Participant Recruitment Research Articles

Functional Outcome after Clinical Recovery from Moderate to Critical COVID-19 among Patients Admitted to the Philippine General Hospital: A Prospective Cohort Study

Background and Objective. COVID-19 is a novel disease primarily affecting the respiratory system. Of those infected, approximately 20% require management in a hospital-setting which may lead to deconditioning. Measures implemented to control spread of the virus also restricted mobility both in the hospital and community setting. The goal of this study was to describe the patient characteristics (age, sex, comorbidities), hospitalization (length of hospital stay, ICU stay, referral to Rehabilitation Medicine), and long-term functional outcome of patients who have clinically recovered from moderate to critical COVID-19 in terms of participation in activities of daily living. Methods. This was a descriptive prospective cohort study conducted at a tertiary government hospital with participant recruitment from September 2020 to February 2021 consisting of clinically recovered adult patients managed as COVID-19 Confirmed via rRT-PCR with moderate, severe, or critical risk status. Descriptive statistics were obtained and multiple regression analysis was done to determine associations between patient demographics and their Barthel Index Scores on follow-up at discharge, one month post-discharge, and six months post-discharge. Results. A total of 63 patients were recruited to our study with an average age of 52.4 years. More recovered patients had fulfilled the criteria of moderate illness (46%), with the most common comorbidity being chronic lung disease (42.1%) and diabetes (42.1%). Almost all had total independence pre-morbidly with better baseline functional scores for the COVID-19 severe population. Majority of the patients (63.5%) were not referred for Rehabilitation services. Across all patients, Barthel Index Score at discharge indicated a significant decline from slight dependence to moderate dependence in performing activities of daily living with the pre-morbid status significantly predicting scores at discharge (β = 0.621, p = 0.001) on multiple regression analysis. Patient demographics, hospitalization and ICU stay and outcome, and referral to Rehabilitation Medicine were not found to be significant factors. In the course of follow up, a high dropout rate was observed across the population and by the end of the study, 57.1% of the participants were alive while among those lost to follow up, 20.6% had expired and the remaining 22.2% had an unknown status. Conclusion. COVID-19 significantly affects the functional outcome of patients in terms of activities of daily living as measured by the Barthel Index. Preliminary data gathered from our study and the high dropout rate supports the need for better follow-up and selecting a tool that is better able to describe the non-demographic factors affecting functionality and participation in activities of daily living.

"There's no us vs. them, it's just us": a creative approach to centring lived experience within the AVATAR2 trial.

This article describes a Patient and Public Involvement (PPI) led creative workshop space held within a clinical trial of a talking therapy for distressing voices (AVATAR2). PPI adds significant value to clinical research and ensures the work is meaningful to patients and their supporters. However, known issues include tokenism, a common power imbalance between PPI colleagues and researchers and a lack of opportunity for PPI to shape the research. PPI has played a key role at all stages of the AVATAR2 trial, including design, recruitment of staff and participants, data collection, analysis, and dissemination. An active and creative group of people was established, with over 30 members flexibly involved across all four sites. PPI group members were from diverse backgrounds, with lived experience of mental health conditions and recovery, and including carers. During this work, PPI colleagues identified that they would value a creative space which would help to promote the study but extend beyond an exclusive focus on trial deliverables. A regular creative workshop was established to support PPI colleagues in their creative work, including material such as poetry, blogs, art and podcasts. PPI colleagues and trial staff have cowritten a reflective piece to share their experiences on the impact of the creative workshops, organised into four themes. We found the workshops to be a powerful tool for forging relationships among trial staff and PPI colleagues, while also fostering personal development. We reflected on how the workshops built up the confidence of attendees and supported demanding trial activities such as public speaking. Finally, we discussed the impact of the workshops on wider trial culture, by upholding the values of the team and challenging the status quo.

Feasibility of recruiting young adults with low socioeconomic status for formative evaluation of a smoking cessation mobile intervention.

Participant recruitment is critical to the success of smoking cessation trials. However, recruitment feasibility studies for inclusion and exclusion criteria commonly used in smoking cessation research remain scarce. We assessed the feasibility of recruiting potential research volunteers (PRVs) under two sets of inclusion criteria to inform eligibility requirements for a smoking cessation mobile intervention trial. We invited PRVs nationwide to participate in qualitative evaluation of a smoking cessation mobile application. To be eligible under Criteria I, participants were aged 18-29 years, neither four-year college graduates nor enrollees, exclusive cigarette smokers, willing to quit within 30 days, and not using cessation aids. Criteria II expanded eligibility to those using cigarettes and non-combustible tobacco products (e.g. e-cigarettes) and willing to quit within 6 months. We calculated recruitment yields and associated costs. Of 10533 PRVs screened for eligibility, 48 were enrolled. Only 54 (0.5%) participants qualified under Criteria I and 164 (1.6%) under Criteria II. Age ineligibility was the top reason for exclusion (66.7%), whereas lifetime smoking, quit timeframe, and other tobacco product use contributed to ineligibility rates ranging from 46.5% to 65.3%. Enrolled participants were equally split by sex and roughly reflected the racial/ethnic composition of the United States. American Indians, who have the highest smoking prevalence, were <5% of enrolled participants. Recruitment costs averaged $106 per PRV. Eligibility requirements used in cessation trials were restrictive for recruitment efforts. Relaxing inclusion criteria will reflect current tobacco use patterns and facilitate the timely completion of trials within budgetary thresholds.

The ADNI Administrative Core: Ensuring ADNI's success and informing future AD clinical trials.

The Alzheimer's Disease Neuroimaging Initiative (ADNI) Administrative Core oversees and coordinates all ADNI activities, to ensure the success and maximize the impact of ADNI in advancing Alzheimer's disease (AD) research and clinical trials. It manages finances and develops policies for data sharing, publications using ADNI data, and access to ADNI biospecimens. The Core develops and executes pilot projects to guide future ADNI activities and identifies key innovative methods for inclusion in ADNI. For ADNI4, the Administrative Core collaborates with the Engagement, Clinical, and Biomarker Cores to develop and evaluate novel, digital methods and infrastructure for participant recruitment, screening, and assessment of participants. The goal of these efforts is to enroll 500 participants, including>50% from underrepresented populations, 40% with mild cognitive impairment, and 80% with elevated AD biomarkers. This new approach also provides a unique opportunity to validate novel methods. HIGHLIGHTS: The Alzheimer's Disease Neuroimaging Initiative (ADNI) Administrative Core oversees and coordinates all ADNI activities. The overall goal is to ensure ADNI's success and help design future Alzheimer's disease (AD) clinical trials. A key innovation is data sharing without embargo to maximize scientific impact. For ADNI4, novel, digital methods for recruitment and assessment were developed. New methods are designed to improve the participation of underrepresented populations.

Residential medication management reviews: a call for improved collaboration and systems integration in aged care

Purpose Residential Medication Management Reviews (RMMR) are a key component of safe, high-quality aged care service delivery. The RMMR is an interdisciplinary approach to medication management that relies on collaboration, communication and integration of systems. Acting as an improvement opportunity, the purpose of this paper is to present findings from a regional study, aimed at assessing the impact of RMMR on falls and hospital admissions and identifies barriers to impactful research in this area. Design/methodology/approach A three-year retrospective quantitative longitudinal practice audit was conducted in a regional state-managed high-care residential facility in Queensland, Australia. Data was collected pre-RMMR and six months post-RMMR. Findings The data collected was insufficient to achieve statistical significance or demonstrate the impact of RMMR on health outcomes. Factors impeding the research included limited ability to collect the data due to the lack of integration of information systems and limited stakeholder engagement resulting in poor recruitment. This highlights the need for improvement in RMMR processes and practices, and indeed wider research collaboration in the aged care sector. Research limitations/implications Thís paper acts as a call to action to improve research and interprofessional collaboration in Australian aged care. Originality/value The aged care industry needs high-quality research to drive practice improvement and collaborative care and service delivery. This paper advocates for improvements in the aged care sector with respect to research engagement and communication pathways between service providers. Advancement in systems integration for information sharing, recruitment of participants and stakeholder engagement will support evidence-based practice and process change.

Perinatal Care Provider Perspectives on Integrating Clinical Research Into the Clinical Infrastructure.

This study explored perinatal health care providers' perspectives on the recruitment of pregnant participants and integrating clinical research into their practice, with a particular emphasis on the complexities introduced by the COVID-19 pandemic. From May to September 2021, semistructured interviews were conducted with 10 perinatal health care providers from an urban US health center. The interview transcripts were analyzed using Braun and Clarke's thematic analysis framework, a rigorous method for analyzing qualitative data by identifying, coding, and reporting themes. This approach allowed us to systematically code the data and identify key themes related to recruitment strategies and integration of clinical trials during prenatal care. Barriers to integrating clinical trials into the perinatal infrastructure included pandemic-related restrictions, heavy workloads, time constraints, ineffective communication and coordination, and maintaining the relevance of the research among providers. Facilitators included the use of communication tools, collaboration with multidisciplinary teams and stakeholders, creation of detailed study information for clinic staff, and fostering commitment to supporting research among providers. The perspectives of perinatal health care providers uncover barriers and facilitators regarding the recruitment of pregnant individuals for clinical trials and shed light on the unprecedented challenges of research in this population during the COVID-19 pandemic and lessons learned postpandemic. This information can support the development of evidence-based solutions and strategies to improve the recruitment of pregnant individuals, as well as enhance clinical research integration into infrastructure in perinatal health clinics.

Using a Device-Free Wi-Fi Sensing System to Assess Daily Activities and Mobility in Low-Income Older Adults: Protocol for a Feasibility Study.

Older adults belonging to racial or ethnic minorities with low socioeconomic status are at an elevated risk of developing dementia, but resources for assessing functional decline and detecting cognitive impairment are limited. Cognitive impairment affects the ability to perform daily activities and mobility behaviors. Traditional assessment methods have drawbacks, so smart home technologies (SmHT) have emerged to offer objective, high-frequency, and remote monitoring. However, these technologies usually rely on motion sensors that cannot identify specific activity types. This group often lacks access to these technologies due to limited resources and technology experience. There is a need to develop new sensing technology that is discreet, affordable, and requires minimal user engagement to characterize and quantify various in-home activities. Furthermore, it is essential to explore the feasibility of developing machine learning (ML) algorithms for SmHT through collaborations between clinical researchers and engineers and involving minority, low-income older adults for novel sensor development. This study aims to examine the feasibility of developing a novel channel state information-based device-free, low-cost Wi-Fi sensing system, and associated ML algorithms for localizing and recognizing different patterns of in-home activities and mobility in residents of low-income senior housing with and without mild cognitive impairment. This feasibility study was conducted in collaboration with a wellness care group, which serves the healthy aging needs of low-income housing residents. Prior to this feasibility study, we conducted a pilot study to collect channel state information data from several activity scenarios (eg, sitting, walking, and preparing meals) using the proposed Wi-Fi sensing system continuously over a week in apartments of low-income housing residents. These activities were videotaped to generate ground truth annotations to test the accuracy of the ML algorithms derived from the proposed system. Using qualitative individual interviews, we explored the acceptability of the Wi-Fi sensing system and implementation barriers in the low-income housing setting. We use the same study protocol for the proposed feasibility study. The Wi-Fi sensing system deployment began in November 2022, with participant recruitment starting in July 2023. Preliminary results will be available in the summer of 2025. Preliminary results are focused on the feasibility of developing ML models for Wi-Fi sensing-based activity and mobility assessment, community-based recruitment and data collection, ground truth, and older adults' Wi-Fi sensing technology acceptance. This feasibility study can make a contribution to SmHT science and ML capabilities for early detection of cognitive decline among socially vulnerable older adults. Currently, sensing devices are not readily available to this population due to cost and information barriers. Our sensing device has the potential to identify individuals at risk for cognitive decline by assessing their level of physical function by tracking their in-home activities and mobility behaviors, at a low cost. DERR1-10.2196/53447.

Understanding faculty perspectives on health equity curriculum implementation in graduate medical education: a qualitative study.

Despite increased awareness of persistent healthcare disparities, integrating health equity education into medical residency curricula needs urgent expansion. The Accreditation Council for Graduate Medical Education (ACGME) mandates addressing healthcare disparities and social determinants of health, but implementation remains insufficient due to pervasive barriers. To explore residency faculty perspectives at one institution surrounding implementing a health equity curriculum within their programs. Between November 2022 and April 2023, qualitative interviews and focus groups were conducted with residency faculty participants (n = 13) from a large academic medical institution. Participants were recruited via an internal email list directory of program directors. Semi-structured sessions explored faculty perspectives on health equity curriculum implementation. Data analysis utilized template analysis and thematic coding. Faculty perceived barriers included limited time for teaching health equity, challenges in prioritizing health equity content within the curriculum, lack of formal training and expertise, discomfort in leading discussions, and institutional barriers such as resource allocation and lack of buy-in. Findings underscored the need for institutionally supported faculty development and protected learning time for health equity education. Despite participant recruitment and representation limitations, the study provides valuable insights for addressing curricular challenges. This study highlights critical areas for improving health equity curriculum implementation in graduate medical education. Addressing these faculty barriers can enhance resident competency in identifying and addressing healthcare disparities. The study received approval from the Thomas Jefferson Institutional Review Board (IRB #22E.762).

EPID-24. OPTIMIZING PATIENT RECRUITMENT FOR BRAIN TUMOR STUDIES: LEVERAGING THE POWER OF GOOGLE ADS TO CONNECT WITH AFFECTED FAMILIES

Abstract OBJECTIVE We assessed the effectiveness of using Google Ads to recruit individuals with familial glioma into a genetic research study. METHODS We conducted a comparative analysis between two periods: March 1 to June 30, 2023 (with Google Ads) and March 1 to June 30, 2021 (without Google Ads). We targeted individuals searching for brain tumor information using Google Ads, directing them to a study landing page. We analyzed metrics such as advertisement clicks, impressions, click-through rate, and cost per click. Our eligibility criteria included families with at least two members having glioma, with one currently living with the condition, aged 18 or older, and residing in the United States. RESULTS The 2023 Google Ads campaign generated 7,228 clicks, 82,242 impressions, an 8.79% click-through rate, and a cost per click of $0.62. The number of interested individuals increased from 13 in 2021 (without Google Ads) to 35 in 2023 (with Google Ads), with 20 indicating they found the study through Google Ads. However, the increase lacked statistical significance (x2=1.48, p=0.22). CONCLUSION Google Ads enhanced our participant outreach and recruitment for the glioma study, although the results were not statistically significant. This approach shows promise for recruiting participants for rare disease research. We recommend that future studies consider longer durations and larger sample sizes to better assess its impact. Additionally, due to the prevalence of misinformation about familial glioma, we submitted and conducted a survey to the Society of NeuroOncology to evaluate the attitudes and beliefs of physicians and other healthcare professionals towards familial glioma. This survey aims to address misconceptions and improve understanding within the healthcare community.

Lack of pragmatic attitude of self-labelled pragmatic trials on manual therapy: a methodological review.

Pragmatic randomized controlled trials are getting more interest to improve trials' external validity. This study aimed to assess how pragmatic the design of the self-labelled pragmatic randomised controlled trials in the manual therapy field is. We searched MEDLINE and the Cochrane Central Register of Controlled Trials for self-labelled pragmatic randomised controlled trials in the manual therapy field until January 2024 were included. Two independent reviewers collected and extracted data related to the intention of the trial, the rationale for the intervention, and specific features of the trial and performed an assessment using the PRECIS-2 tool. Of 39 self-labelled pragmatic trials, the mean PRECIS-2 score was 3.5 (SD: 0.6). Choice of outcome measures, how the interventions were performed, the follow-up of the participants and how all the available data were included in the statistical analysis were the domains rated as most 'pragmatic'. Participants' eligibility, recruitment, and setting obtained lower scores. Less than 25% of the trials claimed that the aim was to investigate an intervention under real-world conditions and to make clinical decisions about its effectiveness. In the 21% of the sample the authors described neither the proof-of-concept of the intervention nor the state of previous studies addressing related research questions. Self-labelled pragmatic randomised controlled trials showed a moderately pragmatic attitude. Beyond the label 'pragmatic', the description of the intention of the trial and the context of every PRECIS-2 domain is crucial to understanding the real pragmatism of a trial.

Public Participation GIS for Healthy Urban Planning

This scoping review investigates the utilization of public participatory geographic information system (PPGIS) methods in the context of healthy urban planning. A set of scientific publications (n = 38) applying PPGIS in urban settings has been extracted to map the addressed health topics, the characteristics of science–practice cooperation, and participation bias. Findings show that predominantly spatially well-representable features are subject to PPGIS surveys, while cluster analysis reveals specific patterns in health topic combinations. PPGIS results add value for officials performing their tasks. However, as a new tool, the full potential to aid planning has yet to be unleashed. PPGIS has been believed to reduce participation barriers and partially succeeds in reaching more diverse participants, as experiences with public participation show. However, there is no improvement in the recruitment of participants with lower levels of education.

Which Psychosocial Risks Are Necessary for Developing Depression During Adolescence? A Novel Approach Applying Necessary Condition Analysis.

Although many factors predict adolescent depression, risks that operate as necessary conditions (i.e., the absence of the factor conveys the absence of the outcome) have been largely unexplored. This study aimed to evaluate which psychosocial risk factors might serve as necessary conditions for future onset of depression across adolescence. At baseline we assessed cognitive and personality risks, symptom severity, stressful events, and past depression history among 382 adolescents (225 girls; age M = 12.6), who were then followed over 2 years with repeated diagnostic interviews to ascertain depression onset. We applied an innovative statistical approach in mental health research, namely Necessary Condition Analysis (NCA). Results showed that baseline rumination (d = .50), stressful events (d = .37), depressive symptoms (d = .23), and self-criticism (d = .35) all emerged as significant necessary conditions for adolescents to be diagnosed with depressive disorder(s) over subsequent 24 months. Overall, 13.5% of the sample did not show all the necessary conditions (i.e., they lacked one or more conditions) and were therefore virtually immune from experiencing one or more major depressive episodes (MDEs) over the follow-up, and 65.5% did not meet all those conditions for experiencing three or more MDEs (i.e., recurrent depression). The findings can inform future theory building and testing as well as clinical applications via screening of necessary risk to future pediatric depression so that youth who may most benefit from effective interventions can be identified. The Necessary Conditions for Depressive Symptomsand Major Depressionin Adolescence; https://osf.io; b5ced. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Key contextual factors involved with participation in medical and genomic screening and research for African American and White Americans: a qualitative inquiry.

Tremendous progress has been made promoting diversity in recruitment for genomic research, yet challenges remain for several racial demographics. Research has cited intertwined fears of racial discrimination and medical mistrust as contributing factors. This study aimed to identify key factors to establishing trust in medical and genomic screening and research among African Americans and White Americans. Participants completed online focus groups and resulting transcripts were analyzed using a qualitative descriptive approach, with content analysis methods based on recommendations by Schreier. Fifteen African Americans and twenty-three White Americans participated in the study, 63% of which were female. The mean age of participants was 38.5 (SD = 16.6). The Overarching Theme of Trust is Context Dependent was identified, along with the following five themes describing elements influencing trustworthiness for our participants: (1) Professional Experience, Education, and Training Bolster Trust; (2) Trust Depends on Relationships; (3) Cross-checking Provided Information is Influential in Establishing Trust; (4) Trust is Undermined by Lack of Objectivity and Bias; and (5) Racism is an Embedded Concern and a Medical Trust Limiting Component for African Americans. To effectively address mistrust and promote recruitment of diverse participants, genomic research initiatives must be communicated in a manner that resonates with the specific diverse communities targeted. Our results suggest key factors influencing trust that should be attended to if we are to promote equity appropriately and respectfully by engaging diverse populations in genomic research.

Recruiting and retaining healthcare workers in Scotland to a longitudinal COVID-19 study: a descriptive analysis

BackgroundRapid timescales for the design and delivery of research were common during the COVID-19 pandemic. The recruitment and retention of healthcare workers (HCWs) as participants in research studies are notoriously challenging, but this was exacerbated during the pandemic by the unprecedented demand placed on the workforce. The SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN study) is a prospective multicentre cohort study following HCWs in the UK. This paper discusses the strategies and challenges associated with recruitment and retention of HCW participants in Scotland.MethodsThere were 44,546 HCWs recruited to the SIREN study, of whom 6,285 were recruited by research teams at ten different research sites in Scotland between October 2020 and March 2021. Information on target and actual sample size, availability of resource, recruitment rate, and recruitment and engagement strategies by site was collated from SIREN study documentation and discussions with local key SIREN site staff. Individual-level data from 6,153 HCW participants with ongoing consent for all data usage were also collated, including socio-demographic data and information on withdrawal (in first year) and opt-in to a study extension after one year. Factors associated with these outcomes were explored in logistic regression analyses.ResultsDifferent recruitment strategies were used in each site according to local agreements, protocol and staff capacity, with the recruitment period ranging from 13 to 160 days. The locally-agreed recruitment target was met in four sites. The proportion of participants who withdrew in the first year ranged from 3.1 to 24.8% by site, while subsequent opt-in to a 12-month study extension ranged from 28.6 to 74.8%. The sites with the highest proportions of withdrawals were the same four sites with lowest proportions of opt-in. On an individual level, there was a lower level of retention among younger participants, and those from lower socio-economic backgrounds and minority ethnic groups.ConclusionsSite-specific factors including research-readiness likely had a significant influence on recruitment and retention, more so than the specific recruitment or retention strategies employed. Independent of site factors, individual-level variables influenced recruitment and retention, suggesting targeted strategies may be needed to promote research engagement among particular socio-demographic groups.

The Implementation of the Advocacy Intervention for Midlife and Older Women Who Have Experienced Intimate Partner Violence: Protocol for a Randomized Controlled Trial.

Midlife and older women who experience intimate partner violence (IPV) often have less access to supports and services than younger women. There is far less focus on research and supports for midlife and older women compared to younger women experiencing IPV, and often, neither elder abuse nor IPV services meet their needs. Few interventions are available to meet the needs of midlife and older women. The goal of this randomized controlled trial is to test the effectiveness of an advocacy intervention for midlife and older women who experience IPV and to learn from the experiences of those who implement and participate in the program. This trial is a 2-arm, unblinded, parallel, pragmatic randomized controlled trial with a qualitative component. Eligible participants will be women who live in the Maritime provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), who are in midlife and older (aged approximately ≥50 years), and who are currently in a relationship with an abusive partner or have recently left an abusive partner. Facilitators will be trained to deliver the intervention. The intervention will be entirely virtual and will consist of 2 components: (1) an empowerment component, which will involve sharing resources and information with the women; and (2) a social support component, which will include providing support and encouragement to women for 12 weeks. Quantitative effectiveness data will be collected from all trial participants at baseline, 3 months after the intervention, and 9 months after the intervention about the incidence and severity of IPV, physical and mental health, and safety behaviors and strategies. Qualitative interviews will be conducted with the facilitators and intervention group participants. Control group participants will receive a static, nontailored version of the advocacy intervention for midlife and older women (AIM) intervention materials after baseline data collection. A total of 12 facilitators have been trained to deliver the AIM intervention to trial participants. Participant recruitment and data collection will be completed in January 2025. Data analysis will continue throughout the data collection period, and the results will be disseminated by December 2025. This research will result in the adaptation and testing of a program to support and empower midlife and older women in the Maritime provinces of Canada who experience IPV. International Standard Randomized Controlled Trial Registry ISRCTN30646991; https://doi.org/10.1186/ISRCTN30646991. DERR1-10.2196/57886.

BELCOHORT: towards a population-based cohort for health research and policy support in Belgium

Abstract Background In the past decades much progress has been made in Belgium in the development and valorisation of population-based data collections which are directly or indirectly related to health. New surveys have been set up and the use of medico-administrative and environmental data for public health research gained momentum. However, no infrastructure is currently in place to link survey data with existing sources in a longitudinal perspective to address research questions directly relevant to health policy. BELCOHORT is a three-year pilot project aimed at developing a population based cohort enriched with these different data sources. The project is considered as a step towards a large population cohort in Belgium. Methods A first wave of participant recruitment was organized in February 2024 using the Belgian national register as a sampling frame, and 41,153 households were invited (targeted sample of 5000 individuals aged 18-69). A first baseline survey (online and paper) was organized and an annual follow-up is planned. Linkages procedures will be implemented with administrative data and geospatial data on air pollution and green space. The inclusion of data from physical examinations and biological samples will be explored. Results In the first recruitment wave the individual response rate was only 2.5%, leading to a sample of 1,947 participants. The sample showed an under-representation of women (45%), people aged 18-24 years (2%) and low educated people (21%). In total, 23% of participants opted to complete the first baseline questionnaire on paper. Stakeholder meetings have been started to implement the individual and geospatial linkages. Conclusions This project generate insights that will assist in methodological choices in the development of a large population cohort in Belgium. In the second recruitment lessons learned from the first data collection will be used to improve the response rate as well as the participation of under-represented groups. Key messages • This study provides insights on how existing population-based data collections including administrative and environmental data can be valorized in setting up a population cohort. • Recruitment strategies for a population cohort should be tested thoroughly and adapted in order to obtain a well-balanced sample composition.

Roma mothers of infant children in the health system - a qualitative study

Abstract Background The Roma in Bulgaria constitute the third largest group - 4% of the population. Data on demographic processes by ethnicity are scarce. A national survey in 2003 found significant differences in infant mortality - 9.9‰ for Bulgarian, 18‰ for Turkish, and 28‰ for Roma infants. Poverty among Roma children, risk of poor education, especially for girls, barriers to accessing health services remain high. We aim to reveal the cultural specificity in prenatal behavior and infant care among Roma mothers in the context of the role of the Bulgarian health service. Methods In-depth interviews with Roma mothers of infants up to 1 year were utilized for data collection. To ensure heterogeneity among the interviewees, several “nests” with varying socio-cultural status in the Varna district were identified in advance for participants recruitment. A list of interview themes concerning respondents’ relationships with the public health system with an emphasis on the experiences of mothers was drawn up. Results Ten interviews with mothers having between 1 and 7 children were conducted in 2023. The mothers recounted discriminatory experiences during their interactions with certain health facilities (maternity wards), which act as barriers to accessing and utilizing health services. Maternity and infant counselling services are highly esteemed with favorable influence on child health outcomes. There has been a positive shift away from early marriage and childbirth towards prioritizing education for Roma girls. Mothers prioritize their children, and there is no neglect in their care. Family relations and support are being upgraded, with Roma fathers becoming involved in child care. Respondents express their educational needs and hopes for community-based support to better cope with their roles as mothers. Conclusions Ethno-cultural factors shaping the mother’s role maintain traditional family support, while also reflecting significant modernization that needs societal support. Key messages • A glimpse into people’s experiences of the healthcare system - a clue to its effectiveness. • Тhe ethno-cultural factors in Roma are subject to modernization.

An examination of caregiver burden and contributing factors in cases of congenital microtia deformity.

This study aimed to assess the burden and influencing factors among primary caregivers of children with congenital microtia. A total of 153 primary caregivers of children with congenital microtia who underwent auricular reconstruction surgery at a tertiary A-grade hospital in Xi'an between October 2019 and August 2022, were recruited using convenience sampling. The Zarit Caregiver Burden Interview (ZBI) was employed to evaluate caregiver burden. While convenience sampling allowed for the practical recruitment of participants, its limitations include potential selection bias, which may affect the generalizability of the results. The mean total ZBI score was 30.07 ± 12.29. Among the participants, 26 caregivers (17.0%) reported no burden, 102 caregivers (66.7%) reported mild burden, 22 caregivers (14.4%) reported moderate burden, and 3 caregivers (2.0%) reported severe burden. Multivariate regression analysis identified several significant factors influencing caregiver burden, including the location and severity of the lesion, educational level, method of medical payment, monthly household income, communication with others about the child's condition, caregiver self-blame or guilt, and family support (all P < .05). Primary caregivers of children with congenital microtia face substantial burdens, emphasizing the need for targeted healthcare interventions. Strategic approaches are essential to address the psychological, social, and financial challenges they encounter. Future research should focus on longitudinal studies and interventions to enhance caregiver well-being and patient outcomes. However, caution is advised when generalizing these findings due to the sampling limitations.

Plasma and breast milk adipokines in women across the first year postpartum and their association with maternal depressive symptoms and infant neurodevelopment: Protocol for the APPLE prospective cohort study.

Adiponectin and leptin play important roles in the central nervous system. During the postpartum period, there is a need for a better understanding of the relationship between these cytokines and the neurological development of the infant, as well as their influence on preventing maternal depressive symptoms. To assess the correlation between adiponectin and leptin in maternal plasma and breast milk and their association with: infant neurodevelopment at 6 and 12 months of age; and maternal mental health over the first year postpartum. Prospective cohort study with four follow-up. Mothers and their newborns are recruited within the first 15 days postpartum (baseline). Follow-up visits occur at 2, 6, and 12 months postpartum. Visits include blood and breast milk collection, application of the Edinburgh Postnatal Depression Scale and Beck Depression Inventory to assess maternal mental health, application of the Bayley-III scale for infant developmental assessment, maternal and infant anthropometry and body composition, evaluation of reproductive history, mother-infant bonding, breastfeeding, consumption of ultra-processed foods, sleep quality, and socio-economic and demographic data. The research received funds in August 2022, and participant recruitment began in September 2022. The sample size will consist of 95 mother-child pairs. As of September 2023, 68 participants have been recruited. The project will provide insights into the association between adiponectin and leptin with postpartum depression and infant neurodevelopment, ultimately promoting improved care and quality of life for these groups. Additionally, it will provide data on the type of delivery, infant physical growth, maternal and infant body composition changes, sleep quality, consumption of ultra-processed foods, and maternal metabolic health, including vitamin D metabolites, oxidized polyunsaturated fatty acid metabolites, phospholipid species and triacylglycerols, which are of significant relevance to public health and, when interconnected, may yield important results and contribute to the existing literature. Name of the registry: Brazilian Clinical Trials Registry (ReBec). Registration number: RBR-9hcby8c.

Epidemiology of Mansonella perstans and Loa loa: Prevalence and Specific Risk Factors in Njombe-Penja Health District, Littoral Region of Cameroon

Aim: This epidemiological survey aimed to determine the prevalence and specific risk factors of Mansonella perstans and Loa loa infections in the Njombe-Penja Health District of Cameroon. This region is endemic for filarial infections, posing significant public health burden. Study Design: A cross-sectional study was conducted among 360 participants, representing various occupational groups and areas of settlements. Place and Duration of Study: The study was conducted in the Njombe-Penja Health District of the Littoral Region of Cameroon. Recruitment of participants, biological samples collection and questionnaire administration was done over a period of 1 month (July 2023). Methodology: Fifty microliters (50 µL) of peripheral blood was collected using capillary tubes, and analyzed for microfilarial presence and load. Structured questionnaires were used to collect data on demographic characteristics, exposure to risk factors, and preventive practices. Descriptive statistics, Chi-square tests with p-values, and odds ratios were calculated to identify significant associations. Results: The results showed a prevalence of 45.8% for M. perstans and 19.4% for L. loa, with higher infection rates among farmers, especially those working in the large scale banana farming sector, and those living near water bodies (P = .002, OR = 3.15). Poor environmental sanitation (P = .004, OR = 2.75), and low monthly income (&lt; 50,000 CFA) (P = .001, OR = 2.32), were also significantly associated with increased infection risk. Although 70.0% of participants were aware of the diseases, only 50.0% could identify key symptoms. Preventive measures like using bed nets and insect repellents were linked to a lower risk of infection (P =.003, OR = 2.10). Conclusion: Mansonella perstans and L. loa infections are highly prevalent in the district, driven by occupational exposure, socioeconomic factors, and environmental risks. Interventions should focus on improving sanitation, enhancing public health education, and expanding healthcare access.