Implementation Of Effective Strategies Research Articles

Development of Tools to Understand the Relationship between Good Management Practices and Nest Losses in Meliponiculture: A Pilot Study in Latin American Countries

Insect pollination services amount to USD 235–577 billion. Seventy five percent of agricultural production for human consumption depends on pollination, mainly by bees. A decline in pollinators, including Meliponini tribe bees, will impact the economy, food security, human health, and ecosystem stability, especially in tropical forests where stingless bees are the main pollinators. The objective of this survey was to understand the relationship between good management practices and nest losses in meliponiculture, encompassing biosecurity and conservation criteria. A 36-question survey was organized and spread. We received 92 responses, representing 4548 managed nests. The primary motivation for engaging in meliponiculture was biodiversity conservation (92%). More than 50% of the questions on biosecurity were answered as “applied”. Hand washing before any activity with bees was the main rule, followed by material sterilization and personal protective equipment use. The annual mortality rate of stingless bee nests was estimated at 15%. Nest invaders (72%) and nearby sources of pollution (60%) were identified as the main potential causes of nest losses. From a general perspective, meliponiculture practices continue to expand remarkably. The implementation of effective nest management strategies is associated with a reduction in nest losses. It is important to consider One Health’s perspective to ensure optimal management practices.

Exploring the trend of age-standardized mortality rates from cardiovascular disease in Malaysia: a joinpoint analysis (2010–2021)

IntroductionCardiovascular disease (CVD) is a major health concern worldwide, particularly in low- and middle-income countries. The COVID-19 pandemic that emerged in late 2019 may have had an impact on the trend of CVD mortality. This study aimed to investigate the trend and changes in CVD mortality rates in Malaysia, using age-standardized mortality rates (ASMR) from 2010 to 2021.MethodsThe Malaysian population and mortality data from 2010 to 2021 were obtained from the Department of Statistics Malaysia (DOSM). ASMRs from CVD per 100,000 population were calculated based on the World Health Organization (2000–2025) standard population using the direct method. The ASMRs were computed based on sex, age groups (including premature mortality age, 30–69 years), and CVD types. The annual percent change (APC) and average annual percent change (AAPC) of the ASMR with corresponding 95% confidence intervals (95% CI) were estimated from joinpoint regression model using the Joinpoint Regression Program, Version 4.9.1.0.ResultsThroughout the study period (2010–2021), ASMRs for CVD exhibited an increase from 93.1 to 147.0 per 100,000, with an AAPC of 3.6% (95% CI: 2.1 to 5.2). The substantial increase was observed between 2015 and 2018 (APC 12.6%, 95% CI: 5.4%, 20.3%), with significant changes in both sexes, and age groups 50–69, 70 years and over, and 30–69 (premature mortality age). Notably, the ASMR trend remained consistently high in the premature mortality age group across other age groups, with males experiencing higher rates than females. No significant changes were detected before or after the COVID-19 pandemic (between 2019 and 2021), except for females who died from IHD (10.3% increase) and those aged 0–4 (25.2% decrease).ConclusionOverall, our analysis highlights the persistently high burden of CVD mortality in Malaysia, particularly among the premature mortality age group. These findings underscore the importance of continued efforts to address CVD risk factors and implement effective prevention and management strategies. Further research is needed to fully understand the impact of the COVID-19 pandemic on CVD mortality rates and to inform targeted interventions to reduce the burden of CVD in Malaysia.

Meeting Social Needs in a Crisis Context: Lessons Learned from Integrating the 'Take Care Initiative' into New York City's Testing and Contact Tracing Program.

The COVID-19 pandemic highlighted the importance of addressing social needs in a crisis context. Some US jurisdictions integrated a social service component into case investigation and contact tracing (CI/CT) programs, including the New York City (NYC) Test & Trace (T2) Program; the Take Care initiative referred NYC residents who tested positive or were exposed to COVID-19 to services to support isolation and quarantine and meet basic needs. More research is needed to determine effective implementation strategies for integrating social needs provision into CI/CT programs. To identify barriers and facilitators to the implementation of the Take Care initiative, we conducted key informant interviews with program staff, community-based organization partners, and cases and contacts as part of a larger evaluation of the T2 program. Interviews were recorded, transcribed, and analyzed using rapid qualitative methods. Key facilitators to implementation included utilizing a case management software system, employing strategies to encourage service uptake, leveraging cross-agency collaborations, and partnering with community-based organizations for resource navigation. Barriers identified included external management of the software system, challenges reaching and engaging the public, administrative complications due to shifting collaborations, and management of CBO partners' structure and hiring. Based on our findings, we provide recommendations to support effective planning and implementation of social needs service provision in a crisis context. Future research should focus on testing promising implementation strategies highlighted in this study and applying them to varied contexts and crisis situations.

Current status of white mango scale (Aulacaspis Tubercularis Newstead) and associated factors in Assosa district western Ethiopia

White mango scale (Aulacaspis tubercularis Newstead; Hemiptera: Diaspididae) is a major insect pest of mango production threatening production and marketing of mango in Ethiopia. The present study was conducted to determine the current status of the white mango scale (WMS) and to identify the factors contributing to the damage level of the pest. A cross-sectional survey was conducted in ten selected kebeles in Assosa district, western Ethiopia, during 2021/2022 cropping season. Data on infestation level and WMS life-stage abundance were recorded from fifty randomly selected mango orchards. Data on the prevalence of WMS and factors influencing the distribution and damage levels of white mango scale infestations were analyzed using SAS and SPSS software respectively. The results of this study indicate that WMS infestation was prevalent in all assessed mango growing areas of the district. There was a significant (p < 0.05) difference between kebeles and mango orchards in infestation level and WMS life-stage population densities. Poor cultivation, crop husbandry practices, and pest management strategies have been identified as the major contributing factors for high pest infestation. The study indicates that WMS infestations are increasing in the study area; thus, there has to be strong efforts towards the implementation of safe and effective management strategies.

Transport and Accumulation of Microplastics from Biosolids to Australian Agricultural Soils: Detection of Microplastics Down to 1 μm.

The shift toward sustainable agriculture involves replacing inorganic fertilizers with organic alternatives like biosolids. However, concerns arise over emerging contaminants, such as microplastics (MPs), which remain largely unregulated. Despite their common use in Australia, the transfer of MPs from biosolids to agricultural soils remains largely unknown. Herein, we have investigated the abundance, characteristics, and transport of MPs resulting from biosolids application in two Queensland agricultural sites. MP concentrations were significantly higher in biosolid-amended soils (average of 1137 MPs/kg) than in reference sites (average of 36 MPs/kg), correlating with the volume, time since application, and frequency of biosolids application. MPs > 25 μm were predominantly polyethylene, polypropylene, and poly(methyl methacrylate) fragments (up to 85%). Fibers constitute only 15-30% of MPs and mainly in larger sizes (average 1011 μm), whereas fragments (average 188 μm) and beads (average 72 μm) had smaller size ranges. Despite analytical challenges using Raman spectroscopy, detected smaller MPs (1-25 μm) were fragments composed of polyethylene, polypropylene, and poly(vinyl alcohol). This study provides the first report of MPs down to 1 μm in Australian agricultural soils. Our findings suggest a need to assess the long-term impact of MPs in biosolids on soil health and food safety. We call on policymakers to consider the implementation of effective MP source control strategies and the development of guidelines for acceptable biosolids application rates.

Assessing Historical Landslide Risk Management Based on Trigger Magnitude and Consequences: A Case Study from the Rokko Mountains, Kobe, Japan

AbstractLandslides are a common hazard in mountainous regions, and many countries have implemented landslide risk management to mitigate their negative impacts. Assessing the effectiveness of those measures is important to improve technical and political decision-making and to enhance the selection and implementation of effective landslide risk management strategies. Here, we assessed effectiveness in landslide risk management based on the magnitude of rainfall characteristics that triggered landslides (inducing factor) and landslide consequences in the Rokko mountains, Kobe, Japan. The number of check dams was used as an indicator of progress in landslide risk management. For fatal landslide events in 1938 and 1967, rainfall characteristics that triggered landslides were estimated using the three-layer tank model, and their magnitude was quantified by the return period (RP). We then compared these rainfall magnitudes and landslide consequences (i.e., fatalities and completely collapsed houses) between the two events. The RP of the first tank storage layer value, which indicates rainfall characteristics triggering shallow landslides, was higher at landslides in 1967 than in 1938, whereas landslide consequences were less in 1967 than in 1938. 218 units of check dams were intensively constructed by landslide risk management from 1938 to 1967 and reduced the damage from landslides in 1967 that were triggered by higher magnitude rainfall than in 1938. This study also highlighted the importance of focusing on the magnitude of the inducing factor and landslide consequences to assess the effectiveness of landslide risk management at a local scale.

The simultaneous presence of active BK, Epstein Barr, and human cytomegalovirus infection and their correlation by host factors in patients suspected of kidney transplant rejection

AimsThis study aims to evaluate the presence of EBV, HCMV, and BKV genomic sequences in the plasma samples (active infection/viremia) of kidney transplant recipients suspected of rejection and to investigate host and risk factors related to the activation of these viruses in these patients.MethodsIn this cross-sectional single-center study, plasma samples were collected from 98 suspected kidney transplant rejection patients at Labafinejad Hospital, Tehran, Iran, between December 2022 and June 2023. Quantitative real-time PCR assays for HCMV, EBV, and BK were performed using GeneProof Real-time PCR kits. ROC curve analysis was used to determine the viral load cutoff point for each virus.FindingsHCMV active viremia was detected in 18 (18.36%) recipients, EBV active viremia in 7 (7.14%), and BKV active viremia in 5 (5.10%). ROC results indicated viral load cutoff points of 778, 661, and 457 points for HCMV, EBV, and BKV, respectively. The duration of time after transplantation significantly differed between active viremia and no viremia groups (120.5 vs. 46 months, P = 0.014). In the BKV active viremia group, the increase in creatinine compared to baseline creatinine was significantly higher than in the no viremia group (2.7 vs. 0.8, P = 0.017). The odds ratio of HCMV active viremia in patients taking tacrolimus was 2.84 times higher, and the odds of HCMV active viremia in patients taking antithymocyte globulin was 3.01 times higher than in patients not taking these drugs.ConclusionRapid and timely diagnosis of viral active infections in kidney transplant patients is crucial for effective disease management and implementation of appropriate treatment strategies. Identifying potential risk factors, including host and treatment-related factors that influence transplantation, can facilitate the development of suitable preventive strategies.

Exploring the Impact of HR 4.0 on Organizational Performance

This study investigates the relationship between the adoption of HR 4.0 technologies and quality hires, focusing on the mediating and moderating effects of skill matching. The hypotheses propose that the adoption of HR 4.0 technologies significantly influences quality hires directly. as well as indirectly through skill matching as a mediating factor and moderating factor. This study explores the significant impact that HR 4.0 technologies have on hiring excellent employees for businesses. This study explains the complex effects of cutting-edge technology tools like automation, machine learning, artificial intelligence (AI), and data analytics on the hiring and selection process through a thorough examination of the literature and empirical evidence. These findings highlight the importance of both the adoption of HR 4.0 technologies and the implementation of effective skill matching strategies in enhancing the quality of hires within organizations. Implications for theory and practice are discussed, along with suggestions for future research.

Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol

BackgroundOpioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.MethodsThis is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.DiscussionMost ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.Trial RegistrationClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991.

Using an Exploratory Factor Approach to Determine Strategies for Effective Implementation of Teaching Practicum in Schools

Teaching practicum is a vital component of pre-service teaching courses. However, researchers have shown concern about the quality of implementation of these courses. Resultantly, students show low-profile abilities in teaching and learning when they join professional service as teachers. The primary purpose of this study was to develop a scale for exploring strategies for effective practicum implementation and, secondly, to ascertain teachers’ perceptions about the effect of these strategies on the effective implementation of teaching practicum in schools. A survey questionnaire was developed and used for data collection. The questionnaire was developed based on a review of the literature and expert judgment. A total of 77 students participated in the study from a private college of teacher education in Peshawar. The students were selected based on a convenient sampling technique. The dimensionality of the scale was checked through exploratory factor analysis. The principal component analysis revealed a 4-factor structure as an essential strategy for the effective implementation of teaching practicum for pre-service teachers. These strategies were clear communication, showing respect, professional behavior and motivation. It is concluded that the scale can be used for measuring the effectiveness of teaching practicum in other contexts. The results of this study may be used for improving the curriculum implementation of teaching practicum in teacher training institutes. This study is significant as it provides firsthand knowledge to the management and administration of teacher education institutions about the essential strategies that can be used to enrich further teaching practicum, a pivotal element of teacher education.

Training Dental Teams to Address Community Health: Necessary Partnerships and Evaluation of an Evidence-Based Curriculum

Abstract: Background: Annually, 27 million Americans visit a dental professional but not a physician. Dental professionals must recognize that they are members of their patients’ primary care teams. Continuing education must then prepare them to appropriately serve their specific communities. Objectives: The objective of this paper was to describe the implementation of an evidence-based model to train dental professionals on how to respond to community-level health needs. The paper details crucial partnerships and provides evidence and key considerations for replicating the curriculum to improve population health. Methods: The Extension for Community Healthcare Outcomes (ECHO) model was used in one state where dental health care use is challenging for persons living rural, eligible for Medicaid, aging, and those who are American Indian. This formative evaluation knowledge assessments, data on participants’ changes in clinical care practice, web analytics, and artifact review to assess effective implementation strategies and necessary community partnerships. Conclusions: Successful implementation of the curriculum required active participation and partnership with state provider associations, the office of Medicaid, the state Board of Dental Licensure, and others. Without engaged partners, the curriculum would not have been community relevant, nor would it have had case presentation from local providers. In a state with only 427 practicing dentists, live attendance ranged between 9 and 22 dental team members, with between 11 and 91 views of the recorded sessions. Using the evidence-based ECHO model, which requires community health partnerships, is a cost-effective, and accessible, method to offering community specific education for dental providers across a large geographic region.

Network Functions in Cloud: Kubernetes Deployment Challenges

The rapid evolution of cloud computing has paved the way for deploying network functions (NFs) in cloud environments, significantly enhancing the flexibility, scalability, and efficiency of modern network infrastructures. Kubernetes, an open-source container orchestration platform, has emerged as a leading tool for deploying and managing these cloud-based network functions. However, despite its widespread adoption, Kubernetes presents several deployment challenges specific to network functions, stemming from its design, scalability, and operational intricacies. This paper delves into the core challenges faced during the deployment of network functions on Kubernetes, focusing on issues related to network performance, security, service orchestration, and resource management. The abstract aims to provide an overview of the technical hurdles and propose potential strategies to overcome them, thus contributing to the optimization of Kubernetes-based NF deployments in cloud environments. By analyzing existing literature and case studies, the paper identifies key areas where improvements are needed and discusses the implications of these challenges for the future of cloud-based network functions. Ultimately, the paper seeks to guide network architects and cloud engineers in better understanding the complexities of Kubernetes deployments for network functions and in developing more effective strategies for successful implementation.

MULTIVARIATE PROBIT MODELING OF CLIMATE-SMART ADAPTATION CHOICES AMONG FARMERS IN SUB-SAHARAN AFRICA: GHANAIAN STUDY OF COCOA FARMERS

Climate change and variability pose significant challenges to cocoa production in many sub-Saharan African countries, and Ghana is no exception. Therefore, knowledge of how farmers react to climate change and its variability effects is crucial in developing policies and programs to guide the design and implementation of effective climate-smart adaptation strategies at the farm level in Africa. This study aims to examine climate-smart adaptation choices cocoa farmers make as coping strategies for climate change and variability in Ghana using a multivariate probit modeling approach. Following a multistage sampling procedure, primary data was collected from 720 cocoa farmers across the major cocoa-growing regions in Ghana. The study found major adaptation choices for cocoa farmers to include improved and resistant varieties, optimal fertilizer application, optimal pesticide application, adjusting planting/harvesting dates, shade tree management, crop diversification, non-crop diversification, and off-farm economic diversification. We further observed that farmers’ adaptation choices were significantly influenced by climate change and adaptation-related variables such as rainfall variability index, temperature variability index, climate change impact perception index, and CSA awareness as well as agroclimatic zone effects. Concerning the influence of farmer and farm-specific variables, the study identifies that sex, age, education, farm size, quality of extension services delivery, access to credit, and membership in farmer groups were significant predictors of farmers’ CSA decision choices. This study offers beneficial insights for policymakers and stakeholders on how to promote climate-smart adaptation methods among cocoa farmers in Ghana.

Risk Mitigation Strategies for Sustainable Poultry Supply Chain Management

The livestock sector is an important pillar in providing animal protein and sustaining the rural economy. However, the sector faces major challenges from environmental and socio-economic issues, such as climate change and environmental degradation, which can threaten its sustainability. Negative impacts such as environmental contamination can reduce production quality and quantity and increase supply chain operational costs. This study aims to identify effective risk mitigation strategies to reduce these negative impacts and improve the sustainability of supply chain management. Data were collected from laying duck farms and analyzed using the House of Risk (HOR) method with a Phase 1 and 2 approach. This approach allows the identification of the most critical risks and risk agents and mapping mitigation priorities. Key findings indicate that providing drugs or vaccines to prevent animal virus outbreaks is the highest priority mitigation strategy, while strategic policy decision-making has the lowest priority. Overall, 15 risks and 21 risk agents were identified. This study implies that the implementation of effective mitigation strategies can significantly reduce operational risks, strengthen the resilience of the livestock sector, and support the sustainability of supply chain management as a whole.

Effect of parenting centers on caregiver mental health ——Evidence from a large scale randomized controlled trial in rural China

In the context of economic development, the escalating prevalence of depression, anxiety and stress poses substantial challenges, not only impacting individuals' physical and mental well-being but also exerting a profound influence on future human capital. This study conducts an exploratory analysis of the effects of a center-based early childhood development intervention on the mental health of the caregivers, utilizing data from a cluster randomized controlled trial involving 1652 caregivers in rural China. Over the course of two years, caregivers and children in 50 villages received individualized parenting training, one-on-one parenting classes, and access to open play spaces in village parenting centers. Our findings reveal sustained and significant intervention effects on caregivers' anxiety and stress symptoms. The primary mechanisms driving these effects include increased parenting time investment, alterations in parenting styles, and changes in the level of trust in others. Furthermore, our research demonstrates that the positive treatment effects on mental health outcomes are more pronounced among caregivers of children who initially lower development skills. The intervention exhibits a stronger impact on caregivers with lower educational attainment, particularly when the caregivers are grandmothers. These results underscore the importance of governmental attention to mental health issues in rural China, suggesting avenues for intervention through the provision of parenting knowledge and spaces facilitating caregiver-child interactions. This research contributes valuable insights into addressing mental health challenges in rural settings, promoting effective strategies for future policy implementation.

Robotics in Physical Rehabilitation: Systematic Review.

As the global prevalence of motor disabilities continues to rise, there is a pressing need for advanced solutions in physical rehabilitation. This systematic review examines the progress and challenges of implementing robotic technologies in the motor rehabilitation of patients with physical disabilities. The integration of robotic technologies such as exoskeletons, assistive training devices, and brain-computer interface systems holds significant promise for enhancing functional recovery and patient autonomy. The review synthesizes findings from the most important studies, focusing on the clinical effectiveness of robotic interventions in comparison to traditional rehabilitation methods. The analysis reveals that robotic therapies can significantly improve motor function, strength, co-ordination, and dexterity. Robotic systems also support neuroplasticity, enabling patients to relearn lost motor skills through precise, controlled, and repetitive exercises. However, the adoption of these technologies is hindered by high costs, the need for specialized training, and limited accessibility. Key insights from the review highlight the necessity of personalizing robotic therapies to meet individual patient needs, alongside addressing technical, economic, social, and cultural barriers. The review also underscores the importance of continued research to optimize these technologies and develop effective implementation strategies. By overcoming these challenges, robotic technologies can revolutionize motor rehabilitation, improving quality of life and social integration for individuals with motor disabilities.

Community-Based Participatory Research and System Dynamics Modeling for Improving Retention in Hypertension Care

The high prevalence of hypertension calls for broad, multisector responses that foster prevention and care services, with the goal of leveraging high-quality treatment as a means of reducing hypertension incidence. Health care system improvements require stakeholder input from across the care continuum to identify gaps and inform interventions that improve hypertension care service, delivery, and retention; system dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and ways to model sustainable system-level improvements. To assess the association of simulated interventions with hypertension care retention rates in the Nigerian primary health care system using system dynamics modeling. This decision analytical model used a participatory research approach involving stakeholder workshops conducted in July and October 2022 to gather insights and inform the development of a system dynamics model designed to simulate the association of various interventions with retention in hypertension care. The study focused on the primary health care system in Nigeria, engaging stakeholders from various sectors involved in hypertension care, including patients, community health extension workers, nurses, pharmacists, researchers, administrators, policymakers, and physicians. Simulated intervention packages. Retention rate in hypertension care at 12, 24, and 36 months, modeled to estimate the effectiveness of the interventions. A total of 16 stakeholders participated in the workshops (mean [SD] age, 46.5 [8.6] years; 9 [56.3%] male). Training of health care workers was estimated to be the most effective single implementation strategy for improving retention in hypertension care in Nigeria, with estimated retention rates of 29.7% (95% CI, 27.8%-31.2%) at 12 months and 27.1% (95% CI, 26.0%-28.3%) at 24 months. Integrated intervention packages were associated with the greatest improvements in hypertension care retention overall, with modeled retention rates of 72.4% (95% CI, 68.4%-76.4%), 68.1% (95% CI, 64.5%-71.7%), and 67.1% (95% CI, 64.5%-71.1%) at 12, 24, and 36 months, respectively. This decision analytical model study showed that community-based participatory research could be used to estimate the potential effectiveness of interventions for improving retention in hypertension care. Integrated intervention packages may be the most promising strategies.

Challenges in implementing treat-to-target in rheumatoid arthritis: a perspective from Brazilian rheumatologists

BackgroundPatient management in rheumatoid arthritis (RA) has evolved to a “treat-to-target” (T2T) approach, which entails intensive treatment and regular follow-up with the goal of achieving low levels of disease activity or clinical remission. Even though a T2T approach is endorsed by professional organizations and yields superior outcomes, its implementation remains incomplete. EVEREST (EleVatE care in RhEumatoid arthritiS with Treat-to-target) is a quality-improvement initiative designed to improve the widespread implementation of a personalized T2T strategy and enable patients with RA to reach their full potential for remission. We describe the Brazilian results from the Global T2T Survey, first part of the EVEREST program.MethodsBetween June and September 2022, we conducted an online survey targeting rheumatologists in Brazil. Our objective was to evaluate the barriers and knowledge gaps hindering the effective implementation of T2T strategies. To achieve this, we employed a set of multiple-choice questions specifically crafted to elicit responses categorized in a structured order.Results166 rheumatologists participated in the survey, 51% of them with more than 21 years of experience in rheumatology. Regarding the perceived challenges in the management of RA in clinical practice, the highest percentage of agreement/strong agreement among the participants was related to the contradictory results of disease activity measures (60%). In terms of the main barriers to assess the disease activity in clinical practice, the lack of adherence to treatment and contradictory assessments between patient-reported outcomes and composite measures were indicated by 75% and 59% of the participants, respectively, as a moderate/serious barrier. The most frequently knowledge and skill gaps related to the management of RA pointed out by the participants were on the difficulty to assess patients’ health literacy (54% stated to have no more than intermediate knowledge on standardized methods to assess it and 43% no more than intermediate skills on determining the level of health literacy of the patients). In general, the use of tools to support the management of RA patients in clinical practice was indicated to be unusual by the participants. Self-reflection questionnaires, patient education materials and treatment consideration checklists were pointed out as the least frequently used tools (85%, 64% and 62% of the participants stated to use them never, rarely, or only sometimes, respectively).ConclusionsOur findings indicate a greater need for design, selection, and uptake of practical strategies to further improve communication between healthcare providers and patients with RA, as well as for promoting well-informed, collaborative decision-making in their care.

STRATEGIES FOR THE PREVENTION AND CONTROL OF HYPERTENSION IN RURAL COMMUNITIES

Hypertension is a prevalent chronic condition that can lead to serious complications such as cardiovascular disease, stroke and kidney failure. The prevalence of hypertension is especially high in rural communities, where factors such as limited access to health care, lack of health information and socioeconomic conditions can contribute to a lack of control of the disease. Prevention and control strategies tailored to these communities are crucial to reducing the burden of hypertension and improving the overall health of the rural population. This brief explores effective strategies for the prevention and control of hypertension in rural communities, highlighting innovative approaches and associated challenges. The aim of this paper is to review and analyze strategies for the prevention and control of hypertension in rural communities. It aims to identify the main interventions that have proved effective, discuss approaches adapted to the needs and resources of rural communities, and address the challenges faced in implementing these strategies. This is a literature review, using qualitative and quantitative assumptions, using the PubMed, Scopus and Google Scholar databases. The health descriptors “Hypertension”, “Hypertension Management in Rural Areas”, “Telemedicine”, “Community Interventions” and “Rural Health Policies” were used to refine the research. The time frame covers the years 2018 to 2022. The focus is to promote a comprehensive understanding of best practices and areas that need more attention to improve the management of hypertension in rural contexts. Preventing and controlling hypertension in rural communities requires a multifaceted approach that takes into account the particularities of these areas, including barriers to accessing healthcare, resource limitations and specific cultural needs. Education is key to preventing hypertension. Awareness programs about risk factors, the importance of regular blood pressure monitoring and lifestyle changes can have a significant impact. Community initiatives such as workshops, lectures and local media campaigns can help raise awareness of hypertension and promote healthy habits. Improving access to healthcare is crucial for hypertension control in rural areas. This can include the implementation of mobile health units, telemedicine and partnerships with health organizations to provide regular medical services and blood pressure monitoring. Community screening programs and regular consultations can help identify and treat cases of hypertension early. Interventions that encourage a healthy diet, rich in fruit, vegetables and low in sodium, as well as regular physical activity, are essential for the prevention and control of hypertension. Nutritional education programs and the promotion of community physical activities, such as walking groups or sports, can be effective in promoting a healthy lifestyle. Thus, many people with hypertension also have other health conditions, such as diabetes or obesity. Integrated strategies that address hypertension alongside other health conditions can improve overall outcomes. This includes chronic disease management programs that provide support for managing multiple health conditions simultaneously. Involving the community in the planning and implementation of prevention and control strategies can increase the acceptance and effectiveness of interventions. Community groups, local leaders and non-governmental organizations can play an important role in promoting health programs and mobilizing resources. The effective implementation of hypertension control strategies in rural communities faces several challenges. Barriers can include a lack of adequate health infrastructure, a shortage of health professionals, limited access to medicines and treatments, and cultural factors that can affect the acceptance of interventions. In addition, logistical and financial difficulties can limit the ability to implement and maintain health programs in remote areas. Therefore, the approach to preventing and controlling hypertension in rural communities must be adapted to the specific needs and characteristics of these areas. Effective strategies include community education and awareness, improving access to health care, promoting a healthy lifestyle and integrated management of comorbidities. Involving the community and overcoming challenges related to infrastructure and resources are critical aspects for the success of these strategies. With a multifaceted and collaborative approach, it is possible to reduce the prevalence and impact of hypertension in rural communities, promoting better health and an improved quality of life for their inhabitants.

Perceived Usefulness of a Mandatory Information System

This study examines the adoption and implementation of an information system in a mandatory context focusing on an Israeli governmental organization. The system referred to as “Slot” is an online platform for managing educational activities within this organization. The research investigates the impact of the system on its functionality users and the results of its usage. Additionally, the study explores factors that influence the acceptance and utilization of information systems, including whether the willingness to use the system under instruction depends on other variables. The key findings of this study are: perceived ease of use significantly and positively influences perceived usefulness; perceived usefulness significantly and positively affects symbolic adoption; and supervisor influence significantly and positively impacts perceived usefulness. Moreover, the relationship between perceived ease of use and symbolic adoption is entirely mediated by perceived usefulness as is the relationship between supervisor influence and symbolic adoption. The study’s limitations include the relatively small sample size and the specific context of the research, which may limit the generalizability of the findings. Future research could explore similar models in different organizational settings to validate and extend the applicability of the results. The findings suggest that enhancing the perceived ease of use and usefulness of mandatory systems can significantly impact their symbolic adoption, with supervisory influence playing a crucial role in shaping user perceptions. These insights can inform strategies for more effective implementation and management of information systems in mandatory settings.