Prevention of RSV bronchiolitis in infants with maternal immunization or monoclonal antibodies for the newborn: What do women choose?

IntroductionInternational guidelines emphasise the role of heart valve centres (HVC) and specialist heart valve clinics (SHVC) to deliver optimal care to patients with heart valve disease (HVD). We sought to determine whether we could reaffirm the importance of SHVCs in our centre.MethodsA total of 3731 consecutive non-SHVC (N-SHVC) patients were reviewed over 18 months. Patients (134) with a primary diagnosis of HVD were compared with 173 consecutive SHVC attendees based on international guidelines. Concordance was defined as adherence to recommended frequency of follow-up, investigations, timing of surgery and valve care advice, and discordance as any deviation from this.ResultsOf 134 N-SHVC patients (4.5%) with HVD, 89 (66.4%) had native valve disease and 45 (33.6%) prior heart valve surgery compared with 123 (71.1%) and 50 (28.9%) of SHVC patients, respectively, in the SHVC cohort. In symptomatic patients, the relationship to HVD was not documented in 31.5% of N-SHVC patients versus 5.7% of SHVC patients (p<0.001). Exercise testing was used infrequently in N-SHVCs compared with SHVCs (3.4% vs 32%, p<0.001) and surgical referral was lower (3.4% vs 26.8%, p<0.001). No N-SHVC patients with prior valve surgery received endocarditis prevention advice compared with 100% of SHVC patients. Overall, 34 (38.2%) of N-SHVC patients with native valve disease and 34 (84.4%) with prior cardiac surgery had discordant management compared with 4 (3.3%) and 2 (4%) of SHVC patients respectively.ConclusionAlmost 5% of patients with valve disease are still seen in an N-SHVC setting despite the availability of an SHVC within the same institute and receive suboptimal care.

43. Preventive Care Advice Receipt Across Health Areas From Mid-adolescence to Young Adulthood: Who receives care?

Early Response to a Behavioral Community-Based Educational Intervention on Cardiovascular Risk Profile and Well-Being.

Providing advice on prevention topics is a mandatory part during health checks for children in Germany. We aimed to investigate receipt of advice from the parents' perspective using data from the KUNO-Kids health study. Parents completed questionnaires at the child's third (N = 1280) and fourth (N = 997) birthday and reported utilization of health checks, receipt of advice on prevention topics (physical activity, nutrition, media consumption, speech development) and their satisfaction. Predictive factors were analysed in multivariable regression models. Nearly all parents attended the health checks; about 60% reported having received advice on any of the investigated prevention topics. Their satisfaction with the advice they received was high. The receipt of advice was positively associated with raising a boy and having higher health literacy and negatively associated with being a first-time parent and being older at childbirth. Findings indicate that advice on prevention topics is not routinely provided or not remembered by parents. There is considerable potential for improvement in the effective communication of prevention advice during health checks.

To support occupational physicians (OPs) in the execution of preventive tasks, a peer coaching intervention was developed and implemented in existing peer groups. The aim of this study was to examine the effects of the intervention on OPs' execution of preventive tasks in practice. A total of 41 peer groups, including 231 OPs, participated in this cluster randomised controlled trial, of which 21 groups were assigned to the intervention group (N=106) and 20 to the control group (N=125). The intervention consisted of three peer coaching meetings aimed to promote the execution of preventive tasks. Data regarding the execution of preventive tasks, measured as percentage of their working time and hours allocated to specific preventive tasks, were collected at baseline, 6-month and 12-month follow-up. The effect of the intervention was examined by linear multilevel analysis. Both the intervention and control group increased the percentage of working time allocated to prevention, from 14% at baseline to 17% at 12-month follow-up, but no significant differences between the study groups were found. For specific preventive tasks, the intervention group increased their time allocated to giving secondary prevention advice by 5 monthly hours compared with baseline. The intervention was found not to have an effect on the percentage of working time allocated to prevention, possibly due to contextual factors. However, intervention effects were found for giving secondary preventive advice. Future studies should focus on the willingness of employers and occupational health and safety to invest in prevention and refinement of the intervention under study. ISRCTN15394765.

Background.Higher childhood (pre-morbid) cognitive function (IQ) appears to confer a lower risk of cardiovascular disease (CVD) episodes in adulthood, however, the underpinning mechanisms are uncertain. We tested the association between childhood cognitive ability and later CVD risk factors that may underpin this gradient.Methods.We used data from two well-characterized prospective birth cohort studies initiated in the United Kingdom in 1958 (N=10870) and 1970 (N=9278). Cognitive function was quantified using validated written tests at around 10 years of age. A total of 16 biological, psychosocial, and behavioral risk factors were collected at 46–48 (1970 cohort) and 61–65 (1958 cohort) years of age in both studies. Associations were summarized using linear and logistic regression.Results.After pooling the data and controlling for early life confounding factors, higher childhood cognitive ability was related to more favorable levels of 4/4 psychosocial, 3/3 behavioral, and 6/9 biological risk factors in middle/older age. The magnitude of these relationships increased from biological, to behavioral then psychosocial risk factors. For example, a one standard deviation higher cognitive test score was related to protective levels of body mass index (beta coefficient [95% confidence interval]: −0.58 [−0.70, −0.45]; p-value <0.001), triglycerides (−0.03 [−0.04, −0.01]; <0.001), cigarette smoking (odds ratio [95% confidence interval]: 0.72 [0.67, 0.76] <0.001), depressive symptoms (0.79 [0.74, 0.84]; <0.001), and a high prestige occupation (2.27 [2.21, 2.35]; <0.001). There was some evidence of mediation via educational attainment.Conclusions.The present correlations implicate a series of mechanistic pathways which may connect cognition with subsequent CVD events. The greater burden of unfavorable risk factors at the lower end of the cognition spectrum suggests that compliance with preventive health advice may be sub-optimal.

Antimicrobial use in animals may contribute to antimicrobial resistance (AMR), which poses direct risks to animal health and welfare and can potentially impact human health since some diseases affect both animals and people. This study determined the level of awareness regarding AMR among livestock farmers in Northern Uganda. A community-based cross-sectional study was conducted among livestock farmers in three districts of Northern Uganda, namely, Gulu, Omoro, and Amuru districts. A structured questionnaire was used to collect data. Data from 246 participants, with a median age of 38 years (interquartile range: 29-50 years), were analyzed. Most farmers had attained a primary level of education (n = 125, 50.8%) and grew crops as their major economic activity (n=88, 35.8%). Goats were the most commonly reared animals (n = 167, 67.7%). The median distance from the nearest drug shop was 2km (interquartile range: 1-5 km). Most farmers had good awareness on AMR (158, 64.2%), with more than half of the farmers (n = 134, 54.5%) having heard of AMR, but only 48 (35.8%) understood its correct meaning. Most farmers (n = 220, 89.4%) noted AMR as an important issue in farming, with many farmers (n = 133, 54.5%) opting to seek veterinary advice for prevention. Most farmers had appropriate AMU (219, 89.0%), with 203 (82.5%) having used antimicrobials in the last 12 months. Most farmers (n = 184, 74.8%) obtained drugs and dosage from veterinary doctors, with majority following the recommended dosage (n = 227, 92.3%) and proper withdrawal periods (n = 221, 89.8%). Overall, few farmers (n = 81, 32.9%) received training on AMR, with more than half getting training from veterinary professionals (n = 41, 55.4%). The major source of information was veterinary professionals (n = 181, 73.6%), followed by radio stations (n = 160, 65.0%). Using logistic regression where P<0.05 was considered statistically significant, secondary education was the only factor significantly influencing AMR awareness at multivariable analysis (aOR: 1.85, 95% CI: 0.80-4.26, P=0.030), while age group 52-85 years was the only factor significantly associated with appropriate practices at both bivariate analysis (cOR: 8.10, 95% CI: 1.07-61.37, P=0.043) and multivariable analysis with a stronger significance (aOR: 11.19, 95% CI: 1.50-83.36, P=0.018). A chi-square analysis was done where P<0.05 was considered statistically significant, and it showed that there was a significant difference to access to veterinary services across districts (P=0.014) and a highly significant association between training and appropriate practices in farmers (X 2 (1) = 13.048, P=0.000). Most livestock farmers had limited understanding of what AMR precisely means, which highlights a significant knowledge gap.

Preventive oral healthcare is essential for overall well-being, yet its delivery varies significantly across Europe due to structural, cultural, and socioeconomic factors. Current dental systems often prioritise treatment over prevention, highlighting a need to understand public attitudes toward preventive care. This study uses the validated PAPOH questionnaire to explore the cross-country differences in 6 domains related to their attitudes and experiences of prevention in oral healthcare across six European countries. Participants were recruited via a market research company to ensure demographic representativeness. The PAPOH questionnaire assessed 6 domains: cost, motivation, responsibility, advice received, whether personalised advice was given and knowledge. Data were analysed using linear and logistic regression models, adjusted for variables including age, income, and access to dental care. Ethical approvals were secured across participating institutions. There were 3,372 participants in six countries sampled by age and gender. Over half (54.8%) reported below-average incomes. The analysis on cost being a barrier showed this was a feature for Ireland (aOR 1.90) and Hungary (aOR 1.61), for Germany this was less of a feature (aOR 0.64). Motivation- Ireland (AMD 0.83) and Hungary (AMD 1.26) scored higher than the UK, while The Netherlands scored lower (AMD - 0.65). Hungary reported higher responsibility scores (aOR 1.58). Preventive advice was rated higher in Ireland (aOR 1.50) and Hungary (aOR 2.80), but lower in Denmark and The Netherlands. Personalised advice was noted more in Denmark (aOR 1.88) and The Netherlands (aOR 1.51). Knowledge scores were lower in all countries except Denmark which may have been due to practices around rinsing after brushing. Significant cross-country differences in attitudes and experiences highlight the role of socioeconomic and cultural factors in shaping preventive oral healthcare. Tailored public health strategies and improved cross-national messaging are essential to address disparities and enhance preventive care delivery.

Interstitial lung disease (ILD) is one of the most common manifestations of systemic sclerosis (SSc), with most patients requiring treatment with immunosuppressive or anti-fibrotic agents to control ILD progression. Since gastrointestinal (GI) tract complications are widespread in this patient setting, we focused on their prevention and management. We conducted a modified Delphi study following best practices for consensus studies. We involved 20 expert rheumatologists from 8 Italian regions in two online rounds conducted between April and September 2024. An agreement of at least two-thirds of panellists was achieved on most topics explored, including the need for a preliminary evaluation of GI status in patients with SSc-ILD undergoing anti-fibrotic therapy (100% agreement), taking into account the presence of pre-existing diarrhoea (100%), weight loss (95%) and nausea/loss of appetite (100%), the definition of specific tests and exams for these conditions, the need of informing patients on potential GI complications (100%) and nutritional preventive advice (85%), and the monitoring of GI status during anti-fibrotic therapy (100%), at 3-month intervals (75%). Further, dose-reduction of anti-fibrotic therapy and, if needed, temporary discontinuation, was agreed in presence of side effects including diarrhoea (95%) or weight loss (85%). In the presence of nausea or loss of appetite, dose-reduction was also agreed, with no immediate need for drug discontinuation (90%). This study provided a detailed list of expert-based recommendations to guide everyday clinical practice of SSc-ILD, though prospective validation is needed to confirm their effectiveness in preventing and managing GI side effects.

IntroductionHealth literacy (HL) is essential for making informed health-related decisions, for example enabling parents to reduce their child’s allergy risk. Health literacy does not, however, rely solely on an individual’s capacities, but is strongly influenced by external factors. Midwives provide important health advice to families, particularly since their relationship is close during a time of significant transition. This offers them a unique opportunity to positively influence the HL of parents, which in turn may support the health and well-being of the whole family. The aim of this study is to develop and evaluate an intervention that can support midwives in providing allergy prevention advice in a way that is in line with the concept of HL.Methods and analysisIn accordance with the recommendations of the Medical Research Council framework in the first phase of this study, we will survey midwives (target sample size=379) in Germany regarding their practices, the potential barriers they face and enabling factors in providing advice on early childhood allergy prevention in an HL-responsive way. The data will be subjected to descriptive statistical analysis. Two co-design workshops will then be conducted with various stakeholders in two regions (Rhineland-Palatinate and Saxony) of Germany. Following the protocol proposed by the Stanford Design Thinking School, we will use design thinking to collect ideas for the intervention. Based on these ideas and our previous qualitative and quantitative study, we will develop an intervention in collaboration with didactic experts. The intervention will be piloted in three groups (midwives=10–15, midwives working as practice supervisors=5–10, students of midwifery=10–20). For the process evaluation, we will use observation protocols of the intervention conduct and qualitative interviews. For the outcome evaluation, we will use a questionnaire and observations in simulation laboratories with students of midwifery.Ethics and disseminationThis study protocol was approved by the Ethics Committee of the University of Regensburg (ID 23-3441-101) and is in compliance with the Declaration of Helsinki. Participation in the study will only be possible after informed consent has been given. Our results will be presented at national and international conferences and published in scientific journals. Additionally, once it has been finalised, we will make the intervention available to educational institutions for (future) midwives.

Abstract In this paper we look at the translation of a Norwegian-language mobile app offering preventive health advice to parents with infants, studying the use of translation strategies as risk management (e.g. Pym, 2021). Analysing the think-aloud protocols of a translator and quality checker (QC) and examples from a ST/TT pair, we found that the core translation strategies chosen in the face of three translation challenges - lesser-known infant-care terminology, explicit references to the female body, and the oral register used in the app - were Paraphrase and Cultural filtering (Chesterman, 2016). These were, furthermore, used in executing a risk trade-off strategy: the risk of skewing the advice was considered smaller than losing potential readers by staying (uncomfortably) close to the ST. Reasons for the translator and QC's calculations of the relative importance of these risks might be low awareness of the degree of precision of the advice given in the ST (due to a lack of access to the full app, and/or the deceptive informality of the ST), habitual assumptions about the typical goals of apps (money-making, which calls for translations that will ‘sell’), and/or general pressure from domestication norm in translation into English.

BackgroundAbout 40% of cancers are preventable through evidence-based interventions; however, uptake remains suboptimal. Knowledge and acceptance of primary and secondary preventive measures in the general population is not sufficient. We hypothesized that a web-based tool providing comprehensive, easily accessible, and individualized information on preventive strategies for multiple tumor entities could support informed decisions.ObjectiveThis study aimed to evaluate an interactive web application offering guideline-based, risk-adapted information on preventive measures for colorectal, breast, and prostate cancer.MethodsThe content of web application was developed based on German S3 guidelines. Evaluation questions consisted of the system usability scale questionnaire and queries developed by the Prevent-Take-up consortium. An initial version was tested by two focus groups comprising general practitioners (GPs), specialists and patients, revised and then made publicly available in GPs’ offices, hospitals, and pharmacies. We report on the evaluation of the revised web application. Data were collected from 2022‐2023. The web application also gathers information regarding family and individual risk factors and offers personalized recommendations (eg, to seek further information). Personal data related to specific recommendations were not stored. Participants receiving a recommendation from the web application were asked to anonymously answer questions about the information provided and the website application’s functionality using a 5-point Likert scale. As breast cancer mainly occurs in women and prostate cancer only in men, the questions regarding prevention had intrinsic sex specific items and hence all data were evaluated by sex using descriptive statistics. The main evaluation questions were (1) usability or user-friendliness of the web application for cross-entity cancer prevention and (2) motivation of users to seek further preventive advice by the information received.ResultsData from the first 101 users (62 female, 38 male, one unspecified; predominantly aged 50‐70 y) showed high score regarding user-friendliness (female 47/62, 76%; male 25/38, 65%), question comprehensibility (female 54/62, 87%; male 32/38, 83%), and the relevance of recommendations (female 47/62, 76%; male 24/38, 63%). A total of 37/62 (59%) of female and 16/38 (44%) of male participants appreciated the web application’s functionality; 29/62 (47%) of female and 14/38 (37%) of male participants reported increased knowledge about prevention and early detection of colorectal, breast, and prostate cancers. Additionally, 44/62 (71%) of female and 18/38 (47%) of male participants expressed willingness to follow-up on the web application’s recommendations and seek more information from their GPs.ConclusionsOur web application for risk-adapted prevention across multiple cancers was rated as user-friendly by participants. Having used the web application, more female participants than males were willing to seek further information on prevention and early detection measures. Overall, our study demonstrates that a web application can be a useful tool to deliver integrated and individualized prevention recommendations.

Evaluating a user-centered design driven multifactorial falls risk assessment tool in primary care: a randomized effectiveness-implementation study.

Injuries are a common cause of harm to travellers, many of which can be prevented with some simple strategies and prior preparation. While general practitioners (GPs) often focus on immunisation and infectious disease prevention in travel consultations, they are also well-positioned to provide injury prevention advice. OBJECTIVE: This article aims to describe common injury categories among travellers. These include road injuries, water (and water safety), selfies, drugs and alcohol, and children and older adults. It also offers practical advice for GPs to share with patients to help reduce injury risk. This article outlines common injury risks faced by travellers and highlights the importance of tailored safety advice based on destination, activities and individual health status. The article also emphasises the value of a well-prepared first aid kit and the role of GPs in reinforcing safety behaviours. By incorporating injury prevention into pre-travel consultations, GPs can help reduce harm and potentially save lives.

BackgroundWhile the importance of prevention in the workplace is widely recognized, the implementation of preventive tasks by occupational physicians (OPs) in the Netherlands remains limited. To support OPs in their preventive role, a peer coaching intervention was developed and implemented in existing peer groups. Peer coaching has been studied in various settings, but not yet in the context of occupational health. The aim of this study was therefore to examine the effects of the intervention on OPs’ execution of preventive tasks in practice.MethodsA total of 41 peer groups including 231 OPs participated in this cluster randomized controlled trial, of which 21 groups were assigned to the intervention condition (N = 106) and 20 to the control condition (N = 125). The intervention consisted of three peer coaching meetings aimed to promote the execution of preventive tasks. Data regarding the execution of preventive tasks, measured as percentage of their working time and hours allocated to specific preventive tasks, were collected at baseline, six-month and twelve-month follow-up. The effect of the intervention was examined by linear multilevel analysis.ResultsBoth the intervention and control group increased the percentage of working time allocated to prevention, from 14% at baseline to 17% at twelve-months follow-up, but no significant differences between the study groups were found. For specific preventive tasks, the intervention group increased their time allocated to giving secondary prevention advice with 5 monthly hours compared to baseline. For other preventive tasks, no effects were found.DiscussionThe intervention was found to not have an effect: both the intervention and control condition significantly increased their percentage of working time allocated to preventive tasks. This was possibly due to contextual factors. Future studies should focus on willingness of employers and OHS to invest in prevention, and refinement of the intervention under study.Key messages• Despite the intervention, time allocated to prevention increased equally in both groups, likely due to growing contextual awareness in the professional field about the importance of prevention.• The intervention improved time spent on secondary prevention, but systemic barriers like employer cooperation and financial incentives limited broader implementation of preventive tasks.

Due to their antimicrobial constituents, mouthwashes are well-known to be clinically effective for reducing plaque biofilms containing bacteria and reducing gingival inflammation. However, with a variety of products now available (often containing more than one active ingredient), it is important to consider which chemical constituents are most suitable for different types of oral disease and how mouthwashes should be best used. This article thus updates professionals on techniques for use and which agent to select, using current professional guidelines and the highest level of evidence available. As examples, clinicians need to be aware of adjunctive approaches for mouthwash use and 'spit don't rinse with water' instructions. However, there is currently insufficient evidence on mouthwashes and the oral microbiome (including systemic health) to support microbiome testing to guide a choice. After consulting the literature, this article reiterates that adjunctive fluoride mouthwashes, alongside effective toothbrushing and interdental cleaning, are effective for preventing dental caries. Adjunctive chlorhexidine, essential oils and/or cetylpyridinium chloride mouthwashes may also be effective for managing plaque-induced periodontal diseases at early stages. Some possible risks to mouthwash use are highlighted, including allergies, tooth staining and oral microbiome dysbiosis. Until more evidence is available, clinicians should ensure that benefits outweigh risks and refer to current mouthwash guidelines to support personalised preventive care advice.

Chikungunya is a mosquito-spread virus that can cause an unpleasant influenza-like illness, with fever and severe joint pain. This virus is found in tropical and sub-tropical countries worldwide, with risk regions including the Caribbean, South and Central America, Africa, Asia and the Pacific Islands. Chikungunya cases and outbreaks are increasingly being reported outside of tropical areas, including mainland Europe. No locally acquired cases have been reported in the UK, but imported cases have been confirmed in returning travellers. All UK travellers visiting risk areas should be advised to follow good insect bite prevention advice. Two new chikungunya vaccines have been licensed in the UK. Practice nurses advising travellers about chikungunya should be familiar with the Joint Committee on Vaccination and Immunisation guidance about these newly licenced vaccines, which are not currently expected to be available on the NHS. This article provides an overview of chikungunya, including symptoms, treatment and prevention.

BackgroundThis study aims to develop a advanced machine learning model to predict the fall risk among community-dwelling elders. This study could present actionable advices for early prevention of fall risk.MethodsBetween October and December 2022, 977 older adults from the Hannan District of Wuhan were recruited. Data was collected using structured questionnaires. The sample was randomly split into training (732 participants) and testing (245 participants) sets at a 3:1 ratio. The primary outcome was the occurrence of fall. Five machine learning models—Random Forest (RF), Gradient Boosted Decision Tree (GBDT), Light Gradient Boosting Machine (LGBM), Extreme Gradient Boosting (XGBoost), and Categorical Features Gradient Boosting (CatBoost)—were evaluated against a Logistic Regression (LR) model. Model performance was assessed using AUC, accuracy, precision, sensitivity, specificity, and F1 score.ResultsAmong the 977 older adults, 195 experienced falls (20.0%). ROC curve analysis showed AUC values of LR, RF, LGBM, GBDT, XGBoost, and CatBoost were, respectively, 0.8390, 0.8632, 0.8614, 0.8544, 0.8705, and 0.8719. CatBoost had the highest AUC, indicating the best predictive performance. SHapley Additive exPlanations (SHAP) analysis identified key features influencing the CatBoost model: history of falls, comorbidities, polypharmacy, sleep disorders, ADL, TUG results, frailty status, and use of assistive devices.ConclusionThe fall risk prediction model for community-dwelling older adults, developed with CatBoost, showed excellent performance and can aid in early clinical assessment and fall prevention.

Content analysis of malaria-related health information published in online travel blogs.