Multifaceted Intervention Research Articles

Postintensive care syndrome family: A comprehensive review.

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.

Improving Medication Adherence Levels in Inflammatory Bowel Disease (IBD) Patients: A Narrative Evidence-Based Review.

Inflammatory bowel disease (IBD) management is typified by a long-term medication regimen which can comprise multiple medications prescribed in different combinations, doses, frequencies, and with various administration routes. This complexity can make medication adherence (MA) - patients taking their medications per the prescription - for patients with IBD a challenge. The research corpus contains diverse interventions aimed at improving MA in patients with IBD. Therefore, to condense the evidenced strategies for ease of reference, this narrative evidence-based review broadly outlines the patient-level interventions reported. The interventions are grouped as educational, behavioural, cognitive-behavioural, and multicomponent. They, however, present mixed results as to their efficacy at improving MA, with those employing combined approaches being the most promising. This reflects the reality that MA is impacted by multiple factors encompassing those pertaining to the patient, disease, therapy, patients' socioeconomic status, and health system. Hence, the most ideal interventions would likely be multifaceted patient-level interventions alongside policy/system-level strategies, to maximise the potential for successfully improving patients' MA. These findings might have been impacted by the heterogeneity of the studies in terms of the method of MA assessment, duration of interventions, and more besides.

Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis.

The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings. To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings. A systematic review and meta-analysis. We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs). Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality. Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.

Enhancing nutritional knowledge and self-regulation among adolescents: efficacy of a multifaceted food literacy intervention.

This health literacy intervention study, conducted on adolescent students, aimed to evaluate the impact of a comprehensive educational program on promoting healthy eating habits. The intervention sought to enhance adolescents' knowledge about nutrition, foster self-regulation skills, and ultimately improve their overall health, including their body mass index (BMI). Through a multi-component approach that combined theoretical learning with practical activities and the integration of digital tools such as the MyFitnessPal app, the study targeted improvements in food literacy, which encompasses nutrition knowledge, food label interpretation skills, and cooking abilities. These elements are critical in influencing adolescents' food choices and eating behaviors, with a focus on increasing the consumption of fruits and vegetables while reducing the intake of fast food and processed snacks. The intervention was structured around a series of educational workshops and interactive sessions, facilitated by professionals experienced in nutrition. These sessions covered topics such as food composition, the importance of a balanced diet, and strategies for avoiding excessive consumption of processed and high-energy-density foods. A distinctive feature of the program was its use of digital tools to enhance engagement and allow for the practical application of learned concepts through food tracking and activity monitoring. Preliminary results indicate positive outcomes in terms of increased food knowledge and improved dietary habits among participants. Notably, there was a significant improvement in adolescents' BMI, highlighting the potential of food literacy interventions to contribute to better physical health outcomes. The study underscores the importance of adopting multidisciplinary and technology-enhanced approaches in educational programs aimed at promoting healthy eating among adolescents. The study's findings suggest that well-structured food education programs, tailored to address the specific needs of adolescents, can facilitate positive changes in eating behavior. This highlights the critical role of food literacy in adolescents' health and wellbeing and points to the need for continued investment in research and development to optimize intervention strategies. The integration of digital technologies and a focus on self-regulation strategies are identified as promising avenues for future research and educational practice, reinforcing the call for innovative investments in food education and health promotion among the youth.

Determinants of minimum dietary diversity for lactating and pregnant women.

Maternal and child health, which is integral to public health, depends on maintaining a healthy diet during pregnancy and lactation to achieve optimal outcomes. This study aimed to investigate the prevalence and determinants of minimum dietary diversity (MDD) among pregnant and lactating women (PLW) in this particular context. A stratified cluster sampling approach was employed, encompassing intervention areas (Rangpur and Nilphamari in Bangladesh) as strata, with 30 clusters. The study included 631 pregnant and lactating women (PLW) aged 15 to 49 years, focusing on their consumption of a minimally diverse diet. The outcome variable was binary: MDD (1 = if they consumed ≥ 5 food items from a basket of 10 food groups, indicating they met the MDD; 0 = if they consumed < 5 items, indicating they did not meet the MDD), assessed based on ten food groups over a 24-hour period. The data were analyzed using a binary logistic regression model. The study found that 51.19% of PLW met MDD criteria, indicating positive dietary practices. Those aged 21-49 years had significantly lower odds of meeting MDD than those aged 15-20 years. Education played a key role, with completion of primary (p = 0.029) and secondary incomplete education (p = 0.055) associated with higher odds of meeting MDD. Other identified predictors included climate-smart techniques for agriculture, women's empowerment, food security, producing legume, nut and seeds and negative impact on family expenditure due to increase in commodity prices, especially food prices. Employing climate-smart agriculture increased odds by 1.58 times (p = 0.028), empowered women had 2.31 times higher odds (p < 0.001), and food security played a crucial role (p = 0.006). Moreover, producing legumes, nuts, or seeds was significantly associated with higher odds of meeting MDD (OR = 1.55, p = 0.039), while experiencing negative economic impacts lowered the odds (OR = 0.63, p = 0.034). The study provides insights into factors influencing MDD among PLW in northern Bangladesh. Empowering women and promoting climate-smart techniques for agriculture emerged as pivotal determinants, alongside enhancing education levels, increasing food security, and addressing economic barriers. Implementing multifaceted interventions that consider socio-demographic diversity, economic disparities, and dietary preferences is crucial for enhancing dietary diversity and improving health outcomes in this vulnerable population.

Medication-related burden and its association with medication adherence among elderly tuberculosis patients in Guizhou, China: a cross-sectional study.

Tuberculosis (TB) morbidity and mortality are significantly increasing in the elderly worldwide. Their optimal health outcomes are hampered by medication related burden (MRB) and poor treatment adherence. Understanding th e MRB status from patients' perspectives and its association with adherence among elderly TB patients will help achieve the End TB targets. Thus, we aimed to identify the incidence of MRB and nonadherence among elderly TB patients in Guizhou, and determine their association. A cross-sectional study was conducted in three prefectures with high TB notifications in Guizhou in 2022. The data were collected via face-to-face structured interviews. MRB was measured using the Living with Medicines Questionnaire version 3 (LMQ-3), which consists of eight domains. Nonadherence was assessed by treatment interruption, which was defined as any interruption lasting at least 1day at any time within the last 3months. A binary unconditional logistic regression model was used to determine the association between variables. Of the 405 elderly TB patients enrolled, 49.4% and 42.7% of the respondents perceived suffering from moderate and high MRB, respectively. The incidence of nonadherence among patients was 33.6%. Patients with higher scores in domain 2 (practical difficulties) [OR adj = 1.19; 95% CI (1.11-1.28)] and domain 4 (side effects burden of prescribed medications) [OR adj = 1.16; 95% CI (1.06-1.27)] were more likely to experience nonadherence. But, patients with higher scores in domain 8 (control/autonomy of medicine use) [OR adj = 0.70; 95% CI (0.61, 0.81)] were more likely to occur adherence. Patients with a high education level [OR adj = 0.29; 95% CI (0.08, 0.92)] had a decreased risk of nonadherence, but those with a living expense from a retirement salary [OR adj = 2.55; 95% CI (1.16, 5.71)] had an increased risk of nonadherence. The incidence of MRB and medication nonadherence is high among elderly TB patients in Guizhou. The significant associations between the three domains of MRB and nonadherence highlight that measuring MRB in multiple dimensions using the LMQ-3 in elderly TB patients could assist clinicians in providing patient-centered care, and multifaceted interventions targeting the identified problems should be implemented to reduce MRB and nonadherence among elderly TB patients in Guizhou.

Implementation of multifaceted diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital.

Clostridioides difficile infection (CDI) is a common, healthcare-associated infection. However, in Japan, testing for CDI is infrequent, suggesting that its incidence may be underestimated. This study aimed to examine the implementation of a multifaceted, diagnostic stewardship (DS) for CDI in a small Japanese hospital during the coronavirus 2019 pandemic. Before-after study. A small Japanese community hospital. Healthcare workers including physicians, nurses, and pharmacists. A multifaceted intervention including (1) the addition of CD testing criteria to the hospital guidelines; (2) provision of a tutorial on CD testing to physicians, nurses, and pharmacists; (3) assessment by clinical pharmacists and nurses of the need for CD testing in patients with nosocomial diarrhea and issuance of recommendations for CD testing to physicians; (4) reporting of data on the CD testing rate and CDI incidence in the study center. The CD testing rate increased before the pandemic (+0.16/10,000 patient-days (PD); P = .28), decreased significantly during the pandemic (-0.79/10,000 PD; P = .02), and then increased significantly immediately after the implementation of the intervention (+29.6/10,000 PD; P < .01). Similarly, the CDI incidence increased significantly before the pandemic (+0.26/10,000 PD; P = .02) and decreased significantly during the pandemic (-0.49/10,000 PD; P = .01). Implementation of the intervention resulted in an immediate and significant increase in the CDI incidence (+6.2/10,000 PD; P < .01). Multifaceted DS involving multidisciplinary specialists was effective in improving CD testing, suggesting that appropriate testing can contribute to diagnosing CDI accurately.

Impact and interventions of waterborne and foodborne illnesses caused by bacterial pathogens in Nigeria: A review

Waterborne and foodborne illnesses caused by bacterial pathogens are major public health concerns, especially in developing countries like Nigeria—waterborne pathogens such as Escherichia coli, Salmonella spp. and Klebsiella spp. Contribute to the spread of health challenges, primarily due to poor sanitation, contaminated drinking water, and inadequate hygiene. Similarly, foodborne pathogens, including Escherichia coli, Listeria monocytogenes and Salmonella spp., are major causes of human illness, with animal-based foods often acting as transmission vectors. This review examines the current state of diagnosis, highlighting that most household water sources in Nigeria are vulnerable to contamination, with significant microbial loads exceeding WHO standards. It raises the need for effective interventions such as improved hygiene practices, water supply, sanitation and food safety management systems. Furthermore, this review discusses the impact of these pathogens on public health, noting that waterborne and foodborne diseases result in substantial mortality and economic burdens. Also, implementing good hygienic practices, Hazard Analysis Critical Control Point (HACCP) systems, and public health education are essential strategies for reducing the incidence of these diseases. This review concludes by calling for a collaborative effort among governments, policymakers, stakeholders, and researchers to develop and implement multifaceted interventions to combat these pervasive health threats.

Mathematical modelling of COVID-19 transmission with optimal control and cost-effectiveness analysis

The present global health threat is the novel coronavirus disease (COVID-19), caused by a new strain of the SARS-CoV-2 coronavirus. In this study, have employed optimal control theory, aided by Pontryagin’s Maximum Principle, to explore optimal control measures. Specifically, we have investigated time-dependent intervention strategies, including the proper use of personal protective measures and vaccination. Bifurcation analysis was conducted and results shows that the model system exhibit a forward bifurcation. The optimal control system have been numerically simulated using the fourth-order Runge–Kutta methods. The results show that the implementation of the combination of the two interventions was more significant and effective in minimizing the spread of the COVID-19 than the implementation of a single control measure. These findings underscore the significance of multifaceted intervention approaches over singular control measures. Notably, the combined implementation of interventions emerges as markedly more effective in containing COVID-19 transmission. Moreover, our study identifies personal protective measures as a particularly cost-effective intervention, offering substantial relief from the burden of the pandemic within the population. We anticipate that our research will inform evidence-based approaches to pandemic control and aid in the ongoing global efforts to safeguard public health.

Asthma Control and Associated Factors Among Children with Current Asthma - Findings from the 2019 Child Behavioral Risk Factor Surveillance System - Asthma Call-Back Survey.

This study aimed to determine the prevalence and correlates of uncontrolled asthma among children with current asthma in four US states. We also determined the rates and correlates of asthma-related hospitalization, urgent care center (UCC), or emergency department (ED) visits. We analyzed the 2019 Behavioral Risk Factor Surveillance Survey (BRFSS) Asthma Call-back Survey (ACBS) datasets. Asthma control status was classified as well-controlled or uncontrolled asthma based on day- and night-time asthma symptoms, activity limitation or use of rescue medications. Multivariable logistic regression models were used to identify the correlates of uncontrolled asthma and asthma-related hospitalization or UCC/ED visits. Among 249 children with current asthma, 55.1% had uncontrolled asthma while 40% reported asthma-related hospitalization or UCC/ED visits in the past year. Non-Hispanic ethnicity, ages of 0-9 and 15-17 years, household income <$25,000, and not having a flu vaccination had higher odds of uncontrolled asthma. Conversely, asthma self-management education and households with two children compared to one were positively associated with uncontrolled asthma. For healthcare utilization, male and non-Hispanic children, along with those from households earning <$25,000 exhibited higher odds of asthma-related hospitalization and UCC/ED visits. Uncontrolled asthma and asthma-related visits to UCC/ED and hospitalization are common among children with current asthma. These outcomes are influenced by low household income and male sex, among other factors which call for multi-faceted interventions by healthcare providers and policymakers. Targeted strategies to effectively manage asthma and reduce the need for emergency healthcare services are recommended.

Adherence to antiretroviral therapy among cisgender gay, bisexual and other men who have sex with men in Brazil: Evaluating the role of HIV-related stigma dimensions.

In Brazil, ~35% of people living with HIV (PLHIV) have poor adherence to antiretroviral therapy (ART). HIV-related stigma is associated with worst continuum of care outcomes, however evidence from Brazil is scarce. We explored pathways between HIV-related stigma dimensions and ART adherence among Brazilian cisgender gay, bisexual and other men who have sex with men (MSM) living with HIV. A sample of MSM ≥18 years was recruited online between February/March 2020 through advertisements on Hornet, a location-based dating app. Validated scales were used to assess ART adherence and HIV-related stigma. Indirect and direct pathways between HIV-related stigma dimensions and ART adherence were estimated using structural equation models while considering socio-demographic and substance use related variables. Models were estimated using mean- and variance-adjusted weighted least squares, and goodness of fit indices were calculated. Among 1,719 MSM living with HIV who reported starting ART, 70% were adherent. There was evidence of indirect effects of concerns about public attitudes (standardized coefficient (SC) = -0.095, 95% confidence interval (95%CI) = -0.172 - -0.017) and personalized HIV-stigma (SC = -0.022, 95%CI = -0.043 - -0.001) on ART adherence mediated through negative self-image. Personalized HIV stigma and concerns about public attitudes were both positively associated with negative self-image (SC = 0.129, 95%CI = 0.066-0.193; SC = 0.549, 95%CI = 0.494-0.603), and concerns about public attitudes was associated with HIV disclosure concerns (SC = 0.522, 95%CI = 0.463-0.581). However, the direct paths from personalized HIV stigma and concerns about public attitudes to ART adherence were not significant. Our research underscores the critical need for multifaceted interventions to eliminate HIV-related stigma at both individual and societal levels. At the individual level, psychotherapeutic interventions to improve self-image might helpful. Additionally, public policy should aim to dismantle structural stigma with awareness campaigns on various media channels, integration of anti-stigma curriculum into schools, and training for professionals.

Practice of key essential nutrition action messages and associated factors among mothers of children aged six months to two years old in Karat town, Konso zone, South Ethiopia, 2024: a community-based cross-sectional study.

Key essential nutrition actions (ENA) messages are a comprehensive and evidence-based nutritional package designed to improve the nutritional status during the critical first 1,000 days of life. The poor practice of ENA contributes significantly to mortality and morbidity related to malnutrition in young children. However, there is a dearth of studies focusing on the practice of key ENA messages among mothers and the factors associated with their practice. Therefore, this study aimed to assess the practice of key ENA messages among mothers of children aged 6 months to 2 years in Karat town, Konso zone, South Ethiopia in 2024. A community-based cross-sectional study involving 421 mothers of children aged 6 months to 2 years was conducted in Karat town, Konso zone, South Ethiopia from January 15 to February 29, 2024. Respondents were chosen using computer-generated random numbers. A structured, pretested, and interviewer-administered questionnaire was used to collect data. Following coding and entry into EpiData 3.1, the data were exported to SPSS version 25 for analysis. Logistic regression (bivariate and multivariable) was employed to identify factors influencing mothers' practice of key ENA messages, and statistical significance was set at p < 0.05 with a 95% confidence interval. The study found that 47.6% (95% CI: 42.8, 52.42%) of mothers demonstrated good practices. Having secondary education or higher, institutional delivery, receiving nutritional counseling during antenatal care (ANC), receipt of postnatal care (PNC) services, having good knowledge, and having a good attitude towards ENA all increase the likelihood of good practice. This study emphasizes the need for multifaceted interventions to improve ENA practice among mothers residing in Karat town. To effectively address this issue, it is crucial to implement targeted education programs, strengthen postnatal care services, and nutritional counseling into routine antenatal care, promote institutional deliveries, and enhance awareness.

Redefining hypnosis: A narrative review of theories to move towards an integrative model

Hypnosis is an ancient mind-body intervention that has regained interest with the surge of research in the last decade documenting its clinical validity. Yet, theoretical controversies and misconceptions prevail among theorists, clinicians, and the general public, impeding the understanding, acceptance, replication, and use of hypnosis. Providing adequate information, which dispels misconceptions and promotes more balanced views, is warranted to facilitate the implementation and adoption of hypnosis in clinical and research settings. This review re-examines the conceptualisation of hypnosis throughout history and the theoretical controversies surrounding it while highlighting their meeting points and clinical implications. Despite dichotomies, a broad agreement appears across theoretical approaches regarding hypnotic analgesia effects, key components, and vocabulary. Further, theories highlight key factors of hypnotic responding. For instance, social theories highlight social and contextual variables, whereas state theories highlight biopsychosocial mechanisms and individual factors. Based on theories, the terms hypnotherapy or clinical hypnosis are recommended to refer to the therapeutic use of hypnosis in psychotherapeutic and medical contexts, respectively. This review concludes with a model that integrates various theories and evidence and presents hypnosis as a complex multifaceted intervention encompassing multiple procedures, phenomena, and influencing factors. This review intends to deepen our understanding of hypnosis, and promote its more rapid adoption and adequate implementation in research and clinical contexts, in addition to steering research towards evidence-based hypnotic practice. The review can have important research and clinical implications by contributing to advancing knowledge regarding hypnotic procedures, phenomena, and influencing factors.

Antimicrobial Effects of Plant-Based Supplements on Gut Microbial Diversity in Small Ruminants.

Every year in the United States, approximately 48 million people are affected by bacterial illnesses that are transmitted through food, leading to 3000 fatalities. These illnesses typically stem from food animals and their by-products, which may harbor dangerous pathogens like Salmonella enterica, Listeria monocytogenes, enterohemorrhagic Escherichia coli O157:H7, and Campylobacter jejuni. Factors that contribute to contamination include manure used as a soil amendment, exposure to polluted irrigation water, and contact with animals. To improve food safety, researchers are studying pre-slaughter intervention methods to eliminate bacterial contamination in live animals. While small ruminants are vital to global agriculture and income generation for small farms, traditional feeding practices involve supplements and antibiotics to boost performance, which contributes to antibiotic resistance. Hence, researchers are looking for friendly bacterial strains that enhance both animal and human health without impacting livestock productivity. The global trend is to minimize the use of antibiotics as feed supplements, with many countries prohibiting or limiting their use. The aim of this review is to provide a comprehensive insight on the antioxidant capabilities, therapeutic attributes, and applications of bioactive compounds derived from sweet potato tops (SPTs), rice bran (RB) and radish tops (RTs). This overview provides an insight on plant parts that are abundant in antioxidant and prebiotic effects and could be used as value-added products in animal feed and pharmaceutical applications. This review was based on previous findings that supplementation of basal diets with natural supplements represents a multifaceted intervention that will become highly important over time. By remarkably reducing the burden of foodborne pathogens, they apply to multiple species, are cheap, do not require withdrawal periods, and can be applied at any time in food animal production.

Pilot study to evaluate the need and implementation of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care.

To evaluate the need and feasibility of a nurse-led antimicrobial stewardship (AMS) programme in two Australian residential aged care homes (RACHs) to inform a stepped-wedged, cluster randomized controlled trial (SW-cRCT). A mixed-methods pilot study of a nurse-led AMS programme was performed in two RACHs in Victoria, Australia (July-December 2019). The AMS programme comprised education, infection assessment and management guidelines, and documentation to support appropriate antimicrobial use in urinary, lower respiratory and skin/soft tissue infections. The programme was implemented over three phases: (i) pre-implementation education and integration (1 month); (ii) implementation of the intervention (3 months); and (iii) post-intervention evaluation (1 month). Baseline RACH and resident data and weekly infection and antimicrobial usage were collected and analysed descriptively to evaluate the need for AMS strategies. Feedback on intervention resources and implementation barriers were identified from semi-structured interviews, an online staff questionnaire and researcher field notes. Six key barriers to implementation of the intervention were identified and used to refine the intervention: aged care staffing and capacity; access to education; resistance to practice change; role of staff in AMS; leadership and ownership of the intervention at the RACH and organization level; and family expectations. A total of 61 antimicrobials were prescribed for 40 residents over the 3 month intervention. Overall, 48% of antibiotics did not meet minimum criteria for appropriate initiation (respiratory: 73%; urinary: 54%; skin/soft tissue: 0%). Several barriers and opportunities to improve implementation of AMS in RACHs were identified. Findings were used to inform a revised intervention to be evaluated in a larger SW-cRCT.

Evaluation of Self-Management Behaviors and Its Correlation with the Metabolic Syndrome among the Type 2 Diabetes Mellitus Patients of Northern Saudi Arabia.

Self-management behavior among diabetes patients is essential to monitor blood sugar levels, make necessary lifestyle changes, and help patients reduce their risk of complications from diabetes. We assessed the prevalence of metabolic syndrome (MS) and its association with self-management behavior and sociodemographic characteristics among 310 patients with type 2 diabetes mellitus (T2DM) attending different diabetes care centers in northern Saudi Arabia. We evaluated the self-management behaviors of patients with T2DM using a validated Arabic version of the Summary of Diabetes Self-Care Activities Scale. Regarding MS, we applied the National Cholesterol Education Program (NCEP) Adult Treatment Plan-3 (ATP-3) guidelines. A logistic regression analysis was used to identify the predictors of MS. We found that more than one-third (36.5%) of patients had MS according to the NCEP ATP-3 criteria. The prevalence of MS was significantly associated with unsatisfactory self-management behaviors. Regarding sociodemographic predictors for MS, we found a significant association between gender (ref: female: Adjusted OR (AOR) = 1.89, 95%CI = 1.17-2.95, p = 0.007) and body mass index (ref.: normal range: AOR = 2.98, 95%CI = 1.31-5.07, p = 0.003). Our findings suggest a tailor-made multifaceted intervention to improve the self-management behaviors of T2DM patients, which, in turn, can reduce MS.

Health providers readiness in managing intimate partner violence in public health institutions, Ethiopia.

Intimate Partner Violence (IPV) is a worldwide public health problem and major human and legal rights abuses of women. It affects the physical, sexual, and psychological aspects of the victims therefore, it requires complex and multifaceted interventions. Health providers are responsible for providing essential healthcare services for IPV victims. However, there is a lack of detailed information on whether or not health providers are ready to identify and manage IPV. Therefore, this study aimed to assess health providers' readiness and associated factors in managing IPV in public health institutions at Hawassa, Ethiopia. Institutional based cross-sectional study was conducted through a simple random sample of 424 health providers. Data was collected with an anonymous questioners using physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool. Linear regression analysis was used to examine relationships among variables. The strength of association was assessed by using unstandardized β with 95% CI. The mean score of perceived provider's readiness in managing IPV was 26.18± 6.69. Higher providers age and providers perceived knowledge had positive association with provider perceived readiness in managing IPV. Whereas not had IPV training, absence of a protocol for dealing with IPV management, and provider attitude had a negative association with provider perceived readiness in managing IPV. This study reviled that health providers had limited perceived readiness to manage IPV. Provision of training for providers and develop protocol for IPV managements have an important role to improve providers readiness in the managements of IPV.

SELF-DIRECTED AGEISM OUTCOMES ASSOCIATED WITH AGEISM-REDUCTION INTERVENTIONS: A SCOPING REVIEW

Abstract Self-directed ageism refers to stereotyping, prejudice, and discrimination toward oneself based on age or perceived age. Self-directed ageism research is limited but growing as the conceptualization of ageism evolves and the implementation of ageism-reduction interventions increases. A scoping review was conducted to explore self-directed ageism outcomes associated with ageism-reduction interventions among populations measured. The PRISMA-ScR checklist guided study methods. A systematic search for relevant peer-reviewed journal articles was conducted in 2022 using eight EBSCOhost databases. Fifty-two studies were included after screening was completed on 19,309 articles. Ageism-reduction interventions that assessed self-directed ageism outcomes were primarily implemented among college students (k = 20), older adults (k = 18), and children (k = 8). Despite methodological variation among included studies, such as measured domains of self-directed ageism, measures used, duration, dosage, and specific intervention characteristics, results suggest that purposeful in person intergenerational contact across age groups and in person intergenerational contact with aging education among college students and children are commonly effective in reducing self-directed ageism. Other interventions were found to be effective for certain age groups. Results provide initial support to suggest that intergenerational contact and aging education interventions can be similarly effective at reducing self-directed ageism as they are at reducing other-directed ageism. This scoping review also highlights several gaps in the literature. Notably, a universal definition for self-directed ageism is needed, a lifespan perspective of self-directed ageism should be taken, and research is needed to identify mechanisms of change responsible for significant outcomes achieved, especially within multifaceted interventions.

The public's antibiotic use behavioural patterns and their determinants for upper respiratory tract infections: a latent class analysis based on consumer behaviour model in China.

The irrational use of antibiotics among the public is a major contributor to antimicrobial resistance (AMR), which is a serious global threat. Prior studies have demonstrated that there are different behavioural patterns regarding antibiotic use among the public, and targeted interventions for subgroups with different behavioural patterns may be more effective. Thus, this study aimed to identify the public's behavioural patterns of antibiotic use for upper respiratory tract infections (URTIs) and their influencing factors. A cross-sectional survey was conducted among the general population in Chongqing, China. Consumer decision-making (Consumer Behaviour Model, CBM) was used to assess the public's behaviours regarding antibiotic use, including need recognition, information searching, alternative evaluation, obtaining antibiotics, antibiotic consumption, and postuse evaluation. Furthermore, a latent class analysis was used to identify the underlying behavioural patterns among the public. The identified behavioural patterns of antibiotic use were further linked with individuals' capacity, opportunity, and motivation factors of antibiotic use based on a multinominal logistic regression to explore possible determinants. A total of 815 respondents were enrolled in the study. The public's irrational use of antibiotics was prevalent, including antibiotic self-medication (39.63%), nonprescription antibiotic purchasing (59.02%), and early stopping of antibiotic prescriptions (76.56%). Participants had inadequate knowledge of antibiotics (Mean = 2.33, SD = 1.71), reported high availability to antibiotics (Mean = 7.13, SD = 2.41), held strong belief in antibiotic effectiveness (Mean = 10.29, SD = 2.71), and demonstrated a high perceived threat of AMR (Mean = 12.30, SD = 3.20). Four behavioural patterns regarding antibiotic use for URTIs were identified, namely, "antibiotic self-medicators" (n = 165, 20.25%), "formal health care seekers" (n = 216, 26.50%), "various treatment users" (n = 198, 24.20%), and "self-medication without antibiotics" (n = 236, 28.96%). Individuals' self-efficacy of antibiotic use, belief in antibiotic effectiveness, awareness of antibiotic side effects, perceived antibiotic availability, social influence, and demographics (age, education, medical insurance, and having a medical background) were significantly associated with the public's different behavioural patterns of antibiotic use for URTIs. This study calls for collaborative efforts among the public, physicians, policy makers, and the implementation of precise and multifaceted interventions to effectively reduce irrational use of antibiotics in the public. Such interventions include identifying subgroups within the public to provide more targeted education about antibiotics and the management of URTIs, reinforcing the regulation of antibiotic dispensing, and improving physicians' rational antibiotic prescriptions.

Acceptability of a community-embedded intervention for improving adolescent sexual and reproductive health in south-east Nigeria: A qualitative study

Introduction Adolescents have limited access to quality sexual and reproductive health (SRH) services that are key to healthy sexual lives in many low and middle-income countries such as Nigeria. Hence, context-specific interventions are required to increase adolescents’ access to and utilisation of SRH. This paper provides new knowledge on the acceptability of a community-embedded intervention to improve access to SRH information and services for adolescents in Ebonyi state, southeast Nigeria. Methods A community-embedded intervention was implemented for six months in selected communities. Thereafter the intervention was assessed for its acceptability using a total of 30 in-depth interviews and 18 focus group discussions conducted with policymakers, health service providers, school teachers, community gatekeepers, parents and adolescents who were purposively selected as relevant stakeholders on adolescent SRH. The interview transcripts were coded in NVivo 12 using a coding framework structured according to four key constructs of the theoretical framework for acceptability (TFA): affective attitude, intervention coherence, perceived effectiveness, and self-efficacy. The outputs of the coded transcripts were analysed, and the emergent themes from each of the four constructs of the TFA were identified. Results The intervention was acceptable to the stakeholders, from the findings of its positive effects, appropriateness, and positive impact on sexual behaviour. Policymakers were happy to be included in collaborating with multiple stakeholders to co-create multi-faceted interventions relevant to their work (positive affective attitude). The stakeholders understood how the interventions work and perceived them as appropriate at individual and community levels, with adequate and non-complex tools adaptable to different levels of stakeholders (intervention coherence). The intervention promoted mutualistic relations across stakeholders and sectors, including creating multiple platforms to reach the target audience, positive change in sexual behaviour, and cross-learning among policymakers, community gatekeepers, service providers, and adolescents (intervention effectiveness), which empowered them to have the confidence to provide and access SRH information and services (self-efficacy). Conclusions Community-embedded interventions were acceptable as strong mechanisms for improving adolescents’ access to SRH in the communities. Policymakers should promote the community-embedded strategy for holistic health promotion of adolescents.