Preventive Health Interventions Research Articles

Facilitating subgroup identification: the use of decision trees in breast cancer screening uptake

Abstract Introduction Organized breast cancer screening (BCS) programs are effective prevention measures for women aged 50-69 to prevent the sixth cause of death in Germany. It is unclear which sociodemographic factors and potential interactions are associated with never-attendance. Explorative approaches such as decision trees offer an inductive approach to intersectional subgroup identification based on different computational decisions. This study discusses two approaches for estimating the likelihood of not attending BCS in Germany. Methods Women aged 50-69 (N = 3,644) were selected from the German 2020 European Health Interview Survey. We estimate the risk of not attending BCS first by employing cross-classification regression analysis utilising known social dimensions and second by leveraging the nodes of the best-performing decision tree as exposure variables. Results The first approach, adjusting for age, found that women born in Germany had 1.97 higher odds (p = 0.015) of never attending BCS than high-income women not born in Germany. Conditional Inference Tree (mincriterion= 0.6040046, maxdepth=3) adjusted to optimise sensitivity and the Area Under the Curve (71.43% sensitivity, 63.21% AUC), identified 8 relevant intersectional groups characterised by unique combinations of family status, perceived social support, working situation, experienced physical limitation, and region, with the highest odds of 4.85 (p < 0.001) of not attending BCS for women living with their couple and children or non-conventional household constellations who perceived little, uncertain or a lot of social support. Conclusions Using explorative decision trees for subgroup identification, the study provides more detailed insights into women at higher risk of not attending BCS in Germany, aiding, on the one hand, more precise health reporting data and, on the other hand, enhanced preventive public health interventions. Key messages • Explorative decision trees for subgroup identification allow for more detailed insights into women at higher risk of not attending BCS in Germany for enhanced preventive public health interventions. • Women living with their couple and children or non-conventional constellations who perceived little, uncertain or a lot of social support are at the highest odds of never attending BCS in Germany.

Promoting sexual health in schools: a systematic review of the European studies

Abstract Background Sexual ill-health causes a high health burden. There is, therefore, a need for more effective sexual health promotion interventions. Previous research has focused on preventive sexual health interventions and the limited evidence concerning school-based sexual health promotion interventions has not been synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in European schools. Methods A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and a narrative synthesis of the included studies was performed, highlighting the collective results. Results The review included 17 records, reporting 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All qualitative studies described positive effects as experienced by the participants, and ten of the quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. Conclusions The findings indicate good evidence for the effectiveness of interventions with a health promotion approach, underscoring the importance of sexual health resources such as respect, communication skills, and attitudes. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas, e.g., sexual health literacy is less studied and can be recommended to be included in future research. Key messages • The synthesized evidence sheds light on the lack of evaluated interventions employing holistic and positive, resource-focused sexual health promotion interventions targeting European adolescents. • The included school-based sexual health promotion studies, although limited in number, show evidence of promising effects on sexual health outcomes among participants.

Preventive interventions on vector-borne diseases related to climate change: an Umbrella review

Abstract Background Vector-borne diseases (VBDs) are a global challenge to public health, being influenced by ecological factors and climate change. Despite the several preventive public health interventions that can be implemented, the evidence of their impact is still fragmented. An organic overview of the current evidence can provide relevant information on the effectiveness of these actions. Methods We conducted an umbrella review following the PRIOR checklist. Relevant reviews were searched using PubMed and Cochrane databases. We considered eligible all systematic reviews published in English between 2013 and 2023, containing meta-analysis on public health interventions aimed at reducing incidence, prevalence, or the burden of disease of VBDs, without demographic restrictions. Results We screened 1971 records. 51 reviews were included. 38 reported outcomes targeting Malaria, 9 Dengue, 2 Yellow Fever, 1 Leishmaniasis,1 Zika, 1 Chikungunya, 1 Crimean-Congo haemorrhagic fever, 1 Lyme disease and 1 Schistosomiasis. Several interventions were assessed worldwide. 18 reviews considered chemoprophylaxis, 9 net/curtains, 8 vaccines, 6 repellents, 3 housing interventions, 2 community participation, 2 MTaT and 2 oral supplementations. Authors stated conclusions are favourable to the interventions assessed for the 73%, but the certainty level is mostly considered low. Conclusions Public health preventive interventions are fundamental in responding to the threat of VBDs, but their impact may vary depending on several factors. Further research must provide more effective interventions and strategies, with a cohesive presentation of their evidence. Key messages • Effective reduction of VBDs burden requires a combination of interventions that must be tailored to local ecological, social, and epidemiological factors. • Evidence presented in this umbrella review can inform evidence-based policies and programs aimed at combating VBDs at local, national, and global levels.

Association Between Diet and Mental Health Outcomes in a Sample of 13,887 Adolescents in Canada.

The high prevalence of mental disorders among adolescents calls for community-based and population-level prevention strategies. Diet is an important intervention target for primary prevention of mental disorders among adolescents. We used data from a large longitudinal study of Canadian adolescents (aged 14-18 y) to examine prospective associations between diet and mental health outcomes. We estimated the effect of diet (ie, consumption of vegetables and fruit and sugar-sweetened beverages [SSBs]) at baseline on depressive symptoms, anxiety symptoms, and psychological well-being (measured by the Center for Epidemiologic Studies Depression Scale-Revised, Generalized Anxiety Disorder 7 scale, and Flourishing Scale, respectively) and at 1-year follow-up in a sample of 13,887 Canadian secondary school students who participated in the 2017-2018 and 2018-2019 cycles of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary (COMPASS) behavior study. We applied linear mixed-effects methods informed by a directed acyclic graph. Sensitivity analyses assessed the robustness of the effect estimates to unmeasured confounding variables. Baseline SSB consumption was associated with greater severity of depressive (β = 0.04; 95% CI, 0.01-0.06) and anxiety (β = 0.02; 95% CI, 0-0.05) symptoms, particularly among male students, and poorer psychological well-being (β = -0.03; 95% CI, -0.05 to -0.01) at follow-up. Baseline vegetables and fruit consumption was positively associated with psychological well-being (β = 0.06; 95% CI, 0.03-0.10) but not other mental health outcomes at follow-up. Our results support the notion that diet should be part of comprehensive mental health prevention and promotion interventions to reduce the prevalence of mental health disorders among adolescents.

Using social media to share universal messages about early language and literacy development with parents and caregivers

Purpose Health promotion and prevention interventions to support children’s early language and literacy development are essential, however little is known about how social media can be used in this context. This study evaluated an intervention which aimed to build capacity of parents in supporting children’s language and literacy skills, implemented using Facebook. Method A cross-sector partnership of Australian speech-language pathologists developed a suite of universal messages for parents to support their child’s language development. Messages were delivered across 12 weeks via Facebook. A convergent mixed methods study design was used to evaluate survey responses from parents of children aged 0–5 years, before (n = 136) and after the intervention (n = 61). Social media analytics were collected. Result Participants identified social media was a helpful way to receive information about supporting their child’s language and literacy development, reporting an increase in knowledge following the intervention. Participants reported they trusted information provided in Facebook posts as it was from professionals and evidence-based sources. The usability (i.e. look and layout) was generally rated highly. Conclusion Social media is a valuable tool for speech-language pathologists to deliver universal messages. Future social media initiatives should be co-designed with families and social media professionals to ensure delivery of trusted, consistent, and user-friendly information.

Impact of PRECEDE-PROCEED Model Audits in Cancer Screening Programs in Lombardy Region: Supporting Equity and Quality Improvement.

Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE-PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. This study evaluated the application of systemic audits based on the PRECEDE-PROCEED model across Lombardy cancer screening programs. A systematic region-wide audit was performed in 2019, and follow-up audits were performed in 2022-2023. Data were collected using structured analysis methodologies, including epidemiological, behavioural, and organisational assessments. The 2019 audit showed strengths in participation and quality standards but identified challenges in cervical cancer screening coverage and waiting times for assessments. Improvements plans included the digitisation of processes and stakeholder engagement. The 2022-2023 audits reported increased coverage for breast and colorectal screenings, but a slight decline in participation rates and examination coverage. Organisational improvements were noted, yet gaps in training and equity-targeted actions remained. The PRECEDE-PROCEED model audits led to notable improvements in the quality and equity of cancer screening programs in Lombardy. Sustained focus on digital integration, continuous re-training, and targeted equity interventions is essential for further progress.

The Dynamic Adaptation of the Journey of Hope: A School-Based Intervention to Support Pandemic and Disaster-Affected Children and Youth.

The Journey of Hope (JoH) is an evidence-based behavioral health prevention intervention model designed for disaster-affected children and youth. While the in-person JoH model has been extensively delivered and studied, the virtual implementation of this intervention, specifically tailored for the unique needs of children and youth during the COVID-19 pandemic, has not been previously explored. In this context, authors of this article adapted the JoH to a virtual delivery model, aiming to provide access to behavioral health preventive services for children and youth during the COVID-19 pandemic when in-person services were not feasible. This adaptation, utilizing the dynamic adaptation process (DAP) and community-based participatory research (CBPR) principles, was carefully designed to meet pandemic-related challenges while maintaining the core components of the original intervention. The primary objectives of this article are twofold: (1) to provide an overview of the theoretical and conceptual underpinnings of the JoH-C19, including the framework that guided the adaptation, and (2) to describe the virtually adapted curriculum and initial pilot of the JoH-C19. This adaptation represents a crucial step in ensuring the accessibility of virtual behavioral health interventions for young populations facing various collective traumas and challenges in a rapidly evolving world.

Role of mothers in preventing tuberculosis in children: A scoping review

Tuberculosis (TB) remains a significant global health challenge, especially for children. The aim of this scoping review was to investigate the role of mothers in preventing childhood TB transmission and highlight effective strategies and associated barriers. A systematic literature search was conducted using PubMed, Web of Science, and Scopus, covering articles up to January 17, 2024. The search included keywords like “mother,” “parents,” “care,” “prevention,” and “tuberculosis.” Eligibility criteria included peer-reviewed articles on maternal health interventions for TB prevention in children and published in English. The study selection process involved screening titles and abstracts, followed by full-text reviews by Rayyan Artificial Intelligence (AI). Eighteen studies were analyzed, revealing the crucial roles of mothers and healthcare workers in TB prevention. The results indicated that in South Africa, only 47% of eligible pregnant women underwent Mantoux testing, with lower rates in rural areas. The isoniazid preventive therapy (IPT) uptake rate was 79%, with geographical variations. Barriers included insufficient patient information, inadequate screening facilities, and healthcare providers' knowledge gaps. Parental involvement, particularly by mothers, is vital for adherence to TB preventive measures. Challenges in integrating TB case-finding with antenatal care and prevention of mother-to-child transmission (PMTCT) services included inconsistent screening and healthcare worker shortages. Enhancing health services, reducing stigma, and integrating TB prevention into existing programs are essential. In conclusion, this review underscores that effective childhood TB prevention requires a coordinated approach that incorporates the efforts of the mother and healthcare worker. Addressing barriers such as contact tracing gaps and diagnostic delays, alongside enhancing maternal health education and support, is essential for improving TB prevention and management. Targeted interventions and collaborative efforts are needed to reduce transmission and improve health outcomes, particularly in bridging rural-urban disparities.

Dynamic Progression of Hypertension and Diabetes in the Democratic Republic of Congo from 2019 to 2023.

Introduction: The Democratic Republic of Congo (DRC) does not have national prevalence data for arterial hypertension (HTN) or diabetes (type I and II combined) to aid evidence-based decision-making, despite the assumption of epidemiological transition in low- and middle-income countries. The aim of this study was to estimate a proxy of prevalence for HTN and diabetes. Methodology: This study used routine monthly reported data pertaining to HTN and diabetes from the District Health Information Software 2 (DHIS2), spanning 2019-2023. Data underwent quality assessment and adjustments using standardization before analysis. Equity analyses were carried out at the national and sub-national levels. Epidemiological curves and maps were produced to analyze trends in the prevalence of HTN and diabetes among adults aged 18 and over. Permission to use the data was obtained from the regulatory authority. Results: Over five years, incidence of HTN increased from 13.23% (CI 95%: 13.22-13.24) to 15.23% (CI 95%: 15.22-15.24) (+15.1% relative increase), and diabetes rose from 2.73% (CI 95%: 2.72-2.74) to 3.345% (CI 95%: 3.34-3.35) (+16.3% relative increase), with provincial variations observed. Conclusions: In the DRC, hypertension and diabetes are advancing rapidly. Primary and preventative healthcare services and public health interventions must prioritize these diseases.

Assessment of Vitamin D, Vitamin B12, and Folate Levels in Recently Identified Pregnant Females.

Background: Pregnancy is a critical period where optimal maternal and fetal health depends on adequate nutritional status. Deficiencies in essential vitamins, such as vitamin D, vitamin B12, and folate, can result in adverse health outcomes. Objective: This study aims to assess the serum levels of vitamin D, vitamin B12, and folate in early pregnancy. Methodology: This cross-sectional research was conducted at Kurdistan Private Hospital in Duhok, Kurdistan Region of Iraq, from September 2022 to October 2023. The study included 150 pregnant women, with ages ranging from 18 to 45 years. Serum levels of vitamin D, vitamin B12, and folate were measured using the Automatic Clinical Chemistry Analyzer COBAS e 411 (Roche Diagnostics, Basel, Switzerland). Results: The mean age of the participants was 29 years (standard deviation [SD] = 6.2 years), with ages ranging from 18 to 45 years. The average serum human chorionic gonadotropin (HCG) level was 4,292 mIU/mL (SD = 3,947 mIU/mL), with a range of 98 to 10,000 mIU/mL. The mean serum levels were 17.8 ng/mL (SD = 11.6) for vitamin D, 367 pg/mL (SD = 245) for vitamin B12, and 11.5 ng/mL (SD = 4.6) for folate. The prevalence of vitamin D deficiency was significant, with 92 participants (61.3%) having levels below 20 ng/mL, 39 participants (26%) having insufficient levels ranging from 20 to 29 ng/mL, and only 19 participants (12.7%) having sufficient levels between 30 and 100 ng/mL. No cases of vitamin D toxicity (>150 ng/mL) were observed. Regarding vitamin B12, 32 participants (21.3%) had deficient levels (<200 pg/mL), while 118 participants (78.7%) had normal levels. Folate analysis revealed that 3 participants (2%) had moderate deficiency (2-3 ng/mL), 14 participants (9.3%) had mild deficiency (3-6 ng/mL), and there were no cases of severe folate deficiency (<2 ng/mL). Pearson correlation analysis showed weak correlations between the study variables, with the strongest being a weak negative correlation between age and serum folate levels (-0.18). Conclusions: The study found a high prevalence of vitamin D deficiency among the pregnant women included in the study, while the levels of folate and vitamin B12 were comparable to worldwide estimates. These findings focus attention on the importance of monitoring and addressing nutritional deficiencies at the beginning and throughout pregnancy. They also underline the need for preventive health interventions to correct these deficiencies and achieve the best outcomes for both maternal and fetal health.

Measuring accumulation: Constructing a tool for evaluating cumulative harm in children engaged with an intensive family support service

AbstractThere is a significant body of research that attests to the deleterious impact of an accumulation of adverse childhood experience across the lifespan, which provides a strong rationale for the development of a means for evaluating this accumulation in a high‐risk population. We developed a theory‐driven measure, the Cumulative Experiences Index, and conducted a pilot study to test its utility. The Cumulative Experiences Index derives a cumulative harm score that can be used to inform intervention and prevention strategies, programmes and initiatives across all tiers of public health prevention intervention. The Cumulative Experiences Index was piloted with 50 participants aged 8–17 years old who were actively engaged with an Intensive Family Support service. The study explores whether cases rated as low, medium or high severity on the Cumulative Experiences Index corresponded with severity ratings on the three measures of concurrent validity: the Strengths and Difficulties Questionnaire, Kessler‐10 and Children's Revised Impact of Events Scale. The Index provides a valid and accurate means of reflecting the interconnectedness and complexity of exposure to different forms of harm that accumulates over time. Practitioners and researchers will benefit from using the Cumulative Experiences Index—a new valid and reliable measure of cumulative harm.

Co-producing an intervention to prevent mental health problems in children and young people in contact with child welfare services

BackgroundChildren and young people (CYP) in contact with child welfare services are at high risk of developing mental health problems. There is a paucity of evidenced-based preventative interventions provided to this population.ObjectiveThis project worked in partnership with CYP, their parents/caregivers and the professionals who support them to co-produce a preventative mental health intervention for CYP in contact with child welfare services.Participants and settingWe recruited a purposive sample of CYP in contact with child welfare services (n = 23), parents/caregivers (n = 18) and practitioners working within child welfare services and mental health services (n = 25) from the North East of England and convened co-production workshops (n = 4).MethodsThis project followed the established principles for intervention development, applying the six steps to quality intervention development (6SQUID) approach. The mixed method research consisted of four work packages with continuous engagement of stakeholders throughout the project. These were: a systematic review of reviews; focus groups with practitioners; interviews with parents/caregivers and CYP; co-production workshops.ResultsWe identified that the primary risk factor affecting CYP in contact with child welfare services is the experience of childhood adversity. The quality of relationships that the CYP experiences with both their parent/caregivers and the professionals involved in their care are considered to be the main factors amenable to change.ConclusionsWe found that a trauma-informed, activity-based intervention with an embedded family-focused component provided to CYP who have experienced adversity is most likely to prevent mental health problems in those in contact with child welfare services.

Cultural and social factors associated with generalized anxiety disorder among adolescent mothers during the postpartum period in Malawi: a cross-sectional survey

BackgroundThe postnatal period is an important time for adolescent mothers to regain their health as they adjust to life with their infants. However, it is also a time when mothers are vulnerable to mental health problems. Generalized anxiety disorders (GADs) are among the common mental disorders that can impact mothers. Anxiety disorders can have adverse effects on a child’s cognitive development. However, there is a scarcity of studies pertaining to anxiety disorders among adolescent mothers in Malawi.MethodsA cross-sectional survey was conducted among adolescent postnatal mothers aged ≤ 19 years to establish the prevalence of probable GAD and identify cultural and social factors that influence anxiety in this population. Adolescent mothers were recruited from the Mitundu Rural Hospital catchment area in Lilongwe district, Malawi. A two-stage random sampling method was employed: clinics were randomly selected, and participants were recruited via systematic random sampling. The Generalized Anxiety Disorder (GAD-7) scale was used to assess anxiety. Data were analyzed using SPSS version 27.ResultsOf the 395 adolescent mothers who participated, 34% were aged 14–17. The prevalence of probable GAD (GAD-7 ≥ 10) was 31.9%. Increased social support decreased the odds of probable GAD (aOR 0.95, 95% CI: 0.91–0.98, p < 0.001). Experiencing intimate partner violence (IPV) increased the likelihood of probable GAD (aOR 4.80, 95% CI: 1.23–18.82, p = 0.02), while those who had contact with a health worker postnatally (aOR 0.38, 95% CI: 0.17–0.83, p = 0.02) and those who were “not prayerful” (aOR, 0.43, 95% CI: 0.21–0.87, p = 0.02) were less likely to report probable GAD.ConclusionsGiven that the prevalence of probable GAD among adolescent mothers in Malawi is higher compared to the global estimates of their peers, policies and guidelines that prioritize the maternal mental health of adolescent mothers in Malawi are required. The findings also highlight the importance of enhancing social support among family and community. Co-designed mental health promotion, prevention, and early interventions to involve health workers and religious leaders are recommended.

The impact of suicide registers and other monitoring systems on suicide prevention: A scoping review.

Decreasing suicide mortality has become an overarching goal for societies worldwide. Suicide registers and other monitoring systems are a valuable source of information that can be used for addressing the suicide phenomenon and evaluating preventative interventions. This scoping review provides an overview of literature published in the last decade that has focussed on the operations (functioning) and characteristics of suicide registers and other suicide monitoring systems. Four electronic databases were searched in 2020 for identifying published material from January 2010 to October 2020. The searches were updated in October 2023 to include material from 2020 to date. Grey literature through Google searches and mental health commissions websites and the reference lists of selected documents were also searched. Twenty-five articles were included in this review. Nearly half the articles were from the United States, followed by Australia. Nine countries were identified as having used suicide registers or suicide-specific monitoring systems to inform suicide prevention. Monitoring mechanisms varied across the countries examined. No article provided evidence that definitively linked suicide registers or other monitoring systems for suicide with the prevention of suicide or reduction in suicide rates. However, a variety of benefits of suicide monitoring for preventative and public health interventions were identified. The number of nations with surveillance systems for suicide prevention is low. Further, there is a lack of consistency in the systematic collection, analysis and interpretation of suicide-related information across the countries examined. Efforts to establish high-quality suicide surveillance systems that can be accessed in a timely and easy manner are needed to inform tailored strategies for suicide prevention.

Systematic Development of an AI Chatbot for Physical Activity Habit Formation in Prehypertension Individual Integrating Needs, Theories, and Evidence.

Prehypertension, an early stage in the development of hypertension, impacts a substantial segment of the adult population worldwide. Addressing this issue, our study introduces HabitBot, an AI-driven chatbot tailored to encourage physical activity (PA) habits among individuals with prehypertension. HabitBot combines natural language processing with multidisciplinary approaches, drawing from both theoretical frameworks and empirical studies. The chatbot development followed a systematic, five-phase process: comprehensive needs assessment, literature review on behavior change theories, analysis for selecting effective behavior change techniques (BCTs), prototype design through intervention mapping, and refining the intervention based on user feedback. The outcome includes a prototype that integrates the Health Action Process Approach and Habit Formation Theory, utilizing twelve identified BCTs effective in fostering PA habits. User feedback further refined the chatbot across multiple dimensions such as user interface, content accessibility, and privacy. HabitBot exemplifies an innovative integration of behavior change strategies with advanced language model technology, paving the way for digital health interventions in chronic disease prevention. Future studies should assess its long-term efficacy in habit formation and explore its applicability to various demographic groups.

How to plan and provide general anesthesia for a troop of 98 hamadryas baboons (Papio hamadryas) for contraceptive and preventative health interventions.

Present an approach to the safe and efficient provision of anesthesia and birth control measures to a large group of primates. 98 hamadryas baboons (Papio hamadryas) held in a German zoological institution. A group of 12 veterinarians, 2 zookeepers, and 6 volunteers anesthetized all animals within 2 days. The baboons were orally premedicated with midazolam (0.1 to 0.5 mg/kg) and anesthetized with medetomidine (40 to 60 µg/kg, IM) and ketamine (2 to 4 mg/kg, IM); isoflurane at rates of 1.5% to 2% was used for maintaining anesthesia if necessary. All animals received a physical examination, prophylactic medication, and tuberculin testing. For population management, the animals received a contraceptive implant (adult females), orchiectomy (young males), or vasectomy (breeding males). Young males received intratesticular blocks with lidocaine. All animals received atipamezole (125 to 150 µg/kg) before recovery. Premedication resulted in anxiolysis, which facilitated separating and darting. Median time from darting to access to the animal was 10 minutes. Mean anesthetic times were 25 minutes for females and 55 minutes for males. The depth of anesthesia was appropriate for the procedures. No fatalities were recorded. One animal was injured by other baboons but recovered after treatment. Health management and birth control measures are necessary in baboon troops under human care. Anesthesia and/or contraception of individual animals often leads to intraspecific aggression. This case series describes how to provide anesthesia and contraception to an entire troop as an alternative approach that can be adopted to future similar interventions.

Co-design and usability testing in the development of a digital health intervention for the secondary prevention of cardiovascular disease: The INTERCEPT Study (Preprint)

Co-design and usability testing in the development of a digital health intervention for the secondary prevention of cardiovascular disease: The INTERCEPT Study (Preprint)

Comparing times of self-harm presentations to hospital emergency departments in children, adolescents, young adults and adults: a national registry study 2007–2019

PurposeThe few studies that have explored self-harm presentation times at hospital emergency departments (EDs) – an important factor that can determine if a patient receives a mental health assessment – primarily focus on adult samples. This study examined the times of self-harm presentations to EDs, self-harm methods used, mental health assessments, and admission data across different age-groups.MethodsUsing data from the National Self-Harm Registry Ireland over a 13-year timeframe (2007–2019), this study compared times, days, seasons, methods of self-harm, and admission data for children (8–12 years), adolescents (13–17 years), young adults (18–25 years) and adults (> 25 years).ResultsThe majority of the 152,474 self-harm presentations (78.6%) for all ages occurred out-of-hours (outside the standard working hours or in-hours times of 09:00–17:00, Monday-Friday). The four hours before midnight had the highest proportions of self-harm presentations for adolescents (27.9%) and adults (23.1%), whereas the four hours after midnight had the highest proportion of self-harm presentations for young adults (22.9%). The 16:00-midnight timeframe had highest proportion of self-harm presentations in children (52.3%). Higher proportions of patients received a mental health assessment in-hours compared to out-of-hours among young adults (78.2% vs. 73.3%) and adults (76.1% vs. 72.0%). Self-harm presentations were lowest during summer months in children and adolescents.DiscussionHospitals should ensure that adequate resources are available for individuals presenting with self-harm, especially in the case of overcrowded EDs, and protocols need to be designed for those presenting with self-harm due to intoxication. In line with national policy, protocols for patients presenting during out-of-hours should be designed that can incorporate services from allied health multidisciplinary teams, social work, addiction services and counselling organisations. Given the lower rates of self-harm during school holidays for children and adolescents, the school environment must be considered in the context of mental health and self-harm public health prevention interventions.

Enhancing Aviation Safety through AI-Driven Mental Health Management for Pilots and Air Traffic Controllers.

This article provides an overview of the mental health challenges faced by pilots and air traffic controllers (ATCs), whose stressful professional lives may negatively impact global flight safety and security. The adverse effects of mental health disorders on their flight performance pose a particular safety risk, especially in sudden unexpected startle situations. Therefore, the early detection, prediction and prevention of mental health deterioration in pilots and ATCs, particularly among those at high risk, are crucial to minimize potential air crash incidents caused by human factors. Recent research in artificial intelligence (AI) demonstrates the potential of machine and deep learning, edge and cloud computing, virtual reality and wearable multimodal physiological sensors for monitoring and predicting mental health disorders. Longitudinal monitoring and analysis of pilots' and ATCs physiological, cognitive and behavioral states could help predict individuals at risk of undisclosed or emerging mental health disorders. Utilizing AI tools and methodologies to identify and select these individuals for preventive mental health training and interventions could be a promising and effective approach to preventing potential air crash accidents attributed to human factors and related mental health problems. Based on these insights, the article advocates for the design of a multidisciplinary mental healthcare ecosystem in modern aviation using AI tools and technologies, to foster more efficient and effective mental health management, thereby enhancing flight safety and security standards. This proposed ecosystem requires the collaboration of multidisciplinary experts, including psychologists, neuroscientists, physiologists, psychiatrists, etc. to address these challenges in modern aviation.

Childhood vaccination hesitancy in Saudi Arabia: are we still facing a problem? A narrative review.

Vaccination is a crucial public health intervention for infection prevention. Yet, vaccine hesitation has emerged as a pressing public health concern. The objective of this review is to identify the widespread and causes of vaccine hesitancy prevalance among parents of children in Saudi Arabia. A narrative review, surveying several databases, including PubMed, PubMed Central, Scopus, Google Scholar, and relevant regional journals. We selected studies related to vaccine hesitancy prevalence and causes after removing duplicates and screening for relevance and access to full text. A total of 18 articles met the final selection criteria.The prevalence of parental vaccination reluctance in Saudi Arabia shown significant variability; ranging from 3.1-72.2%. Concerns regarding vaccine side effects appeared as the foremost reason for vaccine hesitancy. The review concluded that numerous Saudi Arabian parents still hesitate to vaccinate their children. They believe the potential adverse effects of vaccination outweigh the protective benefits against diseases.