Non-medical Interventions Research Articles

COVID-19 Contact Tracing: Ghana’s Efforts in the Application of Geospatial Technology in Minimizing the Impact of the Pandemic

COVID-19 has presented unusual challenges for individuals, governments and societies across the globe. Several non-medical and non-pharmaceutical interventions have demonstrated to be critical in addressing the resultant impacts. One notable tool among these interventions is the application of technology in identifying infected persons or individuals coming into contact with those infected. Policy think-tanks have invested in geospatial technology and information systems to help resolve contact tracing inefficiencies to curtail the fast spread of the disease. This study highlights the extent of the application of geospatial technology in COVID-19 contact tracing in Ghana. Here, it was demonstrated that majority of young adults that form the greater part of Ghana’s population have access to digital devices which serve as primary catalysts in facilitating effective and efficient contact tracing. Case count of the pandemic continues to surge sharply from one month to the other since the first recorded case on March 12, 2020. A huge number of cases were recorded in the southern part of the country, as against cases recorded in the north. Mobility patterns depicted the migration of more people from regions with a high number of case count to regions with lower counts. We recommend a holistic and proactive approach to the use of smart mobile devices and applications in enhancing contact tracing. Privacy and data protection laws must be prioritized and supported by effective legislative and policy frameworks that serve as the legal basis for the management of personal information.

Hydroxypropyl Methylcellulose-Based Nasal Sprays Effectively Inhibit In Vitro SARS-CoV-2 Infection and Spread.

The ongoing coronavirus disease (COVID-19) pandemic has required a variety of non-medical interventions to limit the transmission of the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One such option is over-the-counter nasal sprays that aim to block virus entry and transmission within the nasal cavity. In this study, we assessed the ability of three hydroxypropyl methylcellulose (HPMC)-based powder nasal sprays, produced by Nasaleze, to inhibit SARS-CoV-2 infection and release in vitro. Upon application, the HPMC powder forms a gel-like matrix within the nasal cavity—a process we recapitulated in cell culture. We found that virus release from cells previously infected with SARS-CoV-2 was inhibited by the gel matrix product in a dose-dependent manner, with virus levels reduced by >99.99% over a 72 h period at a dose of 6.4 mg/3.5 cm2. We also show that the pre-treatment of cells with product inhibited SARS-CoV-2 infection, independent of the virus variant. The primary mechanism of action appears to be via the formation of a physical, passive barrier. However, the addition of wild garlic provided additional direct antiviral properties in some formulations. We conclude that HPMC-based nasal sprays may offer an additional component to strategies to limit the spread of respiratory viruses, including SARS-CoV-2.

Solving Social Problems in Aging Rural Japanese Communities: The Development and Sustainability of the Osekkai Conference as a Social Prescribing during the COVID-19 Pandemic

Social prescribing is critical during the coronavirus disease 2019 (COVID-19) pandemic. Social prescribing refers to non-medical interventions related to culture and traditions; they are increasingly being proposed to address wider determinants of health as well as help patients improve health behaviors and manage their conditions effectively. Traditional and cultural behaviors in the community can be utilized for effective social prescribing. Due to the pandemic, social participation opportunities have decreased, resulting in the absence of Osekkai, a traditional Japanese behavior. A driver of Osekkai is the Osekkai conference; it is the model through which Osekkai is implemented in communities to bring resources and individuals together to address community needs. This research aims to clarify the Osekkai conference’s development process and how it can solve social problems, thereby leading to the creation of sustainable communities. We conducted semi-structured interviews with Osekkai conferences’ participants and organizers during the COVID-19 pandemic. We used thematic analysis to achieve the research aims. A total of 12 participants were interviewed. Five themes were developed from the thematic analysis: driver of the Osekkai conference’s development, trajectory of continuity, chain of Osekkai, changes in communities and participants, and sustainability of the conferences. This study showed how reviving traditional behaviors helps face initial difficulties. It described these increasing traditional behaviors in terms of social prescribing that changes the community’s and citizens’ social capital. Reviving traditional behaviors created new challenges and solutions during the pandemic.

Resistance exercise improves learning and memory and modulates hippocampal metabolomic profile in aged rats

Physical activity has been considered an important non-medication intervention to preserve mnemonic processes during aging. However, how resistance exercise promotes such benefits remains unclear. A possible hypothesis is that brain-metabolic changes of regions responsible for memory consolidation is affected by muscular training. Therefore, we analyzed the memory, axiety and the metabolomic of aged male Wistar rats (19–20 months old in the 1st day of experiment) submitted to a 12-week resistance exercise protocol (EX, n = 11) or which remained without physical exercise (CTL, n = 13). Barnes maze, elevated plus maze and inhibitory avoidance tests were used to assess the animals’ behaviour. The metabolomic profile was identified by nuclear magnetic resonance spectrometry. EX group had better performance in the tests of learning and spatial memory in Barnes maze, and an increase of short and long-term aversive memories formation in inhibitory avoidance. In addition, the exercised animals showed a greater amount of metabolites, such as 4-aminobutyrate, acetate, butyrate, choline, fumarate, glycerol, glycine, histidine, hypoxanthine, isoleucine, leucine, lysine, niacinamide, phenylalanine, succinate, tyrosine, valine and a reduction of ascorbate and aspartate compared to the control animals. These data indicate that the improvement in learning and memory of aged rats submitted to resistance exercise program is associated by changes in the hippocampal metabolomic profile.

Dysregulated Inflammation During Obesity: Driving Disease Severity in Influenza Virus and SARS-CoV-2 Infections.

Acute inflammation is a critical host defense response during viral infection. When dysregulated, inflammation drives immunopathology and tissue damage. Excessive, damaging inflammation is a hallmark of both pandemic influenza A virus (IAV) infections and Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infections. Chronic, low-grade inflammation is also a feature of obesity. In recent years, obesity has been recognized as a growing pandemic with significant mortality and associated costs. Obesity is also an independent risk factor for increased disease severity and death during both IAV and SARS-CoV-2 infection. This review focuses on the effect of obesity on the inflammatory response in the context of viral respiratory infections and how this leads to increased viral pathology. Here, we will review the fundamentals of inflammation, how it is initiated in IAV and SARS-CoV-2 infection and its link to disease severity. We will examine how obesity drives chronic inflammation and trained immunity and how these impact the immune response to IAV and SARS-CoV-2. Finally, we review both medical and non-medical interventions for obesity, how they impact on the inflammatory response and how they could be used to prevent disease severity in obese patients. As projections of global obesity numbers show no sign of slowing down, future pandemic preparedness will require us to consider the metabolic health of the population. Furthermore, if weight-loss alone is insufficient to reduce the risk of increased respiratory virus-related mortality, closer attention must be paid to a patient’s history of health, and new therapeutic options identified.

6.I. Workshop: Social Prescribing: what has been learned in developing evidence, what challenges and solutions?

Abstract Social prescribing is seen as a mechanism for addressing the social determinants of health, preventing exacerbation of pre-existing diseases, reducing attendance in primary and emergency care and improving general population health and well-being. Social prescribing involves individuals being referred/self-referring to non-medical interventions run by a third-party organisation. Social prescribing has received widespread attention internationally; however, the evidence base to support social prescribing lacks rigour, and gaps remain. The complexity of social prescribing, in that it involves multiple referral routes, partners, pathways and outcomes, poses challenges for its evaluation and research. Researchers across Europe have developed different projects of research to address the challenges associated with evaluating social prescribing. Development of the evidence base for social prescribing is crucial in informing policy and public health systems to deliver effective interventions that contribute to individual, community and systemic outcomes. This workshop aims to share different approaches that have been taken across Europe to address issues in producing evidence base and share learning about the challenges and solutions that researchers have developed, specifically regarding research about implementation and evaluation of social prescribing. The workshop will be structured in a first part of presentations and the second part of open discussion with presenters and the audience. This workshop will present five papers which will address two key questions: 1. What have we learned about developing the evidence in social prescribing?; 2. What challenges have we experienced, and what solutions have we come up with? The short presentations will cover examples of social prescribing initiatives based on implementation and evaluation studies conducted in diverse European countries. Learning shared with the audience through the presentations will stimulate discussions around challenges with implementing and evaluating social prescribing. This workshop will inform the development of an overarching guidance on implementing social prescribing interventions, as well as identify parallel challenges in other areas of public health. Key messages Interactive session to discuss strategies for successful social prescribing projects addressing complex health issues that are relevant to stakeholders and for research to inform practice and policy. Collaboration with interdisciplinary stakeholders is crucial in developing the evidence base for social prescribing.

Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth

There is increasing recognition of the importance of addressing both medical care practices and interventions, as well as nonmedical factors and interventions for the mother–infant dyad in neonatal intensive care. This update addresses the evidence for medical and nonmedical practices affecting the outcomes of infants born preterm who require intensive care.

Non-medical Interventions to Reduce the Burden of Psychosocial and Economic Impacts of COVID-19 Pandemic: A Scope Review

Context: COVID-19, like the other pandemics, apart from its impacts on peoples' health, has had diverse huge impacts on psycho-socio-economic aspects of societies globally. Hence, applying appropriate interventions to reduce the indirect burden of this pandemic is as important as patients’ care. Objectives: In this study, we aimed to review the main interventions against the economic and psychosocial impacts of the COVID-19 pandemic. Method: This scope review was conducted to determine what measures have been taken by governments against different non-medical (economic and psychosocial) consequences of the COVID-19 pandemic. The authors reviewed the relevant articles published from December 2019 to December 2020 through three databases of PubMed/MEDLINE, Scopus, and Google Scholar. The interventions in three areas of economic, social, or psychological were exerted, and in the review of the articles, the country and the target population were considered. Finally, the results were categorized and presented descriptively. Results: Regarding the negative consequences of the COVID-19 pandemic in psychosocial and economic aspects of societies, governments, especially in developed countries, have established measures to reduce the burdens of these consequences. Apart from interventions related to the general population, at-risk and vulnerable groups and also those with low socio-economic status are specific target populations for interventions. Conclusions: The future of the COVID-19 pandemic is uncertain and unpredictable. Governments and their decisions will play a vital role in determining the trend of the pandemic. Therefore, it is the responsibility of governments, especially in lower-middle-income countries (LMICs), to support vulnerable people and protect them against the devastating socio-economic and psychological effects of this pandemic using all their capacity.

Cognitive Behavior Therapy Targeting Intolerance of Uncertainty Versus Selective Serotonin Reuptake Inhibitor for Generalized Anxiety Disorder: A Randomized Clinical Trial

AbstractGiven the high prevalence and adverse outcomes associated with generalized anxiety disorder (GAD), development and expansion of effective treatment modalities are important. The present study compared the effectiveness of cognitive behavior therapy targeting intolerance of uncertainty (CBT-IU) and selective serotonin reuptake inhibitors (SSRIs) for treating GAD. A total of 30 Iranian patients with GAD (Mage = 25.16 ± 6.73) were randomised to receive either CBT-IU (n = 15) or SSRI (n = 15). Measures included the Structured Clinical Interview for DSM-5 (SCID-5), Penn State Worry Questionnaire (PSWQ), Why Worry-II (WW-II), Intolerance of Uncertainty Scale (IUS), and Negative Problem Orientation Questionnaire (NPOQ). Repeated measures analysis of variance tested differential treatment outcomes. The results of intention-to-treat (ITT) analysis indicated that although both CBT-IU and SSRI were effective treatments for GAD, CBT-IU produced significantly better results than SSRI at post-treatment. This clinical trial provides preliminary cross-cultural support for the treatment of GAD using CBT-IU, with findings suggesting that this non-medication intervention reduces GAD symptoms.

SARS-CoV-2: Origin, Intermediate Host and Allergenicity Features and Hypotheses.

The goal of this study is to investigate the probable intermediate hosts and the allergenicity of the notorious virus SARS-CoV-2 to understand how this virus emerged. The phylogenetic analysis of the virus spike proteins indicates that SARS-CoV-2 falls into various small subclades that include a bat coronavirus RaTG13, suggesting bats as a likely natural origin. Refined alignment of the spike protein in NCBI found several fragments that are specific to SARS-CoV-2 and/or SARS-CoV are specific to Rattus norvegicus and/or Mus musculus, suggesting that rodents are the intermediate reservoir of SARS-CoV-2 and SARS-CoV. To evaluate the allergenicity values, the binding affinities of human leukocyte antigen (HLA) class I or II molecules with the spike proteins were calculated, and the results showed that both SARS-CoV-2 and SARS-CoV are predicted to bind to fourteen HLA class I and II molecules with super-high HLA allele-peptide affinities. The infection rate of individuals who have HLA alleles with very high binding affinities who might become infected and develop into refractory patients if there were no medical or non-medical interventions is about 7.36% and 4.78% of Chinese and Americans, respectively. Extremely high temperature and exceptionally low precipitation, the common climate factors between the outbreak sites of COVID-19 in Wuhan in 2019 and SARS in Guangdong in 2002, might have promoted coronavirus evolution into more virulent forms. Our hypothesis suggests that early immunization with an allergenically-engineered virus, in combination with continued surveillance of meteorological factors and viral mutations, may be one of the most powerful prophylactic modalities to fight this virus.

Empowering the crowd: feasible strategies for epidemic management in high-density informal settlements. The case of COVID-19 in Northwest Syria

More than 1 billion people live in informal settlements worldwide, where precarious living conditions pose unique challenges to managing a COVID-19 outbreak. Taking Northwest Syria as a case study, we...

Illness Experiences of Chilean Women With Sjögren's Syndrome: The Patient Perspective.

Sjögren's syndrome (SS) challenges everyday functioning and well-being. The aim of this study was to structure and summarize the life experiences of Chilean women with SS in an integrated model. Interviews from a previous study yielded 75 experiences of living with SS. A sample of 30 women with SS sorted these experiences by content and rated their level of agreement with each experience. A hierarchical cluster analysis was used to structure the experiences of the participants with SS in a comprehensive overview. A team-based consensus analysis was used to define the number of clusters. The level of agreement was examined with Wilcoxon's signed rank test. Ten clusters were identified and grouped into 6 main categories: symptoms (clusters: mucosal dryness and related symptoms), social environment, emotion management (clusters: fears and sadness), information (clusters: uncertainty and lack of knowledge), coping strategy (clusters: resilience and self-care), and health staff relationship. The clusters that describe the more common experiences among patients were resilience, self-care, uncertainty, lack of knowledge, health staff relationship, and mucosal dryness. This study provided an integrated and structured overview of disease experiences comprising both biomedical and psychosocial aspects as being of vital importance for the health of patients with SS. The overview can be used to get a quick impression of disease experiences that are important for an individual patient, in a therapeutic goal setting, and in the construction and evaluation of medical and nonmedical interventions or education.

Taxonomy of effective strategies to reduce unnecessary caesareans: a systematic review.

The increasing trend in unnecessary caesarean sections has caused maternal and neonatal health concerns worldwide. Various medical and non-medical interventions have been designed and implemented to reduce caesarian section overuse. However, their efficacy is questionable. This study aimed to identify and classify effective interventions to reduce unnecessary caesarian sections. We searched EMBASE, MEDLINE, Web of Knowledge and Scopus databases for articles, using appropriate search strategies, up to 2 June 2020. Overall, 7951 identified articles were screened and assessed using a valid quality assessment checklist. Finally, 109 eligible studies were included in this review. Thematic content analysis was used to identify and classify the effective interventions. Overall, 188 effective caesarian section reduction measures were identified. They were categorized into 45 actions, 16 intervention groups and 6 WHO building blocks, including "governance and leadership", "financing", "health workforce", "medical products and technologies", "information" and "service delivery". Using qualified and competent staff, intra-partum services, and oversight were the most commonly applied interventions to reduce unnecessary caesarian sections. A taxonomy of effective strategies to reduce unnecessary caesarian sections was developed in this study. A holistic approach is crucial to addressing the new epidemic of unnecessary caesarian section. Multiple interventions based on the underlying causes of caesarian section overuse should be designed and implemented at local and global levels.

Timing of procedural interventions in childhood renovascular hypertension.

Renovascular hypertension (RVHTN) is a rare, often complex condition due to multiple etiologies including congenital stenoses, vasculitides, and fibromuscular dysplasia. Among children with RVHTN who require multiple and escalating medications to control blood pressure, the optimal timing of a procedural intervention involves a balance of numerous factors. In this presentation of a 1-month-old girl with RVHTN, the treating medical team had to consider multiple factors in the initial management and timing of interventions to treat her underlying cause of RVHTN, including concerns for kidney health, degree of hypertension, age and size of the patient, and potential methods of procedural intervention. Initially, she was treated conservatively until concern for poor renal growth arose and a durable surgical intervention was thought feasible and safe. The evidence regarding the timing of non-medical interventions in pediatric RVHTN is limited. Considerations should include patient age, size, disease severity, comorbid conditions, and degree of medical management required to maintain safe blood pressures that allow for growth and reverse cardiac damage. The optimal interventions have not been evaluated by controlled trials and should be decided on a case-by-case basis with consideration of center expertise and family preferences.

Intra-city variability of fine particulate matter during COVID-19 lockdown: A case study from Park City, Utah

Urban air quality is a growing concern due a range of social, economic, and health impacts. Since the SARS-CoV-19 pandemic began in 2020, governments have produced a range of non-medical interventions (NMIs) (e.g. lockdowns, stay-at-home orders, mask mandates) to prevent the spread of COVID-19. A co-benefit of NMI implementation has been the measurable improvement in air quality in cities around the world. Using the lockdown policy of the COVID-19 pandemic as a natural experiment, we traced the changing emissions patterns produced under the pandemic in a mid-sized, high-altitude city to isolate the effects of human behavior on air pollution. We tracked air pollution over time periods reflecting the Pre-Lockdown, Lockdown, and Reopening stages, using high quality, research grade sensors in both commercial and residential areas to better understand how each setting may be uniquely impacted by pollution downturn events. Based on this approach, we found the commercial area of the city showed a greater decrease in air pollution than residential areas during the lockdown period, while both areas experienced a similar rebound post lockdown. The easing period following the lockdown did not lead to an immediate rebound in human activity and the air pollution increase associated with reopening, took place nearly two months after the lockdown period ended. We hypothesize that differences in heating needs, travel demands, and commercial activity, are responsible for the corresponding observed changes in the spatial distribution of pollutants over the study period. This research has implications for climate policy, low-carbon energy transitions, and may even impact local policy due to changing patterns in human exposure that could lead to important public health outcomes, if left unaddressed.

Clinical audit of prescribing for attention deficit hyperactivity disorder (ADHD) in children and young people services (CYPS)

BackgroundThe audit aimed to assess, when 3rd and 4th line medications were prescribed for ADHD, if practice was compliant with Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) prescribing guidelines and the updated NICE Guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management 2018.MethodThe audit was conducted in the four Teesside Child & Adolescent community teams during April/May 2018. Each team identified all patients prescribed 3rd and 4th line ADHD medications leading to 30 responses (n = 30).Information was collected from electronic and paper medical records using a designated audit tool compiled from the above evidence based guidelines. The data were analysed for compliance against standards using an excel spreadsheet and reviewed by the audit lead.ResultThere were many areas of good practice demonstrated in the audit including diagnostic recording, pre-treatment non-medical interventions where ADHD was not severe, and use of Methylphenidate as first line medication in accordance with BNF limits. In the majority of records reviewed, there was good evidence of a variety of NICE recommended non-medication interventions which were often continued post medication initiation.There was also very good evidence of comprehensive verbal and written information and psychoeducation including benefits and potential side effects of medication (92% verbal and 58% written).A pre-treatment assessment was completed in all but 3 cases, 1 of which had no assessment documented and 2 cases were transferred from out of area.Issues identified by the audit, where there was deviation from guidelines, included 4 cases where Methylphenidate was not prescribed as first line, of these, 3 were prescribed Atomoxetine due to parental choice and one was due to contraindications, suggesting patient choice was an important factor in selection of 2nd line medication.The audit demonstrates that clinical practice had moved away from the previous guidance in NICE CG72 (to prescribe atomoxetine 2nd line) towards the prescription of Lisdexamfetamine 2nd line (75%) as reflected in the new NICE guidelines: NG87, 2018 (updated 2019).ConclusionThis audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced good practice in areas such as pre-assessment, information and psychological education, initial use of Methylphenidate, use of Lisdexamfetamine 2nd line, as well as consideration of patient choice. Importantly the audit highlighted that implementation of updated NICE compliant trust guidance, followed by a planned trust-wide audit will promote continuous improvement in patient care.

Role of police in preventing the spread of COVID-19 through social distancing, quarantine and lockdown: An evidence-based comparison of outcomes across two districts

The COVID-19 pandemic is a formidable challenge to societies and governments across the world. The non-medical interventions of social distancing, quarantine and lockdown have been adopted to prevent transmission of the disease by contact. In some countries, police have been used to enforce public health laws. This research analyses data from two districts in the State of Kerala, India to examine whether police efforts had any impact on the outcome of reducing transmission of the disease by contact. Analysing the different methods used by the police across the two districts, this study concludes that police efforts at non-medical interventions reduce the spread of the disease. The study also concludes that, in contrast to mere enforcement of public health laws and regulations, the strategic use of resources is an important factor in achieving better outcomes.

Could social prescribing contribute to type 2 diabetes prevention in people at high risk? Protocol for a realist, multilevel, mixed methods review and evaluation

IntroductionSocial prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type...

Interventions to Improve Post-Detoxification Treatment Engagement and Alcohol Recovery: Systematic Review of Intervention Types and Effectiveness

Most inpatient alcohol detoxification patients do not seek treatment post-discharge, which increases the risk of relapse and re-hospitalization. To date, there have been no efforts to synthesize the evidence supporting the broad range of available interventions for this critical transition. The current study is a systematic review and evaluation of interventions designed to promote treatment engagement and recovery following alcohol detoxification. The initial literature search yielded 6419 articles, published since 1999, from PubMed, CINAHL, PsycINFO, Psychology & Behavioral Sciences Collection and PsycARTICLES databases, 49 of which were eligible for full review. Data extraction included in-depth evaluation of intervention types, study and research design features, reported outcomes and study quality/bias indicators. All articles were coded by independent raters and final results were obtained through consensus. Interventions included medical/medication, psychological/psychosocial, technological, mutual-help and combined approaches. On average, medical/medication interventions were less, and psychological/psychosocial and technological interventions were more likely to demonstrate efficacy with respect to treatment engagement and recovery. There was significant variability in study quality/bias but no significant differences across intervention types. Studies differed considerably across measured outcomes, internal and external validity, in/exclusion criteria and documentation of co-occurring psychiatric disorders. Over half of studies reviewed reported empirical support for the intervention(s) evaluated. Although findings slightly favor non-medical interventions, the variability in study design and quality/bias requires more rigorous follow-up research. Recommendations from this review may guide future implementation and intervention development, which are critically needed to improve post-detoxification care and outcomes for patients with alcohol use disorder.

Aspecte juridice privind sănătatea publică în contextul istoric al marilor epidemii

"Although the concept of public health is a modern one and the scientific understanding of infectious diseases and their transmissibility is less than 200 years old, even ancient and medieval societies reacted in an organized manner to the great epidemics and the threat they posed to public order and their very existence. In spite of the fact that the sources of contagious diseases were often vaguely or wrongly understood, some of the measures that these older societies began to take (the quarantine, cordon sanitaire, isolating the sick, disinfecting objects) proved effective and have been continuously perfected along the centuries. This study will attempt to discuss, using the historical method, some of the most important normative non-medical interventions in the history of epidemics that have survived to this day. Due to the legal nature of this study, we will not discuss the medical aspects of public health during pandemics, like vaccination, treatment, diagnosis or medical care. The focus of this study will be decisively European, although some passing references will be made to North America."