33%) or both (22%) aged 4-11 years (M = 7.6 ± 1.8) were included. Assessments were performed before and after an 8-week intervention period. The primary outcome was the change in parental stress. Caregiver stress experience due to CB was also rated daily via ecological momentary assessments within the app. Secondary outcomes included the intensity of the child's CB, dysfunctional parenting, feelings of parental competency as well as caregivers' mood (rated daily in the app) and feedback on the app collected via the Mobile Application Rating Scale. We observed increases in parental stress in terms of conscious feelings of incompetence. However, we also saw improvements in parental stress experience due to CB and overreactive parenting, and descriptive improvements in CB intensity and caregiver mood. ProVIA-Kids pioneers behaviour analysis in a digital and automated format, with participants reporting high acceptance. Pilot results highlight the potential of the ProVIA-Kids app to positively influence child behaviour and caregiver mental health over a longer intervention period. The study was registered at https://www.drks.de (ID = DRKS00029039) on May 31, 2022.

Trajectory patterns and factors associated with acceptance of disability in young and middle-aged breast cancer patients: a longitudinal study.

To explore the trajectories of acceptance of disability in young and middle-aged breast cancer patients based on a latent class growth analysis, investigate factors associated with each trajectory, and identify whether return to normal living differs in different trajectories. Young and middle-aged patients newly diagnosed with breast cancer who underwent surgery were followed up at baseline, and 1, 3, and 6months in China. Participants completed sociodemographic information questionnaires, the Adaptation of Disability Scale Revised, and the Reintegration to Normal Living Index. A latent class growth analysis was used to explore the trajectories of acceptance of disability. Among 212 patients newly diagnosed with breast cancer, the mean age of patients was 45.44years. The majority of participants were with invasive carcinoma (77.8%). Three classes were identified: high acceptance of disability increasing group (high-increasing, 13.7%), moderate acceptance of disability stable group (moderate-stable, 67.9%), and moderate acceptance of disability decreasing group (moderate-decreasing, 18.3%). Being unemployed or retired and receiving endocrine therapy are risk factors associated with acceptance of disability. Carcinoma in situ is a protective factor associated with acceptance of disability. Participants diagnosed with carcinoma in situ and who not receive endocrine therapy were more likely to be in high-increasing group. Unemployed participants before surgery were more likely to be in moderate-decreasing group. Moreover, the Reintegration to Normal Living Index scores had significant differences from baseline to 6months of follow-up. The high-increasing group had the highest average Reintegration to Normal Living Index scores than the moderate-stable group and the moderate-decreasing group, showing similar patterns at four timepoints. We identified three trajectories of acceptance of disability. Dynamic and individualized intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively increase acceptance of disability.

Self-Screening for Cervical Cancer Offered through a Digital Platform in a Region of British Columbia with Lower Screening Rates.

Cervical cancer is highly preventable through vaccination, early detection, and treatment, yet is the fourth most common cancer globally. HPV testing is superior to cytology for the detection of cervical pre-cancer, and jurisdictions around the world are implementing HPV primary screening, which offers the opportunity for self-screening, an important self-care intervention. Digital health solutions are also increasingly important components of self-care. In this study, we assessed the acceptability and completion of self-screening for cervical cancer offered through a digital platform within a low screening uptake region of British Columbia. The primary objective of this study was to evaluate the acceptability of self-screening for cervical cancer offered through a digital platform as measured by return rates of self-screening kits. Patients due or overdue for cervix screening were invited to participate. Eligible participants registered online to receive a self-screening kit, which included a device for vaginal self-screening, instructions, and a return envelope, sent to their home. After self-screening using the vaginal device, HPV testing was conducted. HPV-negative participants were returned to routine screening, and HPV-positive participants were recommended for cytology or colposcopy. Attendance rates at follow-up were evaluated. Participants were invited to complete an acceptability survey. From April 2019 to December 2023, 283 participants were sent kits, with 207 kits returned for a completion rate of 73%. Of valid samples (n = 202), 15 were HPV positive, and 93% attended follow-up care. Most respondents found the CervixCheck website easy to use, informative, and secure and were satisfied with receiving their results online. CervixCheck had a high completion rate among participants who were sent a self-screening kit. High compliance with recommended follow-up and high acceptability of self-screening for cervical cancer was observed. Most participants indicated they would self-screen again in the future. Innovative approaches to cervical screening, including self-screening and the use of digital health interventions, are ways to enhance equity and improve uptake of cervical screening.

A mixed-method randomised controlled feasibility trial of digital CBT and emotion regulation skills training for employees in the workplace (REST)

Background and aimDigital interventions for depression and anxiety can be as effective as face-to-face therapy. One in six workers experience some form of mental health problems, making the workplace a potential avenue to deliver mental health interventions as part of a stepped care model. This study aimed to assess the acceptability, feasibility, and preliminary efficacy of a digital cognitive behavioural therapy (dCBT) on depression and anxiety for employees in the workplace.MethodsA mixed-methods evaluation of employees allocated to dCBT (n=25), or a waitlist control group (n=27) was used to assess five feasibility objectives related to recruitment of employers and employees, engagement, study procedure and preliminary efficacy of the intervention. Quantitative outcome measures and qualitative interviews at 8 weeks post-randomisation were used. Quantitative outcomes were also assessed within subject at 3-, 6-, and 12-month follow-up. Qualitative data was analysed using thematic and framework analysis in Nvivo, whilst quantitative outcomes were analysed using mixed effect linear models between and within subject in R and SPSS.ResultsThirty-Three businesses agreed to facilitate the delivery of three trials run by the University of Warwick in their workplaces. 52 participants consented into the REST trial. Adherence/usage of participants of the treatment platform was just over 50% across the whole sample. There was a reduction in depression and anxiety symptoms post-intervention and at follow-up timepoints across all participants and over time although there were no statistically significant between group differences. High acceptability and satisfaction of the intervention were reported by participants based on qualitative interview data at post-intervention.ConclusionsResults from this feasibility study suggests that the dCBT programme (REST) was acceptable and shows improvement in depression and anxiety symptoms, albeit not over and above the treatment effects in the control group. Recruitment of participants and engagement with the intervention made the feasibility of the delivery somewhat challenging. With better recruitment promotion and engagement strategies, as well as implementing the learnings from the feasibility trial, a fully powered study can inform the efficacy of the REST intervention.Trial registrationThe study is registered in the BMC Springer Nature ISRCTN registry ISRCTN31161020 (registered on 08/06/2021).