Impact Of Program Research Articles

An Analysis of the Impact of Self-Help Group Bank Linkage Program on Sustainable Development

India's banking system has advanced its reach to the poorest people in urban and rural areas. It is recognized that their credit requirements are frequent, unpredictable and very small. However, these are crucial for the development of the rural regions. Therefore, the country's banking system has emphasized this area to promote savings and insurance financial products in this target population. Hence, alternative policies, procedures, and systems have been developed to fulfil these people's credit requirements. One such program is Self-help Group Bank Linkage, which is implemented to provide easy microfinance to members of these groups. This paper adopts a qualitative research methodology to discuss the impact of self-help bank linkage programs on sustainable development. This is assessed through a framework of UN’s 17 sustainable development goals. A systematic review has been conducted to determine the effectiveness of this program in attaining these goals in India. The study's results pointed out this program's impact on sustainable development. It has been found to directly and indirectly impact the attainment of many UN sustainable development goals. The study aims to analyze the effectiveness of microfinancing programs in rural India in achieving UN sustainable development goals. Entire rural India is considered for this paper. A qualitative research methodology has been adopted for this paper. Past research work and governmental data have been used to find the impact of self-help bank linkage programs on poverty alleviation. Household incomes have increased, and people have become financially empowered. There is a broader contribution to sustainable development practice and theory with the implementation of this program. People have gained access to better housing, education, clean drinking water, energy and health.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

Evaluating the Effects of an 8-Week Zumba Exercise Program on Physical Fitness in Sedentary Women: A Randomized Controlled Trial

Objectives. This study aimed to evaluate the impact of an 8-week Zumba exercise program on physical fitness and body composition among sedentary women. The primary goals were to assess changes in muscle mass, flexibility, back strength, cardiovascular fitness, body weight, and body fat percentage. Materials and methods. Twenty-four female volunteers (mean age: 22.30 ± 2.10 years, height: 162.80 ± 4.00 cm) from North India were randomly assigned to either an experimental group, participating in a structured Zumba program (60-minute sessions, thrice weekly), or a control group, maintaining their usual activities. The initial and follow-up assessments comprised the measurement of height, weight, Body Fat Percentage (BFP), Body Muscle Mass (BMM), grip strength, back strength, flexibility, and Maximal Oxygen Consumption (VO₂max). Results. The statistical analysis conducted using the SPSS 26 software and the Wilcoxon Signed-Rank Test revealed significant improvements in the experimental group. Body weight decreased from 58.20 ± 5.10 kg to 56.80 ± 5.00 kg (p = 0.002), body fat percentage dropped from 25.10 ± 5.80% to 23.80 ± 6.00% (p = 0.03), and body muscle mass increased from 20.40 ± 3.20 kg to 21.00 ± 3.30 kg (p = 0.04). Grip strength improved from 32.50 ± 5.00 kg to 33.20 ± 4.80 kg (p = 0.05), back strength rose from 85.00 ± 22.00 kg to 105.00 ± 25.00 kg (p = 0.001), flexibility increased from 31.00 ± 2.80 cm to 34.00 ± 2.50 cm (p = 0.002), and VO₂Max increased from 41.00 ± 5.00 ml/kg/min to 44.00 ± 4.50 ml/kg/min (p = 0.001). No significant changes were observed in the control group. Conclusions. The 8-week Zumba program significantly enhanced physical fitness and body composition in sedentary women, improving muscle mass, flexibility, back strength, and cardiovascular fitness. These findings support Zumba as an effective and enjoyable exercise option, promoting an active lifestyle and better health outcomes, reinforcing its role as a comprehensive fitness solution suitable for encouraging sustained physical activity.

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years.

Antibiotics are the most prescribed drugs for children worldwide, but overuse and misuse have led to an increase in antibiotic resistance. Antimicrobial stewardship programmes (ASPs) have proven feasible in reducing inappropriate antimicrobial use. The study aimed at evaluating the impact and sustainability of an ASP with multiple interventions over 8 years. This quasi-experimental study was conducted between 2014 and 2022 in the paediatric acute care unit of Padua University Hospital. Demographic and clinical data were retrieved from the electronic clinical records. Daily prescriptions were collected and analysed based on the AWaRe classification and using days of therapy (DOT) out of 1000 patient days (DOT/1000PDs). The primary outcome was to assess the change in overall antibiotic consumption and of access and watch antibiotics, stratifying patients with and without comorbidities. Trends in antibiotic consumption (DOTs/1000PD) were assessed using joinpoint regression analysis. A total of 3118 children were included. Total antibiotic consumption remained stable and low in patients without comorbidities, ∼300 DOT/1000PDs, whereas a statistically significant constant reduction was observed in children with comorbidities, from almost 500 DOT/1000PPDs to <400 DOT/1000PDs. Access consumption increased in both groups of patients, whereas watch consumption constantly decreased, although statistically significant only in children with comorbidities. Implementing a multistep ASP has proven feasible and sustainable in improving antibiotic prescriptions for previously healthy and fragile children. All the implemented interventions were low cost, and with efficient use of resources, ensuring an ASP that was effective, practical, and easily replicable and implementable in various healthcare settings.

Analysis of Human Resource Development Training in Improving Employee Performance

In the contemporary period marked by globalization and modernization, Indonesian society has made significant strides, particularly in the fields of information and technology. Despite these advancements, there remain challenges that necessitate the development of individuals into exceptional human beings equipped with comprehensive skills. This study focuses on evaluating the effectiveness of human resource development training at the National Narcotics Agency office in Gunungsitoli City. The objective is to ascertain the implementation and impact of such training programs on employee performance. Employing a qualitative field research approach, the study was conducted at the aforementioned office, with agency employees serving as key informants. Data were primarily gathered through interviews, and the analysis utilized descriptive methods to articulate the current conditions observed in the field. Findings from the research indicate that training and development are crucial for enhancing employee competencies and aligning them with the organization’s vision and mission, thereby fostering an adept workforce at BNNK Gunungsitoli.

The Impact of Youth Leadership Program on Perceived Employability Skills: Evidence from Brunei Darussalam

Youth leadership programs foster skills development in youth which are pivotal for gaining successful careers and being more employable throughout their career. Given the concerning youth unemployment issues in Brunei, the study aims to highlight the importance of youth leadership programs and examine their influence on perceived employability skills. By utilising structural equation modelling to analyse the survey data gathered from 229 samples of participants from youth leadership programs, it was revealed that the impact of learning involving skills-based and attitudinal outcomes has significant positive relationships with perceived employability skills. The results further confirmed the role of behavioural outcomes as a mediating variable in the relationship between learning and perceived employability skills. Findings from this study can be valuable for program designers, practitioners, and stakeholders in contributing to the process of structuring and making ongoing improvements to these programs to align with the essential employability skills. It also offers youth the foundation to be employable in the 21st-century job market, by highlighting the importance of youth leadership programs as a channel through which youth acquire desirable capabilities necessary for attaining a set of attributes that reflect the employability skills sought by employees in the current competitive job market. Therefore, the study can be a starting point in moving forward to mitigate the unemployment issues in Brunei through improving programs to meet the demand of employers concerning employability skills. The study provides notable contributions to the existing body of literature on youth leadership development in Brunei as well as contributing to a few other studies in the Asian region to demonstrate the impact of youth leadership programs on employability skills perceptions.

Using Raz-kids Reading Program to Enhance Fifth Grade EFL Omani Students’ Reading Comprehension Skills and Boost their Motivation

This study aimed to evaluated the impact of Raz-kids program on the reading comprehension of fifth-grade students using a quasi-experimental design. A total of 64 students from Welayat Bidbid School in A’Dakhilia Governorate in the Sultanate of Oman, were divided into two groups: control and experimental. Over a two-month period, the experimental group used Raz-kids reading program daily at home, engaging in reading activities, listening exercises, and quizzes to enhance their reading skills. The findings indicated a noticeable improvement in reading comprehension scores, although it is not statistically significant, among participant students in the experimental group compared to the control group. Also, it was found that, the program positively influenced students' motivation towards reading, with participants expressing a willingness to recommend it to their peers. These results suggest that Raz-kids program is an effective supplementary tool for improving reading comprehension and fostering positive attitudes towards reading among fifth-grade students.

The role of preventive medicine in reducing chronic disease Burden in the USA: A Systematic Review

Chronic diseases, including cardiovascular disease, diabetes, cancer, and respiratory illnesses, are the leading causes of morbidity and mortality in the United States, placing a significant burden on individuals, healthcare systems, and the economy. Preventive medicine, encompassing primary, secondary, and tertiary strategies, plays a crucial role in mitigating this burden by focusing on disease prevention and health promotion. This systematic review aims to evaluate the effectiveness of preventive medicine in reducing the chronic disease burden in the USA. Through a comprehensive search of peer-reviewed studies, we explore the impact of screening programs, early detection, lifestyle interventions, and health policies designed to prevent chronic diseases. The review highlights the success of preventive measures in decreasing disease incidence, improving health outcomes, and reducing healthcare costs. However, challenges such as disparities in access to care, patient adherence, and the integration of preventive services into the broader healthcare system remain significant barriers. The review concludes by discussing policy implications, recommending strategies to overcome implementation challenges, and outlining future research directions to enhance the role of preventive medicine in combating chronic diseases in the USA.

Impact of Rural Finance Institution Building Programme on Socioeconomic Condition of Beneficiaries in Anambra State, Nigeria

Rural Finance Institution Building Programme (RUFIN) was established to improve the income, food security and general living conditions of poor rural households with financial services that will be improved in terms of quality, quantity and access to deposit, loan and transfer services. It is expected that the intervention of RUFIN should result in positive changes in the socioeconomic condition of the beneficiaries. The study evaluated the impact of RUFIN on the socioeconomic condition of RUFIN beneficiaries in Anambra State, Nigeria. Multistage, purposive and snowball sampling techniques were used to select 60 RUFIN beneficiaries (RB) and 60 non-RUFIN beneficiaries (NRB) for the study. Data were collected using structured interview schedule and personal observations. Descriptive and inferential statistics were used to analyse data generated. The average amount of loan obtained by RB was N67,266.70 at an average payback period of one year. Sex (t=-5.61) and years of farming experience (t=2.25) significantly (p≤0.05) influenced the amount of loan obtained while age (t=2.36) significantly (p≤0.05) influenced the number of loans obtained. RUFIN resulted in positive but not significant changes on 12(52.2%) of 23 items used in assessing the impact of the programme on the socioeconomic condition of the beneficiaries. The study recommended that RUFIN should enhance the loanable amount and payback duration which may in a long run, positively affect the socioeconomic condition of the beneficiaries. Also, farmers should be educated by extension agents on all sources of agricultural loans, use of loans, loans repayment plans, and how to diversify agricultural income for lasting impact on livelihood.

The effect of an educational program based on the strategy of generating ideas (Scamper) in the teaching of history on developing critical thinking skills among gifted students in the center of Erbil Governorate.

The research aims to identify the impact of an educational program based on the strategy of generating ideas (Scamper) in developing critical thinking skills among gifted students. The experimental approach and the two equal groups with pretest and posttest design have been adopted which requires the two groups, one experimental group and the other control group, and two zero hypotheses were formulated to achieve the research objectives. The research community consisted of students of the seventh grade of day schools in the center of Erbil Governorate for the academic year (2021-2022), where (Shinirwe Mixed Basic Education School for the Gifted Students) was chosen, and two classes were chosen randomly from four classes in the seventh grade to be: (a) The Experimental Group and (b) The Control Group, where it included (40) students, of whom (20) twenty students were distributed to the experimental group and (20) other twenty students were distributed to the control group. The experimental group studied according to the educational program based on the strategy of generating ideas (Scamper), while the control group studied according to the traditional (usual) method. To achieve the objectives of the research, the critical thinking standard of (Watson and Kleiser) was used where the number of its paragraphs in its final form has reached to (147) paragraphs distributed on critical thinking skills (hypothesis skill, interpretation skill, discussion skill, reasoning skill, conclusion skill). This is after verifying the validity and reliability using the Cronbach's alpha coefficient, where the reliability coefficient was (0.87) and the reliability coefficient by the two-half method, and after its modification, the value of the stability coefficient was (0.85). Among the most important results reached are the following: There is a statistically significant difference at the level of significance (a = 0.05) between the average grades of the experimental group and the control group in developing critical thinking skills, in favor of the experimental group. In light of the results reached, the two researchers recommended the necessity of adopting an educational program based on the (Scamper) strategy in teaching history, and a number of proposals were proposed.

Climate-sensitive training for sustainable business in Dickson County with global applications

Purpose This paper aims to examine the implementation and impact of climate-sensitive training programs tailored to the specific climate risks and business needs of Dickson County, Tennessee. It aims to emphasize the importance of integrating climate adaptation strategies into business training and to propose a replicable model that can be adapted to regions facing similar challenges, contributing to global sustainability efforts. Design/methodology/approach The research uses Dickson County’s climate profile as a case study, analyzing its impact on local businesses in sectors such as agriculture, manufacturing and tourism. This paper integrates theoretical frameworks, including organizational learning and adaptive capacity, to provide practical strategies for climate-sensitive training. It further incorporates insights from local institutions, industry partnerships and public data, using a qualitative approach to analyze key themes related to training effectiveness and sustainability. Findings The findings demonstrate that climate-sensitive training significantly enhances the resilience and sustainability of businesses by preparing them to address local climate challenges. Critical factors for successful implementation include stakeholder engagement, industry-specific customization and the continuous evaluation of training outcomes. The model presented shows promise for broader applicability in other regions, especially when localized climate data and collaborative efforts are integrated. Originality/value This paper provides a novel, region-specific approach to climate-sensitive training, distinguishing itself by combining theoretical insights with practical strategies for businesses. By focusing on localized adaptation and stakeholder collaboration, the model addresses an existing gap in the literature on climate adaptation training for smaller, climate-vulnerable regions. This work offers a replicable and scalable framework that contributes to the global discourse on sustainable development and climate resilience in business practices.

Ensuring Quality and Consistency in OPC-53 Cement Testing: A Comprehensive Proficiency Testing Evaluation

The proficiency testing (PT) program is a critical part of quality assurance in laboratories, especially within industries like construction where cement testing is essential. This study provides a comprehensive evaluation of the fifth PT scheme for Ordinary Portland Cement (OPC) grade 53, conducted by the Nodal Laboratory. The key parameters assessed in this program were standard consistency, compressive strength, and soundness using the Le-Chatelier method. Twenty-four laboratories participated, and their performance was analyzed using advanced statistical methods, adhering to ISO 17043:2010 and ISO 13528:2015 standards. The results showed that most laboratories performed satisfactorily, with only one outlier identified in the soundness test. This paper covers all aspects of the PT program, from sample preparation to the distribution of materials, as well as the homogeneity and stability tests conducted on the samples. Statistical evaluation was carried out using Z-scores, which allowed the laboratories to be ranked according to their performance in each parameter. This method highlights discrepancies and provides a clear framework for participating laboratories to improve their testing procedures. Proficiency testing is essential for maintaining high standards in laboratory performance. It helps standardize testing methods across multiple laboratories, ensuring that OPC-53 cement meets strict quality and performance specifications. The program enables laboratories to identify performance gaps and take corrective actions, ensuring the reliability and accuracy of results. Participation in PT programs is a step toward continuous improvement, keeping laboratories aligned with international standards, ultimately benefiting the broader construction industry by ensuring the structural integrity of buildings and infrastructure. This study underscores the importance of regular PT participation. It not only provides a benchmark for laboratory performance but also ensures compliance with ISO standards. This fosters the consistent quality of cement used in large-scale construction, reducing the risk of structural failures and contributing to long-term safety and durability. The findings demonstrate the positive impact of PT programs on overall testing accuracy and laboratory reliability, emphasizing their role in advancing best practices in the construction industry.

Impact of the WELLBASED urban programs on health, well-being, and energy poverty

Abstract Background The WELLBASED project developed and implemented urban programs across six pilot sites to tackle energy poverty. This study aimed to evaluate these programs’ effectiveness on a broad range of health, well-being, and energy poverty indicators. Methods a controlled study was performed in six European pilot sites. Participants in the intervention condition receive the 12-month WELLBASED urban program. Participants were recruited via different methods and provided informed consent to participate in the 18-month study. Self-report questionnaires were completed at baseline, 6-, 12 and 18 months in both research conditions. In the intervention group, monthly health monitoring of e.g. heart rate and blood pressure, and continuous monitoring of indoor CO2, temperature and humidity were performed. Descriptive statistics and regression analyses are performed to assess the impact of the urban programs on health, well-being and energy poverty-indicators Results In the baseline sample (n = 1350; n = 661 intervention group, n = 689 control group) the mean age was 49 years (SD 16), 15.6% was &amp;gt;65 years, 65% were women, and 42% was married. At baseline people reported not feeling comfortable warm in winter (58%) or cool in summer (70%), 43% reported damp or leak. Preliminary findings at 6-month follow-up indicate changes in HR-QoL, subjective well-being and depression/anxiety differ strongly per pilot site location (p &amp;lt; 0.01). In summer 2024 all data will be available for analysis. Conclusions the comprehensive urban programs developed in the WELLBASED project may support public health to tackle energy and improve health and well-being of vulnerable citizens.

The Impact of a 12-Week Workplace Physical Activity Program on the Quality of Life of Sedentary Workers: A Pilot Study

Office workers frequently display behavioral patterns marked by extended periods of sedentary and seated work. In this context, the implementation of a workplace exercise program has been shown to be effective in mitigating health-related risk factors. This study aimed to evaluate the impact of a 12-week workplace exercise program on the quality of life of employees whose primary occupational duties involve prolonged sitting. The final sample comprised 19 participants (6 females and 13 males), aged between 21 and 48 years (M = 32.26; SD = 9.03). Among these participants, 78.9% reported engaging in a hybrid work arrangement, 15.8% followed an on-site work regimen, and 5.3% worked remotely. Furthermore, 84.2% of participants reported sitting for 6 to 8 h per day, while 15.8% reported sitting for between 9 and 12 h daily. The quality of life of participants was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey. A paired samples t-test was employed to examine differences between dependent variables. The results revealed a statistically significant improvement in general health (p &lt; 0.01), vitality (p &lt; 0.01), social functioning (p &lt; 0.05), and the mental health summary measure (p &lt; 0.04). Promoting physical activity through workplace exercise programs offers substantial benefits for workers’ health and quality of life, contributing to the prevention of occupational diseases.

Estimating the impact of the COVID-19 vaccination programme in Ireland: December 2021-March 2023

Abstract Background In Autumn 2023, COVID-19 booster vaccines were offered to all those aged ≥50 years in Ireland. There was concern that vaccine fatigue would impact uptake. We aimed to quantify the direct impact of the COVID-19 vaccination programme on averted outcomes in individuals aged ≥50 years, during a period of Omicron variant dominance, to inform vaccination strategy and public health communication. Methods We conducted a retrospective observational study from December 2021 to March 2023 in Ireland. We considered as averted outcomes symptomatic SARS-CoV-2 presentations to primary care, emergency department (ED) presentations, hospitalisations, intensive care unit (ICU) admissions and deaths due to COVID-19. We used an adapted formula from other vaccine impact published studies, including national data on notified outcomes, vaccine coverage data and vaccine effectiveness (VE) estimates, sourced from the WHO’s live systematic VE review, to estimate the count and prevented fraction of outcomes in ≥ 50-year-olds averted by the COVID-19 vaccination programme. The number of expected outcomes in the absence of vaccination was calculated by summing the counts of outcomes observed and outcomes averted. Results Between December 2021 and March 2023, the COVID-19 vaccination programme averted 48,551 symptomatic presentations to primary care (36% of expected), 9,517 ED presentations (53% of expected), 102,160 hospitalisations (81% of expected), 3,303 ICU admissions (89% of expected) and 15,985 deaths (87% of expected). Conclusions During Omicron dominance, the COVID-19 vaccination programme averted symptomatic and severe outcomes, including deaths due to COVID-19, underscoring the benefits of COVID-19 vaccination. In the context of vaccine fatigue emerging as an important public health issue in Ireland and internationally, these findings can inform future COVID-19 booster vaccination programmes and communication about the reason for and importance of COVID-19 vaccination. Key messages • The COVID-19 vaccination programme in Ireland prevented illness and death in people aged ≥50-years. Vaccination therefore protected population health and the healthcare system. • These findings can be used to inform future COVID-19 vaccination policies, planning for winter, pandemic preparedness and communisation about the importance of ongoing COVID-19 vaccination programmes.

Expression of myostatin and folistatin as a response to high-load strength training to counteract the loss of muscle mass in heart failure with preserved ejection fraction

Abstract Background and Purpose Muscle loss is a common complication in patients with heart failure (HF) associated with a significant increase in morbidity and mortality. Myokines (muscle proteins) play a crucial role in the pathophysiology of the disease; in particular, an imbalance in myostatin and follistatin has been reported. Although strength training (ST) within a cardiac rehabilitation (CR) program can modulate the expression of these myokines, its effect in patients with HF with preserved ejection fraction (HFpEF) is unknown. We hypothesize that in this population, ST with high load and low repetitions can mitigate muscle cachexia with better myiokine overexpression in this population. Our objective is to evaluate the impact of a CR program with emphasis on high-load, low-repetition ST on the regulation of these muscle proteins, muscle gain and cardiorespiratory fitness (CRFit) in patients with HFpEF. Methods Quasi-experimental study of a CR program (24 sessions of 90 minutes, 3 times a week, for 8 weeks), with the following structure: warm-up (10 minutes), 30-minute ST of high loads (&amp;gt;85% maximum repetition, 1MR) with low repetitions (3-5) and rest times between sets of 2 minutes; then 30 minutes of aerobic resistance training at moderate intensity (60-80% of maximum heart rate) and finally breathing exercises and cool-down (10 minutes). Myokines were determined by immunoassays. Muscular strength was determined by 1MR in biceps, triceps, lateral deltoid, quadriceps, hamstrings, gastrocnemius and soleus. For CRFit, maximum oxygen consumption (VO2) was measured and six-minute walk test protocol was also performed. Pre and post-intervention comparison was made using paired t test, Pearson's correlation was used in data analysis and a value of p&amp;lt;0.05 was considered significant. Results 59 patients were admitted, of which 8 of them left due to decompensation. Of the remaining 51 (62.7% male), the mean age was 66±8 years, all of them with HFpEF (M:55±2.4% vs W:54±2.1%; p=0.743). The other diagnoses in the study population were myocardial revascularization (52.94%), angioplasty (29.41%), valve replacement (11.6%), arterial hypertension (60%) and obesity (35%). After CR program it was observerd an improvement in VO2 (from 9.95±2.6 to 13.32±1.7; p=0.022) and meters traveled (243±41 to 349±14; p=0.002), and a decrease in myostatin levels (3337.1±69.2 to 2448.0±70.6; p=0.001) and elevation of follistatin (2167.4±96.9 to 3231.6±67.7; p=0.001). We found a strong positive correlation between follistatin levels and muscle percentage (r=0.8947 Pearson, graph1) and a strong negative correlation with myostatin and muscle percentage (r= -0.8034 Pearson, graph2). Conclusion A phase II CR program with a ST component based on high loads and low repetitions improved muscle strength and mass, FitCR and distance traveled in patients with HFpEF, without modify hemodynamic function. Follistatin levels increased by 49.09% and myostatin levels decreased by 26.65%.

Impact of an Active Nutrition Program on Weight Loss and Metabolic Health in Overweight and Obese Adults: A Randomized Controlled Trial

Impact of an Active Nutrition Program on Weight Loss and Metabolic Health in Overweight and Obese Adults: A Randomized Controlled Trial

A comprehensive evaluation of an artificial intelligence based digital pathology to monitor large-scale deworming programs against soil-transmitted helminths: A study protocol.

Manual screening of a Kato-Katz (KK) thick stool smear remains the current standard to monitor the impact of large-scale deworming programs against soil-transmitted helminths (STHs). To improve this diagnostic standard, we recently designed an artificial intelligence based digital pathology system (AI-DP) for digital image capture and analysis of KK thick smears. Preliminary results of its diagnostic performance are encouraging, and a comprehensive evaluation of this technology as a cost-efficient end-to-end diagnostic to inform STH control programs against the target product profiles (TPP) of the World Health Organisation (WHO) is the next step for validation. Here, we describe the study protocol for a comprehensive evaluation of the AI-DP based on its (i) diagnostic performance, (ii) repeatability/reproducibility, (iii) time-to-result, (iv) cost-efficiency to inform large-scale deworming programs, and (v) usability in both laboratory and field settings. For each of these five attributes, we designed separate experiments with sufficient power to verify the non-inferiority of the AI-DP (KK2.0) over the manual screening of the KK stool thick smears (KK1.0). These experiments will be conducted in two STH endemic countries with national deworming programs (Ethiopia and Uganda), focussing on school-age children only. This comprehensive study will provide the necessary data to make an evidence-based decision on whether the technology is indeed performant and a cost-efficient end-to-end diagnostic to inform large-scale deworming programs against STHs. Following the protocolized collection of high-quality data we will seek approval by WHO. Through the dissemination of our methodology and statistics, we hope to support additional developments in AI-DP technologies for other neglected tropical diseases in resource-limited settings. The trial was registered on September 29, 2023 Clinicaltrials.gov (ID: NCT06055530).

Effect of a cardiovascular post discharge sms support program on healthcare utilisation - the hearthealth program

Abstract Background Cardiovascular disease (CVD) is a leading cause of mortality worldwide[1]. Targeting modifiable risk factors is key to primary and secondary prevention of CVD but many barriers to good risk factor control exist[2]. SMS message programs have shown to be an efficient modality to deliver information to improve knowledge and risk factor profiles for CVD patients[3]; however, their impact on healthcare utilisation has not been thoroughly examined. The HeartHealth program is a text message post-discharge support program delivered to CVD patients. It comprised regular semi-personalised text messages providing CVD information, advice, and support to patients over a 6-month period. Purpose This study aimed to examine the impact of the Heart Health program on healthcare service utilisation. Methods Patients ≥18 years old who recently attended cardiology clinics or were discharged from a cardiology unit, between April 2020 and April 2022 were invited to the program. We compared healthcare utilisation rates in patients who enrolled into the HeartHealth text program (intervention group) to contemporaneous patients who did not enrol in the program (control group). The primary outcome was the incidence rate of all-cause healthcare utilisation events (composite of ED presentations and/or hospital admissions for any medical cause) in the 6 months post-discharge. The secondary outcomes were incidence rates of CVD events and unplanned CVD events. All analyses were adjusted for demographic and co-morbidity variables. Results 11542 patients were included in analysis (intervention: 4324, control: 7218), mean age 58.8 years, 60.7% were male, and 78.3% with English as their preferred language. HeartHealth Intervention participants had lower rates of the primary outcome of healthcare service events compared to control participants (mean number of events 0.43 intervention vs 0.52 control, adjusted rate ratio [RR], 0.91 [95% CI, 0.83-0.99], p=0.033, Table 1). The intervention was significantly more effective in older patients compared to younger patients (RR, 0.82, [95% CI, 0.72-0.93] in patients aged ≥65 years, compared to patients &amp;lt;65 years, RR, 0.98, [95% CI, 0.87-1.10]; p-value for interaction =0.043, Figure 1). The subset of CVD events and unplanned CVD events were numerically lowering in the intervention group compared to the control, but the risk ratio not statistically significantly different in adjusted models (Table 1). Conclusion This analysis demonstrates that a text message post-discharge support program for CVD patients decreased the need for healthcare service utilisation for all medical causes. Future randomised controlled trials are required to further support these findings.Figure 1:Adjusted interaction analysisTable 1:Adjusted Incidence of events

Impact of a clinician-to-clinician electronic consultation program in heart failure patients with previous hospitalization. Implications for heart failure multidisciplinary management

Abstract Background A clinician-to-clinician electronic consultation (e-consultation) programme may not only improve the accessibility to care but may also impact patient outcomes, particularly in heart failure (HF) patients with a previous episode of hospitalization (HFH), group of patients associated with a worse outcome. Purpose To evaluate the impact of an outpatient care management programme that includes a clinician-to-clinician e-consultation on delay time in care, hospital admissions, and mortality in a high-risk group of patients with heart failure (HF) and previous episodes of HF hospitalization (HFH). Materials and methods We selected 6444 HF patients who visited the cardiology service at least once between 2010 and 2021. Of these, 4146 were attended in e-consultation, and 2230 had previous HFH (Fig 1a). Using an interrupted time series regression model, we analysed the impact of incorporating e-consultation into the healthcare model in the group of patients with HFH and evaluated the elapsed time to cardiology care, HF, cardiovascular (CV), and all-cause hospital admissions and mortality, calculating the incidence relative risk (iRR). We performed a multivariate logistic regression for each of these outcomes in both groups. Results Patients with HFH had a higher prevalence of men (P &amp;lt; 0.001) but had a similar age (P = 0.267) compared to patients without HFH. Patients with HFH had a higher prevalence of diabetes (P &amp;lt; 0.001), ischaemic heart disease (P = 0.036), and peripheral arterial disease (P = 0.008) (Fig 1b). In the group of patients with HFH, the introduction of e-consult substantially decreased waiting times to cardiology care (8.6 [8.7] vs. 55.4 [79.9] days, P &amp;lt; 0.001) (Fig 2a). In that group of patients, after e-consult implantation, hospital admissions for HF were reduced (iRR [95%CI]: 0.837 [0.840–0.833]), 0.900 [0.862–0.949] for CV and 0.699 [0.678–0.726] for all-cause hospitalizations (Fig 2b). There was also lower mortality (iRR [95%CI]: 0.715 [0.657–0.798] due to HF, 0.737 [0.764–0.706] for CV and 0.687 [0.652–0.718] for all-cause) (Fig 2c). The improved outcomes after e-consultation implementation were significantly higher in the group of patients with previous HFH. The multivariate analyses showed a higher risk of hospitalizations in men, patients with HFH, and those who required more emergency department assistance (Fig 2d). Conclusions In patients with HFH, an outpatient care programme that includes an e-consultation significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year. Our results may have implications for optimize the heart failure care organization.Figure 1Figure 2