Preventive Health Interventions Research Articles

The Impact of Covid-19 Pandemic on Child Routine Immunization Programs: A Systematic Review

Immunization is one of the most successful, most accepted and proven cost-effective public health preventive interventions in the world and has saved 2 to 3 million children from immunization-preventable diseases. The COVID-19 outbreak and the effort being made to overcome the outbreak could cause negative impacts on the utilization of basic immunization services. During the outbreak, basic immunization coverage rate in various regions had decreased. This article conducted a comprehensive and systematic literature search in electronic databases (PubMed, ScienceDirect, Sage Journal, SpringerLink, ClinicalKey, and Oxford Academic) with articles published in the last 5 years and adjusted according to inclusion and exclusion criteria. This systematic review use PRISMA (Preferred, Reporting Items for Systematic Review and Meta-analysis). There were 2 studies that met the final inclusion criteria. The results showed a significant reduction of basic immunization coverage happen especially during the early period of pandemic. Six themes are identified related to the decrease: 1) Covid-19 lockdown; (2) motivation for childhood immunization; (3) availability of biosafety procedures and personal protective equipment (PPE); (4) service adjustments and guidelines during the pandemic; (5) the availability of vaccines; and (6) the resilience of the immunization program in view of COVID-19. Childhood routine immunization coverage rate significantly decreased during the early period of the pandemic. Interventions for providers and parents is required to ensure adequate catch-up of delayed/missed immunizations in order to prevent potential outbreaks of vaccine-preventable diseases.

The Effect of Social Contacts on the Uptake of Health Innovations among Older Ethnic Minorities in the UK: A Mixed Methods Study

Several studies have highlighted specific views on ageing among older migrants in Europe that tend to be outdated or more pessimistic than the general population. However, the current literature does not provide explanations for such observations. This mixed methods study considers the diffusion of innovation among older migrants as a possible explanatory factor. A critical component of the diffusion of innovation theory is how information is accessed, exchanged, and communicated through social contacts. This study employs the fundamental mathematical model of diffusion to examine the differential effects of diffusion of innovation based on the social contact rates among migrant groups compared to the overall UK population. As there is no direct information on social contact rates among migrants in the UK, the analysis uses the equivalence from the migrants’ home countries as proxies. This study utilises social matrices of contact data for the UK based on publicly available information from a European survey and other publications for the contact rate for three sending countries where there are large migrant groups in the UK and Europe (India, Pakistan and Turkey). The analysis shows that, when controlling for other factors, migrants are likely to suffer considerable delays in the diffusion of innovations compared to the majority UK population. The findings have several policy implications concerning promoting inclusive public health and disease prevention interventions, which are essential components of a sustainable healthcare system for an increasingly diverse UK older population.

The Long-Term Outcomes of Mental Health First Aid Training for University Students

AbstractThis study aimed to address current gaps in the literature on the impacts of Mental Health First Aid (MHFA) training by comparing long-term outcomes on different cohorts. University students studying health and non-health degrees, university staff and community members who had completed MHFA within the past three years completed a survey to assess their mental health literacy, and their use of knowledge and skills acquired through the training. The study found few significant differences between the different group outcomes and between different time points post-completion of MHFA. This study found that although participant-reported measures show positive outcomes from MHFA, further research on the common tools used to rate mental health literacy and how mental health literacy impacts behaviours and help-seeking would provide greater insight into the outcomes of running MHFA as a mental health prevention and early intervention program at universities.

Exploration of Health-Promoting Interventions Addressing Modifiable Health Factors & Perceptions of Health Status

Abstract Date Presented 04/21/2023 This study included a scoping review mapping preventive health interventions and semistructured interviews exploring how adults perceived their health and lifestyle as influencing their beliefs about health prevention. Primary Author and Speaker: Allison Naber Additional Authors and Speakers: Whitney Lucas Molitor

Mental health intervention research in Latin American correctional settings: A scoping review.

The Latin American prison population has grown faster than anywhere else globally over the past two decades, reaching a total of 1.7 million people at any given time. However, research on mental health prevention and treatment interventions in Latin American prisons remains scarce. This study aimed to systematically review and synthesize research on prison mental health interventions conducted in the region. We used a two-stage scoping review design guided by the JBI Manual for Evidence Synthesis. Searches took place in December 2021 in nine databases using descriptors and synonyms. First, all prison mental health research in Latin America was retained. Secondly, using title and abstract screening, all research possibly related to interventions was retained for full text evaluation. Studies reporting interventions were assessed by country, language, institution, population, intervention type, intervention focus and outcomes. N = 34 studies were included in this review. These were 13 case reports, seven expert consensus papers and 14 quantitative studies (four randomized controlled trials, nine cohort studies, one quasi-experimental study). Fourteen interventions were targeted at promoting prosocial behavior, seven studies each aimed to improve mental health and to treat substance use disorders. Six studies involved the treatment of sexual offending behavior, and 3 focused on reducing criminal recidivism. Psychoeducation (n = 12) and motivational interviewing (n = 5) were the most frequent intervention types studied. Promising data from trials showed that anger management, depression, substance use and reoffending could be successfully addressed through interventions. Implementation and effectiveness research of mental health interventions in Latin American prisons is scarce. Addressing mental health, substance use and prosocial behavior outcomes should be considered in future research. There is a particular dearth of controlled trials describing quantifiable outcomes.

Survival rate of ovarian cancer in Asian countries: a systematic review and meta-analysis

BackgroundOvarian cancer is amongst one of the most commonly occurring cancers affecting women, and the leading cause of gynecologic related cancer death. Its poor prognosis and high mortality rates can be attributed to the absence of specific signs and symptoms until advance stages, which frequently leads to late diagnosis. Survival rate of patients diagnosed with ovarian cancer can be used in order to better assess current standard of care; the aim of this study is to evaluate the survival rate of ovarian cancer patients in Asia.MethodsSystematic review was performed on articles that were published by the end of August 2021 in five international databases, including Medline / PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar. The Newcastle-Ottawa quality evaluation form was used for cohort studies to evaluate the quality of the articles. The Cochran-Q and I2 tests were used to calculate the heterogeneity of the studies. The Meta-regression analysis was also done according to when the study was published.ResultsA total of 667 articles were reviewed, from which 108 were included in this study because they passed the criteria. Based on a randomized model, the survival rates of ovarian cancer after 1, 3 and 5 years were respectively 73.65% (95% CI, 68.66–78.64), 61.31% (95% CI, 55.39–67.23) and 59.60% (95% CI, 56.06–63.13). Additionally, based on meta-regression analysis, there was no relationship between the year of study and survival rate.ConclusionsThe 1-year survival rate was higher than that of 3- and 5-year for ovarian cancer. This study provides invaluable information that can not only help establish better standard of care for treatment of ovarian cancer, but also assist in development of superior health interventions for prevention and treatment of the disease.

A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia.

The Australian National Preventive Health Strategy 2021-2030 recommended the establishment of evidence-based frameworks to enable local public health services to identify strategies and interventions that deliver value for money. This study aimed to review the cost-effectiveness of preventive health strategies to inform the reorientation of local public health services towards preventive health interventions that are financially sustainable. Four electronic databases were searched for reviews published between 2005 and February 2022. Reviews that met the following criteria were included: population: human studies, any age or sex; concept 1: primary and/or secondary prevention interventions; concept 2: full economic evaluation; context: local public health services as the provider of concept 1. The search identified 472 articles; 26 were included. Focus health areas included mental health (n = 3 reviews), obesity (n = 1), type 2 diabetes (n = 3), dental caries (n = 2), public health (n = 4), chronic disease (n = 5), sexual health (n = 1), immunisation (n = 1), smoking cessation (n = 3), reducing alcohol (n = 1), and fractures (n = 2). Interventions that targeted obesity, type 2 diabetes, smoking cessation, and fractures were deemed cost-effective, however, more studies are needed, especially those that consider equity in priority populations.

Health prevention intervention for chronic tissue fibrosis: Based on the specific expression of CCL19/21 + mast cell

Chronic tissue fibrosis is a common pathological feature of connective tissue diseases and malignant tumors, and its prevention has been a major focus of relevant research.However, the details of the mechanism of action of tissue-colonizing immune cells in fibroblast migration are unclear. In this study, connective tissue disease tissue specimens and solid tumor specimens were selected to observe the relationship between mast cells and interstitial fibrosis and the expression characteristics of mast cells. Our findings suggest that the number of mast cells in the tissue correlates with the degree of pathological fibrosis and that mast cells specifically express the chemokines CCL19 and CCL21, especially CCL19. CCR7+ fibroblasts are highly expressed in mast cell clusters. The mast cell line HMC-1 regulates CD14+ monocyte-derived fibroblasts via CCL19. In disease tissue fibrosis, mast cell activation may increase the expression of chemokines, especially CCL19, in the tissue, thereby inducing a large number of CCR7-positive fibroblasts to migrate to specific tissues. This study lays a foundation for the mechanism of tissue fibrosis and provides evidence for the mechanism by which mast cells induce fibroblast migration.Through the experimental results of this paper, we can combine the induction factors of chronic tissue fibrosis and put forward targeted health prevention strategies.

Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Protocol for a Mixed Methods Implementation and Pilot Randomized Controlled Trial

Background Obesity is common in individuals with severe mental illness (SMI), contributing to a significantly shortened lifespan when compared to the general population. Available weight loss treatments have attenuated efficacy in this population, underscoring the importance of prevention and early intervention. Objective Here, we describe a type 1 hybrid study design for adapting and pilot-testing an existing mobile health intervention for obesity prevention in individuals with early SMI and Class I or early-stage obesity, defined as a BMI of 30-35. Methods An existing, evidence-based interactive obesity treatment approach using low-cost, semiautomated SMS text messaging was selected for adaptation. Community mental health clinics and Clubhouse settings in Eastern Missouri and South Florida were identified to participate. This study has the following 3 aims. First, using the Enhanced Framework for Reporting Adaptations and Modifications to Evidence-based interventions, contextual aspects of the clinical and digital treatment environments are identified for adaptation, considering 5 main stakeholder groups (clinical administrators, prescribing clinicians, case managers, nurses, and patients). Following a 2-week trial of unadapted SMS text messaging, Innovation Corps methods are used to discover needed intervention adaptations by stakeholder group and clinical setting. Second, adaptations to digital functionality and intervention content will be made based on themes identified in aim 1, followed by rapid usability testing with key stakeholders. A process for iterative treatment adaptation will be developed for making unplanned modifications during the aim 3 implementation pilot study. Individuals working in partner community mental health clinics and Clubhouse settings will be trained in intervention delivery. Third, in a randomized pilot and feasibility trial, adults with 5 years or less of treatment for an SMI diagnosis will be randomized 2:1 to 6 months of an adapted interactive obesity treatment approach or to an attentional control condition, followed by a 3-month extension phase of SMS text messages only. Changes in weight, BMI, and behavioral outcomes, as well as implementation challenges, will be evaluated at 6 and 9 months. Results Institutional review board approval for aims 1 and 2 was granted on August 12, 2018, with 72 focus group participants enrolled; institutional review board approval for aim 3 was granted on May 6, 2020. To date, 52 participants have been enrolled in the study protocol. Conclusions In this type 1 hybrid study design, we apply an evidence-based treatment adaptation framework to plan, adapt, and feasibility test a mobile health intervention in real-world treatment settings. Resting at the intersection of community mental health treatment and physical health promotion, this study aims to advance the use of simple technology for obesity prevention in individuals with early-stage mental illness. Trial Registration ClinicalTrials.gov NCT03980743; https://clinicaltrials.gov/ct2/show/NCT03980743 International Registered Report Identifier (IRRID) DERR1-10.2196/42114

Health Promotion in Popular Web-Based Community Games Among Young People: Proposals, Recommendations, and Applications.

Young people use digital technology on a daily basis and enjoy web-based games that promote social interactions among peers. These interactions in web-based communities can develop social knowledge and life skills. Intervening via existing web-based community games represents an innovative opportunity for health promotion interventions. The aim of this study was to collect and describe players' proposals for delivering health promotion through existing web-based community games among young people, elaborate on related recommendations adapted from a concrete experience of intervention research, and describe the application of these recommendations in new interventions. We implemented a health promotion and prevention intervention via a web-based community game (Habbo; Sulake Oy). During the implementation of the intervention, we conducted an observational qualitative study on young people's proposals via an intercept web-based focus group. We asked 22 young participants (3 groups in total) for their proposals about the best ways to carry out a health intervention in this context. First, using verbatim transcriptions of the players' proposals, we conducted a qualitative thematic analysis. Second, we elaborated on recommendations for action development and implementation based on our experiences and work with a multidisciplinary consortium of experts. Third, we applied these recommendations in new interventions and described their application. A thematic analysis of the participants' proposals revealed 3 main themes and 14 subthemes related to their proposals and process elements: the conditions for developing an attractive intervention within a game, the value of involving peers in developing the intervention, and the ways to mobilize and monitor gamers' participation. These proposals emphasized the importance of interventions involving and moderating a small group of players in a playful manner but with professional aspects. We established 16 domains with 27 recommendations for preparing an intervention and implementing it in web-based games by adopting the codes of game culture. The application of the recommendations showed their usefulness and that it was possible to make adapted and diverse interventions in the game. Integrated health promotion interventions in existing web-based community games have the potential for promoting the health and well-being of young people. There is a need to incorporate specific key aspects of the games and gaming community recommendations, from conception to implementation, to maximize the relevance, acceptability, and feasibility of the interventions integrated in current digital practices. ClinicalTrials.gov NCT04888208; https://clinicaltrials.gov/ct2/show/NCT04888208.

Perceived Stress among Healthcare Students and Its Association with Anxiety and Depression: A Cross-Sectional Study in Saudi Arabia.

Introduction. Healthcare students are subjected to high-stress levels due to different academic, social, and financial stressors. Persistent and severe stress might predispose students to depression and anxiety. Therefore, this research aims to investigate the level of perceived stress among healthcare students and its relation to anxiety and depression. Methods. A prospective cross-sectional study using a validated questionnaire was conducted among healthcare students in Saudi Arabia. The 14-item Perceived Stress Scale (PSS) was used to evaluate perceived stress, and depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). All statistical analyses were carried out using PSPP Statistical Analysis Software version 1.2.0. Results. A total of 701 respondents participated in this study. The average age of the students was 20.9 years old, and 59.3% were female. Almost three-quarters of students perceive themselves as stressed. Around two-thirds were categorized as having borderline/cases of depression or anxiety. Perceived stress was four times more likely among students with cases of anxiety [Adjusted Odds Ratio (AOR) = 4.83; 95% CI 2.89, 8.06], depression [AOR = 4.79; 95% CI 2.68, 8.53] as compared with those without these conditions. Conclusions. Stress is highly prevalent among healthcare students, and it is strongly associated with female gender and students' anxiety and depression. Therefore, the mental health of healthcare students is an essential factor affecting perceived stress and at-risk individuals. Therefore, preventative mental health interventions targeting healthcare students are necessary to help improve mental health and cope with stressors in academic education.

Psychiatric and non-psychiatric population vulnerabilities in time of a crisis: the unsuspected aggression factor

ObjectivesIn March 2020, France faced a health crisis due to the COVID-19 outbreak that, like previous infectious disease crises, involved high psychological and emotional stress, a series of factors that influenced the ongoing mental health crisis.MethodsWe recruited 384 respondents to complete an online questionnaire during the second month of isolation: 176 psychotherapy recipients (68 were currently attending psychiatric care) and 208 healthy controls. We measured demographic characteristics, impulsivity, aggression, hopelessness, suicidal risk, and the global level of anxiety and depression in order to estimate potential discrepancies in clinical measures across these populations.ResultsOur results indicate that the group currently undergoing psychiatric care was prone to loneliness and social isolation. Regarding clinical and nonclinical population, there were differences in suicidal risk, depression, anxiety, and hopelessness but mainly in aggression. Regression analysis also demonstrated that aggression surprisingly influenced anxiety levels. Patients undergoing therapy compared with patients who were not displayed differences only in suicidal risk, anxiety, and hopelessness, with those undergoing therapy having higher scores. The outpatient group undergoing therapy had a significantly lower level of impulsivity. Moreover, the regression to predict anxiety and depression levels from correlated factors highlighted the potentially heightened role of aggression in predicting anxiety in the clinical group.ConclusionNew research into stress reactions should assess other clinical signals, such as aggression, and examine preventive mental health interventions in times of crisis.

Health Prevention Intervensions for the Control of Hypertension: a Systematic Review

Hypertension is a major cardiovascular risk factor (CVD), contributing significantly to the worldwide burden of cardiovascular disease and disability, but its control remains an unmet challenge for public health systems. WHO estimates that there are 1.28 billion adults (aged 30-79 years) in the world with hypertension and an estimated 46% of them do not know they suffer from hypertension because hypertension is the silent killer. This Systematic Review aims to identify and analyze preventive health interventions for hypertension control, as well as promotional efforts that can be done to reduce the prevalence of hypertension at the global level. This study uses the Systematic Review method to search for articles based on several databases, namely Scopus, EMBASE, ScienceDirect, and PubMed on May 12, 2023. Search results with keywords hypertension, health prevention interventions, hypertension health promotion, hypertension control, decreased prevalence of hypertension. After being filtered based on suitability with the title and research objectives, relevant research articles were obtained, the full text was free and the publication year 2018-2023 produced 8 articles. The results of this study are several efforts to prevent the increase in the prevalence of hypertension, namely by promoting health to carry out physical activity, reducing stress levels, balanced diet and nutrition, maintaining ideal body weight, reducing salt consumption, not smoking and reducing cigarette smoke, avoiding alcoholic beverages, and lifestyle education interventions through education and counseling. Further research is needed regarding the most effective interventions for the prevention and control of hypertension.

Health Prevention Interventions for Adults in the Community: A Scoping Review of Intervention Characteristics

This scoping review was designed to determine which adults receive preventative health interventions, the types of interventions for modifiable risk factors, the health professionals, including occupational therapy practitioners providing these interventions, and where they are delivered to adults in the community. The databases searched were PubMed, Ageline, and CINAHL and included research meeting the inclusion criteria and published between 2016–2021. All included studies addressed health prevention. 5,399 articles were screened with 83 of these included in the final review. Older adults, White and Black individuals, and females were the most prevalent individuals and groups to receive health prevention interventions and occupational therapy professionals were involved in 5% of the reviewed studies. As there is a need for preventative health interventions to help reduce negative health outcomes and occupational therapy professionals have important skills in health prevention this study illustrates the types of health prevention provided to adults receiving intervention in the community and points to areas of opportunity for occupational therapy professionals.

Privacy and utility of genetic testing in families with hereditary cancer syndromes living in three countries: the international cascade genetic screening experience.

Background: Hereditary breast and ovarian cancer and Lynch syndrome are associated with increased lifetime risk for common cancers. Offering cascade genetic testing to cancer-free relatives of individuals with HBOC or LS is a public health intervention for cancer prevention. Yet, little is known about the utility and value of information gained from cascade testing. This paper discusses ELSI encountered during the implementation of cascade testing in three countries with national healthcare systems: Switzerland, Korea, and Israel. Methods: A workshop presented at the 5th International ELSI Congress discussed implementation of cascade testing in the three countries based on exchange of data and experiences from the international CASCADE cohort. Results: Analyses focused on models of accessing genetic services (clinic-based versus population-based screening), and models of initiating cascade testing (patient-mediated dissemination versus provider-mediated dissemination of testing results to relatives). The legal framework of each country, organization of the healthcare system, and socio-cultural norms determined the utility and value of genetic information gained from cascade testing. Conclusion: The juxtaposition of individual versus public health interests generates significant ELSI controversies associated with cascade testing, which compromise access to genetic services and the utility and value of genetic information, despite national healthcare/universal coverage.

Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews.

Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.

Recent advances in NAFLD: current areas of contention.

This brief review focuses on two contentious issues within the field of non-alcoholic fatty liver disease (NAFLD); the first is the recent effort to redefine NAFLD as metabolic (dysfunction)-associated fatty liver disease (MAFLD). The modification of "NAFLD" to "MAFLD" is expected to highlight the role of metabolic factors in the disease aetiology, which is hoped to improve patient understanding of the disease, facilitate patient-physician communication and highlight the importance of public health interventions in prevention and management. The diagnostic criteria for MAFLD allow it to coexist with other forms of liver disease, which recognises that metabolic dysfunction contributes towards disease progression in other liver pathologies, such as alcoholic liver disease. However, there remain concerns that renaming NAFLD may be premature without fully considering the broader implications, from diagnostic criteria to trial endpoints; therefore, the new definition has not yet been accepted by major societies. Another contentious issue within the field is the gap in our understanding of how patients undergoing therapeutic interventions should be monitored to assess amelioration/attenuation or the worsening of their liver disease. Biomarker scoring systems (such as the ELF test and FIB-4 test) and imaging techniques (such as transient elastography [TE] and magnetic resonance imaging [MRI] techniques) are proven to be reasonably accurate, and comparable with histology, in the diagnosis of NAFLD and evaluation of disease severity; however, their use in monitoring the response of disease to therapeutic interventions is not well established. Whilst biomarker scoring systems and TE are limited by poor diagnostic accuracy in detecting moderate fibrosis (e.g. F2 liver fibrosis defined by histology), more accurate MRI techniques are not practical for routine patient follow-up due to their expense and limited availability. More work is required to determine the most appropriate method by which therapeutic interventions for NAFLD should be monitored in clinical practice.

A blended model to support brief interventions in primary care: A qualitative study of usability and acceptability of HealthEir in community pharmacy.

Brief interventions for lifestyle behaviour change are effective health promotion interventions. Primary care settings, including pharmacies, are the most frequently visited healthcare facilities and are well placed to provide brief health interventions. However, despite the evidence-based and policy guidance, barriers to brief interventions have limited their implementation. This study aimed to explore the usability and acceptability of HealthEir, a blended model with digital, print, and communication elements designed to support the delivery of brief health-promoting interventions in pharmacy practice. Usability tests using a think aloud protocol and set tasks (to assess usability) and semi-structured interviews (to assess acceptability) were conducted with fifteen patients and twelve pharmacists. Usability data were analysed deductively using Nielsen's five quality components of usability as a framework. Acceptability data were analysed using inductive thematic analysis. All participants found HealthEir straightforward to use and completed the required tasks without assistance. A small number of patient and pharmacist participants identified opportunity for improvement of the digital element. Acceptability was also high, with individual comments from participants identifying opportunity for improvements to HealthEir, and two patients identifying privacy or safety concerns. The majority of comments regarding acceptability reflected wider social and cultural challenges such as perceptions of the roles of pharmacists and pharmacies and the low priority of preventative health interventions. HealthEir has been demonstrated to be a usable and acceptable support that has the potential to overcome barriers to delivery of brief interventions in pharmacies. Usability and acceptability testing identified minor changes that may further improve its design prior to piloting and implementation.

Awareness of Cervical Cancer Screening Amongst Pakistani Medical Students and Doctors; A Systematic Review

Background Cervical cancer screening is one of the most important public health interventions for cervical cancer prevention, yet awareness among Pakistani medical students and doctors is alarmingly low. Objective: to provide an in-depth understanding of the awareness and attitudes of Pakistani medical students and doctors towards cervical cancer screening Methodology: A systematic review of the literature was conducted, and qualitative and quantitative findings from studies conducted between January 2010 and June 2022 were synthesized. Results: The research found that Pakistani medical students and doctors have limited knowledge of cervical cancer and cervical cancer screening and a generally negative attitude towards cervical cancer screening. The paper also identified numerous influencing factors that contribute to the low awareness and attitudes towards the screening, such as traditional cultural beliefs, lack of training and education, and limited access to health care services. Conclusion, the research found a desperate need for interventions to raise awareness and to create an environment of acceptance and support for cervical cancer screening among Pakistani medical students and doctors. Keywords: Cervical Cancer, Screening, Pakistani Medical Students and Doctors, Knowledge, Pap smear, Human Papilloma Virus (HPV)

EHealth Familias Unidas Mental Health: Protocol for an effectiveness-implementation hybrid Type 1 trial to scale a mental health preventive intervention for Hispanic youth in primary care settings.

This article focuses on the rationale, design and methods of an effectiveness-implementation hybrid type I randomized trial of eHealth Familias Unidas Mental Health, a family-based, online delivered intervention for Hispanic families to prevent/reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. Utilizing a rollout design with 18 pediatric primary care clinics and 468 families, this study addresses intervention effectiveness, implementation research questions, and intervention sustainment, to begin bridging the gap between research and practice in eliminating mental health and drug use disparities among Hispanic youth. Further, we will examine whether intervention effects are partially mediated by improved family communication and reduced externalizing behaviors, including drug use, and moderated by parental depression. Finally, we will explore whether the intervention's impact on mental health and drug use, as well as sustainment of the intervention in clinics, varies by quality of implementation at clinic and clinician levels. Trail registration: ClinicalTrials.gov Identifier: NCT05426057, First posted June 21, 2022.