Prevention Programs Research Articles

Beyond secondary prevention drugs: added benefit in survival and events of a healthy lifestyle in patients after an acute coronary syndrome

Abstract Background Despite advances in drug treatment and secondary prevention programs, cardiovascular disease remains the leading cause of death. The full extent and independent benefit of a healthy lifestyle, particularly after optimal medical therapy in secondary prevention, has not been widely reported. Purpose To quantify the added benefit on survival and events of a healthy lifestyle following an acute coronary syndrome (ACS). Our study seeks to answer the question: Is adherence to medical therapy sufficient or a healthy lifestyle provides additional improvement?. Methods This a prospective observational multi-center study of 685 patients included during admission for ACS. At 6 months patients were asked about their post-ACS lifestyle and were given a score (range: 0-7) with the following items: Intake of ≥3 fruits and vegetables/day, ≥2 fish servings/week, ≤7 alcohol beverages/week, feeling stress RESULTS: After adjusting for demographic variables, cardiovascular risk factors, characteristics of the index event, high-sensitivity C-reactive protein (hs-CRP), and drug therapy, multivariate Cox regression showed that the lifestyle SCORE was independently and inversely associated with both the incidence of the primary outcome (ischemic events [any ACS, stroke, or Transient Ischemic Attack] or death) (HR 0.65 (CI95% 0.44-0.96); p=0.029) and death (HR 0.41 [95%CI 0.18-0.91]; p=0.029). Statin therapy was also independently and inversely associated with both the incidence of the primary outcome. Kaplan-Meier curves showed a higher event-free survival for both outcomes in patients with SCORE≥4 than in those with SCORE<4 (p=0.03 and p<0.001, respectively). Additionally, patients with a SCORE≥4 had a significantly greater decrease of total cholesterol (-52 [-16.5, -79] vs -38 [-7.5, -68] mg/dl; p=0.040) and hs-CRP (-1.1 [-0.1, 2.5] vs -0.5 [0.7, -1.9] mg/L; p=0.001) at six months. Conclusions Among patients with ACS and similar medical therapy, a healthy lifestyle is an independent and added marker of a lower incidence of ischemic events and death. It is also associated with a better lipid profile and lower inflammation.

Backyard flock sampling and artificial intelligence: A dual strategy for early detection of Avian Influenza and Newcastle Disease

Avian Influenza (AI) and Newcastle Disease (ND) are significant avian diseases that pose substantial threats to the commercial poultry industry due to their high contagion rates and potential for severe outcomes. Recent shifts in the epidemiology and ecology of both viruses have led to devastating impacts on wild bird and poultry populations, as well as farms and communities worldwide. These challenges underscore the necessity for One Health approaches to pandemic prevention and preparedness, emphasizing the need for multisectoral collaboration among animal, environmental, and public health sectors. To mitigate future pandemic risks, it is essential to control the transmission of AI and ND viruses among domestic and wild animals as well as humans. This involves addressing the upstream drivers of outbreaks, ensuring rapid response mechanisms, and conducting thorough risk assessments for zoonotic diseases. Effective implementation and maintenance of prevention programs, surveillance, and outbreak responses require strong political commitment and sustainable funding. A robust combination of active and passive surveillance strategies should be applied to monitor and control them. In addition, the integration of modern technologies, such as artificial intelligence and big data analytics, can enhance both active and passive surveillance efforts by improving the accuracy and speed of data collection, analysis, and reporting. The use of backyard flocks as an early warning system for avian diseases represents a proactive approach to understanding and managing the risks associated with AI and ND through targeted surveillance and timely interventions. In response to these challenges, the EpirORNIS Project aimed to leverage these sentinel backyard flocks for early detection of AI and ND, thereby enhancing surveillance and control strategies.

Stability and change in moral disengagement and bullying participation across three years of Japanese middle school

ABSTRACT The present study investigates the longitudinal relationships between bullying roles (bullying, passive bystanding, victimization) and moral disengagement to examine influences on the shifting role of bullying in Japanese middle school students. Participants were 271 Japanese students (Time 1: M age = 12.72, SD = .45, 136 boys and 135 girls) recruited from two public middle schools (9 classes). Five data collection occasions in Grades 7 to 9 alternated between surveys of self-reported bullying behavior (three timepoints) and moral disengagement (two timepoints). Structural equation modeling showed that moral disengagement was reciprocally related to bullying and passive bystanding. Victimization was only related to moral disengagement in Grade 9, such that moral disengagement in June predicted increased victimization experiences in December. These findings suggest that intervention and prevention programs in schools need to actively address moral disengagement, with a focus on bystanders as well as perpetrators and victims of bullying.

Effect of malocclusion severity on oral health and its correlation with socioeconomical status in Iranian adolescents

BackgroundThis study aimed to assess the effect of malocclusion severity according to the Index of Treatment Need (IOTN) on oral health (dental caries and gingivitis), and its correlation with socioeconomic status (SES) in Iranian adolescents.MethodsThis descriptive cross-sectional study was conducted on adolescents between 10 and 16 years in Tehran city, who underwent clinical dental examination. The Dental Health Component (DHC) of the IOTN was used to assess the severity of malocclusion. The DMFT index was calculated to assess dental caries, and the gingival index (GI) was calculated for gingival health assessment. For oral hygiene assessment, the Oral Hygiene Index-Simplified (OHI-S) was calculated, and a questionnaire was used.ResultsTotally, 306 adolescents participated in this study. The frequency of IOTN grades was 88 (28.8%), 89 (26.1%) ,49 (16%), 60 (19.6%), and 29 (9.5%) for grades 1 to 5, respectively. The multinomial logistic regression showed that by an increase in OHI-S score, the odds of having IOTN grade 4 compared to grade 1 increased. Postgraduate parental level of education decreased the odds of having IOTN grade 4 compared to grade 1. Furthermore, there was an inverse correlation between oral hygiene practice and the odds of having IOTN grade 5 compared to grade 1.ConclusionsMalocclusion may hinder oral hygiene practice, and resultantly increase plaque accumulation. This risk may be amplified in children with lower SES, highlighting the need for preventive and educational oral health programs.

OASAS will deliver free test strips and naloxone to New Yorkers

New Yorkers can get free fentanyl test strips, xylazine test strips and/or naloxone from the state Office of Addiction Services and Supports (OASAS). These can be requested from the local Opioid Overdose Prevention Program or a pharmacy, according to OASAS, if supplies are needed immediately. For a directory of Opioid Overdose Prevention Programs, go here. Delivery will take two weeks, according to OASAS. To order the test strips and naloxone, submit a request through the website: https://forms.ny.gov/s3/Harm‐Reduction‐Order‐Form. The initiative is paid for by the Opioid Settlement Fund.

Colorectal cancer research priorities in Uganda: perspectives from local key experts and stakeholders.

The incidence of colorectal cancer (CRC) is increasing in Uganda but there is limited local research to guide policy and programming for CRC prevention and control. A stakeholder engagement workshop took place in Kampala on 19March 2024 to identify challenges and opportunities for CRC prevention and control in Uganda. A total of 30 stakeholders with expertise in CRC primary and secondary prevention, diagnosis, treatment, palliative care as well as cancer survivors participated in the workshop. Key challenges for primary prevention included low knowledge/awareness of CRC among the general population and health workers, and rising prevalence of CRC related risk factors. Limited CRC screening, diagnostic facilities and specialists were identified as barriers to diagnosis. Treatment related challenges included limited accessibility to surgical services and drugs, late-stage presentation leading to poor treatment response, treatment abandonment and drug related toxicity. Lack of universal health coverage policies, limited community-based cancer awareness programs, and lack of national cancer registries were cited as policy and economics challenges. Opportunities to address these challenges were discussed. Our findings highlight areas for further research and prioritization to address Uganda's growing CRC burden and may be applicable to other low-resource settings.

Neuroplasticity and Cocaine Exposure During Adolescence

The adolescent brain is particularly vulnerable to the effects of cocaine exposure due to ongoing neurodevelopment especially in areas that are crucial for cognitive and emotional regulation. This review explores the multifaceted impact of cocaine on neuroplasticity during adolescence, thereby highlighting both the immediate and long-term consequences of drug exposure. Key findings from recent studies indicate that cocaine use during adolescence leads to significant alterations in synaptic plasticity, dendritic spine morphology, and neurotransmitter systems, which may persist into adulthood and contribute to addictive behaviors. Additionally, the interaction between genetic predispositions, environmental stressors, and drug exposure is emphasized. The review also analyzed the risks of early-life stress and social isolation on cocaine-induced neuroplasticity, which can render anxiety-related behaviors and lead to neurological changes. Future studies should incorporate longitudinal design to understand the long-term trajectory of neuroplasticity induced by cocaine. This paper can provide some suggestions to the development of prevention and intervention programs for adolescents at risk.

Factors Associated with the Rate of Initial Parental Engagement in a Parenting Program Aimed at Preventing Children's Behavioural Problems.

Parenting programs have been shown to be effective in preventing and reducing externalising problems in young children. Despite their efficacy, the low rate of initial parental engagement in these programs is a major challenge for clinicians and researchers. Few studies have examined factors associated with rates of initial engagement in parenting prevention programs, most probably due to limited data on families refusing intervention. The purpose of this study was to examine the sociodemographic characteristics as well as child and parent characteristics in the prediction of parents' refusal to engage in a randomised control trial (RCT) evaluating the parenting program ÉQUIPE (French version of COPE) offered as a prevention intervention to families with preschool children (4-5years) who showed low self-control at the age of 2years. A total of 268 families were recruited from a longitudinal community sample followed from pregnancy (3D study), with 162 parents accepting to be randomised to a control or intervention group and 106 families refusing to engage in the RCT. Of the 83 families randomised to the intervention condition, 32 accepted, and 51 refused to participate in the intervention before or during the transition to formal schooling. ANOVAs and logistic regressions were used to examine factors associated with parents' refusal to engage in (1) the RCT and (2) the intervention. Results showed that parents who reported lower scores on perceived parental efficacy and higher perceived relationship quality had higher odds of refusing to participate in the study. Also, participating parents who refused to participate in the intervention were more likely parents of girls and reported significantly higher parental efficacy and impact. The findings of the current study could guide clinicians and researchers in improving parental recruitment strategies.

Perceptions and experiences of a multi-domain preventive health programme: a qualitative study informing future community-based health interventions in singapore

BackgroundDespite global popularity, Community-based Health Intervention (CBHI) programmes have yet to be fully incorporated into Singapore’s public healthcare systems, with most initiatives focusing on specific diseases. This qualitative study aimed to evaluate older adults’ perceptions of the “Get Well, Live Well” multi-domain preventive health programme, explore the effectiveness of Community Health Workers (CHWs) in promoting health literacy and modifying health behaviours, and examine participants’ experiences in the CHW-delivered CBHI programme.MethodsPurposeful sampling was used to recruit study subjects from participants in the “Get Well, Live Well” programme until data saturation was achieved. In-depth, semi-structured, one-to-one telephone interviews were conducted in English or Chinese with participants aged ≥ 40 years. Audio recordings were translated into English as needed and transcribed in full. The collected data were anonymised, and thematic analysis was performed by three trained evaluators using a structured process.ResultsThe final study sample included 19 subjects (median age of 64 years; 84% women; and 95% Chinese). Three key themes emerged regarding the programme’s value, interactions with CHW, also known as Care Connectors, and their facilitation of health services/behaviours. Participants acknowledged that the “Get Well, Live Well” programme provided physical/emotional support, improved health literacy, and enhanced social interaction. The programme’s effectiveness may depend on Care Connector’s personal qualities, service quality beyond expectation, connection with participants, and their proactive and authoritative roles in facilitating health services/behaviours.ConclusionThe findings suggest that future Community-based Health Interventions could benefit from deploying CHWs with strong people skills to enhance the programme’s success.

Discussion of HIV and Other Sexually Transmitted Infections with Sex Partners of Nigerian Men who have Sex with Men and Transgender Women: Implications for Interventions to Promote Safer Sex Practices.

Discussion of HIV and other sexually transmitted infections (STIs) among sex partners facilitates risk reduction. We evaluated HIV/STI-related communications, including broad assessment of any self-reported discussion of the topic and specific discussion of each partners' HIV status, among a historically marginalized and presently criminalized community of sexual and gender minorities (SGM) in Nigeria. From 2013-2018, we enrolled SGM aged 18+ in Lagos or 16+ in Abuja who reported anal sex with men. At enrollment and 3-, 9-, and 15-month follow-up visits, participants were asked about their sexual behaviors and communications with main sexual partners (MSP) and casual sexual partners (CSP). Questions included "have you talked with your [MSP/CSP] about sexually transmitted infections and HIV?" Multivariable robust Poisson regression with generalized estimating equations was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV/STI-related communications with some or all of each type of sexual partner. Among 2795 SGM enrolled with median age 23 years (interquartile range 20-27), questions about HIV/STI-related communications with MSP were answered by 2436 (87.2%) and with CSP by 2398 (85.9%). Communication with MSP was reported by 68.1% (1659/2436), of whom 897 (54.1%) discussed their own HIV status and 925 (55.8%) discussed their partner's status. Communication with CSP was reported by 43.9% (1052/2398), of whom 389 (37.0%) discussed their own HIV status and 385 (36.6%) discussed their partner's status. Among participants with both MSP and CSP, HIV/STI-related communication with MSP was more common among participants with higher than secondary education (aRR 1.40 [95%CI 1.24-1.58)], who were divorced/separated/widowed (aRR 1.19 [95% CI 1.06-1.33]), who discussed their HIV status with CSP (aRR 1.18 [95%CI 1.10-1.25]), discussed CSP's HIV status (aRR 1.20 [95%CI 1.13-1.27]), and used a condom at last sex with CSP (aRR 1.16 [95%CI 1.08-1.25]). HIV/STI-related communication with CSP was more common among participants with higher than secondary education (aRR 1.36 [95%CI 1.12-1.66]); who were divorced/separated/widowed (aRR 1.38 [95%CI 1.13-1.69]), who discussed their HIV status with MSP (aRR 1.47 [95%CI 1.27-1.69]), who discussed CSP's HIV status (aRR 1.22 [95%CI 1.06-1.40]) and used a condom at last sex with CSP (aRR 1.22 (95%CI 1.08-1.38]). HIV/STI-related communications with main and casual sex partners were both associated with safer sex with CSP. HIV prevention and treatment programs for SGM should promote open communications in sexual relationships and consider deployment of modern strategies to facilitate disclosure, especially in settings with criminalizing legislation.

Relationship of Tetrad Dark Personality Traits and Delinquent Behavior among Adolescents: Moderating Role of Social Support

The current research studies the relationship between Dark Tetrad personality dimensions: Machiavellianism, narcissism, psychopathy, sadism, and delinquency in adolescence while considering the role of social support as the moderator. For this study the cross-sectional research design was used and the sample included 300 adolescents comprising 150 males and 150 females in the age group of 10 to 19 years randomly selected from twin cities of Islamabad and Rawalpindi. The data were collected using the Short Dark Tetrad (SD4) self-reported delinquency – Problem Behavior Frequency Scale and Child and Adolescent Social Support Scale (CASSS). The analyses conducted found positive and significant correlations between the dark personality traits and the delinquent behaviors with each of the dark personality traits being positively correlated with the manifests of delinquent behaviour. Furthermore, the study revealed that social support acted as a moderator that could help decrease the delinquency rate among the adolescents who possess a high level of dark personality traits. These imply that dark personality facets and insufficient social support should be targeted to reduce delinquency among adolescents. The results imply that any prevention or treatment programs targeted at decreasing delinquency must take into account the presence of dark personality features in adolescents, especially through modulating the perceived usefulness of social support. The insights from the research can be quite useful for schools, families, and community-oriented programs to design effective interventions not only to address behavior management but also to address the potentially detrimental effects associated with these personality traits.

Moving Diabetes Prevention Programs to the Workplace: A Qualitative Exploration of Barriers and Facilitators to Participant Engagement When Implemented by an Employer-Based Clinic.

The Diabetes Prevention Program (DPP), an effective evidence-based strategy to reduce the incidence of type 2 diabetes, has been widely implemented in various locations, including workplaces. However, most people do not remain engaged in the program for the recommended full year. Limited qualitative research exists around participant engagement in the workplace DPP. Our study aimed to explore participant engagement in the DPP delivered through the employer-based clinic (EBC) at a large technology company. The DPP was implemented through the EBC at a large technology company in Southern California, beginning in September 2019 by using in-person and virtual synchronous group classes before and during the COVID-19 pandemic. Virtual focus groups with DPP participants from 2 inaugural cohorts were conducted via Zoom from October 2020 to February 2021. Data were analyzed by using inductive thematic analysis. Five focus groups with 2 to 3 participants in each (total n = 12) were conducted, 2 focus groups per cohort and 1 focus group with the group instructors. Barriers and facilitators to engagement in the DPP were grouped into thematic domains: Individual Drivers, Small Group Community, Workplace Setting, Integrated EBC, and the COVID-19 Pandemic. Results showed that prepandemic workplace demands (ie, meetings, travel) affected DPP participation, yet the group setting provided social support in the workplace to engage in and maintain healthy habits. With the move to a virtual synchronous offering during the pandemic, participants valued the group setting but expressed a preference for in-person meetings. Collectively, participant engagement was bolstered by shared buy-in and collaboration between the employer and the EBC. Our findings suggest that engagement in a workplace DPP can be supported by addressing workplace-specific barriers and gaining buy-in from employers. Delivering the DPP, in person and virtually, through an EBC has the potential to engage employees who have prediabetes.

Internalizing Pathways to Adolescent Substance Use from Adverse Childhood Experiences

The mediating role of anxious, depressive, and somatic symptoms was examined in the association between adverse childhood experiences (ACEs) and adolescent substance use, with attention to the unique effects of each set of symptoms within the same model. Adolescents (n = 701) were assessed over time (ages 3–17) in a majority male (70.5%) and white (89.9%) sample. Findings indicate that depressive symptoms mediated the association between ACEs and adolescent cigarette and marijuana use. Although significant indirect effects remained when accounting for externalizing behavior, a novel protective pathway emerged through parent-reported youth anxiety and alcohol use. Assessing internalizing symptoms as separate facets within the same model is critical if we are to inform prevention programs that are tailored to the individual needs of youth who have experienced ACEs.

Exploring reciprocal links between early adolescent coping and internalizing symptoms.

The rising prevalence of depression and anxiety among adolescents is a public health concern. Early adolescence is a key developmental period to reduce risks for internalizing symptoms through primary prevention programs, yet additional research is needed on modifiable factors, such as coping skills, to target to mitigate risk factors. Therefore, we investigated the reciprocal link between coping style and internalizing symptoms among a racially/ethnically diverse sample of early adolescents (n = 1273) from 12 middle schools over 1 year. We leveraged a longitudinal data set of a cluster, randomized trial of a preventive intervention from 12 middle schools in a large public-school district in the United States to test our hypotheses using multilevel modeling. The sample was 49% female and racially/ethnically diverse (39% Hispanic/Latinx, 23% Black/African American, 12% Asian or Pacific Islander, 11% other, 9% White, and 5% multiracial). Participants (ages 12-14) completed a baseline questionnaire in 7th grade (Spring 2018) and a 1-year follow-up questionnaire in 8th grade (Spring 2019). Depressive and anxious symptoms affected levels of active and avoidant coping skill use over the 1-year period of the study, indicating that symptoms can be an impetus for maladaptive coping. We also identified bidirectional links between active coping and depression in addition to avoidant coping and anxiety. Our findings have implications for augmenting coping psychoeducation within prevention programs to reduce internalizing symptoms among early adolescents and for future longitudinal and qualitative research exploring how coping skills reduce risks for internalizing symptoms throughout adolescence and into early adulthood.

79 Using artificial intelligence and machine learning to automate injury prevention surveillance data

Abstract Background The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is a pan-Canadian injury and poisoning surveillance system that tracks patients presenting to Canadian Emergency Departments (EDs). Like many surveillance systems, data is input in a manual fashion with humans screening all charts. Natural language processing algorithms using transformer models can analyze text from triage notes of previous CHIRPP-positive patients to train models to predict future CHIRPP patients. We sought to automate these functions using machine learning and artificial intelligence. Objectives The objective of this initiative is to automate detection of injured patients using artificial intelligence. Once charts are identified, a further summarization model will automatically generate a narrative of the events surrounding the injury, as required for the surveillance system. Design/Methods ED notes were obtained from an electronic health record for all patients visiting the ED from October 2018 to December 2021 (n =203626). All charts were manually reviewed to determine if patients met the criteria for CHIRPP. CHIRPP-positive patients made up 24.8% (n = 50499) of the total presentations. Patient charts were randomly split into train (70%) and validation (30%) datasets. Pre-trained distilbert-base-uncased model from Huggingface was utilized. The best model according to AUROC was selected for further development. For note summarization, we fine-tuned a multi-task model (t5-small) from the Huggingface repository. We used human summaries from the same dataset (October 2018-December 2021) as training data (49,078 note, summary pairs). A 70/30 train/validation split was performed. Results Our model captured 90% of all positive cases while reducing the total number of charts for review by 77%, 75% and 63% for train, validation and test sets respectively. See AUC curve (figure 1). Based on 2022 volumes this is a reduction to 24,027 from 64,938 charts. For note summarization, when we compared the cosine similarities of human summaries to actual note text vs t5-small summaries to note text we saw remarkable similarity implying high model performance. Conclusion Our model has shown that high volumes of charts that were previously screened manually can utilize natural language processing to automate the task with minimal sacrifices in terms of data capture and accuracy, dramatically reducing cost while improving speed to reporting. Our summarization model also showed potential for further automating this process. This application to an injury prevention program has wide scale applicability and scalability.

Advancing Pharmaceutical Care in Community Pharmacies in Poland: A Blueprint for Enhanced Patient Care Quality

Background: This article reviews the current state of pharmaceutical care in community pharmacies in Poland and proposes a collaborative framework for its advancement. While pharmaceutical care has evolved significantly worldwide, with Europe leading the way, Poland has lagged in its development. Although Polish pharmacists are well-qualified and community pharmacies are numerous, pharmaceutical care remains underdeveloped. Methods: We conducted a literature review and analyzed case studies from European countries with advanced pharmaceutical services. Based on these findings, we collaborated with policy makers, commissioners, and academics to develop a framework for enhancing pharmaceutical care in Poland. The plan emphasizes integrating seven key services into Polish community pharmacies. Results: Our proposed framework outlines seven essential pharmaceutical services: medicine use reviews, new medicine services, minor ailment services, repeat prescription services, integrated prevention programs, cardiovascular disease prevention programs, and vaccination programs. Evidence from other European countries suggests that implementing these services could significantly improve health outcomes and patient quality of life. This is particularly important in light of Poland’s ageing population, the rising prevalence of chronic diseases, and the healthcare system’s increasing burden due to polypharmacy. Conclusions: The proposed framework presents a practical and collaborative approach to advancing pharmaceutical care in Poland. By adopting these key services, community pharmacies could play a more integral role in improving patient care quality and alleviating pressure on the broader healthcare system.

12 Access to paediatric maltreatment services through a northern community hospital

Abstract Background Few studies have evaluated how paediatric maltreatment services based in community hospitals can provide access to care for populations who live far away from tertiary centres. The Violence Intervention Prevention Program (VIPP) and the Paediatric Abuse and Referral Evaluation (PARE) clinic based in a northern community hospital in Canada offer assessment for sexual and physical maltreatment. Objectives The aim of the study was to describe demographic and clinical characteristics of patients accessing VIPP and PARE services and to characterize the length of time required to access care. Design/Methods We conducted a retrospective chart review of patients, under 16 years of age, who attended PARE clinic for initial consultation between 2017-2019. Analyses were descriptive. This work was approved by the research ethics board at our hospital. There are no funding disclosures. Results Of 164 patients, 62.2% were female; 37.8% male. The mean age was 6.6 years, ranging from 1 month to 15.9 years. 54.3% of referrals were for suspected physical maltreatment, 44.4% for suspected sexual maltreatment and 1.2% for both. 87.5% of patients listed home addresses within the hospital’s city limits. The maximum distance travelled from home to access care was 171 km. 87.2% of patients presented through the emergency department; a minority presented through direct referral to outpatient services (11.5%) or through inpatient (1.2%). When called from the emergency department, on-call VIPP nurses responded within a mean of 32 minutes for initial assessment. These patients received a maltreatment assessment by a paediatrician through the PARE clinic a mean of 14.3 days later. If patients did not present through the emergency department, the mean wait time for a maltreatment assessment by a paediatrician was 16 days. 13.4% (22/164) required referral to other medical or multidisciplinary services. General paediatrics (11/22) was the most frequent referral, followed by community speech programs (5/22). A minority (3.0%) of cases required consultation with external maltreatment teams, where two cases were peer-reviewed with a tertiary care team, one with a paediatric maltreatment physician at another community hospital and two cases were reviewed with a paediatric tertiary care radiologist. Conclusion Our results suggest that community-based paediatric maltreatment services provide care for our regional northern population. There is timely on-call access to allied-health providers through the emergency department. All patients were able to be assessed locally and none were required to travel to a tertiary care hospital. Further study is needed to assess how our data compares to other community maltreatment programs.

Risks of Cervical Cancer Recurrence After Fertility-Sparing Surgery and the Role of Human Papillomavirus Infection Types

Cervical cancer is a largely preventable malignancy of the uterine cervix. The tendencies in cervical cancer morbidity and mortality have remained similar for the past decade, albeit with increasing frequency in low- and middle-income countries (LMICs). Moreover, in the majority of LMICs, cervical cancer is the second most prevalent cancer and the second most common cause of cancer-related death among reproductive-age women. High-risk human papillomavirus (HR-HPV) infections have been proven to be associated with up to 95% of cervical cancer cases, with HPV-16 and HPV-18 types being responsible for approximately 70% of all cervical cancers, with the other high-risk HPV types accounting for up to a further 25%. More recently, the latest data appear to confirm there is a change in the frequency of HR-HPV occurrence, especially HPV-16 and HPV-18, as a reflection of the implementation of preventive vaccination programs. Owing to the growing incidence of cervical cancer among reproductive-age women and with the development of cancer management approaches, fertility-sparing options have been proposed for early-stage cervical cancer management as an option for young women, especially those with unaccomplished reproductive desires. However, methods applied for this purpose (cold-knife conization, loop electrosurgical excision, trachelectomy) have variable outcomes and do not prevent risks of relapse. Multiple factors are involved in cervical cancer recurrence, even in cases treated at the early stage of the disease. In this review, the authors unveil whether HPV infection and virus type could be one of the key factors associated with cervical cancer recurrence after fertility-sparing surgery. Reviews of the literature reveal that recurrent and persistent HR-HPV infection is a strong predictor of cervical lesions’ relapse. In particular, HPV-16 and HPV-18 infections and their persistence have been reported to be associated with cervical cancer recurrence. HR-HPV genotyping before and after fertility-sparing surgery for cervical cancer could facilitate a personalized approach and improve the overall survival rate. Screening for HR-HPV is essential during the follow-up of cervical cancer-treated women and will help to predict possible cancer recurrence.

Adverse Childhood Experiences in Parental History and how they Relate to Subsequent Observed Parent–Child Interaction: A Systematic Review

Abstract Background Adverse childhood experiences (ACEs) in parental history have been associated with higher self-reported rates of negative parenting behaviors and lower self-reported rates of positive parenting behaviors. Further research is needed to explore the association between parental ACEs and the observed parent–child interaction quality. Parent–child interactions are a potential pathway behind the continuity of ACEs across generations. Objective This review aimed to expand on existing literature by synthesizing evidence on the associations between parental ACEs and parent–child interactions, assessed through videotaped observations, the gold standard for interaction assessment. Methods A systematic literature search conducted in October 2022 in Medline, EMBASE, and PsycInfo identified twenty-four articles. The studies assessed parental childhood adversity and the quality of parent–child interaction across high- and low-risk samples. Results In 79% of studies, higher rates of childhood adversity were related to lower quality of observed parent–child interaction. Childhood abuse and neglect were linked to fewer positive and more negative parenting behaviors. Among household challenges, only witnessing family violence negatively impacted interaction quality. In 58% of studies, ACEs directly influenced interaction, while in 21% this effect was mediated by other factors. This pattern held across different sample types. Conclusions The evidence suggesting a relationship between parental ACEs and lower quality of parent–child interaction is robust, given the reliability and validity of observational measures. Considering the influence of the quality of parent–child interaction on a child’s development, interventions and prevention programs focusing on parent–child interaction should consider screening for parental ACEs.

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the “design thinking” framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND – Let’s get moving (physical activity intervention) and i-REBOUND – Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND – Let’s get moving and i-REBOUND – Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.