Implementation Of Interventions Research Articles

Applying cognitive walkthrough methodology to improve the usability of an equity-focused implementation strategy

BackgroundOur research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention.MethodsWe applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions.ResultsUsability ratings (scale 0–100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from “marginal acceptability” to “acceptable”. Ten usability problems were identified across four PEDDI tasks, comprised of 2–3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations.ConclusionsUsability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings.

Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program.

Public health care policymakers and payers are increasingly investing in efforts to address patients' health-related social needs (HRSNs) as a strategy for improving health while controlling or reducing costs. However, evidence regarding the implementation and impact of HRSN interventions remains limited. California's Whole Person Care Pilot program (WPC) was a Medicaid Section 1115 waiver demonstration program focused on the provision of care coordination and other services to address eligible beneficiaries' HRSN. In this study, we examine pilot-level variation in impact on acute care utilization and identify factors associated with differential outcomes. The majority of pilots reduced emergency department (ED) visits for enrollees relative to matched controls; however, only four pilots reduced both ED visits and hospitalizations. Coincidence analysis results highlight the importance of cross-sector partnerships, field-based outreach and engagement, and adequate program investment in differentiating pilots that reduced acute care utilization from those that did not.

Relationship Between Neurodevelopmental Areas and Difficulties in Emotional-Behavioural Variables in Children With Typical Development Under 2 Years of Age: Sex Differences.

The aim of this study was to examine the relationship between neurodevelopmental areas and possible difficulties in emotional-behavioural variables, and to determine if sex moderated this relationship. A community sample of 231 boys and girls with typical development and with a mean age of 19.84 months was evaluated, using the Bayley-III and CBCL 1.5-5 scales. The main results confirmed: (1) better linguistic abilities in girls in both language areas (receptive communication and expressive communication), finding more evidence according to the Bayesian analysis in expressive communication; (2) in the emotional-behavioural area girls had higher scores in withdrawal; (3) significant negative correlations of low magnitude were found between the Bayley and CBCL scales, particularly in the areas of language and cognitive and internalising and externalising problems; (4) children with low cognitive abilities and those with poor receptive communication showed more inter and externalising difficulties; (5) no significant predictive value or moderating effect of sex was found, (6) the number of participants who simultaneously manifested significant deficits in both domains (neurodevelopmental and emotional-behavioural) was very reduced. Future research should corroborate these results and the characteristics of the relationship found at these early ages. Detecting the population at risk in the first two years of life would enable the implementation of interventions aimed at improving neurodevelopmental deficits and emotional-behavioural problems. Thus, identification of deficits in one domain should lead to evaluation of the other.

Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial.

About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program-adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)-is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco's harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983. DERR1-10.2196/57236.

Exploring the Views of Barbers and Stylists on the Acceptability of Delivering Community-Based Interventions to Promote COVID-19 Testing and Vaccination in South Carolina

Background: The COVID-19 pandemic has underscored the need for effective community-based interventions to promote disease prevention and reach high-risk, underserved communities. Trusted community leaders like barbers and stylists may serve as effective conduits for intervention implementation. This study aimed to explore the perceived acceptability of an intervention to promote COVID-19 testing and vaccination delivered by barbers in South Carolina. Methods: We conducted exploratory in-depth interviews to ascertain barbers’ and stylists’ perceptions and identify potential barriers and facilitators. Data analysis used a deductive coding approach to identify themes and was guided by the Theoretical Framework of Acceptability. Results: Sixteen participants were interviewed. Participants expressed positive reactions towards the interventions. Acceptability was influenced by strong trust relationships with clients, perceived community influence, self-efficacy in providing the intervention, and a shared sense of responsibility for community health. However, potential barriers included declining public concern about COVID-19, vaccine hesitancy, and limited COVID-19 knowledge among barbers and stylists. Participants emphasized the need for training and incentives for effective and sustained intervention delivery. Conclusions: Barbers and stylists are well-positioned to promote COVID-19 testing and vaccination due to their trusted roles and community influence. Given the complacency from the waning perceived COVID-19 threat and the historical mistrust in health interventions, vaccine hesitancy must be addressed through supportive communication strategies.

Early Intervention after Rape to prevent post-traumatic stress symptoms (the EIR-study): an internal pilot study of a randomized controlled trial

BackgroundRape is one of the trauma incidents with the highest risk of subsequent post-traumatic stress disorder. Early interventions, such as prolonged exposure therapy (PE), have shown promise in preventing PTSD following a sexual assault. The primary objective of this internal pilot trial was to examine the feasibility of the EIR study protocol, which used modified prolonged exposure therapy (mPE) as a preventive intervention after rape.MethodsThis parallel two-arm clinical pilot study involved three sexual assault centers (SACs) in Trondheim, Oslo, and Vestfold, with data collected between June 2022 and March 2023. Women seeking assistance at one of these three SACs within 72 h after rape or attempted rape received acute medical treatment and forensic examinations. Women who wanted further psychosocial treatment were, if eligible and consenting, recruited to complete baseline assessments and a clinical interview before being randomized to one of two study arms. The intervention group prescribed up to five sessions of modified PE (mPE) in addition to treatment as usual (TAU), starting within the first 14 days after the rape incident, followed by weekly sessions. The other group received TAU.The present pilot evaluation is based on 22 participants, i.e., nine mPE + TAU and 13 TAU alone. Primary outcomes were predefined progression criteria regarding recruitment, retention, intervention implementation, a harm reporting system, and applying biological measurements and actigraphy.ResultsDuring the 6-month recruitment period, 235 women visited the three SACs. After eligibility screening and consent, 22 (9.4%) women were randomized. Three months later, 14 (63.6%) participants completed the final assessments. Intervention implementation was successful using trained SAC personnel to deliver mPE. The harm reporting system was used according to the study’s plan, and adverse and serious adverse events were detected during the trial. The biological measurements and actigraphy had substantial missing data but were still considered usable for statistical analyses.ConclusionIt may be feasible to conduct a full-scale RCT of early intervention after rape by comparing mPE + TAU to TAU alone. Minor design refinements were made to the protocol to enhance the main study outcome.Trial registrationClinicalTrials.gov Identifier: NCT05489133. Registered on 15 July 2022, retrospectively.

The Main Challenges Faced in the Implementation of Government Policy Interventions towards Access to Pre-primary and Primary Education by Street Children in North Rift, Kenya

Aims: Despite of the strong policy measures to have street children in school, many school-going-age are still not attending school. Therefore, the main purpose of this paper was to evaluate challenges faced in the implementation of Government policy interventions towards access to pre-primary and primary education by street children in North Rift, Kenya. Study Design: The study adopted a mixed method research design. Place and Duration of the Study: A survey was conducted in three towns of the North Rift Counties of Kenya (Kapsabet, Eldoret, and Kitale) which are the headquarters of the respective counties. Data collection done in the period between 1st December and 31st December 2022 Methodology: Purposive and simple random sampling was used to select 322 respondents (218 males and 23 females with a modal age of 10 -15 years; 18 female and 27 female teachers were aged between 30 – above 40 years). Data was collected using observation guides, in-depth interviews, and questionnaires. Descriptive and inferential statistics as well as theme analysis were used to analyze the data, respectively. The data was coded and analyzed using themes. Results: Main reasons street children had not enrolled in school were a lack of money for school materials (56.2%) and an unattractive school environment (30%). Other reasons included having to work to support their families (1.3%), distance to school (0.9%), being born and raised on the streets, being over-aged, and early parenting responsibilities. Conclusion: The study concluded that government policy interventions alone are insufficient for improving street children's access to education. Effective implementation requires collaborative efforts from all stakeholders, addressing barriers like poverty and parenting responsibilities, and restructuring education to include informal systems.

Profile of Ocular Trauma in Pediatric Population in a Tertiary Care Hospital

BACKGROUND Ocular trauma is the major cause for preventable monocular blindness and visual impairment worldwide. It accounts for 8%-14% of total injuries in the pediatric age group. Various studies have shown its higher incidence in this age group. They have different patterns of ocular injuries than adults and have age specific type of injuries. The number of blind years that a child lives with compared to an adult is far more. Most of the previous studies have been on ocular trauma among the adult population, specifically the factory workers in the city of Ludhiana. Moreover, this study aimed to derive a relation between the time of presentation from the injury and the final visual outcome which has rarely been reported in other studies. Profile of ocular trauma in an area is a dynamic and ever changing trend. Therefore, we proposed to study the profile of ocular trauma in pediatric population presenting to our hospital. METHODS A total of 60 patients between the age of 0 to 17 years were included in this study. The study was conducted from 15th December 2020 to 31st May 2022. Complete ocular examination was done at the time of presentation and after management; The best corrected visual acuity was noted at the end of three months. RESULTS Among our study subjects 45% belonged to the age group of 11-17 years. A male predominance (68.3%) was noted. For most of the subjects, the duration between time of injury and time of examination was less than 6 hours. The proportion of closed globe type of injury (80%) was significantly higher as compared to open globe (8.3%) and extraocular type of injury (11.7%). At the 3 month follow up, out of the 53 study subjects, 92.45% had good visual outcome (VO), 3.77% had fair VO and 3.77% had poor VO respectively. CONCLUSIONS Most of the pediatric ocular trauma may be avoided, which emphasizes the value of health education, adult supervision, and the implementation of suitable interventions to lessen the frequency and severity of trauma. Better visual outcome is expected with a shorter duration between time of injury and time of presentation.

Using Normalisation Process Theory to explore the contribution of stakeholder workshops to the development and refinement of a complex behavioural intervention: the STAMINA lifestyle intervention

BackgroundThe National Institute for Health and Care Excellence (NICE) recommend that men with prostate cancer on androgen deprivation therapy (ADT) are offered twice weekly supervised aerobic and resistance exercise to address side effects of treatment. However, supervised exercise is not routinely offered in standard clinical practice. The STAMINA programme grant for applied research (PGfAR) has been designed to evaluate whether this recommendation can be delivered within standard NHS care. This paper describes how future implementation of NICE recommendations within the NHS was explored during complex intervention development to enable evaluation of a lifestyle intervention.MethodsTwo stakeholder workshops were conducted to explore factors pertinent to future implementation of the STAMINA Lifestyle intervention (SLI). Normalisation Process Theory (NPT) provided the theoretical framework for discussion and analysis. Stakeholder workshop 1 focussed on intervention coherence and buy-in. Stakeholder workshop 2 explored barriers and facilitators for embedding SLI into the context of the NHS, with delivery partner Nuffield Health, in the future.ResultsWorkshops were attended by healthcare professionals (n = 16), exercise professionals (n = 17), members of public involved in PPI including patients (n = 12), health psychologists (n = 2), clinical commissioners (n = 4), cancer charities (n = 3), a cancer alliance (n = 1) and health economist (n = 1). Stakeholders agreed that professional training packages should emphasise the uniqueness of the SLI and underpinning theory and evidence (Coherence). To further engagement, the use of STAMINA champions and information about the delivery partner were recommended to enhance confidence and knowledge (Cognitive participation). Furthermore, a simple communication (Collective Action) and progress reporting system (Reflexive Monitoring) was suggested to fit into existing infrastructure within the NHS and community partner.ConclusionsApplication of NPT within two stakeholder workshops enhanced complex intervention development. Context-specific strategies to support implementation of SLI within the context of a trial were proposed, sensed-checked, and considered acceptable. The organisational implications of embedding and sustaining the intervention in preparation for wider NHS roll-out were considered (if proven to be effective) and will be explored in the qualitative component of a process evaluation underpinned by NPT.Trial registration(ISRCTN: 46385239). Registered on July 30, 2020.

Implementation of health-promoting retail initiatives in the Healthier Choices in Supermarkets Study—qualitative perspectives from a feasibility study

BackgroundImproving food environments like supermarkets has the potential to affect customers’ health positively. Scholars suggest researchers and retailers collaborate closely on implementing and testing such health-promoting interventions, but knowledge of the implementation of such interventions is limited. We explore the implementation of four health-promoting food retail initiatives selected and developed by a partnership between a research institution, a large retail group, and a non-governmental organisation.MethodsThe four initiatives included downsizing of bags for pick’n’ mix sweets and soda bottles at the check-out registers, shelf tags promoting healthier breakfast cereal options, and replacing a complimentary bun with a banana offered to children. The initiatives were implemented for 6 weeks (or longer if the store manager allowed it) in one store in Copenhagen, Denmark. Data were collected through observations, informal interviews with customers, and semi-structured interviews with retailers. We conducted a thematic analysis of transcripts and field notes inspired by process evaluation concepts and included quantitative summaries of selected data.ResultsTwo out of four initiatives were not implemented as intended. The implementation was delayed due to delivery issues, which also resulted in soda bottles not being downsized as intended. The maintenance of the shelf tags decreased over time. Retailers expressed different levels of acceptability towards the initiatives, with a preference for the complimentary banana for children. This was also the only initiative noticed by customers with both positive and negative responses. Barriers and facilitators of implementation fell into three themes: Health is not the number one priority, general capacity of retailers, and influence of customers and other stakeholders on store operation.ConclusionsThe retailers’ interests, priorities, and general capacity influenced the initiative implementation. Retailers’ acceptability of the initiatives was mixed despite their involvement in the pre-intervention phase. Our study also suggests that customer responses towards health-promoting initiatives, as well as cooperation with suppliers and manufacturers in the development phase, may be determining to successful implementation. Future studies should explore strategies to facilitate implementation, which can be applied prior to and during the intervention.

Digital Literacy as an Indicator of Adolescent Mental Health and Implementation for the Role of School Counselor: A Systematic Literature Review

The impact of problematic social media leads to mental health tendencies experienced by teenagers. One of the skills that teenagers are pioneering in using social media is digital literacy skills. The tendency for low levels of digital literacy among teenagers is very likely to be correlated with the mental health conditions of teenagers. This research aims to describe the correlation of digital literacy as an indicator of adolescent mental health and how role of school counselors. This research method is a systematic literature review with the search keywords "digital literacy"; "adolescent mental health"; "digital literacy and mental health" on the ScienceDirect, Sage, Taylor and Francis platforms. The results of the identification resulted in 14 articles which were studied in depth and resulted in the finding that digital literacy skills contributed to the mental health conditions of teenagers. Digital literacy is a link between teenagers and the digital world which will have an impact on mental health. Implementation of prevention and intervention is carried out by school counselors to prevent the impact of adolescent mental health problems.

Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION): Study protocol for a randomized controlled trial of a web-based platform integrating nutrition, physical activity, and mindfulness for individuals with obesity

Excess body weight, suboptimal diet, physical inactivity, alcohol consumption, sleep disruption, and elevated stress are modifiable risk factors associated with the development of chronic diseases. Digital behavioural interventions targeting these factors have shown promise in improving health and reducing chronic disease risk. The Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION) study is a parallel group, two-arm, randomized controlled trial evaluating the effects of adding healthcare professional guidance and peer support via group-based sessions to a web-based wellness platform (experimental group, n = 90) compared to a self-guided use of the platform (active control group, n = 90) among individuals with a body mass index (BMI) of 30–35 kg/m2 and aged 40–65 years. Obesity is defined by a high BMI. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which holistically integrates nutrition, physical activity, and mindfulness programs. Over 16 weeks, the experimental group uses the web-based wellness platform daily and engages in weekly online support group sessions. The active control group exclusively uses the web-based wellness platform daily. Assessments are conducted at baseline and weeks 8 and 16. The primary outcome is between-group difference in weight loss (kg) at week 16, and secondary outcomes are BMI, percent weight change, proportion of participants achieving 5 % or more weight loss, dietary intake, physical activity, alcohol consumption, sleep, and stress across the study. A web-based wellness platform may be a scalable approach to promote behavioural changes that positively impact health. This study will inform the development and implementation of interventions using web-based wellness platforms and personalized digital interventions to improve health outcomes and reduce chronic disease risk among individuals with obesity.

Spatial scales of COVID-19 transmission in Mexico.

During outbreaks of emerging infectious diseases, internationally connected cities often experience large and early outbreaks, while rural regions follow after some delay. This hierarchical structure of disease spread is influenced primarily by the multiscale structure of human mobility. However, during the COVID-19 epidemic, public health responses typically did not take into consideration the explicit spatial structure of human mobility when designing nonpharmaceutical interventions (NPIs). NPIs were applied primarily at national or regional scales. Here, we use weekly anonymized and aggregated human mobility data and spatially highly resolved data on COVID-19 cases at the municipality level in Mexico to investigate how behavioral changes in response to the pandemic have altered the spatial scales of transmission and interventions during its first wave (March-June 2020). We find that the epidemic dynamics in Mexico were initially driven by exports of COVID-19 cases from Mexico State and Mexico City, where early outbreaks occurred. The mobility network shifted after the implementation of interventions in late March 2020, and the mobility network communities became more disjointed while epidemics in these communities became increasingly synchronized. Our results provide dynamic insights into how to use network science and epidemiological modeling to inform the spatial scale at which interventions are most impactful in mitigating the spread of COVID-19 and infectious diseases in general.

Assessing the acceptability of a culturally adapted group-based pediatric intervention, Kokajjiriri, for Marshallese mothers and infants to improve nutrition and prevent childhood obesity.

Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. A multi-methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24-h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group-based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention. Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources. This is the first study to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group-based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children.

The use of video-based interventions to teach activity of daily living to children with autism spectrum disorder–scoping review

The study aimed to delve into the successful implementation of Video-Based Intervention (VBI) in improving activity of daily living skills (ADL) among children with autism spectrum disorder (ASD). Three primary electronic databases were utilised to perform this review: WOS, Scopus and Google Scholar. The process primarily used the research methodologies by Arksey and O'Malley as a framework. In the course of performing the scoping review, three themes emerged: firstly, a wide range of VBI techniques can be employed to enhance the skills of children with ASD; secondly, when VBI is coupled with adequate implementation support specifically tailored for children with ASD, it can effectively improve their daily living abilities. Essentially, the findings of this study support that VBI implementations can promote desired skills in ADL among children with ASD. Furthermore, additional implementation support complements video modeling, improving skill acquisition in ASD. This research enhances the existing knowledge base dedicated to enhancing the quality of life for children with ASD, providing valuable insights for educators, clinicians, and families involved in their care.

Motivational Factors Influencing the Choice of Medical Studies and Future Career Plans among Montenegrin Students.

There is a concerning trend of emigration among highly educated individuals in Montenegro. This includes medical professionals who seek better job opportunities abroad. The aim of the present study was to identify the primary motivational factors driving Montenegrin medical students to pursue a career in medicine, and whether these factors undergo changes over the course of their studies. A cross-sectional study included 210 medical students in Montenegro, 27.62% were males, and 72.38% were females. The mean age of the students was 21.90 years (SD=3.05) (range 19-39). Their academic motivation was analysed using the Academic Motivation Scale, previously validated in various cultural contexts. The results showed that autonomous motivation levels were higher than controlled motivation levels (p<0.001) among students in Montenegro, which has been previously associated with better learning outcomes. Students with medical doctors among their family members had higher extrinsic motivation related to rewards and punishments (extrinsic motivation with external regulation p=0.018). Amotivation showed a trend of increasing as the students got closer to graduation (p=0.057). Only 8.1% of students planned a career in primary healthcare, and 1% wished to specialize in family medicine. This study's findings, which indicate high levels of autonomous motivation among medical students, are of significant importance. They contribute to a comprehensive understanding of the motivation factors among medical students and young healthcare professionals in Montenegro. Moreover, they provide a basis for the implementation of strategic interventions to retain highly skilled medical professionals within the country's workforce, thereby addressing the concerning trend of emigration among this group.

Using physical health apps to promote healthy lifestyles in youth mental healthcare: A nationwide perspective-gathering exercise of over 400 service users

Digital technologies have presented a myriad of new solutions for improving cardiometabolic and behavioural health in the general population. However, the ways in which such advances could be applied to address the heightened health-risk behaviours and associated diseases in mental healthcare is unknown. To examine this, 492 young people with mental illness (YPMI) were recruited from 27 Primary Care and NHS mental healthcare sites across the UK, covering various diagnoses (excluding eating disorders). Participants were presented with four types of physical health apps, delivering: 1) Health Tracking; 2) Health Coaching; 3) Health Connections; and 4) Instructional Videos, and completed an online perspective-gathering exercise on the preferred utility, features, behavioural targets of these technologies, and barriers/facilitators to uptake. Results showed a high level of perceived utility across each of the four app types, with physical activity, sleep and diet emerging as preferred behavioural targets. Feedback on ideal app features indicated a need for integrated physical-mental health tracking, and expert-led instructional content/coaching, with less interested expressed towards sharing data with clinical teams. These findings can improve the development, future trials, and clinical implementation of digital lifestyle interventions in mental healthcare, through better accounting for the needs and preferences of YPMI.

Characteristics of inpatient and outpatient respiratory syncytial virus mortality in Gavi-eligible countries

The current understanding of the RSV-related mortality age distribution in low- and lower-middle-income countries (LMICs) relies on a limited number of disease incidence studies reporting wide age bands, and lacking specificity to Gavi-eligible countries. Understanding the age distribution of RSV-related deaths is crucial for the implementation of RSV interventions in LMICs that rely on support from Gavi. This study aims to provide the age profile of RSV mortality specifically in Gavi-eligible countries.Utilizing data from the RSV GOLD project, an ongoing global online mortality registry focusing on children under the age of 5 with laboratory-confirmed RSV infection, we employed two models (Complete Data Model and Prospective Data Model) to estimate the age profiles. To mitigate biases related to age group representation, we applied post-stratification weighting in our analysis.We included 423 pediatric deaths, including 145 from the community, under 2 years of age from 15 Gavi-eligible countries. Both models identified a peak age at 1 month and found that the majority of RSV-related mortality cases (59–77 %) from Gavi-eligible countries occur before 6 months of life. However, the models exhibited disparities in other age-related metrics. We present fitted age-at-time-of-death probability distributions to aid impact and cost-effectiveness studies.We expect that implementing infant RSV immunization strategies, such as maternal vaccination or infant immunoprophylaxis, will have high impact on RSV-related mortality in Gavi-eligible countries. The divergent results from the two models underscore the importance of carefully considering potential biases in retrospective and surveillance data when interpreting the age profile of RSV mortality cases in future research.

The perceptions and experiences of caregivers of patients with dysphagia: A qualitative meta-synthesis.

To understand the perceptions and experiences of family caregivers of adult patients with dysphagia. Dysphagia is a common symptom and burdens caregivers greatly. There is a growing body of studies concentrating on caregivers and caregiving experiences. However, no qualitative meta-synthesis has been conducted to explore the perceptions and experiences of family caregivers. A qualitative meta-ethnography. A search was conducted for relevant articles in six electronic databases (PubMed, Web of Science, CINAHL, Ovid, Cochrane Library, ProQuest) and two Chinese databases (CNKI, Wanfang Data) from inception to February 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to evaluate study quality. The meta-ethnographic method was used to synthesize data from qualitative studies. The study was reported according to EQUATOR guidelines. Eleven studies were included and three themes emerged: (1) emotion and perception, (2) change and challenge (3) adaption and coping. This review highlighted the challenges and positive coping experienced by caregivers. Findings directly inform the development and implementation of supportive interventions to reduce caregivers' stress and promote adaptive coping. Pay attention to the needs of family caregivers of dysphagia. Family caregivers' perceived severity of dysphagia requires assessment. Caregivers need knowledge, support, and guidance to reduce their burden and fulfill their role.

Impact of Hand Hygiene Interventions on Handwashing Practices and Microbial Risk: A Study in an Orphanage-based School in Pakistan

BackgroundOrphaned children are often deprived of quality care, making them more susceptible to diseases due to inadequate hand hygiene. ObjectiveThe present study aimed to assess the prevalence of hand hygiene practices and detect bacterial loads on children's hands before and after hygiene interventions in an orphanage school. Method: The study enrolled all the orphan children registered with the Save Our Souls (SOS) children’s orphanage School in Pakistan. The WHO standard checklist for assessing handwashing practices and swab samples from the hand were collected to evaluate the impact of hand-hygiene practices on bacterial load before and after the intervention. The Quantitative Microbial Risk Assessment (QMRA) model was used to predict the health risk. ResultThe study identified the two most common bacteria: S. aureus and E. coli. Before exposure to the intervention, S. aureus contamination was observed in both groups: intervention (1261 CFU/Hand) and control (1008 CFU/Hand) while E. coli in children's hands were prevalent in the intervention (1042 CFU/Hand) and control (1798 CFU/Hand) groups. The bacterial contamination was significantly reduced after the intervention (S. aureus 166 CFU/ml and E. coli 185 CFU/ml). The higher bacterial ingestion rate was attributed to hand contamination and increased bacteria transfer from hand to mouth. ConclusionThe implementation of the multicomponent hand hygiene intervention showed improvement in accessibility to hand hygiene resources and practices. The findings underscore the need for hygiene interventions in orphanage schools to improve health and educational outcomes.