Pre-post Analysis Research Articles

Systems Analysis and Improvement Approach to optimize the pediatric and adolescent HIV Cascade (SAIA-PEDS): a pilot study

IntroductionChildren and adolescents lag behind adults in achieving UNAIDS 95-95-95 targets for HIV testing, treatment, and viral suppression. The Systems Analysis and Improvement Approach (SAIA) is a multi-component implementation strategy previously shown to improve the HIV care cascade for pregnant women and infants. SAIA merits adaptation and testing to reduce gaps in the pediatric and adolescent HIV cascade.MethodsWe adapted the SAIA strategy components to be applicable to the pediatric and adolescent HIV care cascade (SAIA-PEDS) in Nairobi and western Kenya. We tested whether this SAIA-PEDS strategy improved HIV testing, linkage to care, antiretroviral treatment (ART), viral load (VL) testing, and viral load suppression for children and adolescents ages 0–24 years at 5 facilities. We conducted a pre-post analysis with 6 months pre- and 6 months post-implementation strategy (coupled with an interrupted time series sensitivity analysis) using abstracted routine program data to determine changes attributable to SAIA-PEDS.ResultsBaseline levels of HIV testing and care cascade indicators were heterogeneous between facilities. Per facility, the monthly average number of children/adolescents attending outpatient and inpatient services eligible for HIV testing was 842; on average, 253 received HIV testing services, 6 tested positive, 6 were linked to care, and 5 initiated ART. Among those on treatment at the facility, an average of 15 had a VL sample taken and 13 had suppressed VL results returned.Following the SAIA-PEDS training and mentorship, there was no substantial or significant change in the ratio of HIV testing (RR: 0.803 [95% CI: 0.420, 1.532]) and linkage to care (RR: 0.831 [95% CI: 0.546, 1.266]). The ratio of ART initiation increased substantially and trended towards significance (RR: 1.412 [95% CI: 0.999, 1.996]). There were significant and substantial improvements in the ratio of VL tests ordered (RR: 1.939 [95% CI: 1.230, 3.055]) but no substantial or significant change in the ratio of VL results suppressed (RR: 0.851 [95% CI: 0.554, 1.306]).ConclusionsThe piloted SAIA-PEDS implementation strategy was associated with increases in health system performance for indicators later in the HIV care cascade, but not for HIV testing and treatment indicators. This strategy merits further rigorous testing for effectiveness and sustainment.

Remote Care Management for Older Adult Populations With Elevated Prevalence of Depression or Anxiety and Comorbid Chronic Medical Illness: A Systematic Review.

Comorbidity of psychiatric and medical illnesses among older adult populations is highly prevalent and associated with adverse outcomes. Care management is a common form of outpatient support for both psychiatric and medical conditions in which assessment, care planning, and care coordination are provided. Although care management is often remote and delivered by telephone, the evidence supporting this model of care is uncertain. To perform a systematic review of the literature on remote care management programs for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A multidatabase search was performed. Articles were included for review if they studied fully remote care management for older adult populations with elevated prevalence of depression or anxiety and chronic medical illness or poor physical health. A narrative synthesis was performed. A total of 6 articles representing 6 unique studies met inclusion criteria. The 6 studies included 4 randomized controlled trials, 1 case-matched retrospective cohort study, and 1 pre-post analysis. Two studies focused on specific medical conditions. All interventions were entirely telephonic. Five of 6 studies involved an intervention that was 3 to 6 months in duration. Across the 6 studies, care management demonstrated mixed results in terms of impact on psychiatric outcomes and limited impact on medical outcomes. No studies demonstrated a statistically significant impact on health care utilization or cost. Among older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness, remote care management may have favorable impact on psychiatric symptoms, but impact on physical health and health care utilization is uncertain. Future research should focus on identifying effective models and elements of remote care management for this population, with a particular focus on optimizing medical outcomes.

Inhibition and excitation in the sexual brain: An useful tool for the prediction of therapeutic outcomes in women with sexual dysfunction

ABSTRACT Introduction The “Dual control model” of sexual response postulates that sexual desire and associated behaviors depend on the balance between excitation and inhibition. These aspects have not been evaluated in women with sexual dysfunction (FSD). Objective To explore the psychosexual correlates of excitation and inhibition in women with FSD, according to their menopausal state. We also aimed at performing a pre-post analysis in a sub-sample of patients followed for 3-6 months, investigating the possible relationships between excitation and inhibition and the changes in questionnaires related to sexual function. Methods In an observational, retrospective study, we recruited a consecutive series of 66 women consulting for FSD. Patients underwent a clinical evaluation, a structured interview and completed several self-administered questionnaires, including Sexual Inhibition/Sexual Excitation Scale (SIS/SES), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT) and Middlesex Hospital Questionnaire (MHQ). A subgroup of patients (n=28) was evaluated at 3-6 months follow-up, using the FSFI and FSDS-R questionnaires. Results In pre-menopausal women, the SIS1 scale (Sexual inhibition due to the fear of performance failure) was associated with the diagnosis of Hypoactive Sexual Desire Disorder (HSDD), even after adjusting for confounders (p=0.047), whereas in post-menopausal women, we found an association between HSDD and the SES scale (total sexual excitation) (p=0.039; see also Figure 1). Given these correlations, we developed two cut-off values for the SES and SIS1 scales, according to which a score < 49 on the SES (in postmenopausal women) and a score > 34 on the SIS1 (in premenopausal women) accurately identified patients diagnosed with HSDD. In post-menopausal women, the ROC curve for the SES scale showed an accuracy (AUC) of 0.734 +- 0.107, p=0.037, in identifying HSDD; considering a cut-off value of 49, the sensitivity and specificity for HSDD detection were 85.7% and 66.7%, respectively (Fig. 2). In premenopausal women, the ROC curve for the SIS1 scale showed an AUC of 0.853 +- 0.081, p=0.007, in identifying HSDD; considering a cut-off value of 34, the sensitivity and specificity for HSDD detection were 78.6% and 75.0%, respectively (Fig. 3). At follow-up, the mean change in FSFI total score was not correlated with the SES or SIS2 scales (p=0.214 and p=0.402, respectively), but only with the SIS1 scale (p=0.026). When comparing patients with low excitation (SES scale <49) and high inhibition (SIS1 scale >34) with the rest of the sample, they showed a significantly lower change in FSFI total score (p=0.018). Conclusions In women consulting for FSD, sexual excitation and inhibition, which may be easily assessed by the SIS/SES questionnaire, emerge as key aspects in both the diagnostic evaluation and planning of therapeutic outcomes, in the perspective of a personalized sexual medicine approach. Disclosure Work supported by industry: no.

관상동맥 질환을 경험한 중년 남성의 심장재활 프로그램 시 비만도에 따른 심박수, 혈압, 심폐기능의 차이

Purpose: The purpose of this study is to assess the change in heart rate, blood pressure and cardiopulmonary function by the cardiac rehabilitation program depending on the degree of obesity in middle-aged men with coronary artery disease in Korea.BR Method: The subjects, 30 middle-aged males diagnosed with acute myocardial infarction, were divided into 15 control group (NOG) and 15 obese group (OG). For 8 weeks, subjects were comparatively analyzed for the effects of the cardiac rehabilitation program on heart rate, blood pressure and cardiopulmonary function according to obesity. Analysis was performed with a two-way repeated measure ANOVA to analyze the difference between before and after the cardiac rehabilitation program for each subject. And a paired t-test was conducted to verify before and after changes.BR Results: The results of this study are as follows. 1) Rest heart rate, the interaction effect between the group and time, was found to have a statistically significant difference (p=.025). As a result of pre-post analysis within each group, there was a significant decrease in the NOG p(=.000). Maximum heart rate showed a significant difference according to the time of the main effect test p(=.020). 2) Blood pressure at maximal systolic showed a significant difference according to the time of the main effect test (p=.009). Pre-post analysis within each group showed a significant increase in the NOG (p=.037). 3) Maximum oxygen intake showed a significant difference according to the time of the main effect stet (p=.000). Pre-post analysis within each group was significantly increased in the NOG (p=.000), OG (p=.005). 4) Rate-pressure product at stage 3 showed a significant difference according to the time of the main effect test (p=.045). Pre-post analysis within each group was significantly decreased in the NOG p(=.023). Rate-pressure product at maximal showed a significant difference according to the time of the main effect test (p=.006). Pre-post analysis within each group was significantly increased in the NOG (p=.049), OG (p=.047).BR Conclusion: In summary, the findings in this study confirm that both groups are effective in cardiac rehabilitation programs and that their effects are different. Therefore, various cardiac rehabilitation programs are needed and follow-up studies are required in the future.

Effectiveness of Static and Dynamic Weight Shift Balance Strategies to Improve Balance Performance in patients With Stroke-

Aim: To enhance the balance in post stroke patients by the implementation of static and dynamic weight shift balance strategies. Methods: Data from 32 patients who complete selection criteria were included to this study. Study design was Randomized controlled trial (RCT). Written informed consent were taken from every individual participating in this study before performing any physical examination. Patients were allocated into two equal groups. On 1st day balance was assessed by Brunel Balance Assessment (BBA), re-accessed by the end of 3rd week and at 6th week. There were two groups, one is Experimental (Group A) receiving static and dynamic weight shift balance training strategies along with conventional physiotherapy treatment while control group (Group B) receiving only conventional rehabilitation program. Results: The results of the BBA (Brunel Balance Assessment) scale showed statistically significant variations in the pre-post analysis for the experimental group with the p-value less than 0.05. By comparing the BBA scale score of group A and B has shown that there was significant difference between post treatment scores, post treatment mean BBA score was 7.000±1.4142 in group A while 3.6250±1.85742 in group B, with the value of p 0.00, showing that group A is better in improving balance of stroke patients. Conclusion: Implementation of static and dynamic balance strategies has a significant effect on improvement of balance in the patients suffering from stroke. Keywords: BBA (brunel balance assessment), CVA (cerebrovascular accident) and RCT (randomized controlled trial)

Children’s behaviour in Beginning Days of School: Occupational Therapy Intervention based Study

Background: For some children, transits may be frustrating or may provoke anxiety, and it may lead to challenging behaviours.Objective: The aim of this study was to assess the influence of occupational therapy intervention on gradual change in behaviour of a child in preschool, while transit. Methods: Eighteen pre-schoolers in control and eighteen pre-schoolers in experimental group were assigned (12 females and 24 males). Based on randomized controlled study design Preschool Behaviour Questionnaire (PBQ) was used to assess the pre-schoolers behaviour. Result: According to the result the experimental pre-post analysis (P=0.00; 95%CI: 18.96, 22.90) were statistically lower than the control group pre-post analysis (P=0.201; 95%CI: -8.23,35.98) and showed a significant improvement in behaviour of a pre-schooler while transit from home to school which was the principal focus area of occupational therapy.Conclusion: The study reflected significant improvement in certain behavioural areas like command following, sitting tolerance and peer interaction in pre-schoolers with occupational therapy early intervention program

The Multifaceted Impact of COVID-19 on Social Media Users' Wellbeing and Relationship With Urban Nature

As the coronavirus disease 2019 (COVID-19) pandemic has unfolded, the media is increasingly recognizing the value of urban nature, with greenspace use increasing. In cities, where people often lack access to private greenspaces, parks and other urban greenspaces offer opportunities for exercise and physically distanced socializing. Previous research has demonstrated the benefits of urban greenspaces to both physical and mental health, during times of relative stability. Here, we seek to examine how people's responses to greenspace are affected by a global pandemic, which uniquely affects both physical movements and mental wellbeing in the population at large. We compare tweets focused on nature- and greenspace-related keywords and hashtags from March to July 2019 with tweets from the same period in 2020 for metropolitan regions in the United States. We also examine the influence of stay-at-home restrictions in 2020. These posts reinforce findings from conventional survey approaches showing that people's relationship to greenspace is multifaceted. Furthermore, the results of our pre–post analysis of people's outdoor use suggest that the pandemic has had a differential impact on these multifaceted dimensions of people's engagement with nature. By applying a multidimensional construct of wellbeing, we identify Positive emotion, Positive relationships, and Meaning as subfactors of wellbeing that potentially can be increased by urban nature. These findings are important in demonstrating that greenspace in cities played a critical role in individuals' resilience and wellbeing during the early months of the pandemic and highlighting the need for maintaining and expanding access to urban greenspaces in the future, for the benefit of all city residents.

Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia

BackgroundLong-acting injectable (LAI) antipsychotics use is associated with improved adherence which can reduce the rate of relapse, hospitalization, and associated costs in patients with schizophrenia. Young adults could be at higher risk of poor adherence, hence use of LAI in this population may offer a benefit but the evidence is limited. This study aimed to compare clinical and economic outcomes before and after the initiation of LAI antipsychotics in commercially insured young adults (18-35 years of age) with schizophrenia.MethodsA retrospective claims data study was conducted using the data from the IBM MarketScan® Commercial Claims and Encounters (CCAE) Database. Patients with a continuous enrollment of at least 1-year before and 1-year after the first observed schizophrenia diagnosis (index date) and with the use of ≥1 typical or atypical LAI antipsychotic during the post-index follow-up period were included. A pre-post analysis was conducted to compare relapse rates, healthcare resource utilization, and costs before (from index date to LAI initiation) and after LAI initiation (to end of follow up).ResultsA total of 2222 patients who initiated LAIs after an index schizophrenia diagnosis were identified. The per patient per month (PPPM) composite relapse event rate (0.109 pre-LAI to 0.073 post-LAI) and hospitalization rate (0.091 to 0.058), all-cause inpatient visits (0.231 to 0.119), and length of stay (2.694 to 1.092 days) significantly decreased from before LAI initiation to after LAI initiation with similar trends seen for mental health and schizophrenia-related measures (all significant; P < 0.0001). All-cause total costs ($4898 to $3078 PPPM) were also decreased after LAI initiation, with similar trends seen for mental health and schizophrenia-related costs (all significant; P < 0.0001). Although medication costs were higher post-LAI period ($311 to $542 PPPM), the cost increase was substantially offset by the decreased costs associated with total healthcare costs.ConclusionsTreatment with LAI antipsychotics was associated with a decrease in relapse event rate, healthcare resource utilization, and costs after LAI initiation compared to before LAI initiation in commercially insured young adults with schizophrenia. Treatment with LAIs in young adults with schizophrenia is potentially associated with significant cost savings to commercial payers.

Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data.

PurposeTo assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR‐EHR) data.Materials and methodsThe case group (denture wearers) included matched EDR‐EHR data of patients who received removable partial, complete, and implant‐supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients’ receiving complete or partial denture) of the matching cases. The qualified patients’ EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls.ResultsThe final cohort included 10,481 matched EDR‐EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers’ mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre‐post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post‐index time. Hemoglobin (Hb) was higher pre‐index, and was decreasing during the time period but did not change post‐index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post‐index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post‐index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post‐index.ConclusionsThe study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.

Does company performance really improve following mergers? A pre-post analysis of differences in Greece

Merger transactions occur in various business sectors and are a drastic way of corporate restructuring. For several companies, mergers are the only path to gaining access to new resources, improving profitability, and achieving business excellence. The purpose of this study is to investigate the mergers that occurred among companies and reveal different aspects of their final results beyond the traditional and simple comparison methods of analysis. Thus, several merger events from Greek companies are tracked and compared by evaluating various accounting measures from their published financial accounts. The preliminary statistical results from univariate data analysis with accounting comparisons reveal no significant business performance changes after mergers. Then, the merger event is examined per company from each year’s released financial statements with a not used before proposed method of analysis: comparison of pre- and post-merger performance by employing a heat-map with a multi-step approach. The results showed that five companies out of eighteen examined present a deterioration on separate sections of accounting performance (profitability, capital structure, and leverage). While univariate statistical analysis of comparison in pre- and post-merger performance failed to signalize these differences, the heat-map methodology approach with a multi-step approach revealed them. The obtained results show important differences in the accounting performance of almost one-third (27.8%) from the examined sample companies. Thus, the findings reveal the usefulness of the new proposed approach in merger analysis.

Comparing race and ethnicity across safety-net and non-safety net practices pre- and post-an HIV screening alert.

CONTEXT: Societal and economic burdens of human immunodeficiency virus (HIV) continue to grow, even as treatments and prevention for this disease becomes more readily available and efficacious. HIV screening is more likely to be performed in minority (including Black) patient populations compared to whites. The likelihood of getting screened also depends on primary care practice attributes. OBJECTIVE: Evaluate HIV screening demographics by safety-net and non-safety net practices. STUDY DESIGN and ANALYSIS: Pre-post analysis. SETTING: Atrium Health is a non-profit, vertically integrated healthcare system with approximately 16 million patient encounters per year across the Southeast US. POPULATION STUDIED: Twelve primary care practices, including four safety-net practices serving predominantly Medicaid and uninsured patients, with over 115,00 patients between the ages of 18 and 64 were selected for the educational intervention. INTERVENTION/INSTRUMENT: A system-wide electronic medical record alert prompting HIV screening was implemented in October 2017 targeting adults between 18-64 years old. In addition to the system alert, a provider peer-to-peer educational program detailing HIV disease epidemiology, screening recommendations, and algorithms to guide screening efforts was developed. OUTCOME MEASURES: HIV screenings. RESULTS: From October 2016- April 2017, 3,413 patients were screened for HIV at the twelve participating primary care practices. Immediately after the HIV alert activation, from October 2017 - April 2018, 6,256 patients were screened, resulting in an 83% increase in screening. However, increases were different based on practice type, race and ethnicity. Black patients in safety net clinics had higher screening rates prior to the alert and showed less of an increase in screening (37%) compared to whites (102%) after the alert was activated. Hispanic/Latino patients showed similar increases at both safety net (99%) and non-safety net (108%) practices. Both Black and white patients showed larger increases of 99% and 139% in non-safety net clinics. Chi-squared analysis comparing the percentage of patients screened during these time periods was significantly different (p=0.001). CONCLUSION: While race and practice characteristics influence the likelihood of HIV screening, EMR modifications and provider education can significantly enhance screening and care for patients with HIV regardless of race and practice type.

Interactive Learning System for Learning Calculus

Background: IT tools assist in creating a more participative and independent learning environment. They have brought a new perspective to collaborative learning where students do not just sit in a chair and swallow lecture content but instead participate in creating and sharing knowledge. However, interactivity promoted through the implementation of technology is limited in many cases. Purpose: This research develops an interactive application for learning calculus that promotes human-system interaction via augmented reality (AR) and human-human interaction through chat functions. The study examines the effect of both interactivities on learning experience and how that learning experience affects the performance of learning. Methods: The research adopted a quasi-experimental study design and pre-post test data analysis to evaluate the effect of interactivities on learning experience and consequently the effect of learning experience on learning performance. The subjects were exposed to the developed application for learning the calculus chapter ‘Revolution of Solids” in a controlled environment. The study validated its research framework through partial least squares path modelling and tested three hypotheses via pre-and post-test evaluation. Conclusions: The results found that both interactivities affect learning experience positively; human-human interactivity has a higher impact than human-system interactivity. It was also found that learning performance as part of the learning experience increased from pre-test to post-test.

Mindfulness practice correlates with reduced exam-induced stress and improved exam performance in preclinical medical students with the \u201cacting with awareness\u201d, \u201cnon-judging\u201d and \u201cnon-reacting\u201d facets of mindfulness particularly associated with improved exam performance

BackgroundMedical students demonstrate higher levels of psychological distress compared with the general population and other student groups, especially at exam times. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body’s stress response. This study investigated the relationship of mindfulness to exam-induced stress, salivary cortisol and exam performance in undergraduate medical students.MethodsA controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the five facet mindfulness questionnaire (FFMQ) and provided saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures.ResultsExam-induced salivary cortisol concentration showed a significant negative relation with exam performance. Total FFMQ score showed a significant positive relation with exam performance and a significant negative relation with exam-induced salivary cortisol. The specific mindfulness facets of acting with awareness, non-judging and non-reacting also showed a positive correlation with exam performance.ConclusionsThis study suggests that there exists an important relationship between mindfulness and the physiological biomarker of stress, cortisol, and this manifests into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. In particular, this study identifies the acting with awareness, non-judging and non-reacting facets of mindfulness to be significantly associated with exam performance suggesting that these may be important facets for clinical educators to target when helping students with mindfulness practice.

Wheelchair Skills Education and Training for Children with Spina Bifida and/or Hydrocephalus and Their Parents: A Pilot Study

Background: Many children with spina bifida and/or hydrocephalus use manual wheelchairs. However, training to ensure appropriate wheelchair use is limited and informal, and this negatively impacts daily activity and participation. Evidence suggests formal training can increase children’s confidence and independence, with early intervention being critical for healthy development. In Ireland, like in many other regions internationally, such interventions are not readily available to families. Aim and objectives: The overall aim of the study was to pilot wheelchair skills training for children aged 3–8 years with spina bifida and/or hydrocephalus and their parents, to develop a sustainable program. The objectives were: (1) to develop and evaluate a wheelchair skills information pack; (2) to investigate the impact of training on children’s performance of wheelchair skills; (3) to explore parents’ perspectives on how training influenced their children’s daily participation; (4) to identify beneficial aspects of program delivery for children and parents. Methods: We applied a mixed-methods study design that included three stages: (1) evaluation of the use of a bespoke wheelchair skills information pack; (2) within-subject pre-post analysis of the wheelchair skills test (WST) and individual training goals; (3) qualitative thematic analysis of Photovoice documentary narratives from focus groups with parents. Results: Four children and their parents participated in the study. Parents reported the wheelchair skills information pack to be useful, recommending more child-friendly images, and the provision of the pack when children first receive their wheelchairs. Analysis of the pre/post-WST showed an increase in the performance of skills. Parents’ perspectives and experiences are captured in two Photovoice themes: (1) children developing their skills, (2) supporting parents to support their children. Conclusion: The pilot program was a success for these families, highlighting potential gaps in Irish wheelchair provision services and the need for wheelchair skills education and training to support parents and children.

Assessing Microbial Water Quality, Users' Perceptions and System Functionality Following a Combined Water Safety Intervention in Rural Nepal

Risk-based water safety interventions are one approach to improve drinking water quality and consequently reduce the number of people consuming faecally contaminated water. Despite broad acceptance of water safety planning approaches globally, there is a lack of evidence of their effectiveness for community-managed piped water supplies in rural areas of developing countries. Our research, in the form of a cluster-based controlled pre-post intervention analysis, investigated the impact of a combined water safety intervention on outcomes of microbial water quality, users' perceptions and piped system functionality in rural Nepal. The study enrolled 21 treatment systems and 12 control systems across five districts of the Karnali and Sudurpaschim provinces. Treatment group interventions included field laboratories for microbial analysis, regular monitoring of water quality including sanitary inspections, targeted treatment and infrastructure improvements, household hygiene and water filter promotion, and community training. In certain systems, regular system-level chlorination was implemented. Before and after the interventions, the microbial water quality was measured at multiple points within the water system. This information was complemented by household interviews and sanitary inspections. The main result to emerge from this study is that chlorination is the only identified intervention that led to a significant reduction in E. coli concentration at the point of consumption. Secondly, the effectiveness of other interventions was presumably reduced due to higher contamination at endline in general, brought about by the monsoon. All the interventions had a positive impact on users' perceptions about their water system, as measured by expectations for future functionality, satisfaction with the services received, and awareness of the potential health risks of drinking contaminated water. For future applications we would recommend the more broadly applied use of chlorination methods at system level as a key component of the package of risk-based water safety interventions.

Potentiale und Herausforderungen von ärztlichen Videosprechstunden in der Pflegeeinrichtung aus der Sicht der Versorgenden - eine qualitative Prä-Post-Studie

IntroductionThe implementation of medical video consultations in nursing homes can support primary care in rural areas and counteract the shortage of physicians. So far, video consultations have been limited to pilot projects and have not yet been comprehensively implemented. The present study addresses potentials of video consultations and challenges that may arise during the implementation of medical video consultations. MethodsTwenty-one guided interviews (pre-implementation: n = 13; post-implementation: n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). The data was analyzed using qualitative content analysis. The results were contrasted in a pre-post analysis. ResultsAlmost all of the interviewees’ expectations regarding video consultations described prior to implementation have been met: time savings, improved communication, reduction of information breaks and increase in the quality of care. After implementation, other unexpected advantages of telemedical care became apparent, such as the possibility of regular monitoring or the improved ability to plan routine visits without interrupting the daily schedule. At the same time, the implementation of video consultations is associated with the following challenges: defining responsibilities, acquiring experience in handling video consultation tools, providing for sufficient qualification and training, dealing with new billing modalities as well as missing links between nursing documentation and medical information systems. DiscussionVideo consultations can improve health care routines in nursing homes, lead to a wider availability of medical services, and contribute to improving patient safety and the quality of care. However, various aspects and contextual factors need to be addressed when implementing video consultations. These include: implementation of technical requirements, initial training with test consultations, continuous interactive development of potential fields of application, and the definition of the respective responsibilities of caregivers, physicians and medical assistants.

An Integrated mHealth Campaign to Reduce the Risk of Falling for Older Adults.

The number of falls among older adults is rising due to an aging population worldwide. An integrated communication campaign utilizing mHealth (mobile health) encouraged older adults to perform strength, balance, and flexibility exercises to reduce their risk of falling. Campaign development was guided by a mixed-method approach which incorporated expert interviews (N = 3), qualitative interviews (N = 22), and a quantitative baseline pre-campaign survey (N = 274) with older adults. We evaluated the campaign impact with a pre-post survey analysis (post n = 141). Impact was measured by knowledge, attitudes, self-efficacy, and behaviors as key Social Cognitive Theory factors to exercise adoption. Results showed that respondents with campaign exposure had a significant increase in all factor scores from pre- to post-campaign survey, which was significantly higher in the group with campaign exposure. The impact evaluation illustrated how digital mobile channels effectively provide means to reach older adults to reduce their risk of falling.

Effect of McConnell Patelar Taping on Joint Position Sense and Threshold to Detection Passive Motion in Sub acute Stroke Patient

The purpose of this study is to analyse the effect of McConnell patellar taping on joint position sense and threshold to detection passive motion in sub acute stroke patient. This is an pre-post test analysis experimental study (n=8). The McConnell patelar taping placed on knee joint in paresis side for 30 minute with McConnell technique and measured by isokinetic dynamometer (Cybex). This research placed in Physical Medicine and Rehabilitation outpatient clinic Dr Soetomo General Hospital. Eight sub acute stroke patient in this study had average age 46.38 ± 11.01 years old and onset of stroke 3,87 ± 1,13 months. The result of McConnell patelar taping application showed significant increase of knee joint position sense in 150 (from 10,78 ± 3,5 to 12,22 ± 3,64 degree) , 300 (from 23,17 ± 3,54 to 24,27 ± 3,50 degree) and improve threshold to detection passive motion (from 13,09 ± 3,49 to 12,09 ± 3,51 second ). Result of this study, conclude that application of McConnell patellar taping can increase joint position sense and improve threshold to detection passive motion and useful for improvement on proprioception in sub acute stroke patient.

The impact of COVID-19 on physical activity behaviour in Italian primary school children: a comparison before and during pandemic considering gender differences

BackgroundThe World Health Organization stated an average of 60 min of Moderate to Vigorous Physical Activity (MVPA) that children should accumulate every day.Nevertheless physical inactivity is growing and, due to restrictions imposed during pandemic, PA levels of children might be more negatively affected.The study aimed to analyse the impact of COVID-19 on the PA of an Italian sample of primary school children by comparing it before and during COVID-19 considering gender differences.MethodsA pre-post analysis (October 2019–January 2021) was conducted using a randomized sample (N = 77) from the I-MOVE study settled in an Italian primary school. Both objective (Actigraph accelerometers) and self-reported (PAQ-c questionnaires) assessments of PA were performed. Changes were compared using T-Student and Chi-Square test. Gender differences were calculated using Anova.ResultsWeekly and daily minutes time spent in MVPA significantly decreased respectively by − 30.59 ± 120.87 and − 15.32 ± 16.21 from before to during pandemic while the weekly time spent in sedentary behaviour increased (+ 1196.01 ± 381.49). PAQ-c scores followed the same negative trend (− 0.87 ± 0.72). Boys seem to have suffered more than girls from the imposed restrictions.ConclusionThese findings outline the need for strategies to promote PA and reduce sedentary behaviours in children to prevent COVID-19 restriction long-term effects.

Simple pre-post analysis overestimates the impacts of new public transit services on ridership: Evidence from a quasi-experimental study of new bus rapid transit in Columbus, Ohio, USA

This paper empirically demonstrates the value of quasi-experimental study designs to evaluate the direct impacts of new public transit services on ridership within its corridor. Using a new bus rapid transit (BRT) service, CMAX, in Columbus, Ohio, USA, as an example, we compare its impact on ridership based on a pre-post and quasi-experimental analysis framework. We conduct the pre-post analysis using a ridership space-time cube exploring a massive Automatic Passenger Counter (APC) database. Differences in total passenger counts before and after the BRT intervention indicate a 36% increase in ridership within its corridor. However, this patronage increase may not be attributable solely to the new public transit service. Potential confounding effects include systemwide ridership trends and a new unlimited transit pass program for downtown workers. To address these issues, we adopt a quasi-experimental study design with a difference-in-differences (DiD) identification strategy. We use propensity score matching (PSM) to match a counterfactual control group with the treatment group when implementing DiD model. After accounting for confounding effects, we find a less than 5% increase but not statistically significant impacts of CMAX on ridership. Our results support the argument that a simple pre-post analysis ignoring confounding effects can lead to a misleading evaluation of a new public transit service’s direct impact on ridership.