Individual Interventions Research Articles

Collaborations between health services and educational institutions to develop research capacity in health services and health service staff: a systematic scoping review

BackgroundParticipation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff.MethodsThe scoping review framework by Arksey and O’Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search.ResultsOf the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce.ConclusionThis review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes.

The Effectiveness of Individual Intervention Based on Reality Therapy in Individuals Under Probation Due to Substance Use

ÖZET The aim of this research is to examine the effectiveness of individual intervention based on reality therapy in individuals under probation due to substance use. While conducting the research using the mixed-method approach, a single-subject experimental design was employed in the research’s quantitative dimension and employed a case study was done in its qualitative dimension. Two females and five males participated in the research. It was found that following the experimental intervention, there was a tendency for all participants to experience an increase in the levels of love/belonging, power and entertainment needs, as well as partially meeting freedom needs and increasing internal locus of control and responsibility levels.

Assessing Energy Availability and Glucose Dynamics in Adolescent Cyclists: Implications for Nutritional Interventions During the Competitive Season

Background: The risk of developing a state of low energy availability (LEA) (<30 kcals/kg free-fat mass) in endurance athletes is known and recommendations for nutrition are available. However, information on male adolescent cyclists and the influence of hot temperatures is limited. Objectives: The aim of this study was to investigate the impact on energy availability of two 4-day nutritional intervention strategies: (1) supplementary carbohydrate (CHO) intake during exercise and (2) designing and implementing individual nutritional interventions. Methods: Each intervention was preceded by a 4-day basal assessment. Eight competitive male junior road cyclists (aged 16–17 years) were investigated using a 4-day diet and activity records, alongside bioelectric impedance analysis. Their real-time power output, interstitial glucose, and temperature were recorded via sensors and a bike computer. Their energy intake (EI) was estimated from daily, self-reported food diaries. Results: Overall, 100% and 71% of the cyclists were in a state of LEA during the baseline assessment of the supplementary CHO and nutritional interventions, respectively. LEA prevalence, not modified by supplementary CHO intake alone (from 100% to 87%, ns), was markedly reduced by the individual nutritional intervention (from 71% to 14%, p < 0.05). When considering all the data as a whole, LEA was positively influenced by the training load (OR 1.06; 95% Cl 1.03 to 1.09) and free-fat mass (OR 1.46; 1.04 to 2.04) and was negatively affected by EI (OR 0.994; 0.991 to 0.997). A hot environment (air temperature) failed to influence the LEA or glucose dynamics. Conclusions: the nutritional intervention, but not the supplementary CHO intake, markedly reduced the prevalence of LEA in adolescents, who often fail to match their energy expenditure with their energy intake during the competitive season. Nutritional education is essential for adolescent endurance cycling teams.

A Longitudinal Multi-Method Inquiry of Educational Workers’ Use of Interventions for Positive Mental Wellbeing

Background and Objectives: Compassion fatigue and burnout are two distinct forms of mental health distress faced by educational workers. Researchers have shown a high level of both phenomena across the field of education; however, a better understanding of what educational workers already do for positive mental and emotional health is needed. Methods: This research study examined three years of data, collected via survey, inquiring into the various interventions, namely supports and resources, that educational workers use to support positive mental health. Results: Quantitative data analysis via descriptive and inferential statistics revealed that educational workers relied heavily on their personal support network followed distantly by medical professionals and other interventions, revealing a gap that needs to be addressed by employers. Qualitative thematic analysis revealed a trend towards increased use of environmental interventions to promote positive mental wellbeing. Conclusions: The data analysis suggested areas of focus required to ensure workplace wellbeing, and that programs too focused on individual or self-directed interventions would not be well received by educators. Suggestions for other interventions that might be helpful for leaders and policy-makers are provided.

Proximal and distal minority stressors and mental health among young gay and bisexual men and other men who have sex with men (GBMSM) in Kisumu, Kenya.

Young gay and bisexual men and other men who have sex with men (GBMSM) in Kenya experience pervasive intersectional stigma and discrimination, contributing to elevated levels of negative mental health symptoms. Grounded in the Minority Stress Model, this paper explores associations of proximal and distal minority stressors with three types of negative mental health outcomes among young HIV-negative GBMSM (n = 63) between the ages of 19-34 who participated in a pilot trial of a sexual health intervention. Using the PHQ-9, GAD-7, and PC-PTSD-5 screening measures, levels of clinically significant symptoms were reported as follows: 15.8% depressive symptoms, 12.7% anxiety symptoms, 31.7% posttraumatic stress symptoms. Results from stepwise linear regression analyses suggest that GBMSM-related stigma (distal stressor) was the strongest correlate for all three mental health outcomes, and concealment motivation (proximal stressor) was an additional significant correlate only in the depressive symptoms model. These findings should be viewed with caution and seen as initial observations given the small sample which limits our interpretations of the findings. Structural-level interventions are needed to decrease GBMSM's exposure to intersectional stigma and discrimination, such as decriminalization of same-sex sexual activity, as well as individual and group-level interventions that assist GBMSM with improving their adaptive coping strategies.

Comparative effectiveness of cognitive behavioural therapy, modafinil, and their combination for treating fatigue in multiple sclerosis (COMBO-MS): a randomised, statistician-blinded, parallel-arm trial

Fatigue is one of the most disabling symptoms reported by people with multiple sclerosis. Although behavioural and pharmacological interventions might be partly beneficial, their combined effects have not been evaluated for multiple sclerosis fatigue, or examined with sufficient consideration of characteristics that might affect treatment response. In this comparative effectiveness research trial, we compared the effectiveness of cognitive behavioural therapy (CBT), modafinil, and their combination for treating multiple sclerosis fatigue. This randomised, analyst-blinded, parallel-arm, comparative effectiveness trial was done at two universities in the USA. Adults (aged ≥18 years) with multiple sclerosis and problematic fatigue (Fatigue Severity Scale [FSS] score ≥4) were randomly assigned (1:1:1), using a web-based treatment assignment system with minimisation, to receive CBT, modafinil, or both for 12 weeks. Statisticians were masked to group assignment, but participants, study neurologists, CBT interventionalists, and coordinators were not masked to treatment assignment. The primary outcome was the change in Modified Fatigue Impact Scale (MFIS) from baseline to 12 weeks, assessed using multiple linear regression, adjusted for age, sex, study site, anxiety, pain, baselines MFIS score, and physical activity. Analyses were done by intent to treat. The trial was registered with clinicaltrials.gov, NCT03621761, and is completed. Between Nov 15, 2018, and June 2, 2021, 336 participants were randomly assigned treatment (114 assigned to CBT, 114 assigned to modafinil, and 108 assigned to combination therapy). At 12 weeks, CBT (n=103), modafinil (n=107), and combination therapy (n=102) were associated with clinically meaningful within-group MFIS reductions of 15·20 (SD 11·90), 16·90 (15·90), and 17·30 (16·20) points, respectively. Change in MFIS scores from baseline to 12 weeks did not differ between groups: relative to combination therapy, the adjusted total mean difference in MFIS change score was 1·88 (95% CI -2·21 to 5·96) for CBT and 1·20 (-2·83 to 5·23) for modafinil. Most common adverse events for modafinil-containing treatment groups included insomnia (eight [7%] for modafinil and eight [7%] for combination therapy) and anxiety (three [3%] for modafinil and nine [8%] for combination therapy). Modafinil, CBT, and combination therapy were associated with similar reductions in the effects of multiple sclerosis fatigue at 12 weeks. Combination therapy was not associated with augmented improvement compared with the individual interventions. Further research is needed to determine whether effects of these interventions on multiple sclerosis-related fatigue is influenced by sleep hygiene and sleepiness. No serious adverse events related to the study drug were encountered. Patient-Centered Outcomes Research Institute and National Multiple Sclerosis Society.

Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis.

An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers including upper aero-digestive tract cancer, stomach cancer, ischaemic heart disease (IHD) and stroke; with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially. We synthesised the effectiveness of behavioural interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioural intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at six months post-intervention follow up. For continuous abstinence at six months, the intervention was superior to active comparator (RR 2.32; 95% CI 1.78-3.02), and usual care (RR 4.39; 95% CI 2.38-8.11). For point prevalence abstinence at six months, the intervention was superior to active comparator (RR 1.76; 95% CI 1.28-2.44), and usual care (RR 2.37; 95% CI 1.47-3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons, except for 6-month continuous outcomes. Implementation research is needed to understand factors for programme sustainability and equity of impact of behavioural interventions in reducing tobacco use in LMICs. Our review is an important step towards the understanding of effectiveness of behaviour interventions for tobacco cessation suited for low- and middle-income countries and which are responsive to the contextual needs of such countries.

Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis

BackgroundBurnout among resident physicians during training has been prevalent, prompting training centers to introduce interventions at the individual or organizational level. However, empirical evidence is crucial before implementing such programs in practice.MethodsA systematic review and meta-analysis was carried out to evaluate the effectiveness of individual and organizational interventions in reducing burnout among resident physicians. Searching was done across five databases—PubMed, Scopus, ScienceDirect, Embase, and Cochrane Library from 1 December 2023 to 26 August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for our reporting of study selection process. Eligibility criteria were randomized or non-randomized designs, with prospective intervention, with a comparator group focused on individual or organizational interventions reducing burnout, in any language and publication date. The Maslach Burnout Inventory scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were the three outcome measures. Two investigators independently extracted the data. The risk of bias was evaluated using Cochrane risk-of-bias tool for randomized trials (RoB2) and non-randomized studies of interventions (ROBINS-I). Cohen’s d and heterogeneity was estimated using a random-effects DerSimonian-Laird model and visualized by forest plots. Sensitivity analyses were carried out by leave-one-out meta-analysis.ResultsWe identified 33 eligible studies (n = 2536), comprising 25 (75.8%) individual intervention studies and 8 (24.2%) organizational intervention studies. Cohen’s d for individual intervention versus control were as follows: EE -0.25 (95% CI -0.40 to -0.11, p < 0.01, I2 = 49.3%), and DP -0.17 (95% CI -0.32 to -0.03, p = 0.02, I2 = 50.0%). The organizational intervention showed no significant association with any domain. Sensitivity analyses were robust in all outcomes, with differences in intervention description and design identified as potential contributors to heterogeneity.ConclusionsVarious interventions, including individual coaching, meditation, and organization interventions, have been implemented to improve resident burnout. The effectiveness of intervention demonstrated none to small practical significance in improving burnout. Data inconsistency and high risk of bias across studies limited the validity of the pooled results. Further studies should focus on a combined approach.RegistrationThe study was registered on PROSPERO, under PROSPERO registration number CRD42022349698.

Adolescent, caregivers, and therapists’ experiences of youth and family suicide intervention: A qualitative study

Objective This study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12–18, their parents/caregivers and therapists). Method Data were collected through semi-structured individual interviews and analyzed using consensual qualitative research methods. Results Four domains were identified: Focusing on the youth-parent relationship, individual therapy for young people and their parents, conjoint therapy, and public service structures and systemic practice that facilitated tailored treatment. All participant groups valued intervention that improved the youth-parent relationship; however, they held different views about its influence on suicidality and recovery. Separate youth and parent therapy was crucial for facilitating the tailoring of treatment and enhancing the reparative potential of conjoint therapy. Barriers to productive intervention included inaccessible, fragmented, and siloed treatment that excluded parents, stigmatizing clinician responses, and acute care that was not attuned to need or developmental context. Helpful intervention was systemically and attachment-informed, multi-disciplinary, individually tailored, and integrated freely available specialist therapy with crisis and inpatient care. Conclusion A relational, nuanced, and flexible approach is needed to tailor youth suicide treatment in the context of the complexity of youth-parent relationships.

Examining Lifestyle Risk Factor Clusters and Mental Health in Adults

Abstract Background Lifestyle risk factors often cluster, impacting both physical and mental health. Studies reveal bidirectional relationships between lifestyle factors and health. The aim of this study is to examine the relationship between mental health problems, self-reported depression, and lifestyle risk factors in a sample of the adult population in Turkey. Methods 2022 Turkey Health Survey (THS) data were used. The sample group was made using cross-sectional data of approximately 22742 individuals in the adult population over 15 years of age. Two-stage clustering method was used to determine vital risk factor clusters. Regression analysis was used to determine the relationship between vital risk factor clusters and self-reported depression and mental health problems. Results Lifestyle risk factors were grouped into 4 clusters. It was observed that unhealthy diet, inadequate physical activity, and smoking, which are modifiable lifestyle risk factors, were together in the clusters. It was also observed that self-reported depression and mental problems were more associated with clusters with more than one lifestyle risk factor. In addition, women, married individuals, and individuals over 65 years of age were more associated with mental problems. Conclusions As a result of the findings, there was an association between people with mental problems and lifestyle risk factors such as smoking, unhealthy diet, and insufficient physical activity. These findings may help to plan and implement more effective health policies and individual interventions targeting groups with multiple lifestyle risk factors in the future. Key messages • The target group was determined to improve community mental health and to make necessary interventions. • Since inadequate physical activity, which is one of the vital risk factors, and unhealthy nutrition and smoking tend to cluster together, it was determined that these problems should be prioritised

Acceptance and Commitment Therapy for Hypersexuality: A Pilot Study

Hypersexuality refers to the inability to control sexual desire. Despite it has shown serious consequences for physical, psychological and social health, the evidence of available psychological interventions is still insufficient. In this open-label pilot study, an Acceptance and Commitment Therapy (ACT) intervention was conducted with adults with clinically significant levels of hypersexuality aimed to examine its feasibility and usefulness. The intervention consisted of eight weekly online individual psychological intervention sessions. Outcome self-report measures were administered at baseline, after the intervention and a 3 months follow-up. Behavioral and subjective informed changes in sexual practices were weekly assessed through self-monitoring. Twelve participants (M age = 38.8 ± 11.5 years, 83.3% male, 66.7% homo or bisexual) completed the intervention. The feasibility was found to be good, with all the participants completing the training and high levels of satisfaction. Hypersexuality, psychological flexibility, cognitive fusion and mindfulness scores significantly improved after the ACT intervention, with large effect sizes. Clinically significant changes in hypersexuality were found for the vast majority of participants, besides reductions in the time dedicated to planning and practicing sex and the sexualized drug use. Results indicate that ACT-based interventions may be considered feasible and potentially effective therapeutic alternatives for hypersexuality.

72 Hospital level of service, rural-urban hospital location, and neonatal resuscitation interventions at birth: A population-based study in Alberta, Canada from 2000-2020

Abstract Background Advanced neonatal resuscitation interventions (ANRIs: endotracheal intubation, chest compressions, and epinephrine) are rarely needed for infants born at ≥34 weeks gestational age (GA). However, healthcare providers (HCPs) in community hospitals can encounter the need for ANRIs, while having less experience and resources than HCPs in centers with neonatal intensive care units (NICUs). Understanding practice differences between hospitals of different levels of service (LofS) and rural/urban location can inform quality improvement to reduce health disparities. Objectives To examine how hospital level of service and rural/urban location relate to ANRI rates in Alberta, Canada, a universal public health system with standardized Neonatal Resuscitation Program (NRP) training. Design/Methods All live births ≥34 weeks GA in Alberta from 2000-2020 inclusive were examined using retrospective, population-level administrative data from the Alberta Perinatal Health Program (APHP). Hospitals (n=97) were contacted to determine annual LofS during the study period, with levels (0,1A/B/C,2,3) based on provincial obstetrical triage for availability of delivery support, cesarean-sections, obstetricians, paediatricians/neonatologists, and NICUs. Hospitals were further subcategorized by population and proximity to metropolitan centers.(Table 1) Rates of individual interventions or any ANRI were compared. Results There were 971,403 live births during the study period with a mean GA of 38.9 weeks; 1.6% were missing ANRI data, 955,835 births were included. Most occurred in hospitals with level 2 (57.4%) or level 3 (21.8%) NICUs; few occurred at sites with no delivery support (Level 0, 0.1%). ANRI rates were intubation (0.8%), chest compression (0.2%), and epinephrine (0.02%), any ANRI (0.96%, ~1/1000 live births). However, chest compression rates progressively decrease, and intubation rates progressively increase as LofS increases.(Table 1, Figure 1) When considering rural/urban location, there were outliers in chest compression rates in remote 0 (25.4/1000 live births) and metro-influenced 1A (30.2/1000 live births), intubation in remote 1C (33.3/1000 live births) and metro 0 (193.5/1000 live births) and epinephrine in metro 0 (64.5/1000 live births). Conclusion In this population-based cohort study of ≥34 weeks births, there were higher chest compressions rates and lower intubations rates at hospitals without NICUs despite standardized training. Reasons for this difference require further investigation; potential solutions such as targeted outreach education and introduction of laryngeal mask airways could be explored.

Psychological morbidity among coal miners compared to other occupations in Appalachia

ObjectivesDepressive symptoms, anxiety, and post-traumatic stress disorder (PTSD) are common morbidities among coal miners, but the risk of these morbidities has not been analyzed relative to other occupations taking into account relevant covariates.MethodsUsing random digit dialing, we surveyed men aged 50 or over with a history of employment who resided in counties in Appalachia with high coal workers’ pneumoconiosis (CWP) mortality rates. We used the Primary Care Post-Traumatic Stress (PTSD) Screen and the Brief Trauma Questionnaire to query specific traumatic experiences. We used the Patient Health Questionnaire scale to assess depression symptoms and the Generalized Anxiety Disorder questionnaire to measure anxiety. Multivariable logistic regression analyzed associations between coal mining and depression, anxiety, and PTSD, adjusting for trauma, smoking and demographics.ResultsOf 1,428 participants, 233 (16.3%) reported coal mining employment. Coal mining was associated with increased odds of depression (OR 1.6; 95% CI 1.1 to 2.4) and anxiety (OR 1.7; 95% CI 1.1 to 2.7). Among those with any trauma (n = 711), coal mining was not associated with increased risk of PTSD (OR 0.80; 95% CI 0.5 to 1.3]. Non-coal trauma was associated with three-fold increased odds of anxiety (OR 3.2; 95% CI 2.0 to 5.1); for coal trauma, anxiety was associated with six-fold increased odds (OR 6.0; 95% CI 2.9 to 12.4).ConclusionsAppalachian region coal miners carry an increased burden of depression and anxiety. This should be recognized by clinicians and at a population level, as worthy of individual and public health intervention.

Effects of an individual cognitive stimulation intervention on global cognition, memory, and executive function in older adults with mild to moderate Alzheimer's disease.

To determine the efficacy of a 12-week individual cognitive stimulation (iCS) intervention on global cognition, memory, and executive function of older adults with mild to moderate Alzheimer's disease (AD). Protocolized analysis using data from a multicenter, single-blind, randomized, parallel two-arm RCT of iCS for older adults with probable AD. A sample of 142 people with probable Alzheimer's disease attending 13 Portuguese institutions providing care and support services for older adults were selected. Intervention group (n = 72) received 24 iCS sessions, twice a week for 12 weeks. Control group (n = 70) maintained their activities as usual. Outcomes included global cognitive function (Mini-Mental State Examination, and Alzheimer's Disease Assessment Scale-Cognitive Subscale), memory (Memory Alteration Test, and Free and Cued Selective Reminding Test), and executive functioning (Frontal Assessment Battery). All participants were assessed at baseline (T0), after the intervention (T1), and 12 weeks follow-up (T2). The results showed significant improvements in memory performance at follow-up for the intervention group and greater stability in global cognition in the intervention relative to the control group. The current iCS protocol shows effectiveness in cognitive functioning in older adults with probable AD, particularly for memory upon completion of the intervention and at follow-up, adding further support to previous iCS studies showing similar results and to the effectiveness of the current intervention.

The influence of frailty: How the associations between modifiable risk factors and dementia vary

BackgroundThe Lancet Commission has highlighted 12 modifiable risk factors for dementia. However, the effects of addressing these risk factors among the heterogeneous older adult population is not fully understood. We compared the association between risk factors and dementia by frailty, conceptualized as an explanation for the underlying health heterogeneity in old age. MethodsData were from the UK Biobank, a cohort study with over 500,000 participants aged 37–73 between 2006 and 2010. Frailty was measured by five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants meeting 0, 1–2, and 3–5 criteria were considered non-frail, prefrail, and frail, respectively. We included 13 modifiable risk factors. We used logistic regression to determine the associations of risk factors with 10-year dementia among non-frail, pre-frail, and frail individuals, respectively. Additionally, we adopted a g-computation method to estimate the individual and combined population intervention effects (PIE) of the risk factors for dementia. ResultsOf 381,419 participants, 58.4 %, 38.2 %, and 3.4 % were classified as non-frail, pre-frail, and frail, respectively. Except for smoking, depression, and excessive alcohol use, the other 10 risk factors had a stronger association with dementia among frailer individuals. We observed the highest PIEs among frail individuals when considering hypothetical interventions targeting low education, physical inactivity, central obesity, social isolation, hearing impairment, hypertension, diabetes, high nitrogen dioxide (NO2) exposure, high exposure of particulate matter with a diameter less than or equal to 2.5 micrometers (PM2.5), and traumatic brain injury individually. For the hypothetical interventions targeting all 13 risk factors together, we found a graded increase in the PIE across frailty status. ConclusionThe associations between modifiable risk factors and dementia were stronger among the frail. We advocate for incorporating frailty assessments to pinpoint those most likely to benefit from targeted risk factor interventions.

Adopting sustainable innovations for remote access to TB and HIV care in South Africa.

For the last decade, South Africa has made substantial progress to control the dual HIV and TB epidemics. However, disruptions in TB and HIV treatment during the COVID-19 pandemic threatened to reverse this. This study aimed to identify adaptations in HIV and TB service delivery models in response to COVID-19 and government restrictions. This information informed the development of an online survey, which was utilized as part of a consultation exercise to further capture adaptations made to HIV/TB service delivery within the South African context. The literature review involved screening 380 titles and abstracts, identifying 30 HIV and TB studies across 19 countries, and categorizing 90 individual interventions into ten thematic areas. Common themes included interventions addressing screening, testing, diagnosis, medication collection and delivery support, and virtual models. Digital health interventions and adaptations to medication collection/delivery were reported in 38% of studies. Analysis of survey responses from 33 stakeholders in South Africa revealed that 47% of interventions targeted HIV, 11% TB, and 23% HIV/TB integrated service delivery. Most interventions (81%) were integrated into the national HIV or TB program, with implementation occurring at various levels: 39% at facility level, 35% at sub-district or district level, and 18% at provincial level. Programmatic data was available for 86% of interventions, with 50% being funded. This study demonstrated that services can be delivered in locations other than in health facilities (e.g., community-based or home-based) and that integrated services can also free up additional resources. Although studies varied, COVID-19 accelerated the adoption of differentiated service delivery (DSD) models for TB care, including multi-month dispensing (MMD) for TB preventative therapy (TPT) and TB treatment, home-based or mobile outreach screening and testing, and community pickup points (PuP) for TB medications. These initiatives had previously lagged behind HIV-focused DSD models, and it is crucial to sustain these services beyond the pandemic. To achieve universal health coverage, it will also be important to capitalize on these experiences and learn from HIV-focused DSD models so programs can deliver integrated person-centered chronic care services for TB, HIV, and non-communicable diseases.

Electronic Nudges to Increase Influenza Vaccination in Patients With Chronic Diseases

Despite strong worldwide guideline recommendations, influenza vaccination rates remain suboptimal among young and middle-aged patients with chronic diseases. Effective scalable strategies to increase vaccination are needed. To investigate whether electronically delivered letter-based nudges informed by behavioral science could increase influenza vaccination uptake among patients aged 18 to 64 years with chronic diseases. Nationwide pragmatic registry-based randomized clinical implementation trial conducted between September 24, 2023, and May 31, 2024, enrolling all Danish citizens aged 18 to 64 years who met criteria for free-of-charge influenza vaccination in light of preexisting chronic disease. All trial data were sourced from nationwide administrative health registries. Randomized in 2.45:1:1:1:1:1:1 ratio to no letter (usual care) or 6 different behaviorally informed electronic letters. The primary end point was receipt of influenza vaccination on or before January 1, 2024, assessed in 7 prespecified coprimary comparisons (all intervention groups pooled vs usual care and each individual intervention group vs usual care). Absolute risk difference in proportions and a crude relative risk were calculated for each comparison. A total of 299 881 participants (53.2% [159 454] female, median age, 52.0 [IQR, 39.8-59.0] years) were randomized. Compared with usual care, influenza vaccination rates were higher among those receiving any intervention letter (any intervention letter, 39.6% vs usual care, 27.9%; difference, 11.7 percentage points; 99.29% CI, 11.2-12.2 percentage points; P < .001). Each individual letter type significantly increased influenza vaccination with the largest effect sizes observed with a repeated letter sent 10 days after the initial letter (repeated letter, 41.8% vs usual care, 27.9%; difference, 13.9 percentage points; 99.29% CI, 13.1-14.7 percentage points; P < .001) and a letter emphasizing potential cardiovascular benefits of vaccination (cardiovascular gain, 39.8% vs usual care, 27.9%; difference, 11.9 percentage points; 99.29% CI, 11.1-12.7 percentage points; P < .001). Vaccination rates were improved across major subgroups. In a nationwide randomized clinical implementation trial, electronically delivered letter-based nudges markedly increased influenza vaccination compared with usual care among young and middle-aged patients with chronic diseases. The results of this study suggest that simple, scalable, and cost-efficient electronic letter strategies may have substantial public health implications. ClinicalTrials.gov Identifier: NCT06030739.

Efficacy of interventions aimed at reducing explicit and implicit weight bias in healthcare students: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to determine the efficacy of interventions aimed at reducing weight bias in healthcare students, and to explore factors that may impact intervention success. A systematic review and random-effects meta-analyses were conducted by including studies that examined the efficacy of weight bias reduction interventions for healthcare students. Of the 3463 journal articles and dissertations screened, 67 studies (within 64 records) met inclusion criteria, with 35 studies included in the meta-analyses (explicit = 35, implicit [and explicit] = 10) and 32 studies included in the narrative synthesis (explicit = 34, implicit [and explicit] = 3). Weight bias interventions had a small but positive impact, g = -0.31 (95% CI = -0.43 to -0.19, p < 0.001), in reducing students' explicit weight bias but there was no intervention effect on implicit weight bias, g = -0.12 (95% CI = -0.26 to 0.02, p = 0.105). There was considerable heterogeneity in the pooled effect for explicit bias (I2 = 74.28, Q = 132.21, df = 34, p < 0.001). All subgroup comparisons were not significant (p > 0.05) and were unable to explain the observed heterogeneity. Narrative synthesis supported meta-analytic findings. The small but significant reduction of explicit weight bias encourages the continued testing of interventions, irrespective of variation in individual intervention components. Contrarily, reductions in implicit weight bias may only be possible from a large societal shift in negative beliefs and attitudes held towards people living in larger bodies.

The effect of online motivational interviewing on pregnant women's smoking cessation behaviour: A randomized controlled trial.

This study aims to examine the effect of online individual motivational interviewing based on the transtheoretical model on pregnant women's smoking cessation behaviour. Sixty-two pregnant women who did not complete the 16th gestational week and who smoked were randomly assigned to intervention (n = 31) and control (n = 31) groups. While the intervention group was administered model-based motivational individual counselling interventions, the control group was administered no interventions. The results showed that 58.1% of the pregnant women in the intervention group and 22.6% of the pregnant women in the control group ceased smoking. Online motivational interviewing based on the transtheoretical model was found to be effective in pregnant women's smoking cessation.

Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review

BackgroundThe impact of rapid urbanization taking place across the world is posing variegated challenges. Especially in terms of communicable disease, the risk is more concentrated in urban poor areas where basic amenities are inadequate. This systematic review synthesizes evidence on the effective community-based interventions (CBIs) aimed at preventing and controlling infectious diseases among the urban poor in low- and middle-income countries (LMICs).MethodsThis systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. A comprehensive search across five major databases was conducted to capture literature on CBIs published between 2011 and 2021. Scientific articles of any design that reported any type of CBIs effective in preventing and controlling infectious diseases (tuberculosis, diarrhea, typhoid, dengue, hepatitis B and C, influenza, and COVID-19) were included. Screening and selection of studies were done by two pairs of independent researchers using the predefined eligibility criteria. The risk of bias in included studies was assessed using the modified checklist outlined in the Cochrane Handbook for Systematic Reviews of Interventions and Effective Public Health Practice Project (EPHPP). Analysis of effective CBIs was guided by the conceptual framework for integrated CBIs for neglected tropical diseases (NTDs), and narrative synthesis was carried out. Geographical restrictions were limited to LMICs and papers published in English.ResultsOut of 18,260 identified papers, 20 studies met the eligibility criteria and were included in this review. Community-based screening and socio-economic support, community-based vector control, behavior change communication, capacity building of the community health workers (CHWs), health education, and e- and m-health interventions were found as effective CBIs. Diversified CBIs were found to be effective for specific diseases, including tuberculosis (TB), diarrhea, dengue, influenza and ARI, and hepatitis B and C. Bundling of interventions were found to be effective against specific diseases. However, it was difficult to isolate the effectiveness of individual interventions within the bundle. The socio-cultural context was considered while designing and implementing these CBIs.ConclusionThe effectiveness of an intervention is inextricably linked to social context, stakeholder dimensions, and broader societal issues. System approach is recommended, emphasizing context-specific, multi-component interventions that address social determinants of health. Integrating these interventions with public health strategies and community involvement is crucial for sustainable outcomes. These findings can guide the design of future interventions for better prevention and control of communicable diseases in urban poor areas.Systematic review registrationPROSPERO CRD42021278689.